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Salari N, Morddarvanjoghi F, Abdolmaleki A, Rasoulpoor S, Khaleghi AA, Hezarkhani LA, Shohaimi S, Mohammadi M. The global prevalence of myocardial infarction: a systematic review and meta-analysis. BMC Cardiovasc Disord 2023; 23:206. [PMID: 37087452 PMCID: PMC10122825 DOI: 10.1186/s12872-023-03231-w] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 04/08/2023] [Indexed: 04/24/2023] Open
Abstract
BACKGROUND Myocardial infarction (MI) is one of the life-threatening coronary-associated pathologies characterized by sudden cardiac death. The provision of complete insight into MI complications along with designing a preventive program against MI seems necessary. METHODS Various databases (PubMed, Web of Science, ScienceDirect, Scopus, Embase, and Google scholar search engine) were hired for comprehensive searching. The keywords of "Prevalence", "Outbreak", "Burden", "Myocardial Infarction", "Myocardial Infarct", and "Heart Attack" were hired with no time/language restrictions. Collected data were imported into the information management software (EndNote v.8x). Also, citations of all relevant articles were screened manually. The search was updated on 2022.9.13 prior to the publication. RESULTS Twenty-two eligible studies with a sample size of 2,982,6717 individuals (< 60 years) were included for data analysis. The global prevalence of MI in individuals < 60 years was found 3.8%. Also, following the assessment of 20 eligible investigations with a sample size of 5,071,185 individuals (> 60 years), this value was detected at 9.5%. CONCLUSION Due to the accelerated rate of MI prevalence in older ages, precise attention by patients regarding the complications of MI seems critical. Thus, determination of preventive planning along with the application of safe treatment methods is critical.
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Affiliation(s)
- Nader Salari
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Amir Abdolmaleki
- Department of Operating Room, Nahavand School of Allied Medical Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Shabnam Rasoulpoor
- Department of Psychiatric Nursing, Miandoab School of Nursing, Urmia University of Medical Sciences, Urmia, Iran
| | - Ali Asghar Khaleghi
- Cellular and Molecular Research Center, Gerash University of Medical Sciences, Gerash, Iran
| | - Leila Afshar Hezarkhani
- Neuroscience Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shamarina Shohaimi
- Department of Biology, Faculty of Science, University Putra Malaysia, Serdang, Selangor, Malaysia
| | - Masoud Mohammadi
- Cellular and Molecular Research Center, Gerash University of Medical Sciences, Gerash, Iran.
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2
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Prevalence of Myocardial Injury and Myocardial Infarction in Patients with a Hypertensive Emergency: A Systematic Review. Diagnostics (Basel) 2022; 13:diagnostics13010060. [PMID: 36611351 PMCID: PMC9818542 DOI: 10.3390/diagnostics13010060] [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: 10/19/2022] [Revised: 12/12/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
Myocardial injury and myocardial infarction can complicate a hypertensive emergency, and both are associated with poor prognosis. However, little is known about the prevalence of myocardial injury and the different subtypes of myocardial infarction in patients with hypertensive emergencies. This systematic review aims to determine the prevalence of myocardial infarction and its subtypes, and the prevalence of myocardial injury in patients with hypertensive emergencies following the PRISMA guideline. A systematic search of PubMed, Web of Science, and EBSCOHost (MEDLINE) databases was carried out from inception to identify relevant articles. A total of 18 studies involving 7545 patients with a hypertensive emergency were included. Fifteen (83.3%) studies reported on the prevalence of myocardial infarction ranging from 3.6% to 59.6%, but only two studies specifically indicated the prevalence of ST-elevation and non-ST-elevation myocardial infarction. The prevalence of myocardial injury was obtained in three studies (16.7%) and ranged from 15% to 63%. Despite being common, very few studies reported myocardial injury and the subtypes of myocardial infarction among patients presenting with a hypertensive emergency, highlighting the need for more research in this area which will provide pertinent data to guide patient management and identify those at increased risk of major adverse cardiovascular events.
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3
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Kanaoka K, Iwanaga Y, Nakai M, Nishioka Y, Myojin T, Kubo S, Okada K, Soeda T, Noda T, Sakata Y, Miyamoto Y, Saito Y, Imamura T. Outpatient cardiac rehabilitation dose after acute coronary syndrome in a nationwide cohort. Heart 2022; 109:40-46. [PMID: 35241624 DOI: 10.1136/heartjnl-2021-320434] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 01/18/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Cardiac rehabilitation (CR) is effective in patients with acute coronary syndrome (ACS); however, CR programmes have not been fully implemented. This study aimed to reveal the current practice of outpatient CR and the dose-effect relationship of CR in real-world settings. METHODS We performed a nationwide retrospective cohort study using the National Database of Health Insurance Claims and Specific Health Checkups of Japan. Patients with ACS who underwent percutaneous coronary intervention between April 2014 and March 2018 were included. We analysed the implementation rate and dose of outpatient CR and the association between dose and outcomes. RESULTS Out of 202 320 patients who underwent percutaneous coronary intervention for ACS, a total of 20 444 (10%) underwent outpatient CR. The median (IQR) number of total CR sessions was 9 (3-17), and the median (IQR) duration for each session was 60 (42-60) min. Patients were divided into four groups according to the total number of sessions (≤9 times or ≥10 times) and the duration per session (<50 min or ≥50 min). Compared with the low-number/short-duration group, the adjusted HR for all-cause mortality was 1.00 (95% CI 0.80 to 1.24, p=0.97) in the low-number/long-duration group, 0.63 (95% CI 0.46 to 0.87, p=0.005) in the high-number/short-duration group and 0.74 (95% CI 0.60 to 0.92, p=0.008) in the high-number/long-duration group, respectively. CONCLUSION We found that the participation rate for outpatient CR after ACS was low and the doses of sessions vary in real-world settings. A higher number of total sessions of outpatient CR is associated with a better prognosis irrespective of the session's duration.
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Affiliation(s)
- Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoshitaka Iwanaga
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Michikazu Nakai
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yuichi Nishioka
- Department of Public Health, Nara Medical University, Kashihara, Japan
| | - Tomoya Myojin
- Department of Public Health, Nara Medical University, Kashihara, Japan
| | - Shinichiro Kubo
- Department of Public Health, Nara Medical University, Kashihara, Japan
| | - Katsuki Okada
- Department of Transformative System for Medical Information, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tsunenari Soeda
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Tatsuya Noda
- Department of Public Health, Nara Medical University, Kashihara, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yoshihiro Miyamoto
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Tomoaki Imamura
- Department of Public Health, Nara Medical University, Kashihara, Japan
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4
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Young A, Garcia M, Sullivan SM, Liu C, Moazzami K, Ko YA, Shah AJ, Kim JH, Pearce B, Uphoff I, Bremner JD, Raggi P, Quyyumi A, Vaccarino V. Impaired Peripheral Microvascular Function and Risk of Major Adverse Cardiovascular Events in Patients With Coronary Artery Disease. Arterioscler Thromb Vasc Biol 2021; 41:1801-1809. [PMID: 33730873 PMCID: PMC8062308 DOI: 10.1161/atvbaha.121.316083] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- An Young
- Department of Epidemiology (A.Y., MG., S.M.S., C.L., K.M., A.J.S., B.P., I.U., V.V.), Rollins School of Public Health, Emory University, Atlanta, GA.,Emory Clinical Cardiovascular Research Institute, Division of Cardiology (A.Y., M.G., K.M., A.J.S., J.H.K., A.Q., V.V.), Emory University School of Medicine, Atlanta, GA
| | - Mariana Garcia
- Department of Epidemiology (A.Y., MG., S.M.S., C.L., K.M., A.J.S., B.P., I.U., V.V.), Rollins School of Public Health, Emory University, Atlanta, GA.,Emory Clinical Cardiovascular Research Institute, Division of Cardiology (A.Y., M.G., K.M., A.J.S., J.H.K., A.Q., V.V.), Emory University School of Medicine, Atlanta, GA
| | - Samaah M Sullivan
- Department of Epidemiology (A.Y., MG., S.M.S., C.L., K.M., A.J.S., B.P., I.U., V.V.), Rollins School of Public Health, Emory University, Atlanta, GA
| | - Chang Liu
- Department of Epidemiology (A.Y., MG., S.M.S., C.L., K.M., A.J.S., B.P., I.U., V.V.), Rollins School of Public Health, Emory University, Atlanta, GA
| | - Kasra Moazzami
- Department of Epidemiology (A.Y., MG., S.M.S., C.L., K.M., A.J.S., B.P., I.U., V.V.), Rollins School of Public Health, Emory University, Atlanta, GA.,Emory Clinical Cardiovascular Research Institute, Division of Cardiology (A.Y., M.G., K.M., A.J.S., J.H.K., A.Q., V.V.), Emory University School of Medicine, Atlanta, GA
| | - Yi-An Ko
- Biostatistics and Bioinformatics (Y.-A.K.), Rollins School of Public Health, Emory University, Atlanta, GA
| | - Amit J Shah
- Department of Epidemiology (A.Y., MG., S.M.S., C.L., K.M., A.J.S., B.P., I.U., V.V.), Rollins School of Public Health, Emory University, Atlanta, GA.,Emory Clinical Cardiovascular Research Institute, Division of Cardiology (A.Y., M.G., K.M., A.J.S., J.H.K., A.Q., V.V.), Emory University School of Medicine, Atlanta, GA.,Atlanta VA Medical Center (A.J.S., J.D.B.)
| | - Jeong Hwan Kim
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology (A.Y., M.G., K.M., A.J.S., J.H.K., A.Q., V.V.), Emory University School of Medicine, Atlanta, GA
| | - Brad Pearce
- Department of Epidemiology (A.Y., MG., S.M.S., C.L., K.M., A.J.S., B.P., I.U., V.V.), Rollins School of Public Health, Emory University, Atlanta, GA
| | - Irina Uphoff
- Department of Epidemiology (A.Y., MG., S.M.S., C.L., K.M., A.J.S., B.P., I.U., V.V.), Rollins School of Public Health, Emory University, Atlanta, GA
| | - J Douglas Bremner
- Psychiatry and Behavioral Sciences (J.D.B.), Emory University School of Medicine, Atlanta, GA.,Atlanta VA Medical Center (A.J.S., J.D.B.)
| | - Paolo Raggi
- Mazankowski Alberta Heart Institute, University of Alberta, Canada (P.R.)
| | - Arshed Quyyumi
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology (A.Y., M.G., K.M., A.J.S., J.H.K., A.Q., V.V.), Emory University School of Medicine, Atlanta, GA
| | - Viola Vaccarino
- Department of Epidemiology (A.Y., MG., S.M.S., C.L., K.M., A.J.S., B.P., I.U., V.V.), Rollins School of Public Health, Emory University, Atlanta, GA.,Emory Clinical Cardiovascular Research Institute, Division of Cardiology (A.Y., M.G., K.M., A.J.S., J.H.K., A.Q., V.V.), Emory University School of Medicine, Atlanta, GA
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5
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Han X, Bai L, Jeong MH, Ahn JH, Hyun DY, Cho KH, Kim MC, Sim DS, Hong YJ, Kim JH, Ahn Y. Higher Long-Term Mortality in Patients with Non-ST-Elevation Myocardial Infarction than ST-Elevation Myocardial Infarction after Discharge. Yonsei Med J 2021; 62:400-408. [PMID: 33908210 PMCID: PMC8084695 DOI: 10.3349/ymj.2021.62.5.400] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 03/04/2021] [Accepted: 03/09/2021] [Indexed: 01/25/2023] Open
Abstract
PURPOSE This study aimed to compare mortality rates after discharge between the patients with non-ST-elevation myocardial infarction (NSTEMI) and those with ST-elevation myocardial infarction (STEMI), and identify each mortality risk factors in these two types of myocardial infarction. MATERIALS AND METHODS Between 2011 and 2015, 13105 consecutive patients were enrolled in the Korea Acute Myocardial Infarction-National Institute of Health registry (KAMIR-NIH); 12271 patients with acute myocardial infarction met the inclusion criteria and were further stratified into the STEMI (n=5828) and NSTEMI (n=6443) groups. The occurrence of mortality and cardiac mortality at 3 years were compared between groups, and the factors associated with mortality for NSTEMI and STEMI were evaluated. RESULTS The comparison between these two groups and long-term follow-up outcomes showed that the cumulative rates of all-cause and cardiac mortality were higher in the NSTEMI group than in the STEMI group [all-cause mortality: 10.9% vs. 5.8%; hazards ratio (HR), 0.464; 95% confidence interval (CI), 0.359-0.600, p<0.001; cardiac mortality: 6.6% vs. 3.5%, HR, 0.474; 95% CI, 0.344-0.654, p<0.001, respectively). In the NSTEMI group, low left ventricular ejection fraction (LVEF; <40%), no percutaneous coronary intervention (PCI), old age (≥65 years), and low hemoglobin level (<12 g/dL) were identified as risk factors for 3-year mortality. In the STEMI group, old age, low glomerular filtration rate (<60 mL/min/1.73 m²), low LVEF, high heart rate (>100 beats/min), no PCI, and low hemoglobin level were identified as the risk factors for 3-year mortality. CONCLUSION The NSTEMI group had higher mortality compared to the STEMI group during the 3-year clinical follow-up after discharge. Low LVEF and no PCI were the main risk factors for mortality in the NSTEMI group. In contrast, old age and renal dysfunction were the risk factors for long-term mortality in the STEMI group.
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Affiliation(s)
- Xiongyi Han
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Department of Cardiology, Yanbian University Hospital, Yanji, China
| | - Liyan Bai
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Department of Cardiology, Yanbian University Hospital, Yanji, China
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea.
| | - Joon Ho Ahn
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Dae Young Hyun
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Kyung Hoon Cho
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Min Chul Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Doo Sun Sim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Young Joon Hong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Ju Han Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
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6
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Vallabhajosyula S, Jentzer JC, Prasad A, Sangaralingham LR, Kashani K, Shah ND, Dunlay SM. Epidemiology of cardiogenic shock and cardiac arrest complicating non-ST-segment elevation myocardial infarction: 18-year US study. ESC Heart Fail 2021; 8:2259-2269. [PMID: 33837667 PMCID: PMC8120375 DOI: 10.1002/ehf2.13321] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 03/08/2021] [Accepted: 03/12/2021] [Indexed: 12/20/2022] Open
Abstract
Aims This study aims to evaluate the impact of the combination of cardiogenic shock (CS) and cardiac arrest (CA) complicating non‐ST‐segment elevation myocardial infarction (NSTEMI). Methods and results Adult (>18 years) NSTEMI admissions using the National Inpatient Sample database (2000 to 2017) were stratified by the presence of CA and/or CS. Outcomes of interest included in‐hospital mortality, early coronary angiography, hospitalization costs, and length of stay. Of the 7 302 447 hospitalizations due to NSTEMI, 147 795 (2.0%) had CS only, 155 522 (2.1%) had CA only, and 41 360 (0.6%) had both CS and CA. Compared with 2000, the adjusted odds ratios (ORs) and 95% confidence interval (CIs) for CS, CA, and both CS and CA in 2017 were 3.75 (3.58–3.92), 1.46 (1.42–1.50), and 4.52 (4.16–4.87), respectively (all P < 0.001). The CS + CA (61.2%) cohort had higher multiorgan failure than CS (42.3%) and CA only (32.0%) cohorts, P < 0.001. The CA only cohort had lower rates of overall (52% vs. 59–60%) and early (17% vs. 18–27%) angiography compared with the other groups (all P < 0.001). CS + CA admissions had higher in‐hospital mortality compared with those with CS alone (aOR 4.12 [95% CI 4.00–4.24]), CA alone (aOR 1.69 [95% CI 1.65–1.74]), or without CS/CA (aOR 22.66 [95% CI 22.06–23.27]). The presence of CS, either alone or with CA, was associated with higher hospitalization costs and longer hospital length of stay. Conclusions The combination of CS and CA is associated with higher rates of acute non‐cardiac organ failure and in‐hospital mortality in NSTEMI admissions as compared with those with either CS or CA alone.
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Affiliation(s)
- Saraschandra Vallabhajosyula
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.,Center for Clinical and Translational Science, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN, USA
| | - Jacob C Jentzer
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Abhiram Prasad
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Lindsey R Sangaralingham
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA
| | - Kianoush Kashani
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.,Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Nilay D Shah
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA.,Department of Health Services Research, Mayo Clinic, Rochester, MN, USA
| | - Shannon M Dunlay
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Department of Health Services Research, Mayo Clinic, Rochester, MN, USA
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7
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Alfaddagh A, Khraishah H, Rashed W, Sharma G, Blumenthal RS, Zubaid M. Clinical characteristics and outcomes of young adults with first myocardial infarction: Results from Gulf COAST. IJC HEART & VASCULATURE 2020; 31:100680. [PMID: 33304990 PMCID: PMC7710649 DOI: 10.1016/j.ijcha.2020.100680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/28/2020] [Accepted: 11/13/2020] [Indexed: 11/24/2022]
Abstract
CVD risk factors are common in young Gulf-Arabs presenting with first AMI. Older AMI patients receive less potentially lifesaving therapies than young adults. In-hospital adverse CVD events and mortality were low in young adults with AMI. Mortality up to 12-months post-AMI was lower in young adults than in older adults.
Introduction Limited data exists on the risk factor profile and outcomes of young patients suffering their first acute myocardial infarction (AMI). Methods We examined 1562 Gulf-Arabs without prior cardiovascular disease presenting with first AMI enrolled in the Gulf COAST prospective cohort. Clinical characteristics were compared in patients ≤50 years of age (young) vs. >50 years (older). Associations between age group and in-hospital adverse events (re-infarction, heart failure, cardiogenic shock, cardiac arrest, stroke, and in-hospital death) or post-discharge mortality were estimated using logistic regression. Results Young patients represented 26.1% (n = 407) of first AMI cases and were more likely to be men (82.8% vs. 66.5%), current smokers (49.9% vs 19.0%), obese (38.3% vs 28.0%), and have family history of premature coronary artery disease (21.4% vs 10.4%) compared with older patients (all P < 0.001). Young patients were more likely to receive β-blockers (83.0% vs 74.4%; P < 0.001), clopidogrel (82.3% vs 76.0%; P = 0.009) and primary reperfusion therapy (85.6% vs. 75.6%; P = 0.003). Young adults had lower in-hospital death (adjusted odds ratio [aOR] = 0.37; 95%CI = 0.16–0.86) or any in-hospital adverse cardiovascular events (aOR = 0.53; 95%CI = 0.34–0.83). Young adults had lower likelihood of cumulative death at 12-month post-discharge (aOR = 0.34; 95%CI = 0.19–0.59) after adjusting for potential confounders. Conclusion Young patients with first AMI were more likely to be obese, smokers and have family history of premature coronary artery disease compared to older adults. Young patients were more likely to receive guideline-proven therapies and have better in-hospital and post-discharge mortality. These data highlight important age-related care gaps in patients suffering AMI for the first time.
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8
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Zhao Z, Wang X, Wang S, Zhou R, Liu Y, Su L, Li C, Lin S, Liu H, Zhao L, Mao J. Study on the clinical assessment of integrated rehabilitation of Traditional Chinese Medicine and western medication for acute myocardial infarction. Medicine (Baltimore) 2020; 99:e21592. [PMID: 32846768 PMCID: PMC7447369 DOI: 10.1097/md.0000000000021592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE This trial aims to evaluate the efficacy and safety of the Baduanjin exercise in patients with acute myocardial infarction (AMI). METHODS A single-center, open, randomized controlled clinical trial will be conducted to evaluate the effectiveness of the Baduanjin exercise on the rehabilitation of AMI patients. It plans to enroll 64 patients. Patients will be divided evenly into 2 groups using a random number table method. There will be 32 cases in each group. Patients in the experimental group will be treated with standardized drug therapy combined with Baduanjin exercise, while patients in the control group will be treated with standardized drug therapy combined with routine exercise. The primary outcome is the peak oxygen consumption (Peak VO2) during cardiopulmonary exercise test (CPET). The secondary outcomes include CPET, echocardiography, Seattle angina pectoris scale, hospital depression and anxiety scale, Pittsburgh Sleep Quality Index scale, scores of 4 examinations, and diagnostic methods of traditional Chinese medicine and composite endpoint events, etc. DISCUSSION:: This study will be the first to evaluate the effect of the Baduanjin exercise on the Peak VO2 in patients with AMI. STUDY REGISTRATION This study has been registered on the Chinese Clinical Trial Registry (No: ChiCTR1800016209, protocol version 1.2).
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9
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Acute renal impairment in older adults treated with percutaneous coronary intervention for ST-segment elevation myocardial infarction. Coron Artery Dis 2020; 30:564-568. [PMID: 30973353 DOI: 10.1097/mca.0000000000000742] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Elderly individuals ( ≥ 75 years) constitute an increasing proportion of patients presenting with myocardial infarction treated with primary percutaneous coronary intervention (PCI), but only limited data are available regarding the incidence and prognostic implications of acute kidney injury (AKI) in this group of patients. OBJECTIVE To evaluate the incidence and prognostic implications of AKI in older adults ( ≥ 75 years) with ST-segment elevation myocardial infarction (STEMI) treated with primary PCI. PATIENTS AND METHODS A retrospective cohort, observational, single-center study of consecutive 416 older patients with STEMI (≥ 75 years) treated with primary PCI between January 2008 and August 2017 was conducted. AKI was defined as an increase of at least 0.3 mg/dl in serum creatinine within 48 h following admission. RESULTS A total of 96/416 (23%) patients developed AKI. The occurrence of AKI was associated with adverse in-hospital outcomes, higher 30 days (25 vs. 6%; P < 0.001), and long-term mortality (46 vs. 17%; hazard ratio: 3.2; 95% confidence interval: 2.1-4.7; P < 0.001). Among patients with AKI, 46/96 (48%) demonstrated recovery of renal function at hospital discharge. Lack of renal function recovery at discharge (50/96 patients; 52%) was associated with the occurrence of new or progression of baseline chronic kidney disease. CONCLUSION Among older patients with STEMI undergoing primary PCI, AKI is a frequent complication associated with adverse renal short-term and long-term outcomes.
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10
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Wang TKM, Grey C, Jiang Y, Jackson R, Kerr A. Contrasting Trends in Acute Coronary Syndrome Hospitalisation and Coronary Revascularisation in New Zealand 2006-2016: A National Data Linkage Study (ANZACS-QI 27). Heart Lung Circ 2020; 29:1375-1385. [PMID: 31974025 DOI: 10.1016/j.hlc.2019.11.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/28/2019] [Accepted: 11/18/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND Evaluating trends in acute coronary syndrome (ACS) and invasive coronary procedures, including coronary angiography, percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) can identify areas for improvement in clinical care and inform future health planning. This national data-linkage study reports trends in ACS hospitalisations and procedure rates in New Zealand between 2006 and 2016. METHODS All adult ACS hospitalisations and associated angiography and revascularisation procedures were identified from hospital discharge codes. Crude and age-standardised ACS incidence and procedure rates were calculated for each calendar year. RESULTS Between 2006 and 2016 there were 188,264 ACS admissions. During this time, there was a steady decline in hospitalisation rates, from 685 to 424 per 100,000 per year. This decline was observed in both sexes and in all age groups. There were also significant increases in coronary angiography and revascularisation rates, from 29.8% to 54.3% and 20.6% to 37.3%, respectively, between 2006 and 2016. The rate of revascularisation by PCI increased from 16.0% to 31.0%, a greater increase than revascularisation by CABG, which increased from 4.6% to 6.5%. Increases in procedures were observed in all age groups and both sexes. The proportions of coronary angiograms that resulted in revascularisation each year consistently ranged from 67 to 70% throughout the period. CONCLUSIONS Acute coronary syndrome hospitalisation rates in New Zealand decreased by nearly 40% between 2006 and 2016, while the use of coronary angiography and revascularisation after ACS nearly doubled. The similar proportions of angiograms that resulted in revascularisation each year suggests that, despite the doubling of angiograms over the 10-year study period, they are not over-utilised.
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Affiliation(s)
- Tom Kai Ming Wang
- Department of Cardiology, Middlemore Hospital, Auckland, New Zealand; Greenlane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - Corina Grey
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Yannan Jiang
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Rod Jackson
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Andrew Kerr
- Department of Cardiology, Middlemore Hospital, Auckland, New Zealand; School of Population Health, University of Auckland, Auckland, New Zealand.
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Kazmi SHA, Datta S, Chi G, Nafee T, Yee M, Kalia A, Sharfaei S, Shojaei F, Mirwais S, Gibson CM. The AngelMed Guardian ® System in the Detection of Coronary Artery Occlusion: Current Perspectives. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2020; 13:1-12. [PMID: 32021496 PMCID: PMC6954830 DOI: 10.2147/mder.s219865] [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: 06/18/2019] [Accepted: 12/13/2019] [Indexed: 11/23/2022] Open
Abstract
Total ischemic time, which specifies the time from the onset of chest pain to initiation of reperfusion during percutaneous coronary intervention, consists of two intervals: symptom to door time and door to balloon time. A door to balloon time of 90 mins or less has become a quality-of-care metric in the management of ST elevation myocardial infarction (STEMI). While national efforts made by the American College of Cardiology (ACC) and American Heart Association (AHA) have curtailed in-hospital door to balloon time over the years, a reduction in pre-hospital symptoms to door time presents a challenge in modern interventional Cardiology. Early and complete revascularization has been associated with improved clinical outcomes in MI and strategies that may help reduce symptom to door time, and thus the total ischemic time, are crucial. Rapidly evolving ST-segment changes commonly develop prior to ischemia-related symptom onset, and are detectable even in patients with clinically unrecognized silent MIs. Therefore, a highly intelligent ischemia detection system that alerts patients of ST segment deviation may allow for rapid identification of acute coronary occlusion. The AngelMed Guardian® System is a cardiac activity monitoring and alerting system designed for rapid identification of intracardiac ST-segment changes among patients at a high risk for recurrent ACS events. This article reviews the clinical studies evaluating the design, safety and efficacy of the AngelMed Guardian System and discusses the clinical implications of the device.
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Affiliation(s)
- Syed Hassan Abbas Kazmi
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sudarshana Datta
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Gerald Chi
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Tarek Nafee
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Megan Yee
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Akshun Kalia
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sadaf Sharfaei
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Fahimehalsadat Shojaei
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sabawoon Mirwais
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - C Michael Gibson
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Coronary Artery Disease: From Mechanism to Clinical Practice. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1177:1-36. [PMID: 32246442 DOI: 10.1007/978-981-15-2517-9_1] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In most developed countries, coronary artery disease (CAD), mostly caused by atherosclerosis of coronary arteries, is one of the primary causes of death. From 1990s to 2000s, mortality caused by acute MI declined up to 50%. The incidence of CAD is related with age, gender, economic, etc. Atherosclerosis contains some highly correlative processes such as lipid disturbances, thrombosis, inflammation, vascular smooth cell activation, remodeling, platelet activation, endothelial dysfunction, oxidative stress, altered matrix metabolism, and genetic factors. Risk factors of CAD exist among many individuals of the general population, which includes hypertension, lipids and lipoproteins metabolism disturbances, diabetes mellitus, chronic kidney disease, age, genders, lifestyle, cigarette smoking, diet, obesity, and family history. Angina pectoris is caused by myocardial ischemia in the main expression of pain in the chest or adjoining area, which is usually a result of exertion and related to myocardial function disorder. Typical angina pectoris would last for minutes with gradual exacerbation. Rest, sit, or stop walking are the usual preference for patients with angina, and reaching the maximum intensity in seconds is uncommon. Rest or nitroglycerin usage can relieve typical angina pectoris within minutes. So far, a widely accepted angina pectoris severity grading system included CCS (Canadian Cardiovascular Society) classification, Califf score, and Goldman scale. Patients with ST-segment elevated myocardial infarction (STEMI) may have different symptoms and signs of both severe angina pectoris and various complications. The combination of rising usage of sensitive MI biomarkers and precise imaging techniques, including electrocardiograph (ECG), computed tomography, and cardiac magnetic resonance imaging, made the new MI criteria necessary. Complications of acute myocardial infarction include left ventricular dysfunction, cardiogenic shock, structural complications, arrhythmia, recurrent chest discomfort, recurrent ischemia and infarction, pericardial effusion, pericarditis, post-myocardial infarction syndrome, venous thrombosis pulmonary embolism, left ventricular aneurysm, left ventricular thrombus, and arterial embolism.
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Wita K, Wilkosz K, Wita M, Kułach A, Wybraniec MT, Polak M, Matla M, Maciejewski Ł, Fluder J, Kalańska-Łukasik B, Skowerski T, Gomułka S, Turski M, Szydło K. Managed Care after Acute Myocardial Infarction (MC-AMI) - a Poland's nationwide program of comprehensive post-MI care - improves prognosis in 12-month follow-up. Preliminary experience from a single high-volume center. Int J Cardiol 2019; 296:8-14. [PMID: 31256995 DOI: 10.1016/j.ijcard.2019.06.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/08/2019] [Accepted: 06/14/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Despite progress in the treatment of acute myocardial infarction (AMI), long-term prognosis in MI survivors remains a challenge. The Managed Care in Acute Myocardial Infarction (MC-AMI, KOS-zawal) is the first program of a comprehensive, supervised care for patients with AMI to improve long-term prognosis. It includes acute intervention, complex revascularization, cardiac rehabilitation (CR), outpatient follow-up, and prevention of SCD. Our aim was to assess the relation between participation in MC-AMI and major adverse cardiovascular and cerebrovascular events (MACCE) in 12-month follow-up. METHODS AND RESULTS In this single-center, retrospective analysis we compared 719 patients participating in MC-AMI and compared them to 1130 subjects in the control group. After propensity score matching, two groups of 529 subjects each were compared. MC-AMI was related with MACCE reduction by 40% in a 12-month observation. Participants of MC-AMI had a higher adherence to cardiac rehabilitation (98 vs. 14%), higher rate of scheduled revascularisation (coronary artery bypass grafting: 9.8% vs. 4.9%, p ≪ 0.001; elective percutaneous coronary intervention: 3.0% vs 2.1%, p ≪ 0.05) and ICD implantation (2.8% vs. 0.6%, p ≪ 0.05) compared to control. Multivariable Cox regression analysis revealed MC-AMI to be inversely associated with the occurrence of MACCE (HR = 0.500, 95% Cl 0.349-0.718, p ≪ 0.001). Besides, older age, diabetes mellitus, hyperlipidemia, prior PAD, previous UA, and lower LVEF were significantly associated with the primary endpoint. CONCLUSIONS MC-AMI is the first program of comprehensive care for AMI patients. MC-AMI improves prognosis by increasing the rate of patients undergoing CR, complete revascularization and ICD implantation, thus reducing MACCE.
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Affiliation(s)
- Krystian Wita
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Katarzyna Wilkosz
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Marcin Wita
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Andrzej Kułach
- Department of Cardiology, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland.
| | - Maciej T Wybraniec
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Mateusz Polak
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Monika Matla
- Department of Cardiology, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Łukasz Maciejewski
- Department of Cardiology, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Joanna Fluder
- Third Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Barbara Kalańska-Łukasik
- Third Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Tomasz Skowerski
- Department of Cardiology, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Szymon Gomułka
- Daily Cardiology Rehabilitation Department, Upper Silesian Medical Center in Katowice, Katowice, Poland
| | - Maciej Turski
- Daily Cardiology Rehabilitation Department, Upper Silesian Medical Center in Katowice, Katowice, Poland
| | - Krzysztof Szydło
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
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Elkoustaf RA, Aldaas OM, Batiste CD, Mercer A, Robinson M, Newton D, Burchett R, Cornelius C, Patterson H, Ismail MH. Lifestyle Interventions and Carotid Plaque Burden: A Comparative Analysis of Two Lifestyle Intervention Programs in Patients with Coronary Artery Disease. Perm J 2019; 23:18.196. [PMID: 31634108 DOI: 10.7812/tpp/18.196] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The cardioprotective effects of intensive lifestyle regimens in primary prevention have been elucidated; however, there is a paucity of data comparing the effects of different lifestyle regimens in patients with established coronary artery disease (CAD) or CAD equivalent, specifically vis-à-vis carotid plaque regression. METHODS We performed a randomized, single-center, single-blind study in 120 patients with established CAD. Patients were randomly assigned to either 9 months of the Complete Health Improvement Program (CHIP), an outpatient lifestyle enrichment program that focuses on improving dietary choices, enhancing daily exercise, increasing support systems, and decreasing stress; or to 9 months of an ad hoc, nonsequential combination of various healthy living classes offered separately through a health maintenance organization and referred to as the Healthy Heart program. Baseline and 9-month change in carotid intima-media thickness (CIMT) were measured. RESULTS Among 120 participants, data were analyzed for 79, of which 68 (86%) completed the study. Both average CIMT and average maximum CIMT increased over 9 months, but the changes between groups were insignificant. There were marked differences in the mean body mass index favoring the CHIP group (-1.9 [standard deviation = 1.9]; p < 0.001) and statistically significant within-group improvements in blood pressure, triglyceride level, 6-minute walk test result, self-assessment well-being score, and Patient Health Questionnaire-9 score that were not observed between groups. CONCLUSION Neither the CHIP nor Healthy Heart was effective in inducing plaque regression in patients with established CAD after a 9-month period. However, both were effective in improving several CAD risk factors, which shows that the nonsequential offering of healthy lifestyle programs can lead to similar outcomes as a formal, sequential, established program (CHIP) in many aspects. These results have important implications as to how lifestyle changes will be implemented as tertiary prevention measures in the future.
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Affiliation(s)
| | - Omar M Aldaas
- Department of Medicine, University of California, San Diego, CA
| | | | - Adina Mercer
- Department of Family Medicine, Riverside Medical Center, CA
| | | | - Darlene Newton
- Department of Preventive Medicine, Riverside Medical Center, CA
| | - Raoul Burchett
- Department of Preventive Medicine, Riverside Medical Center, CA
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Goeddel LA, Hopkins AN, Fernando RJ, Núñez-Gil IJ, Ramakrishna H. Analysis of the 4th Universal Definition of Myocardial Infarction-Key Concepts and Perioperative Implications. J Cardiothorac Vasc Anesth 2019; 33:3486-3495. [PMID: 30738751 DOI: 10.1053/j.jvca.2019.01.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Indexed: 01/10/2023]
Affiliation(s)
- Lee A Goeddel
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Amanda N Hopkins
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Rohesh J Fernando
- Department of Anesthesiology, Wake Forest School of Medicine, Winston Salem, NC
| | - Iván J Núñez-Gil
- Interventional Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Harish Ramakrishna
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ.
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Ge Z, Baber U, Claessen BE, Farhan S, Chandrasekhar J, Li SX, Sartori S, Kini AS, Rao SV, Weiss S, Henry TD, Vogel B, Sorrentino S, Faggioni M, Kapadia S, Muhlestein B, Strauss C, Toma C, DeFranco A, Effron MB, Keller S, Baker BA, Pocock S, Dangas G, Mehran R. The prevalence, predictors and outcomes of guideline-directed medical therapy in patients with acute myocardial infarction undergoing PCI, an analysis from the PROMETHEUS registry. Catheter Cardiovasc Interv 2018; 93:E112-E119. [DOI: 10.1002/ccd.27860] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 08/12/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Zhen Ge
- Icahn School of Medicine at Mount Sinai; New York New York
- Division of Cardiology, Nanjing First Hospital; Nanjing Medical University; Nanjing China
| | - Usman Baber
- Icahn School of Medicine at Mount Sinai; New York New York
| | | | - Serdar Farhan
- Icahn School of Medicine at Mount Sinai; New York New York
| | | | - Shawn X. Li
- Geisel School of Medicine Dartmouth; Lebanon New Hampshire
| | | | | | - Sunil V. Rao
- The Duke Clinical Research Institute; Durham North Carolina
| | | | | | - Birgit Vogel
- Icahn School of Medicine at Mount Sinai; New York New York
| | | | | | | | | | | | - Catalin Toma
- University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
| | | | - Mark B. Effron
- Eli Lilly and Company; Indianapolis Indiana
- John Ochsner Heart and Vascular Center; Ochsner Medical Center; New Orleans Louisiana
| | | | | | - Stuart Pocock
- London School of Hygiene and Tropical Medicine; London UK
| | - George Dangas
- Icahn School of Medicine at Mount Sinai; New York New York
| | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai; New York New York
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Al-Hawwas M, Tsitlakidou D, Gupta N, Iliescu C, Cilingiroglu M, Marmagkiolis K. Acute Coronary Syndrome Management in Cancer Patients. Curr Oncol Rep 2018; 20:78. [PMID: 30132257 DOI: 10.1007/s11912-018-0724-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE OF REVIEW Coronary artery disease and cancer often co-exist. Patients with cancer have been excluded by most major cardiology trials and registries and their management remains largely empiric. Cancer patients experience an approximately 10-times increased mortality compared to the general population. Conservative therapy of ACS in cancer therapy results in 1-year mortality of 74%. This review article aims to describe the mechanisms of acute coronary syndromes in cancer patients, their clinical presentation, and their management. RECENT FINDINGS Newer studies have shed light on the mechanisms of ACS in cancer patients, which are different and related to the type of malignancy and its associated therapy. Medication-specific coronary effects (vasospasm, endothelial dysfunction, spontaneous thrombosis, accelerated atherosclerosis), radiation vasculitis, cancer cell coronary embolism, and coronary compression from thoracic malignancies are unique ACS mechanisms in cancer patients. Close collaboration between oncologists and cardiologists for thoughtful patient selection and decision making strategies is necessary to provide optimal medical care.
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Affiliation(s)
- Malek Al-Hawwas
- University of Arkansas for Medical Sciences and Central Arkansas Veterans Health Care System, 4301 W Markham St, Little Rock, AR, 72205, USA.
| | | | - Neha Gupta
- Academy of the Lakes, 2331 Collier Pkwy, Land O, Lakes, FL, 34639, USA
| | - Cezar Iliescu
- MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Mehmet Cilingiroglu
- Arkansas Heart Hospital, 1701 South Shackleford Rd., Little Rock, AR, 72211, USA
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Sharma R, Hiebert B, Cheung D, Jassal DS, Minhas K. Primary Coronary Intervention in Octogenarians and Nonagenarians With ST-Segment Elevation Myocardial Infarction: A Canadian Single-Center Perspective. Angiology 2017; 69:718-723. [PMID: 29232970 DOI: 10.1177/0003319717746520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The proportion of individuals >80 years of age constitute an increasing proportion of patients who present with ST-segment elevation myocardial infarction (STEMI). The objective of this study is to evaluate in-hospital outcomes and 1-year survival of very elderly patients who present with an STEMI and undergo primary percutaneous coronary intervention (pPCI). Between 2009 and 2015, individuals >80 years of age (very elderly patients) with an STEMI presenting at a single tertiary Canadian care center were included in the study. A random sample of 100 individuals aged 65 to 69 years over the same time period were selected as a control group. A total of 284 patients were included in the study population including 100 controls, 164 octogenarians, and 20 nonagenarians. Of total, 1661 pPCIs occurred during this study period with the very elderly population (>80 years) comprising 11.1% of the total pPCIs. Compared with controls, individuals aged >80 are more likely to have a delay in treatment with increased rates of bleeding, acute kidney injury, rehospitalization, and a trend toward longer hospital stays following pPCI for STEMI. Although in-hospital and 1-year mortality were similar between both cohorts >80 years of age with STEMI, their overall survival was reduced compared with controls.
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Affiliation(s)
- Rajat Sharma
- 1 Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brett Hiebert
- 1 Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - David Cheung
- 1 Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Davinder S Jassal
- 1 Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,2 Institute of Cardiovascular Sciences, St Boniface Albrechtsen Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada.,3 Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,4 Department of Physiology and Pathophysiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kunal Minhas
- 1 Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Liang D, Zhang J, Lin L, Zong W. The Difference on Features of Fragmented QRS Complex and Influences on Mortality in Patients with Acute Coronary Syndrome. ACTA CARDIOLOGICA SINICA 2017; 33:588-595. [PMID: 29167610 DOI: 10.6515/acs20170810b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Objectives To investigate whether the fragmented QRS (fQRS) complexes can be used to distinguish patients with early non-ST elevation myocardial infarction (NSTEMI) from those with unstable angina (UA). Background fQRS complex has been found to be linked to myocardial infarction and cardiac death. Methods The clinical data of 302 patients who had been diagnosed with coronary artery disease were retrospectively reviewed. Incidence of fQRS complex within 48 h of presentation was analyzed and patients with acute myocardial infarction (AMI) (n = 240) were followed up by telephone interviews for a mean of 61.47 (range, 59.60-63.35) months. Results Patients with NSTEMI exhibited higher incidence of fQRS than those with UA (p = 0.047). The incidence of fQRS in the inferior wall leads was significantly higher than that of other leads in patients with anterior wall infarction (p < 0.05). Kaplan-Meier analysis revealed a higher mortality rate in AMI patients with fQRS compared to non-fQRS patients (p = 0.001). Conclusions Presence of fQRS complexes within 48 hours of presentation may be used to differentiate NSTEMI patients from UA patients. fQRS may also be used as a survival predictor for patients with AMI.
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Affiliation(s)
- Di Liang
- Department of Cardiology, The Third People's Hospital of Hubei Province, Wuhan, Hubei 430033, China
| | - Jingyi Zhang
- Department of Cardiology, The Third People's Hospital of Hubei Province, Wuhan, Hubei 430033, China
| | - Li Lin
- Department of Cardiology, The Third People's Hospital of Hubei Province, Wuhan, Hubei 430033, China
| | - Wenxia Zong
- Department of Cardiology, The Third People's Hospital of Hubei Province, Wuhan, Hubei 430033, China
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Lee MS, Shlofmitz E, Lluri G, Kong J, Neverova N, Shlofmitz R. Outcomes of patients with myocardial infarction who underwent orbital atherectomy for severely calcified lesions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:497-500. [DOI: 10.1016/j.carrev.2017.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 05/01/2017] [Accepted: 05/03/2017] [Indexed: 11/16/2022]
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Murugiah K, Wang Y, Nuti SV, Li X, Li J, Zheng X, Downing NS, Desai NR, Masoudi FA, Spertus JA, Jiang L, Krumholz HM. Are non-ST-segment elevation myocardial infarctions missing in China? EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2017; 3:319-327. [DOI: 10.1093/ehjqcco/qcx025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 07/25/2017] [Indexed: 12/18/2022]
Abstract
Abstract
Aims
ST-segment elevation myocardial infarctions (STEMI) in China and other low- and middle-income countries outnumber non-ST-segment elevation myocardial infarctions (NSTEMI). We hypothesized that the STEMI predominance was associated with lower biomarker use and would vary with hospital characteristics.
Methods and results
We hypothesized that the STEMI predominance was associated with lower biomarker use and would vary with hospital characteristics. Using data from the nationally representative China PEACE-Retrospective AMI Study during 2001, 2006, and 2011, we compared hospital NSTEMI proportion across categories of use of any cardiac biomarker (CK, CK-MB, or troponin) and troponin, as well as across region, location, level, and teaching status. Among 15 416 acute myocardial infarction (AMI) patients, 14% had NSTEMI. NSTEMI patients were older, more likely female, and to have comorbidities. Median hospital NSTEMI proportion in each study year was similar across categories of any cardiac biomarker use, troponin, region, location, level, and teaching status. For instance, in 2011 the NSTEMI proportion at hospitals without troponin testing was 11.2% [inter quartile range (IQR) 4.4–16.7%], similar to those with ≥ 75% troponin use (13.0% [IQR 8.7–23.7%]) (P-value for difference 0.77). Analysed as continuous variables there was no relationship between hospital NSTEMI proportion and proportion biomarker use. With troponin use there was no relationship in 2001 and 2006, but a modest correlation in 2011 (R = 0.16, P = 0.043). Admissions for NSTEMI increased from 0.3/100 000 people in 2001 to 3.3/100 000 people in 2011 (P-value for trend < 0.001).
Conclusion
STEMI is the dominant presentation of AMI in China, but the proportion of NSTEMI is increasing. Biomarker use and hospital characteristics did not account for the low NSTEMI rate.
Clinical trial registration
www.clinicaltrials.gov (NCT01624883).
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Affiliation(s)
- Karthik Murugiah
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, 330 Cedar St, Boardman 110, P.O. Box 208056, New Haven, Connecticut 06520-8056, USA
| | - Yongfei Wang
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, 330 Cedar St, Boardman 110, P.O. Box 208056, New Haven, Connecticut 06520-8056, USA
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, 1 Church Street, Suite 200, New Haven, Connecticut 06510-3330, USA
| | - Sudhakar V. Nuti
- Department of Internal Medicine, Yale University School of Medicine, 330 Cedar St, Boardman 110, P.O. Box 208056, New Haven, Connecticut 06520-8056, USA
| | - Xi Li
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing 100037, China
| | - Jing Li
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing 100037, China
| | - Xin Zheng
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing 100037, China
| | - Nicholas S. Downing
- Department of Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, Massachusetts 02115, USA
| | - Nihar R. Desai
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, 330 Cedar St, Boardman 110, P.O. Box 208056, New Haven, Connecticut 06520-8056, USA
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, 1 Church Street, Suite 200, New Haven, Connecticut 06510-3330, USA
| | - Frederick A. Masoudi
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Campus Box B132, 12401 East 17th Avenue, Room 522, Aurora, Colorado 80045, USA
| | - John A. Spertus
- Saint Luke’s Mid America Heart Institute/University of Missouri-Kansas City, 4401 Wornall Road, Kansas City, Missouri 64111, USA
| | - Lixin Jiang
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing 100037, China
| | - Harlan M. Krumholz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, 330 Cedar St, Boardman 110, P.O. Box 208056, New Haven, Connecticut 06520-8056, USA
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, 1 Church Street, Suite 200, New Haven, Connecticut 06510-3330, USA
- Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, 333 Cedar Street, SHM I-456 P.O. Box 208088, New Haven, Connecticut 06520, USA
- Department of Health Policy and Management, Yale School of Public Health, 60 College Street, P.O. Box 208034, New Haven CT 06520-8034, USA
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Masoumi A, Rosenblum HR, Garan AR. Cardiogenic Shock in Older Adults. CURRENT CARDIOVASCULAR RISK REPORTS 2016. [DOI: 10.1007/s12170-016-0522-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Pelletier R, Choi J, Winters N, Eisenberg MJ, Bacon SL, Cox J, Daskalopoulou SS, Lavoie KL, Karp I, Shimony A, So D, Thanassoulis G, Pilote L. Sex Differences in Clinical Outcomes After Premature Acute Coronary Syndrome. Can J Cardiol 2016; 32:1447-1453. [PMID: 27683172 DOI: 10.1016/j.cjca.2016.05.018] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/09/2016] [Accepted: 05/10/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Over past decades, the incidence of acute coronary syndrome (ACS) has increased in young women, and greater mortality rates after discharge were observed among young women vs men. We revisited this issue with contemporary data from the Gender and Sex Determinants of Cardiovascular Disease: From Bench to Beyond Premature Acute Coronary Syndrome (GENESIS-PRAXY), a multicentre prospective cohort study. METHODS One thousand two hundred thirteen patients were enrolled in GENESIS-PRAXY from 26 centres across Canada, the United States, and Switzerland between January 2009 and April 2013. We assessed major adverse cardiac events (MACE) and mortality over 12 months after ACS. The role of sex as a predictor of outcomes was determined with Cox proportional hazard regression analysis. RESULTS We included 1163 patients with complete data. The occurrence of MACE was 9% and 8% in women and men, respectively (P = 0.75), and 1% of women and men died during follow-up. In adjusted models, there was no sex difference in the risk of MACE or mortality. The proportion of patients with all-cause rehospitalization was higher in women (13%) compared with men (9%; P = 0.006), but cardiac rehospitalization rates were similar in both sexes regardless of ACS type. Among first rehospitalizations, the majority was classified as cardiac related (69%), with chest pain or angina (28%) and myocardial infarction (19%) reported as the most common reasons for first rehospitalization. CONCLUSIONS Women were more likely than men to be rehospitalized for all causes but not for a cardiac cause. In contrast to earlier studies, men and women had similar mortality and MACE outcomes at 1 year.
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Affiliation(s)
- Roxanne Pelletier
- Divisions of Clinical Epidemiology and General Internal Medicine, The Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - Jin Choi
- Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Nicholas Winters
- Divisions of Clinical Epidemiology and General Internal Medicine, The Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - Mark J Eisenberg
- Divisions of Cardiology and Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada
| | - Simon L Bacon
- Department of Exercise Science, Concordia University, Montréal, Québec, Canada
| | - Jafna Cox
- Division of Cardiology, Department of Medicine and Department of Community Health and Epidemiology, Halifax, Nova Scotia, Canada
| | - Stella S Daskalopoulou
- Division of General Internal Medicine, Department of Medicine, McGill University, McGill University Health Centre, Montréal, Québec, Canada
| | - Kim L Lavoie
- Department of Psychology, University of Québec in Montréal, Montréal, Québec, Canada
| | - Igor Karp
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Avi Shimony
- Division of Cardiology, Soroka Medical Center, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Derek So
- Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - George Thanassoulis
- Division of Cardiology, Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada
| | - Louise Pilote
- Divisions of Clinical Epidemiology and General Internal Medicine, The Research Institute of the McGill University Health Centre, Montréal, Québec, Canada.
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Sanchis-Gomar F, Perez-Quilis C, Leischik R, Lucia A. Epidemiology of coronary heart disease and acute coronary syndrome. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:256. [PMID: 27500157 DOI: 10.21037/atm.2016.06.33] [Citation(s) in RCA: 621] [Impact Index Per Article: 77.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The aim of this review is to summarize the incidence, prevalence, trend in mortality, and general prognosis of coronary heart disease (CHD) and a related condition, acute coronary syndrome (ACS). Although CHD mortality has gradually declined over the last decades in western countries, this condition still causes about one-third of all deaths in people older than 35 years. This evidence, along with the fact that mortality from CHD is expected to continue increasing in developing countries, illustrates the need for implementing effective primary prevention approaches worldwide and identifying risk groups and areas for possible improvement.
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Affiliation(s)
| | - Carme Perez-Quilis
- Research Institute of the Hospital 12 de Octubre ('i+12'), Madrid, Spain
| | - Roman Leischik
- Faculty of Health, School of Medicine, University Witten/Herdecke, Hagen, Germany
| | - Alejandro Lucia
- Research Institute of the Hospital 12 de Octubre ('i+12'), Madrid, Spain;; European University of Madrid, Madrid, Spain
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Fitchett DH, Goodman SG, Leiter LA, Lin P, Welsh R, Stone J, Grégoire J, Mcfarlane P, Langer A. Secondary Prevention Beyond Hospital Discharge for Acute Coronary Syndrome: Evidence-Based Recommendations. Can J Cardiol 2016; 32:S15-34. [PMID: 27342696 DOI: 10.1016/j.cjca.2016.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 02/20/2016] [Accepted: 03/01/2016] [Indexed: 12/21/2022] Open
Abstract
In the past 3 decades, a better understanding of the pathophysiology of cardiovascular disease has resulted in innovations in the treatment and prevention of its clinical manifestations such as death, myocardial infarction, or stroke. After an acute coronary syndrome there are short- and long-term risks of subsequent cardiovascular events. This leads to opportunities to initiate strategies to reduce complications resulting from myocardial injury (cardiac protection) and to prevent recurrent acute coronary events (vascular protection). The results from clinical trials inform best practice and guidelines for patient management. Despite clear and consistent guidelines, an important number of patients are not receiving these treatments. Moreover, many others do not receive treatment that follows the strategy proven in the clinical trial and this is associated with a significant loss of opportunities to improve outcomes. The Canadian Heart Research Centre has therefore assembled a panel of experts to provide a review of available data and distill it to specific evidence-based recommendations that can be used by specialists and primary care physicians as a platform for secondary prevention. The therapeutic recommendations are conveniently divided into vascular protection (dual antiplatelet therapy, lipid-lowering, and renin angiotensin system inhibition) which should be considered in all patients; cardiac protection (addition of β-blocker therapy) in patients with left ventricular dysfunction including consideration for management of heart failure; and continuing management of risk factors and comorbid conditions on the basis of the specific patient profile. These recommendations are intended as a decision support tool and a quick reference for Canadian physicians.
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Affiliation(s)
- David H Fitchett
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
| | - Shaun G Goodman
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Heart Research Centre, University of Alberta, Edmonton, Alberta, Canada; Vigour Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Lawrence A Leiter
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Peter Lin
- Canadian Heart Research Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Robert Welsh
- Vigour Centre, University of Alberta, Edmonton, Alberta, Canada
| | - James Stone
- University of Calgary, Calgary, Alberta, Canada
| | - Jean Grégoire
- Montreal Heart Centre, University of Montreal, Montreal, Quebec, Canada
| | - Philip Mcfarlane
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Anatoly Langer
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Heart Research Centre, University of Alberta, Edmonton, Alberta, Canada
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Pouche M, Ruidavets JB, Ferrières J, Iliou MC, Douard H, Lorgis L, Carrié D, Brunel P, Simon T, Bataille V, Danchin N. Cardiac rehabilitation and 5-year mortality after acute coronary syndromes: The 2005 French FAST-MI study. Arch Cardiovasc Dis 2015; 109:178-87. [PMID: 26711546 DOI: 10.1016/j.acvd.2015.09.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/28/2015] [Accepted: 09/30/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Clinical studies have shown a beneficial effect of cardiac rehabilitation (CR) on mortality. OBJECTIVE To study the effect of CR prescription at discharge on 5-year mortality in patients with acute myocardial infarction (AMI). METHODS Participants, from the 2005 French FAST-MI hospital registry, were 2894 survivors at discharge, divided according to AMI type: ST-segment elevation myocardial infarction (STEMI; n=1523) and non-STEMI (NSTEMI; n=1371). The effect of CR prescription on mortality was analysed using a Cox proportional hazards model. RESULTS At discharge, 22.1% of patients had a CR prescription. Patients referred to CR were younger (62.4 vs. 67.5years), were more frequently men and more had presented with STEMI (67.8% vs. 48.3%) than non-referred patients. Ninety-four (14.7%) deaths occurred among patients referred to CR and 585 (25.9%) among non-referred patients (P<0.001). After multivariable adjustment, the association between CR and mortality remained significant (hazard ratio [HR] 0.76, 95% confidence interval [CI] 0.60-0.96). Analyses stratified by sex, age (<60 vs.≥60years) and AMI type showed that the inverse association was stronger in men (HR 0.64, 95% CI 0.48-0.87) than in women (HR 0.95, 95% CI 0.64-1.39), in younger (HR 0.34, 95% CI 0.15-0.77) than in older patients (HR 0.84, 95% CI 0.65-1.07) and in NSTEMI (HR 0.63, 95% CI 0.46-0.88) than in STEMI (HR 0.99, 95% CI 0.69-1.40). CONCLUSION After hospitalization for AMI, referral to CR remains a significant predictor of improved patient survival; some subgroups seem to gain greater benefit.
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Affiliation(s)
- Marion Pouche
- Department of Epidemiology, Health Economics and Public Health, UMR1027 Inserm-University of Toulouse III, Toulouse University Hospital (CHU), 31073 Toulouse cedex 7, France
| | - Jean-Bernard Ruidavets
- Department of Epidemiology, Health Economics and Public Health, UMR1027 Inserm-University of Toulouse III, Toulouse University Hospital (CHU), 31073 Toulouse cedex 7, France.
| | - Jean Ferrières
- Department of Epidemiology, Health Economics and Public Health, UMR1027 Inserm-University of Toulouse III, Toulouse University Hospital (CHU), 31073 Toulouse cedex 7, France; Department of Cardiology B, Toulouse Rangueil University Hospital (CHU), 31059 Toulouse cedex 9, France
| | - Marie-Christine Iliou
- Department of Cardiac Rehabilitation, AP-HP, Corentin-Celton Hospital, 92130 Issy-les Moulineaux, France
| | - Hervé Douard
- Department of Cardiology, Bordeaux University Hospital, 33604 Pessac, France
| | - Luc Lorgis
- Department of Cardiology, University Hospital, Laboratory of Cardiometabolic Physiopathology and Pharmacology, Inserm U866, University of Burgundy, 21034 Dijon, France
| | - Didier Carrié
- Department of Cardiology B, Toulouse Rangueil University Hospital (CHU), 31059 Toulouse cedex 9, France
| | - Philippe Brunel
- Department of Cardiology, Nouvelles Cliniques Nantaises, 44277 Nantes cedex 2, France
| | - Tabassome Simon
- Department of Pharmacology and Clinical Research Unit (URCEST), AP-HP, Saint-Antoine Hospital, Pierre-and-Marie-Curie University (UPMC-Paris 06), Inserm U970, 75012 Paris, France
| | - Vincent Bataille
- Department of Epidemiology, Health Economics and Public Health, UMR1027 Inserm-University of Toulouse III, Toulouse University Hospital (CHU), 31073 Toulouse cedex 7, France
| | - Nicolas Danchin
- Department of Cardiology, AP-HP, Georges-Pompidou European Hospital, René-Descartes University, Inserm U970, 75908 Paris, France
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Qaderdan K, Ishak M, Heestermans AA, de Vrey E, Jukema JW, Voskuil M, de Boer MJ, van‘t Hof AW, Groenemeijer BE, Vos GJA, Janssen PW, Bergmeijer TO, Kelder JC, Deneer VH, ten Berg JM. Ticagrelor or prasugrel versus clopidogrel in elderly patients with an acute coronary syndrome: Optimization of antiplatelet treatment in patients 70 years and older--rationale and design of the POPular AGE study. Am Heart J 2015; 170:981-985.e1. [PMID: 26542508 DOI: 10.1016/j.ahj.2015.07.030] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 07/20/2015] [Indexed: 10/23/2022]
Abstract
RATIONALE Dual antiplatelet therapy with acetylsalicylic acid in combination with a more potent P2Y12- inhibitor (ticagrelor or prasugrel) is recommended in patients with acute coronary syndrome without ST-segment elevation (NSTE-ACS) to prevent atherothrombotic complications. The evidence on which this recommendation is based shows that ticagrelor and prasugrel reduce atherothrombotic events at the expense of an increase in bleeding events when compared with clopidogrel. However, it remains unclear whether ticagrelor or prasugrel has a better net clinical benefit in elderly patients with NSTE-ACS when compared with clopidogrel. The POPular AGE trial is designed to address the optimal antiplatelet strategy in elderly NSTE-ACS patients. STUDY DESIGN POPular AGE is a multicenter, open-label, randomized controlled trial that aims to include 1000 patients ≥70years of age with NSTE-ACS. Patients are randomly assigned to receive either clopidogrel or a more potent P2Y12 inhibitor (ticagrelor or prasugrel). The first primary end point is any bleeding event requiring medical intervention. The second primary end point is the net clinical benefit, a composite of all-cause mortality, nonfatal myocardial infarction, nonfatal stroke, "PLATelet inhibition and patient Outcomes" major bleeding, or "PLATelet inhibition and patient Outcomes" minor bleeding. Patients will be followed for 1 year after randomization, and analyses will be performed on the basis of intention to treat. CONCLUSION The POPular AGE is the first randomized controlled trial that will assess whether the treatment strategy with clopidogrel will result in fewer bleeding events without compromising the net clinical benefit in patients ≥70years of age with NSTE-ACS when compared with a treatment strategy with ticagrelor or prasugrel.
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Lim HS, Andrianopoulos N, Sugumar H, Stub D, Brennan AL, Lim CC, Barlis P, Van Gaal W, Reid CM, Charter K, Sebastian M, New G, Ajani AE, Farouque O, Duffy SJ, Clark DJ. Long-term survival of elderly patients undergoing percutaneous coronary intervention for myocardial infarction complicated by cardiogenic shock. Int J Cardiol 2015; 195:259-64. [DOI: 10.1016/j.ijcard.2015.05.130] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 05/20/2015] [Accepted: 05/20/2015] [Indexed: 11/16/2022]
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Helft G, Georges JL, Mouranche X, Loyeau A, Spaulding C, Caussin C, Benamer H, Garot P, Livarek B, Teiger E, Varenne O, Monségu J, Mapouata M, Petroni T, Hammoudi N, Lambert Y, Dupas F, Laborne F, Lapostolle F, Lefort H, Juliard JM, Letarnec JY, Lamhaut L, Lebail G, Boche T, Jouven X, Bataille S. Outcomes of primary percutaneous coronary interventions in nonagenarians with acute myocardial infarction. Int J Cardiol 2015; 192:24-9. [DOI: 10.1016/j.ijcard.2015.04.227] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 03/23/2015] [Accepted: 04/29/2015] [Indexed: 01/25/2023]
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Electrocardiographic Predictors of Cardiovascular Mortality. DISEASE MARKERS 2015; 2015:727401. [PMID: 26257460 PMCID: PMC4519551 DOI: 10.1155/2015/727401] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 06/20/2015] [Accepted: 07/02/2015] [Indexed: 01/26/2023]
Abstract
Cardiovascular diseases are the main causes of mortality. Sudden cardiac death may also appear in athletes, due to underlying congenital or inherited cardiac abnormalities. The electrocardiogram is used in clinical practice and clinical trials, as a valid, reliable, accessible, inexpensive method. The aim of the present paper was to review electrocardiographic (ECG) signs associated with cardiovascular mortality and the mechanisms underlying those associations, providing a brief description of the main studies in this area, and consider their implication for clinical practice in the general population and athletes. The main ECG parameters associated with cardiovascular mortality in the present paper are the P wave (duration, interatrial block, and deep terminal negativity of the P wave in V1), prolonged QT and Tpeak-Tend intervals, QRS duration and fragmentation, bundle branch block, ST segment depression and elevation, T waves (inverted, T wave axes), spatial angles between QRS and T vectors, premature ventricular contractions, and ECG hypertrophy criteria.
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Chen HY, Gore JM, Lapane KL, Yarzebski J, Person SD, Gurwitz JH, Kiefe CI, Goldberg RJ. A 35-Year Perspective (1975 to 2009) into the Long-Term Prognosis and Hospital Management of Patients Discharged from the Hospital After a First Acute Myocardial Infarction. Am J Cardiol 2015; 116:24-9. [PMID: 25933734 DOI: 10.1016/j.amjcard.2015.03.035] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 03/26/2015] [Accepted: 03/26/2015] [Indexed: 12/24/2022]
Abstract
There are limited population-based data available describing trends in the long-term prognosis of patients discharged from the hospital after an initial acute myocardial infarction (AMI). Our objectives were to describe multidecade trends in post-discharge mortality and their association with hospital management practices in patients discharged from all medical centers in Central Massachusetts after a first AMI. Residents of the Worcester, Massachusetts, metropolitan area discharged from all hospitals in Central Massachusetts after a first AMI from 1975 to 2009 comprised the study population (n = 8,728). Multivariable-adjusted logistic regression analyses were used to examine the association between year of hospitalization and 1-year post-discharge mortality. The average age of this population was 66 years, and 40% were women. Patients hospitalized in 1999 to 2009, compared with those discharged in 1975 to 1984, were older, more likely to be women, and have multiple previously diagnosed co-morbidities. Hospital use of invasive cardiac interventions and medications increased markedly over time. Unadjusted 1-year mortality rates were 12.9%, 12.5%, and 15.8% for patients discharged during 1975 to 1984, 1986 to 1997, and 1999 to 2009, respectively. After adjusting for several demographic characteristics, clinical factors, and inhospital complications, there were no significant differences in the odds of dying at 1-year post-discharge during the years under study. After further adjustment for hospital treatment practices, the odds of dying at 1 year post-discharge was 2.43 (95% confidence interval = 1.83 to 3.23) times higher in patients hospitalized in 1999 to 2009 than in 1975 to 1984. In conclusion, the increased use of invasive cardiac interventions and pharmacotherapies was associated with enhanced long-term survival in patients hospitalized for a first AMI.
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Roger VL. Cardiovascular diseases in populations: secular trends and contemporary challenges-Geoffrey Rose lecture, European Society of Cardiology meeting 2014. Eur Heart J 2015; 36:2142-6. [PMID: 25994744 DOI: 10.1093/eurheartj/ehv220] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 05/05/2015] [Indexed: 11/14/2022] Open
Abstract
Geoffrey Rose pioneered the concept that, to reduce the burden of disease, improving the population distribution of a risk factor was preferable to interventions that target high-risk individuals. Reflecting on this concept prompted us to ask if temporal trends in the burden of cardiovascular disease support this hypothesis. This perspective article summarizes the Geoffrey Rose lecture given at the European Society of Cardiology meeting in 2014 and examines how cardiovascular diseases have evolved over the past three decades focusing on temporal trends in myocardial infarction and heart failure.
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Affiliation(s)
- Véronique L Roger
- Department of Health Sciences Research and Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Baker NC, Lipinski MJ, Lhermusier T, Waksman R. Overview of the 2014 Food and Drug Administration Cardiovascular and Renal Drugs Advisory Committee meeting about vorapaxar. Circulation 2015; 130:1287-94. [PMID: 25287768 DOI: 10.1161/circulationaha.114.011471] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Nevin C Baker
- From the Department of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Michael J Lipinski
- From the Department of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Thibault Lhermusier
- From the Department of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Ron Waksman
- From the Department of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
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Cayla G, Silvain J, Collet JP, Montalescot G. Updates and current recommendations for the management of patients with non-ST-elevation acute coronary syndromes: what it means for clinical practice. Am J Cardiol 2015; 115:10A-22A. [PMID: 25728969 DOI: 10.1016/j.amjcard.2015.01.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The American Heart Association (AHA) and the American College of Cardiology (ACC) have recently updated their joint guidelines for the management of patients with non-ST-elevation acute coronary syndromes (NSTE-ACS, including unstable angina [UA] and non-ST-elevation myocardial infarction [NSTEMI]). These guidelines replace the 2007 guidelines and the focused updates from 2011 and 2012 and now combine UA and NSTEMI into a new classification, NSTE-ACS, and updating the terminology around noninvasive management to ischemia-guided strategy. The latest guidelines include updated recommendations for the use of the oral antiplatelet agents (P2Y12 inhibitors) prasugrel and ticagrelor as part of dual-antiplatelet therapy-the cornerstone of treatment for these patients. This report provides a comprehensive overview of the new and modified recommendations for the management of patients with NSTE-ACS and the evidence supporting them. Also, where appropriate, similarities and differences between the current recommendations of the AHA/ACC and those of the European Society of Cardiology (ESC) are highlighted. For example, the AHA/ACC recommends the P2Y12 inhibitor ticagrelor over clopidogrel in all patients with NSTE-ACS and clopidogrel, prasugrel, or ticagrelor for patients in whom percutaneous coronary intervention is planned, whereas the ESC guidelines specifically recommend individual P2Y12 inhibitors for particular patient subgroups.
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Affiliation(s)
- Guillaume Cayla
- Service de Cardiologie, Centre Hospitalier Universitaire Nîmes (ACTION group, Université Montpellier 1), INSERM 937, Nîmes, France; Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtrière (ACTION group, AP-HP, Université Paris 6), INSERM 937, Paris, France
| | - Johanne Silvain
- Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtrière (ACTION group, AP-HP, Université Paris 6), INSERM 937, Paris, France
| | - Jean-Philippe Collet
- Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtrière (ACTION group, AP-HP, Université Paris 6), INSERM 937, Paris, France
| | - Gilles Montalescot
- Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtrière (ACTION group, AP-HP, Université Paris 6), INSERM 937, Paris, France.
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Gibson MC, Krucoff M, Fischell D, Fischell TA, Keenan D, Abueg C, Patel C, Holmes D. Rationale and design of the AngeLmed for Early Recognition and Treatment of STEMI trial: a randomized, prospective clinical investigation. Am Heart J 2014; 168:168-74. [PMID: 25066555 DOI: 10.1016/j.ahj.2014.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 05/16/2014] [Indexed: 10/25/2022]
Abstract
Significant improvements in door-to-balloon times have led to a reduction in mortality in ST-segment elevation myocardial infarction; however, mean symptom-to-door times remain at 2 to 3 hours. An intracardiac electrogram monitoring device may be beneficial in high-risk patients by alerting them to rapidly progressive ST-segment changes indicative of acute coronary occlusion. The Cardiosaver and DETECT phase I clinical studies demonstrated the safety, feasibility, and potential benefit of using an intracardiac electrogram monitoring device to alert the patient to seek medical attention. The goal of the randomized, prospective ALERTS Trial (Clinicaltrials.gov no. NCT00781118) is to evaluate the efficacy of an implantable monitoring device (IMD) in reducing the composite of either cardiac or unexplained death, new Q-wave myocardial infarction, or symptom-to-door time of >2 hours for confirmed thrombotic events. The IMD alerts the patient in real time when ST-segment deviation from a personalized baseline exceeds the trigger threshold. The trial is designed to enroll high-risk post-acute coronary syndrome patients or patients with previous multivessel coronary artery bypass surgery. All patients have the IMD implanted, with 1:1 unblinded randomization to the alerting feature being either turned on versus turned off for the first 6 months. Randomization occurs at the first follow-up visit, 7 to 14 days after the implantation of the IMD. Subjects then return for follow-up visits at months 1, 3, and 6 and thereafter every 6 months until closure of the investigational device exemption. Subjects who cannot be implanted successfully or who have the device explanted are removed from the study and followed up for a minimum of 30 days post-procedure. If a subject experiences a device-related complication and/or adverse experience, the subject is followed up until resolution or until the condition becomes stable and no further change is anticipated.
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Akgul O, Uyarel H, Pusuroglu H, Surgit O, Turen S, Erturk M, Ayhan E, Bulut U, Baycan OF, Demir AR, Uslu N. Predictive value of a fragmented QRS complex in patients undergoing primary angioplasty for ST elevation myocardial infarction. Ann Noninvasive Electrocardiol 2014; 20:263-72. [PMID: 25040877 DOI: 10.1111/anec.12179] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the prognostic value of fragmented QRS (fQRS) on electrocardiography (ECG) patients with acute ST-segment elevation in myocardial infarction (STEMI), who are undergoing primary percutaneous coronary intervention (PCI). METHODS We prospectively enrolled 414 consecutive STEMI patients (mean age of 55.2 ± 12.2 years old, range of 26-91-years old) undergoing primary PCI. The study patients were divided into two groups according to the presence or absence of fQRS as shown by ECG in the first 48 hours. The presence of fQRS group was defined as fQRS(+) (n = 91), and the absence of fQRS group was defined as the fQRS(-) (n = 323) group. Clinical characteristics and the one-year outcome of the primary PCI were analyzed. RESULTS The patients in the fQRS(+) group were older (mean age 60.7 ± 12.5 vs. 53.6 ± 11.6 years old, P < 0.001). Higher one-year all-cause mortality rates were observed in the fQRS group upon ECG (23.1% vs. 2.5%, P < 0.001, respectively). When using the Cox multivariate analysis, the presence of fQRS on the ECG was found to be a powerful independent predictor of one-year all-cause mortality (hazard ratio: 5.24, 95% confidence interval: 1.43-19.2, P = 0.01). CONCLUSIONS These results suggest that the presence of fQRS on ECG was associated with an increased in-hospital cardiovascular mortality, and one-year all-cause mortality in patients with STEMI who are under primary PCI.
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Affiliation(s)
- Ozgur Akgul
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey
| | - Huseyin Uyarel
- Department of Cardiology, School of Medicine, Bezmialem Vakıf University, Istanbul, Turkey
| | - Hamdi Pusuroglu
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey
| | - Ozgur Surgit
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey
| | - Selahattin Turen
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Erturk
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey
| | - Erkan Ayhan
- Department of Cardiology, School of Medicine, Balıkesir University, Balıkesir, Turkey
| | - Umit Bulut
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey
| | - Omer Faruk Baycan
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey
| | - Ali Riza Demir
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey
| | - Nevzat Uslu
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey
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Abstract
Coronary artery disease (CAD) mortality has been declining in the United States and in regions where health care systems are relatively advanced. Still, CAD remains the number one cause of death in both men and women in the United States, and coronary events have increased in women. Many traditional risk factors for CAD are related to lifestyle, and preventative treatment can be tailored to modifying specific factors. Novel risk factors also may contribute to CAD. Finally, as the risk for CAD is largely understood to be inherited, further genetic testing should play a role in preventative treatment of the disease.
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Youn JC, Seo SM, Lee HS, Oh J, Kim MS, Choi JO, Lee HY, Cho HJ, Kang SM, Kim JJ, Baek SH, Jeon ES, Park HY, Cho MC, Oh BH. Trends in hospitalized acute myocardial infarction patients with heart failure in Korea at 1998 and 2008. J Korean Med Sci 2014; 29:544-9. [PMID: 24753702 PMCID: PMC3991798 DOI: 10.3346/jkms.2014.29.4.544] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 02/04/2014] [Indexed: 11/20/2022] Open
Abstract
Heart failure (HF) complicating acute myocardial infarction (AMI) is common and is associated with poor clinical outcome. Limited data exist regarding the incidence and in-hospital mortality of AMI with HF (AMI-HF). We retrospectively analyzed 1,427 consecutive patients with AMI in the five major university hospitals in Korea at two time points, 1998 (n = 608) and 2008 (n = 819). Two hundred twenty eight patients (37.5%) in 1998 and 324 patients (39.5%) in 2008 of AMI patients complicated with HF (P = 0.429). AMI-HF patients in 2008 were older, had more hypertension, previous AMI, and lower systolic blood pressure than those in 1998. Regarding treatments, AMI-HF patients in 2008 received more revascularization procedures, more evidence based medical treatment and adjuvant therapy, such as mechanical ventilators, intra-aortic balloon pulsation compared to those in 1998. However, overall in-hospital mortality rates (6.4% vs 11.1%, P = 0.071) of AMI-HF patients were unchanged and still high even after propensity score matching analysis, irrespective of types of AMI and revascularization methods. In conclusion, more evidence-based medical and advanced procedural managements were applied for patients with AMI-HF in 2008 than in 1998. However the incidence and in-hospital mortality of AMI-HF patients were not significantly changed between the two time points.
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Affiliation(s)
- Jong-Chan Youn
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Suk Min Seo
- Cardiovascular Center and Cardiology Division, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Korea
| | - Hye Sun Lee
- Department of Biostatistics, Yonsei University College of Medicine, Seoul, Korea
| | - Jaewon Oh
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Min Seok Kim
- Heart Failure and Cardiac Transplantation Center, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin-Oh Choi
- Cardiovascular Center and Cardiology Division, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hae-Young Lee
- Cardiovascular Center and Cardiovascular Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun-Jai Cho
- Cardiovascular Center and Cardiovascular Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Seok-Min Kang
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Joong Kim
- Heart Failure and Cardiac Transplantation Center, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Hong Baek
- Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Eun-Seok Jeon
- Cardiovascular Center and Cardiology Division, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun-Young Park
- Division of Cardiovascular and Rare Diseases, Center for Biomedical Sciences, Korea National Institute of Health, Cheongwon, Korea
| | - Myeong-Chan Cho
- Division of Cardiovascular and Rare Diseases, Center for Biomedical Sciences, Korea National Institute of Health, Cheongwon, Korea
- Regional Cardiovascular Disease Center, Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Byung-Hee Oh
- Cardiovascular Center and Cardiovascular Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Ferreira-González I. The epidemiology of coronary heart disease. ACTA ACUST UNITED AC 2014; 67:139-44. [PMID: 24795124 DOI: 10.1016/j.rec.2013.10.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 10/02/2013] [Indexed: 02/07/2023]
Abstract
Understanding the societal impact and trends of coronary heart disease through basic epidemiological measures is essential to evaluate treatment effectiveness and organize resource distribution. In the following narrative review, data are presented on the prevalence, incidence, and prognosis of coronary heart disease in general and of acute coronary syndrome in particular.
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Affiliation(s)
- Ignacio Ferreira-González
- Unidad de Epidemiología, Servicio de Cardiología, Hospital Vall d'Hebron y CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
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Zahn R, Erbel R, Nienaber CA, Neumann FJ, Nef H, Eggebrecht H, Senges J. Endovascular aortic repair of thoracic aortic disease: early and 1-year results from a German multicenter registry. J Endovasc Ther 2014; 20:265-72. [PMID: 23731294 DOI: 10.1583/12-4107r.1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To report a "real-world" multicenter experience in the use of thoracic endovascular aortic repair (TEVAR) for diseases of the descending thoracic aorta. METHODS A prospective, multicenter, German TEVAR Registry was established in October 2008 and enrolled 191 patients (134 men; mean age 64.5±13.2 years) from 7 hospitals up to March 2011. Stent-graft implantation was performed for Stanford type B aortic dissection (104, 55.3%), true thoracic aortic aneurysm (91, 48.7%), intramural hematoma (20, 10.7%), penetrating aortic ulcer (16, 8.6%), and traumatic aortic rupture (6, 3.2%). RESULTS Per patient, a mean of 1.2±0.7 stent-grafts were implanted. Technical success was 92.1% (164/178); 15 (8.5%) endoleaks (types I-III) were reported. Intervention duration was a mean 107±122 minutes. During the hospital stay, stroke occurred in 3.9% of patients (7/180) and paraplegia in 1.7% (3/180). Reintervention was performed in 3.3% (6/180). The mortality was 5.5% (10/181) in-hospital and 5.6% at 30 days. The mean follow-up was 24.5±27.7 months. The Kaplan-Meier estimates of 1-year reintervention and death rates were 7.2% and 11.4%, respectively. CONCLUSION In this real-world TEVAR registry for acute or chronic descending aortic diseases, technical success was high and the short-term complication rate was acceptable. However, the high reintervention rate observed in the present study mandates thorough clinical and imaging follow-up after an initially successful procedure.
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Affiliation(s)
- Ralf Zahn
- Abteilung für Kardiologie, Herzzentrum Ludwigshafen, Germany.
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Asanuma YF, Shimada Y, Kouzu N, Yokota K, Nakajima K, Sato K, Akiyama Y, Isozaki M, Mikami AS, Kobayashi H, Mimura T. Serum osteoprotegerin concentration is associated with carotid atherosclerotic plaque in patients with rheumatoid arthritis. Mod Rheumatol 2014. [DOI: 10.3109/s10165-012-0654-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Matsue Y, Yoshida K, Nagahori W, Ohno M, Suzuki M, Matsumura A, Hashimoto Y, Yoshida M. Peripheral microvascular dysfunction predicts residual risk in coronary artery disease patients on statin therapy. Atherosclerosis 2013; 232:186-90. [PMID: 24401235 DOI: 10.1016/j.atherosclerosis.2013.11.038] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Revised: 10/30/2013] [Accepted: 11/01/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Although lowering of low-density lipoprotein cholesterol (LDL-C) by statins is essential in treatment of coronary artery disease (CAD) patients, there is considerable residual risk of secondary coronary artery events (CAE). We examined whether microvascular dysfunction (MiD), measured by peripheral artery tonometry (PAT), can predict prognosis of CAD patients previously treated with statins. METHODS We measured log-transformed reactive hyperemia index (L_RHI) in 213 CAD patients who had already achieved LDL-C <100 by statin therapy. Patients were followed-up for secondary CAE for a median of 2.7 years. Patients were divided into two groups: L_RHI ≥ 0.54 (n = 99) and L_RHI < 0.54 (n = 114). RESULTS During follow-up, CAE occurred in 4 (4.0%) patients in the L_RHI ≥ 0.54 group and 18 (15.8%) patients in the L_RHI < 0.54 group (P = 0.006). Cox regression analysis indicated that L_RHI was an independent predictor for CAE even after adjustment by Framingham traditional risk factors (FRF; age, T-C/HDL-C ratio, systolic blood pressure, diabetes, current smoker, and gender) and estimated glomerular filtration rate (eGFR) for secondary CAE (HR 0.79, 95% CI: 0.66-0.95). ROC analysis for CAE prediction showed that the AUC for models including FRF only, FRF + eGFR, and FRF + eGFR + L_RHI were 0.60, 0.71, and 0.77, respectively. Moreover, adding eGFR to FRF only (0.63, P = 0.003) and adding L_RHI to the FRF + eGFR model were associated with significant improvement of net reclassification improvement (0.79, P = 0.007). CONCLUSION MiD measured by non-invasive PAT adds incremental predictive ability to traditional risk factors for prognosis of CAD patients successfully treated with statins.
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Affiliation(s)
- Yuya Matsue
- Department of Cardiology, Kameda Medical Center, Chiba, Japan; Life Science and Bioethics Research Center, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Kazuki Yoshida
- Department of Rheumatology, Kameda Medical Center, Chiba, Japan; Harvard School of Public Health, Boston, MA, USA
| | - Wataru Nagahori
- Department of Cardiology, Kameda Medical Center, Chiba, Japan
| | - Masakazu Ohno
- Department of Cardiology, Kameda Medical Center, Chiba, Japan
| | - Makoto Suzuki
- Department of Cardiology, Kameda Medical Center, Chiba, Japan
| | | | - Yuji Hashimoto
- Department of Cardiology, Kameda Medical Center, Chiba, Japan
| | - Masayuki Yoshida
- Life Science and Bioethics Research Center, Tokyo Medical and Dental University, Tokyo, Japan
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Dalli J, Colas RA, Serhan CN. Novel n-3 immunoresolvents: structures and actions. Sci Rep 2013; 3:1940. [PMID: 23736886 PMCID: PMC3672887 DOI: 10.1038/srep01940] [Citation(s) in RCA: 176] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 05/13/2013] [Indexed: 02/08/2023] Open
Abstract
Resolution of inflammation is now held to be an active process where autacoids promote homeostasis. Using functional-metabololipidomics and in vivo systems, herein we report that endogenous n-3 docosapentaenoic (DPA) acid is converted during inflammation-resolution in mice and by human leukocytes to novel n-3 products congenerous to D-series resolvins (Rv), protectins (PD) and maresins (MaR), termed specialized pro-resolving mediators (SPM). The new n-3 DPA structures include 7,8,17-trihydroxy-9,11,13,15E,19Z-docosapentaenoic acid (RvD1n-3 DPA), 7,14-dihydroxy-8,10,12,16Z,19Z-docosapentaenoic acid (MaR1n-3 DPA) and related bioactive products. Each n-3 DPA-SPM displayed protective actions from second organ injury and reduced systemic inflammation in ischemia-reperfusion. The n-3 DPA-SPM, including RvD1n-3 DPA and MaR1n-3 DPA, each exerted potent leukocyte directed actions in vivo. With human leukocytes each n-3 DPA-SPM reduced neutrophil chemotaxis, adhesion and enhanced macrophage phagocytosis. Together, these findings demonstrate that n-3 DPA is converted to novel immunoresolvents with actions comparable to resolvins and are likely produced in humans when n-3 DPA is elevated.
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Affiliation(s)
- Jesmond Dalli
- Center for Experimental Therapeutics and Reperfusion Injury, Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Institutes of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA
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Ahn MS, Kim JB, Yoo BS, Lee JW, Lee JH, Youn YJ, Ahn SG, Kim JY, Lee SH, Yoon J, Choe KH. Fragmented QRS complexes are not hallmarks of myocardial injury as detected by cardiac magnetic resonance imaging in patients with acute myocardial infarction. Int J Cardiol 2013; 168:2008-13. [DOI: 10.1016/j.ijcard.2012.12.086] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 11/09/2012] [Accepted: 12/28/2012] [Indexed: 12/21/2022]
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Molecular basis of cardioprotective effect of antioxidant vitamins in myocardial infarction. BIOMED RESEARCH INTERNATIONAL 2013; 2013:437613. [PMID: 23936799 PMCID: PMC3726017 DOI: 10.1155/2013/437613] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 06/18/2013] [Indexed: 02/07/2023]
Abstract
Acute myocardial infarction (AMI) is the leading cause of mortality worldwide. Major advances in the treatment of acute coronary syndromes and myocardial infarction, using cardiologic interventions, such as thrombolysis or percutaneous coronary angioplasty (PCA) have improved the clinical outcome of patients. Nevertheless, as a consequence of these procedures, the ischemic zone is reperfused, giving rise to a lethal reperfusion event accompanied by increased production of reactive oxygen species (oxidative stress). These reactive species attack biomolecules such as lipids, DNA, and proteins enhancing the previously established tissue damage, as well as triggering cell death pathways. Studies on animal models of AMI suggest that lethal reperfusion accounts for up to 50% of the final size of a myocardial infarct, a part of the damage likely to be prevented. Although a number of strategies have been aimed at to ameliorate lethal reperfusion injury, up to date the beneficial effects in clinical settings have been disappointing. The use of antioxidant vitamins could be a suitable strategy with this purpose. In this review, we propose a systematic approach to the molecular basis of the cardioprotective effect of antioxidant vitamins in myocardial ischemia-reperfusion injury that could offer a novel therapeutic opportunity against this oxidative tissue damage.
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Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, Chavey WE, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS, Zoghbi WA, Arend TE, Oetgen WJ, May C, Bradfield L, Keller S, Ramadhan E, Tomaselli GF, Brown N, Robertson RM, Whitman GR, Bezanson JL, Hundley J. 2012 ACCF/AHA Focused Update Incorporated Into the ACCF/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction. Circulation 2013; 127:e663-828. [DOI: 10.1161/cir.0b013e31828478ac] [Citation(s) in RCA: 181] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Akbarzadeh F, Pourafkari L, Ghaffari S, Hashemi M, Sadeghi-Bazargani H. Predictive value of the fragmented QRS complex in 6-month mortality and morbidity following acute coronary syndrome. Int J Gen Med 2013; 6:399-404. [PMID: 23761979 PMCID: PMC3674017 DOI: 10.2147/ijgm.s40050] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Fragmented QRS encompasses different RSR’ patterns showing various morphologies of the QRS complexes with or without the Q wave on a resting 12-lead electrocardiogram. It has been shown possibly to cause adverse cardiac outcomes in patients with some heart diseases, including coronary artery disease. In view of the need for risk stratification of patients presenting with acute coronary syndrome in the most efficacious and cost-effective way, we conducted this study to clarify the value of developing fragmented QRS in a cohort of patients presenting with their first acute coronary syndrome in predicting 6-month mortality and morbidity. Methods One hundred consecutive patients admitted to the coronary care unit at Shahid Madani Heart Center in Tabriz from December 2008 to March 2009 with their first acute coronary syndrome were enrolled in this prospective study. Demographic and electrocardiographic data on admission, inhospital mortality, and need for revascularization were recorded. Electrocardiography performed 2 months after the index event was examined for development of fragmented QRS. Mortality and morbidity was evaluated at 6-month follow-up in all patients. Results The patients were of mean age 57.7 ± 12.8 years, and 84% were men. The primary diagnosis was unstable angina in 17 (17%) patients, non-ST elevation myocardial infarction (MI) in 11 (11%), anterior or inferior ST elevation MI in 66 (66%), and postero-inferior MI in six (6%). Fragmented QRS was present in 30 (30%) patients during the first admission, which increased to 44% at the 2-month follow-up and to 53% at the 6-month follow-up. The presence of various coronary risk factors and drug therapy given, including fibrinolytic agents, had no effect on development of fragmented QRS. Mortality was significantly higher (P = 0.032) and left ventricular ejection fraction was significantly lower (P = 0.001) in the fragmented QRS group at the 6-month follow-up. Conclusion This study strongly suggests that fragmented QRS on initial presentation with acute coronary syndrome is not predictive of subsequent events but, if present 6 months later, could be predictive of an adverse outcome.
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Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, Chavey WE, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS, Jneid H, Ettinger SM, Ganiats TG, Philippides GJ, Jacobs AK, Halperin JL, Albert NM, Creager MA, DeMets D, Guyton RA, Kushner FG, Ohman EM, Stevenson W, Yancy CW. 2012 ACCF/AHA focused update incorporated into the ACCF/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013; 61:e179-347. [PMID: 23639841 DOI: 10.1016/j.jacc.2013.01.014] [Citation(s) in RCA: 373] [Impact Index Per Article: 33.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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