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Wang S, Zhang Y, Qi D, Wang X, Zhu Z, Yang W, Li M, Hu D, Gao C. Age and gender mediated the association between anemia and 30-day outcomes in patients with ST-segment elevated myocardial infarction. IJC HEART & VASCULATURE 2024; 51:101377. [PMID: 38464962 PMCID: PMC10920728 DOI: 10.1016/j.ijcha.2024.101377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/09/2024] [Accepted: 02/25/2024] [Indexed: 03/12/2024]
Abstract
Background The higher prevalence of anemia in females and elderly may be attributed to its association with worsened outcomes in ST-elevation myocardial infarction (STEMI) patients. We aimed to evaluate the precise effects of age and gender on the association between anemia and 30-day outcomes. Method We identified 4350 STEMI patients and divided into anemia and non-anemia. Effects were analyzed as categories using Cox proportional-hazards regression and as continuous using restricted cubic splines. Propensity score matching (PSM) and mediation analysis were applied to identify intermediate effects. Results Anemic patients were older, more likely to be female, and experienced doubled all-cause death (7.3 % versus 15.0 %), main adverse cardiovascular and cerebrovascular events (MACCE, 11.1 % versus 20.2 %), heart failure (HF, 5.1 % versus 8.6 %), and bleeding events (2.7 % versus 5.4 %). After adjustment, the association between anemia and all-cause death (Hazard ratio (HR) 1.15, 95 % confidence interval (95 %CI) 0.93-1.14), MACCE (HR 1.14, 95 %CI 0.95-1.36) and HF (HR 1.19, 95 %CI 0.92-1.55) were insignificant, the effects persisted nullified across age classes (P-interaction > 0.05) and PSM (P > 0.05). Ulteriorly, age mediated 77.6 %, 66.2 %, 48.0 %, gender mediated 38.1 %, 15.0 %, 3.2 %, age and gender together mediated 99.8 % 72.9 %, 48.1 % of the relationship. Anemia was independently associated with bleeding events (HR 2.02, 95 %CI 1.42-2.88), the effects consisted significant regardless of PSM (P < 0.05), age, and gender classes (P-interaction > 0.05), and no mediating role of age and gender were observed. Conclusions In STEMI patients, age and gender largely mediated the relationship between anemia and all-cause death, MACCE, and HF, anemia was independently associated with bleeding complications.
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Affiliation(s)
- Shan Wang
- Department of Cardiology, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital Heart Center, Zhengzhou, Henan, China
- Henan Institute of Cardiovascular Epidemiology, Zhengzhou, Henan, China
- Henan Key Lab for Prevention and Control of Coronary Heart Disease, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - You Zhang
- Department of Cardiology, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital Heart Center, Zhengzhou, Henan, China
- Henan Institute of Cardiovascular Epidemiology, Zhengzhou, Henan, China
- Henan Key Lab for Prevention and Control of Coronary Heart Disease, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Datun Qi
- Department of Cardiology, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital Heart Center, Zhengzhou, Henan, China
- Henan Key Lab for Prevention and Control of Coronary Heart Disease, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Xianpei Wang
- Department of Cardiology, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital Heart Center, Zhengzhou, Henan, China
- Henan Key Lab for Prevention and Control of Coronary Heart Disease, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Zhongyu Zhu
- Department of Cardiology, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital Heart Center, Zhengzhou, Henan, China
- Henan Key Lab for Prevention and Control of Coronary Heart Disease, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Wei Yang
- Department of Cardiology, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital Heart Center, Zhengzhou, Henan, China
- Henan Key Lab for Prevention and Control of Coronary Heart Disease, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Muwei Li
- Department of Cardiology, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital Heart Center, Zhengzhou, Henan, China
- Henan Key Lab for Prevention and Control of Coronary Heart Disease, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Dayi Hu
- Henan Institute of Cardiovascular Epidemiology, Zhengzhou, Henan, China
- Institute of Cardiovascular Disease, Peking University People's Hospital, Beijing, China
| | - Chuanyu Gao
- Department of Cardiology, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital Heart Center, Zhengzhou, Henan, China
- Henan Institute of Cardiovascular Epidemiology, Zhengzhou, Henan, China
- Henan Key Lab for Prevention and Control of Coronary Heart Disease, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, Henan, China
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Günlü S, Arpa A, Kayan F, Güzel T, Kılıç R, Aktan A, Altintaş B, Karahan MZ. The prognostic value of ORBIT risk score in predicting major bleeding in patients with acute coronary syndrome. Thromb Res 2023; 229:258-262. [PMID: 37236868 DOI: 10.1016/j.thromres.2023.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/24/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND The most significant adverse effect of antithrombotic medication in acute coronary syndrome (ACS) is major bleeding, which is related to increased mortality. Studies on ORBIT risk score in predicting major bleeding in ACS patients are limited. OBJECTIVE This research aimed to examine whether the ORBIT score calculated at the bedside can identify major bleeding risk in patients with ACS. METHODS This research was retrospective, observational, and conducted at a single center. Analyses of receiver operating characteristics (ROC) were utilized to define the diagnostic value of CRUSADE and ORBIT scores. The predictive performances of the two scores were compared using DeLong's method. Discrimination and reclassification performances were evaluated by the integrated discrimination improvement (IDI), and net reclassification improvement (NRI). RESULTS The study included 771 patients with ACS. The mean age was 68.7 ± 8.6 years, with 35.3 % females. 31 patients had major bleeding. Twenty-three of these patients were BARC 3 A, five were BARC 3 B, and three were BARC 3 C. Bleeding history [OR (95 % CI), 2.46 (1.02-5.94), p = 0.021], hemoglobin levels [OR (95 % CI), 0.54 (0.45-0.63), p < 0.001], and age > 74 years [OR (95 % CI), 1.03 (1.01-1.06), p = 0.039] were independent predictors of major bleeding. The ORBIT score was an independent predictor of major bleeding in the multivariate analysis: continuous variables [OR (95 % CI), 2.53 (2.61-3.95), p < 0.001] and risk categories [OR (95 % CI), 3.06 (1.69-5.52), p < 0.001]. Comparison of c-indexes for major bleeding events revealed a non-significant difference for the discriminative ability of the two tested scores (p = 0.07) with a continuous NRI of 6.6 % (p = 0.026) and an IDI of 4.2 % (p < 0.001). CONCLUSION In ACS patients, the ORBIT score independently predicted major bleeding.
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Affiliation(s)
- Serhat Günlü
- Department of Cardiology, Mardin Artuklu University School of Medicine, Mardin, Turkey.
| | - Abdulkadir Arpa
- Department of Cardiology, Bismil State Hospital, Diyarbakır, Turkey
| | - Fethullah Kayan
- Department of Cardiology, Mardin Artuklu University School of Medicine, Mardin, Turkey
| | - Tuncay Güzel
- Department of Cardiology, Health Science University, Gazi Yasargil Training and Research Hospital, Diyarbakır, Turkey
| | - Raif Kılıç
- Department of Cardiology, Private Memorial Hospital, Diyarbakır, Turkey
| | - Adem Aktan
- Department of Cardiology, Mardin Training and Research Hospital, Mardin, Turkey
| | - Bernas Altintaş
- Department of Cardiology, Health Science University, Gazi Yasargil Training and Research Hospital, Diyarbakır, Turkey
| | - Mehmet Zülkif Karahan
- Department of Cardiology, Mardin Artuklu University School of Medicine, Mardin, Turkey
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Scarsini R, Tebaldi M, Rubino F, Sgreva S, Vescovo G, Barbierato M, Vicerè A, Galante D, Mammone C, Lunardi M, Tavella D, Pesarini G, Campo G, Leone AM, Ribichini FL. Intracoronary physiology-guided percutaneous coronary intervention in patients with diabetes. Clin Res Cardiol 2023; 112:1331-1342. [PMID: 37338598 PMCID: PMC10449663 DOI: 10.1007/s00392-023-02243-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/02/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVE The risk of vessel-oriented cardiac adverse events (VOCE) in patients with diabetes mellitus (DM) undergoing intracoronary physiology-guided coronary revascularization is poorly defined. The purpose of this work is to evaluate the risk of VOCE in patients with and without DM in whom percutaneous coronary intervention (PCI) was performed or deferred based on pressure-wire functional assessment. METHODS This is a retrospective analysis of a multicenter registry of patients evaluated with fractional flow reserve (FFR) and/or non-hyperaemic pressure ratio (NHPR). Primary endpoint was a composite of VOCE including cardiac death, vessel-related myocardial infarction (MI), and ischemia-driven target vessel revascularization (TVR). RESULTS A large cohort of 2828 patients with 3353 coronary lesions was analysed to assess the risk of VOCE at long-term follow-up (23 [14-36] months). Non-insulin-dependent-DM (NIDDM) was not associated with the primary endpoint in the overall cohort (adjusted Hazard Ratio [aHR] 1.18, 95% CI 0.87-1.59, P = 0.276) or in patients with coronary lesions treated with PCI (aHR = 1.30, 95% CI 0.78-2.16, P = 0.314). Conversely, insulin-dependent diabetes mellitus (IDDM) demonstrated an increased risk of VOCE in the overall cohort (aHR 1.76, 95% CI 1.07-2.91, P = 0.027), but not in coronary lesions undergoing PCI (aHR 1.26, 95% CI 0.50-3.16, P = 0.621). Importantly, in coronary lesions deferred after functional assessment IDDM (aHR 2.77, 95% CI 1.11-6.93, P = 0.029) but not NIDDM (aHR = 0.94, 95% CI 0.61-1.44, P = 0.776) was significantly associated with the risk of VOCE. IDDM caused a significant effect modification of FFR-based risk stratification (P for interaction < 0.001). CONCLUSION Overall, DM was not associated with an increased risk of VOCE in patients undergoing physiology-guided coronary revascularization. However, IDDM represents a phenotype at high risk of VOCE.
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Affiliation(s)
- Roberto Scarsini
- Division of Cardiology, Department of Medicine, Verona University Hospital, Piazzale A. Stefani 1, 37126, Verona, Italy.
- Division of Cardiology, University of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy.
| | - Matteo Tebaldi
- Azienda Ospedali Riuniti Marche Nord, Emodinamica e Cardiologia Interventistica, Pesaro, Italy
| | - Francesca Rubino
- Division of Cardiology, Department of Medicine, Verona University Hospital, Piazzale A. Stefani 1, 37126, Verona, Italy
- Division of Cardiology, University of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy
| | - Sara Sgreva
- Division of Cardiology, Department of Medicine, Verona University Hospital, Piazzale A. Stefani 1, 37126, Verona, Italy
- Division of Cardiology, University of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy
| | | | | | - Andrea Vicerè
- Istituto di Cardiologia Università Cattolica del Sacro Cuore, Rome, Italy
| | - Domenico Galante
- Dipartimento di Scienze Cardiovascolari Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Concetta Mammone
- Division of Cardiology, Department of Medicine, Verona University Hospital, Piazzale A. Stefani 1, 37126, Verona, Italy
| | - Mattia Lunardi
- Division of Cardiology, Department of Medicine, Verona University Hospital, Piazzale A. Stefani 1, 37126, Verona, Italy
| | - Domenico Tavella
- Division of Cardiology, Department of Medicine, Verona University Hospital, Piazzale A. Stefani 1, 37126, Verona, Italy
| | - Gabriele Pesarini
- Division of Cardiology, Department of Medicine, Verona University Hospital, Piazzale A. Stefani 1, 37126, Verona, Italy
| | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona (Ferrara), Italy
| | - Antonio Maria Leone
- Dipartimento di Scienze Cardiovascolari Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Diagnostic and Interventional Unit Ospedale Fatebenefratelli Isola Tiberina Gemelli Isola, Rome, Italy
| | - Flavio Luciano Ribichini
- Division of Cardiology, Department of Medicine, Verona University Hospital, Piazzale A. Stefani 1, 37126, Verona, Italy.
- Division of Cardiology, University of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy.
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Erkens R, Duse D, Wernly B, Flaatten H, Fjølner J, Bruno RR, Wolff G, Artigas A, Kelm M, Beil M, Sviri S, Schaller SJ, Fuest K, Szczeklik W, Piayda K, Elhadi M, Joannidis M, Nedergaard HK, Oeyen S, Moreno R, Leaver S, de Lange DW, Guidet B, Jung C. Associations of anemia and blood transfusions with mortality in old, critically ill COVID-19 patients - Results from the prospective COVIP Study. Clin Hemorheol Microcirc 2023; 84:309-320. [PMID: 37248892 DOI: 10.3233/ch-231790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
AIMS Anemia is common in the old and often observed in critically ill patients. Increased age is associated with higher mortality following a COVID-19 infection, making old patients prone to poor outcomes. We investigated whether anemia at admission to the ICU or the need for blood transfusion was associated with 90-day mortality in older, critically ill COVID-19 patients. METHODS In this prospective multicenter study, the 90-day mortality of COVID-19 patients≥70 years treated in 138 intensive care units (ICU) was analyzed. Associations between anemia (WHO definition) at admission and discharge from ICU and the use of red blood cell (RBC) transfusions with mortality were assessed. Hemoglobin thresholds of RBC transfusions in old, critically ill COVID-19 patients were recorded. RESULTS In 493 patients (350 anemic, 143 non-anemic), anemia (WHO definition) at the time of ICU admission was not associated with impaired overall survival. Transfusion and severe anemia (hemoglobin≤10 g/dL) at ICU discharge were independently associated with a higher risk of 90-day mortality. CONCLUSION The need for red blood cell transfusions and severe anemia at ICU discharge, but not at the timepoint of admission, were independently associated with 90-day mortality in critically-ill old COVID-19 patients.
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Affiliation(s)
- Ralf Erkens
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Dragos Duse
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Bernhard Wernly
- Department of Cardiology, Paracelsus Medical University, Salzburg, Austria
| | - Hans Flaatten
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Jesper Fjølner
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Raphael Romano Bruno
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Georg Wolff
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Antonio Artigas
- Department of Intensive Care Medicine, Parc Tauli Hospital Universitari, Institut d'Investigació I Innovacio Par tauli (I3PT-CERCA), CIBER Enfermedades Respiratorias, Autonomous University of Barcelona, Barcelona, Spain
| | - Malte Kelm
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
- CARID (Cardiovascular Research Institute Düsseldorf), Düsseldorf, Germany
| | - Michael Beil
- Department of Medical Intensive Care, Hadassah University Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sigal Sviri
- Department of Medical Intensive Care, Hadassah University Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Stefan J Schaller
- Department of Anesthesiology and Operative Intensive Care Medicine (CVK, CCM), Charitè-Universitätsmedizin Berlin, Freie Universiätt Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Kristina Fuest
- Klinikum Rechts der Isar, Department of Anaesthesiology & Intensive Care Medicine, School of Medicine, Technical University Munich, Munich, Germany
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Kerstin Piayda
- Department of Cardiology and Angiology, Universitätsklinikum Gießen und Marburg, Gießen, Germany
| | | | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Helene Korvenius Nedergaard
- Department of Anesthesiology and Intensive Care, University Hospital of Southern Denmark, Kolding, and Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Sandra Oeyen
- Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium
| | - Rui Moreno
- Unidade de Cuidados Intensivos Neurocríticos e Trauma, Hospital de São José, Centro Hospitalar Universitério de Lisboa Central, Faculdade de Ciências Médicas de Lisboa, Nova Médical School, Lisbon, Portugal
| | - Susannah Leaver
- General Intensive Care, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Dylan W de Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Bertrand Guidet
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: Épidémiologie Hospitalière Qualité et Organisation des Soins, Paris, France
- Assistance Publique -Hôpitaux de Paris, Hôpital Saint-Antoine, Service de Réanimation Médicale,, Paris, France
| | - Christian Jung
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
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Bruno RR, Wolff G, Kelm M, Jung C. Pharmacological treatment of cardiogenic shock - A state of the art review. Pharmacol Ther 2022; 240:108230. [PMID: 35697151 DOI: 10.1016/j.pharmthera.2022.108230] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 05/30/2022] [Accepted: 06/07/2022] [Indexed: 12/14/2022]
Abstract
Cardiogenic shock is a clinical syndrome of impaired tissue perfusion caused by primary cardiac dysfunction and inadequate cardiac output. It represents one of the most lethal clinical conditions in intensive care medicine with mortality >40%. Management of different clinical presentations of cardiogenic shock includes guidance of cardiac preload, afterload, heart rate and contractility by differential pharmacological modulation of volume, systemic and pulmonary vascular resistance and cardiac output besides reversing the triggering cause. Data from large registries and randomized controlled trials on optimal diagnostic guidance as well as choice of pharmacological agents has accrued significantly in recent years. This state-of-the-art review summarizes the basic concepts of cardiogenic shock, the diagnostic work-up and currently available evidence and guideline recommendations on pharmacological treatment of cardiogenic shock.
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Affiliation(s)
- Raphael Romano Bruno
- Heinrich-Heine-University Duesseldorf, Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Duesseldorf, Germany
| | - Georg Wolff
- Heinrich-Heine-University Duesseldorf, Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Duesseldorf, Germany
| | - Malte Kelm
- Heinrich-Heine-University Duesseldorf, Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Duesseldorf, Germany; Cardiovascular Research Institute Düsseldorf (CARID), Duesseldorf, Germany
| | - Christian Jung
- Heinrich-Heine-University Duesseldorf, Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Duesseldorf, Germany.
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Jung C, Rezar R, Wischmann P, Masyuk M, Datz C, Bruno RR, Kelm M, Wernly B. The role of anemia on admission in acute coronary syndrome - An umbrella review of systematic reviews and meta-analyses. Int J Cardiol 2022; 367:1-10. [PMID: 36055474 DOI: 10.1016/j.ijcard.2022.08.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/10/2022] [Accepted: 08/24/2022] [Indexed: 01/28/2023]
Abstract
INTRODUCTION The role of erythrocytes in the acute coronary syndrome (ACS) is complex. The aim of this review in terms of PICO (P: patients; I: intervention; C: comparison; O: outcome) was to summarize systematic reviews in patients (P) with acute coronary syndrome, evaluating the effects of (I) 1) iron deficiency, 2) administration of an erythropoiesis-stimulating agent (ESA), 3) anemia on admission, 4) red blood cell transfusion, 5) a restrictive transfusion strategy in comparison (C) to 1) no iron deficiency, 2) no ESA 3) no anemia on admission, 4) no red blood cell transfusion, 5) a liberal transfusion strategy on mortality (O). METHODS We used AMSTAR2 to assess the methodological quality of systematic reviews and grade the available research. The primary endpoint was all-cause mortality. RESULTS Using the data from 2,787,005 patients, the following conditions were associated with worse outcome in patients with ACS: anemia on admission (RR 2.08 95%CI 1.70-2.55) and transfusion (1.93 95%CI 1.12-3.34) of red blood cells. A liberal transfusion (RR 0.86 95%CI 0.70-1-05), administration of ESA (RR 0.55 95%CI 0.22-1.33) and iron deficiency (OR 1.24 95%CI 0.12-13.13) were not associated with altered all-cause mortality. CONCLUSION Patients suffering from ACS and anemia on admission are at particular risk for adverse outcome. There is evidence of associations between adverse outcomes and receiving red blood cell transfusions.
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Affiliation(s)
- Christian Jung
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225 Duesseldorf, Germany.
| | - Richard Rezar
- Department of Cardiology and Intensive Care Medicine, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020 Salzburg, Austria.
| | - Patricia Wischmann
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225 Duesseldorf, Germany
| | - Maryna Masyuk
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225 Duesseldorf, Germany
| | - Christian Datz
- Department of Internal Medicine, Teaching Hospital of the Paracelsus Medical University Salzburg, General Hospital Oberndorf, Paracelsus Medical University Salzburg, Oberndorf, Austria.
| | - Raphael Romano Bruno
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225 Duesseldorf, Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225 Duesseldorf, Germany
| | - Bernhard Wernly
- Department of Internal Medicine, Teaching Hospital of the Paracelsus Medical University Salzburg, General Hospital Oberndorf, Paracelsus Medical University Salzburg, Oberndorf, Austria; Center for Public Health and Healthcare Research, Paracelsus Medical University of Salzburg, Strubergasse 21, 5020 Salzburg, Austria
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7
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Wischmann P, Bruno RR, Wernly B, Wolff G, Afzal S, Rezar R, Cramer M, Heramvand N, Kelm M, Jung C. Relevance of pre-existing anaemia for patients admitted for acute coronary syndrome to an intensive care unit: a retrospective cohort analysis of 7418 patients. EUROPEAN HEART JOURNAL OPEN 2022; 2:oeac040. [PMID: 35919579 PMCID: PMC9260305 DOI: 10.1093/ehjopen/oeac040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/30/2022] [Accepted: 06/13/2022] [Indexed: 11/14/2022]
Abstract
Aims Patients with acute coronary syndrome (ACS) frequently suffer from anaemia, but its role in patients admitted to an intensive care unit (ICU) is unclear. This analysis evaluates the prognostic relevance of different degrees of anaemia and their specific impact on disease severity and the outcome in critically ill ACS patients. Methods and results and results The multi-centre electronic Intensive Care Unit Collaborative Research Database was used, and all patients admitted with ACS were included in a retrospective analysis. Anaemia and its degrees were defined according to the criteria by the World Health Organization. A multi-level logistic regression analysis was used to fit three sequential regression models for the binary primary outcome of hospital mortality. A total of 7418 patients were included; 3437 patients (46%) had anaemia on admission. Patients with anaemia were significantly older [61 (53–70) vs. 70 (61–78) years, P < 0.001], more often female (P < 0.001), and required an increased rate of vasopressor use (P < 0.001) and mechanical ventilation (P < 0.001). With the higher Sequential organ failure assessment score (1 vs. 2; P < 0.001) and Acute Physiology And Chronic Health Evaluation (35 vs. 47; P < 0.001) scores, a higher degree of anaemia was associated with prolonged ICU stay (2 vs. 5 days, P < 0.001). Even patients with mild anaemia needed significantly from more intensive treatment and suffered worse outcome. Intensive care unit and hospital mortality were inversely associated with haemoglobin levels. Conclusion Nearly half of critically ill patients with ACS suffer from anaemia, which is associated with increased illness severity, complex ICU procedures, and mortality—even in mild anaemia. Haemoglobin on admission is an independent factor for adverse outcome.
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Affiliation(s)
- Patricia Wischmann
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf , Moorenstr. 5, 40225 Düsseldorf , Germany
| | - Raphael Romano Bruno
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf , Moorenstr. 5, 40225 Düsseldorf , Germany
| | - Bernhard Wernly
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University , Strubergasse 21, 5020 Salzburg , Austria
- Center for Public Health and Healthcare Research, Paracelsus Medical University Salzburg , Strubergasse 21, 5020 Salzburg , Austria
| | - Georg Wolff
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf , Moorenstr. 5, 40225 Düsseldorf , Germany
| | - Shazia Afzal
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf , Moorenstr. 5, 40225 Düsseldorf , Germany
| | - Richard Rezar
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg , Strubergasse 21, 5020 Salzburg , Austria
| | - Mareike Cramer
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf , Moorenstr. 5, 40225 Düsseldorf , Germany
| | - Nadia Heramvand
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf , Moorenstr. 5, 40225 Düsseldorf , Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf , Moorenstr. 5, 40225 Düsseldorf , Germany
- Cardiovascular Research Institute Düsseldorf (CARID), Heinrich Heine University , Moorenstraße 5, 40225 Duesseldorf , Germany
| | - Christian Jung
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf , Moorenstr. 5, 40225 Düsseldorf , Germany
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8
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Kim HT, Lee JH, Nam JH, Lee CH, Son JW, Kim U, Park JS, Shin DG. Long-Term Safety and Efficacy of Prolonged Dual Antiplatelet Therapy according to Baseline Anemia after Percutaneous Coronary Intervention. Yonsei Med J 2022; 63:211-219. [PMID: 35184423 PMCID: PMC8860942 DOI: 10.3349/ymj.2022.63.3.211] [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] [Received: 05/31/2021] [Revised: 10/07/2021] [Accepted: 11/30/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE We aimed to evaluate the outcomes of prolonged dual antiplatelet therapy (DAPT) depending on baseline anemia after percutaneous coronary intervention (PCI). MATERIALS AND METHODS Among the 1470 study participants, 448 (30.5%) were classified as having baseline anemia. We categorized the study population according to baseline anemia and DAPT duration: ≤12-month (m) DAPT (n=226) vs. >12-m DAPT (n=222) in anemic patients, and ≤12-m DAPT (n=521) vs. >12-m DAPT (n=501) in non-anemic patients. RESULTS During a follow-up of 80.8 (interquartile range 60.6-97.1) months, anemic patients showed a higher incidence of major adverse cardiovascular and cerebrovascular events (MACCEs) (26.9% vs. 17.1%, p<0.001) and major bleeding (9.8% vs. 5.1%, p=0.006). Among the non-anemic patients, prolonged DAPT was associated with a reduced rate of MACCEs [inverse probability of treatment weighting (IPTW) adjusted hazard ratio (HR), 0.78; 95% confidence interval (CI), 0.63-0.96; p=0.019] without an increase in major bleeding (IPTW adjusted HR, 1.12; 95% CI, 0.75-1.68; p=0.574). However, prolonged DAPT was not related to the incidence of MACCEs (IPTW adjusted HR, 1.11; 95% CI, 0.88-1.39; p=0.387), with increased major bleeding (IPTW adjusted HR, 2.01; 95% CI, 1.32-3.06; p=0.001) among anemic patients. CONCLUSION Although extended DAPT led to a reduction in MACCEs in non-anemic patients, it was related to increased major bleeding without reducing MACCEs in anemic patients.
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Affiliation(s)
- Hun-Tae Kim
- Cardiovascular Division, Yeungnam University College of Medicine, Yeungnam University Medical Center, Daegu, Korea
- Cardiovascular Division, Pohang Semyeong Christianity Hospital, Pohang, Korea
| | - Jung-Hee Lee
- Cardiovascular Division, Yeungnam University College of Medicine, Yeungnam University Medical Center, Daegu, Korea
- Division of Cardiology, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
| | - Jong-Ho Nam
- Cardiovascular Division, Yeungnam University College of Medicine, Yeungnam University Medical Center, Daegu, Korea
| | - Chan-Hee Lee
- Cardiovascular Division, Yeungnam University College of Medicine, Yeungnam University Medical Center, Daegu, Korea
| | - Jang-Won Son
- Cardiovascular Division, Yeungnam University College of Medicine, Yeungnam University Medical Center, Daegu, Korea
| | - Ung Kim
- Cardiovascular Division, Yeungnam University College of Medicine, Yeungnam University Medical Center, Daegu, Korea
| | - Jong-Seon Park
- Cardiovascular Division, Yeungnam University College of Medicine, Yeungnam University Medical Center, Daegu, Korea
| | - Dong-Gu Shin
- Cardiovascular Division, Yeungnam University College of Medicine, Yeungnam University Medical Center, Daegu, Korea
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9
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Wongthida T, Lumkul L, Patumanond J, Wongtheptian W, Piyayotai D, Phinyo P. Development of a Clinical Risk Score for Prediction of Life-Threatening Arrhythmia Events in Patients with ST Elevated Acute Coronary Syndrome after Primary Percutaneous Coronary Intervention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19041997. [PMID: 35206186 PMCID: PMC8872110 DOI: 10.3390/ijerph19041997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/03/2022] [Accepted: 02/08/2022] [Indexed: 12/10/2022]
Abstract
ST-elevated acute coronary syndrome (STEACS) is a serious condition requiring timely treatment. Reperfusion with primary percutaneous coronary intervention (pPCI) is recommended and preferred over fibrinolysis. Despite its efficacy, lethal complications, such as life-threatening arrhythmia (LTA), are common in post-PCI patients. Although various risk assessment tools were developed, only a few focus on LTA prediction. This study aimed to develop a risk score to predict LTA events after pPCI. A risk score was developed using a retrospective cohort of consecutive patients with STEACS who underwent pPCI at Chiangrai Prachanukroh Hospital from January 2012 to December 2016. LTA is defined as the occurrence of malignant arrhythmia that requires advanced cardiovascular life support (ACLS) within 72 h after pPCI. Logistic regression was used for model derivation. Among 273 patients, 43 (15.8%) developed LTA events. Seven independent predictors were identified: female sex, hemoglobin < 12 gm/dL, pre- and intra-procedural events (i.e., respiratory failure and pulseless arrest), IABP insertion, intervention duration > 60 min, and desaturation after pPCI. The LTA score showed an AuROC of 0.93 (95%CI 0.90, 0.97). The score was categorized into three risk categories: low (<2.5), moderate (2.5–4), and high risk (>4) for LTA events. The LTA score demonstrated high predictive performance and potential clinical utility for predicting LTA events after pPCI.
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Affiliation(s)
- Thanutorn Wongthida
- Office of Research and Knowledge Management, Chiang Rai Hospital, Chiang Rai 57000, Thailand;
| | - Lalita Lumkul
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (L.L.); (J.P.)
- Center of Multidisciplinary Technology for Advanced Medicine (CMUTEAM), Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Jayanton Patumanond
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (L.L.); (J.P.)
| | - Wattana Wongtheptian
- Cardiology Unit, Department of Medicine, Chiang Rai Hospital, Chiang Rai 57000, Thailand;
| | - Dilok Piyayotai
- Cardiology Unit, Department of Medicine, Faculty of Medicine, Thammasat University, Pathum Thani 10120, Thailand;
| | - Phichayut Phinyo
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (L.L.); (J.P.)
- Department of Family Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Musculoskeletal Science and Translational Research (MSTR), Chiang Mai University, Chiang Mai 50200, Thailand
- Correspondence:
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10
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Yang Y, Huang Y. Association between serum hemoglobin and major cardiovascular adverse event in Chinese patients with ST-segment elevation myocardial infarction after percutaneous coronary intervention. J Clin Lab Anal 2021; 36:e24126. [PMID: 34894008 PMCID: PMC8761445 DOI: 10.1002/jcla.24126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/06/2021] [Accepted: 11/09/2021] [Indexed: 11/07/2022] Open
Abstract
Background ST‐segment elevation myocardial infarction (STEMI) is a common clinical acute and severe disease, and it is of great significance to evaluate the prognosis of these patients. Hemoglobin levels are associated with a variety of diseases, but studies on Chinese patients with STEMI after percutaneous coronary intervention (PCI) have not been sufficient. Methods This was a secondary analysis based on a prospective cohort study of patients undergoing PCI in Taizhou, Zhejiang, China. We performed multivariable logistic regression to explore the association between the serum hemoglobin and the incidence of major cardiovascular adverse event (MACE) in patients after PCI. We also used a generalized additive model and smooth curve fitting to explain the nonlinear relationship after adjusting the potential confounders. Finally, the heterogeneity among specific groups was examined by subgroup analysis. Results Of all 462 patients enrolled in this study, 118 (25.54%) developed MACE. There was a negative correlation between serum hemoglobin and MACE in all three models (hazard ratio [HR] 0.82, 95% confidence interval [CI 0.72, 0.93], HR 0.86, 95% CI [0.76,0.98], and HR 0.87, 95% CI [0.74,0.98], respectively). In the subgroup analysis, the negative correlation existed between the patients who had myocardial infarction (MI) history (p for interaction = 0.0059) after adjusting covariates. However, no significant differences were found between age and sex groups (p for interaction = 0.1381, 0.4103, respectively). Conclusion Our results indicated that patients who received PCI with low preoperative hemoglobin were more likely to develop MACE, especially if they have already had a history of MI.
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Affiliation(s)
- Yulu Yang
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 JieFang Avenue, Wuhan, Hubei, 430022, China
| | - Yun Huang
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 JieFang Avenue, Wuhan, Hubei, 430022, China
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11
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Hu H, Wang S, Tang G, Zhai C, Shen L. Impact of anemia on in-stent restenosis after percutaneous coronary intervention. BMC Cardiovasc Disord 2021; 21:548. [PMID: 34798833 PMCID: PMC8603472 DOI: 10.1186/s12872-021-02355-1] [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: 04/08/2021] [Accepted: 10/29/2021] [Indexed: 12/18/2022] Open
Abstract
Background Anemia is a common risk factor for post-percutaneous coronary intervention (PCI) adverse events; however, data on its association with in-stent restenosis (ISR) is limited. Methods 538 patients who underwent PCI between January 2017 and September 2019 and follow-up angiography 9–12 months after the initial PCI were enrolled in this study. Baseline clinical and procedural characteristics were compared between the ISR and non-ISR groups, and independent predictors of ISR were determined using propensity score matching. Results The incidence of anemia was 53.5% in patients with ISR and 19.0% in those without ISR. Univariable logistic regression analyses showed that anemia (OR, 4.283; 95% CI, 1.949–9.410; P < 0.001), diabetes mellitus (OR, 2.588; 95% CI, 1.176–5.696; P = 0.018), chronic kidney disease (OR, 3.058; 95% CI, 1.289–7.252; P = 0.011), multiple stenting (OR, 2.592; 95% CI, 1.205–5.573; P = 0.015), bifurcation lesion (OR, 2.669; 95% CI, 1.236–5.763; P = 0.012), and calcification (OR, 3.529; 95% CI, 1.131–11.014; P = 0.030) were closely associated with ISR. Low-density lipoprotein cholesterol (LDL-c) levels and stent diameter were also significantly linked to ISR, as was anemia (P = 0.009) after propensity score matching. Conclusion Anemia is closely associated with post-PCI ISR, and patients with lower hemoglobin levels are at a higher risk of ISR.
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Affiliation(s)
- Huilin Hu
- Department of Cardiology, Affiliated Hospital of Jiaxing University, No.1882 Zhonghuan South Road, Jiaxing, Zhejiang, China
| | - Shijun Wang
- Department of Cardiology, Affiliated Hospital of Jiaxing University, No.1882 Zhonghuan South Road, Jiaxing, Zhejiang, China
| | - Guanmin Tang
- Department of Cardiology, Affiliated Hospital of Jiaxing University, No.1882 Zhonghuan South Road, Jiaxing, Zhejiang, China
| | - Changlin Zhai
- Department of Cardiology, Affiliated Hospital of Jiaxing University, No.1882 Zhonghuan South Road, Jiaxing, Zhejiang, China
| | - Liang Shen
- Department of Cardiology, Affiliated Hospital of Jiaxing University, No.1882 Zhonghuan South Road, Jiaxing, Zhejiang, China.
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12
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Razuk V, Camaj A, Cao D, Nicolas J, Hengstenberg C, Sartori S, Zhang Z, Power D, Beerkens F, Chiarito M, Meneveau N, Tron C, Dumonteil N, Widder JD, Ferrari M, Violini R, Stella PR, Jeger R, Anthopoulos P, Mehran R, Dangas GD. Impact of anemia on short-term outcomes after TAVR: A subgroup analysis from the BRAVO-3 randomized trial. Catheter Cardiovasc Interv 2021; 98:E870-E880. [PMID: 33909348 DOI: 10.1002/ccd.29753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 04/26/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To determine the prognostic impact of anemia in patients randomized to bivalirudin or unfractionated heparin (UFH) during transcatheter aortic valve replacement (TAVR). BACKGROUND Whether the periprocedural use of bivalirudin as compared with UFH in anemic patients undergoing TAVR has an impact on outcomes remains unknown. METHODS The BRAVO-3 trial compared the use of bivalirudin versus UFH in 802 high risk patients undergoing transfemoral TAVR for severe symptomatic aortic stenosis. Patients were stratified according to the presence (defined as hemoglobin levels <13 g/dl in men and <12 g/dl in women) or absence of anemia. The primary outcomes were net adverse cardiac events (NACE; a composite of all-cause mortality, myocardial infarction, stroke, or bleeding) and major bleeding (Bleeding Academic Research Consortium ≥3b) at 30 days. RESULTS Among 798 patients with available baseline hemoglobin levels, 427 (54%) were anemic of whom 221 (52%) received bivalirudin. There were no significant differences in NACE and major bleeding at 30 days between patients with and without anemia, irrespective of the type of anticoagulant used (pinteraction = 0.71 for NACE, pinteraction = 1.0 for major bleeding). However, anemic patients had a higher risk of major vascular complications (adjusted OR 2.43, 95% CI 1.42-4.16, p = 0.001), and acute kidney injury (adjusted OR 1.74, 95% CI 1.16-2.59, p = 0.007) compared to non-anemic patients at 30 days. CONCLUSIONS Anemia was not associated with a higher risk of NACE or major bleeding at 30 days after TAVR without modification of the treatment effects of periprocedural anticoagulation with bivalirudin versus UFH.
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Affiliation(s)
- Victor Razuk
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Anton Camaj
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Johny Nicolas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Christian Hengstenberg
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Zhongjie Zhang
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - David Power
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Frans Beerkens
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mauro Chiarito
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nicolas Meneveau
- Department of Cardiology, University Hospital Jean Minjoz, Besançon, France
| | - Christophe Tron
- Division of Cardiology, Rouen University Hospital, Rouen, France
| | - Nicolas Dumonteil
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | - Julian D Widder
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Markus Ferrari
- Interventional Cardiology, Helios Dr. Horst Schmidt Kliniken Wiesbaden, Wiesbaden, Germany
| | - Roberto Violini
- Interventional Cardiology Unit, San Camillo Hospital, Rome, Italy
| | - Pieter R Stella
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Raban Jeger
- Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | | | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - George D Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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13
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Wester A, Mohammad MA, Olivecrona G, Holmqvist J, Yndigegn T, Koul S. Validation of the 4-Item PRECISE-DAPT Score: A SWEDEHEART Study. J Am Heart Assoc 2021; 10:e020974. [PMID: 34612051 PMCID: PMC8751860 DOI: 10.1161/jaha.121.020974] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background The Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy (PRECISE‐DAPT) score has been shown to predict out‐of‐hospital major bleeding after myocardial infarction treated with percutaneous coronary intervention and dual antiplatelet therapy (DAPT). However, large validation studies have been scarce and the discriminative ability for patients with a preexisting bleeding risk factor (elderly, underweight, women, anemia, kidney dysfunction, or cancer) in a real‐world setting is unknown. Methods and Results Patients undergoing percutaneous coronary intervention for myocardial infarction between 2008 and 2017 were included from the SWEDEHEART (Swedish Web System for Enhancement of Evidence‐Based Care in Heart Disease Evaluated According to Recommended Therapies) registry (n=66 295). The predictive value of the PRECISE‐DAPT score for rehospitalization with major bleeding during dual antiplatelet therapy was evaluated using receiver operating characteristic analyses. A high PRECISE‐DAPT score (≥25; n=13 894) was associated with increased risk of major bleeding (3.9% versus 1.8%; hazard ratio [HR], 2.2; 95% CI, 2.0–2.5; P<0.001) compared with a non‐high score (<25; n=52 401). The score demonstrated a c‐statistic of 0.64 (95% CI, 0.63–0.66). The discriminative ability of the score to further stratify bleeding risk in patients with preexisting bleeding risk factors was poor, especially in patients who are elderly (c‐statistic=0.57; 95% CI, 0.55–0.60) or underweight (c‐statistic=0.56; 95% CI, 0.51–0.61), for whom a non‐high PRECISE‐DAPT score was associated with similar bleeding risk as a high PRECISE‐DAPT score in the general myocardial infarction population. Conclusions In this nationwide population‐based study, the PRECISE‐DAPT score performed moderately in the general myocardial infarction population and poorly in patients with preexisting bleeding risk factors, where its usefulness seems limited.
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Affiliation(s)
- Axel Wester
- Department of Cardiology Clinical Sciences Lund UniversitySkåne University Hospital Lund Sweden
| | - Moman A Mohammad
- Department of Cardiology Clinical Sciences Lund UniversitySkåne University Hospital Lund Sweden
| | - Göran Olivecrona
- Department of Cardiology Clinical Sciences Lund UniversitySkåne University Hospital Lund Sweden
| | - Jasminka Holmqvist
- Department of Cardiology Clinical Sciences Lund UniversitySkåne University Hospital Lund Sweden
| | - Troels Yndigegn
- Department of Cardiology Clinical Sciences Lund UniversitySkåne University Hospital Lund Sweden
| | - Sasha Koul
- Department of Cardiology Clinical Sciences Lund UniversitySkåne University Hospital Lund Sweden
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14
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Murrone A, di Uccio FS, Amodeo V, Aspromonte N, Caldarola P, Casella G, Cipriani M, De Luca L, Di Lenarda A, Domenicucci S, Francese GM, Imazio M, Roncon L, Urbinati S, Valente S, Di Pasquale G, Gulizia MM, Colivicchi F, Gabrielli D. ANMCO POSITION PAPER: Timing of coronary angiography in non-ST-segment elevation acute coronary syndromes. Eur Heart J Suppl 2021; 23:C196-C203. [PMID: 34456646 PMCID: PMC8388606 DOI: 10.1093/eurheartj/suab068] [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] [Indexed: 12/04/2022]
Abstract
The European Society of Cardiology guidelines on non-ST-elevation acute coronary syndromes suggest different temporal strategies for the angiographic study depending on the risk profile. The scientific evidence underlying the guideline recommendations and the critical issues currently existing in Italy, that often do not allow either an extended strategy of revascularization within 24 h or the application of the principle of the same day transfer from a spoke to a hub centre, are analysed. The position paper focuses, in particular, on the subgroup of patients with a defined diagnosis of non-ST-elevation myocardial infarction by proposing a timing of coronary angiography/revascularization that takes into account the available scientific evidence and the organizational possibilities of a considerable part of national cardiology services.
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Affiliation(s)
- Adriano Murrone
- Cardiology-ICU Department, Ospedali di Città di Castello e di Gubbio-Gualdo Tadino, AUSL Umbria 1, Via Guerriero Guerra, Perugia 06127, Italy
| | | | - Vincenzo Amodeo
- Cardiology-ICU Department, Ospedale Santa Maria degli Ungheresi, Polistena, RC, Italy
| | - Nadia Aspromonte
- Heart Failure Unit, Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | | | - Gianni Casella
- Cardiology Department, Ospedale Maggiore, Azienda USL di Bologna, Bologna, Italy
| | - Manlio Cipriani
- Cardiology 2-Cardiac Failure and Trasplantation Unit, Cardiotoracovascular Department “A. De Gasperis”, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Leonardo De Luca
- Cardiology Unit, Cardiotoracovascular Department, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
| | - Andrea Di Lenarda
- Cardiovascular and non Cardiovascolular, Cardiovascolular and Sports Medicine Department, Azienda Sanitaria Universitaria Giuliano Isontina-ASUGI, Trieste, Italy
| | | | - Giuseppina Maura Francese
- Cardiology Department, Azienda di Rilievo Nazionale e Alta Specializzazione “Garibaldi”, Catania, Italy
| | - Massimo Imazio
- Cardiology Department, P.O.U. Santa Maria della Misericordia, Udine, Italy
| | - Loris Roncon
- Cardiology Department, Ospedale Santa Maria della Misericordia, Rovigo, Italy
| | - Stefano Urbinati
- Cardiology Department, Ospedale Bellaria, Azienda USL di Bologna, Bologna, Italy
| | - Serafina Valente
- Clinical-Surgical Cardiology and ICU Department, A.O.U. Senese, Ospedale Santa Maria alle Scotte, Siena, Italy
| | | | - Michele Massimo Gulizia
- Cardiology Department, Azienda di Rilievo Nazionale e Alta Specializzazione “Garibaldi”, Catania, Italy
- Fondazione per il Tuo cuore—Heart Care Foundation, Firenze, Italy
| | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Department, Presidio Ospedaliero San Filippo Neri, ASL Roma 1, Roma, Italy
| | - Domenico Gabrielli
- Cardiology Unit, Cardiotoracovascular Department, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
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15
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Zhao Y, Li J, Ma S, Jiang Z, Li Z, Wang X, Han Y, Li Y. Impact of extended dual antiplatelet therapy on long-term prognosis in patients with acute coronary syndrome complicated with anemia: A sub-analysis of the real-world OPT-CAD study. Catheter Cardiovasc Interv 2021; 98:E235-E242. [PMID: 33817946 DOI: 10.1002/ccd.29676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/08/2021] [Accepted: 03/16/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To evaluate the impact of extended dual antiplatelet therapy (DAPT) beyond 12 months on long-term prognosis in acute coronary syndrome (ACS) patients complicated with anemia undergoing percutaneous coronary intervention (PCI). BACKGROUND Anemia is frequent among ACS patients and is associated with increased risk of adverse clinical outcomes. METHODS A total of 6,953 patients were enrolled from the Optimal anti Platelet Therapy for Chinese patients with Coronary Artery Disease (OPT-CAD) study. A landmark analysis comparing extended DAPT versus single antiplatelet therapy (SAPT) at 12-24 months were performed in anemia patients without premature discontinuation of DAPT before 9 months and major clinical adverse events within 12 months. The primary outcome was major adverse cardiovascular and cerebrovascular events (MACCE), defined as a composite of all-cause death, myocardial infarction, and stroke. RESULTS Patients with anemia (n = 1,728) had higher rates of MACCE, all-cause mortality, and BARC type 2, 3, 5 bleeding (p < .05) compared to those without anemia (n = 5,225). Anemia patients received extended DAPT (n = 1,010) were associated with a lower risk of stroke (0.3% vs. 1.8%; HR, 0.14; 95% CI, 0.03-0.71; p = .018) compared to those received SAPT (n = 342). The rates of MACCE and all revascularization were lower in patients with extended DAPT, but the differences were not statistically significant. Risk of all-cause mortality and bleeding were comparable between the two groups. CONCLUSIONS Extended DAPT beyond 12 months may reduce the incidence of stroke without increasing the risk of bleeding in anemic ACS patients who tolerate 12-month DAPT.
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Affiliation(s)
- Yu Zhao
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
- The Graduate School, Dalian Medical University, Dalian, China
| | - Jing Li
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Sicong Ma
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Zaixin Jiang
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Zhiguo Li
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Xiaozeng Wang
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Yaling Han
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Yi Li
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
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Yoshioka N, Takagi K, Tanaka A, Morita Y, Yoshida R, Kanzaki Y, Nagai H, Watanabe N, Yamauchi R, Komeyama S, Sugiyama H, Shimojo K, Imaoka T, Sakamoto G, Ohi T, Goto H, Ishii H, Morishima I, Murohara T. The Mid-term Mortality and Mode of Death in Survivors with ST-elevation Myocardial Infarction. Intern Med 2021; 60:1665-1674. [PMID: 33390500 PMCID: PMC8222117 DOI: 10.2169/internalmedicine.6549-20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective The popularity of primary percutaneous coronary intervention (p-PCI) for ST-elevation myocardial infarction (STEMI) has increased over the past decades. Despite improvements in in-hospital mortality rates, it is clinically important to investigate the prognoses after discharge. However, data on the mode of death and prognostic factors are limited. We analyzed these factors in a Japanese cohort in the modern p-PCI era. Methods Between January 2004 and December 2017, a total of 1,222 patients who underwent p-PCI within 24 hours from the onset of STEMI and were alive at discharge (mean age, 67.7 years old; men, 75.5%), were evaluated. The two-year mortality was analyzed using a Cox regression model, and the mode of death was evaluated. Results The rate of mortality at 2 years was 5.7%. Non-cardiac death was more frequent than cardiac death (62.6% vs. 37.4%). A Cox multivariate analysis identified the following as independent predictors of the 2-year mortality: hemoglobin (log-transformed) [adjusted hazard ratio (HR), 0.048; 95% confidence interval (CI), 0.008-0.29; p<0.001], age above 80 years old (adjusted HR, 2.26; 95% CI, 1.30-3.91; p=0.004), Killip class ≥II (adjusted HR, 1.99; 95% CI, 1.17-3.39; p=0.011), brain natriuretic peptide level (log-transformed) (adjusted HR, 1.47; 95% CI, 1.09-2.01; p=0.013), and body mass index (log-transformed) (adjusted HR, 0.16; 95% CI, 0.030-0.84; p=0.030). Conclusion This study demonstrated that the 2-year mortality was 5.7% in STEMI survivors after p-PCI. Non-cardiac death was more frequent than cardiac death. Compared to well-known clinical variables, angiographic findings did not have a significant influence on the mid-term mortality.
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Affiliation(s)
- Naoki Yoshioka
- Department of Cardiology, Ogaki Municipal Hospital, Japan
- Department of Cardiology, Nagoya University Graduate School of Medicine, Japan
| | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Japan
- Department of Cardiology, Nagoya University Graduate School of Medicine, Japan
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Japan
| | | | - Ruka Yoshida
- Department of Cardiology, Nagoya University Graduate School of Medicine, Japan
| | | | - Hiroaki Nagai
- Department of Cardiology, Ogaki Municipal Hospital, Japan
| | - Naoki Watanabe
- Department of Cardiology, Ogaki Municipal Hospital, Japan
| | - Ryota Yamauchi
- Department of Cardiology, Ogaki Municipal Hospital, Japan
| | | | | | - Kazuki Shimojo
- Department of Cardiology, Ogaki Municipal Hospital, Japan
| | - Takuro Imaoka
- Department of Cardiology, Ogaki Municipal Hospital, Japan
| | - Gaku Sakamoto
- Department of Cardiology, Ogaki Municipal Hospital, Japan
| | - Takuma Ohi
- Department of Cardiology, Ogaki Municipal Hospital, Japan
| | - Hiroki Goto
- Department of Cardiology, Ogaki Municipal Hospital, Japan
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Japan
| | | | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Japan
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Babes EE, Zaha DC, Tit DM, Nechifor AC, Bungau S, Andronie-Cioara FL, Behl T, Stoicescu M, Munteanu MA, Rus M, Toma MM, Brisc C. Value of Hematological and Coagulation Parameters as Prognostic Factors in Acute Coronary Syndromes. Diagnostics (Basel) 2021; 11:850. [PMID: 34065132 PMCID: PMC8151317 DOI: 10.3390/diagnostics11050850] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 04/30/2021] [Accepted: 05/07/2021] [Indexed: 12/26/2022] Open
Abstract
The values of hematological and coagulation biomarkers were evaluated as predictors of in hospital mortality and complications, in patients with acute coronary syndromes (ACS). This retrospective observational study enrolled 936 ACS subjects admitted to the Clinical Emergency Hospital of Oradea, Romania, between January-December 2019. Hematological and coagulation parameters were obtained at admission. During hospitalization, the following adverse events were recorded: death, ventricular rhythm disturbances, atrial fibrillation, heart failure, re-infarction, and stroke. Accuracy of hematological and coagulation parameters as predictors of adverse outcome were also evaluated. The diagnosis was unstable angina in 442 patients (47.22%), non-ST-elevation myocardial infarction (NSTEMI) in 113 patients (12.1%) and ST-elevation myocardial infarction (STEMI) in 381 patients (40.70%); 87 patients (9.29%) died during hospitalization and 193 (20.7%) developed complications. Predictors for in hospital mortality were as follows: red cell distribution width (RDW) (AUC 0.691, p < 0.0001), white blood cells (WBC) (AUC 0.684, p < 0.0001), neutrophils (NEU) (AUC 0.684, p < 0.0001), and prothrombin time (PT) (AUC 0.765, p < 0.0001). WBC (AUC 0.659, p < 0.0001), NEU (AUC 0.664, p < 0.0001), RDW (AUC 0.669, p < 0.0001), and PT (AUC 0.669, 95% CI 0.622-0.714, p < 0.0001) also had accuracy for complications prediction. RDW had a good ability to predict heart failure in NSTEMI patients (AUC 0.832, p < 0.0001). An acceptable ability to predict ventricular rhythm disturbances occurrence had WBC (AUC 0.758, p < 0.0001) and NEU (AUC 0.772, p < 0.0001). Hematological and coagulation parameters can help in risk stratification of ACS patients. RDW, WBC, NEU, and PT were able to predict mortality and in-hospital complications in ACS patients. RDW has a good accuracy in predicting complications and heart failure in NSTEMI patients. WBC and NEU are good predictors for ventricular rhythm disturbances.
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Affiliation(s)
- Elena Emilia Babes
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (E.E.B.); (M.S.); (M.A.M.); (M.R.); (C.B.)
- Clinical Emergency Hospital of Oradea, 410169 Oradea, Romania;
| | - Dana Carmen Zaha
- Clinical Emergency Hospital of Oradea, 410169 Oradea, Romania;
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy of Oradea, University of Oradea, 410073 Oradea, Romania
| | - Delia Mirela Tit
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania; (D.M.T.); (M.M.T.)
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania
| | - Aurelia Cristina Nechifor
- Analytical Chemistry and Environmental Engineering Department, Polytechnic University of Bucharest, 011061 Bucharest, Romania;
| | - Simona Bungau
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania; (D.M.T.); (M.M.T.)
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania
| | - Felicia Liana Andronie-Cioara
- Department of Psycho-Neuroscience and Recovery, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Tapan Behl
- Department of Pharmacology, Chitkara College of Pharmacy, Chitkara University, Punjab 140401, India;
| | - Manuela Stoicescu
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (E.E.B.); (M.S.); (M.A.M.); (M.R.); (C.B.)
- Clinical Emergency Hospital of Oradea, 410169 Oradea, Romania;
| | - Mihai Alexandru Munteanu
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (E.E.B.); (M.S.); (M.A.M.); (M.R.); (C.B.)
- Clinical Emergency Hospital of Oradea, 410169 Oradea, Romania;
| | - Marius Rus
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (E.E.B.); (M.S.); (M.A.M.); (M.R.); (C.B.)
- Clinical Emergency Hospital of Oradea, 410169 Oradea, Romania;
| | - Mirela Marioara Toma
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania; (D.M.T.); (M.M.T.)
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania
| | - Ciprian Brisc
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (E.E.B.); (M.S.); (M.A.M.); (M.R.); (C.B.)
- Clinical Emergency Hospital of Oradea, 410169 Oradea, Romania;
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18
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Hussein A, Awad MS, Sabra AM, Mahmoud HEM. Anemia is a novel predictor for clinical ISR following PCI. Egypt Heart J 2021; 73:40. [PMID: 33932182 PMCID: PMC8088416 DOI: 10.1186/s43044-021-00163-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/16/2021] [Indexed: 11/26/2022] Open
Abstract
Background Conflicting data were found regarding the anemia’s effect on percutaneous coronary intervention (PCI) outcomes. We directed our study to investigate anemia’s effect on clinical in-stent restenosis (ISR) following PCI. Results A prospective multi-center cohort study was performed on 470 consecutive participants undergoing elective PCI. We classified the participants into two groups: group 1 who were anemic and group 2 who were non-anemic as a control group. At 1, 3, 6, and 12 months by clinic visits, we followed up with the patients to assess anemia’s clinical ISR effect. We found that 20% of the patients undergoing PCI had anemia. Anemic patients showed a statistically significant higher rate of impaired renal function and diabetes and a higher percentage of the female gender. Multivariate regression analysis for major adverse cardiovascular events (MACEs) after adjusting for confounding factors revealed that anemia represents a more risk on MACE (adjusted hazard ratio (HR) was 4.13; 95% CI 2.35–7.94; p value < 0.001) and carries a higher risk upon clinical ISR (adjusted HR was 3.51; 95% CI 1.88–7.16; p value < 0.001) over 12 months of follow-up. Conclusion Anemic patients going through PCI are generally females, diabetics, and have renal impairment. Anemia might be considered another indicator for clinical ISR and is fundamentally associated with an increased MACE incidence.
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Affiliation(s)
- Ahmed Hussein
- Department of Internal Medicine, Faculty of Medicine, Sohag University, Nasser City, Sohag, 82524, Egypt.
| | - Mohammad Shafiq Awad
- Department of Cardiology, Faculty of Medicine, Beni Suef University, Beni Suef City, 62511, Egypt
| | - Ahlam M Sabra
- Department of Internal Medicine, Faculty of Medicine, South Valley University, Qena City, Qena, 83511, Egypt
| | - Hossam Eldin M Mahmoud
- Department of Internal Medicine, Faculty of Medicine, South Valley University, Qena City, Qena, 83511, Egypt
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19
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Tu SJ, Hanna-Rivero N, Elliott AD, Clarke N, Huang S, Pitman BM, Gallagher C, Linz D, Mahajan R, Lau DH, Sanders P, Wong CX. Associations of anemia with stroke, bleeding, and mortality in atrial fibrillation: A systematic review and meta-analysis. J Cardiovasc Electrophysiol 2021; 32:686-694. [PMID: 33476452 DOI: 10.1111/jce.14898] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/31/2020] [Accepted: 01/10/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Anemia frequently coexists with atrial fibrillation (AF) and has been variably associated with worse outcomes. We performed a systematic review and meta-analysis to comprehensively assess the effect of anemia on mortality, stroke/systemic thromboembolism, and bleeding events in patients with AF. METHODS MEDLINE and Embase were searched from inception until May 2020. Studies examining associations of anemia with the above outcomes in AF patients were included, and maximally adjusted hazard ratios (HRs) meta-analysed. PROSPERO registration number CRD42020171113. RESULTS Twenty-eight studies involving 365 484 patients (41% female, mean age 74.7 years) were included. The average study follow-up ranged from 0.2 to 4.0 years, and the prevalence of anemia was 16%. Anemia was associated with a 78% increase in all-cause mortality (HR, 1.78; 95% confidence interval [CI], 1.44-2.20), 60% increase in cardiovascular mortality (HR, 1.60; 95% CI, 1.17-2.19), 134% increase in noncardiovascular mortality (HR, 2.34; 95% CI, 1.58-3.47) 15% increase in stroke/systemic thromboembolism (HR, 1.15; 95% CI, 1.01-1.31), 78% increase in major bleeding (HR, 1.78; 95% CI, 1.54-2.05), and 77% increase in gastrointestinal bleeding (HR, 1.77; 95% CI, 1.23-2.55). Sensitivity analyses including studies that reported odds ratios did not result in any material change. CONCLUSION Anemia is a frequently observed comorbidity in patients with AF, and is associated with an increased risk of all-cause, cardiovascular and noncardiovascular mortality, stroke/systemic thromboembolism, and major and gastrointestinal bleeding. Future studies are required to explore the causes of anemia in AF, and whether investigation and treatment may be clinically beneficial in affected individuals.
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Affiliation(s)
- Samuel J Tu
- Department of Cardiology, Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Nicole Hanna-Rivero
- Department of Cardiology, Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Adrian D Elliott
- Department of Cardiology, Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Nicholas Clarke
- Department of Cardiology, Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Sonia Huang
- Department of Cardiology, Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Bradley M Pitman
- Department of Cardiology, Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Celine Gallagher
- Department of Cardiology, Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Dominik Linz
- Department of Cardiology, Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Rajiv Mahajan
- Department of Cardiology, Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Dennis H Lau
- Department of Cardiology, Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Prashanthan Sanders
- Department of Cardiology, Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Christopher X Wong
- Department of Cardiology, Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
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20
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A Novel Predictive Model for In-Hospital Mortality Based on a Combination of Multiple Blood Variables in Patients with ST-Segment-Elevation Myocardial Infarction. J Clin Med 2020; 9:jcm9030852. [PMID: 32245024 PMCID: PMC7141500 DOI: 10.3390/jcm9030852] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/16/2020] [Accepted: 03/17/2020] [Indexed: 12/22/2022] Open
Abstract
In emergency clinical settings, it may be beneficial to use rapidly measured objective variables for the risk assessment for patient outcome. This study sought to develop an easy-to-measure and objective risk-score prediction model for in-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI). A total of 1027 consecutive STEMI patients were recruited and divided into derivation (n = 669) and validation (n = 358) cohorts. A risk-score model was created based on the combination of blood test parameters obtained immediately after admission. In the derivation cohort, multivariate analysis showed that the following 5 variables were significantly associated with in-hospital death: estimated glomerular filtration rate <45 mL/min/1.73 m2, platelet count <15 × 104/μL, albumin ≤3.5 g/dL, high-sensitivity troponin I >1.6 ng/mL, and blood sugar ≥200 mg/dL. The risk score was weighted for those variables according to their odds ratios. An incremental change in the scores was significantly associated with elevated in-hospital mortality (p < 0.001). Receiver operating characteristic curve analysis showed adequate discrimination between patients with and without in-hospital death (derivation cohort: area under the curve (AUC) 0.853; validation cohort: AUC 0.879), and there was no significant difference in the AUC values between the laboratory-based and Global Registry of Acute Coronary Events (GRACE) score (p = 0.721). Thus, our laboratory-based model might be helpful in objectively and accurately predicting in-hospital mortality in STEMI patients.
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21
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Discharge Hemoglobin Association with Long-Term Outcomes of ST-Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention. Cardiovasc Ther 2020; 2020:8647837. [PMID: 32190122 PMCID: PMC7068153 DOI: 10.1155/2020/8647837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/11/2019] [Accepted: 01/03/2020] [Indexed: 11/17/2022] Open
Abstract
Background Anemia following acute myocardial infarction (AMI) is associated with poor outcomes. While previous studies in patients with AMI have focused on anemia at admission, we hypothesized that hemoglobin (Hb) decline during hospitalization and lower discharge Hb would be associated with greater long-term mortality in patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). Methods We analyzed records of 983 STEMI patients who were treated with primary PCI. The primary end point was all-cause mortality at 1 year and 2 years. The relationship between discharge Hb levels, decline in Hb levels, bleeding event classification, and all-cause mortality was determined. Results Overall, 16.4% of patients had bleeding events, which were classified by the Thrombolysis in Myocardial Infarction (TIMI) score as 7% minimal, 8.6% minor, and 0.9% major. No significant gastrointestinal bleed and cerebral hemorrhage occurred in hospitals among these patients. The incidence rate of the 2-year all-cause mortality increased with severity of the bleeding event score (8.78% for no bleeding vs. 11.59% for minimal bleeding vs. 20.24% for minor bleeding vs. 55.56% for major bleeding, P < 0.001). Discharge Hb was significantly associated with 2-year mortality in an unadjusted model (hazard ratio (HR) per 1 g/L decrease in discharge Hb = 1.020, 95% confidence interval (CI): 1.006–1.034, P < 0.001). Discharge Hb was significantly associated with 2-year mortality in an unadjusted model (hazard ratio (HR) per 1 g/L decrease in discharge Hb = 1.020, 95% confidence interval (CI): 1.006–1.034, P < 0.001). Discharge Hb was significantly associated with 2-year mortality in an unadjusted model (hazard ratio (HR) per 1 g/L decrease in discharge Hb = 1.020, 95% confidence interval (CI): 1.006–1.034, Conclusions In this population of patients hospitalized for STEMI, all-cause mortality increased with lower discharge Hb, and discharge Hb was a significant predictor of mortality risk.
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22
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Bruno RR, Kelm M, Jung C. Spotlight on comorbidities in STEMI patients. Endocrinol Diabetes Metab 2020; 3:e00102. [PMID: 31922029 PMCID: PMC6947710 DOI: 10.1002/edm2.102] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 10/27/2019] [Indexed: 01/28/2023] Open
Affiliation(s)
- Raphael Romano Bruno
- Division of Cardiology, Pulmonology, and Vascular Medicine Medical Faculty University Hospital Düsseldorf Dusseldorf Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonology, and Vascular Medicine Medical Faculty University Hospital Düsseldorf Dusseldorf Germany
| | - Christian Jung
- Division of Cardiology, Pulmonology, and Vascular Medicine Medical Faculty University Hospital Düsseldorf Dusseldorf Germany
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23
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Wester A, Attar R, Mohammad MA, Andell P, Hofmann R, Jensen J, Szummer K, Erlinge D, Koul S. Impact of Baseline Anemia in Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention: A Prespecified Analysis From the VALIDATE-SWEDEHEART Trial. J Am Heart Assoc 2019; 8:e012741. [PMID: 31387441 PMCID: PMC6759912 DOI: 10.1161/jaha.119.012741] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background The impact of baseline anemia in a contemporary acute coronary syndrome (ACS) population undergoing percutaneous coronary intervention in the era of predominant radial artery access, potent P2Y12 inhibition, and rare use of glycoprotein IIb/IIIa inhibitors has not been adequately studied. Methods and Results ACS patients who underwent percutaneous coronary intervention between 2014 and 2016 in the VALIDATE‐SWEDEHEART (Bivalirudin Versus Heparin in ST‐Segment and Non–ST‐Segment Elevation Myocardial Infarction in Patients on Modern Antiplatelet Therapy in the Swedish Web System for Enhancement and Development of Evidence‐Based Care in Heart Disease Evaluated According to Recommended Therapies Registry) trial without missing values for hemoglobin were included (n=5482). Mortality, myocardial reinfarction, and major bleeding at 180 days were assessed using Cox regression models and propensity score matching. All studied comorbidities were more common in ACS patients who had anemia (n=792). ACS patients with anemia had higher rates of 180‐day mortality (6.9% versus 2.1%; hazard ratio, 1.9; 95% CI, 1.3–2.7; P<0.001), myocardial reinfarction (4.3% versus 1.9%; hazard ratio, 1.7; 95% CI, 1.1–2.7; P=0.013), and major bleeding (13.4% versus 8.2%; hazard ratio, 1.3; 95% CI, 1.0–1.6; P=0.041). The results were most evident in patients with a hemoglobin value <100 g/L, who had a nearly 10 times higher mortality rate. Conclusions Baseline anemia in ACS patients undergoing percutaneous coronary intervention, treated according to current practice including routine radial artery access, constitutes a high‐risk feature for both ischemic events, bleeding events, and mortality. A multidisciplinary approach is warranted to maximize benefit and minimize patient risk. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02311231.
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Affiliation(s)
- Axel Wester
- Department of Cardiology Clinical Sciences Lund University Skåne University Hospital Lund Sweden
| | - Rubina Attar
- Department of Cardiology Clinical Sciences Lund University Skåne University Hospital Lund Sweden.,Department of Cardiology Clinical Medicine Aalborg University Aalborg Denmark
| | - Moman Aladdin Mohammad
- Department of Cardiology Clinical Sciences Lund University Skåne University Hospital Lund Sweden
| | - Pontus Andell
- Department of Cardiology Clinical Sciences Lund University Skåne University Hospital Lund Sweden.,Unit of Cardiology Department of Medicine Karolinska Institute Stockholm Sweden.,Heart and Vascular Division Karolinska University Hospital Stockholm Sweden
| | - Robin Hofmann
- Division of Cardiology Department of Clinical Science and Education Södersjukhuset Karolinska Institute Stockholm Sweden
| | - Jens Jensen
- Department of Clinical Science and Education Södersjukhuset Karolinska Institute Stockholm Sweden.,Unit of Cardiology Capio S:t Göran Hospital Stockholm Sweden
| | - Karolina Szummer
- Unit of Cardiology Department of Medicine Karolinska Institute Stockholm Sweden.,Heart and Vascular Division Karolinska University Hospital Stockholm Sweden
| | - David Erlinge
- Department of Cardiology Clinical Sciences Lund University Skåne University Hospital Lund Sweden
| | - Sasha Koul
- Department of Cardiology Clinical Sciences Lund University Skåne University Hospital Lund Sweden
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