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Sinkovic A, Krasevec M, Suran D, Marinsek M, Markota A. The risk of admission acute heart failure in ST-elevation myocardial infarction patients and air pollution with PM2.5. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Air pollution, in particular exposure to particulate matter fine particles of less than 2.5 microns in diameter (PM2.5), increases the risk of cardiovascular events. Short-term exposure (hours to few days prior) to increased PM2.5 levels even may help trigger ST-elevation myocardial infarction (STEMI) and heart failure exacerbation in susceptible individuals. The risk of vascular events is increased even in exposures below the current European air quality limit values (mean annual levels for PM2.5 less than 10μg/m3, 24-hour mean level less than 25μg/m3).
Purpose
To evaluate predictive role of PM2.5 levels ≥20 μg/m3 one day prior to hospital admission for the risk of admission acute heart failure (AAHF) in STEMI patients.
Methods
In 290 STEMI patients (100 women, 190 men, mean age 65.5±12.9 years), treated by primary percutaneous coronary intervention (PPCI) in 2018, we retrospectively registered the AAHF, defined as classes II-IV by Killip Kimbal classification. Additionally, we registered admission clinical data, potentially contributing to AAHF in STEMI patients such as gender, age ≥65 years, prior resuscitation, admission cTnI ≥5 μg/L (normal levels up to 0.045 μg/L), comorbidities, time to PPCI, and mean daily levels of PM2.5 ≥20 μg/m3 one day before admission. Mean daily, freely available, levels of PM2.5 were measured and registered by Chemical analytic laboratory of Environmental agency of Republic Slovenia. We evaluated the predictive role of admission data for admission AHF in STEMI patients.
Results
AAHF was observed in 34.5% of STEMI patients with the mean daily PM2.5 level 15.7±10.9 μg/m3 on the day before admission. PPCI was performed in 92.1% of all STEMI patients, in AAHF in 87.1% and in non-AAHF patients in 94.7% (p=0.037). AAHF in comparison to non-AAHF was associated significantly with female gender (50.5% vs 25.9%, p<0.001), age over 65 years (71.3% vs 45%, p<0.001), prior diabetes (33.7% vs 14.8%, p<0.001), left bundle branch block (LBBB) (10.9% vs 0.5%, <0.001), admission cTnI ≥5 μg/L (46.7% vs 25.9%, p<0.001) and mean daily levels of PM2.5 ≥20 μg/m3 one day before admission (31.7% vs 19%, p=0.020), but nonsignificantly with arterial hypertension, prior myocardial infarction, anterior STEMI and time to PPCI. Logistic regression demonstrated that significant independent predictors of AAHF were age over 65 years (OR 3.349, 95% CI 1.787 to 6.277, p<0.001), prior diabetes (OR 2.934, 95% CI 1.478 to 5.821, p=0.002), admission LBBB (OR 10.526, 95% CI 1.181 to 93.787, p=0.03), prior resuscitation (OR 3.221, 95% CI 1.336 to 7.761, p=0.009), admission cTnI ≥5μg/l (OR 2.984, 95% CI 1.618 to 5.502, p<0.001) and mean daily levels of PM2.5 ≥20 μg/m3 (OR 2.096, 95% CI 1.045 to 4.218, p=0.038) one day before admission.
Conclusion
Mean daily levels of PM2.5 ≥20μg/m3 one day before admission were among significant independent predictors of AAHF in STEMI patients.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Sinkovic
- University Medical Centre Maribor, Maribor, Slovenia
| | - M Krasevec
- University of Maribor, Medical faculty, Maribor, Slovenia
| | - D Suran
- University Medical Centre Maribor, Maribor, Slovenia
| | - M Marinsek
- University Medical Centre Maribor, Maribor, Slovenia
| | - A Markota
- University Medical Centre Maribor, Maribor, Slovenia
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Sinkovic A, Krasevec M, Golub J, Suran D, Marinsek M, Markota A. STEMI patients in the first and second wave of COVID-19 pandemic in Slovenia. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Countries, severly hit by COVID-19 pandemic in spring 2020, reported reduced admissions and increased mortality of STEMI patients. The first wave of COVID-19 pandemic in Slovenia was mild, but in the second wave (October to December 2020) COVID-19 cases and fatalities significantly increased. To overcome the pandemic, restrictions to full lockdown, rapid redeployment and mobilization of healthcare resources, as well as reduction or delayed hospital admissions for acute non-communicable conditions were were undertaken.
Purpose
To evaluate STEMI admissions, the delay in treatment, complications and mortality of STEMI patients in the first and second wave of COVID-19 pandemic and comparison of data to 3 months (March-May) in 2019.
Methods
We retrospectively analysed the data of STEMI patients, admitted in March to May 2019 and in the first (March-May) and in the second wave (October-December) of the COVID-19 pandemic in 2020. We compared STEMI admissions, age, gender, comorbidities, time to primary coronary intervention (PPCI), the rate of PPCI, TIMI III flow after PPCI, prior resuscitations, hospital complications such as heart failure, arrhythmias, bleedings, acute kidney injury and mortality between 2019 and both waves of COVID-19 pandemic.
Results
Between STEMI patients in 2019 and patients in the first and the second wave of COVID-19 pandemic there were nonsignificant differences in STEMI admissions (90 patients vs 96 patients vs 81 patients), in gender, age, comorbidities, the rate of primary percutaneous intervention (PPCI, 94.4% vs 94.8% vs 91.4%), TIMI III flow after PPCI, anterior STEMI, in prior resuscitations (10% vs 10.4% vs 16%). Compared to 2019, admission acute heart failure was nonsignificantly increased in COVID-19 pandemic (30% vs 34.4% vs 39.5%). Within the first 3 hours of STEMI PPCI was performed nonsignificantly less likely in the first wave and significantly less likely in the second wave (35.5%* vs 30.2% vs 19.8%*, *p=0.037) in comparison to 2019. The incidence of acute kidney injury was similar in the first wave, but nonsignificantly increased in the second wave (6.6% vs 5.2% vs 9.8%), compared to 2019 and hospital infection was nonsignificantly increased in both COVID-19 periods (15.6% vs 20.8% vs 27.2%). In hospital heart failure was nonsignificantly increased in the first wave and significantly increased in the second one (23.3%* vs 27.1% vs 42%*, *p=0.015), as well as mitral regurgitation (10%* vs 18.8% vs 26.9%*, *p=0.008). Hospital mortality was nonsignificantly increased in bothe waves of the pandemic (8.9% vs 9.4% vs 13.6%).
Conclusions
In paralell to the increased severity of COVID-19 pandemic in the second wave there was less STEMI admissions, significantly less timely performed PPCI with significantly increased hospital heart failure, resulting in nonsignificantly increased hospital mortality.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Sinkovic
- University Medical Centre Maribor, Maribor, Slovenia
| | - M Krasevec
- University of Maribor, Medical faculty, Maribor, Slovenia
| | - J Golub
- University Medical Centre Maribor, Maribor, Slovenia
| | - D Suran
- University Medical Centre Maribor, Maribor, Slovenia
| | - M Marinsek
- University Medical Centre Maribor, Maribor, Slovenia
| | - A Markota
- University Medical Centre Maribor, Maribor, Slovenia
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Sinkovic A, Marinsek M, Svensek F. Acute kidney injury in the setting of acute ST-elevation myocardial infarction. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Marinsek M, Sinkovic A. A randomized trial comparing the effect of ramipril and losartan in survivors of ST-elevation myocardial infarction. J Int Med Res 2010; 37:1577-87. [PMID: 19930866 DOI: 10.1177/147323000903700536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study investigated the effect of 8 weeks of treatment with ramipril or losartan on N-terminal pro-brain natriuretic peptide (NT-proBNP) plasma levels, plasminogen activator inhibitor-1 (PAI-1) activity, echocardiographic parameters and lipid profiles in patients after acute myocardial infarction (MI). Patients were randomly assigned to receive up to 10 mg/day ramipril (n = 27) or up to 100 mg/day losartan (n = 26). No significant differences in any of the tested variables were observed between the two treatment groups, either before or after treatment. Within the losartan-treated group a significant decrease in levels of NT-proBNP (211.1 +/- 211.5 versus 94.7 +/- 150.1 pg/ml), total cholesterol (5.7 +/- 1.0 versus 4.6 +/- 1.1 mmol/l), and low-density lipoprotein-cholesterol (3.5 +/- 0.9 versus 2.7 +/- 1.0 mmol/l) was observed after treatment compared with baseline. Thus, after an acute MI, losartan seems equal to ramipril in terms of the NT-proBNP levels, echocardiographic parameters, PAI-1 activity and lipid profiles that were achieved.
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Affiliation(s)
- M Marinsek
- Department of Medical Intensive Care, University Clinical Centre Maribor, Maribor, Slovenia
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Marinsek M, Zupan-Meznar A, Rovan K, Zagozen P, Pekolj-Bicanic M, Strmcnik A, Meznar M, Kovacic D. 17: Preoxygenation in Cardioversion-Related Procedural Sedation With Etomidate and Low-Dose Midazolam. Ann Emerg Med 2008. [DOI: 10.1016/j.annemergmed.2008.06.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kovacić D, Marinsek M, Gobec L, Lainscak M, Podbregar M. Effect of selective and non-selective β-blockers on body weight, insulin resistance and leptin concentration in chronic heart failure. Clin Res Cardiol 2007; 97:24-31. [PMID: 17694376 DOI: 10.1007/s00392-007-0571-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2006] [Accepted: 06/28/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Chronic heart failure (CHF) is characterized by increased insulin resistance and hyperleptinaemia. We aimed to study effects of selective and non-selective beta-blockers on body weight, insulin resistance, plasma concentrations of leptin and resistin in patients with CHF. METHODS Twenty-six non-cachectic beta-blocker-naive patients with CHF were randomized and treated with either carvedilol or bisoprolol. Body weight, plasma concentrations of leptin, resistin, fasting glucose and insulin were measured at baseline and after 6 months of therapy. Insulin resistance was estimated by homeostasis model assessment- estimated insulin resistance (HOMA-IR). RESULTS Body weight increased significantly in the carvedilol group (mean change + 2.30 kg, p = 0.023) while it did not change in the bisoprolol group (mean change -0.30 kg, p = 0.623) (ns between groups). Plasma leptin concentration increased only in the carvedilol group (mean change + 4.20 ng/ml, p = 0.019) (ns between groups). Fasting glucose and resistin remained unchanged in both groups. After 6 months, mean plasma insulin concentration changed significantly differently (p = 0.015) in the bisoprolol (mean change +3.1 microU/ml) compared to the carvedilol group (mean change -6.3 microU/ml) and HOMA-IR was consequently higher in the bisoprolol compared to the carvedilol group (5.2 +/- 4.2 vs 2.8 +/- 1.6, p = 0.046). CONCLUSION This study found different metabolic effects of carvedilol and bisoprolol in non-cachectic patients with CHF. With unchanged fasting plasma glucose concentration after 6 months of treatment, carvedilol significantly decreased plasma insulin concentration and insulin resistance compared to bisoprolol.
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Affiliation(s)
- D Kovacić
- Department of Cardiology, General and Teaching Hospital Celje, Celje, Slovenia
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Marinsek M, Pekolj-Bicanic M, Kovacic D, Zuran I, Podbregar M. 258. Ann Emerg Med 2006. [DOI: 10.1016/j.annemergmed.2006.07.715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Marinsek M, Kovacic D, Versnik D, Golez S, Parasuh M, Podbregar M. Prospective Evaluation of Satisfaction with Emergency Department Analgesia in Patients with Acute Undifferentiated Abdominal Pain. Ann Emerg Med 2005. [DOI: 10.1016/j.annemergmed.2005.06.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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