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1.
Sally Aldous A. Mark Richards Peter M. George Louise Cullen William A. Parsonage Dylan Flaws Christopher M. Florkowski Richard W. Troughton Jack W. O'Sullivan Christopher M. Reid Laura Bannister Martin Than 《International journal of cardiology》2014
Objectives
The aim of this study is to compare a new improved point of care cardiac troponin assay (new POC-cTnI) with 1. its predecessor (old POC-cTnI) and 2. a high sensitivity assay (hs-cTnI) for the diagnosis of acute myocardial infarction (AMI) and for major adverse cardiac events (MACE) by 30 days.Methods
This is a single centre observational study, set in Christchurch Hospital, New Zealand. Patients presenting to the emergency department with non-traumatic chest pain underwent blood sampling at 0 h and 2 h post presentation for analysis with the 3 cTnI assays for the outcome of AMI and for analysis using an accelerated diagnostic protocol (ADP-normal 2 h troponins, normal electrocardiograms and Thrombolysis In Myocardial Infarction (TIMI) score of 0 or ≤ 1) for 30 day MACE.Results
Of 962 patients, 220 (22.9%) had AMI. Old POC-cTnI was least sensitive at 70.0% (65.4–73.9%) by 2 h (p < 0.001). New POC-cTnI, sensitivity 93.6% (89.9–96.2%) had similar sensitivity to hs-cTnI, sensitivity 95.0% (91.5–97.3%) (p = 0.508). There were 231 (24.0%) patients with 30 day MACE. When used as part of the ADP, all assays had 100% (98.0–100%) sensitivity using TIMI = 0. Sensitivities of new POC-cTnI ADP, 98.3% (95.4–99.4%), old POC-cTnI, 96.5% (93.2–98.4%) and hs-cTnI, 98.7% (96.0–99.7%) were similar (p = 0.063–0.375) using TIMI ≤ 1.Conclusions
A new POC-cTnI has improved sensitivity for AMI and MACE compared with its predecessor and comparable sensitivity to a high sensitivity assay. Now that sensitivities of the POC assay are improved, the new assay may be a useful alternative to central laboratory assays when rapid turn-around times are not possible. 相似文献2.
Sally C. Inglis Judith Bebchuk Sultan A. Al-Suhaim Jessica Case Marc A. Pfeffer Scott D. Solomon Yingxin Hou Bertram Pitt Henry J. Dargie Ian Ford John Kjekshus Faiez Zannad Kenneth Dickstein John J.V. McMurray 《International journal of cardiology》2013
Objectives
To examine the prevalence of peripheral artery disease (PAD) and the relationship between PAD and cardiovascular (CV) outcomes in subjects with left ventricular systolic dysfunction, heart failure or both after acute myocardial infarction (MI).Background
PAD is associated with poorer prognosis in patients with stable and unstable coronary heart disease but whether PAD is associated with worse outcomes following substantial acute MI is unknown.Methods
Univariate and multivariate Cox proportional hazards modelling was used to compare clinical outcomes in an individual-patient meta-analysis of 4 trials (CAPRICORN, EPHESUS, OPTIMAAL and VALIANT).Results
Of the 28,771 patients randomized, 2357 (8.2%) had PAD. These patients were older and had more co-morbidity and were less likely to be prescribed aspirin or a beta-blocker compared to patients without PAD. Over a mean follow-up of 2.7 years, 5121 (17.8%) patients died and 15,055 (52.3%) experienced CV death or hospitalization. PAD was an independent predictor of all individual and composite CV outcomes examined (including heart failure), with the exception of stroke. In patients with PAD (compared to those without PAD), the adjusted hazard ratio (HR) for all-cause mortality was 1.25 (95% CI 1.15–1.37; p < 0.001) and the HR for CV death, non-fatal MI, non-fatal stroke or heart failure hospitalization was 1.24 (1.16–1.33; p < 0.001).Conclusions
PAD is common and is an independent predictor of worse outcomes in patients already at high risk after MI because of left ventricular systolic dysfunction, heart failure or both. These patients represent an important group for intensive application of secondary preventive therapies. 相似文献3.
Mike H. Bao Yinggan Zheng Cynthia M. Westerhout Yuling Fu Galen S. Wagner Bernard Chaitman Christopher B. Granger Paul W. Armstrong 《Journal of electrocardiology》2014
Objectives
To evaluate quantitative relationships between baseline Q-wave width and 90-day outcomes in ST-segment elevation myocardial infarction (STEMI).Background
Baseline Q-waves are useful in predicting clinical outcomes after MI.Methods
3589 STEMI patients were assessed from a multi-centre study.Results
1156 patients of the overall cohort had pathologic Q-waves. The 90-day mortality and the composite of mortality, congestive heart failure (CHF), or cardiogenic shock (p < 0.001 for both outcomes) rose as Q-wave width increased. After adapting a threshold ≥ 40 ms for inferior and ≥ 20 ms for lateral/apical MI in all patients (n = 3065) with any measureable Q-wave we found hazard ratios (HR) for mortality (HR: 2.44, 95% confidence interval (CI) (1.54–3.85), p < 0.001) and the composite (HR: 2.32, 95% CI (1.70–3.16), p < 0.001). This improved reclassification of patients experiencing the composite endpoint versus the conventional definition (net reclassification index (NRI): 0.23, 95% CI (0.09-0.36), p < 0.001) and universal MI definition (NRI: 0.15, 95% CI (0.02–0.29), p = 0.027).Conclusions
The width of the baseline Q-wave in STEMI adds prognostic value in predicting 90-day clinical outcomes. A threshold of ≥ 40 ms in inferior and ≥ 20 ms for lateral/apical MI enhances prognostic insight beyond current criteria. 相似文献4.
Giovanni Andrea Contini Francesco Nicolini Daniela Fortuna Davide Pacini Davide Gabbieri Luigi Vignali Marco Valgimigli Antonio Manari Claudio Zussa Paolo Guastaroba Rossana De Palma Roberto Grilli Tiziano Gherli 《International journal of cardiology》2013
Background
The study compares five-year clinical outcomes of CABG vs PCI in a real world population of diabetic patients with multivessel coronary disease since it is not clear whether to prefer surgical or percutaneous revascularization.Methods
Between July 2002 and December 2008, 2885 multivessel coronary diabetic patients underwent revascularization (1466 CABG and 1419 PCI) at hospitals in Emilia-Romagna Region, Italy and were followed for 1827 ± 617 days by record linkage of two clinical registries with the regional administrative database of hospital admissions and the mortality registry. Five-year incidences of MACCE (mortality, acute myocardial infarction [AMI], stroke, and repeat revascularization [TVR]) were assessed with Kaplan–Meier estimates, Cox proportional hazards regression and cumulative incidence functions of death and TVR, to evaluate the competing risk of AMI on death and TVR. The same analyses were applied to the propensity score matched subgroup of patients undergoing CABG or PCI with DES and with complete revascularization.Results
PCI had higher mortality for all causes (HR: 1.8, 95% CI 1.4–2.2 p < 0.0001), AMI (HR: 3.3, 95% CI 2.4–4.6 p < 0.0001) and TVR (HR: 4.5, 95% CI 3.4–6.1 p < 0.0001). No significant differences emerged for stroke (HR: 0.8, 95% CI 0.5–1.2 p = 0.26).The higher incidence of AMI caused higher mortality in PCI group. Results did not change comparing CABG with PCI patients receiving complete revascularization or DES only.Conclusions
Diabetics show a higher incidence of MACCE with PCI than with CABG: thus diabetes and its degree of control should be considered when choosing the type of revascularization. 相似文献5.
Onkar S. Dhillon Hafid K. Narayan Sohail Q. KhanDominic Kelly Paulene A. QuinnIain B. Squire Joan E. DaviesLeong L. Ng 《International journal of cardiology》2013
Background
Soluble ST2 is a marker of cellular stress and injury whose natural ligand is interleukin-33. We investigate, for the first time, the relationship of IL-33 and ST2 with death at 30-days, 1-year and beyond in unselected STEMI patients. We assess the incremental value they offer over GRACE score and NT-proBNP. Secondary endpoints were heart failure readmission and re-infarction.Methods
ST2 and IL-33 were measured in 677 patients 3–5 days after admission. Median follow-up was 587 (134–2818) days during which 101 (15%) patients died.Results
ST2 was higher in those who died when compared to event-free survivors (median [range] 1125 [123–15781] vs. 630 [59–11729] pg/ml, p < 0.001) as was IL-33 (75 [5.4-17893] vs. 5.4 [5.4-16466] pg/mL, p = 0.006). Multivariate Cox regression analysis reveals that elevated ST2 is associated with increased risk of mortality at 30-days (HR 9.34, p < 0.001) and 1-year (HR 3.15, p = 0.001). These relationships continued after further adjustment for GRACE-RS and NT-proBNP. Combining ST2 (c-statistic 0.82, p < 0.001), GRACE-RS (0.82, p < 0.001) and NT-proBNP (0.84, p < 0.001) leads to a significant improvement in the c-statistic for 30-day mortality to 0.90 (p = 0.01). IL-33 above 5.4 pg/ml was independently associated with increased mortality at 30-days (HR 4.16, p = 0.007) and 1-year (HR 2.29, p = 0.008) but, did not add incremental prognostic value over using GRACE-RS and NT-proBNP. The ratio IL-33/ST2 was not associated with events.Conclusions
Elevated ST2 and IL-33 were both associated with increased mortality. ST2 demonstrated incremental value over contemporary risk markers but, IL-33 did not. ST2 has a potential role in risk stratification using a multi-marker approach. 相似文献6.
Emil Binsell-Gerdin Anna Graipe Joachim Ögren Tomas Jernberg Thomas Mooe 《International journal of cardiology》2014
Background/objectives
Hemorrhagic stroke is a rare but serious complication after an acute myocardial infarction (AMI). The aims of our study were to establish the incidence, time trends and predictors of risk for hemorrhagic stroke within 30 days after an AMI in 1998–2008.Methods
We collected data from the Register of Information and Knowledge about Swedish Heart Intensive Care Admissions (RIKS-HIA). All patients with a myocardial infarction 1998–2008 were included, n = 173,233. The data was merged with the National Patient Register in order to identify patients suffering a hemorrhagic stroke. To identify predictors of risk we used Cox models.Results
Overall the incidence decreased from 0.2% (n = 94) in 1998–2000 to 0.1% (n = 41) in 2007–2008. In patients with ST-elevation myocardial infarction the corresponding incidences were 0.4% (n = 76) in 1998–2000 and 0.2% (n = 21) in 2007–2008, and after fibrin specific thrombolytic treatment 0.6% and 1.1%, respectively, with a peak of 1.4% during 2003–2004. In total 375 patients (0.22%) suffered a hemorrhagic stroke within 30 days of the AMI. The preferred method of reperfusion changed from thrombolysis to percutaneous coronary intervention (PCI). Older age (hazard ratio (HR) > 65- ≤ 75 vs ≤ 65 years 1.84, 95% confidence interval (CI) 1.38–2.45), thrombolysis (HR 6.84, 95% CI 5.51–8.48), history of hemorrhagic stroke (HR 12.52, CI 8.36–18.78) and prior hypertension (HR 1.52, CI 1.23–1.86) independently predicted hemorrhagic stroke within 30 days.Conclusions
The rate of hemorrhagic stroke within 30 days of an AMI has decreased by 50% between 1998 and 2008. The main reason is the shift in reperfusion method from thrombolysis to PCI. 相似文献7.
Adriana Roncella Christian Pristipino Cinzia Cianfrocca Silvia Scorza Vincenzo Pasceri Francesco Pelliccia Johan Denollet Susanne S. Pedersen Giulio Speciale 《International journal of cardiology》2013
Background
Previous studies on cognitive and interpersonal interventions have yielded inconsistent results in ischemic heart disease patients.Methods
101 patients aged ≤ 70 years, and enrolled one week after complete revascularization with urgent/emergent angioplasty for an AMI, were randomized to standard cardiological therapy plus short-term humanistic–existential psychotherapy (STP) versus standard cardiological therapy only.Primary composite end point was: one-year incidence of new cardiological events (re-infarction, death, stroke, revascularization, life-threatening ventricular arrhythmias, and the recurrence of typical and clinically significant angina) and of clinically significant new comorbidities. Secondary end points were: rates for individual components of the primary outcome, incidence of re-hospitalizations for cardiological problems, New York Heart Association class, and psychometric test scores at follow-up.Results
94 patients were analyzed at one year. The two treatment groups were similar across all baseline characteristics. At follow-up, STP patients had had a lower incidence of the primary endpoint, relative to controls (21/49 vs. 35/45 patients; p = 0.0006, respectively; NNT = 3); this benefit was attributable to the lower incidence of recurrent angina and of new comorbidities in the STP group (14/49 vs. 22/45 patients, p = 0.04, NNT = 5; and 5/49 vs. 25/45, p < 0.0001, NNT = 3, respectively). Patients undergoing STP also had statistically fewer re-hospitalizations, a better NYHA class, higher quality of life, and lower depression scores.Conclusion
Adding STP to cardiological therapy improves cardiological symptoms, quality of life, and psychological and medical outcomes one year post AMI, while reducing the need for re-hospitalizations. Larger studies remain necessary to confirm the generalizability of these results.Clinical trial registration
ClinicalTrial.gov: NCT00769366 相似文献8.
Carla Koopman Michiel L. Bots Aloysia A.M. van Oeffelen Ineke van Dis W.M. Monique Verschuren Peter M. Engelfriet Simon Capewell Ilonca Vaartjes 《International journal of cardiology》2013
Objective
We studied time trends in acute myocardial infarction (AMI) incidence, including out-of-hospital mortality proportions and hospitalized case-fatality rates. In addition, we compared AMI trends by age, gender and socioeconomic status.Methods
We linked the national Dutch hospital discharge register with the cause of death register to identify first AMI in patients ≥ 35 years between 1998 and 2007. Events were categorized in three groups: 178,322 hospitalized non-fatal, 43,210 hospitalized fatal within 28 days, and 75,520 out-of-hospital fatal AMI events. Time trends were analyzed using Joinpoint and Poisson regression.Results
Since 1998, age-standardized AMI incidence rates decreased from 620 to 380 per 100,000 in 2007 in men and from 323 to 210 per 100,000 in 2007 in women. Out-of-hospital mortality decreased from 24.3% of AMI in 1998 to 20.6% in 2007 in men and from 33.0% to 28.9% in women. Hospitalized case-fatality declined from 2003 onwards. The annual percentage change in incidence was larger in men than women (− 4.9% vs. − 4.2%, P < 0.001). Furthermore, the decline in AMI incidence was smaller in young (35–54 years: − 3.8%) and very old (≥ 85 years: − 2.6%) men and women compared to middle-aged individuals (55–84 years: − 5.3%, P < 0.001). Smaller declines in AMI rates were observed in deprived socioeconomic quintiles Q5 and Q4 relative to the most affluent quintile Q1 (P = 0.002 and P = 0.015).Conclusions
Substantial improvements were observed in incidence, out-of-hospital mortality and short-term case-fatality after AMI in the Netherlands. Young and female groups tend to fall behind, and socioeconomic inequalities in AMI incidence persisted and have not narrowed. 相似文献9.
Petr Widimsky Zuzana Motovska Jorge Belardi Patrick Serruys Sigmund Silber Stephan Windecker Franz-Josef Neumann 《International journal of cardiology》2013
Background
Outcome data are limited in patients with ST-segment elevation acute myocardial infarction (STEMI) or other acute coronary syndromes (ACSs) who receive a drug-eluting stent (DES). Data suggest that first generation DES is associated with an increased risk of stent thrombosis when used in STEMI. Whether this observation persists with newer generation DES is unknown. The study objective was to analyze the two-year safety and effectiveness of Resolute™ zotarolimus-eluting stents (R-ZESs) implanted for STEMI, ACS without ST segment elevation (non-STEACS), and stable angina (SA).Methods
Data from the Resolute program (Resolute All Comers and Resolute International) were pooled and patients with R-ZES implantation were categorized by indication: STEMI (n = 335), non-STEACS (n = 1416), and SA (n = 1260).Results
Mean age was 59.8 ± 11.3 years (STEMI), 63.8 ± 11.6 (non-STEACS), and 64.9 ± 10.1 (SA). Fewer STEMI patients had diabetes (19.1% vs. 28.5% vs. 29.2%; P < 0.001), prior MI (11.3% vs. 27.2% vs. 29.4%; P < 0.001), or previous revascularization (11.3% vs. 27.9% vs. 37.6%; P < 0.001). Two-year definite/probable stent thrombosis occurred in 2.4% (STEMI), 1.2% (non-STEACS) and 1.1% (SA) of patients with late/very late stent thrombosis (days 31–720) rates of 0.6% (STEMI and non-STEACS) and 0.4% (SA) (P = NS). The two-year mortality rate was 2.1% (STEMI), 4.8% (non-STEACS) and 3.7% (SA) (P = NS). Death or target vessel re-infarction occurred in 3.9% (STEMI), 8.7% (non-STEACS) and 7.3% (SA) (P = 0.012).Conclusion
R-ZES in STEMI and in other clinical presentations is effective and safe. Long term outcomes are favorable with an extremely rare incidence of late and very late stent thrombosis following R-ZES implantation across indications. 相似文献10.
C.P. Gale B.A. Cattle P.D. Baxter D.C. Greenwood A.D. Simms J. Deanfield K.A.A. Fox A.S. Hall R.M. West 《International journal of cardiology》2013
Background
Mortality rates after acute myocardial infarction (AMI) have declined, but there is uncertainty regarding the extent of improvements in early mortality in the elderly.Methods
Mixed-effects regression analysis of 30-day mortality using data from 478,242 patients with AMI at 215 hospitals in England and Wales stratified by STEMI/NSTEMI, sex, and age group. A hospital opportunity-based composite score (OBCS) for aspirin, ACE-inhibitor, statin, β blocker, and referral for cardiac rehabilitation was used as measure of quality of hospital care.Results
30-day mortality rates (95% CI) fell from 10.7% (10.6 to 10.9%) in 2004/5 to 8.4% (8.3 to 8.6%) in 2008/9. The median (IQR) hospital OBCSs increased over time, 2004/5: 87.3 (7.2), 2006/7: 88.9 (6.3), 2008/9: 90.3 (6.1), P < 0.001, and were similar between age groups (18 to < 65 years, 65 to 79 years, and ≥ 80 years) for STEMI: 89.4 (6.5) vs. 89.4 (6.6), vs. 89.2 (6.5) and NSTEMI: 88.6 (7.3) vs. 88.8 (7.0) vs. 88.9 (7.0), respectively For males, all age groups except patients < 65 years demonstrated a significant decrease in adjusted mortality. For females, only patients ≥ 80 years demonstrated a significant reduction in adjusted mortality. A 1% increase in hospital OBCS was associated with a 1% decrease in 30-day mortality (95% CI: 0.99 to 0.99, P < 0.001).Conclusion
In England and Wales, for patients with AMI there are age and sex-dependent differences in improvements in 30-day mortality. Whereas young males with AMI have reached an acceptable performance plateau, all other groups are either improving or, more importantly, are yet to demonstrate this. 相似文献11.
Markus Lingman Marianne Hartford Thomas Karlsson Johan Herlitz Aigars Rubulis Kenneth Caidahl Lennart Bergfeldt 《Journal of electrocardiology》2014
Objective
To study effects of ischemia-reperfusion on ventricular electrophysiology in humans by three-dimensional electrocardiography.Methods
Fifty-seven patients with first-time acute anterior ST elevation myocardial infarction were monitored from admission and > 24 h after symptom onset with continuous vectorcardiography (VCG; modified Frank orthogonal leads). Global ventricular depolarization and repolarization (VR) measures were compared at maximum vs. minimum ST vector magnitude (STVM) (median 208; 111–303 vs. 362; 165–1359 min after symptom onset).Results
At maximum vs. minimum STVM the Tarea (overall VR dispersion) almost tripled (118 vs. 41 μVs; p < 0.0001), the T-loop bulginess was 90% greater (Tavplan 0.91 vs 0.48 μV; p < 0.0001), and Tpeak-end/QT was 39% larger (0.32 vs 0.23; p < 0.0001). QRSarea (overall dispersion of depolarization) was 12% larger at maximum STVM, while QRS duration was 10% longer at minimum STVM.Conclusions
Ischemia-reperfusion was accompanied by profound and transient alterations of VR dispersion, while changes in depolarization were modest and delayed. 相似文献12.
C. Simsek L. Räber M. Magro E. Boersma Y. Onuma G.G. Stefanini T. Zanchin B. Kalesan P. Wenaweser P. Jüni R.J. van Geuns R.T. van Domburg S. Windecker P.W.J.C. Serruys 《International journal of cardiology》2013
Background
Newer generation everolimus-eluting stents (EES) improve clinical outcome compared to early generation sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES). We investigated whether the advantage in safety and efficacy also holds among the high-risk population of diabetic patients during long-term follow-up.Methods
Between 2002 and 2009, a total of 1963 consecutive diabetic patients treated with the unrestricted use of EES (n = 804), SES (n = 612) and PES (n = 547) were followed throughout three years for the occurrence of cardiac events at two academic institutions. The primary end point was the occurrence of definite stent thrombosis.Results
The primary outcome occurred in 1.0% of EES, 3.7% of SES and 3.8% of PES treated patients ([EES vs. SES] adjusted HR = 0.58, 95% CI 0.39–0.88; [EES vs. PES] adjusted HR = 0.29, 95% CI 0.13–0.67). Similarly, patients treated with EES had a lower risk of target-lesion revascularization (TLR) compared to patients treated with SES and PES ([EES vs. SES], 5.6% vs. 11.5%, adjusted HR = 0.68, 95% CI: 0.55–0.83; [EES vs. PES], 5.6% vs. 11.3%, adjusted HR = 0.51, 95% CI: 0.33–0.77). There were no differences in other safety end points, such as all-cause mortality, cardiac mortality, myocardial infarction (MI) and MACE.Conclusion
In diabetic patients, the unrestricted use of EES appears to be associated with improved outcomes, specifically a significant decrease in the need for TLR and ST compared to early generation SES and PES throughout 3-year follow-up. 相似文献13.
Background
Several previous studies examined the association between acute myocardial infarction (AMI) incidence and temperature and/or air pollution. Results of these studies have been inconsistent and few studies have been done in cities with sub-tropical or tropical climates.Methods
Daily data on AMI hospitalizations, mean temperature and humidity, and pollutants, were collected for 2000–2009 for three warm-climate Asian cities. Poisson Generalized Additive Models were used to regress daily AMI counts on temperature, humidity, and pollutants while controlling for day of the week, long-term trends and seasonal effects. Smoothing splines allowing non-linear associations were used for temperature and humidity while pollutants were modeled as linear terms.Results
A 1 °C drop below a threshold temperature of 24 °C was significantly (p < .0001) associated with AMI hospitalization increases of 3.7% (average lag 0–13 temperature) in Hong Kong, 2.6% (average lag 0–15) in Taipei, and 4.0% (average lag 0–11) in Kaohsiung. No significant heat effects were observed. Among pollutants same day nitrogen dioxide (NO2) levels were the strongest predictors in all three cities, with a 10 mg/m3 increase in NO2 being associated with a 1.1% rise in AMI hospitalization in Hong Kong, and a 10 ppb rise being associated with 4.4% and 2.6% rises in Taipei and Kaohsiung, respectively.Conclusions
Cool temperatures and higher NO2 levels substantially raised AMI risk in these warm-climate cities and the effect sizes we observed were stronger than those found in previous studies. More attention should be paid to the health dangers of cold weather in warm-climate cities. 相似文献14.
15.
Saurav Chatterjee Debanik Chaudhuri Rajesh Vedanthan Valentin Fuster Borja Ibanez Sripal Bangalore Debabrata Mukherjee 《International journal of cardiology》2013
Background
Intravenous (IV) beta-blockade is currently a Class IIa recommendation in early management of patients with acute coronary syndromes (ACS) without obvious contraindications.Methods
We searched the PubMed, EMBASE and the Cochrane Register for Controlled Clinical Trials for randomized clinical trials from 1965 through December, 2011, comparing intravenous beta-blockers administered within 12 hours of presentation of ACS with standard medical therapy and/or placebo. The primary outcome assessed was the risk of short-term (in-hospital mortality-with maximum follow up duration of 90 days) all-cause mortality in the intervention group versus the comparator group. The secondary outcomes assessed were ventricular tachyarrhythmias, myocardial reinfarction, cardiogenic shock, and stroke. Pooled treatment effects were estimated using relative risk with Mantel–Haenszel risk ratio, using a random-effects model.Results
Sixteen studies enrolling 73,396 participants met the inclusion ⁄ exclusion criteria. In- hospital mortality was reduced 8% with intravenous beta-blockers, RR = 0.92 (95% CI, 0.86–1.00; p = 0.04) when compared with controls. Moreover, intravenous beta-blockade reduced the risk of ventricular tachyarrhythmias (RR = 0.61; 95 % CI 0.47–0.79; p = 0.0003) and myocardial reinfarction (RR = 0.73, 95 % CI 0.59–0.91; p = 0.004) without increase in the risk of cardiogenic shock, (RR = 1.02; 95% CI 0.77–1.35; p = 0.91) or stroke (RR = 0.58; 95 % CI 0.17–1.98; p = 0.38).Conclusions
Intravenous beta-blockers early in the course of appropriate patients with ACS appears to be associated with significant reduction in the risk of short-term cardiovascular outcomes, including a reduction in the risk of all-cause mortality. 相似文献16.
Background
Administrative data have been used to construct risk-adjustment models for provider profiling to benchmark hospital performance for acute myocardial infarction (AMI), but much less for acute coronary syndrome (ACS). We assess the impact on risk model performance and hospital-level mortality rate ratios (SMRs) of three key issues: comorbidity measurement methods, inter-hospital transfers and post-discharge deaths.Methods
Logistic regression models for 30-day total mortality used three years of national public hospital emergency (unplanned) admissions data for England for ACS (n = 329,369) linked to death registrations. We compared using the Charlson comorbidity index with modelling previous admissions.Results
Prior admission for various conditions such as cancer and renal failure was associated with higher post-ACS mortality, whereas previous AMIs, PCI and unstable angina admissions were associated with lower mortality. The Charlson comorbidity index performed better than one- and five-year admission histories. Discrimination (c = 0.81) was comparable with that from clinical databases. Adjusted 30-day total mortality rates ranged between hospitals from 6.3% to 13.3%.Median differences in SMRs between the comorbidity-adjustment methods were small. Although SMRs and outlier status could change, a hospital's ‘qualitative’ mortality rating (low, average or high) was not affected. In contrast, a sizeable minority of SMRs changed by ≥ 10 points if transfers were excluded or post-discharge deaths ignored. Model choice occasionally affected funnel plot outlier status.Conclusions
Models for comparing hospitals' ACS mortality can be constructed with good discrimination using English administrative hospital data. Adjusting for transfers in and capturing post-discharge deaths are more important than the choice of comorbidity adjustment. 相似文献17.
Sally C. Inglis James D. Lewsey Gordon D.O. Lowe Pardeep Jhund Michelle Gillies Simon Stewart Simon Capewell Kate MacIntyre John J.V. McMurray 《International journal of cardiology》2013
Background
Angina and intermittent claudication impair function and mobility and reduce health-related quality of life. Both symptoms have similar etiology, yet the physical and psychological impacts of these symptoms are rarely studied in community-based cohorts or in individuals with isolated symptoms.Methods
The 2003 Scottish Health Survey was a cross-sectional survey which enrolled a random sample of individuals aged 16–95 years living in Scotland. The Rose Angina Questionnaire, the Edinburgh Claudication Questionnaire, the Short Form-12 (SF-12) and the General Health Questionnaire were completed. Self-assessed general health was reported. Survey results were linked to national death records and mortality at five years was calculated. Subjects with isolated angina or intermittent claudication and neither symptom were compared (22 participants with both symptoms were excluded); 7403 participants (aged ≥ 16 years) were included.Results
Participants with angina (n = 205; 60 ± 15 years; 45% male) rated their general health worse and were more likely to have a potential mental-health problem than those with intermittent claudication (n = 173; 61 ± 15 years; 41% male). Mean (standard deviation) physical and mental component scores on the SF-12 were higher for participants with intermittent claudication relative to those with angina (physical component score: 42.3 (10.6) vs. 35.0 (11.7), p < 0.001; mental component score: 52.3 (8.5) vs. 46.5 (11.7), p = 0.001). There was an observed absolute difference in five-year mortality of 4.8% (angina 12.3%, 95% CI 8.5–17.6; intermittent claudication 7.5%, 95% CI 4.4–12.6) although not statistically significant (p = 0.16).Conclusions
Both intermittent claudication and angina adversely impact general and mental health and survival, even in a relatively young, community-based cohort. 相似文献18.
Philip Haaf Raphael Twerenbold Tobias Reichlin Jonathan Faoro Miriam Reiter Christophe Meune Stephan Steuer Stefano Bassetti Ronny Ziller Cathrin Balmelli Isabel Campodarve Christa Zellweger Ashley Kilchenmann Affan Irfan Jana Papassotiriou Beatrice Drexler Christian Mueller 《International journal of cardiology》2013
Background
The purpose of this study was to investigate the utility of mid-regional pro-adrenomedullin (MR-proADM) in the early diagnosis and risk stratification of patients with acute chest pain in comparison with established and novel biomarkers and risk scores.Methods
In this prospective, observational, international, multi-center trial (APACE), MR-proADM was determined in 1179 unselected patients with acute chest pain. Patients were followed for 24 months.Results
MR-proADM concentrations at presentation were higher in patients with AMI (median: 0.78 nmol/l, IQR 0.60–1.13) than in patients with other diagnoses (0.64 nmol/l, IQR 0.49–0.86 nmol/l; p < 0.001). The diagnostic accuracy of MR-proADM for AMI as quantified by the area under the receiver operating characteristic curve (AUC) was 0.66. Adding MR-proADM to hs-cTnT could not improve its diagnostic accuracy for AMI (p = 0.431). Seventy-six percent of all deaths occurred in the fourth quartile of MR-proADM (> 0.90 nmol/l). Adding MR-proADM to the TIMI-score (AUC 0.87) predicted 1-year mortality more accurately than the TIMI-score alone (AUC 0.82; p < 0.001). Net reclassification improvement (TIMI vs. additionally MR-proADM) amounted to 0.137 (p = 0.012). MR-proADM had higher prognostic accuracy as compared to hs-cTnT in patients with AMI (p = 0.015) and in those without AMI (p = 0.003). MR-proADM at presentation was tantamount to GRACE score and BNP as to its prognostic accuracy for mortality. The AUC for the prediction of cardiovascular events amounted to 0.63.Conclusions
While MR-proADM does not have clinical utility in the early diagnosis of AMI or predicting cardiovascular events in patients with acute chest pain, it may provide prognostic value for all-cause mortality. 相似文献19.
Nassim Naderi Hossein Masoomi Tahseen Mozaffar Shaista Malik 《International journal of cardiology》2014
Background
Although cerebrovascular accident (CVA) is a relatively infrequent complication of acute myocardial infarction (AMI), the occurrence of CVA in patients with AMI is associated with increased morbidity and mortality. We wanted to assess post-AMI CVA rate in the United States and identify the associated patient characteristics, comorbidities, type of AMI, and utilization of invasive procedures.Methods
This is an observational study from the Nationwide Inpatient Sample, 2006–2008. Using multivariate regression models, we assessed predictive risk factors for post-AMI CVA among patients admitted for AMI.Results
Among the 1,924,413 patients admitted for AMI, the overall rate of CVA was 2% (ischemic stroke: 1.47%, transient ischemic attack [TIA]: 0.35% and hemorrhagic stroke: 0.21%). In this sample of AMI patient, higher incidence of CVA was associated with: CHF (adjusted odds ratio [AOR] 1.71; 95% confidence interval [CI], 1.58–1.84,), age over 65 AOR, 1.65; 95% CI, 1.60–1.70, alcohol abuse AOR, 1.60; 95% CI, 1.49–1.73, cocaine use AOR, 1.48; 95% CI, 1.29–1.70, atrial fibrillation AOR, 1.43; 95% CI, 1.39–1.46, Black race AOR, 1.35; 95% CI, 1.30–1.40, female gender AOR, 1.32; 95% CI, 1.29–1.35, peripheral vascular disease [PVD] AOR, 1.26; 95% CI, 1.22–1.30, coronary artery bypass graft (CABG) AOR, 1.22; 95% CI, 1.17–1.27, P < 0.0001, STEMI AOR, 1.17; 95% CI, 1.14–1.20 and teaching hospitals AOR, 1.09; 95% CI, 1.06–1.12.Conclusion
Female gender, older age (age ≥ 65), black ethnicity, comorbidities including CHF, PVD, atrial fibrillation as well as STEMI and undergoing CABG were associated with the highest risk of CVA post-AMI. 相似文献20.
Joanna Kaluza Susanna C. Larsson Niclas Håkansson Alicja Wolk 《International journal of cardiology》2014