Modifiable risk factors (RFs) play an important role in the development and prognosis of acute myocardial infarction (AMI).
Objectives
This study sought to study the prevalence rates of modifiable RFs during a first AMI, sex/race differences, and temporal trends in U.S. young adults.
Methods
This was a retrospective cohort analysis of the U.S. National Inpatient Sample years 2005 and 2015 to identify adults 18 to 59 years of age hospitalized for a first AMI. Prevalence rates, race and sex differences, and temporal trends of hypertension, diabetes mellitus, obesity, smoking, dyslipidemia, and drug abuse were analyzed in these patients.
Results
The authors’ study included 1,462,168 young adults with a first AMI (mean age 50 ± 7 years, 71.5% men, 58.3% white) of whom 19.2% were 18 to 44 years of age, and 80.8% were 45 to 59 years of age. In the 18- to 44-year group, smoking (56.8%), dyslipidemia (51.7%), and hypertension (49.8%) were most prevalent, and 90.3% of patients had at least 1 RF. In the 45- to 59-year group, hypertension (59.8%), dyslipidemia (57.5%), and smoking (51.9%) were most prevalent, and 92% patients had at least 1 RF. Significant sex and racial disparities were observed in the prevalence of individual RFs. Women had a higher prevalence of diabetes mellitus, hypertension, and obesity, and men had a higher prevalence of dyslipidemia, drug abuse, and smoking. The prevalence of all these RFs increased temporally except for the rate of dyslipidemia, which decreased more recently. Trends were generally consistent across sex and racial groups.
Conclusions
During a first AMI in young adults in whom preventive measures are more likely to be effective, modifiable RFs were highly prevalent and progressively increased over time. Significant sex and racial disparities were observed for individual RFs. 相似文献
To review the methods available for the risk stratification of non-ST elevation (NSTE) acute coronary syndrome (ACS) patients and to evaluate the use of risk scores for their initial risk assessment.
DATA SOURCES:
The data of the present review were identified by searching PUBMED and other databases (1996 to 2008) using the key terms “risk stratification”, “risk scores”, “NSTEMI”, “UA” and “acute coronary syndrome”.
STUDY SELECTION:
Mainly original articles, guidelines and critical reviews written by major pioneer researchers in this field were selected.
RESULT:
After evaluation of several risk predictors and risk scores, it was found that estimating risk based on clinical characteristics is challenging and imprecise. Risk predictors, whether used alone or in simple binary combination, lacked sufficient precision because they have high specificity but low sensitivity. Risk scores are more accurate at stratifying NSTE ACS patients into low-, intermediate- or high-risk groups. The Global Registry of Acute Cardiac Events risk score was found to have superior predictive accuracy compared with other risk scores in ACS population. Treatments based according to specific clinical and risk grouping show that certain benefits may be predominantly or exclusively restricted to higher risk patients.
CONCLUSION:
Based on the trials in the literature, the Global Registry of Acute Cardiac Events risk score is more advantageous and easier to use than other risk scores. It can categorize a patient’s risk of death and/or ischemic events, which can help tailor therapy to match the intensity of the patient’s NSTE ACS. 相似文献
Review of: Bonaca MP, Bhatt DL, Cohen M, et al. Long-term use of ticagrelor in patients with prior myocardial infarction. N Engl J Med. 2015;372:1791-1800.
This Practice Pearl reviews the recent study Prevention of Cardiovascular Events in Patients with Prior Heart Attack Using Ticagrelor Compared With Placebo on a Background of Aspirin-Thrombolysis in Myocardial Infarction 54 (PEGASUS-TIMI 54). It challenges the current standard of care of 12 months of dual antiplatelet followed by aspirin indefinitely. The study demonstrated that patients who received ticagrelor, either the 60 mg or 90 mg twice daily plus aspirin, showed a decreased risk of cardiovascular death, myocardial infarction, or stroke. The PEGASUS-TIMI 54 trial also proved that the benefit of ticagrelor was seen early and continued to accrue over time, with a median of 33 months of follow-up, meaning that the benefit persists over time. It is important to note that both doses of the ticagrelor were associated with higher incidence of bleeding, but the rates of fatal bleeding did not show any difference between the ticagrelor or placebo. 相似文献
Understanding the similarities and differences between myocardial infarction with or without ST-segment elevation is an essential step for proper patients’ management in current practice. Both syndromes are caused by critical stenosis or total occlusion of coronary arteries (mostly due to thrombosis on atherosclerotic plaque), and manifest with a similar clinical presentation. Recent epidemiologic studies show that the relative incidence of ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) moves in an opposite fashion (decreasing and increasing respectively), with a prognosis that is worse at short-term follow-up for STEMI but comparable at long-term. Current management differs, as for STEMIs, immediate reperfusion is recommended, while for NSTEMIs, risk stratification is mandatory in order to stratify patients’ risk, and then decide the timing for coronary angiography. Periprocedural and technical aspects of the interventional management, as well as antithrombotic medications, are for the most similarly implemented in the two types of MI, with routine radial access, DES implant, and novel P2Y12 inhibitors representing the standard of care in both cases.The following review article aims to compare the two types of MI, with and without persistent ST-segment elevation. The main purpose is to explore their similarities and differences and address areas of uncertainty with regards to clinical presentation, therapeutic management, and prognosis. The identification of high-risk NSTEMI patients is important as they may require an individualised approach that can substantially overlap with current STEMI recommendations, and their mortality remains high if their management is delayed. 相似文献
Fractional flow reserve (FFR) is the reference standard for the assessment of the functional significance of coronary artery stenoses, but remains underutilized. Our aims were to study whether FFR changed the decision for treatment of intermediate coronary lesions and to assess the clinical outcome in the deferred and intervention groups.
Methods
In this retrospective study, coronary angiograms of patients with moderately stenotic lesions (40–70%) for which FFR was performed were re-analyzed by three experienced interventional cardiologists (blinded to FFR results) to determine its angiographic significance and whether to defer or perform an intervention.
Results
We revised 156 equivocal lesions of 151 patients. The clinical presentation were stable angina (65.6%) and acute coronary syndrome in (34.4%). All reviewers had concordant agreement to do PCI in 59 (37.8%) lesions based on angiographic assessment. Interestingly 23 (39%) of these lesions were functionally non-significant by FFR. The reviewers agreed to defer 97 (62.2%) lesions, however, 32 (33%) of these lesions were functionally significant by FFR and necessitated PCI. MACE were similar in both groups (1.5% vs 2.4%, p?=?1.0).
Conclusion
Mismatches between visually- and FFR- estimated significance of intermediate coronary stenosis are frequently encountered across a wide spectrum of clinical presentations. FFR leads to a change in decision for coronary intervention. The clinical and cost implications of such changes-in areas with limited resources- needs further evaluation. 相似文献
We discuss a case report of a 66-year-old male with no prior cardiac history who presented to the hospital with persistent hiccups and shortness of breath. Following a positive nuclear stress test and cardiac catheterization, a rare anatomical variant of a sinoatrial nodal artery originating from the right posterolateral artery was revealed. 相似文献
AimStudies on the changes in the presentation and management of acute myocardial infarction (AMI) during the COVID-19 pandemic from low- and middle-income countries are limited. We sought to determine the changes in the number of admissions, management practices, and outcomes of AMI during the pandemic period in India.Methods & ResultsIn this two-timepoint cross-sectional study involving 187 hospitals across India, patients admitted with AMI between 15th March to 15th June in 2020 were compared with those admitted during the corresponding period of 2019.We included 41,832 consecutive adults with AMI. Admissions during the pandemic period (n = 16414) decreased by 35·4% as compared to the corresponding period in 2019 (n = 25418). We observed significant heterogeneity in this decline across India. The weekly average decrease in AMI admissions in 2020 correlated negatively with the number of COVID cases (r = −0·48; r2 = 0·2), but strongly correlated with the stringency of lockdown index (r = 0·95; r2 = 0·90). On a multi-level logistic regression, admissions were lower in 2020 with older age categories, tier 1 cities, and centers with high patient volume. Adjusted utilization rate of coronary angiography, and percutaneous coronary intervention decreased by 11·3%, and 5·9% respectively.ConclusionsThe magnitude of reduction in AMI admissions across India was not uniform. The nature, time course, and the patient demographics were different compared to reports from other countries, suggesting a significant impact due to the lockdown. These findings have important implications in managing AMI during the pandemic. 相似文献