POST-DISCHARGE INITIATION OF MINERALOCORTICOID RECEPTOR ANTAGONISTS IN PATIENTS WITH POST-STEMI LV DYSFUNCTION: FOLLOW-UP STUDY FROM THE VANCOUVER COASTAL HEALTH AUTHORITY ST-ELEVATION MYOCARDIAL INFARCTION PROGRAM

2020 ◽  
Vol 36 (10) ◽  
pp. S13
Author(s):  
E. Wong ◽  
C. Fordyce ◽  
G. Wong ◽  
T. Lee ◽  
M. Arnesen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Health Authority ◽  
Mineralocorticoid Receptor ◽  
St Elevation Myocardial Infarction ◽  
Mineralocorticoid Receptor Antagonists ◽  
Post Discharge ◽  
Follow Up Study ◽  
Lv Dysfunction ◽  
St Elevation

Abstract 332: Persistent Use Of Evidence-Based Medications After Discharge Among Patients With Non-ST Elevation Myocardial Infarction Treated At Academic Versus Non-Academic Hospitals

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Jennifer Rymer ◽  
Lisa McCoy ◽  
Laine Thomas ◽  
Eric Peterson ◽  
Tracy Wang
Keyword(s):  
Myocardial Infarction ◽  
Beta Blockers ◽  
St Elevation Myocardial Infarction ◽  
Hospital Treatment ◽  
Evidence Based ◽  
Post Discharge ◽  
Academic Hospitals ◽  
St Elevation ◽  
And Gender

Background: While academic hospitals are more likely to apply evidence-based therapies in-hospital for patients with non-ST elevation myocardial infarction (NSTEMI) than non-academic hospitals, differences in post-discharge persistence of evidence-based medications have never been evaluated. Methods: We examined 3,184 NSTEMI patients over age 65 treated at 250 hospitals in 2006 in the CRUSADE registry linked to Medicare part D pharmacy data. Using multivariable Poisson regression adjusting for case mix, we compared continued filling of prescriptions for beta-blockers, ACEI/ARB, clopidogrel, and statins at 90 days and 1 year post-discharge between patients treated at academic and non-academic hospitals. Results: Patients treated at academic hospitals were more frequently non-white (19% vs. 8%, p<0.001), but age (median 76 years) and gender (53% female) were not significantly different from patients treated at non-academic hospitals. Patients at academic hospitals were more likely to have a Charlson score >4 (36% vs. 30%, p=0.001), yet the rates of in-hospital PCI (48%) and CABG (8%) were similar between groups. Rates of persistence to evidence-based medications did not differ substantially between patients treated at academic vs. non-academic hospitals at 90 days or 1 year (Table). Persistence to all drug classes prescribed at discharge was low and not significantly different between academic and non-academic hospitals at 90 days (46% vs. 45%, p=0.44 with adjusted incidence rate ratio (IRR)=0.99 (0.95,1.04) and at 1-year (39% vs. 39%, p=0.93, adjusted IRR=1.02 (0.98,1.07)). There were no significant differences in index hospitalization duration (median 4 days, interquartile range (IQR) 3-6 for both, p=0.51) and time to first post-discharge cardiac follow-up visit (median 28 days [IQR 15-54] vs. 28 days [IQR 16-56], p=0.25) between patients treated at academic vs. non-academic hospitals. Conclusion: Rates of persistence to evidence-based medications were similar between older NSTEMI patients treated at academic vs. non-academic hospitals, and may reflect similar in-hospital treatment and post-discharge cardiac follow-up. However, persistence rates are low both early and late post-discharge, highlighting a continued need for quality improvement efforts to optimize post-MI management.

Early vascular responses to ultrathin biodegradable polymer sirolimus-eluting stent for the treatment of st-elevation myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y Oishi ◽  
T Shinke ◽  
H Tanaka ◽  
K Ogura ◽  
K Arai ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Clinical Outcomes ◽  
Antiplatelet Therapy ◽  
St Elevation Myocardial Infarction ◽  
Current Generation ◽  
Vascular Responses ◽  
Post Procedure ◽  
St Elevation ◽  
Sirolimus Eluting Stent

Abstract Background Recent clinical study suggests newer-generation drug-eluting stents (DES) that combine ultrathin strut and nano-coating with biodegradable polymers sirolimus-eluting stent (BP-SES) could improve long-term clinical outcomes in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) over current generation DES. However, safety profiles in very early phase have not been systematically addressed. Objective and method We exploratory investigate early vascular response following BP-SES implantation in patients with STEMI to reveal mechanism of the favorable clinical outcomes in recent studies using frequency domain-optical coherence tomography (FD-OCT). Consecutive twenty patients with STEMI who underwent FD-OCT immediately after primary PCI and were eligible for follow-up FD-OCT at 2 weeks after implantation were enrolled between June 2018 and November 2019. Results Twenty patients (age 62.7±11.3 years, male 85.0%) were enrolled with frequencies of hypertension (45.0%), diabetes mellitus (35.0%), dyslipidemia (55.0%) and smoking (80.0%). Aspiration catheter were used in all patients, and 1.13±0.34 stents were used. Only one patient (5.0%) received chronic antiplatelet therapy with aspirin prior to the onset of STEMI. All patients started to receive prasugrel as thienopyridine from this event and continued dual antiplatelet therapy for 2 weeks. The percentage of uncovered struts significantly decreased from post-procedure to 2W follow-up (69±18% post-procedure versus 30±11% at 2W follow up, p&lt;0.0001). Malapposed struts also decreased (5.6±5.7% post-procedure versus0.9±1.2% at 2W follow up, p&lt;0.0001).The average protrusion area of athero-thrombotic burden numerically decreased (0.37±0.19 at post-procedure versus 0.34±0.14 mm2 at 2W follow up, p=0.19) and its volume showed similar tendency (10.60±6.40 at post-procedure versus 9.36±5.14 mm3 at 2W follow up, p=0.19). Conclusion(s) This study firstly elucidated very early vascular responses following ultrathin strut BP-SES implantation in STEMI patients, showing early progression of strut coverage and resolution of athero-thrombotic materials. This technology may have a potential to overcome the current generation DESs in this clinical setting. Thrombus, uncovered and malapposed struts Funding Acknowledgement Type of funding source: None

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