scholarly journals Incidence of bifurcation coronary lesion as a culprit lesion in patients with acute myocardial infarction: Impact of treatment strategy on short and long term outcomes

2020 ◽  
Author(s):  
Hazar HARBALIOĞLU ◽  
Caner TURKOGLU ◽  
Taner ŞEKER ◽  
Alaa QUİSİ ◽  
Omer GENC ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Treatment Strategy ◽  
Culprit Lesion ◽  
Long Term Outcomes ◽  
Coronary Lesion ◽  
Short And Long Term

scholarly journals Impact of Admission Hyperglycemia on Short and Long-Term Prognosis in Acute Myocardial Infarction: MINOCA versus MIOCA

2021 ◽  
Author(s):  
Pasquale Paolisso ◽  
Alberto Foà ◽  
Luca Bergamaschi ◽  
Francesco Angeli ◽  
Michele Fabrizio ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Coronary Arteries ◽  
Hospital Death ◽  
Diabetic Patients ◽  
Long Term Outcomes ◽  
Short And Long Term ◽  
The Impact

Abstract BackgroundThe prognostic role of hyperglycemia in patients with myocardial infarction and obstructive coronary arteries (MIOCA) is acknowledged, while data on non-obstructive coronary arteries (MINOCA) are still lacking. Recently, we demonstrated that admission stress-hyperglycemia (aHGL) was associated with a larger infarct size and inflammatory response in MIOCA, while no differences were observed in MINOCA. We aim to investigate the impact of aHGL on short and long-term outcomes in MIOCA and MINOCA patients.MethodsMulticenter, population-based, cohort study of the prospective registry, designed to evaluate the prognostic information of patients admitted with acute myocardial infarction to S. Orsola-Malpighi and Maggiore Hospitals of Bologna metropolitan area. Among 2704 patients enrolled from 2016 to 2020, 2431 patients were classified according to the presence of aHGL (defined as admission glucose level ≥ 140mg/dL) and AMI phenotype (MIOCA/MINOCA): no-aHGL (n = 1321), aHGL (n = 877) in MIOCA and no-aHGL (n = 195), aHGL (n = 38) in MINOCA. Short-term outcomes included in-hospital death and arrhythmias. Long-term outcomes were all-cause and cardiovascular mortality.ResultsaHGL was associated with a higher in-hospital arrhythmic burden in MINOCA and MIOCA, with increased in-hospital mortality only in MIOCA. After adjusting for age, gender, hypertension, Killip class and AMI phenotypes, aHGL predicted higher in-hospital mortality in non-diabetic (HR = 4.2; 95% CI 1.9–9.5, p = 0.001) and diabetic patients (HR = 3.5, 95% CI 1.5–8.2, p = 0.003). During long-term follow-up, aHGL was associated with 2-fold increased mortality in MIOCA and a 4-fold increase in MINOCA (p = 0.032 and p = 0.016). Kaplan Meier 3-year survival of non-hyperglycemic patients was greater than in aHGL patients for both groups. No differences in survival were found between hyperglycemic MIOCA and MINOCA patients. After adjusting for age, gender, hypertension, smoking, LVEF, STEMI/NSTEMI and AMI phenotypes (MIOCA/MINOCA), aHGL predicted higher long-term mortality.ConclusionsaHGL was identified as a strong predictor of adverse short- and long-term outcomes in both MIOCA and MINOCA, regardless of diabetes. aHGL should be considered a high-risk prognostic marker in all AMI patients, independently of the underlying coronary anatomy.Trial Registrationdata were part of the ongoing observational study AMIPE: Acute Myocardial Infarction, Prognostic and Therapeutic Evaluation. ClinicalTrials.gov Identifier: NCT03883711.

Impact of high bleeding risk criteria on short- and long-term outcomes in patients with acute myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Dai ◽  
A.O Okada ◽  
Y.H Hyodo ◽  
T.N Nakano ◽  
S.T Tomomori ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Bleeding Risk ◽  
Long Term Outcomes ◽  
Kaplan Meier ◽  
Short And Long Term ◽  
High Bleeding Risk ◽  
Minor Criteria ◽  
The Impact

Abstract Background The Academic Research Consortium (ARC) proposed the new definition of high bleeding risk (HBR) criteria. It remains unknown about the prevalence and the impact of HBR on clinical outcome after acute myocardial infarction (AMI). Purpose To assess the prevalence and the impact of HBR on short- and long-term outcomes in patients with AMI. Methods Between January 2015 and January 2018, 412 patients with AMI underwent coronary angiography within 24 hours after the onset of chest pain. According to HBR criteria proposed by ARC, we divided patients into 2 groups; HBR and non-HBR group. We considered a patient HBR if the patient met at least 1 major criteria or 2 minor criteria. Major criteria included severe CKD (eGFR<30 ml/min), severe anemia (Hgb<11 g/dl), active cancer, and the use of oral anticoagulant drug. Minor criteria included high age (≥75), moderate CKD (eGFR 30–59 ml/min), moderate anemia (Hgb 11–12.9 g/dl for men and 11–11.9 g/dl for women). Kaplan-meier method was used to compare long-term outcome of HBR and non-HBR group. Major adverse cardiovascular events (MACE) were defined as all-cause death, non-fetal MI, and stroke. Results Patients with HBR were found in 37% of patients with AMI. In-hospital mortality (11.3% vs 4.2%, p=0.008) and MACE rate was significantly higher in HBR than non-HBR group (Figure). HBR group was associated with higher all-cause death (15.7% vs 2.5%, p<0.0001) and intracranial bleeding (4.8% vs 0.5%, p=0.02) than non-HBR group, although the incidence of non-fetal MI was comparable between two groups (7.6% vs 8.5%, p=0.76). Conclusions AMI patients with HBR were associated with worse outcomes both short- and long-term. Kaplan-Meier curves for MACE Funding Acknowledgement Type of funding source: None

scholarly journals Impact of admission hyperglycemia on short and long-term prognosis in acute myocardial infarction: MINOCA versus MIOCA

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Pasquale Paolisso ◽  
Alberto Foà ◽  
Luca Bergamaschi ◽  
Francesco Angeli ◽  
Michele Fabrizio ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Coronary Arteries ◽  
Hospital Death ◽  
Diabetic Patients ◽  
Long Term Outcomes ◽  
Short And Long Term ◽  
The Impact

Abstract Background The prognostic role of hyperglycemia in patients with myocardial infarction and obstructive coronary arteries (MIOCA) is acknowledged, while data on non-obstructive coronary arteries (MINOCA) are still lacking. Recently, we demonstrated that admission stress-hyperglycemia (aHGL) was associated with a larger infarct size and inflammatory response in MIOCA, while no differences were observed in MINOCA. We aim to investigate the impact of aHGL on short and long-term outcomes in MIOCA and MINOCA patients. Methods Multicenter, population-based, cohort study of the prospective registry, designed to evaluate the prognostic information of patients admitted with acute myocardial infarction to S. Orsola-Malpighi and Maggiore Hospitals of Bologna metropolitan area. Among 2704 patients enrolled from 2016 to 2020, 2431 patients were classified according to the presence of aHGL (defined as admission glucose level ≥ 140 mg/dL) and AMI phenotype (MIOCA/MINOCA): no-aHGL (n = 1321), aHGL (n = 877) in MIOCA and no-aHGL (n = 195), aHGL (n = 38) in MINOCA. Short-term outcomes included in-hospital death and arrhythmias. Long-term outcomes were all-cause and cardiovascular mortality. Results aHGL was associated with a higher in-hospital arrhythmic burden in MINOCA and MIOCA, with increased in-hospital mortality only in MIOCA. After adjusting for age, gender, hypertension, Killip class and AMI phenotypes, aHGL predicted higher in-hospital mortality in non-diabetic (HR = 4.2; 95% CI 1.9–9.5, p = 0.001) and diabetic patients (HR = 3.5, 95% CI 1.5–8.2, p = 0.003). During long-term follow-up, aHGL was associated with 2-fold increased mortality in MIOCA and a 4-fold increase in MINOCA (p = 0.032 and p = 0.016). Kaplan Meier 3-year survival of non-hyperglycemic patients was greater than in aHGL patients for both groups. No differences in survival were found between hyperglycemic MIOCA and MINOCA patients. After adjusting for age, gender, hypertension, smoking, LVEF, STEMI/NSTEMI and AMI phenotypes (MIOCA/MINOCA), aHGL predicted higher long-term mortality. Conclusions aHGL was identified as a strong predictor of adverse short- and long-term outcomes in both MIOCA and MINOCA, regardless of diabetes. aHGL should be considered a high-risk prognostic marker in all AMI patients, independently of the underlying coronary anatomy. Trial registration data were part of the ongoing observational study AMIPE: Acute Myocardial Infarction, Prognostic and Therapeutic Evaluation. ClinicalTrials.gov Identifier: NCT03883711.

Abstract 3518: High Remnant Lipoprotein Levels Adversely Affect Short- and Long-term Outcomes for Patients with Acute Myocardial Infarction and Type 2 Diabetes Mellitus

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Takamitsu Nakamura ◽  
Mitsumasa Hirano ◽  
Yoshinobu Kitta ◽  
Yasushi Kodama ◽  
Akira Mende ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Long Term Outcomes ◽  
Remnant Lipoprotein ◽  
Type 2 Dm ◽  
Short And Long Term

Diabetes mellitus (DM) adversely affects prognosis in patients with acute myocardial infarction (AMI). Evidence shows that lipids-lowering therapy rather than glycemic control reduces macrovascular events in these patients, but it remains unclear which lipoprotein fractions contribute to negative effects. We previously showed that high levels of remnant lipoprotein, a triglyceride-rich lipoprotein, were an independent risk of future coronary events in patients with chronic coronary artery disease and DM. This study examined the hypothesis that remnant lipoproteinemia may adversely affect short- and long-term prognosis in patients with AMI and DM. Methods and Results: A prospective study was performed in 268 consecutive patients with Type 2 DM who were enrolled on day 5 after AMI. Fasting serum levels of remnant lipoproteins (remnant-like lipoprotein particles cholesterol; RLP-C) on day 5 after AMI were measured by an immunoseparation method. Adverse events, a composite of cardiac death, nonfatal MI, or recurrent unstable myocardial ischemia leading to unplanned revascularization therapy, were assessed during follow-up periods of 30 days and 1 year after AMI. Events rates were higher in patients with than without higher RLP-C levels (≥ 5.5 mg/dL, 50 th percentile of the distribution) during both short- and long-term follow-up periods (30 days post-MI, 8.2% [11/134 patients] vs. 2.2% [3/134 patients], p <0.05; 1 year post-MI, 15% [20] vs. 7.5% [10], p <0.05). In multivariate Cox hazard analyses, higher RLP-C levels were a significant predictor of adverse events during 30 days and 1 year independently of enrollment levels of glucose, LDL-C, and non-HDL-C (hazard ratios 2.1 and 1.7, 95% CI 1.8 – 3.9 and 1.3 – 4.0, respectively, both p<0.01). RLP-C levels were significantly correlated with C-reactive protein levels and intimal thickening of carotid artery at enrollment (r =0.30 and 0.39, respectively, both p<0.01). Conclusions: High remnant lipoprotein levels adversely affect short- and long-term outcomes in patients with AMI and Type 2 DM. The pro-inflammatory and pro-atherothrombogenic effects of remnant lipoprotein may contribute to coronary plaques instability in patients with AMI and Type 2 DM.

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