15 results on '"Acute Coronary Syndrome/mortality"'
Search Results
2. ProACS risk score: An early and simple score for risk stratification of patients with acute coronary syndromes
- Author
-
Sílvia Aguiar Rosa, Rui Cruz Ferreira, Marta Afonso Nogueira, Adriana Belo, and Ana Teresa Timóteo
- Subjects
Male ,lcsh:Diseases of the circulatory (Cardiovascular) system ,Acute coronary syndrome ,medicine.medical_specialty ,Time Factors ,Population ,030204 cardiovascular system & hematology ,HSM CAR ,Logistic regression ,Risk Assessment ,Acute Coronary Syndrome/mortality ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Linear regression ,medicine ,Humans ,Hospital Mortality ,Registries ,Acute Coronary Syndrome ,education ,General Environmental Science ,Aged ,Killip class ,education.field_of_study ,Framingham Risk Score ,Portugal ,business.industry ,medicine.disease ,030228 respiratory system ,lcsh:RC666-701 ,Cohort ,General Earth and Planetary Sciences ,Female ,Medical emergency ,Cardiology and Cardiovascular Medicine ,business ,Risk assessment - Abstract
Introduction: There are barriers to proper implementation of risk stratification scores in patients with acute coronary syndromes (ACS), including their complexity. Our objective was to develop a simple score for risk stratification of all-cause in-hospital mortality in a population of patients with ACS. Methods: The score was developed from a nationwide ACS registry. The development and internal validation cohorts were obtained from the first 31 829 patients, randomly separated (60% and 40%, respectively). The external validation cohort consisted of the last 8586 patients included in the registry. This cohort is significantly different from the other cohorts in terms of baseline characteristics, treatment and mortality. Multivariate logistic regression analysis was used to select four variables with the highest predictive potential. A score was allocated to each parameter based on the regression coefficient of each variable in the logistic regression model: 1 point for systolic blood pressure ≤116 mmHg, Killip class 2 or 3, and ST-segment elevation; 2 points for age ≥72 years; and 3 points for Killip class 4. Results: The new score had good discriminative ability in the development cohort (area under the curve [AUC] 0.796), and it was similar in the internal validation cohort (AUC 0.785, p=0.333). In the external validation cohort, there was also excellent discriminative ability (AUC 0.815), with an adequate fit. Conclusions: The ProACS risk score enables easy and simple risk stratification of patients with ACS for in-hospital mortality that can be used at the first medical contact, with excellent predictive ability in a contemporary population. Resumo: Introdução: Existem algumas barreiras à implementação adequada dos scores de estratificação de risco em doentes com síndrome coronária aguda (SCA), tais como a sua complexidade. O nosso objetivo foi desenvolver um score simples para estratificação de risco de mortalidade hospitalar de todas as causas numa população de doentes com SCA. Métodos: O score foi desenvolvido a partir de um registo nacional de SCA. A coorte de desenvolvimento e de validação interna foi obtida a partir dos primeiros 31 829 doentes, aleatoriamente separados (60 e 40%, respetivamente). A coorte de validação externa é composta pelos últimos 8586 doentes incluídos no registo. Esta coorte é significativamente diferente das restantes (características basais, tratamento e mortalidade). Foi utilizada análise de regressão logística multivariada para selecionar as quatro variáveis com maior potencial preditivo e foi atribuída uma pontuação baseada no coeficiente de regressão de cada variável no modelo de regressão logística: um ponto para TAS ≤ 116 mmHg, classe Killip 2 ou 3, e elevação segmento ST, dois pontos para idade ≥ 72 anos e três pontos para classe Killip 4. Resultados: O novo score tem uma boa capacidade preditiva na coorte de desenvolvimento (area under curve [AUC] 0,796), semelhante à coorte de validação interna (AUC 0,785, p=0,333). Na coorte de validação externa também apresentou uma excelente capacidade discriminativa (AUC 0,815), com calibração adequada. Conclusões: O score de risco ProACS permite uma estratificação de risco precoce e simples em doentes com SCA para mortalidade hospitalar, que pode ser utilizada no primeiro contacto médico, com excelente capacidade preditiva numa população contemporânea. Keywords: Risk stratification score, Acute coronary syndromes, Prognosis, Palavras-chave: Score de estratificação de risco, Síndromes coronárias agudas, Prognóstico
- Published
- 2017
3. Diabetes and baseline glucose are associated with inflammation, left ventricular function and short- and long-term outcome in acute coronary syndromes: role of the novel biomarker Cyr 61
- Author
-
Olivier Muller, Arnold von Eckardstein, Allan Davies, Roland Klingenberg, Christian M. Matter, Christian Templin, Marco Roffi, Lorenz Räber, Thomas F. Lüscher, François Mach, Fabian Nietlispach, Baris Gencer, David Nanchen, Patric Winzap, Slayman Obeid, Stephan Windecker, University of Zurich, and Lüscher, Thomas F
- Subjects
Blood Glucose ,Male ,lcsh:Diseases of the circulatory (Cardiovascular) system ,Time Factors ,Endocrinology, Diabetes and Metabolism ,030204 cardiovascular system & hematology ,Ventricular Function, Left ,Body Mass Index ,11459 Center for Molecular Cardiology ,0302 clinical medicine ,Risk Factors ,030212 general & internal medicine ,Myocardial infarction ,Prospective Studies ,Stroke ,Original Investigation ,10038 Institute of Clinical Chemistry ,2. Zero hunger ,Ejection fraction ,Diabetes ,Middle Aged ,Prognosis ,3. Good health ,2712 Endocrinology, Diabetes and Metabolism ,10209 Clinic for Cardiology ,Biomarker (medicine) ,Female ,Inflammation Mediators ,Cardiology and Cardiovascular Medicine ,Switzerland ,Major cardiovascular and cerebrovascular events ,Acute coronary syndrome ,medicine.medical_specialty ,Acute Coronary Syndrome/blood ,Acute Coronary Syndrome/mortality ,Acute Coronary Syndrome/physiopathology ,Acute Coronary Syndrome/therapy ,Aged ,Biomarkers/blood ,Blood Glucose/metabolism ,Cysteine-Rich Protein 61/blood ,Diabetes Mellitus/blood ,Diabetes Mellitus/mortality ,Diabetes Mellitus/therapy ,Glycated Hemoglobin A ,Humans ,Hyperglycemia/blood ,Hyperglycemia/mortality ,Hyperglycemia/therapy ,Inflammation/blood ,Inflammation/mortality ,Inflammation/therapy ,Inflammation Mediators/blood ,Percutaneous Coronary Intervention ,Risk Assessment ,Stroke Volume ,Acute coronary syndromes ,Glucose ,Inflammation ,Mortality ,610 Medicine & health ,2705 Cardiology and Cardiovascular Medicine ,03 medical and health sciences ,Diabetes mellitus ,Internal medicine ,medicine ,Diabetes Mellitus ,cardiovascular diseases ,Acute Coronary Syndrome ,Glycated Hemoglobin ,business.industry ,medicine.disease ,lcsh:RC666-701 ,2724 Internal Medicine ,Hyperglycemia ,business ,Body mass index ,Mace ,Biomarkers ,Cysteine-Rich Protein 61 - Abstract
Background Hyperglycemia in the setting of an acute coronary syndrome (ACS) impacts short term outcomes, but little is known about longer term effects. We therefore designed this study to firstly determine the association between hyperglycemia and short term and longer term outcomes in patients presenting with ACS and secondly evaluate the prognostic role of diabetes, body mass index (BMI) and the novel biomarker Cyr61 on outcomes. Methods The prospective Special Program University Medicine-Acute Coronary Syndrome (SPUM-ACS) cohort enrolled 2168 patients with ACS between December 2009 and October 2012, of which 2034 underwent PCI (93.8%). Patients were followed up for 12 months. Events were independently adjudicated by three experienced cardiologists. Participants were recruited from four tertiary hospitals in Switzerland: Zurich, Geneva, Lausanne and Bern. Participants presenting with acute coronary syndromes and who underwent coronary angiography were included in the analysis. Patients were grouped according to history of diabetes (or HbA1c greater than 6%), baseline blood sugar level (BSL; 11.1 mmol/L) and body mass index (BMI). The primary outcome was major adverse cardiac events (MACE) which was a composite of myocardial infarction, stroke and all-cause death. Secondary outcomes included the individual components of the primary endpoint, revascularisations, bleeding events (BARC classification) and cerebrovascular events (ischaemic or haemorrhagic stroke or TIA). Results Patients with hyperglycemia, i.e. BSL ≥ 11.1 mmol/L, had higher levels of C-reactive protein (CRP), white blood cell count (WBC), creatinine kinase (CK), higher heart rates and lower left ventricular ejection fraction (LVEF) and increased N-terminal pro-brain natriuretic peptide. At 30 days and 12 months, those with BSL ≥ 11.1 mmol/L had more MACE and death compared to those with BSL Conclusions and relevance In this large, prospective, independently adjudicated cohort of in all comers ACS patients undergoing PCI, both a history of diabetes and elevated entry glucose was associated with inflammation and increased risk of MACE both at short and long-term. The mediators might involve increased sympathetic activation, inflammation and ischemia as reflected by elevated Cyr61 levels leading to larger levels of troponin and lower LVEF. Trial registration Clinical Trial Registration Number: NCT01000701. Registered October 23, 2009
- Published
- 2019
4. Income level and inequality as complement to geographical differences in cardiovascular trials
- Author
-
Patrick Rossignol, William B. White, Zohra Lamiral, Bertram Pitt, João Pedro Ferreira, John J.V. McMurray, Pooja Dewan, Faiez Zannad, Centre d'investigation clinique plurithématique Pierre Drouin [Nancy] (CIC-P), Centre d'investigation clinique [Nancy] (CIC), Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM), Center for Molecular and Vascular Biology, Catholic University of Leuven - Katholieke Universiteit Leuven (KU Leuven), University of Michigan [Ann Arbor], University of Michigan System, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM), Contrat de Plan Etat-Lorraine and FEDER Lorraine, Pfizer (EPHESUS, EMPHASIS-HF), Takeda (EXAMINE), IMPACT GEENAGE, ANR-15-IDEX-0004,LUE,Isite LUE(2015), ANR-15-RHUS-0004,FIGHT-HF,Combattre l'insuffisance cardiaque(2015), Centre d'investigation clinique plurithématique Pierre Drouin (CIC-P), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), CIC-Nancy, Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy]-Institut National de la Santé et de la Recherche Médicale (INSERM), ANR-15-IDEX-04-LUE,LUE,Lorraine Université d'Excellence(2016), and ANR-15-RHU-0004,FIGHT-HF ,Fighting Heart Failure
- Subjects
Male ,Inequality ,media_common.quotation_subject ,[SDV]Life Sciences [q-bio] ,Ethnic group ,low-middle income (LMICs) ,030204 cardiovascular system & hematology ,cardiovascular (CV) trials ,03 medical and health sciences ,0302 clinical medicine ,Economic inequality ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,Cause of Death ,Health care ,Outcome Assessment, Health Care ,Medicine ,Humans ,Multicenter Studies as Topic ,030212 general & internal medicine ,country or regional differences ,Acute Coronary Syndrome ,10. No inequality ,Developing Countries ,media_common ,Cause of death ,Aged ,Randomized Controlled Trials as Topic ,Heart Failure ,business.industry ,Mortality rate ,Developed Countries ,1. No poverty ,Age Factors ,countries with greater inequality ,Per capita income ,medicine.disease ,Prognosis ,Comorbidity ,MESH: Acute Coronary Syndrome/ethnology ,Acute Coronary Syndrome/mortality ,Acute Coronary Syndrome/therapy ,Developed Countries/economics ,Developing Countries/economics ,Female ,Guideline Adherence/statistics & numerical data ,Heart Failure/ethnology ,Heart Failure/mortality ,Heart Failure/therapy ,Income ,Outcome Assessment ,Health Care ,Socioeconomic Factors ,3. Good health ,Guideline Adherence ,Cardiology and Cardiovascular Medicine ,business ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology ,Demography - Abstract
International audience; BACKGROUND:Analyses of country or regional differences in cardiovascular (CV) trials are based on geographical subgroup analyses. However, apart from map location and related racial, ethnic, and genetic variations, identified differences may also depend on social structure and provision and access to health care, for which country income and income inequality are indicators. The aim of the study was to examine the association between country per capita income and income inequality and prognosis in patients with heart failure or an acute coronary syndrome in 3 international trials (EMPHASIS-HF, EPHESUS, and EXAMINE).METHODS:Countries were classified into high income or low-middle income (LMICs) and into low, middle, or high inequality using the Gini index. The main outcome measures were all-cause and CV death.RESULTS:Patients from LMICs and countries with higher inequality were younger, were less often white, had fewer comorbid conditions, and were less often treated with guideline-recommended therapies, including devices. These patients had higher adjusted mortality rates (+15% to +70%) compared with patients from high-income countries and countries with less inequality. Patients from countries with the combination of greater inequality and low-middle income had particularly high mortality rates (+80% to +190%) compared with those that did not have both characteristics. Living in a country that is poor and has inequality had more impact on death rates than any comorbidity. These findings were reproduced in 3 trials.CONCLUSIONS:Patients from LMICs and countries with greater inequality had the highest mortality rates. The prognostic impact of income and inequality is substantial and should be considered when looking into subgroup differences in CV trials.Copyright © 2019 Elsevier Inc. All rights reserved.
- Published
- 2019
5. Impact of Periodontal Disease on Late Morbimortality (10 Years) of Pacientes with Acute Coronary Syndrome
- Author
-
Moacir Fernandes de Godoy, Gabriel Andrey Ricci, Luis Lemos Moras, Marina Bragheto Oliveira, Thamara Angeliny Carvalho, and Renata Accarini
- Subjects
Acute coronary syndrome ,medicine.medical_specialty ,business.industry ,Proportional hazards model ,Medical record ,Hazard ratio ,Dental Plaque ,030206 dentistry ,030204 cardiovascular system & hematology ,Periodontal Diseases/complications ,Dental plaque ,medicine.disease ,Acute Coronary Syndrome/mortality ,03 medical and health sciences ,0302 clinical medicine ,Oral microbiology ,Internal medicine ,Medicine ,Risk factor ,business ,Prospective cohort study ,Gengivitis, Plaque Atherosclerotic - Abstract
Background: It is known that predisposing factors for periodontal disease (PD) and cardiovascular diseases are similar, just as dissemination of oral flora pathogens can induce the development of cardiovascular diseases, which play a direct role on the morbimortality of patients. Objective: To assess the impact of periodontal disease in the presence of acute coronary syndrome on late morbimortality after long-term follow-up of patients (10 years). Methods: The historical prospective study of continuous assessment was based on the evaluation of 345 medical records of patients hospitalized for acute coronary syndrome, divided into 3 groups: edentulous, with periodontal disease and without periodontal disease. The patients studied were in the ICU, in 2006, with a clinical picture of acute coronary syndrome submitted to invasive stratification with coronary angiography on the basis of clinical indication and were reassessed over the next 10 years. The qualitative variables were compared using the Chi-square test. Long-term mortality was assessed using the Kaplan-Meier curves, quantified with the hazard ratio (HR) and a confidence interval of 95% and compared through Cox regression. P values of less than or equal to 0.05 were regarded as statistically significant. Results: Of the 345 patients, 233 had at least one coronary obstruction greater than or equal to 50%, being the main group for comparison according to the different status of periodontal disease (without periodontal disease, with periodontal disease and edentulous). In this cardiovascular condition, we found a difference in mortality among edentulous patients compared to those free of periodontal disease, with a p = 0.004 and a hazard ratio of 10.496 (95% CI: 4.988-22.089). A significant difference was also noted between edentulous patients and patients with periodontal disease, with a p = 0.0017 and a hazard ratio of 2.512 (95% CI: 1.491-4.234). Conclusion: A significant increase in mortality was found according with the progression of periodontal disease, which justifies its classification as an important risk factor for the development of cardiovascular diseases, as well as the need for prevention and treatment of oral diseases.
- Published
- 2018
6. Drug-eluting stents versus bare-metal stents for acute coronary syndrome
- Author
-
Christian Gluud, Janette Greenhalgh, Joshua Feinberg, Sanam Safi, Janus Christian Jakobsen, Juliet Hounsome, Naqash J Sethi, and Emil Eik Nielsen
- Subjects
Acute coronary syndrome ,medicine.medical_specialty ,medicine.medical_treatment ,education ,030204 cardiovascular system & hematology ,Acute Coronary Syndrome/mortality ,Angina ,03 medical and health sciences ,0302 clinical medicine ,Cause of Death ,Internal medicine ,medicine ,Humans ,Pharmacology (medical) ,Stents/adverse effects ,cardiovascular diseases ,030212 general & internal medicine ,Myocardial infarction ,Acute Coronary Syndrome ,Randomized Controlled Trials as Topic ,Unstable angina ,business.industry ,Drug-Eluting Stents/adverse effects ,Absolute risk reduction ,Percutaneous coronary intervention ,Drug-Eluting Stents ,equipment and supplies ,medicine.disease ,Surgery ,Clinical trial ,surgical procedures, operative ,Relative risk ,Stents ,business - Abstract
Background Approximately 3.7 million people died from acute coronary syndrome worldwide in 2012. Acute coronary syndrome, also known as myocardial infarction or unstable angina pectoris, is caused by a sudden blockage of the blood supplied to the heart muscle. Percutaneous coronary intervention is often used for acute coronary syndrome, but previous systematic reviews on the effects of drug-eluting stents compared with bare-metal stents have shown conflicting results with regard to myocardial infarction; have not fully taken account of the risk of random and systematic errors; and have not included all relevant randomised clinical trials. Objectives To assess the benefits and harms of drug-eluting stents versus bare-metal stents in people with acute coronary syndrome. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, LILACS, SCI-EXPANDED, and BIOSIS from their inception to January 2017. We also searched two clinical trials registers, the European Medicines Agency and the US Food and Drug Administration databases, and pharmaceutical company websites. In addition, we searched the reference lists of review articles and relevant trials. Selection criteria Randomised clinical trials assessing the effects of drug-eluting stents versus bare-metal stents for acute coronary syndrome. We included trials irrespective of publication type, status, date, or language. Data collection and analysis We followed our published protocol and the methodological recommendations of Cochrane. Two review authors independently extracted data. We assessed the risks of systematic error by bias domains. We conducted Trial Sequential Analyses to control the risks of random errors. Our primary outcomes were all-cause mortality, major cardiovascular events, serious adverse events, and quality of life. Our secondary outcomes were angina, cardiovascular mortality, and myocardial infarction. Our primary assessment time point was at maximum follow-up. We assessed the quality of the evidence by the GRADE approach. Main results We included 25 trials randomising a total of 12,503 participants. All trials were at high risk of bias, and the quality of evidence according to GRADE was low to very low. We included 22 trials where the participants presented with ST-elevation myocardial infarction, 1 trial where participants presented with non-ST-elevation myocardial infarction, and 2 trials where participants presented with a mix of acute coronary syndromes. Meta-analyses at maximum follow-up showed no evidence of a difference when comparing drug-eluting stents with bare-metal stents on the risk of all-cause mortality or major cardiovascular events. The absolute risk of death was 6.97% in the drug-eluting stents group compared with 7.74% in the bare-metal stents group based on the risk ratio (RR) of 0.90 (95% confidence interval (CI) 0.78 to 1.03, 11,250 participants, 21 trials/22 comparisons, low-quality evidence). The absolute risk of a major cardiovascular event was 6.36% in the drug-eluting stents group compared with 6.63% in the bare-metal stents group based on the RR of 0.96 (95% CI 0.83 to 1.11, 10,939 participants, 19 trials/20 comparisons, very low-quality evidence). The results of Trial Sequential Analysis showed that we did not have sufficient information to confirm or reject our anticipated risk ratio reduction of 10% on either all-cause mortality or major cardiovascular events at maximum follow-up. Meta-analyses at maximum follow-up showed evidence of a benefit when comparing drug-eluting stents with bare-metal stents on the risk of a serious adverse event. The absolute risk of a serious adverse event was 18.04% in the drug-eluting stents group compared with 23.01% in the bare-metal stents group based on the RR of 0.80 (95% CI 0.74 to 0.86, 11,724 participants, 22 trials/23 comparisons, low-quality evidence), and Trial Sequential Analysis confirmed this result. When assessing each specific type of adverse event included in the serious adverse event outcome separately, the majority of the events were target vessel revascularisation. When target vessel revascularisation was analysed separately, meta-analysis showed evidence of a benefit of drug-eluting stents, and Trial Sequential Analysis confirmed this result. Meta-analyses at maximum follow-up showed no evidence of a difference when comparing drug-eluting stents with bare-metal stents on the risk of cardiovascular mortality (RR 0.91, 95% CI 0.76 to 1.09, 9248 participants, 14 trials/15 comparisons, very low-quality evidence) or myocardial infarction (RR 0.98, 95% CI 0.82 to 1.18, 10,217 participants, 18 trials/19 comparisons, very low-quality evidence). The results of the Trial Sequential Analysis showed that we had insufficient information to confirm or reject our anticipated risk ratio reduction of 10% on cardiovascular mortality and myocardial infarction. No trials reported results on quality of life or angina. Authors' conclusions The current evidence suggests that drug-eluting stents may lead to fewer serious adverse events compared with bare-metal stents without increasing the risk of all-cause mortality or major cardiovascular events. However, our Trial Sequential Analysis showed that there currently was not enough information to assess a risk ratio reduction of 10% for all-cause mortality, major cardiovascular events, cardiovascular mortality, or myocardial infarction, and there were no data on quality of life or angina. The evidence in this review was of low to very low quality, and the true result may depart substantially from the results presented in this review. More randomised clinical trials with low risk of bias and low risks of random errors are needed if the benefits and harms of drug-eluting stents for acute coronary syndrome are to be assessed properly. More data are needed on the outcomes all-cause mortality, major cardiovascular events, quality of life, and angina to reduce the risk of random error.
- Published
- 2017
7. Anti-apolipoprotein A-1 IgG as an independent cardiovascular prognostic marker affecting basal heart rate in myocardial infarction
- Author
-
Magaly Python, Nicolas Vuilleumier, Guido Reber, Richard W. James, Emmanuel Charbonney, Rene Nkoulou, Michel F. Rossier, François Mach, Pascale Roux-Lombard, and Sabrina Pagano
- Subjects
Male ,Biological Markers/metabolism ,Myocardial Infarction ,Immunoglobulin G ,Stroke/mortality ,Heart Rate ,Reference Values ,Myocytes, Cardiac ,Myocardial infarction ,Prospective Studies ,Stroke ,ddc:616 ,Aged, 80 and over ,Heart Failure/mortality ,biology ,Middle Aged ,Prognosis ,Heart Rate/immunology ,Treatment Outcome ,Cardiology ,Female ,lipids (amino acids, peptides, and proteins) ,Cardiology and Cardiovascular Medicine ,Adult ,medicine.medical_specialty ,Acute coronary syndrome ,Dose-Response Relationship, Immunologic ,Enzyme-Linked Immunosorbent Assay ,Acute Coronary Syndrome/mortality ,Internal medicine ,Heart rate ,medicine ,Animals ,Humans ,Acute Coronary Syndrome ,Rats, Wistar ,Immunoglobulin G/*metabolism ,Myocardial Infarction/*diagnosis/mortality/physiopathology ,Aged ,Heart Failure ,Apolipoprotein A-I ,business.industry ,Arrhythmias, Cardiac/*diagnosis/physiopathology ,Reproducibility of Results ,Myocytes, Cardiac/immunology ,Arrhythmias, Cardiac ,medicine.disease ,Rats ,Endocrinology ,Heart failure ,biology.protein ,Myocardial infarction diagnosis ,business ,Apolipoprotein A-I/*immunology ,Mace ,Biomarkers - Abstract
AIMS: To assess the prognostic value of anti-apolipoprotein A-1 (anti-apoA-1) IgG after myocardial infarction (MI) and its association with major cardiovascular events (MACEs) at 12 months and to determine their association with resting heart rate (RHR), a well-established prognostic feature after MI. Anti-apoA-1 IgG have been reported in MI without autoimmune disease, but their clinical significance remains undetermined. METHODS AND RESULTS: A total of 221 consecutive patients with MI were prospectively included, and all completed a 12-month follow-up. Major cardiovascular events consisted in death, MI, stroke, or hospitalization either for an acute coronary syndrome or heart failure. Resting heart rate was obtained on Holter the day before discharge under the same medical treatment. Neonate rat ventricular cardiomyocytes (NRVC) were used in vitro to assess the direct anti-apoA-1 IgG effect on RHR. During follow-up, 13% of patients presented a MACE. Anti-apoA-1 IgG positivity was 9% and was associated with a higher RHR (P = 0.0005) and higher MACE rate (adjusted OR, 4.3; 95% CI, 1.46-12.6; P = 0.007). Survival models confirmed the significant nature of this association. Patients with MACE had higher median anti-apoA-1 IgG values at admission than patients without (P = 0.007). On NRVC, plasma from MI patients and monoclonal anti-apoA-1 IgG induced an aldosterone and dose-dependent positive chronotropic effect, abrogated by apoA-1 and therapeutic immunoglobulin (IVIG) pre-incubation. CONCLUSIONS: In MI patients, anti-apoA-1 IgG is independently associated with MACE at 1-year, interfering with a currently unknown aldosterone-dependent RHR determinant. Knowing whether anti-apoA-1 IgG assessment could be of interest to identify an MI patient subset susceptible to benefit from apoA-1/IVIG therapy remains to be demonstrated.
- Published
- 2017
8. Prognosis of cardiovascular and non-cardiovascular multimorbidity after acute coronary syndrome
- Author
-
Thomas F. Lüscher, Nicolas Rodondi, Roland Klingenberg, Stephan Windecker, François Mach, Lorenz Räber, Silvia Canivell, Dik Heg, Christian M. Matter, David Carballo, David Nanchen, Baris Gencer, Olivier Muller, University of Zurich, and Nanchen, David
- Subjects
Male ,Myocardial Infarction ,lcsh:Medicine ,Blood Pressure ,030204 cardiovascular system & hematology ,Vascular Medicine ,0302 clinical medicine ,Recurrence ,Risk Factors ,Medicine and Health Sciences ,Coronary Heart Disease ,Prospective Studies ,030212 general & internal medicine ,Myocardial infarction ,Family history ,lcsh:Science ,Prospective cohort study ,Stroke ,Aged, 80 and over ,2. Zero hunger ,Cardiac Rehabilitation ,Multidisciplinary ,Hazard ratio ,Drugs ,Middle Aged ,Angina ,Prognosis ,3. Good health ,Hospitalization ,Treatment Outcome ,Cardiovascular Diseases ,10209 Clinic for Cardiology ,Cardiology ,Female ,Research Article ,Acute coronary syndrome ,medicine.medical_specialty ,610 Medicine & health ,Rehabilitation Medicine ,03 medical and health sciences ,Diagnostic Medicine ,360 Social problems & social services ,Internal medicine ,medicine ,Humans ,Acute Coronary Syndrome ,Acute Coronary Syndrome/complications ,Acute Coronary Syndrome/diagnosis ,Acute Coronary Syndrome/mortality ,Aged ,Cardiovascular Diseases/complications ,Cardiovascular Diseases/mortality ,Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use ,Multimorbidity ,Multivariate Analysis ,Proportional Hazards Models ,Pharmacology ,1000 Multidisciplinary ,business.industry ,Proportional hazards model ,lcsh:R ,Statins ,medicine.disease ,lcsh:Q ,Hydroxymethylglutaryl-CoA Reductase Inhibitors ,business ,Body mass index - Abstract
OBJECTIVE To examine the prognosis of patients with cardiovascular and non-cardiovascular multimorbidity after acute coronary syndrome compared to patients without prior multimorbidity. METHODS This multicenter prospective cohort study in Switzerland included 5,635 patients hospitalized with acute coronary syndrome between 2009 and 2014, with a one-year follow-up period. We defined cardiovascular and non-cardiovascular multimorbidity as having at least two prior comorbidities before the index hospitalization. Multivariable adjusted Cox proportional models were built to assess the one-year risk of recurrent cardiovascular events, defined as cardiovascular mortality and non-fatal myocardial infarction or stroke. The final model was adjusted for age, gender, body mass index, tobacco consumption, education, and family history of cardiovascular disease, prescription of high-dose statinsat discharge and use of cardiac rehabilitation after discharge. RESULTS Overall, 3,664 patients (65%) had no multimorbidity, 1,839 (33%) had cardiovascular multimorbidity, 62 (1%) had non-cardiovascular multimorbidity, and 70 (1%) had both cardiovascular and non-cardiovascular multimorbidity. The multivariate risk of recurrent cardiovascular events was increased among patients with cardiovascular multimorbidity (hazard ratio (HR) 2.05, 95% CI: 1.54-2.73, p
- Published
- 2018
9. Left Atrial Volume Index as Predictor of Events in Acute Coronary Syndrome
- Author
-
Luciano Barros Pires and Rodrigo Pires dos Santos
- Subjects
Male ,lcsh:Diseases of the circulatory (Cardiovascular) system ,medicine.medical_specialty ,Letter to the editor ,Cardiac Volume ,Acute Coronary Syndrome/mortality ,Myocardial reperfusion ,Síndrome Coronariana Aguda ,Tamanho do Orgão ,Internal medicine ,Atrial Fibrillation ,Humans ,Medicine ,Heart Atria ,Acute Coronary Syndrome ,Letter to the Editor ,Reperfusão Miocárdica ,mortalidade ,business.industry ,Atrial fibrillation ,Organ Size ,medicine.disease ,Átrios do Coração ,lcsh:RC666-701 ,Fibrilação Atrial ,Cardiology ,Atrial Function, Left ,Female ,Cardiology and Cardiovascular Medicine ,business ,Heart atrium - Published
- 2015
10. Mortalidade em um Ano após Evento Coronário Agudo e seus Preditores Clínicos: O estudo ERICO
- Author
-
Rafael Caire de Oliveira dos Santos, Nelson Samesima, Alessandra C. Goulart, Alexandre C. Pereira, Carlos Alberto Pastore, Rodrigo Martins Brandão, Márcio Sommer Bittencourt, Itamar S. Santos, Paulo A. Lotufo, Isabela M. Benseñor, and Debora Sitnik
- Subjects
Male ,Fatores de Risco ,Estudos de Coortes ,lcsh:Diseases of the circulatory (Cardiovascular) system ,Acute coronary syndrome ,Pediatrics ,medicine.medical_specialty ,Time Factors ,Síndrome Coronariana Aguda / mortalidade ,Prognóstico ,Letalidade ,Acute Coronary Syndrome/mortality ,Diabetes Complications ,Cohort Studies ,Coronary artery disease ,Sex Factors ,Risk Factors ,medicine ,Humans ,Registries ,Myocardial infarction ,Acute Coronary Syndrome ,Aged ,Cause of death ,Lethality ,business.industry ,Mortality rate ,Hazard ratio ,Age Factors ,Original Articles ,Middle Aged ,Prognosis ,medicine.disease ,Acute Coronary Syndrome / mortality ,Hospitalization ,lcsh:RC666-701 ,Hypertension ,Female ,Death certificate ,Epidemiologic Methods ,Cardiology and Cardiovascular Medicine ,business ,Brazil ,Cohort study - Abstract
Background:Information about post-acute coronary syndrome (ACS) survival have been mostly short-term findings or based on specialized, cardiology referral centers.Objectives:To describe one-year case-fatality rates in the Strategy of Registry of Acute Coronary Syndrome (ERICO) cohort, and to study baseline characteristics as predictors.Methods:We analyzed data from 964 ERICO participants enrolled from February 2009 to December 2012. We assessed vital status by telephone contact and official death certificate searches. The cause of death was determined according to the official death certificates. We used log-rank tests to compare the probabilities of survival across subgroups. We built crude and adjusted (for age, sex and ACS subtype) Cox regression models to study if the ACS subtype or baseline characteristics were independent predictors of all-cause or cardiovascular mortality.Results:We identified 110 deaths in the cohort (case-fatality rate, 12.0%). Age [Hazard ratio (HR) = 2.04 per 10 year increase; 95% confidence interval (95%CI) = 1.75–2.38], non-ST elevation myocardial infarction (HR = 3.82 ; 95%CI = 2.21–6.60) or ST elevation myocardial infarction (HR = 2.59; 95%CI = 1.38–4.89) diagnoses, and diabetes (HR = 1.78; 95%CI = 1.20‑2.63) were significant risk factors for all-cause mortality in the adjusted models. We found similar results for cardiovascular mortality. A previous coronary artery disease diagnosis was also an independent predictor of all-cause mortality (HR = 1.61; 95%CI = 1.04–2.50), but not for cardiovascular mortality.Conclusion:We found an overall one-year mortality rate of 12.0% in a sample of post-ACS patients in a community, non-specialized hospital in São Paulo, Brazil. Age, ACS subtype, and diabetes were independent predictors of poor one‑year survival for overall and cardiovascular-related causes. Fundamento:Dados sobre sobrevida após uma síndrome coronariana aguda (SCA) são geralmente de curto prazo ou baseados em centros cardiológicos.Objetivo:Descrever a frequência de ocorrência de óbito em um ano no Estudo de Registro de Insuficiência Coronariana (ERICO), e seus preditores.Métodos:Foram analisados 964 participantes ERICO incluídos de fevereiro/2009 a dezembro/2012. O estado vital dos participantes foi obtido por telefone e fontes oficiais de óbito. A causa de morte foi determinada pelos certificados de óbito. Foi utilizado o teste log-rank para comparar probabilidades de sobrevivência. Construímos modelos de regressão de Cox, brutos e ajustados (para idade, sexo e subtipo de SCA), para estudar se o subtipo de SCA ou características de entrada no estudo foram preditores independentes de mortalidade.Resultados:Identificamos 110 óbitos (frequência de ocorrência de óbito, 12,0%). A idade (risco relativo [RR] em 10 anos = 2,04; intervalo de confiança de 95% [IC95%]=1,75-2,38), infarto do miocárdio sem elevação do segmento ST (RR = 3,82; IC95% = 2,21-6,60) ou infarto do miocárdio com elevação do segmento ST (RR = 2,59; IC95% = 1,38‑4,89) e diabetes (RR = 1,78; IC95% = 1,20-2,63) foram fatores de risco significativos para mortalidade geral em modelos ajustados. Encontramos resultados semelhantes para mortalidade cardiovascular. Diagnóstico prévio de doença arterial coronariana também foi um preditor independente de mortalidade geral (RR = 1,61; IC95% = 1,04-2,50), mas não de mortalidade cardiovascular.Conclusão:Encontramos uma frequência de ocorrência de óbito em um ano de 12,0% nesta amostra de pacientes pós-SCA de um hospital comunitário em São Paulo. Idade, subtipo de SCA e diabetes foram preditores independentes de pior sobrevida em um ano.
- Published
- 2015
11. Acute coronary syndrome in patients younger than 30 years – aetiologies, baseline characteristics and long-term clinical outcome
- Author
-
Markus Oberhänsli, Jean-Christophe Stauffer, Stéphane Cook, Tobias Rutz, Aris Moschovitis, Serban-George Puricel, Cédric Lehner, Stephan Windecker, Berhard Meier, Mario Togni, Mathieu Stadelmann, and Peter Wenaweser
- Subjects
Adult ,Male ,medicine.medical_specialty ,Acute coronary syndrome ,medicine.medical_treatment ,Myocardial Infarction ,610 Medicine & health ,Coronary Artery Disease ,Coronary Angiography ,Chest pain ,Cocaine-Related Disorders ,Young Adult ,Percutaneous Coronary Intervention ,Risk Factors ,Acute Coronary Syndrome/etiology ,Acute Coronary Syndrome/mortality ,Acute Coronary Syndrome/therapy ,Cocaine-Related Disorders/complications ,Coronary Artery Disease/complications ,Dyslipidemias/epidemiology ,Endocarditis/complications ,Familial Mediterranean Fever/complications ,Female ,Follow-Up Studies ,Humans ,Myocardial Infarction/etiology ,Myocardial Infarction/mortality ,Myocardial Infarction/therapy ,Retrospective Studies ,Smoking/epidemiology ,Thrombophilia/complications ,Treatment Outcome ,Internal medicine ,medicine ,Clinical endpoint ,Thrombophilia ,Myocardial infarction ,Acute Coronary Syndrome ,Coronary atherosclerosis ,Dyslipidemias ,Endocarditis ,business.industry ,Smoking ,Percutaneous coronary intervention ,General Medicine ,medicine.disease ,Familial Mediterranean Fever ,Surgery ,Etiology ,medicine.symptom ,business ,Mace - Abstract
BACKGROUND Coronary atherosclerosis begins early in life, but acute coronary syndromes in adults aged
- Published
- 2013
12. Outcome of patients with acute coronary syndrome in hospitals of different sizes. A report from the AMIS Plus Registry
- Author
-
Burkhardt Seifert, Paul Erne, Amis Plus Investigators, Hans Rickli, Dragana Radovanovic, Jean-Christophe Stauffer, Marco Maggiorini, Philip Urban, René Simon, Markus Schmidli, Felix Gutzwiller, AMIS Plus Investigators, Hess, F., Simon, R., Hangartner, P.J., Lessing, P., Hufschmid, U., Hunziker, P., Grädel, C., Schönfelder, A., Windecker, S., Schläpfer, H., Evéquoz, D., Vögele, A., Ryser, D., Müller, P., Jecker, R., Niedermaier, G., Droll, A., Hongler, T., Stäuble, S., Haarer, J., Schmid, H.P., Quartenoud, B., Bietenhard, K., Gaspoz, J.M., Keller, P.F., Wojtyna, W., Oertli, B., Schönenberger, R., Simonin, C., Waldburger, R., Schmidli, M., Weiss, E.M., Marty, H., Zender, H., Steffen, C., Hugi, A., Koltai, E., Pedrazzini, G., Erne, P., Luterbacher, T., Jordan, B., Pagnamenta, A., Urban, P., Feraud, P., Beretta, E., Stettler, C., Repond, F., Widmer, F., Lusser, H., Polikar, R., Bassetti, S., Iselin, H.U., Giger, M., Egger, P., Kaeslin, T., Frey, R., Herren, T., Eichhorn, P., Neumeier, C., Grêt, A., Schöneneberger, R., Rickli, H., Yoon, S., Loretan, P., Stoller, U., Veragut, U.P., Bächli, E., Weber, A., Federspiel, B., Weisskopf, M., Schmidt, D., Hellermann, J., Graber, M., Haller, A., Peter, M., Gasser, S., Siegrist, P., Fatio, R., Vogt, M., Ramsay, D., Bertel, O., Maggiorini, M., Eberli, F., Christen, S., University of Zurich, and Erne, Paul
- Subjects
Male ,medicine.medical_specialty ,Acute coronary syndrome ,Survival ,610 Medicine & health ,2700 General Medicine ,Outcome (game theory) ,Outcome Assessment, Health Care ,Humans ,Medicine ,In patient ,Hospital Mortality ,Registries ,Acute Coronary Syndrome ,Intensive care medicine ,Acute Coronary Syndrome/mortality ,Aged ,Aged, 80 and over ,Female ,Health Facility Size ,Hospitals/classification ,Inpatients ,Middle Aged ,Outcome Assessment (Health Care) ,Switzerland/epidemiology ,business.industry ,10060 Epidemiology, Biostatistics and Prevention Institute (EBPI) ,General Medicine ,medicine.disease ,Hospitals ,business ,Switzerland ,Inhospital mortality - Abstract
To assess the impact of admission to different hospital types on early and 1-year outcomes in patients with acute coronary syndrome (ACS). Between 1997 and 2009, 31 010 ACS patients from 76 Swiss hospitals were enrolled in the AMIS Plus registry. Large tertiary institutions with continuous (24 hour/7 day) cardiac catheterisation facilities were classified as type A hospitals, and all others as type B. For 1-year outcomes, a subgroup of patients admitted after 2005 were studied. Eleven type A hospitals admitted 15987 (52%) patients and 65 type B hospitals 15023 (48%) patients. Patients admitted into B hospitals were older, more frequently female, diabetic, hypertensive, had more severe comorbidities and more frequent non-ST segment elevation (NSTE)-ACS/unstable angina (UA). STE-ACS patients admitted into B hospitals received more thrombolysis, but less percutaneous coronary intervention (PCI). Crude in-hospital mortality and major adverse cardiac events (MACE) were higher in patients from B hospitals. Crude 1-year mortality of 3747 ACS patients followed up was higher in patients admitted into B hospitals, but no differences were found for MACE. After adjustment for age, risk factors, type of ACS and comorbidities, hospital type was not an independent predictor of in-hospital mortality, in-hospital MACE, 1-year MACE or mortality. Admission indicated a crude outcome in favour of hospitalisation during duty-hours while 1-year outcome could not document a significant effect. ACS patients admitted to smaller regional Swiss hospitals were older, had more severe comorbidities, more NSTE-ACS and received less intensive treatment compared with the patients initially admitted to large tertiary institutions. However, hospital type was not an independent predictor of early and mid-term outcomes in these patients. Furthermore, our data suggest that Swiss hospitals have been functioning as an efficient network for the past 12 years.
- Published
- 2010
13. Does Admission NT-ProBNP Increase the Prognostic Accuracy of GRACE Risk Score in the Prediction of Short-Term Mortality After Acute Coronary Syndromes?
- Author
-
José Alberto Oliveira, Rui Cruz Ferreira, Fernando Miranda, Ana Teresa Timóteo, Ruben Ramos, Alexandra Toste, and Maria Lurdes Ferreira
- Subjects
Male ,Logistic regression ,HSM CAR ,Severity of Illness Index ,Ventricular Dysfunction, Left ,Patient Admission ,Risk Factors ,Natriuretic Peptide, Brain ,Medicine ,Acute Coronary Syndrome/complications ,Hospital Mortality ,Framingham Risk Score ,Middle Aged ,Prognosis ,HSM PAT CLIN ,Quartile ,Predictive value of tests ,Emergency Medicine ,Portugal/epidemiology ,Female ,Cardiology and Cardiovascular Medicine ,medicine.medical_specialty ,Risk Assessment ,Statistics, Nonparametric ,Acute Coronary Syndrome/mortality ,Predictive Value of Tests ,Internal medicine ,Severity of illness ,Humans ,Radiology, Nuclear Medicine and imaging ,Acute Coronary Syndrome ,Intensive care medicine ,Risk Assessment/methods ,Ventricular Dysfunction, Left/etiology ,Retrospective Studies ,Analysis of Variance ,Chi-Square Distribution ,Portugal ,business.industry ,Retrospective cohort study ,medicine.disease ,Acute Coronary Syndrome/diagnosis ,Peptide Fragments ,Logistic Models ,ROC Curve ,Heart failure ,Multivariate Analysis ,Linear Models ,Acute Coronary Syndrome/blood ,Natriuretic Peptide, Brain/blood ,business ,Peptide Fragments/blood ,Chi-squared distribution ,Biomarkers ,Biomarkers/blood - Abstract
BACKGROUND: NT-proBNP has prognostic implications in heart failure. In acute coronary syndromes (ACS) setting, the prognostic significance of NT-proBNP is being sought. We studied short-term prognostic impact of admission NT-proBNP in patients admitted for ACS and in association with GRACE risk score (GRS). METHODS AND RESULTS: We studied 1035 patients admitted with ACS. Patients were divided in quartiles according to NT-proBNP levels on admission: Q1
- Published
- 2009
14. The SYNTAX score predicts early mortality risk in the elderly with acute coronary syndrome having primary PCI
- Author
-
Scherff, Frank, Vassalli, Giuseppe, Suerder, Daniel, Mantovani, Antonio, Corbacelli, Carlo, Pasotti, Elena, Catherine Klersy, Auricchio, Angelo, Moccetti, Tiziano, and Pedrazzini, Giovanni B.
- Subjects
Aged, 80 and over ,Male ,Time Factors ,Coronary Angiography ,Prognosis ,Acute Coronary Syndrome/mortality ,Acute Coronary Syndrome/radiography ,Aged ,Angioplasty, Balloon, Coronary ,Cause of Death/trends ,Female ,Follow-Up Studies ,Humans ,Predictive Value of Tests ,Registries ,Retrospective Studies ,Risk Assessment/methods ,Risk Factors ,Survival Rate/trends ,Risk Assessment ,Survival Rate ,Cause of Death ,Acute Coronary Syndrome - Abstract
BACKGROUND: The SYNTAX score (SXscore), an angiographic score reflecting coronary lesion complexity, predicts clinical outcomes in patients with left main or multivessel disease, and in patients with ST-segment elevation myocardial infarction undergoing primary PCI. The clinical SXscore (CSS) integrates the SXscore and clinical variables (age, ejection fraction, serum creatinine) into a single score. We analyzed these scores in elderly patients with acute coronary syndrome (ACS) undergoing primary PCI. The purpose of this analysis was not to decide which patients should undergo PCI, but to predict clinical outcomes in this population. METHODS: The SXscore was determined in a consecutive series of 114 elderly patients (mean age, 79.6 ± 4.1 years) undergoing primary PCI for ACS. Outcomes were stratified according to SXscore tertiles: SXLOW ≤15 (n = 39), 15< SXMID
15. Frequência e Motivos para a não Administração e Suspensão de Medicamentos durante um Evento de Síndrome Coronariana Aguda. Estudo ERICO
- Author
-
Paulo A. Lotufo, Itamar S. Santos, Alessandra C. Goulart, Isabela M. Benseñor, and Rafael Caire de Oliveira dos Santos
- Subjects
Gynecology ,medicine.medical_specialty ,Síndrome Coronariana Aguda/mortalidade ,Suspensão do Tratamento/tratamento farmacológico ,business.industry ,Health Care (Public Health) ,030204 cardiovascular system & hematology ,Acute Coronary Syndrome/mortality ,Morbidade ,03 medical and health sciences ,Atenção à Saúde ,0302 clinical medicine ,Withholding Treatment /drug therapy ,RC666-701 ,medicine ,Platelet aggregation inhibitor ,Diseases of the circulatory (Cardiovascular) system ,Morbidity ,Cardiology and Cardiovascular Medicine ,business - Abstract
Resumo Fundamentos: Poucos estudos discutiram causas para o subtratamento medicamentoso na SCA. Objetivos: Avaliar a não-administração e suspensão de medicamentos durante o tratamento intra-hospitalar da SCA na Estratégia de Registro de Síndrome Coronariana Aguda (estudo ERICO). Métodos: Analisamos prontuários de 563 participantes ERICO para avaliar a frequência e motivos da não administração e/ou suspensão de medicamentos. Construímos modelos de regressão logística para avaliar se sexo, idade ≥65 anos, nível educacional ou subtipo de SCA estavam associados com (a) não administração de ≥1 medicamentos; e (b) não administração ou suspensão de ≥1 medicamentos. O nível de significância foi 5%. Resultados: A amostra é composta por 58,1% de homens e com idade mediana de 62 anos. Em 183 (32,5%) participantes ≥1 medicamentos não foram administrados e 288 (51,2%) apresentaram ≥1 medicamentos não administrados ou suspensos. As causas mais frequentes foram risco de sangramento (aspirina, clopidogrel e heparina), insuficiência cardíaca (betabloqueadores) e hipotensão (inibidores da enzima conversora da angiotensina e bloqueadores dos receptores da angiotensina). Indivíduos com idade ≥65 anos (razão de chances [RC]:1,51; intervalo de confiança de 95% [IC95%]:1,05-2,19) e com angina instável (RC:1,72; IC95%:1,07-2,75) tiveram maior chance de não-administração. Considerando apenas pacientes com infarto do miocárdio, idade ≥65 anos foi associada tanto à não administração quanto à não administração ou suspensão. Conclusões: A não administração ou suspensão de ≥1 medicamento não foi rara no estudo ERICO. Indivíduos com idade ≥65 anos ou com angina instável tiveram maior chance de não administração e podem ser subtratados nesse cenário. Abstract Background: Few studies have discussed the reasons for pharmacological undertreatment of Acute Coronary Syndrome (ACS). Objectives: To determine the frequency and reasons for the non-administration and suspension of medications during in-hospital treatments of ACS in the Strategy of Registry of Acute Coronary Syndrome (ERICO) study. Methods: The present study analyzed the medical charts of the 563 participants in the ERICO study to evaluate the frequency and reasons for the non-administration and/or suspension of medications. Logistic regression models were built to analyze if sex, age ≥65 years of age, educational level, or ACS subtype were associated with (a) the non-administration of ≥1 medications; and (b) the non-administration or suspension of ≥1 medications. The significance level was set at 5%. Results: This study's sample included 58.1% males, with a median of 62 years of age. In 183 (32.5%) participants, ≥1 medications were not administered, while in 288 (51.2%), ≥1 medications were not administered or were suspended. The most common reasons were the risk of bleeding (aspirin, clopidogrel, and heparin), heart failure (beta blockers), and hypotension (angiotensin-converting enzyme inhibitors and angiotensin receptor blockers). Individuals aged ≥65 (odds ratio [OR]:1.51; 95% confidence interval [95% CI]:1.05-2.19) and those with unstable angina (OR:1.72; 95% CI:1.07-2.75) showed a higher probability for the non-administration of ≥1 medication. Considering only patients with myocardial infarction, being ≥65 years of age was associated with both the non-administration and the non-administration or suspension of ≥1 medication. Conclusions: Non-administration or suspension of ≥1 medication proved to be common in this ERICO study. Individuals of ≥65 years of age or with unstable angina showed a higher probability of the non-administration of ≥1 medication and may be undertreated in this scenario. (Arq Bras Cardiol. 2020; 115(5):830-839)
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.