Impact of Complete Revascularization on Six-Year Clinical Outcomes and Incidence of Acute Decompensated Heart Failure in Patients With ST-Segment Elevation Myocardial Infarction and Multivessel Coronary Artery Disease

Ahn, Min Joo; Kim, Min Chul; Ahn, Youngkeun; Sim, Doo Sun; Hong, Young Joon; Kim, Ju Han; Jeong, Myung Ho; Cho, Jeong Gwan; Park, Jong Chun

doi:10.1016/j.amjcard.2017.11.025

“…Acute myocardial infarction is typically divided into ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction [ 13 ], while ST-segment elevation myocardial infarction is one of the essential causes of acute decompensated heart failure, with a mortality rate of 5% to 8% during hospitalization and a high readmission rate [ 14 ]. Recent studies have identified that the majority of patients with ST-segment elevation myocardial infarction have underlying diseases, with diabetes being a common underlying condition [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Correlation between Glycated Haemoglobin Level, Cardiac Function, and Prognosis in Patients with Diabetes Mellitus Combined with Myocardial Infarction

Zeng

¹

,

An²,

Li³

et al. 2022

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Objective. This study was to investigate the correlation between glycated haemoglobin (HbA1c) level, cardiac function, and prognosis in patients with diabetes mellitus combined with myocardial infarction. Methods. Ninety-three patients with type 2 diabetes mellitus combined with acute myocardial infarction who were hospitalized and treated in our hospital from January 2021 to June 2021 were recruited for prospective analysis and equally divided into group A ( HbA 1 c < 6.5 % ), group B ( 6.5 % ≤ HbA 1 c ≤ 8.5 % ), and group C ( HbA 1 c > 8.5 % ) using the random number table method, with 31 patients in each group. General data of patients were collected on admission and blood glucose and cardiac function indexes were measured; the incidence of myocardial infarction and death during the follow-up period was recorded at 6 months after discharge. Results. There was a significant difference in blood glucose (FBG) and HbA1c levels at fasting between the three groups ( P < 0.05 ). There were statistically significant differences in plasma levels of N-terminal probrain natriuretic peptide (NT-proBNP) and uric acid (UA), left ventricular end diastolic diameter (LVEDD), left ventricular end systolic volume (LVESV), left ventricular ejection fraction (LVEF), and cardiac function classification of the New York Heart Association (NYHA) among the three groups ( P < 0.05 ). By statistical analysis, the HbA1c level was positively correlated with FBG, NT-proBNP, UA, LVEDD, LVESD, and NYHA grades but negatively correlated with LVEF ( P < 0.05 ). The incidence rate of myocardial infarction and mortality was significantly higher in group C than in groups A and B ( P < 0.05 ). Conclusion. HbA1c level in patients with diabetes mellitus combined with myocardial infarction is closely related to the degree of cardiac function damage. Glycated haemoglobin levels are associated with the development of cardiac insufficiency in patients with acute myocardial infarction; glycated haemoglobin is also an independent predictor of major adverse cardiovascular events. Reasonable and effective blood glucose control is of great significance to the prognosis of patients.

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“…Numerous studies have demonstrated that the method of revascularization had an impact on prognosis [22,23]. In the DANAMI-3-PRIMULTI trial of 1 countries and 627 patients, compared with FFR-guided functional CR, MVD-STEMI patients treated with IRA-only strategy (anatomical IR) had a 1.7-fold increase in 27-month MACE risk (22% vs 13%, P = 0.004), mainly including all-cause mortality, non-fatal reinfarction, and ischaemia-driven revascularisation [24].…”

Section: Diatebes and Fir And Macementioning

confidence: 99%

Clinical outcomes guided by quantitative flow ratio in multivessel disease and ST-elevation myocardial infarction patients with diabetes mellitus

Xian,

Luo,

Liu

et al. 2023

Preprint

0

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Background Quantitative flow ratio (QFR) had good feasibility and accuracy in assessing the hemodynamisc compared with fraction flow reservation (FFR) as the reference. Diabetes mellitus (DM) worsens the prognosis of multivessel disease and ST-elevation myocardial infarction (MVD-STEMI) patients. However, the role of QFR in MVD-STEMI patients with DM is unknown. The purpose of this study is to investigate the clinical outcomes of patients with MVD-STEMI under different diabetes status and revascularization assignment guided by quantitative flow ratio (QFR). Methods A total 724 patients were enrolled in our study and allocated into nondiabetes mellitus (nonDM) cohort and DM cohort. Under the guidance of QFR, cohorts are divided into functional complete revascularization (FCR) layering and functional incomplete revascularization (FIR) layering. The primary outcome was a composite of major adverse cardiovascular events (MACE) including cardiac death, ischemia-driven revascularization (target vessel revascularization and nontarget vessel revascularization), rehospitalization due to unstable angina pectoris, and nonfatal myocardial infarction at 3-year follow up. Results DM cohort (22.9% vs 13.6%, P = 0.002) and FIR layering (24.0% vs 12.6%, P < 0.001) were more prone to MACE. The incidence of MACE in four groups were as follows: 27.9% DM + FIR > 18.5% nonDM + FIR > 16.1% DM + FCR > 9.8% nonDM + FCR. Besides, DM and FIR had been proven to be important predictors of MACE after adjustment for baseline clinical differences (HR = 1.60, 95%CI = 1.03–2.49, P = 0.036; HR = 1.71, 95%CI = 1.13–2.57, P = 0.011). By incorporating QFR-guided residual SYNTAX score (rSSQFR) into model of clinical risk factors, the predictive ability of the model for MACE was significantly improved, especially in the DM (+ IR) population (AUC = 0.812, 95%CI = 0.750–0.874) vs AUC = 0.666, 95%CI = 0.581–0.751, P < 0.001). Conclusions Diatebes status and functional incomplete revascularization strategy increased 3-year rates of MACE in patients with MVD-STEMI. The use of QFR by DM population is more valuable than that of nonDM population.

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“…Major adverse cardiac events (MACE) for the purposes of follow-up were as follows: (1) acute myocardial infarction; (2) decompensated heart failure; (3) target vessel revascularization and (4) mortality due to cardiac disease [20].…”

Section: Angiographic Evaluationmentioning

confidence: 99%

Prognostic significance of serum potassium level for major adverse cardiac events and death in patients with coronary atherosclerotic disease

Altaf

¹

,

Alam

²

,

Salahuddin³

et al. 2020

Acta Angiologica

0

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Introduction: Serum potassium levels have been shown in some animal studies to be associated with the process of atherosclerosis. We decided to assess the correlation of serum potassium level in ischemic heart disease patients with disease severity and its relationship with prognosis in terms of major acute cardiac events (MACE). Material and methods: This was a cross-sectional cohort study carried out at cardiology department of Rehman Medical Institute, from July 2016 to 31 st Aug. 2018 a period of 26 months. 622 patients were included in the study. Clinical and angiographic characteristics were assessed based on the serum potassium level. Correlation of serum potassium level with Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) and Gensini scores was also evaluated. Follow up for MACE was carried out after one year. Results: Mean serum potassium level was 3.93 ± 0.95 (mEq/l) in coronary artery disease patients. Serum potassium level showed negative correlation with SYNTAX score (r =-0.60, p < 0.05) and Gensini score (r =-0.64, p < 0.05). There was also a significant difference between low and high potassium level in relation to the multi-vessel disease on coronary angiography (p < 0.05). Low potassium level was a good predictor of adverse outcomes as shown by Kaplan-Meier analysis. Multivariate Cox regression analysis showed that serum potassium level and diabetes were independent predictors of MACE (p < 0.05). Conclusion: Low serum potassium level is correlated with more severe coronary atherosclerosis. Low potassium levels are associated with significantly poor outcomes.

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Impact of Complete Revascularization on Six-Year Clinical Outcomes and Incidence of Acute Decompensated Heart Failure in Patients With ST-Segment Elevation Myocardial Infarction and Multivessel Coronary Artery Disease

Cited by 4 publications

References 24 publications

Correlation between Glycated Haemoglobin Level, Cardiac Function, and Prognosis in Patients with Diabetes Mellitus Combined with Myocardial Infarction

Correlation between Glycated Haemoglobin Level, Cardiac Function, and Prognosis in Patients with Diabetes Mellitus Combined with Myocardial Infarction

Clinical outcomes guided by quantitative flow ratio in multivessel disease and ST-elevation myocardial infarction patients with diabetes mellitus

Prognostic significance of serum potassium level for major adverse cardiac events and death in patients with coronary atherosclerotic disease

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