Long-term Prognosis in Patients With Concomitant Acute Coronary Syndrome and Aortic Stenosis

Chew, Nicholas; Zhang, Audrey; Ong, Joy; Koh, Sophie; Kong, Gwyneth; Ho, Yeung Jek; Lim, Oliver Zi Hern; Chin, Yip Han; Lin, Chaoxing; Djohan, Andie Hartanto; Kuntjoro, Ivandito; Kong, William; Hon, Jimmy Kim Fatt; Lee, Chi‐Hang; Chan, Mark; Yeo, Tiong‐Cheng; Tan, Huay‐Cheem; Poh, Kian‐Keong; Loh, Poay Huan

doi:10.1016/j.cjca.2022.03.010

Cited by 7 publications

(6 citation statements)

References 36 publications

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“…We excluded patients with missing data necessary for categorization of nutrition or body weight status. [21][22][23][24] Baseline demographic and clinical characteristics, previous medical history, clinical status at presentation, angiographic and procedural characteristics, echocardiographic characteristics, and medications on discharge were retrospectively collected from the electronic clinical records. Information on in-hospital complications and survival status were also retrieved.…”

Section: Study Setting and Populationmentioning

confidence: 99%

Long-Term Prognosis of Patients With Coexisting Obesity and Malnutrition After Acute Myocardial Infarction: A Cohort Study

Kong

Zhang

Chong

et al. 2023

Circ: Cardiovascular Quality and Outcomes

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BACKGROUND: The double burden of malnutrition, described as the coexistence of malnutrition and obesity, is a growing global health issue. This study examines the combined effects of obesity and malnutrition on patients with acute myocardial infarction (AMI). METHODS: Patients presenting with AMI to a percutaneous coronary intervention-capable hospital in Singapore between January 2014 and March 2021 were retrospectively studied. Patients were stratified into the following: (1) nourished nonobese, (2) malnourished nonobese, (3) nourished obese, and (4) malnourished obese. Obesity and malnutrition were defined according to the World Health Organization definition (body mass index ≥27.5 kg/m 2 ) and Controlling Nutritional Status score, respectively. The primary outcome was all-cause mortality. The association between combined obesity and nutritional status with mortality was examined using Cox regression, adjusted for age, sex, AMI type, previous AMI, ejection fraction, and chronic kidney disease. Kaplan-Meier curves for all-cause mortality were constructed. RESULTS: The study included 1829 AMI patients, of which 75.7% were male and mean age was 66 years. Over 75% of patients were malnourished. Majority were malnourished nonobese (57.7%), followed by malnourished obese (18.8%), nourished nonobese (16.9%), and nourished obese (6.6%). Malnourished nonobese had highest all-cause mortality (38.6%), followed by the malnourished obese (35.8%), nourished nonobese (21.4%), and nourished obese (9.9%, P <0.001). Kaplan-Meier curves demonstrated least favorable survival in malnourished nonobese group, followed by malnourished obese, nourished nonobese, and nourished obese. With nourished nonobese group as the reference, malnourished nonobese had higher all-cause mortality (hazard ratio, 1.46 [95% CI, 1.10–1.96], P =0.010), but only a nonsignificant increase in mortality was observed in the malnourished obese (hazard ratio, 1.31 [95% CI, 0.94–1.83], P =0.112). CONCLUSIONS: Among AMI patients, malnutrition is prevalent even in the obese. Compared to nourished patients, malnourished AMI patients have a more unfavorable prognosis especially in those with severe malnutrition regardless of obesity status, but long-term survival is the most favorable among nourished obese patients.

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Section: Study Setting and Populationmentioning

confidence: 99%

Long-Term Prognosis of Patients With Coexisting Obesity and Malnutrition After Acute Myocardial Infarction: A Cohort Study

Kong

Zhang

Chong

et al. 2023

Circ: Cardiovascular Quality and Outcomes

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“…A multivariable Cox regression model was constructed to investigate the independent determinants of long‐term all‐cause mortality, including hepatic steatosis, advanced hepatic fibrosis, age, sex (female), ethnicity, AMI type (STEMI), previous myocardial infarction, diabetes, BMI and left ventricular ejection fraction. These variables were adjudicated based on their prognostic impact in AMI, as established in previous studies 15,19‐21,23 . The Kaplan–Meier survival curves for all‐cause mortality were constructed and stratified according to hepatic steatosis and advanced hepatic fibrosis status.…”

Section: Methodsmentioning

confidence: 99%

“…In this retrospective, observational cohort, we studied adult patients, aged 21 years and older, who presented with AMI from 1 January 2014 to 31 March 2021 to a tertiary percutaneous coronary intervention (PCI)-capable hospital in Singapore, [20][21][22] which, along with two other spoke hospitals, make up the Western network that provides PCI services to the Western region in Singapore. 23,24 All patients presented with either ST-elevation myocardial infarction (STEMI) or non-ST elevation myocardial infarction (NSTEMI), and were directed to the Emergency Department at the hub hospital or via interhospital transfers from the spoke hospitals.…”

Section: Setting and Designmentioning

confidence: 99%

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Hepatic steatosis and advanced hepatic fibrosis are independent predictors of long‐term mortality in acute myocardial infarction

Chin

Lim

Kong

et al. 2023

Diabetes Obesity Metabolism

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Aim To examine the prevalence and prognosis of hepatic steatosis and fibrosis in post‐acute myocardial infarction (AMI) patients. Methods Patients presenting with AMI to a tertiary hospital were examined from 2014 to 2021. Hepatic steatosis and advanced hepatic fibrosis were determined using the Hepatic Steatosis Index and fibrosis‐4 index, respectively. The primary outcome was all‐cause mortality. Cox regression models identified determinants of mortality after adjustments and Kaplan–Meier curves were constructed for all‐cause mortality, stratified by hepatic steatosis and advanced fibrosis. Results Of 5765 patients included, 24.8% had hepatic steatosis, of whom 41.7% were diagnosed with advanced fibrosis. The median follow‐up duration was 2.7 years. Patients with hepatic steatosis tended to be younger, female, with elevated body mass index and an increased metabolic burden of diabetes, hypertension and hyperlipidaemia. Patients with hepatic steatosis (24.6% vs. 20.9% mortality, P < .001) and advanced fibrosis (45.6% vs. 32.9% mortality, P < .001) had higher all‐cause mortality rates compared with their respective counterparts. Hepatic steatosis (adjusted hazard ratio 1.364, 95% CI 1.145‐1.625, P = .001) was associated with all‐cause mortality after adjustment for confounders. Survival curves showed excess mortality in patients with hepatic steatosis compared with those without (P = .002). Conclusions Hepatic steatosis and advanced fibrosis have a substantial prevalence among patients with AMI. Both are associated with mortality, with an incrementally higher risk when advanced fibrosis ensues. Hepatic steatosis and fibrosis could help risk stratification of AMI patients beyond conventional risk factors.

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“…In this issue of the Canadian Journal of Cardiology, Chew and colleagues 1 report on the outcomes of 563 patients with acute coronary syndrome (ACS) and aortic stenosis (AS), seen over a 10-year period. They demonstrate that approximately one-half of those with moderate or severe AS, and more than one-third of those with mild AS, died during follow-up, which averaged 2.5 years.…”

Section: See Article By Chew Et Al Pages 1220e1227 Of This Issuementioning

confidence: 99%

Acute Coronary Syndrome and Aortic Stenosis: A Lethal Combo!

Thompson

2022

Canadian Journal of Cardiology

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Long-term Prognosis in Patients With Concomitant Acute Coronary Syndrome and Aortic Stenosis

Cited by 7 publications

References 36 publications

Long-Term Prognosis of Patients With Coexisting Obesity and Malnutrition After Acute Myocardial Infarction: A Cohort Study

Long-Term Prognosis of Patients With Coexisting Obesity and Malnutrition After Acute Myocardial Infarction: A Cohort Study

Hepatic steatosis and advanced hepatic fibrosis are independent predictors of long‐term mortality in acute myocardial infarction

Acute Coronary Syndrome and Aortic Stenosis: A Lethal Combo!

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