Trends in presenting characteristics and hospital mortality among patients with ST elevation and non-ST elevation myocardial infarction in the National Registry of Myocardial Infarction from 1990 to 2006

Rogers, William J.; Frederick, Paul D.; Stoehr, Edna; Canto, John G.; Ornato, Joseph P.; Gibson, C. Michael; Pollack, Charles V.; Gore, Joel M.; Chandra-Strobos, Nisha; Peterson, Eric D.; French, William J.

doi:10.1016/j.ahj.2008.07.030

Cited by 360 publications

(242 citation statements)

References 36 publications

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“…On the other hand, it should be kept in mind that the overall decreased mortality after MI results primarily from a more effective therapy, which has been applied consistently not only to men, but also to women. 26,27 The network in Essen, with its standardized therapy for both genders, therefore displays gender differences independent of different therapeutic approaches.…”

Section: Discussionmentioning

confidence: 99%

Gender‐Related Differences in Patients With ST‐Elevation Myocardial Infarction: Results From the Registry Study of the ST Elevation Myocardial Infarction Network Essen

Hailer¹,

Naber

Koslowski³

et al. 2011

Clinical Cardiology

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Background:The Myocardial Infarction Network Essen was initiated in order to establish a standardized procedure with immediate reopening of the infarcted vessel for patients with ST-elevation myocardial infarction (STEMI) in the city of Essen, Germany. The present study aims to evaluate gender-related differences in presentation of disease and clinical outcome. Hypothesis: Gender is associated with differences in presentation and outcome of STEMI. Methods: All patients with STEMI were included without exception. Parameters such as risk profile, mortality, and relevant time intervals were documented. The follow-up period was 1 year. Results: For this study, 1365 patients (72.1% male) were recruited. Women were significantly older, with higher prevalence of diabetes (28.1% vs 20.3%, P = 0.004) and hypertension (76.5% vs 64.8%, P < 0.0005). Analysis of time intervals between symptoms to actions showed no significant differences. However, women tended to wait longer before calling for medical assistance (358 vs 331 min, P = 0.091). In-hospital mortality was comparable with respect to gender, whereas women had higher 1-year mortality (18.6% vs 13.2%). Age and diabetes were associated with a higher mortality. Adjusted for age, gender is no longer an independent risk factor. In the follow-up period, significantly more women were readmitted to the hospital without a difference in the frequency of reangiography, surgery, or target-vessel revascularization. Conclusions: The present data display a successful implementation of a standardized procedure in patients with STEMI. Although differences between genders are not as obvious as expected, efforts should be taken to perform a gender-specific risk analysis as well as to promote education about proper behavior in case of new onset of angina. IntroductionAlthough gender-related differences in treatment and prognosis of acute myocardial infarction (MI) have been documented for more than a decade, the results are still conflicting. Some investigations have described a generally consistent pattern of less-intensive treatment in acute MI

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Section: Discussionmentioning

confidence: 99%

Gender‐Related Differences in Patients With ST‐Elevation Myocardial Infarction: Results From the Registry Study of the ST Elevation Myocardial Infarction Network Essen

Hailer¹,

Naber

Koslowski³

et al. 2011

Clinical Cardiology

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“…Western data in NRMI registry from 1990 to 2006 shows, the proportion of NSTEMI increased from 14.2% to 59.1% (P < 0.0001), whereas the proportion of STEMI decreased. 15 But, Indian data in CREATE registry, of the 20,468 patients who were given a definite diagnosis, 12,405 (60.6%) had STEMI and Sharma R et al showed most patients had STEMI 995 (63.7%) followed by UA 390 (25%) and NSTEMI 177 (11.3%). 16 Prevalence of PAD in ACS patients in this study (13.06%) was lower than western study but was more than the middle Eastern countries and male prevalence of PAD is established which is consistent with previous studies.…”

Section: Discussionmentioning

confidence: 99%

A study to assess frequency of peripheral arterial disease in patients presenting with acute coronary syndrome

2017

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Background: To determine the frequency of peripheral arterial disease (PAD) in patients presenting with acute coronary syndrome (ACS) and association of PAD with different risk factors of coronary artery disease (CAD) and to look for in hospital outcome of ACS patients with or without PAD.Methods: This cross-sectional observation study was undertaken in the department of cardiology, IPGME&R Hospital, Kolkata from June 2015 to August 2016 to recruit 199 consecutive patients admitted with ACS and were evaluated with detailed clinical history, physical examination, ABI (Ankle Brachial Index) measurement, echocardiography and appropriate blood investigations.Results: Among 199 total ACS patients, STEMI was the predominant mode of presentation (71.86%) and majorities were male. PAD was seen in 26 patients and mean age was 56.68±8.84 years. Factors independently related with PAD in acute coronary syndromes are hypertension (OR- 1.49; 95% CI: 0.615-3.232), diabetes (OR- 2.55;95% CI : 0.9762-6.6665), smoking (OR-2.55; 95% CI: 1.055-6.19), past history of CVA (OR-11.15;95% CI: 1.77-70.32), LV systolic dysfunction (OR-1.388; 95% CI:0.607-3.1742). 2 and 13 patients died within 7 days of admission among 26 ACS-PAD group (7.69%) and 173 ACS-non-PAD group (7.5%) respectively and most of them had STEMI.Conclusions: Significant numbers of ACS patients are having PAD and older age, male sex, diabetes, hypertension, smoking and LV systolic dysfunction were found to be independent predictors for PAD in ACS patients. Early in hospital mortality was seem to be dependent on clinical presentation, not on presence or absence of PAD.

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“…Lifestyle adjustments in the general population, e.g., reduction in smoking and of serum cholesterol levels, have contributed to the reduction in incidence [5]. Among patients with AMI, the relative occurrence of STEMI has decreased and the occurrence of NSTEMI has increased, and NSTEMI is now more common than STEMI [6]. The decrease in incidence has been paralleled by an impressive improvement in mortality, e.g., in Sweden the standardized 30-day mortality in STEMI went from 12.9% to 6.3% between 1996 and 2007 [7].…”

Section: Acute Coronary Syndromementioning

confidence: 99%

Acute coronary syndrome – the present and future role of biomarkers1)

Lindahl¹

2013

Clinical Chemistry and Laboratory Medicine

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Over the past two decades there have been dramatic changes in the diagnosis, treatment and prognosis of acute coronary syndrome (ACS). Several new treatment modalities have been added and the prognosis has improved dramatically. Biomarkers play a crucial role in the management of ACS. At present, cardiac troponin is the biomarker of choice for diagnosis of acute myocardial infarction (AMI). Currently, there are no other biomarkers, which can compete, neither regarding specificity nor regarding early sensitivity. However, there is still a clinical need of a biomarker able to reliably rule-in or rule-out AMI immediately on admission. MicroRNAs seem to be promising new candidates for diagnostic purposes. The optimal combination of biomarkers and new imaging techniques is another important area for research. The list of biomarkers associated with an adverse prognosis in ACS is long. However, for most of them it has been very difficult to prove an added clinical value. Only cardiac troponin, and to some degree also B-type natriuretic peptides, is widely used in clinical practice for risk assessment. Among new markers, growth differentiation factor 15 and the midregional part of the prohormone of adrenomedullin, have shown some promising results. Since the renal function is assessed in clinical routine, also markers of the renal function have gained increasing interest. Cardiac troponin has been proven useful for selection of antithrombotic, antiplatelet and invasive treatment. Besides cardiac troponin, no other markers have consistently been shown to be useful for selection of specific treatments.

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Trends in presenting characteristics and hospital mortality among patients with ST elevation and non-ST elevation myocardial infarction in the National Registry of Myocardial Infarction from 1990 to 2006

Cited by 360 publications

References 36 publications

Gender‐Related Differences in Patients With ST‐Elevation Myocardial Infarction: Results From the Registry Study of the ST Elevation Myocardial Infarction Network Essen

Gender‐Related Differences in Patients With ST‐Elevation Myocardial Infarction: Results From the Registry Study of the ST Elevation Myocardial Infarction Network Essen

A study to assess frequency of peripheral arterial disease in patients presenting with acute coronary syndrome

Acute coronary syndrome – the present and future role of biomarkers1)

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