253 research outputs found
Impact of Coronavirus Disease 2019 Pandemic on the Incidence and Management of OutâofâHospital Cardiac Arrest in Patients Presenting With Acute Myocardial Infarction in England
Background: Studies have reported significant reduction in acute myocardial infarctionârelated hospitalizations during the coronavirus disease 2019 (COVIDâ19) pandemic. However, whether these trends are associated with increased incidence of outâofâhospital cardiac arrest (OHCA) in this population is unknown. /
Methods and Results: Acute myocardial infarction hospitalizations with OHCA during the COVIDâ19 period (February 1âMay 14, 2020) from the Myocardial Ischaemia National Audit Project and British Cardiovascular Intervention Society data sets were analyzed. Temporal trends were assessed using Poisson models with equivalent preâCOVIDâ19 period (February 1âMay 14, 2019) as reference. Acute myocardial infarction hospitalizations during COVIDâ19 period were reduced by >50% (n=20 310 versus n=9325). OHCA was more prevalent during the COVIDâ19 period compared with the preâCOVIDâ19 period (5.6% versus 3.6%), with a 56% increase in the incidence of OHCA (incidence rate ratio, 1.56; 95% CI, 1.39â1.74). Patients experiencing OHCA during COVIDâ19 period were likely to be older, likely to be women, likely to be of Asian ethnicity, and more likely to present with STâsegmentâelevation myocardial infarction. The overall rates of invasive coronary angiography (58.4% versus 71.6%; P<0.001) were significantly lower among the OHCA group during COVIDâ19 period with increased time to reperfusion (mean, 2.1 versus 1.1 hours; P=0.05) in those with STâsegmentâelevation myocardial infarction. The adjusted inâhospital mortality probability increased from 27.7% in February 2020 to 35.8% in May 2020 in the COVIDâ19 group (P<.001). /
Conclusions: In this national cohort of hospitalized patients with acute myocardial infarction, we observed a significant increase in incidence of OHCA during COVIDâ19 period paralleled with reduced access to guidelineârecommended care and increased inâhospital mortality
Incidence, Predictors, and Clinical Impact of Early Prasugrel Cessation in Patients With ST-Elevation Myocardial Infarction.
BACKGROUND: Early withdrawal of recommended antiplatelet treatment with clopidogrel adversely affects prognosis following percutaneous coronary interventions. Optimal antiplatelet treatment is essential following ST-segment elevation myocardial infarction (STEMI) given the increased risk of thrombotic complications. This study assessed the frequency, predictors, and clinical impact of early prasugrel cessation in patients with STEMI undergoing primary percutaneous coronary interventions. METHODS AND RESULTS: We pooled patients with STEMI discharged on prasugrel in 2 prospective registries (Bern PCI Registry [NCT02241291] and SPUM-ACS (Inflammation and Acute Coronary Syndromes) [NCT01000701]) and 1 STEMI trial (COMFORTABLE-AMI (Comparison of Biomatrix Versus Gazelle in ST-Elevation Myocardial Infarction) [NCT00962416]). Prasugrel treatment status at 1Â year was categorized as no cessation; crossover to another P2Y12-inhibitor; physician-recommended discontinuation; and disruption because of bleeding, side effects, or patient noncompliance. In time-dependent analyses, we assessed the impact of prasugrel cessation on the primary end point, a composite of cardiac death, myocardial infarction, and stroke. Of all 1830 included patients (17% women, mean age 59Â years), 83% were treated with new-generation drug-eluting stents. At 1Â year, any prasugrel cessation had occurred in 13.8% of patients including crossover (7.2%), discontinuation (3.7%), and disruption (2.9%). Independent predictors of any prasugrel cessation included female sex, age, and history of cerebrovascular event. The primary end point occurred in 5.2% of patients and was more frequent following disruption (hazard ratio 3.04, 95% confidence interval,1.34-6.91; P=0.008), without significant impact of crossover or discontinuation. Consistent findings were observed for all-cause death, myocardial infarction, and stent thrombosis following prasugrel disruption. CONCLUSIONS: In this contemporary study of patients with STEMI, early prasugrel cessation was not uncommon and primarily involved change to another P2Y12-inhibitor. Disruption was the only type of early prasugrel cessation associated with statistically significant excess in ischemic risk within 1Â year following primary percutaneous coronary interventions
Deletion of L-Selectin Increases Atherosclerosis Development in ApoEâ/â Mice
Atherosclerosis is an inflammatory disease characterized by accumulation of leukocytes in the arterial intima. Members of the selectin family of adhesion molecules are important mediators of leukocyte extravasation. However, it is unclear whether L-selectin (L-sel) is involved in the pathogenesis of atherosclerosis. In the present study, mice deficient in L-selectin (L-selâ/â) animals were crossed with mice lacking Apolipoprotein E (ApoEâ/â). The development of atherosclerosis was analyzed in double-knockout ApoE/L-sel (ApoEâ/â L-selâ/â) mice and the corresponding ApoEâ/â controls fed either a normal or a high cholesterol diet (HCD). After 6 weeks of HCD, aortic lesions were increased two-fold in ApoEâ/â L-selâ/â mice as compared to ApoEâ/â controls (2.46%±0.54% vs 1.28%±0.24% of total aortic area; p<0.05). Formation of atherosclerotic lesions was also enhanced in 6-month-old ApoEâ/â L-selâ/â animals fed a normal diet (10.45%±2.58% vs 1.87%±0.37%; p<0.05). In contrast, after 12 weeks of HCD, there was no difference in atheroma formation between ApoEâ/â L-selâ/â and ApoEâ/â mice. Serum cholesterol levels remained unchanged by L-sel deletion. Atherosclerotic plaques did not exhibit any differences in cellular composition assessed by immunohistochemistry for CD68, CD3, CD4, and CD8 in ApoEâ/â L-selâ/â as compared to ApoEâ/â mice. Leukocyte rolling on lesions in the aorta was similar in ApoEâ/â L-selâ/â and ApoEâ/â animals. ApoEâ/â L-selâ/â mice exhibited reduced size and cellularity of peripheral lymph nodes, increased size of spleen, and increased number of peripheral lymphocytes as compared to ApoEâ/â controls. These data indicate that L-sel does not promote atherosclerotic lesion formation and suggest that it rather protects from early atherosclerosis
Impact of COVID19 Pandemic on the Incidence and Management of Out of Hospital Cardiac Arrest in Patients Presenting with Acute Myocardial Infarction in England
Background
Studies have reported significant reduction in acute myocardial infarctionârelated hospitalizations during the coronavirus disease 2019 (COVIDâ19) pandemic. However, whether these trends are associated with increased incidence of outâofâhospital cardiac arrest (OHCA) in this population is unknown.
Methods and Results
Acute myocardial infarction hospitalizations with OHCA during the COVIDâ19 period (February 1âMay 14, 2020) from the Myocardial Ischaemia National Audit Project and British Cardiovascular Intervention Society data sets were analyzed. Temporal trends were assessed using Poisson models with equivalent preâCOVIDâ19 period (February 1âMay 14, 2019) as reference. Acute myocardial infarction hospitalizations during COVIDâ19 period were reduced by >50% (n=20 310 versus n=9325). OHCA was more prevalent during the COVIDâ19 period compared with the preâCOVIDâ19 period (5.6% versus 3.6%), with a 56% increase in the incidence of OHCA (incidence rate ratio, 1.56; 95% CI, 1.39â1.74). Patients experiencing OHCA during COVIDâ19 period were likely to be older, likely to be women, likely to be of Asian ethnicity, and more likely to present with STâsegmentâelevation myocardial infarction. The overall rates of invasive coronary angiography (58.4% versus 71.6%; P<0.001) were significantly lower among the OHCA group during COVIDâ19 period with increased time to reperfusion (mean, 2.1 versus 1.1 hours; P=0.05) in those with STâsegmentâelevation myocardial infarction. The adjusted inâhospital mortality probability increased from 27.7% in February 2020 to 35.8% in May 2020 in the COVIDâ19 group (P<.001).
Conclusions
In this national cohort of hospitalized patients with acute myocardial infarction, we observed a significant increase in incidence of OHCA during COVIDâ19 period paralleled with reduced access to guidelineârecommended care and increased inâhospital mortality
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