13 research outputs found
Survival of Myocardial Infarction Patients with Diabetes Mellitus at the Invasive Era (Results from the VĂĄrosmajor Myocardial Infarction Registry)
Introduction. Due to the lifelong nature of diabetes mellitus (DM), it has been demonstrated to have significant effects on patientsâ morbidity and mortality. The present study aimed to assess the effects of DM on the clinical outcome and survival in patients who underwent percutaneous coronary intervention (PCI) due to myocardial infarction (MI) and to examine the relationship of DM to the type of the MI and to left ventricular (LV) and renal functions. Methods. A total of 12,270 patients with ST-elevation MI (STEMI) or non-ST-elevation MI (NSTEMI) were revascularized at our Institution between 2005 and 2013. In this pool of patients, 4388 subjects had DM, while 7018 cases had no DM. Results. In both STEMI and NSTEMI, the 30-day and 1-year survival were worse in diabetic patients as compared to non-diabetic cases. In the patients with DM, NSTEMI showed worse prognosis within 1-year than STEMI similarly to non-diabetic subjects. Regarding survival, the presence of DM seemed to be more important than the type of MI. Regardless of the presence of DM, reduced LV function was a maleficent prognostic sign and DM significantly reduced the prognosis both in case of reduced and normal LV function. Survival is primarily affected by LV function, rather than DM. Worse renal function is associated with worse 30-day and 1-year survival in both cases with and without DM. Considering different renal functions, the presence of DM worsens both short- and long-term survival. Survival is primarily affected by renal function, rather than DM. Conclusions. The results from a high-volume PCI center confirm significant the negative prognostic impact of DM on survival in MI patients. DM is a more important prognostic factor than the type of the MI. However, survival is primarily affected by LV and renal functions, rather than DM. These results could highlight our attention on the importance of recent DM treatment with new drugs including SGLT-2 inhibitors and GLP-1 antagonists with beneficial effects on survival
KoronaÌriaintervencioÌ akut miokardiaÌlis infarktusban SARS-COVID-19-jaÌrvaÌny alatt
CeÌlkituÌzeÌs: A SARS-COVID-19-jaÌrvaÌny 2. eÌs 3. hullaÌma tetoÌzeÌsekor intervencioÌs centrumukba keruÌlt akut ST-elevaÌ- cioÌs eÌs nem-ST-elevaÌcioÌs sziÌvinfarktusos betegek kezeleÌsi adatainak oÌsszehasonliÌtaÌsa az egy eÌvvel koraÌbbi ugyanazon naptĂĄri idoÌszakeÌval. Betegek eÌs moÌdszerek: A szerzoÌk 6 hoÌnapos idoÌtartamban vizsgaÌltaÌk a panasz kezdeteÌtoÌl az elsoÌ egeÌszseÌguÌgyi kontaktusig (EKG-keÌsziÌteÌs), innen a centrumba keruÌleÌsig, intervencioÌ eseteÌn a felveÌteltoÌl a kateÌteres muÌtoÌbe keruÌleÌseÌig eÌs ott a ballon nyitaÌsaÌig eltelt idoÌt. A hasonloÌ idoÌintervallumok szignifikaÌns kuÌloÌnbseÌget a keÌt perioÌdusban nem mutattak. A kontrollidoÌszakhoz keÌpest a jaÌrvaÌny alatt csoÌkkent a felvett (602 versus 532, p=0,0002) eÌs intervencioÌra keruÌlt esetek (543 versus 465, p=0,0001) szaÌma. A diagnosztikus kateÌterezeÌst eÌs az intervencioÌt igyekeztek a legkoraÌbbi lehetseÌges idoÌpontban elveÌgezni. EredmeÌnyek: Az intervencioÌra keruÌlt ST-elevaÌcioÌs infarktusos esetek szaÌma leÌnyegeÌben azonos volt (234 versus 236) a keÌt perioÌdusban, a nem-ST-elevaÌcioÌsokeÌ jelentoÌsen csoÌkkent (309 versus 229, p=0,0001). A kontrollidoÌszakhoz keÌpest nem szignifikaÌns meÌrteÌkben noÌtt a leÌgzeÌs eszkoÌzoÌs segiÌteÌseÌt igeÌnyloÌk szaÌma (8,7 versus 12,3%), a keringeÌs eszkoÌzoÌs segiÌteÌseÌt igeÌnyloÌkeÌ azonos volt, mindkeÌt csoportban 1,7%. Akut vagy halasztott koszoruÌeÌrmuÌteÌt mindkeÌt idoÌszakban koÌzel hasonloÌ araÌnyban vaÌlt szuÌkseÌgesseÌ (2,3 versus 2,6%). A 30 napos halaÌlozaÌsi araÌny az oÌsszes felvett infarktusos betegekneÌl noÌtt a jaÌrvaÌny idoÌszakaÌban (9,3 versus 16,5%, p=0,003). IntervencioÌn aÌtesettekneÌl a kuÌloÌnbseÌg statisztikailag nem volt szignifikaÌns (9,0 versus 13,4%), az intervencioÌra nem keruÌltekneÌl az araÌny jelentoÌsen kuÌloÌnboÌzoÌtt (11,3 versus 39,7%). Az eÌves oÌsszes halaÌlozaÌs a kontrollidoÌszakhoz keÌpest a jaÌrvaÌny alatt magasabb volt az oÌsszes infarktusos betegneÌl (19,0 versus 24,4%, p=0,03). MegbeszeÌleÌs: A SARS-COVID-19-jaÌrvaÌny alatt jelentoÌsen csoÌkkent a felvett akut infarktusos betegek szaÌma, ennek oka a kevesebb nem-ST-elevaÌcioÌs eset. ReÌszben ez is okozhatja az oÌsszes felvett beteg magasabb 30 napos eÌs egyeÌves halaÌlozaÌsi araÌnyaÌt. A panaszok kezdeteÌtoÌl a ballonnyitaÌsig eltelt idoÌ reÌszintervallumai sem a centrumba bekeruÌleÌsig, sem a ballon nyitaÌsĂĄig leÌnyegesen nem kuÌloÌnboÌztek a keÌt idoÌszakban. Az oÌsszes esetre vonatkozoÌan a primer intervencioÌk szaÌma szignifikaÌnsan csoÌkkent, ezen beluÌl az ST-elevaÌcioÌs infarktusokeÌ nem. Az eszkoÌzoÌs leÌgzeÌssegiÌteÌs araÌnya noÌtt a jĂĄrvĂĄny idoÌszakĂĄban, de nem eÌrte el a statisztikai szignifikancia meÌrteÌkeÌt. Az eszkoÌzoÌs keringeÌssegiÌteÌs eÌs a bypass muÌteÌti araÌny leÌnyegeÌben azonos volt. | Aim of the study: Treatment data comparison of the acute ST-elevation and non-ST-elevation myocardial infarction
patients admitted to their intervention center at the peak of the 2nd and 3 rd waves of the SARS-COVID-19 epidemic with
those of the same calendar period one year earlier.
Results: The number of ST-elevation infarction cases undergoing intervention was essentially the same (234 versus
236) in the two periods, while the number of non-ST-elevation infarction cases decreased significantly (309 versus
229, p=0.0001). Compared to the control period, number of those requiring respiratory assistance increased non-
significantly (8.7 versus 12.3%), while the number of those requiring circulatory assistance was the same, 1.7% in both
groups. Need of acute or delayed coronary artery surgery became necessary in almost the same proportion in both
periods (2.3 versus 2.6%). The 30-day mortality rate increased in all enrolled patients with infarcts during the epidemic
period (9.3 versus 16.5%, p=0.003). For those who underwent the coronary intervention, difference was not statistically
significant (9.0 versus 13.4%), for those who did not undergo the intervention, the ratio was significantly different (11.3
versus 39.7%). Compared to the control period, the annual total mortality during the epidemic was higher for all patients
with infarction (19.0 versus 24.4%, p=0.03).
Discussion: During SARS-COVID-19 epidemic, the number of admitted acute myocardial infarction patients decreased
significantly, probably the reason for this was the diminished number of non-ST elevation cases. In part, this may be the
reason for the higher 30-day and one-year mortality rates of all admitted patients too. The sub-intervals of the time from
the onset of complaints to the opening of the balloon did not differ significantly in the two periods, neither until admis-
sion to the interventional center nor until the opening of the balloon. For all cases, the number of primary interventions
decreased significantly, but not for ST elevation infarctions. The rate of assisted breathing increased during the period
of epidemic, but did not reach statistically significant values. The rates of assisted circulatory support and bypass sur-
gery were essentially the same
Prognosis of the non-ST elevation myocardial infarction complicated with early ventricular fibrillation at higher age
Early ventricular fibrillation (EVF) predicts mortality in ST-segment elevation myocardial infarction (STEMI) patients. Data are lacking about prognosis and management of non-ST-segment elevation myocardial infarction (NSTEMI) EMI with EVF, especially at higher age. In the daily clinical practice, there is no clear prognosis of patients surviving EVF. The present study aimed to investigate the risk factors and factors influencing the prognosis of NSTEMI patients surviving EVF, especially at higher age. Clinical data, including 30-day and 1-year mortality of 6179 NSTEMI patients, were examined; 2.44% (n=151) survived EVF and were further analyzed using chi-square test and uni- and multivariate analyses. Patients were divided into two age groups below and above the age of 70 years. Survival time was compared with Kaplan-Meier analysis. EVF was an independent risk factor for mortality in NSTEMI patients below (HR: 2.4) and above the age of 70 (HR: 2.1). Mortality rates between the two age groups of NSTEMI patients with EVF did not differ significantly: 30-day mortality was 24% vs 40% (p=0.2709) and 1-year mortality was 39% vs 55% (p=0.2085). Additional mortality after 30 days to 1 year was 15% vs 14.6% (p=0.9728). Clinical characteristics of patients with EVF differed significantly from those without in both age groups. EVF after revascularization-within 48 h-had 11.2 OR for 30-day mortality above the age of 70. EVF in NSTEMI was an independent risk factor for mortality in both age groups. Invasive management and revascularization of NSTEMI patients with EVF is highly recommended. Closer follow-up and selection of patients (independent of age) for ICD implantation in the critical first month is essential
A hazai szĂvinfarktus-ellĂĄtĂĄs eredmĂ©nyĂ©t befolyĂĄsolĂł tĂ©nyezĆk elemzĂ©se
A mindenki szĂĄmĂĄra elĂ©rhetĆ korszerƱ invazĂv szĂvinfarktus-ellĂĄtĂĄs ellenĂ©re, a jĂł korai eredmĂ©nyekkel szemben, a hazai infarktusos betegek halĂĄlozĂĄsa hosszĂș tĂĄvon jelentĆsen meghaladja a hasonlĂł ellĂĄtĂĄsban rĂ©szesĂŒlĆ eurĂłpai betegekĂ©t. Ahhoz, hogy ezen vĂĄltoztatni lehessen, szĂŒksĂ©ges az ide vezetĆ okok rĂ©szletes elemzĂ©se, feltĂĄrĂĄsa. A hazai heveny szĂvinfarktusos betegek adatainak elemzĂ©sĂ©vel megĂĄllapĂtottuk, hogy a betegek rövid Ă©s hosszĂș tĂĄvon bekövetkezĆ halĂĄlozĂĄsĂĄt milyen tĂ©nyezĆk befolyĂĄsoljĂĄk. Az elemzĂ©s a 2003-tĂłl napjainkig tartĂł idĆszakot öleli fel több regiszter adatainak vizsgĂĄlatĂĄval (Semmelweis Egyetem, VĂĄÂrosmajori SzĂv- Ă©s ĂrgyĂłgyĂĄszati Klinika VMAJOR I. Ă©s VMAJOR II. regiszter, EuÂrĂłÂpai KardiolĂłgiai TĂĄrsasĂĄg Stent for Life I. Ă©s II. programja, a KözĂ©p-magyarorszĂĄgi InÂfarkÂtusellĂĄtĂĄs ĂNTSZ-regisztere, a BudaÂpest Modell adatbĂĄzisa). A rĂ©szletes elemzĂ©sek alapjĂĄn megĂĄllapĂthatĂł, hogy ST-elevĂĄciĂłs infarktus (STEMI) esetĂ©ben a primer percutan coronariaintervenciĂł arĂĄnya eurĂłpai szintƱ, az ST-elevĂĄciĂłval nem jĂĄrĂł akut coronaria szindrĂłmĂĄs (NSTEMI) betegek invazĂv ellĂĄtĂĄsa a szĂŒksĂ©ges arĂĄny alatt van. A hazai ST-elevĂĄciĂłs myocardialis infarktusos betegek Ășgynevezett hezitĂĄciĂłs ideje a környezĆ orszĂĄgokĂ©nĂĄl lĂ©nyegesen hosszabb, a hazai infarktusos populĂĄciĂł ĂĄltalĂĄnos cardiovascularis rizikĂłja a GRACE regiszter ĂĄtlagĂĄnĂĄl szignifikĂĄns mĂ©rtĂ©kben magasabb. ElemzĂ©seink Ă©s eredmĂ©nyeink alapjĂĄn komplex, szakmapolitikai döntĂ©seket is befolyĂĄsolĂł stratĂ©giai terv dolgozhatĂł ki a korszerƱ ellĂĄtĂĄsban rĂ©szesĂŒlĆ infarktusos betegek kĂ©sĆi halĂĄlozĂĄsĂĄnak csökkentĂ©se cĂ©ljĂĄbĂłl
MiokardiĂĄlis infarktusos nĆk halĂĄlozĂĄsĂĄnak epidemiolĂłgiai vizsgĂĄlata = Epidemiologic research of mortality rates in women surviving acute myocardial infarction
BevezetĂ©s: Nemzetközi Ă©s hazai irodalmi adatok egy rĂ©sze alapjĂĄn az akut miokardiĂĄlis infarktusos nĆk halĂĄlozĂĄsa magasabb, mint a fĂ©rfiakĂ©. Ezt az ĂĄtlagĂ©letkorbeli kĂŒlönbsĂ©ggel, a nĆk kĂ©slekedĆ, kevĂ©sbĂ© invazĂv szemlĂ©letƱ ellĂĄtĂĄsĂĄval, valamint kĂŒlönösen fiatalabb Ă©letkorban, az eltĂ©rĆ patomechanizmussal magyarĂĄzzĂĄk. CĂ©l: NagyforgalmĂș invazĂv centrumban 10 Ă©v alatt kezelt nĆk Ă©s fĂ©rfiak halĂĄlozĂĄsi adatainak ĂĄtfogĂł epidemiolĂłgiai vizsgĂĄlata. MĂłdszer: A VĂĄrosmajori SzĂv- Ă©s ĂrgyĂłgyĂĄszati KlinikĂĄn 2005 Ă©s 2014 között akut miokardiĂĄlis infarktuson ĂĄtesett 12120 konszekutĂv beteg adatainak retrospektĂv elemzĂ©sĂ©t vĂ©geztĂŒk. EredmĂ©nyek: A nĆk ĂĄtlagĂ©letkora (70±12,5 Ă©v) szignifikĂĄnsan magasabb (p<0,001), mint a fĂ©rfiakĂ© (64±12,8 Ă©v). A teljes korosztĂĄlyban nĆknĂ©l szignifikĂĄnsan alacsonyabb volt a szĂvelĂ©gtelensĂ©g (p=0,046), a helyszĂni reszuszcitĂĄciĂł (p=0,017), a kamrafibrillĂĄciĂł (p=0,008) elĆfordulĂĄsa, valamint a csĂșcs Troponin-T-szint (p=0,04). Az ĂĄtlagos idĆablakot tekintve, a nĆk hamarabb jutottak megfelelĆ ellĂĄtĂĄshoz (p=0,02). A 45 Ă©v alatti nĆk esetĂ©ben szignifikĂĄnsan gyakoribb a szĂvelĂ©gtelensĂ©g (p=0,005), magasabb a NSTEMI-arĂĄny (61%). A fĂ©rfiak Ă©s nĆk halĂĄlozĂĄsĂĄt összehasonlĂtva, a 12 ĂłrĂĄn tĂșli STEMI esetĂ©ben mind a 30 napos (7%/10%; p=0,68), mind az egyĂ©ves (16,5%/21%; p=0,13) halĂĄlozĂĄs tendenciajelleggel magasabb volt a nĆk esetĂ©ben, de a kĂŒlönbsĂ©g nem volt szignifikĂĄns. KövetkeztetĂ©s: EredmĂ©nyeink azt igazoljĂĄk, hogy több mint 10000 beteg adatainak elemzĂ©se alapjĂĄn invazĂv szemlĂ©letƱ ellĂĄtĂĄssal a nĆk nemzetközi irodalombĂłl ismert magasabb halĂĄlozĂĄsa elkerĂŒlhetĆ. A 45 Ă©v alatti Ă©letkorban, illetve a megkĂ©sett (12 ĂłrĂĄn tĂșli) STEMI esetĂ©ben Ă©szlelt tendenciajelleggel magasabb, de nem szignifikĂĄns halĂĄlozĂĄs jelzi ezen populĂĄciĂł fokozottan veszĂ©lyeztetett voltĂĄt. = Background: According to some international and national studies, mortality rates in females surviving acute myocardial infarction (AMI) are higher than those in males. Differences in age, patomechanism, especially at younger age, as well as the less invasive aspect of the treatment are suggested as possible reasons. The aim of our extensive epidemiologic study was to examine the mortality rates of men and women treated in the last 10 years in an interventional cardiology centre handling high amount of patients. Methods: We performed a retrospective analysis on the data of 12120 consecutive patients surviving acute myocardial infarction between 2005 and 2014 at the Heart and Vascular Center of Semmelweis University. Results: There was a significant difference (p<0.001) between the mean age of women (70±12.5 years) and men (64±12.8 years). The incidence of heart failure (p=0.046), CPR (p=0.017) and ventricular fibrillation (p=0.008) was significantly lower among women just as the peak troponin level (p=0.04). Considering the mean time frame, women got proper care (p=0.02) sooner. Among women below the age of 45 heart failure was more common (p=0.005) and the NSTEMI rate was higher (61%). Comparing the one month (7%/10%; p=0.68) and one-year mortality rates (16.5%/21%; p=0.13) in case of STEMI performed after 12 hours, women had worst prognosis than men. Conclusion: Based on our examination of more than 10000 patients, our results prove that with more invasive treatment, the higher mortality of women can be avoided. The tendency of higher â but not significant â mortality rates we noticed, at younger age (<45 years) and by STEMIs performed after 12 hours, shows the higher risk of this population
Survival of Myocardial Infarction Patients with Diabetes Mellitus at the Invasive Era (Results from the Városmajor Myocardial Infarction Registry)
Due to the lifelong nature of diabetes mellitus (DM), it has been demonstrated to have significant effects on patients’ morbidity and mortality. The present study aimed to assess the effects of DM on the clinical outcome and survival in patients who underwent percutaneous coronary intervention (PCI) due to myocardial infarction (MI) and to examine the relationship of DM to the type of the MI and to left ventricular (LV) and renal functions. A total of 12,270 patients with ST-elevation MI (STEMI) or non-ST-elevation MI (NSTEMI) were revascularized at our Institution between 2005 and 2013. In this pool of patients, 4388 subjects had DM, while 7018 cases had no DM. In both STEMI and NSTEMI, the 30-day and 1-year survival were worse in diabetic patients as compared to non-diabetic cases. In the patients with DM, NSTEMI showed worse prognosis within 1-year than STEMI similarly to non-diabetic subjects. Regarding survival, the presence of DM seemed to be more important than the type of MI. Regardless of the presence of DM, reduced LV function was a maleficent prognostic sign and DM significantly reduced the prognosis both in case of reduced and normal LV function. Survival is primarily affected by LV function, rather than DM. Worse renal function is associated with worse 30-day and 1-year survival in both cases with and without DM. Considering different renal functions, the presence of DM worsens both short- and long-term survival. Survival is primarily affected by renal function, rather than DM. The results from a high-volume PCI center confirm significant the negative prognostic impact of DM on survival in MI patients. DM is a more important prognostic factor than the type of the MI. However, survival is primarily affected by LV and renal functions, rather than DM. These results could highlight our attention on the importance of recent DM treatment with new drugs including SGLT-2 inhibitors and GLP-1 antagonists with beneficial effects on survival