Abstract
Background
Patent foramen ovale (PFO) closure has been shown to reduce the risk of recurrent stroke in selected patients. Different PFO occluding devices have been validated by the ...authorities and are used in the clinical practice.
Purpose
The main purpose of this study is to compare the use of two types of devices for PFO closure, the GORE CARDIOFORM Septal occluder and the AMPLATZER occluders (PFO or CRIBIFORM) in terms of major clinical safety and efficacy outcomes.
Methods
In this single-center retrospective study, the final cohort comprised 182 patients who underwent PFO closure between January 2012 and May 2019 (mean age 57±13 years, 34% males). The population was divided in two groups according to the device used (GORE CARDIOFORM Septal occluder n=66, 36% or the AMPLATZER occluders n=116, 64%). The endpoints assessed at 6 months, were the presence of a significant shunt (at least moderate 10–25 microbubbles at rest or during the Valsalva manoeuvre), the incidence of supraventricular arrythmias, recurrent stroke, or serious device-related adverse events.
Results
At 6 months, a small percentage of patients with significant residual shunt was found in both the GORE and the AMPLATZER groups (7% vs 14% respectively, p=0.182). The incidence of supraventricular arrythmias was lower in the GORE as compared to the AMPLATZER group (9.1% vs 22.4% respectively, p=0.023). During the 6-month follow-up period there were 3 ischemic strokes, all of them in the AMPLATZER group, but this difference did not reach statistical significance (p=0.188). Finally, no serious device-related adverse events were noted in the total cohort.
Conclusion
PFO closure with a GORE device is related to lower incidence of supraventricular arrythmias at 6 months. The presence of a significant residual shunt and the incidence of recurrent stroke were comparable between both groups.
Funding Acknowledgement
Type of funding sources: None.
Abstract
Introduction
The COVID-19 pandemic has placed unprecedented strain on healthcare systems around the world, with potential repercussions on the quality of care of patients with other ...diseases. From a cardiological perspective, there have been concerns that the pandemic may have impacted the management of the most acute cardiovascular conditions.
Purpose
We evaluated the impact of the COVID-19 pandemic on the management of ST-elevation myocardial infarction (STEMI) in Switzerland by assessing a range of quality-of-care metrics during the first year of the pandemic, as compared with the preceding year.
Methods
Data on STEMI patients hospitalised in Switzerland from 1st January 2019 to 31st December 2020 were obtained from the Acute Myocardial Infarction in Switzerland (AMIS) registry. Symptom-to-first-medical-contact (symptom-to-FMC) time, symptom-to-door time, and door-to-balloon (DTB) time were compared between 2020 and 2019 in an analysis by year and by month. Additionally, rates of in-hospital all-cause mortality and in-hospital major adverse cardiovascular events (MACE: all-cause mortality, MI, stroke) were compared.
Results
Data on 2192 STEMI patients were available. Compared with the preceding 12 months, the first year of the pandemic was not associated with a significant change in median symptom-to-FMC time (2020: 90 minutes vs 2019: 95 minutes, p=0.32) or median symptom-to-door time (2020: 145 min vs 2019: 157 min, p=0.51). In 2020, February (start of the pandemic) and March (start of national lockdown) were associated with increased DTB times as compared with the same months of 2019 (+7 minutes, +10 minutes, respectively). However, overall median door-to-balloon times remained stable (2020: 40 min vs 2019: 39 min, p=0.06). Furthermore, there was no significant difference in the proportion of patients undergoing percutaneous coronary intervention (2020: 95.6% vs 2019: 95.1%, p=0.54). Finally, there were no significant differences in median length of stay (2020: 4 days vs 2019: 157 min, p=0.51), in-hospital all-cause mortality (2020: 4.9% vs. 2019: 4.2%, p=0.41) or MACE (2020: 6.2% vs. 2019: 5.6%, p=0.52).
Conclusions
Although there are some limitations associated with the present study inherent to its retrospective observational design (for instance, a potentially important number of late comers may not have been included in the registry), the data suggest that despite the impact of COVID-19 on the healthcare system in Switzerland in 2020, STEMI management as defined by a range of quality-of-care metrics remained effective and efficient.
Funding Acknowledgement
Type of funding sources: None.
Abstract
Introduction
Little is known about patients with acute myocardial infarction (AMI) and chronic lung disease (CLD). The aim of our study was to analyze risk factors, treatment, and outcome of ...AMI patients with CLD over the last 20 years using the nationwide AMIS Plus registry.
Methods
All AMI patients enrolled in the AMIS Plus registry with data on CLD between January 2002 and December 2021 were included. Chronic lung disease was determined according to the definition used in the Charlson Comorbidity Index. Data on baseline characteristics, regular medication, immediate therapy within 24 hours, in-hospital interventions and treatments, in-hospital outcome, complications and discharge medication were analyzed using descriptive statistics and logistic regression.
Results
Among 53,680 AMI patients, 5.8% had a CLD. The CLD group included 26.6% female and 73.4% male patients. Gender distribution was similar in patients with and without CLD. Patients with CLD were significantly older (71.2 vs. 65.8 y; p<0.001), more frequently diagnosed with NSTEMI, had more comorbidities and were less frequently never smokers (17.4% vs. 35.3%; p<0.001) compared to patients without CLD. In addition, CLD patients were less likely to receive aspirin, P2Y12 inhibitors, beta-blockers, ACE inhibitors and statins (all p<0.001), and were also less likely to undergo percutaneous coronary interventions (68.7% vs. 82.5%; p<0.001). Median length of stay was 2 days longer for CLD patients. Patients with CLD had more major adverse cardiac and cerebrovascular events in-hospital (10.3% vs. 5.9%; p<0.001) and higher crude in-hospital mortality (8.3% vs. 4.7%; p<0.001). However, multivariable regression analysis showed that CLD was not an independent predictor for in-hospital mortality (OR 1.19 (95% CI 0.98–1.45), p=0.081).
Conclusion
Patients with CLD were less likely to receive evidence-based medicine and had a worse in-hospital outcome compared to those without CLD. However, after adjustment, CLD was not an independent predictor of in-hospital mortality.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): AstraZeneca AG, Biotronik (Schweiz) AG
Abstract
Introduction
The impact of acute myocardial infarction (AMI) on the ability to pursue professional life is not well defined. Using a nationwide database, we aimed to describe the ability to ...return to work after AMI in Switzerland and identify factors associated therewith.
Methods
AMI patients of working-age enrolled in the AMIS Plus registry between 01/2006 and 09/2020 with data on self-reported work status before and 12 months after AMI were included. Using the Kruskal-Wallis rank sum test or Fisher's exact test we compared patient characteristics between those who did not reduce work hours, those who reduced, and those no longer working 12 months after the AMI.
Results
Of 4315 AMI patients (median (IQR) age 54 (49, 59)), 3204 (74.3%) did not reduce work, 592 (13.7%) reduced and 519 (12.0%) stopped working. Patients not reducing were youngest (median age (IQR)): 54y (49y, 58y), those who reduced: 56y (51y, 60y), those who stopped: 56y (51y, 61y), p<0.001) and more often men (no reduction: 90%, reduced: 80%, stopped: 82%, p<0.001). Patients who reduced showed worst cardiac function at AMI reflected in the highest rates of Killip class>2 (no reduction: 1.8%, reduced: 5.2%, stopped: 3.3%, p<0.001) and resuscitation before admission (no reduction: 4.1%, reduced: 6.9%, stopped: 4.0%, p=0.008). Patients who stopped work had the most comorbidities such as past AMI (no reduction: 8.6%, reduced: 10%, stopped: 13%, p=0.003), hypertension (no reduction: 45%, reduced: 50%, stopped: 54%, p<0.001), diabetes (no reduction: 10%, reduced: 13%, stopped: 16%, p<0.001) and cerebrovascular disease (no reduction: 0.8%, reduced: 1.2%, stopped: 2.3%, p=0.007). There was no significant difference for rehabilitation participation during follow up (no reduction: 84%, reduced: 86%, stopped: 84%, n.s. for all group comparisons). Multivariable regression showed that the reduction group had a higher proportion of women (OR 2.30; 95% CI 1.80–2.93 p<0.001) and were more likely to have a Killip class >2 at admission (OR 2.58; 95% CI 1.54–4.31 p<0.001) as compared to the no reduction group whereas the comparison between no reduction and work stop identified comorbidities (past MI (OR 1.46; 95% CI 1.07–1.94 p=0.016), diabetes (OR 1.59; 95% CI 1.21–2.09 p=0.001), cerebrovascular disease (OR 2.53; 95% CI 1.22–5.25 p=0.013)) and being female (OR 1.98; 95% CI 1.51–2.58 p<0.001) as major predictors for work stop.
Conclusion
Our data showed that 1:7 had reduced and 1:8 stopped professional activity 1 year after AMI. Younger age, being male and lower rates of comorbidities such as a past AMI, hypertension, diabetes and cerebrovascular disease were important factors associated with returning to work after AMI. Work reduction was significantly related with worse cardiac function whereas work stop was more related with comorbidities.
Funding Acknowledgement
Type of funding sources: None.
Abstract
Background
Patients with a total coronary occlusion (TCO) of the infarct-related artery (IRA) frequently present as ST-segment elevation myocardial infarction (STEMI). However, patients ...presenting as non-ST-segment elevation acute coronary syndromes (NSTE-ACS) on a routine ECG may actually have TCO at angiography, typically involving left circumflex (LCx) or right coronary artery (RCA) as the IRA. These patients might be at higher risk of MACE due to a delayed diagnosis and, consequently, an inappropriately prolonged time window to revascularization. Herein, we aimed to describe clinical characteristics and outcomes of IRA location in patients presenting with ACS enrolled in a real-world prospective cohort.
Methods
Between 2009 and 2017, 4,787 ACS patients were prospectively recruited in the SPUM-ACS prospective study. The primary outcome measure was major adverse cardiovascular events (MACE), a composite of all-cause death, non-fatal myocardial infarction and non-fatal stroke at one year. Multivariable-adjusted Cox regression models were fit using backward selection. Coronary angiographies were reviewed by operators of each site to assess the IRA location and TCO was defined in the presence of TIMI 0 flow.
Results
4,542 ACS patients (95% of the total cohort) had angiographic studies available. Patients with left main (n=75) and bypass graft (n=55) as culprit artery were excluded and a final sample size of 4,412 patients were included in the present analysis; 56% (n=2469) presented with ST-elevation myocardial infarction (STEMI) and 44% (n=1943) with NSTE-ACS. Overall, the IRA was the right coronary artery (RCA) in 33.9% (n=1494), the left-anterior descending coronary artery (LAD) in 45.6% (n=2013) and the left circumflex (LCx) in 20.5% (n=905). In those presenting with STEMI, patients with LAD as IRA had an increased risk of MACE (1.43, 95% CI 1.02-2.00, p = 0.04) as compared to those with RCA and LCx. In those presenting with NSTE-ACS, LCx and RCA as IRA had more frequently a TCO compared to the LAD (27% and 24%, respectively, vs. 9%, p<0.001). Features of patients with NSTE-ACS associated with TCO of the IRA included elevated lymphocyte and neutrophil counts, higher hs-CRP and hs-TnT, lower eGFR, and absent history of MI. Among patients with NSTE-ACS, LCx as IRA but not LAD and RCA was associated with an increased risk of MACE at one 1 year (fully adjusted HR 1.68, 95% CI 1.10-2.59, p=0.02; reference: RCA and LAD).
Conclusion
Among all ACS patients included in the SPUM-ACS, those with NSTE-ACS at initial ECG and RCA and LCx involvement had more often a TCO of the IRA, but only LCx as IRA was an independent predictor of MACE during follow-up. Hs-CRP levels, lymphocytes and neutrophils counts, hs-TnT, eGFR and history of MI at admission were found to be independent predictors of IRA occlusion at angiography. Thus, NSTE-ACS patients showing such features should further be evaluated for timely PCI.
Abstract
Background
Although impressive advances in the treatment of patients with acute coronary syndromes (ACS) have been achieved over the last decades, morbidity and mortality of patients with ...diabetes and ACS remain substantial. This study aimed at investigating long-term trends in treatment and outcomes of patients with diabetes and ACS, using data from a large, prospective, nation-wide database.
Methods
Patients with ST segment elevation myocardial infarction (STEMI) or non-ST segment elevation myocardial infarction (NSTEMI) enrolled in the prospective AMIS Plus registry between 01/2003 and 12/2018 and available data on diabetes diagnosis were included in the analysis. Major adverse cardiovascular events (MACE), a composite of all-cause death, non-fatal myocardial infarction, and cerebrovascular events were assessed for each 3-year period.
Results
Out of 49'413 ACS patients, 10'200 (20.6%) had diabetes (29.4% women). In diabetic patients, the percentage of women decreased from 32.3% in 2002–2004 to 25.9% in 2017–2019 (p<0.001). Diabetic patients were older (p<0.001), more frequently women (p<0.001), and had a higher body mass index (p<0.001). They less often underwent percutaneous coronary intervention (p<0.001) and were more frequently treated by coronary artery bypass grafting (p<0.001). Over the 18-year period, the percentage of diabetic patients undergoing PCI or CABG increased (p<0.001). While treatment with glycoprotein IIb/IIIa inhibitors, low-molecular weight heparin, and beta blockers decreased over time, administration of aspirin, P2Y12 inhibitors, lipid-lowering drugs, and unfractionated heparin increased. Rates of MACE were 9.5% and 5.2% in diabetic and non-diabetic patients (p<0.001). Rates of mortality (7.7% versus 4.1%, p<0.001), recurrent myocardial infarction (1.5% versus 0.9%, p<0.001), and cerebrovascular events (1.2% versus 0.6%, p<0.001) were higher in diabetic as compared with non-diabetic patients, with highest rates of MACE, mortality, and myocardial infarction observed in diabetic women. Rates of MACE decreased from 11.8% in 2002–2004 to 7.5% in 2017–2019 in diabetic patients (p for trend <0.001). While rates of mortality (9.4% to 5.9%, p for trend =0.001) and rates of recurrent myocardial infarction (3.4% to 0.9%, p for trend <0.001) decreased over time, rates of cerebrovascular events remained stable (p for trend =0.34). Trends were the same in diabetic women and men.
Conclusions
Rates of MACE significantly decreased over the 18-year period in both diabetic women and men, with highest rates observed in diabetic women. Despite the observed improvements, rates of MACE remained 50% higher in diabetic as compared with non-diabetic patients. These findings emphasize that advanced strategies particularly targeting the vulnerable high-risk diabetic patient population are warranted to further improve quality of care in ACS.
Funding Acknowledgement
Type of funding sources: None.
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