Objective:To analyze the risk factors for death during hospitalization in patients with acute myocardial infarction(AMI)complicated by gastrointestinal bleeding(GIB).Methods:260 patients with AMI complicated by GIB wh...Objective:To analyze the risk factors for death during hospitalization in patients with acute myocardial infarction(AMI)complicated by gastrointestinal bleeding(GIB).Methods:260 patients with AMI complicated by GIB who were admitted to the cardiology department of a hospital from January 2022 to December 2023 were retrospectively analyzed.27 patients who died during hospitalization were designated as the control group and the 233 patients who survived as the observation group.Baseline data and clinical indexes of patients in the two groups were compared,and multifactorial logistic regression was applied to analyze the risk factors for death during hospitalization in patients with AMI complicated by GIB.Results:Univariate analysis showed that the control group had higher proportions of patients with Killip classification III to IV on admission,new arrhythmias,and mechanical complications,as well as higher heart rates,white blood cell counts,urea nitrogen,and creatinine levels.The proportion of patients who received transfusion therapy during hospitalization was also higher in the control group.Conversely,the control group had lower systolic and left ventricular ejection fraction rates compared to the observation group,with statistically significant differences(P<0.05).Multifactorial logistic regression analysis revealed that new-onset arrhythmia(OR=2.724,95%CI 1.289-5.759),heart rate>100 beats/min(OR=3.824,95%CI 1.472-9.927),left ventricular ejection fraction<50%(OR=1.884,95%CI 0.893-3.968),BUN level(OR=1.029,95%CI 1.007-1.052),and blood transfusion(OR=3.774,95%CI 1.124-6.345)were independently associated with an increased risk of death during hospitalization in patients with AMI complicated by GIB.Conclusions:New arrhythmia,heart rate>100 beats/min,left ventricular ejection fraction<50%,elevated BUN levels,and blood transfusion are risk factors for death during hospitalization in patients with AMI complicated by GIB.展开更多
BACKGROUND The variability of metabolic biomarkers has been determined to provide incremental prognosis information,but the implications of electrolyte variability remained unclear.METHODS We investigate the relations...BACKGROUND The variability of metabolic biomarkers has been determined to provide incremental prognosis information,but the implications of electrolyte variability remained unclear.METHODS We investigate the relationships between electrolyte fluctuation and outcomes in survivors of acute myocardial infarction(n=4386).Ion variability was calculated as the coefficient of variation,standard deviation,variability independent of the mean(VIM)and range.Hazard ratios(HR)were estimated using the multivariable-adjusted Cox proportional regression method.RESULTS During a median follow-up of 12 months,161(3.7%)patients died,and heart failure occurred in 550(12.5%)participants after discharge,respectively.Compared with the bottom quartile,the highest quartile potassium VIM was associated with increased risks of all-cause mortality(HR=2.35,95%CI:1.36–4.06)and heart failure(HR=1.32,95%CI:1.01–1.72)independent of cardiac troponin I(c Tn I),N terminal pro B type natriuretic peptide(NT-pro BNP),infarction site,mean potassium and other traditional factors,while those associations across sodium VIM quartiles were insignificant.Similar trend remains across the strata of variability by other three indices.These associations were consistent after excluding patients with any extreme electrolyte value and diuretic use.CONCLUSIONS Higher potassium variability but not sodium variability was associated with adverse outcomes post-infarction.Our findings highlight that potassium variability remains a robust risk factor for mortality regardless of clinical dysnatraemia and dyskalaemia.展开更多
Most cases of sudden cardiac death are attributed to sustained ventricular tachyarrhythmias(VTs), triggered by acute coronary occlusion. Autonomic dysfunction, an important arrhythmogenic mechanism in this setting, is...Most cases of sudden cardiac death are attributed to sustained ventricular tachyarrhythmias(VTs), triggered by acute coronary occlusion. Autonomic dysfunction, an important arrhythmogenic mechanism in this setting, is being actively investigated, aiming at the advent of preventive strategies. Recent experimental studies have shown vagal withdrawal after anterior myocardial infarction, coinciding with high incidence of VTs, followed by more gradual sympathetic activation coinciding with a second arrhythmia peak. This article summarizes recent knowledge on this intriguing topic, generating hypotheses that can be investigated in future experimental and clinical studies.展开更多
BACKGROUND Previous studies have established a role of gout in predicting risk and prognosis of cardiovascular diseases. However, large-scale data on the impact of gout on inpatient outcomes of acute coronary syndrome...BACKGROUND Previous studies have established a role of gout in predicting risk and prognosis of cardiovascular diseases. However, large-scale data on the impact of gout on inpatient outcomes of acute coronary syndrome (ACS)-related hospitalizations and post-revascularization is inadequate. AIM To evaluate the impact of gout on in-hospital outcomes of ACS hospitalizations, subsequent healthcare burden and predictors of post-revascularization inpatient mortality. METHODS We used the national inpatient sample (2010-2014) to identify the ACS and goutrelated hospitalizations, relevant comorbidities, revascularization and postrevascularization outcomes using the ICD-9 CM codes. A multivariable analysis was performed to evaluate the predictors of post-revascularization in-hospital mortality. RESULTS We identified 3144744 ACS-related hospitalizations, of which 105198 (3.35%) also had gout. The ACS-gout cohort were more often older white males with a higher prevalence of comorbidities. Coronary artery bypass grafting was required more often in the ACS-gout cohort. Post-revascularization complications including cardiac (3.2% vs 2.9%), respiratory (3.5% vs 2.9%), and hemorrhage (3.1% vs 2.7%) were higher whereas all-cause mortality was lower (2.2% vs 3.0%) in the ACSgout cohort (P < 0.001). An older age (OR 15.63, CI: 5.51-44.39), non-elective admissions (OR 2.00, CI: 1.44-2.79), lower household income (OR 1.44, CI: 1.17- 1.78), and comorbid conditions predicted higher mortality in ACS-gout cohort undergoing revascularization (P < 0.001). Odds of post-revascularization inhospital mortality were lower in Hispanics (OR 0.45, CI: 0.31-0.67) and Asians (OR 0.65, CI: 0.45-0.94) as compared to white (P < 0.001). However, postoperative complications significantly raised mortality odds. Mean length of stay, transfer to other facilities, and hospital charges were higher in the ACS-gout cohort. CONCLUSION Although gout was not independently associated with an increased risk of postrevascularization in-hospital mortality in ACS, it did increase postrevascularization complications.展开更多
Background Cumulative evidence demonstrates that primary percutaneous coronary intervention(PCI)is a mperfusion strategy for ST-elevation myocardial Infarction(STEMI).This study was undertaken to evaluate the pre-...Background Cumulative evidence demonstrates that primary percutaneous coronary intervention(PCI)is a mperfusion strategy for ST-elevation myocardial Infarction(STEMI).This study was undertaken to evaluate the pre-hospital care-seeking pathway and subsequent care quality in patients with STEMI in the Beijing health care system,which offers patients a choice between seeking care in a small community hospital(SH group)or a large hospital(LH group).Methods Between January 1 and December 31,2006, a cross-sectional and multicenter survey was conducted in 11 hospitals qualified as tertiary centers in Beijing and included consecutive patients with STEMI admitted within 24 hours after onset of symptoms.Results Among the 566 patients interviewed,28.3%first arnved at a small community hospitaI and were transferred to large hospitals with the ability to perform primary PCI.The median total pre-hospital delay in the SH group(n=160)was significantly longer than in the LH group(n=406)(225 vs.120 minutes,P〈0.001).Multivariate analysis showed that interpreting symptoms to non-cardiac origin(OR,1.996;95%CI: 1.264-3.155),absence of history of myocardial infarction(OR,1.595;95%CI:1.086-3.347),non-health insuranca coverage(OR,1.931;95%Cl:1.079-3.012)and absence of sense of impending doom (OR,4.367;95%CI:1.279-1 4.925) were independent predictors for choosing small hospitals.After adjusting for demographics and medical history,patients in the SH group were 1.698 times(95% CI: 1.1 82-3.661) less likely to receive primary PCI compared with those in the LH group. Conclusions Above one fourth of the STEMI patients in Beijing experienced inter-hospital transfer.Factors including symptoms interpretation,symptoms,history of myocardial infarcUon,and insurance coverage were associated with the patients'pre-hospital care-seeking pathway.The patients who were transferred had longer pre-hospital delays and were less Iikely to receive primary PCI.展开更多
Background Acute myocardial infarction (AMI) is the leading cause of morbidity and disability among Iranian population. Pre-hospital delay is an important cause of increasing early and also late mortality in AMI. Th...Background Acute myocardial infarction (AMI) is the leading cause of morbidity and disability among Iranian population. Pre-hospital delay is an important cause of increasing early and also late mortality in AMI. Thus the aim of the present study was to identify the factors influencing pre-hospital delay among patients with AMI in Iran. Methods Between August 2010 and May 2011, a cross-sectional and single-center survey was conducted on 162 consecutive patients with ST-elevation myocardial infarction (STEMI) admitted to Cardiac Care Unit (CCU) of Dr. Heshmat Hospital, Rasht. All patients were interviewed by the third author within 7 days after admission by using a four-part questionnaire including socio-demographic, clinical, situational and cognitive factors. Data were analyzed by descriptive and Logistic regression model at P 〈 0.05 using SPSS 16. Results Mean age was (60.11±12.29) years in all patients. Majority of patients (65.4%) were male. The median of pre-hospital delay was 2 hours, with a mean delay of 7.4 hours (±16.25 hours). Regression analysis showed that admission in weekend (P 〈0.04, 0R=1.033, 95% Cl=1.187-2.006) and misinterpretation of symptoms as cardiac origin (P 〈0.002, OR=1.986, 95% Cl=1.254-3.155) and perceiving symptoms to not be so serious (P 〈0.003, OR=3.264, 95% Cl=1.492-7.142) were factors influencing pre-hospital delay 〉 2 hours. Conclusions Our findings highlight the importance of cognitive factors on decision-making process and pre-hospital delays. Health care providers can educate the public on AMI to enable them recognize the signs and symptoms of AMI correctly and realize the benefits of early treatment.展开更多
目的探讨宿迁地区基层胸痛中心发病至送达胸痛中心大门(symptom onset to door,StoD)时间的影响因素及对策。方法选择2022年1月—2023年6月宿迁市中西医结合医院胸痛中心收治的81例急性心肌梗死患者为研究对象。根据患者StoD时间分为≤...目的探讨宿迁地区基层胸痛中心发病至送达胸痛中心大门(symptom onset to door,StoD)时间的影响因素及对策。方法选择2022年1月—2023年6月宿迁市中西医结合医院胸痛中心收治的81例急性心肌梗死患者为研究对象。根据患者StoD时间分为≤6 h组50例与>6 h组31例。统计人口学资料以及相关影响因子,利用单因素分析与多因素logistic回归分析胸痛中心StoD时间的影响因素。结果2组疼痛程度评分、通过120入院还是自行来院、社区医生是否通过网络将心电图结果传输至胸痛中心、发病症状是否典型、家属态度是否积极、有无心血管疾病危险因素、是否夜间发病、发病地点与就诊医院的距离等指标比较,差异有统计学意义(P<0.05)。单因素分析及多因素logistic回归分析显示,自行来院、发病症状不典型、有心血管疾病危险因素、夜间发病、发病地点与就诊医院距离远均是胸痛中心StoD时间的危险因素,家属态度积极为保护因素(P<0.05)。结论基层胸痛中心StoD时间受患者来院途径、症状表现以及发病时间等影响,而家属积极态度有利于缩短StoD时间,需提高家属对疾病的认识,发挥区域诊疗中心协同救治的作用,缩短StoD时间及提高救治效率。展开更多
文摘Objective:To analyze the risk factors for death during hospitalization in patients with acute myocardial infarction(AMI)complicated by gastrointestinal bleeding(GIB).Methods:260 patients with AMI complicated by GIB who were admitted to the cardiology department of a hospital from January 2022 to December 2023 were retrospectively analyzed.27 patients who died during hospitalization were designated as the control group and the 233 patients who survived as the observation group.Baseline data and clinical indexes of patients in the two groups were compared,and multifactorial logistic regression was applied to analyze the risk factors for death during hospitalization in patients with AMI complicated by GIB.Results:Univariate analysis showed that the control group had higher proportions of patients with Killip classification III to IV on admission,new arrhythmias,and mechanical complications,as well as higher heart rates,white blood cell counts,urea nitrogen,and creatinine levels.The proportion of patients who received transfusion therapy during hospitalization was also higher in the control group.Conversely,the control group had lower systolic and left ventricular ejection fraction rates compared to the observation group,with statistically significant differences(P<0.05).Multifactorial logistic regression analysis revealed that new-onset arrhythmia(OR=2.724,95%CI 1.289-5.759),heart rate>100 beats/min(OR=3.824,95%CI 1.472-9.927),left ventricular ejection fraction<50%(OR=1.884,95%CI 0.893-3.968),BUN level(OR=1.029,95%CI 1.007-1.052),and blood transfusion(OR=3.774,95%CI 1.124-6.345)were independently associated with an increased risk of death during hospitalization in patients with AMI complicated by GIB.Conclusions:New arrhythmia,heart rate>100 beats/min,left ventricular ejection fraction<50%,elevated BUN levels,and blood transfusion are risk factors for death during hospitalization in patients with AMI complicated by GIB.
基金supported by the National Key R&D Program of China(No.2016YFC1301100)National Natural Science Foundation of China(No.81827806,81870353,31771241)Key Laboratory of Myocardial Ischemia,Ministry of Education(No.KF201903)。
文摘BACKGROUND The variability of metabolic biomarkers has been determined to provide incremental prognosis information,but the implications of electrolyte variability remained unclear.METHODS We investigate the relationships between electrolyte fluctuation and outcomes in survivors of acute myocardial infarction(n=4386).Ion variability was calculated as the coefficient of variation,standard deviation,variability independent of the mean(VIM)and range.Hazard ratios(HR)were estimated using the multivariable-adjusted Cox proportional regression method.RESULTS During a median follow-up of 12 months,161(3.7%)patients died,and heart failure occurred in 550(12.5%)participants after discharge,respectively.Compared with the bottom quartile,the highest quartile potassium VIM was associated with increased risks of all-cause mortality(HR=2.35,95%CI:1.36–4.06)and heart failure(HR=1.32,95%CI:1.01–1.72)independent of cardiac troponin I(c Tn I),N terminal pro B type natriuretic peptide(NT-pro BNP),infarction site,mean potassium and other traditional factors,while those associations across sodium VIM quartiles were insignificant.Similar trend remains across the strata of variability by other three indices.These associations were consistent after excluding patients with any extreme electrolyte value and diuretic use.CONCLUSIONS Higher potassium variability but not sodium variability was associated with adverse outcomes post-infarction.Our findings highlight that potassium variability remains a robust risk factor for mortality regardless of clinical dysnatraemia and dyskalaemia.
文摘Most cases of sudden cardiac death are attributed to sustained ventricular tachyarrhythmias(VTs), triggered by acute coronary occlusion. Autonomic dysfunction, an important arrhythmogenic mechanism in this setting, is being actively investigated, aiming at the advent of preventive strategies. Recent experimental studies have shown vagal withdrawal after anterior myocardial infarction, coinciding with high incidence of VTs, followed by more gradual sympathetic activation coinciding with a second arrhythmia peak. This article summarizes recent knowledge on this intriguing topic, generating hypotheses that can be investigated in future experimental and clinical studies.
文摘BACKGROUND Previous studies have established a role of gout in predicting risk and prognosis of cardiovascular diseases. However, large-scale data on the impact of gout on inpatient outcomes of acute coronary syndrome (ACS)-related hospitalizations and post-revascularization is inadequate. AIM To evaluate the impact of gout on in-hospital outcomes of ACS hospitalizations, subsequent healthcare burden and predictors of post-revascularization inpatient mortality. METHODS We used the national inpatient sample (2010-2014) to identify the ACS and goutrelated hospitalizations, relevant comorbidities, revascularization and postrevascularization outcomes using the ICD-9 CM codes. A multivariable analysis was performed to evaluate the predictors of post-revascularization in-hospital mortality. RESULTS We identified 3144744 ACS-related hospitalizations, of which 105198 (3.35%) also had gout. The ACS-gout cohort were more often older white males with a higher prevalence of comorbidities. Coronary artery bypass grafting was required more often in the ACS-gout cohort. Post-revascularization complications including cardiac (3.2% vs 2.9%), respiratory (3.5% vs 2.9%), and hemorrhage (3.1% vs 2.7%) were higher whereas all-cause mortality was lower (2.2% vs 3.0%) in the ACSgout cohort (P < 0.001). An older age (OR 15.63, CI: 5.51-44.39), non-elective admissions (OR 2.00, CI: 1.44-2.79), lower household income (OR 1.44, CI: 1.17- 1.78), and comorbid conditions predicted higher mortality in ACS-gout cohort undergoing revascularization (P < 0.001). Odds of post-revascularization inhospital mortality were lower in Hispanics (OR 0.45, CI: 0.31-0.67) and Asians (OR 0.65, CI: 0.45-0.94) as compared to white (P < 0.001). However, postoperative complications significantly raised mortality odds. Mean length of stay, transfer to other facilities, and hospital charges were higher in the ACS-gout cohort. CONCLUSION Although gout was not independently associated with an increased risk of postrevascularization in-hospital mortality in ACS, it did increase postrevascularization complications.
文摘Background Cumulative evidence demonstrates that primary percutaneous coronary intervention(PCI)is a mperfusion strategy for ST-elevation myocardial Infarction(STEMI).This study was undertaken to evaluate the pre-hospital care-seeking pathway and subsequent care quality in patients with STEMI in the Beijing health care system,which offers patients a choice between seeking care in a small community hospital(SH group)or a large hospital(LH group).Methods Between January 1 and December 31,2006, a cross-sectional and multicenter survey was conducted in 11 hospitals qualified as tertiary centers in Beijing and included consecutive patients with STEMI admitted within 24 hours after onset of symptoms.Results Among the 566 patients interviewed,28.3%first arnved at a small community hospitaI and were transferred to large hospitals with the ability to perform primary PCI.The median total pre-hospital delay in the SH group(n=160)was significantly longer than in the LH group(n=406)(225 vs.120 minutes,P〈0.001).Multivariate analysis showed that interpreting symptoms to non-cardiac origin(OR,1.996;95%CI: 1.264-3.155),absence of history of myocardial infarction(OR,1.595;95%CI:1.086-3.347),non-health insuranca coverage(OR,1.931;95%Cl:1.079-3.012)and absence of sense of impending doom (OR,4.367;95%CI:1.279-1 4.925) were independent predictors for choosing small hospitals.After adjusting for demographics and medical history,patients in the SH group were 1.698 times(95% CI: 1.1 82-3.661) less likely to receive primary PCI compared with those in the LH group. Conclusions Above one fourth of the STEMI patients in Beijing experienced inter-hospital transfer.Factors including symptoms interpretation,symptoms,history of myocardial infarcUon,and insurance coverage were associated with the patients'pre-hospital care-seeking pathway.The patients who were transferred had longer pre-hospital delays and were less Iikely to receive primary PCI.
文摘Background Acute myocardial infarction (AMI) is the leading cause of morbidity and disability among Iranian population. Pre-hospital delay is an important cause of increasing early and also late mortality in AMI. Thus the aim of the present study was to identify the factors influencing pre-hospital delay among patients with AMI in Iran. Methods Between August 2010 and May 2011, a cross-sectional and single-center survey was conducted on 162 consecutive patients with ST-elevation myocardial infarction (STEMI) admitted to Cardiac Care Unit (CCU) of Dr. Heshmat Hospital, Rasht. All patients were interviewed by the third author within 7 days after admission by using a four-part questionnaire including socio-demographic, clinical, situational and cognitive factors. Data were analyzed by descriptive and Logistic regression model at P 〈 0.05 using SPSS 16. Results Mean age was (60.11±12.29) years in all patients. Majority of patients (65.4%) were male. The median of pre-hospital delay was 2 hours, with a mean delay of 7.4 hours (±16.25 hours). Regression analysis showed that admission in weekend (P 〈0.04, 0R=1.033, 95% Cl=1.187-2.006) and misinterpretation of symptoms as cardiac origin (P 〈0.002, OR=1.986, 95% Cl=1.254-3.155) and perceiving symptoms to not be so serious (P 〈0.003, OR=3.264, 95% Cl=1.492-7.142) were factors influencing pre-hospital delay 〉 2 hours. Conclusions Our findings highlight the importance of cognitive factors on decision-making process and pre-hospital delays. Health care providers can educate the public on AMI to enable them recognize the signs and symptoms of AMI correctly and realize the benefits of early treatment.