Population Trends in Percutaneous Coronary Intervention 20-Year Results From the SCAAR (Swedish Coronary Angiography and Angioplasty Registry)
ABSTRACT OBJECTIVES: The aim of this study was to describe the characteristics and outcome of all consecutive patients treated with PCI in an unselected nation-wide cohort over the last 2 decades. BACKGROUND: Over the last 20 years, treatment with percutaneous coronary intervention (PCI) has evolved dramatically but the change in patient characteristics has not been well described. METHODS: We included all patients undergoing a PCI procedure for the first time between January 1990 and December 2010 from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). Patients were divided in different cohorts based on the year of the first PCI procedure. RESULTS: A total of 144,039 patients were included. The mean age increased from 60.1 (SD±9.9) years in 1990-1995 to 67.1 (±11.2) years in 2009-2010. The proportion of patients presenting with unstable coronary artery disease and STEMI increased from 27.4% and 6.2% to 47.7% and 32.5% respectively. Diabetes and multivessel disease were more often present in the later year cohorts. The 1-year mortality increased from 2.2% in 1990-1995 to 5.9% in 2009-2010, but after adjustment for age and indication a modest decrease was shown, mainly in STEMI patients. CONCLUSIONS: Characteristics of PCI patients have changed substantially over time reflecting the establishment of new evidence. The increasing age and proportion of patients undergoing PCI for acute coronary syndromes greatly influence outcome. The understanding of the changing patient characteristics is important for the translation of evidence to real-world clinical practice.
SourceAvailable from: Annelieke M Roest[Show abstract] [Hide abstract]
ABSTRACT: Background Although a number of risk factors are known to predict mortality within the first years after myocardial infarction, little is known about interactions between risk factors, whereas these could contribute to accurate differentiation of patients with higher and lower risk for mortality. This study explored the effect of interactions of risk factors on all-cause mortality in patients with myocardial infarction based on individual patient data meta-analysis.Methods Prospective data for 10,512 patients hospitalized for myocardial infarction were derived from 16 observational studies (MINDMAPS). Baseline measures included a broad set of risk factors for mortality such as age, sex, heart failure, diabetes, depression, and smoking. All two-way and three-way interactions of these risk factors were included in Lasso regression analyses to predict time-to-event related all-cause mortality. The effect of selected interactions was investigated with multilevel Cox regression models.ResultsLasso regression selected five two-way interactions, of which four included sex. The addition of these interactions to multilevel Cox models suggested differential risk patterns for males and females. Younger women (age <50) had a higher risk for all-cause mortality than men in the same age group (HR 0.7 vs. 0.4), while men had a higher risk than women if they had depression (HR 1.4 vs. 1.1) or a low left ventricular ejection fraction (HR 1.7 vs. 1.3). Predictive accuracy of the Cox model was better for men than for women (area under the curves: 0.770 vs. 0.754).Conclusions Interactions of well-known risk factors for all-cause mortality after myocardial infarction suggested important sex differences. This study gives rise to a further exploration of prediction models to improve risk assessment for men and women after myocardial infarction.BMC Medicine 12/2014; 12(1):242. DOI:10.1186/PREACCEPT-1708900131424681 · 7.28 Impact Factor
Article: Rationale and Design of a Double-blind, Multicenter, Randomized, Placebo controlled Clinical trial of Early Administration of Intravenous Beta-blockers in Patients with ST-elevation Myocardial Infarction before Primary PCI. : EARLY Beta-blocker Administration before primary PCI in patients with ST-elevation Myocardial Infarction (EARLY-BAMI) trial[Show abstract] [Hide abstract]
ABSTRACT: Beta-blockers have a class 1a recommendation in the treatment of patients with ST-elevation Myocardial Infarctions (STEMI) as they are associated with a reduced mortality, recurrent myocardial infarction, life-threatening arrhythmias and with prevention of unfavorable left ventricular remodeling. Whether early administration, prior to primary percutaneous coronary intervention (PCI), of intravenous beta-blockers, reduces the infarct size in the current era is unknown. Hypothesis We postulate that the early administration of beta-blockers will reduce the myocardial infarcted area as assessed by magnetic resonance imaging (MRI) at 30 days. Design In a multinational, multicenter, double blind, placebo-controlled, randomized trial patients with symptoms and signs of STEMI and transferred to a hospital for primary PCI will be randomized in a 1:1 fashion to intravenous Metoprolol (5 mg twice daily) administration or placebo. Before admission study treatment will be started as soon as possible after the diagnosis of STEMI. After admission primary PCI will be performed as per standard of care. After primary PCI medical treatment will occur as per current guidelines in all patients, including the use of oral beta-blockers. The primary endpoint is the myocardial infarct size as assessed by MRI at 30 days. Based on a superiority design and assuming an 18% relative infarct size reduction (from 28% to 23.5%), 408 patients are required to be enrolled, accounting for 20% drop-out (α = 0.05 and power = 80%). Summary The EARLY-BAMI trial is a multinational, multicenter, double blind, placebo-controlled, randomized clinical trial that will investigate the impact of intravenous Metoprolol administration prior to primary PCI for STEMI on myocardial infarct size as measured with MRI at 30-days.American Heart Journal 07/2014; DOI:10.1016/j.ahj.2014.07.015 · 4.56 Impact Factor
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ABSTRACT: Coronary heart disease (CHD) is one of the leading causes of morbidity and the most common cause of death in older adults. Paradoxically, elderly patients tend to be systematically excluded from randomized-controlled cardiovascular trials, which complicates decision-making in this population. Management of CHD in the elderly is frequently more difficult in virtue of chronic comorbid conditions and aging-intrinsic dynamics. Despite these challenges, the number of elderly and very elderly patients undergoing percutaneous coronary interventions (PCI) is increasing. Elderly patients in many registries and large clinical series exhibit even a greater benefit from interventional procedures than younger patients, but they have a higher rate of overall complications. We present an overview of the current available evidence of PCI in older adults with stable and unstable CHD, including comparisons between drug-eluting and bare-metal stents, transfemoral and transradial access, and methods of revascularization. Adjuvant antiplatelet and antithrombotic therapies are also discussed.Progress in Cardiovascular Diseases 09/2014; 57(2). DOI:10.1016/j.pcad.2014.07.002 · 2.44 Impact Factor