Dataset Information

Benefit of Early Statin Initiation within 48 Hours after Admission in Statin-Naive Patients with Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention.

ABSTRACT: BACKGROUND AND OBJECTIVES:Although current guidelines recommend early initiation of statin in patients with acute myocardial infarction (AMI), there is no consensus for optimal timing of statin initiation. METHODS:A total of 3,921 statin-naïve patients undergoing percutaneous coronary intervention were analyzed, and divided into 3 groups according to statin initiation time: group 1 (statin initiation <24 hours after admission), group 2 (24-48 hours) and group 3 (?48 hours). We also made 3 stratified models to reduce bias: model 1 (<24 hours vs. ?24 hours), model 2 (<48 hours vs. ?48 hours) and model 3 (<24 hours vs. 24-48 hours). The endpoint was major adverse cardiac events (MACE; composite of cardiac death, myocardial infarction and target-vessel revascularization) during median 3.8 years. RESULTS:During follow-up, incidence of MACE was lower in early statin group in both model 1 (14.3% vs. 18.4%, hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.66-0.91; p=0.002) and model 2 (14.6% vs. 19.7%, HR, 0.81; 95% CI, 0.67-0.97; p=0.022). After propensity-score matching, results remained unaltered. Statin initiation <24 hours reduced MACE compared to statin initiation ?24 hours in model 1. Statin initiation <48 hours also reduced MACE compared to statin initiation later in model 2. However, there was no difference in incidence of MACE between statin initiation <24 hours and 24-48 hours) in model 3. CONCLUSIONS:Early statin therapy within 48 hours after admission in statin-naïve patients with AMI reduced long-term clinical outcomes compared with statin initiation later. TRIAL REGISTRATION:ClinicalTrials.gov Identifier: NCT02385682.

SUBMITTER: Kim MC

PROVIDER: S-EPMC6511534 | biostudies-literature | 2019 May

REPOSITORIES: biostudies-literature

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Benefit of Early Statin Initiation within 48 Hours after Admission in Statin-Naïve Patients with Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention.

Kim Min Chul MC Ahn Youngkeun Y Cho Jae Yeong JY Lee Ki Hong KH Sim Doo Sun DS Yoon Nam Sik NS Yoon Hyun Ju HJ Kim Kye Hun KH Hong Young Joon YJ Park Hyung Wook HW Kim Ju Han JH Jeong Myung Ho MH Cho Jeong Gwan JG Park Jong Chun JC Chang Kiyuk K Seung Ki Bae KB

Korean circulation journal 20190212 5

<h4>Background and objectives</h4>Although current guidelines recommend early initiation of statin in patients with acute myocardial infarction (AMI), there is no consensus for optimal timing of statin initiation.<h4>Methods</h4>A total of 3,921 statin-naïve patients undergoing percutaneous coronary intervention were analyzed, and divided into 3 groups according to statin initiation time: group 1 (statin initiation <24 hours after admission), group 2 (24-48 hours) and group 3 (≥48 hours). We als ...[more]

PMID: 30808084

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Project description:BackgroundClose to 1 in 5 patients admitted to a skilled nursing facility (SNF) are readmitted to the acute hospital within 30 days, and a substantial percentage are readmitted within 2 days of the SNF admission. These rapid returns to the hospital may provide insights for improving care transitions between the acute hospital and the SNF.ObjectivesTo describe the characteristics of SNF to hospital transfers that occur within 48 hours and 30 days of SNF admission based on root cause analyses (RCAs) performed by SNF staff, and identify potential areas of focus for improving transitions between hospitals and SNFs.DesignTrained staff from SNFs enrolled in a randomized, controlled clinical trial of the INTERACT (Interventions to Reduce Acute Care Transfers) quality improvement program performed retrospective RCAs on hospital transfers during a 12-month implementation period.SettingSNFs from across the United States.Participants64 of 88 SNFs randomized to the intervention group submitted RCAs.InterventionsSNFs were implementing the INTERACT quality improvement program.MeasuresData were abstracted from the INTERACT Quality Improvement (QI) tool, a structured, retrospective RCA on hospital transfers.ResultsAmong 4658 transfers for which data on the time between SNF admission and hospital transfer were available, 353 (8%) occurred within 48 hours of SNF admission, 524 (11%) 3 to 6 days after SNF admission, 1450 (31%) 7 to 29 days after SNF admission, and 2331 (50%) occurred 30 days or longer after admission. Comparisons between transfers that occurred within 48 hours and within 30 days of SNF admission to transfers that occurred 30 days or longer after SNF admission revealed several statistically significant differences between patient risk factors for transfer, symptoms and signs precipitating the transfers, and other characteristics of the transfers. Hospitalization in the last 30 days and year was significantly more common among those with rapid returns to the hospital. Shortness of breath was significantly more common among those transferred within 48 hours or 30 days, and falls, functional decline, suspected respiratory infection, and new urinary incontinence less common. SNF staff rated a higher proportion of transfers within 30 days versus 30 days or longer as potentially preventable (25.1% vs 21.5%, P = .005). Case descriptions derived from the QI tools of transfers back to the hospital within 48 hours of SNF admission illustrate several factors underlying these rapid returns to the hospital.ConclusionRCAs on transfers back to the hospital shortly after SNF admission provide insights into strategies that both hospitals and SNFs can consider in collaborative efforts to reduce potentially avoidable hospital readmissions.

Project description:Low level of testosterone may be associated with cardiovascular diseases in men, as some evidence suggests a protective role for testosterone in cardiovascular system. Little is known about the possible role of serum testosterone in response to reperfusion therapy in ST-elevation myocardial infarction (STEMI) and its relationship with ST-segment recovery. The present study was conducted to evaluate the association of serum testosterone levels with ST-segment resolution following primary percutaneous coronary intervention (PPCI) in male patients with acute STEMI.Forty-eight men (mean age 54.55 ± 12.20) with STEMI undergoing PPCI were enrolled prospectively. Single-lead ST segment resolution in the lead with maximum baseline ST-elevation was measured and patients were divided into two groups according to the degree of ST-segment resolution: complete (> or =50%) or incomplete (<50%). The basic and demographic data of all patients, their left ventricular ejection fraction (LVEF) and laboratory findings including serum levels of free testosterone and cardiac enzymes were recorded along with angiographic finding and baseline TIMI (Thrombolysis in Myocardial Infarction) flow and also in-hospital complications and then these variables were compared between two groups.A complete ST-resolution (≥50%) was observed in 72.9% of the patients. The serum levels of free testosterone (P = 0.04), peak cardiac troponin (P = 0.03) were significantly higher and hs-CRP (P = 0.02) were lower in patients with complete ST-resolution compared to those with incomplete ST-resolution. In-hospital complications were observed in 31.2% of patients. The patients with a lower baseline TIMI flow (P = 0.03) and those who developed complications (P = 0.04) had lower levels of free testosterone. A significant positive correlation was observed between the left ventricular function and serum levels of free testosterone (P = 0.01 and r = +0.362).This study suggests that in men with STEMI undergoing PPCI, higher serum levels of testosterone are associated with a better reperfusion response, fewer complications and a better left ventricular function.

Project description:BackgroundAdmission hyperglycemia (AH) is a common finding in patients with acute coronary syndrome and has been reported to be associated with increased morbidity and mortality. Prior studies suggest that AH could be associated with reperfusion failure. We conducted a systematic review and meta-analysis to explore an association between AH and risk of reperfusion failure in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI).MethodsTwo investigators searched the databases of MEDLINE and EMBASE from inception to February 2021. Study eligibility was independently determined by two investigators and needed to demonstrate association of AH and rate of reperfusion failure, or sufficient raw data to calculate the effect size. Participants were classified into two groups corresponding to their level of admission hyperglycemia. Group 1 was defined as an AH of ≥120-150 mg/dl, and group 2 as ≥150-200 mg/dl. Data from each study were combined using the random-effects model, the generic inverse-variance method of Der Simonian and Laird. The heterogeneity of effect size was quantified using the I2 statistic. A sensitivity analysis was performed by omitting one study at a time. Publication bias was assessed using a funnel plot and the Egger's test. All data analyses were performed using STATA SE version 14.2.ResultsA total of ten studies from 2008 to 2019 met eligibility criteria and were included in the final analysis. We found that AH is associated with increased risk of reperfusion failure in both group 1 (pooled OR=1.78, 95% CI: 1.35-2.33, I2=63.2%, P<0.001) and group 2 (pooled OR=1.44, 95% CI: 1.14-1.82, I2=57.1%, P<0.001). Sensitivity analysis showed that none of the results were significantly altered after removing one study at a time. In subgroup analysis of non-diabetic patients, we found that AH is also associated with increased risk of reperfusion failure in both group 1 (pooled OR=1.81, 95% CI: 1.29-2.54, P<0.001) and group 2 (pooled OR=1.61, 95% CI: 1.17-2.21, P<0.001). We did not perform a funnel plot or Egger's test as the number of available outcomes was insufficient to reject the assumption of funnel plot asymmetry.ConclusionsOur systematic review and meta-analysis demonstrated that AH is associated with increased risk of reperfusion failure in STEMI patients undergoing pPCI, in the non-diabetic population.

Project description:BackgroundPredicting early respiratory failure due to COVID-19 can help triage patients to higher levels of care, allocate scarce resources, and reduce morbidity and mortality by appropriately monitoring and treating the patients at greatest risk for deterioration. Given the complexity of COVID-19, machine learning approaches may support clinical decision making for patients with this disease.ObjectiveOur objective is to derive a machine learning model that predicts respiratory failure within 48 hours of admission based on data from the emergency department.MethodsData were collected from patients with COVID-19 who were admitted to Northwell Health acute care hospitals and were discharged, died, or spent a minimum of 48 hours in the hospital between March 1 and May 11, 2020. Of 11,525 patients, 933 (8.1%) were placed on invasive mechanical ventilation within 48 hours of admission. Variables used by the models included clinical and laboratory data commonly collected in the emergency department. We trained and validated three predictive models (two based on XGBoost and one that used logistic regression) using cross-hospital validation. We compared model performance among all three models as well as an established early warning score (Modified Early Warning Score) using receiver operating characteristic curves, precision-recall curves, and other metrics.ResultsThe XGBoost model had the highest mean accuracy (0.919; area under the curve=0.77), outperforming the other two models as well as the Modified Early Warning Score. Important predictor variables included the type of oxygen delivery used in the emergency department, patient age, Emergency Severity Index level, respiratory rate, serum lactate, and demographic characteristics.ConclusionsThe XGBoost model had high predictive accuracy, outperforming other early warning scores. The clinical plausibility and predictive ability of XGBoost suggest that the model could be used to predict 48-hour respiratory failure in admitted patients with COVID-19.

Project description:BackgroundEvidence suggests that high-dose statin pretreatment may reduce the risk of periprocedural myocardial infarction (PMI) and major adverse cardiac events (MACE) for certain patients; however, previous analyses have not considered patients with a history of statin maintenance treatment. In this meta-analysis of randomized controlled trials (RCTs), we reevaluated the efficacy of short-term high-dose statin pretreatment to prevent PMI and MACE in an expanded set of patients undergoing elective percutaneous coronary intervention.MethodsWe searched the PubMed/Medline database for RCTs that compared high-dose statin pretreatment with no statin or low-dose statin pretreatment as a prevention of PMI and MACE. We evaluated the incidence of PMI and MACE, including death, spontaneous myocardial infarction, and target vessel revascularization at the longest follow-up for each study for subgroups stratified by disease classification and prior low-dose statin treatment.ResultsTwenty-four RCTs with a total of 5,526 patients were identified. High-dose statin pretreatment was associated with 59% relative reduction in PMI (odds ratio [OR]: 0.41; 95% confidence interval [CI]: 0.34-0.49; P<0.00001) and 39% relative reduction in MACE (OR: 0.61; 95% CI: 0.45-0.83; P = 0.002). The benefit of high-dose statin pretreatment on MACE was significant for statin-naive patients (OR: 0.69; 95% CI: 0.50-0.95; P = 0.02) and prior low dose statin-treated patients (OR: 0.28; 95% CI: 0.12-0.65; P = 0.003); and for patients with acute coronary syndrome (OR: 0.52; 95% CI: 0.34-0.79; P = 0.003), but not for patients with stable angina (OR: 0.71; 95% CI 0.45-1.10; P = 0.12). Long-term effects on survival were less obvious.ConclusionsHigh-dose statin pretreatment can result in a significant reduction in PMI and MACE for patients undergoing elective PCI. The positive effect of high-dose statin pretreatment on PMI and MACE is significant for statin-naïve patients and patients with prior treatment. The positive effect of high-dose statin pretreatment on MACE is significant for patients with acute coronary syndrome.

Dataset Information

Benefit of Early Statin Initiation within 48 Hours after Admission in Statin-Naive Patients with Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention.

Publications

Benefit of Early Statin Initiation within 48 Hours after Admission in Statin-Naïve Patients with Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention.

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