关键词： ST-elevation myocardial infarction   30-day mortality   Dynamic prediction   Two-stage scoring system  

摘要： The existing risk sores for ST-elevation myocardial infarction (STEMI) patients cannot balance timeliness, feasibility, and accuracy. This study aimed to develop and validate a two-stage scoring system capable of dynamic evaluation for 30-day mortality among STEMI patients. We recruited 3939 patients and randomly assigned (7:3) to derivation (N = 2757) and internal validation (N = 1182) datasets, an independent cohort of 1315 STEMI patients was used for external validation. The two-stage scoring system was developed based on factors associated with 30-day mortality identified by multivariate analysis and their availability in course of management. The first medical contact (FMC) stage risk score comprised six predictors (age, gender, systolic blood pressure, heart rate, Killip class, and anterior myocardial infarction), the in-hospital risk score included serum creatinine and left ventricular ejection fraction on this basis. The area under the curve (AUC) were 0.816, 0.854, 0.843, and 0.876 in derivation and internal validation for FMC and in-hospital stage risk score with satisfactory calibration ability. FMC stage risk score displayed equivalent predictive ability with TIMI risk score and GRACE score, in-hospital stage risk score obtained promotion in AUC, integrated discrimination improvement, and net reclassification improvement (all P < 0.001) compared with the classic risk scores. The reproducibility and effectiveness of the risk scores were statistically confirmed in the external validation cohort. The two-stage scoring system had good ability for predicting 30-day mortality and useful to dynamically identify high-risk STEMI patients. Trial registration: [NCT02641262] [29 December 2015].

关键词： Impella   left ventricle unloading   onset-to-unloading time   ST-segment-elevation myocardial infarction  

摘要： It is unclear whether the impact of prereperfusion unloading on improving survival is sustained throughout all periods from the onset in patients with ST-segment elevation myocardial infarction. This study is a post hoc analysis of the Japanese registry for Pectaneous Ventricular Assist Device (J-PVAD) registry. In all patients registered in J-PVAD between February 2020 and December 2021, patients with ST-segment elevation myocardial infarction complicated with cardiogenic shock and treated with Impella support alone were selected. A total of 2 cohorts were provided based on whether the onset-to-unloading time was <6 hours. The patients were divided into 2 groups according to prereperfusion or postreperfusion unloading in each cohort. The primary outcome was the 30-day survival rate. The independent factors of survival were identified with a multivariable Cox proportional hazard regression analysis after adjusting for the variables that were statistically significant in the univariable analysis. Patients with prereperfusion unloading had a significantly higher 30day survival rate than patients with postreperfusion unloading (91% vs 67%, p <0.01) in the cohort with an onset-to-unloading time >= 6 hours, whereas patients with prereperfusion or postreperfusion unloading had similar 30-day survival rates (88% vs 91%, p = 0.64) in the cohort with an onset-to-unloading time <6 hours. A multivariable analysis revealed that prereperfusion use of Impella was an independent factor of survival (hazard ratio 0.249,95% confidence interval 0.070 to 0.889, p = 0.03) in the onset-to-unloading time >= 6 hours cohort. In conclusion, prereperfusion left ventricular unloading could be a crucial treatment to improve the short-term survival rate when the onset-to-left ventricular unloading time was >= 6 hours. (c) 2024 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

关键词： NSTEMI   Ward   CCU   Mortality  

摘要： Background: Specialist cardiac care has been shown to reduce inpatient mortality following non-ST segment myocardial infarction (NSTEMI), but whether this benefit extends beyond index admission is unclear. Methods: Using the linked Myocardial Ischaemia National Audit Project (MINAP) registry, and Office for National Statistics mortality recording, we included 425,205 NSTEMI patients admitted to UK hospitals, between January 2005 and March 2019 that survived to discharge. 217,964 (52 %) were admitted to a specialty cardiac ward. Multivariable Cox-regression models were applied to imputed data to estimate Hazard Ratios for mortality over our study period. Results: Patients admitted to specialty cardiology wards were younger (70 years vs. 75), less often female (32 % vs. 40 %) but more often received statins (86 % vs. 84 %) or beta-blockers (83 % vs. 77 %) (all P < 0.001). One-year (aHR:0.84, 95 % CI 0.83-0.86), and ten-year mortality (aHR: 0.88, 95 % CI 0.87-0.89) were lower in patients admitted to specialty cardiac wards, compared to admitted elsewhere (all P < 0.001). There was significant geographic variation in the proportion admitted to speciality cardiac wards (London 59 % vs. East of England 43 %), with over 1700 deaths potentially avoided if the MINAP target of 80 % was reached. Conclusion: Patients admitted to a cardiac ward had significantly lower mortality compared to alternate wards persisting up to ten-years. There is wide regional variation in the proportion of patients who received specialist cardiology care during their admission and an opportunity exists for lives saved if the proportion of NSTEMI patients admitted to a cardiac ward were to reach the MINAP target of 80 %.

关键词： Complete revascularization   ST-segment elevation myocardial infarction   culprit-lesion   meta-analysis   multivessel disease   percutaneous coronary intervention  

摘要： Patients with ST-segment elevation myocardial infarction (STEMI) frequently present with multivessel coronary artery disease (CAD) during primary percutaneous coronary intervention, and the optimal timing of complete revascularization (CR) in these cases remains uncertain. This study aims to assess major adverse cardiovascular events (MACEs) and procedural complications in patients with STEMI with multivessel CAD who underwent immediate (index procedure) versus staged CR. We conducted a systematic review and meta-analysis of randomized controlled trials comparing immediate to staged CR in STEMI and multivessel CAD. Trials were identified by way of a systematic search of MEDLINE, Embase, and Cochrane Libraries from database inception to March 6, 2024. The data were analyzed using the RevMan software. A total of 5 randomized controlled trials (n = 1,415) were included in our study, which showed no significant differences in MACEs (13.3% vs 9.8%, relative risk [RR] 1.07, 95% confidence interval [CI] 0.62 to 1.83), all-cause mortality (3% vs 4.55%, RR 0.70, 95% CI 0.41 to 1.21), or myocardial infarction (4.5% vs 2.6%, RR 1.43, 95% CI 0.58 to 3.55) at a weighted mean follow-up duration of 16 months. However, the staged group had a higher rate of unplanned revascularization (8.6% vs 4.4%, RR 1.92, 95% CI 1.21 to 3.04). In conclusion, in patients with STEMI with multivessel CAD, at a mean follow-up of approximately 1.3 years, there is no significant difference in immediate versus staged revascularization (SR) for MACEs;however, SR was associated with a significantly higher incidence of unplanned ischemia-driven revascularization. SR within the index hospitalization may be as effective as immediate CR;further trials are needed to confirm this. We conducted a meta-analysis of 5 randomized controlled trials comparing immediate to staged complete revascularization in patients with ST-segment elevation myocardial infarction with multivessel coronary artery disease. There was no