Universal Definition of Myocardial Infarction

Ahn

Cathet Cardio Intervent

et al. 2014

Objectives: We examined long-term outcomes and predictors of major adverse cardiac events after the full metal jacket (FMJ) stent implantation. Background: The FMJ procedure has been used to treat diffuse coronary artery disease (CAD), but long-term outcomes remain unknown. Methods: The study population consisted of 347 consecutive patients (352 lesions) who had been treated for de novo diffuse CAD with FMJ stents (stent length 60 mm). Results: The mean age was 61.0 6 10.1 years, and the stent length was 71.9 6 13.7 mm. The procedural success rate was 97.7%. Major in-hospital complications (one death and two acute stent thromboses) occurred in three patients (0.7%). The median follow-up was 101 months (interquartile range, 95-108 months). During follow-up, there were 60 deaths (33 cardiac), 20 myocardial infarctions, and 94 revascularizations. Definite stent thrombosis occurred in 12 patients. The eventfree survival rate for cardiac death, cardiac death/myocardial infarction, or cardiac death/ myocardial infarction/target lesion revascularization was 90.5 6 1.6, 85.8 6 1.9, and 71.6 6 2.5% at 8 years, respectively. Left ventricular dysfunction (ejection fraction < 45%) was an independent predictor of cardiac death (OR: 4.88; 95% CI: 1.81-13.13; P 5 0.002). Left ventricular dysfunction and a stent length > 80 mm were significantly related to cardiac death/myocardial infarction. Likewise, a stent length > 80 mm was an independent predictor of cardiac death/myocardial infarction/target lesion revascularization (OR: 2.45; 95% CI: 1.16-5.19; P 5 0.019). Conclusion: Long-term outcomes appear favorable after FMJ procedures, and left ventricular dysfunction and a stent length > 80 mm are major predictors of major adverse cardiac events. These findings might be useful in identifying the most suitable treatments for patients with very diffuse CAD. V C 2013 Wiley Periodicals, Inc.

Section: Methodsmentioning

confidence: 99%

Long‐term (8 year) outcomes and predictors of major adverse cardiac events after full metal jacket drug‐eluting stent implantation

Ahn

Cathet Cardio Intervent

et al. 2014

“…We prospectively enrolled 100 consecutive patients with AHFs [18][19][20][21][22] Our series comprises AHF patients with ACS (submitted to mechanical revascularization [23][24][25][26][27]), and those with decompensated heart failure. All patients were rapidly transferred to our ICCU either from the Emergency Department (ED) or from the Catheterization Laboratory after mechanical revascularization.…”

Section: Methodsmentioning

confidence: 99%

Acute hyperglycemia and insulin resistance in acute heart failure syndromes without previously known diabetes

et al. 2011

No data is so far available on the relation between glucose values and insulin resistance and mortality, both at short-and long-term, in patients with acute heart failure syndromes (AHF). We prospectively assessed in 100 consecutive non-diabetic AHF patients whether acute glucose metabolism, as indicated by fasting glycemia and insulin resistance (HOMA index) was able to affect short-and long-term mortality. In the overall population, 51 patients showed admission glucose values [140 mg/dl. No significant difference was observed in admission and peak glycemia, insulin and C-peptide values and in HOMA-index between dead and survived patients. At multivariate logistic backward stepwise analysis the following variables were independent predictors for in-ICCU mortality (when adjusted for left ventricular ejection frac- In consecutive patients with acute heart failure without previously known diabetes, we documented, for the first time, that fasting glucose and insulin values and insulin resistance do not affect mortality at short-and longterm. Inflammatory activation (as indicated by the leukocyte count and the fibrinogen) and NT-pro BNP levels are independent predictors for early death while the eGFR affects the long-term mortality.

“…Reviewers confirmed diagnoses of acute coronary syndrome, heart failure, and pneumonia using specialty society guidelines. [18][19][20][21] Additional inclusion criteria included speaking English or Spanish, not being enrolled in hospice care, and ability of the patient or caregiver to participate in a telephone interview. Patients were consented over the telephone within a week of hospital discharge.…”

Section: Patientsmentioning

confidence: 99%

Medication Reconciliation Accuracy and Patient Understanding of Intended Medication Changes on Hospital Discharge

et al. 2012

BACKGROUND: Adverse drug events after hospital discharge are common and often serious. These events may result from provider errors or patient misunderstanding. OBJECTIVE: To determine the prevalence of medication reconciliation errors and patient misunderstanding of discharge medications. DESIGN: Prospective cohort study SUBJECTS: Patients over 64 years of age admitted with heart failure, acute coronary syndrome or pneumonia and discharged to home. MAIN MEASURES:We assessed medication reconciliation accuracy by comparing admission to discharge medication lists and reviewing charts to resolve discrepancies. Medication reconciliation changes that did not appear intentional were classified as suspected provider errors. We assessed patient understanding of intended medication changes through post-discharge interviews. Understanding was scored as full, partial or absent. We tested the association of relevance of the medication to the primary diagnosis with medication accuracy and with patient understanding, accounting for patient demographics, medical team and primary diagnosis. KEY RESULTS: A total of 377 patients were enrolled in the study. A total of 565/2534 (22.3 %) of admission medications were redosed or stopped at discharge. Of these, 137 (24.2 %) were classified as suspected provider errors. Excluding suspected errors, patients had no understanding of 142/205 (69.3 %) of redosed medications, 182/223 (81.6 %) of stopped medications, and 493 (62.0 %) of new medications. Altogether, 307 patients (81.4 %) either experienced a provider error, or had no understanding of at least one intended medication change. Providers were significantly more likely to make an error on a medication unrelated to the primary diagnosis than on a medication related to the primary diagnosis (odds ratio (OR) 4.56, 95 % confidence interval (CI) 2.65, 7.85, p<0.001). Patients were also significantly more likely to misunderstand medication changes unrelated to the primary diagnosis (OR 2.45, 95 % CI 1.68, 3.55), p<0.001). CONCLUSIONS: Medication reconciliation and patient understanding are inadequate in older patients postdischarge. Errors and misunderstandings are particularly common in medications unrelated to the primary diagnosis. Efforts to improve medication reconciliation and patient understanding should not be diseasespecific, but should be focused on the whole patient.