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1.
Angiol Sosud Khir ; 26(3): 142-149, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33063760

RESUMO

AIM: The study was aimed at comparatively assessing the immediate results of coronary artery bypass grafting operations without artificial circulation performed in non-ST-segment elevation acute myocardial infarction and chronic ischaemic heart disease. PATIENTS AND METHODS: The main group with non-ST-segment elevation acute myocardial infarction enrolled a total of 101 patients undergoing coronary artery bypass grafting without artificial circulation. The patients' age varied from 47 to 87 years, median 66.0 years (60.0; 71.0). The indication for the operation was persistent myocardial ischaemia on the background of carried out therapy with impossibility of performing percutaneous coronary intervention due to anatomy of coronary arteries and peculiarities of their pathology. The comparison group of chronic ischaemic heart disease was composed of 108 patients undergoing elective coronary artery bypass grafting without artificial circulation. The patients' age varied from 40 to 92 years, median - 60.0 years (58.0; 68.0). The patients with acute myocardial infarction had a significantly greater (p<0.05) number of coronary arteries measuring in diameter 2.5 mm and more, with significant occlusive and stenotic lesions, as well as a higher total SYNTAX score. The patients undergoing elective surgery were found to have an initially higher (p<0.05) left ventricular ejection fraction. RESULTS: In the group of acute myocardial infarction the waiting times for coronary artery bypass grafting varied from 2 to 8 days, median of waiting - 4.0 days (4.0; 5.0). The lethality rate (p<0.05) in the group of acute myocardial infarction amounted to 3.0% (3 cases) and in the group of chronic ischaemic heart disease to 0.9% (1 case). Twenty-one (20.8%) operations were carried out within the first 72 hours, with eighty surgical interventions (79.2%) performed after 72 hours from the onset of the disease. All 3 (3.8%) lethal outcomes were observed after coronary artery bypass grafting procedures performed later than 72 hours from the onset of acute myocardial infarction (p>0.05). The total number of complications (p>0.05) amounted to 18 (17.8%) and 10 (9.3%) in the group of acute myocardial infarction and in the group of chronic ischaemic heart disease, respectively. CONCLUSION: The immediate results of delayed coronary artery bypass grafting procedures without artificial circulation for acute myocardial infarction and chronic ischaemic heart disease were statistically comparable (p>0.05) by the lethality and complication rates. Lethality in the group of non-ST-segment elevation acute myocardial infarction din not depend on the time of operation after the onset of the disease.


Assuntos
Infarto do Miocárdio , Intervenção Coronária Percutânea , Ponte de Artéria Coronária , Humanos , Infarto do Miocárdio/diagnóstico , Volume Sistólico , Função Ventricular Esquerda
3.
J Cardiovasc Med (Hagerstown) ; 21(11): 869-873, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33009170

RESUMO

AIMS: The purpose of this study was to verify the impact on the number and characteristics of coronary invasive procedures for acute coronary syndrome (ACS) of two hub centers with cardiac catheterization facilities, during the first month of lockdown following the COVID-19 pandemic. MATERIALS AND METHODS: Procedural data of ACS patients admitted between 10 March and 10 April 2020 were compared with those of the same period of 2019. RESULTS: We observed a 23.4% reduction in ACS admissions during 2020, with a decrease for both ST-elevation myocardial infarction (STEMI) (-5.6%) and non-ST-elevation myocardial infarction (-34.5%), albeit not statistically significant (P = 0.2). During the first 15 days of the examined periods, the reduction in ACS admissions reached 52.5% (-25% for STEMI and -70.3% for non-ST-elevation myocardial infarction, P = 0.04). Among STEMI patients, the rate of those with a time delay from symptoms onset longer than 180 min was significantly higher during the lockdown period (P = 0.01). Radiograph exposure (P = 0.01) was higher in STEMI patients treated in 2020 with a slightly higher amount of contrast medium (P = 0.1) and number of stents implanted (P = 0.1), whereas the number of treated vessels was reduced (P = 0.03). Percutaneous coronary intervention procedural success and in-hospital mortality were not different between the two groups and in STEMI patients (P NS for all). CONCLUSION: During the early phase, the COVID-19 outbreak was associated with a lower rate of admissions for ACS, with a substantial impact on the time delay presentation of STEMI patients, but apparently without affecting the in-hospital outcomes.


Assuntos
Síndrome Coronariana Aguda , Infecções por Coronavirus , Hospitalização/estatística & dados numéricos , Infarto do Miocárdio , Pandemias , Intervenção Coronária Percutânea , Pneumonia Viral , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/epidemiologia , Síndrome Coronariana Aguda/etiologia , Síndrome Coronariana Aguda/terapia , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Diagnóstico Tardio/estatística & dados numéricos , Feminino , Mortalidade Hospitalar , Humanos , Controle de Infecções/métodos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/cirurgia , Avaliação de Processos e Resultados em Cuidados de Saúde , Pandemias/prevenção & controle , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/métodos , Intervenção Coronária Percutânea/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Tempo para o Tratamento/estatística & dados numéricos
4.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2800-2803, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018588

RESUMO

Cardiac biomechanical modelling is a promising new tool to be used in prognostic medicine and therapy planning for patients suffering from a variety of cardiovascular diseases and injuries. In order to have an accurate biomechanical model, personalized parameters to define loading, boundary conditions and mechanical properties are required. Achieving personalized modelling parameters often requires inverse optimization which is computationally expensive; hence techniques to reduce the multivariable complexity are in need. Presented in this paper is the fundamental blueprint to create a library of scar tissue mechanical properties to be used in modelling the healing mechanics of hearts that have suffered acute myocardial infarction. This library can be used to reduce the number of variables necessary to capture the scar tissue mechanical properties down to 1. This single parameter also carries information pertaining to staging of the scar tissue healing, predict its rate, and predict its collagen density. This information can be potentially used as valuable biomarkers to adjust existing or develop new treatment plans for patients.


Assuntos
Infarto do Miocárdio , Redes Neurais de Computação , Cicatriz , Colágeno , Humanos , Cicatrização
5.
Artigo em Inglês | MEDLINE | ID: mdl-33050220

RESUMO

Coronavirus disease 2019 (COVID-19) has quickly become a worldwide health crisis.Although respiratory disease remains the main cause of morbidity and mortality in COVID patients,myocardial damage is a common finding. Many possible biological pathways may explain therelationship between COVID-19 and acute myocardial infarction (AMI). Increased immune andinflammatory responses, and procoagulant profile have characterized COVID patients. All theseresponses may induce endothelial dysfunction, myocardial injury, plaque instability, and AMI.Disease severity and mortality are increased by cardiovascular comorbidities. Moreover, COVID-19has been associated with air pollution, which may also represent an AMI risk factor. Nonetheless,a significant reduction in patient admissions following containment initiatives has been observed,including for AMI. The reasons for this phenomenon are largely unknown, although a real decreasein the incidence of cardiac events seems highly improbable. Instead, patients likely may presentdelayed time from symptoms onset and subsequent referral to emergency departments because offear of possible in-hospital infection, and as such, may present more complications. Here, we aim todiscuss available evidence about all these factors in the complex relationship between COVID-19and AMI, with particular focus on psychological distress and the need to increase awareness ofischemic symptoms.


Assuntos
Infecções por Coronavirus/epidemiologia , Infarto do Miocárdio/epidemiologia , Pneumonia Viral/epidemiologia , Humanos , Pandemias , Fatores de Risco
8.
Medicine (Baltimore) ; 99(36): e21983, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899042

RESUMO

Coronary artery ectasia (CAE) patients were more prone to present with acute myocardial infarction (AMI), this case-control research aimed to explore the underlying factors relating AMI for them.This study investigated a serial of 119 patients who underwent coronary angiography and were diagnosed as CAE between the years 2016 and 2017 at the Beijing Friendship Hospital; 32 of the patients developed AMI and 87 did not develop AMI. The possible factors relating to AMI, including disease history, cardiovascular risk factors, thrombotic condition, inflammation status, and coronary imaging characteristics, were comprehensively compared between CAE patients with and without AMI.CAE patients with AMI had a lower antiplatelet rate, a higher blood low-density lipoprotein cholesterol level, increased neutrophil to lymphocyte (NL) ratio, higher Gensini score, and larger proportions of Markis type II. Logistic regression analysis also indicated that AMI history, lower antiplatelet rate, higher NL ratio, higher low-density lipoprotein cholesterol level and Gensini score, as well as Markis type II were associated with AMI in CAE patients.AMI history, lower antiplatelet treatment rates, poor blood lipid control and higher coronary stenosis extent, higher inflammatory response, and Markis type II were closely related to the incidence of AMI in CAE patients.


Assuntos
Doença da Artéria Coronariana/complicações , Infarto do Miocárdio/etiologia , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Dilatação Patológica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tromboelastografia
9.
Int Heart J ; 61(5): 879-887, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32921674

RESUMO

Since the number of elderly patients suffering from acute myocardial infarction (AMI) has been increasing in developed countries, primary percutaneous coronary intervention (PCI) for the very elderly aged ≥80 years old is already common. The study aimed to examine the determinants of in-hospital death among the very elderly with AMI in current PCI era. We included 412 consecutive AMI patients aged ≥ 80 years old who received PCI to the culprit lesion; however, 42 patients (10.2%) died during the index hospitalization. Thus, univariate and multivariate logistic regression analyses were performed to identify the determinants of in-hospital death. Of note, the modified KATZ index, which is a seven-point scale ranging from 0 to 6 (0 point indicating no dependence and six points indicating full dependence), was calculated to evaluate pre-admission activity of daily living (ADL). In multivariate analysis, cardiac arrest (OR 4.642, 95% CI 1.177-18.305, P = 0.028), Killip class IV (versus Killip class I: OR 5.732, 95% CI 1.076-16.630, P = 0.001), modified KATZ index (OR 1.212, 95% CI 1.001-1.469, P = 0.049), hemoglobin levels (OR 0.803, 95% CI 0.656-0.983, P = 0.033), use of temporary pacemaker (OR 2.603, 95% CI 1.010-6.709, P = 0.048), final Thrombolysis In Myocardial Infarction (TIMI) flow grade 3 (versus TIMI ≤ 2: OR 0.240, 95% CI 0.093-0.618, P = 0.003), and mechanical circulatory support (OR 4.264, 95% CI 1.818-10.005, P = 0.001) were found to be significantly associated with in-hospital death. In conclusion, in-hospital outcomes of the very elderly with AMI were still poor in the current PCI era. Poor pre-admission ADL as well as cardiogenic shock and anemia were determined to be strongly associated with in-hospital death.


Assuntos
Mortalidade Hospitalar , Infarto do Miocárdio/cirurgia , Intervenção Coronária Percutânea , Atividades Cotidianas , Idoso de 80 Anos ou mais , Anemia/epidemiologia , Estimulação Cardíaca Artificial/estatística & dados numéricos , Oxigenação por Membrana Extracorpórea/estatística & dados numéricos , Feminino , Parada Cardíaca/epidemiologia , Humanos , Balão Intra-Aórtico/estatística & dados numéricos , Masculino , Análise Multivariada , Infarto do Miocárdio/epidemiologia , Fatores de Risco , Choque Cardiogênico/epidemiologia
10.
Int Heart J ; 61(5): 888-895, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32921675

RESUMO

Although B-type natriuretic peptide (BNP) has gradually gained recognition as an indicator in risk stratification for patients with acute myocardial infarction (AMI), the prognostic impact on long-term clinical outcomes in patients with non-ST-segment elevation acute myocardial infarction (NSTEMI) without creatine kinase (CK) elevation remains unclear.This prospective multicenter study assessed 3,283 consecutive patients with AMI admitted to 28 institutions in Japan between 2012 and 2014. We analyzed 218 patients with NSTEMI without CK elevation (NSTEMI-CK) for whom BNP was available. In the NSTEMI-CK group, patients were assigned to high- and low-BNP groups according to BNP values (cut-off BNP, 100 pg/mL). The primary endpoint was defined as a composite of all-cause death, non-fatal myocardial infarction, non-fatal stroke, cardiac failure, and urgent revascularization for unstable angina up to 3 years. Primary endpoints were observed in 60 (33.3%) events among patients with NSTEMI-CK. Kaplan-Meier analysis revealed a significantly higher event rate for primary endpoints among patients with high BNP (log-rank P < 0.001). After adjusting for covariates, a higher BNP level was significantly associated with long-term clinical outcomes in NSTEMI-CK (adjusted hazard ratio, 4.86; 95% confidence interval, 2.18-12.44; P < 0.001).The BNP concentration is associated with adverse long-term clinical outcomes among patients with NSTEMI-CK who are considered low risk. Careful clinical management may be warranted for secondary prevention in patients with NSTEMI-CK with high BNP levels.


Assuntos
Angina Instável/epidemiologia , Creatina Quinase/sangue , Insuficiência Cardíaca/epidemiologia , Mortalidade , Infarto do Miocárdio/epidemiologia , Peptídeo Natriurético Encefálico/sangue , Infarto do Miocárdio sem Supradesnível do Segmento ST/sangue , Acidente Vascular Cerebral/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Angina Instável/cirurgia , Causas de Morte , Feminino , Humanos , Japão/epidemiologia , Masculino , Revascularização Miocárdica/estatística & dados numéricos , Infarto do Miocárdio sem Supradesnível do Segmento ST/terapia , Prognóstico , Modelos de Riscos Proporcionais
11.
N Z Med J ; 133(1522): 128-132, 2020 09 25.
Artigo em Inglês | MEDLINE | ID: mdl-32994622

RESUMO

Myocardial infarction with non-obstructive coronary arteries (MINOCA) is an increasingly recognised condition and it accounts for approximately 10% of all cases of MI. Despite the absence of obstructive coronary artery disease, patients with MINOCA are at increased risk of morbidity and mortality compared to the general population. While many well recognised conditions can present as MINOCA, it can be difficult to reach a final diagnosis with certainty due to the relative infrequency of these conditions in the general population and the lack of diagnostic gold-standard tests. The most common causes of MINOCA are myocarditis, coronary vasospasm, coronary plaque disruption and coronary thrombus or embolism. These can be assessed by way of cardiac magnetic resonance imaging, intra-coronary imaging modalities and clinically relevant diagnostic blood tests, respectively. There are less common and rarer aetiologies which should be considered in the absence of an apparent cause, each with a unique diagnostic standard. By following a systematic approach of diagnostic tests, an underlying cause of MINOCA can be found in the majority of cases, allowing a directed management strategy to be pursued.


Assuntos
Doença das Coronárias , Infarto do Miocárdio , Algoritmos , Doença das Coronárias/complicações , Doença das Coronárias/diagnóstico por imagem , Vasos Coronários/fisiopatologia , Diagnóstico por Computador , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/etiologia
12.
N Z Med J ; 133(1521): 40-54, 2020 09 04.
Artigo em Inglês | MEDLINE | ID: mdl-32994636

RESUMO

AIMS: Ischaemic heart disease (IHD) mortality rates after myocardial infarction (MI) are higher in Maori and Pacific compared to European people. The reasons for these differences are complex and incompletely understood. Our aim was to use a contemporary real-world national cohort of patients presenting with their first MI to better understand the extent to which differences in the clinical presentation, cardiovascular (CVD) risk factors, comorbidity and in-hospital treatment explain the mortality outcomes for Maori and Pacific peoples. METHODS: New Zealand residents (≥20 years old) hospitalised with their first MI (2014-2017), and who underwent coronary angiography, were identified from the All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) registry. All-cause mortality up to one year after the index admission date was obtained by linkage to the national mortality database. RESULTS: There were 17,404 patients with a first ever MI. European/other comprised 76% of the population, Maori 11.5%, Pacific 5.1%, Indian 4.3% and Other Asian 2.9%. Over half (55%) of Maori, Pacific and Indian patients were admitted with their first MI before age 60 years, compared with 29% of European/other patients. Maori and Pacific patients had a higher burden of traditional and non-traditional cardiovascular risk factors, and despite being younger, were more likely to present with heart failure and, together with Indian peoples, advanced coronary disease at presentation with first MI. After adjustment for age and sex, Maori and Pacific, but not Indian or Other Asian patients had significantly higher all-cause mortality at one year compared with the European/other reference group (HR 2.55 (95% CI 2.12-3.07), HR 2.98 (95% CI 2.34-3.81) for Maori and Pacific respectively). When further adjusted for differences in clinical presentation, clinical history and cardiovascular risk factors, the excess mortality risk for Maori and Pacific patients was reduced substantially, but a differential persisted (HR 1.77 (95% CI 1.44-2.19), HR 1.42 (95% CI 1.07-1.83)) which was not further reduced by adjustment for differences in in-hospital management and discharge medications. CONCLUSION: In New Zealand patients after their first MI there is a three-fold variation in one-year mortality based on ethnicity. At least half of the inequity in outcomes for Maori, and three-quarters for Pacific people, is associated with differences in preventable or modifiable clinical factors present at, or prior to, presentation.


Assuntos
Disparidades nos Níveis de Saúde , Infarto do Miocárdio/mortalidade , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/prevenção & controle , Nova Zelândia/epidemiologia , Fatores de Risco
14.
Int Heart J ; 61(5): 905-912, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32921660

RESUMO

There is little data on management and outcomes of atrial fibrillation (AF) patients on direct oral anticoagulants (DOAC) undergoing general surgery.We retrospectively assessed 98 surgeries in 85 nonvalvular AF patients aged 73 ± 8 (59 men) receiving DOACs. Cardiac, emergency, and minimally invasive surgeries were excluded.The CHA2DS2-VASc score ranged from 0 to 8. The DOACs being given were: dabigatran, 16; rivaroxaban, 25; apixaban, 28; and edoxaban, 16. While the DOACs were not suspended in 11 cases, they were interrupted for a median of 2.0 days before surgery and restarted at a median of 3.0 days after surgery. There were 9 complications (9.2%), 3 instances of thromboembolism and 6 bleeding. Thromboembolism occurred at a mean of 3.0 postoperative days, all of which occurred before resumption of DOACs, while bleeding events occurred at a mean of 4.0 postoperative days. Two of the 3 patients with thromboembolism went into cardiopulmonary arrest during the event, but were resuscitated. There were significantly more patients with congestive heart failure or combined antiplatelets in the patients with complications. The complication group had a significantly higher HAS-BLED score and lower preoperative hemoglobin level. There were no significant differences in the management of DOAC interruption between those with complications and without.The perioperative complication rate in nonvalvular AF patients undergoing elective surgery treating with DOACs was 9.2%. Patients with congestive heart failure, receiving combined therapy with antiplatelets, a higher HAS-BLED score, or lower preoperative hemoglobin level were at higher risk. Further studies evaluating the ideal perioperative DOAC protocol are warranted.


Assuntos
Fibrilação Atrial/tratamento farmacológico , Doenças das Artérias Carótidas/epidemiologia , Infarto Cerebral/epidemiologia , Inibidores do Fator Xa/administração & dosagem , Infarto do Miocárdio/epidemiologia , Assistência Perioperatória/métodos , Hemorragia Pós-Operatória/epidemiologia , Tromboembolia/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Antitrombinas/administração & dosagem , Fibrilação Atrial/complicações , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Dabigatrana/administração & dosagem , Procedimentos Cirúrgicos do Sistema Digestório , Procedimentos Cirúrgicos Eletivos , Embolia/epidemiologia , Endoscopia , Feminino , Humanos , Masculino , Procedimentos Ortopédicos , Complicações Pós-Operatórias/epidemiologia , Pirazóis/administração & dosagem , Piridinas/administração & dosagem , Piridonas/administração & dosagem , Estudos Retrospectivos , Rivaroxabana/administração & dosagem , Tiazóis/administração & dosagem , Tromboembolia/etiologia , Procedimentos Cirúrgicos Urológicos , Procedimentos Cirúrgicos Vasculares
15.
Nat Commun ; 11(1): 4432, 2020 09 04.
Artigo em Inglês | MEDLINE | ID: mdl-32887874

RESUMO

Spontaneous coronary artery dissection (SCAD) is a non-atherosclerotic cause of myocardial infarction (MI), typically in young women. We undertook a genome-wide association study of SCAD (Ncases = 270/Ncontrols = 5,263) and identified and replicated an association of rs12740679 at chromosome 1q21.2 (Pdiscovery+replication = 2.19 × 10-12, OR = 1.8) influencing ADAMTSL4 expression. Meta-analysis of discovery and replication samples identified associations with P < 5 × 10-8 at chromosome 6p24.1 in PHACTR1, chromosome 12q13.3 in LRP1, and in females-only, at chromosome 21q22.11 near LINC00310. A polygenic risk score for SCAD was associated with (1) higher risk of SCAD in individuals with fibromuscular dysplasia (P = 0.021, OR = 1.82 [95% CI: 1.09-3.02]) and (2) lower risk of atherosclerotic coronary artery disease and MI in the UK Biobank (P = 1.28 × 10-17, HR = 0.91 [95% CI :0.89-0.93], for MI) and Million Veteran Program (P = 9.33 × 10-36, OR = 0.95 [95% CI: 0.94-0.96], for CAD; P = 3.35 × 10-6, OR = 0.96 [95% CI: 0.95-0.98] for MI). Here we report that SCAD-related MI and atherosclerotic MI exist at opposite ends of a genetic risk spectrum, inciting MI with disparate underlying vascular biology.


Assuntos
Anomalias dos Vasos Coronários/genética , Genes Neoplásicos , Infarto do Miocárdio/genética , Doenças Vasculares/congênito , Proteínas ADAMTS/genética , Doenças das Artérias Carótidas/complicações , Doenças das Artérias Carótidas/genética , Cromossomos/genética , Estudos de Coortes , Doença da Artéria Coronariana/genética , Feminino , Displasia Fibromuscular/complicações , Displasia Fibromuscular/genética , Estudo de Associação Genômica Ampla , Humanos , Proteína-1 Relacionada a Receptor de Lipoproteína de Baixa Densidade/genética , Masculino , Metanálise como Assunto , Proteínas dos Microfilamentos/genética , Fatores de Risco , Doenças Vasculares/genética
16.
PLoS One ; 15(9): e0239801, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32970774

RESUMO

While hospital admissions for myocardial infarction (MI) and pulmonary embolism (PE) are decreased during the COVID-19 pandemic, controversy remains about respective complication and mortality rates. This study evaluated admission rates, complications, and intrahospital mortality for selected life-threatening cardiovascular emergencies (MI, PE, and acute aortic dissection (AAD)) during COVID-19-associated restrictive social measures (RM) in Styria, Austria. By screening a patient information system for International Statistical Classification of Diseases and Related Health Problems (ICD) diagnosis codes covering more than 85% of acute hospital admissions in the state of Styria (~1.24 million inhabitants), we retrospectively identified patients with admission diagnoses for MI (I21, I22), PE (I26), and AAD (I71). Rates of complications such as cardiogenic shock and cardiopulmonary resuscitation, treatment escalations (thrombolysis for PE), and mortality were analyzed by patient chart review during 6 weeks following onset of COVID-19 associated RM, and during respective time frames in the years 2016 to 2019. 1,668 patients were included. Cumulative admissions for MI, PE and AAD decreased (RR 0.77; p<0.001) during RM compared to previous years. In contrast, intrahospital mortality increased by 65% (RR 1.65; p = 0.041), mainly driven by mortality following MI (RR 1.80; p = 0.042). PE patients received more frequently thrombolysis treatment (RR 3.63; p = 0.006), while rates of cardiogenic shock and cardiopulmonary resuscitation remained unchanged. Of 226 patients hospitalized during RM, 81 patients with suspected COVID-19 disease were screened for SARS-CoV-2 infection with only 5 testing positive. Thus, cumulative hospital admissions for cardiovascular emergencies decreased during COVID-19 associated RM while intrahospital mortality increased.


Assuntos
Aneurisma Dissecante/mortalidade , Infecções por Coronavirus/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Infarto do Miocárdio/mortalidade , Pneumonia Viral/epidemiologia , Embolia Pulmonar/mortalidade , Idoso , Idoso de 80 Anos ou mais , Áustria , Betacoronavirus , Serviço Hospitalar de Emergência/tendências , Feminino , Mortalidade Hospitalar/tendências , Hospitalização/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos
18.
Lancet Public Health ; 5(10): e536-e542, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32950075

RESUMO

BACKGROUND: The COVID-19 pandemic has had a profound effect on general health care. We aimed to evaluate the effect of a nationwide lockdown in France on admissions to hospital for acute myocardial infarction, by patient characteristics and regional prevalence of the pandemic. METHODS: In this registry study, we collected data from 21 centres participating in the ongoing French Cohort of Myocardial Infarction Evaluation (FRENCHIE) registry, which collects data from all patients admitted for ST segment elevation myocardial infarction (STEMI) or non-ST segment elevation myocardial infarction (NSTEMI) within 48 h of symptom onset. We analysed weekly hospital admissions over 8 weeks: the 4 weeks preceding the institution of the lockdown and the 4 weeks following lockdown. The primary outcome was the change in the number of hospital admissions for all types of acute myocardial infarction, NSTEMI, and STEMI between the 4 weeks before lockdown and the 4 weeks after lockdown. Comparisons between categorical variables were made using χ2 tests or Fisher's exact tests. Comparisons of continuous variables were made using Student's t tests or Mann-Whitney tests. Poisson regression was used to determine the significance of change in hospital admissions over the two periods, after verifying the absence of overdispersion. Age category, region, and type of acute myocardial infarction (STEMI or NSTEMI) were used as covariables. The FRENCHIE cohort is registered with ClinicalTrials.gov, NCT04050956. FINDINGS: Between Feb 17 and April 12, 2020, 1167 patients were consecutively admitted within 48 h of acute myocardial infarction (583 with STEMI, 584 with NSTEMI) and were included in the study. Admissions for acute myocardial infarction decreased between the periods before and after lockdown was instituted, from 686 before to 481 after lockdown (30% decrease; incidence rate ratio 0·69 [95% CI 0·51-0·70]). Admissions for STEMI decreased from 331 to 252 (24%; 0·72 [0·62-0·85]), and admissions for NSTEMI decreased from 355 to 229 (35%; 0·64 [0·55-0·76]) following institution of the lockdown, with similar trends according to sex, risk factors, and regional prevalence of hospital admissions for COVID-19. INTERPRETATION: A marked decrease in hospital admissions was observed following the lockdown, irrespective of patient characteristics and regional prevalence of COVID-19. Health authorities should be aware of these findings, in order to adapt their message if the COVID-19 pandemic persists or recurs, or in case of future major epidemics. FUNDING: Recherche Hospitalo-Universitaire en Santé iVasc.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infarto do Miocárdio/terapia , Pandemias/prevenção & controle , Admissão do Paciente/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Sistema de Registros , Fatores de Risco
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