Irene R Dégano1, Isaac Subirana2, Danilo Fusco3, Luigi Tavazzi4, Inge Kirchberger5, Dimitrios Farmakis6, Jean Ferrières7, Ana Azevedo8, Marina Torre9, Pascal Garel10, Max Brosa11, Marina Davoli3, Christa Meisinger5, Vanina Bongard12, Carla Araújo8, John Lekakis6, Albert Francès13, Conxa Castell14, Roberto Elosua1, Jaume Marrugat15. 1. CIBER Cardiovascular Diseases, Instituto de Salud Carlos III (ISCIII), Madrid, Spain; REGICOR Study Group, Cardiovascular Epidemiology and Genetics Group, Program of Epidemiology and Public Health, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain. 2. CIBER Epidemiology and Public Health, ISCIII, Madrid, Spain; REGICOR Study Group, Cardiovascular Epidemiology and Genetics Group, Program of Epidemiology and Public Health, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain. 3. Department of Epidemiology, Lazio Regional Health Service, Rome, Italy. 4. Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola, Italy. 5. MONICA/KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Augsburg, Germany; Helmholtz Zentrum München, German Research Center for Environmental Health, Institute for Epidemiology II, Neuherberg, Germany. 6. Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian, University of Athens Medical School, Athens, Greece. 7. Department of Cardiology, Toulouse Rangueil Hospital, Toulouse University School of Medicine, Toulouse, France. 8. Department of Clinical Epidemiology, Predictive Medicine and Public Health, Faculdade de Medicina, Universidade do Porto and EPI Unit Institute of Public Health, Universidade do Porto (ISPUP), Porto, Portugal. 9. Istituto Superiore di Sanità, Rome, Italy. 10. HOPE - European Hospital and Healthcare Federation, Brussels, Belgium. 11. Oblikue Consulting SL, Barcelona, Spain. 12. Department of Epidemiology, UMR 1027 INSERM-Toulouse University, Toulouse, France. 13. Department of Urology, IMIM, Barcelona, Spain. 14. Department of Health, Government of Catalonia, Barcelona, Spain. 15. CIBER Cardiovascular Diseases, Instituto de Salud Carlos III (ISCIII), Madrid, Spain; REGICOR Study Group, Cardiovascular Epidemiology and Genetics Group, Program of Epidemiology and Public Health, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain. Electronic address: jmarrugat@imim.es.
Abstract
BACKGROUND: Percutaneous coronary intervention (PCI) reduces mortality in most myocardial infarction (MI) patients but the effect on elderly patients with comorbidities is unclear. Our aim was to analyse the effect of PCI on in-hospital mortality of MI patients, by age, sex, ST elevation on presentation, diabetes mellitus (DM) and chronic kidney disease (CKD). METHODS: Cohort study of 79,791 MI patients admitted at European hospitals during 2000-2014. The effect of PCI on in-hospital mortality was analysed by age group (18-74, ≥75years), sex, presence of ST elevation, DM and CKD, using propensity score matching. The number needed to treat (NNT) to prevent a fatal event was calculated. Sensitivity analyses were conducted. RESULTS: PCI was associated with lower in-hospital mortality in ST and non-ST elevation MI (STEMI and NSTEMI) patients. The effect was stronger in men [Odds ratio (95% confidence interval) 0.30 (0.25-0.35)] than in women [0.46 (0.39-0.54)] aged ≥75years, and in NSTEMI [0.22 (0.17-0.28)] than in STEMI patients [0.40 (0.31-0.5)] aged <75years. PCI reduced in-hospital mortality risk in patients with and without DM or CKD (54-72% and 52-73% reduction in DM and CKD patients, respectively). NNT was lower in patients with than without CKD [≥75years: STEMI=6(5-8) vs 9(8-10); NSTEMI=10(8-13) vs 16(14-20)]. Sensitivity analyses such as exclusion of hospital stays <2days yielded similar results. CONCLUSIONS: PCI decreased in-hospital mortality in MI patients regardless of age, sex, and presence of ST elevation, DM and CKD. This supports the recommendation for PCI in elderly patients with DM or CKD.
BACKGROUND: Percutaneous coronary intervention (PCI) reduces mortality in most myocardial infarction (MI) patients but the effect on elderly patients with comorbidities is unclear. Our aim was to analyse the effect of PCI on in-hospital mortality of MI patients, by age, sex, ST elevation on presentation, diabetes mellitus (DM) and chronic kidney disease (CKD). METHODS: Cohort study of 79,791 MI patients admitted at European hospitals during 2000-2014. The effect of PCI on in-hospital mortality was analysed by age group (18-74, ≥75years), sex, presence of ST elevation, DM and CKD, using propensity score matching. The number needed to treat (NNT) to prevent a fatal event was calculated. Sensitivity analyses were conducted. RESULTS: PCI was associated with lower in-hospital mortality in ST and non-ST elevation MI (STEMI and NSTEMI) patients. The effect was stronger in men [Odds ratio (95% confidence interval) 0.30 (0.25-0.35)] than in women [0.46 (0.39-0.54)] aged ≥75years, and in NSTEMI [0.22 (0.17-0.28)] than in STEMI patients [0.40 (0.31-0.5)] aged <75years. PCI reduced in-hospital mortality risk in patients with and without DM or CKD (54-72% and 52-73% reduction in DM and CKD patients, respectively). NNT was lower in patients with than without CKD [≥75years: STEMI=6(5-8) vs 9(8-10); NSTEMI=10(8-13) vs 16(14-20)]. Sensitivity analyses such as exclusion of hospital stays <2days yielded similar results. CONCLUSIONS: PCI decreased in-hospital mortality in MI patients regardless of age, sex, and presence of ST elevation, DM and CKD. This supports the recommendation for PCI in elderly patients with DM or CKD.
Authors: Anh Trung Nguyen; Hai Quang Pham; Thanh Xuan Nguyen; Thu Thi Hoai Nguyen; Huong Thi Thu Nguyen; Tam Ngoc Nguyen; Dung Thi Kim Dinh; Hai Thanh Phan; Son Hoang Nguyen; Bach Xuan Tran; Carl A Latkin; Roger C M Ho; Cyrus S H Ho; Thang Pham; Huyen Thi Thanh Vu Journal: Diabetes Metab Syndr Obes Date: 2020-10-22 Impact factor: 3.168
Authors: Anand R Nair; Eric A Johnson; Hsin-Jung Yang; Ivan Cokic; Joseph Francis; Rohan Dharmakumar Journal: PLoS One Date: 2020-12-02 Impact factor: 3.240
Authors: Daniel Fernández-Bergés; Irene R Degano; Reyes Gonzalez Fernandez; Isaac Subirana; Joan Vila; Manuel Jiménez-Navarro; Silvia Perez-Fernandez; Mercé Roqué; Antoni Bayes-Genis; Francisco Fernandez-Aviles; Antonio Mayorga; Vicente Bertomeu-Gonzalez; Juan Sanchis; Marcos Rodríguez Esteban; Antonio Sanchez-Hidalgo; Esther Sanchez-Insa; Ane Elorriaga; Emad Abu Assi; Alberto Nuñez; Jose Manuel Garcia Ruiz; Pedro Morrondo Valdeolmillos; Daniel Bosch-Portell; Iñaki Lekuona; Andres Carrillo-Lopez; Alberto Zamora; Berta Vega-Hernandez; Javier Alameda Serrano; Catalina Rubert; Luis Ruiz-Valdepeñas; Laura Quintas; Luis Rodríguez-Padial; Jessica Vaquero; Luis Martinez Dolz; Jose A Barrabes; Pedro L Sanchez; Alessandro Sionis; Julio Martí-Almor; Roberto Elosua; Rosa-María Lidon; David Garcia-Dorado; Jaume Marrugat Journal: Open Heart Date: 2020-08