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Acute myocardial infarction and diabetes mellitus: Is admission glycosylated hemoglobin predictive of one-year major adverse cardiovascular events?
24 groups of patients had a high baseline risk profile and an increased likelihood of in-hospital complications. The crude in-hospital mortality rate was higher in patients with previous atrial fibrillation than in those with new-onset atrial fibrillation (22% vs. 12%; P < 0.001; 30% vs. 10%; P < 0.001). The long-term mortality rate was 11.11/100 patient-years in patients with previous atrial fibrillation and 5.35/100 patient years in those with new-onset atrial fibrillation (both groups, P < 0.001). New-onset fibrillation alone (odds ratio = 1.55; 95% confidence interval, 1.08—2.22) was an independent predictor of in-hospital mortality. Previous atrial fibrillation (hazard ratio = 1.24; 95% confidence interval, 0.94—1.64) and new-onset atrial fibrillation (hazard ratio = 0.98; 95% confidence interval, 0.80—1.21) were not independent predictors of long-term mortality. Conclusions New-onset atrial fibrillation during hospitalization is an independent risk factor for in-hospital mortality in acute myocardial infarction. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2018.10.047 171
Clinical predictors of left main coronary artery disease in patients with NSTE-ACS F. Boukerche ∗ , L. Hammou Cardiologie, CHU Oran, Oran, Algeria ∗ Corresponding author. Adresse e-mail : [email protected] (F. Boukerche) Background Risk stratification in non-ST-elevation acute coronary syndrome makes use of clinical variables that can identify patients at an increased risk of complications. Purpose Our objective was to identify clinical variables that predict significant stenosis of the left main coronary artery in NSTEACS. Methods The study included 296 patients who were admitted because of non-ST-elevation acute coronary syndrome. All underwent coronary angiography. Patients were divided into 2 groups: those with significant left main coronary artery stenosis (n = 21) and those without (n = 275). Results Univariate analysis showed that the variables significantly associated with left main coronary artery stenosis were age ≥ 70 years (12.1% vs. 4.9%; P = 0.04), male sex (10.5% vs. 2.4%; P = 0.01), recurrent angina (20.3% vs. 3.8%; P < 0.0001), heart rate ≥ 100 (20.8% vs. 5.9%; P = 0.019) left heart failure (23.1% vs. 6.4%; P = 0.05), and an ankle-brachial index < 0.9 (19.4% vs. 5.4%; P = 0.007). In the multivariate analysis, the independent clinical predictors of left main coronary artery disease were recurrent angina, heart rate ≥ 100 bpm and left heart failure at initial assessment. Conclusions The presence of recurrent angina, heart rate ≥ 100 and left heart failure at initial assessment patients with non-STelevation acute coronary syndrome could be a useful predictor of significant left main coronary artery disease. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2018.10.048
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Acute myocardial infarction and diabetes mellitus: Is admission glycosylated hemoglobin predictive of one-year major adverse cardiovascular events? B. Mouhat 1,2 , M. Zeller 2,∗ , B. Vergès 3 , F. Chagué 1 , M. Maza 1 , J.C. Beer 1 , Y. Cottin 1 1 CHU Dijon Bourgogne, service de cardiologie 2 Université Bourgogne Franche-Comté, Équipe PEC2, EA 7460 3 CHU Dijon Bourgogne, service d’endocrinologie, Dijon, France ∗ Corresponding author. Adresse e-mail : [email protected] (M. Zeller) Background In diabetic patients with acute myocardial infarction (MI), prognostic value of glycosylated hemoglobin (HbA1c) remains debated. Purpose In a large observational study, we aimed to identify the prognostic value of HbA1c measured on admission for acute MI in diabetic patients regarding one-year major adverse cardiovascular events (MACE). Methods From the RICO survey database, all consecutive patients with or without known diabetes with acute MI (n = 3005) from January 2001 to June 2016 were included. We divided our population into 4 quartiles: HbA1c ≤ 6.5% (n = 807), 6.5—7% (n = 722), 7.2—8.1% (n = 748), ≥ 8.2% (n = 728) for the analysis. Results On admission, median age was 73 years old, median HbA1c and glucose were 7.0% and 9.6 mmol/L. Compared to HbA1c ≤ 6.5% group, HbA1c ≥ 8.2% group was made up of younger persons (74 vs. 70 years old, P < 0.001), had most important body mass index > 30 kg/m2 (221 (28%) vs. 241 (33%), P = 0.041), had less important high blood pressure rate (610 (76%) vs. 508 (70%), P = 0.016) and had a stronger anti-diabetic treatment (insulin plus oral anti-diabetic medication: 44 (6%) vs. 176 (24%), P < 0.001). Regarding the clinical data, HbA1c ≥ 8.2% group had more STEMI [372 (46%) vs. 395 (54%), P = 0.002], more multi-vessel disease [446 (60%) vs. 455 (67%), P = 0.007] but lower GRACE score (156 vs. 150, P = 0.020) than HbA1c ≤ 6.5% group. We did not observed any difference concerning one year MACE between the 4 groups [HbA1c ≤ 6.5%: 243 (30.1%); 6.6—7.0%: 227 (31.4%); 7.1—8.1%: 246 (32.9%); ≥ 8.2%: 239 (32.8%), P = 0.6]. Conclusions Even in case of extreme glycometabolic chronic derangement, our results showed that the initial HbA1c has no one-year prognostic significance value after acute MI in our large diabetic population. However, these patients remain in a high-risk cardiovascular population and need close multidisciplinary followup. The chronical hyperglycemia prognostic value should be studied over a much longer period. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2018.10.049 382
Long-term outcomes of coronary chronic total occlusion: Percutaneous coronary intervention versus optimal medical therapy K. Ben Brahim ∗ , R. Gribaa , M. Slim , O. Labidi , M. Abdallah , H. Ghardallou , E. Boughzela Cardiologie, CHU Sahloul, Sousse, Tunisia ∗ Corresponding author. Adresse e-mail : [email protected] (K.B. Brahim) Background Coronary chronic total occlusion (CTO) are associated with poor prognosis and cardiac death. Successful chronic total occlusions (CTO) percutaneous coronary intervention (PCI)
Clinical predictors of left main coronary artery disease in patients with NSTE-ACS F. Boukerche ∗ , L. Hammou Cardiologie, CHU Oran, Oran, Algeria ∗ Corresponding author. Adresse e-mail : [email protected] (F. Boukerche) Background Risk stratification in non-ST-elevation acute coronary syndrome makes use of clinical variables that can identify patients at an increased risk of complications. Purpose Our objective was to identify clinical variables that predict significant stenosis of the left main coronary artery in NSTEACS. Methods The study included 296 patients who were admitted because of non-ST-elevation acute coronary syndrome. All underwent coronary angiography. Patients were divided into 2 groups: those with significant left main coronary artery stenosis (n = 21) and those without (n = 275). Results Univariate analysis showed that the variables significantly associated with left main coronary artery stenosis were age ≥ 70 years (12.1% vs. 4.9%; P = 0.04), male sex (10.5% vs. 2.4%; P = 0.01), recurrent angina (20.3% vs. 3.8%; P < 0.0001), heart rate ≥ 100 (20.8% vs. 5.9%; P = 0.019) left heart failure (23.1% vs. 6.4%; P = 0.05), and an ankle-brachial index < 0.9 (19.4% vs. 5.4%; P = 0.007). In the multivariate analysis, the independent clinical predictors of left main coronary artery disease were recurrent angina, heart rate ≥ 100 bpm and left heart failure at initial assessment. Conclusions The presence of recurrent angina, heart rate ≥ 100 and left heart failure at initial assessment patients with non-STelevation acute coronary syndrome could be a useful predictor of significant left main coronary artery disease. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2018.10.048
Absabsts 303
Acute myocardial infarction and diabetes mellitus: Is admission glycosylated hemoglobin predictive of one-year major adverse cardiovascular events? B. Mouhat 1,2 , M. Zeller 2,∗ , B. Vergès 3 , F. Chagué 1 , M. Maza 1 , J.C. Beer 1 , Y. Cottin 1 1 CHU Dijon Bourgogne, service de cardiologie 2 Université Bourgogne Franche-Comté, Équipe PEC2, EA 7460 3 CHU Dijon Bourgogne, service d’endocrinologie, Dijon, France ∗ Corresponding author. Adresse e-mail : [email protected] (M. Zeller) Background In diabetic patients with acute myocardial infarction (MI), prognostic value of glycosylated hemoglobin (HbA1c) remains debated. Purpose In a large observational study, we aimed to identify the prognostic value of HbA1c measured on admission for acute MI in diabetic patients regarding one-year major adverse cardiovascular events (MACE). Methods From the RICO survey database, all consecutive patients with or without known diabetes with acute MI (n = 3005) from January 2001 to June 2016 were included. We divided our population into 4 quartiles: HbA1c ≤ 6.5% (n = 807), 6.5—7% (n = 722), 7.2—8.1% (n = 748), ≥ 8.2% (n = 728) for the analysis. Results On admission, median age was 73 years old, median HbA1c and glucose were 7.0% and 9.6 mmol/L. Compared to HbA1c ≤ 6.5% group, HbA1c ≥ 8.2% group was made up of younger persons (74 vs. 70 years old, P < 0.001), had most important body mass index > 30 kg/m2 (221 (28%) vs. 241 (33%), P = 0.041), had less important high blood pressure rate (610 (76%) vs. 508 (70%), P = 0.016) and had a stronger anti-diabetic treatment (insulin plus oral anti-diabetic medication: 44 (6%) vs. 176 (24%), P < 0.001). Regarding the clinical data, HbA1c ≥ 8.2% group had more STEMI [372 (46%) vs. 395 (54%), P = 0.002], more multi-vessel disease [446 (60%) vs. 455 (67%), P = 0.007] but lower GRACE score (156 vs. 150, P = 0.020) than HbA1c ≤ 6.5% group. We did not observed any difference concerning one year MACE between the 4 groups [HbA1c ≤ 6.5%: 243 (30.1%); 6.6—7.0%: 227 (31.4%); 7.1—8.1%: 246 (32.9%); ≥ 8.2%: 239 (32.8%), P = 0.6]. Conclusions Even in case of extreme glycometabolic chronic derangement, our results showed that the initial HbA1c has no one-year prognostic significance value after acute MI in our large diabetic population. However, these patients remain in a high-risk cardiovascular population and need close multidisciplinary followup. The chronical hyperglycemia prognostic value should be studied over a much longer period. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2018.10.049 382
Long-term outcomes of coronary chronic total occlusion: Percutaneous coronary intervention versus optimal medical therapy K. Ben Brahim ∗ , R. Gribaa , M. Slim , O. Labidi , M. Abdallah , H. Ghardallou , E. Boughzela Cardiologie, CHU Sahloul, Sousse, Tunisia ∗ Corresponding author. Adresse e-mail : [email protected] (K.B. Brahim) Background Coronary chronic total occlusion (CTO) are associated with poor prognosis and cardiac death. Successful chronic total occlusions (CTO) percutaneous coronary intervention (PCI)