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Lack of improvement in five-year total mortality among patients with incident acute myocardial infarction: Data of the French southwestern MONICA registry
01 — Coronary heart disease
11 104
Lack of improvement in five-year total mortality among patients with incident acute myocardial infarction: Data of the French southwestern MONICA registry
Fig. 1
Sudden cardiac arrest etiologies by age groups.
Disclosure of interest peting interest.
The authors declare that they have no com-
https://doi.org/10.1016/j.acvdsp.2018.10.015 174
Case-fatality after a hospitalization for acute coronary syndrome in 2015: A national study A. Gabet 1,∗ , P. Tuppin 2 , V. Olié 1 Santé publique France, Saint-Maurice 2 General Health Insurance Scheme (Caisse nationale d’assurance maladie), Paris, France ∗ Corresponding author. Adresse e-mail : [email protected] (A. Gabet) 1
Background Previous study described acute myocardial infarction case fatality in France in cardiac care unit but no recent study analyzed all hospitalized acute coronary syndrome with one year follow-up. Purpose The objectives of this study were to analyze very early to late case fatality rates in patients hospitalized for ACS in 2015 in France, their determinants and time-trends between 2010 and 2015. Methods Data were extracted from the national health insurance information system. Hospitalisation for ACS were collected by using ICD-10 codes as primary discharge diagnosis for ST-elevation myocardial infarction (STEMI), other MI and unstable angina (UA). Multivariate Cox models adjusted for age, comorbidities, sex, previous ACS, social deprivation of the municipality of residence, invasive procedures and pharmacological treatment refund were used to assess determinants of case-fatality respectively at 3 day after hospital admission, 4—30 day and 31—365 day after excluding dead patients of the preceding periods. Results In 2015, 84,202 persons were hospitalized for ACS with 34.9% for STEMI, 20.5% for other MI and 44.7% for UA. Mean age were 65.2, 69.1 and 68.1 respectively. Cumulative 3-day, 30-day and 1-year case-fatality were 3.9%, 8.4% and 13.8% for STEMI, 2.7%, 6.5% and 14.4% for other MI, and 0.4%, 2.0% and 7.2% for UA. In multivariate analysis, female sex was associated with higher 3day case-fatality among STEMI only, particularly < 65 years of age [HR = 1.47(1.30—1.68)]. Social deprivation was associated with an increase of all case-fatality outcomes. Additional adjustment for hospital management and medication delivery did not change the results. Conclusion Case-fatality up to 1 year after a hospitalization for ACS remained non-negligible. Women seemed to be at particular risk of very early case-fatality. Social inequalities independently impacted all period outcomes. No significant change in ACS case fatality were found between 2010 and 2015. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2018.10.016
S. Huo Yung Kai 1,∗ , J.B. Ruidavets 1 , Jean Ferrières 1,2 1 Department of epidemiology, Health Economics and Public Health, UMR 1027 Inserm, université Toulouse 3 2 Department of cardiology, Toulouse-Rangueil University Hospital, Toulouse University School of Medicine, Toulouse, France ∗ Corresponding author. Adresse e-mail : [email protected] (S. Huo Yung Kai) Background Acute myocardial infarction (AMI) management changes as guidelines evolve. The hypothesis of this study is that the survival of incident AMI should improve with time. Purpose The objective is to compare, according to the period of onset, the five-year total mortality in patients with incident AMI, supposing that mortality varies depending on the period considered and AMI management changed during these periods. Methods Data of the Haute-Garonne AMI registry was used to assess men and women (aged 35—74 years) who presented with AMI and who had no personal history of myocardial infarction or angina pectoris. Cases that happened between 1997 and 2005 were considered. The vital status five years after the event was assessed. Incidence rates of total mortality was expressed per 1000 person-year (with 95% confidence intervals). Total mortality was compared according to the period of onset (reference: 1997 to 1999/2000 to 2002/2003 to 2005) using sex-stratified Cox proportional hazards regression analyses adjusted for age. Results A total of 3924 incidents AMI were hospitalized between 1997 and 2012: 82.9% were men, median age at onset was 59.6 years old (58.2 and 66.7 years old, respectively for men and women). Among all incident cases of AMI, incidence rate of total mortality was 35.5 [95% CI: 32.8, 38.4] per 1000 person-year. Men and women rates were respectively: 35.2 [32.3, 38.4] and 37.2 [30.8, 44.9] per 1000 person-year. The incidence rates of total mortality by sex and year are shown in Fig. 1. The results of the Cox analyses stratified by sex are presented in Table 1. Conclusion Our study shows that the total mortality five years after an incident AMI does not vary significantly over time.
Fig. 1 Incidence rates of total mortality among incident AMI by sex and year (1997—2005).
12
Absabsts
Table 1 Comparison of total mortality by period (Cox regression analyses).
Periods 1997—1999 2000—2002 2003—2005 Age at AMI
Men (n = 509)
Women (n = 108)
HR
95% CI
HR
95% CI
1.00 0.82 1.07 1.05
— 0.66 0.87 1.04
1.00 0.91 0.93 1.06
— 0.57 0.58 1.03
— 1.02 1.32 1.06
198
— 1.44 1.48 1.08
HR: hazard ratio; CI: confidence interval. Disclosure of interest peting interest.
The authors declare that they have no com-
https://doi.org/10.1016/j.acvdsp.2018.10.017 132
In patients with acute myocardial infarction, PCSK9 levels do not predict severity and recurrence of cardiovascular events M. Zeller 1,∗ , G. Lambert 2 , M. Farnier 3,4 , M. Maza 4 , L. Rochette 1 , C. Vergely 1 , Y. Cottin 4 1 Université Bourgogne Franche-Comté, Equipe PEC2, EA 7460, Dijon 2 Université de La Réunion, Inserm UMR 1188, Sainte-Clotilde 3 Point Médical, lipidologie et maladies métaboliques 4 CHU Dijon Bourgogne, service de cardiologie, Dijon, France ∗ Corresponding author. Adresse e-mail : [email protected] (M. Zeller) Background In patients with coronary artery disease (CAD), it remains unclear whether serum PCSK9 levels can predict the severity of the disease and the risk of future cardiovascular events. Methods Among the patients admitted for an acute myocardial infarction (MI) from September 2015 to December 2016 in an intensive care unit from a university hospital, serum PCSK9 levels were measured on admission in patients not previously receiving statin therapy. We aimed to evaluate the association between PCSK9 levels, metabolic parameters, severity of CAD on coronary angiography, and the risk of in-hospital events and at one-year follow-up. Results In a total of 648 patients (mean age: 66 years, 67% male), the median PCSK9 was 263 ng/ml, higher for females compared with males (270 vs. 256 ng/mL, P < 0.009). Serum PCSK9 was associated with LDL cholesterol (r = 0.083, P = 0.036), total cholesterol (r = 0.136, P = 0.001) and triglycerides (r = 0.137, P = 0.0001). A positive association was also observed in the subgroup of patients with CRP > 10 mg/L (P < 0.001), but not with NT-proBNP, troponin and Creatinine Kinase. PCSK9 levels were similar whatever the SYNTAX score or the number of significant coronary lesions. Moreover, PCSK9 levels were not predictive of in-hospital events (death, recurrent MI and stroke) and events (cardiovascular death, cardiovascular events, recurrent MI) at one-year follow-up. Conclusion In this large cohort of patients hospitalized for acute MI and not previously receiving statin therapy, PCSK9 levels do not predict the severity or the recurrence of cardiovascular events. The clinical utility of measuring PCSK9 levels remains to be demonstrated for this category of patients. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2018.10.018
Thursday, January 17th, 2019
Impact and predictive factors of bleeding complications in elderly patients admitted for an acute coronary syndrome: Insights from the ANTARCTIC trial B. Lattuca 1,2,∗ , Guillaume Cayla 1 , J. Silvain 2 , T. Cuisset 3 , Florence Leclercq 4 , S. Manzo-Silberman 5 , C. Saint-Étienne 6 , N. Delarche 7 , R. El Mahmoud 8 , D. Carrie 9 , G. Souteyrand 10 , A. Diallo 11 , J.P. Collet 2 , E. Vicaut 11 , G. Montalescot 2 1 CHU Caremeau Département de cardiologie Nîmes, Nîmes 2 Sorbonne University, Paris 06 (UPMC), ACTION Study Group, Inserm UMRS 1166, Cardiology Institute, Pitié-Salpêtrière, University Hospital, AP—HP, Paris 3 ACTION Study Group, Aix-Marseille University, Cardiology department, Inserm UMR1062, Inra UMR1260, centre hospitalier universitaire La Timone, Marseille 4 Montpellier university, cardiology department, centre hospitalier universitaire de Montpellier, Montpellier 5 Cardiology department, centre hospitalier universitaire Lariboisière, AP—HP, Paris 6 Cardiology department, centre hospitalier universitaire de Tours, Tours 7 Cardiology department, hôpital Francois Mitterrand, Pau 8 Cardiology department, hôpital Ambroise Paré, Boulogne-Billancourt 9 Cardiology department, centre hospitalier universitaire Rangueil, Toulouse 10 Cardiology department, centre hospitalier universitaire Gabriel Montpied, Clermont-Ferrand 11 ACTION Study Group, Epidemiology and Clinic Research Unit, Lariboisière University Hospital, Paris, France ∗ Corresponding author. Adresse e-mail : [email protected] (B. Lattuca) Background Elderly patients are at high-risk of bleeding, particularly in the setting of acute coronary syndrome treated with an invasive strategy. Treatment adjustment by platelet function testing (PFT) failed to improve clinical outcomes in the randomized ANTARCTIC trial. Purpose This prespecified substudy aims at determining the predictive factors of bleeding and their relation to ischemic events and mortality. Methods We analyzed the 877 patients over the age of 75 years from the ANTARCTIC trial and randomized to a strategy of dose or drug antiplatelet therapy adjustment or a conventional strategy without PFT. In the monitoring group, patients received prasugrel 5 mg daily after coronary stenting and treatment was adjusted according to PFT. Correlation between occurrence of bleeding and major cardiovascular adverse events (MACE) defined as the composite of cardiovascular death, myocardial infarction and stroke was analyzed at one year. Results Clinically relevant bleedings (Bleeding Academic Research Consortium types 2, 3 or 5) were frequently observed (20.6%, n = 181 patients) with one third occurring in the first month. MACE occurred more frequently at one year in patients with a bleeding (16.6% vs. 7.6%, adj.HR: 2.04(1.24;3.38); P = 0.005). Rates of myocardial infarction and stroke were higher at one year after bleeding (9.9% vs. 4.5%, adj.HR: 2.40(1.24;4.66); P = 0.0093 and 6.6% vs. 1%, adj.HR: 5.55(2.04;15.06); P = 0.0008 respectively) without significant difference in death (6.6% vs. 4.0%; HR: 1.20(0.57;2.51); P = 0.63). Predictive factors of major bleedings in the multivariate model were age > 85 years [adj.HR:
11 104
Lack of improvement in five-year total mortality among patients with incident acute myocardial infarction: Data of the French southwestern MONICA registry
Fig. 1
Sudden cardiac arrest etiologies by age groups.
Disclosure of interest peting interest.
The authors declare that they have no com-
https://doi.org/10.1016/j.acvdsp.2018.10.015 174
Case-fatality after a hospitalization for acute coronary syndrome in 2015: A national study A. Gabet 1,∗ , P. Tuppin 2 , V. Olié 1 Santé publique France, Saint-Maurice 2 General Health Insurance Scheme (Caisse nationale d’assurance maladie), Paris, France ∗ Corresponding author. Adresse e-mail : [email protected] (A. Gabet) 1
Background Previous study described acute myocardial infarction case fatality in France in cardiac care unit but no recent study analyzed all hospitalized acute coronary syndrome with one year follow-up. Purpose The objectives of this study were to analyze very early to late case fatality rates in patients hospitalized for ACS in 2015 in France, their determinants and time-trends between 2010 and 2015. Methods Data were extracted from the national health insurance information system. Hospitalisation for ACS were collected by using ICD-10 codes as primary discharge diagnosis for ST-elevation myocardial infarction (STEMI), other MI and unstable angina (UA). Multivariate Cox models adjusted for age, comorbidities, sex, previous ACS, social deprivation of the municipality of residence, invasive procedures and pharmacological treatment refund were used to assess determinants of case-fatality respectively at 3 day after hospital admission, 4—30 day and 31—365 day after excluding dead patients of the preceding periods. Results In 2015, 84,202 persons were hospitalized for ACS with 34.9% for STEMI, 20.5% for other MI and 44.7% for UA. Mean age were 65.2, 69.1 and 68.1 respectively. Cumulative 3-day, 30-day and 1-year case-fatality were 3.9%, 8.4% and 13.8% for STEMI, 2.7%, 6.5% and 14.4% for other MI, and 0.4%, 2.0% and 7.2% for UA. In multivariate analysis, female sex was associated with higher 3day case-fatality among STEMI only, particularly < 65 years of age [HR = 1.47(1.30—1.68)]. Social deprivation was associated with an increase of all case-fatality outcomes. Additional adjustment for hospital management and medication delivery did not change the results. Conclusion Case-fatality up to 1 year after a hospitalization for ACS remained non-negligible. Women seemed to be at particular risk of very early case-fatality. Social inequalities independently impacted all period outcomes. No significant change in ACS case fatality were found between 2010 and 2015. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2018.10.016
S. Huo Yung Kai 1,∗ , J.B. Ruidavets 1 , Jean Ferrières 1,2 1 Department of epidemiology, Health Economics and Public Health, UMR 1027 Inserm, université Toulouse 3 2 Department of cardiology, Toulouse-Rangueil University Hospital, Toulouse University School of Medicine, Toulouse, France ∗ Corresponding author. Adresse e-mail : [email protected] (S. Huo Yung Kai) Background Acute myocardial infarction (AMI) management changes as guidelines evolve. The hypothesis of this study is that the survival of incident AMI should improve with time. Purpose The objective is to compare, according to the period of onset, the five-year total mortality in patients with incident AMI, supposing that mortality varies depending on the period considered and AMI management changed during these periods. Methods Data of the Haute-Garonne AMI registry was used to assess men and women (aged 35—74 years) who presented with AMI and who had no personal history of myocardial infarction or angina pectoris. Cases that happened between 1997 and 2005 were considered. The vital status five years after the event was assessed. Incidence rates of total mortality was expressed per 1000 person-year (with 95% confidence intervals). Total mortality was compared according to the period of onset (reference: 1997 to 1999/2000 to 2002/2003 to 2005) using sex-stratified Cox proportional hazards regression analyses adjusted for age. Results A total of 3924 incidents AMI were hospitalized between 1997 and 2012: 82.9% were men, median age at onset was 59.6 years old (58.2 and 66.7 years old, respectively for men and women). Among all incident cases of AMI, incidence rate of total mortality was 35.5 [95% CI: 32.8, 38.4] per 1000 person-year. Men and women rates were respectively: 35.2 [32.3, 38.4] and 37.2 [30.8, 44.9] per 1000 person-year. The incidence rates of total mortality by sex and year are shown in Fig. 1. The results of the Cox analyses stratified by sex are presented in Table 1. Conclusion Our study shows that the total mortality five years after an incident AMI does not vary significantly over time.
Fig. 1 Incidence rates of total mortality among incident AMI by sex and year (1997—2005).
12
Absabsts
Table 1 Comparison of total mortality by period (Cox regression analyses).
Periods 1997—1999 2000—2002 2003—2005 Age at AMI
Men (n = 509)
Women (n = 108)
HR
95% CI
HR
95% CI
1.00 0.82 1.07 1.05
— 0.66 0.87 1.04
1.00 0.91 0.93 1.06
— 0.57 0.58 1.03
— 1.02 1.32 1.06
198
— 1.44 1.48 1.08
HR: hazard ratio; CI: confidence interval. Disclosure of interest peting interest.
The authors declare that they have no com-
https://doi.org/10.1016/j.acvdsp.2018.10.017 132
In patients with acute myocardial infarction, PCSK9 levels do not predict severity and recurrence of cardiovascular events M. Zeller 1,∗ , G. Lambert 2 , M. Farnier 3,4 , M. Maza 4 , L. Rochette 1 , C. Vergely 1 , Y. Cottin 4 1 Université Bourgogne Franche-Comté, Equipe PEC2, EA 7460, Dijon 2 Université de La Réunion, Inserm UMR 1188, Sainte-Clotilde 3 Point Médical, lipidologie et maladies métaboliques 4 CHU Dijon Bourgogne, service de cardiologie, Dijon, France ∗ Corresponding author. Adresse e-mail : [email protected] (M. Zeller) Background In patients with coronary artery disease (CAD), it remains unclear whether serum PCSK9 levels can predict the severity of the disease and the risk of future cardiovascular events. Methods Among the patients admitted for an acute myocardial infarction (MI) from September 2015 to December 2016 in an intensive care unit from a university hospital, serum PCSK9 levels were measured on admission in patients not previously receiving statin therapy. We aimed to evaluate the association between PCSK9 levels, metabolic parameters, severity of CAD on coronary angiography, and the risk of in-hospital events and at one-year follow-up. Results In a total of 648 patients (mean age: 66 years, 67% male), the median PCSK9 was 263 ng/ml, higher for females compared with males (270 vs. 256 ng/mL, P < 0.009). Serum PCSK9 was associated with LDL cholesterol (r = 0.083, P = 0.036), total cholesterol (r = 0.136, P = 0.001) and triglycerides (r = 0.137, P = 0.0001). A positive association was also observed in the subgroup of patients with CRP > 10 mg/L (P < 0.001), but not with NT-proBNP, troponin and Creatinine Kinase. PCSK9 levels were similar whatever the SYNTAX score or the number of significant coronary lesions. Moreover, PCSK9 levels were not predictive of in-hospital events (death, recurrent MI and stroke) and events (cardiovascular death, cardiovascular events, recurrent MI) at one-year follow-up. Conclusion In this large cohort of patients hospitalized for acute MI and not previously receiving statin therapy, PCSK9 levels do not predict the severity or the recurrence of cardiovascular events. The clinical utility of measuring PCSK9 levels remains to be demonstrated for this category of patients. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2018.10.018
Thursday, January 17th, 2019
Impact and predictive factors of bleeding complications in elderly patients admitted for an acute coronary syndrome: Insights from the ANTARCTIC trial B. Lattuca 1,2,∗ , Guillaume Cayla 1 , J. Silvain 2 , T. Cuisset 3 , Florence Leclercq 4 , S. Manzo-Silberman 5 , C. Saint-Étienne 6 , N. Delarche 7 , R. El Mahmoud 8 , D. Carrie 9 , G. Souteyrand 10 , A. Diallo 11 , J.P. Collet 2 , E. Vicaut 11 , G. Montalescot 2 1 CHU Caremeau Département de cardiologie Nîmes, Nîmes 2 Sorbonne University, Paris 06 (UPMC), ACTION Study Group, Inserm UMRS 1166, Cardiology Institute, Pitié-Salpêtrière, University Hospital, AP—HP, Paris 3 ACTION Study Group, Aix-Marseille University, Cardiology department, Inserm UMR1062, Inra UMR1260, centre hospitalier universitaire La Timone, Marseille 4 Montpellier university, cardiology department, centre hospitalier universitaire de Montpellier, Montpellier 5 Cardiology department, centre hospitalier universitaire Lariboisière, AP—HP, Paris 6 Cardiology department, centre hospitalier universitaire de Tours, Tours 7 Cardiology department, hôpital Francois Mitterrand, Pau 8 Cardiology department, hôpital Ambroise Paré, Boulogne-Billancourt 9 Cardiology department, centre hospitalier universitaire Rangueil, Toulouse 10 Cardiology department, centre hospitalier universitaire Gabriel Montpied, Clermont-Ferrand 11 ACTION Study Group, Epidemiology and Clinic Research Unit, Lariboisière University Hospital, Paris, France ∗ Corresponding author. Adresse e-mail : [email protected] (B. Lattuca) Background Elderly patients are at high-risk of bleeding, particularly in the setting of acute coronary syndrome treated with an invasive strategy. Treatment adjustment by platelet function testing (PFT) failed to improve clinical outcomes in the randomized ANTARCTIC trial. Purpose This prespecified substudy aims at determining the predictive factors of bleeding and their relation to ischemic events and mortality. Methods We analyzed the 877 patients over the age of 75 years from the ANTARCTIC trial and randomized to a strategy of dose or drug antiplatelet therapy adjustment or a conventional strategy without PFT. In the monitoring group, patients received prasugrel 5 mg daily after coronary stenting and treatment was adjusted according to PFT. Correlation between occurrence of bleeding and major cardiovascular adverse events (MACE) defined as the composite of cardiovascular death, myocardial infarction and stroke was analyzed at one year. Results Clinically relevant bleedings (Bleeding Academic Research Consortium types 2, 3 or 5) were frequently observed (20.6%, n = 181 patients) with one third occurring in the first month. MACE occurred more frequently at one year in patients with a bleeding (16.6% vs. 7.6%, adj.HR: 2.04(1.24;3.38); P = 0.005). Rates of myocardial infarction and stroke were higher at one year after bleeding (9.9% vs. 4.5%, adj.HR: 2.40(1.24;4.66); P = 0.0093 and 6.6% vs. 1%, adj.HR: 5.55(2.04;15.06); P = 0.0008 respectively) without significant difference in death (6.6% vs. 4.0%; HR: 1.20(0.57;2.51); P = 0.63). Predictive factors of major bleedings in the multivariate model were age > 85 years [adj.HR: