Clinical InvestigationAcute Ischemic Heart DiseaseEffect of comorbidity on coronary reperfusion strategy and long-term mortality after acute myocardial infarction
Section snippets
Patient population
The design of the AMI-Florence registry has been detailed elsewhere.10 Briefly, the Florence health district (about 800 000 inhabitants) comprises 5 community hospitals and 1 teaching hospital, the latter implementing high-volume programs for primary PCI (fully operative 24 h/d, 7 d/wk). All residents in the Florence area arriving alive to the emergency department of 1 of the 6 hospitals between March 2000 and February 2001 with a suspected STEMI were prospectively screened for eligibility and
Results
Overall, 198 patients had no comorbidity, whereas 542 had at least one chronic comorbidity. Of these, 184 had a cardiac, 135 a noncardiac, and 223 at least one cardiac and one noncardiac comorbidity. The prevalence of comorbidity increased from 48% at age <55 years to 83% at age >74 years (P < .001).
The prevalence of each comorbidity and results from age-adjusted bivariate Cox analyses testing the association of comorbidities with 1-year prognosis, which were used to calculate individual
Discussion
The most rapid and complete coronary reperfusion is the desirable therapeutic goal to be achieved in acute MI.1 At least in selected subgroups in whom thrombolysis is known to be less effective or relatively contraindicated,4 primary PCI may produce better results and extends the benefit of coronary reperfusion to nearly all cases of STEMI.13 Whereas underutilization of thrombolysis in older patients with AMI may be justified, at least in part, by an age-associated increase in the
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Cited by (23)
Impact of Charlson Co-Morbidity Index Score on Management and Outcomes After Acute Coronary Syndrome
2020, American Journal of CardiologyCitation Excerpt :Paradoxically, a notable finding of our study is that ACS patients with severe co-morbid burden are more likely to be conservatively managed as compared to their counterparts with lesser or no co-morbidities. Previously the AMI Florence working group reported that coronary reperfusion strategy was less frequently adopted in patients with increasing chronic co-morbidity score based on data analysis of a population-based registry with a smaller sample size (n = 740), which included only STEMI patients.24 The same group also demonstrated that application of PCI was associated with a long-term survival advantage that increased progressively with increase in risk profile in ACS patients and hypothesized that a conservative approach in these multimorbid patients may not justified.25
Temporal Trends in Comorbidity Burden and Impact on Prognosis in Patients With Acute Coronary Syndrome Using the Elixhauser Comorbidity Index Score
2020, American Journal of CardiologyCitation Excerpt :Only a few studies have examined the impact of comorbidity burden on receipt of invasive management in patients with ACS. A study of 740 patients with ST-elevation myocardial infarction reported lower rates of coronary reperfusion (primary PCI or thrombolysis) in those with a higher chronic comorbidity score.13 While this study provides us with insights in to the invasive management (or lack thereof) of a specific subgroup of AMI, in a modest number of patients, our analysis confirms that this finding is consistent nationwide in both STEMI and NSTEMI subgroups.
The interaction effect of cardiac and non-cardiac comorbidity on myocardial infarction mortality: A nationwide cohort study
2020, International Journal of CardiologyCitation Excerpt :These findings were also supported by our sensitivity analyses on MI type or drug compliance. The more infrequent practice of coronary reperfusion therapy among patients with severe comorbidity may contribute to increased short-term mortality[23]. Several issues should be considered when interpreting our results.
Effectiveness of a combination of ezetimibe and statins in patients with acute coronary syndrome and multiple comorbidities: A 6-year population-based cohort study
2017, International Journal of CardiologyCitation Excerpt :Lichtman et al. showed that patients with ACS and comorbidities such as pneumonia, severe gastrointestinal bleeding, anemia, stroke, or sepsis have a poor prognosis [15]. In addition to acute comorbidities, patients with ACS and chronic conditions have also been reported to show increased mortality [16]. The effectiveness of ezetimibe combined with statins in these patients has not been extensively studied.
- h
see Appendix A.