Showing papers by "Anselm K. Gitt published in 2001"

Incidence, determinants, and clinical course of reinfarction in-hospital after index acute myocardial infarction (results from the pooled data of the maximal individual therapy in acute myocardial infarction [MITRA], and the myocardial infarction registry [MIR]).

Abstract: There are few data about the incidence, determinants, and clinical course of in-hospital repeat acute myocardial infarction (RE-AMI) after an index AMI. From June 1994 to June 1998, 22,613 patients with AMI as an index event were registered by the Maximal Individual Therapy in Acute Myocardial Infarction (MITRA) and Myocardial Infarction Registries (MIR). Of these, 1,071 (4.7%) had a RE-AMI. For the index event, 9,143 patients (40.5%) were treated with thrombolysis, 1,707 (7.5%) with primary angioplasty, and 443 (2.0%) with a combination of both. Multivariate analysis showed that previous AMI (odds ratio [OR] 1.59; 95% confidence intervals [CI] 1.35 to 1.86), age >70 years (OR 1.57; 95% CI 1.36 to 1.81), diagnostic first electrocardiogram (OR 1.37; 95% CI 1.19 to 1.59), and female gender (OR 1.14; 95% CI 1.05 to 1.32) were independently associated with a higher incidence of RE-AMI. The incidence of RE-AMI was higher when patients received thrombolysis (OR 1.36; 95% CI 1.15 to 1.61), and it was lower when they underwent primary angioplasty (OR 0.74; 95% CI 0.53 to 1.03) or received beta blockers (OR 0.84; 95% CI 0.72 to 0.97). Patients with RE-AMI had higher hospital mortality compared with those without RE-AMI (OR 4.35; 95% CI 3.83 to 4.95). Multivariate logistic regression analysis showed an independent association of RE-AMI with in-hospital death (OR 6.60; 95% CI 5.61 to 7.70), repeat revascularization (OR 2.91; 95% CI 2.42 to 3.50), low workload capacity on the bicycle ergometry test (OR 2.17; 95% CI 1.71 to 2.76), and ejection fraction 70 years, diagnostic first electrocardiogram, and female gender are independent determinants for RE-AMI. Thrombolysis is associated with a higher and beta blockers with a lower incidence of RE-AMI. Once a RE-AMI occurs, it is a strong predictor of in-hospital mortality and morbidity.

Effect of preinfarction angina pectoris on outcome in patients with acute myocardial infarction treated with primary angioplasty (results from the Myocardial Infarction Registry [MIR])

Abstract: Preinfarction angina is associated with better clinical outcome in patients with acute myocardial infarction (AMI) who receive intravenous thrombolysis. This has not been proved in patients with AMI treated with primary angioplasty. We analyzed the data of the prospective multicenter Myocardial Infarction Registry (MIR). Of 14,440 patients with AMI, 774 with a prehospital delay of ≤12 hours were treated with primary angioplasty. Five hundred thirty-two patients (68.7%) had preinfarction angina. Patients with preinfarction angina were slightly older than patients without (63 vs 62 years, p = 0.042), prehospital delay was 1 hour longer (180 vs 120 minutes, p = 0.001), and arterial hypertension was more prevalent (47.6% vs 32.2%, odds ratio [OR] 1.91, 95% confidence intervals [CI] 1.39 to 2.62). There was no significant difference in hospital mortality (5.6% vs 3.3%, OR 1.75, 95% CI 0.79 to 3.87), reinfarction, stroke, or the combined end point of death, reinfarction, or stroke between the 2 groups. Logistic regression analysis showed no association of preinfarction angina with the occurrence of either death (OR 2.21, 95% CI 0.91 to 6.08) or the combined end points (OR 1.10, 95% CI 0.55 to 2.31). There was also no significant difference in mortality (6% vs 5.1%, OR 1.19, 95% CI 0.56 to 2.52), reinfarction, stroke, postinfarction angina, or the combined end points between patients with preinfarction angina within 48 hours compared with patients with preinfarction angina between 49 hours and 4 weeks before the AMI. Thus, the MIR data showed no protective effects of preinfarction angina in patients with AMI treated with primary angioplasty.

Incidence, risk factors, and clinical outcome of stroke after acute myocardial infarction in clinical practice

Abstract: In this analysis of ischemic and hemorrhagic strokes after acute myocardial infarction (AMI) in 21,330 consecutively included patients with AMI, we found an incidence of stroke after AMI of 1.2% and a very poor prognosis. Previous stroke, atrial fibrillation, and older age were the strongest predictors of stroke after AMI; thrombolysis was a borderline risk factor and early therapy with aspirin was associated with a reduction in stroke after AMI.

Aktuelle Verordnungspraxis von CSE-Hemmern bei Entlassung aus der Klinik nach akutem Myokardinfarkt

Abstract: Wir untersuchten den Einsatz von CSE-Hemmern im klinischen Alltag bei Patienten nach akutem Myokardinfarkt in Deutschland bei 17732 konsekutiv eingeschlossenen Patienten der Myokardinfarktregister MIR-1 und MITRA-1. Eine klinische Nachbeobachtungsstudie wurde bei der MITRA-1-Studie durchschnittlich nach 18 Monaten durchgefuhrt. Insgesamt erhielten 30% der Patienten mit akutem Myokardinfarkt einen CSE-Hemmer bei Entlassung. Von 1994–1998 wurde eine Zunahme der Verordnung der CSE-Hemmer von 6% auf 44% beobachtet, aber auch 1998 erhielten noch weniger als die Halfte der Patienten mit akutem Myokardinfarkt einen CSE-Hemmer bei Entlassung. In einer logistischen Regressionsanalyse waren komplizierende Begleiterkrankungen wie Niereninsuffizienz (OR 0,7), Herzinsuffizienz (OR 0,7) und Diabetes mellitus (OR 0,9) mit einer geringen Verordnung von CSE-Hemmern assoziiert. Lebensalter >70 Jahre (OR 0,5) war ebenfalls mit einer geringeren Verordnung von CSE-Hemmern bei Entlassung aus der Klinik assoziiert. Die Patienten, die mit CSE-Hemmern entlassen worden waren, hatten eine niedrigere Langzeitmortalitat von 5,8% als die Patienten ohne CSE-Hemmer mit 12,9%. Nach Adjustierung fur Alter und Begleiterkrankungen war die CSE-Hemmer-Verordnung mit einer grenzwertig signifikanten Reduktion der Langzeit-Mortalitat assoziiert (multivariate OR 0,7, 95% KI 0,4–1,0). Eine Subgruppenanalyse des Therapienutzens, gemessen an der „number needed to treat” (NNT), der Zahl der Patienten, die mit CSE-Hemmern behandelt werden mussen, um einen Todesfall zu verhindern, wies bei den Patienten mit kardiovaskularen Risikofaktoren, wie Herzinsuffizienz (NNT 7,5), Diabetes mellitus (NNT 7,8) und Alter >70 Jahre (NNT 13,8), einen groseren Nutzen der Therapie nach als bei Patienten ohne diese Risikofaktoren (NNT 345). Die Hochrisikopatienten erhielten jedoch weniger CSE-Hemmer verordnet als Patienten ohne diese Risikofaktoren (Verordnungshaufigkeit 11,8% versus 19,8%).

Quality assurance in acute myocardial infarct

Abstract: The Ludwigshafen myocardial infarction project has demonstrated, that an intense public media campaign can reduce prehospital delays in acute myocardial infarction. With an additional intrahospital improvement, this can lead to a better and more frequent use of recanalization (thrombolysis or percutaneous transluminal coronary angioplasty [PTCA]). Several large multicentric registries (60 minutes myocardial infarction project, MIR, MITRA) with a total of about 40,000 patients at over 300 hospitals in Germany showed, that intrahospital improvement of infarction therapy can also be achieved in other hospitals. Voluntary participation in an infarction registry leads to quality control and improvement. Two factors are especially important: (1) documentation of every infarction patient, and (2) documentation of the reasons why therapy was given or withheld in every single patient. The improvement in early therapy is associated with a 20% reduction of hospital mortality (MITRA-1). The media campaign in Ludwigshafen to reduce pre-hospital patient delay, however, could not yet be carried out in other areas effectively and intensely enough.