Background Coronary heart disease incidence, mortality and short-term case-fatality have improved substantially during the past decades. Recent changes in the long-term prognosis among survivors of acute coronary syndrome are less well known. Our aim was to investigate the long-term prognosis of acute coronary syndrome. Design An observational myocardial infarction register study. Methods Data was derived from the population based Finnish Myocardial Infarction register. Patients aged 35 or higher, who had their first acute coronary syndrome during 1993–2011 and survived the first 28 days, were included in the analysis (n = 13,336). Endpoints were fatal and non-fatal cardiovascular disease events and all-cause mortality at one year and three years after the index event. We also compared the prognosis of acute coronary syndrome survivors with the prognosis of an apparently healthy population with the same age, sex and area of residence, derived from the FINRISK study. Results Significant declines over time were observed in the risk of a new cardiovascular disease event. At three year follow-up the age- and study area-adjusted hazard ratio per calendar year was 0.969 (95% confidence interval 0.960–0.977, p = 4.63 × 10−13) among men and 0.969 (95% confidence interval 0.961–0.978, p = 1.01 × 10−11) among women. Despite the improvement in prognosis, the age-standardized three year cardiovascular disease free survival of acute coronary syndrome patients was significantly lower than in the FINRISK control group (for men p = 6.64 × 10−27 and for women p = 2.11 × 10−15). Conclusion The prognosis of acute coronary syndrome survivors has improved during the 18-year period but is still much worse than the prognosis of comparable general population.

Trends in long-term prognosis after acute coronary syndrome

BACKGROUND: Experiences from the first wave of the 2019 coronavirus disease (COVID-19) pandemic can aid in the development of future preventive strategies To date, risk prediction models for COVID-19-related incidence and outcomes in hemodialysis (HD) patients are missing METHODS: We developed risk prediction models for COVID-19 incidence and mortality among HD patients We studied 38 256 HD patients from a multi-national dialysis cohort between 3 March and 3 July 2020 Risk prediction models were developed and validated, based on predictors readily available in outpatient HD units We compared mortality among patients with and without COVID-19, matched for age, sex and diabetes RESULTS: During the observational period, 1259 patients (3 3%) acquired COVID-19 Of these, 62% were hospitalized or died Mortality was 22% among COVID-19 patients with odds ratios 219 8 [95% confidence interval (CI) 80 6-359] to 342 7 (95% CI 60 6-13 595 1), compared to matched patients without COVID-19 Since the first wave of the pandemic affected most European countries during the study, the risk prediction model for incidence of COVID-19 was developed and validated in European patients only [N = 22 826 area under the ROC curve(AUC)(Dev) 0 64, AUC(Val) 0 69] The model for prediction of mortality was developed in all COVID-19 patients (AUC(Dev) 0 71, AUC(Val) 0 78) Angiotensin receptor blockers were independently associated with a lower incidence of COVID-19 in European patients CONCLUSIONS: We identified modifiable risk factors for COVID-19 incidence and outcome in HD patients Our risk prediction tools can be readily applied in clinical practice This can aid in the development of preventive strategies for future waves of COVID-19

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Risk prediction of COVID-19 incidence and mortality in a large multi-national hemodialysis cohort: implications for management of the pandemic in outpatient hemodialysis settings

Changes in Emergency Department Visits, Diagnostic Groups, and 28-Day Mortality Associated With the COVID-19 Pandemic: A Territory-Wide, Retrospective, Cohort Study.

http://www.annemergmed.com/article/S0196064421012865/pdf

Changes in Emergency Department Visits, Diagnostic Groups, and 28-Day Mortality Associated With the COVID-19 Pandemic: A Territory-Wide, Retrospective, Cohort Study

In the era of the coronavirus disease 2019 (COVID-19) pandemic, acute cardiac injury (ACI), as reflected by elevated cardiac troponin above the 99th percentile, has been observed in 8%-62% of patients with COVID-19 infection with highest incidence and mortality recorded in patients with severe infection. Apart from the clinically and electrocardiographically discernible causes of ACI, such as acute myocardial infarction (MI), other cardiac causes need to be considered such as myocarditis, Takotsubo syndrome, and direct injury from COVID-19, together with noncardiac conditions, such as pulmonary embolism, critical illness, and sepsis. Acute coronary syndromes (ACS) with normal or near-normal coronary arteries (ACS-NNOCA) appear to have a higher prevalence in both COVID-19 positive and negative patients in the pandemic compared to the pre-pandemic era. Echocardiography, coronary angiography, chest computed tomography and/or cardiac magnetic resonance imaging may render a correct diagnosis, obviating the need for endomyocardial biopsy. Importantly, a significant delay has been recorded in patients with ACS seeking advice for their symptoms, while their routine care has been sharply disrupted with fewer urgent coronary angiographies and/or primary percutaneous coronary interventions performed in the case of ST-elevation MI (STEMI) with an inappropriate shift toward thrombolysis, all contributing to a higher complication rate in these patients. Thus, new challenges have emerged in rendering a diagnosis and delivering treatment in patients with ACI/ACS in the pandemic era. These issues, the various mechanisms involved in the development of ACI/ACS, and relevant current guidelines are herein reviewed.

COVID-19 and Acute Myocardial Injury and Infarction: Related Mechanisms and Emerging Challenges.

Introduction and objectives Despite advances in treatment, patients with acute myocardial infarction (AMI) still exhibit unfavorable short- and long-term prognoses. In addition, there is scant evidence about the clinical outcomes of patients with AMI and coronavirus disease 2019 (COVID-19). The objective of this study was to describe the clinical presentation, complications, and risk factors for mortality in patients admitted for AMI during the COVID-19 pandemic.Methods This prospective, multicenter, cohort study included all consecutive patients with AMI who underwent coronary angiography in a 30-day period corresponding chronologically with the COVID-19 outbreak (March 15 to April 15, 2020). Clinical presentations and outcomes were compared between COVID-19 and non-COVID-19 patients. The effect of COVID-19 on mortality was assessed by propensity score matching and with a multivariate logistic regression model.Results In total, 187 patients were admitted for AMI, 111 with ST-segment elevation AMI and 76 with non-ST-segment elevation AMI. Of these, 32 (17%) were diagnosed with COVID-19. GRACE score, Killip-Kimball classification, and several inflammatory markers were significantly higher in COVID-19-positive patients. Total and cardiovascular mortality were also significantly higher in COVID-19-positive patients (25% vs 3.8% [P 140 (OR, 23.45; 95%CI, 2.52-62.51; P = .005) and COVID-19 (OR, 6.61; 95%CI, 1.82-24.43; P = .02) were independent predictors of in-hospital death.Conclusions During this pandemic, a high GRACE score and COVID-19 were independent risk factors associated with higher in-hospital mortality.

Risk factors for in-hospital mortality in patients with acute myocardial infarction during the COVID-19 outbreak

Resumen Introduccion y objetivos A pesar de los avances en el tratamiento del infarto agudo de miocardio (IAM), este sigue presentando un pronostico desfavorable. Hay poca evidencia acerca de la evolucion de los pacientes con IAM y la enfermedad por coronavirus 2019 (COVID-19). El objetivo del estudio es describir la presentacion clinica, las complicaciones y los factores predictores de mortalidad hospitalaria en pacientes con IAM durante el brote de COVID-19 en Espana. Metodos Se realizo un estudio de cohortes, prospectivo y multicentrico de todos los pacientes consecutivos con IAM en tratamiento invasivo durante el brote de COVID-19 (15 de marzo a 15 de abril de 2020). Se compararon las caracteristicas clinicas de los pacientes positivos para COVID-19 con las de los negativos, y se evaluo el efecto de la COVID-19 en la mortalidad mediante emparejamiento por puntuacion de propension y regresion logistica. Resultados Se incluyo a 187 pacientes con IAM: 111 con elevacion del segmento ST y 76 sin elevacion. De ellos, 32 (17%) resultaron positivos para COVID-19. Las puntuaciones GRACE y Killip-Kimball y varios marcadores inflamatorios resultaron significativamente mayores en los pacientes con COVID-19. La mortalidad total y cardiovascular fueron significativamente mayores en los pacientes con COVID-19 (el 25 frente al 3,8%; p 140 (OR = 23,45; IC95%, 2,52-62,51; p = 0,005) y la COVID-19 (OR = 6,61; IC95%, 1,82-24,43; p = 0,02) resultaron factores independientes de mortalidad hospitalaria. Conclusiones Durante el brote epidemico, la puntuacion GRACE elevada y la COVID-19 fueron los factores independientes de mortalidad hospitalaria en los pacientes con IAM.

Roberto Mateos Gaitán

Papers

Risk factors for in-hospital mortality in patients with acute myocardial infarction during the COVID-19 outbreak

Factores de riesgo de muerte hospitalaria en pacientes con infarto agudo de miocardio durante la pandemia de la COVID-19