Background: Patients with cardiovascular disease (CVD) and risk factors have increased rates of adverse events and mortality after hospitalization for coronavirus disease 2019 (COVID-19). In this study, we attempted to identify and assess the effects of CVD on COVID-19 hospitalizations in the USA using a large national database.
Methods: The current study was a retrospective analysis of data from the US National (Nationwide) Inpatient Sample from 2020. All adult patients 18 years of age and older who were admitted with the primary diagnosis of COVID-19 were included. The primary outcome was in-hospital mortality, while secondary outcomes included prolonged hospital length of stay, mechanical ventilation, and disposition other than home. Prolonged hospital length of stay was defined as a length of stay greater than the 75 th percentile for the full sample. The diagnoses were identified using the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes.
Results: A total of 1 050 040 patients were included in the study, of which 454 650 (43.3%) had prior CVD. Patients with CVD had higher mortality during COVID-19 hospitalization (19.3 vs. 5.0%, P < 0.001). Similarly, these patients had a higher rate of prolonged hospital length of stay (34.5 vs. 21.0%, P < 0.001), required mechanical ventilation (15.4 vs. 5.6%, P < 0.001), and were more likely to be discharged to a disposition other than home (62.5 vs. 32.3%, P < 0.001). Mean hospitalization cost was also higher in patients with CVD during hospitalization ($24 023 vs. $15 320, P < 0.001). Conditional logistic regression analysis showed that the odds of in-hospital mortality [odds ratio (OR), 3.23; 95% confidence interval (CI), 2.91-3.45] were significantly higher for COVID-19 hospitalizations with CVD, compared with those without CVD. Similarly, prolonged hospital length (OR, 1.82; 95% CI, 1.43-2.23), mechanical ventilation (OR, 3.31; 95% CI, 3.06-3.67), and disposition other than home (OR, 2.01; 95% CI, 1.87-2.21) were also significantly higher for COVID-19 hospitalizations with coronary artery disease.
Conclusion: Our study showed that the presence of CVD has a significant negative impact on the prognosis of patients hospitalized for COVID-19. There was an associated increase in mortality, length of stay, ventilator use, and adverse discharge dispositions among COVID-19 patients with CVD. Adjustment in treatment for CVD should be considered when providing care to patients hospitalized for COVID-19 to mitigate some of the adverse hospital outcomes.
{"title":"Burden of cardiovascular disease on coronavirus disease 2019 hospitalizations in the USA.","authors":"Kelvin Chan, Jiana Baker, Abigail Conroy, Muni Rubens, Venkataraghavan Ramamoorthy, Anshul Saxena, Mukesh Roy, Javier Jimenez, Sandra Chaparro","doi":"10.1097/MCA.0000000000001390","DOIUrl":"10.1097/MCA.0000000000001390","url":null,"abstract":"<p><strong>Background: </strong>Patients with cardiovascular disease (CVD) and risk factors have increased rates of adverse events and mortality after hospitalization for coronavirus disease 2019 (COVID-19). In this study, we attempted to identify and assess the effects of CVD on COVID-19 hospitalizations in the USA using a large national database.</p><p><strong>Methods: </strong>The current study was a retrospective analysis of data from the US National (Nationwide) Inpatient Sample from 2020. All adult patients 18 years of age and older who were admitted with the primary diagnosis of COVID-19 were included. The primary outcome was in-hospital mortality, while secondary outcomes included prolonged hospital length of stay, mechanical ventilation, and disposition other than home. Prolonged hospital length of stay was defined as a length of stay greater than the 75 th percentile for the full sample. The diagnoses were identified using the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes.</p><p><strong>Results: </strong>A total of 1 050 040 patients were included in the study, of which 454 650 (43.3%) had prior CVD. Patients with CVD had higher mortality during COVID-19 hospitalization (19.3 vs. 5.0%, P < 0.001). Similarly, these patients had a higher rate of prolonged hospital length of stay (34.5 vs. 21.0%, P < 0.001), required mechanical ventilation (15.4 vs. 5.6%, P < 0.001), and were more likely to be discharged to a disposition other than home (62.5 vs. 32.3%, P < 0.001). Mean hospitalization cost was also higher in patients with CVD during hospitalization ($24 023 vs. $15 320, P < 0.001). Conditional logistic regression analysis showed that the odds of in-hospital mortality [odds ratio (OR), 3.23; 95% confidence interval (CI), 2.91-3.45] were significantly higher for COVID-19 hospitalizations with CVD, compared with those without CVD. Similarly, prolonged hospital length (OR, 1.82; 95% CI, 1.43-2.23), mechanical ventilation (OR, 3.31; 95% CI, 3.06-3.67), and disposition other than home (OR, 2.01; 95% CI, 1.87-2.21) were also significantly higher for COVID-19 hospitalizations with coronary artery disease.</p><p><strong>Conclusion: </strong>Our study showed that the presence of CVD has a significant negative impact on the prognosis of patients hospitalized for COVID-19. There was an associated increase in mortality, length of stay, ventilator use, and adverse discharge dispositions among COVID-19 patients with CVD. Adjustment in treatment for CVD should be considered when providing care to patients hospitalized for COVID-19 to mitigate some of the adverse hospital outcomes.</p>","PeriodicalId":10702,"journal":{"name":"Coronary artery disease","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141087046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-05-28DOI: 10.1097/MCA.0000000000001391
Zhiyuan Ma, Marc Kervin Antoine, Huseng Vefali, Yugandhar Manda, Philip Salen, Melinda Shoemaker, Jill Stoltzfus, Peter Puleo
Objectives: Patients presenting with suspected ST segment elevation myocardial infarction frequently have symptoms in addition to chest pain, including dyspnea, nausea or vomiting, diaphoresis, and lightheadedness or syncope. These symptoms are often regarded as supporting the diagnosis of infarction. We sought to determine the prevalence of the non-chest pain symptoms among patients who were confirmed as having a critically diseased coronary vessel as opposed to those with no angiographic culprit lesion.
Methods: Data from 1393 consecutive patients with ST segment elevation who underwent emergent coronary angiography were analyzed. Records were reviewed in detail for symptoms, ECG findings, prior history, angiographic findings, and in-hospital outcomes.
Results: Dyspnea was present in 50.8% of patients, nausea or vomiting in 36.5%, diaphoresis in 51.2%, and lightheadedness/syncope in 16.8%. On angiography, 1239 (88.9%) patients had a culprit lesion and 154 (11.1%) were found not to have a culprit. Only diaphoresis had a higher prevalence among the patients with, as compared with those without a culprit, with an odds ratio of 2.64 ( P < 0.001). The highest occurrence of diaphoresis was among patients with a totally occluded artery, with an intermediate frequency among patients with a subtotal stenosis, and the lowest prevalence among those with no culprit. These findings were consistent regardless of ECG infarct location, affected vessel, patient age, or sex. Among the subset of patients who presented without chest discomfort, none of the symptoms were associated with the presence of a culprit.
Conclusion: The presence of diaphoresis, but not dyspnea, nausea, or lightheadedness is associated with an increased likelihood that patients presenting with ST elevation will prove to have a culprit lesion. In patients who present with ST elevation but without chest discomfort, these symptoms should not be regarded as 'chest pain equivalents'. Further objective data among patients with angiographic confirmation of culprit lesion status is warranted.
目的:疑似 ST 段抬高型心肌梗死的患者除胸痛外还常伴有其他症状,包括呼吸困难、恶心或呕吐、全身乏力、头晕或晕厥。这些症状通常被视为心肌梗死诊断的佐证。我们试图确定被确诊为冠状动脉血管严重病变的患者与没有血管造影罪魁祸首病变的患者之间非胸痛症状的发生率:方法: 分析了 1393 名连续接受急诊冠状动脉造影术的 ST 段抬高患者的数据。详细审查了患者的症状、心电图结果、既往史、血管造影结果和住院结果等记录:结果:50.8%的患者出现呼吸困难,36.5%的患者出现恶心或呕吐,51.2%的患者出现心悸,16.8%的患者出现头晕/晕厥。在血管造影检查中,1239 名患者(88.9%)有病灶,154 名患者(11.1%)没有病灶。与没有罪魁祸首的患者相比,只有舒张症的发病率较高,其几率比为 2.64(P 结论:舒张症的发病率高于无罪魁祸首的患者):出现舒张而非呼吸困难、恶心或头晕,与出现 ST 波抬高的患者被证实有罪魁祸首病变的可能性增加有关。对于出现 ST 波抬高但无胸部不适的患者,不应将这些症状视为 "胸痛等同物"。有必要在血管造影证实为罪魁祸首病变的患者中进一步收集客观数据。
{"title":"Non-chest pain symptoms and likelihood of coronary occlusion in emergency department patients with ST segment elevation undergoing emergent coronary angiography.","authors":"Zhiyuan Ma, Marc Kervin Antoine, Huseng Vefali, Yugandhar Manda, Philip Salen, Melinda Shoemaker, Jill Stoltzfus, Peter Puleo","doi":"10.1097/MCA.0000000000001391","DOIUrl":"10.1097/MCA.0000000000001391","url":null,"abstract":"<p><strong>Objectives: </strong>Patients presenting with suspected ST segment elevation myocardial infarction frequently have symptoms in addition to chest pain, including dyspnea, nausea or vomiting, diaphoresis, and lightheadedness or syncope. These symptoms are often regarded as supporting the diagnosis of infarction. We sought to determine the prevalence of the non-chest pain symptoms among patients who were confirmed as having a critically diseased coronary vessel as opposed to those with no angiographic culprit lesion.</p><p><strong>Methods: </strong>Data from 1393 consecutive patients with ST segment elevation who underwent emergent coronary angiography were analyzed. Records were reviewed in detail for symptoms, ECG findings, prior history, angiographic findings, and in-hospital outcomes.</p><p><strong>Results: </strong>Dyspnea was present in 50.8% of patients, nausea or vomiting in 36.5%, diaphoresis in 51.2%, and lightheadedness/syncope in 16.8%. On angiography, 1239 (88.9%) patients had a culprit lesion and 154 (11.1%) were found not to have a culprit. Only diaphoresis had a higher prevalence among the patients with, as compared with those without a culprit, with an odds ratio of 2.64 ( P < 0.001). The highest occurrence of diaphoresis was among patients with a totally occluded artery, with an intermediate frequency among patients with a subtotal stenosis, and the lowest prevalence among those with no culprit. These findings were consistent regardless of ECG infarct location, affected vessel, patient age, or sex. Among the subset of patients who presented without chest discomfort, none of the symptoms were associated with the presence of a culprit.</p><p><strong>Conclusion: </strong>The presence of diaphoresis, but not dyspnea, nausea, or lightheadedness is associated with an increased likelihood that patients presenting with ST elevation will prove to have a culprit lesion. In patients who present with ST elevation but without chest discomfort, these symptoms should not be regarded as 'chest pain equivalents'. Further objective data among patients with angiographic confirmation of culprit lesion status is warranted.</p>","PeriodicalId":10702,"journal":{"name":"Coronary artery disease","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11426977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141157922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-05-03DOI: 10.1097/MCA.0000000000001378
Fatih Oksuz, Mikail Yarlioglues, Kadir Karacali, Mehmet Erat, Ibrahim Etem Celik, Mustafa Duran
Objective: Saphenous vein graft disease (SVGD) remains a challenging issue for patients with coronary artery bypass grafting (CABG). It is associated with poor outcomes and atherosclerosis is the major cause of SVGD. Uric acid to albumin ratio (UAR) is a new marker which associated with cardiovascular mortality. We aim to evaluate the relationship between the SVGD and UAR.
Methods: We retrospectively enrolled 237 patients who underwent elective coronary angiography (CAG) for stable angina or positive stress test results >1 year after CABG. The patients were divided into two groups; SVGD (+) patients and SVGD (-) patients. The SVGD was defined as presence of at least 50% stenosis in at least 1 SVG.
Results: UAR were significantly higher in the SVGD (+) group ( P < 0.001). Similarly, Hs-CRP, white blood cell count, and neutrophil count were significantly higher in SVGD (+) group ( P = 0.03, P = 0.027 P = 0.01, respectively). In multivariate logistic regression analysis, time interval after CABG [OR = 1.161, 95% confidence interval (CI) 1.078-1.250; P < 0.001] and UAR (OR = 2.691, 95% CI 1.121-6.459; P < 0.001) were found to be independent predictors of SVGD.
Conclusion: Our results suggested that UAR could be a simple and available marker to predict SVGD in patients with CABG who underwent elective percutaneous coronary intervention.
{"title":"Relationship between uric acid to albumin ratio and saphenous vein graft disease in patients with coronary artery bypass graft.","authors":"Fatih Oksuz, Mikail Yarlioglues, Kadir Karacali, Mehmet Erat, Ibrahim Etem Celik, Mustafa Duran","doi":"10.1097/MCA.0000000000001378","DOIUrl":"10.1097/MCA.0000000000001378","url":null,"abstract":"<p><strong>Objective: </strong>Saphenous vein graft disease (SVGD) remains a challenging issue for patients with coronary artery bypass grafting (CABG). It is associated with poor outcomes and atherosclerosis is the major cause of SVGD. Uric acid to albumin ratio (UAR) is a new marker which associated with cardiovascular mortality. We aim to evaluate the relationship between the SVGD and UAR.</p><p><strong>Methods: </strong>We retrospectively enrolled 237 patients who underwent elective coronary angiography (CAG) for stable angina or positive stress test results >1 year after CABG. The patients were divided into two groups; SVGD (+) patients and SVGD (-) patients. The SVGD was defined as presence of at least 50% stenosis in at least 1 SVG.</p><p><strong>Results: </strong>UAR were significantly higher in the SVGD (+) group ( P < 0.001). Similarly, Hs-CRP, white blood cell count, and neutrophil count were significantly higher in SVGD (+) group ( P = 0.03, P = 0.027 P = 0.01, respectively). In multivariate logistic regression analysis, time interval after CABG [OR = 1.161, 95% confidence interval (CI) 1.078-1.250; P < 0.001] and UAR (OR = 2.691, 95% CI 1.121-6.459; P < 0.001) were found to be independent predictors of SVGD.</p><p><strong>Conclusion: </strong>Our results suggested that UAR could be a simple and available marker to predict SVGD in patients with CABG who underwent elective percutaneous coronary intervention.</p>","PeriodicalId":10702,"journal":{"name":"Coronary artery disease","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140854050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-27DOI: 10.1097/MCA.0000000000001424
Iosif Bikakis, Konstantinos C Theodoropoulos, Matthaios Didagelos, Georgios Perdikos, Alexandra Liakopoulou, Antonios Kouparanis, Antonios Ziakas
{"title":"A very rare variant of single coronary artery.","authors":"Iosif Bikakis, Konstantinos C Theodoropoulos, Matthaios Didagelos, Georgios Perdikos, Alexandra Liakopoulou, Antonios Kouparanis, Antonios Ziakas","doi":"10.1097/MCA.0000000000001424","DOIUrl":"https://doi.org/10.1097/MCA.0000000000001424","url":null,"abstract":"","PeriodicalId":10702,"journal":{"name":"Coronary artery disease","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142343085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-27DOI: 10.1097/MCA.0000000000001426
Edward T Ha, Kumudha Ramasubbu, Shudhanshu Alishetti, Marline Attallah, Manish A Parikh, Yuhei Kobayashi
{"title":"Coronary angiography-derived microvascular assessment (IMRangio) in patients with amyloidosis: a first US report.","authors":"Edward T Ha, Kumudha Ramasubbu, Shudhanshu Alishetti, Marline Attallah, Manish A Parikh, Yuhei Kobayashi","doi":"10.1097/MCA.0000000000001426","DOIUrl":"https://doi.org/10.1097/MCA.0000000000001426","url":null,"abstract":"","PeriodicalId":10702,"journal":{"name":"Coronary artery disease","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142343087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-27DOI: 10.1097/MCA.0000000000001427
Ilya Losin, Ela Giladi, Ziad Arow, Ranin Hilu, Tal Ovdat, Abid Assali, David Pereg
Background: Nonagenarians are a fast-growing age group among acute coronary syndrome (ACS) patients. While new therapeutic options have improved outcomes of ACS patients, data regarding very elderly ACS patients are limited. We aimed to evaluate temporal trends in the treatment and outcomes of nonagenarian ACS patients.
Methods: Included were ACS patients aged below 90 years enrolled in ACS Israeli Survey. Patients were divided into two groups according to enrolment period: early (2000-2010) and recent (2012-2021). The primary endpoints were 30-day major adverse cardiovascular events and all-cause mortality. Secondary outcomes included in-hospital and 1-year all-cause mortality.
Results: Included were 316 elderly ACS patients. Of them, 184 were enrolled in the early and 132 in recent surveys. Patients enrolled in the recent period were more commonly referred for an invasive strategy and more commonly received guideline-based medical therapy. All-cause mortality at 30 days was significantly lower in the recent group compared with the early group (12.5 and 26.1%, respectively, P = 0.005). Rates of 30-day major adverse cardiovascular events were also significantly lower in the recent group (21.9 and 35.9%, respectively, P = 0.012). Patients in the recent group received more aggressive medical therapy in discharge but at 30-day follow-up, no difference in medical treatment was observed in the two groups. There were no significant differences in 1-year mortality rates.
Conclusions: Treatment of nonagenarians with ACS has improved over the past decade. Treatment improvement was associated with a significant improvement in 30-day outcomes without any effect in 1 year. Nevertheless, even with contemporary treatment, nonagenarians with ACS remain a high-risk group with high mortality rates.
{"title":"Temporal trends in the treatment and outcome of nonagenarians with acute coronary syndrome.","authors":"Ilya Losin, Ela Giladi, Ziad Arow, Ranin Hilu, Tal Ovdat, Abid Assali, David Pereg","doi":"10.1097/MCA.0000000000001427","DOIUrl":"https://doi.org/10.1097/MCA.0000000000001427","url":null,"abstract":"<p><strong>Background: </strong>Nonagenarians are a fast-growing age group among acute coronary syndrome (ACS) patients. While new therapeutic options have improved outcomes of ACS patients, data regarding very elderly ACS patients are limited. We aimed to evaluate temporal trends in the treatment and outcomes of nonagenarian ACS patients.</p><p><strong>Methods: </strong>Included were ACS patients aged below 90 years enrolled in ACS Israeli Survey. Patients were divided into two groups according to enrolment period: early (2000-2010) and recent (2012-2021). The primary endpoints were 30-day major adverse cardiovascular events and all-cause mortality. Secondary outcomes included in-hospital and 1-year all-cause mortality.</p><p><strong>Results: </strong>Included were 316 elderly ACS patients. Of them, 184 were enrolled in the early and 132 in recent surveys. Patients enrolled in the recent period were more commonly referred for an invasive strategy and more commonly received guideline-based medical therapy. All-cause mortality at 30 days was significantly lower in the recent group compared with the early group (12.5 and 26.1%, respectively, P = 0.005). Rates of 30-day major adverse cardiovascular events were also significantly lower in the recent group (21.9 and 35.9%, respectively, P = 0.012). Patients in the recent group received more aggressive medical therapy in discharge but at 30-day follow-up, no difference in medical treatment was observed in the two groups. There were no significant differences in 1-year mortality rates.</p><p><strong>Conclusions: </strong>Treatment of nonagenarians with ACS has improved over the past decade. Treatment improvement was associated with a significant improvement in 30-day outcomes without any effect in 1 year. Nevertheless, even with contemporary treatment, nonagenarians with ACS remain a high-risk group with high mortality rates.</p>","PeriodicalId":10702,"journal":{"name":"Coronary artery disease","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142343088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Unveiling the silent threat of a left ventricular pseudoaneurysm.","authors":"Argyro Kalompatsou, Eirini Beneki, Konstantinos Tsioufis, Constantina Aggeli","doi":"10.1097/MCA.0000000000001422","DOIUrl":"https://doi.org/10.1097/MCA.0000000000001422","url":null,"abstract":"","PeriodicalId":10702,"journal":{"name":"Coronary artery disease","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142281590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-17DOI: 10.1097/MCA.0000000000001421
Minna Järvensivu-Koivunen, Jussi Hernesniemi, Juho Tynkkynen
Background: Smoking is a known risk for sudden cardiac death (SCD) in the general population. However, its significance in patients with acute coronary syndrome (ACS), a condition that also elevates the risk of SCD, is disputable.
Methods: A total of 9704 consecutive ACS patients with available smoking data were included in the analysis. Comprehensive patient data were obtained from the Mass Data in Detection and Prevention of Serious Adverse Events in Cardiovascular Disease research database. A composite endpoint of SCD, SCD aborted by successful resuscitation and accurate implantable cardioverter defibrillator therapy to otherwise potentially fatal ventricular fibrillation/ventricular tachycardia was used. Univariate, age- and sex-adjusted, and a multivariate fine-gray competing risk regression with adjustment to traditional risk factors was conducted.
Results: Median follow-up time was 6.8 years (IQR, 4.1-10.2), and 454 (4.7%) SCD cases were identified. At the baseline, 23.7% (N = 2444) were active smokers, and 20.8% (N = 2146) were ex-smokers. In the multivariate model, active smokers had an elevated risk of 1.79 (95% CI, 1.41-2.27; P < 0.001) for future SCD. Ex-smokers had no elevated risk for SCD in fine-gray subdistribution hazard. Also, active smokers were notably younger (mean age 58.7 years) than non- or ex-smokers (71.1 years and 68.9 years, respectively, P < 0.001 for both comparisons).
Conclusion: Active smokers had a 79% higher risk of SCD when compared with nonsmokers. Smoking cessation should be heavily encouraged after ACS. Also, a person's smoking status should be considered in further studies developing SCD and implantable cardioverter defibrillator-benefit risk scores.
{"title":"Smoking and sudden cardiac death in patients with previous coronary artery disease.","authors":"Minna Järvensivu-Koivunen, Jussi Hernesniemi, Juho Tynkkynen","doi":"10.1097/MCA.0000000000001421","DOIUrl":"https://doi.org/10.1097/MCA.0000000000001421","url":null,"abstract":"<p><strong>Background: </strong>Smoking is a known risk for sudden cardiac death (SCD) in the general population. However, its significance in patients with acute coronary syndrome (ACS), a condition that also elevates the risk of SCD, is disputable.</p><p><strong>Methods: </strong>A total of 9704 consecutive ACS patients with available smoking data were included in the analysis. Comprehensive patient data were obtained from the Mass Data in Detection and Prevention of Serious Adverse Events in Cardiovascular Disease research database. A composite endpoint of SCD, SCD aborted by successful resuscitation and accurate implantable cardioverter defibrillator therapy to otherwise potentially fatal ventricular fibrillation/ventricular tachycardia was used. Univariate, age- and sex-adjusted, and a multivariate fine-gray competing risk regression with adjustment to traditional risk factors was conducted.</p><p><strong>Results: </strong>Median follow-up time was 6.8 years (IQR, 4.1-10.2), and 454 (4.7%) SCD cases were identified. At the baseline, 23.7% (N = 2444) were active smokers, and 20.8% (N = 2146) were ex-smokers. In the multivariate model, active smokers had an elevated risk of 1.79 (95% CI, 1.41-2.27; P < 0.001) for future SCD. Ex-smokers had no elevated risk for SCD in fine-gray subdistribution hazard. Also, active smokers were notably younger (mean age 58.7 years) than non- or ex-smokers (71.1 years and 68.9 years, respectively, P < 0.001 for both comparisons).</p><p><strong>Conclusion: </strong>Active smokers had a 79% higher risk of SCD when compared with nonsmokers. Smoking cessation should be heavily encouraged after ACS. Also, a person's smoking status should be considered in further studies developing SCD and implantable cardioverter defibrillator-benefit risk scores.</p>","PeriodicalId":10702,"journal":{"name":"Coronary artery disease","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142281589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}