Lower Rates Of Heart Failure Research Articles

Lower Rates of Heart Failure and Death in Acute Coronary Syndromes

for patients with acute coronary syndromes (ACS), with reduction in mortality and morbidity associated with these treatments. The study reinforces the need to further improve adherence to evidence-based guidelines and demonstrates the clinical benefit that can be achieved with such a strategy. However, Fox et al did not assess the temporal pattern in outcomes in patients with diabetes. In a study examining the changing patterns in outcome after acute myocardial infarction (AMI) in multiple hospitals in the United Kingdom, we analyzed data from more than 3000 unselected patients sustaining an AMI in either 1995 or 2003 and assessed changes in care and all-cause mortality at 30 days and 18 months. 2 Our data support those of Fox et al showing improved quality of care for all patients with AMI. However, patients with diabetes did not demonstrate the improvement in survival seen in patients without diabetes. Between 1995 and 2003, 18-month mortality in nondiabetic patients fell from 30.1% to 25.7%, an approximately 15% relative reduction (P=.008). However, 18-month mortality in patients with diabetes was not significantly changed over this period (38% in 1995 vs 36.4% in 2003; P=.71). The reasons for our findings are unclear, although current treatment strategies may fail to address specific aspects of vascular pathophysiology in patients with diabetes. For example, insulin resistance, oxidative stress, and inflammation may be inadequately addressed by current treatments. 3 Moreover, cardiologists may not fully adhere to recognized guidelines regarding the optimal management of diabetes. 4 The global population of patients with type 2 diabetes is projected to reach 366 million by 2030. 5 With the increasing prevalence of diabetes, the results of the efforts to improve outcome post ACS may be abrogated or even reversed. To avoid this, research into the prevention and management of cardiovascular diseases in diabetes must be

Lower Rates of Heart Failure and Death in Acute Coronary Syndromes

Lower Rates of Heart Failure and Death in Acute Coronary Syndromes

Impact of ramipril versus other angiotensin-converting enzyme inhibitors on outcome of unselected patients with ST-elevation acute myocardial infarction

We examined the impact of treatment with ramipril versus other angiotensin-converting enzyme (ACE) inhibitors on clinical outcome in unselected patients of the prospective multicenter registry Maximal Individual Therapy of Acute Myocardial Infarction PLUS registry (MITRA PLUS). Of 14,608 consecutive patients with ST-elevation acute myocardial infarction, 4.7% received acute therapy with ramipril, 39.0% received other ACE inhibitor therapy, and 56.3% received no ACE inhibitor therapy. In a multivariate analysis, the treatment with ramipril compared with the treatment without ACE inhibitors was associated with a significantly lower hospital mortality and a lower rate of nonfatal major adverse coronary and cerebrovascular events. Compared with other generic ACE inhibitors, ramipril therapy was independently associated with a significantly lower hospital mortality (odds ratio [OR] 0.54, 95% confidence interval [CI] 0.32 to 0.90) and a lower rate of nonfatal major adverse coronary and cerebrovascular events (OR 0.65, 95% CI 0.46 to 0.93), but not with a lower rate of heart failure at discharge (OR 0.79, 95% CI 0.50 to 1.27).

Prognosis of patients with a recurrent acute myocardial infarction before and in the reperfusion era—A national study

Background Patients with recurrent acute myocardial infarction (AMI) are at increased risk for morbidity and mortality. We compared the outcome of patients with recurrent AMI hospitalized in coronary care units in the prereperfusion and reperfusion eras. Methods The study population comprised 2 large-scale cohorts with recurrent AMI: (1) 1415 (24%) of 5839 consecutive patients with AMI hospitalized in 1981 to 1983 (Secondary Prevention Reinfarction Israeli Nifedipine Trial [SPRINT] Registry) and (2) 1093 (25%) of 4317 patients with AMI from three national surveys performed in 1992 to 1996. Results Patients in the 1990s had significantly lower rates of heart failure and cardiogenic shock. The 7-day mortality declined from 18% in 1981-1983 to 10% in 1992-1996 (adjusted odds ratio [OR] 0.57 [0.44-0.75]), the 30-day mortality rate from 26% to 16% (OR 0.56 [0.44-0.71]), and the 1-year mortality rate from 39% to 26% (adjusted hazard ratio [HR] 0.64 [0.54-0.75]), respectively. In the 1992-1996 cohort, the adjusted risk of 7-day, 30-day, and 1-year mortality for patients with recurrent AMI treated with thrombolysis in comparison to patients without thrombolysis was OR 1.69 (1.07-2.65), 1.51 (1.03-2.23), and HR 1.18 (0.90-1.55), respectively. The mortality rate among patients treated with early percutaneous transluminal coronary angioplasty/coronary artery bypass grafting was 3% versus 12% at 7 days (OR 0.36 [0.16-0.73]), 7% versus 18% at 30 days (OR 0.45 [0.25-0.77]), and 16% versus 29% at 1 year (HR 0.64 [0.46-0.96]), in comparison to patients without revascularization. Conclusion The prognosis of patients with recurrent AMI improved significantly during the reperfusion era. Although thrombolysis may have a limited therapeutic effect among patients with recurrent AMI, an interventional approach seems more appropriate when indicated. A randomized trial of thrombolysis versus early revascularization is needed in patients with recurrent AMI. (Am Heart J 2001;141:478-84.)