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Opis: Background: Air pollution with increased concentrations of fine (< 2.5 μm) particulate matter (PM2.5) increases the risk of cardiovascular morbidity and mortality. Even short-term increase of PM2.5 may help trigger ST-elevation myocardial infarction (STEMI) and heart failure (HF) in susceptible individuals, even in areas with good air quality. Purpose: To evaluate the role of PM2.5 levels ≥ 20 μg/m3 in admission acute HF in STEMI patients. Materials and Methods: In 290 STEMI patients with the leading reperfusion strategy primary percutaneous coronary intervention (PPCI), we retrospectively studied independent predictors of admission acute HF and included admission demographic and clinical data as well as ambient PM2.5 levels ≥ 20 μg/m3. We defined admission acute HF in STEMI patients as classes II–IV by Killip Kimball classification. Results: Acute admission HF was observed in 34.5% of STEMI patients. PPCI was performed in 87.1% of acute admission HF patients and in 94.7% non-HF patients (p= 0.037). Significant independent predictors of acute admission HF were prior diabetes (OR 2.440, 95% CI 1.100 to 5.400, p=0.028), admission LBBB (OR 10.190, 95% CI 1.160 to 89.360, p=0.036), prior resuscitation (OR 2.530, 95% CI 1.010 to 6.340, p=0.048), admission troponin I≥ 5μg/l (OR 3.390, 95% CI 1.740 to 6.620, p< 0.001), admission eGFR levels (0.61, 95% CI 0.52 to 0.72, p < 0.001), and levels of PM2.5 ≥ 20 μg/m3 (OR 2.140, 95% CI 1.005 to 4.560, p=0.049) one day before admission. Conclusion: Temporary short-term increase in PM2.5 levels (≥ 20 μg/m3) one day prior to admission in an area with mainly good air quality was among significant independent predictors of acute admission HF in STEMI patients.
Ključne besede: admission acute heart failure, ST-elevation myocardial infarction, air pollution, PM2.5
Objavljeno v DKUM: 14.10.2024; Ogledov: 0; Prenosov: 1
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Opis: Purpose: There are well-known gender differences in mortality of patients with ST-elevation myocardial infarction (STEMI). Our purpose was to assess factors of hospital mortality separately for men and women with STEMI, which are less well known. Patients and Methods: In 2018– 2019, 485 men and 214 women with STEMI underwent treatment with primary percutaneous coronary intervention (PCI). We retrospectively compared baseline characteristics, treatments and hospital complications between men and women, as well as between nonsurviving and surviving men and women with STEMI. Results: Primary PCI was performed in 94% of men and 91.1% of women with STEMI, respectively. The in-hospital mortality was significantly higher in women than in men (14% vs 8%, p=0.019). Hospital mortality in both genders was associated significantly to older age, heart failure, prior resuscitation, acute kidney injury, to less likely performed and less successful primary PCI and additionally in men to hospital infection and in women to bleeding. In men and women ≥ 65 years, mortality was similar (13.3% vs 17.8%, p = 0.293). Conclusion: Factors of hospital mortality were similar in men and women with STEMI, except bleeding was more likely observed in nonsurviving women and infection in nonsurviving men.
Ključne besede: ST-elevation myocardial infarction, female sex, male sex, sex differences, hospital mortality, 30-day survival, 6-month survival
Objavljeno v DKUM: 12.07.2024; Ogledov: 124; Prenosov: 14
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Opis: Lipoprotein(a) (Lp(a)) is a well-recognised risk factor for ischemic heart disease (IHD) and calcific aortic valve stenosis (AVS). Methods: A retrospective observational study of Lp(a) levels (mg/dL) in patients hospitalised for cardiovascular diseases (CVD) in our clinical routine was performed. The Lp(a)-associated risk of hospitalisation for IHD, AVS, and concomitant IHD/AVS versus other non-ischemic CVDs (oCVD group) was assessed by means of logistic regression. Results: In total of 11,767 adult patients, the association with Lp(a) was strongest in the IHD/AVS group (eβ = 1.010, p < 0.001), followed by the IHD (eβ = 1.008, p < 0.001) and AVS group (eβ = 1.004, p < 0.001). With increasing Lp(a) levels, the risk of IHD hospitalisation was higher compared with oCVD in women across all ages and in men aged ≤75 years. The risk of AVS hospitalisation was higher only in women aged ≤75 years (eβ = 1.010 in age < 60 years, eβ = 1.005 in age 60–75 years, p < 0.05). Conclusions: The Lp(a)-associated risk was highest for concomitant IHD/AVS hospitalisations. The differential impact of sex and age was most pronounced in the AVS group with an increased risk only in women aged ≤75 years.
Ključne besede: acute myocardial infarction, aortic valve stenosis, atherosclerosis, cardiovascular diseases, cardiovascular risk, ischemic heart disease, lipoprotein(a), postmenopausal women
Objavljeno v DKUM: 12.06.2024; Ogledov: 137; Prenosov: 7
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Opis: Background: Hypertension has become a very frequent chronic disease worldwide and Slovenia is no exception. It is defined as a serious risk factor for developing different cardiovascular diseases. Several important studies proved that cardiovascular diseases are the main reason of deaths in more than 50 % of cases in the developed countries. All mentioned facts are indicating that treatment costs in patients with hypertension and cardiovascular diseases represent an important economic burden, which cannot be neglected. It may also be expected that in the next few decades the situation will become even worse. The reasons are the expected earlier disease development due to unhealthy life style and the fact that people live longer and populations are growing older. The mentioned facts have motivated the study, which would enable the estimation of patients’ number in the observed population and the evaluation of economic burden when using beta blockers, drugs which have become an important choice in antihypertensive treatment and are also used in patients with different cardiovascular complications. The projections indicating the expected trends of mentioned problems in the forthcoming decades would also be of interest. Methods: To answer some of the indicated questions, a simulation model was developed, which enabled the prediction of patients with hypertension and the influence of this disease to the development of myocardial infarction. Modeling was performed using the available statistical data and published studies. Main attention was devoted to the circumstances in Slovenia, but the results were also verified using the available data for some other countries. Combination of simulation results with demographic data enabled the estimation of the number of patients observed. In addition, expenses for the observed groups of patients were evaluated and, based on that, the economic burden was estimated. The mentioned expenses include hospitalizations, drugs required and the estimated mortality-related expenses. The developed model was accomplished with dynamical mathematical structure predicting the development of population number in Slovenia in the forthcoming decades, taking into account that the demographic properties remain unchanged. Also the observation of potential scenario regarding patients’ number and thus expected economic burden distribution among younger and older population is made possible. Results: In the paper simulation results are presented which enable the estimation of patients with hypertension and their connection with those who have experienced myocardial infarction. It is possible to observe the prevalence and the number of patients in Slovenia by age. In addition, economic burden associated with the observed groups of patients is calculated taking into account needed drugs, hospitalizations and patient mortality. In such circumstances it is possible to expect that in the group of one million people approximately 264,000 are patients with hypertension for whom, when healed optimally with beta blockers, over EUR 13 million is needed per year. In the same group of one million people are also patients with myocardial infarction. Among them 11 % experienced infarction within the current year. This amounts to more than 22,000 such patients and over EUR 22 million needed for them each year. In the case of unchanged statistical demographic characteristics in the future, it can be expected that in 50 years relative economic burden for active population would become twice as high as it is now. Conclusions: For optimal treatment, hospitalization and due to mortality more than EUR 35 million per year would be needed for patients with hypertension (around 260,000 patients) and for those who have experienced myocardial infarction (around 22,000) if observing the population of one million people. As the population is growing older, it can be expected that the relative economic burden will become significantly greater for active population in the forthcoming decades.
Ključne besede: hypertension, myocardial infarction, beta blockers, economic burden, modelling, simulation
Objavljeno v DKUM: 28.03.2017; Ogledov: 1100; Prenosov: 63
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