Temporal trends in in-hospital complications of acute coronary syndromes: Insights from the nationwide AMIS Plus registry.
Acute coronary syndrome
Complication
Percutaneous coronary intervention
Journal
International journal of cardiology
ISSN: 1874-1754
Titre abrégé: Int J Cardiol
Pays: Netherlands
ID NLM: 8200291
Informations de publication
Date de publication:
15 08 2020
15 08 2020
Historique:
received:
08
12
2019
revised:
29
03
2020
accepted:
01
04
2020
pubmed:
20
4
2020
medline:
15
5
2021
entrez:
20
4
2020
Statut:
ppublish
Résumé
Acute coronary syndrome (ACS)-related morbidity and mortality remain substantial. Data on temporal trends in in-hospital complications of ACS patients are scarce. This study sought to investigate whether the incidence of in-hospital complications of ACS patients changed over time. Acute coronary syndrome patients prospectively enrolled in the National Registry of Acute Myocardial Infarction in Switzerland (AMIS Plus) between 2003 and 2018 and with available data on in-hospital complications were included in the analysis. Rates of in-hospital complications, including recurrent angina, recurrent myocardial infarction, cerebrovascular events, cardiogenic shock, bleeding, acute renal failure, sepsis/systemic inflammatory response syndrome (SIRS)/multiorgan dysfunction syndrome (MODS), AV block needing pacing and new-onset atrial fibrillation, were assessed for each 2-year period. Among 47,845 ACS patients, in-hospital complications significantly decreased from 22.0% in 2003/2004 to 18.9% in 2017/2018 (p for trend <0.001). An initial decline in rates of in-hospital complications to 15.7% in 2009/2010 (p for trend <0.001) was followed by a constant increase thereafter (p for trend = 0.002). While rates of recurrent angina, recurrent myocardial infarction, and cardiogenic shock decreased over time, rates of bleeding events, acute renal failure, sepsis/SIRS/MODS, and new-onset atrial fibrillation increased. Rates of in-hospital complications were higher in women, mainly due to a constantly increased risk of bleeding and AV block needing pacing. The decrease in ischemic complications was paralleled by a concomitant increase in non-ischemic events. These findings emphasize that advanced strategies targeting non-ischemic complications are warranted to further improve quality of care of ACS patients.
Sections du résumé
BACKGROUND
Acute coronary syndrome (ACS)-related morbidity and mortality remain substantial. Data on temporal trends in in-hospital complications of ACS patients are scarce. This study sought to investigate whether the incidence of in-hospital complications of ACS patients changed over time.
METHODS
Acute coronary syndrome patients prospectively enrolled in the National Registry of Acute Myocardial Infarction in Switzerland (AMIS Plus) between 2003 and 2018 and with available data on in-hospital complications were included in the analysis. Rates of in-hospital complications, including recurrent angina, recurrent myocardial infarction, cerebrovascular events, cardiogenic shock, bleeding, acute renal failure, sepsis/systemic inflammatory response syndrome (SIRS)/multiorgan dysfunction syndrome (MODS), AV block needing pacing and new-onset atrial fibrillation, were assessed for each 2-year period.
RESULTS
Among 47,845 ACS patients, in-hospital complications significantly decreased from 22.0% in 2003/2004 to 18.9% in 2017/2018 (p for trend <0.001). An initial decline in rates of in-hospital complications to 15.7% in 2009/2010 (p for trend <0.001) was followed by a constant increase thereafter (p for trend = 0.002). While rates of recurrent angina, recurrent myocardial infarction, and cardiogenic shock decreased over time, rates of bleeding events, acute renal failure, sepsis/SIRS/MODS, and new-onset atrial fibrillation increased. Rates of in-hospital complications were higher in women, mainly due to a constantly increased risk of bleeding and AV block needing pacing.
CONCLUSIONS
The decrease in ischemic complications was paralleled by a concomitant increase in non-ischemic events. These findings emphasize that advanced strategies targeting non-ischemic complications are warranted to further improve quality of care of ACS patients.
Identifiants
pubmed: 32305559
pii: S0167-5273(19)36050-4
doi: 10.1016/j.ijcard.2020.04.003
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
16-24Informations de copyright
Copyright © 2020 Elsevier B.V. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of competing interest The AMIS Plus registry is funded by unrestricted grants from the Swiss Heart Foundation and from Abbott Medical AG, Amgen AG, AstraZeneca AG, Bayer AG, Biotronik (all Switzerland) AG, Boston Scientific AG, B. Braun Medical AG, Cordis-Cardinal Health GmbH, Daiichi Sankyo (Switzerland) AG, Medtronic (Switzerland) AG, Novartis Pharma Switzerland AG, Sanofi-Aventis (Switzerland) SA, Servier (Switzerland) SA, SIS Medical Distribution AG, Terumo Germany GmbH, Vascular Medical GmbH, Swiss Working Group for Interventional Cardiology. The sponsors did not play any role in the design, data collection, analysis, or interpretation of the registry.