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      In-Hospital Mortality and Time from Onset of Symptoms of Acute Myocardial Infarction in 540 Patients Undergoing Primary Coronary Angioplasty


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          The time from the onset of symptoms of acute myocardial infarction to primary coronary angioplasty was 18 ± 23 h in 386 men and 19 ± 24 h in 154 women (p not significant) and 14 ± 19 h in 27 blacks, 19 ± 23 h in 493 whites, and 13 ± 11 h in 20 patients of different races (p not significant). In-hospital mortality was 6% in 144 patients aged ≧70 years and 1% in 396 patients <70 years (p < 0.005). In-hospital mortality was 2% in 386 men and 4% in 154 women (p not significant). In-hospital mortality was 2% in 493 whites, 4% in 27 blacks, and 0% in 20 patients of other races (p not significant). In-hospital mortality was 6% in 143 patients with a left ventricular ejection fraction (LVEF) <40% and 1% in 397 patients with a LVEF ≧40% (p < 0.005). In-hospital mortality was 5% in 223 patients with a glomerular filtration rate (GFR) <90 ml/min and 1% in 317 patients with a GFR ≧90 ml/min (p < 0.005).

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          Prediction of Creatinine Clearance from Serum Creatinine

          A formula has been developed to predict creatinine clearance (C cr ) from serum creatinine (S cr ) in adult males: Ccr = (140 – age) (wt kg)/72 × S cr (mg/100ml) (15% less in females). Derivation included the relationship found between age and 24-hour creatinine excretion/kg in 249 patients aged 18–92. Values for C cr were predicted by this formula and four other methods and the results compared with the means of two 24-hour C cr’s measured in 236 patients. The above formula gave a correlation coefficient between predicted and mean measured Ccr·s of 0.83; on average, the difference between predicted and mean measured values was no greater than that between paired clearances. Factors for age and body weight must be included for reasonable prediction.
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            Hospital-level racial disparities in acute myocardial infarction treatment and outcomes.

            Previous studies have documented racial disparities in treatment of acute myocardial infarction (AMI) among Medicare beneficiaries. However, the extent to which unobserved differences between hospitals explains some of these differences is unknown. The objective of this study was to determine whether the observed racial treatment disparities for AMI narrow when analyses account for differences in where blacks and whites are hospitalized. Retrospective observational cohort study using Medicare claims and medical record review. This study included 130,709 white and 8286 black Medicare patients treated in 4690 hospitals in 50 US states for confirmed AMI in 1994 and 1995. Measures in this study were receipt of reperfusion, aspirin, and smoking cessation counseling during hospitalization; prescription of aspirin, angiotensin-converting enzyme inhibitor, and beta-blocker at hospital discharge; receipt of cardiac catheterization, percutaneous coronary intervention (PCI), or bypass surgery (CABG) within 30 days of AMI; and 30-day and 1-year mortality. Within-hospital analyses narrowed or erased black-white disparities for medical treatments received during the acute hospitalization, widened black-white disparities for follow-up surgical treatments, and augmented the survival advantage among blacks. These findings indicate that, on average, blacks went to hospitals that had lower rates of evidence-based medical treatments, higher rates of cardiac procedures, and worse risk-adjusted mortality after AMI. Incorporating the hospital effect altered the findings of racial disparity analyses in AMI and explained more of the disparities than race. A policy of targeted hospital-level interventions may be required for success of national efforts to reduce disparities.
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              Impact of renal insufficiency in patients undergoing primary angioplasty for acute myocardial infarction.

              The prognostic importance of renal insufficiency (RI) in patients undergoing primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) has not been well characterized. PCI was performed in 2082 AMI patients without shock presenting within 12 hours of symptom onset in a prospective, multicenter randomized trial. RI was defined as a calculated (Cockroft-Gault) creatinine clearance (CrCl) or =70%; 20.6% versus 11.8%, P=0.024) and infarct artery reocclusion (14.7% versus 7.3%, P=0.02). Baseline RI in patients with AMI undergoing primary PCI is associated with a markedly increased risk of mortality, as well as bleeding and restenosis. Novel approaches are needed to improve the otherwise poor prognosis of patients with RI and AMI.

                Author and article information

                S. Karger AG
                February 2007
                18 July 2006
                : 107
                : 2
                : 107-110
                Department of Medicine, Cardiology Division, Westchester Medical Center/New York Medical College, Valhalla, N.Y., USA
                94587 Cardiology 2007;107:107–110
                © 2007 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                : 09 November 2005
                : 05 February 2006
                Page count
                Tables: 3, References: 15, Pages: 4
                Original Research

                General medicine,Neurology,Cardiovascular Medicine,Internal medicine,Nephrology
                Left ventricular ejection fraction,Primary coronary angioplasty,Glomerular filtration rate,Acute myocardial infarction


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