Literature Review 7 pages

Author/

Date

Theoretical/

Conceptual

Framework

Research

Question(s)/

Hypotheses

Methodology

Analysis &

Results

Conclusions

Implications for

Future research

Implications

For practice

Brovyk

Rindina

Kravchun

Tabachenko

Yermak

Romanyuk

(2019)

Factors associated with recurrent cardiovascular problems in obese patients that previously had a heart attack

To analyze the incidence of recurrent cardiovascular events in obese patients after myocardial infarction during a 6month followup period, depending on the combination of ticagrelor or clopidogrel with acetylsalicylic acid as part of dual antiplatelet therapy.

75 patients with AMI with ST segment elevation and concomitant obesity divided into 2 subgroups: the first included 31 patients who received the combination of ASA + ticaglelor, and the second 44 patients treated with the combination of ASA + clopidogrel in the DAPT; GRACE scale for risk of hospitalization and 6-month mortality

In the 6-month follow-up period, 28 patients had a recurrent MI and/or unstable angina (UA), which was 37.56 % of all patients

In 37.56 % of patients with acute myocardial infarction with elevation of the ST segment and adjunctive obesity, there was a recurrent coronary event in the form of myocardial infarction or unstable angina in the presence of high GRACE score.

Treatment recommendations for obese patients that have suffered an MI should include the combination of acetylsalicylic and ticagrelor to prevent recurrent events.

Obese patients should be more thoroughly assessed to determine their risk factors for MI and appropriate interventions should immediately begin.

Myftiu

Sulo

Burazeri

Daka

Sharka

Shkoza

Sulo

(2017)

Risk factors in initial and recurrent MI

Potential differences in the clinical profile and in-hospital treatment between patients hospitalized with an incident and recurrent AMI

324 patients admitted in the Coronary Care Unit of ‘Mother Teresa’ hospital, Tirana, Albania from 2013 to 2014; logistic regression analyses conducted to measure differences between initial and recurrent acute MI

50 (15.4%) had a prior AMI,

recurrent cases were older (P=0.01), more often women (P=0.01), less educated (P=0.01), and smoked less (P=0.03), Recurrent cases experienced more

often heart failure (HF) (OR=2.48; 95% CI: 1.31–4.70), impaired left ventricular ejection fraction (OR=1.97; 95% CI:

1.05–3.71), and multivessel disease (OR=6.32; 95% CI: 1.43–28.03) than incident cases

More severe clinical expression of the disease and underutilization of treatment among recurrent AMIs led to poorer prognosis

Immediate need for a shift in the focus of attention toward preventive measures

Patients with associated risk factors need more in depth treatment planning to encourage significant lifestyle changes

Karjalainen

Nimela

Laine

Airaksinen

Ylitalo

Nammas

(2016)

Stent underexpansion after stent implementation following an MI

Comparison of post-coronary dilation in recurrent MI prevention to those that did not have post-coronary dilation

Post hoc analysis of the BASE ACS trial which randomized 827 patients (1:1) with ACS to

receive either titanium-nitride-oxideecoated bioactive stents or everolimus-eluting stents.

Of 827

patients enrolled in the BASE ACS trial, 357 (43.2%) underwent PD. Median follow-up

duration was 5 years. Patients who underwent PD had less frequent nonfatal MI events

at long-term follow-up, compared with those who did not (4.5% vs 8.5%, respectively, p [

0.02). The rates of MACE (15.7% vs 15.1%, respectively, p [ 0.81),

Patients treated with early percutaneous

coronary intervention for ACS who underwent PD had less frequent nonfatal MI events at

long-term follow-up, compared with those who did not; MACE rates were not significantly

different.

More studies should observe the effects of PD stents to prevent recurrent MI

Patients with a stent should be assessed to determine whether post-coronary dilation occured

Kanuri

Ipe

Kassab

Gao

Liu

Skaar

Kreutz

(2018)

Alterations of the physiological functioning of the cardiovascular system due to variations in micro-RNA

Circulating miRNA have the potential to become reliable

biomarkers for risk stratification and early detection of cardiovascular events.

Whole blood samples were collected from 437 subjects undergoing

cardiac catheterization, who were followed for recurrent cardiovascular events during a mean follow up of 1.5

years

A differential pattern of miRNA expression was found among controls, CAD patients with no events, and

CAD patients with recurrent events. MiRNA previously associated with MI, CAD, endothelial function, vascular

smooth muscle cells, platelets, angiogenesis, heart failure, cardiac hypertrophy, arrhythmia, and stroke were

found variably expressed in our case-control cohorts. Seventy miRNA (FDR<0.05) were linked to the risk of

recurrent myocardial infarction and future stent thrombosis, as compared to CAD patients with subsequently

uneventful follow up.

MiRNA next generation sequencing demonstrates altered fingerprint profile of whole blood miRNA

expression among subjects with subsequent recurrent thrombotic events on standard medical therapy as compared to subjects with no recurrent cardiovascular events.

Investigating the specific risk factors in MiRNA sequences may be useful

Knowing a patient is at higher risk due to MiRNA variations could assist with treatment planning

Osmak

Titov

Matveeva

Bashinskaya

Shakhnovich

Sukhinina

Kukava

Ruda

Favorova

(2018)

Adverse cardiovascular events and increased mortality following an MI

Retrospective study to evaluate the contribution of allelic variations in 9p21.3 locus and

in 21 atherogenesis-related genes to the development of hard cardiac events in a cohort of patients of Russian

ethnicity after the first acute MI during long-term follow-up

133 unrelated patients (104 men and 29 women, the mean age of

the first MI 53.7 ± 9.3 years) with the first MI as the index event were

enrolled in 2013 to the retrospective study based on long-term followup.

Linkage analysis of the investigated polymorphic loci with Haploview 4.2 software showed complete linkage

disequilibrium (LD) between rs10757278 and rs1333049 in the 9p21.3

region (D'=1, LOD > 2).

Kaplan-Meier curves that show frequencies of unfavorable outcomes

at different times for carriers of alleles/genotypes of 9p21.3

(rs1333049, rs10757278) and MTHFR (rs1801133)

Some of the atherogenesis-related

and MI-associated loci could influence long-term postinfarction

prognosis of hard cardiac events in patients who underwent the first MI,

namely, 9p21.3 rs1333049*GG and MTHFR rs1801133*TT are risk

genotypes for unfavorable outcomes.

Analysis of 9p21.3 rs1333049 polymorphism

could be used to improve the GRACE scale in ethnic Russians

Persons with Russian ethnicity could benefit from a genetic analysis prior to an MI

Radovanovic

Maurer

Bertel

Witassek

Urban

Stauffer

Pedrazzini

Erne

(2016)

Therapy and outcome differences in patients with initial and recurrent MI

This study aimed to evaluate the impact of prior MI on therapies and outcomes in patients who presented with ST-elevation MI (STEMI).

All STEMI patients enrolled from 2002 to 2014 in the AMIS Plus registry were included. Outcome was analyzed using logistic multivariate regression.

From 19,665 STEMI patients, 2845 (14%) had reMI. These patients were older (69.5y vs. 64.2y; p < 0.001), more frequently male, with more risk factors (hypertension, dyslipidemia), and more comorbidities. Patients with reMI presented 25 min earlier than those with first MI, were more frequently in Killip class 3/4 (12% vs. 7%; p < 0.001), and were less likely to receive guideline- recommended drug therapy: aspirin (93% vs. 97%; p < 0.001), P2Y12 inhibitors (76% vs. 83%; p < 0.001), or statins (73% vs. 77%; p < 0.001), or undergo primary percutaneous coronary intervention (77% vs. 87%; p < 0.001). A subgroup (n = 4486) was followed 1 year after discharge (3893 with first MI and 593 with reMI at initial hospitalization). Crude mortality was 2.9% for patients with first MI vs. 6.7% for those with reMI (OR 1.68, 95% CI 1.14–2.47; p = 0.008).

Patients with recurrent MI were less likely to receive evidence-based treatment and had worse in-hospital and 1-year outcomes compared to patients with first MI.

Patients with recurrent MI seek help for their discomfort faster although they have less typical symptoms and according to their biomarker levels they also experience a smaller recurrent MI.

Short- and long-term management of patients with recurring MI should be improved.

Dias

Maier

Junior

Moser

Santos

Oliveira

(2019)

Possible factors associated with risk for recurrent MI

Aim to investigate possible factors for the

recurrence of acute myocardial infarction of a patient attended

in the coronary care unit in the perspective of relatives.

Descriptive, qualitative, case study where data collected using pilot interviews

The

relative reported that the intense physical activity performed

by the patient, the excessive consumption of alcohol and nonadherence

to drug therapy, have contributed to the second event

of AMI. The same mentioned that the guidance received during

the high, were only around for medicines prescribed, highlighting

the absence of guidance about the changes in life style and the

realization of the same by health care professionals, in particular

nursing staff.

The

guidelines during the high are not being effective in the prevention

of the recurrence of AMI, and highlights the need to rethink the

role of professional nursing in relation to the guidelines provided,

as a way of facilitating the patient’s adherence to medication

treatment and changes in lifestyle.

Implementations of specific and permanent educational programs

for this line of care are needed that highlight nursing actions in the production

of cardiovascular prevention and rehabilitation (CVR) measures,

ensuring physical, mental and social conditions, focusing

on the severity of the disease. disease and changes in lifestyle.

Healthcare facilities need specific treatment plans established for patients with a previous MI

Wang

Leifheit

Normand

Krumholz

(2020)

Risks for recurrent MI in the year following the initial

Do rehospitalizations after AMI further increase risk of recurrent AMI?

The study included Medicare fee-for-

service

patients aged ≥65 years discharged alive after AMI from

acute-care

hospitals in fiscal years 2009–2014. The outcome was recurrent AMI within 1 year of the index AMI. The Clinical

Classifications Software (CCS) was used to classify rehospitalizations into disease categories. A Cox regression model was

fit accounting for CCS-specific

hospitalizations as time-varying

variables and patient characteristics at discharge for the index

AMI, adjusting for the competing risk of death.

The rate of 1-year

recurrent AMI was 5.3% (95% CI, 5.27%–5.41%), and median

(interquartile range) time from discharge to recurrent AMI was 115 (34–230) days. Eleven disease categories (diabetes mellitus,

anemia, hypertension, coronary atherosclerosis, chest pain, heart failure, pneumonia, chronic obstructive pulmonary disease,

gastrointestinal hemorrhage, renal failure, complication of implant or graft) were associated with increased risk of recurrent

AMI. Septicemia was associated with lower recurrence risk. Hazard ratios ranged from 1.6 (95% CI, 1.55–1.70, heart failure)

to 1.1 (95% CI, 1.04–1.25, pneumonia) to 0.6 (95% CI, 0.58–0.71, septicemia).

Patient risk of recurrent AMI changed based on the occurrence of hospitalizations after the index AMI.

Risk-stratification after an acute myocardial

infarction is necessary to inform the choice of

clinical strategies.

Improving

post–acute care to prevent unplanned rehospitalizations, especially rehospitalizations for chronic diseases, and extending the

focus of outcomes measures to condition-specific

rehospitalizations within 30 days and beyond is important for the secondary

prevention of AMI.

Korenevskiy

Seregin

Ivanov

Kolesnik

Siplivy

Makkonen

Dmitrieva

Kicha

Zuarev

(2018)

Electrical characteristics of biologically active points (BAP) in the

meridian of the heart

Discussion of the employment of the electrical characteristics of biologically active points (BAP) in the

meridian of the heart to solve the task of prognosticating recurrence of myocardial infarctions during the reha_

bilitation period using fuzzy decision rules.

A total of 40 patients with MI were observed.

Observations of changes in patients’ status were made

over the period of a year. The study groups included peo_

ple with increases in the energy characteristics of the

major points of the heart meridian.

Employment of only the electrical characteristics of informative BAP

was found to provide a reliability level of greater than 0.85 in decision_making, with a significant uncertainty

zone. If additional features characterizing long_term psychoemotional tension − lipid peroxidation and antioxi_

dant activity − are included, the reliability of prognoses of recurrence of myocardial infarction during remission

reaches 0.95.

Results from mathematical modeling and statistical

calculations for representative control cohorts showed

that use of all four components gave a level of confidence

in the correct prognosis of the occurrence of myocardial

infarction during remission of 0.95.

Electrical characteristics of recurrent MI’s should be investigated for correlations.

Having accurate electrical information can assist with treatment planning.

Bohn

Schofl

Zimmer

Hummel

Heise

Siegel

Karges

Riedl

Holl

(2016)

Guideline adherence

Myocardial infarction

Secondary prevention

Stroke

Type 2 diabetes

To analyze whether medical care is in accordance

with guidelines for secondary prevention of myocardial infarction

(MI), or stroke in patients with type 2 diabetes from Germany and

Austria.

29,325 patients (≥20 years of age) with type 2

diabetes and MI, or stroke, documented between 2006 and 2015

were selected from the Diabetes-Patienten-Verlaufsdokumentation

database.

HbA1C

<7.5 % was achieved in 64.9 % (MI), and in 61.1 % (stroke) of patients. LDL <100 mg/dl was documented in 56.2 % (MI), and in

42.2 % (stroke). Non-smoking was reported in 92.0 % (MI), and in

93.1 % (stroke), physical activity in 9.6 % (MI), and 5.5 % (stroke).

Target values of blood pressure (<130/80 mmHg in MI, 120/70-

140/90 in stroke) were reached in 67.0 % (MI), and in 89.9 %

(stroke). Prescription prevalence of inhibitors of platelet aggregation

(IPA) was 50.7 % (MI), and 31.7 % (stroke). 57.0 % (MI), and 40.1

% (stroke) used statins, 65.1 % (MI), and 65.8 % (stroke) used any

type of antihypertensives, and ACE inhibitors were prescribed in

49.7 % (MI), and 41.3 % (stroke). A body mass index (BMI) <27

kg/mÇ and the use of beta blockers were only recommended in

subjects with MI. Of the patients with MI, 32.0 % had a BMI <27

kg/mÇ, and 59.5 % used beta blockers.

Achievement

of treatment goals in secondary prevention of MI, or stroke in

subjects with type 2 diabetes needs improvement. Target goals

were met more frequently in patients with MI compared to subjects

with stroke.

Additional research into appropriate reduction of risk factors to prevent MI are needed.

There remains great potential to reduce the risk of repeated

macrovascular events and premature death, as well as to increase

patients' quality of life.