Acute Acute Myocardial Infarction Research Articles

Analysis of barriers associated with emergency medical service activation in patients with acute stroke and acute myocardial infarction from Zhongjiang County of Sichuan Province in China

ObjectivesThe purpose of this study was to investigate the preferred modes of transportation to the hospital among patients with acute stroke and acute myocardial infarction (AMI), as well as to identify the factors that influence the utilization of ambulances.MethodsWe conducted a cross-sectional study, including patients who were diagnosed with acute stroke and AMI, at the people’s hospital of Zhongjiang, from September 30th, 2022 to August 30th, 2023. All patients were divided into emergency medical service (EMS)-activation group and self-transportation group. Chi-square and t-tests were utilized to discern differences between groups at baseline. To screen relevant variables, we employed the Least Absolute Shrinkage and Selection Operator (LASSO) regression analysis using R package glmnet. Subsequently, we performed a logistic regression analysis to identify predictors of EMS activation according the results of LASSO regression.Resultswe collected 929 valid questionnaires. 26.16% of the patients required the services of EMS. 90.9% of individuals have not received any formal first aid education. 42.1% of them reported that they had no understanding of cardiovascular and cerebrovascular diseases. Diagnosed as AMI (OR 0.22, 95%CI 0.06 to 0.88) or acute cerebral infarction (OR 0.26, 0.10 to 0.68), the distance between the patient and the nearest 120 network hospital when the patient had these symptoms (OR 0.97, 0.94 to 0.99), the patient’s son or daughter was there when the patient was symptomatic (OR 0.58, 0.37 to 0.94), the patient (OR 0.19, 0.05 to 0.72) and the patient’s partner (wife or husband) (OR 0.36, 0.16 to 0.85) had decided that the patient needed further medical help, Among patients who did not seek immediate help after symptom onset, thinking that the symptoms will disappear spontaneously (OR 0.34, 0.13 to 0.92) or not wanting to disturb others (OR 0.06, 0.01 to 0.66) or believing that they are not important symptoms (OR 0.15, 0.05 to 0.42) were factors independently associated with less ambulance use. Age (OR 1.02, 1.00 to 1.04), Stroke patients have experienced symptoms of disturbance of consciousness or convulsions (OR 2.99, 1.72 to 5.2) were independent factors associated with increased ambulance use.ConclusionThere is still ambulance underutilization among patients with acute stroke and AMI in county territory of China. Moreover, it is needed to raise the level of first aid education and awareness about EMS. Additionally, private clinic doctors and the public should gain adequate understanding of the severity of acute stroke and AMI, as well as their common symptoms, the crucial importance of prompt medical intervention. Finally, we propose that all township hospitals should be integrated into the 120 emergency networks and equipped with emergency first aid capabilities, pre-hospital care, and transportation abilities.

Muscle quality and major adverse cardiovascular events in post-acute myocardial infarction: A prospective cohort study

Background & aimsFunctional muscle quality, as assessed through the muscle quality index (MQI), represents a contemporary method to measure the capacity to generate force. Despite its potential, the prognostic significance of MQI remains uncertain in various clinical conditions, particularly among patients following acute myocardial infarction (AMI). In light of this, our study sought to evaluate the prognostic relevance of MQI concerning major adverse cardiovascular events (MACE) in patients following AMI. Methods and resultsThis is a secondary analysis of a prospective cohort study that included subjects aged ≥20 years from a Cardiovascular Unit Hospital. Functional muscle quality was estimated using MQI, defined as the ratio of handgrip strength (HGS) to muscle mass (MM) derived from bioelectrical impedance analysis. The outcomes included prolonged length of hospital stay, new adverse cardiovascular events (AMI, stroke and hospital readmission for unstable angina), and cardiovascular mortality. A composite score comprising all adverse events over the 1-year follow-up was calculated and defined as MACE. This study included 163 patients, with a median age of 61 years (IQ: 54–69 years), and the majority consisted of males (76.1%). Individual components of the functional muscle quality (HGS and MM) were not associated with any of the adverse outcomes. Only MQI was associated mortality over the 1-year follow-up. For each increase in MQI, the hazard of mortality decreases: adjusted HR: 0.08 (95% CI 0.01–0.84). ConclusionFunctional muscle quality assessed by the MQI may be a valuable clinical predictor of 1-year cardiovascular mortality in patients hospitalized post-AMI.

Negative association of apelin plasma levels with epicardial fat thickness in patients with stable angina and acute myocardial infarction: A case-control study.

Apelin is one of the endogenous peptides that play a key role in the homeostasis of cardiovascular diseases. The purpose of the current study was to evaluate the correlation between apelin levels and epicardial fat thickness (EFT) in patients with stable angina and acute myocardial infarction (AMI). In a case-control study, 90 patients nominated for angiography were enrolled in the study and divided into three groups: healthy subjects without angiographic findings (Con), stable angina pectoris group (SAP), and acute AMI group. Data collected from all subjects included biochemical, echocardiographic, and angiographical parameters. The Gensini score analyzed the severity of coronary artery disease (CAD). A decrease in adjusted apelin levels was evident in the AMI and SAP groups compared with healthy individuals (for both P < 0.001), especially in the AMI group. In addition, a detectable negative association was identified between apelin and Gensini score (r = -0.288, P = 0.006), Ck-MB (r = -0.300, P = 0.004), EFT (r = -0.300, P = 0.004), and troponin-T (r = -0.288, P = 0.006). Myocardial injury in patients with CAD appears to play a significant role in apelin concentration independent of the role of adipose tissue, which requires further studies.

Twelve-year trends in unprotected left main coronary artery occlusion: insights from a real-world multicentre study.

Acute myocardial infarction (AMI) resulting from unprotected left main coronary artery (LMCA) occlusion and subtotal occlusion is a life-threatening condition. Although AMI management has improved in the past two decades, there is limited information on recent trends in patient characteristics, management, and outcomes for acute unprotected LMCA-related AMI. This study aims to assess such trends over a 12year period. This retrospective multicentre study includes patients with unprotected LMCA occlusion/subtotal occlusion admitted to three tertiary hospitals between 2008 and 2020. The patients were divided into two groups based on the chronology of presentation: a 'past group' (January 2008 to December 2014) and a 'contemporary group' (January 2015 to December 2020). The study compares clinical characteristics, management approaches, and outcomes between the two groups. The study includes 128 patients, with 51 (40%) in the 'past group' and 77 (60%) in the 'contemporary group'. Baseline risk factors did not show statistically significant differences between the two groups, except for hypertension (49% vs. 74%; P=0.005). Chest pain was more frequent in the 'past group' (98% vs. 89%; P=0.014), and a trend towards more cardiac arrests was observed in the 'contemporary group' (18% vs. 31%; P=0.087). Revascularization type did not differ significantly (P=0.419), but manual thrombectomy was less frequently used (41% vs. 23%; P=0.032) and stent implantation showed a trend towards higher rates (66% vs. 78%; P=0.150) in the 'contemporary cohort'. There was a gradual shift from bare-metal to drug-eluting stents, with a significantly higher percentage of ticagrelor/prasugrel loading in the 'contemporary cohort' (5% vs. 79%; P<0.001). The use of mechanical circulatory support (MCS), although not statistically significant, was higher among patients in the 'past group' (67% vs. 51%; P=0.073). The type of MCS differed significantly between groups, with a decrease in intra-aortic balloon pump use (67% vs. 42%; P=0.005) and an increase in veno-arterial extracorporeal membrane oxygenation (4% vs. 22%; P=0.005) and Impella system (0% vs. 3%) over time. Survival analysis showed no significant differences (P=0.599; log-rank test) in all-cause mortality between the different time groups, with the long-term survival rate being approximately 30%. In our real-world population, despite the progressive use of newer drugs and more advanced devices over time, patients with unprotected LMCA occlusion/subtotal occlusion remain a subpopulation with poor prognosis.

In-hospital and 1-year mortality associated with percutaneous coronary intervention use in patients with acute myocardial infarction older than 90 years

Abstract Background Patients older than 90 years are less likely to receive percutaneous coronary intervention (PCI) for treatment of acute myocardial infarction (AMI). This is due to the lack of evidence derived from randomized trials, multimorbidity, and possible futility. We investigated the prognostic impact of PCI in a large population of patients hospitalized with AMI in the period 2003-2018, by using the Lombardy Health Database (Italy). Methods We analyzed data of all patients &amp;gt;90 years hospitalized with AMI (both STEMI and NSTEMI) in Lombardy. Patients were grouped according to whether they were treated or not with PCI during index hospitalization. The primary outcome was in-hospital mortality. One-year mortality and 1-year re-hospitalization for acute heart failure (AHF) or AMI were considered as secondary endpoints. Results During the study period, 15,954 patients (median age 92 [91-94] years); 50% STEMI) were hospitalized with a primary diagnosis of AMI. Twelve percent of them (n=1,954) were treated with PCI. The in-hospital mortality rate in the entire cohort was 22% (29% in STEMI and 15% in NSTEMI). It was significantly lower in patients treated with PCI than in those not treated with PCI (15% vs. 23%; P&amp;lt;0.0001). In the overall population, 1-year mortality was 56% and 1-year re-hospitalization for AHF/AMI was 19%. Both these endpoints were less frequent in PCI-treated (37% vs. 58% and 16% vs. 21%, respectively; P&amp;lt;0.0001). The adjusted risk of the study endpoints was significantly lower in patients treated with PCI: OR 0.61 (95% CI 0.54-0.69) for in-hospital mortality; HR 0.53 (95% CI 0.49-0.57) for 1-year mortality; HR 0.68 (95% CI 0.66-0.70) for 1-year re-hospitalization for AHF/AMI. The figure shows the 1-year survival curves of AMI patients treated or not treated with PCI. Similar results were found in STEMI and NSTEMI patients considered separately. Conclusions Our real-world data showed that in patients with AMI older than 90 years of age, PCI use is associated with a significant in-hospital and 1-year clinical benefit.

Serological short-chain fatty acid and trimethylamine N-oxide microbial metabolite imbalances in young adults with acute myocardial infarction

Acute myocardial infarction (AMI) is associated with systemic inflammatory processes and metabolic alterations. Microbial-derived metabolites, such as short-chain fatty acids and trimethylamine N-oxide (TMAO), have emerged in recent years as key players in the modulation of inflammation, with potential implications for cardiovascular diseases. We performed a prospective observational study that monitored the serological concentration of bacterial metabolites in 45 young patients (<55 years) without cardiovascular risk factors but with AMI, at hospital admission and at 3 months of follow-up, and compared them with a control group. TMAO and acetate levels were significantly higher in AMI, whereas butyrate and propionate were significantly lower. The acetate/propionate ratio showed the most discrimination between AMI and controls by receiver operating characteristic analysis (area under the curve 0.769, P < 0.0001). A multivariate logistic regression model revealed that this ratio was independently associated with AMI. Short-chain fatty acid concentrations, but not TMAO, exhibited significant correlations with inflammatory and coagulation parameters. Three months after the acute AMI event, all metabolite levels returned to those observed in healthy controls except butyrate. In conclusion, our study reveals disturbances of the serological concentration of microbiota-derived metabolites in AMI that are also related to inflammatory and coagulation parameters. These findings highlight an interesting field of study in the potential role of microbial metabolites from gut in cardiovascular disease.

Prognostic Impact of Percutaneous Coronary Intervention in Older Patients Hospitalized with Acute Myocardial Infarction: Real-World Findings from the Lombardy Health Database.

Older patients are less likely to receive percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) compared to younger patients. We investigated the prognostic impact of PCI in a large population of patients hospitalized with AMI in the period 2003-2018 by using the administrative Lombardy Health Database (Italy). We considered all patients aged ≥75 years hospitalized with AMI (either STEMI or NSTEMI) from 2003 to 2018 in Lombardy. Patients were grouped according to whether they were treated or not with PCI during the index hospitalization. The primary outcome was in-hospital mortality. The secondary endpoints were 1-year mortality and 1-year re-hospitalization for acute heart failure (AHF) or AMI. 116,063 patients aged ≥75 years (mean age 83 ± 6; 48% males; 46% STEMI) were hospitalized with a primary diagnosis of AMI. Thirty-seven percent of them (n = 42,912) underwent PCI. The in-hospital mortality rate was significantly lower in PCI-treated patients (6% vs. 15%; p < 0.0001). One-year mortality and 1-year re-hospitalization for AHF/AMI were less frequent in PCI-treated patients (16% vs. 41% and 15% vs. 21%, respectively; p < 0.0001). The adjusted risks of the study endpoints were lower in PCI-treated patients: OR 0.37 (95% CI 0.36-0.39) for in-hospital mortality; HR 0.37 (95% CI 0.36-0.38) for 1-year mortality; HR 0.74 (95% CI 0.71-0.77) for 1-year re-hospitalization for AHF/AMI. Similar results were found in STEMI and NSTEMI patients considered separately. Our real-world data showed that in patients with AMI ≥ 75 years of age, PCI use is associated with lower in-hospital and 1-year mortality.

P66 PROGNOSTIC IMPACT OF PERCUTANEOUS CORONARY INTERVENTION IN ACUTE MYOCARDIAL INFARCTION PATIENTS OLDER THAN 75 YEARS. REAL–WORLD FINDINGS FROM THE LOMBARDY REGION

Abstract Background Older patients, generally defined as individuals age &amp;gt;75 years, are less likely to receive percutaneous coronary intervention (PCI) for treatment of acute myocardial infarction (AMI) compared to younger patients. This is due to the paucity of evidence derived from randomized trials, concerns about possible PCI–related side effects, and multimorbidity. We investigated the prognostic impact of PCI in a large population of patients hospitalized with AMI in the period 2003–2018, by using the administrative Lombardy Health Database. Methods We analyzed data of all patients &amp;gt;75 years hospitalized with AMI (both STEMI and NSTEMI) from 2003 to 2018 in Lombardy. Patients were grouped according to whether they were treated or not with PCI during index hospitalization. The primary outcome was in–hospital mortality. One–year mortality and 1–year re–hospitalization for acute heart failure (AHF) or AMI were considered as secondary endpoints. Results During the study period, 116,063 patients (mean age 83±6; 48% males; 46% STEMI) were hospitalized with a primary diagnosis of AMI. Thirty–seven percent of them (n=42,912) were treated with PCI. The in–hospital mortality rate in the entire cohort was 12%. It was significantly lower in patients treated with PCI than in those not treated with PCI (6% vs. 15%; P&amp;lt;0.0001). In the overall population, 1–year mortality was 32% and 1–year re–hospitalization for AHF/AMI was 19%. Both these endpoints were less frequent in PCI–treated patients (16% vs. 41% and 15% vs. 21%, respectively; P&amp;lt;0.0001). The adjusted risk of the study endpoints was significantly lower in patients treated with PCI: OR 0.37 (95% CI 0.36–0.39) for in–hospital mortality; HR 0.37 (95% CI 0.36–0.38) for 1–year mortality; HR 0.74 (95% CI 0.71–0.77) for 1–year re–hospitalization for AHF/AMI. Similar results were found in STEMI and NSTEMI patients considered separately. Conclusions Our real–world data showed that in patients with AMI &amp;gt;75 years of age, PCI use is associated with a significantly lower in–hospital mortality and up to 1 year. This work was partly financed by the Italian Ministry of Health and the Lombardia Region (Grant NET–2016–02364191; EASY–NET)

Growth Differentiation Factor 15: A Prognostic Marker in Patients with Acute Chest Pain without Acute Myocardial Infarction.

Acute chest pain is associated with an increased risk of death and cardiovascular events even when acute myocardial infarction (AMI) has been excluded. Growth differentiation factor-15 (GDF-15) is a strong prognostic marker in patients with acute chest pain and AMI, but the prognostic value in patients without AMI is uncertain. This study sought to investigate the ability of GDF-15 to predict long-term prognosis in patients presenting with acute chest pain without AMI. In total, 1320 patients admitted with acute chest pain without AMI were followed for a median of 1523 days (range: 4 to 2208 days). The primary end point was all-cause mortality. Secondary end points included cardiovascular (CV) death, future AMI, heart failure hospitalization, and new-onset atrial fibrillation (AF). Higher concentrations of GDF-15 were associated with increased risk of death from all causes (median concentration in non-survivors vs survivors: 2124 pg/mL vs 852 pg/mL, P < 0.001), and all secondary end points. By multivariable Cox regression, GDF-15 concentration ≥4th quartile (compared to <4th quartile) remained an independent predictor of all-cause death (adjusted hazard ratio (HR): 2.75; 95% CI, 1.69-4.45, P < 0.001), CV death (adjusted HR: 3.74; 95% CI, 1.31-10.63, P = 0.013), and heart failure hospitalization (adjusted HR: 2.60; 95% CI, 1.11-6.06, P = 0.027). Adding GDF-15 to a model consisting of established risk factors and high-sensitivity cardiac troponin T (hs-cTnT) led to a significant increase in C-statistics for prediction of all-cause mortality. Higher concentrations of GDF-15 were associated with increased risk of mortality from all causes and risk of future CV events.

Impact of medications on outcomes in patients with acute myocardial infarction and chronic obstructive pulmonary disease: A nationwide cohort study.

Various inhaled bronchodilators have been associated with cardiovascular safety concerns. This study aimed to investigate the long-term impact of chronic obstructive pulmonary disease (COPD) and the safety of COPD medications in patients after their first acute myocardial infarction (AMI). This nationwide cohort study was conducted using data from the Taiwan National Health Insurance Research Database. Patients hospitalized between 2000 and 2012 with a primary diagnosis of first AMI were included and divided into three cohorts (AMI, ST-elevation myocardial infarction [STEMI], and non-STEMI [NSTEMI]). Each cohort was propensity score matched (1:1) with patients without COPD. A Cox proportional hazards regression model was used to estimate hazard ratios (HRs) with 95% CIs. A total of 186 112 patients with AMI were enrolled, and COPD was diagnosed in 13 065 (7%) patients. Kaplan-Meier curves showed that patients with COPD had a higher mortality risk than those without COPD in all cohorts (AMI, STEMI, and NSTEMI). The HR of mortality in AMI, STEMI, and NSTEMI patients with COPD was 1.12 (95% CI, 1.09-1.14), 1.20 (95% CI, 1.14-1.25), and 1.07 (95% CI, 1.04-1.10), respectively. Short-acting inhaled bronchodilators and corticosteroids increased mortality risk in all three cohorts. However, long-acting inhaled bronchodilators reduced mortality risk in patients with AMI (long-acting beta-agonist [LABA]: HR, 0.87; 95% CI, 0.81-0.94; long-acting muscarinic antagonist [LAMA]: HR, 0.82; 95% CI, 0.69-0.96) and NSTEMI (LABA: HR, 0.89; 95% CI, 0.83-0.97; LAMA: HR, 0.80; 95% CI, 0.68-0.96). This study demonstrated that AMI patients with COPD had higher mortality rates than those without COPD. Using inhaled short-acting bronchodilators and corticosteroids reduced survival, whereas long-acting bronchodilators provided survival benefits in AMI and NSTEMI patients. Therefore, appropriate COPD medication for acute AMI is crucial.

Interrelation between baseline plaque characteristics and changes in coronary atherosclerosis with the PCSK9-inhibitor alirocumab: insights from the PACMAN-AMI randomized trial

Abstract Background Patients with acute myocardial infarction (AMI) frequently experience recurrent atherothrombotic events, largely attributable to non-culprit lesions with high-risk characteristics. Statins can halt the progression of coronary atherosclerosis, and addition of protein convertase subtilisin/kexin type 9-inhibitors (PCSK9i) results in incremental low-density lipoprotein cholesterol (LDL-C) lowering and atheroma regression. Purpose We sought to examine the interrelation between baseline imaging characteristics, on-treatment LDL-C levels, and changes in coronary atherosclerosis as assessed by serial, multi-modality intracoronary imaging in patients with AMI. Methods This is a post hoc analysis from the PACMAN-AMI randomized trial. Patients were randomly allocated to biweekly alirocumab 150 mg vs. placebo on top of high-intensity statin initiated within 24h of presentation with AMI, and underwent serial imaging of the two non-infarct-related arteries at baseline and after 52 weeks. The primary endpoint was percent atheroma volume (PAV) by intravascular ultrasound (IVUS). Powered secondary endpoints were maximal lipid core burden index (maxLCBI4mm) by near-infrared spectroscopy (NIRS) and minimum fibrous cap thickness (FCTmin) by optical coherence tomography (OCT). Results Of 300 randomized patients (mean age 58.5±9.8 years, 18.7% women, baseline LDL-C 3.94±0.87 mmol/L), IVUS was serially performed in 265 patients (537 arteries). LDL-C levels decreased to 1.92±0.79 mmol/L with placebo and 0.61±0.61 mmol/L with alirocumab (p&amp;lt;0.001). Compared with placebo (statin alone), alirocumab added to statin resulted in greater PAV reduction (−2.13% vs. −0.92%; p&amp;lt;0.001), greater maxLCBI4mm reduction (−79.42 vs. −37.60; p=0.006), and greater increase in FCTmin (62.67 vs. 33.19 μm; p=0.001). Changes in PAV and maxLCBI4mm were inversely related to on-treatment LDL-C levels, and change in FCTmin was positively related to on-treatment LDL-C levels (Figure 1). Across all patients, we found significant, inverse relationships between change in PAV and baseline PAV [slope: −0.072 (95% CI −0.101 to −0.042); p&amp;lt;0.001], between change in maxLCBI4mm and baseline maxLCBI4mm [slope: −0.437 (95% CI −0.505 to −0.369); p&amp;lt;0.001], and between change in FCTmin and baseline FCTmin [slope: −0.436 (95% CI −0.541 to −0.332); p&amp;lt;0.001]; these findings indicate greater PAV and maxLCBI4mm regression in lesions with greater PAV and LCBI4mm at baseline, and greater fibrous cap thickening in lesions with thinner fibrous caps at baseline. Conclusion In this study of intensive LDL-C lowering treatment initiated in the acute AMI setting, more favorable plaque changes were observed in patients with lower on-treatment LDL-C levels and in lesions with more adverse baseline plaque characteristics. Whether AMI patients with high-risk plaque features might derive greater clinical benefit from early initiation of intensive LDL-C-lowering therapies requires further investigation. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Sanofi, Regeneron

Acute myocardial infarction and concomitant acute intracranial hemorrhage: clinical characteristics and outcomes

This study aimed to evaluate the demographic and clinical characteristics, treatments and outcomes of concomitant acute myocardial infarction (AMI) and acute intracranial hemorrhage (ICH). All patients diagnosed with concomitant AMI...

Chronic activation of cardiac Atg-5 and pancreatic Atg-7 by intermittent fasting alleviates acute myocardial infarction in old rats

BackgroundAging is associated with cardiovascular and metabolic changes, increasing the susceptibility to acute myocardial infarction (AMI). Intermittent fasting (IF) has a beneficial effect on the age-associated cardiovascular diseases. The present study was planned to investigate the possible protective effect of IF against acute AMI induced by isoproterenol (ISO) in old rats and its possible underlying mechanisms mediated by heart and pancreatic autophagy. Thirty Male Wistar rats were divided into four groups: adult; old; Old-ISO (rats subjected to AMI by ISO) and Old-F-ISO groups (rats were subjected to IF for 4 weeks and AMI by ISO).ResultsIF significantly increased the mRNA expression of cardiac Atg-5 and pancreatic Atg-7 in Old-F-ISO versus old and adult groups. This was associated with a significant decrease in serum troponin-I, serum creatine kinase (CK-MB), cardiac malondialdehyde and cardiac TNF-α, fasting plasma glucose, and HOMA-IR in Old-F-ISO compared to Old-ISO group. Also, IF significantly decreased the age-related overall and visceral obesity in Old-F-ISO versus old and Old-ISO groups. Histological studies revealed attenuation of the local inflammatory response in Old-F-ISO versus Old-ISO group. Pancreatic Atg-7 and heart Atg-5 were significantly increased in Old-ISO versus old rats.ConclusionsIF protects against acute AMI in old rats, possibly, via chronic activation of heart Atg-5 and pancreatic Atg-7, and alleviation of age-related overall and visceral obesity. Thus, IF could be a dietary lifestyle modification for attenuation of the susceptibility to acute AMI in aged population. On the other hand, acute activation of heart and pancreatic autophagy by ISO might augment cardiac injury.

Oxidative Stress Markers in Young Patients with Acute Myocardial Infarction and Their Correlation with Cardiac Enzymes

Objective: The relationship between oxidative stress and acute myocardial infarction has been shown in studies. Total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) reflect the oxidative balance. The risk factors, clinical features, and prognosis of acute myocardial infarction (AMI) in young patients differ from older counterparts. This study aims to determine the oxidative stress in the young acute AMI patients and its' correlation with cardiac markers within 48 hours by the quantitative measurement of TAS, TOS, and OSI. Material and Method: In this prospective, controlled study, we included 50 patients who were 45 years old or younger and diagnosed with AMI, as well as 20 healthy individuals as the control group. TOS and TAS were measured from venous blood samples via the spectrophotometric method. The oxidative stress index was obtained from these parameters. Results: Forty-five of totally 50 patients were male, and the mean age was (36±6.8). TOS and OSI values were found significantly higher than in the control group (p=0.002, p=0.005, respectively). TAS values were found not to be different from the control group (p=0.46). A significant correlation was found between CK 0. hour (h.), and TOS 0. h., CK-MB 0. h., and TOS 0. h., CK 48. h. and OSI 48. h., CK-MB 48. h. and OSI 48. h., respectively (r=0.36, p=0.008), (r=0.46, p=0.001), (r=0.32, p=0.03), (r=0.36, p&lt;0.01). Conclusion: Oxidative stress increases in the early hours of AMI. The TOS and OSI values are correlated with cardiac markers at only some time points, and their prognostic values are limited in young AMI patients. TAS is not correlated with cardiac markers.

The Role of Sleep Quality and Mental Health in Cardiovascular Disease

Objectives: Cardiovascular diseases (CVDs) may accompany other diseases. Of which can name sleep disorders and also other psychiatric disorders. Aim: In current study we evaluate the concomitant mental health disorders and the sleep quality among the acute myocardial infarction (AMI) and acute coronary syndrome (ACS) patients. Method:180 cases were selected through random sampling. 90 of the cases were hospitalized because of acute myocardial AMI and 90 patients were admitted with the diagnosis of ACS. Demographic, GHQ 28 and PSQI questionnaire was applied to evaluate the demographic features, psychological wellbeing and sleep quality subsequently. Results: 57.8% of cases were women 42.2% were men. The age range was 27 75 years old and the mean age was 49.93+11.73years old. 87.8% of the patients were married and rest were single. The mean score for the GHQ 28 questionnaire was22.43+10.99in patients with angina and in AMI patients.38.8% of ACS patients and 50% of AMI patients didn’t feel well psychologically. The mean score for sleep quality in ACS patients was 3.08+3.6 and 4.06+3.8 in AMI patients. 32.3% of ACS cases and 24.4% of AMI cases had troubles in sleeping. Conclusion: The mental health disorders prevail in AMI and ACS patients. Furthermore, the poor sleep quality was correlated with mental health disorders. Keywords: Sleep Wake Disorders, Mental Health, Acute Coronary Syndrome, Myocardial Infarction

Understanding and Informing Community Emergency Cardiovascular Disease Preparedness during the COVID-19 Pandemic: Stroke Ready

IntroductionAcute stroke and acute myocardial infarction (AMI) treatments are time sensitive. Early data revealed a decrease in presentation and an increase in pre-hospital delay for acute stroke and AMI during the coronavirus disease 2019 (COVID-19) pandemic. Thus, we set out to understand community members’ perception of seeking acute stroke and AMI care during the COVID-19 pandemic to inform strategies to increase cardiovascular disease preparedness during the pandemic. MethodsGiven the urgency of the clinical and public health situation, through a community-based participatory research partnership, we utilized a rapid assessment approach. We developed an interview guide and data collection form guided by the Theory of Planned Behavior (TPB). Semi-structured interviews were recorded and conducted via phone and data was collected on structured collection forms and real time transcription. Direct content analysis was conducted guided by the TPB model and responses for AMI and stroke were compared. ResultsWe performed 15 semi-structured interviews. Eighty percent of participants were Black Americans; median age was 50; 73% were women. Participants reported concerns about coronavirus transmission in the ambulance and at the hospital, hospital capacity and ability to triage, and quality of care. Change in employment and childcare also impacted participants reported control over seeking emergent cardiovascular care. Based on these findings, our community and academic team co-created online materials to address the community-identified barriers, which has reached over 8,600 users and engaged almost 600 users. ConclusionsWe found that community members’ attitudes and perceived behavioral control to seek emergent cardiovascular care were impacted by the COVID-19 pandemic. Community-informed, health behavior theory-based public health messaging that address these constructs may decrease prehospital delay.

Rationale and Design of the ACS-BP Study: Prognostic Value of In-Hospital Blood Pressure and Indices of Atherosclerosis in Acute Coronary Syndromes.

High blood pressure (BP) is a leading risk factor for coronary artery disease and other major cardiovascular events. Blood pressure variability (BPV), ambulatory arterial stiffness index (AASI) and ankle- brachial index (ABI) have been proposed as indices that can improve risk stratification for an adverse cardiac outcome. However, their utility in the setting of acute coronary syndromes (ACS) is unclear. The ACS-BP study is a single-centre observational cohort study designed to investigate the prognostic role of haemodynamic load and arterial stiffness indices for cardio-renal outcomes in patients with acute myocardial infarction (AMI). All consecutive patients admitted with a diagnosis of acute AMI with or without ST segment elevation were screened for inclusion in the study. The management of AMI will follow current guidelines. Data from baseline clinical and laboratory parameters during their hospitalization were collected. The haemodynamic load of each patient was determined by clinical BP values as well as 24-h ambulatory BP monitoring. The AASI was calculated from the raw 24-h BP data and ABI was measured after the third day of hospitalization using a certified device. Patients were followed-up for 12 months in order to collect data for hard cardiovascular and renal endpoints. The study results should clarify the role of these non-invasive tools in secondary risk stratification of such patients.

Size-fractionated particulate air pollution and myocardial infarction emergency hospitalization in Shanghai, China

BackgroundFine particulate matter (PM2.5) air pollution has been associated with increased risks of acute myocardial infarction (AMI), but it remains unknown about the potentially differentiated effects of size-fractionated particulate matter on AMI risk. ObjectiveTo identify the specific size ranges that dominate the effects of particulate matter on AMI onset. MethodsWe conducted a time-series study in Shanghai, China from January 2014 to December 2018. We evaluated particle size distribution of 0.01 μm to 2.5 μm from an environmental supersite and AMI emergency hospitalizations from the largest cardiovascular hospital in Shanghai. We used over-dispersed generalized additive models to estimate the associations of size-fractionated particle number concentrations (PNC) with AMI and its types. ResultsWe identified a total of 4720 AMI emergency hospitalizations. PM2.5 was significantly associated with increased AMI risk on the concurrent day. The associations were significant only for PNC < 0.3 μm. For an IQR increase of PNCs for size ranges 0.01–0.03 μm, 0.03–0.05 μm, 0.05–0.10 μm and 0.10–0.30 μm, AMI hospitalizations increased by 6.68% (95% CI: 2.77%, 10.74%), 6.53% (95% CI: 2.08%, 11.17%), 5.78% (95% CI: 0.92%, 10.88%) and 5.92% (95% CI: 1.31%, 10.74%), respectively. The associations of PNC < 0.05 μm remained significant when adjusting for other air pollutants. There were consistently much stronger associations of particles with ST-segment elevation AMI than those with non-ST-segment elevation AMI. ConclusionsThis epidemiological investigation suggested that ultrafine particles, especially those <0.05 μm, may be mainly responsible for the acute AMI risk induced by PM2.5.

Postconditioning with Nitrates Protects Against Myocardial Reperfusion Injury: A New Use for an Old Pharmacological Agent.

Early reperfusion remains the key therapy to salvage viable myocardium and must be applied as soon as possible following an acute myocardial infarction (AMI) to attenuate the ischemic insult. However, reperfusion injury may develop following reintroduction of blood and oxygen to vulnerable myocytes, which results in more severe cell death than in the preceding ischemic episode. Ischemic postconditioning (I-PostC) provides a cardioprotective effect in combination with pharmacological agents. Although nitrates have been tested in many experimental and clinical studies of acute AMI to evaluate the cardioprotective effect, few investigations have been focused on nitrates postconditioning in patients undergoing percutaneous coronary intervention (PCI). This review presents the manifestations of myocardial reperfusion injury (RI) and potential mechanisms underlying it, and provides the mechanisms involved in the cardioprotection of I-PostC. We also present a new therapeutic approach to attenuate RI by use of an ‘old’ agent – nitrates – in AMI patients.

Critical Organizational Issues for Cardiologists in the COVID-19 Outbreak: A Frontline Experience From Milan, Italy.

Critical Organizational Issues for Cardiologists in the COVID-19 Outbreak: A Frontline Experience From Milan, Italy.