Acute Myocardial Infarction Death Research Articles

Comparison of 30-Day Unplanned Readmissions to the Index Versus Nonindex Hospital After Percutaneous Coronary Intervention

There is limited information about readmissions to index compared with nonindex hospitals after percutaneous coronary intervention (PCI). This study aims to evaluate the rates, causes, and outcomes for unplanned readmissions following PCI depending on whether the patients were admitted to the index or nonindex hospital. Patients who underwent PCI between 2010 and 2014 in the United States. Nationwide Readmission Database were evaluated for unplanned readmissions at 30 days to index and nonindex hospitals. A total of 2,183,851 procedures were analyzed, with a 9.2% 30-day unplanned readmission rate documented, and 7.1% and 2.1% of these readmissions were admitted to the index and nonindex hospitals, respectively. There was also a higher prevalence of co-morbidities among patients readmitted to nonindex hospitals, and more patients who were discharged against medical advice at index PCI. Noncardiac readmissions were lower among patients who were readmitted to the index compared with nonindex hospital (53.4% vs 61.1%, p < 0.001). There were greater adjusted odds of acute myocardial infarction (AMI) (odds ratio [OR] 1.14 95%CI 1.06 to 1.22), PCI (OR 2.25 95%CI 2.06 to 2.46), and composite outcome (AMI, readmission PCI, and all-cause death) (OR 1.64 95%CI 1.53 to 1.75) for patients readmitted to the index hospital but their odds of all-cause death were lower (OR 0.77 95%CI 0.68 to 0.88). The majority of readmissions after PCI are to the index hospital that the PCI was undertaken, and these patients are more likely to have a readmission diagnosis of AMI and undergo a repeat PCI but less likely to die compared with patients admitted to a nonindex hospital.

Epidemiological characteristics of pre-hospital mortality due to acute myocardial infarction from 1999 to 2016 in Tianjin city

To explore the epidemiological characteristics, trends and relevant factors of pre-hospital mortality due to acute myocardial infarction (AMI) from 1999 to 2016 in Tianjin city, based on mortality surveillance information and household registration population information. Standardized mortality rates were calculated using the year 2000 world standard population. From 1999 to 2016, the research result showed that the pre-hospital crude mortality rates of AMI were 39.47/100 000 to 90.64/100 000 and the standardized mortality rates were 30.92/100 000 to 53.90/100 000. The proportion of pre-hospital AMI deaths was 73.96%-81.92% (t=1.09, P>0.05) within the same period. Aged, female, rural residents, unmarried, divorced, widowed, low education level, and outdoor workers have a relative higher proportion of pre-hospital AMI mortality.

Shock index and TIMI risk index as valuable prognostic tools in patients with acute coronary syndrome complicated by cardiogenic shock.

BackgroundThe aim of the study was to evaluate the usefulness of the shock index (SI) and the TIMI risk index (TRI Thrombolysis in Myocardial Infarction Risk Index) one hour after successful primary percutaneous coronary intervention (pPCI) for predicting in-hospital mortality in patients with acute coronary syndrome complicated by cardiogenic shock (CS).MethodsForty-seven consecutive patients with acute myocardial infarction (AMI) complicated by CS were included in this prospective observational study. All patients underwent pPCI and obtained TIMI Grade Flow 3. SI and TRI were calculated one hour after pPCI.ResultsThe primary endpoint—death from cardiovascular causes—occurred in 17 patients (36%). All calculated parameters were significantly higher in fatal CS than in the non-fatal CS group. A multivariate logistic regression model found only TRI to be an independent, significant predictor of death in the study group, with a proposed cut-off point of 66, with sensitivity 76.5% and specificity 83.3% (AUC 0.811, p = 0.00001).ConclusionsThe simple parameters of clinical assessment—SI and TRI—calculated one hour after a successful pPCI of infarct related artery are important predictors of death in AMI complicated by cardiogenic shock.

Acute Myocardial Infarction Mortality Rates and Trends in Romania between 1994 and 2017.

Introduction: The current study aimed to assess recent acute myocardial infarction (AMI) mortality rates and trends in Romania between 1994 and 2017. This dataset is a necessity in the context of the current improvement of emergency protocols, medical addressability, and modernization of hospital infrastructure. Materials and Methods: The study is a retrospective analysis of an anonymized mortality database containing all deaths registered in Romania during 1994–2017. AMI crude mortality rates (CMR) and age-standardized mortality rates (ASMR) were calculated using the European Standard Population. Poisson regression was used for calculating the annual percentage change (APC) in mortality, subsequently used to make mortality predictions through the year 2030. Results: There were 197,152 AMI deaths in women (39.3% of total AMI), and 304,644 (60.7%) in men. Mortality rates were higher in men as compared with women for the entire time covered by the study. Based on the 1994–2017 ASMR dynamics, predictions for the year 2030 showed an overall AMI ASMR of 70.9 (95% CI 69.9–71.9), with gender analysis showing 46.8 (95% CI 45.8–47.9) in women and 104.1 (95% CI 102.3–105.8) in men. Conclusion: Acute myocardial infarction age-standardized mortality rates decreased significantly in Romania between 1994 and 2017 in close correlation to the implementation of national healthcare programs.

P628Association of outpatient cardiac rehabilitation with mortality and morbidities in patients with acute myocardial infarction

Abstract Background/Introduction Outpatient cardiac rehabilitation (CR) is commonly recommended for patients with acute myocardial infarction (AMI). However, the survival benefit has recently been contested, especially with no survival benefit having been found in non-Western countries. Purpose To investigate whether outpatient CR, under current real-world clinical practice, is associated with lower mortality and morbidity risks in patients with AMI. Methods The retrospective cohort study was conducted from January 2011 to June 2016 (final date of follow-up: July 31, 2016) with a nation-wide administrative database for acute-care hospitals in Japan. Data for 7,411 patients were analyzed, with 5,654 fulfilling the inclusion criteria of being admitted for AMI and receiving both percutaneous coronary intervention and inpatient CR between January 2011 and December 2014. We compared patients who participated in outpatient CR at least once within 180 days of discharge and who did not. To account for measured baseline imbalances between outpatient CR participants and non-participants, 1:1 propensity-score matching was performed. The primary outcome was a composite of all-cause death and recurrence of AMI after the landmark time-point of day 180 after discharge. Secondary outcomes included all-cause death, recurrence of AMI, and heart failure. Results Among 5,654 patients (mean [SD] age, 66.8 [12.4] years; 21.2% female; median follow-up period [IQR] 1.44 [0.87 to 2.27] years), 730 (12.9%) received outpatient CR. Of 1,458 propensity-score matched patients, outpatient CR participants did not show a significantly lower risk of the primary outcome than non-participants (1.38 vs. 2.12 per 100 patient-years; hazard ratio [HR], 0.71 [95% CI, 0.32 to 1.61]). Similarly, outpatient CR participation was not associated with lower risks of all-cause death (0.68 vs. 1.31 per 100 patient-years; HR, 0.83 [95% CI, 0.25 to 2.73]), recurrence of AMI (0.69 vs. 0.88 per 100 patient-years; HR, 0.56 [95% CI, 0.19 to 1.66]) or heart failure (2.01 vs. 2.06 per 100 patient-years; HR, 0.89 [95% CI, 0.47 to 1.72]), respectively. Conclusion Among patients with AMI who received percutaneous coronary intervention and inpatient CR, outpatient CR was not associated with lower risks of mortality and morbidities. The survival benefit of outpatient CR should be reaffirmed under current real-world clinical practice, especially in non-Western countries.

P2674Rapid rule-out of myocardial infarction with a novel high precision point-of-care troponin assay appears safe and effective

Abstract Background High sensitivity troponin assays were developed to improve analytical sensitivity and precision at the decision cut-points for the diagnosis and rule out of acute myocardial infarction (AMI). Central laboratory assays have achieved this but point of care assays, which have the ability to accelerate decision making due to much shorter turnaround times, have remained lacking. Purpose To ascertain the threshold for decision making and subsequent clinical utility for ruling out AMI on presentation in patients attending the emergency department acutely with chest pain, using a high precision point of care troponin assay (TnI Nx), (i-STAT, Abbott). Methods We measured arrival TnI-Nx concentrations in stored plasma samples in adults presenting acutely to the emergency department with chest pain. The primary outcome was an AMI or cardiac death on index admission or within 30 days. We used 2000 bootstrapped data sets to derive and validate a suitable threshold for TnI-Nx before calculating diagnostic test performance. We pre-specified this threshold must have a &lt;1% false negative rate for the primary outcome. We compared this with a core laboratory high sensitivity troponin I (hs-TnI) (Abbott Architect) using the early rule-out cut-point (European Society of Cardiology) at the limit of detection (2 ng/L). Results We recruited 1320 patients of whom 192 (14.1%) had the primary outcome. The TnI-Nx threshold was determined to be 8 ng/L with subsequent sensitivity of 99.0% (95% confidence interval: 97.3% to 100%), negative predictive value of 99.7% (99.2% to 100%) and specificity of 59.0% (56.0% to 62.0%). The hs-TnI had a sensitivity of 99.5% (98.2% to 100%), negative predictive value of 99.7% (99.0% to 100%), and specificity of 28.4% (25.8% to 31.2%) at 2ng/L. Conclusion A high precision point of care assay, TnI-Nx, with a decision threshold of 8ng/L, has comparable rule out performance compared with a core laboratory high sensitivity assay and therefore could potentially be used for early decision making in the assessment of acute chest pain. Acknowledgement/Funding Research grant from Abbott Point of Care. Senior Research Fellowship from ECF, CMRF and CDHB. Clinical Research Fellowship from NZ HRC

Glycaemic control and excess risk of major coronary events in patients with type 2 diabetes: a population-based study

ObjectiveThe purpose of the study was to investigate the excess risk of acute myocardial infarction (AMI) and death from coronary artery disease (coronary heart disease, CHD) in relation to age,...

Relation Between Statewide Hospital Performance Reports on Myocardial Infarction and Cardiovascular Outcomes

Healthcare systems may be judged on quality of care and access to health services. Studies on the association of hospital quality of care scores and clinical outcomes have yielded mixed results. With the help of a richer and more representative database, the aim of our study was to shed light on these inconsistencies. We examined the association of 4 process of care scores (prescription of aspirin, β blocker, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker used for left ventricular systolic dysfunction, and an overall composite score) for acute myocardial infarction (AMI), reported in the Hospital Performance Reports, with 30-day and 1-year rates of readmission for AMI and cardiovascular (CV) death. Clinical outcomes were from the Myocardial Infarction Data Acquisition System, an administrative database that comprises all patient CV disease admissions to acute care hospitals in New Jersey. CV death was related with overall score (adjusted odds ratio [OR] 0.821, 95% confidence interval [CI] 0.726 to 0.930, p = 0.002) at 30 days and with all 4 scores at 1 year (OR ranging from 0.829 to 0.997, p <0.01). Readmission due to AMI was associated with the overall score (OR 0.789, 95% CI 0.691 to 0.902, p <0.0001) and the aspirin score (OR 0.995, 95% CI 0.990 to 1, p = 0.046) at 30 days. Low hospital performance scores for AMI were associated with increased CV death and readmission for AMI. In conclusion, healthcare providers should allocate their resources to improving hospital performance to decrease AMI case fatality, AMI readmissions, and CV-related healthcare spending.

Impact of smoke-free legislation on acute myocardial infarction and stroke mortality: Tianjin, China, 2007–2015

BackgroundSmoke-free legislation is an effective way to protect the population from the harms of secondhand smoke and has been implemented in many countries. On 31 May 2012, Tianjin became one...

Complete percutaneous myocardial revascularization in patients with STEMI complicated by cardiogenic shock

Background/Aim. Despite considerable progress in terms of early myocardial revascularization and the use of mechanical circulatory support, cardiogenic shock continues to be the leading cause of death in acute myocardial infarction. The current recommendations of the European Society of Cardiology advocate early revascularization of all critical stenosis or highly unstable lesions in the state of cardiogenic shock, while recently published studies favour the early revascularization of the infarct related artery only, in patients with acute myocardial infarction with the ST segment elevation (STEMI) presenting with cardiogenic shock. The aim of the study was to assess the impact of the complete early percutaneous myocardial revascularization in an acute myocardial infarction complicated by cardiogenic shock on intra- hospital mortality. Methods. The research was conducted as a retrospective observational analysis of data obtained from the hospital registry for cardiogenic shock. The study group consisted of 235 patients treated in the period from August 2007 until October 2016 for STEMI complicated by cardiogenic shock. Three groups were formed. The first group consisted of patients with one vessel disease who underwent revascularization of infarct related artery; the second group of patients had multi-vessel disease and only culprit lesions were revascularized and the third one consisted of patients with multi-vessel disease and the complete myocardial revascularization performed. Additional subgroups were formed in reference to the intra-aortic balloon pump (IABP) implantation. Intra-hospital mortality was analyzed in all groups and subgroups. Results. Revascularization of the culprit lesion alone among patients with multivessel disease was performed in 142 (60.4%) patients while the complete revascularization (revascularization of ?culprit? and other significant lesions) was performed in 28 (11.9%) patients with multi-vessel disease. There were 65 (27.7%) patients with single-vessel disease who underwent revascularization of infarct related artery. The lowest mortality was found in the group of patients with multi-vessel coronary disease who underwent complete myocardial revascularization and had IABP implanted (mortality was 35.7%). The difference in the mean value of the left ventricular ejection fraction (EF) between the surviving and deceased patients was statistically significant (p &lt; 0.005). The average EF of survivors was 44% (35%?50%) while 30% (25%?39.5%) deceased of patients. Based on the obtained data, the mathematically predictive model was tested. The receiver operating characteristic (ROC) curve showed that our model is a good predictor of fatal outcome (p &lt; 0.0005; AUROC = 0.766) with the sensitivity of 80.3%, and the specificity of 67%. Conclusion. STEMI complicated by cardiogenic shock is still associated with a high mortality rate. Complete myocardial revascularization independently as well as in combination with an IABP, significantly reduces mortality in patients with acute STEMI complicated by cardiogenic shock.

Acute Coronary Syndromes in the Elderly: Impact of Age on Diagnosis and Terapeutic Management

Abstract Cardiovascular pathology in the elderly is a topic of particular interest because it is themain cause of morbidity and mortality in this segment of the population, but also because in the last century the population over 60 years (this is the arbitrary limit from which a person is considered to be elderly) has doubled and is estimated to increase 2-3 times during the first century of this millennium. With the aging of the population, the number of associated diseases increases, but also the complexity of treatment for these diseases and the cost of hospitalization. Ischemic coronary artery disease has an increased incidence in the elderly population. Acute myocardial infarction (AMI) with ST segment elevation is manifested relatively frequently with atypical symptoms at onset - dyspnea, diaphoresis, nausea, confusion, epigastric pain, syncope. The influence of age on diagnosis and therapeutic management. There are no electrical changes in 40% of the elderly with acute myocardial infarction. Statistics show that 50% of patients addmited for AMI are elderly and 80% of acute myocardial infarction deaths occur in the elderly, due to both greater risk of post-treatment complications (eg left ventricular rupture after fibrinolysis) and general suboptimal treatment in the eldery, either due to age, comorbidities and atypical presentation delaying the diagnosis. Generally, outcomes of patients undergoing percutaneous coronary intervention are better compared to patients treated with fibrinolysis, the invasive strategy being thus preferred in these patients.

Secondary Stroke Prophylaxis with Clopidogrel Produces Sufficient Antiplatelet Response

BackgroundAntiplatelet therapy is a cornerstone prevention strategy for secondary ischemic stroke (IS) and transient ischemic attack (TIA). Yet, a proportion of patients who receive antiplatelet therapy experience recurrent ischemic cerebrovascular events. A recent meta-analysis found an increased risk of recurrent stroke in clopidogrel- or aspirin-treated patients with ischemic stroke who had high on-treatment platelet reactivity (HTPR). Few studies have focused specifically on clopidogrel HTPR. Therefore, the aim of this study was to examine the relationship between clopidogrel HTPR and recurrent ischemic events in a population of Danish patients with IS. MethodsWe performed a prospective observational study to evaluate the relationship between HTPR defined as platelet reaction units >208 and a composite primary endpoint of recurrent stroke, TIA, acute myocardial infarction (AMI), or vascular death over a 2-year follow-up period. ResultsA total of 142 patients were included in the final statistical analysis, but only 3 patients (2.1%) demonstrated clopidogrel HTPR. The median time of on-treatment platelet testing was 75 days. Recurrent IS, TIA, AMI, or vascular death occurred in 14 patients (10%). Of these, 1 new ischemic event (AMI) occurred in a HTPR patient. There was no difference in the frequency of new ischemic events between the HTPR and non-HTPR groups (P = .27); moreover, the number of patients with HTPR was too small for statistical analysis. ConclusionsClopidogrel HTPR does not seem to be a major contributor to recurrent ischemic events in Danish ischemic stroke patients.

LO57: Very low concentrations of high-sensitivity troponin T at presentation can rapidly exclude acute myocardial infarction in a significant proportion of ED chest pain patients

Introduction: Chest pain is one of the most common presenting complaints to emergency departments (EDs) across the world, and the exclusion of acute myocardial infarction (AMI) using troponin testing is central to the care of many of these patients. While testing strategies using conventional troponin assays require repeat testing over many hours to avoid missed diagnoses, high-sensitivity troponin (hs-cTn) assays may be able to exclude AMI in a large proportion of patients with a single result at presentation. This objective of this study is to validate the ability of very low concentrations of hs-cTn at presentation to exclude AMI in ED chest pain patients. Methods: This prospective cohort study was conducted at a single urban tertiary center and regional percutaneous coronary intervention site in Calgary, Alberta. Patients were eligible for enrolment if they presented to the ED with chest pain, were 25-years or older and required biomarker testing to rule out AMI at the discretion of the attending emergency physician. Patients were excluded if they had clear acute ischemic ECG changes, new arrhythmia or renal failure requiring hemodialysis. A high-sensitivity troponin result (Roche Elecsys hs-cTnT) was obtained in all patients at presentation. The primary outcome was AMI on the index visit. Secondary outcomes included 30-day AMI and major adverse cardiac events (MACE - including AMI, revascularization or cardiac death). Electronic medical records were reviewed and telephone follow-up was obtained for all patients at 30-days to ensure relevant events were captured. Two physician adjudication (board-certified emergency physician and cardiologist) was obtained for all outcomes. This study was REB approved. Results: A total of 1,167 patients were enrolled from August 2014 September 2016, of which 191 (16.3%) patients had an initial troponin below the limit of blank (LoB, &lt;3 ng/L) and 416 (32.8%) were below the limit of detection (LoD, &lt;5 ng/L). The sensitivity of a single troponin below the LoB (&lt;3 ng/L) for index AMI was 100% (95% CI 96.2%-100%) and for 30-day AMI was 100% (95% CI 96.4-100%). The sensitivity of a troponin below the LoD (&lt;5 ng/L) for index AMI was 97.9% (95% CI 92.7%-99.8%) and for 30-day AMI was 98.0% (95% CI 93.0-99.8%). Sensitivity for 30-day MACE at both cutoffs was lower: 98.4% (95% CI 94.3-99.8%) for &lt;3 ng/L, and 94.4% (95% CI 88.8-97.7%) for &lt;5 ng/L, respectively; however, negative predictive values remained high at both cutoffs: &lt;3 ng/L, 99.0% (95% CI 96.3-99.9%) and &lt;5 ng/L, 98.3% (95% CI 96.6-99.3%). Conclusion: A high sensitivity troponin T result below the LoB (&lt;3 ng/L) is highly sensitive for excluding AMI and identifies patients at low risk of 30-day MACE. A result below the LoB (&lt;5 ng/L) will identify a larger population of patients as low risk but has a greater risk of missed AMI and MACE.

LO59: External validation of a 2-hour rapid diagnostic algorithm for ruling out acute myocardial infarction in emergency department patients with chest pain using a high-sensitivity troponin-T assay

Introduction: Ruling out acute myocardial infarction (AMI) using serial troponin testing is central to the care of many emergency department (ED) patients with chest pain. While diagnostic strategies using conventional troponin assays require repeat sampling over many hours to avoid missed diagnoses, serial high-sensitivity troponin (hs-cTn) assays may be able to exclude AMI in most patients within 1 or 2 hours. However, many of the initial studies deriving and validating these rapid diagnostic algorithms had all hs-cTn samples analyzed in a central core lab likely representing optimal assay performance. This objective of this study is to validate a 2-hour rapid diagnostic algorithm to exclude AMI in ED chest pain patients using an hs-cTn assay in real world practice. Methods: This prospective cohort study was conducted at a single urban tertiary center and regional percutaneous coronary intervention site in Calgary, Alberta. Patients were eligible for enrolment if they presented to the ED with chest pain, were 25-years or older and required biomarker testing to rule out AMI at the discretion of the attending emergency physician. Patients were excluded if they had clear acute ischemic ECG changes, new arrhythmia or renal failure requiring hemodialysis. A high-sensitivity troponin result (Roche Elecsys hs-cTnT) was obtained in all patients at ED presentation and 2-hours later. The primary outcome was AMI on the index visit. Secondary outcomes included 30-day AMI and 30-day major adverse cardiac events (MACE - including AMI, revascularization or cardiac death). Electronic medical records were reviewed and telephone follow-up was obtained for all patients at 30-days to ensure relevant events were captured. Two physician adjudication (board-certified emergency physician and cardiologist) was obtained for all outcomes. This study was REB approved. Results: A total of 549 patients were enrolled from August 2014 September 2016 with 2-hour serial hs-cTnT results, of which 349 (63.6%) met the 2-hour rapid diagnostic algorithm low risk criteria (time 0 h/2 h hs-cTnT &lt;14 ng/L and delta 2 h &lt;4 ng/L). The sensitivity of the 2-hour low risk criteria for index AMI was 98.4% (95% CI 91.3%-100%) and for 30-day AMI was 98.4% (95% CI 91.6-100%). The sensitivity for 30day MACE was lower 84.4% (95% CI 74.4-91.7%) but maintained a high negative predictive value, 96.6% (95% CI 94.1-98.2%). Conclusion: A 2-hour rapid diagnostic algorithm using an hs-cTnT assay was highly sensitive for AMI on the index visit and successfully identified patients at low risk of 30-day AMI. Sensitivity for MACE was lower, reminding us that while biomarker-only rapid diagnostic algorithms excel at ruling out AMI, careful clinical risk stratification is needed to avoid missed MACE events.

LO56: External validation of a 1-hour rapid diagnostic algorithm for ruling out acute myocardial infarction in emergency department patients with chest pain using a high-sensitivity troponin-T assay

Introduction: Ruling out acute myocardial infarction (AMI) using serial troponin testing is central to the care of many emergency department (ED) patients with chest pain. While diagnostic strategies using conventional troponin assays require repeat sampling over many hours to avoid missed diagnoses, serial high-sensitivity troponin (hs-cTn) assays may be able to exclude AMI in most patients within 1 or 2 hours. However, many of the initial studies deriving and validating these rapid diagnostic algorithms had all hs-cTn samples analyzed in a central core lab likely representing optimal assay performance. This objective of this study is to validate a 1-hour rapid diagnostic algorithm to exclude AMI in ED chest pain patients using an hs-cTn assay in real world practice. Methods: This prospective cohort study was conducted at a single urban tertiary center and regional percutaneous coronary intervention site in Calgary, Alberta. Patients were eligible for enrolment if they presented to the ED with chest pain, were 25-years or older and required biomarker testing to rule out AMI at the discretion of the attending emergency physician. Patients were excluded if they had clear acute ischemic ECG changes, new arrhythmia or renal failure requiring hemodialysis. A high-sensitivity troponin result (Roche Elecsys hs-cTnT) was obtained in all patients at ED presentation and 1-hour later. The primary outcome was AMI on the index visit. Secondary outcomes included 30-day AMI and 30-day major adverse cardiac events (MACE - including AMI, revascularization or cardiac death). Electronic medical records were reviewed and telephone follow-up was obtained for all patients at 30-days to ensure relevant events were captured. Two physician adjudication (board-certified emergency physician and cardiologist) was obtained for all outcomes. The study was REB approved. Results: A total of 350 patients were enrolled from August 2014 September 2016 with 1-hour serial hs-cTnT results, of which 219 (62.6%) met the 1-hour rapid diagnostic algorithm low risk criteria (time 0h hs-cTnT &lt;12ng/L and delta 1h &lt;3ng/L). The sensitivity of the 1-hour low risk criteria for index AMI was 97.2% (95% CI 85.5%-99.9%) and for 30-day AMI was 97.3% (95% CI 85.8-99.9%). The sensitivity of the low risk criteria for 30-day MACE was lower 80.9% (95% CI 66.7-90.9%) but maintained a high negative predictive value, 95.9% (95% CI 92.3-98.1%). Conclusion: A 1-hour rapid diagnostic algorithm using an hs-cTnT assay was highly sensitive for AMI on the index visit and successfully identified patients at low risk of 30-day AMI; however, sensitivity for 30-day MACE was much lower. Of note, the 1-hour algorithm appears to be less sensitive for both AMI and 30-day MACE than a 2-hour algorithm validated in the same population.

Acute Effect of Air Pollutant Sulfur Dioxide on Acute Myocardial Infarction Mortality from 2011 to 2017 in Jinan City

Objectives: The objective of this study is to quantitatively analyze the acute effects of atmospheric pollutant sulfur dioxide (SO2) on acute myocardial infarction (AMI) death in residents of Jinan City. Methods: A descriptive analysis of data on daily weather, air pollutants, and residents' AMI death events was collected from 2011 to 2017 in Jinan city. A generalized additive model (GAM) based on the Quasi-Poisson regression was used to analyze the associations of AMI deaths and SO2. The lag effect of current day (lag0~lag3) and cumulative lagged effect (lag01~lag03) were explored. The excess risk (ER) and 95% confidence interval (CI) of AMI deaths were calculated for every 10 μg/m3 increase in SO2. Results: A total of 40,843 AMI deaths occurred between 2011 and 2017, with a daily average of 16 deaths. During the same period, the average annual value of SO2was 65 μg/m3. An increase in SO2concentration of 10 μg/m3 was associated with an increased risk of death related to AMI at lag 1 by 0.35% (95% CI: 0.06%–0.64%). Especially in cold months, a higher increased risk of 0.49% (95% CI: 0.19%–0.79 %) for AMI death was observed with SO2a 10 μg/m3 increase. While there was a significant cumulative hysteresis effect, the maximum cumulative hysteresis effect appeared in lag 02. Conclusions: The atmospheric pollutant SO2in Jinan City has a significant acute effect on the risk of death from AMI , especially a higher increased risk was observed in cold months.

Elevated IL-27 in patients with acute coronary syndrome is associated with adverse ventricular remodeling and increased risk of recurrent myocardial infarction and cardiovascular death

Background and aimsIL-27 is an immunoregulatory cytokine belonging to the IL-6/IL-12 family that was found to be elevated in acute coronary syndrome (ACS) patients. We investigated whether IL-27 is related to post-ischemic cardiac remodeling and long-term prognosis in this patient group. MethodsWe included 524 ACS patients, defined as acute myocardial infarction (AMI) or unstable angina (UA). A subgroup of 107 patients donated blood samples 6 weeks after the index event, and underwent a follow-up echocardiographical examination at 1 year. We measured plasma levels of IL-27, high sensitivity troponin T (hsTNT), C-reactive protein (hsCRP) and cystatin C at baseline and in the 6-week samples. The median follow-up period of the cohort was 2.2 years. ResultsThe incidence of the combined end-point of AMI and cardiovascular death was higher in patients with plasma IL-27 within the top two tertiles both at baseline and after 6 weeks. After correction for cardiovascular risk factors, medication, hsTNT, hsCRP, and eGFR, patients with baseline IL-27 levels within the highest tertile had a significantly elevated risk for the combined end-point compared with the lowest tertile (hazard ratio 2.70, 95% CI 1.06–6.90, p = .038). Additionally, higher baseline IL-27 levels were associated with deleterious left ventricular remodeling and deterioration of systolic and diastolic function during the first year of follow-up. ConclusionsElevated IL-27 at the time of an ACS is independently related to impaired cardiac function and worse long-term prognosis. Our data warrants further mechanistic studies to elucidate the involvement of IL-27 in cardiac repair and remodeling after ACS.

Clinical analysis for the death of 127 patients with acute myocardial infarction and nursing strategies

How to give the corresponding nursing strategies for the risk factors of death is the focus of the current clinical nursing of AMI. Therefore, this study aims to determine causes of death in patients with Acute Myocardial Infarction (AMI) and the nursing strategies. The clinical data of 127 AMI patients treated in our center from January 1st, 2010 to December 31st, 2014, categorized into observed group and control group according to psychological counselling, were retrospectively analysed. Total of 68 patients were enrolled in observed group with 59 patients enrolled in control group. 48 (70.6%) of observed group had complicated infection and 43 (72.9%) of control group, respectively. The mortality of observed group was 17.65%, lower than 33.90% of control group (p=0.035). Multivariate logistic regression analysis indicated that age (≥ 70 y), less-awareness, complicated infection and accompanying conditions such as cardiogenic shock might be high-risk factors of AMI-induced death. In conclusion, AMI deaths are associated with diverse causes. Active and effective nursing approaches, such as psychological counselling, may help to decrease the risk of AMI deaths. The corresponding nursing strategies for these death-related factors included tailored patient education, psychological counselling, concentrated nursing care, reasonable nursing resource planning, continuous ECG monitoring and close observation.

Ispitivanje povezanosti težine srca sa rupturom srca kod 119 slučajeva umrlih od akutnog infarkta miokarda

Introduction. Cardiovascular and blood vessel diseases are the most common cause of death, which is shown by data obtained in our and foreign authors' research, and acute myocardial infarction is the most common emergency in internal medicine and its mortality is very high, about one third of total mortality. The aim of this paper is to determine whether there is a statistically significant difference in heart weight in deceased patients with acute myocardial infarction (AMI) with heart rupture and with AMI without heart rupture. Methods. The research material is made up of 119 autopsied patients at the Institute of Pathology of the University of Kragujevac Medical Faculty and Clinical Center Kragujevac. The following pathological morphological research methods were applied: autopsy, macroscopic diagnostics and microscopic analysis. In addition, a statistical processing of results was performed, and the Pharmocologic Circulapon System Student's t-test statistical software package was used to test the significance of differences. A value of p<0.05 was considered as a statistically significant difference, and a value of p<0.01 as highly significant. Results and Discussion. Out of 119 cases of AMI deaths, of which 74 male and 45 female, heart rupture was found in 21 cases. Of the 74 men who died of AMI, 13 had a rupture, and of the 45 women who died of AMI, 8 had a rupture. The heart weight was measured in each respondent who died of AMI and the correlation between heart weight and rupture was investigated. The study showed that there was a statistically significant difference (p<0.05) in the average heart weight between the autopsied who had and those who did not have heart rupture, and that those who did not have heart rupture had significantly more heart weight. The study showed that there was a statistically significant difference (p<0.05) in the average heart weight between the autopsied men who had and those who did not have heart rupture. The heart of those men who did not have heart rupture had more weight. There were no statistically significant differences (p>0.05) in the mean heart weight between the autopsied women who had and those who did not have heart rupture. Conclusion. The study showed the difference in the heart weight of autopsied patients who had and those who did not have heart rupture, and that those who did not have heart rupture had significantly more heart weight. In relation to sex, the heart of those men who did not have heart rupture had more weight, while in women there are no statistically significant differences (p>0.05) in the average heart weight in those with and without rupture of the heart.

Cost and cost-effectiveness of a school-based education program to reduce salt intake in children and their families in China.

ObjectiveThe School-based Education Program to Reduce Salt Intake in Children and Their Families study was a cluster randomized control trial among grade five students in 28 primary schools and their families in Changzhi, China. It achieved a significant effect in lowering systolic blood pressure (SBP) in all family adults by 2.3 mmHg and in elderlies (aged > = 60 years) by 9.5 mmHg. The aim of this study was to assess the cost-effectiveness of this salt reduction program.MethodsCosts of the intervention were assessed using an ingredients approach to identify resource use. A trial-based incremental cost-effectiveness ratio (ICER) was estimated based on the observed effectiveness in lowering SBP. A Markov model was used to estimate the long-term cost-effectiveness of the intervention, and then based on population data, extrapolated to a scenario where the program is scaled up nationwide. Findings were presented in terms of an incremental cost per quality-adjusted life year (QALY). The perspective was that of the health sector.ResultsThe intervention cost Int$19.04 per family and yielded an ICER of Int$2.74 (90% CI: 1.17–12.30) per mmHg reduction of SBP in all participants (combining children and adult participants together) compared with control group. If scaled up nationwide for 10 years and assumed deterioration in treatment effect of 50% over this period, it would reach 165 million families and estimated to avert 42,720 acute myocardial infarction deaths and 107,512 stroke deaths in China. This would represent a gain of 635,816 QALYs over 10-year time frame, translating into Int$1,358 per QALY gained.ConclusionBased on WHO-CHOICE criteria, our analysis demonstrated that the proposed salt reduction strategy is highly cost-effective, and if scaled up nationwide, the benefits could be substantial.Trial registrationClinicalTrials.gov NCT01821144