Acute Myocardial Infarction Events Research Articles

Impact of DApagliflozin on Cardiac Functionnfollowing Anterior Myocardial Infarction in Non-diabetic Patients – DACAMI (a Randomized Controlled Clinical Trial)

Abstract Background This study aims at identifying if there is a role for Sodium glucose co- transporter 2 inhibitors (SGLT2i) in the event of acute myocardial infarction. Patients who presented with anterior ST- elevation myocardial infarction (STEMI) & had undergone successful primary percutaneous coronary intervention for the left anterior descending coronary were randomized into a study group & a control group. The study group received dapagliflozin 10 mg once daily. The primary endpoint was cardiac function assessed by both; a biomarker (i.e.: N-terminal pro-Brain Natriuretic Peptide – NT-proBNP) measured at baseline & at 12 weeks post the cardiac event & echocardiographic parameters (left ventricular ejection fraction, left ventricular diastolic dimension & left ventricular mass index) assessed at baseline, 4-weeks & 12-weeks post the cardiac event. Results From October 2021 to April 2022, a final 100 patients were randomized. The median drop of NT- proBNP in the study group was significant compared to the control group (p-value 0.043). In addition, the decrease in the left ventricular mass index (LV mass index) was also significant in the study group compared to the control group. Conclusions Dapagliflozin seems to have a role in preventing left ventricular dysfunction & maintaining cardiac function following anterior ST-elevation myocardial infarction. More Large-scale trials need to be done to further confirm these findings. This trial is registered retrospectively at the US National Institutes of Health (ClinicalTrial.gov) with identifier number: NCT05424315 – June 16th, 2022. (https://ClinicalTrials.gov/ct2/show/nct05424315)

Association between synoptic types in Beijing and acute myocardial infarction hospitalizations: A comprehensive analysis of environmental factors

BackgroundEnvironmental factors like air pollution and temperature can trigger acute myocardial infarction (AMI). However, the link between large-scale weather patterns (synoptic types) and AMI admissions has not been extensively studied. This research aimed to identify the different synoptic air types in Beijing and investigate their association with AMI occurrences. MethodsWe analyzed data from Beijing between 2013 and 2019, encompassing 2556 days and 149,632 AMI cases. Using principal component analysis and hierarchical clustering, classification into distinct synoptic types was conducted based on weather and pollution measurements. To assess the impact of each type on AMI risk over 14 days, we employed a distributed lag non-linear model (DLNM), with the reference being the lowest risk type (Type 2). ResultsFour synoptic types were identified: Type 1 with warm, humid weather; Type 2 with warm temperatures, low humidity, and long sunshine duration; Type 3 with cold weather and heavy air pollution; and Type 4 with cold temperatures, dryness, and high wind speed. Type 4 exhibited the greatest cumulative relative risk (CRR) of 1.241 (95%CI: 1.150, 1.339) over 14 days. Significant effects of Types 1, 3, and 4 on AMI events were observed at varying lags: 4–12 days for Type 1, 1–6 days for Type 3, and 1–11 days for Type 4. Females were more susceptible to Types 1 and 3, while individuals younger than 65 years old showed increased vulnerability to Types 3 and 4. ConclusionAmong the four synoptic types identified in Beijing from 2013 to 2019, Type 4 (cold, dry, and windy) presented the highest risk for AMI hospitalizations. This risk was particularly pronounced for males and people under 65. Our findings collectively highlight the need for improved methods to identify synoptic types. Additionally, developing a warning system based on these synoptic conditions could be crucial for prevention.

Acute Infarct of Myocardium without Coronary Arterial Obstructive Disease in a Patient with Colon Cancer: A Case Report

Acute Infarct of Myocardium without Coronary Arterial Obstructive Disease in a Patient with Colon Cancer: A Case Report

Disparities and Outcomes in the First and Second Year of the Pandemic on Events of Acute Myocardial Infarction in Coronavirus Disease 2019 Patients.

Background and Objectives: Coronavirus disease 2019 (COVID-19) caused several cardiovascular complications, including acute myocardial infarction (AMI), in infected patients. This study aims to understand the overall trends of AMI among COVID-19 patients during the first two years of the pandemic and the disparities and outcomes between the first and second years. Materials and Methods: The retrospective analysis was conducted via the 2020 and 2021 National Inpatient Sample (NIS) database for hospitalizations between April 2020 and December 2021 being analyzed for adults with a primary diagnosis of COVID-19 who experienced events of AMI. A comparison of month-to-month events of AMI and mortality of AMI patients with concomitant COVID-19 was made alongside their respective patient characteristics. Results: Out of 2,541,992 COVID-19 hospitalized patients, 3.55% experienced AMI. The highest rate of AMI was in December 2021 (4.35%). No statistical differences in trends of AMI mortality were noted over the 21 months. AMI cases in 2021 had higher odds of undergoing PCI (aOR 1.627, p < 0.01). They experienced higher risks of acute kidney injury (aOR 1.078, p < 0.01), acute ischemic stroke (aOR 1.215, p < 0.01), cardiac arrest (aOR 1.106, p < 0.01), need for mechanical ventilation (aOR 1.133, p < 0.01), and all-cause mortality (aOR 1.032, 95% CI 1.001-1.064, p = 0.043). Conclusions: The incidence of AMI among COVID-19 patients fluctuated over the 21 months of this study, with a peak in December 2021. COVID-19 patients reporting AMI in 2021 experienced higher overall odds of multiple complications, which could relate to the exhaustive burden of the pandemic in 2021 on healthcare, the changing impact of the virus variants, and the hesitancy of infected patients to seek care.

Endothelial-Derived Microparticles Associate with Hospital Major Adverse Cardiovascular Events but not with Long-Term Adverse Events in Acute Myocardial Infarction

AbstractEndothelial-derived microparticles (EDMP) are markers of vascular function and convey roles in coagulation, inflammation, vasoactivity, angiogenesis, and cellular apoptosis, which implicate acute myocardial infarction (AMI). This study aimed to investigate whether, among AMI, on-admission EDMP counts affect hospital major adverse cardiovascular events (MACE) and whether the change of EDMP in 30-day posthospital discharge affects long-term follow-up MACE. The research design was a prospective cohort study. The subjects were 119 patients diagnosed and hospitalized with AMI, who were enrolled consecutively. The EDMP was measured on hospital admission and repeated 30-day posthospital discharge. The outcomes were in the hospital MACE comprised of cardiac mortality, heart failure, cardiogenic shock, reinfarction, and resuscitated ventricular arrhythmia. Furthermore, long-term follow-up were performed on 30-day, 90-day, and 1-year posthospital AMI discharge. The on-admission EDMP counts were significantly higher in subjects with hospital MACE compared with those without (median [interquartile range]: 27,421.0 [6,956.5–53,184.0] vs. 11,617.5 [4,599.0–23,336.7] counts/µL, p = 0.028). The EDMP counts cutoff value of &gt;26,810.0 counts/µL (52.4% sensitivity, 81.6% specificity) had significantly increased hospital MACE occurrence (adjusted odd ratio: 4.45, 95% confidence interval: 1.47–13.53, p = 0.008). The EDMP counts were significantly increased after 30-day posthospital discharge. Both on-admission and 30-day EDMP counts and the changes in EDMP counts did not impact MACE on the long-term follow-up. In conclusion, higher on-admission EDMP counts were independently associated with hospital MACE among AMI. However, on-admission and 30-day postdischarge EDMP and their changes did not impact long-term follow-up MACE.

National Trends and Outcomes of Acute Myocardial Infarction After Transcatheter Aortic Valve Replacement

BackgroundPrior studies have reported decreased use of an invasive approach for acute myocardial infarction (AMI) in patients undergoing transcatheter aortic valve replacement (TAVR). ObjectivesThe aim of this study was to determine whether prior TAVR affects the use of subsequent coronary revascularization and outcomes of AMI in a contemporary national data set. MethodsConsecutive TAVR patients from 2016 to 2022 were identified from the U.S. Vizient Clinical Data Base who were hospitalized after the index TAVR hospitalization with ST-segment elevation myocardial infarction (STEMI) or non–ST-segment elevation myocardial infarction (NSTEMI). Patients with STEMI or NSTEMI with or without prior TAVR from the same time period were compared for the use of coronary angiography, revascularization, and in-hospital outcomes. Propensity score matching was used to account for imbalances in patient characteristics. ResultsAmong 206,229 patients who underwent TAVR, the incidence of STEMI was 25 events per 100,000 person-years of follow-up, and that of NSTEMI was 229 events per 100,000 person-years. After propensity matching, the use of coronary revascularization was similar in the prior TAVR and no TAVR cohorts in both the STEMI (65.3% vs 63.9%; P = 0.81) and NSTEMI (41.4% vs 41.7%; P = 0.88) subgroups. Compared with patients without prior TAVR, in-hospital mortality was higher in the prior TAVR cohort in patients with STEMI (27.1% vs 16.7%; P = 0.03) and lower in those with NSTEMI (5.8% vs 8.2%; P = 0.02). ConclusionsIn this large, national retrospective study, AMI events after TAVR were infrequent. There were no differences in the use of coronary revascularization for STEMI or NSTEMI in TAVR patients compared with the non-TAVR population. In-hospital mortality for STEMI is higher in TAVR patients compared with those without prior TAVR.

Prolonged Dual Antiplatelet Therapy in Acute Myocardial Infarction Patients Without Revascularization: China Acute Myocardial Infarction Registry Study

At least 12-month dual antiplatelet therapy (DAPT) is one of the standards of care following Percutaneous Coronary Intervention (PCI) in patients with acute coronary syndrome. However, study on prolonged DAPT for acute myocardial infarction (AMI) patients without revascularization is limited. We studied 1744 AMI patients without revascularization from the China Acute Myocardial Infarction registry between January 2013 and September 2014. These patients were on DAPT and did not experience AMI, stroke, or bleeding events at 12-month follow-up. We divided them into two groups: 12-month DAPT group (DAPT for at least 12 months but less than 18 months) and 18-month DAPT group (DAPT for at least 18 months). The primary outcome is 24-month all-cause death. Overall, 1221 (70.0%) patients took DAPT for ≥12 months but <18 months, while 523 (30.0%) patients took DAPT for ≥18 months. The two groups had comparable proportions with high ischemic risk (27.0% vs. 25.6%, P = 0.5418), as well as high bleeding risk (29.0% vs. 28.5%, P = 0.8316). At 24 months, the all-cause mortality rate of 18-month DAPT group was significantly lower than that for 12-month DAPT group (3.7% vs 5.9%, P = 0.0471). Adjusted hazard ratio for all-cause death also showed statistical significance (0.59, 95% CI: 0.35-0.99, P = 0.0444). In conclusion, DAPT for at least 18 months appears to be associated with lower 24-month mortality for non-revascularization AMI patients without events within 12 months after onset.

Differences in Attitudes and Barriers Towards Advance Care Planning Amongst Ischemic Heart Disease Patients: A Cross-Sectional Study.

Perceptions towards advanced care planning (ACP) amongst individuals with Ischemic Heart Disease before or after a life-threatening Acute Myocardial Infarction event is underexamined and could impact the appropriate timing for ACP advocacy. This cross-sectional study assessed awareness and intentions regarding ACP in individuals with Ischemic Heart Disease, both before and after an Acute Myocardial Infarction, and explored the motivating effect of a near-fatal Acute Myocardial Infarction event on its engagement. This study was conducted from 24 August 2021 through 13 March 2023, whereby patients were administered a one-time questionnaire with no follow-up required. Patients with either chronic Ischemic Heart Disease (group A) or a recent Acute Myocardial Infarction event (group B) were recruited from the outpatient National University Heart Centre, Singapore. 101 patients (n = 51 for Group A, n = 50 for Group B) were recruited. Mean age (SD) was 59 (10.5) years and 84 were male (83.2%). Between both groups, patients in group B reported significantly higher scores on 'Lack of information' and 'Self-efficacy' domains, and had no ACP awareness nor plans of doing an ACP compared to group A. ACP awareness was the sole significant predictor of intentions of doing an ACP in the final regression model (P < .05). Interestingly, this study suggests that surviving a potentially life-threatening heart condition did not result in higher intention of doing an ACP. Thus, advocacy of ACP in the community should simply start by raising awareness levels widely and may not need to be focused on individuals' state of health.

Impact of genetic background as a risk factor for atherosclerotic cardiovascular disease: A protocol for a nationwide genetic case-control (CV-GENES) study in Brazil.

Atherosclerotic Cardiovascular Disease (ASCVD) represents the leading cause of death worldwide, and individual screening should be based on behavioral, metabolic, and genetic profile derived from data collected in large population-based studies. Due to the polygenic nature of ASCVD, we aimed to assess the association of genomics with ASCVD risk and its impact on the occurrence of acute myocardial infarction, stroke, or peripheral artery thrombotic-ischemic events at population level. CardioVascular Genes (CV-GENES) is a nationwide, multicenter, 1:1 case-control study of 3,734 patients in Brazil. Inclusion criterion for cases is the first occurrence of one of the ASCVD events. Individuals without known ASCVD will be eligible as controls. A core lab will perform the genetic analyses through low-pass whole genome sequencing and whole exome sequencing. In order to estimate the independent association between genetic polymorphisms and ASCVD, a polygenic risk score (PRS) will be built through a hybrid approach including effect size of each Single Nucleotide Polymorphism (SNP), number of effect alleles observed, sample ploidy, total number of SNPs included in the PRS, and number of non-missing SNPs in the sample. In addition, the presence of pathogenic or likely pathogenic variants will be screened in 8 genes (ABCG5, ABCG8, APOB, APOE, LDLR, LDLRAP1, LIPA, PCSK9) associated with atherosclerosis. Multiple logistic regression will be applied to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI), and population attributable risks will be calculated. Clinical trial registration: This study is registered in clinicaltrials.gov (NCT05515653).

Short term outcomes of carotid surgery: the real-world experience of a single teaching center.

Surgical treatment of symptomatic extracranial carotid stenosis is well established for preventing neurological events and should adhere to optimal quality standards. However, there is growing concern as to whether results of controlled trials are replicable in real-world settings. To assess a symptomatic carotid stenosis population that underwent surgery and its short-term outcomes in a real-world context at a professional training center. Observational study using data collected from medical records from January 2012 to January 2023. Patients undergoing operations for other carotid diseases and with concomitant heart surgery were excluded. A total of 70 patients undergoing angioplasty or carotid endarterectomy were included. Population subsets undergoing angioplasty or endarterectomy were similar. Differences in anesthetic modality and a longer operative time in the carotid endarterectomy subgroup were statistically significant. There were 4 cases of stroke, only 3 of which (2 minor and 1 major) were related to the index lesion. Thus, the rate of major operation-related stroke was 1.43% and the rate of any lesion-related stroke was 4.29%. There was 1 case of AMI in the angioplasty group and there were no deaths in the sample. The overall rate of major adverse cardiovascular events was 5.71%. There were no statistical differences between the endarterectomy and angioplasty groups regarding the main outcomes. The rates of outcomes of ischemic stroke, acute myocardial infarction, death, and major adverse cardiovascular events at this center are in line with the rates reported by randomized controlled trials, demonstrating the feasibility of carotid surgery in centers with teaching programs.

Identification of acute myocardial infarction and stroke events using the National Health Insurance Service database in Korea.

The escalating burden of cardiovascular disease (CVD) is a critical public health issue worldwide. CVD, especially acute myocardial infarction (AMI) and stroke, is the leading contributor to morbidity and mortality in Korea. We aimed to develop algorithms for identifying AMI and stroke events from the National Health Insurance Service (NHIS) database and validate these algorithms through medical record review. We first established a concept and definition of "hospitalization episode," taking into account the unique features of health claims-based NHIS database. We then developed first and recurrent event identification algorithms, separately for AMI and stroke, to determine whether each hospitalization episode represents a true incident case of AMI or stroke. Finally, we assessed our algorithms' accuracy by calculating their positive predictive values (PPVs) based on medical records of algorithm- identified events. We developed identification algorithms for both AMI and stroke. To validate them, we conducted retrospective review of medical records for 3,140 algorithm-identified events (1,399 AMI and 1,741 stroke events) across 24 hospitals throughout Korea. The overall PPVs for the first and recurrent AMI events were around 92% and 78%, respectively, while those for the first and recurrent stroke events were around 88% and 81%, respectively. We successfully developed algorithms for identifying AMI and stroke events. The algorithms demonstrated high accuracy, with PPVs of approximately 90% for first events and 80% for recurrent events. These findings indicate that our algorithms hold promise as an instrumental tool for the consistent and reliable production of national CVD statistics in Korea.

Diabetes and the Risk of Heart Failure Among More Than 60,000 Acute Myocardial Infarction Survivors: A Systematic Review and Meta-Analysis

BackgroundDiabetes mellitus (DM) has raided its incidence across the last decades. It brings several cardiovascular complications. DM increases acute myocardial infarction (AMI) risk and affects systolic and diastolic function. Several studies have explored the association between DM and AMI complications, like heart failure (HF). Therefore, we synthesized evidence regarding the association between DM and HF among AMI survivors. MethodsWe performed a systematic review of longitudinal studies that explored the association between DM and HF after AMI. The search was from inception to January 2023 in Pubmed, Scopus and EMBASE. We excluded studies that did not clearly state if HF was new-onset after AMI. We performed a meta-analysis following the randomed-effect model with the inverse variance method. ResultsFrom 4,512 articles, we selected 19 cohort studies (n=60 451) of AMI survivors. Mean age ranged from 55.4 to 77.8 years. More than 60% of patients were male. In comparison with non-diabetics, those AMI survivors with diabetes had higher risk of new-onset heart failure (RR: 1.78, 95%CI: 1.58-2.01) (attached figure). In addition, left ventricular ejection fraction (%) was lower among diabetic survivors (MD: -1.57, 95%CI: -2.69 to -0.45). As exploratory analysis, AMI in the anterior wall was the most frequent without significant differences between DM and non-DM (pooled prevalence in DM: 54% vs. non-DM: 49%). Diabetes was associated with higher risk of mortality (RR: 2.09, 95% CI: 1.52-2.88) and reinfarction (RR: 1.59, 95% CI: 1.22-2.08) after an AMI event. All studies had low risk of bias. ConclusionsAfter AMI, DM patients have a strong risk of HF. Comprehensive clinical follow-up should be done among this population.

Effectiveness of Early Direct Oral Anticoagulant Monotherapy within One Year of Coronary Stent Implantation in Patients with Atrial Fibrillation: A Nationwide Population-Based Study

We evaluated the effectiveness of early direct oral anticoagulant (DOAC) monotherapy within one year after percutaneous coronary intervention (PCI) in patients with atrial fibrillation (AF) using Korean National Health Insurance Service data. AF patients who underwent PCI were included and divided into the DOAC monotherapy group and the combination therapy group (DOAC with an antiplatelet agent) based on the medications used at 6 months after PCI. A major adverse cardiovascular event (MACE) was defined as a composite of cardiovascular death, acute myocardial infarction (AMI), stroke, or systemic thromboembolic event between 6 and 12 months after PCI. In the overall study population, the DOAC dose reduction rate was high in both the monotherapy group (70.8%) and the combination therapy group (79.1%). After propensity score matching, the MACE incidence was not significantly different between the two groups (hazard ratio [HR] 1.42 [0.90–2.24]). The numerical trend for higher MACE in the monotherapy group was mainly driven by the difference in stroke incidence (HR 1.84 [0.97–3.46]). All-cause death (HR 1.29 [0.61–2.74] or the incidence of major bleeding (HR 1.07 [0.49–2.35]) results were similar in the two groups. In conclusion, early DOAC monotherapy was not significantly associated with MACE risk between 6 and 12 months after PCI.

Assessing Awareness and Actions Must Be Taken in Acute Myocardial Infarction: A Cross-Sectional Study on the General Population in Alahssa, Saudi Arabia.

Acute myocardial infarction (AMI), commonly referred to as a heart attack, is a leading global cause of mortality, necessitating immediate recognition and appropriate actions. This study aims to assess AMI awareness and response among the general population in Alahssa, Saudi Arabia. A descriptive cross-sectional design was employed, with surveys distributed via online platforms. Participants aged 18 years and older, residing in Alahssa, and providing informed consent were included. Among 406 participants, 74.1% had good knowledge levels. Notably, 216 (53.2%) recognized calling an ambulance as the initial response to AMI symptoms. The Internet (140, 28.9%) and healthcare professionals (113, 23.3%) were primary information sources, with "sudden pain or discomfort in arms or hands" (287, 27.8%) as the most recognized symptom. "Obesity" and "heart disease" (304, 12.3%) were the most common risk factors. Demographic variations in knowledge were observed. This study highlights the need to enhance public awareness of AMI, particularly among specific demographic groups. Targeted educational campaigns can improve knowledge, promote appropriate actions, and ultimately enhance outcomes during AMI events in Alahssa, Saudi Arabia.

Assessment of Lipid Profile Treatment Practices and Lipid Levels in Post-Myocardial Infarction Patients: Results from a Tertiary Care Hospital of Pakistan

Objectives: Acute myocardial infarction (AMI) stands as a global leading cause of mortality. Following AMI, meticulous management of patients' lipid profiles for secondary prevention becomes paramount. We conducted this study to assess lipid profile practices and levels in post-AMI patients, which are crucial for secondary prevention.&#x0D; Methodology: In this cross-sectional study, we analyzed patients who had experienced their first AMI event in the past three years. We assessed fasting and non-fasting lipid profiles, reviewed statin therapy prescriptions, and examined patient compliance. The recommended dose was defined as rosuvastatin ≥20 mg or atorvastatin ≥40 mg, with target total cholesterol levels set at &lt;160 mg/dL and target LDL (low-density lipoprotein) cholesterol at &lt;55 mg/dL.&#x0D; Results: Among 195 patients, 71.3% were male, and the mean age was 57.1±10.2 years. The median duration since AMI was 36 [IQR: 10-48] months and 60% were diagnosed with STEMI (ST-segment elevation myocardial infarction). Only 13.8% of patients were advised to undergo lipid profile testing after AMI, 88.7% of patients were on the recommended statin therapy, and 91.8% of patients were compliant with statin therapy. Only 11.5% had LDL-cholesterol within the target range and 71.7% had total cholesterol within the target range. Hospital admission in the past 12 months was reported by 14.4%, and the re-admission rate was significantly higher among non-compliant patients (37.5% vs. 5.6%). Subsequent AMI event rate was also significantly higher among non-compliant patients (43.8% vs. 11.7%).&#x0D; Conclusion: Our study highlights that while most post-AMI patients receive the recommended minimum statin therapy, the inadequate practice of lipid assessment may compromise therapy optimization and raise the risk of subsequent events.

Cardiovascular outcomes, mortality, and bleeding in patients with acute myocardial infarction and a history of cancer: a report from the multi-center, nationwide prospective database JAMIR

Abstract Background Limited data are available regarding the cardiovascular outcome including bleeding of patients with history of cancer who develop acute myocardial infarction (AMI). Purpose The purpose of this study was to analyze the characteristics and clinical outcomes of patients following AMI according to the history of cancer in in a contemporary cohort. Methods Consecutive patients with spontaneous onset of AMI were enrolled between December 2015 and May 2017 at 50 institutions in the Japan AMI Registry (JAMIR), a multi-center, nationwide prospective registry. Patients were divided into 2 groups according to a history of cancer at admission for index AMI events. The outcomes of interest were all-cause death, major bleeding defined as BARC type 3 or 5, and composite ischemic events defined as cardiovascular death, myocardial infarction and ischemic stroke. These events were analyzed by the log-rank test, and Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated with a Cox proportional hazards model with adjustment for covariates such as age, sex, body weight, ST-elevation MI, use of anticoagulants, history of cerebrovascular disease, trans-radial approach procedure, Killip class ≥2, estimated glomerular filtration rate, and history of previous MI or percutaneous coronary intervention. Results A total of 3,411 AMI patients were enrolled, and followed for a median of 358 days. Among those, 292 patients (8.6%) had a history of cancer and they were older and had more comorbidities than those without (mean age [standard deviation], 76.0 [9.9] vs 67.4 [13.3]; P&amp;lt;0.001). They had a similar risk of composite ischemic events (adjusted HR [adjHR] 1.18 [95% CI 0.80–1.75], P=0.39), and major bleeding (adjHR 1.13 [95% CI 0.70–1.83], P=0.61) compared with those without, whereas were at higher risk for all-cause mortality (adjHR 1.64 [95% CI 1.16–2.32], P=0.005; Figure 1). While no between-group difference in cardiovascular death was observed, non-cardiovascular death and death due to cancer were higher in the cancer group than in the no-cancer group (adjHR 1.38 [95% CI 0.85–2.24], P=0.19; adjHR 2.05 [95% CI 1.24–3.39], P=0.005; adjHR 18.16 [95% CI 6.74–48.97], P&amp;lt;0.001, respectively). When further stratified by age, there was neither the difference in cardiovascular events nor bleeding events by the presence or absence of a history of cancer, whereas the difference in all-cause mortality became pronounced in the group aged&amp;lt;75 years but not in the group aged&amp;gt;75 years (adjHR 3.32 [1.88–5.85] and 1.26 [0.81–1.96], respectively; Figures 1 and 2). There was a significant interaction between caner and age (P for interaction=0.008). Conclusion The real-world multi-center database JAMIR demonstrated that a history of cancer was associated with increased mortality in AMI patients aged&amp;lt;75 years. These results might suggest the need for a multidisciplinary approach to improve the prognosis of younger AMI patients with a history of cancer.Figure 1Figure 2

Abstract 18320: Vessel-Specific Coronary Inflammation Quantified Using Perivascular Fat Attenuation Index Score on CCTA Detects the Vulnerable Coronary Artery and Predicts Acute Plaque Events

Background: Coronary artery inflammation can be detected non-invasively on routinely performed coronary computed tomography angiograms (CCTA) by measuring the 3D changes of perivascular adipose tissue attenuation. Fat attenuation index (FAI) Score is the corrected metric of coronary inflammation measured in any of the 3 coronary arteries, and predicts acute myocardial infarction (AMI). Although FAI score is able to detect the vulnerable patient, it is unclear whether it can be used to detect the vulnerable artery in advance of an acute event. Aim: To evaluate the ability of FAI Score to detect the vulnerable coronary artery in patients undergoing CCTA for investigation of chest pain. Methods: Consecutive patients (n = 3,393, mean age 61±15, 57% male) from two UK hospitals in the Oxford Risk Factors and Non Invasive Imaging (ORFAN) study underwent CCTA between 2010-2018 for suspected coronary artery disease (CAD), and were followed up prospectively for a median of 7.7 years. AMI events were recorded via nationwide screening and the culprit vessel was identified based on the target lesion in percutaneous coronary intervention (PCI). FAI score was generated with CaRi-Heart® device. Results: A total of 296 AMI events occurred during the follow up period and 176 patients underwent PCI (59 attributed to the right coronary artery (RCA), and 93 to left anterior descending artery (LAD)). Patients with high FAI score in the LAD had 2 times higher risk for AMI in the LAD (Fig. A), but not in the RCA (HR 1.73 95% CI 0.96-3.08, p=0.07). Similarly, patients with high FAI score in the RCA had 1.9 times higher risk for AMI in the RCA (Fig. B), and modestly elevated risk for an AMI from the LAD. (HR 1.62, 95% CI 1.02-2.59, p=0.04) Conclusion: Vessel-specific FAI score predicts AMI caused by a culprit lesion in the corresponding coronary artery. The ability of FAI score to identify the vulnerable artery before it gives a plaque rupture event may be useful in planning targeted therapeutic interventions.

Abstract 13012: Impact of End-Stage Renal Disease on Short-Term Outcomes Among Adults Undergoing Percutaneous Mitral Valve Repair

Introduction: Patients with end-stage renal disease (ESRD) are predisposed to multiple complications following invasive and non-invasive procedures. With the recent introduction of percutaneous mitral valve repair (PMVR), there needs to be more data on ESRD patients' outcomes following such procedures. Our analysis aims to bridge data via national hospitalization records. Methods: We used de-identified data of adults(ages 18 and more) undergoing PMVR between 2016-2020 via the National Inpatient Sample. Patients were separated into two groups based on the presence of a diagnosis of ESRD. We excluded all other forms of Chronic kidney disease classifications from our control group. Differences in outcomes were studied via logistic regression models. Results: Between 2016-2020, a total of 24680 procedures of PMVR were performed in the United States that met our selection criteria. Among them, 1655 (6.7%) patients were reported with a diagnosis of ESRD, while 23025 (93.3%) were without any diagnosis of CKD or ESRD. Patients with ESRD consisted of a younger cohort (mean age 68.68 years) compared to the non-ESRD group (mean age 77.39 years, p&lt;0.01). Furthermore, the ESRD group showed a higher mean Charlson Comorbidity Index Score (CCI) score (6.47) compared to the non-ESRD group (score of 2.20). Most procedures were conducted in Urban teaching centers (90.4% of non-ESRD patients and 93.4% of ESRD patients). ESRD patients recorded higher odds of sepsis (aOR 1.747, 95% CI 1.191-2.560, p&lt;0.01), major bleeding (aOR 8.316, 95% CI 7.336-9.426, p&lt;0.01), postprocedural respiratory failure (aOR 2.531, 95% CI 1.441-4.445, p&lt;0.01), and mortality (aOR 2.109, 95% CI 1.513-2.940, p&lt;0.01). The two groups showed no differences in acute myocardial infarction events (aOR 1.235, 95% CI 0.899-1.697, p=0.193) during their hospitalization for the procedure. Conclusions: Patients with ESRD experienced poorer outcomes following PMVR as they had higher odds of mortality, postprocedural respiratory failure, major bleeding, and sepsis. Thus, physicians must adequately address the potential complications with and without the procedure and closely monitor the post-operative progress.

Abstract 12153: Prevalence and Prognostic Implications of Worsening Renal Function After Acute Myocardial Infarction

Introduction: Limited data exist on the association between longitudinal changes in renal function and long-term clinical outcomes in patients who survive acute myocardial infarction (AMI) events. Hypothesis: We sought to investigate the relationship between worsening renal function (WRF) at one-year follow-up and clinical outcomes at three years after AMI. Methods: We analyzed data from 13,104 patients enrolled in the national AMI registry from November 2011 to December 2015. Patients with all-cause death, recurrent myocardial infarction (re-MI), and re-hospitalization for heart failure (rHHF) at one-year follow-up after AMI were excluded. A total of 6,235 patients were extracted and divided into WRF and non-WRF groups. WRF was defined as a ≥25% decrease in estimated glomerular filtration rate (eGFR) from baseline to one-year follow-up. The primary outcome was three-year major adverse cardiac events (MACE), a composite of all-cause death, re-MI, and rHHF. Results: On average, a -1.5 ml/min/1.73 m 2 /year rate of decline in eGFR was exhibited, and 575 (9.2%) patients exhibited WRF at one-year follow-up. After multiple adjustments, WRF at one-year follow-up was independently associated with increased risks of MACEs (adjusted hazard ratio: 1.498, 95% confidence interval: 1.113-2.016, P =0.01), all-cause death, and re-MI at three-year follow-up (Figure 1). Older age, female, diabetes, hypertension, non-ST segment elevation AMI, anterior AMI, anemia, left ventricular ejection fraction &lt;35%, and baseline eGFR &lt;30 ml/min/1.73 m 2 were identified as independent predictors of WRF after AMI. Conclusions: WRF at one-year follow-up after AMI intuitively seems like a risk marker indicating multiple comorbidities. Monitoring serum creatinine in patients at one-year follow-up after AMI may help to identify those who are at the highest risk and guide effective long-term therapeutics.

One-Stop Plasmonic Nanocube-Excited SERS Immunoassay Platform of Multiple Cardiac Biomarkers for Rapid Screening and Progressive Tracing of Acute Myocardial Infarction.

Rapid and precise acute myocardial infarction (AMI) diagnosis is essential for preventing patient death. In addition, the complementary roles of creatine kinase muscle brain (CK-MB) and cardiac troponin I (cTnI) cardiac biomarkers in the early and late stages of AMI demand their simultaneous detection, which is difficult to implement using conventional fluorescence and electrochemical technologies. Here, a nanotechnology-based one-stop immuno-surface-enhanced Raman scattering (SERS) detection platform is reported for multiple cardiac indicators for the rapid screening and progressive tracing of AMI events. Optimal SERS is achieved using optical property-based, excitation wavelength-optimized, and high-yield anisotropic plasmonic gold nanocubes. Optimal immunoassay reaction efficiencies are achieved by increasing immobilized antibodies. Multiple simultaneous detection strategies are implemented by incorporating two different Raman reports with narrow wavenumbers corresponding to two indicators and by establishing a computational SERS mapping process to accurately detect their concentrations, irrespective of multiple enzymes in the human serum. The SERS platform precisely estimated AMI onset and progressive timing in human serum and made rapid AMI identification feasible using a portable Raman spectrometer. This integrated platform is hypothesized to significantly contribute to emergency medicine and forensic science by providing timely treatment and observation.