Acute Myocardial Infarction Patients Research Articles

Exploring cardiac vector propagation in acute myocardial infarction: a spatial velocity perspective.

To objectively characterize the spatial-velocity dynamics of the QRS-loop in the vectorcardiogram (VCG) of patients with acute myocardial infarction (AMI). VCG was constructed as a space curve directly with three quasi-orthogonal leads I, aVF and V2 recorded by conventional ECG of 25healthy individuals and 50 AMI patients. Spatial velocity (SV) of the dynamic QRS loop, spatial distance (SD), and spatial magnitude (SM) were recorded, along with axis-specific component attributes of vector magnitude such as ΔX, ΔY, and ΔZ. Decreased SV (12-25%, p = 0.02) and SD (10-26%, p = 0.02) and altered spatial propagation patterns of ventricular vectors in AMI were recorded, with changes in specific axes based on infarct location. Significant vector changes were found in the Y-Axis in IWMI (p = 0.005) and X-Axis in cases of AWMI (p = 0.02), as compared to controls. There was no apparent alteration of SM in AMI. Decreased SV and SD without any significant alteration of SM indicates close approximation and clustering of the tips of the ventricular vector in AMI. This may be due to dilation, thinning, and stress of the ventricular wall in early post infarction ventricular remodeling, along with relative ischemia due to associated tachycardia and higher myocardial oxygen demand.

Association between endothelial activation and stress index and 30-day mortality risk in acute myocardial infarction patients: a study based on the medical information mart for intensive care-IV database

ObjectiveThis study aimed to evaluate the association between the Endothelial Activation and Stress Index (EASIX) and 30-day mortality risk in acute myocardial infarction (AMI) patients.MethodsUsing a retrospective cohort design, data were extracted from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database between 2008 and 2019. Patients diagnosed with AMI at intensive care unit (ICU) admission were included. EASIX score was calculated as follows: lactate dehydrogenase (LDH) level (U/L) × creatinine level (mg/dL)/platelet count (109/L). Cox regression models assessed the association between EASIX and 30-day mortality, with subgroup analyses based on age, gender, AMI subtype, and sepsis status.ResultsA total of 1,036 patients were analyzed, among whom 323 did not survive beyond 30 days post-ICU admission. Higher EASIX scores were associated with increased 30-day mortality in AMI patients [Hazard ratio (HR): 1.70, 95% confidence interval (CI): 1.17–2.46, P = 0.005). Subgroup analyses supported these findings and revealed significant interactions between EASIX and variables such as gender and AMI subtype (P < 0.05).ConclusionElevated EASIX scores are significantly correlated with increased 30-day mortality risk in AMI patients, suggesting EASIX as a valuable prognostic tool that may inform clinical management strategies to improve outcomes in AMI.Clinical trial numberNot applicable.

Hair cortisol concentration, a stress biomarker, is gradually increasing before an acute myocardial infarction

Background Chronic stress is believed to play a role in the pathophysiology of acute myocardial infarction (AMI). Cortisol is a biomarker associated with stress. We sought to assess stress contribution to AMI using hair cortisol concentration (HCCs) as a surrogate biomarker. Methods HCC was measured in hair segments, corresponding to distinctive periods before hair sampling, in 102 male AMI patients and 50 healthy male controls. Standard baseline variables were collected for both groups, whereas for AMI patients, laboratory and psychological tests were also carried out. Linear mixed models were applied to assess the effect of group and baseline variables on the trend of cortisol before hair sampling. Results HCC was significantly higher in AMI patients the last 30 days before hair sampling with an overall higher rate of increase (time-group interaction P &lt; 0.001). AMI patients with BMI ≥25 kg/m2 had a slower rate of increase compared with those with BMI &lt;25 kg/m2 (adjusted P = 0.008). Among AMI patients, there was no difference in the rate of cortisol increase between STEMI and NSTEMI patients (time-group interaction P = 0.841). Lower BMI conferred higher rates of cortisol increase irrespectively of AMI type. Conclusion HCC, a biomarker of stress, showed an increasing trend over a period of 2 months before the occurrence of AMI suggesting a potential role of stress, through cortisol secretion, in the pathophysiology of AMI.

Clinical characteristics and in-hospital event rate of chronic obstructive pulmonary disease patients with concurrent acute myocardial infarction

This study was to investigate the clinical features of chronic obstructive pulmonary disease (COPD) patients with concurrent acute myocardial infarction (AMI) and analyze the occurrence of in-hospital adverse events. Patients with AMI who were admitted to Beijing Chaoyang Hospital from January 2019 to August 2023 were retrospectively collected. All patients were divided into COPD with concurrent AMI group and simple AMI group according to whether they were with concurrent COPD. All patients received interventional treatment for AMI. The clinical features and the occurrence of in-hospital adverse events were compared between the two groups. A total of 183 AMI patients aged (65.6±13.6) years were enrolled, including 142 males (77.6%). There were 94 patients (51.4%) in simple AMI group and 89 patients (48.6%) in COPD with concurrent AMI group, respectively. Patients in COPD with concurrent AMI group were older, had higher Killip grade, rate of smoking and previous percutaneous coronary intervention history, creatinine and B-type natriuretic peptide levels, and lower albumin, hemoglobin, low-density lipoprotein cholesterol, white blood cell count and cardiac troponin I than those of simple AMI group (all P<0.05). There were no significant differences in echocardiographic parameters between the two groups (all P>0.05). The proportion of β-blockers, angiotensin-converting enzyme inhibitors/angiotensin-blockers used in COPD with concurrent AMI group was lower (P<0.05). Patients in COPD with concurrent AMI group had longer length of hospital stay than those in simple AMI group (P=0.028). The incidence of primary endpoint events in COPD with concurrent AMI group was higher than that in simple AMI group (27.0% vs 18.0%, P=0.002). The current study indicates that COPD patients with concurrent AMI have longer length of hospital stay and higher incidence of in-hospital events, which are worthy of significant attention in clinical practice.

Nomogram for Predicting in-Hospital Severe Complications in Patients with Acute Myocardial Infarction Admitted in Emergency Department.

There is lack of predictive models for the risk of severe complications during hospitalization in patients with acute myocardial infarction (AMI). In this study, we aimed to create a nomogram to forecast the likelihood of in-hospital severe complications in AMI. From August 2020 to January 2023, 1024 patients with AMI including the modeling group (n=717) and the validation group (n=307) admitted in Changsha Central Hospital's emergency department. Conduct logistic regression analysis, both univariate and multivariate, on the pertinent patient data from the modeling cohort at admission, identify independent risk factors, create a nomogram to forecast the likelihood of severe complications in patients with AMI, and assess the accuracy of the graph's predictions in the validation cohort. Age, heart rate, mean arterial pressure, diabetes, hypertension, triglycerides and white blood cells were seven independent risk factors for serious complications in AMI patients. Based on these seven variables, the nomogram model was constructed. The nomogram has high predictive accuracy (AUC=0.793 for the modeling group and AUC=0.732 for the validation group). The calibration curve demonstrates strong consistency between the anticipated and observed values of the nomogram in the modeling and validation cohorts. Moreover, the DCA curve results show that the model has a wide threshold range (0.01-0.73) and has good practicality in clinical practice. This study developed and validated an intuitive nomogram to assist clinicians in evaluating the probability of severe complications in AMI patients using readily available clinical data and laboratory parameters.

Health Status Outcomes after Acute Myocardial Infarction in Patients without Standard Modifiable Risk Factors.

Background: Prior studies of patients presenting with acute myocardial infarction (AMI) without Standard Modifiable Risk Factors (SMuRFs), such as diabetes, dyslipidemia, hypertension, and smoking, reported higher in-hospital but lower long-term mortality than those with SMuRFs. However, the impact of SMuRFs on health status outcomes (patients’ symptoms, function, and quality of life) after a first AMI are unknown. Methods: Data from two prospective registries, PREMIER and TRIUMPH, were used to identify patients with no prior history of coronary disease hospitalized at 31 U.S. hospitals for AMI between 2003-2008. Serial health status over 12 months was collected using the Seattle Angina Questionnaire (SAQ) Summary Score. Changes in SAQ over 12 months were compared between patients with and without SMuRFs using hierarchical linear mixed models with sequential adjustments for baseline SAQ scores, clinical, and sociodemographic characteristics. Results: Among 4076 patients with a first AMI (mean age 58.4±12.4, 34% female, 22% Black), 569 (14.0%) presented without SMuRFs. Compared with patients with SMuRFs, those without SMuRFs were more likely to be male, White, have higher income and education, fewer depressive symptoms, and higher baseline SAQ Summary Scores (83.5±13.2 vs. 79.6±16.5). After adjusting for baseline SAQ scores, patients without SMuRFs had larger SAQ Summary Score improvements at 12 months than those with SMuRFs (adjusted difference between groups = 2.61 points, 95%CI: 1.29-3.93), but sequential adjustment for clinical and socioeconomic characteristics attenuated this difference (1.69 points, 95% CI 0.40-1.97). Conclusions: Among AMI patients, those without modifiable risk factors had similar health status at 12-months as compared with those having modifiable cardiovascular risk factors, which should provide reassurance to those with less targets for secondary prevention.

The Diagnosis and Prognosis Value of Circulating Exosomal lncRNA MALAT1 and LNC_000226 in Patients With Acute Myocardial Infarction: An Observational Study.

Acute myocardial infarction (AMI) stands as a leading cause of global morbidity and mortality. This study aims to explore the potential roles of circulating exosomal lncRNA MALAT1 and LNC_000226 in AMI diagnosis and prognosis. This retrospective observational study included 90 patients with AMI and 88 patients with normal coronary artery (NCA). Plasma exosomes were isolated via ultracentrifugation, and the levels of exosomal lncRNA MALAT1 and LNC_000226 were examined using qRT-PCR. Major adverse cardiovascular events (MACEs) that occurred during 1-year follow-up post-stent implantation were collected. The diagnostic value of exosomal MALAT1 and LNC_000226 was determined by receiver operating characteristic (ROC) analysis. The association between exosomal LNC_000226 and MACEs was assessed by Kaplan-Meier and Cox regression analysis. Both lncRNA MALAT1 and LNC_000226 levels in plasma exosomes were elevated in AMI patients compared to NCA controls. Moreover, LNC_000226 (AUC: 0.889, sensitivity: 82%, specificity: 72%) exhibited superior diagnostic performance compared to MALAT1 (AUC: 0.707, sensitivity: 71%, specificity: 57%). During 1-year follow-up period, the incidence of MACEs was significantly higher among patients with high exosomal LNC_000226 levels compared to those with low exosomal LNC_000226 levels [64% (29/45) vs. 40% (18/45), p < 0.05]. Multivariable Cox regression analysis revealed a positive association between exosomal LNC_000226 level and the risk of MACEs in AMI patients (HR: 1.959, 95% CI: 1.040-3.689). Circulating exosomal lncRNA MALAT1 and LNC_000226 are promising biomarkers for diagnosing AMI, with LNC_000226 potentially indicating a prognosis.

Increased perivascular fibrosis and pro-fibrotic cellular transition in intramyocardial blood vessels in myocardial infarction patients

Background and objectivesStructural and functional changes in the intramyocardial microcirculation increase the risk of myocardial infarction (MI). This study investigated intramyocardial perivascular fibrosis and pro-fibrotic cellular transitions in deceased acute and subacute MI patients to explore their involvement in the pathogenesis of MI. MethodsLeft ventricular tissue (LV) was obtained from the infarction area of autopsied patients with acute-phase MI (3–6 h; n = 24), subacute-phase MI (5–14 days; n = 12), and noninfarcted controls (n = 14). Perivascular fibrosis and fibroblast activation protein (FAP) expression were quantified using (immuno)histochemistry. Fibroblast-like transitioning of vascular smooth muscle cells (VSMC) and endothelial cells (EC) was quantified using immunofluorescent microscopy. ResultsPerivascular fibrosis was elevated in acute-phase (77.69 %) and subacute-phase (72.19 %: border zone 95.18 %: infarct core) MI patients (p < 0.0001) compared to controls (61.03 %). FAP expression was higher in both acute-phase (1.46 %) and subacute-phase (18.01 %: border zone 5.67 %: infarct core) compared to controls (0.46 %) (p < 0.05). VSMC fibroblast-like cellular transition (SMA + S100A4+ vessels fraction) was higher in acute-phase (31.96 %) and subacute-phase (21.90 %: border zone; 37.25 %: infarct core) MI compared to controls (8.95 %) (p < 0.05). Similarly, EC fibroblast-like cellular transition (CD31 + S100A4+ area fraction) was increased in acute-phase MI (10.14 %) and subacute-phase MI (8.31 %: border zone 10.15 %: infarct core) compared to controls (2.67 %) (p < 0.05). ConclusionIncreased perivascular fibrosis, fibroblast activation and vascular cellular transition in intramyocardial blood vessels of MI patients may contribute to MI development. Further increases of FAP expression and perivascular fibrosis, particularly in subacute-phase infarct cores, suggest MI itself exacerbates fibroblast activation and perivascular fibrosis, theoretically increasing reinfarction risk.

Thrombus aspiration in primary percutaneous coronary intervention in acute ST-elevation myocardial infarction patients with high thrombus burden: one-year outcomes in a tertiary healthcare center in Ho Chi Minh City

Abstract Background Primary percutaneous coronary intervention (PCI) can dislodge atherosclerotic debris, risking microvascular embolism. Thrombus aspiration (TA) before stenting in ST-segment elevation myocardial infarction (STEMI) patients has been linked to reduced mortality, lower recurrence of heart attacks, and improved cardiac function. However, limited research exists on the effectiveness of TA in Vietnam, underscoring the need for further studies to enhance cardiovascular care. This prospective observational study was conducted to evaluate the role of TA in STEMI patients admitted with a substantial thrombus burden at Nguyen Tri Phuong Hospital. Results Out of 92 participants, 68 underwent TA treatment. Post-treatment, the TA group exhibited better TIMI and TMP flow grades and a higher rate of ST-segment normalization, with no significant difference in major adverse cardiac events (MACEs) at 30-day and 12-month follow-ups compared to those untreated. Conclusions TA during PCI enhances ST-segment normalization and TIMI and TMP scores in STEMI patients, improving myocardial perfusion. No difference in MACE occurrence was noted between groups after 30 days and 12 months, suggesting TA’s potential benefits without increasing adverse outcomes.

A cross sectional study on prevalence of hypomagnesemia and hypokalemia in patients with STEMI and its relationship with occurrence of arrhythmias

Background: Cardiovascular disease is one of the leading causes of mortality, morbidity, and increased health-care cost. Magnesium and potassium has been implicated in the pathogenesis of acute myocardial infarction (AMI) and its complications. Magnesium ions and potassium ions are considered essential for the maintenance of functional integrity of myocardium. The serum magnesium and potassium concentration was found to have great significance in AMI. The present study was undertaken to evaluate the prognostic value of serum magnesium and potassium in AMI. Aim: This study aimed to assess the dynamic changes in serum magnesium and potassium levels in acute STEMI patients and evaluate whether these levels correlate with presence of arrhythmias. Materials and methods: A comprehensive analysis was conducted over 18 months on 100 patients with acute STEMI. ECG examination was done and blood sample was taken for evaluation of serum magnesium and serum potassium. Statistical analysis was performed to examine correlation with MI and arrhythmias. Results: In the present study 51-60 years of age were maximum, males were most commonly seen. Mean ±SD of serum magnesium in VPC was 1.900±.3232, sinus tachycardia was 1.850±.1195, maximum in RBBB was 2.200±.000 followed by RBBB/CHB was 2±0, and minimum in 1.288±.5621. Results were found to be significant when comparing type of arrhythmia with serum magnesium. Mean ±SD of serum potassium in VPC was 3.030±.9627, sinus tachycardia was 3.638±.4502, maximum in RBBB was 4.600±.000 and minimum VT/RBBB in 2.850±1.0344. Results were found to be significant. Conclusion: Patients of AMI with low serum magnesium and potassium levels are found to be more prone to develop arrhythmias as compared to those with normal serum magnesium and potassium levels. Hence, it can be concluded that measurement of serum magnesium and potassium level is of prognostic significance in AMI.

Impact of regional medical self-sufficiency on mortality from cancer, stroke and myocardial infarction

ObjectivesThis study aimed to explore the impact of regional medical self-sufficiency on mortality from cancer, stroke and myocardial infarction (MI), and make policy suggestions to address regional health disparities and promote national health outcomes. Study designA multilevel analysis of nationwide data. MethodsThis study employed the Korean National Health Insurance Service-National Sample Cohort database at the individual level and the Korean Medical Utilization Statistics at the regional level. The study population included 31,862 individuals who were newly diagnosed with cancer, 16,793 with stroke and 2936 with MI between 2011 and 2019. Multilevel logistic regression was used to address the clustered structure of regional-level data with individual-level data on demographics and health details nested within it. ResultsRegional medical self-sufficiency did not significantly impact 1-year mortality in cancer patients. For patients with stroke and MI, a low level of medical self-sufficiency in the residential area was associated with a notably increased likelihood of dying within 1 month by 1.03 (95 % confidence interval [CI]: 1.02–1.07) and 1.44 (95 % CI: 1.08–2.01) times, respectively. Stratified analysis by region of residence showed that even if cancer patients lived in Seoul and metropolitan areas, they had an increased risk of death within 1 year if the medical self-sufficiency of their treatment areas was low (adjusted odds ratio [aOR]: 1.19, 95 % CI: 1.03–1.38). Moreover, for patients with MI living in medically underserved areas, the risk of death tended to increase with lower income. ConclusionsThe findings demonstrated that for acute stroke or MI patients, living in areas with low self-sufficiency of medical care had a higher likelihood of dying within 1 month. To improve national health outcomes and address regional medical disparities, it is crucial to prioritise policies such as establishing specialised centres dedicated to managing acute cardio-cerebrovascular conditions in each region.

Fear of progression in patients with acute myocardial infarction: a cross-sectional study

BackgroundAcute myocardial infarction (AMI) is the most serious manifestation of coronary artery disease. At present, existing treatments cannot change the risk factors for the occurrence of the disease, so patients are prone to fear of progression or recurrence, and studies have shown that excessive fear will cause patients to over-examine, mental abnormalities, suicide and other behaviors, increase unnecessary medical care costs and the social medical burden. Thus to investigate the current situation of progression fear in patients with Acute Myocardial Infarction (AMI) admitted to hospital in stable stage and analyze its influencing factors.MethodsThis is a cross-sectional study. In this study, 160 AMI patients admitted to the Department of Cardiology of a 3 A hospital in Changchun from November 2022 to April 2023 were selected as the research sample by a convenient sampling method. Patients completed the general information questionnaire, the Fear of Progression Questionnaire-Short Form (FoP-Q-SF), the Brief Illness Perception Questionnaire (BIPQ), the Medical Coping Modes Questionnaire (MCSQ), the Social Support Rating Scale (SSRS), and the Positive Psychological Questionnaire (PPQ) at the time of stable condition. Using SPSS 25.0 software for data analysis, statistical methods mainly include descriptive statistics, analysis of variance, Pearson correlation analysis and multiple linear regression analysis.ResultsA total of 160 subjects were included, among which the score of simplified fear of progression scale was (33.43 ± 7.09), and the incidence of disorder of fear of progression was 50.60%. The influencing factors included gender (Beta = 0.118, P<0.05), disease perception (Beta = 0.445, P<0.001), psychological capital (Beta=-0.252, P<0.05) and resignation (Beta = 0.167, P < 0.05).ConclusionThe overall level of fear of progression in patients with AMI at the stable stage of hospitalization is above the medium level. Nursing staff should focus on AIM patients suffering from multiple diseases and lacking awareness of their own diseases, and provide personalized health guidance and psychological nursing targeted to improve patients’ rehabilitation, quality of life and FoP level.

SCAI cardiogenic shock classification for predicting short-term mortality in acute myocardial infarction

Background: Cardiogenic shock (CS) remains a critical complication of acute myocardial infarction (AMI) with severe outcomes. The Society for Cardiovascular Angiography and Interventions (SCAI) classification is a valuable tool for assessing the severity and progression of CS. Objectives: Our study aimed to evaluate the association between initial SCAI classification and 30-day mortality in AMI patients and assess the prognostic value of SCAI changes within 24 hours post-admission. Methods: All patients with AMI were classified according to the SCAI stages at admission and re-evaluated after 24 hours. 30-day mortality rates were compared across SCAI stages, and Cox regression analysis was used to assess the risk of death based on 24-hour transition SCAI classification. Results: At admission, among 232 AMI patients, 50.8% were classified as SCAI A, 21.6% as SCAI B, 23.3% as SCAI C, and 4.3% as SCAI D/E. The 30-day mortality rates for each classification were 1.7% for SCAI A, 30.0% for SCAI B, 68.5% for SCAI C, and 90% for SCAI D/E. Within 24 hours of admission, 14.5% of patients experienced a worsening SCAI stage, 73.4% remained unchanged SCAI, and 12.1% showed improved SCAI. Patients with a worsening SCAI classification had a significantly higher risk of 30-day mortality, with an adjusted hazard ratio (HR) of 50.4 compared to those with stable SCAI status (p log-rank = 0.00001). Conversely, patients with stable or improved SCAI stages had notably lower mortality rates. Conclusion: The initial SCAI stage at admission and its changes within 24 hours are crucial predictors of 30-day mortality in AMI patients with CS.

Association between stress hyperglycemia ratio and mortality in acute myocardial infarction patients with and without atrial fibrillation: a retrospective cohort study from the MIMIC-IV database

BackgroundThe stress hyperglycemia ratio (SHR) potently predicts adverse outcomes in patients with acute myocardial infarction (AMI), and previous studies reported U-shaped relationships between SHR and adverse prognosis. However, the relationship between SHR and mortality risk in AMI patients with or without atrial fibrillation (AF) remained unknown, and which factors affect the mortality in lower SHR patients were unclear. This study aims to research the relationship between SHR and mortality risk in AMI patients with or without AF, and whether AF affects the mortality in lower SHR patients.MethodsWe conducted a cohort study using data from 3233 patients with a first diagnosis of AMI from the MIMIC-IV (version 2.2) database. Patients were divided into two groups based on AF. The study outcome was 1-year all-cause mortality. SHR was defined as the index calculated by the formula: SHR = (admission glucose) (mmol/L) / (1.59 * HbA1c [%] – 2.59).ResultsU-shaped association between SHR and all-cause mortality was found only in AMI patients with AF, not in AMI patients without AF. For AMI patients with AF, the inflection point for the curve was found to be a SHR of 1.09, either lower (OR, 0.30; 95%CI, 0.10, 0.94) or higher (OR, 3.28; 95%CI, 2.01, 5.34) SHR is associated with increased mortality. However, a linear relationship was found in patients without AF, higher (OR, 1.95; 95%CI, 1.52, 2.51) SHR is associated with increased mortality. For patients with SHR ≤ 1.09, AF increased the risk of all-cause mortality(OR, 1.50; 95%CI, 1.10, 2.05), while this effect was not found in patients with SHR > 1.09.ConclusionThe association between SHR and mortality in AMI patients with or without AF is different: U-shaped association between SHR and all-cause mortality only in AMI patients with AF, not in AMI patients without AF. AF is a factor that make the difference by increasing the risk of mortality in AMI patients with low SHR. Lower SHR may increase mortality through the onset of AF. This study emphasizes avoiding “relative hypoglycemia”, SHR = 1.09 is the moderately tight glycemic control, which means glucose level is about (1.59 * HbA1c [%] – 2.59) * 1.09 mmol/L.Trial registrationClinical trial number: not applicable.

Impact of Baseline Hypoalbuminemia on Long-Term Survival Following Acute Myocardial Infarction According to Body Mass Index

Serum albumin and body mass index (BMI, kg/m2) have been associated with outcomes following acute myocardial infarction (AMI). Aiming to assess whether the mortality risk inflicted by hypoalbuminemia (&lt;3.5 g/dL) in this context is influenced by BMI, we conducted a retrospective analysis of AMI survivors hospitalized during 2004–2017. Stratified by admission-time albumin level and BMI, eligible cases were evaluated for all-cause mortality up to 10 years after discharge. A total of 6283 individuals (74.1% males, mean age 64.1 ± 13.1 years, 44.3% with ST-elevation MI) were included. Of them, 22.7% had hypoalbuminemia and 1.2%, 41.0%, and 28.6% were underweight (BMI &lt; 18.5), overweight (BMI 25–30), and obese (BMI ≥ 30), respectively. Over a median of 7.9 (IQR, 4.8–10.0) years of follow-up, 42.5% of patients died. Hypoalbuminemia was independently associated with a heightened mortality risk overall (AdjHR = 1.54, 95%CI 1.42–1.67, p &lt; 0.001), accounted for by the normal weight (AdjHR = 1.73, 95%CI 1.50–1.99, p &lt; 0.001), overweight (AdjHR = 1.55, 95%CI 1.35–1.79, p &lt; 0.001), and class 1 obesity (BMI 30–35) (AdjHR = 1.37, 95%CI 1.12–1.68, p = 0.002) subgroups. Upon interaction analysis, the mortality risk imposed by hypoalbuminemia was most pronounced among individuals with normal BMI. In conclusion, hypoalbuminemia constituted a negative prognostic marker for long-term survival in AMI patients with normal or mildly elevated but not reduced or severely increased BMI. Pending further research, addressing hypoalbuminemia based on BMI range may prove beneficial.

Risk analysis and risk prediction of in-hospital heart failure in patients with acute myocardial infarction after emergency intervention surgery

BackgroundPercutaneous coronary intervention (PCI) can rapidly open the culprit vessels of acute myocardial infarction (AMI) and save ischemic myocardium, but it is often accompanied by a variety of complications, including heart failure (HF).Please check if the article title is presented correctlyYes, it is presented correctlyObjectiveWe aimed to (i) analyze the possible risk factors affecting the occurrence of in-hospital HF after emergency PCI in patients with AMI through clinical data and (ii) establish a personalized risk prediction model for the occurrence of HF after emergency PCI in patients with AMI.Please check if the author names and affiliations are captured correctlyYes, they are captured correctlyMethodsClinical data of 676 AMI patients who consecutively underwent emergency PCI between January 2020 and October 2023 at the First Affiliated Hospital of Guangxi University of Chinese Medicine were collected. Based on whether in-hospital HF occurred after PCI, the study subjects were divided into the HF group (91 cases) and the non-HF group (585 cases). Independent risk factors were screened using univariate and multivariate logistic regression. A nomogram model of the risk of HF was drawn using R, and the discriminative power was evaluated by calculating the area under the ROC curve and drawing the calibration curve and decision curve.ResultsIn this study, the incidence of in-hospital HF events in AMI patients after emergency PCI was 13.46%. The analysis showed that age, troponin levels, D-dimer levels, left ventricular ejection fraction (LVEF), and Gensini score were independent predictors of the occurrence of in-hospital HF in AMI patients after emergency PCI (P < 0.05). The AUC of the nomogram model were 0.87 (95% CI: 0. 82–0.91) and 0.85 (95% CI: 0. 76–0.93) in the training and validation sets, respectively. The Hosmer–Lemeshow goodness-of-fit test in the training set suggested that the difference between predicted and actual risks of the predictive model was not statistically significant (χ2 = 5.8185, P = 0.6676), and this was confirmed by the Hosmer–Lemeshow goodness-of-fit test in the validation set (χ2 = 9.4774, P = 0.3036).ConclusionsThe predictive model for the risk of in-hospital HF in AMI patients after emergency PCI includes age, troponin levels, D-dimer levels, LVEF, and Gensini score. It has a good differentiation ability and good accuracy, it can be used to intuitively and independently screen high-risk populations, and it has high predictive value for the occurrence of HF after PCI in AMI patients, so it can be used to assist clinicians in early screening, in identifying patients at high risk of postoperative HF, and in the implementation of targeted intervention therapy.Please check if "Strengths and limitations of this study" was captured and presented correctlyYes, it was captured and presented correctly

Diagnostic and prognostic values of HCG15 and morrbid in acute myocardial infarction.

Acute myocardial infarction (AMI) represents the gravest manifestation of ischemic heart disease, with the primary cause of mortality and morbidity worldwide. Although timely and accurate diagnosis of AMI is crucial in clinical practice, they are impeded by the limitation of current biomarkers. We aimed to explore the potential predictive value of two novel long non-coding RNA (lncRNA) HCG15 and Morrbid in AMI diagnosis and prognosis. We measured the lncRNA levels in the blood samples of 412 AMI patients and 111 healthy volunteers with the RT-PCR method. Receiver operating characteristic (ROC) curves were plotted to access the diagnostic value of selected lncRNAs. Restricted cubic splines (RCS) and the Kaplan-Meier method were utilized to examine the predictive value of the selected lncRNAs in AMI diagnosis. ROC curves identified an acceptable diagnostic value of HCG15 and Morrbid (AUC for HCG15: 0.937; AUC for Morrbid: 0.940). RCS and Kaplan-Meier analysis revealed the cut-off value of 3.6 for HCG15 and 4.0 for Morrbid have a good predictive value in MACCE within 12 months once AMI was diagnosed (p-value for HCG15: p = 0.025; p-value for Morrbid: p < 0.0001). HCG15 and Morrbid were confirmed as promising lncRNA biomarkers for both diagnosis and prognosis of AMI in this study. Additionally, their importance of application in real-world clinical practice and underlying mechanisms in AMI diagnosis and prognosis remain to be explored.

The predictive value of CK-MB on the curative effect of urokinase combined with LMWH calcium in AMI.

This study investigates the predictive value of CK-MB in treating acute myocardial infarction (AMI) with urokinase combined with low molecular weight heparin (LMWH) calcium. AMI patients treated at our hospital from April 2020 to August 2022 were included in this prospective, multi-center cohort study. Patients were randomly assigned to a urokinase group or a combined treatment group (urokinase plus LMWH). CK-MB levels were measured using ELISA, and adverse reactions were recorded. The accuracy of CK-MB as a predictor was evaluated via ROC curve analysis and AUC. Before treatment, CK-MB levels were similar in both groups (p > 0.05). Post-treatment, levels were significantly lower in the combined group (p < 0.05). The combined group had a higher proportion of mild CK-MB elevation and lower moderate/severe elevations (p < 0.05). Adverse reaction rates were similar (p > 0.05). The combined treatment group showed higher effectiveness (p < 0.05), with better sensitivity (94%) and specificity (82%) than the urokinase group (sensitivity 89%, specificity 78%). CK-MB is a valuable predictor for evaluating the efficacy of urokinase plus LMWH in AMI treatment, offering advantages in reducing CK-MB levels and improving outcomes.

Differential statin intensity and outcomes in patients following myocardial infarction with very low low-density lipoprotein cholesterol.

Despite increasing evidence on the benefits of statin therapy for acute myocardial infarction (AMI), differential outcomes in accordance with statin intensity have not been evaluated in patients with AMI and low-density lipoprotein cholesterol (LDL-C) levels < 55 mg/dL. Therefore, this study aimed to compare the clinical outcomes of high- and moderate-intensity statin therapy in this population. A total of 752 participants with AMI and LDL-C levels < 55 mg/dL from a Korean nationwide multicenter observational cohort (2016-2020) were included and categorized into two groups: high-intensity statin group (n = 384) and moderate-intensity statin group (n = 368). The primary outcome was 1-year major adverse cardiac and cerebrovascular events (MACCEs). Propensity score matching (PSM) and Cox models were used to determine whether statin intensity independently influenced the primary outcome. Compared to the moderate-intensity statin group, the high-intensity statin group had a comparable risk of MACCE in all Cox models and PSM-adjusted analyses. The cumulative incidence of MACCE was comparable between the two groups. Statin intensity appeared to have no significant impact on clinical outcomes in AMI patients with LDL-C levels < 55 mg/dL. These results underscore the need for further investigations aimed at refining treatment strategies for this specific patient cohort, potentially reducing treatment-related burdens without compromising clinical effectiveness.

Overexpression of long non-coding RNA cytoskeleton regulator RNA in patients with acute myocardial infarction with arrhythmia.

Complications of arrhythmia often occur in patients with acute myocardial infarction (AMI). This study mainly explored the expression and diagnostic significance of long non-coding RNA CYTOR (lncRNA CYTOR) in patients with AMI with arrhythmia, and analyzed the effects of CYTOR on inflammation and oxidative stress responses of cardiomyocytes. CYTOR expression in serum samples from 119 cases of AMI with arrhythmia and 119 healthy subjects was determined by qRT-PCR. Receiver operating characteristic (ROC) curve was drawn to evaluate the diagnostic function of serum CYTOR in AMI with arrhythmia. AMI cell models were constructed by hypoxia/reoxygenation treatment. The pathological function of CYTOR in AMI was determined by the detection of inflammatory factors and oxidative stress indicators. Serum CYTOR was upregulated in patients with AMI with arrhythmia, which has a certain ability to distinguish patients from healthy individuals (P<0.001, AUC=0.8963). The levels of interleukin-1beta (IL-1β), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and malondialdehyde (MDA) were increased in the AMI cell model, while superoxide dismutase (SOD) levels were decreased (P<0.001), which was alleviated by silencing CYTOR. Overexpression of CYTOR may aggravate the condition of AMI patients with arrhythmia, which promotes oxidative stress injury and inflammatory response of cardiomyocytes. CYTOR can be a reference factor for diagnostic biomarkers of AMI with arrhythmia.