Prognosis Of Acute Myocardial Infarction Research Articles

From Classic to Modern Prognostic Biomarkers in Patients with Acute Myocardial Infarction.

Despite all the important advances in its diagnosis and treatment, acute myocardial infarction (AMI) is still one of the most prominent causes of morbidity and mortality worldwide. Early identification of patients at high risk of poor outcomes through the measurement of various biomarker concentrations might contribute to more accurate risk stratification and help to guide more individualized therapeutic strategies, thus improving prognoses. The aim of this article is to provide an overview of the role and applications of cardiac biomarkers in risk stratification and prognostic assessment for patients with myocardial infarction. Although there is no ideal biomarker that can provide prognostic information for risk assessment in patients with AMI, the results obtained in recent years are promising. Several novel biomarkers related to the pathophysiological processes found in patients with myocardial infarction, such as inflammation, neurohormonal activation, myocardial stress, myocardial necrosis, cardiac remodeling and vasoactive processes, have been identified; they may bring additional value for AMI prognosis when included in multi-biomarker strategies. Furthermore, the use of artificial intelligence algorithms for risk stratification and prognostic assessment in these patients may have an extremely important role in improving outcomes.

Cytokine storm: behind the scenes of the collateral circulation after acute myocardial infarction.

At least 17 million people die from acute myocardial infarction (AMI) every year, ranking it first among causes of death of human beings, and its incidence is gradually increasing. Typical characteristics of AMI include acute onset and poor prognosis. At present, there is no satisfactory treatment, but development of coronary collateral circulation (CCC) can be key to improving prognosis. Recent research indicates that the levels of cytokines, including those related to promoting inflammatory responses and angiogenesis, increase after the onset of AMI. In the early phase of AMI, cytokines play a vital role in inducing development of collateral circulation. However, when myocardial infarction is decompensated, cytokine secretion increases greatly, which may induce a cytokine storm and worsen prognosis. Cytokines can regulate the activation of a variety of signal pathways and form a complex network, which may promote or inhibit the establishment of collateral circulation. We searched for published articles in PubMed and Google Scholar, employing the keyword “acute myocardial infarction”, “coronary collateral circulation” and “cytokine storm”, to clarify the relationship between AMI and a cytokine storm, and how a cytokine storm affects the growth of collateral circulation after AMI, so as to explore treatment methods based on cytokine agents or inhibitors used to improve prognosis of AMI.

Correlation between serum laminin levels and prognosis of acute myocardial infarction.

BackgroundAcute myocardial infarction (AMI) is a critical cardiovascular disease (CVD). Laminin (LN) is involved in the process of myocardial fibrosis and ventricular remodeling observed in AMI; however, there are currently no studies on the correlation between LN and AMI prognosis.PurposeTo explore the predictive value of serum LN levels for major adverse cardiovascular events (MACE) in patients, 6 months after an acute myocardial infarction.MethodsA total of 202 AMI patients who were hospitalized in the Department of Cardiology of the Second Affiliated Hospital of Nantong University between December 2019 and December 2020 were included. The observation endpoint was the occurrence of MACE. Univariate and multivariate logistic analyses were used to evaluate the relationships between the variables and endpoint. The predictive value of LN for MACE in AMI patients was assessed using receiver operating characteristic (ROC) analysis.ResultsA total of 47 patients developed MACE. Univariate logistic analysis showed that smoking, emergency percutaneous coronary intervention (EPCI), age, cardiac troponin I (c-TNI) levels, N-terminal prohormone brain natriuretic peptide (NT-proBNP) levels, and LN levels were associated with the occurrence of MACE (p < 0.05). Multivariate logistic analysis showed that LN was an independent predictor of MACE (odds ratio [OR] = 1.021, 95%CI: 1.014–1.032, p < 0.001). According to the ROC curve, LN can be used as an effective predictor of MACE (AUC = 0.856, 95%CI: 0.794–0.918, p < 0.001). According to the cutoff value, LN>58.80 ng/ml (sensitivity = 83.00%, specificity = 76.80%) or LN>74.15 ng/ml (sensitivity = 76.6%, specificity = 83.2%) indicate a poor prognosis for AMI. Different cut-off values are selected according to the need for higher sensitivity or specificity in clinical applications.ConclusionsLN may be a predictor of MACE following AMI in patients and could be utilized as a novel substitute marker for the prevention and treatment of AMI.

Exploration of the Clinical Significance of Blood Routine Test and Coagulation Test in the Prognosis of Acute Myocardial Infarction (AMI)

Exploration of the Clinical Significance of Blood Routine Test and Coagulation Test in the Prognosis of Acute Myocardial Infarction (AMI)

Aberrant Circulating SNHG1 Serves as a Biomarker to Distinguish Acute Myocardial Infarction and Construction of a Risk Model for Secondary Heart Failure.

Abstract: Acute myocardial infarction (AMI) is a severe condition observed in patients with coronary heart disease, and heart failure (HF) often occurs after AMI. This study aimed to evaluate the clinical significance of long noncoding RNA (lncRNA) small nucleolar RNA host gene 1 (SNHG1) in the diagnosis and prognosis of AMI and to construct a logistic predict model to determine the risk of post-AMI HF. This study analyzed the data of 229 patients with AMI. Serum SNHG1 levels were examined using quantitative real-time PCR, and its diagnostic value was evaluated using receiver operating characteristic analysis. The predictive value of SNHG1 for HF onset was evaluated using the Kaplan–Meier method and Cox regression analysis. The risk factors and predictive parameters included in the predictive model of post-AMI HF were determined using multivariate logistic regression analysis. In this study, we found that reduced serum SNHG1 was negatively correlated with the Gensini score of patients with AMI. The diagnostic performance of combining cardiac troponin I (cTnI) and creatine kinase (CK)-MB and SNHG1 was the best. Lower SNHG1 expression served as an independent indicator for HF secondary to AMI. A logistic risk model was constructed with the following equation: , and the predictive accuracy of this model was relatively high with an area under the curve of 0.890. Taken together, our results revealed that reduced SNHG1 combining cTnI and CK-MB had the best diagnostic performance in patients with AMI. A logistic risk model based on SNHG1, age, cTnI, CK-MB, left ventricular ejection fraction, and Gensini score may help to determine the development of HF in patients with AMI.

Clinical Significance of Routine Blood and Coagulation Tests in the Prognosis of Acute Myocardial Infarction

Clinical Significance of Routine Blood and Coagulation Tests in the Prognosis of Acute Myocardial Infarction

Pre-existing Proton Pump Inhibitor Treatment and Short-Term Prognosis of Acute Myocardial Infarction Patients.

IntroductionEvidence suspects proton pump inhibitor (PPI) use is a risk factor of poor prognosis of acute myocardial infarction (AMI). We aimed to investigate the association between pre-existing PPI use before emergency department (ED) visit and short-term prognosis of AMI patients.Materials and MethodsAMI patients admitted to ED were included and categorized as cohorts with or without pre-existing PPI use. Hospital mortality, length of hospital stay, being admitted to intensive care unit (ICU), and length of (total) ICU stay were studied as prognostic outcomes. Multivariable logistic regression or linear regression were used to estimate the associations between pre-existing PPI use and the outcomes after adjusting for potential confounders.ResultsA total of 2001 AMI patients were included. No significant difference was found in hospital mortality and length of ICU stay between cohorts; patients with pre-existing PPI use showed a significantly longer length of hospital stay (median 3.81 vs. 3.20 days, P = 0.002) but lower proportion of being admitted to ICU (25.59% vs. 40.83%, P < 0.001) compared to those without pre-existing PPI use. Pre-existing PPI use was not associated with hospital mortality [odds ratio (OR) 1.08, 95% confidence interval (CI) 0.58–1.99], length of hospital stay (β = 0.23, 95% CI −0.35 to 0.82), and length of ICU stay (β = −0.18, 95% CI −1.06 to 0.69), but was statistically significantly associated with lower risk of being admitted to ICU (OR 0.69, 95% CI 0.52–0.92).ConclusionThe current study does not support newly diagnosed AMI patients with pre-existing PPI use before ED visit would experience worse short-term prognosis than those without.

Long-Term Prognosis of Acute Myocardial Infarction Associated With Metabolic Health and Obesity Status

ObjectiveEmerging evidence supports the favorable cardiovascular health in nonobese subjects with healthy metabolism. However, little is known regarding the prognosis across the range of metabolic phenotypes once cardiovascular disease is established. We examined the prognosis of patients with acute myocardial infarction (AMI) stratified according to metabolic health and obesity status. MethodsThis is a retrospective study on consecutive patients with AMI admitted to a tertiary hospital between 2014 and 2021. Patients were allocated into the following 4 groups based on metabolic and obesity profile: (1) metabolically healthy obese (MHO), (2) metabolically healthy nonobese (MHNO), (3) metabolically unhealthy obese (MUO), and (4) metabolically unhealthy nonobese (MUNO). Metabolic health was defined in accordance to the Biobank Standardisation and Harmonisation for Research Excellence in the European Union Healthy Obese Project. The primary outcome was all-cause mortality. The Cox regression analysis examined the independent association between mortality and metabolic phenotypes, adjusting for age, sex, AMI type, chronic kidney disease, smoking status, and left ventricular ejection fraction. ResultsOf 9958 patients, the majority (68.5%) were MUNO, followed by MUO (25.1%), MHNO (5.6%), and MHO (0.8%). MHO had the lowest mortality (7.4%), followed by MHNO (9.7%), MUO (19.2%), and MUNO (22.6%) (P < .001). Compared with MHNO, MUO (hazard ratio [HR], 1.737; 95% confidence interval [CI], 1.282-2.355; P < .001) and MUNO (HR, 1.482; 95% CI, 1.108-1.981; P = .008) had a significantly higher mortality risk but not MHO (HR, 1.390; 95% CI, 0.594-3.251; P = .447), after adjusting for confounders. The Kaplan-Meier curves showed favorable survival in the metabolically healthy and obesity groups, with the highest overall survival in the MHO, followed by MHNO, MUO, and MUNO (P < .001). ConclusionMetabolically healthy and obese patients with AMI have favorable prognosis compared with metabolically unhealthy and nonobese patients. It is equally important to prioritize intensive metabolic risk factor management to weight reduction in the early phase after AMI.

Disruption of Circadian Rhythms by Shift Work Exacerbates Reperfusion Injury in Myocardial Infarction

BackgroundShift work is associated with increased risk of acute myocardial infarction (AMI) and worsened prognosis. However, the mechanisms linking shift work and worsened prognosis in AMI remain unclear. ObjectivesThis study sought to investigate the impact of shift work on reperfusion injury, a major determinant of clinical outcomes in AMI. MethodsStudy patient data were obtained from the database of the EARLY-MYO-CMR (Early Assessment of Myocardial Tissue Characteristics by CMR in STEMI) registry, which was a prospective, multicenter registry of patients with ST-segment elevation myocardial infarction (STEMI) undergoing cardiac magnetic resonance (CMR) imaging after reperfusion therapy. The primary endpoint was CMR-defined post-reperfusion infarct size. A secondary clinical endpoint was the composite of major adverse cardiac events (MACE) during follow-up. Potential mechanisms were explored with the use of preclinical animal AMI models. ResultsOf 706 patients enrolled in the EARLY-MYO-CMR registry, 412 patients with STEMI were ultimately included. Shift work was associated with increased CMR-defined infarct size (β = 5.94%; 95% CI: 2.94-8.94; P < 0.0001). During a median follow-up of 5.0 years, shift work was associated with increased risks of MACE (adjusted HR: 1.92; 95% CI: 1.12-3.29; P = 0.017). Consistent with clinical findings, shift work simulation in mice and sheep significantly augmented reperfusion injury in AMI. Mechanism studies identified a novel nuclear receptor subfamily 1 group D member 1/cardiotrophin-like cytokine factor 1 axis in the heart that played a crucial role in mediating the detrimental effects of shift work on myocardial injury. ConclusionsThe current study provided novel findings that shift work increases myocardial infarction reperfusion injury. It identified a novel nuclear receptor subfamily 1 group D member 1/cardiotrophin-like cytokine factor 1 axis in the heart that might play a crucial role in mediating this process. (Early Assessment of Myocardial Tissue Characteristics by CMR in STEMI [EARLY-MYO-CMR] registry; NCT03768453)

STUDY OF PROGNOSTIC VALUE OF RATIO OF NEUTROPHIL TO LYMPHOCYTE TO PREDICT PROGNOSTIC OUTCOMES IN PATIENTS WITH ACUTE ST ELEVATION MYOCARDIAL INFARCTION.

Introduction: Atherosclerosis is a inammatory disease of arterial wall which have multifactorial causes. So study was done to investigate the role of neutrophil lymphocyte ratio in prediction of in hospital adverse events in ST elevated myocardial infarction (STEMI) patients thrombolysed with streptokinase (SK). Material and methods: The study consisted observational retrospective longitudinal study. In this 70 patients [47 (67.1%) men, 23(32.8%) women, mean age 53.6 ± 11.16 years], diagnosed case of acute ST elevation MI. Patints were devided in two group according to NLR (High NLR and Low NLR) detected by CBC. Result: A Total of 42 cases developed complications; in high NLR groups had higher rate of complications like Arrhythmia 6(60%), cardiogenic shock 12(80%), heart failure 10(77%), Post MI Angina 2 (50%) in hospital than those in low NLR group. Conclusion: Our ndings reveal that N/L ratio, a simple marker which can be derived from a routine complete blood count test was signicantly and independently related to prognosis of Acute myocardial infarction.

Plasma Quantitative Lipid Profiles: Identification of CarnitineC18:1-OH, CarnitineC18:2-OH and FFA (20:1) as Novel Biomarkers for Pre-warning and Prognosis in Acute Myocardial Infarction

This study was aimed to determine the association between potential plasma lipid biomarkers and early screening and prognosis of Acute myocardial infarction (AMI). In the present study, a total of 795 differentially expressed lipid metabolites were detected based on ultra-performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS). Out of these metabolites, 25 lipid metabolites were identified which showed specifical expression in the AMI group compared with the healthy control (HC) group and unstable angina (UA) group. Then, we applied the least absolute shrinkage and selection operator (LASSO) and support vector machine-recursive feature elimination (SVM-RFE) methods to obtain three lipid molecules, including CarnitineC18:1-OH, CarnitineC18:2-OH and FFA (20:1). The three lipid metabolites and the diagnostic model exhibited well predictive ability in discriminating between AMI patients and UA patients in both the discovery and validation sets with an area under the curve (AUC) of 0.9. Univariate and multivariate logistic regression analyses indicated that the three lipid metabolites may serve as potential biomarkers for diagnosing AMI. A subsequent 1-year follow-up analysis indicated that the three lipid biomarkers also had prominent performance in predicting re-admission of patients with AMI due to cardiovascular events. In summary, we used quantitative lipid technology to delineate the characteristics of lipid metabolism in patients with AMI, and identified potential early diagnosis biomarkers of AMI via machine learning approach.

Serum cystatin C is associated with the prognosis in acute myocardial infarction patients after coronary revascularization: a systematic review and meta-analysis

ObjectiveOur study aimed to assess the association between serum cystatin C levels and prognosis in acute myocardial infarction (AMI) patients after coronary reconstructive surgery.MethodsWe searched PubMed, Embase, and Cochrane Library up to January 21, 2022 without language restriction. Outcomes were major cardiovascular events (MACEs) and mortality. The risk ratio (RR) and 95% confidence interval (CI) were merged by random-effect models.ResultsWe included 8 studies with a total of 7,394 subjects in our meta-analysis. Our meta-analysis showed that higher-level of serum cystatin C levels were associated with higher risk of MACEs (RR = 2.52, 95% CI 1.63–3.89, P < 0.001) and mortality (RR = 2.64, 95% CI 1.66–4.19, P < 0.001) in AMI patients after coronary revascularization. Subgroup analysis showed that the serum cystatin C levels were associated with significantly higher risk of MACEs (RR = 2.72, 95% CI 1.32–5.60, P = 0.006) and mortality (RR = 2.98, 95% CI 1.21–7.37, P = 0.020) in AMI patients after percutaneous coronary intervention (PCI). However, in AMI patients after coronary artery bypass surgery, there were no significantly higher risk of MACEs (RR = 2.41, 95% CI 0.98–5.93, P = 0.05) and mortality (RR = 3.15, 95% CI 0.76–13.03, P = 0.10). Further subgroup analysis showed that this significantly higher risk of MACEs and mortality did not change with the study sample size, study population area or study follow-up time.ConclusionThe meta-analysis demonstrated that higher serum cystatin C levels were associated with significantly higher risk of MACEs and mortality in AMI patients after PCI. It is a biomarker for risk stratification for predicting the prognosis in AMI patients after PCI.

Associations of serum expressions of miR-499 and sex determining region Y-box 6 with prognosis of acute myocardial infarction patients

Abstract Background: To explore the associations of serum expressions of miR-499 and sex determining region Y-box 6 (SOX6) with major adverse cardiovascular and cerebrovascular events (MACCE) and prognosis of acute myocardial infarction (AMI) patients undergoing percutaneous coronary intervention (PCI). Methods: The clinical data of 132 patients diagnosed from February 2016 to October 2019 were collected. Serum miR-499 and SOX6 expressions were detected by RT-qPCR. Optimal cut-off values were determined using receiver operating characteristic curves, based on which patients were divided into low and high miR-499 expression groups, and high and low SOX6 expression groups. Survival curves were plotted using Kaplan-Meier method, and the independent risk factors for MACCE were explored by multivariate logistic regression analysis. A nomogram model was established based on the factors and validated using internal data. Results: AMI group had higher miR-499 expression and lower SOX6 expression than those of control group (P&lt;0.05). After PCI, miR-499 expression decreased and SOX6 expression increased (P&lt;0.05). Low miR-499 expression group had higher 3-year survival and MACCE-free rates than those of high miR-499 expression group (P&lt;0.05). Low SOX6 expression group had lower 3-year survival and MACCE-free rates than those of high SOX6 expression group (P&lt;0.05). AMI history, LVEF, CK-MB, miR-499 and SOX6 expressions were independent risk factors for MACCE (P&lt;0.05). The nomogram model had high accuracy for predicting overall survival, with a concordance index of 0.742 (95%CI=0.684-0.845). Conclusions: AMI patients have increased serum expression of miR-499 and decreased expression of SOX6. High miR-499 expression is an independent risk factor for poor prognosis. The established nomogram model can be used to predict the risk of MACCE after PCI.

Lactobacillus levels and prognosis of patients with acute myocardial infarction.

OBJECTIVETo explore the relationship between Lactobacillus and prognosis of acute myocardial infarction (AMI) patients treated by percutaneous coronary intervention (PCI) and its correlation with clinical parameters.METHODSConsecutive patients with AMI in the coronary care unit of Tianjin Chest Hospital in China who received emergency PCI between July 2017 and December 2018 were enrolled. Subjects’ fecal 16S rDNA gene sequencing data were analyzed and subjects were categorized into low, medium and high level groups according to stool Lactobacillus measurements. The primary endpoints were major adverse cardiac events. Cox regression analysis was used to analyze the relationship between Lactobacillus and prognosis. Spearman correlation analysis and trend tests were used to assess the relationship between Lactobacillus and the clinical indicators.RESULTSThe data of 254 patients were included in the analysis. Mean age was 65.90 ± 11.56 years, and 152 patients (59.84%) were male. Follow-up time was 652 (548.25−753.00) days. Multivariate Cox regression analysis showed a significantly lower risk of major adverse cardiac events in patients with Lactobacillus > 7.1 copies/g [adjusted hazard ratio (HR) = 0.216, 95% CI: 0.094−0.493,P < 0.001] compared to patients with Lactobacillus ≤ 3.6 copies/g. Statistically significant differences were shown in ST-segment elevation myocardial infarction (STEMI) (HR = 0.217, 95% CI: 0.085−0.551, P = 0.001). Lactobacillus was a protective factor for male smokers aged over 60 years whose brain natriuretic peptide was over 1,000 pg/mL. Spearman correlation analysis showed that Lactobacillus correlated negatively with white blood cells, neutrophils, high-sensitivity C-reactive protein, TroponinT, creatine kinase, creatine kinase-MB and brain natriuretic peptide (downward trend), and correlated positively with left ventricular ejection fraction (upward trend). CONCLUSIONSThis study is the first to reveal the correlation between Lactobacillus and inflammation and myocardial damage after STEMI. STEMI patients, especially male smokers aged over 60 years with severe impairment of cardiac function, have better outcomes with high levels of Lactobacillus, suggesting new therapeutic strategies for improving the prognosis and quality of life of AMI patients.

Liver stiffness assessed by Fibrosis-4 index predicts heart failure in AMI patients

Abstract Funding Acknowledgements Type of funding sources: None. It has been recently reported that the liver stiffness, which reflects increased central venous pressure, measured by transient elastography increases along with decompensated heart failure (HF) developing and decreases with clinical improvement. A simple index for the assessment of liver stiffness and/or impairment of liver reserve may be useful in patients with HF. We calculated each patient´s FIB4 index(F4I) using the following formula: (age (years)× aspartate aminotransferase (IU/L)/platelet count (10９/L)× square root of alanine aminotransferase (IU/L)). Patients with an F4I≥2.67 were classified into the high F4I group and these patients were strongly suspected to have non-alcoholic fatty liver disease (NAFLD). NAFLD is also said to be a form of metabolic syndrome expressed in the liver. And lately NAFLD is associated with increased risk of acute myocardial infarction (AMI) and stroke and cardiovascular surrogate markers. But Little is known about F4I with the influence of AMI prognosis. This study included 167 AMI patients who underwent primary percutaneous coronary intervention within 24h of onset. Consecutive patients were divided into two groups based on their F4I at discharge: First group (2.67 ≤F4I, n = 27), second group (F4I &amp;lt;2.67, n = 140) . And we assessed the association between F4I and CV events including cardiac death, recurrent AMI, recurrent PCI (TLR) and re-hospitalization of heart failure during 13 months. Result: High F4I (2.67≤ F4I ,19% VS F4I &amp;lt;2.67, 6%: P = 0.045) related to the re-hospitalization of heart failure. Univariate odds ratio was 3.45. F4I is significantly related to the re-hospitalization of heart failure. Conclusion: A simple index F4I is significantly related to the prognosis of adverse cardiac events after AMI patients. Abstract Figure. Predictor of Re-hospitalization of HF

Determination of the temporary disability duration in patientswith acute myocardial infarction depending on the body mass index

Prolonged temporary disability in patients with acute myocardial infarction (AMI) is more common in the presence of concomitant abnormalities. Adipokine C1q/TNF-related protein 3 (CTRP-3) is produced by adipose tissue and exhibits anti-inflammatory and cardioprotective properties. The course and prognosis of AMI depend on the presence of comorbid disorders and hence are objects of scientific interest. Aim. To identify risk factors affecting the temporary disability duration in AMI patients depending on body mass index (BMI). Materials and methods. The study involved 189 patients with ST-segment elevation AMI who were divided into 3 groups depending on BMI. The first group included 60 patients with AMI and normal BMI, the second group comprised 68 patients with AMI and excess body weight (EBW) and the third group was composed of 61 AMI patients with obesity. CTRP-3 was determined by enzyme-linked immunosorbent assay. Statistical data were processed using the licensed software package IBM SPPS Statistics (version 27.0). Significance of differences between normally distributed mean values of quantitative variables was assessed by ANOVA with Bonferroni correction for multiple comparisons. The logistic regression method was used to determine the period of temporary disability. The difference was considered significant at a P value ˂ 0.05. Results. In analyzing the studied indicators, a significant decrease in the concentration of CTRP-3 was found in AMI patients with obesity on the first day compared to AMI patients with normal BMI (P &lt; 0.001), which indicated the effect of obesity on the AMI development. The following indicators were determined to construct a model for predicting the duration of temporary disability, namely CTRP-3 on day 1, glucose on day 1, the presence of permanent atrial fibrillation, early complicationsof AMI. Conclusions. The proposed method helped to determine the duration of temporary disability in patients with AMI depending on BMI, which would improve the provision of high-quality diagnostics and treatment of patients by reducing the economic costs of the length of hospital stay.

Elevated plasma proprotein convertase subtilisin/kexin type-9 is associated with poor prognosis of acute myocardial infarction in hypertension patients

Whether serum proprotein convertase subtilisin/kexin type 9 (PCSK9) affects the prognosis of patients after the percutaneous coronary intervention (PCI) in hypertension patients remains unknown. A total of 2350 acute myocardial infarction (AMI) subjects with hypertension after PCI were enrolled. Subjects were under 30-months follow-up and divided into the major cardiovascular adverse event (MACE) Group and the non-MACE Group. Cox regression analysis were performed for the risk factors of occurrence of MACE. The relationship between the level of PCSK9 and Gensin score was analyzed by Pearson correlation. Two hundred and thirty-two patients were divided to the MACE Group. Age over 55 (hazard ratio (HR) = 2.52; p = 0.032), smoking (HR = 1.02; p &lt; 0.001), diabetes mellitus (HR = 1.35; p &lt; 0.001) and PCSK9 levels over 1011.3 ng/mL (HR = 1.05; ptdf &lt; 0.001) were risk factors of occurrence of MACE. Baseline levels of PCSK9 was significantly related with Gensini score in ST segment elevation myocardial infarction (STEMI) patients ( r = 0.51), all patients ( r = 0.37) and non-STEMI patients ( r = 0.34, p &lt; 0.001). A high baseline PCSK9 level was the risk factor of poor prognosis of AMI patients with hypertension after PCI. PCSK9 levels were associated with the Gensini score in STEMI patients. Trial registration: This trial was registered at clinicaltrials.gov as NCT04100434.

Association of Red Blood Cell Distribution Width-Albumin Ratio for Acute Myocardial Infarction Patients with Mortality: A Retrospective Cohort Study.

BackgroundRed blood cell distribution width (RDW) was a risk factor for poor prognosis in acute myocardial infarction (AMI). Recent reports suggested that combining RDW with other laboratory metrics could provide a better prediction. This retrospective study aimed to investigate whether the RDW-albumin ratio (RAR) may be associated with mortality after an AMI.MethodsThis cohort study was conducted among adults (over 16 years old) with AMI in the Medical Information Mart for Intensive Care Database III V1.4 (MIMIC-III). The primary outcome was 30-day mortality, and the secondary outcome was 1-year and 3-year mortality. Cox hazard regression model and Kaplan–Meier survival curves were constructed to estimate the effect of biomarkers on mortality. We used three models to adjust for potential bias. Receiver operating characteristic (ROC) curves and the area under the curve (AUC) were analyzed for the excellent performance of RAR on prognosis.ResultsA total of 826 patients were eventually enrolled in our study. In multivariate analysis, RAR was found to be associated with 30-day mortality (Model 3: HR = 1.23, 95% CI = 1.09-1.39, P < .001). In addition, Subgroup analysis showed that the effect of RAR was higher in female patients than in male patients (P for interaction = .026). Kaplan-Meier survival curves showed that patients in the lower RAR quartile tended to have higher survival rates in the short and long term. AMI patients with RAR ≥ 4 had a 122% increase in 3-year mortality. Results of ROC and AUC showed that the prognostic performance of RAR for mortality was the best (30-day mortality: 0.703; 1-year mortality: 0.729; 3-year mortality: 0.737).ConclusionsRAR is a simple and stable predictor of prognosis in AMI patients. Our results support RAR = 4.0 as a criterion for prognostic risk stratification of AMI patients.

Comparative Evaluation of Salivary and Serum High-Sensitive C-Reactive Protein in Acute Myocardial Infarction.

Aim:The aim of this study is to comparatively evaluate the serum and salivary high-sensitive C-reactive protein (hs-CRP) in patients with acute myocardial infarction (MI).Subjects and Methods:The study group consisted of 60 patients of whom 30 were MI patients and 30 were controls. Serum hs-CRP was assessed using particle-enhanced immunoturbidimetric assay. Saliva hs-CRP is determined using a microplate reader cum UV photospectrometer from BMG.Results:In this study, levels of both serum and salivary hs-CRP in control and MI patients showed a positive correlation. Saliva can be used as an alternative biofluid to determine hs-CRP in MI patients.Conclusion:Saliva can be used as a alternative biofluid to determine the risk as well as to determine prognosis in acute myocardial infarction.

Risk Factors in Young Adults With First Myocardial Infarction

Modifiable risk factors (RFs) play an important role in the development and prognosis of acute myocardial infarction (AMI). This study sought to study the prevalence rates of modifiable RFs during a first AMI, and sex differences in Tunisian young adults. This was a retrospective cohort analysis of a Tunisian tertiary center. From January 2014 to December 2020, we retrospectively studied data of patients with AMI younger than 45 years of age hospitalized for a first AMI. Prevalence rates of hypertension, diabetes mellitus, obesity, smoking, dyslipidemia, and drug abuse were analyzed in these patients. We enrolled 210 patients in the study. The prevalence of AMI in young patients was 8.5%. The mean age was 39.3 ± 4.9 years with a sex ratio of 11. The most frequent cardiovascular risk factors were smoking (88,6%) and dyslipidemia (32%) were the most prevalent risk factors (RF), and 98.6% of patients had at least 1 RF. Hypertension, diabetes, obesity, and drug abuse had a prevalence respectively of 30%, 28%, 8%, and 7.6%. Women had a higher prevalence of diabetes mellitus, hypertension, and obesity, and men had a higher prevalence of dyslipidemia, drug abuse, and smoking. During a first AMI in young adults in whom preventive measures are more likely to be effective, modifiable RFs were highly prevalent and progressively increased over time. Significant sex disparities were observed for individual RFs.