Recurrent Acute Myocardial Infarction Research Articles

Recurrent acute myocardial infarction and atrial fibrillation.

Recurrent acute myocardial infarction and atrial fibrillation.

A Case of Very Late Bare-Metal Coronary Stent Thrombosis Two Weeks after Aspirin Discontinuation, Histopathologic Thrombus Findings and Clinical Considerations

There have been consistent evidences that atherosclerotic changes occur inside bare metal stents (BMS) during an extended period after implantation. This report describes the histopathologic features of aspirated material harvested from a patient with definite very late stent thrombosis of a BMS implanted 18 years prior. The patient presented with a recurrent anterior acute myocardial infarction 14 day after aspirin discontinuation. We suggest that vulnerable neointimal tissue inside the stent struts of BMS may be one potential trigger of thrombosis when the protection of aspirin treatment is ceased.

EVALUATION OF TREATMENT OF PATIENTS WITH ACUTE MYOCARDIAL INFARCTION BEFORE REFERENCE EVENT AND BEFORE DISCHARGE FROM THE HOSPITAL: REGISTER DATA (KHABAROVSK CITY). PART 2

Aim. To study a treatment of patients with acute myocardial infarction (AMI) before and during hospitalization in a Khabarovsk hospital, which has an opportunity of primary percutaneous coronary intervention (PCI), as well as hospital outcomes according to the AMI Register. Material and methods. 321 patients consecutively hospitalized in the Khabarovsk Regional Vascular Center were included into AMI Register: 177 patients with ST-segment elevation AMI (STEMI; 55.1%); 135 patients non-ST-segment elevation AMI (non-STEMI; 42.1%); 9 patients with early recurrence of AMI and early post-infarction stenocardia (2.8%). Results. Before reference AMI a frequency of administration of statins was 13.7%, angiotensin-renin blockers – 29.3%, acetylsalicylic acid – 28.7%, beta-blocker – 25%. Among patients with atrial fibrillation only 7 ones (17%) were treated with oral anticoagulants. 141 patients (79.6%) with STEMI underwent PCI procedure: primary PCI – 82.3% and delayed PCI – 17.7%. PCI with coronary stenting was performed in 86.5% of patients with STEMI. Frequency of PCI in non-STEMI patients was 42%: primary PCI – 43.9%, delayed PCI – 56.1%, PCI with coronary stenting – 43.9%. Gender and age of the patients did not influence the choice of tactics of revascularization in STEMI and non-STEMI (PCI(+), PCI(-), PCI with coronary stenting) (p<0.05). Medication in hospital: double antithrombotic therapy (DATT) was prescribed in 86.9% of patients; direct anticoagulants – in 91.2%, statins – in 97.2%, beta-blockers – in 88.5%; renin-angiotensin-aldosterone system inhibitors – in 90.6%. A total lethality in STEMI was 15.2%, and in non-STEMI – 1.5%. Lethality in PCI-negative patients with STEMI was higher than this in patients with non-STEMI (p<0.001). In STEMI patients lethality was 3.3 times lower in PCI-positive patients in comparison with PCI-negative patients. Conclusion. AMI Register demonstrated that before reference AMI very few patients were covered with modern medicines influencing prognosis. AMI hospital treatment in Khabarovsk Regional Vascular Center was characterized by a high rate of primary PCI, DATT, enoxaparin, and high-dose statin therapy.

Preventing future acute coronary events:Can we find and treat either the vulnerable plaque or the vulnerable, high risk patient?

&lt;p&gt;Acute myocardial infarction (AMI) and sudden cardiac death (SCD) contribute to the leading cause of mortality for adults in the United States – cardiovascular disease. Over the last 3 decades, there have been tremendous improvements in our ability to: rapidly detect (eg. Troponin utilization) and treat acute coronary syndromes (eg.new medications, percutaneous coronary intervention), lower cardiovascular risk (eg. statins) and standardize cardiovascular care through widely available guideline-directed medical therapies. Nevertheless, according to the American Heart Association, in 2010 there were still an estimated 915,000 new or recurrent AMIs and 278,000 SCD events.&lt;sup&gt;1&lt;/sup&gt;So this begs the question, what more can we do to prevent devastating future acute coronary events?&lt;/p&gt;

Predictors and in-hospital prognosis of recurrent acute myocardial infarction.

ObjectiveTo investigate the contributing factors and in-hospital prognosis of patients with or without recurrent acute myocardial infarction (AMI).MethodsA total of 1686 consecutive AMI patients admitted to Peking University People's Hospital from January 2010 to December 2015 were recruited. Their clinical characteristics were retrospectively compared between patients with or without a recurrent AMI. Then multivariable logistic regression was used to estimate the predictors of recurrent myocardial infarction.ResultsRecurrent AMI patients were older (69.3 ± 11.5 vs. 64.7 ± 12.8 years, P < 0.001) and had a higher prevalence of diabetes mellitus (DM) (52.2% vs. 35.0%, P < 0.001) compared with incident AMI patients, they also had worse heart function at admission, more severe coronary disease and lower reperfusion therapy. Age (OR = 1.03, 95% CI: 1.02–1.05; P < 0.001), DM (OR = 1.86, 95% CI: 1.37–2.52; P < 0.001) and reperfusion therapy (OR = 0.74; 95% CI: 0.52–0.89; P < 0.001) were independent risk factors for recurrent AMI. Recurrent AMI patients had a higher in-hospital death rate (12.1% vs. 7.8%, P = 0.039) than incident AMI patients.ConclusionsRecurrent AMI patients presented with more severe coronary artery conditions. Age, DM and reperfusion therapy were independent risk factors for recurrent AMI, and recurrent AMI was related with a high risk of in-hospital death.

Plasma Catestatin in Patients with Acute Coronary Syndrome

Objectives: To measure plasma catestatin levels in patients with acute coronary syndrome and investigate whether there is an association between catestatin levels and long-term outcome. Methods: Patients (n = 170) with suspected acute coronary syndrome who underwent emergency coronary angiography were enrolled, including 46 with acute ST-segment elevation myocardial infarction (STEMI), 89 with unstable angina pectoris (UAP), and 35 without coronary artery disease (CAD). All patients were followed for 2 years to measure the occurrence of major adverse cardiovascular events (MACEs), including death from a cardiovascular cause, recurrent acute myocardial infarction, or hospital admission for heart failure or revascularization. Results: On average, the plasma catestatin levels in patients with STEMI (0.80 ± 0.62 ng/ml) and UAP (0.99 ± 0.63 ng/ml) were significantly lower than the levels seen in the control group with no evidence of CAD (1.38 ± 0.98 ng/ml; p = 0.001). In multivariable linear regression, body mass index, presence of hypertension, and type of CAD were independently related to the plasma catestatin level. However, there were no significant differences in MACEs between patients with high and low levels of catestatin. Conclusions: The plasma catestatin levels in patients with STEMI and UAP were lower than the levels seen in patients without CAD.

Severe Acute Myocardial Infarction during Induction Chemotherapy for Retroperitoneal Germ Cell Tumor : A Case Report

A 37-year-old man presented at our hospital. Pathological examination of a right orchiectomy specimen, radiographic examination, and tumor marker profile resulted in a diagnosis of retroperitoneal nonseminomatous germ cell tumor (intermediate risk according to IGCC classification). Laboratory testing revealed mild elevation of low density lipoprotein cholesterol. Induction chemotherapy with bleomycin, etoposide and cisplatin (BEP) was started, but he complained of chest pain on day 10 of the second cycle of BEP. We immediately started cardiac monitoring. One hour later, he suffered cardiac arrest due to ventricular fibrillation. Fortunately, sinus rhythm was restored after defibrillation. A diagnosis of acute myocardial infarction (AMI) with total occlusion at the mid-portion of the left anterior descending coronary artery was established by coronary angiography. After percutaneous transluminal coronary angioplasty was successfully performed, he recovered uneventfully. The induction chemotherapy was re-started 19 days after AMI. To avoid endothelial damage by bleomycin, we elected to treat with etoposide, ifosfamide, and cisplatin (VIP). After two further courses of VIP, the patient underwent resection of retoperitoneal tumor and achieved complete remission. The patient has remained disease-free during 3 years follow up without recurrence of AMI.

Myocardial infarction at the border of two centuries: demographic and social tendencies

The aim of the study was to compare the incidence, onset, and the course of acute myocardial infarction (AMI) among the population of Tomsk in 1984 and 2013. Materials and Methods: The study was based on the analytic database of the World Health Organization epidemiology program AMI Registry (RAMI). Epidemiology of AMI was studied among the urban population aged 20 years and older. A total of 739 and 983 AMI cases were analyzed in 1984 and 2013 respectively. Results: The proportion ofpatients older than 60 years significantly increased in the age structure of AMI patients during the study period. The occurrence of AMI with atypical clinical onset increased by three times; anamnestic background of AMI worsened; and the number of episodes with preinfarction angina increased. Analysis of the AMIpicture revealed an increase in the occurrence of Q (QS)-wave myocardial infarction and a significant rise in the frequency of complications; the frequency of chronic heart failure, cardiac arrhythmias, and recurrent AMI was especially high. Conclusion: An increase in the proportion of elderly and senile people in the age structure resulted in an aggravation of the diagnostic and prognostic features of AMI during the study period. Evidently, the existing situation requires optimization of medical assistance for patients of older age groups with emphasis on the development and the implementation of recommendations concerning the prediction, diagnosis, treatment, and rehabilitation of these patients.

Prolonged dual antiplatelet therapy in stable coronary disease: comparative observational study of benefits and harms in unselected versus trial populations

Objective To estimate the potential magnitude in unselected patients of the benefits and harms of prolonged dual antiplatelet therapy after acute myocardial infarction seen in selected patients with high risk...

Postinfarction ventricular septal rupture: can we improve clinical outcome of surgical repair?

Postinfarction ventricular septal rupture (VSR) is a lethal structural complication following acute myocardial infarction (AMI). Surgical repair of VSR was first reported in 1957 by Cooley. Since then, many methods have been introduced, variously using right and/or left ventriculotomy. Daggett used infarctectomy and septal reconstruction via left ventriculotomy, reporting 52% operative mortality when repair was attempted within 21 days, but only 7% when done after 3 weeks. Komeda and David described single pericardial patch infarct exclusion without infarctectomy through a left ventriculotomy in 1990. It seemed conceptually simple, and became a standard technique. Modifications of that technique and development of other methods have been reported by many surgeons. Nonetheless, recent clinical outcomes of surgical repairs demonstrated operative mortality from 19 to 81%. Predictors for poor survival include cardiogenic shock, the need for repair within 7 days after AMI, posterior VSR and shunt recurrence. Reasons for poor outcomes after surgical repair of VSR include preoperative cardiogenic shock, the unclear boundary between infarction and viable myocardium in the acute phase, and frequent shunt recurrence. Surgical complications such as bleeding from an LV incision and low output syndrome are significant concerns as well. We propose that the fundamental requirements for VSR closure include a sufficiently large patch securely fixed on the LV side of the septum, minimal damage to LV function, and simplicity of technique. Our "extended sandwich patch technique" fulfills those requirements, and has yielded improved outcomes without shunt recurrence, even within 7 days following onset, and for posterior VSR.

Impact of Distal Protection with Filter-Type Device on Long-term Outcome after Percutaneous Coronary Intervention for Acute Myocardial Infarction: Clinical Results with Filtrap®.

Aim: Although distal embolization during percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) deteriorates cardiac function, whether distal protection (DP) can improve prognosis is still controversial. We investigated whether a filter-type DP device, Filtrap®, could improve long-term outcomes after PCI for AMI.Method: We studied 164 patients (130 men, mean age: 65.7 years) who underwent PCI. Patients were divided into two groups based on the use of Filtrap®. The occurrence of congestive heart failure (CHF) and major adverse cardiac events (MACE) defined as cardiac death, recurrent AMI, and target vessel revascularization were compared.Result: Between DP (n = 53, 41 men, mean age: 65.5 years) and non-DP (n = 111, 89 men, mean age: 65.8 years) groups, although there was significantly greater plaque area in the DP group than in the non-DP group, there were no significant differences in coronary reperfusion flow after PCI. Interestingly, patients with CHF in the non-DP group exhibited a higher CK level than those in the DP group. During a 2-year follow-up period, cumulative CHF was significantly lower in the DP group than in the non-DP group (log-rank p = 0.018), and there was no significant difference in the MACE rate (log-rank p = 0.238). The use of DP device could not predict MACE, but could predict CHF by multivariate analysis (odds ratio = 0.099, 95% CI: 0.02–0.42, p = 0.005).Conclusion: These results demonstrate that favorable clinical outcomes could be achieved by the filter-type DP device in AMI, particularly in patients with CHF.

A 50&apos;s woman of recurrent acute myocardial infarction that cause was considered spontaneous coronary artery dissection

A 50&apos;s woman of recurrent acute myocardial infarction that cause was considered spontaneous coronary artery dissection

Biomarkers of Subclinical Atherosclerosis and Natural Products as Complementary Alternative Medicine.

Cardiovascular diseases (CVD) are considered the leading cause of morbidity and mortality from chronic diseases in the world. In addition, about 20% of first and recurrent acute myocardial infarctions (MI) are silent. In this context, subclinical atherosclerosis culminates in evident CVD, through the evolution of early risk factors such as hypercholesterolemia, hypertriglyceridemia and others. The main problem in CVD is related to the long-time between the start of the subclinical atherosclerosis and the manifestation of the disease. The identification of subjects at risk of such events is obviously substantial, since identification leads to implementation and compliance with effective preventive measures that reduce such risk. In this sense, this review demonstrates biomarkers as an alternative to early detection of subclinical atherosclerosis. One of the proposed biomarkers is the Ischemia-modified albumin (IMA), being considered a promising biochemical biomarker for atherosclerotic conditions. Another marker that is gaining strength and is associated with the IMA are the advanced oxidation protein products (AOPP), its measurement provides information on the level of exposure to potentially harmful changes to proteins and metabolic control. And last but not least we have nitric oxide as an early marker mainly related to endothelial dysfunction. In this review also is evidenced the use of the Campomanesia xanthocarpa, a plant native to southern region from Brazil extensively used as complementary and alternative medicine, and natural products to reduce protein oxidation and improve the availability of nitric oxide and consequently vascular function, reducing the risk for development of CVD.

Abstract 10116: Polyunsaturated Fatty Acid Treatment and Post-discharge Outcomes Following Acute Myocardial Infarction

Introduction: Clinical trial data regarding efficacy of n-3 polyunsaturated fatty acids (PUFA) in improving outcomes following acute myocardial infarction (AMI) are mixed and large observational studies of non-trial populations are lacking. Methods: We collected data from 5 Italian Local Health Units for patients discharged with the primary diagnosis of AMI between January 1, 2010 and December 31, 2011. Using unique patient identifiers, patients were linked across government hospital discharge, medication prescription, and mortality databases and followed for 12 months post-discharge. Results: Overall, 2,425 (21.5%) of 11,269 patients received n-3 PUFA during follow-up at 1 g/day. Patients treated with n-3 PUFA tended to be younger, male, diabetic, and more likely to receive guideline medical therapy, including beta-blockers, ACE inhibitors/ARB, statins, and antiplatelet therapy (P&lt;0.001; Table). After adjustment for patient characteristics and concurrent therapies, n-3 PUFA treatment was associated with reduction in death (HR 0.76, 95% CI 0.59-0.97) and recurrent AMI (HR 0.65, 95% CI 0.49-0.87) through 12 months. Conclusions: In this large, contemporary, observational study of patients hospitalized for AMI, n-3 PUFA treatment was independently associated with robust reduction in post-discharge clinical events.

The eff ect of sex counselling in the sexual activity of acute myocardial infarction patients after primary percutaneous coronary intervention

Background Primary percutaneous coronary intervention has improved the outcome of acute myocardial infarction (AMI) patients. Counselguided sex rehabilitation effi cacy in acute myocardial infarction patients receiving percutaneous coronary intervention remains unknown.Objective The aim of the study was to study counsel-guided sex rehabilitation effi cacy in AMI patients receiving percutaneous coronary intervention.Methods 240 AMI patients who received percutaneous coronary intervention were randomly divided into a control and a counselling group. Control group patients were given written sex rehabilitation instruction before discharge, while counselling group patients were given written instruction before discharge and monthly counselling with healthcare providers. Before discharge, the fi rst evaluation was performed for frequency of and satisfaction with sexual activity before AMI. At one year of follow-up, the time of resuming, frequency of and satisfaction with sexual activity was evaluated. The main adverse event rates were also investigated.Results No signifi cant diff erences in age, sex, smoking status, hypertension, diabetes, PVD (peripheral vascular disease), EF (ejection fraction) or GRACE (Global Registry of Acute Coronary Events) score were found between the groups. Both groups suff ered reduced frequency of and satisfaction with sexual activity after AMI as compared with prior to presentation with AMI. However, compared with controls, the counselling group had higher scores for frequency of and satisfaction with sexual activity after AMI. The time to resume sexual activity after AMI in the counselling group was signifi cantly shorter than was found for the control group. There were no signifi cant diff erences between the groups for recurrent AMI, non-fatal stroke, admitting the patient for angina, all-cause death or adverse events.Conclusions Intermittent discussions between healthcare providers and AMI patients improved resumption of sexual activity. Encouraging patients who received complete coronary revascularization to resume sexual activity shortly after AMI was safe.

Efficiency of rehabilitation after acute myocardial infarction

The purpose of this study was to evaluate the recurrence rate and medical expenses of acute myocardial infarction (AMI) following inpatient cardiac rehabilitation. A total of 834 patients with AMI were divided into Group 1 (with inpatient cardiac rehabilitation) and Group 2 (without inpatient cardiac rehabilitation). The results showed that Group 1 had a lower AMI recurrence rate (a 0.640-fold lower hazards ratio) than Group 2 [95% confidence interval (CI) = 0.197–1.863; p = 0.004]. Compared with the medical costs of Group 2, Group 1 also had lower medical costs (a 0.947-fold lower hazards ratio) than Group 2 (95% CI = 0.934–0.981; p = 0.042). These findings have implications for the decision making of clinicians and health policymakers attempting to provide adequate services for patients with AMI.

Mismatch of presenting symptoms at first and recurrent acute myocardial infarction. From the MONICA/KORA Myocardial Infarction Registry

It is unknown whether the symptoms of first and recurrent acute myocardial infarction (AMI) are similar in the same person. This study examined the frequency of symptom mismatch, which factors are associated with a symptom mismatch and how symptom mismatch is related to 28-day case fatality. Observational study. The sample consisted of 1282 persons with a first and recurrent AMI, recruited from a population-based AMI registry, 1985-2011. Occurrence of 11 symptoms was recorded in first and recurrent AMI using standardized patient interview. Logistic regression modelling adjusted for demographic and clinical variables was applied. Mismatch was highest for dyspnoea (40.6%) and lowest for chest symptoms (10.4%). Compared with women, men were less likely to have a mismatch of pain between the shoulder blades (odds ratio (OR) 0.58, 95% confidence interval (CI) 0.43-0.79), pain in the throat/jaw (OR 0.67, 95% CI 0.50-0.91), nausea (OR 0.62, 95% CI 0.47-0.82), vomiting (OR 0.50, 95% CI 0.36-0.71), or fear of death (OR 0.71, 95% CI 0.53-0.94), or to have three or more mismatching symptoms (OR 0.60, 95% CI 0.45-0.79). Persons with diabetes were more likely to have a mismatch in chest symptoms, whereas persons with hyperlipidaemia or persons who received any revascularization therapy at first infarction were significantly less likely to have a mismatch of chest symptoms. Twenty-eight-day case fatality significantly increased with the number of mismatching symptoms (OR 1.14, 95% CI 1.02-1.28). Patients with AMI may benefit from information about the possibility that a recurrent infarction may be associated with different symptoms.

Impact of age-adjusted insulin-like growth factor 1 on major cardiovascular events after acute myocardial infarction: results from the fast-MI registry.

The GH/IGF-1 axis is being targeted for therapeutic development in diseases such as short stature, cancer, and metabolic disorders. The impact of IGF-1 in cardiovascular disease remains controversial. We therefore studied whether IGF-1 at admission for acute myocardial infarction (AMI) predicted death, recurrent AMI, and stroke over a 2-year follow-up. Using data from the French registry of Acute ST-elevation and non-ST-elevation Myocardial Infarction registry, we measured IGF-1 among all the 1005 patients with AMI who participated in the serum data bank. Because IGF-1 decreases with age, a standardized IGF-1 score was calculated as previously described [IGF-1 score = (log [IGF-1 (micrograms per liter)] + 0.00625 × age - 2.555)/0.104]. Impact of IGF-1 score (continuous and quartiles) on outcomes were compared using Cox proportional hazards regression models. During follow-up, 190 patients died or had a recurrent AMI or stroke. Patients in the lowest quartile of IGF-1 were older and more frequently female and diabetic compared with patients in the other quartiles. After adjustment for known cardiovascular factors, an increase of five units of IGF-1 score was associated with a 30% decrease of the risk of events during follow-up (adjusted hazard ratio 0.70; 95% confidence interval 0.54-0.92; P = .0093). Similarly, the lowest quartile of IGF-1 was associated with an increased risk of events (adjusted hazard ratio 1.52, 95% confidence interval 1.11-2.08; compared with others quartiles, P = .010). Low IGF-1 score is associated with an increased risk of all-cause death, recurrent myocardial infarction, and stroke in AMI patients. Whether patients treated by IGF-1 axis inhibitors have a specific clinical course after AMI would be worth studying.

MODEL TO DETERMINE THE FORECAST OF ACUTE MYOCARDIAL INFARCTION IN PATIENTS WITH OBESITY GIVEN THE COPEPTIN’S AND TROPONIN’S I LEVEL

It was examined 50 patients with acute myocardial infarction (AMI) and obesity, among which in 10 patients developed recurrent AMI during the first week of illness. It was established that it is advisable to use a model according to the level of copeptin to predict recurrence of AMI in patients with obesity. Combining in model of prognosis of copeptin and troponin I concentration and allows to increase the specificity of 80 % in terms of high sensitivity (80 %). Obtained results on the predictor properties of copeptin and troponin in the ratio of relapse of AMI in patients with obesity can be considered as indicators of recurrence of AMI in patients with accompanying obesity.

Increased mortality after a first myocardial infarction in human immunodeficiency virus-infected patients; a nested cohort study.

AimsHIV infection may be associated with an increased recurrence rate of myocardial infarction. Our aim was to determine whether HIV infection is a risk factor for worse outcomes in patients with coronaray artery disease.MethodsWe compared data aggregated from two ongoing cohorts: (i) the Acute Myocardial Infarction in Switzerland (AMIS) registry, which includes patients with acute myocardial infarction (AMI), and (ii) the Swiss HIV Cohort Study (SHCS), a prospective registry of HIV-positive (HIV+) patients. We included all patients who survived an incident AMI occurring on or after 1st January 2005. Our primary outcome measure was all-cause mortality at one year; secondary outcomes included AMI recurrence and cardiovascular-related hospitalisations. Comparisons used Cox and logistic regression analyses, respectively.ResultsThere were 133 HIV+, (SHCS) and 5,328 HIV-negative [HIV-] (AMIS) individuals with incident AMI. In the SHCS and AMIS registries, patients were predominantly male (72% and 85% male, respectively), with a median age of 51 years (interquartile range [IQR] 46–57) and 64 years (IQR 55–74), respectively. Nearly all (90%) of HIV+ individuals were on successful antiretroviral therapy. During the first year of follow-up, 5 (3.6%) HIV+ and 135 (2.5%) HIV- individuals died. At one year, HIV+ status after adjustment for age, sex, calendar year of AMI, smoking status, hypertension and diabetes was associated with a higher risk of death (HR 4.42, 95% CI 1.73-11.27). There were no significant differences in recurrent AMIs (4 [3.0%] HIV+ and 146 [3.0%] HIV- individuals, OR 1.16, 95% CI 0.41-3.27) or in hospitalization rates (OR 0.68 [95% CI 0.42-1.11]).ConclusionsHIV infection was associated with a significantly increased risk of all-cause mortality one year after incident AMI.