Acute Myocardial Infraction Patients Research Articles

Abstract 13502: Prognostic Significance of Non-Infarct-Related Coronary Artery Chronic Total Occlusion in Patients Presenting With Acute Myocardial Infarction: A Systematic Review and Meta-Analysis

Introduction: In patients with acute myocardial infraction (AMI), multivessel coronary artery disease (CAD) is associated with worse prognosis than single-vessel CAD. Several observational studies have reported worse clinical outcomes in AMI patients with non-infarct-related artery chronic total occlusion (n-IRA CTO). We performed a systematic review and meta-analysis to evaluate the prognostic significance of n-IRA CTO in patients with AMI. Methods: Systematic review was performed querying PubMed, Google Scholar, Cochrane and clinicaltrials.gov from Inception through May 2022. Studies comparing AMI patients with and without n-IRA CTO were included. Outcomes included in-hospital, 30-day and long-term mortality, cardiac mortality, major adverse cardiovascular events (MACE), and major bleeding. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using random effects models. Results: Five prospective, eight retrospective and 3 subgroup analyses of randomized control trials (RCTs) (n-IRA CTO n=2,521, no CTO n=18,397) were identified. Presence of n-IRA CTO was associated with higher in-hospital (RR 2.86, 95% CI 1.77-4.62, p<0.0001, Figure A), 30-day (RR 2.54, 95% CI 1.66-3.89, p<0.00001, B) and long-term mortality (RR 2.32, 95% CI 1.81-2.99, p<0.00001, C), as well as increased risk for cardiac mortality (RR 2.24, 95% CI 1.79-2.81, p<0.0001, D), MACE (RR 1.51, 95% CI 1.32-1.74, p<0.0001, E), and major bleeding (RR 1.99, 1.16-3.41, p=0.01, F) when compared to AMI patients without n-IRA CTO. Conclusions: In AMI patients, the presence of n-IRA CTO is associated with increased mortality and morbidity. Future studies should evaluate whether intensive monitoring and specialized care can improve outcomes in these patients.

Validity and Reliability of the Thai Version of the Cardiac Anxiety Questionnaire-Revised Among Thai Cardiac Patients

Objective: To translate and validate the Thai version of the Cardiac Anxiety Questionnaire – Revised.Material and Methods: This was a descriptive statistic and exploratory factor analysis. The data collection was from March 2020 untill December 2020. From this, 213 acute myocardial infarction patients, aged from 30–59 years, who answered the questionnaire – Revised were included . The internal reliability of identified domains was evaluated using Cronbach’s alpha coefficient >0.7. An item-total correlation coefficient between 0.3 and 0.7. Factor loading ≥0.4 were acceptable as enough to establish a factor. A p-value of less than 0.050 was considered significant.Results: The Cronbach’s alpha of the Cardiac Anxiety Questionnaire – Revised Thai version was 0.83. Item-total and inter-item correlation coefficients were also tested (r=0.21 to 0.81, r=0.00 to 0.72, respectively). Five factors that explained 65.1% of the total variance were identified. Communalities in each factor; ranging from 0.38 to 0.83. Factor 1 had four items reflecting avoidance (Items 2, 7, 9 and 12). Factor 2 had five items that captured worry and fear (Items 10, 13, 14, 15 and 16). Factor 3 had three items that captured attention (Items 1, 6 and 8). Factor 4 had two items, these two items had high factor loading (>0.80) that explained abnormal symptoms (Items 3 and 4) and factor 5 had four items that reflected safety and seeking (items 5, 11, 17 and 18)Conclusion: The reliability and validity of the Thai version of the Cardiac Anxiety Questionnaire – Revised was suitable to measure anxiety in Thai acute myocardial infraction patients.

Effect of Health Literacy on Decision Delay in Patients With Acute Myocardial Infarction.

Background: Health literacy (HL) is a risk factor for adverse outcomes in patients with cardiovascular disease, and shorter pre-hospital delay time is crucial for successful treatment of acute myocardial infraction (AMI) patients. Most previous studies focused on the influencing factors of pre-hospital delay but ignore the essential contribution of decision delay.Aims: Therefore, the purpose of this study was to explore the effect of HL on decision delay.Methods: Continuously included AMI patients admitted to a grade A class three hospital in Chongqing. HL level was assessed using Brief Health Literacy Screen and categorized as adequate or inadequate. Mann-Whitney U-test and Chi-square test were used to compare the differences between groups, and binary logistic regression was used to analyze the association between HL and decision delay.Results: A total of 217 AMI patients were enrolled in this study, including 166 males (76.5%) and 51 females (23.5%), with the median age was 68 years old; 135 (62.2%) patients had delayed decision-making while 82 (37.8%) did not; 157 (72.7%) patients had inadequate HL and 59 (27.3%) had adequate HL. The total HL score of non-delayed group was higher than that in delayed group (9.22 vs. 7.02, P < 0.000).Conclusion: After adjusting for covariates, HL was significantly negatively associated with decision time. AMI patients with inadequate HL were more likely to delay seeking timely medical care.

Role of Genetic & Epigenetic Modifications of Low-Density Lipoprotein Receptor (LDLR) Gene in South Indian Acute Myocardial Infraction Patients

Background: Acute Myocardial Infarction (AMI) has conventional risk factors as well as genetic and epigenetic modifications of various genes. Among them gene coding for Low density lipoprotein receptor (LDLR) plays a strategic role in cholesterol homeostasis by eliminating excess LDL-C in blood. LDLR gene promoter polymorphism & DNA methylation status might regulate the expression of genes & its activity. Objective: The present study is designed to evaluate the association of LDLR gene promoter c.-139delCTCCCCCTGC polymorphism & DNA methylation status with Acute Myocardial Infarction (AMI). Methods: 300 angiographically documented MI patients and 300 healthy individuals were recruited for the study. Genomic DNA & RNA was extracted from the whole blood using commercially available assay kits further RNA was converted to cDNA. Biochemical parameters like Total cholesterol, LDL-C, HDL-C, and Triglycerides were estimated using kit methods. Results: The risk factors like systolic, diastolic blood pressures, hypertension, diabetes mellitus, smoking, lipids were found to be significantly higher in AMI patients compared to controls. The genotype and allele distributions of the LDLR c.-139del polymorphism revealed that DD genotype & D-allele were found to be higher among the AMI patients than that of controls. Furthermore, we have observed LDLR gene differential promoter DNA methylation status & mRNA expression. In addition, Insilco analysis have shown that there is a change in TF binding at the Insertion & Deletion sites. Conclusion: The findings of the study suggest that the LDLR c.-139del DD genotype might be used as prognostic marker in risk prediction of Acute Myocardial Infarction.

Gender Predliction and Confunding Factors Affecting Pre Hospital Delay Among Acute Myocardial Infraction Patients.

Background: Acute Myocardial Infarction (AMI) is a serious and life-threatening manifestation of coronary artery disease (CAD) affecting both males and females, which need immediate management. The present study was aimed to assess the gender difference and factors affecting pre-hospital delay among patients with AMI.Subjects and Methods:The 291 patients admitted with AMI from01-01-2018 to 31-12-2018 were studied. A descriptive comparative design was adopted for the study. Socio personal and clinical variables of the subjects were assessed. Pre-hospital delay was measured in terms of time from the onset of symptoms till the patient reaches a health care setting. One hour after the onset of symptom of AMI was considered as the Golden hour. Data was analyzed using SPSS 20.0 software.Results:Out of the 291 patients with AMI (146 males and 145 females), only 32.4% of males and 24.1% of females reached a health care setting within 1 hr of onset of symptoms. 35.2% of male patients and 43.5% of female patients reached the health care setting only after 6 hrs of onset of symptoms. Among the male patients, pre hospital delay was significantly associated with place of onset of symptoms (p&lt;0.05), presence of someone with the patient at the time of onset of symptoms (p&lt;0.05), and perception of symptoms developed, as an emergency (P&lt;0.001). Whereas in female patients, significant association was observed in pre hospital delay with age of the patient (p&lt;0.05), nature of the first symptom experienced (P&lt;0.05) and perception of symptoms developed as an emergency (p&lt;0.001).Conclusion: Our study shows the existence of pre hospital delay among patients with AMI in both males and females. The factors affecting pre hospital delay vary between males &amp; females.

P17 In-hospital mortality and clinical features of Japanese patients with acute myocardial infarction diagnosed by universal definition in real world from kanagawa-acute cardiovascular registry (K-ACTIVE)

Abstract Background Cardiac troponin (cTn) has been used as the preferred biomarker of myocardial injury for diagnosis of acute myocardial infraction (AMI) by universal definition. A large number of patients formerly classified by creatine kinase (CK) as unstable angina with the WHO criteria in Japan are now diagnosed by cTn as non-ST elevation myocardial infarction (NSTEMI). In this report, we aimed to understand its prevalence and clinical features of AMI diagnosed by using universal definition and the WHO criterial in real world. Method This registry is a cross-sectional study of 53 facilities in Kanagawa prefecture of Japan. 4372 AMI patients were enrolled who received primary percutaneous coronary intervention (PCI) between October 1, 2015 and January 29, 2019. Patients were divided into 3 groups, 3268 patients with ST elevation myocardial infarction (STEMI), 628 patients with NSTEMI patients who satisfied the WHO criteria with CK elevation beyond twice upper limit of normal (NSTEMI + CK), and 476 patients with NSTEMI who didn’t satisfy the WHO criteria without CK elevation (NSTEMI-CK). Result Baseline clinical characteristics of the study patients are shown in Table 1. In-hospital mortality was significantly lower in patients with NSTEMI-CK (1.9%) than in STEMI (6.0%, P &amp;lt; 0.001) and NSTEMI + CK (5.3%, P &amp;lt; 0.004) (Figure 1). Kaplan-Meier analyses for 0-30 days of cardiac death are shown in Figure 2. From day 0, the Kaplan-Meier curves began to diverge in favor of NSTEMI-CK for up to 30 days. Conclusion AMI patients showed distinct clinical features depends on the type. We should be aware of the difference for the diagnosis of AMI by using universal definitions. Table 1. STEMI (n = 3268) NSTEMI + CK (n = 628) NSTEMI-CK (n = 476) STEMI vs NSTEMI + CK P value STEMI vs NSTEMI-CK P value NSTEMI + CK vs NSTEMI-CK P value Age(years) 68(59-77) 69(61-78) 70(61-79) Male 76% 77% 75% 0.54 0.74 0.47 Concomitant diseases Hypertention 65.4% 70.5% 69.3% 0.013 0.097 0.65 Diabetes 33.5% 36.5% 37.3% 0.15 0.11 0.78 Dyslipidemia 56.1% 61.2% 61.3% 0.018 0.03 0.96 Hemodialysis 2.3% 2.1% 6.8% 0.86 &amp;lt;0.001 0.01 Smoking 66.3% 63.1% 64.6% 0.13 0.48 0.62 Atrial fibrillation 9.6% 10.7% 14.4% 0.57 0.04 0.23 Previous MI 8.3% 17.3% 15.7% &amp;lt;0.001 &amp;lt;0.001 0.47 In-hospital mortality 6.0% 5.3% 1.9% 0.49 &amp;lt;0.001 0.004 Abstract P17 Figure 1. 2.

Is there a Correlation between Monocyte Chemoattractant Protein-1 with Autotaxin, Azurocidin-1, Apolipoprotein C-III and Elastase-2 in Male Iraqi Acute Myocardial Infraction Patients?

Acute Myocardial infarction (AMI) is one of the important reasons of loss of life and bodily incapacity global prompt via cardiovascular diseases (CVD). AMI stimulates the innate immune system that is required to employee leukocytes to remove necrotic cells and recruit myocardial healing. To evaluate serum concentrations of Monocyte Chemoattractant Protein-1 (MCP-1), Autotaxin (ATX), Azurocidin-1 (AZU-1), Apolipoprotein C-III (APOC3) and Elastase-2 (ELA-2) in male Iraqi AMI patients and healthy controls (HCs), and explain the association of MCP-1with ATX, AZU-1, APOC3 and ELA-2 in male Iraqi AMI patients, also explore the best parameter which can use to differentiate between AMI patients. This case-control study included 84 men aged 40–68 years. Waist circumference (WC), hip circumference (HC), thoracic circumference (TC), neck circumference (NC), height, weight, age, and further covariates were obtained via an inquiry form. They were separated into two equivalent groups: the patients group and the healthy group, serum concentrations of MCP-1, ATX, AZU-1, APOC3 and ELA-2 were estimated via ELISA. Serum of MCP-1, ATX, AZU-1, APOC3 and ELA-2 concentrations were importantly greater in patients with AMI than in HCs (p&lt; 0.001). MCP-1 concentrations were importantly linked with ATX, AZU-1, APOC3 and ELA-2 in AMI cases (p&lt; 0.001). The greater value of MPC-1 association was with ELA-2 (r=0.592). MCP-1 exhibited the maximum value for área under curve (AUC=1) in comparison to other studied biomarkers. The present data explained the role of MCP-1, ATX, AZU-1, APOC3 and ELA-2 in AMI disease; we found they have central functions in this disease, mainly obese patients. Attention must be taken to avoid confusion among risk markers and risk factors. Great serum concentrations of MCP-1 offered important correlations between risk markers and risk factors of AMI disease.

P5516Short-term and long-term mortality among acute myocardial infarction patients admitted to hospitals on weekends as compared with weekdays

Abstract Background As in other countries, manpower shortage in weekends and holidays is a common problem in either private hospitals or public hospitals in Taiwan. Whether the manpower shortage in weekends and holidays is associated with poor quality of medical care is a noteworthy subject and several investigations from different countries have been published already. Purpose This study examined the difference of short-term and long-term mortality between acute myocardial infraction patients admitted to hospitals on weekends and weekdays in Taiwan. Methods We conducted a retrospective, nationwide cohort study based on the National Health Insurance claims database in Taiwan. Adult patients aged 20 years or older who were admitted with a diagnosis of acute myocardial infarction between Jan. 1 2006 and Dec. 31 2014 were identified. Only the first attack of acute myocardial infarction was retained for analysis. The multivariate logistic regression model was applied with adjustment of baseline characteristics at both patient level and hospital level. The outcome variables included in-hospital mortality and one-year cumulative mortality after the index hospitalization. Results We identified 53861 patients with acute myocardial infarction as the weekend group, while 130908 patients as the weekday group. The mean age was 68 years old and 68% of the subjects were male in both groups. ST-elevation myocardial infarction constituted 23% of the patients and up to 46% of the subjects underwent percutaneous coronary intervention during the index hospitalization in both groups. Among the weekend group, the in-hospital mortality was 15.8% while the in-hospital mortality was 16.2% in the weekday group (standardized difference = 0.01). The one-year cumulative mortality was 30.2% and 30.9% in the weekend group and the weekday group, respectively (standardized difference = 0.02). The adjusted odds ratio (aOR) concerning in-hospital mortality of the weekend group compared with the weekday group was 0.98 (95% confidence interval [CI]: 0.95–1.01, p=0.11). Also we found no difference in one-year cumulative mortality between the two study groups (aOR = 0.98, 95% CI: 0.96–1.01, p=0.15). Conclusions As for acute myocardial infraction patients in Taiwan, admission on weekends or weekdays did not have a significant impact on either in-hospital mortality or one-year cumulative mortality. Acknowledgement/Funding Ministry of Science and Technology, the Executive Yuan, Taiwan (MOST 106-2410-H-002-218-, and MOST 107-2410-H-002-237-)

Correlation of Homocysteine Levels With Folate Acid, Cyanocobalamine, and Pyridoxine Serum Levels In Acute Infark Miocard Patients

Cardiovascular disease is the cause of the highest mortality rate in the world. Acute myocardial infarction is one of the 5 major manifestations of coronary heart disease and the highest mortality rate in Indonesia. Hyperhomocysteinemia is one of the risk factors for the occurrence of acute myocardial infarction. The metabolism of homocysteine is influenced by folate acid, cyanocobalamin, and pyridoxine. Enzimsistationin-β-synthetase and cystationin-γ-liase that catalyze the transsulfuration of homocysteine are highly depended on pyridoxine. This study aims to determine the association of homocysteine with folate acid, cyanocobalamin, and pyridoxine serum levels in acute myocardial infraction patients. Cross-sectional design study with 25 samples of acute myocardial infraction patients are selected randomly. The research was conducted from July to December 2016 in Biomedical laboratory Andalas University. Homocysteine, folate acid, cyanocobalamin, and pyridoxine levels were examined by the ELISA method. Data is analyzed by the Pearson correlation test. The mean result of examination of homocysteine level was 23.17±9.2 nmol/mL, pyridoxine level 128.44 ± 34.02 pmol/L, cyanocobalamine level 188.79 ± 10.23 pmol/L and folate acid level 2.72 ± pmol / L. Statistic analysis test found that there is a significant relationship of levels of homocysteine with pyridoxine (r = -0.530), but there is a very weak relationship with cyanocobalamine and folate acid (r = - 0.027 and - 0.003). There is a significant relationship of homocysteine levels with pyridoxine serum on acute myocardial infarction patients. And there is a very weak relationship of homocysteine levels with cyanocobalamine and folate acid.

Hospital volumes and outcomes for inpatients with acute myocardial infarction in Shanxi, China: an observational study

BackgroundMany studies have examined the relationship between hospital volume and outcomes for inpatients with acute myocardial infraction (AMI) in developed countries. However, very few studies of this relationship have been conducted for inpatients with AMI in China. This study aimed to assess the relationship between hospital volume and clinical outcomes for inpatients with AMI in Shanxi, China. MethodsData from a total of 15 747 patients with AMI who were treated in 56 hospitals in Shanxi, China, were analysed. Hospital volume was defined as the number of inpatients with AMI in 2015 at each hospital, and hospitals were sorted into three groups by volume (low volume [<385 inpatients], medium volume [385–637 inpatients], and high volume [>637 inpatients]). Patient and hospital characteristics were adjusted using multivariable logistic regression and linear regression, and the relationships between hospital volume and in-hospital mortality, length of stay, and total hospitalization costs were assessed for inpatients with AMI. FindingsThe crude in-hospital mortality rate was 1.93% among the 15 747 patients with AMI. Adjusted in-hospital mortality among AMI patients was significantly lower for medium-volume hospitals (odds ratio [OR] 0·605, 95% CI 0·411–0·900) compared to low-volume hospitals, whereas no significant difference was found between low-volume hospitals and high-volume hospitals (0·783, 0·525–1·178). Lengths of stay in medium-volume hospitals and high-volume hospitals were 0·915 days (95% CI 0·880–0·951) and 1.047 days (1·007–1·088) days longer, respectively, than in low-volume hospitals. The hospitalization costs per inpatient with AMI in medium-volume hospitals (OR 1·087, 95% CI 1·051–1·125) and high-volume hospitals (1·230, 1·188–1·274) were higher than in low-volume hospitals. InterpretationGiven that in-hospital mortality was lower in medium-volume hospitals than in low-volume and high-volume hospitals, it is important to recognise that pursuit of high patient volumes and volume-based referral may not improve overall outcomes for inpatients with AMI, particularly in countries in which medical resources are strained. FundingNational Natural Science Foundation of China (number 71473099).

Clinical Manifestation of Acute Myocardial Infarction: Classified by Age and Gender

Background The purpose of the study was to evaluate clinical manifestations of acute myocardial infarction as classified by age and gender.Methods This cross sectional study was conducted in a coronary care unit of a regional urban medical center in northern Iran (Amol). A total of 366 patients diagnosed with acute myocardial infarction were recruited from January to June 2013. Patient demographic information, past medical history, and current symptom data were collected.Results Multivariate logistic analyses were performed to identify risk predictors of myocardial infarction patients classified by age and gender. Risk predictors for older patients were dyspnea, OR = 1.76 (95% CI 1.01, 3.06), weakness odds ratio = 2.35 (95% CI 1.31, 4.21), nausea odds ratio = 1.83 (95% CI 1.04, 3.20), vomiting odds ratio = 2.48 (95% CI 1.34, 4.57), fatigue odds ratio=1.87 (95% CI 1.02, 3.39), belching, odds ratio = 2.13 (95% CI 1.08, 4.20), and hiccups odds ratio = 2.81 (95% CI 1.25, 6.30). Sub group analysis in older women patients identified weakness odds ratio = 3.13 (95% CI 1.11, 8.85), and belching odds ratio = 34.70 (95% CI 3.86, 312.2) as risk predictors. Among older men patients, the predominant symptoms were sweating odds ratio = 3.74 (95% CI 1.06, 13.2) and vomiting odds ratio = 2.54 (95% CI 1.10, 5.91).Conclusions This study concludes that older acute myocardial infraction patients were more likely to have non-specific symptoms. Initial assessment for acute myocardial infarction should consider the possibility of non-specific clinical manifestations, such as weakness and belching in older women, and sweating and vomiting in older men.

Analysis of predictive factors of intestinal obstruction in acute myocardial infraction patients afterprimary percutaneous coronary intervention

Objective to determine predictive factors of intestinal obstruction in acute myocardial infraction (AMI) patients after primary percutaneous coronary intervention (PCI) and to establish predictive model. Methods A total of 1220 AMI patients underwent primary PCI in Jiangxi provincial people's hospitalfrom June2004 toJune 2014were retrospectively analyzed. And 1025 cases of them whichall met the inclusion and exclusion criteriawere randomlydivided by using random number generated by SPSS 17.0 into two cohorts: model derivation cohort (MDC) and model validation cohort (MVC). MDC was divided into intestinal obstruction group and control group. predictive factors were identified using univariable andmultivariable logistic regression analysis in MDC. Interger point values were assigned to each predictor based upon their coefficient in multivariable logistic regression model to establish scoring model. The summed scores of each case in MVC were calculated to test predictive ability of the model by ROC cure. Results Total of 1 025 patients, 103 patients were diagnosed with different types of intestinal obstruction and the incidence of intestinal obstruction was 10.0%. Low position intestinal obstruction, incomplete intestinal obstruction and simple intestinal obstructionwere main characteristics in these patients. logistic regression analysis identified ten risk factorscan predict the appearance of intestinal obstruction: age >65 years old (OR =1.44, 95%CI∶1.26-4.63, P =0.000) , diabetes mellitus (OR =3.37, 95% CI∶2.39- 9.47, P =0.000) , habitual constipation (OR =4.75, 95% CI∶3.58-11.24, P =0.024) , inferior and extensive anterior wall myocardial infarction (OR =2.16, 95% CI∶1.94-4.79, P =0.017) , cardiac function grade≥3 class (Killip classification) (OR =2.86, 95% CI∶1.98-5.67, P=0.002) , femoral approach (OR =2.76, 95%CI∶1.38-6.12, P =0.002) , K+<3.5 mmol/L (OR=1.86, 95%CI∶1.11- 5.47, P=0.005) , taking laxative (OR =3.59, 95% CI∶2.99-10.21, P =0.000) , using morphine (OR=1.98, 95%CI∶1.07-3.12, P=0.021) and estimated glomerular filtration rate (eGFR) <60 mL·min-1·1.73m-2 (OR=1.19, 95%CI∶1.10-3.22, P=0.031). and areas under the ROC cure was 0.815 (95% CI∶0.802-0.883, P =0.000) and indicating the accuracy of predicting intestinal obstruction. Conclusions age> 65 years old, diabetes mellitus, habitual constipation, inferior and extensive anterior parts of myocardial infarction, cardiac functiongrade≥3class (Killip classification), femoral approach, K+<3.5mmol/L, taking laxative, using morphine and eGFR <60 ml. min-1.1.73m-2 were important predictive factors for intestinal obstruction in AMI patients after underwent 0 and the scoring model can predict accurately intestinal obstruction in such patients. Key words: Acute myocardial infraction; Primary percutaneous coronary intervention; Intestinal obstruction; Forecasting

Reliability and Validity of the Chinese Version Appropriateness Evaluation Protocol

ObjectiveTo adapt the Appropriateness Evaluation Protocol (AEP) to the specific settings of health care in China and to validate the Chinese version AEP (C-AEP).MethodsForward and backward translations were carried out to the original criteria. Twenty experts participated in the consultancy to form a preliminary version of the C-AEP. To ensure applicability, tests of reliability and validity were performed on 350 admissions and 3,226 hospital days of acute myocardial infraction patients and total hip replacement patients in two tertiary hospitals by two C-AEP reviewers and two physician reviewers. Overall agreement, specific agreement, and Cohen’s Kappa were calculated to compare the concordance of decisions between pairs of reviewers to test inter-rater reliability and convergent validity. The use of “overrides” and opinions of experts were recorded as measurements of content validity. Face validity was tested through collecting perspectives of nonprofessionals. Sensitivity, specificity, and predictive values were also reported.ResultsThere are 14 admission and 24 days of care criteria in the initial version of C-AEP. Kappa coefficients indicate substantial agreement between reviewers: with regard to inter-rater reliability, Kappa (κ) coefficients are 0.746 (95% confidence interval [CI] 0.644–0.834) and 0.743 (95% CI 0.698–0.767) of admission and hospital days, respectively; for convergent validity, the κ statistics are 0.678 (95% CI 0.567–0.778) and 0.691 (95% CI 0.644–0.717), respectively. Overrides account for less than 2% of all judgments. Content validity and face validity were confirmed by experts and nonprofessionals, respectively. According to the C-AEP reviewers, 18.3% of admissions and 28.5% of inpatient days were deemed inappropriate.ConclusionsThe C-AEP is a reliable and valid screening tool in China’s tertiary hospitals. The prevalence of inappropriateness is substantial in our research. To reduce inappropriate utilization, further investigation is needed to elucidate the reasons and risk factors for this inappropriateness.

A non-parametric method for hazard rate estimation in acute myocardial infarction patients: kernel smoothing approach.

Kernel smoothing method is a non-parametric or graphical method for statistical estimation. In the present study was used a kernel smoothing method for finding the death hazard rates of patients with acute myocardial infarction. By employing non-parametric regression methods, the curve estimation, may have some complexity. In this article, four indices of Epanechnikov, Biquadratic, Triquadratic and Rectangle kernels were used under local and k-nearest neighbors' bandwidth. For comparing the models, were employed mean integrated squared error. To illustrate in the study, was used the dataset of acute myocardial infraction patients in Bushehr port, in the south of Iran. To obtain proper bandwidth, was used generalized cross-validation method. Corresponding to a low bandwidth value, the curve is unreadable and the regression curve is so roughly. In the event of increasing bandwidth value, the distribution has more readable and smooth. In this study, estimate of death hazard rate for the patients based on Epanechnikov kernel under local bandwidth was 1.011 x 10(-11), which had the lowest mean square error compared to k-nearest neighbors bandwidth. We obtained the death hazard rate in 10 and 30 months after the first acute myocardial infraction using Epanechnikov kernelas were 0.0031 and 0.0012, respectively. The Epanechnikov kernel for obtaining death hazard rate of patients with acute myocardial infraction has minimum mean integrated squared error compared to the other kernels. In addition, the mortality hazard rate of acute myocardial infraction in the study was low.

Apolipoprotein CIII and Atherosclerosis

The prevailing concept of mechanisms responsible for the development of atherosclerotic lesions largely focuses on the accumulation and retention of low-density lipoproteins in the arterial intima and their subsequent oxidative modification. This oxidation leads to activation of the endothelium, and particularly, expression of adhesion molecules that mediate leukocyte adherence and chemokines which initiate the inflammation reaction that is widely accepted as being responsible for the development and progression of atherosclerotic lesions.1,2 There is also a strong body of evidence to indicate that elevated triacylglycerides (triglycerides) are an independent risk factor for atherosclerosis.3–5 Article p 731 One mechanism that can contribute to elevated triglycerides involves apolipoprotein CIII (apoCIII). apoCIII is a small protein that resides on the surface of very-low-density lipoproteins (VLDLs), low-density lipoproteins, chylomicrons, and high-density lipoproteins (Figure). It exists as multiple species, as either a nonglycosylated isoform (apoCIIIo) or a glycosylated isoform (apoCIII1 or apoCIII2); all three isoforms have similar plasma half-lives and probably have very similar physiological functions. Increased apoCIII production is a characteristic feature of patients with hypertriglyceridemia,6 and plasma apoCIII levels have been positively correlated with plasma triacylglycerol concentrations and also have been associated with severity of hypertriglyceridemia.7 Elevated plasma apoCIII concentration and, specifically, accumulation of apoCIII in triacylglycerol-rich lipoproteins is casually related to hypertriglyceridemia in patients with metabolic syndrome and has also been associated with insulin resistance.8 apoCIII is a major regulator of lipolysis, as it noncompetitively inhibits endothelial-bound lipoprotein lipase, the enzyme that hydrolyzes triacylglycerols in …

Toward the Development of a Lab-on-a-Chip Dual-Function Leukocyte and C-Reactive Protein Analysis Method for the Assessment of Inflammation and Cardiac Risk

Inflammation has been identified as the underlying cause of atherosclerosis, a condition associated with the deposition of lipids in the lining of arteries, which progressively leads to acute myocardial infraction (AMI) or heart attack. Serum concentrations of markers of inflammation, including C-reactive protein (CRP), and the leukocyte count are powerful predictors for the development of coronary heart disease (1)(2)(3)(4)(5)(6)(7). In addition, AMI patients with increased CRP concentrations or leukocyte counts are at higher risk of mortality and recurrent AMI (8)(9)(10)(11)(12). The combination of these 2 biomarkers provides additive and powerful diagnostic information. In fact, people with both high leukocyte counts and high CRP concentrations exhibit a 7-fold higher risk for heart disease (7). Although tests targeting CRP concentrations and leukocyte counts are widely available in clinical settings, they are performed separately on different instruments. Consequently, these tests require large sample volumes, additional sample preparation steps, and longer assay times. In addition, the clinical instruments and methodologies currently used to perform these tests are not suitable for point-of-care testing, such as in a doctor’s office and in the (more relevant to a heart attack setting) emergency room or ambulance. Clearly, the diagnostic and prognostic value of these biomarkers would be increased if these 2 tests could be performed concurrently on the same instrument, in a convenient, accurate, and highly accessible manner. Previously we described studies of the design, fabrication, and testing of lab-on-a-chip (LOC) structures composed of chemically sensitized beads that are populated into etched silicon wafers with integrated fluid-handling and optical detection capabilities (13)(14)(15)(16)(17)(18)(19). These miniaturized systems have been used for the identification and quantification of electrolytes, …

Trajectories of anxiety and depression in denying and nondenying acute myocardial infarction patients during hospitalization

Out of 36 acute myocardial infraction patients, 17 were classified as deniers and 19 as hnon-deniers; all were scored for anxiety, depression and denial at six intervals (days 1–2, 3–4, 5–7, 8–10, 11–14, 15–25) during their hospital stay. Anxiety scores, high for both gropus on the first two days, declined more rapidly for deniers. The latter were rated significantly less anxious bu days 3–4, while the non-deniers' level of anxiety remained elevated until days 5–7. Depression scores dropped for deniers on days 5–7; non-deniers showed no such change. Denial scores dropped significantly in both groups but occured sooner for non-deniers (days 8–10) than for deniers (days 11–14). The decline of denial followed a fall in anxiety scores; however, denial continued to operate after this fall three times longer for the denier. Non-deniers appeared to shed their fears more slowly and drop their guard more quickly than deniers. As discharge approached trajectories of both anxiety and depression scores appeared on the rise. This was countered in the denier by a notable mobilization of denial as evidenced by a rise in denial scores. The non-deniers failed to respond in this fashion.