After Acute Myocardial Infarction Patients Research Articles

Predictors of Early and Late Enrollment in Cardiac Rehabilitation, Among Those Referred, After Acute Myocardial Infarction

Cardiac rehabilitation (CR) after acute myocardial infarction (AMI) is a Class I recommendation. Although referral to CR after an AMI has recently become a performance measure, many patients may not participate. To illuminate potential barriers to participation, we examined the prevalence of, and patient-related factors associated with, CR participation within 1 and 6 months after an AMI. We studied 2096 AMI patients enrolled from 19 US sites in the Prospective Registry Evaluating outcomes after Myocardial Infarction: Events and Recovery (PREMIER) registry. Analyses were limited to those patients referred for CR at the time of AMI hospitalization. A multivariable, conditional logistic regression model, stratified by hospital, was used to identify sociodemographic, comorbidity, and clinical factors independently associated with CR participation within 1 and 6 months of AMI hospital discharge. Only 29% (419/1450) and 48.25% (650/1347) of AMI patients who received referral for CR participated within 1 and 6 months after discharge, respectively. Women (odds ratio [OR], 0.61; 95% confidence interval [CI], 0.44-0.86), uninsured (OR, 0.39; 95% CI, 0.21-0.71), and patients with hypertension (OR, 0.58; 95% CI, 0.43-0.78) and peripheral arterial disease (OR, 0.43; 95% CI, 0.22-0.85) were less likely to participate at 1 month. At 6 months after AMI, older patients (OR, 0.85 for each 10-year increment; 95% CI, 0.74-0.97), smokers (OR, 0.59; 95% CI, 0.44-0.80), and patients with economic burden (OR, 0.56; 95% CI, 0.38-0.81) were less likely to participate. Caucasians (OR, 1.73; 95% CI, 1.16-2.58) and educated patients (OR, 1.81; 95% CI, 1.42-2.30) were more likely to participate at 6 months. Patients with previous percutaneous interventions were less likely to participate at both 1 and 6 months post-AMI. Among patients referred for CR post-AMI, participation remains low both at 1 and 6 months after AMI. Because CR is associated with beneficial changes in cardiovascular risk factors and better outcomes after AMI, more aggressive efforts are needed to increase CR participation after referral.

Changes in social support within the early recovery period and outcomes after acute myocardial infarction

ObjectiveTo examine changes in social support during early recovery after acute myocardial infarction (AMI) and determine whether these changes influence outcomes within the first year. MethodsAmong 1951 AMI patients enrolled in a 19-center prospective study, we examined changes in social support between baseline (index hospitalization) and 1month post-AMI to longitudinally assess their association with health status and depressive symptoms within the first year. We further examined whether 1-month support predicted outcomes independent of baseline support. Hierarchical repeated-measures regression evaluated associations, adjusting for site, baseline outcome level, baseline depressive symptoms, sociodemographic characteristics, and clinical factors. ResultsDuring the first month of recovery, 5.6% of patients had persistently low support, 6.4% had worsened support, 8.1% had improved support, and 80.0% had persistently high support. In risk-adjusted analyses, patients with worsened support (vs. persistently high) had greater risk of angina (relative risk=1.46), lower disease-specific quality of life (β=7.44), lower general mental functioning (β=4.82), and more depressive symptoms (β=1.94) (all p≤.01). Conversely, patients with improved support (vs. persistently low) had better outcomes, including higher disease-specific quality of life (β=6.78), higher general mental functioning (β=4.09), and fewer depressive symptoms (β=1.48) (all p≤.002). In separate analyses, low support at 1month was significantly associated with poorer outcomes, independent of baseline support level (all p≤.002). ConclusionChanges in social support during early AMI recovery were not uncommon and were important for predicting outcomes. Intervening on low support during early recovery may provide a means of improving outcomes.

Renal Function at Hospital Admission and Mortality Due to Acute Kidney Injury after Myocardial Infarction

BackgroundThe role of an impaired estimated glomerular filtration rate (eGFR) at hospital admission in the outcome of acute kidney injury (AKI) after acute myocardial infarction (AMI) has been underreported. The aim of this study was to assess the influence of an admission eGFR<60 mL/min/1.73 m2 on the incidence and early and late mortality of AMI-associated AKI.MethodsA prospective study of 828 AMI patients was performed. AKI was defined as a serum creatinine increase of ≥50% from the time of admission (RIFLE criteria) in the first 7 days of hospitalization. Patients were divided into subgroups according to their eGFR upon hospital admission (MDRD formula, mL/min/1.73 m2) and the development of AKI: eGFR≥60 without AKI, eGFR<60 without AKI, eGFR≥60 with AKI and eGFR<60 with AKI.ResultsOverall, 14.6% of the patients in this study developed AKI. The admission eGFR had no impact on the incidence of AKI. However, the admission eGFR was associated with the outcome of AMI-associated AKI. The adjusted hazard ratios (AHR, Cox multivariate analysis) for 30-day mortality were 2.00 (95% CI 1.11–3.61) for eGFR<60 without AKI, 4.76 (95% CI 2.45–9.26) for eGFR≥60 with AKI and 6.27 (95% CI 3.20–12.29) for eGFR<60 with AKI. Only an admission eGFR of <60 with AKI was significantly associated with a 30-day to 1-year mortality hazard (AHR 3.05, 95% CI 1.50–6.19).ConclusionsAKI development was associated with an increased early mortality hazard in AMI patients with either preserved or impaired admission eGFR. Only the association of impaired admission eGFR and AKI was associated with an increased hazard for late mortality among these patients.

The effect of bone marrow-derived cells on diastolic function and exercise capacity in patients after acute myocardial infarction

BackgroundThe early- to mid-term impact of bone-marrow-derived stem cells (BMC) on diastolic function and exercise capacity after acute myocardial infarction (AMI) remains controversial. We performed a systematic analysis to assess whether BMC transfer is related to an early improvement in diastolic function and exercise capacity after AMI. MethodsRandomized controlled trials (RCTs) of BMC therapy after AMI were extracted from MEDLINE, EMBASE and CENTRAL and analyzed for a change in tissue Doppler annular early (Ea) and late diastolic (Aa) velocities, mitral inflow E velocity to tissue Doppler Ea (E/Ea) ratio, exercise time and exercise capacity. ResultsA total of 365 patients were included from 6 trials. A greater improvement was observed in the E/Ea ratio after 1year in the BMC group compared to the control group. Additionally, the BMC-treated patients had a larger improvement in exercise time, ventilation/CO2 production (VE/VCO2 slope) and respiratory exchange ratio (RER) after 1year. ConclusionThe results indicate that intracoronary BMC treatment in AMI patients leads to a mid-term improvement in diastolic function and exercise capacity.

Abstract 308: Incidence of Non-Cardiac Chest Pain in Follow-up After Acute Myocardial Infarction and Association with Clinical Outcomes

Background: Non-cardiac chest pain is common in the general population, but its incidence after acute myocardial infarction (AMI) is unknown. Moreover, whether patients with non-cardiac chest pain after AMI experience poorer outcomes than patients without these symptoms is unclear. Methods: Within the 24-US center TRIUMPH registry, we classified patients as having or not having a physician-adjudicated readmission with non-cardiac chest pain and assessed patients' health status and 2-year mortality. Patients' health status was evaluated using the quality of life domain of the disease-specific Seattle Angina Questionnaire (SAQ QoL) and the physical and mental component summary scores of the generic Short Form 12 (SF-12) at 1, 6, and 12 months after AMI. The associations between non-cardiac chest pain hospitalization and 2-year mortality and patients' health status were assessed using hierarchical, multivariable logistic regression and repeated measures linear regression, respectively, adjusting for potential confounders. Results: Of 3127 AMI patients, 130 (4.2%) were hospitalized with non-cardiac chest pain over the follow-up period. Two-year mortality was similar between patients with (3.8%) and without non-cardiac chest pain (6.8%, p=0.19). In contrast, patients hospitalized with non-cardiac chest pain had worse adjusted disease-specific health status (SAQ-QoL: -10.61 points [95% CI -13.48, -7.74])) and generic health status (SF-12 physical component summary: -2.78 points [95% CI -4.24, -1.32]); SF-12 mental component summary (-3.51 points [95% CI -4.88, -2.14]). Married patients were independently less likely to be hospitalized (OR 0.6, 95% CI 0.4-0.9) while those with a history of chronic heart failure were more likely to be admitted with non-cardiac chest pain (OR 2.2, 95% CI 1.2-3.9). Conclusions: Patients hospitalized with non-cardiac chest pain experienced worse health status in the first year after AMI than patients without these symptoms, suggesting these patients experience ongoing, rather than transient, poor health status post-AMI. Further research is needed to elucidate the etiology of poor health status in these patients and develop novel treatment strategies for improving their physical functioning and quality of life.

Linear and nonlinear analysis of heart rate variability in healthy subjects and after acute myocardial infarction in patients

The objectives of this study were to evaluate and compare the use of linear and nonlinear methods for analysis of heart rate variability (HRV) in healthy subjects and in patients after acute myocardial infarction (AMI). Heart rate (HR) was recorded for 15 min in the supine position in 10 patients with AMI taking β-blockers (aged 57 ± 9 years) and in 11 healthy subjects (aged 53 ± 4 years). HRV was analyzed in the time domain (RMSSD and RMSM), the frequency domain using low- and high-frequency bands in normalized units (nu; LFnu and HFnu) and the LF/HF ratio and approximate entropy (ApEn) were determined. There was a correlation (P < 0.05) of RMSSD, RMSM, LFnu, HFnu, and the LF/HF ratio index with the ApEn of the AMI group on the 2nd (r = 0.87, 0.65, 0.72, 0.72, and 0.64) and 7th day (r = 0.88, 0.70, 0.69, 0.69, and 0.87) and of the healthy group (r = 0.63, 0.71, 0.63, 0.63, and 0.74), respectively. The median HRV indexes of the AMI group on the 2nd and 7th day differed from the healthy group (P < 0.05): RMSSD = 10.37, 19.95, 24.81; RMSM = 23.47, 31.96, 43.79; LFnu = 0.79, 0.79, 0.62; HFnu = 0.20, 0.20, 0.37; LF/HF ratio = 3.87, 3.94, 1.65; ApEn = 1.01, 1.24, 1.31, respectively. There was agreement between the methods, suggesting that these have the same power to evaluate autonomic modulation of HR in both AMI patients and healthy subjects. AMI contributed to a reduction in cardiac signal irregularity, higher sympathetic modulation and lower vagal modulation.

MEDICATION NONADHERENCE AMONG PATIENTS WITH ACUTE MYOCARDIAL INFARCTION TREATED WITH PERCUTANEOUS CORONARY INTERVENTION: INSIGHTS FROM THE TRANSLATE-ACS STUDY

Understanding the patient and provider factors contributing to medication nonadherence after acute myocardial infarction (AMI) is critical to optimizing long-term outcomes. We assessed heart medication adherence via the Morisky Questionnaire 6 weeks after hospitalization among 2487 AMI patients

Low Levels of Vascular Endothelial Growth Factor B Predict Left Ventricular Remodeling After Acute Myocardial Infarction

BackgroundLeft ventricular (LV) remodeling is a prognostically important development after acute myocardial infarction (AMI). We recently reported that vascular endothelial growth factor B (VEGFB) may be a potential new biomarker of LV remodeling. This potential biomarker was evaluated in the present study. Methods and ResultsPatients with AMI (n = 290) and healthy volunteers (n = 42) were included. Plasma VEGFB levels were assessed before discharge. LV remodeling was determined by echocardiography at 6 months’ follow-up. Levels of VEGFB were elevated in AMI patients compared with healthy volunteers (1.5-fold; P = .001). Mean plasma levels of VEGFB were 64% higher (P < .001) in patients in whom LV end-diastolic volume (EDV) decreased during follow-up (ΔEDV ≤ 0; n = 144; reverse remodeling) compared with patients in whom ΔEDV increased (ΔEDV > 0; n = 146; remodeling). Using logistic regression models, independent relationships were found between VEGFB (odds ratio [OR] 0.8, 95% confidence interval [CI] 0.7–0.9; P = .0007) and infarct territory (OR 1.7, 95% CI 1.1–2.8; P = .02). Patients with anterior MI and low levels of VEGFB had the highest risk of remodeling. VEFGB outperformed N-terminal pro–B-type natriuretic peptide to predict LV remodeling, and low levels of VEGFB (<100 pg/mL) provided a specificity of 90%. Adding VEGFB to a clinical model involving age, sex, smoking habit, and infarct territory resulted in a net reclassification index of 11.7%. ConclusionsPlasma levels of VEGFB increase after AMI and correlate with preservation of cardiac function. Low levels of VEGFB accurately predict LV remodeling. Therefore, circulating VEGFB may have clinical utility in the identification of patients at high risk of remodeling after AMI.

Apelin and vascular endothelial growth factor are associated with mobilization of endothelial progenitor cells after acute myocardial infarction

This study was designed to determine the levels of early endothelial progenitor cells (EPCs), apelin, vascular endothelial growth factor (VEGF) and stromal cell-derived growth factor-1 (SDF-1) after acute myocardial infarction (AMI), and to investigate the relationships between these cytokines and early EPCs. Early EPCs, defined as CD133+, KDR+, and CD34+ cells, were quantified by flow cytometry. The levels of early EPCs and those cytokines in AMI patients were significantly different from those with coronary artery disease or controls (P < 0.05). Plasma apelin levels were inversely correlated with Gensini score and early EPCs (both P < 0.01). Early EPCs, VEGF and SDF-1 showed different patterns of changes in AMI patients during the first 24 h. The trend in the change of early EPCs was proportionally correlated with that of VEGF (P < 0.05). AMI patients exhibited increased early EPCs with remarkably decreased apelin levels and enhanced VEGF levels.

Impact of Low Levels of Vascular Endothelial Growth Factor After Myocardial Infarction on 6-Month Clinical Outcome

Vascular endothelial growth factor (VEGF) is induced by myocardial ischemia and is thought to facilitate cardiovascular repair after acute myocardial infarction (AMI). However, the association between the plasma VEGF levels and clinical outcome in AMI patients is unclear. We evaluated 879 AMI patients undergoing successful primary revascularization within 24h of symptom onset. The patients were classified into 3 groups according to tertiles of plasma VEGF levels at 7 days after the onset of AMI. Major adverse cardiovascular and cerebrovascular events (MACCE), defined as cardiac death, recurrent acute coronary syndrome, hospital readmission for heart failure, or stroke, were assessed during the 6-month follow-up period. The incidence of MACCE was the least frequent in the middle tertile. Compared to the middle tertile, patients in the low tertile were at a significantly higher risk for MACCE even after adjusting for baseline characteristics (hazard ratio [HR] 2.67, 95% confidence interval [CI] 1.18-6.06, P=0.019). An absence of statin treatment before onset and a younger age (HR 0.54, 0.87; 95%CI 0.33-0.90, 0.76-0.99; P=0.017, 0.037; respectively) were significantly associated with low VEGF. Low plasma VEGF levels at 7 days after the onset of AMI were associated with a significantly increased risk for MACCE during 6 months of follow-up.

Prognostic Value of Left Atrium Remodeling after Primary Percutaneous Coronary Intervention in Patients with ST Elevation Acute Myocardial Infarction

The purpose of this study is to assess the relationship between left atrial (LA) size and outcome after acute myocardial infarction (AMI) in patients undergoing primary percutaneous coronary intervention (PCI) and to evaluate dynamic changes in LA size during long-term follow-up. Echocardiographic analyses were performed on 253 AMI patients (174 male and 79 female, 65.4 ± 13.7 yr) undergoing PCI. These subjects were studied at baseline and at 12 months. Clinical follow-up were done at 30.8 ± 7.5 months. We assessed LA volume index (LAVI) at AMI-onset and at 12-month. Change of LAVI was an independent predictor of new onset of atrial fibrillation or hospitalization for heart failure (P = 0.002). Subjects who survived the 12-month period displayed an increased LAVI mean of 1.86 ± 4.01 mL/m2 (from 26.1 ± 8.6 to 28.0 ± 10.1 mL/m2, P < 0.001). The subject group that displayed an increased LAVI correlated with a low left ventricular ejection fraction, large left ventricle systolic and diastolic dimensions and an enlarged LA size. In conclusion, change of LAVI is useful parameter to predict subsequent adverse cardiac event in AMI patients. Post-AMI echocardiographic evaluation of LAVI provides important prognostic information that is significantly greater than that obtained from clinical and laboratory parameters alone.

Prescription Prevalence and Continuing Medication Use for Secondary Prevention After Myocardial Infarction

Current guidelines recommend using aspirin, clopidogrel, beta-blockers, statins, and angiotensin converting enzyme (ACE) inhibitors after acute myocardial infarction (AMI). Although there is evidence that patients often stop taking these medications prematurely, long-term data reflecting the actual reality of care are lacking. We studied prescription prevalence and treatment persistence of secondary prevention in patients who had an AMI by analyzing relevant claims data from a German sickness fund, the Techniker Krankenkasse (these data are not necessarily representative of the entire German population). Insurees who were discharged from the hospital between 2001 and 2006 with AMI as their main discharge diagnosis were classified as users or non-users of each of the types of drug listed above on the basis of the prescriptions that they obtained in the first 90 days after they left the hospital. Treatment persistence was statistically assessed with survival analysis. Switches from one drug class to another were not examined. Of 30,028 AMI patients, 82% were initially prescribed a beta-blocker, 73% a statin, 69% an ACE inhibitor, 66% aspirin (without self-medication), and 61% clopidogrel. Five years after discharge, 10% of the patients for whom aspirin was initially prescribed were still taking it; the corresponding figures for the other drug classes were 17% for statins, 31% for ACE inhibitors, and 36% for beta-blockers. The greatest drop in treatment persistence occurred approximately one year after the AMI. Treatment persistence with recommended medication after AMI is still in need of improvement. Patient education should start as soon as possible after infarction, because the greatest drops in medication use appear to occur within one year after AMI.

Abstract 11: Impact of DES Versus BMS on Quality of Life Following Percutaneous Coronary Intervention: Insights From the TRIUMPH Registry

Background: While drug eluting stents (DES) are known to reduce restenosis, as compared with bare metal stents (BMS), the comparative effectiveness of stent type on health status outcomes after acute myocardial infarction (AMI) is unknown. Methods: We compared 6-month health status outcomes in 1,583 AMI patients enrolled in the 26-center TRIUMPH study who were treated exclusively with DES (n=974) or BMS (n=609). Patient-reported health status was assessed with the Seattle Angina Questionnaire (SAQ) and the physical and mental summary scales of the Short-Form 12 (SF-12). A multivariate linear regression model was used to examine the association between stent type and patient-reported health status after extensive adjustment for 25 demographic, clinical and procedural variables, including baseline health status. Findings: Patients were predominantly Caucasian (77.8%) and male (73.2%), with a mean age of 59±11 years and a high prevalence of cardiovascular risk factors, including hypertension (58.9%), dyslipidemia (48.5%), and diabetes (23.7%). Baseline health status was similar in the DES and BMS groups, and both groups experienced significant improvements in their health status within 6 months. At 6 months, treatment with DES was associated with significantly greater improvements in the SAQ quality of life (+3.61, 95% C.I. 1.55-5.67), SAQ physical limitation (+5.63, 95% C.I. 3.25-8.00), and SF-12 mental component (+1.38, 95% C.I. 0.37-2.39) scores at 6 months. Changes in the SAQ treatment satisfaction, SAQ angina frequency, and the SF-12 physical component scores were not statistically different between groups. Conclusions: Among unselected patients undergoing PCI for AMI, DES use was associated with a greater improvement in patient-reported health status measures during 6 month follow up as compared with BMS. Further investigation is needed to determine the mechanisms of this benefit and whether it is sustained during longer term follow up.

Abstract P224: Determinants of Quality of Life Following Myocardial Infarction

Introduction: Optimizing quality of life (QOL) after acute myocardial infarction (AMI) is a major goal of treatment. Unlike mortality, for which numerous prediction models are available, no risk stratification models predicting QOL after AMI exist. Methods: In the prospective 24-center US TRIUMPH registry, 2693 AMI patients were assessed at baseline and 1 year after AMI for disease-specific QOL with the Seattle Angina Questionnaire (SAQ). Median regression (to account for skewed outcome distribution) was used to build a prediction model for 1-year QOL. Using 60 candidate sociodemographic, economic, and clinical variables, a linear regression model was built that fit all covariates against the predicted value of SAQ QOL as the dependent variable. The least significant covariates were sequentially removed until 90% of the variance of the full model was explained. Models accounted for clustering within site. Non-linear spline terms were considered for all continuous variables. Results: After variable selection, poor QOL at 1 year was associated with younger age, female sex, prior heart failure, prior CABG, depressive symptoms, perceived stress, low monthly financial reserves, self-reported financial difficulty getting medical care, and poor baseline SAQ QOL (Table). The R 2 of the median regression model was 11.9%, and the median absolute prediction error (the expected value of the absolute difference between the future and predicted responses) was 8.44 (interquartile range: 3.81 to 16.28). Conclusions: This is the first predictive model for QOL after AMI ever reported and demonstrates that traditional demographics and medical comorbidities only partly predict QOL. This model identifies important patient factors associated with QOL that may be targets for further intervention (such as financial difficulties and stress), can be used to identify high-risk patients, and may permit comparisons among hospitals in risk-adjusted QOL outcomes. Table Predictors of Long-term Disease-Specific QOL After Myocardial Infarction Predictor Estimate (95% Confidence Interval) of 1-Year Change in Median SAQ QOL Scores P-Value Age (per 10 years) 3.10 (2.58, 3.62) &lt;0.001 Female sex -2.61 (-4.03, -1.18) &lt;0.001 Prior heart failure -2.48 (-5.15, 0.19) 0.069 Prior bypass surgery -3.69 (-6.23, -1.14) 0.005 Baseline disease-specific QOL score (per 5 points) 0.43 (0.27, 0.60) &lt;0.001 Baseline Patient Health Questionnaire depression score (per 5 points) -2.37 (-3.25, -1.48) &lt;0.001 Baseline Perceived Stress Score (per 4 points) -1.15 (-2.02, -0.28) 0.010 Self-reported financial difficulty getting medical care -7.99 (-10.99, -4.99) &lt;0.001 Monthly financial reserves Just enough to make ends meet vs. Some money left over -0.08 (-1.34, 1.18) 0.90 Not enough to make ends meet vs. Some money left over -3.77 (-6.35, -1.19) 0.004

Adherence to risk factor management instructions after acute myocardial infarction: the role of emotional support and depressive symptoms.

Emotional support and depression may influence adherence to risk factor management instructions after acute myocardial infarction (AMI), but their role requires further investigation. To examine the longitudinal association between perceived emotional support and risk factor management adherence and assess depressive symptoms as a moderator of this association. Among 2,202 AMI patients, we assessed adherence to risk factor management instructions over the first recovery year. Modified Poisson mixed-effects regression evaluated associations, with adjustment for demographic and clinical factors. Patients with low baseline support had greater risk of poor adherence over the first year than patients with high baseline support (relative risk [RR] = 1.20, 95% confidence interval [CI] = 1.02-1.43). In stratified analyses, low support remained a significant predictor of poor adherence for non-depressed (RR = 1.41, 95% CI = 1.23-1.61) but not depressed (RR = 1.01, 95% CI = 0.78-1.30) patients (p for interaction < 0.001). Low emotional support is associated with poor risk factor management adherence after AMI. This relationship is moderated by depression, with a significant relationship observed only among non-depressed patients.

Cardiac medication prescribing and adherence after acute myocardial infarction in Chinese and South Asian Canadian patients

BackgroundFailure to adhere to cardiac medications after acute myocardial infarction (AMI) is associated with increased mortality. Language barriers and preference for traditional medications may predispose certain ethnic groups at high risk for non-adherence. We compared prescribing and adherence to ACE-inhibitors (ACEI), beta-blockers (BB), and statins following AMI among elderly Chinese, South Asian, and Non-Asian patients.MethodsRetrospective-cohort study of elderly AMI survivors (1995-2002) using administrative data from British Columbia. AMI cases and ethnicity were identified using validated ICD-9/10 coding and surname algorithms, respectively. Medication adherence was assessed using the 'proportion of days covered' (PDC) metric with a PDC ≥ 0.80 indicating optimal adherence. The independent effect of ethnicity on adherence was assessed using multivariable modeling, adjusting for socio-demographic and clinical characteristics.ResultsThere were 9926 elderly AMI survivors (258 Chinese, 511 South Asian patients). More Chinese patients were prescribed BBs (79.7% vs. 73.1%, p = 0.04) and more South Asian patients were prescribed statins (73.5% vs. 65.2%, p = 0.001). Both Chinese (Odds Ratio [OR] 0.53; 95%CI, 0.39-0.73; p < 0.0001) and South Asian (OR 0.78; 95%CI, 0.61-0.99; p = 0.04) patients were less adherent to ACEI compared to Non-Asian patients. South Asian patients were more adherent to BBs (OR 1.3; 95%CI, 1.04-1.62; p = 0.02). There was no difference in prescribing of ACEI, nor adherence to statins among the ethnicities.ConclusionDespite a higher likelihood of being prescribed evidence-based therapies following AMI, Chinese and South Asian patients were less likely to adhere to ACEI compared to their Non-Asian counterparts.

Presence of endothelial colony-forming cells is associated with reduced microvascular obstruction limiting infarct size and left ventricular remodelling in patients with acute myocardial infarction

Endothelial colony-forming cells (ECFCs) are known to increase after acute myocardial infarction (AMI). We examined whether the presence of ECFCs is associated with preserved microvascular integrity in the myocardium at risk by reducing microvascular obstruction (MVO). We enrolled 88 patients with a first ST elevation AMI. ECFC colonies and circulating progenitor cells were characterized at admission. MVO was evaluated at 5days and infarct size at 5days and at 6-month follow-up by magnetic resonance imaging. ECFC colonies were detected in 40 patients (ECFC(pos) patients). At 5days, MVO was of greater magnitude in ECFC(neg) versus ECFC(pos) patients (7.7±5.3 vs. 3.2±5%, p=0.0002). At 6months, in ECFC(pos) patients, there was a greater reduction in infarct size (-32.4±33 vs. -12.8±24%; p=0.003) and a significant improvement in left ventricular (LV) volumes and ejection fraction. Level of circulating CD34+/VEGF-R2+ cells was correlated with the number of ECFC colonies (r=0.54, p<0.001) and relative change in infarct size (r=0.71, p<0.0001). The results showed that the presence of ECFC colonies is associated with reduced MVO after AMI, leading to reduced infarct size and less LV remodelling and can be considered a marker of preserved microvascular integrity in AMI patients.

Ex vivo Effects of an Oenothera paradoxa Extract on the Reactive Oxygen Species Generation and Neutral Endopeptidase Activity in Neutrophils from Patients after Acute Myocardial Infarction

Oxidative stress induced by reactive oxygen species (ROS) is considered to play an important part in the aetiology of coronary heart disease. Apart from ROS, neutrophils are a source of neutral endopeptidase (NEP) that inactivates protective natriuretic peptides. The aim of the present study was to evaluate the in vitro ROS generation and inhibition of NEP activity in neutrophils obtained from healthy volunteers and from patients after acute myocardial infarction (AMI) by an aqueous extract of Oenothera paradoxa. Neutrophils isolated from AMI patients showed two-fold higher ROS generation compared with cells from healthy donors, especially in the lucigenin-enhanced luminescence model, which suggests intensive O₂⁻ generation. The addition of O. paradoxa extract at concentrations of 0.2, 2 and 20 µg/mL resulted in a significant reduction in ROS generation. The extracellular NEP activity was higher in patients after AMI compared with healthy individuals (15.0 ± 0.9 versus 10.3 ± 0.5 nmol AMC/10(6) cells/60 min; p = 0.001). The addition of O. paradoxa extract at concentrations of 20, 50 and 100 µg/mL resulted in a significant reduction in NEP activity in both groups. O. paradoxa extract appears to be an interesting candidate for supplementation in the prevention of cardiovascular diseases.

P2-142 Effect of chronic therapy with statins before infarction in patients with acute myocardial infarction

IntroductionEfficacy of preventive therapy with statins in reducing mortality and cardiovascular morbidity in patients with and without cardiovascular disease has been shown in clinical settings, but effectiveness results were not...

Relationship between infarct size and severity measured by gated SPECT and long-term left ventricular remodelling after acute myocardial infarction

After acute myocardial infarction (AMI), left ventricular (LV) remodelling may occur despite successful reperfusion. This study aimed to investigate by gated single photon emission computed tomography (SPECT) the long-term evolution of myocardial perfusion and LV function after AMI and to identify the predictors of LV remodelling. Sixty-eight AMI patients successfully treated by primary percutaneous coronary intervention underwent (99m)Tc-sestamibi gated SPECT at 1 month (baseline) and over 6-month follow-up after the acute event. LV remodelling was defined as 20% increase in LV end-diastolic volume at follow-up. At baseline, patients with remodelling (n = 14) showed larger (infarct size 29.3 ± 7.8%) and more transmural (infarct severity 0.28 ± 0.10) infarctions, and reduced LV ejection fraction (35.4 ± 5.6%), but similar LV volume indexes, compared to patients without remodelling (n = 54) (infarct size 20.8 ± 14.4%, p < 0.05, infarct severity 0.40 ± 0.11, p < 0.001, ejection fraction 44.5 ± 9.2, p < 0.001). At stepwise multivariate regression analysis, infarct severity showed the best predictive value for predicting LV remodelling (F = 5.54, p < 0.05). Using the thresholds identified by receiver-operating characteristic curve analysis, infarct size and severity detected patients with remodelling with 75% accuracy and 95% negative predictive value. Infarct resorption (defined as the defect size difference between follow-up and baseline) was comparable between patients with (-4.4 ± 8.4%) and without remodelling (-6.8 ± 9.4%) (p = NS). Perfusion parameters assessed by gated SPECT in the subacute phase after successfully treated AMI correlate with changes in functional parameters at long-term follow-up. Infarct severity is more effective than infarct size, but both are helpful for predicting LV remodelling.