Cases Of AMI Research Articles

Burden and economic impact of PM2.5 exposure on Acute Myocardial Infarction in Portugal, 2011-2021

Abstract Background Air pollution, specifically particulate matter with a diameter of 2.5 micrometers (PM2.5), is the primary environmental health risk in Europe. Exposure to PM2.5 increases the risk of cardiovascular diseases, including AMI, resulting in high direct costs associated with in-patient treatment. This study aims to estimate the avoidable and attributable disease and economic burden of AMI due to ambient PM2.5 exposure in Portugal between 2011 and 2021. Methods National databases were used to assess the annual number of hospitalisations and deaths due to AMI between 2011 and 2021. The annual mean costs were calculated using a direct cost analysis (bottom-up micro-costing) to assess the direct economic burden of AMI. In turn, these cases and associated costs were multiplied by the respective morbidity and mortality population attributable fraction (PAF) to estimate the number of hospital admissions and deaths, and their associated costs attributable to ambient PM2.5 exposure. For 2019 and 2021, an alternative scenario of exposure was considered (2021 WHO Air Quality Guidelines), and the avoidable morbidity and mortality costs were determined using the potential impact fraction (PIF). Results Between 2011 and 2021, there were 130,447 hospitalisations and 47,968 deaths due to AMI, with 4.79% and 28.90%, respectively, attributable to ambient PM2.5 exposure. This translates to a direct economic burden of morbidity of more than 44 million euros and mortality of almost 195 million euros. If the proposed scenario guidelines were met, 279 cases and 448 deaths would have been avoided in 2019, resulting in a savings of almost 9.7 million euros. In 2021, 93 cases and 355 deaths would have been avoided, with approximately 4 million euros saved. Conclusions Exposure to ambient PM2.5 significantly contributes to AMI cases and deaths in Portugal, imposing a significant economic burden. These findings highlight the urgent need for measures to improve air quality. Key messages • PM2.5 pollution in Portugal drives AMI cases and fatalities, entailing significant economic costs. • Adhering to WHO air quality guidelines promises substantial reductions in AMI incidence and save millions annually in healthcare expenditure.

Comprehensive statistical analysis of causes of death and histopathological diagnosis in medico-legal investigations of sudden cardiac deaths

Background and objectives. Sudden cardiac deaths (SCDs) have a significant impact worldwide. Its distribution trends may vary across different communities globally. Consequently, investigating sudden cardiac deaths necessitates a regional, multi-faceted approach. This study aims to ascertain the pathological background of the patients who died in the context of sudden cardiac death and analyze it statistically to generate some trends and define the occurrence of disease. Materials and methods. We conducted a retrospective analysis of the causes of death for cases from the Legal-Medicine Department of Maramures County, Romania, between 2021 and 2023. From this cohort, we identified and selected cases of SCD and conducted a statistical analysis of the number of cases, gender distribution, age group distribution, and the underlying cardiac pathology that led to this outcome. Results. 276 sudden cardiac deaths (SCD) were identified from 1,186 autopsies. Males accounted for 75% of SCD cases, with a mean age of 58.8 years. Advanced myocardial fibrosis (41.6%) was the most frequent cause, followed by coronary artery disease (18.12%) and acute myocardial infarction (17.4%). Males had significantly more AMI cases (p = 0.045), while females had more coronary artery disease and advanced myocardial fibrosis, though not statistically significant. Conclusions. Sudden cardiac death predominantly affects males, particularly those aged 51–60, with advanced myocardial fibrosis being the most common cause. The gender difference in AMI prevalence was significant, highlighting the need for targeted prevention and diagnostic improvements. Further research in liaison with experts in all fields is required.

Assessment the Incidence of Inferior Wall Myocardial Infarction, its Association with Right Ventricular Infarction and Function and its Clinical Outcome

Introduction: Myocardial infarction is one of the most common diagnoses in hospitalized patients. Myocardial infarction was previously thought to be a disease of mainly the left ventricle. Right ventricular infarction was just a pathological entity. Myocardial infarction may go undetected or may lead to catastrophic events leading to sudden cardiac death or causing severe hemodynamic derangements. Objective: To find out the Assessment the incidence of Inferior Wall Myocardial Infarction, its association with right ventricular infarction and function and its clinical outcome. Methods: The hospital based observational cross-sectional study was contacted at Department of Cardiology, Mymensingh Medical College Hospital, Bangladesh from 1st January 2022 to 30th January 2024. Conducted in intensive care unit, on an in-patient basis, consist of 50 cases of inferior wall MI. In patients with RVMI, the hospital death is high and major complications are greater. Right ventricular infarction leads to hemodynamic instability, atrio-ventricular conduction blocks, and in-hospital mortality in patients with inferior wall myocardial infarction. Results: Out of the total 150 cases of acute MI were included. The incidence of IMI among all the cases of AMI was 33.3%. In our study group of IMI RVI incidence was 30%. So, the incidence of RVI in all cases of AMI was 10%. There is a significant association between IWMI and RVMI and RVMI is seen in about 20% of cases and most common complication encountered was hypotension followed by complete heart block. The mean age of participants was 58.33 and maximum number of patients was in the age group of 40-60 (43%) and consists of 80% males and 20% females. Among them 51.4% was hypertensive, 22.8% were diabetic, 74.3% smokers, 11.42% were alcoholics. In this study 58.33% of patients with RVMI and 2% of patients without RVMI were presented with hypotension at the time of admission. Complete heart block seen in 13.33% of IWMI patients and Hypotension seen in 20% IWMI patients RVMI group. Right ventricular myocardial infarction seen in 20% of IWMI cases and TR is seen 66% of patients of IWMI with RVMI and 4% of patients of IWMI without RVMI. Conclusion: The incidence of mortality and complications can be reduced only when we are fully aware of the diagnosis and the complications that can occur in RVI. So, in all cases of IMI, RVI should be looked for by using simple and specific investigation like RPLs of ECG. Involvement of the right ventricle in inferior wall myocardial infarction significantly affects the mortality and morbidity and complications.

Investigating the Nurses and Doctors Attitudes' Regarding the Management of Acute Myocardial Infarction Patients Who Used the Thrombolytic Agents in Babylon Teaching Hospitals 2022rses and Doctors Regarding Management of Patients with Acute Myocardial Infarction Using Thrombolytic Agents in the Teaching Hospitals of Babylon, Iraq in 2022

Introduction and purpose: Ischemic heart disease and myocardial infarction are the most common causes of death in the world, and nurses play a key role in the management of these patients. Adequate attitude of health care workers towards the management of patients with acute myocardial infarction using thrombolytic agents is very important and this issue is part of patients' rights. Aims: The present study was conducted with the aim of study investigate the attitude of nurses and doctors regarding the management of patients with acute myocardial infarction using thrombolytic agents in the teaching hospitals of Babylon, Iraq in 2022. Research method: In this comparative study, 103 nurses and 13 doctors were selected in 2022 by available sampling method the type of sample was purposive and was conducted on nurses and doctors working in cardiac and coronary resuscitation units in Babylon Specialized Hospitals. Information was collected using two questionnaires including demographic questionnaire and attitude measurement questionnaire the attitudes questionnaire contained parts that included nurses and doctors, and a section specific to nurses only. Results: Among the studied nurses, the largest number were university nurses (36.9% bachelor, 8.7% master). (89.3%) of the nurses had work experience in the coronary care department and (73.8%) of them were currently working in the coronary care department. (78.6%) worked in the morning shift. (76.7%) of the nurses did not have a history of passing the training course in the coronary care department. (54.4%) of the nurses have a diploma and only (2.9%) of them have completed an academic course. The score of doctor’s attitude about the management of patients with acute myocardial infarction using thrombolytic agents was in the range of 68 to 98 with a mean and standard deviation of 83.62 ± 9.62. Based on the results of the independent t-test, there was no significant difference between nurses and doctors regarding the management of patients with acute myocardial infarction using thrombolytic agents (p=0.210). Conclusion: The study concludes that both nurses and doctors in Babylon Teaching Hospitals show a positive attitude towards managing acute myocardial infarction patients using thrombolytic agents. Despite variations in experience and training, both groups are prepared to provide effective care for these patients. The findings suggest a readiness within the medical staff to handle cases of AMI with thrombolytic therapy, highlighting the importance of continued education and training in coronary care management.

Prognostic impact of carotid plaque imaging using total plaque area added to SCORE2 in middle-aged subjects: the ARteris Cardiovascular Outcome (ARCO) cohort study.

Many cardiovascular events occur in seemingly healthy individuals.We set out to assess the predictive value of atherosclerosis imaging in combination with cardiovascular risk calculators in subjects aged 40-65 years. We compared PROCAM (PROspective CArdiovascular Münster study), SCORE (Systematic COronary Risk Evaluation) and SCORE2 with carotid ultrasound (total plaque area, TPA) in subjects without cardiovascular disease. In this prospective cohort study, follow-up was obtained by phone or mail from patients; or from clinical records, if needed. In 2842 subjects (mean age 50±8 years; 38% women), cardiovascular events occurred in 154 (5.4%) of them over an mean follow-up period of 5.9 (range 1-12) years, specifically: 41 cases of AMI (myocardial infarction), 16 strokes, 21 CABG (coronary artery bypass grafting), 41 PTCA (percutaneous transluminal coronary angioplasty) and 35 CAD (coronary artery disease). Mean PROCAM risk was 5±6%, mean SCORE risk was 1.3±1.6% and mean SCORE2 risk was 5±3%. Both for the primary outcome (major adverse cardiovascular events, MACEs, i.e. AMI + strokes) and the secondary outcome (atherosclerotic cardiovascular disease, ASCVD, i.e. MACEs + CABG + CAD + PTCA), hazards increased significantly for TPA tertiles and SCORE2 post-test risk between 6.7 to 12.8 after adjustment for risk factors (age, smoke, sex, systolic blood pressure, lipids, medication) and after adjustment for results from PROCAM, SCORE and SCORE2. Model performance was statistically improved regarding model fit in all models using TPA. Net reclassification improvement for SCORE2 with TPA post-test risk increased significantly by 24% for MACEs (p = 0.01) and 39% for ASCVD (p <0.0001). Integration of TPA post-test risk into SCORE2 adds prognostic information, supporting the use of carotid ultrasound when assessing ASCVD risk in subjects aged 40-65 years.

Abstract 12803: Disparities in Care Among COVID-19 Patients With ST-Elevation Myocardial Infarction Admitted in Rural and Urban Teaching Centers

Introduction: During the pandemic of COVID-19, resources ran scarce in various regions, which impacted access and availability of treatment options. Our study aims to compare outcomes of COVID-19-positive patients (CPP) who reported a diagnosis of ST-elevation myocardial infarction (STEMI) in either rural centers (RC) or urban teaching centers(UTC). Methods: De-identified data of CPP adults with STEMI from the 2020 National Inpatient Sample for admissions between April-December 2020 were analyzed. Patient characteristics and outcomes between RC and UTC were compared. Results: We found 4690 STEMI cases among CPP. Most cases were hospitalized in UTC(4255 cases, 90.7%), with 9.3% seeking care RC (Table 1). Cases in UTC were younger (mean age 66.28 years) and with a higher mean Charlson Comorbidity Index (CCI) score (mean score 4.31) than those at RC (mean age 71.75 years, p&lt;0.01, mean CCI score 4.00, p&lt;0.01). Medicare primarily covered both centers. A higher proportion of patients in RC were Whites (77.4%), while 50.0% of AMI cases at UTC were Whites. Patients at UTC also had a higher prevalence of prior stroke (6.3% vs. 3.4%, p=0.016) and lipid disorder (53.3% vs. 43.7%, p&lt;0.01) than those in RC but showed a lower prevalence of diabetes (44.3% vs. 50.6%, p=0.012). No differences in the prevalence of prior myocardial infarction, hypertension, smoking, obesity, chronic kidney disease, and sex were noted. Cases in UTC reported a higher incidence of cardiogenic shock (18.2% vs. 3.4%, aOR 6.631, 95% CI 3.850-11.421, p&lt;0.01), PCI use (42.1% vs. 20.7%, aOR 2.482, 95% CI 1.910-3.225, p&lt;0.01), and death (44.4% vs. 40.2%, aOR 1.513, 95% CI 1.197-1.912, p&lt;0.01). Conclusions: Adults with COVID-19 with STEMI admitted UTC were sicker with a higher mean CCI score and reported higher PCI use and mortality. Further studies investigating the distribution of resources during the pandemic and proposals to improve care access in rural and urban teaching hospitals should be conducted.

Comparison between In-Hospital and Out-of-Hospital Acute Myocardial Infarctions: Results from the Regional Myocardial Infarction Registry of Saxony-Anhalt (RHESA) Study.

Risk factors and outcomes of in-hospital ST elevation myocardial infraction (STEMI) are well explored. Recent findings show that non-ST elevation myocardial infarction (NSTEMI) accounts for the majority of in-hospital infarctions (IHMIs). Our aim was to identify differences between IHMI and out-of-hospital myocardial infraction (OHMI) in terms of risk factors, treatment and outcomes, including both STEMI and NSTEMI. We analyzed the Regional Myocardial Infarction Registry of Saxony-Anhalt dataset. Patient characteristics, treatments and outcomes were compared between IHMI and OHMI. The association between clinical outcomes and myocardial infarction type was assessed using generalized additive models. Overall, 11.4% of the included myocardial infractions were IHMI, and the majority were NSTEMI. Patients with IHMI were older and had more comorbidities than those with OHMI. Compared to OHMI, in-hospital myocardial infarction was associated with higher odds of 30-day mortality (OR = 1.85, 95% CI 1.32-2.59) and complications (OR = 2.36, 95 % CI 1.84-3.01). We provided insights on the full spectrum of IHMI, in both of its classifications. The proportion of IHMI was one ninth of all AMI cases treated in the hospital. Previously reported differences in the baseline characteristics and treatments, as well as worse clinical outcomes, in in-hospital STEMI compared to out-of-hospital STEMI persist even when including NSTEMI cases.

Status of Quality and Compliance to Inpatient Quality Indicators and Patient Safety Indicators in a Selected Private Corporate Hospital at Dhaka City Bangladesh

Background: The stutus of quality and compliance to inpatient quality indicators (IQIs) and patient safety indicators (PSIs) in corporate hospitals at dhaka city Bangladesh are not known as they are not adequately studied. Objective: The present descriptive cross-sectional study was therefor undertaken to know the status of quality and compliance to selected IQIs and PSIs in a selected private (corporate) hospital at Dhaka City Bangladesh. The period of study and hospital data collection period were May to August 2019 and January to March 2019 respectively. Methods: Selected IQIs and PSIs developed by Agency for Healthcare Research and Quality (AHRQ), USA and hospital facilities utilization parameters were investigated. Data were collected using questionnaires and checklists for the period of January to March 2019 from the purposively selected private (corporate) hospital. Sociodemographic information of randomly selected junior doctors and nurses were taken. Randomly selected senior clinicians, nurses and executives were interviewed regarding knowledge about selective IQIs, PSIs, JCIS, ISO relevant to quality healthcare. Data were analysed by SPSS programme version 20. Results: The hospital has all relevant admistrative and clinical departments, bed patterns and has efficient admission and discharge processes for inpatients. Bed utilization was 87.5% of total 159 available beds. Patients visited OPD: 2434 per day, admitted: 28 per day and discharged with successful outcome: 27 per day. Average length of stay (ALS), hospital acquired infection (HAI) and hospital deaths were 3.6 days, 1.76% (18/1000 cases), and 124 (01 per day) respectively during data collection period. Tests done in Laboratory Medicine were 267637 with Clinical Biochemistry tests highest (51.21%) and investigations in Radiology-Imaging departments were 74997 with X-rays being highest (40.22%). Of the five selected IQIs, total CABG cases done were 191 with 04 hospital deaths i.e. 2.1% (21 per 1000 cases) and total AMI cases done were 140 with 12 hospital deaths i.e. 8.5% (85 per 1000 cases). No casualties were reported for caesarean deliveries or primary/normal deliveries. None of the five selected PSIs were traced over the data collection period. Conclusion: These findings suggested that the selected hospital’s services were demanding and it was concerned about quality healthcare services. However, comparative studies with other private corporate hospotals at Dhaka City including larger number of respodents are warrented. Bangladesh Medical Res Counc Bull 2023; 49(2): 98-112

A comprehensive framework to estimate the frequency, duration, and risk factors for diagnostic delays using bootstrapping-based simulation methods

BackgroundThe incidence of diagnostic delays is unknown for many diseases and specific healthcare settings. Many existing methods to identify diagnostic delays are resource intensive or difficult to apply to different diseases or settings. Administrative and other real-world data sources may offer the ability to better identify and study diagnostic delays for a range of diseases.MethodsWe propose a comprehensive framework to estimate the frequency of missed diagnostic opportunities for a given disease using real-world longitudinal data sources. We provide a conceptual model of the disease-diagnostic, data-generating process. We then propose a bootstrapping method to estimate measures of the frequency of missed diagnostic opportunities and duration of delays. This approach identifies diagnostic opportunities based on signs and symptoms occurring prior to an initial diagnosis, while accounting for expected patterns of healthcare that may appear as coincidental symptoms. Three different bootstrapping algorithms are described along with estimation procedures to implement the resampling. Finally, we apply our approach to the diseases of tuberculosis, acute myocardial infarction, and stroke to estimate the frequency and duration of diagnostic delays for these diseases.ResultsUsing the IBM MarketScan Research databases from 2001 to 2017, we identified 2,073 cases of tuberculosis, 359,625 cases of AMI, and 367,768 cases of stroke. Depending on the simulation approach that was used, we estimated that 6.9–8.3% of patients with stroke, 16.0-21.3% of patients with AMI and 63.9–82.3% of patients with tuberculosis experienced a missed diagnostic opportunity. Similarly, we estimated that, on average, diagnostic delays lasted 6.7–7.6 days for stroke, 6.7–8.2 days for AMI, and 34.3–44.5 days for tuberculosis. Estimates for each of these measures was consistent with prior literature; however, specific estimates varied across the different simulation algorithms considered.ConclusionsOur approach can be easily applied to study diagnostic delays using longitudinal administrative data sources. Moreover, this general approach can be customized to fit a range of diseases to account for specific clinical characteristics of a given disease. We summarize how the choice of simulation algorithm may impact the resulting estimates and provide guidance on the statistical considerations for applying our approach to future studies.

Predyktory prohnozuvannia sertsevo-sudynnykh podii ta inshykh uskladnen systemy krovoobihu u khvorykh iz hostrym koronarnym syndromom (ohliad literatury; rezultaty vlasnykh doslidzhen)

Introduction. More than 15 million cases of AMI are recorded annually in the world, and in Ukraine in 2017 – 41.786 cases. Undoubtedly, acute coronary syndrome (ACS) manifests various complications of blood flow. At the same time, in such patients, significantly fewer works are devoted to predictors of other complications of the cardiovascular system. The aim of the study. Write a literature review and include the results of own research on predictors of predicting cardiovascular events and other complications of the blood flow system in ACS. Materials and methods. We used 49 published articles and our own research results on the study of predictors of predicting cardiovascular events and other complications of the blood flow system after undergoing ACS. The results of our own research are presented in a complex algorithm for predicting SCD in cardiovascular pathology, and our own criteria for cardiovascular events are given. Results. It has been proven that an increase in the thickness of the LV wall in patients with hypertension can be associated with an almost 7-fold increase in the risk of death. In our opinion, LVH in STEMI in combination with hypertension has a negative impact on the development of cardiovascular events. The development of pathological remodeling of the LV leads to further dilatation, deformation of the walls and cavities of the heart, a progressive decrease in the inotropic function of the LV with the development of congestive heart failure. Some authors suggest prognostic predictors of the development of acute left ventricular failure. The prognostic role of endothelial dysfunction in cardiovascular events is poorly understood. Conclusions. In recent years, predictors of the development of cardiovascular events (death, non-fatal MI, stroke, UA), as well as such complications of the blood flow system as acute left ventricular failure, progression of heart failure, development of VE 3-5 grades according to Laun have been established in patients with a transferred STEMI and UA in recent years , severe heart blocks with the occurrence of syncopal states. According to our data, clinical, ECG, and echocardiographic diagnostic criteria are predictors of cardiovascular events. The specified predictors of cardiovascular events and various complications of the blood flow system after a STEMI and UA need to be taken into account by cardiologists, emergency physicians, and family physicians in their practice and to carry out therapeutic measures aimed at preventing their occurrence in patients.

Association between Outdoor Air Pollution and Fatal Acute Myocardial Infarction in Lithuania between 2006 and 2015: A Time Series Design.

Air pollution has a significant effect on human health and there is a broad body of evidence showing that exposure to air pollution is associated with an increased risk of adverse health effects. The main objective of this study was to assess the association of traffic-related air pollutants with fatal AMI during the ten-year period. The study was conducted in Kaunas city, where the WHO MONICA register included a total of 2273 adult cases of fatal AMI cases during the 10-year study period. We focused on the period between 2006 and 2015. The associations between exposure to traffic-related air pollution and the risk of fatal AMI were evaluated by using a multivariate Poisson regression model, RR presented per an increase in IQR. It was found that the risk of fatal AMI was significantly higher in all subjects (RR 1.06; 95% CI 1.00-1.12) and women (RR 1.12; 95% CI 1.02-1.22) when the concentration of PM10 in the ambient air was increased 5-11 days before the onset of AMI, adjusting for NO2 concentration. The effect was stronger during spring in all subjects (RR 1.12; 95% CI 1.03-1.22), in men (RR 1.13; 95% CI 1.01-1.26), in younger-aged (RR 1.15; 95% CI 1.03-1.28), and in winter in women (RR 1.24; 95% CI 1.03-1.50). Our findings show that ambient air pollution increases the risk of fatal AMI, and this pertains to PM10 specifically.

Stress hyperglycemia ratio and neutrophil to lymphocyte ratio are reliable predictors of new-onset atrial fibrillation in patients with acute myocardial infarction.

The occurrence of new-onset atrial fibrillation (NOAF) post-acute myocardial infarction (AMI) is associated with worse outcomes. In this study, we sought to assess the predictive effect of stress hyperglycemia ratio (SHR) and neutrophil to lymphocyte ratio (NLR) to predict NOAF in patients with AMI. We recruited 3,194 individuals with AMI but free of atrial fibrillation (AF). AMI cases were stratified into groups according to SHR and NLR quartiles and were further categorized based on diabetes status. High SHR and high NLR were defined as the highest quartile of SHR and NLR. A nomogram incorporating risk factors for NOAF was constructed using multivariate logistic regression analyses. The performance of the novel nomogram was tested for predictive performance, agreement between the actual and predicted probability, and clinical utility using area under the curve (AUC), bootstrapped calibration curves, and decision curve analysis, respectively. A total of 245 (7.67%) patients developed NOAF post-AMI. The NOAF cases had higher values of SHR and NLR than non-NOAF patients after AMI regardless of diabetes status. After adjusting for potential confounders, high SHR and NLR were independently associated with NOAF post-AMI. Moreover, the novel nomogram incorporating high NLR and high SHR for NOAF risk estimation in patients with AMI showed satisfactory performance assessed by the AUC, calibration curves, decision curve analysis. SHR and NLR were independently associated with NOAF in AMI patients. The constructed novel nomogram that incorporates SHR and NLR might assist in NOAF risk stratification post-AMI.

Abstract 12101: Impact of COVID-19 Pandemic on the Incidences of Hospitalizations for Acute Myocardial Infarction and Out-of-Hospital Cardiac Death. A Nation-Level Analysis

Introduction: COVID-19 infection has increased the risk of thrombosis, and the pandemic has impacted the utilization of healthcare services. Hypothesis: The study aims to investigate the consequences of the COVID-19 pandemic on the incidence of hospitalization for acute myocardial infarction (IH-AMI) and out-of-hospital cardiovascular deaths rate (OH-CVD). Methods: The analysis was done on data collected in the National Database of Death Records, the National Health Information System, and the Information System of Infectious Diseases. Incidence and number of deaths were expressed per 100 000 inhabitants. For comparison of time periods incidence rate ratio was applied. Over-mortality was described as a change in % against the reference period 2016-2019. Results: The population for the analysis consisted of 50,745 AMI cases and 204,392 OH-deaths from any cause. In the pandemic year (vs. 2016-2019 period), there was a significant decrease in AMI hospitalizations with an incidence rate ratio of 0.949 (0.911;0.989) for acute STEMI and 0.949 (0.911;0.989) for NSTEMI, respectively. A significant relationship was found between the decrease in acute STEMI hospitalizations and the number of COVID-infected patients. The risk of OH-CVD increased significantly in 2020 compared to the mean death rates in 2016-2019. The analysis of over-mortality against the reference period 2016-2019 shows the increase of OH-CVD associated with the decrease in hospitalization for acute STEMI significantly related to the number of COVID19 cases (Figure). Conclusions: The COVID-19 pandemic significantly affected the number of IH-AMI while increasing the incidence of OH-CVD. These changes were directly impacted by the number of infected in the population. It is, therefore, necessary to focus efforts on informing the population about the safety of hospitalization and ensuring full availability of health care services even in pandemic times.

Decreased Testosterone Levels Precede a Myocardial Infarction in Both Men and Women

The potential role of the hormone testosterone in the risk for myocardial infarction is investigated in this study of middle-aged men and women compared with a large random control sample from the general population. Radioimmunoassay was used to measure testosterone levels in hair, approximately 1 month and 3months before an ST-elevation or non-ST-elevation acute myocardial infarction. Mean testosterone levels were measured for middle-aged men and women (n=168) with diagnosed myocardial infarction (the acute myocardial infarction [AMI] cases). As controls, n=3,150 randomly selected subjects from the general population of similar age were measured at 1 time point. No significant difference in testosterone levels in hair was found 3months before AMI for men and women compared with the controls. However, 1 month before AMI, the testosterone levels were decreasing (p <0.001) for both men (from 2.84 to 2.10pg/mg) and women (from 1.43 to 1.10pg/mg), indicating that a decrease in testosterone concentrations precedes a severe cardiac event. Conventional cardiovascular risk factors were tested as confounders but did not alter this tendency. The AMI cases were also compared with a randomly selected second control group from the general population (n=205), for whom comparable segmental hair analyses were conducted. A tendency of some decreasing testosterone levels, also in the small control group, was only significant for men. This control group was a small sample, and there might be some natural biologic variation in testosterone levels over time. This study indicates that decreased testosterone levels may be among the pathophysiological processes preceding myocardial infarction and merits further investigation.

Acute Mesenteric Ischemia in Critically Ill Patients. Possibilities of Laboratory Diagnostics. Systematic Literature Review and Meta-Analysis

Background Acute mesenteric ischemia (ami) is diagnosed in 1 case per 5,000–15,000 operations associated with elective abdominal surgical intervention and in 1 case of 1,000 emergency laparotomies associated with the acute abdomen clinical features. Non-occlusive disorders account for 20-30% of all cases of ami. The absence of pathognomonic symptoms and syndromes, as well as specific laboratory markers of ami, determines significant difficulties in the early diagnosis of this disease, especially in critically ill patients.Aim of study To identify the main laboratory markers of acute mesenteric ischemia applicable in the resuscitation and intensive care unit (ricu) based on a systematic literature review.Material and methods A systematic search and selection of publications was carried out in march-april 2021 in accordance with the prisma system checklist (prisma, preferred reporting items for systematic reviews and meta-analyzes). The search used two databases: the cochrane library of systematic reviews (https://www.cochranelibrary.com) and the pubmed bibliographic database (https://pubmed.ncbi.nlm.nih.gov). Key terms in the search parameters were: acute mesenteric ischemia; bowel necrosis predictors; laboratory diagnostics of mesenteric ischemia. Search parameters were limited to the year of publication (not later than 2015). The main results of the review included patients with an established diagnosis of acute mesenteric ischemia, indicating the level of laboratory parameters (ph of mixed venous blood, lactate, d-dimer, white blood count, mpv, i-fabp, serum marker and alpha-glutathione-s-transferase, indicators of the coagulation and hemostasis). Case reports and editorial letters were excluded from the search.Results The threshold value for serum l-lactate ranged from 1.05 mmol/l to 5.6 mmol/l. The sensitivity of serum lactate for the diagnosis of ami ranged from 34.7% (95% ci: 0.82–91.64%) to 89.51% (95.4% ci: 75.12–94.28%), and the specificity ranged from 47.3% (94.7% ci: 26.54–67.98%) to 94.5% (93.2% ci: 75.44–96.85%). The threshold level of d-dimer varied from 0.58 nmol/l to 7.84 nmol/l. The sensitivity of blood d-dimer for the diagnosis of ami was 72.6% (94% ci: 56.1–92.4%) to 99.7% (94% ci: 69.15–100%); the specificity ranged from 69% (95% ci: 7.41–33.63%) to 97.89% (95% ci: 90.42–98.1%). Parameters such as transaminases (ast, alt), mpv, ldh, d-lactate, serum amylase were not included in the review due to the lack of a sufficient number of studies.Conclusion Today, there is no highly specific laboratory marker that could be considered the “gold standard” in the laboratory diagnosis of acute mesenteric ischemia. The most promising in predicting ami are serum levels of l-lactate and d-dimer.

Investigation of 5-Year Interconnections between Local Earth Magnetic Field Fluctuations and Acute Myocardial Infarction in Lithuania

The impact of the local Earth magnetic field (LEMF) on cardiovascular events has been studied recently. Data gathered during past years encouraged us to conduct this epidemiological analysis evaluating the association between changes in LEMF and hospital admissions due to AMI in Lithuania between August 2014 and September 2019. This study is unique due to its coverage of all Lithuanian patients. The frequency of morbidity of AMI was compared with the intensity of the LEMF and correlation coefficient was evaluated. The LEMF was measured by the Global Coherence Monitoring Network magnetometer located in Lithuania. LEMF was measured by pikotesla square (pT²). The LEMF was analized in five frequency ranges [Hz], generally called between Schumann resonance, which overlap with the human brain activity waves on electroencefalogram (EEG) frequency ranges (here, they are named as SDelta (0-3.5Hz), STheta (3.5-7Hz), SAlpha (7-15Hz), SBeta (15-32Hz) and SGamma (32-65Hz) to distinguish from the EEG bands). Significant correlations between weekly admissions of AMI cases and the weekly LEMF strength in five frequency ranges and in total range was found. A clear negative correlation was observed between cases of AMI in female group and LEMF frequency ranges SDelta (0-3.5Hz), STheta (3.5-7Hz), SAlpha (7-15Hz), SBeta (15-32Hz) and in total range. In the second half of the year the number of AMI is lower, therefore negative correlations between SDelta (0-3.5Hz), STheta (3.5-7Hz), SAlpha (7-15Hz) and SBeta (15-32Hz) ranges are stronger than in the first one. This is particularly noticeable in 2016 and 2018 years.

Lipid profile in newly diagnosed patients of acute myocardial infarction with no other concomitant disease, in tertiary care hospital, Peshawar.

Objective: To see lipid profile in patients of AMI having no other concomitant disease. Study Design: Cross Sectional study. Setting: Coronary Care Unit, Lady Reading Hospital Peshawar. Period: July 2016 to January 2017. Material &amp; Methods: One hundred newly diagnosed cases of AMI, admitted in coronary care unit, Lady Reading Hospital, Peshawar as emergency and 100 normal subjects were included in the study. Sampling technique was Convenient sampling. Lipid profile was measured by using Cobas Chemistry analyzer, Roche, in Pathology Department, LRH, Peshawar. Results were analyzed by independent t-test. Results: There were 100 patients and 100 normal individuals included by consecutive sampling in the study. Out of 100 patients 85 (85%) were male and 15 (15%) were female. Age ranged from 26-80 years (50.87 ± 11.02). It was observed that 82% of the AMI patients had cholesterol levels less than 200mg/dl while LDL was less than 100mg/dl in all of the patients. However, HDL which is protective lipoprotein was found to be less than 40mg/dl. It was also observed that 82% of the patients had normal Blood Pressure whereas only 18% had high blood pressure. The working conditions of most of the patients (85%) were sedentary. Conclusion: In majority of the cases, blood pressure was normal. However HDL-C was less than 40 mg/dl in cases which is alarming. Besides, Sedentary Life style was found to be the major factor contributing to AMI.

Impact of comprehensive smoke-free policy compliance on SHS exposure and health condition of the Georgian population.

INTRODUCTIONGeorgia made steps forward in 2017 and adopted new amendments to its tobacco control legislation, which mostly correspond to the FCTC requirements. Among other changes in the regulations is a ban on smoking in public buildings and public transport, with a few exemptions (casinos, big slot clubs, performances in theatres, taxis). The regulation entered into force on 1 May 2018.METHODSThe aim of the study is to assess the outcomes of the comprehensive smoke-free legislation in Georgia. We used a logical model for data collection and analysis. Our evaluation focuses on smoking prevalence related survey data, SHS exposure, monitoring results on compliance of new tobacco control regulations, Quitline data, and air quality measurement results.RESULTSThe indoor air quality improved by 91% in the hospitality sector (from 1408 to 126 μg/m3 in 2018 and 117 μg/m3 in 2019), by 80% in public settings (from 531 to 112 μg/m3 in 2018 and 98 μg/m3 in 2019) and sufficiently in healthcare facilities (from 219 to 97–98 μg/m3 in 2018–2019). Demand for Quitline services increased by 30%. New cases of AMI declined by 32% during 2017–2019.CONCLUSIONSA comprehensive smoke-free policy with a high level of compliance (≥95%) had a positive impact on the decline of SHS exposure and tremendous improvement of indoor air quality in public places and promotes a decrease in illnesses related to the cardiovascular system in Georgia. Also, demand increased for smoking-cessation services.

Impact of COVID-19 Pandemic on STEMI Networks in Central Romania.

The COVID-19 pandemic has had a major impact on cardiovascular emergencies. The aim of this study was to investigate the impact of the COVID-19 pandemic on a regional network for management of ST-segment elevation acute myocardial infarction (STEMI). Methods: We report a single center’s experience of patients hospitalized for ACS in a high-volume hub of a STEMI network during the lockdown (in the first pandemic trimester), compared with the same time interval of the previous year and including all consecutive patients referred for an AMI during the second trimester of 2020 (from April to June) or during the same time interval of the previous year, 2019. Results: The absolute number of hospital admissions for AMI decreased by 22.3%, while the non-AMI hospitalizations decreased by 77.14% in Q2-2020 compared to Q2-2019 (210 vs. 48, p < 0.0001). As a consequence, the percentage of AMI cases from the total number of hospital admission increased from 38% to 68% (p < 0.0001), AMI becoming the dominant pathology. In the STEMI group there was a significant reduction of 55% in the absolute number of late STEMI presentations. Functionality of the STEMI network at the hub level did not present a significant alteration with only a minor increase in the door-to-balloon time, from 34 min to 41 min. However, at the level of the network we recorded a lower number of critical cases transferred to the interventional center, with a dramatic reduction of 56.1% in the number of critical STEMI cases arriving in the acute cardiac care unit (17.0% vs. 7.3%, p-0.04 for KILLIP class III, and 21.17% vs. 11.11%, p = 0.08 for resuscitated out of hospital cardiac arrest). Conclusions: The COVID-19 outbreak did not have a major impact on the interventional center’s functionality, but it limited the capacity of the regional STEMI network to bring the critical patient with complicated STEMI to the cathlab in time during the first months of the lockdown. Even a very well-functioning STEMI network like the one in Central Romania had difficulties bringing the most critical STEMI cases to the cathlab in time.

Cardiovascular risk factors associated with acute myocardial infarction and stroke in the MADIABETES cohort

We aimed to develop two models to estimate first AMI and stroke/TIA, respectively, in type 2 diabetes mellitus patients, by applying backward elimination to the following variables: age, sex, duration of diabetes, smoking, BMI, and use of antihyperglycemic drugs, statins, and aspirin. As time-varying covariates, we analyzed blood pressure, albuminuria, lipid profile, HbA1c, retinopathy, neuropathy, and atrial fibrillation (only in stroke/TIA model). Both models were stratified by antihypertensive drugs. We evaluated 2980 patients (52.8% women; 67.3 ± 11.2 years) with 24,159 person-years of follow-up. We recorded 114 cases of AMI and 185 cases of stroke/TIA. The factors that were independently associated with first AMI were age (≥ 75 years vs. < 75 years) (p = 0.019), higher HbA1c (> 64 mmol/mol vs. < 53 mmol/mol) (p = 0.003), HDL-cholesterol (0.90–1.81 mmol/L vs. < 0.90 mmol/L) (p = 0.002), and diastolic blood pressure (65–85 mmHg vs. < 65 mmHg) (p < 0.001). The factors that were independently associated with first stroke/TIA were age (≥ 75 years vs. < 60 years) (p < 0.001), atrial fibrillation (first year after the diagnosis vs. more than one year) (p = 0.001), glomerular filtration rate (per each 15 mL/min/1.73 m2 decrease) (p < 0.001), total cholesterol (3.88–6.46 mmol/L vs. < 3.88 mmol/L) (p < 0.001), triglycerides (per each increment of 1.13 mmol/L) (p = 0.031), albuminuria (p < 0.001), neuropathy (p = 0.01), and retinopathy (p = 0.023).