AMI Patients Research Articles

Frequency and Short Term Survival of Acute Myocardial Infarction Patients with Diabetes Mellitus

Objective: To assess frequency and survival of AMI patients with diabetes mellitus. Study Type: Prospective observational study. Study Place and Duration: DG Khan Medical College & DHQ Teaching Hospital, DG Khan, from 1st June 2020 to 30th May 2021. Material and methods: The study comprised instances of Type II diabetes mellitus that required admission in the hospital due to ST elevation myocardial infarction and met the other criteria. Electrocardiogram (ECG) 6 hourly, cardiac enzymes on arrival, repeated at two, four, eight, twelve, and twenty four hours, and Troponin T fast assay are among the tests performed. On the basis of the above-mentioned work-up, the definitive diagnosis was made within 48 hours for acute myocardial infarction after admission. The HbA1c level and blood glucose level were also checked to determine the diabetic state. Results: Overall 366 diabetes patients with AMI were studied. Out of these, 269 (73.5%) were males and 97 (26.5%) were females. The mean age of the patients was 44.86±12.26 years. Inferior wall MI was found in (33.3%) patients and left ventricle dysfunction was found in (21.6%) patients. CK-MB and troponin T enzyme was found in raised diabetes patients, (51.9%) and (90.7%), respectively. n=44 (12.0%) deaths were reported in 1-10 days, n=43 (11.7%) deaths were reported in 11-20 days and n=51 (13.9%) deaths were reported in 21-30 days. Conclusion: In current study it was concluded that in patients with diabetes mellitus, the short term mortality increases. Keywords: Frequency, Short term, Acute Myocardial Infarction (MI), Diabetes Mellitus(DM), Mortality, Shortness of Breath, Chest Pain

A Cross Sectional Study on Hypokalemia in Patients with Acute Myocardial Infarction

Introduction: Hypokalemia was found to be more common in women, those with hypertension, and those on chronic diuretic therapy.
 Objectives of the Study: The main objective of the study is to analyse the hypokalemia in patients with acute myocardial infarction.
 Materials and Methods: This cross sectional study was conducted in District Head Quarter Teaching Hospital Faisalabad during 2019 to 2020. The data was collected from 100 male and female patients with myocardial infarction. The effect of plasma potassium concentration on patient survival after a myocardial infarction is investigated. 
 Results: The data was collected from 100 patients of MI. Mean age of male patients was found to be 64.12±12.34 and female patients was 46.21±10.24. There was statistically significant decrease in serum sodium and potassium levels in study group among both the ages compared to normal healthy control group. Serum sodium, potassium, chloride, calcium levels were significantly lower in the AMI patients and magnesium levels were slightly raised among cases than controls.
 Conclusion: It is concluded that reduction in sodium level was assessed only in patients with AMI as compared to healthy persons. Estimation of serum electrolyte is of utmost importance for diagnosis and prognosis of AMI.

A study of management and biochemical outcomes in AMI patients supported with different mechanical devices in a single center

IntroductionPatients with myocardial infarction (MI) and cardiogenic shock (CS) have poor outcomes in terms of morbidity and mortality. Many devices act as a ‘bridge’ in case of cardiogenic shock, by providing circulatory support and buy time so that the patient either recovers or receives a transplant or a long-term device. Materials and methodsThis is a retrospective observational study where all patients (n = 286) getting admitted for MI and CS were included. The different variables are compared across the three groups [extracorporeal membrane oxygenation (ECMO), Intra-aortic balloon pump (IABP) and IABP + ECMO]. The fourth group (Impella) had only 6 patients and no statistical analysis has been done for the same, to avoid skewness of results. ResultsThere are a total of 286 patients in the study out of which ECMO was used in 99 patients, IABP in 138 patients, both IABP and ECMO in 43 patients, and Impella in 6 patients. The patients differed in terms of diagnosis category, pre-existing hypertension, pre-existing diabetes, pre-existing hyperlipidemia, pre-existing heart failure, and other co-morbidities. The groups also differed in terms of the cardiac findings like heart rate, left ventricular end-diastolic diameter (LVED), and left ventricular ejection fraction (LVEF). Stents were implanted more commonly among the IABP (22.5%) and IABP + ECMO group (25.6%) as compared to the ECMO group (6.1%), and the difference was statistically significant (p Value = 0.0012). The median time for device usage in ECMO group was 147 h, as compared to 130 h among IABP group and 144 h among IABP + ECMO group, and the difference was statistically significant between the ECMO and IABP group (p Value = 0.047). The median time for breathing machine assisted ventilation was also highest in the ECMO group (262 h), as compared to IABP (86 h) and IABP + ECMO group (177 h). Patients in the ECMO group had the higher heart rate than patients in IABP group (median heart rate: 95 vs 86 beats per minute). Left ventricular ejection fraction was highest in the IABP group (41% in IABP group Vs 24.5% in ECMO group & 35% in IABP + ECMO group). ConclusionThough the three groups (IABP, ECMO and ECMO + IABP) were heterogenous, there was a clear advantage in terms of outcomes in the group in which more than one device was used. In conclusion we can say that all three devices have their own advantages and disadvantages, and they have a distinct hemodynamic footprint and thus should be used after detailed assessment of the patient.

ST-segment elevation versus non-ST-segment elevation myocardial infarction in current smokers after newer-generation drug-eluting stent implantation.

We compared the 2-year major clinical outcomes between ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) in patients who are current smokers who underwent successful percutaneous coronary intervention (PCI) with newer-generation drug-eluting stents (DESs). The availability of data in this regard is limited.A total of 8357 AMI patients were included and divided into 2 groups: the STEMI group (n = 5124) and NSTEMI group (n = 3233). The primary endpoint was the occurrence of major adverse cardiac events (MACE), defined as all-cause death, recurrent myocardial infarction (re-MI), or coronary repeat revascularization. The secondary endpoints were the cumulative incidences of the individual components of MACE and stent thrombosis (definite or probable).After propensity score-matched (PSM) analysis, 2 PSM groups (2250 pairs, C-statistics = 0.795) were generated. In the PSM patients, both for 1 month and at 2 years, the cumulative incidence of MACE (P = .183 and P = .655, respectively), all-cause death, cardiac death, re-MI, all-cause death or MI, any repeat revascularization, and stent thrombosis (P = .998 and P = .341, respectively) was not significantly different between the STEMI and NSTEMI groups. In addition, these results were confirmed using multivariate analysis.In the era of contemporary newer-generation DESs, both during 1 month and at 2 years after index PCI, the major clinical outcomes were not significantly different between the STEMI and NSTEMI groups confined to the patients who are current smokers. However, further research is needed to confirm these results.

Echocardiographic Evaluation of Systolic Left Ventricular function in Acute Myocardial Infarction in 1st Week of Hospitalization

Objectives: To assess systolic left ventricular function determined by left ventricular ejection fraction (LVEF) with the help of Echocardiography and correlate with ECG findings in patients of AMI. Methods: One hundred (100) cases of acute myocardial infarction were studied in the Department of Cardiology, DMCH from July 2015 to December 2015. It was an observational study. All selected patients were interviewed with a preformed questionnaire and were observed up to 7 days in hospital. Echocardiography was done to assess left ventricular ejection fraction (LVEF) by applying Teichholz (cube) formula. Results: 83% of them were males and 17% of them were females. Mean age (±SD) was 52.24±11.59 years (range 34-82 years). The important risk factors among the study subjects, was hypertension (45%) (Male 40.96%; Female 64.7%) followed by Diabetes mellitus (33%) (Male 31.32%; Female 41.17%). Most of the admitted patients could reach in hospital within 4-12 hours of onset of symptoms and most of the patients of acute myocardial infarction had anterior wall involvement (37%). Mild systolic LV dysfunction (52.87%) was revealed in echocardiography among the survivors. Conclusion: The incidence of AMI was seen common among farmers who were mostly hypertensive. Systolic LV dysfunction was common in most patients where anterior wall involvement was present. Bangladesh J Medicine July 2022; 33(1) : 12-18

Clinical Characteristics and Short-Term Outcomes of Patients Presenting with Acute Myocardial Infarction having Multi-vessel disease - A Single Middle- eastern Tertiary-Care Center Experience

ObjectivePatients with multi-vessel coronary artery disease (MVD) compared to single-vessel coronary artery disease (CAD) have more comorbidities and poor in-hospital outcomes. We aim to analyze MVD-AMI patients regarding clinical data and short-term outcomes. MethodsThis is a retrospective analysis of the prospectively collected data registry, a single-center study reviewing the clinical details and hospital outcome measures of AMI patients referred to our center for early revascularization from 2016 to 2019. ResultOut of 3041 patients presented with AMI, 491 (16%) had MVD on coronary angiogram. MVD-AMI patients were older, had a higher prevalence of DM, HTN, and prior history of ischemic heart disease compared to the non- MVD -AMI group (p < 0.001 for all). However, they presented more with non-anterior myocardial infarction, showed higher rates of post-myocardial infarction LV dysfunction, and mortality (p < 0.001). Older MVD-AMI patients showed higher rates of in-hospital morbidities and mortality compared to younger ones (p < 0.001). MVD- AMI women and Middle Eastern patients were older and showed a higher prevalence of cardiovascular risk factors compared to MVD-AMI men and South Asian patient population respectively. There were no significant differences recorded among the different subgroups of MVD-AMI patients regarding the hospital outcome measures. ConclusionOur study highlighted the clinical characters and poor outcomes of a high-risk group of MVD-AMI with different demographic backgrounds. Although age was a strong predictor for in-hospital poor outcomes, neither gender nor ethnicity affected the outcomes in them.

Outcomes between prediabetes and type 2 diabetes mellitus in older adults with acute myocardial infarction in the era of newer-generation drug-eluting stents: a retrospective observational study

BackgroundThe comparative clinical outcomes between prediabetes and type 2 diabetes mellitus (T2DM) in older adults with AMI in the era of newer-generation drug-eluting stents (DES) are limited. We investigated the 2-year clinical outcomes of these patients.MethodsA total of 5492 AMI patients aged ≥65 years were classified into three groups according to their glycemic status: normoglycemia (group A: 1193), prediabetes (group B: 1696), and T2DM (group C: 2603). The primary outcome was the occurrence of major adverse cardiac events (MACE), defined as all-cause death, recurrent myocardial infarction (Re-MI), and any repeat revascularization. The secondary outcome was stent thrombosis (ST).ResultsThe primary and secondary outcomes cumulative incidences were similar between the prediabetes and T2DM groups. In both the prediabetes and T2DM groups, the cumulative incidences of MACE (adjusted hazard ratio [aHR]: 1.373; p = 0.020 and aHR: 1.479; p = 0.002, respectively) and all-cause death or MI (aHR: 1.436; p = 0.022 and aHR: 1.647; p = 0.001, respectively) were significantly higher than those in the normoglycemia group. Additionally, the cumulative incidence of all-cause death in the T2DM group was significantly higher than that in the normoglycemia group (aHR, 1.666; p = 0.003).ConclusionsIn this retrospective study, despite the 2-year clinical outcomes of the patients with prediabetes and T2DM in the older adults were worse than those in the normoglycemia group; they were similar between the prediabetes and T2DM groups. Hence, comparable treatment strategies should be strengthened between prediabetes and T2DM in older adults with AMI.Trial registrationRetrospectively registered.

Differences in mortality and causes of death between STEMI and NSTEMI in the early and late phases after acute myocardial infarction.

BackgroundThe detailed causes of death in non–ST-segment–elevation myocardial infarction (NSTEMI) have not been adequately evaluated compared to those in ST-segment elevation myocardial infarction (STEMI).MethodsThe study population was 6,228 AMI patients who underwent percutaneous coronary intervention (STEMI: 4,625 patients and NSTEMI: 1,603 patients). The primary outcome was all-cause death.ResultsWithin 6 months after AMI, the adjusted mortality risk was not significantly different between NSTEMI patients and STEMI patients (HR: 0.83, 95%CI: 0.67–1.03, P = 0.09). Regarding the causes of death within 6 months after AMI, mechanical complications more frequently occurred in STEMI patients than in NSTEMI patients, while proportions of post resuscitation status on arrival and heart failure were higher in in NSTEMI patients than in STEMI patients. Beyond 6 months after AMI, the adjusted mortality risk of NSTEMI relative to STEMI was not significantly different. (HR: 1.04, 95%CI: 0.90–1.20, P = 0.59). Regarding causes of death beyond 6 months after AMI, almost half of deaths were cardiovascular causes in both groups, and breakdown of causes of death was similar between NSTEMI and STEMI.ConclusionThe mortality risk within and beyond 6 months after AMI were not significantly different between STEMI patients and NSTEMI patients after adjusting confounders. Deaths due to post resuscitation status and heart failure were more frequent in NSTEMI within 6 months after AMI.

Abstract 10868: Risk Factors and Long-Term Outcomes of Cardiogenic Shock in Young Patients with Myocardial Infarction - The Mass General Brigham Young-MI Registry

Introduction: Cardiogenic shock complicating acute myocardial infarction (CS-AMI) is associated with high morbidity and mortality, yet data among younger individuals are limited. Methods: Retrospective cohort study of consecutive AMI patients aged 18-50 years admitted to 2 tertiary care academic centers from 2000-2016. CS was determined by physician review of electronic health records (EHR) using the SCAI CS classification system. Baseline characteristics, treatment and outcomes including all-cause mortality (ACM), cardiovascular mortality (CVM) and 1-year hospitalization for heart failure (HHF) were adjudicated by physicians using EHR and death records. Mahalanobis distance matching was used to define a comparator group in the non-CS cohort. Results: The study included 2097 AMI patients (mean age 44 ± 5.1 years, 74% white, 81% male), with CS-AMI identified in 148 (7%) patients. There were no significant differences in age, sex or race between groups, although CS-AMI patients were more likely to have public or no insurance (p=0.02). Independent factors associated with CS-AMI included female sex, STEMI at presentation, out of hospital cardiac arrest, left main coronary disease, diabetes and peripheral artery disease. Over a median follow up of 11.2 years, compared to 461 matched non-CS-AMI patients and controlling for relevant covariates, CS-AMI patients had significantly higher ACM (aHR 2.84, p&lt;0.001), CVM (aHR 4.09, p&lt;0.001), and 1-year HHF (aHR 6.18, p=0.001) (Figure 1). In landmark analyses, CS-AMI patients who survived to discharge continued to have significantly higher risk of CVM (aHR 2.76, p=0.016) compared with matched non-CS AMI patients. All results were similar in the full cohort comparison. Conclusion: Cardiogenic shock is infrequent amongst young AMI patients, but associated with substantially higher overall and post-discharge mortality, and 1-year heart failure hospitalizations after AMI compared to those without cardiogenic shock.

Abstract 11647: Influence of Hypercoagulability and Impaired Fibrinolysis on Occurrence of Acute Myocardial Infarction and Prognostic Implication Following Percutaneous Coronary Intervention

Introduction: Although a plaque damage such as rupture is quite commonly observed, catastrophic event with clinical symptoms is not common in real practice. Hypothesis: Hypercoagulability and impaired fibrinolysis can be associated with the risk of coronary thrombosis and long-term clinical prognosis in patients with coronary artery disease (CAD). Methods: CAD patients who underwent percutaneous coronary intervention (PCI) (n=2,705) were enrolled (presented with acute myocardial infarction [AMI], 47.8%). Global hemostatic properties were evaluated with thromboelastographic assay (TEG ® ) showing hypercoagulability (maximal amplitude [MA]: platelet-fibrin clot strength) and impaired fibrinolysis (LY 30 : percent lysis 30 minutes after maximal clot strength). Major adverse cardiovascular events (MACEs) were defined as a composite of cardiovascular death, myocardial infarction, or stroke. Results: Patients presented with AMI showed higher MA (66.5±7.8 vs. 65.3±7.2 mm, P&lt;0.001) and lower LY 30 levels (1.0±2.5% vs. 1.2±2.2%, P=0.009) compared with non-AMI patients. Combined criteria of ‘MA≥68 mm’ and ‘LY 30 &lt;0.2%’ increased the risk of AMI occurrence by 1.7-fold. During 4-year follow-up, MACE was associated with ‘MA≥68 mm’ (hazard ratio [HR] 1.447, 95% confidential interval [CI] 1.051-1.992, P=0.024) and ‘LY 30 &lt;0.2%’ (HR 1.328, 95% CI 0.965-1.828, P=0.081), respectively. In multivariate analysis, patients with ‘MA≥68 mm’ and ‘LY 30 &lt;0.2%’ showed an increased risk of MACE compared to those with ‘MA&lt;68 mm’ and ‘LY 30 ≥0.2%’ (adjusted HR 1.863, 95% CI 1.191-2.913, P=0.006) (Figure 1). Subgroup analysis showed that this trend was consistent irrespective of baseline demographics and lesional characteristics. Conclusions: Hypercoagulability and impaired fibrinolysis were more frequently observed in AMI patients. In addition, these properties were significantly associated with post-PCI clinical prognosis.

Abstract 12960: Identifying Gaps in Practice Patterns for Routine Lipid Profiles and High-Intensity Statins in Acute Myocardial Infarction Patients Prior to an Acute Coronary Syndrome Event

Introduction: According to the 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, admitting orders for the patient with STEMI should include a serum lipid profile in laboratory tests. Subsequently, the 2018 Guideline on the Management of Blood Cholesterol guidelines state that in primary prevention statins are recommended for patients with severe hypercholesterolemia and in adults 40 to 75 years of age either with diabetes mellitus or at higher ASCVD risk. Methods: A baseline review of data from Get With The Guidelines® - CAD across 10 pilot sites was conducted. An initial 430 patients were excluded from the Ezetimibe Considered for Very High-Risk Patients measure due to missing data fields. Interviews were conducted with participating sites to determine the root cause of the incomplete data. Results: The root cause analyses resulting from these interviews and case studies revealed that lipid profiles were not consistently performed. Further, only two patients were included in the numerator for the Ezetimibe Considered for Very High-Risk Patients measure. An analysis of 455 eligible patients showed that 70% of AMI patients seen by these hospitals were not presenting on any statin therapy prior to their acute event. Conclusions: Despite the clinical guideline recommendations for lipid management for both acute and secondary prevention, there remains much room for improvement. Preliminary results from this learning collaborative highlight the need for improved lipid profiling practices in the acute setting for STEMI patients and an opportunity for intervention through modifiable risk factor reduction in the form of statin therapy in the outpatient setting. We have identified a gap in AMI patient care, which presents the opportunity to improve long-term patient outcomes through heightened lipid profile collection sensitivity. At a systemic level, further research needs to be conducted to determine why patients are presenting with severe acute coronary events without prior management of their blood cholesterol levels. We hope through continued studies with the pilot sites we will observe a shift in practice patterns and improved non-statin lipid-lowering medication consideration for very high-risk ASCVD patients.

Identification of MYH6 as the potential gene for human ischaemic cardiomyopathy.

The present study aimed to explore the potential hub genes and pathways of ischaemic cardiomyopathy (ICM) and to investigate the possible associated mechanisms. Two microarray data sets (GSE5406 and GSE57338) were downloaded from the Gene Expression Omnibus (GEO) database. The limma package was used to analyse the differentially expressed genes (DEGs). Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment, Disease Ontology (DO) and Gene Ontology (GO) annotation analyses were performed. A protein‐protein interaction (PPI) network was set up using Cytoscape software. Significant modules and hub genes were identified by the Molecular Complex Detection (MCODE) app. Then, further functional validation of hub genes in other microarrays and survival analysis were performed to judge the prognosis. A total of 1065 genes were matched, with an adjusted p < 0.05, and 17 were upregulated and 25 were downregulated with|log2 (fold change)|≥1.2. After removing the lengthy entries, GO identified 12 items, and 8 pathways were enriched at adjusted p < 0.05 (false discovery rate, FDR set at <0.05). Three modules with a score >8 after MCODE analysis and MYH6 were ultimately identified. When validated in GSE23561, MYH6 expression was lower in patients with CAD than in healthy controls (p < 0.05). GSE60993 data suggested that MYH6 expression was also lower in AMI patients (p < 0.05). In the GSE59867 data set, MYH6 expression was lower in CAD patients than in AMI patients and lower in heart failure (HF) patients than in non‐HF patients. However, there was no difference at different periods within half a year, and HF was increased when MYH6 expression was low (p < 0.05–0.01). We performed an integrated analysis and validation and found that MYH6 expression was closely related to ICM and HF. However, whether this marker can be used as a predictor in blood samples needs further experimental verification.

Substantially elevated thromboembolic and bleeding risks in patients with AMI following acute/subacute stroke events

Abstract Introduction AMI infrequently but concomitantly occurs after stroke events. Current guideline recommends primary PCI with DAPT in the setting of AMI. However, this approach is not necessarily applicable in AMI subjects following acute/subacute stroke events due to its bleeding risk. Clinical management and outcomes of these AMI subjects following remains uncertain. Purpose To characterize management and clinical outcomes in patients with AMI following acute/subacute stroke events (=post-stroke AMI). Methods The current study retrospectively analyzed 2041 AMI patients hospitalized at our institute from 2007 to 2018. Post-stroke AMI was defined as its occurrence within 14 days after ischemic/hemorrhagic stroke. The use of reperfusion and anti-thrombotic therapies, and the occurrence of major adverse cardiovascular events (=CV death, non-fatal MI and non-fatal stroke) and major bleeding events (BARC type 3 or 5) were compared in post-stroke and non-post-stroke AMI patients. Results Post-stroke AMI was identified in 1.1% of entire subjects (=23/2041). Of these, 65% of them (=15/23) had AMI within 3 days from the onset of stoke event. Over 60% of them was due to cardioembolic stroke, followed by hemorrhagic (9%), atherothrombotic ones (8%) and other causes (22%). Post-stroke AMI patients were more likely to exhibit Af (p=0.02) and a history of hemodialysis (p=0.009), and have a lower BMI (p=0.04) and hemoglobin level (p=0.02). They were less likely to receive emergent coronary angiography, and primary PCI was conducted in only 65% of post-stroke AMI patients (Table). Furthermore, they more frequently received thrombectomy (p=0.04) alone rather than stent implantation (p=0.002) (Table). With regard to anti-thrombotic therapy, the proportion of DAPT use was significantly lower in post-stroke AMI subjects (52 vs. 89%, p=0.0001), and 17% of them did not receive any anti-thrombotic agents. Of note, only 48% (p=0.04) and 43% (p=0.0001) of post-stroke AMI patients were treated with other established medical therapies including β-blocker and statin, respectively. During the observational period (median = 2.9 years), post-stroke AMI was associated with a greater likelihood experiencing major adverse cardiovascular events (log-rank p&amp;lt;0.001, Figure), CV death (log-rank p&amp;lt;0.0001) and stroke events (log-rank p&amp;lt;0.0001). Furthermore, the frequency of their major bleeding events was substantially elevated (log-rank p&amp;lt;0.001, Figure). Conclusions In our real-world data, the adoption of guideline-recommended reperfusion and anti-thrombotic therapies were considerably low in AMI subjects following acute/subacute stroke events. Given their elevated risk of cardiovascular and bleeding events, it is required to establish better therapeutic management for mitigating their thrombotic/bleeding risks. Funding Acknowledgement Type of funding sources: None. Table 1Figure 1

Platelet reactivity and immature platelets in patients with Covid-19

Abstract Background Coronavirus disease 2019 (Covid-19) is associated with high incidence of thromboembolic events, both venous and arterial. Currently, there are no clinical or laboratory markers to guide antithrombotic therapy in COVID-19 patients. Immature platelets represent a population of hyper-reactive platelets associated with arterial thrombotic events. Objectives To determine indices of immature platelets and platelet reactivity in Covid-19 patients. Methods This prospective study compared consecutive COVID-19 patients (n=47, median age = 56 years) to patients with acute myocardial infarction (AMI, n=100, median age = 59 years) and a group of stable patients with cardiovascular risk factors (n=64, median age=68 years). Immature platelet fraction (IPF) and immature platelet count (IPC) were determined by the Sysmex XN-3000 auto-analyzer on admission and at subsequent time-points. Results IPF% on admission was higher in the Covid-19 group than the stable group and similar to the AMI group (4.8% [IQR 3.4–6.9], 3.5% [2.7–5.1], 4.55% [3.0–6.75], respectively, p=0.005 for Covid-19 vs. stable). IPC on admission was also higher in the Covid-19 group than the stable group and similar to the AMI group (10.8×109/L [8.3–18.1], 7.35×109/L [5.3–10.5], 10.7×109/L [7.7–16.8], respectively, P&amp;lt;0.0001 for Covid-19 vs. stable). The maximal IPF% among the Covid-19 group was higher than the stable group and similar to the AMI group. The maximal IPC in the Covid-19 group was higher than the maximal IPC in both the stable and AMI groups (Covid-19: 14.4×109/L [9.4–20.9], AMI: 10.9×109/L [7.6–15.2], P=0.0035, Stable: 7.55×109/L [5.55–10.5], P&amp;lt;0.0001). Conclusions Patients with Covid-19 have increased immature platelets indices compared to stable patients with cardiovascular risk factors, and as the disease progresses also compared to AMI patients. Enhanced platelet turnover and reactivity may, therefore, have a role in the development of thrombotic events in Covid-19 patients. Funding Acknowledgement Type of funding sources: None. IPF in COVID-19, AMI and stable groups

TMAO (trimethylamine n-oxide) as a potential biomarker of individual severe stress perception in posttraumatic stress disorder (PTSD)-vulnerable patients after acute myocardial infarction

Abstract Background Acute myocardial infarction is not only a somatic disease but potentially triggers psychological effects, too. Post-traumatic stress disorder (PTSD) is a common stress-related disorder. It is characterized by numerous symptoms, such as flashbacks, intrusions, nightmares and severe anxiety, as well as uncontrollable, intense and disturbing thoughts and feelings related to the traumatic experience. However, with regard to the development of PTSD, individual stress perception might be crucial since not every serious traumatic experience leads to PTSD. To date, almost no biological correlates of an individual's perception of stress have been identified as being associated with the long-term development of PTSD. Objective The aim of the study was to determine whether blood levels of TMAO vary immediately after AMI (1) in patients with or without depression, and (2) in patients with AMI induced PTSD symptomatology (subsyndromal PTSD and full PTSD). Furthermore, we investigated whether TMAO is a potential biomarker that might be useful in the prediction of PTSD symptomatology in the long term. Method A total of 114 AMI patients were assessed with standardized clinical psychiatric interviews based on the Hamilton Depression Scale (HAMD-17) after admission to the hospital and 6 months later. In addition, the CAPS-5 was used to explore PTSD symptoms (subsyndromal PTSD and full PTSD) 6 months after AMI. To assess patients' TMAO status, serum samples were collected at hospitalization and 6 months after AMI. Results Study participants with post-myocardial infarction PTSD symptomatology (subsyndromal PTSD and full PTSD) had significantly higher TMAO levels immediately after AMI than patients without PTSD symptoms (ANCOVA: TMAO (PTSD x time), F = 4.544, df = 1, p=0.035). In contrast, depressive symptomatology 6 months after AMI had no influence on TMAO levels (TMAO (depression x time), F = 0.083, df = 1, p=0.774). With the inclusion of additional clinical predictors in a hierarchical logistic regression model, TMAO becomes a significant predictor of PTSD symptomatology. Conclusions An elevated TMAO level immediately after AMI might reflect severe stress in PTSD-vulnerable patients, which might also lead to a short-term increased gut permeability to trimethylamine (TMA), the precursor of TMAO. Thus, elevated TMAO might be a biological correlate for stress that is associated with vulnerability to PTSD and might help to identify patients at increased risk. Funding Acknowledgement Type of funding sources: None.

The need and duration of BB therapy in post MI patients with preserved left ventricular ejection fraction: a meta-analysis

Abstract Background Oral beta-blockers have beneficial effect on long-term mortality in high-risk as low left ventricular ejection fraction (LVEF) patients with MI, but the effect and duration of use of Beta-blockers in post-AMI patients with preserved LVEF is still unknown. Methods We performed a systematic search in Cochrane library, Embase, Medline, Pubmed, Scopus, Web of Science, clinical trial registries, and for eligible studies (26,431 patients). Data for outcomes were pooled as Hazard ratios (HRs), with 95% confidence interval, using RevMan software for windows. Results The pooled effect-estimate showed significant decrease in all cause mortality in beta-blocker group (HR 0.71, 95% CI 0.62–0.82). A subgroup analysis regarding duration of use of BB (≤1 year or &amp;gt;1 year), age (≤65 or ≥65),sex, use of CCB, presence of HTN or DM, and LVEF (≥50 or ≥40) was done. No significant subgroup differences were detected: duration of use of BB (p=0.32), age (p=0.23), sex (p=0.84), CCBs (p=0.28), HTN (p=0.32), DM (p=0.92),and LVEF (p=0.06). No significant differences between bet-blocker vs. no beta-blockers in terms of cardiac death (HR 0.69, 95% CI 0.33–1.46), re-infarction (HR1.00, 95% CI 0.68–1.48), re-hospitalization (HR1.08, 95% CI 0.32–3.68), and revascularization (HR 0.94, 95% CI 0.76–1.16). Conclusion Beta-blockers might reduce mortality of post-AMI patients with preserved LVEF, but failed to prevent cardiac events. The upcoming trials (REBOOT, BETAMI, DANBLOCK, and ABYSS) will define the use of Beta-blockers in post AMI patients with preserved Left ventricular ejection fraction. Funding Acknowledgement Type of funding sources: None.

Analysis of Characteristics of Patients with Non-ST-Segment Elevation Myocardial Infarction by Cardiac Magnetic Resonance Imaging.

BackgroundIn this study, cardiac magnetic resonance imaging was used to investigate the characteristics of patients who have total coronary occlusion but manifest with non-ST-segment elevation myocardial infarction (NSTEMI), and we assessed the extent of infarct transmurality and myocardial necrosis size in NSTEMI patients.Material/MethodsWe enrolled all patients diagnosed at our hospital with subtotal or total occlusion of the culprit artery (TOCA), based on the coronary angiography, who successfully underwent PCI within 12 h of admission, and who had CMR imaging performed within 2 days after the PCI.ResultsBased on 12-lead ECG findings, 48% of patients were categorized as having STEMI and 52% as having NSTEMI. TOCA was detected by coronary angiography in 43% of NSTEMI patients, and in 60% and 33% of normal ST segment and ST-segment depression MI patients, respectively. The transmural segments were found in 78% of STEMI patients and 31% of NSTEMI patients (P<0.05). Transmural infarction segments were found in 64% of NSTEMI patients with TOCA and in 8% of NTOCA patients (P<0.05). Moreover, the number of transmural segments in ST-segment depression MI patients was the lowest (P<0.05). Infarct size in STEMI patients was significantly larger than in patients with NSTEMI (P<0.05), whereas there was no statistically significant difference in patients with normal ST segment and ST-segment depression MI patients (P>0.05).ConclusionsIdentification TOCA by coronary angiography and transmural infarction by DE-MRI can be challenging in AMI patients with non-ST-segment elevation. In approximately 30% of non-ST-segment elevation MI patients, transmural infarction was detected by DE-MRI. Therefore, TOCA accompanied by transmural infarction in non-ST-segment-elevation MI patients is not uncommon.

Study of Some Inflammatory Mediators in the Serum of Patients With Atherosclerosis and Acute Myocardial Infarction.

Background and aim of the studyThe aim of this study is to evaluate the changes in the inflammatory mediator’s serum amyloid A (SAA), adiponectin, and resistin in the serum of patients with stable angina and acute myocardial infarction.Subjects and methodsThe study was done on 60 subjects divided into three groups: 20 healthy normal individuals as a control group, 20 patients with stable angina (atherosclerotic plaque), and 20 patients with myocardial infarction. Fasting blood samples were withdrawn from all subjects and serum was prepared. SAA, resistin, and adiponectin levels were quantitatively measured by enzyme-linked immunosorbent assay (ELISA).ResultsThe SAA level was significantly higher in both stable angina and the acute myocardial infarction group than the control group (2.7179 ± 0.44501 mg/L) and the serum resistin level was significantly higher (p-value = 0.0) in the stable angina (8.368 ± 1.633 ng/ml) and the acute myocardial infarction (13.606 ± 2.067 ng/ml) groups (p-value= 0.0) than the control group. (2.4272±1.25210 ng/ml). Moreover, resistin levels in stable angina when compared to the AMI showed a significant difference between them (p-value = 0.0) while adiponectin was significantly lower in the acute myocardial infarction group. (6.641±2.6011 µg/mL, p-value = 0.019) than its level in the control group (11.873±1.798 µg/mL). While the adiponectin level showed no significant differences between stable angina in comparison to the AMI.ConclusionSAA can be used as a confirmatory marker for stable angina and a diagnostic tool for AMI patients. Both SAA and resistin may participate in the atherosclerosis process as an effectors molecule of inflammatory reactions. For adiponectin, we concluded that it has the antiatherogenic property and its levels were lower in both the stable angina and acute myocardial infarction groups.

Impact of admission hyperglycemia on short and long-term prognosis in acute myocardial infarction: MINOCA versus MIOCA

BackgroundThe prognostic role of hyperglycemia in patients with myocardial infarction and obstructive coronary arteries (MIOCA) is acknowledged, while data on non-obstructive coronary arteries (MINOCA) are still lacking. Recently, we demonstrated that admission stress-hyperglycemia (aHGL) was associated with a larger infarct size and inflammatory response in MIOCA, while no differences were observed in MINOCA. We aim to investigate the impact of aHGL on short and long-term outcomes in MIOCA and MINOCA patients.MethodsMulticenter, population-based, cohort study of the prospective registry, designed to evaluate the prognostic information of patients admitted with acute myocardial infarction to S. Orsola-Malpighi and Maggiore Hospitals of Bologna metropolitan area. Among 2704 patients enrolled from 2016 to 2020, 2431 patients were classified according to the presence of aHGL (defined as admission glucose level ≥ 140 mg/dL) and AMI phenotype (MIOCA/MINOCA): no-aHGL (n = 1321), aHGL (n = 877) in MIOCA and no-aHGL (n = 195), aHGL (n = 38) in MINOCA. Short-term outcomes included in-hospital death and arrhythmias. Long-term outcomes were all-cause and cardiovascular mortality.ResultsaHGL was associated with a higher in-hospital arrhythmic burden in MINOCA and MIOCA, with increased in-hospital mortality only in MIOCA. After adjusting for age, gender, hypertension, Killip class and AMI phenotypes, aHGL predicted higher in-hospital mortality in non-diabetic (HR = 4.2; 95% CI 1.9–9.5, p = 0.001) and diabetic patients (HR = 3.5, 95% CI 1.5–8.2, p = 0.003). During long-term follow-up, aHGL was associated with 2-fold increased mortality in MIOCA and a 4-fold increase in MINOCA (p = 0.032 and p = 0.016). Kaplan Meier 3-year survival of non-hyperglycemic patients was greater than in aHGL patients for both groups. No differences in survival were found between hyperglycemic MIOCA and MINOCA patients. After adjusting for age, gender, hypertension, smoking, LVEF, STEMI/NSTEMI and AMI phenotypes (MIOCA/MINOCA), aHGL predicted higher long-term mortality.ConclusionsaHGL was identified as a strong predictor of adverse short- and long-term outcomes in both MIOCA and MINOCA, regardless of diabetes. aHGL should be considered a high-risk prognostic marker in all AMI patients, independently of the underlying coronary anatomy.Trial registration data were part of the ongoing observational study AMIPE: Acute Myocardial Infarction, Prognostic and Therapeutic Evaluation. ClinicalTrials.gov Identifier: NCT03883711.

Outcomes of Acute ST-Elevation Cardiac Disease in a Tertiary Level Hospital in Bangladeshi Young Adults' Risk Factors and Consequences

Background: AMI happens earlier and more often in South Asians compared to Western populations. In Bangladesh, very little information is known about the connections between avoidable risk factors and outcomes of AMI in young people. This research aims to discover risk variables and the in-hospital results of AMI among those under the age of 40 in Bangladesh. Methods: A cohort study of individuals with an acute case of Acute ST-Segment Elevation MI (STEMI) was done, which examined all patients aged under 40 and over 40 years of age in successive groups of 50. The clinical findings, biochemistry data, nutrition, and echocardiography result of the participants were compared against each other, including an examination and hospitalization outcomes. Regression analysis was done to determine the risk factors related to a patient's hospital-based treatment, controlling for other confounding variables previously discovered. Results: Young and older patients were about 36.5 and 57 years old, respectively. The most striking factors contributing to the greater incidence of AMI in the younger group were their age (OR 3.4, 95% CI 1.2–9.75), smoking (OR 2.4, 95% CI 1.04–5.62), family history of myocardial infarction (OR 2.4, 95% CI 1.11–5.54), homocysteine (OR 1.2, 95% CI 1.08–1.36), and frequent consumption of rice (OR 3.5, 95% CI 1.15–10.6). Lastly, beef consumption (OR 4.5, 95% CI 1.83–11.3) also contributed to a greater AMI risk. Older patients were considerably more likely to experience heart failure (a 70% higher probability), reinfarction (a 50% higher chance), arrhythmia (a 70% higher chance), and cardiogenic shock (a 6-fold larger risk) in multivariate analysis. Conclusion: Young AMI patients tend to have better outcomes in the hospital than their older counterparts since they have a distinct risk profile. To help Bangladesh youth avoid life-shortening diseases, Bangladesh should reduce avoidable risk factors, such as smoking, bad food, obesity, and poor ......