Among Acute Myocardial Infarction Research Articles

Effect of alirocumab on quantitative flow ratio and diameter stenosis in non-infarct related arteries from patients with acute myocardial infarction: a PACMAN-AMI randomized clinical trial substudy

Abstract Introduction Treating hypercholesterolemia with proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors on top of statins leads to plaque regression and stabilization. The effects of PCSK9 inhibitors on coronary physiology and angiographic diameter stenosis (DS%) are unknown. Quantitative Flow Ratio (QFR) is a novel method to assess coronary hemodynamics. Purpose We aimed to investigate the effects of the PCSK9 inhibitor alirocumab on QFR and 3D-Quantitative Coronary Angiography (3D-QCA) DS% in non-infarct-related arteries (non-IRA) among acute myocardial infarction (AMI) patients. Methods This was a pre-specified substudy of the PACMAN trial, a randomized, double-blind, placebo-controlled trial comparing alirocumab vs. placebo on top of high-intensity rosuvastatin among AMI patients. QFR and 3D-QCA were assessed at baseline and 1-year follow-up in any non-infarct related artery (non-IRA) with ≥2.0mm diameter and >25% 3D-QCA DS%. The pre-specified primary endpoint was the number of patients with mean QFR increase from baseline to follow-up, and the secondary endpoint the change in 3D-QCA DS%. Results Of 300 enrolled patients, 265 had serial follow-up, of which 193 underwent serial QFR/3D-QCA analysis in 282 non-IRA. Baseline mean QFR was 0.96[IQR 0.91-0.98] and mean DS% 36.96±7.88% in the alirocumab group vs. 0.96[IQR 0.91-0.99] (p=0.593) and 36.63±8.46% (p=0.742) in the placebo group. At 1-year, QFR increased in 50/94 (53.2%) patients with alirocumab vs. 40/99 (40.4%) with placebo (Δ12.8%; OR=1.7, 95%CI 0.9-3.0; p=0.076). When excluding non-IRA with QFR >0.95, QFR increased in 37/57 (64.9%) patients with alirocumab vs. 22/50 (44.0%) with placebo (Δ20.9%; OR=2.4, 95%CI 1.1-5.2; p=0.031). DS% decreased by -1.03±7.28% with alirocumab and increased by +1.70±8.27% with placebo (Δ-2.54%, 95%CI -4.51 to -0.57; p=0.012). Conclusions Treatment of AMI patients with alirocumab vs. placebo for 1 year resulted in a significant regression in angiographic DS%. While no overall improvement of coronary hemodynamics was observed with alirocumab as compared to placebo, potential benefits were found in alirocumab treated patients with baseline QFR ≤0.95.Figure 1.Flowchart and primary endpointFigure 2.Secondary endpoint

Ticagrelor vs Clopidogrel in Acute Myocardial Infarction Patients With a History of Ischemic Stroke

ObjectiveTo investigate whether use of ticagrelor compared to clopidogrel is associated with different risks for thrombotic events or major bleeding among acute myocardial infarction (AMI) patients with a prior history of acute ischemic stroke. Patients and MethodsThis retrospective cohort study used the Health and Welfare Database in Taiwan. Stroke patients prescribed ticagrelor plus aspirin or clopidogrel plus aspirin after a primary hospitalization for AMI between July 1, 2013, and December 31, 2018, were included. Inverse probability of treatment weighting was applied to balance covariates between treatment groups. The primary effectiveness outcome included a composite measure of AMI, acute ischemic stroke, or all-cause mortality. The primary safety outcome included a composite measure of intracranial hemorrhage (ICH) and major gastrointestinal bleeding. The secondary effectiveness and safety outcomes comprised each of the individual components that make up the primary effectiveness and safety outcomes, respectively. ResultsA total of 1691 eligible patients were included in the study, of whom 734 (43.4%) received ticagrelor plus aspirin and 957 received clopidogrel plus aspirin. There were no significant differences observed in the primary and secondary effectiveness outcomes between the two study groups. However, the use of ticagrelor was associated with a higher risk of ICH (ticagrelor: 8.68 per 1000 person-year; clopidogrel: 2.17 per 1,000 person-year; HR, 3.34; 95% CI, 1.27 to 8.81, P = .01) compared with clopidogrel. ConclusionIn AMI patients with a history of acute ischemic stroke, the risks of cardiovascular events were comparable between ticagrelor plus aspirin and clopidogrel plus aspirin. However, ticagrelor was associated with a higher risk of ICH. Ticagrelor should be used cautiously in AMI patients with a history of acute ischemic stroke.

A-39 | Impact of Obesity on In-Hospital Post Percutaneous Coronary Intervention Outcomes in Otherwise Metabolically Healthy Patients With Acute Myocardial Infarction: A Propensity Matched Analysis Using National Inpatient Sample, 2020

Obesity paradox in post percutaneous intervention (PCI) outcomes among acute myocardial infarction (AMI) patients is a well-known controversial finding. In studies that discussed the obesity paradox, patients at least had diabetes, hypertension, or hyperlipidemia. We studied the relationship between obesity and in-hospital post-PCI outcomes among AMI patients with no diabetes, hypertension, or hyperlipidemia (otherwise metabolically healthy). We extracted data from the National Inpatient Sample 2020 using the ICD-10 codes for admissions of obese and non-obese AMI patients treated with PCI. We excluded patients with diabetes, hypertension, and hyperlipidemia after identifying them through Elixhauser comorbidity software. After propensity score matching (PSM) obese and non-obese patients for age and sex, we performed multivariate regression analysis, adjusted for demographics, hospital-level factors, and comorbidities to calculate adjusted odds ratio (AOR) for in-hospital post-PCI outcomes. In 2020, 25605 otherwise metabolically healthy AMI patients had PCI; 2825 were obese, and 22780 were non-obese. However, after PSM for age and sex, there were 2795 patients in each cohort. In the obese cohort, 68.2% were males, 82.6% were white, and 54.9% were aged 45-64. Most common comorbidities in obese vs. non-obese cohorts were smoking (23.8% vs. 24.7%), chronic pulmonary disease (14.3% vs. 11.6%), and prior MI (6.3% vs. 6.1%). A statistically significant difference was not observed in in-hospital all-cause mortality (AOR 1.14, 95%CI 0.63-2.10, p=0.661), post-operative stroke (AOR 1.17, 95%CI 0.50-2.75, p=0.714), and acute kidney injury (AOR 1.20, 95%CI 0.84-1.72, p=0.322) among obese and non-obese cohorts. In this large population-based analysis, we found no statistically significant association between obesity and post-PCI outcomes in otherwise metabolically healthy patients with AMI. Larger prospective studies can help demystify the controversial "obesity paradox" in cardiovascular diseases.

Increased national mortality in acute myocardial infarction hospitalization during the COVID-19 pandemic

This retrospective study describes the effect of the COVID-19 pandemic on epidemiologic trends and highlights disparities in outcomes among acute myocardial infarction (AMI) hospitalizations. The National Inpatient Sample database from 2016 to 2020 was searched for hospitalizations of adult patients with AMI as a principal diagnosis using Clinical Classifications Software Refined codes. The admission rate for each calendar year was obtained as admission per 1000 adults hospitalized. The primary outcome was a comparison of inpatient mortality, and the secondary outcomes were the length of hospital stay and total hospital charge between prepandemic and pandemic years. During the pandemic (2020), the admission rate for AMI was 31.1 admissions per 1000 adults hospitalized compared to 33.4 admissions in 2019 (prepandemic) (P < 0.001). When compared to the prepandemic admissions, those admitted during the pandemic had a lower mean age (66.5 ± 13.2 vs 66.9 ± 13.4, P < 0.001), with more women (36.3% vs 37.3%, P < 0.001). The inpatient mortality during the pandemic was 5.0% compared to 4.5% in 2019 (P < 0.001). Mortality increased 12.0% in women vs 9.5% in men, 13.2% in Blacks vs 8.9% in Whites, and 6.5% in low-income vs 4.3% in high-income household hospitalizations. In conclusion, our study showed a statistically significant reduction in AMI admission rates during the pandemic and an increase in inpatient mortality. There were significant disparities in the increase in mortality across sociodemographic groups.

Abstract 9747: Gastrointestinal Bleeding in Acute Myocardial Infarction Patients Undergoing Coronary Artery Bypass Graft Surgery; A National Study

Introduction: While gastrointestinal (GI) bleeding is a possible surgical complication, there is a paucity of information on the incidence and risk among Acute Myocardial Infarction (AMI) patients undergoing Coronary artery bypass graft surgery (CABG). Methods: We queried the 2019 National Inpatient Sample to identify cases of GI bleeding among AMI patients undergoing CABG. Patient characteristics and risk factors were estimated using multiple logistic regression. Results: Our analysis found that 48590 patients with AMI underwent CABG, and 865 (1.8%) gastrointestinal bleeding events were recorded. It was more prevalent among Whites (aOR 1.462, p=0.012) and Hispanics (aOR 2.436, p&lt;0.01), patients of ages &gt;60 (aOR 1.591, p&lt;0.01), with a diagnosis of supraventricular tachycardia (aOR 1.688, p&lt;0.01), paroxysmal atrial fibrillation (aOR 1.670, p&lt;0.01), cirrhosis (aOR 3.363, p&lt;0.01), acute kidney injury (aOR 1.864, p&lt;0.01), covered by Medicare (aOR 1.494, p=0.010), and with peripheral vascular disease (aOR 1.731, p&lt;0.01). Meanwhile, patients with hypertension (aOR 0.573, p&lt;0.01), smokers (aOR 0.744, p&lt;0.01), hyperlipidemia (aOR 0.477, p&lt;0.01), and obesity (aOR0.799, p&lt;0.01) reported lower risks. A mortality rate of 12.7% was observed. Females (aOR 1.967, p=0.017), cirrhosis (aOR 5.521, p&lt;0.01), acute kidney injury (aOR 3.657, p&lt;0.01), ventricular tachycardia (aOR 2.002, p=0.033), paroxysmal atrial fibrillation (aOR 2.535, p&lt;0.01), and hyperkalemia (aOR 2.397, p=0.013) predisposed to greater inpatient deaths, while diabetes (aOR 0. 491, p&lt;0.01) and hyperlipidemia (aOR 0. 198, p&lt;0.01) showed a reduced risk. Finally, a higher overall risk of inpatient death was seen among AMI patients who underwent CABG if they had GI bleeding (aOR 2.674, p&lt;0.01). Conclusions: GI bleeding can lead to a poor outcome among AMI patients who underwent CABG during their hospitalization. We also found several factors predisposing these patients to such events.

Abstract 15758: Association of Socioeconomic, Racial, and Regional Factors in In-Hospital Mortality Among Acute Myocardial Infarction Patients in the United States: A National Analysis of 2.8 Million Admissions

Background: Socioeconomic, racial, and regional disparities have been associated with worse clinical outcomes among patients with coronary disease. We evaluated the association of income, race, and geographic variation and in-hospital mortality among acute myocardial infarction (AMI) admissions in the United States. Methods: We conducted a retrospective cohort study using the Nationwide Inpatient Sample from 2015 to 2019. A multi-level logistic regression model was used (with sampling weights) to investigate the association between in-hospital mortality and income quartiles by patient’s ZIP code, race, and hospital regions, while adjusting for hospital clustering, lifestyle factors, clinical history, and hospital-level factors. Results: A total of 2,798,225 hospitalizations (≥18 years) with a principal diagnosis of AMI were identified. In multivariable analysis, compared with the highest income quartile, residents in the lowest income quartile (OR=1.10 [1.08–1.13] P &lt;0.001) or second lowest income quartile (OR=1.07 [1.05–1.09] P &lt;0.001) had higher odds of in-hospital mortality. Compared with those identifying as White, Black (OR=0.89 [0.87–0.91] P &lt;0.001) and Hispanic (OR=0.91 [0.88–0.93] P &lt;0.001) groups had lower odds of mortality, while Asian or Pacific Islander (OR=1.07 [1.03–1.11] P &lt;0.001), Native American (OR=1.11 [1.02–1.21] P &lt;0.05), and Unspecified groups (OR=1.09 [1.05–1.13] P &lt;0.001) had higher odds of mortality. Residents in the South had higher mortality than those in the Northeast (OR=1.06 [1.00–1.12] P &lt;0.05). Conclusion: Our large contemporary study shows that lowest income residents, Whites, Asian or Pacific Islanders, and Native Americans and residents of South had higher in-hospital mortality compared with highest income residents, Blacks and Hispanics, and residents in the Northeast. Additional studies are needed to better understand the complex mechanisms that underpin disparities in outcomes among AMI patients.

The value of myocardial work in detecting the reduction of left ventricular global systolic function in acute myocardial infarction patients with preserved ejection fraction

Objective: To investigate the diagnosis value of myocardial work (MW) in evaluating left ventricular global systolic function among acute myocardial infarction (AMI) patients with preserved ejection fraction (LVEF). Methods: This study was a diagnostic trial in a prospective case-control design. AMI patients with preserved LVEF were enrolled as AMI(LVEF>50%) group and age and sex-matched healthy individuals undergoing healthy checkup in our hospital were collected as control group. Two-dimensional dynamic images, including standard apical two-chamber, long-axis and four-chamber views in 3 consecutive cardiac cycles were acquired. General clinical data, routine echocardiography and myocardial work parameters were obtained from all subjects. The indices were compared between the two groups. Intra-observer and inter-observer repeatability of myocardial work parameters were evaluated by intra-group correlation coefficient (ICC). Receiver operator characteristic (ROC) curve was used to determine the diagnostic value of global constructive work (GCW), global wasted work (GWW), global work efficiency (GWE) and global work index (GWI) on the reduction of left ventricular global systolic function in AMI(LVEF>50%) group. Results: There were 30 patients in AMI(LVEF>50%) group, the age was (67.3±9.7)years, and 14 cases were female(46.7%). Thirty participants were included in the control group, the age was (68.1±8.6)years, and 12 cases were female (40.0%). Compared with the control group, left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), interventricular septum thickness (IVSD), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), peak early diastolic velocity of mitral orifice/tissue Doppler velocity of posterior mitral annulus (E/e), left ventricular mass (LVM), left ventricular mass index (LVMI) were significantly higher, while E and e values were significantly lower in AMI (LVEF>50%) group (all P<0.05). Compared with the control group, GCW ((1 145.9±440.1)mmHg% (1 mmHg=0.133 kPa) vs. (1 425.7±355.4)mmHg%), GWE ((80.9±9.5)% vs. (87.3±5.5)%), GWI ((1 001.3±416.2)mmHg% vs. (1 247.6±341.7)mmHg%) and the absolute value of long axis integral strain (GLS) ((8.5±3.4)% vs. (11.4±3.7)%) were significantly lower, while peak strain dispersion(PSD)((101.3±66.4)ms vs. (74.7±31.9)ms) was significantly higher in AMI(LVEF>50%) group (P all<0 05). There was no significant difference in GWW((177.2±71.1)mmHg% vs. (155.7±64.6)mmHg%) between the two groups (P>0.05). The reproducibility of GCW, GWW, GWE and GWI within and between observers were satisfactory (all ICC>0.75). ROC curve analysis showed that all four parameters, GCW, GWW, GWE, and GWI, could be used for the diagnosis of reduced left ventricular systolic function in patients with AMI (LVEF>50%), and their areas under the ROC curve were 0.896,0.929,0.808,0.862. Conclusion: Myocardial work assessment is valuable on diagnosing left ventricular global systolic function reduction in AMI patients with preserved LVEF.

Home health care after discharge is associated with lower readmission rates for patients with acute myocardial infarction.

We studied the utilization of home health care (HHC) among acute myocardial infarction (AMI) patients, impact of HHC on and predictors of 30-day readmission. We queried the National Readmission Database (NRD) from 2012 to 2014identify patients with AMI discharged home with (HHC+) and without HHC (HHC-). Linkage provided in the data identified patients who had 30-day readmission, our primary end-point. The probability for each patient to receive HHC was calculated by a multivariable logistic regression. Average treatment of treated weights were derived from propensity scores. Weight-adjusted logistic regression was used to determine impact of HHC on readmission. A total of 406 237 patients with AMI were discharged home. Patients in the HHC+ cohort (38 215 patients, 9.4%) were older (mean age 77 vs. 60 years P < 0.001), more likely women (53 vs. 26%, P < 0.001), have heart failure (5 vs. 0.5%, P < 0.001), chronic kidney disease (26 vs. 6%, P < 0.001) and diabetes (35 vs. 26%, P < 0.001). Patients readmitted within 30-days were older with higher rates of diabetes (RR = 1.4, 95% CI: 1.37-1.48) and heart failure (RR = 5.8, 95% CI: 5.5-6.2). Unadjusted 30-day readmission rates were 21 and 8% for HHC+ and HHC- patients, respectively. After adjustment, readmission was lower with HHC (21 vs. 24%, RR = 0.89, 95% CI: 0.82-0.96; P < 0.001). In the United States, AMI patients receiving HHC are older and have more comorbidities; however, HHC was associated with a lower 30-day readmission rate.

Machine Learning to Predict Contrast-Induced Acute Kidney Injury in Patients With Acute Myocardial Infarction.

Objective: To develop predictive models for contrast induced acute kidney injury (CI-AKI) among acute myocardial infarction (AMI) patients treated invasively.Methods: Patients with AMI who underwent angiography therapy were enrolled and randomly divided into training cohort (75%) and validation cohort (25%). Machine learning algorithms were used to construct predictive models for CI-AKI. The predictive models were tested in a validation cohort.Results: A total of 1,495 patients with AMI were included. Of all the patients, 226 (15.1%) cases developed CI-AKI. In the validation cohort, Random Forest (RF) model with top 15 variables reached an area under the curve (AUC) of 0.82 (95% CI: 0.76–0.87), while the best logistic model had an AUC of 0.69 (95% CI: 0.62–0.76). ACEF (age, creatinine, and ejection fraction) model reached an AUC of 0.62 (95% CI: 0.53–0.71). RF model with top 15 variables achieved a high recall rate of 71.9% and an accuracy of 73.5% in the validation group. Random Forest model significantly outperformed logistic regression in every comparison.Conclusions: Machine learning algorithms especially Random Forest algorithm improves the accuracy of risk stratifying patients with AMI and should be used to accurately identify the risk of CI-AKI in AMI patients.

P819Post-procedural cholesterol and inflammatory risk in acute myocardial infarction patients undergoing percutaneous coronary intervention

Abstract Objective This study sought to depict the combined association of post-procedural cholesterol and inflammatory risk with clinical outcomes among acute myocardial infarction (AMI) patients undergoing percutaneous coronary intervention (PCI) and pick out patients with highest comprehensive risk. Methods A total of 4802 AMI-PCI patients were divided into quartiles according to post-procedural low-density lipoprotein cholesterol (LDL-C), C-reactive protein (CRP) level respectively and in combinations for risk analysis. Univariate and adjusted multivariate analysis with Cox model were performed. Hazard ratio (HR) for short-term (90 days) and long-term (1 year) were compared for major adverse cardiovascular events (MACE), including cardiac death, recurrent myocardial infarction and ischemic stroke. Results A significant change in the hazards of 90-day MACE was seen among patients in the highest quartile of post-procedural LDL-C [HR: 0.526 (0.291, 0.951), p=0.034] and highest quartile of CRP [HR: 2.119 (1.150, 3.920), p=0.016]. For 1-year outcomes, only a trend for increasing risk was seen in patients with higher post-procedural CRP (p-trend = 0.016). Combination analysis for cholesterol/inflammatory risk showed that patients lying simultaneously in the lowest quartile of LDL-C and highest quartile of CRP gained the highest risk in the 90-day [HR: 3.16 (1.124, 8.886), p=0.029] and 1-year [HR: 2.515 (1.153, 5.486), p=0.020] follow up. Hazard ratios (HR) for short-term (90 days) and long-term (1 year) primary outcomes according to cholesterol and inflammatory risk 90 days 1 year Type of risk Unadjusted HR (95% CI) P value Adjusted HR (95% CI) P value P for trend Unadjusted HR (95% CI) P value Adjusted HR (95% CI) P value P for trend LDL, mmol/L Quartile 2 0.742 (0.441, 1,248) 0.260 0.663 (0.390, 1.125) 0.128 0.033 0.722 (0.364, 1.125) 0.150 0.683 (0.435, 1.072) 0.097 0.251 Quartile 3 0.653 (0.381, 1.121) 0.122 0.597 (0.344, 1.038) 0.068 0.850 (0.557, 1.229) 0.453 0.850 (0.550, 1.312) 0.462 Quartile 4 0.517 (0.288, 0.928) 0.027 0.526 (0.291, 0.951) 0.034 0.673 (0.427, 1.061) 0.088 0.708 (0.444, 1.131) 0.149 CRP, mg/L Quartile 2 1.365 (0.717, 2.599) 0.334 1.295 (0.654, 2.522) 0.448 0.007 1.063 (0.656, 1.722) 0.805 0.998 (0.608, 1.636) 0.992 0.016 Quartile 3 1.306 (0.681, 2.502) 0.442 1.279 (0.654, 2.499) 0.472 0.999 (0.612, 1.630) 0.996 0.968 (0.586, 1.597) 0.897 Quartile 4 2.354 (1.312, 4.221) 0.004 2.119 (1.150, 3.920) 0.016 1.657 (1.069, 2.570) 0.024 1.528 (0.967, 2.413) 0.069 Multivariate analysis was adjusted for age, sex and traditional cardiovascular risk factors. Combined cholesterol/inflammatory risk Conclusion AMI-PCI patients with lower post-procedural LDL-C and higher CRP might encounter greater cardiovascular risk. Patients with the lowest LDL-C and highest CRP gained extremely high risk and required special attention.

Assessment of prevalence of cardiovascular risk factors among AMI patients

Background: Among the most common chronic diseases that afflict humans worldwide are diabetes, cardiovascular diseases (CVDs), osteoporosis, arthritis, obesity, chronic obstructive pulmonary disease, inflammatory bowel disease, central nervous system degenerative diseases and some cancers. Hence; the present study was undertaken for assessing the prevalence of cardiovascular risk factors among acute myocardial infarction (AMI) population. Materials & Methods: A total of 200 AMI subjects were enrolled in the present study. Complete demographic details of all the patients were obtained. A self-framed questionnaire was given to all the subjects for obtaining the complete medical, clinical and demographic of all the patients.Socio-economic status was defined on basis of modified Kuppuswamy’s Scale, according to which, Socio-economic classes were divided into upper, middle and lower. Blood samples were obtained from all the patients for assessing the hematological and biochemical profile. Results: Significant results were obtained while assessing the age-wise correlation of patients. There were 110 males and 90 females in the present study. 33.5 percent of the patients belonged to upper class, while 365 percent of the patients belonged to middle class. 30 percent of the patients belonged to lower class. Significantly higher number of diabetic and hypertensive patients was seen in the present study. Conclusion: Diabetes, hypertension and increasing age were found to be significant cardiovascular risk factors.

Clinical significance of diabetes on symptom and patient delay among patients with acute myocardial infarction-an analysis from China Acute Myocardial Infarction (CAMI) registry.

BackgroundDiabetes is frequently associated with poor prognosis among acute myocardial infarction (AMI) patients. Patients with these comorbidities often have atypical symptoms and subsequent delay in treatment. Few studies have reported detailed AMI symptoms in patients with diabetes. This study compared AMI symptoms and presentation characteristics between diabetics and non-diabetics.MethodsWe included patients from the China AMI registry diagnosed with AMI between January 2013 and September 2014. Baseline characteristics, symptomology, and delay in treatment were compared between diabetics and non-diabetics. Multivariable logistic regression analysis was used to explore independent predictors of atypical symptoms.ResultsA total of 4450 (20.2%) patients had diabetes. They were older, more often women, higher in body mass index, and more likely to have non-ST segment elevation myocardial infarction. Fewer diabetic patients presented with persistent precordial chest pain (63.1% vs. 68%, P < 0.0001), diaphoresis (60.1% vs. 65.6%, P < 0.0001), fatigue (16.7% vs. 18.3%, P = 0.0123), and incontinence (0.4% vs. 0.7%, P = 0.0093). Time to hospital presentation was longer among patients with diabetes than those without. In multivariable analysis, diabetes was identified as an independent predictor of atypical symptoms (OR: 1.112, 95% CI: 1.034–1.196).ConclusionsOur study is the first large-scale study providing evidence that diabetics are less likely to present with typical chest pain and more likely to experience treatment delay when suffering from an AMI. Our results may increase clinician awareness of recognizing AMI patients rapidly to reduce diagnosis and treatment delay, particularly in the context of diabetes.

Risk Factors for Predicting Mortality among Old Patients with Acute Myocardial Infarction during Hospitalization.

To explore the risk factors to predict mortality among acute myocardial infarction (AMI) patients aged ≥ 80 years during their hospitalization. A cohort of AMI patients aged ≥ 80 years hospitalized in our hospital were recruited from 2005 to 2014. Variables, including demographics, medical history, hemodynamic condition and laboratory results, were collected and analyzed to find risk factors predicting mortality during hospitalization. Amonga total of 384 patients enrolled in this study, the hospital mortality rate was 23.4%. By multivariable stepwise regression analysis, nine independent significant predictors associated with mortality during hospitalization were identified: history of stoke, cardiac shock, Killip class III to IV, ventricular tachycardia, pulse rate ≥ 100 bpm and EF ≤ 40% at presentation, in-hospital bleeding, initial serum creatinine concentration ≥ 177 umol/L and elevated initial WBC level. Prior angina was identified as a protective factor. Hosmer-Lemeshow test indicated good fitness of the predicting variables. Patients aged 80 and over have high mortality during hospitalization, and the risk prediction factors are clinically useful for predicting mortality in old patients with AMI.

A16184 Clinical profile of acute myocardial infarction patients with and without hypertension

Objectives:The association between clinical profile such as electrocardiographic changes and angiographic changes without and with comorbid hypertension among acute myocardial infarction (AMI) patients is not explored in Indian population. To examine the clinical profile among AMI patients with and

Effect of preinfarction angina on primary percutaneous coronary intervention outcomes

Background: Preinfarction angina has been recognized as a surrogate for preconditioning episodes. This study was designed to evaluate the cardiovascular effects of preinfarction anginal episodes among acute myocardial infarction (AMI) patients undergoing primary percutaneous coronary intervention (PCI). Materials and Methods: Of 520 patients who had undergone primary PCI, 393 patients were finally included in a prospective cohort study. Standard primary PCI procedure according to the latest guidelines was performed. The patients were divided into three groups based on previous symptoms as follows: asymptomatic (Group A), chronic stable angina (Group B) and unstable angina (Group C). Results: A total of 393 patients were evaluated. 185 (47.1%) patients were described as asymptomatic, 48 (12.2%) had stable angina and 160 (40.7%) were categorized as unstable angina. There was no significant difference among the study groups regarding pre- and post-PCI thrombolysis in myocardial infarction flow grade (P = 0.81). Median of peak post-PCI creatine-kinase-muscle/brain level of Group A (asymptomatic) was 250.5 (115.5–389), and it was significantly higher than Group C (176 [60.00–313.50]) (P = 0.03). Q wave formation was observed in 142 (88.75%), 31 (64.5%), and 96 (52.0%) patients of Group A, B, and C patients, respectively, which was significantly higher in asymptomatic patients (P = 0.002). There was no significant difference among the three groups regarding in-hospital and 6-month mortality (P = 0.36, 0.06, respectively). The composite endpoint of 6-month mortality, acute coronary events, cerebrovascular accidents, and target vessel revascularization was not significantly different between the three groups (P = 0.11). Conclusion: Preinfarction angina among AMI patients undergoing primary PCI seems to have a limited beneficial effect on infarct size, and this benefit was not translated to any clinical benefit.

Quality of Acute Myocardial Infarction Care in Canada: A 10-Year Review of 30-Day In-Hospital Mortality and 30-Day Hospital Readmission

BackgroundThe recently released Canadian cardiac care quality indicators include 30-day in-hospital mortality and readmission rates after percutaneous coronary intervention (PCI) and isolated coronary artery bypass grafting (CABG). We examined long-term trends and provincial variations in these outcomes among acute myocardial infarction (AMI) patients. MethodsWe included patients aged 18 years and older who were hospitalized with a primary diagnosis of AMI between 2004 and 2013 in all Canadian provinces except Quebec. We calculated 30-day in-hospital death and readmission rates after PCI as well as isolated CABG. We used logistic regressions to evaluate baseline-adjusted temporal trends and provincial variations in mortality and readmission. ResultsAmong 341,001 AMI episodes in 323,862 unique patients, 43.1% and 7% received PCI and CABG, respectively. Mortality after PCI (2.8%) remained stable (odds ratio [OR], 1.01; P = 0.399), whereas mortality after isolated CABG (2.5%) decreased over time (OR, 0.96; P = 0.017). Readmission after PCI (8.8%) increased (OR, 1.06; P < 0.001), whereas readmission after isolated CABG (11.4%) remained stable over time (OR, 0.99; P = 0.116). Compared with Alberta, mortality and readmission after PCI were highest in Saskatchewan (mortality: OR, 1.32; P = 0.001; readmission: OR, 1.24; P < 0.001), whereas mortality after isolated CABG was highest in Newfoundland and Labrador (OR, 2.05; P = 0.010) and readmission after isolated CABG was highest in New Brunswick (OR, 1.49; P = 0.001). ConclusionsThere was no change in mortality, and a slight increase in readmission rates after PCI, and modest improvements in mortality and readmission rates after CABG among AMI patients during the study period. Significant interprovincial variations remained. A stronger focus on pan-Canadian coordination in AMI care and a set of standard benchmarks for AMI-specific PCI- and CABG-related quality indicators are needed.

Characteristics of and outcomes for elderly patients with acute myocardial infarction: differences between females and males.

ObjectivesThis study analyzed age-adjusted sex differences among acute myocardial infarction (AMI) patients aged 75 years and above with regard to 7-year mortality (primary end point) and the frequency of angiograms and admission to the coronary care unit (CCU) as well as 1-year mortality (secondary end points).MethodsA retrospective cohort study comprised 1,414 AMI patients (748 females and 666 males) aged at least 75 years, who were admitted to Sahlgrenska University Hospital in Gothenburg, Sweden, during two periods (2001/2002 and 2007). All comparisons between female and male patients were age adjusted.ResultsFemales were older and their previous history included fewer AMIs, coronary artery bypass grafting procedures, and renal diseases, but more frequent incidence of hypertension. On the contrary, males had higher age-adjusted 7-year mortality in relation to females (hazard ratio [HR] 1.16 with corresponding 95% confidence interval [95% CI 1.03, 1.31], P=0.02). Admission to the CCU was more frequent among males than females (odds ratio [OR] 1.38 [95% CI 1.11, 1.72], P=0.004). There was a nonsignificant trend toward more coronary angiographies performed among males (OR 1.34 [95% CI 1.00, 1.79], P=0.05), as well as a nonsignificant trend toward higher 1-year mortality (HR 1.18 [95% CI 0.99, 1.39], P=0.06).ConclusionIn an AMI population aged 75 years and above, males had higher age-adjusted 7-year mortality and higher rate of admission to the CCU than females. One-year mortality did not differ significantly between the sexes, nor did the frequency of performed coronary angiograms.

Higher education is associated with reduced risk of heart failure among patients with acute myocardial infarction: A nationwide analysis using data from the CVDNOR project.

Coronary heart disease (CHD) outcomes are characterised by socioeconomic gradients. Although heart failure (HF) is a severe complication of CHD, sparse evidence exists on the association between socioeconomic status and HF among coronary patients. This study aimed to explore potential educational differences in the risk of HF among acute myocardial infarction (AMI) patients in Norway during 2001-2009. A total of 70,506 patients hospitalised for an incident (first) AMI and without history of HF were included in the analyses. Information on education was obtained from the Norwegian Education Database and categorised into primary, secondary or tertiary. In 12,487 (17.7%) patients, HF was present at admission or developed during the AMI hospitalisation (early-onset HF). Compared to patients with primary education, patients with secondary or tertiary education had 9% [incidence rate ratio (IRR) = 0.91; 95% confidence interval (CI): 0.87-0.94] and 20% (IRR = 0.80; 95% CI: 0.75-0.86) lower risks of early-onset HF, respectively. Of the 54,095 AMI patients discharged alive without concurrent HF, 6375 (11.8%) were subsequently hospitalised with or died from late-onset HF during a median follow-up period of 3.4 years. Compared to patients with primary education, those with secondary or tertiary education had 14% [hazard ratio (HR = 0.86; 95% CI: 0.82-0.91] and 27% (HR = 0.73; 95% CI: 0.66-0.80) lower risks of HF, respectively. Educational differences in the risk of HF were not influenced by gender. We observed an inverse association between educational level and risk of HF. More efforts in preventing this severe complication of AMI among less educated patients may help to reduce the socioeconomic gap in survival following coronary events.

Barriers to timely treatment-seeking in patients with acute myocardial infarction in Malaysia: a qualitative study.

BackgroundPersisting delay in seeking treatment among Acute Myocardial Infarction (AMI) patients was reported in Malaysia despite intensified efforts in educating the public on symptoms of AMI and the importance of seeking prompt treatment. Studies outside Malaysia have shown that patients’ personal thoughts during symptom onset could contribute to the delay. The purpose of this study is to explore the barriers of AMI patients prior to the decision of seeking treatment in Malaysia.MethodsA qualitative descriptive research approach was chosen. Individual in-depth interviews were conducted among 18 patients with AMI. Data were analysed using thematic analysis. Recordings were transcribed and coded, codes were subsequently organized into categories. The stages of coding and identifying categories were repeated before themes were identified.ResultsThree meaningful themes with nine sub-themes that may have influenced the delayed decision to seek treatment were identified. Some themes identified were culturally bound.ConclusionsThe findings of this study give insights on barriers prior to the decision of seeking treatment when patients were experiencing AMI. Findings indicates that interventions targeted at increasing knowledge about AMI symptoms and correct actions using an informative approach at the current practice may not be adequate to reduce patient delay. The findings of this study could provide basis for the development of interventions that are culturally relevant to the Malaysians setting to promote behavioural change in the population and reduce pre-hospital delay.

Abstract 308: Predictors of Depression Recognition and Site Variability in Depression Recognition in Young AMI Survivors

Background: Depression among acute myocardial infarction (AMI) survivors is common and associated with adverse outcomes in the year following their AMI. In young women and men, about 1 in 3 patients suffer from depressive symptoms following their AMI. Early depression recognition is important to ensure timely treatment, and potentially improve outcomes. It is unknown, however, how well providers recognized potential depression in young AMI patients, what patient factors are associated with recognition, and how much variation there is across centers. Methods: VIRGO is a multi-center, international, prospective observational study that enrolled 3,350 AMI patients aged 18-55 years (67.1% women) between 2008-2012. During the index hospitalization for AMI, the Patient Health Questionnaire [PHQ-9] was administered to collect depressive symptoms experienced over the past 2 weeks (cut-off score ≥10 indicated potential depression). Demographic, socio-economic, cardiovascular risk, AMI-severity, and depression treatment data were collected through patient interviews and chart abstraction. Depression recognition was defined as having PHQ-9 scores ≥10 and receiving depression treatment (anti-depressants and/or counseling referral) at discharge and/or at 1-month follow-up. Results: During AMI admission, 1,057 (32%) patients had PHQ-9 scores ≥10. Overall, 41% were recognized by their providers. Independent predictors of having patients’ depressive symptoms recognized were: having health insurance (OR=1.46, CI95% 1.03-2.06), history of lung disease (OR=2.02, CI95% 1.36-2.99), and a higher PHQ-9 score (OR=1.06, CI95% 1.03-1.10). African Americans (OR=0.34, CI95% 0.21-0.54), males (OR=0.52, CI95% 0.37-0.74) and married patients (OR=0.72, CI95% 0.54-0.95) were less likely to be recognized. Recognition rates by AMI treating facility (Figure) ranged from 15 to 60%, with a median OR of 1.25 (CI = 1.00, 1.61). Conclusion: Depression recognition rates are poor in young AMI patients with substantial variation observed across AMI treating facilities. Males, African Americans, and uninsured patients are less often recognized and may continue to be at risk of poor AMI outcomes.