MI Cases Research Articles

Study of Serum Uric Acid in Acute Myocardial Infarction

BACKGROUND: Acute myocardial infarction (AMI) is overwhelmingly the most important form of ischemic heart disease (IHD) which continues to be the leading cause of death in the industrialized and developing countries like India, despite spectacular progress in their prevention, detection and treatment over the last three decades. The relation between uric acid and cardiovascular disease is observed not only with frank hyperuricemia (defined as more than 6mg/dl in women & more than 7 mg/dl in men) but also with uric acid levels considered to be normal but at high range. AIMS AND OBJECTIVES: To study the serum uric acid level of patients of Acute Myocardial Infarction admitted to our hospital. To correlate the serum uric acid levels on day 0,3,7 and comparing with killips class with coefficient of correlation and to assess the morbidity and mortality of these patients. METHODS: This hospital based case study was performed in Dr.PSIMS& RF, Chinoutpalli , Krishna district, Andhra Pradesh, south India from October 2016 to September 2017. A total of 75 cases of Acute MI were studied. All the subjects were interviewed, examined and investigated as per the predesigned proforma. RESULTS: 75 cases of acute MI were included in the study. Mean SUA for discharged patients was4.67 ±1.95 /dl and it was 7.1 ±1.45 mg/dl for the patients who died in the hospital. SUA levels were significantly higher in the patients who succumbed as compared to those who were discharged from the hospital (p = 0.000). CONCLUSION: Serum uric levels are correlated with killip’s classification. Patients of higher killips class have higher uric acid levels.Combination of killip’s class and serum uric acid levels after acute myocardial infarction is a good predictor of mortality. Serum uric acid levels were high in the patients who died in the seven day follow up period and the patients who died were also in higher killip’s class.

7184 Type 2 Diabetes As An Independent Risk Factor For Increased Incidence Of Cardiovascular Events In Patient With Nonalcoholic Fatty Liver Disease

Abstract Disclosure: E. Roh: None. K. Son: None. H. Jung: None. J. Huh: None. S. Lee: None. S. Ihm: None. K. Han: None. J. Kang: None. Background: Although coexistence of type 2 diabetes (T2DM) and non-alcoholic fatty liver disease (NAFLD) has been linked to unfavorable metabolic profile and an increasing cardiovascular risk, the impact of T2DM on the risk of developing CVD within the context of NAFLD remains unclear. This study aimed to investigate long-term CVD outcomes in patients with NAFLD according to glycemic status using nationwide cohort of Korean adults. Methods: This retrospective, longitudinal study included 1,057,775 patients with NAFLD, who had participated in the national health screening in 2009 and were followed up until 2020. The baseline glycemic status was divided into three categories [normal fasting glucose (NFG), impaired fasting glucose (IFG) and T2DM]. Cox proportional hazards models were used to assess the association of glycemic status with incident CVD. Results: During a median follow-up period of 10.3 years, 26,491 cases of MI, 55,791 cases of stroke, and 11,147 cases of CV death were identified. After adjusting for possible covariates, participants with T2DM had a higher risk of CVD, with hazard ratios of 1.394 (95% CI 1.351−1.439) for MI and 1.391 (95% CI 1.362−1.420) for stroke, and 1.457 (95% CI 1.392−1.524) for CV mortality, compared to those with NFG. The increased risk of CVD attributable to T2DM was more profound among individuals with fewer conventional CVD risk factos, including younger age, not obese, and the absence of hypertension. Conclusions: These results suggest that the identification of T2DM in individuals of NAFLD may help the prediction of future progression of CVD. Presentation: 6/3/2024

Half-century trend in morbidity, mortality, lethality from acute myocardial infarction in persons aged 25–64 years and the influence on the risk of developing acute myocardial infarction of psychosocial factors in conditions in Russia / Siberia from the perspective of the WHO international programs Register of Acute Myocardial Infarction, MONICA

Purpose of the study: To establish over half a century (1977–2022) trends in morbidity, mortality, mortality from acute myocardial infarction (AMI) in people aged 25–64 years and the influence of psychosocial factors (PSF) on the risk of developing AMI in Russia/Siberia with positions of the international programs of the World Health Organization (WHO) Register of Acute Myocardial Infarction (RAMI), MONICA.Material and methods. The study under the “RАMI” program began on 01/01/1977 in Oktyabrsky, and on 01/01/1981 – in the Leninsky and Kirovsky districts of Novosibirsk among people aged 25–64. In these same areas, since 1983, Institute of internal and preventive medicine, as a WHO center, has been implementing the MONICA program. Differences in AMI case-finding programs have not been identified. Both programs continue to operate to this day. All cases of acute MI for the entire study period were coded as ST-segment elevation myocardial infarction (STEMI) or non-ST-segment elevation myocardial infarction (NSTEMI). For prehospital deaths, the variable “died outpatients from AMI (DOPAMI)” was introduced. Random representative samples of people aged 25–64 years (n = 4800) were examined in the Oktyabrsky district at standard epidemiological screenings (1984, 1988, 1994), where trait anxiety (A) was studied using the Spielberger test (the presence of levels of population stress); Social support was determined using the Berkman – Syme test. To determine the risk of developing AMI depending on HR for 20 years, all new cases of AMI were recorded in the studied sample of three screenings that did not have CVD at the time of examination. Statistical analysis was performed using the free software computing environment R (v.3.6.3).Results. The incidence of AMI per 1000 residents of people aged 25–64 years in Russia/Siberia, according to international AMI programs, MONICA, is one of the highest in the world and is relatively stable throughout the entire half-century observation period, with the exception of some years of growth due to socio-economic instability in society, and is twice as high as Rosstat data. Mortality per 100,000 inhabitants from AMI resembles the dynamics of incidence, with the exception of 1977–1978 – a decrease. For the first time, in our study, a significant decrease in mortality and mortality of patients with AMI in 1978 compared to 1977 was obtained due to a decrease in inpatient mortality and mortality as a result of work under the WHO AMI program. For the first time, in our study, the cause of death in excess of the population in Russia was determined in the period 1988, 1993–1994, 1998 – these are acute cardiovascular diseases, not alcohol consumption. Prehospital mortality and mortality prevail throughout all years of observation and are 2–3 times higher than in-hospital mortality and are based on sudden death. Mortality, like morbidity, for RАMI is 2 times higher than according to official statistics. For the first time, our study showed that the increase in morbidity and mortality from AMI in Russia is associated with psychosocial factors.Conclusions. It has been established that the morbidity, mortality and mortality rates of the population from AMI in Russia/Siberia are one of the highest in the world and are relatively stable throughout the entire half-century observation period, with the exception of some years of growth due to socioeconomic instability in society. Prehospital mortality and mortality prevail throughout all years of observation and are 2–3 times higher than hospital mortality. Indicators of morbidity, mortality and lethality of the population from AMI, when increasing, are the main markers of increasing social stress in the population.

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.

Torsades De Pointes Complicating Acute Myocardial Infarction, Twisting the Prognosis

Introduction Torsades de pointes (TdP), a form of polymorphic ventricular tachycardia that manifests in the setting of an acquired or congenital QT interval prolongation. Polymorphic VT can occur in hyper acute phase or healing phase of an acute myocardial infarction. The presence of necrotic area caused by the infarction explains the existence of a possible circuit as well as the appearance of a re-entry arrhythmia. Aims and Objectives Our aim is to study the incidence of long Qt induced TdP in acute MI patients and its prognostic implications. We also want to analyze the impact of primary percutaneous transluminal coronary angioplasty in the management of these subset of patients. Methods In this cross-sectional observational study done from May 2021 to May 2022, We have studied 320 cases of acute MI, of which 6 were found to have TdP (1.9%). Four patients had inferior wall myocardial infarction and 2 patients had Non-ST elevation MI. Thrombolysis was done in 2 cases. Two cases underwent primary angioplasty. One case was recommended for coronary artery bypass grafting. All cases underwent appropriate electrolyte correction, besides cardioversion, as needed. Results All patients with TdP had prolonged QT interval. 50% of patients had mild hypokalemia. Two patients had complete heart block. Three patients had severe left ventricular dysfunction. Patients who underwent primary angioplasty survived. Thrombolysis had less impact on survival in Acute Mi with TdP. Conclusion Early percutaneous coronary angioplasty, combined with electrolyte correction, improves the prognosis in TdP complicating acute MI.

#3934 SAFETY AND EFFICACY OF EVOLOCUMAB AMONG KIDNEY TRANSPLANT PATIENTS AT HIGH CARDIOVASCULAR RISK

Abstract Background and Aims Proprotein convertase subtilisin/Kexin type A(PCSK-9) inhibitors have not been evaluated among kidney transplant recipients (KTR) despite its favorable cardiovascular profile. We aimed to evaluate the safety and efficacy of evolocumab in reducing lipids and cardiovascular events among risky KTR. Method One hundred ninety-five KTR - who were followed up in Hamed Al-Essa organ transplant center with high cardiovascular risk score (>20)-were enrolled in this prospective randomized controlled study between June 2017 and June 2018. Patients who received statin and evolocumab (140 mg/ 2 weeks, group1, n = 97) while those maintained on statin alone comprised group 2(n = 98). After 24 months, they were followed up clinically and by laboratory investigations. Results The two groups had comparable demographics. Before enrollment in the study, we observed a higher prevalence of NODAT in group 2 and more smokers in group 1(p < 0.05). Basal graft function was significantly higher in group 1, while the type of immunosuppression was equivalent in both groups(p > 0.05). We found no significant differences between the two groups concerning cardiovascular events, and both graft and patient outcomes (p > 0.05). Despite the comparable triglycerides levels, we found significantly higher basal cholesterol in group 1(5.5 vs. 4.7, p < 0.001), which came down significantly in the same group after three months and thereafter (p = 0.031) compared to group 2 and basal values (p < 0.001). We reported 2 cases of acute MI and one atrial fibrillation in group2. Conclusion Evolocumab is a promising lipid-lowering agent among risky KTR. Earlier cholesterol reduction was observed in group 1 without significant positive cardiovascular impact.

Yoga as secondary prevention and cardiac rehabilitation in myocardial infarction

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The prevalence of coronary artery disease is racing at a fast pace. The risk factors of myocardial infarction are old age, male sex, previous MI , diabetes, hypercholesterolemia, hypertension, unhealthy diet , smoking , physical inactivity and psychosocial stress. Interventional and pharmacological approaches are accessible these days for reduction of mortality and morbidity in myocardial infarction. Yoga as a compliment is inexpensive and devoid of side effects which has been shown to reduce body weight, blood pressure, cholesterol, blood sugar & improve physical and mental well being due to relative parasympathetic excess. Many studies performed earlier had small sample size and duration. Therefore, yoga is affordable and can be recommended along with conventional treatment to prevent and improve the outcome in MI cases. Purpose 1. To study the effect of yoga on risk factors following myocardial infarction. 2. To study the effect of yoga on Beck's Depression Inventory score. Methods Our study that comprised of 300 patients were randomized into test group (n=150) who were subjected to conventional treatment and yoga and control group (n=150) subjected to conventional treatment only. The study included patients diagnosed as myocardial infarction above 18 years with their consent to participate. Patients with hemodynamic instability, heart failure, pregnancy, prior yoga practice, arrhythmia ,cardiac pacemaker, autonomic neuropathy and musculoskeletal disease were excluded. Initially, assessment of clinical & biochemical parameters and routine investigations were performed. Beck's depression score was calculated. Yoga was started on 4th day after MI (test group) and there were sessions of 10 minutes of pranayam , 15 minutes of shavasan and 15 minutes of transcendental meditation. The patients were followed after 24 weeks for assessment of clinical & biochemical parameters. Carotid doppler & depression score was evaluated. The primary outcome included change in risk factors from baseline to the end of study period and secondary outcome was change in Beck's Depression score. Results After 24 weeks of intervention, a significant improvement was noted among yoga group in comparison to control group for BMI (p=0.04), heart rate (p=0.01), systolic & diastolic blood pressure (p<0.05), fasting & post prandial blood sugar (p<0.05), HbA1c (p=0.03), Beck's depression score (p=0.001) and lipid profile (p<0.05).In contrast, no improvement was seen for carotid intima media thickness. Conclusion On the basis of the study, it was concluded that conventional therapy with yoga has a positive impact on risk factors of MI and psychosocial stress. Therefore, yoga can be recommended to reduce morbidity and mortality after MI. Large trials with more number of cases and long term follow up are needed so that yoga as an intervention, can be added for secondary prevention and rehabilitation in myocardial infarction cases.

(398) Remission of Type 2 Diabetes, Mortality, and Major Adverse Cardiovascular Events in Men with Hypogonadism and Type 2 Diabetes Receiving Long-term Testosterone Therapy in Comparison to an Untreated Control Group in a Urological Registry Study

Abstract Introduction We had reported previously that 34.3% of patients with hypogonadism and type 2 diabetes (T2DM) receiving testosterone therapy (TTh) up to 11 years in our registry study achieved remission of their T2DM after a mean time of 8.6±2.9 years (Haider KS et al. Diabet Obes Metab 2020;22:2055-2068). Remission is defined as discontinuation of anti-diabetic medication while maintaining HbA1c within the non-diabetic range for at least three months. Objective to investigate effects of long-term TTh up to 13 years in men with hypogonadism and T2DM on glycemic control, remission of T2DM, mortality, and major adverse cardiovascular events (MACE). Methods In an ongoing registry study in men with hypogonadism (total testosterone ≤350 ng/mL and at least moderate symptoms on the Aging Males’ Symptoms scale, AMS) in a single urology office, 370 men had type 2 diabetes. 190 men received testosterone undecanoate (TU) injections 1000 mg/12 weeks following an initial 6-week interval (T-group), 180 opted against TTh and served as controls (CTRL). Patients’ T2DM was treated at the local diabetes center which included mandatory lifestyle education. Glycemic control (HbA1c) was measured and insulin resistance (HOMA-IR) calculated at each or each other visit. Absolute measures with standard deviations (SDs) as well as changes over time, adjusted for age, weight, waist circumference, fasting glucose, blood pressure, lipids, and quality of life to account for baseline differences between groups, are reported for a duration of 13 years. Results Mean (median) follow-up: T-group 9.0±3.4 (9), CTRL 9.7±3.2 (11) years, total observation time: T-group 1703, CTRL 1747 patient-years. Baseline age was 60.0±6.4 (T-group) and 63.0±4.9 years (CTRL) (p<0.0001). 71 patients (37.4%) in the T-group and 74 (41.1%) in CTRL had a history of cardiovascular disease (myocardial infarction MI, stroke, or coronary artery disease diagnosis) (p<0.05). Baseline smoking prevalence was 41.6% (79 men) in the T-group and 37.4% (67 men) in CTRL (p=0.415). HbA1c decreased from 9.5±1.4% to 5.5±1.2% in the T-group and increased from 7.8±0.7% to 10.5±1.2% in CTRL (means ± SDs). Mean adjusted change from baseline (least squares means ± SEs) at 13 years was -3.7±0.2 (T-group) and +3.4±1.2 (CTRL) (p<0.0001 for all). HOMA-IR decreased from 10.2±2.1 to 1.5±0.3 in the T-group and increased from 7.3±1.3 to 14.8±2.5 in CTRL. Mean adjusted change from baseline at 13 years was -8.3±0.3 (T-group) and +6.8±0.4 (CTRL) (p<0.0001 for all). In the T-group, 108 patients (56.8%) went into remission. The median time to remission was 87 months. During the entire observation period, 21 patients (11.1%) died in the T-group vs. 62 (34.4%) in CTRL (p<0.0001). Major adverse cardiovascular events (MACE): in the T-group, there were no cases of MI or stroke. In CTRL, there were 62 cases of MI (34.4%) and 51 cases of stroke (28.3%). Conclusions Long-term TTh in men with hypogonadism and T2DM improves glycemic control and insulin resistance and reduces mortality and MACE, compared to untreated controls. Every other patient receiving TTh achieves remission of T2DM. Disclosure Yes, this is sponsored by industry/sponsor: Bayer AG, Berlin, Germany. Clarification Industry funding only - investigator initiated and executed study. Any of the authors act as a consultant, employee or shareholder of an industry for: Bayer AG.

Associations between environmental noise and myocardial infarction and stroke: Investigating the potential mediating effects of hypertension

BackgroundWe investigated whether hypertension may be a mediator in the pathway linking environmental noise exposure to incident MI and stroke. MethodsSeparately for MI and stroke, we built two population-based cohorts from linked health administrative data. Participants were residents of Montreal (Canada) between 2000 and 2014, aged 45 years and older who were free of hypertension and MI or stroke at time of entry. MI, stroke and hypertension were ascertained from validated case definitions. Residential long-term environmental noise exposure, expressed as the annual mean level acoustic equivalent 24 h (LAeq24h), was estimated from a land use regression model. We performed mediation analysis based on the potential outcomes framework. We used a Cox proportional hazards model for the exposure-outcome model and a logistic regression for the exposure-mediator model. In sensitivity analysis we applied a marginal structural approach to estimate the natural direct and indirect effects. ResultsEach cohort included approximately 900 000 individuals, with 26 647 incident cases of MI and 16 656 incident cases of stroke. 36% of incident MI and 40% of incident stokes had previously developed hypertension. The estimated total effect per interquartile range increase (from 55.0 to 60.5 dB A) in the annual mean LAeq24h was 1.073 (95% confidence interval (CI): 1.070–1.077) for both MI for stroke. We found no evidence of exposure-mediator interaction for both outcomes. The relationships between environmental noise and MI and stroke was not mediated by hypertension. ConclusionsThis population-based cohort study suggests that the main route by which environmental noise exposure may cause MI or stroke is not through hypertension.

TICAGRELOR VS. CLOPIDOGREL: CLINICAL OUTCOMES IN ST-ELEVATION MYOCARDIAL INFARCTION PATIENTS

A large, randomised control trial known as PLATO study proved a turning point in the assessment of superiority of ticagrelor over clopidogrel in post- MI cases. This breakthrough in assessing the quantum of efcacy of ticagrelor over clopidogrel in post-MI patients led to changes in international guidelines. However, based on the mortality index associated with these two drugs, the outcome is not encouraging, and both ticagrelor and clopidogrel are on par in terms of efcacy or safety. Recurrent episodes of bleeding were more common in patients who were prescribed ticagrelor than in patients who were given clopidogrel. However, future trials with longer follow-up time periods may be able to answer all the remaining questions

Wild type through Omicron: Maternal outcomes across COVID-19 waves

SARS-CoV-2 has been associated with poor maternal complications. Few studies exist that specifically compare maternal outcomes across the waves and variants of the pandemic. We sought to determine if maternal complication of COVID differ across COVID-19 waves. Retrospective study of pregnant patients diagnosed with SARS-CoV-2 between 3/6/20 and 2/28/22 at a single academic center. Three distinct waves of the pandemic were identified that correlated to the following variants: Wild type (3/6/20-12/31/20), Alpha/Delta (1/1/21-12/14/21), and Omicron (12/15/21-2/28/22). Baseline demographics and clinical outcomes were collected. The primary outcome was development of maternal COVID-19 complications (venous thromboembolism, pneumonia, acute respiratory failure, stroke, myocardial infarction, acute renal or hepatic failure, and transaminitis). Statistical analysis was performed using Chi square tests, student T-tests, and logistic regression modeling, with significance defined as p< 0.05. There were 654 patients included in the analysis with 190 (29%) in the wild type wave, 207 (31%) in the Alpha/Delta wave, and 257 (39%) in the Omicron wave. Women diagnosed during the wild type wave (OR 22.9 (95% CI 2.9-177.4)) or the Alpha/Delta wave (OR 10.6 (95% CI 1.3-85.1)) had significantly higher odds of maternal complications compared to those diagnosed during the Omicron wave. Pneumonia was the most common complication, and the incidence differed across waves: 7.4% during the wild type, 4.3% during the Alpha/Delta, and 0.4% during the Omicron wave (p< 0.001). Rates of other maternal complications across waves are shown in Figure 1. There were no cases of stroke, MI, acute renal or hepatic failure. Women diagnosed during Omicron were more likely to be AMA and have co-morbidities, whereas parity, Hispanic ethnicity, GA at diagnosis and government insurance were greater during the wild type wave (p< 0.05) [Table 1]. Maternal complications of COVID were higher during the Wild type and Alpha/Delta waves compared to the Omicron wave.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

A STUDY ON THE PROGNOSTIC SIGNIFICANCE OF HYPONATREMIA IN ACUTE MYOCARDIAL INFARCTION- A PROSPECTIVE LONGITUDINAL STUDY

Background: Hyponatremia, dened as a serum sodium concentration &lt;135 mEq/L, is the most common electrolyte disorder in hospitalized patients. Hyponatremia also increases the morbidity and mortality following myocardial infarction. MI is a major cause of death and is a global health problem reaching epidemic in both developed as well as in developing countries. Aims and Objectives: To study hyponatremia as a prognostic marker in patients with acute myocardial infarction-STEMI and NSTEMI. Material and Methods: This prospective, longitudinal observational study was conducted during December 2018 – October 2020 in 152 cases of acute MI. Results: Male preponderance in the patients hospitalised due to acute MI was 73.03%. The mean age of females was 59.46±9.42 years affected by acute MI was more than males i.e. 53.23±9.92 years. Hyponatremia was present in 39.47% of the cases with acute MI. Mild hyponatremia was the most prevalent 71.67% and severe hyponatremia was the least prevalent 3.33%. Diabetes mellitus was more prevalent in cases of MI with hyponatremia 53.33% vs 25%. The GRACE scores were higher in the cases having hyponatremia and increases with the increase in severity of hyponatremia. The TIMI scores were higher in the cases having hyponatremia and increases with the increase in severity of hyponatremia. The mean duration of hospital stay was 9.99 ± 8.69 days. STEMI was more prevalent 75.66% than NSTEMI. AWMI cases were more in the population with hyponatremia 78% than in the population with normal serum sodium 53.85%. Acute MI cases with hyponatremia had lower mean LVEF than those with normal serum sodium levels. Primary reperfusion therapy (thrombolysis/primary PCI) was done in 44.08% of the cases and no signicant association was found between it and outcomes in the hyponatremia group. Complications were present in 23.03% of the cases in hyponatremia group (p &lt;0.05). Mortality was present in 2.64% of the cases and more common in the cases with hyponatremia (p&gt;0.05). The odds of complications (including death) was 2.91 times in the cases with hyponatremia as compared to cases with normal serum sodium levels, 2.47 times in the cases with mild hyponatremia as compared to cases with normal serum sodium levels, 3.42 times in the cases with moderate hyponatremia as compared to cases with normal serum sodium levels and 25 times in the cases severe hyponatremia as compared to cases with normal serum sodium levels. Conclusion: It can be concluded that the severity of MI is more in cases with hyponatremia and hyponatremia is associated with poorer outcomes in terms of complications post MI and mortality.

Assessment of right atrial function in inferior wall AMI

Background: Approximately 30–50% of patients with inferior infarction have some involvement of the right ventricle. The right ventricular (RV) infarction almost invariably develops in association with a large infarction of the adjacent septum and inferior 0 walls, but isolated infarction of the right ventricle is seen in just 3–5% of autopsy-proven cases of MI. This study is designed to assess the right atrial (RA) functions in inferior wall acute myocardial infarction (AMI) (IWMI) echocardiographically and to compare it with patients who do not have history of ischemic heart disease (IHD) but having risk factors for IHD. Aims and Objectives: The aims of this study were to study the patients presenting with Inferior wall MI IWMI for RA function. Materials and Methods: Patients admitted in the Cardiology ward of R G Kar Medical College and Hospital with IWMI from March 2020 to March 2022 were included in the study. Results: Average Measurement of RA volume index (RAVI) and RA Pressure (RAP) was highest among patients with IWMI+RV myocardial infarction (RVMI). Out of 100 IWMI patients, 33 had high RAVI and RAP and out of 100 non-IHD patients none had high RAVI. Conclusion: In our study, there was no statistically significant difference in average RAVI and RAP in patients presenting with IWMI and in patients with risk factors for myocardial infarction but without AMI. However, patients presented with IWMI+RVMI showed statistically significant increased RAVI and RAP as compared to inferior wall AMI only.

Are There Differences in the Demographics and Clinical Outcomes Between Asian and European Patients Treated With the COMBO Dual Therapy Stent in the REDUCE Trial Populations?

Background: This study aimed to assess differences in clinical characteristics and outcomes between Asian and European patients treated with the COMBO dual therapy stent in the REDUCE trial. Methods: In the REDUCE trial, 1,496 patients who underwent successful COMBO stent implantation were randomised to 3- or 12-month dual antiplatelet therapy groups. Of these, 449 (30%) were Asian and 1,047 (70%) were European. Given that no significant differences were observed between the 3- and 12-month dual antiplatelet therapy cohorts for both sites, the overall data of Asian patients were compared with those of European patients in terms of clinical characteristics and outcomes. Results: The Asian cohort was younger and comprised fewer women than the European cohort. They also had more cases of type 2 diabetes (33.0% versus 15.1%), hypercholesterolaemia (54.6% versus 41.7%) and hypertension (55.7% versus 48.5%) but had fewer previous interventions compared with European patients. Regarding procedures, Asian patients had more cases of infarct-related vessel in the left anterior descending artery. The primary endpoint indices among Asian patients at 90, 180, 360 and 720 days were lower than those among European patients, which can be attributed to the lower number of cases of target-vessel revascularisation, bleeding (Bleeding Academic Research Consortium classification II, III or V) and MI among the Asian cohort. Conclusion: Despite having a higher incidence of cardiovascular risk factors, more ST-elevation MI cases and more cases of culprit lesion located at the proximal left anterior descending artery, Asian patients in the REDUCE trial showed lower trends of target-vessel revascularisation, bleeding and MI than European patients in the REDUCE trial.

Joint effect of myocardial infarction and obesity on the risk of venous thromboembolism: The Tromsø Study

BackgroundMyocardial infarction (MI) is associated with an increased risk of venous thromboembolism (VTE). Obesity is a recognized risk factor for both MI and VTE. Whether obesity further increases the risk of VTE in MI patients is scarcely investigated. AimTo study the joint effect of MI and obesity on the risk of VTE. MethodsStudy participants (n = 29 410) were recruited from three surveys of the Tromsø Study (conducted in 1994–1995, 2001, and 2007–2008) and followed up through 2014. All incident MI and VTE cases during follow‐up were recorded. Cox regression models with MI as a time‐dependent variable were used to estimate hazard ratios (HRs) of VTE (adjusted for age and sex) by combinations of MI exposure and obesity status. Joint effects were assessed by calculating relative excess risk and attributable proportion (AP) due to interaction. ResultsDuring a median of 19.6 years of follow‐up, 2090 study participants experienced an MI and 784 experienced a VTE. Among those with MI, 55 developed a subsequent VTE, yielding an overall incidence rate (IR) of VTE of 5.3 per 1000 person‐years (95% confidence interval [CI]: 4.1–6.9). In the combined exposure group (MI+/Obesity+), the IR was 11.3 per 1000 person‐years, and the adjusted HR indicated a 3‐fold increased risk of VTE (HR 3.16, 95% CI: 1.99–4.99) compared to the reference group (MI−/Obesity−). The corresponding AP was 0.46 (95% CI: 0.17–0.74). ConclusionsThe combination of MI and obesity yielded a supra‐additive effect on VTE risk of which 46% of the VTE events were attributed to the interaction.

Preexisting atrial fibrillation and myocardial infarction: only 10% of infarcts directly linked to atrial fibrillation.

The aim of the study was to evaluate the incidence and prognosis of type 1 myocardial infarction (T1MI) and type 2 MI (T2MI) in patients with acute MI and known atrial fibrillation (AF) to identify MI directly linked to AF. Among the 669 patients, four patients with hyperthyroidism were excluded, and among the remaining 665 patients, about two-thirds were diagnosed with T1MI, and the remaining third were diagnosed with T2MI. AF was the direct cause of MI in 9.8% of our overall population [1.8% of T1MI type C (coronary embolism), 4.9% of T2MI type A and 3.1% of T2MI type B]. Among patients with T2MI, 30-day mortality was lower when the trigger was AF than for the other triggers, for both type 2A (6% vs. 11%) and type 2B (0% vs. 13%). Most cases of AF-related MI are, thus, T2MI, for which therapeutic guidelines are lacking. Given the diverse triggers in T2MI, a specific approach using etiological patterns is needed to properly determine the optimal therapeutic.

416-P: Mortality, Major Adverse Cardiovascular Events (MACE) and Diabetic Complications in Men with Hypogonadism and Type 2 Diabetes on Long-Term Testosterone Treatment: An Update from a Urological Registry Study

Background: Men with hypogonadism are at increased risk of MACE and mortality. Studies in men with T2DM show that testosterone therapy reduces both MACE and mortality. Methods: In a registry of 883 men with hypogonadism, 370 men (41.9%) have T2DM. 190 received TU 1000 mg/12 weeks (T-group) , 180 opted against treatment (CTRL) . All patients received standard diabetes treatment including lifestyle courses at a diabetes center. MACE, mortality, and diabetic complications were recorded and compared between groups. Results: Mean baseline age in the T-group and CTRL was 61.0±5.3 and 63.0±4.9 years. Mean follow-up in T-group and CTRL was 9.0 and 9.7 years. 71 patients (37.4%) in the T-group and 74 (41.1%) in CTRL had a history of cardiovascular disease (myocardial infarction MI, stroke, or coronary artery disease diagnosis) (p&amp;lt;0.05) . Baseline smoking prevalence was 41.6% (79 men) in the T-group and 37.4% (67 men) in CTRL (p=0.415) . The T-group had a worse baseline risk factor profile than CTRL: BMI (36.5±4.4 vs. 32.8±4.7 kg/m²) , systolic blood pressure (163.0±13.3 vs. 145.5±14.5 mmHg) , LDL (4.7±0.8 vs. 4.1±1.4 mmol/L) , HbA1c 9.5±1.4 vs. 7.8±0.7% (p&amp;lt;0.00for all) . Mortality: during the entire observation period, 21 patients (11.1%) died in the T-group vs. 62 (34.4%) in CTRL (p&amp;lt;0.0001) . Major adverse cardiovascular events (MACE) : in the T-group, there were no cases of MI or stroke. In CTRL, there were 62 cases of MI (34.4%) and 51 cases of stroke (28.3%) . Diabetic complications: in the T-group and CTRL, the incidence of retinopathy was 4 (2.1%) vs. 30 (16.7%) (p&amp;lt;0.0001) , nephropathy 1 (0.01%) vs. 7 (0.4%) (p=0.05) , polyneuropathy (5.3%) vs. 97 (53.9%) (p&amp;lt;0.0001) , diabetic foot syndrome 0 (0%) vs. 17 (9.4%) (p&amp;lt;0.0001) . Conclusions: Long-term treatment with TU in men with hypogonadism and T2DM reduces mortality, MACE, and diabetic complications, compared to untreated controls. Disclosure K.S.Haider: Other Relationship; Bayer AG. A.Haider: Other Relationship; Bayer AG. F.Saad: Consultant; Bayer AG, Stock/Shareholder; AbbVie Inc., Bayer AG, GlaxoSmithKline plc. Funding Bayer AG

Prognostic Value of the Leuko-Glycemic Index in Acute Myocardial Infarction Patients with or without Diabetes

PurposeThe leuko-glycaemic index (LGI) is an index that combines white blood cell count and blood glucose and could be a marker of systemic inflammatory response syndrome. The prognostic value of the LGI in acute myocardial infarction (AMI) is still unclear. We aimed to investigate the prognostic value of the LGI for short- and long-term prognosis in AMI patients with different diabetic status.Patients and MethodsThis was an observational, multicenter study involving 1256 AMI patients admitted in 11 hospitals between March 2014 and June 2019 in Chengdu. White blood cell count and blood glucose were measured on admission. The LGI was calculated by multiplying both values and dividing them by a thousand. Logistic regression was used to explore the predictive value of LGI in in-hospital mortality. Receiver operating characteristic curve was used to determine the optimal cut-off values of the LGI to predict in-hospital mortality. The patients were classified into diabetic and non-diabetic groups and further divided into higher and lower LGI subgroups according to the optimal cut-off values. The endpoints were all-cause mortality during the hospitalization and major adverse cardiovascular and cerebrovascular events (MACCE) during follow-up, including all-cause mortality, non-fatal myocardial infarction, vessel revascularization and non-fatal stroke.ResultsLGI was an independent predictor of all-cause mortality during the hospitalization in non-diabetics, but not in diabetics. The optimal cut-off values of diabetics and non-diabetics were 3593 mg/dl. mm3 and 1402 mg/dl. mm3, respectively. Whether diabetics or not, in-hospital mortality was higher in the higher LGI subgroup (p-value < 0.001). And in the follow-up of 15 months (9 months, 22 months), we observed 99 (8.6%), 6 (0.5%), 54 (4.7%) and 29 (2.5%) cases of death, non-fatal MI, revascularization and non-fatal stroke, respectively. The cumulative incidence of MACCE during follow-up was higher in the higher LGI subgroup, both in the diabetics and non-diabetics (p-value < 0.05). In non-diabetics, higher LGI was an independent predictor of MACCE.ConclusionLGI was an independent predictor for short- and long-term prognosis in AMI patients without diabetes, but had no prognostic value for short- and long-term prognosis of AMI patients with diabetes.

Use of Optical Coherence Tomography in MI with Non-obstructive Coronary Arteries.

MI with non-obstructive coronary arteries (MINOCA) comprises an important minority of cases of acute MI. Many different causes have been implicated in the pathogenetic mechanism of MINOCA. Optical coherence tomography (OCT) is an indispensable tool for recognising the underlying pathogenetic mechanism when epicardial pathology is suspected. OCT can reliably identify coronary lesions not apparent on conventional coronary angiography and discriminate the various phenotypes. Plaque rupture and plaque erosion are the most frequently found atherosclerotic causes of MINOCA. Furthermore, OCT can contribute to the identification of ischaemic non-atherosclerotic causes of MINOCA, such as spontaneous coronary artery dissection, coronary spasm and lone thrombus. Recognition of the exact cause will enable therapeutic management to be tailored accordingly. The combination of OCT with cardiac magnetic resonance can set a definite diagnosis in the vast majority of MINOCA patients.

English

BACKGROUND We wanted to assess the significance of diagnosis and prognosis of lung function tests in chronic obstructive pulmonary diseases (COPD) &amp; cardiovascular diseases in this study. METHODS This study was conducted among 200 patients in the outpatient departments of General Medicine and Cardiology of King George Hospital/AMC. Data was collected with Spirometer machine (Digital), HELIOS-401, Recorders &amp; Medicare Systems Pvt. Ltd, Haryana, Chandigarh-160002, India. The data were entered into MS Excel and analysed in SPSS v21. RESULTS Of the 200 patients enrolled in the study, 146 (73 %) were males and 54 (27 %) were females with an average age of 50.38 ± 9.86 yrs. In the study population, pulmonary function parameters were significantly different in COPD compared to control and a P- value of less than 0.05 was considered statistically significant. The difference in pulmonary function parameters between Controls, COPD, Post MI &amp; Post MI &amp; COPD groups was statistically significant. Whereas the pulmonary function parameters between the post-MI and controls were not statistically significantly different with a P-value of more than 0.05. In the study population, the pulmonary function parameters were significantly different between the Post MI and control, COPD and control, Post MI with COPD and control. CONCLUSIONS The diagnosis of COPD was done by the Lung function test which is considered the gold standard test. The lung function was improved in Post MI cases of more than one-month duration. KEY WORDS Lung Function Tests, COPD, Cardiovascular Diseases, Spirometry