Combined Myocardial Infarction Research Articles

External validation of the Systematic COronary Risk Evaluation 2 (SCORE2) model in cancer patients

Abstract Background Guidelines recommend cardiovascular disease (CVD) risk stratification before cancer treatment to better identify patients for intensified follow-up or cardioprotective treatment. Only a limited number of CVD risk stratification tools exists for cancer patients which at present is not widely used nor extensively validated. The ESC Guidelines on Cardio-oncology 2022 suggest using traditional CVD models like the SCORE2 (Systematic Coronary Risk Estimation 2). However, external validation in cancer populations is lacking. Purpose Our aim was to study the prevalence of CVD risk factors and incidence of cardiovascular events in a cancer cohort and externally validate the Systematic COronary Risk Evaluation 2 (SCORE2) model in this context. Methods We included 1058 patients from a large-scale populational study without diabetes or established CVD aged 40 to 69 years and diagnosed with cancer between 2006 and 2012. Participants were assessed for cardiovascular risk factors at baseline and followed until Sept 2023. The Norwegian Cancer Registry provided patient specific information about cancer characteristics and therapy. The primary outcome was the combination of myocardial infarction (MI), stroke or CVD mortality, which was retrieved from the local hospitals’ registries and the national causes of death registry. Performance was assessed using smooth calibration curves of predicted and observed risk and Harrel’s C-statistic for discrimination, both corrected for competing risks. SCORE2 was recalibrated by adapting the model with a single multiplicative constant based on the expected-to-observed ratio (E/O-ratio). Results The most common cancer types were gastrointestinal cancer (19%), male genital including prostate cancer (19%) and breast cancer (18%). Mean (SD) age was 58.6 (7.6) years, 54% were female. Prevalence of cardiovascular risk factors are shown in Table 1. In total, 121 (11%) individuals had a CVD event (MIs 53 (44%), strokes 46 (38%) and CVD deaths 22 (18%)) during a median (interquartile range) follow-up of 11.1 (3.4 to 13.1) years, and 360 (34%) died due to non-CVD causes. Calibration plots showed adequate agreement between estimated and observed 10-year prognosis after recalibration (C-statistics 0.685, 95% CI 0.643 to 0.728), Figure 1. E/O-ratio for men was 0.65 and for women 0.63, indicating underestimation of the observed CVD incidence. After recalibration, the median estimated 10-year risk was 8.1% (IQR 5 to 11), 36% had >10% 10-year risk and 9% had >15% 10-year risk. Conclusion SCORE2 underestimated CVD risk in a general cancer population but showed adequate agreement after recalibration and C-statistics aligned with the original external validation cohorts. SCORE2 is useful also in cardio-oncology setting (after recalibration) to identify individuals at higher risk of developing CVD.

Skeletonized Versus Pedicled Harvesting of the Internal Thoracic Artery and Long-Term Clinical Outcomes in Coronary Artery Bypass Surgery.

The internal thoracic artery (ITA) is the most important conduit for coronary artery bypass grafting. Recent evidence suggests that skeletonized ITA harvesting yields long-term outcomes inferior to those of pedicled harvesting. The aim was to investigate the impact of the ITA harvesting method on 10-year mortality and major adverse cardiovascular events. In this observational cohort study, we identified all patients from the SWEDEHEART (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) register who underwent isolated coronary artery bypass grafting using at least 1 ITA at Karolinska University Hospital from 2012 to 2021. The main outcome was all-cause mortality, and the secondary outcomes were a combination of myocardial infarction, repeat revascularization, heart failure, and stroke. Outcomes were ascertained using national health data registers and compared between the skeletonized and pedicled groups using weighted flexible parametric survival models. Among 3267 patients, 1657 (51%) underwent pedicled ITA harvesting and 1610 (49%) underwent skeletonized ITA harvesting. The patients' mean age was 66 years, and 15% were women. The weighted all-cause mortality incidence rate in the pedicled versus skeletonized ITA group was 2.6% (95CI, 2.2%-3.0%) versus 2.6% (95% CI, 2.2%-3.1%), respectively (hazard ratio (HR), 1.01 [95% CI, 0.81-1.27]). The weighted major adverse cardiovascular events incidence rate was 7.8% (95% CI, 7.1%-8.6%) versus 7.5% (95% CI, 6.7%-8.4%), respectively (HR, 0.94 [95% CI, 0.82-1.08]). We found no significant differences in all-cause mortality or major adverse cardiovascular events rates between the 2 ITA harvesting methods.

Locoregional anesthesia is associated with decreased cardiac complications in symptomatic heart failure patients undergoing carotid endarterectomy

ObjectiveAlthough the current literature reports no advantage for locoregional anesthesia (LRA) over general anesthesia (GA) in patients undergoing carotid endarterectomy (CEA), there remains a gap in understanding the impact of LRA on individuals with congestive heart failure (CHF). This study aims to assess whether the choice of anesthesia influences the rates of perioperative complications within this patient population. MethodsUsing the Vascular Quality Initiative CEA module, all patients undergoing CEA between 2013 and 2023 were identified. The subset of patients with CHF was included, and patients were divided based on the type of anesthesia received. Patient characteristics and outcomes were compared using the χ2 or Fischer's exact test as appropriate for categorical variables and the independent t test or Mann-Whitney U test as appropriate for continuous variables. A sensitivity analysis was performed based on the symptomatic status of CHF, and the association between anesthesia modality and postoperative outcomes was studied using multivariable logistic regression analysis. The primary outcomes of this study included perioperative stroke, myocardial infarction (MI), acute HF, and the combination of MI and acute HF defined as major cardiac complications. ResultsA total of 21,292 patients (19,730 receiving GA, 1562 receiving LRA) with a diagnosis of CHF undergoing CEA were identified. On multivariable logistic regression analysis, LRA was independently associated with lower MI (odds ratio [OR]; 0.35; 95% confidence interval [CI], 0.13–0.96), acute HF (OR, 0.27; 95% CI, 0.09-0.87), major cardiac complications (OR, 0.30; 95% CI, 0.13-0.67), hemodynamic instability (OR, 0.64; 95% CI, 0.53-0.78), cranial nerve injury (OR, 0.40; 95% CI, 0.19-0.81), shunt use (OR, 0.25; 95% CI, 0.20-0.31), and neuromonitoring device use (OR, 0.20; 95% CI, 0.17-0.24) compared with GA in patients with symptomatic CHF. No difference in MI, acute HF, and major cardiac complications was seen in patients with asymptomatic CHF. ConclusionsCEA can be performed safely in patients with CHF. Using LRA is associated with a decreased incidence of perioperative cardiac complications in patients with symptomatic HF undergoing CEA.

Indicators of myocardial electrical instability during high-dose atorvastatin therapy in patients after acute myocardial infarction in combination with COVID-19

Indicators of myocardial electrical instability during high-dose atorvastatin therapy in patients after acute myocardial infarction in combination with COVID-19

Myocardial infarction in combination with anaphylactic shock (Kounis syndrome): a case report

Introduction. Allergic reactions and side effects are a common consequence of drug use and account for ~5% of all hospital admissions. The co-occurrence of ana phylactic shock and acute myocardial infarction (AMI) is called Kounis synd rome (KS).Brief description. The article analyzes the case of ceftriaxone-induced KS in a 56-year-old female patient with a history of anaphylactic shock after ampicillin therapy. The patient was treated on an outpatient basis due to an acute upper respiratory infection. The patient was diagnosed with acute bronchitis, in connection with which antibiotic therapy with azithromycin was started. Due to inefficiency the drug was canceled and ceftriaxone 1 g in 3,5 ml of 1% lidocaine solution 2 times a day was prescribed. After the first intramuscular injection, the patient developed anaphylactic shock, which was stopped by intravenous administration of prednisolone 120 mg, dexamethasone 8 mg and adrenaline hydrochloride 1,0 ml. Almost immediately, the ST segment elevation was recorded, in connection with which thrombolytic therapy with fortelyzin 15 mg was performed. Coronary angiography revealed thrombotic occlusion of the left anterior descending artery in the upper segment. Further examination verified AMI in the patient.Discussion. This case of AMI is pathogenetically associated with anaphylactic shock. However, the available data on the state of patient coronary system and no data on the morphologic characteristics of thrombus do not make it possibelr to define a type of KS.Conclusion. This clinical case indicates the need for a thorough allergic anamnesis collection by physicians of any specialty and prescribing medications taking it into account.

Features of indicators of central pressure and stiffness in patients with primary myocardial infarction in combination with COVID-19

Features of indicators of central pressure and stiffness in patients with primary myocardial infarction in combination with COVID-19

Cardiovascular risk factors in patients with primary myocardial infarction in combination with COVID-19

Cardiovascular risk factors in patients with primary myocardial infarction in combination with COVID-19

Динаміка показників кардіогемодинаміки у хворих на гострий інфаркт міокарда з супутнім цукровим діабетом 2 типу протягом 6 місяців спостереження

The purpose of the study was to monitor the dynamics of cardiohemodynamics in patients with acute myocardial infarction in combination with type 2 diabetes mellitus during 6 months of follow-up. Materials and methods. The study involved 120 patients: group 1 – patients with acute myocardial infarction with type 2 diabetes mellitus (n = 70), group 2 – patients with acute myocardial infarction (n = 50). The control group included 20 healthy individuals. All patients underwent general instrumental and clinical examinations. In the course of echocardiographic (echocardiography) study, the parameters of the left ventricle were determined and calculated: end diastolic volume, end systolic volume, end diastolic size, end systolic size, posterior thickness, the thickness of the interventricular septum, the ejection fraction of the left ventricle, the size of the left atrium, the size of the aorta, stroke volume. Results and discussion. The average indicators of cardiohemodynamics on the first day of hospitalization were as follows: end diastolic volume in patients of the 1st group was 165.85±36.22 ml; of the 2nd – 133.44±27.19 ml; control – 54.54±21.48 ml; end systolic volume – 104.57±28.86 ml; 77.93±21.56 ml; 21.69±7.49 ml, respectively; end diastolic size – 5.74±0.6 ml; 5.22±0.49 ml; 3.55±0.58 ml, respectively; end systolic size – 4.66±0.62 ml; 4.11±0.52 ml; 2.41±0.32 ml, respectively; the ejection fraction of the left ventricle – 37.51±6.27%; 42.9±7.45%; 56.75±7.22%, respectively; posterior thickness – 1.37±0.13 cm; 1.32±0.13 cm; 1.07±0.08 cm, respectively; the thickness of the interventricular septum – 1.26±0.11 cm; 1.27±0.11 cm; 1.13±0.08 cm, respectively; the size of the left atrium – 4.07±0.31 cm; 3.75±0.46 cm; 3.19±0.15 cm, respectively; the size of the aorta – 3.39±0.27 cm; 3.3±0.22 cm; 2.97±0.16 cm, respectively; stroke volume – 60.27±13.3 cm3; 2nd – 57.01±10.72 cm3; 28.39±12.38 cm3, respectively. Six months after acute myocardial infarction, a positive trend in cardiohemodynamic parameters was observed, maintaining a tendency for worse indicators in the presence of acute myocardial infarction. Conclusion. Thus, impaired carbohydrate metabolism in the form of insulin resistance, hyperinsulinemia and stress hyperglycemia on the background of coronary events in type 2 diabetes mellitus leads to negative changes in geometry, mass, systolic and diastolic function of the left ventricle, which must be paid special attention to hemodynamic predictors of cardiovascular complications and heart failure

Molecular genetic markers of myocardial infarction in combination with type 2 diabetes

Aim. To study associations of rs2464196 and rs11212617 polymorphisms with the development of myocardial infarction (MI) in combination with type 2 diabetes (T2D).Material and methods. The study included two groups: main group (n=115) — patients with prior myocardial infarction and T2D, comparison group (n=116) — patients with myocardial infarction without T2D, hospitalized from December 1, 2018 to December 31, 2019 at the Regional Vascular Center № 1 of the City Clinical Hospital № 1. Participants were comparable in sex and age. Patients underwent clinical and instrumental investigations, a genetic test for single nucleotide polymorphisms, which showed associations with the development of MI and T2D according to genome-wide association study (GWAS): rs2464196 of the HNF1A gene, rs11212617 of the ATM gene.Results. Carriage of the AA genotype of the HNF1A rs2464196 polymorphism was found to be associated MI in combination with T2D in the general group (odds ratio (OR), 3,180, 95% confidence interval (CI), 1,206-8,387, p=0,015). After division of the group by sex, significant differences remained only in women (OR=9,706, 95% CI, 1,188-79,325, p=0,011).Conclusion. The data obtained can make it possible to identify a priority group of patients for personalized prevention of cardiovascular diseases.

Myocardial infarction and COVID‑19 in a “non‑COVID” hospital: epidemiology, annual analysis

Purpose of the work: to assess the prevalence of myocardial infarction and COVID-19 in a «non-COVID» hospital.Materials and methods: the first part of the work is monitoring data from June 2020 to May 2021, the second part is an analysis of monitoring from August 2017 to May 2021.Research results. According to the data obtained, the peak of the combination of myocardial infarction with COVID-19 lagged behind the total pool of COVID-19 patients by a month, while there was a decrease in the overall incidence of unstable angina pectoris and an increase in the number of patients with myocardial infarction. Obviously, people were slow to seek medical attention. This led to an increase in the time from the onset of symptoms to hospital admission, a later initiation of treatment, and an increase in the incidence of thrombosis in COVID-19 survivors.Conclusions. In patients, myocardial infarction predominated in the structure of acute coronary syndrome in patients, which is associated, on the one hand, with an increase in the time from the onset of symptoms to admission to the hospital and an increased risk of thrombosis in persons who have undergone COVID-19.

PROGNOSTIC VALUE ENDOTHELIAL MONOCYTE ACTIVATING POLYPEPTIDE – ІІ IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION IN COMBINATION WITH 2 DIABETES MELLITUS AS A MARKER OF RECURRENT CARDIOVASCULAR EVENTS WITHIN 6 MONTHS OF OBSERVATION

The aim of the research. Analyze the prognostic value of endothelial monocyte activating polypeptide – ІІ as a marker of recurrent cardiovascular events in patients with acute myocardial infarction with type 2 diabetes mellitus within 6 months of follow-up after a coronary event.
 Materials and methods. The research involved 120 patients. All subjects were included in 2 groups: group 1 - patients with acute myocardial infarction (AMI) and type 2 diabetes mellitus (DM), group 2 - patients with AMI (n = 50). The control group included 20 healthy individuals.
 Examination of patients was performed on the basis of the cardiology department for patients with acute myocardial infarction KNP "City Clinical Hospital №27" HMR and the 1st cardiology department of Kharkiv Clinical Hospital by rail №1 branch "Health Center" of the Joint Stock Company "Ukrainian Railways" .
 The participants of the research on the first day of AMI were determined the level of human endothelial monocyte activating polypeptide – ІІ (EMAP-II) in the serum using enzyme-linked immunosorbent assay using a commercial test system manufactured by Bioassay Technology Laboratory (China) in accordance with the enclosed instructions on enzyme-linked immunosorbent assay "Labline-90" (Austria).
 General clinical and instrumental examinations were performed on patients who were part of the 1st, 2nd groups and control groups.
 People who participated in the research were informed about the purpose, objectives, materials and methods of the research by signing an informed consent to participate in it. During the research, measures were taken to ensure the anonymity of each of its participants.
 Statistical processing of survey results was performed using software package StatSoft Inc USA - "Statistica 6.0".
 Research results. The average level of EMAP-II in patients who were in the 1st group was 4.54 ± 0.331 ng / ml, the 2nd - 2.74 ± 0.21 ng / ml, in the control group - 1.1 ± 0.037 ng / ml (p <0.05).
 A recurrent cardiovascular event in the form of recurrent AMI occurred in 19 patients (27.14%) who were part of the 1st group and in 7 patients (14%) who belonged to the 2nd group.
 The research found that the value of EMAR-II> 5.42 μmol / l in patients with AMI in combination with type 2 diabetes and> 2.64 μmol / l in patients with AMI without concomitant type 2 DM is a predictor recurrence of AMI within 6 months of follow-up after a coronary event.
 Based on the results of the research, a multifactor logistic regression model for the prognosis of recurrent AMI in patients with AMI in combination with type 2 DM was developed using EMAR-II for 6 months of follow-up after a coronary event.
 Conclusions. Thus, the level of endothelial monocyte activating polypeptide – ІІ in patients with acute myocardial infarction correlates with the presence of comorbid pathology in the form of type 2 diabetes mellitus, having the highest level in its presence, reflecting endothelial dysfunction that pathogenetically combines these diseases.
 According to the above, to date, the question remains about the prognostic value of endothelial monocyte activating polypeptide – ІІ in acute myocardial infarction in patients with concomitant type 2 diabetes mellitus during the 6-month follow-up period after a cardiovascular event.
 It is advisable to further research the rate of endothelial dysfunction - endothelial monocyte activating polypeptide – ІІ as a predictor of recurrent cardiovascular events in patients with acute myocardial infarction in combination with concomitant type 2 diabetes mellitus within 6 months after the coronary event.

ANNUAL OUTCOMES OF ACUTE MYOCARDIAL INFARCTION COMBINED WITH TYPE 2 DIABETES MELLITUS

Abstract. Relevance. The combination of acute myocardial infarction (AMI) and type 2 diabetes mellitus (DM2) entails early disability and mortality of the population, including among people of working age. The study of long-term outcomes of AMI in patients with type 2 diabetes is necessary to improve secondary prevention programs and reduce cardiovascular mortality. Aim of the study. To evaluate the prognosis of myocardial infarction in combination with type 2 diabetes mellitus for 1 year. Material and methods. He main group consisted of 115 patients with AMI and DM 2 (55 men and 60 women, the average age of patients was 63,2±5,3 years, men 62,3±5,5 years, women 64,3±4,9 years). The comparison group included 116 patients with AMI without concomitant DM 2 (in the comparison group 60 men, 56 women (mean age of patients 63,6±5,4 years, men 62,1±4,2 years, women 65,2±5,7 years). 12 months after the inclusion of patients in the study, an assessment of "endpoints" was carried out. Statistical data analysis was carried out using the modules of the SPSS Statistics 23.0 program. Results. It was revealed that a history of type 2 diabetes increases the risk of cardiovascular death by 7.9 times (OR 7,929, 95% CI 1,758-35,758, p=0,002), 2.1 times (OR 2,138, 95% CI 1,050- 4,353, p= 0,034) the risk of repeated hospitalizations for myocardial ischemia. The annual unfavorable prognosis of AMI is affected by: a history of coronary artery disease (OR 5,653 CI 2,114- 5,114, p≤ 0,001); CHF II-IV FC according to NYHA (OR 4,316 CI 0,916-20,330, p= 0,048); multivessel coronary lesion (OR 4,759 CI 1,018-22,248, p= 0,032); anterior localization of AMI (OR 3,646 CI 1,630-8,156, p=0,01); brachiocephalic artery stenosis (OR 4,278 CI 1,042- 17,559, p=0,031); stage 3-4 chronic kidney disease (OR 6,406 CI 2,589- 15,852, p≤0,01); obesity (OR 2,368 CI 1,086- 5,164, p= 0,029). Conclusion. The ideas about the annual outcomes of AMI in combination with type 2 diabetes in patients treated with modern methods of reperfusion therapy have been expanded.

Chastota porushen rytmu i providnosti ta antyarytmichna efektyvnist upstream-terapii u khvorykh na hostryi infarkt miokarda z komorbidnymy metabolichnym syndromom i endotelialnoiu dysfunktsiieiu sudyn

Context. Cardiac arrhythmias and conduction disorders are the most common reperfusion complications in patients with myocardial infarction (MI) in both acute and late postinfarction periods, which significantly complicates the course of the disease and often leads to an unfavorable prognosis for the early and distant periods. Objective. To evaluate the frequency of arrhythmias and conduction and the antiarrhythmic efficacy of upstream therapy in patients with acute MI with comorbid metabolic syndrome (MS) and endothelial vascular dysfunction. Materials and methods. The experimental group consisted of 42 patients with acute myocardial infarction in combination with MS, who underwent urgent coronary angiography followed by balloon angioplasty and stenting of the infarct-dependent coronary artery, as well as standard drug therapy according to the MOH protocol. Patients in the experimental group also received 5 intravenous infusions of arginine-carnitine mixture (4.2 g and 2.0 g, respectively) in 100 ml of solvent. The nature of the clinical course of MI was compared with that in 38 patients with MI in combination with MS (control group), who did not receive additional treatment and were comparable in age (56.64 ± 0.91 and 54.85 ± 0.76 years, respectively). Results. It was found that patients with MI with comorbid MS on percutaneous coronary intervention most often developed reperfusion syndrome with manifestations of arrhythmias and conduction. Under the influence of standard drug treatment in patients of the control group there was a significant clinical and functional improvement, though sinus tachycardia, ventricular extrasystole of high grades and supraventricular extrasystole remained resistant to treatment. There was also a pronounced endothelial vascular dysfunction, which in the process of standard treatment in patients of the control group did not reach the level of healthy individuals (p-value less than 0.05). Conclusions. In patients with acute MI with comorbid MS, who underwent balloon angioplasty and stenting of the infarct-dependent coronary artery, a pronounced vascular endothelial dysfunction and electrical instability is observed, accompanied by reperfusion arrhythmias and arrhythmias. The use of arginine-carnitine mixture as upstream therapy helped to restore endothelial function and showed a pronounced antiarrhythmic effect, which significantly reduced the incidence and severity of complications of acute MI such as reperfusion arrhythmias.

TO THE QUESTION OF FEATURES OF ATHEROSCLEROTIC CORONARY LESION IN PATIENTS WITH PRIMARY AND REPEATED MYOCARDIAL INFARCTION

To the article TO THE QUESTION ABOUT THE FEATURES OF ATHEROSCLEROTIC CORONARY DISEASE IN PATIENTS WITH PRIMARY AND REPEATED MYOCARDIAL INFARCTION Features of atherosclerotic lesions of the coronary arteries (CA) in patients with myocardial infarction (MI) is the subject of numerous studies. The assessment of the lesion of the coronary stream was carried out according to the results of coronary angiography (CAG) in 50 patients with primary MI (IM primary.) And 30 patients with repeated MI (IM repeated.).It was found that in patients with both IM primary and IM repeated pre-dominantly multivessel lesions with localization of stenoses in the branches of both coronary arteries. Differences in the localization of coronary artery stenoses are more pronounced in men. The presence of diabetes mellitus (DM) largely neutralized the differences in IMprimary and IM repeated. The most pronounced changes in both coronary arteries and their occlusion were noted with a combination of MI with diabetes mellitus and arterial hypertension (AH).

Прогностичне значення асиметричного диметиларгініну щодо розвитку ускладнень в госпітальному періоді гострого інфаркту міокарда з елевацією сегмента ST у хворих на цукровий діабет 2 типу

The purpose of the study was to determine the prognostic value of asymmetric dimethylarginine in the development of complications in the hospital period of acute myocardial infarction with ST segment elevation in patients with type 2 diabetes mellitus. Material and methods. The study design consisted of 120 patients. They were divided into 2 groups. Group 1 consisted of patients with acute myocardial infarction and concomitant type 2 diabetes mellitus (n=70), group 2 included patients with acute myocardial infarction without concomitant type 2 diabetes mellitus (n=50). Patients of both groups matched on age and sex (60 men (50%) and 60 women (50%); their average age was 66.35±0.91 years, р<0.05). The control group consisted of 20 almost healthy people, among them 12 women (60%) and 8 men (40%) (average age was 45.17±2.88 years). The patients were divided into 3 tertiles according to the level of аsymmetric dimethylarginine (ADMA): ADMA ⩽1.45 μmol/l – 1st tertile; 1.45 μmol/l< ADMA ⩽1.98 μmol/l - 2nd tertile; ADMA >1.98 μmol/l - 3rd tertile. Results and discussion. The obtained results showed that the level of ADMA in patients with acute myocardial infarction in combination with type 2 diabetes was by 2.57 times (p <0.05) higher compared to patients without concomitant type 2 diabetes. In particular, the ADMA level was at 1.57±0.11 μmol/l in patients with acute myocardial infarction in combination with concomitant type 2 diabetes, while in patients with acute myocardial infarction without concomitant type 2 diabetes it was at 0.61±0.06 μmol/l. The ADMA value at >1.13 μmol/l in patients with acute myocardial infarction in combination with type 2 diabetes is a predictor of acute left ventricular failure. The ADMA tertiles were used to determine the acute myocardial infarction severity class based on the Killip scale. It is noteworthy that severer classes of acute myocardial infarction on the Killip scale were observed in a patient whose ADMA value belonged to the 3rd tertile group. We determined the ADMA value of A >2.08 μmol/l in patients with acute myocardial infarction in combination with type 2 diabetes, which was a predictor of a life-threatening condition of cardiogenic shock. Conclusion. The asymmetric dimethylarginine exhibits the following predictor properties: in relation to the development of acute left ventricular failure – at >1.13 μmol/l; in relation to the development of cardiogenic shock - at >2.08 μmol/l during the hospital period of acute myocardial infarction with ST-segment elevation in patients with concomitant type 2 diabetes. It is advisable to continue studying the marker of endothelial dysfunction (asymmetric dimethylarginine) as a predictor of adverse myocardial infarction in combination with concomitant type 2 diabetes

Маркери ендотеліальної дисфункції як предиктори ускладненого перебігу гострого інфаркту міокарда у поєднанні з цукровим діабетом 2 типу

Today, the endothelium is considered to be a multifunctional organ and a non-specific marker in the pathogenesis of diseases of the cardiovascular system. The course of diseases of the cardiovascular system depends on the presence of comorbid pathology, where type 2 diabetes is one of the possible representations of such pathology. The purpose of the study was to determine the diagnostic role of marker of endothelial dysfunction in patients with acute myocardial infarction with concomitant type 2 diabetes mellitus with regard to the clinical course of comorbid conditions. Material and methods. The study design consisted of 120 patients. They were divided into 2 groups: Group 1 consisted of patients with acute myocardial infarction and concomitant type 2 diabetes (n=69), Group 2 consisted of patients with acute myocardial infarction without concomitant type 2 diabetes (n=51). Patients of both groups matched on age and sex (60 men (50%) and 60 women (50%); their average age was 66.35±0.91 years, р<0,05). The control group consisted of 20 almost healthy people, among them 12 women (60%) and 8 men (40%) (average age was equal to 45.17±2.88 years). Examination of patients was conducted on the basis of Municipal Non-profit Enterprise "City Clinical Hospital No. 27" of Kharkiv City Council in the department of cardiology for patients with acute myocardial infarction. Diagnoses were determined according to the current criteria. All patients enrolled in the study signed a voluntary informed consent to participate in it. All patients underwent general clinical and instrumental examinations. The level of endothelial monocyte-activating polypeptide II in participants of the study was determined on the first day of acute myocardial infarction by using a commercial test system "Human Endothelial monocyte activating polepeptide II ELISA KIT". Results and discussion. According to the results of the study, in patients with acute myocardial infarction in combination with type 2 diabetes the levels of endothelial monocyte-activating polypeptide II was higher than in patients without concomitant type 2 diabetes by 1.65 times (p <0.05). The course of the study revealed the level of endothelial monocyte-activating polypeptide II, which was marked by high risk of cardiogenic shock and acute left ventricular failure. Having analyzed the parameter of endothelial dysfunction in terms of mortality, the researchers made the following conclusion: the endothelial monocyte-activating polypeptide II values greater than 3.44 ng/ml were the predictor of cardiovascular death probability during 6 months. Conclusion. The results of analysis of endothelial function made with use of the marker of endothelial monocyte-activating polypeptide II in patients with acute myocardial infarction with concomitant type 2 diabetes showed that such indicator can be deemed as predictor in complicated comorbid conditions

Ремоделирование сердца и сосудов, особенности тревожно-депрессивного статуса у пациентов пожилого возраста с инфарктом миокарда в сочетании с фибрилляцией предсердий

Ремоделирование сердца и сосудов, особенности тревожно-депрессивного статуса у пациентов пожилого возраста с инфарктом миокарда в сочетании с фибрилляцией предсердий

Myocardial infarction, prothrombotic genotypes, and venous thrombosis risk: The Tromsø Study

BackgroundThe risk of venous thromboembolism (VTE) is increased after a myocardial infarction (MI). Some prothrombotic genotypes associated with VTE have also been associated with risk of MI. Whether prothrombotic single‐nucleotide polymorphisms (SNPs) further increase the risk of VTE in MI patients is scarcely investigated. AimTo study the combined effect of MI and prothrombotic SNPs on the risk of VTE. MethodsCases with incident VTE (n = 641) and a randomly sampled subcohort weighted for age (n = 1761) were identified from the 4 to 6 surveys of the Tromsø Study (1994‐2012). DNA was genotyped for rs8176719 (ABO), rs6025 (F5), rs1799963 (F2), rs2066865 (FGG), and rs2036914 (F11). Hazard ratios (HRs) for VTE with 95% confidence intervals (CIs) were estimated by categories of risk alleles and MI status. ResultsPatients with MI had a 1.4‐fold increased risk of VTE, and adjustments for the 5 SNPs, either alone or in combination, did not affect this relationship (adjusted HR, 1.52; 95% CI, 1.12‐2.07). In subjects without MI, an increased risk of VTE was observed for each of the individual SNPs (≥1 vs. 0 risk alleles), and the risk increased linearly with increasing number of risk alleles in the 5‐SNP score. The combination of MI and prothrombotic genotypes, either as individual SNPs or in the 5‐SNP score, did not result in an excess risk of VTE. ConclusionThe relationship between MI and VTE was not explained by these 5 prothrombotic genotypes. Prothrombotic genotypes did not yield an excess risk of VTE in patients with MI.

The choice of treatment for myocardial infarction based on individual cardiovascular risk and symptoms of coronary heart disease

According to the data of hospital mortality of patients of the Shymkent cardiological center, the most frequent case of the indicator at the stationary stage in patients with myocardial infarction occurs when the class of acute heart failure according to Killip II-IV is determined in patients, the level of blood glucose is more than 8.0 mmol/l, the level of blood creatinine is more than 123.8 mmol/l and the absence of arterial hypertension when entering the clinic. The main causes of mortality among such elderly and senile patients were Killip class II-IV, blood glucose level of more than 7.30 mmol/l, blood creatinine level of more than 141.4 mmol/l, belonging to the female sex and the absence of hypertension on admission. Implementation of coronary artery stenting taking into account risk factors affecting mortality in hospital in patients with acute myocardial infarction leads to a decrease in hospital mortality and long-term mortality, compared with conservative treatment. Implantation of drug-coated stents and uncoated metal stents equally reduced the mortality rate of myocardial infarction in patients. In elderly and senile patients with myocardial infarction in combination with diabetes mellitus after coronary artery stenting there is a deterioration in long-term survival. Long-term survival at the end of 2010-2018 was 83.67%, while in patients with concomitant diabetes mellitus - only 40.03%, p=0.045 (Log-rank test). Thrombolytic therapy did not improve survival in hospital and long-term patients in the elderly and senile age group. Implementation of thrombolysis in elderly and senile patients hospitalized up to 1.5 hours from the onset of symptoms of myocardial infarct, leads to an unreliable reduction in mortality (p=0.085), hospitalized later than 1.5 hours - there is an increase in mortality compared with patients without thrombolysis(p=0.848). Coronary stenting in acute myocardial infarction reduced mortality in elderly and senile patients regardless of the time between the onset of symptoms of myocardial infarction and hospitalization (p=0.486 and p=0.004).

In Vitro Effects of the Novel Platelet αIIbβ3 Receptor Antagonist RUC-4 on the Verifynow Assays: Potential for Point-of-Care Monitoring of RUC-4 Therapy

Introduction: RUC-4 is a novel platelet integrin αIIbβ3 antagonist specifically designed for first point-of-medical contact (ambulance or ER) treatment of patients with ST segment elevation myocardial infarction in combination with aspirin. Ongoing Phase 1 studies indicate that RUC-4 at a dose of 0.075 mg/kg administered subcutaneously can inhibit ADP-induced platelet aggregation by ~80% within 15 minutes, with a return toward baseline within 60-90 minutes. It may be advantageous to monitor the antiplatelet effects of RUC-4 on admission to the hospital, but optical aggregometry (OA) takes too long to guide immediate therapeutic decisions. The automated VerifyNow (VN) assays provide rapid point-of-care assessment of the effect of antiplatelet agents. The VN IIb/IIIa assay uses a thrombin receptor activating peptide (isoTRAP) to activate the platelets and the VN Aspirin assay uses arachidonic acid, whereas the PRU (P2Y12) assay uses isoTRAP in one channel and a mixture of ADP and PGE1 in another. We recently reported that: 1. Aspirin does not affect the IC50 for RUC-4 when measured by OA of platelet-rich plasma (PRP) in response to ADP, and 2. The IC50 is lower in PRP that is prepared from blood anticoagulated with citrate rather than PPACK, consistent with RUC-4's mechanism of action in displacing the Mg2+ ion from the MIDAS domain (Vootukuri et al., J Clin Transl Sci; in press). We now have explored the sensitivity of the VN assays to RUC-4 and the effects of aspirin and different anticoagulants. Methods: Whole blood anticoagulated with either sodium citrate (0.32%) or PPACK (100 µM) from healthy volunteers who were either taking or not taking daily aspirin was treated in vitro with RUC-4 to achieve final whole blood concentrations between 30 and 900 nM. Blood was incubated for 10 minutes at room temperature and then tested with either the IIb/IIIa or PRU cartridge. Results: Whole blood samples were obtained from 13 healthy volunteers who provided consent, of whom 7 were taking aspirin. The antiplatelet effect of aspirin in the latter 7 participants was confirmed with the VN Aspirin assay. 1. PPACK vs citrate anticoagulation in blood from individuals who were not treated with aspirin. The percent inhibition values produced by different concentrations of RUC-4 in whole blood anticoagulated with either PPACK or citrate and activated with isoTRAP were highly correlated (R2=0.95; p<0.01) despite differences in absolute values (IC50s of 141 ± 5 vs 88 ± 7 nM, respectively, p=0.01; n=6). The comparable values using ADP+PGE1 as the activator were also highly correlated (R2=0.95; p<0.01) despite differences in absolute values (IC50s of 128 ± 5 vs 69 ± 8 nM, p=0.01; n=6). Based on these results, we selected citrate-anticoagulated blood for additional studies because vacuum blood collection tubes containing citrate, but not PPACK, are available commercially. 2. Effect of RUC-4 on VN assays: a) Impact of aspirin on results in the PRU cartridge. The IC50s in the isoTRAP channel were similar using blood from individuals who were not taking aspirin (88 ± 7 nM) or taking aspirin (97 ± 20 nM; p=0.35; n=9). Similar results were obtained using the ADP+ PGE1 channel (69 ± 8 vs 70 ± 8 nM; p=0.84; n=9). b) Comparison of the 2 different isoTRAP channels with blood from people on aspirin. RUC-4 showed similar dose-responses in both isoTRAP channels, with an IC50 of 79 ± 26 nM in the IIb/IIIa cartridge vs 97 ± 20 nM in the PRU cartridge (p=0.12; n=5). c) Comparison of the isoTRAP vs ADP+PGE1 channel using blood from people on aspirin. The ADP+PGE1 channel was more sensitive to the lower concentrations of RUC-4 than the isoTRAP channel, showing, for example, ~40% inhibition at 30 nM compared to ~20%, respectively (Figure; p<0.02 based on comparison of IC50s ). Discussion: We conclude that RUC-4 produces dose-dependent inhibition of the VN isoTRAP channels in both the IIb/IIIa and PRU cartridges, as well as the ADP+PGE1 channel in the PRU cartridge. The PRU cartridge ADP+PGE1 channel is more sensitive than the isoTRAP channel to low concentrations of RUC-4. Since P2Y12 antagonists inhibit the ADP+PGE1 channel, but not the isoTRAP channels, the effect of RUC-4 on patients who are not treated with a P2Y12 antagonist may be monitored with the PRU ADP+PGE1 channel or the isoTRAP channel in either the PRU or IIb/IIIa cartridge. The RUC-4 effects in patients treated with a P2Y12 antagonist may be monitored with the isoTRAP channel in either cartridge. Figure Disclosures Coller: Accumetrics/Instrumentation Laboratory: Patents & Royalties: VerifyNow assay; Scholar Rock: Consultancy, Equity Ownership; CeleCor: Consultancy, Equity Ownership, Research Funding; Centocor/Janssen: Patents & Royalties: abxicimab.