Complication Of Myocardial Infarction Research Articles

Cardiac arrest and post-discharge mortality in patients with myocardial infarction: A large-scale nationwide registry analysis

BackgroundCardiac arrest is a serious complication of acute myocardial infarction. The implementation of contemporary approaches to acute myocardial infarction management, including urgent revascularization procedures, has led to significant improvements in short-term outcomes. However, the extent of post-discharge mortality in patients experiencing cardiac arrest during acute myocardial infarction remains uncertain. This study aimed to determine the post-discharge outcomes of patients with cardiac arrest. MethodsWe analysed data from the J-PCI OUTCOME registry, a Japanese prospectively planed, observational, multicentre, national registry of percutaneous coronary intervention involving consecutive patients from 172 institutions who underwent percutaneous coronary intervention and were discharged. Patients who underwent percutaneous coronary intervention for acute myocardial infarction between January 2017 and December 2018 and survived for 30 days were included. Mortality in patients with and without cardiac arrest from 30 days to 1 year after percutaneous coronary intervention for acute myocardial infarction was compared. ResultsOf the 26,909 patients who survived for 30 days after percutaneous coronary intervention for acute myocardial infarction, 1,567 (5.8%) had cardiac arrest at the onset of acute myocardial infarction. Patients with cardiac arrest were younger and more likely to be males than patients without cardiac arrest. The 1-year all-cause mortality was significantly higher in patients with cardiac arrest than in those without (11.9% vs. 2.8%, p < 0.001) for all age groups. Multivariable analysis showed that cardiac arrest was an independent predictor of all-cause long-term mortality (hazard ratio: 2.94; 95% confidence interval: 2.29–3.76). ConclusionsPatients with acute myocardial infarction and concomitant cardiac arrest have a worse prognosis for up to 1 year after percutaneous coronary intervention than patients without cardiac arrest.

Kenaf Seed Cysteine Protease (KSCP) Inhibits the Intrinsic Pathway of the Blood Coagulation Cascade and Platelet Aggregation.

Thrombosis is the key event that obstructs the flow of blood throughout the circulatory system, leading to stroke, myocardial infarction and severe cardiovascular complications. Currently, available antithrombotic drugs trigger several life-threatening side effects. Antithrombotic agents from natural sources devoid of adverse effects are grabbing high attention. In our previous study, we reported the antioxidant, anticoagulant and antiplatelet properties of kenaf seed protein extract. Therefore, in the current study, purification and characterization of cysteine protease from kenaf seed protein extract responsible for potential antithrombotic activity was undertaken. Purification of KSCP (Kenaf Seed Cysteine Protease) was carried out using gel permeation and ion exchange column chromatography. The purity of the enzyme was evaluated by SDS PAGE (Sodium Dodecyl-Sulfate Polyacrylamide Gel Electrophoresis). RP-HPLC (Reverse Phase High-Performance Liquid Chromatography), MALDI-TOF (Matrix-Assisted Laser Desorption Ionization Time-Of-Flight) and CD (Circular Dichroism techniques) were employed for its characterization. Proteolytic, fibrinolytic and kinetic study was done using spectroscopy. Plasma recalcification time, Prothrombin Time (PT), Thrombin clotting time (TCT), Activated Partial Thromboplastin Time (APTT), bleeding time and platelet aggregation studies were carried out for antithrombotic activity of KSCP. A single sharp band of KSCP was observed under both reduced and non-reduced conditions, having a molecular mass of 24.1667kDa. KSCP was found to contain 30.3% helix turns and 69.7% random coils without a beta-pleated sheet. KSCP digested casein and fibrin, and its activity was inhibited by iodoacetic acid (IAA). KSCP was optimally active at pH 6.0 at the temperature of 40°C. KSCP exhibited anticoagulant properties by interfering in the intrinsic pathway of the blood coagulation cascade. Furthermore, KSCP dissolved both whole blood and plasma clots and platelet aggregation. KSCP purified from kenaf seed extract showed antithrombotic potential. Hence, it could be a better candidate for the management of thrombotic complications.

Sex differences in hospitalization for ventricular arrhythmia after a first myocardial infarction in patients without indication for implantable cardioverter-defibrillator implantation

Abstract Background Ventricular arrhythmias (VAs) represent a serious complication of myocardial infarction (MI). Incidence rate of VAs and sudden cardiac death is commonly reported to be lower in women than in men after MI (1,2). While data regarding SCD and VAs after MI in patients with implantable cardioverter defibrillator (ICD) are well described, data regarding the incidence of readmissions for VA in patients without ICD implantation criteria after a first MI are scarce, as well as the impact of sex on their occurrence. Objective This study aims to investigate the impact of sex on VA occurrences in post-MI patients without ICD implantation criteria. Methods This study was conducted using the French national health data system using electronic codes for procedures (CCAM) and hospitalizations data (PMSI). The study population consisted of patients discharged after a first MI and without criteria for ICD implantation. Results Between January 2014 and January 2015, 137,736 patients were hospitalized in France with a diagnosis of first MI and were followed using CCAM and PMSI codes. Among the 112,465 alive at discharge, 6838 patients were excluded due to criteria for the implantation of an ICD for primary or secondary prevention. Of the remaining 105,629 patients, 1600 (1.51%) were rehospitalized for VA with a median delay of 505 days (IQR 110-1208). Men had almost twice the risk of VA than women after initial discharge for MI (OR 1.88, 95% CI 1.65-2.14; p&amp;lt;0.0001). Among the 72,103 men included, 1240 (1.72%) were rehospitalized for VA with a median delay of 514 days (IQR 107-1212). Factors independently associated with VA in men were previous atrial fibrillation (OR 1.91, 95% CI 1.66 - 2.21, p&amp;lt;0.0001), previous vascular disease (OR 1.28, 95% CI 1.10 - 1.50, p=0.002), absence of coronary angioplasty (OR 1.28, 95% CI 1.10 - 1.50, p=0.002), previous diabetes (OR 1.19, 95% CI 1.04 - 1.36, p=0.012), previous hypertension (OR 1.19, 95% CI 1.05 - 1.34, p=0.007), previous or in-hospital congestive heart failure (OR 1.47, 95% CI 1.03-2.08, p=0.032 and OR 1.65, 95% CI 1.32-2.07, p&amp;lt;0.0001), and age (patients between 60 and 79 yo being at the higher risk of VA compared to &amp;lt;60 and &amp;gt;80yo patients, p=0.002 and &amp;lt;0.0001 respectively). Among the 33,526 women included, 360 (1.07%) were rehospitalized for VA with a median (IQR) delay of 461 days (116-1159) after MI. Factors independently associated with VA were previous atrial fibrillation (OR 1.68, 95% CI 1.30 - 2.18, p&amp;lt;0.0001), previous vascular disease (OR 1.37, 95% CI 1.01 - 1.84, p=0.041), and age (patients between 60 and 79 yo being at the higher risk of VA compared to &amp;gt;80yo patients, p=0.001). Conclusion The risk of readmission for VAs after a first MI is significantly lower in women compared to men, with distinct predictive factors. These findings suggest that sex-specific VA risk stratification and management strategies may be warranted after an initial MI.Sexe influence on post-MI VAs occurence

In-hospital outcomes of anterior versus non-anterior st elevation myocardial infarction complicated with complete atrioventricular block

Abstract Background Complete atrioventricular block (CAVB) is an infrequent complication of acute ST-elevation myocardial infarction (STEMI), and information on its outcomes is scarce. We aimed to address the characteristics and in-hospital outcomes of patients with anterior versus non-anterior STEMI complicated with CAVB in a contemporary, nationwide, all-comer registry, in the U.S. Methods Using the National Inpatient Sample (NIS) database, we identified patients who were hospitalized with STEMI, complicated with CAVB between 2016- 2019. Patients with any cardiac implantable electronic device (CIED) in-situ were excluded. Baseline characteristics, in-hospital procedures and outcomes including time to temporary or permanent pacemaker (PPM)/implantable cardioverter defibrillator (ICD) implantation, length of stay and mortality were collected. Results A total of 17470 patients, were hospitalized with a primary diagnosis of STEMI and concomitant diagnosis of CAVB, 2755(15.8%) with Anterior and 14715(84.2%) with non-anterior STEMI. Non-anterior STEMI patients included more women, had higher prevalence of hypertension, dyslipidemia, smoking history and chronic pulmonary disease, while anterior STEMI patients had higher prevalence of chronic kidney disease and ischemic cardiomyopathy. Anterior STEMI patient had significantly higher rate of in hospital death [955 (35%) vs 2220 (15%), p&amp;lt;0.001], CPR, VT/VF, cardiac arrest, acute heart failure, respiratory failure, mechanical ventilation &amp;gt;96 hours and acute kidney injury. In both groups 40% received temporary pacemaker, but mean time to implantation was longer in anterior STEMI patients [1.1±3.3 vs 0.3±1.2 days, p&amp;lt;0.001]. Rate of any permanent CIED implantation was also significantly higher in the anterior STEMI patients with longer time to PPM implantation, [3.3±3.5 vs 2.8±2.8 days, p&amp;lt;0.001]. Use of mechanical circulatory support devices was significantly higher in anterior STEMI patients. Conclusion In STEMI patients complicated with CAVB, in-hospital outcomes of anterior STEMI were worse comparing to non-anterior STEMI, with significantly higher rates of in-hospital death, in-hospital complications and CIED implantations.

#88 Establishment of machine learning-based risk prediction model for acute kidney injury after acute myocardial infarction

Abstract Background and Aims Acute kidney injury (AKI) is a common complication of acute myocardial infarction (AMI) with high morbidity, mortality and lack of effective treatment, so prevention is particularly important. This study intends to use machine learning to establish a precise prediction model for AKI after AMI. Method AMI patients were consecutively collected from July 2011 to December 2016 in Beijing Anzhen Hospital, Capital Medical University. First, SelectFromModel and Lasso regression model were used to select features. A predictive model (Model A) was then created using a multivariate logistic regression model in the training set and validated in the test set. At the same time, the prediction model (Model B) is created by machine learning algorithm in the training set. The process of model construction and evaluation is implemented by Python. The algorithm includes MLP, SVM, KNN and SimpleRNN, from which the model with the largest area under the ROC curve (Model B) is selected and verified in the test set. DeLong method was used to compare the model B with model A to compare whether the area under the ROC curve was better than multivariate logistic regression model and select the best model. Results A total of 6014 AMI patients were included in this study, 70% were randomly selected as the training set, and the remaining 30% were used as the test set. Males comprised 80.5% of the total population with a mean age of 58.4 ± 11.7 years. The incidence of AKI in the overall population was 11.2% (674/6014) (Fig. 1). A total of 12 important characteristics were included in the model, including the number of myocardial infarctions, ST-segment elevation myocardial infarction, ventricular tachycardia, third-degree atrioventricular block, decompensated heart failure at admission, admission serum creatinine value, admission urea nitrogen value, admission CK-MB peak value, whether diuretics were used, maximum daily dose of diuretics, days of diuretic use, and whether statins were used. Logistic regression analysis resulted in an area under the ROC curve of 0.80 (95% CI, 0.76-0.84) in the test set (Fig. 2). The models were constructed by MLP, SVM, KNN and SimpleRNN algorithms, respectively, and validated in the test set to calculate the area under the ROC curve of each model in the test set (Fig. 3), and finally the model constructed by MLP algorithm was selected as model B, and its area under the ROC curve was 0.82 (95% CI, 0.78–0.85). The area under the ROC curve of the two models was compared at p=0.363, but the machine learning algorithm constructed models with higher absolute values (Fig. 4). Conclusion The prediction model of AKI risk after AMI constructed based on machine learning is similar to that constructed by logistic regression analysis in terms of prediction ability, but the model constructed by machine learning algorithm has a better trend, indicating that the machine learning algorithm may improve the prediction ability of prediction model and provide an effective tool for early identification of these high-risk patients in clinical practice, early preventive measures, and reduction of morbidity.

ANOTHER BRICK IN THE WALL: A STRANGE CASE OF A BIG HUG

Abstract Background Left ventricular pseudoaneurysm (LVP) is a rare complication of myocardial infarction MI (less than 0,1% of all patients with MI) and develops when cardiac rupture is contained by adherent pericardium or scar tissue, thus contains no endocardium or myocardium, unlike a true left ventricular aneurysm (LVA). Clinical Case A 41–year–old man without remote cardiac history was admitted to the Emergency Department with chest pain that had started 7 days before after a referred ‘big hug’ from a friend. Results of the physical examination were unremarkable. Electrocardiogram: T waves negative in the inferior and lateral leads. Blood exams: normal troponins, C–reactive protein and D–dimer values. Chest computed tomography: no sign of pulmonary embolism. Transthoracic echocardiography (TE): ejection fraction 45%, voluminous aneurismal chamber communicating with the infero–posterior wall of the LV, stratified thrombus and mild mitral valve regurgitation. Coronary angiography: three vessel coronary artery disease. The last diagnosis was established by cardiac magnetic resonance imaging (MRI) which revealed a voluminous pseudoaneurysm of the inferior wall (56 mm x 50 mm with a 51 mm neck) and transmural late gadolinium enhancement (LGE) of the wall adjacent to the pseudoaneurysm with fibroadipose replacement and calcific metaplasia. The patient was transferred to the Cardiac Surgery Department. Intraoperatively the LVP was resected and the defect of the LV was repaired with a patch in bovine pericardium. In addition, coronary artery bypass grafting and mitral valve repair were performed. Discussion LVP develops when pericardium, in combination with thrombus and inflammation, surrounds a cardiac rupture. Inferior and posterolateral myocardial infarction (MI), due to occlusion of the Circumflex artery, are responsible for 82% of the LVP. LVP can be also found in the apical region due to anterior MI. In conclusion symptoms, signs, electrocardiographic abnormalities and radiographic findings seen in patients with LVP can be indistinguishable from those in patients with coronary disease alone. TE is the first non–invasive method for early diagnosis of LVA, but MRI is the gold standard for differential diagnosis between true aneurysm vs pseudoaneurysm. LGE of the pericardium is a new specific marker of pseudoaneurysm as opposed to true aneurysm.

A Case of Left Ventricular Pseudoaneurysm as a Complication of Late-Presenting ST-Segment Elevation Myocardial Infarction

A Case of Left Ventricular Pseudoaneurysm as a Complication of Late-Presenting ST-Segment Elevation Myocardial Infarction

Incidence of left ventricle thrombus formation in patients with STEMI in the current era of antithrombotic treatment

Abstract Funding Acknowledgements None. Introduction Left ventricular (LV) thrombus formation is a serious complication of acute ST-segment elevation myocardial infarction (STEMI) which may result in ischemic stroke and systemic thromboembolism. There is limited evidence on the incidence and impact of LV thrombus in STEMI patients in the current era of antithrombotic treatment. Purpose To evaluate the incidence of LV thrombus formation in STEMI patients and to assess clinical predictor factors of LV thrombus formation leading to in-hospital major cardiac events (MACCE). Methods We prospective collected data from 504 STEMI patients treated with primary percutaneous intervention (PCI) in our large volume university hospital from April 2019 to September 2019. All patients underwent echocardiography examination at presentation and at hospital discharge. Results Mean age of the patients was 66.2 years and 78.8% were male. The incidence of LV thrombus formation was 5% in overall cohort and 9.4% in anterior STEMI. Among patients with LV thrombus, the majority had anterior STEMI (96% vs 48.4%; p&amp;lt;0.001), lower LV ejection fraction (LVEF)(35% vs 43%; P&amp;lt;0.001), more increased LV dimension /volume (36%vs7.3%; p&amp;lt;0.001), more apical aneurism/dyskinesia presence (36% vs 9%; p&amp;lt;0.001), longer ischemia time (25 hours vs 14 hours; p&amp;lt;0.002), more increased TPI values (p-0.22) and underwent less coronary angiography (p&amp;lt;0.02) and primary PCI (P=0.021). Increased LV dimension/volume was associated with 3.35 times higher risk of having LV thrombus (p=0.023). Also anterior STEMI was associated with 14 times higher risk of having LV thrombus=0.012. Patients with LV thrombus had a numerically higher incidence of in-hospital MACCE events (20% vs 13.5%; p=0.36). Conclusion The incidence of LV thrombus formation in STEMI still remain high regardless of primary PCI treatment and current antithrombotic treatment, and is higher in patients with anterior STEMI, lower LVEF, adverse ventricular remodeling, apical aneurism/dyskinesia presence, late hospital presentation and longer ischemia time. The presence of LV thrombus was independently associated with in-hospital MACCE events.

A-1 | Effect of Hospital Teaching Status on the Myocardial Infarction Complications

A-1 | Effect of Hospital Teaching Status on the Myocardial Infarction Complications

Impact of Exercise Intensity on Cardiovascular Disease in a Rat Model of Hypertension: A Systematic Review and Meta-Analysis

Objective: Hypertension increases the risk of morbidity and mortality including stroke, myocardial infarction, and other serious complications. To prevent these events, regular exercise has been recommended as a nonpharmacological intervention for hypertensive patients, but the optimal exercise intensity, in response to the variation of the condition, remains a subject of investigation. Therefore, our study investigates the impact of exercise training on the disease progression in spontaneously hypertensive rats (SHR), a well-established rat model of hypertension. Specifically, we aim to perform a meta-analysis that measures the effects of low, moderate, and high-intensity exercise on at least one of the following cardiovascular variables: systolic blood pressure (SBP), mean arterial pressure (MAP), and resting heart rate (RHR). Hypothesis: We hypothesize that the meta-analysis findings will determine that treadmill training at low and moderate intensities will significantly improve SBP, MAP, and RHR in SHRs. We also anticipate that we will find that high intensity will produce less benefit due to its stress-inducing effects. Methods: We performed a meta-analysis adhering to the PRISMA guidelines. A systematic search for scientific studies was conducted in the CINAHL, EMBASE, SPORTDiscus, and SciFinder databases using the following key words: “spontaneously hypertensive rat,” and “exercise” yielded 900+ research articles. Subsequent selection of articles included studies that comprised of only treadmill running, more than 45 minutes of exercise per day during the training period, at least five days of training per week, and a duration of at least four weeks. Finally, eligible studies included at least one of the three cardiovascular parameters. Each study was categorized into low, moderate, or high intensity based on either treadmill speed or VO2 max, or both. Quantitative SBP, MAP, and RHR data were extracted from the included studies. Results: A total of 90 studies are included in this qualitative analysis, 9.6% of which include female rats. Preliminary data analysis evaluating means for each intensity determined that all levels of intensity significantly benefited the measured cardiovascular parameters. However, the degree of benefit was greater in the low and moderate intensities as compared to the high intensity. Conclusion: All levels of intensity exercise had a beneficial response to lowering cardiovascular parameters in SHR, however, low and moderate levels of intensity produced the greatest effects. The failure of high-intensity exercise to improve cardiovascular outcomes may suggest a role played by oxidative stress and merits further investigation. Further subgroup analysis based on sex, age, and duration of exercise will be conducted to determine if these confounding variables play role in modulating these benefits. This research was supported by the MJ Murdock charitable trust. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Association of monocyte to HDL cholesterol ratio and a composite risk score with left ventricular aneurysm formation in patients with acute ST-segment elevation myocardial infarction.

Left ventricular aneurysm (LVA) is an important complication of acute myocardial infarction. This study aimed to investigate the potential predictive value of the monocyte count to high-density lipoprotein cholesterol ratio (MHR) and a composite risk score in determining the formation of LVA in patients with acute ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention. We recruited 1005 consecutive patients with STEMI. Multivariable logistic regression analysis was conducted identify the independent risk factors for LVA formation. Predictive power of MHR and composite risk score for LVA formation were assessed using receiver operating characteristic curve analysis. The MHR was significantly higher among patients with LVA compared to those without LVA [6.6 (3.8-10.8) vs. 4.6 (3.3-6.3), P < 0.001]. Univariable logistic regression analysis revealed that MHR (OR = 3.866, 95% CI = 2.677-5.582, P < 0.001) was associated with the risk of LVA formation. The predictive value of MHR remained significant even after multivariate logistic regression analysis [odds ratio (OR) = 4.801, 95% confidence interval (CI) = 2.672-8.629, P < 0.001]. The discriminant power of MHR for LVA is 0.712, which is superior to both monocyte (C statistic = 0.553) and high-density lipoprotein cholesterol (C statistic = 0.654). The composite risk score including MHR, gender, LVEF, hemoglobin, lymphocyte and left anterior descending artery as the culprit vessel could significantly increase the predictive ability (C statistic = 0.920). A higher MHR could effectively identify individuals at high risk of LVA formation, especially when combined with gender, LVEF, hemoglobin, lymphocyte and left anterior descending artery as the culprit vessel.

Leuko-glycemic index as a predictor of complications in myocardial infarction: RECUIMA registry

Leuko-glycemic index as a predictor of complications in myocardial infarction: RECUIMA registry

Ventricular apical wall rupture and ventricular aneurysm formation concurrent with ventricular septal dissection and rupture due to ST-segment elevation myocardial infarction: a case report

The most common mechanical complications of acute myocardial infarction include free-wall rupture, ventricular septal rupture (VSR), papillary muscle rupture and pseudoaneurysm. It is rare for a patient to experience more than one mechanical complication simultaneously. Here, we present a case of ST-segment elevation myocardial infarction (STEMI) complicated with three mechanical complications, including ventricular apical wall rupture, ventricular aneurysm formation and ventricular septal dissection (VSD) with VSR. Cardiac auscultation revealed rhythmic S1 and S2 with a grade 3 holosystolic murmur at the left sternal border. Electrocardiogram indicated anterior ventricular STEMI. Serological tests showed a significant elevated troponin I. Bedside echocardiography revealed ventricular apical wall rupture, apical left ventricle aneurysm and VSD with VSR near the apex. This case demonstrates that several rare mechanical complications can occur simultaneously secondary to STEMI and highlights the importance of bedside echocardiography in the early diagnosis of mechanical complications.

Search for predictors of complications of acute coronary syndrome with ST segment elevation – protocol of a prospective open cohort study PROMETHEUS

During the first year after myocardial infarction, coronary artery restenosis, fatal arrhythmias, hospitalization for heart failure or cardiac death may occur. It is necessary to search for biomarkers to predict complications of myocardial infarction. As such predictors, it seems promising to introduce the ABCDE-SE echocardiographic protocol, as well as study the metabolism of vitamin D and proteins of the fibrinolysis system. Cardiospecific microRNAs-21, -29, -143 can be used as pathogenetic factors in the development of complications; it is proposed to study the ongoing pharmacotherapy and patients’ compliance with it as controllable factors.Aim: To search for predictors of complications of myocardial infarction based on the assessment of echocardiographic parameters, vitamin D metabolism, components of the fibrinolysis system and cardiac-specific microRNAs.Material and Methods. The PROMETHEUS study is designed as a prospective, open-label, non-randomized cohort study. It is planned to include 300 patients newly admitted to the vascular center with a preliminary diagnosis of ST-segment elevation ACS. All patients will have their vitamin D concentrations determined; genetic variants of polymorphisms of the vitamin D receptor gene and vitamin D binding protein; concentrations of urokinase and soluble urokinase receptor; microRNA-21, -29, -143, as well as echocardiography using the ABCDE-SE protocol at 1, 3, 6 and 12 months from inclusion. Pharmacotherapy will be assessed at all stages.Expected results: Based on the results of the study, a comprehensive algorithm for optimizing the prediction and prevention of complications of myocardial infarction will be developed and introduced into practical healthcare.

Carotid endarterectomy and transcarotid artery revascularization can be performed with acceptable morbidity and mortality in patients with chronic kidney disease

ObjectivePatients with chronic kidney disease (CKD) are considered a high-risk population, and the optimal approach to the treatment of carotid disease remains unclear. Thus, we compared outcomes following carotid revascularization for patients with CKD by operative approach of carotid endarterectomy (CEA), transfemoral carotid artery stenting (TFCAS), and transcarotid arterial revascularization (TCAR). MethodsThe Vascular Quality Initiative was analyzed for patients undergoing carotid revascularizations (CEA, TFCAS, and TCAR) from 2016 to 2021. Patients with normal renal function (estimated glomular filtration rate >90 mL/min/1.72 m2) were excluded. Asymptomatic and symptomatic carotid stenosis were assessed separately. Preoperative demographics, operative details, and outcomes of 30-day mortality, stroke, myocardial infarction (MI), and composite variable of stroke/death were compared. Multivariable analysis adjusted for differences in groups, including CKD stage. ResultsA total of 90,343 patients with CKD underwent revascularization (CEA, n = 66,870; TCAR, n = 13,459; and TFCAS, n = 10,014; asymptomatic, 63%; symptomatic, 37%). Composite 30-day mortality/stroke rates were: asymptomatic: CEA, 1.4%; TCAR, 1.2%; TFCAS, 1.8%; and symptomatic: CEA, 2.7%; TCAR, 2.3%; TFCAS, 3.7%. In adjusted analysis, TCAR had lower 30-day mortality compared with CEA (asymptomatic: adjusted odds ratio [aOR], 0.4; 95% confidence interval [CI], 0.3-0.7; symptomatic: aOR, 0.5; 95% CI, 0.3-0.7), and no difference in stroke, MI, or the composite outcome of stroke/death in both symptom cohorts. TCAR had lower risk of other cardiac complications compared with CEA in asymptomatic patients (aOR, 0.7; 95% CI, 0.6-0.9) and had similar risk in symptomatic patients. Compared with TFCAS, TCAR patients had lower 30-day mortality (asymptomatic: aOR, 0.5; 95% CI, 0.2-0.95; symptomatic: aOR, 0.3; 95% CI, 0.2-0.4), stroke (symptomatic: aOR, 0.7; 95% CI, 0.5-0.97), and stroke/death (asymptomatic: aOR, 0.7; 95% CI, 0.5-0.97; symptomatic: aOR, 0.6; 95% CI, 0.4-0.7), but no differences in MI or other cardiac complications. Patients treated with TFCAS had higher 30-day mortality (aOR, 1.8; 95% CI, 1.2-2.5) and stroke risk (aOR, 1.3; 95% CI, 1.02-1.7) in symptomatic patients compared with CEA. There were no differences in MI or other cardiac complications. ConclusionsAmong patients with CKD, TCAR and CEA showed rates of stroke/death less than 2% for asymptomatic patients and less than 3% for symptomatic patients. Given the increased risk of major morbidity and mortality, TFCAS should not be performed in patients with CKD who are otherwise anatomic candidates for TCAR or CEA.

A case report of history of anterior myocardial infarction complicated with left ventricular pseudoaneurysm

Pseudoaneurysm, a fatal complication of myocardial infarction, is a mortal complication of left ventricular rupture limited by pericardium and haematoma, which allows life to continue compared to rupture. In this case report, we tried to describe the successful management of the patient who presented to our clinic with dyspnoea from diagnosis to surgery in the literature.

THE VALUE OF HOLTER MONITORING AND THE LEVEL OF SYSTEMIC INFLAMMATION IN PATIENTS WITH STABLE ISCHEMIC HEART DISEASE COMBINED WITH TYPE 2 DIABETES, DEPENDING ON THE NUMBER OF AFFECTED CORONARY ARTERIES

Diabetes mellitus (DM) is one of the significant medical and social problems of modern society, which is due to high morbidity and prevalence, frequent occurrence of chronic micro- and macrovascular complications. Coronary heart disease (CHD) in patients with type 2 diabetes is 2-4 times more common than in people of the same age without diabetes [1]. In the absence of apparent signs of atherosclerosis, the risk of developing coronary artery disease in the next 10 years is 30% [2]. To date, the course and prognosis of this group of patients have not been sufficiently studied, objective clinical and diagnostic criteria for the development of complications of myocardial infarction have not been developed, and the problem of choosing pathogenetically based methods of treatment of CHD in combination with type 2 diabetes remains unresolved [3].The aim of the work was to investigate the informativeness of Holter monitoring (HM), the correlation of HM indicators, C-reactive protein (CRP) and carbohydrate metabolism in patients with stable coronary heart disease (CHD) in combination with type 2 diabetes for the prognosis of the course of this pathology, timely individual treatment and prevention occurrence of endpoints.Material and methods. The study involved 95 patients with coronary heart disease with angina pectoris functional class (FC) III and heart failure (HF FC III with a preserved left ventricular ejection fraction (LVEF); of them, 60 patients had concomitant type 2 DM in the compensation stage.Results. In patients with comorbidity (a combination CHD and type 2 diabetes), episodes of ST depression/elevation, tachycardia, and extrasystoles were more often registered in patients with multivessel lesions of CA (р&lt;0.05), according to HM; the content of CRP in blood serum increased in proportion to the severity of the course of the disease, which depended on the number of affected CA.Conclusions. The nature and severity of the course of CHD correlate with comorbid pathology and the number of CAs affected by atherosclerosis. In the case of multivessel damage, according to the data of clinical, functional and laboratory research, an aggressive progression of cardiac pathology was noted.

S100A8/A9 as a prognostic biomarker with causal effects for post-acute myocardial infarction heart failure

Heart failure is the prevalent complication of acute myocardial infarction. We aim to identify a biomarker for heart failure post-acute myocardial infarction. This observational study includes 1062 and 1043 patients with acute myocardial infarction in the discovery and validation cohorts, respectively. The outcomes are in-hospital and long-term heart failure events. S100A8/A9 is screened out through proteomic analysis, and elevated circulating S100A8/A9 is independently associated with heart failure in discovery and validation cohorts. Furthermore, the predictive value of S100A8/A9 is superior to the traditional biomarkers, and the addition of S100A8/A9 improves the risk estimation using traditional risk factors. We finally report causal effect of S100A8/A9 on heart failure in three independent cohorts using Mendelian randomization approach. Here, we show that S100A8/A9 is a predictor and potentially causal medicator for heart failure post-acute myocardial infarction.

Successful surgical management of three mechanical complications of acute myocardial infarction: ventricular septal defect, severe mitral regurgitation and ventricular aneurysm

Successful surgical management of three mechanical complications of acute myocardial infarction: ventricular septal defect, severe mitral regurgitation and ventricular aneurysm

Echocardiography in the Recognition and Management of Mechanical Complications of Acute Myocardial Infarction.

Although rare, the development of mechanical complications following an acute myocardial infarction is associated with a high morbidity and mortality. Here, we review the clinical features, diagnostic strategy, and treatment options for each of the mechanical complications, with a focus on the role of echocardiography. The growth of percutaneous structural interventions worldwide has given rise to new non-surgical options for management of mechanical complications. As such, select patients may benefit from a novel use of these established treatment methods. A thorough understanding of the two-dimensional, three-dimensional, color Doppler, and spectral Doppler findings for each mechanical complication is essential in recognizing major causes of hemodynamic decompensation after an acute myocardial infarction. Thereafter, echocardiography can aid in the selection and maintenance of mechanical circulatory support and potentially facilitate the use of a percutaneous intervention.