Coronary Mortality Research Articles

Absolute iron deficiency, coronary artery calcification and cardiovascular mortality in maintenance haemodialysis patients.

The effects of iron on vascular calcification in rats and vascular smooth muscle cells were recently reported, but clinical studies on iron and vascular calcification are scant. We studied the associations of absolute iron deficiency, coronary artery calcification and mortality in patients with maintenance haemodialysis (MHD). Transferrin saturation (TSAT), ferritin, mean corpuscular haemoglobin (MCH) and Agatston coronary artery calcium score (CACS) were studied at baseline in MHD patients and followed up for 3 years. Cox proportional hazard analyses for mortality and linear regression analyses for CACS were performed. In 306 patients, the median age was 67 (56-81) years, dialysis duration was 76 (38-142) months, and diabetes prevalence was 42.5%. Fifty-two patients had died by 3 years. Patients with absolute iron deficiency (TSAT <20% and ferritin <100 ng/mL) (n = 102) showed significantly higher CACS (p = .0266) and C-reactive protein (p = .0011), but a lower frequency of iron formulation administration compared with patients without absolute iron deficiency at baseline (n = 204). Absolute iron deficiency was a significant predictor for 3-year cardiovascular (CV) mortality (hazard ratio: 2.08; p = .0466), but not for 3-year all-cause mortality. CACS was significant predictor for both 3-year CV and all-cause mortality (p <.05). Absolute iron deficiency and MCH were significant determinants of CACS (p < .05). MHD patients with absolute iron deficiency showed significantly higher CACS than others, and absolute iron deficiency was a significant risk factor for coronary artery calcification and 3-year CV mortality in MHD patients, but was not a significant predictor for 3-year all-cause mortality.

ST-elevation myocardial infarction in patients with type 2 diabetes mellitus. Influence of the SGLT2 inhibitor dapagliflozin

Background. Patients with type 2 diabetes mellitus (T2DM) have a 2-fold higher risk of deve­loping coronary heart disease and mortality than those without carbohydrate metabolism disturbances. The reason for such negative trends is the occurrence of metabolic stress due to hyperglycemia and insulin resistance, which causes disturbance in energy metabolism and ischemic damage to cardiomyocytes. The purpose of the study is to improve the effectiveness of rehabilitation treatment and assess the dynamics of quality of life in patients with ST-elevation myocardial infarction (STEMI) and T2DM who are at high risk of develo­ping cardiac complications during the inpatient treatment by including the sodium-glucose transport protein 2 (SGLT2) inhibitor dapagliflozin in the comprehensive therapy. Materials and methods. The study group consisted of 38 patients with STEMI and T2DM who received dapagliflozin in addition to percutaneous coronary intervention (PCI). The control group included 37 patients with STEMI and T2DM who received only standard protocol treatment after PCI. In addition to general clinical examinations and assessment of quality of life using the EuroQol Group EQ-5D-5L questionnaire (1990), echocardiography was performed to determine general and local myocardial contractility by the Simpson method; plasma levels of glucose, insulin were evaluated, and insulin resistance was determined by the HOMA-IR. Results. Patients with STEMI and T2DM after PCI most often developed reperfusion syndrome with left ventricular failure and rhythm disturbances. Under the influence of standard medical treatment, a significant clinical and functional improvement was observed, but postinfarction remodeling progressed with impaired systolic and diastolic function and the development of heart failure syndrome, as well as treatment-resistant atrial and ventricular fibrillation paroxysms, supraventricular and ventricular extrasystoles, and bundle branch block. In patients of the study group with STEMI and T2DM on the comprehensive treatment with the SGLT2 inhibitor dapagliflozin, a significant decrease in the frequency of rhythm and conduction disturbances was noted on the se­cond day of observation, as well as a decrease in postinfarction left ventricular remodeling, which ultimately manifested in a statistically significant improvement of myocardial contractility (ejection fraction increased by 6.7 %) and a decrease in diastolic dysfunction. There was also a significant decrease in the frequency and severity of reperfusion arrhythmias, which was achieved due to the cardiometabolic effect of the SGLT2 inhibitor dapagliflozin. Conclusions. The inclusion of the SGLT2 inhibitor dapagliflozin in the comprehensive treatment led to a significant improvement in central cardiac hemodynamic parameters and a decrease in the frequency and severity of reperfusion arrhythmias and acute left ventricular failure, which contributed to the improvement in quality of life.

Effect of Mudgadi Kashaya Peya and Selected Yoga Techniques in Overweight

Overweight is defined as abnormal or excessive fat accumulation that presents a risk to health. Once considered a problem only in high-income countries, overweight and obesity are now dramatically on the rise in low and middle-income countries, particularly in urban settings. Overweight and obesity are the fifth greatest risk factors for death worldwide. Due to secondary consequences including obesity, type-2 diabetes mellitus, coronary heart disease, dyslipidemia, etc., the morbidity and mortality of overweight people are rising. Obesity and overweight are primarily caused by an imbalance in energy between calories consumed and calories burned. To maintain balance between the two, the management approach attempts to reduce energy intake while boosting energy expenditure. In Ayurveda, overweight can be correlated to Sthoulya. In this study an intervention along with addition of one dietary intervention was made into the daily routine of subjects. Here yoga is most suitable adaptation of physical activity and Mudgadi kashaya peya is a dietary preparation having Kapha medohara property which can reduce the over gaining weight and presence health.

Dose-Response Associations of Lipid Traits With Coronary Artery Disease and Mortality

Apolipoprotein B (apoB), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG) are associated with coronary artery disease (CAD). However, trial evidence for the association of intensive LDL-C lowering and TG lowering with mortality is less definitive. To investigate the associations of apoB, LDL-C, and TG with CAD and mortality, both overall and by sex and age, and to characterize the shapes of these associations. This genetic association study used linear and nonlinear mendelian randomization (MR) to analyze a population-based cohort of individuals of European ancestry from the UK Biobank, which recruited participants from 2006 to 2010 with follow-up information updated until September 2021. Data analysis occurred from December 2022 to November 2023. Genetically predicted apoB, LDL-C, and TG. The primary outcomes were CAD, all-cause mortality, and cause-specific mortality. Genetic associations with CAD were calculated using logistic regression, associations with all-cause mortality using Cox proportional hazards regression, and associations with cause-specific mortality using cause-specific Cox proportional hazards regression with censoring for other causes of mortality. This study included 347 797 participants (mean [SD] age, 57.2 [8.0] years; 188 330 female [54.1%]). There were 23 818 people who developed CAD and 23 848 people who died. Genetically predicted apoB was positively associated with risk of CAD (odds ratio [OR], 1.65 per SD increase; 95% CI 1.57-1.73), all-cause mortality (hazard ratio [HR], 1.11; 95% CI, 1.06-1.16), and cardiovascular mortality (HR, 1.36; 95% CI, 1.24-1.50), with some evidence for larger associations in male participants than female participants. Findings were similar for LDL-C. Genetically predicted TG was positively associated with CAD (OR, 1.60; 95% CI 1.52-1.69), all-cause mortality (HR, 1.08; 95% CI, 1.03-1.13), and cardiovascular mortality (HR, 1.21; 95% CI, 1.09-1.34); however, sensitivity analyses suggested evidence of pleiotropy. The association of genetically predicted TG with CAD persisted but it was no longer associated with mortality outcomes after controlling for apoB. Nonlinear MR suggested that all these associations were monotonically increasing across the whole observed distribution of each lipid trait, with no diminution at low lipid levels. Such patterns were observed irrespective of sex or age. In this genetic association study, apoB (or, equivalently, LDL-C) was associated with increased CAD risk, all-cause mortality, and cardiovascular mortality, all in a dose-dependent way. TG may increase CAD risk independent of apoB, although the possible presence of pleiotropy is a limitation. These insights highlight the importance of apoB (or, equivalently, LDL-C) lowering for reducing cardiovascular morbidity and mortality across its whole distribution.

Traditional risk factors and premature acute coronary syndromes in South Eastern Europe: a multinational cohort study

The age-standardized death rates under 65 years from ischemic heart disease in South Eastern Europe are approximately twice as high than the Western Europe average, but the reasons are not completely recognized. The aim of the present study was to address this issue by collecting and analyzing data from a large, multinational cohort. We enrolled 70,953 Caucasian patients with first acute coronary syndrome, from 36 urban hospital in 7 South Eastern European countries and assessed their life expectancy free of acute coronary syndrome and mortality within 30 days after hospital admission from acute coronary syndrome as estimated in relation to dichotomous categories of traditional risk factors (current smoking, hypertension, diabetes and hypercholesterolemia) stratified according to sex. Compared with patients without any baseline traditional risk factors, the presence of all four risk factors was associated with a 5-year shorter life expectancy free of acute coronary syndrome (women: from 67.1±12.0 to 61.9±10.3 years; r=-0.089; p<0.001 and men: from 62.8±12.2 to 58.9±9.9 years; r=-0.096; p<0.001). Premature acute coronary syndrome (women <67 years and men <63 years) was remarkably related to current smoking and hypercholesterolemia among women (RRs: 3.96; 95% CI: 3.72-4.20 and 1.31; 95% CI: 1.25-1.38, respectively) and men (RRs: 2.82; 95% CI: 2.71-2.93 and 1.39; 95% CI: 1.34-1.45, respectively). Diabetes was most strongly associated with death from premature acute coronary syndrome either in women (RR: 1.52; 95% CI: 1.29-1.79) or men (RR: 1.63; 95% CI: 1.41-1.89). Public health policies in South Eastern Europe should place significant emphasis on the four traditional risk factors and the associated lifestyle behaviors to reduce the epidemic of premature ischemic heart disease. None.

Effect of AGTR1 A1166C genetic polymorphism on coronary artery lesions and mortality in patients with acute myocardial infarction.

The pathogenesis and prognosis of patients with acute myocardial infarction (AMI) may be influenced by both genetic and environmental factors. Findings on the relationship of polymorphisms in various genes encoding the renin-angiotensin-aldosterone system with coronary artery lesions and mortality in AMI patients are inconsistent. The aim of this study was to determine whether the AGTR1 A1166C genetic polymorphism affects coronary artery lesions and 1-year mortality in post-AMI patients. Patients with their first AMI admitted to Cho Ray Hospital, Vietnam, from January 2020 to August 2021 were enrolled in this prospective clinical study. All participants underwent invasive coronary angiography and were identified as having the genotypes of AGTR1 A1166C by way of a polymerase chain reaction method. All patients were followed up for all-cause mortality 12 months after AMI. The association of the AGTR1 A1166C polymorphism with coronary artery lesions and 1-year mortality was evaluated using logistic regression and Cox regression analysis, respectively. Five hundred and thirty-one AMI patients were recruited. The mean age was 63.9 ± 11.6 years, and 71.6% of the patients were male. There were no significant differences in the location and number of diseased coronary artery branches between the AA and AC+CC genotypes. The AC and CC genotypes were independently associated with ≥ 90% diameter stenosis of the left anterior descending (LAD) artery (odds ratio = 1.940; 95% confidence interval (CI): 1.059-3.552, p = 0.032). The 1-year all-cause mortality rate difference between patients with the AC and CC genotypes versus those with the AA genotype was not statistically significant (hazard ratio = 1.000, 95% CI: 0.429-2.328, p = 1.000). The AGTR1 A1166C genetic polymorphism is associated with very severe luminal stenosis of the LAD but not with mortality in AMI patients.

The Relationship of Fetuin-A with Coronary Calcification, Carotid Atherosclerosis, and Mortality Risk in Non-Dialysis Chronic Kidney Disease.

This study investigated the relationship of fetuin-A with coronary calcification, carotid atherosclerosis, and mortality risk in non-dialysis chronic kidney disease (CKD). The study included 135 adult patients with CKD at stages 3-5, who were divided into coronary artery calcification (CAC) and non-CAC groups. We excluded current smokers and individuals with diabetes mellitus, inflammatory conditions, liver diseases, acute kidney failure, chronic hemodialysis, and cancer. We conducted kidney function tests, complete blood counts, and measured serum levels of fetuin-A, tumor necrosis factor-alpha (TNF-α), high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), total cholesterol (TC), total triglycerides (TG), high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol. Cardiac spiral computed tomography was used to calculate the CAC score, employing the Agatston method. Carotid ultrasonography was performed to assess carotid intima-media thickness (CIMT) and to detect the presence of plaques. CAC patients had considerably higher levels of TNF-α (p<0.001), IL-6 (p<0.001), hs-CRP (p=0.006), TC, TG, parathyroid hormone (PTH) (p<0.001) and phosphorus (p<0.001) than non-CAC patients. They also had significantly lower levels of fetuin-A (p<0.001). Fetuin-A was considerably lower in CKD subgroups as CKD progressed. Fetuin-A (p=0.046), age (p=0.009), TNF-α (p=0.027), IL-6 (p=0.005), TG (p=0.002), PTH (p=0.002), and phosphorus (p=0.004) were significant predictors of CAC. CAC and fetuin-A were strong predictors of all-cause mortality and cardiovascular (CV) mortality. Fetuin-A was a significant predictor of CIMT (p=0.045). Fetuin-A reliably predicted CAC and CIMT. Fetuin-A and CAC emerged as significant risk factors for all-cause and CV mortality in non-dialysis CKD.

Safety and Efficacy of Proprotein Convertase Subtilisin-Kexin Type 9 Inhibitors After Acute Coronary Syndrome: A Meta-analysis of Randomized Controlled Trials.

Elevated circulating cholesterol levels in patients with acute coronary syndrome (ACS) increase morbidity and mortality. Recent studies reported that PCSK9 inhibitors (PCSK9i) have a beneficial effect on various domains of patients' lipid profiles and cardiovascular and mortality outcomes. Here, we aim to further investigate the efficacy and safety of PCSK9i in patients with ACS or who experienced recent episodes. We comprehensively searched PubMed, Scopus, Web of Science and Cochrane CENTRAL to identify all randomized controlled trials comparing PCSK9i versus placebo. Data were extracted and analysed using Stata/MP version 17.0. Eleven studies (n = 24,732) were included in this meta-analysis. In terms of efficacy outcomes, compared with the control group, PCSK9i significantly decreased levels of LDL-C, TC, TG, Lp (a) and Apo-B, with the following values, respectively: Cohen's d of - 1.25, 95% confidence interval (CI - 1.64 to - 0.87); Cohen's d of - 1.32, 95% CI (- 1.83 to - 0.81); Cohen's d of - 0.26, 95% CI (- 0.37 to - 0.14); Cohen's d of - 0.70, 95% CI (- 1.15 to - 0.26); and Cohen's d of - 1.46, 95% CI (- 1.97 to - 0.94). The levels of HDL-C and Apo-A1 increased by: Cohen's d 0.27, 95% CI (0.16-0.39) and Cohen's d of 0.30, 95% CI (0.17-0.42), respectively. Regarding safety outcomes, PCSK9i was associated with lower odds of myocardial infarction (MI) and cerebrovascular events with the following values, respectively: OR = 0.87, 95% CI (0.78-0.97) and OR = 0.71, 95% CI (0.52-0.98). PCSK9i was associated with better lipid profile and quality of life of patients and can be recommended as an optimal treatment strategy. Further trials should study combinations of PCSK9i with other lipid-lowering drugs.

Trends in coronary mortality in incident and recurrent cases from 2000 to 2018 in France

Trends in coronary mortality in incident and recurrent cases from 2000 to 2018 in France

Occupational exposure to vapors, gasses, dusts, and fumes in relation to causes of death during 24 years in Helsinki, Finland

PurposeEnvironmental particulate matter (PM) exposure has been shown to cause excess all-cause and disease-specific mortality. Our aim was to compare disease-specific mortality by estimated occupational exposure to vapors, gasses, dusts, and fumes (VGDF).MethodsThe data source is the Helsinki part of the population-based FinEsS study on chronic obstructive pulmonary diseases including information on age, education level, main occupation, sex, and tobacco smoking combined with death registry information. We compared estimated VGDF exposure to mortality using adjusted competing-risks regression for disease-specific survival analysis for a 24-year follow-up.ResultsCompared to the no-exposure group, the high occupational VGDF exposure group had sub-hazard ratios (sHR) of 1.7 (95% CI 1.3–2.2) for all cardiovascular-related and sHR 2.1 (1.5–3.9) for just coronary artery-related mortality. It also had sHR 1.7 (1.0–2.8) for Alzheimer’s or vascular dementia-related mortality and sHR 1.7(1.2–2.4) for all respiratory disease-related mortality.ConclusionLong-term occupational exposure to VGDF increased the hazard of mortality- to cardiovascular-, respiratory-, and dementia-related causes. This emphasizes the need for minimizing occupational long-term respiratory exposure to dust, gasses, and fumes.

Abstract B042: Chemotherapy in a patient with the malignant inter-arterial course of the right coronary artery A choice between cancer or the heart?

Abstract Introduction: Congenital coronary artery anomalies can increase the risk of sudden cardiac death, especially during exercise. Cancer patients with concurrent coronary artery disease face higher mortality rates due to delayed percutaneous coronary intervention. Furthermore, anthracycline chemotherapy, a common cancer treatment, can worsen pre-existing cardiac abnormalities. Despite the complexity of managing cancer patients with coronary artery anomalies, there is a lack of clear guidelines. This report presents a case of malignant interarterial course of the right coronary artery in a patient with Human T-lymphotropic virus type I-associated adult T-cell leukemia/lymphoma and discusses the challenges of chemotherapy in such cases. Case presentation: A 38-year-old male presented with weakness and palpitations. Laboratory findings revealed abnormalities, including elevated troponin and severe narrowing of the right coronary artery. Electrocardiograms showed ST elevations initially, followed by T-wave inversions. Although the patient had a pre-existing coronary anomaly, chemotherapy was initiated due to life-threatening tumor lysis syndrome and refractory lactic acidosis. Cardiac catheterization or surgical intervention was not possible due to comorbidities. A follow-up echocardiogram after six months of chemotherapy showed no acute changes. Discussion: Managing cancer patients with congenital coronary artery anomalies is challenging. Malignant interarterial course of the right coronary artery is particularly concerning due to the risk of sudden cardiac death. In this case, the patient's symptoms and abnormal electrocardiogram led to the identification of the coronary anomaly. However, immediate intervention was not feasible due to the patient's critical condition. The initiation of anthracycline-based chemotherapy in this patient posed a dilemma. Anthracyclines can cause cardiotoxicity, worsening pre-existing cardiac anomalies. Despite the lack of guidelines, chemotherapy was administered due to the urgent need for cancer treatment. Regular monitoring was essential to detect any cardiac changes. Conclusion: Managing cancer patients with coronary artery anomalies and administering anthracycline chemotherapy remains challenging due to limited guidelines. The case highlights the importance of recognizing and managing these anomalies to reduce the risk of sudden cardiac death. Guidelines for managing cardiac complications in cancer patients with pre-existing anomalies are needed. Further research is necessary to provide evidence-based guidance for such cases. Citation Format: Aliya M. Khan. Chemotherapy in a patient with the malignant inter-arterial course of the right coronary artery A choice between cancer or the heart? [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B042.

EPH224 Temporal Trends of Percutaneous Transluminal Coronary Angioplasty Procedure and Mortality Rates in the Brazilian Public Healthcare: A Real World Data Analysis From 2014 to 2022

EPH224 Temporal Trends of Percutaneous Transluminal Coronary Angioplasty Procedure and Mortality Rates in the Brazilian Public Healthcare: A Real World Data Analysis From 2014 to 2022

Abstract B043: Challenges in managing cancer patients with congenital coronary artery anomalies: A case report

Abstract Introduction: Congenital coronary artery anomalies are rare cardiac abnormalities that can increase the risk of sudden cardiac death, particularly during exercise. Patients with cancer and concurrent coronary artery disease face higher mortality risks, as they often receive delayed percutaneous coronary intervention. Additionally, anthracycline chemotherapy, commonly used in cancer treatment, can cause cardiotoxicity and worsen pre-existing cardiac abnormalities. Despite the complexity of managing cancer patients with coronary artery anomalies, there is a lack of clear guidelines and consensus on optimal approaches. This report presents a unique case of a patient with a malignant inter-arterial course of the right coronary artery and newly diagnosed Human T-lymphotropic virus type I-associated adult T-cell leukemia/lymphoma, discussing the challenges and implications of chemotherapy in such cases. Case Presentation: A 38-year-old male presented with weakness and palpitations, exhibiting abnormal laboratory findings. CT angiography revealed a malignant inter-arterial course of the right coronary artery with severe narrowing. Electrocardiograms showed ST elevations and subsequent T-wave inversions. Despite the increased risk of cardiomyopathy due to the coronary anomaly, the patient required chemotherapy for life-threatening tumor lysis syndrome and refractory lactic acidosis. Anthracycline-based chemotherapy was initiated, and a follow-up echocardiogram after six months showed no acute changes. Conclusion: Managing cancer patients receiving anthracycline chemotherapy remains challenging due to limited guidelines. Anthracycline-induced cardiotoxicity is a concern, especially in patients with pre-existing cardiac anomalies like the malignant inter-arterial course of the right coronary artery. This case emphasizes the importance of recognizing and managing such anomalies in cancer patients to reduce the risk of sudden cardiac death. The higher mortality risk in cancer patients with coronary artery disease highlights the need for guidelines in managing anomalous coronary vessels in cancer patients. Further research is necessary to develop evidence-based strategies for managing cardiac complications in cancer patients, particularly those with pre-existing cardiac anomalies. Citation Format: Aliya M. Khan, Sophia Navajas Urisote, Danish A. Sheikh. Challenges in managing cancer patients with congenital coronary artery anomalies: A case report [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B043.

Assessment of Cardiac Dysfunctions in Patients with Liver Cirrhosis Admitted in a Tertiary Care Centre

BACKGROUND&#x0D; The presence of cardiovascular dysfunction in liver cirrhosis has been studied over the past several years. Cardiovascular dysfunctions in cirrhosis increase the risk of coronary artery disease and mortality after TIPSS insertion and liver transplantation. Cirrhotic cardiomyopathy also plays an important role in the pathogenesis of hepatorenal syndrome. All these data highlight the need for rigorous cardiovascular risk assessment in patients with liver cirrhosis.&#x0D; METHODS&#x0D; After obtaining institutional approval, we analysed 96 consenting patients with liver cirrhosis satisfying inclusion criteria. Relevant history of the cases was sought through a structured questionnaire. Appropriate clinical examinations were done. Echocardiogram, ECG and biochemical parameters of the patients were examined and recorded. Data analysis was done using SPSS software.&#x0D; RESULTS&#x0D; 51% of the patients had QTc &gt; 0.44 seconds in ECG which was suggestive of electrophysiological abnormality. The systolic dysfunction was assessed by presence of left ventricular ejection fraction below 55%, which was detected in 4.2% of the patients. E/A ratio less than 1 and deceleration time more than 200 msec were taken as parameters suggestive of the presence of diastolic dysfunction. 34.4% had an E/A ratio &lt; 1 and 42.7% of the patients had a deceleration time more than 200 msec. 53% were found to have cirrhotic cardiomyopathy. The prevalence of CCM was increasing with the severity of liver disease. 53.1% of the patients had left ventricular hypertrophy and there was significant association between the prevalence of LVH and severity of cirrhosis. 38.5% of the patients had coronary artery disease as per history and ECG findings. No significant association was obtained between the prevalence of CAD and severity of CLD. 4.2% patients had arrhythmia and there was a significant association with the severity of disease. Troponin I was elevated in 20.8% of the patients.&#x0D; CONCLUSIONS&#x0D; Liver cirrhosis is a risk factor for cardiovascular dysfunctions. Most of the patients with cardiac compromise were asymptomatic. 53% patients were diagnosed to have cirrhotic cardiomyopathy. The prevalence of cardiovascular dysfunctions was found to increase with the rising severity of cirrhosis as per CTP score. Diastolic dysfunction was more prevalent than systolic dysfunction. The prevalence of cardiovascular dysfunctions was lesser among patients with regular follow-up and treatment for cirrhosis liver. 38.5% of the patients had coronary artery disease. The prevalence of arrhythmias was 4.2%. Troponin levels were elevated in 20.8% patients.

The adrenomedullin system and risk of cardiogenic shock or death complicating acute coronary syndromes

Abstract Introduction Cardiogenic shock (CS) is the leading cause of death due to acute coronary syndromes (ACS) and mortality remained nearly unchanged over the past two decades. Immediate revascularization of the infarct-related artery is the treatment strategy of choice to reduce CS-related mortality, but early identification of patients at high risk of CS and death is challenging. The adrenomedullin (ADM) system modulates vascular tone and endothelial barrier function and monitoring its activity may enhance early risk assessment of ACS patients prone to experience CS and ultimately death. Methods In 4293 ACS patients, prospectively recruited at 4 Swiss university hospitals, the 3 major ADM system components were assessed in plasma at the time of acute presentation by blinded study personnel: ADM-glycine (its inactive substrate), peptidylglycine α-amidating monooxygenase (PAM; the ADM-amidating enzyme), and the biologically active ADM-amide (bio-ADM). Patients were monitored for in-hospital development of CS and followed at 30 days and 1 year with external event adjudication. The relationship of each ADM system component with features of CS pathophysiology (such as proxies for the decrease in cardiac contractile mass, increase in cardiac stress or systemic inflammation) was estimated by means of partial correlation coefficients. Multivariable-adjusted regression models were fit to assess their independent association with CS development and death. Results Baseline ADM-glycine, PAM and bio-ADM levels were tightly linked to features of CS (Fig. 1), with each ADM system component associating with in-hospital CS (odds ratio, 95% confidence interval [CI] per doubling in each, 2.04, 1.79-2.33, P&amp;lt;.001; 1.91, 1.63-2.23, P&amp;lt;.001; 1.72, 1.11-2.66, P=.016). The association of each marker with CS remained robust after adjusting for established risk factors for in-hospital development of CS, including all hemodynamic-, patient-, and procedure-related variables informing the ORBI risk score (1.65, 1.35-2.00, P&amp;lt;.001; 1.50, 1.26-1.77, P&amp;lt;.001; and 1.87, 1.13-3.11, P=.015). Notably, integration of ADM-glycine, PAM, and bio-ADM into the ORBI risk prediction model conferred increased discriminative performance for the prediction of in-hospital CS (AUC, 0.76 vs. 0.81, P&amp;lt;.001), ranking the ADM system second among all variables informing the score (Fig. 2). While both ADM-glycine and bio-ADM independently associated with mortality risk at 30-days (multivariable-adjusted hazard ratio per doubling, 95% CI, 1.93, 1.54-2.42, P&amp;lt;.001; and 1.81, 1.34-2.44, P&amp;lt;.001) and 1-year (1.41, 1.18-1.68, P&amp;lt;.001; and 1.52, 1.24-1.87, P&amp;lt;.001), PAM showed no association with these outcomes (P&amp;gt;.05). Conclusions Monitoring key regulators of the ADM system improves early risk assessment of ACS patients at high risk of CS, with admission ADM-glycine and bio-ADM representing independent risk factors for 30-day and 1-year mortality post-ACS.

Influence of air pollution on NSTEMI incidence and acute coronary syndrome mortality - the 10-year community-level analysis including 80 million patient-years. EP-PARTICLES study

Abstract Introduction During the last years, air pollution has emerged as an important modifiable cardiovascular risk factor. Most research focused on heavy-polluted agglomerations and big cities, neglecting its influence on cardiovascular health in smaller cities and villages. Purpose The study aimed to assess the spatio-temporal trends and the influence of air pollution on the non-ST-elevation myocardial infarction (NSTEMI) incidence and acute coronary syndrome (ACS) mortality in an urban and rural environment. Moreover, the study aimed to investigate whether there is a connection between the influence of air pollution on hospitalization and cause-specific mortality. Methods The analysis included data on 7 main air pollutants in 709 communities in Eastern Poland in 2011-2020. Mortality data were obtained from National Health Fund and daily air pollution concentrations for each community were obtained from National Public Health Institute. Time-stratified panel data Poisson regression techniques were used. The influence of each air pollutant was analysed at a single-day lag (0-6 days) and multi-day lag (0-1, 0-6, 0-30 days) and presented as an odds ratio (OR) with a 95% confidence interval (CI) for an increase in 10 μg/m3. Results Incidence of NSTEMI was associated with exposition to benzo-a-pyrene (BaP) on all analysed lag patterns (OR 1.121, 95% CI 1.075-1.168 for lag 0, OR 1.241, 95% CI 1.169-1.317 for lag 0-30) and to particulate matter with a diameter of &amp;lt;10 and &amp;lt;2.5 μm (PM10, PM2.5), CO and NO2 on the most of analysed lag patterns (OR 1.01, 95% CI 1.005-1.015 for PM10 on lag 0, OR 1.013, 95% CI 1.007-1.02 for PM2.5 on lag 0, OR 1.017, OR 1.002, 95% CI 1.001-1.003 for CO on lag 0, 95% CI 1.007-1.028 for NO2 on lag 0). O3 and SO2 had a protective influence on NSTEMI incidence on longer lags (OR 0.984, 95% CI 0.977-0.992 for O3 on lag 0-30, OR 0.978, 95% CI 0.963-0.993 for SO2 on lag 5) Mortality due to the ACS was associated with an increase in NO2 and CO concentrations on all lag patterns (OR 1.03, 95% CI 1.02-1.04 for NO2 on lag 0, OR 1.089, 95% CI 1.068-1.11 for NO2 on lag 0-30, OR 1.003, 95% CI 1.002-1.004 for CO on lag 0, OR 1.089, 95% CI 1.068-1.11 for CO on lag 0-30). PMs concentrations had a protective effect on ACS mortality on all lag patterns (OR 0.971, 95% CI 0.966-0.976 for PM10 on lag 0, OR 0.964, 95% CI 0.958-0.971 for PM2.5 on lag 0). Conclusions An increase in most of the major air pollutants concentrations have an influence on NSTEMI incidence. Different lag patterns for air pollutants suggest various mechanisms of detrimental effect. Cause-specific mortality analysis showed the results mostly opposite to incidence analysis. It suggests that a high rate of garbage codes may prevent high-quality population analysis focusing on cause-specific mortality. The development of air quality monitoring stations and the correct use of ICD-10 diagnoses may be crucial in drawing important conclusions from environmental studies.

The efficacy of coronary sinus reduction in refractory angina: A meta-analysis

Abstract Objectives Refractory angina is a frequent complain of patients with coronary artery disease. Its management is challenging despite the available pharmacological approaches. Interventional approaches have also been attempted, with coronary sinus reduction (CSR) being the main treatment option. Purpose This meta-analysis aimed to assess the efficacy of CSR in improving symptoms and cardiovascular endpoints in patients with refractory angina. Methods We searched the Pubmed database till 26/2/2023 for studies assessing the impact of CSR in refractory angina. The primary outcome of interest was the improvement in Canadian Cardiovascular Society (CCS) category by at least one class. Secondary outcomes included the implantation success, the proportion of patients improving by at least two CCS classes, as well as the rates of new myocardial infarction/percutaneous coronary intervention and mortality at follow-up. Results The literature search resulted in 190 studies. After screening of title/abstract/full-text, a total of 10 studies (1400 patients) were included in the meta-analysis. The median follow-up was 12.8 months (range: 4-24 months). High rates of implantation success (97%, 95% confidence interval (CI) 95%-98) were reported. Improvement by at least one CCS class was reported by 77% (95% CI 73%-81%). Improvement by at least two CCS classes was seen in 41% (95% CI 36%-47%). The proportion of patients exhibiting a new myocardial infarction/percutaneous coronary intervention was 7% (95% CI 3%-16%), while the mortality rate was 7% (95% CI 3%-14%). Conclusion Coronary sinus reduction is a procedure accompanied by high success rates, and is effective in improving symptoms in a considerable proportion of patients with refractory angina.

Abstract 17952: Age-Dependent Disparities on Associations of Socioeconomic, Lifestyle, and Metabolic Risk Factors With Major Cardiovascular Diseases and Mortality

Introduction: Existing studies that quantified and compared the relative risks (RRs) and population-attributable risks (PARs) of modifiable risk factors for cardiovascular diseases (CVDs) and mortality by age have been limited to conventional factors and moderate PARs. Methods: 335 540 participants from UK Biobank were stratified into &lt;55 years (n=138 058), 55-65 years (n=140 224), and ≥65 years (n=57 258). The outcomes included incident CVD, coronary heart disease, heart failure (HF), ischaemic stroke, CVD mortality, and all-cause mortality. Results: The PARs for CVD cases and deaths were 11-24% for socioeconomic factors, 14-27% for lifestyle factors, and 34-41% for metabolic factors, which collectively measured 58-82%. Younger participants had significantly higher RRs of CVDs associated with socioeconomic, lifestyle, and metabolic risk factors (P interaction &lt;0.05), and higher PARs from socioeconomic and lifestyle risk factors (Figure). For socioeconomic factors, area deprivation accounted for 10.5% of CVD deaths, while PARs of low education for CVDs and mortality ranged from 9.1% to 12.8%. Smoking accounted for 4.2-10.9% of PARs for CVDs and mortality, and other lifestyle factors such as unhealthy sleep (i.e. 5.6% for CVD mortality) and poor diet (i.e. 5.5% for IS) also contributed to moderate PARs. Metabolic risk factors accounted for 30.9% (28.6-33.2%) to 44.9% (39.0-50.7%) of CVD cases and deaths in all age groups, with hypertension being the predominant risk factor (22.4-32.5%). Conclusions: Socioeconomic and lifestyle risk factors showed stronger associations with CVDs and mortality among relatively younger people, while cases attributed to metabolic risk factors were consistently high in all age groups. This study further supports the role of an integrated CVD prevention strategy that combines social, behavioural, and medical approaches, especially among younger population.

Comprehensive systematic review and meta-analysis on anticoagulants and aspirin for stroke prevention in non-valvular atrial fibrillation patients.

Non-valvular atrial fibrillation (NVAF) is a common manifestation of cardiac arrhythmia, whose significance is heightened in the context of an aging global population and changing lifestyles, leading to an increased incidence. Stroke prevention in NVAF is a complex challenge that requires a comprehensive exploration of interventions. The emergence of Direct Oral Anticoagulants (DOACs) is a potential treatment, necessitating a thorough evaluation of their safety and efficacy. As the quest for the best strategy for thrombotic risk in these patients continues, the interaction between DOAC and aspirin has become the focus of research. With a rigorous methodological approach, we conducted a thorough search of scientific databases up to August 2023. The methodology involved meticulous screening, careful data extraction, and rigorous assessment of trial quality, all conducted by two independent investigators. The results were synthesized through standardized mean differences, accompanied by 95% confidence intervals. DOACs demonstrated significant enhancements in stroke prevention for NVAF, which was indicated by favorable outcomes in bleeding (RR = 4.04, 95% CI: 3.96, 4.12), coronary artery disease (RR = 2.45, 95% CI: 2.42, 2.48), mortality (RR = 0.49, 95% CI: 0.43, 0.56), myocardial infarction (RR = 1.85, 95% CI: 1.81, 1.88), and stroke (RR = 1.50, 95% CI: 1.47, 1.54). Notably, DOACs demonstrated optimal efficacy for NVAF patients with stroke. DOACs may be potentially effective for preventing stroke after NVAF.

Global Registry of Acute Coronary Events Score Underestimates Post-Acute Coronary Syndrome Mortality among Cancer Patients

Background Patients with prior cancer are at increased risk of acute coronary syndrome (ACS) with poorer post-ACS outcomes. We aimed to ascertain if the Global Registry of Acute Coronary Events (GRACE) score accurately predicts mortality risk among patients with ACS and prior cancer. Methods We linked nationwide ACS and cancer registries from 2007 to 2018 in Singapore. A total of 24,529 eligible patients had in-hospital and 1-year all-cause mortality risk calculated using the GRACE score (2471 prior cancer; 22,058 no cancer). Results Patients with prior cancer had two-fold higher all-cause mortality compared to patients without cancer (in-hospital: 22.8% versus 10.3%, p &lt; 0.001; 1-year: 49.0% vs. 18.7%, p &lt; 0.001). Cardiovascular mortality did not differ between groups (in-hospital: 5.2% vs. 4.8%, p = 0.346; 1-year: 6.9% vs. 6.1%, p = 0.12). The area under the receiver operating characteristic curve of the GRACE score for prediction of all-cause mortality was less for prior cancer (in-hospital: 0.64 vs. 0.80, p &lt; 0.001; 1-year: 0.66 vs. 0.83, p &lt; 0.001). Among patients with prior cancer and a high-risk GRACE score &gt; 140, in-hospital revascularization was not associated with lower cardiovascular mortality than without in-hospital revascularization (6.7% vs. 7.6%, p = 0.50). Conclusions The GRACE score performs poorly in risk stratification of patients with prior cancer and ACS.