Days Of Acute Myocardial Infarction Research Articles

Left Ventricular Function, Congestion, and Effect of Empagliflozin on Heart Failure Risk After Myocardial Infarction

BackgroundEmpagliflozin reduces the risk of heart failure (HF) hospitalizations but not all-cause mortality when started within 14 days of acute myocardial infarction (AMI). ObjectivesThis study sought to evaluate the association of left ventricular ejection fraction (LVEF), congestion, or both, with outcomes and the impact of empagliflozin in reducing HF risk post-AMI. MethodsIn the EMPACT-MI (Trial to Evaluate the Effect of Empagliflozin on Hospitalization for Heart Failure and Mortality in Patients with Acute Myocardial Infarction) trial, patients were randomized within 14 days of an AMI complicated by either newly reduced LVEF<45%, congestion, or both, to empagliflozin (10 mg daily) or placebo and were followed up for a median of 17.9 months. ResultsAmong 6,522 patients, the mean baseline LVEF was 41 ± 9%; 2,648 patients (40.6%) presented with LVEF <45% alone, 1,483 (22.7%) presented with congestion alone, and 2,181 (33.4%) presented with both. Among patients in the placebo arm of the trial, multivariable adjusted risk for each 10-point reduction in LVEF included all-cause death or HF hospitalization (HR: 1.49; 95% CI: 1.31-1.69; P < 0.0001), first HF hospitalization (HR: 1.64; 95% CI: 1.37-1.96; P < 0.0001), and total HF hospitalizations (rate ratio [RR]: 1.89; 95% CI: 1.51-2.36; P < 0.0001). The presence of congestion was also associated with a significantly higher risk for each of these outcomes (HR: 1.52, 1.94, and RR: 2.03, respectively). Empagliflozin reduced the risk for first (HR: 0.77; 95% CI: 0.60-0.98) and total (RR: 0.67; 95% CI: 0.50-0.89) HF hospitalizations, irrespective of LVEF or congestion, or both. The safety profile of empagliflozin was consistent across baseline LVEF and irrespective of congestion status. ConclusionsIn patients with AMI, the severity of left ventricular dysfunction and the presence of congestion was associated with worse outcomes. Empagliflozin reduced first and total HF hospitalizations across the range of LVEF with and without congestion. (Trial to Evaluate the Effect of Empagliflozin on Hospitalization for Heart Failure and Mortality in Patients with Acute Myocardial Infarction [EMPACT-MI]; NCT04509674)

DYNAMICS OF THE LEVELS OF ASYMMETRIC DIMETHYLARGININE AND PLASMINOGEN ACTIVATOR INHIBITOR TYPE 1 IN PATIENTS WITH ACUTE ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION AND TYPE 2 DIABETES MELLITUS DEPENDING ON THE REPERFUSION STRATEGY

Introduction. Despite the major successes achieved in the treatment of acute coronary syndromes (ACS), acute myocardial infarction (AMI) remains the main cause of death among the working-age population of Ukraine. The means of treatment of interventional cardiology can actually reduce the mortality of patients with ACS, improve the course of the acute period of the disease and ensure less reduction in the functional capabilities of the heart in the future. Among the many pathogenetic mechanisms of vascular inflammation in coronary heart disease and type 2 diabetes, endothelial dysfunction is the determining factor.&#x0D; The aim of the study. To evaluate the levels of plasminogen activator inhibitor type 1, asymmetric dimethylarginine and endothelial nitric oxide synthase on the 10-14th day in patients depending on the presence or absence of concomitant diabetes type 2 and the type of reperfusion therapy.&#x0D; Materials and methods. 130 patients with acute myocardial infarction were examined, who were divided into 2 groups: 1 group consisted of patients with acute myocardial infarction with accompanying type 2 diabetes (n=73), 2 group – patients with acute myocardial infarction without type 2 diabetes (n =57). The quantitative content of the plasminogen activator inhibitor type 1 (PAI-1) was determined by the immunoenzymatic method using a commercial test system manufactured by Technoclone PAI-1 ELISA Kit (Austria), endothelial nitric oxide synthase (NOS) – Enzyme-Linked Immunosorbent Assay (ELISA) Kit For Nitric Oxide Synthase Endothelial, asymmetric dimethylarginine (ADMA) – Immunodiagnostik ADMA ELISA Kit (Austria).&#x0D; Results. Percutaneous coronary intervention (PCI) contributes to a more significant decrease in the content of the marker of endothelial dysfunction – ADMA and an increase in NOS on the 10-14th day of acute myocardial infarction in comparison with standard therapy. During PCI, the level of PAI-1 did not reliably change during treatment due to post-inflammatory and post-traumatic activation of platelets in the vascular wall.&#x0D; Conclusions. In patients with acute myocardial infarction with type 2 diabetes mellitus, percutaneous coronary intervention contributes to a significant decrease in the content of asymmetric dimethylarginine and an increase in NOS on the 10-14th day of acute myocardial infarction, but was not accompanied by a significant decrease in the level of PAI-1, which in general indicates positive effect of performed myocardial revascularization.

Major adverse cardiovascular events associated with testosterone treatment: a pharmacovigilance study of the FAERS database.

Background and purpose: Testosterone is an essential sex hormone in maintaining masculine characteristics, which is prescribed for male hypogonadism as testosterone replacement treatment (TRT). Herein, we investigated long-standing controversies about the association between TRT and major adverse cardiovascular events (MACEs), based on real world adverse event (AE) reports, registered in the Food and Drug Administration Adverse Event Reporting System (FAERS). Methods: Publicly available FAERS data from 1 January 2004 to 31 December 2022 were retrieved from the Food and Drug Administration (FDA) website. The data mining protocol including the reporting odds ratio (ROR) and the Bayesian confidence propagation neural network (BCPNN) was applied to analyze overreporting caused by risk factors and MACEs, including TRT, morbidities, and ages. The ROR and the BCPNN were also applied to investigate the annually developing trend of pharmacovigilance (PV) signals in the real world, retrospectively. Results: A total of 3,057 cases referring to MACEs, with a median age of 57 years old (yo), were identified from 28,921 cases of testosterone users. MACEs related to PV signals have emerged since 2014, including cardiac death, non-fatal myocardial infarction, and non-fatal stroke. Myocardial infarction (MI) (ROR: 9.46; IC025: 3.08), acute myocardial infarction (AMI) (ROR: 16.20; IC025: 3.72), ischemic cardiomyopathy (ROR: 11.63; IC025: 2.20), and cardiomyopathy (ROR: 5.98; IC025: 1.96) were the most significant signals generated, and weaker signals included cardiac failure acute (ROR: 4.01; IC025: 0.71), cardiac arrest (ROR: 1.88; IC025: 0.56), and ventricular fibrillation (VF) (ROR: 2.38; IC025: 0.38). The time-to-onset (TTO) of MACEs was calculated with a median of 246 days for AMI. Conclusion: For myocardial infarction and cardiomyopathy, TRT statistically tended to increase the risk of MACEs, while for cardiac arrhythmia, cardiac failure, and stroke, TRT demonstrated beneficial effects among the population with morbidities, such as testosterone deficiency (TD), diabetes mellitus (DM), and hypertension. MACEs were rare but led to serious outcomes including significant increase in death and disability. Since 2018, and before 2014, reports referring to TRT associated with MACEs were relatively scarce, which indicated that there might be a considerable number of cases that went unrecorded, due to neglection. Health workers and testosterone users might pay more attention to testosterone-induced MACEs.

Predictors of Carbohydrate Metabolism Disorders and Lethal Outcome in Patients after Myocardial Infarction: A Place of Glucose Level.

The aim of this study was to reveal statistical patterns in patients with acute myocardial infarction (AMI) that cause the development of carbohydrate metabolism disorders (CMD) (type 2 diabetes mellitus and prediabetes) and death within 5 years after AMI. 1079 patients who were treated with AMI in the Almazov National Medical Research Center were retrospectively selected for the study. For each patient, all data from electronic medical records were downloaded. Statistical patterns that determine the development of CMDs and death within 5 years after AMI were identified. To create and train the models used in this study, the classic methods of Data Mining, Data Exploratory Analysis, and Machine Learning were used. The main predictors of mortality within 5 years after AMI were advanced age, low relative level of lymphocytes, circumflex artery lesion, and glucose level. Main predictors of CMDs were low basophils, high neutrophils, high platelet distribution width, and high blood glucose level. High values of age and glucose together were relatively independent predictors. With glucose level >11 mmol/L and age >70 years, the 5-year risk of death is about 40% and it rises with increasing glucose levels. The obtained results make it possible to predict the development of CMDs and death based on simple parameters that are easily available in clinical practice. Glucose level measured on the 1st day of AMI was among the most important predictors of CMDs and death.

Динаміка рівня ендотеліального моноцитактивуючого пептиду-ІІ у хворих на гострий інфаркт міокарда з супутнім цукровим діабетом 2 типу

The purpose of the study was to investigate the dynamics of endothelial monocyte activating polypeptide-ІІ in patients with acute myocardial infarction with concomitant diabetes mellitus type 2 six months after a coronary event. Materials and methods. 120 patients participated in the study: group 1 – patients with acute myocardial infarction with diabetes mellitus type 2 (n=70), group 2 – patients with acute myocardial infarction (n=50). The control group included 20 practically healthy people. All patients underwent laboratory and instrumental examination on the first day of acute myocardial infarction and 6 months after it. The level of endothelial monocyte activating polypeptide-ІІ was determined using the test system “Human Endothelial Monocyte Activating Polypeptide-ІІ ELISA KIT”. Results and discussion. The average level of endothelial monocyte activating polypeptide-ІІ on the first day of an acute myocardial infarction was: in patients who were part of the 1st group – 4.54 ± 0.331 ng/ml; 2nd – 2.74 ± 0.21 ng/ml; control group – 1.1 ± 0.037 ng/ml (р&lt;0.05). In patients of the 1st group, half a year after acute myocardial infarction, the average level of endothelial monocyte activating polypeptide-ІІ was equal to 3.6 ± 0.11 ng/ml; 2nd – 2.28 ± 0.05 ng/ml (р&lt;0.00001). Re-examination of patients, depending on treatment tactics, showed the following results: in patients with acute myocardial infarction with concomitant diabetes mellitus type 2 after cardiac ventriculography, the endothelial monocyte activating polypeptide-ІІ level was equal to 3.5 ± 0.04 ng/ml; in patients with acute myocardial infarction with concomitant diabetes mellitus type 2 after standard anticoagulant therapy it was 3.71 ± 0.03 ng/ml; in patients with isolated acute myocardial infarction after cardiac ventriculography – 2.24 ± 0.01 ng/ml; in patients with isolated acute myocardial infarction after standard anticoagulant therapy – 2.33 ± 0.04 (р&lt;0.01). Conclusion. Endothelial monocyte activating polypeptide-ІІ is a marker of endothelial dysfunction that has prognostic properties in relation to comorbid pathology in the form of acute myocardial infarction with. diabetes mellitus type 2. In patients with an acute myocardial infarction in the presence of diabetes mellitus type 2, a higher level of endothelial monocyte activating polypeptide-ІІ was noted on the 1st day of a coronary event and 6 months after it, compared to patients with an isolated acute myocardial infarction and individuals of the control group (p&lt;0.05). After cardiac ventriculography in patients, the level of endothelial monocyte activating polypeptide-ІІ was significantly lower compared to this indicator after standard anticoagulant therapy

Abstract 13993: Sex Differences in Cardiac Structure and Function Following Acute Myocardial Infarction: Insights From the PARADISE-MI Echocardiographic Sub-Study

Introduction: Women have a higher incidence of heart failure (HF) hospitalizations than men following acute myocardial infarction (AMI). The extent to which differential cardiac remodeling between men and women might account for this higher risk in women is poorly understood. Hypothesis: Women and men have differences in cardiac remodeling after AMI that are predictive of clinical outcomes. Methods: The Prospective ARNI versus ACE inhibitor trial to Determine Superiority in reducing heart failure Events after Myocardial Infarction (PARADISE-MI) trial randomized patients within 0.5 to 7 days of AMI complicated by left ventricular (LV) dysfunction, pulmonary congestion, or both to sacubitril/valsartan or ramipril. In the pre-specified echocardiographic sub-study, 544 participants were enrolled to undergo protocol echocardiography at the time of randomization and after 8 months. Results: At baseline, women (n=142, 26%) were older, more likely to have a history of hypertension, and less likely to have a history of MI. Women had a higher LV ejection fraction (LVEF), lower LV end-diastolic index (LVEDVi) and end-systolic volume index (LVESVi), and LV mass index, but no difference in left atrium (LA) volume index compared with men (Table). Women had better diastolic function compared with men. The absolute and relative changes in these echocardiographic parameters from baseline to 8 months were not significantly different between women and men. In univariate analyses, baseline LVEF, LVEDVi, LVESVi, LA dimensions and diastolic measurements are associated with primary outcome (Table). Conclusion: In PARADISE-MI, women have higher LVEF and lower indexed LV and LA chamber sizes compared to men following high-risk MI. The changes between baseline and 8-month in LVEF, LV and LA dimensions did not differ significantly between men and women, suggesting that differential cardiac remodeling post-MI may not account for the increased HF risk in women compared with men.

Кореляційні зв’язки ендотеліального моноцитактивуючого пептиду-ІІ та тропоніну І у хворих на коморбідну патологію

The purpose of the study was to investigate the correlation between the levels of endothelial monocyte activating polypeptide-ІІ and troponin I in patients with acute myocardial infarction and diabetes mellitus type 2. Materials and methods. 120 patients took part in the study: 1st group – acute myocardial infarction patients with diabetes mellitus type 2 (n=70), 2nd group – patients with acute myocardial infarction (n=50). The control group included 20 practically healthy people. According to the orders of the Ministry of Health of Ukraine, the patients were diagnosed with acute myocardial infarction and diabetes mellitus type 2. All patients underwent laboratory and instrumental examinations on the first day of acute myocardial infarction. The level of endothelial monocyte activating polypeptide-ІІ (EMAP-II) was determined using the "Human Endothelial monocyte activating polypeptide-ІІ ELISA KIT" test system. Statistical processing of the research results was carried out using the "Statistica 6.0" software package. Results and discussion. The average level of endothelial monocyte activating polypeptide-ІІ on the first day of acute myocardial infarction was: in patients who were part of the 1st group – 4.54±0.331 ng/ml; 2nd – 2.74±0.21 ng/ml; in the control group – 1.1±0.037 ng/ml (р&lt;0.05). The average level of troponin I on the first day of acute myocardial infarction was: in patients of the 1st group – 4.89±2.46 ng/ml; 2nd – 2.67±2.06 ng/ml; in the control group – 0.06±0.04 ng/ml (р˂0.00001). In the course of the correlation analysis, a direct significant correlation was found between the levels of endothelial monocyte activating polypeptide-ІІ and troponin I (r=0.700; p˂0.05). Correlation between the levels of endothelial monocyte activating polypeptide-ІІ and troponin I in patients of the 1st group was: between these indicators in patients who had a mild form of diabetes mellitus type 2 – a direct strong correlation (r=0.900; p˂0.05); moderate – a direct noticeable correlation (r=0.439; p&gt;0.05); difficult – direct strong correlation (r=0.754; p˂0.05). Conclusion. Endothelial monocyte activating polypeptide-ІІ has a high diagnostic value in patients with acute myocardial infarction with diabetes mellitus type 2. When patients with the above-mentioned diseases were combined, the level of this indicator was significantly higher than in patients with isolated acute myocardial infarction and the control group (p&lt;0.05). Troponin I hyperactivity was detected in patients with acute myocardial infarction, especially when combined with diabetes mellitus type 2 (p&lt;0.00001). When determining the above-mentioned indicators in patients of the 1st group according to the forms of diabetes mellitus type 2, a directly proportional dependence with these parameters was found (р&lt;0.05). In the course of the correlation analysis, a direct significant correlation between the levels of endothelial monocyte activating polypeptide-ІІ and troponin I was revealed (р˂0.05)

The impact of COVID-19 on clinical outcomes among acute myocardial infarction patients undergoing early invasive treatment strategy.

BackgroundThe implications of coronavirus disease 2019 (COVID‐19) infection on outcomes after invasive therapeutic strategies among patients presenting with acute myocardial infarction (AMI) are not well studied.HypothesisTo assess the outcomes of COVID‐19 patients presenting with AMI undergoing an early invasive treatment strategy.MethodsThis study was a cross‐sectional, retrospective analysis of the National COVID Cohort Collaborative database including all patients presenting with a recorded diagnosis of AMI (ST‐elevation myocardial infarction (MI) and non‐ST elevation MI). COVID‐19 positive patients with AMI were stratified into one of four groups: (1a) patients who had a coronary angiogram with percutaneous coronary intervention (PCI) within 3 days of their AMI; (1b) PCI within 3 days of AMI with coronary artery bypass graft (CABG) within 30 days; (2a) coronary angiogram without PCI and without CABG within 30 days; and (2b) coronary angiogram with CABG within 30 days. The main outcomes were respiratory failure, cardiogenic shock, prolonged length of stay, rehospitalization, and death.ResultsThere were 10 506 COVID‐19 positive patients with a diagnosis of AMI. COVID‐19 positive patients with PCI had 8.2 times higher odds of respiratory failure than COVID‐19 negative patients (p = .001). The odds of prolonged length of stay were 1.7 times higher in COVID‐19 patients who underwent PCI (p = .024) and 1.9 times higher in patients who underwent coronary angiogram followed by CABG (p = .001).ConclusionThese data demonstrate that COVID‐19 positive patients with AMI undergoing early invasive coronary angiography had worse outcomes than COVID‐19 negative patients.

Динаміка показників ліпідного профілю крові у хворих на гострий інфаркт міокарда з супутнім цукровим діабетом 2 типу в залежності від обраної тактики лікування

The purpose of the study was to analyze the dynamics of lipid profile in patients with acute myocardial infarction with concomitant type 2 diabetes mellitus for 6 months of follow-up. Materials and methods. 120 patients took part in the study: 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. Depending on the tactics of treatment, 4 subgroups were formed depending on the tactics of treatment (coronary ventriculography with coronary artery stenting / standard anticoagulant therapy with dual antiplatelet therapy) and the presence or absence of type 2 diabetes mellitus. The diagnosis of "acute myocardial infarction" and "type 2 diabetes mellitus" was established in accordance with current orders of the Ministry of Health of Ukraine. All patients underwent laboratory and instrumental examinations on the first day of acute myocardial infarction and 6 months after it. The study was conducted in strict compliance with basic ethical principles. Statistical processing of the results of this study was performed using the software package StatSoft Inc. USA – "Statistica 6.0". Results and discussion. The average lipid profile on the first day of hospitalization in the examined groups was as follows: total cholesterol in patients of the 1st group was equal to 7.1 ± 1.05 mmol/L; 2nd – 5.45 ± 0.65 mmol/L; control – 2.47 ± 0.42 mmol/L; low-density lipoprotein cholesterol – 4.63 ± 1.07 mmol/L; 3.04 ± 0.65 mmol/L; 0.29 ± 0.32 mmol/L, respectively; low-density lipoprotein cholesterol – 0.64 ± 0.1 mmol/L; 0.47 ± 0.08 mmol/L; 0.24 ± 0.08 mmol/L, respectively; high-density lipoprotein cholesterol – 1.05 ± 0.21 mmol/L; 1.41 ± 0.18 mmol/L; 1.63 ± 0.16 mmol/L, respectively; triglyceride – 3.14 ± 0.48 mmol/L; 2.09 ± 0.57 mmol/L; 1.14 ± 0.39, respectively; atherogenic factor – 6.29 ± 2.92 mmol/L; 2.98 ± 0.86 mmol/L; 0.52 ± 0.21 mmol/L, respectively (p˂0.00001). These indicators were assessed separately for each of the four subgroups. In 6 months after bearing acute myocardial infarction the positive dynamics of indicators of a lipid profile was noted, but the tendency concerning worse indicators in the presence of type 2 diabetes mellitus remained. Patients who underwent coronary artery stenting during treatment compared with patients who received standard anticoagulant therapy with antiplatelet drugs, had a faster positive dynamics of lipid profile. Conclusion. Thus, in patients with comorbid pathology in the form of acute myocardial infarction with type 2 diabetes mellitus, there are high rates of atherogenic lipid fractions, high values of atherogenic factor against the background of low values of antiatherogenic lipid fractions, which has prognostic value in the course of the disease in relation to the progression of atherosclerotic vascular lesions. After coronary ventriculography, a faster positive dynamics of the above indicators was noted, which indicates the superiority of reperfusion methods of treatment over standard drugs

Association of dementia with in-hospital outcomes in primary heart failure and acute myocardial infarction hospitalizations

BackgroundDementia and cardiovascular diseases contribute to a significant disability and healthcare utilization in the elderly. ObjectiveThe in-hospital treatment patterns and outcomes of heart failure (HF) and acute myocardial infarction (AMI) are not well-studied in this population. MethodsWe used the National Inpatient Sample database to identify AMI and HF hospitalizations in adults ≥65 years between 2016 and 2018. ResultsA total of 2,466,369 HF hospitalizations (277,900 with dementia [11.3%]) and 1,094,155 AMI hospitalizations (100,365 with dementia [9.2%]) were identified. Patients with dementia were older (mean age 83.8 vs 78.6 years for HF, and 83.0 vs 75.8 years for AMI) with female predominance (59.0% for HF and 56.0% for AMI) than those without dementia. In adjusted analysis, patients with dementia had higher in-hospital mortality (HF 4.7% vs 3.1%, aOR 1.33 [1.27–1.39] and AMI 9.9% vs 5.9%, aOR 1.23 [1.17–1.30]), p < 0.001) and lower mechanical circulatory support utilization. Patients with AMI and dementia were less likely to receive revascularization (including percutaneous coronary intervention, coronary artery bypass grafting, and thrombolysis), vasopressors, and invasive mechanical ventilation. They had a longer mean length of stay (LOS) (5.5 vs 5.3 days for HF and 5.1 vs 4.8 days for AMI, p < 0.001 for both), a lower inflation-adjusted cost of care for AMI ($15,486 vs $23,215, p < 0.001), and higher rates of transfer to rehabilitation facilities. ConclusionPatients with dementia admitted for HF or AMI had higher in-hospital mortality, a longer LOS, and were less likely to receive aggressive revascularization interventions after AMI.

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.&#x0D; 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.&#x0D; 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" .&#x0D; 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).&#x0D; General clinical and instrumental examinations were performed on patients who were part of the 1st, 2nd groups and control groups.&#x0D; 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.&#x0D; Statistical processing of survey results was performed using software package StatSoft Inc USA - "Statistica 6.0".&#x0D; 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 &lt;0.05).&#x0D; 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.&#x0D; The research found that the value of EMAR-II&gt; 5.42 μmol / l in patients with AMI in combination with type 2 diabetes and&gt; 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.&#x0D; 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.&#x0D; 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.&#x0D; 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.&#x0D; 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.

Asymmetric dimethylarginine – a marker of repeated cardiovascular events in patients with comorbid pathology

Annotation. Today, diseases of the cardiovascular system retain their leading position among the incidence in the world. The presence of comorbid pathology in the form of type 2 diabetes mellitus (DM) significantly complicates the course of these diseases, worsening its prognosis. The aim of the study: to analyze the prognostic value of asymmetric dimethylarginine (ADMA) as a marker of recurrent cardiovascular events in patients with acute myocardial infarction with type 2 diabetes for 6 months of follow-up. 120 patients were examined: group 1 – patients with acute myocardial infarction (AMI) in combination with type 2 diabetes mellitus (n=70), group 2 - patients with isolated AMI (n=50). The control group included 20 practically healthy individuals. All patients underwent general clinical and instrumental examinations, on the first day of AMI the level of ADMA was determined using a commercial test system "Human Asymmetrical Dimethylarginine ELISA". Statistical processing of the obtained data was performed using the software package StatSoft Inc, USA – "Statistica 6.0". The analysis of the average level of ADMA showed a significantly higher value of this indicator in patients with AMI in combination with type 2 DM than in patients without concomitant type 2 DM 2.57 times (1.57±0.11 μmol / l and 0.61±0.06 μmol / l, respectively), (p&lt;0,05. ADMA level &gt;1,72 μmol / l in patients with AMI in combination with type 2 DM and &gt;0,69 μmol / l in patients with AMI without concomitant type 2 DM was identified as a predictor of recurrent acute myocardial infarction within 6 months of follow-up. Thus, the level of ADMA was higher in the presence of comorbid pathology in the form of type 2 DM in patients with AMI, reflecting endothelial dysfunction combining disease. It is advisable to further study this indicator of endothelial dysfunction as a predictor of the adverse course of AMI in combination with concomitant type 2 DM.

Peripheral neutrophils and naive CD4 T cells predict the development of heart failure following acute myocardial infarction: A bioinformatic study.

Heart failure (HF) secondary to acute myocardial infarction (AMI) is still a worldwide problem with a high mortality rate. The current study aimed to explore early and reliable predictive biomarkers of HF following AMI. The gene expression profile GSE59867 was downloaded from GEO. Array data from peripheral blood mononuclear cells (PBMCs) was used from 46 control patients and 111 patients with AMI at four time points: (i) first day of AMI; (ii) 4-6 days after AMI; (iii) one month after AMI; and (iv) six months after AMI. Among the 111 AMI patients, nine with HF and eight without HF were studied. CIBERSORT was used to analyze the relative proportions of immune cells in PBMCs. The proportions of immune cells in different groups were compared. Differentially expressed genes (DEGs) were analyzed with R language packages. The percentages of monocytes and neutrophils increased significantly on the first day of AMI, and then decreased gradually. The percentage of regulatory T cells increased significantly 4-6 days after AMI, while the percentage of resting memory CD4 cells, CD8 T cells, and resting natural killer cells decreased significantly on the first day of AMI, and then increased gradually. Patients who developed HF had a significantly higher proportion of neutrophils in PBMCs on the first day of AMI, but had a significantly lower proportion of naive CD4 T cells. Two shared genes, interleukin-1 receptor 2 (IL1R2) and leucine-rich repeat neuronal protein 3 (LRRN3), were found to have potentially important roles in predicting the development of HF following AMI. A higher proportion of neutrophils and a lower proportion of naive CD4 T cells in PBMCs on the first day of AMI may be correlated with the development of HF following AMI. IL1R2 and LRRN3 may exert functions in the development of HF following AMI.

Peripheral neutrophils and naive CD4 T cells predict the development of heart failure following acute myocardial infarction: A bioinformatic study

IntroductionHeart failure (HF) secondary to acute myocardial infarction (AMI) is still a worldwide problem with a high mortality rate. The current study aimed to explore early and reliable predictive biomarkers of HF following AMI. MethodsThe gene expression profile GSE59867 was downloaded from GEO. Array data from peripheral blood mononuclear cells (PBMCs) was used from 46 control patients and 111 patients with AMI at four time points: (i) first day of AMI; (ii) 4-6 days after AMI; (iii) one month after AMI; and (iv) six months after AMI. Among the 111 AMI patients, nine with HF and eight without HF were studied. CIBERSORT was used to analyze the relative proportions of immune cells in PBMCs. The proportions of immune cells in different groups were compared. Differentially expressed genes (DEGs) were analyzed with R language packages. ResultsThe percentages of monocytes and neutrophils increased significantly on the first day of AMI, and then decreased gradually. The percentage of regulatory T cells increased significantly 4-6 days after AMI, while the percentage of resting memory CD4 cells, CD8 T cells, and resting natural killer cells decreased significantly on the first day of AMI, and then increased gradually. Patients who developed HF had a significantly higher proportion of neutrophils in PBMCs on the first day of AMI, but had a significantly lower proportion of naive CD4 T cells. Two shared genes, interleukin-1 receptor 2 (IL1R2) and leucine-rich repeat neuronal protein 3 (LRRN3), were found to have potentially important roles in predicting the development of HF following AMI. ConclusionA higher proportion of neutrophils and a lower proportion of naive CD4 T cells in PBMCs on the first day of AMI may be correlated with the development of HF following AMI. IL1R2 and LRRN3 may exert functions in the development of HF following AMI.

Clinical burden of MACE in patients with multivessel disease during the early period following acute myocardial infarction

Abstract Background Despite numerous interventions that have improved outcomes in acute myocardial infarction (AMI) patients, the first 90 days after AMI remains a high-risk period for recurrent events. Due to higher disease burden and suboptimal outcomes, it is crucial to characterize the clinical burden upon patients with multivessel disease (MVD) and various comorbidities. Purpose To describe the post-AMI clinical burden of major adverse cardiovascular events (MACE) in patients with MVD at 30, 90, and 365 days. Methods This was a retrospective cohort study (1st January, 2008 to 31st December, 2018) using data from a longitudinal, representative UK population health dataset comprising primary care data from the Clinical Practice Research Datalink (CPRD). This was linked to data from the Hospital Episode Statistics (HES) and Office of National Statistics (ONS) databases to identify patients with a confirmed diagnosis code of MVD. A MACE was defined as any one of non-fatal MI, non-fatal stroke, or cardiovascular death. The prevalence of MACE among post-AMI patients with MVD and the effect of concurrent risk factors was quantified. Results 403,631 patients with MVD were identified (21.69% of the total study population), nearly one-fifth of whom (n=78,128; 19.35%) experienced an AMI after their first recorded diagnosis of MVD (MVD+). The mean and median age of MVD+ patients was 66 years, and the majority (72.9%) were male. Almost half (48.9%) had a Charlson co-morbidity score of at least 1, and 99.8% had an index of multiple deprivation recorded, distributed evenly across the quintiles. At least one of the composite MACE occurred in 9,533 (12.2%), 11,694 (14.9%), and 15,188 (19.4%) MVD+ patients within 30, 90, and 365 days, respectively. In MVD+ patients with 2 or more additional risk factors (peripheral artery disease [PAD], age &amp;gt;65, prior AMI; w/out comorbid diabetes; n=7,531), the proportion of MACE within 90 days was substantially higher (42.7%). Non-fatal MI was the most common MACE episode in MVD+ patients, occurring in 7,696, (9.8%), 8,924 (11.4%), and 10,673 (13.7%) MVD+ patients at 30, 90, and 365 days, respectively. Within 90 days of AMI, 39.1% of MVD+ patients with 2 or more risk factors experienced non-fatal MI. Conclusions MVD patients have a considerable clinically relevant burden of MACE following AMI. The majority of 1-year recurrent events occurred within 90 days of MACE, with 90-day risk almost 3-fold higher in patients with two additional risk factors. For patients with MVD and other risk factors, opportunities remain for treatments that may reduce the risk of recurrent events in the early period following AMI. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): CSL Behring

Correlation between Increased Serum Vascular Endothelial Growth Factor Levels and 30-Day-Outcome After Acute Myocardial Infarction

Vascular Endothelial Growth Factor (VEGF) plays an important role in the process of regeneration and vascular repair. Atherogenesis and angiogenesis contribute to the formation of coronary collateral circulation as an alternative source of blood supply during the repairing process of Acute Myocardial Infarction (AMI). This study aimed to investigate the elevation of VEGF and its correlation to Peripheral Blood Mononuclear Cells (PBMC) and Major Adverse Cardiovascular st nd th Events (MACE). Serum VEGF measurements were carried out on 1 , 2 , and the 5 -day onset of angina on 20 patients using st th Chemwell Analyzer based on ELISA method. PBMC was counted on days 1 and 5 according to CBC results from Automatic Cell Counter Sysmex XN-1000i. The major adverse cardiovascular event was recorded 30 days after AMI onset. It was found nd that serum VEGF level in this study was 169.3±34.5 pg/mL on the 1st day, 217.0±49.7 pg/mL on the 2 day, and th th 249.2±48.5 pg/mL on the 5 day. Serum VEGF levels increased gradually and the highest value was found on the 5 day st (p=0.000). There was no correlation between elevated serum VEGF levels with PBMC on the 1 day (p=0.429, r=-0.035) and th the 5 day of AMI (p=0.225, r=+0.081). There was no correlation between elevated serum VEGF levels with incidence of MACE on 30 days after onset of AMI (OR=0.959, 95% CI, p=0.302). Serum VEGF concentrations are increased in Acute Myocardial Infarction and can be used as a marker of myocardial injury. However, this study was unable to prove its role in the outcome of AMI

Safety and Feasibility of MitraClip Implantation in Patients with Acute Mitral Regurgitation after Recent Myocardial Infarction and Severe Left Ventricle Dysfunction.

Patients with severe mitral regurgitation (MR) after myocardial infarction (MI) have an increased risk of mortality. Transcatheter mitral valve repair may therefore be a suitable therapy. However, data on clinical outcomes of patients in an acute setting are scarce, especially those with reduced left ventricle (LV) dysfunction. We conducted a multinational, collaborative data analysis from 21 centers for patients who were, within 90 days of acute MI, treated with MitraClip due to severe MR. The cohort was divided according to median left ventricle ejection fraction (LVEF)—35%. Included in the study were 105 patients. The mean age was 71 ± 10 years. Patients in the LVEF < 35% group were younger but with comparable Euroscore II, multivessel coronary artery disease, prior MI and coronary artery bypass graft surgery. Procedure time was comparable and acute success rate was high in both groups (94% vs. 90%, p = 0.728). MR grade was significantly reduced in both groups along with an immediate reduction in left atrial V-wave, pulmonary artery pressure and improvement in New York Heart Association (NYHA) class. In-hospital and 1-year mortality rates were not significantly different between the two groups (11% vs. 7%, p = 0.51 and 19% vs. 12%, p = 0.49) and neither was the 3-month re-hospitalization rate. In conclusion, MitraClip intervention in patients with acute severe functional mitral regurgitation (FMR) due to a recent MI in an acute setting is safe and feasible. Even patients with severe LV dysfunction may benefit from transcatheter mitral valve intervention and should not be excluded.

Нові можливості оцінювання ризику розвитку госпітальних ускладнень у хворих з гострим інфарктом міокарда з елевацією сегмента ST за даними вивчення клітинного складу крові

The aim – to create a new method of assessing the development of hospital complications in STEMI patients by studying blood cell composition and its adaptation to practical application in general clinical practice.Materials and methods. The study was involved 317 patients with acute myocardial infarction (AMI) who was admitted from January 2014 to June 2020 to the intensive care unit. Some patients were evaluated retrospectively and were in group 1 (n=214). Group 2 – 103 patients, who were studied prospectively. The group of patients did not differ in clinical and anamnestic characteristics and treatment. An index of hospital complications was created for assessing the criteria of the severity of the clinical course.Results and discussion. A number of correlation analyses were performed to examine the relationships between white blood components, platelet heterogeneity and systemic inflammation, and the hospital complication index. On the basis of these data we have built a complex index – leukocyte-platelet index (LTI): LTI (conditional unit) = ((GRA – MON) / LYM) · 10 + PDWc + P-LCR, where: GRA is the number of granulocytes in the blood test, MON is the number of monocytes, LYM is the number of lymphocytes, PDWc is the percentage of platelet distribution by size, and P-LCR is the percentage of large (&gt; 12fL) platelets. When assessing in group 1 correlations with the index of nosocomial complications and combined indicators: neutrophil-lymphocyte ratio (NLR) and the LTI index created by us showed the highest degree of correlation with the index of hospital complications (p&lt;0.001 and p&lt;0.0005, respectively). When the value of LTI &gt; 137 conventional units can be judged on the increased risk of nosocomial complications of AMI (sensitivity 64 %, specificity 78 %, area under the curve 0.72). Thus, in a prospective approbation study, the LTI on the first day of AMI was significantly (p&lt;0.05) better than other indicators, in particular, better than the widely used leukocyte marker NLR in determining the susceptibility to the undesirable course of the hospital period of the disease.Conclusions. The created computer algorithm for calculating the risk index of complications in patients with AMI on the first day can be widely implemented in modern health care facilities in Ukraine.

Percutaneous coronary intervention in patients with cancer and readmissions within 90 days for acute myocardial infarction and bleeding in the USA.

The post-discharge outcomes of patients with cancer who undergo PCI are not well understood. This study evaluates the rates of readmissions within 90 days for acute myocardial infarction (AMI) and bleeding among patients with cancer who undergo percutaneous coronary intervention (PCI). Patients treated with PCI in the years from 2010 to 2014 in the US Nationwide Readmission Database were evaluated for the influence of cancer on 90-day readmissions for AMI and bleeding. A total of 1933324 patients were included in the analysis (2.7% active cancer, 6.8% previous history of cancer). The 90-day readmission for AMI after PCI was higher in patients with active cancer (12.1% in lung, 10.8% in colon, 7.5% in breast, 7.0% in prostate, and 9.1% for all cancers) compared to 5.6% among patients with no cancer. The 90-day readmission for bleeding after PCI was higher in patients with active cancer (4.2% in colon, 1.5% in lung, 1.4% in prostate, 0.6% in breast, and 1.6% in all cancer) compared to 0.6% among patients with no cancer. The average time to AMI readmission ranged from 26.7 days for lung cancer to 30.5 days in colon cancer, while the average time to bleeding readmission had a higher range from 38.2 days in colon cancer to 42.7 days in breast cancer. Following PCI, patients with cancer have increased risk for readmissions for AMI or bleeding, with the magnitude of risk depending on both cancer type and the presence of metastasis.

Timing of coronary artery bypass grafting after acute myocardial infarction: does it influence outcomes?

IntroductionThe optimal timing of coronary artery bypass grafting (CABG) operations in patients with recent acute myocardial infarction (AMI) remains unclear.AimTo assess the influence of timing on post-operative outcomes in patients undergoing CABG following AMI.Material and methodsIn this retrospective analysis 12,224 consecutive patients undergoing CABG were included. 2477 (20.5%) patients had a history of AMI. Based on timing, patients were divided into 3 groups: those operated within 7 days of AMI; those operated after 7 days but within 1 month; and a third group operated after 1 month but within 3 months. The 3 groups were compared in terms of baseline, intra-operative, and post-operative morbidity and mortality. Multivariate analysis was carried out to assess the independent influence of timing of CABG on outcomes.ResultsThere was no difference in terms of previous neurological events (p = 0.554), presence of carotid artery disease (p = 0.555), prevalence of hypertension (p = 0.119), diabetes (p = 0.144), hypothyroidism (p = 0.53), chronic obstructive pulmonary disease (p = 0.079), peripheral vascular disease (p = 0.771), and impaired left ventricular function (p = 0.072). On univariate analysis, mortality risk was highest between 1 week and 1 month (p = 0.003). Multivariate analysis showed that the closer the MI and CABG duration, the higher the mortality (co-efficient –0.517; p = 0.019; odds ratio = 0.596; 95% CI: 0.388–0.917).ConclusionsThe duration between MI and CABG has a direct influence on outcomes after CABG. While it is clear that the longer the duration between MI and CABG, the lower the mortality risk, it is however difficult to decide on an exact cut-off time frame.