Days Of Myocardial Infarction Research Articles

Health Services Use and Outcomes for Hospital Admissions With a Major Cardiovascular Event Recorded in Health Care Administrative Data in Patients Receiving Maintenance Hemodialysis: A Retrospective Cohort Study.

Administrative data are used in studies of hemodialysis care to report cardiovascular-related hospitalizations. Showing recorded events are associated with significant health care resource use and poor outcomes would confirm that administrative data algorithms identify clinically meaningful events. The objective of this study was to describe the 30-day health service use and outcomes when a hospital admission with myocardial infarction, congestive heart failure, or ischemic stroke is recorded in administrative databases. This is a retrospective review of linked administrative data. Patients receiving maintenance in-center hemodialysis in Ontario, Canada, between April 1, 2013, and March 31, 2017, were included. Records from linked health care databases at ICES in Ontario, Canada were considered. We identified hospital admission with the most responsible diagnosis recorded as myocardial infarction, congestive heart failure, or ischemic stroke. We then assessed the frequency of common tests, procedures, consultations, post-discharge outpatient drug prescriptions, and outcomes within 30 days following the hospital admission. We used descriptive statistics to summarize results using counts and percentages for categorical variables and means with standard deviations or medians with quartile ranges for continuous variables. There were 14 368 patients who received maintenance hemodialysis between April 1, 2013, and March 31, 2017. The number of events per 1000 person-years was 33.5 for hospital admissions with myocardial infarction, 34.2 for congestive heart failure, and 12.9 for ischemic stroke. The median (25th, 75th percentile) duration of hospital stay was 5 (3-10) days for myocardial infarction, 4 (2-8) days for congestive heart failure, and 9 (4-18) days for ischemic stroke. The chance of death within 30 days was 21% for myocardial infarction, 11% for congestive heart failure, and 19% for ischemic stroke. Events, procedures, and tests recorded in administrative data can be misclassified compared with medical charts. In patients receiving maintenance hemodialysis, hospital admissions of major cardiovascular events routinely recorded in health administrative databases are associated with significant use of health service resources and poor health outcomes.

VISCOSE AND THROMBOCYTIC-AGGREGATION DISORDERS ON PATIENTS WITH MYOCARDIAL INFARCTION WITH STABLE ELEMENTATION OF ST SEGMENT

Relevance. Clinical studies indicate a significant role in the pathogenesis of acute myocardial infarction, the functional state of platelet aggregation and blood viscosity, which determine the nature of blood flow in the vessels at the level of macro– and microcirculation.
 Objective: the aim of the study was to analyze changes in viscosity and platelet-aggregation disorders under the influence of different tactical, diagnostic and interventional approaches in patients with myocardial infarction and stable elevation of the ST segment in the presence of multivascular coronary artery disease.
 Materials and methods. Patient inclusion criteria for the study: MI with persistent ST-segment elevation; multi-vascular atherosclerotic coronary artery disease; angiographically significant stenosis of the coronary vessels more than 50-70%, at least in 2 projections; functionally significant stenosis of the coronary arteries, according to the fractional blood flow reserve (FBFR) (<0.80). 102 patients were divided into 4 groups of the same type. The groups used 4 different tactical and treatment-diagnostic approaches. Group 1 (n = 25) - occlusion of an infarct-dependent vessel was detected using coronary angiography and its immediate stenting was performed; FBFR was established on days 2-3, and stenosis of infarction-independent arteries was proved; using optical coherence tomography (OCT), the stability, size, length of atheroma was assessed and delayed stenting of these vessels was performed. Group 2 (n = 26) - stenting of the infarct-dependent artery was performed; FBFR was established on days 2-3, but without OCT, followed by stenting of infarct-independent arteries. Group 3 (n = 25) - carried out simultaneous stenting of infarct-dependent and infarct-independent vessels after coronary angiography. Group 4 (n = 26) - only stenting of the infarct-dependent vessel was performed. All patients received standard two-component antiplatelet therapy (acetylsalicylic acid 75-150 mg/day and clopidogrel 75 mg/day) and received 20 mg of atorvastatin and 10 mg of ezetimibe. The results obtained in patients were compared with those results obtained in 30 practically healthy people of the same age and gender. The number of platelets and the concentration of fibrinogen were determined in each subject. Using a viscometer and a laser aggregometer the degree of platelet adhesion, the time of platelet adhesion, the degree of platelet aggregation, and blood viscosity were assessed. All indicators were studied three times - on the first day of myocardial infarction, after 3-4 weeks, and after a year. 
 Results. Hyperviscous and hypercoagulable syndromes were established in patients with MI with persistent ST-segment elevation. They manifested themselves in the first weeks by a compensatory increase in the number of platelets, blood viscosity, fibrinogen levels, and an increase in platelet aggregation. Delayed stenting of infarct-independent arteries used in group 1 contributed to a lower amplitude of fluctuations of all laboratory parameters in comparison with other tactical and therapeutic approaches.
 Conclusions. It is possible to optimize the state of viscosity and the processes of adhesion/aggregation of platelets due to the systemic stepwise improvement of arterial blood supply. Traditional tactical and therapeutic-diagnostic principles of management of such category of patients do not fundamentally improve the state of viscous and coagulation-aggregation parameters even when using double antiplatelet therapy.

Relationship of the degree of coronary lesion and serum adipokine levels in patients with myocardial infarction

Abstract The role of adipokines in the development of myocardial infarction (MI) is being actively discussed. It is of interest to determine the association between the degree of coronary lesion and serum levels of the studied parameters, as well as the prognostic role of these factors in relation to the risk of developing an unfavorable outcome of MI, which is important for choosing the tactics of a therapeutic strategy. Aims Identification of the presence and characteristics of the relationship of the degree of coronary lesions with the levels of adiponectin and leptin in the blood serum of patients with MI. Materials and methods The study included 119 patients with ST-segment elevation MI who signed voluntary informed consent. Depending on the degree of coronary lesion, patients were divided into 3 groups by the SYNTAX Score: 47 moderate (≤22, Group 1), 42 severe (23–31, Group 2) and 30 extremely severe (≥32, Group 3). The concentrations of adiponectin and leptin was determined in blood serum by ELISA on the 1st and 12th days of hospitalization (BioVendor, USA). Statistical analysis was performed using Statistica 9.0. Results The concentrations of the studied parameters in the blood serum of patients on the 1st day of hospitalization were: adiponectin 7.72 (6.5; 13.0) μg/ml, leptin 7.48 (5.98; 12.5) ng/ml. On the 12th day, there was an increase in the level of adiponectin by 1.5 times and a decrease in leptin by 1.6 times. Correlation analysis revealed significant dependences of the degree of coronary lesion according to the SYNTAX Score with the serum adiponectin level both on the 1st (r=−0.48; p=0.01) and on the 12th day (r=−0.44; p=0.02), and leptin level on the 1st (r=0.35; p=0.01) and 12th days (r=0.37; p=0.01). Conclusions The results of this study indicate a relationship between the degree of coronary lesion, assessed by the SYNTAX Score, and the serum adipokine profile in patients with MI. Based on the data obtained, it can be concluded that the studied markers are capable of reflecting the degree of coronary artery disease already on the 1st day of myocardial infarction and the possibility of using the risk of developing myocardial infarction as biomarkers. Funding Acknowledgement Type of funding sources: None.

ОСТРАЯ И ХРОНИЧЕСКАЯ СЕРДЕЧНАЯ НЕДОСТАТОЧНОСТЬ ПОСЛЕ ИНФАРКТА МИОКАРДА: КЛИНИЧЕСКИЕ И ФУНКЦИОНАЛЬНЫЕ МАРКЕРЫ

Вackground. The last decade has seen an increase in the number of people who have had myocardial infarction (MI). This phenomenon contributes to an increase in the long-term incidence of chronic cardiovascular diseases, including chronic heart failure. Purpose of the study. To identify the most significant clinical and functional indicators characterizing acute and chronic heart failure after myocardial infarction. Patient Characterization and Research Methods. This analysis included 186 patients who had myocardial infarction from January 2019 to January 2020: 86 people, the main subgroup, with signs of CHF above FC 2 (NYHA) (mean age 64.3 g) and 100 people, the comparison subgroup, without signs of CHF or had CHF 1 FC (NYHA) (mean age 62.6 l). After 1 year, clinical outcomes were assessed: cardiovascular death, repeated hospitalizations due to decompensation of CHF, death from other causes, stroke, repeated myocardial infarction, unplanned coronary revascularization. Results. In the acute period of myocardial infarction in the main subgroup (MI + CHF more than 2cl NYHA), all patients had symptoms of acute heart failure (AHF) in the form of Killip II and Killip III. Predictors of the development of chronic heart failure were the presence of a history of ischemic heart disease, confirmed in accordance with the recommendations, before myocardial infarction; decreased fraction of the left ventricle, detected before discharge and on the 30th day of myocardial infarction; the presence of atrial fibrillation (AF). One-year unfavorable outcomes in the main group were significantly more frequent. Subanalysis of long-term drug therapy showed that cardiovascular death was significantly less common in the subgroup of patients taking ARNI than in the subgroup of enalapril. Conclusion. In the present study, we studied postinfarction myocardial remodeling, which is realized in the form of the formation of a syndrome of acute and chronic heart failure. It has been shown that immediate reperfusion and restriction of the necrosis zone, as well as long-term use of drugs that inhibit SAS and RAAS, stimulating NPP, can inhibit the development of AHF and death. The CHF problem requires further fundamental research in order to develop new approaches that can affect more subtle mechanisms, such as the expression of specific genes involved in the disease, in order to reduce the persisting excess mortality for this pathology.

The role of infectious and seasonal factors in the development of myocardial infarction in men under 60 years old

The influence of seasonal and infectious factors on the risk of an unfavorable outcome in the first 56 days of myocardial infarction, a complicated course of the disease, the development of chronic heart failure of the second functional class and higher during this period was studied. The results of examination and treatment of 556 men 1960 years old with verified type I myocardial infarction were evaluated. The analysis of the risks of an unfavorable outcome, a complicated course of the disease, and the development of chronic heart failure was carried out by the method of multivariate analysis of variance. Chronic foci of infections of the abdominal cavity and kidneys, myocardial infarction in winter, spring and autumn have a moderate negative effect on the prognosis of the disease in the examined. Predictors of unfavorable prognosis are heterogeneous across the seasons. Frequent respiratory infections and chronic inflammatory lung diseases reduce the risk of death in those examined in the first months of myocardial infarction, however, they significantly increase the risk of developing chronic heart failure (bibl.: 19 refs).

Progression of the atherosclerotic lesions of the coronary arteries in patients after myocardial infarction at 3-year follow-up

The aim – to study and analyze the clinical and functional characteristics and parameters of lipid metabolism in patients after acute myocardial infarction (MI), depending on the progression of atherosclerosis according to the data of repeated coronary angiography (CAG) during a three-year follow-up.Materials and methods. The study prospectively included 91 patients with primary Q-MI, 47 of whom underwent a full cardiac rehabilitation (CR) program with physical training (FT), 44 patients – had only complexes of physical exercises and distance walking in accordance with the terms of MI. For three years, CAG was performed in 38 patients, in 18 (group 1) of whom the progression of the atherosclerotic process was established, in 20 (group 2) progression was not visualized in CAG. 53 patients (group 3) had a stable satisfactory condition and refused to repeat CAG. Treatment was performed in accordance with modern guidelines with urgent stenting of the infarct-dependent coronary artery. All patients underwent dosed testing on a bicycle ergometer, echocardiography and an evaluation of lipid metabolism indicators. Control examinations were carried out at discharge on the 10-15th day of myocardial infarction and in dynamics after 1 and 3 years. Results and discussion. Undesirable cardiovascular events (recurrent MI, coronary artery bypass grafting, restenosis, and hemodynamic significant stenoses) occurred only in the 1st group: 7 events – during the first year, also 7 – during the second year, and the last 14 – during the third year. In the second group, in the first week of myocardial infarction stent thrombosis occurred in 2 patients, coronary bypass grafting was performed according to the data of urgent coronary angiography also in 2 patients. During the 3-years follow up in the group with the progression of atherosclerosis the number of patients with diabetes mellitus tripled, and there was also a tendency to an increase in body mass index. According to the results of the exercise test on a bicycle ergometer and echocardiography, significant differences in the groups were not established, however, a positive trend in the dynamics of observation was noted in patients of the 2nd group without progression of atherosclerosis. Low-density lipoprotein cholesterol values ​​were obtained on the 5–7th day of myocardial infarction at the background of high-intensity statin therapy and were considered as basic. Further results showed the best performance in the first 6–12 months after myocardial infarction with better adherence to medical recommendations in the period as close as possible to acute MI. In the group of patients with progression of atherosclerosis, the maximum decrease in the level of low-density lipoprotein cholesterol (up to 2.10 (1.79–2.38) mmol/L) was observed after 6 months, followed by an increase in 1 and 3 years to a level exceeding the baseline. Variations in this indicator in patients without progression were 1.85–2.02–1.83 mmol/L, which was close to the recommended target values ​​(up to 2019).Conclusions. In the group with the progression of the atherosclerotic process, the number of patients with diabetes mellitus increased over 3 years and a tendency towards an increase in body mass index was observed. Most of the patients returned to smoking by the end of the first year after myocardial infarction, but then 3 years later, some of the patients in group 2 stopped smoking again, which may indicate the effectiveness of training and the psychological component of cardiac rehabilitation in the group without progression of the atherosclerotic process. The results of echocardio­­graphy and the level of exercise tolerance at the time of examination did not differ in patients with and without progression of the atherosclerotic process. Maintaining the target levels of LDL cholesterol is possible only under the condition of long-term high-intensity statin therapy under the supervision of a physician, adherence to the comprehensive recommendations of stage III CR at each contact with the patient.

Comparative Results of Emergency Carotid Endarterectomy and Emergency Carotid Angioplasty With Stenting in the Acute Period of Ischemic Stroke. Multicenter Study Results

AIM OF STUDY Study of hospital results of emergency carotid endarterectomy (CEE) and carotid angioplasty with stenting (CAS) in the acute period of acute cerebrovascular accident (ACVA). MATERIAL AND METHODS From January 2008 to August 2020, the study included 615 patients with hemodynamically significant stenosis of the internal carotid arteries (ICA), operated on in the acute period of ischemic stroke (within 3 days from the onset of stroke). Depending on the type of revascularization implemented, all patients were divided into 2 groups: group 1 — CAS (n=312); 2nd group — CEE (n=357). Inclusion criteria were as follows: 1. Mild neurological disorders: NIHSS score 3–8; Modified Rankin Scale score 2 of less; Barthel Scale > 61; 2. Indications for CEE / CAS according to the current national recommendations; 3. Ischemic focus in the brain not more than 2.5 cm in diameter. Exclusion criteria: 1. Presence of con-traindications to CEE / CAS. Carotid angioplasty with stenting was performed according to the standard technique; in all cases, distal embolism protection systems were used. Carot-id endarterectomy was performed according to the classical and eversion techniques. When the retrograde pressure in the ICA was less than 60% of the systemic pressure, a temporary shunt (TS) was installed. In the postoperative period, all patients underwent multispiral computed tomography (MSCT) of the brain. In the absence of negative dynam-ics in the neurological status, MSCT was performed on the 7th day after the operation, if available, it was performed urgently. The checkpoints were the development of such unfa-vorable cardiovascular events as death, myocardial infarction (MI), stroke / transient is-chemic attack (TIA), “mute” stroke, “mute” hemorrhagic transformations, combined end-point (death + all strokes / TIA + MI). Strokes were mute if diagnosed according to MSCT, without symptoms. RESULTS In 69% of diabetic patients with anterior myocardial infarction and in 63% of patients with posterolateral MI 12 months after PCI, signs of LV inferiority were revealed in the form of an increase in the indices of end-diastolic and systolic volumes of the LV and low ejection fraction (≤45%). In patients without diabetes, these figures were 18% and 31%, respectively. High concentrations of NT-proBNP on the first day of myocardial infarction after PCI were of the greatest value in the diagnosis and prognosis of LV UR after 12 months. RESULTS When analyzing hospital complications, significant differences in the frequency of lethal outcome were not obtained (group 1: n=6 (1.92%); group 2: n=8 (2.24%); p=0.98; OR=0.85; 95% CI 0.29–2.49); MI (group 1: n=5 (1.6%); group 2: n=5 (1.4%); p=0.91; OR=1.14; 95% CI 0.32–3.99 ); ACVA (ischemic type) / TIA (group 1: n=5 (1.6%); group 2: n=6 (1.7%); p=0.82; OR=0.95; 95% CI 0.28–3.15), as well as “mute” ACVA (group 1: n=7 (2.2%); group 2: n=15 (4.2%); p=0.23; OR=0.52; 95% CI 0.21–1.3). However, the vast majority of hemorrhagic transformations (group 1: n=2 (0.64%); group 2: n=13 (3.6%); p=0.018; OR=0.17; 95% CI 0.03–0.76) and all “mute” hemorrhagic transformations (group 1: n=0; group 2: n=26 (7.3%); p=0.001; OR=0.02; 95% CI 0.001–0.33) were observed only in the CEE group, which was reflected in the maximum values of the combined end point: group 1: n=22 (7.05%); group 2: n=73 (20.4%); p<0.0001; OR=0.29; 95% CI 0.17–0.48). Thus, in the CEE group, every 5th patient had a complication. CONCLUSION Carotid angioplasty with stenting is the safest method of revascularization for patients in the acute period of ACVA. This is largely due to the reduction in the risk of reperfusion syndrome and the prevention of embolism due to the use of modern protection systems. Carotid endarterectomy can be performed with comparable efficiency only when a tempo-rary shunt is placed in the internal carotid arteries in the absence of unstable atheroscle-rotic plaque.

Participation of the C-terminal propeptide procollagen type I in the formation of cardiofibrosis in patients with myocardial infarction with preserved left ventricular ejection fraction

Aim. To study the dynamics of procollagen type I carboxy-terminal propeptide (PICP) with an assessment of potential associations with cardiac fibrosis (CF) and diastolic dysfunction (DD) of the left ventricle (LV) during the hospitalization and one year after ST segment elevation myocardial infarction (STEMI).Material and methods. The study included 120 patients with STEMI. There were following inclusion criteria: diagnosis of STEMI (2015 European Society of Cardiology guidelines); Killip £III acute heart failure (AHF); signed informed consent; patient age >18 years old. There were following exclusion criteria: STEMI due to percutaneous coronary intervention or coronary artery bypass grafting; Killip IV AHF; patient age >80 years; clinically significant comorbidities; death of the patient during the first day of hospitalization. On the 1st, 12th day of the disease and after a year all patients underwent echocardiography and the PICP concentration was determined. One year after myocardial infarction, contrast-enhanced cardiac magnetic resonance imaging was performed to assess CF. In the analyzed group of patients, on day 1 of STEMI, mean values of LV ejection fraction (EF) in the range of 40-49% were observed in 3 (2,5%) patients, LVEF <40% — in 31 (26%), LVEF ≥50% — in 86 (71,7%). The final analysis was performed on a sample of patients with preserved LVEF (n=86) (71,7%).Results. On the first day of myocardial infarction, signs of DD were noted in 25 (29,1%) patients, while after 1 year, their number increased by 9 (10%) and amounted to 34 (39,5%) patients. In 15 (17,6%) people, worsening of myocardial systolic dysfunction was noted. Patients with a CF ³16% had the highest PICP expression on the first day of the disease. CF ≥16% one year after STEMI with preserved EF is associated with PICP concentration on day 1 of the disease. In addition, multidirectional correlations were revealed between the CF ≥16% and parameters of LV diastolic function (e’, mean pulmonary artery pressure, E/e’).Conclusion. Determination of the PICP concentration on the 1st day of myocardial infarction will allow early identification of patients at risk of CF one year after STEMI with preserved EF.

Predictive Value of N-Terminal Prohormone of Brain Natriuretic Peptide in Long-Term Remodeling of the Left Ventricle in Diabetic Patients of Young and Middle Age With Acute Coronary Syndrome After Percutaneous Coronary Intervention

Abstract. Recently, quantitative analysis of the level of the N-terminal prohormone of the brain naturetic peptide (NT-proBNP) has been widely used to diagnose heart failure (HF). A statistically significant correlation was found between the serum NT-proBNP concentration and HF stage. It was found that in patients with high cardiovascular risk, NT-proBNP has the highest predictive value in relation to mortality. In young and middle-aged patients with diabetes mellitus (DM) with myocardial infarction (MI) and stents of an infarct-associated artery, the frequency of unfavorable remodeling (UR) of the left ventricle (LV) in the long-term prognosis was studied. The frequency of atherosclerotic lesions of the coronary arteries (CA) in patients with diabetes in acute coronary syndrome (ACS) was determined, the results of echocardiographic parameters were presented in the follow-up dynamics, the value of serum NT-proBNP in predicting LV UR 12 months after myocardial infarction (MI) was determined.Aim of study. To assess the diagnostic capabilities of NT-proBNP in the long-term prediction of the development of LV infarction in patients with MI with diabetes in young and middle age after percutaneous coronary intervention (PCI).Design. Prospective controlled non-randomized trial. The patients were examined twice: on the first day of ACS after PCI with stenting of infarct-associated coronary artery and 12 months after AMI. The study included 191 patients with ACS with / without ST-segment elevation, who were divided into two groups. The main group included 76 patients with ACS with diabetes mellitus, the comparison group included 115 patients with ACS without diabetes mellitus. Patients in both groups were comparable in age, gender, comorbidity, and complications of AMI. The duration of diabetes was, on average, 6 years (from one to 12 years).Material and methods. All patients underwent electrocardiography, echocardiography, tests for the content of troponin I, NT-proBNP, glycosylated hemoglobin, lipids, determined the level of creatinine in the blood and the glomerular filtration rate according to the Modification of diet in renal disease (MDRD). All patients were examined twice: on the first day of ACS after PCI with stenting of infarct-associated coronary artery and 12 months later.Results. In 69% of diabetic patients with anterior myocardial infarction and in 63% of patients with posterolateral MI 12 months after PCI, signs of LV inferiority were revealed in the form of an increase in the indices of end-diastolic and systolic volumes of the LV and low ejection fraction (≤45%). In patients without diabetes, these figures were 18% and 31%, respectively. High concentrations of NT-proBNP on the first day of myocardial infarction after PCI were of the greatest value in the diagnosis and prognosis of LV UR after 12 months.Conclusion. The NT-proBNP level of more than 776 pg/ml on the first day after PCI is an indicator of an unfavorable long-term prognosis in patients with young and middle-aged diabetes in terms of the development of LV systolic dysfunction.

Abstract 14556: Is There a Relationship Between Lipoprotein (a) and Proprotein Convertase Subtilisin /keksin Type 9 and Cardiovascular Events After Acute Myocardial Infarction?

Introduction: Lipoprotein (a) (Lp(a)) has atherogenic effects. Proprotein convertase subtilisin /keksin type 9 (PCSK9) involved in the degradation of LDL-C receptors, increasing LDL-C blood level. Hypothesis: Identify the relationship between Lp(a) and PCSK9 blood levels and major cardiovascular events (unstable angina, myocardial infarction, cardiovascular death) after acute myocardial infarction. Methods: The study included 119 patients with acute myocardial infarction (97 men and 22 women aged 50-70 years). Blood samples were taken on the 2nd day of myocardial infarction. The Lp(a) blood level was determined by immunoturbidimetry (RANDOX), the PCSK9 blood level was determined by ELISA (BioVendor). Primary combined endpoint included hospitalization due to myocardial infarction and unstable angina and cardiovascular death. Patient follow-up was 52 weeks. Statistical analysis methods included Mann-Whitney test and non-parametric correlation by Spearman. Results: In 36 (30.2%) patients with acute myocardial infarction the Lp(a) blood levels were higher than 30 mg/dL. In 83 (69.7%) patients the Lp(a) blood level were below 30 mg/dL. Mean values of Lp(a) blood level was 29.26 ± 2.79 (men 27.71 ± 2.82 mg/dL, women 36.07 ± 8.54 mg/dL, p = 0.797). Mean PCSK9 blood level was 479.7 ± 15.4 ng/ml (males 465.6 ± 16.2ng/ml, females 534.9 ± 38.9 ng/ml, p = 0.122). There was no significant correlation of Lp(a) blood level with total cholesterol, LDL-C, triglycerids and PCSK9 blood levels. No significant correlation was found between Lp(a) and PCSK9 blood levels and cardiovascular events within 12 months. In the group of smoking patients (n = 22) there was found negative correlation between PCSK9 and HDL-C blood levels (-0.45, p = 0.039). Conclusions: Due to the fact that there is no relationship between Lp(a) and PCSK9 blood levels and subsequent cardiovascular events within 52 weeks, the effectiveness of the use of PCSK9 inhibitors after acute myocardial infarction is doubtful.

The influence of the treatment recommendations completeness on the first day of myocardial infarction with the Q wave of the left ventricle with expansion to the right ventricle on the clinical course of the disease

The aim — to determine the correlation between the implementation completeness of the recommendations for treatment on the first day of the Q­IM of the left ventricle (LV) posterior wall (PW) with expansion to the right ventricle (RV) on the clinical course of the disease.Materials and methods.155 patients with Q­MI of the PWLV with expansion to the RV aged 64.11 ± 2.42 years, 103 (66.5 %) men and 52 (33.5 %) women were examined. Patients were divided into two groups: the 1st group — 29 (18.7 %) patients, who demonstrated severe hemodynamic complications (cardiogenic shock (CS) and Killip III); the 2nd group — 126 (81.3 %) patients with a stable hemodynamics. The quality of therapy was evaluated in the first 24 hours of MI treatment.Results and discussion. Severe hemodynamic complications were more common in women (p = 0.0016) and were associated with later hospitalization (p < 0.05), and with a low frequency of the ECG RV3—RV4 (p = 0.00001) recording at the prehospital stage. The development of CS and Killip III in patients with Q­IM of the PWLV with expansion to the RV was associated with low frequency of adequate doses of antiplatelet drugs prescription (p = 0.001), anticoagulants (p = 0.00002) and statins (p = 0.037) in the prehospital stage. The correlation between the development of severe hemodynamic disorders and the insufficient use of infusion solutions for the purpose of preload restoration on the RV (p = 0.011) and the high frequency of drugs with vasodilator properties application, in particular, ACE/ARA (p = 0.0004), nitrates (89 7 %, p = 0.0005), diuretics (62.1 %, p = 0.0012) and MgSO4 (51.7 %, p = 0.002) was established.Conclusions. In patients with Q­IM PWLV with expansion to the RV, the development of life­threatening hemodynamic complications, in particular, CS and Killip III, is significantly associated with a low level of diagnosis of the RV MI and non­compliance with the requirements of treatment recommendations on the first day of MI.

The effect of quercetin on the C-reactive protein dynamics and the long-term prognosis in patients with myocardial infarction of the right ventricle on the background of the q-myocardial infarction of the left ventricle

Aim of research: to estimate the influence of quercetin on the dynamic of C-reactive protein, course of myocardial infarction and long-term prognosis of patients with myocardial infarction of the right ventricle on the background of Q-MI of the left ventricle. Materials and methods. There were examined 208 patients with myocardial infarction of the right ventricle: the 1 st group - 155 patients on the background of the Q-MI of the posterior wall of the left ventricle, and the 2 nd group – 53 patients with right ventricle MI on the background of Q-MI of the left ventricle of the circular localization, aged 64.11±0.78 years. Quercetin was prescribed from the 1 st day of myocardial infarction: in the 1 st group – in 88 (55.5%) patients, in the 2 nd group – in 32 (60.4%) patients. The concentration of C-reactive protein in blood serum was determined on the 2 nd day of myocardial infarction and in 6 months with enzyme immunoassay analysis using HS-CRP EIA (Vienna, Austria). Follow-up was (30.6±4.5) months. Study endpoints were: cardiovascular death, unstable angina, recurrent myocardial infarction, heath failure hospitalizations and stroke. Results. The therapy by quercetin was accompanied by the reliable decrease of the risk of fatal arrhythmias, early post-infarction angina, manifestations of the acute and chronic heart failure in the acute period of myocardial infarction of the right ventricle. Quercetin prescription was associated with the reliable decrease of the C-reactive protein (р=0.006) levels in 6 months after myocardial infarction. There was established the predictor role of C-reactive protein after 6 months after infarction in the development of recurrent myocardial infarction (11.4%), unstable angina (7.7%) during 30.6 months. The therapy by quercetin in the 1 st group was associated with the decrease of the frequency of recurrent myocardial infarctions (р=0.012), heart failure hospitalizations (р=0.0056) and cases of the cardio-vascular death (р=0.039); in the 2 nd group – with the decrease of cases of unstable angina (р=0.012) and cardio-vascular death (р=0.01) comparing with patients on the standard therapy. Conclusion. Using of the quercetin in addition to the standard therapy in patients with myocardium infarction of the right ventricle is associated with the reliable decrease of cardiovascular events, particularly cardiovascular death, hospitalizations because of unstable angina and heart failure during 30.6 months of observation and positive dynamics of the C-reactive protein in 6 months after myocardium infarction. The level of C-protein in 6 months after myocardium infarction is an additional risk factor of cardiovascular complications during 30.6 months after myocardium infarction of the right ventricle

Up-regulated TLR4 in cardiomyocytes exacerbates heart failure after long-term myocardial infarction.

It remains unclear whether and how cardiomyocytes contribute to the inflammation in chronic heart failure (CHF). We recently reviewed the capacity of cardiomyocytes to initiate inflammation, by means of expressing certain immune receptors such as toll-like receptors (TLRs) that respond to pathogen- and damage-associated molecular patterns (PAMP and DAMP). Previous studies observed TLR4-mediated inflammation within days of myocardial infarction (MI). This study examined TLR4 expression and function in cardiomyocytes of failing hearts after 4 weeks of MI in rats. The increases of TLR4 mRNA and proteins, as well as inflammatory cytokine production, were observed in both the infarct and remote myocardium. Enhanced immunostaining for TLR4 was observed in cardiomyocytes but not infiltrating leucocytes. The injection of lentivirus shRNA against TLR4 into the infarcted heart decreased inflammatory cytokine production and improved heart function in vivo. Accordingly, in cardiomyocytes isolated from CHF hearts, increases of TLR4 mRNA and proteins were detected. More robust binding of TLR4 with lipopolysaccharide (LPS), a PAMP ligand for TLR4, and heat shock protein 60 (HSP60), a DAMP ligand for TLR4, was observed in CHF cardiomyocytes under a confocal microscope. The maximum binding capacity (Bmax ) of TLR4 was increased for LPS and HSP60, whereas the binding affinity (Kd) was not significantly changed. Furthermore, both LPS and HSP60 induced more robust production of inflammatory cytokines in CHF cardiomyocytes, which was reduced by TLR4-blocking antibodies. We conclude that the expression, ligand-binding capacity and pro-inflammatory function of cardiomyocyte TLR4 are up-regulated after long-term MI, which promote inflammation and exacerbate heart failure.

Implantable Cardioverter-Defibrillator Use Among Medicare Patients With Low Ejection Fraction After Acute Myocardial Infarction.

Implantable cardioverter-defibrillators (ICDs) are not recommended within 40 days of myocardial infarction (MI); thus, ICD implantation might not be considered during the post-MI care transition. To examine ICD implantation rates and associated mortality among older MI patients with low ejection fraction (EF). Retrospective observational study of Medicare beneficiaries with an EF of 35% or less after MI, treated at 441 US hospitals between 2007 and 2010, excluding patients with prior ICD implantation. Follow-up data were available through December 2010. ICD implantation within 1 year of MI vs no ICD implantation within 1 year of MI. Patient characteristics associated with receiving an ICD within 1 year after discharge and 2-year mortality associated with ICD implantation. Among 10,318 MI patients with EF of 35%or lower, the cumulative 1-year ICD implantation rate was 8.1% (95%CI, 7.6%-8.7%). Patients with ICD implantation were more likely to have prior coronary artery bypass graft procedures, higher peak troponin levels, in-hospital cardiogenic shock, and cardiology follow-up within 2 weeks after discharge relative to patients who did not receive an ICD within 1 year. Implantation of ICD was associated with lower 2-year mortality (15.3 events per 100 patient-years [128 deaths in 838 patient-years] vs 26.4 events per 100 patient-years [3033 deaths in 11 479 patient-years]; adjusted HR, 0.64; 95%CI, 0.53-0.78). [table: see text] In this large registry study of older patients who experienced MI from 2007-2010, fewer than 1 in 10 eligible patients with low EF received an ICD within 1 year after MI, although ICD implantation was associated with lower risk-adjusted mortality at 2 years. Additional research is needed to determine evidence-based approaches to increase ICD implantation among eligible patients.

Diabetic hyperglycemia improves lipid profile and oxidative stress after myocardial infarction in rats (LB49)

This study was designed to evaluate the lipid and oxidative stress profiles in diabetic rats that had undergone 15 days of myocardial infarction. Male Wistar rats were divided into control (C), diabetic (D), myocardial infarction (MI) and diabetic myocardial infarction (DMI). Left coronary artery occlusion was performed after 15 days of diabetes (STZ) and accompanied for more 15 days. The free fatty acids and triacylglycerol content and oxidative stress profile were determined by biochemical analysis in left ventricle. The free fatty acids were increased in DMI: 1.16±0.2 vs D: 0.45±0.09; MI: 0.72±0.1 and C: 0.4±0.05 mg/g of tissue, however the triacylglycerol was increased in D: 2.12±0.3 and decreased in DMI: 0.72±0.1 and MI: 1±0.2 vs C: 1.45±0.1 mg/g of tissue. The catalase activity was increased in DMI: 0.62±0.1; D: 0.56±0.09 vs C: 0.29±0.05 and MI: 0.35± 0.02 nmol/mg and glutathione peroxidase increased in DIM: 0.04±0.008 vs D: 0.02±0.003; MI: 0.02 ±0.0002 and C: 0.01±0.005 umol/min/mg. The superoxide anion and protein carbonylation were increased in MI group: 7±0.9 vs D:4±0.5; DIM:4±0.5 and C:4±0.4 O2‐mmoles/mg and MI:2.65 ± 0.36 vs D: 1.5 ± 0.24; DIM: 1.22 ± 0.2 and C: 1.45 ± 0.26 nmol/mg. These findings suggest that diabetic rats exposed to an ischemic injury showed an increase in the lipids utilization and an oxidative stress reduction, supporting previously published data of improvement of the cardiac function in these model.Grant Funding Source: Fapesp

Altered Gene Expression Pattern in Peripheral Blood Mononuclear Cells in Patients with Acute Myocardial Infarction

BackgroundDespite a substantial progress in diagnosis and therapy, acute myocardial infarction (MI) is a major cause of mortality in the general population. A novel insight into the pathophysiology of myocardial infarction obtained by studying gene expression should help to discover novel biomarkers of MI and to suggest novel strategies of therapy. The aim of our study was to establish gene expression patterns in leukocytes from acute myocardial infarction patients.Methods and ResultsTwenty-eight patients with ST-segment elevation myocardial infarction (STEMI) were included. The blood was collected on the 1st day of myocardial infarction, after 4–6 days, and after 6 months. Control group comprised 14 patients with stable coronary artery disease, without history of myocardial infarction. Gene expression analysis was performed with Affymetrix Human Gene 1.0 ST microarrays and GCS3000 TG system. Lists of genes showing altered expression levels (fold change >1.5, p<0.05) were submitted to Ingenuity Pathway Analysis. Gene lists from each group were examined for canonical pathways and molecular and cellular functions. Comparing acute phase of MI with the same patients after 6 months (stable phase) and with control group we found 24 genes with changed expression. In canonical analysis three pathways were highlighted: signaling of PPAR (peroxisome proliferator-activated receptor), IL-10 and IL-6 (interleukin 10 and 6).ConclusionsIn the acute phase of STEMI, dozens of genes from several pathways linked with lipid/glucose metabolism, platelet function and atherosclerotic plaque stability show altered expression. Up-regulation of SOCS3 and FAM20 genes in the first days of myocardial infarction is observed in the vast majority of patients.

Abstract P338: Differences in Costs, Length of Stay and Mortality for Myocardial Infarction and Related Disorders in Non Federal Hospitals

BACKGROUND: Validated estimates of costs, length of stay, and mortality rates are necessary for the treatment and prevention of acute myocardial infarction in patient admitted to federal hospitals. Estimates based on data from few healthcare institutions may not be generalizable to all hospitals. HYPOTHESIS: To assess the hypothesis that there will be significant differences in costs, length of stay, and in-hospital mortality rates between inpatient with: (1) acute myocardial infarction only, (2) diabetic acute myocardial infarction and (3) diabetes only in non federal hospitals. METHODS: Data were extracted and analyzed from 4,400 hospital patients with both diabetes and myocardial infarction using International Classification of Diseases-9-Clinical Modification (ICD 9-CM) primary diagnosis codes from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database. Data were retrospectively extracted from 1,056 hospitals in 42 States. Descriptive and multivariate statistical techniques were used to examine patient characteristics and outcome-related factors associated with the inpatient costs. RESULTS: Patients with acute myocardial infarction only incurred the highest average cost ($68,036, n = 24,791), followed by patients with diabetic myocardial infarction ($65,937, n = 4,400), and diabetes only ($33,680, n = 1,021,933) in 2008 hospital stay. The average LOS was at 6.3 days for myocardial infarction, 7.5 days for diabetic myocardial infarction, 4.95 days for diabetes. Inpatient with myocardial infarction only 2,056 (8.2%), diabetic myocardial infarction 350 (7.9%) and diabetes only 25,377 (2.5%) died during hospitalization. Regression analysis showed that patient comorbidities for both diabetic myocardial infarction were highly significant at p &lt; .0001 ranking from fluid and electrolyte 306 (6.0%), renal failure 558 (12.6%), peripheral vascular disorders 363 (8.2%) and congestive heart failure 306 (6.0%). For each procedure, as days from admission to the first procedure increased, average costs consistently decreased ranging from less than one day ($11, 681.00) to 9 days ($100.00). Also, average costs were significantly high, p &lt; .0001 with patient location, patient disposition, risk mortality and disease severity. Patient gender and ethnicity were also significant, p &lt; .005 and p &lt;.006 respectively. CONCLUSIONS: In conclusion, acute myocardial infarction remains the index for increased inpatient mortality, costs and length of stay in patients with both diabetes and myocardial infarction. Inpatients outcomes could be decreased enormously if patient could be screened and treated appropriately on admission to prevent complications like acute myocardial infarction. This study has revealed that appropriate estimation of costs in acute myocardial infarction disorders would help in accurate allocation of funds for preventive measures.

PP-242 COMPLETE DISSECTION OF LEFT ANTERIOR DESCENDING ARTERY IN A YOUNG WOMAN AFTER MYOCARDIAL INFARCTION

Spontaneous coronary artery dissection (SCAD) is a rare clinical condition that causes acute coronary syndrome and sudden cardiac death. Herein, we report a case of left anterior descending artery dissection after myocardial infarction. On the third day of myocardial infarction after successful thrombolysis, the patient had recurrent chest pain without any ST wave elevation. She was referred to our clinic for coronary angiography which showed completely dissected left anterior descending (LAD) artery. She was referred to a tertiary centre with intravascular ultrasonography (IVUS) capability. Her control angiogram showed restored flow with only minimal dissection (so IVUS was not performed) in the mid LAD. The lesions in the distal and mid LAD were stented. The final angiogram showed TIMI-III flow. Percutaneous coronary intervention is the first choice of treatment in patients with single-vessel spontaneous coronary artery dissection with ongoing signs of ischemia.

Značaj TIMI skora kod bolesnika sa akutnim infarktom miokarda sa ST elevacijom

Background: The prognosis of patients with acute coronary syndrome (ACS) can be determined on the basis of the TIMI risk score, which is one of the scores easily applicable for quantitative risk assessment of patients. The primary objective of this paper is to assess whether the TIMI risk score significant predictor of poor outcome in our patients with STEMI, within the first month and within the first year of monitoring. A secondary aim of the study is the correlation TIMI score and ejection fraction (EF), wall motion score index (WMSI) and infarct size in the same patients during the early post-infarction period. Method: The study included 115 patients with STEMI, age 56.6 ± 10.2 years, 79 men and 36 women, who were hospitalized in the coronary care unit of CCS. TIMI risk score was calculated for all patients and based on: patient's age, previous risk factors (diabetes, hypertension and angina pectoris), and systolic blood pressure on admission rate, Killip class, weight, presence of ST elevation on the front wall or left bundle branch block and the time of onset of symptoms. Echocardiography was done within 7 days of myocardial infarction and parameters EF and WMSI were determined. Infarct size was estimated based on the maximum levels of creatine kinase (CK). Patients were followed at regular check-ups for a period of one year. Results: The cut-off value of the TIMI risk score in patients with STEMI was 4.5 with a very high specificity 85.7 % and sensitivity 81.1 %. TIMI risk score is a significant predictor of poor outcome in a one-month (RR 1.57, 95 % CI 1.28 to 1.93, p <0.001), and one-year follow-up period (RR 1.52, 95 % CI 1.25 to 1.84, p <0.001). A significant correlation was found between the TIMI score and EF (47.83 % ± 8.28 %), p = 0.001, and between the TIMI score and WMSI (1.25 ± 0.22), p = 0.003 in the early post-infarction period. Conclusion: TIMI score in STEMI patients calculated after patient admission to the CCU is one of the easily applicable and reliable scores for the quantitative assessment of risk for poor outcome within the first month and within the first year of the disease. Also, the TIMI score correlate with parameters of systolic left ventricular function in these patients.

Safety of Esophagogastroduodenoscopy within 30 Days of Myocardial Infarction: A Retrospective Cohort Study from a Canadian Tertiary Centre

Patients who experience myocardial infarction (MI) are at risk of gastrointestinal (GI) bleeding complications. Endoscopic evaluation may lead to cardiopulmonary complications. Guidelines and studies regarding the safety of endoscopy in this population are limited. To evaluate the safety of endoscopy in a retrospective cohort of post-MI patients at a Canadian tertiary centre. Using hospital diagnostic⁄procedure codes, the charts of patients meeting the inclusion criteria of having ST elevation MI or non-ST elevation MI, and GI bleeding detected at endoscopy were reviewed. The information retrieved included demographics, medical history, medications, endoscopy details and cardiopulmonary⁄GI events. A total of 121 patients experienced an MI and underwent endoscopy within 30 days. However, only 44 met the inclusion criteria and were reviewed. The mean age of the patients was 75 years, and 55% were female. The mean hemoglobin level was 86 g⁄L, and 38 of 44 patients required a transfusion. Comorbidities included hypertension (82%), diabetes (46%), heart failure (55%), stroke (21%), lung disease (27%), previous MI (46%), cardiac bypass surgery (30%), history of GI bleed (25%), history of ulcer (18%) and ejection fraction <50% (48%). The median number of days to endoscopy after MI was three. Complications included seven patients with acute coronary syndrome, one with arrhythmia, one with respiratory failure, one with aspiration pneumonia and two with perforation. Age, hemoglobin level or timing of endoscopy did not significantly predict a complication. Patients with GI bleeding after MI often have comorbidities and are on antiplatelet agents. Endoscopy is a valuable tool in the diagnosis and management of bleeding complications, but must be weighed against the potential risk of other complications, which in the present study occurred in more than 25% of procedures.