Diagnosis Of After Acute Myocardial Infarction Research Articles

Determinants of 1-year mortality after acute myocardial infarction in patients with and without diabetes

The gap in excess mortality between patients with and without diabetes has not decreased over time. The aim of this study was to investigate the determinants of mortality after acute myocardial infarction (AMI) in patients with diabetes and without diabetes in a contemporary population. A retrospective analysis of a cohort of 266 patients with a diagnosis of AMI during 2022 was carried out. Patients living with diabetes had higher 1-year mortality, even after adjustment for covariates. Estimated glomerular filtration (eGFR) rate was independently associated with increased mortality in patients with diabetes. Plasma glucose was independently associated with peak troponin in patients both with and without diabetes. These data suggest that patients living with diabetes and with a low eGFR warrant more aggressive risk reduction and use of nephroprotective medications. Further studies are needed to assess whether early blood glucose control improves cardiovascular outcomes in all patients with AMI.

Obstructive sleep apnea modulates clinical outcomes post-acute myocardial infarction: A large longitudinal veterans’ dataset report

BackgroundWhile the longer-term Obstructive Sleep apnea (OSA)-related intermittent hypoxia (IH) leads to various comorbidities, it has become increasingly evident that OSA confers protective advantages during and after acute myocardial infarction (AMI). We hypothesized in patients who were admitted with acute MI, the presence of OSA is associated with lower in-hospital mortality compared to those without a prior diagnosis of OSA. MethodsIn this nationwide retrospective study utilizing Veterans Health Administration records, we included patients hospitalized for MI with a history of sleep disorders from 1999 to 2020. We divided patients into two cohorts: those with OSA and those without OSA. The primary outcome was in-hospital mortality during AMI hospitalization. We analyzed the data using logistic regression and calculated the odds ratio of in-hospital mortality. ResultsOut of more than four million veterans with any sleep diagnosis, 76,359 patients were hospitalized with a diagnosis of AMI. We observed 30,116 with OSA (age, 64 ± 10 years; BMI, 33 ± 7 kg/m2) and 43,480 without OSA (age, 68 ± 12 years; BMI, 29 ± 6 kg/m2). The aOR of in-patient mortality (n = 333 (1.1%)) was lower in those with OSA (aOR, 0.43; 95% CI, 0.38 to 0.49) compared to without-OSA (n = 1,102, 2.5%). However, the OSA cohort had a higher proportion of the prolonged length of stay (28.1%). ConclusionsPresence of OSA is associated with lower in-hospital mortality among patients admitted for AMI, after adjusting for various demographic and co-morbidity factors. This study highlights the complex relationship between OSA and cardiovascular health and highlights the need for further research in this area.

Assessment of global longitudinal strain and plasma natriuretic peptide in patients with asymptomatic left ventricular dysfunction.

Objective The purpose of this study was to investigate the association between global longitudinal strain (GLS) and plasma NT-proBNP for predicting left ventricular (LV) performance in asymptomatic patients after acute myocardial infarction (AMI).Material and methods We prospectively included patients with diagnosis of AMI without clinical signs and symptoms of heart failure (HF) and followed these patients for 6 mos. Baseline echocardiography was performed at admission, and follow-up echocardiography was performed after 6 mos. A normal GLS was defined as having an absolute value of ≥16 %. According to the baseline GLS, participants were divided into two groups and compared. In all participants, blood samples of plasma NT-proBNP were obtained at admission, before discharge, and 6 mo after discharge.Results The study population was consisted of 98 participants, of which 80 (81.6 %) were males, and the mean age was 56.0±9.3 years. Baseline echocardiography showed that most of the participants (60, 61.2 %) had abnormal GLS<16 %, whereas 38 (38.8 %) participants had normal or borderline GLS ≥16 %. Compared with the normal GLS group, participants with abnormal GLS had higher GRACE score, higher troponin I concentration, lower systolic blood pressure, lower mean LV ejection fraction, and decreased LV diastolic function. At 6‑mo follow-up, only LV systolic function remained significantly different between the two groups. Compared to baseline, there was a significant improvement of GLS in the abnormal GLS group at 6‑mo follow-up (p=0.04). Prevalence of complications after AMI was significantly higher in this group. There were significant differences between baseline and discharge NT-proBNP concentrations between the two groups (p<0.05). In the abnormal GLS group, there were significant correlations between baseline and discharge NT-proBNP concentrations with baseline LV systolic function. Discharge NT-proBNP concentration also correlated significantly with 6‑mo follow-up GLS. For determining the effect of baseline GLS abnormality, the areas under the ROC curve for baseline and discharge NT-proBNP concentrations were 0.73 (95 % CI 0.60-0.85, p=0.001) and 0.77 (95 % CI 0.66-0.87, p<0.001), respectively. Regarding early prediction of follow-up GLS abnormality, the area under the ROC curve for discharge NT-proBNP concentration was significantly higher 0.70 (95 % CI 0.55-0.84, p=0.016). The optimum cut-off value of discharge NT-pro-BNP was 688.5 pg / ml, with 72.4 % sensitivity and 65.4 % specificity to predict 6‑mon GLS abnormality following acute myocardial infarction.Conclusion The main finding of this study is that impaired LV GLS is associated with elevated plasma concentrations of NT-proBNP in post-AMI patients. Pre-discharge NT-proBNP concentration combined with impaired initial GLS could predict worsening LV systolic function over time in asymptomatic post-AMI patients.

Outpatient Register of Patients with Acute Myocardial Infarction: Assessment of the Hypertension Impact on Long-term Prognosis

Aim. To assess the impact of arterial hypertension (AH) on the long-term outcomes in patients after acute myocardial infarction (AMI).Material and methods. 160 patients were included: 106 (66.2%) men and 54 (33.8%) women, average age 74.2±11.2 years, discharged from Moscow hospitals with a diagnosis of AMI (from March 01, 2014 till June 30, 2015) and applied to the city polyclinic №9 in Moscow or its branches for outpatient observation. The information was obtained on the basis of medical documentation of the polyclinic and data of patients’ examination/questioning by phone, conducted every 2 months. The follow-up duration was 1 year, the incidence of cardiovascular complications (CVC) was estimated: death, nonfatal AMI, nonfatal cerebral stroke, new cases of atrial fibrillation (AF), hospitalization for unstable angina, hypertensive crisis, heart failure, unplanned surgical interventions on the heart and blood vessels.Results. AH before the development of reference AMI was observed in 118 (73.4%) patients: 48 women and 70 men; in women, AH was recorded more often than in men: 88.9% and 66.0%, respectively, p<0.05. Patients with AH were older than patients without AH: 63.0 (54.0; 74.0) and 55.5 (49.0; 61.0) years, respectively, p<0.001, among them there were more retirees 76 (64.4%) and patients with disabilities 45 (38.1%), p<0.05. Patients with AH compared with patients without AH were less likely to smoke (18.6% and 38.1%, respectively) and drank alcohol (30.5% and 52.4%, respectively), p<0.05 for both; more likely to visit the outpatient clinic (89.0% and 66.7%, respectively), p<0.05. There were no significant differences between the groups of patients with and without AH in the history of cerebral stroke, AMI, arrhythmia by AF type, diabetes mellitus and obesity, except for angina of tension (18.6% and 2.4%, respectively) and hypercholesterolemia (37.3% and 11.9%, respectively), p<0.05 for both. Despite the fact that patients with AH were significantly more often prescribed antihypertensive, lipid-lowering and antithrombotic drugs before reference AMI, the frequency of their use was low: renin-angiotensin-aldosterone system blockers were prescribed in 70 (59.3%) patients, beta-blockers – in 35 (29.7%), calcium antagonists – in 20 (16.9%), diuretics – in 13(11.0%), antiplatelet agents – in 39 (33.1%), statins – in 9 (7.6%) patients. After one year of follow-up, CVC was registered in 33 (28.0%) patients with AH and 9 (21.4%) patients without AH (p=0.41). There was no statistically significant effect of AH on long-term outcomes of AMI, adjusted risk ratio =1.30 [95% confidence interval 0.68- 2.49], p>0.05. The effect of AH on the development of CVC, estimated using the Kaplan-Mayer curve, was not statistically significant (p=0.120).Conclusion. During 1 year of follow-up after AMI in patients with AH the frequency of CVC – death, nonfatal AMI, nonfatal cerebral stroke, new cases of AF, hospitalization for unstable angina, hypertensive crisis, heart failure – did not exceed the overall frequency of CVC in patients without AH.

Systemic lupus erythematosus is associated with poor outcome after acute myocardial infarction

BackgroundSystemic lupus erythematosus (SLE) is associated with a higher risk of cardiovascular disease. However, it is not clear whether or not SLE is associated with poor outcomes after acute myocardial infarction (AMI). Methods and resultsUsing the Taiwan National Health Insurance Database, we identified the SLE group as patients with AMI who have a concurrent discharge diagnosis of SLE. We also selected an age-, sex-, hospital level-, and admission calendar year-matched non-SLE group at a ratio of 1:3 from the total non-SLE group. One hundred fifty-one patients with SLE, 113,791 patients without SLE, and 453 matched patients without SLE were admitted with a diagnosis of AMI. Patients with SLE were significantly younger, predominantly female, and more likely to have chronic kidney disease than those without SLE. The in-hospital mortality rates were 12.6%, 9.0%, and 4.2% in the SLE, total non-SLE, and matched non-SLE groups, respectively. The in-hospital mortality was significantly higher in the SLE group than in the total non-SLE group (OR = 1.98; 95% CI = 1.2–3.26) and the matched non-SLE group (mortality OR = 2.20; 95% CI = 1.06–4.58). In addition, the SLE group was associated with a borderline significant risk of prolonged hospitalization when compared with the non-SLE group. ConclusionSLE is associated with a higher risk of in-hospital mortality and a borderline significantly higher risk of prolonged hospitalization after AMI.

Long-Term Use of Antiplatelet Therapy in Real-World Patients with Acute Myocardial Infarction: Insights from the PIPER Study.

The aim of this study was to assess long-term drug adherence and prognosis in real-world patients discharged on dual-antiplatelet therapy (DAPT) after acute myocardial infarction (AMI). A retrospective cohort analysis using administrative databases kept by eight local health units was performed. DAPT exposure (defined as ≥ 2 prescriptions), adherence, and the occurrence of major adverse events (MACE) were analyzed during a 36-month follow-up. The analysis included 11,101 patients who were discharged alive with a primary diagnosis of AMI. Of these, 5,919 patients (53.31%) were discharged on DAPT without a diagnosis of cancer or anemia, without transient DAPT discontinuation, and represented the study population. DAPT discontinuation occurred in 2,200 patients (37.2%) and in 1,995 (33.7%) after the first 6 and 12 months, respectively, whereas 423 patients (7.1%) were still on DAPT after 36 months. Patients who maintained DAPT up to 12 months had a significantly lower overall mortality, compared with patients who discontinued DAPT after 6 months. Exposure to DAPT at 3 years was associated with reduced all-cause mortality (hazard ratio [HR]: 0.067, 95% confidence interval [CI]: 0.027–0.162, p < 0.001) and reduced recurrent AMI (HR: 0.02, 95% CI: 0.003–0.173, p < 0.001). In conclusion, this study shows that prolonged DAPT over 12 months is maintained in a relevant number of patients after AMI. However, adherence to antiplatelet therapy in first 12 months after AMI is still unsatisfactory and efforts to enhance patients' compliance are warranted. Exposure to prolonged DAPT at 3 years seems to be associated with a significant reduction in all-cause mortality and AMI.

Thirty-day rehospitalizations among elderly patients with acute myocardial infarction: Impact of postdischarge ambulatory care.

Rehospitalization after acute myocardial infarction (AMI) is common in elderly patients. It increases morbimortality and health care expenditures. The association between ambulatory care after discharge for AMI and rehospitalization has never been studied in France. We analyzed the impact of ambulatory care on rehospitalization of elderly patients (≥65 years) within 30 days after hospital discharge.We conducted a nationwide population-based study of elderly patients hospitalized with a main diagnosis of AMI in France between 2011 and 2013. We excluded patients hospitalized for AMI in the previous year and those who died during the index hospitalization or within 30 days after discharge. The primary outcome was the first all-cause 30-day rehospitalization in an acute care hospital. Individual and neighborhood-level variables were compared among rehospitalized and nonrehospitalized patients. Determinants of 30-day rehospitalization were identified using logistic regression models.Among the 624 eligible patients, 137 (22.0%) were rehospitalized within 30 days after discharge. In multivariate analyses, chronic kidney failure (odds ratio [OR] 1.88; 95% confidence interval [CI], 1.01-3.53) was an independent predictor of 30-day rehospitalization. We found no association among deprivation and spatial accessibility measures and 30-day rehospitalization. The purchase of lipid-lowering drugs prescription within 7 days after discharge was associated with a reduced risk of 30-day rehospitalization (OR 0.53; 95% CI, 0.36-0.79).This study highlights the role of coordination among hospital and primary care physicians in post-AMI discharge and follow-up among elderly patients. Specifically, targeted interventions to reduce 30-day rehospitalizations should focus on patients with comorbidities and use of prescription drugs after hospital discharge.

Gender Impact on 30-Day Readmissions After Hospitalization With Acute Myocardial Infarction Complicated by Cardiogenic Shock (from the 2013 to 2014 National Readmissions Database)

Previous studies have suggested that women are more likely to have increased risk of readmissions after acute myocardial infarction (AMI); however, this difference has not been examined in the setting of AMI complicated by cardiogenic shock. Thus, we aimed to compare 30-day readmissions in women versus men initially admitted with AMI complicated with cardiogenic shock. In this observational study, we used the Nationwide Readmissions Databases years 2013 and 2014 to identify subjects who were initially hospitalized with a primary diagnosis of AMI complicated by cardiogenic shock, and discharged alive. The 30-day readmission rates between women and men were compared using a multivariate Cox regression model adjusting for variable co-morbidities, as well as a propensity-matched analysis. Of 1,116,933 patients who had AMI, 39,807 (3.6%) had cardiogenic shock and were discharged alive. The rates of in-hospital procedures such as percutaneous coronary intervention, coronary artery bypass grafting, and intra-aortic balloon placement were less frequent in women. Thirty-day readmissions were higher in women (20.7%) than in men (17.6%), after adjustment for various co-morbidities (hazards ratio 1.09, 95% confidence interval 1.00 to 1.19, p = 0.04), and in the propensity-matched analysis (hazards ratio 1.10, 95% confidence interval 1.01 to 1.21, p = 0.04). In conclusion, women are at a higher risk of 30-day readmissions after AMI complicated with cardiogenic shock.

Percepção de homens após infarto agudo do miocárdio

Objective: To understand men’s perception about their feelings, repercussions of lifestyle change and family participation after acute myocardial infarction (AMI). Methods: Qualitative descriptive study conducted between March and June 2016 in Goiânia, Goias, Brazil, using semi-structured interviews with adult men who had an episode of infarction. The analysis of the interviews was based on Grounded Theory, from which the following explanatory categories emerged: Feelings experienced by the patients after diagnosis of AMI; Repercussion of lifestyle change with focus on feeding and physical activity; Family involvement and support. Results: In the midst of the whirlwind of feelings that accompanied the diagnosis of AMI, the fear of finitude and of abandoning the family stood out. Lifestyle change, as an essential element of non-drug treatment, was initiated. However, with regard to feeding, they were partially insufficient due to the lack of adequate nutritional guidelines. As for physical activity, there was adequate awareness, but the difficulty of maintaining the new habit prevailed. Families have proved to be the main source of social support, being decisive in this process. The adherence was partial and the lack of continuity was the main obstacle. Conclusion: The success of continuous therapeutic planning depends on users’ adherence, who experience difficulties in this aspect, even in the face of adequate social support. There is a clear need for raising awareness of secondary prevention and its benefits, of food education and of maintaining habit changes.

Abstract 514: Sex-Related Disparities in Outcomes After Myocardial Infarction Among Patients With Atrial Fibrillation: Evidence From a Nationwide Study

Background: The overall mortality rate after acute myocardial infarction (AMI) is falling in the United States. However, outcomes remain unacceptably worse in females compared to males. It is not known how coexisting atrial fibrillation (AF) modify outcomes among the sexes. We sought to examine the association of sex with clinical characteristics and outcomes after AMI among patients with AF. Methods: We accessed the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS), to extract all hospitalizations between 2007 and 2011 for patients above 18yrs with principal diagnosis of AMI and coexisting diagnosis of AF using ICD 9-CM codes. The NIS represents the largest all-payer hospitalization database in the United States, sampling approximately 8 million hospitalizations per year. We also extracted outcomes data (length of stay (LOS), stroke and in-hospital mortality) after AMI among Patients with AF. We then compared sex differences. Univariate and Multivariate analysis were conducted to determine the presence of statistically significant difference in outcomes between men and women. Results: A total of 184,584 AF patients with AMI were sampled, consisting of 46.82% (86,420) women and 53.13% (98,164) men. Compared with men, women with AF and AMI had a greater multivariate-adjusted risk for increased stroke rate (aOR=1.51, 95% CI=1.45-1.59), and higher in-hospital mortality (aOR=1.12, 95% CI=1.09-1.15). However, female gender was not significantly associated with longer LOS (aOR=-0.22, 95% CI= -0.29-(-0.14). Conclusion: In this large nationwide study of a population-based cohort, women experienced worse outcomes after AMI among patients with AF. They had higher in-hospital mortality and increased stroke rates. Our findings highlight the need for targeted interventions to improve these disparities in outcomes.

Right ventricular function measured by TAPSE in obese subjects at the time of acute myocardial infarction and 2 year outcomes

IntroductionObesity is associated with significantly better outcome after acute myocardial infarction (AMI), a phenomenon known as ‘obesity paradox’. Tricuspid annular plane systolic excursion (TAPSE) is an echocardiographic measurement of right ventricular (RV) function and has prognostic implications at the time of AMI. MethodsWe examined the difference in RV function among patients admitted with AMI according to obesity status. In a single center cohort analysis of 105 patients admitted between 2010 and 2011 with the diagnosis of AMI. Demographic, anthropometric data and cardiovascular risk factors were prospectively collected. All subjects had echocardiogram within 48h of AMI diagnosis for TAPSE calculations. Subjects were divided into two groups based on their obesity status. ResultsObese subjects had better RV function compared to non-obese, TAPSE: 19±6.6 vs. 16±4.9mm; p 0.02 at the time of AMI. There was no significant difference in TAPSE between OSA and non-OSA subjects, 19±6.3 vs. 17±6.2mm; p 0.21. After 2years of follow up, patients with obesity and better RV function were less likely to develop new onset heart failure (HF) with OR 0.30 (95% CI 0.09–0.93; p 0.03) and OR 0.31 (95% CI 0.11–0.76; p 0.007) respectively. ConclusionObese patients had better RV function measured by TAPSE at the time AMI when compared non-obese patients. Patients with better RV function at the time of AMI were less likely to develop new-onset HF and there was a trend in the obese group to less likely develop new-onset HF after 2year follow up.

Changes in Employment Status after Myocardial Infarction among Men.

According to the Turkey Burden of Disease Study, 10% of the national burden of disease is attributed to cardiovascular diseases. Although the standardized coronary heart disease (CHD) rate is falling in general, CHD prevalence among young people is rising. On the other hand, as a result of increased life expectancy and higher retirement ages, the CHD rate among workers is also increasing. Therefore, work ability and return to work after diagnosis are important for population health and well-being. Socioeconomic factors and working conditions may play a key role as well as clinical conditions described in the literature that affect returning to work. The aims of this qualitative study are exploring the changes in employment and working conditions of the patients after acute myocardial infarction (AMI) and affecting factors such as socioeconomic, personal and environmental. Qualitative research. The research population are fifty-three patients who are engaged in paid employment when the people have been diagnosed with myocardial infarction for the first time between 2011 and 2012 at a university hospital coronary care unit. We intended to reach the whole population. Twenty-seven patients were contacted whose phone numbers were accessible from the hospital records. Semi-structured in-depth interviews were conducted with twelve patients in a meeting room at the hospital. The interviews were tape-recorded accompanied by note-taking and the content analysis method were evaluated. While many of the participants continued to work at the same job by working less, one third of them said that they were thinking about getting an easier job if they have the opportunity. On the other hand, in most cases, there were neither assessments about their work ability, nor changes to their working conditions after AMI. They had to cope with their conditions, such as economic or psychosocial, without any support. While the patients have to return to work for economic and social reasons, they expressed uncertainty about working after a diagnosis of AMI and could not reach professional support to assess their work abilities. Therefore, specific algorithms and assessment tools to manage the return to work of AMI patients would be useful.

Effects of Polyunsaturated Fatty Acid Treatment on Postdischarge Outcomes After Acute Myocardial Infarction

Clinical trials studying the efficacy of n-3 polyunsaturated fatty acids (PUFA) in reducing adverse events after acute myocardial infarction (AMI) have yielded conflicting results, and data regarding the influence of n-3 PUFA treatment after AMI in routine clinical practice are scarce. We conducted a retrospective observational cohort study including patients from 5 Italian Local Health Units who were discharged from the hospital with a primary diagnosis of AMI from January 1, 2010, to December 31, 2011. Using unique patient identifiers, patients were linked across governmental hospital discharge, medication prescription, and mortality databases and followed for 12-months post-index discharge. Patient characteristics and risk of all-cause mortality and repeat AMI were compared by n-3 PUFA prescription after discharge (for outcome analyses, defined as ≥ 2 prescriptions) at a presumed dose of 1 g/day. Overall, 11,269 patients met inclusion criteria, of which 2,425 patients (21.5%) were prescribed n-3 PUFA during follow-up. Patients treated with n-3 PUFA tended to be younger, men, and carry a diagnosis of diabetes and were more likely to be receiving guideline-recommended post-AMI medical therapy, including β blockers, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, statins, and antiplatelet therapy (all p <0.001). After adjusting for patient characteristics and concurrent therapies, n-3 PUFA treatment was associated with reduced all-cause mortality (hazard ratio 0.76, 95% CI 0.59 to 0.97) and recurrent AMI (hazard ratio 0.65, 95% CI 0.49 to 0.87) through 12-month follow-up. In conclusion, in this large, contemporary, observational study of "real-world" Italian patients hospitalized for AMI, the use of n-3 PUFA was independently associated with a robust reduction in all-cause mortality and recurrent AMI. These data support further randomized controlled trials with n-3 PUFA therapy in the post-AMI setting.

Sensitive point-of-care monitoring of cardiac biomarker myoglobin using aptamer and ubiquitous personal glucose meter

Myoglobin (Myo), which is one of the early markers to increase after acute myocardial infarction (AMI), plays a major role in urgent diagnosis of cardiovascular diseases. Hence, monitoring of Myo in point-of-care is fundamental. Here, a novel assay for sensitive and selective detection of Myo was introduced using a personal glucose meter (PGM) as readout. In the presence of Myo, the anti-Myo antibody immobilized on the surface of polystyrene microplate could capture the target Myo. Then the selected aptamer against Myo, which was obtained using our screening process, was conjugated with invertase, and such aptamer-invertase conjugates bound to the immobilized Myo due to the Myo/aptamer interaction. Subsequently, the resulting “antibody-Myo–aptamer sandwich” complex containing invertase conjugates hydrolyzed sucrose into glucose, thus establishing direct correlation between the Myo concentration and the amount of glucose measured by PGM. By employing the enzyme amplification, as low as 50pM Myo could be detected. This assay also showed high selectivity for Myo and was successfully used for Myo detection in serum samples. This work may provide a simple but reliable tool for early diagnosis of AMI in the world, especially in developing countries.

Usefulness of the QRS-T Angle to Improve Long-Term Risk Stratification of Patients With Acute Myocardial Infarction and Depressed Left Ventricular Ejection Fraction

In light of the low cost, the widespread availability of the electrocardiogram, and the increasing economic burden of the health-related problems, we aimed to analyze the prognostic value of automatic frontal QRS-T angle to predict mortality in patients with left ventricular (LV) systolic dysfunction after acute myocardial infarction (AMI). About 467 consecutive patients discharged with diagnosis of AMI and with LV ejection fraction ≤40% were followed during 3.9 years (2.1 to 5.9). From them, 217 patients (47.5%) died. The frontal QRS-T angle was higher in patients who died (116.6±52.8 vs 77.9±55.1, respectively, p<0.001). The QRS-T angle value of 90° was the most accurate to predict all-cause cardiac death. After multivariate analysis, frontal QRS-T angle remained as an excellent predictor of all-cause and cardiac deaths, increasing the mortality 6% per each 10°. For the global mortality, the hazard ratio for a QRS-T angle>90° was 2.180 (1.558 to 3.050), and for the combined end point of cardiac death and appropriate implantable cardioverter defribrillator therapy, it was 2.385 (1.570 to 3.623). This independent predictive value was maintained even after adjusting by bundle brunch block, ST-elevation AMI, and its localization. In conclusion, a wide automatic frontal QRS-T angle (>90°) is a good discriminator of long-term mortality in patients with LV systolic dysfunction after an AMI. The ability to easily measure it from a standard 12-lead electrocardiogram together with its prognostic value makes the frontal QRS-T angle an attractive tool to help clinicians to improve risk stratification of those patients.

Disparities in Revascularization Rates After Acute Myocardial Infarction Between Aboriginal and Non-Aboriginal People in Australia

This study examined revascularization rates after acute myocardial infarction (AMI) for Aboriginal and non-Aboriginal patients sequentially controlling for admitting hospital and risk factors. Hospital data from the state of New South Wales, Australia (July 2000 through December 2008) were linked to mortality data (July 2000 through December 2009). The study sample were all people aged 25 to 84 years admitted to public hospitals with a diagnosis of AMI (n=59 282). Single level and multilevel Cox regression was used to estimate rates of revascularization within 30 days of admission. A third (32.9%) of Aboriginal AMI patients had a revascularization within 30 days compared with 39.7% non-Aboriginal patients. Aboriginal patients had a revascularization rate 37% lower than non-Aboriginal patients of the same age, sex, year of admission, and AMI type (adjusted hazard ratio, 0.63; 95% confidence interval, 0.57-0.70). Within the same hospital, however, Aboriginal patients had a revascularization rate 18% lower (adjusted hazard ratio, 0.82; 95% confidence interval, 0.74-0.91). Accounting for comorbidities, substance use and private health insurance further explained the disparity (adjusted hazard ratio, 0.96; 95% confidence interval, 0.87-1.07). Hospitals varied markedly in procedure rates, and this variation was associated with hospital size, remoteness, and catheterization laboratory facilities. Aboriginal Australians were less likely to have revascularization procedures after AMI than non-Aboriginal Australians, and this was largely explained by lower revascularization rates at the hospital of first admission for all patients admitted to smaller regional and rural hospitals, a higher comorbidity burden for Aboriginal people, and to a lesser extent a lower rate of private health insurance among Aboriginal patients.

Prostate specific antigen levels after acute myocardial infarction.

Prostate Specific Antigen (PSA), a member of kallikrein family, is a specific serine protease of prostatic tissue. In some case reports, changes in PSA levels after acute myocardial infarction (AMI) have been reported. In this study we evaluated variations in PSA levels post-AMI. Twenty-six male patients who had PSA levels within reference limits were included in the study. The diagnosis of AMI was confirmed by clinical findings, ECG (electrocardiogram) and cardiac marker studies. Serum total PSA (tPSA) and free PSA (fPSA) levels were measured at days 0 (day of admission), 1, 2 and 3 after AMI. PSA/albumin ratio was also calculated in order to evaluate the effect of dilution. A statistical analysis of the results of all patients revealed significant decrease in tPSA levels and tPSA/Albumin ratio at day 2 when compared to days 0 and 3, which showed a similar pattern. Changes of fPSA and fPSA/ Albumin ratio according to days were not found significant. In only four patients we found increased levels of tPSA and increased fPSA levels in three of them. These patients displayed severe problems such as renal failure, cardiac failure, ventricular aneurysm and cerebral ischemia due to cardiac arrest. The lower tPSA levels on day 2 suggest that tPSA can be eliminated rapidly from the circulation on days 1 and 2, probably through the formation of complexes of tPSA with acute phase proteins.

Primary prevention of defibrillator implantation after myocardial infarction: clinical practice and compliance to guidelines

The purpose of this study is to investigate compliance to established guidelines regarding primary prevention with implantable cardioverter-defibrillator (ICD) in patients with left ventricular dysfunction after acute myocardial infarction (AMI) in a clinical setting. A retrospective study of medical records from patients admitted to two hospitals in Stockholm during 2008-2009 with a diagnosis of AMI and who at discharge had a left ventricular ejection fraction ≤35%. An evaluation of follow-up and echocardiographic recordings was performed 1-3 months after AMI. A total of 2023 patients <80 years, with AMI discharged from hospital, were screened for left ventricular dysfunction defined as ejection fraction (EF) ≤35%. Altogether 187 patients were identified and an ICD was implanted in 25 (13%) patients. In 52 (28%) patients, there were contraindications for ICD therapy. An improved EF at follow-up, making ICD treatment redundant, was observed in 48 (41%) patients who underwent an ECHO at follow-up or later. Seventeen (9%) patients without an ICD died during follow-up and out of these five patients died from sudden cardiac death (SCD), they had no contraindication to ICD therapy. An inadequate follow-up according to guidelines was found in 59 (32%) patients. The follow-up of post-myocardial infarction patients with left ventricular dysfunction according to guidelines was insufficient in this population and may have increased the risk for SCD. A significant proportion of patients experienced improved left ventricular function during short-term follow-up making preventive ICD treatment redundant.

Thirty-day mortality after AMI: effect modification by gender in outcome studies

Possible effect modifiers are often considered as confounders when applying pre-defined risk-adjustment models. The aim was to provide evidence of effect modification by gender in comparative evaluations of hospitals on 30-day in-hospital mortality after acute myocardial infarction (AMI). Ninety-two Italian hospitals discharging more than 300 patients with a diagnosis of AMI during 2004 were considered. Patients discharged or transferred within 48 h of hospital admission were excluded. Comorbidities recorded in previous and current admissions were used to define patients' health status and to build the adjustment model, in which an interaction term (gender by hospital) was introduced to test the presence of effect modification. The end point was the 30-day in-hospital mortality after AMI. The study population consists of 38,544 incident events of AMI from 92 Italian hospitals. Eleven hospitals showed a significant effect modification by gender. In one of them, the overall mortality rate was comparable with that of the reference category, but a significant excess risk for women was found [odds ratios (ORs) = 2.3; P < 0.01]. In 10 hospitals, the overall adjusted ORs presented a significant excess mortality compared with the benchmark: three had a significant excess mortality only among females (ranging from 230 to 370%), four only among males (ranging from 110 to 200%), and three among both genders. An effect modification by gender was found. The results suggest that in comparative hospital performances evaluation, stratification by gender is desirable to investigate possible differences in attitudes and practices of health services in the treatment of men and women.

Patterns of Hospital Performance in Acute Myocardial Infarction and Heart Failure 30-Day Mortality and Readmission

In 2009, the Centers for Medicare & Medicaid Services is publicly reporting hospital-level risk-standardized 30-day mortality and readmission rates after acute myocardial infarction (AMI) and heart failure (HF). We provide patterns of hospital performance, based on these measures. We calculated the 30-day mortality and readmission rates for all Medicare fee-for-service beneficiaries ages 65 years or older with a primary diagnosis of AMI or HF, discharged between July 2005 and June 2008. We compared weighted risk-standardized mortality and readmission rates across Hospital Referral Regions and hospital structural characteristics. The median 30-day mortality rate was 16.6% for AMI (range, 10.9% to 24.9%; 25th to 75th percentile, 15.8% to 17.4%; 10th to 90th percentile, 14.7% to 18.4%) and 11.1% for HF (range, 6.6% to 19.8%; 25th to 75th percentile, 10.3% to 12.0%; 10th to 90th percentile, 9.4% to 13.1%). The median 30-day readmission rate was 19.9% for AMI (range, 15.3% to 29.4%; 25th to 75th percentile, 19.5% to 20.4%; 10th to 90th percentile, 18.8% to 21.1%) and 24.4% for HF (range, 15.9% to 34.4%; 25th to 75th percentile, 23.4% to 25.6%; 10th to 90th percentile, 22.3% to 27.0%). We observed geographic differences in performance across the country. Although there were some differences in average performance by hospital characteristics, there were high and low hospital performers among all types of hospitals. In a recent 3-year period, 30-day risk-standardized mortality rates for AMI and HF varied among hospitals and across the country. The readmission rates were particularly high.