Diagnosis Of AMI Research Articles

Abstract 12766: Tropsensor: A Rapid Non-Invasive Transdermal Solution For Troponin Measurement

Introduction: Early identification of Acute Myocardial Injury can prompt rapid triage and appropriate interventions to improve clinical outcomes. Over 10 million patients present at the ED with chest-pain, with the majority due to non-cardiac causes, resulting in unnecessary burdens for Emergency Departments (ED). An instant non-invasive method to measure cardiac troponin (cTn) would therefore be of great benefit. Identified need: All Guidelines recommend the use of high sensitivity (HS) cTn for the diagnosis of acute coronary syndromes (ACS). Current biochemical biomarker testing relies on labeling the cTn with turnaround times often an hour or more. Point-of-care solutions reduce the test time, but still depend on the proper handling of samples and blood processing techniques that could lead to difficulties. Tropsensor provides a non-invasive alternative to standard of care (SOC) hs-cTn measurements without the need for a blood draw. The molecular infrared spectroscopy-based transdermal device provides a cTn readout within 5 minutes and allows for serial measurements without any of the delays or complications of blood draws. Methods: A 26-patient (consented and IRB approved) study was conducted at Zuckerberg San Francisco General Hospital with recruitment based on ACS-related presenting symptoms at the ED. Wrist-worn Tropsensor was used on the patients while the corresponding troponin was determined using a high sensitivity (SOC) assay (Siemens ADVIA Centaur) via a blood draw. Results and conclusions: A Pearson’s correlation of 82% with the hs-cTnI was observed. AMI diagnosis sensitivity was 100%, Specificity=50%, PPV=81.8%, NPV=100% and accuracy=84.6%. The Tropsensor modality seems to provide data similar to that of a hs-cTn assay. If so, it would accelerate the assessment of patients presenting with chest pain. By not requiring a blood draw, the Tropsensor could provide a rapid, safe, standardized and reliable source for cTn while allowing bedside serial trending. It thus has the potential to streamline cardiac care workflow by ruling-out many non-cardiac patients and identifying those with high values who are at risk. Such an approach has the potential to facilitate appropriate patient triage towards early discharge of emergent treatment.

No need for a cardiologist for AMI diagnosis – progress of transforming a behemoth telemedicine program with artificial intelligence

Abstract Background The Latin American Telemedicine Infarct Network (LATIN) Telemedicine is a mammoth hub and spoke model that provides an umbrella of AMI protection for 100 million patients. In the program, 826,043 patients had a telemedicine encounter; 7,400 with AMI were diagnosed; 4,332 of them managed with guidelines-based strategies. We have gradually begun implementing a system for using Artificial Intelligence (AI) algorithms embedded into EKGs for rapid and accurate STEMI detection and validated the results with a cardiologist's interpretations. Purpose To test whether an AI-driven EKG algorithm can effectively substitute a cardiologist for STEMI telemedicine protocols. Methods The AI algorithm construction was in the following fashion. Sample: a selection of 8,511 EKG and 90,592 classified heartbeats. Pre-processing: segmentation of each EKG into individual heartbeats. Training & testing: 90% and 10% of the total dataset, respectively. Classification: 1-D Convolutional Neural Network; the study constructed classes for each heartbeat. The algorithm was next deployed on a consecutive series of LATIN EKG records to diagnose STEMI. We afterwards compared the algorithm's results with eight expert cardiologists' interpretations of the same sample. Results This study achieved a concordance of 91% between the AI algorithm and cardiologist interpretation (Figure 1). Conclusions The initial results with AI algorithms for STEMI diagnosis are encouraging and may provide the base work for new tools for cardiologists to improve their efficiency. Moreover, implementing this innovative tool may overcome current limitations associated with the telemedical management of this disease. Funding Acknowledgement Type of funding sources: None.

Acute Mesenteric Ischemia in Critically Ill Patients. Possibilities of Laboratory Diagnostics. Systematic Literature Review and Meta-Analysis

Background Acute mesenteric ischemia (ami) is diagnosed in 1 case per 5,000–15,000 operations associated with elective abdominal surgical intervention and in 1 case of 1,000 emergency laparotomies associated with the acute abdomen clinical features. Non-occlusive disorders account for 20-30% of all cases of ami. The absence of pathognomonic symptoms and syndromes, as well as specific laboratory markers of ami, determines significant difficulties in the early diagnosis of this disease, especially in critically ill patients.Aim of study To identify the main laboratory markers of acute mesenteric ischemia applicable in the resuscitation and intensive care unit (ricu) based on a systematic literature review.Material and methods A systematic search and selection of publications was carried out in march-april 2021 in accordance with the prisma system checklist (prisma, preferred reporting items for systematic reviews and meta-analyzes). The search used two databases: the cochrane library of systematic reviews (https://www.cochranelibrary.com) and the pubmed bibliographic database (https://pubmed.ncbi.nlm.nih.gov). Key terms in the search parameters were: acute mesenteric ischemia; bowel necrosis predictors; laboratory diagnostics of mesenteric ischemia. Search parameters were limited to the year of publication (not later than 2015). The main results of the review included patients with an established diagnosis of acute mesenteric ischemia, indicating the level of laboratory parameters (ph of mixed venous blood, lactate, d-dimer, white blood count, mpv, i-fabp, serum marker and alpha-glutathione-s-transferase, indicators of the coagulation and hemostasis). Case reports and editorial letters were excluded from the search.Results The threshold value for serum l-lactate ranged from 1.05 mmol/l to 5.6 mmol/l. The sensitivity of serum lactate for the diagnosis of ami ranged from 34.7% (95% ci: 0.82–91.64%) to 89.51% (95.4% ci: 75.12–94.28%), and the specificity ranged from 47.3% (94.7% ci: 26.54–67.98%) to 94.5% (93.2% ci: 75.44–96.85%). The threshold level of d-dimer varied from 0.58 nmol/l to 7.84 nmol/l. The sensitivity of blood d-dimer for the diagnosis of ami was 72.6% (94% ci: 56.1–92.4%) to 99.7% (94% ci: 69.15–100%); the specificity ranged from 69% (95% ci: 7.41–33.63%) to 97.89% (95% ci: 90.42–98.1%). Parameters such as transaminases (ast, alt), mpv, ldh, d-lactate, serum amylase were not included in the review due to the lack of a sufficient number of studies.Conclusion Today, there is no highly specific laboratory marker that could be considered the “gold standard” in the laboratory diagnosis of acute mesenteric ischemia. The most promising in predicting ami are serum levels of l-lactate and d-dimer.

Identification of potential biomarkers and immune-related pathways related to immune infiltration in patients with acute myocardial infarction

BackgroundAcute myocardial infarction (AMI), a medical condition caused by the ischemic necrosis of cardiac tissues, is due to sudden occlusion of the coronary arteries in patients including transplant recipients. It is the leading reason for death and disability worldwide. This study aimed to search potential biomarkers related to the progression of AMI and identify the related immune-related pathways, as also examine their association with the immune cell infiltration and diagnostic value for AMI. MethodsDatasets of gene microarray were extracted from (www.ncbi.nlm.nih.gov/geo) the Gene Expression Omnibus (GEO) database and AMI-related biomarkers were obtained by differential expression analysis and weighted correlation network analysis (WGCNA). Subsequently, the support vector machine–recursive feature elimination (SVM–RFE) and the least absolute shrinkage and selection operator (LASSO) regression analyses were used to mine AIM-related hub markers. For the assessment of the diagnostic value of these markers for AMI, the receiver operator characteristic (ROC) curves were plotted. Additionally, the single-sample gene set enrichment analysis (ssGSEA) was performed to determine the immune cell infiltration. ResultsA total of 1273 differentially expressed genes (DEGs) were obtained. Nine co-expression modules were obtained after WGCNA. Among them, the brown-colored module was identified as the hub for AMI (correlation [cor] = 0.73, P = 1.1e-87), and intersected with the DEGs yielded a total of 88 shared genes. Subsequently, five hub genes were obtained from the analysis of the LASSO regression and SVM–RFE algorithm. Ultimately, using the ROC curves, the diagnostic values of these genes for AMI were confirmed. The five hub genes were also found to be significantly associated with the infiltration levels of multiple immune cells. Moreover, the DEGs were mainly enriched in the inflammatory and immune-related gene sets evidenced by the functional enrichment analysis. ConclusionThe five hub genes may serve as potential markers for AMI diagnosis and the findings have implications for further investigations on the molecular mechanisms underlying AMI.

Is the standardized phase angle a predictor of short- and long-term adverse cardiovascular events in patients with acute myocardial infarction? A cohort study

ObjectivesAcute myocardial infarction (AMI) is myocardial necrosis resulting from myocardial ischemia, and its risk factors are usually a combination of the consumption of tobacco, inadequate diet, obesity, and a sedentary lifestyle, in addition to preexisting comorbidities. These risk factors may compromise cellular integrity, affecting physiologic and nutritional components. The phase angle (PhA) has been measured by bioelectrical impedance analysis (BIA) to identify the quality of the cell membrane and the distribution of body fluids. The aim of this study was to verify if the standardized PhA (SPhA) is a predictor of short- and long-term adverse cardiovascular events in patients after AMI. MethodsThis was a prospective cohort study including hospitalized adult patients with a diagnosis of AMI. Demographic, clinical, and nutritional data were collected. The PhA was calculated through the measuring of the resistance (R) and reactance (Xc) from BIA, and it was adjusted based on reference values for sex and age, presenting, therefore, the SPhA. Low SPhA was defined as that <10th percentile of distribution. Hospital length of stay (LOS) and major adverse cardiac events (MACE), such as new hospital admission for unstable angina, new MI, and cardiovascular mortality, were observed. The sample comprised 153 patients, with a mean age of 61.2 ± 12.6 y, with 57.5% being older adults. ResultsFifteen patients with low SPhA (values <–3.10) had a longer LOS compared with those with normal SPhA (median 14 versus 8 d, P = 0.007), and shorter time for the occurrence of death (320 versus 354 d, P = 0.024). In the multivariate analysis, an association was observed between SPhA and longer LOS (hazard ratio, 9.25; P = 0.005), but not with mortality and MACE (P > 0.05 for all). ConclusionSPhA was a predictor of longer LOS, but not of long-term adverse cardiac events in patients following AMI.

Construction of Novel Gene Signature-Based Predictive Model for the Diagnosis of Acute Myocardial Infarction by Combining Random Forest With Artificial Neural Network.

BackgroundAcute myocardial infarction (AMI) is one of the most common causes of mortality around the world. Early diagnosis of AMI contributes to improving prognosis. In our study, we aimed to construct a novel predictive model for the diagnosis of AMI using an artificial neural network (ANN), and we verified its diagnostic value via constructing the receiver operating characteristic (ROC).MethodsWe downloaded three publicly available datasets (training sets GSE48060, GSE60993, and GSE66360) from Gene Expression Omnibus (GEO) database, and differentially expressed genes (DEGs) were identified between 87 AMI and 78 control samples. We applied the random forest (RF) and ANN algorithms to further identify novel gene signatures and construct a model to predict the possibility of AMI. Besides, the diagnostic value of our model was further validated in the validation sets GSE61144 (7 AMI patients and 10 controls), GSE34198 (49 AMI patients and 48 controls), and GSE97320 (3 AMI patients and 3 controls).ResultsA total of 71 DEGs were identified, of which 68 were upregulated and 3 were downregulated. Firstly, 11 key genes in 71 DEGs were screened with RF classifier for the classification of AMI and control samples. Then, we calculated the weight of each key gene using ANN. Furthermore, the diagnostic model was constructed and named neuralAMI, with significant predictive power (area under the curve [AUC] = 0.980). Finally, our model was validated with the independent datasets GSE61144 (AUC = 0.900), GSE34198 (AUC = 0.882), and GSE97320 (AUC = 1.00).ConclusionMachine learning was used to develop a reliable predictive model for the diagnosis of AMI. The results of our study provide potential gene biomarkers for early disease screening.

Integrated Bioinformatics-Based Analysis of Hub Genes and the Mechanism of Immune Infiltration Associated With Acute Myocardial Infarction.

BackgroundAcute myocardial infarction (AMI) is a fatal disease that causes high morbidity and mortality. It has been reported that AMI is associated with immune cell infiltration. Now, we aimed to identify the potential diagnostic biomarkers of AMI and uncover the immune cell infiltration profile of AMI.MethodsFrom the Gene Expression Omnibus (GEO) data set, three data sets (GSE48060, GSE60993, and GSE66360) were downloaded. Differentially expressed genes (DEGs) from AMI and healthy control samples were screened. Furthermore, DEGs were performed via gene ontology (GO) functional and kyoto encyclopedia of genes and genome (KEGG) pathway analyses. The Gene set enrichment analysis (GSEA) was used to analyze GO terms and KEGG pathways. Utilizing the Search Tool for Retrieval of Interacting Genes/Proteins (STRING) database, a protein–protein interaction (PPI) network was constructed, and the hub genes were identified. Then, the receiver operating characteristic (ROC) curves were constructed to analyze the diagnostic value of hub genes. And, the diagnostic value of hub genes was further validated in an independent data set GSE61144. Finally, CIBERSORT was used to represent the compositional patterns of the 22 types of immune cell fractions in AMI.ResultsA total of 71 DEGs were identified. These DEGs were mainly enriched in immune response and immune-related pathways. Toll-like receptor 2 (TLR2), interleukin-1B (IL1B), leukocyte immunoglobulin-like receptor subfamily B2 (LILRB2), Fc fragment of IgE receptor Ig (FCER1G), formyl peptide receptor 1 (FPR1), and matrix metalloproteinase 9 (MMP9) were identified as diagnostic markers with the value of p < 0.05. Also, the immune cell infiltration analysis indicated that TLR2, IL1B, LILRB2, FCER1G, FPR1, and MMP9 were correlated with neutrophils, monocytes, resting natural killer (NK) cells, gamma delta T cells, and CD4 memory resting T cells. The fractions of monocytes and neutrophils were significantly higher in AMI tissues than in control tissues.ConclusionTLR2, IL1B, LILRB2, FCER1G, FPR1, and MMP9 are involved in the process of AMI, which can be used as molecular biomarkers for the screening and diagnosis of AMI. In addition, the immune system plays a vital role in the occurrence and progression of AMI.

Bleed or Clot? Managing Bleeding in Post Thrombolysis Patient with Massive Pulmonary Embolism Who Underwent Recent Major Cancer Surgery

51 years old female, with invasive left breast cancer stage T3N0M0 developed syncope, hypotension, chest pain, and ST elevation in anterior leads on the next day following Left Mastectomy. The initial diagnosis of AMI revised to massive pulmonary embolism after tranthoracic enchocardiogram. However, IV (intravenous) Metalyse was given as thrombolysis therapy and the patient showed a good initial response. Subsequently, the patient developed massive bleeding from the surgical site. Bleeding was successfully controlled with total of 11 units packed cells, 4 units fresh frozen plasma, 4 units of platelet, and 6 units of cryoprecipitate as well as prothrombin complex concentrate. Local compression bandage and continuous surgical site drainage were applied in this case. Following successful control in bleeding unfractionated heparin infusion was given for 2days followed by low molecular weight heparin for 2days and discharged with a direct oral anticoagulant. On follow up visit, the patient made an excellent recovery and planned for further treatment for breast cancer. Thrombolysis therapy and anticoagulant therapy in post-operative patients with high-risk bleeding posses great challenges. Careful evaluation of bleeding versus clotting is the key to good outcomes.

ACUTE SUPERIOR MESENTERIC VESSEL THROMBOSIS CAUSING BOWEL ISCHEMIA – A 5 CASE SERIES

Background: Acute mesenteric ischemia consists of the sudden, partial or complete, interruption of the blood ow in superior or inferior mesenteric vessels that result in intestinal ischemia. The incidence was exponentially increasing with age and no difference has been observed between sexes. Aim: The Aim of this case series was to highlight clinical presentation, the difculty in diagnosis and importance of early intervention and the prognosis of superior mesenteric vessel thrombosis with bowel ischemia. This article presented a case series of intestinal infarction through obstruction of superior mesenteric vessels – three cases of acute mesenteric artery thrombosis, two case of acute mesenteric vein thrombosis. Materials and methods: The materials for this case series was collected from patients diagnosed and admitted as acute superior mesenteric vessel thrombosis in various surgical units in Department of General Surgery, Govt. Kilpauk Medical College &amp; Hospital &amp; Govt Royapettah Hospital,Chennai. All 5 cases have been analyzed for this study during period of 18 months from March 2020 to Augest 2021. All Cases with superior mesenteric vessels thrombosis were included.No exclusion criteria. Results: This case series consisted of 5 cases, three cases of acute mesenteric artery thrombosis and two case of acute mesenteric vein thrombosis. In this case series, superior mesenteric artery thrombosis was more common with male preponderance. 4 out of 5 cases were male in which Superior mesenteric artery was more common when compared to vein thrombosis. Out of 5 cases, 2 cases were asymptomatic with mild abdominal discomfort. Most common complaints of 5 cases were sudden onset of abdominal pain with or without vomiting. Abdominal distension/ Constipation were not seen in all cases. Out of 5 cases, 2post- operative stay and no complications after surgery. 2 cases developed postop complications.1 case had deceased because of late presentation. Conclusion: The diagnosis of AMI is difcult and mostly delayed resulting in irreversible bowel ischemia which requires emergency intervention. Mortality and morbidity for AMI remains high, and in patients requiring extensive bowel resection the survival rate was low. As AMI mostly affects the elderly population physicians have to be aware of the possibility of this condition when facing the elderly patient even with mild sudden onset of abdominal pain complaints. An interdisciplinary collaboration is must, since patients are not initially evaluated by surgeons.

Circulating long non-coding RNA TTTY15 and HULC serve as potential novel biomarkers for predicting acute myocardial infarction

IntroductionAcute myocardial infarction (AMI) is a ubiquitous cardiovascular disease ensuing adverse prognosis caused by myocardial necrosis. Effective and rapid diagnosis of AMI is essential to following treatment in clinical practice while the existed biomarkers have inherent limitations. Consequently, exploration of novel biomarkers is needed. Long noncoding RNA (lncRNA) emerges as the upcoming biomarkers adopted in clinical use, and we aim at investigating the diagnostic power of lncRNA TTTY15 and HULC in AMI patients.MethodWe measured lncRNA level in 80 AMI patients and 36 healthy volunteers in discovering cohort and 50 AMI patients and 20 healthy volunteers in verification cohort with quantitative RT-PCR method. Receiver operating characteristic (ROC) analysis was administered to detect the diagnostic power of selected lncRNAs. Regression and correlation analyses were performed to explore the related factors.ResultsROC analysis reveals the superiority of TTTY15 and HULC as biomarkers against conventional AMI biomarkers CKMB (AUC of TTTY15: 0.915 versus CKMB: 0.768 versus TnT: 0.869); AUC of HULC: 0.905 versus CKMB: 0.768 versus TnT: 0.869). Regression and correlation analysis indicates that TTTY15 and HULC may be one of the contributing factors to AMI and related to accepted risk factors.ConclusionOur results revealed the diagnostic potency of lncRNA TTTY15 and HULC, and they could also be treated as novel therapeutic targets in AMI therapy, hinting inspiration to the cardiologist in clinical practice.

Hospital-Level Disparities in the Management and Outcomes of Cardiac Arrest Complicating Acute Myocardial Infarction

There are limited contemporary data evaluating the relation between hospital characteristics and outcomes of patients with cardiac arrest complicating acute myocardial infarction (AMI-CA). As such, we used the National Inpatient Sample database (2000 to 2017), to identify adult admissions with primary diagnosis of AMI and concomitant CA. Interhospital transfers were excluded, and hospitals were classified based on location and teaching status (rural, urban nonteaching, and urban teaching) and bed size (small, medium, and large). Among 494,083 AMI-CA admissions, 9.3% received care at rural hospitals, 43.4% at urban nonteaching hospitals, and 47.3% at urban teaching hospitals. Compared with urban nonteaching and teaching hospitals, AMI-CA admissions at rural hospitals received lower rates of cardiac and noncardiac procedures. Admissions to urban teaching hospitals had higher rates of acute organ failure, concomitant cardiogenic shock, and cardiac and noncardiac procedures. When hospitals were stratified by bed size, 9.8% of AMI-CA admissions were admitted to small capacity hospitals, 26.0% to medium capacity, and 64.2% to large capacity hospitals. The use of cardiac and noncardiac procedures was lower in small hospitals with higher rates of use in medium and large hospitals. In-hospital mortality was higher in urban nonteaching (adjusted odds ratio [OR] 1.17; 95% confidence interval [CI]1.14 to 1.20; p <0.001) and urban teaching hospitals (adjusted OR 1.36; 95% CI 1.32 to 1.39; p <0.001) compared with rural hospitals. Compared with small hospitals, medium (adjusted OR 1.11; 95% CI 1.08 to 1.14; p <0.001) and large hospitals (adjusted OR 1.22; 95% CI 1.19 to 1.25; p <0.001) were associated with higher in-hospital mortality. In conclusion, AMI-CA admissions to large and urban hospitals had higher in-hospital mortality compared with small and rural hospitals potentially owing to greater acuity.

Clinical characteristics and outcome of patients with acute mesenteric ischemia: a retrospective cohort analysis

BackgroundAcute mesenteric ischemia (AMI) is an uncommon, but life-threatening clinical entity due to late diagnosis resulting in irreversible ischemic bowel necrosis. The most common causes of AMI are the embolic occlusion and the acute thrombosis of the mesenteric circulation. Typical treatment is composed of an early revascularization of the mesenteric circulation followed by abdominal surgery for resection of nonviable intestine and restoration of the intestinal continuity, but the mortality rates remain high.MethodsA retrospective cohort analysis was conducted, aiming to evaluate clinical characteristics, performed surgical procedures and outcomes of patients with acute mesenteric ischemia who underwent emergency abdominal surgery at a high volume surgical center in Germany.ResultsOverall, 53 patients were identified with the intraoperatively proven diagnosis of AMI. Overall hospital mortality was with 62% comparable to the literature. Nineteen patients presented with an intraoperatively verified complete and non-reversible intestinal infarction without any angiographic or surgical option for a revascularization of the mesenteric circulation or an option for intestinal resection. From the rest of the patients, 14 underwent intestinal resection of the ischemic area without restoration of intestinal continuity; the other 20 underwent resection with a primary anastomosis to restore intestinal continuity. The mortality rate of these patients with curative-intended surgery remained high (41% of patients died). Pre- and postoperative hyperlactatemia were associated with lower survival of these patients.ConclusionAMI remains a life-threatening abdominal emergency. Therapeutic approaches are highly depended on acting surgeon’s decision, being affected by subjectively rated bowel viability and physical condition of the affected patient. Only selected patients with good bowel viability appear to be suitable for receiving primary anastomosis. The results clearly indicate the need for further research to develop therapeutic approaches for a better management of AMI and to improve outcome of affected patients.

Eotaxin-1 Levels in Patients with Myocardial Infarction.

Acute myocardial infarction is one of the leading causes of morbidity and mortality worldwide. Eotaxin-1, an eosinophil-specific chemoattractant, has been shown to be overexpressed in human atherosclerotic lesions. Eotaxin-1 levels are higher in coronary artery disease patients than in healthy individuals. In this study, we aimed to determine the eotaxin-1 concentrations of patients with myocardial infarction and to investigate the role of eotaxin-1 in myocardial infarction. The study included 42 patients diagnosed with AMI (patients with suspected AMI based on history, physical examination, ECG, and biochemical markers and confirmed by angiography) and 40 healthy controls. Plasma eotaxin-1 levels were determined by enzyme-linked immunosorbent assay (ELISA). Eotaxin-1, troponin-I, CK, and CKMB levels were statistically higher in the patient group than in the control group. ROC analysis demonstrated that eotaxin-1 gave a sensitivity of 93% and a specificity of 48% once the cutoff value was 341.6 pg/mL. Additionally, the ROC analysis showed that troponin I yielded a specificity of 100% and a sensitivity of 91% when the cutoff value was 0.025 µg/L. Eotaxin-1/eosinophils appear to have a role in coronary artery disease independent of known risk factors. Accordingly, this study and recent studies suggest that eotaxin-1 may be useful in the diagnosis of AMI in addition to other cardiac markers.

A Cross Sectional Study on Hypokalemia in Patients with Acute Myocardial Infarction

Introduction: Hypokalemia was found to be more common in women, those with hypertension, and those on chronic diuretic therapy.&#x0D; Objectives of the Study: The main objective of the study is to analyse the hypokalemia in patients with acute myocardial infarction.&#x0D; Materials and Methods: This cross sectional study was conducted in District Head Quarter Teaching Hospital Faisalabad during 2019 to 2020. The data was collected from 100 male and female patients with myocardial infarction. The effect of plasma potassium concentration on patient survival after a myocardial infarction is investigated. &#x0D; Results: The data was collected from 100 patients of MI. Mean age of male patients was found to be 64.12±12.34 and female patients was 46.21±10.24. There was statistically significant decrease in serum sodium and potassium levels in study group among both the ages compared to normal healthy control group. Serum sodium, potassium, chloride, calcium levels were significantly lower in the AMI patients and magnesium levels were slightly raised among cases than controls.&#x0D; Conclusion: It is concluded that reduction in sodium level was assessed only in patients with AMI as compared to healthy persons. Estimation of serum electrolyte is of utmost importance for diagnosis and prognosis of AMI.

Gender-Related Differences of Cardiac Troponin-I Levels in Patients with Acute Myocardial Infarction at Time of Acute Chest Pain

Background: Cardiac Troponins-I (CTNI) are myoregulatory polypeptides that control the actin-myosin interface, considered specific to cardiomyocytes. Age and sex variances in the extent of CTNI levels have arisen a recent debatable emphasis. Existing revisions do not display a reliable clinical power of sex-specific CTNI 99th centiles, which actually might mirror procedural aspects. Nevertheless, from a biochemical viewpoint, the trends of sex-specific CTNI 99th centiles seem sensible for the ruling-in of acute myocardial infarction AMI. Vulnerable females may be missed when applying the male sex-specific threshold.&#x0D; This study aimed to determine whether gender differences in CTNI exist in patients with AMI presented with chest pain.&#x0D; Methodology: The study was a cross-sectional, single-center, included 236-patients with AMI diagnosis by cardiologists at Merjan teaching hospital during the period from April to July 2020 from patients attending the hospital for cardiac consultation complaining of acute chest pain suggestive of AMI. Blood analysis had initiated at the time of admission included serum creatinine, blood urea, R/FBS, WBCs, PCV, and serum CTNI. A p-value below 0.05 specifies statistical significance. All statistical bioanalyses had performed by IBM-SPSS, version-25 for Windows.&#x0D; Results: The mean age of participants was 67.5 years, the men were dominant 76.2%. The incidence of DM and hypertension were significantly high and 24.5% of the patients were current smokers. Biochemical serum analysis revealed mean creatinine, urea, sugar, and STI values were 79.8±4.2 mmol/l, 15.9±1.7 mmol/l, 10.9±0.9 mmol/l, and 7.9±0.6 ng/ml separately. Both hypertension and smoking were significantly (p-0.001) more among males compared to the females, which is not the case for the prevalence of DM. The males were heavier significantly than females (p-0.001). Almost, there was no impact of gender on most of the other study variables other than serum TNI levels, which were significantly higher among the males (p-0.001).&#x0D; Conclusion: In patients with AMI presented with acute chest pain, the routine of CTNI in the diagnosis of AMI is based on the patient's gender. The application of gender-dependent cutoff levels for CTNI analyses appears to be highly suggested.

Abstract 9447: Hospital-level Disparities in Management and Outcomes of Cardiac Arrest Complicating Acute Myocardial Infarction

Background: There is limited contemporary data exploring the impact of hospital characteristics on the outcomes of AMI-CA patients. Methods: We used the National Inpatient Sample database (2000-2017), to identify adult admissions with a primary diagnosis of AMI and concomitant CA. Inter-hospital transfers were excluded and hospitals were classified based on location and teaching status (rural, urban nonteaching and urban-teaching), and bed size (small, medium and large) as specified by the Agency for Healthcare Research and Quality Results: Among 494,083 AMI-CA admissions, 9.3% received care at rural hospitals, 43.4% at urban non-teaching hospitals, and 47.3% at urban teaching hospitals. Compared to urban non-teaching and teaching hospitals, AMI-CA admissions at rural hospitals received lower rates of coronary angiography (36.5% vs 57.7% vs 69.1%), PCI (28.1% vs 42.6% vs 52.1%), CABG (3.4%, 7.6% vs. 10.1%), MCS (10.1% vs 17.8% vs 22.6%), and invasive mechanical ventilation (42.9%, 49.7% vs. 48.7%) (all p &lt;0.001). Admissions to urban teaching hospitals had higher rates of acute organ failure, concomitant cardiogenic shock and higher rates of cardiac and non-cardiac procedures. When hospitals were stratified by bed-size, 9.8% of AMI-CA admissions were admitted to small hospitals, 26.0% to medium-sized, and 64.2% to large hospitals. Compared to medium and large hospitals, AMI-CA admissions at small hospitals had lower rates of coronary angiography (48.9% vs 56.8% vs 64.7%), PCI (37.5% vs 42.5% vs 48.4%), CABG (5.3%, 6.8% vs. 9.5%), MCS (14.3% vs 17.3% vs 21%), and invasive mechanical ventilation (48.3%, 50.1% vs. 48%) (all p &lt;0.001). In-hospital mortality was higher in urban non-teaching (adjusted odds ratio [aOR] 1.17 [95% confidence interval {CI} 1.14-1.20]; p&lt;0.001) and urban teaching hospitals (aOR 1.36 [95% CI 1.32-1.39]; p&lt;0.001) compared to rural hospitals. Compared to small hospitals, medium (aOR 1.11 [95% CI 1.08-1.14]; p&lt;0.001) and large hospitals (aOR 1.22 [95% CI 1.19-1.25]; p&lt;0.001) were associated with higher in-hospital mortality. Conclusions: AMI-CA admissions to large and urban hospitals had higher in-hospital mortality compared to small and rural hospitals potentially due to greater acuity.

Mesenteric ischemia in patients with COVID-19: an updated systematic review of abdominal CT findings in 75 patients.

BackgroundAcute mesenteric ischemia (AMI) is a less common but devastating complication of COVID-19 disease. The aim of this systematic review was to assess the most common CT imaging features of AMI in COVID-19 and also provide an updated review of the literature on symptoms, treatment, histopathological and operative findings, and follow-up of these patients.MethodsA systematic literature search of four databases: Pubmed, EMBASE, WHO database, and Google Scholar, was performed to identify all the articles which described abdominal CT imaging findings of AMI in COVID-19.ResultsA total of 47 studies comprising 75 patients were included in the final review. Small bowel ischemia (46.67%) was the most prevalent abdominal CT finding, followed by ischemic colitis (37.3%). Non-occlusive mesenteric ischemia (NOMI; 67.9%) indicating microvascular involvement was the most common pattern of bowel involvement. Bowel wall thickening/edema (50.9%) was more common than bowel hypoperfusion (20.7%). While ileum and colon both were equally involved bowel segments (32.07% each), SMA (24.9%), SMV (14.3%), and the spleen (12.5%) were the most commonly involved artery, vein, and solid organ, respectively. 50% of the patients receiving conservative/medical management died, highlighting high mortality without surgery. Findings on laparotomy and histopathology corroborated strikingly with CT imaging findings.ConclusionIn COVID-19 patients with AMI, small bowel ischemia is the most prevalent imaging diagnosis and NOMI is the most common pattern of bowel involvement. Contrast-enhanced CT is a powerful decision-making tool for prompt diagnosis of AMI in COVID-19, thereby potentially improving time to treat as well as clinical outcomes. Graphical abstract Supplementary InformationThe online version contains supplementary material available at 10.1007/s00261-021-03337-9.

English

BACKGROUND Cardiovascular diseases are one of the leading causes of morbidity and mortality worldwide. High Ca levels and low Mg levels are associated with increased cardiovascular risk in the general population.1 The balance between Ca and Mg seems to play an important role in homeostasis since Mg is considered as physiologic antagonist of Ca.2 Hence Ca/Mg ratio was considered to study its association with acute coronary syndrome (ACS). METHODS This is a case control study conducted in Karnataka Institute of Medical Sciences, Hubli over a period of 2 years, February 2019 to December 2020. 200 cases and 150 controls were included in the study. The biochemical measurements including complete blood count (CBC), cardiac biomarkers, liver function tests, renal function tests (RFT), serum electrolytes and lipid profile were measured using standard laboratory methods. Student ‘t’ test was used to compare the data. Optimum cut-offs for diagnosis of acute myocardial infarction was calculated using receiver operating characteristics (ROC) analysis. The association among markers was established by calculating Pearson’s correlation. RESULTS Serum Ca/Mg ratio was significantly higher (p value &lt; 0.001) in ACS when compared to control groups. It was also found that Ca/Mg ratio was significantly lower (p value &lt; 0.001) in non-ST elevation myocardial infarction (NSTEMI) when compared to STEMI group. Serum Mg was significantly lower (p value &lt; 0.001) in ACS group when compared to control group. Significant correlation (p value &lt; 0.05) was found between serum Ca/Mg ratio and cardiac markers (CKMB, Troponin-I). ROC analysis of Ca/Mg (4.19) ratios showed optimum cut-offs in diagnosis of AMI. CONCLUSIONS Serum Ca/Mg could be useful adjuvant marker in diagnosis of AMI. The ratio is higher in ST-segment elevation myocardial infarction when compared to non-STsegment myocardial infarction, which could be due to greater decrease in Mg levels when compared Ca in ACS. KEYWORDS ST Elevation Myocardial Infarction (STEMI), Non ST Elevation Myocardial Infarction (NSTEMI), Calcium (Ca), Magnesium (Mg), Acute Coronary Syndrome (ACS), Creatine Kinase-MB (CK-MB).

Impact of availability of catheter laboratory facilities on management and outcomes of acute myocardial infarction presenting with out of hospital cardiac arrest

ObjectivesWe aimed to identify whether the availability of catheter laboratory affects clinical outcomes of out-of-hospital cardiac arrest (OHCA) complicating myocardial infarction (AMI). MethodsPatients admitted with a diagnosis of AMI and OHCA from the Myocardial Ischaemia National Audit Project (MINAP) between 2010 to 2017 were stratified into three groups based on initial hospital’s catheter laboratory status: hospitals without a catheter laboratory (No-catheter lab hospitals), hospitals with diagnostic catheter laboratory (Diagnostic hospitals), and hospitals with PCI facilities (PCI hospitals). We used multivariable logistic regression to evaluate factors associated with clinical outcomes. ResultsWe included 12,303 patients of which 9,798 were admitted to PCI hospitals, 1,595 to no-catheter lab hospitals, and 910 to diagnostic hospitals. Patients admitted to PCI hospitals were more frequently reviewed by a cardiologist (96%, p < 0.001) than no-catheter lab hospitals (80%) and diagnostic hospitals (74%), and more likely to receive coronary angiography (PCI hospitals (87%), diagnostic hospitals (31%), no-catheter lab hospitals (54%), p < 0.001). They also were more likely to undergo PCI (PCI hospitals (42%), diagnostic hospitals (17%), no-catheter lab hospitals (17%), p < 0.001). After adjustment, there was no significant difference in the in-hospital mortality (OR 0.76, 95% CI 0.55–1.06) or re-infarction (OR 1.28, 95% CI 0.72–2.26) in patients admitted to PCI hospitals nor in patients admitted to diagnostic hospitals (mortality (OR 1.28, 95% CI 0.72–2.26), re-infarction (OR 1.38, 95% CI 0.68–2.82)). ConclusionThere is variation in coronary angiography use between hospitals without a catheter laboratory and PCI centres, which was not associated with better in-hospital survival.

Soluble MICA versus Troponin as Early snd Specific Predictor for Acute Myocardial Infarction in Patients with Chronic Kidney Disease

Abstract Background Accurate early detection &amp; early management of MI as a life threatening condition in patients with CKD , who are more likely than those without it to have elevated troponin levels still challenging. Recently, MICA could be activated in the normal tissues by a variety of stimuli, such as ischemia/reperfusion-induced tissue injury. Aim of the Work To compare sensitivity and specificity of serum sMICA to that of Troponin for early and accurate diagnosis of AMI in patients with CKD. Patients and Methods Total 30 patients was enrolled in the study and divided into 2 groups A &amp; B (15 for each one) in NHI , cTnI and sMICA was assayed in both groups; in the group A,cTnI &amp; sMICA was assayed serially according to time from arrival of the patient to ED (0 hour , 3 hours, 6 hours, 12 hours, and 24 hours ) and recording the pattern of rising, peaking &amp; falling of both biomarkers.. ‘ Results At zero hour both markers were positive serum level in both groups but lower in sMICA then pattern of rising and peaking of sMICA was early than TnI in AMI group which peaks later. Conclusion sMICA could be considered as a novel predictor that more sensitive and specific than cTnI.