Diagnosis Of AMI Research Articles

New Electrocardiographic Algorithm for the Diagnosis of Acute Myocardial Infarction in Patients With Left Bundle Branch Block.

BackgroundCurrent electrocardiographic algorithms lack sensitivity to diagnose acute myocardial infarction (AMI) in the presence of left bundle branch block.Methods and ResultsA multicenter retrospective cohort study including consecutive patients with suspected AMI and left bundle branch block, referred for primary percutaneous coronary intervention between 2009 and 2018. Pre‐2015 patients formed the derivation cohort (n=163, 61 with AMI); patients between 2015 and 2018 formed the validation cohort (n=107, 40 with AMI). A control group of patients without suspected AMI was also studied (n=214). Different electrocardiographic criteria were tested. A total of 484 patients were studied. A new electrocardiographic algorithm (BARCELONA algorithm) was derived and validated. The algorithm is positive in the presence of ST deviation ≥1 mm (0.1 mV) concordant with QRS polarity, in any lead, or ST deviation ≥1 mm (0.1 mV) discordant with the QRS, in leads with max (R|S) voltage (the voltage of the largest deflection of the QRS, ie, R or S wave) ≤6 mm (0.6 mV). In both the derivation and the validation cohort, the BARCELONA algorithm achieved the highest sensitivity (93%–95%), negative predictive value (96%–97%), efficiency (91%–94%) and area under the receiver operating characteristic curve (0.92–0.93), significantly higher than previous electrocardiographic rules (P<0.01); the specificity was good in both groups (89%–94%) as well as the control group (90%).ConclusionsIn patients with left bundle branch block referred for primary percutaneous coronary intervention, the BARCELONA algorithm was specific and highly sensitive for the diagnosis of AMI, leading to a diagnostic accuracy comparable to that obtained by ECG in patients without left bundle branch block.

The biomarkers of key miRNAs and target genes associated with acute myocardial infarction.

BackgroundAcute myocardial infarction (AMI) is considered one of the most prominent causes of death from cardiovascular disease worldwide. Knowledge of the molecular mechanisms underlying AMI remains limited. Accurate biomarkers are needed to predict the risk of AMI and would be beneficial for managing the incidence rate. The gold standard for the diagnosis of AMI, the cardiac troponin T (cTnT) assay, requires serial testing, and the timing of measurement with respect to symptoms affects the results. As attractive candidate diagnostic biomarkers in AMI, circulating microRNAs (miRNAs) are easily detectable, generally stable and tissue specific.MethodsThe Gene Expression Omnibus (GEO) database was used to compare miRNA expression between AMI and control samples, and the interactions between miRNAs and mRNAs were analysed for expression and function. Furthermore, a protein-protein interaction (PPI) network was constructed. The miRNAs identified in the bioinformatic analysis were verified by RT-qPCR in an H9C2 cell line. The miRNAs in plasma samples from patients with AMI (n = 11) and healthy controls (n = 11) were used to construct receiver operating characteristic (ROC) curves to evaluate the clinical prognostic value of the identified miRNAs.ResultsWe identified eight novel miRNAs as potential candidate diagnostic biomarkers for patients with AMI. In addition, the predicted target genes provide insight into the molecular mechanisms underlying AMI.

The Association Between Myoglobin, Troponin I, Hfabp and Nt-Probnp Levels with Acute Myocardial Infarction in Patients with Acute Coronary Syndrome

Introduction: Myocardial infarction is one of the five major manifestations of coronary heart disease. Myoglobin heart markers, Isoenzyme Creatine Kinase-MB (CK-MB), cardiac Troponin I (cTnI) or Troponin T (cTnT), Heart type fatty acid-binding protein (HFABP) and NT-proBNPare currently used in assisting the diagnosis of acute myocardial infarction. The study aimed to analyze the association of cardiac marker examination results of myoglobin, cTnI, HFABP and NT-proBNP with AMIoccurrence on examination I and examination II. Method: This study enrolled33 patients in Installation of Emergency Carewith suspected acute coronary syndrome, from March to August 2013. Serum samples were taken including cTnT, myoglobin, cTnI, HFABP and NT-proBNP. Then, it was further analyzed. Results: There was an association between myoglobin, cTnI, HFABP, and NT-proBNP with AMI events. Myoglobin and HFABP wereearly markers for the diagnosis of AMI, the mean levels of both markers was higher at the first examination (&lt;1 hour admitted patients) when compared with 6 hours later after being tested. Essentially, the diagnostic value of both did not differ, only HFABP was more specific than myoglobin. Troponin I showed to be the best choice in the diagnosis of AMI because of the high sensitivity and specificity. Conclusion: An association between myoglobin, cTnI, HFABP, and NT-proBNP with AMI events was found. Myoglobin, cTnI, HFABP can be used in diagnosing AMI patients, whereas NT-proBNP is not recommended for the diagnosis of AMI due to its low specificity.

The role of human heart-type Fatty Acid Binding Protein in the early detection of myocardial injury in Acute Coronary Syndrome

Objectives: To evaluate the use of H-FABP as a novel marker in early detection of cardiac damage (MI) in patients presenting with symptoms of acute coronary syndrome (ACS). Methods: This cross-sectional study included 250 subjects; 125 patients of ACS presenting within four hours of the onset of chest pain and/dyspnea and 125 age and sex-matched healthy controls. An initial blood sample was taken from patients at presentation. Blood samples of healthy control subjects were also taken. The blood samples of both groups were centrifuged and stored at -200 C for H-FABP analysis. All the patients and control subjects were thoroughly examined and detailed history was taken. The diagnostic test was troponin-T.H-FABP concentrations of all samples were measured by ELISA-kit. The results were analyzed statistically. A p-value≤0.05 was considered statistically significant. Results: In 125 patients of ACS, H-FABP showed a sensitivity of 85% and specificity of 83.3% for acute MI diagnosis at a cut-off level of 16 ng/ml. Positive predictive values and negative predictive values were 96.8% and 48.4% respectively. The accuracy was 84.4%and the area under the ROC curve was 0.842. Conclusion: Evaluation of heart-type fatty acid-binding Protein (H-FABP) within four hours of onset ACS symptoms may be a valuable tool in the diagnosis of AMI. Keywords: Heart-type fatty acid-binding protein, Acute coronary syndrome, Myocardial infarction.

Impact of left ventricular assist devices and heart transplants on acute myocardial infarction and heart failure mortality and readmission measures.

Concern has been raised about consequences of including patients with left ventricular assist device (LVAD) or heart transplantation in readmission and mortality measures. We calculated unadjusted and hospital-specific 30-day risk-standardized mortality (RSMR) and readmission (RSRR) rates for all Medicare fee-for-service beneficiaries with a primary diagnosis of AMI or HF discharged between July 2010 and June 2013. Hospitals were compared before and after excluding LVAD and heart transplantation patients. LVAD indication was measured. In the AMI mortality (n = 506,543) and readmission (n = 526,309) cohorts, 1,166 and 1,016 patients received an LVAD while 3 and 2 had a heart transplantation, respectively. In the HF mortality (n = 1,015,335) and readmission (n = 1,254,124) cohorts, 789 and 931 received an LVAD, while 212 and 202 received a heart transplantation, respectively. Less than 2% of hospitals had either ≥6 patients who received an LVAD or, independently, had ≥1 heart transplantation. The AMI mortality and readmission cohorts used 1.8% and 2.8% of LVADs for semi-permanent/permanent indications, versus 73.8% and 78.0% for HF patients, respectively. The rest were for temporary/external indications. In the AMI cohort, RSMR for hospitals without LVAD patients versus hospitals with ≥6 LVADs was 14.8% and 14.3%, and RSRR was 17.8% and 18.3%, respectively; the HF cohort RSMR was 11.9% and 9.7% and RSRR was 22.6% and 23.4%, respectively. In the AMI cohort, RSMR for hospitals without versus with heart transplantation patients was 14.7% and 13.9% and RSRR was 17.8% and 17.7%, respectively; in the HF cohort, RSMR was 11.9% and 11.0%, and RSRR was 22.6% and 22.6%, respectively. Estimations changed ≤0.1% after excluding LVAD or heart transplantation patients. Hospitals caring for ≥6 patients with LVAD or ≥1 heart transplantation typically had a trend toward lower RSMRs but higher RSRRs. Rates were insignificantly changed when these patients were excluded. LVADs were primarily for acute-care in the AMI cohort and chronic support in the HF cohort. LVAD and heart transplantation patients are a distinct group with differential care requirements and outcomes, thus should be considered separately from the rest of the HF cohort.

A MACHINE LEARNING ALGORITHM TO PREDICT ACUTE MYOCARDIAL INFARCTION OVER 30 MINUTES

Chest pain is a common presentation in the emergency department (ED). Variation in high sensitivity cardiac troponin I (hs-cTnI) by age and gender make diagnosis of AMI more challenging. Machine learning integrates these variables to allow more accurate and rapid evaluation of possible AMI. We

Overexpression of miR-375 Protects Cardiomyocyte Injury following Hypoxic-Reoxygenation Injury.

The aim of the study was to evaluate the clinical significance of microRNA-375 in acute myocardial infarction patients and its mimic action in hypoxia/reoxygenation- (H/R-) induced ventricular cardiomyocyte H9c2 injury. In the current study, 90 ST-elevated acute MI patients (STEMI), 75 non-ST-elevated acute MI patients (NSTEMI), 90 healthy subjects, 14 weeks old mice, and ventricular cardiomyocyte H9c2 were included. The expressions of plasma microRNA-375 in patients with STEMI and NSTEMI and AMI mouse models were remarkably decreased than in controls (P < 0.001). The areas under the curve (AUC) of plasma microRNA-375 were revealed 0.939 in STEMI and 0.935 in NSTEMI subjects. Moreover, microRNA-375 levels in H/R-exposed cardiac H9c2 cells were evidently downregulated and significantly increased apoptosis rate and caspase-3 activity levels, while overexpression of miR-375 remarkably reduced apoptosis percentage and caspase-3 levels as compared with normal cells. Furthermore, this study also demonstrated that Nemo-like kinase (NLK), NLK mRNA, and protein expression levels were significantly downregulated in H/R-injured H9c2 cells, on the contrary, H9c2 cells transfected with mimic-miR-375 greatly upregulated NLK mRNA and protein expression. Plasma microRNA-375 may serve as an essential clinical biomarker for diagnosis of early-stage AMI. Mimic expression of miR-375 significantly prevented H/R-induced cardiomyocyte injury by decreasing caspase-3 activity through upregulation of the NLK gene, recommended as a new therapeutic option for AMI patient.

EXAMINATION OF THE IMPACT OF CHARACTERISTICS OF THE HEALTH ISSUES, LENGTH OF TIME SINCE THEMYOCARDIAL INFARCTION AND COMORBIDITY TO THE QUALITY OF LIFE OF DISEASED OF MYOCARDIAL INFARCTION

&amp;lt;p&amp;gt;Introduction: Acute myocardial infarction is a common and urgent disease with potentially poor prognosis, so the examination of the quality of life of diseased and all factors that affect it are very important. Objective of the paper is to examine the impact of the characteristics of the health issues, thelength of time since the myocardial infarction as well as the comorbidity to the quality of life of diseased of myocardial infarction.&amp;lt;/p&amp;gt; &amp;lt;p&amp;gt;Methods: In order to assess the impact of acute myocardial infarction on the quality of life of diseased, a retrospectiveprospective study was conducted, designed as a cross sectional study. The followingwas used during the research: sociodemographic questionnaire, questionnaire for assessment of health status, comorbidity and characteristics of health issues of patients and Short Form 36 Health Survey, i.e. SF-36. Statistical analysis of data was made using the SPSS software statistical program.&amp;lt;/p&amp;gt; &amp;lt;p&amp;gt;Results: The study covered 175 subjects, of which 113 (64.6%) were male and 62 (35.4%) female. In relation to the time of diagnosis of AMI in 29.7% of subjects, the diagnosis was set in the last month, while in the remaining 70.3% it was diagnosed in the last year to a month. The highest number of respondents (68.6%) felt a strong pain before reporting to a healthinstitution for treatment, 63.4% of the respondents had cardiovascular comorbidity and the highest number of respondents (83.4%) has diagnosed arterial hypertension. Physical functioning (65.48: 81.42) (t = -6.841; p = 0.001), limitation due to physical health (51.44: 76.62) (t = -7.364; p = 0.001), the presence of bodily pains (35.88: 57.05) (t = - 7.943; p = 0.001), general health (59.04: 75.75) (t = -7.277; p = 0,001), vitality (52.78: 56.99) (t = -4.796; p = 0.001), social functioning (39.42: 63.31) (t = -7.099; p = 0.001), limitation due to emotional problems (33.97: 61.51) = -6.693; p = 0.001) and mental health (36.69: 53.97) (t = -7.714; p = 0.001) are domains in which there is a high statistically significant difference in mean values between groups of subjects compared to the time of diagnosis, whereby respondents which diagnosis was set in the last year to a month have statistically significantly better quality of health compared to those which diagnosis was set in the last month. When it comes to a common measure of physical health and mental health, a group of subjects diagnosed in the last year to a month also showed statistically significantly better results than respondents in whom AMI diagnosis was found in the last month (t = -4.152; p = 0.001; t = -7.147; p = 0.001).&amp;lt;/p&amp;gt; &amp;lt;p&amp;gt;Discussion: The quality of life related to health is significantly lower in subjects diagnosed with AMI in the last month compared to respondents who have been diagnosed in the last year to a month and between groups of subjects of different sexes there is no statistically significant difference in any of the quality life domains related to health. When it comes to the age of respondents, HRQOL is significantly higher in all domains of physical and mental health in the younger group of respondents.&amp;lt;/p&amp;gt; &amp;lt;p&amp;gt;Conclusion: Myocardial infarction affects the quality of life of the diseased,which is significantly better in the younger age group compared to the older respondents, and does not differ in relation to gender. The quality of life of patients with myocardial infarction differs in relation to the time since myocardial infarction and those diagnosed with AMIduring the reception to the hospital in the last month have significantly lower quality of life compared to subjects with AMI diagnosed in the last year to a month. The quality of life of patients with myocardial infarction is worse if the health issues are more expressed and there is comorbidity.&amp;lt;/p&amp;gt;

P6142LATIN telemedicine - expanded umbrella of cost-effective ami coverage for 100 million people

Abstract Background AMI is a unique entity where the immediate diagnosis can be made by a single test, the EKG. Despite this matchless attribute of easy diagnosis, developing (and some developed) countries lack resources and efficient pathways for urgent and reliable diagnosis of AMI. With Latin Telemedicine Infarct Network (LATIN), we have previously presented Telemedicine as a pragmatic solution for urgent and accurate diagnosis of AMI. In this work, we reveal pathways of scalable population-based AMI management models. Purpose To utilize telemedicine as a foundation pillar for creating cost-effective and global models of AMI management. Methods LATIN pilot tested the hypothesis of remote guidance of AMI management and expanded access by creating a hub and spoke, STEMI systems of care that exploited regional resources. A highly efficient, web-based, cloud-computing prototype was developed and scrupulously monitored with a new metric of time to telemedicine diagnosis (TTD). STEMI systems of care were created to efficiently triage the diagnosed patients for being treated with thrombolysis, pharmaco-invasive management or Primary PCI. This stratagem had enormous provincial variability and was constrained mainly by ambulance structure. Telemedicine and IT costs were forced lower and enabled a cost-effective process to hugely provide access to 100 million patients located in poorer regions of Colombia, Brazil, Mexico, and Argentina. Education and training have formed the mantra for LATIN and stakeholder development, and ambulance systems development has remained immutable goals. Results Almost 800,000 patients were successfully screening through LATIN with a cost for accurate STEMI diagnosis of &lt; $3, a tele accuracy that exceeded 95% and with TTD &lt;4 minutes. A total of 8,440 (1.1%) of patients were diagnosed with AMI in this manner and 3,924 (46.5%) urgently reperfused, mainly with Primary PCI (3,048, 77.8%). D2B times have been lowered now to 51 minutes but this is fortuitous, as several PCI-capable facilities are small, and direct transfer to the catheterization laboratory is easy. Door in and Door out times and transport times remain high as a large number of patients are denied by insurance and other payers for treatment. Overall, mortality is 5.2%. Conclusions Global financial and philanthropic institutions should contemplate models analogous to LATIN for saving the lives of millions of poor patients in developing countries from AMI.

P880Cardiovascular mortality in patients with MINOCA and prognostic effect of statin treatment

Abstract Introduction Several studies have showed a substantial risk of death in patients with MINOCA. However, little is still known about the causes of death in these patients compared to patients with MI with significant coronary lesions. On the other hand, using statins treatment in MINOCA has demonstrated to have prognosis benefit in a recent observational. In this study, we aim to describe the previous aspects in a contemporary cohort of patients with AMI. Methods We analyzed retrospective data from 4,499 consecutive patients discharged with a confirmed diagnosis of AMI from January/2010 to December/2016. Patients with coronary lesions &lt;50% were classified as MINOCA. Patients with Tako-Tsubo syndrome were excluded. The time to death in patients with MINOCA vs MI-OCA was analyzed and the causes of death (CV death and non-CV death) were compared. When the cause of death was unknown, it was classified as unknown. The log-rank test was used to find differences in death rate between both groups. The effect of statin treatment was tested. Results 643 patients (14.3%) were diagnosed with MINOCA. The prevalence of women was higher among patients with MINOCA (42.8% vs. 22.6%, p&lt;0.01). The MINOCA were older (69±13 years vs. 66±13 years, p&lt;0.01) with a higher prevalence of hypertension (70.85% vs. 65.3%, p=0.007), previous stroke (10.65 vs. 7.0%; p=0.001), COPD (14.0% vs. 9.95, p=0.002) and cancer history (9.2% vs. 7.6%, p=0.16). In contrast, the MINOCA patients had a lower prevalence of active smoking (19.9% vs. 35%, p&lt;0.01), DM (33.0 vs. 29.4%, p=0.07), dyslipidemia (65.8% vs. 66.3%, p=0.81) and peripheral arteriography (7.3% vs. 8.3%, p=0.41). STEMI was the most frequent form of hospital presentation in the MINOCA cohort (41.95% vs. 19.1%). LVEF was higher in the MINOCA cohort (55% ± 11% vs. 52% ± 10%, p=0.006). At discharge, 86.5% of MINOCAs were treated with statin vs. 86.5% in MI-OCA. The statins prescribed at discharge were of higher potency at 78.2% in MINOCA vs. 88.1% in MI-OCA, moderate potency in 16.1% vs 9.5%, and lower potency in 5.7% vs. 2.4%, respectively (p=0.001). During a median follow-up of 15 months (IQR: 12.6–26.0 months), there were 383 deaths (8.5%), of which 314 occurred in the MI-OCA cohort (8.2%) and 69 occurred in MINOCA cohort (11.1%); p=0.001. 47.8% (n=33/69) were deaths of CV origin in the MINOCA group vs. 48.1% (n=151/314) in the MI-OCA group (p=0.61). The cause of death could not be determined in 6 patients (8.7%) with MINOCA and in 46 (14.7%) with MI-OCA (p=0.19). No benefit of the statin treatment of any potency was observed in MINOCA (HR=0.8 [95% CI: 0.4–1.6]) whether there was benefit in MI-OCA group (HR=0.7 [95% CI 0.5–0.98]). Conclusions There is a considerable difference in the comorbidities between MINOCA and MI-OCA, but a similar rate of death of CV origin in the medium term. The lack of benefit of statin treatment has to be confirmed in other larger studies.

Temporal trends, predictors, and outcomes of acute kidney injury and hemodialysis use in acute myocardial infarction-related cardiogenic shock.

BackgroundThere are limited data on acute kidney injury (AKI) complicating acute myocardial infarction with cardiogenic shock (AMI-CS). This study sought to evaluate 15-year national prevalence, temporal trends and outcomes of AKI with no need for hemodialysis (AKI-ND) and requiring hemodialysis (AKI-D) following AMI-CS.MethodsThis was a retrospective cohort study from 2000–2014 from the National Inpatient Sample (20% stratified sample of all community hospitals in the United States). Adult patients (>18 years) admitted with a primary diagnosis of AMI and secondary diagnosis of CS were included. The primary outcome was in-hospital mortality in cohorts with no AKI, AKI-ND, and AKI-D. Secondary outcomes included predictors, resource utilization and disposition.ResultsDuring this 15-year period, 440,257 admissions for AMI-CS were included, with AKI in 155,610 (35.3%) and hemodialysis use in 14,950 (3.4%). Older age, black race, non-private insurance, higher comorbidity, organ failure, and use of cardiac and non-cardiac organ support were associated with the AKI development and hemodialysis use. There was a 2.6-fold higher adjusted risk of developing AKI in 2014 compared to 2000. Presence of AKI-ND and AKI-D was associated with a 1.3 and 1.7-fold higher adjusted risk of mortality. Compared to the cohort without AKI, AKI-ND and AKI-D were associated with longer length of stay (9±10, 12±13, and 18±19 days respectively; p<0.001) and higher hospitalization costs ($101,859±116,204, $159,804±190,766, and $265,875 ± 254,919 respectively; p<0.001).ConclusionAKI-ND and AKI-D are associated with higher in-hospital mortality and resource utilization in AMI-CS.

Acute respiratory failure and mechanical ventilation in cardiogenic shock complicating acute myocardial infarction in the USA, 2000\u20132014

BackgroundThere are limited epidemiological data on acute respiratory failure (ARF) in cardiogenic shock complicating acute myocardial infarction (AMI-CS). This study sought to evaluate the prevalence and outcomes of ARF in AMI-CS.MethodsThis was a retrospective study of AMI-CS admissions during 2000–2014 from the National Inpatient Sample. Administrative codes for ARF and mechanical ventilation (MV) were used to define the cohorts of no ARF, ARF without MV and ARF with MV. Admissions with a secondary diagnosis of AMI and with chronic MV were excluded. Outcomes of interest included in-hospital mortality, temporal trends of ARF prevalence and resource utilization.Measurements and main resultsDuring 2000–2014, 439,436 admissions for AMI-CS met the inclusion criteria. ARF and MV were noted in 57% and 43%, respectively. Admissions with non-ST-elevation AMI-CS, of non-White race and with non-private insurance received MV more frequently. Noninvasive ventilation and invasive MV increased from 0.4% and 39.2% (2000) to 3.6% and 46.4% (2014), respectively (p < 0.001). Coronary angiography and percutaneous coronary intervention were used less frequently in admissions receiving ARF with MV. Compared to admissions with no ARF, ARF without MV (adjusted odds ratio (aOR) 1.56 [95% confidence interval (CI) 1.53–1.59]; p < 0.001) and ARF with MV (aOR 2.50 [95% CI 2.47–2.54]; p < 0.001) were associated with higher in-hospital mortality. Admissions with ARF without MV had greater resource utilization and lesser discharges to home as compared to no ARF.ConclusionsIn this contemporary AMI-CS cohort, the presence of ARF and MV use was noted in 57% and 43%, respectively, and was associated with higher in-hospital mortality.

Routine creatine kinase testing does not provide clinical utility in the emergency department for diagnosis of acute coronary syndromes

BackgroundDespite the high sensitivity and negative predictive value of contemporary high-sensitivity troponin T assays (hsTnT), creatine kinase (CK) continues to be routinely tested for the diagnosis of acute coronary syndrome (ACS). We conducted a study to identify the clinical utility of routine CK measurement, its relevance in clinical decision making in the era of hsTnT, and the potential cost-savings achievable by limiting its use.MethodsWe conducted a retrospective review of all adult patients presenting to a tertiary care center in the year 2017. We identified patients presenting with cardiac complaints who had non-diagnostic hsTnT and positive CK. These patients underwent chart review to determine whether a diagnosis of AMI was made.ResultsA total of 36,251 presentations were reviewed. 9951 had cardiac complaints and 8150 had CK measured. 82% of these patients had hsTnT and CK measured; 2012 of these patients had non-diagnostic hsTnT with positive CK. Of these 2012 patients, only 1 was subsequently diagnosed with AMI (0.012%). CK provided no diagnostic benefit over hsTnT alone in > 99.9% of cases. With a cost for CK of $4/test, we estimated that routine CK testing costs at least $32,000 per year in our center, and over $100,000 per year across the region.ConclusionRoutine CK testing does not provide a significant benefit to patient care and therefore represents an unnecessary system cost. Routine CK testing for the diagnosis of AMI should be eliminated from emergency departments in the era of hsTnT assays.

Hospital-Level Disparities in the Outcomes of Acute Myocardial Infarction With Cardiogenic Shock

There are limited data on hospital-level disparities in cardiogenic shock complicating acute myocardial infarction (AMI-CS). A retrospective cohort of adult admissions from the National Inpatient Sample database during 2000 to 2014, with primary diagnosis of AMI and concomitant CS were identified. Interhospital transfers were excluded. Hospitals were classified into rural, urban nonteaching and urban teaching (location and teaching status) and small, medium and large (bedsize). The primary endpoint was in-hospital mortality and secondary endpoints included use of early coronary angiography, percutaneous coronary intervention (PCI) and mechanical circulatory support (MCS). Multivariable regression was used to adjust for potential confounding. During 2000 to 2014, 362,065 AMI-CS admissions met the inclusion criteria, of which 92% and 69% respectively were admitted to urban and large hospitals. Admissions to urban and large hospitals were more frequently male, younger, with lower co-morbidity, and higher illness severity. There was a steady increase in early coronary angiography, PCI and MCS across the various hospital categories. Admission to an urban nonteaching hospital (adjusted odds ratio [aOR] 0.81; 95% confidence interval [CI] 0.78 to 0.84], p <0.001) and urban teaching hospital (aOR 0.87 [95% CI 0.84 to 0.91, p <0.001) were associated with lower mortality compared with rural hospitals. In comparison to a small hospital, admission to a large hospital (aOR 0.94 [95% CI 0.91 to 0.98); p = 0.002) was associated with lower in-hospital mortality. Large and urban hospitals had greater use of early coronary angiography, PCI, MCS. In conclusion, there are hospital-level disparities in the management and outcomes of AMI-CS which are not fully accounted for differences in patient characteristics.

Circulating miR-26a-1, miR-146a and miR-199a-1 are potential candidate biomarkers for acute myocardial infarction

BackgroundAcute myocardial infarction (AMI) was considered to be one of the major causes of morbidity and mortality worldwide. In order to manage the acute myocardial infarction outbreaks, accurate biomarkers for risk prediction are needed. Circulating microRNAs (miRNAs) may act as diagnostic and prognostic biomarkers for cardiovascular events.MethodsThis study aimed to determine the possibility of circulating miRNAs used as biomarkers for AMI and their dynamic expression levels before and after percutaneous coronary intervention (PCI) in patients. Circulating miR-26a-1, miR-27a, miR-30d, miR-146a, miR-199a-1 and miR-423 were selected and validated in 31 AMI patients and 27 matched controls by quantitative real-time PCR (qPCR).ResultsThe expression levels of plasma miR-26a-1, miR-146a and miR-199a-1 were significantly increased in AMI patients. Receiver operating characteristic (ROC) analysis indicated that miR-26a-1, miR-146a and miR-199a-1 showed considerable diagnostic efficiency for predicting AMI. Furthermore, we demonstrated that the combination of miR-26a-1, miR-146a and miR-199a-1 facilitated AMI diagnosis.ConclusionsOur findings suggest that circulating miR-26a-1, miR-146a and miR-199a-1 have the potential to be used as biomarkers for AMI diagnosis.

THE DIAGNOSTIC VALUE OF TROPONIN I TESTING TO CORONARY ANGIOGRAPHY WITH A POINT OF CARE TESTING INSTRUMENT IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

Myocardial infarction consists of STEMI and NSTEMI. Acute myocardial infarction is diagnosed by WHO criteria when at least two of the following three criteria are met: chest pain, electrocardiography (ECG) result changes, and biomarker. Troponin I is specific for cardiac muscle and has an increased level even in small cardiac muscle necrosis and not affected by the renal failure and muscle trauma but have not been standardized by WHO. This research aimed to find the effectivity of Troponin I examination with POCT to help the diagnosis and early detection of AMI. Thus each product has varied sensitivity and specificity. A cross-sectional study was conducted in the Clinical Pathology Laboratory and Cardiac Center of the Dr. Wahidin Sudirohusodo Hospital Makassar using suspected AMI patients as the subject. Troponin I level tested by POCT from August 2015 to July 2016. Data were analyzed statistically using the ROC curve with SPSS software. A total of 88 patients suspected with AMI, aged 36 to 75 years old. From the tested cut-off values (0.02, 0.03, 0.04, 0.5, 0.06, 0.07, 0.08 μg/L) the best cut-off value was 0.03 μg/L (93.9% sensitivity, 95.5% specificity, PPV 98.4%, NPV 84.0%, and 94.3% accuracy) where the cut-off value of 0.03 μg/L was the value recommended by the toolkit manual. Even if the cut-off value of 0.02 or 0.04 was used, the sensitivity and specificity value was still fairly good. Troponin I testing using POCT with a cut-off value of 0.03 μg/L can be used routinely in supporting the AMI diagnosis because it is a rapid test with a portable instrument and excellent diagnostic value.

Biomarkers in acute myocardial infarction: current perspectives.

PurposeAcute myocardial infarction (AMI) is the most common cause of death in the world. Comprehensive risk assessment of patients presenting with chest pain and eliminating undesirable results should decrease morbidity and mortality rates, increase the quality of life of patients, and decrease health expenditure in many countries. In this study, the advantages and disadvantages of the enzymatic and nonenzymatic biomarkers used in the diagnosis of patients with AMI are given in historical sequence, and some candidate biomarkers – hFABP, GPBB, S100, PAPP-A, RP, TNF, IL6, IL18, CD40 ligand, MPO, MMP9, cell-adhesion molecules, oxidized LDL, glutathione, homocysteine, fibrinogen, and D-dimer procalcitonin – with a possible role in the diagnosis of AMI are discussed.MethodsThe present study was carried out using meta-analyses, reviews of clinical trials, evidence-based medicine, and guidelines indexed in PubMed and Web of Science.ResultsThese numerous AMI biomarkers guide clinical applications (diagnostic methods, risk stratification, and treatment). Today, however, TnI remains the gold standard for the diagnosis of AMI. Details in the text will be given of many biomarkers for the diagnosis of AMI.ConclusionWe evaluated the advantages and disadvantages of routine enzymatic and nonenzymatic biomarkers and the literature evidence of other candidate biomarkers in the diagnosis of AMI, and discuss challenges and constraints that limit translational use from bench to bedside.

NOSOLOGICAL STRUCTURE OF ACUTE CORONARY EVENTS AT ADMISSION AND AT DISCHARGE, PATIENT COMPLIANCE AND NEAREST FORECAST (DATA OF THE RACSMI-UZ REGISTER)

Introduction. Basing on the data of the “RACSMI-UZ” register, the article provides comparative analysis of the structure and transformation of diagnoses during acute coronary conditions in the dynamics (at admission and discharge), assesses patients' adherence to drug therapy depending on gender and also describes analysis of its effect on the short-term prognosis.Material and methods. The study material included 449 patients with ACS/AMI hospitalized to relevant health care facilities of the experimental district of Tashkent. Two groups of patients were distinguished depending on the gender: group 1 included 243 male patients, and group 2 consisted of 206 female patients. Results. The registration showed that ACS/AMI was more often observed in men than in women (54.1% vs. 45.9%, respectively). Male patients proved to be younger than female ones (p &lt;0.05); obesity of different degree prevailed in women (48.0% in women vs. 29.6% in men, p &lt;0.05). In the male population, AMI at admission was registered in 43 (17.7%) patients but the number of patients with this diagnosis increased at discharge (61 subjects, or 25.1%). Out of 243 men, 3.7% died and the largest number of deaths occurred in patients with initial diagnosis of unstable angina. In the female population, the incidence of AMI both with and without Q at admission was recorded 2 times less frequent than that at discharge from the hospital (8.7% of cases at admission and 17.5% of cases at discharge), which shows low vigilance of healthcare professionals in diagnostics of AMI in women. Mortality from ACS/ AMI in women was 3.4% with the largest number of deaths being associated with the initial diagnosis of AMI without Q. Compliance in females was somewhat higher than in males; men were prone to taking more medications (Mc’s), though there were no significant differences between men and women by the proportion of Mc’s taken. The direct correlation was found between the patients’ compliance level and the time interval: from admission to death of the respondent (p&gt; 0.05).Conclusion. ACS / AMI was more often recorded in men than in women, while the age of men was younger (p&lt;0.05). Alertness of primary care physicians in ACS / AMI was low, especially for women. Compliance in women was higher than in men. Thus, the higher was the patient adherence to therapy, the more stable the body appeared to cardio stress.

MiRNA-1, miRNA-145 as a Myocardial Infarction Diagnostic Biomarker

Many myocardial infarction biomarkers currently available but they are a lack of specificity, therefore present study suggests to evaluate the significant importance of miRNA-1, miRNA-145 as biomarkers for early diagnosis of myocardial infarction. A blood sample was collected from three groups. The first group was patients with acute myocardial infarction (MI), the Second group was patients who have a risk factor for MI, and the Third group included healthy volunteers. Serum blood of this sample used to RNA purification and cDNA application with stem-loop specific primer then miRNA-1, and miRNA-145 was quantitated by using RT-PCR. The level of miR-1 fold change was significantly highest in the MI group followed by risk group and then by control group (P&lt;0.05). while of miRNA-145 fold change was significantly lowest in the MI group followed by risk group and then by control group (P&lt;0.05). A receiver operator characteristic (ROC) analysis; the cut off value was identified at miRNA-1 of &gt;5.28 fold change with a sensitivity of 91.67 % and a specificity of 90.7%, while the cut off value of miRNA-145 has cut off ≤ 0.7 fold change with a sensitivity of 95.83 % and a specificity of 89.47%. miRNA-1, miR145 has high sensitivity and Specificity in this study which was bushed to using them as an alone biomarker or supported for Another biomarker in AMI diagnosis.

Study of pro-oxidant status in acute myocardial infarction

Background: Apart from several well documented risk factors; oxidative stress may play an important role in the pathogenesis of myocardial infarction. Our study has been designed to investigate the pro-oxidant status in AMI patients who have no previous history of diabetes, hypertension and habit of smoking.Aims and Objectives: To measure the level of serum thiobarbituric acid reactive substances(TBARS) to assess the extent of oxidative damage in recently diagnosed cases of AMI and to look for any correlation between this stress marker and some of the lipid profile markers.Materials and Methods: A cross sectional study was conducted in a tertiary care hospital with 50 non-diabetic, non-hypertensive, non-smoker AMI patients of either sex as Cases and 50 age and sex matched healthy Controls. The biochemical parameters were measured by validated techniques.Results: Level of serum TBARS (4.78 ± 1.06 nmol/ml) has significantly increased (p&lt;0.001) in cases with respect to control group(2.19±0.41 nmol/ml); a positive correlation between serum TBARS and LDL; a negative correlation between serum TBARS and HDL in cases.Conclusion: Our study indicates an increased oxidative stress in AMI patients even in absence of some high risk factors which are oxidative stress inducers by themselves. This evidence suggests that oxidative stress itself may play an important role in the pathogenesis of myocardial infarction. So, the oxidative stress marker may have the importance in early diagnosis of AMI. It also suggests the potential appropriateness of antioxidant therapy in the prevention of AMI.Asian Journal of Medical Sciences Vol.9(4) 2018 31-34