Early Infarction Research Articles

Coronary lesion complexity in patients with heterozygous familial hypercholesterolemia hospitalized for acute myocardial infarction: data from the RICO survey

BackgroundAlthough patients with familial heterozygous hypercholesterolemia (FH) have a high risk of early myocardial infarction (MI), the coronary artery disease (CAD) burden in FH patients with acute MI remains to be investigated.MethodsThe data for all consecutive patients hospitalized in 2012–2019 for an acute MI and who underwent coronary angiography were collected from a multicenter database (RICO database). FH (n = 120) was diagnosed using Dutch Lipid Clinic Network criteria (score ≥ 6). We compared the angiographic features of MI patients with and without FH (score 0–2) (n = 234) after matching for age, sex, and diabetes (1:2).ResultsAlthough LDL-cholesterol was high (208 [174–239] mg/dl), less than half of FH patients had chronic statin treatment. When compared with non-FH patients, FH increased the extent of CAD (as assessed by SYNTAX score; P = 0.005), and was associated with more frequent multivessel disease (P = 0.004), multiple complex lesions (P = 0.022) and significant stenosis location on left circumflex and right coronary arteries. Moreover, FH patients had more multiple lesions, with an increased rate of bifurcation lesions or calcifications (P = 0.021 and P = 0.036, respectively). In multivariate analysis, LDL-cholesterol levels (OR 1.948; 95% CI 1.090–3.480, P = 0.024) remained an independent estimator of anatomical complexity of coronary lesions, in addition to age (OR 1.035; 95% CI 1.014–1.057, P = 0.001).ConclusionsFH patients with acute MI had more severe CAD, characterized by complex anatomical features that are mainly dependent on the LDL-cholesterol burden. Our findings reinforce the need for more aggressive preventive strategies in these high-risk patients, and for intensive lipid-lowering therapy as secondary prevention.

Artery of Percheron Infarction: A Characteristic Pattern of Ischemia and Variable Clinical Presentation: A Literature Review.

The Artery of Percheron (AOP) is an uncommon anatomic variant that provides arterial supply to the paramedian region of the thalami and bilaterally to the rostral part of the midbrain; it is a solitary arterial trunk that branches from a proximal segment of the posterior cerebral artery (PCA). Although AOP infarction results in a characteristic pattern of ischemia-namely bilateral paramedian thalamic infarct with or without midbrain involvement-it may cause diagnostic difficulties due to the variety of its clinical presentations and wide differentials, as well as its small diameter and the difficulty of obtaining visualization through diagnostic imaging. Early neuroimaging of AOP infarction and correct diagnosis are mandatory for early initiation of the appropriate treatment and better patient outcomes. In this study, we discuss imaging the patterns of AOP infarction and its differentials and clinical presentation.

Detecting the Early Infarct Core on Non-Contrast CT Images with a Deep Learning Residual Network

PurposeTo explore a new approach mainly based on deep learning residual network (ResNet) to detect infarct cores on non-contrast CT images and improve the accuracy of acute ischemic stroke diagnosis. MethodsWe continuously enrolled magnetic resonance diffusion weighted image (MR-DWI) confirmed first-episode ischemic stroke patients (onset time: less than 9 h) as well as some normal individuals in this study. They all underwent CT plain scan and MR-DWI scan with same scanning range, layer thickness (4 mm) and interlayer spacing (4 mm) (The time interval between two examinations: less than 4 h). Setting MR-DWI as gold standard of infarct core and using deep learning ResNet combined with a maximum a posteriori probability (MAP) model and a post-processing method to detect the infarct core on non-contrast CT images. After that, we use decision curve analysis (DCA) establishing models to analyze the value of this new method in clinical practice. Results116 ischemic stroke patients and 26 normal people were enrolled. 58 patients were allocated into training dataset and 58 were divided into testing dataset along with 26 normal samples. The identification accuracy of our ResNet based approach in detecting the infarct core on non-contrast CT is 75.9%. The DCA shows that this deep learning method is capable of improving the net benefit of ischemic stroke patients. ConclusionsOur deep learning residual network assisted with optimization methods is able to detect early infarct core on non-contrast CT images and has the potential to help physicians improve diagnostic accuracy in acute ischemic stroke patients.

Early postoperative acute myocardial infarction in kidney transplant recipients: A nested case-control study.

The epidemiology of early acute myocardial infarctions after kidney transplantation has not been well characterized. This study sought to examine the incidence, risk factors, and clinical outcomes of early acute myocardial infarctions or EAMI in kidney transplant recipients. A total of 1976 patients who underwent kidney transplantation at our center from Jan 1, 2000, to Sept 30, 2016, were included. A nested case-control design was used to study EAMI risk factors using a conditional logistic regression model. A Cox proportional hazards model was used to assess the association of EAMI with death-censored graft failure, death with graft function, and total graft failure. Seventy four patients had an EAMI within 3months post-transplant. Based on univariable analyses, risk factors for EAMI included age and recipient history of diabetes mellitus or coronary artery disease. After adjustment, recipient history of coronary artery disease was the only independent predictor for EAMI (OR 3.76, p<.001). Patients who experienced EAMI were more likely to experience death-censored graft failure, death with graft function, and total graft failure. While the incidence of EAMI in kidney transplant recipients is relatively low, these data show that EAMI has profound long-term effects on morbidity and mortality.

Myoglobin and C5b9 immunohistochemistry studies in heart tissue from sudden unexpected natural death cases

ABSTRACT The post-mortem diagnosis for acute myocardial infarction is one of the most challenging because acute myocardial infarction in the first 4 hours does not provide specific changes. Hence, this research evaluated the effectiveness of immunohistochemistry staining for detecting early myocardial infarction. Immunohistochemical staining for myoglobin and C5b9 were conducted on myocardial tissue from four groups with the following criteria: 1. Acute myocardial infarction cases (18 cases, positive control), 2. Severe coronary atherosclerosis cases (19 cases), 3. Natural deaths with unknown cause of death (12 cases), 4. Negative control. The results were that myoglobin staining was found positive in 17 cases of group 1 (94.4%), 13 cases of group 2 (68.4%), 3 cases of group 3 (25%), and 6 cases of group 4 (60%). C5b9 staining was found positive in 18 cases of group 1(100%), 10 cases of group 2 (52.6%), 4 cases of group 3 (33.3%), and 7 cases of group 4 (70%). The results showed that no statistical significance was found in a comparative analysis between group 4 and group 2. Hence, the results of staining for C5b9 and myoglobin conflict with the findings of prior research because the specificity in identifying acute myocardial infarction was low.

Study of autopsy diagnosis of early myocardial infarction (MI) by triphenyl tetrazolium chloride (TTC) and histopathology

Introduction: Sudden death was defined as one which has taken place within 24 hours from the onset of symptoms & signs of disease. The diagnosis of sudden death due to acute Myocardial Infarction (MI) is difficult not only for forensic expert but for pathologist as on gross examination one may not find infarct area. To determine the usefulness, efficiency and reliability of new technique (TTC), this study has been undertaken and comparative analysis of are carried out to determine MI during the autopsy along with routine histological examination by H&E stain. Material and Methods: Total 107 hearts were divided into 2 groups - 1) Control group - known cases of MI and ischemic heart disease. 2) Negative control group - cases of sudden natural death, as phyxial deaths and accidental traumatic cases. The heart slices are incubated in 1 % soln. of TTC in phosphate buffer at pH 8.5 at approximately 37°c for 20-30min. Unstained slice is read as positive and bright pink stained is negative Results: It is observed that in Group-1 out of 15 cases TTC staining technique was positive in 80% cases while H&E method was positive in 33.33% cases. Similarly in Group-2, out of 92 cases, TTC staining technique which is positive in 43.47% cases suggesting that the technique is more superior and sensitive technique to determine the cause of death as MI over H&E method which is positive in 22.82% cases. Conclusion: TTC staining technique is more sensitive & efficient method than the H&E stain. Keywords: Heart slice, H&E-staining, MI, Sudden death, TTC

Empagliflozin prevents from early cardiac injury post myocardial infarction in non-diabetic mice

ObjectivesSodium-glucose cotransporter 2 (SGLT2) inhibitors have been confirmed to reduce the rate of rehospitalization for heart failure and cardiovascular death in diabetic patients. The aim of our study was to investigate the cardioprotective role of SGLT2 inhibitors in early myocardial infarction (MI) of non-diabetic mice. MethodsC57BL/6 mice underwent left artery coronary artery descending (LAD) ligation to induce MI. Following the surgery, animals were randomized to receive saline or empagliflozin. Empagliflozin (EMPA) was administrated at 10 mg/kg per day by oral gavage for 2 weeks. Echocardiography, histological staining and qualitative RT-PCR were performed to assess the cardiac remodeling post MI. In vitro experiments were performed to evaluate the effect of empagliflozin on apoptosis, oxidative stress and mitochondrial membrane potential of cardiomyocyte subjected to hypoxic treatment. ResultsCompared with MI group, the empagliflozin treatment group showed improved cardiac function, reduced infarct size and interstitial fibrosis. Empagliflozin also inhibited cardiomyocyte apoptosis by alleviating oxidative stress and restoring mitochondrial membrane potential. Immunoblotting analysis revealed activated AMP-activated protein kinase (AMPK) signaling may mediated the cardioprotective role of empagliflozin. ConclusionsIn summary, empagliflozin could inhibit cardiomyocyte apoptosis and improve cardiac remodeling early MI, which provided insights into the benefic effect of empagliflozin on MI patients without diabetes.

Individualized blood pressure management during endovascular treatment of acute ischemic stroke under procedural sedation (INDIVIDUATE) - An explorative randomized controlled trial.

BackgroundOptimal blood pressure is not well established during endovascular therapy of acute ischemic stroke. Applying standardized blood pressure target values for every stroke patient might be a suboptimal approach.AimTo assess whether an individualized intraprocedural blood pressure management with individualized blood pressure target ranges might pose a better strategy for the outcome of the patients than standardized blood pressure targets.Sample size: Randomization of 250 patients 1:1 to receive either standard or individualized blood pressure management approach.Methods and designWe conduct an explorative single-center randomized controlled trial with a PROBE (parallel-group, open-label randomized controlled trial with blinded endpoint evaluation) design. In the control group, intraprocedural systolic blood pressure target range is 140–180 mmHg. The intervention group is the individualized approach, which is maintaining the intraprocedural systolic blood pressure at the level on presentation (±10 mmHg).Study outcomes: The primary endpoint is the modified Rankin scale assessed 90 days +/− 2 weeks after stroke onset, dichotomized by 0–2 (favorable outcome) to 3–6 (unfavorable outcome). Secondary endpoints include early neurological improvement, infarction size, and systemic physiology monitor parameters.DiscussionAn individualized approach for blood pressure management during thrombectomy could lead to a better outcome for stroke patients. The trial is registered at clinicaltrials.gov as ‘Individualized Blood Pressure Management During Endovascular Stroke Treatment (INDIVIDUATE)’ under NCT04578288.

Inflammatory bowel disease and the risk of cardiovascular diseases

Inflammatory bowel disease (IBD) includes both ulcerative colitis and Crohn's disease, which are well recognised as chronic systemic and immune-mediated conditions that frequently involve extraintestinal manifestations. Although comorbidities have long been the subject of research in other chronic inflammatory diseases, this concept is also emerging in IBD. Many pathologies have been linked to IBD, including cardiovascular disease, which is the main cause of death in developed countries. IBD patients are at increased risk of conditions such as early atherosclerosis and myocardial infarction or venous thrombosis and pulmonary thromboembolism. The aim of this review is to make an approximation of the physiopathology of the different manifestations of cardiovascular disease in patients with IBD and how to prevent them.

EIS-Net: Segmenting early infarct and scoring ASPECTS simultaneously on non-contrast CT of patients with acute ischemic stroke.

Detecting early infarct (EI) plays an essential role in patient selection for reperfusion therapy in the management of acute ischemic stroke (AIS). EI volume at acute or hyper-acute stage can be measured using advanced pre-treatment imaging, such as MRI and CT perfusion. In this study, a novel multi-task learning approach, EIS-Net, is proposed to segment EI and score Alberta Stroke Program Early CT Score (ASPECTS) simultaneously on baseline non-contrast CT (NCCT) scans of AIS patients. The EIS-Net comprises of a 3D triplet convolutional neural network (T-CNN) for EI segmentation and a multi-region classification network for ASPECTS scoring. T-CNN has triple encoders with original NCCT, mirrored NCCT, and atlas as inputs, as well as one decoder. A comparison disparity block (CDB) is designed to extract and enhance image contexts. In the decoder, a multi-level attention gate module (MAGM) is developed to recalibrate the features of the decoder for both segmentation and classification tasks. Evaluations using a high-quality dataset comprising of baseline NCCT and concomitant diffusion weighted MRI (DWI) as reference standard of 260 patients with AIS show that the proposed EIS-Net can accurately segment EI. The EIS-Net segmented EI volume strongly correlates with EI volume on DWI (r=0.919), and the mean difference between the two volumes is 8.5mL. For ASPECTS scoring, the proposed EIS-Net achieves an intraclass correlation coefficient of 0.78 for total 10-point ASPECTS and a kappa of 0.75 for dichotomized ASPECTS (≤ 4vs. >4). Both EI segmentation and ASPECTS scoring tasks achieve state-of-the-art performances.

Kinetics and prognostic value of soluble VCAM-1 in ST-segment elevation myocardial infarction patients.

BackgroundSoluble vascular cell adhesion molecule‐1 (sVCAM‐1) is a biomarker of endothelial activation and inflammation. There is still controversy as to whether it can predict clinical outcome after ST‐elevation myocardial infarction (STEMI). Our aim was to assess the sVCAM‐1 kinetics and to evaluate its prognostic predictive value.MethodWe prospectively enrolled 251 consecutive STEMI patients who underwent coronary revascularization in our university hospital. Blood samples were collected at admission, 4, 24, 48 h and 1 month after admission. sVCAM‐1 serum level was assessed using ELISA assay. All patients had cardiac magnetic resonance imaging at 1‐month for infarct size (IS) and left ventricular ejection fraction (LVEF) assessment. Clinical outcomes were recorded over 12 months after STEMI.ResultssVCAM‐1 levels significantly increased from admission up to 1 month and were significantly correlated with IS, LVEF, and LV end‐systolic and diastolic volume. (H48 area under curve (AUC) ≥ H48 median) were associated with an increased risk of adverse clinical events during the 12‐month follow‐up period with a hazard ratio (HR) = 2.6 (95% confidence interval [CI] of ratio = 1.2–5.6, p = .02). The ability of H48 AUC for sVCAM‐1 to discriminate between patients with or without the composite endpoint was evaluated using receiver operating characteristics with an AUC at 0.67 (0.57–0.78, p = .004). This ability was significantly superior to H48 AUC creatine kinase (p = .03).ConclusionsIn STEMI patients, high sVCAM‐1 levels are associated with a poor clinical outcome. sVCAM‐1 is an early postmyocardial infarction biomarker and might be an interesting target for the development of future therapeutic strategies.

Diagnostic value of copeptin combined with hypersensitive cardiac troponin T detection in early acute myocardial infarction: A protocol of randomized double-blind diagnostic trial.

Background:The sensitivity and specificity of the routine detection of acute myocardial infarction (AMI) in early diagnosis are not high, which can not meet the clinical needs. Copeptin combined with hypersensitive cardiac troponin T (hs-cTnT) is a new detection scheme, and its value in the early diagnosis of acute myocardial infarction is still unclear. Accordingly, the aim of this study is to evaluate the diagnostic value of copeptin combined with hypersensitive troponin T detection in early acute myocardial infarction.Methods:This is a prospective, randomized; double-blind diagnostic trial to investigate the diagnostic value of copeptin combined with hypersensitive troponin T detection in early acute myocardial infarction. Approved by the clinical research ethics of our hospital. Patients were randomly divided into one of 2 test protocols: (A) copeptin combined with hs-cTnT group and (B) cardiac troponin I (cTnI) group. Patients, doctors, nurses, inspectors, and data-gathering assistants were blinded to group allocation. We will focus on the sensitivity comparison of the 2 detection methods at different time periods and the sensitivity and specificity comparison of the two detection methods. Data were analyzed using the statistical software package SPSS version 25.0 (Chicago, IL).Discussion:The purpose of this study is to evaluate the diagnostic value of copeptin combined with hypersensitive cardiac troponin T detection in early acute myocardial infarction. The results of this study will establish clinical evidence for the detection of high sensitivity cardiac troponin T in the early diagnosis of acute myocardial infarction.Ethics and dissemination:Private information from individuals will not be published. This systematic review also does not involve endangering participant rights. Ethical approval was not required. The results may be published in a peer-reviewed journal or disseminated at relevant conferences.OSF Registration number:DOI 10.17605/OSF.IO/6TE5Z.

The change index of quantitative electroencephalography for evaluating the prognosis of large hemispheric infarction.

A growing number of studies have demonstrated the role of quantitative electroencephalography in assessing brain function in neuro-intensive care units. Still, few studies have examined patients with large hemisphere infarction. Thirty patients with large hemisphere infarction were included in this preliminary study, and the patients were divided into the death group (twelve patients) and survival group (eighteen patients). Electroencephalography monitored the patients, and a computerized tomography inspection was performed. The quantitative electroencephalography of the alpha-beta/delta-theta ratio change index was calculated and used to predict the prognosis of early large hemisphere infarction patients. The relationship between three months modified Rankin Scale, and alpha-beta/delta-theta ratio change index was analyzed. The death group had negative changes for alpha-beta/delta-theta ratio change index (-0.0140 ± 0.0193), while there was an opposite trend in the survival group, the median is 0.004 (-0.0067, 0.0137). The death group's brain function decreased more severely and rapidly than the survival group (P = 0.004). The highest diagnostic value (AUC value 0.815, P < 0.001) was observed when the alpha-beta/delta-theta ratio change index dropped and exceeded -0.008. The area under the GCS curve was 0.674, but its predictive ability was low (P = 0.094). The correlation analysis result showed that the 3-month modified Rankin Scale was negatively correlated with the alpha-beta/delta-theta ratio change index (r = -0.489, P = 0.006). The alpha-beta/delta-theta ratio change index is considered an indicator for predicting the prognosis of large hemisphere infarction. Therefore, the alpha-beta/delta-theta ratio change index may be a reliable quantitative EEG parameter that predicts the early prognosis of patients with acute large hemispheric infarction.

The Effect of Gold Nanoparticles Combined with High-Quality Nursing in Patients with Myocardial Infarction

This study was established to study the effect of gold nanoparticles combined with high-quality nursing in patients with acute myocardial infarction (AMI). Under the condition of reflux, a nano gold strip was prepared. One hundred patients with AMI who were treated from April to September 2018 at our Hospital were selected for analysis, divided equally between the observation group and the control group. The associated responses of inflammation factors related to myocardial infarction were determined by molecular analysis. The levels of factors in patients with AMI were significantly higher than those in healthy subjects (P &lt; 0.05). These findings suggest that a nano gold strip can be used for diagnosing early myocardial infarction.

Platelet to Lymphocyte Ratio as a Predictor of Infarct-Related Artery Patency in Patients Undergoing Primary Percutaneous Coronary Intervention

Background: In myocardial infarction (MI) patients, myocardial reperfusion and subsequently, early infarct related artery (IRA) patency are very critical in this emergency situation. Recently, there is growing research on the ability of platelet to lymphocyte ratio (PLR) to be a predictor of outcome and its value as a marker for inflammation and coagulopathy detection. Our work aims at finding the relation between PLR and the prognosis of IRA in STEMI patients. Methodology: Two hundred cases presented with STEMI were included for the study. Patency of IRA was estimated by Thrombolysis in Myocardial Infarction (TIMI) grade. Patent IRA was defined as TIMI grade III flow and occluded IRA was defined as TIMI grade 0-II flow. Blood samples were withdrawn on admission at emergency department to calculate PLR. Results: Forty-one (20.5%) cases revealed TIMI 3 flow in IRA before pPCI. Occluded group showed significantly higher PLR than patent group with mean PLR 231.3±94.2 vs 100.95±37.7 respectively with P value <0.0001. Multivariate regression analysis demonstrated, both HTN [95% CI (- 0.135)-(-0.747)] & PLR ratio [95% CI (-0.001)-(-0.002)] together are the most independent predictors for TIMI flow in IRA (F-ratio=12.2, p<0.001). Conclusion: our results show that high Platelet lymphocyte ratio predicts patency of IRA independently in cases with STEMI before pPCI.

Annexin V Levels as an Indicator of Myocardial Cell Death after Myocardial Infarction

Background:Myocardial ischemia is associated with apoptosis of cardiomyocyte and because of apoptotic cell death is characterized by externalization of Phosphatidylserine on the cell membrane, so it is amenable to targeting by Annexin V. Objective: To compare plasma concentrations of Annexin V in patients who had an early infarct with patients without infarction. And to analyze the plasma concentration of Annexin V in relationship to cardiovascular risk factors. Patients and Methods: A Case-control study of 100 patients (case) who are diagnosed with Myocardial Infarction (MI) and admitted to the coronary care unit of Baqubah Teaching Hospital and another 100 patients homogenous in terms of age and gender and who attended the hospital for other cause than myocardial infarction is selected as the control group during a period between the first of April and the first of July 2019. A special questionnaire used to collect the required information, an early morning blood sample is taken to measure the level of Annexin V by ELISA, Student’s t-test, ANOVA test and Chi_square test to find an association and differences between variables. Results: The results showed that The mean Annexin V level is significantly higher in cases (10.48155ng/ml) than control (1.28803ng/ml) with p-value =0.001 and a sample taken within 24 hours after MI is significantly higher in the mean level of Annexin V then the sample taken after 24 hours of MI. Conclusion: Generally, the measurement of Annexin V level has provided a good diagnostic test to evaluate myocardial infarction. Keywords: Myocardial infarction, Annexin V, Phosphatidylserine, Apoptosis

Enhanced Nox-2 derived oxidative stress in offspring of patients with early myocardial infarction

Enhanced Nox-2 derived oxidative stress in offspring of patients with early myocardial infarction

Abstract 15371: Risk of Early Recurrent Myocardial Infarction After Index Myocardial Infarction Stratified by Index Treatment Strategy

Introduction: Survivors of Myocardial Infarction (MI) remain at increased risk for another cardiovascular event. The purpose of our study was to assess the role of index treatment strategy in developing early recurrent MI after acute MI. Methods: We analyzed all cases of MI at a single quaternary care medical center from January 1 st , 2010 to January 1 st , 2017, and identified all cases of recurrent MI within 90 days of index MI. Early recurrent MI cases were further stratified depending on the treatment strategy for index MI. Reinfarctions were also stratified according to the time of readmission into early (0-30 days after discharge) and late (30-90 days after discharge) time periods. Results: We identified 6,626 patients admitted with an acute MI and 168 cases of recurrent MI within 90 days of discharge. Among the index MI patients, 4354 (66%) patients underwent revascularization whereas 2272 (34%) underwent medical management. An unadjusted comparison of the risk of readmission among the 3 different revascularization strategies showed that the CABG group appeared to have the lowest risk of readmission with a recurrent MI, and there was no significant difference in the late risk of readmission between PCI and CABG groups (P=0.8). The medically managed group had the highest late risk of readmission with a recurrent MI. Conclusions: The risk of readmission with a recurrent MI is higher in patients who undergo medical management for index MI. Aiming to improve the standard of care in these patients should be the focal point of interest to curb these reinfarctions.

Risk Factors of Cerebral Infarction and Myocardial Infarction after Carotid Endarterectomy Analyzed by Machine Learning.

Objective The incidence of cerebral infarction and myocardial infarction is higher in patients with carotid endarterectomy (CEA). Based on the concept of coprotection of heart and brain, this study attempts to screen the related factors of early cerebral infarction and myocardial infarction after CEA with the method of machine learning to provide clinical data for the prevention of postoperative cerebral infarction and myocardial infarction. Methods 443 patients who received CEA operation under general anesthesia within 2 years were collected as the research objects. The demographic data, previous medical history, degree of neck vascular stenosis, blood pressure at all time points during the perioperative period, the time of occlusion, whether to place the shunt, and the time of hospital stay, whether to have cerebral infarction and myocardial infarction were collected. The machine learning model was established, and stable variables were selected based on single-factor analysis. Results The incidence of cerebral infarction was 1.4% (6/443) and that of myocardial infarction was 2.3% (10/443). The hospitalization time of patients with cerebral infarction and myocardial infarction was longer than that of the control group (8 (7, 15) days vs. 7 (5, 8) days, P = 0.002). The stable related factors were screened out by the xgboost model. The importance score (F score) was as follows: average arterial pressure during occlusion was 222 points, body mass index was 159 points, average arterial pressure postoperation was 156 points, the standard deviation of systolic pressure during occlusion was 153 points, diastolic pressure during occlusion was 146 points, mean arterial pressure after entry was 143 points, systolic pressure during occlusion was 121 points, and age was 117 points. Conclusion Eight factors, such as blood pressure, body mass index, and age, may be related to the postoperative cerebral infarction and myocardial infarction in patients with CEA. The machine learning method deserves further study.

Coronary lesion complexity in patients with familial hypercholesterolemia hospitalized for an acute myocardial infarction: data from the French RICO Survey

Abstract Background Although patients with familial heterozygous hypercholesterolemia (FH) are at high risk of early myocardial infarction (MI), coronary artery disease (CAD) burden of FH patients with acute MI remains to be investigated. Methods All consecutive patients hospitalized for an acute MI in a multicenter database (RICO) from 2012–2017 who underwent coronary angiography were considered. FH (n=86) was diagnosed using Dutch Lipid Clinic Network criteria (score ≥6). The angiographic features of FH patients were compared with patients without FH (score 0–2) (n=166), after matching for age, sex and diabetes (1:2). Results When compared with patients without FH, patients with FH had higher prevalence of personal and familial history of CAD (17 vs 5%, and 74 vs 5%, p=0.002 and p&amp;lt;0.001, respectively), and hypertension (54 vs 36%, p=0.006). Chronic statin treatment was used in only 45% of FH patients. At coronary angiography, FH had increased extent of CAD (SYNTAX score 11 (4–21) vs 8 (3–16), p=0.049) and multivessel disease (58% vs 43%, p=0.021). Significant stenosis was more frequent in left and right marginal coronary arteries. FH patients showed a trend toward more complex lesions, with less thrombus (28 vs 39%, p=0.076), but a 2 times higher rate of bifurcation lesions and calcifications (23 vs 12% and 20 vs 10%, p=0.021 and p=0.036). Conclusions This study addressing the coronary lesions features of FH patients with acute MI shows that FH patients had more severe CAD burden, and were characterized by complex anatomy features. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): ARS Bourgogne Franche Comté, CHU Dijon Bourgogne