Acute Myocardial Infarction In Elderly Patients Research Articles

Risk factors and prognosis of postoperative acute myocardial infarction in elderly hip fracture patients combined with coronary heart disease

IntroductionThis article mainly studies the risk factors for postoperative acute myocardial infarction (AMI) in elderly hip fracture patients combined with coronary heart disease (CHD), constructs a prediction model, and evaluates the prognosis of all the patients.MethodsThis article retrospectively collected elderly patients with hip fracture and CHD who underwent hip fracture surgery at the Third Hospital of Hebei Medical University from January 2019 to December 2021. Demographic data, laboratory indicators, and imaging examination results were collected from the medical case system. The risk factors of postoperative AMI were determined by univariate and multivariate logistic regression, and a nomogram prediction model was established. The ROC curve, calibration curve and DCA decision curve were plotted by R language software. The patients in the training set were followed up for 2 years to evaluate their survival situation.Results1094 eligible patients were divided into a training set (n = 824 from January 1, 2019 to September 31, 2021) and a validation set (n = 270 from October 1, 2021 to December 31, 2022). In the training set, women accounted for 58.6%; The average age of the patients was 79.45 years old; The main type of fracture was intertrochanteric fracture. There were 64.7% patients taken B receptor blockers; A total of 166 (20.1%) patients underwent percutaneous coronary intervention (PCI); Hypertension accounted for 55.5%; 520 (63.1%) patients had a preoperative waiting time greater than 3 days; The average hemoglobin value upon admission was 101.36 g/L; The average intraoperative bleeding volume was 212.42 ml; The average surgical time was 2.5 ± 0.3 h; Reginal anesthesia accounted for 29.7%; 63 (68.5%) AMI patients had no obvious clinical symptoms; 68 (73.9%) AMI patients did not show ST-segment elevation in ECG; The risk factors of postoperative AMI were age, hemoglobin at admission, diabetes, chronic kidney disease, intraoperative bleeding, and reginal anesthesia. The AUC of the nomogram prediction model was 0.729. The AUC in the validation set was 0.783. Survival analysis showed a significant statistical difference in 2-year mortality between patients with AMI and without AMI, among all the patients with AMI, patients with ECG ST-segment elevation has higher mortality than patients without ECG ST-segment elevation.ConclusionOur research results found that the incidence of postoperative AMI in elderly patients with hip fractures and CHD was 11.1%. Age, diabetes, hemoglobin at admission, regional anesthesia, chronic kidney disease, and intraoperative bleeding are risk factors. The AUC of the nomogram in training set is 0.729. The 2-year mortality rate of the patients with AMI is higher than that of patients without AMI.

BRIDGING THE GAP: ADDRESSING DISPARITIES IN REPERFUSION THERAPY FOR ELDERLY PATIENTS WITH ACUTE MYOCARDIAL INFARCTION IN EASTERN EUROPE

This paper addresses disparities in reperfusion therapy, particularly primary percutaneous coronary interventions (PCI), for elderly patients experiencing acute myocardial infarction (AMI). Despite proven benefits, our center’s data reveals a stark contrast in PCI rates between younger and older patients, leading to significantly higher mortality among the elderly. Rooted in concerns about comorbidities, the reluctance to administer PCI prompts ethical questions and necessitates a critical examination of age-based clinical decision-making. The paper advocates for optimized AMI management protocols, emphasizing an individualized approach and evidence-based guidelines. Recognizing challenges in accurate AMI diagnosis in the elderly, educational initiatives target healthcare professionals and the population, disseminating information about symptoms and treatment benefits. To combat age-related stereotypes, digital tools like virtual consultations and telemedicine enhance accessibility to information. The paper proposes policy initiatives prioritizing clinical condition over age in treatment decisions, ensuring equitable care. In conclusion, urgent action is required to bridge the gap in reperfusion therapy for elderly AMI patients. By fostering inclusivity, implementing education, and advocating policy changes, we aim to ensure every patient, irrespective of age, receives timely and appropriate life-saving interventions.

The association between serum uric acid / serum creatinine ratio and in-hospital outcomes in elderly patients with acute myocardial infarction

BackgroundThe role of Serum uric acid (SUA) in acute myocardial infarction (AMI) was controversial, which might be influenced by the renal clearance function of the patients. The present study aimed to explore the association between serum uric acid to serum creatinine ratio (SUA/Scr), reflecting a net production of SUA, and the in-hospital outcomes of elderly patients with AMI.MethodsIn this retrospective study, a total of 330 elderly AMI patients (≥ 75 years) were enrolled. Data of SUA and Scr on admission were collected to calculate SUA/Scr ratio. Logistic regression analysis and receiver-operating curves were performed to assess the association between SUA/Scr ratio and in-hospital major adverse cardiovascular events (MACEs) and all-cause death.ResultsAmong the 330 patients, 68 patients had MACEs and 44 patients died. Patients with MACEs or died had lower SUA/Scr values compared with those without MACEs or survival (P < 0.05). Univariate logistic analysis showed that a lower value of SUA/Scr (< 3.45) was significantly associated with in-hospital MACEs (odd ratios (OR): 2.359, 95% confidential interval (CI): 1.369–4.065, P = 0.002) and death (OR: 2.424, 95% CI: 1.275–4.608, P = 0.007). After correcting for confounding factors, a lower SUA/Scr value was still independently associated with in-hospital MACEs (OR: 2.144, 95% CI: 1.169–3.934, P = 0.014) and death (OR: 2.125, 95% CI: 1.050–4.302, P = 0.036). Subgroup analysis showed that the association between a lower SUA/Scr ratio and increased risk of in-hospital outcomes could observed only in males (OR: 2.511, 95%CI: 1.211–5.207, P = 0.013 for MACEs; OR: 2.730, 95% CI: 1.146–6.502, P = 0.023 for death).ConclusionsA lower SUA/Scr ratio was associated with an increased risk of in-hospital adverse events in elderly patients with AMI, especially in males, which maybe a marker of poor outcomes for elderly AMI patients.

Abstract 17263: Outcomes and Trends of Percutaneous Coronary Intervention in Nonagenarians With Acute Myocardial Infarction: Results From National Inpatient Sample 2016-2020

Background: Acute myocardial infarction (MI) is a leading cause of mortality and morbidity among the elderly. Multiple co-morbidities and advanced age often impede the need for cardiac catheterization in these patients. The literature studying percutaneous coronary intervention (PCI) in nonagenarian patients with acute MI is limited. Methods: We examined hospitalized acute MI patients with age 90 or above that were included in the National Inpatient Sample 2016-2020. Acute MI was defined by using the International Classification of Diseases -10. Patients aged less than 90 years were excluded. Outcomes were expressed as percentages. Multivariable logistic regression analysis was used to examine the association of PCI and age 90 or above with primary outcome of mortality, and secondary outcomes [ Figure1]. We also studied the yearly trends of PCI in nonagenarian patients with acute MI patients. Results: Of the total hospitalized patients with acute MI (n = 3,120,759), 4.6% (n=142,675) patients were aged 90 years or above. Of these, 9.4% (n= 3,615) died in PCI group and 12.7% (n= 13,215) died in non - PCI group. PCI was performed in 27% (n= 38,430) of the nonagenarian patients with acute MI. The most common outcomes in PCI group were acute heart failure (37.5%), Acute kidney injury (28 %), and atrial arrhythmia (23%). PCI in nonagenarian patients with acute MI was associated with decreased odds of mortality (OR 0.75, 95% CI 0.68-0.82, p value &lt;0.001) and having any of the secondary outcomes (OR 0.74, 95% CI 0.69- 0.79, p value &lt;0.001) [Figure 1]. From 2016-2020, there are increasing yearly trends of PCI in nonagenarian patients with acute MI (p value &lt;0.001). Conclusion: Acute MI in elderly patients is associated with significant increased mortality and adverse events. PCI in acute MI patients with age 90 years or above was associated with decreased odds of mortality.

Abstract 11810: Is the Presence of Statin Use Before Onset of Disease Associated With In-Hospital Mortality in Elderly Patients With Acute Myocardial Infarction?

Introduction: The effect of statin on preventing cardiovascular events is clear, and aggressive lipid-lowering therapy with statins is strongly recommended for patients with coronary artery disease including of acute myocardial infarction (AMI). Hypothesis: The relationship between in-hospital mortality of AMI and statin use before onset of AMI in the elderly patients is unknown, we thus assessed. Methods: The subjects were 207 consecutive AMI patients aged 65 years or older who underwent successful percutaneous coronary intervention (PCI) at Kagoshima university hospital between January 2015 and March 2021. We investigated the association between in-hospital mortality after PCI and baseline characteristics including Global Registry of Acute Coronary Events (GRACE) risk score, which is widely used for estimating mortality in AMI patients. Results: Twenty-three patients (11%) died in-hospital. The mortality rate was significantly lower in patients who were taking statins at presentation compared to those who were not (3% vs. 16%, p=0.002). Univariate logistic regression analysis of risk factors for in-hospital mortality revealed that statin use before onset of AMI, level of serum albumin, level of high sensitivity C-reactive protein (hs-CRP) and GRACE risk score were associated with in-hospital mortality. Multivariate logistic analysis models adjusted for age, statin use, level of serum albumin, level of hs-CRP, and GRACE risk score showed that statin use [Odd's ratio (OR): 0.13, 95% confidence interval (CI): 0.02-0.81, p=0.029] and GRACE risk score (OR: 1.04, 95% CI: 1.02-1.06, p &lt;0.001) were independently associated with in-hospital mortality. The optimal cut-off on the receiver-operating characteristic curve of GRACE risk score for predicting in-hospital mortality was 160. In addition, multivariate logistic analysis models using GRACE risk score ≥160 and non-use of statin before the onset of AMI showed greater risk of in-hospital mortality (HR 19.24; 95% CI 6.62-55.94; p &lt;0.001) after PCI as compared to patients with GRACE risk score &lt;160 and statins use. Conclusions: In elderly AMI patients undergoing PCI, statin use before the onset of AMI was an independent risk factor for in-hospital mortality, as was the GRACE risk score.

Characteristics of Preoperative Acute Myocardial Infarction in Elderly Hip Fracture Patients and Construction of a Clinical Prediction Model: A Retrospective Cohort Study.

The prognosis of elderly patients with acute myocardial infarction (AMI) is poor, and this study aimed to investigate the characteristics and predictors of preoperative AMI in elderly hip fracture patients and to propose a valid clinical prediction model. We collected clinical data of older hip fracture patients from January 2019 to December 2020. The data collected include demographic and clinical characteristics, underlying diseases and laboratory results. In AMI patients, we further collected type of myocardial infarctions, clinical symptoms, electrocardiogram (ECG), Killip class and diagnosis method. The prediction model was constructed by using Least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression analyses. In addition, the constructed prediction model was transformed into a nomogram. The performance of the model was evaluated using the area under receiver operating characteristic curve (AUC), calibration curve, and decision curve analysis (DCA). Bootstrapping was used for validation. There are 40 (4.2%) cases developed AMI in all 958 patients. There were 685 (71.5%) female patients and 273 (28.5%) male patients. Among 40 AMI patients, 38 (95.0%) had Type 2 myocardial infarction (T2MI) and 2 (5.0%) had Type 1 myocardial infarction (T1MI). The majority of these ECG were ST segment depression (57.5%). Most elderly AMI patients (67.5%) presented asymptomatic. Predictors for preoperative AMI were higher age (OR 2.386, 95% CI 1.126-5.057), diabetes (OR 5.863, 95% CI 2.851-12.058), Hb≤100 g/L (OR 3.976, 95% CI 1.478-10.695), CRP≥40 mg/L (OR 6.998, 95% CI 2.875-17.033), and ALB≤35 g/L (OR 2.166, 95% CI 1.049-4.471). Good discrimination and calibration effect of the model was showed. Interval validation could still achieve the C-index value of 0.771. DCA demonstrated this nomogram has good clinical utility. This model has a good predictive effect on preoperative AMI in elderly patients with hip fracture, which can help to better plan clinical evaluation.

Elevated ApoB/apoA-1 is Associated with in-Hospital Mortality in Elderly Patients with Acute Myocardial Infarction.

Apolipoprotein B/apolipoprotein A-1 (apoB/apoA-1) has been shown to be strongly associated with the risk of future cardiovascular disease, but the association between apoB/apoA-1 and the risk of in-hospital death in elderly patients with acute myocardial infarction(AMI) is inconclusive. To investigate the association between apoB/apoA-1 and the risk of in-hospital death in elderly patients with AMI. From December 2015 to December 2021, a total of 1495 elderly AMI patients (aged ≥ 60 years) with complete clinical history data were enrolled in the Second Hospital of Dalian Medical University. Outcome was defined as all-cause mortality during hospitalization. Multivariate logistic regression and restricted spline cubic (RCS) models were used to evaluate the association between apoB/apoA-1 and in-hospital mortality risk, respectively. Receiver operating characteristic(ROC) curves were used to evaluate the predictive value of apoB/apoA-1 for in-hospital mortality events. Discordance analysis was performed when apoB/apoA-1 and LDL-C/HDL-C were not in concordance. (1) A total of 128 patients (8.6%) died during hospitalization. Patients in the death group had higher apoB/apoA-1 than those in the non-death group, but lower apoA-1 levels than those in the non-death group, and the difference was statistically significant (P < 0.05); (2) Multivariate logistic regression analysis showed that apoB/apoA-1 was associated with the risk of in-hospital death in elderly AMI patients [Model 3 OR = 3.524 (1.622-7.659), P = 0.001]; (3) ROC curve analysis showed that apoB/apoA-1 (AUC = 0.572, P = 0.011) had some predictive value for the risk of in-hospital death in elderly AMI patients; (4) RCS models showed a linear dose-response relationship between apoB/apoA-1 and in-hospital death after adjusting for confounders (P for non-linearity = 0.762). ApoB/apoA-1 is associated with the risk of in-hospital death in elderly patients with AMI, and is superior to other blood lipid parameters and blood lipid ratio.

An Easy-to-Use Nomogram Based on SII and SIRI to Predict in-Hospital Mortality Risk in Elderly Patients with Acute Myocardial Infarction.

Inflammatory response is closely associated with poor prognosis in elderly patients with acute myocardial infarction (AMI). The aim of this study was to develop an easy-to-use predictive model based on medical history data at admission, systemic immune inflammatory index (SII), and systemic inflammatory response index (SIRI) to predict the risk of in-hospital mortality in elderly patients with AMI. We enrolled 1550 elderly AMI patients (aged ≥60 years) with complete medical history data and randomized them 5:5 to the training and validation cohorts. Univariate and multivariate logistic regression analyses were used to screen risk factors associated with outcome events (in-hospital death) and to establish a nomogram. The discrimination, calibration, and clinical application value of nomogram were evaluated based on receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA), respectively. The results of multivariate logistic regression showed that age, body mass index (BMI), previous stroke, diabetes, SII, and SIRI were associated with in-hospital death, and these indicators will be included in the final prediction model, which can be obtained by asking the patient's medical history and blood routine examination in the early stage of admission and can improve the utilization rate of the prediction model. The areas under the ROC curve for the training and validation cohorts nomogram were 0.824 (95% CI 0.796 to 0.851) and 0.809 (95% CI 0.780 to 0.836), respectively. Calibration curves and DCA showed that nomogram could better predict the risk of in-hospital mortality in elderly patients with AMI. The nomogram constructed by combining SII, SIRI, and partial medical history data (age, BMI, previous stroke, and diabetes) at admission has a good predictive effect on the risk of in-hospital death in elderly patients with AMI.

Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio are Important Indicators for Predicting in-Hospital Death in Elderly AMI Patients.

To investigate the role of neutrophil-to-lymphocyte ratio(NLR) and platelet-to-lymphocyte(PLR) in predicting the risk of in-hospital mortality in elderly acute myocardial infarction(AMI) patients. This study was a single-center, retrospective and observational study. From December 2015 to December 2021, a total of 1550 elderly patients (age ≥ 60 years) with AMI with complete clinical history data were enrolled in the Second Hospital of Dalian Medical University. Routine blood tests were performed on admission, and NLR and PLR were calculated based on neutrophil, platelet, and lymphocyte counts. Outcome was defined as all-cause mortality during hospitalization. Cox regression and restricted spline cubic(RCS) models were used to evaluate the association of NLR and in-hospital mortality risk and the association of PLR with in-hospital mortality risk, respectively. (1) A total of 132 (8.5%) patients died during hospitalization. From the results of blood routine, the white blood cell, neutrophil, NLR and PLR in the death group were higher than those in the non-death group, while the lymphocyte was lower than that in the non-death group, and the difference was statistically significant (P < 0.05). (2) The results of receiver operating characteristic(ROC) curves analysis showed that the predictive ability of NLR (AUC = 0.790) for in-hospital death was better than that of PLR (AUC = 0.637). (3) Multivariate Cox proportional regression hazard models showed that high NLR was associated with the risk of in-hospital mortality in elderly AMI patients (HR = 3.091, 95% CI 2.097-4.557, P < 0.001), while high PLR was not. (4) RCS models showed a nonlinear dose-response relationship between NLR and in-hospital death (P for nonlinear = 0.0007). High NLR (> 6.69) is associated with the risk of in-hospital mortality in elderly patients with AMI and can be an independent predictor of poor short-term prognosis in elderly patients with AMI.

The impact of angiotensin-converting-enzyme inhibitors versus angiotensin receptor blockers on 3-year clinical outcomes in elderly (≥ 65) patients with acute myocardial infarction without hypertension.

This study aimed to investigate the impact of angiotensin-converting-enzyme inhibitors (ACEI) and angiotensin II type 1 receptor blockers (ARB) on 3-year clinical outcomes in elderly (≥ 65) acute myocardial infarction (AMI) patients without a history of hypertension who underwent successful percutaneous coronary intervention (PCI) with drug-eluting stents (DES). A total of 13,104 AMI patients who were registered in the Korea AMI registry (KAMIR)-National Institutes of Health (NIH) were included in the study. The primary endpoint was 3-year major adverse cardiac events (MACE), which was defined as the composite of all-cause death, recurrent myocardial infarction (MI), and any repeat revascularization. To adjust baseline potential confounders, an inverse probability weighting (IPTW) analysis was performed. The patients were divided into two groups: the ACEI group, n = 872 patients and the ARB group, n = 508 patients. After IPTW matching, baseline characteristics were balanced. During the 3-year clinical follow-up, the incidence of MACE was not different between the two groups. However, incidence of stroke (hazard ratio [HR], 0.375; 95% confidence interval [CI], 0.166-0.846; p = 0.018) and re-hospitalization due to heart failure (HF) (HR, 0.528; 95% CI, 0.289-0.965; p = 0.038) in the ACEI group were significantly lower than in the ARB group. In elderly AMI patients who underwent PCI with DES without a history of hypertension, the use of ACEI was significantly associated with reduced incidences of stroke, and re-hospitalization due to HF than those with the use of ARB.

Risk Factors, Clinical Profile and Outcome of Acute Myocardial Infarction in Elderly Patients

Background: Coronary heart disease is the leading cause of death among elderly patients. Although, chest pain is the most common presentation of acute myocardial infarction (AMI) in elderly patients, there can be of predominance of other ischemic symptoms such as giddiness, dyspnoea, vomiting, sweating and epigastric pain in the absence of chest pain. Objective: To assess the risk factors, various symptoms, complications, prognosis and outcome of elderly patients with acute myocardial Infarction (AMI). Methods: This is a prospective study was carried out at Dept. of Cardiology, Shaheed Tajuddin Ahmad Medical College Hospital, Gazipur, Bangladesh from January to July 2022. Seventy (70) elderly patients admitted to STAMCH with the diagnosis of acute myocardial infarction and patients satisfying the inclusion criteria were included in the study. Results: Among the seventy patients the majority of the patients belonged to the age group 60-69 years. Twenty percent of the patients presented without chest pain. The atypical presentations included dyspnoea, giddiness, vomiting, sweating and epigastric pain. Mortality rate was 20%. Conclusions: Even though chest pain is the most common presentation in elderly AMI patients, atypical symptoms such as shortness of breath, giddiness, vomiting, sweating and epigastric pain without chest pain are much more common. This signifies the need of examining physicians to identify meticulously for acute myocardial infarction in elderly though they may not present typically.

Protective effect of recombinant human brain natriuretic peptide against contrast-induced nephropathy in elderly acute myocardial infarction patients: A randomized controlled trial.

Increasing reports have demonstrated that recombinant human brain natriuretic peptide (rhBNP) can improve acute myocardial infarction (AMI) and heart failure. However, whether it can improve renal function and decrease the risk of contrast-induced nephropathy (CIN) in elderly AMI patients is still unclear. To explore the effect of rhBNP on CIN in elderly AMI patients after percutaneous coronary intervention (PCI). One hundred and thirty-one elderly AMI patients underwent PCI from January 2017 to July 2021. Patients were either given 1 mL of 0.9% normal saline/(kg/h) for 72 h after PCI (control group, n = 66) and or intravenous rhBNP [1.5 mg/kg followed by 0.0075 mg/(kg/min)] for 72 h (rhBNP treatment group, n = 65). Serum creatinine and cystatin C levels, creatinine clearance rate, and eGFR were measured at 24 h, 48 h, and 72 h after PCI. Research nurses collected data on handwritten forms, and then stored them in password-protected electronic databases. The creatinine clearance rate and eGFR were increased, while the creatinine and cystatin C levels were decreased significantly in the rhBNP treatment group compared to the control group at 48 h and 72 h. The incidence of CIN (P = 0.028) and acute heart failure (P = 0.017) also significantly decreased in the rhBNP group. No significant difference was noted between the two groups in cardiac death and recurrent AMI. Early application of rhBNP could protect renal function and decrease the incidence of CIN after primary PCI and acute heart failure.

P206 IMPACT OF AGE, GENDER AND HEART FAILURE ON MORTALITY TRENDS AFTER ACUTE MYOCARDIAL INFARCTION IN ITALY

Abstract Background The outcome of patients with acute myocardial infarction (AMI) may vary substantially based on baseline risk. We aimed at analyzing the impact of gender, age and heart failure (HF) on mortality trends, based on a nationwide, comprehensive and universal administrative database of AMI. Methods This is a nationwide cohort study of patients admitted with AMI from 2009 to 2018 in all Italian hospitals. In–hospital mortality rate (I–MR) and 1–year post–discharge mortality rate (1–Y–MR) were assessed. Results Among the 1,000,965 AMI events included in the analysis, 43.6% occurred in patients aged ≥75 years, 34.7% in females and 21.8% in AMI complicated by HF at the index hospitalization (Figure 1). Both I–MR and 1–Y–MR significantly decreased over time (from 8.87% to 6.72%; mean annual change − 0.23%; confidence intervals (CI): − 0.26% to − 0.20% and from 12.24% to 10.59%; mean annual change − 0.18%; CI: − 0.24% to − 0.13%, respectively). This trend was confirmed in younger and elderly AMI patients, in both sexes (Figure 2). In AMI patients complicated by HF, both I–MR and 1–Y–MR were markedly high, regardless of age and gender. Conclusions This contemporary, nationwide study suggests that I–MR and 1–Y–MR are still elevated, albeit decreasing over time. Elderly patients and those with HF at the time of index admission, present a particularly high risk of fatal events, regardless of gender.

Clinical Nursing Pathway Improves Therapeutic Efficacy and Quality of Life of Elderly Patients with Acute Myocardial Infarction.

Purposes To clarify the impacts of clinical nursing pathway (CNP) on therapeutic efficacy and quality of life (QOL) of senile acute myocardial infarction (AMI) patients. Methods The clinical records of 177 elderly AMI patients who received treatment in the First Hospital of Quanzhou Affiliated to Fujian Medical University were retrospectively studied. They were assigned into the control group (the Con; n = 79; from June 2019 to January 2020) and the research group (the Res; n = 98; from February 2020 to July 2020). Emergency percutaneous coronary intervention (PCI) was performed in all the cases. Additionally, the Con and the Res were given routine care and CNP, respectively. The two groups were compared in total emergency treatment time, hospital stay, medical expenses, recurrence rate of myocardial infarction (MI), overall response rate (ORR), incidence of complications, cardiac function indexes, negative mood scores, QOL, and nursing satisfaction. Results The ORR was higher, and the incidence of complications was lower in the Res versus the Con; the Res presented significantly less emergency treatment time and hospitalization and statistically lower medical expenses and recurrence rate of MI; the Res outperformed the Con in cardiac function indexes, alleviation of negative mood, QOL, and nursing satisfaction. Conclusions While effectively improving clinical efficacy and reducing the incidence of complications, CNP can relieve the bad mood of elderly patients with AMI and improve their cardiac function, QOL, and nursing satisfaction, which is worthy of clinical promotion.

Impact of age, gender and heart failure on mortality trends after acute myocardial infarction in Italy

BackgroundThe outcome of patients with acute myocardial infarction (AMI) may vary substantially based on baseline risk. We aimed at analyzing the impact of gender, age and heart failure (HF) on mortality trends, based on a nationwide, comprehensive and universal administrative database of AMI. MethodsThis is a nationwide cohort study of patients admitted with AMI from 2009 to 2018 in all Italian hospitals. In-hospital mortality rate (I-MR) and 1-year post-discharge mortality rate (1-Y-MR) were assessed. ResultsAmong the 1,000,965 AMI events included in the analysis, 43.6% occurred in patients aged ≥75 years, 34.7% in females and 21.8% in AMI complicated by HF at the index hospitalization. Both I-MR and 1-Y-MR significantly decreased over time (from 8.87% to 6.72%; mean annual change −0.23%; confidence intervals (CI): − 0.26% to −0.20% and from 12.24% to 10.59%; mean annual change −0.18%; CI: − 0.24% to −0.13%, respectively). This trend was confirmed in younger and elderly AMI patients, in both sexes. In AMI patients complicated by HF, both I-MR and 1-Y-MR were markedly high, regardless of age and gender. ConclusionsThis contemporary, nationwide study suggests that I-MR and 1-Y-MR are still elevated, albeit decreasing over time. Elderly patients and those with HF at the time of index admission, present a particularly high risk of fatal events, regardless of gender.

Low levels of dihomo-gamma-linolenic acid are associated with all-cause death in elderly patients with a recent myocardial infarction

Abstract Background In a previous study*, low levels of the omega-6 fatty acid (FA) dihomo-gamma (γ)-linolenic acid (DGLA; C20:3w6), were independently associated with poor 7-year outcome in elderly patients after acute coronary syndrome. Aim In order to further evaluate DGLA as a predictor of outcome, we measured n-6 FAs including DGLA in serum samples from elderly subjects with a recent acute myocardial infarction (AMI). Methods Baseline samples from the OMEMI (Omega-3 Fatty acids in Elderly with Myocardial Infarction) trial* in which a total of 1027 patients, aged 70 to 82 years, were included 2–8 weeks after an MI, were used. The pre-specified primary outcome during 2 years follow-up was major adverse cardiac events (MACE), which consisted of nonfatal MI, unscheduled coronary revascularization, stroke, all-cause death, or hospitalization for heart failure. Cox regression analysis was used to relate serum n-6 FA levels, measured by gas chromatography and reported as % weight of total FA (%wt) to the risk of incident cardiovascular events. Three models were employed in the multivariable analysis, adjusting for: 1) age, sex and body mass index; 2) + baseline omega-3 FA supplementation; 3) + prevalent hypertension. Results Median DGLA levels at baseline (n=1.002) were 2.89 (Q1–Q3 2.43–3.38) %wt. After 2 years follow-up, 152 patients experienced incident MACE, including n=55 all-cause death. The univariate hazard ratio (HR) for MACE, employing continuous DGLA values was 0.89 (95% CI 0.72–1.08) per %wt increase in DGLA, p=0.24, and for all-cause death 0.72 (95% CI 0.48–1.07), p=0.11. In the multivariable Cox regression models for MACE, concentrations of DGLA did not reach statistical significance; p=0.12, 0.09 and p=0.07 in Models 1, 2 and 3, respectively. In univariate analysis, HR for total death in the three higher quartiles of DGLA as compared to the lowest quartile was 0.51 (95% CI 0.30–0.80), p=0.016. Results remained statistically significant in all the multivariable models. Model 1: HR 0.54 (0.31–0.95), p=0.03; Model 2: HR 0.50 (0.28–0.91) p=0.02; Model 3: HR 0.49 (0.27–0.88), p=0.017. Conclusion Low serum levels of DGLA were associated with increased risk of all-cause death after AMI in elderly patients, thus, suggesting DGLA to be protective. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Stein Erik Hagen Foundation for Clinical Heart Research, Oslo, Norway.

LEFT VENTRICLE REARRANGEMENT IN PATIENTS WITH CRITICAL OSTIAL STENOSIS OF THE LEFT MAIN TRUNK COMPLICATED WITH ISCHEMIC MITRAL REGURGITATION

In this work, we studied the possibility of stenting the left coronary artery trunk in patients with subacute myocardial infarction on a background of critical stenosis of the left coronary artery trunk, reduced left ventricular ejection fraction and surgically significant mitral regurgitation. We analyzed treatment outcomes of 97 patients who underwent stenting of left main trunk for subacute stage of myocardial infarction. All patients had mitral insufficiency of II–III degree. The echocardiography data were analyzed before surgery, 7 days, 30 days and 12 months after surgical treatment. Direct stenting of the left coronary artery trunk was performed in 38 (39.2%) patients. 59 (60.8%) patients underwent Culotte bifurcation stenting. A good treatment effect was achieved in 89 (91.2%) patients. As a result of the LV myocardial remodeling, EF increased by 1.44 times (p &lt; 0.05). There was a significant decrease in the degree of mitral insufficiency by 39% to surgically insignificant from 5.9 to 3.6 mm (p &lt; 0.05). Stent placement as an initial treatment in elderly patients with more than 24 hours after the onset of acute myocardial infarction (AMI) originated from a critical lesion of the left coronary artery trunk and concomitant pronounced mitral insufficiency proved as fully justified and safe. We assume that this treatment enables to improve ejection fraction and reduce severity of mitral regurgitation in elderly AMI patients.

Evaluation of the effect of older age on the diagnostic specificity of high-sensitivity troponin I and high-sensitivity troponin T in patients with suspected acute myocardial infarction

Abstract Background Cardiac troponins have become the gold standard for appropriate and rapid diagnosis of an acute myocardial infarction (AMI). However, elevated cardiac troponins levels can be observed in the absence of AMI in elderly patients and therefore a loss of specificity is seen in the diagnosis of AMI in elderly patients. Purpose This study aims to define old age in suspected AMI and to evaluate the effect of older age on the diagnostic specificity of a high sensitivity troponin I (hs-cTnI) and high sensitivity troponin T (hs-cTnT) assay in elderly women and men. Methods This study used data from patients with suspected AMI who were enrolled between 08–2011 and 10–2016 to a multicentre biomarker registry and an University Hospital and with available hs-cTnI and hs-cTnT upon admission (n=564 patients). First, we investigated the effect of age on the specificity of both hs-cTnI and hs-cTnT to detect AMI continuously. We then classified over seventy-year-olds as elderly (n=281; 49,8%) and compared the specificity of hs-cTnI and hs-cTnT between elderly and younger patients. Results In the group of older patients, 62.6% (n=176) were diagnosed with AMI compared with 50.9% (n=144) in younger age patients (p&amp;lt;0.01). Elderly patients had higher median levels of hs-cTnI and hs-cTnT than younger patients: 45.4 ng/L vs. 13.1 ng/L hs-cTnI (p&amp;lt;0.001) and 36.8 ng/L vs. 12.8 ng/L hs-cTnT (p&amp;lt;0.001) irrespective of the final diagnosis. Figure1 shows a shift in diagnostic specificity for the whole troponin concentration range in elderly patients compared to younger patients starting at the age of 60 years with clear impact in patients older than 70 years used as threshold for old age in further analyses. Applying the 99th percentile cut-off led to a specificity of 93.5% (95% CI: 88.1–97.0%) in younger patients vs. 88.6% (95% CI: 80.9–94.0%) in elderly patients for hs-cTnI and of 91.4% (95% CI: 85.4–95.5%) vs. 65.7% (95% CI: 55.8–74.7%) for hs-cTnT. To achieve the same specificity in elderly patients as in younger patients, optimized rule-in cut-offs were calculated with 2.6-fold of the 99th percentile for hs-cTnI (68.9 ng/L) and 3.1-fold of the 99th percentile for hs-TnT (43.9 ng/L). Conclusions The specificity of both, hs-cTnI and hs-cTnT is significantly reduced in elderly patients due to higher hs-cTnT and hs-cTnI levels in elderly patients at admission irrespective of the final diagnosis. A relevant loss in diagnostic specificity is observed at 70 years of age starting already at 60 years. Use of assay-specific adjusted cut-offs for hs-cTnI and hs-cTnT for elderly patients regains diagnostic specificity that leads to a more accurate decision-making concerning “rule-in” for older patients with suspected AMI. Funding Acknowledgement Type of funding source: None

Value of heart rate variability on dynamic electrocardiogram in predicting ventricular fibrillation in elderly acute myocardial infarction patients.

Ventricular fibrillation (VF) is the main cause of sudden death in Acute myocardial infarction (AMI) patients. Identifying arrhythmia as early as possible is of great significance in improving prognosis of AMI patients. The article is aimed at exploring the predictive value of heart rate variability (HRV) of dynamic electrocardiogram (DCG) in VF of elderly AMI patients. A total of 122 elderly AMI patients were enrolled as the research objects. They were divided into VF group and simple AMI group (AMI group). All underwent DCG test after admission. The basic data of patients were compared. HRV of DCG was observed. The predictive value of HRV of DCG in VF of elderly AMI patients was evaluated by receiver operating characteristic (ROC) curves. The ratio of Killip at grade II-III, activity of creatine kinase-MB (CK-MB), standard deviation of all R-R intervals (SDNN), the standard deviation of the R-R intervals (SDANN), root-mean-square of the successive differences of normal RR intervals (rMSSD) and percentage of NN50 in the total number of NN intervals PNN50 (PNN50%)]in VF group were higher than those in AMI group (P<0.05). The area under the ROC curves (AUC)and cut-off values of SDNN, SDANN, rMSSD and PNN50% were (0.773, 0.761, 0.800, 0.819) and (135.675, 106.850, 33.570, 14.080), respectively. HRV of DCG is of certain predictive value for VF in the elderly with AMI, which is expected to be an auxiliary diagnosis method of VF.

Effects of atorvastatin combined with bivalirudin on coagulation function, cardiac function, and inflammatory factors of percutaneous coronary intervention in elderly patients with acute myocardial infarction.

Acute myocardial infarction (AMI) occurs when atherosclerotic lesions which present in the coronary arteries cause the intravascular plate to rupture and with the result of myocardial ischemia, hypoxia, and infarct. The preferred treatment for AMI is currently percutaneous coronary intervention (PCI), for which the key to the success is the choice of anticoagulant and thrombolytic drugs during surgery. Here, we aim to explore the effects of atorvastatin combined with bivalirudin on coagulation function, cardiac function, and inflammatory factors in elderly patients with AMI who underwent PCI. The clinical data of 86 AMI patients who were admitted to our hospital between February 2016 and May 2018 were retrospectively analyzed. Based on different treatments, the patients were divided into the control group and the observation group, with 43 patients in each group. The control group patients were treated with bivalirudin, and the observation group was treated with bivalirudin plus atorvastatin. Both groups of patients underwent PCI and the clinical efficacy, coagulation function, cardiac function, inflammatory factor levels and cardiovascular events (MACE), and other clinical data were compared between the groups. The total clinical effective rate in the observation group was significantly higher than that in the control group (90.90% vs. 72.09%) (P<0.05). Fibrinogen (Fg) and D-dimer (D-D) levels were significantly decreased after treatment in both groups but were significantly lower in the observation group than in the control group. The prothrombin time (PT) was significantly prolonged after treatment in both groups but was significantly longer in the observation group than in the control group after treatment (P<0.05). Meanwhile, the left ventricular end-diastolic diameter (LVEDD) and left ventricular end-systolic diameter (LVESD) were significantly reduced after treatment in both groups but were significantly lower in the observation group than in the control group, whereas the left ventricular ejection fraction (LVEF) was significantly higher in the observation group compared with the control group after treatment (P<0.05). After treatment, serum levels of transforming growth factor-β1 (TGF-β1), tumor necrosis factor-α (TNF-α), and IL-6 were significantly reduced in both groups but the levels were significantly lower in the observation group than in the control group (P<0.05). The overall incidence of MACE in the observation group was significantly lower than that in the control group (9.30% vs. 30.23%) (P<0.05). Atorvastatin combined with bivalirudin can improve the efficiency of clinical treatment in elderly AMI patients who undergo PCI, while simultaneously improving blood coagulation function and reducing the occurrence of bleeding, compared with bivalrudin alone. It can also decrease the level of inflammatory factors, promote vascular recanalization, and improve myocardial ischemia, thereby reducing the incidence of MACE and improving patient prognosis.