Elevation Myocardial Infarction Research Articles

The predictive significance of red cell distribution width in anterior ST- elevation myocardial infarction and its relationship with hospital mortality

Objectives: The clinical diagnosis of acute myocardial infarction (AMI) involves assessing the patient's medical history and indirect evidence of myocardial necrosis using biochemical, electrocardiogram (ECG), or imaging methods. Ischemia, hypoxia, and myocardial necrosis result from a disrupted blood supply to the coronary arteries, typically due to atherosclerosis, thrombosis, and coronary artery obstruction. Given the rising incidence and healthcare costs of ST-elevation myocardial infarction (STEMI), particularly anterior STEMI (ant-STEMI), this study examines the diagnostic value of red cell distribution width (RDW) in ant-STEMI patients and its impact on hospital and one-year mortality post-primary angioplasty. Methods: This study focused on patients with ant-STEMI undergoing primary angioplasty at Shahid Madani Hospital, Tabriz, Iran, from 2018 to 2019. Exclusion criteria included patients receiving drug or antithrombotic treatment, undergoing coronary artery bypass grafting (CABG), not receiving primary percutaneous coronary intervention (PPCI), suffering from STEMI types other than anterior STEMI, having a history of thalassemia or anemia, and those with incomplete patient records. In-hospital complications, such as cardiogenic shock, hematoma, bleeding, and heart failure (HF), were recorded and analyzed using SPSS 23. Results: In this retrospective and analytical study of 300 patients, there was no significant relationship between RDW levels and in-hospital (P-value=0.59) and one-year mortality (P-value=0.68). However, RDW was significantly associated with hospital complications such as HF, cardiogenic shock, angio-hematoma, gastrointestinal bleeding, and stent thrombosis (P-value<0.01). Conclusions: Our study showed that RDW is not a reliable prognostic factor for mortality in anterior STEMI patients.

Temperature and myocardial infarction among migrants in Kuwait

BackgroundKuwait, one of the world’s hottest countries, faces increasing temperatures due to climate change. With a large migrant population predominantly employed in physically demanding jobs, the exact effects and burdens...

Pre-Hospital Point-of-Care Troponin: Is It Possible to Anticipate the Diagnosis? A Preliminary Report.

Background: Thanks to the evolution of laboratory medicine, point-of-care testing (POCT) for troponin levels in the blood (hs-cTn) has been greatly improved in order to quickly diagnose acute myocardial infarction (AMI) with an accuracy similar to standard laboratory tests. The rationale of the HEART POCT study is to propose the application of the 0/1 h European Society of Cardiology (ESC) algorithm in the pre-hospital setting using a POCT device (Atellica VTLi). Methods: This is a prospective study comparing patients who underwent pre-hospital point-of-care troponin testing (Atellica VTLi) with a control group that underwent standard hospital-based troponin testing (Elecsys). The primary objectives were to determine if the 0/1 h algorithm of the Atellica VTLi is non-inferior to the standard laboratory method for diagnosing AMI and to analyze rule-out/rule-in times and emergency department (ED) stay times. The secondary objective was to evaluate the feasibility of pre-hospital troponin testing. Results: The Atellica VTLi demonstrated reasonable sensitivity for detecting AMI, with sensitivity increasing from 60% at the first measurement (time 0) to 80% at the second measurement (time 1 h). Both the Atellica VTLi and the Elecsys method showed high negative predictive value (NPV), indicating that a negative troponin result effectively ruled out AMI in most cases. Patients in the Atellica VTLi group experienced significantly shorter times to diagnosis and discharge from the emergency department compared to the control group (Elecsys). This highlights a potential benefit of point-of-care testing: streamlining the diagnostic and treatment processes. Conclusions: POCT allows for rapid troponin measurement, leading to a faster diagnosis of non-ST-segment elevation myocardial infarction (NSTEMI). This enables earlier initiation of appropriate treatment, potentially improving patient outcomes and the efficiency of emergency department operations. POCT could be particularly beneficial in pre-hospital settings, enabling faster triage and transportation of patients to appropriate care centers.

Predicting Mortality in Patients Hospitalized With Acute Myocardial Infarction: From the National Cardiovascular Data Registry.

In-hospital mortality risk prediction is an important tool for benchmarking quality and patient prognostication. Given changes in patient characteristics and treatments over time, a contemporary risk model for patients with acute myocardial infarction (MI) is needed. Data from 313 825 acute MI hospitalizations between January 2019 and December 2020 for adults aged ≥18 years at 784 sites in the National Cardiovascular Data Registry Chest Pain-MI Registry were used to develop a risk-standardized model to predict in-hospital mortality. The sample was randomly divided into 70% development (n=220 014) and 30% validation (n=93 811) samples, and 23 separate registry-based patient characteristics at presentation were considered for model inclusion using stepwise logistic regression with 1000 bootstrapped samples. A simplified risk score was also developed for individual risk stratification. The mean age of the study cohort was 65.3 (SD 13.1) years, and 33.6% were women. The overall in-hospital mortality rate was 5.0% (n=15 822 deaths). The final model included 14 variables, with out-of-hospital cardiac arrest, cardiogenic shock, and ST-segment elevation MI as the strongest independent predictors of mortality. The model also included age, comorbidities (dyslipidemia, diabetes, prior percutaneous coronary intervention, cerebrovascular disease, and peripheral artery disease), heart failure on admission, heart rate, systolic blood pressure, glomerular filtration rate, and hemoglobin. The model demonstrated excellent discrimination (C-statistic, 0.868 [95% CI 0.865-0.871]) and good calibration, with similar performance across subgroups based on MI type, periods before and during the COVID-19 pandemic, and hospital volume. The simplified risk score included values from 0 to 25, with mortality risk ranging from 0.3% with a score of 0 to 1 up to 49.4% with a score >11. This contemporary risk model accurately predicts in-hospital mortality for patients with acute MI and can be used for risk standardization across hospitals and at the bedside for patient prognostication.

The prognostic and therapeutic significance of polyunsaturated fatty acid‐derived oxylipins in ST‐segment elevation myocardial infarction

The prognostic and therapeutic significance of polyunsaturated fatty acid‐derived oxylipins in ST‐segment elevation myocardial infarction

The impact of specialist cardiology inpatient care on the long-term outcomes of non-ST-segment elevation myocardial infarction (NSTEMI): A nationwide cohort study.

Specialist cardiac care has been shown to reduce inpatient mortality following non-ST segment myocardial infarction (NSTEMI), but whether this benefit extends beyond index admission is unclear. Using the linked Myocardial Ischaemia National Audit Project (MINAP) registry, and Office for National Statistics mortality recording, we included 425,205 NSTEMI patients admitted to UK hospitals, between January 2005 and March 2019 that survived to discharge. 217,964 (52 %) were admitted to a specialty cardiac ward. Multivariable Cox-regression models were applied to imputed data to estimate Hazard Ratios for mortality over our study period. Patients admitted to specialty cardiology wards were younger (70 years vs. 75), less often female (32 % vs. 40 %) but more often received statins (86 % vs. 84 %) or beta-blockers (83 % vs. 77 %) (all P < 0.001). One-year (aHR:0.84, 95 % CI 0.83-0.86), and ten-year mortality (aHR: 0.88, 95 % CI 0.87-0.89) were lower in patients admitted to specialty cardiac wards, compared to admitted elsewhere (all P < 0.001). There was significant geographic variation in the proportion admitted to speciality cardiac wards (London 59 % vs. East of England 43 %), with over 1700 deaths potentially avoided if the MINAP target of 80 % was reached. Patients admitted to a cardiac ward had significantly lower mortality compared to alternate wards persisting up to ten-years. There is wide regional variation in the proportion of patients who received specialist cardiology care during their admission and an opportunity exists for lives saved if the proportion of NSTEMI patients admitted to a cardiac ward were to reach the MINAP target of 80 %.

Real-World Analyses of the De-Escalation of Dual Antiplatelet Therapy in Treatment of Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention in Taiwan.

Dual antiplatelet therapy (DAPT) is the standard treatment for acute myocardial infarction (MI). This study aimed to investigate the use of DAPT and de-escalation after discharge in real-world practice among patients with acute MI undergoing percutaneous coronary intervention (PCI) in Taiwan. Using the Taiwan National Health Insurance Research Database, we included patients who received PCI for acute MI and survived to discharge with DAPT from 2011 to 2021. The choice of different P2Y12 inhibitors at discharge and de-escalation therapy after discharge were analyzed. Overall, 58989 patients (mean age 61.9 ± 13.2 years, male 81.4%) were included. The initial use of aspirin plus ticagrelor (A + T) increased from 4.8% in 2013 to 73.2% in 2021 (p < 0.01). Switch to de-escalation therapy occurred in 52.7% of the A + T users at 9 months follow-up. Aspirin plus clopidogrel (A + C) and ticagrelor monotherapy were the most commonly used de-escalation therapies in the first 6 months. Multivariable logistic regression analysis demonstrated that older patients and those with non-ST-segment elevation MI, multi-vessel PCI, baseline bleeding risk and bleeding events during follow-up were more likely to receive ticagrelor monotherapy than A + C. A + T has become the major initial DAPT for patients with acute MI undergoing PCI in Taiwan, but de-escalation is not uncommon after discharge. Ticagrelor monotherapy was more likely to be prescribed than A + C in those with multi-vessel PCI or bleeding concern.

Eosinopenia in patients with acute myocardial infarction- longitudinal imaging insights from the CAPRI study.

Eosinophils are recruited to the heart during acute myocardial infarction (MI) and are considered part of the inflammatory response associated with adverse clinical outcomes. We assessed the impact of eosinopenia on cardiac imaging biomarkers in patients presenting with ST-segment elevation MI. This is a post-hoc analysis of the Evaluating the effectiveness of intravenous Ciclosporin on reducing reperfusion injury in pAtients undergoing PRImary percutaneous coronary intervention (CAPRI) trial. Patients underwent cardiac MRI within 1 week and 12 weeks and low eosinophil was defined as less than 40 cells/ml. The study included 52 patients and 38% had low eosinophil. Ciclosporin administration was comparable between patients with low versus normal eosinophils. The ischaemia time was significantly longer in low eosinophil patients [262 (205-325) vs. 138 (102-195) minutes, P < 0.001]. At 12 weeks, patients with eosinopenia had larger infarct size [9.8% (5.7-18.4) vs. 7.4% (1.9-10.2), P = 0.045], larger left ventricle (LV) end systolic volume (89 ± 28 vs. 68 ± 23, P = 0.02), and lower LV ejection fraction (EF) (49 ± 9 vs. 58 ± 7, P < 0.001). After adjustments for significant predictors, including ischaemia time, low eosinophil count was an independent predictor of worse LVEF at 12 weeks [-5.78, 95% CI (-11.22 to -0.34), P = 0.038] but not infarct size [1.83, 95% CI (-2.77 to 6.43), P = 0.43]. Patients with low eosinophil count had larger infarct size and LV volumes and worse adverse remodeling compared to those with normal eosinophil count. At 12 weeks, eosinopenia was an independent predictor of worse LVEF but not infarct size.

Mortality prediction of inpatients with NSTEMI in a premier hospital in China based on stacking model.

Acute myocardial infarction (AMI) remains a leading cause of hospitalization and death in China. Accurate mortality prediction of inpatient is crucial for clinical decision-making of non-ST-segment elevation myocardial infarction (NSTEMI) patients. In this study, a total of 3061 patients between January 1, 2017 and December 31, 2022 diagnosed with NSTEMI were enrolled in this study. A new method based on Stacking ensemble model is proposed to predict the in-hospital mortality risk of NSTEMI using clinical data. This method mainly consists of three parts. Firstly, oversampling technique was used to alleviate the class imbalance problem. Secondly, the feature selection method of Recursive Feature Elimination (RFE) was selected for effective feature selection. Finally, a unique double-layer stacking model is designed to improve the performance of the algorithm. Seven classical artificial intelligence methods of Logistic Regression (LR), Decision Tree (DT), Support Vector Machine (SVM), Random Forest (RF), Adaptive Boosting (ADB), Extra Tree (ET), and Gradient Boosting Decision Tree (GBDT) were selected as candidate models for the base model of the first layer of the model, and extreme gradient enhancement (XGBOOST) was selected as the meta-model for the second layer. Patient were divided into the surviving group and the death group, and a total of 57 clinical features showed statistically significant for the two groups and finally included in the subsequent model. The results show that the Area Under Curve (AUC) of the Stacking model proposed in this paper is 0.987, which is higher than that of LR (0.934), DT (0.946), SVM (0.942), RF (0.948), ADB (0.949), ET (0.938) and GBDT (0.920). At the same time, the proposed Stacking model has higher performance than each single model in terms of Accuracy, Precision, Recall and F1 evaluation indicators. The Stacking model proposed in this paper can integrate the advantages of LR, DT, SVM, RF, ADB, ET and GBDT models to achieve better prediction performance. This model can provide valuable insights for physicians to identify high-risk patients more precisely and timely, thereby maximizing the potential for early clinical interventions to reduce the mortality rate.

Ticagrelor vs Prasugrel for Acute Coronary Syndrome in Routine Care

In patients with acute coronary syndrome (ACS) undergoing invasive treatment, ticagrelor and prasugrel are guideline-recommended P2Y12 receptor inhibitors. The ISAR-REACT5 randomized clinical trial demonstrated superiority for prasugrel, although concerns were raised about the generalizability of some underpowered subgroup analyses. To emulate a randomized clinical trial evaluating the safety and effectiveness of ticagrelor vs prasugrel under the conditions of routine care in individuals with ACS planned to undergo an invasive treatment strategy. This new-user cohort study included secondary data from a German statutory health insurance claims database between January 2012 and December 2021, using 1:1 propensity score nearest-neighbor matching to emulate ISAR-REACT5. Individuals with ACS receiving either ticagrelor or prasugrel treatment after hospital discharge were followed up for 1 year. Eligibility criteria closely emulated those of ISAR-REACT5 and included age of 18 years or older and cardiovascular risk factors. Data were analyzed from May 2023 to May 2024. Outpatient prescription of ticagrelor or prasugrel. The primary end point was the composite of all-cause mortality, myocardial infarction (MI), or stroke within 1 year of outpatient treatment initiation. Secondary end points included individual components of the primary end point and stent thrombosis. The safety end point was major bleeding. A Cox proportional hazards regression model was fitted to the overall cohort. Of 17 642 propensity score-matched individuals (mean [SD] age, 63.1 [10.9] years; 73.9% male), 8821 received ticagrelor and 8821 received prasugrel. Agreement was met in 11 of 12 predefined agreement metrics when comparing the results with ISAR-REACT5. The primary composite end point of all-cause mortality, MI, or stroke occurred in 815 individuals (9.2%) receiving ticagrelor and 663 (7.5%) receiving prasugrel (hazard ratio [HR], 1.24; 95% CI, 1.12-1.37). Myocardial infarction (HR, 1.20; 95% CI, 1.06-1.36) and stroke (HR, 1.33; 95% CI, 1.02-1.74) each occurred significantly more often in the ticagrelor group. Analysis of all-cause mortality (HR, 1.27; 95% CI, 0.99-1.64), stent thrombosis (HR, 1.11; 95% CI, 0.89-1.30), and major bleeding (HR, 1.12; 95% CI, 0.96-1.32) revealed no significant differences between treatment groups. Subgroup analysis showed that prasugrel was associated with the primary composite end point in fewer individuals with ST-segment elevation MI (338 of 4941 [6.8%] vs 451 of 4852 [9.3%]). This cohort study found that prasugrel was associated with lower rates of all-cause mortality, MI, or stroke compared with ticagrelor in individuals with ACS undergoing an invasive treatment strategy in routine care, particularly in individuals with ST-segment elevation MI. The findings suggest that carefully designed database studies can complement and extend findings from randomized clinical trials, informing guidelines and clinical decision-making.

Efficacy and safety of different revascularization strategies in patients with non-ST-segment elevation myocardial infarction with multivessel disease: a systematic review and network meta-analysis.

The optimal timing of revascularization in non-ST-segment elevation myocardial infarction (NSTEMI) with multivessel disease (MVD) remains controversial. We investigated the impact of different revascularization strategies on clinical outcomes to assess the optimal revascularization strategy for these patients. We performed a network meta-analysis of cohort studies comparing revascularization strategies in NSTEMI with MVD. Effect sizes were calculated as odds ratios (ORs) using a random-effects model. The primary efficacy outcome was all-cause mortality and the primary safety outcome was recurrent myocardial infarction. Eight eligible studies involving 34,151 patients receiving four revascularization strategies were analyzed. Compared to conventional culprit-only revascularization (COR), planned complete multi-vessel percutaneous coronary intervention during a second hospitalization (MV-PCI) reduced the risk of major adverse cardiovascular events (MACEs) (MV-PCI vs. COR: OR = 0.53; 95% CI: 0.38-0.74) and decreased all-cause mortality (MV-PCI vs. COR: OR = 0.53; 95% CI: 0.30-0.93) and the likelihood of repeat revascularization (MV-PCI vs. COR: OR = 0.55; 95% CI: 0.37-0.82). However, compared to COR, immediate complete revascularization (ICR) but not MV-PCI was associated with reduced risk of recurrent MI (COR vs. ICR: OR = 1.39; 95% CI: 1.07-1.81; MV-PCI vs. COR: OR = 0.64; 95% CI: 0.40-1.01). Compared to MV-PCI: COR and staged complete revascularization during index PCI (SCR) increased the risk of cardiovascular mortality (MV-PCI vs. COR: OR = 0.48; 95% CI: 0.34-0.70; MV-PCI vs. SCR: OR = 0.62; 95% CI: 0.40-0.96). COR also had significantly higher cardiovascular mortality compared to ICR (COR vs. ICR: OR = 1.38; 95% CI: 1.02-1.85). Complete revascularization is more effective compared to culprit-only revascularization for most follow-ups.

Differential Impacts of Invasive Percutaneous Coronary Intervention and Conservative Strategy on Elderly Patients with Non-ST-Segment Elevation Myocardial Infarction: An Analysis of Short-Term and Long-Term Survival

Aims/Background The present study investigated the short-term and long-term outcomes of an invasive strategy in percutaneous coronary intervention (PCI) and a conservative strategy in non-ST-segment elevation myocardial infarction (NSTEMI) patients older than 80 years, with the aim to identify the strategy that is more beneficial than the other to this demographic population. Methods A total of 139 patients from Beijing Anzhen Hospital and the Cao County People’s Hospital were included in this study, comprising those aged &gt;80 years and diagnosed with NSTEMI between 2017 and 2022. The main observation indicator was all-cause death, whereas the secondary indicators included composite endpoint events of recurrent myocardial infarction, need for urgent revascularization, recurrent angina, stroke, death, and major bleeding. Results Among these participants, 72 patients received PCI while the rest (n = 67) received the conservative treatment. Compared to patients who received the conservative treatment, patients who received PCI had significantly lower rates of all-cause mortality during hospitalization and 30 days of follow-up. Conclusion Our findings support that patients older than 80 years with NSTEMI can benefit from PCI compared to the conservative treatment.

Myocardial Ischemic Syndromes: A New Nomenclature to Harmonize Evolving International Clinical Practice Guidelines.

Since the 1960s, cardiologists have adopted several binary classification systems for acute myocardial infarction (MI) that facilitated improved patient management. Conversely, for chronic stable manifestations of myocardial ischemia, various classifications have emerged over time, often with conflicting terminology-eg, "stable coronary artery disease" (CAD), "stable ischemic heart disease," and "chronic coronary syndromes" (CCS). While the 2019 European guidelines introduced CCS to impart symmetry with "acute coronary syndromes" (ACS), the 2023 American guidelines endorsed the alternative term "chronic coronary disease." An unintended consequence of these competing classifications is perpetuation of the restrictive terms "coronary" and 'disease', often connoting only a singular obstructive CAD mechanism. It is now important to advance a more broadly inclusive terminology for both obstructive and non-obstructive causes of angina and myocardial ischemia that fosters conceptual clarity and unifies dyssynchronous nomenclatures across guidelines. We, therefore, propose a new binary classification of "acute myocardial ischemic syndromes" and "non-acute myocardial ischemic syndromes," which comprises both obstructive epicardial and non-obstructive pathogenetic mechanisms, including microvascular dysfunction, vasospastic disorders, and non-coronary causes. We herein retain accepted categories of ACS, ST-segment elevation MI, and non-ST-segment elevation MI, as important subsets for which revascularization is of proven clinical benefit, as well as new terms like ischemia and MI with non-obstructive coronary arteries. Overall, such a more encompassing nomenclature better aligns, unifies, and harmonizes different pathophysiologic causes of myocardial ischemia and should result in more refined diagnostic and therapeutic approaches targeted to the multiple pathobiological precipitants of angina pectoris, ischemia, and infarction.

Abstract 4134729: Quantitative, time-efficient viability cardiac magnetic resonance with delayed-phase dynamic contrast enhancement model: a pilot study in dogs with myocardial infarction

Introduction: Late gadolinium enhancement (LGE) is the gold standard for myocardial viability imaging, recommended by all major cardiology societies. In this study, we aimed to develop a time-efficient viability imaging technique utilizing a dynamic contrast enhancement(dDCE) model to shorten the LGE wait time, provide quantitative measures of the contrast washout procedure, and potentially enable a fast and quantitative mean for scar imaging. Methods: A canine study(n=10) was conducted on reperfused myocardial infarction(MI). A dDCE model using dynamic post-contrast T1 maps was adopted to depict the contrast washout process. dDCE maps were reconstructed using the whole dataset(dDCE 30min ) and a 5-minute subset of the T1 maps(dDCE 5min ). To test the dDCE models for shortening the LGE wait time, LGE dDCE images were synthesized using the dDCE 5min maps and compared to the clinical LGE images. Remote and MI dDCE parameters on dDCE 30min and dDCE 5min maps were compared to test the model's ability to extract physiological features. Results: dDCE 30min and dDCE 5min map showed a good visuospatial difference between remote and MI(Fig. 1A) and no quantitative difference (Fig.1B). v e and PS showed a significant elevation in MI than in remote (61.12±13.65% vs 13.43±5.00%, P =0.018; 44.62±21.40mL/g/min vs 0.42±0.55mL/g/min, P =0.018, respectively). v p and F p were significantly decreased in MI than in remote (4.17±2.06% vs 10.85±3.77%, P =0.02; 1.11±0.32mL/g/min vs 1.51±0.42mL/g/min, P =0.04, respectively). Representative LGE and LGE dDCE images showed high agreement in the presence of MI (Fig. 2A). Bland-Altman analysis showed good agreement between LGE and LGE dDCE images for the measurement of infarct area (bias, -1.74 ± 6.60 %, Fig. 2B) and transmuraltiy (bias, 1.86 ± 2.73 %, Fig. 2C). The simple liner regression showed strong correlations between LGE and LGE dDCE images for the infarct area (R 2 , 0.95; slope, 0.93, P &lt;0.01; Fig. 2D) and transmurality (R 2 , 0.97; slope, 0.93, P &lt;0.01; Fig. 2E). ROC analysis showed that the AUC was 0.97 (95% CI: 0.94 to 1.00) (Fig. 2F). Increased lesion-blood pool contrast by 10 folds on dDCE images improved subendocardial MI detection (Fig.3). Conclusions: The developed dDCE model provides comparable viability assessment ability to the standard LGE images without the prolonged wait time and reflects MI pathophysiological changes. It shows the potential for a rapid and quantitative myocardial viability imaging protocol using cardiac magnetic resonance.

Abstract 4137448: Systemic Heparin Administration Does Not Inhibit microRNA Amplification in Patients with Myocardial Infarction

Purpose: MicroRNAs (miRs) have been proposed as biomarkers of myocardial infarction (MI), but prior evidence has demonstrated that heparin, commonly administered to patients presenting with MI, inhibits amplification during quantitative PCR (qPCR). The purpose of this study was to determine whether qPCR amplification of miRs is reduced in plasma of patients receiving heparin and if heparinase reverses this effect. Methods: Blood samples were collected and plasma recovered from patients with normal coronary arteries who had undergone CT coronary angiography ( N=5 ) or who had received intravenous heparin at the time of invasive coronary angiography( N=8 ). Blood was also collected at the time of invasive coronary angiography from patients presenting with ST elevation MI ( N=9 ). RT-qPCR was performed to quantify levels of 84 cardiac miRs, and Cel-miR-39-3p was utilized as a spike-in control. MiR qPCR was also performed following the addition of heparinase to plasma from 2 patients without MI treated with heparin and 2 patients presenting with MI who had received heparin. Results: Mean age of patients was 57 years, and 55% of patients were male. As compared with control patients, the cycle number for cel-miR-39-3p was significantly increased for patients receiving heparin (Figure 1a). No difference was seen in levels of cel-39-3p in heparin-treated patients with respect to the presence or absence of MI. Cel-miR-39-3p cycle times decreased when heparinase was added to samples from heparin-treated patients (Figure 1b). In contrast, heparin did not increase cycle times in any of the cardiac miRs tested, and cycle times decreased even further for miRs 499a-5p and 208b-3p in patients with MI (Figure 2). Conclusions: Systemic heparin treatment inhibits qPCR amplification of cel-mir-39-3p but does not inhibit endogenous miR amplification under these conditions. MiRs 499a-5p and 208b-3p are potentially important candidates for MI detection and quantification.

Abstract 4120196: Temporal Trends and Predictors of Cardiac Biomarker Testing in the Emergency Department, 2014-2021

Background: Presenting symptoms risk stratify patients presenting to the Emergency Department (ED) to determine their likelihood of having a myocardial infarction (MI) and need for cardiac biomarker testing. Since the 2014 AHA/ACC non-ST segment elevation MI (NSTEMI) guideline, little is known regarding cardiac biomarker testing trends in the United States. Methods: We analyzed data from the National Hospital Ambulatory Medical Care Survey for consecutive adult ED visits between 2014 and 2021 in the United States. The primary outcome was the proportion of ED visits where cardiac biomarker testing occurred. Subgroup analysis was performed for visits with chest pain, non-chest pain anginal equivalents, and non-anginal symptoms. Survey-weighted multivariable logistic regression was used to generate adjusted odds ratios (aOR) to assess predictors of cardiac biomarker utilization. Results: In total, 87,965 ED visits were sampled, representing a weighted total of 644,531,395 visits. Cardiac biomarker testing occurred in 7.21% of all ED visits (95% CI, 6.27%-8.29%) and increased over time (Figure, P =0.03 for trend). When stratified by symptoms, utilization of testing mainly increased among patients with non-chest pain anginal equivalents (Figure, P =0.02 for trend). Cardiac biomarker testing was most frequently used for patients with chest pain (34.9%) and non-chest pain anginal equivalents (39.3%). Nonetheless, 25.8% of patients who underwent testing had no chest pain or anginal equivalents. Cardiac biomarker testing was more frequent among patients with older age (aOR 1.03 per year, 95% CI 1.03-1.04), tachycardia (aOR 1.26, 95% CI 1.13-1.41), tachypnea (aOR 1.71, 95% CI 1.47-1.98), history of heart failure (aOR 1.33, 95% CI 1.15-1.54), prior venous thromboembolism (aOR 1.43, 95% CI 1.12-1.83), and those treated in a rural setting (aOR 1.63, 95% CI 1.14-2.32). Conclusion: Cardiac biomarker testing in the ED has increased over time, mostly attributed to increased utilization among patients with a low pre-test probability of MI. Notably, 25% of individuals who underwent cardiac biomarker testing had no chest pain or anginal-equivalent symptoms. More judicious utilization of cardiac biomarker testing may be needed.

The Association between Tricuspid Annular Plane Systolic Excursion and Infarcted Related Artery in Patients with Inferior ST- Elevation Myocardial Infarction

The Association between Tricuspid Annular Plane Systolic Excursion and Infarcted Related Artery in Patients with Inferior ST- Elevation Myocardial Infarction

Defective biological activities of high-density lipoprotein identify patients at highest risk of recurrent cardiovascular event.

Low cholesterol efflux capacity and elevated levels of Interleukin-1ß (IL-1ß) are both associated with residual cardiovascular risk in patients with acute myocardial infarction (MI) and may be used as new biomarkers to identify patients at higher cardiovascular risk. We evaluated potential synergetic effect of cholesterol efflux capacity and IL-1ß on recurrent major adverse cardiovascular events (MACE) at one-year in 2012 patients with acute ST- segment elevation MI who underwent primary percutaneous coronary intervention. In addition, we evaluated the contribution to residual risk of HDL biological functions from 20 patients of the two extreme subgroups, focusing on cholesterol efflux capacity and anti-inflammatory properties. Patients with MACE during the first year after the MI had significantly lower serum cholesterol efflux capacity as compared to those without recurrent events and higher level of IL-1ß, both associations were confirmed after multivariate analysis. We found an inverse relationship between CEC and circulating levels of the inflammatory markers IL-1ß, defining a very high risk (Low CEC/High IL-1ß) and a low risk (High CEC/Low IL-1ß) group of patients. Patients combining Low CEC/High IL-1ß exhibited the highest risk of recurrent MACE at one year showing an additive prognostic value of these biomarkers, regardless of all the other clinical or biological factors. In this very high-risk subgroup, patients exhibited reduced HDL-efflux capacity and defective ABCA1 and SR-BI with enhanced pro-inflammatory activity as a potential explanation for our clinical findings. Impaired cholesterol efflux capacity and elevated IL-1β synergistically increase the residual cardiovascular risk in MI patients, which could be explained by reduced HDL-efflux capacity and enhanced HDL pro-inflammatory activity.

Triggering type and long-term survival following ST segment elevation-myocardial infarction treated with primary percutaneous coronary intervention.

Physical and emotional stress are recognized triggers of acute coronary syndromes, including ST segment elevation-myocardial infarction (STEMI). We have previously shown that identifiable triggers precede symptoms in over one-third of STEMI patients and inversely correlate with the extent of coronary artery disease (CAD). This study aims to investigate the association between trigger type (physical vs. emotional) and long-term mortality in STEMI patients treated with primary percutaneous coronary intervention (PCI). This retrospective, single-center observational study included all patients admitted with an STEMI diagnosis from January 2008 to December 2013. Physical and emotional triggers were identified retrospectively from patient records. Mortality data were obtained from the Israeli Ministry of Health. Of 1345 consecutive STEMI patients treated with primary PCI, mortality data were available for 1267 patients (median age: 61 years). A trigger preceding symptoms onset was identified in 36.5% of patients, with 85% experiencing physical stress and 15% emotional stress. Triggered STEMI patients tended to be younger with fewer comorbidities and lower incidence of multiple vessel CAD compared with nontriggered patients. Notably, emotionally triggered STEMI patients exhibited improved long-term survival compared with those without emotional triggers or with physical triggers. predictor of enhanced long-term survival post-PCI compared with physical triggering. Emotional triggering was identified as an independent. Patients with emotionally triggered STEMI showed less extensive CAD and improved long-term survival following PCI compared with those with physically triggered STEMI. These findings highlight the importance of considering both the presence and type of trigger in the management of STEMI patients and their long-term prognosis.

Young adults with acute coronary syndrome undergoing percutaneous coronary intervention: Insights from the Houston Methodist Young ACS-PCI Registry

BackgroundLimited data exist on the risk profile and prognosis of young patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). This study sheds light on the burden of cardiovascular risk factors and outcomes in this population. MethodsThe Houston Methodist Young ACS-PCI registry is a retrospective analysis of young adults (18 to 50 years) undergoing PCI for ACS between 2010 and 2022. Outcomes of interest were major adverse cardiovascular events (MACE: all-cause mortality, myocardial infarction (MI), ischemic stroke) at one year. ResultsAmong 629 patients (median age, 46 years, 23.5% women, and 65.3% White adults), 69.2% had Non-ST-Segment Elevation MI. A total of 22.7% had prior MI, 26.2% prior PCI, and 9.2% had prior coronary artery bypass graft surgery. The prevalence of active smoking, dyslipidemia, hypertension, and diabetes was 69.4%, 82.2%, 80.4%, and 39.6%, respectively. Age-adjusted diabetes rates increased over time, while dyslipidemia, hypertension, and obesity rates remained unchanged. The femoral artery was the most common arterial access (85.2%), 72.7% had one vessel disease, 44.3% had the left anterior descending artery as the culprit vessel, and 78.5% of patients received one stent. At a median of 3.8 years, all-cause mortality was 28 deaths per 1000 person-years. At one year, 11.4% experienced MACE; racial and ethnic minority (Black, Hispanic, and Others), dialysis, prior MI, and stent diameter were independent predictors of MACE. ConclusionsThe study highlights a notable burden of cardiovascular risk factors and cardiovascular outcomes in young adults with ACS undergoing PCI, underscoring the need for strategies to enhance risk assessment and guide interventions among young adults.