Elevation Acute Myocardial Infarction Research Articles

Early outcome in patients with STEMI undergoing primary PCI and high Zwolle risk score discharged within 72 hours

Abstract Funding Acknowledgements None. Introduction Zwolle risk score has been used to guide decision for early discharge in patients with ST- elevation acute myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). There is limited evidence on the outcome of patients with high score discharged within 72 hours from primary PCI. Our study aim is to evaluate the outcomes via 1 - month follow up in patients with STEMI undergoing primary PCI, with different Zwolle risk who were discharged within 72 hours from the hospital. Purpose To evaluate 1-month outcome of STEMI patients treated with primary PCI discharged within 72 hours according to Zwolle risk score. Methods We studied 187 consecutive STEMI patients from April 2022 to December 2022, presented in hospital within 12 hours of initial of chest pain, treated with primary PCI and discharged within 72 hours from hospital admission based on physician’s clinical judgement and patient’s preference. Patients were divided in two groups according to Zwolle risk score – low risk (≤3) and high risk (>3). The composite of major adverse events (MACE) consisting of: death, non-fatal re-infarction, stroke and repeat intervention at 1-month follow up was the primary endpoint. Follow up rate was 100%. Results There were 131 patients in the low risk and 56 in high risk groups. Males were 90% versus 80.3% in the low vs high risk group; in addition, mean age was 58.64 ± 10.6 vs 67.8± 6.24 years, respectively; mean ischemic time was 4.78± 3.03 vs 6.9 ± 3.6 hours, respectively; anterior localization was present in 32.8% vs 46.4% of the patients, respectively; 3-vessel coronary artery disease was present in 29.0% vs 46.4% of the patients, respectively; final TIMI 3 flow was present in all vs 96.4% of the patients, respectively. MACE occurred in 7 patients (3.8%) in the low risk group versus 3 patients (5.3%) in the high risk group (P = 0.63). Conclusions In our study population at higher Zwolle risk score was not associated with a worse early outcome among STEMI patients discharged within 72 hours.

Factors Associated With Hospital Mortality in Acute Myocardial Infarction

Aim    To determine clinical and laboratory parameters associated with in-hospital mortality in patients with acute myocardial infarction and to develop a multifactorial prognostic model of in-hospital mortality.Material and methods    This was a study based on the 2019-2020 Registry of acute coronary syndrome of the Tyumen Cardiology Research Center, a branch of the Tomsk National Research Medical Center. The study included 477 patients with ST-segment elevation acute myocardial infarction (AMI), 617 patients with non-ST segment elevation AMI, and 26 patients with unspecified AMI. In-hospital mortality was 6.0 % (n=67). Clinical and laboratory parameters were assessed on the day of admission. The separation power of indicators associated with in-hospital mortality was determined using a ROC analysis. The data array of each quantitative parameter was converted into a binary variable according to the obtained cut-off thresholds, followed by creation of a multifactorial model for predicting in-hospital mortality using a stepwise analysis with backward inclusion (Wald). The null hypothesis was rejected at p<0.05.Results    The multivariate model for prediction of in-hospital mortality included age (cut-off, 72 years), OR 3.0 (95 % CI: 1.5-5.6); modified shock index (cut-off threshold, 0.87), OR 1.5 (95 % CI: 1.1-2.0); creatine phosphokinase-MB (cut-off threshold, 32.8 U / L), OR 4.1 (95 % CI: 2.2-7.7); hemoglobin (121.5 g / l), OR 1.7 (95 % CI: 1.2-2.3); leukocytes (11.5×109 / l), OR 1.9 (95 % CI: 1.3-2.6); glomerular filtration rate (60.9 ml / min), OR 1.7 (95 % CI: 1.2-2.2); left ventricular ejection fraction (42.5 %), OR 4.1 (95 % CI: 2.0-8.3); and size of myocardial asynergy (32.5 %), OR 2.6 (95 % CI: 1.4-5.0).Conclusions    Independent predictors of in-hospital mortality in AMI are age, modified shock index, creatine phosphokinase-MB, peripheral blood leukocyte count, hemoglobin concentration, left ventricular ejection fraction, size of myocardial asynergy, and glomerular filtration rate. The in-hospital mortality model had a high predictive potential: AUC 0.930 (95 % CI: 0.905-0.954; p <0.001) with a cutoff threshold of 0.15; sensitivity 0.851, and specificity 0.850. 

Neutrophil-to-albumin ratio: a promising tool for CAD assessment in non-ST elevation AMI.

In the context of coronary artery disease (CAD) pathogenesis, inflammation has emerged as a critical player. This study investigates the potential of the Neutrophil-to-Albumin Ratio (NAR) as a novel biomarker for assessing CAD severity and extension in patients suffering from acute myocardial infarction (AMI) without ST-segment elevation. We conducted a comprehensive analysis of consecutive patient records (n = 211) from a single center, focusing on individuals diagnosed with non-ST elevation AMI. To gauge CAD severity, we employed Syntax Scores (SS) and examined their correlation with NAR, C-reactive protein-albumin ratio (CRPALB), and the systemic immune inflammation index (SII). Statistical analyses were conducted to establish associations and predictive capabilities. Our analysis revealed a significant correlation between NAR and Syntax Scores (r: .416, p<0.01). Notably, patients with intermediate-high SS exhibited significantly elevated NAR values compared to those in the low SS group [20.86+5.38 vs. 16.41+6.30 (p<0.001)]. Furthermore, NAR outperformed CRPALB, SII, and Neutrophil Percent-to-Albumin Ratio (NPAR) in discriminating CAD severity, as demonstrated by the Receiver Operating Characteristic (ROC) curve analysis (NAR AUC: 0.736; CRPALB AUC: 0.673; SII AUC: 0.660; NPAR AUC: 0.717). This study underscores the potential of NAR as a robust predictor of CAD severity and extension in non-ST elevation AMI patients. While previous markers, such as CRPALB and SII, are advantageous, NAR's superior predictive capabilities are a valuable addition to the clinician's toolkit, offering enhanced risk assessment for this specific patient subgroup.

The role of mineralocorticoid receptor antagonists in the prevention and treatment of chronic heart failure after acute myocardial infarction

This review article examines the role of mineralocorticoid receptor antagonists (AMP) in the treatment of heart failure (CH) in patients who have suffered acute myocardial infarction (AMI). The pathogenetic basis of the effect of AMPs on myocardial remodeling after AMI is considered. The pharmacological characteristics of drugs of this class are described: spironolactone and eplerenone. The results of the main studies proving the protective role of eplerenone in patients who have suffered AMI with HF of varying severity (EPHESUS, EMPHASIS-HF, ALBATROSS, REMINDER) are covered. The effectiveness of eplerenone was analyzed depending on the timing of its administration. The safety of the drug in comparison with spironolactone was considered. In conclusion, it was concluded that it is advisable to use these drugs in routine therapy in acute, subacute and long-term periods of ST-segment elevation AMI and with a left ventricular ejection fraction ≤40%, heart failure or diabetes mellitus, when patients already receive angiotensin-converting enzyme inhibitors and beta blockers and in the absence of renal failure or hyperkalemia. In this case, preference should be given to eplerenone as a drug having the most convincing evidence base and having a favorable tolerance profile. The introduction into medical practice of effective, accessible generics of eplerenone allows expanding its use in real clinical practice

Clinical profile, treatment strategy and prognostic value of intraventricular thrombus detection

Abstract Background The clinical course of patients with intraventricular thrombus (IVT) is highly variable. Controversy still exists about the length of anticoagulant treatment and its prognostic relevance. Purpose Our objective is to describe the epidemiology and clinical course of patients with IVT. Methods All patients with an echocardiographic finding of IVT in our tertiary hospital between 2005 and 2021 were retrospectively analyzed. Demographic, clinical, echocardiographic, and treatment variables were collected. Patients were followed-up to 24 months. Results A total of 195 patients with IVT were finally included. The 84.4% were male and the mean age was 65.4 ± 14.1 years. Baseline characteristics are shown in the Table. The diagnosis of IVT was mostly made in the context of an acute myocardial infarction (AMI) (55.9%), of which 60.5% had new-onset ST-segment elevation AMI and 23.5% evolved infarction. The thrombus finding was incidental in 38.0% of the cases while 5.6% debuted as stroke. Regarding the morphological characteristics, 40.5% of the thrombi were sessile, 31.2% mural shape, and 28.3% pedicled. At diagnosis, the LVEF was 38.6 ± 11.7% with an end-diastolic volume of 132.3 ± 64.2ml. Once diagnosed 86.7% of patients were on anticoagulation, 55.4% on 2PY12 inhibitor and 78.5% on acetylsalicylic acid. At 12 and 24 months, the proportion of anticoagulated patients was significantly reduced (62% and 59.4%, respectively). 24.9% continued with a P2Y12 inhibitor at 12 months and only 9% at 2 years. During follow-up, 24.4% of the patients had events at 6 months (2.4% AMI, 7.2% stroke, 2.4% systemic embolism and mortality was 14.7%). In this period there were 8.9% of hemorrhages. The proportion of ischemic events and mortality decreased at one year (5.6%) and at two years (12.1%). Complete IVT clearance was documented in 87% and the median time to resolution was 119 days [49.5-347.5]. IVT recurrence was observed in 10.7% of the cases, up to 50% detected before 2 years from diagnosis. Conclusions Most patients with IVT were diagnosed after an AMI. Despite current recommendations, more than 50% of patients continued anticoagulation at 2 years. A quarter developed events 6 months after diagnosis, and this proportion decreased significantly after this period. A recurrence rate of 10.7% was observed in our population.

Abstract 12153: Prevalence and Prognostic Implications of Worsening Renal Function After Acute Myocardial Infarction

Introduction: Limited data exist on the association between longitudinal changes in renal function and long-term clinical outcomes in patients who survive acute myocardial infarction (AMI) events. Hypothesis: We sought to investigate the relationship between worsening renal function (WRF) at one-year follow-up and clinical outcomes at three years after AMI. Methods: We analyzed data from 13,104 patients enrolled in the national AMI registry from November 2011 to December 2015. Patients with all-cause death, recurrent myocardial infarction (re-MI), and re-hospitalization for heart failure (rHHF) at one-year follow-up after AMI were excluded. A total of 6,235 patients were extracted and divided into WRF and non-WRF groups. WRF was defined as a ≥25% decrease in estimated glomerular filtration rate (eGFR) from baseline to one-year follow-up. The primary outcome was three-year major adverse cardiac events (MACE), a composite of all-cause death, re-MI, and rHHF. Results: On average, a -1.5 ml/min/1.73 m 2 /year rate of decline in eGFR was exhibited, and 575 (9.2%) patients exhibited WRF at one-year follow-up. After multiple adjustments, WRF at one-year follow-up was independently associated with increased risks of MACEs (adjusted hazard ratio: 1.498, 95% confidence interval: 1.113-2.016, P =0.01), all-cause death, and re-MI at three-year follow-up (Figure 1). Older age, female, diabetes, hypertension, non-ST segment elevation AMI, anterior AMI, anemia, left ventricular ejection fraction &lt;35%, and baseline eGFR &lt;30 ml/min/1.73 m 2 were identified as independent predictors of WRF after AMI. Conclusions: WRF at one-year follow-up after AMI intuitively seems like a risk marker indicating multiple comorbidities. Monitoring serum creatinine in patients at one-year follow-up after AMI may help to identify those who are at the highest risk and guide effective long-term therapeutics.

Venous excess ultrasound score and acute kidney injury in patients with acute coronary syndrome.

Systemic venous congestion is associated with an increased risk of acute kidney injury (AKI) in critically ill patients. Venous Excess Ultrasound Score (VExUS) has been proposed as a non-invasive score to assess systemic venous congestion. We aimed to evaluate the association between VExUS and AKI in patients with acute coronary syndrome (ACS). This is a prospective study including patients with the diagnosis of ACS (both ST elevation and non-ST elevation ACS). VExUS was performed during the first 24 h of hospital stay. Patients were classified according to the presence of systemic congestion (VExUS 0/≥1). The primary objective of the study was to determine the occurrence of AKI, defined by KDIGO criteria. A total of 77 patients were included. After ultrasound assessment, 31 (40.2%) patients were categorized as VExUS ≥1. VExUS ≥1 was more frequently found in inferior vs. anterior myocardial infarction/non-ST-segment elevation acute myocardial infarction (48.3 vs. 25.8 and 22.5%, P = 0.031). At each increasing degree of VExUS, a higher proportion of patients developed AKI: VExUS = 0 (10.8%), VExUS = 1 (23.8%), VExUS = 2 (75.0%), and VExUS = 3 (100%; P < 0.001). A significant association between VExUS ≥1 and AKI was found [odds ratio (OR): 6.75, 95% confidence interval (CI): 2.21-23.7, P = 0.001]. After multivariable analysis, only VExUS ≥1 (OR: 6.15; 95% CI: 1.26-29.94, P = 0.02) remained significantly associated with AKI. In patients hospitalized with ACS, VExUS is associated with the occurrence of AKI. Further studies are needed to clarify the role of VExUS assessment in patients with ACS.

Association of non-HDL-C-to-HDL-C ratio with coronary lesions and its prognostic performance in first-onset NSTEMI

Aim: The study sought to investigate the association of non-high-density-lipoprotein cholesterol-to-high-density-lipoprotein cholesterol ratio (NON-HDL-C:HDL-C) with coronary lesions and major adverse cardiovascular events (MACE) in first-onset non-ST-segment elevation acute myocardial infarction. Methods: A cohort of 426 patients undergoing early invasive therapy was enrolled in the final analysis. MACE included cardiac death, nonfatal myocardial infarction, target vessel revascularization, congestive heart failureand nonfatal stroke. Results: NON-HDL-C:HDL-C revealed a powerful diagnostic performance for multiple cardiovascular risk factors (p<0.05). NON-HDL-C:HDL-C was an independent predictor for severe coronary lesions and MACE (p<0.05). Subgroup analysis further examined the robustness, especially in elderly, male, dyslipidemic or nondiabetic patients. Conclusion: NON-HDL-C:HDL-C is associated with coronary lesions and prognosis in non-ST-segment elevation acute myocardial infarction.

Driving Time to the Nearest Percutaneous Coronary Intervention-Capable Hospital and the Risk of Case Fatality in Patients with Acute Myocardial Infarction in Beijing.

Timely arrival at a hospital capable of percutaneous coronary intervention (PCI) is critical in treating acute myocardial infarction (AMI). We examined the association between driving time to the nearest PCI-capable hospital and case fatality among AMI patients. A total of 142,474 AMI events during 2013-2019 from the Beijing Cardiovascular Disease Surveillance System were included in this cross-sectional study. The driving time from the residential address to the nearest PCI-capable hospital was calculated. Logistic regression was used to estimate the risk of AMI death associated with driving time. In 2019, 54.5% of patients lived within a 15-min drive to a PCI-capable hospital, with a higher proportion in urban than peri-urban areas (71.2% vs. 31.8%, p < 0.001). Compared with patients who had driving times ≤15 min, the adjusted odds ratios (95% CI, p value) for AMI fatality risk associated with driving times 16-30, 31-45, and >45 min were 1.068 (95% CI 1.033-1.104, p < 0.001), 1.189 (95% CI 1.127-1.255, p < 0.001), and 1.436 (95% CI 1.334-1.544, p < 0.001), respectively. Despite the high accessibility to PCI-capable hospitals for AMI patients in Beijing, inequality between urban and peri-urban areas exists. A longer driving time is associated with an elevated AMI fatality risk. These findings may help guide the allocation of health resources.

Mortality among acute myocardial infarction patients admitted to hospitals on weekends as compared with weekdays in Taiwan

Weekend effect has been considered to be associated with poorer quality of care and patient’s survival. For acute myocardial infarction (AMI) patients, the question of whether patients admitted during off-hours have worse outcomes as compared with patients admitted during on-hours is still inconclusive. We conducted this study to explore the weekend effect in AMI patients, using a nationwide insurance database in Taiwan. Using Taiwan National Health Insurance (NHI) claims database, we designed a retrospective cohort study, and extracted 184,769 incident cases of AMI through the NHI claims database between January 2006 and December 2014. We divided the patients into weekend admission group and weekday admission group. Patients were stratified as ST elevation/non-ST elevation AMI and receiving/not receiving percutaneous coronary intervention (PCI). We used a logistic regression model to examine the relative risk of in-hospital mortality and 1-year mortality which were obtained from the Taiwan National Death Registry between study groups. We found no difference between weekend group and weekday group for risk of in-hospital mortality (15.8% vs 16.2%, standardized difference 0.0118) and risk of 1-year mortality (30.2% vs 30.9%, standardized difference 0.0164). There was no statistically significant difference among all the comparisons through the multivariate logistic regression analysis adjusting for all the covariates and stratifying by the subtypes of AMI and whether or not executing PCI during hospitalization. As for AMI patients in Taiwan, admission on weekends or weekdays did not have a significant impact on either in-hospital mortality or 1-year cumulative mortality.

Obesity and Myocardial Infarction-The Place of Obesity Among Cardiovascular Risk Factors-Retrospective Study.

This study is a retrospective study conducted at the Craiova Emergency Clinical Hospital between October 2020 and January 2023. Enrolled patients are 60, 36 patients with ST-segment elevation myocardial infarction and 24 patients with non-ST-segment elevation acute myocardial infarction. The data was collected from the hospital's official database and then analyzed using Microsoft Excel and the Toolbar Data Analysis. The mean age of the patients in the study was 62 years with a minimum of 34 years and a maximum of 84 years. 23(38.3%) of patients were smokers, 7(11.6%) were ex-smokers and 30(50%) were non-smokers. 49(81.6%) patients were hypertensive. 44(73%) had cholesterol greater than 200mg/dl. 54(90%) had LDL>100mg/dl, 18(30%) had HDL>45mg/gl, 24(40%) patients had serum TG>150mg/dl, 17(28%) were overweight and 13(22%) were obese, 30(50%) were normal weight. 18(30%) patients had type 2 diabetes. Among the cardiovascular risk factors in the patients studied, hypertension was the most common, followed by dyslipidemia, obesity, smoking, diabetes mellitus, and very rarely the use of drugs and anabolic substances.

RELATIONSHIP BETWEEN PARAMETERS OF ADIPOKINE AND LIPID PROFILES IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION AND TYPE 2 DIABETES MELLITUS

Abstract. Introduction. Nowadays, it becomes topical to search for methods of diagnosis and treatment for polymorbid patients. The importance of the study on pathophysiological mechanisms of acute myocardial infarction (AMI) in patients with type 2 diabetes mellitus (DM) has been shown. The aim of the study: to examine the relationship between adipokine and lipid profiles in AMI patients with the presence or absence of type 2 DM. Material and methods. The study was conducted over a period from September 1, 2018 to December 31, 2020. A total of 134 patients with ST-segment elevation AMI in the presence or absence of type 2 DM aged 58.97 ± 7.92 years hospitalized in the intensive care unit of Government Institution “L. T. Malaya Therapy National Institute of the National Academy of Medical Sciences of Ukraine” and Kharkiv Railway Clinical Hospital No. 1 of the branch “Center of Healthcare” were enrolled in the study. Group 1 included 74 patients with AMI and type 2 DM aged 59.42 ± 7.66 years. Group 2 (comparison group) comprised 60 patients with AMI without type 2 DM aged 58.42 ± 8.25 years. The control group consisted of 20 otherwise healthy individuals. Serum concentrations of fatty acid-binding protein 4 (FABP4) and C1q/TNF-related protein 3 (CTRP3) of patients were measured by enzyme-linked immunosorbent assay. Serum total cholesterol (TC) and high-density lipoprotein (HDL) cholesterol were analyzed by peroxidase enzymatic method. Triglyceride (TG) levels were measured by enzymatic colorimetric method. The atherogenic index was calculated by the A.M. Klimov formula. The levels of very low-density lipoprotein (VLDL) cholesterol and low-density lipoprotein (LDL) cholesterol were estimated by the Friedewald formula. Results and discussion. The patients in Group 1 were found to have higher levels of serum TG in comparison with Group 2 patients (р&lt;0.05). In groups 1 and 2, there was an upward tendency in the levels of TC and LDL (р ˃0.05), as well as a significant 4.04 and 2.92 times increase in VLDL, respectively, as compared to the control group (p&lt;0.05). The serum levels of FABP4 were significantly increased, while CTRP3 levels were decreased in AMI patients compared to those in otherwise healthy individuals (р&lt;0.05). In AMI patients with type 2 DM (group 1), an inverse correlation was found between FABP4 and VLDL (r = 0.502, p&lt;0.05), TG (r = 0.596, p&lt;0.001); between CTRP3 and TC (r = -0.507, p&lt;0.05), LDL (r = -0.512, p&lt;0.05). In patients with AMI (group 2), an inverse correlation was revealed between FABP4 and VLDL (r = 0.453, p = 0.006), TG (r = 0.439, p = 0.009); between CTRP3 and TC (r = -0.413, p = 0.001), LDL (r = -0.429, p = 0.01). Conclusions. The characteristics of changes in the FABP4 and CTRP3 serum levels are evidence of an adipokine metabolism imbalance in AMI with the presence or absence of type 2 DM, indicating a metabolic shift in this patient category. The relationship between lipid profile markers and FABP4 and CTRP3 may indicate the influence of the latter on lipid metabolism.

Relationship between the degree of myocardial damage according to contrast-enhanced cardiac magnetic resonance imaging and laboratory data in patients with acute myocardial infarction

Aim. To evaluate the information value of a complex of clinical and biochemical parameters of myocardial damage in predicting the development of transmural myocardial damage according to magnetic resonance imaging (MRI) in patients with acute myocardial infarction (AMI).Material and methods. The study included patients admitted to the emergency cardiology department with acute coronary syndrome. All patients underwent invasive coronary angiography, laboratory tests, and dynamic determination of cardiac biomarkers. In the interval of 6,1±4 days from admission to the hospital, patients underwent contrast-enhanced cardiac MRI. According to the pattern of delayed contrast enhancement, patients were divided into two groups: with a transmural and subendocardial pattern.Results. The mean age of patients was 62,5±10,5 years, while 27 (71,1%) had ST-segment elevation AMI. Among the risk factors for coronary artery disease, dyslipidemia (89,5%), hypertension (68,4%), and smoking (57,9%) were the most common. Creatine phosphokinase-MB (CPK-MB), serum high-sensitivity cardiac troponin I (cTnI) and C-reactive protein (CRP) values after 24 h were significantly higher in patients with transmural hyperenhancement. Moderate positive relationship was found between the global size of left ventricular (LV) damage according to MRI data and the levels of CPK-MB after 24 h and 4 days, as well as with CRP after 24 h, 4 and 7 days, and cTnI level after 24 h and 4 days. In the group of patients with transmural pattern, the global size of LV damage was significantly higher. Patients of this group were characterized by higher prevalence of microvascular obstruction. In a univariate regression analysis, there were following significant predictors of transmural myocardial damage: CPK-MB after 4 days (p=0,023) and ST segment elevation (p=0,029). Multivariate regression analysis showed that the only independent predictor of transmural myocardial damage was an increase in CPKMB after 4 days (p=0,023).Conclusion. An independent predictor of LV transmural damage in AMI was an elevated level of CPK-MB after 4 days. However, this laboratory marker had unsatisfactory information completeness and predictive quality. In this regard, cardiac MRI in patients with AMI, compared with the standard clinical assessment, can be considered preferable for assessing the depth of myocardial damage, risk stratification, and prognosis.

Characteristics and outcomes of percutaneous coronary interventions in patients with spontaneous coronary artery dissection. A study from the administrative minimum data set of the Spanish National Health System.

Coronary revascularization in patients with spontaneous coronary artery dissection (SCAD) is challenging. Indications and results of percutaneous coronary interventions (PCI) in SCAD patients are not well established. To assess indications and results of PCI in SCAD. The minimum basic data set of the Spanish National Health System (years 2016-2019) was used to identify 804 episodes of acute myocardial infarction (AMI) and SCAD, with a crude in-hospital mortality rate of 3%. Of these, 368 (46.8%) patients were revascularized with PCI during admission whereas 436 (54.2%) were managed conservatively. Revascularization and in-hospital mortality rates both declined over the study period (p for trend both < 0.05). SCAD patients treated with PCI were older, more frequently male, and had higher frequency of diabetes, ST-segment elevation AMI and cardiogenic shock, compared to patients managed conservatively. The crude in-hospital mortality rate was higher in patients treated with PCI (4.9% vs. 1.4%; p = 0.004). However, after adjusting by propensity score (223 pairs) the in-hospital mortality rate was similar in the two groups (Adj OR: 1.21; 95%CI: 0.30-1.57; p = 0.76). Readmissions at 30-days were higher in patients managed conservatively (7.1 vs. 1.6%, p < 0.001) and this difference was maintained after propensity score adjustment (Adj average treatment effect: 2% vs. 12.2%; OR: 0.15; 95%CI: 0.04-0.45; p < 0.001). Revascularization is frequently used in unselected patients with AMI and SCAD but its use is declining. Patients with SCAD treated with PCI have a higher in-hospital mortality but this appears to be explained by their adverse baseline clinical characteristics.

Mechanical circulatory support devices in left main occlusion: a multicenter study from 2008 to 2020

Abstract Introduction Evidence of benefit in the use of mechanical circulatory support devices (MCS) in patients with acute myocardial infarction (AMI) is scarce. We aimed to evaluate the clinicalcharacteristics, prognosis and factors associated with the use of MCS in patients with AMI due to left main (LM) occlusion. Methods We performed a retrospective multicenter study of 128 consecutive patients with AMI with ≤12h of presentation with LM occlusion submitted to immediate reperfusion between January 1, 2008, until December 31, 2020 in three terciary hospitals of Portugal. Among this cohort, we divided patients into two groups according to the use of MCS devices. Results Regarding the baseline characteristics no statistically significant differences were found, except for the presence of cerebrovascular disease (2.9% in group with vs 16.9% in group without MCS, p=0.007) and peripheral artery disease (8.8% in group with vs 22% in group without MCS, p=0.037). We observed that the use of MCS devices was statistically different between the three centers (47.8%, 42%, 8.7%, p&amp;lt;0.001). No differences were found at presentation for ST-segment elevation vs non-ST segment elevation AMI (p=NS). The presence of cardiogenic shock (72.4% vs 45.8%, p=0.002), cardiac arrest (27.5% vs 23.7%, p=0.034) and more severe thrombolysis in myocardial infarction (TIMI) flow at presentation (55.1% vs 35.6%, p=0.015) were more frequent in group with MCS. The rate of 1-year cumulative mortality was high in both groups (31/59=52.5% in the group without vs 47/69=68.1%, p=NS). Also, no statistically significant differences were found in terms of survival, but we observed a trend to higher mortality in those who received MCS as Kaplan-Meier survival curves show (log rank=0.062). Finally, in multivariable analysis, older age [odds ratio (OR), 0.935; 95% CI, 0.87–0.99], the presence of diabetes (OR, 0.223; 95% CI, 0.056–0.88), peripheral artery disease (OR, 0.070; 95% CI, 0.009–0.566) and extra-hospitalar cardiac arrest (OR, 0.06; 95% CI, 0.007–0.543) were characteristics associated with lower odds of receiving MCS. Contrarily, male sex (OR, 5; 95% CI, 1–20.4) and the presence of cardiogenic shock (OR, 5.7; 95% CI, 1.42–23) were factors associated with higher use of MCS. Conclusion The use of MCS does not seem to modify prognosis in patients admitted withAMI due to left main occlusion. Only cardiogenic shock and male gender were predictors of MCS use. Funding Acknowledgement Type of funding sources: None.

Immuno-inflammatory response in patients after myocardial infarction and involvement in fibrosis in vitro

Abstract Background Pathophysiology of acute myocardial infarction (AMI) has been described in mice and is based on a three-stage model involving temporal modifications of immune cells and fibroblasts. The acute inflammatory phase is followed by a reparative phase and fibrous scar maturation phase. Purinergic signaling, particularly P2Y11 receptor, has been reported to be involved in the regulation of inflammation after ischemia and could be an actor of resolution of inflammation after AMI. Purpose The aims of our study were: (1) to characterize the immune and P2Y11R profiles of AMI patients and (2) to analyze interactions between patients' immune cells and cardiac fibroblasts in vitro. Methods We collected peripheral blood mononuclear cells (PBMC) of 182 patients at various times (H0, H4, H24, H48, D3, M1, M6, M12) after reperfused ST-segment elevation AMI, and of 30 healthy donors. Expression level of genes involved in tolerogenicity profile of dendritic cells (HMOX1, STAT3, IDO1), in T cell polarization (CD4, FOXP3, TBX21/GATA3) as well as P2RY11 were evaluated by RT-PCR. P2Y11R expression was analyzed using flow cytometry. PBMC and human cardiac fibroblasts (HCF) were co-cultured during one day (5PBMC/1 HCF) and gene level expression (ACTA2/VIM, COL1A1), phenotype (α-SMA/vimentin) and secretory (soluble collagen) profiles were analyzed by RT-PCR, flow cytometry and Sircol assay. Results In the first 48 hours after AMI, the expression level of HMOX1 (fold-change = 8.478 at H48, p&amp;lt;0.0001), STAT3 (2.856 at H0, p=0.0027) and CD4 increased (2.451 at H48, p=0.0052); IDO1 (0.2055 at H24, p&amp;lt;0.0001) and TBX21/GATA3 ratio decreased (0.4498 at H48, p=0.0026); FOXP3 did not vary significantly. In the same time, the expression level of P2RY11 increased (2.124 at H0, p=0.0015) as well as protein expression in T cells (median MFI = 845.5 at H0 vs 229.5 for healthy donors, p=0.0375). In vitro, we observed a non-significant increase of ACTA2/VIM ratio in HCF co-cultured with H24, M1, M6 PBMC; of α-SMA/vimentin with H48, M12 PBMC; of COL1A1 with H24, H48, M12 PBMC; and of soluble collagen in coculture supernatant with M1 PBMC. Conclusion Our results suggest that P2Y11R could be involved in evolution of immune response after AMI, and that, in the first 2 days, circulating immune cells have a reparative profile and could participate in the transformation of fibroblast into myofibroblasts. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Fondation pour la recherche médicale

Clustering of Environmental Parameters and the Risk of Acute Myocardial Infarction.

The association between days with similar environmental parameters and cardiovascular events is unknown. We investigate the association between clusters of environmental parameters and acute myocardial infarction (AMI) risk in Singapore. Using k-means clustering and conditional Poisson models, we grouped calendar days from 2010 to 2015 based on rainfall, temperature, wind speed and the Pollutant Standards Index (PSI) and compared the incidence rate ratios (IRR) of AMI across the clusters using a time-stratified case-crossover design. Three distinct clusters were formed with Cluster 1 having high wind speed, Cluster 2 high rainfall, and Cluster 3 high temperature and PSI. Compared to Cluster 1, Cluster 3 had a higher AMI incidence with IRR 1.04 (95% confidence interval 1.01–1.07), but no significant difference was found between Cluster 1 and Cluster 2. Subgroup analyses showed that increased AMI incidence was significant only among those with age ≥65, male, non-smokers, non-ST elevation AMI (NSTEMI), history of hyperlipidemia and no history of ischemic heart disease, diabetes or hypertension. In conclusion, we found that AMI incidence, especially NSTEMI, is likely to be higher on days with high temperature and PSI. These findings have public health implications for AMI prevention and emergency health services delivery during the seasonal Southeast Asian transboundary haze.

Immuno-inflammatory response in patients after myocardial infarction and involvement in fibrosis in vitro

Pathophysiology of acute myocardial infarction (AMI) has been described in mice and is based on a three-stage model involving temporal modifications of immune cells and fibroblasts. The acute inflammatory phase is followed by a reparative phase and fibrous scar maturation phase. Purinergic signaling, particularly P2Y11 receptor, has been reported to be involved in the regulation of inflammation after ischemia and could be an actor of resolution of inflammation after AMI. The aims of our study were: (1) to characterize the immune and P2Y11R profiles of AMI patients and (2) to analyze interactions between patients’ immune cells and cardiac fibroblasts in vitro. We collected peripheral blood mononuclear cells (PBMC) of 182 patients at various times (H0, H4, H24, H48, D3, M1, M6, M12) after reperfused ST-segment elevation AMI, and of 30 healthy donors. Expression level of genes involved in tolerogenicity profile of dendritic cells (HMOX1, STAT3, IDO1), in T cell polarization (CD4, FOXP3, TBX21/GATA3) as well as P2RY11 were evaluated by RT-PCR. P2Y11R expression was analyzed using flow cytometry. PBMC and human cardiac fibroblasts (HCF) were co-cultured during one day (5PBMC/1 HCF) and gene level expression (ACTA2/VIM, COL1A1), phenotype (α-SMA/vimentin) and secretory (soluble collagen) profiles were analyzed by RT-PCR, flow cytometry and Sircol assay. In the first 48 hours after AMI, the expression level of HMOX1 (fold-change = 8.478 at H48, P < 0.0001), STAT3 (2.856 at H0, P = 0.0027) and CD4 increased (2.451 at H48, P = 0.0052); IDO1 (0.2055 at H24, P < 0.0001) and TBX21/GATA3 ratio decreased (0.4498 at H48, P = 0.0026); FOXP3 did not vary significantly. In the same time, the expression level of P2RY11 increased (2.124 at H0, P = 0.0015) as well as protein expression in T cells (median MFI = 845.5 at H0 vs. 229.5 for healthy donors, P = 0.0375). In vitro, we observed a non-significant increase of ACTA2/VIM ratio in HCF co-cultured with H24, M1, M6 PBMC; of α-SMA/vimentin with H48, M12 PBMC; of COL1A1 with H24, H48, M12 PBMC; and of soluble collagen in coculture supernatant with M1 PBMC. Our results suggest that P2Y11R could be involved in evolution of immune response after AMI, and that, in the first 2 days, circulating immune cells have a reparative profile and could participate in the transformation of fibroblast into myofibroblasts.

Abstract 161: Trends In Time-Incremental Mortality After Hospitalization For Incident Acute Myocardial Infarction Among Medicare Beneficiaries, 2008-2017

Background: New medical technologies and advancements in care quality have transformed care of patients hospitalized with incident acute myocardial infarction (AMI). While some advances may impact short-term mortality (e.g., mechanical circulatory support), others may take much longer to impact mortality (e.g., cardiac rehabilitation). Little is known about trends in time-incremental AMI mortality rates. Methods: We identified all patients hospitalized with incident AMI using a 5% sample of Medicare fee-for-service beneficiaries from 2008 to 2017. We used a three-year look back to exclude patients with a prior AMI hospitalization. We calculated unadjusted in-hospital, 30-day, 1-year, 2-year, and 3-year mortality rates by dividing the total number of all-cause deaths during each period by the corresponding number of patients who were hospitalized. We used logistic regression models to adjust mortality rates for patient demographics (age, sex, race/ethnicity) and a variety of comorbid conditions. Using 2008 as the baseline, we calculated annual incremental mortality rates for each time period. We performed subgroup analyses among AMI patients with ST-segment and non-ST-segment elevation. Results: From 2008 to 2017, we identified 42,567 patients hospitalized with incident AMI (mean age 81 years, 44% male, 86% white). The largest incremental declines in mortality rates were observed for the in-hospital (2.9% [CI 2.7 to 3.1%]), 30-day (2.1% [CI 1.9 to 2.3%], and 1-year (2.9% [CI 2.6 to 3.2%] time periods. Mortality declines were smaller but persisted for the 2-year (1.5% [CI 1.2 to 1.8%]), and 3-year (0.5% [CI 0.2 to 0.8%]; Figure) time periods. Similar patterns were observed among both ST-segment and non-ST-segment elevation AMI patients. Conclusions: For patients hospitalized with incident AMI, advances in care have led to incremental declines in mortality across time periods spanning the hospital stay through 3 years after discharge.

Association of Plasma Methylglyoxal Increase after Myocardial Infarction and the Left Ventricular Ejection Fraction.

Background: Preclinical studies suggest that methylglyoxal (MG) increases within the myocardium upon acute myocardial infarction (AMI) and thereafter contributes to adverse postinfarct remodeling. The aims of this study were to test whether MG increases in plasma of humans after AMI and whether this increase is related to the left ventricular ejection fraction (LVEF). Methods: The plasma samples of 37 patients with ST elevation AMI undergoing primary percutaneous coronary intervention (pPCI) acquired in a previously conducted randomized controlled trial testing remote ischemic conditioning (RIC) were analyzed by means of high-performance liquid chromatography. Time courses of the variables were analyzed by means of mixed linear models. Multiple regression analyses served to explore the relationship between MG levels and the LVEF. Results: Compared to the MG levels upon admission due to AMI, the levels were increased 2.4-fold (95% CI, 1.6–3.6) 0.5 h after reperfusion facilitated by pPCI, 2.6-fold (1.7–4.0) after 24 h and largely returned to the baseline after 30 d (1.1-fold, 0.8–1.5). The magnitude of the MG increase was largely independent of that of cardiac necrosis markers. Overall, the highest MG values within 24 h after AMI were associated with the lowest LVEF after 4 d. While markers of myocardial necrosis and stretch quantified within the first 24 h explained 52% of the variance of the LVEF, MG explained additional 23% of the variance (p < 0.001). Conclusions: Considering these observational data, it is plausible that the preclinical finding of MG generation after AMI negatively affecting the LVEF also applies to humans. Inhibition of MG generation or MG scavenging might provide a novel therapeutic strategy to target post-AMI myocardial remodeling and dysfunction.