Elevation Myocardial Infarction Patients Research Articles

A-46 | Crude and Propensity Matched In-Hospital Outcomes of Acute ST Elevation Myocardial Infarction in patients with & without Chronic Total Occlusion of Coronaries

A-46 | Crude and Propensity Matched In-Hospital Outcomes of Acute ST Elevation Myocardial Infarction in patients with & without Chronic Total Occlusion of Coronaries

A-8 | Propensity Matched In-Hospital Outcomes of Acute ST Elevation Myocardial Infarction in Patients with Simultaneous Chronic Total Occlusion

A-8 | Propensity Matched In-Hospital Outcomes of Acute ST Elevation Myocardial Infarction in Patients with Simultaneous Chronic Total Occlusion

Clinical Implications of High-Sensitivity Troponin Elevation Levels in Non-ST-Segment Elevation Myocardial Infarction Patients: Beyond Diagnostics.

Standard troponin has long been pivotal in diagnosing coronary syndrome, especially Non-ST-Segment Elevation Myocardial Infarction (NSTEMI). The recent introduction of high-sensitivity troponin (hs-cTnI) has elevated it to the gold standard. Yet, its nuanced role in predicting angiographic lesions and clinical outcomes, notably in specific populations like obesity, remains underexplored. Aim: To evaluate the association between hs-cTnI magnitude in NSTEMI patients and angiographic findings, progression to acute heart failure, and its performance in obesity. Methods: Retrospective study of 208 NSTEMI patients at a large university center (2020-2023). Hs-cTnI values were assessed for angiographic severity, acute heart failure, and characteristics in the obese population. Data collected and diagnostic performance were evaluated using manufacturer-specified cutoffs. Results: 97.12% of patients had a single culprit vessel. Hs-cTnI elevation correlated with angiographic stenosis severity. Performance for detecting severe coronary disease was low, with no improvement using a higher cutoff. No association was found between hs-cTnI and the culprit vessel location. Hs-cTnI did not predict acute heart failure progression. In the obese population, hs-cTnI levels were higher, but acute heart failure occurred less frequently than in non-obese counterparts. Conclusions: In NSTEMI, hs-cTnI elevation is associated with significant stenosis, but not with location or acute heart failure. Obesity correlates with higher hs-cTnI levels but a reduced risk of acute heart failure during NSTEMI.

Background and objectives: Acute coronary syndrome is the leading cause of death all over the world, there are many different risk factors as important etiology for this acute condition, this syndrome has been studied in different countries with a variety of results. The aim was to define different risk factors for the patients admitted to Erbil cardiac center and to

Background and objectives: The most prevalent and chronic form of systemic autoimmune disease, rheumatoid arthritis is characterized by persistent inflammation, deteriorating joint function with time, increasing comorbidity, and increased mortality. The aim of this study was to know the frequency of joints involved, to know the prevalence of seropositive Rheumatoid arthritis, and evaluation of demographic features of the patients with Rheumatoid arthritis. Methods: A cross-sectional, descriptive study was undertaken on 110 patients at Rizgary teaching hospital in Erbil city. From January 2022 and January 2023. We evaluated and diagnosed the patients. Serological investigations including Anti-cyclic citrullinated peptide and rheumatoid factor were done for all of the patients. Results: One hundred ten patients 80% were female and 20 % were male. The mean age (SD) was 51.39 (12.6) years, majority of the patients were obese (45.5%). Only 14.5% of the sample were smokers, and rate of illiteracy was 60%. The most common joints involved were metacarpo-pharyngeal joint 73.6% followed by wrist joint 63.6%. Most common comorbid disease was hypertension 29.1% followed by diabetes mellitus, and thyroid disease (15.5%, 10%) respectively. Prevalence of seropositive rheumatoid arthritis was 80.9%. Majority of the patients used methotrexate, while the most common biologic used by the patients was etanercept 12.7%. Conclusions: Our rheumatoid arthritis patients' demographics, joint involvement, and serological characteristics matched those of some regional and international studies, however we discovered a higher proportion of women and a higher percentage of illiteracy.

Temporary transvenous cardiac pacing in cathlab - myocardial infarction versus other causes - differences, complications, and prognosis. Data from a single-center retrospective analysis.

Transvenous temporary cardiac pacing (TTCP) is a lifesaving procedure, but the incidence of complications and prognosis depends on the underlying cause. The aim of this study was to compare the characteristics, complications, and prognosis in patients with myocardial infarction (MI) requiring TTCP vs. patients with TTCP due to other causes. The present analysis involved 244 cases in whom TTCP was performed between 2017 and 2021 in a high-volume cathlab. All the procedures were performed by an interventional cardiologist. MI constituted 46.3% of the patients (n = 113), including 63 ST-segment elevation MI patients (55.75%). Non-MI patients (control group) consisted of patients with any cause of bradycardia requiring TTCP. Myocardial infarction patients requiring TTCP are younger and have a higher prevalence of hypertension and heart failure. The pacing lead is more frequently inserted during asystole/resuscitation, and pacing was needed for a longer time. MI patients required cardiac implantable electronic device implantation less frequently than in other causes (22% vs. 82%, p < 0.01). The incidence of TTCP complications did not differ. The incidence of in-hospital death was 6.5-fold higher in TTCP patients with MI. Logistic regression showed MI to be a strong predictor of in-hospital death (odds ratio: 8.1; 95% confidence interval: 1.3-57.9). In-hospital mortality in MI patients requiring TTCP is 6.5-fold higher than in other patients with bradycardia. The complication rate of TTCP is similar in MI and non-MI patients. It is not TTCP but the severity of MI itself and the fact that a pacing lead is frequently implanted in asystole or during resuscitation that is responsible for the higher mortality rate.

Retracted: Intelligent Algorithm-Based Coronary Angiography Characteristics of Acute Non-ST-Segment Elevation Myocardial Infarction Patients with Different Genders.

[This retracts the article DOI: 10.1155/2022/6447472.].

Sex aspects of guideline-directed therapy in young ST- elevation myocardial infarction patients

Abstract Background Young women are at specific risk for a poor outcome after ST- elevation myocardial infarction (STEMI). We aimed to investigate sex- and age-specific differences in adherence to a guideline-directed drug therapy for secondary prophylaxis and to assess its effect on overall survival. Methods Administrative health insurance data (≈26 million members) was screened for patients 18- &amp;lt; 60 years with STEMI from 01/2008 to 12/2018. Patient demographics, details on in-hospital treatment, long-term adherence to guideline-directed drug therapy and the effect on mortality was assessed. Results 59,401 patients &amp;lt;60 years (19.3 % women, median age 53 (IQR 48 - 56) were treated in-hospital with STEMI. Overall, adherence to a guideline-directed heart failure therapy decreased over time. 180 days post STEMI, 80.3 % of women and 82.9 % of men &amp;lt;60 were on complete secondary prophylaxis with ACE/AT1 blockers, beta blockers, statins and a platelet activation inhibitor. Five years after the event, however, only 36.6 % of women and 40.9 % of men were under complete therapy. Similarly with a lower drug adherence, women showed a poorer outcome after STEMI with a 90-day mortality of 7.9 % compared to 6.4 % in men as well as a poorer overall survival (p&amp;lt;0.001). After adjustment for patients’ risk factors, there was a clear association between guideline directed therapy and overall survival. The positive association increased with the number of drugs taken. Moreover, sex-specific differences were specifically evident, if all four drugs were prescribed. The effect on overall survival of one heart failure drug was marginal and not sex-specific with a HR of 0.88 (95% CI 0.76-1.02) in women versus HR 0.91 (95% CI 0.84 - 0.99) in men (pint =0.707). Under complete guideline directed therapy, however, HR for overall survival was 0.22 (95% CI 0.19-0.26) in women versus HR 0.31 (95% CI 0.28 - 0.33) in men (pint &amp;lt;0.001). Conclusion Long-term adherence to an optimal guideline-directed drug therapy after STEMI is generally low with specifically women &amp;lt;60 years lacking a consistent therapy. The lack of consistent therapy is one aspect explaining the poor outcome after STEMI in younger women. Our data show, that women specifically benefit from a consistent secondary prophylaxis. As the underutilization of heart failure drugs is contributory to the unfavorable outcome in young female and male patients, systematic approaches and education of healthcare providers are needed to ensure the long-term use of heart failure drugs specifically in this patient cohort at risk.Kaplan-Meier estimatesCox regression analysis

Synergistic effect of Interleukin-1beta and cholesterol efflux capacity on outcomes in acute myocardial infarction patients

Abstract Background 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. Both pathways are currently evaluated as new therapeutic targets in ongoing clinical trials. Objectives We evaluated potential synergetic effect of cholesterol efflux capacity and IL-1ß on recurrent major cardiovascular events (MACE) at one-year in patients with acute ST-segment elevation MI who underwent primary percutaneous coronary intervention. Methods Cholesterol efflux capacity and IL-1ß were measured among 2012 ST-segment elevation MI patients enrolled in a prospective cohort. The association of these biomarkers with the primary outcome of MACE (MI, Stroke, or cardiovascular death) was evaluated at one-year follow-up using a multivariate-cox proportional regression analysis. In addition, in-vitro analysis of anti-atherogenic properties of HDL particles was also performed. Results Patients with both, a reduced cholesterol efflux capacity and an elevated level of IL-1b, exhibited the highest risk of recurrent MACE at one year compared to patients with both high cholesterol efflux capacity and low IL-1b (adjusted HR: 3.28; 95% CI: 1.83 to 5.89, p&amp;lt;0.0001) (Figure). In this high-risk subgroup, patients exhibited HDL particles defective for ABCA1-dependent efflux capacity with enhanced pro-inflammatory activity as a potential explanation for our clinical findings. Conclusion Defective cholesterol efflux capacity and elevated IL-1β increase synergistically the residual cardiovascular risk in MI patients.

Abstract 12184: Non-ST Segment Elevation Myocardial Infarction in Patients Admitted With Sepsis: A Comparison of Ischemia-Guided Strategy and Early Catheterization

Introduction: Sepsis and Non-ST Segment Elevation Myocardial Infarction (NSTEMI) are common medical conditions that often coexist and can cause significant morbidity and mortality. The optimal management strategy for these patients remains unclear. The American Heart Association (AHA) recommends an ischemia-guided approach in patients with stable NSTEMI, but it is unknown if this strategy is beneficial in the setting of sepsis. The aim of this study was to evaluate the outcomes of an ischemia-guided strategy in patients with sepsis and NSTEMI who underwent left heart catheterization (LHC) and percutaneous intervention (PCI). Methods: This study utilized data from the National Inpatient Sample (NIS) from 2016-2020. Patients admitted with a principal diagnosis of sepsis and a secondary diagnosis of NSTEMI were included in the study. Patients with cardiogenic shock or STEMI were excluded from the study due to the necessity of urgent or emergent left heart catheterization. Patients were divided into two groups based on the timing of LHC &amp; PCI, within 24 hours or 48-72 hours of admission. Logistic linear regression was used to adjust for multiple factors including patient demographics, hospital characteristics, and comorbidities. Results: A total of 298,855 patients were included in the analysis, with 48% of them being females and a mean age of 73 years. Patients who received an ischemia-guided strategy had lower mortality rates (OR: 0.45, 95% CI: 0.27-0.74, P=0.002) and a lower risk of heart failure exacerbation (OR: 0.74, 95% CI: 0.56-0.97, P=0.030) compared to those who did not receive this strategy. There was no significant difference in length of stay (Coefficient: 0.33, 95% CI: -0.34 - 1.01, P=0.330), cardiac arrest (OR: 0.08, 95% CI: 0.00-28.0, P=0.401), or gastrointestinal bleed (OR: 0.81, 95% CI: 0.49-1.33, P=0.412) between the two groups. Conclusion: This study suggests that an ischemia-guided strategy may be beneficial in patients with sepsis and NSTEMI compared to urgent percutaneous coronary intervention. The strategy was associated with lower mortality rates and a lower risk of heart failure exacerbation. Further studies are needed to confirm these findings and determine the optimal management strategy for this patient population.

Trends in incidence and clinical outcome of non-ST elevation myocardial infarction in patients with amyloidosis in the United States, 2010–2020

Study objectiveTo assess temporal changes in clinical profile and in-hospital outcome of patients with amyloidosis presenting with non-ST elevation myocardial infarction, NSTEMI. Design/settingWe conducted a retrospective observational study using the National Inpatient Sample (NIS) database from January 1, 2010, to December 31, 2020. Main outcomesPrimary outcome of interest was trend in adjusted in-hospital mortality in patients with amyloidosis presenting with NSTEMI from 2010 to 2020. Our secondary outcomes were trend in rate of coronary revascularization, and trend in duration of hospitalization. ResultsWe identified 272,896 hospitalizations for amyloidosis. There was a temporal increase in incidence of NSTEMI among patients aged 18-44 years from 15.5 % to 28.0 %, a reverse trend was observed in 45–64 years: 22.1 % to 17.7 %, p = 0.043. There was no statistically significant difference in rate of coronary revascularization from 2010 to 2020; 16.3 % to 14.2 %, p = 0.86. We observed an increased odds of all-cause in-hospital mortality in patients with NSTEMI compared to those without NSTEMI (aOR = 2.2, 95 % CI: 1.9–2.6, p < 0.001) but there was a decrease trend in mortality from 21.5 % to 11.3 %, p = 0.013 for trend. Hospitalization duration was also observed to decreased from 14.1 days to 10.9 days during the study period (p = 0.055 for trend). ConclusionIn patients with amyloidosis presenting with NSTEMI, there was increased incidence of NSTEMI among young adults, a steady trend in coronary revascularization, and a decreasing trend of adjusted all-cause in-hospital mortality and length of hospitalization from 2010 to 2020 in the United States.

Acute ST-segment elevation myocardial infarction in a patient with dextrocardia and left common carotid artery arising from the brachiocephalic trunk: a case report

Dextrocardia is a rare anatomical anomaly in which the heart resides on the right side. Difficulties in diagnosing coronary pathology in this group of patients can significantly delay the diagnosis and worsen the treatment prognosis. This article presents a rare case of emergency percutaneous coronary intervention for acute ST-segment elevation myocardial infarction in a patient with dextrocardia and left common carotid artery arising from the brachiocephalic trunk. Taking into account the technical difficulties, the option of common femoral artery access during emergency percutaneous coronary intervention for STsegment elevation myocardial infarction in patients with dextrocardia or other anomalies in the location of internal organs and great vessels without confirmed earlier coronary anatomy.

Comparison Between the Effects of Primary Angioplasty and Pharmaco-Invasive Strategy on Left Ventricular Functions in ST- Elevation Myocardial Infarction Patients

Comparison Between the Effects of Primary Angioplasty and Pharmaco-Invasive Strategy on Left Ventricular Functions in ST- Elevation Myocardial Infarction Patients

Transitioning to Unfractionated Heparin in Treatment of Non-ST-Segment Elevation Myocardial Infarction Patients on Direct Oral Anti-Xa Inhibitors.

The heparin anti-Xa assay is affected by the use of direct oral anticoagulants (DOACs) and is utilized in the management of intravenous unfractionated heparin. Patients with non-ST-segment myocardial infarction (NSTEMI) receive intravenous unfractionated heparin with prior administration of DOACs poses challenges given these laboratory abnormalities. On this background, we evaluate if an elevated heparin anti-Xa assay may lead to the decision to delay heparin in the management of NSTEMI patients and the outcome of in-hospital mortality. This is a single-center chart review study with patients admitted between January 2019 and December 2020. Patients with a documented DOAC home medication and a diagnosis of NSTEMI were included.Data was collected for heparin anti-Xa levels at baseline, after 6 and 12 hours of hospitalization, in addition to the reason for the delay in the administration of heparin. Statistical analysis included the determination of r-squared correlation and one-way ANOVA using GraphPad Prism 8.0. A total of 44 patients were divided into three groups based on baseline Xa levels of patients. Elevated Xa level was noted more in patients who were taking apixaban. Heparin infusion was delayed among this sub-group of patients. Elevated baseline heparin anti-Xa levels were significantly improved after 12 hours. There was no correlation between elevated anti-Xa levels and activated partial thromboplastin time. No in-hospital mortality was observed among any of the subgroups. Collectively, this study demonstrates that the high sensitivity of heparin anti-Xa assay to DOACs affect assay accuracy and result in elevated heparin anti-Xa level with the use of DOACs resulting in delayed start of heparin therapy in treating NSTEMI patients.

Outcomes of ST elevation myocardial infarction in patients with cancer: a nationwide study.

To assess processes of care and clinical outcomes in cancer patients with ST elevation myocardial infarction (STEMI) according to cancer type. This is a national population-based study of patients admitted with STEMI in the UK between January 2005 and March 2019. Data were obtained from the National Heart Attack Myocardial Infarction National Audit Project (MINAP) registry and the Hospital Episode Statistics registry. We identified 353448 STEMI-indexed admissions between 2005 and 2019. Of those, 8581 (2.4%) had active cancer. Prostate cancer (29% of STEMI patients with cancer) was the most common cancer followed by haematologic malignancies (14%) and lung cancer (13%). Cancer patients were less likely to receive invasive coronary revascularization (60.0% vs. 71.6%, P<0.001] and had higher in-hospital death [odd ratio (OR) 1.39, 95% confidence interval (CI) 1.25-1.54] and bleeding (OR 1.23, 95% CI 1.03-1.46). Cancer patients had higher mortality at 30 days (HR 2.39, 95% CI 2.19-2.62) and 1 year (HR 3.73, 95% CI 3.58-3.89). Lung cancer was the cancer associated with the highest risk of death in the hospital (OR 1.75, 95% CI 1.39-2.22) and at 1 year (OR 8.08, 95% CI 7.44-8.78). Colon cancer (OR 1.98, 95% CI 1.24-3.14) was the main cancer associated with major bleeding. All common cancer types were associated with higher mortality at 1 year. Cardiovascular death (62%) was the main cause of death in the first 30 days, while cancer (52%) was the main cause of death within 1 year. STEMI patients with cancer have a higher risk of short- and long-term mortality, particularly lung cancer. Colon cancer is the main cancer associated with major bleeding. Cardiovascular disease was the main cause of death in the first month, whereas cancer was the main cause of death within 1 year.

Prevalence of non-ST segment elevation myocardial infarction in patients with acute coronary syndrome having normal ECG

Background: Coronary artery disease is a major worldwide health issue of immense scope. It is the biggest cause of death and illness in both male and female all over the globe. Objective: To assess the “prevalence of non-ST segment elevation myocardial infarction in patients with acute coronary syndrome having normal ECG. Methodology: The current study was cross sectional carried out at the department of cardiology, Qazi Hussain Ahmad Medical Complex Nowshera. The duration of study was one years from January 2021 to January 2022. The proforma created for this research was then filled out with the requireds information. The SPSS version 24.0 was used to input and analyze the data. Results: In our research, totally 150 patients were included. The male patients in our study were 97 (64.67%) while female participants were 53 (35.33%). The prevalence of Non-ST segment elevation myocardial infarction in patients with acute coronary syndrome having normal ECG was 37 (24.67%). Conclusion: Our study concludes that the prevalence of “non-ST segment elevation myocardial infarction” in patients with acute coronary syndrome having normal ECG was high.

β-blocker dose, heart rate reduction, and death in patients with heart f ailure: a systematic review

Background: In individuals with systolic chronic Heart failure (HF), β-blockers enhance cardiac function and increase survival. The precise processes driving these advantages are unclear, though. It is uncertain if there is a direct link between clinical results with these medications and heart rate (HR) decrease. According to recommendations, β-blockers should be administered to individuals with HF at effective dosages in clinical studies. It is unknown if the advantages of β-blockade are dose-related, even though the disadvantages are. Aim: To investigate the survival benefits of β-blockade in HF and its association with the level of HR reduction or the β-blocker dose. Methods: This is an updated systematic review of studies discussing the survival benefits of β-blockade in HF and its association with the level of HR reduction or the β-blocker dose between 2020 and 2022. The PubMed and Google Scholar databases were used to explore studies regarding our subject. The keywords included &amp;quot;β-blocker Dose, Heart Rate Reduction, Death, Patients, and Heart Failure,&amp;quot; and were used in various combinations. The inclusion criteria were original studies that reported the survival benefits of β-blockade in HF and its association with the level of HR reduction or the β-blocker dose and full-text articles. Results: Though 240 articles were obtained, only 8 of them met the inclusion criteria. The studies included more than 120,348 patients: 4 prospective studies, 1 case series, 1 multicenter, a randomized clinical trial, and 2 observational cohort studies. Conclusion: Oral β-blocker therapy was independently associated with a lower risk of poor in-hospital outcomes in sore throat speech therapy (ST)-elevation myocardial infarction patients with Killip class II or III HF. In individuals with chronic or acute coronary syndrome, an HR of 70 bpm was related to poorer clinical indicators and prognosis. β-blocker therapy was independently associated with a lower risk of all-cause death. In HF patients with reduced ejection fraction with advanced chronic kidney disease, using β-blockers was linked to decreased morbidity and death rates. Moreover, HF patients who receive medical treatment with βb can reverse exercise oscillatory ventilation.

Association of Waist and Hip Ratio with the Angiographic Severity of Coronary Artery Disease in Patients with Non ST Segment Elevation Myocardial Infarction

Background: Obesity is a proven independent risk factor for coronary artery disease. There are different Methods for evaluation of obesity. The aim of this study is to evaluate the association between waist hip ratio and the severity of CAD in non-ST-segment elevation myocardial infarction patients. Methods: This cross-sectional observational study was done at the National Institute of Cardiovascular Diseases (NICVD), Dhaka. A total of 100 patients with NSTEMI who underwent coronary angiogram during the indexed hospitalization period were included in this study. On the basis of WHR, study patients were divided into two groups 50 patients of NSTEMI with normal WHR (Male &lt;0.90, Female &lt;0.80) were assigned as group I and 50 patients of NSTEMI with increased WHR (Male ³0.90, Female ³0.80) were assigned as group II. Results: The mean age of patients was 49.6±7.9 years and 52.3±8.7 years in Group I and Group II respectively with a male predominance in both the groups. No significant difference was found in between two groups in terms of demographic characteristics and traditional risk factors for CAD. Different parameters of angiographic severity of CAD were significantly higher in patients with increased WHR. Patients with non critical CAD (14% vs 0%, P = 0.02) and single vessel disease (58% vs 24%, P = 0.005) were more frequent in Group I, on the contrary double vessel disease (24% vs. 56%, P = 0.001) and triple vessel disease (4% vs. 20%, P = 0.03) were significantly more frequent in patients of Group II. Patients with moderate to severe CAD (Gensini score ³36) were found more in Group II than that of in Group I (24% vs. 76%, P &lt;0.001) and there was statistically significant higher Gensini score was found in Group II (21.96±19.72 vs. 44.18±28.91, P &lt;0.001). Significant positive correlation was found in between WHR and coronary artery disease severity measured by vessel score (r = 0.41, P &lt; 0.001) and Gensini score (r = 0.31, P&lt; 0.001). Multivariate regression analysis yielded that the risk of having significant CAD are 3.45 times more in patients with increased WHR than those of normal WHR (95% CI: 1.229-12.979, P = 0.01). Conclusion: Abdominal obesity, as evidenced by increased WHR, may be considered as a predictor of the severity of CAD in patients with acute NSTEMI. Bangladesh Heart Journal 2022; 37(2): 122-129

Impact of Diabetes on 10-Year Outcomes Following ST-Segment-Elevation Myocardial Infarction: Insights From the EXAMINATION-EXTEND Trial.

Background Long-term outcomes of ST-segment-elevation myocardial infarction in patients with diabetes have been barely investigated. The objective of this analysis from theEXAMINATION-EXTEND (10-Years Follow-Up of the EXAMINATION trial) trial was to compare 10-year outcomes of patients with ST-segment-elevation myocardial infarction with and without diabetes. Methods and Results Of the study population, 258 patients had diabetes and 1240 did not. The primary end point was patient-oriented composite end point of all-cause death, any myocardial infarction, or any revascularization. Secondary end points were the individual components of the primary combined end point, cardiac death, target vessel myocardial infarction, target lesion revascularization, and stent thrombosis. All end points were adjusted for potential confounders. At 10 years, patients with diabetes showed a higher incidence of patient-oriented composite end point compared with those without (46.5% versus 33.0%; adjusted hazard ratio [HR], 1.31 [95% CI, 1.05-1.61]; P=0.016) mainly driven by a higher incidence of any revascularization (24.4% versus 16.6%; adjusted HR, 1.61 [95% CI, 1.19-2.17]; P=0.002). Specifically, patients with diabetes had a higher incidence of any revascularization during the first 5 years of follow-up (20.2% versus 12.8%; adjusted HR, 1.57 [95% CI, 1.13-2.19]; P=0.007) compared with those without diabetes. No statistically significant differences were found with respect to the other end points. Conclusions Patients with ST-segment-elevation myocardial infarction who had diabetes had worse clinical outcome at 10 years compared with those without diabetes, mainly driven by a higher incidence of any revascularizations in the first 5 years. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04462315.

An altered balance of plasma arginine metabolites is associated with increased thickness of the coronary intima-media complex in the adjacent to the culprit segment of an infarct-related artery

Abstract Background The biomarkers of atherosclerosis remain insufficiently understood. Purpose We sought to investigate whether an altered balance of arginine metabolites in patients following myocardial infarction (MI) is associated with remodeling of the adjacent to the culprit segments of an infarct-related artery (IRA) and with clinical outcomes. Methods Arginine and its metabolites including ornithine, citrulline, proline and asymmetric dimethylarginine were measured using liquid chromatography and tandem mass spectrometry in 85 consecutive ST-segment elevation MI patients upon admission and at 6-month follow-up and were compared with morphology of the adjacent to the culprit proximal and distal 10-mm segments of IRA assessed with optical coherence tomography. A composite ischemic event was defined as death, recurrent MI, stroke, or unplanned percutaneous coronary intervention. Results The ratios of citrulline/ornithine and citrulline/arginine decreased 5.22 and 2.20 times (both P&amp;lt;0.001) respectively, while the ornithine/arginine index (I_O/A) increased 2.96 times (P&amp;lt;0.001) following ischemia compared with stable follow-up, indicating the enhanced arginase activity over nitric oxide synthase (NOS) in acute phase of STEMI. Follow-up I_O/A correlated with the mean intima-media (R=0.34, P=0.003, Figure 1A) and intima (R=0.30, P=0.008) diameter of an adjacent to the culprit IRA segment. By multivariate analysis, apart from male gender (P&amp;lt;0.001) and diabetes mellitus (P=0.02), a higher follow-up I_O/A was associated with the larger mean intima-media diameter of an adjacent to the culprit IRA segments (coefficient 0.218, 95% confidence interval 0.040–0.397, P=0.017, per 0.01). Within the median follow-up of 25 (19–35) months, ischemic composite endpoint was found in 13 (15.3%) patients. The follow-up I_O/A reached the area under the ROC curve of 0.78 (95% confidence interval 0.66–0.91, P=0.005) for prediction of composite ischemic endpoint with a cut-off value of ≥0.57, and a sensitivity of 72.3% and specificity of 80.0% (Figure !B). Conclusions Our findings provide arguments that during the acute phase of MI, arginine metabolism is shifted from NOS towards arginase, as compared to 6-month stable conditions. Simultaneously, the enhanced residual arginase activity over NOS in chronic phase was correlated with a higher thickness of intima or intima-media in the adjacent to the culprit segment within the IRA, and was also associated with unfavorable clinical outcomes. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Grant of the National Science Center of Poland (Number 2016/21/B/NZ5/01378 to J.Z.)

Features of the course of non-ST elevation myocardial infarction in patients with a history of COVID-19

Aim To study the clinical course of non-ST segment elevation myocardial infarction (NSTEMI) in hospitalized patients after COVID-19 and to evaluate the effect of baseline characteristics of patients on the risk of complications.Material and methods The study included 209 patients with NSTEMI; 104 of them had had COVID-19. The course of myocardial infarction (MI) was analyzed at the hospital stage, including evaluation of the incidence rate of complications (fatal outcome, recurrent MI, life-threatening arrhythmias and conduction disorders, pulmonary edema, cardiogenic shock, ischemic stroke, gastrointestinal bleeding).Results Mean age of patients after COVID-19 was 61.8±12.2 years vs. 69.0±13.0 in the comparison group (p&lt;0.0001). The groups were comparable by risk factors, clinical data, and severity of coronary damage. Among those who have had СOVID-19, there were fewer patients of the GRACE high risk group (55.8 % vs. 74.3 %; p&lt;0.05). Convalescent COVID-19 patients had higher levels of C-reactive protein and troponin I (p&lt;0.05). The groups did not significantly differ in the incidence of unfavorable NSTEMI course (p&gt;0.05). However, effects of individual factors (postinfarction cardiosclerosis, atrial fibrillation, decreased SpO2, red blood cell concentration, increased plasma glucose) on the risk of complications were significantly greater for patients after COVID-19 than for the control group (p&lt;0.05).Conclusion Patients with NSTEMI, despite differences in clinical history and laboratory data, are characterized by a similar risk of death at the hospital stage, regardless of the past COVID-19. Despite the absence of statistically significant differences in the incidence of in-hospital complications, in general, post-COVID-19 patients showed a higher risk of complicated course of NSTEMI compared to patients who had not have COVID-19. In addition, for this category of patients, new factors were identified that previously did not exert a clinically significant effect on the incidence of complications: female gender, concentration of IgG to SARS-CoV-2 ≥200.0 U/l, concentration of С-reactive protein ≥40.0 mg/l, total protein &lt;65 g/l. These results can be used for additional stratification of risk for cardiovascular complications in patients with MI and also for development of individual protocols for evaluation and management of NSTEMI patients with a history of COVID-19.