Episode Of Acute Myocardial Infarction Research Articles

Spontaneous coronary artery dissection in Spain: a study using the minimum data set of the Spanish National Health System

Introduction and objectivesSpontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction (AMI). We sought to compare the results on in-hospital mortality and 30-day readmission rates among patients with AMI-SCAD vs AMI due to other causes (AMI-non-SCAD). MethodsRisk-standardized in-hospital mortality (rIMR) and risk-standardized 30-day readmission ratios (rRAR) were calculated using the minimum dataset of the Spanish National Health System (2016-2019). ResultsA total of 806 episodes of AMI-SCAD were compared with 119 425 episodes of AMI–non-SCAD. Patients with AMI-SCAD were younger and more frequently female than those with AMI–non-SCAD. Crude in-hospital mortality was lower (3% vs 7.6%; P<.001) and rIMR higher (7.6±1.7% vs 7.4±1.7%; P=.019) in AMI-SCAD. However, after propensity score adjustment (806 pairs), the mortality rate was similar in the 2 groups (AdjOR, 1.15; 95%CI, 0.61-2,2; P=.653). Crude 30-day readmission rates were also similar in the 2 groups (4.6% vs 5%, P=.67) whereas rRAR were lower (4.7±1% vs 4.8%±1%; P=.015) in patients with AMI-SCAD. Again, after propensity score adjustment (715 pairs) readmission rates were similar in the 2 groups (AdjOR, 1.14; 95%CI, 0.67–1.98; P=.603). ConclusionsIn-hospital mortality and readmission rates are similar in patients with AMI-SCAD and AMI–non-SCAD when adjusted for the differences in baseline characteristics. These findings underscore the need to optimize the management, treatment, and clinical follow-up of patients with SCAD.

Frequency of Metabolic Syndrome among Patients who Sustained Acute Myocardial Infarction

Background: Metabolic syndrome is a constellation of various cardiovascular risk factors. Patients having Metabolic syndrome in association with ischemic heart disease tend to have more comorbidities and worse hospital course. Objective: To assess the frequency of metabolic syndrome among patients who sustained acute myocardial infarction without prior history of acute coronary events.&#x0D; Marerial and Methods: This was a crossectional descriptive study, conducted after ethical approval from institutional research board and ethical committee, at cardiology department of Qazi Hussain Ahmad medical complex Nowshera from 5th August 2020 st to 20th March 2021. Patients presenting with 1 ever episode of acute myocardial infarction were recruited into the study. 195 patients were recruited into the present study using WHO sample size calculator. &#x0D; Results: Among 195 patients with acute MI, 58.5% (n=114) had metabolic syndrome. Frequency of metabolic syndrome increased with increasing age (57.8% vs 31.5% vs 10.5%; p=0.043). There was a significantly increased prevalence of hypertension (32.5% vs 67.5%; p=0.017), diabetes (35.9% vs 64.1%; p=0.027), elevated plasma triglycerides (30.7% vs 69.3%; p=0.047), low HDL cholesterol (36.8% vs 63.2%; p=0.003) and abdominal obesity (28.9% vs 71.1%; p=0.001) among the group of acute MI patients with metabolic syndrome as compared to those who had no metabolic syndrome. The difference in the frequency of MetS among male and females (59.6% vs 41.4%; p=0.56) was statistically insignificant.Conclusion: Among patients who had sustained acute MI, 58.5% (n=114) patients were found to have Metabolic Syndrome. Key Words: Abdominal obesity, myocardial infarction, coronary artery disease.

Disección coronaria espontánea en España: un estudio sobre bases administrativas realizado a partir del Conjunto Mínimo Básico de Datos español

Introduction and objectivesSpontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction (AMI). We sought to compare the results on in-hospital mortality and 30-day readmission rates among patients with AMI-SCAD vs AMI due to other causes (AMI-non-SCAD). MethodsRisk-standardized in-hospital mortality (rIMR) and risk-standardized 30-day readmission ratios (rRAR) were calculated using the minimum dataset of the Spanish National Health System (2016-2019). ResultsA total of 806 episodes of AMI-SCAD were compared with 119 425 episodes of AMI–non-SCAD. Patients with AMI-SCAD were younger and more frequently female than those with AMI–non-SCAD. Crude in-hospital mortality was lower (3% vs 7.6%; P<.001) and rIMR higher (7.6±1.7% vs 7.4±1.7%; P=.019) in AMI-SCAD. However, after propensity score adjustment (806 pairs), the mortality rate was similar in the 2 groups (AdjOR, 1.15; 95%CI, 0.61-2,2; P=.653). Crude 30-day readmission rates were also similar in the 2 groups (4.6% vs 5%, P=.67) whereas rRAR were lower (4.7±1% vs 4.8%±1%; P=.015) in patients with AMI-SCAD. Again, after propensity score adjustment (715 pairs) readmission rates were similar in the 2 groups (AdjOR, 1.14; 95%CI, 0.67–1.98; P=.603). ConclusionsIn-hospital mortality and readmission rates are similar in patients with AMI-SCAD and AMI–non-SCAD when adjusted for the differences in baseline characteristics. These findings underscore the need to optimize the management, treatment, and clinical follow-up of patients with SCAD.

Impact of myocardial revascularization on long-term outcomes in a nationwide cohort of first acute myocardial infarction survivors.

The long-term clinical benefits of myocardial revascularization in a contemporary, nationwide cohort of acute myocardial infarction (AMI) survivors are unclear. We aimed to compare the mortality rates and clinical outcomes at 8 years of patients admitted in Italy for a first AMI managed with or without myocardial revascularization during the index event. This is a national retrospective cohort study that enrolled patients admitted for a first AMI in 2012 in all Italian hospitals who survived at 30 days. The outcomes of interest were all-cause mortality, major cardio-cerebrovascular events (MACCE), and re-hospitalization for heart failure (HF) at 8 years. Time to events was analysed using a Cox and Fine and Gray multivariate regression model. A total of 127 431 patients with AMI were admitted to Italian hospitals in 2012. The study cohort consisted of 62 336 AMI events, of whom 63.8% underwent percutaneous or surgical revascularization ≤30 days of the index hospital admission. At 8 years, the cumulative incidence of all-cause death was 36.5% (24.6% in revascularized and 57.6% in not revascularized patients). After multiple corrections, the hazard ratio (HR) for all-cause mortality in revascularized vs. not revascularized patients was 0.61 (P < 0.0001). The rate of MACCE was 45.7% and 65.8% (adjusted HR 0.83; P < 0.0001), while re-hospitalizations for HF occurred in 17.6% and 29.8% (adjusted HR 0.97; P = 0.16) in AMI survivors revascularized and not revascularized, respectively. In our contemporary nationwide cohort of patients at their first AMI episode, those who underwent myocardial revascularization within 1 month from the index event compared to those not revascularized presented an adjusted 39% risk reduction in all-cause mortality and 17% in MACCE at 8-year follow-up.

C58 LONG–TERM SURVIVAL OF PATIENTS ADMITTED FOR A FIRST AMI EVENT AND MANAGED WITH MYOCARDIAL REVASCULARIZATION OR CONSERVATIVE APPROACH IN ITALY

Abstract Background The long–term clinical benefits of myocardial revascularization in a contemporary cohort of patients with acute myocardial infarction (AMI) are unclear. We aimed to compare the overall mortality rates at 8 years of patients admitted in Italian hospitals with a first AMI managed with or without myocardial revascularization during the index event. Methods This is a national retrospective cohort study that enrolled patients admitted with a first AMI in 2012 in all Italian hospitals. The outcome of interest was all–cause mortality at 8 years. Time to events was analyzed using a Cox multivariate regression model. Results A total of 97,271 patients with AMI were admitted to an Italian hospital in 2012. Patients with a previous AMI or myocardial revascularization (n = 27,350) have been excluded from this analysis. Among the remaining 69,921 AMI events, 56.6% underwent a percutaneous coronary intervention (PCI) or a coronary artery by–pass grafting (CABG) during the index admission. The crude 8–year survival was 0.76% for patients treated with PCI or CABG in the index admission and 0.34% for patients managed with a conservative approach (Figure 1). Considering the differences in risk factors, the invasive approach showed a significantly lower risk of long–term mortality compared to the conservative management (hazard ratio=0.55; 95% confidence intervals 0.53–0.56) (Figure 2). Conclusions In a contemporary nationwide cohort of patients at their first AMI episode, those who underwent a myocardial revascularization during the index event presented an adjusted 45% relative risk reduction in overall mortality at 8–year follow–up compared with those treated only medically.

The initial validation of indonesian version of heartqoL: a short health-related quality of life questionnaire for post-myocardial infarction patients

Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Indonesia Ministry of Health Background HeartQoL questionnaire was developed to measure specific health-related quality of life for post-myocardial infarction patients. However, it has not been adapted and tested for its validity and reliability for Indonesian population. Purpose To assess the validity and reliability of the Indonesian version of the HeartQoL Questionnaire in post-acute myocardial infarction patients. Method We admitted 102 Indonesian-native speaking patients treated at a tertiary hospital who experienced the first episode of acute myocardial infarction (93% male; mean age = 56.8 years) into the study. They were randomly contacted to fill out the Indonesian version of HeartQoL and SF-36 questionnaire independently. Construct validity of the HeartQoL questionnaire was analyzed using exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and convergent validity was assessed by correlation of the HeartQoL and SF-36 similar subscales, whereas internal consistency was examined using Cronbach's Alpha value. Results EFA showed that the Indonesian version of HeartQoL consisted of 14-items with a 2-factor structure, and CFA supported the results by showing a satisfactory fit, CFI = 0.972, TLI = 0.961, and RMSEA = 0.075. Convergent validity was shown by r &amp;gt; 0.50 for physical and mental domain. The internal consistency of the HeartQoL scales was indicated by the Cronbach's Alpha value of 0,865-0.953. Conclusions The Indonesian version of the HeartQol questionnaire is a valid and reliable measure to assess the quality of life of patients after myocardial infarction.

Efficacy and safety of fondaparinux versus unfractionated heparin in patients hospitalised with severe COVID-19 pneumonia and coagulopathy: a randomised, open-label clinical trial

Funding AcknowledgementsType of funding sources: Public hospital(s). Main funding source(s): Syarifah Ambami Rato Ebu General Hospital, Bangkalan, East Java, IndonesiaBackgroundThe use of unfractionated heparin (UFH) has been renowned to reduce mortality in COVID-19. There are no data about the efficacy and safety of fondaparinux (FPX) in COVID-19.PurposeTo evaluate the efficacy and safety of FPX as compared to UFH in patients hospitalised with severe COVID-19 and coagulopathy.MethodsThis was a single-center, open-label, equally randomised, parallel-group study conducted between April 1st and July 15th, 2021. Eligible and consenting patients were randomly assigned (1:1 ratio) to receive either FPX or UFH, in prophylactic and therapeutic dose. The primary efficacy endpoint was 28-day all-cause mortality; and secondary efficacy endpoints were episode of acute myocardial infarction (MI), objectively confirmed venous (VTE) or arterial thromboembolism (ATE), progression to non-invasive ventilation (NIV) or invasive mechanical ventilation (IMV), progression to ARDS, sepsis, acute kidney injury (AKI) and acute lung oedema (ALO). The primary safety endpoint was major bleeding (MB); and secondary safety endpoint was clinically relevant non-major bleeding (CRNMB). All composite endpoints were analysed on a 28-day intention-to-treat basis. All patients received guideline-driven therapy throughout the study.ResultsDuring allocated period, 250 (71%) of 352 patients were eligible and were assigned to either FPX or UFH group. The baseline characteristics were well-matched between the two groups (all p > 0.05). FPX compared with UFH revealed no significant difference in 28-day all-cause mortality (35.2% vs. 39.2%, hazard ratio [HR] 0.88, p = 0.59). FPX exhibited no significant difference in the trend of thromboembolic events i.e. acute MI (16.8% vs. 16.8%, HR 0.78, p = 0.53); VTE (2.4% vs. 3.2%, HR 0.49, p = 0.42); and ATE (1.6% vs. 1.6%, HR 0.94, p = 0.95) compared to UFH. Among those not on NIV or IMV at randomisation, FPX showed no significant difference in the proportion of patients meeting the composite endpoint of progression to NIV/IMV (33.6% vs. 35.2%, HR 0.91, p = 0.74) or ARDS (25.6% vs. 24.8%, HR 0.91, p = 0.77). FPX group demonstrated no significant difference in the progression to septic shock (24% vs. 24.8%, HR 0.97, p = 0.92), AKI (19.2% vs. 16%, HR 1.01, p = 0.98), and ALO (10.4% vs. 12%, HR 1.19, p = 0.79) than UFH. Allocation to FPX had no significant effect on the proportion of patients discharged from hospital within 28 days (64% vs. 59.2%, HR 0.72, p = 0.43). Regarding safety, there was no significant difference between FPX and UFH group in terms of major bleeding (1.6% vs. 1.6%, HR 0.88, p = 0.88) or CRNMB (8% vs. 8.8%, HR 0.74, p = 0.53) at 28 days. Our prespecified sub-analysis comparing patients who received the respective therapeutic or prophylactic dose revealed that the efficacy and safety outcomes at 28 days did not differ between the FPX and UFH group (all p > 0.05).ConclusionIn patients hospitalised with severe COVID-19 and coagulopathy, FPX was associated with similar efficacy and safety as compared to UFH. Figure. Baseline characteristics of study groups Figure. Allocation of FPX on composite endpoints

Risk Factors and Outcomes of Heart Failure Following First-Episode of Acute Myocardial Infarction-A Case Series Study of 161,384 Cases.

Background: Heart failure (HF) is one of the important complications of acute myocardial infarction (AMI), but the epidemiology, associated risks and outcomes have not been well investigated in the era of broad use of fluoroscopy-guided angiographic intervention. Methods: We analysed 161,384 subjects who had experienced the first episode of AMI during 1 January 2000 and 31 December 2012 using the Taiwan National Health Insurance Research Database. Results: During the index AMI hospitalization, 23.6% of cases developed HF. Female, ≥65 years-old, non-ST-segment elevation type of MI, diabetes mellitus (DM), peripheral vascular occlusion disease (PAOD), chronic obstructive pulmonary disease (COPD), atrial fibrillation, and ventricular tachycardia/fibrillation (VT/VF) were associated with higher risks of developing HF. HF cases had inferior survival outcomes compared to non-HF cases in both the short and long term. Among those HF patients, ≥65 years, DM, PAOD, and VT/VF were associated with worse outcomes. On the contrary, coronary reperfusion intervention and treat-to-target pharmacologic treatment were associated with favourable survival outcomes. Conclusions: HF remains common in the modern age and poses negative impacts in survival of AMI patients. It highlights that prudent prevention and early treatment of HF during AMI hospitalization is an important medical issue.

In-hospital outcomes of mechanical complications in acute myocardial infarction: Analysis from a nationwide Spanish database.

Mechanical complications represent an important cause of mortality in myocardial infarction (MI) patients. This is a nationwide study performed to evaluate possible changes in epidemiology or prognosis of these complications with current available strategies. Information was obtained from the minimum basis data set of the Spanish National Health System, including all hospitalizations for acute myocardial infarction (AMI) from 2010 to 2015. Risk-standardized in-hospital mortality ratio was calculated using multilevel risk adjustment models. A total of 241,760 AMI episodes were analyzed, MI mechanical complications were observed in 842 patients: cardiac tamponade in 587, ventricular septal rupture in 126, and mitral regurgitation due to papillary muscle or chordae tendineae rupture in 155 (there was more than one complication in 21 patients). In-hospital mortality was 59.5%. On multivariate adjustment, variables with significant impact on in-hospital mortality were: age (OR 1.06; 95% CI 1.04-1.07; p < 0.001), ST-segment elevation AMI (OR 2.91; 95% CI 1.88-4.5; p < 0.001), cardiogenic shock (OR 2.35; 95% CI 1.66-3.32; p < 0.001), cardio-respiratory failure (OR 3.48; 95% CI 2.37-5.09; p < 0.001), and chronic obstructive pulmonary disease (OR 1.85; 95% CI 1.07-3.20; p < 0.001). No significant trends in risk-adjusted in-hospital mortality were detected (IRR 0.997; p = 0.109). Cardiac intensive care unit availability and more experience with mechanical complications management were associated with lower adjusted mortality rates (56.7 ± 5.8 vs. 60.1 ± 4.5; and 57 ± 6.1 vs. 59.9 ± 5.6, respectively; p < 0.001). Mechanical complications occur in 3.5 per thousand AMI, with no significant trends to better survival over the past few years. Advanced age, cardiogenic shock and cardio-respiratory failure are the most important risk factors for in-hospital mortality. Higher experience and specialized cardiac intensive care units are associated with better outcomes.

Importance of Geospatial Heterogeneity in Chronic Disease Burden for Policy Planning in an Urban Setting Using a Case Study of Singapore.

Chronic disease burdens continue to rise in highly dense urban environments where clustering of type II diabetes mellitus, acute myocardial infarction, stroke, or any combination of these three conditions is occurring. Many individuals suffering from these conditions will require longer-term care and access to clinics which specialize in managing their illness. With Singapore as a case study, we utilized census data in an agent-modeling approach at an individual level to estimate prevalence in 2020 and found high-risk clusters with >14,000 type II diabetes mellitus cases and 2000–2500 estimated stroke cases. For comorbidities, 10% of those with type II diabetes mellitus had a past acute myocardial infarction episode, while 6% had a past stroke. The western region of Singapore had the highest number of high-risk individuals at 173,000 with at least one chronic condition, followed by the east at 169,000 and the north with the least at 137,000. Such estimates can assist in healthcare resource planning, which requires these spatial distributions for evidence-based policymaking and to investigate why such heterogeneities exist. The methodologies presented can be utilized within any urban setting where census data exists.

Socioeconomic status, access to invasive coronary angiography, and mortality of acute myocardial infarction patients

This paper examines the role of socioeconomic status (SES) and access to care in affecting the survival of acute myocardial infarction (AMI) patients. The question is asked in the context of Australia's universal health care system where equity of access is a stated policy objective. We jointly model the probability of patients being admitted to a catheterisation-capable hospital, receiving invasive coronary angiography (ICA), and surviving 30 days post discharge as a recursive system of probit equations. From the recursive system, we are able to disentangle the direct effects of SES on survival from the indirect effects of SES on access. We further interact SES with the short-term catheterisation capacity of admitting hospitals to investigate whether the access gap between SES groups widens when capacity was limited. We make use of hospital administrative data from the state of Victoria to construct a sample of all admissions of AMI episodes in a seven-year period (2004/05-–2011/12). We find that the likelihood of access is significantly lower for socioeconomically disadvantaged patients. However, while access affects the survival probability, these effects are small compared to the direct effects of SES on survival probabilities. We further find that capacity has no effects on access, on average, across all patients, but when interacting with SES, access by disadvantaged patients appears to be impacted more in situations of limited capacity compared to less disadvantaged groups. We show that even in Australia, with its universal health system, SES plays a significant role in affecting the access to care and subsequent survival. The findings suggest that public health strategies to reduce inequality in health should attempt not only to improve access but also address the direct effects of SES.

What's New in Shock? January 2021.

What's New in Shock? January 2021.

Abstract 12546: Major Adverse Cardiovascular Events and Hospital Readmissions in the 90 Days Following Acute Myocardial Infarction: Redefining the Risk Period

Introduction: Centers for Medicare &amp; Medicaid Services (CMS) has implemented a voluntary bundled payment program centered on a 90-day period for acute myocardial infarction (AMI) to increase the quality of care and reduce costs. Tying payments and penalties to a 90-day period, versus the current 30-day period for quality metrics, redefines the risk period for recurrent events following AMI. Objective: To quantify the clinical burden of recurrent events in the 30- and 90-day period post AMI. Methods: A retrospective cohort analysis was conducted of 30- and 90-day major adverse cardiovascular events (MACE: mortality, AMI readmission and stroke), all-cause and cardiac rehospitalization among patients with a primary diagnosis of AMI within a Medicare population. Results: This analysis included 125,772 Medicare patients. At 90 days, the overall rate of all-cause and cardiac rehospitalization was 23.7% and 13.2%, respectively. The rate of MACE at 90 days was 10.2%. Rates of all outcomes increased significantly between day 30 and day 90 (p&lt;0.0001, Figure 1). Relative increases were observed in all-cause rehospitalization (82.1%), cardiac rehospitalization (77.8%), MACE (99.8%), AMI readmission (374.3%), mortality (82.2%), and stroke (77.8%). Conclusions: The 90-day period post AMI is associated with significant healthcare burden, with approximately one quarter of AMI episodes associated with hospital readmissions. Rates of outcomes increase substantially between 30 and 90 days post AMI, in particular AMI readmission increases disproportionately relative to the increase in timeframe. These findings represent a significant impact when moving from a 30- to a 90-day payment bundling model.

Impact of pre-treatment with acetylsalicylic acid on the severity of a first myocardial infarction in diabetic patients

Abstract Introduction Diabetes Mellitus (DM) is one of the main risk factors for cardiovascular disease (CVD). Guidelines on the use of acetylsalicylic acid (ASA) for primary prevention of CVD in this population are conflicting. A potential reduction in the severity of a first episode of Acute Myocardial Infarction (AMI) could be seen has an additional argument for the use of ASA in primary prevention. Aim: To evaluate the impact of prior intake of ASA on the presentation, severity and short-term prognosis of AMI in diabetic patients without history of CVD. Methods Retrospective analysis of diabetic patients without previous evidence of CVD diagnosed with type 1 AMI between January 2002 and December 2018, inserted in a multicentric registry of acute coronary syndromes. Patients were dichotomized according to whether or not they were taking ASA prior to the index event. Groups were compared according to clinical, analytical and imaging endpoints. Results A total of 2596 patients were included, predominantly men (66.4%), with a mean age of 68±12 years old. Patients on ASA (19.7%) were significantly older (71±10 vs. 67±12, p&amp;lt;0.001) and had a higher prevalence of hypertension (89.2% vs 77.9%, p&amp;lt;0.001), dyslipidaemia (69.8% vs. 61.1%, p&amp;lt;0.001) and chronic kidney disease (10.6% vs. 4.9%, p&amp;lt;0.001). Overall, there was a lower prevalence of AMI with ST-segment elevation (36.5% vs. 50.8%, p&amp;lt;0.001) in patients on ASA. However, the same group of patients had a significantly higher probability of evolution in Killip class &amp;gt; I (25.4% vs. 17.0%, p&amp;lt;0.001), a higher median BNP elevation (315 [126–623] vs. 166 [64–431], p&amp;lt;0.001); and a lower average ejection fraction upon discharge (49.0±12 vs. 51±12, p=0.011). Patients on prior regular intake of ASA also had a higher prevalence of multivessel disease (38.4% vs. 28.9%, p&amp;lt;0.001) and multiple significant stenosis (70.2% vs. 61.7%, p&amp;lt;0.001). There was no significant difference regarding the percentage of electrical complications (2.3% vs. 1.2%, p=0.06), use of intra-aortic balloon pump (1.0 vs. 0.9%, p=0.74) and in-hospital death (3.0% vs. 2.4%, p=0.46). In a logistic regression model adjusted for age, sex, comorbidities and previous medication as variates, prior ASA intake was an independent predictor of a lower rate of AMI with ST-segment elevation (ExpB −0.34; 95% CI: 0.57–0.89; p=0.003). On the contrary, when adjusted to these variables, prior ASA intake was not an independent predictor of higher BNP (p=0.13) or higher probability of multivessel disease (p=0.22) or presence of ≥1 significant stenosis (p=0.31). Conclusions In this population of diabetic patients with a first episode of ACS, prior use of ASA in the context of primary prevention was associated with a significant lower rate of ST-segment elevation myocardial infarction. Funding Acknowledgement Type of funding source: None

Good long-term survival of Icelandic women following acute myocardial infarction

Abstract Background Mortality from coronary artery disease has decreased considerably in recent decades in Western societies, but less in women compared with men. Possible explanations for this difference include delayed medical attention, atypical presenting symptoms and also a higher incidence of myocardial infarction with non-obstructive coronary arteries in women. In addition, recent studies suggest that women with acute myocardial infarction (AMI) are less likely to receive treatment according to guidelines, which results in worse prognosis for women. Iceland is listed as one of the most gender-equal countries in the world and we hypothesised that this may reduce the gender gap in treatment and survival following AMI. Purpose The aim of this nationwide study was to compare clinical characteristics and treatment of men and women with AMI, identify independent risk factors for long-term mortality and estimate the impact of gender on relative survival. Methods This was a retrospective cohort study on all patients in Iceland with STEMI (2008–2018) and NSTEMI (2013–2018) who had obstructive coronary artery disease on coronary angiography. Information about patients and angiography results and treatment were obtained from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) and electronic health records. Data for all-cause mortality was extracted through linkage with Statistics Iceland and survival was estimated with Kaplan-Meier method and Cox regression analysis used to identify significant risk factors for long-term mortality. Excess mortality from the AMI episode was estimated by comparing the survival with age- and gender-matched population in Iceland in 30-day intervals. Results A total of 1345 STEMI patients (24% women) and 1249 NSTEMI patients (24% women) were evaluated. Women with both STEMI (mean age: 71±11. vs. 67±12) and NSTEMI (mean age: 69±13 vs. 62±12) were older and less likely to have a cardiovascular history. There was no gender difference in the extent of coronary artery disease or treatment. Whilst long-term survival for women following STEMI (A) was lower, female gender was not found to be an independent risk factor for mortality after adjusting for age and comorbidities (HR 0.98, 95%-CI: 0.75–1.29). The survival after NSTEMI was similar between genders (B) and female gender was a protective prognostic factor (HR 0.67, 95% CI: 0.46–0.97). There was an excess 30-day mortality following STEMI (C) and NSTEMI (D) for both women and men compared to the matched Icelandic population, but thereafter the mortality rate was similar. Conclusion Our findings indicates that women and men in Iceland receive comparable treatment for AMI, including invasive treatment. Prognosis following NSTEMI is better in women. Higher early mortality after STEMI may be caused by delays in presentation and diagnosis as well as older age of women because female gender was not a significant risk factor for mortality. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): University hospital of Iceland, 4 weeks research leave

Association of NPAC score with survival after acute myocardial infarction

Background and aimsRisk stratification in acute myocardial infarction (AMI) is important for guiding clinical management. Current risk scores are mostly derived from clinical trials with stringent patient selection. We aimed to establish and evaluate a composite scoring system to improve short-term mortality classification after index episodes of AMI, independent of electrocardiography (ECG) pattern, in a large real-world cohort. MethodsUsing electronic health records, patients admitted to our regional teaching hospital (derivation cohort, n = 1747) and an independent tertiary care center (validation cohort, n = 1276), with index acute myocardial infarction between January 2013 and December 2017, as confirmed by principal diagnosis and laboratory findings, were identified retrospectively. ResultsUnivariate logistic regression was used as the primary model to identify potential contributors to mortality. Stepwise forward likelihood ratio logistic regression revealed that neutrophil-to-lymphocyte ratio, peripheral vascular disease, age, and serum creatinine (NPAC) were significant for 90-day mortality (Hosmer- Lemeshow test, p = 0.21). Each component of the NPAC score was weighted by beta-coefficients in multivariate analysis. The C-statistic of the NPAC score was 0.75, which was higher than the conventional Charlson's score (C-statistic = 0.63). Judicious application of a deep learning model to our dataset improved the accuracy of classification with a C-statistic of 0.81. ConclusionsThe NPAC score comprises four items from routine laboratory parameters to basic clinical information and can facilitate early identification of cases at risk of short-term mortality following index myocardial infarction. Deep learning model can serve as a gatekeeper to facilitate clinical decision-making.

Plaque morphology assessed by optical coherence tomography in the culprit lesions of the first episode of acute myocardial infarction in patients with low low-density lipoprotein cholesterol level

BackgroundThere remains a residual risk for acute myocardial infarction (AMI) even with low low-density lipoprotein cholesterol (LDL-C) levels. This study aimed to characterize the culprit lesion morphology of AMI by optical coherence tomography (OCT) in patients with low LDL-C. MethodsFour-hundred and nine culprit lesions of 409 patients with their first presentation of AMI imaged by OCT were investigated. OCT analysis included the presence of plaque rupture and thin-capped fibroatheroma (TCFA). Fibrous cap thickness and lipid length were also measured. Intravascular ultrasound (IVUS) was performed in 368 (90.0%) patients. OCT and IVUS findings were compared between patients with LDL-C < 100 mg/dl (lower-LDL group) and those with LDL ≥ 100 mg/dl (higher-LDL group). ResultsLower-LDL group included 93 (22.7%) patients. Plaque rupture (54.8% vs. 68.7%, p = 0.018) and TCFA (39.8% vs. 54.6%, p = 0.013) were less frequently observed in lower-LDL than in higher-LDL. Fibrous cap was thicker [73 (59–109) µm vs. 63 (57–83) µm, p = 0.028] and lipid length was smaller [5.4 (2.3–9.9) mm vs. 7.1 (4.1–10.5) mm, p = 0.012] in lower-LDL than in higher-LDL. There were no significant differences in IVUS parameters including plaque burden or remodeling index between the two groups. ConclusionsPatients with lower LDL-C showed more prevalent intact fibrous cap and less vulnerable features in the culprit lesions, which may suggest the need for exploring a specific strategy for the prevention of plaque erosion in low LDL-C subjects.

Low adherence to statin treatment during the 1st year after an acute myocardial infarction is associated with increased 2nd-year mortality risk-an inverse probability of treatment weighted study on 54 872 patients.

AimsExperiencing an acute myocardial infarction (AMI) is a life-threatening event and use of statins can reduce the probability of recurrence and improve long-term survival. However, the effectiveness of statins in the real-world setting may be lower than the reported efficacy in randomized clinical trials. Therefore, we aimed to investigate whether low statin treatment adherence during the year following an AMI episode is associated with increased 2nd-year mortality.Methods and resultsWe analysed all 54 872 AMI patients aged ≥45 years, admitted to Swedish hospitals between 2010 and 2012, and who survive at least 1 year after the AMI episode. We defined low adherence as a medication possession ratio <50% or non-use of statins. Applying inverse probability of treatment weighting (IPTW), we investigated the association between low adherence and all-cause, cardiovascular disease (CVD), and non-CVD mortality during the 2nd year. Overall, 20% of the patients had low adherence during the 1st year and 8% died during the 2nd year. In the IPTW analysis, low adherence was associated with an increased risk of all-cause [absolute risk difference (ARD) = 0.048, number needed to harm (NNH) = 21, relative risk (RR) = 1.71], CVD (ARD = 0.035, NNH = 29, RR = 1.62), and non-CVD mortality (ARD = 0.013, NNH = 77, RR = 2.17).ConclusionIn the real-world setting, low statin adherence during the 1st year after an AMI episode is associated with increased mortality during the 2nd year. Our results reaffirm the importance of achieving a high adherence to statin treatment after suffering from an AMI.

P5014The NPAC score for predicting survival after incident acute myocardial infarction

Abstract Background Risk stratification in acute myocardial infarction (AMI) is important for guiding clinical management. Current risk scores are mostly derived from clinical trials with stringent patient selection. We aimed to establish and evaluate a composite scoring system to predict short-term mortality after index episodes of AMI, independent of electrocardiography (ECG) pattern, in a large real-world cohort. Methods Using electronic health records, patients admitted to our regional teaching hospital (derivation cohort, n=2127) and an independent tertiary care center (validation cohort, n=1276) with index acute myocardial infarction between January 2013 and December 2017 as confirmed by principal diagnosis and laboratory findings, were identified retrospectively. Results Univariate logistic regression was used as the primary model to identify potential contributors to mortality. Stepwise forward likelihood ratio logistic regression revealed that neutrophil-to-lymphocyte ratio, peripheral vascular disease, age, and serum creatinine (NPAC) were significant predictors for 90-day mortality (Hosmer-Lemeshow test, P=0.21). Each component of the NPAC score was weighted by beta-coefficients in multivariate analysis. The C-statistic of the NPAC score was 0.75, which was higher than the conventional Charlson's score (C-statistic=0.63). Application of a deep learning model to our dataset improved the accuracy of classification with a C-statistic of 0.81. Multivariate binary logistic regression Variable β Adjusted Odds ratio (95% CI) P-value Points Age ≥65 years 1.304 3.68 (2.63–5.17) &lt;0.001 2 Peripheral vascular disease 1.109 3.03 (1.52–6.04) 0.002 2 NLRt ≥9.51 1.100 2.73 (2.12–3.51) &lt;0.001 1 Creatinine≥109 μmol/L 1.003 3.00 (2.35–3.85) &lt;0.001 2 NPAC deep learning model Conclusions The NPAC score comprised of four items from routine laboratory parameters and basic clinical information and can facilitate early identification of cases at risk of short-term mortality following index myocardial infarction. Deep learning model can serve as a gate-keeper to provide more accurate prediction to facilitate clinical decision making.

P5473Perceived well-being after acute myocardial infarction according to diabetic status and its impact long-term mortality. The FAST-MI programme

Abstract Background Little information is available regarding subjective well-being according to diabetic status in patients surviving an acute myocardial infarction (AMI). Aims and methods A health status questionnaire was sent to all patients participating in the nationwide French FAST-MI cohorts (2005, 2010 and 2015) one year after the acute episode of AMI, with a specific question on overall health condition (how do you feel: very well, well, fair, poor) (n=6082), and additional questions on the presence of any chest pain (n=4590), presence nuisance bleedings (n=3968), and reporting of perceived medication side-effects (n=2220). Answers were analysed according to diabetic status. We also analysed in the 2005 and 2010 cohorts whether subjective health status at one year was a correlate of 5-year mortality. Results Compared with non-diabetic patients (n=4692), those with diabetes (n=1390) had a poorer perceived health status (poor/fair health status: 40% vs 30%, P&lt;0.001), more presence of chest pain (31% vs 23%, P&lt;0.001), but less nuisance bleedings (47% vs 56%, P&lt;0.001) and similar reported medication side-effects (37% vs 41%, P=0.12). Using logistic regression analysis, diabetes was an independent correlate of poorer health status (any diabetes OR vs non-diabetic 1.29, 1.13–1.49, P&lt;0.001; non-insulin-treated: 1.17, 1.00–1.36, P=0.05, insulin-treated: 1.58, 1.29–1.94, P&lt;0.001). In diabetic patients, perceived health condition at one year was an independent correlate of 5-year death (Cox multivariate analysis): compared with patients reporting very good health, HR (95% CI) 2.16 (1.08–4.32) for good health, 3.06 (1.53–6.11) for fair health, and 3.63 (1.55–8.55) for poor health; in non-diabetic patients, 5-year survival was similar in those reporting good or very good health status, but lower in those reporting fair or poor health status (Figure). Figure 1. 5-year survival by health status Conclusion Compared with non-diabetic patients, patients with diabetes described a poorer general health and more residual chest pain after AMI, but had less nuisance bleedings. Health condition reported one year after AMI was an independent correlate of subsequent long-term mortality, particularly for diabetic patients. Acknowledgement/Funding Amgen, AstraZeneca, Bayer, Daiichi-Sankyo, Eli-Lilly, GSK, MSD, Novartis, Pfizer, Sanofi, Servier