Events Myocardial Infarction Research Articles

Drug-coated balloon: an effective alternative to stent strategy in small-vessel coronary artery disease-a meta-analysis.

Small-vessel coronary artery disease (CAD) is frequently observed in coronary angiography and linked to a higher risk of lesion failure and restenosis. Currently, treatment of small vessels is not standardized while having drug-eluting stents (DES) or drug-coated balloons (DCBs) as possible strategies. We aimed to conduct a meta-analytic approach to assess the effectiveness of treatment strategies and outcomes for small-vessel CAD. Comprehensive literature search was conducted using PubMed, Embase, MEDLINE, and Cochrane Library databases to identify studies reporting treatment strategies of small-vessel CAD with a reference diameter of ≤3.0 mm. Target lesion revascularization (TLR), target lesion thrombosis, all-cause death, myocardial infarction (MI), and major adverse cardiac events (MACE) were defined as clinical outcomes. Outcomes from single-arm and randomized studies based on measures by means of their corresponding 95% confidence intervals (CI) were compared using a meta-analytic approach. Statistical significance was assumed if CIs did not overlap. Thirty-seven eligible studies with a total of 31,835 patients with small-vessel CAD were included in the present analysis. Among those, 28,147 patients were treated with DES (24 studies) and 3,299 patients with DCB (18 studies). Common baseline characteristics were equally distributed in the different studies. TLR rate was 4% in both treatment strategies [0.04; 95% CI 0.03-0.05 (DES) vs. 0.03-0.07 (DCB)]. MI occurred in 3% of patients receiving DES and in 2% treated with DCB [0.03 (0.02-0.04) vs. 0.02 (0.01-0.03)]. All-cause mortality was 3% in the DES group [0.03 (0.02-0.05)] compared with 1% in the DCB group [0.01 (0.00-0.03)]. Approximately 9% of patients with DES developed MACE vs. 4% of patients with DCB [0.09 (0.07-0.10) vs. 0.04 (0.02-0.08)]. Meta-regression analysis did not show a significant impact of reference vessel diameter on outcomes. This large meta-analytic approach demonstrates similar clinical and angiographic results between treatment strategies with DES and DCB in small-vessel CAD. Therefore, DES may be waived in small coronary arteries when PCI is performed with DCB.

High Self-Reported Levels of Pain 1 Year After a Myocardial Infarction Are Related to Long-Term All-Cause Mortality: A SWEDEHEART Study Including 18 376 Patients.

Background Pain increases the risk for cardiovascular diseases, including myocardial infarction (MI). However, the impact of pain on mortality after MI has not yet been investigated in large studies with long-term follow-up periods. Thus, we aimed to examine various levels of pain severity 1 year after an MI as a potential risk for all-cause mortality. Methods and Results We collected data from 18 376 patients, aged <75 years, who had a registered MI event during the period from 2004 to 2013 and with measurements of potential cardiovascular risk indicators at hospital discharge from the Swedish quality register SWEDEHEART (Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies). Self-reported levels of experienced pain according to EuroQol-5 dimension instrument were recorded in secondary prevention clinics 1 year after hospital discharge. We collected all-cause mortality data up to 8.5 years (median, 3.4 years) after the 1-year visit. The Cox proportional hazard regression was used to estimate hazard ratio (HR) and 95% CI. Moderate pain and extreme pain were reported by 38.2% and 4.5%, respectively, of included patients. There were 1067 deaths. Adjusted HR was 1.35 (95% CI, 1.18-1.55) and 2.06 (95% CI, 1.63-2.60) for moderate and extreme pain, respectively. Pain was a stronger mortality predictor than smoking. Conclusions Pain 1 year after MI is highly prevalent, and its effect on mortality 1 year after MI was found to be more pronounced than smoking. Clinicians managing patients after MI should recognize the need to consider experienced pain when making prognosis or treatment decisions.

THE EFFICACY AND SAFETY OF VASOPRESSORS FOR SEPTIC SHOCK PATIENTS: A SYSTEMIC REVIEW AND NETWORK META-ANALYSIS.

Background: Septic shock is a distributive shock with decreased systemic vascular resistance and MAP. Septic shock contributes to the most common causes of death in the intensive care unit (ICU). Current guidelines recommend the use of norepinephrine as the first-line vasopressor, whereas adrenergic agonists and vasopressin analogs are also commonly used by physicians. To date, very few studies have synthetically compared the effects of multiple types of vasoactive medications. The aim of this study was to systemically evaluate the efficacy of vasoactive agents both individually and in combination to treat septic shock. Methods: The PubMed, MEDLINE, Embase, Web of Science, and Cochrane Central Register for Controlled Trials (CENTRAL) were searched up to May 12, 2022, to identify relevant randomized controlled trials. A network meta-analysis was performed to evaluate the effect of different types of vasopressors. The primary outcome was 28-day all-cause mortality. The secondary outcome was the ICU length of stay. Adverse events are defined as any undesirable outcomes, including myocardial infarction, cardiac arrhythmia, peripheral ischemia, or stroke and cerebrovascular events. Findings: Thirty-three randomized controlled trials comprising 4,966 patients and assessing 8 types of vasoactive treatments were included in the network meta-analysis. The surface under the cumulative ranking curve provided a ranking of vasoactive medications in terms of 28-day all-cause mortality from most effective to least effective: norepinephrine plus dobutamine, epinephrine, vasopressin, terlipressin, norepinephrine, norepinephrine plus vasopressin, dopamine, and dobutamine. Dopamine was associated with a significantly shorter ICU stay than norepinephrine, terlipressin, and vasopressin, whereas other vasoactive medications showed no definite difference in ICU length of stay. Regarding adverse events, norepinephrine was associated with the highest incidences of myocardial infarction and peripheral ischemia. Dopamine was associated with the highest incidence of cardiac arrhythmia. Epinephrine and terlipressin were associated with the highest incidences of myocardial infarction and peripheral ischemia. Interpretation: The results of this network meta-analysis suggest that norepinephrine plus dobutamine is associated with a lower risk of 28-day mortality in septic shock patients than other vasoactive medications, and the use of dopamine is associated with a higher risk of 28-day mortality due to septic shock than norepinephrine, terlipressin, and vasopressin.

The potential impact of computed tomography coronary calcium score screening on patients with dyslipidemia

Background Coronary artery calcium (CAC) scoring helps determine whether patients with known coronary artery disease (CAD) should initiate medical management by predicting future cardiac event risk. CAC scoring is underutilized because many insurance companies consider it experimental. This study aimed to determine whether CAC screening of patients at risk for CAD is associated with decreased risk of myocardial infarction and improved survival. Methods The TriNetX research network was used for this study. Two cohorts of 86,574 patients aged 40 to 70 years were created. All patients were diagnosed with dyslipidemia and without CAD, and the cohorts were matched for demographics, comorbidities, and statin use. One cohort had been screened with CAC scoring while the other had not. The primary outcomes of this study were myocardial infarction and overall survival at 5 years. Results Screened patients had 44% fewer myocardial infarction events at 5 years with a 76% lower risk of death. Conclusion CAC scoring is associated with reduced risk of myocardial infarction and death in asymptomatic dyslipidemia patients and should be considered as a screening tool in these patients. The presumed mechanism for improved outcomes is that early identification of CAD results in earlier or more intensive treatment, reducing future cardiac event risk.

The protective effects of humanin in rats with experimental myocardial infarction: The role of asprosin and spexin

ObjectiveIn this study, by applying humanin (HN) before myocardial infarction (MI) in rats, its protection in MI and the possible roles in asprosin and spexin were investigated. Materials and methodsThe rats were divided into 7 groups each with 6 rats (group I (control), group II (HN 48th hour), group III (HN 7th day), group IV (MI 48th hour), group V (MI 7th day), group VI (MI + HN 48th hour), group VII (MI + HN 7th day). To create MI, 200 mg/kg isoproterenol (ISO) was administered subcutaneously to the rats. 2 mg/kg HN was given intraperitoneally (ip) to rats alone and before MI. Molecular parameters asprosin and spexin were examined by immunohistochemical in heart tissue. Biochemical parameters (aspartate aminotransferase (AST), lactate dehydrogenase (LDH), creatine kinase MB (CK-MB), Troponin I) were studied in serum by enzyme-linked immunosorbent assay (ELISA) method. ResultsIt was found in the study that the levels of spexin elevated especially towards the 7th day after MI and decreased more significantly towards the 7th day, after HN application before MI. Asprosin elevated significantly towards the 7th day after MI and decreased especially on the 7th day after HN application before MI. Also, serum AST, LDH, CK-MB, and Troponin I levels tended to decrease and a significant decrease was detected in congested veins in the heart tissue at the 48th hour of MI and erythrocyte extravasation, congested veins and necrotic muscle fibers at the 7th day of MI in rats given HN before MI. ConclusionIt was concluded that HN has a cardioprotective effect in MI and asprosin and spexin might mediate this effect.

Pregnancy Loss and the Risk of Myocardial Infarction, Stroke, and All-Cause Mortality: A Nationwide Partner Comparison Cohort Study.

Background Pregnancy loss has been associated with myocardial infarction, stroke, and all-cause mortality in women through unknown mechanisms. The aim of this study was to examine these associations in women and their male partners. Methods and Results In this register-based cohort study, all people born between 1957 and 1997, residing in Denmark between 1977 and 2017, and with a registered partner of the opposite sex were eligible for inclusion. Male partners through cohabitation, marriage, or paternity constituted the male cohort. Exposure to pregnancy loss was categorized as follows: 0, 1, 2, or ≥3 pregnancy losses. The outcomes of interest were myocardial infarction, stroke, and all-cause mortality. The Cox proportional hazards model estimated hazard ratios (HRs), adjusted for age, calendar year, parity, and parental history of myocardial infarction or stroke. During follow-up, 1 112 507 women experienced 4463 events of myocardial infarction compared with 13 838 events among 1 120 029 male partners. With the no pregnancy loss group as reference, the adjusted HRs of myocardial infarction in the female cohort after 1, 2, and ≥3 pregnancy losses were as follows: 1.1 (95% CI, 1.0-1.2), 1.3 (95% CI, 1.1-1.5), and 1.4 (95% CI, 1.1-1.8), respectively. In the male partner cohort, the corresponding estimates were 1.0 (95% CI, 1.0-1.1), 1.1 (95% CI, 1.0-1.2), and 1.0 (95% CI, 0.8-1.2), respectively. The outcome of stroke showed similar results. Pregnancy loss was not significantly associated with increased mortality in either sex. Conclusions Pregnancy loss or stillbirth was significantly associated with myocardial infarction and stroke in women but not their male partners. Pregnancy loss or stillbirth was not significantly associated with all-cause mortality in women or male partners.

Association of Hypoxia-Inducible Factor Prolyl Hydroxylase Inhibitors with Cardiovascular Events and Death in Dialysis Patients: A Systematic Review and Meta-Analysis

Background: Anemia is a common finding among patients with advanced chronic kidney disease, especially those on dialysis. The recent introduction of hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs) has raised some concerns about the cardiovascular and thrombotic complications of this class of drugs. Objectives: This meta-analysis aimed to assess the safety of HIF-PHIs in patients with end-stage kidney disease (ESKD) versus standard therapy with erythropoiesis-stimulating agents (ESAs). Methods: Databases were searched on April 2022. Studies that reported incidence of all-cause mortality; major cardiovascular adverse events (MACEs); myocardial infarction (MI); stroke and thrombotic events in the use of HIF-PHIs or ESA on ESKD patients in hemodialysis or peritoneal dialysis were evaluated. Data were extracted from published reports, and quality assessment was performed per Cochrane recommendations. Results: 12,821 patients from ten randomized controlled trials were included in this study. Most patients (83%) were on hemodialysis. 6,461 (50.3%) were using HIF-PHIs, and 6,360 (49.6%) were in the ESA group. The pooled estimated incidence of all-cause mortality was 769 in the HIF-PHIs group (relative-risk ratios (RR): 1.04; confidence interval (CI): 0.95–1.14; p = 0.52; I² = 0%). There was no difference in the groups regarding the outcomes of MACE in the analysis of the three studies that reported this outcome (RR: 0.95; CI: 0.87–1.04; p = 0.69; I² = 0%). In addition, there was no statistical difference among the outcomes of MI, stroke, or thrombotic events. Conclusions: Among patients with ESKD on dialysis, the use of HIF-PHIs was non-inferior regarding the safety outcomes when compared to standard of care therapy.

Theory-based cognitive–narrative intervention versus didactic education for promoting prompt care-seeking for acute myocardial infarction: A multisite mixed-methods randomized controlled trial

BackgroundProlonged delays by patients in making care-seeking decisions remain a significant obstacle to the effective management of acute myocardial infarction. ObjectivesThis study aimed to compare the effects of a theory-based cognitive–narrative intervention with those of didactic education over a 24-month period on the participants' attitudes, beliefs, and knowledge regarding acute myocardial infarction, prehospital delay time, and the use of an ambulance. We also explored participants' engagement in the intervention. DesignThis study adopted a sequential mixed-methods design comprising a multisite randomized controlled trial and a qualitative study. MethodsCommunity-dwelling adult patients with a prior history of acute myocardial infarction in the past year were recruited from four hospitals in Hong Kong. They were randomly assigned to an 8-week theory-based cognitive–narrative intervention that involved a vivid experience of complex decision-making or didactic education. The Acute Coronary Syndrome Response Index questionnaire was administered at baseline (T0) and at 3- (T1), 12- (T2), and 24-month (T3) follow-up time points. Prehospital delay time and the use of an ambulance were evaluated for those participants who had recurrent acute myocardial infarction attacks during the study period. ResultsA total of 608 participants were randomly assigned to the theory-based cognitive–narrative intervention group (n = 304) or the didactic education group (n = 304). The intervention group reported greater improvements than the control group in their attitudes (β = −1.053, p = 0.002) and beliefs (β = −0.686, p = 0.041) regarding acute myocardial infarction and care-seeking at T1. These effects were sustained at T2 [attitudes (β = −0.797, p = 0.018); beliefs (β = −0.692, p = 0.047)] and T3 [attitudes (β = −0.717, p = 0.024); beliefs (β = −0.701, p = 0.032)]. Sixty-three participants experienced another acute myocardial infarction event by T2. The median delay times for the intervention and control groups were 3.13 h (interquartile range (IQR: 1.15–6.48)) and 4.82 h (IQR: 2.23–9.02), respectively. The prehospital delay time was significantly reduced in the intervention group compared with the control group (β = −0.07, p = 0.011). The qualitative findings echoed the quantitative findings, as participants indicated that the intervention helped them to understand the variable nature of the disease presentation, which enabled them to recognize the symptoms more readily. ConclusionThe novel cognitive–narrative intervention used in this study effectively improved the participants' attitudes and beliefs regarding acute myocardial infarction and reduced the prehospital delay time. Trial registrationThis study was registered with the International Clinical Trials Registry Platform of the World Health Organization (ChiCTR-IIC-17010576) on February 2, 2017; the first participant was recruited on January 11, 2018.

High triglyceride-glucose index and stress hyperglycemia ratio as predictors of adverse cardiac events in patients with coronary chronic total occlusion: a large-scale prospective cohort study

BackgroundThe triglyceride-glucose (TyG) index and the stress hyperglycaemia ratio (SHR) are both positively associated with cardiovascular (CV) risk in patients with coronary heart disease. However, the prognostic value of these two biomarkers has not been well elucidated in patients with chronic total occlusion (CTO). Therefore, this study aims to evaluate the association of the TyG index and the SHR with long-term prognosis in patients with CTO.MethodsThis prospective cohort study consecutively included 2740 angina patients with CTO from January 2017 to December 2018 at Fuwai Hospital. The outcomes are a composite of CV death and target vessel myocardial infarction (TVMI) and major CV cerebrovascular adverse events (MACCEs, including all-cause death, nonfatal MI, ischaemia-driven target vessel revascularization, and stroke). The association between biomarkers and prognosis was analysed by multivariable Cox proportional hazard models, and the predictive value was determined by a receiver-operating characteristic (ROC) curve.ResultsDuring the follow-up with a median time of 3 years, 179 (6.5%) cases of MACCEs and 47 (1.7%) cases of CV death or TVMI were recorded. Patients with a high TyG index (> 9.10) and a high SHR (> 0.87) showed a significantly increased risk of CV death/TVMI (TyG index: HR 4.23, 95% CI 1.58–11.37; SHR: HR 5.14, 95% CI 1.89–13.98) and MACCEs (TyG index: HR 2.47, 95% CI 1.54–3.97; SHR: HR 2.91, 95% CI 1.84–4.60) compared with those with a low Tyg index and a low SHR (TyG < 8.56, SHR < 0.76). The area under the curve (AUC) values were 0.623 (TyG index) and 0.589 (SHR) for CV death/TVMI and 0.659 (TyG index) and 0.624 (SHR) for MACCEs. Furthermore, patients with both a high TyG index and a high SHR showed the highest risk of clinical outcomes among patients with different levels of these two biomarkers, and the AUC for the TyG-SHR combination was larger than the TyG index alone in predicting MACCE risk.ConclusionsThe study revealed that a high TyG index and a high SHR were significantly correlated with poor prognosis in patients with CTO and suggested that these two biomarkers are reliable in predicting long-term prognosis in CTO patients.

Predictive value of CHA2 DS2 -VASc score for in-hospital prognosis of patients with acute ST-segment elevation myocardial infarction undergoing primary PCI.

This study aimed to explore the predictive value of CHA2 DS2 -VASc score for in-hospital major adverse cardiac events (MACEs) in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary artery intervention. A total of 746 STEMI patients were divided into four groups according to CHA2 DS2 -VASc score (1, 2-3, 4-5, >5). The predictive ability of the CHA2 DS2 -VASc score for in-hospital MACE was made. Subgroup analysis was made between gender differences. In a multivariate logistic regression analysis model including creatinine, total cholesterol, and left ventricular ejection fraction, CHA2 DS2 -VASc score was an independent predictor of MACE as a continuous variable (adjusted odds ratio: 1.43, 95% confidence interval [CI]: 1.27-1.62, p < .001). As a category variable, using the lowest CHA2 DS2 -VASc score of 1 as a reference, CHA2 DS2 -VASc score 2-3, 4-5, >5 groups for predicting MACE was 4.62 (95% CI: 1.94-11.00, p = .001), 7.74 (95% CI: 3.18-18.89, p < .001), and 11.71 (95% CI: 4.14-33.15, p < .001). The CHA2 DS2 -VASc score was also an independent risk factor for MACE in the male group, either as a continuous variable or category variable. However, CHA2 DS2 -VASc score was not a predictor of MACE in the female group. The area under the curve value of the CHA2 DS2 -VASc score for predicting MACE was 0.661 in total patients (74.1% sensitivity and 50.4% specificity [p < .001]), 0.714 in the male group (69.4% sensitivity and 63.1% specificity [p < .001]), but there was no statistical significance in the female group. CHA2 DS2 -VASc score could be considered as a potential predictor of in-hospital MACE with STEMI, especially in males.

A novel de-escalation antiplatelet therapy for patients with acute coronary syndrome undergoing percutaneous coronary intervention.

To investigate the effect of different DAPTs in patients with ACS undergoing PCI, and to identify the most efficient DAPT to reduce the risk of ischemia and bleeding after PCI. Between March 2017 and December 2021, 1598 patients with ACS who underwent PCI were included in the study. The DAPT protocol included the clopidogrel group (aspirin 100 mg + clopidogrel 75 mg), ticagrelor group (aspirin 100 mg + ticagrelor 90 mg), de-escalation Group 1 (reduced dose of ticagrelor [from 90 mg to 60 mg]) after 3 months of oral DAPT [aspirin 100 mg + ticagrelor 90 mg]), and de-escalation Group 2 (switched from ticagrelor to clopidogrel after 3 months of oral DAPT [aspirin 100 mg + ticagrelor 90 mg]). All patients received a 12-month follow-up. The primary endpoint was net adverse clinical events (NACEs) that included the composite endpoints of cardiac death, myocardial infarction, ischemia-driven revascularization, stroke, and bleeding events. There were 2 secondary endpoints, major adverse cardiovascular and cerebrovascular events (MACCEs) and bleeding. No statistically significant difference was found in the incidence of NACEs between the 4 groups at the average 12-month follow-up (15.7% vs 19.2% vs 16.7% vs 20.4%). Cox regression analysis revealed that DAPT ticagrelor group regimen (hazard ratio [HR] 0.547; 95% confidence interval [CI]: 0.334-0.896; P = .017) were associated with a lower risk of MACCEs. Age (HR 1.024; 95% CI: 1.003-1.046; P = .022). DAPT de-escalation Group 2 regimen (HR 1.665; 95% CI: 1.001-2.767; P = .049) were marginally associated with a higher risk of MACCEs. Ticagrelor group regimen (HR 1.856; 95% CI: 1.376-2.504; P < .001) was associated with higher risk of bleeding events. Ticagrelor group regimen (HR 1.606; 95% CI: 1.179-2.187; P = .003) were associated with a higher risk of minor bleeding events. For patients with ACS underwent PCI, there were no significant difference in the incidence of NACEs between 3 and 12 months after PCI between de-escalation and non-de-escalation therapies. Compared with ticagrelor-based 12-month DAPT, there was no significant difference in MACCEs and bleeding events in patients receiving de-escalation treatment (ticagrelor reduction from 90 to 60 mg, 3 months after PCI).

Sirolimus-Coated Balloon in an All-Comer Population of Coronary Artery Disease Patients: The EASTBOURNE Prospective Registry

BackgroundDrug-coated balloons (DCB) represent 1 of the most promising innovations in interventional cardiology and may represent a valid alternative to drug-eluting stents. Currently, some sirolimus-coated balloons (SCB) are being investigated for several coronary artery disease applications. ObjectivesThis study sought to understand the role of a novel SCB for the treatment of coronary artery disease. MethodsEASTBOURNE (All-Comers Sirolimus-Coated Balloon European Registry) is a prospective, multicenter, investigator-driven clinical study that enrolled real-world patients treated with SCB. Primary endpoint was target lesion revascularization (TLR) at 12 months. Secondary endpoints were procedural success, myocardial infarction (MI), all-cause death, and major adverse clinical events (a composite of death, MI, and TLR). All adverse events were censored and adjudicated by an independent clinical events committee. ResultsA total population of 2,123 patients (2,440 lesions) was enrolled at 38 study centers in Europe and Asia. The average age was 66.6 ± 11.3 years, and diabetic patients were 41.5%. De novo lesions (small vessels) were 56%, in-stent restenosis (ISR) 44%, and bailout stenting occurred in 7.7% of the patients. After 12 months, TLR occurred in 5.9% of the lesions, major adverse clinical events in 9.9%, and spontaneous MI in 2.4% of the patients. The rates of cardiac/all-cause death were 1.5% and 2.5%, respectively. The primary outcome occurred more frequently in the ISR cohort (10.5% vs 2.0%; risk ratio: 1.90; 95% CI: 1.13-3.19). After multivariate Cox regression model, the main determinant for occurrence of the primary endpoint was ISR (OR: 5.5; 95% CI: 3.382-8.881). ConclusionsEASTBOURNE, the largest DCB study in the coronary field, shows the safety and efficacy of a novel SCB in a broad population of coronary artery disease including small vessels and ISR patients at mid-term follow-up. (The All-Comers Sirolimus-Coated Balloon European Registry [EASTBOURNE]; NCT03085823)

465-P: Anti-inflammatory Therapies in Patients with Established Cardiovascular Disease or High Cardiovascular Risks

Background: To evaluate the association between anti-inflammatory therapies and the incidence of cardiovascular events in patients with established cardiovascular disease (CVD) or high cardiovascular risks. Methods: Literature retrieval was conducted in Pubmed, Medline, Embase, the Cochrane Central Register of Controlled Trials and Clinicaltrial.gov website from the inception to July 2022. Randomized controlled trials compared anti-inflammatory therapies with placebo in patients with established CVD or high cardiovascular risks were included. The results of the meta-analysis were computed as the odds ratio (OR) with 95% confidence interval (CI). Results: Compared with placebo, anti-inflammatory therapies were associated with decreased incidence of myocardial infarction (MI) (OR=0.93, 95%CI, 0.87 to 0.98), which was mainly driven by therapies targeting central IL-6 signaling pathway (OR=0.84, 95%CI, 0.76 to 0.94). IL-1 inhibitors treatment was associated with reduced risks of heart failure (OR=0.32, 95%CI, 0.14 to 0.76) while lower incidence of stroke was observed in patients with colchicine treatment (OR=0.46, 95%CI, 0.28 to 0.77). MI events were less frequent in patients over 65 years old (OR=0.90, 95%CI, 0.82 to 0.98) or with follow-up duration over 1 year (OR=0.90, 95%CI, 0.84 to 0.96)when comparing anti-inflammatory therapies with placebo. Conclusion: Anti-inflammatory therapies, especially those targeting central IL-6 signaling pathway may serve as promising treating strategies to ameliorate the risk of MI. Meanwhile, IL-1 inhibitor and colchicine were associated with decreased risks of heart failure and stroke respectively. MI risk reductions by anti-inflammatory therapies seem to be more prominent in patients who were elderly and with long follow-up duration. Disclosure C.Lin: None. Z.Li: None. X.Cai: None. L.Ji: Other Relationship; Eli Lilly and Company, Novo Nordisk, Merck &amp; Co., Inc., Bayer Inc., Sanofi-Aventis U.S., Roche Pharmaceuticals, MSD Life Science Foundation, AstraZeneca, Boehringer Ingelheim Inc., Abbott, Metronics. Funding National Natural Science Foundation of China (81970698, 81970708); Beijing Natural Science Foundation (7202216)

791-P: Comparing the Real-World Effects of Once-Weekly GLP-1 RAs and DPP-4 Inhibitors on Ischemic Stroke and Myocardial Infarction in Individuals with T2D and ASCVD

Despite guidelines advocating for their use, there is limited real-world evidence comparing the effects of once-weekly (OW) glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dipeptidyl peptidase 4 inhibitors (DPP-4is) on the risk of cardiovascular events in individuals with type 2 diabetes (T2D) and atherosclerotic cardiovascular disease (ASCVD). This retrospective cohort study compared the time to incidence of ischemic stroke, myocardial infarction (MI), and 2-point major adverse cardiovascular events (MACE; ischemic stroke or MI) while on treatment in new adult users of OW GLP-1 RAs and DPP-4is who had T2D and ASCVD using data from the Optum Clinformatics® Data Mart (2017-2021). Patients were followed until drug discontinuation, enrollment end, or an event. Inverse probability of treatment weighting was used to balance baseline characteristics, and survival analyses were conducted to compare risks during exposure, defined as continuous use of either drug. We found that users of OW GLP-1 RAs (weighted N=25,287) had significantly lower risks of ischemic stroke (HR=0.74 [95% CI, 0.63, 0.87]), MI (0.78 [0.67, 0.92]), and 2-point MACE (0.76 [0.68, 0.86]) compared with users of DPP-4is (weighted N=39,684; all P&amp;lt;0.01). This study suggests that OW GLP-1 RAs reduce the risk of MI and stroke relative to DPP-4is in individuals with T2D and ASCVD. Disclosure X. Tan: Employee; Merck &amp; Co., Inc. Stock/Shareholder; Merck &amp; Co., Inc. Employee; Novo Nordisk. Stock/Shareholder; Novo Nordisk. Y. Liang: Employee; Novo Nordisk. J.R. Rajpura: Employee; Novo Nordisk. L. Yedigarova: Employee; Novo Nordisk. Stock/Shareholder; AbbVie Inc. J. Noone: Employee; Novo Nordisk. L. Xie: Employee; Pfizer Inc., Novo Nordisk A/S. A. de Havenon: Consultant; Novo Nordisk, Integra Lifesciences Holdings Corp. Other Relationship; UpToDate. Stock/Shareholder; TitinKM, Certus.

Concomitant Use of Antiplatelet Agents and Proton-Pump Inhibitors Increases the Risk of Adverse Cardiovascular Events: A Nationwide Population-Based Cohort Study Using Balanced Operational Definitions.

Antiplatelet agents are commonly used in combination with proton-pump inhibitors (PPIs) in patients with acute coronary syndrome who are at risk of gastrointestinal hemorrhage. However, studies have reported that PPIs can alter the pharmacokinetics of antiplatelet agents and result in adverse cardiovascular events. We enrolled 311 patients who received antiplatelet therapy with PPIs for >30 days and 1244 matched controls following a 1:4 propensity score matching during the index period. Patients were followed up until death, myocardial infarction, coronary revascularization, or the end of the follow-up period. Patients who used antiplatelet therapy with PPIs were found to be at higher risk of mortality than the controls (adjusted hazard ratio (HR): 1.77; 95% confidence interval (CI): 1.30-2.40). The adjusted HR for patients who used antiplatelet agents with PPIs developing myocardial infarction and coronary revascularization events was 3.52 (95% CI: 1.34-9.22) and 4.74 (95% CI: 2.03-11.05), respectively. Additionally, middle-aged patients or those within 3 years of concomitant use showed a higher risk of myocardial infarction and coronary revascularization. Our findings suggest that antiplatelet therapy combined with PPIs has a higher mortality risk in patients with gastrointestinal bleeding and is associated with an increased risk of myocardial infarction and coronary revascularization.

990-P: Estimating the National Costs of T2DM in the UK within the Context of Contemporary Guidelines

Background: The updated National Institute for Health and Care Excellence (NICE) type 2 diabetes (T2D) guidelines extend the recommendation of SGLT2 inhibitors (SGLT2i) for hyperglycaemia management to include their use in those with atherosclerotic cardiovascular disease (ASCVD), chronic heart failure (HF), chronic kidney disease (CKD) or high CVD risk. Our study estimates the potential cost consequence in the UK of the broad positioning of SGLT2i within updated guidelines (NG28-2022) versus previous guidelines (NG28-2015). Methods: The Cardiff T2D model was used to project lifetime outcomes and costs for T2D patients across established UK treatment pathways including metformin, sulfonylurea, DPP-4 inhibitors and NPH insulin with or without SGLT2i combination to reflect former vs. updated guidelines. Analyses were conducted in four subgroups (ASCVD, HF with reduced ejection fraction (HFrEF), CKD, high CVD risk). Projected outcomes were extrapolated to national level using population estimates from NICE’s guideline companion resource impact report. Results: Predicted lifetime costs for 1.7 Mn SGLT2i eligible T2D patients in the UK were estimated at £87.1 Bn with NG28-2022 compared to £101.7 Bn with NG28-2015. Net savings associated with NG28-2022 management of £14.56 Bn were attributable to comorbid CKD (£5.09 Bn), high CVD risk (£4.77 Bn), ASCVD (£3.96 Bn) and comorbid HFrEF (£0.74 Bn). Overall net savings were predicted despite an increase in pharmacy costs of £5.57 Bn. Changes in metabolic parameters and reduction in cardiovascular and kidney progression rates were predicted to prevent 20183 myocardial infarction events, 66651 HF events and 140303 events of end stage kidney failure. The magnitude of savings was a combination of event reductions and the number of eligible patients in subgroups. Conclusion: Our study indicates that uptake of SGLT2 inhibitors in line with NICE guidelines has the potential to improve health and be cost saving despite an increase in pharmacy costs. Disclosure P.Mcewan: Other Relationship; AstraZeneca. V.Foos: Other Relationship; AstraZeneca. R.Martin: Employee; AstraZeneca. J.Chen: Employee; AstraZeneca, Eli Lilly and Company.

Association between admission heart rate and major adverse cardiovascular events in acute myocardial infarction participants with different left ventricular ejection fraction

BackgroundThis study intended to investigate the independent effect of admission heart rate (HR) on the risk of major adverse cardiovascular events (MACEs) in acute myocardial infarction (AMI) patients with different left ventricular ejection fraction (LVEF) levels. MethodsThe study was a secondary analysis of the Acute Coronary Syndrome Quality Improvement in Kerela Trial. The relationship between admission HR and 30-day adverse outcomes in AMI patients with different LVEF levels was detected using a Logistic regression model. Interaction tests were used to compare the effects of different subgroups on HR and MACEs. ResultsOur study enrolled 18,819 patients. In both partially and fully adjusted models (Model1 and Model2), the risk of MACEs was highest in patients with HR ≥ 120 (OR: 1.62, 95%CI: (1.16, 2.26), P = 0.004, Model1; OR: 1.46, 95%CI: (1.00, 2.12), P = 0.047, Model2). There was a significant interaction between LVEF and HR (P for interaction = 0.003). Meanwhile, the trend test for this association showed that HR was positively and significantly associated with the MACEs in LVEF≥40% group (OR (95%CI): 1.27 (1.12, 1.45), P < 0.001). However, in LVEF<40% group, the trend test was not statistically significant (OR (95%CI): 1.09 (0.93, 1.29), P = 0.269). ConclusionThis study found that elevated admission HR was associated with a significantly higher risk for MACEs in patients admitted with AMI. Elevated admission HR was significantly associated with the risk of MACEs in AMI patients without low LVEF but not those with low LVEF (<40%). LVEF levels should be considered when evaluating the association between admission HR and the prognosis of AMI patients in the future.

#4378 GLOMERULAR HYPERFILTRATION AS RISK FACTOR FOR MAJOR ADVERSE CARDIOVASCULAR EVENTS AFTER ACUTE MYOCARDIAL INFARCTION

Abstract Background and Aims A reduced glomerular filtration rate (GFR) is a definite risk factor for major adverse cardiovascular event (MACE) in acute myocardial infarction (AMI) patients. While glomerular hyperfiltration (GHF) is associated with early phases of kidney disease, it is unclear whether GHF is associated with higher risk of MACE. Method 9,561 AMI patients with estimated GFR ≥ 60 mL/min/1.73 m2 were enrolled from prospective population-based national cohort. GHF was defined as GFR &amp;gt; 90th percentile after adjustment for age, sex, lean body mass and history of diabetes and hypertension, systolic blood pressure, left ventricular ejection fraction and use of angiotensin converting enzyme inhibitor or receptor blocker. Patients were divided into two groups (normal filtration group vs. GHF group) and occurrence of 3-year MACEs after AMI were investigated. Sensitivity analyses with different adjusted variables for hyperfiltration or with different patient exclusion criteria, and propensity score matching were conducted to determine consistency of our results. Results The GFR in 956 patients with GHF was 113.1±13.1 and it was significantly higher than those in normal filtration patients (87.7±13.1; P&amp;lt;0.001). The incidence rate of MACEs was higher in patients with GHF, and patient with GHF showed significantly higher risk of MACEs even after adjustment for several confounders (hazard ratio [HR] 1.37; 95% confidence interval [CI] 1.11-1.63) compared to normal filtration patients. GHF group had significantly higher risk of all-cause mortality (HR 1.65; 95% CI 1.26-2.17) and cardiac death (HR 1.80; 95% CI 1.28-2.54). There was no significant difference in the risk of non-cardiac death between two groups. Sensitivity analyses and propensity score matched analysis also showed similar findings. Conclusion GHF was independently associated with increased risk of MACE after AMI and the hazardous effects of GHF was pronounced in all-cause mortality and cardiac death. Our findings suggest that GHF might be a useful marker for predicting MACE after AMI.

#5644 SELECTED CARDIOVASCULAR AND NON-CARDIOVASCULAR EVENTS IN INCIDENT AND PREVALENT DIALYSIS PATIENTS IN THE US MEDICARE POPULATION

Abstract Background and Aims The ASCEND-D/ID trial reported safety and efficacy of daprodustat in patients receiving dialysis [1,2]. Rates and types of clinical outcomes vary between incident and prevalent dialysis patients. This study assessed events, of which most were described as safety events in ASCEND-D/ID trial, among incident dialysis patients on erythropoiesis-stimulating agents (ESAs) and prevalent dialysis patients in the US Medicare population. Method This is a retrospective, observational cohort study using United States Renal Data System data. The study included incident dialysis-dependent (IDD) patients from 2017–2019 and, separately, prevalent dialysis-dependent (PDD) patients as of January 1, 2018. For IDD patients, the index date was the dialysis initiation date; for PDD patients, the index date was January 1, 2018. To establish the cohorts, we further required patients to have at least 6 continuous months of Medicare Parts A and B coverage prior to, and be aged ≥18 years on, the index date. For IDD patients, we also required ESA use on the index date to better support comparability to the PDD patients. Patients with a history of kidney transplant or who had cancer during the year prior to, or who had a hospitalization for heart failure (HF), myocardial infarction (MI), or a stroke in the 4 weeks before, the index date were excluded. Patients were followed from index date (for IDD patients, follow-up started from index date plus 60 days to ascertain dialysis modality stability) to the earliest date of death, loss of Medicare coverage, kidney transplantation, or December 31, 2019. Events assessed were cardiovascular (CV: all-cause death, HF, MI, stroke, thromboembolic events [TEE], major adverse CV events [MACE: composite of death, MI, stroke], and MACE+HF) and non-CV (cancer, gastric erosions, ocular events, seizures, serious infection) events, derived from medical claims in the follow-up period using ICD-10 diagnosis, Healthcare Common Procedure Coding System, and Current Procedural Terminology codes in the follow-up period. HF, MI, stroke, and serious infection events were defined as inpatient events. TEEs included vascular access thrombosis (VAT), deep venous thrombosis (DVT), and pulmonary embolism (PE). First event rates were calculated separately for IDD and PDD cohorts and expressed as number of events per 100 patient-years. Results The IDD cohort contained 23,909 patients; the PDD cohort, 230,055. Median follow-up time was 12.6 months for the IDD cohort and 24.0 months for PDD cohort. Mean ages of the IDD and PDD cohorts were 70.3 and 63.3 years, respectively. Compared with the PDD cohort, patients in the IDD cohort were more likely to be female (48.2% vs 43.7%), of non-Hispanic White race (61.6% vs 40.4%), less likely be of lower-income status (33.0% vs 47.4% for Medicare/Medicaid dual enrollment and 38.6% vs 57.0% for Part D low-income subsidy) and with higher proportion of comorbidities. First event rates are shown in the Table for the IDD and PDD cohorts. Compared with the PDD cohort, patients in the IDD cohort had higher rates of all-cause mortality (17.3 vs 16.8 per 100 patient-years), stroke (1.8 vs 1.4), VAT (109.4. vs 67.2, hemodialysis patients only), and MACE (20.9 vs 20.3); however, they had lower rates of MI (3.1 vs 3.5), HF (7.1 vs 8.9), DVT (3.2 vs 4.0), and MACE+HF (25.6 vs 26.9). For non-CV events, patients in the IDD cohort had lower event rates for nearly all events except malignancies. Conclusion ESA-treated IDD patients had higher event rates for some CV events but lower rates for most non-CV events compared with PDD patients. As expected, however, rates of VAT were higher in IDD patients than PDD patients. These background event rates in real-world populations with wide ESA use provide context when considering potential alternative treatments for anemia. Limitation of this descriptive study includes the reporting of crude (unadjusted) rates, and therefore should be interpreted with caution. Funding: GSK (study 217316).

In Case You Haven't Heard…

Heart attacks are linked to faster cognitive decline over time, a new study suggests. Individuals who experience a myocardial infarction (heart attack) appear to have a faster cognitive decline over time than those who do not experience a myocardial infarction, according to a report published May 30 in JAMA Neurology. The findings point to the importance of tracking the cognitive function of heart attack patients and suggest that high‐risk patients should be counseled on the potential cognitive ramifications of such an event, wrote lead author Michelle C. Johansen, M.D., Ph.D., of the Johns Hopkins University School of Medicine and colleagues. “The findings also suggest that prevention of [myocardial infarction] may be a strategy to preserve brain health in older adults,” they added. The sample included 30,465 individuals, average age 64, who had no history of myocardial infarction, dementia, or stroke at the time of their first cognitive assessment. The individuals were followed for a median of 6.4 years, during which time 1,033 (3.4%) experienced one or more myocardial infarction events. The primary outcome measure was change in global cognition; secondary outcomes were changes in memory and executive function.