Events In Acute Myocardial Infarction Patients Research Articles

Thrombus aspiration is associated with improved platelet inhibition rate following dual antiplatelet therapy in acute myocardial infarction patients

BackgroundIt is well-established that thrombus aspiration during primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) indicates a higher thrombus burden and necessitates more intensive antithrombotic therapy. The bidirectional association between adverse events in AMI patients and platelet reactivity is typically observed during dual antiplatelet therapy (DAPT).ObjectiveTo investigate platelet reactivity after DAPT in AMI patients with thrombus aspiration performed during PCI.MethodsIn this retrospective study, we examined 269 consecutive AMI patients who underwent PCI and recorded their demographic, clinical and laboratory data. The platelet reactivity was measured with thromboelastogram (TEM).ResultsUltimately, 208 patients were included in this study and divided into a Thrombus Aspiration group (N = 97) and a PCI Alone group (N = 111) based on whether thrombus aspiration was performed or not. The adenosine diphosphate (ADP)-induced platelet inhibition rate in the Thrombus Aspiration group was higher than that in the PCI Alone group (P < 0.001). Furthermore, multivariate linear regression analysis revealed that the ADP-induced platelet inhibition rate was independently associated with leukocyte count, thrombus aspiration and the combination of aspirin and ticagrelor as DAPT after adjusting for potential covariates in all AMI patients.ConclusionIn conclusion, clinicians should exercise heightened attention towards the bleeding risk among patients undergoing PCI concomitant with Thrombus Aspiration postoperatively.

Effect of sacubitril-valsartan on left ventricular remodeling in patients with acute myocardial infarction after primary percutaneous coronary intervention: a systematic review and meta-analysis.

Sacubitril-valsartan has been widely reported for reducing the risk of cardiovascular death and improving left ventricular remodeling in patients with heart failure (HF). However, the effect of sacubitril-valsartan in patients with acute myocardial infarction (AMI) remains controversial. Therefore, we conducted this meta-analysis to investigate whether sacubitril-valsartan could reverse left ventricular remodeling and reduce cardiovascular adverse events in AMI patients after primary percutaneous coronary intervention (PPCI). Two researchers independently retrieved the relevant literature from PubMed, Embase, The Cochrane Library, China National Knowledge Infrastructure (CNKI), and the Wanfang database. The retrieval time was limited from inception to 1 June 2023. Randomized controlled trials (RCTs) meeting the inclusion criteria were included and analyzed. In total, 21 RCTs involving 2442 AMI patients who underwent PPCI for revascularization were included in this meta-analysis. The meta-analysis showed that compared with the angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB), sacubitril-valsartan treatment in AMI patients after PPCI significantly reduced left ventricular end-diastolic dimension (LVEDD) (weighted mean difference (WMD) -3.11, 95%CI: -4.05∼-2.16, p < 0.001), left ventricular end-diastolic volume (LVEDV) (WMD -7.76, 95%CI: -12.24∼-3.27, p = 0.001), left ventricular end-systolic volume (LVESV) (WMD -6.80, 95%CI: -9.45∼-4.15, p < 0.001) and left ventricular end-systolic dimension (LVESD) (WMD -2.53, 95%CI: -5.30-0.24, p < 0.001). Subgroup analysis according to the dose of sacubitril-valsartan yielded a similar result. Meanwhile, PPCI patients using sacubitril-valsartan therapy showed lower risk of major adverse cardiac events (MACE) (OR = 0.36, 95%CI: 0.28-0.46, p < 0.001), myocardial reinfarction (OR = 0.54, 95%CI: 0.30-0.98, p = 0.041) and HF (OR = 0.35, 95%CI: 0.26-0.47, p < 0.001) without increasing the risk of renal insufficiency, hyperkalemia, or symptomatic hypotension. At the same time, the change of LV ejection fraction (LVEF) (WMD 3.91, 95%CI: 3.41-4.41, p < 0.001), 6min walk test (6MWT) (WMD 43.56, 95%CI: 29.37-57.76, p < 0.001) and NT-proBNP level (WMD -130.27, 95%CI: -159.14∼-101.40, p < 0.001) were statistically significant. In conclusion, our meta-analysis indicates that compared with ACEI/ARB, sacubitril-valsartan may be superior to reverse left ventricular remodeling, improve cardiac function, and effectively reduce the risk of MACE, myocardial reinfarction, and HF in AMI patients after PPCI during follow-up without increasing the risk of adverse reactions including renal insufficiency, hyperkalemia, and symptomatic hypotension.

Association of Increased Pulse Wave Velocity With Long-Term Clinical Outcomes in Patients With Preserved Ankle-Brachial Index After Acute Myocardial Infarction

Low ankle-brachial index (ABI) is an established risk factor for long-term cardiovascular outcomes in patients with acute myocardial infarction (AMI), and brachial-ankle pulse wave velocity (ba-PWV) may also be a risk factor. However, there is a significant overlap between low ABI and high ba-PWV. The purpose of this retrospective study was to examine whether increased ba-PWV was associated with long-term clinical outcomes in AMI patients with normal ABI. We included 932 AMI patients with normal ABI and divided them into the high PWV group (≥1,400 cm/s; n=646) and the low PWV group (<1400 cm/s; n=286) according to the ba-PWV values measured during the AMI hospitalisation. The primary endpoint was the major adverse cardiovascular events (MACE) defined as the composite of all-cause death, nonfatal myocardial infarction, and hospitalisation for heart failure. During the median follow-up duration of 541 days (Q1: 215 days-Q3: 1,022 days), a total of 154 MACE were observed. The Kaplan-Meier curves showed that MACE was more frequently observed in the high PWV group than in the low PWV group (p<0.001). The multivariate Cox hazard analysis revealed that high ba-PWV was significantly associated with MACE (hazard ratio [HR] 1.587; 95% CI 1.002-2.513; p=0.049) after controlling multiple confounding factors. High ba-PWV was significantly associated with long-term adverse events in AMI patients with normal ABI. Our results suggest the usefulness of PWV as a prognostic marker in AMI with normal ABI.

Temporal Trends of Major Bleeding and Its Prediction by the Academic Research Consortium-High Bleeding Risk Criteria in Acute Myocardial Infarction.

Limited data exist on the temporal trend of major bleeding and its prediction by the Academic Research Consortium-High Bleeding Risk (ARC-HBR) criteria in acute myocardial infarction (AMI) patients undergoing percutaneous coronary intervention (PCI). We investigated 10-year trends of major bleeding and predictive ability of the ARC-HBR criteria in AMI patients. In a multicenter registry of 10,291 AMI patients undergoing PCI between 2004 and 2014 the incidence of Bleeding Academic Research Consortium (BARC) 3 and 5 bleeding was assessed, and, outcomes in ARC-defined HBR patients with AMI were compared with those in non-HBR. The primary outcome was BARC 3 and 5 bleeding at 1 year. Secondary outcomes included all-cause mortality and composite of cardiovascular death, myocardial infarction, or ischemic stroke. The annual incidence of BARC 3 and 5 bleeding in the AMI population has increased over the years (1.8% to 5.8%; p < 0.001). At 1 year, ARC-defined HBR (n = 3371, 32.8%) had significantly higher incidence of BARC 3 and 5 bleeding (9.8% vs. 2.9%; p < 0.001), all-cause mortality (22.8% vs. 4.3%; p < 0.001) and composite of ischemic events (22.6% vs. 5.8%; p < 0.001) compared to non-HBR. During the past decade, the incidence of major bleeding in the AMI population has increased. The ARC-HBR criteria provided reliable predictions for major bleeding, mortality, and ischemic events in AMI patients.

Relationship between in-hospital event rates and high bleeding risk score in patients undergoing primary percutaneous coronary intervention for acute myocardial infarction.

Academic Research Consortium for High Bleeding Risk (ARC-HBR) was defined as a criterion for predicting the risk of bleeding in patients who undergo percutaneous coronary intervention (PCI). Major bleeding is related to in-hospital mortality. However, few studies examining the HBR criteria in patients with acute myocardial infarction (AMI) have been reported. We analyzed the relationship between HBR criteria in AMI patients and in-hospital events. This study was a single-center retrospective study that included 781 patients who underwent PCI for ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) from January 2010 to December 2018. Patients were classified into the HBR group (n = 309, 39.6%) and non-HBR group (n = 472, 60.4%) and investigated. The primary endpoint was the incidence of in-hospital mortality, major bleeding, recurrent MI, and stroke. As a secondary endpoint, a multivariate analysis of cases of in-hospital death was performed to identify predictors of in-hospital mortality. As the primary outcome, the rate of all events in the HBR group was significantly higher than that in the non-HBR group (29.1% vs. 11.2%, p < 0.001). Among the individual events, the rates of major bleeding (11.3% vs. 3.8%, p < 0.001) and in-hospital mortality (16.2% vs. 4.2%, p < 0.001) were significantly higher in the HBR group. Regarding the secondary outcome, the overall in-hospital mortality rate was 9.0%. The multivariate analysis revealed that ejection fraction < 40%, HBR, Killip 4, and left main trunk lesion were significant predictors of in-hospital mortality. In conclusion, the HBR criteria were associated with in-hospital events in AMI patients who underwent primary PCI.

Association of Asymptomatic Low Ankle-Brachial Index with Long-Term Clinical Outcomes in Patients after Acute Myocardial Infarction.

Aims: Peripheral arterial disease (PAD) is the well-known risk factor for cardiovascular events. Although low ankle–brachial index (ABI) is recognized as a risk factor in general population, low ABI without any symptoms of PAD has not been established as a prognostic marker in patients with acute myocardial infarction (AMI) yet. The purpose of this retrospective study was to examine whether asymptomatic low ABI was associated with long-term clinical outcomes in AMI patients without treatment history of PAD. Methods: We included 850 AMI patients without a history of PAD and divided them into the preserved ABI (ABI ≥ 0.9) group (n=760) and the reduced ABI (ABI ＜0.9) group (n=90) on the basis of the ABI measurement during the hospitalization. The primary endpoint was the major adverse cardiovascular events (MACE) defined as the composite of all-cause death, non-fatal myocardial infarction, and hospitalization for heart failure. Results: During the median follow-up duration of 497 days (Q1: 219 days to Q3: 929 days), a total of 152 MACE were observed. The Kaplan–Meier curves showed that MACE were more frequently observed in the reduced ABI group than in the preserved ABI group (p＜0.001). The multivariate COX hazard analysis revealed that reduced ABI was significantly associated with MACE (hazard ratio 2.046, 95% confidence interval 1.344–3.144,p=0.001) after controlling confounding factors. Conclusions: Reduced ABI was significantly associated with long-term adverse events in AMI patients without a history of PAD. Our results suggest the usefulness of ABI as a prognostic marker in AMI patients irrespective of symptomatic PAD.

Prognostic value of admission serum magnesium in acute myocardial infarction complicated by malignant ventricular arrhythmias

Although electrolyte abnormalities are related to worse clinical outcomes in patients with acute myocardial infarction (AMI), little is known about the association between admission serum magnesium level and adverse events in AMI patients complicated by out-of-hospital cardiac arrest presenting with malignant ventricular arrhythmias (OHCA-MVA). We investigated the prognostic value of serum magnesium level on admission in these patients. We retrospectively analyzed the data of 165 consecutive reperfused AMI patients complicated with OHCA-MVA between April 2007 and February 2020 in our university hospital. Serum magnesium concentration was measured on admission. The primary outcome was in-hospital death. Fifty-four patients (33%) died during hospitalization. Higher serum magnesium level was significantly related to in-hospital death (Fine & Gray's test; p<0.001). In multivariable logistic regression analyses, serum magnesium level on admission was independently associated with in-hospital death (hazard ratio 2.68, 95% confidence interval 1.24-5.80) even after adjustment for covariates. Furthermore, the incidences of cardiogenic shock necessitating an intra-aortic balloon pump (p=0.005) or extracorporeal membrane oxygenation (p<0.001), tracheal intubation (p<0.001) and persistent vegetative state (p=0.002) were significantly higher in patients with higher serum magnesium level than in those with lower serum magnesium level. In reperfused AMI patients complicated by OHCA-MVA, admission serum magnesium level might be a potential surrogate marker for predicting in-hospital death.

Usefulness of diastolic dysfunction score in predicting long-term prognosis of acute myocardial infarction patients with preserved ejection fraction

Abstract Background To investigate the usefulness of left ventricular diastolic dysfunction (LVDD) score in the prediction of future major cardiovascular events (MACEs) in acute myocardial infarction (AMI) patients with preserved ejection fraction (EF). Methods Among 2,539 AMI patients from January 2012 to December 2015, a total of 1,374 patients with preserved EF and no atrial fibrillation were enrolled and were followed up for 3 years. Four parameters which were used for the categorization of DD in the current 2016 recommendation of American Society of Echocardiography (ASE) (septal e' &amp;lt;7cm/s, E/e' &amp;gt;14, tricuspid regurgitation velocity &amp;gt;2.8m/s, and LAD &amp;gt;40mm) were used for DD scoring. The integer score was assigned to each parameter as 1 point. The development of MACEs including death, recurrent MI, any revascularization, or hospitalization due to heart failure (HHF) was evaluated. Results Study subjects were divided into 5 groups by the current 2016 ASE criteria; LVDD score 0 (n=354), score 1 (n=496), score 2 (n=333), score 3 (n=139), and score 4 (n=52). During 3 years of clinical follow up, MACEs were developed in 271 patients; 142 death, 74 recurrent MI, 99 revascularization, and 32 HHF. MACEs were significantly increased as LVDD scores were increased; MACEs in LVDD score 0 (n=43, 12.1%), score 1 (n=73, 14.7%), score 2 (n=73, 21.9%), score 3 (n=51, 36.7%), and score 4 (n=31, 59.6%), (ptrend &amp;lt;0.001). On Kaplan-Meier survival curve analysis, MACEs free survival was significantly lower as LVDD scores were increased (Figure 1). Conclusion The present study demonstrated that MACEs were significantly increased as LVDD scores were increased in AMI patients with preserved EF. Therefore, it is suggested that this novel scoring system by using the current 2016 ASE criteria for diastolic function evaluation may provide comprehensive risk assessment and thus would be useful in predicting upcoming CV events in AMI patients with preserved EF. MACE free survival according to the LVDD Funding Acknowledgement Type of funding source: None

Clinical significance of platelet reactivity during prasugrel therapy in patients with acute myocardial infarction

BackgroundAlthough some studies have examined platelet reactivity (PR) during prasugrel treatment, little is known about PR during the early treatment period and its clinical significance in Japan. MethodsWe investigated the early and medium-term efficacy and safety of prasugrel in patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI). Seventy-eight patients were enrolled and PR was measured (in P2Y12 reaction units; PRU) by the VerifyNow P2Y12 assay (Accumetrics, San Diego, CA, USA). ResultsIn 44 patients, serial measurement revealed that PR was significantly higher at 2h after administration of the 20-mg loading dose of prasugrel than on the morning of the second day at 17.6±6.6h after administration (191.6±75.5 vs. 138.5±68.9PRU). During the 8-month follow-up period, bleeding events occurred in 18 patients (23.1%) (GUSTO minor: 15 patients). Multivariate regression analysis identified oral anticoagulant use as a significant predictor of bleeding events during admission [odds ratio (OR): 4.214, 95% confidence interval (CI): 1.005–17.669, p=0.049]. Administration of prasugrel via a nasogastric tube was a significant predictor of high on-treatment platelet reactivity (HTPR) (PRU≥230) (OR: 43.100, 95% CI: 4.517–411.251, p=0.001). In addition, HTPR was a significant predictor of major adverse cardiac events (cardiovascular death, non-fatal myocardial infarction, stent thrombosis, stroke, and sustained ventricular tachycardia) during the 8-month follow-up period (OR: 4.911, 95% CI: 1.164–20.722, p=0.030). ConclusionsIt is feasible to treat AMI patients with prasugrel. HTPR is a significant independent risk factor for adverse events in AMI patients receiving prasugrel after primary PCI.

The prognostic value of fragmented QRS complex of ECG in predicting re-occurrence of cardiac events after emergency percutaneous coronary intervention in patients with acute myocardial infarction

Objective To investigate the value of fragmented QRS complexes (fQRS) in predicting 1 year major adverse cardiac events (MACE) incidence after emergency percutaneous coronary intervention (PCI) for acute ST elevation myocardial infarction (STEMI).Methods Ninety-two acute myocardial infarction (AMI) patients treated with direct PCI were included and divided into fQRS group and non-fQRS group according to the presentations of 12-lead ECG recorded in 72 hours after PCI.The myocardial injury markers and MACE incidence were compared between the two groups during hospitalization.All patients were followed up for 1 year for the incidence of MACE.Results On the serial 12-lead ECG recorded for monitoring acute myocardial infarction patients during the in-hospital stay 72h after PCI,44/92 (47.8％) patients were included in non-fQRS group and 48/92 (52.2％) in fQRS group.Compared with non-fQRS group,the ischemic time before PCI was longer with increase in white blood cells count (WBC) after PCI in fQRS group (P =0.016 and P =0.026).Compared with non-fQRS group,the median of peak values of cTNI,CK-MB,and LVEF were respectively higher in fQRS group (P =0.035,0.003,0.048).The incidence of MACE during hospitalization was remarkably high but not significantly different between two groups (P =0.053).The peak values of cTNI,CK-MB were significantly higher in patients with fQRS presenting in both anterior and inferior wall than those in patients with fQRS presenting in anterior wall or inferior wall alone,while lower LVEF and higher MACE occurred in fQRS group without statistical difference from those in non-fQRS group.During a follow-up of mean one year,there were 19 MACE occurred in all patients.The incidence of 1 year MACE in fQRS group was significantly higher than that in non-fQRS group (31.3％ vs.9.1％,P =0.018).Survival analysis showed that event-free survival in fQRS group was significantly lower than that in non-fQRS group (P =0.004).COX model indicated that fQRS was an independent risk factor for re-occurreance of cardiac events in AMI patients after emergency PCI (HR:2.19,95％ CI:1.38-3.50,P =0.023).ROC curve was used for comparing the sensitivity and specialty between fQRS group and ST segment return from the elevated group in predicting MACE of which the area under curve (AUC) was 0.71 and 0.62,respectively without significant difference (Z =1.22,P =0.225).Conclusions fQRS can be used as an independent risk factor for predicting re-occurreance of cardiac events in AMI patients after emergency PCI. Key words: Acute myocardial infarction; Percutaneous coronary intervention; Fragmented QRS; Prognosis

CORRELATION BETWEEN ENDOTHELIAL DYSFUNCTION EVALUATED BY PERIPHERAL ARTERIAL TONOMETRY AND PROGNOSIS OF ACUTE MYOCARDIAL INFARCTION

ObjectivesTo explore whether the use of Peripheral Arterial Tonometry (PAT) in the evaluation of admission vascular endothelial function of acute myocardial infarction (AMI) patients can predict recurrence of major adverse...

CORRELATION BETWEEN ENDOTHELIAL DYSFUNCTION TESTED BY PERIPHERAL ARTERIAL TONOMETRY AND PROGNOSIS OF ACUTE MYOCARDIAL INFARCTION AND PLASMA ADIPONECTIN

ObjectivesTo explore whether the use of Peripheral Arterial Tonometry (PAT) in the evaluation of admission vascular endothelial function of acute myocardial infarction (AMI) patients can predict recurrence of major adverse...

Association between red blood cell distribution width and the risk of future cardiovascular events

In patients with acute myocardial infarction (AMI), high red blood cell distribution width (RDW) seems to predict further cardiovascular events, although the mechanism and its possible relation with anaemia and inflammation remains uncertain. We determined in 119 AMI patients before hospital discharge RDW, along with haemoglobin, haematimetric indices and inflammatory parameters (fibrinogen, C-reactive protein, plasma viscosity, neutrophil count). In the follow-up period (21 ± 11 months), 30 patients (25%) developed a recurrent cardiovascular event. In the lineal regression analysis, MCH and neutrophil count were independent determinants for RDW (beta coefficient = -0.544 p < 0.001; beta coefficient: 0.279 p = 0.001, respectively). The logistic regression analysis showed that RDW >14% increases the risk of future events by 6 times; OR 6.19 IC 95% (2.1-18.5); even after adjusting for anaemia, mean corpuscular haemoglobin (MCH) <27 pg/L, fibrinogen >400 mg/dL and neutrophil count >5.7 (103/μL). Our results confirm that RDW, an available and inexpensive measurement reported in routine blood cell counts, seems to be an independent predictor for recurrent cardiovascular events in AMI patients. As we found no association of RDW with either anaemia or inflammatory parameters, the mechanism responsible for increased RDW deserves further research.

Long-Term Nitrate Use in Acute Myocardial Infarction (The Heart Institute of Japan, Department of Cardiology Nitrate Evaluation Program)

The lack of any randomized controlled trials demonstrating a beneficial effect of nitrates for the secondary prevention of coronary artery disease leads to a negative recommendation in current practice guidelines. The aim of the present study was to examine the efficacy of nitrate therapy for the treatment of acute myocardial infarction (AMI) in the contemporary revascularization era. Of 2,736 consecutive patients with AMI (1,677 on nitrate therapy and 1,059 control patients not receiving nitrates), 1,766 patients were matched according to a propensity score (883 receiving nitrates and 883 control subjects). Before propensity score matching, the patients treated with nitrates were significantly older, had a higher Killip class, and underwent less aggressive revascularization and less modern pharmacotherapy compared with the patients who were not given nitrates. A total of 117 patients (11.0%) died in the control group and 317 patients (18.9%) in the nitrate group (hazard ratio, 1.70; 95% CI, 1.38-2.10; P < 0.001) during a 5-year follow-up period. In contrast, among propensity score-matched patients, 110 patients (12.5%) died in the control group and 126 patients died (14.3%) in the nitrate group (hazard ratio, 1.06; 95% CI 0.82-1.36, P = 0.678). The 1-, 3- and 5-year cumulative mortality rates (Kaplan-Meier method) were respectively 4.5%, 9.8%, and 14.1% in the control group versus 5.2%, 9.8%, and 14.8% in the nitrate group. There were also no statistical or clinical differences between the two matched groups with regard to the other endpoints assessed. Our results suggest that nitrate therapy does not increase mortality and cardiac events in AMI patients. Our results differ from those of previous observational studies, suggesting that new prospective randomized clinical trials are needed in the current revascularization era.

The expression of TNF‐α converting enzyme at the site of ruptured plaques in patients with acute myocardial infarction

Tumour necrosis factor-alpha (TNF-alpha) converting enzyme (TACE) plays an essential role in the TNF-alpha shedding process, which could affect the outcome of acute myocardial infarction (AMI). However, it remains unclear whether it originates from the ruptured plaque or represents a systemic process. This study analysed TACE-mediated TNF-alpha shedding at the site of ruptured plaques in AMI patients and compared them with a systemic mechanism. The study included 60 patients with AMI who underwent percutaneous coronary intervention (PCI) and 21 patients with stable angina pectoris (SA). Local samples from the site of plaque were taken from AMI using aspiration catheter treatment. Systemic samples were also taken from the aorta in all patients with AMI and SA. Systemic levels of TACE and TNF-alpha were higher in AMI patients than in SA patients. In AMI patients, these levels were higher in local samples than in systemic samples. A positive correlation was seen between local TACE and TNF-alpha levels in AMI patients. Thrombus material removed from the ruptured plaque showed immunostainings of TACE and TNF-alpha in infiltrating macrophages. By six months follow-up study, local TACE levels remained the only significant independent predictors of adverse cardiac events in AMI patients. This study demonstrates that local expression of TACE is related to TNF-alpha shedding at the site of ruptured plaques in AMI patients. In addition, local TACE expression at the site of ruptured plaques may play an important role in poor outcomes in patients with AMI.