Events In Myocardial Infarction Patients Research Articles

ПРОГНОЗ НАСТУПЛЕНИЯ ЗНАЧИМЫХ ИШЕМИЧЕСКИХ СОБЫТИЙ И ЛЕТАЛЬНОГО ИСХОДА У БОЛЬНЫХ ИНФАРКТОМ МИОКАРДА НА ФОНЕ ХРОНИЧЕСКОЙ ОБСТРУКТИВНОЙ БОЛЕЗНИ ЛЕГКИХ

Introduction. Myocardial infarction remains significant due to its high prevalence and disability. Of particular importance is the prediction of the risk of adverse events in myocardial infarction patients with cardiorespiratory comorbidity, in particular with chronic obstructive pulmonary disease. It can be assumed that endogenous intoxication syndrome can be considered as a predictor of life-threatening events (repeated myocardial infarction, stroke) and lethal outcome in patients with myocardial infarction against chronic obstructive pulmonary disease. Aim. The aim is to determine the probability of combined endpoint development (repeated myocardial infarction, stroke, lethal outcome) in patients with myocardial infarction against chronic obstructive pulmonary disease during 12-month follow-up depending on gender-anamnestic and clinical-functional characteristics. Material and methods. We examined 325 patients with myocardial infarction - 195 patients with myocardial infarction against chronic obstructive pulmonary disease and 130 patients with myocardial infarction without chronic obstructive pulmonary disease (comparison group). As markers of endogenous intoxication syndrome, we studied middle weight molecules, hematological intoxication indices, blood gas indices, apoptosis, protein and lipid peroxidation and antioxidant protection, inflammation and renal function. Statistical data processing was performed using SPSS 26.0 software package. Results and discussion. Two-stage cluster analysis resulted in four clusters characterizing the type of endogenous intoxication syndrome: «polymarker-retentive», «necrotic- inflammatory», «hypoxic-inflammatory» and a cluster with no endogenous intoxication syndrome. The polymarker- retentive type of endogenous intoxication syndrome prevailed among patients with myocardial infarction against chronic obstructive pulmonary disease. Recurrent myocardial infarction, stroke and mortality constituted the combined endpoint. A decision tree was constructed to determine the probability of developing the combined endpoint in patients with myocardial infarction against the background of chronic obstructive pulmonary disease during the 12-month follow-up. It was found that the most significant predictors of combined endpoint occurrence are polymarker-retentive type of endogenous intoxication syndrome, the presence of acute infarction period complications and pronounced bronchoobstruction (degree 3-4). Conclusion. The constructed decision tree allows to stratify patients with high risk of repeated infarction, stroke and lethal outcome during the first year of follow-up after myocardial infarction against chronic obstructive pulmonary disease without increasing economic costs, which promotes optimization of treatment and secondary prevention in this category of patients.

Risk of mortality and other adverse outcomes from myocardial infarction in cancer survivors: a meta-analysis.

Myocardial infarction (MI) is an acute cardiovascular disease that can increase prognosis risks such as arrhythmia, heart failure, shock, etc. Studies have found that even well-controlled coexistence of cancer could affect the quality of life in MI patients. However, the prognostic impact of cancer on MI patients is controversial. This meta-analysis aimed to assess the influence of cancer on the risk of future all-cause mortality, cardiovascular mortality, and major adverse cardiovascular and cerebrovascular events (MACCE) in MI patients. The Embase, PubMed, and Cochrane libraries were searched for cohort studies and case-control from inception to May 2022. The quality of the included pieces of literature was assessed using the Newcastle-Ottawa Quality Assessment Scale (NOS). All statistical analyses were performed using Stata statistical software versions 14.0 and 16.0. Sensitivity analysis assessed the robustness of the results, and funnel plots and Egger's tests evaluated the publication bias. A total of 10 studies were included, covering 7,210,530 participants. Summary analyses show that compared with non-cancer patients, cancer increased the risk of long-term all-cause mortality in MI patients (HR 1.58, 95% CI 1.36-1.84, I2 = 94.2%). However, no significant difference was observed in the risk of cardiovascular mortality (HR 1.18, 95% CI 0.91-1.54, I2 = 52.4%) or MACCE (HR 1.26, 95% CI 0.94-1.70, I2 = 99.2%). In subgroup analysis, cancer was associated with the risk of recurrent MI (HR 1.18, 95% CI 1.03-1.34, I2 = 88.8%), and major bleeding (HR 2.01, 95% CI 1.60-2.52, I2 = 93.1%), with no significant difference in the risk of stroke (HR 1.11, 95% CI 0.97-1.27, I2 = 85.1%). This meta-analysis shows that cancer increases the risk of all-cause mortality, recurrent MI, and major bleeding in MI patients but is not associated with the risk of cardiovascular death. Therefore, comprehensive multidisciplinary management and monitoring of potential future adverse events in MI patients with cancer are needed. The meta-analysis was registered in the International Register of Prospective Systematic Reviews (NO. CRD42022332775).

Post-myocardial infarction rehabilitation and secondary prevention in hospitals.

Norwegian studies have documented poor cardiovascular risk factor control and a high incidence of new cardiovascular events in myocardial infarction patients. There is little knowledge about the scope of secondary prevention treatment and cardiac rehabilitation in Norwegian hospitals. Therefore, we wanted to conduct a survey of discharge routines and outpatient follow-up after myocardial infarction. In October 2018, the heads of cardiology departments and nurse managers/physiotherapists at cardiology outpatient clinics at all Norwegian hospitals (N = 51) were contacted and asked to take part in a telephone interview. A total of 40 doctors (78%) and 51nurses/physiotherapists (100%) conducted the telephone interview. Eleven hospitals used standardised discharge summary templates with treatment targets and expected follow-up. Ten hospitals offered routine outpatient follow-up. A total of 47hospitals (92%) offered multidisciplinary cardiac rehabilitation, 'heart school' classes or cardiac exercise training, and of these 9 (18%) offered multidisciplinary comprehensive cardiac rehabilitation in line with international recommendations. The survey revealed considerable differences in reported discharge routines and the provision of cardiac rehabilitation and outpatient follow-up at Norwegian hospitals.

Artificial Intelligence Uncovered Clinical Factors for Cardiovascular Events in Myocardial Infarction Patients with Glucose Intolerance.

Glucose intolerance (GI), defined as either prediabetes or diabetes, promotes cardiovascular events in patients with myocardial infarction (MI). Using the pooled clinical data from patients with MI and GI in the completed ABC and PPAR trials, we aimed to identify their clinical risk factors for cardiovascular events. Using the limitless-arity multiple testing procedure, an artificial intelligence (AI)-based data mining method, we analyzed 415,328 combinations of < 4 clinical parameters. We identified 242 combinations that predicted the occurrence of hospitalization for (1) percutaneous coronary intervention for stable angina, (2) non-fatal MI, (3) worsening of heart failure (HF), and (4) all causes, and we analyzed combinations in 1476 patients. Among these parameters, the use of proton pump inhibitors (PPIs) or plasma glucose levels > 200 mg/dl after 2 h of a 75 g oral glucose tolerance test were linked to the coronary events of (1, 2). Plasma BNP levels > 200 pg/dl were linked to coronary and cardiac events of (1, 2, 3). Diuretics use, advanced age, and lack of anti-dyslipidemia drugs were linked to cardiovascular events of (1, 3). All of these factors were linked to (4). Importantly, each finding was verified by independently drawn Kaplan-Meier curves, indicating that the determined factors accurately affected cardiovascular events. In most previous MI patients with GI, progression of GI, PPI use, or high plasma BNP levels were linked to the occurrence of coronary stenosis or recurrent MI. We emphasize that use of AI may comprehensively uncover the hidden risk factors for cardiovascular events.

Artificial Intelligence Uncovered Clinical Factors for Cardiovascular Events in Myocardial Infarction Patients with Glucose Intolerance in the Cohort of Two Large-Scale ABC and PPAR Clinical Trials

Background: Glucose intolerance (GI), defined as either prediabetes or diabetes, promotes cardiovascular events in patients with myocardial infarction (MI). Using the pooled clinical data from patients with MI and GI in the completed ABC and PPAR trials, we aimed to identify their clinical risk factors for cardiovascular events. Methods: Using the limitless-arity multiple testing procedure, an artificial intelligence (AI)-based data mining method, we analyzed 415,328 combinations of <4 clinical parameters. Findings: We identified 242 combinations that predicted the occurrence of hospitalization for (1) percutaneous coronary intervention for stable angina, (2) non-fatal MI, (3) worsening of heart failure (HF), and (4) all causes, and we analyzed combinations in 1,476 patients. Among these parameters, plasma glucose levels >200 mg/dl after 2 hours of a 75g oral glucose tolerance test or the use of proton pump inhibitors (PPIs) predicted the coronary events of (1, 2). Plasma BNP levels >200pg/dl predicted coronary and cardiac events of (1, 2, 3). Diuretics use, advanced age, and lack of anti-dyslipidemia drugs were predictors of cardiovascular events of (1, 3). These factors were linked to (4). Importantly, each finding was verified by independently drawn Kaplan–Meier curves, indicating that the determined factors accurately predicted cardiovascular events. Interpretation: In most previous MI patients with GI, progression of GI or PPI use predicted the occurrence of coronary stenosis; recurrent MI and high plasma BNP levels predicted the subsequent worsening of HF. We emphasize that use of AI is effective to comprehensively uncover the clinical risk factors of cardiovascular events. Trial Registration: This study was a sub-analysis of the ABC Study (Alpha-glucosidase-inhibitor Blocks Cardiac Events in Patients with Myocardial Infarction and Impaired Glucose Tolerance; ClinicalTrials.gov identification number: NCT00212017) and the Pioglitazone Protects DM Patients Against Re-Infarction Study (PPAR; Clinicaltrials.gov identification number: NCT00212004 and UMIN: No. 000091). Funding Statement: Grants-in-Aid from the Ministry of Health, Labour and Welfare of Japan; Grants-in-Aid from the Ministry of Education, Culture, Sports, Science and Technology of Japan; and Grants-in-Aid from the Japan Agency for Medical Research and Development. Declaration of Interests: No relationship to industry for K.S., H.F, Y.M.,J.K., S.I, and T.W. MK reports grants from Japanese government, grants from Japan Heart Foundation, grants from Japan Agency for Medical Research and Development , personal fees from Daiichi-Sankyo, personal fees from Pfizer, grants and personal fees from Ono, personal fees from Bayer, grants and personal fees from Novartis, grants and personal fees from Bheringer, grants and personal fees from Tanabe-Mitubishi, personal fees from Japan Medical Data Center, grants and personal fees from Takeda, grants and personal fees from Astra Zeneca, outside the submitted work. Ethics Approval Statement: Approval was obtained from the institutional review boards and ethics committees of all involved hospitals and all patients provided written informed consent. The study was performed in accordance with the principles of the Declaration of Helsinki and the Japanese Ethical Guidelines for Clinical Research.

Predicting long-term cardiovascular outcomes of patients with acute myocardial infarction using soluble ST2.

Background The increase in soluble suppression of tumorigenicity 2 (sST2) both in the diagnosis and prognosis of heart failure is well established; however, existing data regarding sST2 values as the prognostic marker after myocardial infarction (MI) are limited and have been conflicting. This study aimed to assess the clinical significance of sST2 in predicting 1-year adverse cardiovascular (CV) events in MI patients. Materials and methods In this prospective study, 380 MI patients were included. Participants were grouped into low sST2 (n = 264, mean age: 60.0 ± 12.1 years) and high sST2 groups (n = 116, mean age: 60.5 ± 11.6 years), and all study populations were followed up for major adverse cardiovascular events (MACE) which are composed of CV mortality, target vessel revascularization (TVR), non-fatal reinfarction, stroke and heart failure. Results During a 12-month follow-up, 68 (17.8%) patients had MACE. CV mortality and heart failure were significantly higher in the high sST2 group compared to the low sST2 group (15.5% vs. 4.9%, p = 0.001 and 8.6% vs. 3.4% p = 0.032, respectively). Multivariate Cox regression analysis concluded that high serum sST2 independently predicted 1-year CV mortality [hazard ratio (HR) 2.263, 95% confidence interval (CI) 1.124-4.557, p = 0.022)]. Besides, older age, Killip class >1, left anterior descending (LAD) as the culprit artery and lower systolic blood pressure were the other independent risk factors for 1-year CV mortality. Conclusions High sST2 levels are an important predictor of MACE, including CV mortality and heart failure in a 1-year follow-up period in MI patients.

Relationship of obesity to adverse events in myocardial infarction patients without primary percutaneous coronary intervention: results from the Occluded Artery Trial (OAT)

Objective: Our goal was to investigate the “obesity paradox” in myocardial infarction populations without primary percutaneous coronary intervention (PPCI).Methods: The Occluded Artery Trial (OAT, Clinicaltrials.gov: NCT00004562) is a randomized, multicenter study to investigate the influence of routine percutaneous coronary intervention (PCI) on the clinical outcomes of myocardial infarction patients without PPCI. We stratified these patients into three groups according to body mass index (BMI): normal, 18.5 kg/m2 ≤ BMI < 25 kg/m2; overweight, 25 kg/m2 ≤ BMI < 30 kg/m2; obese, BMI ≥ 30 kg/m2. The purpose of our study was to investigate the effects of BMI on the primary endpoint (all-cause mortality) and the secondary endpoint (cardiac death, non-cardiac death or New York Heart Association [NYHA] class IV heart failure) in the population enrolled in the OAT.Results: A total of 2153 patients (99.4%) constituted the final study population. We found that obese patients were younger and were more likely to have cardiovascular risk factors compared with other BMI groups. A U-shaped relationship was observed between BMI and all-cause mortality. The adjusted hazard ratios (HRs) were 0.892 (95% CI: 0.658–1.210, p = .460) for normal weight patients and 0.671 (95% CI: 0.508–0.888, p = .013) for overweight patients compared with obese patients. The same pattern was also observed for non-cardiac death. The adjusted HRs were 0.919 (95% CI: 0.601–1.40, p = .663) for normal weight patients and 0.524 (95% CI: 0.346–0.792, p = .004) for overweight patients compared with obese patients. We did not find any statistical differences among BMI categories in terms of cardiac death or NYHA class IV heart failure.Conclusions: A U-shaped relationship was observed between BMI and all-cause mortality or non-cardiac death. Overweight patients have the lowest risk of all-cause mortality, which may be attributed to their having the lowest risk of non-cardiac death of the groups studied.

Immunoglobulin G levels predicts risk of recurrent adverse cardiovascular events in myocardial infarction patients

Background: Patients with myocardial infarction (MI) are at an increased risk of experiencing recurrent major adverse cardiovascular events (MACE) but predicting MACE has remained challenging. Immunoglobulins are implicated in cardiovascular disease, although the predictive value of total immunoglobulin G (IgG) has not yet been evaluated in a secondary prevention setting. This study examined whether total IgG is predictive of MACE in an MI population, and how total IgG compared to the predictive value of C-reactive protein (CRP), an acute inflammatory marker. Methods: We conducted a case–control study with 40 MI subjects (cases) who experienced MACE within 1 year of their index admission. Cases were matched for age, sex, diabetes and presentation with 77 controls who did not have MACE. Pre-discharge plasma samples were analysed for total IgG and CRP. Results: We observed higher levels of total plasma IgG in MI subjects with MACE (24.9 (16.2–43.7) mg/mL) compared to controls (18.4 (9.1–37.3) mg/mL; p < 0.05). Higher levels of IgG were associated with increased risk of MACE in our MI population. MI subjects within quartiles 3 and 4 of total IgG had 6 times and 4 times, respectively, the rate of MACE compared to subjects in quartile 1. There was no difference in CRP levels between cases and controls (1.1 (0.5–3.0) vs. 1.9 (0.6–6.1) mg/mL, p = 0.10), and no relationship was observed between CRP and MACE. Conclusion: Pre-discharge IgG level was a better marker for predicting MACE post-MI than CRP, which had no predictive value in this study.

Hydroxychloroquine for the prevention of recurrent cardiovascular events in myocardial infarction patients: rationale and design of the OXI trial.

Inflammation of the arterial wall plays a central role in the pathogenesis of atherosclerosis. Among patients with rheumatic diseases, anti-rheumatic medication reduces the incidence of cardiovascular (CV) diseases, but only few studies have addressed their cardioprotective effects on patients with no rheumatic diseases. Hydroxychloroquine (HCQ) is an anti-rheumatic drug commonly used in the treatment of rheumatoid arthritis and systemic lupus erythematosus. In addition to its anti-inflammatory properties, HCQ reduces cholesterol levels and the risk of type II diabetes, and has also anti-platelet effects. The OXI trial is an event-driven trial that will randomize 2500 patients hospitalized for myocardial infarction (MI). Participants will receive active HCQ or placebo for at least 12 months, and until 350 CV events are confirmed. The primary trial endpoint is the composite of death, MI, hospitalization for unstable angina, urgent percutaneous coronary intervention, and urgent coronary artery bypass grafting. Secondary trial endpoints are the primary end point plus stroke, the effect of HCQ treatment on lipids, on the incidence of Type 2 diabetes, on the level of haemoglobin A1c, and on inflammatory parameters. A 6 months placebo-controlled safety pilot trial with 200 patients is currently ongoing to assess the safety of HCQ in the setting of MI. The OXI trial will determine whether treatment with HCQ, as compared with placebo, will reduce recurrent CV events among MI patients. If positive, then the OXI trial would provide an entirely novel multitarget approach for the secondary prevention of atherosclerotic cardiovascular diseases (ACVD).

Periodontal Disease and Recurrent Cardiovascular Events in Survivors of Myocardial Infarction (MI): The Western New York Acute MI Study

Periodontal disease and cardiovascular disease (CVD) have been the focus of much research, but little is known about their roles in the recurrent event risk in patients with CVD. This study investigates whether periodontal disease is related to recurrent CVD events and mortality in survivors of incident myocardial infarction (MI). Participants (668 males and 216 females; mean age: 54 + or - 8.5 years) were recruited (1997 through 2004) from two western New York county hospitals and completed an interviewer-administered questionnaire regarding lifestyle habits, clinical measurements, and a comprehensive dental examination. The periodontal disease status was measured by the mean clinical attachment loss (AL). Follow-up surveys assessed hospitalizations or medical procedures; cardiovascular events were validated by medical records. A National Death Index (NDI) Plus search was conducted. The outcome was recurrent fatal and non-fatal cardiovascular events (International Classification of Diseases codes 390 to 450). After an average follow-up of 2.9 years, 154 events were reported. Among never-smokers, the adjusted hazard ratio (95% confidence interval) for the mean clinical AL (millimeters) was 1.43 (1.09 to 1.89). No associations were found in ever-smokers (clinical AL by smoking interaction: P <0.05). These findings indicate that periodontal disease may be an important factor in determining recurrent cardiovascular events in MI patients and not merely a marker for the effects of cigarette smoking.

Pravastatin reduces the incidence of cardiac events among patients with myocardial infarction.

We retrospectively compared the incidence of cardiac events in myocardial infarction (MI) patients treated in our departments between 1990 and 1999 with pravastatin or without cholesterol-lowering agents. Our aim was to evaluate the efficacy of pravastatin in the secondary prevention of MI. Cardiac events--defined as fatal or nonfatal recurrent MI, sudden cardiac death, and death from congestive heart failure--occurred in 8 (2.2%) of 356 MI patients treated with pravastatin (17.1 cases/1.000 person x year) and in 39 (5.6%) of 700 MI patients not treated with cholesterol-lowering agents (54.3 cases/1000 person x year), which represented a significant decline among those taking pravastatin (P < 0.05, odds ratio: 0.39, 95% (CI: 0.18-0.84). Likewise, total mortality was significantly lower among patients treated with pravastatin (18 cases, 5.1%; 38.4 cases/1,000 person x year vs 77 cases, 11.0%; 107.2 cases/1,000 person x year, P < 0.01, odds ratio: 0.43, 95% CI: 0.25-0.73). Subgroup analysis revealed a significantly lower incidence or cardiac events in the pravastatin group for 6 of the items among 53 patient characteristics, and was lower but not significant for 45 items and was greater but not significant only for 2 items. Furthermore, multivariate analysis confirmed pravastatin to be a useful factor for preventing the occurrence of cardiac events in MI patients (P < 0.05, odds ratio: (0.44, 95% CI: 0.20-0.95), and Kaplan-Meier curves also showed pravastatin to significantly reduce the incidence of both cardiac events and total mortality. These findings are consistent with those previously reported by several large-scale clinical trials carried out in Western countries, and demonstrate that pravastatin is useful for secondary prevention of MI in Japanese patients.