Factor In Acute Myocardial Infarction Research Articles

Secretome of apoptotic peripheral blood cells (APOSEC) attenuates microvascular obstruction in a porcine closed chest reperfused acute myocardial infarction model: role of platelet aggregation and vasodilation

Although epicardial blood flow can be restored by an early intervention in most cases, a lack of adequate reperfusion at the microvascular level is often a limiting prognostic factor of acute myocardial infarction (AMI). Our group has recently found that paracrine factors secreted from apoptotic peripheral blood mononuclear cells (APOSEC) attenuate the extent of myocardial injury. The aim of this study was to determine the influence of APOSEC on microvascular obstruction (MVO) in a porcine AMI model. A single dose of APOSEC was intravenously injected in a closed chest reperfused infarction model. MVO was determined by magnetic resonance imaging and cardiac catheterization. Role of platelet function and vasodilation were monitored by means of ELISA, flow cytometry, aggregometry, western blot and myographic experiments in vitro and in vivo. Treatment of AMI with APOSEC resulted in a significant reduction of MVO. Platelet activation markers were reduced in plasma samples obtained during AMI, suggesting an anti-aggregatory capacity of APOSEC. This finding was confirmed by in vitro tests showing that activation and aggregation of both porcine and human platelets were significantly impaired by co-incubation with APOSEC, paralleled by vasodilator-stimulated phosphoprotein (VASP)-mediated inhibition of platelets. In addition, APOSEC evidenced a significant vasodilatory capacity on coronary arteries via p-eNOS and iNOS activation. Our data give first evidence that APOSEC reduces the extent of MVO during AMI, and suggest that modulation of platelet activation and vasodilation in the initial phase after myocardial infarction contributes to the improved long-term outcome in APOSEC treated animals.Electronic supplementary materialThe online version of this article (doi:10.1007/s00395-012-0292-2) contains supplementary material, which is available to authorized users.

Letter by Verkissen and Kop Regarding Article, “Risk of Acute Myocardial Infarction After the Death of a Significant Person in One's Life: The Determinants of Myocardial Infarction Onset Study”

To the Editor: The death of a significant person can be an important precipitating factor for acute myocardial infarction (MI). Mostofsky et al1 recently reported that grief over the death of a significant person is associated with a marked increased risk of MI in the subsequent days (hazard ratio, 21.1; 95% confidence interval, 13.1–34.1). This finding is consistent with previous prospective investigations showing that adverse life events such as the death of a loved one are associated with increased risk of cardiovascular disease–related mortality.2,3 The interpretation of the findings by Mostofsky et al requires further consideration because of the reliance on case-crossover methodology.4 …

Psychiatric Morbidity as a Risk Factor for Hospital Readmission for Acute Myocardial Infarction: An 8-Year Follow-up Study in Spain

Most previous studies assess the effect of depression and other psychiatric variables as risk factors for acute myocardial infarction; however, studies that assess the effect of psychiatric disorders as a whole are scarce, compared with other non-psychiatric factors. The aim of this study is to assess the importance of psychiatric morbidity, compared with other risk factors, in hospital readmission for acute myocardial infarction. This is a 8-year follow-up study in which the Hospital Discharge Administrative Database was used. From the total sample (11,062 patients), 590 patients (4.88%) were diagnosed with some mental disorder. Psychiatric disorders were more common in women than in men with myocardial infarction (4.76 % and 6.20%, respectively, p-value = 0.002). For those who have had recurrence of stroke, mental disease influences in the consecutive readmission for AMI with the same severity as did tobacco, diabetes, or obesity. The main finding of this study is the enormous impact of psychiatric disorders on readmissions for AMI, comparable to diabetes, obesity, cerebral vascular disease, and hypertension. Interestingly, the efforts made to treat and prevent psychiatric disorders in AMI patients are clearly lower than those health authorities make with respect to classic risk factors.

Evaluation of risk factors in acute myocardial infarction patients admitted to the coronary care unit, Tripoli Medical Centre, Libya

The aim of this study was to provide an overview of the risk factors for acute myocardial infarction in patients attending Tripoli Medical Centre, Libya. Records were reviewed for 622 patients with a mean age of 58.3 (SD 12.9) years. Diabetes mellitus (48.2%), hypertension (35.7%) and smoking (50.6%) were among the risk factors reported. There were 110 patients (17.7%) who died during hospitalization, mainly suffering cardiogenic shock (48.0%). The rate of use of thrombolytic therapy was low in patients who were female (40.4% versus 58.4% for males), older age (31.6% for those > 85 years versus 63.3% for patients < 55 years), diabetics (45.3% versus 62.0% for non-diabetic patients) and hypertensives (47.3% versus 57.8% for non-hypertensive patients). Prevention strategies should be implemented in order to improve the long-term prognosis and decrease overall morbidity and mortality from coronary artery disease in Libyan patients.

Proteomic profiling of acute coronary thrombosis reveals a local decrease in pigment epithelium-derived factor in acute myocardial infarction

Thrombotic occlusion of an epicardial coronary artery on the grounds of atherosclerotic plaque is considered the ultimate step in AMI (acute myocardial infarction). However, the precise pathophysiological mechanisms underlying acute coronary occlusion are not fully understood. We have analysed proteomic profiles of systemic plasma and plasma derived from the site of coronary plaque rupture of non-diabetic patients with STEMI (ST-segment elevation myocardial infarction). Label-free quantification of MS/MS (tandem MS) data revealed differential regulation of complement cascade components and a decrease in anti-thrombotic PEDF (pigment epithelium-derived factor) between CS (culprit site)-derived plasma and systemic plasma. PEDF, which is known to have a protective role in atherothrombosis, was relatively decreased at the CS, with a level of expression inverse to local MMP-9 (matrix metalloproteinase-9) activity. CS plasma displayed enhanced proteolytic activity towards PEDF. Proteomics of coronary thrombus aspirates indicate that PEDF processing is associated with coronary plaque rupture.

Study of Serum Homocysteine levels In Acute Myocardial Infarction And The First Degree Relative In A Rural Medical Centre

Objectives:This study was conducted to know the association between homocysteine levels in acute myocardial infarction patients and to compare with the first degree relative of the patients and controls attending R. L. Jalappa Hospital, affiliated to Sri Devaraj Urs Medical College, Kolar. Methodology: The study included 50 acute myocardial infarction patients, 50 first degree relative of the patients and 50 healthy controls. Serum homocysteine levels were measured in all the groups and the levels were studied and compared among the groups. Serum homocysteine was assayed by chemiluminescence microparticle immunoassay. Results: The mean Homocysteine levels in the patient group were 25.2±14.7µmol/l and in the first degree relative of the patient, it was 14.1±3.4 µmol/l and in controls was 11.7±2.9µ mol/l .The levels were higher in patients when compared to the other two groups. Homocysteine levels were elevated in 64% of the patients, and 32% of the first degree relative and 18% of controls. Hyperhomocysteinemia without any risk factors was present in 18% of the patients. Conclustion: Homocysteine emerged as an independent risk factor in acute myocardial infarction. Therefore it should be evaluated in all patients with acute myocardial Infarction. Key Words: Homocysteine, Acute myocardial infarction

AS-128: Prognostic Value of Plasma HbA1c in Diabetic Patients with Acute ST Segment Elevation Myocardial Infarction

Diabetes mellitus is associated with an increased risk of mortality after acute myocardial infarction, but there are a few study of plasma HbA1c as a prognostic factor in acute myocardial infarction. We aimed to determine the contribution of admission plasma HbA1c on acute myocardial infarction prognosis.

Serum ferritin—a novel risk factor in acute myocardial infarction

BackgroundA possible association between body iron status and risk of coronary heart disease (CHD) has been found to be controversial from the data obtained from various studies. ObjectivesTo study the relationship of serum ferritin with acute myocardial infarction (AMI) in univariate and multivariate analysis and to assess the relationship of high serum ferritin with established conventional risk factors. MethodsHospital based case-control study of 75 cases of AMI, and 75 age and equal number of age, and gender-matched controls without having AMI in the age group of 30–70 years. ResultsMedian serum ferritin levels were significantly higher in cases (220 μg/L) than controls (155 μg/L) (P ≤ 0.0001. In univariate analysis in addition to ferritin > 200 μg/L (odds ratio [OR] 6.71, 95% confidence interval [CI] = 3.22–12.89, P<0.05), diabetes (OR=7.68, 95% CI=2.95–19.13, P<0.05), hypertension (HTN) (OR=2.36, 95% CI=1.02–5.14, P<0.05) high-density lipoprotein (HDL) < 35 mg/dL (OR = 11.9, 95% CI = 2.66–52.57, P<0.05) and smoking (OR=2.17, 95% CI = 1.12–3.87, P< 0.05) were found to be significantly associated with AMI. After controlling for all conventional risk factors, in multiple logistic regression analysis, high ferritin was significantly associated with AMI. (adjusted OR=5.72, 95% CI=2.16–15.17, P < 0.001). Serum ferritin was significantly higher in diabetics than non-diabetics (P < 0.01). ConclusionHigh serum ferritin is strongly and independently associated with AMI.

Contents of second peak in the circadian variation of acute myocardial infarction in the Japanese population

Circadian variation has been accepted as a factor in acute myocardial infarction (AMI). An increased incidence of cardiac events in the morning has been reported for a long time. Recent reports have indicated that the onset of AMI shows two peaks, which occur in the morning and evening. It has also been demonstrated that circadian pattern of AMI may vary with sex and age. We investigated 522 consecutive patients who underwent primary percutaneous coronary intervention (PCI) for ST segment elevation myocardial infarction (STEMI) between 2000 and 2010. The patients were classified into 3 age groups: younger (≤59 years old), intermediate (60-79 years old), and older (≥80 years old). Clinical data were investigated, including the age and sex, angiographic characteristics, and time of onset of STEMI. There were two peaks in the onset of STEMI throughout the day, which were at 7:00-10:00 and 19:00-21:00 h, among all patients (male and female). Stratified analysis showed that older females formed the main part of the second peak. There were two peaks in the onset of STEMI in a Japanese population in Tokyo. The second peak was significantly dominated by the older female group. Age and gender influenced the second peak in the circadian variation of AMI in a Japanese population in Tokyo.

Association of 25-hydroxyvitamin D deficiency with NT-pro BNP levels in patients with acute myocardial infarction: a cross-sectional analysis

BackgroundNutritional vitamin D deficiency is an emerging risk factor for acute myocardial infarction (AMI) and heart failure. The association of 25-hydroxyvitamin D levels with N-terminal pro B-type natriuretic peptide (NT-proBNP), a robust prognostic marker for post-AMI mortality and heart failure, is unknown and could illuminate a potential pathway for adverse outcomes among post-AMI patients with 25-hydroxyvitamin D deficiency.MethodsIn a cross-sectional analysis, we studied 238 AMI patients from 21 U.S. centers to test the association of nutritional vitamin D (25-hydroxyvitamin D [25(OH)D]) deficiency with NT-proBNP levels. Levels of 25(OH)D levels were categorized as normal (≥30 ng/mL), insufficient (>20 - <30 ng/mL), deficient (>10 - ≤20 ng/mL), or severely deficient (≤10 ng/mL).ResultsLow 25(OH)D levels were found in 95.7% of AMI patients. No significant trends for higher mean baseline log NT-proBNP levels in severely deficient (6.9 ± 1.3 pg/mL), deficient (6.9 ± 1.2 pg/mL), and insufficient (6.9 ± 0.9 pg/ml) groups were observed as compared with patients having normal (6.1 ± 1.7 pg/mL) levels, P = 0.17. Findings were similar in the subset of patients who had follow-up NT-proBNP levels drawn at one month. In multivariate regression modeling, after adjusting for multiple covariates, 25(OH)D was not associated with NT-proBNP.ConclusionsPotential associations between nutritional vitamin D deficiency and prognosis in the setting of AMI are unlikely to be mediated through NT-proBNP pathways. Future studies should examine other mechanisms, such as inflammation and vascular calcification, by which 25(OH)D deficiency could mediate adverse outcomes post-AMI.

Risk of myocardial infarction associated with chronic hepatitis C virus infection: a population‐based cohort study*

Hepatitis C virus (HCV) infection is associated with systemic inflammation and metabolic complications that might predispose patients to atherosclerosis. However, it remains unclear if HCV infection increases the risk of acute myocardial infarction (MI). To determine whether HCV infection is an independent risk factor for acute MI among adults followed in general practices in the United Kingdom (UK), a retrospective cohort study was conducted in The Health Improvement Network, from 1996 through 2008. Patients ≥18 years of age with at least 6 months of follow-up and without a prior history of MI were eligible for study inclusion. HCV-infected individuals, identified with previously validated HCV diagnostic codes (n = 4809), were matched on age, sex and practice with up to 15 randomly selected patients without HCV (n = 71 668). Rates of incident MI among patients with and without a diagnosis of HCV infection were calculated. Adjusted hazard ratios were estimated using Cox proportional hazards regression, controlling for established cardiovascular risk factors. During a median follow-up of 3.2 years, there was no difference in the incidence rates of MI between HCV-infected and -uninfected patients (1.02 vs 0.92 events per 1000 person-years; P = 0.7). HCV infection was not associated with an increased risk of incident MI (adjusted HR, 1.10; 95% confidence interval [CI], 0.67-1.83). Sensitivity analyses including the exploration of a composite outcome of acute MI and coronary interventions yielded similar results (adjusted HR, 1.16; 95% CI, 0.77-1.74). In conclusion, HCV infection was not associated with an increased risk of incident MI.

Abstract P84: The Impact of a Potential Nationwide Comprehensive Smoking Ban on Acute Myocardial Infarction Hospitalizations

Introduction: Smoking is a well established risk factor for acute myocardial infarction (AMI). The potential impact of a nationwide comprehensive smoking ban (CSB) legislation on the incidence of AMI hospital admissions is not known. The aim of this analysis is to determine the impact of a nationwide CSB legislation on the incidence of AMI hospitalizations. Methods: We contacted the department of health at states with no CSB law for information on the total number of AMI discharges (ICD-9-CM 410), length of stay and charges in dollars for 2007. Expected decrease in the number of AMI in the year following a potential implementation of a nationwide CSB was calculated by multiplying the current number of AMI by the pooled relative risk reduction (RRR) obtained from a recent published meta analysis (RR 0.89). Results: In 2007, 37 States had CSB laws. There were 169,043 AMI hospitalizations in states without CSB. A nationwide smoking ban would result in 18,596 less AMI hospitalizations in the year following such a ban. This is associated with more than 92 million dollars in direct cost savings. Conclusion: A nationwide CSB legislation would result in significant reduction in the number of AMI hospitalizations. This is associated with significant cost saving. Further studies are needed to evaluate the impact of CSB on admission from other disease states.

Analysis of polymorphisms Leiden Factor V G1691A and prothrombin G20210A as risk factors for acute myocardial infarction

Thrombotic risk increases in elderly, therefore, the understanding of the genetic predisposition of hypercoagulability could make the difference in the prevention of venous and/or arterial thrombotic events. Laboratory evaluation of hyperfibrinogenemia, increased Factor VII levels, antiphospholipid antibodies presence and hyperhomocysteinemia are considered to have a consistent high predictivity for arterial thrombophilic diseases. Anyway, a large debate exists on the validity of testing Leiden Factor V (FV) G1691A and/or prothrombin (FII) G20210A polymorphisms in patients affected by arterial thrombotic diseases, despite of the several observations described. Here we report data strongly suggesting that at least the FII G20210A polymorphism might be considered an important risk factor for acute myocardial infarction in aged patients (55-80 years old). On the other hand, in spite of a not different genotypic and allelic distribution for the Leiden FV G1691A mutation, the presence of one or both the two polymorphisms is significantly higher among cases than in controls. In conclusion, our data suggest that FII G20210A and/or Leiden FV might be involved as risk factor for arterial disorders in about 5% of old subjects, justifying the opportunity of a genetic screening and an eventual preventive treatment, in particular in old subjects in which other and major risk factors, as hypertension and atherosclerosis, are detected.

The role of diabetes mellitus as a risk factor of acute myocardial infarction

To determine the impact of elevated in-hospital glucose level on outcome of patients with acute myocardial infarction (AMI), and evaluate the role of diabetes mellitus as a risk factor of AMI. The study included a retrospective analysis of AMI patients who were admitted to No. 81 Hospital of PLA from January 2000 to May 2010. In patients without a history of diabetes, and those with fasting blood glucose (FBG)≥7.0 mmol/L at admission but returned to normal range soon after admission were defined as stress hyperglycemia of non-diabetic AMI patients. Both diabetic patients and non-diabetic patients were stratified into four mutually exclusive groups according to FBG levels: <7.0, 7.0-7.9, 8.0-11.0 and ≥11.1 mmol/L. The in-hospital mortality, incidence of complications, and treatment to lower glucose level were analyzed. Logistic regression analysis was conducted on risk factors of outcome of AMI patients. One hundred and fifty-two AMI patients were enrolled with 45 diabetic patients and 107 patients without previous diabetes. In diabetic group patients with FBG≥8.0 mmol/L and those with FBG≥11.1 mmol/L accounted for 73.3% (33 cases) and 46.7% (21 cases), respectively. In non-diabetic group patients with stress hyperglycemia accounted for 43.9% (47 cases), among which patients with FBG levels of 7.011.0 mmol/L accounted for 91.5% (43 cases). Compared with the non-diabetic group, the in-hospital mortality was significantly higher in diabetic group (35.6% vs. 15.9%, P=0.007). In both groups, the in-hospital mortality presented an elevating tendency with an increasing FBG level. Multivariate Logistic regression analysis demonstrated that in diabetic group patients with FBG≥8.0 mmol/L had 12.28-fold higher risk of death than patients with FBG<8.0 mmol/L, and that in non-diabetic group patients with FBG≥7.0 mmol/L had 4.81-fold higher risk of death than patients with FBG<7.0 mmol/L. FBG was an independent risk factor of death with relative odds ratio (OR) 1.03, with 95% confidence interval (95%CI) 1.01-1.16, P=0.012, and OR 1.56, 95%CI 1.09-2.23, P=0.015 in diabetic group and non-diabetic group, respectively. The incidence of congestive heart failure in diabetic group was significantly higher than that in non-diabetic group (40.0% vs. 22.4%, P=0.027). In non-diabetic group, the incidence of lung infection, congestive heart failure, serious arrhythmias and acute cerebrovascular events (51.1%, 34.0%, 27.7%, 14.9%, respectively) was increased significantly in patients with FBG≥7.0 mmol/L than that in patients with FBG<7.0 mmol/L (18.3%, 13.3%, 10.0%, 0, respectively, P<0.05 or P<0.01). This association was not seen in diabetic group. 80.0% of patients (36 cases) in diabetic group received anti-hyperglycemia treatments in which insulin therapy accounted for 63.9% (23 cases), while there was not even 1 patient who needed insulin therapy in non-diabetic patients with stress hyperglycemia. In-hospital mortality and complications were significantly increased in diabetic AMI patients and in non-diabetic AMI patients with stress hyperglycemia. Both a history of diabetes mellitus and stress hyperglycemia have strong influence on AMI prognosis. It seems to be more plausible to collaborate blood glucose level with history of diabetes in considering risk factors in AMI patients.

Glutathione S-Transferase Gene Polymorphism as a Susceptibility Factor for Acute Myocardial Infarction and Smoking in the North Indian Population

Objectives: Glutathione S-transferase (GST) plays a key role in the detoxification of xenobiotic atherogens generated by smoking. We investigated whether functional GST gene polymorphism might be associated with acute myocardial infarction (AMI) and smoking. No such investigation has previously been conducted among North Indians. Methods: 230 patients with AMI and 300 healthy controls of North Indian ethnicity were enrolled in the study. GSTM1/T1/P1 gene polymorphisms were examined using restriction fragment length polymorphism. Results: When GST polymorphism was analyzed in patients with AMI, GSTM1 null genotype frequencies were 0.24 and 0.21 among cases with coronary artery disease and controls, respectively. The respective GSTT1 null genotype frequencies were 0.10 and 0.20 (p = 0.001). GSTP1 variant Val/Val allele frequencies were 0.02 and 0.07 with p = 0.03. After risk factor adjustment, only GSTP1Val/Val was found to be protective against disease. Considering the effect of GST (T1, M1, and P1) gene polymorphism on smoking, subjects were further divided into smokers and nonsmokers. However, GSTT1 null as well as GSTP Val/Val genotypes were protective only in nonsmokers (p = 0.01 and p = 0.04). Conclusions: A significant protective effect of GSTT1 null and GSTP1 Val genotype against disease was observed in patients with AMI although protection was limited to nonsmokers.

Periodontal treatment effects on endothelial function and cardiovascular disease biomarkers in subjects with chronic periodontitis: protocol for a randomized clinical trial

BackgroundPeriodontal disease (PD) is an infectious clinical entity characterized by the destruction of supporting tissues of the teeth as the result of a chronic inflammatory response in a susceptible host. It has been proposed that PD as subclinical infection may contribute to the etiology and to the pathogenesis of several systemic diseases including Atherosclerosis. A number of epidemiological studies link periodontal disease/edentulism as independent risk factor for acute myocardial infarction, peripheral vascular disease, and cerebrovascular disease. Moreover, new randomized controlled clinical trials have shown an improvement on cardiovascular surrogate markers (endothelial function, sICAM, hsPCR level, fibrinogen) after periodontal treatment. Nonetheless, such trials are still limited in terms of external validity, periodontal treatment strategies, CONSORT-based design and results consistency/extrapolation. The current study is designed to evaluate if periodontal treatment with scaling and root planning plus local delivered chlorhexidine improves endothelial function and other biomarkers of cardiovascular disease in subjects with moderate to severe periodontitis.Methods/DesignThis randomized, single-blind clinical trial will be performed at two health centers and will include two periodontal treatment strategies. After medical/periodontal screening, a baseline endothelium-dependent brachial artery flow-mediated dilatation (FMD) and other systemic surrogate markers will be obtained from all recruited subjects. Patients then will be randomized to receive either supragingival/subgingival plaque cleaning and calculus removal plus chlorhexidine (treatment group) or supragingival plaque removal only (control group). A second and third FMD will be obtained after 24 hours and 12 weeks in both treatment arms. Each group will consist of 49 patients (n = 98) and all patients will be followed-up for secondary outcomes and will be monitored through a coordinating center. The primary outcomes are FMD differences baseline, 24 hours and 3 months after treatment. The secondary outcomes are differences in C-reactive protein (hs-CRP), glucose serum levels, blood lipid profile, and HOMA index.DiscussionThis RCT is expected to provide more evidence on the effects of different periodontal treatment modalities on FMD values, as well as to correlate such findings with different surrogate markers of systemic inflammation with cardiovascular effects.Trial registration numberClinicalTrials.gov Identifier: NCT00681564.

Body composition and body fat distribution in relation to later risk of acute myocardial infarction: a Danish follow-up study

Obesity is a modifiable risk factor for acute myocardial infarction (MI), but lean body mass (LBM) may also be an important factor. Low LBM may increase the risk of MI and LBM may modify the effect of obesity on MI. Thus, the inability of the classical anthropometric measures to evaluate LBM may lead to misclassification of MI risk in both lean and obese persons. We investigated the associations between incident MI and bioelectrical impedance analyses (BIA) derived measures of body composition in combination with body mass index (BMI) and anthropometric measures of body fat distribution. From 1993 to 1997, 27 148 men and 29 863 women, aged 50 to 64 year, were recruited into the Danish prospective study Diet, Cancer and Health. During 11.9 years of follow-up we identified 2028 cases of incident MI (1487 men and 541 women). BMI, waist circumference (WC), hip circumference and BIA of body composition including body fat mass (BFM), body fat percentage and LBM were measured at baseline. We used Cox proportional hazard models with age as time axis and performed extensive control for confounding. Weight, BMI, classical estimates of abdominal obesity and BIA estimates of obesity showed significant positive associations with incident MI. However, BFM adjusted for WC showed no association. Low LBM was associated with a higher risk of incident MI in both genders, and high LBM was associated with a higher risk in men. Obesity was positively associated with MI. Estimates of obesity achieved by BIA seemed not to add additional information to classical anthropometric measures regarding MI risk. Both high and low LBM may be positively associated with MI.

Concomitant renal insufficiency and diabetes mellitus as prognostic factors for acute myocardial infarction

BackgroundDiabetes mellitus and renal dysfunction are prognostic factors after acute myocardial infarction (AMI). However, few studies have assessed the effects of renal insufficiency in association with diabetes in the context of AMI. Here, we investigated the clinical outcomes according to the concomitance of renal dysfunction and diabetes mellitus in patients with AMI.MethodsFrom November 2005 to August 2008, 9905 patients (63 ± 13 years; 70% men) with AMI were enrolled in a nationwide prospective Korea Acute Myocardial Infarction Registry (KAMIR) and were categorized into 4 groups: Group I (n = 5700) had neither diabetes nor renal insufficiency (glomerular filtration rate [GFR] ≥ 60 ml/min/1.73 m2), Group II (n = 1730) had diabetes but no renal insufficiency, Group III (n = 1431) had no diabetes but renal insufficiency, and Group IV (n = 1044) had both diabetes and renal insufficiency. The primary endpoints were major adverse cardiac events (MACE), including a composite of all cause-of-death, myocardial infarction, target lesion revascularization, and coronary artery bypass graft after 1-year clinical follow-up.ResultsPrimary endpoints occurred in 1804 (18.2%) patients. There were significant differences in composite MACE among the 4 groups (Group I, 12.5%; Group II, 15.7%; Group III, 30.5%; Group IV, 36.5%; p < 0.001). In a Cox proportional hazards model, after adjusting for multiple covariates, the 1-year mortality increased stepwise from Group III to IV as compared with Group I (hazard ratio [HR], 1.96; 95% confidence interval [CI], 1.34-2.86; p = 0.001; and HR, 2.42; 95% CI, 1.62-3.62; p < 0.001, respectively). However, Kaplan-Meier analysis showed no significant difference in probability of death at 1 year between Group III and IV (p = 0.288).ConclusionsRenal insufficiency, especially in association with diabetes, is associated with the occurrence of composite MACE and indicates poor prognosis in patients with AMI. Categorization of patients with diabetes and/or renal insufficiency provides valuable information for early-risk stratification of AMI patients.

Smoking effect on ischemic heart disease in young patients

Objective:To evaluate the effect of tobacco smoking on the risk of nonfatal acute myocardial infarction in young adults (≤45 years).Patient and Methods:We conducted a population-based case-control study with 329 incident acute myocardial infarction cases (42 women; 287 men), consecutively admitted to the Cardiology department of hospitals in Aleppo, Syria, and 778 controls (486 women; 292 men), selected within the noninstitutionalized Aleppo population, during 2008-2010. Odds ratios (OR) and 95% confidence intervals (95%CI) were calculated using unconditional logistic regression.Results:The prevalence of current smoking was 80.8% in male cases and 53.8% in male controls (OR = 3.63, 95%CI: 2.50, 5.27) and 59.5% of female cases were smokers compared with 35.8% of controls (OR = 2.64, 95%CI: 1.39, 5.02). No interaction was found between current smoking and gender on myocardial infarction risk (P = 0.401). A dose-effect response was present, the odds favoring myocardial infarction reaching an eight-fold increase for those who smoked >25 cigarettes/day compared with never smokers. The risk estimate for former smokers was similar to never smokers.Conclusions:Tobacco smoking is an important independent risk factor for acute myocardial infarction in young adults, with similar strength of association for both genders.

Relationship between Two AMI Risk Factors: Low Serum Lipoprotein Lipase Mass and Hypoadiponectinemia

Recent clinical studies have reported that low lipoprotein lipase mass in preheparin serum (s-LpL) and hypoadiponectinemia are important risk factors for acute myocardial infarction (AMI). The aim of this study was to elucidate the relationship between low s-LpL and hypoadiponectinemia, both of which are risk factors for AMI. One hundred and thirty-seven male patients with AMI and fifty-three males with normal coronary arteries (NCA) were enrolled in the study. Coronary risk factors, including s-LpL and serum total adiponectin concentrations (t-adiponectin), were compared. Both s-LpL and t-adiponectin were significantly lower in patients with AMI than in subjects with NCA (s-LpL, NCA: 48.1±11.0 ng/mL, AMI: 38.9±11.1 ng/mL, p< 0.01; t-adiponectin, NCA: 7.7±2.9 µg/mL, AMI: 6.1±3.3 µg/mL, p< 0.01). In AMI patients, there was a significant positive correlation between s-LpL and t-adiponectin (r=0.46, p< 0.01). Furthermore, multivariate analysis indicated that both s-LpL and t-adiponectin were independent variables for AMI (s-LpL: p< 0.05, t-adiponectin: p< 0.05). These results indicate that although low s-LpL and hypoadiponectinemia are associated with each other, they are independent risk factors for AMI.