Factor In Acute Myocardial Infarction Research Articles

Risk factors for myocardial infarction and stroke in Africa

Background: Definitive information on the strength of association between various risk factors and cardiovascular disease in Africa is lacking. Objective: We conducted a systematic review of studies investigating risk factors for acute myocardial infarction (AMI) and stroke in Africa. Data sources: We searched Medline and Embase as well as the reference lists of the included articles. Study eligibility criteria: We included case-control and cohort studies conducted in an African country, which assessed risk factors for first episodes of (AMI) or stroke in people of any age. Methods: Two independent reviewers screened studies for eligibility, extracted data and assessed study quality. We described measures of association (odds ratios) with confidence intervals of risk factors for AMI and stroke separately. Results: Twelve articles reporting results from five case-control studies met our inclusion criteria but only one study (INTERHEART ) investigated risk factors for AMI. No eligible cohort studies were identified. The direction of association for established risk factors for AMI and stroke seem to be similar globally but the strength of association of various risk factors varies between countries and within African ethnic groups. In Africa, diabetes and hypertension had the highest risk associated with AMI and hypertension was the strongest risk factor for stroke. Overall, the quality of the included case-control studies was good. Conclusions and implications: Our results confirm the urgent need for prospective studies investigating risk factors for AMI and stroke in African populations. A few high quality case-control studies exist but these do not adequately represent the cultural and genetic diversity in Africa, or the influence of infections on cardiovascular outcomes. Dynamic risk factors that rely on self-report such as diet, physical activity and stress will be better assessed through longitudinal cohort studies.

Allopurinol, benzbromarone and risk of coronary heart disease in gout patients: A population-based study

BackgroundThe effect of gout on the risk of developing coronary artery disease (CAD) is uncertain. Some studies have found that gout is a risk factor for acute myocardial infarction. This study examined the changes in risk of CAD in gout patients taking allopurinol and/or benzbromarone, and analyzed the dose-response relationship of both drugs with CAD incidence. MethodsThe medical records of one million subjects from 2000 to 2011 were provided by the Taiwan National Health Insurance Research Database. Cox proportional hazard ratio was used to compare the risk of CAD in gout patients taking allopurinol or/and benzbromarone with those taking neither drug. Hazard ratios (HR) were adjusted for possible confounding factors, including age, gender, hypertension, hyperlipidemia, diabetes mellitus, chronic kidney disease, and relevant medications. ResultsOf 8047 gout patients, 1422 were treated with allopurinol (Group A), 4141 with benzbromarone (Group B), and 2484 with both drugs (Group A/B) during the follow-up period. Our results showed the incidence of CAD after adjusting for covariates for Group A, Group B, and Group A/B did not significantly differ from the comparison group. However, after adjustment for covariates in dose-response analyses, treatment with over 270 defined daily doses (DDDs) of allopurinol, and over 360 DDDs of benzbromarone, was associated with a significantly reduced risk of CAD. ConclusionWe found that the use of allopurinol and benzbromarone, whether alone or in combination, had a linear dose-response relationship between the numbers of defined daily doses and the risk of CAD, especially in higher DDDs.

A study of risk factors for acute myocardial infarction in patients below 35 years in eastern India

Background: Coronary artery disease (CAD) is most common cause of mortality. Its incidence in young Indians is about 12%–16%. Myocardial infarction (MI) in young can be divided into two groups, those with angiographically normal coronaries and those with CAD. 15%–20% of those with CAD have no identifiable risk factors and therefore miss the opportunity for primary prevention. Recent reports have suggested that increased lipoprotein a (Lp[a]) and hyperhomocysteinemia play an important role in MI. The true prevalence of CAD in young is grossly underestimated.Aims: (1) Study of risk factors for MI in patients <35 years. (2) Clinical presentation. (3) Disease pattern in coronary angiography. (4) To assess the relationship of emerging risk factors such as homocysteine and Lp(a) with MI.Materials and Methods: Fifty patients aged 35 years or younger diagnosed with acute MI were included.Results: The majority of patients were males (80%). The mean age was 33.3 in males and 31.8 years in females. Chest pain was the most common presenting complaint (94%). Smoking was the most prevalent risk factor (72%). Hyperhomocysteinemia (42%) and raised Lp(a) (24%) were emerging risk factors. Anterior wall MI was most prevalent (64%) and most patients had single vessel disease with left descending coronary being the most commonly involved artery.Conclusions: Homocysteine and Lp(a) should be measured in young MI patients. Smoking cessation and prevention of diabetes and hypertension should be encouraged. As young patients have more discrete lesion, timely revascularization will reduce myocardial damage.

SAT-042 - Alcoholic cirrhosis is not a risk factor for acute myocardial infarction: a nationwide cohort study

SAT-042 - Alcoholic cirrhosis is not a risk factor for acute myocardial infarction: a nationwide cohort study

ABO Gene Polymorphism and Thrombomodulin -33G>A Polymorphism Were Not Risk Factors for Myocardial Infarction in Javanese Men.

Genetic factors contribute to about a half of coronary artery diseases. During the last several decades, some studies suggested that non-O blood group and thrombomodulin polymorphism −33G>A are the risk factors of coronary artery disease especially in Asia. There was no prior study in Indonesia regarding this issue. Hence, this study was designed to investigate the correlation of ABO polymorphism and thrombomodulin polymorphism −33G>A with the incidence of acute myocardial infarction (AMI). A total of 192 subjects were enrolled in this case control study. AMI patients were diagnosed based on World Health Organization criteria. Healthy patients were subjects with AMI risk factor without any sign and symptoms of AMI. Patients with diabetes mellitus, cancer, and arrhythmia were excluded from this study. Genotyping for both polymorphisms was performed by PCR RFLP methods. The result of this study suggested that ABO polymorphism and thrombomodulin polymorphism −33G>A were not risk factors of AMI, p = 0.727 and p = 0.699, respectively. Furthermore, the analysis to identify the synergy of these polymorphisms failed to prove their correlation with AMI (p = 0.118). Conclusively, this study showed that ABO polymorphism and thrombomodulin polymorphism −33G>A were not risk factors of AMI.

Circulating long non-coding RNAs as biomarkers of acute myocardial infarction

For the past decades, acute myocardial infarction (AMI) has been the most common cause of death in both genders. The invention of percutaneous intervention (PCI) has saved thousands of lives. The most important prognostic factor for AMI is the time between the onset of AMI and revascularization. Heart centers around the world have devoted themselves to improving the evaluation tools for AMI. Among these evaluation tools, MI biomarkers have undergone the most evolution over the past decade. Traditionally used protein biomarkers like CK-MB and troponin are limited by serum instability and low sensitivity, especially if patient is admitted right after chest pain. Because both biomarkers require 4–6 hours to be detectable. Recently, the researches of one type of noncoding RNA namely long non-coding RNA (lncRNA) in the MI field has become popular. Even not coding any protein in most cases, lncRNA has an astounding effect on protein expression and modification. Expressions of lncRNA in the peripheral blood have been found to change during AMI. Both basic and clinical studies suggest that circulating lncRNA can be potentially used as a biomarker for myocardial injury.

Low protein Z plasma level is a risk factor for acute myocardial infarction in coronary atherosclerosis disease patients

ObjectivesTo examine plasma protein Z (PZ) levels in acute myocardial infarction (AMI) and chronic coronary atherosclerosis disease (CCAD) patients without history of AMI and explore its potential clinical significance. MethodsPlasma PZ concentrations were measured in 90 AMI patients (Group A), 87 CCAD patients without AMI history who remained free of major clinical events at least one year (Group B), and 88 clinically healthy controls (Group C). ResultsPZ was found to be significantly lower (P<0.001) in Group A (1508.5±486.2ng/mL) compared with Group B (1823.0±607.8ng/mL) and C (2001.7±733.0ng/mL) and in Group A+B compared with Group C (Group A+B 1663.1±570.0 ng/mL, P<0.001). No statistically significant difference was reached between Group B and C (P=0.081). PZ level was significantly correlated with concentration of creatine kinase MB, high sensitive-cardiac troponin T, high sensitive C reactive protein, D-dimer and coagulation factor II and may be a useful predictor for AMI (OR: 1.38, 95% CI: 1.13–1.77, P=0.03). Subgroup analysis showed PZ concentration below the lowest tertile (<1398ng/mL) had a significantly increased risk for AMI and CCAD (OR: 3.39; 95% CI: 1.12–10.31; P=0.03 and OR: 7.39; 95% CI: 2.62–20.79; P<0.001 respectively). ConclusionsPZ deficiency is found in AMI patients and could potentially reflect the myocardium injury, local coagulation activation and inflammation response during the acute phase of coronary atherosclerosis disease.

GW27-e1082 Effect of Inflammatory factors of acute myocardial infarction complicated with cardiac shock in patients undergoing IABP and the Shenfu injection treatment

GW27-e1082 Effect of Inflammatory factors of acute myocardial infarction complicated with cardiac shock in patients undergoing IABP and the Shenfu injection treatment

PS 11-23 IMPACT OF ADMISSION BLOOD PRESSURE AND HISTORY OF HYPERTENSION ON CLINICAL OUTCOMES OF PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

Objective: Hypertension (HTN) has been considered a strong risk factor of acute myocardial infarction (AMI). However, growing evidence suggests that low blood pressure (BP) plays a role against adequate myocardial perfusion in AMI. We aimed to investigate how admission BP status impact on clinical outcomes after percutaneous coronary intervention (PCI) in Korean acute myocardial infarction (AMI) patients. Design and Method: Between November 2011 and December 2014 a total of 12,432 consecutive AMI patients were enrolled in Korea Acute Myocardial Infarction Registry. They were divided into four groups according to admission BP status [Group I (n = 970): patients with normal BP and without HTN history, Group II (n = 1,957): patients with normal BP and with HTN history, Group III (n = 1,494): patients with high BP and with HTN history, Group IV (n = 531): patients with high BP and without HTN history]. Primary endpoint was composite of major adverse cardiac events (MACE) at one year. Results: Kaplan-Meier analysis showed lowest incidence of MACE in Group IV (p < 0.0001 by log-rank test). Group III also showed better results than Group I or II (p < 0.0001). However, Group I and II showed similar results, which showed highest incidence of MACE. Moreover, survival analysis using Cox proportional hazard model revealed that patients in Group IV turned out to be one of the independent factors for prediction of MACE-free survival (HR 0.867, 95% CI 0.773–0.972, p = 0.015) even after adjusting clinically relevant multiple variables. Conclusions: Non-hypertensive AMI patients presenting with high admission BP showed most favorable clinical outcomes among groups at one year after PCI.

ACUTE MYOCARDIAL INFARCTION

The frequency of modifiable risk factors of acute myocardial infarction variesgreatly in different countries and populations of the world. Objective: To find out the frequencyof modifiable risk factors in patients with acute myocardial infarction. Design: Cross-sectionalstudy. Setting: Cardiology Department. Ayub Teaching Hospital Abbottabad, Period: 1st Jan2015 and 30th June 2015. Material and Methods: A total of 224 patients of acute myocardialinfarction Patients were enquired about the presence of hypertension, diabetes mellitus,smoking and family history of ischemic heart disease. Fasting blood sugar and lipid profilewere recorded. Results: Out of 224, 90.6% patients had at least one risk factor. Hypertensionwas found to be the most common risk factor (55.4%), followed by smoking (43.8%) andDiabetes Mellitus (27.2%). Dyslipidemia was found to be the least common (23.2%) risk factor.Conclusion: Hypertension is the most common modifiable risk factor in patients of acutemyocardial infarction, followed by smoking and diabetes.

PERCEPTION OF EMERGENCY NURSES IN USING A CHEST PAIN ASSESSMENT PROTOCOL

A qualitative and descriptive study aimed at identifying the perception of nurses at the emergency service of a hospital in Southern Brazil on the use of a nursing protocol for classifying chest pain, implemented at a private hospital in the Brazilian Southeast. The protocol considers, among others, the characteristics of the chest pain, risk factors and flowcharts that lead to the nursing action of classifying the risk. Seven nurses participated in the study through semi-structured interview, between January and February 2014. For the data analysis, Content Analysis was used. The results reveal a consensus among nurses that the protocol prioritizes care; identifies risk factors for acute myocardial infarction more easily and identifies the type of pain. The lengthiness and time consumption were revealed as negative considerations. For the nurses, the protocol is applicable to the service as it supported their conduct.

Analysis of Ambient Influences Affecting Interleukin-6 Secretion in the Context of Clinical Trials of Stem Cell Therapy for Myocardial Infarction.

Contradictory results of large clinical trials of stem cell therapy in acute myocardial infarction (AMI) have impeded a wider clinical use. As signalling via paracrine factors in AMI has received more and more attention recently, we sought to compare processing protocols with special emphasis on interleukin-6 (IL-6), a factor of major relevance for triggering cardioprotective signals via STAT3 and PI3K. Bone marrow and peripheral blood mononuclear cells were processed according to protocols used in the REPAIR-AMI and ASTAMI study. Keeping cells at higher temperatures significantly boosted secretion of IL-6. Moreover, the use of autologous serum and X-Vivo medium was superior over reagents used in the protocol of the ASTAMI study. External influencing factors (higher temperature, use of a modern cell culture medium supplemented with serum) led to higher concentrations of IL-6. These results could provide an explanation for the superior results found in the REPAIR-AMI study.

Prevalence of diabetes in patients with myocardial infarction: a study in a tertiary care centre

Background: Diabetics experience a greater mortality during the acute phase of myocardial infarction (MI) and a higher morbidity in the postinfarction period. This study was conducted to assess the prevalence of diabetes as a risk factor for acute myocardial infarction. Methods: Detailed demographic details such as age, gender, weight, BMI, blood pressure, smoking and alcohol details, previous clinical and medical history were noted for all the patients. Blood was collected from the patients for random blood glucose levels and HbA1c levels. On the 2 nd and the 5 th days of admission, fasting blood glucose levels were measured. Results: 63.5% patients were males and only 36.5% of them were females with the average age being around 66 years. Most of the patients who were admitted to the hospital with MI were obese or overweight with elevated cholesterol and triglyceride levels. Out of the 104 patients, 59 (56.7%) had no diabetics, 29 (27.9%) were known diabetics. 11 (10.6%) of them were identified as diabetic during the hospitalization. Conclusions: The chronic and acute hyperglycaemia associated to acute coronary syndromes, mainly in acute myocardial infarction is an independent and determinant factor in the outcome for patients with and without diabetes mellitus.

Investigation of fibrous cap stresses on vulnerable plaques leading to heart attacks.

Rupture-prone plaques in the coronary arteries, called ``vulnerable plaques'', are recognized as the key factor in acute myocardial infarction. Vulnerable plaques have a thin fibrous cap over a large fatty core and are highly susceptible to rupture. In general, this type of plaque rupture is mainly associated with stress concentrated on the fibrous cap. Fibrous cap stresses are counted among the most important factors in the plaque rupture process and must be taken into consideration when assessing the plaque vulnerability leading to heart attacks. The objective of this paper was to investigate the effects of nitinol stent deployment on the morphological changes of vulnerable plaques and then to propose a new stent design concept for effectively reducing fibrous cap stresses and the associated rupture risk. The deployment of a self-expanding nitinol stent was modeled, and the resulting stress distribution on the fibrous cap was investigated. The fibrous cap stresses were more uniformly distributed and the maximum stress was reduced by 13% when the crown number of the stent was increased. This study demonstrates an excellent approach to stent design that could effectively reduce the risk of a vulnerable plaque rupturing and causing a heart attack.

Hiperglucemia se asocia a mayor número de desenlaces adversos en individuos latinoamericanos con infarto agudo de miocardio

BackgroundAlterations in glucose metabolism have been reported as risk and poor prognostic factors for acute myocardial infarction (AMI); however in Latin-American population this information is limited. Thus, an evaluation was performed on the association between glycaemic status and short- and long-term outcomes in patients with a first AMI. MethodsA multicentre, prospective, observational, cohort study was conducted in 8 hospitals from Colombia and Ecuador. ResultsA total of 439 patients with confirmed AMI were included, of which 305 (69.5%) had prediabetes or type2 diabetes mellitus (DM2). Compared with normal glycaemia group, patients with known DM2 had greater risk of prolonged hospital stay (HR: 2.60, 95%CI: 1.38-4.92, P=.003), Killip class iii/iv (HR: 9.46, 95%CI: 2.20-40.62, P=.002), and in-hospital heart failure (HR: 10.76, 95%CI: 3.37-34.31, P<.001). Patients with prediabetes, new DM2, and known DM2 showed higher rates of major adverse cardiovascular events after 3years follow-up. ConclusionGlucose metabolism abnormalities have an important significance in the short- and long-term prognosis in Latin-American patients that survive a first AMI.

Risk factors of acute myocardial infarction in middle-aged and adolescent people (< 45years) in Yantai.

BackgroundYantai is a developed medium-sized coastal city in Eastern China, having a population of 1.6845 million. With the development of economy, some middle-aged and adolescent people (< 45 years) devote themselves to work and suffer from greater stress, which makes them ignore their own health. Moreover, they have unhealthy lifestyles and lack the knowledge of cardiovascular risk factors.ObjectivesTo identify the risk factors for first acute myocardial infarction in middle-aged and adolescent people in Yantai, a developed medium-sized coastal city in Eastern China.MethodsA total of 154 consecutive patients with first acute myocardial infarction (< 45 years), were enrolled in case group, and 462 patients without myocardial infarction were enrolled in control group. Three controls with the same sex and age were matched to each case. The risk factors were identified with univariate and multivariate analysis.ResultsUnhealthy food habit (eating seafood and meanwhile drinking beer), hypertension, current smokers, self-perceived stress, diabetes mellitus, obesity, sleep insufficience, hypercholesterolaemia and fatigue were independent risk factors for first acute myocardial infarction (P < 0.05).ConclusionsBesides those recognized risk factors for cardiovascular disease (hypertension, hypercholesterolemia, diabetes mellitus and smoking), eating seafood and meanwhile drinking beer, self-perceived stress, sleep insufficience, obesity and fatigue were also the risk factors for first acute myocardial infarction in middle-aged and adolescent people in Yantai.

Uric acid lowering therapy in cardiovascular diseases.

Recent evidence would indicate that high serum uric acid (SUA) levels can be a significant and independent risk factor for hypertension and cardiovascular diseases, such as ischemic heart disease and heart failure. In the last few years an independent risk relationship between hyperuricemia, cardiovascular disease and mortality has also been reported. Hyperuricemia has been shown as an independent risk factor for acute myocardial infarction and an independent and conjoint association of either gout and SUA with total and cardiovascular mortality has been reported, with mortality impact in gout patients increasing with rising SUA concentrations, even for SUA levels in the normal to high range. These findings prompted a growing research interest on the possible benefits of uric acid lowering drugs in cardiovascular diseases. Indeed, clinical studies have reported on the beneficial effects of uric acid lowering drugs, in particular of xanthine oxidase inhibitors, in hypertension, ischemic heart disease and heart failure. Two main mechanisms have been claimed to explain the dangerous effects of hyperuricemia and, as a consequence, the benefits of uric acid lowering therapy: endothelial dysfunction and systemic inflammation. This brief review aims to summarize current evidence from human studies on the role of acid uric lowering therapy in cardiovascular diseases for practical and clinical purposes. The possible mechanisms underlying the benefits of acid uric lowering therapy are also addressed.

Gender: the state of being male or female.

Gender: the state of being male or female.

Use of copeptin and high-sensitive cardiac troponin T for diagnosis and prognosis in patients with diabetes mellitus and suspected acute myocardial infarction

BackgroundDiabetes is a major risk factor for acute myocardial infarction (AMI). Assessment of diabetic patients is challenging due to an often atypical presentation of symptoms. We aimed to evaluate the two novel biomarkers copeptin and high-sensitive cardiac troponin (hs-TnT) for the improvement of early diagnosis and risk-stratification in patients with diabetes and suspected AMI. MethodsIn this prospective international multicenter study we evaluated 379 patients with diabetes in a cohort of 1991 patients presenting with symptoms suggestive of AMI. The measurement of biomarkers was performed at presentation. ResultsAmong the 379 diabetic patients, 32.7% had AMI, and in the 1621 patients without diabetes, 18.8% had AMI. The additional use of copeptin improved the diagnostic accuracy provided by conventional troponin alone (AUC 0.86 vs. 0.79, p=0.004). During a median follow-up of 814days, 49 (13.1%) diabetic patients died. Cumulative 2-year survival rate for patients with copeptin levels below 9pmol/l was 96.6% compared to 82.8% in patients above that level (p<0.001). The same was observed for hs-TnT with a cutoff level of 14ng/l (97.7% vs. 82.0%, p<0.001) respective of cTnT with a cutoff level of 10ng/l (93.5% vs. 75.6%, p<0.001). In multivariate Cox analysis, copeptin, hs-TnT and cTnT were strong and independent predictors of 24-month-mortality. Using the dual marker strategy (copeptin and troponin) identified two groups of high-risk patients where 22.5% of the group with hs-cTnT and copeptin above the cutoff and 28.6% with cTnT and copeptin above the cutoff died. ConclusionIn diabetic patients, copeptin only slightly improves the early diagnosis of AMI provided by hs-cTnT. However, both markers (copeptin and troponin) predict long-term mortality accurately and independently of each other.

Risk Factors of Postoperative Myocardial Infarction after Colorectal Surgeries

There are limited data regarding the specific risk factors of postoperative myocardial infarction (MI) in patients undergoing colorectal resectional surgery. We sought to identify risk factors of acute MI after colorectal resection operations. The National Inpatient Sample database was used to identify patients who had postoperative MI after colorectal resection operations between 2002 and 2010. Statistical analysis was performed to identify factors predictive of postoperative MI. We sampled a total of 2,513,124 patients undergoing colorectal resection, of whom 38,317 (1.5%) sustained a postoperative MI. Patients with postoperative MI had associated 28.5 per cent in-hospital mortality. Risk factors identified include (P < 0.01): history of congestive heart failure (odds ratio [OR], 8.18), chronic renal failure (OR, 3.86), age 70 years or older (OR, 3.68), peripheral vascular disorders (OR, 2.93), fluid and electrolyte disorders (OR, 2.69), emergency admission (OR, 2.56), preoperative weight loss (OR, 2.49), cardiac valvular disease (OR, 2.46), chronic lung disease (OR, 1.75), deficiency anemia (OR, 1.22), colorectal cancer (OR, 1.77), and hypertension (OR, 1.14). Postoperative MI occurs in less than 2 per cent of colorectal resections. However, patients sustaining postoperative MI are over six times more likely to die. Congestive heart failure and chronic renal failure are the strongest predictors of postoperative MI.