Higher Risk Of Myocardial Infarction Research Articles

Clinical outcomes of comparison between type-III cap and non-cap acute coronary syndrome patients in 3 year follow up

Abstract Background Coronary artery perforation(CAP) is potentially fatal complication of percutaneous coronary intervention(PCI) in acute coronary syndrome(ACS).There is no study in literature comparing long term clinical outcomes of type III-CAP-ACS and non-CAP-ACS patients. Purpose The aim of this study was to investigate in hospital- 1-year and 3-year clinical outcomes of type III-CAP during PCI in ACS patients. Methods Data from ACS patients who had type III-CAP during PCI from January 2010 to Jaunary 2020 at different high volume centers in Turkey were collected.A retrospective cohort of 43,791 patients who underwent PCI was used:120 patients with CAP and 43,671 case-control patients were evaluated.Propensity score matching was used to evaluate the association between differing CAP. Clinical angiographic and procedural characteristics, their management and outcomes were analyzed retrospectively in 1-year and 3-year follow up.Multiple regressions were used to identify predictors of coronary perforation and its association with outcomes. Results The mean age of subjects was 66.5±11.9 years(61.8%males).Of all ACS patients were 247STEMI(37.9%), 216NSTEMI(33.2%) and 188UA(28.9%).Non significant differences were identified between the CAP and non-CAP groups in hospital follow-up for, cardiac death, major bleeding, and stent thrombosis except cerebrovascular event(p=0.003).At three year, differences remained different between myocardial infarction(MI)(p=0.038),coronary artery bypass graft(CABG)(p=0.001),stent thrombosis(ST)(p=0.002),major bleeding(p=0.029) and cerebrovascular event(CVE)(p=0.011)), was observed in the CAP/non-CAP group.Median follow-up of was 36 months.The all-cause mortality was 33.3% in CAP group versus 1.8% in non-CAP group at 1-year and 28.3% in CAP group versus 6.9% in non-CAP group at 3-years(p=0.001,p=0.001). Conclusions There was no significat difference between type-III-CAP and non-CAP group in hospital mortality.The procedural, clinical, 1 and 3-year outcomes of type III-CAP showed that relatively high risk of MI,CABG,CVE,ST and major bleeding under 1 and 3-year follow-up.Also, non-CAP ACS patients had better survival compared to type III CAP ACS patients in 3- year follow up.Figure 1Figure 2

Abstract 15993: The Association of Aspirin With and Without Statin on Cardiovascular Outcomes in Primary Prevention Patients With Diabetes Mellitus

Background: The role of aspirin in primary prevention of ASCVD amongst high-risk individuals with diabetes mellitus remains unclear. We investigated aspirin use with and without statin and its association with future ASCVD events in a cohort of real-world primary prevention patients with diabetes mellitus. Methods: Primary prevention patients with diabetes were stratified based on HbA1c levels (6.5-7%, 7-9%, >9%) and 10-year ASCVD risk (High-risk [≥20%]). Aspirin use was defined as no use, seldom used (<30% of the time), sometimes used (≥30% - < 70% of the time), and often used (≥70% of the time). Cox regression assessed HRs of myocardial infarction (MI), stroke, and mortality with aspirin use. Results: Of 79, 597 patients with diabetes, 44.6% were classified as high-risk. These patients showed highest utilization of aspirin (45.7%) and statin (44.9%). Compared to high-risk patients with diabetes and an HbA1c of >9% on both a statin and an aspirin, those on statin alone had higher risk of MI [HR MI 1.74 (1.44-2.212), p <0.001], ischemic stroke [HR STROKE 2.52 (1.92-3.29), p <0.001], and mortality [HR 1.67 (1.27-2.19), p <0.001] (Table). Aspirin use alone was associated with higher risk of MI [HR 3.11 (2.42-4.00), p <0.001], ischemic stroke [HR 3.12 (2.08-4.67), p <0.001], and mortality [HR 3.77 (2.71-5.23), p < 0.0004] in the high-risk population with HbA1c >9% (Table). At all A1c levels, patients on no statin or aspirin were at significantly higher risk for MI, stroke, and mortality (Table). In high-risk patients with an HbA1c >9%, ASA use ≥ 70% resulted in significantly lower risk of MI [HR 0.58 (0.49-0.69), p<0.001)], ischemic stroke [HR 0.36 (0.28-0.46), p<0.001] and mortality [HR 0.52 (0.42-0.66), p<0.001]. Conclusion: Low dose aspirin may play a role in prevention of ASCVD events in high-risk patients with diabetes. Future studies can clarify the risk-benefit ratio of using aspirin with statin in patients with poor glycemic control for primary prevention of ASCVD events.

Abstract 18200: Prognostic Importance of Serial NT-proBNP Measurements Following High-Risk Mi: The PARADISE-MI Trial

Introduction: N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a potent predictor of heart failure (HF) and death following myocardial infarction (MI). NT-proBNP levels change post MI. Hypothesis: Serial measurements of NT-proBNP add prognostic information. Aims: To investigate the prognostic importance of NT-proBNP two weeks after MI in PARADISE-MI and to identify predictors of week 2 NT-proBNP. Methods: Patients with MI and LVEF ≤40% and/or pulmonary congestion (n=5661) were randomized to sacubitril/valsartan or ramipril. Patients with NT-proBNP measured at week 2 (n=1057) were analyzed. Associations of week 2 NT-proBNP with subsequent clinical outcomes were evaluated with Cox models adjusted for baseline NT-proBNP, age, sex, atrial fibrillation (AF), LVEF, STEMI presentation, BMI, eGFR, high-sensitivity troponin T (hs-cTnT), time from presentation to randomization and treatment assignment. Results: Median NT-proBNP was 1425 [685, 2598] ng/L at week 2, declining 23% (95% CI, 20-26%) from baseline. Patients in the highest NT-proBNP quartile at week 2 (≥2616 ng/L) were older, had lower LVEF and eGFR, higher Killip class, more AF, and higher baseline NT-proBNP (all p≤0.05). Higher NT-proBNP at week 2 was independently associated with greater risk of CV death or incident HF (adjusted HR [aHR] 1.62 per log2; 95% CI, 1.30-2.03), HF hospitalization (aHR 1.96; 95% CI, 1.46-2.62) and all-cause death (aHR 1.86; 95% CI, 1.40-2.47). Higher baseline NT-proBNP and hs-cTnT, longer interval between presentation and randomization and female sex were associated with higher week 2 NT-proBNP levels while sacubitril/valsartan was associated with lower levels (Table). Conclusions: Patients with elevated NT-proBNP two weeks after high-risk MI are at greater risk of subsequent death or incident HF, even after adjusting for baseline level. Higher baseline NT-proBNP and hs-cTnT are predictive of higher week 2 NT-proBNP while sacubitril/valsartan decreases levels.

Abstract 16212: Sex-Based Statin Utilization and Cardiovascular Disease Outcomes: A Real World Secondary Prevention Cohort

Introduction: Current guidelines recommend using high-intensity statins in patients with clinical ASCVD.However, real world adherence to GDSI use and recurrent events remains less known. Sex difference in statin use have been previously reported. We evaluated sex-based disparities in GDSI use and recurrent ASCVD outcomes in a large healthcare network. Methods: Using EMR, we assessed statin use and intensity amongst patients with established prior ASCVD events (MI, ischemic stroke/TIA) and PAD from 2010-2022. Statins were categorized into GDSI (high intensity), <gdsi (moderate="" or="" low="" intensity)="" or no statin use. Outcomes of interest included repeat MI, stroke/TIA and all-cause mortality. Incident rates (IR) and Cox regression hazard ratios (HR) of ASCVD outcomes were calculated across statin categories stratified by sex. Results: Amongst 45,949 patients,31% were women. Women had more diabetes (29% vs 24%) and higher LDL-C (94.9 ± 40.8 vs 87.6 ± 37.1 mg/dL) than men. During a follow-up period of 5 years, women were less likely to be started on GDSI (61.6% vs 65.8%, p<0.01) and achieve LDL-C<70mg/dL (41% vs and 49%, p<0.01) as compared to men. GDSI use lowered IRs for all outcomes in both sexes (Table 1). Women on GDSI had higher risk of MI (HR 1.21 [1.12-1.31)],stroke (1.21 [1.08-1.34] and mortality (1.12 [1.05-1.20]), all p<0.01) than men. Conclusions: In a contemporary cohort of secondary prevention patients, women were less likely to be prescribed GDSI than men and less likely to achieve guideline concordant LDL-C<70mg/dL. This was associated with a higher risk of recurrent ASCVD events in women as compared to men. More sex specific interventions are needed to ensure adequate preventive treatment for both sexes. Abbreviations: Atherosclerotic cardiovascular disease (ASCVD), guideline directed statin intensity (GDSI), Electronic medical records (EMR),Myocardial Infarction (MI), Peripheral arterial disease (PAD), Transient Ischemic attack (TIA)

Long-Term Cumulative Exposure to High γ-Glutamyl Transferase Levels and the Risk of Cardiovascular Disease: A Nationwide Population-Based Cohort Study.

Elevated γ-glutamyl transferase (γ-GTP) levels are associated with metabolic syndrome. We investigated the association of cumulative exposure to high γ-GTP with the risk of cardiovascular disease (CVD) in a large-scale population. Using nationally representative data from the Korean National Health Insurance system, 1,640,127 people with 4 years of consecutive γ-GTP measurements from 2009 to 2012 were included and followed up until the end of 2019. For each year of the study period, participants were grouped by the number of exposures to the highest γ-GTP quartile (0-4), and the sum of quartiles (0-12) was defined as cumulative γ-GTP exposure. The hazard ratio for CVD was evaluated using the Cox proportional hazards model. During the 6.4 years of follow-up, there were 15,980 cases (0.97%) of myocardial infarction (MI), 14,563 (0.89%) of stroke, 29,717 (1.81%) of CVD, and 25,916 (1.58%) of death. Persistent exposure to high γ-GTP levels was associated with higher risks of MI, stroke, CVD, and death than those without such exposure. The risks of MI, stroke, CVD, and mortality increased in a dose-dependent manner according to total cumulative γ-GTP (all P for trend <0.0001). Subjects younger than 65 years, with a body mass index <25 kg/m2, and without hypertension or fatty liver showed a stronger relationship between cumulative γ-GTP and the incidence of MI, CVD, and death. Cumulative γ-GTP elevation is associated with CVD. γ-GTP could be more widely used as an early marker of CVD risk, especially in individuals without traditional CVD risk factors.

FRI529 Hypothyroidism And Systemic Lupus Erythematosus: A Nationwide Analysis

Abstract Disclosure: F. Sami: None. S. Sami: None. A. Razok: None. T. Ayub: None. A. Olafimihan: None. Background: Hypothyroidism is the most common thyroid disease in Systemic Lupus Erythematosus (SLE) and more prevalent in SLE than the general population. Our aim is to study the prevalence, epidemiology and likelihood of hypothyroidism with SLE as well as impact on outcomes and healthcare burden. Methods: The National Inpatient Database from 2016-2019 was used to extract patient populations. Data was stratified to reflect national estimates. Adult patients with principal diagnosis of SLE and hypothyroidism as a primary or secondary diagnosis were identified. Epidemiology was compared. We analyzed mortality rates, hospital charges (THC) and length of stay (LOS). Secondary outcomes included sepsis, congestive heart failure (CHF), renal and respiratory failure, stroke and myocardial infarction (MI). Statistical analysis was performed with STATA17. Univariate and multivariate regression analyses adjusted for confounders. Results: Among 721,090 adult SLE patients, 17.64% had hypothyroidism. In SLE-hypothyroid group, there were more females (93.46% vs 87.35%, odds ratio 2.01) and whites ( 65.82%vs 33.53%, OR 2.37). The mean age was higher (59.95 SD 15.56 vs 50.91 SD 16.94, P-value 0.000) with significantly more patients in 60-80 years group (44.64% vs 28.56%) and less in 18-40 year age group (1.68% vs 29.01%). African-Americans and Hispanics were significantly less in hypothyroid group with OR 0.34 and 0.87 respectively. Charlson comorbidity Index was ssignificantly high (3.2 vs 2.97). Hypothyroidism was significantly more among higher socioeconomic class of SLE patients (20.62% vs 16.7%) and less prevalent among the low socioeconomic class (28.88% vs 35.36%) based on annual income. There was no significant rise in mortality when adjusted for confounders (1.93% vs 1.97%, P-value 0.702), mean length of stay (5.41 vs 5.46, P-value 0.284), or total hospital charges ($63372 vs 64065, P-value 0.273) between two groups. There was a significantly higher prevalence of MI (3.21% vs 2.9%, P-value 0.01,OR 1.11) and CHF (5.94% vs 5%, P-value 0.00,OR 1.2). Prevalence of sepsis (8.92% vs 8.77%, P-value 0.449), renal failure (37.94% vs 37.79%), respiratory failure (37.63% vs 37.84%) and stroke (0.88% vs 0.93%,) was comparable with no significant difference. Odds ratio for hypothyroidism in SLE was 1.5, p-value 0.000. Conclusion: SLE patients with hypothyroidism are more females, Caucasians, of higher mean age, between 60-80 years of age, and from higher socioeconomic status. There is no effect on mortality, LOS and THC, rate of sepsis, stroke, renal and respiratory failure with hypothyroidism. There is a significantly higher risk of MI and CHF. SLE patients have 1.5 times increased risk of developing hypothyroidism. This emphasizes screening at-risk individuals when suspicion arises, for timely diagnoses and improving outcomes. Presentation: Friday, June 16, 2023

Increased risk of myocardial infarction in amyotrophic lateral sclerosis: A nationwide cohort study in South Korea

BackgroundThe risk of myocardial infarction (MI), the major form of CVD, in amyotrophic lateral sclerosis (ALS) is currently unknown. We investigated the risk of MI in ALS and analyzed the effect of ALS-related physical disability on the risk of MI using the Korean National Health Insurance Service database. MethodsA total of 659 ALS patients and 10,927 non-ALS participants were finally selected between January 1, 2011, and December 31, 2015. A Cox hazard regression model was used to examine the hazard ratios (HRs) for MI in ALS after adjustment for potential confounders. ResultsThe incidence rate of MI was 26.2 per 1000 person-years, and the adjusted HR (aHR) for MI in ALS patients was 10.6 (95% confidence interval [CI] 7.2–15.4) compared with the controls. ALS patients who developed physical disability had an even higher risk of MI (aHR 18.6, 95% CI 11.5–30.0) compared with those who did not develop disability (aHR 7.4, 95% CI 4.6–11.9). The increased risk of MI was more prominent in female subjects than in male subjects (aHR 17.8, 95% CI 10.8–29.4 vs. aHR 6.9, 95% CI 4.1–11.6, P for interaction 0.006) and in obese subjects than in non-obese subjects (aHR 17.8, 95% CI 10.5–30.1 vs. aHR 7.9, 95% CI 4.9–12.8, P for interaction 0.018). ConclusionsOur findings suggest that the risk of MI is high in ALS patients compared with a control population, and the risk is more prominent in those who develop physical disability, or who are female or obese.

Effectiveness and Safety of Enteric-Coated vs Uncoated Aspirin in Patients With Cardiovascular Disease

Clinicians recommend enteric-coated aspirin to decrease gastrointestinal bleeding in secondary prevention of coronary artery disease even though studies suggest platelet inhibition is decreased with enteric-coated vs uncoated aspirin formulations. To assess whether receipt of enteric-coated vs uncoated aspirin is associated with effectiveness or safety outcomes. This is a post hoc secondary analysis of ADAPTABLE (Aspirin Dosing: A Patient-Centric Trial Assessing Benefits and Long-term Effectiveness), a pragmatic study of 15 076 patients with atherosclerotic cardiovascular disease having data in the National Patient-Centered Clinical Research Network. Patients were enrolled from April 19, 2016, through June 30, 2020, and randomly assigned to receive high (325 mg) vs low (81 mg) doses of daily aspirin. The present analysis assessed the effectiveness and safety of enteric-coated vs uncoated aspirin among those participants who reported aspirin formulation at baseline. Data were analyzed from November 11, 2019, to July 3, 2023. ADAPTABLE participants were regrouped according to aspirin formulation self-reported at baseline, with a median (IQR) follow-up of 26.2 (19.8-35.4) months. The primary effectiveness end point was the cumulative incidence of the composite of myocardial infarction, stroke, or death from any cause, and the primary safety end point was major bleeding events (hospitalization for a bleeding event with use of a blood product or intracranial hemorrhage). Cumulative incidence at median follow-up for primary effectiveness and primary safety end points was compared between participants taking enteric-coated or uncoated aspirin using unadjusted and multivariable Cox proportional hazards models. All analyses were conducted for the intention-to-treat population. Baseline aspirin formulation used in ADAPTABLE was self-reported for 10 678 participants (median [IQR] age, 68.0 [61.3-73.7] years; 7285 men [68.2%]), of whom 7366 (69.0%) took enteric-coated aspirin and 3312 (31.0%) took uncoated aspirin. No significant difference in effectiveness (adjusted hazard ratio [AHR], 0.94; 95% CI, 0.80-1.09; P = .40) or safety (AHR, 0.82; 95% CI, 0.49-1.37; P = .46) outcomes between the enteric-coated aspirin and uncoated aspirin cohorts was found. Within enteric-coated aspirin and uncoated aspirin, aspirin dose had no association with effectiveness (enteric-coated aspirin AHR, 1.13; 95% CI, 0.88-1.45 and uncoated aspirin AHR, 0.99; 95% CI, 0.83-1.18; interaction P = .41) or safety (enteric-coated aspirin AHR, 2.37; 95% CI, 1.02-5.50 and uncoated aspirin AHR, 0.89; 95% CI, 0.49-1.64; interaction P = .07). In this post hoc secondary analysis of the ADAPTABLE randomized clinical trial, enteric-coated aspirin was not associated with significantly higher risk of myocardial infarction, stroke, or death or with lower bleeding risk compared with uncoated aspirin, regardless of dose, although a reduction in bleeding with enteric-coated aspirin cannot be excluded. More research is needed to confirm whether enteric-coated aspirin formulations or newer formulations will improve outcomes in this population. ClinicalTrials.gov Identifier: NCT02697916.

Incidence of Cardiovascular Disease and Venous Thromboembolism in Patients With Atopic Dermatitis.

Atopic dermatitis (AD) may increase risk for atherothrombotic and cardiovascular (CV) disease. Determine CV disease and venous thromboembolism risk among patients with AD. Cohort study using electronic health data from U.K. general practices in 1994 to 2015. Children (<18 y) and adults (≥18 y) with AD were matched to patients without AD on age, same practice, and encounter date. Treatments and specialist referrals served as proxies of AD severity. Outcomes were incident myocardial infarction, cerebrovascular accident (CVA), diabetes, hypertension, dyslipidemia, deep vein thrombosis (DVT), and pulmonary embolism. Cox regression analysis was used to compare outcomes in AD versus non-AD patients. Comparing 409,341 children with AD (93.2% mild, 5.5% moderate, and 1.3% severe) to 1,809,029 unaffected children, AD was associated with higher risk of DVT (hazard ratio [HR] 1.23; 95% confidence interval [95% CI] 1.02-1.48) and severe AD was associated with higher risk of CVA (HR 2.43; 95% CI 1.13-5.22) and diabetes (HR 1.46; 95% CI 1.06-2.01). Comparing 625,083 adults with AD (65.7% mild, 31.4% moderate, and 2.9% severe) to 2,678,888 unaffected adults, AD, especially when severe, was associated with higher risk of DVT (HR 1.14; 95% CI 1.11-1.18; and HR 1.64; 95% CI 1.49-1.82, respectively) and small but increased risks of CVA, diabetes, and dyslipidemia. Adults with severe AD had higher risk of myocardial infarction (HR 1.27; 95% CI 1.15-1.39), CVA (HR 1.21; 95% CI 1.13-1.30), diabetes (HR 1.15; 95% CI 1.09-1.22), dyslipidemia (HR 1.11; 95% CI 1.06-1.17), and pulmonary embolism (HR 1.39; 95% CI 1.21-1.60) compared with adults without AD. Atopic dermatitis, particularly when severe, is associated with small but increased risks of CV risk factors and events and significantly increased risk of venous thromboembolism.

Wellens’ syndrome in clinical practice

Despite the declining cardiovascular mortality, the incidence of myocardial infarction (MI) is still high, and therefore the issues of its timely diagnosis remain extremely relevant. In addition to the main diagnostic criteria and typical electrocardiographic (ECG) signs, there are many secondary patterns that suggest MI. Wellens’ syndrome (WS) is one of these ECG patterns, which indicates that the patient is at high risk of left ventricular anterior wall MI, caused by occlusion of the anterior interventricular artery (AIA) or its critical stenosis. Despite the relatively low incidence of WS, it is necessary to increase physicians’ awareness in order to prevent MI and reduce its possible negative consequences.This article presents clinical cases of WS, which show the importance of its diagnosis in the management of patients with anginal pain. The first patient is 43-year-old with a diagnosis of class III exertional angina, a history of anginal pain, and the presence of inverted T waves in V2-V3 leads. AIA stenting was performed on the 7th day of hospitalization. The second patient is 67-year-old with a similar diagnosis and history, biphasic T waves in I, aVL, V1-V3 and V5-V6 leads, deeply inverted T waves in V4. Stenting of the AIA and right coronary artery (RCA) was performed on days 5-6 after the most severe episode of anginal pain and after the anginal pain became recurrent. In both cases, WS was not diagnosed. The third patient, 57-year-old, with T wave inversion in II, III, aVF, leads ST segment elevation of less than 1 mm in lead III, minimal ST segment depression in aVL and V2-V3 leads, followed in less than 2 hours by ST segment elevation in II, III, aVF leads. In this patient, WS was diagnosed in a timely manner, urgent coronary angiography was performed, 99% RCA stenosis was detected, and RCA stenting was performed. The outcome is left ventricular inferior wall non-Q wave MI. The last cited case of WS indicates that this syndrome develops not only with AIA damage, but also with damage to other coronary arteries.

Effect of COVID-19 on the Long-term Cardiovascular Outcomes among Patients with Alcohol Use Disorder: A Retrospective Cohort Study Including 45,842 Patients.

This study was conducted to determine the risk of major acute cardiovascular events (MACEs) following COVID-19 among patients with alcohol use disorder (AUD). This is a 1-year follow-up retrospective cohort study that used data from TriNetX, a multi-institutional research network platform. We compared the risks of incident MACEs in patients with AUD who had a positive diagnosis for COVID-19 and patients who had not had COVID-19 during the follow-up year. We enrolled 45,842 patients with AUD with and without COVID-19 history who had similar baseline characteristics from matching. During the follow-up period, the patients with AUD with COVID-19 history had a higher risk of overall MACEs than that of those without COVID-19 history (hazard ratio [HR], 2.013; 95% confidence interval [CI], 1.810-2.240). In addition, the patients with AUD with COVID-19 history had a higher risk of myocardial infarction (HR, 3.778; 95% CI, 2.873-4.969), stroke (HR, 2.411; 95% CI, 2.016-2.883), heart failure (HR, 2.206; 95% CI, 1.866-2.607), arrhythmia (HR, 2.359; 95% CI, 2.041-2.727), and inflammatory heart disease (HR, 3.042; 95% CI, 1.976-4.682). Patients with AUD who survived COVID-19 had a significantly higher risk of incident cardiovascular diseases within 12 months than that of the patients with AUD without COVID-19 history.

Sex hormones and the risk of myocardial infarction in women and men: a prospective cohort study in the UK Biobank

ObjectivesThere is conflicting evidence around the role of sex hormones with cardiovascular outcomes. The aim of this study was to examine the association of sex hormones with the risk of myocardial infarction (MI) in pre- and post-menopausal women, and men in the UK Biobank.MethodsThe UK Biobank is a prospective population-based cohort study, that recruited over 500,000 (aged 40–69 years) women and men between 2006 and 2010.Sex specific cox regression models, estimating hazard ratios (HRs) and women to men ratio of HRs (RHR) with respective 95% confidence intervals (CI), were used to model the association of sex hormones [oestrogen, testosterone, oestrogen: testosterone (O/T) ratio, sex hormone–binding globulin (SHBG) and the free androgen index (FAI)], measured at study baseline, with incident MI for women and men.ResultsData were from 479,797 participants [264,282 (55.1%) women] without a history of MI at study baseline. Over 12.5 years of follow-up, there were 4,908 MI events in women and 10,517 in men. Neither oestrogen nor testosterone were associated with MI in women and men after multiple adjustment. For men, but not women, a unit higher log-transformed O/T ratio was associated with a lower risk of MI 0.79 (0.65, 0.95) after adjustment for traditional CVD risk factors. The corresponding women to men RHR (95% CI) was 1.24 (0.99, 1.56). Higher SHBG (per unit) was also associated with a lower risk of MI in men 0.94 (0.89, 0.99), and not in women 1.02 (0.95, 1.09) after multiple adjustment, the corresponding women to men RHR (95% CI) was 1.09 (1.00, 1.18). Higher FAI was associated with a higher risk of MI in men 1.09 (1.02, 1.15), though not in women 0.97 (0.92, 1.02), the corresponding women to men RHR was 0.89 (0.82, 0.97). Finally, there were differential effects in the association of SHBG and FAI between pre- and post-menopausal women.ConclusionsA higher O/T ratio was associated with a lower risk of MI, and a higher FAI with a higher risk of MI after adjustment for CVD risk factors in men, but not in women. Thus, hormone ratios, rather than each alone, may play an important role in modulating the effect of MI.

Clinical Outcomes of Comparison Between Type III Coronary Artery Perforation (CAP) and non-CAP Acute Coronary Syndrome Patients During 3-Year Follow-up.

Coronary artery perforation (CAP) is a potentially fatal complication of percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS). This study aimed to investigate in-hospital, 1-year, and 3-year clinical outcomes of type III CAP during PCI in patients with ACS. The study retrospectively evaluated 118 patients with CAP and 43,226 case-control patients. Clinical, angiographic, and procedural characteristics, management, and outcomes were analyzed retrospectively at 1-year and 3-year follow-ups. The mean age of the patients was 66.5 ± 11.9 years (61.8% males). There was no significant difference in hospital mortality between the type III CAP and non-CAP groups. The all-cause mortality was 33.3% in the CAP group vs 1.8% in the non-CAP group at 1 year, and 28.3% in CAP group vs 6.9% in non-CAP group at 3 years (p = .001 for both comparisons). The procedural, clinical, and 1 and 3-year outcomes of type III CAP showed a relatively high risk of myocardial infarction, coronary artery bypass graft, cerebrovascular event, stent thrombosis, and major bleeding at the 1 and 3-year follow-ups. In addition, non-CAP ACS patients had better survival (log-rank: p < .001, 34.29 months 95% Confidence Interval [33.58-35.00]) than type III CAP ACS patients (29.53 months 95% Confidence Interval [27.28-31.78]) at the 3-year follow-up visit.

Causality of particulate matter on cardiovascular diseases and cardiovascular biomarkers.

Previous observational studies have shown that the prevalence of cardiovascular diseases (CVDs) is related to particulate matter (PM). However, given the methodological limitations of conventional observational research, it is difficult to identify causality conclusively. To explore the causality of PM on CVDs and cardiovascular biomarkers, we conducted a Mendelian randomization (MR) analysis. In this study, we obtained summary-level data for CVDs and cardiovascular biomarkers including atrial fibrillation (AF), heart failure (HF), myocardial infarction (MI), ischemic stroke (IS), stroke subtypes, body mass index (BMI), lipid traits, fasting glucose, fasting insulin, and blood pressure from several large genome-wide association studies (GWASs). Then we used two-sample MR to assess the causality of PM on CVDs and cardiovascular biomarkers, 16 single nucleotide polymorphisms (SNPs) for PM2.5 and 6 SNPs for PM10 were obtained from UK Biobank participants. Inverse variance weighting (IVW) analyses under the fixed effects model were used as the main analytical method to calculate MR Estimates, followed by multiple sensitivity analyses to confirm the robustness of the results. Our study revealed increases in PM2.5 concentration were significantly related to a higher risk of MI (odds ratio (OR), 2.578; 95% confidence interval (CI), 1.611-4.127; p = 7.920 × 10-5). Suggestive evidence was found between PM10 concentration and HF (OR, 2.015; 95% CI, 1.082-3.753; p = 0.027) and IS (OR, 2.279; 95% CI,1.099-4.723; p = 0.027). There was no evidence for an effect of PM concentration on other CVDs. Furthermore, PM2.5 concentration increases were significantly associated with increases in triglyceride (TG) (OR, 1.426; 95% CI, 1.133-1.795; p = 2.469 × 10-3) and decreases in high-density lipoprotein cholesterol (HDL-C) (OR, 0.779; 95% CI, 0.615-0.986; p = 0.038). The PM10 concentration increases were also closely related to the decreases in HDL-C (OR, 0.563; 95% CI, 0.366-0.865; p = 8.756 × 10-3). We observed no causal effect of PM on other cardiovascular biomarkers. At the genetic level, our study suggested the causality of PM2.5 on MI, TG, as well HDL-C, and revealed the causality of PM10 on HF, IS, and HDL-C. Our findings indicated the need for continued improvements in air pollution abatement for CVDs prevention.

Cardiovascular events risk in patients with systemic autoimmune diseases: a prognostic systematic review and meta-analysis.

Chronic inflammation is considered a risk factor for the development of atherosclerosis and cardiovascular (CV) events. We seek to assess the risk of CV events in patients with Systemic autoimmune diseases (SAD), such as Systemic Lupus Erythematosus (SLE), Rheumatoid Arthritis (RA), Psoriasis (Ps) and Ankylosing Spondylitis (AS), compared with the general population. A systematic search of MEDLINE from inception up to May 2021 was performed. Observational studies including individuals with and without autoimmune diseases (SLE, RA, Ps, AS), which reported a measure of association and variability for the effect of SAD on CV events, were included. The random effects meta-analysis was performed using the Hartung-Knapp-Sidik-Jonkman approach to obtain the pooled estimates. Cardiovascular Events including CV mortality, non-fatal myocardial infarction (MI), non-fatal stroke and coronary revascularization were the main outcomes evaluated. Fifty-four studies were selected, with a total of 24,107,072 participants. The presence of SAD was associated with an increased risk of CV mortality (HR 1.49 [95% CI 1.10-2.03]), non-fatal MI (HR 1.42 [95% CI 1.23-1.62]), and non-fatal stroke (HR 1.47 [95% CI 1.28-1.70]). RA, SLE, and Ps (particularly with arthritis) were significantly associated with a higher risk of MI and stroke. SAD was also associated with an increased risk of Major Adverse Cardiovascular Events (MACE) (HR 1.45 [95% CI 1.16-1.83]). Patients with SAD present an increased risk of CV morbidity and mortality, which should be considered when establishing therapeutic strategies. These findings support the role of systemic inflammation in the development of atherosclerosis-driven disease.

Association between cumulative atherogenic index of plasma exposure and risk of myocardial infarction in the general population

BackgroundAtherogenic index of plasma (AIP) has been confirmed as a novel marker for myocardial infarction (MI), but few evidence on the long-term AIP and MI risk in general populations. We thus aimed to evaluate the relationships of cumulative exposure to AIP and its accumulation time course with the risk of MI.MethodsA total of 54,440 participants were enrolled in the Kailuan study. Time-weighted cumulative AIP was calculated as the weighted sum of the mean AIP value for each time interval, then normalized by total exposure duration, the exposure duration was from 2006 to 2010. Duration of high AIP exposure was defined as the duration with high AIP and ranged from 0 to 6 years. The time course of AIP accumulation was categorized by the combination of time-weighted cumulative AIP < or ≥ median (− 0.12) and AIP slope.ResultsAfter 11.05 years of follow-up, 766 incident MI cases were documented. After adjustment for potential confounders, higher risk of MI was observed in participants with the highest time-weighted cumulative AIP quartile (HR, 1.89; 95% CI 1.47–2.43), the longest exposure duration of high AIP (HR, 1.52; 95% CI 1.18–1.95), and those with high time-weighted cumulative AIP and negative slope (HR, 1.42; 95% CI 1.13–1.79).ConclusionsLong-term cumulative exposure to AIP and the time course of AIP accumulation increased the risk of MI. High AIP earlier resulted in a greater risk increase than later in life with the same time-weighted cumulative AIP, emphasizing the importance of controlling atherogenic dyslipidemia early in life.

Liver fibrosis is associated with an increased risk of non-fatal myocardial infarction.

Liver fibrosis is a risk factor for liver-related adverse outcomes and cardiovascular disease (CVD). Recently, the non-invasive Hepamet fibrosis score (HFS) has been validated as a tool capable to identify with good diagnostic accuracy subjects with advanced liver fibrosis. It is unsettled whether HFS is capable to identify individuals at higher risk of CVD. To investigate whether individuals with liver fibrosis measured with HFS have higher risk of myocardial infarction (MI) in adults participating in the CATAnzaro MEtabolic RIsk factors (CATAMERI) study. Participants (n = 2948) were divided into three groups according to HFS: low risk of fibrosis (<0.12); intermediate risk of fibrosis (≥0.12 to <0.47); high risk of fibrosis (≥0.47). The association between the liver fibrosis risk and MI was analysed by a logistic regression analysis. As compared with those having the lowest risk (5.3%), a higher proportion of subjects with moderate or high risk of liver fibrosis had MI (12.9% and 24.4%, respectively; p < 0.001). In a logistic regression analysis, individuals at increased risk of liver fibrosis exhibited a threefold increased risk of having MI as compared to those with low risk (OR 3.18; 95% CI 1.31-7.70) independently of confounders including smoking, cholesterol, triglycerides, anti-hypertensive, lipid-lowering and glucose-lowering therapies. In this cross-sectional study, individuals with higher values of HFS show a higher risk of MI, suggesting that HFS may be a useful tool to identify not only individuals with liver fibrosis but also those at the increased risk of CVD.

Association Between Historical Neighborhood Redlining and Cardiovascular Outcomes Among US Veterans With Atherosclerotic Cardiovascular Diseases

In the 1930s, the government-sponsored Home Owners' Loan Corporation (HOLC) established maps of US neighborhoods that identified mortgage risk (grade A [green] characterizing lowest-risk neighborhoods in the US through mechanisms that transcend traditional risk factors to grade D [red] characterizing highest risk). This practice led to disinvestments and segregation in neighborhoods considered redlined. Very few studies have targeted whether there is an association between redlining and cardiovascular disease. To evaluate whether redlining is associated with adverse cardiovascular outcomes in US veterans. In this longitudinal cohort study, US veterans were followed up (January 1, 2016, to December 31, 2019) for a median of 4 years. Data, including self-reported race and ethnicity, were obtained from Veterans Affairs medical centers across the US on individuals receiving care for established atherosclerotic disease (coronary artery disease, peripheral vascular disease, or stroke). Data analysis was performed in June 2022. Home Owners' Loan Corporation grade of the census tracts of residence. The first occurrence of major adverse cardiovascular events (MACE), comprising myocardial infarction, stroke, major adverse extremity events, and all-cause mortality. The adjusted association between HOLC grade and adverse outcomes was measured using Cox proportional hazards regression. Competing risks were used to model individual nonfatal components of MACE. Of 79 997 patients (mean [SD] age, 74.46 [10.16] years, female, 2.9%; White, 55.7%; Black, 37.3%; and Hispanic, 5.4%), a total of 7% of the individuals resided in HOLC grade A neighborhoods, 20% in B neighborhoods, 42% in C neighborhoods, and 31% in D neighborhoods. Compared with grade A neighborhoods, patients residing in HOLC grade D (redlined) neighborhoods were more likely to be Black or Hispanic with a higher prevalence of diabetes, heart failure, and chronic kidney disease. There were no associations between HOLC and MACE in unadjusted models. After adjustment for demographic factors, compared with grade A neighborhoods, those residing in redlined neighborhoods had an increased risk of MACE (hazard ratio [HR], 1.139; 95% CI, 1.083-1.198; P < .001) and all-cause mortality (HR, 1.129; 95% CI, 1.072-1.190; P < .001). Similarly, veterans residing in redlined neighborhoods had a higher risk of myocardial infarction (HR, 1.148; 95% CI, 1.011-1.303; P < .001) but not stroke (HR, 0.889; 95% CI, 0.584-1.353; P = .58). Hazard ratios were smaller, but remained significant, after adjustment for risk factors and social vulnerability. In this cohort study of US veterans, the findings suggest that those with atherosclerotic cardiovascular disease who reside in historically redlined neighborhoods continue to have a higher prevalence of traditional cardiovascular risk factors and higher cardiovascular risk. Even close to a century after this practice was discontinued, redlining appears to still be adversely associated with adverse cardiovascular events.

SCAI Expert Consensus Statement on Management of In-Stent Restenosis and Stent Thrombosis.

Stent failure remains the major drawback to the use of coronary stents as a revascularization strategy. Recent advances in imaging have substantially improved our understanding of the mechanisms underlying these occurrences, which have in common numerous clinical risk factors and mechanical elements at the time of stent implantation. In-stent restenosis remains a common clinical problem despite numerous improvements in-stent design and polymer coatings over the past 2 decades. It generates significant health care cost and is associated with an increased risk of death and rehospitalization. Stent thrombosis causes abrupt closure of the stented artery and therefore carries a high risk of myocardial infarction and death. This Society for Cardiovascular Angiography & Interventions (SCAI) Expert Consensus Statement suggests updated practical algorithmic approaches to in-stent restenosis and stent thrombosis. A pragmatic outline of assessment and management of patients presenting with stent failure is presented. A new SCAI classification that is time-sensitive with mechanistic implications of in-stent restenosis is proposed. Emphasis is placed on frequent use of intracoronary imaging and assessment of timing to determine the precise etiology because that information is crucial to guide selection of the best treatment option. SCAI recommends image-guided coronary stenting at the time of initial implantation to minimize the occurrence of stent failure. When in-stent restenosis and stent thrombosis are encountered, imaging should be strongly considered to optimize the subsequent approach.

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

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