History Of Prior Myocardial Infarction Research Articles

Prediction of Myocardial Infarction Using a Combined Generative Adversarial Network Model and Feature-Enhanced Loss Function.

Accurate risk prediction for myocardial infarction (MI) is crucial for preventive strategies, given its significant impact on global mortality and morbidity. Here, we propose a novel deep-learning approach to enhance the prediction of incident MI cases by incorporating metabolomics alongside clinical risk factors. We utilized data from the KORA cohort, including the baseline S4 and follow-up F4 studies, consisting of 1454 participants without prior history of MI. The dataset comprised 19 clinical variables and 363 metabolites. Due to the imbalanced nature of the dataset (78 observed MI cases and 1376 non-MI individuals), we employed a generative adversarial network (GAN) model to generate new incident cases, augmenting the dataset and improving feature representation. To predict MI, we further utilized multi-layer perceptron (MLP) models in conjunction with the synthetic minority oversampling technique (SMOTE) and edited nearest neighbor (ENN) methods to address overfitting and underfitting issues, particularly when dealing with imbalanced datasets. To enhance prediction accuracy, we propose a novel GAN for feature-enhanced (GFE) loss function. The GFE loss function resulted in an approximate 2% improvement in prediction accuracy, yielding a final accuracy of 70%. Furthermore, we evaluated the contribution of each clinical variable and metabolite to the predictive model and identified the 10 most significant variables, including glucose tolerance, sex, and physical activity. This is the first study to construct a deep-learning approach for producing 7-year MI predictions using the newly proposed loss function. Our findings demonstrate the promising potential of our technique in identifying novel biomarkers for MI prediction.

Factors associated with early, late, and very late stent thrombosis among patients with acute coronary syndrome undergoing coronary stent placement: analysis from the ATLAS ACS 2-TIMI 51 trial.

Stent thrombosis (ST) is an uncommon but serious complication of stent implantation. This study aimed to explore factors associated with early, late, and very late ST to help guide risk assessment and clinical decision-making on ST. The analysis included patients who received stent placement for the index acute coronary syndrome (ACS). Cumulative incidence of ST was assessed at 30 days (early ST), 31-360 days (late ST), 361-720 days (very late ST), and up to 720 days. Cox proportional hazards models were used to assess associations between ST and various factors, including patient characteristics [i.e., age, sex, ACS presentation, history of hypertension, smoking, diabetes, prior myocardial infarction (MI), heart failure, prior ischemic stroke, and cancer], laboratory tests [i.e., positive cardiac biomarker, hemoglobin, platelet count, white blood cell (WBC) count], and treatment [i.e., drug-eluting stent (DES) vs. bare-metal stent (BMS) and anticoagulant with rivaroxaban vs. placebo]. Among the 8,741 stented patients, 155 ST events (2.25%) occurred by Day 720. The cumulative incidences of early, late, and very late ST were 0.80%, 0.81%, and 0.77%, respectively. After multivariable adjustment, age ≥ 75 [hazard ratio (HR) = 2.13 (95% confidence interval, CI: 1.26-3.60)], a history of prior MI [HR = 1.81 (95% CI: 1.22-2.68)], low hemoglobin level [HR = 2.34 (95% CI: 1.59-3.44)], and high WBC count [HR = 1.58 (95% CI: 1.02-2.46)] were associated with a greater risk of overall ST, whereas DES [HR = 0.56 (95% CI: 0.38-0.83)] and rivaroxaban therapy [HR = 0.63 (95% CI: 0.44-0.88)] were associated with a lower risk of overall ST up to 720 days. Low hemoglobin level and high WBC count were associated with early ST (low hemoglobin: HR = 2.35 [95% CI: 1.34-4.12]; high WBC count: HR = 2.11 [95% CI: 1.17-3.81]). Low hemoglobin level and prior MI were associated with a greater risk of late ST (low hemoglobin: HR = 2.32 [95% CI: 1.26-4.27]; prior MI: HR = 2.98 [95% CI: 1.67-5.31]), whereas DES was associated with a lower risk of late ST [HR = 0.33 (95% CI: 0.16-0.67)]. Age ≥75 years was associated with very late ST. The study identified positive and negative associations with early, late, and very late ST. These variables may be useful in constructing risk assessment models for ST. http://www.clinicaltrials.gov, identifier NCT00809965.

Abstract 15723: Assessing Revascularization Strategies: The Impact of Heart Flow Analysis on Coronary Computed Tomography Angiography

Introduction: Fractional Flow Reserve (FFR) is a technique used to assess the severity of coronary artery disease. Hypothesis: This study aimed to compare the impact of Heart Flow analysis, a CT-based FFR analysis, on patients who underwent Coronary Computed Tomography Angiography (C-CTA) at an Appalachian hospital. Methods: We collected data from January 2nd, 2019, to March 1st, 2023, from the data warehouse at Charleston Area Medical Center. The study included 5,470 patients with CTA, which were divided into two cohorts: 4,750 patients without Heart Flow analysis and 900 patients with Heart Flow analysis. Propensity score matching (PSM) was used to create two well-matched cohorts for comparative analysis. Results: Out of the total patients, 900 (16.4%) received Heart Flow analysis in addition to C-CTA, while 4,750 (83.6%) had C-CTA alone. The group of patients undergoing Heart Flow analysis had a higher prevalence of key comorbidities, including hypertension, diabetes, and prior history of myocardial infarction. After matching, both groups consisted of 900 patients each. Interestingly, while HDL cholesterol levels were similar between the groups, the Heart Flow group demonstrated lower levels of non-HDL cholesterol (102.0 vs 110 mg/dL, p=0.05), total cholesterol (147.6 vs 156 mg/dL, p=0.01), and LDL cholesterol (74.1 vs 81.8 mg/dL, p=0.05). The all-cause mortality rate was similar between the Heart Flow group and the non-Heart Flow group (2.3% vs 2.3%, p=1.00), as was the rate of myocardial infarction (3.5% vs 3.5%, p=1.00). However, the Heart Flow group exhibited a significantly higher rate of stent implantation (21.0% vs 9.2%, p<0.001) and bypass surgery (31.1% vs 1.3%, p=0.01). Conclusions: Heart Flow analysis integrated with C-CTA provides valuable insights into the selection of revascularization strategies for patients with coronary artery disease. While it did not significantly impact all-cause mortality and myocardial infarction rates compared to C-CTA alone, the utilization of Heart Flow analysis was associated with higher rates of stent implantation and bypass surgery. These findings highlight the potential of Heart Flow analysis in guiding the choice of optimal revascularization methods and improving outcomes.

Abstract 18297: Association Of Maximum Daily Mobility After Open Cardiac Surgery And Clinical Outcomes

Introduction: Hospital-based mobility after coronary artery bypass graft (CABG) and valve surgery using a mid-sternal incision is valuable and facilitated by use of Phase 1 cardiac rehabilitation. However, rehabilitation services may be limited and patients may not receive the full benefits of early mobility. Further, factors associated with maximum daily mobility and clinical outcomes need to be better understood. Research Questions: What is the degree of maximum daily mobility variability during hospitalization and what factors are associated with higher maximum daily mobility? Methods: This prospective, correlational design used a daily mobility form, surveys and medical records data from 5 hospitals in 5 states. Nurses collected mobility (daily) and psychological status (one time, post intensive care unit [ICU] stay) using valid and reliable tools. Medical record data were retrieved by analysts. Maximum daily mobility scores were categorized into 4 groups; higher levels represented greater mobility. Relationships between mobility category scores and patient factors were described using Spearman correlations (95% confidence intervals. Results: Of 650 participants with a median [25th, 75th percentile] of 4.0 [3.0, 5.0] days of post-ICU daily mobility data, lowest to highest category rates were 9.5% (n=62), 9.8% (n=63), 16.2% (n=105) and 64.5% (n=419). Higher maximum daily mobility was associated with hospital site, younger age, male gender, commercial insurance, lower body mass index, no history of prior myocardial infarction, heart failure, aortic or pulmonic valve disease, cerebrovascular disease or diabetes, higher hemoglobin/hematocrit, lower serum creatinine and lower rates of prolonged ventilation (all p &lt0.05). Higher maximum daily mobility was associated with higher general health perception scores (rho 0.12 (0.04, 0.19), p=0.003, shorter hospital length of stay and an increased likelihood of discharge to home (both p &lt0.01). Conclusions: After CABG/valve surgery, maximal daily mobility varied by multiple factors, many of which were not directly associated with patient’s ability to ambulate. Attention to achieving higher post-ICU daily mobility levels are warranted.

Abstract 11999: COVID-19 Increases the Risk of New Myocardial Infarction in Patients With Prior Myocardial Infarction

Introduction: The pathology of coagulopathy in patients with COVID-19 infection is not fully understood and it is believed to differ from the other critical illness. Hypothesis: we aimed to investigate the incidence and type of thromboembolic events (TEE) and particularly myocardial infarction (MI) in patients who were hospitalized with Covid-19 infection with a prior MI. We hypothesized that Covid-19 infection increases the rate of new TEE in this population regardless of age and gender. Methods: A retrospective analysis was conducted for all adult patients (≥18 years of age) admitted for treatment in quarantine centers with COVID-19 infection and developed TEE during the hospital course between February and August 2020. Patients were categorized based on the history of prior MI, age (<55 vs ≥55) and gender. The type of TEE was specified Results: Between February and August 2020, 16,903 patients with COVD-19 infection were admitted in the country and 210 (1.2%) developed TEE (89% were males, 55% were <55 years old, 72% were south Asians, and 80.5% had prior MI). Out of patients with prior MI, 92.5% developed another MI (Figure 1). DVT and portal vein thrombosis were common than new MI in patients without prior MI (Figure 2). New MI was more evident in young male patients who had prior MI; however, it was also reported in young males with no prior MI. No new MI was noted in females with no prior MI. Conclusions: the rate of TEE, particularly MI, increases after Covid-19 infection in patients with prior MI. Age and gender had great impact on the occurrence of TEE as well.

Abstract 11969: Association Between Blood Lead Levels and Silent Myocardial Infarction in the General Population

Background: While the connection between environmental lead exposure and cardiovascular disease (CVD) is well-known, the association with silent myocardial infarction (SMI) remains unexplored. Aims: Our objective was to examine if there is a connection between higher blood lead levels (BLL) and increased prevalence of SMI in the general population. Methods: This analysis included 7,283 (mean age 56.1±2.52 years, 52.5% women, 49.8% Whites) participants from the Third National Health and Nutrition Examination Survey who were free of CVD. Graphite furnace atomic absorption spectrophotometry was used to measure blood lead levels (BLL). SMI was defined as the presence of electrocardiographic evidence of myocardial infarction (MI) without a prior history of MI. Multivariable logistic regression analysis was used to examine the cross-sectional association between baseline BLL and SMI. Results: Participants with higher levels of BLL had a higher prevalence of SMI (SMI prevalence 0.4%, 0.9% and 2.4% across BLL tertiles). In a multivariable-adjusted model, the highest BLL tertile was associated with over three times the odds of SMI compared to the first tertile, with an odds ratio of 3.42 (95% CI: 1.76-6.63). There was a 9% increase in the odds of SMI for every 1 μg/dL increase in BLL (Table). This association was consistent across subgroups stratified by median age, sex, and race. Conclusion: Higher BLL levels are associated with a higher likelihood of SMI in the general US population. These results underscore the ongoing need for efforts to minimize lead exposure among the general public.

Patients living farther from a tertiary care center are more likely to undergo peripheral arterial bypass for acute and chronic limb-threatening ischemia

ObjectiveThe aim of this study was to assess the association between the proximity to the tertiary care hospital and the severity of peripheral arterial disease (PAD) at the time of lower extremity bypass (LEB) in a rural-urban mix region. MethodsPatients undergoing LEB from 2010 to 2020 at Penn State Milton S. Hershey Medical Center were reviewed and stratified into two study groups based on a median distance from hospital (ie, Group I: ≥34 miles and Group II: <34 miles). Patients’ demographic features, preoperative data including comorbidities, and medications were analyzed. A univariate analysis for the patient characteristics between the two study groups, along with evaluation of postoperative outcomes, and a multivariate predictive modeling to study the PAD stage as the indication of LEB was performed. A P-value of < .05 was set as a significant difference between the groups for all the analyses. ResultsThere were 175 patients (49.9%) in Group I and 176 patients (50.1%) in Group II with a mean age of 65 ± 11.92 years (median, 64.61 years). No significant difference was observed in gender (P = .530), age (P = .906), and functional status (P = .830) between study groups. It was observed that patients in Group I were more likely to be overweight or obese (71.3% vs 57%; P = .007) and had a prior history of myocardial infarction (24.3% vs 15.3%; P = .036) in comparison to Group II. No postoperative outcomes were found to be statistically different between the study groups. The multivariate analyses based on various confounders displayed that patients in Group I had 56% higher likelihood of LEB for chronic limb-threatening ischemia (adjusted odds ratio, 1.56; 95% confidence interval, 0.92-2.62; P = .042). Group I patients also had five times higher odds of LEB for acute limb ischemia (adjusted odds ratio, 5.07; 95% confidence interval, 1.42-18.13; P = .012) as compared with those in the Group II. ConclusionsPatients’ proximity to a major tertiary hospital may have implications on the disease progression for patients with PAD and could also be related to inadequate vascular services in primary and secondary hospitals. Lack of preventive care and disease management in regions afar from a tertiary hospital could be other implicating factors and highlights the need for outreach programs, along with distribution of vascular specialists, to reduce geographical disparities and ensure equity in access to care.

ПЕРСОНИФИЦИРОВАННЫЙ ПОДХОД К ОЦЕНКЕ РИСКА РАЗВИТИЯ ПОВТОРНЫХ СЕРДЕЧНО-СОСУДИСТЫХ СОБЫТИЙ И ХРОНИЧЕСКОЙ БОЛЕЗНИ ПОЧЕК У ПАЦИЕНТОВ С ИНФАРКТОМ МИОКАРДА И ОСТРЫМ ПОВРЕЖДЕНИЕМ ПОЧЕК

Introduction: AKI (acute kidney injury) is a common comorbid condition in patients with AMI (acute myocardial infarction), complicating its course and treatment. In the future, the prognosis of these patients after discharge from the hospital, as well as the incidence of recurrent cardiovascular events (CVS) and chronic kidney disease (CKD) are not known. The purpose of the study: to study the predictors of the development of recurrent cardiovascular events (CVS) in patients with myocardial infarction (MI) with acute kidney injury (AKI). Develop a calculator - a risk meter for repeated CCC. Materials and methods: the study was performed in the Altai Regional Cardiological Dispensary. 193 patients with MI and PCI (percutaneous coronary intervention) were included, divided into 2 groups: the first - 123 patients aged 62.8±1.1 years with MI and AKI, the second - 70 patients without AKI, age 61.3± 1.6 years. Upon admission and before discharge, the level of the KIM-1 molecule (Kidney Injury Molecule-1) and IL-18 (interleukin-18) was studied by ELISA in the urine. All patients underwent coronary angiography using low-osmolar contrast. One year after discharge, the frequency of development of repeated CCC was assessed. Statistical calculations were carried out using statistical packages STATISTICA 12.0. The level of statistical significance was taken equal to 0.05. Results. The level of KIM-1 (at admission) in the first group was statistically higher than in the second: 1998.9±147.6 versus 1289.8±126.1 pg/ml p=0.001, and IL-18 in the AKI group exceeded the corresponding parameter of the group without AKI: 179.0±12.9 versus 114.9±11.5 pg/ml p=0.007, respectively. A year later, it was found that the frequency of recurrent cardiovascular events was higher in the group with AMI and AKI: unstable angina was diagnosed in 26 (21.1%) patients in the group with AKI and 5 (7.1%) patients without AKI in history, p=0.010; 19 (15.4%) and 2 (2.8%) patients, p=0.006, 20 (16.2%) and 3 (4.2%), p=0.013 patients, respectively, had repeated myocardial infarction and progression of CHF in a year . Progression of renal dysfunction during the year was observed 5 times more often in patients with MI and AKI: CKD C2 was diagnosed in 49 (39.8%) patients of the first group and 16 (22.8%) of the second, p = 0.01; CKD C3a and C3b stages - in 34 (27.6%), p˂0.001 and 19 (15.4%) patients, p=0.002, respectively, CKD stage C4 was detected in 4 (3.2%) patients of the group with AMI and AKI in the early postinfarction period. As a result of constructing a multifactorial logistic regression model, predictors were identified that have a multiplicative effect on the development of recurrent CV events: BMI over 25 kg/m2 increases the risk of recurrent CV events by 0.91 [0.83; 0.99] times, p=0.028, history of prior MI in 3.32 [1.24; 9.86] times, p=0.022. Increase in CRP by 1.01 [1; 1.03] times, p=0.045, troponin I, 0.97 [0.94;1] times, p=0.037, and IMT-1, 1 [1;1] times, p=0.030. On the development of CKD: an increase in age is associated with an increase in the chances of developing CKD by 1.18 [1.1; 1.29], p ˂0.001; troponin I by 0.96 times [0.92; 1], p=0.030; systolic blood pressure in 1.03 [1; 1.07] times, p = 0.029. A calculator has been developed for risk stratification of the development of recurrent CV events and an algorithm for managing this category of patients after discharge from the hospital. Conclusions: thus, the identified predictors make it possible to calculate the risk of developing recurrent CV events and CKD using the developed calculator and allocate these patients to a separate group for personalized observation, taking appropriate measures of secondary prevention.

Reduced Left Ventricular Twist Early after Acute ST-Segment Elevation Myocardial Infarction as a Predictor of Left Ventricular Adverse Remodelling.

The left ventricular (LV) remodelling process represents the main cause of heart failure after a ST-segment elevation myocardial infarction (STEMI). Speckle-tracking echocardiography (STE) can detect early deformation impairment, while also predicting LV remodelling during follow-up. The aim of this study was to investigate the STE parameters in predicting cardiac remodelling following a percutaneous coronary intervention (PCI) in STEMI patients. The study population consisted of 60 patients with acute STEMI and no history of prior myocardial infarction treated with PCI. The patients were assessed both by conventional transthoracic and ST echocardiography in the first 12 h after admission and 6 months after the acute phase. Adverse remodelling was defined as an increase in LVEDV and/or LVESV by 15%. Adverse remodelling occurred in 26 patients (43.33%). By multivariate regression equation, the risk of adverse remodelling increases with age (by 1.1-fold), triglyceride level (by 1.009-fold), and midmyocardial radial strain (mid-RS) (1.06-fold). Increased initial twist decreases the chances of adverse remodelling (0.847-fold). The LV twist presented the largest area under the receiver operating characteristic (ROC) curve to predict adverse remodelling (AUROC = 0.648; 95% CI [0.506;0.789], p = 0.04). A twist value higher than 11° has a 76.9% specificity and a 72.7% positive predictive value for reverse remodelling at 6 months.

Reduction of Calcium Scores Using Intravenous Chelation: A Retrospective Pilot Study.

This pilot study presents a retrospective analysis of 10 asymptomatic patients with a positive calcium score who received a series of intravenous calcium ethylenediaminetetraacetic acid (EDTA) chelations. Current standards for cardiovascular risk stratification include assessments of cholesterol, blood pressure, blood sugar, lifestyle, obesity, and family history. Despite addressing traditional risk factors, myocardial infarctions and cerebrovascular accidents remain the leading causes of death and disability worldwide. Asymptomatic decay of the vascular system is a prelude to catastrophic events, and calcium scores are emerging as a significant adjunct for risk assessment. Positive calcium scores correlate with an increased risk of cardiovascular events. However, there are no therapies known to reliably reverse calcium scores. Previous studies have demonstrated that intravenous chelation therapy reduces cardiovascular morbidity and mortality in patients with a prior history of myocardial infarction; however, its mechanism of action is unknown. One theory is that chelation therapy would reverse calcium buildup in coronary arteries, which is known to have a positive correlation with the risk of having a cardiovascular event. The 10 patients had no prior history of coronary artery disease. Infusions were administered in an outpatient setting. Patients were encouraged to receive a treatment every month. No other supplements or prescriptions were required as part of the treatment. An average of 26.9 chelations were administered over an average of 37.9 months. Calcium scores decreased by an average of 27.38%, and all 10 patients experienced a reduction in scores. This study demonstrates that chelation has the potential to reduce calcium scores. Since calcium scores correlate with cardiovascular risk, reducing the calcium score may reduce the risk of an event. If these results are supported by larger, placebo-controlled studies, chelation therapy may become an option that could be added to statins and other FDA-approved therapies for primary prevention in patients with a positive calcium score.

Patients Residing Afar From Tertiary Care Center Are More Likely to Receive Lower Extremity Revascularization for Chronic Limb-Threatening Ischemia: A Relationship Between the Distance From Hospital and Clinical Severity of Peripheral Arterial Disease

This study aimed to assess the association between the proximity to the hospital and the severity of peripheral arterial disease at the time of infrainguinal lower extremity bypass (LEB) in a rural-urban mixed region. Medical records of patients undergoing LEB from 2010 to 2020 at Penn State Milton S. Hershey Medical Center were reviewed and stratified into two study groups based on the median distance of their residence from the hospital (group I: ≥34 miles and group II: <34 miles). Patients’ demographic features, preoperative data including comorbidities, the severity of peripheral arterial disease (PAD), and medications were analyzed. Univariate analysis for the patient characteristics between the two study groups, evaluation of postoperative outcomes, and multivariate predictive modeling to study the PAD stage as the indication of LEB were performed. A P value of <.05 was set as a significant difference between the groups for all the analyses. A total of 351 patients met the inclusion criteria for this study. There were 175 (49.9%) patients in group I and 176 (50.1%) patients in group II, with a mean age of 65 ± 11.92 years (median: 64.61 years). No significant difference was observed in gender (P = .530), age (P = .906), and functional status (P = .830) between the study groups. It was observed that patients in group I were more overweight or obese (71.3% vs 57%, P = .007) and had a prior history of myocardial infarction (24.3% vs 15.3%, P = .036) compared with those in group II. No postoperative outcomes were found to be statistically different between the study groups. The multivariate analyses based on various confounders displayed that patients in group I were less likely to be treated for life-limiting claudication (adjusted odds ratio [AOR]: 0.36 [0.20-0.65]; P = .001) and had a 56% higher likelihood of LEB for chronic limb-threatening ischemia (AOR: 1.56 [0.92-2.62]; P = .042). Group I patients also had five times higher odds of LEB for acute limb ischemia (AOR: 5.07 [1.42-18.13]; P = .012). The Fig shows the distribution of patients by indication of LEB and patient’s residence in a zip code. Patient proximity to a major tertiary hospital may have implications for the disease progression of patients with PAD. It could be related to inadequate vascular services in primary and secondary hospitals. The lack of preventive care and disease management in regions afar from a tertiary hospital could be other factors. This highlights the need for vascular surgery outreach programs and the distribution of vascular specialists to reduce geographical disparities and ensure equity in access to care.

Left ventricular thrombus in a patient with recurrent ischemic stroke events—The role of echocardiography

Cardiac ultrasound is recommended in investigating ischemic stroke events. There is increasing evidence that direct oral anticoagulants can be safely used instead of vitamin K antagonists in the setting of left ventricular thrombus. Cardioembolic stroke is responsible for an increasing number of ischemic strokes. Compared to other causes of stroke, cardioembolic strokes affect a larger brain area. Left ventricular (LV) thrombi account for up to 10% of cardioembolic strokes. It is essential to identify patients at high risk of LV thrombus formation, such as patients with a history of myocardial infarction, patients with reduced ejection fraction, or patients with cardiomyopathies. We present a patient with an ischemic stroke, and the cardiac ultrasound revealed a reduced ejection fraction and the presence of LV thrombus at the apex. The patient had no prior history of cardiovascular diseases. Even in a resource-limited setting, cardiac ultrasound is recommended to investigate stroke or transient ischemic attack events, especially in patients with a prior history of myocardial infarction. Although patients with LV thrombus should be treated with oral anticoagulants for at least 3 months, the role of direct oral anticoagulants and the optimal period of anticoagulation in this setting needs further investigation.

Post market surveillance registry (PIONEER) of the Yukon Choice PC-Elite Coronary Stent System for percutaneous coronary intervention in Indian acute coronary syndrome population

AimThe aim of this study was to assess the safety and efficacy profile of a newer generation biodegradable DES, the Yukon Choice PC Elite with a temperature controlling mechanism, in patients with acute coronary syndrome (ACS). MethodsThis prospective multi-center study (PIONEER Registry) was conducted in an Indian ACS population, therefore providing data in real world clinical practice. Patients with ACS underwent DES implantation in de novo native-vessel coronary lesions with the Yukon Choice PC Elite biodegradable polymer DES and were followed up for a year. ResultsA total 999 patients were evaluated. The majority of patients were male (79.2%). A total of 6.7% of the patients had a history of prior myocardial infarction (MI) and 2.7% of patients had a history of previous coronary artery bypass graft. The clinical presentations of the patients included: unstable angina pectoris (UA) (46.4%), ST-segment elevation MI (STEMI) (38.1%), and Non-ST-segment elevation MI (NSTEMI) (15.4%). Implantation of the device was successful in 99.9% of cases. The median stent length and stent size were 21.0 mm (Range: 8.0–40.0 mm) and 2.8 mm (Range 2.0–4.0 mm), respectively. Through to one-year clinical follow-up after percutaneous coronary intervention, all-cause death occurred in 4 of 999 patients (Crude Percentage: 0.4%). Cardiac death, MI, TLR, and stent thrombosis were occurred in 1 (0.1%), 8 (0.8%), 12 (1.2%) and 1 (0.1%) patients, respectively. ConclusionThe results of this post marketing surveillance registry suggest favorable safety and efficacy outcomes associated with the Yukon Choice PC Elite biodegradable DES in a real world Indian ACS population.

Abstract 12159: Trends in Subsequent Myocardial Infarction Hospitalizations and Inpatient Mortality Among Cancer Patients With Prior Myocardial Infarction

Background: Patients hospitalized with subsequent/recurrent myocardial infarction (MI) suffer from high morbidity and mortality burden. Owing to the lack of contemporary data on cancer patients, we aimed to study the trends of subsequent Mi in this population. recurrent MI admissions and mortality in patients with prior history of MI and active cancer diagnoses. Methods: The National Inpatient Sample (2016-2019) was queried to identify adults with an active cancer diagnosis and prior MI hospitalization for subsequent MI admissions. Primary outcomes were nationwide trends in subsequent MI admissions and in-hospital mortality with sex and racial disparities. Trend analysis was performed by linear-by-linear regression method. Results: Cancer patients with prior MI (n=470755, median age 75 [IQ 67-82 years]) had 5.6% (26320) subsequent MI admissions. Subsequent MI hospitalizations mostly had male (69.3%), white (81.5%), enrolled in Medicare (81.1%), and South (31.1%) region admissions. Subsequent MI patients had higher complicated hypertension (58.4 vs 39.3%), diabetes with chronic complications (33 vs 21.4%), drug abuse (2.3 vs 1.4%) and obesity (13.6 vs 10.6%) than patients without subsequent MI. Subsequent MI admissions had a declining trend from 2016 to 2019 for both sex and all races except Hispanics (p trend &lt;0.05) [Fig. 1a]. All-cause in-hospital mortality showed a significant declining trend for males (p trend &lt;0.05), but a marginal increase was seen in females [Fig. 1b]. Furthermore, stratified by race, no significant change in mortality trend was noticed. Conclusion: There were declining trends in subsequent MI hospitalizations in cancer patients with prior MI in all sex/racial groups except in Hispanics. Males had improved outcomes in terms of in-hospital mortality, however, this improvement was not evident in females and on racial stratification.

Abstract 11473: An EHR-Based Machine Learning Model Predicts Myocardial Infarction Better Than an ECG-Based Machine Learning Model and the Pooled Cohort Equations

Introduction: Patients at high risk for myocardial infarction (MI) benefit from treatments designed for primary prevention, especially cholesterol lowering therapy. The pooled cohort equations (PCE) are the most commonly used risk predictor for future MI but show only modest performance. Hypothesis: Electronic health record (EHR)-based, and ECG-based machine learning models are better at predicting MI as compared toPCE. Methods: We retrospectively included all patients (age 40-79) with clinical encounters in Geisinger, having at least 1 clinically acquired ECG and no prior history of MI. Incident MI within 10 years of an index ECG was identified. The ability of 2 machine learning models to predict MI were compared to the PCE: 1) an XGBoost model with EHR data (age, sex, race, smoking history, vitals, 24 lab tests) as input features; and 2) a deep neural network (DNN) that used ECG traces, age, and sex as inputs. Models were compared based on area under the receiver operating characteristic curve (AUROC). Results: A total of 103,933 ECGs from 34,932 patients had sufficient follow-up, 21% of ECGs were followed by an MI event within 10 years. The EHR-based XGBoost model had the best performance (AUROC 81%) in comparison with both the ECG-based DNN model (AUROC 68%) and the PCE (AUROC 72%). 9% of the total encounters were predicted to be ‘high risk’ by the EHR-based model and not by the pooled cohort equations. In that subgroup, 60% of patients were not on a statin and the 10-year MI event rate was 26%. 20% of encounters were predicted to be ‘high risk’ by the PCE and not by the EHR-based model. The event rate in that subgroup was 12%. Conclusions: An EHR-based XGBoost model, but not an ECG-based DNN, is superior to the PCE in predicting future MI. Patients identified as high risk by the EHR-based model but missed by the PCE, have a high rate of future MI. Statin use in that group is low, suggesting ample opportunity for intervention.

Clinical Significance of Elevated Levels of Cardiac Troponin T in Patients with Chronic Kidney Disease at Lagos University Teaching Hospital, Lagos

Background: This is an observational study of pre-dialysis patients with Chronic Kidney Disease (CKD) attending nephrology clinic at Lagos University Teaching Hospital to determine the clinical significance of elevated levels of Cardiac Troponin T (CTT) and possible associated factors.&#x0D; Methods: One hundred and forty-three (143) patients with CKD and no prior history of myocardial infarction were recruited and their serum levels of CTT were determined within 3 months of sample collection and storage at -80° C. ECG findings and clinical variables were compared. The 99 percentile cut-off value was derived using healthy individuals that met the inclusion criteria.&#x0D; Results: Mean blood CTT level was significantly higher in CKD patients compared to the general population. The 99th percentile value derived in the reference sample population was 48.02pg/ml. Statistical analysis showed significant association of CTT elevation with left ventricular hypertrophy, decreased renal function and age.&#x0D; Conclusion: CTT is generally elevated in pre-dialysis patients with CKD and a single elevated blood level of CTT above the 99th percentile may suggest asymptomatic Acute Coronary Syndrome. Serial rising levels of CTT and other clinical features will be of diagnostic significance in the diagnosis and management of asymptomatic acute coronary syndrome in patients with CKD.&#x0D; &#x0D; Authors&#x0D; O I Ajie , E C Azinge, B T Bello , T A Oshodi , O O Soriyan, I C Udenze &#x0D;

Case Report: Acute myocardial infarction with acute left ventricular failure and acute renal damage following mRNA-1273 vaccination: Possible adverse effect of COVID-19 vaccination?

Background: Evaluating potential vaccine side effects is often a prerequisite to combat the coronavirus disease 2019 (COVID-19) pandemic more effectively in a low-resource setting where herd immunity could be the most feasible option. Case report: Here, we present, an 80-year-old man with multiple comorbidities was admitted into the coronary care unit at Ibn Sina Medical College Hospital (Dhaka, Bangladesh) with severe central chest pain and respiratory distress after receiving the first dose of Moderna vaccine on July 26, 2021. On admission, his blood pressure was 110/70 mmHg, pulse 90 beats/min, respiratory rate 22 breaths/min, temperature 36.7°C. He had a vesicular breath sound with bilateral basal crepitations and normal heart sounds. On the ECG, significant changes were observed. Other lab findings were significant troponin-I: 1.72 ng/ml, trace protein and glucose in the urine, total white blood cell count: 12820/cm3; HbA1c, 7.5%; serum creatinine, 1.56 mg/dl; serum electrolytes: sodium 133 mmol/L, chloride 92 mmol/L. The patient had a medical history of prior myocardial infarction, diabetes mellitus, and hypertension but no chronic kidney disease, cerebrovascular disease, or bronchial asthma. After admission, he was treated conservatively with necessary medications and monitored periodically. The patient was diagnosed with acute myocardial infarction with left ventricular failure with acute kidney injury on chronic kidney disease with diabetes mellitus and hypertension. He was discharged from the hospital on day six with proper medicinal support with full recovery. Conclusions: Though acute cardiac complications following COVID-19 vaccines are unusual, this case report can contribute to further molecular research to identify the possible role of vaccine compounds in triggering such complications among the general population.

Long-Term Beta-Blocker Therapy in Patients With Stable Coronary Artery Disease After Percutaneous Coronary Intervention.

BackgroundIt is unclear whether beta-blocker treatment is advantageous in patients with stable coronary artery disease (CAD) who underwent percutaneous coronary intervention (PCI). We evaluated the clinical impact of long-term beta-blocker maintenance in patients with stable CAD after PCI with drug-eluting stent (DES).MethodsFrom a nationwide cohort database, we identified the stable CAD patients without current or prior history of myocardial infarction or heart failure who underwent DES implantation. An intention-to-treat principle was used to analyze the impact of beta-blocker treatment on long-term outcomes of major adverse cardiovascular events (MACE) composed of cardiovascular death, myocardial infarction, and hospitalization with heart failure.ResultsAfter stabilized inverse probability of treatment weighting, a total of 78,380 patients with stable CAD was enrolled; 45,746 patients with and 32,634 without beta-blocker treatment. At 5 years after PCI with a 6-month quarantine period, the adjusted incidence of MACE was significantly higher in patients treated with beta-blockers [10.0 vs. 9.1%; hazard ratio (HR) 1.11, 95% CI 1.06–1.16, p < 0.001] in an intention-to-treat analysis. There was no significant difference in all-cause death between patients treated with and without beta-blockers (8.1 vs. 8.2%; HR 0.99, 95% CI 0.94–1.04, p = 0.62). Statistical analysis with a time-varying Cox regression and rank-preserving structure failure time model revealed similar results to the intention-to-treat analysis.ConclusionsAmong patients with stable CAD undergoing DES implantation, long-term maintenance with beta-blocker treatment might not be associated with clinical outcome improvement.Trial RegistrationClinicalTrial.gov (NCT04715594).

Prevention of Cardiovascular Events and Mortality With Icosapent Ethyl in Patients With Prior Myocardial Infarction

BackgroundREDUCE-IT was a double-blind trial that randomized 8,179 statin-treated patients with controlled low-density lipoprotein cholesterol and moderately elevated triglycerides to icosapent ethyl (IPE) or placebo. There was a significant reduction in the primary endpoint, including death from cardiovascular (CV) causes. The specific impact of IPE among patients with prior myocardial infarction (MI) was unknown. ObjectivesOur goal was to examine the benefit of IPE on ischemic events among patients with prior MI in REDUCE-IT. MethodsWe performed post hoc analyses of patients with prior MI. The primary endpoint was CV death, MI, stroke, coronary revascularization, or hospitalization for unstable angina. The key secondary endpoint was CV death, MI, or stroke. ResultsA total of 3,693 patients had a history of prior MI. The primary endpoint was reduced from 26.1% to 20.2% with IPE vs placebo; HR: 0.74 (95% CI: 0.65-0.85; P = 0.00001). The key secondary endpoint was reduced from 18.0% to 13.3%; HR: 0.71 (95% CI: 0.61-0.84; P = 0.00006). There was also a significant 35% relative risk reduction in total ischemic events (P = 0.0000001), a 34% reduction in MI (P = 0.00009), a 30% reduction in CV death (P = 0.01), and a 20% lower rate of all-cause mortality (P = 0.054), although there was a slight increase in atrial fibrillation. Sudden cardiac death and cardiac arrest were also significantly reduced by 40% and 56%, respectively. ConclusionsPatients with a history of prior MI in REDUCE-IT treated with IPE demonstrated large and significant relative and absolute risk reductions in ischemic events, including CV death. (A Study of AMR101 to Evaluate Its Ability to Reduce Cardiovascular Events in High Risk Patients With Hypertriglyceridemia and on Statin. The Primary Objective is to Evaluate the Effect of 4 g/Day AMR101 for Preventing the Occurrence of a First Major Cardiovascular Event. [REDUCE-IT]; NCT01492361)

Severe Pulmonary Bleeding after Assist Device Implantation: Incidence, Risk Factors and Prognostic Impact.

Background: Continuous flow left ventricular assist devices (CF-LVAD) improve survival in patients with advanced heart failure but confer risk of bleeding complications. Whereas pathophysiology and risk factors for many bleeding complications are well investigated, the literature lacks reports about pulmonary bleeding. Therefore, it was the aim of the present study to assess incidence, risk factors, and clinical relevance of pulmonary bleeding episodes after LVAD implantation. Methods: We retrospectively analyzed our institutional database of 125 consecutive patients who underwent LVAD implantation between 2008 and 2017. Demographic and clinical variables related to bleeding were collected. The primary endpoint was incidence of severe pulmonary bleeding (SPB). Results: Nine out of 125 patients suffered from SPB during the postoperative course (7.2%) 11 days after surgery in the median. None of them had a known history of lung disease or bleeding disorder. History of prior myocardial infarction (0% vWD. 42.2%, p = 0.012) and ischemic cardiomyopathy (25.0% vs. 50.0%, p = 0.046) were less frequent in the SBP group. Concomitant aortic valve replacement was more common in the group with SPB (33.3% versus 7.0%, p = 0.034). Surgical (blood loss 9950 vs. 3800 mL, p = 0.012) as well as ear-nose-throat (ENT) bleedings (33% vs. 4.6%, p = 0.015) were observed more frequently in patients with SPB. SPB was associated with a complicated postoperative course with a higher incidence of acute kidney failure (100% versus 36.7%, p = 0.001) and delirium (44.4% versus 14.8%, p = 0.045); a higher need for red blood cell (26 packs versus 7, p < 0.001), fresh frozen plasma (18 units versus 6, p = 0.002), and platelet transfusion (8 pools versus 1, p = 0.001); longer ventilation time (1206 versus 171 h, p = 0.001); longer ICU-stay (58 versus 13 days, p = 0.002); and higher hospital mortality (66.7% vs. 29%, p = 0.029). Conclusion: SPB is a rare but serious complication after LVAD implantation and is significantly associated with higher morbidity and mortality. The pathophysiology and potential risk factors are unknown but may include coagulation disorders and frequent suctioning or empiric bronchoscopy causing airway irritation.