In-hospital Acute Myocardial Infarction Research Articles

Is dependent cannabis use in adult hospitalizations with inflammatory bowel disease associated with major adverse cardiovascular and cerebrovascular events? Insights from National Inpatient Sample Analysis

Background Inflammatory bowel disease (IBD) and dependent cannabis use or cannabis use disorder (CUD+) are independent risk factors for cardiovascular diseases. Usage of cannabis for pain increased in IBD patients. However, associated cardiovascular safety remains unclear. This study aims to investigate the major adverse cardiac and cerebrovascular events (MACCE) associated with CUD + in hospitalized IBD patients. Methods We analyzed the National Inpatient Sample 2020 using ICD-10-CM codes; hospitalized IBD patients were identified and divided based on CUD's presence or absence. Multivariable regression models were performed to evaluate MACCE [in-hospital mortality, acute myocardial infarction (AMI), cardiac arrest (CA), and acute ischemic stroke (AIS)] odds after adjusting for baseline demographics, hospital-level characteristics, and relevant cardiac/extra-cardiac morbidities. Results Among the 302,770 hospitalized adult IBD patients, 3.1% (9,490) had CUD+. The majority of patients in the CUD + cohort were white (67.7%), male (57.5%), and aged between 18 and 44 years (66.2%). Cardiovascular risk factors like hypertension, diabetes, hyperlipidemia, and prior myocardial infarction were higher in the CUD − cohort (p <0.001) compared to the CUD + cohort. The CUD + cohort had a lower rate of MACCE (3.1% vs. 5.8%), crude in-hospital mortality (0.7% vs. 2.2%), AMI (1.7% vs. 2.6%), CA (0.3% vs. 0.7%), and AIS (0.6% vs. 1.2%) with statistical significance (p <0.001). However, after adjusting for baseline characteristics and comorbidities, the adjusted odds ratios (aORs) did not show a statistically significant difference for MACCE (aOR = 0.9, 95% CI = 0.65–1.25, p = 0.530), CA (aOR = 0.54, 95% CI = 0.2–1.47, p = 0.227), and AIS (aOR = 0.86, 95% CI = 0.43–1.73, p = 0.669). Conclusion Our study did not find a statistically significant difference in MACCE among hospitalized IBD patients with and without CUD. This emphasizes the need for more extensive prospective studies focusing on the quantity, method, and duration of cannabis use (recreational or medicinal) in patients with IBD.

Impact of Magnesium on In-Hospital Ami Outcomes in Bangladesh.

Background: Coronary artery disease (CAD) is a major cause of death globally. Bangladesh has a high prevalence of CAD, especially in urban areas. Acute myocardial infarction (AMI) is a serious condition that occurs when there’s a blockage in the coronary arteries. Electrolyte imbalances, such as magnesium deficiency, can worsen AMI. Objectives: To evaluate the association between serums magnesium level on in-hospital acute myocardial infarction outcomes. Study Design and Methods: This prospective study recruited 110 patients diagnosed with AMI in Dhaka, Bangladesh. Researchers measured serum magnesium levels, monitored patients, and recorded clinical outcomes. Results: The study found that patients with lower magnesium levels were more likely to experience complications such as arrhythmias, cardiogenic shock, and left ventricular dysfunction. Conclusion: The study highlights the importance of monitoring magnesium levels in AMI patients. However, more research is needed to determine the optimal magnesium level and its impact on patient outcomes.

Ambient particulate matter and in-hospital case fatality of acute myocardial infarction: A multi-province cross-sectional study in China

The acute myocardial infarction (AMI) outcomes have been extensively linked with ambient particulate matter (PM). However, whether a smaller particle has greater impact and the consequent attributable burden associated with PM of different sizes remain unclear. We conducted a multi-province cross-sectional study among AMI patients using the inpatient discharge datasets from four Chinese provinces (Shanxi, Sichuan, Guangxi, and Guangdong) from 2014 to 2019. Ambient PM exposure for each patient was assessed using the ChinaHighAirPollutants dataset. We employed the mixed-effects logistic regression models to evaluate the association of PM of different sizes (PM1, PM2.5, PM10) on in-hospital case fatality. The potential reducible fractions in in-hospital case fatality were estimated through counterfactual analyses. Of 177,749 participants, 125,501 (70.6 %) were male and the in-hospital case fatality rate was 4.9%. For short-term (7-day average) exposure, the odds ratios (ORs) for PM1, PM2.5, and PM10 (per 10 µg/m3) were 1.052 (95 % confidence interval [CI], 1.032–1.071), 1.026 (95 % CI, 1.014–1.037), and 1.016 (95% CI, 1.008–1.024), respectively. The estimated ORs for long-term exposure (annual average) were 1.303 (95 % CI, 1.252–1.356) for PM1, 1.209 (95 % CI, 1.178–1.241) for PM2.5, 1.157 (95 % CI, 1.134–1.181) for PM10. Short-term exposure to PM1 showed the highest potential reducible fraction (8.5 %, 95 % CI, 5.0–11.7 %), followed by PM2.5 and PM10, while the greatest potential reducible fraction of long-term exposure was observed in PM10 (30.9 %, 95 % CI, 27.2–34.4%), followed by PM2.5 and PM1. In summary, PM with smaller size had a more pronounced impact on in-hospital AMI case fatality, with PM1 exhibiting greater effects than PM2.5 and PM10. Substantial health benefits for AMI patients could be achieved by mitigating ambient PM exposure.

Microbiota‐related metabolites fueling the understanding of ischemic heart disease

Microbiota‐related metabolites fueling the understanding of ischemic heart disease

Identifying and Solving Gaps in Pre- and In-Hospital Acute Myocardial Infarction Care in Asia-Pacific Countries.

Acute myocardial infarction (AMI) is a major cause of morbidity and mortality in the Asia-Pacific region, and mortality rates differ between countries in the region. Systems of care have been shown to play a major role in determining AMI outcomes, and this review aims to highlight pre-hospital and in-hospital system deficiencies and suggest possible improvements to enhance quality of care, focusing on Korea, Japan, Singapore and Malaysia as representative countries. Time to first medical contact can be shortened by improving patient awareness of AMI symptoms and the need to activate emergency medical services (EMS), as well as by developing robust, well-coordinated and centralized EMS systems. Additionally, performing and transmitting pre-hospital electrocardiograms, algorithmically identifying patients with high risk AMI and developing hospital networks that appropriately divert such patients to percutaneous coronary intervention-capable hospitals have been shown to be beneficial. Within the hospital environment, developing and following clinical practice guidelines ensures that treatment plans can be standardised, whilst integrated care pathways can aid in coordinating care within the healthcare institution and can guide care even after discharge. Prescription of guideline directed medical therapy for secondary prevention and patient compliance to medications can be further optimised. Finally, the authors advocate for the establishment of more regional, national and international AMI registries for the formal collection of data to facilitate audit and clinical improvement.

Prediction of Acute Myocardial Infarctionin Asian Patients With AcuteIschemic Stroke: The CTRAN Score.

Patients with acute ischemic stroke (AIS) are susceptible to acute myocardial infarction (AMI), which would lead to a dramatic increase of in-hospital mortality. The authors established and validated an easy-used model to stratify the risk of in-hospital AMI among patients with AIS. We consecutively included patients with AIS who were admitted within 7days from symptom onset in our prospectively maintained database (NCT04487340) from January 2016 to December 2020. In the derivation cohort from 70 centers, we developed a score to predict in-hospital AMI by integrating the bedside-accessible predictors identified via multivariable logistic regression. Then in the validation cohort from 22 centers, we externally evaluated the performance of this score. Overall, 96,367 patients were included. In-hospital AMI occurred in 392 (0.41%) patients. The final model, named CTRAN, incorporated 5 predictors including the history of coronary heart disease, malignant tumor, renal insufficiency, age, and baseline National Institutes of Health Stroke Scale score. The CTRAN score was confirmed in the validation cohort using receiver operating characteristic curve, which yielded an area under the curve of 0.758 (95%CI: 0.718-0.798). The CTRAN score could be a good tool for clinicians to identify patients with AIS at high in-hospital AMI risk.

Abstract 12474: Acute Myocardial Infarction Following Hospitalizations for Gastrointestinal Bleeding: Incidence, Predictors, Management, and Outcomes

Introduction: Patients hospitalized with gastrointestinal bleeding (GIB) are at risk for acute myocardial infarction (AMI). Clinical characteristics of patients with AMI after a GIB are poorly characterized. We sought to evaluate the incidence, management and outcomes of AMI following hospitalization for GIB. Methods: Patients admitted with a diagnosis of GIB were identified in the 2014 United States Nationwide Readmission Database using ICD-9 diagnosis codes. Hospital readmissions for AMI within 90 days of GIB were identified. Patients with AMI after GIB were compared to those without a prior GIB to determine differences in management and in-hospital outcomes. Invasive management of AMI was defined as invasive angiography or coronary revascularization. Logistic regression models were used to estimate odds of invasive management and all-cause, in-hospital morality after adjustment for clinical covariates. Results: A total of 644,622 patients with GIB were identified, of which 7,523 (1.2%) were readmitted for AMI within 90 days. Older age, diabetes mellitus, chronic kidney disease, coronary and peripheral artery disease, unknown GIB source, and AMI during the index GIB hospitalization were associated with 90-day AMI readmission. Compared to AMI patients without a recent GIB, patients with AMI within 90 days after GIB were older (74.4 vs. 68.4 years, p&lt;0.01), more likely to be women (47% vs. 41.1%, p&lt;0.01), have kidney disease (43.2% vs. 22.4%, p&lt;0.01), present with non-ST segment elevation MI (82% vs. 73%, p&lt;0.01), and were less likely to undergo invasive management of AMI (28% vs 63%, P&lt;0.01; adjusted odds ratio [aOR] 0.40, 95% CI 0.37-0.44). Recent hospitalization for GIB within 90 days was associated with higher all-cause in-hospital AMI mortality (22% vs 9%, P&lt;0.01; aOR 1.86 [1.68-2.06]). Conclusion: In the first 3 months after hospitalization for GIB, 1 of every 83 patients was readmitted with AMI. Patients with AMI after GIB were less likely to undergo invasive management of AMI and had higher mortality than those without recent GIB. Strategies to reduce morbidity and mortality of GIB-associated thrombosis are needed.

Abstract 11880: Outcomes of Transcatheter Rheumatic Mitral Valve Repair

Introduction: The aim of this analysis was to investigate if mitral transcatheter edge-to-edge repair (TEER) presents a safe and effective option for patients with severe symptomatic rheumatic mitral regurgitation. Hypothesis: Mitral TEER in rheumatic valvular disease (RVD) is challenging due to leaflet thickening and calcification but is performed in select cases. Limited data exists on its outcomes. Methods: We queried the Nationwide Readmissions Database for hospitalizations for mitral TEER in the United States between 2016 and 2018. Propensity score weighted regression analysis was conducted to evaluate the association of RVD with in-hospital outcomes and 90-day readmissions after mitral TEER. Results: A total of 18,240 mitral TEER procedures were included in analysis, including 1,779 (10%) in patients with RVD. Mitral TEER in patients with RVD was associated with no difference in overall in-hospital mortality compared to patients without RVD (odds ratio [OR] 1.47, 95% confidence interval [CI] 0.94-2.30, p 0.089). However, RVD was associated with higher in-hospital acute myocardial infarction (OR 1.65, 95%CI 1.07-2.56), acute kidney injury (OR 1.58, 95%CI 1.30-1.94), ventricular arrhythmia (OR 1.50, 95%CI 1.12-2.01), high-degree heart block (OR 1.67, 95%CI 1.25-2.23) and conversion to open surgical repair or replacement (OR 2.53, 95%CI 1.02-6.30). Mitral TEER in RVD was also associated with higher 90-day all-cause readmission (hazard ratio [HR] 1.19, 95% CI 1.04-1.47, p 0.012), although there was no difference in heart failure readmission or readmission for surgical repair/replacement. Conclusions: Mitral TEER might be a reasonable option for carefully selected patients with RVD at very high surgical risk who also have favorable anatomy.

In-hospital myocardial infarction and adherence to evidence-based drug therapies: a real-world evaluation

ObjectivesThis study aimed to measure adherence to chronic polytherapy following an acute myocardial infarction (AMI) and to find out associations between adherence and the setting of AMI onset (in vs...

Patients with acute myocardial infarction and atrial fibrillation: association of anaemia with risk of in-hospital bleeding, stroke and other death causes

Purposes To explore the association of anaemia with risk of outcomes of in-hospital patients with acute myocardial infarction (AMI) and atrial fibrillation (AF). Methods Patients with AF and AMI at their first hospitalizations in three hospitals (Beijing Tongren Hospital, Beijing Friendship Hospital, Capital Medical University and China-Japan Friendship Hospital) were retrospectively reviewed and divided into two groups (with vs. without anaemia) according to haemoglobin within one day before or after admission. Results 864 patients with AF and AMI (mean age:74.22 years; 39.9% female) were included in the current study. Patients with anaemia had increased risk of any bleeding (adjusted OR: 2.29, 95% CI: 1.43–3.68, p = 0.001), minor bleeding (adjusted OR: 2.37, 95% CI:1.40–4.01, p = 0.001), gastrointestinal bleeding (adjusted OR: 2.53, 95% CI:1.51–4.25, p < 0.001) and other death causes (adjusted OR: 1.71, 95% CI: 1.07–2.72, p = 0.02) compared to those without anaemia according to logistic regression. However, there was no difference in the risk of stroke or/and systematic embolism (SE) between patients with and without anaemia. Conclusions In the Chinese in-hospital AMI and AF cohort, anaemia was shown to be associated with increased risk of any bleeding, minor bleeding, gastrointestinal bleeding and other death causes, but not the risk of stroke or/and SE.

Impact of preexisting coronary arterial disease in patients undergoing percutaneous mitral valve repair (MitraClip).

Percutaneous mitral valve repair with Mitraclip device has been approved for the treatment of symptomatic mitral valve regurgitation in patients deemed high surgical risk. It's unclear whether the presence of preexisting coronary arterial disease (CAD) affects the postprocedural outcomes of Mitraclip. The study population was extracted from the 2016 Nationwide Readmissions Data (NRD) using the International Classification of Diseases, Tenth Revision, Clinical Modifications/Procedure Coding System (ICD-10-CM/PCS) for Mitraclip, preexisting CAD, and postprocedural complications. Study primary endpoints included in-hospital all-cause mortality, cardiogenic shock, acute myocardial infarction (AMI), acute kidney injury (AKI), stroke, acute respiratory failure, length of hospital stay (LOS), and 30-day readmission rate. A total of 2,539 discharges that had Mitraclip during the index hospitalization, 62.3% had history of preexisting CAD. Mean age was 78.5 years and 46.6% were female. Overall, the presence of preexisting CAD was associated with higher AMI (1.6 vs. 0.4%, p < .01), however, there was no significant differences in terms of in-hospital all-cause mortality (2.2 vs. 2.6%, p = .52), cardiogenic shock (3.4 vs. 4.1%, p = .39), AKI (14.7 vs. 13.6%, p = .43), stroke (0.9 vs. 0.5%, p = .31), acute respiratory failure (9.7 vs. 8.8%, p = .43), LOS (5.3 vs. 5.3 days, p = .85) or 30-day readmission rate (14.6 vs. 14.4%, p = .92). These results persisted after adjustment for baseline characteristics. The subgroup of CAD patients who received percutaneous coronary intervention (PCI) was associated with higher in-hospital mortality (22.5 vs. 2.0%, p < .01), cardiogenic shock (25.0 vs. 3.3%, p < .01), AMI (22.5 vs. 0.8%, p < .01), AKI (55.0 vs. 13.7%, p < .01), stroke (10.0 vs. 0.6%, p < .01), acute respiratory failure (45.0 vs. 8.8%, p < .01), and longer LOS (21.5 vs. 5.1 days, p < .01), however there was no significant difference in 30-day readmission rate (15.0 vs. 14.5%, p = .95). Preexisting CAD was associated with higher in-hospital AMI post-Mitraclip but with comparable mortality and other morbidities. Patients who received PCI during the same index hospitalization had higher in-hospital mortality and morbidity.

Abstract 14920: Predictors of Adverse Outcomes Following Elective Ascending Aortic Aneurysm Repair: A Nationwide Cohort Study

Introduction: Elective surgical intervention for ascending aortic aneurysm (AA) is performed when the risk of a future aortic catastrophe outweighs the risk of surgery; however, the data of complication rates following elective repair are limited. Methods: We analyzed adults &gt;18 years of age hospitalized for elective ascending AA surgical intervention in the 2016 and 2017 Nationwide Readmissions Databases. The primary outcome was in-hospital mortality. Secondary outcomes were acute ischemic stroke (AIS), acute myocardial infarction (AMI) and non-elective 30-day readmission. Bayesian lasso probit regression models were used to identify independent predictors of primary and secondary outcomes. Results: Among 4,073 patients hospitalized for elective surgical repair, 28.9% were female. Mean age was 63.0 ± 12.4 years. Concomitant aortic valve surgery was performed in 67%. Overall, 72 (1.8%) died during the initial hospitalization (Figure A). Predictors of in-hospital mortality are shown in Figure B. Of patients alive at discharge, 482 (11.8%) were readmitted within 30 days, with a mortality rate of 2.3% during readmission. Predictors of non-elective 30-day readmission included non-urban localization (Change in probability: 32.5%, 21.7 - 45.7%), chronic liver disease (18.1%, 11.4 - 27.0%), and chronic neurological disorder (15.9%, 12.1 - 20.1%). Main causes of readmissions were arrythmias (20.3%), procedural complications (14.5%), and peri-, endo-, or myocarditis (9.3%). While procedural volume varied between one and 68 procedures / institution, it was not associated with in-hospital mortality, AIS, AMI, or 30-day readmission (p&gt;0.05 for all). Conclusions: One in 25 patients will have a significant complication or die following elective ascending aortic repair and 1 in 8 will be readmitted within 30 days. The risk of surgery compared to the risk of a future aortic catastrophe should be thoroughly assessed prior to recommendation of an ascending AA repair.

Uncertainty in classification of death from fatal myocardial infarction: A nationwide analysis of regional variation in incidence and diagnostic support.

AimsThe usefulness of mortality statistics relies on the validity of death certificate diagnosis. However, diagnosing the causal sequence of conditions leading to death is not simple. We examined diagnostic support for fatal acute myocardial infarction (AMI) and investigated its association with regional variation.Methods and resultsFrom Danish nationwide registers, we identified the study population (N = 3,244,051) of whom 36,669 individuals were recorded with AMI as the underlying cause-of-death between 2002 and 2015. We included clinical diagnoses, procedures, and claimed prescriptions related to atherosclerotic disease to evaluate the level of diagnostic support for fatal AMI in three diagnostic groups (Definite; Plausible; Uncertain). Adjusted mortality rates, rate ratios, and odds ratios were estimated for each AMI category, stratified by hospital region using multivariable regression models. More than one-third (N = 12,827, 35%) of deaths reported as fatal AMI had uncertain diagnostic support. The largest regional variation in AMI mortality rate ratios, varying from 1.16 (95%CI:1.02;1.31) to 1.62 (95%CI:1.43;1.83), was found among cases with uncertain diagnostic supportive data. Substantial inter-regional differences in the degree to which death occurs outside hospital [OR: 1.01 (95%CI:0.92;1.12) - 1.49 (95%CI:1.36;1.63)] and general practitioners determining the cause-of-death at home were present. Minor regional differences [OR: 0.96 (95%CI:0.85;1.07) - 1.16 (95%CI:1.04;1.29)] in in-hospital AMI mortality were observed.ConclusionThere is significant regional variation associated with recording AMI as a cause-of-death. This variation is predominately based on death certificate diagnoses without diagnostic supportive evidence. Studies of fatal AMI should include a stratification on supportive evidence of the diagnosis.

Holiday and weekend effects on mortality for acute myocardial infarction in Shanxi, China: a cross-sectional study.

To examine the effects of holiday and weekend admission on in-hospital mortality for patients with acute myocardial infarction (AMI) in China. Patients with AMI in 31 tertiary hospitals in Shanxi, China from 2014 to 2017 were included (N = 54,968). Multivariable logistic regression models were used to examine the effects of holiday and weekend admission on in-hospital mortality. Compared to non-holiday and weekday admissions, holiday and weekend admissions, respectively, were associated with increases in risk-adjusted mortality rates. Chinese National Day was associated with an additional 10 deaths per 1000 admissions (95% confidence interval (CI): (0, 20))-a relative increase from baseline mortality of 64% (95% CI: (1%, 128%)). Sunday was associated with an additional 4 deaths per 1000 admissions (95% CI: (0, 7))-a relative increase from baseline mortality of 23% (95% CI: (3%, 45%)). We found no evidence of gender differences in holiday or weekend effects on mortality. Holiday and weekend admissions were associated with in-hospital AMI mortality. The admissions on Chinese National Day and Sunday contributed to the observed "holiday effect" and "weekend effect," respectively.

Daytime-Dependent Cardioprotection in Cardiac Surgery: A Large Propensity-matched Cohort Study

A recent article provided compelling evidence for a cardioprotective effect of afternoon compared with morning operation in patients undergoing aortic valve replacement. The present study sought to investigate any daytime-dependent effect on perioperative myocardial injury or clinical outcomes in a large cohort of patients undergoing elective cardiac surgery. The study identified all patients who underwent nonemergency aortic valve replacement and/or on-pump coronary artery bypass grafting at the Department of Cardiothoracic and Vascular Surgery of Aarhus University Hospital, Aarhus, Denmark between 1999 and 2018. Propensity-score matching was used to create adjusted cohorts for morning and afternoon operation. The primary end point was a composite of 30-day mortality and in-hospital acute myocardial infarction (major adverse cardiac events). Secondary end points were new-onset in-hospital atrial fibrillation, peak creatine kinase-MB levels, and up to 19 years of follow-up for all-cause mortality. The study identified 7148 patients who underwent either aortic valve replacement with or without coronary artery bypass grafting (n= 2806) or isolated coronary artery bypass grafting (n= 4342). Propensity-score matching resulted in comparable cohorts of morning and afternoon operation. The morning and afternoon operation cohorts had no differences in the rates of major adverse cardiac events after both procedures. Similarly, no daytime-dependent variation in the rate of new-onset in-hospital atrial fibrillation, long-term all-cause mortality, or peak creatine kinase-MB levels could be identified. In this large cohort study of Danish patients, who underwent either aortic valve replacement and/or coronary artery bypass grafting, the study identified no clinically relevant biorhythm for myocardial ischemia-reperfusion tolerance.

In-hospital Myocardial Infarction: Scale of the Problem

All cases of acute myocardial infarction (AMI) can be divided into outpatient-onset AMI and in-hospital-onset AMI depending on the place and circumstances of their development. In this review we consider the problem of in-hospital AMI. Special attention is paid to specific features of its clinical manifestations and the scale of the clinical problem. Possible causes of difficulties in the diagnosis and treatment of this condition are presented in comparison with those in patients with outpatient-onset AMI.

Incidence, Risk Factors, and Outcomes Associated With In-Hospital Acute Myocardial Infarction

Studies of acute myocardial infarction (AMI) occurring outside the hospital have informed approaches to addressing risk, treatment, and patient outcomes. Similar insights for in-hospital AMI are lacking. To determine the incidence, risk factors, and outcomes associated with in-hospital AMI. Cohort, nested case-control, and matched cohort study of patients hospitalized in US Veterans Health Administration facilities between July 2007 and September 2009. The incidence of in-hospital AMI was determined from a complete cohort of in-hospital AMI relative to the total number of inpatient admissions. From the in-hospital AMI cohort, detailed medical record review was performed on 687 cases and 687 individually matched controls. Risk factors and outcomes associated with in-hospital AMI were determined from matched comparison of in-hospital AMI cases to hospitalized controls. Candidate risk factors for in-hospital AMI included characteristics at the time of admission and in-hospital variables prior to the index date. In the determination of the incidence and risk factors associated with in-hospital AMI, the outcome of interest was in-hospital AMI. All-cause mortality was the main outcome of interest following in-hospital AMI. A total of 5556 patients with in-hospital AMI (mean [SD] age, 73 [10] years; 5456 [98.2%] male) were identified among 1.3 million admissions, with an incidence of 4.27 in-hospital AMI events per 1000 admissions. Independent risk factors associated with in-hospital AMI included intensive care unit setting, history of coronary artery disease, heart rate greater than 100 beats/min, hemoglobin level less than 8 g/dL, and white blood cell count 14 000/μL or greater. Compared with the matched control group, mortality was significantly higher for patients with in-hospital AMI (in-hospital mortality, 26.4% vs 4.2%; 30-day mortality, 33.0% vs 10.0%; 1-year mortality, 59.2% vs 34.4%). In-hospital AMI was common and associated with common cardiovascular risk factors and markers of acute illness. Patient outcomes following in-hospital AMI were poor, with 1-year mortality approaching 60%. Further study of in-hospital AMI may yield opportunities to reduce in-hospital AMI risk and improve patient outcomes.

Long-term prognosis is related to mid-term changes of glucometabolic status in patients with acute myocardial infarction treated invasively

Glucometabolic status (GS) in patients with acute myocardial infarction (AMI) has an impact on prognosis, but it may change over time. To evaluate the prognosis after AMI treated invasively with respect to changes in GS assessed by oral glucose tolerance test at discharge and at mid-term follow-up visit (FU-visit). Glucometabolic status was assessed by two-hour post-load glycaemia and defined as abnormal glucose tolerance (AGT) or normal glucose tolerance (NGT). Out of 454 in-hospital AMI survivors, 368 (81%) patients completed an FU-visit and were divided into four groups with respect to GS at discharge and FU-visit: group 1 - AGT at discharge and FU-visit (n = 101); group 2 - AGT at discharge and NGT at FU-visit (n = 48); group 3 - NGT at discharge and AGT at FU-visit (n = 114); and group 4 - NGT at discharge and FU-visit (n = 105). All-cause mortality was compared between groups with log-rank test. Median time from AMI to FU-visit was seven months. Median remote follow-up duration after AMI was 31 months. Two-hour post load glycaemia was significantly higher in patients with confirmed AGT at FU-visit than in other groups. Mortality was higher in group 1 (11.9%) than in group 2 (2.1%; p = 0.034) and group 4 (2.9%; p = 0.009). Mortality rates between group 2 and 4 were similar (2.1% vs. 2.9%; p = 0.781). There was no significant difference in mortality between group 1 and group 3 (11.9% vs. 6.1%; p = 0.114). Mortality in group 3 was over two-fold higher than in group 4; however, this difference was statistically non-significant (6.1% vs. 2.9%; p = 0.247). Prognosis for patients with confirmed AGT was unfavourable; however, patients with AGT at discharge, in whom GS improved, had similar mortality to subjects with persistent NGT. The major clinical implication from this study is the finding that reassessment of GS by repeated oral glucose tolerance test has significant prognostic value and makes initial risk stratification performed at discharge more reliable.

Attributing Responsibility: Hospitals Account for 20% of Variance in Acute Myocardial Infarction Patient Mortality.

Applying a log-logistic accelerated failure time mixed effects model to a sample of 95,504 in-hospital patients with acute myocardial infarction (AMI) between 2005 and 2010 in the United States, we measured the relative contribution of hospitals (vs. patients) in explaining in-hospital AMI mortality. Before adjusting for age, race, income, 29 comorbidities of AMI patients, and primary payer, hospital characteristics explained 19.93% of the variance in AMI in-hospital mortality. After controlling for these, variance explained declined by 5.65%, to 14.28%. These findings have implications for policymakers in assessing hospitals' "responsibility" for AMI patient mortality, for hospitals in allocating resources toward improving AMI patient care, and for medical intermediaries in making liability judgments and payment allocations to hospitals.

Abstract 12595: Variation in the Timing of Myocardial Infarctions After Hurricane Katrina: Eight Years After the Storm

Introduction: The onset of acute myocardial infarction (AMI) has historically occurred with peaks on weekdays (especially Monday) and mornings, thought to be associated with stressful times of the day and week. AMI incidence increased in New Orleans following Hurricane Katrina with alterations in this chronobiology. The objective of this study is to determine the lasting impact of natural disasters on AMI chronobiology, which is currently unknown. Hypothesis: We hypothesized that the timing of AMI onset would return to pre-Katrina patterns given the amount of time lapsed since the storm. Methods: Single-center, retrospective, observational cohort analysis conducted at Tulane University Health Sciences Center (TUHSC) including symptomatic patients admitted for AMI with elevated troponin I. Exclusions were age &lt; 18 years, hospital transfers, in-hospital AMIs, and inadequate documentation of day and time of symptom onset. There were two cohorts: pre-Katrina, including patients admitted in the 6 years prior to storm landfall (8/29/99 - 8/28/05, n=299), and post-Katrina, including patients admitted in the 8 years after TUHSC re-opened after the storm (2/14/06 - 2/14/14, n=1479). Medical records were reviewed for symptom onset and various demographic, clinical and laboratory data. AMI incidence was defined as the number of AMI admissions divided by total hospital admissions. Results: Post-Katrina AMI incidence decreased on Mondays, weekdays, and mornings, and increased on nights and weekends (p&lt;0.0001, see table). The post-Katrina cohort had a significantly higher prevalence of smoking (53% vs 34%, p&lt;0.01), unemployment (39% vs 7%, p&lt;0.01) and lack of health insurance (25% vs 8%, p&lt;0.01) without significant differences in age or sex. Conclusions: After Hurricane Katrina, the expected morning, weekday, and Monday peaks of AMI onset were eliminated. Traditional patterns of AMI onset may be altered for prolonged periods of time following natural disasters.