Incidence Of Recurrent Myocardial Infarction Research Articles

Abstract 4120924: Effect Of Colchicine On Myocardial Infarction: Updated Systematic Review And Meta-analysis Of Randomized Controlled Trials

Background: Colchicine, in multiple ways, has beneficial as well as adverse effects on patients with myocardial infarction. Objective: Our current study aims to study the efficacy as well as harmful effects of colchicine on patients with myocardial infarction. Methods: A comprehensive search was conducted on PubMed, the Cochrane Library, Scopus, Google Scholar, and Clinical trials till May 2024, and Randomized controlled trials were searched investigating the effect of Colchicine on patients with Myocardial Infarction. The quality of trials was assessed with the Cochrane risk of bias tool. Our primary Outcomes include adverse cardiovascular events while secondary outcomes include All-cause Mortality, adverse gastrointestinal effects, levels of hs-CRP, incidence of stroke, cardiac arrest, and hospitalization urgency. Risk ratios and mean differences were pooled under the Random-effect Model. Results: Statistical analysis shows that colchicine did not impact all-cause Mortality (RR =1.00, 95% CI=0.72-1.39, P=0.98, I2=0%), cardiac arrest (RR=0.81, 95% CI=0.33-1.95, P=0.63, I2=0), incidence of stroke(RR=0.45, 95% CI= 0.17-1.19, P=0.11, I2=36%) recurrent myocardial infarction (RR=0.78, 95%CI=0.57-1.06, P=0.11, I2=11%) and levels of hs-CRP (MD= -0.87, 95% CI=-1.80-0.06, P=0.07, I2=67%). However, colchicine shows statistically significant reduction in cardiovascular events(RR=0.75, 95%CI=0.60-0.94 , P=0.01, I2= 48%) , hospitalization urgency(RR=0.46, 95% CI=0.31-0.68, P=0.0001, I2=0%) and statistically significant increase adverse gastrointestinal events (RR=1.86, CI=1.14-3.02, P=0.01, I2=79%). Conclusion: Hence, we conclude that colchicine reduces adverse cardiovascular events, hospitalization urgency and increases adverse gastrointestinal events especially diarrhea in patients with myocardial infarction. However, colchicine did not reduce all-cause deaths, cardiac arrest, stroke incidence, the incidence of recurrent myocardial infarction, and hs-CRP; we still believe that the effect of colchicine on myocardial infarction needs further investigation and encourages the researcher to conduct more trials, especially with long-term follow-up.

Dipeptidyl peptidase-4 inhibitors versus sulfonylureas on the top of metformin in patients with diabetes and acute myocardial infarction.

Recent trials have shown that both the extent of glycated hemoglobin reduction and the duration of enhanced glycemic control are major factors that may affect cardiovascular outcome results. We aimed to investigate the impact of metformin (MET) combined with dipeptidyl peptidase-4 (DPP4) inhibitors or sulfonylureas (SU) on long-term clinical outcomes in patients with acute myocardial infarction (AMI) and type 2 diabetes mellitus (DM). This study was a prospective cohort trial. From November 2011 to December 2015, a total of 13,104 AMI patients were consecutively enrolled from the Korea AMI registry-National Institutes of Health. The patients were divided into the MET + DPP4 inhibitors group and the MET + SU group. The primary endpoint, major adverse cardiac events (MACE), was defined as the composite of all-cause death, recurrent myocardial infarction (MI), and any repeat revascularization up to 3-year follow-up. To adjust baseline potential confounders, an inverse probability weighting (IPTW) analysis was performed. Baseline well-matched two groups were generated (the MET + DPP4 inhibitors group, n=468 and the MET + SU group, n=468). During 3-year clinical follow-up, the cumulative incidence of MACE between the two groups was not significantly different after adjustment (16.8% for MET + DPP4 inhibitors group vs. 19.4% for MET + SU group, P=0.302). However, the MET + DPP4 inhibitors group was associated with reduced risk of MI [1.3% vs. 4.9%; hazard ratio (HR): 0.228, 95% confidence interval (CI): 0.090-0.580, P=0.001] than the MET + SU group. In patients with AMI and type 2 DM, the use of MET combined with DPP4 inhibitors was associated with reduced incidence of recurrent MI than MET combined with SU during 3-year follow-up.

Frailty measured using an electronic frailty index and outcomes in older patients with myocardial infarction

Abstract Background Frailty is common amongst older patients with myocardial infarction and is an independent predictor of poor clinical outcomes. Despite this, frailty is not systematically or objectively measured nor routinely used in risk stratification. The electronic Frailty Index (eFI) is a frailty assessment tool which uses electronic health records to identify and classify frailty and has been shown to correlate well with in-person frailty assessment. However, the performance of the eFI in disease specific populations and its ability to predict individual patient outcomes is unclear. Purpose To assess the relationship between frailty, measured using the eFI, and the management and outcomes of older patients with myocardial infarction. Methods Consecutive patients admitted to hospital in the South East of Scotland between 01/10/2014 and the 01/03/2021 with a primary diagnosis of myocardial infarction were identified using International Classification of Disease (ICD-10) code I21 or I22. Patients under the age of 65 (n= 3,601) and those with no biomarker evidence of myocardial injury were excluded (n=1,301). The provision of guideline recommended therapy, recurrent hospital admission due to myocardial infarction, heart failure or stroke and 12-month all-cause mortality were compared between groups based on eFI classification (fit, mild, moderate or severely frail). Results Of the 3,930 patients (mean age 78 [SD 8] years, 43% female, 83% Caucasian), 2,324 (59%) were classified as frail with 1,421 (36%), 664 (17%), and 239 (6%) classified as mild, moderate and severely frail, respectively. The eFI was measurable in all patients. Patients with any degree of frailty were less likely to receive anti-platelet therapy, ACE inhibitor or angiotensin receptor blocker or beta-blocker therapy or undergo revascularisation with fewer than 1 in 10 patients with severe frailty undergoing inpatient coronary catheterisation (7.5% vs 57% non-frail, P <0.001 for all). Frailty was independently associated with an increased incidence of recurrent myocardial infarction, heart failure or stroke within 12 months with the odds greatest in those with severe frailty (OR 1.93 (95% CI 1.42-2.61%)). The primary outcome of all-cause death at 12-months occurred in 355 (25%), 226 (34%) and 109 (46%) patients with mild, moderate and severe frailty compared with 176 (11%) in non-frail patients (Figure 1). Frailty status was an independent risk factor for all-cause mortality with the risk of death greatest in those with severe frailty (HR 2.64 (95% CI 1.63 – 3.67, p<0.001)). Conclusion The eFI identified patients at increased risk of in-patient death, major adverse cardiovascular events, and all-cause mortality within 12 months following myocardial infarction. Measurement of the eFI from linked healthcare data is feasible and could be used to aide personalised risk stratification and service utilisation in older patients admitted with myocardial infarction.Cumulative incidence plotForest plot with adjusted hazard ratio

Efficacy and Safety of Therapeutic Hypothermia as an Adjuvant Therapy for Percutaneous Coronary Intervention in Acute Myocardial Infarction: A Systematic Review and Meta-Analysis.

The study aims to compare the use of hypothermia in patients with myocardial infarction (MI) undergoing percutaneous coronary intervention (PCI) with control. We systematically searched four electronic databases until March 2022. The inclusion criteria were any study design that compared hypothermia in patients with MI undergoing PCI with control. The risk of bias assessment of the included randomized controlled trials was conducted through Cochrane Tool, while the quality of the included cohort studies was assessed by the NIH tool. The meta-analysis was performed on RevMan. A total of 19 studies were entered. Regarding the mortality, there were nonsignificant differences between hypothermia and control (odds ratio [OR] = 1.06, 95% confidence interval [CI] 0.75 to 1.50, p = 0.73). There was also no significant difference between the control and hypothermia in recurrent MI (OR = 1.21, 95% CI 0.64 to 2.30, p = 0.56). On the other hand, the analysis showed a significant favor for hypothermia over the control infarct size (mean difference = -1.76, 95% CI -3.04 to -0.47, p = 0.007), but a significant favor for the control over hypothermia in the overall bleeding complications (OR = 1.88, 95% CI 1.11 to 3.18, p = 0.02). Compared with the control, hypothermia reduced the infarct size of the heart, but this finding was not consistent across studies. However, the control had lower rates of bleeding problems. The other outcomes, such as death and the incidence of recurrent MI, were similar between the two groups.

Adropin – A new player in energy regulation predicts long-term prognosis of patients with acute myocardial infarction

BackgroundAs a novel energy homeostasis regulator, Adropin not only plays a vital part in meditating energy metabolism, but also has a certain correlation with atherosclerotic diseases. The purpose of this study was to evaluate the effect of Adropin on the long-term prognosis of patients with acute myocardial infarction (AMI). Methods162 recruited patients with AMI were divided into low Adropin group (Adropin<166.3 pg/mL, n = 82) and high Adropin group (Adropin≥166.3 pg/mL, n = 80), according to the mean value of serum Adropin level. Patients were followed up and major adverse cardiac events (MACEs) were recorded. The Kaplan-Meier method and Cox regression model were used to evaluate the survival of patients and the related factors of cardiac events. ResultsDiabetes was more common in low Adropin group than that in high Adropin group (P < 0.05). Patients were followed up for an average of 50.3 ± 19.2 months. MACEs occurred in 37 patients (22.8%), including 6 cardiac deaths (3.7%), 14 recurrent myocardial infarction (8.6%) and 17 rehospitalization of heart failure (10.5%). The incidence of recurrent myocardial infarction in low Adropin group was higher than that in high Adropin group (13.4% vs 3.8%, P < 0.05). There was no significant difference in the overall incidence of MACE, cardiac death and rehospitalization of heart failure between the two groups. Kaplan-Meier method (log rank test) analysis results showed that patients with low Adropin had lower survival rate without recurrent myocardial infarction (log rank P = 0.035). ConclusionLow Adropin level was associated with an increased risk of long-term recurrent myocardial infarction in patients with AMI.

The interaction of persistent antiphospholipid antibodies positivity and cigarette smoking is associated with an increased risk of cardiovascular events: Cross-sectional and longitudinal analysis

BackgroundThe antiphospholipid antibody (aPL)-positivity was suggested as a nontraditional risk of coronary artery disease (CAD) and it was associated with cigarette smoking. The co-occurrence of them was usually reported in individuals with cardiovascular diseases. This study was to demonstrate their interaction on the increasing risk of cardiovascular events. Methods and resultsA total of 826 consecutive male individuals who underwent coronary angiography (CAG) /percutaneous coronary intervention (PCI) were prospectively followed and classified into three groups based on different smoking statuses. The current smoking subjects had the highest occurrence of aPL-positivity, including aCL IgM (20.1%) and aβ2GP1 IgM (15.5%). IgM isotype positivity was an independent risk factor of CAD in the multivariate model, OR: 2.70 (1.52–4.80) for aCL IgM and OR:2.50 (1.35–4.63) for aβ2GP1 IgM.The interaction of current smoking and IgM isotype positivity was significantly associated with increased risk of CAD, OR: 8.75(4.59–16.66) for aCL IgM and OR: 8.78(4.28–17.98) for aβ2GP1 IgM. During about 3 years of follow-up, the smoking patients carrying persistent aPL positivity had the highest cumulative incidence of recurrent myocardial infarction and in-stent restenosis after CAD. ConclusionThe interaction of current smoking and IgM isotype positivity was significantly associated with the increased risk of CAD, including positive aCL IgM and aβ2GP1 IgM. Cigarette smoking elevated the risk of subsequent cardiovascular events in the presence of IgM isotype positivity, including recurrent myocardial infarction and in-stent restenosis.

Clinical efficacy evaluation of minimally invasive cardiac surgery coronary artery bypass grafting in patients with multivessel coronary artery disease

Objective: To investigate the clinical efficacy of minimally invasive cardiac surgery coronary artery bypass grafting (MICS CABG) in the treatment of patients with multivessel coronary artery disease. Methods: A total of 147 patients with multi-vessel coronary artery disease and coronary heart disease who underwent surgical treatment in Henan Provincial People's Hospital from March 2016 to March 2019 were retrospectively selected. Of which, 69 patients were treated by MICS CABG (minimally invasive group) and 78 patients were treated using the traditional thoracotomy (traditional group). The perioperative indexes, serum myocardial enzyme indexes and renal function indexes of patients before and after operation were compared between the two groups; Two groups of patients were followed up for 2 years; the incidence of adverse cardiovascular events (MACE) was recorded, and survival analysis was performed. Results: The age of the patients in the minimally invasive group and the traditional group were (66.9±5.8) and (68.2±7.0) years old, respectively, and the proportions of males were 60.9% (42 cases) and 51.3% (40 cases) (all P>0.05). All patients in the two groups successfully completed the operation, and no patients in the minimally invasive group were converted to thoracotomy. Before surgery, there was no significant difference in serum cTnI, CK-MB, BUN, Scr, and creatinine clearance between the minimally invasive group and the traditional group (all P>0.05). After re-examination 48 hours after operation, the serum cTnI in the minimally invasive group was (3.109±0.664) μg/L, and the CK-MB was (18.03±3.27) U/L, which were lower than those in the traditional group (3.438±0.715) μg/L, (20.63±4.28) U/L; the difference was statistically significant (all P<0.05). During the 2-year follow-up, there was no statiscally significant difference in the incidence of recurrent myocardial infarction, postoperative atrial fibrillation, postoperative stroke, arrhythmia, heart failure, thrombosis, cardiac death, and MACE events between the minimally invasive group and the traditional group. Statistical significance (all P>0.05). The survival curve analysis showed that the cumulative rates of MACE events in the minimally invasive and traditional groups were 17.39% and 26.92%, respectively (P=0.171). Conclusions: The effect of MICS CABG in the treatment of patients with multivessel coronary artery disease and coronary heart disease is not much different from that of traditional open thoracotomy, but the former is less traumatic, quicker after surgery, and has clinical significance for the recovery of patients' myocardial function.

The role of deferred stenting in the treatment of ST-elevation myocardial infarction: a systematic review and meta-analysis

Background: There have been a big number of studies assessing the efficacy of delayed coronary artery stenting (DCAS) in the prevention of no-reflow microvasculature injury compared to the standard immediate coronary artery stenting (ICAS) in ST-segment elevation myocardial infarction (STEMI). However, the results of these studies are contradictory in a lot of ways.&#x0D; Aim: To summarize studies on the assessment of DCAS in the prevention of no-reflow compared to the standard ICAS.&#x0D; Materials and methods: We performed a systematic literature search in PubMed, Google Scholar, and eLIBRARY.RU databases. The analysis included 17 studies with a total sample of 3505 patients. The comparative analysis included angiography-based endpoints prevalence of no-reflow (thrombolysis in myocardial infarction, TIMI 3 and myocardial blush grade, MBG 2, corrected TIMI frame count, CTFC) and clinical endpoints of all-cause mortality, cardiovascular mortality, major adverse cardiac events (MACE), recurrent myocardial infarction and recurrent revascularization. In addition, the analysis included the assessment of ST-elevation resolution, left ventricular ejection fraction values in the delayed post-intervention period and between-group differences.&#x0D; Results: The no-reflow phenomenon was significantly less frequent in the DCAS groups for the following parameters: epicardial flow TIMI 3 (odds ratio (OR) 2.00; 95% confidence interval (CI) 1.492.69; p 0.00001; I = 16%), myocardial perfusion MBG 2 (OR 4.69; 95% CI 1.9811.14; p = 0.0005; I = 59%), CTFC (mean difference (MD) 10.29; 95% CI 0.9619.62; p = 0.03; I = 96%). The analysis of secondary endpoints showed that MACE were less frequent in the DCAS groups (OR 1.29; 95% CI 1.041.60; p = 0.02; I = 42%), the difference becoming more significant in the studies with high initial thrombotic burden (TTG 3) (OR 1.83; 95% CI 1.282.62; p = 0.0009; I = 41%). The most clinically significant decrease of the MACE rate was found in 5 studies (n = 656) with high initial thrombotic burden (TTG 3) and mean time to repeated intervention from 4 to 7 days (OR 3.15; 95% CI 1.865.32; p 0.0001; I = 0%). The reverse trend for a benefit in the ICAS group was observed in the studies with a high initial thrombotic burden (TTG 3) and mean time to recurrent intervention of 48 hours (OR 0.60; 95% CI 0.301.19; p = 0.14; I = 20%). The ICAS and DCAS groups did not differ in overall mortality (p = 0.31), cardiovascular mortality (p = 0.49), repeated revascularization (p = 0.66), and ST resolution of 70% (p = 0.65). In the DCAS groups, there was an obvious trend to lower incidence of recurrent myocardial infarction (OR 1.28; 95% CI 0.951.73; p = 0.10; I = 0%), as well as to higher myocardial mass during the deferred analysis of left ventricular ejection fraction (OR -0.79; 95% CI -1.61 -0.04; p = 0.06; I = 36%).&#x0D; Conclusion: Deferred coronary artery stenting is an effective method for prevention of no-reflow. In patients with extended coronary thrombosis (TTG 3) and STEMI, the DCAS technique with time to recurrent intervention of 4 to 7 days decreases the probability of MACE compared to that with immediate stenting of the index coronary artery.

Atrial Fibrillation and Coronary Artery Disease: A Long-Term Perspective on the Need for Combined Antithrombotic Therapy

Older adults with atrial fibrillation (AF) are often treated with the shortest possible duration of antiplatelet/anticoagulant therapy after myocardial infarction (MI) or percutaneous coronary intervention (PCI) due to concern for bleeding. However, the risk of recurrent MI or PCI prompting antiplatelet therapy extension is unknown in this population. Using the National Cardiovascular Data Registry linked to Medicare claims, we described the cumulative incidence of recurrent MI or PCI over a median of 7-year follow-up for patients ≥65 years old with AF discharged alive after acute MI between 2008 and 2017. We used pharmacy fill data to describe the proportion of patients filling prescriptions for both oral anticoagulants and P2Y12 inhibitors for ≥50% of the indicated duration after MI or PCI. Of 187 622 older patients discharged alive after MI, 50 539 (26.9%) had AF. Over a median of 7-year follow-up in patients with AF, the cumulative incidence was 14.5% for recurrent MI, 12.1% for PCI, 7.9% for stroke, and 9.5% for bleeding hospitalization. Among 7998 patients with AF and recurrent MI or PCI, 1668 (20.9%) had >1 MI or PCI during follow-up. Assuming each MI or PCI should be followed by 6 months of P2Y12 inhibitor therapy, patients with AF who had a recurrent MI/PCI had a median estimated indication for antiplatelet/anticoagulant treatment of 287 days (194, 358), but filled both P2Y12 inhibitor and oral anticoagulant for a median of 0 days (0, 21). In this cohort, 12.2% of patients filled prescriptions for both a P2Y12 inhibitor and oral anticoagulant for ≥50% of the indicated duration. Older adults with AF and MI have high incidences of downstream recurrent MI or PCI requiring extended antiplatelet/anticoagulant therapy durations, yet many appear to be under-treated. These results highlight the need for better thrombosis prevention strategies in this group of patients.

FGB, TNFα, IL-1β, LPL, ITGB3, and TGFB1 genes polymorphism in patients with recurrent myocardial infarction

The aim . To evaluate the association of fibrinogen ( FGB ), tumor necrosis factor α ( TNF α), interleukin 1β ( IL-1 β), lipoprotein lipase ( LPL ), platelet glycoprotein ( ITGB3 ), and transforming growth factor β ( TGFB1 ) genes with the incidence of recurrent myocardial infarction (MI) in patients living in the middle Volga region. Materials and methods . The study included 104 people with recurrent MI compared to 280 people who had just one episode of MI. TNFα (rs1800629), IL1B (rs16944), TGFB1b (rs1800469), FGB (rs1800788), ITGB3 (rs5918) and LPL (rs328) gene polymorphism was determined in all patients using competing TaqMan probes. Association estimation was performed with multivariate logistic regression analysis. Results . Patients with recurrent MI much more often had TNFα , IL1B , TGFB1b , FGB , ITGB3 and LPL allele and genotype polymorphism. Moreover the risk of MI increased significantly in a case of combination of FGB (alleles and genotypes) and TNF α (alleles and genotypes) gene polymorphisms (OR = 4.04, 95% CI = (1.895–8.615), p = 0.0001). Conclusion . Thus, FGB , LPL , TNF α, TGFB1b and ITGB3 gene polymorphism are associated with more severe coronary heart disease and may be a risk factor of recurrent MI development. The dominant total contribution of the FGB (rs1800788) and TNF α (rs1800629) polymorphic genes to the development of recurrent MI in the population of the middle Volga region was revealed.

Three-year outcomes of selective incomplete versus complete revascularization in heart failure patients receiving multivessel percutaneous coronary intervention

Abstract Background Heart failure (HF) patients with multi-vessel disease (MVD) are often associated with comorbidities to limit the possibility to achieve complete revascularization (CR) in percutaneous coronary intervention (PCI). The planned selective incomplete revascularization (SIR) may be an alternative opinion for these patients. Purpose To investigate 3-year clinical outcomes of SIR versus CR in HF patients with MVD in a real-word registry. Methods A total of 566 HF patients with MVD receiving either SIR or CR were enrolled. SIR was planned pre-PCI based on clinical exams to avoid non-viable tissue revascularization. Major adverse cardiac events (MACEs) was a composite of in-hospital death, recurrent myocardial infarction, any revascularization, and all-cause death at 3-year follow-up. Results There was no significant differences between SIR and CR groups in in-hospital death, any revascularization, all-cause death and MACEs (24.3% vs. 24.9%, p=0.922). However, SIR had a significant lower incidence of recurrent myocardial infarction than CR (3.2% vs. 7.2%, p=0.032). Conclusion The 3-year outcomes of PCI with planned SIR were completely comparable to with CR in HF patients with MVD. Planned SIR can be an opinion for HF patients with MVD who are not suitable to achieve CR. Kaplan-Meier curve of 3-year MACEs Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Chang Gung Medical Research Program

Comparison of effects of triple antithrombotic therapy and dual antiplatelet therapy on long-term outcomes of acute myocardial infarction.

Warfarin is an alternate choice for patients who are not eligible for non-vitamin K oral anticoagulants after acute myocardial infarction (AMI). This study aimed to compare the long-term outcome of triple antithrombotic therapy (TAT) with that of dual antiplatelet therapy (DAPT) after AMI. This was a nationwide, propensity score-matched, case-control study of 186,112 first AMI patients, of whom 2,825 received TAT comprising aspirin, clopidogrel, and warfarin. Propensity score matching in a ratio of 1:4 by age, sex, comorbidities, and treatment was adopted, Finally, 2,813 AMI patients and 11,252 matched controls that were administered TAT and DAPT (aspirin and clopidogrel), respectively, were included in our analysis. The 12-year overall survival rate did not differ between both strategies (P = .3167). TAT was beneficial in old age (hazard ratio [HR] = 0.92), female sex (HR = 0.86), atrial fibrillation (AF) (HR = 0.80), hypertension (HR = 0.92), cerebrovascular accident (HR = 0.90), and in the absence of percutaneous coronary intervention (HR = 0.79). TAT reduced the rate of recurrent myocardial infarction (P = .0108) but did not affect the rate of stroke (P = .4867), gastrointestinal bleeding (P = .3889), or intracranial hemorrhage (ICH) (P = .3449). TAT reduces the incidence of recurrent myocardial infarction and does not increase the risk of major bleeding, while compared to DAPT.

Translating clinical evidence into value-based payment models: pooled analyses of innovative real-world outcomes agreements for ticagrelor in the United States.

Innovative value strategies for reimbursement of medications include value-based agreements (VBAs) between payers and pharmaceutical manufacturers, which have the potential to improve affordability and patient access to therapy, as well as lead to a reduction in downstream health events and associated medical costs. VBAs link payment for a medication to its performance in real-world clinical practice measured against prespecified outcomes that are aligned to existing evidence. Given its high prevalence, economic burden, and impact on mortality, cardiovascular disease (namely, coronary heart disease) represents an opportunity for VBAs to contribute to improved health outcomes and patient experiences while reducing or containing total medical costs. AstraZeneca developed a VBA framework directly comparing 2 antiplatelet therapies indicated to treat acute coronary syndrome (ACS)-ticagrelor and clopidogrel-based on the PLATO trial, which demonstrated superiority for ticagrelor in reducing the incidence of recurrent myocardial infarction (MI) in patients with ACS. Between 2015 and 2018, 11 contract-years of VBAs utilizing this framework were implemented in commercial and Part D health insurance plans, totaling nearly 32,000 unique patients in which pooled analyses were conducted. Aggregated VBA results indicate that ticagrelor consistently outperformed expectations in reducing recurrent MI vs clopidogrel, while also illustrating how comparative VBA frameworks of this nature may overcome challenges noted for VBAs and be utilized more broadly in future applications.

Percutaneous Coronary Interventions in Patients With ST-Elevation Myocardial Infarction: 10-Years Follow-up

Aim To study long-term results and to identify predictors of death in patients with ST-segment elevation acute myocardial infarction (STEMI) who underwent endovascular revascularization.Materials and methods This study included 283 patients registered in the hospital registry of percutaneous coronary interventions (PCI) for STEMI from 2006 through 2009. Analysis of 10-year results included all-cause and cardiovascular death rate, incidence of recurrent myocardial infarction (MI), repeated revascularization, stroke, stent restenosis and thrombosis. Also, a composite endpoint МАССЕ (Major Adverse Cardiovascular and Cerebrovascular Events) was evaluated, which included death, recurrent MI, repeated PCI, stent restenosis and thrombosis, coronary bypass, and stroke.Results Information about the health condition was provided by 204 (72.1 %) patients. Mean follow-up period was 120.1±9.5 months. All-cause mortality was 25.5 % with cardiovascular death determined in 19.1 % of cases. Recurrent MI developed in 21.6 % of patients; in 1.5 % of cases, recurrent MI resulted from thrombosis of previously implanted stents. Repeated PCI was performed for 31.9 % of patients; in 13.7 % of cases, the PCI was performed for stent restenosis. Coronary bypass was performed for 5.4 % of patients. Incidence of stroke was 10.3 %. Major cardiovascular and cerebrovascular complications (МАССЕ) during the follow-up period were determined in 60.3 % patients. According to the Cox proportional hazards regression model, age ≥65 years (odds ratio (OR), 3.75 at 95 % confidence interval (CI) from 1.75 to 8.03; р=0.001) and incomplete coronary revascularization (OR, 3.09 at 95 % CI from 1.52 to 6.30; р=0.002) were independent predictors of death based on data of the 10-year observation.Conclusion Therefore, at 10 years following endovascular revascularization, STEMI patients showed a moderate death rate with a high incidence of major cardiovascular and cerebrovascular complications. The leading causes for fatal outcomes were recurrent cardiovascular complications. The major predictors of death for the coming 10-year period included age ≥65 years and incomplete myocardial revascularization.

P6390Macrophages as contributors to chronic inflammation and cardiac fibrosis in patients with myocardial infarction

Abstract Introduction The functional characteristics of tissue macrophages associated with the progression of cardiac fibrosis in clinic are still unknown. Purpose The purpose was to study cardiac macrophage phenotypes contributing to the development of chronic inflammation and fibrosis in patients with myocardial infarction (MI). Methods The study included 41 patients with fatal MI type 1. Group 1 (n=24) comprised patients who died within 72 hours of MI (the inflammatory phase) and group 2 (n=17) comprised patients who died 4–28 days after MI (the regenerative phase). Macrophage infiltration (number of cells) in the heart was assessed by double immunofluorescence in the non-infarct area. Each area was evaluated in 20 random fields. We used CD163, CD206, stabilin-1, α-smooth muscle actin (α-SMA), interleukin-10 (IL-10) as markers of M2-like macrophages. Results The number of CD163+/CD206− (p=0.087) and CD163+/206+ (p=0.072) macrophages was higher during the regenerative phase of MI. The number of CD163-/CD206+, stabilin-1+/α-SMA-, stabilin-1+/α-SMA+, stabilin-1+/IL-10−, stabilin-1+/IL-10+, stabilin-1-/IL-10+ did not significantly change throughout the entire period of MI. The comparison of various M2 macrophage subpopulations into groups revealed following. In group 1 the number of CD163+/CD206− and CD163+/CD206+ cells prevailed over CD163−/CD206+ (p=0.033 and p=0.003, respectively), stabilin1+/α-SMA− cells over stabilin-1+/α-SMA+ (p&lt;0.001), and stabilin-1+/IL-10+ cells over stabilin-1+/IL-10− (p=0.018). In group 2 the quantity of stabilin-1+/α-SMA− macrophages prevailed over stabilin-1+/α-SMA+ (p=0.005) and stabilin-1+/IL-10+ over stabilin-1−/IL-10+ (p=0.028). In group 1 the number of CD163+/CD206+ cells correlated with the absolute and the relative number of peripheral blood monocytes prior to the onset of death (R=0.97), while the quantity of stablin-1+/α-SMA+ cells correlated with the absolute number of peripheral blood monocytes at admission (R=-0.53). In group 2 the quantity of CD206+/CD163− cells correlated with the absolute and the relative number of monocytes in the peripheral blood at admission (R=0.73 and R=0.59, respectively), the quantity of CD163+/CD206− macrophages with the incidence of recurrent MI (R= 0.54), and the number of stabilin-1+/α-SMA+ macrophages with the age of patients (R=-0.58). Conclusions We have suggested that the key cardiac macrophage phenotypes contributing to the development of chronic inflammation and cardiac fibrosis in the regenerative phase of MI were stabilin-1+/α-SMA− and stabilin-1+/IL-10+. We revealed subpopulation of stabilin-1+/α-SMA+ macrophages, that indicated the possibility of cellular transdifferentiation and macrophage plasticity. Thus, our results supports that understanding the role of macrophages in initiation, progression, and resolution of cardiac fibrosis is one of the most promising goal in the design of anti-fibrotic treatment strategies for patients with MI.

Relation of Testosterone Normalization to Mortality and Myocardial Infarction in Men With Previous Myocardial Infarction

The effect of normalization of serum testosterone levels with testosterone replacement therapy (TRT) in patients with a history of myocardial infarction (MI) is unknown. The objective of this study was to determine the incidence of recurrent MI and all-cause mortality in subjects with a history of MI and low total testosterone (TT) with and without TRT. We retrospectively examined 1,470 men with documented low TT levels and previous MI, categorized into Gp1: TRT with normalization of TT levels (n = 755) Gp2: TRT without normalization of TT levels (n = 542), and Gp3: no TRT (n = 173). The association of TRT with all-cause mortality and recurrent MI was compared using propensity score-weighted Cox proportional hazard models. All-cause mortality was lower in Gp1 versus Gp2 (hazard ratio [HR] 0.76, confidence interval [CI] 0.64 to 0.90, p = 0.002), and Gp1 versus Gp3 (HR 0.76, CI 0.60 to 0.98, p = 0.031). There was no significant difference in the risk of death between Gp2 versus Gp3 (HR 0.97, CI 0.76 to 1.24, p = 0.81). Adjusted regression analyses showed no significant differences in the risk of recurrent MI between groups (Gp1 vs Gp3, HR 0.79, CI 0.12 to 5.27, p = 0.8; Gp1 vs Gp2 HR 1.10, CI 0.25 to 4.77, p = 0.90; Gp2 vs Gp3 HR 0.58, CI 0.08 to 4.06, p = 0.58). In conclusion, in a large observational cohort of male veterans with previous MI, normalization of TT levels with TRT was associated with decreased all-cause mortality compared with those with non-normalized TT levels and the untreated group. Furthermore, in this high-risk population, TRT was not associated with an increased risk of recurrent MI.

Influence of Secondary Prevention and Risk Factors to Recurrent Miocard Infark on Acute Coronary Syndrome Patients in General Hospital Surakarta Indonesia

The patient who had myocardial infraction has a risk of recurrent myocardial infraction. Secondary prevention including antiplatelet, beta-blocker, statin, ACE inhibitor/ARB aims to prevent recurrent myocardial infarction. This study aimed to find the influence of secondary prevention and risk factors on the occurrence of recurrent myocardial infraction. This research was conducted with quantitative and case-control retrospectively. The subjects were 80 respondents consisting of 40 respondents in the case group and 40 respondents in control group patients. Data were analyzed using bivariate analysis of chi-square test followed by multivariate analysis of logistic regression. Rate of recurrent myocardial infarction (MI) with antiplatelet therapy decreased from 64.3% to 34.2%, with beta-blocker therapy decreased from 57.7% to 35.7%, with statin therapy decreased from 65.9% to 30.5%, with ACE inhibitor/ARB therapy decreased from 65.9% to 30.5%, with a combination of fourth therapy reduced from 57.4% to 34.6%. Chi-square test showed that there was a statistically significant relationship between antiplatelet therapy (p = 0.007), statin therapy (p = 0.002), ACE inhibitor / ARB therapy (p = 0.002), family history (p = 0.011) and adherence (p = 0.007) to recurrent MI. While multivariate analysis of logistic regression showed that the variables influencing the incidence of recurrent myocardial infarction were did not use antiplatelet therapy (P = 0,005; OR= 4.006) and statin therapy (P = 0,029; OR= 3.111). The secondary prevention reduced the incident of recurrent myocardial infarction.

Elevated Serum Non-HDL (High-Density Lipoprotein) Cholesterol and Triglyceride Levels as Residual Risks for Myocardial Infarction Recurrence Under Statin Treatment.

Objective- Secondary prevention for recurrent myocardial infarction (MI) is one of the most important therapeutic goals in patients with old MI (OMI). Although statins are widely used for this purpose, there remains considerable residual risk even after LDL (low-density lipoprotein cholesterol) is well controlled by statins. Approach and Results- We examined clinical impacts of nHDL (nonhigh-density lipoprotein cholesterol) and its major components triglyceride and LDL as residual risks for acute MI recurrence, using the database of our CHART (Chronic Heart Failure Analysis and Registry in the Tohoku District)-2 Study, the largest-scale cohort study of cardiovascular patients in Japan. We enrolled 1843 consecutive old MI patients treated with statins (mean age 67.3 years, male 19.2%) in the CHART-2 Study. The incidence of recurrent acute MI during the median 8.6-year follow-up was compared among the groups divided by the levels of nHDL (<100, 100-129, and ≥130 mg/dL), LDL (<70, 70-99, and ≥100 mg/dL), triglyceride (<84, 84-149, and ≥150 mg/dL), and combination of LDL and triglyceride. Kaplan-Meier curves and multiple Cox proportional hazards models showed that higher levels of nHDL, but not LDL or triglyceride alone, were associated with higher incidence of recurrent acute MI. Furthermore, higher triglyceride levels were associated with higher incidence of recurrent MI in patients with LDL <100 mg/dL but not in those with LDL ≥100 mg/dL. Conclusions- These results indicate that management of residual risks for acute MI recurrence should include nHDL management considering both LDL and triglyceride in old MI patients under statin treatment. Clinical Trial Registration- URL: http://www.clinicaltrials.gov . Unique identifier: NCT00418041.

A new rational approach to reach LDL-cholesterol concentration objectives after an acute coronary syndrome

Introduction and objectivesAdequate LDL cholesterol (LDLc) control after an acute coronary syndrome (ACS) is a crucial secondary prevention strategy to minimise the incidence of recurrent myocardial infarction and cardiovascular death. There are tables that predict the necessary dosage of lipid-lowering treatment from the initial LDLc but have not been tested in ACS. Variables associated with optimal LDLc after an ACS were analysed and the therapeutic yield of the use of Masana's recommendations in this setting. MethodsA total number of 326 ACS-patients were included between January-2015 and May-2016. Baseline LDLc concentration and prescribed hypolipemiant treatment at hospital discharge were registered. We analysed the variables associated with optimal LDLc levels (<70mg/dl) control during follow-up. ResultsAmong our patient population (72% male, age 66±13 years), the hypolipemiant treatment at hospital discharge fulfilled the Masana's recommendations in 196 (60%) patients. After a follow-up period of 122 [66–184] days the targeted LDLc levels were achieved in 148 (45%) patients, being this percentage greater among those in whom the Masana's recommendations were fulfilled (109/196, 56%), as compared with the remaining (39/130, 30%; p<0.001). The male gender (p<0.001), the absence of prior history of dyslipemia (p<0.001) and the adherence to Masana's recommendations (p=0.007) were independent predictors for the achievement of targeted LDLc levels during follow-up. ConclusionsIn less than half of ACS-patients adequate mid-term LDLc control is obtained. The dosage of the lipid-lowering therapy according to Masana's recommendations helps to achieve this important therapeutic goal.

Una nueva estrategia para alcanzar los niveles objetivos de colesterol LDL tras un síndrome coronario agudo

Introduction and objectivesAdequate LDL cholesterol (LDLc) control after an acute coronary syndrome (ACS) is a crucial secondary prevention strategy to minimize the incidence of recurrent myocardial infarction and cardiovascular death. There are tables that predict the necessary dosage of lipid-lowering treatment from the initial LDLc but have not been tested in ACS. Variables associated with optimal LDLc after an ACS were analyzed and the therapeutic yield of the use of Masana's recommendations in this setting. MethodsA total number of 326 ACS-patients were included between January-2015 and May-2016. Baseline LDLc concentration and prescribed hypolipemiant treatment at hospital discharge were registered. We analyzed the variables associated with optimal LDLc levels (<70mg/dL) control during follow-up. ResultsAmong our patient population (72% male, age 66±13 years), the hypolipemiant treatment at hospital discharge fulfilled the Masana's recommendations in 196 (60%) patients. After a follow-up period of 122 [66-184] days the targeted LDLc levels were achieved in 148 (45%) patients, being this percentage greater among those in whom the Masana's recommendations were fulfilled (109/196, 56%), as compared with the remaining (39/130, 30%; P<.001). The male gender (P<.001), the absence of prior history of dyslipemia (P<.001) and the adherence to Masana's recommendations (P=.007) were independent predictors for the achievement of targeted LDLc levels during follow-up. ConclusionsIn less than half of ACS-patients adequate mid-term LDLc control is obtained. The dosage of the lipid-lowering therapy according to Masana's recommendations helps to achieve this important therapeutic goal.