Incidence Of ST-elevation Myocardial Infarction Research Articles

Gender differences in Clinical Characteristics and Outcomes of Heart Failure with Reduced Ejection Fraction

Background and Objectives: Studies evaluating gender differences and outcomes in heart failure with reduced ejection fraction are limited in Iraq. The aim of this study was to assess the clinical characteristics, risk factors, outcomes and severity of heart failure with reduced ejection fraction in both genders. Patients and Methods: This is a prospective cohort study of 117 patients aged more than 18 years who had been admitted to the Hawler Cardiac Center or medical ward with heart failure with reduced ejection fraction for the period from December 2021 till 30th of October 2022. The clinical characteristics, severity of left ventricular systolic dysfunction and the outcomes over three months were compared between women and men. Results: One hundred seventeen patients were included in the study, 61 (52.1%) patients were male and 56 (47.9%) were female with male to female ration (1.09:1), p-value (0.017). Women presented with higher incidence of moderate left ventricular systolic dysfunction 36(64.2%), obesity 43 (76.8%) p-value=0.017*, dyslipidemia 27 (48.2%) p-value=0.038, pulmonary hypertension 4 (7.1%), atrial fibrillation 15(26.8%) and high cardiac hospitalization 12 (21.4%), while men have high incidence severe left ventricular systolic dysfunction 33(54.1% ) p-value=0.046, smoking 42 (68.9%); p-value <0.001 and ST-segment elevation myocardial infarction 28 (45.9%) p-value <0.001. the p-values off all above findings are less than <0.05 respectively Conclusions: There are major differences in risk factors, clinical presentation and outcomes between both genders. The majority of women presented with moderate left ventricular systolic dysfunction and higher rate of cardiac hospitalization while men presented with severe left systolic dysfunction associated with high incidence of ST-elevation myocardial infarction.

The Gender Spectrum of In-hospital Survival Post Primary Percutaneous Coronary Intervention for ST Elevation Myocardial Infarction: Exploring Age-driven Trends.

The study was aimed to evaluate gender difference and age & gender specific interaction of in-hospital outcomes of patients with ST elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). This was a prospective cohort study of 1748 patients with STEMI undergoing primary PCI. The study was dichotomised according to gender to evaluate the difference in the outcome. The study was further stratified based on an age cut-off of 75 years to examine the age-specific gender relationship in survival outcomes. Independent variables for in-hospital mortality were analysed through logistic regression. There were 314 (17.96%) females with an average age of 60.80 years and 1434 (82.03%) males with an average age of 54.87 years. The prevalence of diabetes (24.8% vs. 13.2%) and hypertension (33.1% vs. 12.9%) was significantly higher in female patients compared to male patients, whereas the significantly higher number of male patients were smokers. On multivariate analysis, odds of female gender OR = 3.54 (1.37-9.17), killip class >2 OR = 3.05 (1.97-4.71) and baseline creatinine OR = 2.27 (1.22-4.23) were found as significant predictors of in-hospital mortality. The crude odds ratio of 2.35 (1.49-3.72) and adjusted OR of 2.05 (1.27-3.30) for female mortality was significant among patients aged <75-years. While patients with ≥75-years of age, the mortality difference was insignificant. Although the incidence of STEMI was higher in male compared to female patients, female patients had two-fold higher in-hospital mortality than male. Female gender was an independent predictor for in-hospital mortality in patients <75-years of age.

What if youth is not enough? Acute coronary syndrome in young patients

Abstract Funding Acknowledgements None. Background Acute Coronary Syndromes (ACS) are the leading cause of mortality in Spain. Further research is needed in order to know risk factors and outcomes in young patients so that medicians could optimize their management and prevention. Purpose Identifying risk factors, clinical characteristics and short-term outcomes in Acute Coronary Syndrome in patients aged 40 and under. Methods A retrospective analysis of patients under 40 years of age who were admitted for ACS, out of 3,859 ACS admissions in Cardiology Intensive Care Unit (CICU) in our hospital between 2012 and 2022. Results 67 patients (1.73%) were included, most of them were males (83.6%). Baseline characteristics are summarized in Table 1. 77.6% had hypertension (HTA), 22.4% had diabetes (DM) and 34.3% had dyslipidemia (DLP). 79.1% were smokers, 9.1% had a history of alcoholism and 29.9% were cocaine users. None of them had a history of stroke, atrial fibrillation (AF). Only 3% had ischemic heart disease. 68.7% of them were ST-elevation myocardial infarction (STEMI) and inferior STEMI was the most common (38.7%). In anterior STEMI (22 patients), 15 had a severe lesion in the mid-left anterior descending artery (LAD), and 6 in the left main stem (LM). Single-vessel disease was the most common (70.8%), with 3-vessel disease in 4.6%. 75.8% received percutaneous coronary intervention (PCI), and 3% underwent bypass surgery. During admission, 10.5% progressed to Killip class III-IV. The ICU mortality was 1.5%. 9% received vasoactive drugs and 4.5% were intubated. Non-invasive ventilation was used in 3% and high-flow nasal cannula oxygen therapy in 5.3%. 3% received intra-aortic balloon pump support and 1.5% underwent dialysis or ultrafiltration. 4.5% received an implantable cardioverter-defibrillator (ICD), although none of them developed bundle branch block or atrioventricular node block, nor AF. After discharge, 11.1% had recurrent ACS, and up to 5.6% underwent PCI again, with a mortality rate of 11.8%. Conclusion Approximately 2% of ACS occur in people younger than 40 years of age. Substance abuse (smoking, cocaine and alcoholism) becomes more prevalent in this group. Prevalence of comorbidities (such as diabetes and nephropathy) are lower, making them less prone to short-term heart failure. However, they are more susceptible to recurrent ischemic events. There is a high incidence of inferior STEMI and LM-STEMI. For these reasons, medicians may need to find out a substance abuse in this group and further research into other risk factors, such as coronary disease family history.Basal characteristicsClinical evolution of patients

Long-term air pollution exposure is associated with higher incidence of ST-elevation myocardial infarction and in-hospital cardiogenic shock

Previous studies have reported the association between myocardial infarction (MI) and air pollution (AP). However, limited information is available regarding the long-term effects of AP on the relative incidence rates of ST-elevation MI (STEMI) and Non-ST-elevation MI (NSTEMI). We investigated the association between long-term exposure to AP and the incidence of STEMI. Between January 2006 and December 2015, a total of 45,619 eligible patients with Acute Myocardial Infarction (AMI) were enrolled in the Korea Acute MI Registry (KAMIR) and KAMIR-National Institutes of Health. Mixed-effect regression models were used to examine the association between the annual average ambient AP before MI onset and the incidence of STEMI, and to evaluate the association of AP with the incidence of in-hospital cardiogenic shock. After mixed-effect regression model analysis, particulate matter (PM) 10 µm or less in diameter (PM10) was associated with increased incidence of STEMI compared with NSTEMI (odds ratio [OR] 1.009, 95% Confidence Interval [CI] 1.002–1.016; p = 0.012). For in-hospital cardiogenic shock complication, PM10 and SO2 were associated with increased risk, PM10 (OR 1.033, 95% CI 1.018–1.050; p < 0.001), SO2 (OR 1.104, 95% CI 1.006–1.212; p = 0.037), respectively. Policy-level strategies and clinical efforts to reduce AP exposure are necessary to prevent the incidence of STEMI and severe cardiovascular complications.

Prevention of metabolic syndrome implies prevention of severe and multivessel coronary artery disease

Abstract Funding Acknowledgements Type of funding sources: None. Background and Purpose Metabolic Syndrome (MS) is the result of metabolic, clinical, and hemodynamic disturbances caused by a group of cardiometabolic risk factors. The particular components of the syndrome are each individually also a predisposing factor for Coronary Artery Disease (CAD). The purpose of our study is to demonstrate the direct correlation of MS with the angiographic severity of CAD so that by affecting by prevention of one axis of this equation, a favorable effect is automatically achieved on its outcome as well. Methods We have studied 151 patients, 124 males - 27 females of mean age 63.56 ± 11.28 years, who were hospitalized for Acute Coronary Syndrome (ACS) and underwent coronary angiography. MS definition is according to the criteria set by the respective scientific companies. Thus, patients were classified into Group A with MS (46 patients - 35 males, 11 females - mean age 62.07 ± 11.35 years) and Group B without MS (105 patients - 89 males, 16 females – a mean age 65.06 ± 12.54 years). The correlation between MS, and the severity of CAD, has been estimated using the SYNTAX Score. Results Group A patients had a higher incidence of ST-elevation myocardial infarction (STEMI) than Group B patients, namely 32 patients (69.56%) versus 28 patients (26.67%), (p = 0.002), a higher incidence of multivessel disease, 20 patients (43.48%) versus 16 patients (16.8%), (p = 0.02), reduced Ejection Fraction (42.4% ± 9.6% vs. 53.5% ± 6.54% - p = 0.01) and higher SYNTAX Score (19.52 ± 7, 68 vs. 9.64 ± 5.32 - p = 0.01). In Group A with MS, lipid levels disorders were also observed (Total cholesterol, triglycerides, LDL, HDL - p = 0.01), higher values of fasting plasma glucose and HbA1c but also of mean platelet volume (MPV), which is considered a significant prognostic factor in patients with CAD (11.91 ± 1.93 femtolitres vs. 9.84 ± 1.06 femtolitres). Conclusions MS is associated with more severe clinically and angiographically CAD. Prevention and regulation of MS factors are significant for the avoidance of the occurrence of severe coronary syndrome.

The four seasons in acute coronary syndrome

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Acute coronary syndrome (ACS) is one of the most common health problems in the world, and the leading cause of death. The goals of this study are to determine ACS incidence and the seasonal distribution of ocurrence (Spring/Summer/Autumn/Winter) as well as clinical outcomes per season. Methods Retrospective and observational analysis of consecutive patients hospitalized for ST-elevation myocardial infarction (STEMI) in the Critical Coronary Care Unit (CCCU) of a tertiary center with Mediterranean climate from July 2011 to September 2022. We analyzed the influence of the seasons on the incidence and characteristics of ACS. Results We enrolled a total of 1668 patients: 431 in Winter, 382 in Spring, 405 in Summer and 450 in Autumn, with the baseline characteristics summarized in Table 1. There were no differences in baseline characteristics among the 4 seasons, except for the higher prevalence of obesity in Autumn. There was no statistically significant difference in the incidence of STEMI among seasons, although numerically the highest incidence was recorded in Autumn. The occurrence of ACS was not different according to age or sex. ACS complications were not statistically different among seasons with similar incidence of ventricular arrythmias (VT, VF), invasive mechanical ventilation support, need for inotrope/vasopressor support or development of de-novo atrial fibrillation. In-hospital mortality is less frequent in Autumn, but the differences did not reach statistical significance. Conclusions In this Mediterranean climate cohort, STEMI incidence was higher in Autumn, although no differences in clinical profile or outcomes were found among seasons.

The incidence and outcomes of high-risk acute coronary syndromes in Western Cape Province, South Africa: A prospective cohort study.

Tygerberg Hospital (TBH) is a tertiary-level hospital in Western Cape Province, South Africa, that provides healthcare to a large low- to middle-income population with services including centralised advanced cardiac care. Acute coronary syndrome (ACS) remains an important cause of death in the region despite a high burden of communicable diseases, including HIV. To describe the incidence of ST-elevation myocardial infarction (STEMI) and high-risk non-ST-elevation ACS (HR-NSTEACS) in the TBH referral network, describe the in-hospital and 30-day mortality of these patients, and identify important high-risk population characteristics. The Tygerberg Acute Coronary Syndrome Registry database is an ongoing prospective study that enrols all STEMI and HR-NSTEACS patients in the TBH referral network. All patients aged >18 years presenting with STEMI or HR-NSTEACS were treated in accordance with current European Society of Cardiology guidelines and were included prospectively over a 9-month surveillance period. A waiver of consent was granted to include patients who died before giving informed consent. Data collected included a demographic profile, risk factors for cardiovascular disease, in-hospital therapy and 30-day mortality. A total of 586 patients were enrolled, with a male predominance (64.5%) and incidence rates of STEMI and HR-NSTEACS of 14.7 per 100 000 and 15.6 per 100 000, respectively. The mean patient age was 58 years, and STEMI patients tended to be younger than HR-NSTEACS patients (56 v. 58 years; p=0.01). Cardiovascular risk factors were prevalent overall, but hypertension (79.8% v. 68.3%; p<0.01) and pre-existing IHD (29.1% v. 7.0%; p=0.03) were more prevalent in the HR-NSTEACS group. HIV was present in 12.6% of patients tested, similar to the background population rate. The overall 30-day all-cause mortality rate was 6.1%, with an in-hospital mortality rate of 3.9%. The 30-day mortality rates were similar for STEMI (1.8%) and HR-NSTEACS (2.6%) (p=0.75). HIV did not affect mortality rates. Use of a guideline-based approach to treating ACS in a low- to middle-income country setting yields mortality rates comparable to those in high-income countries. However, the lower-than-expected incidence rates of both STEMI and HR-NSTEACS in a relatively young population with a high prevalence of traditional cardiovascular risk factors, and a relatively high proportion of STEMI, suggest potential under-recording of ischaemic heart disease in the region. The rate and outcomes of coronary artery disease (CAD) in people living with HIV were similar to those in people without HIV, suggesting that traditional risk factors still drive CAD outcomes in the region.

The Impact of the COVID-19 Pandemic on Coronary Interventional Cardiology Activity in King Abdulaziz Medical City: A Retrospective Study.

The COVID-19 pandemic has decreased the number of patients undergoing coronary interventional procedures. This study aimed to identify the impact of the COVID-19 pandemic on the volume of patients and the types of interventional cardiology procedures performed at King Abdulaziz Cardiac Center(KACC) in Riyadh, Saudi Arabia. A retrospective chart review was undertaken with a sample size of 301 patients aged over 18 years, who underwent various cardiac interventions at King Abdulaziz Cardiac Center (KACC) between March 15, 2019, and February 29, 2020 (prior to the pandemic, group A), and between March 1, 2020, and March 15, 2021 (during the pandemic, group B). The BESTCare 2.0 system (ezCaretech,Seoul, South Korea) was used to collect data, Microsoft Office Excel (Microsoft® Corp., Redmond, WA) was utilized for data entry, and the Statistical Package for Social Sciences software(IBM SPSS Statistics, Armonk, NY) was employed for data analysis. There was a 21.4% decrease in the number of procedures performed during the pandemic. The largest age group within the population was ≥60 years, comprising 43.5% and 52.3% of groups A and B, respectively. Most patients had a body mass index (BMI) of >30, i.e., 43.5% of patients before the pandemic and 47.7% after the pandemic. In group A,39.9% were smokers and60.6% in group B. The prevalence of hypertension and obesity was higher in group B, i.e., 77.3% and 42.3%, respectively. The incidence of ST-elevation myocardial infarction (STEMI) was 39.9% in group A and 39.4% in group B. For non-ST-elevation myocardial infarction (NSTEMI), the comparable statistics were 56.5% and 49.2%, respectively. In groups A and B, readmission frequencies were 17.9% and 20%, respectively. The study indicates a minor decline in the number of percutaneous coronary interventions (PCIs) conducted in the interventional cardiology department of King Abdulaziz Cardiac Center (KACC) immediately following the COVID-19 outbreak, reflecting a steady activity in the center.

Comparison of Intracoronary and Intravenous Administration of High Dose Bolus Tirofiban in Patients of St Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Acute ST-elevation myocardial infarction (STEMI) is a condition in which transmural myocardial ischemia causes myocardial necrosis and is the leading cause of death. Objectives: To compare the efficacy of tirofiban bolus administration via percutaneous coronary intervention (PCI) and intravenous route (IV) in STEMI patients for restoration of myocardial perfusion. Methods: A retrospective cross-sectional study was conducted at Cardiology Department, Hayatabad Medical Complex, Peshawar, during 2021-22. The study comprised 168 STEMI patients divided into Group A and B (n=84), treated with tirofiban PCI and IV route, respectively. Results: Incidence of STEMI was three folds higher in males than females, and the mean age of the patients was 55 years. Smoking and obesity were the potential risk factors. Patients in Group A had a better clinical outcome and prognosis than Group B. In comparison to the IV treatment group (91.66%), the ST-segment resolution time was considerably lower (P&lt;0.05) in the PCI group (48.80%). In both groups, the observational parameters for TIMI flow grade, TIMI major and minor bleeding, MBG, and MACE were not-significantly different (P≥0.05), comprising percentages 94, 3.57, 9.52, 71.42, 5.95%, and 84.52, 2.38, 13.09, 75, 15.47%, respectively. In comparison to IV therapy group, the LVEF percentage in PCI group was statistically significant (P&lt;0.05) after 24 hours and 30 days (57, 63 and 52, 58%, respectively). Conclusions: It was concluded that STEMI patients treated with PCI tirofiban bolus had significantly greater (p&lt;0.05) recovery rates, left ventricular ejection fractions and better clinical outcomes than IV-treated group

Readmission in Patients With ST-Elevation Myocardial Infarction in 4 Age Groups (45 to

The incidence of ST-elevation myocardial infarction (STEMI) among younger adults is increasing due to an increased prevalence of cardiometabolic risk factors. Readmissions after STEMI in young patients could lead to substantial health care costs and a significant burden on health care resources. Although STEMI readmissions are well studied in elderly patients, limited data are available regarding readmissions after STEMI in young patients and the etiologies remain poorly understood. Because younger patients with STEMI have different sociodemographic profiles th;an older patients with STEMI, one would postulate that the risk factors for readmissions in young patients would differ from that reported in the older patients with STEMI. We performed a contemporary nationwide study using the 2016 and 2017 Nationwide Readmissions Database to identify patterns of readmissions after STEMI in the young adult population. Our analysis of the Nationwide Readmissions Database revealed a total of 243,747 hospitalizations for STEMI between 2016 and 2017. Readmission rates demonstrated a steady increase from discharge, increasing to 7.8% at 30 days and 10.3% at 60 days before relatively plateauing at 12.1% at 90 days. Cardiovascular etiologies were the most common cause of readmission (53.6%). After multivariable analysis, development of cardiogenic shock (adjusted odds ratio 1.48, 95% confidence interval 1.11 to 1.97; p = 0.008) and acute renal failure (adjusted odds ratio 1.46, 95% confidence interval 1.14 to 1.87; p = 0.003) during the index admission were associated with significantly higher rates of readmission. In conclusion, close monitoring in young patients who presented with STEMI and concomitant with cardiogenic shock or acute renal failure, and possibly, aggressive therapy during index admission may be needed. However, this population may be heterogeneous and further research is needed.

IMPACT OF COVID-19 PANDEMIC ON ST-SEGMENT-ELEVATION MYOCARDIAL INFARCTION ADMISSIONS AND OUTCOME IN THE NORTH OF IRAN

Objectives: To determine the incidence of ST-Elevation myocardial infarction (STEMI), patterns of care, and outcomes during the COVID-19 era in a hot-spot region. Methodology: From February to April 2020, all the STEMI patients were recruited and compared with the STEMI patients in the equivalent period of the previous year. Demographic and clinical information, coronary angiography data, and in-hospital mortality were collected and compared with the non-COVID-19 group. All data analysis was done using IBM SPSS version 20. Results: There was found a 40% reduction in STEMI admissions during the COVID-19 era compared to the equivalent period in 2019 (55 vs. 92, Rate Ratio (RR):0.60, 95% CI, 0.49-0.70, p&lt;0.001). Compared with the pre-COVID-19 study group, STEMI patients hospitalized during the pandemic were significantly younger (mean age: 56.10 in 2020 vs. 60.83 in 2019 p=0.012). The percentage of primary percutaneous coronary intervention referral was significantly higher than the previous year (47.8% vs. 75.9% p=0.001). In-hospital death occurred in 4 (4.4%) of STEMI patients admitted before the COVID-19 time, while none of the COVID-19 period studied cases died in hospital (p=0.298). Conclusion: Admissions for STEMI were substantially reduced during the COVID-19 pandemic. No changes in overall in-hospital mortality or quality indicators were detected.

ST-Elevation Myocardial Infarction Outcomes: A United States Nationwide Emergency Departments Cohort Study.

Literature regarding trends in incidence and mortality of ST-elevation myocardial infarction (STEMI) in emergency departments (EDs) is limited. To study the trends of incidence and mortality of STEMI. Using the National Emergency Department Sample database in the United States, we identified all ED encounters for patients presenting with STEMI using International Classification of Diseases codes. A linear p-trend was used to assess the trends. Out of the 973 million ED encounters represented, 641,762 (65/100,000; mean age 69 [59-81] years, 35.8% female) adult patients were recorded with STEMI. Among the major complications associated with STEMI, a total of 49,401 (7.7%) had cardiac complications, which included acute heart failure (n=9361, 1.6%), ventricular tachycardia or fibrillation (n=12,267, 1.91%), conduction block (n=20,165, 3.1%), and cardiogenic shock (n=7608, 1.2%). There were 5675 (0.9%) patients recorded with cerebrovascular events, which included acute ischemic stroke among 5205 (0.8%) patients and 470 (0.1%) with transient ischemic attack. Acute kidney injury was recorded for 10,082 (1.6%) patients. The trend for incidence of STEMI in the ED had decreased from 7.76/10,000 in 2011 to 4.07/10,000 in 2018 (linear p-trend 0.0006). However, the yearly mortality of STEMI related to ED encounters had remained relatively steady: 7.56% in 2011 to 7.50% in 2018 (linear p-trend 0.2364). Despite the fact that the number of patients presenting to the ED with STEMI has been decreasing, the mortality trends have remained steady. Further research of in-hospital STEMI may yield opportunities to reduce the risk of complications, improve patient outcomes and decrease health care burden.

Atmospheric features and risk of ST-elevation myocardial infarction in Porto (Portugal): A temperate Mediterranean (Csb) city

Introduction and objectivesSome atmospheric features have been linked to the triggering of myocardial infarction. Because data from the Temperate-Mediterranean is scarce, we sought to study whether meteorological parameters influence the incidence of ST-elevation myocardial infarction (STEMI) as confirmed by primary percutaneous intervention in a city with temperate weather (Porto, Portugal). MethodsRetrospective analysis of a series of STEMI-patients from January 2010 to December 2017. Temperature (T), relative humidity (RH), precipitation, and atmospheric pressure were obtained from a government-led institute. We utilized a generalized linear model (GLM) with a Poisson distribution, where a series of models with multivariable analysis were computed. The effects (GLM coefficients) are presented as excess relative risk (ERR). ResultsOne thousand and four consecutive STEMI-patients were included. The most important predictors of STEMI were Tmin two days before (for 1°C drop ERR=1.9%, p=0.009) and a 1% increase in RH three days before (EER=0.7%, p=0.006). Conversely, the same increase in RH the day before reduced the relative risk (EER=-0.6%, p=0.023). Temperature range, atmospheric pressure and precipitation had no impact on STEMI incidence. ConclusionIn a Temperate-Mediterranean city hot or cold temperature extremes, temperature drop and relative humidity had a significant impact on the occurrence of STEMI.

Abstract 11749: Rates of Adverse Cardiovascular Outcomes in Patients With Peripheral Arterial Disease Did Not Vary by Neighborhood Deprivation Estimates

Introduction: Socioeconomic factors including neighborhoods with limited resources have a negative impact on cardiovascular outcomes in peripheral arterial disease (PAD) patients. An area deprivation index (ADI) quantifies a region’s socioeconomic conditions, which have been linked to health outcomes. Hypothesis: The patients with PAD living in disadvantaged neighborhoods as identified with higher ADI, will have higher co-morbidities and lower access to treatment, resulting in higher incidence of ST-elevation myocardial infarction (STEMI). Methods: Using electronic medical records, we identified patients with PAD (n=6331), using ICD 10 code of I 70 and I 73, with encounter from January 1, 2019 to June 2, 2021. Patients were stratified into four different groups by ADI. Baseline characteristics, comorbidities and medications were recorded for all patients. Using Wilcoxon Rank Sum Test and Pearson Chi Square tests, descriptive statistics are presented for baseline characteristics and comorbidities in table 1. Results: Patients with PAD with the highest ADI (n=1582), were younger (64 ±12), more likely to be African American (59.5%) and current smokers (41.4%) (p&lt;0.001). There were significant differences in co-morbidities across the four groups of different ADIs (p&lt;0.001), with hypertension (83.9% vs 69.6%), CHF (25.3% vs. 17.7%) and diabetes mellitus (15.1% vs.10.4%) being more common in the group with the highest ADI, compared to the group with the lowest ADI. These patients with the highest ADI, were also more likely to be prescribed aspirin, any antiplatelet, a statin or an ACE inhibitor (p&lt; 0.001), suggesting appropriate access to medical therapy. However, the incidence of STEMI was not statistically significant between the groups (p=0.377). Conclusions: PAD patients living in neighborhoods with higher ADI have higher co-morbidities as compared to those in areas with lower ADI. The incidence of STEMI is low in all groups independent of ADI

ST elevation myocardial infarction and kidney transplant: A large cohort study: STEMI and renal transplant

BackgroundThe literature on outcomes of ST-elevation myocardial infarction (STEMI) amongst kidney transplant recipients (KTR) is limited. ObjectiveTo study the outcomes of STEMI among KTR. MethodsData from the national readmissions database (NRD) sample that constitutes 49.1% of the stratified sample of all hospitals in the USA were analyzed for hospitalizations with STEMI among KTR for the years 2012-2018. Complications associated with STEMI were extracted using International Classification of Diseases codes. ResultsA total of 588,668 index KTR hospitalizations (mean age 57.67±14.22 years; female 44.5%) of which 3,496 (0.59%) had STEMI were recorded in the NRD for the years 2012-2018. A total of 11,676 (1.98%) patients died during the hospitalization. In-hospital mortality among STEMI was higher, 465 (13.3%), than without-STEMI 11,211 (1.92%). Among the complications, mechanical complications occurred among 1.0% vs 0.02%, cardiogenic shock 10.6 vs 0.3%, ventricular arrythmias 8.3% vs 0.8%, conduction block 6.9% vs 2%, stroke 4.1% vs 1.9%, and acute kidney injury 31.6% vs 28.3% among STEMI and without-STEMI respectively. Among coronary procedures, coronary angiography was performed among 1,999 (57.2%) of which 1,777 (50.8%) had percutaneous coronary intervention (PCI). On coarsened exact matching of baseline characteristics, PCI was less likely associated with mortality, odds ratio 0.39 (95% confidence interval 0.24-0.64; p=0.0002). The trends of mortality among STEMI were steady (p-trend 0.11). PCI trend increased (p-trend 0.008) and incidence of STEMI decreased over the study years 2012 (0.66%)-2018(0.474%). A total of 84,810 (14.4%) patients were readmitted in 30 days of which 696 (20%) patients were among the STEMI subgroup. ConclusionSTEMI is not an uncommon complication among KTR and is associated with significant mechanical complications. Improvement in cardiovascular risk factors might improve the STEMI rates among KTR.

Are there sex differences in the effect of type 2 diabetes in the incidence and outcomes of myocardial infarction? A matched-pair analysis using hospital discharge data

BackgroundTo analyze incidence, use of therapeutic procedures, and in-hospital outcomes in patients with ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI) according to the presence of type 2 diabetes (T2DM) in Spain (2016–2018) and to investigate sex differences.MethodsUsing the Spanish National Hospital Discharge Database, we estimated the incidence of myocardial infarctions (MI) in men and women with and without T2DM aged ≥ 40 years. We analyzed comorbidity, procedures, and outcomes. We matched each man and woman with T2DM with a non-T2DM man and woman of identical age, MI code, and year of hospitalization. Propensity score matching was used to compare men and women with T2DM.ResultsMI was coded in 109,759 men and 44,589 women (30.47% with T2DM). The adjusted incidence of STEMI (IRR 2.32; 95% CI 2.28–2.36) and NSTEMI (IRR 2.91; 95% CI 2.88–2.94) was higher in T2DM than non-T2DM patients, with higher IRRs for NSTEMI in both sexes. The incidence of STEMI and NSTEMI was higher in men with T2DM than in women with T2DM. After matching, percutaneous coronary intervention (PCI) was less frequent among T2DM men than non-T2DM men who had STEMI and NSTEMI. Women with T2DM and STEMI less frequently had a code for PCI that matched that of non-T2DM women. In-hospital mortality (IHM) was higher among T2DM women with STEMI and NSTEMI than in matched non-T2DM women. In men, IHM was higher only for NSTEMI. Propensity score matching showed higher use of PCI and coronary artery bypass graft and lower IHM among men with T2DM than women with T2DM for both STEMI and NSTEMI.ConclusionsT2DM is associated with a higher incidence of STEMI and NSTEMI in both sexes. Men with T2DM had higher incidence rates of STEMI and NSTEMI than women with T2DM. Having T2DM increased the risk of IHM after STEMI and NSTEMI among women and among men only for NSTEMI. PCI appears to be less frequently used in T2DM patients After STEMI and NSTEMI, women with T2DM less frequently undergo revascularization procedures and have a higher mortality risk than T2DM men.

Impact of short-term air pollution exposure on acute coronary syndrome in two cohorts of industrial and non-industrial areas: A time series regression with 6,000,000 person-years of follow-up (ACS - Air Pollution Study)

BackgroundThere is a lack of studies directly comparing the effect of air pollution on acute coronary syndrome (ACS) occurrence in industrial and non-industrial areas. ObjectivesA comparison of association of air pollution exposure with ACS in two cohorts of industrially different areas. Materials and methodsThe study covered 6,000,000 person-years of follow-up and five pollutants between 2008 and 2017. A time series regression analysis with 7-lag was used to assess the effects air pollution on ACS. ResultsA total of 9046 patients with ACS were included in the analysis, of whom 3895 (43.06%) had ST-elevation myocardial infarction (STEMI) - 45.39% from non-industrial area, and 42.37% from industrial area; and 5151 (56.94%) had non-ST-elevation myocardial infarction (NSTEMI) - 54.61% from non-industrial area and 57.63% from industrial area. The daily concentrations of PM2.5, PM10, NO2, SO2, CO were higher in industrial than in non-industrial area (P < 0.001). In non-industrial area, an increase of 10 μg/m3 of NO2 concentration (Odds Ratio (OR) = 1.126, 95%CI = 1.009–1.257; P = 0.034, lag-0) and an increase of 1 mg/m3 in CO concentration (RR = 1.055, 95%CI = 1.010–1.103; P = 0.017, lag-0) were associated with an increase in the number of hospitalization due to NSTEMI (for industrial area increase of 10 μg/m3 in NO2 (OR = 1.062, 95%CI = 1.020–1.094; P = 0.005, lag-0), SO2 (OR = 1.061, 95%CI = 1.010–1.116; P = 0.018, lag-4), PM10 (OR = 1.010, 95%CI = 1.001–1.030; P = 0.047, lag-6). In STEMI patients in industrial area, an increased hospitalization was found to be associated with an increase of 10 μg/m3 in SO2 (OR = 1.094, 95%CI = 1.030–1.162; P = 0.002, lag-1), PM2.5 (OR = 1.041, 95%CI = 1.020–1.073; P < 0.001, lag-1), PM10 (OR = 1.030, 95%CI = 1.010–1.051; P < 0.001, lag-1). No effects of air pollution on the number of hospitalization due to STEMI were noted from non-industrial area. ConclusionThe risk of air pollution-related ACS was higher in industrial over non-industrial area. The effect of NO2 on the incidence of NSTEMI was observed in both areas. In industrial area, the effect of PMs and SO2 on NSTEMI and STEMI were also observed. A clinical effect was more delayed in time in patients with NSTEMI, especially after exposure to PM10. Chronic exposure to air pollution may underlie the differences in the short-term effect between particulate air pollution impact on the incidence of STEMI.

Sex Differences in the Effects of COPD on Incidence and Outcomes of Patients Hospitalized with ST and Non-ST Elevation Myocardial Infarction: A Population-Based Matched-Pair Analysis in Spain (2016-2018).

We aimed to compare the incidence, clinical characteristics, and outcomes of patients admitted with myocardial infarction (MI), whether ST elevation MI (STEMI) or non-ST elevation MI (NSTEMI), according to the presence of chronic obstructive pulmonary disease (COPD), and to identify variables associated with in-hospital mortality (IHM). We selected all patients with MI (aged ≥40 years) included in the Spanish National Hospital Discharge Database (2016–2018). We matched each patient suffering COPD with a non-COPD patient with identical age, sex, type of MI, and year of hospitalization. We identified 109,759 men and 44,589 women with MI. The MI incidence was higher in COPD patients (incident rate ratio (IRR) 1.32; 95% confidence interval (CI) 1.29–1.35). Men with COPD had higher incidence of STEMI and NSTEMI than women with COPD. After matching, COPD men had a higher IHM than non-COPD men, but no differences were found among women. The probability of dying was higher among COPD men with STEMI in comparison with NSTEMI (odds ratio (OR) 2.33; 95% CI 1.96–2.77), with this risk being higher among COPD women (OR 2.63; 95% CI 1.75–3.95). Suffering COPD increased the IHM after an MI in men (OR 1.14; 95% CI 1.03–1.27), but no differences were found in women. COPD women had a higher IHM than men (OR 1.19; 95% CI 1.01–1.39). We conclude that MI incidence was higher in COPD patients. IHM was higher in COPD men than in those without COPD, but no differences were found among women. Among COPD patients, STEMI was more lethal than NSTEMI. Suffering COPD increased the IHM after MI among men. Women with COPD had a significantly higher probability of dying in the hospital than COPD men.

Extreme weather conditions as a gender-specific risk factor for acute myocardial infarction.

Acute coronary syndrome is a disease with high prevalence and high mortality. Exposure to heat or cold increases the risks of myocardial infarction significantly. Gender-specific effects of this have not yet been examined. Our goal was to determine whether extreme weather conditions, which become more and more frequent, are gender-specific risk factors for myocardial infarction, in order to help provide faster diagnosis and revascularization therapy for patients. We analysed the incidence of ST-elevation myocardial infarction (STEMI) in a large urban area over a 65-months period in a cohort study. A day was the unit of analysis. Incidence rate ratios (IRR) with Poisson regression models were calculated. All patients with STEMI on Saturdays and Sundays were included. Gender, high or low perceived temperatures (PT), a function of temperature, wind speed and humidity, and meteorological cold and heat warnings by the Austrian Central Institute for Meteorology and Geodynamics (ZAMG) were considered as risk factors. During the 562days of the study period, a total of 1109 patients with STEMI (803; 72% men, mean age 61;14years) were included. The gender difference between men and women was much more pronounced on cold (0°C) days (85% of patients male; 1.8 per day) than on hot (20°C) days (71% male; 1.4 per day) or days without extreme temperatures (72% male; 1.4 per day). We found significant interaction between gender and cold days (IRR of the interaction term 2.3 (95% CI 1.2-4.6), p=0.02). No gender-specific effect was observed on warm days (IRR for interaction 0.9 (95% CI 0.6-1.3), p=0.3). Low perceived temperature pronouncedly increases the already elevated risk for STEMI in males. Whether this effect is based on gender alone, or on one of the cardiovascular risk factors which are more common in men, is up to further study.

Interplay between COVID-19, pollution, and weather features on changes in the incidence of acute coronary syndromes in early 2020

BackgroundCoronavirus disease 2019 (COVID-19) has caused an unprecedented change in the apparent epidemiology of acute coronary syndromes (ACS). However, the interplay between this disease, changes in pollution, climate, and aversion to activation of emergency medical services represents a challenging conundrum. We aimed at appraising the impact of COVID-19, weather, and environment features on the occurrence of ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) in a large Italian region and metropolitan area. Methods and resultsItaly was hit early on by COVID-19, such that state of emergency was declared on January 31, 2020, and national lockdown implemented on March 9, 2020, mainly because the accrual of cases in Northern Italy. In order to appraise the independent contribution on changes in STEMI and NSTEMI daily rates of COVID-19, climate and pollution, we collected data on these clinical events from tertiary care cardiovascular centers in the Lazio region and Rome metropolitan area. Multilevel Poisson modeling was used to appraise unadjusted and adjusted effect estimates for the daily incidence of STEMI and NSTEMI cases.The sample included 1448 STEMI and 2040 NSTEMI, with a total of 2882 PCI spanning 6 months. Significant reductions in STEMI and NSTEMI were evident already in early February 2020 (all p<0.05), concomitantly with COVID-19 spread and institution of national countermeasures. Changes in STEMI and NSTEMI were inversely associated with daily COVID-19 tests, cases, and/or death (p<0.05). In addition, STEMI and NSTEMI incidences were associated with daily NO2, PM10, and O3 concentrations, as well as temperature (p<0.05). Multi-stage and multiply adjusted models highlighted that reductions in STEMI were significantly associated with COVID-19 data (p<0.001), whereas changes in NSTEMI were significantly associated with both NO2 and COVID-19 data (both p<0.001). ConclusionsReductions in STEMI and NSTEMI in the COVID-19 pandemic may depend on different concomitant epidemiologic and pathophysiologic mechanisms. In particular, recent changes in STEMI may depend on COVID-19 scare, leading to excess all-cause mortality, or effective reduced incidence, whereas reductions in NSTEMI may also be due to beneficial reductions in NO2 emissions in the lockdown phase.