Incidence Of Acute Myocardial Infarction Research Articles

Long-Term Prognostic Impact of Sex in Patients with Chronic Coronary Syndrome: A 17-Year Prospective Cohort Study.

Background: Women and men with chronic coronary syndrome (CCS) have different clinical features and management, and studies on mid-term prognosis have reported conflicting results. Our objective was to investigate the impact of the female sex in the prognosis of the disease in the very long term. Methods and Results: We investigated differential features and very long-term prognosis in 1268 consecutive outpatients with CCS (337 [27%] women and 931 [73%] men). Women were older than men, more likely to have hypertension, diabetes, angina, and atrial fibrillation, and less likely to be exsmoker/active smoker and to have been treated with coronary revascularization (p < 0.05 for all). The prescription of statins, antiplatelets, and betablockers was similar in both groups. After up to 17 years of follow-up (median = 11 years, interquartile range = 4-15 years), cumulative incidences of acute myocardial infarction (10.2% vs. 11.8%) or stroke (11% vs. 10%) at median follow-up were similar, but the risks of major cardiovascular events (acute myocardial infarction, stroke, or cardiovascular death, 41.2% vs. 33.6%), hospital admission for heart failure (20.9% vs. 11.9%), or cardiovascular death (32.3% vs. 22.1%) were significantly higher for women (p < 0.0005), with a nonsignificant trend to higher overall mortality (45.2% vs. 39.1%, p = 0.07). However, after multivariate adjustment, all these differences disappeared. Conclusion: Although women and men with CCS presented a different clinical profile, and crude rates of major cardiovascular events, heart failure and cardiovascular death were higher in women, female sex was not an independent prognostic factor in this study with up to 17 years of follow-up.

The Effects of Tobacco Smoking Status on the Short-term Outcomes of Patient’s Post-acute Myocardial Infarction: A Longitudinal Study

Background: Although cigarette smoking is a risk factor for cardiovascular disease (CVD), smoking cessation has considerable effects on the reduction of mortality and incidence of acute myocardial infarction (AMI). This study was done to examine the effect of tobacco smoking status and its short-term outcomes after AMI. Materials and Methods: In this longitudinal study, 96 patients smoking tobacco products (cigarette and waterpipe) within the age range of 30-70 years who had undergone angiography following the first AMI were evaluated. The patients were evaluated at three time points in terms of tobacco smoking status, additional myocardial infarction (MI), hospitalization due to cardiac events, and some other variables. Data collection was done using a checklist and phone calls. Results: The mean age of the patients was 52.99±9.2 years. Six months following the first MI, more than 60% of the patients had ceased their tobacco smoking, but over time and at the end of the study, this value diminished, especially in waterpipe smokers. The chance of hospitalization among the men younger than 54 years who were not smokers at the baseline was 0.801. On the other hand, this chance for men below 54 years who smoked 1-10 cigarettes per day was 4.75 times higher (OR=4.747, P=0.002). In addition, men younger than 54 years who smoked waterpipe twice or more per day were hospitalized 31 times more frequently compared to the men who did not smoke waterpipe (P=0.001, OR=31.112). Conclusion: Not smoking cigarettes or waterpipe over time would considerably reduce the chance of hospitalization due to CVD.

A szívinfarktus incidenciája, a betegek ellátásának és prognózisának összehasonlítása Magyarország különböző fejlettségű járásaiban

Several international studies have already confirmed the importance of the socioeconomic status of acute myocardial infarction patients in terms of patient care and prognosis. To our knowledge, a nationwide examination of this kind has not yet taken place in Hungary. The investigation of this problem field was made possible by the fact that from January 1, 2014, all healthcare providers must record the data of patients treated with a diagnosis of acute myocardial infarction in the database of the Hungarian Myocardial Infarction Registry (HUMIR). In this study, the authors searched for an answer to whether the complex development index (CDI) in Hungary's 174 districts and 23 capital districts influences the treatment and prognosis of acute myocardial infarction patients. Based on the CDI worked out by the Hungarian Central Statistical Office, the authors divided the Hungarian districts into low (CDI_L), medium (CDI_M) and high (CDI_H) CDI groups according to their values. They examined the incidence, hospital treatment and prognosis of acute myocardial infarction in these administrative-territorial units. The HUMIR included 66,253 patients treated by myocardial infarction between 2015 and 2019. Their place of residence could be identified based on the zip code and in which district it was located. In the examined population, 29,101 patients with ST-elevation (STEMI) and 37,152 without ST-elevation (NSTEMI) received treatment for acute myocardial infarction. In the population over 15 years of age, the age-standardized incidence of STEMI was 68.8 per 100,000 inhabitants a year in the CDI_L group and 52.7 per 100,000 inhabitants a year in the CDI_H group. Almost the same values were found in all three CDI subgroups of NSTEMI incidence (69.5 and 67 per 10,000 inhabitants a year). The frequency of percutaneous coronary intervention in the case of STEMI was higher than in NSTEMI, but within the groups, CDI did not influence the performance of this treatment. In the case of STEMI, the rates of patients who underwent percutaneous coronaria intervention in all three CDI subgroups (CDI_L, CDI_M, CDI_H) were 83.5%, 83.7%, 83.5%, while in the case of NSTEMI they were 57.4%, 57.7%, 57.3%. The authors applied a Cox multivariate regression analysis to examine myocardial infarction mortality. The CDI did not affect the 30-day mortality rates in the case of any myocardial infarction: the hazard ratio (HR) values were 0.906 and 0.914 (p = 0.04659; p = 0.04686) in the case of STEMI, while 1.067 and 1.001 (p = 0.16520; p = 0.98933) in the case of NSTEMI. In the case of a STEMI diagnosis, the risk of the 30-364-day and the 1-year mortality in the subgroup of CDI_H was significantly lower (HR = 0.822 and 0.816) than in the subgroup of CDI_L (p = 0.00096 and p = 0.00001). In the case of NSTEMI diagnosis, the authors found a difference in the risk of beyond 1-year mortality by comparing the districts in the subgroup of CDI_L with the districts in CDI_H: in the latter case, the HR of the mortality was 0.876, which was significantly lower (p = 0.00029) than in the subgroup of CDI_L. The CDI has independent prognostic significance in determining the late prognosis of acute myocardial infarction patients. Orv Hetil. 2022; 163(47): 1862-1871.

Effect of Early Multidisciplinary Collaboration Combined with Cluster Strategy on Acquired Debilitating Syndrome in ICU of Patients with Acute Myocardial Infarction.

To investigate the preventive effect of early multidisciplinary collaboration combined with cluster strategy on acquired frailty syndrome in ICU of patients with acute myocardial infarction (AMI). A total of 240 patients with myocardial infarction (MI) admitted to ICU in The Third Affiliated Hospital of Qiqihar Medical University, Qiqihar, China from March 2018 to March 2020 were selected. The patients were randomly divided into experiment group and control group equally according to random number method. The experimental group was treated with early multidisciplinary collaboration and cluster strategy, while the control group was treated with routine nursing mode. Duration of ventilation, total length of stay, length of ICU stay, New York College of Cardiology cardiac function classification, MRC-Score, BI and complications during hospitalization were recorded. After intervention, there were statistically significant differences in ventilation duration, total length of stay, length of stay in ICU, Heart function classification of New York Cardiology Society, MRC-Score, BI index, SF-36 score and complications during hospitalization in 2 groups (P < 0.05), and the above indicators in the experimental group were better than those in the control group. Early multidisciplinary collaboration combined with cluster strategy can significantly reduce the incidence of AMI in ICU of MI patients.

Rate and Risk Factors of Acute Myocardial Infarction after Debut of Chronic Kidney Disease-Results from the KidDiCo.

Chronic kidney disease (CKD) is a known risk factor for cardiovascular disease, including acute myocardial infarction. However, whether this risk is only associated with severe kidney disease or is also related to mildly impaired kidney function is still under debate. The incidence rate and risk factors of incident acute myocardial infarction (AMI) in patients with CKD are sparse. Potential differences in risk factor profiles between CKD patients with incident AMI and CKD patients with a prior AMI have not been sufficiently investigated. Furthermore, important factors such as albuminuria and socio-economic factors are often not included. The primary aim of this study was to establish the incidence rate of AMI after CKD debut. Secondly, to evaluate the importance of different CKD stages and the risk of having an AMI. Finally, to identify individuals at risk for AMI after CKD debut adjusted for prevalent AMI. Based on data from the kidney disease cohort of Southern Denmark (KidDiCo), including 66,486 CKD patients, we established incidence rates and characteristics of incident AMI among patients within a 5-year follow-up period after CKD debut. A Cox regression was performed to compute the cause-specific hazard ratios for the different risk factors. The incidence rate for CKD stage G3-5 patients suffering acute myocardial infarction is 2.5 cases/1000 people/year. In patients without a previous myocardial infarction, the risk of suffering a myocardial infarction after CKD debut was only significant in CKD stage G4 (HR = 1.402; (95% CI: 1.08-1.81); p-value = 0.010) and stage G5 (HR = 1.491; (95% CI: 1.01-2.19); p-value = 0.042). This was not the case in patients who had suffered an acute myocardial infarction prior to their CKD debut. In this group, a previous myocardial infarction was the most critical risk factor for an additional myocardial infarction after CKD debut (HR = 2.615; (95% CI: 2.241-3.05); p-value &lt; 0.001). Irrespective of a previous myocardial infarction, age, male sex, hypertension, and a low educational level were significant risk factors associated with an acute myocardial infarction after CKD debut. The incidence rate of AMI in patients with CKD stage G3-5 was 2.5 cases/1000 people/year. Risk factors associated with incident AMI in CKD stage G3-5 patients were CKD stage, age, and hypertension. Female sex and higher educational levels were associated with a lower risk for AMI. Prior AMI was the most significant risk factor in patients with and without previous AMI before fulfilling CKD stage G3-5 criteria. Only age, sex, and a medium-long educational level were significant risk factors in this group.

Abstract 11659: Comparing Rates of Acute Myocardial Infarction Between Cancer Therapies in Patients With Non-Small Cell Lung Cancer

Introduction: The prevalence of cardiovascular disease (CVD) has increased in patients with cancer, contributing significantly to mortality among cancer survivors. Cardiotoxicity of anti-cancer drugs may play a role in the development of CVD among cancer survivors, including incidence of acute myocardial infarction (AMI). We analyzed AMI rates in patients with non-small cell lung cancer (NSCLC) treated with one of four cancer regimens. Methods: We used national data from the Veterans Affairs (VA) Corporate Data Warehouse and VA Cancer Registry. We identified 9,619 veterans diagnosed with NSCLC during 2015-2019 who initiated one of four oncological therapies: chemotherapy, immune checkpoint inhibitors (ICI) with chemotherapy, ICI monotherapy, or tyrosine kinase inhibitors monotherapy (TKI). Patients were categorized according to the first therapy received. We identified subsequent hospitalizations for AMI within two years of initiating the oncological treatment. We estimated AMI rates per 100 patient-years and risk adjusted relative hazard ratio (HR) of AMI by treatment type using Cox Regression Model to adjust for age, AMI history, comorbidities, malignancy stage, and histology. Results: Among 9,618 veterans identified, 5,510 (57.3%) initiated treatment with chemotherapy, 2,820 (29.3%) ICI with chemotherapy, 829 (8.6%) with ICI monotherapy, and 459 (4.8%) with TKI. Over a follow-up period of 2 years, 158 (1.6%) patients experienced an AMI and 5,917 (61.5%) died. The incidence of AMI per 100 patient-years (95% CI) was as follows; chemotherapy 0.86 (0.70-1.06), ICI with chemotherapy 0.77 (0.58-1.03), ICI monotherapy 0.91 (0.52-1.60), and TKI 0.43 (0.16-1.15). When compared to chemotherapy alone, adjusted HR (95% CI) for ICI with chemotherapy, ICI monotherapy, and TKI were 1.09 (0.91-1.31), 1.02 (0.75-1.38), and 1.50 (0.94-2.37), respectively. When compared to TKI or ICI with chemotherapy, the ICI monotherapy cohort did not have a statistically significant adjusted HR for AMI risk. Conclusion: Among Veterans with NSCLC, the incidence of AMI was low and there was no difference in risk between the initial oncological regimens. The high competing risk of mortality in our cohort may also have contributed to the lack of between-group differences.

Abstract 14809: Longitudinal Trends in the Incidence of Covid-19 in Acute Myocardial Infarction Patients

Introduction: Existing studies have reported association between acute myocardial infarction (AMI) and risk of fatal outcomes in COVID-19 patients. However, impact of Omicron COVID-19 variant on the incidence of AMI has not been studied. We aimed to ascertain longitudinal trends in incidence of COVID-19 in AMI patients with a focus on the Omicron period. Methods: We included all hospitalized patients from March 2020 to January 31 st , 2022 at all Cleveland Clinic hospitals in the U.S. who had an ICD-10 code I21 representing AMI. Data was obtained using Slicer Dicer. Primary outcome was longitudinal trends in incidence of COVID-19 in AMI patients and secondary outcome was the incidence of COVID-19 in Omicron as compared with previous waves. Hospitalisations were stratified based on following periods: stay at home order [03/2020-05/2020]; pre-vaccination [06/2020-01/2021]; post-vaccination but before delta wave [02/2021-06/2021]; delta wave [07/2021-08/2021]; and Omicron wave [12/2021-01/2022]. Trends over study period were assessed using Mann-Kendall test. Comparison of outcomes across different COVID-19 pandemic periods was performed using the chi-square test. Results: Total of 14908 hospitalizations were identified. Overall incidence rate of COVID-19 in AMI patients was 7.62% (1137/14908). From March 2020 until January 31 st , 2022, there has been a significant increase in incidence rate of COVID-19 in AMI patients from 0.83% to 29.92%, p=0.006. Incidence rate of COVID-19 in AMI during the Omicron period (25.7% (322/1252)) was significantly higher compared with the stay at home order (2.3%), pre-vaccination (8.2%), post-vaccination (4.3%), and delta wave (3.7%), p&lt;0.001. Furthermore, incidence of COVID-19 in AMI patients decreased post-vaccination period until emergence of Omicron variant. Conclusions: There has been a significant increase in the incidence of COVID-19 amongst the AMI patients which is attributed to the emergence of Omicron variant.

Anxiety and depression symptoms, albuminuria and risk of acute myocardial infarction in the Norwegian HUNT cohort study

BackgroundStudies suggest increased risk for an outcome in people with joint exposures that share common causal pathways. The objective of this study was to determine the risk of incident acute myocardial infarction (AMI) following exposure to both albuminuria and/or anxiety and depression symptoms.MethodsParticipants who provided urine samples to the HUNT2 (1995–97) or HUNT3 (2007–2009) surveys were followed until the end of 2016. Albuminuria was measured by Albumin Creatine Ratio (ACR) and participants self-reported mood and anxiety symptoms on the Hospital Anxiety and Depression scale. We used Cox regression to estimate hazard ratios (HRs) for first incident AMI considering interaction between exposures and additive models to calculate the proportion of AMI that were attributable to the synergy of both exposures, adjusted for the Framingham variables.ResultsEleven thousand fourteen participants free of previous AMI were eligible for participation, with 1234 incident AMIs occurred during a mean 13.7 years of follow-up. For participants who had a healthier CVD risk profile, the HR for AMI of having both albuminuria (3–30 mg/mmol) and depression (≥8) was 2.62 (95% 1.12–6.05) compared with a HR 1.34 (95% CI 1.04–1.74) with raised ACR only (Likelihood Ratio-test 0.03). Adding anxiety (≥8) to albuminuria (3–30) tripled the risk (HR 3.32 95% CI 1.43–7.17). The additive models suggest that these risks are not higher than expected based on each risk factor alone.ConclusionsThis study indicate that the risk of AMI in persons with elevated albuminuria but with an otherwise healthy CVD profile might be amplified by anxiety and depression symptoms. The increased risk with joint risk factors is not higher than expected based on each risk factor alone, which indicate that the risk factors do not share causal pathways.

Abstract 11336: Optimized Machine Learning Models by Identification of Candidate Predictors for 30-Day Readmission Risk Prediction Among Patients Hospitalized for Acute Myocardial Infarction

Introduction: Acute myocardial infarction (AMI) is a leading cause of death in the US. More than 800,000 adults experience an AMI each year, and up to 20% of the patients are rehospitalized within 30 days. Predicting 30-day readmission accurately could help clinicians identify high-risk patients and tailor treatment accordingly. Hypothesis: The neural network will generate the best performing model for predicting 30-day readmissions following an AMI. Methods: The cohort included adults hospitalized with incident AMI (6,506) at Dartmouth Hitchcock Medical Center between 2011-2016. Patients who died before discharge (236) were excluded, leaving 6,270 patients. Our outcome was 30-day hospital readmissions. Candidate features were selected using an Extra Tree Classifier. Selected features included demographics and clinical characteristics. Multiple imputation using K-Nearest Neighbors was performed. Five machine learning models were implemented: logistic regression, LASSO, neural network, random forest, and XGBoost. Models were evaluated on a hold-out test-set, using AUROC. Results: Among the cohort, about 36% were female, the majority were white and non-Hispanic, and the 30-day readmission rate was 6.2%. Neural network was the best performing model with an AUROC of 0.80 (95% CI: 0.75, 0.84). However, the XGBoost and random forest models performed similarly with AUROCs of 0.80 (95% CI: 0.76, 0.85) and 0.79 (95% CI: 0.75, 0.84), respectively. The logistic regression and LASSO models performed poorly, with AUROCs below 0.5, respectively. Important predictor variables were major depression, race, and antidepressant at discharge. Conclusions: Neural network, random forest, and XGBoost models predicted 30-day readmission following an AMI with good performance. Across these models, depression was an important feature for predicting 30-day readmissions. Results reinforce the importance of mental health among patients hospitalized for AMI.

The Value of Rivaroxaban Combined with Ticagrelor in Antithrombotic Therapy after PCI in Patients with Nonvalvular Atrial Fibrillation with Acute Coronary Syndrome.

Based on a retrospective cohort study, to investigate the value of rivaroxaban combined with ticagrelor in antithrombotic therapy after PCI in patients with nonvalvular atrial fibrillation with acute coronary syndrome. A total of 60 patients from January 2019 to May 2021 accepted therapy with antithrombotic therapy after PCI. The patients treated with ticagrelor were set as the control group, and those given rivaroxaban combined with ticagrelor were set as the research group. The curative effect, myocardial level, TIMI blood flow grade, platelet aggregation rate, and the incidence of cardiovascular events were taken from the comparisons. The research group's therapeutic impact was superior to the control group's therapeutic impact, and the value was higher. After treatment, the myocardial levels of the two groups decreased, and the levels of troponin I, creatine kinase isoenzyme, and hypersensitive C-reactive protein in the research group were greatly less than those in the control group, and the difference was statistically significant (P < 0.05). After operation, the TIMI blood flow classification in the experimental group was better than that in the control group, and the difference was statistically significant (P < 0.05). The experimental group's platelet aggregation incidence was considerably lower than the control group's platelet aggregation incidence at 0.5 and 2 hours following surgery, and the difference was statistically significant (P < 0.05). The incidence of acute myocardial infarction, cardiogenic death, and intractable angina pectoris in the research group was significantly lower than that in the control group. Rivaroxaban combined with ticagrelor in the treatment of nonvalvular atrial fibrillation with acute coronary syndrome after percutaneous coronary intervention; the TIMI blood flow grade is better than ticagrelor, which is of great significance to reduce mortality and has high safety in clinical application.

Incidence of Acute myocardial infarction and concurrent altered sensorium presentation as cerebrovascular accident in emergency department In IGIMS Hospital

Incidence of Acute myocardial infarction and concurrent altered sensorium presentation as cerebrovascular accident in emergency department In IGIMS Hospital

Prior Cancer Is Associated with Lower Atherosclerotic Cardiovascular Disease Risk at First Acute Myocardial Infarction.

Patients with cancer are at increased risk of acute myocardial infarction (AMI). It is unclear if the Atherosclerotic Cardiovascular Disease (ASCVD) risk score at incident AMI is reflective of this higher risk in patients with prior cancer than those without. We linked nationwide AMI and cancer registries from 2008 to 2019. A total of 18,200 eligible patients with ASCVD risk score calculated at incident AMI were identified (1086 prior cancer; 17,114 no cancer). At incident AMI, age-standardized mean ASCVD risk was lower in the prior cancer group (18.6%) than no cancer group (20.9%) (p &lt; 0.001). Prior to incident AMI, smoking, hypertension, hyperlipidemia and diabetes mellitus were better controlled in the prior cancer group. However post-AMI, prior cancer was associated with lower guideline-directed medical therapy usage and higher all-cause mortality (adjusted hazard ratio 1.85, 95% confidence interval 1.66-2.07). AMI occurred despite better control of cardiovascular risk factors and lower age-standardized estimated mean 10-year ASCVD risk among patients with prior cancer than no cancer. Prior cancer was associated with lower guideline-directed medical therapy post-AMI and higher mortality.

Myocardial revascularization surgery with bilateral internal mammary artery

Introduction: The internal mammary artery is the only graft with a long-term impact on mortality in patients with coronary artery disease. Some questions limit the use of both arteries simultaneously, such as prolonged surgical time, risk of sternal infections, especially in diabetic and obese patients. This study sought to describe the 5-year experience in patients revascularized with bilateral internal mammary artery (BIMA). Methods: Descriptive cohort follow-up study. 42 patients underwent myocardial revascularization with BIMA between 2015-2020, Manuel-Uribe-Ángel Hospital, Envigado-Colombia. Secondary and primary information sources. Univariate analysis was developed for the description of variables. Results: Mean age of 55.2 years, 19% were diabetic, mean body mass index (BMI) 24.5 kg/sq.mt; severe coronary artery disease 90.5%, 95.2% with complete revascularization. No patient presented surgical site infection. Median follow-up of 5.1 years during which 5.4% suffered an acute myocardial infarction, 13.5% required percutaneous coronary intervention, 16.2% died, 33.3% of which were attributed to a cardiac cause. Discussion: The participants had a normal average BMI, 19% were diabetic; they had adequate metabolic control, presenting mean glycosylated hemoglobin of 7.09%. In the studied population there were no cases of surgical site infection and 16.2% of the cohort presented angina, which is lower than that described in other studies. Incidence of acute myocardial infarction and percutaneous coronary intervention was similar to the ones reported in other studies. Conclusion: In the studied population, patients with BMI in the normal range and glycemia with adequate metabolic control, myocardial revascularization with BIMA was a safe technique with acceptable medium-term cardiovascular outcomes.

Brátt hjartadrep meðal yngri einstaklinga: rannsókn á nýgengi, áhættuþáttum og horfum

INTRODUCTION: The incidence of acute myocardial infarction (AMI) might not be decreasing as much among young adults as in the general population in recent years. The goal of our study was to explore incidence, risk factors and prognosis of AMI among young patients in Iceland. MATERIAL AND METHODS: This was a retrospective case control study. The data was obtained from the SCAAR-SWEDEHEART database, medical records from Landspitali University Hospital and the death register from the Directorate of Health. The epidemiology of women ≤55 years and men ≤50 years diagnosed with AMI (STEMI/NSTEMI) in Iceland in 2014-2020 was compared with older patients. RESULTS: Of all the cases (2852), 344 patients (12%) were young. No change was demonstrated in the incidence of AMI in the young patients during the study period. The proportion of STEMI was higher among young patients (52% vs. 35%, p&lt;0.001). Smoking (50% vs. 26%, p&lt;0.001) and obesity (BMI&gt;30 kg/m2)(47% vs. 36%, p&lt;0.01) were more prevalent in younger patiens compared to the older. Older patients were more likely to die in the year following the AMI, both from all-cause (7% vs. 3%, p&lt;0.05) and cardiovascular mortality (7% vs. 3%, p&lt;0.05). A difference in recurrent AMI between the young and older patients was not demonstrated (2% vs. 3%, p=0.3). CONCLUSION: During the research period, a change in the incidence of AMI among young patients, was not demonstrated. Younger patients with AMI have different risk factors than older patients, they have lower mortality rate but the same risk of recurrent AMI.

Ventricular fibrillation complicating acute myocardial infarction in women

Abstract Background Very little data is available in women presenting with ventricular fibrillation in the setting of acute myocardial infarction. Purpose To investigate sex-discrepancies in the incidence, characteristics and outcomes of acute myocardial infarction complicated by ventricular fibrillation. Methods Data were analyzed from the FAST-MI registry, which prospectively included 14,406 patients with acute myocardial infarction (mean age 66±14 years, 72% male, mean left ventricular ejection fraction 52±12%, 59% with ST elevation myocardial infarction). All consecutive patients admitted to French cardiac intensive care units ≤48 hours from acute myocardial infarction onset during a 1-month period every five years during 1995 and 2015 were included. This analysis focused on ventricular fibrillation occurring during the initial in-hospital stay for acute myocardial infarction in women compared to men. Results A total of 359 patients developed ventricular fibrillation during acute myocardial infarction, including 81 women (2.0% of 4,091 women overall) and 278 men (2.7% of 10,315) (p=0.02). ST-elevation myocardial infarction (OR 2.29, 95% CI 1.75–2.99, p&amp;lt;0.001) was independently associated with occurrence of ventricular fibrillation, while female gender (OR 0.73, 95% CI 0.56–0.95, p=0.02), hypertension (OR 0.75, 95% CI 0.60–0.94, p=0.01) and prior MI (OR 0.69, 95% CI 0.50–0.96, p=0.03) were protective factors. Women were less likely to have percutaneous coronary intervention during hospitalization than men (48.1% vs. 69.1%, OR 0.48, 95% CI 0.29–0.80, p&amp;lt;0.001). One-year mortality was higher in women compared to men (23.1% vs. 7.0%, HR 5.5, 95% CI 1.7–17.2, p=0.001). However, after adjustment for age, type of myocardial infarction and percutaneous coronary intervention, female gender was no longer associated with a worse one-year mortality (adjusted HR 1.04, 95% CI 0.71–1.51, p=0.85). Conclusion and relevance Women have lower risk of developing ventricular fibrillation during acute myocardial infarction compared to men. However, they are less likely to receive early coronary interventions than men, possibly contributing to worse outcomes. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): French Society of Cardiology

Associations of comorbidity patterns and in-hospital outcomes in Chinese young females (&amp;lt;55 years) presenting with ST-segment elevation myocardial infarction: a nationwide registry study

Abstract Background Recent evidence demonstrated an increasing trend for acute myocardial infarction (MI) incidence in young females globally. Identification of distinct clinical comorbidity patterns in this population may allow more precise therapy and improvement in clinical care. Purpose This study was designed to identify specific comorbidity patterns and to examine their associations with in-hospital outcomes in female ST-Segment Elevation Myocardial Infarction (STEMI) patients under 55 years of age based on the China Chest Pain Center (CCPC) Database. Methods From March 7, 2017, to December 29, a total of 267,405 STEMI patients (66,568 females, 24.9%) were admitted to CCPC. Comorbidity patterns were derived among 6,024 female patients (48.5±5.6 years old) under 55 years of age, using hierarchical clustering applied to 15 medical conditions/histories. The study outcome was defined as the composite of in-hospital adverse events (death, new-onset/worsening heart failure, mechanical complications, recurrent MI, and cerebral ischemic stroke). Associations between multimorbidity patterns and clinical outcomes were evaluated by multivariable-adjusted logistic regression models. Results Three comorbidity patterns were derived based on hierarchical clustering, including P1 (histories of hypertension, cerebrovascular disease, heart failure and coronary artery disease), P2 (histories peripheral arterial disease, atrial fibrillation, thyroid dysfunction, anemia, chronic kidney disease, cerebrovascular disease and peptic ulcer) and P3 (obesity, histories of hyperlipidemia, diabetes and smoking, family history of cardiovascular diseases). After adjustment for age, admission levels of systolic blood pressure and heart rate, receiving reperfusion treatment or not, and medical therapies in-hospital (antiplatelet drugs, statins, β-blockers and anticoagulants), compared with participants without multimorbidity, P1 (odds ratios [OR] = 1.60, 95% confidence interval [CI]: 1.26 to 2.04) and P3 (OR = 1.45, 95% CI: 1.10 to1.92) demonstrated relatively higher risks for in-hospital composite outcomes. Compared with patients without comorbidity patterns, the clustering of the above comorbidity patterns dose-dependently augmented the risks for in-hospital composite outcomes, from any one pattern (OR = 1.49, 95% CI: 1.23 to1.81), to any two patterns (OR = 2.46, 95% CI: 1.82 to 3.34) and to three patterns (OR = 4.51, 95% CI: 1.12 to 18.16). Conclusion In a nationwide STEMI registry, our results provided the proof-of-concept evidence that specific comorbidity patterns of young female STEMI were associated with differential in-hospital outcomes. Further work is needed to validate the utility and values in decision making of these multimorbidity patterns for appropriate management strategies in young female STEMI patients. Funding Acknowledgement Type of funding sources: None.

Acute myocardial infarction in young adults: incidence, risk factors and prognosis

The incidence of acute myocardial infarction (AMI) might not be decreasing as much among young adults as in the general population in recent years. The goal of our study was to explore incidence, risk factors and prognosis of AMI among young patients in Iceland. This was a retrospective case control study. The data was obtained from the SCAAR-SWEDEHEART database, medical records from Landspitali University Hospital and the death register from the Directorate of Health. The epidemiology of women ≤55 years and men ≤50 years diagnosed with AMI (STEMI/NSTEMI) in Iceland in 2014-2020 was compared with older patients. Of all the cases (2852), 344 patients (12%) were young. No change was demonstrated in the incidence of AMI in the young patients during the study period. The proportion of STEMI was higher among young patients (52% vs. 35%, p<0.001). Smoking (50% vs. 26%, p<0.001) and obesity (BMI>30 kg/m2)(47% vs. 36%, p<0.01) were more prevalent in younger patiens compared to the older. Older patients were more likely to die in the year following the AMI, both from all-cause (7% vs. 3%, p<0.05) and cardiovascular mortality (7% vs. 3%, p<0.05). A difference in recurrent AMI between the young and older patients was not demonstrated (2% vs. 3%, p=0.3). During the research period, a change in the incidence of AMI among young patients, was not demonstrated. Younger patients with AMI have different risk factors than older patients, they have lower mortality rate but the same risk of recurrent AMI.

Incidence of Acute Myocardial Infarction in Patients Presenting With Cerebrovascular Accident in a Tertiary Care Centre in Eastern India.

Acute myocardial infarction in individuals who have had a cerebrovascular accident or transient ischemic attack (CVA-TIA) is a medical emergency, which must be examined and treated as soon as possible. Physicians face a significant problem in managing this scenario because early treatment of one ailment would surely postpone treatment of the other. Early detection and treatment will have an impact on the patient's morbidity and mortality in the future, as well as aid in the patient's rehabilitation. On the basis of ECG alterations and cardiac biomarkers, a prospective observational study was conducted in 103 diagnosed CVA patients to investigate the incidence of myocardial infarction. Infarct and hemorrhagic CVA cases were evenly distributed. According to the age-based distribution, the highest rate of myocardial infarction (8%, 8) was observed in those aged 51-60 years. The male-to-female ratio is 1.86:1. Thirty-two patients had diabetes, among them 75% had only elevated creatine kinase MB (CKMB) with no myocardial infarction (MI), whereas 59 patients had hypertension of which 70% had only elevated CK-MB with no MI. ST-elevation myocardial infarction (STEMI) with high CKMB accounted for 14.78% (15) of the cases, but the majority (71%, 73) of the cases had elevated CKMB with no MI, and the rest presented with normal CKMB. Elevated CKMB with or without STEMI serves as a poor prognosticating factor. Therefore, these patients should be managed on a priority basis for a better outcome.

Acute Cardiovascular Toxicity of Cocaine.

Cocaine is one of the most commonly abused drugs and represents a major public health concern. Cocaine users frequently present to the emergency department, with chest pain being the most common presenting complaint. The incidence of acute myocardial infarction in patients with cocaine-associated chest pain is often quoted as 6%, but it is highly variable depending on the included population. Risk assessment can be challenging in these patients; serial assessment of electrocardiograms and troponins is often required. This review focuses on the assessment and management of patients presenting with cocaine-associated chest pain and cardiotoxicity. Specific treatments are discussed, including benzodiazepines, nitroglycerin, calcium channel blockers, and phentolamine, and how treatment priorities differ from patients with noncocaine presentations. The use of beta-blockers in this population remains controversial, and the literature around its use is reviewed. The most recent literature and recommendations for the use of percutaneous coronary intervention and fibrinolytics in cocaine-associated myocardial infarction is discussed as well. Cocaine-associated dysrhythmias are suggested to be the cause of sudden cardiac death in some users. The pathophysiology and evidence-based treatments for dysrhythmias are reviewed. This review provides evidence-based recommendations for the assessment and management of patients presenting with cocaine-associated cardiovascular toxicity.

Troponin T and Cardiac Enzyme Levels since Onset of Chest Pain in Patients Suspected of Acute Myocardial Infarction (AMI) in Punjab, Pakistan

Objective: To early diagnose the patients of AMI by using cardiac markers like CK, CK-MB, to find out the significance of these enzymes in comparison with high sensitive Troponin T hs and to find out the presence of a micro-infarction by using newly developed cTnT hs method. Patients and Methods: This was a cross sectional study, conducted at Punjab Institute of Cardiology and included 545 patients. Blood sample of every patient “Suspected of AMI” was sent to the laboratory for estimation of CK, CK-MB by conventional kit method and a high sensitive Troponin T reagent kit was used for prompt diagnosis of AMI. Patients of varying age were included and demographic details like hypertension, diabetes and smoking, family history of IHD, were collected to find out association with AMI. Results: Out of 545 study participants 62.65% (n=341) were male and 37.43% (n=204) were females, the mean age was 54.8 ± 13.42 years, the most frequent risk factor seen was hypertension (HTN in 72.0 % (n=90), followed by Smoking 45.5% (n=90), Diabetes mellitus (DM) 43.3% (n=90), and frequency of family history was seen 18.8% (n=90) in patients positive for acute myocardial infarction (AMI). 78.8% (n=90) males and 21.2%(n=90) females, indicated more prevalence of AMI in male population with frequency of AMI in patients from 41-60 years of age. There was significant association between hypertension, smoking and diabetes with AMI. Family history was not significantly associated with the incidence of AMI. CPK, CK-MB were performed on patient’s serum sample according to the procedures determined by reagent kits of Roche Diagnostic company on Chemistry Analyzer Hitachi 912. Optimized UV test method was used according to DGKC (German Society of Clinical Chemistry and Laboratory Medicine) and IFCC. Special Chemistry analyzer Cobas e 411, automated instrument was used for the quantitative measurement of Troponin T by using Chemiluminescence method (Troponin T hs reagent kits of Roche Diagnostic Company). Conclusion: It was concluded that a direct relationship exists between Troponin T and CPK, and CK-MB was more specific with even more closer and linear relationship with Troponin T hs. It was further observed that high sensitive Troponin T reagent method alone was sufficient to make a final diagnosis of AMI. Troponin T hs alone not only reduces the investigation time but reduces the overall cost as well. Keywords: Acute Myocardial Infarction.