Infarction Angina Research Articles

Abstract 195: The Effect Of Phosphodiesterase-5 Inhibitors On Major Adverse Cardiovascular Events And Mortality In A Large Cohort Of Men With Erectile Dysfunction From A Nationwide Insurance Database: A Retrospective Study

Background: Phosphodiesterase type 5 inhibitor (PDE-5i) medications are effective in treating Erectile Dysfunction (ED) for tens of millions of men in the US and worldwide. The objective of this study was to determine the effect of PDE-5is on the incidence of major adverse cardiovascular events (MACE) (composite outcome of cardiovascular (CV) death, hospitalization for myocardial infarction, coronary revascularization, stroke, heart failure, or unstable angina pectoris) and all-cause death. Methods: A retrospective observational cohort study was conducted in a large US commercial and Medicare insurance claims database in men with ≥1 diagnosis of ED without prior MACE hospitalization within 1 year from Jan 2006 to Oct 2020. The exposed group had ≥1 claim for PDE-5i; the unexposed group had no claims for PDE-5i and were matched 2:1 on baseline risk variables. The primary outcome was MACE and secondary outcome was all-cause death, determined by multivariate Cox proportional hazard modeling. Death data were obtained via National Death Index linkage. Results: In this population, MACE was reduced by 13% in men exposed (n=23,816) to PDE-5is (hazard ratio (HR) 0.87; 95% Confidence Interval (CI) 0.79-0.95) vs. non-exposure (n=48,682) over mean follow up of 29 and 37 months, respectively. This was driven by reductions in coronary revascularization (HR 0.85; 0.73-0.98), heart failure (HR 0.83; 0.72-0.97), unstable angina (HR 0.78; 0.64-0.96), and CV death (HR 0.61; 0.41-0.90). PDE-5i-exposed men had a 25% reduction in all-cause death (HR 0.75; 0.65-0.87). Men without coronary artery disease but with CV risk factors at baseline showed a similar pattern. In the main study cohort, men in the highest quartile of PDE-5i exposure had the greatest reductions in MACE (HR 0.45; 0.37-0.54) and all-cause death (HR 0.51; 0.37-0.71) vs. the lowest exposure quartile. In a subgroup with baseline type 2 diabetes (n=6,305), PDE-5i exposure was associated with a lower MACE risk (HR 0.79; 0.64-0.97). All comparisons are significant at p<0.05. Conclusions: In a large population of US men with ED, PDE-5i exposure was associated with reductions in MACE, CV death, and overall death risk compared to non-exposure. Risk reduction was positively correlated with PDE-5i exposure level.

Abstract 198: Cardiovascular Outcomes, Behavioral Risk Factors, And Health Insurance In Transgender Population In The United States Of America: Analysis From The 2020 Behavioral Risk Factor Surveillance Survey

Background: There is paucity of clinical data regarding the health and cardiovascular (CV) outcomes of transgender (TG) population. Our aim was to determine the association of CV outcomes (and behavioral risk factors) with being TG in the USA. Methods: We utilized Centers for Disease Control's Behavioral Risk Factor Surveillance Survey (BRFSS) 2020 to determine responders who identified as TG. Non-TG (Cis gender) were also identified and used as controls. Behavioral risk factors such as history of smoking, lack of exercise, and heavy alcohol consumption (adult men having >14 drinks/week and adult women having >7 drinks/week) were measured. CV outcomes such as stroke, myocardial infarction (MI) and stable angina (SA) were noted. Lack of health insurance and college education were also analyzed. Data was studied in STATA 15 and multivariate logistic regression was used to estimate adjusted odds ratios (AOR) reported with p-value (significance=<0.05). Results: There were 401,958 individuals in this survey. 1017 (0.25%) and 235887 (58.7%) were TG and cis genders respectively. There was a significant association of being TG and reporting stroke (AOR 1.87, [1.71-1.92], p=0.002) and MI (AOR 1.45, [1.39-1.55], p=0.003) compared to Cis genders. Association of TG population with reporting SA was statistically insignificant (p=0.66). TG group was also more likely to not have exercised in the past 30 days (AOR 2.71, [2.51-2.89], p=0.009). Heavy alcohol consumption in past 30 days was significantly higher in TG group (AOR 1.36, [1.21-1.44], P=0.002) compared to Cis genders. There was no significant association of smoking noted (p=0.5). TG population had higher odds of reporting depression (AOR 1.53, [1.50-1.61], p<0.001) compared to Cis genders. They were also more likely to not have health insurance (AOR 0.44, [0.36-0.71], p<0.002), and lack college education (AOR 0.53, [0.50-0.81], p<0.003). Conclusion: Transgender population reports higher rates of cardiovascular diseases (stroke and MI), depressive disorder and heavy alcohol consumption. They are also more likely to not exercise, lack basic health insurance and college education contributing to worse clinical outcomes.

DIAGNOSTIC SIGNIFICANCE OF OXIDATIVE STRESS IN PATIENTS WITH CORONARY HEART DISEASE

Abstract. Cardiovascular diseases remain the leading cause of death in recent decades worldwide, especially in developed countries. Cardiovascular pathology can begin with risk factors that can cause local vascular damage and end with systemic complications leading to organ failure and death, which makes it necessary to understand the biochemistry of events associated with the entire process of progression of cardiovascular diseases and is crucial for diagnosis, prevention and treatment. It is known that the state of blood vessels is influenced by multiple factors of hemodynamic conditions, extracellular signaling proteins, including interleukins, cytokines, and intracellular biochemical molecules, including reactive oxygen and nitrogen species. The aim of the work was to evaluate the factors of oxidative stress and antioxidant protection in patients with coronary heart disease. The study included 96 patients of working age with a verified diagnosis of coronary artery disease. Statistical analysis was carried out using the StatTech v. 2.6.5. To assess the diagnostic significance of quantitative signs in predicting a certain outcome, the method of analyzing ROC curves was used. The article presents data on the quantitative content of nitric oxide, myeloperoxidase, superoxide dismutase in the blood serum of patients with coronary heart disease (acute myocardial infarction and unstable angina pectoris), describes the relationship between changes in their level, and assesses the diagnostic significance of the studied parameters. The obtained data on the production of nitric oxide, myeloperoxidase and superoxide dismutase in patients with acute myocardial infarction and unstable angina indicate an important prognostic value of assessing oxidative stress and the antioxidant system for early risk stratification of adverse outcomes in patients with coronary heart disease.

PERSONALIZED RISK ASSESSMENT OF RAPIDLY PROGRESSIVE ATHEROSCLEROSIS

Abstract. Вackground. Progressive atherosclerosis is accompanied by unfavorable clinical outcomes, study and understanding of this process, creation of risk assessment method is necessary for individualization of approaches to treatment and prevention of this condition. Purpose of the study. Creation of risk assessment method of atherosclerosis progression for personalized approach to treatment, rehabilitation and secondary prevention. Patient Characteristics and Study Methods. A retrospective cohort study included 202 patients with coronary heart disease: 147 men and 55 women. The mean age of the patients was 53.3±7.16 years. Group 1 included patients who had had myocardial infarction or unstable angina, emergency arterial stenting, stroke, peripheral artery thrombosis, critical ischemia, and lower extremity amputation within 2 years before study inclusion. Patients in the comparison group did not have these events. The influence of each of the studied parameters on the probability of fast progressing atherosclerosis was determined by factor and correlation analysis. Results. As a result of the study, an innovative method for predicting the risk of developing rapidly progressing atherosclerosis in a patient was developed, including determining the patient's age, the presence or absence of carotid stenosis by 50% or more of the vessel lumen on at least one side, body mass index obesity, history of stable angina pectoris, high-sensitivity C-reactive protein (hsSRP) and high-density lipoprotein cholesterol (HDL-cholesterol) serum concentrations. The sensitivity, specificity and accuracy of the proposed method are above 80%. An application for the registration of the invention was filed to the Russian Federal Service for Intellectual Property, Patents and Trademarks (Rospatent). Conclusion. The proposed model was developed on the basis of studying the indexes in Russian patients. It shows the weight of one or another factor that influences the probability of rapidly progressing atherosclerosis. The model is easy to use and allows to individualize prophylaxis in this category of patients.

Cost-effectiveness analysis of dapagliflozin for the treatment of type 2 diabetes mellitus in Spain: results of the DECLARE-TIMI 58 study

BackgroundThe objective of this study was to carry out a cost-effectiveness analysis of dapagliflozin, as an add-on therapy to standard of care (SoC), for the treatment of type 2 diabetes mellitus (T2DM) in Spain, based on the results of the DECLARE-TIMI 58 trial.MethodsA discrete event simulation model (Cardiff T2DM) based on the data observed in the DECLARE-TIMI 58 trial was adapted to the Spanish setting to estimate the costs and health outcomes of treatment with dapagliflozin in patients with T2DM who had or were at risk of atherosclerotic cardiovascular disease. Macrovascular events (hospitalization for heart failure, myocardial infarction, stroke, and unstable angina), end-stage renal disease and cardiovascular and non-cardiovascular mortality were modeled according to the survival equations of the DECLARE-TIMI 58 study. Microvascular events (blindness and ulcers) were estimated based on the risk equations of the UK Prospective Diabetes Study. The analysis was conducted from the Spanish National Health System perspective and the time horizon was 30 years. The results were evaluated in terms of cost per quality-adjusted life year (QALY) gained. Only direct health costs were included, and a 3% discount rate was applied to costs and health outcomes. Univariate and probabilistic sensitivity analyses (PSA) were made to assess the robustness of the results.ResultsIn the main analysis, dapagliflozin was a dominant therapeutic option compared with placebo, with greater effectiveness (0.08 QALYs) and lower associated total costs per patient (€ -2,921). The univariate sensitivity analysis and the PSA confirmed the robustness of the results. The PSA showed the probability that dapagliflozin was a dominant alternative compared with placebo was 84.2% and that it was cost-effective of 92.1%, under a willingness-to-pay of € 20,000/QALY gained. ConclusionsThe analysis of data from the DECLARE-TIMI 58 trial shows that dapagliflozin would be a cost-effective option in Spain for the treatment of adult patients with T2DM, as an add-on therapy to SoC, compared with placebo.

Tolerance Of Dosed Physical Loads In The Rehabilitation Of Patients With A Recent Experience Of Myocardial Infarction Or Unstable Angina

The study of reaction to dosed physical load of patient with recent experience of myocardial infarction or unstable angina to assess objectively physical condition and performance, to appoint an adequate individual program of physical rehabilitation and to optimize the effectiveness of the sanatorium stage of rehabilitation of this category of patients. Design: Study and observational analysis. Parameter: The subsidiary«Sanatorium-resort rehabilitation center «Slaviansk resort», the sanatorium «Yubileiny», Ukraine. Participants: Patients with recent experience of myocardial infarction or unstable angina who arrived at the sanatorium stage of rehabilitation from cardiological hospitals of Donetsk and Lugansk regions (Ukraine). Intervention: Non-invasive treatment (i.e., therapeutic exercise). Results: 3530 patients who arrived at the sanatorium stage of rehabilitation from cardiological hospitals of Donetsk and Lugansk regions (Ukraine) on 29,4 ±2,4 day of illness were examined. Men accounted for 64%, women-36%. The average age of the patients was 54,4 ±1,8 years old. 1127 people (31,93%) had a Q-positive myocardial infarction (MI), 388 people (10,99%)-a Q-negative, 2015 people (57,08 %)-an unstable angina. When studying the tolerance to dosed physical activity, threshold or inadequate reactions were observed in 144 patients (12.78%) who had Q-positive myocardial infarction, 13 patients (3.35%) who had Q-negative myocardial infarction and 89 patients (4.42%) who had unstable angina. Threshold or inadequate responses in patients with recent experience of Q-positive myocardial infarction were recorded 3-4 times more often. The electrocardiographic examination revealed most often changes in the terminal part of the ventricular complex in the form of inversion or reversal of T waves, to a greater extent in patients who had Q-positive myocardial infarction. Conclusion: It was found during study that patients with recent experience of Q-positive myocardial infarction master less physical activity at the sanatorium stage of rehabilitation than patients of other groups. Our study has shown that an insufficient level of physical activity does not give an optimal effect in increasing the functional reserves of the cardiovascular system and the body, and insufficient control of an increase in the level of physical activity is fraught with negative consequences. Careful selection of optimal physical activity for this category of patients allowed to prescribe adequate physical activity to patients and avoid possible complications.

ROLE OF GSK-3 IN THE PATHOGENESIS OF CORONARY HEART DISEASE

Cardiovascular disease is the leading cause of morbidity and mortality worldwide. A strategy for early diagnosis of cardiovascular disease can help reduce the number of complications and deaths in patients. Research by the world's leading scientists is aimed at studying the pathogenetic links underlying the development of heart disease. The study of the molecular signaling pathways responsible for the induction of cardiac hypertrophy is of great clinical interest, and the potential therapeutic use of these molecules could prevent or slow down pathological myocardial remodeling and heart failure leading to cardiomyocyte death or dysfunction. The article discusses the influence of the components of the immune system on the pathogenesis of cardiovascular diseases. The role of GSK-3 kinase, which plays an important role in the regulation of proliferation, differentiation, apoptosis, and metabolic processes in the cell, as well as participates in the regulation of various signaling pathways, including Wnt / β-catenin and TGF-β-signaling, has been evaluated. Serum levels of GSK-3α and GSK-3β, as well as pro- and anti-inflammatory cytokines (IL-1β, IL-10 and TNF-α) were assessed in patients with coronary artery disease (myocardial infarction and unstable angina pectoris) and relatively healthy persons. The relationship of these indicators with clinical and laboratory data has been analyzed. The results obtained indicate the important role of immune processes in the pathogenesis of coronary heart disease. The performed combinatorial analysis of glycogen synthase kinase 3, serum cytokines with laboratory data (leukocyte and LDL levels) can help assess the severity of coronary heart disease and can help in determining risk stratification in patients with angina pectoris.

Predictor significance of β<sub>2</sub>-microglobulinuria in determining the risk of cardiovascular complications in patients with chronic ischemic heart disease

BACKGROUND. The relevance of identifying new biomarkers of the cardio-renal syndrome in patients with coronary heart disease is beyond doubt. It is promising to study the indicators of tubular dysfunctions as predictors of the risk of cardiovascular complications in patients without primary kidney pathology.THE AIM. Analysis of the effect of β2-microglobulinuria on the prognosis of cardiovascular complications in patients with chronic ischemic heart disease in the long-term period after myocardial revascularization.PATIENTS AND METHODS. The study included 90 patients with coronary artery disease and indications for myocardial revascularization. Coronary bypass surgery was performed in 64 people, coronary artery stenting - in 26. Clinical and anamnestic data were collected in all patients, standard laboratory and instrumental diagnostics were performed. In addition, the level of β2-microglobulin (β2-MG) in the first morning portion of urine was determined at different study dates. The endpoint was considered to be the presence of acute forms of coronary heart disease - myocardial infarction and unstable angina. Survival after 5.8 ±0.1 years after myocardial revascularization was 69 %.RESULTS. A positive linear relationship of weak strength was established between the level of diastolic blood pressure (DBP) and β2-MG of urine obtained before myocardial revascularization (r = 0.28, p = 0.03). Moreover, the Kaplan-Meyer survival analysis showed the effect of an increase in β2-MG of urine over 0.2 ng/ml on the risk of AMI in the long-term period after myocardial revascularization (p = 0.025). It was found that an increase in the concentration of β2-MG in urine determined before myocardial revascularization is a statistically significant risk factor for the development of unstable angina in the long-term period after RM (χ2-criterion = 7.17, p = 0.007).CONCLUSION. It has been shown that an increase in the concentration of β2-MG in urine, reflecting the presence of tubular dysfunctions, can be considered as a predictor of an unfavorable cardiovascular prognosis in patients in the long-term period after myocardial revascularization.

Abstract 13360: Racial Differences in Hospitalization Rates of Patients Who Receive a Diagnosis of Acute Coronary Syndrome in the Emergency Department

Introduction: Although there is literature on missed diagnoses of acute coronary syndrome (ACS) in the Emergency Department (ED), and on avoidable admissions to hospitals, no previous studies have examined racial disparities in hospitalization rates among patients who received a discharge code of ACS in the ED. Hypothesis: We hypothesized that Non-White patients are more likely to be discharged home with a diagnosis of ACS than White individuals, and that health insurance, as a mediator, drives racial disparities in these hospitalization rates. Methods: We examined 51,022,910 discharge records of ED visits in Florida, New York, and Utah in years 2008, 2011, 2014, 2016/7, using state-specific data from the Healthcare Cost and Utilization Project. We identified ED admissions for acute myocardial infarction (AMI) or unstable angina using the International Classification of Disease ninth or tenth revision diagnosis codes, excluding those with chronic coronary heart disease to examine incident events only. We used generalized estimating equation models to compare risks of being sent home across race/ethnic groups including White, Black, Hispanic, and Asian/Pacific Islander patients. We used inverse probability weighting to estimate the mediating role of health insurance status on the associations. Results: Among 235,936 patients who visited the ED and received a discharge code of ACS in the study period, the proportion discharged home was 12 % among Black patients, 6 % among White patients, 9 % among Hispanic patients, and 9 % among Asian or Pacific islander patients. In age and sex-adjusted models the incidence risk ratio (IRR) for being discharged home was 1.3 (95% CI, 1.2 - 1.3) in Black patients 1.2 (95 % CI, 1.1 - 1.3) in Hispanic patients and 1.1 (95% CI, 0.9 -1.3) in Asian or Pacific Islander patients compared with White patients. Health insurance status did not play any role as a mediator. In patients below 55 years of age, differences were magnified for all racial groups compared to White patients. Conclusions: Racial disparities exist in hospitalization of AMI at the ED, which are especially marked among younger patients. Health insurance does not explain these racial differences; other possible causes need to be investigated.

Abstract 10843: P2Y12 Inhibitor Adherence Patterns in Patients with Acute Coronary Syndrome

Introduction: Dual antiplatelet therapy with P2Y12 inhibitors (P2Y12i) and ASA reduce cardiac events after acute coronary syndrome (ACS). Use has shifted from clopidogrel to ticagrelor, a more potent P2Y12i with higher bleeding risk, dosed twice rather than once daily. As these factors may impact adherence, a better understanding of adherence patterns by agent is needed. Methods: We conducted a population-based cohort study using administrative claims data in Ontario, Canada between 4/2014-3/2018. We identified individuals ≥65 years of age who were admitted for myocardial infarction or unstable angina and had filled a P2Y12i prescription within 7 days of discharge. We excluded patients who died within 1 year after discharge. We calculated “good” adherence [proportion of days covered (PDC) 1 year post-ACS ≥80%, and also used group-based trajectory models to characterize longitudinal patterns of good adherence by time over 1 year. Results: We included 21,680 ACS patients with 45.0% (n=9,763) prescribed ticagrelor and 55.0% (n=11,917) prescribed clopidogrel [mean age±SD: 73.6±6.8/77.3±8.3 years, 65.4%/56.2% male, PCI during index admission 87.4%/48.5%, respectively]. Overall, the good adherence rate was 73.0% for ticagrelor and 78.9% for clopidogrel. We identified 3 adherence patterns in the year post-ACS: 67.8% of ticagrelor and 75.0% of clopidogrel patients were in the adherent group (PDC≥80%), while 17.1 %/13.4% were in the gradually non-adherent, and 15.1%/11.6% were in the rapidly non-adherent groups, respectively. (Figure) Conclusions: Adherence rates and trajectories appeared more favorable for clopidogrel in the first year post-ACS. However, patient characteristics differed between the clopidogrel and ticagrelor populations and these may be associated with the observed adherence patterns. Identification of nonadherence risk factors and barriers specific to each trajectory group is needed to improve adherence and clinical outcomes.

Eight-year post-trial follow-up of morbidity and mortality of telephone health coaching

BackgroundHealth coaching is a patient-centred approach to supporting self-management for the chronic conditions. However, long-term evidence of effectiveness of health coaching remains scarce. The object of this study was to evaluate the long-term effect of telephone health coaching (THC) on mortality and morbidity among people with type 2 diabetes (T2D), coronary artery disease (CAD) and congestive heart failure (CHF)..Methods1535 T2D, CAD and CHF patients with unmet treatment targets were randomly allocated into an intervention group (n = 1034) and control group (n = 501). Intervention group received monthly individual strength-based, autonomy supportive THC sessions (average 30 min) for behavior change with a specially trained nurse for 12 months additional to usual health care. Control group received usual health care services. The primary outcome was a composite of death from cardiovascular causes or non-fatal stroke or non-fatal myocardial infarction (AMI) or unstable angina pectoris (UAP) during a follow-up of 8 years Three other composite endpoints with distinct combinations of fatal and non-fatal cardiovascular events and death from any cause were used as secondary outcomes. Other outcomes followed were the most relevant components of the composite endpoints. Randomized controlled trial (RCT) data was linked to Finnish national health and social care registries and electronic health records (EHR). Post-trial eight-year evaluation was conducted using intention-to-treat (ITT) and per-protocol (PP) analysis.ResultsThe composite primary outcome event rate per 100 person years was lower in the intervention group (3.45) than in control group (3.88) in ITT -analysis, but the difference was not statistically significant (hazard ratio in the intervention group 0.87; 95% CI, 0.71 to 1.07; P = 0.19). In the subgroup (T2D, CAD/CHF) analysis, there were no statistically significant effects. The secondary PP-analysis showed statistically significant benefits for those who participated in the study.ConclusionsNo statistically significant effect of health coaching on mortality and morbidity was found in intention to treat analysis. The per protocol results suggest, however, that the intervention may be effective among patients who are willing and able to participate in health coaching. More research is needed to identify patients most likely to benefit from low-intensity health coaching.Trial registrationNCT00552903 (registration date: the 1st of November 2007, updated the 3rd of February 2009).

Sirtuin-1 in Egyptian patients with coronary artery disease

BackgroundCoronary artery disease (CAD) represents the leading cause of death worldwide. Animal and human studies have demonstrated that silent information regulator 1 (SIRT1) is involved in a wide range of physiological and pathological processes. This study aimed to measure the plasma level of SIRT1 in patients with CAD and explore its correlation with cardiovascular risk factors.ResultsPlasma SIRT1 was significantly lower in patients with chronic coronary syndrome (CCS) than in those in the control group and was significantly lower in patients with both acute myocardial infarction and unstable angina than in those in the control group and with CCS. Moreover, plasma SIRT1 was positively correlated with platelet count and negatively correlated with cholesterol and triglyceride levels.ConclusionsThe plasma level of SIRT1 is lower in patients with CAD compared to control and it could be a possible marker for this disease. Multi-center studies with follow-up measurements are recommended for further investigation.

Gender differences in characteristics, treatment and outcomes in ST elevation myocardial infarction patients in four European countries

Abstract Introduction Women receive less evidence-based care than men and have higher mortality after myocardial infarctions than men. But it is not known how the gender difference in risk factors, treatments and outcomes differs between European countries. Purpose In order to investigate the gender differences in European countries with different economic predispositions we aimed to describe and compare baseline characteristics, in-hospital management, medications at discharge and death outcomes of man and woman ST-elevation infarction (STEMI) patients following routine clinical practice in Sweden, Norway, Hungary and Estonia. Methods The study population is patients over the age of 18 with STEMI who were treated in hospital 2014–2017 (for Norway between 2013–2016) and registered in one of the national myocardial infarction registers. Patients with non-ST elevation infarction and unstable angina were excluded. Risk factors, hospital treatment, and prescription medications were obtained from the national myocardial infarction registries from each country. Mortality in-hospital, after 30 days and after 1 year, was obtained from national death registers. Results Women were on average older, had more comorbidities and higher mortality in hospital, after 30 days and one year after hospitalization. Women received coronary angiography, percutaneous coronary intervention, left ventricular ejection fraction assessment and evidence-based drugs to a lesser extent than men. Conclusions The study illustrates that there are differences in characteristics, management, treatments and outcomes between men and women in all of the studied countries no matter economic predispositions. Generally, women are treated with guideline recommended therapy to a lesser extent than men in the studied countries. Funding Acknowledgement Type of funding sources: None.

Retrospective evaluation of hematological parameters for the differentiation between non-st elevation myocardial infarction and unstable angina

Retrospective evaluation of hematological parameters for the differentiation between non-st elevation myocardial infarction and unstable angina

СОСТОЯНИЕ ФУНКЦИИ ПОЧЕК ПРИ ИНФАРКТЕ МИОКАРДА С РЕЦИДИВИРУЮЩИМИ ЭПИЗОДАМИ ИШЕМИИ У МУЖЧИН МОЛОДОГО И СРЕДНЕГО ВОЗРАСТА

Relevance. Changes in renal function and their significance in reinfarction and early postinfarction angina have not been insufficiently established. Aim. To evaluate renal function changes in men under 60 years old with recurrent myocardial infarction and early postinfarction angina to improve prevention and outcomes. Material and methods. The study included men aged 19-60 years old with type I myocardial infarction. Patients are divided into two age-comparable groups: I - the study group, with recurrent myocardial infarction and/or early postinfarction angina - 110 patients; II - control, without it - 555 patients. A comparative assessment of renal function changes in first 48 hours (1) and the end of third week disease (2), also risk analysis of recurrent ischemia and poor outcome in selected groups were performed. Results. The study group was distinguished by high levels of creatinine1 (0.11±0.03 (mmol/l)), lower - glomerular filtration rate (74.2±20.6 (ml/min/1.73 m2)) from the control (0.10±0.02 (mmol/l) and 78.3±17.9 (ml/min/1.73 m2), respectively; p=0.04). In both groups, there was a deterioration in indicators (creatinine, I: 2.3%; II: 5.9%; glomerular filtration rate - I: -5.8 and -6.3%, respectively; p<0.0001) during the observation period. The risk of recurrent ischemia increases with creatinine1 levels≥0.11 mmol/l and a glomerular filtration rate1˂70 ml/min/1.73 m2. In the study group, the risk of poor outcome is high with normal renal function. In the control group, it increased at creatinine1 levels≥0.10 mmol/l, glomerular filtration rate1˂65 ml/min/1.73 m2. Conclusions. Patients with recurrent ischemia have higher creatinine levels than controls. In both groups, during the study, there was a slight increase in creatinine and a decrease in glomerular filtration rate. The above values of renal function indices should be used in the formation of groups at high risk of early recurrence of ischemia and poor outcomes, as well as for predictive modeling of these complications.

Reliability and validity of the Korean version of the MacNew heart disease Health-related Quality of Life questionnaire

BackgroundMyocardial infarction and unstable angina are prevalent in Korea. The MacNew Heart Disease health-related quality of life questionnaire is a widely used patient-reported outcome measure for patients with heart disease in several countries. In this study, we tested the validity and reliability of the Korean version of the MacNew (K-MacNew).MethodsParticipants were 200 patients who had experienced unstable angina or myocardial infarction, and were recruited from a tertiary hospital in Korea. The K-MacNew was developed using forward–backward translation techniques. Construct validity (including discriminative validity), concurrent validity, and internal consistency reliability of the K-MacNew were assessed. Discriminative validity was assessed by examining the between-group differences in the K-MacNew scores according to functional capacity, anxiety, and depression levels. Concurrent validity was examined by correlating the K-MacNew dimensions with the physical and mental health domains of the 36-item Short Form Health Survey Instrument (SF-36).ResultsFactor analysis results of the K-MacNew demonstrated a three-factor structure (emotional, physical, and social) that explained 57.92% of the variance. Significant differences in the K-MacNew scores were observed according to patients’ functional capacity, anxiety, and depression levels. The SF-36 physical health domain score showed a moderate positive correlation with the physical dimension score of the K-MacNew (r = 0.517, P < 0.001), and the SF-36 mental health domain score showed a strong positive correlation with the emotional dimension of K-MacNew (r = 0.745, P < 0.001). The K-MacNew showed good internal consistency, with a Cronbach’s α of 0.947 for the global scale.ConclusionThe K-MacNew demonstrated good reliability and validity for use as a patient-reported outcome measure and is ready for the assessment of the health-related quality of life of patients with coronary artery disease in Korea. To establish the clinical validity of the K-MacNew, additional studies should be conducted to verify the validity and reliability of the K-MacNew in a number of participants, including those with various types of coronary artery disease.

Coronary plaque instability assessed by positron emission tomography and optical coherence tomography

BackgroundNon-ST-elevation myocardial infarction (NSTEMI) and unstable angina (UA) are caused often by destabilization of non-flow limiting inflamed coronary artery plaques. 18F-fluorodeoxyglucose (FDG) uptake with positron emission tomography/computed tomography (PET/CT) reveals plaque inflammation, while intracoronary optical coherence tomography (OCT) reliably identifies morphological features of coronary instability, such as plaque rupture or erosion. We aimed to prospectively compare these two innovative biotechnologies in the characterization of coronary artery inflammation, which has never been attempted before.MethodsOCT and FDG PET/CT were performed in 18 patients with single vessel coronary artery disease, treated by percutaneous coronary intervention (PCI) with stent implantation, divided into 2 groups: NSTEMI/UA (n = 10) and stable angina (n = 8) patients.ResultsPlaque rupture/erosion recurred more frequently [100% vs 25%, p = 0.001] and FDG uptake was greater [TBR median 1.50 vs 0.87, p = 0.004] in NSTEMI/UA than stable angina patients. FDG uptake resulted greater in patients with than without plaque rupture/erosion [1.2 (0.86–1.96) vs 0.87 (0.66–1.07), p = 0.013]. Among NSTEMI/UA patients, no significant difference in FDG uptake was found between ruptured and eroded plaques. The highest FDG uptake values were found in ruptured plaques, belonging to patients with NSTEMI/UA. OCT and PET/CT agreed in 72% of patients [p = 0.018]: 100% of patients with plaque rupture/erosion and increased FDG uptake had NSTEMI/UA.ConclusionFor the first time, we demonstrated that the correspondence between increased FDG uptake with PET/CT and morphology of coronary plaque instability at OCT is high.

СОСТОЯНИЕ ЛИПИДНОГО ОБМЕНА У МУЖЧИН МОЛОДОГО И СРЕДНЕГО ВОЗРАСТА С ИНФАРКТОМ МИОКАРДА И РЕЦИДИВИРУЮЩИМИ ЭПИЗОДАМИ ИШЕМИИ

Relevance. Dyslipidemia is considered one of the main risk factors for the development of recurrent myocardial infarction and early postinfarction angina. Aim. To evaluate the features of lipid metabolism in acute and subacute myocardial infarction in men under 60 years old with recurrent episodes of ischemia (recurrent myocardial infarction and/or early postinfarction angina) to search for new approaches to improve prevention measures. Material and methods. The study included men aged 19-60 years old with type I myocardial infarction. Patients are divided into two age-comparable groups: I - the study group, with recurrent myocardial infarction - 68 patients; II - control, without it - 427 patients. A comparative assessment of lipid metabolism parameters and their dynamics in selected groups were performed. Results. The study group differed in higher levels of total serum cholesterol (6.17±1.78 mmol/l) from the control group (5.56±1.28 mmol/l; p=0.02) at the end of the third week of disease, its dynamics during the observation period (I: 9.1%; p&lt;0.0001; II: -1.8%; p&lt;0.0001) and the dynamics of the atherogenic coefficient (I: -4.7.1; p=0.02; II: 6.3%; p&lt;0.0001). In both groups, the group showed an increase in lipoproteins of low (I: 33.1; p=0.02; II: 45.5%; p&lt;0.0001) and very low density (I: 275.8; p=0,0004; II: 233.4%; p&lt;0.0001), atherogenic indices, decrease: triglycerides (I: -31.8%; p=0.02; II: -1.7%; p&lt;0.0001) and high-density lipoproteins (I: -0.6%; p=0.02; II: -6.1%; p&lt;0.0001). Conclusions. The group with recurrent ischemia is characterized by more pronounced hypercholesterolemia at the end of the subacute period of myocardial infarction in comparison with the control group due to an increase in the concentrations of atherogenic lipid metabolism fractions. The dynamics of indices and the coefficient of atherogenicity during this period is multidirectional, which requires additional study.

ОСОБЕННОСТИ ПЕРИФЕРИЧЕСКОЙ ГЕМОДИНАМИКИ У МУЖЧИН МОЛОДОГО И СРЕДНЕГО ВОЗРАСТА С РЕЦИДИВИРУЮЩИМ ТЕЧЕНИЕМ ИНФАРКТА МИОКАРДА

Relevance. Hemodynamics changes in recidivating myocardial infarction and early postinfarction angina are not well understood. In recent years, the frequency of these complications has been increasing. Aim. To evaluate peripheral hemodynamics changes in men under 60 years old with recurrent myocardial infarction and early postinfarction angina to improve prevention and outcomes. Material and methods. The study included men aged 19-60 years old with type I myocardial infarction. Patients are divided into two age-comparable groups: I - the study group, with recurrent myocardial infarction - 102 patients; II - control, without it - 541 patients. A comparative assessment of hemodynamics changes in first 48 hours (1) and the end of third week disease (2), also risk analysis of recurrent ischemia and poor outcome in selected groups were performed. Results. The study group was distinguished by a high level of total peripheral resistance1 (2055.5±965.2 (dyn×sec×cm-5)) from the control (2055.5± 965.2 (dyn×sec×cm-5); p=0.02). In both groups, a decrease in the values of all indicators was noted (p&lt;0.05). A more pronounced decrease in total peripheral resistance was found in the study group, and in the parameters of blood pressure and heart rate - in the control group. The values of total peripheral resistance1 ≥1600 dyne×sec×cm-5 were the markers of the risk of ischemia recurrence. Predictors of poor outcome are blood pressure levels1 (systolic &lt;97; diastolic &lt;70; mean &lt;93.3 (mm Hg)); total peripheral resistance1 &lt;1746.2 dyne×sec×cm-5 and heart rate (˃92 per min). Conclusions. Patients with recurrent ischemia are characterized by higher levels of total peripheral resistance in the first hours of myocardial infarction. For both groups, a decrease in all studied indicators is determined. The above values of hemodynamic parameters should be used in the formation of groups with a high risk of early recurrence of ischemia and an unfavorable outcome, as well as for prognostic modeling of these complications.

ELECTROLYTIC EXCHANGE FEATURES DURING MYOCARDIAL INFARCTION WITH RECURRENT EPISODES OF ISCHEMIA IN MEN UNDER 60 YEARS OLD

Relevance. Recurrent myocardial infarction and early postinfarction angina negatively effects on the prognosis of myocardial infarction. Aim. To evaluate myocardial infarction sodium, potassium, chlorides, calcium metabolism, features in men under 60 years old with recurrent myocardial infarction and early postinfarction angina to improve prevention and outcomes. Material and methods. The study included men aged 19-60 years old with type I myocardial infarction. Patients are divided into two age-comparable groups: I - the study group, with recurrent myocardial infarction - 110 patients; II - control, without it - 555 patients. A comparative analysis of blood serum electrolyte levels, their dynamics from the first hours to the end of the third week of myocardial infarction in the selected groups were performed. Their impact on the risk of recurrent ischemia and unfavorable outcome was assessed. Results. In the study group, in the first hours of the disease, the levels of chloride were higher (103.7±5.5 and 101.7±4.7 (mmol/l); p=0.002), and total calcium at the end of the third week of myocardial infarction (2.3±0.2 mmol/l) - lower than in the control (2.46±0.16; p=0.001). With an unfavorable outcome in the study group, the sodium level was lower in the first hours of the disease (138.7±4.9 and 142.7±6.6 (mmol/l); p=0.049). Moreover, the risk of its development was associated with sodium levels ≥148.0 mmol/l (absolute risk: 100.0%; relative - 13.8; p&lt;0.0001) and potassium levels ≥5.3 mmol/l (absolute: 71,4%; relative - 12.4; p&lt;0.0001). The risk of developing recurrent episodes of ischemia in the examined increased at chloride levels ≥104.7 mmol/l (absolute: 28.4%; relative: 3.1; p=0.0001) and sodium ≥139.0 mmol/l (absolute: 19.5%; relative: 1.7; p=0.03) in the first hours of myocardial infarction and calcium (&lt;2.4 mmol/l) at the end of the third week of the disease (absolute: 31.0%; relative: 4.9; p=0.003). Conclusions. The listed combinations of levels of basic electrolytes in blood serum are markers of recurrence of ischemia in myocardial infarction and poor outcome. They should be used to identify risk groups with the necessary preventive measures and for predictive modeling.