Location Of Myocardial Infarction Research Articles

Characterization of dynamic changes in cardiac microstructure after reperfused ST-elevation myocardial infarction by biphasic diffusion tensor cardiovascular magnetic resonance.

Microstructural disturbances underlie dysfunctional contraction and adverse left ventricular (LV) remodelling after ST-elevation myocardial infarction (STEMI). Biphasic diffusion tensor cardiovascular magnetic resonance (DT-CMR) quantifies dynamic reorientation of sheetlets (E2A) from diastole to systole during myocardial thickening, and markers of tissue integrity [mean diffusivity (MD) and fractional anisotropy (FA)]. This study investigated whether microstructural alterations identified by biphasic DT-CMR: (i) enable contrast-free detection of acute myocardial infarction (MI); (ii) associate with severity of myocardial injury and contractile dysfunction; and (iii) predict adverse LV remodelling. Biphasic DT-CMR was acquired 4 days (n = 70) and 4 months (n = 66) after reperfused STEMI and in healthy volunteers (HVOLs) (n = 22). Adverse LV remodelling was defined as an increase in LV end-diastolic volume ≥ 20% at 4 months. MD and FA maps were compared with late gadolinium enhancement images. Widespread microstructural disturbances were detected post-STEMI. In the acute MI zone, diastolic E2A was raised and systolic E2A reduced, resulting in reduced E2A mobility (all P < .001 vs. adjacent and remote zones and HVOLs). Acute global E2A mobility was the only independent predictor of adverse LV remodelling (odds ratio .77; 95% confidence interval .63-.94; P = .010). MD and FA maps had excellent sensitivity and specificity (all > 90%) and interobserver agreement for detecting MI presence and location. Biphasic DT-CMR identifies microstructural alterations in both diastole and systole after STEMI, enabling detection of MI presence and location as well as predicting adverse LV remodelling. DT-CMR has potential to provide a single contrast-free modality for MI detection and prognostication of patients after acute STEMI.

Comparing One-Year Survival in Anterior Versus Inferior ST-Elevation Myocardial Infarction Patients: Results of a Cohort Study in Western Iran

Background: The site of acute myocardial infarction (MI) plays a pivotal role in determining the prognosis and risk assessment for patients experiencing their first ST-segment elevation MI (STEMI). Objectives: This study aims to compare one-year survival rates in patients with anterior versus inferior ST-elevation myocardial infarction. Methods: This registry-based cohort study was conducted from July 2018 to December 2019, examining data from STEMI patients. A total of 643 patients diagnosed with STEMI who met the inclusion criteria were enrolled. Patients were categorized based on the location of their myocardial infarction (MI) into two groups: Those with anterior MI and those with inferior MI. Their progress was meticulously followed over the course of one year. For data analysis, Cox proportional hazards models were used to calculate two sets of hazard ratio estimates: The initial unadjusted (crude) hazard ratios and the fully adjusted hazard ratios, which accounted for potential confounding factors. Along with these hazard ratio estimates, their corresponding 95% confidence intervals (HR, 95% CI) were obtained. All statistical analyses were performed using R software version 4.2.1. Results: Throughout the follow-up period, totaling 598 patients and 4,109 person-days, only 7 patients (1.09%) were lost to follow-up. The analysis revealed no significant difference in one-year mortality rates between the inferior and anterior STEMI groups, with rates of 37 (8.39%) versus 15 (7.69%), respectively, yielding a P-value of 0.767. However, it is noteworthy that the mortality risk trended higher in the inferior MI group, with a hazard ratio of 1.093 (95% CI: 0.60 - 1.99). Conclusions: In conclusion, our study highlights the heightened mortality risk associated with inferior wall MI. These results underscore the prognostic value of MI location, shedding light on its potential role in predicting the severity and extent of infarction, thereby guiding clinical decision-making and risk management strategies in STEMI patients.

Surgical Outcomes of Post-myocardial Infarction Ventricular Septal Defect/Rupture: A Systematic Review and Meta-Analysis.

Ventricular septal defect (VSD) is a catastrophic acute myocardial infarction (MI) complication. Despite a significant reduction in the prevalence of post-MI VSD with the advancement of surgical techniques, it is still considered fatal with a high mortality rate. The trends in the clinical outcomes of patients with post-MI VSD show discretion due to the complexity of the disease. Therefore, the present analysis aimed to evaluate the surgical outcomes and associated risks in the patients of post-MI VSD. A thorough literature survey resulted in 40 studies of our interest. The pooled proportion of differential variables, including the incidence of cardiogenic shock, 30-day survival, and overall mortality, were estimated using Bayesian hierarchical models. The risk difference was estimated for the location of MI and VSD and mortality in patients with coronary artery bypass graft (CABG). In addition, the heterogeneity tests for inconsistency and publication biases using Egger's and Begg's tests were also estimated. The analysis revealed a significant risk difference of 0.23 and 0.27 for the anterior vs. posterior location of MI and VSD, respectively. Further, the pooled proportion of 30-day survival and mortality was found to be 54.43% (95% credible interval (CI): 52.88-55.98%) and 48.22% (95% CI: 4-12.3%), respectively. Moreover, the heterogeneity test revealed significant inconsistencies in all the datasets withan I2index of >90% (p<0.0001). Lastly, the publication bias results suggested no evidence of asymmetry and small-study effects. Conclusively, the surgical management of post-MI VSD patients is considered beneficial; however, the outcomes signify its fatal behavior.

Lymphatic insufficiency leads to distinct myocardial infarct content assessed by magnetic resonance TRAFFn, T1ρ and T2 relaxation times

The role of cardiac lymphatics in the pathogenesis of myocardial infarction (MI) is unclear. Lymphatic system regulates cardiac physiological processes such as edema and tissue fluid balance, which affect MI pathogenesis. Recently, MI and fibrosis have been assessed using endogenous contrast in magnetic resonance imaging (MRI) based on the relaxation along a fictitious field with rank n (RAFFn). We extended the RAFFn applications to evaluate the effects of lymphatic insufficiency on MI with comparison to longitudinal rotating frame (T1ρ) and T2 relaxation times. MI was induced in transgenic (TG) mice expressing soluble decoy VEGF receptor 3 that reduces lymphatic vessel formation and their wild-type (WT) control littermates for comparison. The RAFFn relaxation times with rank 2 (TRAFF2), and rank 4 (TRAFF4), T1ρ and T2 were acquired at time points 0, 3, 7, 21 and 42 days after the MI at 9.4 T. Infarct sizes were determined based on TRAFF2, TRAFF4, T1ρ and T2 relaxation time maps. The area of differences (AOD) was calculated based on the MI areas determined on T2 and TRAFF2, TRAFF4 or T1ρ relaxation time maps. Hematoxylin–eosin and Sirius red stained histology sections were prepared to confirm MI locations and sizes. MI was detected as increased TRAFF2, TRAFF4, T1ρ and T2 relaxation times. Infarct sizes were similar on all relaxation time maps during the experimental period. Significantly larger AOD values were found together with increased AOD values in the TG group compared to the WT group. Histology confirmed these findings. The lymphatic deficiency was found to increase cardiac edema in MI. The combination of TRAFF2 (or TRAFF4) and T2 characterizes MI and edema in the myocardium in both lymphatic insufficiency and normal mice without any contrast agents.

Survival in Patients with Post-myocardial Infarction Ventricular Septal Rupture: A Retrospective Observational Study

Introduction: Post-myocardial infarction ventricular septal rupture (post-MI-VSR) is a dreaded complication with high mortality. There is a varied survival pattern among patients who have undergone surgical repair. Aim: To assess the survival rates in patients who underwent surgical repair for post-MI-VSR in a single centre. Materials and Methods: A retrospective observational study was conducted in the Department of Cardiothoracic Surgery at Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India. The patient records from January 2005 to December 2020, who underwent surgical repair of postMI-VSR, were reviewed. The perioperative variables, mortality, and survival data were analysed. Kaplan-Meier analysis was performed to assess the survival time. Results: The mean age of the studied patients was 58.4±7.5 years. A total of 73 patients underwent surgery for post-MIVSR. A total of 40 (55.80%) were males and 33 (45.20%) were females. Overall, 36 (49.32%) patients had diabetes, and 27 (36.99%) had hypertension. Anterior Myocardial Infarction (MI) (n=56, 76.71%) was the most common location of MI. The mean Cardiopulmonary Bypass (CPB) and clamp times were 144.05±59.09 and 105.38±38.34 minutes, respectively. The mean survival time was 2619.564 days {95% Confidence Interval (CI) 2105.936 to 3133.192}. Conclusions: As revascularisation confers a significant survival advantage, VSR repair with concomitant Coronary Artery Bypass Graft (CABG) appears beneficial.

MCA-net: A multi-task channel attention network for Myocardial infarction detection and location using 12-lead ECGs

Problem:Myocardial infarction (MI) is a classic cardiovascular disease (CVD) that requires prompt diagnosis. However, due to the complexity of its pathology, it is difficult for cardiologists to make an accurate diagnosis in a short period. Aim:In the clinical, MI can be detected and located by the morphological changes on a 12-lead electrocardiogram (ECG). Therefore, we need to develop an automatic, high-performance, and easily scalable algorithm for MI detection and location using 12-lead ECGs to effectively reduce the burden on cardiologists. Methods:This paper proposes a multi-task channel attention network (MCA-net) for MI detection and location using 12-lead ECGs. It employs a channel attention network based on a residual structure to efficiently capture and integrate features from different leads. On top of this, a multi-task framework is used to additionally introduce the shared and complementary information between MI detection and location tasks to further enhance the model performance. Results:Our method is evaluated on two datasets (The PTB and PTBXL datasets). It achieved more than 90% accuracy for MI detection task on both datasets. For MI location tasks, we achieved 68.90% and 49.18% accuracy on the PTB dataset, respectively. And on the PTBXL dataset, we achieved more than 80% accuracy. Conclusion:Numerous comparison experiments demonstrate that MCA-net outperforms the state-of-the-art methods and has a better generalization. Therefore, it can effectively assist cardiologists to detect and locate MI and has important implications for the early diagnosis of MI and patient prognosis.

Profilin 2 and Endothelial Exosomal Profilin 2 Promote Angiogenesis and Myocardial Infarction Repair in Mice.

Cardiovascular diseases (CVD) are the leading cause of death worldwide, wherein myocardial infarction (MI) is the most dangerous one. Promoting angiogenesis is a prospective strategy to alleviate MI. Our previous study indicated that profilin 2 (PFN2) may be a novel target associated with angiogenesis. Further results showed higher levels of serum PFN2 and exosomal PFN2 in patients, mice, and pigs with MI. In this study, we explored whether PFN2 and endothelial cell (EC)-derived exosomal PFN2 could increase angiogenesis and be beneficial for the treatment of MI. Serum PFN2, exosomes, and exosomal PFN2 were elevated in rats with MI. PFN2 and exosomes from PFN2-overexpressing ECs (OE-exo) enhanced EC proliferation, migration, and tube formation ability. OE-exo also significantly increased the vessel number in zebrafish and protected the ECs from inflammatory injury. Moreover, OE-exo-treated mice with MI showed improvement in motor ability, ejection fraction, left ventricular shortening fraction, and left ventricular mass, as well as increased vessel numbers in the MI location, and decreased infarction volume. Mechanistically, PI3K might be the upstream regulator of PFN2, while ERK might be the downstream regulator in the PI3K-PFN2-ERK axis. Taken together, our findings demonstrate that PFN2 and exosomal PFN2 promote EC proliferation, migration, and tube formation through the PI3K-PFN2-ERK axis. Exosomal PFN2 may be a valuable target in the repair of MI injury via angiogenesis.

CineCT platform for in vivo and ex vivo measurement of 3D high resolution Lagrangian strains in the left ventricle following myocardial infarction and intramyocardial delivery of theranostic hydrogel

Myocardial infarction (MI) produces acute changes in strain and stiffness within the infarct that can affect remote areas of the left ventricle (LV) and drive pathological remodeling. We hypothesized that intramyocardial delivery of a hydrogel within the MI region would lower wall stress and reduce adverse remodeling in Yorkshire pigs (n = 5). 99mTc-Tetrofosmin SPECT imaging defined the location and geometry of induced MI and border regions in pigs, and in vivo and ex vivo contrast cine computed tomography (cineCT) quantified deformations of the LV myocardium. Serial in vivo cineCT imaging provided data in hearts from control pigs (n = 3) and data from pigs (n = 5) under baseline conditions before MI induction, post-MI day 3, post-MI day 7, and one hour after intramyocardial delivery of a hyaluronic acid (HA)-based hydrogel with shear-thinning and self-healing properties to the central infarct area. Isolated, excised hearts underwent similar cineCT imaging using an ex vivo perfused heart preparation with cyclic LV pressurization. Deformations were evaluated using nonlinear image registration of cineCT volumes between end-diastole (ED) and end-systole (ES), and 3D Lagrangian strains were calculated from the displacement gradients. Post-MI day 3, radial, circumferential, maximum principal, and shear strains were reduced within the MI region (p < 0.04) but were unchanged in normal regions (p > 0.6), and LV end diastolic volume (LV EDV) increased (p = 0.004), while ejection fraction (EF) and stroke volume (SV) decreased (p < 0.02). Post-MI day 7, radial strains in MI border zones increased (p = 0.04) and dilation of LV EDV continued (p = 0.052). There was a significant negative linear correlation between regional radial and maximum principal/shear strains and percent infarcted tissue in all hearts (R2 > 0.47, p < 0.004), indicating that cineCT strain measures could predict MI location and degree of injury. Post-hydrogel day 7 post-MI, LV EDV was significantly reduced (p = 0.009), EF increased (p = 0.048), and radial (p = 0.021), maximum principal (p = 0.051), and shear strain (p = 0.047) increased within regions bordering the infarct. A smaller strain improvement within the infarct and normal regions was also noted on average along with an improvement in SV in 4 out of 5 hearts. CineCT provides a reliable method to assess regional changes in strains post-MI and the therapeutic effects of intramyocardial hydrogel delivery.

Short- and Long-term Myocardial Infarction Survival Rate According to the Type of Drugs Prescribed at the Time of Discharge: A Study Using Iran National Registry Data.

Coronary artery disease is among the first causes of death in Iran. Secondary prevention with drug therapy is recommended following acute myocardial infarction (MI) to reduce the risk of new cardiovascular events and death. This is a retrospective cohort study on data collected from 21181 cases of MI recorded by the MI Registry of Iran from 2013 to 2014. Ten therapies that were prescribed to patients at the time of discharge were divided into 6 groups. Survival rates were estimated using the Kaplan-Meier method and Cox regression analysis. The most common MI location was in the anterior wall (31.87%). Anticoagulants, aspirin, clopidogrel were the most common prescribed medications (94.73%). Overall, 28-day (short-term) and 3-year survival rates were 0.95 (95% CI: 0.95-0.96) and 0.82 (95% CI: 0.81-0.82). In non-ST-elevation myocardial infarction (NSTEMI) patients, the lowest short- and long-term survival rates were observed when diuretic, anticoagulants/ aspirin and clopidogrel, beta-blockers and statins medication were simultaneously taken and the highest short- and long-term survival rates were observed in patients who took anticoagulants, aspirin and clopidogrel, nitrate agent and calcium blockers, beta-blockers and statins medication. In STEMI patients, the lowest short- and long-term survival rates were observed when diuretic, anticoagulants, aspirin and clopidogrel, nitrate agent and calcium blockers, angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) were simultaneously taken. The highest short- and long-term survival rates were observed in patients who received anticoagulants, aspirin and clopidogrel, nitrate agent and calcium blockers, beta-blockers, statins, ACEIs and ARBs. Prescription of the best combination of drugs, in addition to adherence to a healthy lifestyle and medication, can improve the survival rates after MI.

Correlation of Standard ECG with 2D-Echo and Serum Troponin I in Locating the Site of Myocardial Infarction and its ExtentAn Observational Study

Introduction: Cardiovascular diseases are the leading causes of death in developed countries, and its incidence is on the rise in developing countries. Electrocardiogram (ECG), 2 Dimensional Echocardiography (2D-Echo) and myocardial injury biomarkers help in the diagnosis, prognostification of Myocardial Infarction (MI). Aim: To correlate the findings of ECG, 2D-Echo and Troponin I levels in locating the site and extent of MI. Materials and Methods: This observational study was conducted in the cardiology Intensive Care Unit (ICU)/ward, PES Hospital, Kuppam, Andhra Pradesh, India, from January 2019 to June 2020. A total of 95 patients of acute MI were studied at baseline, and repeat 12 lead ECG, 2D-Echo and serum troponin I levels were recorded. Ejection Fraction (EF) was estimated from the QRS score by means of a formula, and Echocardiographic correlation was obtained on the same day with ECG-QRS scoring by direct estimation of EF in ‘Q’ wave infarction. High sensitivity cardiac Troponin – I was measured at the time of hospitalisation and repeated at six hours if required, and its levels were correlated to the extent of MI i.e., Left Ventricular Ejection Fraction (LVEF). The categorical data were analysed using Chi-square test and p&lt;0.05 was considered as statistically significant. Regression analysis was done for associated factors. Results: There was better correlation between EF calculated from ECG-QRS scoring system and 2D-Echo (r value-0.78, p-value &lt;0.001). There was poor correlation between serum Troponin I levels at admission, and extent of MI i.e., LVEF as estimated by ECG and 2D-Echo (r=-237.13, p=0.334 and r=-120.78, p=0.585). There was a significant correlation between serum Troponin I levels at 72 hours of chest pain or peak values and extent of MI i.e., LVEF as estimated by ECG and 2D-Echo (r=-1446.14, p&lt;0.001 and r=-1354.42, p&lt;0.001). Conclusion: The location of MI, seen on ECG, correlated broadly with those seen on 2D-Echo. 2D-Echo was able to elaborate regional wall motion abnormalities in detail when compared to the ECG. LVEF can be calculated from ECG at bedside in Q wave infarction, which correlated fairly with 2D-Echo findings.

Abstract 13758: Right Ventricular Dysfunction Contributes to Left Ventricular Thrombus Formation After Myocardial Infarction

Introduction: Thromboembolic events such as stroke due to left ventricular thrombus (LVT) formation accompany acute myocardial infarction (MI). Risk factors for the development of LVT after MI have been identified based on limited data, including MI location, severe ventricular wall motion abnormalities or aneurysm, and reduced left ventricular ejection fraction (LVEF). Hypothesis: The purpose of this study was to define additional determinants of LVT formation following acute anterior MI through comparing clinical and echocardiographic characteristics between patients with and without LVT formation during the first 3 months after MI. Methods: This case-control-study comprised acute anterior MI patients with and without LVT, who were selected from a cohort of 1327 consecutive patients with ischemic heart failure in our hospital. The cases and controls were matched for age, sex, and LVEF. LVT was detected by routine/contrast echocardiography or cardiac magnetic resonance imaging during the first 3 months following MI. Results: Formation of apical aneurysm after MI was independently associated with LVT formation (72.0% vs. 43.5%, odds ratio [OR]=5.06, P=0.005). Echocardiographic risk factors associated with LVT formation included reduced mitral annular plane systolic excursion (MAPSE&lt;7mm, OR=4.69), moderate-severe diastolic dysfunction (OR=2.71), and right ventricular (RV) dysfunction [reduced tricuspid annular plane systolic excursion (TAPSE)&lt;17mm (OR=5.48), reduced RV factional area change (RV_FAC)&lt;0.35 (OR=3.32), and enlarged RV diameters (OR=1.62)]. Subgroup analysis showed reduced TAPSE (OR=5.12, P=0.010) associated with increased risk of LVT formation in anterior MI patients without apical aneurysm, independent of clinical and other echocardiographic covariates. Conclusions: RV dysfunction as determined by reduced TAPSE and RV_FAC is independently associated with LVT formation in acute anterior MI patients, especially in the setting of MI patients without the formation of an apical aneurysm. This suggests that besides assessment of left ventricular abnormalities, assessment of concomitant RV dysfunction is of importance in risk stratification of LVT formation in patients with acute anterior MI.

Left ventricular thrombosis following apical myocardial infarction: may CMR strain analysis tell us something?

Abstract Funding Acknowledgements Type of funding sources: None. Background Left ventricular thrombosis (LVT) is a possible complication following myocardial infarction (MI). Besides infarct size, risk factors for LVT include ST-elevated MI (STEMI), anterior and apical location, reduced left ventricular ejection fraction (LVEF) and the presence of microvascular obstruction. Echocardiography quantified myocardial strain has been associated with LVT following MI. Recently, global longitudinal strain, calculated with feature tracking (FT) - CMR, emerged as an independent predictor of major cardiovascular events following MI. Anyway, the relationship between abnormalities on FT-CMR and LVT following MI is still unexplored. Aim of our study is to investigate the possible association between abnormal strain on FT-CMR and LVT following apical STEMI. Methods We performed a retrospective analysis including all patients with a previous apical STEMI, who underwent CMR at our Institute between August 2013 and October 2020. Patients with ongoing anticoagulant therapy were excluded. Differences in global and segmental strain on CMR between patients with and without LVT were tested in a propensity-matched sample, using LVEF, age, gender, time from MI diagnosis and number of LV segments with transmural late gadolinium enhancement (LGE) as covariates to assign propensity score. Furthermore, difference in terms of apical to global radial strain percentual deviation (AGD), calculated as [(Global Radial Strain – Apical Radial Strain)/Global Radial Strain] * 100, was tested. Results Of 356 patients with apical STEMI undergoing CMR at our center, 37 (10.4%) were diagnosed with LVT. After performing a propensity score matching, we obtained a sample of 36 pairs, with a mean age of 65 (SD 11) years, and a median EF of 35% (IQR 27-42); 59 (82%) of them were male. A significant difference in terms of apical radial strain was found between the two groups, with a median strain of 10.75 (IQR 6.8–16.5) in patients without LVT compared to a value of 5.25 (IQR 2.7–9-6) in patients with LVT (p = 0.007). No differences were found in terms of global longitudinal, radial and circumferential strain (p = 0.19, p= 0.2 and p= 0.49 respectively) and segmental circumferential and longitudinal strain. When considering the AGD parameter, a significant difference was found between the two groups, with a median deviation of 12% (IQR -20; +48) in patients without LVT and 51% (IQR +47; +75) in patients with LVT (p= 0.0003). Furthermore, an AGD value of 26% was found to be the most accurate in terms of sensitivity and specificity applying a Receiver Operating Characteristic (ROC) curve analysis (AUC 0.74; CI 0.62-0.85). Conclusions Among patients with transmural MI involving LV apex, reduced apical radial strain on FT-CMR is associated with the presence of LV thrombosis. Furthermore, among patients developing LV thrombi, a greater apical radial strain deviation from the global one was found, with a threshold value of 26% at ROC curve analysis.

Comparative effectiveness of ventricular tachycardia ablation versus escalated antiarrhythmic drug therapy by location of myocardial infarction: A sub-study of the VANISH trial

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Fonds de recherché du Québec-Santé (FRQS) [post doctoral award for Dr. Samuel) BACKGROUND Complexity of ventricular tachycardia (VT) substrate, efficiency of lesion formation, and the size and thickness of infarction area border zones differ based on location of myocardial infarctions (MI). These differences may translate into heterogeneity in risk of events and effectiveness of treatments for VT. Small observational studies suggest that VT from inferior infarctions have higher risk of early recurrence despite smaller infarct areas. However, differential effectiveness of VT treatments based on location of MI not been definitively established. PURPOSE The objective of this sub-study of the Ventricular tachycardia AblatioN versus escalated antiarrhythmic drug therapy in ISchemic Heart disease (VANISH) randomized trial was to compare the effectiveness of VT ablation by location of MI in reducing the composite endpoint of all-cause mortality, VT storm, or appropriate ICD therapy when compared to escalated pharmacological therapy in VT patients with a prior MI. METHODS VANISH participants were categorized into 3 subgroups based on MI location: 1. Inferior (may also have MI in other locations); 2. Non-inferior (no inferior MI, all patients not in group 1); and 3. Anterior (may also have MI in other locations). Inverse probability of treatment weighting was used to balance baseline characteristics (ie. age, sex, comorbidities, medications, and the location of additional infarctions) between patients randomized to ablation or escalated therapy within each subgroup. Weighted Cox proportional hazards models were calculated separately for each subgroup. RESULTS Of 259 patients enrolled in the VANISH trial [median age 69.8 (IQR 63.0-74.2) years, 7.0% women], 135 had an inferior MI, 124 a non-inferior MI, and 83 an anterior MI. Among patients with an inferior MI, no statistically significant difference in the primary outcome was detected between patients randomized to ablation or escalated therapy [aHR 0.78 (95% CI 0.51-1.20)]. In contrast, patients with non-inferior MIs had a statistically significant reduction in the incidence of the primary outcome with ablation [aHR 0.48 (95% CI 0.27-0.86)]; which was of greater magnitude than the reduction observed in the overall results of the VANISH trial [HR 0.72 (95% CI 0.53-0.98)]. In addition, a trend towards a reduction in the primary outcome with ablation was detected in patients with anterior MIs [aHR 0.50 (95% CI 0.23-1.09)]. CONCLUSION The effectiveness of VT ablation versus escalated pharmacological therapy varies based on the location of the MI. Patients with MI scars located only in non-inferior regions of the ventricles derive greater benefit from VT ablation in reducing VT-related events. Further studies are required to explore reasons for this finding and to assess the impact of VT treatment strategies based on MI location in optimizing outcomes.

In-hospital outcomes of sustained ventricular tachycardia in the setting of Acute Coronary Syndrome

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf on behalf of the Investigators of " Portuguese Registry of ACS " Introduction Sustained ventricular tachycardia (SVT) complicates up to 20% of acute coronary syndromes (ACS) and it is, therefore, important to access its impact on prognosis and identify patients with higher risk of SVT. Objective To evaluate predictors of early onset (&amp;lt;48h) and late onset (≥48h) SVT. Methods Based on a multicenter retrospective study, data collected from admissions between 1/10/2010 and 4/09/2019. Patients (pts) were divided in two groups (G): A – pts that presented early onset SVT (ESVT), and B – pts that presented late onset SVT (LSVT). Pts without data on previous cardiovascular history or uncompleted clinical data were excluded. Logistic regression was performed to assess predictors of SVT in ACS. Results Between 29851 pts with ACS, 364 (1.2%) presented SVT. ESVT – 251 pts (69%); LSVT – 91 pts (25%). LSVT G was older (74 ± 13 vs 68 ± 14, p = 0.003), was admitted directly to cat lab less frequently (10.1% vs 24.8%, p = 0.003), had longer times from first symptoms to admission (440min vs 261 min, p &amp;lt; 0.001) and had higher rates of previous stroke (14.4% vs 6.8%, p = 0.028). LSVT G had higher rates of non-ST-elevation myocardial infarction (MI) (35.2% vs 23.1%, p = 0.025) and lower rates of ST-elevation MI (53.8% vs 71.7%, p = 0.002), although both G were similar regarding MI location (anterior – p = 0.135, inferior – p = 0.097). LSVT G had higher systolic blood pression (130 ± 33 vs 122 ± 33, p = 0.050), presented more frequently in Killip-Kimball class ≥2 (52.5% vs 35.5%, p = 0.005) and with atrial fibrillation (21.2% vs 12.4%, p = 0.045), and had higher brain-natriuretic peptide (1075 vs 329, p &amp;lt; 0.001). LSVT G was treated more frequently with diuretics (80.0% vs 47.8%, p &amp;lt; 0.001), amiodarone (62.2% vs 48.8%, p = 0.029), digoxin (8.9% vs 2.4%, p = 0.013) and levosimendan (11.1% vs 2.8%, p = 0.004). ESVT G had higher rates of performed coronarography (88.4% vs 79.1%, p = 0.028) but lower rate of 3 vessels disease (58.5% vs 70.8%, p = 0.017). LSVT G had higher rates of severe (&amp;lt;30%) left ventricle dysfunction (32.9% vs 15.4%, p &amp;lt; 0.001) and need to non-invasive ventilation (23.1% vs 6.8%, p &amp;lt; 0.001). Regarding in-hospital complications, ESVT G had higher rates of heart failure (34.7% vs 19.1%, p = 0.006), atrioventricular block (15.7% vs 1.1%, p &amp;lt; 0.001), atrial fibrillation (20.4% vs 7.7%, p = 0.006) and major haemorrhage (5.2% vs 0.0%, p = 0.024). LSVT G had higher rates of in-hospital death (44.4% vs 20.9%, p &amp;lt; 0.001) and in-hospital stay (14 days vs 7 days, p &amp;lt; 0.001). The G were similar regarding re-infarction (p = 0.216), shock (p = 0.179), mechanical complications (p = 1.00), cardiac arrest (p = 0.097) and stroke (0.348) rates. Logistic regression confirmed ESVT was predictive in-hospital heart failure (p = 0.010, OR 2.67) and de novo AF (p = 0.001, OR 5.56), whether LSVT was predictive of in-hospital death (p = 0.002, OR 2.70). Conclusion LSVT was associated with higher rates of in-hospital complications, but ESVT was associated with higher in-hospital mortality.

Short and Long-Term Survival Rates Following Myocardial Infarction and Its Predictive Factors: A Study Using National Registry Data.

Background: Coronary artery disease is the most common cause of death worldwide as well as in Iran. The present study was designed to predict short and long-term survival rates after the first episode of myocardial infarction (MI). Methods: The current research is a retrospective cohort study. The data were collected from the Myocardial Infarction Registry of Iran in a 12-month period leading to March 20, 2014. The variables analyzed included smoking status, past medical history of chronic heart disease, hypertension, diabetes, hyperlipidemia, signs and symptoms during an attack, post-MI complications during hospitalization, the occurrence of arrhythmias, the location of MI, and the place of residence. Survival rates and predictive factors were estimated by the Kaplan–Meier method, the log-rank test, and the Cox model. Results: Totally, 21 181 patients with the first MI were studied. There were 15 328 men (72.4%), and the mean age of the study population was 62.10±13.42 years. During a 1-year period following MI, 2479 patients (11.7%) died. Overall, the survival rates at 28 days, 6 months, and 1 year were estimated to be 0.95 (95% CI: 0.95 to 0.96), 0.90 (95% CI: 0.90 to 0.91), and 0.88 (95% CI: 0.88 to 0.89). After the confounding factors were controlled, history of chronic heart disease (p<0.001), hypertension (p<0.001), and diabetes (p<0.001) had a significant relationship with an increased risk of death and history of hyperlipidemia (p<0.001) and inferior wall MI (p<0.001) had a significant relationship with a decreased risk of death. Conclusion: The results of this study provide evidence for health policy-makers and physicians on the link between MI and its predictive factors.

Risk factors, clinical presentation, angiographic profile and 30-day outcomes of young patients (aged ≤35 Years) with ST-elevation myocardial infarction

Background: Acute ST-elevation myocardial infarction (STEMI) is the most devastating form of coronary artery disease (CAD). The aim of the present study was to assess the risk factors, clinical presentation, angiographic profile and 30-day outcomes of young patients (aged ≤35 years) with STEMI. Materials and Methods: Between 1 March, 2019 and 29 February, 2020, a total of 75 young patients aged ≤35 years old, with acute STEMI were included in the study. All patients underwent coronary angiography and were evaluated for clinical presentation, risk factors for CAD, management and in hospital and 30-day outcome. Results: The mean age of patients was 31 ± 4.5 years and 96% were male. The most common cardiovascular risk factor was smoking (66.7%), followed by dyslipidaemia (61%), family history of CAD (40%) and obesity (33.3%). Diabetes mellitus (9.3%) and hypertension (14.7%) were less common. Novel risk factors such as high-sensitivity C-reactive protein, lipoprotein (a) and hyperhomocysteinaemia were having significant association to young myocardial infarction (MI). The most common location of MI was the anterior wall (68%). Significant CAD was found in 86.7% of patients. Most patients had single vessel disease (68%) with left anterior descending being the most common vessel involved (53.3%). There was no mortality during hospitalisation or 30-day period. Conclusion: Acute MI in young (≤35 years) almost exclusively occurs in male and smoking is the most common cardiovascular risk factor. Young patients have less extensive coronary involvement and favourable outcomes.

Gender divides in the clinical profiles of patients with acute myocardial infarction at a tertiary care center in South India.

BACKGROUND:Early identification of myocardial infarction (MI) is a determinant in the provision of appropriate treatment modalities. The focus of the present study is on the identification of gender-based differences in risk factors, clinical manifestations, and coronary angiography findings in patients presenting with MI.MATERIALS AND METHODS:A cross-sectional study was conducted among patients admitted with MI at a tertiary care center in South India during March 2016 to June 2017. Selected 120 male and 120 female consecutive patients admitted with acute MI, who had survived and been stabilized. Data was collected using a pre-tested structure data sheet. Appropriate parametric and nonparametric tests were used to analyze the data.RESULTS:Participants were homogenous as regards age (P < 0.107); majority of men and women were from the rural areas. About 32.5% of the men interpreted the pain as due to a cardiac problem or indigestion, whereas 60.8% of the women thought it was fatigue/muscle pain. The self-interpretation or perception of pain in both genders was statistically significant (P < 0.001). Compared to the men, the females increasingly presented with atypical symptoms (P = 0.005). Regarding ST-elevated MI, male preponderance was noted (P = 0.004)). Considering the anatomical location of MI, the presentation of Inferior Wall Myocardial Infarction (IWMI) was predominant in females compared to men (P = 0.003). The majority of men had increased presentation of single-vessel disease compared to women (P = 0.02), whereas normal coronaries and double-vessel disease were found statistically significantly higher in females (P = 0.03 and P = 0.008, respectively).CONCLUSION:Public education is needed on the atypical presentations which are common with women than in men. The public should, therefore, be informed of those symptoms and how to recognize them so that they may seek medical care promptly.

Comparison of Left Ventricular Global Strain in Anterior and Non-anterior Wall Myocardial Infarction With CMR Tissue Tracking.

Left ventricular (LV) myocardial dysfunction occurs after myocardial infarction (MI) is associated with the location, infarct size, and transmurality degrees of MI. The myocardial strain is a sensitive index used for the quantification of myocardium dysfunction. This study used Tissue-Tracking to evaluate whether the different location of MI would result in different myocardial dysfunction. One hundred patients diagnosed with MI who underwent cardiovascular magnetic resonance examination were included. The tissue-tracking indices, LV global radial strain (GRS), global circumferential strain (GCS), global longitudinal strain (GLS), and the infarct size (IS,% of LV mass) were quantified. There were 42 cases of anterior wall MI (AWMI) and 58 cases of non-anterior wall MI (NAWMI). The GCS of AWMI was significantly lower than that of NAWMI (P = 0.036). In the same level of infarct size, the myocardial strain of AWMI was not significantly different from NAWMI group (P > 0.05). The GRS and GCS were significantly different between transmurality > 50% group with transmurality ≤ 50% group (P < 0.05). The present study demonstrated that LV MI is associated with reduced myocardial strain, and the infarct size and degrees of transmurality were both related to the decline of myocardial strain in patients with MI.

Primary percutaneous coronary intervention in nonagenarian patients

Abstract Background Given the continuous increase in life expectancy, elderly patients with ST segment elevation myocardial infarction (STEMI) are becoming a growing proportion of those referred for primary percutaneous coronary intervention (pPCI). However, this population is usually excluded from randomized trials and limited data are available to guide clinical decisions. The aim of this study-level meta-analysis was to describe and analyze the determinants of outcomes in this population. Methods We searched the literature for studies reporting ischemic and hemorrhagic outcomes and/or mortality in nonagenarian patients undergoing pPCI. An analysis of the heterogeneity between studies in outcome reports was performed with I2 test. A univariate meta-regression analysis was conducted to explore the relationship between outcomes of interest and classic cardiovascular risk factors, gender, previous myocardial infarction (MI), MI location, PCI characteristics, hemodynamic instability, vascular access, intra-aortic balloon pump (IABP) and Glycoprotein IIb/IIIa inhibitor (GPI) use. Results Overall, 15 observational studies met our inclusion criteria, with a total of 6787 patients; mean age was 92.4 and 35% were male. The incidence of in-hospital death was 21.3%, 1.4% of our population suffered an in-hospital ischemic stroke and 11.1% faced acute renal failure; in-hospital major bleedings affected 1.7% of the population, but blood-transfusion was needed in 6.9%. Long-term mortality rate was 21.5%. Killip III-IV at admission was related with increased in-hospital mortality (β: 0.2%; p: 0.041), but lower incidence of ARF (β: −0.6%; p: 0.004). Angiographic success was associated with a lower incidence of long-term all-cause mortality (β: −1.7%; p: 0.017) and higher incidence of ARF (β: 1.7%, p&amp;lt;0.001). A higher number of coronary stents implanted was associated with a lower incidence of long-term all-cause mortality (β: −73%; p: 0.01). A higher long-term all-cause mortality was related with male gender (β: 0.9%; p: 0.027) and previous MI (β: 1.5%; p: 0.007). Diabetes was associated with a lower incidence of long-term all-cause mortality (β: −0.8%; p: 0.014) despite a higher incidence of in-hospital blood transfusion (β: 0.5%, p: 0.05), while a history of MI (β: 0.1%; p: 0.049), as well as the use of GPI (β: 0.04) was related with a higher incidence of in-hospital major bleeding. The use of IABP was related with a lower incidence of long-term all-cause death (β: 6.5%; p&amp;lt;0.001) and in-hospital major bleeding (β: −0.4%; p: 0.038). Discussion Our meta-analysis, pooling the largest cohort of nonagenarians undergoing pPCI confirms the feasibility of urgent percutaneous coronary intervention also in this frail population. In particular, although angiographic success increased the incidence of in-hospital ARF, it was associated with a higher long-term survival underling the pivotal role of myocardial reperfusion. Funding Acknowledgement Type of funding source: None

Differential Outcomes With Edetate Disodium-Based Treatment Among Stable Post Anterior vs. Non-Anterior Myocardial Infarction Patients

BackgroundThe Trial to Assess Chelation Therapy (TACT) found that chelation therapy significantly reduced clinical events in patients with a history of myocardial infarction (MI). The initial report of TACT included the observation of an interaction between edetate disodium infusions and MI location, as well as diabetes. Thus, we examined in greater detail the effect of edetate disodium chelation therapy as a function of MI location and diabetes. MethodsPatients (n = 1708) at least 6 weeks post-MI and age ≥ 50 were randomized to receive 40 infusions of a 500 mL chelation solution or placebo (median follow-up 55 months). The effect of edetate disodium on the primary outcome (all-cause mortality, MI, stroke, hospitalization for angina, or coronary revascularization) was assessed as a function of MI location using log-rank test and Cox regression model, adjusting for other prognostic variables. ResultsAmong patients with post anterior MI (n = 674), chelation was associated with a lower risk of the primary endpoint (HR 0.63, 95% CI 0.47–0.86, p = 0.003) among anterior MI patients, but not in post non-anterior MI (n = 1034) patients (HR 0.96, 95% CI 0.77–1.20, p = 0.702) (p-for-interaction = 0.032). The point estimates for each component of the primary endpoint favored chelation therapy. The differing treatment effect in patients with post anterior vs. non-anterior MI was consistent among patients with or without diabetes and remained significant after adjusting for other prognostic variables (p < 0.01). ConclusionsEdetate disodium infusions reduced the risk of cardiovascular events among patients with a prior anterior MI. Future studies should focus on replicating these results and understanding the mechanisms of benefit.