Mortality In Myocardial Infarction Patients Research Articles

Pharmacological Modulation of Cardiac Remodeling after Myocardial Infarction.

Cardiac remodeling describes a series of structural and functional changes in the heart after myocardial infarction (MI). Adverse post-MI cardiac remodeling directly jeopardizes the recovery of cardiac functions and the survival rate in MI patients. Several classes of drugs are proven to be useful to reduce the mortality of MI patients. However, it is an ongoing challenge to prevent the adverse effects of cardiac remodeling. The present review aims to identify the pharmacological therapies from the existing clinical drugs for the treatment of adverse post-MI cardiac remodeling. Post-MI cardiac remodeling is a complex process involving ischemia/reperfusion, inflammation, cell death, and deposition of extracellular matrix (ECM). Thus, the present review included two parts: (1) to examine the basic pathophysiology in the cardiovascular system and the molecular basis of cardiac remodeling and (2) to identify the pathological aspects of cardiac remodeling and the potential of the existing pharmacotherapies. Ultimately, the present review highlights drug repositioning as a strategy to discover effective therapies from the existing drugs against post-MI cardiac remodeling.

Clinical and Angiographic Features of Patients With Out-of-Hospital Cardiac Arrest and Acute Myocardial Infarction

BackgroundSudden cardiac arrest is a serious complication of acute myocardial infarction (MI). Although in-hospital mortality from MI has decreased, the mortality of MI patients complicated with out-of-hospital cardiac arrest (OHCA) remains high. However, the features of acute MI patients with OHCA have not been well known. ObjectivesWe sought to characterize the clinical and angiographic features of acute MI patients with OHCA comparing with those without OHCA. MethodsWe retrospectively analyzed 480 consecutive patients with acute MI undergoing percutaneous coronary intervention. Patients complicated with OHCA were compared with patients without OHCA. ResultsOf the patients, 141 (29%) were complicated with OHCA. Multivariate analysis revealed that age (odds ratio [OR]: 0.8; 95% confidence interval [CI]: 0.7 to 0.9 per 5 years; p < 0.001), estimated glomerular filtration rate (OR: 0.8; 95% CI: 0.7 to 0.8 per 10 ml/min/1.73 m2; p < 0.001), peak creatine kinase-myocardial band (OR: 1.3; 95% CI: 1.2 to 1.4 per 102 U/l; p < 0.001), calcium-channel antagonists use (OR: 0.4; 95% CI: 0.2 to 0.7; p = 0.002), the culprit lesion at the left main coronary artery (OR: 5.3; 95% CI: 1.9 to 15.1; p = 0.002), and the presence of chronic total occlusion (OR: 2.9; 95% CI: 1.5 to 5.7; p = 0.001) were significantly associated with OHCA. ConclusionsYounger age, no use of calcium-channel antagonists, worse renal function, larger infarct size, culprit lesion in the left main coronary artery, and having chronic total occlusion were associated with OHCA.

Predictors of all-cause 1-year mortality in myocardial infarction patients.

Compared with the general population, myocardial infarction (MI) survivors have a higher risk of mortality in the first year after the index event.The aim of this study was to determine the associations between variables obtained during the index admission and 1-year all-cause mortality on follow-up.A cohort of 296 patients was enrolled in the study, with a median age of 63.8 ± 12.68 years. All patients received a coronary angiography and stent implantation by percutaneous coronary intervention. Each variable was tested for association with all-cause mortality, using chi-square tests for categorical and binary variables and t tests for continuous variables. The relative prognostic power of each significant variable was further evaluated by logistic regression before and after adjustment for differences in baseline characteristics.Patients who were deceased after 1-year of MI had significantly higher mean age, increased prevalence of diabetes, and elevated heart rate as compared to those who were surviving. Univariate analysis indicated that patient mortality within 1-year of MI was strongly correlated with higher rates of pump failure on admission (P < .0001), bleeding complications (P = .02), the severity of coronary artery disease measured by Gensini score (P = .04), and decreased left ventricular ejection fraction (LVEF) (P < .0001). After adjustment of baseline variables, only pump failure (P = .006) and reduced LVEF (P < .0001) were independently associated with 1-year mortality.Our study shows that LVEF dysfunction and pump failure are independent predictors of 1-year all-cause post-MI mortality, while the severity of coronary artery disease and bleeding did not qualify as independent predictors. Also, age, history of diabetes, and elevated heart rate may be used as markers for increased mortality rates.

Coffee Consumption Reduces Mortality in Patients with Acute Myocardial Infarction

Aim: Acute myocardial infarction (AMI) is the number one cause of death in 2000. Usually, coffee restriction was advised to patients with cardiovascular diseases. Recent studies indicate coffee might have a cardioprotective effect.Method: Systematic search was done on Pubmed and Cochrane. Title and abstract screening were initiated on 12 articles, followed by selection with inclusion and exclusion criteria, and selected one meta-analysis study to be critically appraised. Result: The meta-analysis study appraised resulted with a good score. Reduction in mortality rate was found, and an inverse relationship was concluded between heavy coffee consumption versus no consumption and mortality in acute myocardial infarction patients. RR = 0.54 95% CI [0.45 – 0.65].Conclusion: Coffee consumption and mortality in myocardial infarction patients have an inverse relationship, with the highest risk reduction found in heavy coffee drinkers.

Moderate coffee consumption associated with lower risk of mortality in prior Acute Coronary Syndrome patients: prospective analysis in ERICO cohort

AbstractCoffee is one of the most widely consumed beverages around the world. Several studies have observed an inverse association between coffee consumption and all-cause mortality in population-based studies. Nevertheless, little is known about these associations in patient populations with a prior Acute Coronary Syndrome (ACS). To examine the association between coffee consumption and the risk of mortality in patients with a prior acute myocardial infarction (MI) or unstable angina. Data were from the longitudinal prospective study “Strategy of Registry of Acute Coronary Syndrome Cohort - ERICO”. The cohort involved 1,085 patients diagnosed with ACS, between 2009 to 2013. For this analysis we used data after 180 days until 4 years’ follow-up, totalizing 928 participants. The coffee consumption was obtained using a questionnaire multiplying the reported frequency by the reported portion size. Subsequently was calculated the average of coffee intake (mL/day) and categorized (cups/day) into ≤ 1, 1–3, and &gt; 3. Information on mortality was ascertained by medical registries and death certificates. Cox regression models to estimate hazard ratios (HRs) for mortality according to coffee consumption adjusted for potential confounders were performed. Kaplan-Meier survival curves with the log-rank test were analyzed. Most patients (99.0%) drank coffee, and the median total coffee intake was 125 mL/day. During a median follow-up of 4 years, a total of 111 deaths occurred, including 59 CVD-related and 24 MI-related deaths. Moderate coffee consumption was inversely associated with all-cause mortality. Participants who consumed 1–3 cups of coffee/day, showed an 81% lower risk of all-cause mortality than those who consumed ≤ 1 cup/day (adjusted HR 0.19; 95%CI: 0.11, 0.34). For patients with higher coffee consumption (&gt; 3 cups/day), there was a positive association with mortality, with HR of 2.10 (95%CI: 1.05, 4.22). Corresponding HRs were 0.22 (95%CI: 0.11, 0.48) for 1–3 cups/day and 2.66 (95%CI: 1.04, 6.83) for &gt; 3 cups/day for CVD mortality; and 0.23 (95%CI: 0.07, 0.71) and 1.59 (95%CI: 0.25, 10.0) for MI mortality, respectively. After stratification by smoking status the analysis revealed lower risk of all-cause mortality in never and former smokers drinking 1–3 cups/day (HRs 0.10; 95%CI: 0.04, 0.24 and 0.18; 0.08, 0.42, respectively). Among current smokers there was a positive association between &gt; 3 cups/day and mortality (HR 8.50; 95%CI: 1.18, 16.35). The moderate consumption of coffee, impacted in a lower risk of all-cause, CVD and MI mortality in patients with a prior Acute Coronary Syndrome, particularly in nonsmokers.

Cardiac shock care center — the next stage in the treatment of cardiogenic shock

The key step in achieving a significant reduction in mortality in patients with myocardial infarction (MI) was the organization of a wide network of specialized PCI-centers that provide care for patients with acute coronary syndrome (ACS) on the 24/7 mode in accordance to clear protocols. However, currently in-hospital mortality of MI patients, complicated by cardiogenic shock (CS), remains extremely high and averages 50 %. The formation of a system of highly specialized centers seems to be the most promising opportunity to improve the prognosis of patients with CS. The article discusses the world scientific and clinical experience in organizing cardiac shock care centers, the features of their internal structure, as well as the administrative and logistical aspects of entire system operation.

Serum cholesterol efflux capacity and mortality in patients with acute myocardial infarction

Serum cholesterol efflux capacity, a biomarker of the early step of the reverse cholesterol transport, has been associated with atherosclerosis independently of high-density lipoprotein (HDL) cholesterol level. To evaluate the prognostic impact of serum cholesterol efflux capacity on mortality in a large cohort of patients hospitalized for an acute myocardial infarction (MI). Serum cholesterol efflux capacity was measured in 1,609 consecutive patients admitted with an acute MI. In a fully adjusted model that included age, sex, traditional cardiovascular risk factors including lipid levels, and prognostic factors of MI, serum cholesterol efflux capacity was a strong predictor of survival (adjusted hazard ratio for mortality per 1-SD increase in serum cholesterol efflux capacity, 0.79; 95% confidence interval: 0.66 to 0.95; P = 0.0132). Patients displaying an elevated serum cholesterol efflux capacity had a marked lower rate of mortality at 6 years (adjusted hazard ratio: 0.54 [0.32 to 0.89]; P = 0.0165) as compared with patients with reduced serum cholesterol efflux capacity. Serum cholesterol efflux capacity, an integrative marker of reverse cholesterol transport pathway and efficacy, was inversely associated with all-cause mortality in MI patients independently of HDL cholesterol level and other risk factors.

Outcomes associated with dual antiplatelet therapy after myocardial infarction in patients with aortic stenosis

BackgroundAcquired loss of the largest von Willebrand factor multimers is a common hemostatic disturbance in patients with aortic valve stenosis (AS), resulting in impaired platelet adhesion and increased bleeding risk. AS is also associated with atherosclerosis and myocardial infarction (MI). Our aim was to study the clinical outcomes associated with AS in MI patients treated with dual antiplatelet therapy (DAPT) in a nationwide hospital-based register study. MethodsBased on nationwide hospital discharge registers from Sweden (2005–2010) and Denmark (2005–2015), we calculated 1-year incidence rates and hazard ratios of bleeding, recurrent MI, and all-cause mortality in MI patients with and without AS treated with DAPT. Results from both countries were also combined in a meta-analysis. ResultsWe included 50,460 MI patients from Sweden and 50,307 MI patients from Denmark, of which 3% had AS. The bleeding rates (per 100 person-years) in Sweden and Denmark were 3.2 and 3.3 among patients without AS vs. 9.2 and 8.3 among patients with AS. All-cause mortality rates were 7.1 vs. 28.7 in Sweden and 5.8 vs. 30.7 in Denmark among patients without and with AS, respectively. Patients with AS had an increased risk of bleeding, recurrent MI and all-cause mortality. Combined results from both countries were similar for bleeding (hazard ratio 1.59 [0.98–2.59]), recurrent MI (1.78 [1.25–2.54]), and all-cause mortality (1.76 [1.26–2.47]). ConclusionAS was associated with an increased risk of bleeding, recurrent MI and mortality after MI when treated with DAPT. Individualized selection of antiplatelet therapy may be warranted in this high-risk population.

Age-Specific Sex-Based Differences in Anemia in Patients with Myocardial Infarction.

Background: Data are lacking concerning possible age-specific sex-based differences in anemia in myocardial infarction (MI) patients and its association with the outcome. The aim was to assess whether these differences in anemia (on admission and at discharge) in MI patients who underwent percutaneous coronary intervention (PCI) are associated with the outcome. Methods: Data from 5579 MI patients (31.0% women) undergoing PCI at our institution were analyzed. Men and women in different age groups were compared regarding anemia and its association with the 30-day and long-term all-cause mortality. Data were analyzed using descriptive statistics. Results: Women suffered anemia more than men (37.5% vs. 26.8%; p < 0.0001). The prevalence of anemia increased rapidly with age in men but not in women. A J-shaped relationship between age and anemia was found in women. The lower the age, the greater the difference in the prevalence of anemia between the sexes. The difference in the prevalence of anemia at discharge was even more pronounced. Anemia on admission (odds ratio [OR] = 1.39; 95% confidence interval [CI] = 1.10-1.76; p = 0.005) and at discharge (OR = 2.61; 95% CI = 1.98-3.44; p < 0.0001) predicted a higher 30-day mortality. Women had a better adjusted long-term prognosis (hazard ratio [HR] = 0.78; 95% CI = 0.69-0.87; p < 0.0001) for the total population. Anemia on admission (HR = 1.43; 95% CI = 1.29-1.60; p < 0.0001) and at discharge (HR = 1.96; 95% CI = 1.23-2.21; p < 0.0001) predicted a higher long-term mortality. Conclusion: Younger women with MI suffer anemia more frequently than their male peers. Anemia was associated with a worse outcome. Age-specific sex-based differences in anemia help to explain the increased sex-related mortality in MI patients undergoing PCI.

Association of Serum Cholesterol Efflux Capacity With Mortality in Patients With ST-Segment Elevation Myocardial Infarction

BackgroundSerum cholesterol efflux capacity, a biomarker that integrates contributors and modulators of the initial step of the reverse cholesterol transport, has been associated with atherosclerosis independently of high-density lipoprotein (HDL) cholesterol level. ObjectivesThe authors evaluated the prognostic impact of serum cholesterol efflux capacity on mortality in a large cohort of patients hospitalized for an acute myocardial infarction (MI). MethodsSerum cholesterol efflux capacity, cholesteryl ester transfer protein (CETP) activity, total cholesterol, low-density lipoprotein cholesterol, HDL cholesterol, and triglyceride levels were measured in 1,609 consecutive patients admitted with an acute MI. The primary endpoint was all-cause mortality evaluated at 6 years with a median follow-up of 1.9 years (interquartile range: 1.5 to 4.2 years). An analysis by quartile of serum cholesterol efflux capacity was also performed. ResultsIn a fully adjusted model that included age, sex, traditional cardiovascular risk factors including lipid levels, and prognostic factors of MI, serum cholesterol efflux capacity was a strong predictor of survival (adjusted hazard ratio for mortality per 1-SD increase in serum cholesterol efflux capacity, 0.79; 95% confidence interval: 0.66 to 0.95; p = 0.0132). Patients displaying an elevated serum cholesterol efflux capacity had a marked lower rate of mortality at 6 years (adjusted hazard ratio: 0.54 [0.32 to 0.89]; p = 0.0165) as compared with patients with reduced serum cholesterol efflux capacity. ConclusionsSerum cholesterol efflux capacity, an integrative marker of reverse cholesterol transport pathway and efficacy, was inversely associated with all-cause mortality in MI patients independently of HDL cholesterol level and other risk factors.

Predicting Sudden Deaths Following Myocardial Infarction in Malaysia Using Machine Learning Classifiers

Myocardial infarction (MI) is among the top causes of death in Malaysia. The mortality rate following MI was high, especially within the first 30 days after the onset. This paper study the ability of k-Nearest Neighbors (kNN) and Naïve Bayes algorithms to predict the 30-day mortality of MI patients, using. The dataset used for this study is provided by National Cardiovascular Disease Database (NCVD) which consist of 2840 MI patients from hospitals in Malaysia. The sudden death predictions made by the machine learning are based on the age, gender, year of onset, smoking habit, BMI, diabetes, hypertension and cholesterol level. The result suggests that kNN algorithm has better performance in predicting the sudden death compared to Naïve Bayes. The number of independent variables plays an important role in mortality prediction, and removing insignificant variables improve the performance.

Percutaneous coronary intervention reduces mortality in myocardial infarction patients with comorbidities: Implications for elderly patients with diabetes or kidney disease

BackgroundPercutaneous coronary intervention (PCI) reduces mortality in most myocardial infarction (MI) patients but the effect on elderly patients with comorbidities is unclear. Our aim was to analyse the effect of PCI on in-hospital mortality of MI patients, by age, sex, ST elevation on presentation, diabetes mellitus (DM) and chronic kidney disease (CKD). MethodsCohort study of 79,791 MI patients admitted at European hospitals during 2000–2014. The effect of PCI on in-hospital mortality was analysed by age group (18–74, ≥75years), sex, presence of ST elevation, DM and CKD, using propensity score matching. The number needed to treat (NNT) to prevent a fatal event was calculated. Sensitivity analyses were conducted. ResultsPCI was associated with lower in-hospital mortality in ST and non-ST elevation MI (STEMI and NSTEMI) patients. The effect was stronger in men [Odds ratio (95% confidence interval) 0.30 (0.25–0.35)] than in women [0.46 (0.39–0.54)] aged ≥75years, and in NSTEMI [0.22 (0.17–0.28)] than in STEMI patients [0.40 (0.31–0.5)] aged <75years. PCI reduced in-hospital mortality risk in patients with and without DM or CKD (54–72% and 52–73% reduction in DM and CKD patients, respectively). NNT was lower in patients with than without CKD [≥75years: STEMI=6(5–8) vs 9(8–10); NSTEMI=10(8–13) vs 16(14–20)]. Sensitivity analyses such as exclusion of hospital stays <2days yielded similar results. ConclusionsPCI decreased in-hospital mortality in MI patients regardless of age, sex, and presence of ST elevation, DM and CKD. This supports the recommendation for PCI in elderly patients with DM or CKD.

Sex-Related 30-Day and Long-Term Mortality in Acute Myocardial Infarction Patients Treated with Percutaneous Coronary Intervention.

The data on sex as an independent risk factor for death in acute myocardial infarction (MI) patients are still contrasting. The aim was to assess how sex influences 30-day and long-term all-cause mortality in MI patients undergoing percutaneous coronary intervention (PCI). Data from 3624 MI patients undergoing PCI at our institution from January 2009 to December 2014, 30.6% were women, were analyzed. A propensity-matched analysis was performed to adjust for differences in the baseline characteristics between men and women. The effect of sex on 30-day and long-term mortality was observed. Multivariate logistic regression modeling was used for 30-day mortality and Cox regression analysis for long-term mortality. The median follow-up time was 27 months (25th, 75th percentile: 9, 48). Women had a significantly higher unadjusted 30-day (5.9% in men vs. 9.5% in women; p < 0.0001) and long-term mortality (13.5% in men vs. 19.0% in women; p < 0.0001). In a propensity-matched analysis, female sex was not associated with a higher 30-day (adjusted odds ratio: 1.46; 95% confidence interval: 0.97-2.19) or long-term mortality (hazard ratio 1.02; 95% CI 0.81-1.28). Age older than 77 years, cardiogenic shock, PCI of left anterior descending artery (LAD), thrombolysis in myocardial infarction (TIMI) flow less than 3 after PCI, hypertension, dyslipidemia, and P2Y12 receptor antagonists were identified as independent predictors of 30-day and long-term mortality. In addition, renal failure requiring dialysis predicted long-term mortality. Older age, comorbidities, worse clinical presentation, and adjunctive pharmacotherapy rather than sex may explain the higher mortality rate in women with MI undergoing PCI.

Editor’s Choice- Gender difference in prognostic impact of in-hospital bleeding after myocardial infarction – data from the SWEDEHEART registry

Bleeding complications increase mortality in myocardial infarction patients. Potential gender difference in bleeding regarding prevalence and prognostic impact is still controversial. Gender comparison regarding incidence and prognostic impact of bleeding in patients hospitalised with myocardial infarction during 2006-2008. Observational study from the SWEDEHEART register. Outcomes were in-hospital bleedings, in-hospital mortality and one-year mortality in hospital survivors. A total number of 50,399 myocardial infarction patients were included, 36.6% women. In-hospital bleedings were more common in women (1.9% vs. 3.1%, p<0.001) even after multivariable adjustment (odds ratio (OR) 1.17, 95% confidence interval (CI) 1.01-1.37). The increased risk for women was found in ST-elevation myocardial infarction (OR 1.46, 95% CI 1.10-1.94) and in those who underwent percutaneous coronary intervention (OR 1.80, 95% CI 1.45-2.24). In contrast the risk was lower in medically treated women (OR 0.79, 95% CI 0.62-1.00). After adjustment, in-hospital bleeding was associated with higher risk of one-year mortality in men (OR 1.35, 95% CI 1.04-1.74), whereas this was not the case in women (OR 0.97, 95% CI 0.72-1.31). Female gender is an independent risk factor of in-hospital bleeding after myocardial infarction. A higher bleeding risk in women appeared to be restricted to invasively treated patients and ST-elevation myocardial infarction patients. Even though women have higher short- and long-term mortality, there was no difference between the genders among bleeders. After multivariable adjustment the prognostic impact of bleeding complications was higher in men.

Short-term effects of atmospheric particulate matter on myocardial infarction: a cumulative meta-analysis.

Atmospheric particulate matter (PM) is hypothesized to increase the risk of myocardial infarction (MI). However, the epidemiological evidence is inconsistent. We identified 33 studies with more than 4 million MI patients and applied meta-analysis and meta-regression to assess the available evidence. Twenty-five studies presented the effects of the PM level on hospitalization for MI patients, while eight studies showed the effects on mortality. An increase in PM10 was associated with hospitalization and mortality in myocardial infarction patients (RR per 10 μg/m(3) = 1.011, 95% CI 1.006-1.016; RR per 10 μg/m(3) = 1.008, 95 % CI 1.004-1.012, respectively); PM2.5 also increased the risk of hospitalization and mortality in MI patients (RR per 10 μg/m(3) = 1.024, 95% CI 1.007-1.041 for hospitalization and RR per 10 μg/m(3) = 1.012, 95% CI 1.010-1.015 for mortality). The results of the cumulative meta-analysis indicated that PM10 and PM2.5 were associated with myocardial infarction with the addition of new studies each year. In conclusion, short-term exposure to high PM10 and PM2.5 levels revealed to increase risk of hospitalization and mortality for myocardial infarction. Policy support of pollution control and individual protection was strongly recommended.

Modeling of in hospital mortality determinants in myocardial infarction patients, with and without stroke: A national study in Iran.

Background:The data and determinants of mortality due to stroke in myocardial infarction (MI) patients are unknown. This study was conducted to evaluate the differences in risk factors for hospital mortality among MI patients with and without stroke history.Materials and Methods:This study was a retrospective, cohort study; 20,750 new patients with MI from April, 2012 to March, 2013 were followed up and their data were analyzed according to having or not having the stroke history. Stroke and MI were defined based on the World Health Organization's definition. The data were analyzed by logistic regression in STATA software.Results:Of the 20,750 studied patients, 4293 had stroke history. The prevalence of stroke in the studied population was derived 20.96% (confidence interval [CI] 95%: 20.13–21.24). Of the patients, 2537 (59.1%) had ST-elevation MI (STEMI). Mortality ratio in patients with and without stroke was obtained 18.8% and 10.3%, respectively. The prevalence of risk factors in MI patients with and without a stroke is various. The adjusted odds ratio of mortality in patients with stroke history was derived 7.02 (95% CI: 5.42–9) for chest pain resistant to treatment, 2.39 (95% CI: 1.97–2.9) for STEMI, 3.02 (95% CI: 2.5–3.64) for lack of thrombolytic therapy, 2.2 (95% CI: 1.66–2.91) for heart failure, and 2.17 (95% CI: 1.6–2.9) for ventricular tachycardia.Conclusion:With regards to the factors associated with mortality in this study, it is particularly necessary to control the mortality in MI patients with stroke history. More emphasis should be placed on the MI patients with the previous stroke over those without in the interventions developed for prevention and treatment, and for the prevention of avoidable mortalities.

Acute Stress Disorder Symptoms Predict All-Cause Mortality Among Myocardial Infarction Patients: a 15-Year Longitudinal Study.

Studies have recognized myocardial infarction (MI) as a risk for acute stress disorder (ASD), manifested in dissociative, intrusive, avoidant, and hyperarousal symptoms during hospitalization. This study examined the prognostic role of ASD symptoms in predicting all-cause mortality in MI patients over a period of 15years. One hundred and ninety-three MI patients filled out questionnaires assessing ASD symptoms during hospitalization. Risk factors and cardiac prognostic measures were collected from patients' hospital records. All-cause mortality was longitudinally assessed, with an endpoint of 15years after the MI. Of the participants, 21.8% died during the follow-up period. The decedents had reported higher levels of ASD symptoms during hospitalization than had the survivors, but this effect became nonsignificant when adjusting for age, sex, education, left ventricular ejection fraction, and depression. A series of analyses conducted on each of the ASD symptom clusters separately indicated that-after adjusting for age, sex, education, left ventricular ejection fraction, and depression-dissociative symptoms significantly predicted all-cause mortality, indicating that the higher the level of in-hospital dissociative symptoms, the shorter the MI patients' survival time. These findings suggest that in-hospital dissociative symptoms should be considered in the risk stratification of MI patients.

Epidemiological pattern of myocardial infarction and modelling risk factors relevant to in-hospital mortality: the first results from the Iranian Myocardial Infarction Registry.

Myocardial infarction (MI) care and treatment contribute greatly to the patients' fatality and mortality. Assessing and monitoring mortalities and the effective factors are necessary in MI care and treatment programs. No comprehensive and population-based study has yet been conducted in Iran to determine the epidemiological pattern of MI, and particularly in-hospital mortality rate and the effective factors. To determine the epidemiological pattern of MI based on person-, time-, place-, and mortality-associated risk factors. This was a prospective, population-based cohort study, which analysed the data of 20,750 MI patients in Iran in 2012. MI was diagnosed based on ICD-10: codes I21 and I22. The cohort of the patients was defined in terms of the date at diagnosis, hospitalisation, and the date at discharge (recovery or death due to MI). The in-hospital mortality rate was calculated by Cox regression. Univariate analysis and multiple logistic regression were used to determine the effective factors on the patients' mortality. The odds ratio (95% confidence interval [CI]) was reported using Stata software. The relative frequency of in-hospital mortality was 12.1%. The in-hospital mortality rate was higher in women than in men, and 6.74 (95% CI 6.4-7.0) per 100 person-years were at risk of death. The highest relative mortality (13.2%) was obtained in January (11 Dey to 11 Bahman in the Persian calendar) and the lowest (5.9%) in May (11 Ordibehest to 10 Khordad in the Persian calendar). Age of over 84 years, female gender, educational level, smoking, lack of thrombolytic therapy, type 2 diabetes, chest pain prior to arriving in hospital, right bundle branch block, ventricular tachycardia, percutaneous coronary intervention, lateral MIs, and ST segment elevation myocardial infarction (STEMI) were determinants of in-hospital mortality in the patients. The relative frequency of mortality was higher from STEMI (83.7% of deaths in registry) vs. non-STEMI (16.3% of deaths in registry). STEMI, lack of thrombolytic therapy, age of over 84 years, and ventricular tachycardia have the greatest effect on in-hospital mortality in MI patients. The results of this study are helpful in planning for monitoring and promotion of healthcare of the patients.

Inflammatory Bowel Disease Does Not Impact Mortality, but Increases Length of Hospitalization in Patients with Acute Myocardial Infarction

Purpose: A previous study has reported a survival advantage in patients with acute myocardial infarction (MI) who have rheumatoid arthritis. However, the outcomes of acute MI in patients with inflammatory bowel disease (IBD) (i.e. ulcerative colitis [UC] or Crohn's disease [CD]) are unknown. Methods: We performed a cross-sectional study, utilizing data from the Nationwide Inpatient Sample (NIS) from the years 1998-2010, to determine outcomes of MI in patients with UC and CD. ICD-9-CM codes were used to identify patients with CD (555.X), UC (556.X), and acute MI (410.X). First, we used logistic regression to determine the effect of UC and CD on MI mortality after adjusting for potential confounders. Then we compared the outcomes in MI patients who had UC and CD to matched MI patients without UC or CD. Matching was done for sex, Charlson Comorbidity Index (CCI), subtype of MI, primary payer, weekend admission, emergent or urgent admission, hospital region, urban location of hospital, teaching hospital status, calendar year (all exact match), age (+/- 2 years), and annual hospital MI volume (+/- 100). Results: Over 13 years, NIS contained data on 2,629,161 MI patients, of whom 3,607 had UC and 3,784 had CD. After applying sample weights, this is representative of 12,958,453 MI, 17,883 UC, and 18,809 CD patients. On multivariate logistic regression, UC (OR 1.12, 95% CI: 0.98-1.29) and CD (OR: 0.99, 95% CI: 0.86-1.15) did not affect in-hospital mortality in MI patients. The predictors of mortality from MI are shown in Figure 1. In the matched sample, there was no difference in MI in-hospital mortality in patients with UC vs. without UC (7.75% vs. 7.05%; P=0.25) or patients with CD vs. without CD (6.50% vs. 6.59%; P= 0.87). Table 1 shows the length of stay and total charges in the matched data set.Figure 1: Forest plot that shows the predictors of mortality.Table: Table. Shows the length of stay and total charges in the matched datasetConclusion: This study shows that having IBD does not impact in-hospital mortality from MI. However, MI patients with IBD have longer length of hospitalization compared to those without. In addition, MI patients with UC had higher total charges for hospitalization.

Cholesterol levels and the association of statins with in-hospital mortality of myocardial infarction patients insights from a Chilean registry of myocardial infarction.

Hypercholesterolemia is a strong risk factor for myocardial infarction (MI). There is scarce information regarding lipoprotein levels among patients with MI in Latin America as well as about the association of very early statin therapy during the course of acute MI. Very early statin prescription might be associated with a reduction on in-hospital mortality in MI patients with nearly normal lipid levels. Prospective registry database analysis of MI patients admitted between 2001 and 2007 at a single university hospital from which demographics, treatments, clinical variables, and mortality were assessed. Patients naïve to statin therapy were divided in 2 groups, according to whether they received (group A) or did not receive (group B) statins during the first 24 hours after admission. In the 1465 patients analyzed, mean plasma levels of total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol (HDL-C) were 197, 117, and 44 mg/dL, respectively, and 41.8% had HDL-C ≤40 mg/dL. Among statin naïve patients (n = 1272), 67% were classified in group A and 33% in group B. Overall in-hospital mortality was 4.1%: 1.8% in group A and 8.5% in group B. In the multivariate analysis, including propensity score for statin prescription, the odds ratio for in-hospital mortality for group A was 0.971 (95% confidence interval: 0.944-0.999, P = 0.04). In the Chilean registry of MI patients, low HDL-C was the main lipid disturbance. Very early statin use after MI appears to be associated with a borderline significant and independent reduction of in-hospital mortality.