Onset Of Myocardial Infarction Research Articles

Cumulative incidence and risk factors of myocardial infarction during 21 years of follow-up: comparing two cohorts of middle-aged men born 30 years apart

Abstract Background The morbidity and mortality burden associated with coronary artery disease (CAD) has declined over the past decades which are believed to be attributable to reductions in the prevalence of major cardiovascular risk factors alongside with improvements in acute management of myocardial infarction (MI). Nevertheless, CAD remains one of the leading causes of death globally. Recent studies indicated that some major cardiovascular risk factors have been modified over time, with decreasing number of smokers and hypercholesterolemia and increasing rates of obesity and diabetes. This may have impact on the incidence of CAD. Therefore, further understanding of changes of major risk factors for CAD overtime is needed. Aim To study cumulative incidence and predictors of MI in two random general population samples consisting of middle-aged men born 30 years apart. Method The "Study of Men Born In 1913" and the "Study of Men Born In 1943" are two longitudinal cohort studies investigating cardiovascular risk factors and diseases, performed in the same geographic area and using the same methodology, with repeated examinations. Both cohorts were followed prospectively for 21 years from the 50 years of age. MI was defined as new onset of myocardial infarction, fatal or non-fatal. Results A total number of 1625 participants were included in the study. Men born in 1943 had a 34% lower risk of acute MI [HR 0.66 (0.50-0.88), p=0.0051] during follow-up as compared to men born in 1913. Both cohorts had similar risk factors and hypertension was associated with at least 2-fold higher risk for incident MI in men born in 1943 [HR 2.33 (95% CI 1.41 - 3.83)], p=0.0009 as compared to the risk in men born in 1913 [HR: 1.10 (0.74-1.62)]. Conclusion Despite declining incidence of MI the last five decades, risk profile of MI remained almost the same, and hypertension became an increasingly prominent risk factor to MI. Greater efforts should be dedicated in primary prevention in order to further reduce the risk of MI.

Improving myocardial infarction emergency care: a joint intervention study of the Berlin Brandenburg Myocardial Infarction Registry (B2HIR) and emergency medical services (QS-Notfall)

Abstract Background Rapid myocardial reperfusion is needed to improve clinical outcome after a ST-elevation myocardial infarction (STEMI). Missed early explicit STEMI diagnoses were shown to unfavourably delay STEMI care. A networked approach between emergency medical systems (EMS) and cardiology hospital departments is useful to establish early valid pre-hospital STEMI diagnoses. Purpose The publicly funded "QS-Notfall" joint health services research study intended to improve STEMI care in Berlin (BE) and Brandenburg (BB) by implementing pre-hospital tele-ECG transmission and online ECG training for EMS personnel. Methods As part of B2HIR, 21 cardiology hospital departments (19 in BE, 2 in BB) together with EMS (BE firefighters and regional BB EMS), supported by the Berlin Medical Chamber, established 2 joint interventions to accelerate STEMI care. All EMS and hospitals implemented GDPR compliant telemedical transmission and structured handling of pre-hospital ECGs from patients with chest pain. In addition, we developed an ECG e-learning for emergency physicians and EMS personnel ("STEMI einfach erkennen") and communication between EMS and hospitals was enforced. Patients with acute myocardial infarction (AMI) and symptom onset ≤24h were enrolled. Symptom onset, first medical contact, time of hospital admission ("door"), time of guidewire passage into the coronary artery (reperfusion), and respective care delays were assessed. First obtained ECGs were blindly validated by 3 expert cardiologists. We compared a reference period to a 12-month intervention period with regard to care delays. In addition, STEMI care was analyzed according to the actual use of telemedical ECG transmission and according to the validity of ECG diagnoses. Results N=7303 cases were enrolled (reference period 3657, intervention period 3646, age 66.9y, 27.1% female, STEMI 49.4%). The usage of ECG transmission varied notably between hospitals (7.5%–74%). Tele EMS ECG usage in STEMI was associated with shorter door to reperfusion time (BB 11min, p<0.04, BE 12min, p<0.001) compared to STEMI care w/o ECG transmission. The difference was more pronounced during hospital off-hours (BB 30min, p=0.003 and BE 14min, p<0.001). An unmistaken EMS STEMI diagnosis related to a shorter door to reperfusion time (BE: by 106min; BB: by 49min) compared to an unsettled STEMI diagnosis (p<0.001). The rate of ECG transmission for STEMI patients in BE was 21.4%, in BB 55.7%. Accordingly, we found no significant difference in STEMI door to reperfusion delays between the reference period and the intervention period in BE (+1min) and a shorter reperfusion delay (by 11min) in BB (p=0.049). Conclusions The universal implementation of a joint intervention to improve STEMI care in a complex system of various EMS and hospital departments is challenging. Telemedical ECG transmission and an unmistaken early STEMI diagnosis are associated with a significantly shorter time delay to myocardial reperfusion.

Variations in the costs of atrial fibrillation: a longitudinal study across 27 European and Central Asian countries

Abstract Background/Introduction For many conditions, disease complications are the main driver of care costs. Atrial fibrillation (AF) – the commonest manifestation of cardiac arrhythmia – increases the risk of stroke and coronary heart disease, both of which are costly. Although the clinical burden of AF is widely documented, it is unknown to what extent AF-related complications contribute to healthcare costs and if these costs vary across countries. Purpose To assess the individual patient healthcare costs associated with AF-related complications and their variation across 27 European and Central Asian countries. Methods We used data from the European Society of Cardiology’s Atrial Fibrillation General Registry, a prospective, multinational registry of 10,249 atrial fibrillation patients from 27 countries with two-years of annual follow-up. Information on patients’ clinical characteristics, healthcare visits, as well as diagnostic and interventional procedures were collected at each visit. Atrial fibrillation related complications were angina, non-ST-elevation myocardial infarction (NSTEMI), ST-elevation myocardial infarction (STEMI), thromboembolic events, haemorrhagic events, and new onset or worsening heart failure. All healthcare resource use (inpatient stays, outpatient visits, and medications) were costed using 2019 UK unit costs to better assess variations in overall resource use across countries. We used panel data methods to assess the association of AF-related complications and healthcare costs and resource use. The models were adjusted for patients’ clinical and sociodemographic characteristics, prior medication use and geographical location. Results Over the follow-up period, 745 (8%) patients had an AF-related complication at 12-months and 477 (6%) at 24-months. Of the total 1,222 complications, the most common AF-related complication was new onset or worsening heart failure which occurred in 567 (3%) patients with complications. Overall, angina (£2,629, 95% CI: 1869 to 3361) and haemorrhagic events (£2,549, £2,199 to £2,900) incurred the highest cost, whereas non-stable myocardial infarction (£1,367, £687 to £2,048) incurred the least additional cost. We found significant regional variation. Costs of angina in Eastern EU and in non-EU former Soviet republics were, respectively, £1,362 (-£2,262 to -£461) and £1,416 (-£2,571 to -£261) lower than in Western Europe. Whereas costs in Southern EU and Northern EU countries were £721 (-£2,629 to £1,186) and £344 (-£1,460 to £ 674) lower than in Western Europe. Conclusions Although disease complications are costly in all countries, notable differences were observed across countries. These differences were driven by fewer investigations, clinic visits, and ER admissions. Our results, therefore, highlight the regional variations in resource use patterns across countries, limiting the generalisability of country-specific economic evaluations to other jurisdictions.

Automatic measurement of short-term variability of repolarization to indicate ventricular arrhythmias in a porcine model of cardiac ischaemia.

An automated method for determination of short-term variability (STV) of repolarization on intracardiac electrograms (STV-ARIauto) has previously been developed for arrhythmic risk monitoring by cardiac implantable devices, and has proved effective in predicting ventricular arrhythmias (VA) and guiding preventive high-rate pacing (HRP) in a canine model. Current study aimed to assess (i) STV-ARIauto in relation to VA occurrence and secondarily (ii-a) to confirm the predictive capacity of STV from the QT interval and (ii-b) explore the effect of HRP on arrhythmic outcomes in a porcine model of acute myocardial infarction (MI). Myocardial infarction was induced in 15 pigs. In 7/15 pigs, STV-QT was assessed at baseline, occlusion, 1 min before VA, and just before VA. Eight of the 15 pigs were additionally monitored with an electrogram catheter in the right ventricle, underwent echocardiography at baseline and reperfusion, and were randomized to paced or control group. Paced group received atrial pacing at 20 beats per min faster than sinus rhythm 1 min after occlusion. Short-term variability increased prior to VA in both STV modalities. The percentage change in STV from baseline to successive timepoints correlated well between STV-QT and STV-ARIauto. High-rate pacing did not improve arrhythmic outcomes and was accompanied by a stronger decrease in ejection fraction. STV-ARIauto values increase before VA onset, alike STV-QT in a porcine model of MI, indicating imminent arrhythmias. This highlights the potential of automatic monitoring of arrhythmic risk by cardiac devices through STV-ARIauto and subsequently initiates preventive strategies. Continuous HRP during onset of acute MI did not improve arrhythmic outcomes.

"We are in the forgotten corner!" a qualitative study of experiences and challenges among Chinese older women at the onset of acute myocardial infarction.

Acute myocardial infarction (AMI) is a common and serious cardiovascular disease (CVD) that is one of the leading causes of death among women globally and in China. However, there are sex-associated differences and inequalities in the detection and management of AMI, especially in older people. There is little research demonstrating how challenges and barriers affect older women's help-seeking behavior and health-related procedures in China. The objective of this study was to explore the experiences of older women with AMI, focusing on their perception, challenges, and coping strategies at the onset of AMI in Wuhan, China. This study utilized a qualitative research design approach and conducted semi-structured, in-depth, and audio-recorded interviews with 18 women aged 65-84 years, purposively selected from two tertiary hospitals in Wuhan City from November 2021 to April 2022. Interpretative Phenomenological Analysis (IPA) was used in this study to analyze the data on 18 participants and three major themes were generated: disease perception disorder, negative coping strategies, and barriers due to social-environmental contexts. To reduce older women's delay in seeking help, healthcare professionals should provide public health education that emphasizes sex-related disparities, and age-specific knowledge-attitude aspects to high-risk groups. Policy-based and health administration recommendations, including e-health information support, access to care, and social-environmental factors, should be highlighted to promote women's health behavior.

Mind the Gap: Model-Based Switching from Selatogrel to Maintenance Therapy with Oral P2Y12 Receptor Antagonists.

Background: The P2Y12 receptor antagonist selatogrel is being developed for subcutaneous self-administration with a ready-to-use autoinjector at the onset of acute myocardial infarction (AMI) symptoms. The unique pharmacological profile of selatogrel (fast, potent, and short-acting) can bridge the time gap between the onset of AMI and first medical care. A clinical Phase 1 study showed a time-dependent pharmacodynamic interaction between selatogrel and loading doses of clopidogrel and prasugrel. As treatment switching is a common clinical practice, the assessment of subsequent switching from a clopidogrel loading dose to the first maintenance dose of oral P2Y12 receptor antagonists is highly relevant. Objectives: Model-based predictions of inhibition of platelet aggregation (IPA) for the drugs triggering pharmacodynamic interactions were to be derived to support clinical guidance on the transition from selatogrel to oral P2Y12 receptor antagonists. Methods: Scenarios with selatogrel 16 mg administration or placebo followed by a clopidogrel loading dose and, in turn, prasugrel or ticagrelor maintenance doses at different times of administration were studied. Population pharmacokinetic/pharmacodynamic modeling and simulations of different treatment scenarios were used to derive quantitative estimates for IPA over time. Results: Following selatogrel/placebo and a clopidogrel loading dose, maintenance treatment with ticagrelor or a prasugrel loading dose followed by maintenance treatment quickly achieved sustained IPA levels above 80%. Prior to maintenance treatment, a short time span from 18 to 24 h was identified where IPA levels were predicted to be lower with selatogrel than with placebo if clopidogrel was administered 12 h after selatogrel or placebo. Predicted IPA levels reached with placebo alone and a clopidogrel loading dose at 4 h were consistently lower than with selatogrel administration, followed by a clopidogrel loading dose at 12 h. If a clopidogrel loading dose is administered at 12 h, selatogrel maintains higher IPA levels up to 16 h. IPA levels are subsequently lower than on the placebo until the administration of the first maintenance dose. Conclusions: Model-based predictions informed the transition from selatogrel subcutaneous administration to oral P2Y12 therapy. The application of modeling techniques illustrates the value of employing pharmacokinetic and pharmacodynamic modeling for the simulation of various clinical scenarios of switching therapies.

Prognosis value of EAS index in patients with obstructive coronary artery disease.

EAS index is reported to be an adjunctive tool for risk stratification in addition to left ventricular ejection fraction (LVEF). This study aimed to verify the predictive value of EAS index among coronary artery disease (CAD) patients with different cardiac systolic function levels. A total of 477 patients with obstructive CAD were included in the exploratory analysis of a prospective cohort between October 2017 and January 2018 at Guangdong Provincial People's Hospital. EAS index, e'/(a' × s'), is a novel parameter assessed by tissue Doppler imaging (TDI) indicating combined diastolic and systolic performance. Any occurrence of major adverse cardiovascular event (MACE) was recorded, including first onset of myocardial infarction, stroke, readmission for heart failure, coronary revascularization, or cardiovascular death that occurred within 6 months of the first admission. Kaplan-Meier survival and Cox regression analyses were applied to testify the predictive value of EAS index for cardiovascular outcome. A total of 415 patients (87.2%) completed the follow-up (median, 25.9 months) and experienced 101 (24.3%) MACEs, 17 (4.0%) deaths, and 139 (33.4%) composite events. Elevated EAS index was significantly associated with a higher incidence of MACE, even after adjustment for age, sex, body mass index, N-terminal pro brain natriuretic peptide, high-sensitivity troponin T, high-density lipoprotein, stenosis degree, and other TDI parameters [Model 3, hazard ratio: 1.81, 95% confidence interval (CI): 1.15-2.85]. For different levels of cardiac function, Kaplan-Meier survival analysis revealed that elevated EAS index was associated with higher MACE incidence only in patients with LVEF ≥50% (P<0.05). EAS index is an independent predictor of MACE in patients with obstructive CAD, which could be utilized as a tool for risk stratification in CAD patients or incorporated into a prediction model to improve efficacy.

Protective role of the nitric oxide synthases system in inter-organ communication

The role of the nitric oxide synthases (NOSs) system in inter-organ communication is not fully understood. We addressed this point in our mice lacking all three NOS isoforms (triple n/i/eNOSs-/- mice). We previously reported that the triple n/i/eNOSs-/- mice spontaneously develop myocardial infarction. However, it takes a long time (approximately 1 year) to develop myocardial infarction. We then revealed that 2/3-nephrectomized triple n/i/eNOSs-/- mice suddenly die due to early onset of myocardial infarction, succeeding in developing an experimentally useful model of myocardial infarction. These results suggest the protective role of NOSs in reno-cardiac communication. We next studied the role of NOSs in bone marrow cells (BM) in vascular lesion formation. Constrictive vascular remodeling and neointimal formation at 14 days after carotid artery ligation were markedly accelerated in wild-type (WT) mice transplanted with triple n/i/eNOSs-/- BM as compared with those with WT BM. These results suggest the protective role of NOSs in BM-vascular communication. We then investigated the role of NOSs in BM in pulmonary hypertension (PH). The extents of PH at 3 weeks after hypoxic exposure were markedly exacerbated in WT mice transplanted with triple n/i/eNOSs-/- BM as compared with those with WT BM, suggesting the protective role of NOSs in BM-lung communication. These lines of evidence indicate that systemic and BM NOSs may be a novel therapeutic target in MI, vascular disease, and PH.

Protectin D1 Alleviates Myocardial Ischemia/Reperfusion Injury by Regulating PI3K/AKT Signaling Pathway.

Myocardial ischemia/reperfusion (I/R) injury after the onset of acute myocardial infarction (AMI) can be life-threatening, and there is no effective strategy for therapeutic intervention. Here, we studied the potential of protectin D1 in protecting from I/R-induced cardiac damages and investigated the underlying mechanisms. An in vivo rat model of I/R after AMI induction was established through the ligation of the left anterior descending (LAD) artery to assess the cardiac functions and evaluate the protective effect of protectin D1. Protectin D1 protected against I/R-induced oxidative stress and inflammation in the rat model, improved the cardiac function, and reduced the infarct size in myocardial tissues. The beneficial effect of protectin D1 was associated with the up-regulation of miRNA-210 and the effects on PI3K/AKT signaling and HIF-1α expression. Together, our data suggest that protectin D1 could serve as a potential cardioprotective agent against I/R-associated cardiac defects.

Cold Spells and the Onset of Acute Myocardial Infarction: A Nationwide Case-Crossover Study in 323 Chinese Cities.

Few studies have explored the relationships between cold spells and acute myocardial infarction (AMI) using the information of symptom onset. We assessed the impact of cold spells on AMI onset and the potential effect modifiers. We conducted a time-stratified case-crossover study among 456,051 eligible patients with AMI from 2,054 hospitals in 323 Chinese cities between January 2015 and June 2021 during cold seasons (November to March). Nine definitions of cold spells were used by combining three relative temperature thresholds (i.e., lower than the 7.5th, 5th, and 2.5th percentiles) and three durations of at least 2-4 consecutive d. Conditional logistic regressions with distributed lag models were applied to evaluate the cumulated effects of cold spells on AMI onset over lags 0-6 d, after adjusting for daily mean temperature. The associations generally appeared on lag 1 d, peaked on lag 3 d, and became nonsignificant approximately on lag 5 d. Cold spells defined by more stringent thresholds of temperature were associated with higher risks of AMI onset. For cold spell days defined by a daily mean temperature of percentile and durations of , , and , the percentage changes in AMI risk were 4.24% [95% confidence interval (CI): 2.31%, 6.20%], 3.48% (95% CI: 1.62%, 5.38%), and 2.82% (95% CI: 0.98%, 4.70%), respectively. Significant AMI risks associated with cold spells were observed among cases from regions without centralized heating, whereas null or much weaker risks were found among those from regions with centralized heating. Patients years of age were more susceptible to cold spells. This national case-crossover study presents compelling evidence that cold spells could significantly increase the risk of AMI onset. https://doi.org/10.1289/EHP11841.

Theory-based cognitive–narrative intervention versus didactic education for promoting prompt care-seeking for acute myocardial infarction: A multisite mixed-methods randomized controlled trial

BackgroundProlonged delays by patients in making care-seeking decisions remain a significant obstacle to the effective management of acute myocardial infarction. ObjectivesThis study aimed to compare the effects of a theory-based cognitive–narrative intervention with those of didactic education over a 24-month period on the participants' attitudes, beliefs, and knowledge regarding acute myocardial infarction, prehospital delay time, and the use of an ambulance. We also explored participants' engagement in the intervention. DesignThis study adopted a sequential mixed-methods design comprising a multisite randomized controlled trial and a qualitative study. MethodsCommunity-dwelling adult patients with a prior history of acute myocardial infarction in the past year were recruited from four hospitals in Hong Kong. They were randomly assigned to an 8-week theory-based cognitive–narrative intervention that involved a vivid experience of complex decision-making or didactic education. The Acute Coronary Syndrome Response Index questionnaire was administered at baseline (T0) and at 3- (T1), 12- (T2), and 24-month (T3) follow-up time points. Prehospital delay time and the use of an ambulance were evaluated for those participants who had recurrent acute myocardial infarction attacks during the study period. ResultsA total of 608 participants were randomly assigned to the theory-based cognitive–narrative intervention group (n = 304) or the didactic education group (n = 304). The intervention group reported greater improvements than the control group in their attitudes (β = −1.053, p = 0.002) and beliefs (β = −0.686, p = 0.041) regarding acute myocardial infarction and care-seeking at T1. These effects were sustained at T2 [attitudes (β = −0.797, p = 0.018); beliefs (β = −0.692, p = 0.047)] and T3 [attitudes (β = −0.717, p = 0.024); beliefs (β = −0.701, p = 0.032)]. Sixty-three participants experienced another acute myocardial infarction event by T2. The median delay times for the intervention and control groups were 3.13 h (interquartile range (IQR: 1.15–6.48)) and 4.82 h (IQR: 2.23–9.02), respectively. The prehospital delay time was significantly reduced in the intervention group compared with the control group (β = −0.07, p = 0.011). The qualitative findings echoed the quantitative findings, as participants indicated that the intervention helped them to understand the variable nature of the disease presentation, which enabled them to recognize the symptoms more readily. ConclusionThe novel cognitive–narrative intervention used in this study effectively improved the participants' attitudes and beliefs regarding acute myocardial infarction and reduced the prehospital delay time. Trial registrationThis study was registered with the International Clinical Trials Registry Platform of the World Health Organization (ChiCTR-IIC-17010576) on February 2, 2017; the first participant was recruited on January 11, 2018.

An Experimental Model of Myocardial Infarction for Studying Cardiac Repair and Remodeling in Knockout Mice.

Cardiovascular disease is the most prevalent cause of death in Western countries, with acute myocardial infarction (MI) being the most prevalent form. This paper describes a protocol for studying the role of galectin 3 (Gal-3) in the temporal evolution of cardiac healing and remodeling in an experimental animal model of MI. The procedures described include an experimental model of MI with a permanent coronary ligature in male C57BL/6J (control) and Gal-3 knockout (KO) mice, an echocardiography procedure to study cardiac remodeling and systolic function in vivo, a histological evaluation of interstitial myocardial fibrosis with picrosirius red-stained and rhodamine-conjugated lectin-stained sections for studying myocyte hypertrophy by the cross-sectional area (MCSA), and the quantification of infarct size and cardiac remodeling (scar thinning, septum thickness, and expansion index) by planimetry in slices stained with Masson's trichrome and triphenyl tetrazolium chloride. Gal-3 KO mice with MI showed disrupted cardiac remodeling and an increase in the scar thinning ratio and the expansion index. At the onset of MI, myocardial function and cardiac remodeling were also severely affected. At 4 weeks post MI, the natural evolution of fibrosis in infarcted Gal-3 KO mice was also affected. In summary, the experimental model of MI is a suitable model for studying the temporal evolution of cardiac repair and remodeling in mice with the genetic deletion of Gal-3 and other animal models. The lack of Gal-3 affects the dynamics of cardiac repair and disrupts the evolution of cardiac remodeling and function after MI.

Rationale and Study Design of the TSOC-Fully Organized Registry for the Management of Symptomatic ACS Study (T-FORMOSA Study).

Successful implementation of practice guidelines has been challenging in the treatment of acute coronary syndrome (ACS), leaving room for improvement. A nationwide registry can provide more information than that recorded in the National Health Insurance Research Database (NHIRD). We conducted a prospective, nationwide, multi-center ACS full spectrum registry involving 3600 patients admitted to hospitals within 24 hours of the onset of myocardial infarction with ST-segment elevation or ACS without ST-segment elevation. In total, 41 sites including medical centers and regional hospitals were selected across Taiwan. The data for each patient are collected at 3 time points for the main study: during hospitalization, 6 months, and 12 months after the discharge. The milestone for first patient in was reached on January 7, 2022, and complete enrollment is expected before October 2023. The primary aims of the main study are to determine the degree of guideline-directed medical therapies and to identify prognostic predictors associated with 1-year composite outcomes, including death, myocardial infarction, stroke, and unplanned coronary revascularization in ACS patients. Thereafter, the patient data will be analyzed every 3 to 5 years for up to 20 years after discharge using the NHIRD in the extended study. We hypothesized that a greater increase in the implementation of guideline-directed medical therapies can be observed. The results of the current study will add new and important information regarding a broad spectrum of ACS to drive further investigations.

Tackling dynamic prediction of death in patients with recurrent cardiovascular events.

In the field of cardiovascular disease, recurrent events such as stroke or myocardial infarction (MI) are often encountered, leading to an increase in the risk of death. Accurately evaluating the prognosis of patients and dynamically predicting the risk of death by considering the historical recurrent events can improve medical decisions and lead to better health care outcomes. Recently proposed joint modeling approaches within the Bayesian framework have inspired the development of a dynamic prediction tool, which can be applied for subject-level prediction of death with implementation in software packages. The prediction model incorporates subject heterogeneity with subject-level random effects that account for unobserved time-invariant factors and an extra copula function capturing the part caused by unmeasured time-dependent factors. Thereafter, given the prespecified landmark time , the survival probability for a prediction horizon time of interest can be estimated for each individual. The prediction accuracy is assessed by time-dependent receiving operating characteristic curve and the area under the curve and the Brier score with calibration plots is compared to traditional joint frailty models. Finally, the tool is applied to patients with multiple attacks of stroke or MI in the Cardiovascular Health study and the Atherosclerosis Risk in Communities study for illustration.

Air pollution and cardiovascular heath in a changing climate

Air pollution and cardiovascular heath in a changing climate

Association between engagement in exercise training and peak cardiac biomarker concentrations following ST-elevation myocardial infarction

BackgroundRegular exercise training is an important factor in prevention of myocardial infarction (MI). However, little is known whether exercise engagement prior to MI is related to the magnitude of post-MI...

Association of PM2.5 from agriculture sources and acute myocardial infarction onset: results from 2015 to 2018 in China

Background and purpose: Acute myocardial infarction (AMI) is a manifestation of coronary artery disease. Fine particulate matter (PM2.5) has been regarded as a risk factor for AMI-related mortality and hospitalizations. Agricultural activities contribute greatly to PM2.5 formation, indicating potential health risks of PM2.5 in agricultural areas. Health effect studies on agricultural source remain scarce, and currently available evidence is controversial. This study investigated the health effects of short-term exposure to PM2.5 from agricultural sources on AMI onset using a nationwide analysis in China. Methods: We reviewed case records from the China Cardiovascular Association Database and extracted the data of 355,815 patients with AMI onset from 1,653 hospitals for the period 2015 to 2018. We obtained daily concentrations of PM2.5 from agricultural sources using the source-oriented Community Multiscale Air Quality model. Moreover, we proposed a time-stratified case-crossover study to examine associations between exposure to PM2.5 from agricultural sources and AMI onset and determined lag effects with a maximum of 3 days. Additionally, we conducted multiple subgroup and sensitivity analyses. Results: Exposure to PM2.5 caused a significantly increased risk of the onset of AMI and its subtypes. Short-term exposure to PM2.5 from agricultural sources on the current day (lag 0) was positively associated with a 4.4% (95% confidence interval [95% CI]: 3.3%–5.5%), 4.9% (95% CI: 3.5%–6.3%), and 3.4% (95% CI: 1.5%–5.4%) increase in the odds of AMI, ST-elevation myocardial infarction (STEMI), and non-STEMI (NSTEMI), for each 10 μg/m3 increase. Meanwhile, higher risk estimations were pronounced in individuals who were aged above 65 years, who lived in southern China, and who resided in the rural area setting, and significant differences were mostly found in NSTEMI onsets. Conclusions: Short-term exposure to PM2.5 from agricultural sources may trigger the onset of AMI and its two subtypes. Improving agriculture management through ammonia emission abatement can help in achieving PM2.5 reduction and protecting public health.

STUDY OF STRESS HYPERGLYCEMIA AS AN IN-HOSPITAL PROGNOSTIC FACTOR IN ACUTE ST ELEVATION MYOCARDIAL INFARCTION PATIENTS

Introduction: According to the American Diabetes Association and American Association of Clinical Endocrinologists' consensus on inpatient hyperglycemia, any blood glucose level higher than 7.8 mmol/l (140 mg/dl) without symptoms of preceding diabetes is considered stress hyperglycemia or hospital-related hyperglycemia. Methodology: all patients admitted with acute onset of ST-elevation myocardial infarction within 12 hours of onset, age more than 18 and less than 80 years at tertiary care hospitals were included in this study Result: In the case group mean age was 55.4 years while in the control group mean age 57.5 years was In case group mean Hba1c 5.6 and SD 1.0 was while in control group mean Hba1c 5.3 and SD was 1.1 with p value 0.234. Conclusion: Mortality was commonly noted in the stress hyperglycaemic groups. 5(25%) deaths were noted in group, while in euglycemic group 4(11.4%) death were noted in group.

The Difference of Chest Pain in Adult and Elderly Patients with Acute Myocardial Infarction

Chest pain in an acute attack of myocardial infarction cannot be underestimated because this pain will have a harmful impact on the patient. Pain is influenced by personality, life stress, social economic factor, cognitive, and psychology factor. There is no study comparing chest pain between adult and elderly patients with coronary artery disease. Thus, this study to compare chest pain in patients with acute myocardial infarction in adults and the elderly. This research is a quantitative analytic study with a documentation study. With the purposive sampling technique, the number of samples in this study was 68 respondents. The statistical analysis employed the Mann Withney test. Out of total participant ( n=68), 72,1 % were elderly, 60,3 % were male and 79,4 % were STEMI. The results were obtained from the pain scale in adults with a mean value of 54.11 and a mean value at the elderly age 26.90 with a value of p (0.000). There is a significant difference between myocardial infarction pain in adults and acute myocardial infarction pain in the elderly. Adult more high intensity of pain than elderly patients. This study recommended that health workers so provide serious treatment for chest pain patients in elderly althaought the pain is not serious.

Vitamin D levels and &lt;i&gt;TaqI&lt;/i&gt;, &lt;i&gt;BsmI&lt;/i&gt; and &lt;i&gt;ApaI&lt;/i&gt; variants of the vitamin D receptor gene in coronary heart disease patients with disease debut at different ages

Introduction. Vitamin D deficiency may be a natural predictor of the onset of coronary heart disease (CHD) and myocardial infarction (MI) at a young age. The results of studies of the various variants association of the vitamin D receptor (VDR) gene with the risk of CHD are contradictory, which leads to the study of genetic variants of the VDR gene as predictors of the onset of the disease at the age of 45 years and younger in the Russian population. The objective was to determine the distribution of TaqI, BsmI and ApaI genotypes of the VDR gene variants and the level of vitamin D sufficiency in CHD patients with different age of onset of the disease and myocardial infarction, among residents of St. Petersburg. Methods and materials. The study included 410 CHD patients and 320 examined patients without CHD clinical signs of comparable age (p&gt;0.05). All patients with CHD underwent coronary angiography. Typing of VDR gene variants was carried out by polymerase chain reaction and subsequent restriction analysis. Determination of the level of 25(OH)D blood serum was carried out by enzyme immunoassay. Results. The level of 25(OH)D in the blood serum of CHD patients was lower than in the control group (15.61±0.52 ng/ml and 20.82±0.69 ng/ml respectively; p=0.001). Severe 25(OH)D deficiency was detected more often in CHD patients and was associated with an increased risk of CHD (23 % and 8 % respectively; p=0.001, OR=3.54 (1.88÷6.67)). The normal level of 25(OH)D sufficiency was more often detected in patients from the comparison group than in CHD patients, and was associated with a decrease of CHD risk (16 % and 4 % respectively; p=0.0002, OR=OR=0,21 (0,09÷0,48)). The presence of the aa genotype and the a allele (ApaI), the bb genotype and the b allele of the VDR gene (BsmI) is associated with an increased risk of CHD and the onset of the disease and MI at the age of 45 years and younger. Conclusions. Severe 25(OH)D deficiency is typical for CHD patients and was associated with an increased risk of CHD. The presence of the aa genotype and the a allele (ApaI), the bb genotype and the b allele of the VDR gene (BsmI) is associated with an increased risk of CHD and with the onset of the diseases and myocardial infarction at a young age. The TaqI variant of the VDR gene is not associated with the risk of CHD.