Course Of Myocardial Infarction Research Articles

Myocardial infarction mortality after COVID-19: a nationwide population-based cohort study

Abstract Background Coronavirus disease 2019 (COVID-19) is associated with an increased risk of myocardial infarction (MI). Small studies suggest that MI in patients with recent COVID-19 may have a distinct clinical course and a worse prognosis, compared to MI without recent COVID-19. Whether previous COVID-19 vaccination modifies the clinical course of MI after recent COVID-19 is also unknown. Purpose To compare mortality in people with MI with and without recent COVID-19, and to examine the impact of previous COVID-19 vaccination. Methods Using Danish health registries, we conducted a nationwide population-based cohort study comprising all adults (≥18 years) with a first-time MI between 26 May 2020 and 9 March 2022. We excluded patients with <1 year of residence in Denmark prior to their MI. The exposure was recent COVID-19 defined by a positive SARS-CoV-2 PCR test ≤90 days before MI. We followed the patients for 30 days from the date of their MI admission until death (if any), or emigration, whichever came first. We used Cox proportional-hazards regression to compute hazard ratios (HRs) for death within 30 days after MI. Using propensity-score balancing of confounders with stabilised inverse probability weighting, we adjusted for differences in age, sex, DANCAMI comorbidity burden, use of selected medications, and calendar period between MI patients with and without recent COVID-19. We stratified by COVID-19 vaccination status. Results Of 11,919 included patients with MI, 332 patients had COVID-19 within 90 days before MI. The COVID-19 exposed patients were characterised by a larger proportion of males and COVID-19 vaccinations, lower age, and a longer median time from first COVID-19 vaccination to MI compared to the COVID-19 unexposed patients. 34 of the patients with recent COVID-19 (10.2%) and 702 of the patients without recent COVID-19 (6.1%) died within 30 days after their MI, resulting in a crude HR of 1.71 with a 95% confidence interval (CI) of 1.21–2.42 for the patients with recent COVID-19. After adjusting by stabilised inverse probability weighting, this HR further increased to 2.08 (95% CI: 1.23–3.52). Previous COVID-19 vaccination modified this association with a three-fold increased mortality in unvaccinated MI patients with recent COVID-19, while the mortality HR associated with recent COVID-19 was close to one in patients who were previously COVID-19 vaccinated. Conclusion Patients with recent COVID-19 had increased short-term mortality after MI, but only if unvaccinated.

Inhospital outcomes of myocardial infarction in patients receiving direct oral anticoagulants

Aim. To evaluate the clinical course and inhospital outcomes of myocardial infarction (MI) in patients receiving continuous direct oral anticoagulant (DOAC) therapy.Material and methods. Data from 390 patients treated for MI were included in the analysis. The mean age was 64.1±12.8 years. The majority were men (61,5%; n=240). All patients underwent standard diagnostic and therapeutic procedures according to clinical guidelines, including coronary angiography and percutaneous coronary intervention when indicated. Clinical, anamnestic and laboratory data (including C-reactive protein level, troponin I, coagulation test) were analysed. The inhospital course of MI, mortality and incidence of complications were evaluated.Results. Patients were divided into two groups according to DOAC therapy received. The main group included 41 patients with constant DOAC intake, while the control group consisted of 349 patients not receiving DOAC. Patients aged 65 years and older accounted for 68,3% (n=28) of the main group (p=0,0033), with a high proportion of cerebral circulation disorders and venous thrombosis (p<0,01). Atrial fibrillation was diagnosed in 75,6% (n=31) of patients in the main group (p<0,0001). ST elevation MI (STEMI) was seen in 39,0% (n=16) of cases in the main group and 47,3% (n=165) of cases in the control group (p=0,3161). As a result, 85,4% (n=35) of patients in the main group had a high GRACE-1 risk, compared to 50,4% (n=176) in the control group (p<0,0001). The two groups did not differ significantly in the severity of heart failure (p=0,1549). ST-segment resolution on admission electrocardiogram was observed in 43,8% (n=7) of the main group and 18,1% (n=30) of the control group (p=0,0238). According to coronary involvement severity and the type of antegrade flow in the infarct-related artery, patients in both groups were comparable (p>0,05). Prior DOAC administration had no significant effect on the incidence of gastrointestinal bleeding (odds ratio (OR), 3,96 (95% Confidence Interval (CI) 0,76–20,66)) and mortality (OR 1,47 (95% CI 0,37-5,85)) during hospitalization.Conclusion. Patients with MI who received continuous DOAC therapy had significantly more frequent ST-segment resolution at hospital admission compared with patients who did not receive DOAC. DOAC administration had no significant effect on mortality and incidence of inhospital complications of MI.

Clinical characteristics and risk factors of in-hospital mortality among patients undergoing percutaneous pericardiocentesis.

Percutaneous pericardiocentesis represents a salvage procedure in case of cardiac tamponade and diagnostic procedure in chronic pericardial effusion of unknown source. The study aimed to analyze the clinical characteristics of patients subject to pericardiocentesis and the predictors of in-hospital mortality. The study represents a registry that covered consecutive patients undergoing percutaneous pericardiocentesis from 2011 to 2022 in high-volume tertiary reference center. Electronic health records were queried to obtain demographic and clinical variables. The primary endpoint was in-hospital mortality, while secondary endpoint was the need for recurrent pericardiocentesis. Out of 132 456 patients hospitalized in the prespecified period, 247 patients were subject to percutaneous pericardiocentesis (53.9% women; median age of 66 years) who underwent 273 procedures. In-hospital death was reported in 14 patients (5.67%), while recurrent pericardiocentesis in 24 patients (9.72%). Iatrogenic cause was the most common etiology (42.5%), followed by neoplastic disease (23.1%) and idiopathic effusion (14.57%). In logistic regression analysis in-hospital mortality was associated with myocardial infarction (MI)-related etiology (p = 0.001) and recurrent/persistent cardiogenic shock (p = 0.001). Iatrogenic etiology and neoplastic disease seem to be the most common indications for pericardiocentesis, while in-hospital mortality was particularly high in patients with spontaneous tamponade in the course of MI.

Myocardial Infarction in Patients with and without COVID-19: Comparisons of Characteristics, Clinical Courses, and Outcomes.

COVID-19 has rapidly become a global health emergency. This infection can cause damage to various organs. Injury to myocardial cells is one of the salient manifestations of COVID-19. The clinical course and outcome of acute coronary syndrome (ACS) are influenced by various factors, including comorbidities and concomitant diseases. One of these acute concomitant diseases is COVID-19, which can affect the clinical course and outcome of acute myocardial infarction (MI). The present cross-sectional study compared the clinical course and outcome of MI and some of its practical factors between patients with and without COVID-19. The study population consisted of 180 patients (129 males and 51 females) diagnosed with acute MI. Eighty patients had COVID-19 infection concurrently. The mean age of the patients was 65.62 years. The frequencies of non-ST-elevation MI (vs ST-elevation MI), lower ejection fractions (<30), and arrhythmias were significantly higher in the COVID-19 group than in the non-COVID-19 group (P=0.006, 0.003, and P<0.001, respectively). The single-vessel disease was the most frequent angiographic result in the COVID-19 group, while the double-vessel disease was the most frequent angiographic result in the non-COVID-19 group (P<0.001). It appears that patients with ACS who are co-infected with COVID-19 infection need essential care.

Type 2 myocardial infarction: the potential for early detection

Aim. To evaluate the potential of using factors associated with type 2 myocardial infarction (MI) for its early diagnosis.Material and methods. This prospective study included 204 patients diagnosed with acute coronary syndrome (ACS). At the time of admission, each patient underwent standard examinations for ACS patients. The 1-year stage consisted of telephone survey of patients on the course of long-term postinfarction period. There were following endpoints: death, recurrent coronary events and hospitalization.Result. Patients with type 2 MI accounted for 10,8% (n=22) of the entire analyzed sample. A model for prehospital diagnosis of probable type 2 MI has been developed. The model included clinical and history data that allow to suggest the type 2 MI course without invasive and laboratory studies. The model included signs (body mass index ≥35, kg/m2, atrial fibrillation+Killip I, hemoglobin &lt;110 g/l within 1 year before MI, chronic obstructive pulmonary disease), the most common in type 2 MI patients according to own data and previous studies.Conclusion. A model of prehospital clinical assessment of MI risk has been developed for making a preliminary diagnosis and forming different patient streams at the admission stage for the final verification of the diagnosis.

The results of the use of thrombolytic therapy in acute myocardial infarction at the prehospital and hospital stage

The aim of the study was study of the use of thrombolytic therapy (TLT) in patients with myocardial infarction (MI) with ST segment elevationat the prehospital and hospital stage. The study included 181 patients with ST elevation MI. Depending on the thrombolytic used, the patients were divided into two groups: patients treated with streptokinase were included in the 1st group (n=78); the 2nd group (n=51) included patients with MI with ST segment elevation, who did not undergo TLT due to late seeking medical help or the presence of contraindications. TLT was performed both at the prehospital stage and in a hospital setting. We analyzed the time before TLT, the clinical course of MI, mortality, and complications. The time from the onset of clinical symptoms was 2.70.22 hours. The high efficiency of these thrombolytics was established in 66% of patients. Mortality during TLT was 6.4–7.7%, without TLT - 24%. Carrying out TLT in the first 3 hours from the onset of a heart attack was accompanied by a decrease in mortality to 3.4%. Not a single case of intracranial hemorrhage and allergic reactions was recorded.± TLT with streptokinase in patients with MI with ST segment elevation on the ECG in real clinical practice was characterized by high efficiency, a decrease in hospital mortality, complications, and a low percentage of side effects.

Течение инфаркта миокарда у женщин трудоспособного возраста

The incidence of myocardial infarction (MI) among women of working age has continued to grow in recent years, being a great socio-economic problem. The purpose — to study the features of MI course in women under the age of 60. Results. The following risk factors were identified: hyperlipidemia (74.2%), arterial hypertension (AH) (69.4%), smoking (35.5%), obesity (37.1%), and diabetes mellitus (DM) (29.0%). Hyperuricemia (HU) occurred in 38.7% of patients. Repeated MI was observed in 3.2% of patients. Anterior and lower MI occurred with approximately the same frequency (45.2% and 40.3%, respectively). The percentage of coronary artery (CA) lumen stenosis was 81.2 ± 19.6%. Thrombosis with complete CA occlusion was detected in 61.3%. The percentage of brachiocephalic artery (BCA) lumen stenosis was 21.5 ± 7.5%. Thickness of the intima-media complex (TIMC) of BCA in the carotid artery bifurcation zone was 1.1 ± 0.2 mm on the right and 1.1 ± 0.2 mm on the left. We revealed a direct correlation between the level of uric acid (AU) and TIMC BCA (correlation coefficient 0.36; p ˂ 0.05) and an inverse correlation between the UA values and the glomerular filtration rate (GFR) (correlation coefficient 0.36; p ˂ 0.05), which indicates the important role of HU. Conclusions. Among the risk factors of MI development in women under 60 years of age, hyperlipidemia, hypertension, smoking, HU and DM are of the greatest importance. Hemodynamically significant stenosis was only in CA, multifocal atherosclerosis was not detected. HU is the most important factor of MI development in women. It has a negative effect on BCA and GFR and increases the likelihood of a brain stroke. It is necessary to include UA in the standards of examination of all forms of coronary heart disease. In case of a high cardiovascular risk, it should be reduced to the target level below 360 mmol/l to prevent cardiovascular complications.

ИЗМЕНЕНИЯ ЛИПИДНОГО ОБМЕНА В НАЧАЛЬНЫЕ ПЕРИОДЫ ИНФАРКТА МИОКАРДА, ОСЛОЖНЕННОГО ОСТРЫМ ПОВРЕЖДЕНИЕМ ПОЧЕК, У МУЖЧИН МОЛОДОГО И СРЕДНЕГО ВОЗРАСТА

Relevance. Changes in lipid metabolism during myocardial infarction (MI) complicated by acute kidney injury (AKI) are potentially important for evaluating the effects of therapy and expanding the possibilities of prevention. Aim. To evaluate the changes in lipid metabolism during acute and subacute MI periods and their role in the complication’s development in men under 60 years old (y.o.) with AKI to im-prove prevention and outcomes. Material and methods. The results of inpatient examination and treatment of men aged 20-60 y.o. with MI were studied. Patients were divided into two age-comparable groups: the study group, with AKI - 22 patients and the control group, without it - 141 patients. The parameters of lipid metabolism and their dynamics were compared in the first hours (1) and at the end of the third week of MI (2) in selected groups, their influence was assessed (risk analysis by Pearson's Chi-square test) on the risk of AKI development and complications MI in the study group. Results. In the study group, the following were observed: higher levels of low-density lipo-protein2 (LDL2) (5.53±2.50 mmol/l) compared to the control group (3.33±2.45 mmol/l; p=0.02); an increase in the levels of very low-density lipoproteins, a coefficient and an atherogenic index, a decrease in triglycerides (TG) at the end of the third week of the disease. The risk of AKI development was associated with the concentration of TG1≥1.88 mmol/l (p=0.007). Complicated course of MI in the study group is characterized by levels of LDL1≥4.0 (p=0.02), high-density lipoprotein1 (HDL1)˂1.1 (mmol/l; p=0.02), and their ratio (LDL1/HDL1) ≥4.5 (p =0.02). Conclusions. In AKI, persistent atherogenic changes in lipids are noted both in the acute and at the end of the subacute period of MI. The risk of developing AKI increases at levels of TG1≥1.88 mmol/l, and the complicated course of MI in the study group is associated with lev-els of LDL1≥4.0, HDL1˂1.1 (mmol/l) and LDL1/HDL1≥4.5. It is expedient to use them in predictive modeling.

ОСОБЕННОСТИ КЛИНИЧЕСКОГО ТЕЧЕНИЯ ИНФАРКТА МИОКАРДА, ОСЛОЖНЕННОГО ОСТРОЙ ЗАДЕРЖКОЙ МОЧИ, У МУЖЧИН МОЛОДОГО И СРЕДНЕГО ВОЗРАСТА

Abstract. Relevance. Acute urinary retention (AUR) in myocardial infarction (MI) negatively affects the course and prognosis of the disease. Aim. To evaluate the MI clinical course of AUR development during the acute and subacute periods of disease in men under 60 years old to improve prevention and outcomes. Materials and methods. The study included men aged 19-60 years with type I myocardial in-farction. Patients were divided into two age-comparable groups: I - study group, with ACR - 22 patients; II - control, without urination disorders - 644 patients. A comparative analysis of the features of the medical history and clinical course in the selected groups were performed. Pear-son's Chi-square method was used to analyze the risks of ACR development. Results of the study. The study group differed from the control group in a higher frequency of cardiac arrhythmias and conduction disorders at the onset of coronary artery disease (I: 61.9; II: 24.9%; p = 0.0007), higher incidence of multiple MI complications (100 and 44.0%; ; respectively; p &lt; 0.0001), severe and extremely severe condition of patients (59.0 and 19.6%; p &lt; 0.0001). Asystole (absolute risk: 42.1%; relative: 18.0; p &lt; 0.0001), hydrothorax (41.7%; 15.9; p &lt; 0.0001), the patient’s severe condition in the first hours of illness (30%; 36.5; p &lt; 0.0001), and onset of CHD with heart rhythm and conduction disturbances (7.7%; 4.6; p = 0.0001) were the most significant ACR predictors. Conclusion. Patients with ACR are characterized by a more severe MI course. Combinations of listed above factors indicate an increased risk of development this complication. It is advisable to use them for predictive modeling and the formation of risk groups for timely prevention.

ANALYSIS OF MEDICAL PURPOSES ANDPRICE AVAILABILITY OF THE ASSORTMENT OF BETA-ADRENOBLOCKERS USED FOR THE TREATMENT OF MYOCARDIAL INFARCTION

Patients who have had myocardial infarction (MI) represent a group of patients with a very high risk of cardiovascular complications: first of all, recurrent myocardial infarction, chronic heart failure and cardiovascular death. Clinical studies have shown an increase in life expectancy after MI when prescribing selective β-blockers for long-term prophylaxis, especially in the presence of chronic heart failure complicating the course of MI. The main clinical goals of prescribing β-blockers are to improve the supply of oxygen to the myocardium and to prevent the development of life-threatening cardiac arrhythmias. In view of the above, drugs in this group should be used indefinitely in patients with MI [7]. In recent years, the analysis of the affordability of the use of treatment technologies, including for cardiovascular diseases (CVD), has stood out as a serious scientific area with its methodology, scientific tools and is currently an important source of information that helps in making management decisions in healthcare [3.6]. The purpose of this article was to conduct such an analysis in relation to the use of β-blockers in MI in Kuzbass.

Association of cardiovascular biomarkers with myocardial and coronary imaging characteristics in patients having acute myocardial infarction and type 2 diabetes mellitus

Aim. To assess the dynamic changes and clinical significance of biomarkers of inflammatory processes in patients with acute myocardial infarction (MI) with/ or without type 2 diabetes mellitus (T2DM) and primary percutaneous coronary intervention (pPCI) at various stages of treatment.Methods. 96 patients with acute MI after pPCI were examined. The level of inflammation markers was measured 4 times: before pPCI (first day from admission to the hospital), on the third day, 7–10 days (before discharge from the hospital) and 40–45 days after pPCI.Results. All groups of patients with MI showed an increase in the plasma activity of biomarkers of inflammatory processes. After pPCI for 40–45 days, there is a significant difference in the concentration of biomarkers, depending on the comorbid T2DM presence. Strong associations were found between cardiovascular biomarkers and post-MI cardiac remodeling and coronary atherosclerosis progression.Conclusion. The assessment of the levels of biomarkers of inflammatory processes may have additional clinical value in estimating the course of MI, including patients with T2DM at the postinfarction stages.

Chastota porushen rytmu i providnosti ta antyarytmichna efektyvnist upstream-terapii u khvorykh na hostryi infarkt miokarda z komorbidnymy metabolichnym syndromom i endotelialnoiu dysfunktsiieiu sudyn

Context. Cardiac arrhythmias and conduction disorders are the most common reperfusion complications in patients with myocardial infarction (MI) in both acute and late postinfarction periods, which significantly complicates the course of the disease and often leads to an unfavorable prognosis for the early and distant periods. Objective. To evaluate the frequency of arrhythmias and conduction and the antiarrhythmic efficacy of upstream therapy in patients with acute MI with comorbid metabolic syndrome (MS) and endothelial vascular dysfunction. Materials and methods. The experimental group consisted of 42 patients with acute myocardial infarction in combination with MS, who underwent urgent coronary angiography followed by balloon angioplasty and stenting of the infarct-dependent coronary artery, as well as standard drug therapy according to the MOH protocol. Patients in the experimental group also received 5 intravenous infusions of arginine-carnitine mixture (4.2 g and 2.0 g, respectively) in 100 ml of solvent. The nature of the clinical course of MI was compared with that in 38 patients with MI in combination with MS (control group), who did not receive additional treatment and were comparable in age (56.64 ± 0.91 and 54.85 ± 0.76 years, respectively). Results. It was found that patients with MI with comorbid MS on percutaneous coronary intervention most often developed reperfusion syndrome with manifestations of arrhythmias and conduction. Under the influence of standard drug treatment in patients of the control group there was a significant clinical and functional improvement, though sinus tachycardia, ventricular extrasystole of high grades and supraventricular extrasystole remained resistant to treatment. There was also a pronounced endothelial vascular dysfunction, which in the process of standard treatment in patients of the control group did not reach the level of healthy individuals (p-value less than 0.05). Conclusions. In patients with acute MI with comorbid MS, who underwent balloon angioplasty and stenting of the infarct-dependent coronary artery, a pronounced vascular endothelial dysfunction and electrical instability is observed, accompanied by reperfusion arrhythmias and arrhythmias. The use of arginine-carnitine mixture as upstream therapy helped to restore endothelial function and showed a pronounced antiarrhythmic effect, which significantly reduced the incidence and severity of complications of acute MI such as reperfusion arrhythmias.

Influence of apoe and slco1b1 genes on lipid spectrum and clinical presentation in patients with myocardial infarction and diabetic nephropathy

Abstract Objective To evaluate effect of APOE and SLCO1B1 genes on course of myocardial infarction (MI) in patients with diabetic nephropathy (DN). Materials and methods 185 patients treated about MI were examined (Male – 60.5%, 39.5% – females, average age 64.1±4.2 years). Patients were divided into 2 groups: the first (I) – 93 patients with MI and DN, the second (II) – 92 persons with MI without DN. Polymorphism of the APOE (rs769452) and SLCO1B1 (rs4149056) genes. In first 3 days level of total cholesterol (TH) and low density lipoproteins (LDL) were determined in all patients. Results Based on the data presented in table 1, patients with MI and DN had a statistically more frequent rate of the LeuPro genotype than in the comparison group, relative to group II – 6.2%, p&amp;lt;0.05. Heterozygotes of the ValAla gene (SLCO1B1) were also more often detected in patients of group I – 26.9% versus group II – 9.8%, p&amp;lt;0.05. Analysis of lipid profile indices in heterozygotes revealed a statistically significant difference only between LDL indices, p&amp;lt;0.05. Clinical presentation: acute heart failure (AHF) III–IV classes by Killip – 2.8 times more often in patients of group I, p&amp;lt;0.05. Chronic heart failure (CHF) NYHA III-IV developed 3 times more often in group I than in the second, p&amp;lt;0.05. High-grade ventricular heart rhythm disorders - more often in group I – 24.7%, relative to the control – 8.7%, p&amp;lt;0.05. Relapses of acute coronary syndrome (ACS) occurred 3 times more often in I than the second, p&amp;lt;0.05. Hospital mortality: I – 11.8%, II – 5.4%, p&amp;lt;0.05. Conclusions 1. Heterozygous type of inheritance of the Leu28Pro polymorphism of APOE gene and Val174Ala of SLCO1B1 gene, in patients with MI and DN that was confirmed by high levels of TH and LDL, p&amp;lt;0.05. 2. Clinical course of MI in the group with DN against the background of genetically determined hyperlipidemia, and possibly, in association with it was characterized by multiple complications: AHF and CHF, ventricular arrhythmias, relapses of ACS and deaths. Features of the clinical picture Funding Acknowledgement Type of funding source: None

Single-Cell RNA Sequencing Analysis Reveals a Crucial Role for CTHRC1 (Collagen Triple Helix Repeat Containing 1) Cardiac Fibroblasts After Myocardial Infarction.

Cardiac fibroblasts (CFs) have a central role in the ventricular remodeling process associated with different types of fibrosis. Recent studies have shown that fibroblasts do not respond homogeneously to heart injury. Because of the limited set of bona fide fibroblast markers, a proper characterization of fibroblast population heterogeneity in response to cardiac damage is lacking. The purpose of this study was to define CF heterogeneity during ventricular remodeling and the underlying mechanisms that regulate CF function. Collagen1α1-GFP (green fluorescent protein)-positive CFs were characterized after myocardial infarction (MI) by single-cell and bulk RNA sequencing, assay for transposase-accessible chromatin sequencing, and functional assays. Swine and patient samples were studied using bulk RNA sequencing. We identified and characterized a unique CF subpopulation that emerges after MI in mice. These activated fibroblasts exhibit a clear profibrotic signature, express high levels of Cthrc1 (collagen triple helix repeat containing 1), and localize into the scar. Noncanonical transforming growth factor-β signaling and different transcription factors including SOX9 are important regulators mediating their response to cardiac injury. Absence of CTHRC1 results in pronounced lethality attributable to ventricular rupture. A population of CFs with a similar transcriptome was identified in a swine model of MI and in heart tissue from patients with MI and dilated cardiomyopathy. We report CF heterogeneity and their dynamics during the course of MI and redefine the CFs that respond to cardiac injury and participate in myocardial remodeling. Our study identifies CTHRC1 as a novel regulator of the healing scar process and a target for future translational studies.

Changes in pattern of complications in acute myocardial infarction over a ten-year follow-up: gender specificities

Aim. To compare changes in pattern of complications in acute myocardial infarction (MI) among Tomsk population at the age of &gt;20 years over a ten-year follow-up period (2008-2017).Material and methods. The study was carried out on the basis of the World Health Organization Acute Myocardial Infarction Registry. In 2008, 800 MI cases were recorded (62,4% — men; 37,6% — women (p&lt;0,001)). In 2017, acute MI was restarted in 906 patients (58,1% — men; 41,9% — women (p&lt;0,05)). According to age pattern in 2008, there were 62,1% of patients &gt;60 years of age (among men — 49,1%; among women — 83,7% (p&lt;0,0001)), which after 10 years were 74,5 % (p&lt;0,001).Results. In 2008, a complicated course of MI was observed in 49,9% of patients, in 2017, much more often — in 80,4% of patients (p&lt;0,001). Over the analyzed period, incidence of acute aneurysm, myocardial rupture, and recurrent MI decreased. At the same time, the number of patients with post-MI heart failure (HF) significantly increased. In 2008, there were no significant differences in the incidence of MI complications in men and women. The most common complication in both men and women was arrhythmias and conduction disorders. After 10 years, the statistics remained virtually unchanged, with the exception of pulmonary embolism, which was significantly more common in women. Noteworthy is a significant increase in the number of HF patients (among men and women).Conclusion. Over a ten-year follow-up period, significant changes in patterns of MI complications in Tomsk were not revealed. It should be noted that MI became more severe and was more often accompanied by complications, the most common of which was HF. This is due to an increase in the age pattern of elderly and senile patients.

Early or First Aid Administration Versus Late or In-hospital Administration of Aspirin for Non-traumatic Adult Chest Pain: A Systematic Review.

Chest pain is a common symptom of acute coronary syndrome, including myocardial infarction (MI). Treatment with antiplatelet agents, such as aspirin, improves survival, although the ideal dose is uncertain. It is unknown if outcomes can be improved by giving aspirin early in the course of MI as part of the first-aid management as opposed to late or in-hospital administration.We searched the Medline, Embase, and Cochrane databases and used Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) and Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) for determining the certainty of evidence. We included studies in adults with non-traumatic chest pain, where aspirin was administered early (within two hours) following the onset of chest pain as part of first-aid management as compared with late or in-hospital administration (The International Prospective Register of Systematic Reviews (PROSPERO) registration number: CDR153316). From 1470 references, we included three studies (one randomized controlled trial (RCT) and two non-RCTs). Early administration (median 1.6 hours or pre-hospital) was associated with increased survival as compared with late administration (median 3.5 hours or in-hospital) at seven days; risk ratio (RR) 1.04 (95% CI 1.03-1.06), 30 days RR 1.05 (95% 1.02-1.07), and one-year RR 1.06 (95% CI1.03-1.10). The evidence is of very low certainty due to limitations in study design and the imprecision of the evidence.This systematic review would suggest that the early or first-aid administration of aspirin to adults with non-traumatic chest pain improves survival as compared with late or in-hospital administration.

The transcriptome of circulating cells indicates potential biomarkers and therapeutic targets in the course of hypertension-related myocardial infarction

Hypertension (HT) is the most common public-health challenge and shows a high incidence around the world. Cardiovascular diseases are the leading cause of mortality and morbidity among the elderly (age > 65 years) in the United States. Now, there is widespread acceptance of the causal link between HT and acute myocardial infarction (MI). This is the first data-mining study to identify co-expressed differentially expressed genes (co-DEGs) between HT and MI (relative to normal control) and to uncover potential biomarkers and therapeutic targets of HT-related MI. In this manuscript, HT-specific DEGs and MI-specific DEGs and differentially expressed microRNAs (DE-miRNAs) were identified in Gene Expression Omnibus (GEO) datasets GSE24752, GSE60993, GSE62646, and GSE24548 after data consolidation and batch correction. Subsequently, enrichment in Gene Ontology (GO) terms and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways as well as protein–protein interaction networks were identified, and single-gene gene set enrichment analysis was performed to determine the affected biological categories and networks. Cross-matching of the results on co-DE-miRNAs and predicted miRNAs targeting the co-DEGs was conducted and discussed as well. We found that MYC and HIST1H2BO may be associated with HT, whereas FCGR1A, FYN, KLRD1, KLRB1, and FOLR3 may be implicated in MI. Moreover, co-DEGs FOLR3 and NFE2 with predicted miRNAs and DE-miRNAs, especially miR-7 and miR-548, may be significantly associated and show huge potential as a new set of novel biomarkers and important molecular targets in the course of HT-related MI.

P1480 A case of triple left ventricular aneurysms diagnosed by CT and echocardiography

Abstract 【Background】 Left ventricular aneurysms is complication of myocardial infarction (MI) that can lead to death or serious morbidity. False aneurysm is rare complications of myocardial infarction or iatrogenic perforation and represent a contained myocardial rupture. False aneurysm does not contain all the three layers of the myocardium and is frequently lined by pericardium and mural thrombus. Definitive diagnosis is achieved by echocardiography, computed tomography (CT), angiography, or magnetic resonance imaging. Coexistence of true and false aneurysms is rare. 【Case】 A 58 years old man with a history of hypertension and MI was referred to our hospital for aneurysmectomy. During the course of prior MI, he got fever and pericardial effusion. CT revealed that three left ventricular aneurysms were present. Also, three aneurysms were connected by narrow ducts each other. Transthoracic echocardiography (TTE) revealed that three ventricular aneurysms were connected via acceleration blood flow which swirling in the spherical aneurysm. We determined that this triple ventricular aneurysms were at high risk for rupture, so we performed surgery. The postoperative course was good and he was discharged without any complications. 【Discussion】 False aneurysms occur after hemorrhagic dissection into an area of transmural infarction and most commonly result in free intrapericardial rupture of the heart, cardiac tamponade, and death. Rarely, if the overlying pericardium becomes adherent to the epicardium along the surface of the infarct, it can contain the rupture. We were able to evaluate the mechanism of development with triple left ventricular aneurysms using CT and TTE. We could know about spatial comprehension of triple aneurysms using CT. False aneurysms were restricted enlargement due to stiff pericardium because of complicating Dressler syndrome. We hypothesis that aneurysms were enlarging in the direction of the base of heart in the adhered pericardium space. We were able to evaluate the thickness of aneurysms and blood flow condition using TTE. TTE revealed that the wall of aneurysm was fragile. Multimodality imaging like TTE or cardiac CT are useful diagnostic methods in this case. Abstract P1480 Figure. Triple aneurysms

P4503A multi-site coronary vein sampling study on cardiac troponin T degradation in non-ST-elevation myocardial infarction

Abstract Background High-sensitivity cardiac troponin (hs-cTn) assays have reduced specificity for myocardial infarction (MI). In conditions other than MI, cardiac troponin T (cTnT) elevations have been attributed to small cTnT fragments. In search of improved cTnT assay specificity for MI, determination of the in-vivo molecular appearance of cTnT during MI is pivotal. Purpose To determine cTnT composition close to its site of release and during the course of MI by multi-site coronary venous system (CVS) and peripheral sampling. Methods Lithium-heparinized (LH) plasma and serum samples were obtained from multiple CVS locations in NSTEMI patients. Additionally, samples were drawn from a peripheral artery and vein followed by collections at 6- and 12 hours post-catheterization. cTnT concentrations were measured using the hs-cTnT immunoassay (Roche). The molecular cTnT composition was determined by gel filtration chromatography and Western blotting in an early and late presenting patient. Results CVS hs-cTnT concentrations were 28% higher than in the peripheral artery sample (n=71, p&lt;0.001). In contrast to LH plasma, serum caused pre-analytical cTn T-I-C complex disintegration and cTnT degradation. CVS samples demonstrated presence of cTn T-I-C complex, free intact cTnT, and 29 kDa and 15–18 kDa cTnT fragments in higher absolute concentrations than measured peripherally. While the proportion of cTn T-I-C complex decreased and disappeared over time, 15–18 kDa cTnT fragments increased. Moreover, cTn T-I-C complex was more prominent in the early versus the late presenting patient. Central illustration Conclusions In NSTEMI, cTnT is released as a combination of cTn T-I-C complex, free intact cTnT and multiple cTnT fragments. Over time, the composition of observed cTnT forms changes due to in-vivo degradation. These findings serve as a stepping stone to improve diagnostic accuracy of the hs-cTnT assay for MI.

Comparison of QT interval variability of coronary patients without myocardial infarction with that of patients with old myocardial infarction

BackgroundThe significant association of myocardial ischemia with elevated QT interval variability (QTV) has been reported in myocardial infarction (MI) patients. However, the influence of the time course of MI on QTV has not been investigated systematically. MethodShort-term QT and RR interval time series were constructed from the 5 min electrocardiograms of 49 coronary patients without MI and 26 patients with old MI (OMI). The QTV, heart rate variability (HRV), and QT–RR coupling of the two groups were analyzed using various time series analysis tools in the time- and frequency-domains, as well as nonlinear dynamics. ResultsNearly all of the tested QTV indices for coronary patients with OMI were higher than those for patients without MI. However, no significant differences were found between the two groups in any of the variables employed to assess the HRV and QT–RR coupling. All of the markers that showed statistical significances in univariate analyses still possessed the capabilities of distinguishing between the two groups even after adjusting for studied baseline characteristics, including the coronary atherosclerotic burden. ConclusionsThe results suggested that the QTV increased in coronary patients with OMI compared to those without MI, which might reflect the influence of post-MI remodeling on the beat-to-beat temporal variability of ventricular repolarization. The non-significant differences in the HRV and QT–RR couplings could indicate that there were no differences in the modulation of the autonomic nervous system and interaction of QT with the RR intervals between the two groups.