Risk Factor For Myocardial Infarction Research Articles

Public awareness of early symptoms of acute myocardial infarction among Saudi population.

Introduction:Globally speaking, cardiovascular disease is the leading cause of mortality, with coronary artery disease (CAD) contributing to half of the cases. A major complication of CAD is myocardial infarction (MI). The clinical outcomes of MI are predominantly time-dependent; therefore, it is paramount that the general public is familiar with the early symptoms of MI.Aim:The main objective is to gauge the local public awareness of the early symptoms of MI, and their knowledge of the best course of action to be taken from the onset of symptoms.Method:A cross-sectional study was conducted using google forms. Participants were randomly selected through multiple social media platforms. The study included Saudi citizens who were 18 years or older, with no current or prior experience in the health care field. The questionnaire assessed the participants' awareness of 14 risk factors for CAD. The variables investigated were participants' knowledge of the symptoms, causes, appropriate course of action to be taken, and the risk factors of CAD.Results:A total of 1689 participants were involved in this study. Sixty percent were females, and 29.2% were in the age group of 18–24 years. Seventy-three percent of the participants knew the definition of heart attack, and 90% knew that chest pain is a symptom of a heart attack. Approximately, 75% of the participants recognized that hypertension, cigarette smoking, and high cholesterol are the risk factors of MI. In terms of knowledge, Al Madinah province obtained the highest score when compared with other regions.Conclusion:This study showed the overall knowledge and awareness of CAD was suboptimal, indicating that awareness initiatives and patient education of CAD need more work in Saudi Arabia, especially in high-risk groups and lower education groups. More studies are needed to identify the efficiency and population access of different approaches for CAD awareness.

Acute Myocardial Infarction in Young Adults: Prevalence, Clinical Background and In-Hospital Outcomes with Particular Reference to Socio-Economic Influences a Middle Eastern Tertiary Center Experience

Background: Acute myocardial infarction in young individuals can cause death and disability in early life and has serious consequences for the patients, their family causing an increased economic burden on health system. Identifying the risk factors for acute myocardial infarction in this group of people is necessary for risk factor modification and developing cost-effective secondary prevention strategies as young. The aim of this study was to determine the prevalence, clinical background and in-hospital outcome of AMI among young (age ≤45 years) adults and its socioeconomic burden. Results: All Acute myocardial infarction patients during the period from 2016-2019 were divided into two groups: young adults (age≤45) and older adults (age>45). Age data were available for 3081 patients admitted with acute myocardial infarction. Out of these 593 (19%) patients were young adults with mean age of 39±6.2 whilst 2488 (80.7%) were older adults with mean age of 60±9. Young adult Patients were more of male gender (92% vs 82%, p<0.001) more smoker (47% vs 30 %, p<0.001) and had more prevalence of obesity (BMI ≥30 34% vs 27%, p<0.001) but were less diabetics (43% vs 57%, p<0.001) and less hypertensive (35% vs 58 %, p<0.001).Young adult patients had higher level of LDL (120±47 vs. 112.9±41.6, P=0.02), total cholesterol (189.2±54.4 vs. 173.9±47.7, P<0.001) and triglycerides (157.7±104.4 vs. 126.6±91, P<0.001).Young adult patients had more extensive thrombus and frequently required thrombus aspiration (16 % vs. 11%, p=0.003) but less common left main disease (0.9% vs 4%, p<0.001) and 3 vessels disease (8% vs 18%, p<0.001). Young adult patients had less deterioration of left ventricular function (EF 42.4±10.4 vs. 41.1±10.6, P=0.04). There was highly significant negative correlation between left ventricular ejection fraction (LVEF) and age (P<0.001) but positive correlation between age and length of in hospital stay (p=0.02).In-hospital complications including pulmonary edema, cardiogenic shock, cardiac arrest and mortality were similar in the two groups. Age, female gender and diabetes were found to be the independent predictors for in-hospital mortality among our patients (P=0.003, 0.05 and 0.05 respectively)

Eff ects of metabolic syndrome on onset age and long-term outcomes in patients with acute coronary syndrome.

We aim to investigate effects of metabolic syndrome on onset age and long-term outcomes in patients with acute coronary syndrome (ACS). Patients with ACS (n=6,431) who underwent percutaneous coronary intervention from January to December 2013 were enrolled. After excluding patients with previous coronary artery disease, 1,558 patients were diagnosed with early-onset ACS (men aged ≤50 years; women aged ≤60 years) and 3,044 patients with late-onset ACS. Baseline characteristics and five-year clinical outcomes were measured. Body mass index, triglyceride, low-density lipoprotein cholesterol, and uric acid concentrations were significantly higher, while the high-density lipoprotein cholesterol (HDL-C) concentration was lower in the early-onset ACS group (P<0.001). Multivariate logistic regression revealed obesity (odds ratio [OR] 1.590, 95% confidence interval [CI] 1.345-1.881), hypertriglyceridemia (OR 1.403, 95% CI 1.185-1.660), and low HDL-C (OR 1.464, 95% CI 1.231-1.742) as independent risk factors for early-onset ACS (all P<0.001). The five-year follow-up showed that the incidences of all cause death (1.5% vs. 3.8%, P<0.001), cardiac death (1.1% vs. 2.0%, P=0.023), and recurrent stroke (2.2% vs. 4.2%, P<0.001) were lower, while bleeding events were more frequent in the early-onset ACS group. A subgroup analysis showed higher incidences of recurrent myocardial infarction (MI) and revascularization in patients with early-onset ACS and metabolic syndrome. Obesity, hypertriglyceridemia, and lower HDL-C level are independent risk factors for early-onset ACS, recurrent MI, and revascularization. The control of metabolic syndrome may reduce the incidence of early-onset ACS and improve the long-term prognosis.

Risk Assessment of Myocardial Infarction for Diabetics through Multi-Aspects Computing

INTRODUCTION: Myocardial infarction (MI) is a type of cardiovascular disease. Cardiovascular disease is the major side effect of diabetes. It causes damage to heart muscle due to interruption in the blood flow. The chance of getting this disease is high in diabetes patients.OBJECTIVES: To choose a dataset with features related to diabetes, parameters of ECG and risk factors of MI for effective prediction. Predict myocardial infarction in both type-1 and type-2 diabetic patients using regression techniques. Recognise the best algorithm.METHODS: Multiple linear regression, ridge regression and lasso regression are existing techniques in addition to which proposed technique lasso regression is used to develop a model for prediction. The trained models are compared to know better performing algorithm. Estimation statistics namely confidence and prediction intervals are used to show the amount of uncertainty in predicted values. The statistical measures in regression analysis namely root mean squared error and r_squared value are used to evaluate and compare algorithms.RESULTS: The proposed algorithm ‘lasso regression’ has achieved better values of RMSE and r_squared as 0.418 and 0.2278 respectively compared to remaining techniques.CONCLUSION: Best performance of proposed algorithm was noticed and hence using lasso regression for prediction of myocardial infarction in diabetes patients gives better results.

AN EVIDENCE BASED ASSESSMENT OF MOST COMMON RISK FACTORS OF MYOCARDIAL INFARCTION: ANALYSIS FROM A LOCAL POPULATION

The current study was designed for risk assessment of different factors like smoking, diabetes, obesity, and gender in the development of myocardial infarction (MI). A total of one hundred and twelve participants (n=112) was included in this case and control study. They were further divided into two groups. Group A, constituted of fifty controls whereas sixty-two age and sex-matched confirmed cases of Myocardial Infarction were selected for group B. Specially design questionnaire was filled and response form was collected from different hospitals of Lahore. Body mass index (BMI) was used to determine the obesity. The current study demonstrated that the advanced age is itself a risk factor of MI, other factors like smoking, diabetes and obesity were also found to be statistically significant contributory elements. From the results of current study and past literature it is very much evident that above mentioned risk factors have significant role in sudden cardiac death by potentiating the MI. So, by avoiding or controlling these risk factors a deadly event myocardial infarction can be avoided.

Emergency care for hypertensive crises: how to save a patient? Review of modern recommendations

Background. Arterial hypertension (AH) is a risk factor for stroke and myocardial infarction. In low-income countries, the prevalence of hypertension is 42 %. Hypertensive crisis (HC) is an acute increase in blood pressure – BP (systolic BP &gt;200 mm Hg, diastolic BP &gt;120 mm Hg), which is accompanied by the threat or progression of target organs damage and requires the immediate controlled reduction of BP.&#x0D; Objective. To describe the emergency care for HC.&#x0D; Materials and methods. Analysis of current recommendations and literature data.&#x0D; Results and discussion. HC are classified into uncomplicated (uHC) and complicated (cHC). Perioperative hypertension can be considered a separate subtype of HC. Risk factors for HC include uncontrolled hypertension, refusal to take antihypertensive drugs, emotional stress, excessive fluid and salt intake, alcohol abuse, smoking, physical overload, meteopathic factors, obesity. uHC require BP lowering within 2-6 hours; drugs are administered orally; there is no need for hospitalization. cHC requires BP lowering within 30-120 minutes; drugs are administered intravenously; the patient must be hospitalized. After maintaining the target pressure &lt;160/100 mm Hg within 2-3 hours the patient can be transitioned to the oral drug administration. Therapeutic armamentarium for HC includes nitroprusside, nicardipine, clevidipine, esmolol, labetalol, nitroglycerin, urapidil, and phenoldopam. Labetalol, nicardipine, clevedipine and phenoldopam are not available in Ukraine. The choice of drug should be based on the dominant linjury of the target organ. In case of uHC it is expedient to use nifedipine, captopril, metoprolol, propranolol, clonidine (all of them orally). It should be noted that the parenteral administration of antihypertensive drugs can be carried out only by specially trained personnel with monitoring of BP and hemodynamic parameters, as well as in the presence of conditions for resuscitation. Esmolol (Biblok, “Yuria-Pharm”) is indicated for HC with renal failure, dissection of the aorta or pulmonary edema. It is also advisable to use Biblok in perioperative hypertension. The peculiarities of the Biblok use include the need of infusion into a large diameter vein, usage of lineamats or infusomats, use for no more than 24 hours, and no abrupt termination of the infusion.&#x0D; Conclusions. 1. HC is an acute increase in BP, which is accompanied by the development or progression of damage of target organs and requires immediate controlled reduction of BP. 2. Risk factors for HC include uncontrolled hypertension, refusal to take antihypertensive drugs, emotional stress, excessive fluid and salt intake, alcohol abuse, smoking, exercise, meteopathic factors, obesity. 3. Esmolol (Biblok) is indicated for HC with renal failure, aortic dissection or pulmonary edema, as well as perioperative hypertension.

The C allele of the reactive oxygen species modulator 1 (ROMO1) polymorphism rs6060566 is a biomarker predicting coronary artery stenosis in Slovenian subjects with type 2 diabetes mellitus

BackgroundWe aimed to examine the role of the rs6060566 polymorphism of the reactive oxygen species modulator 1 (ROMO1) gene in the development of myocardial infarction (MI) in Caucasians with type 2 diabetes (T2DM).MethodsA total of 1072 subjects with T2DM were enrolled in this cross-sectional case–control study: 335 subjects with MI and 737 subjects without clinical signs of coronary artery disease (CAD). The genetic analysis of the rs6060566 polymorphism was performed in all subjects. To assess the degree of coronary artery obstruction, a subpopulation of 128 subjects with T2DM underwent coronary computed tomography angiography. Next, endarterectomy samples were obtained during myocardial revascularization from diffusely diseased coronary arteries in 40 cases, which were analysed for ROMO1 expression according to their genotype.ResultsThere were no statistically significant associations between different genotypes or alleles of the rs6060566 polymorphism and MI in subjects with T2DM. The carriers of the C allele of the ROMO1 rs6060566 had a threefold increased likelihood of having 50–75% coronary artery stenosis (Adjusted OR = 3.27, 95% CI 1.16–9.20). Subjects with two affected coronary arteries had a 3.72 fold higher prevalence of MI (OR = 3.72, 95% CI 1.27–10.84). With CAD in LMCA or LAD, MI prevalence was about 3.5-fold higher (p = 0.07 for LMCA and p = 0.01 for LAD). Furthermore, the carriers of the rs6060566 C allele showed higher number of positive cells for ROMO1 expression in endarterectomy samples of coronary arteries.ConclusionsAccording to our study, the rs6060566 polymorphism of the ROMO1 gene is not a risk factor for MI in Caucasians with T2DM. However, we found that subjects carrying the C allele were at a 3.27-fold increased risk of developing severe CAD compared with those who had non-obstructive CAD. Moreover, C allele carriers showed a statistically higher number of cells positive for ROMO1 compared with T allele carriers in coronary endarterectomy samples.

PP538 Burden Of Disease For Patients With Acute Myocardial Infarction Combining Dyslipidemia In China

IntroductionPrevalence of dyslipidemia in Chinese adults is increasing rapidly. Dyslipidemia is one of the most important risk factors for acute myocardial infarction (AMI), which represents a serious disease burden to the country. However, there is no published research on the costs of Chinese patients diagnosed with AMI combining dyslipidemia. This study aimed to report key findings of the disease burden in China, including direct medical costs and direct non-medical costs.MethodsSix hospitals from different geographic areas were selected in China for data collection. Patients who were hospitalized due to AMI combining dyslipidemia from January 1 2016 to December 31 2016 in the six sites were enrolled. Direct medical costs including inpatient and outpatient costs were extracted through electronic medical records; medical costs occurred in other healthcare institutions and direct non-medical costs were collected by a face-to-face questionnaire survey. Results were analyzed with descriptive statistics.ResultsData of 900 patients were analyzed. There were more males (78.40%) than females. The mean age was 62.1 (SD: 11.5). The times of inpatient and outpatient per year were 0.57 and 8.67, respectively. Medium direct medical costs and medium direct non-medical costs were 31,440 RMB (Interquartile range (IQR): 21,533–48,202) (4,443 USD: 3043–6812) and 665 RMB (IQR: 351–1328) (94 USD: 50–188), respectively; while corresponding medium indirect costs per year were 659 RMB (IQR: 226–1579) (93 USD: 32–223).ConclusionsThis is the first study comprehensively analyzing the disease burden of patients diagnosed with AMI combining dyslipidemia in China. The results suggested that the medical cost of this population is still high. Hospitalization cost accounted for 81 percent of the total cost, which was around 1.3 times of the annual per capita disposable income over the same period. Therefore, the importance of providing effective clinical management as well as dyslipidemia prevention and control intervention should be highlighted, especially for middle-aged and elderly males with dyslipidemia.

Rates of major cardiovascular events in patients with a history of myocardial infarction and additional risk factors: Evidence from a Swedish nationwide register-based study

Rates of major cardiovascular events in patients with a history of myocardial infarction and additional risk factors: Evidence from a Swedish nationwide register-based study

VLDL Cholesterol Accounts for One-Half of the Risk of Myocardial Infarction Associated With apoB-Containing Lipoproteins

BackgroundPlasma apolipoprotein B (apoB) is a composite measure of all apoB-containing lipoproteins causing atherosclerotic cardiovascular disease; however, it is unclear which fraction of risk is explained by cholesterol and triglycerides, respectively, in very low-density lipoproteins (VLDLs). ObjectivesThe authors tested the hypothesis that VLDL cholesterol and triglycerides each explain part of the myocardial infarction risk from apoB-containing lipoproteins. MethodsNested within 109,751 individuals from the Copenhagen General Population Study, the authors examined 25,480 subjects free of lipid-lowering therapy and myocardial infarction at study entry. All had measurements of plasma apoB (quantitating number of apoB-containing lipoproteins) and cholesterol and triglyceride content of VLDL, intermediate-density lipoproteins (IDLs), and low-density lipoproteins (LDLs). ResultsDuring a median 11 years of follow-up, 1,816 were diagnosed with myocardial infarction. Per 1-mmol/l higher levels, multivariable-adjusted hazard ratios for myocardial infarction were 2.07 (95% confidence interval [CI]: 1.81 to 2.36) for VLDL cholesterol, 1.19 (95% CI: 1.14 to 1.25) for VLDL triglycerides, 5.38 (95% CI: 3.73 to 7.75) for IDL cholesterol, and 1.86 (95% CI: 1.62 to 2.14) for LDL cholesterol. Per 1-g/l higher plasma apoB, the corresponding value was 2.21 (95% CI: 1.90 to 2.58). In a step-up Cox regression, risk factors for myocardial infarction entered by importance as VLDL cholesterol, systolic blood pressure, smoking, and IDL + LDL cholesterol, whereas VLDL triglycerides did not enter the model. VLDL cholesterol explained 50% and IDL + LDL cholesterol 29% of the risk of myocardial infarction from apoB-containing lipoproteins, whereas VLDL triglycerides did not explain risk. ConclusionsVLDL cholesterol explained one-half of the myocardial infarction risk from elevated apoB-containing lipoproteins, whereas VLDL triglycerides did not explain risk.

Correlation between plasma homocysteine and first myocardial infarction in young patients: Case-control study in Constanta County, Romania.

An elevated level of total plasma homocysteine has been associated with a higher risk of atherosclerosis and coronary heart disease. The aim of our research was to study the relation between homocysteine and myocardial infarction (MI) in young patients. We conducted a case-control study in Constanţa County, Romania including 61 patients, divided in two groups. The first group, the MI group, consisted of 28 patients, male (67.9%) and female (32.1%) aged less than 45 years who were consecutively admitted to the Intensive Coronary Care Unit of the Emergency County Hospital of Constanţa from September 1, 2017 to August 31, 2018 (12 months), with an established diagnosis of first acute MI. The second group, the control group, included 33 patients, male (75.8%) and female (24.2%) aged less than 45 years, with cardiovascular risk factors and/or stable angina pectoris that were consecutively addressed for ambulatory cardiac evaluation at the Outpatient Clinic of Emergency County Hospital of Constanţa during the same period. Fasting plasma homocysteine was determined in both groups, within 24 h after MI onset, respectively after first cardiac exam in the controls. High homocysteine was statistically confirmed to be a risk factor in the study group, especially in association with smoking, chronic kidney disease (CKD), and to a lesser extent with diabetes mellitus (DM) and hypertension. Data analysis was performed using IBM SPSS Statistics 23. The procedures used included descriptive statistics, parametric statistical tests (Independent sample t-test), non-parametric statistical tests [Chi-square test of the association, with the evaluation of odds ratio (OR)]; the significance level used in the analysis (P-value) was 0.05. After adjusting for variables, our study results pointed out a strong association between plasma homocysteine and first acute MI among young patients, emphasising plasma homocysteine as a possible risk factor for myocardial infarction.

Spiritual Well-Being and Its Association with Coronary Artery Disease.

Cardiovascular diseases are the main cause of mortality in the world, generating important socioeconomic and cultural impacts. Spirituality has been associated with the main risk factors for acute myocardial infarction, influencing lifestyle, and drug treatment compliance. Estimate the level of spiritual well-being and its association with coronary artery disease. We conducted a case-control study with 88 adults (42 cases and 46 controls) individually interviewed. Using a spiritual well-being scale and collecting socioeconomic and demographic information. We compared groups by Chi-square and Mann-Whitney tests. Friedman's analysis of variance was used to evaluate the differences between the values assigned to the scale items in each group. Statistically, there was no significant difference between categories and levels of spiritual well-being in any of the groups. Both had high rates, driven by the high level of religious well-being. There was no difference between the rates attributed to the items on the subscale of religious well-being, in the case or control groups (p = 0.959 and p = 0.817). However, the existential well-being subscale revealed variability between the scores attributed to each item in both groups (p < 0.001). The results revealed a high level of spiritual well-being in the analyzed sample. There was no correlation between the levels of spiritual, religious, and existential well-being with coronary artery disease, possibly due to the reduced ability of the religious well-being subscale to discriminate between groups.

T786C eNOS polymorphism as risk factor for recurrent myocardial infarction in young and middleaged patients

Objective. To determine the possible role of the endothelial nitric oxide synthase (eNOS) polymorphism T786C (rs 2070744) in developing of recurrent myocardial infarction (MI) in young and middle-aged patients. Materials and methods. 114 patients with acute MI treated with percutaneous coronary intervention and thrombolysis that were admitted to Clinical cardiologic dispensary (Perm city, Russia) were enrolled into a study. Among them there were 28 patients with recurrent MI. The eNOS T786C polymorphism were determined by real-time PCR. Results. In T786C polymorphism of eNOS, compared with the T/T genotype, it was determined that those with T/C has 2,27 fold (95 % CI: 1.01–5.49), and those with the CC genotype has 2.22 times (95 % CI: 1.30–8.53) (p = 0.034) greater risk of developing recurrent MI. Patients with severe coronary arteries atherosclerosis more frequently had eNOS T786C polymorphism of T/C genotype (OR = 4,67; 95 % CI: 1,38–15,37; p = 0,031). Conclusion. The eNOS T786C variants could be evaluated as recurrent MI risk factor in young and middle-aged patients.

Abstract 13951: Safety, Tolerability and Efficacy of Single-dose Amg 890, a Novel Sirna Targeting Lp(a), in Healthy Subjects and Subjects With Elevated Lp(a)

Introduction: Mendelian and epidemiological randomization studies have identified lipoprotein(a) [Lp(a)] as a risk factor for myocardial infarction and other atherosclerotic events. There are currently no approved medicines that selectively target Lp(a) and have demonstrated reduction in CV events. AMG 890 is a siRNA designed to reduce the production of Lp(a) by targeting mRNA transcribed from the LPA gene. Methods: This phase 1 study evaluated the safety, tolerability, pharmacokinetics (PK), and pharmacodynamics (PD) of AMG 890. Adults with plasma concentrations of Lp(a) ≥ 70 to ≤ 199 nmol/L (cohorts 1-5), and ≥ 200 nmol/L (cohorts 6-7), were randomized 3:1 to receive a single subcutaneous dose of investigational product (IP; AMG 890 or placebo). The primary endpoints were treatment-emergent adverse events (TEAEs), safety laboratory analytes, vital signs and ECGs. Secondary endpoints included PK parameters and percent reduction from baseline in Lp(a). Results: 64 subjects were administered IP (cohorts 1-5: AMG 890, n=30, doses: 3 mg, 9 mg, 30 mg, 75 mg, 225 mg; placebo, n=10; cohorts 6-7: AMG 890, n=18, doses: 9 mg and 75 mg; placebo, n=6). The most common TEAEs were headache (10% AMG 890; 25% placebo) and upper respiratory tract infection (15% AMG 890; 13% placebo); no safety concerns were identified for AMG 890. In cohorts 1-5, single doses of AMG 890 effectively reduced mean Lp(a) levels from baseline by 71-96% (based on doses) at Day 43, and by 80-94% at Day 113 (cohorts 2-5). In cohorts 6 and 7, single doses of AMG 890 effectively reduced mean Lp(a) levels from baseline by 75% and 89% at Day 43, respectively, and by 61% and 80% at Day 113, respectively. Conclusions: In adults with elevated Lp(a), single-dose treatment of AMG 890 was well-tolerated and significantly reduced Lp(a) with observed maximal percent reductions of &gt; 90% and effects persisting for more than 6 months at doses of 9 mg or higher.

Abstract 15837: Particulate Matter 2.5 Exposure Increases Risk of Subsequent Myocardial Infarction

Introduction: Particulate matter 2.5 (PM 2.5 ) are airborne particles small enough to be inhaled into the pulmonary alveoli, and are associated with increased hospitalization rates, morbidity, and mortality. The purpose of this study was to evaluate the levels of PM 2.5 in southeastern Louisiana and describe associated cardiovascular outcomes in patients with a history of myocardial infarction (MI). Methods: Air quality monitoring stations were placed around southeastern Louisiana and were analyzed from March 1 st , 2019 to March 1 st , 2020. Samples were collected every 80 seconds, and values were aggregated at the hourly and daily level. We used conditional logistic regression models to determine the risk of MI. Control observations per patient were created using PM 2.5 exposure on the same day of the week for the two weeks before and after the event. Temperature, pressure, humidity, and their interactions with PM 2.5 were included in the model. Results: The average PM 2.5 exposure for the year was 10.41 ug/m 3 +/- 5.57 ug/m 3 , with a daily low of 1.93 ug/m 3 and a daily high of 31.32 ug/m 3 . Peaks from individual sensors reached PM 2.5 concentrations greater than 100 ug/m 3 . PM 2.5 concentration showed a significant, weakly positive correlation with daily average temperature and a significant, weakly negative correlation with daily average barometric pressure. Among patients (n=263) with history of MI, risk of subsequent MI increased by 24.3% per 10 ug/m 3 increase in PM 2.5 exposure with a lag of three days after exposure. (Figure) No significant risk associated with PM 2.5 exposure was observed at shorter lag times. Conclusion: Although the average PM 2.5 levels in southeastern Louisiana were within the WHO guidelines of air quality, PM 2.5 exposure remained a significant risk factor for MI among a those with previous MI.

Abstract 14342: Redo Surgical Aortic Valve Replacement versus Valve in Valve Transcatheter Aortic Valve Replacement

Introduction: There has been a recent trend towards the increased use of biologic valves at the time of surgical aortic valve replacement (SAVR) with an understanding there may be a potential need for future valve intervention. In this study, we compared the clinical outcomes of Redo-SAVR with valve-in-valve transcatheter aortic valve replacement (VIVTAVR) in patients with a prior history of SAVR. Methods: From 2012 to 2019, 263 patients underwent isolated aortic valve reintervention after prior SAVR: VIV-TAVR (n=187) or redo-SAVR (n=86). Multivariable analysis was performed to identify risk factors mortality and aortic reintervention. Sub-analyses were performed to compare VIV-TAVR patients to Redo-SAVR patients undergoing biologic valve explant and implant (Biologic) as well as VIV-TAVR and Redo-SAVR patients matched by STS Predicted Risk of Mortality (STS PROM). Results: Operative mortality for the Redo-SAVR and VIV-TAVR was 1.2% (1) and 1.6% (3) respectively (p=0.92). Redo-SAVR patients had an increased stroke rate (7.0% vs 1.1%, p=0.02) and longer postoperative length of stay (7 vs 2 days, p&lt;0.0001). VIV-TAVR patients had a higher rate of ≥1+ paravalvular leak (PVL) (21.4% versus 3%, p=0.0002) and a lesser reduction in transvalvular gradient (-21.9 ± 17.6mmHg vs -30.3 ± 20.7mmHg, p=0.0038). The difference in PVL was maintained during the Biologic Sub-analysis (p=0.0034). In the STS PROM Sub-analysis, early mortality was the same for each group (1.2%), and the differences in PVL (p=0.0002) and in transvalvular gradient reduction (p=0.005) were maintained. Preoperative renal failure (p=0.006) and cerebrovascular disease (p=0.04) were risk factors for mortality and prior myocardial infarction (p=0.04) was a risk factor for aortic reoperation for VIV-TAVR. No risk factors were identified for Redo-SAVR. Conclusions: Aortic valve reintervention following prior SAVR is associated with outstanding clinical outcomes. Both Redo-SAVR and VIV-TAVR can be performed with lower than expected predicted mortality. Redo-SAVR was associated with increased morbidity compared to VIV-TAVR, but improved valve function and hemodynamics. Differences in long term valve durability and patient survival between these two therapies are yet to be determined.

Risk Factors of Cerebral Infarction and Myocardial Infarction after Carotid Endarterectomy Analyzed by Machine Learning.

Objective The incidence of cerebral infarction and myocardial infarction is higher in patients with carotid endarterectomy (CEA). Based on the concept of coprotection of heart and brain, this study attempts to screen the related factors of early cerebral infarction and myocardial infarction after CEA with the method of machine learning to provide clinical data for the prevention of postoperative cerebral infarction and myocardial infarction. Methods 443 patients who received CEA operation under general anesthesia within 2 years were collected as the research objects. The demographic data, previous medical history, degree of neck vascular stenosis, blood pressure at all time points during the perioperative period, the time of occlusion, whether to place the shunt, and the time of hospital stay, whether to have cerebral infarction and myocardial infarction were collected. The machine learning model was established, and stable variables were selected based on single-factor analysis. Results The incidence of cerebral infarction was 1.4% (6/443) and that of myocardial infarction was 2.3% (10/443). The hospitalization time of patients with cerebral infarction and myocardial infarction was longer than that of the control group (8 (7, 15) days vs. 7 (5, 8) days, P = 0.002). The stable related factors were screened out by the xgboost model. The importance score (F score) was as follows: average arterial pressure during occlusion was 222 points, body mass index was 159 points, average arterial pressure postoperation was 156 points, the standard deviation of systolic pressure during occlusion was 153 points, diastolic pressure during occlusion was 146 points, mean arterial pressure after entry was 143 points, systolic pressure during occlusion was 121 points, and age was 117 points. Conclusion Eight factors, such as blood pressure, body mass index, and age, may be related to the postoperative cerebral infarction and myocardial infarction in patients with CEA. The machine learning method deserves further study.

Histone Deacetylases (HDACs) and Atherosclerosis: A Mechanistic and Pharmacological Review.

Atherosclerosis (AS), the most common underlying pathology for coronary artery disease, is a chronic inflammatory, proliferative disease in large- and medium-sized arteries. The vascular endothelium is important for maintaining vascular health. Endothelial dysfunction is a critical early event leading to AS, which is a major risk factor for stroke and myocardial infarction. Accumulating evidence has suggested the critical roles of histone deacetylases (HDACs) in regulating vascular cell homeostasis and AS. The purpose of this review is to present an updated view on the roles of HDACs (Class I, Class II, Class IV) and HDAC inhibitors in vascular dysfunction and AS. We also elaborate on the novel therapeutic targets and agents in atherosclerotic cardiovascular diseases.

Psychosocial Risk Factors of Myocardial Infarction: Turning Threat to Opportunity

Myocardial infarction (MI) is a major cause of mortality in the developing world. Modifiable risk factors of MI such as obesity, diabetes, smoking, high blood pressure and dyslipidemia are well known but besides these, there are many psychosocial factors that are independently related to MI. There is a striking dearth of reviews in the literature that examine, collate and summarize the impact of psychological contributors to MI. Present work was done to cover such gaps in knowledge and emphasize the need for psychological risk factors of MI to be considered while devising prevention guidelines and policies. Original research studies, meta-analyses and systematic reviews focusing on psychological factors in the development of MI were retrieved from databases including PubMed, Google Scholar, ProQuest, Elsevier, and Ovid Medline. Psychological factors like depression, anxiety, type A personality, stress, anger, hostility, social isolation and occupational stress were shown to feature consistently as risk factors for MI. Mitigating lifetime psychological distress may help decrease the disease burden of MI.

Modifiable and Non-modifiable Risk Factors in Myocardial Infarction in the Iranian Population

Background and AimCardiovascular disease, especially myocardial infarction, is one of the common causes of death, disability, and productivity reduction globally, which is also rising in Iran. This study evaluated the share of modifiable and non-modifiable risk factors in myocardial infarction in the Iranian population.Materials and MethodsA descriptive-analytic and retrospective study was conducted on 361 patients with myocardial infarction in Alborz, Iran, in 2015-2019. Data collection was done by reviewing records of patients diagnosed with myocardial infarction with ECG changes or increased cardiac enzymes (CPK-MB, Troponin I). Then required information was extracted, and intended data were analyzed with descriptive and inferential statistics by the SPSS software.ResultsAmong the subjects in the study, 71/1% were male, and 28/9% were female. The majority of samples were between the ages of 60 to 71(33/8%), and the least of them were under 30 years old (1/7%). 82.68% of the samples had a positive family history. The most common modifiable risk factors of myocardial infarction in this study were first Hypertension (42/4%), then Diabetes (31/6%), smoking (32/04%), and Hyperlipidemia (15%). Hypertension was significantly associated with gender, age, and diabetes, and Hyperlipidemia is also positively associated with diabetes and Hypertension.ConclusionMyocardial infarction is common in men and patients with Hypertension in the Iranian population. High blood pressure is also associated with gender, age, and diabetes. The prevalence of both modifiable and non-modifiable risk factors and coronary artery occlusion increases with increasing age. Therefore, training a healthy lifestyle and controlling modifiable risk factors from an early age can significantly prevent various cardiovascular diseases in the future.