Risk Factor For Myocardial Infarction Research Articles

Ethnicity affects the risk factors of acute myocardial infarction and should be considered in educational programs.

To compare risk factors among Saudi nationals and expatriates. A retrospective cohort study for patients admitted to the Cardiac Care Unit of one of the largest tertiary care hospitals in Tabuk diagnosed with acute myocardial infarction from September 2018 to August 2019. Risk factors were compared among groups on the basis of their ethnicity. In total 18,746 patients were included. Gender and age were the predominant risk factors; Male (p < 0.05) and age >50 years (p < 0.05). There were significant differences between Saudis and expatriates in all measurable parameters indicating that a genetic factor contributes to the risk factors, which was proved by the significant differences between the Middle East North Africa and South Asia subgroups. Interestingly, the mean values of laboratory results were higher than Saudi populations. The disparity in lipid profile among the studied groups addresses the patient ethnicity should be considered during education programs for the risk factors of cardiovascular disease.

Common Risk Factors Involved In The Development Of Myocardial Infarction In Adults Younger Than 45 Years Of Age.

Pakistan has got a very high prevalence of myocardial infarction (MI). MI presents at pretty young age in this country. The objective of present study was to determine the frequency of common risk factors associated with early development of MI in middle aged adults of less than 45 years. It was a cross sectional study conducted in the Cardiology department of Ayub Teaching Hospital (ATH) Abbottabad from 23rd June 2015 - 10th July 2016. A total of 255 consecutive patients diagnosed with MI admitted to the Cardiology Unit of ATH, Abbottabad. A detailed medical history and general physical examination of the patients was carried out with an emphasis on recording the presence or absence of common risk factors of MI in these patients. All routine investigations (Blood Complete Picture, Urea, Creatinine, Blood Sugar & Lipid Profile) were done. Mean age of the subjects was 39.98±4.61 SD. The frequency of risk factors in descending order was smoking in (38.8%), obesity in (29.4%) and essential hypertension in (21.6%) of the patients. Other risk factors of MI in this study were diabetes mellitus (19.2%), family history of ischemic heart disease (IHD) was (18.8%) and disproportionate dyslipidemias in (12.9%). Sex of patients (male predominance) was found to be significantly associated with diabetes, smoking and dyslipidemia (p<0.05). Male sex, smoking, hypertension and obesity confer an increased risk of myocardial infarction in patients younger than 45 years of age.

Atrial fibrillation is an independent risk factor for new-onset myocardial infarction: a prospective study

Background Atrial fibrillation (AF) and myocardial infarction (MI) share common cardiovascular risk factors, therefore coexistence of AF and MI is very common, in addition, both AF and MI aggravate and exacerbate each other through multiple pathological processes. The aim of this study is to investigate whether AF increases the risk of new-onset MI. Methods In total 171,086 participants from an industrial city in North China were selected and enrolled in this prospective cohort study, participants were divided into the AF group or the non-AF group according to their medical history. 1542 participants from the AF group were propensity-matched with 4626 participants from the non-AF group. All the participants were followed up every 2 years from June 2006 to December 2020, the median follow-up was 14.25 years and the endpoint of this study was new-onset MI. The association between AF and new-onset MI was analysed by using both univariate and multivariate Cox proportional hazards regression analysis. Results New-onset MI was documented in 56 cases from the AF group and 98 cases from the non-AF group, respectively, the cumulative incidence of new-onset MI in the AF group (3.73%) was significantly higher than that in the non-AF group (2.23%) (p < 0.01). In a univariate analysis, AF was associated with an increased risk of new-onset MI (hazard ratio: 1.73, 95% confidence interval: 1.24–2.40), in two multivariable-adjusted analyses, AF was still associated with an increased risk of new-onset MI (hazard ratio: 1.78, 95% confidence interval, 1.28–2.47). Conclusions AF is an independent risk factor for new-onset MI in an industrial population of North China.

SARS-COV-ATE risk assessment model for arterial thromboembolism in COVID-19

Patients with SARS-CoV-2 infection are at an increased risk of cardiovascular and thrombotic complications conferring an extremely poor prognosis. COVID-19 infection is known to be an independent risk factor for acute ischemic stroke and myocardial infarction (MI). We developed a risk assessment model (RAM) to stratify hospitalized COVID-19 patients for arterial thromboembolism (ATE). This multicenter, retrospective study included adult COVID-19 patients admitted between 3/1/2020 and 9/5/2021. Among 3531 patients from the training cohort, 15.5% developed acute in-hospital ATE, including stroke, MI, and other ATE, compared to 13.4% in the validation cohort. The 16-item final score was named SARS-COV-ATE (Sex: male = 1, Age [40–59 = 2, > 60 = 4], Race: non-African American = 1, Smoking = 1 and Systolic blood pressure elevation = 1, Creatinine elevation = 1; Over the range: leukocytes/lactate dehydrogenase/interleukin-6, B-type natriuretic peptide = 1, Vascular disease (cardiovascular/cerebrovascular = 1), Aspartate aminotransferase = 1, Troponin-I [> 0.04 ng/mL = 1, troponin-I > 0.09 ng/mL = 3], Electrolytes derangement [magnesium/potassium = 1]). RAM had a good discrimination (training AUC 0.777, 0.756–0.797; validation AUC 0.766, 0.741–0.790). The validation cohort was stratified as low-risk (score 0–8), intermediate-risk (score 9–13), and high-risk groups (score ≥ 14), with the incidence of ATE 2.4%, 12.8%, and 33.8%, respectively. Our novel prediction model based on 16 standardized, commonly available parameters showed good performance in identifying COVID-19 patients at risk for ATE on admission.

IntraCoronary Artery Retrograde Thrombolysis vs. Thrombus Aspiration in ST-Segment Elevation Myocardial Infarction: Study Protocol for a Randomized Controlled Trial.

BackgroundType 2 diabetes (T2DM) is a major risk factor for myocardial infarction. Thrombus aspiration was considered a good way to deal with coronary thrombus in the treatment of acute myocardial infarction. However, recent studies have found that routine thrombus aspiration is not beneficial. This study is designed to investigate whether intracoronary artery retrograde thrombolysis (ICART) is more effective than thrombus aspiration or percutaneous transluminal coronary angioplasty (PTCA) in improving myocardial perfusion in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI).Methods/DesignIntraCoronary Artery Retrograde Thrombolysis (ICART) vs. thrombus aspiration or PTCA in STEMI trial is a single-center, prospective, randomized open-label trial with blinded evaluation of endpoints. A total of 286 patients with STEMI undergoing PPCI are randomly assigned to two groups: ICART and thrombus aspiration or PTCA. The primary endpoint is the incidence of >70% ST-segment elevation resolution. Secondary outcomes include distal embolization, myocardial blush grade, thrombolysis in myocardial infarction (TIMI) flow grade, and in-hospital bleeding.DiscussionThe ICART trial is the first randomized clinical trial (RCT) to date to verify the effect of ICART vs. thrombus aspiration or PTCA on myocardial perfusion in patients with STEMI undergoing PPCI.Clinical Trial Registration[https://www.chictr.org.cn/], identifier [ChiCTR1900023849].

The impact of hypertension on mortality and the risk of developing geriatric syndromes

Background. Hypertension (HTN) is a major risk factor for the development of cardiovascular disease in young and middle age, however, data on its effect on cardiovascular risk in older adults are contradictory. Objective. To evaluate the impact of high blood pressure on mortality and the course of major geriatric syndromes in the population aged 65 years and older. Design and methods. The prospective cohort Crystal study (2 examinations, 9 years of follow-up), the cross-sectional cohort Eucalyptus study. Sample: a random sample of community-dwelling older adults aged 65 and older (n = 1007). Main parameters: blood pressure, analysis of drug treatment, medical history, laboratory tests, comprehensive geriatric assessment. Results. HTN has been identified as a risk factor for myocardial infarction, cognitive decline, slow gait speed and low muscle strength. However, in people with frailty and slow gait speed, the presence of HTN was associated with a lower risk of all-cause mortality. The lowest risk of all — cause mortality in participants with a slow gait speed was found with systolic blood pressure 140-159 mm Hg [risk ratio (95 % confidence interval) 0,049 (0,009-0,283)], with frailty — with systolic blood pressure 160-180 mm Hg [risk ratio (95 % confidence interval) = 0,109 (0,016-0,758)]. Conclusions. HTN retains its negative predictive value in older adults and is associated with an increased risk of cardiovascular complications, decreased cognitive and physical functions, but a lower risk of mortality in people with frailty and a low level of physical function. An individual approach and an obligatory assessment of the level of physical function in older patients are required when prescribing antihypertensive therapy.

Behavioural risk factors and cardiovascular disease: are women at higher risk?

Previous work has reported that diabetes, smoking, and hypertension are more strongly associated with cardiovascular disease in women than in men. 1 Millett ERC Peters SAE Woodward M Sex differences in risk factors for myocardial infarction: cohort study of UK Biobank participants. BMJ. 2018; 363k4247 Google Scholar , 2 Manfrini O Yoon J van der Schaar M et al. Sex differences in modifiable risk factors and severity of coronary artery disease. J Am Heart Assoc. 2020; 9e017235 Crossref PubMed Scopus (23) Google Scholar In The Lancet, Marjan Walli-Attaei and colleagues 3 Walli-Attaei M Rosengren A Rangarajan S et al. Metabolic, behavioural, and psychosocial risk factors and cardiovascular disease in women compared with men in 21 high-income, middle-income, and low-income countries: an analysis of the PURE study. Lancet. 2022; 400: 811-821 Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar argue that studies on sex differences in cardiovascular risk factors are mainly from high-income countries and add to the literature by reporting their community-based study conducted in 21 high-income, middle-income, and low-income countries. In their analysis, Walli-Attaei and colleagues included 155 724 adults (90 934 [58·4%] women and 64 790 [41·5%] men) aged 35–70 years without a history of cardiovascular disease from the Prospective Urban Rural Epidemiological (PURE) study, who had a median follow-up of 10·1 years (IQR 8·5–12·0), and assessed the primary composite outcome of major cardiovascular events (cardiovascular disease deaths, myocardial infarction, stroke, and heart failure). As of data cutoff (Sept 13, 2021), 4280 major cardiovascular disease events had occurred in women (age standardised incidence rate of 5·0 events [95% CI 4·9–5·2] per 1000 person-years) and 4911 in men (8·2 [8·0–8·4] per 1000 person-years). The hazard ratios (HRs) for the composite outcome of major cardiovascular disease associated with metabolic risk factors were similar in women and in men, except for high non-HDL cholesterol, for which larger HRs were found in men (1·11 [95% CI 1·01–1·21] in women vs 1·28 [1·19–1·39] in men; pinteraction=0·0037). Larger HRs in men than in women were also observed for symptoms of depression (1·09 [0·98–1·21] in women vs 1·42 [1·25–1·60] in men; pinteraction=0·0002). By contrast, behavioural risk factors, such as consumption of a diet of PURE diet score of 4 or lower 3 Walli-Attaei M Rosengren A Rangarajan S et al. Metabolic, behavioural, and psychosocial risk factors and cardiovascular disease in women compared with men in 21 high-income, middle-income, and low-income countries: an analysis of the PURE study. Lancet. 2022; 400: 811-821 Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar and household air pollution, were more strongly associated with cardiovascular disease in women than in men (diet: HR 1·17 [95% CI 1·08–1·26] in women vs 1·07 [0·99–1·15] in men; pinteraction=0·0065; household air pollution: 1·10 [0·99–1·21] vs 1·06 [0·96–1·16]; pinteraction=0·0055). The difference in associations between women and men for risk factors and myocardial infarction followed a pattern similar to the results for the composite outcome of major cardiovascular disease, with the exception of systolic blood pressure (per 20 mm Hg), hypertension, and household air pollution, for which larger HRs were observed in women than in men. The difference in associations between women and men for risk factors and the composite outcome of major cardiovascular disease were similar among countries at different income levels. These findings raise several important issues. Metabolic, behavioural, and psychosocial risk factors and cardiovascular disease in women compared with men in 21 high-income, middle-income, and low-income countries: an analysis of the PURE studyLipid markers and depression are more strongly associated with the risk of cardiovascular disease in men than in women, whereas diet is more strongly associated with the risk of cardiovascular disease in women than in men. The similar associations of other risk factors with cardiovascular disease in women and men emphasise the importance of a similar strategy for the prevention of cardiovascular disease in men and women. Full-Text PDF

Comparison of Cardiac Wall Thicknesses and Coronary Artery Obstructions Between Deaths Resulting From Acute Myocardial Infarction and Deaths From Other Causes.

Objective:The risk factors for myocardial infarction (MI) can be separated into three general categories: non-modifiable factors, modifiable risk factors, and lifestyle. This study aimed to investigate whether or not there was any effect of cardiac wall thickness and coronary artery obstructions on acute MI.Methods:In this retrospective study of histopathological examinations of autopsies, two groups were formed. The first contained 28 cases diagnosed with acute MI and the second 28 cases with no heart pathology and the cause of death was reasons other than heart disease. The subjects in the two groups were similar in age, height, weight, and body mass index. The groups were compared in terms of the left and right ventricular wall thicknesses and the degree of obstruction of the right, left, anterior descending, and circumflex coronary arteries.Results:The mean left ventricular wall thickness was 1.461±0.2767 cm in the acute MI group and 1.386±0.2460 cm in the control group, with no statistically significant difference found between the two groups (p=0.289). A statistically significant difference in the degree of obstruction of the coronary arteries was found between the groups.Conclusions:Although the mean cardiac wall thickness was greater in the acute MI cases, no statistically significant difference was found between the two groups.

Abstract P213: Bridging The Gap In Hypertension Outcomes In Rural United States: A 6-month Report From A Pharmacist-run Hypertension Clinic In An Appalachian University Teaching Hospital

Background: Hypertension (HTN) constitutes a significant risk factor for cardiovascular diseases, including stroke and myocardial infarction. According to CDC, HTN rate is 10% higher in rural areas than in most urban areas. Rural Appalachia has even higher HTN rates (&gt;10% above the national rate). Optimization of rural health care is critical in improving overall outcomes of HTN. We, thus, compared a 6-month trend in BP control pre and post-referral of patients to a pharmacist-led BP clinic. Methods: This was a prospective study carried out in the HTN clinic of an Appalachian teaching hospital. The analysis was restricted to hypertensive patients aged ≥18 years. Interventions included medication management and health promotion. Average and upper limits of BP and the number of office visits in both periods were collected. Paired T-test was used for analysis. A p-value &lt;0.05 is considered to be statistically significant. Results: Of the 51 persons analyzed, 38 were eligible for inclusion. The average systolic BP demonstrated a significant decline from 160s to 140s mm Hg (p-value &lt;0.0001; 95% confidence interval -27.83 to -14.75; SEM 3.228). DBP showed a drop from around 85 to 80 mm Hg (p-value 0.0039; 95% CI -9.683 to -2.002; SEM of 1.895). The upper limits of SBP before and after referral also reached statistical significance (p-value 0.0008; CI -24.43 to -6.976; SEM 4.303). The BMI did not reach statistical significance. Patients visited the clinic almost twice as much after referral within the 6-month period that was studied (1.27 vs 2.29). Conclusions: Overall, pharmacist-led BP control may potentially play a huge role in improving the outcomes of HTN in resource-limited, rural areas.

Clinical Characteristics and Prognosis of Patients With No Standard Modifiable Risk Factors in Acute Myocardial Infarction.

Recently, the impact of the lack of standard modifiable risk factors, including hypertension, diabetes, dyslipidaemia, and current smoking, has been investigated in ST-segment elevation myocardial infarction (MI). The present study aimed to evaluate clinical characteristics and prognosis of the patients with no standard risk factors in acute MI. This bi-centre registry included 1,093 patients with acute MI undergoing percutaneous coronary intervention. The participants were divided into two groups: patients having at least one of the four standard risk factors and those having none of the risk factors. The study endpoints included major adverse cardiovascular events (MACE) (death, recurrent MI, and stroke) and major bleeding events during hospitalisation. Any MACE and major bleeding events after discharge were also evaluated as an exploratory analysis. Of 1,093 patients, 64 (5.9%) had none of the four standard risk factors. The patients with no standard risk factors were likely to present with Killip class IV and cardiac arrest. The rate of in-hospital MACE was higher in patients with no risk factors than in their counterparts (25.0% vs 9.9%; p<0.001), whereas the incidence of in-hospital major bleeding was not significantly different between the two groups (9.4% vs 6.7%; p=0.44). Active cancer and autoimmune/inflammatory diseases were often found in patients with no standard risk factors. After discharge, no significant differences were observed in the risks of MACE and major bleeding events between the two groups. No standard modifiable risk factors were not uncommon and were associated with poor short-term outcomes in patients with acute MI.

Association of psoriasis with myocardial infarction in end-stage renal disease patients

BackgroundPrevious research in non-dialysis patients suggests that the inflammatory skin disease psoriasis is associated with an increased risk of severe vascular events like myocardial infarction (MI). Thus, we determined whether psoriasis represents a significant risk factor for MI in end-stage renal disease (ESRD) patients. MethodsWe queried the United States Renal Data System for ESRD patients starting dialysis between 2004 and 2015. ICD-9 and ICD-10 codes were used to identify those with at least two diagnoses of psoriasis, a diagnosis of MI, and other clinical risk factors. Logistic regression was used to examine the association of psoriasis and various risk factors with MI. ResultsOf a cohort of 1,062,693, we identified 6823 (0.6%) subjects with psoriasis and 181,960 (17.1%) with MI. Of the 6823 patients with psoriasis, 1671 (24%) developed an MI. Psoriasis was associated with an increased risk of MI in an unadjusted model [odds ratio (OR) = 1.34; confidence interval (CI) = 1.26–1.42]. However, after controlling for demographics, dialysis modality, access type, and various conditions related to the Charlson Comorbidity Index, psoriasis was not associated with MI (OR = 0.95, CI = 0.89–1.01). Confounders of the association of psoriasis with MI included congestive heart failure (OR = 5.26, CI = 5.17–5.36), pulmonary disease (OR = 1.25, CI = 1.23–1.26), and diabetes with complications (OR = 1.82, CI = 1.79–1.85). ConclusionsContrary to prior research in the general population, in the ESRD population psoriasis was not associated with an increased risk of MI after controlling for various demographic and clinical parameters. These data emphasize the importance of an integrated approach since comorbidities may influence the choice of therapy for psoriasis and outcomes.

Predisposition to Myocardial Infarction Influenced by Interleukin 13 Gene Polymorphisms: A Case-Control Study.

Background: Additional inflammatory responses and subsequent damage—arising from enhance transcriptional activity or forming the more active protein due to existence of polymorphic sites in the pro-inflammatory cytokines gene loci—give rise to myocardial infarction susceptibility. Objectives: The aim of our study was to explore whether two interleukin-13 gene polymorphisms (−1512A/C and +2044G/A) could serve as underpins genetic susceptibility of myocardial infarction. Methods: The Iranian population that belong to the Parsis ethnic group was involved in the present study. A total 250 patients with definite myocardial infarction—meeting hypertension, hypercholesterolemia, hyperglycemia, and coronary artery disease requirements—were recruited from the Shiraz urban hospitals. 250 age- and sex-matched healthy individuals without a history of cardiovascular disease and heart disease related risk factors constituted the control group. PCR-restriction fragment length polymorphism technique applied to genotyping at −1512A/C and +2044G/A loci. Hardy–Weinberg equilibrium test was performed (combined cases and controls). The differences of the genotype frequencies in cases and controls were analyzed using a chi-square test. Logistic regression analysis was performed to assess the association between the genotypes and most important risk factors for myocardial infarction. All statistical analyses were performed in SPSS Version 22.0. p-values below 0.05 were hailed as statistically significant. Results: Deviation from Hardy–Weinberg equilibrium was not significant in the −1512A/C locus. Statistically significant difference between our study groups was found in genotype frequency of the −1512A/C. This variant was found in associated with myocardial infarction risk factors. The +2044G/A polymorphism was not in Hardy–Weinberg equilibrium and no significant difference observed in the distribution of +2044G/A genotype frequency among cases and controls. However, further analysis revealed that this genotype associated with an increased susceptibility to myocardial infarction risk factors. Conclusions: The presence of interleukin-13 −1512A/C and +2044G/A gene polymorphisms underpin myocardial infarction predisposition in the ethnic Parsis of the Iranian population.

Analysis of clinical characteristics and risk factors of young acute myocardial infarction

OBJECTIVE: The aim of the study is to investigate the clinical characteristics and risk factors for the development of young acute myocardial infarction (AMI). METHODS: A number of 196 AMI patients (31 young patients and 165 older patients) were enrolled in the study. The clinical characteristics in young AMI patients were explored by comparing their baseline characteristics, imaging features and serological results. The risk factors were tested by logistics regression analysis. RESULTS: The younger AMI patients were more likely to have hyperlipidaemia (67.74% vs. 36.97%, P=0.002), a family history of coronary heart disease and hyperlipidaemia (29.03% vs. 12.12%, P=0.025) (51.61% vs. 18.79%, P&lt;0.001), (54.84% vs. 35.15%, P=0.045) (61.29% vs. 34.55%, P=0.008). The proportion of alcohol and tobacco use were higher in younger AMI group. More severe anterior descending lesions involvement (77.42% vs. 46.06%, P=0.002) and a higher Gensini scores (62.23±16.80) vs. (53.00±18.58), P=0.011) were found in CTA imagines of younger AMI patients. The triglyceride levels were also significantly higher in younger AMI patients (2.55±1.59) vs. (1.67±0.79), P=0.005). A family history of hyperlipidaemia, Gensini score, IL-6 and triglycerides were risk factors for young AMI patients. CONCLUSION: Poor lifestyle management and family history were risk factors for the AMI development in young patients.

Assessing the risk factors for myocardial infarction in diet-induced prediabetes: myocardial tissue changes

BackgroundHyperglycaemia is known to result in oxidative stress tissue injury and dysfunction. Interestingly, studies have reported hepatic and renal oxidative stress injury during prediabetes; however, any injury to the myocardium during prediabetes has not been investigated. Hence this study aims to assess changes in the myocardial tissue in an HFHC diet-induced model of prediabetes.MethodsMale Sprague Dawley rats were randomly grouped into non-prediabetes and prediabetes (n = 6 in each group) and consumed a standard rat chow or fed a high-fat-high-carbohydrate diet respectively for a 20-week prediabetes induction period. Post induction, prediabetes was confirmed using the ADA criteria. Aldose reductase, NADH oxidase 1, superoxide dismutase, glutathione peroxide, cardiac troponins were analysed in cardiac tissue homogenate using specific ELISA kits. Lipid peroxidation was estimated by determining the concentration of malondialdehyde in the heart tissue homogenate according to the previously described protocol. Myocardial tissue sections were stained with H&E stain and analysed using Leica microsystem. All data were expressed as means ± SEM. Statistical comparisons were performed with Graph Pad instat Software using the Student's two-sided t-test. Pearson correlation coefficient was calculated to assess the association. Value of p < 0.05 was considered statistically significant.ResultsThe prediabetes group showed a markedly high oxidative stress as indicated by significantly increased NADH oxidase 1 and malondialdehyde while superoxide dismutase and glutathione peroxide were decreased compared to non-prediabetes group. There was no statistical difference between cardiac troponin I and T in the non-prediabetes and prediabetes groups. Cardiac troponins had a weak positive association with glycated haemoglobin.ConclusionThe findings of this study demonstrate that prediabetes is associated with myocardial injury through oxidative stress. Future studies are to investigate cardiac contractile function and include more cardiac biomarkers.

Synthetic Fibroblasts: Terra Incognita in Cardiac Regeneration.

Ischemic heart disease, a major risk factor for myocardial infarction (MI), occurs when the blood vessels supplying oxygen-rich blood to the heart become partially or fully occluded by lipid-rich plaques, resulting in myocardial cell death, remodeling, and scarring. In addition, MI occurs as result of lipid-rich plaque rupture, resulting in thrombosis and vessel occlusion. Cardiac fibroblasts (CFs) and CF-derived growth factors are crucial post-MI in myocardial remodeling. Information regarding the regenerative phenotypes of CFs is scarce; however, regenerative CFs are translationally relevant in myocardial regeneration following MI. The emerging technologies in regenerative cardiology offer cutting-edge translational opportunities, including synthetic cells. In this review, we critically reviewed the current knowledge and the ongoing research efforts on application of synthetic cells for improving cardiac regeneration post-MI. Impact statement Synthetic cells offer tremendous regenerative potential in otherwise deleterious cardiac remodeling postmyocardial infarction. Understanding the role of fibroblasts in cardiac healing and the therapeutic applications of synthetic cells would open a multitude of novel cardiac regenerative approaches. The novel concept of synthetic fibroblasts that emulate native cardiac fibroblasts can provide an effective solution in cardiac healing.

The association of attained age, age at diagnosis, and duration of type 2 diabetes with the long-term risk for major diabetes-related complications

AimWe evaluated the associations of age and duration of type 2 diabetes with major diabetes-related complications. MethodsWe included 1.1 million people with type 2 diabetes from the Australian diabetes registry, followed from 2010 to 2019. We estimated the incidence of hospitalization or death from myocardial infarction (MI), stroke, and heart failure (HF), and hospitalisation for lower extremity amputation (LEA); end-stage kidney disease (ESKD; kidney replacement therapy or death from ESKD); and all-cause mortality. Poisson regression was used to model incidence by attained age, age at diabetes diagnosis, and duration of diabetes. ResultsRisk for complications increased exponentially with diabetes duration. Effects of attained age differed for each complication: age was a strong risk factor for MI, stroke, HF, and mortality, while diabetes duration, not age, was the predominant determinant of LEA and ESKD. At a given age, a 10-year longer diabetes duration was associated with a 1.1–1.5-fold increased risk of stroke and mortality, a 1.5–2.0-fold increased risk of MI and HF, and a 2–4-fold increased risk of LEA and ESKD. ConclusionsDuration of diabetes is a stronger risk factor for ESKD and LEA than it is for cardiovascular disease or mortality.

To the question of the main of acute urinary retention development during myocardial infarction in young and middle-aged men predictors

BACKGROUND: Importance in assessing the course and prognosis of myocardial infarction is given to the study of a combination of two or more chronic diseases in one patient, interconnected by a single pathogenetic mechanism. Urological diseases are not among the most common in myocardial infarction, but during this period they significantly worsen the quality of life, increase the cost of treatment and are also associated with a worse prognosis.&#x0D; AIM: To study the development of acute urinary retention during the acute and subacute periods of myocardial infarction risk factors in men under 60 years old to improve prevention and outcomes.&#x0D; MATERIALS AND METHODS: The study included men aged 1960 years with type I myocardial infarction. Patients were divided into two age-comparable groups: I study group, with acute urinary retention 22 patients; II control, without urination disorders 644 patients. A comparative analysis of the main and additional cardiovascular risk factors observation frequency, the features of the clinical course in the selected groups were performed. Pearsons Chi-square method was used to analyze the risks of developing acute urinary retention.&#x0D; RESULTS: The structure of cardiovascular risk factors in the study group differed from the control group in a higher frequency of coronary artery bypass surgery in the medical history (I: 31.8%; II: 8.4%; p = 0.0002) and pacing (9.1 and 0.5%; respectively; p 0.0001), as well as fibrillation and/or atrial flutter in the medical history (27.3 and 9.2%; p = 0.005), chronic cerebrovascular insufficiency (77.3 and 51.3%; p = 0.02), alcohol abuse (63.6 and 25.2%; p 0.0001), frequent (four and more per year) colds (27.3 and 12.6%; p = 0.04), cardiac arrhythmias and conduction disorders at the onset of coronary artery disease (61.9 and 24.9%; p = 0.0007), smoking for 20 years or more (36.4 and 16.8%; p = 0.003), chronic kidney disease (46.7 and 16.2%; p = 0.02), chronic infection foci of internal organs (77.3 and 39.4%; p = 0.002), urinary (27.3 and 8.6%; p = 0.006) and cholelithiasis (13.6 and 5.4%; p = 0.006). Among the features of the clinical course of the disease, the study group was distinguished by a higher incidence of multiple complications of myocardial infarction (100 and 44.0%; p 0.0001), severe and extremely severe condition of patients (59.0 and 19.6%; p 0.0001). Asystole (absolute risk: 42.1%; relative: 18.0; p 0.0001), hydrothorax (absolute risk: 41.7%; relative: 15.9; p 0.0001), the patients severe condition in the first hours of illness (absolute risk: 100%; relative: 36.5; p 0.0001), alcohol abuse (8.0%; 4.9; p 0.0001), smoking (absolute risk: 4.4%; relative: 8.0; p = 0.01) and onset of CHD with heart rhythm and conduction disturbances (7.7%; 4.6; p = 0.0001) were the most significant predictors of acute urinary retention.&#x0D; CONCLUSIONS: Patients with acute urinary retention are characterized by a more severe course of myocardial infarction. Combinations of listed above factors indicate an increased risk of developing this complication. It is advisable to use them for predictive modeling and the formation of risk groups for early prevention.

Neuropathy scale score as an independent risk factor for myocardial infarction in patients with type 2 diabetes.

To investigate whether peripheral neuropathy scale scores are associated with myocardial infarction (MI) in patients with type 2 diabetes mellitus (T2DM). In this cross-sectional study, 32,463 T2DM patients were enroled from 103 tertiary hospitals in 25 Chinese provinces. Based on a history of MI, participants were divided into the MI group (n=4170) and the non-MI group (n=28,293). All patients were assessed using four neuropathy scales, namely, Neurological Symptom Score (NSS), Neurological Disability Score (NDS), Toronto Clinical Scoring System (TCSS), and Michigan Neuropathy Screening Instrument (MNSI), and some of the patients underwent evaluation of nerve conduction velocity (NCV) (n=20,288). The relationship between these scores and myocardial infraction was analysed. The neuropathy scale scores in the MI group were higher than those in the non-MI group (p<0.001). After dividing patients into four groups based on the grading criteria, our results showed that, in addition to aggravating the degree of neuropathy signs, the incidence of MI increased (p<0.001). Logistic regression analysis results showed that neuropathy scale scores and NCV were both independent risk factors for MI (p<0.001). Furthermore, among the scales used, MNSI presented a higher odds ratio and area under the curve (AUC; 0.625, p<0.001) than the other three scales (AUCNSS =0.575, AUCNDS =0.606, and AUCTCSS =0.602, p<0.001) for MI. Increased scores on these neuropathy scales (NSS, NDS, TCSS, and MNSI) and NCV were significantly associated with increased risk of MI and were considered independent risk factors.

Case Fatality of Patients With Type 1 Diabetes After Myocardial Infarction.

OBJECTIVEType 1 diabetes is a risk factor for myocardial infarction (MI). We aimed to evaluate the case fatality in patients with type 1 diabetes after MI.RESEARCH DESIGN AND METHODSConsecutive patients experiencing MI with type 1 diabetes (n = 1,935; 41% female; mean age 62.5 years) and without diabetes (n = 74,671) admitted to 20 hospitals in Finland from 2005 to 2018 were studied using national registries. The outcome of interest was death within 1 year after MI. Differences between groups were balanced by multivariable adjustments and propensity score matching.RESULTSCase fatality was higher in patients with type 1 diabetes than in propensity score–matched controls without diabetes at 30 days (12.8% vs. 8.5%) and at 1 year (24.3% vs. 16.8%) after MI (hazard ratio 1.55; 95% CI 1.32–1.81; P < 0.0001). Patients with type 1 diabetes had poorer prognosis in subgroups of men and women and of those with and without ST-elevation MI, with and without revascularization, with and without atrial fibrillation, and with and without heart failure. The relative fatality risk in type 1 diabetes was highest in younger patients. Older age, heart failure, peripheral vascular disease, renal failure, and no revascularization were associated with worse prognosis after MI. The case fatality among patients with type 1 diabetes decreased during the study period, but outcome differences compared with patients without diabetes remained similar.CONCLUSIONSPatients with type 1 diabetes are at higher risk of death after MI than patients without diabetes. Our findings call for attention to vigorous cardiovascular disease prevention in patients with type 1 diabetes.

Type A Wellens’ syndrome - A critical electrocardiographic sign

Wellens’ syndrome was first described in 1982[1] and classified into type A and type B. Type A Wellens’ syndrome is characterized by biphasic T-waves in leads V2 and V3, and type B is characterized by deep symmetrical T-wave inversions in the same leads. The study reported that Wellens’ syndrome electrocardiographic (ECG) finding related to left anterior descending (LAD) total or near-total occlusion, which is also described as one of the ST-segment elevation myocardial infarction (STEMI) equivalent signs.[2] Cardiology consultation for possible coronary angiography is necessary for evaluating patients.[3] A 29-year-old male without underlying medical diseases was admitted to our emergency department due to intermittent retrosternal chest tightness for 1 week. His chest pain usually occurs after exertion, accompanied by nausea and dizziness, and subsides 10–15 min after rest. He did not notice other exacerbating or relieving factors. Thus, he visited our emergency department for a consultation. The patient is a nonsmoker with no family history of acute coronary syndrome. In the emergency department, his chest pain had already subsided. He was vitally stable. On physical examination, his cardiac auscultation revealed a regular heartbeat with no murmurs. His ECG performed in the emergency department showed sinus rhythm with biphasic T-waves in leads V2 and V3 without precordial Q waves [Figure 1], which is compatible with type A Wellens’ syndrome. As for his blood examination, his troponin I level is 3.2 ng/mL (normal range < 0.02 ng/mL) and creatine kinase-myocardial band mass is 8.5 ng/mL (normal range <5 ng/mL). He also had thrombocytosis with a platelet count of 993,000/μL.Figure 1: Patient’s initial ECG. ECG: ElectrocardiographicThe patient received aspirin, ticagrelor, and heparin for the myocardial infarction. He received urgent coronary angiography and the examination showed an 85% stenosis of the proximal LAD artery [Figure 2] that was successfully opened through angioplasty. Two drug-eluted stents were placed. After angioplasty, his ECG showed sinus rhythm with no Wellens’ pattern. In addition, he did not experience any chest pain attack after angioplasty. On admission, the patient was diagnosed with essential thrombocythemia through positive JAK-2 V617F mutation test and bone marrow biopsy.Figure 2: Patient’s coronary angiography showed LAD stenosis. (Left) Before the intervention. (Right) After the intervention. LAD: Left anterior descendingWellens’ syndrome is one of the STEMI equivalent ECG signs that need to be treated as acute myocardial infraction in the emergency department.[2] A previous study[1] showed that 75% of the patients with Wellens’ syndrome developed extensive anterior wall myocardial infarction a few weeks after admission. T-wave findings of Wellens’ syndrome are classified into two patterns. In type B, which comprises approximately 75% of cases, the T-wave is deeply inverted and the inverted T-wave is symmetric in contour. In type A, which comprises 25% of cases, the T-wave is biphasic in leads V2 and V3. Other ECG criteria included no loss of R rave or precordial Q waves. Considering noncoronary causes of T-wave inversions, the left ventricular hypertrophy and bundle branch block patterns should be readily recognized by their significant coexistent findings.[3] The characteristic ECG pattern often develops when the patient is not experiencing angina.[3] Patients with ET may present with vasomotor symptoms such as myocardial infarction or stroke. However, in this case, the patient was young and without any risk factors for myocardial infarction before diagnosis. Prompt recognition of the ECG pattern and early cardiology consultation are essential to prevent missing the diagnosis of myocardial infarction. Declaration of patient consent The authors certify that they have obtained appropriate patient consent form. In the form, the patient has given his consent for the images and other clinical information to be reported in the journal. The patient understands that name and initial will not be published and due efforts will be made to conceal the identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.