Symptoms Of Myocardial Infarction Research Articles

Routine Coronary Angiography and Functional Cardiac Tests before Resection of Abdominal Aortic Aneurysm in Patients without Symptoms of Myocardial Infarction

INTRODUCTION: Cardiac complications are leaders in the structure of mortality of patients after resection of abdominal aortic aneurysms (AAA). In recent years more data have been obtained on the possibility of performing invasive coronary angiography (CAG) as a method of preoperative assessment of the condition of the coronary arteries. AIM: To assess the tactics of routine CAG and preventive revascularization of the myocardium in comparison with non-invasive functional tests in patients without clinical manifestations of coronary heart disease (CHD) from positions of the hospital outcomes of AAA resections. MATERIALS AND METHODS: A retrospective study included 205 patients without clinical and instrumental signs of CHD who underwent AAA resection at National Medical Research Center of Surgery named after A. Vishnevsky in 2001–2021. Patients of the first group (n = 55) underwent CAG before AAA resection and, if significant stenosis of coronary arteries was detected, revascularization of the myocardium was performed. In patients of the second group (n = 71), only functional cardiac tests were conducted before the operation. Patients of the third group were operated on without additional evaluation of cardiac status. RESULTS: In 30.9% of patients of the first group, significant coronary lesions were detected, in 29.5% of them with the involvement of the left main coronary artery. This required 10 percutaneous coronary interventions and 5 coronary artery bypass surgeries, which made 27.0% of patients in this group. No cases of myocardial infarction were recorded in this group. In the second and third groups, one case of myocardial infarction in each group was recorded (p = 0.688). There was no significant difference in the postoperative mortality in all the groups (1.8%; 4.2%; 2.5%, respectively; p = 0.704). To this end, maximally invasive diagnostic tactics increased the average waiting time for AAA resection: 52.2 ± 6.0 days in groups without coronary angiography and myocardial revascularization versus 99.2 ± 13.0 days in the first group. CONCLUSION: In a cohort of patients without anamnestic and clinical manifestations of coronary artery disease, the tactics of routine coronary angiography followed by prophylactic myocardial revascularization did not improve the short-term results of AAA resection, while the waiting period for intervention on the abdominal aorta increased. Preoperative tactics with functional cardiac tests also did not affect the treatment results.

Routine Coronary Angiography and Functional Cardiac Tests before Resection of Abdominal Aortic Aneurysm in Patients without Symptoms of Myocardial Infarction

INTRODUCTION: Cardiac complications are leaders in the structure of mortality of patients after resection of abdominal aortic aneurysms (AAA). In recent years more data have been obtained on the possibility of performing invasive coronary angiography (CAG) as a method of preoperative assessment of the condition of the coronary arteries. AIM: To assess the tactics of routine CAG and preventive revascularization of the myocardium in comparison with non-invasive functional tests in patients without clinical manifestations of coronary heart disease (CHD) from positions of the hospital outcomes of AAA resections. MATERIALS AND METHODS: A retrospective study included 205 patients without clinical and instrumental signs of CHD who underwent AAA resection at National Medical Research Center of Surgery named after A. Vishnevsky in 2001–2021. Patients of the first group (n = 55) underwent CAG before AAA resection and, if significant stenosis of coronary arteries was detected, revascularization of the myocardium was performed. In patients of the second group (n = 71), only functional cardiac tests were conducted before the operation. Patients of the third group were operated on without additional evaluation of cardiac status. RESULTS: In 30.9% of patients of the first group, significant coronary lesions were detected, in 29.5% of them with the involvement of the left main coronary artery. This required 10 percutaneous coronary interventions and 5 coronary artery bypass surgeries, which made 27.0% of patients in this group. No cases of myocardial infarction were recorded in this group. In the second and third groups, one case of myocardial infarction in each group was recorded (p = 0.688). There was no significant difference in the postoperative mortality in all the groups (1.8%; 4.2%; 2.5%, respectively; p = 0.704). To this end, maximally invasive diagnostic tactics increased the average waiting time for AAA resection: 52.2 ± 6.0 days in groups without coronary angiography and myocardial revascularization versus 99.2 ± 13.0 days in the first group. CONCLUSION: In a cohort of patients without anamnestic and clinical manifestations of coronary artery disease, the tactics of routine coronary angiography followed by prophylactic myocardial revascularization did not improve the short-term results of AAA resection, while the waiting period for intervention on the abdominal aorta increased. Preoperative tactics with functional cardiac tests also did not affect the treatment results.

Women Acute Myocardial Infarction-Identifying and Understanding the Gender Gap (WAMy-GAP): A Study Protocol.

Barriers to accessing care and misinterpretations of ischemic heart disease symptoms due to lack of awareness contribute to women's delay in seeking care. Women may delay seeking treatment for up to 3 h or even up to 5 days. They often perceive themselves to be at low risk of cardiovascular disease (CVD) and prioritize family responsibilities or household chores. The causes of this delay are multifactorial and influence the decision-making process, particularly in the pre-hospital phase. The objective of this study protocol is to evaluate prodromal symptoms and identify risk behaviors in women with acute myocardial infarction (AMI). This is a protocol for a multicenter study that will be conducted using the mixed-method methodology using the McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey (MAPMISS) to evaluate symptoms and semi-structured interviews to investigate behaviors. This study protocol is intended to fill an important knowledge gap on premonitory and acute symptoms of AMI in women in Italy, as well as to understand the causes and mechanisms underlying delays in accessing healthcare services during an acute event such as AMI. The investigation of this issue will facilitate the removal of gender-related inequalities in the diagnosis and treatment of acute myocardial infarction while also fostering dialogue on the barriers to behavior change.

Clinical, Anamnestic, and Demographic Characteristics of Patients with Myocardial Infarction in Russian Federation According to the Russian Registry of Acute Myocardial Infarction - REGION-IM.

Based on data from the Russian REGION-MI registry, to characterize patients with myocardial infarction (MI) hospitalized in Russian hospitals, describe their historical, demographic, and clinical characteristics, and compare the results with the data of previous Russian and international registries of acute coronary syndrome. REGION-MI is a multicenter prospective observational study. The follow-up period was divided into three stages: during the hospital stay, at 6 and 12 months after the inclusion in the registry. Demographic and historic data and information about the present case of MI were entered into the patient's individual record card. The median age of all patients was 63 years; 68% of patients were men. The mean age of women was older than that of men. Among all MI cases, 70% were ST-segment elevation myocardial infarction (STEMI). Patients with non-ST-segment elevation myocardial infarction (NSTEMI) were older and had more comorbidities than patients with STEMI. The median time from the first symptoms to ECG recording was two hours, and from the first symptoms to CAG 7 hours. CAG was performed in 91% of patients with STEMI and 84% of patients with NSTEMI. Stenting was performed in 69% of patients. Although many patients had a complicated cardiovascular history, at the time of admission only 31.5% of patients were taking at least one drug from the groups of antiplatelets, oral anticoagulants, statins, and beta-blockers. Patients with MI in the Russian Federation are younger than patients with MI in European countries. Among the clinical and historical characteristics, conspicuous is the presence of modifiable risk factors in many patients, as well as the presence of a previous diagnosis of ischemic heart disease. Furthermore, a small proportion of patients took statins, antiplatelet agents or anticoagulants at the outpatient stage, which indicates a great reserve of both primary and secondary prevention of cardiovascular diseases in the Russian Federation. The delayed seeking medical help is also noticeable, which indicates the need for increasing the public awareness of the symptoms of MI and the importance of timely hospitalization.

A randomized clinical trial of catheter ablation and antiarrhythmic drug therapy for suppression of ventricular tachycardia in ischemic cardiomyopathy: The VANISH2 trial

Recurrent ventricular tachycardia (VT) in patients with prior myocardial infarction is associated with adverse quality of life and clinical outcomes, despite the presence of implanted defibrillators (ICDs). Suppression of recurrent VT can be accomplished with antiarrhythmic drug therapy or catheter ablation. The Ventricular Tachycardia Antiarrhythmics or Ablation In Structural Heart Disease 2 (VANISH2) trial is designed to determine whether ablation is superior to antiarrhythmic drug therapy as first line therapy for patients with ischemic cardiomyopathy and VT.The VANISH2 trial enrolls patients with prior myocardial infarction and VT (with one of: ≥1 ICD shock; ≥3 episodes treated with antitachycardia pacing (ATP) and symptoms; ≥5 episodes treated with ATP regardless of symptoms; ≥3 episodes within 24 hours; or sustained VT treated with electrical cardioversion or pharmacologic conversion). Enrolled patients are classified as either sotalol-eligible, or amiodarone-eligible, and then are randomized to either catheter ablation or to that antiarrhythmic drug therapy, with randomization stratified by drug-eligibility group. Drug therapy, catheter ablation procedures and ICD programming are standardized.All patients will be followed until two years after randomization. The primary endpoint is a composite of mortality at any time, appropriate ICD shock after 14 days, VT storm after 14 days, and treated sustained VT below detection of the ICD after 14 days. The outcomes will be analyzed according to the intention-to-treat principle using survival analysis techniques.The results of the VANISH2 trial are intended to provide data to support clinical decisions on how to suppress VT for patients with prior myocardial infarction.Clinicaltrials.gov registration NCT02830360

Age and healthy lifestyle behavior’s disparities and similarities on knowledge of myocardial infarction symptoms and risk factors among public and outpatients in a resource-limited setting, cross-sectional study in greater Gaborone, Botswana

Objectives In this cross-sectional study from Botswana, we investigated knowledge of myocardial infarction (MI) symptoms and risk factors among the general public and outpatients with MI risk factors based on age and lifestyle behaviors, in addition to assessing associations with sociodemographic and MI risk factors.Method Open-ended questionnaires about 8 MI symptoms and 10 risk factors, were administered by research assistants to a representative selection of outpatients (n = 525) and the public (n = 2248). Weight and height were measured in all participants and BMI was calculated. Knowledge scores were compared between the two groups. We examined whether sociodemographic and MI risk factors had impact on the scores. Analyses were further adjusted for lifestyle behavior (smoking status, dietary status and physical activities).ResultsThe valid response rate was 97.9% comprising 97.8% for the public (n = 2199) and 98.1% for outpatients (n = 515). Public respondents (35.2 ± 12.3 years) were younger than outpatients (38.5 ± 12.6 years). The public comprised 56.9% females while outpatients 54.6%.In general, outpatients had higher knowledge of MI symptoms than the public, with mean scores ± SD of 3.49 ± 2.84 vs 2.80 ± 2.54. Outpatients also had higher knowledge score of MI risk factors than the public, with mean scores, 5.33 ± 3.22 vs 3.82 ± 3.07. For MI symptoms, outpatients were more aware than the public for chest pains among all ages, for arm pain/ numbness, neck/ jaw pain radiating to/ from chest, and feeling sick or looking pallor on the skin among those aged 35–49 years.Among both the public and outpatients, lower knowledge of both MI symptoms and risk factors was associated with primary education, not residing/working together, history of hypertension, no history of heart disease/stroke, and obesity. There were similarities and disparities on MI knowledge among respondents with various numbers of healthy lifestyle behaviours.ConclusionResults call for urgent educational campaigns on awareness and knowledge of MI and using strategies based on age and lifestyle behavior.

Public Awareness of Early Symptoms of Acute Myocardial Infarction in Arar, Saudi Arabia

Background: A significant factor in patient delays is a lack of understanding of MI symptoms. Denial, fear, and an undue reliance on self-management could be the causes of more delays. This study aimed to assess the level of public awareness concerning the early symptoms of acute myocardial infarction (MI) and the appropriate actions to be taken when these symptoms manifest in the population of Arar, Saudi Arabia. Methods: A cross-sectional design employing a quantitative approach was used. Data were collected through an online self-administered questionnaire distributed to 390 participants using convenience sampling. The collected data were analyzed using descriptive and inferential statistics. Results: The study revealed mixed awareness levels among participants. While 63.6% correctly recognized chest pain as a symptom of MI, only 61.8% identified radiating pain to the shoulder, arm, back, neck, and jaw as an alarming symptom. Additionally, 74.9% recognized shortness of breath, and 64.6% identified fatigue as potential MI symptoms. Other symptoms, such as cold sweats (57.2%) and nausea (40.3%), were less well-known. Among the recognized risk factors, smoking (86.7%), diabetes (64.1%), and hypertension (79%) were relatively well-acknowledged, while obesity (84.4%) and sedentary lifestyles (86.9%) were recognized to a lesser extent. Age, education, income, city of residence, personal or family history of MI, history of MI among acquaintances, and exposure to AMI information in media and books significantly influenced awareness scores (p < 0.05). Conclusion: The study underscores the importance of tailored public health interventions to enhance MI awareness, especially among younger individuals, those with higher education, and those with lower incomes. It highlights the need for addressing lesser-known risk factors, such as obesity and sedentary lifestyles, to comprehensively prevent MI.

Association Between Acute Myocardial Infarction Symptoms and Short- and Long-term Mortality After the Event

BackgroundIn this study, we investigated various acute myocardial infarction (AMI) symptoms and their associations with short-term (28 day) and long-term mortality. MethodsThe analysis was based on 5900 patients, aged 25 to 84 years, with first-time AMI recorded by the population-based Myocardial Infarction Registry Augsburg between 2010 and 2017. Median follow-up time was 3.8 years (interquartile range: 1.1-6.3). As part of a face-to-face interview, the presence (yes/no) of 11 most common AMI symptoms at the acute event was assessed. Using multivariable-adjusted logistic regression and Cox regression models, the association between various symptoms and all-cause mortality was investigated. P values of the regression models were false discovery rate adjusted. ResultsPain in various body parts (chest pain, left and right shoulder/arm/hand, between shoulder blades), sweating, nausea/vomiting, dizziness and fear of death/feeling of annihilation were significantly associated with a decreased 28-day mortality after AMI. The pain symptoms and sweating were also significantly associated with a decreased long-term mortality. Shortness of breath was significantly associated with a higher long-term mortality. ConclusionsThe absence of several symptoms, including typical chest discomfort (chest pain or retrosternal pressure/tightness), is associated with unfavourable outcomes after AMI. This finding has implications for patient management and public health measures designed to encourage appropriate and prompt medical consultation of patients with atypical AMI symptoms.

Exploring Myocardial Infarction Knowledge, Attitudes, and Practice Among Mogadishu's Somali Residents.

Myocardial infarction and cardiovascular disease are significant global health issues, particularly in Somalia. The Somali population faces challenges due to armed conflict, limited education, and underdeveloped healthcare infrastructure. Cardiovascular risk factors like diabetes, hypertension, and obesity are prevalent, and Somali people face increased susceptibility. This study examined Somalia residents' perceptions, attitudes, and behaviors towards myocardial infarction using a cross-sectional paper-based questionnaire. The sample consisted of 313 urban residents in Mogadishu, aged 20 and above. The questionnaire was written in Somali and was designed for the demographic. Knowledge, attitude, and practice scores were categorized into two groups, with associations between knowledge, attitude, and practice with sociodemographic and health characteristics assessed using Logistic Regression. This study analyzed data from A random sample of participants who arrived at the hospital for various reasons regarding their perceptions, attitudes, and responses towards myocardial infarction. The mean age was 42 ±19 years, with 54% being male and 46% female. Hypertension was the most common comorbidity, followed by dyslipidemia and diabetes. Over half of the respondents had no formal education, and only 3.8% had a smoking history. About 5.7% had a previous history of myocardial infarction. The mean knowledge score was 11.07 ± 0.697, with 53.35% of respondents not knowing enough about myocardial infarction. The majority of the patients showed a favorable attitude, but only a slight majority could recognize symptoms of myocardial infarction. The majority of the patients had inadequate practice and behavior, with 53.6% not practicing regularly or engaging in sports. The research highlights gaps in Mogadishu's Somali community's knowledge and practices regarding myocardial infarction. It emphasizes the need for health education, primary care, and community involvement to improve cardiovascular health awareness and reduce MI incidence.

Insulin resistance in Takotsubo syndrome.

Takotsubo syndrome (TTS) is an acute heart failure (AHF) syndrome mimicking the symptoms of acute myocardial infarction. Impaired outcome has been shown, making risk stratification and novel therapeutic concepts a necessity. We hypothesized insulin resistance with elevated plasma glucose and potentially myocardial glucose deprivation to contribute to the pathogenesis of TTS and investigated the therapeutic benefit of insulin in vivo. First, we retrospectively analysed patient data of n=265 TTS cases (85.7% female, mean age 71.1±14.1years) with documented initial plasma glucose from the Department of Cardiology of the University Hospital Heidelberg in Germany (May 2011 to May 2021). Median split of the study population according to glucose levels (≤123mg/dL vs. >123mg/dL) yielded significantly elevated mean heart rate (80.75±18.96 vs. 90.01±22.19b.p.m., P<0.001), left ventricular end-diastolic pressure (LVEDP, 18.51±8.35 vs. 23.09±7.97mmHg, P<0.001), C-reactive protein (26.14±43.30 vs. 46.4±68.6mg/L, P=0.006), leukocyte count (10.12±4.29 vs. 15.05±9.83/nL, P<0.001), peak high-sensitive Troponin T (hs-TnT, 515.44±672.15 vs. 711.40±736.37pg/mL, P=0.005), reduced left ventricular ejection fraction (EF, 34.92±8.94 vs. 31.35±8.06%, P<0.001), and elevated intrahospital mortality (2.3% vs. 12.1%, P=0.002) in the high-glucose group (Student's t-test, Mann-Whitney U test, or chi-squared test). Linear regression indicated a significant association of glucose with HR (P<0.001), LVEDP (P=0.014), hs-TnT kinetics from admission to the next day (P<0.001), hs-TnT the day after admission (P<0.001), as well as peak hsTnT (P<0.001). Logistic regression revealed significant association of glucose with a composite intrahospital outcome including catecholamine use, respiratory support, and resuscitation [OR 1.010 (1.004-1.015), P=0.001]. To further investigate the potential role of glucose in TTS pathophysiology experimentally, we utilized an in vivo murine model of epinephrine (EPI)-driven reversible AHF. For this, male mice underwent therapeutic injection of insulin (INS, 1IU/kg) or/and glucose (GLU, 0.5g/kg) after EPI (2.5mg/kg), both of which markedly improved mean EF (EPI 34.3% vs. EPI+INS+GLU 43.7%, P=0.025) and significantly blunted mean hs-TnT (EPI 14393pg/mL vs. EPI+INS 6864pg/mL at 24h, P=0.039). Particularly, insulin additionally ameliorated myocardial pro-inflammatory gene expression, suggesting an anti-inflammatory effect of acute insulin therapy. Elevated initial plasma glucose was associated with adverse outcome-relevant parameters in TTS and may present a surrogate parameter of heightened catecholaminergic drive. In mice, insulin- and glucose injection both improved EPI-induced AHF and myocardial damage, indicating insulin resistance rather than detrimental effects of hyperglycaemia itself as the underlying cause. Future studies will investigate the role of HbA1c as a risk stratifier and of insulin-based therapy in TTS.

Awareness of Myocardial Infarction Symptoms and Risk Factors in Saudi Arabia: A Cross-Sectional Study.

Background Cardiovascular disease is the leading global cause of mortality. Recognition of myocardial infarction (MI) symptoms is crucial as it influences clinical outcomes. Furthermore, awareness of MI risk factors assists in obtaining healthier lifestyles, alleviating its burden and mortality rates. This study aims to evaluate the awareness levels of the general population in Saudi Arabia regarding MI symptoms and risk factors and to identify its determinants. Methods A descriptive cross-sectional study was conducted among the general Saudi population, with 1,247 participants, excluding those residing outside Saudi Arabia and healthcare-related individuals. An online self-administered questionnaire encompassed sociodemographic characteristics, awareness of MI symptoms and risk factors, and participants' perceptions concerning appropriate responses during an MI event. Results The majority of participants recognized chest pain and shortness of breath as MI symptoms, with a percentage of 87.1% and 86%, respectively. Risk factors awareness was substantial at 90.3% for smoking and 76.1% for obesity. The mean overall awareness score was 26.6±7.5, and around 36% were aware of both symptoms and risk factors. Higher education levels were positively associated with both risk factors and symptom awareness, while employment status showed negative associations with both. Higher-income correlated with greater risk factors awareness. Gender remained significant, with males exhibiting a lower awareness of risk factors and symptoms. Region and chronic disease status were positively associated with risk factors and symptom awareness. More than 90% of participants perceived going to the emergency room immediately if they recognized an MI attack. Conclusion This study highlights the necessity for inclusive awareness campaigns to enhance the identification of MI symptoms and risk factors in Saudi Arabia. It should focus on groups with limited awareness, such as males, employed and retired individuals, and specific pronounced regional disparities.

Longer symptom onset-to-door time persists despite reductions in STEMI door-to-balloon time: insights from the victorian cardiac outcomes registry

Abstract Background Prompt revascularisation is central to achieving optimal outcomes for patients presenting with ST-segment elevation myocardial infarction (STEMI). To enable this, health systems have traditionally focused on the ‘door-to-balloon’ (DTB) component of total ischaemic time, while comparatively less attention has been given to symptom ‘onset-to-door’ (OTD) time. Objective To determine the temporal trends, predictors and outcomes among patients with increased OTD time. Methods Consecutive patients with STEMI treated with percutaneous coronary intervention (PCI) across 30 hospitals in the Victorian Cardiac Outcomes Registry were analyzed between 2014 and 2020. Linkage with data from Ambulance Victoria was performed for all patients transported via emergency medical services. Trends in OTD and DTB time were evaluated with Cochrane-Armitage test of trend. Characteristics and outcomes of patients with longer OTD time (&amp;gt;60 mins) were compared to those with shorter OTD time (&amp;lt;60 mins). Multivariable predictors of longer OTD were determined with logistic regression and presented as odds ratio and 95%CI in a forest plot. Results A total of 13,494 patients underwent PCI for STEMI with median OTD time of 150mins (86,328) and median DTB time of 66mins (43,107). DTB time progressively reduced over the study period (p=0.001) while the proportion of patients with longer OTD did not change (90.3%, p=0.91). Patients with longer OTD time were more likely to be older (&amp;gt;65yo = 41% vs. 35%, p&amp;lt;0.001), female (22 vs. 16%, p&amp;lt;0.001), live in a lower-socioeconomic area (36 vs. 28%, p&amp;lt;0.001), be treated for diabetes (17 vs. 13%, p&amp;lt;0.001), have developed their symptoms out-of-hours (65 vs. 60%, p=0.002) and present via ambulance [vs. self-present] (81 vs. 63%, p&amp;lt;0.001). Multivariable predictors of longer OTD time are presented in forest plot below. Higher rates of new renal impairment (6.7 vs. 5.0%, p=0.024) and 30-day MI (1.5 vs. 0.7%, p=0.017) were observed among patients with longer OTD, as were numerical trends in new 30-day heart failure (1.4 vs. 0.9%, p=0.22) and in-hospital shock (5.9 vs. 4.7%, p=0.081). Conclusion No change in the proportion of patients presenting with longer onset-to-door times was observed despite a parallel reduction in door-to-balloon time over the study period. Increased community awareness and education on the symptoms of myocardial infarction, particularly targeted at high risk demographic groups, are needed to further reduce ischaemic times.

Effect of symptoms recognition in patients with recurrent acute myocardial infarction: from KRAMI-RCC

Abstract Background Clinical significance of self-recognition for myocardial infarction symptom in the general population has been well-known. However, evidence of self-recognition for ischemic symptoms in patients with recurrent myocardial infarction is limited. The study is aimed to verify the association between self-recognition and clinical characteristics, and clinical outcomes in patients with recurrent myocardial infarction. Method From 2016 to 2019, the Korean Registry of Acute Myocardial Infarction for Regional Cardiocerebrovascular Centers (KRAMI-RCC), a web-based registry for myocardial infarction in South Korea, was used. We divided into two groups based on self-recognition in questionnaire. Patient characteristics and clinical outcomes were analyzed. Result Among 11,894 MI patients, the rate of recurrent MI was 9.7%. The rate of self-recognition in subjects with first MI and recurrent MI was 14.4% and 52.0%, respectively (p&amp;lt;0.001). Patients without responses to the self-recognition questionnaire were excluded (n=86). Finally, enrolled subjects were 1,050. Males had a higher rate of self-recognition (79.3% vs. 69.0%). Younger patients, higher graduation levels, and living with a spouse were associated with the well-recognized symptoms. Chest pain, cold sweating, and radiating pain were related to being noticed as a symptom of MI. However, no difference of respiratory difficulties and stomachache in both groups was observed. The unrecognized group had more frequently occurred with cardiogenic shock and heart failure. A history of stroke and malignancy was associated with a low incidence of recognition. Patients with dyslipidemia had a high recognition rate. There was no difference of symptom recognition between ST elevation MI and non-ST elevation MI. Interestingly, previously registered patients in KRAMI-RCC were significantly associated with higher recognition. The symptom recognition was related to prompt visit in regional cardiovascular centers (57% vs. 47%, p=0.002). The in-hospital mortality rate in the unrecognized group was higher at 6.7% compared to the recognized group (1.5%, p&amp;lt;0.000). Unrecognized MI symptoms and a presentation with cardiogenic shock were independent predictors in multivariate analysis to predict a model for in-hospital mortality. Conclusion The MI symptom recognition rate was still low in patients with recurrent MI. Self-recognition of MI symptoms was an independent predictor for in-hospital mortality. In this study, it is thought that rapid symptom recognition might help patients with myocardial infarction visit the hospital as soon as possible, thereby reducing cardiogenic shock and death.Multivariable analysisSelf-recognition and Outcomes

Variations and Associated Factors in Symptom-to-Balloon (STB) Time and Door-to-Balloon (DTB) Time Before and After the COVID-19 Lockdown: A Hospital-Based Cross-Sectional Study.

During the COVID-19 lockdown, India saw a major restriction in the movement of people. Patients with acute myocardial infarction (MI) required early interventions and follow-up of independent predictors like symptom-to-balloon (STB) time and door-to-balloon (DTB) time. This study aimed to determine changes in STB and DTB time before and after the COVID-19 lockdown and its associated risk factors. A hospital-based cross-sectional study of 105 patients admitted to the cardiac care units (CCU) of two tertiary care centers in a district of Southern India for six months was conducted to compare the changes in STB and DTB time before and after the COVID-19 lockdown (three months before March 2020 and three months after March 2020), and data was collected from medical records. The data collected was then entered into Microsoft Excel (Microsoft Corporation, Washington, USA), numerically coded, and analyzed using SPSS Statistics version 21 (IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.). The Chi-square and Mann-Whitney U tests assessed the association between the dependent and independent variables. The STB/DTB time (before and after the COVID-19 lockdown) was the dependent variable, while the age, gender, co-morbidities, smoking status, and date of admission of patients (before and after the COVID-19 lockdown) were taken as the independent variables. A p-value of <0.05 was considered statistically significant. The predictor variables were identified using the regression method, where all variables with a significance of <0.2 were taken. The overall mean (±SD) STB time was 408.7 (±307.1) minutes, and the mean (±SD) DTB time was 161.7 (±261.6) minutes. The pre-lockdown mean STB time was 404.6 minutes, and the mean DTB time was 153 minutes, whereas the post-lockdown mean STB and DTB time were higher at 413.3 minutes and 171.6 minutes, respectively. Out of the total 105 patients, 95 (90.5%) had an STB time of ≥120 minutes, and 77 (73.3%) had an ideal DTB time of <90 minutes. There was no statistically significant variation in the STB and DTB time before and after the lockdown. Only the age group >60 years (38 (97.4%)) was found to be statistically significant with an STB time of ≥120 minutes after the lockdown (p-value=0.040), and patients referred from primary and secondary care centers (AOR (95% CI)=4.669 (1.129-19.298)) were found to be an independent factor in reducing DTB time before and after the COVID-19 lockdown. The efficiency of the health system, irrespective of the COVID-19 lockdown, was observed; nevertheless, a delay in the overall recognition of symptoms of MI was perceived. The importance of time factors in identifying the symptoms of non-communicable diseases (NCDs), especially MI and stroke, has to be ascertained among the general population.

Growth differentiation factor-15 — a new indicator of unfavorable prognosis in uncomplicated myocardial infarction

Aim. To evaluate the role of growth differentiation factor-15 (GDF-15) in long-term prognosis in patients with uncomplicated myocardial infarction (MI).Material and methods. The study included 118 patients with uncomplicated ST-elevation and non-ST-elevation MI. In addition to the routine examination, all patients were analyzed for GDF-15, as well as the N-terminal pro-brain natriuretic peptide (NT-proBNP) by enzyme immunoassay in the first 48 hours from the onset of MI symptoms. The changes in the patients' condition were assessed by questioning after 1, 3, 6, 12 months, as well as the analysis of medical records in the event of repeated cardiovascular events and deaths. The endpoints were cardiovascular death, hospitalization for recurrent MI, and/or unstable angina. To assess the value of quantitative variables in predicting recurrent cardiovascular events, the ROC analysis was used. The survival function of patients was assessed using the Kaplan-Meier method.Results. Twelve-month follow-up revealed 29 recurrent cardiovascular events, including 2 deaths and 8 recurrent MIs. GDF-15 was predictive of recurrent cardiovascular events with a sensitivity of 77,3% and a specificity of 56,2% (ROCAUC, 0,7±0,065 (95% confidence interval (CI), 0,572-0,827), p=0,004). Patients with GDF-15 ≥2,075 ng/mL had a higher risk of recurrent cardiovascular events (hazard ratio (HR), 3,4 (95% CI, 1,342-8,613), p=0,005). Another prognostic factor influencing the rate of recurrent cardiovascular events was NT-proBNP. An NTproBNP level ≥578 pg/mL was associated with an increased risk of cardiovascular death and rehospitalization for unstable angina and recurrent MI (HR, 4,3 (95% CI 1,828-10,239), p=0,00019).Conclusion. The combined increase in GDF-15 ≥2,075 ng/mL and NT-proBNP ≥578 pg/mL in patients with uncomplicated MI increases the risk of recurrent cardiovascular events over the next 12 months (HR, 4,5 (95% CI, 2,087-9,736), p=0,00018).

Patient Denial of Myocardial Infarction in the Prehospital Phase: Prevalence and Correlates.

Limited knowledge exists regarding patients' denial of myocardial infarction (MI) before hospitalization for an MI. The aim of this study was to determine the prevalence and correlates of denial of MI in the prehospital phase of a confirmed MI. This secondary analysis included 166 hospitalized patients (mean [SD] age, 54.1 [10.5] years) who developed MI outside a healthcare facility and had high congruence between their experienced and expected symptoms. Measurements included the Denial subscale of the Brief COPE Inventory, the modified Response to Symptoms Questionnaire, and a Likert scale measuring perceived risk for MI. Patients who arrived at a hospital at least 1 hour after the onset of their symptoms were considered to have prolonged prehospital delay. Despite their high symptom congruence, 77% of patients denied the possibility of having an MI before hospitalization. The lower denial group was characterized by cardiac history, whereas the higher denial group was distinguished by nonsmoking, a lower perceived risk of MI, less anxiety at symptom onset, and more concerns about seeking medical help. Compared with the lower denial group, patients in the higher denial group were more likely to underestimate the seriousness of their symptoms and delay seeking medical help. The higher denial group responded to symptoms in a more passive manner (eg, waiting), whereas the lower denial group showed a more problem-solving approach (eg, contacting emergency services). Denial of MI is highly prevalent in the prehospital phase and is negatively linked with cognitive, emotional, and behavioral responses to MI symptoms.

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

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

A man in his sixties with acute chest pain.

Chest pain is a frequent symptom of acute myocardial infarction, but the cause is not always coronary atherothrombosis. We present a case where the patient himself had made a correct non-cardiac diagnosis, but this was initially overlooked by the doctor. A man with a history of cardiac infarction was admitted with acute chest pain and troponin elevation. Electrocardiogram suggested ST elevations, echocardiography showed a possible slight hypokinesia, and we primarily suspected an acute coronary syndrome. However, invasive coronary angiography was negative and a primary acute myocardial infarction was less likely. A renewed interview revealed that the patient had worked with a propane burner indoors without adequate ventilation. The patient himself suspected carbon monoxide poisoning. Arterial blood gas showed HbCO 27.4%, which was unfortunately overlooked initially. The patient had carbon monoxide poisoning with symptoms of dizziness, hand ataxia and myocardial ischaemia. He received 100% oxygen and HbCO was normalised. The imbalance between oxygen demand and supply resulted in a type 2 cardiac infarction. A thorough medical history is crucial for correct diagnosis but can unfortunately be missed on a busy shift. This case illustrates the importance of the patient's own diagnostic assumption.

Pre-hospital delays among patients with acute coronary syndrome in the Russian Federation: a multicentre prospective observational cohort study (the AMIR Study)

ObjectiveThis study aimed to describe total pre-hospital delays (symptom onset to admission), patient delays (symptom onset to calling for help), and transport delays (calling for help to admission) experienced by patients with acute coronary syndrome (ACS) in Russia and identify factors associated with longer delays.MethodsA prospective observational cohort study of ACS patients with myocardial infarction recruited in hospitals providing percutaneous coronary intervention (PCI) and those that do not (non-PCI) in 13 regions and at multiple levels of the health system in Russia. Data were collected on pre-hospital delays between symptom onset and admission to the hospital providing definitive treatment, divided into patient delay (time between symptom onset and calling for help) and transport delay (time between calling for help and admission).ResultsOf 902 patients, 701 (77.7%) had full data on pre-hospital delays. The median total pre-hospital delay in our study was 5.1 h, the median patient delay was 1.5 h, and the median transport delay was 2.1 h. Patient delays did not differ by age and sex, although having an ST-elevation myocardial infarction (STEMI) and certain symptom presentations, including severe pain, reduced delays. Transport delays were markedly reduced in those transported by emergency medical services (EMS) and taken directly to the hospital of definitive treatment (rather than to one closer but unable to offer PCI).Although transport delays were reduced in those using EMS, just half of the patients using EMS had a transport delay of &amp;lt;2 h (first medical contact to admission). Among all patients taken directly to the hospital by EMS, 70% were STEMI patients. Of these STEMI patients, 78% had a transport delay of 2 h or more. Among these patients, only 16.0% received thrombolysis in the ambulance. As expected, regional differences were apparent with all types of delay, with the greatest variation found in transport delays.ConclusionDelays are currently longer than the European Society of Cardiology guidelines for STEMI patients and other severe cases. Reducing patient delays will reduce overall delays. Transport delays are inevitable in many regions of Russia, but better triage of patients, increased use of EMS, and early thrombolysis in EMS, particularly for STEMI patients facing excessive transport delays, will reduce delays and buy time before PCI.

Early prediction of left ventricular function improvement in patients with new-onset heart failure and presumed non-ischaemic aetiology

ObjectivesTo determine baseline characteristics predictive of left ventricular ejection fraction (LVEF) recovery in patients diagnosed with heart failure with reduced ejection fraction (HFrEF) and presumed non-ischaemic aetiology.MethodsWe prospectively recruited patients...