Acute Coronary Syndrome Myocardial Infarction Research Articles

Modelled impact of virtual fractional flow reserve in patients undergoing coronary angiography (VIRTU-4)

BackgroundThe practical application of ‘virtual’ (computed) fractional flow reserve (vFFR) based on invasive coronary angiogram (ICA) images is unknown. The objective of this cohort study was to investigate the potential...

A study to observe the association of left ventricular ejection fraction and wall motion score index with duration of early systolic lengthening in patients with non-ST-elevation acute coronary syndrome

Background: Management of non-ST elevation myocardial infarction acute coronary syndrome (NSTEMI ACS) patients is not well defined as that of ST elevation myocardial infarction. The accuracy of results of conventional echocardiography is significantly compromised when imaging is suboptimal, myocardial damage is in small areas, and compensatory hyperkinesias of healthy segment. Aims and Objectives: Duration of early systolic lengthening (DESL) may be employed to identify early myocardial ischemia and thus, may help to prepare treatment strategies for NSTEMI patients. Materials and Methods: A total of 57 patients with NSTEMI ACS attending the cardiology department were included in the study group. Results: More than 80% of patients of NSTEMI have normal or near normal ejection fraction and wall motion score index. In our study, the DESL is prolonged in a significant number of non-ST-elevation acute coronary syndrome patients. Conclusion: As DESL is afterload independent, it is superior to global longitudinal strain in assessing myocardial damage. Several studies including ourselves show that DESL of <50 ms may be the cutoff value to reveal minimal myocardial damage.

Terapi Kompres Hangat Untuk Menurunkan Nyeri Dada Pada Pasien Acute Coronary Syndrome Non-STEMI

Background: Acute Coronary Syndrome is a manifestation of ischemic heart disease that occurs when blood flow to the heart is disrupted, leading to oxygen deficiency. One of the symptoms that arises in patients with Acute Coronary Syndrome is chest pain. One effective non-pharmacological therapy in reducing chest pain in patients with Acute Coronary Syndrome is warm compress therapy. Objective: To analyse effect of applying warm compress therapy to alleviate chest pain in patients with Acute Coronary Syndrome Non-STEMI. Method: The method used in this study is a case report. The instruments used are nursing assessment with the PQRST approach and Pain Measurement Scale with warm compress intervention evaluated over 3x 24 hours. Results: The results of this case study show a decrease in pain scores from 6 to 4 on the first day, decreasing to 3 on the second day and further decreasing to 2 on the third day. Conclusion: Warm compress therapy is effective in relieving chest pain in patients with Non-ST Elevated Myocardial Infarction Acute Coronary Syndrome.

Real-World Risk of Recurrent Cardiovascular Events in Atherosclerotic Cardiovascular Disease Patients with LDL-C Above Guideline-Recommended Threshold: A Retrospective Observational Study.

The 2021 Canadian Cardiovascular Society (CCS) guidelines recommend intensive low-density lipoprotein cholesterol (LDL-C) reduction for patients with atherosclerotic cardiovascular disease (ASCVD). For patients above LDL-C threshold on maximally tolerated statins, adding ezetimibe and/or a proprotein convertase subtilisin/kexin type9 inhibitor (PCSK9i) is recommended. This population-based, real-world study examined cardiovascular (CV) events in patients with ASCVD who are on statins and above current guideline threshold LDL-C levels. Using administrative health data in Alberta, Canada, we identified patients with myocardial infarction (MI), ischemic stroke (IS), or peripheral artery disease with LDL-C > 1.8mmol/L on statins between April 1, 2010 and March 31, 2016. Exploratory subgroups included very high-risk patients with ASCVD shown to derive the most benefit from PCSK9i intensification as identified by the CCS guidelines, including those with acute coronary syndrome (ACS) or recent MI. Frequencies and rates of individual and composite CV events (primary outcome: MI, IS, hospitalization for unstable angina, coronary revascularization, cardiovascular death; secondary outcome: MI, IS, CV death) were calculated over follow-up. The study included 32,984 patients with a mean (standard deviation) follow-up of 40.8 (21.0) months. Overall, 17.7% and 15.6% experienced a primary and secondary outcome, respectively, with rates of 5.58 and 4.83 per 100 patient-years, respectively. CV death and MI were the most common events. Subgroups with recurrent MI and comorbid diabetes exhibited higher CV event rates (23.6% and 22.2% had a primary outcome, respectively). Rates of CV events were notably high in patients with ACS or recent MI (49.4% and 54.0% had a primary outcome, respectively). This real-world study confirms that statin-treated high-risk patients with ASCVD and above-threshold LDL-C levels have substantial incidence of recurrent CV events. These findings reinforce the opportunity for lipid-lowering therapy intensification in high-risk patients to levels below guideline-recommended threshold in order to reduce CV risk.

Procedural and one-year outcomes of robotic-assisted versus manual percutaneous coronary intervention.

Robotic-assisted percutaneous coronary intervention (rPCI) has proven to be feasible and safe. Comparative analyses of rPCI versus manual PCI (mPCI) are scarce. We aimed to investigate procedural aspects and outcomes of rPCI using the second-generation CorPath GRX Vascular Robotic System compared with mPCI in patients with chronic coronary syndrome and non-ST-segment elevation myocardial infarction acute coronary syndrome. From January to April 2021, 70 patients underwent rPCI at the University Heart & Vascular Center Hamburg-Eppendorf and were recruited into the INTERCATH study. By propensity score matching, a control cohort of 210 patients who underwent mPCI from 2015-2021 was identified. Co-primary endpoints were one-year all-cause mortality and major adverse cardiovascular events (MACE) as a composite of cardiovascular death, unplanned target lesion revascularisation, myocardial infarction, and stroke. The median age of the patients (n=280) was 70.7 (25th percentile-75th percentile: 62.0-78.0) years, and 24.6% were female. The Gensini score (28.5 [16.2-48.1] vs 28.0 [15.5-47.0]; p=0.78) was comparable between rPCI versus mPCI. During the PCI procedure, total contrast fluid volume did not differ, whilst longer fluoroscopy times (20.4 min [13.8-27.2] vs 14.4 min [10.4-24.3]; p=0.001) were documented in the rPCI versus mPCI cohort. After 12 months of follow-up, neither all-cause mortality (p=0.22) nor MACE (p=0.25) differed between the groups. rPCI was associated with longer fluoroscopy times compared with mPCI, though without increased use of contrast medium. One-year follow-up revealed no differences in all-cause mortality or MACE, supporting the safety of a robotic-assisted approach.

Immature Platelet Fraction and Acute Coronary Syndrome; a Systematic Review and Meta-Analysis.

Immature Platelet Fraction (IPF) is a measure of the proportion of reticulated platelets (RPs) to all platelets in circulation. IPF may have both prognostic and diagnostic values in patients with Acute Coronary Syndrome (ACS). This study aims to comprehensively summarize the diagnostic utility of IPF levels in patients with ACS, specifically focusing on its ability to differentiate between different subtypes of ACS. We conducted a systematic search in online databases including MEDLINE, Scopus, and Google Scholar up to March 4th 2024, to identify relevant studies. The random-effect model, employing inverse variance for mean differences (MD) and Mantel-Haenszel methods for odds ratios (OR) were utilized to combine the data. Joanna Briggs Institute (JBI) appraisal tool was employed to assess the quality of included studies. Our systematic review contains 15 articles with a total sample size of 2,030 ACS patients. Pooled analysis revealed significant differences in IPF levels of ACS patients compared to healthy controls (MD (95%CI): 2.85 (0.86, 4.85), P-value = 0.004) and stable angina patients (MD (95%CI): 0.58 (0.23, 0.92), P-value < 0.001). Subgroup comparisons within ACS patients demonstrated higher IPF levels in myocardial infarction (MI) vs. unstable angina (UA) (MD (95%CI): 1.81 (0.41, 3.22), P-value = 0.01), ST elevation MI (STEMI) vs. non-ST elevation (NSTEMI) ACS (MD (95%CI): 0.74 (0.31, 1.17), P-value < 0.001), and NSTEMI vs. UA (MD (95% CI): 1.07 (0.24, 1.90), P-value = 0.01). IPF levels could increase in patients with ACS, particularly during the acute phase of STEMI. This suggests that IPF may be a useful biomarker for early diagnosis of ACS. Additionally, IPF levels may help differentiate between ACS subtypes.

Incidence and impact of totally occluded culprit coronary artery in patients with non-ST segment elevation myocardial infarction acute coronary syndrome

Abstract Background Significance of totally occluded culprit coronary artery in patients presenting with non-ST segment elevation myocardial infarction (NSTEMI) is underestimated. Purpose The aim of this study was to evaluate the incidence and impact of totally occluded culprit artery on in-hospital and 6 months follow-up outcomes of NSTEMI acute coronary syndrome (ACS) patients. Methods We collected retrospectively data of 500 NSTEMI patients who presented to our hospital from June 2016 to June 2017. All patients underwent PCI within 72 h of presentation. We excluded patients with cardiogenic shock, prior CABG, and STEMI. Patients were divided into two groups according to pre-procedural culprit vessel thrombolysis in myocardial infarction (TIMI) flow. Group 1, TIMI flow 0 total coronary occlusion, included 112 patients (22.4%). Group 2, TIMI flow 1–3 non-total occlusion, included 388 patients (77.6%). Results Group 1 patients had significantly higher incidence of smoking (p=0.01), significantly higher level of cardiac enzymes (p&amp;lt;0.001), significantly more collaterals (p&amp;lt;0.001), and significantly more LCX and RCA as the culprit vessel (p&amp;lt;0.01), while group 2 patients had significantly higher incidence of diabetes (p=0.02) and significantly more LAD as the culprit vessel. There were no significant differences between the two groups regarding the major adverse cardiac and cerebrovascular events (MACCE) in-hospital (5.3% in totally occluded group vs. 1% in non-totally occluded group, p=0.07), but group 1 patients had significantly higher incidence of in-hospital arrhythmia (8.9% in group 1 vs. 1% in group 2, p=0.007). After 6 months follow-up, there were no significant differences regarding MACCE between the 2 groups after 6 months follow-up (5.4% in group 1 vs. 4.6% of group 2, P=0.24). Conclusion 22.4% of NSTEMI patients have a totally occluded culprit artery. The presence of an occluded culprit artery did not significantly affect the clinical outcomes of NSTEMI patients either in-hospital or after 6 months follow-up but was associated with significantly higher incidence of in-hospital arrhythmia. Funding Acknowledgement Type of funding sources: None.

Ticagrelor or prasugrel in patients with acute coronary syndrome and prior myocardial infarction

Abstract Objectives To investigate the efficacy and safety of ticagrelor versus prasugrel in patients with acute coronary syndrome (ACS) and prior myocardial infarction (MI). Background The efficacy and safety of ticagrelor versus prasugrel in ACS patients with prior MI remains unstudied. Methods Patients with ACS scheduled for an invasive strategy and randomized to ticagrelor or prasugrel in the ISAR-REACT 5 trial with available information concerning prior MI were included in the present analysis. The primary endpoint was the composite of all-cause death, myocardial infarction, or stroke; the secondary endpoint was Bleeding Academic Research Consortium (BARC) type 3 to 5 bleeding. Endpoints were assessed 12 months after randomization. Results A total of 4,015 patients were included in this analysis (prior MI= 631 patients; no prior MI = 3,384 patients). As compared to patients without prior MI, the primary endpoint occurred more frequently in patients with prior MI (12.6% vs. 7.2%; hazard ratio [HR] = 1.78, 95% confidence interval [CI] 1.38–2.29; p= &amp;lt;0.001) without significant difference in terms of secondary endpoint between groups (5.8% vs. 5.7%; HR=1.02 [0.71–1.45]; p=0.921). Patients with prior MI randomized to ticagrelor versus prasugrel displayed higher risk for primary (HR=1.62 [1.03–2.55]) but not secondary endpoint (HR=1.28 [0.56–2.91]). Patients without prior MI randomized to ticagrelor or prasugrel displayed no significant difference in terms of primary (HR=1.28 [0.99–1.65]) or secondary endpoints (HR=1.13 [0.82–1.55]). There was no treatment assignment-by-prior MI status interaction with respect to the primary (p for interaction = 0.373) and the secondary (p for interaction= 0.786) endpoints. Conclusions Patients with ACS and prior MI are at higher risk for recurrent ischemic but not bleeding events. The history of MI does not affect the relative efficacy and safety of ticagrelor versus prasugrel in patients with ACS. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): German Center for Cardiovascular Research (DZHK)Deutsches Herzzentrum München

Incidence and Impact of Totally Occluded Culprit Coronary Artery in Patients With Non-ST Segment Elevation Myocardial Infarction Acute Coronary Syndrome

Incidence and Impact of Totally Occluded Culprit Coronary Artery in Patients With Non-ST Segment Elevation Myocardial Infarction Acute Coronary Syndrome

Global longitudinal strain to identify low-risk patients with suspected ACS

Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Albert Einstein Society Background Determining which chest pain presentations should be treated and considered an acute coronary syndrome/myocardial infarction (ACS/MI) versus those with non-cardiac chest pain (NCCP) can be difficult. Initial evaluation of suspected ACS requires assessment of presenting symptoms, risk factors, ECG, and cardiac biomarkers. Bedside echocardiography can assist in rapid assessment of suspected ACS through measurement of echocardiographic wall motion score index and left ventricular ejection fraction, though the sensitivity of these measurements has been called into question. Global longitudinal strain (GLS) has been associated with significant CAD and has been found to be more reproducible than LVEF. However, its utility in rapid ED evaluation of chest pain remains under-explored. Purpose Assess the utility of speckle-tracking strain in addition to clinical and demographic factors in identification of low-risk patients among those presenting to the ED with suspected ACS. Methods This was a retrospective single center study of 434 hospitalized patients aged 18 years or older in whom ACS (excluding STEMI) was suspected by ED assessment, from 9/1/2015 – 12/31/2019. Echocardiography within 24 hours of admission was analyzed, with left ventricular global longitudinal strain (LVGLS) obtained via AutoSTRAIN software (TOMTEC Imaging Systems GmbH). Patients were identified as having NCCP (n = 158, 36%), myocardial injury (n = 110, 25%), or MI (n = 166, 38%; subdivided into NSTEMI [n = 74, 44.6%] and type II MI [n = 92, 55.4%]) according to the 4th universal definition of MI. Mean strain values were compared between study groups using Independent T tests. Logistic regression and ROC analysis was done to determine the value of LVGLS in the prediction of ACS. Results Non-white subjects were over-represented in the NCCP group (92% vs 8%), versus the myocardial injury and MI groups (65% vs 35%, p &amp;lt; 0.001), and on average the NCCP group was younger (56.5 ± 14.5 vs 64.8 ± 15, p &amp;lt; 0.001). LVGLS was significantly higher for NCCP versus the MI group (17.7 ± 2.8 vs 14.9 ± 3.9, p &amp;lt; 0.001). ROC analysis (c-statistic = 0.72) identified an optimal cutoff at ≤15.6, with sensitivity of 56% and specificity of 82%. Logistic regression analysis, including demographic and clinical variables, identified age, LVGLS, LV end-diastolic volume and serum creatinine as significant independent predictors for NCCP vs ACS. The addition of these factors in the predictive analysis resulted in slightly improved model performance (c-statistic = 0.78). Conclusions LVGLS among patients with suspected ACS is significantly different between NCCP and MI; however, low sensitivity for MI makes it inadequate as a single test to discriminate between the two. Combining LVGLS with other clinical/laboratory factors may have potential utility and will be explored in future work. Abstract Figure. Distribution Plot for LVGLS Abstract Figure. ROC Curve for LVGLS

CRT-100.33 Incidence and Impact of Totally Occluded Culprit Coronary Artery in Patients With Non-ST Segment Elevation Myocardial Infarction Acute Coronary Syndrome

CRT-100.33 Incidence and Impact of Totally Occluded Culprit Coronary Artery in Patients With Non-ST Segment Elevation Myocardial Infarction Acute Coronary Syndrome

Frequency of antiplatelet therapy in coronary artery disease. Data from the disease management programme CAD

Abstract Background Physicians always aim to improve their patients' health and consequently also improve community health. Continued medical education (CME) should be designed to support this goal and thus not only provide knowledge transfer, but also influence clinical decision-making and close performance gaps. However, the relative weight of CME in this process needs to be determined. Purpose Main purpose of the study was to analyse APT prescription rates and differences between subgroups of patients in a disease management programme (DMP) for coronary artery disease (CAD). Methods In a retrospective study we analysed prescription rates for APT in 254,932 CAD patients (male: 64.4%), treated in a total of 3,405 practices in 2019 in a DMP in the region of North Rhine, Germany, to delineate the potential for change by CME to further improve community health. Analyses were run for the whole study population stratified by sex as well as for subgroups of patients suffering from myocardial infarction / acute coronary syndrome (MI/ACS), or who have been treated with percutaneous coronary intervention (PCI) or bypass surgery. Subgroup differences were analysed in a logistic regression model. Results Patients mean age was 72.7±11.2 years (mean ± 1SD), mean duration of DMP participation was 7.2±4.7 years and mean cumulative number of DMP visits was 27±17. APT prescription rates were 85.0% in male and 78.8% in female CAD patients. In subgroups of male CAD patients APT prescription rates were between 89.7% and 92.8%, in the same subgroups of female CAD patients the corresponding rates were between 87.8% and 92.0%. Rates for a missing APT prescription per practice were between 0.0044% and 0.0062% for male and female CAD patients respectively. Rates for a missing APT prescription per practice and DMP visit were 0.0002% for both sexes. In a multivariate model significant positive predictors of APT prescription were male sex (OR=1.37, 95% CI: 1.34–1.40), age ≥76 yrs (OR=1.11, 95% CI: 1.08–1.14), participation in DMP ≥4 and &amp;lt;10 yrs (OR=1.19, 95% CI: 1.16–1.22), MI/ACS (OR=1.14, 95% CI: 1.08–1.20), PCI (OR=1.97, 95% CI: 1.88–2.06) and bypass surgery (OR=1.14, 95% CI: 1.08–1.21). Conclusion Our study demonstrates that a multifaceted intervention, like a DMP, can achieve high attainment rates for APT in CAD. To describe the benchmark for CME to further improve attainment rates, consideration of absolute numbers of eligible patients per practice or physician is probably more appropriate than expression of performance as percentage values. This is especially true if attainment rates show substantial variations between subgroups, if subgroups show substantial variation in size, if attainment rates are already in the order of magnitude of 80% or higher, and if there are disparities in the evidence base underlying treatment recommendations related to subgroups. Funding Acknowledgement Type of funding sources: None.

Genetic and epigenetic associations of ANRIL with coronary artery disease and risk factors

BackgroundBoth DNA genotype and methylation of antisense non-coding RNA in the INK4 locus (ANRIL) have been robustly associated with coronary artery disease (CAD), but the interdependent mechanisms of genotype and methylation remain unclear.MethodsEighteen tag single nucleotide polymorphisms (SNPs) of ANRIL were genotyped in a matched case–control study (cases 503 and controls 503). DNA methylation of ANRIL and the INK4/ARF locus (p14ARF, p15INK4b and p16INK4a) was measured using pyrosequencing in the same set of samples (cases 100 and controls 100).ResultsPolymorphisms of ANRIL (rs1004638, rs1333048 and rs1333050) were significantly associated with CAD (p < 0.05). The incidence of CAD, multi-vessel disease, and modified Gensini scores demonstrated a strong, direct association with ANRIL gene dosage (p < 0.05). There was no significant association between ANRIL polymorphisms and myocardial infarction/acute coronary syndrome (MI/ACS) (p > 0.05). Methylation levels of ANRIL were similar between the two studied groups (p > 0.05), but were different in the rs1004638 genotype, with AA and AT genotype having a higher level of ANRIL methylation (pos4, p = 0.006; pos8, p = 0.019). Further Spearman analyses indicated that methylation levels of ANRIL were positively associated with systolic blood pressure (pos6, r = 0.248, p = 0.013), diastolic blood pressure (pos3, r = 0.213, p = 0.034; pos6, r = 0.220, p = 0.028), and triglyceride (pos4, r = 0.253, p = 0.013), and negatively associated with high-density lipoprotein cholesterol (pos2, r = − 0.243, p = 0.017). Additionally, we identified 12 transcription factor binding sites (TFBS) within the methylated ANRIL region, and functional annotation indicated these TFBS were associated with basal transcription. Methylation at the INK4/ARF locus was not associated with ANRIL genotype.ConclusionsThese results indicate that ANRIL genotype (tag SNPs rs1004638, rs1333048 and rs1333050) mainly affects coronary atherosclerosis, but not MI/ACS. There may be allele-related DNA methylation and allele-related binding of transcription factors within the ANRIL promoter.

Efficacy of high-dose atorvastatin or rosuvastatin loading in patients with acute coronary syndrome undergoing percutaneous coronary intervention: a meta-analysis of randomized controlled trials with GRADE qualification of available evidence.

We aimed to summarize current evidence regarding the impact of a high-dose statin loading before percutaneous coronary intervention (PCI) on short-term outcomes in patients presenting with the acute coronary syndrome (ACS). This meta-analysis was based on a search of the MEDLINE, Cochrane Central Register of Controlled Trials, Ovid Journals, and SCOPUS for randomized controlled trials that compared high-dose atorvastatin or rosuvastatin with no or low-dose statin administered before planned PCI in statin-naive patients with ACS. The primary endpoints were major adverse cardiovascular and cerebrovascular events (MACCE), myocardial infarction (MI), and all-cause mortality at 30days. Prespecified subanalyses were performed with respect to statin and ACS type. A total of eleven trials enrolling 6291 patients were included, of which 75.4% received PCI. High-dose statin loading was associated with an overall 43% relative risk (RR) reduction in MACCE at 30days (RR 0.57, 95% CI 0.41-0.77) in whole ACS population. This effect was primarily driven by the 39% reduction in the occurrence of MI (RR 0.61, 95% CI 0.46-0.80). No significant effect on all-cause mortality reduction was observed (RR 0.92, 95% CI 0.67-1.26). In the setting of ST-elevation myocardial infarction (STEMI), atorvastatin loading was associated with a 33% reduction in MACCE (RR 0.67, 95% CI 0.48-0.94), while in non-ST-elevation myocardial infarction ACS (NSTE-ACS), rosuvastatin loading was associated with 52% reduction in MACCE at 30days (RR 0.48, 95% CI 0.34-0.66). The level of evidence as qualified with GRADE was low to high, depending on the outcome. A high-dose loading of statins before PCI in patients with ACS reduces MACCE and reduces the risk of MI with no impact on mortality at 30days. Atorvastatin reduces MACCE in STEMI while rosuvastatin reduces MACCE in NSTE-ACS at 30days.

ENDOTHELIAL DYSFUNCTION AND ITS MANAGEMENT IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION COMBINED WITH METABOLIC SYNDROME

Background. Oxidative stress, endothelial dysfunction, dyslipidemia and low-grade inflammation induce the disorders of energy metabolism and ischemic damage to cardiomyocytes. It is an essential issue in pathogenesis of acute coronary syndrome/myocardial infarction (ACS/MI). &#x0D; Objective. The aim of the study was to improve the existing pharmacological therapy in patients with ACS/MI combined with metabolic syndrome (MS).&#x0D; Methods. The study enrolled 95 patients with acute myocardial infarction. The patients were divided into 2 groups depending on concomitant metabolic syndrome. All groups were divided to subgroups, where patients received typical standard treatment according to the Ukrainian unified and modified treatment regimen with addition of L-arginine and L-carnitine.&#x0D; Results. In 79.2% of patients with ACS/MI + MS the course of underlying disease was associated with various complications: pericarditis epistenocardica was diagnosed in 39.8% of patients; arrhythmias were present in 35.5% of patients of the main group; left ventricular aneurysm was present in 15.9% of patients. At the same time, significant changes in the indicators of vascular endothelial function in patients with ACS (MI) were revealed (the level of endothelin-1 in the blood plasma was in 2.1 times higher than the reference norm) that was the justification for inclusion of L-arginine and L-carnitine in the complex therapy of comorbid patients. &#x0D; Conclusions. The multi-modality treatment with inclusion of L-arginine and L-carnitine facilitated restoration of energy supply of myocardial contractility, endothelial function of blood vessels, and antioxidant protection of the body and ultimately resulted in a more favorable course of this comorbid problem.

Incidence and impact of totally occluded culprit coronary artery in patients with non-ST segment elevation myocardial infarction acute coronary syndrome

BackgroundSignificance of totally occluded culprit coronary artery in patients presenting with non-ST segment elevation myocardial infarction (NSTEMI) is underestimated. The aim of the study was to evaluate the incidence and impact of totally occluded culprit artery on in-hospital and 6 months follow-up outcomes of NSTEMI acute coronary syndrome (ACS) patients.ResultsWe collected retrospectively data of 500 NSTEMI patients who presented to our hospital from June 2016 to June 2017. All patients underwent PCI within 72 h of presentation. We excluded patients with cardiogenic shock, prior CABG, and STEMI. Patients were divided into two groups according to pre-procedural culprit vessel thrombolysis in myocardial infarction (TIMI) flow. Group 1, TIMI flow 0 total coronary occlusion, included 112 patients (22.4%). Group 2, TIMI flow 1–3 non-total occlusion, included 388 patients (77.6%). Group 1 patients had significantly higher incidence of smoking (p=0.01), significantly higher level of cardiac enzymes (p<0.001), significantly more collaterals (p<0.001), and significantly more LCX and RCA as the culprit vessel (p<0.01), while group 2 patients had significantly higher incidence of diabetes (p=0.02) and significantly more LAD as the culprit vessel. There were no significant differences between the two groups regarding the major adverse cardiac and cerebrovascular events (MACCE) in-hospital (5.3% in totally occluded group vs. 1% in non-totally occluded group, p=0.07), but group 1 patients had significantly higher incidence of in-hospital arrhythmia (8.9% in group 1 vs. 1% in group 2, p=0.007). After 6 months follow-up, there were no significant differences regarding MACCE between the 2 groups after 6 months follow-up (5.4% in group 1 vs. 4.6% of group 2, P=0.24).Conclusion22.4% of NSTEMI patients have a totally occluded culprit artery. The presence of an occluded culprit artery did not significantly affect the clinical outcomes of NSTEMI patients either in-hospital or after 6 months follow-up but was associated with significantly higher incidence of in-hospital arrhythmia.

Incidence and Implications of Atrial Fibrillation/Flutter in Hypertension: Insights From the SPRINT Trial.

We evaluated the impact of intensive blood pressure control on the incidence of new-onset atrial fibrillation/flutter (AF) and the prognostic implications of preexisting and new-onset AF in SPRINT (Systolic Blood Pressure Intervention Trial) participants. New-onset AF was defined as occurrence of AF in 12-lead electrocardiograms after randomization in participants free of AF at baseline. Poisson regression modeling was used to calculate incident rates of new-onset AF. Multivariable-adjusted Cox proportional hazard models were used to evaluate the risk of adverse cardiovascular events (composite of myocardial infarction, non-myocardial infarction acute coronary syndrome, stroke, heart failure, or cardiovascular death). In 9327 participants, 8.45% had preexisting AF, and 1.65% had new-onset AF. The incidence of new-onset AF was 4.53 per 1000-person years, with similar rates in the standard and intensive treatment arms (4.95 versus 4.11 per 1000-person years; adjusted P=0.14). Participants with preexisting AF (adjusted hazard ratio, 1.83 [95% CI, 1.46-2.31]; P<0.001) and new-onset AF (adjusted hazard ratio, 2.45 [95% CI, 1.58-3.80]; P<0.001) had a greater risk for development of adverse cardiovascular events compared with those with no AF. Participants with preexisting AF who achieved blood pressure <120/80 mm Hg at 3 months continued have a poor prognosis (adjusted hazard ratio, 1.88 [95% CI, 1.32-2.70]; P=0.001) compared with those with no AF. Intensive blood pressure control does not diminish the incidence of new-onset AF in an older, high-risk, nondiabetic population. Both preexisting and new-onset AF have adverse prognostic implications. In participants with preexisting AF, residual cardiovascular risk is evident even with on-treatment blood pressure <120/80 mm Hg. Registration- URL: https://www.clinicaltrials.gov; Unique identifier: NCT01206062.

PATHOLOGICAL CHANGES OF THE EYE RETINA AT CARDIOVASCULAR DISEASE AND DIABETES MELLITUS

Objective . In this work we analyzed the current literature data about the retinal damage in cardiovascular diseases and diabetes mellitus (published from 2005 to 2020). The damage of retinal vascular bed and optic nerve represents a relevant problem in the modern world in view of the significant prevalence, severity of retinal irreversible damage leading to disability, and in relation to comorbidity with cardiovascular diseases (CVD). Methods . Publications on selected topic were analyzed from 2005 to 2020. The search was carried out using the electronic databases of the Google Academy (https://scholar.google.com/), PubMed (https://www.ncbi.nlm.nih.gov/pubmed/), eLIBRARY.ru (https: //www.elibrary.ru/) and foreign and national journals devoted to cardiology, therapy and ophthalmology. Results . The analysis of literature showed that atherosclerotic lesion of the microvascular retinal bed is a significant risk factor for acute coronary syndrome myocardial infarction (MI) and stroke. However, the identity of atherosclerotic processes occurring in the retinal vascular bed and in the peripheral arteries remains open. A strong association was shown between hypertensive retinopathy (HR) has with MI, congestive heart failure (CHF) and CHD mortality in large-scale population-based studies such as ARIC and Rotterdam Study. The question of the predictive significance of GR, depending on its degree, remains debatable. There are consistent evidence on the association between HR and CHD and CHF. Diabetic retinopathy (DR) represents a neurovascular complication of diabetes. In predominantly clinical work, there is evidence of the significance of DR as a risk marker for Stroke, diabetics peripheral neuropathy, autonomic cardiac neuropathy, thickness of carotid intima-media, micro albuminuria. A number of other major clinical works has not shown a significant association between DR and stroke. A significant drawback of investigation of the relationship between DR and CVD is a lack of population studies on this topic. Conclusions . Despite the use of modern diagnostic methods and a fairly large number of studies of the eye vascular bed and retina, the data about their relationship with CVD remain scare and contradictory, which is largely due to the limited size of the studied samples, the variability of the estimates, and a complexity of the pathway of atherosclerosis and CVD. The study of association between CVD and retinal pathology in the Russian population with using of automatic assessment of the microvascular bed provides a unique opportunity to solve some contradictory aspects and obtain new data.

The prevalence of abdominal aortic aneurysms in the rural/urban population in central Poland - Gniewkowo Aortic Study.

Abdominal aortic aneurysm (AAA) is a widening of the aorta below the renal arteries with a diameter equal to or greater than 3 cm. The prevalence of AAA is estimated at 4-8% in men aged 65 years or older and 1-2% among women over 65 years old. Participation in screening programmes has decreased the number of aortic ruptures. All men aged 60 years and older, and women aged 65 years and older living in the rural/urban commune in central Poland were invited to participate in the study. In total 922 persons (61% of the invited population) entered the study. The men were divided into two groups: 60-64 years old, and 65 years and older. Screening abdomen ultrasound was performed and demographic data was collected. Among the 922 examined persons two (1.01%) AAAs were diagnosed in the group of men 60-64 years of age, three (0.82%) AAAs amongst women ≥ 65 years old, and 33 (9.29%) AAAs were found in the group of men aged 65 years and older. A positive relationship between the presence of AAA and smoking (p = 0.0048), age of men (p = 0.0009), and history of myocardial infarction/acute coronary syndrome (MI/ACS) (p = 0.0079) was found. There was no correlation between the frequency of AAA and diabetes mellitus (p = 0.46), hypertension (p = 0.38), and family history of AAA (p = 0.44). The prevalence of AAA in men aged 65 years and older is seemingly larger than in previously conducted studies, while among men 60-64 years of age and women aged ≥ 65 it is similar. Older age, smoking, and a history of MI/ACS were the most important risk factors of AAA occurrence.

LIS-3 REGISTER OF THE ACUTE CORONARY SYNDROME: WHAT HAS CHANGED IN A "PORTRAIT" OF A PATIENT AND SHORT-TERM OUTCOMES OF THE DISEASE COMPARED TO LIS-1 REGISTER

Aim. To compare a «portrait» of a patient and hospital lethality between register LIS-1 of myocardial infarction (MI) and register LIS-3 of acute coronary syndrome (ACS). Material and methods. We compared two registers held in Lubertsy town: MI register LIS-1 (2005-2007) and ACS register LIS-3 (01.11.2013-31.07.2015). LIS-1 is a retrospective study; information about patients survived and died in hospital was taken from medical histories. LIS-3 is a prospective study; data on survived patients was collected from questionnaires and medical histories, information about died ones – from medical histories. Results. «Portrait» of a patient of LIS-1 and LIS-3 registers was comparable in gender, age, history of MI, arterial hypertension, atrial fibrillation, and stroke. LIS-3 patients had diabetes mellitus more often, and on the contrary, history of ischemic heart disease (IHD) and angina pectoris – more rarely than LIS-1 patients. ACS was the first manifestation of IHD in 64% of LIS-3 register patients and 31.4% of LIS-1 register patients. Hospital lethality was 15.2% in LIS-1 register and 19.4% in LIS-3 register (p>0.05). Hospital lethality increased in elderly patients in both registers. Atrial fibrillation increased hospital lethality risk in LIS-3 register and long-term mortality risk in LIS-1 register. History of arterial hypertension and angina pectoris re duced hospital lethality risk in LIS-3 register. In LIS-1 register neither of these factors was significant, but left ventricular hypertrophy reduced hospital mortality risk. Conclusion. LIS-1 and LIS-3 patients were comparable in many factors, bud differed in history of IHD (31.4% in LIS-1 register, 64% in LIS-1 register) and angina pectoris. Factors associated with hospital mortality differed in the two registries.