non-ST Elevation Myocardial Infarction Group Research Articles

NSTEMI'da Erken Evrede HALP Skorunun Öngörü Değeri

Introduction: Several inflammatory markers are associated with coronary artery disease severity and worse cardiovascular outcomes. The haemoglobin, albumin, lymphocyte, and platelet (HALP) score is an indicator of inflammation and nutritional status. We aimed to evaluate the practicity of HALP score in non-ST elevation myocardial infarction (NSTEMI) patients. Materials and Methods: This study was designed as a retrospective cohort study. Patients over the age of 18 who have been diagnosed with acute coronary syndrome were retrospectively searched from hospital records. The study groups were formed according to the results of the coronary angiography. Demographic data such as age, gender, total blood count, albümin levels, troponin levels and HALP scores of the patients were analyzed and comparisons between the groups were made decisively. Results: 201 patients were enrolled in the study and the data was obtained from hospital records retrospectively. 79 patients were excluded from the study due to ST segment elevation myocardial infarction (STEMI). The study population was collected under two groups; the NSTEMI group (n=66) and normal coronary arteries (NCA) group (n=56). The mean age of NSTEMI group was 62.3 ± 11.8 and 71.2% (n=47) was male. The mean age of NCA group was 51.8 ± 9.2 and 30.3% (n=17) was male. There were statistically significant difference between NSTEMI and NCA groups in term of age and gender (p<0.05). The HALP score was statistically higher in NSTEMI group compared to NCA group (p<0.001). Age and HALP score have explanatory powers on NSTEMI patients (p=0.001 and p=0.022, in order of). Conclusion: HALP score may be used as an easily applicable and inexpensive method in clinical practice that can contribute to the early diagnosis of NSTEMI patients.

Improved heart function and cardiac remodelling following sacubitril/valsartan in acute coronary syndrome with HF.

This study sought to assess the effect of treatment of sacubitril/valsartan (S/V) on improving cardiac function and reversing cardiac remodelling in patients with acute coronary syndrome (ACS) complicated with heart failure with reduced ejection fraction after percutaneous coronary intervention (PCI). We enrolled 275 ACS patients with reduced left ventricular ejection fraction after PCI. The patients were divided into the routine and S/V groups according to the treatment drugs. The symptoms, N-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations, echocardiographic parameters [left ventricular ejection fraction (LVEF), left ventricular mass index (LVMI), left ventricular end-diastolic volume index (LVEDVI), and left ventricular end-systolic volume index (LVESVI)], major adverse cardiac events (MACEs), and adverse reactions were recorded at baseline and 6months after treatment when a clinical follow-up was performed. The S/V group was further divided into prespecified subgroups including unstable angina (UA) group, non-ST-elevation myocardial infarction (NSTEMI) group, and ST-elevation myocardial infarction (STEMI) group according to the type of ACS. We analysed the changes in LVEF, LVMI, LVEDVI, LVESVI, and NT-proBNP in both groups and evaluated the correlation between the changes in the above variables (ΔLVEF, ΔLVMI, ΔLVEDVI, ΔLVESVI, and ΔNT-proBNP). Cox regression model was used to assess the independent risk factors of MACE. Prespecified subgroup analyses were also conducted. Compared with baseline, LVEF increased significantly (P<0.05), NT-proBNP, LVMI, and LVESVI decreased significantly in both groups after 6months (P<0.05), and LVEDVI decreased significantly in the S/V group (P=0.001). In the S/V group, ΔLVEF (t=-2.745, P=0.006), ΔNT-proBNP (P=0.009), ΔLVEDVI (t=4.203, P=0.001), and ΔLVESVI (t=3.907, P=0.001) were significantly improved than those in the routine group. In the S/V group, ΔLVEF was negatively correlated with ΔNT-proBNP (r=-0.244, P=0.004), ΔLVMI (r=-0.190, P=0.028), ΔLVEDVI (r=-0.173, P=0.045), and ΔLVESVI (r=-0.261, P=0.002). In Cox regression model analysis,ΔLVEF {hazard ratio [HR]=0.87 [95% confidence interval (CI) 0.80-0.95], P=0.003}, ΔLVEDVI [HR=1.04 (95% CI 1.01-1.06), P=0.013], and ΔLVESVI [HR=1.04 (95% CI 1.01-1.08), P=0.026] were independent risk factors for MACE. Subgroup analysis showed that ΔLVEF (t=6.290, P=0.001), ΔLVEDVI (t=2.581, P=0.011), and ΔNT-proBNP (P=0.019) in the NSTEMI group were significantly improved than those in the UA group, ΔLVEDVI in the NSTEMI group was significantly better than that in the STEMI group (t=-3.365, P=0.001), and ΔLVEF in the STEMI group was significantly better than that in the UA group (t=-3.928, P=0.001). There was a significant difference in the survival probability without MACE among the three groups in the analysis of the Kaplan-Meier curve (P=0.042). The incidence of MACE in the UA group was significantly higher than that in the NSTEMI group (32.4% vs. 6.3%, P=0.004). The cardiac function is improved and cardiac remodelling is reversed significantly after treatment of S/V in ACS patients with reduced left ventricular ejection fraction after PCI, and the improvement is more obvious than the routine group. There is a significant negative correlation between the change in LVEF and the changes in NT-proBNP, LVMI, LVEDVI, and LVESVI. The increase of LVEF and the decrease of LVEDVI and LVESVI are protective factors to improve the prognosis. Patients with myocardial infarction and reduced left ventricular ejection fraction might benefit more from the initiation of S/V as first-line heart failure treatment after PCI.

Glycated Haemoglobin and TIMI Score as Risk Predictor in Patients with Acute Myocardial Infarction: A Cross-sectional Study

Introduction: Cardiovascular Disease (CVD) is the leading cause of death and disability globally. The Thrombolysis in Myocardial Infarction (TIMI) score is calculated to assess the risk outcome among myocardial infarction patients. Researchers found that diabetic patients with myocardial infarction have relatively unfavourable outcomes when compared to myocardial infarction patients without diabetes. Aim: To evaluate Glycated Haemoglobin (HbA1c) levels, the TIMI score in Acute Myocardial Infarction (AMI) patients and compare them between ST Elevation Myocardial Infarction (STEMI) and non STEMI (NSTEMI) patients. Materials and Methods: This cross-sectional study was conducted at the Intensive Care Unit (ICU) of the Department of Cardiology at SRM Medical College Hospital and Research Centre, Kattankulathur, Chengalpattu, Tamil Nadu, India, from July 2022 to June 2023. A total of 100 myocardial infarction patients were included and divided into two groups based on Electrocardiogram (ECG) findings and Creatine PhosphokinaseMB (CK-MB) values, with 50 STEMI and 50 NSTEMI. Patients blood samples were evaluated for HbA1c, total cholesterol, Triglycerides (TGL), High-density Lipoprotein Cholesterol (HDL-C), Low-density Lipoprotein Cholesterol (LDL-C), Very High-density Lipoprotein Cholesterol (VLDL-C), and CK-MB parameters. The TIMI score was calculated to evaluate the risk of developing complications among myocardial infarction patients. Pearson’s correlation was used to correlate biochemical parameters with the TIMI score. Results: A total of 100 myocardial infarction patients were analysed in the present study, with 50 being STEMI (mean HbA1c%: 8.0±0.2.8) and 50 being NSTEMI (mean HbA1c%: 7.2±2.0) with a p-value of &lt;0.01*, a high TIMI score in STEMI patients (means 5.38±2.76) and 50 NSTEMI (mean 3.24±1.20) with a p-value of &lt;0.0001*. Also, HbA1c was strongly positively correlated with the TIMI score in both the STEMI and NSTEMI groups, with r-value of 0.6 (p=0.0001*) and 0.7 (p=0.0001*), respectively. CK-MB was correlated with the TIMI score in both STEMI and NSTEMI, with r-value of 0.308 (0.03) and 0.375 (0.007). There was no correlation between the TIMI score and the lipid profile. Conclusion: The study concluded that HbA1c, along with the TIMI score, is a significant predictor of risk outcome in AMI patients.

Layer-specific fast strain-encoded cardiac magnetic resonance imaging aids in the identification and discrimination of acute myocardial injury: a prospective proof-of-concept study

Acute myocardial injury is a common diagnosis in the emergency department and differential diagnoses are numerous. Cardiac magnetic resonance (CMR) strain sequences, such as fast strain ENCoded (fSENC), are early predictors of myocardial function loss. This study assessed the potential diagnostic and prognostic benefits of a layer-specific approach. For this prospective study, patients in the emergency department fulfilling rule-in criteria for non-ST-elevation myocardial infarction (NSTEMI) received an ultra-fast fSENC CMR. Volunteers without cardiac diseases (controls) were recruited for comparison. Measurements were performed in a single heartbeat acquisition to measure global longitudinal strain (GLS) and segmental longitudinal strain and dysfunctional segments. The GLS was measured in two layers and a difference (GLSdifference =GLSepicardial -GLSendocardial) was calculated. The performance of those strain features was compared to standard care (physical examination, cardiac biomarkers, electrocardiogram). According to the final diagnosis after discharge, patients were divided into groups and followed up for 2years. A total of 114 participants, including 50 controls, were included. The 64 patients (51 male) were divided into a NSTEMI (25), myocarditis (16), and other myocardial injury group (23). GLS served as a potent predictor of myocardial injury (area under the curve (AUC) 91.8%). The GLSdifference provided an excellent diagnostic performance to identify a NSTEMI (AUC 83.2%), further improved by including dysfunctional segments (AUC 87.5%, p=0.01). An optimal test was achieved by adding fSENC to standard care (AUC 95.5%, sensitivity 96.0%, specificity 86.5%, p=0.03). No death occurred in 2years for patients with normal GLS and ≤5 dysfunctional segments, while three patients died that showed abnormal GLS or >5 dysfunctional segments. Layer-specific strain is a potential new marker with high diagnostic performance in the identification and differentiation of acute myocardial injuries.

Comparison of Short Term In-Hospital Outcomes in patients presenting with ST-Elevation Myocardial Infarction Versus Non-ST-Elevation Myocardial Infarction

Objective: To compare the short term in-hospital outcomes in patients presenting with acute ST-Elevation Myocardial Infarction (STEMI) and Non-ST-Elevation Myocardial Infarction (NSTEMI). Study Design: Comparative Cross-sectional study. Place and Duration of Study: Adult cardiology department of tertiary care center, Rawalpindi Pakistan, from Aug 2022 to Feb 2023. Methodology: A sample of 323 patients of acute STEMI and NSTEMI were enrolled. Patients fulfilling the inclusion criteria were enrolled through non-probability consecutive sampling. Patients were divided into two groups. The data of short term in hospital outcomes was recorded. Data was entered and analyzed using SPSS version-26:00. Chi-square and t-test were used to find association and mean difference of study variables between study groups. Results: Out of total 317 patients, males were 262(82.6%) and females were 55(17.4%)) with an average age of 63.34±8.96 years in the study. 139(43.8%) patients had Diabetes Mellitus, 146(46.1%) were hypertensive and 73(23.0%) were smokers. 198(62.5%) patients had STEMI and 119(37.5%) had NSTEMI. Mortality within hospital was found in 10(3.2%) patients. There were significant findings with age (p&lt;0.001), gender (p&lt;0.001), diabetes (p=0.01), pulmonary edema (p=0.01) and severe Left Ventricular Dysfunction (LVD) (p&lt;0.001). Higher in-hospital mortality rate was noted in NSTEMI group, i.e. 5(4.2%) compared to STEMI 5(2.5%), but the findings were statistically insignificant (p=0.40). Conclusion: There was no meaningful distinction between the two groups' immediate outcomes. Although patients with NSTEMI had relatively higher complication rates and in-hospital mortality, and patients with STEMI had better short-term outcomes, suggesting that patients with NSTEMI may also require immediate medical attention.

Troponin I and D-dimer levels as triaging biomarkers to distinguish acute pulmonary thromboembolism from myocardial infarction

Background: Acute pulmonary thromboembolism (APTE) is often confused with myocardial infarction. Previous studies have shown that patients with APTE exhibit lower initial and peak cardiac troponin I (CTI) levels, but higher D-dimer (DD) levels, than patients with myocardial infarction. The present study aimed to reaffirm the tree model algorithm using an entirely new set of data.Methods: We reviewed retrospective clinical and laboratory data from patients who were diagnosed with APTE or non-ST-elevation myocardial infarction (NSTEMI) between 2015 and 2016. Subjects who were not classified with a diagnosis or did not have their CTI or DD levels assessed were excluded. We categorized patients according to the previous algorithm and compared the outcomes with the previous test dataset.Results: The analysis involved data from 156 patients with APTE and 363 patients with NSTEMI. In the validation data set, the APTE group showed higher initial DD levels (9.80±10.84 μg/mL) and lower initial CTI levels (0.17±0.54 μg/mL) than the NSTEMI group. The accuracy rate for the test dataset and the validation set were similar. The test set accuracy rate was 91.0%, while the accuracy rate in the validation set improved to 88.6%.Conclusions: Patients with APTE exhibited lower initial and peak CTI levels, but higher DD levels than NSTEMI patients. The accuracy rate estimates were similar between the test set obtained from the tree model algorithm and the validation set. The study findings demonstrate that the assessment of cardiac biomarkers can be useful for differentiating between APTE and NSTEMI.

The Influence of SARS-CoV-2 Infection on Acute Myocardial Infarction Outcomes.

This multicenter retrospective study with a control group was designed to assess the influence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on the outcomes of patients with myocardial infarction (MI). A total of 129 patients with COVID-19 who were treated for MI were included in this study. The control group comprised 129 comparable patients without SARS-CoV-2 infection. The in-hospital, out-of-hospital, and overall mortality were analyzed. A total of thirty-one (24%) patients died in the study group, and two (1.6%) patients died in the control group (OR = 20.09; CI: 4.69-85.97; p < 0.001). Similar results were observed in all analyzed patient subgroups. Multivariable Cox regression analysis confirmed the significant influence of SARS-CoV-2 infection on in-hospital outcomes (HR: 8.48459; CI: 1.982-36.320; p = 0.004). Subanalysis of the groups with COVID-19 plus ST-elevation MI (STEMI) or non-ST-elevation MI (NSTEMI) revealed comparable mortality rates: 14 (21.12%) patients in the NSTEMI group and 17 (26.98%) patients in the STEMI subgroup died (OR: 1.3; CI: 0.56-3.37; p = 0.45). During out-of-hospital observation, no differences in mortality were observed (OR: 0.77; CI: 0.11-4.07; p = 0.73). SARS-CoV-2 infection affects the in-hospital outcomes of patients with both MI and COVID-19, regardless of MI type (STEMI vs. NSTEMI).

Prevalence and Outcomes of Patients With Acute Ischemic Stroke and Concomitant Non–ST-Elevation Myocardial Infarction (Results from the National Inpatient Sample 2016 to 2019)

Acute myocardial infarction (MI) may concomitantly occur with acute ischemic stroke. The incidence and outcomes of acute non-ST-elevation MI (NSTEMI) in acute ischemic stroke are not well studied. We examined hospitalized patients with acute ischemic stroke and a concomitant NSTEMI diagnosis who were included in the National Inpatient Sample 2016 to 2019. Acute ischemic stroke and NSTEMI were defined by using the International Classification of Diseases, Tenth Revision codes. Patients with ST-elevation MI were excluded. The outcomes were expressed as percentages. A multivariable logistic regression analysis was used to examine the association of concomitant acute ischemic stroke and NSTEMI with the primary outcome of mortality and the secondary outcomes. A subgroup analysis of patients with NSTEMI with acute ischemic stroke that underwent percutaneous coronary intervention (PCI) (angiography and angioplasty) was also performed. Of the total hospitalized patients with acute ischemic stroke (n=1,726,265), 1.60% (n=27,630) patients (mean age 73.5 years, 52.2% women, 67% White race) had NSTEMI diagnosed during the hospitalization. Of these, 14.1% (n=3,890) died in the NSTEMI group and 3.4% (n=57,670) died in the non-NSTEMI group. The most common outcomes in the NSTEMI group were Acute kidney injury 31.8%, Intracranial hemorrhage 6.6%, and sepsis 6.13%. NSTEMI in acute ischemic stroke was associated with mortality (odds ratio [OR] 3.60, 95% confidence interval [CI] 3.29 to 3.93, p ≤0.001), ICH (OR 1.46, 95% CI 1.30 to 1.63, p <0.001), and having any of the secondary outcomes (OR 2.73, 95% CI 2.57 to 2.90, p <0.001). PCI was performed in 9.14% of patients with acute ischemic stroke with NSTEMI. PCI was associated with having any of the secondary outcomes (OR 0.83, 95% CI 0.7 to 1.02, p=0.8), mortality (OR 0.35, 95% CI 0.23 to 0.54, p <0.001), and ICH (OR 0.42, 95% CI 0.25 to 0.7, p=0.01). In conclusion, NSTEMI in acute ischemic stroke is associated with increased mortality and other adverse events. PCI in the subgroup of patients with NSTEMI was not associated with increased mortality or intracranial bleeding.

Growth Differentiation Factor-15 in Patients Recovering From Acute Coronary Syndromes

Plasma concentrations of growth differentiation factor-15 (GDF-15) are known to be prognostic in patients with acute coronary syndromes (ACS). However, the pattern of GDF-15 in the months post-ACS remains uncertain. This study aimed to investigate the temporal pattern of circulating GDF-15 in the intermediate to long-term post-ACS. The Biomarker-guided Risk Management following Acute Coronary Syndrome (BioMACS) clinical trial enrolled patients between 1 month and 12 months post-discharge after an ACS. Patients were selected from the trial Usual Care arm, with equal numbers of non-ST elevation myocardial infarction (NSTEMI) and STEMI. Groups were matched by time from ACS. GDF-15 was measured at baseline and 3 months using the ROCHE Cobas assay. Sixty patients were included, 30% were female, and the median age was 67 years. Ethnicity was 81% European, 2% Māori, 7% Pacific, 7% Asian, and 3% Indian. For the whole group, mean GDF-15 concentrations were 1,430 (standard deviation [SD] 632) pg/mL at baseline, and 1,348 (SD 626) pg/mL at 3 months. No significant differences in GDF-15 concentrations were found between NSTEMI and STEMI groups at both timepoints. The change from baseline to 3 months was –93 (SD 462) pg/mL, with no statistically significant difference in the change between the NSTEMI and STEMI groups. GDF-15 was related to age, systolic blood pressure, and measures of renal function (creatinine and estimated glomerular filtration rate). GDF-15 concentrations were elevated in the months post-ACS but remained stable over a further 3-month period. The prognostic role of this biomarker in the convalescent period post-ACS needs to be assessed in future research studies.

The D-Dimer to Troponin Ratio Is a Novel Marker for the Differential Diagnosis of Thoracic Acute Aortic Syndrome from Non-ST Elevation Myocardial Infarction.

Thoracic acute aortic syndrome (AAS) and non-ST elevation myocardial infarction (NSTEMI) have similar clinical presentations, making them difficult to differentiate. This study aimed to identify useful biomarkers for the differential diagnosis of thoracic AAS and NSTEMI. This was a retrospective observational study. consecutive adult patients who visited the emergency department for acute chest pain between January 2015 and December 2021 diagnosed with thoracic AAS or NSTEMI. Clinical variables, including D-dimer (μg/mL) and high-sensitivity troponin T (ng/mL, hs-TnT) levels, were compared between the groups. A total of 52 (30.1%) and 121 (69.9%) patients were enrolled in the thoracic AAS and NSTEMI groups, respectively. Logistic regression analysis revealed that the D-dimer to hs-TnT (D/T) ratio (odds ratio (OR), 1.038; 95% confidence interval (CI), 1.020-1.056; p < 0.001) and the thrombolysis in myocardial infarction (TIMI) score (OR, 0.184; 95% CI, 0.054-0.621; p = 0.006) were associated with thoracic AAS. The D/T ratio had an area under the receiver operating characteristic curve (AUC) of 0.973 (95% CI, 0.930-0.998), and the optimal cutoff value was 81.3 with 91.4% sensitivity and 96.2% specificity. The TIMI score had an AUC of 0.769 (95% CI, 0.644-0.812), and the optimal cutoff value was 1.5 with 96.7% sensitivity and 38.5% specificity. the D/T ratio may be a simple and useful parameter for differentiating thoracic AAS from NSTEMI.

Lipoprotein(a) concentrations in acute myocardial infarction patients are not indicative of levels at six month follow-up.

Lipoprotein(a) [Lp(a)] levels are generally constant throughout an individual's lifetime, and current guidelines recommend that a single measurement is sufficient to assess the risk of coronary artery disease (CAD). However, it is unclear whether a single measurement of Lp(a) in individuals with acute myocardial infarction (MI) is indicative of the Lp(a) level six months following the event. Lp(a) levels were obtained from individuals with non-ST-elevation myocardial infarction (NSTEMI) or ST-elevation myocardial infarction (STEMI) (n = 99) within 24 h of hospital admission and after six months, who were enrolled in two randomized trials of evolocumab and placebo, and in individuals with NSTEMI or STEMI (n = 9) who enrolled in a small observation arm of the two protocols and did not receive study drug, but whose levels were obtained at the same time points. Median Lp(a) levels increased from 53.5 nmol/L (19, 165) during hospital admission to 58.0 nmol/L (14.8, 176.8) six months after the acute infarction (P = 0.02). Subgroup analysis demonstrated no difference in the baseline, six-month, or change between the baseline and six-month Lp(a) values between the STEMI and NSTEMI groups and between the group which received evolocumab and the group that did not. This study demonstrated that Lp(a) levels in individuals with acute MI are significantly higher six months after the initial event. Therefore, a single measurement of Lp(a) in the peri-infarction setting is not sufficient to predict the Lp(a)-associated CAD risk in the post-infarction period. Evolocumab in Acute Coronary Syndrome Trial [EVACS I] NCT03515304, Evolocumab in Patients with Acute Myocardial Infarction [EVACS II], NCT04082442.

The diagnostic utility of creatine kinase-MB versus total creatine phosphokinase ratio in patients with non-ST elevation myocardial infarction from unstable angina.

The present study seeks to find a way to quickly and correctly differentiate myocardial infarction from unstable angina by measuring the creatine kinase-MB/creatine phosphokinase ratio and comparing in non-ST elevation myocardial infarction patients with unstable angina at different time intervals, to improve the health quality of patients with coronary artery disease. The present study is a retrospective epidemiological analysis of 260 patients with non-ST elevation myocardial infarction and 260 patients with unstable angina, including age, sex, creatine kinase-MB, and creatine phosphokinase biomarkers at two-time intervals, including referral (4-8 h from the onset of pain) as the first interval, and 8 h after the first sampling was extracted as the second interval. Moreover, the delta of the creatine kinase-MB/creatine phosphokinase ratio during two interval times was measured. In non-ST elevation myocardial infarction patients in the first and second intervals, creatine kinase-MB/creatine phosphokinase ratio was 32.7 and 33.8% higher than the normal laboratory cutoff (positive), respectively, and in the group of unstable angina patients, this index was positive in 31.9 and 30.4% of patients, respectively. There was no significant difference between the mean creatine kinase-MB to creatine phosphokinase index between the patients with non-ST elevation myocardial infarction and unstable angina (p = 0.507). In the first interval, the sensitivity and specificity of this index in differentiating non-ST elevation myocardial infarction from unstable angina were 51.5 and 57.3% (area under the curve = 0.518), respectively. While in the second interval, the sensitivity and specificity of this index were 17.7 and 87.8% (area under the curve = 0.519), respectively. The creatine kinase-MB/creatine phosphokinase delta in the non-ST elevation myocardial infarction group was significantly higher than in patients with unstable angina during different time intervals (p = 0.01). According to our results, creatine kinase-MB/creatine phosphokinase index cannot help differentiate the two groups of non-ST elevation myocardial infarction and unstable angina. However, the findings show that higher levels of creatine kinase-MB enzyme and creatine kinase-MB/creatine phosphokinase delta in the early hours, 4-16 h after the onset of pain in non-ST elevation myocardial infarction patients, can be used to differentiate between non-ST elevation myocardial infarction and unstable angina.

High Triglyceride-Glucose Index is Associated With Poor Prognosis in Patients With Acute Coronary Syndrome in Long-Term Follow-Up.

The triglyceride-glucose (TyG) index is calculated from fasting triglycerides and fasting glucose levels and is an indicator of insulin resistance. The present study investigates whether the TyG index has a role in predicting clinical outcomes in cases of acute coronary syndrome (ACS). This retrospective study included 646 patients with ST-elevation myocardial infarction (STEMI) and 1048 patients with non-ST-elevation myocardial infarction (NSTEMI). The association between major adverse cardiac events (MACEs) that developed in-hospital and at 60months of follow-up and TyG index values were compared. Patients were divided into 2 groups: TyG index values of ≥8.65 and <8.65. During the hospital stay and 60months of follow-up, 303 MACEs occurred. In both the STEMI and NSTEMI groups, as the TyG index increased, an increase was observed in MACE rates. MACE rates were also found to be highest in the group with TyG index ≥8.65 (P < .001). TyG index, C-reactive protein, and age were independent predictors of MACEs in both the NSTEMI and STEMI groups. The present study found a significant association between higher TyG index values and increased risk of MACEs in ACS patients. The TyG index may prove useful to predict clinical outcomes in ACS patients.

Obesity Paradox in Coronary Thrombus Burden of Patients with Acute Coronary Syndrome.

Background: Acute coronary syndrome (ACS) remains a major cause of morbidity and mortality worldwide. Although obesity is a risk factor for ACS, decreased mortality has been shown in overweight individuals. This study aims to determine the association of body fat parameters such as body fat percentage (BFP), relative fat mass (RFM), and coronary thrombus burden with angiographic thrombotic grade in a series of patients presenting with ACS. Methods: Three hundred ninety patients who underwent percutaneous coronary intervention were enrolled in the study. BFP was calculated using the U.S. Navy formula. RFM index was calculated using gender, height, and waist circumference regardless of weight. Body mass index (BMI) is calculated as the weight in kilograms divided by the square of body length in meters (kg/m2). Two experienced interventional cardiologists reviewed coronary angiograms according to the TIMI thrombus scale. Patients were divided into groups according to thrombus classification and clinical status. Results: RFM, which is an anthropometric measurement parameter for obesity, was inversely related to thrombus burden in patients with ACS. There were no significant differences between ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) groups according to demographic, clinical characteristics, and coronary risk factors. Likewise, RFM, BFP, and BMI were comparable between the two groups. BFP and RFM were lower in patients with thrombus present STEMI group compared with no thrombus group. Thrombus presence was also compared in the NSTEMI group, and BMI, BFP, and RFM were lower in patients with thrombus present NSTEMI group. Conclusions: Our analysis demonstrated that RFM was better than BFP and BMI for predicting thrombus presence in patients with ACS.

Patient mortality dynamics in intensive cardiac care: single department experience

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Intensive cardiac care is celebrating 60 years anniversary since description of a first coronary care unit by Dr. Desmond Julian in 1961. The establishment of such units was a breakthrough in diagnosis, treatment, and the development of critical care medicine. For the last 20 years our intensive cardiac care department has been a leading centre in its field in Lithuania, admitting over 4000 patients each year. Assessment of mortality in intensive cardiac care units is one of the main indicators of quality of healthcare provided. Purpose To examine the dynamics of mortality of patients treated in our intensive cardiac care department in 2000-2020. Methods The de-identified data set of patients who were treated in our intensive cardiac care department in 2000-2020 was gathered from medical records retrospectively. The set consisted of total number of patients treated in the department, the number of patients treated for ST-elevation myocardial infarction (STEMI), the number of patients treated for non-ST-elevation myocardial infarction (NSTEMI), the number of patients treated for pulmonary embolism (PE), and the number of patients who died in each of these groups. The analysis of collected data was performed using MS Excel, IBM SPSS Statistics 26.0 programs. Paired Student’s t-test and Chi-square test were applied. Results were considered statistically significant at p&amp;lt;0.05. Results The analysis population comprised 65583 patients who were treated between years 2000 and 2020 of which 15912 (24.26%) were treated for STEMI, 8609 (13.13%) for NSTEMI, and 1460 (2.23%) for PE. The overall patient mortality in 2000-2020 was 4.76%, patient mortality treated for STEMI was 8.07%, treated for NSTEMI – 4.88%, and treated for PE – 15.74%. Mortality was found to be significantly higher in the STEMI group than in the NSTEMI group (8.07% vs. 4.88%; p&amp;lt;0.001). Mortality in patients treated for STEMI in 2000-2005, 2006-2010, 2011-2015, and 2016-2020 were also found to be statistically significantly different (p=0.001) and consistently decreasing (9.2% vs. 8.0% vs. 7.3% vs. 7.0%). There were no statistically significant differences in the mortality of patients treated for NSTEMI and PE at different time periods (p&amp;gt;0.05) as observed in the STEMI group. Assessing all patients treated in 2000-2020, it was found that statistically significantly more patients died in 2016-2020 (5.2%) than in 2000-2015 (4.6%; p=0.01). Conclusions The highest mortality in patients treated in our intensive cardiac care department in 2000-2020 was observed in the group of patients treated for pulmonary embolism. A consistent decrease in mortality was observed in patients treated for ST-elevation myocardial infarction. The average total patient mortality rate in 2016-2020 was found to be statistically significantly higher than in the previous years.

Arjirofilik Nükleolar Organize Edici Bölgeler Non ST Elevasyonlu Miyokard İnfarktüsünde Hipoksik Yanıtın Yeni bir Belirteci Olabilir mi?

Objective: Non-ST elevation myocardial infarction (NSTEMI) is a type of acute coronary syndrome and its’ incidence is similarly high to ST-elevation myocardial infarction. Nucleolar organizing regions (NORs) are located of the secondary structure of acrocentric chromosome and composed of proteins and ribosomal DNA (rDNA) some of which are argyrophilic. We aimed to investigate the change of AgNOR proteins, which increase in hypoxia, in patients with NSTEMI.&#x0D; Methods: A total of 125 participants, 63 patients with NSTEMI and 62 volunteers without any acute coronary syndrome were included in the study. Echocardiography was performed and both mean AgNOR Number and total AgNOR area/total nuclear area (TAA/TNA) were detected for each individuals.&#x0D; Results: The mean AgNOR number and TAA/TNA ratio were significantly higher in the NSTEMI group than control (p

Dual-energy CT plaque characteristics of post mortem thin-cap fibroatheroma in comparison to infarct-related culprit lesions.

Improvement of non-invasive identification of high-risk plaque may increase the preventive options of acute coronary syndrome. To describe the characteristics of thin-cap fibroatheroma (TCFA) in a post mortem model in comparison to characteristics of culprit lesions in patients with non-ST-elevation-myocardial-infarction (NSTEMI) using the dual energy computed tomography (DECT). Three post mortem hearts were prepared with iodine-contrast, inserted in a Kyoto phantom and scanned by DECT. Six TCFA were identified using histopathological analysis (cap thickness < 65μm and necrotic core > 10% of the plaque area). In the NSTEMI group, 29 patients were scheduled to DECT prior to coronary angiography and invasive treatment. Culprit lesions were identified blinded for the patient history by two independent invasive cardiologists using the coronary angiography. The DECT analysis of TCFA and culprit lesions was performed retrospectively with determination of effective atomic number (Effective-Z), Hounsfield Unit (HU), plaque type (non-calcified, predominantly non-calcified, predominantly calcified or calcified), spotty calcification,, plaque length, plaque volume and plaque burden and the remodeling index. The Effective-Z, HU and plaqueburden were significantly different between TCFA and culprit lesions (P < 0.05).The TCFA plaques were more calcified in comparison to culprit lesions (P < 0.05). No significant difference in the other plaque characteristics was observed. The use of DECT demonstrated different Effective-Z values and different characteristics of post mortem TCFA in comparison to in vivo culprit lesions. This finding may highlight, that not all TCFA should be considered as vulnerable.

Management of patients treated for myocardial infarction in different regions of Hungary and patient survival for 10 years

Regional data on patients' care for myocardial infarction and the long-term follow up of patients have not yet been studied in Hungary. The study aims to analyze the care and 10-year survival of patients recorded during the Hungarian Myocardial Infarction Registry's pilot period in large regions of Hungary. Between Jan 1, 2010 and Dec 31, 2013, the Hungarian Myocardial Infarction Registry recorded data on 23142 patients with voluntary participation. The Research Ethics Committee approved the program. The study included 12104 patients with ST-elevation myocardial infarction (STEMI) and 10768 patients with non-ST-elevation myocardial infarction (NSTEMI). The data processed refer to 128220 patient years based on large regions (West, Central and East Hungary). Percutaneous coronary intervention occurred in 78.4% of STEMI patients and 51.6% of NSTEMI patients. In the NSTEMI group, percutaneous coronary interventions (PCIs) in the Central-Hungary and West-Hungary regions were significantly more common than in the East-Hungary region (p<0.01). During follow-up, PCI in the West-Hungary region, revascularization surgery in the West-Hungary and East-Hungary regions were significantly more common than in the Central-Hungary region (p<0.01). Among STEMI patients, 49.2% of men and 46.6% of women died within 10 years, while in the NSTEMI group 63% and 57.6%, respectively. PCI reduced mortality in both patient groups, sex, at all times of follow-up and in the regions studied (p<0.01). As for STEMI patients, survival was similar in all regions (p = 0.72), while after NSTEMI, 10-year survival in the West-Hungary region was better (p<0.01). There are regional differences in the care and prognosis of patients with myocardial infarction. Orv Hetil. 2021; 162(36): 1438-1450.

Higher Long-Term Mortality in Patients with Non-ST-Elevation Myocardial Infarction than ST-Elevation Myocardial Infarction after Discharge.

PurposeThis study aimed to compare mortality rates after discharge between the patients with non-ST-elevation myocardial infarction (NSTEMI) and those with ST-elevation myocardial infarction (STEMI), and identify each mortality risk factors in these two types of myocardial infarction.Materials and MethodsBetween 2011 and 2015, 13105 consecutive patients were enrolled in the Korea Acute Myocardial Infarction-National Institute of Health registry (KAMIR-NIH); 12271 patients with acute myocardial infarction met the inclusion criteria and were further stratified into the STEMI (n=5828) and NSTEMI (n=6443) groups. The occurrence of mortality and cardiac mortality at 3 years were compared between groups, and the factors associated with mortality for NSTEMI and STEMI were evaluated.ResultsThe comparison between these two groups and long-term follow-up outcomes showed that the cumulative rates of all-cause and cardiac mortality were higher in the NSTEMI group than in the STEMI group [all-cause mortality: 10.9% vs. 5.8%; hazards ratio (HR), 0.464; 95% confidence interval (CI), 0.359–0.600, p<0.001; cardiac mortality: 6.6% vs. 3.5%, HR, 0.474; 95% CI, 0.344–0.654, p<0.001, respectively). In the NSTEMI group, low left ventricular ejection fraction (LVEF; <40%), no percutaneous coronary intervention (PCI), old age (≥65 years), and low hemoglobin level (<12 g/dL) were identified as risk factors for 3-year mortality. In the STEMI group, old age, low glomerular filtration rate (<60 mL/min/1.73 m2), low LVEF, high heart rate (>100 beats/min), no PCI, and low hemoglobin level were identified as the risk factors for 3-year mortality.ConclusionThe NSTEMI group had higher mortality compared to the STEMI group during the 3-year clinical follow-up after discharge. Low LVEF and no PCI were the main risk factors for mortality in the NSTEMI group. In contrast, old age and renal dysfunction were the risk factors for long-term mortality in the STEMI group.

High-Sensitivity Troponin I Assay for Differential Diagnosis of New-Onset Myocardial Infarction in Patients with Acute Decompensated Heart Failure.

PurposeAcute decompensated heart failure (ADHF) caused by ischemic heart disease is associated with higher mortality and requires immediate diagnosis. Recently, novel methods to diagnose non-ST elevation myocardial infarction (NSTEMI) using high-sensitivity cardiac troponin have been applied. We compared the clinical utility of high-sensitivity troponin I (hS-TnI), delta troponin I, and other traditional methods to diagnose NSTEMI in patients with ADHF.Materials and MethodsThis retrospective cross-sectional study was conducted to analyze patients with ADHF who underwent hS-TnI evaluation of 0–2-h protocol in our emergency department. Patients were grouped according to a diagnosis of NSTEMI.ResultsA total of 524 ADHF [ADHF with NSTEMI, n=109 (20.8%)] patients were enrolled in this analysis. The mean values of hS-TnI (ng/mL) in the ADHF with and without NSTEMI groups were 2.44±5.60 and 0.25±0.91, respectively. Multivariable analysis revealed that regional wall-motion abnormality, T-wave inversion/hyperacute T wave, and initial and delta hS-TnI were predictive factors for NSTEMI. Laboratory values related to cardiac biomarkers, including hS-TnI [odds ratio (OR) (95% confidence interval, CI): 2.18], and the delta hS-TnI [OR (95% CI): 1.55] were significant predictors of NSTEMI. Moreover, receiver operating characteristic analysis showed that the areas under receiver operating characteristic curves for electrocardiographic abnormalities, initial hS-TnI, and delta hS-TnI were 0.794, 0.802, and 0.773, respectively.ConclusionFor diagnosis of suspected NSTEMI in patients with ADHF, initial hS-TnI assay has similar predictive value as ischemic changes on electrocardiogram and superior predictive value than delta hS-TnI calculated by the 0–2-h protocol.