non-ST Segment Elevation Research Articles

The prognostic value of tissue Doppler imaging in assessment of left ventricular function in patients with non-ST segment elevation myocardial infarction (NSTEMI) after successful revascularization

The prognostic value of tissue Doppler imaging in assessment of left ventricular function in patients with non-ST segment elevation myocardial infarction (NSTEMI) after successful revascularization

Significance of CHA2DS2-VASc-Hs score in the prediction of adverse in-hospital outcomes in patients with Non-St segment elevation myocardial infarction

Significance of CHA2DS2-VASc-Hs score in the prediction of adverse in-hospital outcomes in patients with Non-St segment elevation myocardial infarction

Elevated uric acid/albumin ratio as a predictor of poor coronary collateral circulation development in patients with non-ST segment elevation myocardial infarction.

Uric acid/albumin ratio (UAR) is a novel composite biomarker with superior predictive value for cardiovascular disease. To investigate the relationship between UAR and coronary collateral circulation (CCC) in patients with non-ST segment elevation myocardial infarction (NSTEMI). A total of 205 NSTEMI patients who underwent coronary arteriography with at least one major coronary stenosis, 95% were included. Patients were divided into two groups according to CCC development: poorly-developed CCC group (Rentrop 0-1) and well-developed CCC (Rentrop 2-3). Univariate analysis and logistic regression analysis were utilized to investigate the factors influencing adverse CCC formation in NSTEMI patients. The receiver operating characteristic (ROC) curve was plotted to evaluate the predictive value of UAR, C-reactive protein (CRP), uric acid, and albumin for patients with poorly developed CCC, and the area under the curve (AUC) was compared. The UAR values of NSTEMI patients were significantly higher in the poorly developed CCC group than those in the well-developed CCC group (10.19 [8.80-11.74] vs. 7.79 [6.28-9.55], p < .001). In the multiple logistic regression tests, UAR (odds ratio [OR]: 1.365, 95% confidence interval [CI]: 1.195-1.560, p < .001), CRP (OR: 1.149, 95% CI: 1.072-1.231, p < .001), and diabetes (OR: 2.924, 95% CI: 1.444-5.920, p = .003) were independent predictors of poorly developed CCC. The ROC curve analysis showed that the optimal cut-off value of UAR was 8.78 in predicting poorly developed CCC with a sensitivity of 76.8% and specificity of 62.4%, with the AUC of 0.737 (95% Cl: 0.668-0.805, p < .001). Elevated UAR may be an independent and effective biomarker for predicting poorly-developed CCC development in NSTEMI patients.

Retrospective review of non-ST segment elevation acute coronary syndrome presenting to the emergency department of a major tertiary center in Saudi Arabia.

Acute coronary syndrome (ACS) comprises a spectrum of diseases ranging from unstable angina (UA), non-ST elevation myocardial infarction (non-STEMI) and ST elevation myocardial infarction (STEMI). Treatment of ACS without STEMI (NSTEMI-ACS) can vary, depending on the severity of presentation and multiple other factors. Analyze the NSTEMI-ACS patients in our institution. Retrospective observational. A tertiary care institution with accredited chest pain center. The travel time from ED booking to the final disposition for patients presenting with chest pain was retrieved over a period of 6 months. The duration of each phase of management was measured with a view to identify the factors that influence their management and time from the ED to their final destination. The data was analyzed using descriptive statistics. Travel time from ED to final destination. 300 patients. The majority of patients were males (64%) between 61 and 80 years of age (45%). The median disposition time (from ED booking to admission order by the cardiology team) was 5 hours and 19 minutes. Cardiology admissions took 10 hours and 20 minutes from ED booking to the inpatient bed. UA was diagnosed in 153 (51%) patients and non-STEMI in 52 (17%). Coronary catheterization was required in 79 (26%) patients, 24 (8%) had coronary artery bypass grafting (CABG) and 8 (3%) had both catheterization and CABG. The time from ED booking to final destination for NSTEMI-ACS patients is delayed due to multiple factors, which caused significant delays in overall management. Additional interventional steps can help improve the travel times, diagnosis, management and disposition of these patients. Single center study done in a tertiary care center so the results from this study may not be extrapolated to other centers.

Can Glypican-6 Levels Be Used to Determine Right Ventricular Remodeling After Non-ST Segment Elevation Myocardial Infarction?

Myocardial infarction is associated with right ventricular (RV) remodeling. Glypican-6 (GPC6), a member of the membrane proteoglycan family, plays a significant role in cardiac remodeling. This study aims to determine if GPC6 can predict RV remodeling after percutaneous coronary intervention (PCI) in patients with non-ST segment elevation myocardial infarction (NSTEMI). The study enrolled 164 consecutive patients with NSTEMI and controls. It compared baseline plasma GPC6 levels, echocardiography, and laboratory parameters between the RV remodeling and non-RV remodeling groups with NSTEMI. Echocardiographic data were measured at baseline and at six months. GPC6 levels were higher in the NSTEMI group 11.06 ng/mL (4.61-18.17) vs. 5.98 ng/mL (3.81-9.83) compared to the control group in the initial phase. RV remodeling, defined as a ≥ 20% increase in RV end-diastolic area (RV EDA), was observed in 23 patients (30%). After six months, RV EDA increased significantly from baseline 18.68 ± 1.20 cm2 vs. 24.91 ± 1.08 cm2, P < 0.001. GPC6 was a significant independent predictor of RV remodeling (hazard ratio [HR]: 1.546, 95% confidence interval [CI]: 1.056-2.245, P < 0.001). Receiver operating characteristic curve (ROC) analyses showed that GPC6 values > 15.5 ng/mL (area under the curve [AUC] = 0.828, sensitivity: 70%, specificity: 74%, P < 0.001) were strong predictors of RV remodeling. NSTEMI patients should be closely monitored for RV remodeling. GPC6 appears useful in detecting RV remodeling following NSTEMI in patients undergoing PCI.

Organized thrombus is a frequent underlying feature in culprit lesion morphology in non-ST-elevation myocardial infarction. A study using optical coherence tomography and magnetic resonance imaging

The concept that the culprit lesion in non-ST segment elevation myocardial infarction (NSTEMI) is caused by sudden plaque rupture with acute thrombus formation has recently been challenged. While angiography is an old gold-standard for culprit identification it merely visualizes the lumen contour. Optical coherence tomography (OCT) provides a detailed view of culprit features. Combined with myocardial edema on cardiac magnetic resonance (CMR), indicating acute ischemia and thus culprit location, we aimed to characterize culprit lesions using OCT. Patients with NSTEMI referred for angiography were prospectively enrolled. OCT was performed on angiographic stenoses ≥50% and on operator-suspected culprit lesions. Hierarchical OCT-culprit identifiers were defined in case of multiple unstable lesions, including OCT-defined thrombus age. An OCT-based definition of an organizing thrombus as corresponding to histological early healing stage was introduced. Lesions were classified as OCT-culprit or non-culprit, and characteristics compared. CMR was performed in a subset of patients. We included 65 patients with 97 lesions, of which 49 patients (75%) had 53 (54%) OCT-culprit lesions. The most common OCT-culprit identifiers were the presence of acute (66%) and organizing thrombus (19%). Plaque rupture was visible in 45% of OCT-culprit lesions. CMR performed in 38 patients revealed myocardial oedema in the corresponding territories of 67% of acute thrombi and 50% of organizing thrombi. A culprit lesion was identified by OCT in 75% patients with NSTEMI. Acute thrombus was the most frequent feature followed by organizing thrombus. Applying specific OCT-criteria to identify the culprit could prove valuable in ambiguous cases.

Association between anaemia and long-term prognosis in patients with non-ST segment elevation myocardial infarction

Background The majority of existing studies examining the association between anaemia and the prognosis of patients with acute coronary syndrome (ACS) have focused on all patients with ACS without further categorisation. As a result, there is a dearth of research specifically exploring the relationship between anaemia and the long-term prognosis of patients with non-ST segment elevation myocardial infarction (NSTEMI). To address this gap, this study aimed to investigate the correlation between anaemia and the long-term prognosis of NSTEMI patients. Methods This study included 482 NSTEMI patients who underwent percutaneous coronary intervention (PCI) at the First Affiliated Hospital of Chongqing Medical University from September 1, 2016 to May 31, 2022, and the patients were classified into the major adverse cardiovascular events (MACE) group and non-MACEs group according to whether or not they had developed MACE as of February 28, 2023 at follow-up.COX regression analysis was used to assess whether anaemia was an independent factor influencing MACE occurrence in patients with NSTEMI. Receiver operating characteristic (ROC) curve analysis was conducted to determine if haemoglobin levels could enhance the predictive capacity of the Global Registry of Acute Coronary Events (GRACE) score for the prognosis of NSTEMI patients. Haemoglobin levels were categorised into two groups based on the optimal cut-off value and transformed into binary data. The log-rank test was performed to compare the two groups, and a risk function was plotted. Results During a median follow-up period of 31 months, 124 (25.7%) MACE were identified. Univariate and multivariate COX regression analyses revealed that sex, age, smoking history, diabetes, creatinine, erythrocyte count, and haemoglobin level were independent risk factors that significantly influenced survival time. Subsequently, ROC curve analysis was performed to evaluate the predictive accuracy of specific variables. When the cut-off value for the decline ratio of haemoglobin was set at 128.50, the area under the curve (AUC) was determined to be 0.604, with a sensitivity of 0.403 and a specificity of 0.771. Similarly, setting the cut-off value for the reduction ratio of the GRACE score at 141.5 yielded an AUC of 0.700, with a sensitivity of 0.645 and a specificity of 0.709. Furthermore, when the cut-off value for the predicted probability of haemoglobin combined with the GRACE score was 0.270, the AUC was calculated as 0.702, with a sensitivity of 0.677 and a specificity of 0.696. Conclusion Haemoglobin levels were identified as an independent factor influencing the survival duration of patients with NSTEMI.

Factors Associated With Hospital Mortality in Acute Myocardial Infarction

Aim To determine clinical and laboratory parameters associated with in-hospital mortality in patients with acute myocardial infarction and to develop a multifactorial prognostic model of in-hospital mortality.Material and methods This was a study based on the 2019-2020 Registry of acute coronary syndrome of the Tyumen Cardiology Research Center, a branch of the Tomsk National Research Medical Center. The study included 477 patients with ST-segment elevation acute myocardial infarction (AMI), 617 patients with non-ST segment elevation AMI, and 26 patients with unspecified AMI. In-hospital mortality was 6.0 % (n=67). Clinical and laboratory parameters were assessed on the day of admission. The separation power of indicators associated with in-hospital mortality was determined using a ROC analysis. The data array of each quantitative parameter was converted into a binary variable according to the obtained cut-off thresholds, followed by creation of a multifactorial model for predicting in-hospital mortality using a stepwise analysis with backward inclusion (Wald). The null hypothesis was rejected at p&lt;0.05.Results The multivariate model for prediction of in-hospital mortality included age (cut-off, 72 years), OR 3.0 (95 % CI: 1.5-5.6); modified shock index (cut-off threshold, 0.87), OR 1.5 (95 % CI: 1.1-2.0); creatine phosphokinase-MB (cut-off threshold, 32.8 U / L), OR 4.1 (95 % CI: 2.2-7.7); hemoglobin (121.5 g / l), OR 1.7 (95 % CI: 1.2-2.3); leukocytes (11.5×109 / l), OR 1.9 (95 % CI: 1.3-2.6); glomerular filtration rate (60.9 ml / min), OR 1.7 (95 % CI: 1.2-2.2); left ventricular ejection fraction (42.5 %), OR 4.1 (95 % CI: 2.0-8.3); and size of myocardial asynergy (32.5 %), OR 2.6 (95 % CI: 1.4-5.0).Conclusions Independent predictors of in-hospital mortality in AMI are age, modified shock index, creatine phosphokinase-MB, peripheral blood leukocyte count, hemoglobin concentration, left ventricular ejection fraction, size of myocardial asynergy, and glomerular filtration rate. The in-hospital mortality model had a high predictive potential: AUC 0.930 (95 % CI: 0.905-0.954; p &lt;0.001) with a cutoff threshold of 0.15; sensitivity 0.851, and specificity 0.850.

Time to coronary catheterization in patients with NST-ACS and high GRACE score

Abstract Introduction Current European guidelines recommend early (&amp;lt;24 hours) invasive coronary angiography (ICA) strategy in certain high-risk non-ST segment elevation acute coronary syndrome (NSTE-ACS) patients, including those with GRACE score over 140. The evidence for this recommendation is based on older trials using pre high-sensitive troponin (HsTn) biomarkers and non-contemporary therapy. Purpose To assess the association between GRACE score over 140, timing of ICA and their interaction on clinical outcomes in patients with ACS with no ST elevation, using (HsTn) as part of the calculated GRACE risk score. Methods and results Between February 1st 2016 and July 31th 2021, 1767 patients with a primary diagnosis of NSTE-ACS without indication for urgent ICA, underwent ICA during index hospitalization. 655 (37%) patients underwent early-invasive ICA (within 24 hours) and 1112 (63%) underwent late ICA (between 24 hours and 1 week). 107 patients had a GRACE risk score of 140 or above and 1660 had a GRACE risk score under 140. The primary composite outcome was all-cause mortality, stroke, and recurrent MI. The median time from admission to ICA was 13.3 hours (IQR 6.0,20.6) for the early group and 59.9 hours for the late group (IQR 23.5,96.3). The vast majority of patients had re-vascularization (75.1%) performed, mostly by PCI (69.4%). There was no difference between the early and late ICA groups in the primary composite outcome (late Catheterization &amp;gt;24h HR 1.196, 95% CI 0.969-1.475, P-value 0.096). Using a multivariable cox regression model for the composite outcome revealed no difference between the early and late ICA groups (late Catheterization &amp;gt;24h HR 1.0735, 95% CI 0.862-1.327, P-value 0.512) with no effect for performing early ICA in patients with GRACE score over 140 (HR 1.291 95% CI 0.910-1.831, p-0.151). Conclusion Early ICA strategy in patients with NSTE-ACS patients and GRACE risk score over 140, compared with late ICA, was not associated with improved composite outcome of death, myocardial infarction, and stroke at 1 year.

Comparison of two angiography-based FFR techniques in NSTEMI Patients: A Multicenter Study

Abstract Background Recently, non-invasive methods ("wire free") to functionally assess the hemodynamic severity of a coronary artery have emerged. FFRangio and QFR are angiography-based technologies that have been validated in patients with chronic and acute coronary syndrome compared to invasive FFR measurement. To date, no direct comparison between these two methods has been reported and they have never been prospectively evaluated in patients presenting exclusively with Non-ST Segment Elevation Myocardial Infarction (NSTEMI). Methods Patients with NSTEMI were prospectively included in this multicenter, single-arm, double-blinded study comparing FFR calculated by FFRangio and QFR - both calculated offline - to invasively-measured FFR (FFRinvasive). FFRinvasive was measured in all angiographically intermediate lesions (30%-70% stenosis) and was then compared to the average value measured by two blinded operators for each angio-based FFR modalities; FFRangio and QFR. The primary endpoints were the sensitivity and specificity of FFRangio and QFR relative to the reference standard FFRinvasive using a cutoff value of ≤0.80. Results Among 129 NSTEMI patients who were screened, 49 patients with 63 vessels in total underwent FFRinvasive measurements, had optimal angiographical views for FFRangio and QFR measurement, and were finally included in the study. The mean value of FFRinvasive was 0.83±0.3 with 22 (36%) being ≤0.80. The mean FFRangio was 0.83±0.1 with 20 (32%) being ≤0.80. FFRangio exhibited a sensitivity of 91%, a specificity of 100% and a diagnostic accuracy of 96.8%. The mean QFR was 0.82±0.3 with 20 (32%) being ≤0.80 and it showed sensitivity of 86.4%, specificity of 98.4% and diagnostic accuracy of 93.7%.The pearson correlation coefficient for FFRangio and QFR were r=0.91 and r=0.76, respectively. Conclusion To our knowledge, this multicenter study represents the first head-to-head comparison between these two non-invasive angiography-derived physiology assessment modalities. Both, FFRangio and QFR, that were performed by two operators, demonstrated great diagnostic performance which is slightly better compared to previous validation studies. Although, based on our study, FFRangioseems to have better sensitivity, further larger validation studies are required.Bland–Altman plotCorrelation for FFR and Angio-Based FFR

Predictors of successful post-PCI optimization in vessels with post-PCI fractional flow reserve &amp;lt;0.90: findings from the FFR REACT trial

Abstract Introduction Recent studies demonstrated a strong relation between suboptimal post-PCI fractional flow reserve (FFR) and clinical outcome. The feasibility of post-PCI FFR optimization and its impact on future clinical outcome remains topic of debate. Purpose The aim of the present substudy of the FFR REACT trial was to identify predictors of 1) absolute FFR increase following optimization and 2) successful functional optimization (final FFR ≥0.90). Methods The FFR REACT trial was a single-center, investigator initiated, randomized controlled trial including patients with (un)stable angina or non-ST segment elevation myocardial infarction and angiographically successful PCI. Following a post-PCI FFR &amp;lt;0.90, patients were randomized to intravascular ultrasound (IVUS)-guided optimization according to a dedicated optimization protocol (intervention arm) or no further treatment (control arm). In case of PCI optimization, FFR and IVUS were repeated to evaluate the optimization result. The present analysis included all patients randomized to IVUS-guided optimization, who actually underwent PCI optimization, and who had pre- and post-optimization FFR values available. We performed multivariate linear and logistic regression models to identify predictors of absolute FFR increase and FFR ≥0.90 following optimization. Results A total of 145 patients were allocated to the IVUS-guided optimization arm with 152 vessels having a post-PCI FFR &amp;lt;0.90 (mean post-PCI FFR: 0.83±0.05), of which 104 vessels (68.4%) underwent additional treatment after IVUS evaluation. Paired FFR measurements (pre- and post-optimization) were available in 100/104 optimized vessels. The mean absolute change in FFR was 0.03±0.06 (p&amp;lt;0.001), and 20/100 (20%) vessels achieved a final FFR ≥0.90. Both left anterior descending arteries (LAD) (mean change = -0.033, 95%CI -0.055- -0.010, p=0.004) and higher post-PCI FFR values (mean change per 0.01 unit increase = -0.005, 95%CI -0.007 - -0.004, p&amp;lt;0.001) were associated with lower changes in FFR following optimization. Independent predictors of achieving a final FFR ≥0.90 were higher post-PCI FFR values (OR 1.26 per 0.01 unit increase, 95%CI 1.06-1.51, p=0.009) and non-LAD vessels (OR 5.72, 95%CI 1.73-18.94, p=0.004). Conclusions Within the FFR REACT trial, we observed that the likelihood of improvement in final FFR values was driven by the initial post-PCI FFR values (before optimization) and the location of the target vessel, with non-LAD lesion location being a significant predictor of FFR increase.

Impact of SGLT2-inhibitors on contrast-induced acute kidney injury in diabetic patients with acute myocardial infarction: data from SGLT2-I AMI PROTECT Registry

Abstract Background Diabetes patients presenting with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI) have an increased risk of contrast induced-acute kidney injury (CI-AKI). It has been shown that SGLT2-I have a nephroprotective effect. Purpose To analyze the association between SGLT2-I treatment and the development of contrast-induced acute kidney injury (CI-AKI) in diabetic patients with AMI (both ST- and non-ST segment elevation myocardial infarction - STEMI and NSTEMI) treated with PCI. Methods In this multicenter international registry, all consecutive diabetic AMI patients undergoing PCI between 2018 and 2021 were enrolled. Based on the admission anti-diabetic therapy, they were divided into SGLT-I users versus non-SGLT2-I users. All patients had estimated glomerular filtration rate (eGFR) of &amp;gt;30 mL/min/1.73 m2. No patient discontinued SGLT2-I during hospitalization. Serum creatinine was collected at admission and within 72 h post-PCI. CI-AKI was defined as absolute (≥0.5 mg/dl) or relative increase (≥25%) in serum creatinine at 48-72 h after PCI compared to baseline serum creatinine values. Results The study population consisted of 646 AMI patients: 111 SGLT2-I users and 535 non-SGLT-I users. The mean age of the overall study population was 70 [61-79] years, and more than 77% were males. The mean T2DM duration was similar for both groups. SGLT2-I patients were younger and with better renal function at admission compared to non-SGLT2-I users (p&amp;lt;0.018 for both). Gender, cardiovascular risk factors, glucose-metabolic control, and comorbidities were similar in the two groups. The rate of STEMI and the main angiographic characteristics were similar between the two study groups, except for the higher number of stents implanted in the SGLT2-I group (p=0.041). Vascular access and contrast dosage did not differ between the 2 cohorts. A similar rate of complete revascularization, staged procedure and complex PCI was observed between the study groups. After PCI, the overall rate of CI-AKI was 76 (11.8%). SGLT2-I users exhibit a lower rate of CI-AKI compared to non-SGLT-I ones (5.4% vs 13.1%, p=0.02), with significantly lower creatinine values both after PCI (p=0.016) and at discharge (p=0.046). At multivariate analysis, after adjusting for all confounding factors, the use of SGLT2-I was identified as independent predictor of reduced rate of CI-AKI (OR 0.374; 95% CI 0.142-0.987, p=0.040). During a median follow-up of 24±13 months, patients with CI-AKI showed a higher incidence of MACE compared to patients without (44.7% vs 25.8%, p=0.001). Conclusion In diabetic patients with AMI, the use of SGLT2-I was associated with a lower risk of CI-AKI during index hospitalization, providing new insights into the cardioprotective effects of SGLT2-I in the setting of AMI.

Variability of the antithrombotic effect of acetylsalicylic acid with the administration of different dosages: reality or myth?

Abstract Introduction We rely on the antithrombotic effect of acetylsalicylic acid (ASA) in a number of pathologies, although other beneficial effects are known, such as its anti-inflammatory properties, when administered in higher doses (500mg, 1000mg per os). However, whether the anti-inflammatory effect decreases the antithrombotic potency of ASA is not known. This gap in evidence may lead to an unnecessary use of two drugs (one antithrombotic and one anti-inflammatory) that could be replaced by ASA alone. This scenario presents frequently: post-infarct pericarditis or when in doubt between non-ST segment elevation myocardial infarction vs myopericarditis. In such cases, the use of ASA could assure both antithrombotic and anti-inflammatory effects. Since the antithrombotic effect of ASA is not scientifically proved for higher doses, currently we use ASA 100mg as an antithrombotic agent and ibuprofen as an anti-inflammatory. This experimental study intends to assess whether ASA maintains its antithrombotic effect when administered in an anti-inflammatory dose. Methods Twenty healthy volunteers were recruited. They all had their platelet function assessed in a qualitative manner, using PFA-200 Innovance technology. The volunteers were randomized into four groups, with 5 participants each. The participants of groups 1, 2, 3 and 4 ingested ASA 100mg, 300mg, 500mg and 1000mg respectively, in a blind experiment. One hour after ingestion (peak of action), the volunteers’ platelet function was reassessed. PFA-200 evaluates platelet function through platelet occlusion time (OT), which is measured in milliseconds (ms). Normal platelet function translates into OT of 82-150ms. If the OT is higher than 150ms, the patient is anti-aggregated. Results Prior to ASA administration, 19/20 volunteers had OT within the reference range. Afterwards, in all four groups, volunteers reached OT &amp;gt; 150ms, regardless of the ASA dose administered. Mean OT values for each group were 188ms [SD-23] , 205ms [SD-63], 262ms[SD-44] and 232ms [SD-47], respectively. Overall SD was 32ms. Conclusion ASA maintains its antithrombotic effect when administered in an anti-inflammatory dose. There is no clear correlation between the potency of antithrombotic effect and the ASA dose administered. This was a pilot study that supports the maintenance of the antithrombotic effect of ASA in higher doses, but further and larger studies are required to corroborate these results.

Abstract 14577: Electrocardiogram Parameters for Predicting the Severity of Coronary Artery Disease in Non-ST Segment Elevation Acute Coronary Syndrome

Background: Quantitative electrocardiogram (ECG) parameters have been found to correlate with severity of coronary artery disease (CAD). Thus, it may serve the purpose of risk stratifying patients with non-ST segment elevation acute coronary syndrome (NSTEACS). But little is known about the accuracy of each parameter.So, this study was done to assess the correlation of ECG parameters with severity of CAD in patients with NSTEACS and to compare the diagnostic accuracy among them. Methods: 178 patients with NSTEACS with left ventricular ejection fraction &gt;50% were selected for the study after excluding patients with heart failure, arrhythmia, prior myocardial infarction or revascularisation. P wave peak time (PWPT), corrected QT dispersion (cQTd) and QT dispersion ratio (QTDR) was calculated in all patients. CAD severity was assessed visually by coronary angiography and calculating the syntax score. Results: PWPT, cQTd and QTDR were increased significantly in patients with left main (LM) or triple vessel disease (TVD) than others. These parameters also showed a strong positive correlation with the syntax score ( P&lt;.001 ). Among these parameters, cQTd showed the best diagnostic accuracy (76% sensitivity and 64% specificity) to detect LM or TVD with a cut-ff value of 74 ms. Conclusion: PWPT, cQTd and QTDR may help to identify high risk patients with NSTEACS and early invasive procedure can be done to salvage a large area of myocardium at jeopardy. These may be particularly helpful to the physicians in periphery who have limited resources. Keywords: coronary artery disease, non-ST segment elevation acute coronary syndrome, P wave peak time, corrected QT dispersion, QT dispersion ratio

Abstract 14776: Myopericarditis Mimicking Myocardial Infarction With Non-Obstructive Coronary Arteries

This is a case of a 76-year-old female with a past medical history of recurrent paroxysmal symptomatic supraventricular tachycardia (SVT), atherosclerotic heart disease, mild aortic and mitral valve regurgitation, mild-moderate tricuspid regurgitation, right bundle branch block, hypothyroidism and bronchiectasis who presented to her dermatology appointment with palpitations and dizziness. She visited the cardiologist's office and was found to have SVT on electrocardiogram which did not terminate with Valsalva maneuvers. She arrived at the emergency department with chest pain and converted to sinus rhythm after 6 mg of intravenous adenosine was administered. Her troponin peaked to 0.21 and she was admitted with concerns for non-ST segment elevation myocardial infarction. Transthoracic echocardiogram showed left ventricular ejection fractions of 61 percent with no wall motion abnormalities and left atrial and inferior vena cava dilation. She underwent left heart catheterization which only showed mild calcification and minimal luminal irregularities of the left anterior descending artery. Cardiac MRI showed myopericarditis and she was discharged with 0.6 mg of colchicine twice daily with plans for outpatient follow up. Discussion Patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) are discovered to have myocarditis on cardiac MRI 25-30% of time. However, this case uniquely demonstrates myopericarditis as the cause for MINOCA which may not have been previously specified. In addition, it is important to emphasize the utility of Cardiac MRI as a non-invasive modality to diagnose MINOCA “mimics”, especially in the female population.

Abstract 13423: Magnetocardiography as a Noninvasive Diagnostic Strategy for Ischemia Evaluating Following Coronary Revascularization of Patients With Non-ST Segment Elevation Myocardial Infarction

Introduction: Magnetocardiography (MCG) constitutes a non-invasive and radiation-free procedure that quantifies the heart's magnetic fields and has exhibited sensitive diagnostic capabilities for ischemia. Typically, MCG presents a distinctive pattern in healthy subjects, characterized by a positive and a negative pole that forms an angle of approximately 45-60 degrees within the T peak segment. Hypothesis: Our study aims to monitor the significant alterations in MCG patterns among patients with Non-ST Segment Elevation Myocardial Infarction (NSTEMI) undergoing revascularization. Methods: Patients were prospectively enrolled and MCG scans were conducted thrice: three days pre-intervention, one week post-intervention, and at a three-month follow-up. Results: Four patients underwent anatomical complete revascularization, while one patient had incomplete revascularization. When comparing the MCG patterns of patients with NSTEMI (Figures B-F) to a normal MCG pattern (Figure A), pre-intervention scans showed angular deflection (80%, except for patient 3) and an anomalous distribution of poles (100%). One week post-intervention, patients who underwent complete revascularization (Figures B-D) had myocardial enzymes normalized, along with slight angle recovery and reshaping of the poles (100%). By the three-month follow-up, these patients experienced symptom resolution, and their MCG patterns showed normalized angles with recovered poles (100%). However, the patient who underwent incomplete revascularization (Figure F) exhibited sustained myocardial ischemia symptoms, with no further angle recovery and continued anomalous distribution of positive poles, both post-intervention and during follow-up. Conclusions: The distribution of poles and angular deflection could potentially serve as indicators of ischemia. MCG may represent a promising strategy for evaluating myocardial recovery in patients with NSTEMI.

Abstract 12184: Non-ST Segment Elevation Myocardial Infarction in Patients Admitted With Sepsis: A Comparison of Ischemia-Guided Strategy and Early Catheterization

Introduction: Sepsis and Non-ST Segment Elevation Myocardial Infarction (NSTEMI) are common medical conditions that often coexist and can cause significant morbidity and mortality. The optimal management strategy for these patients remains unclear. The American Heart Association (AHA) recommends an ischemia-guided approach in patients with stable NSTEMI, but it is unknown if this strategy is beneficial in the setting of sepsis. The aim of this study was to evaluate the outcomes of an ischemia-guided strategy in patients with sepsis and NSTEMI who underwent left heart catheterization (LHC) and percutaneous intervention (PCI). Methods: This study utilized data from the National Inpatient Sample (NIS) from 2016-2020. Patients admitted with a principal diagnosis of sepsis and a secondary diagnosis of NSTEMI were included in the study. Patients with cardiogenic shock or STEMI were excluded from the study due to the necessity of urgent or emergent left heart catheterization. Patients were divided into two groups based on the timing of LHC &amp; PCI, within 24 hours or 48-72 hours of admission. Logistic linear regression was used to adjust for multiple factors including patient demographics, hospital characteristics, and comorbidities. Results: A total of 298,855 patients were included in the analysis, with 48% of them being females and a mean age of 73 years. Patients who received an ischemia-guided strategy had lower mortality rates (OR: 0.45, 95% CI: 0.27-0.74, P=0.002) and a lower risk of heart failure exacerbation (OR: 0.74, 95% CI: 0.56-0.97, P=0.030) compared to those who did not receive this strategy. There was no significant difference in length of stay (Coefficient: 0.33, 95% CI: -0.34 - 1.01, P=0.330), cardiac arrest (OR: 0.08, 95% CI: 0.00-28.0, P=0.401), or gastrointestinal bleed (OR: 0.81, 95% CI: 0.49-1.33, P=0.412) between the two groups. Conclusion: This study suggests that an ischemia-guided strategy may be beneficial in patients with sepsis and NSTEMI compared to urgent percutaneous coronary intervention. The strategy was associated with lower mortality rates and a lower risk of heart failure exacerbation. Further studies are needed to confirm these findings and determine the optimal management strategy for this patient population.

Abstract 12920: Double Peak of Cardiac Troponin T in Non ST-Segment Elevation Myocardial Infarction

Introduction: cardiac biomarkers are the cornerstone of the biological definition of acute myocardial infarction. In previous literature it was shown that hs-Troponin T blood assay follows a typical biphasic kinetic in patients (pts) affected by ST segment elevation myocardial infarction (STEMI), treated by primary percutaneous coronary intervention (PCI), while this does not appear to be the case for creatinphosphokinase (CPK) and hs-Troponin I assays. Hypothesis: According to these previous data, we studied hs-troponin T and CPK kinetics in pts suffering from non-ST segment elevation myocardial infarction (NSTEMI). Methods: we retrospectively analysed blood samples for cardiac biomarkers in NSTEMI pts consecutively admitted to the coronary care unit of our institution from January 2022 to May 2023. Results: A total of 83 pts were included. 89% of pts were treated by PCI; 98% of these pts received PCI within 24 hours from hospital admission. Among the 83 enrolled pts, only 11% was treated by surgical revascularization and/or anti-ischemic pharmacological therapy. A double peak of hs-troponin T was observed only in pts treated by PCI (p=0,0001). In these pts the mean time to first hs-troponin T peak was at 35,84 ± 4,4 hours while the mean time to second hs-troponin T peak was at 78,62 ± 8,7 hours. CPK value at hospital admission was 208,6 ± 34,8 U/L while first hs-troponin T peak was 560,1 ± 112,9 ng/L; the second hs-troponin T peak was 240,3 ± 33,7 ng/L, in absence of CPK double peak. Conclusions: similarly to previous studies in STEMI pts, our data confirm the presence of hs-troponin T double peak, in the absence of CPK second dispersion, also in NSTEMI pts. The hs-troponin T second peak is strongly related to PCI procedure while pts undergoing conservative treatment or surgical coronary revascularization do not show such a kinetic. Another interesting issue is the absence of CPK second dispersion. This could suggest a potential trivial meaning of hs-troponin T second peak. Therefore, the second peak could not be of any significance for prognostic evaluation and appropriate timing of pts discharge from acute cardiac care units.

Abstract 15953: Stressed Into a STEMI

Introduction: Chest pain is the second most common presenting symptom in the emergency department (ED). 5.1% of all presentations with chest pain are acute coronary syndrome (ACS). ACS includes ST-segment elevation myocardial infarction (STEMI), non-ST segment elevation myocardial infarction (NSTEMI), and unstable angina (UA). We present a case of UA that progressed to STEMI after a regadenoson stress test. Case: A 55 years old male with 30 pack-year smoking history presented to the ED with sudden onset, sharp, left-sided chest pain associated with diaphoresis that lasted a few minutes. EKG showed sinus rhythm with premature ventricular complexes without ischemic changes. High sensitivity troponin at 0, 1, and 3 hours were within normal limits. While he was undergoing a radionucleotide stress test, he reported severe chest pain immediately after the regadenoson injection. Bedside telemetry showed ST elevation in inferior leads. EKG was consistent with 1mm ST-elevation in leads II, III, and aVF. He underwent an emergent coronary angiogram which revealed 100% occlusion in the mid-right coronary artery (RCA) and 80% in the second marginal distribution. He received a drug-eluting stent to RCA with the resolution of his chest pain. Discussion: Rupture or erosion of atherosclerotic plaque exposes the underlying thrombogenic core which can lead to occlusion of the coronary artery. A partial occlusion due to an unstable plaque can lead to UA or NSTEMI. STEMI results from complete occlusion of the coronary circulation. In our case, the patient presented with unstable angina however undergoing a stress test triggered him to STEMI. The administration of regadenoson led to coronary vasodilation, resulting in the redistribution of coronary blood flow away from the nearly occluded RCA but what led to plaque rupture at the same time leading to a STEMI is unclear. Conclusions: A regadenson stress test can trigger STEMI in patients with unstable angina however the mechanism is unclear

Abstract 12153: Prevalence and Prognostic Implications of Worsening Renal Function After Acute Myocardial Infarction

Introduction: Limited data exist on the association between longitudinal changes in renal function and long-term clinical outcomes in patients who survive acute myocardial infarction (AMI) events. Hypothesis: We sought to investigate the relationship between worsening renal function (WRF) at one-year follow-up and clinical outcomes at three years after AMI. Methods: We analyzed data from 13,104 patients enrolled in the national AMI registry from November 2011 to December 2015. Patients with all-cause death, recurrent myocardial infarction (re-MI), and re-hospitalization for heart failure (rHHF) at one-year follow-up after AMI were excluded. A total of 6,235 patients were extracted and divided into WRF and non-WRF groups. WRF was defined as a ≥25% decrease in estimated glomerular filtration rate (eGFR) from baseline to one-year follow-up. The primary outcome was three-year major adverse cardiac events (MACE), a composite of all-cause death, re-MI, and rHHF. Results: On average, a -1.5 ml/min/1.73 m 2 /year rate of decline in eGFR was exhibited, and 575 (9.2%) patients exhibited WRF at one-year follow-up. After multiple adjustments, WRF at one-year follow-up was independently associated with increased risks of MACEs (adjusted hazard ratio: 1.498, 95% confidence interval: 1.113-2.016, P =0.01), all-cause death, and re-MI at three-year follow-up (Figure 1). Older age, female, diabetes, hypertension, non-ST segment elevation AMI, anterior AMI, anemia, left ventricular ejection fraction &lt;35%, and baseline eGFR &lt;30 ml/min/1.73 m 2 were identified as independent predictors of WRF after AMI. Conclusions: WRF at one-year follow-up after AMI intuitively seems like a risk marker indicating multiple comorbidities. Monitoring serum creatinine in patients at one-year follow-up after AMI may help to identify those who are at the highest risk and guide effective long-term therapeutics.