Number Of Acute Myocardial Infarction Research Articles

The association between inflammation, arterial stiffness, oxidized LDL and cardiovascular disease in Finnish men with metabolic syndrome – a 15-year follow-up study

BackgroundAll-cause mortality and cardiovascular disease are increased in subjects with metabolic syndrome (MetS). Risk scores are used to predict individual risk of heart disease. We performed a long-term follow-up study to investigate whether risk scores and cardiovascular risk factors such as arterial stiffness, high-sensitive C-reactive protein (hs-CRP) and oxidized LDL (OxLDL) can be used to predict cardiovascular events in Finnish men with MetS.MethodsAfter baseline measurements we followed 105 Finnish men aged 30 to 65 years with MetS for a mean period of 16.4 years. The primary outcome of the study was a composite of myocardial infarction, stroke, symptomatic vascular disease diagnosed with invasive angiography, coronary or peripheral revascularization, amputation due to peripheral vascular disease, cardiovascular death and non-cardiovascular death. The endpoints were retrieved from electronic medical records.ResultsThe number of acute myocardial infarctions and strokes during the first 10 years was lower than estimated by FINRISK score but SCORE predicted cardiovascular death correctly. During the whole follow-up period, 27 of 105 participants (25.8%) had 30 endpoint events. The incidence of the primary composite outcome was significantly lower in subjects with hs-CRP < 1.0 mg/L than in subjects with hs-CRP ≥ 1.0 mg/L (6 of 41 subjects [14.6%] vs. 21 of 64 subjects [32.8%]; p = 0.036). The incidence of the primary composite outcome was higher among subjects with large artery elasticity classified as borderline compared to subjects with normal large artery elasticity (5 of 10 subjects [50%] vs. 22 of 93 subjects [24%]; p = 0.05). There was no difference in the incidence of primary composite outcome in groups with different degrees of small artery elasticity or different level of oxLDL.ConclusionsMen with MetS who had hs-CRP ≥ 1.0 mg/L had higher risk for CVD and all-cause mortality than those with hs-CRP of < 1.0 mg/L. This also applies to subjects with borderline decreased large artery elasticity. The amount of OxLDL had no predictive value on the incidence of CVD and all-cause mortality. Men with MetS participating in the Hämeenlinna Metabolic Syndrome Research Program without lifestyle or drug intervention had better outcome for myocardial infarction or stroke than estimated by the FINRISK score.Trial registrationClinicalTrials.gov NCT01119404 retrospectively registered 07/05/2010.

Arterial Thrombotic Events in Hospitalized COVID-19 Patients: A Short Review and Meta-Analysis.

It is well established that the risk of venous thromboembolism is high in coronavirus disease 19 (COVID-19). The frequency of arterial thromboembolic events (ATEs) in hospitalized patients with COVID-19 is unclear, as is the magnitude of these events in comparison with other infections. We searched MEDLINE from February 2020 to February 2022 for prospective or retrospective cohort studies and randomized clinical trials that reported the number of acute myocardial infarction (AMI), acute ischemic stroke (AIS), acute limb ischemia (ALI), or other ATE as defined by the original authors in hospitalized patients with COVID-19. The pooled frequencies were calculated through meta-analysis using random effects model with logit transformation and presented with relative 95% prediction intervals (95% PI). We retrieved a total of 4,547 studies, 36 of which (28 retrospective cohorts, five prospective cohorts and three randomized trials) were finally included in our analysis. The resulting cohort counted 100,949 patients, 2,641 (2.6%) of whom experienced ATE. The pooled ATE frequency was 2.0% (95% PI, 0.4-9.6%). The pooled ATE frequency for AMI, AIS, ALI, and other ATE was 0.8% (95% PI, 0.1-8.1%), 0.9% (95% PI, 0.3-2.9%), 0.2% (95% PI, 0.0-4.2%), and 0.5% (95% PI, 0.1-3.0%), respectively. In comparison with the ATE incidence reported in three studies on non-COVID viral pneumonia, we did not detect a significant difference from the results in our analysis. In conclusion, we found a non-negligible proportion of ATE in patients hospitalized for COVID-19. Our results are similar to those found in hospitalized patients with influenza or with non-COVID viral pneumonia.

Hospitalization, major complications and mortality in acute myocardial infarction patients during the COVID-19 era: A systematic review and meta-analysis.

Since the SARS-CoV-2 pandemic began, numerous studies have reported a concerning drop in the number of acute myocardial infarction (AMI) admissions. In the present systematic review and meta-analysis, we aimed to compare the rate of AMI admissions and major complication during the pandemic, in comparison with pre-pandemic periods. Three major databases (PubMed, Scopus, and Web of Science Core Collection) were searched. Out of 314 articles, 41 were entered into the study. Patients hospitalized for AMI were 35% less in the COVID-19 era compared with pre-pandemic periods, which was statistically significantly (OR = 0.65; 95% CI: 0.56–0.74; I2 = 99%; p < 0.001; 28 studies). Patients hospitalized for STEMI and NSTEMI were 29% and 34% respectively less in the COVID-19 era compared with periods before COVID-19, which was statistically significantly (OR = 0.71; 95% CI: 0.65 –0.78; I2 = 93%; p < 0.001; 22 studies, OR = 0.66; 95% CI: 0.58–0.73; I2 = 95%; p < 0.001; 14 studies). The overall rate of in-hospital mortality in AMI patients increased by 26% in the COVID-19 era, which was not statistically significant (OR = 1.26; 95% CI: 1.0–1.59; I2 = 22%; p < 0.001; six studies). The rate of in-hospital mortality in STEMI and NSTEMI patients increased by 15% and 26% respectively in the COVID-19 era, which was not statistically significant (OR = 1.15; 95% CI: 0.85–1.57; I2 = 48%; p = 0.035; 11 studies, OR = 1.35; 95% CI: 0.64–2.86; I2 = 45%; p = 0.157; 3 articles). These observations highlight the challenges in the adaptation of health-care systems with the impact of the COVID-19 pandemic.

Association Between 2-Dose vs 3-Dose Hepatitis B Vaccine and Acute Myocardial Infarction

The 2-dose hepatitis B vaccine with a cytosine phosphoguanine adjuvant (HepB-CpG vaccine; Heplisav-B) generated higher seroprotection in prelicensure trials than did a 3-dose hepatitis B vaccine with an aluminum hydroxide adjuvant (HepB-alum vaccine; Engerix-B). However, in 1 trial, a higher number of acute myocardial infarction (MI) events were observed among those who received the HepB-CpG vaccine than among those who received the HepB-alum vaccine, an outcome requiring further study. To compare the rate of acute MI between recipients of HepB-CpG vaccine and HepB-alum vaccine. This prospective cohort noninferiority study was conducted at Kaiser Permanente Southern California (KPSC), an integrated health care system with 15 medical centers and approximately 4.7 million members. The study included 69 625 adults not undergoing dialysis who received at least 1 dose of a hepatitis B vaccine in either family medicine or internal medicine departments at KPSC from August 7, 2018, to October 31, 2019 (November 30, 2020, final follow-up). Receipt of HepB-CpG vaccine vs HepB-alum vaccine. The first dose during the study period was the index dose. Individuals were followed up for 13 months after the index dose for occurrence of type 1 acute MI. Potential events were identified using diagnosis codes and adjudicated by cardiologists. The adjusted hazard ratio (HR) of acute MI was estimated comparing recipients of HepB-CpG vaccine with recipients of HepB-alum vaccine, with inverse probability of treatment weighting (IPTW) to adjust for demographic and clinical characteristics. The upper limit of the 1-sided 97.5% CI was compared with a noninferiority margin of 2. Of the 31 183 recipients of HepB-CpG vaccine (median age, 49 years; IQR, 38-56 years), 51.2% (n = 15 965) were men, and 52.7% (n = 16 423) were Hispanic. Of the 38 442 recipients of HepB-alum (median age, 49 years; IQR, 39-56 years), 50.8% (19 533) were men, and 47.1% (n = 18 125) were Hispanic. Characteristics were well-balanced between vaccine groups after IPTW. Fifty-two type 1 acute MI events were confirmed among recipients of HepB-CpG vaccine for a rate of 1.67 per 1000-person-years, and 71 type 1 acute MI events were confirmed among recipients of HepB-alum vaccine for a rate of 1.86 per 1000 person-years (absolute rate difference, -0.19 [95% CI, -0.82 to 0.44]; adjusted HR, 0.92 [1-sided 97.5% CI, ∞ to 1.32], which was below the noninferiority margin; P < .001 for noninferiority). In this cohort study, receipt of HepB-CpG vaccine compared with HepB-alum vaccine did not meet the statistical criterion for increased risk of acute myocardial infarction.

When More Means Less: The Prognosis of Recurrent Acute Myocardial Infarctions.

Recurrent acute myocardial infarctions (AMI) are common and associated with dismal outcomes. We evaluated the clinical characteristics and the prognosis of AMI survivors according to the number of recurrent AMIs (ReAMI) and the time interval of events (TI). A retrospective analysis of patients who survived following hospitalization with an AMI throughout 2002–2017 was conducted. The number of ReAMIs for each patient during the study period was recorded and classified based on following: 0 (no ReAMIs), 1, 2, ≥3. Primary outcome: all-cause mortality up to 10 years post-discharge from the last AMI. A total of 12,297 patients (15,697 AMI admissions) were analyzed (age: 66.1 ± 14.1 years, 68% males). The mean number of AMIs per patient was 1.28 ± 0.7; the rates of 0, 1, 2, ≥3 ReAMIs were 81%, 13.4%, 3.6% and 1.9%, respectively. The risk of mortality increased in patients with greater number of AMIs, HR = 1.666 (95% CI: 1.603–1.720, p < 0.001) for each additional event (study group), attenuated following adjustment for potential confounders, AdjHR = 1.135 (95% CI: 1.091–1.181, p < 0.001). Increased risk of mortality was found with short TI (<6-months), AdjHR = 2.205 (95% CI: 1.418–3.429, p < 0.001). The risk of mortality following AMI increased as the number of ReAMIs increased, and the TI between the events shortened. These findings should guide improved surveillance and management of this high-risk group of patients (i.e., ReAMI).

A time-series prediction model of acute myocardial infarction in northern of Iran: the risk of climate change and religious mourning

BackgroundAlthough various studies have been conducted on the effects of seasonal climate changes or emotional variables on the risk of AMI, many of them have limitations to determine the predictable model. The currents study is conducted to assess the effects of meteorological and emotional variables on the incidence and epidemiological occurrence of acute myocardial infarction (AMI) in Sari (capital of Mazandaran, Iran) during 2011–2018.MethodsIn this study, a time series analysis was used to determine the variation of variables over time. All series were seasonally adjusted and Poisson regression analysis was performed. In the analysis of meteorological data and emotional distress due to religious mourning events, the best results were obtained by autoregressive moving average (ARMA) (5,5) model.ResultsIt was determined that average temperature, sunshine, and rain variables had a significant effect on death. A total of 2375 AMI’s were enrolled. Average temperate (°C) and sunshine hours a day (h/day) had a statistically significant relationship with the number of AMI’s (β = 0.011, P = 0.014). For every extra degree of temperature increase, the risk of AMI rose [OR = 1.011 (95%CI 1.00, 1.02)]. For every extra hour of sunshine, a day a statistically significant increase [OR = 1.02 (95% CI 1.01, 1.04)] in AMI risk occurred (β = 0.025, P = 0.001). Religious mourning events increase the risk of AMI 1.05 times more. The other independent variables have no significant effects on AMI’s (P > 0.05).ConclusionResults demonstrate that sunshine hours and the average temperature had a significant effect on the risk of AMI. Moreover, emotional distress due to religious morning events increases AMI. More specific research on this topic is recommended.

Abstract 16654: Covid - 19 - Acute Myocardial Infarction and Heart Failure Mortality Trends in a Non-epicenter Region

Introduction: As the novel coronavirus gained acceleration, there are several reports of a decreasing number of hospital admissions for acute myocardial infarctions (AMI) worldwide. It is unclear if this is due to an actual decrease in their incidence or due to patients avoiding hospital visits during the pandemic. We examined the trends in admissions for AMI, acute decompensated heart failure (HF) and their associated mortality in an integrated health system (7 hospitals) in Pittsburgh (Pennsylvania), a non-epicenter region. Hypothesis: If patients are presenting late due to avoiding hospitals, AMI and HF would be associated with increased mortality rates. Methods: We collected data on the total number of admissions and deaths related to AMI (ST and non-ST elevation), HF using ICD-10 codes, during the period of January-April 2020. We compared this with data from the same period in 2018, 2019. Mortality rate was calculated as deaths per 100 admissions. Results: There were 505 AMI admissions in January-April 2020 and 37 died compared to 23 deaths amongst 645 admissions in the same period of 2018 and 2019 (averaged). Similarly, there were 1030 HF admissions in January-April 2020 and 46 died in comparison to 39 deaths amongst 1280 admissions in 2018 and 2019 (averaged). The absolute number of AMI and HF admissions was lower in 2020 (p&lt;0.05, p&lt;0.01). There was no difference in absolute number of deaths attributed to HF or AMI between 2020 and the preceding years (p=0.3). However, mortality rate was higher for HF in 2020 compared to prior 2 years. Conclusions: In this non-epicenter region, there was a significant decrease in admissions for AMI and HF in 2020 compared to 2018-2019 while the absolute number of deaths were similar. Similar mortality rates for AMI across the years suggests that patients were presenting appropriately and that the true incidence was likely low. However, higher mortality rate with HF may suggest a delayed presentation albeit without accounting for confounders.

Time series analysis of meteorological factors and air pollutants and their association with hospital admissions for acute myocardial infarction in Korea

BackgroundWe assessed the association between multiple meteorological factors and air pollutants and the number of acute myocardial infarction (AMI) cases using a multi-step process. MethodsDaily AMI hospitalizations matched with 16 meteorological factors and air pollutants in 7 metropolitan provinces of the Republic of Korea from 2002 to 2017 were analyzed. We chose the best fit model after conducting the Granger causality (GC) test and examined the daily lag time effect on the orthogonalized impulse response functions. To define dose-response relationships, we performed a time series analysis using multiple generalized additive lag models based on seasons. ResultsA total of 196,762 cases of AMI in patients older than 20 years admitted for hospitalization were identified. The distribution of meteorological factors and air pollutants showed characteristics of a temperate climate. The GC test revealed a complex interaction between meteorological factors, including air pollutants, and AMI. The final selected factors were NO2 and temperature; these increased the incidence of AMI on lag day 4 during summer (NO2: population-attributable fraction [PAF], 3.9%; 95% confidence interval [CI], 3.6–4.0; mean temperature: PAF, 3.3%; 95% CI, 2.7–3.9). ConclusionsThis multi-step time series analysis found that average temperature and NO2 are the most important factors impacting AMI hospitalizations, specifically during summer. Based on the model, we were able to visualize the effect-time association of meteorological factors and air pollutants and AMI.

The mystery of "missing" visits in an emergency cardiology department, in the era of COVID-19.; a time-series analysis in a tertiary Greek General Hospital.

BackgroundIn the era of the current COVID-19 health crisis, the aim of the present study was to explore population behavior as regards the visits in the Εmergency Cardiology department (ECD) of a tertiary General Hospital that does not hospitalize SARS-CoV-2 infected patientsMethods and resultsDaily number of visits at the EDC and admissions to Cardiology Wards and Intensive Care Unit of a tertiary General Hospital, in Athens, Greece, were retrieved from hospital’s database (January 1st–April 30th 2018, 2019 and 2020). A highly significant reduction in the visits at ECD of the hospital during March and April 2020 was observed as compared with January and February of the same year (p for linear trend < ·001); in particular the number of visits was 41.1% lower in March 2020 and 32.7% lower in April 2020, as compared to January 2020. As the number of confirmed COVID-19 cases throughout the country increased (i.e., from February 26th to April 2nd) the number of visits at ECD decreased (p = 0.01), whereas, the opposite was observed in the period afterwards (p = 0.01).The number of acute Myocardial infarctions (MI) cases in March 2020 was the lowest compared to the entire three year period (p < 0·001); however, the number of acute MI cases in April 2020 was doubled as compared to March 2020, but still was lower than the preceding years (p < 0·001).ConclusionsIt is hard to explain the mystery of the “missing” emergency hospital visits. However, if this decline in cardiovascular disease related hospital visits is “true”, it is something that needs to be rigorously studied, to learn how to keep these rates down.

Facilitating the identification of patients hospitalized for acute myocardial infarction and heart failure and the assessment of their readmission risk through the Patient Navigator Program

Optimal transition care mitigates early hospital readmission risk. Given limited resources, hospitals need to identify patients with high readmission risk. This article examines whether a coordinated quality improvement campaign can help achieve this objective. The American College of Cardiology Patient Navigator Program, a 2-year quality improvement campaign, sought to assess the impact of transition care interventions on 30-day readmission rates for patients with acute myocardial infarction (AMI) or heart failure (HF) at 35 hospitals. This article examines the change in 2 of the 36 performance metrics the campaign tracked: the number of AMI and HF patients identified predischarge and those whose readmission risk was assessed. The number of facilities identifying AMI and HF patients predischarge increased from 24 (68.6%) and 28 (80.0%), respectively, at baseline, to 34 (97.1%) (P = .0016) and 34 (97.1%) (P = .014), respectively, at 2 years. The number of facilities assessing the readmission risk of AMI and HF patients risk increased from 9 (25.7%) and 11 (31.4%), respectively, at baseline, to 32 (91.4%) (P < .0001) and 33 (94.5%) (P < .0001), respectively, at 2 years. Importantly, baseline reporting of performance for both metrics was poor, with >25% of the hospitals missing data. Implementation of a coordinated quality improvement campaign may increase the number of facilities identifying AMI and HF patients predischarge and assessing their readmission risk. Further research is needed to determine if increased identification reduces 30-day readmission or facilitates improvement in other important clinical outcomes.

Assessment of serum cardiac troponin-I over serum CPK-MB in early diagnosis of acute myocardial infarction (AMI)

Background: The early mortality rate from AMI is 30% with about half of them occurring within 1hour of disability. Although the mortality rate after admission for AMI has declined by 30% over the past decades, approximately 1 of every 25 patients who survive the initial hospitalization die in the first year after AMI. The gold standard for diagnosis of MI has been an elevated serum level of creatinine kinase – myocardial band (CK- MB), the cardiac-specific isoenzyme of CK. However, elevated CK-MB may not detect all myocardial necrosis. In patients who die suddenly after severe or silent episodes of ischemia, autopsies frequently reveal micronecrosis that was not reflected in routine CK-MB measurements. The present study was undertaken to know that serum Cardiac Troponin-I is more sensitive marker than serum CPK-MB in early diagnosis of acute myocardial infarction (AMI).Methods: The study was carried out in tertiary care hospital in Gulbarga. The study was undertaken with an aim to study that serum cardiac troponin-I (cTnl) is more sensitive than serum CK-MB in early diagnosis of acute myocardial infarction (AMI). The study was conducted on patients admitted with history of chest pain suggestive of AMI as diagnosed by WHO criteria to medicine ward of Basaveshwar Teaching and General Hospital, Gulbarga. The period of study was from June 2012 to June 2014. The sample size included 100 patients with history of chest pain suggestive of AMI, selected by simple random method.Results: Our results revealed that cardiac troponin I was more sensitive (62%) than CK-MB in overall cases admitted in between 6-24 hrs from the onset of chest pain. Maximum number (41%) of AMI patients were affected on the anterior wall followed by Inferior wall of AMI. 11 percent were affected with Antero lateral wall wereas 5 to 6 percent were affected with anteroseptal and global acute and right ventricular AMI was seen among 2 percent of patients. Anterior wall AMI was the significantly affected site with AMI (ʎ2:12.5, P:0.0004). The maximum number of acute myocardial infarctions were ST elevation myocardial infarctions. 28% of cases where CKMB is normal, the cTnI detects the AMI cases indicating its sensitivity.Conclusions: Cardiac troponin-I (cTnI) was more sensitive serum marker than CKMB in the early diagnosis of acute myocardial infarction (AMI). Anterior wall was the most significantly affected site of AMI. In the future, further improvements in analytical performance may open additional diagnostic windows.

Projected Real-World Effectiveness of Using Aggressive Low-Density Lipoprotein Cholesterol Targets Among Elderly Statin Users Following Acute Coronary Syndromes in Canada.

BackgroundThe extent to which outcome benefits may be achieved through the implementation of aggressive low‐density lipoprotein (LDL) cholesterol targets in real world settings remains unknown, especially among elderly statin users following acute coronary syndromes.Methods and ResultsA population‐based cohort study consisting of 19 544 post‐acute coronary syndrome statin‐users aged ≥66 years between January 1, 2017 and March 31, 2014 was used to project the number of adverse outcome events (acute myocardial infarction or death from any cause) that could be prevented if all post‐acute coronary syndrome elderly statin users were treated to 1 of 2 LDL cholesterol target levels (≤50 and ≤70 mg/dL). The number of preventable adverse outcomes was estimated by using model‐based expected event probabilities as derived from Cox Proportional hazards models. In total, 61.6% and 25.5% of the elderly patients met LDL cholesterol targets of ≤70 and ≤50 mg/dL, respectively, based on current management. No more than 2.3 adverse events per 1000 elderly statin users (95% confidence interval: −0.7 to 5.4, P=0.62) could be prevented over 8.1 years if all patients were to be treated from current LDL cholesterol levels to either of the 2 LDL cholesterol targets of 70 or 50 mg/dL.ConclusionsThe number of acute myocardial infarctions or death that could be prevented through the implementation of LDL cholesterol targets with statins is negligible among an elderly post‐acute coronary syndrome population. Such findings may have implications for the applicability of newer agents, such as proprotein convertase subtilisin/kexin type‐9‐ inhibitors.

Correlation between Changes in Local Earth's Magnetic Field and Cases of Acute Myocardial Infarction.

The impact of changes in the geomagnetic field on the human body remains the subject of studies across the world, yet there is no consensus. Current studies are observing effects that require further work by researchers in order to find out the mechanisms that would allow a proper assessment of the correlations between the Earth‘s magnetic field variations and changes in human organisms. The main purpose of this study was to investigate possible correlations between the strength of time-varying aspects of the local Earth’s magnetic field and incidence of myocardial infarctions. Study participants included 435 males and 268 females who had diagnosis of myocardial infarction during the period of 1 January 2016 to 31 December 2016 and attended the Department of Cardiology at the Hospital of Lithuanian University of Health Sciences (LUHS), Kauno klinikos. Time varying magnetic field data was collected at the magnetometer site located in Lithuania. After mathematical analysis, the results support the hypothesis that the Earth’s magnetic field has a relationship between the number of acute myocardial infarction with ST segment elevation (STEMI) cases per week and the average weekly geomagnetic field strength in different frequency ranges. Correlations varied in different age groups as well as in males and females, which may indicate diverse organism sensitivity to the Earth’s magnetic field.

The effects of air pollution and weather conditions on the incidence of acute myocardial infarction

ObjectiveIn this retrospective study, we investigated the association between air pollution and weather conditions with the incidence of acute myocardial infarction (AMI) in the city of Kutahya. MethodsA total of 402 patients who were admitted with acute ST segment elevation MI and non–ST segment elevation MI were included in the study in 1 year. Daily maximum, minimum, and mean ambient temperature and mean barometric pressure data were obtained from the Kutahya Meteorology Department. Daily air pollution data were obtained from the Web site of National Air Quality Observation Network (http://www.havaizleme.gov.tr). ResultsIncrease in ambient air temperature in the day of MI and 2days before the day of MI according to their control days was correlated with increase in number of MI cases. When we grouped the patients according to ages as 30-54, 55-65, and >65years, we found that there was a relation between sulfur dioxide (SO2) and the occurrence of AMI for the age group of 30-54 for the same day (D0) (P<.017). The number of AMIs was the lowest in fall season, whereas the number of AMIs was the highest in winter season. ConclusionThere was no statistically significant association between the particulates with diameter b=10μm, SO2 concentrations, air pressure, and the risk of AMI, but there was statistically significant relation between occurrence of MI and SO2 for the patients under age of 55 years. The number of AMIs was the lowest in fall season, whereas the number of AMIs was the highest in winter season.

Abstract 56: Prognosis of Patients with Acute Myocardial Infarction by Hospital Discharge Diagnosis

Background: Research on acute myocardial infarction (AMI) in medical claims largely focuses on hospitalizations where AMI is the primary discharge diagnosis (dx). Limited data are available on AMIs occurring as a secondary dx during hospitalization. Hypothesis: We hypothesized that mortality following AMI is higher when the primary dx is not AMI. Methods: We examined REasons for Geographic And Racial Differences in Stroke (REGARDS) study participants with definite or probable AMIs adjudicated using published guidelines. Participants were categorized by hospital discharge dx from the discharge summary: primary dx, secondary dx, or no dx of AMI. All-cause and cardiovascular mortality after AMI, detected though active follow-up and the National Death Index, were compared using Kaplan-Meier curves with log-rank tests and Cox proportional hazard models adjusted for sociodemographics, medical history, and characteristics of the AMI (clinical evidence of ischemia, peak troponin, and heart failure during hospitalization). Results: Of 877 participants with AMI, 37% had AMI as primary dx, 12% had AMI as a secondary dx, and 51% had no dx of AMI. All-cause mortality (n = 284) was higher among participants with AMI as a secondary dx or without a dx of AMI than among participants with AMI as primary dx, but cardiovascular mortality (n = 150) was similar across groups ( Figure ). Compared to participants with AMI as primary dx, adjusted hazard ratios for all-cause mortality were 1.03 (95% CI 0.68-1.57) and 1.17 (95% CI 0.84-1.62) and for cardiovascular mortality were 0.79 (95% CI 0.46-1.37) and 0.91 (95% CI 0.60-1.38) for participants with AMI as a secondary dx and without a dx of AMI, respectively. Conclusions: Studies of AMI based on primary discharge dx likely under count the number of AMIs and exclude a population with similar prognosis in terms of all-cause and CVD mortality, once clinical differences considered. Further study into the characteristics, in-hospital and post-discharge management of these patients may be warranted.

Days of “Zero” level geomagnetic activity accompanied by the high neutron activity and dynamics of some medical events—Antipodes to geomagnetic storms

The links of many medical-biological events with high levels of geomagnetic activity (GMA) are widely discussed. In recent years, several medical phenomena were described in inverse distribution by time with GMA. Also a concurrent to GMA and solar activity force-cosmic ray activity (CRA) and closely related high energy neutron and proton fluxes are studied as a forces dominating at low GMA and solar activity in relation to considered medical events. The aim of this study was to explore the distribution of some important medical events on days with “Zero” GMA levels, accompanied by high CRA (neutron activity). Medical event data of the Grand Baku region (more than 3 mln inhabitants), Azerbaijan, with daily distribution on the time 1 Dec. 2002-31 Dec. 2007 was compared to daily GMA Kp indices in general (Kp > 0, 1837 days) and 34 days daily GMA indices Kp = 0. Daily CRA data was also compared using neutron monitoring data from two stations. Daily averaged data and their standard deviations on the mentioned GMA levels were compared and statistical significance was established. Results revealed a significant rise in the number of emergencies (n = 1,567,576) and total deaths number (n = 46,360) at the days of “Zero” GMA level. These days were accompanied by significant rise of CRA (neutron activity). For Sudden Cardiac Deaths (SCD, n = 1615) and cerebral stroke (CVA, n =10,054) the increase achieved strong trend to significance level. Acute Myocardial Infarction occurrence (morbidity) and trauma were also absolutely more registered at days with “Zero” GMA level, despite the small number of such days. The average Infection numbers show an inverse relationship with absolutely high registry at the “Zero” GMA level days. Study linking environmental physical activity levels and the human medical data shows that geomagnetic field variations accompanied by the increased level of cosmic ray activity, can have either direct or indirect adverse effects on human health and physiology, even when the magnitude of the geomagnetic field disturbance is extremely small or even is equal to zero. On days of “Zero” daily Kp indices describing Geomagnetic Activity, accompanied by high Cosmic Ray Activity (neutron activity), more medical emergencies and total death number (daily) occurred. Sudden Cardiac Deaths and Cerebral Stroke numbers show a strong trend to significant rise. Absolute increase of number of Acute Myocardial Infarction and less Infections, not achieving statistical significance, was also observed. These results are additional data for considering Cosmic Ray Activity (neutron activity) as an additional factor involved in time distribution of human medical events.

Abstract P84: The Impact of a Potential Nationwide Comprehensive Smoking Ban on Acute Myocardial Infarction Hospitalizations

Introduction: Smoking is a well established risk factor for acute myocardial infarction (AMI). The potential impact of a nationwide comprehensive smoking ban (CSB) legislation on the incidence of AMI hospital admissions is not known. The aim of this analysis is to determine the impact of a nationwide CSB legislation on the incidence of AMI hospitalizations. Methods: We contacted the department of health at states with no CSB law for information on the total number of AMI discharges (ICD-9-CM 410), length of stay and charges in dollars for 2007. Expected decrease in the number of AMI in the year following a potential implementation of a nationwide CSB was calculated by multiplying the current number of AMI by the pooled relative risk reduction (RRR) obtained from a recent published meta analysis (RR 0.89). Results: In 2007, 37 States had CSB laws. There were 169,043 AMI hospitalizations in states without CSB. A nationwide smoking ban would result in 18,596 less AMI hospitalizations in the year following such a ban. This is associated with more than 92 million dollars in direct cost savings. Conclusion: A nationwide CSB legislation would result in significant reduction in the number of AMI hospitalizations. This is associated with significant cost saving. Further studies are needed to evaluate the impact of CSB on admission from other disease states.

The Impact of Ambulance Diversion on Heart Attack Deaths

Hospital ambulance diversions are prevalent and increasing nationwide as emergency departments experience growing congestion. Using negative binomial regressions, this paper links the number of acute myocardial infarction (AMI) deaths to the level and extent of diversion in the five boroughs of New York City. The results indicate that both high levels of ambulance diversion and simultaneous diversion across hospitals are associated with increasing numbers of deaths from AMI.

First responder resuscitation teams in a rural Norwegian community: sustainability and self-reports of meaningfulness, stress and mastering

BackgroundTraining of lay first responder personnel situated closer to the potential victims than medical professionals is a strategy potentially capable of shortening the interval between collapse and start of cardiopulmonary resuscitation (CPR) in cases of out-of-hospital cardiac arrest. In this study we trained lay first responders personnel in basic life support (BLS) and defibrillation for cases of cardiac arrest and suspected acute myocardial infarction (AMI).MethodsForty-two lay first responders living in remote areas or working in industries in the island community of Austevoll, Western Norway, were trained in CPR and defibrillation. We placed particular emphasis on the first responders being able to defibrillate a primary ventricular fibrillation (PVF) in patients with AMI. The trainees were organised in four teams to attend victims of AMI and cardiac arrest while awaiting the arrival of the community emergency medical services. The purpose of the study was to find out whether the teams were able to function during the five-year study project, and to examine whether lives could be saved. The first responders completed questionnaires each year on their experiences of participation. Data on the medical actions of the teams were also collected.ResultsBy the end of the project all groups were functioning. The questionnaires evidenced a reasonable degree of motivation and self-evaluated competence in both types of group organisation, but in spite of this attrition effects in the first responders were considerable. The first responders were called out on 24 occasions, for a total of 17 patients. During the study period no case of PVF occurred after the arrival of the first responders, and the number of AMIs was very low, strongly deviating from what was anticipated. No lives were saved by the project.ConclusionsThe teams were sustained for almost five years without any significant deterioration of self-reported stress or mastering, but still showed attrition effects. Evaluated as a medical project the intervention was not successful, but the small scale prevents us from drawing firm conclusions on this aspect.

20‐year trends in clinical characteristics, therapy and short‐term prognosis in acute myocardial infarction according to presenting electrocardiogram: the MONICA / KORA AMI Registry (1985–2004)

To examine the extent to which evidence-based beneficial therapy is applied in practice, whether this is changing over time and is associated with improved outcomes. Randomized trials have proved efficacy of several treatments for acute myocardial infarction (AMI) with ST-elevation (STEMI), non-ST-elevation (NSTEMI) and bundle branch block (BBB). We prospectively examined all 6748 consecutive patients with AMI aged 25-74 years hospitalized in the study region's major clinic stratified into four time-periods: 1985-1989 (n = 1622), 1990-1994 (n = 1588), 1995-1999 (n = 1450) and 2000-2004 (n = 2088). The increase in numbers of AMI in the last period was mainly, but not exclusively driven by NSTEMI cases. Evidence-based pharmacological therapy increased steeply over time. Invasive procedures increased mainly in the last period with percutaneous coronary intervention and coronary artery bypass graft performed in 30% and 15% in 1998 and 66.0% and 22%, respectively, in 2004. In-hospital complications and 28-day-case fatality decreased significantly from period 1 to period 4 in all patients with AMI. Marked reductions in 28-day-case fatality were mostly seen in BBB patients during the last period (25.3% vs. 10.3%, P < 0.001). Of interest, the odds in 28-day-case fatality reduction was diminished after correction for recanalization therapy (from 0.35, 95% CI: 0.16-0.74 to 0.52, 95% CI: 0.19-1.45). Over the past 20 years, there were substantial changes in pharmacological and interventional therapies in AMI accompanied by reductions in in-hospital complications and 28-day-case fatality in all infarction types with marked reductions in 28-day-case fatality in BBB patients. The latter observation may mainly be because of the increased use of interventional therapy.