Number Of Myocardial Infarctions Research Articles

Protocol for a randomized controlled trial of intensive blood pressure control on cardiovascular risk reduction in patients with atrial fibrillation: Rationale and design of the CRAFT trial

BackgroundCo-morbid hypertension is strong predictor of adverse cardiovascular (CV) outcomes in patients with atrial fibrillation (AF) but the optimal target for blood pressure (BP) control in this patient population has not been clearly defined. MethodsThe Cardiovascular Risk reduction in patients with Atrial Fibrillation Trial (CRAFT) is an investigator-initiated and conducted, international, multicenter, open-label, parallel-group, blinded outcome assessed, randomized controlled trial of intensive BP control in patients with AF. The aim is to determine whether intensive BP control (target home systolic blood pressure [SBP] <120 mmHg) is superior to standard BP control (home SBP <135 mmHg) on the hierarchical composite outcome of time to CV death, number of stroke events, time to the first stroke, number of myocardial infarction (MI) events, time to the first MI, number of heart failure hospitalization (HFH) events, and time to the first HFH. A sample size of 1,675 patients is estimated to provide 80% power to detect a win-ratio of 1.50 for intensive versus standard BP control on the primary composite outcome. Study visits are conducted at 1, 2, 3, and 6 months postrandomization, and every 6 months thereafter during the study. ConclusionsThis clinical trial aims to provide reliable evidence of the effects of intensive BP control in patients with AF. Trial registrationThe trial is registered at ClinicalTrials.gov (NCT04347330)

Impact of Smoking Reduction Scenarios on the Burden of Myocardial Infarction in the French Population Until 2035.

Myocardial infarction (MI) is a cardiovascular disease caused by necrosis of the myocardium, which places a heavy burden on patients. In France, the proportion of daily smokers remains high, reaching at 25.5% in 2020. We evaluated the impact of smoking reduction scenarios on the projection of MI prevalence, mean age of incident cases and number of MI prevented cases until 2035. The French government has introduced smoking cessation policies that have led to an annual decrease in smoking prevalence. Based on this annual decline, we implemented three scenarios (SC) simulating an annual decrease in the proportion of smokers aged over 35 (SC1: 1%, ie, natural evolution without intervention, SC2: 2%, SC3: 9.87%) and a fourth scenario (SC4) in which there is a complete discontinuation of smoking from 2024 onwards using MI hospitalization and demographic data, estimations for the proportion of daily smokers between 35 and 95 years and multi-state models. Between 2023 and 2035, MI prevalence increased from 3.18% to 4.23% in males and from 1.00% to 1.46% in females under SC1. MI prevalence was equal to 4.21%, 4.06%, and 3.82% in males and 1.45%, 1.40%, and 1.34% in females in 2035 according to SC2, SC3, and SC4, respectively. Compared with SC1, 0.68% MI cases would be prevented with SC2, 4.52% with SC3 and 10.34% with SC4, with almost half of cases being prevented before 65 years of age. The increase in the mean age of MI incident cases ranged from 3 to 4 years among males and from 1 to 2 years among females. While reducing tobacco use could substantially reduce the number of MI cases prevented, its prevalence would continue to increase due to the ageing population. An integrated prevention strategy that includes the leading cardiovascular risk factors should more efficiently reduce the future burden of MI.

#2766 Impact of CKD screening in high-risk populations and guideline-directed therapy on CV event occurrence and costs in Europe: an IMPACT CKD analysis

Abstract Background and Aims Chronic kidney disease (CKD) is a growing health problem in Europe exacerbated by aging and the rise of comorbidities such as diabetes mellitus (DM) and hypertension (HTN). Patients with CKD are often multi-morbid and commonly present with cardiovascular (CV) complications. While CV events including myocardial infarction (MI), stroke, and hospitalization for heart failure (HHF) occur more often in patients with advanced CKD, patients with early-stage CKD are also at increased risk. Patients with CKD also experience an increased risk of CV-related mortality, with many patients dying from CV events prior to kidney failure and renal replacement therapy. CV events also present a significant burden to clinicians and healthcare systems due to the high costs and resource use required to manage and treat them. Despite this multidimensional burden, CKD is currently underdiagnosed in Europe, and CKD screening and treatment are rarely included in public health strategies to improve mortality and health outcomes. This study aims to explore the impact of targeted CKD screening followed by guideline-directed therapy in high-risk populations on CV event occurrence and associated treatment costs across Europe. Method The IMPACT CKD microsimulation model simulates CKD progression, CV events, and comorbidities. CKD status is assigned based on estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio levels (UACR), and CKD progression is predicted by an annual eGFR decline rate. The model was used to compare two scenarios in four country populations (Germany, Netherlands, Spain, United Kingdom [UK]): 1) targeted screening for people with DM and/or HTN followed by optimal compliance to guideline-directed therapy and 2) current practice (no screening, underdiagnosis, low treatment rates). Annual targeted screening assumed both eGFR and UACR testing. Treatment initiation for people diagnosed with CKD was based on Kidney Disease Improving Global Outcomes guidelines with a 90% compliance assumed to approximate maximum clinical benefit. Therapies were assumed to have a multiplicative treatment effect on eGFR decline and CV events. Current practice assumed observed diagnosis rates without screening and observed treatment rates in each country. For both scenarios, the model projected incidence of CV events and associated management costs in year 10 (2032) and cumulatively over the 10 simulated years (2023-2032). Results Results compare the targeted screening followed by guideline-directed treatment scenario to continuation of current practices for Germany, Netherlands, Spain, and UK (Table 1). The timely diagnosis of patients with CKD and effective treatment was associated with a reduction of 46.7-53.3%, 38.9-41.6%, and 42.1-50.5% in the number of MI, stroke, and HHF events, respectively in 2032 across the four countries. These decreases in the number of CV events were accompanied by proportional reductions in costs to treat the events. Additionally, this policy approach resulted in declines in the cumulative 10-year CV event development and associated healthcare costs, with MI having the largest reductions (40.6-47.2%), followed by HHF (37.4-43.0%), and stroke (29.8-36.1%) across the four countries. Conclusion This study illustrated that early identification of high-risk patients with CKD coupled with guideline-directed treatment would yield substantial clinical and economic benefits from reducing CV events across all four European countries. Fewer MI, stroke, and HHF events were projected in patients with CKD in both 2032 and cumulatively from 2023 to 2032 due to delayed disease progression following effective interventions. Driven by the reduced clinical burden, lower healthcare costs for CV event management were also predicted. These findings support the need for the adoption of policies for early diagnosis and treatment of CKD to slow disease progression and mitigate the growing CV disease burden among patients with CKD and for health systems. Future studies should explore the costs associated with targeted CKD screening and the guideline-directed pharmacological therapies for CKD.

Myocardial infarction in young patients. Is everything so obvious?

The review is devoted to the analysis of literature data on the features of the course, diagnosis and treatment of myocardial infarction at a young age. Despite the relevance of the problem of myocardial infarction in young people, there is no specific approach to the management and examination of such patients in current clinical guidelines. Literature search was carried out in the following databases: PubMed, Google Scholar, Web of Science from 1990 to 2023 for all studies with the keywords “myocardial infarction and young age”, “atherosclerosis and young age”, “atherothrombosis and young age”. An analysis of all available clinical recommendations of leading specialized societies in the field of cardiology, hematology, and angiology was also carried out. The presented review is not systematic view of the specifics of the subject, its breadth, as well as the task set – to expand the clinical thinking of the doctor. It is undeniable that primary prevention of myocardial infarction is more effective. Given the annual increase in the number of myocardial infarctions at a young age, it is necessary to create a special tool for risk stratification in young patients, since there is no such tool in the clinical guidelines. Despite the greater contribution of non-atherogenic causes to the development of myocardial infarction in young patients, atherosclerosis is still the main cause of its development. The authors of the review confirm the fact that there is currently no specially developed algorithm for managing patients with myocardial infarction at a young age, based on the identification of a number of traditional and non-traditional risk factors, on enhanced rehabilitation measures. All these positions are currently formulated in the aims and objectives of a special sevenyear study of myocardial infarction in young patients planned at our institute.

Real world prognostic impact and predictors of adherence to statin therapy after STEMI on first year follow up: results from the FAST STEMI registry

Abstract Background The impact of statin therapy on cardiovascular outcomes after ST-elevation acute myocardial infarction (STEMI) in real-world patients is understudied. Purpose The aim of this study was to identify predictors of low compliance to statin therapy and estimate its impact on cardiovascular (CV) outcomes and mortality in the first year after the index event. Methods We evaluated real-world adherence to the most common cardiovascular drugs by comparing the number of bought tablets in drugstores to the expected tablets at 1 year and on total follow-up length. A total amount of 6043 patients from 2012 to 2017 was enrolled in the FAST STEMI registry and followed up for 4,7±1,6 years; 299 patients with intraprocedural and intrahospital deaths were excluded. The main outcomes evaluated were all-cause death, cardiovascular death, myocardial infarction, major and minor bleeding events and ischemic stroke. The best compliance cut-off was found by ROC curve analysis with Youden index; Kaplan Meier and Cox proportional hazard models were performed to evaluate cumulative event rates of cardiovascular mortality at follow-up. Predictors of lower adherence were evaluated at univariate and multivariate analysis with logistic regression. Results From a total of 5744 patients 4333 were men (75,4%) with an average age of 64,7±12,5 years old; 699 (2,2%) were diabetic, 311 (5,4%) presented with severe chronic kidney disease (CKD) while 237 (4,1%) had previous ischemic cardiopathy disease. Mean statin adherence was 89,9% (IQR 41,1 – 100): after univariate and multivariate analysis age≥75 (OR 0.597, IC 0.514-0.692), previous ischemic stroke (OR 0.607, IC 0.416-0.886), known ischemic cardiopathy (OR 0.675, IC 0.503-0.904) and chronic kidney disease (OR 0.667, IC 0.552-0.879) resulted as predictors of lower compliance, whereas preserved ejection fraction (OR 1.282, IC 1.133-1.457) resulted predictor of adequate adherence to statin therapy. Statin adherence upper than 49.05% (identified at Youden’s analysis as best cut-off) reduced both cardiovascular (0,3% vs. 6,8%; HR 0.33; 95%CI 0.18-0.59; p = 0,001) and all-cause mortality (0,7% vs 18,1%, HR 0,22, 95%CI 0.15-0.37, p&amp;lt;0.001). Regarding cardiovascular outcomes, statin optimal adherence reduced ischemic stroke incidence (1% vs 2,5%, p=0.001) while there was no difference on the number of myocardial infarctions nor hemorrhagic events at 1-year follow up. Conclusions In the real-world setting, statin adherence after STEMI was independently associated to a reduction of cardiovascular mortality, all-cause mortality and ischemic stroke incidence at 1-year follow-up. Elderly age, previous ischemic stroke, known ischemic cardiopathy and CKD resulted as independent predictors of lower compliance to statin therapy.CV and all-cause mortalityCox regression on CV mortality at 1-year

Sex differences in potential triggers of myocardial infarction.

Internal and external triggers affect seasonal and circadian variations of myocardial infarction (MI). We aimed to assess sex differences in the common triggers of MI. A nationwide, retrospective, cross-sectional postal survey study was conducted. Individuals who experienced a MI during holidays and weekdays were identified through the SWEDEHEART registry. Twenty-seven potential MI triggers were rated in regards to occurring more or less than usual during the last 24 h before the MI. Three areas were covered: activities, emotions, and food or alcohol consumption. A logistic regression model was used to identify sex differences for each trigger and odds ratios (ORs) were reported. Four hundred and fifty-one patients, of whom 317 were men, responded. The most commonly reported triggers were stress (35.3%), worry (26.2%), depression (21.1%), and insomnia (20.0%). Women reported emotional triggers including sadness [OR 3.52, 95% confidence interval (CI) 1.92-6.45], stress (OR 2.38, 95% CI 1.52-3.71), insomnia (OR 2.31, 95% CI 1.39-3.81), and upset (OR 2.69, 95% CI 1.47-4.95) to a greater extent than men. Outdoor activity was less reported by women (OR 0.35, 95% CI 0.14-0.87). No significant sex differences were found in other activities or food and alcohol consumption. Self-experienced stress and distress were higher among women prior to MI compared with men. Understanding sex perspectives in acute triggers may help us find preventive strategies and reduce the excess numbers of MI.

IBCOx-15 Bariatric surgery in patients with BMI greater than 70: analysis of the ACSNSQIP database

Abstract Background Bariatric surgery offers patients short- and long-term benefits to their health and quality of life. Currently, we see more patients with superior body mass index (BMI) looking for these benefits. Evidence-based medicine is integral in the evaluation of risks versus benefit; however, data are lacking in this high-risk population. Objectives To assess the morbidity and mortality of patients with BMI 70 undergoing bariatric surgery. Setting University Hospital, Bronx, New York, USA using national database. Methods Using the American College of Surgeons-National Surgical Quality Improvement Project (ACS-NSQIP) database for years 2005 to 2016, we identified patients who underwent primary laparoscopic sleeve gastrectomy or laparoscopic Roux-en-Y gastric bypass. Patients with BMI ≥70 were assigned to the BMI ≥ 70 (BMI70+) cohort and less obese patients were assigned to the BMI &amp;lt; 70 (U70) cohort. Length of stay and 30-day morbidity and mortality were compared. Results A total of 163,413 patients underwent non-revisional bariatric surgery. Of those, 2322 had a BMI ≥ 70. BMI70+ was associated with increased mortality (0.4% versus 0.1%, P 5.0001), deep vein thrombosis (0.6% versus 0.3%, P 5.007), pulmonary (1.9% versus 0.5%, P 5.0001), renal (0.9% versus 0.2%, P 5.0001), and infectious complications (1.1% versus .4%, P 5 .0001). BMI 70+ patients had longer mean length of stay (2.6 versus 2.1 d, P 5.0001) and operative time (126.1 versus 114.5 min, P 5.0001). There was no statistically significant difference in the number of myocardial infarctions (0.1% versus 0.1%, P 5.319), pulmonary embolisms (0.3% versus 0.2%, P 5.596), and transfusion requirements (0.1% versus 0.1%, P 5.105) between groups. Conclusions Evaluation of risk and benefit is performed on a case-by-case basis, but evidence-based medicine is critical in empowering surgeons and patients to make informed decisions. The overall rate of morbidity and mortality for BMI 701+ patients undergoing bariatric surgery was increased over U70 patients but was still relatively low. Our study will allow surgeons to incorporate objective data into their assessment of risk for super-obese patients pursuing bariatric surgery.

Machine learning models to predict myocardial infarctions from past climatic and environmental conditions

Abstract. Myocardial infarctions (MIs) are a major cause of death worldwide, and both high and low temperatures (i.e. heat and cold) may increase the risk of MI. The relationship between health impacts and climate is complex and influenced by a multitude of climatic, environmental, socio-demographic and behavioural factors. Here, we present a machine learning (ML) approach for predicting MI events based on multiple environmental and demographic variables. We derived data on MI events from the KORA MI registry dataset for Augsburg, Germany, between 1998 and 2015. Multivariable predictors include weather and climate, air pollution (PM10, NO, NO2, SO2 and O3), surrounding vegetation and demographic data. We tested the following ML regression algorithms: decision tree, random forest, multi-layer perceptron, gradient boosting and ridge regression. The models are able to predict the total annual number of MIs reasonably well (adjusted R2=0.62–0.71). Inter-annual variations and long-term trends are captured. Across models the most important predictors are air pollution and daily temperatures. Variables not related to environmental conditions, such as demographics need to be considered as well. This ML approach provides a promising basis to model future MI under changing environmental conditions, as projected by scenarios for climate and other environmental changes.

Medical and cardio-vascular emergency department visits during the COVID-19 pandemic in 2020: is there a collateral damage? A retrospective routine data analysis

BackgroundIn this retrospective routine data analysis, we investigate the number of emergency department (ED) consultations during the COVID-19 pandemic of 2020 in Germany compared to the previous year with a special focus on numbers of myocardial infarction and acute heart failure.MethodsAggregated case numbers for the two consecutive years 2019 and 2020 were obtained from 24 university hospitals and 9 non-university hospitals in Germany and assessed by age, gender, triage scores, disposition, care level and by ICD-10 codes including the tracer diagnoses myocardial infarction (I21) and heart failure (I50).ResultsA total of 2,216,627 ED consultations were analyzed, of which 1,178,470 occurred in 2019 and 1,038,157 in 2020. The median deviation in case numbers between 2019 and 2020 was − 14% [CI (− 11)–(− 16)]. After a marked drop in all cases in the first COVID-19 wave in spring 2020, case numbers normalized during the summer. Thereafter starting in calendar week 39 case numbers constantly declined until the end of the year 2020. The decline in case numbers predominantly concerned younger [− 16%; CI (− 13)–(− 19)], less urgent [− 18%; CI (− 12)–(− 22)] and non-admitted cases [− 17%; CI (− 13)–(− 20)] in particular during the second wave. During the entire observation period admissions for chest pain [− 13%; CI (− 21)–2], myocardial infarction [− 2%; CI (− 9)–11] and heart failure [− 2%; CI (− 10)–6] were less affected and remained comparable to the previous year.ConclusionsED visits were noticeably reduced during both SARS-CoV-2 pandemic waves in Germany but cardiovascular diagnoses were less affected and no refractory increase was noted. However, long-term effects cannot be ruled out and need to be analysed in future studies.Graphical abstract

Raised Glycated Hemoglobin (HbA1c) Level as a Risk Factor for Myocardial Infarction in Diabetic Patients: A Hospital-Based, Cross-Sectional Study in Peshawar

BackgroundDiabetes is a rapidly rising chronic illness in developing countries. The main objective of this research is to compare the frequency of myocardial infarction (MI) in controlled and uncontrolled diabetics in Pakistan, especially in the underprivileged district of Peshawar, and to determine raised blood glucose as a risk factor for MI.MethodologyThis cross-sectional study involving 237 diabetic patients aged 30-80 years was conducted in three major tertiary care hospitals in Peshawar, Pakistan. The inclusion criteria were diabetic patients with glycated hemoglobin (HbA1C) levels of less than 7% considered to be “controlled diabetics” and above 7% considered to be “uncontrolled diabetics.” Data were collected using structured questionnaires, past medical records, and patient history and were analyzed using SPSS software (IBM Corp., Armonk, NY, USA). The study was concluded in March 2022.ResultsThe highest number of MIs occurred in diabetics with HbA1c levels of 8-9% (47.9% of all MIs). There was a significant association between increasing HbA1c levels and the incidence of MI (p = 0.002). The adjusted prevalence odds ratio for MI in uncontrolled diabetics was 6.105 (95% confidence interval = 2.42-15.43), that is, six times increased incidence of MI in patients with HbA1c of more than 7%. Furthermore, with a 1% increase in HbA1c, there was a 10% increase in the proportion of MIs.ConclusionsFrom this study, it is clear that HbA1c levels of 8-9% were most significantly associated with the risk of MI in uncontrolled diabetics, and with rising levels of HbA1c, the risk of MI increased significantly. Thus, this study highlights the importance of HbA1c control in diabetic patients to prevent a heart attack.

ЧАСТОТА ИШЕМИЧЕСКОЙ БОЛЕЗНИ СЕРДЦА НА ФОНЕ РЕЗИСТЕНТНОЙ АРТЕРИАЛЬНОЙ ГИПЕРТОНИИ У ПАЦИЕНТОВ МОЛОДОГО И СРЕДНЕГО ВОЗРАСТОВ

Objective: To establish the frequency of different forms of coronary artery disease (CAD) in patients with resistant arterial hypertension (AH). Methods: Based on the data from clinical and anamnestic studies and the results of electrocardiography (ECG), Holter ECG monitoring (HM-ECG), and bicycle ergometry (VEM), 370 young and middle-aged patients (WHO, 1965), the mean age 54.1±4, with primary AH were diagnosed with CAD according to the Canadian classification (World Health Organization (WHO), 1979; with additions by All-Union Cardiology Research Centre, 1995). With daily monitoring of blood pressure (BP) against the background of antihypertensive therapy (AHT), groups of patients with controlled (CAH; n=84) and resistant (RAH; n=286) arterial hypertension were identified. Results: It was found that in young and middle-aged patients with both CAH and RAH, the frequency of stable angina pectoris (SA) was the highest, mainly due to functional classes (FC) I-II; severe functional classes of SA, and unstable angina (UA) were markedly less frequent; less than a quarter of patients had a myocardial infarction (MI), mainly due to non-Q-wave MI (non-Q-MI). In patients with CAH and RAH FC I-II of SA were predominant (in 70.2% of patients with CAH and 34.3% with RAH; p=0.0001), while FC III-IV of SA were mainly observed against the background of RAH (21% vs. 5% in patients with CAH, p=0.0015). In patients of young and middle age, against the background of RAH, the frequency of UA (18.9%; p=0.0220) and the total number of MI (25.9%; p=0.0482) was higher, than in CAH, mainly due to Q-MI (11.2%; p=0.0360), indicating the severity of coronary insufficiency. The increase in non-Q-MI against the background of RAH was statistically insignificant (p=0.5191). Conclusion: The ratio of the frequency of different forms of CAD against the background of CAH and RAH was unidirectional. However, the overall frequency of severe forms of CAD (UA and MI, especially Q-MI) in patients with RAH significantly exceeded those in patients with CAH, which allowed us to consider RAH as a factor in the progressive course of CAD. Keywords: Coronary artery disease, stable angina, unstable angina, myocardial infarction, resistant arterial hypertension, young and middle age.

Developing a prioritisation framework for patients in need of coronary artery angiography

BackgroundEffective waiting list management and comprehensive prioritisation can provide timely delivery of appropriate services to ensure that the patient needs are met and increase equity in the provision of health services. We developed a prioritisation framework for patients in need of coronary artery angiography (CAA).MethodsWe used a multi-methods approach to elicit effective factors that affect CAA patient prioritisation. Qualitative data wase collected using semi-structured interviews with 15 experts. The final set of factors was selected using experts’ consensus through modifed Delphi technique. The framework was finalised during expert panel meetings.Results212 effective factors were identified based on the literature review, interviews, and expert panel discussion of them, 37 factors were selected for modifed Delphi study. Following two rounds of Delphi discussions, seven final factors were selected and weighed by ten experts using pair-wise comparisons. The following weights were given: the severity of pain and symptoms (0.22), stress testing (0.18), background diseases (0.15), number of myocardial infarctions (0.15), waiting time (0.10), reduction of economic and social performance (0.12), and special conditions (0.08).ConclusionClinical effective factors were important for CAA prioritisation framework. Using this framework can potentially lead to improved accountability and justice in the health system.

Christmas holiday triggers of myocardial infarction

Abstract Background Christmas holidays have been associated with the highest incidence of myocardial infarction (MI). We wanted to assess possible triggers of MI during Christmas. Method A nationwide, retrospective postal survey with case-control design. All individuals suffering a MI during the Christmas holidays 2018 and 2019 in Sweden were identified through the SWEDEHEART registry and a control group matched in age and gender with chronic coronary syndrome who did not seek medical attention during Christmas, were asked for participation. Subjects completed a questionnaire asking them to rate 27 potential MI-triggers as having occurred more or less than usual. Results A total of 189 patients suffering a MI on Christmas Eve, Christmas Day, or Boxing Day and 157 patients in control-group responded to the questionnaire, representing response rates of 66% and 62%, respectively. Patients with MI on Christmas experienced more stress (36.7% vs 20.9%, p=0.002), depression (20.9% vs 10.5%, p=0.024) and worry (25.9% vs 10.1%, p&amp;lt;0.001) compared to the control-group. The food and sweets-consumption were increased in both groups, but to a greater extent in the control-group (33.0% vs 49.7%, p=0.002 and 32.4% vs 43.3, p=0.031). There were no increases in quarrels, anger, economic worries or reduced compliance with medication. Conclusions Patients suffering MI on Christmas holiday experienced higher levels of stress and emotional distress compared to patients with chronic coronary syndrome, possibly explaining the phenomenon of holiday heart attack. Understanding what factors increase the number of MI on Christmas may help reduce the excess number of MIs and cardiovascular burden. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Swedish Heart and Kund FoundationSwedish Scientific Research Council

Christmas holiday triggers of myocardial infarction

Objectives: Christmas holidays have been associated with the highest incidence of myocardial infarction (MI). We wanted to assess possible triggers of MI during Christmas. Design: A nationwide, retrospective postal survey with case-control design. All individuals suffering an MI during the Christmas holidays 2018 and 2019 in Sweden were identified through the SWEDEHEART registry and a control group matched in age and gender with chronic coronary syndrome who did not seek medical attention during Christmas were asked for participation. Subjects completed a questionnaire asking them to rate 27 potential MI-triggers as having occurred more or less than usual. Results: A total of 189 patients suffering an MI on Christmas Eve, Christmas Day, or Boxing Day, and 157 patients in the control group responded to the questionnaire, representing response rates of 66% and 62%, respectively. Patients with MI on Christmas experienced more stress (37% vs. 21%, p = .002), depression (21% vs. 11%, p = .024), and worry (26% vs. 10%, p < .001) compared to the control group. The food and sweets consumption was increased in both groups, but to a greater extent in the control group (33% vs. 50%, p = .002 and 32% vs. 43%, p = .031). There were no increases in quarrels, anger, economic worries, or reduced compliance with medication. Conclusions: Patients suffering MI on Christmas holiday experienced higher levels of stress and emotional distress compared to patients with chronic coronary syndrome, possibly contributing to the phenomenon of holiday heart attack. Understanding what factors increase the number of MI on Christmas may help reduce the excess number of MIs and cardiovascular burden.

Effect of Empagliflozin on Total Events of Myocardial Infarctions by Subtype in the EMPA-REG OUTCOME Trial

In EMPA-REG OUTCOME®, empagliflozin (EMPA) reduced the risk of myocardial infarction (MI) in patients with type 2 diabetes and established atherosclerotic cardiovascular disease. Here we report the effects of EMPA on the total number of MIs by subtype.

Abstract 14959: Effect of Empagliflozin on Total Events of Myocardial Infarctions by Subtype in the EMPA-REG OUTCOME Trial

Introduction: In EMPA-REG OUTCOME®, the sodium-glucose transporter inhibitor, empagliflozin (EMPA), reduced the risk of first cardiovascular (CV) events primarily CV mortality and hospitalization for heart failure in patients with type 2 diabetes (T2D) and established atherosclerotic cardiovascular disease. In analyses including total events, EMPA also reduced the risk of myocardial infarction (MI). Here we report the effects of EMPA on the total number of MIs by subtype. Methods: Patients were randomized to receive EMPA 10 mg, EMPA 25 mg, or placebo. We assessed the effect of pooled EMPA versus placebo on total (first plus recurrent) events of fatal and non-fatal MI using a negative binomial model with robust confidence intervals (CI) that preserves randomization and accounts for the within-patient correlation of multiple events. Post-hoc, we analyzed established subtypes of MI: Type 1: Typically related to plaque-rupture or thrombus; Type 2: Supply-demand; Type 3: Sudden-death related (i.e., fatal MI); Type 4: Percutaneous coronary intervention related; and Type 5: Coronary artery bypass graft related. Except type 3 MIs, MIs were non-fatal. The MIs, including subtypes, were centrally adjudicated and could be assigned to more than one subtype. Results: 7,020 patients were treated. Overall, there was 421 total events of MIs. Specifically, 299, 86, 26, 19, and 1 of the MIs were classified as type 1, 2, 3, 4, and 5 MIs, respectively (not mutually exclusive). Overall, EMPA reduced the risk of total events of MI by 21% versus placebo (rate ratio [95% CI], EMPA versus placebo: 0.79 [0.620; 0.998], p=0.0486; each MI only counted once). The overall reduction in total events of MIs by EMPA was driven by the effect on type 1 and 2 MIs, as well as type 3 MIs, with limited number of type 4 and 5 MIs (Figure). Conclusions: EMPA reduced the risk of total MI events with consistent effects across the most common etiologies, the type 1 (plaque-rupture or thrombus) and 2 (supply-demand) MIs.

Diabetic autonomic neuropathies as a major risk factor for silent myocardial ischemia and infarction: a literature review

A substantial number of myocardial infarctions (MIs) are asymptomatic or associated with mi-nor and atypical symptoms. These symptoms are often atypical or even absent, especially in di-abetic patients. A number of studies on this topic have shown that in the presence of myocardial ischemia and infarction, diabetic patients report angina less frequently than non-diabetic pa-tients. In this article review, we researched several published articles written about this subject and investigated the relationship between Diabetes Mellitus (DM) in patients and the occur-rence of silent myocardial ischemia and infarction due to the onset of diabetic neuropathy (DN), which is brought about by prolonged diabetes. Based on our research of published articles and studies, we found overwhelming evidence that supports the fact that diabetic autonomic neu-ropathy (DAN) is a major contributing factor in the morbidity of silent myocardial ischemia and infarction among patients suffering from DM. Â

The Problem of Increasing Number of Myocardial Infarction: Deaths in Densely Populated Cities

The Problem of Increasing Number of Myocardial Infarction: Deaths in Densely Populated Cities

Anxiety Sensitivity and Physical Inactivity in a National Sample of Adults with a History of Myocardial Infarction.

The psychological factors underlying physical inactivity in vulnerable cardiac adult populations remain understudied. Anxiety sensitivity, a cognitive vulnerability defined as fear of the physical, cognitive, and social consequences of anxiety, may be an important modifiable determinant of physical inactivity. We examined the association of anxiety sensitivity, and each anxiety sensitivity subscale (physical, cognitive, and social concerns), with physical inactivity in adults with a history of myocardial infarction (MI). Using cross-sectional data from a nationally representative survey of adults (N = 1417) in the USA who reported a health professional diagnosis of MI, we used weighted logistic regression models to evaluate the association between anxiety sensitivity (overall, and each subscale) and physical inactivity (self-reported exercise 0-1day/week), with adjustment for age, gender, race, education, number of MIs, and depression. Overall, 34.3% reported physical inactivity. Anxiety sensitivity was associated with greater odds of physical inactivity (OR = 1.01; 95% CI=1.00, 1.02; p = .026). Of the subscales, only physical concerns were associated with physical inactivity (OR = 1.02; 95% CI=1.01, 1.04; p = .008) in the final model. High vs. low fear of shortness of breath was most consistently associated with physical inactivity (OR = 1.49; 95% CI=1.08, 2.06; p < .021). Anxiety sensitivity, generally, and fear of the physical sensations of anxiety (i.e., "fear of shortness of breath"), specifically, are important correlates of physical inactivity in adults with a history of MI. Future research should replicate these findings and experimentally test whether cardiac rehabilitation interventions that include an adjunctive component targeting reduction of anxiety sensitivity overall, or specific somatic symptoms, improve physical activity in this population.

Indirect costs of myocardial infarction in Portugal

IntroductionCardiovascular disease, and particularly myocardial infarction (MI), carries a significant economic burden, through productivity losses (indirect costs) associated with temporary absence from work, that has not yet been adequately studied in Portugal. Our objective was to quantify the indirect costs of MI in the first year after admission. MethodsConsecutive patients admitted to a single center aged <66 years who survived to discharge during a one-year period were included. Employment status on admission was assessed and for every employed patient, their monthly wage was estimated from market wage rates taken from the Ministry of Labor database according to gender and age. The duration of temporary absence from work was assessed in follow-up contacts for up to one year. Indirect costs were calculated in this sample and the results were applied to the number of MIs in Portugal during 2016 and separately to ST-elevation MI (STEMI) and non-ST-elevation acute coronary syndrome. ResultsA total of 219 patients were included, of whom 66.2% were working. The mean monthly labor cost was 1802 euros. A total cost of 760 521.55 euros was obtained. At national level there were 4133 patients aged <66 years admitted with acute MI who survived to discharge. Costs were higher in STEMI patients and the total indirect cost was estimated at 10.12 million euros. ConclusionsIn Portugal, the costs to society of disability-generated productivity losses exceed ten million euros in the first year after MI. Strategies to promote an earlier return to work are needed to lower these costs.