Onset Of Acute Myocardial Infarction Research Articles

Altered NK cell receptor repertoire and function of natural killer cells in patients with acute myocardial infarction: A three-month follow-up study.

NK cells are important in the onset of acute myocardial infarction (AMI) by their ability to secrete IFN-γ and other inflammatory cytokines. They also participate in regulating pathological cardiac remodeling after myocardial infarction. Mechanisms of regulation, however, are incompletely understood. Herein, the aim of this study is to explore the possible association between the expression pattern of different NK cell receptors (phenotype), as well as the cytotoxic function of NK cells from AMI patients with their myocardial function after three months follow-up. We analyzed the phenotype and function of both CD56dimCD16+ and CD56brightCD16- NK cells from twenty-one patients within the first 72 h after ST-elevation AMI and three-month follow-up, as well as fifteen healthy controls. Clinical characteristics and ventricular function determined by echocardiography were also evaluated. NK cells from AMI patients showed an activated phenotype, characterized by high TNF-α production and low percentages of the activating receptor NKG2D. Interestingly, AMI patients display higher levels of circulating IL-10+ NK cells. Three-month follow-up showed that NK cells exhibit a diminished cytotoxic function. These data show that NK cells may have a role mediating myocardial remodeling by regulating the inflammatory response, mainly by the production of IL-10. We also propose that NKG2D may have a role in the onset of the inflammatory response immediately after AMI. The precise regulation of NK cells function may represent an important step in recovery of myocardial function.

Experimental Modeling and Identification of Cardiac Biomarkers Release in Acute Myocardial Infarction

Cardiovascular diseases represent, to date, the major cause of mortality worldwide. Diagnosis of the most frequent of such disease, acute myocardial infarction (AMI), requires the evaluation of time-series measurement of specific cardiac biomarkers concentration. The aim of this paper is to provide the clinicians with a quantitative tool to analyze such time-series, with the final goal of enhancing the diagnostic and prognostic procedures. The proposed approach is based on a novel dynamical model, which synthetically describes the basic mechanisms underlying cardiac troponin (cTnT) release into the plasma after the onset of AMI. Leveraging tools of system identification and a data set of AMI patients treated at our University Hospital, the model has been assessed as an effective tool to quantify the characteristic release curves observed under different conditions. Furthermore, it has been shown how the devised approach is also suitable in those cases where only partial measurements are available to the clinician to recover important clinical information. Finally, an optimal experimental design analysis has been performed in order to gain insights on how to optimize the experimental data collection phase with potentially relevant implications on both the quality and cost of the diagnosis procedure.

Coronary artery bypass grafting in non-ST-segment elevation acute myocardial infarction

The study was aimed at comparatively assessing the immediate results of coronary artery bypass grafting operations without artificial circulation performed in non-ST-segment elevation acute myocardial infarction and chronic ischaemic heart disease. The main group with non-ST-segment elevation acute myocardial infarction enrolled a total of 101 patients undergoing coronary artery bypass grafting without artificial circulation. The patients' age varied from 47 to 87 years, median 66.0 years (60.0; 71.0). The indication for the operation was persistent myocardial ischaemia on the background of carried out therapy with impossibility of performing percutaneous coronary intervention due to anatomy of coronary arteries and peculiarities of their pathology. The comparison group of chronic ischaemic heart disease was composed of 108 patients undergoing elective coronary artery bypass grafting without artificial circulation. The patients' age varied from 40 to 92 years, median - 60.0 years (58.0; 68.0). The patients with acute myocardial infarction had a significantly greater (p<0.05) number of coronary arteries measuring in diameter 2.5 mm and more, with significant occlusive and stenotic lesions, as well as a higher total SYNTAX score. The patients undergoing elective surgery were found to have an initially higher (p<0.05) left ventricular ejection fraction. In the group of acute myocardial infarction the waiting times for coronary artery bypass grafting varied from 2 to 8 days, median of waiting - 4.0 days (4.0; 5.0). The lethality rate (p<0.05) in the group of acute myocardial infarction amounted to 3.0% (3 cases) and in the group of chronic ischaemic heart disease to 0.9% (1 case). Twenty-one (20.8%) operations were carried out within the first 72 hours, with eighty surgical interventions (79.2%) performed after 72 hours from the onset of the disease. All 3 (3.8%) lethal outcomes were observed after coronary artery bypass grafting procedures performed later than 72 hours from the onset of acute myocardial infarction (p>0.05). The total number of complications (p>0.05) amounted to 18 (17.8%) and 10 (9.3%) in the group of acute myocardial infarction and in the group of chronic ischaemic heart disease, respectively. The immediate results of delayed coronary artery bypass grafting procedures without artificial circulation for acute myocardial infarction and chronic ischaemic heart disease were statistically comparable (p>0.05) by the lethality and complication rates. Lethality in the group of non-ST-segment elevation acute myocardial infarction din not depend on the time of operation after the onset of the disease.

A Novel Type of Stem Cells Double-Positive for SSEA-3 and CD45 in Human Peripheral Blood

Peripheral blood (PB) contains several types of stem/progenitor cells, including hematopoietic stem and endothelial progenitor cells. We identified a population positive for both the pluripotent surface marker SSEA-3 and leukocyte common antigen CD45 that comprises 0.04% ± 0.003% of the mononuclear cells in human PB. The average size of the SSEA-3(+)/CD45(+) cells was 10.1 ± 0.3 µm and ∼22% were positive for CD105, a mesenchymal marker; ∼85% were positive for CD19, a B cell marker; and ∼94% were positive for HLA-DR, a major histocompatibility complex class II molecule relevant to antigen presentation. These SSEA-3(+)/CD45(+) cells expressed the pluripotency markers Nanog, Oct3/4, and Sox2, as well as sphingosine-1-phosphate (S1P) receptor 2, and migrated toward S1P, although their adherence and proliferative activities in vitro were low. They expressed NeuN at 7 d, Pax7 and desmin at 7 d, and alpha-fetoprotein and cytokeratin-19 at 3 d when supplied to mouse damaged tissues of the brain, skeletal muscle and liver, respectively, suggesting the ability to spontaneously differentiate into triploblastic lineages compatible to the tissue microenvironment. Multilineage-differentiating stress enduring (Muse) cells, identified as SSEA-3(+) in tissues such as the bone marrow and organ connective tissues, express pluripotency markers, migrate to sites of damage via the S1P-S1P receptor 2 system, and differentiate spontaneously into tissue-compatible cells after homing to the damaged tissue where they participate in tissue repair. After the onset of acute myocardial infarction and stroke, patients are reported to have an increase in the number of SSEA-3(+) cells in the PB. The SSEA-3(+)/CD45(+) cells in the PB showed similarity to tissue-Muse cells, although with difference in surface marker expression and cellular properties. Thus, these findings suggest that human PB contains a subset of cells that are distinct from known stem/progenitor cells, and that CD45(+)-mononuclear cells in the PB comprise a novel subpopulation of cells that express pluripotency markers.

Explainable Prediction of Acute Myocardial Infarction Using Machine Learning and Shapley Values

The early and accurate detection of the onset of acute myocardial infarction (AMI) is imperative for the timely provision of medical intervention and the reduction of its mortality rate. Machine learning techniques have demonstrated great potential in aiding disease diagnosis. In this paper, we present a framework to predict the onset of AMI using 713,447 extracted ECG samples and associated auxiliary data from the longitudinal and comprehensive ECG-ViEW II database, previously unexplored in the field of machine learning in healthcare. The framework is realized with two deep learning models, a convolutional neural network (CNN) and a recurrent neural network (RNN), and a decision-tree based model, XGBoost. Synthetic minority oversampling technique (SMOTE) was utilized to address class imbalance. High prediction accuracy of 89.9%, 84.6%, 97.5% and ROC curve areas of 90.7%, 82.9%, 96.5% have been achieved for the best CNN, RNN, and XGBoost models, respectively. Shapley values were utilized to identify the features that contributed most to the classification decision with XGBoost, demonstrating the high impact of auxiliary inputs such as age and sex. This paper demonstrates the promising application of explainable machine learning in the field of cardiovascular disease prediction.

P1780 Left ventricular golbal longitudinal strain in acute myocardial infarction and incidence of in hospital heart failure

Abstract Background The occurrence of in-hospital heart failure in the acute phase of myocardial infarction carries an ominous prognosis and is often preceded by abrupt loss of functioning myocardium. However ,In hospital heart failure may occur in patients with apparently only minor myocardial injury and preserved or only moderately reduced left ventricular ejection fraction and still carries a significantly increased risk of adverse outcome. In patients with clinical symptoms of heart failure despite preserved left ventricular ejection fraction(heart failure with preserved ejection fraction), abnormalities in longitudinal myocardial mechanics have been reported suggesting that the discrepancy between near normal left ventricular ejection fraction and clinical symptoms may be partially explained by theses indices. Purpose Evaluation of the role of global longitudinal strain in prediction of the occurrence of in hospital heart failure in patients presenting with acute myocardial infarction particularly in patients with normal ,or moderately impaired ejection fraction. Methods forty patients with first attack of acute myocardial infarction were ranked according to killip class during their hospital admission and course. The patients were divided into two groups: Group 1: patients having in-hospital heart failure (killip class &amp;gt; 1).Group2: Patients not having in–hospital heart failure (killip class = 1). Echocardiogaraphic examination was done for them including global longitudinal strain within 72 hours after successful reperfusion .Comparison of different echocardiographic parameters between the two groups was done. Patients with mildly impaired ejection fraction (Ejection fraction &amp;gt; 40%) were studied for echocardiographic parameters correlated significantly with the occurrence of in-hospital heart failure . Results Patients with in-hospital heart failure had significantly impaired global longitudinal strain(-8.63%+1.57% vs -12.41%+1.31%, p = 0.000), lower left ventricular ejection fraction (34.17%+8.17% vs 42.92 %+7.98%,p &amp;lt; 0.001) and higher wall motion score index (1.57 + 0.32 vs 1.31 +0.24 ,p &amp;lt; 0.006). In patients with left ventricular ejection fraction &amp;gt;40% experienced in-hospital heart failure also exhibited significantly impaired global longitudinal strain p= 0.035 . Conclusion Global longitudinal strain can offer accurate, feasible, and non invasive predictor of hemodynamic deterioration in patients with myocardial infarction. Global longitudinal strain was superior to left ventricular ejection fraction , wall motion score index in evaluation of myocardial dysfunction specially in those with preserved left ventricular ejection fraction(EF &amp;gt; 40%).Global longitudinal strain was also superior to left ventricular ejection fraction , wall motion score index in detection of patients with Killip class II ( those without overt heart failure ,and who can be easily missed).

MiR-142 is a Sensitive Biomarker for the Diagnosis and Prognosis of Acute Myocardial Infarction.

Acute myocardial infarction (AMI) is myocardial necrosis caused by acute and persistent ischemia and hypoxia of coronary arteries. AMI is one of the most common diseases in European countries and over 1.5 million AMI patients die of it in the United States annually. A collection of studies proposed that certain micro-RNAs play crucial roles in the onset and development of AMI. Ninety-four AMI patients and 83 non-AMI healthy controls were recruited from Zhongda Hospital, Southeast University between July 2015 and September 2017. Serum samples were collected at admission and the expression of miR-142 was detected using real-time quantitative polymerase chain reaction (RT-qPCR) assays. miR-142 expression was markedly elevated in serum samples of AMI patients compared with the 83 non-AMI healthy controls. miR-142 expression was positively correlated with creatine kinase-KB (CK-MB; r = 0.6731, p = 0.0021) and troponin (r = 0.7138, p = 0.0013). The area under the curve (AUC) of miR-142, CK-MB, and troponin for the diagnosis of AMI were 0.9185, 0.8172, and 0.8717, respectively. Overall survival analysis implied that high miR-142 expression may predict poor survival (log-rank test, p = 0.0146). miR-142 may be a diagnostic and prognostic indicator for AMI, and therefore, it may contribute to AMI clinicopathologic prediction.

Increased Heart Rate during Walk Test Predicts Chronic-Phase Worsening of Renal Function in Patients with Acute Myocardial Infarction and Normal Kidney Function.

Chronic-phase worsening renal function (WRF) in patients with acute myocardial infarction (AMI) has been associated with poor prognosis. However, there is no consensus on either the method of prevention or the cause. The aim of this study was to determine factors predictive of chronic-phase WRF from the viewpoint of circulatory dynamics response to exercise during hospitalization of AMI patients without renal dysfunction on admission. We studied 186 consecutively AMI patients who underwent the 200-m walk test. Chronic-phase WRF was defined as a 20% decrease in estimated glomerular filtration rate (eGFR) from baseline to 8–10 months after AMI onset. Heart rate (HR) and systolic blood pressure recorded during the 200-m walk test were evaluated as circulatory dynamics responses. In total, 94 patients were enrolled. Multiple linear regression analysis showed that ΔHR (peak-rest) associated significantly with ΔeGFR (β = 0.427, p = 0.018). The receiver operating characteristic curve of ΔHR to predict chronic-phase WRF showed an area under the curve of 0.77, with a cut-off value of 22.0 bpm having a 95% sensitivity and 55% specificity. Among circulatory dynamics responses during exercise in the acute phase after AMI, ΔHR was an independent predictor of chronic-phase WRF.

Tuesday left main: Chronobiology of acute myocardial infarction due to left main disease

ObjectivesThe existence of a “weekend effect” for onset of acute myocardial infarction (AMI) has been suggested in the past, but the relation with the culprit vessel has not been investigated. MI due to left main coronary artery lesion represents a particularly serious life-threatening condition. Our study was aimed to assess the chronobiology of admission to the emergency department for AMI considered to be induced by a left main culprit lesion. MethodsWe retrospectively reviewed patients who experienced an AMI due to a left main culprit lesion between January 1, 2008 and January 1, 2018 stratifying them according to the day of admission, on the basis of the symptom onset time; the 30-day cardiovascular mortality was also analyzed on the basis of the time of symptom onset. ResultsOut of 1789 patients with AMI, 130 (7.2%, 104 males and 26 females, mean age 74.5 ± 8.1 years) had left main disease as the culprit lesion. Tuesday was significantly over-represented as the admission day (p < 0.001 for Tuesday vs. other days; p = 0.009 for Tuesday vs. Sunday, respectively). The 30-day cardiovascular survival was not different between patients admitted on Tuesday and those admitted on remaining days (Log-rank, Mantel Cox, p = 0.43; Chi-square = 0.611). A significant difference was noted in patients with AMI on Sunday versus remaining days (Log-rank, Mantel-Cox, p = 0.005; Chi-square = 7.96). The diameter of the left main artery was larger in patients admitted on Tuesdays than on Sundays (p < 0.01). ConclusionThe relation between AMI onset and the day of the week is confirmed by our study, which also suggests that in case of a left main lesion, some delay of the weekend effect might be expected.

HIGH DEGREE AV BLOCK IN PATIENTS PRESENTING WITH ACUTE MYOCARDIAL INFARCTION

Objective: To determine the frequency of high degree AV block in patientspresenting with acute myocardial infarction. Methodology: This cross sectional study was conducted in Department ofCardiology, Hayatabad Medical Complex, Peshawar from 3rd june 2018 to 02ndDecember 2018..Patients were included using non-probability consecutivesampling technique. Both male and female patients with age group 18-65 years,admitted to Coronary Care Unit with myocardial infarction within 4 days of onsetof acute myocardial infarction (ST elevation Myocardial infarction and Non STelevation Myocardial infarction) were included in the study .All patients weresubjected to detailed history, followed by complete routine examination and baseline investigations including ECG (Cardiofax) and echocardiography (GE VividS5), and Troponin-I level(for NSTEMI) and CK-MB(for STEMI) were done anddocumented. P ≤0.05 was taken significant. Results: Total of 275 patients were included in the study. The mean age ofpatients was 56.8 ± 9.32 years. Male patients were 175 (63.6%). About 218(79.3%) patients were found to have ST elevation myocardial infarction (STEMI)and 57(20.7%) had Non ST elevation myocardial infarction (NSTEMI). HighDegree AV block was recorded in 27(8.7%) of patients who presented with acutemyocardial infarction. Conlcusion: High degree AV block is prevalent in patients presenting with alltypes of acute myocardial infarction but more common in inferior wallmyocardial infarction.

P3387Cholesterol crystals in superficial plaque layer detected by optical coherence tomography as a new morphological feature for plaque rupture

Abstract Background While plaque rupture (PR) is the leading cause of acute myocardial infarction (AMI), other etiologies are also involved in the onset of AMI. Cholesterol crystals (CCs) are usually present abundantly in atherosclerotic plaques, especially in the culprit site of AMI. However, the relationship between in vivo CCs and PR is unclear. Optical coherence tomography (OCT) is a high-resolution imaging technique that allows for the in vivo identification of various plaque characteristics including PR and CCs. Purpose The aim of this study was to investigate prevalence and distribution of CCs between patients with AMI with PR, AMI without PR, and SAP. Method This study consisted of 146 patients with coronary artery disease (AMI with PR; n=64, AMI without PR; n=41, and SAP; n=41) who underwent OCT prior to percutaneous coronary intervention. Plaque characteristics in OCT images were assessed according to the consensus document. We classified the distribution of CCs as follows; superficial type CCs were defined by any of the CCs invading the fibrous cap and remaining CCs as deep type CCs. Result There was no statistical difference in clinical characteristics among the three groups. The % diameter stenosis was significantly smaller in the SAP group than others (AMI with PR 91±12% vs. AMI without PR 86±13% vs. SAP 65±9%, p&lt;0.001). The prevalence of CCs was significantly higher in the AMI with PR group than others (AMI with PR 78% vs. AMI without PR 41% vs. SAP 39%, p&lt;0.001). The prevalence of superficial type CCs was significantly different among the groups (AMI with PR 72% vs. AMI without PR 24% vs. SAP 7%, p&lt;0.001). Multivariable logistic analysis demonstrated that lipid plaque (OR 84.5, 95% CI [6.30–11332.33], p&lt;0.001) and superficial type CC (OR 9.5, 95% CI [2.61–34.89], p&lt;0.001) were independent predictors of PR. Conclusion Plaque with CCs invading the fibrous cap is frequently associated with PR in patients with AMI, suggesting. In vivo CC detection is a new morphological feature for plaque rupture. Acknowledgement/Funding This study was supported by a grant from JSPS KAKENHI (17K09557).

P4601Reduced exercise capacity and clinical outcomes following acute myocardial infarction

Abstract Background Reduced exercise capacity is known to be an important predictor of poor prognosis and disability in patients with cardiovascular diseases and chronic heart failure, and even members of the general population. However, data about exercise capacity assessed by cardiopulmonary exercise testing (CPX) in acute myocardial infarction (AMI) patients who underwent primary percutaneous coronary intervention (PCI) is scarce. The purpose of this study is to assess the associated factors and clinical influence of exercise capacity measured by CPX in AMI patients. Methods Among 594 consecutive AMI patients who underwent primary PCI, we examined 136 patients (85.3% men, 64.9±11.9 years) who underwent CPX during hospitalization for AMI. CPX was usually performed five days after the onset of AMI. Reduced exercise capacity was defined as peak oxygen consumption (peak VO2) ≤12. Clinical outcomes including all-cause death, myocardial infarction, and hospitalization due to heart failure were followed. Results Among 136 patients, reduced exercise capacity (peak VO2 ≤12) was seen in 38 patients (28%). Patients with reduced exercise capacity were older, more likely to have hypertension, and had lower renal function. In echocardiography, patients with reduced exercise capacity had higher E/e' and larger left atria. Median follow-up term was 12 months (interquartile range: 9–22). The occurrence of composite endpoints of all-cause death, myocardial infarction, and hospitalization due to heart failure was significantly higher in patients with peak VO2≤12 than those with peak VO2&gt;12 (p&lt;0.001). Multivariate logistic analysis showed that E/e' (Odds ratio, 1.19, 95%, confidence interval 1.09 to 1.31, p&lt;0.001) was an independent predictor of reduced exercise capacity (peak VO2≤12). Cumulative incidence of clinical events Conclusion Diastolic dysfunction is associated with reduced exercise capacity following successful primary PCI in AMI patients and may lead to poorer clinical outcomes.

P5516Short-term and long-term mortality among acute myocardial infarction patients admitted to hospitals on weekends as compared with weekdays

Abstract Background As in other countries, manpower shortage in weekends and holidays is a common problem in either private hospitals or public hospitals in Taiwan. Whether the manpower shortage in weekends and holidays is associated with poor quality of medical care is a noteworthy subject and several investigations from different countries have been published already. Purpose This study examined the difference of short-term and long-term mortality between acute myocardial infraction patients admitted to hospitals on weekends and weekdays in Taiwan. Methods We conducted a retrospective, nationwide cohort study based on the National Health Insurance claims database in Taiwan. Adult patients aged 20 years or older who were admitted with a diagnosis of acute myocardial infarction between Jan. 1 2006 and Dec. 31 2014 were identified. Only the first attack of acute myocardial infarction was retained for analysis. The multivariate logistic regression model was applied with adjustment of baseline characteristics at both patient level and hospital level. The outcome variables included in-hospital mortality and one-year cumulative mortality after the index hospitalization. Results We identified 53861 patients with acute myocardial infarction as the weekend group, while 130908 patients as the weekday group. The mean age was 68 years old and 68% of the subjects were male in both groups. ST-elevation myocardial infarction constituted 23% of the patients and up to 46% of the subjects underwent percutaneous coronary intervention during the index hospitalization in both groups. Among the weekend group, the in-hospital mortality was 15.8% while the in-hospital mortality was 16.2% in the weekday group (standardized difference = 0.01). The one-year cumulative mortality was 30.2% and 30.9% in the weekend group and the weekday group, respectively (standardized difference = 0.02). The adjusted odds ratio (aOR) concerning in-hospital mortality of the weekend group compared with the weekday group was 0.98 (95% confidence interval [CI]: 0.95–1.01, p=0.11). Also we found no difference in one-year cumulative mortality between the two study groups (aOR = 0.98, 95% CI: 0.96–1.01, p=0.15). Conclusions As for acute myocardial infraction patients in Taiwan, admission on weekends or weekdays did not have a significant impact on either in-hospital mortality or one-year cumulative mortality. Acknowledgement/Funding Ministry of Science and Technology, the Executive Yuan, Taiwan (MOST 106-2410-H-002-218-, and MOST 107-2410-H-002-237-)

P5477Usefulness of hypocalcemia at admission as a prognostic marker in patients with acute coronary syndromes

Abstract Background Few studies have focused on the role of serum calcium levels (SCa) in patients with acute myocardial infarction (AMI). Purpose This study aimed to analyze the value of SCa as a prognostic marker in patients with AMI, including both with or without ST elevation. Methods From January-2015 to December-2017, all consecutive patients with AMI admitted to a tertiary care hospital were included. For the purpose of this study, total SCa levels were recorded at admission in each patient. Blood samples were obtained at the first medical contact when the patient arrived to the hospital. Patients were classified according to quartiles depending on their SCa at admission: Q1, under 8.3 mg/dl (N=300); Q2, between 8.4–8.7 mg/dl (N=264); Q3, between 8.8–9.1 mg/dl (N=279) and Q4, over 9.1 mg/dl (N=283). Results A total cohort of 1126 patients was included, 679 (60.3%) had STEMI and 447 (39.7%) were NSTEMI patients. Patients in the Q1 had more in-hospital complications, such as heart failure, bleeding events, new onset AMI, atrioventricular block and contrast induced nephropathy. Patients in the Q1 had higher in-hospital and one-year mortality as compared to that of patients in the Q2-Q4. After multivariate adjustment (Table), low SCa (&lt;8.3mg/dl) remained as an independent predictor of in-hospital mortality (OR 2.91, 95% CI (1.15–7.41), p=0.025). These results were consistent in STEMI and NSTEMI patients. Multivariable analysis Variable OR (95% CI) p GRACE score 1.00 (0.99–1.02) 0.727 CRUSADE score 1.03 (1.01–1.06) 0.011 Age (per year) 1.05 (1.00–1.09) 0.034 STEMI 1.35 (0.41–4.46) 0.617 Diabetes 2.57 (0.97–6.79) 0.056 Low SCa (&lt;8.3) 2.91 (1.15–7.41) 0.025 Killip class at admission 1 Reference 2 4.73 (1.31–17.1) 0.018 3 6.83 (1.70–27.5) 0.007 4 9.83 (1.44–67.1) 0.020 STEMI: ST segment elevation myocardial infarction; SCa: Serum calcium levels; OR: Odds ratio; CI: Confidence interval. Conclusion In patients with AMI, low SCa levels at admission (&lt;8.3mg/dl) are independently associated with higher mortality.

P848Prevalence and Prognosis of Familial Hypercholesterolemia (FH) with Acute Myocardial Infarction (AMI) in China: Chinese Acute Myocardial Infarction (CAMI) Registry

Abstract Background The prevalence and prognosis of familial hypercholesterolemia (FH) with acute myocardial infarction (AMI) in China is unclear. Purpose To invistigate the prevalence and prognosis of familial hypercholesterolemia (FH) with acute myocardial infarction (AMI) in China. Methods In China Acute Myocardial Infarction (CAMI) Registry, 13,002 patients with age 18–80 were consecutively enrolled with first-onset acute myocardial infarction who were naïve to statin before admission from Januanry 1st, 2013 to October 31st, 2014. According to Dutch Lipid Clinical Network Criteria (DLCNC), the patients were divided to heterozygous familial hypercholesterolemia (HeFH) (definite or probable HeFH, possible HeFH) or no HeFH group. All the patients were followed up (average follow-up period, 24 months) and composite major adverse cardiovascular events (ENDPOINT) were recorded which were defined as all-cause death, non-fatal myocardial reinfarction and stroke. Cox regression was performed to analyze the difference of composite endpoint occurrence between HeFH group and no HeFH group. Results The number of the patients in the three groups was as following, 62 in definite or probable HeFH group, 484 in possible HeFH group, 12456 in no HeFH group. The prevalence of HeFH is 4.2% (including 0.47% of definite or probable HeFH, 3.73% of possible FH). The average age of onset of first-time AMI was 54±12,56±12,63±12 years old (p&lt;0.0001) in definite or probable HeFH group, possible HeFH group and no HeFH group, respectively. The percentage of Killip III or above (8.1% vs 4.3% vs 6.3%, p=0.1629), cardiac arrest (1.6% vs 0.6% vs 0.9%, p=0.6990), and TIMI 0–2 grade after primary percutaneous cardiac intervention (PCI) (0% vs 6.8% vs 4.3%, p=0.5866) was not significantly different in definite or probable HeFH group, possible HeFH group and no HeFH group, respectively. After Cox proportional analysis adjusting multiple factors, the rate of composite endpoint during follow-up period was not significantly different (definite or probable HeFH group vs no HeFH group, HR 0. 853, 95% CI 0.381–1.910, p=0.699, possible HeFH group vs no HeFH group, HR1.076, 95% CI 0.795–1.458, p=0.635). The prognosis of FH with AMI in China Conclusions In CAMI Registry, the prevalence of HeFH was 4.2%, the diagnosis of HeFH was not a dependent risk factor for the rate of composite cardiovascular events.

Comparison of clinical presentations and outcomes between adult and elderly acute myocardial infarction patients in emergency department

Background: Acute myocardial infarction (AMI) is one of a leading cause of death. The clinical presentations and outcomes between adults and elderly were still not well established. Methods: We conducted a prospective study to evaluate the clinical manifestations of AMI at emergency department in Taiwan. Patients with unstable angina were excluded. The primary endpoint was all-cause mortality. The inpatient days, discharge activities, complications were collected for comparisons. Results: Overall 210 consecutive cases with acute coronary syndrome were recruited in ER, 202 patients with AMI were enrolled for further analysis (66.3% STEMI and 33.7% NSTEMI). Among all AMI patients, 57 patients (28.2%) aged more than 65 years old. The overall inpatient days and total complications were not significantly different between adult and elderly patients. However, K-M survival analysis displayed that patients over the age of 75 years old was with poor event free survival rate of mortality (Log-rank test, P=0.03), especially for those patients with STEMI (Log-rank test, P=0.01). Cox regression exhibited that chest X-ray finding of cardiomegaly [adjusted hazard ratio (HR), 95% confidence interval (CI): 13.5, 1.27–144, P=0.03] and peak CK-MB levels (adjusted HR, 95% CI: 1.003, 1.001–1.004, P Conclusions: The clinical presentations and outcomes may vary among adult AMI patients and older AMI patients. The chest X-ray finding of cardiomegaly and higher peak CK-MB levels may predict future mortality in AMI patients. The elderly patients over 75 years were with higher mortality after onset of AMI.

Drugs to Inhibit the NLRP3 Inflammasome: Not Always On Target.

Drugs to Inhibit the NLRP3 Inflammasome: Not Always On Target.

Early Versus Late New-Onset Atrial Fibrillation in Acute Myocardial Infarction: Differences in Clinical Characteristics and Predictors.

New-onset atrial fibrillation (NOAF) during acute myocardial infarction (AMI) has significant consequences but is often misdiagnosed. The aim of the study was to evaluate predictors of NOAF throughout different phases of AMI. Patients with AMI admitted to a tertiary medical center were analyzed. Exclusion criteria were preexisting AF, AMI onset ≥24 hours prior to admission, in-hospital death, significant valvular disease, and in-hospital coronary artery bypass graft. Study population were AMI without-NOAF, early-AF (AF terminated within 24 hours of admission), and late-AF (beyond the first 24 hours). Overall 5946 patients were included, age: 64.8 ±14.8 years; 30% women. The incidence of NOAF was 4.6%: 1.6% early-AF, and 3% late-AF. Patients with NOAF comprised greater rate of women, cardiovascular risk-factors burden, severe left ventricular-dysfunction, pulmonary hypertension, valvular disorders, and left atrial enlargement compared with patients without-NOAF. Non-ST-elevation myocardial infarction and inferior-ST-elevation myocardial infarction (STEMI) were significantly more prevalent among early-AF group, while anterior-STEMI, in late-AF. The final multivariate models showed c-statistics of 0.73 and 0.76 for the prediction of new-onset early-AF and late-AF, respectively. In conclusion, there are different clinical predictors of early- versus late-NOAF. The study points out "high risk" AMI population for more meticulous heart rate monitoring for NOAF.

THE RELATIONSHIP BETWEEN CALPROTECTIN AND PARAMETERS OF LIPID AND CARBOHYDRATE METABOLISM, ANTHROPOMETRIC AND INFLAMMATORY PARAMETERS IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION AND DIABETES MELLITUS TYPE 2

Nowadays, an acute myocardial infarction is one of the leading causes of mortality among the population. The EHS-DH registry data clearly illustrate the association between the comorbidities and high mortality following acute myocardial infarction during a year period of follow up. The pronounced influence of carbohydrate metabolism disturbances on the survival of such patients has already been reported. The aim of the study was to analyze the immune inflammation relationships based on assessing calprotectin and the parameters of lipid and carbohydrate metabolism, to evaluate the presence and nature of the relationship between these parameters and carbohydrate metabolism parameters based on the study of blood glucose, insulin and insulin resistance (by the indices HOMA, QUICKI, Caro), anthropometric indicators and inflammatory indicators (monocyte and neutrophile levels). Materials and methods. The study included 64 patients (mean age 65, 31 ± 1.62 years) with acute myocardial infarction and concomitant diabetes mellitus type 2. The design of the study included the primary laboratory investigation of patients during the first day since the onset of acute myocardial infarction with the elevation of the ST segment before the initiation of thrombolytic therapy or percutaneous intervention. The direct correlation between the calprotectin concentration and the HOMA insulin resistance index (R = 0.52; p &lt;0.05), insulinemia (R = 0.57; p &lt;0.05), fasting glycaemia (R = 0, 59; p &lt;0.05), as well as inverse correlation relationships between the Caro index (R = 0.68; p &lt;0.05) and the QUICKI index (R = 0.59; p &lt;0.05) were found out. Moreover, a direct correlation between calprotectin and triglyceride levels (R = 0.31; p &lt;0.05), and negative correlation with high density lipoprotein (R = 0.35; p &lt;0.05) was established as well. The level of total cholesterol and low density lipoproteins showed no significant association with the proinflammatory factor (R = 0.12; p&gt; 0.05 and R = 0.18; p&gt; 0.05, respectively). Conclusions. The increase in the body mass index and the activity of serum monocytes and neutrophils is associated with high concentrations of calprotectin that is accompanied by disturbances of carbohydrate homeostasis towards the growth of insulin resistance and changes of lipidograms of proatherrogenic nature.

Long non-coding RNAs H19, MALAT1 and MIAT as potential novel biomarkers for diagnosis of acute myocardial infarction

In this study, we evaluated the potential of peripheral blood mononuclear cells (PBMC) derived long non-coding RNAs (lncRNAs) as biomarkers for acute myocardial infarction (AMI). To assess the value of PBMCs-derived lncRNAs levels in predicting clinical outcomes in AMI. We measured the PBMC-derived levels of 10 individual lncRNAs which are known to be relevant to cardiovascular disease in PBMCs from 132 AMI patients and 104 healthy participants using quantitative RT-PCR. For AMI group, blood sample were obtained from patients after the onset of AMI. Out of the 10 lncRNAs tested, the mRNA level of lncRNA H19, MIAT and MALAT1 were significantly higher in AMI patients than in healthy control (2.3 ± 0.2 vs. 1.0 ± 0.1, p < 0.001, 1.5±0.1 vs. 1.0±0.1, p = 0.002, 1.8±0.2 vs. 1.0±0.1, p < 0.001, respectively). Receiver operating characteristic curve analyses showed that PBMC-derived H19 had significant diagnostic value for AMI (AUC, 0.753; 95% CI, 0.689˜0.817).Multivariate logistic regression analysis showed that H19 as a dangerous risk for AMI (OR = 2.498, 95% CI, 1.321–4.726, p = 0.005). In addition, the lncRNA H19 alteration was inversely associated with a number of cardiovascular protective factors, and positively associated with cardiovascular risk factors, such as high-density lipoprotein (HDL) (r=-0.198, p = 0.010), lipoprotein A (r=-0.153, p = 0.049), white blood cell counting (r=0.301, p < 0.001) and cardiac ejection fraction (r=-0.157, p = 0.042). Moreover, lncRNA H19 was positively correlated with cardiac biomarkers, i.e. troponinT (r=0.344,p < 0.001), CK (r=0.261, p = 0.001) and CKMB (r=0.24, p = 0.002).Hence, elevated expression level of PBMC-derived H19, MIAT and MALAT1 may be considered as novel biomarkers of AMI.