Past History Of Myocardial Infarction Research Articles

Temporal trends in the prevalence of cardiovascular and non-cardiovascular comorbidities in patients presenting with acute myocardial infarction: Insights from the AMIS Plus registry

Abstract Background Little is known about temporal trends in the prevalence of cardiovascular and non-cardiovascular comorbidities in patients presenting with acute myocardial infarction (AMI). Methods AMIS Plus registry patients enrolled between 2004 and 2021 were stratified based on comorbidities in 3 groups: (1) «cardiovascular comorbidity»: at least one among past history of myocardial infarction, coronary artery bypass grafting or percutaneous coronary intervention, heart failure, peripheral vascular disease, cerebrovascular disease, or atrial fibrillation; (2) «non-cardiovascular comorbidity»: at least one among dementia, chronic lung disease, connective tissue disease, peptic ulcer disease, moderate or severe renal disease, diabetes, liver disease, or cancer disease; and (3) «any comorbidity»: at least one of the mentioned comorbidities. Prevalence and mortality were analysed according to the type of comorbidity in 2-year periods and stratified by sex. Temporal trends were analysed using the Mantel-Haenszel linear-by-linear association Chi-squared test. Results Among the 48’848 patients enrolled, 24’215 (49.6%) had at least one comorbidity. Of these, 17’441 (72.0%) were male and 6’774 (28.0%) female. Over the years, there was a significant decrease in the prevalence of «any comorbidity» (p<0.001) as well as «cardiovascular comorbidity» (p<0.001). A significant decrease in the prevalence of «any comorbidity» as well as «cardiovascular comorbidity» was detected for both sexes. With respect to the prevalence of «non-cardiovascular comorbidity», a significant reduction over time was observed in men but not in women. The reduction of in-hospital mortality over time was significant across all groups, overall and for both sexes individually. Conclusions Over more than a decade, a significant reduction in the prevalence of comorbidities was observed in patients presenting with AMI, with the exception of non-cardiovascular comorbidities in women. This reduction may have contributed, in addition to the improvements in pharmacologic treatments as well as in revascularization, to the improved survival observed over time.Temporal trends of comorbidities

Abstract 17867: Inward Displacement: A Novel CMR Technique for Quantification of Myocardial Wall Motion in Patients With Myocardial Infarction

Introduction: Inward displacement (InD) is a novel parameter which quantifies myocardial wall motion (WM) by measuring the distance travelled by endocardial tracked points towards their corresponding center of the left ventricle in systole, calculated from 3 LAX views obtained during CMR. Hypothesis: InD using CMR is capable of obtaining global quantifiable measurement of WM abnormalities in patients with myocardial infarction (MI) as defined by Late Gadolinium Enhancement (LGE). Methods: We compared patients with history of MI documented by LGE CMR.Studies were acquired in a 1.5 T Siemens Aera (Siemens, Erlangen Germany) scanner with an 18-channel body array coil; Multi-planar ECG-gated cine CMR was obtained using a balanced steady-state free precession readout and LGE images were acquired using an IR prepped sequence 10 min after Gadolinium contrast injection. Offline analysis using automated endocardial LV contour detection was conducted for each of the LAX series and manual corrections were performed as required. InD was measured in mm and expressed as a percentage. Values were compared between MI patients and normal subjects, and analyzed using a Medis Suite workstation (Medis Medical Imaging BV, Leiden, The Netherlands). Results: We analyzed 646 segments in 38 patients of which 9 had past history of myocardial infarction. Global InD for healthy subjects was 28% vs 19% SEM 0.97, as compared to patients with MI (p:< 0.00001). Conclusions: InD is capable of quantification of abnormal motility in subjects with myocardial infarction, therefore producing an objective measure of LV segmental WM abnormalities, further studies are warranted.

Abstract 14708: Cardiovascular Calcium Scoring by Deep Learning is Predictive of Mortality in Emergency Department Patients

Introduction: Computed tomography (CT) imaging is widely used in the emergency department (ED) setting. Calcifications of the coronary arteries, heart valves, and aorta are common incidental findings that may herald clinical or subclinical cardiovascular disease. Hypothesis: We sought to determine whether the quantitative burden of cardiovascular calcifications, as measured by a CT-based deep learning pipeline, would be predictive of short-term mortality in a diverse population of ED patients. Methods: We conducted a prospective single-center cohort study nested in the Quebec COVID-19 Biobank from March 2020 to September 2021. For the purposes of this study, we enlisted adult patients presenting to the ED with cardiopulmonary symptoms who were tested for COVID-19 and underwent CT imaging of the chest. We used a deep learning model previously developed by our team to automate the quantitative scoring of coronary artery calcification (CAC), aortic valve calcification (AVC), mitral annular calcification (MAC), and thoracic aorta calcification (TAC) from the CT images. These calcium scores were categorized as sex-stratified tertiles plus a zero-score referent category. The primary outcome was all-cause mortality at 30 and 90 days adjusted for age, sex, and COVID-19 status using multivariable logistic regression. Results: The study sample consisted of 731 ED visits among 271 unique patients with a mean age of 66 years and 47% females. COVID-19 illness was the main diagnosis in 29% of ED visits. The prevalence of any quantifiable calcification was 51% for CAC, 33% for AVC, 23% for MAC, and 80% for TAC. The statistically significant adjusted odds ratios for mortality were 2.50 (1.08, 5.81) in the highest AVC tertile at 30 days, 2.73 (1.37 5.47) in the highest CAC tertile at 90 days, and 4.42 (1.01, 19.4) in the highest TAC tertile at 90 days. These odds ratio remained similar after further adjustment for past history of myocardial infarction or heart failure. Conclusions: High calcium scores in the coronary arteries, aortic valve, and thoracic aorta are associated with heightened 30-day mortality in ED patients. Deep learning quantification of calcium scores from clinical CT scans is an opportunistic approach for risk stratification.

Histology-verified myocardial fibrosis and quantification in severe AS patients: correlation with non-invasive LV myocardial tissue assessment

Abstract Background Myocardial fibrosis (MF) is a common finding and a potential adverse prognostic marker in several cardiac diseases, including in severe aortic stenosis (AS). While histological analysis obtained through endomyocardial biopsy remains the gold-standard for MF assessment, non-invasive cardiac imaging may offer surrogate biomarkers for fibrosis. We tried to assess the correlation between MF quantification at histopathology and cardiac magnetic resonance (CMR)-derived tissue characterization data in patients with severe AS. Methodology Single-center prospective cohort enrolling 71 patients with severe symptomatic high-gradient AS undergoing surgical aortic valve replacement (SAVR) (mean age 71±9 years; 49% male, mean valvular transaortic gradient 60±20 mmHg; mean left ventricle [LV] ejection fraction 58±9%). Those with past history of myocardial infarction or cardiomyopathy were excluded. All patients underwent pre-operative CMR study with LV tissue characterization and quantification. Normal T1 mapping value was defined as >1021ms as per center protocol. Myocardial tissue was obtained during SAVR either through myocardial biopsy at basal LV septum or harvested from surgical myectomy specimens. Masson's trichrome stain was used for collagen/fibrosis assessment. Automatic quantification was obtained at QuPathTM digital pathology software after applying a dedicated artificial intelligence algorithm on ultra-high-resolution digital slide scanning images. Results Histology-confirmed MF was observed in all patients (median percentage of fibrotic myocardial tissue 15% [IQR 9–22%]). Median global T1 mapping and extracellular volume (ECV) percentage was 1048ms (IQR 1027–1078) and 24% (IQR 20–30%), respectively. Late gadolinium enhancement (LGE) with a non-ischemic pattern was present in 42 patients (59%) with a median LGE mass of 5.8g [IQR 1.0–10.2]; median percentage of 3.7% [IQR 0.6–10.4]. While neither T1 mapping (global or basal LV septum), ECV nor LGE had any significant correlation with histology-confirmed MF (Figure 1) the vast majority had significantly elevated global and basal LV septum T1 mapping – 81% and 92%, respectively. Conclusion In this single-center prospective study, microscopic MF was present in all patients with severe symptomatic high-gradient AS, was accompanied by elevated T1 mapping values but no correlation was found between myocardial fibrosis at histopathology analysis and CMR-derived LV tissue characterization parameters. This may not only stem from sampling (single point biopsy vs. whole myocardial tissue assessment) but also from distinct evaluation of different types of fibrosis by different methods. Funding Acknowledgement Type of funding sources: None.

Clinico-angiographic profiles and in-hospital outcomes of non-ST segment elevation myocardial infarction in Kurdistan Region of Iraq

Objectives: This work aimed to study the clinical, angiographic profiles and in-hospital outcomes of NSTEMI cases in Duhok, Iraq.
 Methods: This prospective study involved 283 patients with NSTEMI who were admitted to Azadi teaching hospital/Azadi heart center in Duhok, Kurdistan region of Iraq, between 2021 and 2022. The patient's demographic variables, major cardiovascular risk factors (smoking, hypertension, diabetes mellitus, hyperlipidemia and family history of coronary artery disease), clinical presentation, past history of myocardial infarction/ previous percutaneous coronary intervention (PCI) and drug history were collected. The GRACE risk score was calculated for each patient. Patients were followed up regarding the management strategies (whether conservative or invasive approach), and in-hospital complications and outcomes.
 Results: The mean GRACE score was 142±26. 70% of cases underwent coronary angiography/ angioplasty, with a mean time to the coronary intervention of 8 days. 17% of the sample had developed different cardiovascular complications, with heart failure being the most common. The mortality rate was 7.4%.
 Conclusion: The study demonstrated higher complications and mortality rates, especially among patients with higher GRACE scores, compared to rates found in most available studies, particularly in western countries. This finding could be secondary to a suboptimal coronary intervention for NSTEMI in terms of time to intervention and the proportion of patients who underwent it.

Clinical impact of peripheral artery disease on acute coronary syndrome

Abstract Introduction Peripheral artery disease (PAD) and acute coronary syndrome (ACS) are two diseases with high morbidity and mortality and, sometimes, may be present simultaneously, making patient management more complex. Purpose This study sought to characterize and evaluate the prognostic impact of PAD in patients with an ACS. Methods This was a retrospective study of patients admitted with an ACS, periodically included in a national multicenter registry, between October 2010 and September 2019. Results Of a total of 26036 patients, 1429 had previous history of PAD. This group had a higher predominance of men (79,5% vs 72,0%, p<0,001) and was older (71±11 years vs 66±14 years, p<0,001). Besides having a higher burden of cardiovascular risk factors, they also had more past history of myocardial infarction (MI), stroke and chronic kidney disease. In patients with PAD, non-ST segment elevation MI was the most frequent type of MI (58,6% vs 45,0%, p<0,001) and left ventricular ejection fraction assessed during hospitalization was lower (49±13% vs 51±12%, p<0,001). These patients were submitted less frequently to a coronary angiography (74,0% vs 85,2%, p<0,001) and, when performed, more cases of multivessel coronary artery disease were found (70,6% vs 50,4%, p<0,001). Nevertheless, they were less likely to undergo revascularization, with fewer angioplasties performed (47,8% vs 64,7%, p<0,001), despite the greater number of coronary artery bypass grafting (9,0% vs 6,0%, p<0,001). Both during hospitalization and at discharge, ticagrelor, beta-blockers and ACE inhibitors were less prescribed in the PAD group. Statins prescription was also lower, but only at discharge. In a multivariate regression analysis, we found that, during hospitalization, the presence of PAD was associated with a significant higher risk of myocardial reinfarction (OR 1,90 (CI 1,18–3,06)) and death (OR 1,43 (CI 1,03–2,00)). In addition, there was a tendency for more strokes (OR 1,88 (CI 0,98–3,61)). During a 1-year follow-up, PAD was also independently associated with a significant increase in mortality (HR 1,50 (CI 1,16–1,95)). Conclusions PAD is a disease present in patients with a higher number of comorbidities and is associated with more severe coronary events. Nevertheless, these patients seem to receive less evidence-based therapy. In this study, PAD was independently associated with a significant increase in short and medium-term major adverse events. Kaplan-Meier curves of 1-year follow-up Funding Acknowledgement Type of funding source: None

SAT-576 Possible Involvement of Thyroid Function in PCSK9 Inhibitor Therapy

INTRODUCTIONProprotein convertase subtilisin kexin type 9 (PCSK9) inhibition is an effective strategy for lowering plasma LDL-cholesterol and enhancing the LDL-cholesterol lowering ability of statins. PCSK9, a serine protease that binds to the LDL receptor promoting its degradation, is an important regulator of LDL metabolism. In addition, LDL-cholesterol is also controlled by TSH and thyroid hormones via PCSK9. TSH has received increasing attention as being closely associated with increased LDL-cholesterol level and higher atherosclerotic risks. In vitro study, the effects of TSH on hepatic PCSK9 expression in HepG2 cells were reported (1). I here report a case of transient hyperthyroidism secondary to PCSK9 inhibitor therapy. This case highlights the involvement of thyroid function in PCSK9 Inhibitor therapy.CLINICAL CASEA 65-year-old man had a weight loss of 6 kg (13 lbs.) in 4 months, accompanied with fatigue. He had a past history of myocardial infarction and his LDL was 83 mg/dL by 2.5mg of rosuvastatin and heart rate was controlled by 10mg of carvedilol. Six months ago, he started a PCSK9 Inhibitor therapy with 140mg of evolocumab every 2 weeks for 6 weeks. He had no preceding viral illness and denied anterior neck pain or tenderness. His height was 1.53 m, weight 52.6 kg (115 lbs.), and body mass index (BMI) 22.46 kg/m2. His thyroid was not enlarged and non-tender without clear palpable thyroid nodules or neck lymph nodes. Hyperthyroidism was suspected and confirmed by thyroid function tests: TSH was less than 0.0005 μIU/mL (normal 0.35–4.94), and free T4 1.830 ng/dL (0.70–1.48). Graves’ disease was considered, and thyroid antibody tests performed. Thyroid peroxidase (TPO) antibody titer was less than 9 IU/mL (<9), and TSI 141% (<120%). To confirm the diagnosis of this hyperthyroid patient, Technetium-99m uptake and scan was done which showed uptake of 0.8% (0.5–7%). After careful observation for 2 months with 5mg of carvedilol, he turned asymptomatic and free T4 lowered to 1.480 ng/dL and TSH remained less than 0.0005 μIU/mL.CLINICAL LESSONSI here report a case of transient hyperthyroidism secondary to PCSK9 inhibitor therapy. There has been no report of hyperthyroidism induced by PCSK9 inhibitors. Immunological influence of anti-PCSK9 therapy on thyroid is unknown. In this case, the decrease of TSH due to hyperthyroidism was considered to reduce hepatic PCSK9 expression, leading to additive effect to PCSK9 inhibitor. PCSK9 inhibitors may modify the effects of hyperlipidemia treatment by causing changes in thyroid function. When using PCSK9 inhibitors, follow-up of thyroid function should be considered. This case highlights the involvement of thyroid function in PCSK9 inhibitor therapy.Reference(1) Gong, Y., Ma, Y., et al. Thyroid stimulating hormone exhibits the impact on LDLR/LDL-c via up-regulating hepatic PCSK9 expression. Metabolism. 2017;76;32–41

Impact of updated recommendations on acetylsalicylic acid use for primary prevention of cardiovascular disease in Canada: a population-based survey.

The debate over acetylsalicylic acid (ASA) therapy for primary prevention of cardiovascular disease (CVD) has recently resurfaced, but scarce data are available on prophylactic ASA use in Canada for this purpose. This study aimed to evaluate the prevalence and factors associated with ASA use, and the potential impact of implementing the most recent (2016) US Preventive Services Task Force recommendations for primary CVD prevention in a Canadian setting. We performed a cross-sectional analysis using data from the CARTaGENE study, which included a representative sample (n = 20 004) of the 2018 general population of the province of Quebec. We assessed eligibility for ASA treatment using US Preventive Services Task Force criteria (age 50-69 yr, no past history of myocardial infarction or stroke, and 10-year risk of CVD of at least 10%). We extrapolated to the entire 2018 Quebec population the number of people who would need to start ASA treatment. A total of 6231 respondents in the CARTaGENE study (54.2% of those aged 50-69 yr with no prior history of CVD) were found to be potentially eligible for ASA use for primary CVD prevention. Of the 6231, 1379 (22.1%) were receiving prophylactic ASA treatment. Factors found to be related to ASA use included age, male sex, regular medical visits, lower education level, obesity, hypertension, diabetes and dyslipidemia. Income and smoking status were not found to be significantly associated with ASA use. Our results indicate that 885 261 people would potentially have started ASA treatment if the US Preventive Services Task Force recommendations had been implemented in Quebec in 2018. Prevalent ASA use for primary CVD prevention was low. Implementation of the 2016 US Preventive Services Task Force recommendations would require initiating ASA treatment in a substantial proportion of people, with undetermined potential benefits.

P1474Simpsons Triplane versus Biplane for left ventricle ejection fraction after myocardial infarction

Abstract Introduction Simpson's biplane (SBP) ignores the apical long-axis plane. It is estimated that 40% of myocardial infarction (MI)-related segmental abnormalities are located in this plane. The real-time triplane (RT3P) overcomes this issue, allowing to obtain all apical views simultaneously, at the same cardiac cycle. This method could be a more precise and reliable alternative to SBP in ejection fraction (EF) quantification in this setting. Purpose The authors aimed to compare EF assessed by two quantification methods, SBP and RT3P, using quantitative three-dimensional echocardiography (3DE) as the reference method, in patients with MI. Methods We have prospectively gathered data from 52 adult patients, which had recent or past history of MI. Exclusion criteria were the presence of atrial fibrillation, unknown coronary anatomy, significant valvular disease, left branch block, ventricular pacing and poor definition of endocardial borders. Estimation of EF by SBP, RT3P and 3DE was performed in all patients and gathered by two experienced operators. The two operators were blinded for the coronary angiography results before volume quantification. They were also blinded for their own measurements, as well as for the other operator's measurements. Spearman's correlation and linear regression were performed for correlation analysis. Bland-Altman plot was used for agreement assessment among the different methods. Interobserver agreement was assessed by Cohen's kappa. Results Patient characteristics are shown in table 1. EF calculation was feasible in all patients. There were excellent correlations between EF measured by SBP vs 3DE and RT3P vs 3DE (r=0.813 and r=0.9 respectively). Test of equality between two correlation coefficients confirmed that EF by RT3P method is significantly more correlated with the reference method, compared with EF by SBP (p=0.004). We have also performed a further analysis to study this results in special subsets. In anterior MI subset, EF by RT3P correlated by 0.909 with 3DE, versus 0.826 from EF by SBP (p=0.019). In inferior MI subset, EF by RT3P correlated by 0.779 with the reference method, versus 0.706 from EF by SBP (p=0.246). Fig 1 Correlation and Bland-Altman plot Conclusions Estimation of EF using SBP and RT3P methods by experienced operators strongly correlate with EF determined by 3DE. The RT3P method showed the strongest correlation between the two methods, which may point to its usefulness in the evaluation of EF in patients with anterior wall motion abnormalities after myocardial infarction.

Furosemide induced bullous pemphigoid: a case report

Bullous pemphigoid is an acquired autoimmune disease characterized by subepidermal vesicles and bullae. The etiology is mostly idiopathic with the highest occurrence in elderly patients. However, it is now well-accepted that bp has been triggered by or associated with drug therapy. Over 50 agents have been implicated as a cause of Drug-induced bullous pemphigoid, including diuretics, ace inhibitors, and antibiotics. We present a case of Bullous pemphigoid in a 75 year old male probably induced by furosemide. A 75 year old male was admitted to the dermatology department of KIMS hospital, Bengaluru. Presented with multiple tense bullae and vesicles over both upper limbs, forearm and few collapsed bullae and vesicles over the extensor aspect of forearm. Patient had a past history of myocardial infarction and undergone coronary artery bypass grafting for the same and treated with multiple medications. Among the treatment given injection furosemide was the one of the drug, after which he developed lesions and also presented with fluid filled bullae. A diagnosis of bullous pemphigoid was made based on clinical history and was treated with prednisolone, halobetasol and antibiotics. The lesions improved significantly with the above management and patient recovered enough to be discharged from the hospital after 5 days. Severe and serious reactions such as bullous pemphigoid can be caused by used drugs like furosemide.

Evaluation of the optimal values of cholesterol of high density lipoproteins in a cohort of men aged 40-59 with myocardial infarction (according to 30-year monitoring of the status of life)

Aim. To establish connection between the functions of 30-year survival rate and concentration of cholesterol high density lipoproteins (C-HDL) in men aged 40-59 years with a past history of a myocardial infarction (MI) and relying on the obtained data to determine the optimal level of C-HDL for the specified cohort.Material and methods. The study includes 141 patients who have had MI more than 6 months ago and observed in clinics of Metallurgical district of the city of Chelyabinsk within the third group of dispensary register. Specified MI cases refer to types 1, 2 of the Third universal definition of MI. The initial stage of study of the target group of men who have a past history of MI lasted from 03.06.1974 to 24.11.1975. Observation points were 0 and 30 years. The endpoint was death. Information about the dead established during the annual monitoring of the status of life. During the observation period 130 persons/92,2% died. Evaluation of survival was carried out according to the method of Kaplan-Meier, based on which a Cox regression model was built with the inclusion of successively higher minimum level of C-HDL, so that survival curves were significantly different. 95% confidence intervals were determined. The confidence bands of survival functions were built on the basis of on non-parametric Kolmogorov-Smirnov test.Results. The analysis of the function of 30-year survival in men aged 40-59 with past history of MI, depending on the level of HDL-C showed: the presence of statistically significant relationships between survival and levels of HDL-C. Optimal concentrations of HDL cholesterol for survival were the values of HDL-C ≥2,0 mmol/l. Statistically significant periods of survival differences are shown on survival curves at different levels of HDL-C. The possibility of prediction of survival of each patient to a certain time depending on the level HDL-C is determined. Initial levels of HDL-C determine the beginning, duration, end of periods of statistically significant survival differences on survival curves.Conclusion. The analysis of 30-year monitoring of the life status of cohort of men aged 40-59 with past history of MI showed a statistically significant dependence of survival on the initial level of HDL-C. The initial concentration of HDL-C are optimal for survival of indicated cohorts of men. HDL-C levels of 2,0-2,9 mmol/l can serve as a therapeutic target for men aged 40-59 with a past history of MI. The functions of 30-year survival in the cohort of middle-aged men who underwent MI, allow to determine the probability of survival of patients with this level of HDL-C to certain time.

A17757 Hypertension in the Lowest Decile Income Population of Guilan, North of Iran

Objectives: Consumption of salty sea foods is very common in northern Iran. On the other hands, cardiovascular events are the leading cause of mortality not only in high income population but also in low income group. It seems that the prevalence of risk factors varies in different income groups. Methods: This was a community base cross sectional study in a representative sample of population who was under support of Imam Khomeini Relief Foundation of from16 cities in northern Iran. Subjects 30 year old and older were interviewed and examined by a trained research team. Blood samples were drawn for biochemical testing. Data analysis was done using SPSS ver 18 software and χ2 test. Results: A total of 22541 persons [8845 men (39.3%) and 13696 women (60.7%)] aged 30 to 103 years with mean age of 69.9 ± 13.2 years were enrolled. Hypertension was seen in 36.9% of cases that most of them were uncontrolled. prevalence of diabetes among this population was 14.5% that only less than one third of them had proper control.. Dyslipidemia was prevalent as 15.7%. 6.1% had past history of Myocardial infarction. Conclusion: The present study showed a different pattern of cardiovascular risk factors in low income groups in comparison to high income population which should be considered in interventional programs.

Gender-associated dimensional differences among normal to non-flow limiting coronary artery dimensions

Aim and objectivesTo study gender-specific differences in coronary artery diameters among subjects with normal to non-flow limiting disease (NFLD) coronary arteries (up to 0 - 20% of stenosis) and to assess the possible association of body-mass index (BMI) with coronary dimensions, among the west coastal population of Karnataka and Kerala. Materials and MethodsA prospective cohort study was conducted for a period of one year. Two thousand angiograms samples were collected and assessed from two study centers (one from each state), after obtaining the ethical clearance. Patients with past history of myocardial infarction and those with recanalized normal looking coronary arteries and those who had diabetes for more than five years were excluded. Ten segments of coronary arteries- left main coronary artery, ostial and proximal segments of left anterior descending artery and its first diagonal branch, ostial and proximal segments of left circumflex coronary artery and its obtuse marginal branch, ramus intermedius and the ostial and proximal segments of the right coronary artery- were included in diameter measurement. BMI values of the patients were calculated. ResultsOut of 2000 patients included in the study, 454 (22.7%; mean age 53.4 ± 14.2 years) had normal to NFLD coronaries of which 253 (55.7%) were males and 201 (44.3%) were females. As compared to women, men had larger diameters of coronary arteries for eight segments, except the obtuse marginal branch and the proximal right coronary artery. A weak, yet statistically significant, negative correlation existed between BMI and coronary artery diameters in total cohort, indicating that an increase in BMI was associated with a decrease in artery diameters. No such association was seen when men and women were assessed separately. ConclusionsThe present study indicates that men have higher caliber for coronary arteries compared to women. The study also indicates that when BMI increases there is a relative decrease in the coronary artery diameter.

Prevalence, management and control of hypertension in older adults on admission to hospital

IntroductionThe aim of this study was to explore the prevalence and management of hypertension among older adults on admission to hospital and to assess the choice of antihypertensive pharmacotherapy in light of relevant comorbid conditions using the national treatment guideline. Materials and methodsA retrospective cross sectional study of 503 patients aged 65years or older admitted to a large metropolitan teaching hospital in Sydney Australia was conducted. The main outcome measures were prevalence of hypertension, blood pressure (BP) control, antihypertensive medication use and the appropriateness of antihypertensive medications. ResultsSixty-nine percent (n=347) of the study population had a documented diagnosis of hypertension and of these, approximately one third were at target BP levels on admission to hospital. Some concerns regarding choice of antihypertensive noted with 51% of those with comorbid diabetes and 30% of those with comorbid heart failure receiving a potentially inappropriate antihypertensive agent. ConclusionsDespite the use of antihypertensive pharmacotherapy, many older adults do not have optimal BP control and are not reaching target BP levels. New strategies to improve blood pressure control in older populations especially targeting women, those with a past history of myocardial infarction and those on multiple antihypertensive medications are needed.

Ocena niechirurgicznego leczenia periodontologicznego u pacjentów z przebytym zawałem mięśnia sercowego

Ocena niechirurgicznego leczenia periodontologicznego u pacjentów z przebytym zawałem mięśnia sercowego

Abstract 12939: 18 F-Sodium Fluoride Positron Emission Tomography for Molecular Imaging of Coronary Atherosclerosis Based on Computed Tomography Analysis

Background: Arterial 18 F-sodium fluoride ( 18 F-NaF) uptake on positron emission tomography (PET) has been reported to reflect active atherosclerosis with osteogenesis and inflammatory stimulus. We evaluated the relation of 18 F-NaF uptake to computed tomography (CT)-based coronary atherosclerosis. Methods: We enrolled 25 patients with ≥1 coronary atherosclerotic lesions detected on cardiac CT, who underwent 18 F-NaF PET/CT. Each lesion was evaluated with luminal stenosis and plaque types (calcium plaque = CP, non-calcified plaque = NCP, and partially calcified plaque = PCP) on coronary CT angiography. For CP and PCP, focal calcium density and volume were measured on plain CT images. For NCP and PCP, the presence of CT-based high-risk features (minimum CT density ≤30 Hounsfield units, and vascular remodeling index ≥1.1) was determined. Focal 18 F-NaF uptake of each lesion on PET/CT was quantified by maximum tissue-to-background ratio (TBR max ). Results: A total of 87 lesions were studied. In a patient-based analysis, 12 patients having a past history of myocardial infarction or unstable angina showed higher maximum TBR max per patient than those without (Fig 1). In a lesion-based analysis, PCP had higher TBR max than CP and NCP, and the lesions with high-risk features had higher TBR max than those without (Fig 2, 3), while TBR max did not correlate with focal calcium density (r = 0.05, p = 0.65) or volume (r = 0.18, p = 0.12). On multivariate analysis adjusted for the presence of &gt;50% stenosis, focal calcium density and volume, and location of lesions, the plaque type of PCP showed a significant correlation with increased TBR max (β = 0.57, p &lt; 0.0001). Conclusions: Coronary arterial 18 F-NaF uptake, independently of calcium amount, is related to the heterogeneous and high-risk features of coronary atherosclerosis based on CT analysis. 18 F-NaF PET/CT may provide a new molecular imaging approach to identify high-risk patients and coronary lesions, in combination with cardiac CT.

High Sensitivity C-Reactive Protein an inflammatory marker and lipoprotein levels in patients with coronary heart disease

Background: C-Reactive Protein is a good marker of systemic inflammation which can be measured easily. Atherosclerosis lesions are intimal thickening of arteries. Inflammatory and immune cells constitute an important part of atheroma. C-RP levels at the upper end of the normal range indicate that a low level of inflammatory response has been initiated. Measurment of hs CRP provides a method to assess the risk of cardiovascular disease very early in life. Aim: Estimation of High sensitivity C-Reactive Protein (HS-CRP) levels which is a marker of inflammation in serum of normal people and patients with past history of myocardial infarction. Materials and Methods: Twenty six serum samples from patients with coronary heart disease (who had previous history of Myocardial Infarction) and twenty-one control samples and were included in the study. High sensitivity C-reactive protein and lipoprotein profile were estimated in patients with coronary heart disease and in age matched controls. Statistical Analysis- All data were represented as mean ± SD. Experimental data were statistically analyzed by students t’-test. For all analysis statistical significance was considered as p &lt; 0.05. Results: Mean hs C-RP level is significantly elevated in patients who had myocardial infarction when compared with age matched controls. Total cholesterol, LDL cholesterol also found to be increased in individuals who had myocardial infarction. Conclusion: Inflammation plays an important role in myocardial infarction. Increased risk of MI is seen in those individuals who have higher levels of hsC-RP. There is also increase in total cholesterol and LDL cholesterol in subjects who had myocardial infarction when compared to controls. Coronary artery disease may be prevented by reducing the inflammation in addition to reducing the LDL cholesterol

Abstract 215: Fatal Arrhythmia In The Adult Patient Of Kawasaki Disease

We herein report the two adult patients hardly predictable sudden cardiac arrest caused by presumed Kawasaki disease (KD). Case 1: A 29- year-old man who had a history of KD at 10 months of his age complicated with bilateral giant coronary aneurysms, and was received a surgery of coronary artery bypass grafting (CABG) when he was 17 years old. He was transferred to emergency center because of sudden cardiac arrest during live concert and revived by automated external defibrillator (AED). Case 2: A 26-year-old man with a history of KD at 1year old of his age, complicated with bilateral giant coronary aneurysms, and was received a catheter intervention of rotational atherectomy (ROTA) to left anterior descending (LAD) artery at 16 years old of his age. He suddenly fell with ventricular fibrillation (VF) on playing futsal, and was hospitalized after revival by AED. Both of them had past history of myocardial infarction (MI) in their youths, however, did not have left ventricular dysfunction, symptomatic arrhythmia, and evidence of acute MI at admission. Therefore, it was difficult to strongly predict possibility of fatal arrhythmia in these cases. Finally, they received the second CABG’s for each after stabilizing and returned to their daily lives. It had been rarely reported a fatal arrhythmia in asymptomatic KD patients with normal left ventricular function with revival with recent spread of life support with public access of defibrillator. Our experiences may suggest one style with a paradigm shift in management of patients with coronary artery complications at the remote period of KD.

Factors affecting time to arrival in hospital among patients with acute myocardial infarction (MI)

Time is crucial in the treatment of acute myocardial infarction but patients still come late to the hospital. This study aims to determine the factors which delay such patients coming to the ICCU. 100 patients (74 men &amp; 26 women) of acute MI were interviewed. The mean time from symptom onset to ICCU arrival was 28 hrs. 55 min. (+ 96hrs 45min). 51 patients came within 6 hours – 13, 20 and 18 within 1,3 and 6 hours. Using the dependent variable of time as a binomial variable, univariate analysis showed that a perception that the chest pain could be cardiac in origin was more common among the early arrivers (&lt;6 hrs) while, visiting a doctor in the clinic instead of going to an ICU directly, was more common among the late arrivers. Logistic regression analysis showed these two as significant factors with a weak to moderate relation (coefficient of determination r 2 = 0.22 only). Analyzing the data using time as a continuous variable, which is the more appropriate statistical method, the statistical significance of the above two factors reduced to a trend, while another factor emerged – presence of a (para)medical person in the family hastened arrival to the ICCU. Multiple regression analysis did not reveal a statistically significant correlation (r2 = 0.089). Gender, age, literacy, mode of transport and past history of MI were not significant factors. To conclude, patients with acute MI still arrive late to the ICCU with two important reasons being the decision making of the patient based on a perception that the pain could be cardiac, and, going to an ICCU directly rather than to a doctor‟s clinic or hospital without such facility.

Lung cancer surgery in patients aged 80years or older: an analysis of risk factors, morbidity, and mortality.

As the population ages, the age of patients undergoing thoracic surgery increases, and elderly patients often have more comorbidities than younger patients. This retrospective study observed preoperative comorbidities, surgical procedures and postoperative morbidity and mortality after lung cancer surgery in patients 80 years of age or older. The medical records of lung cancer patients 80 years of age or older who underwent surgery from January 2003 to December 2012 were reviewed. There were 49 patients (27 males, 22 females), with a median age of 83 years. Thirty patients underwent major pulmonary resection and 18 patients underwent limited pulmonary resection. The median Charlson comorbidity index was 3. Although approximately two-thirds of the patients (20 patients; 40.8%) experienced some kind of postoperative morbidity, more than 80% of the complications were grade 1 or 2 according to the Clavien-Dindo classification. Cerebrovascular disease and chronic obstructive pulmonary disease were significantly associated with moderate-to-severe complications. Postoperative death was observed in two cases (4.1%). In addition, an increased American Society of Anesthesiologists classification score and past history of myocardial infarction, congestive heart failure and/or diabetes mellitus with end-organ damage were significantly associated with mortality. The overall survival rate was 79.6% at 3 years and 53.1% at 5 years. Thoracic surgery shows acceptable morbidity and mortality in patients 80 years of age or older. Patients 80 years of age or older should be offered the best treatments, including surgery, with careful patient evaluation and selection.