Post-acute Myocardial Infarction Patients Research Articles

Assessment of post-myocardial infarction lipid levels and management: Results from a tertiary care hospital of Pakistan.

Lipid treatment practices and levels in post-acute myocardial infarction (AMI) patients, which are crucial for secondary prevention. To evaluate the lipid treatment practices and lipid levels in post-myocardial infarction (MI) patients at a tertiary care hospital in Pakistan. In this cross-sectional study, we analyzed patients who had experienced their first AMI event in the past 3 years. We assessed fasting and non-fasting lipid profiles, reviewed statin therapy prescriptions, and examined patient compliance. The recommended dose was defined as rosuvastatin ≥ 20 mg or atorvastatin ≥ 40 mg, with target total cholesterol levels set at < 160 mg/dL and target low-density lipoprotein cholesterol (LDL-C) at < 55 mg/dL. Among 195 patients, 71.3% were male, and the mean age was 57.1 ± 10.2 years. The median duration since AMI was 36 (interquartile range: 10-48) months and 60% were diagnosed with ST-segment elevation MI. Only 13.8% of patients were advised to undergo lipid profile testing after AMI, 88.7% of patients were on the recommended statin therapy, and 91.8% of patients were compliant with statin therapy. Only 11.5% had LDL-C within the target range and 71.7% had total cholesterol within the target range. Hospital admission in the past 12 months was reported by 14.4%, and the re-admission rate was significantly higher among non-compliant patients (37.5% vs 5.6%). Subsequent AMI event rate was also significantly higher among non-compliant patients (43.8% vs 11.7%). Our study highlights that while most post-AMI patients received the recommended minimum statin therapy dose, the inadequate practice of lipid assessment may compromise therapy optimization and raise the risk of subsequent events.

Smoking behaviour in post-acute myocardial infarction patients: cross-sectional study.

Heart disease remains the leading cause of death in developed countries, and cigarette smoking contributes to a significant proportion of cardiovascular-related deaths. Abstaining from tobacco use is associated with a significant reduction in the risk of recurrent myocardial infarctions. In this cross-sectional study, 384 participants post-acute myocardial infarction (MI) were recruited through random sampling to explore the associations between smoking status and intention to quit smoking. Data collection took place over a 6-month period at a tertiary care hospital, Islamabad, Pakistan. The majority of participants were male (59.9%) and fell into the age category of 46-50 years (37.5%). Heavy daily smokers comprised the largest smoking group (41.6%), and non-ST-elevated MI was the most common subtype (40.1%). Intention to quit smoking varied among participants, with the pre-contemplation stage having the highest representation (19.3%), followed by contemplation (25.8%). Notably, a significant proportion of participants expressed no intention to quit smoking (35.4%). Multinomial logistic regression analysis identified current smoking as a significant predictor of intention to quit in the preparation and contemplation stages. Overall, this study underscores the importance of considering smoking behaviour when evaluating the intention to quit smoking post-MI and highlights the need for tailored interventions and support strategies to address smoking cessation in this population. These findings offer valuable insights for the development of effective strategies aimed at reducing persistent smoking following MI and improving patient outcomes.

Factors Associated With Mortality During the First Year Post Infarction: Survival Analysis of Patients With Acute Myocardial Infarction in Colombia.

Cardiovascular diseases account for over 80% of global deaths. Risk factors and social determinants influence mortality in patients post acute myocardial infarction (AMI). To evaluate factors associated with post-AMI mortality during the one-year follow-up. The study is a prospective cohort study of adults aged 18 years and older with type 1 AMI conducted between October 2021 and January 2024. Intrahospital and outpatient information was collected. Statistical analyses included the Kaplan-Meier survival curve and Cox regression analysis. Proportional hazards and model predictive capacity were evaluated. A total of 1873 patients were included, with a 9.4% mortality rate in the first year. At one year, the estimated survival probability was 88.61% (95% CI: 86.82-90.18). Cox analysis identified several factors associated with mortality, highlighting age (HR = 1.04, 95% CI: 1.02-1.06, p = 0.001), diabetes (HR = 1.77, 95% CI: 1.09-2.87, p = 0.020), renal insufficiency (HR = 2.25, 95% CI: 1.32-3.84, p = 0.003), and type of intervention. The model evaluation showed strong predictive capacity. It is essential to emphasize the importance of comprehensive management in AMI patients with risk factors such as diabetes and chronic kidney disease, as they are significant predictors of mortality during the first year post infarction.

Efficacy and safety of CDR132L in patients with reduced left ventricular ejection fraction after myocardial infarction: Rationale and design of the HF-REVERT trial.

Inhibition of microRNA (miR)-132 effectively prevents and reverses adverse cardiac remodelling, making it an attractive heart failure (HF) target. CDR132L, a synthetic antisense oligonucleotide selectively blocking pathologically elevated miR-132, demonstrated beneficial effects on left ventricular (LV) structure and function in relevant preclinical models, and was safe and well tolerated in a Phase 1b study in stable chronic HF patients. Patients with acute myocardial infarction (MI) and subsequent LV dysfunction and remodelling have limited therapeutic options, and may profit from early CDR132L treatment. The HF-REVERT (Phase 2, multicenter, randomized, parallel, 3-arm, placebo-controlled Study to Assess Efficacy and Safety of CDR132L in Patients with Reduced Left Ventricular Ejection Fraction after Myocardial Infarction) evaluates the efficacy and safety of CDR132L in HF patients post-acute MI (n = 280), comparing the effect of 5 and 10 mg/kg CDR132L, administered as three single intravenous doses 28 days apart, in addition to standard of care. Key inclusion criteria are the diagnosis of acute MI, the development of systolic dysfunction (LV ejection fraction ≤45%) and elevated N-terminal pro-B-type natriuretic peptide. The study consists of a 6-month double-blinded treatment period with the primary endpoint LV end-systolic volume index and relevant secondary endpoints, followed by a 6-month open-label observation period. The HF-REVERT trial may underpin the concept of miR-132 inhibition to prevent or reverse cardiac remodelling in post-MI HF. The results will inform the design of subsequent outcome trials to test CDR132L in HF.

Evaluating time in therapeutic range in post-acute myocardial infarction patients with left ventricular thrombus treated with vitamin K antagonist

Abstract Background The standard of care for the treatment of post-acute myocardial infarction (AMI) patients with left ventricular (LV) thrombus is oral anticoagulation with vitamin K antagonist (VKA). Due to the narrow therapeutic range of VKA, patients require frequent monitoring. Adequacy of anticoagulation can be assessed by time in therapeutic range (TTR). This study aimed to evaluate the clinical characteristics and outcomes of post-AMI patients with LV thrombus treated with VKA, stratified by anticoagulation adequacy in terms of TTR ≥70% vs. TTR &amp;lt;70%. Methods Among 3000 consecutive echocardiogram results containing the keyword "thrombus" from December 2013 to August 2017, we identified 87 post-AMI patients complicated by LV thrombus and treated with VKA oral anticoagulation. Demographics, treatment including TTR, and outcome measures were analysed. Results The cohort was followed up for a median of 4.3 years (IQR 3.6 – 5.3). Patients with and without adequate anticoagulation had no significant differences in terms of age (p = 0.859), gender (p = 0.438), co-morbidities, LV ejection fraction (p = 0.638). A majority of post-AMI patients with LV thrombus treated with VKA had inadequate anticoagulation, as only 25.3% (n = 22) had TTR ≥70%. SAMe-TT2R2 score, a clinical predictor score for adequacy of anticoagulation, was high in the study cohort (median 4, IQR 3 – 5), with no significant difference between the two groups (p = 0.907). On multivariable analysis, TTR &amp;lt;70% was significantly associated with higher incidence of combined outcomes (presence of bleeding, stroke, or mortality) (HR 2.91 [95% CI 1.01 – 8.39], p = 0.048). Patients with TTR &amp;lt;70% had a higher cumulative incidence of bleeding events while on anticoagulation (p = 0.036), and a higher cumulative incidence of overall stroke on Kaplan-Meier analysis, but did not achieve statistical significance (p = 0.077). Patients with TTR &amp;lt;70% had a significantly higher cumulative incidence of combined outcomes (both while on anticoagulation and overall) compared to those with TTR ≥70% (p = 0.026, p = 0.017). Conclusion LV thrombus patients treated with inadequate VKA anticoagulation of TTR &amp;lt;70% had overall poorer outcomes compared to TTR ≥70%. Further studies are needed to evaluate anticoagulation adequacy in this population.

Baseline characteristics of patients enrolled in the EMPACT-MI trial

Abstract Background Empagliflozin has been shown to reduce the risk of adverse cardiovascular (CV) outcomes in patients with type 2 diabetes (T2DM) and in those with heart failure (HF). The impact of empagliflozin in post-acute myocardial infarction (AMI) patients is unknown. Methods and Results The Study to Test the Effect of Empagliflozin on Hospitalization For Heart Failure And Mortality In Patients With Acute Myocardial Infarction (EMPACT-MI) trial screened 6610 participants with AMI and 6522 were randomized to empagliflozin or placebo in addition to standard of care. Patients were eligible for enrollment if they had no history of HF, had been hospitalized with a AMI and had either acute signs or symptoms of congestion that required treatment, and/or a newly depressed LVEF&amp;lt;45%. Patients were also required to have at least one additional risk factor (enrichment criterion). The median (interquartile range) age of trial population was 64 (56-71) years and 75.1% were male. Major comorbidities included hypertension (69.1%), atrial fibrillation (10.9%), prior myocardial infarction (13.0%), and type 2 diabetes (31.7%). The majority (74.3%) of patients presented with an ST elevation myocardial infarction. Overall, 56.9% of patients randomized had acute signs or symptoms of congestion that required treatment, and 78.3% had newly developed left ventricular systolic dysfunction with ejection fraction &amp;lt;45%. Key characteristics of EMPACT-MI patient population are presented on the figure 1. Conclusion EMPACT-MI has randomized 6522 patients with acute MI. EMPACT-MI will establish the benefit and risks of empagliflozin in these patients.

Baseline characteristics of patients enrolled in the EMPACT-MI trial.

Empagliflozin has been shown to reduce the risk of adverse cardiovascular outcomes in patients with type 2 diabetes and in those with heart failure. The impact of empagliflozin in post-acute myocardial infarction (AMI) patients is unknown. The Study to Test the Effect of Empagliflozin on Hospitalization for Heart Failure and Mortality in Patients with Acute Myocardial Infarction (EMPACT-MI) trial screened 6610 participants with AMI and randomized 6522 to empagliflozin or placebo in addition to standard of care. The median (interquartile) age was 64 (56-71) years and 75.1% of patients were male. Major comorbidities included hypertension (69.1%), type 2 diabetes (31.7%), prior myocardial infarction (13.0%), and atrial fibrillation (10.9%). The majority (74.3%) of patients presented with an ST-elevation myocardial infarction. Overall, 56.9% of patients had acute signs or symptoms of congestion requiring treatment and 78.3% had left ventricular systolic dysfunction with ejection fraction <45%. Clinical characteristics, including baseline demographics, rates of revascularization, and cardiovascular medications at discharge were largely comparable to recent trials of the post-AMI population. The EMPACT-MI trial will establish the benefit and risks of empagliflozin treatment in patients with AMI.

Long-term outcomes among stable post-acute myocardial infarction patients living in rural versus urban areas: insights from the prospective, observational TIGRIS registry

BackgroundInsights on the differences in clinical outcomes, quality of life (QoL) and health resource utilisation (HRU) with different levels of care available to post-acute myocardial infarction (AMI) populations in rural...

Insertable cardiac monitors in high-risk post-infarction patients: a cost-effectiveness analysis

Abstract Funding Acknowledgements Type of funding sources: None. Background The randomised SMART-MI trial demonstrated that telemonitoring with insertable cardiac monitors (ICMs) for post-acute myocardial infarction patients with cardiac autonomic dysfunction and a left ventricular ejection fraction between 35-50% is highly effective in detecting serious arrhythmic events (SAE) compared to standard of care (SoC). In SMART-MI, SAE were also predictive of subsequent major adverse cardiac and cerebrovascular events (MACCE) which might be prevented by preemptive interventions. It is unknown whether such a monitoring strategy would be cost-effective. Purpose To evaluate the cost-effectiveness of ICM-based telemonitoring compared to SoC among a UK post-acute myocardial infarction population. Methods We created a Markov model to conduct a cost-effectiveness analysis comparing ICMs to SoC for the SMART-MI population. For the analyses, we hypothesized that the SAE-triggered interventions could prevent clinical complications with certain probabilities. A UK National Health System (NHS) perspective was employed with costs and health-related benefits discounted at 3.5%. We employed 6-months Markov cycles and calculated the model over a lifetime horizon. Patient characteristics and detection probabilities were based on the SMART-MI diagnostic study. UK-specific costs and risk-adjusted parameters were used to model the cardiovascular and cerebrovascular pathways. Scenario, deterministic and probabilistic sensitivity analyses were conducted to control for uncertainty. Results The base-case scenario found an incremental cost-effectiveness ratio (ICER) of the ICM to be £7,812.92 per QALY gained compared to SoC. There were 0.0646 less ischaemic strokes events per patient and 0.0168 less syncope events per patient in the ICM arm compared to SoC. Results were robust to sensitivity analysis. Conclusion Under the assumptions of the study, ICMs were a cost-effective diagnostic tool for detecting arrhythmias compared to SoC, preventing stroke and syncope events in post-acute myocardial infarction patients in the UK.

Predicting new onset atrial fibrillation post acute myocardial infarction: Echocardiographic assessment of left atrial size.

Atrial fibrillation (AF) commonly occurs following acute myocardial infarction (AMI). Left atrial (LA) size has been reported to predict new onset AF in this cohort, however, the optimal metric of left atrial size for risk stratification following AMI is unknown. Patients presenting to a tertiary hospital with incident AMI (NSTEMI or STEMI) and no history of AF were recruited. All patients underwent guideline-based workup and management for AMI, including transthoracic echocardiographic assessment. Three alternative metrics of left atrial size were determined: LA area, maximal and minimal LA volume indexed to body surface area (LAVImax and LAVImin). The primary endpoint was new onset AF diagnoses. Four hundred thirty three patients were included in the analysis, of which 7.1% had a new diagnosis of AF within a median follow-up of 3.8 years. Univariate predictors of incident AF included age, hypertension, revascularization with CABG, NSTEMI presentation, right atrial area, and all three metrics of LA size. Among three multivariable models created for the prediction of new onset AF utilizing alternate metrics of LA size, LAVImin was the only LA size metric found to be an independent predictor. LAVImin is an independent predictor of new onset AF post AMI. LAVImin outperforms echocardiographic assessment of diastolic dysfunction and alternative metrics of LA size (including LA area and LAVImax) for risk stratification. Further studies are needed to validate our findings in post AMI patients, and evaluate whether LAVImin holds similar advantages over LAVImax in other cohorts.

CSL112 Infusion Rapidly Increases APOA1 Exchange Rate via Specific Serum Amyloid-Poor HDL Subpopulations When Administered to Patients Post-Myocardial Infarction.

To characterize the effects of CSL112 (human APOA1 [apolipoprotein A1]) on the APOA1 exchange rate (AER) and the relationships with specific HDL (high-density lipoprotein) subpopulations when administered in the 90-day high-risk period post-acute myocardial infarction. A subset of patients (n=50) from the AEGIS-I (ApoA-I Event Reducing in Ischemic Syndromes I) study received either placebo or CSL112 post-acute myocardial infarction. AER was measured in AEGIS-I plasma samples incubated with lipid-sensitive fluorescent APOA1 reporter. HDL particle size distribution was assessed by native gel electrophoresis followed by fluorescent imaging and detection of APOA1 and SAA (serum amyloid A) by immunoblotting. CSL112 infusion increased AER peaking at 2 hours and returning to baseline 24 hours post-infusion. AER correlated with cholesterol efflux capacity (r=0.49), HDL-cholesterol (r=0.30), APOA1 (r=0.48), and phospholipids (r=0.48; all P<0.001) over all time points. Mechanistically, changes in cholesterol efflux capacity and AER induced by CSL112 reflected HDL particle remodeling resulting in increased small HDL species that are highly active in mediating ABCA1 (ATP-binding cassette transporter 1)-dependent efflux, and large HDL species with high capacity for APOA1 exchange. The lipid-sensitive APOA1 reporter predominantly exchanged into SAA-poor HDL particles and weakly incorporated into SAA-enriched HDL species. Infusion of CSL112 enhances metrics of HDL functionality in patients with acute myocardial infarction. This study demonstrates that in post-acute myocardial infarction patients, HDL-APOA1 exchange involves specific SAA-poor HDL populations. Our data suggest that progressive enrichment of HDL with SAA may generate dysfunctional particles with impaired HDL-APOA1 exchange capacity, and that infusion of CSL112 improves the functional status of HDL with respect to HDL-APOA1 exchange. URL: https://www. gov; Unique identifier: NCT02108262.

Hepatic steatosis and advanced hepatic fibrosis are independent predictors of long-term mortality in acute myocardial infarction.

To examine the prevalence and prognosis of hepatic steatosis and fibrosis in post-acute myocardial infarction (AMI) patients. Patients presenting with AMI to a tertiary hospital were examined from 2014 to 2021. Hepatic steatosis and advanced hepatic fibrosis were determined using the Hepatic Steatosis Index and fibrosis-4 index, respectively. The primary outcome was all-cause mortality. Cox regression models identified determinants of mortality after adjustments and Kaplan-Meier curves were constructed for all-cause mortality, stratified by hepatic steatosis and advanced fibrosis. Of 5765 patients included, 24.8% had hepatic steatosis, of whom 41.7% were diagnosed with advanced fibrosis. The median follow-up duration was 2.7 years. Patients with hepatic steatosis tended to be younger, female, with elevated body mass index and an increased metabolic burden of diabetes, hypertension and hyperlipidaemia. Patients with hepatic steatosis (24.6% vs. 20.9% mortality, P< .001) and advanced fibrosis (45.6% vs. 32.9% mortality, P< .001) had higher all-cause mortality rates compared with their respective counterparts. Hepatic steatosis (adjusted hazard ratio 1.364, 95% CI 1.145-1.625, P= .001) was associated with all-cause mortality after adjustment for confounders. Survival curves showed excess mortality in patients with hepatic steatosis compared with those without (P= .002). Hepatic steatosis and advanced fibrosis have a substantial prevalence among patients with AMI. Both are associated with mortality, with an incrementally higher risk when advanced fibrosis ensues. Hepatic steatosis and fibrosis could help risk stratification of AMI patients beyond conventional risk factors.

Beta-blockers in post-acute myocardial infarction patients: Drug prescription patterns from 2018 to Italy's first wave of the COVID-19 pandemic.

Background: Major guidelines recommend the initiation of a beta-blocker therapy after an acute myocardial infarction (AMI). We aimed to map the treatment pathway of beta-blockers for AMI survivors during the first wave of COVID-19 pandemic in Italy and to investigate predictors for treatment non-initiation. Methods: Healthcare utilization databases of Lombardy Region were investigated. Subjects aged ≥18 years who were hospitalised with AMI in the period February-March-April of 2018, 2019, and 2020 were included, and followed for 30 days from the discharge date, to investigate whether they presented a first prescription of beta-blockers. A multivariate logistic model was performed to evaluate the effect of several covariates on the probability of not receiving a post-AMI beta-blocker therapy. Results: The cohorts comprised 2259, 2383, and 1932 individuals who were hospitalised with AMI in the 3-month period in 2018, 2019, and 2020, respectively. Overall in 2020, about 58-60% of individuals with AMI received a prescription of beta-blockers within 1month after the discharge. A continuous decreasing trend over time was observed. Men were 30% more likely to start the treatment than women, increasing age was associated with significant increasing probability of not receiving a post-infarction beta-blocker therapy, while having received an antihypertensive or lipid-lowering treatment, or having been hospitalized for heart failure prior to the AMI hospitalization reduced the likelihood of not being treated with beta-blockers. Conclusion: The initiation of beta-blocker treatment after AMI remains an under-prescribed practice, that does not seem to have been further affected by the first wave of the COVID-19 pandemic.

Low chronotropic index predicts rehospitalization in post-acute myocardial infarction patients with preserved or mildly reduced left ventricular ejection fraction

Abstract Background There are limited data about the clinical utility of combined stress echocardiography and cardiopulmonary exercise testing (CPET-ESE) in predicting prognosis in patients after acute myocardial infarction (AMI) with preserved left ventricular ejection fraction (LVEF). Aim To assess prognostic parameters using CPET-ESE in post-AMI patients with preserved or mildly reduced LVEF. Methods Eighty-seven patients after the first AMI with LVEF &amp;gt;40% were followed for 2 years (median 1.93 years IQR 1.16–2.41). The composite end-point was all-cause mortality or rehospitalization due to ischaemic heart disease (AMI, unstable angina, percutaneous coronary intervention/coronary artery bypass grafting) or heart failure exacerbation. All patients underwent symptom-limited CPET-ESE on a semi-supine cycle ergometer 3 to 5 weeks after AMI. The chronotropic index was calculated as the percent of heart rate reserve. Six patients refused to complete the survey and they were not included in the analysis. Results Follow-up was conducted in 81 consecutive patients (mean age 59±10 years, 62% males, 50% AMI with ST-segment elevation, 85% on beta-blockers). Mean LVEF was 56±9% and peak VO2 18.5±5.0 mL/kg/min. There were no deaths during follow-up. The composite end-point occurred in 13 patients. In multivariate Cox regression analysis after correction for demographic and clinical variables, only chronotropic index correlated with the composite end-point (HR 0.93, 95% CI 0.87–0.99, p=0.026). A positive predictive value of 33.3% and a negative predictive value of 91.3% (sensitivity 61.5%, specificity 76.5%, area under the curve, AUC 71%) for predicting the composite end-point was established for the chronotropic index ≤36.8% (Fig. 1). There was a statistically significant difference in the composite end-point occurrence (p&amp;lt;0.01) between subgroups with the chronotropic index above and below that threshold (Fig. 2). Conclusions In patients after the first AMI with preserved or mildly reduced left ventricular systolic function, a lower chronotropic index is a predictor of rehospitalization in 2-year follow-up. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Centre of Postgraduate Medical Education, Warsaw, Poland

Plasma tissue factor coagulation activity in post-acute myocardial infarction patients.

IntroductionCoagulation is involved in fibroproliferative responses following acute myocardial infarction (AMI). Left ventricular (LV) remodeling following AMI is closely associated with progression to heart failure. This study aims to assess the association between plasma tissue factor activity and LV remodeling in post-AMI patients.MethodsWe studied 228 patients with AMI and 57 healthy subjects. Patients with AMI were categorized into two age- and sex-matched groups: patients with adverse LV remodeling or reverse LV remodeling, defined by an increase or decrease, respectively, in LV end systolic volume by ≥15% over 6 months. TF activity was measured in plasma collected at baseline (within 72 hours of revascularization), 1 month and 6 months post-AMI. Multiple level longitudinal data analysis with structural equation (ML-SEM) model was used to assess the impact of various clinical variables on TF activity in post-AMI.ResultsPlasma TF activity in post-AMI patients at baseline (29.05 ± 10.75 pM) was similar to that in healthy subjects but fell at 1 month (21.78 ± 8.23, p<0.001) with partial recovery by 6 months (25.84 ± 8.80, p<0.001) after AMI. Plasma TF activity at 6 month post-AMI was better restored in patients with reverse LV remodeling than those with adverse LV remodeling (27.35 ± 7.14 vs 24.34 ± 9.99; p=0.009) independent of gender, age and relevant cardiovascular risk factors.ConclusionsPlasma TF activity decreased after AMI but was better restored at 6 months in patients with reverse LV remodeling. The clinical significance of changes in post-AMI plasma TF activity needs further investigation.

The initial validation of indonesian version of heartqoL: a short health-related quality of life questionnaire for post-myocardial infarction patients

Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Indonesia Ministry of Health Background HeartQoL questionnaire was developed to measure specific health-related quality of life for post-myocardial infarction patients. However, it has not been adapted and tested for its validity and reliability for Indonesian population. Purpose To assess the validity and reliability of the Indonesian version of the HeartQoL Questionnaire in post-acute myocardial infarction patients. Method We admitted 102 Indonesian-native speaking patients treated at a tertiary hospital who experienced the first episode of acute myocardial infarction (93% male; mean age = 56.8 years) into the study. They were randomly contacted to fill out the Indonesian version of HeartQoL and SF-36 questionnaire independently. Construct validity of the HeartQoL questionnaire was analyzed using exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and convergent validity was assessed by correlation of the HeartQoL and SF-36 similar subscales, whereas internal consistency was examined using Cronbach's Alpha value. Results EFA showed that the Indonesian version of HeartQoL consisted of 14-items with a 2-factor structure, and CFA supported the results by showing a satisfactory fit, CFI = 0.972, TLI = 0.961, and RMSEA = 0.075. Convergent validity was shown by r &amp;gt; 0.50 for physical and mental domain. The internal consistency of the HeartQoL scales was indicated by the Cronbach's Alpha value of 0,865-0.953. Conclusions The Indonesian version of the HeartQol questionnaire is a valid and reliable measure to assess the quality of life of patients after myocardial infarction.

Predictive Biomarkers for Postmyocardial Infarction Heart Failure Using Machine Learning: A Secondary Analysis of a Cohort Study.

Background There are few biomarkers with an excellent predictive value for postacute myocardial infarction (MI) patients who developed heart failure (HF). This study aimed to screen candidate biomarkers to predict post-MI HF. Methods This is a secondary analysis of a single-center cohort study including nine post-MI HF patients and eight post-MI patients who remained HF-free over a 6-month follow-up. Transcriptional profiling was analyzed using the whole blood samples collected at admission, discharge, and 1-month follow-up. We screened differentially expressed genes and identified key modules using weighted gene coexpression network analysis. We confirmed the candidate biomarkers using the developed external datasets on post-MI HF. The receiver operating characteristic curves were created to evaluate the predictive value of these candidate biomarkers. Results A total of 6,778, 1,136, and 1,974 genes (dataset 1) were differently expressed at admission, discharge, and 1-month follow-up, respectively. The white and royal blue modules were most significantly correlated with post-MI HF (dataset 2). After overlapping dataset 1, dataset 2, and external datasets (dataset 3), we identified five candidate biomarkers, including FCGR2A, GSDMB, MIR330, MED1, and SQSTM1. When GSDMB and SQSTM1 were combined, the area under the curve achieved 1.00, 0.85, and 0.89 in admission, discharge, and 1-month follow-up, respectively. Conclusions This study demonstrates that FCGR2A, GSDMB, MIR330, MED1, and SQSTM1 are the candidate predictive biomarker genes for post-MI HF, and the combination of GSDMB and SQSTM1 has a high predictive value.

Association of multiple preventive therapies postdischarge and long-term health outcomes after acute myocardial infarction

Statins, beta-blockers, and angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers have been advocated by guidelines as secondary prevention medications to improve the long-term outcomes of post-acute myocardial infarction (AMI) patients. However, adequate drug adherence has always been challenging, and different treatment regimens may lead to divergent outcomes that remain unclear under current myocardial infarction (MI) care standards. This study investigated the association between use of different preventive regimens post-AMI and patients' long-term outcomes. This cohort study used data files from the Taiwan National Health Insurance Research Database. A total of 77 520 people who were hospitalized with AMI between 2002 and 2015 were assessed. On the basis of medication possession ratio (MPR) to individual medications, eight treatment groups were examined in this study. Receiving therapy was defined as MPR ≥40%. We investigated the association between different treatment groups and all-cause mortality in 24 months. Overall, 51 322 patients with ST-elevation MI and 26 198 with non-ST-elevation MI were included in the study. Patients received all three preventive medications show the lowest mortality in 24 months follow-up periods among all treatment groups. Patients who did not usage of any of these three preventive medications had the highest mortality in 24 months (adjusted hazard ratio, 1.78; 95% CI, 1.64-1.93). This mortality rate had the same pattern across the three cohort generations (2002-2005, 2006-2010, and 2011-2015). In this large population-based real-world study, usage of three preventive therapies post-MI was associated with the lowest rate of all-cause mortality.

Efficacy and safety of colchicine after myocardial infarction: a systematic review and meta- analysis

Abstract Background Inflammation plays a key role in atherosclerotic plaque destabilization and adverse cardiac remodeling. Recent evidence has shown a promising role of colchicine in patients with coronary artery disease. Purpose We evaluated the efficacy and safety of colchicine in post-acute myocardial infarction (MI) patients. Methods We searched five electronic databases from inception to January 18, 2021, for randomized controlled trials (RCTs) evaluating colchicine in post-acute MI patients. Primary outcomes were cardiovascular mortality and recurrent MI. Secondary outcomes were all-cause mortality, stroke, urgent coronary revascularization, levels of follow-up high-sensitivity C-reactive protein (hs-CRP), and drug-related adverse events. All meta-analyses used inverse-variance random-effects models. Results Six RCTs (n=6005) patients were included. Colchicine did not significantly reduce cardiovascular mortality (risk ratio [RR], 0.91; 95% confidence interval [95% CI], 0.52–1.61; p=0.64), recurrent MI (RR, 0.87; 95% CI, 0.62–1.22; p=0.28), all-cause mortality (RR, 1.06; 95% CI, 0.61–1.85; p=0.78), stroke (RR, 0.28; 95% CI, 0.07–1.09; p=0.05), urgent coronary revascularization (RR, 0.46; 95% CI, 0.02–8.89; p=0.19), or decreased levels of follow-up hs-CRP (MD, −1.95 mg/L; 95% CI, −12.88 to 8.98; p=0.61) compared to the control group. There was no increase of any adverse event (RR, 0.97; 95% CI, 0.89–1.07; p=0.34) or gastrointestinal adverse events (RR, 2.49; 95% CI, 0.48–12.99; p=0.20). Subgroup analyses by colchicine dose (0.5 versus 1 mg/day), time of follow-up (&amp;lt;1 versus ≥1 year), and treatment duration (≤30 versus &amp;gt;30 days) showed no changes in the overall findings. Conclusion In post-acute MI patients, colchicine does not reduce cardiovascular or all-cause mortality, recurrent MI, or other cardiovascular outcomes. Also, colchicine did not increase drug-related adverse events. Funding Acknowledgement Type of funding sources: None.

Circulating LIPCAR is a potential biomarker of heart failure in patients post-acute myocardial infarction

In heart failure (HF) patients with reduced ejection fraction, LIPCAR, a long noncoding RNA is elevated and is associated with left ventricular remodeling and poor prognosis. We studied the role of LIPCAR in patients with HF post-acute myocardial infarction (AMI) to find biomarkers for early detection of HF. We conducted a study of 127 patients with AMI, of which 59 were patients with HF post-AMI. LIPCAR levels were higher in HF patients post-AMI than patients without HF, and LIPCAR had a high predictive value for diagnosis of HF, which was estimated by receiver operating characteristic curves (AUC: 0.985). The results indicate that LIPCAR may be a marker of early HF after AMI.