Predictor Of Myocardial Infarction Research Articles

Predictors of Myocardial Infarction after Suprainguinal Bypass Using the Vascular Quality Initiative Cardiac Risk Index

Several models have been developed to estimate the risk of postoperative myocardial infarction (POMI). The Vascular Quality Initiative (VQI) Cardiac Risk Index (CRI) was developed specifically for vascular procedures; while suprainguinal bypass carried the second highest odds of POMI, the all-procedure-based model performance declined when applied to the suprainguinal subset. We sought to refine the VQI CRI for application in this high-risk group undergoing open revascularization for aortoiliac occlusive disease.

Methotrexate therapy impacts on red cell distribution width and its predictive value for cardiovascular events in patients with rheumatoid arthritis

BackgroundMethotrexate (MTX) is well known to affect folic acid metabolism, so MTX treatment can result in alterations of mean corpuscular volume (MCV), which may impact on red cell distribution width (RDW), as MCV levels feed into RDW calculation. We thus questioned whether RDW levels and subsequently its diagnostic utility in RA subjects, as reported before, are influenced by ongoing MTX therapy.We assessed the impact of disease modifying drug (DMARD) treatment, especially MTX, on RDW and evaluated their influence on the predictive value of RDW for cardiovascular (CV) events in patients with rheumatoid arthritis (RA). As far as we know, this is the first study evaluating the influence of MTX on RDW.MethodsMedical treatment, disease activity, laboratory parameters and history of CV events were retrospectively analysed in 385 RA patients at disease onset and at last follow up at our clinic. Additionally, in patients with CV event, data were recorded at last follow up prior the CV event.ResultsDisease parameters and laboratory findings associated with a serious vascular event were older age (p < 0,001), longer disease duration (p = 0,002) and a higher RDW at diagnosis (p = 0,025). No differences in RDW levels became evident with any other treatment regimen beside MTX. MTX treated patients had significantly higher RDW compared to subjects without this drug (p < 0,001). In RA patients without MTX treatment, we found RDW level significantly different between those with versus without a CV event, whereas this difference disappeared in subjects receiving MTX.ConclusionMTX impacts on RDW and might therefor reduce its prognostic value for CV events in patients taking MTX, whereas an increased RDW at diagnosis remains an early risk predictor for myocardial infarction and stroke in RA patients.

Serum selenium level in acute myocardial infarction

IntroductionAlthough remarkable developments have been made in the management of cardiovascular disease, myocardial infarction (MI) remains the most common cause of death worldwide. MI is an acute condition of myocardial cell death that occurs as a result of imbalance between the coronary blood supply and myocardial requirements. Lipid peroxidation and excessive production of reactive oxygen species (ROS), such as superoxide anions (O2•-) and hydrogen peroxide, play a major role in the mechanism of MI. ROS directly damage the cell membrane and cause cell necrosis. However, ROS also stimulate signal transfer to upregulate inflammatory cytokines, for example, tumor necrosis factor-α in the ischemic area and the neighboring myocardium.AimThe aims of this article were: (a) to determine serum selenium (Se) and the cut-off value in acute MI patients and the correlation between serum Se and other cardiac biomarkers such as troponin, creatine kinase (CK), creatine kinase myocardial brand (CK-MB), C-reactive protein, and lipogram; and (b) to determine the most predictor risk factor of MI.Materials and methodsThe study was carried out on 120 individuals (60 patients and 60 controls). The patients presented to the Internal Medicine Department and Coronary Care Unit at Assiut University Hospital. The healthy controls were selected and matched for age and sex, and only those who were found to be in good health and free from any signs of chronic diseases or disorders were included.ResultsThe main finding of this analysis that there is a statistical difference between patients and controls in serum Se as the mean Se level in patients was 80.3±20.5 and in controls it was 97.2±14.0 and P value of less than 0.001, Thus, serum Se is significantly low in MI patients. Also, there was no statistical difference in serum Se in terms of sex, smoking, accompanying diseases (diabetes or hypertension), or type of infarction.ConclusionThis study supports a significant association between deficient serum Se concentration with cut-off value of up to 84ng/ml and MI. Strikingly, the most predictor of MI is serum Se, followed by total cholesterol, diabetes mellitus, low-density lipoprotein, and hypertension.

Pretransplant coronary artery disease is a predictor for myocardial infarction and cardiac death after liver transplantation

BackgroundCardiovascular disease is a serious problem of liver transplant (LT) recipients because of increased cardiovascular risk due to immunosuppressive therapy, higher age, intraoperative risk and comorbidities (such as diabetes and nicotine abuse). Reported frequency of cardiovascular events after LT shows a high variability between different LT cohorts. Our aim was to analyze a cohort of LT recipients from a single center in Germany to evaluate frequency of the cardiovascular endpoints (CVE) myocardial infarction and/or cardiac death after LT and to investigate correlations of CVE post LT with pretransplant patient characteristics. PatientsIn total, data from 352 LT patients were analyzed. Patients were identified from an administrative transplant database, and all data were retrieved from patients' charts and reports. ResultsDuring the median follow-up of 4.0 (0−13) years, 10 cases of CVE were documented (six myocardial infarctions and four coronary deaths). The frequency of CVE did not differ according to classic cardiovascular risk factors such as body mass index (p=0.071), total cholesterol (p=0.533), hypertension (p=0.747), smoking (p=1.000) and pretransplant diabetes mellitus (p=0.146). In patients with pretransplant coronary heart disease (n=24; 6.8%) CVE were found more frequently (p=0.024). ConclusionIn summary, we found a rate of 2.8% CVE after LT in a German transplant cohort. Pretransplant CHD was the only risk factor for CVE, but showed no significant impact on overall survival.

Prognostic value of electrocardiogram exercise testing for risk stratification in asymptomatic coronary artery disease.

Several variables of electrocardiogram exercise testing (EET) predict cardiovascular events in the general population and in patients with coronary artery disease (CAD). However, most of the studies have not included patients with asymptomatic CAD. The aim of this study was to evaluate the prognostic value of EET in asymptomatic CAD patients. We carried out a retrospective single-center analysis including all patients with asymptomatic CAD documented by angiography who underwent EET from January 2010 to December 2013. A number of EET variables and three exercise scores [Duke Treadmill Score (DTS), Morise score, and FIT score] were analyzed. The primary endpoint was the combined incidence of myocardial infarction (MI), myocardial revascularization, and death from any cause during follow-up. A total of 306 patients were included (mean age was 65±10 years, 61% had previous MI, and the median exercise capacity was 9.4±2.7 metabolic equivalent of task). The primary endpoint occurred in 15.7% of patients during 3.3 years of follow-up. The DTS and FIT were independent predictors of the primary endpoint unlike the Morise score (DTS: hazard ratio=0.91, 95% confidence interval: 0.85-0.99, P=0.018; FIT score: 0.99, 0.98-0.996, P=0.001; Morise score: 0.97, 0.93-1.02, P=0.20). The DTS was independent predictor of MI or revascularization, whereas FIT predicted death from any cause. Excluding patients with early revascularization, DTS had no predictive power at the composite endpoint. In our population with asymptomatic CAD, FIT and DTS had significant value for risk prediction and consequently the EET can be a valid tool in the clinical follow-up of this population.

Airway obstruction and the risk of myocardial infarction and death from coronary heart disease: a national health examination survey with a 33-year follow-up period.

Chronic obstructive pulmonary disease (COPD) has been associated with coronary mortality. Yet, data about the association between COPD and acute myocardial infarction (MI) remain scarce. We aimed to study airway obstruction as a predictor of MI and coronary mortality among 5576 Finnish adults who participated in a national health examination survey between 1978 and 1980. Subjects underwent spirometry, had all necessary data, showed no indications of cardiovascular disease at baseline, and were followed up through record linkage with national registers through 2011. The primary outcome consisted of a major coronary event-that is, hospitalization for MI or coronary death, whichever occurred first. We specified obstruction using the lower limit of normal categorization. Through multivariate analysis adjusted for potential confounding factors for coronary heart disease, hazard ratios (HRs) (with the 95% confidence intervals in parentheses) of a major coronary event, MI, and coronary death reached 1.06 (0.79-1.42), 0.84 (0.54-1.31), and 1.40 (1.04-1.88), respectively, in those with obstruction compared to others. However, in women aged 30-49 obstruction appeared to predict a major coronary event, where the adjusted HR reached 4.21 (1.73-10.28). In conclusion, obstruction appears to predict a major coronary event in younger women only, whereas obstruction closely associates with the risk of coronary death independent of sex and age.

Complications of Endovascular Aneurysm Repair: Mortality, Myocardial Infarction and Acute Kidney Injury.

Patients undergoing endovascular aneurysm repair (EVAR) have comorbidities that increase the risk of death, myocardial infarction (MI) and acute kidney injury (AKI). Our aim was to evaluate the incidence and predictors of mortality, MI and AKI after EVAR and to compare AKI incidence with Vascular Surgery Kidney Injury Predictive Score (VSKIPS). We conducted a retrospective study of EVAR procedures performed between March 2006 and November 2013. We defined mortality at 30 days, MI as an increase in troponin level to >0.034 ng mL-1 in the first 72 h and AKI as an increase in creatinine level to >0.3 mg dL-1 in the first 48 h after surgery. Risk factors were analysed using logistic regression calculating Hosmer-Lemeshow test and the area under the receiver operating curve (AUROC). Ninety-eight patients were included in the study. The incidence of mortality, MI, and AKI was 2%, 5%, and 18%, respectively. AKI increased the risk of MI [odds ratio (OR) 24.4, p=0.006]. Preoperative serum urea level of >50 mg dL-1 (OR 4.97, p=0.038), general anaesthesia (OR 9.64, p=0.002) and surgery duration (OR 1.53, p=0.043) were considered independent predictors of AKI. The AUROC of the AKI model was 0.886 compared with 0.793 of VSKIPS. We found the incidence of mortality, MI and AKI consistent with that of previous studies. However, we may be underestimating the last two because of the short follow-up time. AKI was an independent predictor of MI. Preoperative serum urea level of >50 mg dL-1, general anaesthesia and surgery duration were considered independent predictors of AKI.

Long-Term Outcomes of Stenting the Proximal Left Anterior Descending Artery in the PROTECT Trial

ObjectivesThis study sought to compare the outcomes of patients undergoing drug-eluting stent implantation according to lesion location within or outside the proximal left anterior descending (LAD) artery. BackgroundProximal LAD artery involvement is considered uniquely in revascularization guidelines. The impact of LAD lesion location on long-term outcomes after revascularization is poorly understood in context of current percutaneous coronary intervention and medical therapy. MethodsAmong 8,709 patients enrolled in PROTECT (Patient Related Outcomes with Endeavor Versus Cypher Stenting Trial), a multicenter percutaneous coronary intervention trial, we compared the outcomes of 2,534 patients (29.1%) (3,871 lesions [31.5%]) with stents implanted in the proximal LAD to 6,172 patients (70.9%) (8,419 lesions [68.5%]) with stents implanted outside the proximal LAD. ResultsAt the 4-year follow-up, death rates were the same (5.8% vs. 5.8%; p > 0.999), but more myocardial infarctions occurred in the proximal LAD group (6.2% vs. 4.9%; p = 0.015). The rate of clinically driven target vessel failure (TVF) (14.8% vs. 13.5%; p = 0.109), major adverse cardiac event(s) (MACE) (15.0% vs. 13.7%; hazard ratio: 1.1; 95% confidence interval: 0.97 to 1.31; p = 0.139), and stent thrombosis (2.1% vs. 2.0%; p = 0.800) were similar. Drug-eluting stent type had no interaction with MACE or TVF. In multivariate analysis, the proximal LAD was a predictor of myocardial infarction (p = 0.038) but not of TVF (p = 0.149) or MACE (p = 0.069). ConclusionsIn this study of contemporary percutaneous coronary intervention, proximal LAD location was associated with higher rates of myocardial infarction during the long-term follow-up, but there were no differences in stent thrombosis, death, TVF, or overall MACE. This finding may suggest that, in the drug-eluting stent era, proximal LAD no longer confers a different prognosis than other lesion sites. (Randomized Study Comparing Endeavor With Cypher Stents [PROTECT]; NCT00476957)

Are Brachiocephalic Atherosclerotic Plaques to be considered as Predictors of Myocardial Infarction in Rheumatoid Arthritis Patients?

Introduction: Carotid ultrasound based on assessment of intima media thickness (IMT) and presence of plaques has been considered to be a cheap and efficient way to measure clinical atherosclerosis. Both carotid IMT and carotid plaques have been proved to be good predictors of CV (cardiovascular) events of rheumatic patients, offering additional value to the traditional risk scores in the prediction of CVD (cardiovascular disease). The objective of the study was to determine whether atherosclerotic brachiocephalic plaques, traditional CV risk factors as well as RA (rheumatoid arthritis) disease activity have an effect on the risk of myocardial infarction in RA patients with comparable disease duration. Methods: A case control study was performed within the prospective cohort of 92 RA patients, out of them were female 81%, aged 40-84. In cases there were 20 patients who had developed their first myocardial infarction (MI) after the diagnosis of RA. The case and control groups were matched by sex and disease duration. RA activity and severity were determined by DAS28 scores and HAQ questionnaires, ultrasonography of synovitis. Information about traditional (BMI, smoking history, diabetes mellitus, primary arterial hypertension) and disease-specific risk factors was thoroughly gathered. AIP (atherogenic index of plasma (log10 TG/HDLC) was calculated. Brachiocephalic artery hemodynamic parameters, IMT and plaques were assessed using the high resolution B mode and Doppler–mode ultrasound. Results: Patients with MI (myocardial infarction) were older in comparison to control RA patients, mostly females (85%). The case and control groups were matched by disease duration and gender. One of the classic risk factors for 95% of patients with MI had been suffering from arterial hypertension (HTN). The odds ratio for MI patients with HTN was 12 (95% CI 1.5 to 95.4). Seropositivity, erosions and synovitis of small joints, joint replacement surgery was similar for case and control groups. Seropositivity was found in 95% of the case group. Despite that, RF (rheumatoid factor) was more presented in case group. High RA disease activity (DAS 28 above 5.1) was observed among 55% of patients with MI (p=0.007). The odds ratio for MI patients with a high disease activity (DAS 28>5.1) was 3.95 (95% CI 1.40 to 11.13). About 50% of cases were smokers. Smoking status, BMI, diabetes, atherogenix index did not differ between cases and controls. IMT (intima media thickness) dx et sin were age dependent, correlated with hemodinamicaly non-significant atherosclerotic plaques. Furthermore, atherosclerotic lesions were not more pronounced in RA patients with versus without CVD. Non-hemodinamicaly significant atherosclerotic plaques and IMT sin were associated with hypertensive disease. Conclusion: In our case-control study, MI was observed in older individuals RF positive, being positively associated with systolic arterial hypertension. Increased risk to MI was found in patients with high disease activity evaluated as DAS 28 above 5.1.

Waist-to-hip measurement ratio among dental students in urban areas

Background: Waist-to-hip ratio (WHR) is an anthropometric measure commonly used to characterize regional adiposity. WHR is a crude estimate of the relative amount of abdominal fat: Higher the hip girth compared to waist girth, the greater the proportion of abdominal fat. As early as the 1980s, several prospective epidemiological studies reported that WHR is a significant predictor of coronary heart disease and death. A large number of studies have since replicated these initial findings, with some reporting that WHR was a stronger predictor of myocardial infarction or mortality risk. Aims and Objectives: To evaluate the WHR in among students of the private dental college, to review the usefulness of waist circumference and WHR measures as predictors of non-communicable disease risk and to define the potential cut off points for public health action. Materials and Methods: A total of 70 young adults studying in private dental college were chosen for the study. Students with systemic illness were excluded from the study. The waist and the hip circumferences were measured. The results were recorded and tabulated. Results: The WHR calculated in students found to be significant in 64.28% of the students and it is not significant in 35.72% of the students and most of the students have an appropriate WHR. Conclusion: The research proves that most of the students studying in Saveetha Dental College were found to have normal WHR. The study will aid the physician in earlier identification of various systemic complications such as obesity, cardiovascular diseases by assessing the WHR.

Long-term prognostic impact of CT-Leaman score in patients with non-obstructive CAD: Results from the COronary CT Angiography EvaluatioN For Clinical Outcomes InteRnational Multicenter (CONFIRM) study

BackgroundNon-obstructive coronary artery disease (CAD) identified by coronary computed tomography angiography (CCTA) demonstrated prognostic value. CT-adapted Leaman score (CT-LeSc) showed to improve the prognostic stratification. Aim of the study was to evaluate the capability of CT-LeSc to assess long-term prognosis of patients with non-obstructive (CAD). MethodsFrom 17 centers, we enrolled 2402 patients without prior CAD history who underwent CCTA that showed non-obstructive CAD and provided complete information on plaque composition. Patients were divided into a group without CAD and a group with non-obstructive CAD (<50% stenosis). Segment-involvement score (SIS) and CT-LeSc were calculated. Outcomes were non-fatal myocardial infarction (MI) and the combined end-point of MI and all-cause mortality. ResultsPatient mean age was 56±12years. At follow-up (mean 59.8±13.9months), 183 events occurred (53 MI, 99 all-cause deaths and 31 late revascularizations). CT-LeSc was the only multivariate predictor of MI (HRs 2.84 and 2.98 in two models with Framingham and risk factors, respectively) and of MI plus all-cause mortality (HR 2.48 and 1.94 in two models with Framingham and risk factors, respectively). This was confirmed by a net reclassification analysis confirming that the CT-LeSc was able to correctly reclassify a significant proportion of patients (cNRI 0.28 and 0.23 for MI and MI plus all-cause mortality, respectively) vs. baseline model, whereas SIS did not. ConclusionCT-LeSc is an independent predictor of major acute cardiac events, improving prognostic stratification of patients with non-obstructive CAD.

Classification rules for identifying individuals at high risk of developing myocardial infarction based on ApoB, ApoA1 and the ratio were determined using a Bayesian approach

ABSTRACTWe have developed a new approach to determine the threshold of a biomarker that maximizes the classification accuracy of a disease. We consider a Bayesian estimation procedure for this purpose and illustrate the method using a real data set. In particular, we determine the threshold for Apolipoprotein B (ApoB), Apolipoprotein A1 (ApoA1) and the ratio for the classification of myocardial infarction (MI). We first conduct a literature review and construct prior distributions. We then develop classification rules based on the posterior distribution of the location and scale parameters for these biomarkers. We identify the threshold for ApoB and ApoA1, and the ratio as 0.908 (gram/liter), 1.138 (gram/liter) and 0.808, respectively. We also observe that the threshold for disease classification varies substantially across different age and ethnic groups. Next, we identify the most informative predictor for MI among the three biomarkers. Based on this analysis, ApoA1 appeared to be a stronger predictor than ApoB for MI classification. Given that we have used this data set for illustration only, the results will require further investigation for use in clinical applications. However, the approach developed in this article can be used to determine the threshold of any continuous biomarker for a binary disease classification.

Tendencies in cardiovascular morbidity and mortality in the population of Siberia

To characterize differences in the risk of development (RD) of myocardial infarction (MI) and stroke during 16 years in an open Siberian population aged 25-64 years and suffering vital exhaustion (VE). We examined a random representative sample of 657 men and 870 women from the Novosibirsk population in the framework of the WHO «MONICA-psychosocial» screening III program (1954). It included registration of socio-demographic data and cases of VE. A total of 15 episodes of MI and 35 strokes were documented in 30 women and 22 men. The level of VE in men was 66,8% (high in 14,6%), in women75,7% (high in 44,4%). RD of MI estimated from the relative risk (RR) in men with VE(RR=2) was higher than in women. It was higher in divorced women (RR=5,4) than in men (RR=4,7). RD of MI was higher in men with VE (OR=2,2 in subjects having elementary education, OR=3,7 in bachelors, OR = 7 in widowers;at the age from 45 to 54 years OR=3,8, at the age from 55 to 64 years OR=5,9) than in women. The overall RD of stroke in subjects of either sex with VE was not significantly different (OR=3,34 in women and 3,1). However, it was higher than in women in men with VE having partially completed secondary-level and elementary education RR=4.8), in divorced and widowed men (RR=3.8 and 3.6 respectively. The study showed that the prevalence of VE in the population aged 25-64yearsis higher than in other age groups and higher in women than in men. VE is a more reliable predictor of MI in men than in women; it is a predictor of stroke in either sexes.

WILL INFLAMMATORY MONOCYTE HETEROGENEITY BE THE KEY TO UNLOCKING THE SECRET OF PREMATURE CORONARY ATHEROSCLEROSIS IN SOUTH ASIANS? A PROSPECTIVE EVALUATION OF CANADIAN SOUTH ASIAN AND CAUCASIANS

Global prevalence of coronary atherosclerosis (CAD) varies with ethnicity. South Asians (SA) have higher rates of myocardial infarction (MI) and present at an earlier age compared to Caucasians (CA). The mechanism of this ethnic difference in atherosusceptibility remains unclear. Inflammatory monocyte number is inversely correlated with infarct size and is an independent predictor of MI and death. Monocyte heterogeneity in South Asian patients, however, has not been evaluated.

INDEKS ATEROGENIK PLASMA DI INFARK MIOKARD AKUT DAN PENYAKIT DIABETES MELITUS

Diabetes Mellitus (DM) is associated with an increased cardiovascular risk. Atherogenic Index of Plasma (AIP) is a strong predictor of myocardial infarction. The aim of this study was to know the difference of AIP in acute myocardial infarction (AMI) with and withoutDM. This study was conducted by cross sectional method using data from the medical records of AMI patients at the Dr. Wahidin Sudirohusodo Hospital, Makassar during January 2010 up to May 2013. The AIP values were calculated by the [log (TG: HDL-C)] formula. All data were classified into two groups. The data were then analyzed by unpaired T test. In this study, AMI was mostly found in the 50–59 years group, 33.63%. The AIP in AMI with DM was higher than without DM (0.69±0.26 vs 0.57±0.26, p=0.001). The AIP in AMI with and without DM was higher in the female than the male group (0.63±0.24 vs 0.62±0.28. P=0.58). The Atherogenic Index of Plasma in AMI with DM was higher than without DM. Based on this study, it can be concluded, that AIP can be used as the predictor of cardiovascular risk in diabetes patients.

Estimating covariate-adjusted measures of diagnostic accuracy based on pooled biomarker assessments.

There is a need for epidemiological and medical researchers to identify new biomarkers (biological markers) that are useful in determining exposure levels and/or for the purposes of disease detection. Often this process is stunted by high testing costs associated with evaluating new biomarkers. Traditionally, biomarker assessments are individually tested within a target population. Pooling has been proposed to help alleviate the testing costs, where pools are formed by combining several individual specimens. Methods for using pooled biomarker assessments to estimate discriminatory ability have been developed. However, all these procedures have failed to acknowledge confounding factors. In this paper, we propose a regression methodology based on pooled biomarker measurements that allow the assessment of the discriminatory ability of a biomarker of interest. In particular, we develop covariate-adjusted estimators of the receiver-operating characteristic curve, the area under the curve, and Youden's index. We establish the asymptotic properties of these estimators and develop inferential techniques that allow one to assess whether a biomarker is a good discriminator between cases and controls, while controlling for confounders. The finite sample performance of the proposed methodology is illustrated through simulation. We apply our methods to analyze myocardial infarction (MI) data, with the goal of determining whether the pro-inflammatory cytokine interleukin-6 is a good predictor of MI after controlling for the subjects' cholesterol levels.

Risk Factors of Myocardial Infarction in the Northern Region of Bangladesh

The worldwide rising incidence of cardiovascular diseases and the associated risk factors could be country or area specific. A case control study identifying important risk factors of myocardial infarction (MI) prevailing in the northern region of Bangladesh, was conducted in two major northern region hospitals, Rajshahi and Rangpur Medical College for a period of 6 months. Majority of the cases (66%) and controls (56%) were in the age range of 41 – 60 years. The proportion of male, married and urban residents were predominant in both the case and control group. The highest percentage of patients with MI were involved in business comparatively patients without MI. Clinical symptoms like chest pain, epigastric pain, breathlessness, dizziness and fatigue were observed to be somewhat higher in cases compared to controls. The logistic regression analysis showed that smoking habit, smokeless tobacco consumption, sedentary lifestyle and dyslipidemia were found independent predictors of MI in northern district patients with odds ratio (OR) (95% confidence interval) being 3.1 (1.2 to 3.7), 2.5 (1.0 to 3.5), 2.0 (1.1 to 3.6) and 2.3 (1.3 to 4.1), respectively.

Usefulness of Plasma Matrix Metalloproteinase-3 Levels to Predict Myocardial Infarction in Men With and Without Acute Coronary Syndrome

Matrix metalloproteinase-3 (MMP-3), or stromelysin-1, is a matrix metalloproteinase which is expressed in atherosclerotic plaques and which has been implicated in the pathogenesis of acute coronary syndrome (ACS). Functional polymorphisms in the promoter region of the human MMP-3 gene resulting in an increased expression of MMP-3 have been shown to predict the risk of incident myocardial infarction (MI). However, there have been no studies that have specifically examined the utility of baseline plasma MMP-3 levels for the prediction of long-term MI. In this study, baseline plasma MMP-3 levels were measured in 355 male patients who were referred for coronary angiography and followed prospectively for the development of enzymatically confirmed MI out to 5years. After adjustment for a variety of baseline clinical, angiographic, and laboratory parameters, plasma MMP-3 levels were an independent predictor of MI at 5years (hazards ratio 1.42, 95% CI 1.13 to 1.79; p= 0.0023). Furthermore, in 5 additional multivariate models that included a variety of contemporary biomarkers associated with adverse outcomes and MI, MMP-3 remained an independent predictor of MI at 5years. Similar results were obtained when the analyses were restricted to the subpopulation of patients presenting with ACS. In conclusion, elevated levels of MMP-3 are associated with an increased risk of long-term MI in patients with and without ACS referred for coronary angiography. Furthermore, this association is independent of a variety of clinical, angiographic, laboratory variables, including biomarkers with established prognostic efficacy for the prediction of MI.

The Total Joint Arthroplasty Cardiac Risk Index for Predicting Perioperative Myocardial Infarction and Cardiac Arrest After Primary Total Knee and Hip Arthroplasty

BackgroundCurrent indices fail to consistently predict risk for major adverse cardiac events after major total joint arthroplasty. MethodsAll primary total knee arthroplasty (TKA) and total hip arthroplasty (THA) were identified from the National Surgical Quality Improvement Program data set. Based on prior analyses, age ≥80 years, history of hypertension, and history of cardiac disease were evaluated as predictors of myocardial infarction and cardiac arrest using stepwise multivariate logistic regression. A series of predictive scores were constructed and weighted to identify the influence of each variable on 30-day postoperative cardiac events, while comparing with the Revised Cardiac Risk Index (RCRI). ResultsAmong 85,129 patients, age ≥80 years, hypertension, and a history of cardiac disease were all statistically significant predictors of postoperative cardiac events (0.32%; n = 275) after TKA and THA (P ≤ .02). Equal weighting of all variables maintained the highest discriminative capacity in both THA and TKA cohorts. Adjusted models explained 75% and 71% of the variation in postoperative cardiac events for those with THA and TKA, respectively, without statistically significant lack of fit (P = .52; P = .23, respectively). Conversely, the RCRI was not a significant predictor of postoperative cardiac events after TKA (odds ratio, 3.36; 95% CI, 0.19, 58.04; P = .40), although it maintained a similar discriminative capacity after THA (76%). ConclusionThe current total joint arthroplasty Cardiac Risk Index score was the most economical in predicting postoperative cardiac complication after primary unilateral TKA and THA. The RCRI was not a significant predictor of perioperative cardiac events for TKA patients but performed similarly to the current model for THA.

Etiology, Frequency, and Clinical Outcomes of Myocardial Infarction After Successful Drug-Eluting Stent Implantation: Two-Year Follow-Up From the ADAPT-DES Study.

The frequency, causes, and impact of myocardial infarction (MI) after successful percutaneous coronary intervention have not been well studied. The Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents (ADAPT-DES) study was a prospective, multicenter registry study of 8582 patients undergoing successful drug-eluting stent implantation at 11 centers in the United States and Germany. After excluding 128 patients with periprocedural MI, we investigated the pathogenesis, frequency, and long-term consequences of non-periprocedural MI in 8454 patients. MI during 2-year follow-up developed in 263 patients (3.3%) at a median (25th and 75th percentiles) time of 318 (129, 503) days. The 263 MIs were subclassified as spontaneous MI (n=78; 29.7%), secondary or indeterminate MI (n=64; 24.3%), stent thrombosis-related MI (n=63; 24.0%), and in-stent restenosis-related MI (n=58; 22.1%). Multivariable predictors of MI included clinical and angiographic factors (acute coronary syndromes presentation, diabetes mellitus, current smoker, multivessel disease, treatment of an in-stent restenotic lesion), laboratory findings (low baseline hemoglobin and reduced creatinine clearance), antiplatelet agent-related factors (higher on-treatment platelet P2Y12 receptor reactivity and premature thienopyridine discontinuation), and not being on a statin at discharge. Patients who experienced an MI during the follow-up period had significantly greater 2-year mortality than those without MI (17.3% [42 deaths] versus 3.4% [265 deaths], P<0.001). By multivariable analysis, the adjusted hazard ratio (95% confidence interval) for subsequent mortality during follow-up was 2.17 (1.06, 4.45) in patients with versus without a non-periprocedural MI (P=0.03). The occurrence of a non-periprocedural MI within 2 years after successful drug-eluting stent implantation is relatively infrequent, but has numerous etiologies and is significantly associated with subsequent mortality. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00638794.