Presence Of Acute Myocardial Infarction Research Articles

Race-ethnicity and sex differences in 1-year survival following percutaneous coronary intervention among Medicare fee-for-service beneficiaries.

Existing literature describing differences in survival following percutaneous coronary intervention (PCI)by patient sex, race-ethnicity and the role of socioeconomic characteristics (SEC)is limited. Evaluate differences in 1-year survival after PCI by sex and race-ethnicity, and explore the contribution of SEC to observed differences. Using a 20% sample of Medicare claims data for beneficiaries aged 65+, we identified fee-for-service patients who received PCI from 2007 to 2015. We performed logistic regression to assess how sex and race-ethnicity relate to procedural indication, inpatient versus outpatient setting, and 1-year mortality. We evaluated whether these relationships are moderated by sequentially controlling for factors including age, comorbidities, presence of acute myocardial infarction (AMI),county SEC, medical resource availabilityand inpatient versus outpatient procedural status. We identified 300,491 PCI procedures, of which 94,863 (31.6%) were outpatient. There was a significant transition to outpatient PCI during the study period, especially for men compared with women and White patients compared with Black patients. Black patients were 3.50 percentage points (p < 0.001) and women were 3.41 percentage points (p < 0.001) more likely than White and male patients to undergo PCI at the time of AMI, which typically occurs in the inpatient setting. Controlling for age and calendar year, Black patients were 2.87 percentage points more likely than non-Hispanic White patients to die within 1 year after PCI. After controlling for Black-White differences in comorbidities, the differences in 1-year mortality decreased to 0.95 percentage points, which then became nonsignificant when further controlling for county resources and state of residence. Women were more likely to experience PCI in the setting of AMI and had less transition to outpatient care during the period. Black patients experienced higher 1-year mortality following PCI, which is explained by differences in baseline comorbidities, county medical resources, and state of residence.

Analysis of C-reactive protein and lactoferrin levels in patients with myocardial infarction with chronic obstructive pulmonary disease depending on presence of complications

Purpose. To analyze the levels of C-reactive protein (CRP) and lactoferrin (LF) in patients with myocardial infarction (MI) with chronic obstructive pulmonary disease (COPD) depending on the presence of acute MI complications.Materials and methods. In total were examined 325 patients with MI: 195 patients with acute MI + COPD and 130 MI patients without COPD and 110 healthy somatic subjects. Complications of acute MI were observed in 84 (43.1 %) MI + COPD patients and in 32 (24.6 %) MI patients without COPD.Results of the study. The level of inflammatory markers we studied was elevated in all observation groups relative to controls. In MI + COPD patients and in MI patients without COPD the level of highly sensitive CRP was statistically significantly higher in the presence of acute period complications. LF levels did not depend on the presence of complications in any of the observation groups.Conclusions. Increased inflammatory markers in MI patients without COPD and in MI + COPD groups indicate the significance of the inflammatory component in the pathogenesis of MI. In patients with MI + COPD the severity of systemic inflammation is maximal. CRP is informative as an indicator of inflammatory response in MI. The highest CRP level was observed in patients with complicated MI.

Thiamine as an outcome predictor in postoperative CABG patients

Abstract Introduction Coronary artery bypass graft surgery (CABG) is one of the most performed cardiovascular procedures worldwide. Despite good outcomes, CABG induces systemic inflammation, increases oxidative stress and increases catabolism. As thiamine act as a cofactor in glucose metabolism and glutathione synthesis, its deficiency could have a high prevalence in critically ill patients. Purpose To assess the association between plasma thiamine concentrations and clinical outcomes and 30-day mortality in patients undergoing non-emergency CABG. Methods Prospective and observational study that included consecutive patients older than 18 years undergoing CABG that assigned the consent form. Plasma thiamine concentrations were determined before and 24 hours after the procedure by the high-performance liquid chromatography method. The clinical outcomes evaluated were perioperative acute myocardial infarction, heart failure, cardiogenic shock, arrhythmias, stroke and acute kidney injury. Mortality was evaluated on the 30th day after CABG. Results The study included 131 patients submitted to CABG. The mean age was 61±9.1 years, 73.3% were men, and the mean EuroScore II value was 1.78±1.3%. Before CABG, plasmatic thiamine concentration was 33±15ng/ml, and 15% of the patients had thiamine deficiency. After CABG, plasmatic thiamine concentration was 20±8ng/ml. All patients diminished plasmatic thiamine concentration after CABG. Mortality was 16% and 24% of patients presented acute kidney injury. Combined outcomes, which included the presence of acute myocardial infarction, heart failure, cardiogenic shock, arrhythmias, stroke, acute kidney injury or death, was present in 52% of the patients. Percentage of thiamine variation between before and after CABG was not associated with mortality (34±14 vs 41±10%; p=0.063); however, it was associated with acute kidney injury (40±14 vs 34±13%; p=0.027) and combined outcomes (37±13 vs 33±14%; p=0.035). Conclusion Percentage of thiamine variation from before to after CABG was associated with acute kidney injury and combined outcomes in these patients. Funding Acknowledgement Type of funding sources: None.

Diffusion of Percutaneous Ventricular Assist Devices in US Markets.

Percutaneous ventricular assist devices (PVADs) have been replacing intra-aortic balloon pumps for hemodynamic support during percutaneous coronary intervention (PCI), even though data supporting a benefit for hard clinical end points remain limited. We evaluated diffusion of PVADs across US markets and examined the association of market utilization of PVAD with mortality and cost. Using the 2013 to 2019 Medicare data, we identified all patients aged ≥65 years who underwent PCI with either a PVAD or intra-aortic balloon pump. We used hospital referral region to define regional health care markets and categorized them in quartiles based on the proportional use of PVADs during PCI. Multilevel models were constructed to determine the association of patient, hospital, and market factors with utilization of PVADs and the association of PVAD utilization with 30-day mortality and cost. A total of 79 176 patients underwent PCI with either intra-aortic balloon pump (47 514 [60.0%]) or PVAD (31 662 [40.0%]). The proportion of PCI procedures with PVAD increased over time (17% in 2013 to 57% in 2019; P for trend, <0.001), such that PVADs overtook intra-aortic balloon pump for hemodynamic support during PCI in 2018. There was a large variation in PVAD utilization across markets (range, 0%-85%), which remained unchanged after adjustment of patient characteristics (median odds ratio, 2.05 [95% CI, 1.91-2.17]). The presence of acute myocardial infarction, cardiogenic shock, and emergent status was associated with a 45% to 50% lower odds of PVAD use suggesting that PVADs were less likely to be used in the sickest patients. Greater utilization of PVAD at the market level was not associated with lower risk mortality but was associated with higher cost. Although utilization of PVADs for PCI continues to increase, there is large variation in PVAD utilization across markets. Greater market utilization of PVADs was not associated with lower mortality but was associated with higher cost.

Early Prediction of Cardiogenic Shock Using Machine Learning.

Cardiogenic shock (CS) is a severe condition with in-hospital mortality of up to 50%. Patients who develop CS may have previous cardiac history, but that may not always be the case, adding to the challenges in optimally identifying and managing these patients. Patients may present to a medical facility with CS or develop CS while in the emergency department (ED), in a general inpatient ward (WARD) or in the critical care unit (CC). While different clinical pathways for management exist once CS is recognized, there are challenges in identifying the patients in a timely manner, in all settings, in a timeframe that will allow proper management. We therefore developed and evaluated retrospectively a machine learning model based on the XGBoost (XGB) algorithm which runs automatically on patient data from the electronic health record (EHR). The algorithm was trained on 8 years of de-identified data (from 2010 to 2017) collected from a large regional healthcare system. The input variables include demographics, vital signs, laboratory values, some orders, and specific pre-existing diagnoses. The model was designed to make predictions 2 h prior to the need of first CS intervention (inotrope, vasopressor, or mechanical circulatory support). The algorithm achieves an overall area under curve (AUC) of 0.87 (0.81 in CC, 0.84 in ED, 0.97 in WARD), which is considered useful for clinical use. The algorithm can be refined based on specific elements defining patient subpopulations, for example presence of acute myocardial infarction (AMI) or congestive heart failure (CHF), further increasing its precision when a patient has these conditions. The top-contributing risk factors learned by the model are consistent with existing clinical findings. Our conclusion is that a useful machine learning model can be used to predict the development of CS. This manuscript describes the main steps of the development process and our results.

Acetylsalicylic acid use is associated with reduced risk of out-of-hospital cardiac arrest in the general population: Real-world data from a population-based study.

AimActivated blood platelet products facilitate myocardial intracellular Ca2+ overload, thereby provoking afterdepolarizations and increasing susceptibility of ischemic myocardium to ventricular fibrillation (VF). These effects are counteracted in vitro by acetylsalicylic acid (ASA), but no prior study investigated whether ASA is associated with decreased out-of-hospital cardiac arrest (OHCA) risk on a population level. Therefore, we studied whether ASA and other antiplatelet drugs (carbasalate calcium, clopidogrel) are associated with decreased risk of OHCA.MethodsWe conducted a population-based case-control study among individuals (772 OHCA-cases with documented VT/VF, 2444 non-OHCA-controls) who had used antiplatelet drugs in the year before index-date (OHCA-date), and studied the association between current antiplatelet drug use and OHCA-risk with multivariable logistic regression analysis.ResultsASA use was associated with reduced OHCA-risk (adjusted odds ratio (ORadj) 0.6 [0.5–0.8]), and more so in women (ORadj 0.3 [0.2–0.6]) than in men (ORadj 0.7 [0.5–0.95], Pinteraction 0.021). Carbasalate calcium was associated with decreased OHCA-risk in women (ORadj 0.5 [0.3–0.9]), but not in men (ORadj 1.3 [0.96–1.7], Pinteraction 0.005). Clopidogrel was not associated with reduction in OHCA-risk. Risk reduction associated with ASA in patients with OHCA was similar in the presence of acute myocardial infarction (AMI) (ORadj 0.6 [0.4–0.9]) and in the absence of AMI (ORadj 0.7 [0.4–1.2]).ConclusionASA use was associated with reduced OHCA-risk in both sexes, and more so in women, while carbasalate calcium only protected women. Clopidogrel was not associated with reduced OHCA-risk.

WHAT ARE THE FACTORS ASSOCIATED WITH UNCONTROLLED BLOOD PRESSURE IN BRAZILIAN HYPERTENSIVE PATIENTS?

Objective: Uncontrolled arterial hypertension (AH) is defined by BP &gt; or = 140/90 mmHg. It has a high prevalence, is associated with the causes of pseudoresistance and is related to several complications and negative health outcomes. Thus, the objective of this study was to investigate the factors associated with the lack of blood pressure control in hypertensive Brazilians treated in public and private services. Design and method: Cross-sectional, analytical, multicenter and national study, carried out with hypertensive adults and elderly individuals, followed by 45 outpatient clinics, included from September 2013 to October 2015 and submitted to interview, clinical and anthropometric evaluation. The outcome variable was uncontrolled pressure (BP &gt; or = 140mmHg systolic and/or &gt; or = 90 mmHg diastolic). Simple and multiple logistic regression analysis was performed. Results: A total of 2,643 participants with a mean age of 61.6 (11.9), 55.7% female and 46.4% with uncontrolled BP were evaluated. Uncontrolled BP was associated: age over 60 years (OR: 1.31 [1.11 - 1.55]); practice of irregular physical activity (OR: 1.28 [1.06 - 1.55]); attending the emergency room for hypertensive crises in the last six months (OR: 1.80 [1.46 - 2.22]); increase in body mass index (OR: 1.02 [1.01 - 1.04]); low adherence to drug treatment (OR: 1.22 [1.04 - 1.44]) and menopause (OR: 1.36 [1.07 - 1.72]). The following were negatively associated: fruit consumption (OR: 0.90 [0.85 - 0.94]); presence of dyslipidemia (OR: 0.75 [0.64 - 0.89]), acute myocardial infarction (OR: 0.59 [0.46 - 0.76]) and peripheral arterial disease (OR: 0.52 [0.34 - 0.78]). Conclusions: Factors associated with non-BP control were: advanced age, increased body mass index, practice of irregular physical activities, need for emergency care and low adherence to pharmacological treatment and protective factors: presence of acute myocardial infarction and peripheral arterial disease, and higher daily fruit intake.

Association of serum sclerostin and osteoprotegerin levels with the presence, severity and prognosis in patients with acute myocardial infarction

BackgroundBone-related proteins (such as sclerostin and osteoprotegerin [OPG]) are involved in the development of atherosclerosis. However, the relationship between bone-related proteins and acute myocardial infarction (AMI) has not been extensively evaluated. The purpose of this study was to assess the association of serum sclerostin and OPG with the presence, severity and prognosis in patients with AMI.MethodsThis study prospectively enrolled 152 patients attacked by acute chest pain. Serum sclerostin and OPG were detected within the first 24 h after AMI diagnosis by ELISA kits. The AMI predictive efficacy of sclerostin and OPG were analyzed by receiver operating characteristics (ROC) curve. Univariable and multivariable linear regression analyses were performed to determine the association between bone-related proteins and scores indicating the severity of coronary artery occlusion. Moreover, prognostic values were assessed by Kaplan–Meier curves and Cox regression analysis.ResultsThere were 92 patients in AMI group, 60 in non-AMI group. Serum levels of sclerostin and OPG were significantly higher in AMI group than in non-AMI group (all p < 0.001), which showed predictive value for the presence of AMI (all p < 0.001). The area under the ROC curve values of sclerostin and OPG were 0.744 and 0.897, respectively. A multivariable linear regression analysis demonstrated that Ln-transformed sclerostin (β = 0.288, p = 0.009) and Ln-transformed OPG (Ln-OPG: β = 0.295, p = 0.019) levels were associated with GENISINI score, independently of conventional clinical parameters. In addition, Ln-OPG levels were still positively associated with GRACE score after adjustments (β = 0.320, p = 0.001). During a 1-year follow-up, patients above the median of sclerostin levels had higher incidence of major adverse cardiac events (MACE) than those below the median (p = 0.028). It was also observed that the MACE rates were higher in patients above the median of OPG levels, though no statistic importance (p = 0.060). After adjusting conventional risk factors by multivariate Cox regression, Ln-OPG was associated with incident MACE (hazard ratio = 2.188 [95% confidence intervals 1.102–4.344], p = 0.025).ConclusionsBone-related proteins could exert a potential role in early risk stratification and prognosis assessment in patients with AMI.

Динаміка показників кардіогемодинаміки у хворих на гострий інфаркт міокарда з супутнім цукровим діабетом 2 типу протягом 6 місяців спостереження

The purpose of the study was to monitor the dynamics of cardiohemodynamics in patients with acute myocardial infarction in combination with type 2 diabetes mellitus during 6 months of follow-up. Materials and methods. The study involved 120 patients: group 1 – patients with acute myocardial infarction with type 2 diabetes mellitus (n = 70), group 2 – patients with acute myocardial infarction (n = 50). The control group included 20 healthy individuals. All patients underwent general instrumental and clinical examinations. In the course of echocardiographic (echocardiography) study, the parameters of the left ventricle were determined and calculated: end diastolic volume, end systolic volume, end diastolic size, end systolic size, posterior thickness, the thickness of the interventricular septum, the ejection fraction of the left ventricle, the size of the left atrium, the size of the aorta, stroke volume. Results and discussion. The average indicators of cardiohemodynamics on the first day of hospitalization were as follows: end diastolic volume in patients of the 1st group was 165.85±36.22 ml; of the 2nd – 133.44±27.19 ml; control – 54.54±21.48 ml; end systolic volume – 104.57±28.86 ml; 77.93±21.56 ml; 21.69±7.49 ml, respectively; end diastolic size – 5.74±0.6 ml; 5.22±0.49 ml; 3.55±0.58 ml, respectively; end systolic size – 4.66±0.62 ml; 4.11±0.52 ml; 2.41±0.32 ml, respectively; the ejection fraction of the left ventricle – 37.51±6.27%; 42.9±7.45%; 56.75±7.22%, respectively; posterior thickness – 1.37±0.13 cm; 1.32±0.13 cm; 1.07±0.08 cm, respectively; the thickness of the interventricular septum – 1.26±0.11 cm; 1.27±0.11 cm; 1.13±0.08 cm, respectively; the size of the left atrium – 4.07±0.31 cm; 3.75±0.46 cm; 3.19±0.15 cm, respectively; the size of the aorta – 3.39±0.27 cm; 3.3±0.22 cm; 2.97±0.16 cm, respectively; stroke volume – 60.27±13.3 cm3; 2nd – 57.01±10.72 cm3; 28.39±12.38 cm3, respectively. Six months after acute myocardial infarction, a positive trend in cardiohemodynamic parameters was observed, maintaining a tendency for worse indicators in the presence of acute myocardial infarction. Conclusion. Thus, impaired carbohydrate metabolism in the form of insulin resistance, hyperinsulinemia and stress hyperglycemia on the background of coronary events in type 2 diabetes mellitus leads to negative changes in geometry, mass, systolic and diastolic function of the left ventricle, which must be paid special attention to hemodynamic predictors of cardiovascular complications and heart failure

Relation of glucose variability to vulnerable plaque formation in patients with coronary artery disease.

Although glucose variability (GV) is reportedly associated with coronary plaque vulnerability, namely lipid-rich plaque, details are not fully understood. The aim of this study was to evaluate relations of GV after discharge to vulnerable plaque formation assessed by near-infrared spectroscopy intravascular ultrasound (NIRS-IVUS) in patients with and without diabetes. A total of 40 patients undergoing percutaneous coronary intervention under NIRS-IVUS guidance were included, among whom 13 (33%) had diabetes and 20 (50%) presented with acute myocardial infarction (MI). GV was evaluated by a flush glucose monitoring system, primarily with mean amplitude of glycemic excursion (MAGE). Lipid-rich plaque was assessed by maximum lipid core burden index in 4mm (maxLCBI4mm) in the target lesion using NIRS-IVUS. Mean MAGE and maxLCBI4mm were 69.7 ± 25.6mg/dl and 508.0 ± 294.9. Intra-day GV was not significantly associated with maxLCBI4mm in the entire study population, while MAGE was correlated with maxLCBI4mm in non-diabetic patients (r = 0.46, p = 0.02). In patients with and without acute MI presentation, no significant relations were found between MAGE and maxLCBI4mm. GV was associated with lipid core plaque formation, especially in non-diabetic patients.

Racial/ethnic differences persist in treatment choice and outcomes in isolated intervention for coronary artery disease

ObjectiveStudies have noted racial/ethnic disparities in coronary artery disease intervention strategies. We investigated trends and outcomes of coronary artery disease treatment choice (coronary artery bypass grafting or percutaneous coronary intervention) stratified by race/ethnicity. MethodsWe queried the National Inpatient Sample for patients who underwent isolated coronary artery bypass grafting or percutaneous coronary intervention (2002-2017). Outcomes were stratified by race/ethnicity (White, African American, Hispanic, Asian). Multivariable logistic regression evaluated associations between race/ethnicity and receiving coronary artery bypass grafting versus percutaneous coronary intervention, in-hospital mortality, and costs. ResultsOver the 15-year period, 2,426,917 isolated coronary artery bypass grafting surgeries and 7,184,515 percutaneous coronary interventions were performed. Compared with White patients, African American patients were younger (62 [interquartile range, 53-70] vs 66 [interquartile range, 57-75] years), were more likely to have Medicaid insurance (12.2% vs 4.4%), and had more comorbidities (Charlson-Deyo index, 1.9 ± 1.6 vs 1.7 ± 1.6) (all P < .01). After adjustment for patient comorbidities, presence of acute myocardial infarction, insurance status, and geography, African Americans were the least likely of all racial/ethnic groups to undergo coronary artery bypass grafting (odds ratio, 0.76; P < .01), a consistent trend throughout the study. African American patients had higher risk-adjusted mortality after coronary artery bypass grafting (odds ratio, 1.09; P < .01). Race/ethnicity was not associated with increased mortality after percutaneous coronary intervention. African American patients had higher hospitalization costs for coronary artery bypass grafting (+$5816; P < .01) and percutaneous coronary intervention (+$856; P < .01) after controlling for confounders. ConclusionsIn this contemporary national analysis, risk-adjusted frequency of coronary artery bypass grafting versus percutaneous coronary intervention for coronary artery disease differed by race/ethnicity. African American patients had lower odds of undergoing coronary artery bypass grafting and worse outcomes. Reasons for these differences merit further investigation to identify opportunities to reduce potential disparities.

Increased expression of IL-20 is associated with ischemic cardiomyopathy and acute myocardial infarction.

Background: The expression and clinical significance of IL-20in coronary artery diseases needs to beanalyzed. Methods: IL-20 and its receptors were analyzed in coronary artery tissues. In a separatestudy, plasma IL-20 was also evaluated. Results: IL-20 and its receptors were significantly higher in coronary artery stenosis tissues from ischemic cardiomyopathypatients than that from controls. T lymphocytes and macrophages were the main source of IL-20 and expressed its receptors abundantly. Plasma IL-20 was significantly higher in acute myocardial infarctionpatients than that in controls. Conclusion: IL-20 was closely associated with the presence of acute myocardial infarction. IL-20 may participate in the progression of coronary artery stenosis and plaque vulnerability via regulating T lymphocytes and macrophages.

Prognostic signs of an unfavorable course of coronary heart disease in patients with type 2 diabetes mellitus

Background. Despite the successful development of medical technologies in the diagnosis of coronary heart disease, mortality due to cardiovascular diseases in the population of patients with diabetes mellitus (DM) is not reduced. The development of an algorithm for the early diagnosis of coronary heart di­sease and ways to correct it is a topical problem of cardiology and endocrinology. The purpose is to determine prognostic signs for an unfavorable course of coronary heart disease and develop a table of test probabilities in order to enhance the effectiveness of risk stratification in patients with type 2 DM. Materials and methods. During 2017–2019, there were observed 40 patients (16 men and 24 women) with type 2 DM in combination with coronary heart disease. We took into account the presence of acute myocardial infarction, acute cerebrovascular accidents (stroke), repeated surgical interventions (percutaneous coronary intervention, coronary artery bypass grafting) for the last 3 years. The average age of patients was 65.5 years. Results. In total, 119 signs recorded in the first three days from the moment of patient’s admission were analyzed as possible predictors of an unfavorable prognosis. As markers of coronary heart disease, parameters were adopted that showed the highest occurrence in the group of patients with adverse course of DM and coronary heart disease. The most patho­gnomonic predictors of coronary heart disease progression in patients with type 2 DM were left ventricular systolic dysfunction (ejection fraction &lt; 40 %), systolic blood pressure &gt; 160 mmHg or diastolic blood pressure above 100 mmHg, electrocardiographic signs of myocardial ischemia, persisting upon discharge from the hospital. Conclusions. Criteria that negatively affect the long-term outcome of coronary heart disease in patients with type 2 diabetes are decompensation of DM, in particular, a high level of fasting glycemia (&gt; 13 mmol/l), as well as an increase in total cholesterol and low-density lipoprotein cholesterol.

Predictors of in-hospital mortality in patients admitted to the emergency department with cardiogenic pulmonary edema

Background: Despite significant advances in the treatment of heart failure, the prognosis of acute cardiogenic pulmonary edema (ACPE) continues to be a serious problem. The objective of this study is to determine the risk factors affecting in-hospital mortality in patients with ACPE.&#x0D; Methods: We enrolled 305 patients who were hospitalized with cardiogenic pulmonary edema as a diagnosis. Clinical, biochemical and echocardiographic variables were collected and analysed. The patients were divided into two groups according to the presence of mortality. Both groups were evaluated in terms of clinical features during admission to the emergency department (ED) and factors affecting in-hospital mortality. &#x0D; Results: Forty-two patients died and the mortality rate was 13.8%. To determine the factors affecting mortality, multiple logistic regression analysis was performed. In the regression analysis, it was seen that age at admission to the ED (OR:1.75, 95% CI 1.18-3.05, p:0.014), systolic blood pressure (OR:0.95, 95% CI 0.31-0.98, p:0.040), presence of acute myocardial infarction (OR:4.17, 95% CI 1.85-7.13, p:0.001), positive troponin (OR:5.47, 95% Cl 1.07-7.46, p:0.011), atrial fibrillation rhythm (OR;3.16, 95% CI 1.81-8.02, p:0.010), inotropic drug usage (OR;5.61, 95% CI 1.87-9.24, p:0.013) increased in-hospital mortality.&#x0D; Conclusion: Our findings could help clinicians in identifying patients with poor prognosis early in the presence of identified risk factors.

Myocardial Infarction Complicated by Ischemic Stroke: Risk Factors, Prognosis, Unresolved Problems and Possible Methods of Prevention

The present work is devoted to the analysis of modern publications on various aspects of the development and course of ischemic stroke in the presence of acute myocardial infarction. A literature search was conducted on the websites of cardiological and neurological societies, as well as on the PubMed, EMBASE, eLibrary databases using the keywords: myocardial infarction, acute coronary syndrome, stroke, acute cerebrovascular accident, myocardial infarction, acute coronary syndrome, stroke. The authors of this review found that although stroke is a relatively rare complication of myocardial infarction, its prevention is an extremely significant task, since it is associated with high mortality, disability and a significant increase in the cost of treatment. So, it is extremely important to detect thrombosis of the left ventricular cavity in a timely manner, to register preexisting atrial fibrillation that occurs earlier or for the first time, followed by the appointment of anticoagulant therapy. Timely reperfusion treatment, the use of statins and modern dual antithrombotic therapy can reduce the risk of developing cerebrovascular accident in patients with myocardial infarction. It is likely that a decrease in the activity of subclinical inflammation after myocardial infarction will also reduce the risk of stroke, as was recently shown in the COLCOT study. Currently, it remains relevant to search for new knowledge about the risk factors for stroke, which complicated the course of myocardial infarction, which will allow developing more effective and personalized preventive measures in a patient with acute coronary syndrome.

Off-pump external pericardial patch repair for post-infarct left ventricular free wall rupture: a case series

We describe an off-pump surgical approach to this challenging condition supported by our results from a case series, which would add to existing literature in the management of this life-threatening complication. We identified seven patients who underwent surgical intervention for left ventricular (LV) free wall rupture at our institution. They were all diagnosed to have cardiac tamponade secondary to free wall rupture of the LV in the presence of acute myocardial infarction. The surgical technique comprised of utilizing an external pericardial patch which was secured using surgical biological glues (fibrin-based sealants or gelatin hydrogels). The 30-day mortality, 1-year survival and 2-year survival were 57, 42 and 42%, respectively. Advanced age, female gender and use of cardiopulmonary bypass were characteristics that were not significantly associated with survival. We advocate the use of an off-pump external pericardial patch repair strategy as a ‘bridge to recovery’ in this extremely high-risk group of patients.

T-wave heterogeneity in standard resting 12-lead ECGs is associated with 90-day cardiac mortality in women following emergency department admission: A nested case-control study.

BackgroundWe investigated whether T‐wave heterogeneity (TWH) can identify patients who are at risk for near‐term cardiac mortality.MethodsA nested case–control analysis was performed in the 888 patients admitted to the Emergency Department (ED) of our medical center in July through September 2018 who had ≥2 serial troponin measurement tests within 6 hr for acute coronary syndrome evaluation to rule‐in or rule‐out the presence of acute myocardial infarction. Patients who died from cardiac causes during 90 days after ED admission were considered cases (n = 20; 10 women) and were matched 1:4 on sex and age with patients who survived during this period (n = 80, 40 women). TWH, that is, interlead splay of T waves, was automatically assessed from precordial leads by second central moment analysis.ResultsTWHV4‐6 was significantly elevated at ED admission in 12‐lead resting ECGs of female patients who died of cardiac causes during the following 90 days compared to female survivors (100 ± 14.9 vs. 40 ± 3.6 µV, p < .0001). TWHV4‐6 generated areas under the receiver‐operating characteristic (ROC) curve (AUC) of 0.933 in women (p < .0001) and 0.573 in men (p = .4). In women, the ROC‐guided 48‐µV TWHV4‐6 cut point for near‐term cardiac mortality produced an adjusted odds ratio of 121.37 (95% CI: 2.89–6,699.84; p = .02) with 100% sensitivity and 82.5% specificity. In Kaplan–Meier survival analysis, TWHV4‐6 ≥ 48 µV predicted cardiac mortality in women during 90‐day follow‐up with a hazard ratio of 27.84 (95% CI: 7.29–106.36, p < .0001).ConclusionElevated TWHV4‐6 is associated with near‐term cardiac mortality among women evaluated for acute coronary syndrome.

Kussmaul's sign for the diagnosis of right ventricular myocardial infarction: a systematic review and meta-analysis of diagnostic test accuracy studies.

Kussmaul's sign, the absence of a drop in jugular venous pressure or a paradoxical increase in jugular venous pressure on inspiration, can be evaluated as an indicator of right ventricular myocardial infarction. Right ventricular myocardial infarction complicates 30-50% of inferior myocardial infarctions and is associated with increased mortality when compared to inferior myocardial infarction without right ventricular involvement. Early recognition allows maintenance of preload. We reviewed the diagnostic test accuracy studies for Kussmaul's sign for diagnosis of right ventricular myocardial infarction. We conducted a librarian-assisted search using PubMed, Medline, Embase, and the Cochrane database from 1965 to October 2019. Only English language restriction was imposed. We identified studies that assessed patients presenting to a hospital with a suspected myocardial infarction who underwent an assessment for Kussmaul's sign and a diagnostic test for right ventricular myocardial infarction. Four independent reviewers extracted data from relevant studies. Study quality was assessed using the QUADAS-2 tool. A bivariate random effects meta-analysis was performed. We identified 122 studies; ten were selected for full review. Eight studies had comparable populations with a total of 469 consecutive patients admitted with acute inferior myocardial infarction and were included in the analysis. Prevalence of right ventricular myocardial infarction was 36% (confidence interval [CI] 95% 31.8-40.5). All reference standards were combined. Kussmaul's sign had a sensitivity of 62.5% (44.6, 77.5), specificity 90% (73.0, 96.8), negative likelihood ratio (LR) 0.2 (0.1-0.8) and positive LR 5.8 (2.5, 13.3). In the presence of acute myocardial infarction, Kussmaul's sign is specific for acute right ventricular myocardial infarction and may serve as an important clinical sign of right ventricular dysfunction requiring preload preserving management.

One-year outcome of the rule-out group according to the 0-h /1-hour algorithm with suspected myocardial infarction in Asian countries

Abstract Background/Introduction; A rapid rule-out or rule-in protocol based on the 0-h/1-hour algorithm using high-sensitivity cardiac troponin T (hs-cTnT) is recommended by the European Society of Cardiology (ESC). Around 40–50% were stratified into “rule-out” group, and their 30-days prognosis was excellent. However, the one-year prognosis is uncertain. We aimed to better characterize these patients. Methods This study was a prospective, multi-center, observational study of patients with suspected non-ST elevation acute coronary syndrome (NSTE-ACS) admitted to 5 hospitals in Japan and Taiwan from 2014 November to 2018 December, respectively. All patients underwent a clinical assessment the included medical history, physical examination, 12-lead ECG, standard blood test, chest radiography. Exclusion criteria were ST elevated myocardial infarction, chronic kidney disease (serum creatinine more than 3 mg/dL) and congestive heart failure, arrhythmia, or infection disease. The patients were divided into three groups according to the algorithm; “rule-out”, “observe” and “rule-in”. The final diagnosis was then adjudicated by 2 independent cardiologists using all available information, including coronary angiography, coronary computed tomography, stress electrocardiography and follow-up data. The presence of acute myocardial infarction (AMI) was defined according to the Fourth Universal Definition of Myocardial Infarction. After hospital discharge patients were follow after one-year b telephone or in written form. Major adverse cardiovascular events (including death myocardial infarction, coronary artery bypass grafting, percutaneous coronary intervention (PCI)) were recorded by establishing contact with the patient and the family physicians. The primary prognosis end point was all-cause mortality. Results Of the 1,187 patients were analyzed after exclusion. The prevalence rate of AMI was 16.1%. According to the algorithm, 42% (n=493) of patients were assigned to “rule-out” group and had no AMI nor death. The most common final adjudicated diagnoses were atypical chest pain (80%), gallstone attack (3%) and vasospastic angina pectoris (2%). All patients with unstable angina (4.7%) underwent PCI. Conclusion(s) Our findings suggest that the “rule-out” group patients according to ESC 0-h/1-hour algorithm provides very high safety and efficacy for the triage toward AMI. Funding Acknowledgement Type of funding source: None

INFLUENCE OF ACUTE CORONARY SYNDROME ON INTRAOPERATIVE DYNAMICS OF IL-6 DURING CORONARY REVASCULARIZATION

Percutaneous x-ray endovascular angioplasty is one of the most modern methods of treatment of severe forms of cardiovascular diseases. In the pathogenesis of acute coronary syndrome, a special place is occupied by the proinflammatory reaction of the body. The main “secondary” marker is interlekin-6. The peak of its production occurs on the first day of damage and correlates with its size. The aim of the study. To investigate the dynamics of interleukin-6 level in the perioperative period of coronary revascularization, depending on the presence of acute coronary syndrome. Materials and methods. This study included 68 patients with coronary artery disease. The patients were divided into three study groups. Group 1 and 2 patients were diagnosed with ACS, and they underwent emergency stenting of coronary vessels in order to recanalize occlusion of the coronary arteries. 3rd group patients did not have ACS and they were recanalized as planned. Results. Analyzing the results of the study, we found that the highest obtained values of IL-6 were in group 1 in comparison with the group of patients who were surgically treated as planned and after stent placement, the interleukin values were 24.8 % higher in group 1 than in group 2 and almost 4 times higher in group 3 (p&lt;0.001). When comparing groups with acute coronary syndrome, interleukin-6 indices were significantly higher by 47.4 % before surgery in group 3 and by 24.9 % after stent placement, which once again confirms the severity of patients with acute myocardial infarction. Conclusions. Intraoperatively proinflammatory interlekin-6 after coronary artery stenting tends to increase in groups with acute coronary syndrome, while in the group with stable angina, these indicators are significantly higher by 22.8 % (p &lt;0.001). The dynamics of Il-6 levels clearly correlates with the severity of the patient's condition and increases in the presence of acute coronary syndrome, especially in the presence of acute myocardial infarction.