Prevalence Of Acute Myocardial Infarction Research Articles

Proposed New Cutoff Value for Troponin in the Diagnosis of Acute Myocardial Infarction (AMI) in Patients with Congestive Heart Failure (CHF) and/or End Stage Renal Disease (ESRD)

Abstract Introduction/Objective In a recent publication, we assessed the efficacy of two serum biomarkers for AMI, cardiac Troponin I (cTnI) and creatine kinase-MB (CK-MB), for patients presenting to our emergency department (ED) with acute chest pain. We found that two conditions, CHF and ESRD in 85 patients, caused a significant number of false positive results that resulted in lowering the specificity and positive predictive value of both tests, which were already reduced by the low prevalence of AMI in our patient population. Removal of these patients resulted in significant increases in the two latter parameters. In this study, we focus on cTnI to determine if changing the cutoff value can increase the sensitivity and specificity of diagnosing acute MI in patients with CHF and ESRD. Methods/Case Report A cohort of 380 patients who presented with acute chest pain in the ED and worked up for acute MI were included, 85 of whom had CHF and/or ESRD. A total of 47 patients (15.4% prevalence) were definitively diagnosed with AMI. An initial serum cTnI sample was collected for each patient. Specificity, sensitivity, positive predictive value (PPV) and negative predictive value (NPV) were then compared using the routine cutoff cTnI value (0.05 ng/mL) and the higher cutoff of 0.2 ng/mL. Results (if a Case Study enter NA) Using the original cutoff of 0.05 ng/mL for cTnI in the patients with CHF or ESRD, the sensitivity and NPV were both 100%, while the specificity and PPV were low at 40.3% and 23%, respectively. Interestingly, when the cutoff was raised from 0.05 to 0.2 ng/mL, the sensitivity decreased by about 8% to 92.3 (12 out of 13 patients with AMI), and the specificity increased almost two-fold to 76.4%. The PPV increased to 40.4% and NPV was 98.2%. These values are comparable with the sensitivity, specificity, PPV and NPV of the total population at 85.3%, 82.4%, 38.7% and 97.7%, respectively. Conclusion The original cutoff value for cTnI in patients with ESRD and CHF produces a very low specificity and PPV. The results of this study suggest that an acceptable cutoff for cTnI to rule-out AMI patients who have CHF and or ESRD is 0.2 ng/mL which is four times higher than the original, but has comparable specificity, sensitivity, PPV and PPV to the total patient population. We note that this study must be regarded as a pilot study since the numbers of patients are small. We recommend a larger study to determine the validity of these conclusions.

Chest pain in patients with cancer: prevalence of myocardial infarction and diagnostic performance of high-sensitivity cardiac troponin T/I

Abstract Background Among patients with active or past cancer presenting with acute chest discomfort to the emergency department (ED), multiple uncertainties remain regarding the prevalence of acute myocardial infarction (AMI), outcomes, and the diagnostic utility of recommended diagnostic tools. Purpose We aimed to evaluate 1) the prevalence of AMI among consecutive patients with a history of cancer presenting with acute chest pain to the ED; 2) time to discharge from the ED and hospitalization rate; 3) the diagnostic accuracy of 34 predefined chest pain characteristics (CPCs) and ECG signatures; 4) the diagnostic accuracy of hs-cTnT and hs-cTnI concentrations; and 5) the performance of the European Society of Cardiology (ESC) 0/1h-hs-cTnT/I algorithms. Methods Patients presenting with chest pain to the ED were prospectively enrolled in an international multicenter diagnostic study. Cancer status was prospectively assessed. Final diagnosis was centrally adjudicated by two independent cardiologists, applying the 4th universal definition of AMI. Findings were externally validated in an independent, multicenter cohort. Results Among 8267 patients, 711 (8.6%) had cancer. Cancer patients had a higher burden of cardiovascular risk factors and preexisting cardiac disease, and more often a final diagnosis of AMI (184 [26%] patients with cancer vs 1562 [21%, P<0.001] without cancer). This difference was largely due to a significantly higher proportion of NSTEMIs in cancer patients (23% vs 17%; p<0.001). Total length of stay in the ED was significantly longer in patients with cancer versus those without (5.2h versus 4.3h, p<0.001). The hospitalization rate was higher in cancer patients (49.8%) than in non-cancer patients (34.3%, P<0.001), driven by non-AMI diagnoses (36.3% vs 21.3%, P<0.001). All-cause mortality at 5-years was 34.4% in patients with cancer versus 8.9% in patients without cancer (P<0.001). In cancer patients, high-sensitivity cardiac troponin (hs-cTn) T, but not hs-cTnI, concentrations had lower diagnostic accuracy for NSTEMI versus those without cancer (hs-cTnT area under the receiver-operating characteristics curve 0.89 [95%CI 0.86-0.92] vs 0.94 [95%CI 0.93-0.94], p<0.001). In cancer patients, the ESC 0/1h-hs-cTnT/I-algorithms maintained a very high safety but had lower efficacy with significantly more patients remaining in the observe zone (with hs-cTnT: 39.0% vs 20.0%, P<0.001). Similar findings were obtained in the external validation cohort. Conclusions Patients with current or past cancer have a substantially higher prevalence of AMI as the cause of acute chest pain. Time to discharge from the ED and the rate of hospitalization are increased, mainly due to non-AMI causes. The diagnostic performance of hs-cTnT/I and the efficacy of the ESC 0/1-h-hs-cTnT/I-algorithms is reduced.

Prevalence and effects of acute myocardial infarction on hospital outcomes among COVID-19 patients.

Acute myocardial infarction (AMI) is one of the most lethal complications of COVID-19 hospitalization. In this study, we looked for the occurrence of AMI and its effects on hospital outcomes among COVID-19 patients. Data from the 2020 California State Inpatient Database was used retrospectively. All COVID-19 hospitalizations with age ≥ 18 years were included in the analyses. Adverse hospital outcomes included in-hospital mortality, prolonged length of stay (LOS), vasopressor use, mechanical ventilation, and ICU admission. Prolonged LOS was defined as any hospital LOS ≥ 75th percentile. Multivariate logistic regression analyses were used to understand the strength of associations after adjusting for cofactors. Our analysis had 94 114 COVID-19 hospitalizations, and 1548 (1.6%) had AMI. Mortality (43.2% vs. 10.8%, P < 0.001), prolonged LOS (39.9% vs. 28.2%, P < 0.001), vasopressor use (7.8% vs. 2.1%, P < 0.001), mechanical ventilation (35.0% vs. 9.7%, P < 0.001), and ICU admission (33.0% vs. 9.4%, P < 0.001) were significantly higher among COVID-19 hospitalizations with AMI. The odds of adverse outcomes such as mortality (aOR 3.90, 95% CI: 3.48-4.36), prolonged LOS (aOR 1.23, 95% CI: 1.10-1.37), vasopressor use (aOR 3.71, 95% CI: 3.30-4.17), mechanical ventilation (aOR 2.71, 95% CI: 2.21-3.32), and ICU admission (aOR 3.51, 95% CI: 3.12-3.96) were significantly more among COVID-19 hospitalizations with AMI. Despite the very low prevalence of AMI among COVID-19 hospitalizations, the study showed a substantially greater risk of adverse hospital outcomes and mortality. COVID-19 patients with AMI should be aggressively treated to improve hospital outcomes.

Chest Pain in Cancer Patients: Prevalence of Myocardial Infarction and Performance of High-Sensitivity Cardiac Troponins

BackgroundLittle is known about patients with cancer presenting with acute chest discomfort to the emergency department (ED). ObjectivesThe aim of this study was to assess the prevalence of acute myocardial infarction (AMI), outcomes, and the diagnostic utility of recommended diagnostic tools in this population. MethodsPatients presenting with chest pain to the ED were prospectively enrolled in an international multicenter diagnostic study with central adjudication. Cancer status was assessed prospectively and additional cancer details retrospectively. Findings were externally validated in an independent multicenter cohort. ResultsAmong 8,267 patients, 711 (8.6%) had cancer. Patients with cancer had a higher burden of cardiovascular risk factors and pre-existing cardiac disease. Total length of stay in the ED (5.2 hours vs 4.3 hours) and hospitalization rate (49.8% vs 34.3%) were both increased in patients with cancer (P < 0.001 for both). Among 8,093 patients eligible for the AMI analyses, those with cancer more often had final diagnoses of AMI (184 of 686 with cancer [26.8%] vs 1,561 of 7,407 without cancer [21.1%]; P < 0.001). In patients with cancer, high-sensitivity cardiac troponin T (hs-cTnT) but not high sensitivity cardiac troponin I (hs-cTnI) concentration had lower diagnostic accuracy for non–ST-segment elevation myocardial infarction (for hs-cTnT, area under the curve: 0.89 [95% CI: 0.86-0.92] vs 0.94 [95% CI: 0.93-0.94] [P < 0.001]; for hs-cTnI, area under the curve: 0.93 [95% CI: 0.91-0.95] vs 0.95 [95% CI: 0.94-0.95] [P = 0.10]). In patients with cancer, the European Society of Cardiology 0/1-hour hs-cTnT and hs-cTnI algorithms maintained very high safety but had lower efficacy, with twice the number of patients remaining in the observe zone. Similar findings were obtained in the external validation cohort. ConclusionsPatients with cancer have a substantially higher prevalence of AMI as the cause of chest pain. Length of ED stay and hospitalization rates are increased. The diagnostic performance of hs-cTnT and the efficacy of both the European Society of Cardiology 0/1-hour hs-cTnT and hs-cTnI algorithms is reduced. (Advantageous Predictors of Acute Coronary Syndromes Evaluation [APACE] Study; NCT00470587)

Validation of diagnosis of acute myocardial infarction and stroke in electronic medical records: a primary care cross-sectional study in Madrid, Spain (the e-MADVEVA Study)

ObjectivesTo validate the diagnoses of acute myocardial infarction (AMI) and stroke recorded in electronic medical records (EMR) and to estimate the population prevalence of both diseases in people aged ≥18...

History of acute myocardial infarction in patients with acute coronary syndrome: population characterization and impact on prognosis

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Patients with a history of Acute Myocardial Infarction (AMI) continue to be underrepresented in large studies on Acute Coronary Syndromes (ACS). Purpose To characterize patients with ACS and previous AMI and to evaluate their impact on the therapeutic approach, complications and in-hospital mortality. Methods We studied 722 patients admitted to a Cardiac Intensive Care Unit with a diagnosis of ACS. We considered 2 groups: patients with previous AMI and patients without previous AMI. Age, gender, personal history, clinical and electrocardiographic presentation of the ACS, treatment at admission, left ventricular ejection fraction (EF), coronary angiography and angioplasty were recorded. The following in-hospital complications were defined: heart failure, cardiogenic shock, re-infarction, mechanical complications, stroke and major hemorrhage. In-hospital mortality was compared between both groups. Results Patients with previous AMI constituted 26.8% (194 patients) of the population studied. These had a higher prevalence of arterial hypertension (92.8% vs 71.2%; p&amp;lt;0.001), diabetes (47.9% vs 30.4%, p&amp;lt;0.001), dyslipidemia (73.6% vs 49 .2%, p&amp;lt;0.001), previous angioplasty (62.1% vs 0.0%; p&amp;lt;0.001), heart failure (14.0% vs 4.7%, p&amp;lt;0.001), arterial disease (13.5% vs 3.6%, p&amp;lt;0.001), chronic renal failure (18.7% vs 9.6%, p=0.009) and previous bleeding (5.3% vs 1.3 %, p=0.002). The D with previous AMI presented more frequently with AMI without ST elevation (62.4% vs 40.7%; p&amp;lt;0.001) and Unstable Angina (10.3% vs 5.3%, p=0.02 ) and less with ST-elevation AMI (22.2% vs 47.3%, p&amp;lt;0.001). At admission, patients with previous AMI received less therapy with unfractionated heparin (20.6% vs 30.7%; p=0.007) and more therapy with angiotensin-2 antagonists (6.2% vs 2.3% , p=0.009), nitrates (62.9% vs 49.2%, p=0.001), ivabradine (5.2% vs 1.7%, p=0.01) and diuretics (34.5% vs 22 .3%, p=0.009). The coronary angiography rate was similar between the groups, however patients with previous AMI underwent more coronary angiography via the femoral route (36.9% vs 15.7%, p&amp;lt;0.0001) and fewer angioplasties (58.5% vs 69 .5%, p=0.006). EF was slightly lower in patients with previous AMI (45.7 ± 9.3% vs 48.3 ± 10.4%, p=0.04). However, there were no differences in the presence of any of the complications considered, as well as in in-hospital mortality. Conclusion Patients with previous AMI have a higher prevalence of co-morbidities and a higher prevalence of AMI without ST elevation and Unstable Angina. The presence of previous AMI was not per se a predictor of in-hospital complications or mortality.

HOW THE PAST SHAPES CURRENT STORIES: (EPI)GENETIC EPIDEMIOLOGICAL PROFILES OF METABOLIC SYNDROME IN BRAZILIAN MENNONITES

Mennonites present cc. 500 years genetic isolation and three bottleneck events that reducedtheir genetic diversity. In order to identify (epi)genetic markers for metabolic syndrome (MS),we used a modified version of the Brazilian National Health Survey to interview 762Mennonites from three settlements, between 2016-2023. We compared 63 vs. 127 exomes(Illumina HiSeq) from Mennonites with/without metabolic syndrome (MS) and genotypedcandidate variants in regulatory regions with mass spectrometry (iPLEX) and sequence-specific amplification (PCR-SSP). We also evaluated DNA methylation of the NR3C1 andFKBP5 genes in peripheral blood mononuclear cells (PBMCs) of up to 66 and 141 individualswith/without MS. MS prevalence was 14.02%, less than half the one reported forNeobrazilians (34.8%, P&amp;lt;0.00001), being paralleled by a three times lower prevalence ofacute myocardial infarction (AMI). Among independent MS risk factors, we found lowermaternal warmth in infancy (OR=1.59, P=0.019) and a higher susceptibility to AMI with theharshest migratory route to Brazil (OR=1.57, P=0.001). Thirty-nine variants of 34 genes wereassociated with MS (p&amp;lt;0.02), 41% create/disrupt CpG sites and 12 were associated withvisceral adipose and/or cardiovascular tissue expression. There were no methylationdifferences between individuals with and without MS in PBMCs with the NR3C1 and FKBP5genes, pointing to other epigenetic causal effects. In conclusion, Mennonites have a peculiarepidemiological profile marked by (epi)genetic founder effects that also affect theirmetabolism, calling for urgent action for prevention and to alleviate the burden ofcomorbidities due to late diagnosis.

Machine learning approach combined with causal relationship inferring unlocks the shared pathomechanism between COVID-19 and acute myocardial infarction.

Increasing evidence suggests that people with Coronavirus Disease 2019 (COVID-19) have a much higher prevalence of Acute Myocardial Infarction (AMI) than the general population. However, the underlying mechanism is not yet comprehended. Therefore, our study aims to explore the potential secret behind this complication. The gene expression profiles of COVID-19 and AMI were acquired from the Gene Expression Omnibus (GEO) database. After identifying the differentially expressed genes (DEGs) shared by COVID-19 and AMI, we conducted a series of bioinformatics analytics to enhance our understanding of this issue. Overall, 61 common DEGs were filtered out, based on which we established a powerful diagnostic predictor through 20 mainstream machine-learning algorithms, by utilizing which we could estimate if there is any risk in a specific COVID-19 patient to develop AMI. Moreover, we explored their shared implications of immunology. Most remarkably, through the Bayesian network, we inferred the causal relationships of the essential biological processes through which the underlying mechanism of co-pathogenesis between COVID-19 and AMI was identified. For the first time, the approach of causal relationship inferring was applied to analyzing shared pathomechanism between two relevant diseases, COVID-19 and AMI. Our findings showcase a novel mechanistic insight into COVID-19 and AMI, which may benefit future preventive, personalized, and precision medicine.Graphical abstract.

Abstract 12945: Disparities in the Prevalence of Acute Myocardial Infarction Among Patients With Non-Alcoholic Fatty Liver Disease a Nationwide Database Analysis

Background: Non-alcoholic liver disease (NAFLD) is among leading causes of chronic liver disease. Recent evidence suggests an association of NAFLD with cardiovascular diseases; however, few studies have analyzed national level database for this relationships. We aimed to assess the trends and predictors of acute myocardial infarction (AMI) among NAFLD patients in the United States. Methods: The National Inpatient Sample (NIS) database from 2016 to 2019 was queried using international classification of disease (ICD-10) diagnostic codes to identify patients with primary diagnosis of NAFLD and secondary diagnosis of AMI. Basic demographic variables were analyzed to determine the disparities in prevalence of AMI among NAFLD patients. Univariate logistic regression model was used to compare the odds of development of AMI among NAFLD patients using demographic characteristics. Multivariate logistic regression analysis was done to determine whether NAFLD is an independent predictor of AMI. Results: A total of 58,519 patients had a diagnosis of NAFLD and of these, 5,448 had AMI. Of these, 61% were males, 82% were aged 50 years and over, 68% were white, 8% Black, 16% Hispanic, Asian or Pacific Islander. Females were less likely to have AMI [OR 0.46, 95% CI 0.43-0.48]. Patients &lt;50 years with NAFLD were less likely to develop AMI [OR 0.41, 95% CI 0.38-0.44]. Compared to the whites, blacks [OR 0.57, 95% CI 0.51-0.61, p&lt; 0.001] were less likely to have AMI. However, Hispanics [OR 1.16, 95% CI 1.07-1.25, p&lt; 0.001] and Asian and Pacific Islanders [OR 1.31, 95% CI 1.13-1.51, p&lt; 0.001] were more likely to have AMI compared to the whites. On multivariate analysis, NAFLD was found to be an independent predictor of AMI [OR 1.55, 95% CI 1.51-1.60, p&lt; 0.001] after controlling for sociodemographic variables such as age, sex, race, smoking status, insurance status, hospital location and teaching status, and clinical variables such as previous MI, Congestive heart failure, diabetes mellitus, chronic kidney disease, hyperlipidemia, and hypertension. Conclusions: This analysis suggests older white males with NAFLD had a higher prevalence of AMI and that NAFLD is an independent predictor of AMI.

Abstract 15868: Prevalence and Effects of Acute Myocardial Infarction on Hospital Outcomes Among COVID-19 Patients

Introduction: In the US, there are approximately 84 million cases of COVID-19 accounting for 1 million deaths. Though there are not many studies, acute myocardial infarction (AMI) is one of the most lethal complications of COVID-19. In this study, we looked for occurrence of AMI and its effects on hospital outcomes among COVID-19 patients. Hypothesis: AMI among COVID-19 hospitalizations could worsen the levels of adverse in-hospital outcomes. Methods: Data from the 2020 California State Inpatient Database was used retrospectively. All COVID-19 hospitalizations with age ≥18 years were included in the analyses. Adverse hospital outcomes included in-hospital mortality, prolonged length of stay, vasopressor use, mechanical ventilation, and ICU admission. Prolonged length of stay included any hospital length of stay ≥75th percentile. We explored for differences in adverse hospital outcomes between those with and without AMI. Multivariate logistic regression analyses were used to understand the strength of these associations after adjusting for cofactors. Results: Our analysis had a total of 94,114 COVID-19 hospitalizations and 1548 (1.6%) had AMI. Adverse hospital outcomes such as mortality (43.2% versus 10.8%, P&lt;0.001), prolonged length of stay (39.9% versus 28.2%, P&lt;0.001), vasopressor use (7.8% versus 2.1%, P&lt;0.001), mechanical ventilation (35.0% versus 9.7%, P&lt;0.001), and ICU admission (33.0% versus 9.4%, P&lt;0.001) were significantly higher among COVID-19 hospitalizations with AMI. The odds of adverse outcomes such as mortality (aOR, 3.90, 95% CI: 3.48-4.36), prolonged length of stay (aOR, 1.23, 95% CI: 1.10-1.37), vasopressor use (aOR, 3.71, 95% CI: 3.30-4.17), mechanical ventilation (aOR, 2.71, 95% CI: 2.21-3.32), and ICU admission (aOR, 3.51, 95% CI: 3.12-3.96) were significantly more prevalent among COVID-19 hospitalizations with AMI. Conclusions: In spite of very low prevalence of AMI among COVID-19 hospitalizations, we observed a substantially greater risk of adverse hospital outcomes and mortality. The hyperinflammatory response of COVID-19 could additionally worsen the factors precipitating mortality among AMI. COVID-19 patients with AMI should be aggressively treated to improve hospital outcomes.

S1288 Disparities in the Prevalence of Acute Myocardial Infarction in Non-Alcoholic Steatohepatitis: A Nationwide Analysis

S1288 Disparities in the Prevalence of Acute Myocardial Infarction in Non-Alcoholic Steatohepatitis: A Nationwide Analysis

The effectiveness of computer assisted programme on knowledge and practice regarding immediate care of patients with myocardial infarction among staff nurses

Myocardial destruction was observed but not modified by the cardiologist. It has become increasingly clear that to make a real impact on the prognosis of patients with myocardial infarction. The goal of medical management is to minimize myocardial damage, preserve myocardial function, and prevent complications. the researcher felt the need to assess the effectiveness of computer assisted programme on knowledge &amp; Practice Regarding immediate care of patient with myocardial infarction among staff nurses in admitted in selected wards of Jawaharlal Nehru Hospital &amp; Research centre sector -9 Bhilai C.G.The purpose of experimental study was to study, observe and explore the cause and effect relationship of a situation. In this study the design used in Quasi Experimental one group pre-test and post test research design. The setting for present study is Jawaharlal Nehru Hospital &amp; Research Centre Sector -9 Bhilai C.G. In this study a total of 30 samples for assessment of knowledge &amp; practice of Jawaharlal Nehru Hospital &amp; Research Centre Sector -9 Bhilai C.G. Non- Probability Purposive Sampling technique was used for selecting the sample.The comparison of knowledge score between pre test &amp; post test in which 20%(6) subjects were in Average , 76.67%(26) subjects were in Good, 3.33%(1) subjects were in Excellent pre test knowledge score regarding immediate care of myocardial infarction patient. In Post test knowledge level the majority of staff nurse’s 46.67% (14) subjects in Excellent knowledge level &amp; 53.33% (16) were in Good knowledge regarding immediate care of myocardial infarction patients. Pre test Mean Knowledge score was 10.53, Mean % was 43.88%, S.D of pre test knowledge score was 2.9 &amp; CV was 27.54 &amp; post test Mean knowledge score was 16.54, Mean % was 68.33%, S.D of post test knowledge score was 2.95 &amp; C.V of post test was 17.99. The Practice score of Pre test Mean was 12, mean % was 50% with S.D 1.88 &amp; C.V was 15.67 &amp; Post test practice Mean score was 19.87, mean % was 82.79 with S.D 2.34 &amp; C.V was 11.78.Prevalence of acute myocardial infarction as the first manifestation of ischemic heart disease is high, approximately 50%. Hypertensive individuals more frequently have symptoms preceding acute myocardial infarction, probably due to ventricular hypertrophy associated with high blood pressure levels.

Troponin T and Cardiac Enzyme Levels since Onset of Chest Pain in Patients Suspected of Acute Myocardial Infarction (AMI) in Punjab, Pakistan

Objective: To early diagnose the patients of AMI by using cardiac markers like CK, CK-MB, to find out the significance of these enzymes in comparison with high sensitive Troponin T hs and to find out the presence of a micro-infarction by using newly developed cTnT hs method. Patients and Methods: This was a cross sectional study, conducted at Punjab Institute of Cardiology and included 545 patients. Blood sample of every patient “Suspected of AMI” was sent to the laboratory for estimation of CK, CK-MB by conventional kit method and a high sensitive Troponin T reagent kit was used for prompt diagnosis of AMI. Patients of varying age were included and demographic details like hypertension, diabetes and smoking, family history of IHD, were collected to find out association with AMI. Results: Out of 545 study participants 62.65% (n=341) were male and 37.43% (n=204) were females, the mean age was 54.8 ± 13.42 years, the most frequent risk factor seen was hypertension (HTN in 72.0 % (n=90), followed by Smoking 45.5% (n=90), Diabetes mellitus (DM) 43.3% (n=90), and frequency of family history was seen 18.8% (n=90) in patients positive for acute myocardial infarction (AMI). 78.8% (n=90) males and 21.2%(n=90) females, indicated more prevalence of AMI in male population with frequency of AMI in patients from 41-60 years of age. There was significant association between hypertension, smoking and diabetes with AMI. Family history was not significantly associated with the incidence of AMI. CPK, CK-MB were performed on patient’s serum sample according to the procedures determined by reagent kits of Roche Diagnostic company on Chemistry Analyzer Hitachi 912. Optimized UV test method was used according to DGKC (German Society of Clinical Chemistry and Laboratory Medicine) and IFCC. Special Chemistry analyzer Cobas e 411, automated instrument was used for the quantitative measurement of Troponin T by using Chemiluminescence method (Troponin T hs reagent kits of Roche Diagnostic Company). Conclusion: It was concluded that a direct relationship exists between Troponin T and CPK, and CK-MB was more specific with even more closer and linear relationship with Troponin T hs. It was further observed that high sensitive Troponin T reagent method alone was sufficient to make a final diagnosis of AMI. Troponin T hs alone not only reduces the investigation time but reduces the overall cost as well. Keywords: Acute Myocardial Infarction.

Predictors of Acute Myocardial Infraction in Patients With Vasculitis: A Nationwide Inpatient Cross-Sectional Study.

ObjectivesThe primary goal of this study is to explore demographic and comorbid factors that increase the hospitalization risk of acute myocardial infarction (AMI) in patients with vasculitis along with the utilization rate of percutaneous coronary intervention (PCI)/angioplasty. Additionally, we aim to study the prevalence of AMI in vasculitis inpatients based on geographical distribution.MethodsWe conducted a retrospective cohort study using the Nationwide Inpatient Sample (NIS) in 2019 involving 33,210 inpatients hospitalized on emergency-based admissions with a co-diagnosis of vasculitis, subdivided into cohorts without AMI (N = 31,790) and with AMI (N = 1,420) as the primary diagnosis. A binomial logistic regression model was used to evaluate the odds ratio (OR) of predictors associated with AMI in patients with vasculitis compared to the non-AMI cohort.ResultsThe prevalence of AMI in the total inpatient population with vasculitis was 4.28%, with a majority of patients being in the older age group of 51-65 years (63%), males (59.2%), and white (59%). Inpatients with vasculitis having pre-existing co-morbid conditions were at greater risk for AMI, such as obesity (OR 2.84, 95%CI 2.78-2.89), metastatic cancer (OR 1.73, 95%CI 1.26-2.37), complicated hypertension (OR 1.64, 95%CI 1.46-1.85), and arthropathies (OR 1.48, 95%CI 1.30-1.68). The in-hospital mortality rate was significantly higher in the AMI cohort compared to the non-AMI cohort (13% vs 2.9%). The utilization rate of PCI/endovascular angioplasty was 13.02% (185 out of 1,420) and had a lower in-hospital mortality rate compared to those managed by medical treatment (8.1% vs 13.8%).ConclusionAMI is an important differential diagnosis to consider in vasculitis patients admitted into the hospital with chest pain. Due to the low prevalence of vasculitis and diagnostic challenges, these primary conditions can be often missed. There is a greater risk of inpatient mortality among vasculitis patients with AMI. Therefore, a higher index of suspicion should be exercised, especially in elderly males with risk factors. Vasculitis patients with chronic comorbidities such as arthropathies, obesity and hypertension are at a greater risk for suffering from AMI. Careful screening and management of cardiovascular risk factors is mandatory in vasculitis patients.

BLOOD PRESSURE AND OTHER CLINICAL CHARACTERISTICS OF PATIENTS WITH MYOCARDIAL INFARCTION UNDER 50 YEARS OF AGE

Objective: Arterial hypertension is the main risk factor for the development of cardiovascular diseases throughout the world. The prevalence of acute myocardial infarction (AMI) is increasing in young adults, especially men. Previous studies have identified that risk factors for AMI included tobacco use, obesity, arterial hypertension, and diabetes may be crucial to young individuals. Compared to the elderly, the risk factors are not well studied among the young patients with AMI. Design and method: We enrolled to our study 41 patients younger than 50 years (thirty-six men) admitted to the Department of Internal I - Cardiology, University Hospital Olomouc, with first episode AMI. We collected detailed information regarding family history of premature CVD (MI/ischaemic stroke in men aged &lt; 55 and in women aged &lt; 65 years, body mass index (BMI), smoking, hypertension, dyslipidemia, diabetes mellitus (DM). Hypertension was defined, according to ESH/ESC (European Society of Hypertension, European Society of Cardiology) guidelines, based on repeated blood pressure measurements, medical history and ongoing blood-pressure-lowering treatment. Results: Among 41 young patients with AMI (average 46 ± 3,4 years old), 15 patients (36,6%) had a known diagnosis of arterial hypertension prior to admisison. Mean level of systolic blood at admission were 128,6 ± 18,22 mmHg, diastolic blood pressure 81,35 ± 12,49 mmHg, mean heart rate was 76,32 ± 13,11 bpm. Uncontrolled arterial hypertension was diagnosed at admision in 6 patients, newly diagnosed hypertension in 4 patients. In our group, we diagnosed ST-elevation MI (STEMI) in 54 % of patients, NSTEMI in 46%. Mean level of TRPI was 24051,43 ± 32860,98 ng/l, NTproBNP was 731,1 ± 1019,92 pg/ml. Mean LDL-cholesterol was 3,26 ± 0,83 mmol/l. We newly diagnosed diabetes mellitus in 2 patients, mean HbA1c was 38,42 ± 9,43 (mmol/mol). Conclusions: In our group of young patients with myocardial infarction was prevalence of uncontrolled hypertension 17%. Compared to a group of healthy patients (data from literature), we found out a higher prevalence of arterial hypertension in our group.

Acute Myocardial Infarction and Periodontitis: Importance of Awareness and Prevention in Latin America

By 2030, non-communicable diseases will have accounted for more than three-quarters of deaths worldwide. Cardiovascular diseases (CVDs) have been the leading cause of death worldwide for several years. Acute myocardial infarction (AMI) is a CVD characterized by necrosis of the heart at the myocardial level due to prolonged ischemia caused by the reduction or sudden absence of coronary blood supply. The prevalence of AMI is higher in men at all ages. The incidence of AMI has decreased in industrialized nations; however, it has been on the rise in Latin America (LATAM) due to lifestyle changes. These changes have caused the combined incidence of CVDs and unresolved health concerns in LATAM, such as infections and malnutrition. It is well known that periodontitis, a highly prevalent chronic infectious inflammatory disease, has been associated with systemic diseases, such as diabetes, kidney diseases, and AMI. This review addresses proposed aspects of the correlation between periodontitis and AMI, explains the importance of preventing periodontitis and CVDs, and analyzes the preventative measures being implemented in LATAM, particularly in Mexico.

Iron and Ferritin as novel screening markers of Acute Myocardial Infarction

Introduction: Cardiovascular disease is a public health problem globally. In India, the prevalence of Acute Myocardial Infarction (AMI) was 6.43%. Several causes lead to AMI, among which excess serum Iron and Ferritin is responsible for an increase in the generation of free radicals, thus accelerate atherogenesis through oxidation of Low-density lipoprotein – cholesterol (LDL-C). Assess serum Iron and Ferritin status and compare them with the cardic marker (CK-MB) among patients with AMI. Methods: The study was performed in a tertiary care centre in TamilNadu, India. This casecontrol study was conducted on 25 patients diagnosed with AMI and 25 age and sex-matched healthy participants as control group. Iron, Ferritin, CK-MB and lipid profile parameters were analyzed in serum samples of the participants. Result: The mean levels of serum Iron, Ferritin, CK-MB and lipid profile parameters were increased significantly among the cases when compared to the control group. CK-MB had a strong positive correlation with serum Iron and Ferritin. Serum Iron and Ferritin also had a positive correlation with total cholesterol and LDL-C, and a negative correlation with Highdensity lipoprotein – cholesterol. The odds of developing AMI in those with serum Iron &gt;51.5µg/dl and Ferritin &gt;137ng/dl were 36 and 61.7 times at higher risk respectively. Conclusion: Higher levels of serum Iron and Ferritin seem to be stronger risk factors for AMI, and shall be considered as early screening cardiac markers for AMI.

Accuracy of the European Society of Cardiology 0/1-, 0/2-, and 0/3-hour algorithms for diagnosing acute myocardial infarction.

Accuracy of the European Society of Cardiology 0/1-, 0/2-, and 0/3-hour algorithms for diagnosing acute myocardial infarction.

Clinical In-Hospital Outcomes of Acute Myocardial Infarction in Patients With Hematological Malignancies.

IntroductionThe purpose of our study is to determine in-hospital outcomes of acute myocardial infarction in patients with hematological malignancies and their subtypes.MethodPatient data were obtained from the nationwide inpatient sample (NIS) database between the years 2009-2014. Patients with hematological cancer subtypes and acute MI (non-ST segment elevation myocardial infarction and ST-segment elevation myocardial infarction (NSTEMI/STEMI) were identified using validated international classification of diseases (ninth revision) and clinical modification (ICD-9-CM) codes. Statistical analysis using the chi-square test was performed to determine the hospital outcomes of acute MI in patients with hematological cancers and subtypes.ResultsThe prevalence of acute myocardial infarction was 2.4% in patients with hematological neoplasms (N=3,027,800). Amongst the subtypes of blood cancers, the highest prevalence of acute MI was seen in lymphocytic leukemia (2.9%). The mortality of MI in patients with hematological malignancies was 16.8% vs 8.8% in patients with non-hematological malignancies, in-hospital costs were $25469 ± 36763 vs. $20534 ± 24767, and length of in-hospital stay was 8.3 ± 10 vs 6.3 ± 7.8 days. Amongst the hematological cancer subtypes, the highest mortality of acute MI was found in myeloid leukemia (23%) followed by multiple myeloma (MM) (17.9%), lymphocytic leukemia (15.9%), and lymphoma (14.4%). The length of stay and hospitalization cost was highest for myeloid leukemia, followed by MM, lymphocytic leukemia, and lymphoma.ConclusionThis study showed that acute MI in patients with hematological malignancies has higher in-hospital mortality, length of stay, and cost. Amongst the blood neoplasm subtypes the highest mortality, length of hospital stay, and hospitalization cost were found in myeloid leukemia.

Risk Factors in Young Adults With First Myocardial Infarction

Modifiable risk factors (RFs) play an important role in the development and prognosis of acute myocardial infarction (AMI). This study sought to study the prevalence rates of modifiable RFs during a first AMI, and sex differences in Tunisian young adults. This was a retrospective cohort analysis of a Tunisian tertiary center. From January 2014 to December 2020, we retrospectively studied data of patients with AMI younger than 45 years of age hospitalized for a first AMI. Prevalence rates of hypertension, diabetes mellitus, obesity, smoking, dyslipidemia, and drug abuse were analyzed in these patients. We enrolled 210 patients in the study. The prevalence of AMI in young patients was 8.5%. The mean age was 39.3 ± 4.9 years with a sex ratio of 11. The most frequent cardiovascular risk factors were smoking (88,6%) and dyslipidemia (32%) were the most prevalent risk factors (RF), and 98.6% of patients had at least 1 RF. Hypertension, diabetes, obesity, and drug abuse had a prevalence respectively of 30%, 28%, 8%, and 7.6%. Women had a higher prevalence of diabetes mellitus, hypertension, and obesity, and men had a higher prevalence of dyslipidemia, drug abuse, and smoking. During a first AMI in young adults in whom preventive measures are more likely to be effective, modifiable RFs were highly prevalent and progressively increased over time. Significant sex disparities were observed for individual RFs.