Prevalence Of MI Research Articles

COMPARISON OF OBESITY RELATED CARDIOMETABOLIC RISKS IN DIABETES TYPE 1 AND 2

Diabetes mellitus (DM) regardless the type is a disease with very high cardiovascular complications rate (CVC). With the increase of obesity prevalence in the whole world, there is increase of DM type 1 number (DM1) with overweight as well. Taken DM1, obesity usually is not considered as a risk factor for CVC. Aim. To study the prevalence of overweight and obesity, and influence on the risk of myocardial infarction development (MI), or stroke in DM1 and type 2 (DM2) patients with various metabolic phenotypes; and to evaluate gender specifics. Material and methods. Patients with DM1 were included, totally 3190 persons, and DM2, totally 71602 persons. All DM patients were selected to 3 subgroups: group 1 — normal bodyweight, group 2 — overweight, and group 3 — obese. In each group the prevalence of MI and stroke was evaluated, and risk estimated. Results. Among DM1 patients with overweight were 29,3% (men 29,0%, women 29,7%). Obesity was registered in 9,7% DM1. In difference with overweight, obesity was registered 2 times more commonly and significantly in men, than in women (6,8% vs. 13,4%; p<0,001). In DM1 patients there were no gender differences; in DM2 patients the prevalence of these complications was statistically more significant and higher in men than in women. Overweight and obesity do not increase risk of MI and stroke in DM2. In DM1 overweight increases 2,4 times the risk of stroke, but not MI; obesity does increase 5,2 times the risk of MI, but only in men. The risk of stroke in DM1 and obesity increases 2,8 times, but only in women. Presence of obesity metabolic phenotype in DM1 increases the risk of MI and stroke, nullifying gender differences. Conclusion. Overweight and obesity do influence differently the CVC risk in DM1 and 2. Prevention and treatment of overweight and obesity, together with carbohydrate metabolism disorder, should be the fundamentals of cardiovascular risk decrease in DM1.

A systematic review on the prevalence of acute myocardial infarction in Iran

In Iran, cardiovascular diseases are the most common causes of death. We aimed to perform a systematic review on the prevalence of acute myocardial infarction (AMI) in Iran based on Persian and English papers had been published from 1985 to 2015. Among 267 initially found articles, 142 were excluded; finally, a total number of 40 articles were found relevant which were reduced to 18. Smoking, hypertension, diabetes mellitus, and hypercholesterolemia were the most common risk factors for AMI. Premature MI prevalence was high in men, and smoking was the most common risk factor among young people. People in urban areas were more likely to experience AMI than rural people. The prevalence of AMI in Iran is high and has increased in recent years. Therefore, to restrain the rising trend of AMI, it is necessary to make the primary and secondary prevention efforts.

Abstract 11524: Preferential Use of Bare Metal Over Drug Eluting Stents in Primary Percutaneous Coronary Intervention: Can We Afford Current European Guidelines Recommendations?

DES reduce TLR risk compared to BMS in primary percutaneous coronary intervention (PPCI), with no benefit in mortality, and are currently recommended as first line therapy by the ESC guidelines. In the current era of budget constraints, proper selection of pts who may truly benefit from DES implantation is important. This study aims to evaluate the clinical outcomes of pts undergoing PPCI with a predetermined strategy of preferential use of BMS over DES. Methods: We retrospectively analyzed 283 consecutive STEMI pts (63±13 years) referred to our institution for PPCI (2007-2013). Hospital protocol recommended default BMS utilization, although it allowed DES implantation at operator’s discretion if the lesion was deemed to have a high restenosis risk. Pts were retrospectively allocated in three groups: Group 1 (n=112, 39.5%) BMS in lesions without a high restenosis risk, Group 2 (n=123, 43.5%) BMS in lesions with a high restenosis risk and Group 3 (n=48, 17%) DES implantation. Mean follow-up was 31± 19 months. Only 2 pts were lost to follow-up. Results: Pts in Groups 2 and 3 had a higher prevalence of diabetes, and pts in Group 3 had a higher prevalence of previous MI. Rates of death, myocardial infarction and stroke were similar among groups. TLR rate was higher in Group 2 (10.7%) vs. Group 1 (2.7%) and 3 (4.2%); p 0.03. Pts treated with BMS (Groups 1 and 2 combined) had a 6.8% TLR rate vs. 4.2% in pts treated with DES (Group 3, p=0.4). Although stent prizes vary among countries, estimating a cost of 500 $ per BMS and 1,000 $ for DES, the cost of a strategy of routine DES utilization in our cohort would have been 283,000 $ instead of the actual 165.500 $ (Δ 117.500 $, 41% savings). Even if only pts with low restenosis risk (Group 1) had been treated with BMS the cost would have been 227.000 $ (Δ 56.000 $ 19.7% savings). DES utilization in Group 1 might have reduced TLR rates but the low figure observed in our cohort (2.7%) indicates that this strategy may not be cost-effective. Conclusions: In pts undergoing PPCI, a strategy of preferential use of BMS showed excellent clinical results and led to important cost savings. In the current era of cost-effectiveness and budget restrictions BMS should be considered at least in pts with a priori low restenosis risk.

LIPOPROTEIN(A) MEANING AS AN ADDITIONAL MARKER OF CARDIOVASCULAR RISK IN PATIENTS WITH FAMILIAL HYPERCHOLESTEROLEMIA

Aim. To analyze the relation of Lp(a) and atherosclerosis development in familial hypercholesterolemia (FHCE). Material and methods. Totally, 81 patient with definite FHCE studied, mean age 39,1±0,4 y. o. The participants were selected to two groups: first — with increased level of Lp(a) >0,3 g/L (n=34); mean age — 44,5±0,3; second — with normal Lp(a) <0,3 g/L (n=47, 58,1%); mean age — 37,5±0,3 y. o. Results. Mean level of Lp(a) in various age persons did not differ significantly. In both subgroups in about a half of all participants there was arterial hypertension (AH) revealed (50,8% and 42,6%, respectively), obesity was diagnosed in one third of both groups, number of smokers was higher in higher Lp(а) group (11,8% and 8,5%). IHD had 25,9% of participants. Revalence of IHD in IHD group was 44, 4%, in non-smoker group — 25,8% (RR 1,72 (0,75; 3,99)), acute myocardial infarction prevalence (MI) in smoking subgroup was — 44,6% versus 13,5% (RR 3,26 (1,26; 8,43)). Among lipid profile parameters LDL level was definitive for IHD development (p=0,012). Presence of obesity increased MI risk 2,54 times in FHCE (OR 2,4 (1,05; 5,63)). With increase of Lp(a) IHD was diagnosed more commonly: 32,4% versus 19%, non-significant (p=0,47). Prevalence of MI in the first group was higher than in the second: 8 (23,5%) and 4 (8,5%), respectively, (OR 3,3 (1,1; 9,8), р=0,03). Conclusion. In FHCE, the risk of IHD was influenced by traditional RF (smoking, obesity, LDL level).

RESULTS OF BIODEGRADABLE VASCULAR ENDOPROSTHESES IMPLANTATION IN ISCHEMIC HEART DISEASE PATIENTS WITH TYPE 2 DIABETES

Aim. To evaluate efficacy of endovascular treatment in patients with diabetes, operated with biodegradable vascular endoprostheses and everolimus eluting stents. Material and methods. Primarily, 143 patients were selected into the study. Then 125 patients included and randomized to 2 groups. Patients of I group (n=57) underwent implantation biodegradable vascular endoprostheses, and the II group (n=68) — coronary stents eluting everolimus. For the control of biodegradable endoprostheses implantation optical coherent tomography was used, that was performed at the end of intervention and in long-term follow-up by 12 months. Results. Totally, 63 biodegradable vascular endoprostheses implanted to the patients of I group, and 102 everolimus coated stents to II group patients. Mean diameter of implanted endoprostheses in group I was — 2,88±0,06 mm, and in group II — 2,68±0,12 mm (р>0,05). Technical success of intervention was 100% in both groups. Total number of serious cardiovascular complications during in-patient phase was 3,5% and 2,94% in groups, respectively (p>0,05). Long-term results were followed-up in 41 patient from group I and in 52 from group II. In 12 months survival rate was 100%. Prevalence of non-fatal MI among I and II group patients was 4,9% and 3,8%, resp. (p>0,05). The reason was progression of atherosclerotic process in other arteries. Restenosis prevalence that required new intervention on target lesion was 2,4% and 1,9%, resp. (p>0,05). Late thrombosis in long-term follow-up was not marked in both groups. Late loss of intrinsic lumen of the vessel, by the data of optical coherent tomography was 0,14±0,19 mm and 0,12±0,23 mm, respectively, for groups I and II (р>0,05). Conclusion. Biodegradable vascular endoprostheses in CHD patients with diabetes and mostly involvement of middle and distal segments of coronary arteries, showed equal efficacy and safety, with everolimus coated stents, in 12 months after intervention.

I/D POLYMORPHISM OF ANGIOTENSINE CONVERTING ENZYME IN CHD PATIENTS OF DIFFERENT AGE AND GENDER

Aim. To analyze spread of alleles and genotypes of ACE gene in CHD patients of different gender and age and to study their realtion with MI risk. Material and methods. Totally 326 individuals of both age, Tomsk city inhabitants, aged 34-79 y. o., included into the study. Of those 173 CHD patients having MI anamnesis and 153 healthy individuals. For the entire group the I/D polymorphism of ACE gene with PCR method using primers by AmpliKit Company (Saint-Petersburg). For the analysis of frequency spread of alleles and genotypes the χ2 criteria used, precise Fischer test and relative risk estimation. Results. By the results of statistic analysis there were no difference between control and patient groups by the prevalence of ACE genes and alleles. While studying women separately there were no siginificant differences between patients and controls in genotypes and alleles. In men with MI in anamesis there was increase of DD genes prevalence comparing to healthy individuals (p=0,038). The analysis of MI prevalence and I/D polymorphism in men and women was performed with relation to age. It is shown that in men younger than 50 y.o. homozygotes there are moreprevalent II and DD genotypes, than in men older than 50 y.o., whom ID genotype is more prevalent (p=0,031). In women group the difference between those younger and older than 55 y.o. the spread of genotypes was similar, but there were more prevalent MIs in older group (p=0,020). Conclusion. The important points of I/D polymorphism of ACE genes influence on MI risk was shown. Among women, sick and healthy, and of various age, there were no significant differences in genitypes prevalence. However there are statistically significant differences in the genotype spread was found in healthy men and men after MI, and in men with the age of 34-50 and 51-79 y.o.

Abstract 16726: Association of Renin-angiotensin System Inhibitors With Reduced Adverse Cardiac Events in Patients With Ischemic Mitral Regurgitation After Acute Myocardial Infarction

Background: Ischemic mitral regurgitation (IMR) portends a poor prognosis during long-term follow-up and has been identified as an independent predictor of heart failure (HF) and reduced long-term survival. Renin-angiotensin system inhibitors (RASI) including angiotensin-converting enzyme inhibitors (ACEI) and angiotensin-receptor blockers (ARB) may improve prognosis in patients with IMR after acute myocardial infarction (AMI). The purpose of this study was to investigate the association of RASI with the incidence of adverse cardiac events in patients with IMR after AMI. Methods: We screened 867 consecutive patients admitted for AMI and underwent emergency coronary angiography between January 2000 and December 2008. A total of 388 patients who were diagnosed to have mild or greater MR evaluated by transthoracic echocardiography within 2 weeks after the onset were enrolled. Results: The mean age was 67±11 years and 297 patients (77%) were men. A total of 297 patients (77%) received RASI before hospital discharge. Patients without RASI were older and more likely to have higher creatinine level compared with patients with RASI. Left ventricular ejection fraction, peak CPK level, prevalence of prior MI were comparable between the two groups. The mean follow-up period was 5.4±3.4 years. During the follow-up, 22 cardiac deaths and 39 HF events occurred. Kaplan-Meier analysis revealed that freedom from cardiac death and HF was significantly higher in patients with RASI than in those without RASI (p<0.001 and p=0.001, respectively). After adjustment with the inverse probability treatment weighting, Cox regression analysis showed a significant beneficial effect of RASI therapy in reducing cardiac death (hazard ratio [HR]: 0.20; p<0.001) and HF (HR: 0.41; p=0.008). Conclusions: RASI was associated with a lower incidence of adverse cardiac events in patients with IMR after AMI.

Non-O blood groups can be a prognostic marker of in-hospital and long-term major adverse cardiovascular events in patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention

BackgroundRecent studies have suggested ABO blood type locus as an inherited predictor of thrombosis, cardiovascular risk factors, myocardial infarction. However, data is scarce about the impact of non-O blood groups on prognosis in patients with ST-elevation myocardial infarction (STEMI). Therefore, we aimed to evaluate the prognostic importance of non-O blood groups in patients with STEMI undergoing primary percutaneous coronary intervention (pPCI) Methods1835 consecutive patients who were admitted with acute STEMI between 2010 and 2015 were included and followed-up for a median of 35.6months. ResultsThe prevalence of hyperlipidemia, total cholesterol, LDL, peak CKMB and no-reflow as well as hospitalization duration were higher in patients with non-O blood groups. Gensini score did not differ between groups. During the in-hospital and long-term follow-up period, MACE, the prevalence of stent thrombosis, non-fatal MI, and mortality were higher in non-O blood groups. In multivariate logistic regression analysis, non-0 blood groups were demonstrated to be independent predictors of in-hospital (OR:2.085 %CI: 1.328-3.274 p=0.001) and long term MACE (OR:2.257 %CI: 1.325-3.759 p<0.001). Kaplan-Meier analysis according to the long-term MACE free survival revealed a higher occurrence of MACE in non-O blood group compared with O blood group (p<0.001, Chi-square: 22.810). ConclusionNon-O blood groups were determined to be significant prognostic indicators of short- and long-term cardiovascular adverse events and mortality in patients with STEMI undergoing pPCI. In conjunction with other prognostic factors, evaluation of this parameter may improve the risk categorization and tailoring the individual therapy and follow-up in STEMI patient population

Clinical outcomes of the intra-aortic balloon pump for resuscitated patients with acute myocardial infarction complicated by cardiac arrest

BackgroundThe aim of this study was to investigate the clinical effects of intra-aortic balloon pump (IABP) in patients who received cardiopulmonary resuscitation (CPR) before procedure. Methods and resultsBetween November 2005 and April 2014, 49,542 patients were enrolled in a prospective cohort study for acute myocardial infarction (AMI) in Korea (KAMIR). CPR was performed in 1700 patients with cardiac arrest. Patients were excluded from the study if they had not undergone a coronary angiogram, if extracorporeal membrane oxygenation or thrombolysis was performed, and if mechanical complications presented. The primary end point was 1-month all-cause mortality. A total of 883 patients in the IABP group and 476 in the control group were included. During the 1-month follow-up, all-cause death occurred in 749 patients (55.1%). The IABP group was predominantly male and had a higher prevalence of ST-segment elevation MI and a higher risk of coronary lesions including left main disease and three-vessel disease. Glycoprotein IIb/IIIa inhibitor was administered less in the non-IABP group. In the total population, the IABP group had worse outcomes in terms of mortality rates after multivariate analysis [hazard ratio (HR) 1.22, 95% confidence interval (CI) 1.02–1.47, p=0.034] without increasing the incidence of recurrent MI, stroke, and major bleeding. After propensity matching with a pair of 452 patients, no significant differences were observed in baseline characteristics or clinical outcomes (HR 1.21, 95% CI 0.93–1.57, p=0.158). ConclusionThe use of IABP did not show clinical benefits in patients with AMI complicated by severe cardiogenic shock after propensity matching analysis.

Abstract 576: Gender Differences in Carotid Artery Plaque Composition Do Not Exist in Response to Lipid Lowering Therapy at Two Years Among Men and Women with Carotid or Coronary Artery Disease and Elevated ApoB Levels

Introduction: Recent, age-adjusted stroke death rates declined greater in men than women. Whether this is related to gender differences in the atherosclerotic plaque response to therapy is not known. Postmortem coronary artery histopathology and post-surgical carotid endarterectomy studies demonstrate that women have less calcification and inflammatory cells, but more smooth muscle cells than men. Hypothesis: We hypothesized that gender differences exist in carotid plaque composition (CPC) in response to lipid lowering therapy (LLT) comparing living men and women. Methods: The CPC study is a prospective, randomized study evaluating the effect of LLT: 1) atorvastatin + placebo + placebo vs 2) atorvastatin + niacin ER + placebo 3) atorvastatin + niacin ER + colsevelam on CPC. Participants had coronary or carotid artery disease and ApoB levels ≥120 mg/dL. CPC was evaluated using MRI. The change over two years in % wall volume (PWV) [(wall volume/total vessel volume) х 100%], a measure of plaque burden that adjusts for variation in artery size, and % lipid rich necrotic core (LRNC) volume among slices with LRNC present were evaluated. Statistical analysis used Wilcoxon rank sum test, chi-square, and multivariate linear regression. Results: There were 40 women and 73 men in the study with both baseline and 2 year MRI scans. Women vs. men were older, mean±SD age 58±9 vs. 54±8 yrs. (p=0.009), had higher HDL-C, 49±14 vs. 40±11 mg/dL (p=0.002), and higher ApoA1 145±26 vs. 126±20 mg/dL (p&lt;0.001). ApoB levels were not significantly different, 127±31 vs. 121±25 mg/dL (p=0.2). Adjusted for age, HDL-C (strongly correlated with ApoA1, r=0.89), ApoE, prevalence of MI and metabolic syndrome (statistically significant in the full baseline cohort), there were no statistically significant gender differences at 2 years with LLT in change in PWV, [[Unable to Display Character: &amp;#8710;]] -0.1 (95% CI: -0.7, 0.6%) (p=0.8) or %LRNC among participants with LRNC, [[Unable to Display Character: &amp;#8710;]] 0.5 (95% CI: -2.5, 3.5%) (p=0.7). Conclusions: We did not detect statistically significant gender differences in change in PWV and %LRNC in response to LLT. Although the results are consistent with no gender differences they remain inconclusive due to the small sample size. Further gender studies in the biology and treatment of arterial atherosclerosis are needed.

PD37-01 ASSOCIATION BETWEEN TESTOSTERONE THERAPY AND THROMBOTIC EVENTS IN ELDERLY MEN

INTRODUCTION AND OBJECTIVES: The association between testosterone therapy (TT) and thrombotic risk in elderly men remains controversial. We evaluated the prevalence of thrombotic events and all-cause mortality in men older than 65 years with hypogonadism treated with testosterone therapy. We compared men treated with testosterone to an age and comorbidity matched cohort of hypogonadal men not treated with TT. METHODS: After IRB approval, we retrospectively reviewed the charts of 217 hypogonadal men (2 AM T 3 years), availability of serum testosterone levels before and after therapy and of a control group (hypogonadal men not treated with TST) for comparison. In addition, we performed a power analysis (80% power), and confirmed that the sample size studied was adequate. Limitations included retrospective study design, a small sample size and lack of information on cause of death. CONCLUSIONS: Consistent with the majority of the studies in the literature, there was increased all-cause mortality in hypogonadal men not treated with testosterone compared to men who received testosterone therapy. There was no difference in prevalence of MI, TIA/ CVA, or PE between patients who were treated with testosterone and hypogonadal men not treated with testosterone.

Impact of hypertension on clinical outcome in STEMI patients undergoing primary angioplasty with BMS or DES: Insights from the DESERT cooperation

BackgroundHypertension is a well known risk factor for atherosclerosis. However, data on the prognostic impact of hypertension in patients with ST elevation myocardial infarction (STEMI) are inconsistent and mainly related to studies performed in the thrombolytic era, with very few data in patients undergoing primary angioplasty. Therefore, the aim of the current study was to evaluate the impact hypertension on clinical outcome in STEMI patients undergoing primary PCI with BMS or DES. MethodsOur population is represented by 6298 STEMI patients undergoing primary angioplasty included in the DESERT database from 11 randomized trials comparing DES vs BMS for STEMI. ResultsHypertension was observed in 2764 patients (43.9%), and associated with ageing (p<0.0001), female gender (p<0.001), diabetes (p<0.0001), hypercholesterolemia (p<0.0001), previous MI (p=0.002), previous revascularization (p=0.002), longer time-to-treatment (p<0.001), preprocedural TIMI 3 flow, and with a lower prevalence of smoking (41% vs 53.9%, p<0.001) and anterior MI (42% vs 45.9%, p=0.002). Hypertension was associated with impaired postprocedural TIMI 0–2 flow (Adjusted OR [95% CI]=1.22 [1.01–1.47], p=0.034). At a follow-up of 1201±440days, hypertension was associated with higher mortality (adjusted HR [95% CI]=1.24 [1.01–1.54], p=0.048), reinfarction (adjusted HR [95% CI]=1.31 [1.03–1.66], p=0.027), stent thrombosis (adjusted HR [95% CI]=1.29 [0.98–1.71], p=0.068) and TVR (adjusted HR [95% CI]=1.22 [1.04–1.44], p=0.013). ConclusionsThis study showed that among STEMI patients undergoing primary angioplasty with DES or BMS, hypertension is independently associated with impaired epicardial reperfusion, mortality, reinfarction and TVR, and a trend in higher ST.

Low specificity of ST-segment elevation or left bundle branch block in the activation for primary percutaneous coronary interventions

Purpose: To determine the diagnostic accuracy of ST-segment elevation (STE) or left bundle branch block (LBBB) in association with acute chest pain prior to hospital admission as activation criteria for primary percutaneous coronary intervention (PPCI). Methods: Prospective observational study of a cohort of consecutive patients with potential diagnosis of acute STE-myocardial infarction (MI) made by a prehospital emergency service in an organizational network, period 2006-2011. Final diagnosis of MI was adjudicated by coronary angiography result. Results: 1228 patients included, 25.5% women. The mean age was 63.4±13.9 years. At time of presentation 24.8% had a history of diabetes, 7% had coronary artery bypass grafts (CABG). The diagnosis of acute MI was confirmed in 80.5% of the total cohort by coronary angiography. Gender, history of diabetes, hypertension or CABG had no impact on the rate of correct diagnosis of MI. However, patients with LBBB (7.1%) had a significantly lower rate of adjudicated diagnosis of MI (58.7%) compared to patients with STE (83.5%). Furthermore, the diagnostic accuracy in predicting acute MI differed significantly across age categories, with the lowest prevalence of definitive MI in patients ≤50 and >75 years of age (73.0% and 77.4%, respectively). Among alternative diagnoses patients ≤50 years presented most frequently with myocarditis (9.5%) and patients >75 years had the highest incidence of hypertensive crisis (5.0%). Accordingly, the rate of successful PPCI also differed significantly across age categories with low rates in these groups (≤50 years: 66.2%; >75 years: 57.7%). Conclusions: With 19.5% false positive activations of PPCI the sensitivity of STE or LBBB in association with acute chest pain for the adjudicated diagnosis of MI by a prehospital emergency service is low. In an organizational network the specificity of diagnostic criteria for acute MI and the prevalence of alternative diagnoses are primarily dependent on age but not gender or other risk factors.

The Prognostic Significance of Frequency and Morphology of Premature Ventricular Complexes during Ambulatory Holter Monitoring

Multiform premature ventricular complexes (PVCs) are associated with an adverse prognosis in patients with structural heart disease. Very frequent PVCs are associated with ventricular dysfunction. Our hypothesis is that multiform PVCs confer an adverse prognosis in the general population. We performed a retrospective cohort study of patients ≥18 years old referred to our institution for 24-hour ambulatory Holter monitoring between July 1, 2008 and December 31, 2009. Holters without PVCs or with more frequent ectopy (couplets, triplets, or nonsustained ventricular tachycardia) were excluded. Clinical and adverse event (AE) data ("major adverse cardiovascular event" or new/worsening heart failure) were gathered from chart review. Data was analyzed by PVC frequency (rare, occasional, or frequent) and pattern (uniform or multiform). A total of 222 patients (43% male, mean age: 55 ± 16 years) were evaluated (median follow-up 2.3 years [IQR: 2.0-2.6]). Median frequency was 2 PVCs per hour (IQR: 1-13). Multiform PVCs were noted in 48%. Patients with multiform PVCs were older, and had a higher prevalence of comorbidities. Thirty-nine AE were noted. Patients with an AE were younger, had a higher prevalence of HTN, diabetes, CAD, CHF, and previous MI. The multiform group had a higher incidence of AE (28%) compared to the uniform group (8%) (P < 0.001). Increasing PVC frequency was associated with a higher incidence of AE (8% vs 24% vs 35%, respectively). In Cox regression analyses, the multiform pattern but not frequency predicted AE. Multiform PVCs were associated with a 4-fold increase in AE in patients referred for ambulatory Holter monitoring.

Association Between ABO Blood Groups And Myocardial Infarction In Jodhpur City of India

Background: Many reports have appeared in recent years showing an association between blood groups and Myocardial Infarction. Clinical studies have shown a significant association between MI and blood group B.Objective: To investigate correlation of ABO blood groups with risk of MI.Methods: The present cross sectional study analyzed ABO blood group among total 400 subjects of any age from the local population of Jodhpur city from July to December 2011.Among them 200 subjects were normal health (135 male and 65 female) students of Dr. S.N. Medical College, Jodhpur and another 200 (135 male, 65 female) were MI patients admitted in the CCU of Mathura Das Memorial (MDM) Hospital, Jodhpur. ABO blood group of all subjects were determined by slide agglutination method. Risk of MI was expressed by risk ratio. Data were analyzed by one sample chi square test.Results: The results obtained in this study showed that the prevalence of MI in blood group B is significantly higher than in all other ABO blood groups.Conclusion: The results may conclude that there is a significant association between MI and blood group B. So this study reveals MI risk is associated with the blood group B. DOI: http://dx.doi.org/10.3329/jbsp.v7i1.11154 J Bangladesh Soc Physiol. 2012, June; 7(1): 13-17

Abstract 9720: Trends In The Prevalence Of Coronary Heart Disease And Congestive Heart Failure Among Adult Population In The U.s.: National Health And Nutrition Examination Survey 2001-2008

Objectives: To evaluate overall trends in the prevalence of coronary heart disease (CHD) and congestive heart failure (CHF) in the U.S. population aged 40 years and older. Methods: A total of 13866 individuals aged 40 and older participated in the household interview and of these 13,067 were both interviewed and examined in National Health and Nutrition Examination Survey (2001-2008). Demographic variables (age, gender, race/ethnicity, education and health insurance) and risk factors (hypertension, diabetes, high cholesterol and body mass index) were included. Definition of coronary heart disease, congestive heart failure and undiagnosed angina as follows: Results: The prevalence of coronary heart disease significantly decreased from 10.3% in 2001-2002 to 8.7% in 2007-2008 ( P-trend &lt; 0.05) but no changes were observed in CHF. CHD prevalence among women ( P-trend = 0.05) and adults with health insurance ( P-trend &lt; 0.05) significantly decreased. In adults who had a total cholesterol &lt; 240 mg/dl, CHD prevalence significantly decreased in those without hypertension and in adults who did not have diabetes ( p-trend &lt; 0.05 for all groups). The prevalence of angina significantly decreased from 4.8% in 2001-2002 to 3.2% in 2007-2008 ( P-trend &lt; 0.05). Meanwhile, the overall prevalence of MI remained unchanged. Conclusion: The overall prevalence of CHD significantly decreased in the 8 years survey period. The results suggest that the overall decreased prevalence in CHD may have been primarily driven by the decreased prevalence in angina because the prevalence of the other components of CHD did not change over this 8 year interval.

Relationship of dyslipidemia and uric acid with the risk of myocardial infarction among hypertensive patients in Trinidad

Objectives: To study the relationship of dyslipidemia and serum uric acid with the risk of myocardial infarction among the hypertensive type 2 diabetic and non-diabetic patients of Trinidad.Methods: Data were obtained from the hospital records of 672 adults who were treated for hypertension in public health clinics in Trinidad.Results: The prevalence of myocardial infarction was 25.45% in the sample. Males accounted for 52.63% while females accounted for 47.37%. Hypertensive type 2 diabetics with dyslipidemia had greater occurrence of MI (23.93%) than non-diabetic hypertensive patients (7.67%) (p = 0.008). Useful predictors of MI included: diabetes mellitus, altered lipid profile, family history of any cardiac conditions. On further analysis, hypertension class (p = 0.003) and serum uric acid quartile (p = 0.029) were also significant predictors of MI.Conclusions: The results suggest that there is a greater prevalence of MI in hypertensive type 2 diabetic patients with dyslipidemia than in non-diabetic hypertensive patients in Trinidad.

Xience Nile, a real-life multicenter prospective Egyptian Xience V registry

Background: Patients undergoing high-risk percutaneous coronary intervention (PCI) are at risk for hemodynamic compromise. In addition to an intraaortic balloon pump, TandemHeart and the Impella device may also be used for temporary hemodynamic support. Indications and benefits of one device vs. another remain poorly defined. We therefore sought to evaluate our experience with these devices in a consecutive series of patients undergoing high-risk PCI. Methods: Seventy-five consecutive patients undergoing high-risk PCI at a single center were retrospectively reviewed. Demographic, procedural and angiographic variables and in-hospital clinical events were collected. The STS, Additive euroSCORE and NCDR CathPCI risk scores were calculated to evaluate procedural risk. Patients undergoing IABP-assisted PCI (I-PCI group, n=47) were compared to those undergoing either Tandem Heart or Impella-assisted PCI (PLVAD-PCI group, n=28). Results: The PLVAD-PCI group was older and had a higher prevalence of CHF and prior MI and significant left main disease and lower EF. Patients in the I-PCI group more commonly presented with acute coronary syndromes or STEMI and more commonly underwent emergent and salvage procedures. STS, Additive euroSCORE and NCDR PCI risk scores were similar between both groups (Table 1). In-hospital mortality was 17% for the entire group. In-hospital mortality and MACE rates were similar in both groups. Conclusions: There were significant baseline, procedural and angiographic differences in patients receiving I-PCI compared to those receiving PLVAD-PCI. Various risk score models showed similar procedural risk between both groups. In-hospital MACE and mortality rates were similar, suggesting that physicians can effectively choose which devices benefit which patients.

Prognostic significance of mean platelet volume on admission in an unselected cohort of patients with non ST-segment elevation acute coronary syndrome

Mean platelet volume (MPV) has been proposed as a marker of platelet reactivity and cardiovascular risk. Its prognostic significance has not been thoroughly investigated in patients with non-ST elevation acute coronary syndrome (NSTE-ACS). We included 1,041 consecutive patients with NSTE-ACS. Patients were divided in quartiles according to the MPV value on admission (fl) i.e. Q1<7.5; Q2=7.5-8.0; Q3=8.1-8.8; Q4≥8.9. The primary study endpoint was the composite of cardiovascular death and re-myocardial infarction (MI) at one year. Secondary study endpoints were individual cardiovascular death and re-MI. Patients in Q4 were older, had a higher prevalence of previous MI, peripheral artery disease and advanced Killip class compared to patients in Q1-Q3. Elevated MPV levels (Q4) was independently associated with gender, smoking status, platelet count and creatinine level. Overall, 210 patients (20.2%) reached the primary endpoint, 124 (12.1%) died from cardiovascular causes and 125 (12.0%) suffered from re-MI. On multivariable analysis patients in Q4 were at higher risk of primary endpoint (HR=1.41; 95%CI 1.06-1.89; p=0.02) whilst the association with cardiovascular death and re-MI was attenuated. MPV as continuous variable was independently associated with both primary endpoint (HR=1.19; 95%CI 1.06-1.33; p=0.003) and cardiovascular death (HR=1.23; 95%CI 1.06-1.42, p=0.006). The incorporation of MPV into a comprehensive model of risk significantly increased the likelihood ratio chi-square for prediction of both the composite endpoint (p=0.004) and cardiovascular death (p=0.009). Therefore, MPV may be useful to improve risk stratification in NSTE-ACS patients and should be included in future prospective studies evaluating the role of platelet function in promoting cardiovascular events.

Uric acid does not affect the prevalence and extent of coronary artery disease. Results from a prospective study

BackgroundHyperuricemia may be involved in the atherosclerotic process due to endothelial dysfunction and facilitation of smooth muscle cell proliferation. However, debates still exist on the independent role of hyperuricemia, due to its association with several cardiovascular risk factors, such as hypertension, hyperlipidemia, obesity and insulin resistance. Thus, the aim of the current study was to investigate in a consecutive cohort of patients undergoing coronary angiography whether hyperuricemia is associated with the extent of coronary artery disease. Methods and ResultsOur population is represented by a total of 1901 consecutive patients undergoing coronary angiography between May 2007 and January 2010 at the Azienda Ospedaliera “Maggiore della Carità”, Novara, Italy. We additionally evaluated platelet aggregation by PFA-100 (Collagen/Epinefrine) and Multiplate. Quantitative coronary angiography and analysis of IMT were performed by experienced cardiologists who had no knowledge of the patients’ clinical information. Higher uric acid was associated with advanced age, larger prevalence of male gender, diabetes, renal insufficiency, hypertension, previous CABG and MI, but with a lower prevalence of family history of CAD. Patients with high uric acid were more often on calcium antagonists, ace-inhibitors, angiotensin receptor antagonists, and, as expected, on diuretics. A significant relationship was observed between uric acid and the prevalence (OR [95% CI] = 1.18 [1.04–1.32], p = 0.01) and severity of CAD (OR [95% CI] = 1.17 [1.03–1.33], p = 0.014). However, the relationship disappeared after correction for baseline confounding factors for both prevalence (OR [95% CI] = 1.06 [0.93–1.21], p = 0.35) and extent of CAD (OR [95% CI] = 1.0 [0.87–1.15], p = 0.96). No relationship was observed between acid uric and IMT (p = 0.73) analyzed in 359 consecutive patients. Finally, there was no relationship between uric acid and platelet aggregation in patients with or without aspirin therapy, as measured by PFA-100 and Multiplate. ConclusionsOur study showed that uric acid is not associated with platelet aggregation, the extent of coronary artery disease and IMT. Thus, waiting for the results of additional large studies, uric acid may not be considered as a risk factor for coronary artery disease, and its reduction by specific therapies may not be recommended to prevent coronary artery disease and atherosclerosis.