Prevalence Of Myocardial Infarction Research Articles

Angina pectoris after coronary angiography or revascularization in pre- and postmenopausal women with coronary artery disease

Abstract Background Menopause is a known risk factor of coronary artery disease (CAD) in women. Earlier studies indicate that the incidence of angina pectoris (AP) increases with age. Some studies suggest that menopause would be a risk factor for AP in women with history of myocardial infarction (MI). However, the evidence is still incomplete. Purpose The aim of this study was to determine whether pre- or postmenopausal women are more symptomatic after revascularization using Canadian Cardiovascular Society (CCS) grading and New York Heart Association (NYHA) classification. We also wanted to evaluate whether the presence of type two diabetes (T2D) had an impact of the volume of the symptoms of CAD. Methods ARTEMIS Study contains 1,947 subjects with angiographically documented CAD with or without T2D (women 31.8%). Nondiabetic patients were matched with T2D patients for age, sex, prior MI and revascularization. Information of the menopause was from 610 women. Results Total of 584 women were at postmenopausal stage and only 26 were at premenopausal stage. The mean age of the premenopausal women was 57.5±10.8 years (P<0.001) and 69.4±7.5 years in postmenopausal women (P<0.001). Among premenopausal women 46.2% were active or ex-smokers and 26.8% of postmenopausal women still smoked or had smoked in the past (P=0.031). There was not statistically significant difference in other baseline characteristics: BMI, LDL or BNP levels, systolic or diastolic blood pressure, syntax score prior or after the revascularization and prevalence of prior MI. Over half of the postmenopausal women (57.4%, p<0.001) reported to suffer chest pain CCS grade ≥ 2 after the revascularization whereas only one fifth of the premenopausal women (23.1%, P<0.001) reported the same level of AP. T2D seemed to increase the symptoms of CAD as 33.3% of the premenopausal and 61.7% of the postmenopausal women with T2D reported AP with severity of CCS grade ≥ 2 (P=0.050). CCS 2 symptoms were reported by 45.7% of the postmenopausal and 19.2% of the premenopausal women, and CCS 3 symptoms by 11.6% of the postmenopausal women, yet only 3.8% of the premenopausal women (p=0.001 for both, respectively). Three quarter of the premenopausal women reported CCS 1 level of symptoms but only 42.6% of the postmenopausal women (P=0.003). Prevalence of each of CCS grade reported within pre- and postmenopausal women with and without T2D are shown in the Table 1. None of the premenopausal women reported NYHA ≥ 2 dyspnea, and the same level of shortness of breath was reported also only from 4.3 % of the postmenopausal women (p=0.005). Among postmenopausal women with T2D, NYHA ≥ 2 symptoms were more common, though statistical significance was not obtained (9.2%, P=0.196). Conclusion Postmenopausal women seem to experience more CAD-related symptoms after angiography or revascularization compared premenopausal women. Presence of T2D seems to associate with higher CCS grade after revascularization.

Association of monocyte-lymphocyte ratio and myocardial infarction in the U.S. population with diabetes.

The monocyte-to-lymphocyte ratio (MLR) has emerged as a novel inflammatory biomarker; however, its relationship with myocardial infarction (MI) in diabetic populations remains unclear. This study aimed to elucidate the association between MLR and MI prevalence in this unique population. This cross-sectional study used data from the National Health and Nutrition Examination Survey (NHANES), 2015-2018. MLR was utilized as both a continuous and categorical factor to examine its correlation with MI in individuals diagnosed with DM. Subgroup and sensitivity analyses were also performed. In this study, 1,295 individuals with DM were enrolled, among whom 148 (11.4%) were diagnosed with MI. Patients with MI showed a greater MLR. Using a smoothed curve-fitting analysis, a linear relationship was observed between MLR and MI (pfor non-linearity = 0.27). Multivariate logistic regression analysis showed that MLR * 10 was positively correlated with the risk of MI (OR = 1.14, 95% CI 1.01∼1.29, p = 0.041). Compared with the lowest quartile, the OR for Q2, Q3, and Q4 were 2.13 (95% CI: 1.01∼4.47), 2.95 (95% CI: 1.45∼6.00), and 2.74 (95% CI: 1.32∼5.69), respectively. Subgroup analyses showed no significant interaction for MLR in any subgroup (all P > 0.05). The receiver operating characteristic (ROC) curve indicated that the area under the curve (AUCs) of MLR for predicting MI was 0.661 (95% CI: 0.617-0.706; P < 0.05). Our study demonstrated that MLR is significantly correlated with MI in patients with DM.

Impact of Smoking Reduction Scenarios on the Burden of Myocardial Infarction in the French Population Until 2035.

Myocardial infarction (MI) is a cardiovascular disease caused by necrosis of the myocardium, which places a heavy burden on patients. In France, the proportion of daily smokers remains high, reaching at 25.5% in 2020. We evaluated the impact of smoking reduction scenarios on the projection of MI prevalence, mean age of incident cases and number of MI prevented cases until 2035. The French government has introduced smoking cessation policies that have led to an annual decrease in smoking prevalence. Based on this annual decline, we implemented three scenarios (SC) simulating an annual decrease in the proportion of smokers aged over 35 (SC1: 1%, ie, natural evolution without intervention, SC2: 2%, SC3: 9.87%) and a fourth scenario (SC4) in which there is a complete discontinuation of smoking from 2024 onwards using MI hospitalization and demographic data, estimations for the proportion of daily smokers between 35 and 95 years and multi-state models. Between 2023 and 2035, MI prevalence increased from 3.18% to 4.23% in males and from 1.00% to 1.46% in females under SC1. MI prevalence was equal to 4.21%, 4.06%, and 3.82% in males and 1.45%, 1.40%, and 1.34% in females in 2035 according to SC2, SC3, and SC4, respectively. Compared with SC1, 0.68% MI cases would be prevented with SC2, 4.52% with SC3 and 10.34% with SC4, with almost half of cases being prevented before 65 years of age. The increase in the mean age of MI incident cases ranged from 3 to 4 years among males and from 1 to 2 years among females. While reducing tobacco use could substantially reduce the number of MI cases prevented, its prevalence would continue to increase due to the ageing population. An integrated prevention strategy that includes the leading cardiovascular risk factors should more efficiently reduce the future burden of MI.

Phytoconstituents with cardioprotective properties: A pharmacological overview on their efficacy against myocardial infarction.

Myocardial infarction (MI) is considered one of the most common cardiac diseases and major cause of death worldwide. The prevalence of MI and MI-associated mortality have been increasing in recent years due to poor lifestyle habits viz. residency, obesity, stress, and pollution. Synthetic drugs for the treatment of MI provide good chance of survival; however, the demand to search more safe, effective, and natural drugs is increasing. Plants provide fruitful sources for powerful antioxidant and anti-inflammatory agents for prevention and/or treatment of MI. However, many plant extracts lack exact information about their possible dosage, toxicity and drug interactions which may hinder their usefulness as potential treatment options. Phytoconstituents play cardioprotective role by either acting as a prophylactic or adjuvant therapy to the concurrently used synthetic drugs to decrease the dosage or relief the side effects of such drugs. This review highlights the role of different herbal formulations, examples of plant extracts and types of several isolated phytoconstituents (phenolic acids, flavonoids, stilbenes, alkaloids, phenyl propanoids) in the prevention of MI with reported activities. Moreover, their possible mechanisms of action are also discussed to guide future research for the development of safer substitutes to manage MI.

Prevalence of Myocardial Infarction in Saudi Arabia: A Systematic Review.

Myocardial infarction (MI), frequently referred to as a heart attack, happens when the blood supply to a region of the myocardium is reduced. It might be quiet or devastating, causing hemodynamic decline and rapid death. The most common cause of MI is coronary artery disease, which is the leading cause of mortality in the United States. Prolonged lack of oxygen can lead to myocardial cell loss and necrosis. Patients may report chest pain, pressure, and electrocardiogram alterations. Management of MI relies greatly on the interprofessional team.The purpose of this study was to determine the incidence of MI in Saudi Arabia. Between 2000 and 2024, English-language papers were gathered to demonstrate the prevalence of MI in Saudi Arabia. Overall, there were four articles. Surveys and studies of national databases were the most utilized methods (n=4).We found that heart attacks are a significant health issue in Saudi Arabia, with certain lifestyle choices and medical conditions increasing the risk.Heart attacks are a major health concern in Saudi Arabia. To lower the number of heart attacks, it's important for people to make healthier lifestyle choices.

Excess Mortality and Loss of Life Expectancy After Myocardial Infarction: A Registry-Based Matched Cohort Study.

The effect of myocardial infarction (MI) on life expectancy is difficult to study because the prevalence of MI hinders direct comparison with the life expectancy of the general population. We sought to assess this in relation to age, sex, and left ventricular ejection fraction (LVEF) by comparing individuals with MI with matched comparators without previous MI. We included patients with a first MI between 1991 and 2022 from the nationwide SWEDEHEART registry (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies), each matched with up to 5 comparators on age, sex, and region of residence. Flexible parametric survival models were used to estimate excess mortality risk and mean loss of life expectancy (LOLE) depending on index year, age, sex, and LVEF, and adjusted for differences in characteristics. A total of 335 748 cases were matched to 1 625 396 comparators. A higher LOLE was observed in younger individuals, women, and those with reduced LVEF (<50%). In 2022, the unadjusted and adjusted mean LOLE spanned from 11.1 and 9.5 years in 50-year-old women with reduced LVEF to 5 and 3.7 months in 80-year-old men with preserved LVEF. Between 1992 and 2022, the adjusted mean LOLE decreased by 36% to 55%: from 4.4 to 2.0 years and from 3.3 to 1.9 years in 50-year-old women and men, respectively, and from 1.7 to 1.0 years and from 1.4 to 0.9 years in 80-year-old women and men, respectively. LOLE is higher in younger individuals, women, and those with reduced LVEF, but is attenuated when adjusting for comorbidities and risk factors. Advances in MI treatment during the past 30 years have almost halved LOLE, with no clear sign of leveling off to a plateau.

Unveiling acute myocardial infarction in young adults of rural India: Exploring demographic, clinical, and angiographic profiles

ABSTRACT Introduction: Cardiovascular disease, particularly myocardial infarction (MI), remains a leading cause of mortality globally and in India. The prevalence of coronary artery disease (CAD) among young adults in India presents unique challenges, marked by earlier onset and distinct risk factor profiles. However, comprehensive data on young MI patients in rural areas are scarce, necessitating an investigation into their demographics, clinical characteristics, and outcomes. Materials and Methods: This institution-based, cross-sectional study was conducted at the Department of Cardiology, NIMS Super Specialty Hospital, Jaipur, focused on individuals under 45 years old admitted with MI. Data encompassing demographic, clinical, echocardiographic, and angiographic profiles were collected and analyzed. The study spanned from December 2022 to December 2023. Results: Among 45 young MI patients studied, males constituted a substantial majority (86.67%). Lower socioeconomic status (SES) was prevalent (71.11%), and risk factors such as smoking (51.11%) and hypertension (35.56%) were notable. Troponin-T/CPK MB levels were significantly elevated in 57.78% of cases, indicating myocardial damage. Angiographic assessments revealed predominance in left anterior descending (LAD) artery abnormalities (55.56%) and a significant proportion underwent primary percutaneous transluminal coronary angioplasty (PTCA) (46.67%). Conclusion: The study highlights the concerning prevalence of MI among young adults in rural areas of India, with a predominance of males and a high prevalence of traditional risk factors such as smoking and hypertension, as well as the notable influence of low SES (P = 0.0046). Contrary to previous studies that linked higher SES and sedentary lifestyles to an increased risk of CAD, this study underscores the significant burden of CAD among young individuals from lower socioeconomic groups. The elevated levels of troponin-T and CPK-MB, along with the predominance of LAD artery abnormalities, emphasize the severity and distinct coronary involvement patterns in this demographic. These findings highlight the urgent need for targeted preventive strategies and improved access to health-care services for young adults in lower socioeconomic groups in rural areas.

Diagnostic and prognostic value of cardiac troponins in emergency department patients presenting after a fall: A prospective, multicenter study.

Emergency department (ED) presentations after a ground-level fall (GLF) are common. Falls were suggested to be another possible presenting feature of a myocardial infarction (MI), as unrecognized MIs are common in older adults. Elevated high-sensitivity cardiac troponin (hs-cTn) concentrations could help determine the etiology of a GLF in ED. We investigated the prevalence of both MI and elevated high-sensitivity cardiac troponin T (hs-cTnT) and I (hs-cTnI), as well as the diagnostic accuracy of hs-cTnT and hs-cTnI regarding MI, and their prognostic value in older ED patients presenting after a GLF. This was a prospective, international, multicenter, cohort study with a follow-up of up to 1 year. Patients aged 65 years or older presenting to the ED after a GLF were prospectively enrolled. Two outcome assessors independently reviewed all discharge records to ascertain final gold standard diagnoses. Hs-cTnT and hs-cTnI levels were determined from thawed samples for every patient. In total, 558 patients were included. Median (IQR) age was 83 (77-89) years, and 67.7% were female. Elevated hs-cTnT levels were found in 384 (68.8%) patients, and elevated hs-cTnI levels in 86 (15.4%) patients. Three patients (0.5%) were ascertained the goldstandard diagnosis MI. Within 30 days, 18 (3.2%) patients had died. Nonsurvivors had higher hs-cTnT and hs-cTnI levels compared with survivors (hs-cTnT 40 [23-85] ng/L in nonsurvivors and 20 [13-33] ng/L in survivors; hs-cTnI 25 [14-54] ng/L in nonsurvivors and 8 [4-16] ng/L in survivors; p < 0.001 for both). A majority of patients (n = 364, 68.8%) presenting to the ED after a fall had elevated hs-cTnT levels and 86 (15.4%) elevated hs-cTnI levels. However, the incidence of MI in these patients was low (n = 3, 0.5%). Our data do not support the opinion that falls may be a common presenting feature of MI. We discourage routine troponin testing in this population. However, hs-cTnT and hs-cTnI were both found to have prognostic properties for mortality prediction up to 1 year.

Myocardial infarction in patients with HIV infection: incidence, risk factors, pathogenesis, clinical performance and treatment

HIV infection increases the risk of premature myocardial infarction (MI) and other atherosclerotic cardiovascular diseases, which are the main noncommunicable cause of death in HIV-infected patients. The review presents the analysis of recent literature on the incidence, prevalence and risk factors of MI in HIV-infected people. It established that MI is associated with the combined effects of traditional cardiovascular risk factors, HIV infection and the cardiometabolic effects of antiretroviral therapy. Pathogenetic features of acute coronary syndrome in HIV infection under conditions of systemic immune-mediated inflammation, hypercoagulation and direct exposure to the virus are highlighted. The clinical features and coronary damage in MI are described. Methods of treating MI are compared. We concluded that the volume and quality of care for patients with HIV and MI is insufficient. From the perspective of possible drug interactions with antiretroviral therapy, effectiveness and safety of methods for secondary prevention of MI was analyzed.

The prevalence of myocardial infarction in the elderly: A systematic review and meta-analysis.

Myocardial Infarction (MI) refers to the destruction and death of cells in the myocardium of the heart. Its prevalence increases with age due to changes in the cardiovascular system. The aim of the present study was to combine, summarize, standardize, resolve inconsistencies in the results of studies, and investigate the impact of potential factors on the prevalence rate of MI in the elderly through a systematic review and meta-analysis. This systematic review and meta-analysis was conducted from 1987 to March 2022. All relevant published studies were searched in PubMed, Embase, Scopus, Web of Science (WoS) databases, and Google Scholar search engine using related MeSH/Emtree and Free Text words. The heterogeneity among studies was quantified using the I2 index. In the initial search, 35453 studies were identified. After eliminating irrelevant studies, finally, 29 articles with a sample size of 3279136 subjects were included in the meta-analysis. After combining the results of the studies included in the meta-analysis, the total prevalence of MI in the elderly was estimated to be 17.6% (95% CI: 12.8 - 23.7%), 16.1% (95% CI: 11.0 - 22.8%) in males, and 12.5% (95% CI: 9.2 - 16.8%) in females. The prevalence of MI increased with the year of publication and the mean age of the elderly (P < 0.001). The results showed that due to the high prevalence of myocardial infarction (MI) in the elderly, it should be addressed within healthcare systems and policy makers should pay more attention to prevention of MI. However, considering the inclusion of heterogeneous studies, the pooled estimation should be interpreted with caution.

Acute Myocardial Infarction Complicated by Death in a Young Medically Free Female: A Case Report

Cardiovascular disease, and particularly myocardial infarction (MI), is the leading cause of disability and death in women worldwide. Young females with MI have previously been disregarded from inclusion in mass epidemiological research and clinical trials due to the physiologically protective properties of oestrogen. Moreover, young women who present with chest pain are often not considered at a risk for MI, which often delays workup and timely intervention, and they remain an unrecognised and under-treated subgroup. We report a case of a 22-year-old, medically free female with MI, with no traditional risk factors, complicated by a final, unfortunate outcome of death. This case report highlights the need to thoroughly investigate the prevalence, symptoms, and types of acute MI in young female patients, as well to create validated tools to assess the risk factors associated with this subgroup.

Implementation of the European Society of Cardiology 0/3-hour accelerated diagnostic protocol, using high sensitive troponin T: a clinical practice evaluation of safety and effectiveness involving 3003 patients with suspected acute coronary syndrome

BackgroundThere have been relatively few studies detailing the real-world effectiveness and safety of accelerated diagnostic protocols (ADP), using high sensitivity cardiac troponin (hs-cTn).ObjectiveTo analyse the safety and effectiveness of early...

Lifestyle and Health Behaviors Associated with Metabolic Syndrome and Cardiovascular Disease.

Background: As the prevalence of cardiovascular disease increases, the socioeconomic burden is expected to increase further. This study aimed to investigate lifestyle and health behaviors related to metabolic syndrome (MetS), myocardial infarction (MI), and stroke prevalence in men and women 50-79 years of age to assess clustering of risk factors. Methods: This study used raw data from the eighth Korea National Health and Nutrition Examination Survey (KNHANES) in 2021. Collected data were analyzed using SPSS 29.0 program. Complex Samples General Linear Model procedure and Complex Samples Logistic Regression procedure were performed. Results: Body mass index of more than 25.0 kg/m2, being a woman, having a middle school education or less, reporting a lower middle economic status, and performing exercise for less than 150 min a week were associated with MetS prevalence. Stress was associated with MI prevalence in men and women. Depression was associated with stroke prevalence in men. Conclusions: This study found that an education on obesity control in men and women is needed to reduce the prevalence of MetS. To reduce the prevalence of MI, stress management is required for men and women. To decrease stroke prevalence, depression management is needed for men.

Does the paradoxical effect of smoking on troponin impact the safety of the ESC 0/1h algorithm?

Abstract Introduction Paradoxically, recent population-based studies reported lower levels of high-sensitivity cardiac troponin (hs-cTn) in current smokers than in never and former smokers. This counterintuitive finding raises questions about the yet not investigated association between smoking and hs-cTn levels and its potential impact on the safety and accuracy of the ESC 0/1h algorithm in patients with suspected acute myocardial infarction (MI). Purpose We sought to investigate the impact of smoking on i) quantitative levels of hs-cTnI and T in patients with symptoms indicative of MI, and ii) the performance of the ESC 0/1h algorithm using both assays. Methods We used data from a prospective cohort study investigating patients with symptoms suggestive of an acute MI who presented to the emergency department of a German tertiary care center. Final diagnoses were adjudicated according to the 4th Universal Definition of MI. Patients with ST-elevation MI were excluded. The population was categorized into three subgroups according to self-reported smoking status, i.e. current, never, and former smokers. Diagnostic accuracies of hs-cTnI and T levels at 0h and 1h, as assessed by the area under the receiver operating curve (ROC-AUC), and the performance, i.e. safety, accuracy and efficacy, of the ESC 0/1h algorithm using both assays were compared between smokers and never/former smokers. Results Among 2,527 patients with suspected MI, 562 (22.2%) were current smokers, 1,352 (53.5%) never and 613 (24.3%) former smokers. The prevalence of MI was comparable between the three groups, while age as well as several cardiovascular risk factors differed across the smoking categories. Hs-cTn levels at baseline were quantitatively lower in current smokers (hs-cTnI 4.8 [2.3, 14.8] ng/L; hs-cTnT 7.0 [4.0, 16.0] ng/L) than in never (hs-cTnI 5.6 [2.6, 16.2] ng/L; hs-cTnT 9.0 [5.0, 21.0] ng/L) and former smokers (hs-cTnI 6.2 [2.9, 15.9] ng/L; hs-cTnT 10.0 [5.0, 23.0] ng/L). Diagnostic accuracies did not differ between current and never/former smokers regarding the ROC-AUC for non-ST-elevation MI, neither based on 0h hs-cTnI (AUC 0.89 [0.85-0.93] vs. 0.88 [0.86-0.90], p=0.72) and 1h hs-cTnI (AUC 0.94 [0.91-0.97] vs. 0.92 [0.90-0.94], p=0.22), nor on 0h hs-cTnT (AUC 0.87 [0.82-0.91] vs. 0.87 [0.85-0.89], p=0.79) and 1h hs-cTnT (AUC 0.94 [0.92-0.96] vs. 0.92 [0.90-0.94], p=0.086). Applying the ESC 0/1h algorithm using hs-cTnI provided a very high and comparable safety for ruling-out MI in current and never/former smokers. Rule-in accuracy was also similar in current and never/former smokers, while the observe zone was slightly larger in never/former smokers (Figure 1A). Similar findings were confirmed for hs-cTnT (Figure 1B). Conclusion Despite paradoxically lower hs-cTnI and T concentrations in current than in never or former smokers with suspected MI, the ESC 0/1h algorithm achieves very high and comparable safety, accuracy and efficacy irrespective of smoking status.

Improving risk stratification of recurrent myocardial infarction in a large real-world dataset using machine learning

Abstract Background Patient (pt) risk stratification for cardiovascular (CV) events is key to determine the appropriate approach to secondary prevention. Several risk scores have been developed (SCORE2, EUROASPIRE, Thrombolysis in Myocardial Infarction [TIMI] risk score for secondary prevention [TRS 2°P]); these are based on few predictors and have low discriminatory power. Machine learning methods using real-word data (RWD) from electronic health records (EHR) databases and capable of handling a multitude of commonly available variables can serve as powerful tools to improve the discriminatory power and generate efficient and clinically relevant risk scores. Purpose This study used a non-linear machine learning model to build an improved risk score for secondary CV events from a large Israeli EHR database. Methods Records of pts with a first record of atherosclerotic CV disease (ASCVD) admission or coronary procedure and available follow-up data (mean: 1052 days) from the period of 01/2005–11/2020 were considered (n=77432 [67% coronary artery disease, 21% carotid artery disease, 12% peripheral artery disease], a stratified 1:1 randomization by cause of admission yielding in training set [n=38716] and test set [n=38716]). The model’s performance was assessed by comparison with TRS 2°P score on the test set independent of the training set. Twenty-six covariates commonly used in clinical routine and widely available in EHR have been selected and a gradient boosting trees algorithm was applied to the pt data at baseline after the original event to predict recurrent myocardial infarction (MI). The ability of the model to discriminate pts was evaluated using the concordance index (c-index), which expresses how well a predicted risk score describes the observed events (1 implies perfect concordance, 0.5 implies random concordance). Results Prediction accuracy of our model showed a c-index for a future MI of 0.74 (95% confidence interval [CI]: 0.72, 0.76) which is significantly higher than 0.57 (95% CI: 0.56, 0.58) obtained with TRS 2°P. Our 2-tier risk score has successfully discriminated a low-risk group (74% of cohort) with a 3-year MI prevalence of 5% from a high-risk group (26% of cohort) that had a 5-fold higher prevalence (26.6%) (Figure 1). In comparison, the 3-tier TRS 2°P yielded an unbalanced distribution of group sizes with a disproportionate intermediate risk group (22% low, 67% intermediate, 11% of high-risk) with a limited clinical discriminatory power (7.1%, 10,2% and 15.6% of observed events, respectively) (Figure 2). Conclusions Our machine learning based risk score model created on a large set of RWD with a long follow-up seems to offer substantial gain of performance compared to the TRS 2°P. The present 2-tier model shows significant gain of accuracy and clinical discriminatory power paving the way for more individualized prevention strategies.Figure 1Figure 2

Characteristics and outcomes of elderly patients undergoing protected percutaneous coronary intervention with impella mechanical circulatory support

Abstract Background/Introduction In high-risk patients, percutaneous coronary intervention (PCI) with Impella mechanical circulatory support has become an important part of the revascularization strategy. However, data regarding the impact of age in patients undergoing Impella-supported PCI are limited. Purpose The aim of this study was to describe the characteristics and outcomes of Impella mechanical circulatory support in patients ≥75 years of age undergoing high-risk PCI. Methods Using the PROTECT III study, a prospective, multicenter, FDA-audited cohort of the Catheter-based Ventricular Assist Device (cVAD) registry, we compared baseline characteristics and clinical outcomes of patients ≥75 years of age with those of patients &amp;lt;75 years of age treated with Impella-supported high-risk PCI. Rates of major adverse cardiovascular and cerebral events (MACCE), defined as the composite of all-cause death, myocardial infarction (MI), stroke/transient ischemic attack, and revascularization, were assessed at 30 days and 90 days, and mortality was assessed to 1 year. A multivariable Cox regression model (including covariates significant in univariable analysis) was used to examine associations between age and clinical outcomes. Results A total of 1237 patients (26.8% female) were included in the analysis; of whom 493 (39.9%) were ≥75 years of age. Patients ≥75 years of age had lower body mass index (27 kg/m² vs. 30 kg/m²), a lower prevalence of diabetes (49% vs. 61%) and prior MI (37% vs. 43%), and lower estimated glomerular filtration rates (eGFR, 60 vs. 74 mL/min/1.73 m²). They more often suffered from severe valvular heart disease (17% vs. 7%), and more frequently underwent left main PCI (58% vs. 39%). Left ventricular ejection fraction was higher in patients ≥75 years of age (37.7±15.9% vs. 32.0±14.5%). (p&amp;lt;0.05 for all comparisons). Baseline SYNTAX scores did not differ among groups. Rates of death and MACCE did not differ between age groups at either 30 days or 90 days (Figure 1). Mortality at 1 year was 24.0% in patients ≥75 years of age and 17.9% in those &amp;lt;75 years of age. Age ≥75 years was associated with an increased risk of mortality at 1 year (unadjusted HR 1.40, 95% CI 1.05-1.86, p=0.02) and the association remained significant after multivariable adjustment (adjusted HR 1.99, 95% CI 1.24-3.18, p=0.004; Figure 2). Conclusion(s) This study demonstrates that increased age ≥75 years was not associated with a higher risk of mortality or MACCE at 30 or 90 days following protected PCI with Impella mechanical circulatory support, suggesting that protected high-risk PCI in elderly patients is safe and feasible. However, age ≥75 years remained an independent predictor for 1-year mortality after protected PCI.30-day and 90-day MACCE1-year All-cause death

FRI529 Hypothyroidism And Systemic Lupus Erythematosus: A Nationwide Analysis

Abstract Disclosure: F. Sami: None. S. Sami: None. A. Razok: None. T. Ayub: None. A. Olafimihan: None. Background: Hypothyroidism is the most common thyroid disease in Systemic Lupus Erythematosus (SLE) and more prevalent in SLE than the general population. Our aim is to study the prevalence, epidemiology and likelihood of hypothyroidism with SLE as well as impact on outcomes and healthcare burden. Methods: The National Inpatient Database from 2016-2019 was used to extract patient populations. Data was stratified to reflect national estimates. Adult patients with principal diagnosis of SLE and hypothyroidism as a primary or secondary diagnosis were identified. Epidemiology was compared. We analyzed mortality rates, hospital charges (THC) and length of stay (LOS). Secondary outcomes included sepsis, congestive heart failure (CHF), renal and respiratory failure, stroke and myocardial infarction (MI). Statistical analysis was performed with STATA17. Univariate and multivariate regression analyses adjusted for confounders. Results: Among 721,090 adult SLE patients, 17.64% had hypothyroidism. In SLE-hypothyroid group, there were more females (93.46% vs 87.35%, odds ratio 2.01) and whites ( 65.82%vs 33.53%, OR 2.37). The mean age was higher (59.95 SD 15.56 vs 50.91 SD 16.94, P-value 0.000) with significantly more patients in 60-80 years group (44.64% vs 28.56%) and less in 18-40 year age group (1.68% vs 29.01%). African-Americans and Hispanics were significantly less in hypothyroid group with OR 0.34 and 0.87 respectively. Charlson comorbidity Index was ssignificantly high (3.2 vs 2.97). Hypothyroidism was significantly more among higher socioeconomic class of SLE patients (20.62% vs 16.7%) and less prevalent among the low socioeconomic class (28.88% vs 35.36%) based on annual income. There was no significant rise in mortality when adjusted for confounders (1.93% vs 1.97%, P-value 0.702), mean length of stay (5.41 vs 5.46, P-value 0.284), or total hospital charges ($63372 vs 64065, P-value 0.273) between two groups. There was a significantly higher prevalence of MI (3.21% vs 2.9%, P-value 0.01,OR 1.11) and CHF (5.94% vs 5%, P-value 0.00,OR 1.2). Prevalence of sepsis (8.92% vs 8.77%, P-value 0.449), renal failure (37.94% vs 37.79%), respiratory failure (37.63% vs 37.84%) and stroke (0.88% vs 0.93%,) was comparable with no significant difference. Odds ratio for hypothyroidism in SLE was 1.5, p-value 0.000. Conclusion: SLE patients with hypothyroidism are more females, Caucasians, of higher mean age, between 60-80 years of age, and from higher socioeconomic status. There is no effect on mortality, LOS and THC, rate of sepsis, stroke, renal and respiratory failure with hypothyroidism. There is a significantly higher risk of MI and CHF. SLE patients have 1.5 times increased risk of developing hypothyroidism. This emphasizes screening at-risk individuals when suspicion arises, for timely diagnoses and improving outcomes. Presentation: Friday, June 16, 2023

Outcome Worse for Women who Experience Myocardial Infarction Before Age 50 Years

Background: From January 2019 to January 2020, the Department of Cardiology at Hayatabad Medical Complex conducted an analysis of 100 patients to discover the likelihood of a poorer outcome for women who have a myocardial infarction (MI) prior to reaching the age of 50. Calculations show that the prevalence of MI in the female population below the age of 50 amounts to 5.7%. Among patients aged 50 and under, females had a 27% higher rate of complications or death due to MI, such as arrhythmias, persistent angina, shock, and need for revascularization, when compared to males, who had only a 7% rate. The study suggests that women who suffer from myocardial infarction before age 50 have a more unfavorable outcome than their male counterparts who experience a similar event at the same age. The study likewise proposed additional prospective research to verify and reinforce its findings. Objectives: In patients under 50 years old, the effects of a heart attack were studied, with a focus on women. Male patients in this age range were also evaluated to compare outcomes. The goal of the research was to examine the results of myocardial infarction (MI) between genders. Methods: From January 2019 to January 2020, the Department of Cardiology at Hayatabad Medical Complex in Peshawar conducted a 100-patient study, retrospectively. The primary outcome focused on the need for revascularization, persistent angina, arrhythmias, and shock, with medical charts being the source of patient data. By analyzing female patients below the age of 50, we calculated the prevalence of myocardial infarction while comparing the rate of death or any other associated complications between male and female patients of the same age range. Results: Among females under the age of 50, a 5.7% prevalence of MI exists. While males only experience a 7% rate of death or complications due to MI, younger females encounter a significantly higher rate of 27%. Conclusion: Before the age of 50, women with a myocardial infarction had a worse outcome compared to men facing a similar event. The study prompted the suggestion for more prospective studies to authenticate the results. Keyboards: Myocardial Infarction, Prevalence, Outcome, Causes, Women, Age 50.

Risk of myocardial infarction in Parkinson's disease: A systematic review and meta-analysis.

Previous studies investigating cardiovascular disorders in patients with Parkinson's disease (PD) showed heterogeneous results regarding whether there is a higher or lower risk of myocardial infarction (MI) in these patients compared to the general population. Because of the inconsistency in findings, herein the aim was to perform a systematic review and meta-analysis to investigate the risk of MI in patients with PD. A comprehensive literature search was performed using four databases, PubMed, Web of Science, Scopus and Embase, in June 2022. Peer-reviewed observational studies comprising case-controls, cohort, cross-sectional and longitudinal studies that reported MI in the PD population were included. After the screening, 20 studies with a total of 80,441 patients with PD and 802,857 controls were included in our qualitative and quantitative synthesis. The pooled estimated odds ratio for MI in PD patients compared to controls was 0.80 (95% confidence interval [CI] 0.56-1.05) which indicates that there is no association. The pooled prevalence of MI was 5% (95% CI 3%-7%) with a range of 1%-20% amongst patients with PD. The men (6%, 95% CI 1%-13%) and women (6%, 95% CI 1%-14%, Q = 29.27, I2 = 98.50%, p < 0.001) had similar MI prevalence. This comprehensive systematic review and meta-analysis provide compelling evidence that PD is associated with a reduced risk of MI. Whilst the exact mechanism underlying this association remains to be fully elucidated, it is clear that certain risk factors for cardiac events appear to be less present in PD patients, which may serve as a protective factor. However, given the reports of increased risk for cerebrovascular events in PD patients, it is possible that the major risk factors for MI and cardiovascular accidents in this population differ. These findings have important implications for clinical management and further research in this area is warranted.

Role of A Single Nucleotide Polymorphism in Thrombospondine 4 Gene in Premature Myocardial Infarction among Population of Southern Iran.

Coronary Artery Diseases (CAD) are the leading cause of Myocardial Infarction (MI). However, their underlying etiology can be found in the interplay between environmental and genetic factors. On the other hand, it has been shown that Extracellular Matrix (ECM) proteins, such as Thrombospondins (TSP), play a crucial regulatory role in vascular pathologies, including atherogenesis. TSPs are extracellular proteins responsible for intercellular and cell-ECM interactions and are involved in regulating functional responses. Recently, a missense mutation in the TSP-4 gene has been reported to potentially increase the risk of CADs. The present study aimed to investigate the role of rs1866389 Guanosine to Cytosine (G/C) Single Nucleotide Polymorphism (SNP) of the TSP-4 gene on the prevalence of premature MI in southern Iran. The present case-control study included 100 patients with premature MI and 100 healthy individuals. The DNA extracted from the blood samples of the participants underwent Polymerase Chain Reaction (PCR) for the sequence of the TSP-4 gene. Afterward, the frequency of C (mutated) and G (normal) alleles of the TSP-4 gene was evaluated in the case and control groups. According to our findings, there was no significant intergroup difference in gender, age, and smoking status. However, the case group was significantly higher in the prevalence of Diabetes mellitus (DM), Hyperlipidemia (HLP), and Hypertension (HTN) compared to the control group. Moreover, 22%, 49%, and 29% of the case group had CC, GC, and GG genotypes in the TSP-4 gene, respectively, while the prevalence of CC, GC, and GG genotypes were 10%, 44%, and 46% in the control group. Also, the prevalence of allele C was significantly higher in the case group (47%) compared to the control group (33%, P=0.043), showing its significant association with the increased risk of premature MI (OR = 1.80; 95% CI = 1.01-3.19). The rs1866389 G/C SNP of the TSP-4 gene significantly increased the risk of premature MI in the population of southern Iran. Thus, such mutated gene can be used as a target for gene therapy or a marker for early detection of individuals at high risk for CADs.