Previous Acute Myocardial Infarction Research Articles

DISCONTINUING DAPT: NOT JUST A MATTER OF SCORES BUT OF INTEGRATED EVALUATION? A KEY ROLE OF IMAGING IN A COMPLEX SCENARIO

Abstract The duration of the dual antiplatelet therapy (DAPT) is a widely debated topic within the scientific community. The latest guidelines on acute coronary syndromes have supported the possibility of different therapeutic approaches tailored to patient characteristics. However, the clinical cardiologist‘s decisions are not always based on certain principles. The following case report is a practical example. Discussion: A 31–years–old man came to our attention after a resuscitated cardiac arrest due to ventricular fibrillation during a motorcycle race. His history was characterized by a previous acute myocardial infarction at the age of thirteen due to a traumatic dissection of the proximal left anterior descending (LAD) coronary artery and ascending aorta treated conservatively, with residual transmural necrosis of the mid and subendocardial anterior wall on cardiac MRI. At the admission, ECG showed ST–segment elevation in the anterior leads. Coronary angiography revealed occlusion of the proximal LAD coronary artery, treated with drug–eluting stent (ONYX 5.0 mm), with evidence of dissection and aneurysmal wall of that segment. The patient started a DAPT with aspirin and prasugrel. At discharge, echocardiogram evidenced a moderate left ventricular dysfunction (ejection fraction 34%) with signs of anterior and apical necrosis. Later, the patient was admitted for a subcutaneous defibrillator implantation, due to persistent moderate ventricular dysfunction. One year after revascularization, a lifelong DAPT strategy with downgrading to clopidogrel was considered the best choice for the following considerations: the young age of the patient, the low bleeding risk (PRECISE DAPT score 8), a not elevated DAPT score (value 2), the revascularization in the aneurysmal segment without an appropriate stent apposition (due to absence of a right sizing) and the previous dissection with sign of partial thrombosis at coronary CT. Conclusions: The anatomical complexity of angioplasty procedures and the delicate balance between ischemic and thrombotic risks have led to continuously evolving therapeutic strategies. The clinical scores currently available cannot often account for complex coronary anatomy. Thus, it‘s essential to consider a personalized approach, individualized on clinical and imaging characteristics, that encompasses ischemic and bleeding risk and procedural data for the appropriate treatment for each patient.

Whole-Blood Transcriptome Unveils Altered Immune Response in Acute Myocardial Infarction Patients With Aortic Valve Sclerosis.

Aortic valve sclerosis (AVSc) presents similar pathogenetic mechanisms to coronary artery disease and is associated with short- and long-term mortality in patients with coronary artery disease. Evidence of AVSc-specific pathophysiological traits in acute myocardial infarction (AMI) is currently lacking. Thus, we aimed to identify a blood-based transcriptional signature that could differentiate AVSc from no-AVSc patients during AMI. Whole-blood transcriptome of AVSc (n=44) and no-AVSc (n=66) patients with AMI was assessed by RNA sequencing on hospital admission. Feature selection, differential expression, and enrichment analyses were performed to identify gene expression patterns discriminating AVSc from no-AVSc and infer functional associations. Multivariable Cox regression analysis was used to estimate the hazard ratios of cardiovascular events in AVSc versus no-AVSc patients. This cross-sectional study identified a panel of 100 informative genes capable of distinguishing AVSc from no-AVSc patients with 94% accuracy. Further analysis revealed significant mean differences in 143 genes, of which 30 genes withstood correction for age and previous AMI or coronary interventions. Functional inference unveiled a significant association between AVSc and key biological processes, including acute inflammatory responses, type I IFN (interferon) response, platelet activation, and hemostasis. Notably, patients with AMI with AVSc exhibited a significantly higher incidence of adverse cardiovascular events during a 10-year follow-up period, with a full adjusted hazard ratio of 2.4 (95% CI, 1.3-4.5). Our findings shed light on the molecular mechanisms underlying AVSc and provide potential prognostic insights for patients with AMI with AVSc. During AMI, patients with AVSc showed increased type I IFN (interferon) response and earlier adverse cardiovascular outcomes. Novel pharmacological therapies aiming at limiting type I IFN response during or immediately after AMI might improve poor cardiovascular outcomes of patients with AMI with AVSc.

Pre-hospital pulse glucocorticoid therapy in patients with ST-segment elevation myocardial infarction transferred for primary percutaneous coronary intervention: a randomized controlled trial (PULSE-MI)

BackgroundInflammation in ST-segment elevation myocardial infarction (STEMI) is an important contributor to both acute myocardial ischemia and reperfusion injury after primary percutaneous coronary intervention (PCI). Methylprednisolone is a glucocorticoid with potent anti-inflammatory properties with an acute effect and is used as an effective and safe treatment of a wide range of acute diseases. The trial aims to investigate the cardioprotective effects of pulse-dose methylprednisolone administered in the pre-hospital setting in patients with STEMI transferred for primary PCI.MethodsThis trial is a randomized, blinded, placebo-controlled prospective clinical phase II trial. Inclusion will continue until 378 patients with STEMI have been evaluated for the primary endpoint. Patients will be randomized 1:1 to a bolus of 250 mg methylprednisolone intravenous or matching placebo over a period of 5 min in the pre-hospital setting. All patients with STEMI transferred for primary PCI at Rigshospitalet, Copenhagen University Hospital, Denmark, will be screened for eligibility. The main eligibility criteria are age ≥ 18 years, acute onset of chest pain with < 12 h duration, STEMI on electrocardiogram, no known allergy to glucocorticoids or no previous coronary artery bypass grafting, previous acute myocardial infarction in assumed culprit, or a history with previous maniac/psychotic episodes. Primary outcome is final infarct size measured by late gadolinium enhancement on cardiac magnetic resonance (CMR) 3 months after STEMI. Secondary outcomes comprise key CMR efficacy parameters, clinical endpoints at 3 months, the peak of cardiac biomarkers, and safety.DiscussionWe hypothesize that pulse-dose methylprednisolone administrated in the pre-hospital setting decreases inflammation and thus reduces final infarct size in patients with STEMI treated with primary PCI.Trial registrationEU-CT number: 2022–500762-10–00; Submitted May 5, 2022. ClinicalTrials.gov Identifier: NCT05462730; Submitted July 7, 2022, first posted July 18, 2022.

Clinical profile and incidence of 36-month cardiovascular events in patients with MINOCA: a regional registry of 126 patients in a tertiary cardiology hospital

Abstract Introduction Atherosclerotic plaque rupture is the main etiology of acute myocardial infarction (AMI). In 5% to 6% of AMIs, however, no obstructive lesions greater than 50% are observed, which are then classified as MINOCA (Myocardial Infarction with Non-obstructive Coronary Arteries).The paradigm of MINOCA as a benign condition has been revisited in recent years, as reduced survival rates and a higher risk of subsequent AMIs have been observed when compared to control groups. Purpose To describe the clinical profile and the risk of cardiovascular outcomes in patients diagnosed with MINOCA in a tertiary cardiology hospital between March 2000 and June 2022. Methods In this single-center cohort, all patients meeting the diagnostic criteria for MINOCA with (1) AMI, as follows: (a) no coronary stenosis ≥ 50% in any potential infarct-related artery; and (b) no other clinically overt specific cause for the acute presentation were evaluated with a median follow-up of 30(9.5-67.3) months. Information was obtained by medical chart. Sample characteristics were described in frequencies and median values(p25%-p75%). The incidence of a new cardiovascular event within 36 months after the MINOCA was estimated using the Kaplan-Meier method and the log-rank test applied to compare groups, accompanied by confidence intervals at 95% and an alpha of 5%(R 3.6.1 for MacOS). Results Of the 126 patients, 57.1% were women about 50 years of age (42.0-57.8). 20.6% had diabetes, 47.6% dyslipidemia, 60.3% hypertension and 20% a previous AMI. The predominant clinical presentation was NSTEMI (55.6%) (Table 1), and 7 patients had an episode of aborted sudden death during hospitalization. 38.1% of patients did not have an identified etiology. The most prevalent pathophysiological mechanism was plaque disruption (16.7%), followed by coronary thromboembolism (13.5%) and spontaneous coronary dissection (SCAD) (13.5%). Among the less frequent causes, we had vasospasm (7.1%) and myocardial bridge (2.4%). Only 3.2% underwent optical coherence tomography (OCT) or intravascular ultrasound (IVUS). No provocative testing was performed. 44.4% underwent cardiac magnetic resonance (CMR), within a median time to perform of 180.0 (60.0-707.5) days after the event. Regarding the discharged medical therapy, 79.4% had a beta-blocker and ACEI/ARB prescribed, 14.3% started anticoagulation and only 34.1% received DAPT. The incidence of a composite outcome (CV death, new AMI, stroke and cardiovascular hospitalization) at 36 months was 15% (CI95% 8.9%-24.6%)(Figure 2). The incidence of new MI was 6.3%(N=8), of stroke 2.4% (N=3), and of cardiovascular hospitalization 17.5%(N=22), with only one death. Conclusion The risk of the primary outcome in 36 months is worthy of note. Notably, most of the incidence was attributable to CV hospitalization. An important number of patients were discharged without a known etiology for their clinical presentation, and, consequentially, lacked individualized treatment.Figure 1.Outcomes

Analysis of risk factors for cardiovascular diseases in migrant workers with acute coronary syndrome

The flow of labor migrants to Russia is steadily growing. The rules for providing medical care to foreign citizens on the territory of the Russian Federation depend on their status. Among the morbidity of migrant workers, infectious diseases, venereal diseases, tuberculosis, injuries, intoxication are leading. This increases the risks to the health of Russians, and also puts an economic burden on the healthcare system of the Russian Federation. The purpose of our study was to study risk factors in migrant workers hospitalized with acute coronary syndrome. The study included 50 migrant workers and 107 Russian citizens hospitalized with acute coronary syndrome. Analysis of risk factors for cardiovascular diseases revealed that in migrant labor patients, the development of acute coronary syndrome occurred at a younger age. There were significantly more smokers among migrant labor patients, they had a lower body mass index, type 2 diabetes mellitus and a previous acute myocardial infarction were significantly less common in the anamnesis. Analysis of clinical and laboratory data of patients hospitalized with acute coronary syndrome revealed that the main risk factors for cardiovascular diseases among migrant workers are smoking and lipid metabolism disorders.

Comorbidities prior to out-of-hospital cardiac arrest and diagnoses at discharge among survivors

BackgroundOut-of-hospital cardiac arrest (OHCA) has a dismal prognosis with overall survival around 10%. Previous studies have shown conflicting results regarding the prevalence and significance of comorbidities in OHCA, as well...

Survival Benefit of Kidney Transplantation in Patients With End-Stage Kidney Disease and Prior Acute Myocardial Infarction.

Patients with end stage kidney disease (ESKD) and a previous acute myocardial infarction (AMI) have less access to KT. Data on ESKD patients with an AMI history who underwent first KT or dialysis between January 2007 and December 2018 were extracted from the Korean National Health Insurance Service. Patients who underwent KT (n = 423) were chronologically matched in a 1:3 ratio with those maintained on dialysis (n = 1,269) at the corresponding dates, based on time-conditional propensity scores. The 1, 5, and 10years cumulative incidences for all-cause mortality were 12.6%, 39.1%, and 60.1% in the dialysis group and 3.1%, 7.2%, and 14.5% in the KT group. Adjusted hazard ratios (HRs) of KT versus dialysis were 0.17 (95% confidence interval [CI], 0.12-0.24; p < 0.001) for mortality and 0.38 (95% CI, 0.23-0.51; p < 0.001) for major adverse cardiovascular events (MACE). Of the MACE components, KT was most protective against cardiovascular death (HR, 0.23; 95% CI, 0.12-0.42; p < 0.001). Protective effects of KT for all-cause mortality and MACE were consistent across various subgroups, including patients at higher risk (e.g., age >65years, recent AMI [<6months], congestive heart failure). KT is associated with lower all-cause mortality and MACE than maintenance dialysis patients with a prior AMI.

Prediction of worsening postoperative renal function in older candidates to elective cardiac surgery: Choosing the best eGFR formula may not be enough

BackgroundThough renal impairment is highly prevalent in older patients and influence post-operative outcomes in cardiac surgery; its prognostic relevance is debated and not fully assessed by surgical risk scores. ObjectiveWe investigated the predictive role of estimated glomerular filtration rate formulas for in-hospital worsening renal function (WRF) after cardiac surgery. MethodsWe prospectively enrolled in single-center cohort study, patients aged ≥ 75 years candidate to elective cardiac surgery. Four creatinine-based equations were used to calculate estimated glomerular filtration rate (eGFR) formulas: Cockroft-Gault, Modification of Diet in Renal Disease, Chronic Kidney Disease Epidemiology, and Berlin Initiative Study 1 formulas. Each patient underwent geriatric and clinical evaluation before surgery with calculation of the Society of Thoracic Surgeons scores. In-hospital WRF was defined as a composite of an increase in SCr ≥0.5 mg/dl or the occurrence of grade III KDIGO acute kidney injury. The association between each eGFR equation, alone and in models including clinical variables, and WRF was analyzed using logistic regressions and ROC analysis. ResultsWRF occurred in 69 patients (19.8%), and the predictors of WRF were previous acute myocardial infarction, hypertension, 4-mt gait speed performance, and preoperative eGFR, irrespective of the equation used. With all equations, inclusion of these additional variables in the logistic regression models improved the prediction of WRF (AUCs 0.798–0.810). ConclusionsAn accurate assessment of renal function and of physical performance should be incorporated into cardiac surgery risk scores to improve prediction of in-hospital WRF and, hence, risk stratification in older adults undergoing elective cardiac surgery.

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.

Long-Term Prognosis of Patients With Coexisting Obesity and Malnutrition After Acute Myocardial Infarction: A Cohort Study.

The double burden of malnutrition, described as the coexistence of malnutrition and obesity, is a growing global health issue. This study examines the combined effects of obesity and malnutrition on patients with acute myocardial infarction (AMI). Patients presenting with AMI to a percutaneous coronary intervention-capable hospital in Singapore between January 2014 and March 2021 were retrospectively studied. Patients were stratified into the following: (1) nourished nonobese, (2) malnourished nonobese, (3) nourished obese, and (4) malnourished obese. Obesity and malnutrition were defined according to the World Health Organization definition (body mass index ≥27.5 kg/m2) and Controlling Nutritional Status score, respectively. The primary outcome was all-cause mortality. The association between combined obesity and nutritional status with mortality was examined using Cox regression, adjusted for age, sex, AMI type, previous AMI, ejection fraction, and chronic kidney disease. Kaplan-Meier curves for all-cause mortality were constructed. The study included 1829 AMI patients, of which 75.7% were male and mean age was 66 years. Over 75% of patients were malnourished. Majority were malnourished nonobese (57.7%), followed by malnourished obese (18.8%), nourished nonobese (16.9%), and nourished obese (6.6%). Malnourished nonobese had highest all-cause mortality (38.6%), followed by the malnourished obese (35.8%), nourished nonobese (21.4%), and nourished obese (9.9%, P<0.001). Kaplan-Meier curves demonstrated least favorable survival in malnourished nonobese group, followed by malnourished obese, nourished nonobese, and nourished obese. With nourished nonobese group as the reference, malnourished nonobese had higher all-cause mortality (hazard ratio, 1.46 [95% CI, 1.10-1.96], P=0.010), but only a nonsignificant increase in mortality was observed in the malnourished obese (hazard ratio, 1.31 [95% CI, 0.94-1.83], P=0.112). Among AMI patients, malnutrition is prevalent even in the obese. Compared to nourished patients, malnourished AMI patients have a more unfavorable prognosis especially in those with severe malnutrition regardless of obesity status, but long-term survival is the most favorable among nourished obese patients.

Using Cytoprotective Features of Succinic Acid During the Rehabilitation of the Patients with Previous Acute Myocardial Infarction Complicated with Decompensated Heart Failure

Aim: To improve treatment effectiveness for patients with previous myocardial infarction (MI) while studying clinical pathogenetic features of decompensated heart failure (HF) in the postinfarction period with the focus of using succinic acid. Materials and Methods: The work is based on the results of an examination of 60 patients with previous MI, who got registered decompensated II А-B CHF. The patients with previous STEMI complicated by decompensated HF were divided into groups: the I group included the patients with previous STEMI, who were getting standard treatment according to the guidelines of the MoH of Ukraine (beta-blockers, ACE inhibitors, dual antiplatelet therapy (acetylsalicylic acid+clopidogrel), nitrates, statins) (n=30); the II group included the patients with previous STEMI, who were getting succinic acid into the therapy complex beside the standard treatment. Results: We determined insignificant improvements in such symptoms, as angina, dyspnea, dizziness, and tiredness in the group of patients receiving standard treatment. Herewith using succinic acid reduced clinical signs of inadequate response to physical exercise significantly. Disregarding the one-sidedness of the probable dynamics of the aforementioned 6MWD characteristics, the positive dynamic was less significant in the case of standard treatment. all examined groups presented positive dynamics concerning decreasing the number of points in the patients with decompensated HF after STEMI during the therapy according to Borg’s scale. Conclusions: The use of succinic acid for patients with decompensated heart failure that occurred after STEMI is accompanied by positive clinical effects, and antiischemic and cytoprotective influence.

Outcomes with IV tenecteplase and IV alteplase for acute ischemic stroke with or without thrombectomy in real-world settings in the United States

Background and PurposeAlthough many stroke centers in United States are using intravenous (IV) tenecteplase (TNK) for acute ischemic stroke patients, there is paucity of comparative data between IV TNK and IV alteplase from real-world settings. Materials and MethodsWe analyzed the data from 122 healthcare facilities in Cerner Real World Data and included patients admitted between February 2016 to April 2022 to determine the effect of IV TNK (compared with IV alteplase) on occurrence of two outcomes in acute ischemic stroke patients stratified by use of thrombectomy: non-routine discharge or death, and intracranial hemorrhage after adjusting for potential confounders. ResultsAmong 30,643 acute ischemic stroke patients analyzed, 29,480 (96.2%) and 1,163 (3.8%) patients received IV alteplase and IV TNK, respectively. The proportion of patients who received thrombectomy was significantly higher among patients who received IV TNK compared with those who received IV alteplase (16.7% versus 11.0%, p<0.001). Occurrence of intracranial hemorrhage was more common among patients treated with IV TNK in acute ischemic stroke patients who did not receive thrombectomy (7.9% versus 5.1%, p<0.001) but not in those who received thrombectomy (20.1% versus 16.8%, p = 0.234). In the logistic regression analysis, patients treated with IV TNK who did not receive thrombectomy were at higher risk of intracranial hemorrhage (OR, 1.34, 95% CI 1.05-1.72, p = 0.02) after adjusting for age (age strata), gender, race/ethnicity, hypertension, diabetes mellitus, atrial fibrillation, hyperlipidemia, malignancy, nicotine dependence, previous ischemic stroke, previous transient ischemic attack, previous intracerebral hemorrhage, previous subarachnoid hemorrhage, previous acute myocardial infarction, atherosclerosis of aorta, previous AKI, congestive heart failure, peripheral vascular disease, and hospital type, aphasia, hemiplegia, neglect, somnolence, stupor and coma, dysphagia, and homonymous hemianopsia. There was no difference in the rate of non-routine discharge or death between patients treated with IV TNK and those treated with IV alteplase in the multivariate analyses. ConclusionsIn an analysis of real-world data, IV TNK was associated with higher rates of intracranial hemorrhage compared with IV alteplase in patients with acute ischemic stroke who did not undergo thrombectomy.

EE84 Cost of Follow-Up After an Ischemic Heart Disease Event in Patients With Atherosclerotic Cardiovascular Disease in Spain: Results From the Reality Study

Background: Ischemic heart disease angina and acute myocardial infarction (AMI) are one of the main causes of morbidity and mortality in developed countries and entails a high resources consumption and costs for health systems. The risk of suffering future CV events and the consequent consumption of resources is increased in those patients who have suffered a previous AMI.

Rate and Risk Factors of Acute Myocardial Infarction after Debut of Chronic Kidney Disease-Results from the KidDiCo.

Chronic kidney disease (CKD) is a known risk factor for cardiovascular disease, including acute myocardial infarction. However, whether this risk is only associated with severe kidney disease or is also related to mildly impaired kidney function is still under debate. The incidence rate and risk factors of incident acute myocardial infarction (AMI) in patients with CKD are sparse. Potential differences in risk factor profiles between CKD patients with incident AMI and CKD patients with a prior AMI have not been sufficiently investigated. Furthermore, important factors such as albuminuria and socio-economic factors are often not included. The primary aim of this study was to establish the incidence rate of AMI after CKD debut. Secondly, to evaluate the importance of different CKD stages and the risk of having an AMI. Finally, to identify individuals at risk for AMI after CKD debut adjusted for prevalent AMI. Based on data from the kidney disease cohort of Southern Denmark (KidDiCo), including 66,486 CKD patients, we established incidence rates and characteristics of incident AMI among patients within a 5-year follow-up period after CKD debut. A Cox regression was performed to compute the cause-specific hazard ratios for the different risk factors. The incidence rate for CKD stage G3-5 patients suffering acute myocardial infarction is 2.5 cases/1000 people/year. In patients without a previous myocardial infarction, the risk of suffering a myocardial infarction after CKD debut was only significant in CKD stage G4 (HR = 1.402; (95% CI: 1.08-1.81); p-value = 0.010) and stage G5 (HR = 1.491; (95% CI: 1.01-2.19); p-value = 0.042). This was not the case in patients who had suffered an acute myocardial infarction prior to their CKD debut. In this group, a previous myocardial infarction was the most critical risk factor for an additional myocardial infarction after CKD debut (HR = 2.615; (95% CI: 2.241-3.05); p-value &lt; 0.001). Irrespective of a previous myocardial infarction, age, male sex, hypertension, and a low educational level were significant risk factors associated with an acute myocardial infarction after CKD debut. The incidence rate of AMI in patients with CKD stage G3-5 was 2.5 cases/1000 people/year. Risk factors associated with incident AMI in CKD stage G3-5 patients were CKD stage, age, and hypertension. Female sex and higher educational levels were associated with a lower risk for AMI. Prior AMI was the most significant risk factor in patients with and without previous AMI before fulfilling CKD stage G3-5 criteria. Only age, sex, and a medium-long educational level were significant risk factors in this group.

Anxiety and depression symptoms, albuminuria and risk of acute myocardial infarction in the Norwegian HUNT cohort study

BackgroundStudies suggest increased risk for an outcome in people with joint exposures that share common causal pathways. The objective of this study was to determine the risk of incident acute myocardial infarction (AMI) following exposure to both albuminuria and/or anxiety and depression symptoms.MethodsParticipants who provided urine samples to the HUNT2 (1995–97) or HUNT3 (2007–2009) surveys were followed until the end of 2016. Albuminuria was measured by Albumin Creatine Ratio (ACR) and participants self-reported mood and anxiety symptoms on the Hospital Anxiety and Depression scale. We used Cox regression to estimate hazard ratios (HRs) for first incident AMI considering interaction between exposures and additive models to calculate the proportion of AMI that were attributable to the synergy of both exposures, adjusted for the Framingham variables.ResultsEleven thousand fourteen participants free of previous AMI were eligible for participation, with 1234 incident AMIs occurred during a mean 13.7 years of follow-up. For participants who had a healthier CVD risk profile, the HR for AMI of having both albuminuria (3–30 mg/mmol) and depression (≥8) was 2.62 (95% 1.12–6.05) compared with a HR 1.34 (95% CI 1.04–1.74) with raised ACR only (Likelihood Ratio-test 0.03). Adding anxiety (≥8) to albuminuria (3–30) tripled the risk (HR 3.32 95% CI 1.43–7.17). The additive models suggest that these risks are not higher than expected based on each risk factor alone.ConclusionsThis study indicate that the risk of AMI in persons with elevated albuminuria but with an otherwise healthy CVD profile might be amplified by anxiety and depression symptoms. The increased risk with joint risk factors is not higher than expected based on each risk factor alone, which indicate that the risk factors do not share causal pathways.

Impact of neighbourhood-level socioeconomic status, traditional coronary risk factors, and ancestry on age at myocardial infarction onset: A population-based register study

BackgroundThere is consensus that low socioeconomic status (SES) is associated with an increased risk of acute myocardial infarction (AMI), but the extent to which traditional coronary risk factors and other characteristics of low SES mediate this effect remains uncertain. This study examined AMI patients residing in neighbouring city districts with the same local hospital despite having among the most considerable differences in mean SES in Norway. Our purpose was to assess low SES as a coronary risk factor and examine whether traditional coronary risk factors or ancestry mediate this effect.MethodsSix hundred six patients (215 and 391 with a low and high neighbourhood-level SES, respectively) admitted to Diakonhjemmet Hospital with non-ST-elevation myocardial infarction (NSTEMI) between 2014 and 2017, entered analysis. Data from the Norwegian Myocardial Infarction Register were used to identify patient characteristics, and the STATA/SE 15.1 software was used to perform the statistical analyses.ResultsPatients from socioeconomically disadvantaged city-districts had a 4.9 years earlier onset of AMI (68.99 vs. 73.89 years; p < 0.001) and a higher prevalence of previous AMI, known diabetes, and current smokers (36% vs. 27%, 25% vs. 12%, and 33% vs. 17%, respectively; all p ≤ 0.05). When only comparing patients with a first time AMI, an even greater difference in the age at AMI onset was found (6.1 yrs; p < 0.001). The difference in age at AMI onset remained statistically significant when adjusting for traditional coronary risk factors (3.28 yrs; 95% confidence interval (CI) 1.11−5.44; p = 0.003), but not when adjusting for presumed non-Northwest-European ancestry (1.81 yrs; 95% CI −0.55 to 4.17; p = 0.132).ConclusionThis study supports earlier research showing an increased risk of AMI in socioeconomically disadvantaged individuals. In our population, presumed non-Northwest-European ancestry could entirely explain the increased risk, whereas traditional coronary risk factors could only partly explain the increased risk.

Heart failure admission to a cardiology department versus other internal medicine department is associated with improved long-term survival

Abstract Background Hospitalization for heart failure (HF) is associated with a high risk of in-hospital mortality, but also poor long-term outcomes. Although most hospital systems aim to admit patients with HF to cardiology departments, a significant proportion is admitted to other internal medicine departments due to shortages of beds and limited resources. The prognostic importance of being admitted to different departments is unknown. Purpose To compare the long-term mortality rate in patients admitted to hospital with a first diagnosis for HF to a cardiology department versus other internal medicine departments at a large academic hospital in Norway with a catchment area of 560,000 individuals. Methods Adult patients with a first ICD-10 diagnosis of HF (I11.0, I13.0, I13.2, I42.x, I50.x) admitted to an internal medicine department at our University Hospital between 2011 and 2019 were included. All-cause mortality was obtained from the Norwegian Cause of death registry until December 31, 2021. Results In total, we included 7,692 patients aged 76.1±13.0 years, of whom 46.0% were women, 57.4% had hypertension, 24.1% diabetes, 47.0% established coronary artery disease (CAD) and 36.0% a previous acute myocardial infarction (AMI). Of these, 50.7% were admitted to the cardiology department, 13.5% to the pulmonary department, 7.6% to the infectious disease department and the rest to other internal medicine departments. Patients admitted to the cardiology department were younger and more frequently men with established heart disease. They were more frequently examined with echocardiography during the first 30 days after admission, but had comparable levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) to those admitted to other departments (Table 1). During mean 5.9 years of follow-up, 56.6% of patients died. Patients admitted to the cardiology department had 37% lower mortality risk compared to other departments (HR 0.63 [95% CI 0.59–0.66], p&amp;lt;0.001). This association persisted after adjusting for age, sex, comorbidities (listed in the Table), NT-proBNP and undergoing echocardiographic examination (HR 0.75 [0.70–0.80], p&amp;lt;0.001). Having an echocardiographic examination was also associated with lower mortality risk in the same multivariable model (HR 0.92 [95% CI 0.86–0.97], p&amp;lt;0.001). Conclusion Admission to a cardiology department with HF is associated with better long-term outcomes compared to admission to other internal medicine departments. These findings support health care policy efforts to expand capacity at cardiology departments to allow best care for these vulnerable patients. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): This study was in part funded by research grants from Novartis.

Beta-blockers in acute coronary syndrome: does rhythm matter?

Abstract Introduction Beta-blockers (BB) are recommended in patients with previous acute myocardial infarction (AMI), aiming to reduce morbidity and mortality. Their benefit is greater in patients with associated left ventricular dysfunction. However, in patients with atrial fibrillation (AF) its prognostic benefit is controversial. Purpose To assess and compare the in-hospital and 1-year prognostic impact of BB prescription after acute coronary syndrome (ACS), in patients with previous or de novo AF, and in patients with sinus rhythm (SR). Methods This was a national multicentre retrospective study of patients hospitalized for ACS between October 2010 and December 2021. A total of 35279 patients was included, and divided in two groups according to the prescription or not of BB. Patients with previous history of ischemic heart disease (myocardial angina, AMI or coronary revascularization) or heart failure, as well as presenting in Killip class IV or submitted to coronary artery bypass graft during admission were excluded. The impact of BB prescription on in-hospital and 1 year mortality rates, in patients with AF versus SR, was compared. Results A total of 14906 patients was selected, 82.5% with and 17.5% without BB prescription. Most patients were in SR (90.2%), with 9.8% presenting previous or new-onset AF. Patients without BB prescription were older (67±14 vs. 63±13 years) and had more comorbidities, namely valvular disease (2.3% vs. 1.2%, p&amp;lt;0.001) and chronic pulmonary obstructive disease (7.1% vs. 3.1%). The mean left ventricular ejection fraction was 53±13% in patients without BB prescription and 52±11 in the group with BB prescription (p&amp;lt;0.001). In-hospital and after discharge BB prescription was less frequent in AF patients (80.2% vs. 82.5% and 74.7% vs. 78.8%, respectively). The in-hospital mortality rate was 2.2%, 1.3% in the BB group and 6.6% in patients without BB prescription (p&amp;lt;0.001). At 1 year, mortality rate increased to 5.1%. BB prescription was associated with lower in-hospital mortality rate regardless of the rhythm, with an 81% risk reduction in SR (OR = 0.19, 95% CI 0.14–0.24) and 79% in AF patients (OR = 0.21, 95% CI 0.13–0.35). In a multivariate regression analysis, after adjusting for all the possible confounders, in-hospital BB prescription was associated with 70% of mortality risk (OR = 0.30, 95% CI 0.23–0.35). Overall, after discharge BB prescription was associated with reduced 1-year mortality risk (HR = 0.57, 95% CI 0.44–0.73), although it didn't reach statistical significance in AF patients (p=0.413). Nevertheless, in a bivariate Cox regression, rhythm showed no impact on BB protective effect (p-interaction = 0.335). As expected, AF had a negative prognostic impact (HR = 3.85, 95% CI 2.66–5.02). Conclusion BB prescription was associated with reduced in-hospital and 1 year mortality rates. The prognostic benefit of BB therapy was equivalent in ACS patients in sinus rhythm and with previous or new-onset AF. Funding Acknowledgement Type of funding sources: None.

AMBULATORY BLOOD PRESSURE MEASUREMENT AS A PREDICTOR OF HYPERTENSION MEDIATED TARGET ORGAN DAMAGE IN VERY ELDERLY POPULATION: THE MAPACHESS STUDY

Objective: International guidelines recommend Ambulatory Blood Pressure Monitoring (ABPM) in the diagnosis and follow-up of hypertensive patients based on the superior reliability prognostic value compared to office BP. Our objective was to analyze the relationship between ABPM control and target organ damage (TOD) in the elderly population. Design and method: Observational, retrospective, longitudinal study of a cohort of treated hypertensive patients older than 75 years. A baseline ABPM was obtained in all patients and was repeated after 6 months follow-up. Clinical data on associated CVRF, TOD, cardiovascular events, and emergency room visits were collected at baseline and 6 months of follow-up. Results: A total of 39 consecutive patients were included, 38.5% women, mean age 80 years (75–89), 30% diabetic, 50% obese and 58% dyslipidemic. Previous stroke was observed in 5.6% patients and 9% had a previous acute myocardial infarction (AMI). The mean in-treatment office BP was 142 (± 22) / 71 (± 14) mm Hg and 30.8% were controlled (BP &lt; 140/90 mmHg). The mean in-treatment 24-hour BP was 141 (± 15) / 70 (± 11) mm Hg. New CV events were observed in 19.7 during follow-up. When we compared the characteristics between the group with good ABPM (defined as mean 24 h BP &lt; 130/80 mm Hg) and the group with poor control, only left ventricular mass index (LVMI) was significantly higher in the latter (170 g/m2 (poor control) vs. 128 g/m2 (good control); Anova p 0.044). Conclusions: In treated elderly hypertensive patients, poor BP control by 24h-ABPM is significantly correlated with a greater degree of LVH. Considering the retrospective design of this pilot study in a very limited number of patients, these findings need to be confirmed in larger studies.

COVID-19 risk perceptions, worries and preventive behaviors in patients with previous myocardial infarction: results from the myocardial infarction registry Augsburg

ABSTRACT Despite the known association of chronic cardiovascular diseases and more severe courses of COVID-19, little is known about individual risk perception of patients with a history of acute myocardial infarction (AMI) and resulting preventive behaviours. In May 2020, a postal survey was conducted, including 150 patients with previous AMI from the myocardial infarction registry Augsburg. The study objective was to assess COVID-19 knowledge, individual risk perception, worries, infection likelihood and preventive behaviours in this patient cohort. From the 100 respondents, 69.7% perceived themselves to be at high risk of developing a severe course of COVID-19. There was a significant positive correlation between dangerousness assessment and knowledge on COVID-19. Despite a majority (70%) of patients rating their susceptibility for an infection as moderate to very high, the individual likelihood of being infected was rated at only 3%. Almost 70% of patients with previous MI classified themselves at high risk for a severe course of COVID-19 infection. As seen in other risk groups as well, the availability of valuable information sources as well as the support in individual risk reduction strategies and psychological coping mechanisms are mandatory, especially since higher knowledge correlates with dangerousness assessment and might lead to better compliance with preventive behaviours.