Prior Angina Research Articles

Globe in the Heart: A Rare Case Report of Giant Coronary Artery Aneurysm

A 22-year-old male having cardiomegaly with prominent right atrium (RA) enlargement in his chest X-ray underwent echocardiography which revealed an anterior mediastinal cystic lesion. Contrast-enhanced computed tomography of the thorax showed saccular contrast filling outpouching from ostia of the right coronary artery (RCA) of size 5.9 × 6.4 cm in anterior atrioventricular groove compressing RA and right ventricle along the RCA course. The left main coronary artery also appeared to be dilated with a diameter of 1.1 cm proximally. The patient denied any prior angina, palpitation, and dyspnea on exertion. This case is reported for its rarity and the dilemma involving its appropriate medical and surgical management.

Comparison Between First-Ever Ischemic Stroke in Young Adults in 1988-1997 and 2008-2017.

To compare incidence of first-ever acute cerebral infarction, etiology and traditional risk factors in young adults 15-49 years in 1988-1997 and 2008-2017 in Hordaland County, Norway. Case-finding of young adults with acute cerebral infarction in 1988-1997 was done retrospectively by computer research from hospital registries in Hordaland County. Young adults with acute cerebral infarction living in the Bergen region in 2008-2017 were prospectively included in a database at Haukeland University Hospital. Traditional risk factors, etiology and modified Rankin scale score on discharge were registered. Crude average incidence of acute cerebral infarction was 11.4 per 100.000 per year in 1988-1997 and 13.2 per 100.000 per year in 2008-2017 (P=0.04). The prevalence of prior myocardial infarction, angina pectoris, and dyslipidemia were lower in the 2008-2017 cohort (all P<0.05). Atherosclerosis was less common in the 2008-2017 cohort (P<0.001). The observed incidence of acute cerebral infarction in young adults increased from 1988-1997 to 2008-2017 in Hordaland County. Atherosclerosis was less common in the 2008-2017 cohort.

Simplified Geleijnse score for identifying chest pain features associated with coronary ischemia

BackgroundThe Geleijnse score, which was proposed to assess for coronary ischemia, has practical limitations. ObjectivesOur aim was to design and evaluate a simplified version of the Geleijnse score. MethodsWe enrolled patients with suspected coronary heart disease but negative troponin T or absence of enzymatic curve, and a non-diagnostic 12-lead ECG. The initial study was performed in a retrospective derivation cohort and the results were subsequently validated in a prospective cohort. ResultsFrom 109 patients included in the derivation cohort, 33 (30.3%) received a diagnosis of coronary heart disease. Chest pain with both arms radiation (OR 3.54), severe intensity (OR 2.41), improvement by nitroglycerin (OR 1.61), associated dyspnea (OR 1.97) and prior exertional angina history (OR 2.91) were independently associated with an ischemic origin on multivariate logistic regression analysis. ROC curves comparison demonstrated both the original and simplified scores presented modest predictive ability with significant difference when analyzed using dichotomous cut-offs (0.647 [simplified] vs. 0.544 [original], p = 0.042) but not as a continuous variable (0.670 [simplified] vs. 0.621 [original], p = 0.396). In 305 patients from the validation cohort, the simplified score presented extensively increased predictive accuracy than the Geleijnse, in the continuous (c-indexes = 0.735 vs. 0.685, p = 0.040) and the dichotomic (c-indexes = 0.682 vs. 0.514, p<0.001) forms. ConclusionsA simplified version of the Geleijnse score, including some routine clinical manifestations associated with coronary heart disease, presented significantly better predictive ability compared to the original score.

The prevalence and risk factors of diabetic peripheral artery disease in Chinese communities

Objective: To investigate the prevalence and risk factors of diabetic peripheral artery disease (PAD) in patients with type 2 diabetes mellitus (T2DM) managed in primary health care in China. Methods: A total of 2 528 T2DM patients were selected using a two-stage cluster random sampling method based on the baseline survey of the "China Diabetic Foot Prevention Model Project." The study was conducted in 2015 among T2DM patients in 8 primary healthcare centers in Changshu county and Jiang'an district of Wuhan, China. Data collection methods included a questionnaire, body measurement, and blood glucose detection. The Ankle-Brachial Index (ABI) is the most widely used noninvasive vascular test. A binary logistic regression model was used to analyze the influence factors. Results: The prevalence of PAD was 11.2% among the diabetic patients managed in primary health care in the two cities. The prevalence of PAD under 55 years old, 55- years old, 65- years old, and ≥75 years old were 7.8%, 6.0%, 12.9% and 22.5%, respectively. Multivariate stepwise logistic regression identified influence factors included older age, higher education level, smoking, drinking, postprandial glucose uncontrol, and prior myocardial infarction or angina. Compared to age <55 years, the odds ratio for PAD were 0.74 for 55- years (95%CI: 0.43-1.28), 1.72 for 65- years (95%CI: 1.05-2.81), 3.56 for 75 years and above (95%CI: 2.07-6.11), respectively. Compared to patients with education in primary school and below, the odds ratio was 1.37 (95%CI: 0.97-1.94), 2.48 (95%CI: 1.73-3.55), 1.99 (95%CI: 1.26-3.13) for those with education levels of junior high school, senior high school, and college, respectively. Current smoking (OR=1.49, 95%CI: 1.02-2.17), current drinking (OR=0.45, 95%CI: 0.28-0.71), postprandial glucose uncontrol (2 h postprandial plasma glucose >10.0 mmol/L: OR=1.72, 95%CI: 1.22-2.43), and prior myocardial infarction or angina (OR=2.32, 95%CI: 1.50-3.61) were influencing factors of PAD. Conclusions: Despite the high prevalence of PAD in diabetes managed in primary health care; multiple risk factors are not effectively aware of and under control. It is urgent to promote ABI screening and standardized management for diabetes, especially in primary health care.

Abstract 12743: Patient Satisfaction and Determinants of 1-Year Mortality Following Acute Coronary Syndrome

Introduction: The association of patient satisfaction with hospital ACS care and risk for long-term outcomes is incompletely described. This is particularly relevant to the Gulf region, where the ACS burden is high and literature on patient satisfaction and outcomes is lacking. The aim was to compare determinants of 1-year mortality based on patient satisfaction with ACS care in the Gulf region. Methods: In a prospective registry of 3566 ACS patients from Bahrain, Kuwait, Oman, and UAE (Gulf COAST registry), we grouped patients by their self-reported overall satisfaction with ACS care reported at 1-month following ACS (low satisfaction [n=1654] vs. high satisfaction [n=1912]; Table). We examined associations of baseline characteristics and risk for 1-year mortality in logistic regression models adjusted for Global Registry of Acute Coronary Events (GRACE) score. Results: Mortality at 1-year following ACS was higher in patients reporting low satisfaction (8.8%; n=146/1654) vs. high satisfaction (5.4%; n=103/1912) ( P &lt;.0001). Women, compared with men, had higher 1-year mortality risk in both satisfaction groups, and statistically significant risk in the low satisfaction group (aOR 1.45 [1.01–2.07]; P &lt;.05). Lack of employment (vs. any employment) was associated with higher 1-year mortality risk in both the low satisfaction (aOR 6.44 [2.58–16.03]) and high satisfaction (aOR 2.58 [1.35–4.93]) groups with borderline significant interaction ( P interaction = .08). In both satisfaction groups, lack of education, hypertension and prior angina were associated with higher 1-year mortality risk, whereas dyslipidemia and diabetes showed no association. Conclusions: Low patient satisfaction with ACS care was associated with higher 1-year mortality risk. Socioeconomic factors such as employment and education were associated with higher 1-year mortality, independent of patient satisfaction, and may guide mortality reduction interventions.

Identification of factors associated with smoking cessation in patients with coronary artery diseases. Findings from a large nationwide cohort of smoking cessation services

Abstract In patients with coronary artery diseases (CAD) (i.e. prior myocardial infarction (MI) or angina), smoking cessation (SC) is a major prevention goal. From a large French national database of SC services, we aimed to describe social, medical and smoking characteristics, as well as predictive factors of SC in men and women with CAD. Methods We conducted a retrospective study of smokers with CAD who visited a SC service and were included in the nationwide database of SC services (CDTnet). Endpoint was the abstinence rate, defined as SC maintained for at least 28 consecutive days, confirmed by an exhaled carbon monoxide &amp;lt;10 ppm. Results Among the 4,532 smokers with CAD (myocardial infarction and angina), 21% (948) were women. The mean age was 55 years in both sexes. Two-thirds had consulted after a hospital contact and nearly half (45%) smoked more than 20 cigarettes per day. Compared to men, women presented more often with anxio-depression symptoms (57% vs 41%) and respiratory diseases (38% vs 28%), were less educated (65% vs 73% had at least one degree), suffered less often from other cardiovascular diseases such as stroke or peripheral arterial disease (16% vs 21%) and much lower rate of alcohol misuse (9% vs 25%). Finally, 82% of smokers received Nicotine Replacement Therapy (NRT) at the first consultation. The abstinence rate achieved was similar in women and men (54%). Factors positively associated with SC in women were: having more than one previous quit attempt, having a level of education ≥ first secondary school diploma) (OR=1.42; CI95% [1.04–1.95]) and using an electronic cigarette at the first consultation (OR=2.74; CI95% [1.22–6.58]). In men, these factors were: being employed (OR=1.25; CI95% [1.08–1.45]), declaring high confidence in quitting (OR=1.24; CI95% [1.07–1.44]) and using NRT (OR=1.41; CI95% [1.13–1.74]). Psychiatric or respiratory diseases were negatively associated with SC in both men and women. In men, the factors negatively associated with SC were: smoking at home, having diabetes, using cannabis and presenting with high nicotine dependence. Among women, living with a smoker hampered SC. Conclusion Our findings on a large nationwide cohort from SC services showed that in smokers with prior MI or angina, it is important to take into account comorbidities, particularly psychiatric and respiratory disorders, in order to improve smoking cessation rates. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): This work was supported by IReSP and INCa through a call for doctoral grants launched in 2019

Outcomes following acute myocardial injury and type 2 myocardial infarction in patients with and without coronary artery disease

Abstract Background Acute myocardial injury and type 2 myocardial infarction typically occur in the setting of a concurrent illness. Differentiating acute myocardial injury from type 2 myocardial infarction is challenging as it relies on the assessment of myocardial ischaemia. Indeed, some have questioned whether this distinction is important, as patients with both conditions are at increased risk of future cardiovascular events. Whether this risk is similar and the role of identifying those with coronary artery disease is uncertain. Purpose To determine whether future risk of cardiovascular events and death differs in patients with type 2 myocardial infarction and acute myocardial injury according to the presence or absence of prior coronary artery disease. Methods We conducted a secondary analysis of a multi-centre randomised controlled trial of 48,282 consecutive patients with suspected acute coronary syndrome. Patients with an adjudicated index diagnosis of acute myocardial injury and type 2 myocardial infarction were stratified according to whether they were known previously to have coronary artery disease defined as prior coronary revascularisation, myocardial infarction, or angina. Cardiovascular death or myocardial infarction adjusted for the competing risk of non-cardiovascular death and all-cause death at one year was compared. Results In 9,115 patients with elevated cardiac troponin concentrations, 1,676 (18%) and 1,121 (12%) had acute myocardial injury and type 2 myocardial infarction, respectively. Patients with either condition known to have coronary artery disease were older (mean [standard deviation] age 78 [11] versus 73 [16] years) and more likely to be female (55% versus 45%) than those with no prior history. Coronary artery disease was previously identified in 40% (454/1,121) and 30% (509/1,167) of those with type 2 myocardial infarction and acute myocardial injury, respectively. Cardiovascular death or myocardial infarction at one year was more common in patients known to have coronary artery disease than those without for both acute myocardial injury (23% [115/509]) versus 14% [158/1,167]; P&amp;lt;0.001) and type 2 myocardial infarction (20% [91/454] versus 10% [69/667]; log-rank P&amp;lt;0.001) (Figure 1). Similarly all-cause death at one year was higher in patients with known coronary artery disease for both acute myocardial injury (31% [357/1,167] versus 18% [123/667]; P&amp;lt;0.001) and type 2 myocardial infarction (40% [115/509] versus 30% [135/454]; P&amp;lt;0.001) (Figure 2). Conclusion Coronary artery disease is recognised in around one third of patients with acute myocardial injury and type 2 myocardial infarction and is associated with higher rates of cardiovascular events and all-cause death. Risk doubled in those with coronary artery disease and was similar whether the index diagnosis was myocardial injury or infarction, suggesting that coronary investigation and secondary prevention may have a role in both conditions. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): The University of Edinburgh and British Heart Foundation

Randomized comparison of chest pain evaluation with FFRCT or standard care: Factors determining US costs

BackgroundFFRCT assesses the functional significance of lesions seen on CTCA, and may be a more efficient approach to chest pain evaluation. The FORECAST randomized trial found no significant difference in costs within the UK National Health Service, but implications for US costs are unknown. The purpose of this study was to compare costs in the FORECAST trial based on US healthcare cost weights, and to evaluate factors affecting costs. MethodsPatients with stable chest pain were randomized either to the experimental strategy (CTCA with selective FFRCT), or to standard clinical pathways. Pre-randomization, the treating clinician declared the planned initial test. The primary outcome was nine-month cardiovascular care costs. ResultsPlanned initial tests were CTCA in 912 patients (65%), stress testing in 393 (28%), and invasive angiography in 94 (7%). Mean US costs did not differ overall between the experimental strategy and standard care (cost difference +7% (+$324), CI −12% to +26%, p ​= ​0.49). Costs were 4% lower with the experimental strategy in the planned invasive angiography stratum (p for interaction ​= ​0.66). Baseline factors independently associated with costs were older age (+43%), male sex (+55%), diabetes (+37%), hypertension (+61%), hyperlipidemia (+94%), prior angina (+24%), and planned invasive angiography (+160%). Post-randomization cost drivers were coronary revascularization (+348%), invasive angiography (267%), and number of tests (+35%). ConclusionsInitial evaluation of chest pain using CTCA with FFRCT had similar US costs as standard care pathways. Costs were increased by baseline coronary risk factors and planned invasive angiography, and post-randomization invasive procedures and the number of tests.Registration at ClinicalTrials.gov (NCT03187639).

Clinical and anamnestic characteristics of patients with non-ST elevation myocardial infarction after COVID-19

Aim. To study clinical, medical history and paraclinical characteristics of patients with non-ST elevation myocardial infarction (NSTEMI) after coronavirus disease 2019 (COVID-19).Material and methods. The study included 209 patients with NSTEMI who were admitted to the Demikhov City Clinical Hospital (Moscow). The patients were divided into 2 groups: the experimental one (n=104) — those after COVID-19, the control one (n=105) — those without history of COVID-19. All patients underwent routine diagnostic investigations in accordance with current standards and clinical guidelines.Results. The mean age of patients in the experimental group was 61,8±12,2 years, while in the control one — 69,0±13,0 years (p&lt;0,0001). Myocardial infarction developed 49 days [34.0; 82.0] after COVID-19. Prior exertional angina was observed in 76,9% of patients in the experimental group and in 88,6% in the control one (χ2 =4,97; p=0,0258). The level of C-reactive protein in the experimental group was 19,2 mg/l [4,9; 53,0], and in the control one — 5,6 mg/l [0,4; 21,8] (p=0,0007). The average troponin I level in the experimental group was 2,7 ng/ml [1,3; 8,0], while in the control one — 1,8 ng/ml [0,8; 3,5] (p=0,0091).Conclusion. Patients with NSTEMI after COVID-19 were significantly younger compared to patients without a history of COVID-19. They had less common exertional angina prior to MI, while C-reactive protein and troponin I levels were significantly higher than in the control group. In addition, in NSTEMI patients after COVID-19, the estimated pulmonary artery systolic pressure was significantly higher compared to patients without a history of COVID-19.

Acute myocardial infarction: Circadian, daily, monthly and seasonal patterns of occurrence in diabetics.

Illustrating the temporal pattern of acute myocardial infarction (AMI), as a major cause of mortality, may help with disease prevention and better treatment. Therefore, the aim of our study was to investigate the circadian, daily, monthly and seasonal patterns of AMI occurrence in patients with diabetes mellitus, and other likely associated factors. This cross-sectional study was performed on 142 diabetic patients admitted to the Imam Ali cardiovascular hospital, Kermanshah, Iran with a diagnosis of ST-segment elevation myocardial infarction (STEMI) from March 2018 to February 2019. Data were collected using a checklist developed based on the study goals. One-way Analysis of Variance (ANOVA) and Chi-Square test (or Fishers҆ Exact test) were used to assess the differences between subgroups. Multiple logistic regression model was constructed to evaluate independent predictors of the AMI occurrence. Out of the 142 diabetic patients, 90 (63.4%) were male. The mean age of the patients was (mean ± SD) 62.81 ± 10.21years. Occurrence of STEMI was the most common during winter (p = 0.001). Prior angina, prior congestive heart failure (CHF), prior stroke, High-density lipoprotein (HDL), and Creatine Phosphokinase (CPK) were significantly associated with seasonal pattern of STEMI (p-value < 0.05). Angiotensin receptor blockers (ARBs) use was associated with an increased odds of the AMI occurrence in winter (OR = 8.32; P = 0.027). The present study of Iranian patients with diabetes revealed that AMI occurred more frequently during the winter compared to the other seasons. ARBs use was associated with an increased odd of the AMI occurrence in winter. The online version contains supplementary material available at 10.1007/s40200-021-00813-3.

Prior angina reduces ıschemic mitral regurgitation in patients with ST-Elevation myocardial ınfarction, role of ıschemic preconditioning.

Mitral regurgitationmay develop due to left ventricular (LV) remodeling within 3months following acute myocardial infarction (AMI) and is called ischemic mitral regurgitation (IMR).Ischemic preconditioning (IPC) has been reported as the most important mechanism of the association between prior angina and the favorable outcome. The aim of this study was to investigate the effect of prior angina on the development and severity of IMR at 3rdmonth in patients with ST elevation MI (STEMI). Fourty five (45) patients admitted with STEMI and at least mild IMR, revascularized by PCI were enrolled. According topresence of prior angina within 72h before STEMI, patients were then divided into two groups as angina (+) (n:26; 58%) and angina (-) (n:19; 42%). All patients underwent 2D transthoracic echocardiography at1st, 3rddays and 3rdmonth. IMR was evaluated byproximal isovelocity surface area (PISA) method: PISA radius (PISA-r), effective regurgitant orifice area (EROA), regurgitant volume (Rvol). LV ejection fraction (EF %) was calculated by Simpson's method. High sensitive troponin T (hs-TnT), creatine phosphokinase myocardial band (CK-MB) and N-terminal pro-brain natriuretic peptid (NTpro-BNP) levels were compared between two groups. Although PISA-r, EROA and Rvol were similar in both groups at 1stand 3rddays, all were significantly decreased (p = 0.012, p = 0.007, p = 0.011, respectively) and EF was significantly increased (p< 0.001) in angina (+) group at 3rdmonth. NTpro-BNP and hs-TnT levels at 1stday and 3rdmonth were similar, however CK-MB level at 3rdmonth was found to be significantly lower in the angina (+) group (p = 0.034). At the end of the 3rdmonth, it was observed that the severity of IMR evaluated by PISA method was decreased and EF increased significantly in patients who defined angina within 72h prior to STEMI, suggesting a relation withIPC.

Abstract 12910: Use of Optimal Medical Therapy in Patients With Cardiovascular Disease Undergoing Cardiac Rehabilitation

Introduction: Optimal Medical Therapy (OMT) in patients with Coronary Artery Disease (CAD) or Heart Failure (HF) is underused despite known benefits. The rate of OMT use among patients enrolled in Cardiac Rehabilitation (CR) is not well known. Purpose: To describe prevalence and characteristics of OMT use in patients with CAD or HF undergoing CR. Methods: CAD patients were defined as those with prior MI, PCI, CABG, or angina. OMT for CAD patients required all currently guideline-recommended medications (aspirin or antiplatelet, statins, beta-blockers (BB); and ACEi/ARB for concurrent HF or DM). The HF group included patients referred to CR for HFrEF or for another indication and had documented left ventricular systolic dysfunction (LVEF&lt;40%, echocardiography). OMT for HF required BB, spironolactone and either ACEi/ARB or Angiotensin Receptor Neprilysin Inhibitor (ARNI) use. Predictors of OMT were identified using with multivariable logistic regression. Results: From January 2015 to December 2019, 612 patients (mean age: 65, 23% female) with CAD were enrolled in CR, with 483 (79%) patients meeting all OMT criteria. CAD patients on OMT were more likely to have hypertension (85%), hyperlipidemia (94%) but less angina (8%). Prior MI, hypertension, hyperlipidemia, and 6-minute walk distance were significantly associated with OMT use.Of 131 HF patients (mean age: 64, 21% female) enrolled in CR, 23 (18%) met all 3 OMT criteria—99 (76%) and 128 (98%) patients met only 2 or 1 of OMT criteria, respectively. Use of spironolactone (least prescribed), ARNI, and ACEi/ARBs all increased over the study period. Study limitations include lack of control for contraindications to medications. Conclusion: Although it has improved over time, OMT use remains low (HF 18%, CAD 79%) among patients enrolled in CR. CR may represent a unique opportunity to enhance OMT use.

The effect of preloading statins prior to primary reperfusion on in-hospital mortality risk in a contemporary large-scale cohort of patients with ST-elevation myocardial infarction

Abstract Background The benefit of statins in secondary prevention of patients stabilized after acute coronary syndrome (ACS) has been well established. However, the benefit of preloading statins, i.e. high-intensity statins prior to reperfusion therapy remains unclear. Most previous studies included all types of ACS patients, and subgroup analysis indicated the benefit of preloading statins was only seen in ST-elevation myocardial infarction (STEMI) patients who underwent percutaneous coronary intervention (PCI). However, the sample size of subgroup population was relatively small and such benefit requires further validation. Objective To investigate the effect of loading dose of statins before primary reperfusion on 30-mortality in patients with STEMI. Methods We enrolled patients in China Acute Myocardial Infarction (CAMI) registry from January 2013 to September 2014. CAMI registry was a prospective multicenter registry of patients with acute acute myocardial infarction in China. Patients were divided into two groups according to statins usage: preloading group and control group. Patients in preloading group received loading does of statins before primary reperfusion and during hospitalization. Patients in control group did not receive statins during hospitalization or at discharge. Primary outcome was in-hospital mortality. Baseline characteristics, angiographic characteristics and outcome were compared between groups. Propensity score (PS) matching was used to mitigate baseline differences between groups and examine the association between preloading statins on in-hospital mortality risk. The following variables were used to establish PS matching score: age, sex, classification of hospitals, clinical presentation (heart failure at presentation, cardiac shock, cardiac arrest, Killip classification), hypertension, diabetes, prior angina, prior myocardial infarction history, prior stroke, initial treatment. Results A total of 1169 patients were enrolled in control group and 6795 in preloading group. A total of 833 patients (334 in control group and 499 in preloading group) died during hospitalization. Compared with control group, preloading group were younger, more likely to be male and present with Killip I classification. The proportion of hypertension and diabetes were higher in preloading group. After PS matching, all the variables used to generate PS score were well balanced. In the PS-matched cohort, 30-day mortality risk was 26.3% (292/1112) in the control group and 11.9% (132/1112) in the preloading group (p&amp;lt;0.0001). Conclusions The current study found preloading statins treatment prior to reperfusion therapy reduced in-hospital mortality risk in a large-scale contemporary cohort of patients with STEMI. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Chinese Academy of Medical Sciences

Coronary Flow Reserve in Patients With Prior Spontaneous Coronary Artery Dissection and Recurrent Angina.

BackgroundA significant proportion of patients with spontaneous coronary artery dissection (SCAD) have ongoing chronic chest pain despite healing of their dissection. We sought to determine whether coronary microvascular dysfunction contributes to post‐SCAD chronic chest pain by performing coronary reactivity testing in the cardiac catheterization laboratory.Methods and ResultsEighteen patients consented to coronary reactivity testing at least 3 months post‐SCAD. Coronary flow reserve (CFR) and index of microcirculatory resistance were measured in the previously affected SCAD artery and 1 non‐SCAD artery. CFR <2.5 was defined as diagnostic of coronary microvascular dysfunction. An abnormal index of microcirculatory resistance was defined as >25 units. Seventeen women underwent coronary reactivity testing (1 had chronic dissection and was excluded). All presented with myocardial infarction and 2 underwent coronary stenting during the initial SCAD event. Fibromuscular dysplasia was present in 70.6% upon screening renal, iliac, and cerebrovascular arteries. Twelve patients (70.6%) had CFR <2.5 and 13 (76.5%) had an index of microcirculatory resistance >25 in at least 1 artery. There was no difference in the frequency of a low CFR measurement between SCAD and non‐SCAD arteries.ConclusionsAmong patients with chronic chest pain after an SCAD event, >70% had coronary microvascular dysfunction as indicated by abnormal CFR or index of microcirculatory resistance in at least 1 coronary artery on invasive coronary reactivity testing. Presence of coronary microvascular dysfunction in both SCAD and non‐SCAD arteries suggests that underlying microvascular abnormalities from vasculopathies such as coronary fibromuscular dysplasia may be the underlying etiology.

LEADER Trial Eligibility and Preventable Cardiovascular Events in US Adults with Diabetes: the National Health and Nutrition Examination Surveys 2007-2016.

The Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results (LEADER) trial showed the cardiovascular disease (CVD) benefits of liraglutide therapy among patients with type 2 diabetes mellitus (T2DM). We applied this trial to US adults with T2DM in terms of eligibility and preventable CVD events. We included US adults with T2DM from the National Health and Nutrition Examination Survey (NHANES) 2007-2016. Eligibility criteria from LEADER primary and secondary prevention cohorts were applied to determine potentially eligible US adults. We estimated the number of primary composite and secondary CVD endpoints that would occur based on LEADER treated and placebo published event rates, with the difference indicating the number of preventable events. Among 4672 (projected to 27.3 million [M]) adults we identified with T2DM, we estimated 800 (4.2 million) (15.4%) to fit LEADER eligibility criteria, including 205 (0.9 M) primary prevention 595 (3.3 M) secondary prevention subjects. Compared to LEADER trial participants, our sample had higher proportions of women and minorities, prior angina, chronic kidney disease, and lipid-lowering medication use. We estimated 21,209 primary composite CVD events, 29,691 extended CVD composite outcomes, 16,967 all-cause deaths, 16,967 cardiovascular deaths, 12,725 myocardial infarctions, and 12,725 microvascular events would be prevented annually if our eligible T2DM subjects were on liraglutide. Liraglutide may prevent many fatal and non-fatal CVD events if provided to US adults meeting LEADER eligibility criteria. More efforts are needed to educate the healthcare providers on the CVD benefits from newer diabetes therapies, including liraglutide.

Comparison of Troponin Elevation, Prior Myocardial Infarction, and Chest Pain in Acute Ischemic Heart Failure

BackgroundPatients with heart failure (HF) with concomitant ischemic heart disease (IHD) have not been well characterized. We examined survival of patients with ischemic HF syndrome (IHFS), defined as presentation with acute HF and concomitant features suggestive of IHD. MethodsPatients were included if they presented with acute HF to hospitals in Ontario, Canada. IHD was defined by any of the following criteria: angina/chest pain, prior myocardial infarction (MI), or troponin elevation that was above the upper limit of normal (mild) or suggestive of cardiac injury. Deaths were determined after hospital presentation. ResultsOf 5353 patients presenting with acute HF, 4088 (76.4%) exhibited features of IHFS. Patients with IHFS demonstrated a higher rate of 30-day (hazard ratio [HR], 1.89; 95% confidence interval [CI], 1.33-2.68) and 1-year death (HR, 1.16, 95% CI, 1.00-1.35) compared with those with nonischemic HF. Troponin elevation demonstrated the strongest association with mortality. Mildly elevated troponin was associated with increased hazard over 30-day (HR, 1.77; 95% CI, 1.12-2.81) and 1-year (HR, 1.63; 95% CI, 1.38-1.93) mortality. Troponins indicative of cardiac injury were associated with increased hazard of death over 30 days (HR, 2.33; 95% CI, 1.63-3.33) and 1 year (HR, 1.40; 95% CI, 1.21-1.61). The association between elevated troponin and higher mortality at 30 days was similar in left ventricular ejection fraction subcategories of HF with reduced ejection fraction, HF with mildly reduced ejection fraction, or HF with preserved ejection fraction (P interaction = 0.588). After multivariable adjustment, prior MI and angina were not associated with higher mortality risk. ConclusionsIn acute HF, elevated troponin, but not prior MI or angina, was associated with a higher risk of 30-day and 1-year mortality irrespective of left ventricular ejection fraction.

Possibilities of PRECISE-DAPT Score for Risk Prediction of Ischemic and Hemorrhagic Events in ST-Elevated Myocardial Infarction (According to the Data of the Registry Study in Kemerovo)

Aim.We aimed to study in real clinical practice the clinical and anamnestic characteristics, the peculiarities of double antiplatelet therapy (DAPT) prescription as well the incidence of ischemic and hemorrhagic events in patients with ST-elevated myocardial infarction (MI) during a year of follow-up, taking into account the baseline PRECISE-DAPT scores.Material and methods.The study included 680 patients with MI from the database of Kemerovo observational registry for acute coronary syndrome (ACS). All the patients retrospectively underwent an individual calculation using the PRECISE-DAPT score. Then, depending on the number of the points, all the patients were divided into the low (less than 25 points) and high (25 or more points) risks groups. Differences in clinical and anamnestic parameters, the peculiarities of DAPT prescription, as well as the incidence of ischemic and hemorrhagic outcomes during a year of follow-up after MI were estimated in the groups.Results.The Russian patients with ST-elevated MI and the high PRECISE-DAPT hemorrhagic risk score had a history of renal pathology (р=0.010), multivessel coronary artery disease and polyvascular disease (р=0.002), prior angina pectoris (р=0.001), as well as the course of the index event with the manifestations of acute coronary failure (р=0.001) more often than the patients from the low-risk group. The patients of the high-risk group less often underwent coronary angiography with stenting (р=0.001), as well as coronary artery bypass grafting (р=0.010) at hospitalization and had a higher in-hospital mortality rate (р=0.002). The patients at high hemorrhagic risk according to the PRECISE-DAPT score were less often prescribed with DAPT within a year after MI (р=0.001) and aspirin monotherapy was preferred more often (р=0.001). At the same time, the patients at high hemorrhagic risk on the PRECISE-DAPT score had more often major bleedings, recurrent MI and deaths (р=0.001) within a year after MI.Conclusion.In the present study, the possibilities of risk assessment with the PRECISE-DAPT score were retrospectively tested on the sample of patients with MI from the ACS registry in Kemerovo city. Good identification of patients with the high risks of hemorrhagic events and ischemic outcomes within 12 months of the follow-up after index MI has been shown, which allows to recommend the PRECISE-DAPT score for a clinical practice in order to rationalize the approaches to DAPT prescription and to optimize the existing approaches to the comprehensive risk assessment of patients with ACS along with existing scales.

Risk Factors for Predicting Mortality among Old Patients with Acute Myocardial Infarction during Hospitalization.

To explore the risk factors to predict mortality among acute myocardial infarction (AMI) patients aged ≥ 80 years during their hospitalization. A cohort of AMI patients aged ≥ 80 years hospitalized in our hospital were recruited from 2005 to 2014. Variables, including demographics, medical history, hemodynamic condition and laboratory results, were collected and analyzed to find risk factors predicting mortality during hospitalization. Amonga total of 384 patients enrolled in this study, the hospital mortality rate was 23.4%. By multivariable stepwise regression analysis, nine independent significant predictors associated with mortality during hospitalization were identified: history of stoke, cardiac shock, Killip class III to IV, ventricular tachycardia, pulse rate ≥ 100 bpm and EF ≤ 40% at presentation, in-hospital bleeding, initial serum creatinine concentration ≥ 177 umol/L and elevated initial WBC level. Prior angina was identified as a protective factor. Hosmer-Lemeshow test indicated good fitness of the predicting variables. Patients aged 80 and over have high mortality during hospitalization, and the risk prediction factors are clinically useful for predicting mortality in old patients with AMI.

PCV8 - One-Year Clinical Outcomes In Patients With Acute Coronary Syndrome In Tianjin, China

To evaluate the one-year clinical outcomes and identify its associated factors in patients with acute coronary syndromes (ACS) in Tianjin, China. Data were obtained from Tianjin Urban Employee Basic Medical Insurance database (2011-2015). Adult patients who were discharged alive after the first ACS-related hospitalization (index hospitalization) during 2012.01.01-2014.12.31 and had continuous enrollment during 12-month pre- (baseline) and 12-month post- (follow-up) index hospitalization were included. Clinical outcomes were measured by subsequent major adverse cardiovascular events (MACE) including hospitalization for myocardial infarction (MI) or stroke, all-cause mortality, or their composite endpoint. Cox model was used to explore the factors associated with MACE. 22,041 patients (64.7±10.7 years; 54.4% male) were identified. 9.5% (N=2,099) experienced MACE during follow-up with a mean number of 1.3±0.8. 3.1% (N=680) had MI, 5.7% (N=1,253) had stroke and 1.4% (N=298) had all-cause death. Among patients who experienced MACE, average time from index discharge to the 1st MACE was 143.2±118.8 days, and 42.1% (N=883) experienced MACE within 90 days after discharge. Being older (age 55-64: Hazard Ratio [95% CI]=1.28 [1.06-1.54]; age 65-74: HR=1.57 [1.27-1.92]; age ≥75: HR=1.91 [1.56-2.35], respectively, vs. age ≤54), male (HR=1.47 [1.34-1.61] vs. female) or patients who had higher Charlson Comorbidity Index (CCI) (HR=1.09 [1.05-1.14]) were more likely to experience MACE. Patients who had prior stroke (HR=1.77 [1.59-1.96]) and prior all-cause hospitalization (HR=1.36 [1.22-1.53]) were more likely to experience MACE, whereas prior angina (HR=0.81 [0.72-0.90]), prior β-blockers utilization (HR=0.82 [0.75-0.91]) and received percutaneous coronary intervention (PCI) during index event (HR=0.73 [0.64-0.82]) were less likely to experience MACE. Stroke is the most common type of MACE among ACS patients in Tianjin. Almost half of the 1st MACE occur within the 3 months after ACS. Patients older, male, having higher CCI and with prior stroke are at higher risk of MACE.

Long term health outcomes in patients with a history of myocardial infarction: A population based cohort study.

BackgroundMyocardial infarction (MI) is associated with high morbidity and mortality, particularly in the first 12 months post-event. Interventions such as dual antiplatelet therapy can reduce the risk of major adverse cardiovascular events (MACE), but the duration of the high-risk time interval and the optimal prescription time frame for these interventions remains unknown.Design, setting, participants, and measurementsWe performed a retrospective cohort study using data from medical services and hospitalizations in Manitoba, Canada for patients admitted with a MI between April 2006 and March 2010, and followed until Nov 30, 2014. We used survival analysis to determine the cumulative incidence of death, subsequent MI, or stroke, and used Cox proportional hazards models to assess factors associated with these endpoints.ResultsThere were 8,493 patients in Manitoba admitted to hospital for a MI during the study period. Of those, 6,749 (79.5%) survived for at least 1 year without a recurrent MI or stroke. In the following year, this population remained at high risk, with 372 (5.5%) of the remaining patients dying in the next twelve months (48.1% cardiovascular deaths), 244 (3.6%) having a recurrent MI, and 74 (1.1%) having a stroke. Older age, male sex, diabetes, prior stroke, prior heart failure, prior unstable angina, and absence of revascularization were associated with worse long-term prognosis.ConclusionsThe risk of MACE remains elevated among post-MI patients after the first year. Interventions to more intensively monitor, evaluate, and treat these patients should be considered beyond the first year following myocardial infarction.