Prognosis Of Myocardial Infarction Research Articles

Severe mental illness and mortality and coronary revascularisation following a myocardial infarction: a retrospective cohort study

BackgroundSevere mental illness (SMI), comprising schizophrenia, bipolar disorder and major depression, is associated with higher myocardial infarction (MI) mortality but lower coronary revascularisation rates. Previous studies have largely focused on schizophrenia, with limited information on bipolar disorder and major depression, long-term mortality or the effects of either sociodemographic factors or year of MI. We investigated the associations between SMI and MI prognosis and how these differed by age at MI, sex and year of MI.MethodsWe conducted a national retrospective cohort study, including adults with a hospitalised MI in Scotland between 1991 and 2014. We ascertained previous history of schizophrenia, bipolar disorder and major depression from psychiatric and general hospital admission records. We used logistic regression to obtain odds ratios adjusted for sociodemographic factors for 30-day, 1-year and 5-year mortality, comparing people with each SMI to a comparison group without a prior hospital record for any mental health condition. We used Cox regression to analyse coronary revascularisation within 30 days, risk of further MI and further vascular events (MI or stroke). We investigated associations for interaction with age at MI, sex and year of MI.ResultsAmong 235,310 people with MI, 923 (0.4%) had schizophrenia, 642 (0.3%) had bipolar disorder and 6239 (2.7%) had major depression. SMI was associated with higher 30-day, 1-year and 5-year mortality and risk of further MI and stroke. Thirty-day mortality was higher for schizophrenia (OR 1.95, 95% CI 1.64–2.30), bipolar disorder (OR 1.53, 95% CI 1.26–1.86) and major depression (OR 1.31, 95% CI 1.23–1.40). Odds ratios for 1-year and 5-year mortality were larger for all three conditions. Revascularisation rates were lower in schizophrenia (HR 0.57, 95% CI 0.48–0.67), bipolar disorder (HR 0.69, 95% CI 0.56–0.85) and major depression (HR 0.78, 95% CI 0.73–0.83). Mortality and revascularisation disparities persisted from 1991 to 2014, with absolute mortality disparities more apparent for MIs that occurred around 70 years of age, the overall mean age of MI. Women with major depression had a greater reduction in revascularisation than men with major depression.ConclusionsThere are sustained SMI disparities in MI intervention and prognosis. There is an urgent need to understand and tackle the reasons for these disparities.

LncRNA-mRNA co-expression analysis discovered the diagnostic and prognostic biomarkers and potential therapeutic agents for myocardial infarction.

Currently, the role of lncRNA in myocardial infarction (MI) is poorly understood. 17 co-expression modules were determined, specifically, the greenyellow, saddlebrown, grey60, royalblue, lightgreen, white, and pink modules were specifically expressed in the acute phase of MI, and brown, darkred, and royalblue, while greenyellow modules were specifically expressed in MI compared with CAD. 12 time-dependent of lncRNA/mRNA clusters with consistent expression trends were also identified. MI-associated modules were mainly enriched to immune, cell cycle, and metabolic pathways. We further obtained a network of 1816 lncRNA-mRNAs with higher expression correlations among these lncRNAs by analyzing the topological properties of the network. Herein, lncRNA RP11-847H18.2 and KLHL28, SPRTN, and EPM2AIP1 were determined as gene markers specifically expressed in MI, and they demonstrated a high predictive performance for MI diagnosis and prognosis. Three drugs, namely, Calcium citrate, Calcium Phosphate, and Calcium phosphate dihydrate, were identified as potential precursors of MI. Finally, gene and lncRNA diagnostic models were developed based on these genes and lncRNAs, with their AUCs averaged above 0.89 in both training and validation datasets. The findings of this study improve the diagnosis and prognosis of MI and personalized treatment of MI.

К ВОПРОСУ ОБ ОСОБЕННОСТЯХ СТРУКТУРЫ ФАКТОРОВ КАРДИОВАСКУЛЯРНОГО РИСКА У МУЖЧИН МОЛОЖЕ 60 ЛЕТ С ИНФАРКТОМ МИОКАРДА И ОСТРЫМ ПОВРЕЖДЕНИЕМ ПОЧЕК

Relevance. Acute kidney injury (AKI) worsens the prognosis of myocardial infarction (MI). Aim. To study the characteristics of cardiovascular (CVD) risk factors in men under 60 years of age with AKI in myocardial infarction (MI) to improve prevention. Material and methods. The study included men aged 19-60 years old with type I MI. Patients are divided into two age-comparable groups: I - the study group, with ACI - 25 patients; II - control, without it - 168 patients. A comparative analysis of the frequency of observation of the main and additional CVD risk factors in groups was performed. Results. In the patients of the study group, more often than in the control group, the following was observed: MI in winter (68.0 and 36.3%, respectively; p = 0.01), with repeated cases - the interval between infarction of more than one year (48.0 and 29.8%; p = 0.04); psychoemotional stress (64.0 and 46.1%; p = 0.04) or hypertensive crisis as a situation provoking MI (28.0 and 19.2%; p = 0.04); a history of: overweight less than 10 years (72.0 and 35.7%; p = 0.002) with moderate obesity (48.0 and 22.6%; p = 0.03), chronic heart failure (36.0 and 14.0%; p = 0.006), peptic ulcer (32.0 and 13.7%; p = 0.01), unstable angina (64.0 and 42.6%; p = 0.003), peripheral angiopathies (80.0 and 56.5%; p = 0.02), coronary angiography (45.5 and 25.5%; p = 0.04) and coronary artery bypass surgery (24.0 and 8.6%; p = 0.009). Conclusions. The structure of CVD risk factors in men under 60 years old with MI and AKI is characterized by the prevalence of moderate obesity, gastroduodenal ulcers, chronic heart failure, stress and crisis course of hypertension, coronary angiography and a history of coronary artery bypass surgery, as well as MI in winter. It is advisable to use the listed combinations of factors in predictive modeling and planning of preventive measures in such patients.

ОСОБЕННОСТИ КЛИНИЧЕСКОГО ТЕЧЕНИЯ ИНФАРКТА МИОКАРДА С ОСТРЫМ ПОВРЕЖДЕНИЕМ ПОЧЕК У МУЖЧИН МОЛОЖЕ 60 ЛЕТ

Relevance. Acute kidneys injury (AKI) negatively affects the prognosis of myocardial infarction (MI). Aim. To evaluate MI clinical features (CF) in men under 60 years old (y.o.) with AKI during MI to improve prevention and outcomes. Material and methods. The study included men aged 19-60 years old with type I MI. Patients are divided into two age-comparable groups: I - the study group, with ACI - 25 patients; II - control, without it - 486 patients. A comparative assessment of the MI CF frequency in selected groups were performed. Results. In patients of the study group more often than in the control group, a combination of MI complications (64.0 and 36.9%; respectively; p = 0.009), psychic disorders (20.0 and 6.9%; p = 0.01), chronic heart failure (CHF) of the second functional class and above (NYHA) at the end of the eighth MI week (72.0 and 43.2%; p = 0.005), with a predominance of newly diagnosed CHF forms (36.0 and 28.0%; p = 0.006). In the study group, less often than in the control group, pulmonary hypertension was noted in the first 48 hours of MI (44.0 and 66.0%; p = 0.02) and at the end of the third MI week (38.1 and 60.3%; p = 0.04). Conclusions. There were no specific clinical signs of AKI in men under 60 y.o. with MI. At the same time, the study group has the worst prognosis during the observation period in terms of the frequency of MI complications combinations and CHF, which requires the start of prophylactic therapy from the moment of AKI verification.

Pronóstico a largo plazo de pacientes con IAMSEST y coronarias sin lesiones obstructivas según los distintos subtipos angiográficos

Introduction and objectivesDiscordant data have been reported on the prognosis of myocardial infarction with nonobstructive coronary arteries (MINOCA). Moreover, few data are available on the impact of angiographic subtypes. The objectives of this study were to assess the prognostic impact on the long-term follow-up of the diagnosis of MINOCA and its angiographic subtypes. MethodsWe included 591 consecutive patients with non–ST-segment elevation myocardial infarction (NSTEMI) who underwent coronary angiography. MINOCA was classified according to angiographic findings as smooth coronary arteries, mild irregularities (< 30% stenosis), and moderate atherosclerosis (30%-49% stenosis). The primary endpoint was a composite of mortality, nonfatal myocardial infarction, and revascularization (MACE) at a median of 5 years of follow-up. ResultsA total of 121 patients (20.5%) showed no obstructive lesions. MINOCA was associated with a lower occurrence of MACE (P=.014; HR, 0.63; 95%CI, 0.44-0.91) and was confirmed as an independent factor in the multivariate analysis (P=.018; HR, 0.63; 95%CI, 0.43-0.92). On analysis of the separate components of the main endpoint, MINOCA was significantly associated with a lower rate of myocardial infarction and revascularization, but not with mortality. Analysis of angiographic subtypes among MINOCA patients showed that smooth coronary arteries were a statistically significant protective factor on both univariate and multivariate analysis, while mild irregularities and 30% to 49% plaques were associated with a higher risk of MACE. ConclusionsMINOCA is associated with a lower rate of MACE, driven by fewer reinfarctions and revascularizations. Within the angiographic subtypes of MINOCA, smooth arteries were independently associated with a lower number of MACE.

THE STRUCTURAL AND FUNCTIONAL MYOCARDIAL STATE PECULIARITIES IN MEN UNDER 60 YEARS OLD WITH MYOCARDIAL INFARCTION AND CHRONIC INFLAMMATORY PULMONARY DISEASES

Relevance. The development of chronic heart failure in chronic inflammatory pulmonary disease (CIPD) after myocardial infarction (MI) remains insufficiently studied. Aim. To evaluate changes in intracardiac hemodynamic parameters in men under 60 years old with CIPD in the acute and subacute MI periods to clarify their significance in the development of chronic heart failure. Material and methods. The study included men aged 19-60 years old with type I MI. Patients are divided into two age-comparable groups: I - the study group, with CIPD - 166 patients; II - control, without it - 490 patients. A comparative assessment of intracardiac hemodynamic in selected groups was performed in first 48 hours (1) and the end of third MI week (2). Results. There was a left ventricle (LV) large dilatation in the study group, as in the first hours of MI (end-systolic volume index (ESVI1) 43.5±21.5 and 36.6±20.7 (ml/m2); p=0.001 ), and at the end of the third week of MI (ESVI2 35.6±16.9 and 32.2±18.4 (ml/m2); p=0.03). There was a left atrium (LA) dilatation (I (1): 40.3±5.3; I (2): 40.9±5.2 (mm) and II (1): 40.7±5.1; II (2): 40.4±5.2 (mm); p≥0.05), right ventricle (RV) dilatation in the first hours of MI (28.3±6.7 and 25.2±6.7 (mm); p = 0.01). There was a significant decrease in the LV ejection fraction in the study group compared to the control at both measurement points (1: 42.6±13.4 and 47.8±13.3 (%), respectively; p=0.0004; 2: 54.9±11.5 and 57.2±12.6 (%); p=0.04). When assessing the dynamics over the observation period, an expansion of the LP was noted in the study group (by 1.4%), in contrast to its decrease in the control group (by 0.6%; p˂0.0001). Also revealed: negative dynamics of the ratio of the velocity of late and early LV filling in the study group (decrease by 6.0%) in comparison with the control (increase by 5.8%; p˂0.0001). Conclusions. Thus, in CIPD, we observed more pronounced dilatation of the RV and LV, systolic and diastolic LV dysfunction in the acute and subacute MI periods. This confirms the negative value of CIPD for the prognosis of MI.

In-Hospital Peak Glycemia in Predicting No-Reflow Phenomenon in Diabetic Patients with STEMI Treated with Primary Percutaneous Coronary Intervention.

Although percutaneous coronary intervention (PCI) significantly improves the prognosis for myocardial infarction, the no-reflow phenomenon is still the major adverse complication of PCI leading to increased mortality, especially for the patients with ST-segment elevation myocardial infarction (STEMI) combined with diabetes. To reduce the occurrence of no-reflow, prognostic factors must be identified for no-reflow phenomenon before PCI. A total of 262 participants with acute STEMI and diabetes were recruited into our cardiovascular center and underwent primary PCI for the analyses of prognostic factors of no-reflow. The patients were divided into two groups according to thrombolysis in myocardial infarction (TIMI): the normal flow and no-reflow groups, and related factors were analyzed with different statistical methods. In the present investigation, the in-hospital peak glycemia was significantly higher in the no-reflow group than the normal flow group, while more narrowed vessels, higher level of initial TIMI flow, were observed in the patients of the no-reflow group. A multivariate logistic regression analysis further demonstrated that peak glycemia was an independent predictor for no-reflow in the diabetic patients with STEMI. Our data indicated the importance of the proper control of glucose before PCI for the diabetic patients with STEMI before PCI to reduce the occurrence of the no-reflow after operation.

Plasma apelin level in acute myocardial infarction and its relation with prognosis: A prospective study

ObjectiveApelin is a novel adipocytokine with a significant role in ischemia/reperfusion injury that is synthesized and secreted in myocardial cells and coronary endothelium. There is debate on its value for the diagnosis and prognosis of myocardial infarction. We aimed to investigate plasma apelin level in patients with acute ST segment elevation (STEMI) and non-ST segment elevation (NSTEMI) myocardial infarction and its relationship with left ventricular function and prognostic parameters.MethodsForty-one patients with STEMI, 21 patients with NSTEMI and 10 patients as control group with normal coronary angiograms were included. Plasma apelin level at presentation was investigated regarding its relationship with other diagnostic and prognostic parameters.ResultsApelin level was significantly higher in acute myocardial infarction (0.31 ± 0.56 ng/mL) compared to control group (0.08 ± 0.05 ng/mL) (p < 0.01). Likewise, it was found to be significantly higher in STEMI group (0.45 ± 0.73 ng/mL) compared to control group (0.08 ± 0.05 ng/mL) (p < 0.01). Although apelin was higher in NSTEMI group (0.13 ± 0.10 ng/mL) compared to control group (0.08 ± 0.05 ng/mL), this difference was not statistically significant (p > 0.05). No correlation was found between apelin and NT-proBNP, hsCRP, troponin, ejection fraction (EF) and Killip score (p > 0.05). A positive correlation was found between apelin and TIMI, GRACE and Gensini scores (p < 0.05). Only GRACE score was found to be correlated with apelin in MI groups.ConclusionApelin level was found to be high in acute myocardial infarction. With its inotropic and vasodilator effects, apelin was thought to have a protective role against severe ischemia.

НЕЗАВИСИМЫЕ ПРЕДИКТОРЫ И ПРОГНОЗИРОВАНИЕ ИНФАРКТА МИОКАРДА В ОТДАЛЕННОМ ПЕРИОДЕ У ПАЦИЕНТОВ С НЕСТАБИЛЬНОЙ СТЕНОКАРДИЕЙ ПОСЛЕ СТЕНТИРОВАНИЯ КОРОНАРНЫХ АРТЕРИЙ

Objective. to develop independent predictors for predicting long-term myocardial infarction (MI) in patients (pts) with unstable angina (UA) after coronary artery stenting (PCI) based on the results of a seven-year follow-up. Materials and Methods. The study involved 165 pts with UA and coronary artery stenting (PCI). PCI was performed in 3.2±1.6 days after admission to the in-patient department. Drug-coated stents (Xience V and Biomatrix) were used, the average number of stents was 2.1±0.8 per person, the average length of the stented area was 43.12±25.6 mm, and the average diameter of the implanted stents was 3.12±0.5 mm. All patients were assessed for troponin I, myeloperoxidase, and C-reactive protein levels; coagulation hemostasis was assessed; and a thrombin generation test was performed. The aggregatogram was performed on the analyzer Multiplate (ASPI-test, ADP-test). The patients underwent echocardiography, coronary angiography. Double antithrombotic therapy with clopidogrel 75 mg and acetylsalicylic acid 75 mg was prescribed for 12 months. The follow-up period was 7±1.6 years. Results. Repeated UA developed in 91 (55.2%) pts during a 7-year follow-up period, myocardial infarction was registered in 21 (12.7%) pts. Cardiovascular mortality was 7.3%. Independent predictors of MI risk included: baseline D-dimer level ≥796 ng/ml AUC 0.766 (RR 5.272; 95% CI 2,125-13,082), endogenous thrombin potential ≥2294.5 nM*min AUC 0.912 (RR 4,769; 95% CI 2,457-10,546), N-terminal fragment of brain natriuretic peptide (NTproBNP) ≥816 pg/ml AUC 0.794 (RR 1,935; 95% CI 1,218-3.075), homocysteine level ≥16 µmol/l AUC 0.707 (RR 1.971; 95% CI 1.140-3.406), highly sensitive C-reactive protein ≥6.4 g/l AUC 0.790 (RR 1.333; 95% CI 1.081-1.644), number of affected arteries≥ 3 AUC 0.714 (RR 2.129; 95% CI 1.237-2.664). The developed model for predicting myocardial infarction included the initial level of endogenous thrombin potential≥2294.5 nM * min, D-dimers ≥796 ng / ml, and the number of affected coronary arteries≥ 3. For the developed model, the AUC was 0.964, which corresponds to the excellent quality of the model. Conclusion. The prognosis of myocardial infarction in patients with unstable angina and stenting of the coronary arteries receiving the standard antiplatelet therapy involves laboratory criteria that reflect the activation of the hemostatic system and the residual thrombogenic risk.

Prognosis of myocardial infarction in young women

Myocardial infarction in young women is rare. it has a poorer prognosis with more complications and an excess mortality in the acute phase compared to MI in young men. Purpose to study the prognostic features of MI in young women. We carried out a prospective study including young women whose age is ≤ 55 years and young men whose age is ≤ 45 years hospitalized for MI in the cardiology department of the CHU Constantine (Algeria) from January 2013 to March 2016. We compared the complications occurring in the acute phase and one year of the event between the 2 groups. Out of 200 MI hospitalized patients, 30.5% were women, with an average age of 48 years. They had more clinical atypia in 34.4% of cases P = NS, more NSTEMI P = NS, had an average of 3 risk factors compared to 2 in men and had more significant coronary lesions. The reperfusion treatment was prescribed with no significant difference in the 2 groups but with a significantly longer mean delay in women. The initial complications were more frequent in women but without significant difference, heart failure 3.3% vs. 1.4%, conductive disorders 11.5% vs. 8.6%, excitability disorders 3.3% vs. 1.4% and embolic complications 4.9% vs. 0%. Hospital complications were significantly frequent in women 32.8% against 20.1%; P = 0.04. With more heart failure 11.5% vs. 6.5%, more excitability disorders 3.3% vs. 1.4%, more conductive disorders 8.2% vs. 2.1%, more thromboembolic complications 3.3% vs. 0% and more LV dysfunction24.6% vs. 18%. Hospital mortality was 4 times more frequent in women 9.8% than men 2.2%; P = 0.02. One year from the initial event, the number of events decreased and tended to be the same for both sexes 7.1% for women versus 8.7% for men. The death rate decreased also 2.4% versus 1.8%. MI in young women has a worse prognosis in the acute phase with excess mortality probably related to more clinical atypia, delayed consultation and severe coronary lesions.

Post-infectious myocardial Infarction: Does percutaneous coronary intervention improve outcomes? A propensity-score matched analysis

Acute infection is a frequent trigger of myocardial infarction (MI). However, whether percutaneous coronary intervention (PCI) improves post-infectious MI prognosis is a major but unsolved issue. We aimed to determine whether PCI at the acute phase of post-infectious MI (PIMI) in patients with angiography-proven coronary stenosis is associated with short and long-term outcome. Prospective observational study of PIMI in the RICO Survey from 2012 to 2017. Among 4573 consecutive MI patients, 476 patients (10%) were PIMI, of whom 375 underwent coronary angiography and 321 patients had a significant stenosis (> 50%). Patients who underwent PCI within the first 48 hours of hospitalization were compared with patients without PCI. In-hospital and one-year mortality (follow-up for 99% of patients) after propensity-score matching, based on clinical and angiographic data. Among the 321 patients, 195 underwent PCI. Before matching procedure, patients without PCI had higher rate of risk factors (hypertension, diabetes, chronic renal failure, and prior coronary artery disease), pneumonia and SYNTAX score than patients without PCI. After propensity score matching, neither in hospital mortality (13% with PCI vs. 8% without PCI; P = .4) nor 1-year mortality (24% with PCI vs. 19% without PCI, P = .5) significantly differed between the 2 groups. In this first prospective cohort of post-infectious MI in coronary care units, PCI might not improve short and long-term prognosis. If confirmed, these results do not claim for systematic invasive procedures after post-infectious MI.

Treatment and Prognosis of Myocardial Infarction Outside Cardiology Departments.

Aim: Our aim was to investigate the characteristics, treatment and prognosis of patients with myocardial infarction (MI) treated outside a cardiology department (CD), compared with MI patients treated at a CD. Methods: A cohort of 1310 patients diagnosed with MI at eight Swedish hospitals in 2011 were included in this observational study. Patients were followed regarding all-cause mortality until 2018. Results: A total of 235 patients, exclusively treated outside CDs, were identified. These patients had more non-cardiac comorbidities, were older (mean age 83.7 vs. 73.1 years) and had less often type 1 MIs (33.2% vs. 74.2%), in comparison with the CD patients. Advanced age and an absence of chest pain were the strongest predictors of non-CD care. Only 3.8% of non-CD patients were investigated with coronary angiography and they were also prescribed secondary preventive pharmacological treatments to a lesser degree, with only 32.3% having statin therapy at discharge. The all-cause mortality was higher in non-CD patients, also after adjustment for baseline parameters, both at 30 days (hazard ratio (HR) 2.28; 95% confidence interval (CI) 1.62–3.22), one year (HR 1.82; 95% CI 1.39–2.36) and five years (HR 1.62; 95% CI 1.32–1.98). Conclusions: MI treatment outside CDs is associated with an adverse short- and long-term prognosis. An improved use of percutaneous coronary intervention (PCI) and secondary preventive pharmacological treatment might improve the long-term prognosis in these patients.

Long-term outcome of patients with NSTEMI and nonobstructive coronary arteries by different angiographic subtypes

Introduction and objectivesDiscordant data have been reported on the prognosis of myocardial infarction with nonobstructive coronary arteries (MINOCA). Moreover, few data are available on the impact of angiographic subtypes. The objectives of this study were to assess the prognostic impact on the long-term follow-up of the diagnosis of MINOCA and its angiographic subtypes. MethodsWe included 591 consecutive patients with non–ST-segment elevation myocardial infarction (NSTEMI) who underwent coronary angiography. MINOCA was classified according to angiographic findings as smooth coronary arteries, mild irregularities (< 30% stenosis), and moderate atherosclerosis (30%-49% stenosis). The primary endpoint was a composite of mortality, nonfatal myocardial infarction, and revascularization (MACE) at a median of 5 years of follow-up. ResultsA total of 121 patients (20.5%) showed no obstructive lesions. MINOCA was associated with a lower occurrence of MACE (P=.014; HR, 0.63; 95%CI, 0.44-0.91) and was confirmed as an independent factor in the multivariate analysis (P=.018; HR, 0.63; 95%CI, 0.43-0.92). On analysis of the separate components of the main endpoint, MINOCA was significantly associated with a lower rate of myocardial infarction and revascularization, but not with mortality. Analysis of angiographic subtypes among MINOCA patients showed that smooth coronary arteries were a statistically significant protective factor on both univariate and multivariate analysis, while mild irregularities and 30% to 49% plaques were associated with a higher risk of MACE. ConclusionsMINOCA is associated with a lower rate of MACE, driven by fewer reinfarctions and revascularizations. Within the angiographic subtypes of MINOCA, smooth arteries were independently associated with a lower number of MACE.

RETRACTED: Design of hospital IoT system and drug intervention in patients with acute myocardial infarction

Acute Myocardial Infarction (AMI) is a leading cause of death and is a worldwide disorder, despite significant progress in diagnosis over the past decade. AMI is a multifactorial disease that is thought to be due to the interaction of genetic and environmental factors. It requires a high degree of knowledge and experience together to predict acute myocardial infarction is a complicated task. Internet of things (IoT) technology, the Internet, the sensor value of the collection for the diagnosis, and prediction of heart disease, have been adopted in the current medical system. To resolve this problem, it has been proposed to evaluate acute myocardial infarction using a more accurate qualified Quick Decision Diagnosis (QDD) algorithm, the IoT of the framework. Smart wearable device and heart monitoring devices have been attached to the patient's monitoring of blood pressure and Electrocardiogram (ECG). QDD is used to classify the sensor data with the received patient's normal and abnormal data. The simulation results show that the QDD-based myocardial infarction prognosis system is better proposed than other methods offered.

Gold Nanoparticle-Based Platforms for Diagnosis and Treatment of Myocardial Infarction.

In recent years, an increasing rate of mortality due to myocardial infarction (MI) has led to the development of nanobased platforms, especially gold nanoparticles (AuNPs), as promising nanomaterials for diagnosis and treatment of MI. These promising NPs have been used to develop different nanobiosensors, mainly optical sensors for early detection of biomarkers as well as biomimetic/bioinspired platforms for cardiac tissue engineering (CTE). Therefore, in this Review, we presented an overview on the potential application of AuNPs as optical (surface plasmon resonance, colorimetric, fluorescence, and chemiluminescence) nanobiosensors for early diagnosis and prognosis of MI. On the other hand, we discussed the potential application of AuNPs either alone or with other NPs/polymers as promising three-dimensional (3D) scaffolds to regulate the microenvironment and mimic the morphological and electrical features of cardiac cells for potential application in CTE. Furthermore, we presented the challenges and ongoing efforts associated with the application of AuNPs in the diagnosis and treatment of MI. In conclusion, this Review may provide outstanding information regarding the development of AuNP-based technology as a promising platform for current MI treatment approaches.

Post-infectious myocardial infarction: does percutaneous coronary intervention improves outcomes?

Abstract Introduction and objectives Acute infections are frequent triggers for myocardial infarction (MI), and associated with poor prognosis. However, whether percutaneous coronary intervention (PCI) improves post-infectious MI prognosis remains unknown. We aimed to evaluate the prognostic impact of PCI at the acute phase of post-infectious MI in patients with significant coronary stenosis. Methods Observational study in 4573 consecutive MI patients of the RICO Survey in coronary units, of whom 476 patients (10%) had a concurrent diagnosis of acute infection at admission. Among them, 321 patients with a significant stenosis (&amp;gt;50%) at coronary angiography were analysed. After propensity score matching based on clinical and angiography data, in-hospital and one-year outcomes were compared between patients with and without PCI. Results Among the 321 patients (mean age 74y), most (n=195 (61%)) underwent PCI. Acute atherothrombotic event (type 1 MI) and STEMI were much more frequent in the PCI group (53 vs 19%, p&amp;lt;0.001, and 51% vs 32%, p=0.001, respectively). As expected, Troponin Ic peak was almost 3 times higher in the PCI group (17 [4–72] vs 6 [1–20] ng/mL, p&amp;lt;0.001). Coronary lesions were less severe in the PCI group (3-vessels disease: 36% vs 52%, p&amp;lt;0.004; SYNTAX score: 11 [6–19] vs 19 [11–28], p&amp;lt;0.001). At one year follow up, recurrence rate (5% for both groups, p=0.8), and cardiovascular (CV) mortality (15% vs 13%, p=0.6) were similar for both groups. After propensity score matching, in-hospital (OR = 1.45 (0.43–4.85), p=0.5) and 1-year CV mortality: OR = 1.73 (0.66–4.54), p=0.3) were similar in patients with and without PCI. Conclusion In this first observational work investigating treatment strategy in post-infectious MI, PCI might not improve short and long-term prognosis. These findings do not support the use of systematic invasive procedures after post-infectious MI. Interventional studies are urgently needed to confirm these findings. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Agence Régionale de Santé Bourgogne Franche Comté, CHU Dijon Bourgogne

The DANish Comorbidity Index for Acute Myocardial Infarction (DANCAMI): Development, Validation and Comparison with Existing Comorbidity Indices.

ObjectiveTo develop and validate the DANish Comorbidity index for Acute Myocardial Infarction (DANCAMI) for adjustment of comorbidity burden in studies of myocardial infarction prognosis.MethodsUsing medical registries, we identified patients with first-time myocardial infarction in Denmark during 2000–2013 (n=36,685). We developed comorbidity indices predicting 1-year all-cause mortality from all comorbidities (DANCAMI) and restricted to non-cardiovascular comorbidities (rDANCAMI). For variable selection, we eliminated comorbidities stepwise using hazard ratios from multivariable Cox models. We compared DANCAMI/rDANCAMI with Charlson and Elixhauser comorbidity indices using standard performance measures (Nagelkerke’s R2, Harrell’s C-statistic, the Integrated Discrimination Improvement, and the continuous Net Reclassification Index). We assessed the significance of the novel DANCAMI variables not included in the Charlson Comorbidity Index. External validation was performed in patients with myocardial infarction in New Zealand during 2007–2016 (n=75,069).ResultsThe DANCAMI included 24 comorbidities. The rDANCAMI included 17 non-cardiovascular comorbidities. In the Danish cohort, the DANCAMI indices outperformed both the Charlson and the Elixhauser comorbidity indices on all performance measures. The DANCAMI indices included multiple variables that were significant predictors of 1-year mortality even after controlling for all variables in the Charlson Comorbidity Index. These novel variables included valvular heart disease (hazard ratio for 1-year mortality=1.25, 95% CI: 1.14–1.35), coagulopathy (1.13, 95% CI: 1.05–1.22), alcohol and drug abuse (1.35, 95% CI: 1.15–1.58), schizophrenia (1.60, 95% CI: 1.46–1.76), affective disorder (1.29, 95% CI: 1.22–1.36), epilepsy (1.26, 95% CI: 1.05–1.50), neurodegenerative disorder (1.30, 95% CI: 1.10–1.54) and chronic pancreatitis (1.71, 95% CI: 1.14–2.56). The results were supported by the external validation in New Zealand.ConclusionDANCAMI assessed comorbidity burden of patients with first-time myocardial infarction, outperformed existing comorbidity indices, and was generalizable to patients outside Denmark. DANCAMI is recommended as a standard approach for comorbidity adjustment in studies of myocardial infarction prognosis.

Short-term Exposure to Fine Particulate Matter and Myocardial Injury among Patients Undergoing Cardiac Catheterization

Background/Aim: Fine particles (PM2.5) are associated with a higher risk for coronary events. Cardiac troponin T (cTnT) is a myocardium-specific protein which is measured clinically for the diagnosis and prognosis of myocardial infarction (MI). An elevation in circulating cTnT also occurs in non-ischemic conditions and indicates myocardial damage. We aimed to investigate short-term PM2.5 effects on cTnT and other myocardial injury-related biomarkers among participants undergoing cardiac catheterizations.Methods: This study included 7,497 plasma cTnT measurements conducted in 2,739 participants presenting to Duke University Hospital (2000 to 2012), partly alongside with measurements of C-reactive protein, fibrinogen, white blood cells, N-terminal-pro brain natriuretic peptide (NT-pro BNP), and partial oxygen pressure (PaO2). Daily PM2.5 was predicted by a neural network-based hybrid model at a 1km resolution and was assigned to participants’ residential addresses. We applied generalized estimating equations to assess associations of PM2.5 with biomarker levels and the risk of a positive cTnT test (cTnT&gt;0.1ng/mL).Results: Mean PM2.5 concentration was 11.8 μg/m3. Median plasma cTnT was 0.05 ng/mL and the prevalence of a positive cTnT test was 35.6% at presentation. For a 10µg/m3 increase in PM2.5 one day before cTnT measurement, plasma cTnT increased by 11.1% (95% CI: 5.3–17.4) and the odds ratio of a positive cTnT test was 1.12 (95% CI: 1.03–1.23). Participants under 60 years [20.9% (95% CI: 10.2–32.6)] or living in rural areas [17.6% (95% CI: 7.3–28.7)] had stronger associations. There was additionally evidence for positive associations of PM2.5 with fibrinogen and NT-pro BNP within one day after exposure, as well as negative associations with PaO2 at lag 3-4 days. Conclusions: Our study suggests that acute PM2.5 exposure may elevate indicators of myocardial injury and exertion, which substantiates the association of air pollution exposure with adverse cardiovascular events. This abstract does not necessarily represent EPA policy.

Worse long-term prognosis in myocardial infarction occurring at weekends or public holidays with insight into myocardial infarction with nonobstructive coronary arteries.

The weekend effect in Polish patients with myocardial infarction (MI) treated in the current network of catheterization laboratories is poorly understood. We sought to investigate long‑term prognosis of patients with MI admitted at weekends or public holidays (NWDs) and on working days (WDs). We enrolled 865 patients with MI hospitalized between 2012 and 2017. The long‑term mortality within the median (IQR) time of 68.5 (36.7-78.4) months was determined in 223 patients (25.8%) admitted on NWDs and in 642 (74.2%) on WDs. Patients admitted on NWDs more often had ST‑segment elevation MI (41.3% vs 30.8%; P = 0.005), left anterior descending artery as an infarct‑related artery (38.1% vs 30.2%; P = 0.031) and incomplete reperfusion expressed as Thrombolysis in Myocardial Infarction flow grade 0/1 following primary angioplasty (6.8% vs 1.6%; P <0.001) as compared with those hospitalized on WDs. Myocardial infarction with nonobstructive coronary arteries (MINOCA) occurred less often on NWDs (4% vs 9%, P = 0.019). The all‑cause long‑term mortality was higher in NWD patients as compared with those admitted on WDs (36.3% vs 28.4%; P = 0.037). By the Cox proportional hazards model with time‑dependent covariates, MI on NWDs (hazard ratio, 1.027; 95% CI, 1.022-1.032; P <0.001) but not MINOCA (hazard ratio, 0.971; 95% CI, 0.595-1.583; P = 0.91) was independently associated with long‑term mortality. Patients hospitalized on NWDs as compared with those admitted on WDs had a larger ischemic territory and more often had transmural MI with incomplete epicardial reperfusion, which resulted in a higher long‑term mortality. The latter outcome was not influenced by MINOCA.

CARDIOVASCULAR RISK FACTORS PECULIARITIES IN MEN UNDER 60 YEARS OLD WITH RECURRENT ISCHAEMIC DAMAGES DURING MYOCARDIAL INFARCTION

Relevance. Recurrent ischemic damages negatively affect the prognosis of myocardial infarction. Aim. To evaluate the peculiarities of cardiovascular risk factors in men younger than 60 years old with myocardial infarction and recurrent ischemic damages to improve prevention, and outcomes. Material and methods. The study included men aged 19-60 years old with type I myocardial infarction. Patients are divided into two age-comparable groups: I - the study group, with recurrent ischemic damages - 95 patients; II - con-trol, without it - 470 patients. A comparative analysis of the frequency of observation of the main and additional car-diovascular risk factors in groups was performed. Results. In patients of the study group, more often than in the control group we observed: hypodynamia (94.7 and 77.7%, respectively; p ˂ 0.05), smoking (86.3 and 72.6%; p ˂ 0.05), myocardial infarction (56.8 and 40.3%; p ˂ 0.05), unstable angina (57.9 and 46.3%; p ˂ 0.05), coronary artery bypass surgery (17.9 and 9, 3%; p ˂ 0.05) in the pa-tient’s medical a history, stress (53.7 and 36.9%; p ˂ 0.05) and changes in meteorological factors (26.4 and 23.0%; p ˂ 0.05) as causes of myocardial infarction , winter (37.9 and 28.1%; p ˂ 0.05) and autumn (28.4 and 18.3%; p ˂ 0.05) periods and impaired renal function (29.2 and 12.1% ; p ˂ 0.05). Conclusions. The use of these factors in prognostic modeling of recurring ischemic damages risk in case of myocardi-al infarction in men under 60 years old, as well as in creating high-risk groups for their development to monitor and conduct preventive measures, will improve the outcome of such patients.