Acute Coronary Syndrome Registry Research Articles

Does frailty have an influence on MINOCA?

Abstract Funding Acknowledgements None. Introduction Frailty is a condition that is associated with aging, the presence of comorbidities and disability. The occurrence of frailty may aggravate the course of illnesses, including myocardial infarction (MI), with significant higher rates of complications and mortality in frail patients. Purpose We aim to build and validate for our population a frailty índex (FI) using the information present in the National Registry of Acute Coronary Syndromes (ACS). This will later be used to characterize the sample and evaluate the impact of frailty in patients with acute myocardial infarction with non-obstructive coronary arteries (MINOCA), in terms of management, complications, in-hospital mortality and 1-year mortality in a real-world scenario. Methods Multicenter retrospective study, based on the National Registry of ACS, from 1/10/2010-24/10/2022. Only patients hospitalized with a diagnosis of MINOCA (coronary stenosis <50%) were included. FI was created including 22 variables identified from baseline characteristics (Table 1). The FI was calculated, ranging between 0-1. Patients were then divided into two groups: Group A - non-frail (FI ≤0.25) – and Group B – frail (FI>0.25). Kaplan-Meier test was performed to establish the survival rates, CV readmissions (R) and R for other causes, at one year. Results A total of 1358 patients were analyzed, 1195 in group A (88.0%) and 163 in group B (12.0%). Mean age was 63.9±13.9 years and 62.8% of the patients were male in group A, while in group B mean age was 68.0±10.8 and 72.4% were men. Group B had more cardiovascular risk factors, such as hypertension (94.5% vs 63.2% p<0.001), diabetes (55.2% vs 22.6% p<0.001), dyslipidemia (52.2% vs 89.0% p<0.001). Patients in group B also had more previous history of heart failure (27.6% vs 4.9% p<0.001), stroke (15.3% vs 3.9% p<0.001) and chronic kidney disease (17.8% vs 1.5% p<0.001). On admission, group B presented: higher heart rate (HR) (15.7% with HR ≥100bpm vs 9.0%; p=0.008), more atrial fibrillation (14.7% vs 6.7%, p<0.001); lower blood pressure (BP) (5.1% with BP <90mmHg vs 1.0%; p<0.001), and higher Killip-Kimball (KK) classification (24.1% in KK class >I vs 8.3%; p<0.001). During hospitalization, group B presented higher maximum creatinine values (2.0±2.2mg/dL vs 1.2±0.9 mg/2mg/dL, p<0.001) and lower hemoglobin values (11.9±2.2 vs 12.9±1.7g/dL, p<0.001). There were no differences between the two groups in terms of complications during hospitalization, intrahospital mortality or regarding lenght of hospital stay or mortality rates, R for CV causes and R for other causes at one-year follow-up, with a Kaplan-Meier test of p=0.186 (Figure 1A), p=0.789 (Figure 1B) and p=0.118 (Figure 1C), respectively. Conclusions As expected, frail patients have more comorbidities than non-frail patients. However, this does not translate into differences in terms of patients’ treatment, number of complications, intrahospital mortality, or 1-year follow up.Figures 1A, 1B and 1C

Prescribing Trends of Renin-Angiotensin System Inhibitors and Mortality among Acute Coronary Syndrome Patients: Insights from the Malaysian National Cardiovascular Disease Registry

Abstract Background: Despite guideline recommendations, suboptimal prescription rates of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) have been observed in patients with acute coronary syndrome. Objective: This study aimed to examine the temporal trends, variations, and mortality outcomes among acute coronary syndrome patients prescribed ACEIs/ARBs in the multi-ethnic population of Malaysia. Methodology: This retrospective study utilized data from the Malaysian National Cardiovascular Disease–Acute Coronary Syndrome registry, encompassing consecutive patient records from 2008 to 2017 (N = 60,854). Ten-year temporal trends of on-discharge ACEIs/ARBs prescription were examined. Demographics, clinical characteristics and 1-year all-cause mortality outcomes were compared between patients prescribed and not prescribed ACEIs/ARBs. Results: The 10-year prescription rate of on-discharge ACEIs/ARBs was 52.8% (n = 32,140), with a significant decline over the years [linear trend test, P = 0.008; SD = 0.03; SE = 0.001; 95% CI = 0.55-0.64]. Patients aged ≥65 years (aOR = 0.79; 95% CI = 0.73–0.86) were less likely to be prescribed ACEIs/ARBs than those aged <65 years. In addition, patients with comorbid diabetes mellitus (DM) (aOR = 0.85; 95% CI = 0.79–0.92) and chronic kidney disease (CKD) (aOR = 0.34; 95% CI = 0.30–0.40) were significantly less likely to receive ACEIs/ARBs. IPW-adjusted survival analysis revealed a 38% lower 1-year all-cause mortality rate in patients prescribed on-discharge ACEIs/ARBs (HR = 0.62; 95% CI = 0.56–0.69; P < 0.001). Conclusion: Acute coronary syndrome patients with concomitant DM and CKD were less likely to receive on-discharge ACEIs/ARBs in Malaysia. Suboptimal prescription rates of ACEIs/ARBs persisted over the 10-year period, despite improved 1-year survival in ACS patients prescribed ACEIs/ARBs.

Impact of chronic total occlusion on prognosis in cardiogenic shock due to unprotected left main coronary artery culprit lesion. Insights from the Polish Registry of Acute Coronary Syndromes.

Notwithstanding readily available revascularization, significant advancements in mechanical circulatory support, and pharmacological progress, cardiogenic shock (CS) secondary to unprotected left main culprit lesion-related acute myocardial infarction (ULMCL-related AMI) is associated with very high mortality. In this population, chronic total occlusion (CTO) is relatively frequent. This study sought to assess the association between the presence of CTO and 12-month mortality in patients with CS due to ULMCL-related AMI. The study included consecutive patients admitted for AMI-related CS with ULMCL who underwent percutaneous coronary intervention (PCI) and were enrolled in the prospective Polish Registry of Acute Coronary Syndromes (PL-ACS) between January 2017 and December 2021. The patients were stratified into two groups based on the presence of at least one CTO. The primary endpoint was all-cause death at 12 months. Of the 250 included patients, 60 (24%) patients had one or more CTOs of a major coronary artery (+CTO), and in 190 (76%) patients, the presence of CTO was not observed (-CTO). The 12-month mortality rates for the +CTO and -CTO patients were 85% and 69.8%, respectively (P log-rank = 0.03). After multivariable adjustment for differences in the baseline characteristics, the presence of CTO remained significantly associated with higher 12-month mortality (hazard ratio, 1.423; 95% CI, 1.027-1.973; P = 0.034). Our analysis showed that in patients with CS due to ULMCL-related AMI treated with PCI, the presence of CTO is associated with worse 12-month prognosis.

Mortality of patients presented with acute ST-segment elevation myocardial infarction according to the status of standard modifiable cardiovascular risk factors

BackgroundStandard modifiable cardiovascular risk factors (SMuRFs) remain well-established elements of assessing cardiovascular risk scores. However, there is growing evidence that patients presented without known SMuRFs at admission demonstrate worse post-myocardial outcomes. The aim of the study was to assess the influence of the SMuRF status on short- and long-term mortality rates in patients with first-time ST-segment elevation myocardial infarction (STEMI). MethodsThis observational, cross-sectional study covered 182,726 patients admitted between 2003–2020 to the CathLabs, according to data from the Polish Registry of Acute Coronary Syndrome. Both baseline characteristics and mortality (in-hospital, 30-day, and 12-month) were examined and stratified by SMuRF status. The predictors of mortality were assessed at selected time points by multivariable analysis. ResultsThe majority of STEMI patients had at least one SMuRF (88.7%), however, mortality rates of SMuRF-less individuals were greater at selected time points of the follow-up (p < 0.001), and persisted at a higher level during each year of the follow-up period compared to the SMuRF group and general population. Furthermore, the SMuRFs status constituted an independent predictor of mortality at the 30-day (OR: 1.345; 95% CI: 1.142–1.585, p < 0.001) and 12-month (OR: 1.174; 95% CI: 1.054–1.308, p < 0.001) follow-ups. ConclusionsSMuRF-less individuals presented with STEMI are at an increased risk of all-cause mortality compared to those with at least one SMuRF. Consequently, further investigations regarding the recognition and treatment of risk factors, irrespective of SMuRF status, are indicated.

The Effect of Beta-Blocker Post-Myocardial Infarction With Ejection Fraction >40% Pooled Analysis From Seven Arabian Gulf Acute Coronary Syndrome Registries.

The use of beta-blockers (BB) in reduced left ventricular ejection fraction (LVEF) post-myocardial infarction (MI) is associated with reduced 1-year mortality, while their role in patients with mid-range and preserved LVEF post-MI remains controversial. We studied 31,620 patients who presented with acute coronary syndrome (ACS) enrolled in seven Arabian Gulf registries between 2005 and 2017. Patients with LVEF ≤40% were excluded. The remaining cohort was divided into two groups: BB group (n = 15,541) and non-BB group (n = 2,798), based on discharge medications. Patients in the non-BB group were relatively younger (55.3 vs. 57.4, P = .004) but higher risk at presentation; with higher Global Registry of Acute Coronary Events (GRACE) score (119.2 vs 109.2, P < .001), higher percentage of cardiogenic shock (3.5 vs 1.4%, P < .001), despite lower prevalence of comorbidities, such as hypertension and hyperlipidemia. BB use was associated with lower 1-year mortality in a multivariate logistic regression analysis, adjusting for major confounders [adjusted odds ratio (OR): 0.71 (95% CI 0.51-0.99)]. This remained the case in a sensitivity analysis using propensity score matching [adjusted OR: 0.34 (95% CI 0.16-0.73)]. In this study, using Arabian Gulf countries registries, the use of BB after ACS with LVEF >40% was independently associated with lower 1-year mortality.

Refusal of prescribed drug therapy (absolute non-adherence) after acute myocardial infarction/unstable angina: data from prospective observation in the LIS-3 registry

Aim. Within the LIS-3 register of acute coronary syndrome (ACS), to evaluate the phenomenon of complete refusal of treatment (absolute non-adherence) after discharge from the hospital of patients diagnosed with acute myocardial infarction (AMI)/unstable angina (UA): to study the characteristics of absolutely nonadherent patients, disease outcomes after 2.5 years after first contact.Material and methods. The study was conducted within the framework of the LIS-3 register. This part of the study included patients who survived ACS and were discharged from the hospital in the first 9 months of 2014 (104 people) and patients who survived ACS and were discharged from the hospital in the first 9 months of 2018 (223 people). Of the 327 patients who survived after AMI/UA, 226 patients remained alive by the time of the first survey (on average 3 years after discharge). The created questionnaire was used, which includes questions about possible long-term outcomes, adherence to visits to medical and preventive institutions (health facilities) and adherence to drug therapy. 221 people answered questions about treatment, 11 (5%) of them did not take any drug therapy (absolutely non-adherent). On average, 29 months (2.5 years) after the initial survey, a repeat survey of completely non-adherent patients or their relatives was carried out, information was collected on the vital status of these patients, repeated cardiovascular events and on the use of recommended drug therapy, about visiting a health facility.Results. When comparing the clinical and demographic characteristics of patients who were adherent and completely non-adherent to the prescribed therapy, no significant differences were noted. By the time of the repeat survey, 4 patients from among those who were completely non-adherent had died, 2 had suffered ACS. Of the 6 patients who survived, at the time of re-contact, 2 had not started taking medications, explaining that they were feeling well, 2 had resumed taking medications in full, 2 — partially, contact with 1 patient was lost.Conclusion. A certain proportion of patients who have suffered AMI/UA completely refuse the prescribed treatment, mainly because they feel well. The likelihood of death and recurrent cardiovascular events in such patients is extremely high.

Time to coronary catheterization in patients with non-ST-segment elevation acute coronary syndrome and high Global Registry of Acute Coronary Events score.

Current guidelines recommend an early (<24 h) invasive coronary angiography (ICA) strategy in non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients with Global Registry of Acute Coronary Events (GRACE) score over 140. Evidence for this recommendation is based on older trials. Between 1 February 2016 and 31 July 2021, 1767 patients with a primary diagnosis of NSTE-ACS without indication for urgent ICA underwent ICA during index hospitalization. Six hundred and fifty-five patients underwent early invasive ICA (within 24 h) and 1112 underwent late ICA (between 24 h and 1 week). One hundred and seven patients had a GRACE risk score of 140 or above and 1660 had a GRACE risk score under 140. The primary composite outcome was all-cause mortality, stroke, and recurrent myocardial infarction (MI). Median time from admission to ICA was 13.3 h (IQR 6.0-20.6) for the early group and 59.9 h for the late group (IQR 23.5-96.3). There was no difference between the early and late ICA groups in the primary composite outcome [late catheterization >24 h hazard ratio 1.196, 95% confidence interval (CI) 0.969-1.475, P -value 0.096]. A multivariable Cox regression model for the composite outcome revealed no difference between the early and late ICA groups (late catheterization >24 h hazard ratio 1.0735, 95% CI 0.862-1.327, P -value 0.512) with no effect for performing early ICA in patients with GRACE score over 140 (hazard ratio 1.291, 95% CI 0.910-1.831, P -value 0.151). An early ICA strategy in patients with NSTE-ACS patients and GRACE risk score over 140, compared with late ICA, was not associated with improved composite outcome of death, myocardial infarction, and stroke at 1 year.

Factors Associated With Hospital Mortality in Acute Myocardial Infarction

Aim To determine clinical and laboratory parameters associated with in-hospital mortality in patients with acute myocardial infarction and to develop a multifactorial prognostic model of in-hospital mortality.Material and methods This was a study based on the 2019-2020 Registry of acute coronary syndrome of the Tyumen Cardiology Research Center, a branch of the Tomsk National Research Medical Center. The study included 477 patients with ST-segment elevation acute myocardial infarction (AMI), 617 patients with non-ST segment elevation AMI, and 26 patients with unspecified AMI. In-hospital mortality was 6.0 % (n=67). Clinical and laboratory parameters were assessed on the day of admission. The separation power of indicators associated with in-hospital mortality was determined using a ROC analysis. The data array of each quantitative parameter was converted into a binary variable according to the obtained cut-off thresholds, followed by creation of a multifactorial model for predicting in-hospital mortality using a stepwise analysis with backward inclusion (Wald). The null hypothesis was rejected at p&lt;0.05.Results The multivariate model for prediction of in-hospital mortality included age (cut-off, 72 years), OR 3.0 (95 % CI: 1.5-5.6); modified shock index (cut-off threshold, 0.87), OR 1.5 (95 % CI: 1.1-2.0); creatine phosphokinase-MB (cut-off threshold, 32.8 U / L), OR 4.1 (95 % CI: 2.2-7.7); hemoglobin (121.5 g / l), OR 1.7 (95 % CI: 1.2-2.3); leukocytes (11.5×109 / l), OR 1.9 (95 % CI: 1.3-2.6); glomerular filtration rate (60.9 ml / min), OR 1.7 (95 % CI: 1.2-2.2); left ventricular ejection fraction (42.5 %), OR 4.1 (95 % CI: 2.0-8.3); and size of myocardial asynergy (32.5 %), OR 2.6 (95 % CI: 1.4-5.0).Conclusions Independent predictors of in-hospital mortality in AMI are age, modified shock index, creatine phosphokinase-MB, peripheral blood leukocyte count, hemoglobin concentration, left ventricular ejection fraction, size of myocardial asynergy, and glomerular filtration rate. The in-hospital mortality model had a high predictive potential: AUC 0.930 (95 % CI: 0.905-0.954; p &lt;0.001) with a cutoff threshold of 0.15; sensitivity 0.851, and specificity 0.850.

Cholesterol-Years and the risk of the first MI

Abstract Background Low-density lipoprotein cholesterol (LDL-C) has been determined as one of the causal factors of Atherosclerotic Cardiovascular Disease (ASCVD). The term "cholesterol-years" represents the cumulative exposure of the arterial wall to LDL-C during the lifetime, and is measured by multiplication of patient’s age, and LDL-C level. According to the theory, exceeding a certain number of "cholesterol-years" increases the risk of myocardial infarction (MI) [1]. So far, there are no studies that assess the effect of "cholesterol-years" on the risk of the first MI. Purpose We aimed to determine whether "cholesterol-years", as an indicator of cumulative exposure to LDL-C, is associated with the risk of development of the first MI in Polish patients. Method Data were extracted from patients from years 2016-2022, who were participants of the Polish Registry of Acute Coronary Syndromes (PL-ACS), a national, multicenter, ongoing, prospective observational registry that includes all patients hospitalized with the acute coronary syndrome (ACS) in Poland. The study group consisted of patients who had not previously been treated with lipid-lowering therapy, with first MI, and had the available data for LDL-C. The association between the "cholesterol-years" and the occurrence of the first MI was assessed using the Spearman’s correlation. All continuous variables were presented as mean (SD), and categorical variables were shown as absolute numbers and percentages. Results The studied group constituted 35,747 patients, with the mean age of 66.5 years, of whom 36% were women. 25,6% of patients had diabetes, 70,8% arterial hypertension, and 62.6% were past-or-present smokers. In patients with the first myocardial infarction, there is a significant linear correlation between cholesterol-years and the age at which the first myocardial infarction occurs. In our observation, exceeding 6,000 "cholesterol-years" at the age of 40 increases the risk of the first myocardial infarction. Conclusion In the large, real-world population, the risk of the first myocardial infarction was linearly correlated with the number of "cholesterol-years", which supports the "cholesterol-years" theory of the risk of development of the first MI.Baseline Characteristics of PatientsCholesterol-years in the study group

Every third patient with advanced renal failure dies within one year following non st-segment elevation myocardial infarction treated with percutaneous coronary intervention

Abstract Background and Aims Kidney failure is highly prevalent in patients with the non-ST-elevation myocardial infarction (NSTEMI). The aim of the study was to evaluate the prognostic significance of baseline renal function regarding in-hospital and 1-year mortality among patients with NSTEMI who were treated with percutaneous coronary intervention (PCI). Methods Data were obtained from the Polish Registry of Acute Coronary Syndromes (PL-ACS). We extracted all patients with NSTEMI (n=47,052) who were treated with PCI between 2017 and 2021. The cumulative incidence of all-cause mortality during the 1-year follow-up was presented using the Kaplan-Meier curves. The linearity of the association between the Esimated Glomerular Filtration Rate (eGFR) with all-cause mortality was evaluated using a likelihood ratio test. The multivariate Cox regression model was created to adjust the relationship between eGFR and all-cause mortality for potential confounders. Results After considering the exclusion criteria, 20,834 cases were evaluated, with a median eGFR of 72.7 (IQR 56.6-87.5) mL/min/1.73 m². The median age was 69 (62-76) years. The study comprised 4,505 patients with normal (90-120), 10,189 with mild (60-89), 5,539 with moderate eGFR (30-59), and 601 with severe renal impairment (15-29). There was a stepwise increase in the crude all-cause death rates across the groups at 1 year. The cox regression model revealed that the relationship between eGFR and the risk of death at 1 year was non-linear (reverse J-shaped, Fig. 1), and the risk was the lowest in patients with eGFR∼90 mL/min/1.73 m². Conclusions There is a J-curve relationship between the eGFR value and 1-year all-cause mortality in patients with NSTEMI and treated with PCI.

Pretreatment with P2Y12 inhibitors and relationship with clinical outcomes in NSTEMI: Analysis of 2 Argentinian registries

Abstract Introduction Pretreatment with P2Y12 inhibitors has been widely studied in the context of NSTEMI patients, with varying results. General consensus is that this strategy should be avoided, unless a long wait time is expected before angiography can be performed. However, it is unclear whether this strategy is associated with a reduction in clinical outcomes, or an increase in bleeding events. Purpose To analyze frequency of pretreatment in NSTEMI in our medium, and association with clinical outcomes. Methods We analyzed the results of two Argentinian acute coronary syndrome registries from 2017 and 2022. We explored incidence of pretreatment, and drug used. We evaluated first through univariate analysis the relationship between pretreatment use and a clinical composite outcome of in hospital events: Myocardial infarction + Mortality + In stent thrombosis + post MI angina + Stroke/TIA. We also explored the relationship of pretreatment with bleeding events (BARC 2 or higher). We later conducted a logistic regression with other clinical variables: Age, gender, diabetes, previous bleeding events, previous MI, aspirin use, anticoagulation, killip-kimball scale and ejection fraction. Results 1297 patients were included in the analysis, after excluding STEMI patients, patients with current use of P2Y12 inhibitors at time of event, and patients who did not undergo angiography. 75.6% were men, 25.6% diabetic, 27,1% smokers, 70.3% hypertensive, and 23.1% had a previous acute coronary syndrome. Mean age was 55.3 years old. Mean GRACE score was 113,5 and CRUSADE 23,8. 44% of patients recieved pretreatment, mostly with clopidogrel (93.5%). Patients that recieved pretreatment were more frequently hypertensive (73.8% vs 67%, p=0.01) and had a higher incidence of previous MI (27% vs 19%, p=0.002). GRACE score was significantly lower in patients that were pretreated (111,5 vs 115, p=0.04). Pretreatment use was significantly associated with a higher incidence of the composite clinical outcome, occuring in 10.1% of patients pretreated and in 6.9% of patients not pretreated (OR 1.56 (1.06-2.3) p=0.02. Bleeding events were numerically more frequent with pretreatment (8.7% vs 5.9%), though did not reach statistical significance (OR 1.51 (0.99-2.3) p=0.054). In multivariate analysis, after adjusting for multiple clinical variables, pretreatment was no longer associated with a higher incidence of clinical outcomes, though also not with a lower incidence (OR 1.4 (0.89-2.3) p=0.13). Discussion Pretreatment, mostly with clopidogrel, did not show a relationship with either benefit or harm with regard to ischemic and bleeding outcomes in NSTEMI patients.

Abstract 17853: Efficacy of Grace Score for Prediction of Mortality in Patients of Acute Coronary Syndrome: A Meta-Analysis

Introduction: The Global Registry of Acute Coronary Syndrome (GRACE) is a validated risk prediction model for acute coronary syndromes (ACS). However, discrimination ability of this model for predicting mortality in ACS remains unclear. The aim of this meta-analysis is to determine the predictive accuracy of GRACE score for mortality in ACS patients. Methods: A comprehensive literature search was conducted across MEDLINE, Embase &amp; the Cochrane Library from inception till May 2023. All studies that reported the C-statistic for predicting in-hospital, 6-month, 1 year &amp; 2-year mortality in ACS patients were included. The generic inverse variance weighted random effects method was used to pool C-statistics &amp; corresponding standard errors (SEs) from each study. Subgroup analysis was conducted based on whether the patients required percutaneous coronary intervention (PCI) or not. Results: A total of 22 studies with a patient population of 132856 were included. For in-hospital mortality (n=99774), the GRACE score showed a good discrimination ability to predict mortality (summary C-statistic 0.86 [0.85-0.87], I 2 =58%). The pooled C-statistic for 6-month mortality (n=24174) was 0.80 (0.70-0.84; I 2 =93%). For 1-year mortality (n=13517), the predictive accuracy of the GRACE score was moderate (summary estimate= 0.77 [0.70-0.83]; I 2 =94%). The GRACE score proved to be moderately accurate in predicting 2-year mortality (n=4972) in ACS patients [0.75 (0.66-0.83); I 2 =66%]. All the findings were consistent across the two subgroups of PCI vs no PCI (p for interaction &gt;0.05). Conclusion: The GRACE score is a simple scoring system that demonstrated good predictive ability for in hospital mortality, &amp; at 6-months while moderate predictive ability for the risk of death at 1-year, &amp; 2-year in patients of ACS with &amp; without PCI.

Impact of pretreatment with P2Y12 inhibitors in patients with acute coronary syndromes without ST elevation. Analysis of 2 multicenter registries

To evaluate the rate of use of antiplatelet pretreatment in patients with non-ST elevated acute coronary syndrome (NSTEACS) and its association with adverse events in two Argentine registries. We retrospectively analyzed two Argentine acute coronary syndrome (ACS) registries from 2017 and 2022. We explored the incidence of pretreatment and the drug used. We evaluated the relationship between this strategy and a composite clinical outcome of in-hospital events: death + myocardial infarction + stent thrombosis + post-MI angina + transient ischemic event/cerebrovascular event, and with bleeding events (BARC 2 or higher). Subsequently, we performed a multivariate analysis by logistic regression with other clinical variables. A total of 1297 patients were included; 75.6% were men, 25.6% diabetics, 27.1% smokers, 70.3% hypertensive, and 23.1% had a previous ACS. The mean age was 55.3 years. The mean GRACE score was 113.5, and the CRUSADE was 23.8. 44% of the patients received pretreatment, the majority with clopidogrel (93.5%). Pretreatment was significantly associated with a higher incidence of the composite clinical outcome (10.1% vs. 6.9%) (OR 1,56; IC 95%: 1,06-2,3; p=0,02). Bleeding events were numerically more frequent with pretreatment (8.7% vs. 5.9%) (OR 1,51; IC95%: 0,99 -2,3; p=0,054). In the multivariate analysis, pretreatment was no longer associated with a higher incidence of ischemic outcomes (OR 1,4; IC95%: 0,89-2,3; p=0,13). Pretreatment was used in almost half of the patients, mainly with clopidogrel, and did not show a reduction in ischemic events in patients with NSTACS.

Forecasting the Risk of Heart Failure Hospitalization After Acute Coronary Syndromes: the CORALYS HF Score

The present study aimed to identify patients at a higher risk of hospitalization for heart failure (HF) in a population of patients with acute coronary syndrome (ACS) treated with percutaneous coronary revascularization without a history of HF or reduced left ventricular (LV) ejection fraction before the index admission. We performed a Cox regression multivariable analysis with competitive risk and machine learning models on the incideNce and predictOrs of heaRt fAiLure After Acute coronarY Syndrome (CORALYS) registry (NCT04895176), an international and multicenter study including consecutive patients admitted for ACS in 16 European Centers from 2015 to 2020. Of 14,699 patients, 593 (4.0%) were admitted for the development of HF up to 1year after the index ACS presentation. A total of 2 different data sets were randomly created, 1 for the derivative cohort including 11,626 patients (80%) and 1 for the validation cohort including 3,073 patients (20%). On the Cox regression multivariable analysis, several variables were associated with the risk of HF hospitalization, with reduced renal function, complete revascularization, and LV ejection fraction as the most relevant ones. The area under the curve at 1year was 0.75 (0.72 to 0.78) in the derivative cohort, whereas on validation, it was 0.72 (0.67 to 0.77). The machine learning analysis showed a slightly inferior performance. In conclusion, in a large cohort of patients with ACS without a history of HF or LV dysfunction before the index event, the CORALYS HF score identified patients at a higher risk of hospitalization for HF using variables easily accessible at discharge. Further approaches to tackle HF development in this high-risk subset of patients are needed.

Stepwise relationship between delay in percutaneous coronary intervention and long-term mortality in patients with non-ST-segment elevation myocardial infarction.

Current guidelines recommend coronary catheterization in patients with non-ST- -segment elevation myocardial infarction (NSTEMI) within 24 hours of hospital admission. However, whether there is a stepwise relationship between the time to percutaneous coronary intervention (PCI) and long-term mortality in patients with NSTEMI treated invasively within 24 hours of admission has not been established yet. The study aimed to evaluate the association between door-to-PCI time and all-cause mortality at 12 and 36 months in NSTEMI patients presenting directly to a PCI-capable center who underwent PCI within the first 24 hours of hospitalization. We analyzed data of patients hospitalized for NSTEMI between 2007-2019, included in the nationwide registry of acute coronary syndromes. Patients were stratified into twelve groups based on 2-hour intervals of door-to-PCI time. The mortality rates of patients within those groups were adjusted for 33 confounding variables by the propensity score weighting method using overlap weights. A total of 37 589 patients were included in the study. The median age of included patients was 66.7 (interquartile range [IQR], 59.0-75.8) years; 66.7% were male, and the median GRACE (Global Registry of Acute Coronary Events) score was 115 (98-133). There were increased 12-month and 36-month mortality rates in consecutive groups of patients stratified by 2-hour door-to-PCI time intervals. After adjustment for patient characteristics, there was a significant positive correlation between the time to PCI and the mortality rates (rs = 0.61; P = 0.04 and rs = 0.65; P = 0.02 for 12-month and 36-month mortality, respectively). The longer the door-to-PCI time, the higher were 12-month and 36-month all-cause mortality rates in NSTEMI patients.

GDF-15 at admission predicts cardiovascular death, heart failure, and bleeding outcomes in patients with CAD.

We aimed to investigate the independent associations between growth differentiation factor 15 (GDF-15) level at admission and cardiovascular (CV) death, thrombotic events, heart failure (HF), and bleeding outcomes in patients with coronary artery disease (CAD). We measured the plasma concentrations of GDF-15 centrally in patients from the BIomarker-based Prognostic Assessment for patients with Stable angina and acute coronary Syndrome (BIPass) registry, which consecutively enrolled patients with CAD from November 2017 to September 2019 at five tertiary hospitals in China. The outcomes included CV death, thrombotic events [myocardial infarction (MI) and ischaemic stroke], HF events [acute HF during hospitalization and hospitalization for HF post-discharge (A/H HF) and cardiogenic shock], and bleeding outcomes [non-coronary artery bypass grafting-related major bleeding and clinically significant bleeding (CSB)] during the 12month follow-up period after hospitalization. Among 6322 patients with CAD {65.4% male, median age 63.7 [inter-quartile range (IQR)] 56.0-70.1years}, the median concentration of plasma GDF-15 at admission was 1091 (IQR 790.5-1635.0) ng/L. Higher concentrations of GDF-15 were associated with an increased risk of CV death [hazard ratio (HR) 1.98, 95% confidence interval (CI) 1.35-2.88, P<0.001], A/H HF (HR 2.69, 95% CI 1.92-3.77, P<0.001), cardiogenic shock (HR 1.46, 95% CI 1.04-2.05, P=0.029), and CSB (HR 1.48, 95% CI 1.22-1.79, P<0.001), but not for MI or stroke, after adjusting for clinical risk factors and prognostic biomarkers. Adding GDF-15 to the model with risk factors and biomarkers improved the net reclassification for CV death, A/H HF, cardiogenic shock, and CSB. In patients with CAD, admission levels of GDF-15 were associated with an increased 1year risk of CV death, HF, and bleeding outcomes, but not with thrombotic events. GDF-15 may be a prognostic biomarker for CV death, HF, and bleeding outcomes and could be used to refine the risk assessment of these specific clinical outcomes. ClinicalTrials.gov Identifier: NCT04044066.

Prognosis of patients with renal failure one year following non-ST-segment elevation myocardial infarction treated with percutaneous coronary intervention

ObjectiveKidney failure is highly prevalent in patients with non-ST-elevation myocardial infarction (NSTEMI). The aim of the study was to evaluate the prognostic significance of baseline renal function regarding in-hospital and 1-year mortality among patients with NSTEMI and treated with percutaneous coronary intervention (PCI). MethodsData were obtained from the Polish Registry of Acute Coronary Syndromes (PL-ACS) and included 47,052 NSTEMI patients treated with PCI between 2017 and 2021. The cumulative incidence of all-cause mortality during the 1-year follow-up was presented using the Kaplan-Meier curves. The multivariable Cox regression model was created to adjust the relationship between eGFR (as a spline term) and all-cause mortality for potential confounders. ResultsAfter considering the exclusion criteria, 20,834 cases were evaluated, with a median eGFR of 72.7 (IQR 56.6-87.5) mL/min/1.73 m2. The median age was 69 (62-76) years. The study comprised 4,505 patients with normal (90-120), 10,189 with mild (60-89), 5,539 with moderate (30-59), and 601 with severe eGFR impairment (15-29). Lower eGFR was associated with worse baseline clinical profile and longer in-hospital delay to coronary angiography. There was a stepwise increase in the crude all-cause death rates across the groups at 1 year. The Cox regression model with a spline term revealed that the relationship between eGFR and the risk of death at 1 year was non-linear (reverse J-shaped), and the risk was the lowest in patients with eGFR∼90 mL/min/1.73 m2. ConclusionsThere is a J-curve relationship between the eGFR value and 1-year all-cause mortality in patients with NSTEMI and treated with PCI.

The influence of severe mitral regurgitation on major adverse cardiac and cerebrovascular events after myocardial infarction in 1-year follow-up: Data from PL-ACS registry.

Mitral regurgitation (MR) is frequently observed in patients with myocardial infarction (MI). However, the incidence of severe MR in contemporary population is unknown. The study evaluates the prevalence and prognostic impact of severe MR in contemporary population of patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI). The study group consists of 8062 patients enrolled in the Polish Registry of Acute Coronary Syndromes over the years 2017‒2019. Only the patients with full echocardiography performed during the index hospitalization were eligible. Primary composite outcome was 12-month major adverse cardiac and cerebrovascular events (MACCE) (death, non-fatal MI, stroke and heart failure [HF] hospitalization) compared between patients with and without severe MR. 5561 NSTEMI patients and 2501 STEMI patients were enrolled into the study. Severe MR occurred in 66 (1.19%) NSTEMI patients and 30 (1.19%) STEMI patients. Multivariable regression models revealed that severe MR is an independent risk factor of all-cause death in 12-month observation (odds ratio [OR], 1.839; 95% confidence interval [CI], 1.012‒3.343; P = 0.046) in all MI patients. Patients with NSTEMI and severe MR had higher mortality (22.7% vs. 7.1%), HF rehospitalization rate (39.4% vs. 12.9%) and MACCE occurrence (54.5% vs. 29.3%). Severe MR was associated with higher mortality (20% vs. 6%) and higher HF rehospitalization (30% vs. 9.8%), stroke (10% vs. 0.8%) and MACCE rates (50% vs. 23.1%) in STEMI patients. Severe MR is associated with higher mortality and MACCE occurrence in patients with MI in 12-month follow-up. Severe MR is an independent risk factor of all-cause death.

Impact of Diabetes on Outcomes in Patients Hospitalized With Acute Myocardial Infarction: Insights From the Atherosclerosis Risk in Communities Study Community Surveillance.

Background Diabetes is associated with increased risk of acute myocardial infarction (AMI). The demographic trends, clinical presentation, management, and outcomes of patients with diabetes who are hospitalized with AMI have not been recently reported. Methods and Results The ARIC (Atherosclerosis Risk in Communities) study conducted hospital surveillance of AMI in 4 US communities. AMI was classified by physician review using a validated algorithm. Medications and procedures were abstracted from the medical record. From 2000 to 2014, 21 094 weighted hospitalizations for AMI were sampled. The prevalence of diabetes steadily increased, from 35% to 41% to 43% (P-trend<0.0001) across 2000 to 2004, 2005 to 2009, and 2010 to 2014, respectively. Patients with diabetes were older (61 versus 59 years of age), more often Black (44% versus 31%), and more commonly women (42% versus 34%). The burden of cardiovascular comorbidities was higher with diabetes and increased temporally. Patients with diabetes less often presented with ST-segment elevation (9% versus 17%) or acute chest pain (72% versus 80%), and had higher mean GRACE (Global Registry of Acute Coronary Syndrome) score (123 versus 109), Thrombolysis in Myocardial Ischemia (TIMI) score (4.3 versus 4.0), and Killip class (1.9 versus 1.5). Patients with diabetes had a lower adjusted probability of receiving aspirin (relative probability, 0.95 [95% CI, 0.91-0.99]), nonaspirin antiplatelets (0.93 [95% CI, 0.86-0.99]), coronary angiography (0.85 [95% CI, 0.78-0.92]), and coronary revascularization (0.85 [95% CI, 0.76-0.92]). Diabetes was associated with a 52% higher hazard of all-cause 1-year mortality (hazard ratio, 1.52 [95% CI, 1.23-1.89]). Conclusions Diabetes is associated with higher risk of death in patients hospitalized with AMI, highlighting the need for adherence to evidence-based therapies in this high-risk population.

Prognosis Related to Reperfusion Therapy Post-Acute Coronary Syndrome in Secondary Care: Long-Term Survival Analysis in the ERICO Study.

Relationship between reperfusion therapy post-acute coronary syndrome (ACS) and mortality in secondary care is not well-known. To evaluate the impact of three therapeutic strategies: (1) exclusive medical therapy, (2) percutaneous coronary intervention (PCI) and (3) coronary artery bypass grafting (CABG) on long-term survival of participants in the Strategy of Registry of Acute Coronary Syndrome (ERICO) study. Survival analyses for all-cause, cardiovascular (CVD) and coronary artery disease (CAD) mortality were performed according to three therapeutic strategies (exclusive medical therapy, PCI or CABG). Cox regression models were used to estimate the hazard ratio (HR) with respective 95% confidence interval (95%CI) from 180 days to four years of follow-up after ACS. Models are presented as crude, age-sex adjusted and further adjusted for previous CAD, ACS subtype, smoking, hypertension, dyslipidemia, left ventricular ejection fraction and according to the number of obstructed (≥ 50%) major coronary arteries. Among 800 participants, the lowest crude survival rates were detected among individuals who underwent CABG (all-cause and CVD). CABG was correlated to CAD (HR: 2.19 [95% CI: 1.05-4.55]). However, this risk lost significance in the full model. PCI was associated to lower probability of fatal events during four-year follow-up: all-cause [multivariate HR: 0.42 (95% CI: 0.26-0.70)], CVD [HR: 0.39 (95% CI: 0.20-0.73)] and CAD [multivariate HR: 0.24 (95% CI: 0.09-0.63)] compared to those submitted to exclusive medical therapy. In the ERICO study, PCI after ACS was associated to better prognosis, particularly CAD survival.