Risk In Acute Myocardial Infarction Research Articles

Red Blood Cell Distribution Width to Albumin Ratio for Predicting Type I Cardiorenal Syndrome in Patients with Acute Myocardial Infarction: A Retrospective Cohort Study.

Red blood cell distribution width to albumin ratio (RAR) is a novel inflammatory biomarker that independently predicts adverse cardiovascular events and acute kidney injury. This study aimed to assess the predictive value of RAR for cardio-renal syndrome type I (CRS-I) risk in acute myocardial infarction (AMI) patients. This study retrospectively enrolled 551 patients who were definitively diagnosed as AMI between October 2021 and October 2022 at the Affiliated Zhongda Hospital of Southeast University. Participants were divided into two and four groups based on the occurrence of CRS-I and the quartiles of RAR, respectively. Demographic data, laboratory findings, coronary angiography data, and drug utilization were compared among the groups. Logistic regression and receiver operating characteristic curve (ROC) analysis were performed to identify independent risk factors for CRS-I and evaluated the predictive value of RAR for CRS-I. Among the cohort of 551 patients, 103 (18.7%) developed CRS-I. Patients with CRS-I exhibited significantly elevated RAR levels compared to those without the condition, and the incidence of CRS-I correlated with escalating RAR. Univariate and multivariate logistic regression analyses identified RAR as an independent risk factor for CRS-I. ROC curves analysis demonstrated that RAR alone predicted CRS-I with an area under the curve (AUC) of 0.683 (95% CI=0.642-0.741), which was superior to the traditional inflammatory marker C-reactive protein (CRP). Adding the variable RAR to the model for predicting the risk of CRS-I further improved the predictive value of the model from 0.808 (95% CI=0.781-0.834) to 0.825 (95% CI=0.799-0.850). RAR is an independent risk factor for CRS-I, and high levels of RAR are associated with an increased incidence of CRS-I in patients with AMI. RAR emerges as a valuable and readily accessible inflammatory biomarker that may play a pivotal role in risk stratification in clinical practice.

Vitamin D and Ceramide Metabolomic Profile in Acute Myocardial Infarction.

Sphingolipids (SLs) influence several cellular pathways, while vitamin D exerts many extraskeletal effects in addition to its traditional biological functions, including the modulation of calcium homeostasis and bone health. Moreover, Vitamin D and SLs affect the regulation of each others' metabolism; hence, this study aims to evaluate the relationship between the levels of 25(OH)D and ceramides in acute myocardial infarction (AMI). In particular, the blood abundance of eight ceramides and 25(OH)D was evaluated in 134 AMI patients (aged 68.4 ± 12.0 years, 72% males). A significant inverse correlation between 25(OH)D and both Cer(d18:1/16:0) and Cer(d18:1/18:0) was found; indeed, patients with severe hypovitaminosis D (<10 ng/mL) showed the highest levels of the two investigated ceramides. Moreover, diabetic/dyslipidemic patients with suboptimal levels of 25(OH)D (<30 ng/mL) had higher levels of both the ceramides when compared with the rest of the population. On the other hand, 25(OH)D remained an independent determinant for Cer(d18:1/16:0) (STD Coeff -0.18, t-Value -2, p ≤ 0.05) and Cer(d18:1/18:0) (-0.2, -2.2, p < 0.05). In light of these findings, the crosstalk between sphingolipids and vitamin D may unravel additional mechanisms by which these molecules can influence CV risk in AMI.

The importance of evaluation for living alone among acute myocardial infarction patients

Abstract Background Assessment of the mortality risk in acute myocardial infarction (AMI) patients is crucial when making medical decisions because AMI is an important public health issue and a major cause of death worldwide. The Global Registry of Acute Coronary Events (GRACE) risk score is useful for estimating in-hospital mortality at the time of admission and is in wide use. On the other hand, in the rapidly aging societies of the modern era, social isolation and absence of support are important welfare issues. Among them, living alone as a proxy for social isolation has been considered to increase the risk of cardiovascular disease. Purpose The purpose of this study was to investigate the association between living alone and cardiac deaths in AMI patients after percutaneous coronary intervention (PCI), and to determine whether this association was independent of GRACE risk score as a score that is widely used in clinical settings. Methods This study was a retrospective cohort study, investigating 277 consecutive AMI patients who underwent successful revascularization of the culprit lesion by primary PCI. Associations between cardiac deaths after PCI and baseline characteristics including living alone and GRACE risk score were assessed. Furthermore, this study also assessed nutritional status using the Geriatric Nutritional Risk Index (GNRI). Results Median duration of follow-up was 1153 days (IQR, 560–1566 days). In this population, median age was 69 years (IQR, 59–77 years), and 198 patients (71%) were male. Eighty-three patients (30%) were living alone. Thirty patients died after PCI, including 20 cardiac deaths. Patients living alone showed higher incidences of cardiac deaths compared with patients not living alone (14% vs. 4%, p=0.004). The proportion of males differed significantly between living alone and not living alone groups (p=0.004). GNRI was significantly lower in the living alone group than in the not living alone group (p&amp;lt;0.001 and p=0.048). GRACE risk score was significantly higher in the living alone group (median, 140; IQR, 107–170) than in the not living alone group (median, 127; IQR, 103–149; p=0.038). Multivariate Cox proportional hazards regression analysis models showed living alone (hazard ratio [HR], 4.17; 95% confidence interval [CI], 1.60–10.84; p=0.003), GNRI (HR, 0.94; 95%CI, 0.91-0.98; p=0.003), and GRACE risk score (HR, 1.03; 95%CI, 1.01-1.04; p&amp;lt;0.001) were significantly associated with cardiac death after PCI. A comparison of p values for the interaction of GRACE risk score and either living alone and GNRI were p=0.082 and p=0.244, respectively. Conclusions The current study revealed that living alone represents an independent risk factor for cardiac deaths in AMI patients after PCI, separate from GRACE risk score. Evaluation of living arrangements may provide more information regarding prognosis for AMI patients.

Association of N-terminal pro-B-type natriuretic peptide levels and mortality risk in acute myocardial infarction across body mass index categories: an observational cohort study

BackgroundThe prognostic value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) across body mass index (BMI) categories in patients with acute myocardial infarction (AMI) is unclear. We aimed to assess the predictive value of NT-proBNP levels and identify the best cutoff values for mortality risk prediction across BMI categories in AMI.MethodsWe analyzed 4677 patients with AMI from the Cardiovascular Centre Beijing Friendship Hospital Database Bank. Patients were classified into underweight (< 18.5 kg/m2), normal-weight (18.5–23.9 kg/m2), overweight (24–27.9 kg/m2), and obese (≥ 28 kg/m2) groups. The association between NT-proBNP (ln-transformed) and mortality was investigated using Cox regression and stratified by BMI.ResultsDuring follow-up (13,787 person-years of observation), 718 patients died, averaging 52.1 events per 1000 person-years. NT-proBNP levels were inversely correlated with BMI (β = − 0.096, P < 0.001). After adjustment, NT-proBNP was independently associated with all-cause mortality (hazard ratio [HR] per 1-SD: 1.82; 95% confidence interval [CI] 1.60–2.07) in patients with AMI. Similar findings were observed in analyses stratified by BMI category, except for the underweight group. Adding NT-proBNP to conventional risk models improved risk discrimination in normal-weight, overweight, and obese patients (C-index changes of 0.036, 0.042, and 0.032, respectively) and classification of patients into predicted mortality risk categories (net reclassification improvement 0.263, 0.204, and 0.197, respectively). The best NT-proBNP cutoff values for 5-year mortality risk prediction across BMI categories were 5710, 4492, 2253, and 1300 pg/ml.ConclusionNT-proBNP level was an independent prognostic factor for mortality in patients with AMI and varied according to BMI. The best NT-proBNP cutoff values for mortality risk prediction reduced as BMI increased.

Elevated blood acetoacetate levels reduce major adverse cardiac and cerebrovascular events risk in acute myocardial infarction.

Although elevated blood ketone body levels reduce major adverse cardiac and cerebrovascular events (MACCEs) risk in chronic heart failure, their relationship with acute myocardial infarction remains unknown. We investigated this relationship in patients with acute myocardial infarction. This single-institution retrospective observational study analyzed data from 114 patients with acute myocardial infarction at Nihon University Hospital from May 1, 2018, to November 1, 2022. The cut-off value of acetoacetate for the incidence of in-hospital MACCE was determined by drawing a receiver operating characteristic curve (ROC) and defining patients with acetoacetate above and below the optimal cut-off point value as ROC and low-acetoacetate (LA) groups, respectively. Propensity score matching was performed between the LA and high-acetoacetate (HA) groups. Sex, peak creatine kinase, lactate, and blood glucose were defined as confounding factors between in-hospital MACCEs and acetoacetate, and 1:1 propensity score matching between the LA and HA groups was used, resulting in 40 patients from both groups enrolled in the analysis. There was a significantly lower incidence of in-hospital MACCEs in the HA group (LA group: 9 [22%] vs HA group: 1 [3%], P = 0.014). In conclusion, in acute myocardial infarction, elevated blood acetoacetate levels reduce the risk of MACCE.

Serum homocysteine relates to elevated lipid level, inflammation and major adverse cardiac event risk in acute myocardial infarction patients.

Aim: This study aimed to evaluate association of homocysteine (Hcy) with major adverse cardiac event (MACE) risk in acute myocardial infarction (AMI). Methods: Serum Hcy data from 196 AMI and 20 angina pectoris patients were retrieved from ahospital's electronic system. AMI patients attended a median of 21.2-month follow-up. Results: Hcy waselevated in AMI patients compared with angina pectoris patients (p=0.020). In AMI patients, Hcy was positively related to total cholesterol, low-density lipoprotein cholesterol, C-reactive protein, infarct size, TNF-α and IL-6, while inversely linked with IL-10 (all p<0.05). Hcy was independently associated with high MACE risk in AMI patients (p=0.024). Conclusion: Serum Hcy correlates with elevated lipid levels, inflammation, infarct size and MACE risk in AMI patients.

External validation of the SWEDEHEART score for predicting in-hospital major bleeding among East Asian patients with acute myocardial infarction.

Risk scores for predicting in-hospital major bleeding in patients with acute myocardial infarction (AMI) are rare. The Swedish web-system for the enhancement and development of evidence-based care in heart disease evaluated according to recommended therapies (SWEDEHEART) score (SS), consisting of five common clinical variables, is a novel model for predicting in-hospital major bleeding. External validation of SS has not yet been completed. A retrospective study recruiting consecutive East Asian patients diagnosed with AMI was conducted in the Second Affiliated Hospital, Zhejiang University. The primary endpoint was the ability of SS to predict in-hospital major bleeding, which was defined as Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding. To validate SS, the discrimination and calibration were assessed in the overall population and several subgroups. The receiver operating characteristic (ROC) curves and the areas under ROC curves (AUCs) were calculated for discrimination. The calibration of SS was evaluated with the unreliability U test. A total of 2,841 patients diagnosed with AMI during hospitalization were included, and 1.94% (55) of them experienced in-hospital major bleeding events. The AUC of SS for the whole population was only 0.60 [95% confidence interval (CI), 0.52-0.67], without an acceptable calibration (p = 0.001). Meanwhile, the highest AUC (0.72; 95% CI, 0.61-0.82) of SS for the primary endpoint was found in the diabetes subgroup, with an acceptable calibration (p = 0.87). This external validation study showed that SS failed to exhibit sufficient accuracy in predicting in-hospital major bleeding among East Asian patients with AMI despite demonstrating acceptable performance in the diabetic subgroup of patients. Studies to uncover optimal prediction tools for in-hospital major bleeding risk in AMI are urgently warranted.

Association between frailty and short- and long-term mortality in patients with critical acute myocardial infarction: Results from MIMIC-IV.

Frailty has been recognized as an important prognostic indicator in patients with acute myocardial infarction (AMI). However, no study has focused on critical AMI patients. We aimed to determine the impact of frailty on short- and long-term mortality risk in critical AMI patients. Data from the Medical Information Mart for Intensive Care (MIMIC)-IV database was used. Frailty was assessed using the Hospital Frailty Risk Score (HFRS). Outcomes were in-hospital mortality and 1-year mortality. Logistic regression and Cox proportional-hazards models were used to investigate the association between frailty and outcomes. Among 5,003 critical AMI patients, 2,176 were non-frail (43.5%), 2,355 were pre-frail (47.1%), and 472 were frail (9.4%). The in-hospital mortality rate was 13.8%, and the 1-year mortality rate was 29.5%. In our multivariable model, frailty was significantly associated with in-hospital mortality [odds ratio (OR) = 1.30, 95% confidence interval (CI): 1.20-1.41] and 1-year mortality [hazard ratio (HR) = 1.29, 95% CI: 1.24-1.35] as a continuous variable (per five-score increase). When assessed as categorical variables, pre-frailty and frailty were both associated with in-hospital mortality (OR = 2.80, 95% CI: 2.19-3.59 and OR = 2.69, 95% CI: 1.93-3.73, respectively) and 1-year mortality (HR = 2.32, 95% CI: 2.00-2.69 and HR = 2.81, 95% CI: 2.33-3.39, respectively) after adjustment for confounders. Subgroup analysis showed that frailty was only associated with in-hospital mortality in critically ill patients with non-ST-segment elevation myocardial infarction (STEMI) but not STEMI (p for interaction = 0.012). In addition, frailty was associated with 1-year mortality in both STEMI and non-STEMI patients (p for interaction = 0.447). The addition of frailty produced the incremental value over the initial model generated by baseline characteristics for both in-hospital and 1-year mortality. Frailty, as assessed by the HFRS, was associated with both in-hospital and 1-year mortality in critical AMI patients. Frailty improves the prediction of short- and long-term mortality in critical AMI patients and may have potential clinical applications.

516 Plaque Analysis Identifies Residual Inflammation In Patients With Recent Acute Myocardial Infarction: Comparison In An Asian-pacific Cohort

Introduction: Residual inflammatory risk in acute myocardial infarction (AMI) patients is associated with future cardiac events. Atheroma quantification using CT coronary angiography (CTCA) can identify non-culprit, high-risk plaque (HRP) in AMI. We compared plaque characteristics of non-culprit lesions in AMI patients with stable coronary artery disease (CAD) patients to identify markers of residual inflammatory risk.

Ceramides and Cardiovascular Risk Factors, Inflammatory Parameters and Left Ventricular Function in AMI Patients.

Background: Ceramides, biologically active lipids correlated to oxidative stress and inflammation, have been associated with adverse outcomes in acute myocardial infarction (AMI). The purpose of this study was to assess the association between ceramides/ratios included in the CERT1 score and increased cardiovascular (CV) risk, inflammatory and left ventricular function parameters in AMI. Methods: high performance liquid chromatography-tandem mass spectrometry was used to identify Cer(d18:1/16:0), Cer(d18:1/18:0), and Cer(d18:1/24:1) levels and their ratios to Cer(d18:1/24:0), in 123 AMI patients (FTGM coronary unit, Massa, Italy). Results: Cer(d18:1/16:0): higher in female patients (<0.05), in patients with dyslipidemia (<0.05), and it directly and significantly correlated with aging, brain natriuretic peptide-BNP, erythrocyte sedimentation rate-ESR and fibrinogen. Cer(d18:1/18:0): higher in females (<0.01) and patients with dyslipidemia (<0.01), and increased according to the number of CV risk factors (considering hypertension, dyslipidemia and diabetes). Moreover, it significantly correlated with BNP, troponin at admission, ESR, C reactive protein-CRP, and fibrinogen. Cer(d18:1/24:1): significantly correlated with aging, BNP, fibrinogen and neutrophils. Cer(d18:1/16:0)/Cer(d18:1/24:0): higher in female patients (<0.05), and in patients with higher wall motion score index-WMSI (>1.7; ≤0.05), and in those with multivessel disease (<0.05). Moreover, it significantly correlated with aging, BNP, CRP, ESR, neutrophil-to-lymphocyte ratio-NRL, and fibrinogen. Cer(d18:1/18:0)/Cer(d18:1/24:0): higher in female patients (<0.001), and increased according to age. Moreover, it was higher in patients with lower left ventricular ejection fraction (<35%, ≤0.01), higher WMSI (>1.7, <0.05), and in those with multivessel disease (0.13 ± 0.06 vs. 0.10 ± 0.05 µM, <0.05), and correlates with BNP, ESR, CRP, fibrinogen and neutrophils, platelets, NLR, and troponin at admission. Multiple regression analysis showed that Cer(d18:1/16:0)/Cer(d18:1/24:0) and Cer(d18:1/18:0)/Cer(d18:1/24:0) remained as independent determinants for WMSI after multivariate adjustment (Std coeff 0.17, T-value 1.9, ≤0.05; 0.21, 2.6, <0.05, respectively). Conclusion: Distinct ceramide species are associated with CV risk, inflammation and disease severity in AMI. Thus, a detailed analysis of ceramides may help to better understand CV pathobiology and suggest these new biomarkers as possible risk predictors and pharmacological targets in AMI patients.

Residual SYNTAX score in relation to culprit-plaque characteristics and cardiovascular risk in acute myocardial infarction:an optical coherence tomography study

Abstract Introduction The residual SYNTAX score (rSS) as the SYNTAX remaining after completion of percutaneous coronary intervention (PCI) was proved to be related to poor outcomes. Purpose This study aimed to investigate the association of culprit-plaque morphology with rSS and the predictive value of rSS for major adverse cardiac events (MACE) in patients with ST-segment elevation myocardial infarction (STEMI). Methods A total of 274 STEMI patients undergoing preintervention optical coherence tomography examination were included and divided into 3 groups – rSS=0 (n=72), 0&amp;lt;rss≤8&amp;gt;8 (n=68). Baseline clinical data and culprit-plaque characteristics were compared. MACE was defined as the composite of all-cause death, recurrence of myocardial infarction (MI), stroke and unplanned revascularization of any coronary artery. Results There was a significant difference in the prevalence of plaque ruptures, lipid-rich plaques, and calcification among the three groups (plaque rupture: 44.4% versus 59.0% versus 64.7%, lowest to highest rSS, p=0.04; lipid-rich plaque: 40.3% versus 54.5% versus 69.1%, lowest to highest rSS, p=0.003; calcification: 38.9% versus 52.5% versus 61.8%, lowest to highest rSS, p=0.024). Multivariate logistic regression analysis indicated that rSS&amp;gt;8 was an independent predictor for plaque rupture (OR: 2.21, 95% CI: 1.19–4.19, P=0.013). During a mean follow-up of 2.2 years, MACE occurred in 47 (17.2%) patients. In fully adjusted analyses, rSS was independently associated with MACE (HR: 1.06, 95% CI: 1.02–1.10, P=0.005); patients with rSS &amp;gt;8 had higher MACE risk compared to rSS=0 (HR: 2.68, 95% CI: 1.11–6.5, P=0.029). Conclusion In STEMI patients, culprit-plaque morphology was significantly correlated with rSS, and elevated rSS was independently associated with cardiovascular risk.&amp;lt;/rss≤8&amp;gt; Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences OCT findingsSurvival curves according to rSS

Evaluation of CHA2DS2-VASc Score as a Predictor of Platelet Reactivity in Acute Myocardial Infarction Patients Treated by Percutaneous Coronary Intervention

Background: The CHA2DS2-VASC score was evaluated as a risk stratification tool used in predicting outcomes in clinical settings other than preventing stroke in patients with atrial fibrillation (AF). But, its use in coronary artery disease patients who recently had percutaneous coronary intervention (PCI) was not thoroughly studied. Aim of work: determining the availability of using CHA2DS2-VASc score as an effective and simple platelet reactivity predictor in acute myocardial infarction (AMI) patients managed with percutaneous coronary intervention. Subjects and methods: Our prospective study included 180 consecutive acute myocardial infarction patients who were submitted to percutaneous coronary intervention and were hospitalized within twelve hours of symptoms onset. They were categorized, according to their CHA2DS2-VASc risk scores, into two groups: low-risk (0–1 score) and high-risk (2–9 score). Following PCI, using light transmittance aggregometry, platelet reactivity was determined utilizing adenosine diphosphate (ADP)-induced platelet aggregation. Results: We found a significant difference between high and low CHA2DS2-VASc score groups regarding sex, BMI, hyperlipidemia, ST-elevation, statins use, and the number of diseased vessels. As regards mean platelet ADP-induced aggregation reactivity, a significant correlation between reduced mean platelet ADP-induced aggregation reactivity and low CHA2DS2-VASc score was detected in comparison to the high score (42.53 ± 16.21 and 50.67 ± 18.1, respectively, and P = 0.002). Conclusion: The CHA2DS2VASc score may be a significant independent platelet reactivity predictor in acute myocardial infarction patients managed with PCI, and thus it can be utilized in assessing the acute stent thrombosis risk in acute myocardial infarction (AMI) patients after PCI

A combined biomarker approach for characterising extracellular matrix profiles in acute myocardial infarction

Extracellular matrix (ECM) biomarkers are useful for measuring underlying molecular activity associated with cardiac repair following acute myocardial infarction (AMI). The aim of this study was to conduct exploratory factor analysis (EFA) to examine the interrelationships between ECM biomarkers, and cluster analysis to identify if distinct ECM profiles could distinguish patient risk in AMI. Ten ECM biomarkers were measured from plasma in 140 AMI patients: MMP-2, -3, -8, -9, periostin, procollagen I N-Terminal propeptide, osteopontin, TGF-β1, TIMP-1 and -4. EFA grouped eight ECM biomarkers into a two-factor solution, which comprised three biomarkers in Factor 1 and five biomarkers in Factor 2. Notably, ECM biomarkers were not separated based on biological function. Cluster analysis grouped AMI patients into three distinct clusters. Cluster One (n = 54) had increased levels of MMP-8, MMP-9, and TGF-B1. Cluster Two (n = 43) had elevated levels of MMP-2, MMP-3, osteopontin, periostin and TIMP-1, and increased high-sensitivity troponin T and GRACE scores. Cluster Three (n = 43) had decreased levels of ECM biomarkers. Circulating ECM biomarkers demonstrated collinearity and entwined biological functions based on EFA analysis. Using cluster analysis, patients with similar clinical presentations could be separated into distinct ECM profiles that were associated with differential patient risk. Clinical significance remains to be determined.

Sex differences in heart failure hospitalisation risk following acute myocardial infarction

ObjectiveWe evaluated the sex differences in 6-month heart failure (HF) hospitalisation risk in acute myocardial infarction (AMI) survivors.MethodsFor this retrospective cohort analysis, adult survivors of an AMI between January and...

Validation of contemporary electrocardiographic indices of area at risk and infarct size in acute ST elevation myocardial infarction (STEMI)

BackgroundElectrocardiographic (ECG) methods to assess area at risk (AAR) and infarct size (IS) in patients with ST-elevation myocardial infarction (STEMI) have been previously established but not validated against contemporary benchmark Cardiac Magnetic Resonance (CMR) measures. We compared ECG-determined and CMR-determined measures for (a) AAR, (b) IS, and (c) myocardial salvage. MethodsSixty patients with ECG evidence of STEMI and CMR imaging performed within 13 days were included. The ECG-determined (a) AAR scores (Aldrich and Wilkins), (b) IS (Selvester score), and (c) myocardial salvage (i.e. [AAR-IS] / AAR × 100%), were compared with CMR-determined measures. ResultsCompared with CMR-determined AAR, both the Wilkins & Aldrich scores underestimated AAR, although the Wilkins (r = 0.72, p < 0.001) showed a better correlation than the Aldrich (r = 0.54, p < 0.001). Bland-Altman analysis revealed a bias of 2.6% (95% limits of agreement: 18.5%, −13.3%) for the Wilkins and 5.9% (95% limits of agreement: 25.6%, −13.8%) for the Aldrich. Estimation of IS was similar between the Selvester score and CMR, with good correlation (r = 0.77, p < 0.001) and agreement (fixed bias 0.4%, 95% limits of agreement 20.8%, −15.5%). However, ECG-determined myocardial salvage significantly underestimated CMR-determined myocardial salvage, with an inverse correlation (r = −0.33, p = 0.01). ConclusionsThe Wilkins score is superior to Aldrich score as an ECG-AAR index, Selvester score is a reasonable ECG estimate of infarct size, though ECG derived myocardial salvage does not have enough accuracy to be used in the clinical setting; it may be an inexpensive surrogate for myocardial salvage in large research studies. Further validation and prognostic studies are required.

The combination of nonthyroidal illness syndrome and renal dysfunction further increases mortality risk in patients with acute myocardial infarction: a prospective cohort study

BackgroundBoth nonthyroidal illness syndrome and renal dysfunction are associated with increased mortality risk in acute myocardial infarction (AMI). However, it is unclear whether combined NTIS and renal dysfunction further increase mortality risk. Therefore, our aim is to investigate whether combined NTIS and renal dysfunction further increases mortality risk in patients with acute myocardial infarction (AMI).MethodsA total of 1295 inpatients with AMI were divided into normal group (n = 692), NTIS group (n = 139), renal dysfunction group (n = 304), and combined NTIS and renal dysfunction group (n = 160). Heart function, in-hospital, all-cause and cardiovascular mortality were compared among the four groups.ResultsAfter adjustment for age and sex, left ventricular ejection fraction was significantly lower in the combined group (48 ± 11%) than in the NTIS group (52 ± 10%, P = 0.017), the renal dysfunction group (52 ± 10%, P = 0.001) and the normal group (56 ± 8%, P < 0.001). After controlling for confounding factors, compared with the normal group, the NTIS and the renal dysfunction group represented higher risks of in-hospital mortality (OR: 3.643, P = 0.028; OR:3.135, P = 0.042, respectively), all-cause mortality (HR: 2.138, P = 0.007; HR: 2.050, P = 0.003, respectively), and cardiovascular mortality (HR:2.134, P = 0.042; HR:2.237, P = 0.010, respectively). Compared to those in the NTIS and the renal dysfunction group, the patients in the combined group showed a further increased risk for in-hospital mortality (OR:2.916, P = 0.039; OR:2.487, P = 0.036, respectively), all-cause mortality (HR: 1.939, P = 0.015; HR: 2.020, P = 0.002, respectively) and cardiovascular mortality (HR:2.420, P = 0.010; HR:2.303, P = 0.002, respectively).ConclusionsBoth NTIS and renal dysfunction increase short-term in-hospital mortality, and long-term all-cause and cardiovascular mortality risk in patients with AMI. Furthermore, the coexistence of NTIS and renal dysfunction presents further increased mortality risk in AMI patients.

Area at risk and collateral circulation in a first acute myocardial infarction with occluded culprit artery. STEMI vs non-STEMI patients

BackgroundIt is unclear why among patients with first acute myocardial infarction and an occluded culprit artery only some present ST segment elevation. In fact, there is no study that compares the angiographic area at risk and the collateral circulation in first NSTEMI vs STEMI patients. Methods and results205 patients admitted for myocardial infarction with occluded culprit artery were included, 132 STEMI and 73 NSTEMI. Demographic data, the area at risk determined by the BARI score and collateral supply by the Rentrop score from the 2 groups were compared. NSTEMI patients showed lower peak Tn I than STEMI in the overall group but also in the 3 subsets with different culprit arteries (p < .001). They also presented a higher rate of left circumflex coronary artery (CFX) as culprit artery (52% vs 14%, p < .001), smaller BARI score area of the culprit artery (5.4 vs 7.6, p < .001), and higher frequency of well-developed collaterals (Rentrop score ≥ 2, 1.82 vs 0.41, p < .001). The latter was also higher in each of the 3 different culprit arteries (p = .002–<0.001) Among 38 NSTEMI patients with CFX occlusion, 20 with ≥1 mm ST depression in V2 to V4 (possible posterior infarction) showed a similar Rentrop score than the 18 with other ECG changes but lower Tn I peak (p = .012). ConclusionsIn first acute myocardial infarction with an occluded culprit artery NSTEMI patients – including those with possible posterior infarction – present smaller infarct size and higher collateral blood supply than STEMI patients in each of the 3 main culprit arteries.

Identification of a single nucleotide polymorphism indicative of high risk in acute myocardial infarction.

Background & objectives:Acute myocardial infarction (AMI) is a major health concern in India. The aim of the study was to identify single nucleotide polymorphisms (SNPs) associated with AMI in patients using dedicated chip and validating the identified SNPs on custom-designed chips using high-throughput microarray analysis.Methods:In pilot phase, 48 AMI patients and 48 healthy controls were screened for SNPs using human CVD55K BeadChip with 48,472 SNP probes on Illumina high-throughput microarray platform. The identified SNPs were validated by genotyping additional 160 patients and 179 controls using custom-made Illumina VeraCode GoldenGate Genotyping Assay. Analysis was carried out using PLINK software.Results:From the pilot phase, 98 SNPs present on 94 genes were identified with increased risk of AMI (odds ratio of 1.84-8.85, P=0.04861-0.003337). Five of these SNPs demonstrated association with AMI in the validation phase (P<0.05). Among these, one SNP rs9978223 on interferon gamma receptor 2 [IFNGR2, interferon (IFN)-gamma transducer 1] gene showed a significant association (P=0.00021) with AMI below Bonferroni corrected P value (P=0.00061). IFNGR2 is the second subunit of the receptor for IFN-gamma, an important cytokine in inflammatory reactions.Interpretation & conclusions:The study identified an SNP rs9978223 on IFNGR2 gene, associated with increased risk in AMI patient from India.

Experimental validation of contrast-enhanced SSFP cine CMR for quantification of myocardium at risk in acute myocardial infarction

BackgroundAccurate assessment of myocardium at risk (MaR) after acute myocardial infarction (AMI) is necessary when assessing myocardial salvage. Contrast-enhanced steady-state free precession (CE-SSFP) is a recently developed cardiovascular magnetic resonance (CMR) method for assessment of MaR up to 1 week after AMI. Our aim was to validate CE-SSFP for determination of MaR in an experimental porcine model using myocardial perfusion single-photon emission computed tomography (MPS) as a reference standard and to test the stability of MaR-quantification over time after injecting gadolinium-based contrast.MethodsEleven pigs were subjected to either 35 or 40 min occlusion of the left anterior descending artery followed by six hours of reperfusion. A technetium-based perfusion tracer was administered intravenously ten minutes before reperfusion. In-vivo and ex-vivo CE-SSFP CMR was performed followed by ex-vivo MPS imaging. MaR was expressed as % of left ventricular mass (LVM).ResultsThere was good agreement between MaR by ex-vivo CMR and MaR by MPS (bias: 1 ± 3% LVM, r2 = 0.92, p < 0.001), between ex-vivo and in-vivo CMR (bias 0 ± 2% LVM, r2 = 0.94, p < 0.001) and between in-vivo CMR and MPS (bias -2 ± 3% LVM, r2 = 0.87, p < 0.001. No change in MaR was seen over the first 30 min after contrast injection (p = 0.95).ConclusionsContrast-enhanced SSFP cine CMR can be used to measure MaR, both in vivo and ex vivo, in a porcine model with good accuracy and precision over the first 30 min after contrast injection. This offers the option to use the less complex ex-vivo imaging when determining myocardial salvage in experimental studies.

Lower myocardial perfusion in borderzones in the area at risk than out of the area at risk in acute myocardial infarction

Background Myocardial infarction (MI) leads to heart failure in a substantial number of patients. Investigation of perfusion in the infarct-adjacent segments can offer better insights into left ventricular remodeling. It is the aim of this study to compare myocardial blood flow (MBF) with cardiac magnetic resonance (CMR) in the infarct borderzones (BZ) and the remote myocardium (RM) in a large patient population in the acute phase of MI.