Risk Of Acute Myocardial Infarction Research Articles

A novel circulating biomarker lnc-MALAT1 for acute myocardial infarction: Its relationship with disease risk, features, cytokines, and major adverse cardiovascular events.

Long noncoding RNA MALAT1 (lnc-MALAT1) modulates atherosclerotic progression, myocardial ischemia injury, and systematic inflammation, which may be closely involved in acute myocardial infarction (AMI) pathogenesis. Thus, the current study intended to explore the relationship of lnc-MALAT1 to disease risk, features, cytokines, and prognostication in AMI patients. This multicenter study consecutively enrolled 160 newly diagnosed AMI patients and 50 controls (angina pectoris patients). Their peripheral blood mononuclear cells were obtained to measure lnc-MALAT1 by RT-qPCR. Serum cytokines in AMI patients were detected by ELISA. In addition, AMI patients were followed up for major adverse cardiovascular event (MACE) risk evaluation. Lnc-MALAT1 was higher in AMI patients than in controls (median: 2.245 vs. 0.996, p=0.004), and it also presented a good capacity for differentiating AMI patients from controls with an area under the curve of 0.823. Lnc-MALAT1 was positively related to C-reactive protein (p=0.005), low-density lipoprotein cholesterol (p=0.022), cardiac troponin I (p=0.021), and infarct size (p=0.007), but not other biochemical indexes in AMI patients. Meanwhile, lnc-MALAT1 was positively associated with tumor necrosis factor-alpha (p=0.001), interleukin (IL)-6 (p=0.031), IL-17A (p=0.042), vascular cell adhesion molecule-1 (p=0.004), and intercellular adhesion molecule-1 (p=0.021) among AMI patients. Importantly, after categorization, lnc-MALAT1 high (vs. low) was related to an elevated MACE accumulation rate (p=0.035); furthermore, a higher lnc-MALAT1 quartile showed a trend to be linked with an increased MACE accumulation rate (p=0.092). Lnc-MALAT1 may serve as a biomarker for AMI risk, infarct size, inflammation and prognosis, but further validation by large-scale studies is needed.

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

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

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

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

Abstract 11755: Burden and Impact of Prediabetes on the Risk of Acute Myocardial Infarction and Subsequent Adverse Cardiovascular Outcomes in Smokers: A National Inpatient Sample Analysis, 2019

Background: The burden of prediabetes (pDM) in smokers remains unknown. We aimed to analyze the burden and impact of prediabetes on AMI [Type 1/Type 2] hospitalizations in smokers and outcomes using a nationally representative sample. Methods: We queried the National Inpatient Sample (2019) to identify AMI-related hospitalizations in adult non-diabetic smokers with vs without pDM using ICD-10 codes. Demographics, comorbidities, and outcomes including major cardiovascular and cerebrovascular adverse events (MACCE) were compared between two cohorts. Results: Overall prevalence of pDM in hospitalized non-diabetic smokers in 2019 was 1.2% (46770/3880640). AMI cohort with pDM often had males (59.4% vs 54.6%), blacks (23 vs 17.7%), Hispanics (8.7 vs 6.4%), Asian/Pacific Islanders (2.7 vs 1%), patients from higher-income quartile (16.4 vs 12.6%), and higher rates of modifiable CVD risk factors. Adjusted multivariable analysis revealed higher risk of overall (aOR 1.73 [1.60-1.88]), T1MI (1.86 [1.70-2.03]) and T2MI (OR 1.39 [1.16-1.67]). The risk of overall AMI was 1.73 times higher in patients with vs. without prediabetes, which was comparable in male (aOR 1.73) and female (aOR 1.72) smokers, however, female smokers with prediabetes had higher T2MI risk (aOR F:1.55, M:1.30) vs. males. Black smokers with prediabetes have the highest risk of overall (aOR 1.85), T1MI (aOR 2.03) and T2MI (aOR 1.77). Among Hispanics, prediabetes increased the risk of overall (aOR 1.69) and T1MI (aOR 1.92) but not T2MI. Prediabetes increased the risk of T1MI (aOR 1.74) in Asians without any association with overall or T2MI [Table 1]. Conclusions: Prediabetes independently increased the risk of overall AMI/T1MI/T2MI-related hospitalizations in non-diabetic smokers. Black smokers with prediabetes had the highest risk of AMI, T1MI and T2MI, and females had a higher risk of T2MI. This highlights the need for a tailored management of CVD risk by sex and race among smokers with prediabetes. .

Abstract 11840: A Meta-Analysis of the Long-Term Outcomes of Acute Myocardial Infarction in Preexisting Coronary Artery Ectasia

Introduction: Coronary artery ectasia is associated with an increased risk of acute myocardial infarction. Hypothesis: This meta-analysis evaluates outcomes following acute myocardial infarction in patients with preexisting coronary artery ectasia. Methods: This meta-analysis was conducted according to PRISMA guidelines. A search strategy was designed to utilize PubMed/Medline, EMBASE, and Google scholar for studies showing the outcomes of acute myocardial infarction in patients with coronary artery ectasia from inception to February 10, 2022. We reported effect sizes as odds ratio (OR) with a 95% confidence interval (CI). We used I 2 statistics to estimate the extent of unexplained statistical heterogeneity: I 2 greater than 50% was considered a high degree of between-study statistical heterogeneity. Results: Of 217 studies initially identified, 7 studies comprising 13499 patients were included in the final analysis. There was no significant difference between patients with coronary ectasia and patients without coronary ectasia in terms of all-cause mortality (OR 0.95; 95% CI 0.58 to 1.56; p = 0.79; I 2 =0%) , MACE (OR 4.04; 95% CI 0.34 to 47.57; p = 0.17; I 2 =95%), myocardial reinfarction (OR 2.13; 95% CI 0.83 to 5.47; p = 0.08; I 2 =59%), target vessel revascularization (OR 1.31; 95% CI 0.69 to 2.48; p = 0.21; I 2 =0%), or requiring mechanical supportive devices (OR 1.32; 95% CI 0.22 to 7.83; p = 0.57; I 2 =56%). (Figures 2-A, B, C, D) Conclusions: Acute myocardial infarction in the presence of coronary artery ectasia is not linked to an increased risk of death, major cardiovascular events, myocardial infarction, or the need for mechanical circulatory support.

Abstract 11659: Comparing Rates of Acute Myocardial Infarction Between Cancer Therapies in Patients With Non-Small Cell Lung Cancer

Introduction: The prevalence of cardiovascular disease (CVD) has increased in patients with cancer, contributing significantly to mortality among cancer survivors. Cardiotoxicity of anti-cancer drugs may play a role in the development of CVD among cancer survivors, including incidence of acute myocardial infarction (AMI). We analyzed AMI rates in patients with non-small cell lung cancer (NSCLC) treated with one of four cancer regimens. Methods: We used national data from the Veterans Affairs (VA) Corporate Data Warehouse and VA Cancer Registry. We identified 9,619 veterans diagnosed with NSCLC during 2015-2019 who initiated one of four oncological therapies: chemotherapy, immune checkpoint inhibitors (ICI) with chemotherapy, ICI monotherapy, or tyrosine kinase inhibitors monotherapy (TKI). Patients were categorized according to the first therapy received. We identified subsequent hospitalizations for AMI within two years of initiating the oncological treatment. We estimated AMI rates per 100 patient-years and risk adjusted relative hazard ratio (HR) of AMI by treatment type using Cox Regression Model to adjust for age, AMI history, comorbidities, malignancy stage, and histology. Results: Among 9,618 veterans identified, 5,510 (57.3%) initiated treatment with chemotherapy, 2,820 (29.3%) ICI with chemotherapy, 829 (8.6%) with ICI monotherapy, and 459 (4.8%) with TKI. Over a follow-up period of 2 years, 158 (1.6%) patients experienced an AMI and 5,917 (61.5%) died. The incidence of AMI per 100 patient-years (95% CI) was as follows; chemotherapy 0.86 (0.70-1.06), ICI with chemotherapy 0.77 (0.58-1.03), ICI monotherapy 0.91 (0.52-1.60), and TKI 0.43 (0.16-1.15). When compared to chemotherapy alone, adjusted HR (95% CI) for ICI with chemotherapy, ICI monotherapy, and TKI were 1.09 (0.91-1.31), 1.02 (0.75-1.38), and 1.50 (0.94-2.37), respectively. When compared to TKI or ICI with chemotherapy, the ICI monotherapy cohort did not have a statistically significant adjusted HR for AMI risk. Conclusion: Among Veterans with NSCLC, the incidence of AMI was low and there was no difference in risk between the initial oncological regimens. The high competing risk of mortality in our cohort may also have contributed to the lack of between-group differences.

A post-marketing safety assessment of COVID-19 mRNA vaccination for serious adverse outcomes using administrative claims data linked with vaccination registry in a city of Japan

IntroductionThe safety profiles of COVID-19 vaccines are incompletely evaluated in Japan. ObjectivesTo examine the risk of serious adverse effects after COVID-19 mRNA vaccination (BNT162b2 and mRNA-1273) in cohort studies and self-controlled case series (SCCS). MethodsUsing an administrative claims database linked with the COVID-19 vaccination registry in a city in Japan between September 2020 and September 2021, we identified health insurance enrolees aged ≥ 18 years. We evaluated the risk of acute myocardial infarction, appendicitis, Bell’s palsy, convulsions/seizures, disseminated intravascular coagulation, immune thrombocytopenia, pulmonary embolism, haemorrhagic or ischemic stroke, venous thromboembolism, and all-cause mortality, 21 days following any COVID-19 mRNA vaccination, compared with non-vaccination periods. For the cohort studies, we estimated incidence rate ratios (IRRs) by Poisson regression and rate differences (IRDs) by weighted least-squares regression, adjusting for sex, age, and Charlson comorbidity index. We applied a modified SCCS design to appropriately treat outcome-dependent exposures. For the modified SCCS, we estimated within-subject IRRs by weighted conditional Poisson regression. Subgroup analyses stratified by sex and age were also conducted. ResultsWe identified 184,491 enrolees [male: 87,218; mean (standard deviation) age: 64.2 (19.5) years] with 136,667 first and 127,322 s dose vaccinations. The risks of any outcomes did not increase in any analyses, except for the fact that the modified SCCS indicated an increased risk of pulmonary embolism after the first dose in women (within-subject IRR [95%CI]: 3.97 [1.18–13.32]). ConclusionThe findings suggested that the COVID-19 mRNA vaccine was generally safe, whilst a signal of pulmonary embolism following the first dose of the COVID-19 mRNA vaccine was observed.

The Differential Systemic Biological Effects between Computer Navigation and Conventional Total Knee Arthroplasty (TKA) Surgeries: A Prospective Study

Distal femur reaming-free total knee arthroplasty (TKA) was reported to possess lower risk of acute myocardial infarction (AMI) or venous thromboembolism (VTE) than conventional TKA in a retrospective population-based study. We tried to offer prospective biological evidence by comparing the levels of AMI and VTE serum surrogate markers among the patients undertaking navigation and conventional TKAs to support these observations. Thirty-four participants undertaking navigation TKA and 34 patients receiving conventional TKA were recruited between February 2013 and December 2015. Blood samples were drawn from all participants before TKA, and 24 and 72 h after TKA, to assess the concentration of soluble P-selectin, matrix metalloproteinase-9 (MMP-9), C-reactive protein (CRP), and interleukin-8 (IL-8) between the participants undergoing navigation and conventional TKAs. We showed that significantly lower serum levels of soluble P-selectin 24 h after, as well as CRP 24 and 72 h after TKA could be observed in the navigation cohort. The more prominent surge of serum soluble P-selectin and CRP were perceived 24 and 72 h after TKA among the participants undergoing conventional TKA. Based upon our prospective biological evidence, the merits of navigation TKA are strengthened by lower levels of AMI and VTE serum surrogate markers.

Serum biomarkers, including nitric oxide metabolites (NOx), for prognosis of cardiovascular death and acute myocardial infarction in an ESSE-RF case–control cohort with 6.5-year follow up

The present case–control study aimed to assess associations of routine and experimental biomarkers with risk for cardiovascular death and acute myocardial infarction (AMI) in a cohort recruited from the multicenter study “Cardiovascular Epidemiology in Russian Federation” (ESSE-RF) to identify experimental biomarkers potentially suitable for expanded evaluation. A total of 222 subjects included cardiovascular death (N = 48) and AMI cases (N = 63) during 6.5-year follow up and matched healthy controls. Seven routine and eight experimental biomarkers were assayed to analyze associations with outcomes using logistic and Cox proportional hazard regressions. Elevated levels of cardiac troponin I (cTnI), C-reactive protein (CRP), and nitric oxide metabolites (NOx) were independently associated (P < 0.001) with higher risk of cardiovascular death (estimated hazard ratio (eHR) = 1.83–3.74). Elevated levels of NOx and cTnI were independently (P < 0.001) associated with higher risk of nonfatal AMI (eHRs = 1.78–2.67). Elevated levels of angiopoietin-like protein 3 (ANGPTL3) were independently associated (P < 0.001) with lower risk of cardiovascular death (eHRs 0.09–0.16) and higher risk of nonfatal AMI (eHR = 2.07; P = 0.01). These results indicated that subsequent expanded validation should focus on predictive impact of cTnI, NOx, CRP, and ANGPTL3 to develop nationwide recommendations for individual stratification of patients with cardiovascular risks.

Correlation Between Low THBS3 Expression in Peripheral Blood and Acute Myocardial Infarction.

Thrombospondin (THBS) 3 is an adhesive glycoprotein involved in cell-cell and cell-matrix interactions. The purpose of this study is to determine whether THBS3 expression in peripheral blood can be used as a biomarker to predict the risk of acute myocardial infarction (AMI). The peripheral blood of 111 patients with stable coronary artery disease (SCAD) and 112 patients with AMI was obtained. The experimental and the control cohorts were the AMI and SCAD groups, respectively. The expression of THBS3 mRNA and protein in both groups was determined using reverse-transcription polymerase chain reaction and enzyme-linked immunosorbent assay. THBS3 expression (range) in the peripheral plasma of patients in the AMI group was lower than that of patients in the SCAD group (4.526 (3.748-5.521), 5.511 (4.726-6.334), respectively), which was 0.82 times lower than the control (p < 0.001). Furthermore, THBS3 mRNA level in the peripheral blood mononuclear cells of patients with AMI was 0.47 times lower than that in patients with SCAD (p < 0.05). AMI was associated with fasting blood glucose levels, platelet counts and low THBS3 expression. Logistic regression analysis revealed that decreased expression of THBS3 protein increased the probability of AMI by 4.076 times (p < 0.01). Additionally, high fasting blood glucose and high platelet counts increased the risk of AMI by 2.819 and 6.515 times, respectively (p < 0.05). THBS3 mRNA and protein levels in the peripheral blood of patients in the AMI group were much lower compared with those of patients in the SCAD group. Low THBS3 expression in peripheral blood was related to AMI and was an independent risk factor for AMI. Thus, low THBS3 expression in peripheral blood may be a novel, suitable molecular marker for the early detection of AMI.

Impact of intravascular ultrasound in acute myocardial infarction patients at high ischemic risk

Introduction and objectivesEvidence for the role of intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) in patients at high ischemic risk of acute myocardial infarction (AMI) is lacking. This study aimed to investigate the long-term clinical impact of IVUS-guided PCI in patients at high ischemic risk of AMI. MethodsAmong 13 104 patients with AMI enrolled in the Korea Acute Myocardial Infarction Registry-National Institutes of Health, we selected 8890 patients who underwent successful PCI with second-generation drug-eluting stent implantation and classified them into 2 groups based on whether or not they were at high ischemic risk or not, defined as any of the following: number of stents implanted ≥ 3, 3 vessels treated, ≥ 3 lesions treated, total stent length> 60mm, left main PCI, diabetes mellitus, and chronic kidney disease. The primary outcome was target lesion failure including cardiac death, target vessel myocardial infarction, and ischemia-driven target lesion revascularization at 3 years. ResultsIn 4070 AMI patients at high ischemic risk, IVUS-guided PCI (21.6%) was associated with a significantly lower risk of target lesion failure at 3 years (6.7% vs 12.0%; HR, 0.54; 95%CI, 0.41-0.72; P <.001) than angiography-guided PCI. The results were consistent after confounder adjustment, inversed probability weighting, and propensity score matching. ConclusionsIn patients at high ischemic risk of AMI who underwent PCI with second-generation drug-eluting stent implantation, use of IVUS guidance was associated with a significant reduction in 3-year target lesion failure.iCreaT study No. C110016.

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

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

The Association of Acute Myocardial Infarction with Pyogenic Spondylitis in Korea: A Nationwide Longitudinal Cohort Study

Objective: The goal of this nationally matched longitudinal study was to investigate the relationship between acute myocardial infarction (AMI) and pyogenic spondylitis (PS) in Korea.Methods: We collected patient data from the National Health Insurance Service Health Screening cohort from January 1, 2004 to December 31, 2015. PS was classified using the International Classification of Diseases codes M46.2 (osteomyelitis), M46.8 (inflammatory spondylopathy), M49.2 (enterobacterial spondylitis), and M49.3 (enterobacterial spondylitis) (spondylopathy in other infectious and parasitic diseases). The PS group had a total of 628 patients. The control group included 3,140 people. Utilizing the Kaplan-Meier technique, the groups’ AMI rates were estimated. A Cox proportional-hazards regression analysis was used to compute the hazard ratio for AMI.Results: After controlling for age and sex, the hazard ratio for AMI in the PS group was 2.241 (95% confidence interval [CI], 1.112-4.516). The adjusted hazard ratio in the PS group was 2.138 after controlling for demographics and concomitant medical conditions (95% CI, 1.056-4.318). In a subgroup analysis, the AMI percentages were substantially greater in the PS group in women over 65, those with diabetes, and in non-hypertension and non-dyslipidemia subgroups. Conclusion: This nationwide longitudinal study found that PS patients had an elevated risk of AMI.

Prior Cancer Is Associated with Lower Atherosclerotic Cardiovascular Disease Risk at First Acute Myocardial Infarction.

Patients with cancer are at increased risk of acute myocardial infarction (AMI). It is unclear if the Atherosclerotic Cardiovascular Disease (ASCVD) risk score at incident AMI is reflective of this higher risk in patients with prior cancer than those without. We linked nationwide AMI and cancer registries from 2008 to 2019. A total of 18,200 eligible patients with ASCVD risk score calculated at incident AMI were identified (1086 prior cancer; 17,114 no cancer). At incident AMI, age-standardized mean ASCVD risk was lower in the prior cancer group (18.6%) than no cancer group (20.9%) (p &lt; 0.001). Prior to incident AMI, smoking, hypertension, hyperlipidemia and diabetes mellitus were better controlled in the prior cancer group. However post-AMI, prior cancer was associated with lower guideline-directed medical therapy usage and higher all-cause mortality (adjusted hazard ratio 1.85, 95% confidence interval 1.66-2.07). AMI occurred despite better control of cardiovascular risk factors and lower age-standardized estimated mean 10-year ASCVD risk among patients with prior cancer than no cancer. Prior cancer was associated with lower guideline-directed medical therapy post-AMI and higher mortality.

Brátt hjartadrep meðal yngri einstaklinga: rannsókn á nýgengi, áhættuþáttum og horfum

INTRODUCTION: The incidence of acute myocardial infarction (AMI) might not be decreasing as much among young adults as in the general population in recent years. The goal of our study was to explore incidence, risk factors and prognosis of AMI among young patients in Iceland. MATERIAL AND METHODS: This was a retrospective case control study. The data was obtained from the SCAAR-SWEDEHEART database, medical records from Landspitali University Hospital and the death register from the Directorate of Health. The epidemiology of women ≤55 years and men ≤50 years diagnosed with AMI (STEMI/NSTEMI) in Iceland in 2014-2020 was compared with older patients. RESULTS: Of all the cases (2852), 344 patients (12%) were young. No change was demonstrated in the incidence of AMI in the young patients during the study period. The proportion of STEMI was higher among young patients (52% vs. 35%, p&lt;0.001). Smoking (50% vs. 26%, p&lt;0.001) and obesity (BMI&gt;30 kg/m2)(47% vs. 36%, p&lt;0.01) were more prevalent in younger patiens compared to the older. Older patients were more likely to die in the year following the AMI, both from all-cause (7% vs. 3%, p&lt;0.05) and cardiovascular mortality (7% vs. 3%, p&lt;0.05). A difference in recurrent AMI between the young and older patients was not demonstrated (2% vs. 3%, p=0.3). CONCLUSION: During the research period, a change in the incidence of AMI among young patients, was not demonstrated. Younger patients with AMI have different risk factors than older patients, they have lower mortality rate but the same risk of recurrent AMI.

Stroke-heart syndrome: sex-specific incidence, risk factors, and major adverse cardiovascular events in 486,515 patients with incident ischaemic stroke

Abstract Background Newly diagnosed cardiovascular complications post-stroke, termed stroke-heart syndrome, are common and associate with worsened prognosis. Purpose To investigate the sex-specific incidence and 5-year major adverse cardiovascular events following stroke-heart syndrome, stratified by pre-existing risk factors (sex, age, obesity, hypertension, type 2 diabetes mellitus, and high LDL cholesterol). Methods A retrospective cohort study was conducted using anonymised electronic medical records from 56 participating healthcare organizations. Patients with incident ischaemic stroke aged ≥18 years with 5-years of follow-up were included. Patients diagnosed with new-onset cardiovascular complications (heart failure, severe ventricular arrhythmia, atrial fibrillation, ischaemic heart disease, takotsubo syndrome) within 4-weeks of incident ischaemic stroke (exposure) were 1:1 propensity score-matched (age, sex, ethnicity, comorbidities, cardiovascular care) with ischaemic stroke patients without newly diagnosed cardiovascular complications (control). Cox proportional hazards regression models produced hazard ratios (HR) with 95% confidence intervals (CIs) and Kaplan-Meier curves for 5-year risk of all-cause mortality, recurrent stroke, and acute myocardial infarction (AMI). Results Of 486,515 patients with ischaemic stroke, 18% (n=87,786) presented with stroke-heart syndrome (47% (n=41,088) female and 52% (n=45,891) male). Following propensity score matching, composite stroke-heart syndrome associated with significantly higher risk of 5-year mortality (HR 1.66 (95% CI 1.62,1.70), P&amp;lt;0.01), recurrent stroke (1.26 (1.24,1.28), P&amp;lt;0.01), and AMI (2.58 (2.50,2.67), P&amp;lt;0.01). These outcomes were similar for both males and females (Figure 1). The risk of mortality, recurrent stroke and AMI following stroke-heart syndrome was relatively higher for patients aged &amp;lt;75 compared to those &amp;gt;75. The risk of all adverse outcomes were relatively higher for females aged &amp;lt;75 compared to males aged &amp;lt;75. Pre-existing obesity associated with a lower risk of mortality for females and males, but a higher risk of recurrent stroke for females. Pre-existing hypertension associated with a lower risk of all outcomes, except recurrent stroke in males. Pre-existing diabetes associated with higher risks for mortality and AMI for both females and males. High LDL cholesterol associated with lower risk of mortality but a higher risk of recurrent stroke and AMI in males and females (Figure 1). Conclusions In this cohort study of patients with incident ischaemic stroke, stroke-heart syndrome occurred in 18% of patients. The overall incidence and subsequent 5-year major adverse cardiovascular events following stroke-heart syndrome were similar for females and males, but with important sex-specific differences when stratified by pre-existing risk factors, including age, obesity, and hypertension. Funding Acknowledgement Type of funding sources: None.

Elevated levels of Lp(a) are associated with coronary lesion complexity in patients hospitalized for an acute myocardial infarction: data from the French RICO Survey

Abstract Background Although patients with elevated Lp(a) are at high risk of acute myocardial infarction (MI), coronary artery disease (CAD) burden associated with Lp(a) remains poorly investigated. Methods Single center study including all consecutive patients hospitalized for an acute MI in Coronary Care Unit from the RICO database (2019–2021) who underwent coronary angiography and blood sample for Lp(a) assessment on admission. Coronary lesion complexity was retrospectively assessed by SYNTAX score and pre-specified angiographic criteria. Patients were compared according to their Lp(a) levels: &amp;lt;50 mg/dL (normal), ≥50 mg/dL and ≤100 mg/dL (high) and &amp;gt;100 mg/dL (very high). Results 921 patients were included, of whom 177 (19.2%) had elevated Lp(a) &amp;gt;50 mg/dL, including 121 (13.1%) with high and 56 (6.1%) with very high Lp(a). Median (IQR) age was similar across the 3 groups (normal: 68 (58–78)y; high: 70 (60–80)y; very high: 69 (61–78)y, p=0.381). When compared with patients with normal Lp(a), patients with high and very high Lp(a) levels had increased prevalence of personal history of CAD (19%, 28% and 29%, respectively, p=0.026) and family history of CAD (19%, 26% and 29%, p=0.032, respectively). The rate of women was more common in very high Lp(a) level than in high and normal groups (46%, 33%, and 29%, respectively, p=0.016). Rate of ST-segment elevation MI was similar for the 3 groups (p=0.961). At coronary angiography, CAD burden, as assessed by SYNTAX score was much higher in elevated Lp(a) groups (11 (6–19), 15 (8–24), 17 (7–25), p=0.001, respectively). Moreover, patients with elevated Lp(a) had more complex coronary lesions (p=0.034), characterized by left main (p=0.021), and calcified lesions (p=0.002) (figure). In-hospital mortality gradually increased across the 3 groups (2.8%, 6.6%, 8.9%, p=0.010, respectively). Conclusions This retrospective study in patients with acute MI shows that elevated Lp(a) were common, associated with high risk for in-hospital mortality. Patients with high Lp(a) were characterized by severe CAD burden, with complex anatomy features including left main and calcified lesions. The long-term prognostic impact of Lp(a)-associated CAD burden needs to be explored. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): ARS Bourgogne Franche ComtéCHU Dijon BourgogneAssociation de Cardiologie de Bourgogne

Risk of acute myocardial infarction, stroke and thromboembolism following COVID-19 vaccination compared to testing positive for COVID-19 infection: a nationwide cohort study of 4.6 mio individuals

Abstract Background Large randomized controlled trials (RCT) have shown that COVID-19 vaccines are effective at preventing severe COVID-19. However, the RCT's are not powered to detect rare adverse events. It has been reported that the new mRNA based COVID-19 vaccines may increase the risk of thromboembolic and ischemic events. Likewise, thromboembolic and ischemic events are also known complications to infection with SARS-CoV-19. Currently, less is known about the risk-reward relationship of receiving an mRNA-based COVID-19 vaccine versus contracting COVID-19 infection with respect to thromboembolic and ischemic outcomes. Purpose To compare the risk of thromboembolic and ischemic events following COVID-19 vaccination to the risk following infection with SARS-CoV-19. Methods The study period was from March 2020 to August 2021. All individuals were &amp;gt;18 years old. The population was stratified into two different groups. The vaccinated group consisted of recipients of the first dose of either Moderna (mRNA-1273, n=488,220) or Pfizer-BioNTech (BNT162b2 mRNA, n=3,186,164) vaccines. Individuals who had previously tested positive for SARS-CoV-19 were excluded. The other group consisted of individuals who had tested positive for SARS-CoV-19 in the same period who had not yet received their first vaccination dose (n=233,926). The exposure period for both groups was set to 28 days following vaccination/testing positive for SARS-CoV-19 (Figure 1). Patient level data were obtained on all included individuals using nationwide registries. Primary outcomes were acute myocardial infarction (AMI), ischemic stroke, pulmonary embolism (PE), and deep venous thrombosis (DVT). Odds ratios were obtained from logistic regression models with the vaccinated group acting as reference. Multivariable models were adjusted for demographics and comorbidities. Results In the vaccinated group, mean age was 53±19 years and 50.3% were female. In the group of participants testing positive for SARS-CoV-19, mean age was 42.1±17.4 years and 50.2% were female. In total, 773 suffered a stroke, 472 suffered a PE, 500 suffered an AMI, and 484 suffered a DVT during the 28-day exposure period. We observed an increased absolute risk of all outcomes for participants testing positive for SARS-CoV-19 as compared to participants being vaccinated (stroke: 0.049% vs 0.019%, p&amp;lt;0.001), (PE: 0.91% vs 0.0072%, p&amp;lt;0.001), (AMI: 0.021 vs 0.013, p=0.0004), and (DVT: 0.037% vs 0.011%, p&amp;lt;0.001). In multivariable models, participants testing positive for SARS-CoV-19 had a significantly increased risk of all outcomes compared to participants being vaccinated: (stroke: OR: 4.0, 95% CI: [2.9–5.6], p&amp;lt;0.001), (PE: OR: 38.6 95% CI: [30.3–48.5], p&amp;lt;0.001), (AMI: OR: 3.3, 95% CI: [2.1–5.00], p&amp;lt;0.001), and (DVT: OR: 5.3, 95% CI: [3.8–7.5], p&amp;lt;0.001) (Figure 2). Conclusion The risks of thromboembolic and ischemic events were substantially higher after SARS-CoV-19 infection than after vaccination in the Danish population. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Gentofte University Hospital

The effect of vitamin K2 supplementation on coronary artery disease in a randomized multicenter trial

Abstract Background Coronary artery calcification (CAC) and especially progression in CAC is a strong predictor of acute myocardial infarction (AMI) and cardiovascular mortality [1]. Observational studies suggest a protective role of vitamin K2 in the development of CAC [2]. Measurement of CAC score in Agatston Units (AU) is common practice, while novel software as AutoPlaque introduces new opportunities to measure coronary plaques [3]. Purpose The aim of this double-blinded randomized multicenter trial is to investigate if vitamin K2 supplementation can reduce the progression of CAC in a population without known coronary disease. Methods AVADEC is a multicenter trial investigating 389 participants randomized to vitamin K2 (720 μg/day) and vitamin D (25 μg/day) versus placebo with a 2-year follow-up from 2018–2019 [4]. The primary endpoint of AVADEC is change in aortic valve calcification. In this substudy, we examined the progression of CAC in participants with no prior coronary disease (no myocardial infarction and/or revascularization) at baseline. Secondary, the change in CAC was evaluated in two prespecified subgroups (low-risk: CAC score &amp;lt;400 AU and high-risk: CAC ≥400 AU at baseline). Non-contrast CT-scans were performed at baseline, 12 and 24 months of follow-up. Contrast CT-scans were performed at baseline and 24 months. CAC score was measured with established software and expressed in Agatston Units (AU). On contrast CT-scans, quantitative coronary plaque composition evaluations were performed by using Autoplaque. Moreover, events (AMI, revascularization and all cause death) were assessed. Results 304 participants (male, mean age 71 years) with no prior coronary disease were identified. The intervention and placebo groups were similar in all traditional cardiovascular risk factors except familial predisposition for cardiovascular disease (14.4% vs. 6.7%, p=0.046). We found progression of CAC in both the intervention and placebo group from baseline to 24 month follow-up (203 AU vs. 254 AU, p=0.089) (Figure 1). The patients with CAC score &amp;lt;400 AU at baseline were equal in progression (77 AU vs. 81 AU, p=0.846). In patients with CAC score ≥400, the progression of CAC was significantly lower in the intervention group (288 AU vs. 380 AU, p=0.047). Yet, preliminary analyses of contrast CT-scans in 180 participants showed no difference in the progression of non-calcified plaque volume (10 mm3 vs. 37 mm3, p=0.276). In addition, the number of events was significantly lower in participants receiving vitamin K2 and D (1.9% vs. 6.7%, p=0.048). Conclusion Patients with no prior coronary disease randomized to vitamin K2 supplementation had a non-significant reduction in CAC development over a 2-year follow-up period. High-risk patients with CAC ≥400 AU had a significantly lower progression of CAC. Additionally, vitamin K2 supplementation significantly reduced the risk of AMI, revascularization and all-cause death. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Danish Cardiovascular Academy (2/3) and the Region of Southern Denmark (1/3).

Acute myocardial infarction in young adults: incidence, risk factors and prognosis

The incidence of acute myocardial infarction (AMI) might not be decreasing as much among young adults as in the general population in recent years. The goal of our study was to explore incidence, risk factors and prognosis of AMI among young patients in Iceland. This was a retrospective case control study. The data was obtained from the SCAAR-SWEDEHEART database, medical records from Landspitali University Hospital and the death register from the Directorate of Health. The epidemiology of women ≤55 years and men ≤50 years diagnosed with AMI (STEMI/NSTEMI) in Iceland in 2014-2020 was compared with older patients. Of all the cases (2852), 344 patients (12%) were young. No change was demonstrated in the incidence of AMI in the young patients during the study period. The proportion of STEMI was higher among young patients (52% vs. 35%, p<0.001). Smoking (50% vs. 26%, p<0.001) and obesity (BMI>30 kg/m2)(47% vs. 36%, p<0.01) were more prevalent in younger patiens compared to the older. Older patients were more likely to die in the year following the AMI, both from all-cause (7% vs. 3%, p<0.05) and cardiovascular mortality (7% vs. 3%, p<0.05). A difference in recurrent AMI between the young and older patients was not demonstrated (2% vs. 3%, p=0.3). During the research period, a change in the incidence of AMI among young patients, was not demonstrated. Younger patients with AMI have different risk factors than older patients, they have lower mortality rate but the same risk of recurrent AMI.