ST-elevation Myocardial Infarction Group Research Articles

The Role of Triglyceride/HDL Ratio, Triglyceride-Glucose Index, and Pan-Immune-Inflammation Value in the Differential Diagnosis of Acute Coronary Syndrome and Predicting Mortality.

Objectives: We aimed to evaluate the predictive importance of various clinical and laboratory parameters in the differential diagnosis of Acute Coronary Syndrome (ACS). Understanding these predictors is critical for improving diagnostic accuracy, guiding therapeutic decisions, and ultimately enhancing patient outcomes. Methods: The study included a total of 427 patients diagnosed with ACS, comprising 142 with unstable angina, 142 with non-ST elevation myocardial infarction (NSTEMI), and 143 with ST elevation myocardial infarction (STEMI). The data were collected from medical records of patients treated at a tertiary care hospital between January 2020 and December 2024. In addition to other biochemical parameters, triglyceride/HDL ratio (THR), triglyceride-glucose index (TGI), and Pan-Immune-Inflammation Value (PIV) were calculated and compared. Results: THR, TGI, PIV, and mortality rate were statistically higher in the STEMI group (p = 0.034, p = 0.031, p = 0.022, p = 0.045, respectively). The risk factors were found to be significantly associated with STEMI in the multiple logistic regression analysis and included age, total cholesterol, triglycerides, diabetes mellitus, smoking, cTnI, LVEF, THR, TGI, and PIV. High THR increases the risk of STEMI (AUC = 0.67, 95% CI: 0.62-0.72, p = 0.020). High THR increases the risk of mortality in ACS patients (AUC = 0.70, 95% CI: 0.65-0.75, p = 0.004). THRs above 3.5 are associated with higher risk. Sensitivity is 75% and specificity is 60%. High TGI increases the risk of mortality in ACS patients (AUC = 0.73, 95% CI: 0.68-0.78, p = 0.007). TGIs above 8.5 are associated with higher risk. Sensitivity is 78% and specificity is 63%. High PIVs increase the risk of mortality in ACS patients (AUC = 0.75, 95% CI: 0.70-0.80, p = 0.009). PIVs above 370 are associated with higher risk. Sensitivity is 80% and specificity is 65%. The combination of TGI, THR, PIV, and cTnI has the highest predictive capability over individual parameters for STEMI and mortality. Conclusions: We found that age, total cholesterol, triglycerides, cTnI, THR, TGI, and PIV increase, low LVEF, presence of diabetes mellitus, and smoking have predictive values for STEMI and mortality in patients with ACS. Unlike the studies in the literature, this is the first study in which cTnI, THR, TGI, and PIV values were evaluated together in ACS and mortality prediction.

Improved heart function and cardiac remodelling following sacubitril/valsartan in acute coronary syndrome with HF.

This study sought to assess the effect of treatment of sacubitril/valsartan (S/V) on improving cardiac function and reversing cardiac remodelling in patients with acute coronary syndrome (ACS) complicated with heart failure with reduced ejection fraction after percutaneous coronary intervention (PCI). We enrolled 275 ACS patients with reduced left ventricular ejection fraction after PCI. The patients were divided into the routine and S/V groups according to the treatment drugs. The symptoms, N-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations, echocardiographic parameters [left ventricular ejection fraction (LVEF), left ventricular mass index (LVMI), left ventricular end-diastolic volume index (LVEDVI), and left ventricular end-systolic volume index (LVESVI)], major adverse cardiac events (MACEs), and adverse reactions were recorded at baseline and 6months after treatment when a clinical follow-up was performed. The S/V group was further divided into prespecified subgroups including unstable angina (UA) group, non-ST-elevation myocardial infarction (NSTEMI) group, and ST-elevation myocardial infarction (STEMI) group according to the type of ACS. We analysed the changes in LVEF, LVMI, LVEDVI, LVESVI, and NT-proBNP in both groups and evaluated the correlation between the changes in the above variables (ΔLVEF, ΔLVMI, ΔLVEDVI, ΔLVESVI, and ΔNT-proBNP). Cox regression model was used to assess the independent risk factors of MACE. Prespecified subgroup analyses were also conducted. Compared with baseline, LVEF increased significantly (P<0.05), NT-proBNP, LVMI, and LVESVI decreased significantly in both groups after 6months (P<0.05), and LVEDVI decreased significantly in the S/V group (P=0.001). In the S/V group, ΔLVEF (t=-2.745, P=0.006), ΔNT-proBNP (P=0.009), ΔLVEDVI (t=4.203, P=0.001), and ΔLVESVI (t=3.907, P=0.001) were significantly improved than those in the routine group. In the S/V group, ΔLVEF was negatively correlated with ΔNT-proBNP (r=-0.244, P=0.004), ΔLVMI (r=-0.190, P=0.028), ΔLVEDVI (r=-0.173, P=0.045), and ΔLVESVI (r=-0.261, P=0.002). In Cox regression model analysis,ΔLVEF {hazard ratio [HR]=0.87 [95% confidence interval (CI) 0.80-0.95], P=0.003}, ΔLVEDVI [HR=1.04 (95% CI 1.01-1.06), P=0.013], and ΔLVESVI [HR=1.04 (95% CI 1.01-1.08), P=0.026] were independent risk factors for MACE. Subgroup analysis showed that ΔLVEF (t=6.290, P=0.001), ΔLVEDVI (t=2.581, P=0.011), and ΔNT-proBNP (P=0.019) in the NSTEMI group were significantly improved than those in the UA group, ΔLVEDVI in the NSTEMI group was significantly better than that in the STEMI group (t=-3.365, P=0.001), and ΔLVEF in the STEMI group was significantly better than that in the UA group (t=-3.928, P=0.001). There was a significant difference in the survival probability without MACE among the three groups in the analysis of the Kaplan-Meier curve (P=0.042). The incidence of MACE in the UA group was significantly higher than that in the NSTEMI group (32.4% vs. 6.3%, P=0.004). The cardiac function is improved and cardiac remodelling is reversed significantly after treatment of S/V in ACS patients with reduced left ventricular ejection fraction after PCI, and the improvement is more obvious than the routine group. There is a significant negative correlation between the change in LVEF and the changes in NT-proBNP, LVMI, LVEDVI, and LVESVI. The increase of LVEF and the decrease of LVEDVI and LVESVI are protective factors to improve the prognosis. Patients with myocardial infarction and reduced left ventricular ejection fraction might benefit more from the initiation of S/V as first-line heart failure treatment after PCI.

Glycated Haemoglobin and TIMI Score as Risk Predictor in Patients with Acute Myocardial Infarction: A Cross-sectional Study

Introduction: Cardiovascular Disease (CVD) is the leading cause of death and disability globally. The Thrombolysis in Myocardial Infarction (TIMI) score is calculated to assess the risk outcome among myocardial infarction patients. Researchers found that diabetic patients with myocardial infarction have relatively unfavourable outcomes when compared to myocardial infarction patients without diabetes. Aim: To evaluate Glycated Haemoglobin (HbA1c) levels, the TIMI score in Acute Myocardial Infarction (AMI) patients and compare them between ST Elevation Myocardial Infarction (STEMI) and non STEMI (NSTEMI) patients. Materials and Methods: This cross-sectional study was conducted at the Intensive Care Unit (ICU) of the Department of Cardiology at SRM Medical College Hospital and Research Centre, Kattankulathur, Chengalpattu, Tamil Nadu, India, from July 2022 to June 2023. A total of 100 myocardial infarction patients were included and divided into two groups based on Electrocardiogram (ECG) findings and Creatine PhosphokinaseMB (CK-MB) values, with 50 STEMI and 50 NSTEMI. Patients blood samples were evaluated for HbA1c, total cholesterol, Triglycerides (TGL), High-density Lipoprotein Cholesterol (HDL-C), Low-density Lipoprotein Cholesterol (LDL-C), Very High-density Lipoprotein Cholesterol (VLDL-C), and CK-MB parameters. The TIMI score was calculated to evaluate the risk of developing complications among myocardial infarction patients. Pearson’s correlation was used to correlate biochemical parameters with the TIMI score. Results: A total of 100 myocardial infarction patients were analysed in the present study, with 50 being STEMI (mean HbA1c%: 8.0±0.2.8) and 50 being NSTEMI (mean HbA1c%: 7.2±2.0) with a p-value of &lt;0.01*, a high TIMI score in STEMI patients (means 5.38±2.76) and 50 NSTEMI (mean 3.24±1.20) with a p-value of &lt;0.0001*. Also, HbA1c was strongly positively correlated with the TIMI score in both the STEMI and NSTEMI groups, with r-value of 0.6 (p=0.0001*) and 0.7 (p=0.0001*), respectively. CK-MB was correlated with the TIMI score in both STEMI and NSTEMI, with r-value of 0.308 (0.03) and 0.375 (0.007). There was no correlation between the TIMI score and the lipid profile. Conclusion: The study concluded that HbA1c, along with the TIMI score, is a significant predictor of risk outcome in AMI patients.

Determination of left ventricular ejection fraction and C-reactive protein by the state of ischemic myocardium – capabilities of ECG digitalization

Aim. To determine the dependence of left ventricular ejection fraction (LVEF) and C-reactive protein (CRP) on the condition of ischemic myocardium considering additional diagnostic data, obtained from differentiated ECG. Material and methods. To achieve the goal, 135 patients with coronary artery disease (CAD) were examined and divided into comparison groups: 48 patients with LVEF &lt;55 % and 87 patients with LVEF ≥55 %. ST-elevation myocardial infarction (STEMI) was diagnosed in 45 of 135 patients, who were grouped according to LVEF: 17 patients with LVEF &lt;50 % and 28 patients with LVEF ≥50 %. Stable angina (SA) was documented in 90 of 135 patients, who were assigned to groups depending on LVEF: 51 patients with LVEF &lt;60 % and 39 patients with LVEF ≥60 %. Depending on the CRP level, 2 SA groups numbering 46 people were formed: 18 patients with a level of CRP ≥0.5 mg/dL and 28 patients with a level of CRP &lt;0.5 mg/dL. The study included clinical examinations, questionnaire, analysis of biomarkers and data of functional methods of examination (echocardiography, coronary ventriculography, ECG digitalization with the assessment of its parameters based on the “Smart-ECG” medical software platform). Results. Patients with CAD and LVEF&lt;55 % had higher values of endothelin-1 (ET-1) (10.21 (7.69; 11.65) pg/ml, Δ +41.81 %, p = 0.040), slightly higher levels of CRP (0.53 (0.35; 0.70) mg/dL, Δ +51.43 %, p = 0.124), lower the maximum speed ratio (MSR) (0.71 ± 0.03, Δ -15.48 %, p = 0.004), but a greater height of the ST-slope (STH) in the ischemic zone on the differentiated ECG (0.65 ± 0.04 mm, Δ +25.00 %, p = 0.022), than those in patients with LVEF ≥55 %. In the STEMI group with LVEF &lt;50 %, slightly higher STH values were noted during the period of maximum elevation of the ST segment on the differentiated ECG (2.51 (1.90; 3.16) mm, Δ +30.05 %, p = 0.060) as compared to the group with LVEF ≥50 %. SA patients with LVEF &lt;60 % had a tendency to higher levels of CRP (0.50 (0.29; 0.67) mg/dL, Δ +51.52 %, p = 0.076) and ET-1 (9.15 (7.00; 11.18) pg/ml, Δ +28.69 %, p = 0.075) in comparison with LVEF ≥60 % group. Patients with SA and a CRP level ≥0.5 mg/dL had higher ET-1 values (10.83 (9.94; 12.64) pg/ml, Δ +58.10 %, p &lt; 0.001), lower values of MSR on the differentiated ECG in the ischemic zone (0.63 (0.52, 0.74) , Δ -41.12 %, p = 0.001) as compared to those in the CRP &lt;0.5 mg/dL group. The negative direction of the T wave and various types of rhythm disturbances in SA patients led to more significant decrease in MSR indicator of the differentiated ECG. Conclusions. Values of LVEF &lt;55 % in CAD, LVEF &lt;50 % in STEMI, LVEF &lt;60 % in SA, CRP ≥0.5 mg/dL in SA are associated with worse indicators of clinical, laboratory and instrumental methods of examination that allow to describe the condition of ischemic myocardium, and the ECG digitalization based on the medical software “Smart-ECG” allows to expand the diagnostic capabilities.

Heart rhythm complexity analysis in patients with inferior ST-elevation myocardial infarction

Heart rhythm complexity (HRC), a subtype of heart rate variability (HRV), is an important tool to investigate cardiovascular disease. In this study, we aimed to analyze serial changes in HRV and HRC metrics in patients with inferior ST-elevation myocardial infarction (STEMI) within 1 year postinfarct and explore the association between HRC and postinfarct left ventricular (LV) systolic impairment. We prospectively enrolled 33 inferior STEMI patients and 74 control subjects and analyzed traditional linear HRV and HRC metrics in both groups, including detrended fluctuation analysis (DFA) and multiscale entropy (MSE). We also analyzed follow-up postinfarct echocardiography for 1 year. The STEMI group had significantly lower standard deviation of RR interval (SDNN), and DFAα2 within 7 days postinfarct (acute stage) comparing to control subjects. LF power was consistently higher in STEMI group during follow up. The MSE scale 5 was higher at acute stage comparing to control subjects and had a trend of decrease during 1-year postinfarct. The MSE area under scale 1–5 showed persistently lower than control subjects and progressively decreased during 1-year postinfarct. To predict long-term postinfarct LV systolic impairment, the slope between MSE scale 1 to 5 (slope 1–5) had the best predictive value. MSE slope 1–5 also increased the predictive ability of the linear HRV metrics in both the net reclassification index and integrated discrimination index models. In conclusion, HRC and LV contractility decreased 1 year postinfarct in inferior STEMI patients, and MSE slope 1–5 was a good predictor of postinfarct LV systolic impairment.

Digitalization of ECG in optimization of diagnostics of acute and chronic coronary syndromes

The aim is to study the additional diagnostic possibilities of indicators obtained by digitalization of ECG in patients with ST-elevation myocardial infarction (STEMI) and stable angina (SA).Material and methods. 135 patients were examined, who were divided into groups depending on the diagnosis: 45 people with STEMI and 90 patients with SA. According to the value of the first derivative of the T wave - the maximum speed ratio (MSR) indicator, patients with STEMI were divided into two groups: group I included 25 people with MSR &lt;0.66, group II - 20 patients with MSR ≥0.66. Patients with SA were also distinguished depending on MSR: group A included 41 patients with MSR &lt;0.87 and group B - 49 patients with MSR ≥0.87. The results of echocardiography, Holter ECG monitoring, coronary ventriculography and digitalization of ECG based on the «Smart-ECG» medical software were evaluated.Results. In the STEMI group, significantly lower MSR values of ischemic zone were noted, compared to the group of patients with SA (0.65±0.02, Δ –25.29%, p&lt;0.001), higher STH values in ischemic zone (0.76±0.04 mm, Δ +58.33%, p&lt;0.001), lower left ventricular ejection fraction (LVEF) (51.96±1.21 %, Δ -9.82%, p&lt;0.001), longer ischemia (919.00 (133, 00; 1310.00) min, Δ +3729.17%, p&lt;0.001), lower standart deviation values of N-N intervals (SDNN) (88.11±6.65 ms, Δ -20.88%, p=0.094). Individuals with SA and MSR &lt;0.87 showed slightly higher values of MSR in lead V2, compared to the group of SA and MSR ≥0.87 (2.51±0.08, Δ +8.19%, p=0.058). In patients with STEMI and MSR &lt;0.66 and with SA and MSR &lt;0.87, compared to the group with STEMI and MSR ≥0.66 and with SA and MSR ≥0.87, lower LVEF were detected (respectively (52.00 (47.75; 55.00) %, Δ -10.34%, p=0.071) and (56.73±0.83%, Δ -3.14%, p=0.088).Conclusions. Primary changes in the repolarization phase, which are inherent for patients with STEMI and SA, cause a change in the speed parameters of the differentiated ECG – reducing of MSR (more intense for patients with STEMI), which indicates a pronounced electrical disbalance of the ischemic myocardium. Lower values of MSR result in worse clinical and functional characteristics of the myocardium for STEMI and SA and are associated with negative prognostic markers of ischemia.

Analysis of short- and medium-term influence of Polish smog on atherothrombotic cardiovascular diseases in 709 counties in Eastern Europe - preliminary results (EP-Particles study)

Abstract Background Polish smog is a specific type of air pollution characterized by high concentrations of particulate matters (PMs) and benzo(a)pyrene (BaP), which causes exceptionally adverse cardiovascular effects. In Eastern Europe, this is a problem in large cities and also small towns, where residents’ suboptimal heating choices lead to poor air quality. Moreover, myocardial infarction and ischemic stroke (IS) are one of the most common causes of emergency hospitalizations in this area. Purpose We aimed to assess the short- and medium-term impact of multiple air pollutants on the incidence of ST Elevation Myocardial Infarction (STEMI) and IS. Methods We collected data on hospitalizations due to IS and STEMI in the years 2011-2020 from National Health Fund. Effects of PM2.5, PM10, NO2, SO2, O3, CO and BaP were calculated using time-stratified panel data Poisson regression. Results are reported as odds ratio (OR) and 95% Confidence Intervals (95%CI) associated with an increase of the interquartile range (IQR) in a daily concentration of air pollutants on the day of exposure (LAG 0), during the week (LAG 0-6) and month (LAG 0-30) after exposure. The study covered 709 counties located in Eastern Europe with 90 million person-years of follow-up. Results We recorded 159,952 and 68,251 cases of IS and STEMI, respectively. The mean age of patients in IS groups was 73.78 years old and 48.46% of them were men. In the STEMI group mean age was 67.52 years old and males accounted for 64.38%. In the figures, we presented the influence of all analyzed air pollutants on IS (Figure 1) and STEMI (Figure 2) incidence. Exposure to PMs was associated with the highest STEMI (PM2.5: OR=1.086, 95%CI 1.074-1.099, p&amp;lt;0.001; PM10: OR=1.091, 95%CI 1.078-1.104, p&amp;lt;0.001) and IS (PM2.5: OR=1.027, 95%CI 1.019-1.035, p&amp;lt;0.001; PM10: OR=1.028, 95%CI 1.02-1.036, p&amp;lt;0.001) occurrence on LAG 0, and this effect increased during the following month. The IQR increase in BaP concentration was associated with increased IS incidence on LAG 0 (OR=1.009, 95%CI 1.002-1.016, p=0.01), LAG 0-6 (OR=1.012, 95%CI 1.004-1.021, p=0.004) and LAG 0-30 (OR=1.016, 95%CI 1.007-1.026, p=0.001). A similar effect was noted on STEMI occurrence. Exposure to CO was associated with increased IS incidence on all analyzed LAGs, whereas in STEMI it only affected LAG 0-30. The IQR increase in O3 had a protective effect on IS occurrence on LAG 0-6 (OR=0.974, 95%CI 0.962-0.987, p&amp;lt;0.001) and LAG 0-30 (OR=0.967, 95%CI 0.952-0.983, p&amp;lt;0.001), while it had a negative effect on STEMI incidence on LAG 0 (OR=1.023; 95%CI 1.006-1.04, p=0.008). Conclusions Polish smog has a detrimental influence on the incidence of atherothrombotic diseases as a result of the toxic effects of mainly PMs and also other air pollutants. Exposure to air pollution can act as a trigger for STEMI and IS. Furthermore, medium-term exposure also increases the risk of STEMI and IS occurrence, most likely due to cumulative doses of air pollutants.

Abstract 17798: Plasma Cardiac miRNA Expression During ST Elevation Myocardial Infarction

Introduction: MicroRNAs (miRs), short sequences of RNA that silence gene expression, have been proposed as biomarkers potentially capable of detecting myocardial infarction earlier and more accurately than troponin. Few studies have assessed expression patterns of cardiac-relevant miRs at the time of ST elevation myocardial infarction (STEMI). Hypothesis: Plasma levels of miRs known to regulate myocardial processes are altered in the plasma of patients early after STEMI onset. Aim: To establish a signature of miRs differentially expressed in plasma of patients with STEMI at the time of presentation. Methods: 10cc blood was obtained at the time of coronary angiography for patients presenting with STEMI(n=9), and plasma was recovered after centrifugation. Patients without coronary heart disease who had undergone coronary angiography served as referent normals(n=5). Following RNA extraction, RT-qPCR was performed to quantify levels of 84 cardiac miRs (Qiagen, Germany) with fold change calculated by the 2 - ΔΔCt method. Results: The mean age was similar between STEMI and referent normal control patients (59±9 vs 60±8), and the mean troponin was numerically higher in the STEMI group (15.4±21 vs 0.00±0; p=0.13). As shown in the table, the expression levels of 25 miRs were significantly increased, and 2 were decreased as compared with control patients (p&lt;0.10). Seven miRs were not detected, and the remaining 47 detectable miRs were not different between the groups(p≥0.10). Cardiac-specific miR-499a-5p and miR-208b-3p demonstrated the greatest fold-change relative to referent normal patients. Conclusions: Cardiac-specific miRs, most notably miR-499a-5p and 208b-3p, as well as many other miRs are differentially expressed early after STEMI onset. Further work is needed to determine whether miRs can detect STEMI earlier or more accurately than troponin or provide incremental diagnostic value for patients presenting with acute coronary syndromes.

Left ventricular dyssynchrony measured by cardiovascular magnetic resonance-feature tracking in anterior ST-elevation myocardial infarction: relationship with microvascular occlusion myocardial damage.

Cardiovascular magnetic resonance-feature tracking (CMR-FT) enables quantification of myocardial deformation and may be used as an objective measure of myocardial involvement in ST-elevation myocardial infarction (STEMI). We sought to investigate the associations between myocardial dyssynchrony parameters and myocardium damage for STEMI. We analyzed 65 patients (45-80 years old) with anterior STEMI after primary percutaneous coronary intervention during 3-7 days [observational (STEMI) group] and 60 healthy volunteers [normal control (NC) group]. Myocardial dyssynchrony parameters were derived, including global and regional strain, radial rebound stretch and displacement, systolic septal time delay, and circumferential stretch. CMR characteristics, including morphologic parameters such as left ventricular ejection fraction (LVEF) (45.3% ± 8.2%) and myocardium damage in late gadolinium enhancement (LGE) (19.4% ± 4.7% LV), were assessed in the observation group. The global radial strain (GRS) and global longitudinal strain (GLS) substantially decreased in anterior STEMI compared with the NC group (GRS: 19.4% ± 5.1% vs. 24.8% ± 4.0%, P < 0.05; GLS: -10.1% ± 1.7% vs. -13.7% ± 1.0%, P < 0.05). Among 362 infarcted segments, radial and circumferential peak strains of the infarcted zone were the lowest (14.4% ± 3.2% and -10.7% ± 1.6%, respectively). The radial peak displacement of the infarct zone significantly decreased (2.6 ± 0.4 mm) (P < 0.001) and manifested in the circumferential displacement (3.5° ± 0.7°) in the STEMI group (P < 0.01). As microvascular occlusion (MVO) was additionally present, some strain parameters were significantly impaired in LGE+/MVO+ segments (radial strain [RS]: 12.2% ± 2.1%, circumferential strain [CS]: -9.6% ± 0.7%, longitudinal strain [LS]: -6.8% ± 1.0%) compared to LGE+/MVO- (RS: 14.6% ± 3.2%, CS: -10.8% ± 1.8%, LS: -9.2% ± 1.3%) (P < 0.05). When the extent of transmural myocardial infarction is greater than 75%, the parameter of the systolic septal delay (mean, 148 ms) was significantly reduced compared to fewer degrees of infarction (P < 0.01). In anterior STEMI, the infarcted septum swings in a bimodal mode, and myocardial injury reduces the radial strain contractility. A more than 75% transmural degree was the septal strain-contraction reserve cut-off point.

Prognostic Value of Redox Status Biomarkers in Patients Presenting with STEMI or Non-STEMI: A Prospective Case-Control Clinical Study.

(1) Background: The aim of our study was to determine the role of oxidative stress (OS) during early evaluation of acute ST-elevated myocardial infarction (STEMI) and non-ST-elevated myocardial infarction (NSTEMI) patients in order to define the role of redox balance in profiling the development of myocardial infarction (MI). (2) Methods: This prospective observational case-control study included 40 consecutive STEMI and 39 NSTEMI patients hospitalized in the coronary care unit of the cardiology clinic at the Kragujevac Clinical Center, Serbia, between 1 January 2016 and 1 January 2017. Blood samples were collected from all patients for measuring cardio-specific enzymes at admission and 12 h after admission to evaluate systemic oxidative stress biomarkers and the activity of antioxidant enzymes. (3) Results: In this study, participants were predominately female (52%), with a mean age of 56.17 ± 1.22 years old in the STEMI group and 69.17 ± 3.65 in the non-STEMI group. According to the Killip classification, the majority of patients (>50%) were at the second and third level. We confirmed the elevation of superoxide anion radicals in the non-STEMI group 6 h after admission in comparison with the STEMI and CTRL groups, but levels had decreased 12 h after admission. Levels of hydrogen peroxide were statistically significantly increased in the NSTEMI group. A positive correlation of superoxide anion radicals and levels of troponin I at admission was observed (r = 0.955; p = 0.045), as well as an inverse correlation between reduced glutathione and levels of NT-pBNP measured 6 h after admission (r = -0.973; p = 0.027). (4) Conclusions: We confirmed that superoxide anion radicals and reduced glutathione observed together with hs-troponin I at admission and NT-pBNP during hospital treatment could be predictors of ST evolution.

Prevalence, hematological parameters, and coagulation profiles: Cardiovascular diseases statistics in the Asir region, Saudi Arabia.

To determine the prevalence of cardiovascular disease (CVD) types in the Asir region of Saudi Arabia and the importance of hematological testing for CVD patients in the context of disease management. This retrospective study comprised 416 CVD patients, and samples were divided based the type of CVD. The Mann Whitney U test was used to compare patients' hematological markers and coagulation profiles to those of healthy controls. The rate of ischemic heart disease (IHD) was 80.7% that of other CVDs, and the rate of ST-elevation myocardial infarction (STEMI) was 37.3% the rate of CVD. Significant differences were observed in the hematological and coagulation parameters of CVD patients compared to the control group. White blood cells (WBC) were significantly higher in STEMI, non-ST-elevation myocardial infarction (NSTEMI), unstable angina (UA), and heart failure (HF) groups. Red blood cells (RBC) were significantly lower in STEMI, NSTEMI, UA, chronic coronary syndrome (CCS), HF, dilated cardiomyopathy (DCM), and ischemic cardiomyopathy (ICM). Red distribution width (RDW) was significantly greater in the HF, DCM, and ICM groups. Prothrombin time (PT) was significantly higher in the STEMI, HF, and DCM groups. ST-elevation myocardial infarction has a higher prevalence rate among CVD patients in the Asir region. Both coagulation and hematological indicators have high potential utility as CVD diagnostic and prognostic markers.

Quantitative evaluation of acute myocardial infarction by feature-tracking cardiac magnetic resonance imaging.

To assess the value of feature-tracking cardiac magnetic resonance (FT-CMR) imaging in the quantitative evaluation of acute myocardial infarction (AMI). We retrospectively analyzed medical records of patients with acute myocardial infarction (AMI) diagnosed in the Department of Cardiology of Hubei No.3 People's Hospital of Jianghan University from April 2020 to April 2022, who underwent feature-tracking cardiac magnetic resonance (FT-CMR) examination. Based on the electrocardiogram (ECG) findings, patients were divided into ST-elevation myocardial infarction (STEMI) (n=52) and non-STEMI (NSTEMI) (n=48) groups. We compared myocardial strain parameters between the two groups and applied the Pearson's test to reveal any correlations between the left ventricular myocardial strain parameters and the number of late gadolinium enhancement (LGE) positive segments; we assessed the clinical value of FT-CMR for predicting STEMI using a receiver operating characteristic (ROC) curve. The number of LGE-positive segments in the STEMI group was significantly higher than that in the NSTEMI group. The myocardial radial, circumferential and longitudinal strains in the STEMI group were significantly lower than those in the NSTEMI group (p<0.05). The number of LGE-positive segments in patients with AMI negatively correlated with the radial, circumferential and longitudinal strains. The results of the ROC curve analysis showed that radial, circumferential and longitudinal strain values have a diagnostic value for STEMI (p<0.05). FT-CMR, a non-invasive and rapid method for analyzing myocardial strains, has a high diagnostic value for AMI and should be helpful for the prevention and intervention of ventricular remodeling after myocardial infarctions.

Lipoprotein(a) concentrations in acute myocardial infarction patients are not indicative of levels at six month follow-up.

Lipoprotein(a) [Lp(a)] levels are generally constant throughout an individual's lifetime, and current guidelines recommend that a single measurement is sufficient to assess the risk of coronary artery disease (CAD). However, it is unclear whether a single measurement of Lp(a) in individuals with acute myocardial infarction (MI) is indicative of the Lp(a) level six months following the event. Lp(a) levels were obtained from individuals with non-ST-elevation myocardial infarction (NSTEMI) or ST-elevation myocardial infarction (STEMI) (n = 99) within 24 h of hospital admission and after six months, who were enrolled in two randomized trials of evolocumab and placebo, and in individuals with NSTEMI or STEMI (n = 9) who enrolled in a small observation arm of the two protocols and did not receive study drug, but whose levels were obtained at the same time points. Median Lp(a) levels increased from 53.5 nmol/L (19, 165) during hospital admission to 58.0 nmol/L (14.8, 176.8) six months after the acute infarction (P = 0.02). Subgroup analysis demonstrated no difference in the baseline, six-month, or change between the baseline and six-month Lp(a) values between the STEMI and NSTEMI groups and between the group which received evolocumab and the group that did not. This study demonstrated that Lp(a) levels in individuals with acute MI are significantly higher six months after the initial event. Therefore, a single measurement of Lp(a) in the peri-infarction setting is not sufficient to predict the Lp(a)-associated CAD risk in the post-infarction period. Evolocumab in Acute Coronary Syndrome Trial [EVACS I] NCT03515304, Evolocumab in Patients with Acute Myocardial Infarction [EVACS II], NCT04082442.

What is changing in the treatment of acute coronary syndrome in the Russian Federation?

The work of the national network of vascular centers of the Russian Federation (RF), based on the Clinical recommendations of the Russian Society of Cardiology and the procedure for providing medical care to patients with cardiovascular diseases, has led to significant positive results in the treatment of patients with acute coronary syndrome (ACS) in the country, although a number of targets have not yet been reached. The purpose of the publication is to demonstrate the trend in therapeutic approaches to the management of patients with ACS in 2020-2022. in Russia and analysis of their effectiveness. Quantitative and qualitative indicators of the treatment of patients with ACS for the presented analysis were obtained on the basis of monitoring data from the Russian Ministry of Health for 2018-2021. presented: Monitoring of measures to reduce mortality from coronary heart disease, letters of the Ministry of Health of Russia dated March 13, 2015 No. 17-6 / 10 / 1-177 and dated July 24, 2015 No. 17-9 / 10 / 2-4128, within which data collection carried out monthly, on the portal of the Federal State Budgetary Institution "TsNIIOIZ" of the Ministry of Health of Russia - Automated system for monitoring medical statistics and the register REGION-IM (Russian Register of Acute Myocardial Infarction) - a multicenter prospective observational cohort study for 2020-2022, organized by the Federal State Budgetary Institution "National Medical Research Center of Cardiology named after Academician E.I. Chazov" of the Ministry of Health of Russia. In Russia with a diagnosis of ACS in 2020 and 2021 403,931 and 397,930 patients were hospitalized, respectively. The decrease in the number of patients diagnosed with ACS admitted to Russian hospitals by 22.32% was mainly due to a significant decrease in hospital admissions of patients diagnosed with non-ST elevation ACS (non-STE-ACS) (by 29.03%). At the same time, the admission of patients with ST elevation myocardial infarction (STEMI) decreased only by 6.02%. Compared to 2018-2019, in 2020-2022. increased mortality in primary percutaneous coronary intervention (PCI) (by 9.6%) and in the general STEMI group (by 12.3%); significantly increased mortality both in the general group of NSTE-ACS (by 48%) and during PCI for patients with non-STE-ACS (by 28.6%); there was an increase in the average annual number of primary PCI (by 12.6%); an absolute and relative increase in the number of PCI in non-STE-ACS was revealed (by 2.7 and 37.1%, respectively). In the country's hospitals, by the time of discharge, 95% of patients receive statins, beta-blockers – 87%, ACE inhibitors – 80%, acetylsalicylic acid – 82%, P2Y12 inhibitors – 98% of patients, regardless of the type of ACS. In Russia in 2020-2022 unfavorable tendencies in the provision of care to patients with ACS include: increased mortality in primary PCI and in the general STEMI group; increased mortality both in the general group of non-STE-ACS and during PCI for patients with non-STE-ACS. The positive results of the work of the national network of vascular centers include: absolute, relative and estimated increase in the number of primary PCI; absolute and relative increase in the number of PCI in non-STE-ACS; a high level of prescribing drugs with a proven positive effect on the prognosis.

Prognostic role of the left ventricular global function index in predicting major adverse cardiovascular events in acute coronary syndrome patients.

Aim: This study aimed to evaluate the prognostic role of the left ventricular (LV) global function index (LVGFI) in predicting major adverse cardiovascular events in patients with acute coronary syndrome after long-term follow-up. Methods: This retrospective study included 718 patients with ST-elevated myocardial infarction (STEMI) and 781 patients with non-ST-elevated myocardial infarction (NSTEMI). The LVGFI was calculated on echocardiography with the following formula: (LV stroke volume/[LV cavity volume + LV myocardial volume]) ×100. Results: Mean LVGFI was higher in the NSTEMI group than in the STEMI group. Decreased LVGFI levels were independent predictors of major adverse cardiovascular events in both the STEMI and the NSTEMI group. Conclusion: Echocardiographic LVGFI may be a useful prognostic screening tool for acute coronary syndrome cohorts.

The point-of-care D-dimer test provides a fast and accurate differential diagnosis of Stanford Type A aortic syndrome and ST-elevated myocardial infarction in emergencies

BackgroundThe research of the sensitivity and specificity point-of-care testing (POCT) of D-dimer as a diagnostic protocol for differential diagnosis of Stanford Type A aortic syndrome (hereafter as TAAS) mimicking ST-elevated myocardial infarction (STEMI) with regular STEMI in the emergency department is limited.MethodsFull medical information of 32 patients confirmed TAAS and 527 patients confirmed STEMI from January 1st, 2016 to October 1st, 2021 were retrospectively analyzed in Shanghai Tenth People’s Hospital of Tongji University.ResultsThe baseline characteristics of two groups of patients were well-balanced post propensity score matching (PSM) analysis, and each group had 32 patients enrolled. Patients in the STEMI group had higher positive cardiac troponin I (cTNI) (0.174 ng/ml vs. 0.055 ng/ml, P = 0.008) results but lower D-dimer (0.365μg/ml vs. 31.50μg/ml, P < 0.001) results than the TAAS group. The D-dimer cutoff value of 2.155μg/ml had the best sensitivity of 100% and specificity of 96.9%, and the positive predictive value (PPV) as well as the negative predictive value (NPV) of the cutoff value were 96.9 and 100%, respectively, in total 64 patients, the area under the curve (AUC) values were 0.998 (95% CI:0.992-1.000, P < 0.001) for the D-dimer. No significant correlation between the D-dimer concentration and the time from symptoms onset to first medical contact in both groups (TAAS group: r = − 0.248, P = 0.170; STEMI group: r = − 0.159, P = 0.383) or significant correlation between D-dimer and creatine clearance (TAAS group: r = − 0.065, P = 0.765; STEMI group: r = 0.222, P = 0.221). The total in-hospital mortality for the patients with TAAS presenting as STEMI was 62.5% (20/32). The mortality rate for TAAS patients confirmed by computed tomography angiography (CTA) was significantly lower (40% vs. 82.4%, P = 0.014) than the mortality rate for TAAS patients confirmed by coronary angiography (CAG) and had a longer average survival time (log-rank = 0.015), less peri-surgical complications especially gastrointestinal hemorrhage (0.00% vs. 55.6%, P < 0.001). CTA diagnosis can reduce the mortality rate by 67.5% (95%CI:0.124-0.850, P = 0.16).ConclusionsThe POCT D-dimer with cut-off 2.155μg/ml would be useful to rule-out TAAS mimicking STEMI from regular STEMI prior to reperfusion therapy. CTA diagnosis is effective in reducing the probability of perioperative complications and lowering perioperative mortality than CAG diagnosis in TAAS patients.

Serum Adropin Level in the Early Period of ST-Elevation Myocardial Infarction and Its Relationship With Cobalamin and Folic Acid.

Studies on biomarkers in the diagnosis of myocardial infarction are ongoing. Adropin is a biomarker that has been studied and has been shown to have different effects. This study aimed to examine the adropin level of patients with myocardial infarction within the first 24 hours, as well as its relationship with cobalamin and folic acid. The control group included 70 patients whose troponin values did not increase and no coronary lesions were detected. In the ST-elevation myocardial infarction (STEMI) group, 70 patients with ST elevation on ECG and coronary total thrombosis on coronary angiography were evaluated. Coronary lesion severity was measured using the SYNergy between the percutaneous coronary intervention (PCI) with TAXUS and Cardiac Surgery (SYNTAX) score tool. Hemogram, troponin, adropin, C-reactive protein (CRP), cobalamin, folic acid, and other biochemical parameters were evaluated in all patients. In the STEMI group, a significant increase was observed in the adropin level along with the troponin and CRP levels in the first 24 hours (p<0.001). Cobalamin and folic acid levels were low in the same group (p:0.016, p<0.001). While a strong negative correlation was observed between adropin and cobalamin, no correlation was found with other parameters. The study supports that adropin could be used as a cardiac biomarker in the early stages of STEMI patients. Another result is with low cobalamin and folic acid levels in patients with myocardial infarction which needs to be further explained with the strong negative correlation between adropin and cobalamin.

Early Postoperative Complications in Patients with Acute Myocardial Infarction During Emergency Coronary Bypassing

Despite the success results of interventional cardiology, the indications for coronary artery bypass grafting in acute myocardial infarction, according to the recommendations, are quite limited. In recent years, the optimization of perioperative management of patients, including myocardial protection, has helped to improve the effects of treatment by emergency surgical revascularization in patients with cardiogenic shock. Thus, it is important to learn the results of emergency surgical myocardial revascularization in patients with acute myocardial infarction (AMI), which were previously considered incurable or in cases where interventional cardiology is ineffective. Therefore, the aim of the study was to conduct a prospective analysis of the immediate clinical results of the early postoperative period to determine the factors of early mortality in emergency coronary artery bypass grafting. Research methods. The research is based on the prospective investigation of 129 patients who were hospitalized in Kyiv “Heart Center” through the period from 2011 to 2015. At 100,0% the ST-elevated myocardial infarction (STEMI) of them it was verified, at 29,0 patients non- ST-elevated myocardial infarction (NSTEMI) was set. In early postoperative period, we have analyzed such events like inotropic support duration, necessity of intra-aortic balloon pump, the episodes of the development kidney injury and respiratory failure, complete atrioventricular blockade, supraventricular tachyarrhythmia episodes, encephalopathy, rethoracotomy needs. Also early postoperative mortality endpoints were evaluated. Research results. It has been proven that in the presence of STEMI type of acute myocardial injury compared with NSTEMI type, there is a higher risk of acute left ventricular failure (p &lt;0.05) followed by intra-aortic balloon pulsation (IABP)- procedure (p &lt;0,05) and inotropic support (p &lt;0,05) in the early postoperative period. In patients of the STEMI group, acute kidney injury was recorded more often with reliable indexes of absolute and relative risks (p &lt;0,05). All cases of transient atrioventricular block after emergency coronary artery bypass grafting (CABG) were registered in patients with STEMI injury with significant changes of odds ratio (p &lt;0.05). It was established that the main structure of respiratory complications was due to prolonged mechanical ventilation, but the difference in the relative risk and odds ratio between the STEMI and NSTEMI groups is insignificant (p&gt; 0.05), however the likelihood of supraventricular arrhythmia and encephalopathy in the NSTEMI group was reliably higher (p &lt;0.05). Estimates of the level of early postoperative mortality (12.4%) proved the probable relative risk (p &lt;0.05) and the odds ratio (p &lt;0.05) of mortality in the STEMI group, which was confirmed by the analysis of cumulative survival by Kaplan-Meyer method (Criterion log-rank 2,74; p = 0,006). Mortality in the STEMI group was associated with previously diagnosed acute heart failure (56,2%), the onset of cardiogenic shock (31,3%) and the development of acute mitral regurgitation (12.5%). Conclusions. STEMI type of acute myocardial damage installed reliably higher absolute and relative risk of acute left ventricle failure (p&lt;0,05) with following intra-aortic balloon pump (p&lt;0,05), inotropic support (p&lt;0,05) and acute kidney injury with glomerular rate reduction (p&lt;0,05) in the early postoperative period. The higher absolute and relative risks of encephalopathy, as well as the possibility of supraventricular arrhythmia presented at NSTEMI patients (p&lt;0,05). All cases of transient atrioventricular blockade and early hospital mortality with reliable odds ratio, absolute and relative risks changes registered at STEMI patients (p&lt;0,05). Prospects for further research are long-term prospective observation, analysis of long-term clinical results of coronary artery bypass grafting in patients with acute myocardial infarction, as well as assessment of risk factors for long-term mortality.

Early changes in myocardial stunning and biomarkers after ST-elevation myocardial infarction compared to the takotsubo syndrome

Abstract Background Takotsubo syndrome (TS) and ST-elevation myocardial infarction (STEMI) are both characterized by sudden cessation of myocardial contractions (myocardial stunning) as well as elevation of cardiac troponins and B-type natriuretic peptides (BNP). Whereas STEMI results in variable degrees of necrosis and persistent cardiac dysfunction, TS results in little to any necrosis and full recovery of cardiac function. No “head-to-head” comparison of the temporal resolution of myocardial stunning and serum biomarkers in STEMI versus takotsubo has been done. Purpose To compare the time course of the recovery of cardiac function and serum biomarkers over the acute and subacute phases of takotsubo and STEMI, with patients with STEMI further subdivided into anterior and non-anterior STEMI. Method The Stunning In Takotsubo and Acute Myocardial Infarction (STAMI) study is a prospective, multi-center study that enrolls patients with TS or STEMI without known pre-existing cardiac dysfunction. Echocardiography, laboratory testing (including troponins and NT-proBNP), and ECG are acquired within 4 hours after acute coronary angiography and at 24±6, 48±12, 72±12 hours and 7±1, 14±2, and 30±2 days. The primary endpoint is the proportion of reversible myocardial akinesia resolved after 72 hours (Figure 1), as determined by echocardiography. Secondary endpoints include troponin-I, troponin-T, and NT-proBNP. Results Preliminary results from 155 patients with STEMI (78 anterior STEMI and 77 non-anterior STEMI) and 32 patients with TS are presented in Figure 1. Mean (SD) age was similar for patients with takotsubo (67±14), anterior STEMI (68±11), and non-anterior STEMI (68±10). All 3 groups showed substantial recovery of cardiac function over the course of the study, with the most pronounced recovery of cardiac function in TS. Compared to both STEMI groups, the TS group also had lower troponin-I to troponin-T ratio, and higher NT-proBNP (Figure 2). The proportion of reversible akinesia that had recovered at 72 hours was similar in patients with TS, anterior STEMI and non-anterior STEMI (p=0.8414). Conclusion The STAMI study will provide the comprehensive assessment of cardiac function and serum biomarker profile of patients with takotsubo and STEMI over the early course of the disease. Preliminary data from the study suggest that early myocardial functional recovery is more substantial but follows a similar time-course in takotsubo and STEMI. The differences in the magnitude of troponin elevation after takotsubo versus STEMI were more pronounced for troponin-I than T. Funding Acknowledgement Type of funding sources: Public grant(s) – EU funding. Main funding source(s): ERC - European Research Council

Comparing Door-To-Balloon Time between ST-Elevation Myocardial Infarction Electrocardiogram and Its Equivalents.

Background: In patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary interventions (pPCI), longer door-to-balloon (DTB) time is known to be associated with an unfavorable outcome. A percentage of patients with acute coronary occlusion present with atypical electrocardiographic (ECG) findings, known as STEMI-equivalents. We investigated whether DTB time for STEMI-equivalent patients was delayed. Methods: This is a retrospective study including patients arriving at an emergency department with the acute coronary syndrome in whom emergent pPCI was performed. ECGs were classified into STEMI and STEMI-equivalent groups. We compared DTB time, with its components, between the groups. We also investigated whether STEMI-equivalent ECG was an independent predictor of DTB time delayed for more than 90 min. Results: A total of 180 patients were included in the present study, and 23 patients (12.8%) presented with STEMI-equivalent ECGs. DTB time was significantly delayed in patients with STEMI-equivalent ECGs (89 (80–122) vs. 81 (70–88) min, p = 0.001). Multivariable logistic regression analysis showed that STEMI-equivalent ECG was an independent predictor of delayed DTB time (odds ratio: 4.692; 95% confidence interval: 1.632–13.490, p = 0.004). Conclusions: DTB time was significantly delayed in patients presenting with STEMI-equivalent ECGs. Prompt recognition of STEMI-equivalent ECGs by emergency physicians and interventional cardiologists might reduce DTB time and lead to a better clinical outcome.