Myocardial Infarction Type Research Articles

Evaluating the Cardiovascular Risk in an Aging Population of People With HIV: The Impact of Hepatitis C Virus Coinfection.

Background People with HIV (PWH) are at an increased risk of cardiovascular disease (CVD) with an unknown added impact of hepatitis C virus (HCV) coinfection. We aimed to identify whether HCV coinfection increases the risk of type 1 myocardial infarction (T1MI) and if the risk differs by age. Methods and Results We used data from NA-ACCORD (North American AIDS Cohort Collaboration on Research and Design) from January 1, 2000, to December 31, 2017, PWH (aged 40-79 years) who had initiated antiretroviral therapy. The primary outcome was an adjudicated T1MI event. Those who started direct-acting HCV antivirals were censored at the time of initiation. Crude incidence rates per 1000 person-years were calculated for T1MI by calendar time. Discrete time-to-event analyses with complementary log-log models were used to estimate adjusted hazard ratios and 95% CIs for T1MI among those with and without HCV. Among 23 361 PWH, 4677 (20%) had HCV. There were 89 (1.9%) T1MIs among PWH with HCV and 314 (1.7%) among PWH without HCV. HCV was not associated with increased T1MI risk in PWH (adjusted hazard ratio, 0.98 [95% CI, 0.74-1.30]). However, the risk of T1MI increased with age and was amplified in those with HCV (adjusted hazard ratio per 10-year increase in age, 1.85 [95% CI, 1.38-2.48]) compared with those without HCV (adjusted hazard ratio per 10-year increase in age,1.30 [95% CI, 1.13-1.50]; P<0.001, test of interaction). Conclusions HCV coinfection was not significantly associated with increased T1MI risk; however, the risk of T1MI with increasing age was greater in those with HCV compared with those without, and HCV status should be considered when assessing CVD risk in aging PWH.

A hybrid decision support system for heart failure diagnosis using neural networks and statistical process control

Timing and precision are two primary keys for myocardial infarction diagnosis. Even minor errors in diagnosis can dramatically increase the treatment process, increase treatment costs, and put the patient in dangerous health states. This paper presents a decision support system (DSS) based on neural networks and statistical process control charts for diagnosing and controlling myocardial infarction (MI) and continuously monitoring the patient’s blood pressure. To this aim, the data was collected from 175 medical documents of patients with MI and 92 recorded successful diagnoses of MI type. A group of patients was used to validate the effectiveness of the proposed system. The results prove that the proposed hybrid model can diagnose MI with high accuracy and precision compared to machine learning algorithms. Tighter control limits with a confidence level of L=2 (confidence interval of 95.45%) in the control determination stage and wider control limits with a confidence level of L=3 (confidence interval of 99.73%) in the condition determination stage led to higher overall accuracy. This method can help physicians make better decisions on diagnosing cardiovascular diseases.

Discovering Patterns of Cardiovascular Disease and Diabetes in Myocardial Infarction Patients Using Association Rule Mining

Highlights: Association Rule Mining tools predict the association of early-onset Myocardial Infarction with Hypertension and Diabetes Mellitus. Association Rule Mining tools using clinical and biochemical attributes can predict the development of Hypertension and Diabetes Mellitus in Myocardial Infarction patients. Abstract: Cardiovascular diseases (CVDs) are a major cause of mortality in diabetic patients. Hypertensive patients are more likely to develop diabetes and hypertension contributes to the high prevalence of CVDs, in addition to dyslipidemia and smoking. This study was to find the different patterns and overall rules among CVD patients, including rules broken down by age, sex, cholesterol and triglyceride levels, smoking habits, myocardial infarction (MI) type on ECG, diabetes, and hypertension. The cross-sectional study was performed on 240 subjects (135 patients of ST-elevation MI below 45 years and 105 age matched controls). Association rule mining was used to detect new patterns for early-onset myocardial infarction. A hotspot algorithm was used to extract frequent patterns and various promising rules within real medical data. The experiment was carried out using "Weka'', a tool for extracting rules to find out the association between different stored real parameters. In this study, we found out various rules of hypertension like “Rule 6” says that if levels of BP Systolic &gt; 131 mmHg, LpA2 &gt; 43.2 ng/ml, hsCRP &gt; 3.71 mg/L, initial creatinine &gt; 0.5 mg/dl, and initial Hb ≤15 g/dl (antecedent), then the patient will have 88% chance of developing hypertension (consequent). Similarly for diabetes mellitus with finding their lift and confidence for different support like “Rule 6”, if MI type on ECG = ’Inferior Wall MI’ with STATIN=No, and levels of Triglycerides ≤325 (antecedent), then the patient had a 67% chance of developing diabetes mellitus. We concluded that early-onset myocardial infarction is significantly associated with hypertension and diabetes mellitus.Using association rule mining, we can predict the development of hypertension and diabetes mellitus in MI patients.

Clinical Characteristics, Outcomes, and Epidemiological Trends of Patients Admitted With Type 2 Myocardial Infarction.

Type 2 myocardial infarction (T2MI) was first established as a unique entity in 2007. However, its clinical features are not well characterized. This study aimed to determine the clinical characteristics, predictors of mortality, and hospitalization trends of patients with T2MI. The National Inpatient Sample database was queried for patients hospitalized in the United States with T2MI (January 2018 to December 2019). Data were used to assess baseline characteristics, primary diagnoses, predictors of mortality, and hospitalization and mortality trends of T2MI. During the 24-month study period, 1,789,485 (76%) patients were admitted with type 1 myocardial infarction (T1MI) and 563,695 (24%) were admitted with T2MI. Patients with T2MI were more likely to be older (71 vs 68 years; P < .001) and female (47.5% vs 38.3%; P < .001), with fewer comorbidities related to coronary atherosclerosis. African Americans were the only race with a significantly higher rate of hospitalization for T2MI (15.9% vs 11.6%; P < .001). The predictors of mortality were similar in both the T2MI and T1MI cohorts. Sepsis (23.47%), hypertensive heart disease (15.35%), and atrial arrhythmias (4.49%) were the most common principal diagnoses for T2MI. T2MI hospitalizations trended consistently upward during the study period. Monthly in-hospital mortality rates were consistently higher for T2MI versus T1MI (P < .001). T2MI is a unique and heterogeneous clinical entity. Despite increased awareness, there is a lack of standardization of medical management and timing for revascularization, even as mortality rates remain persistently elevated compared with T1MI. Certain demographics, including African Americans, may be disproportionately affected.

Serial measurements of protein and microRNA biomarkers to specify myocardial infarction subtypes.

BackgroundWhile cardiac-specific troponin (cTn) allows for rapid diagnosis of acute type 1 myocardial infarction (T1MI), its performance to differentiate acute myocardial injury (AI) or type 2 myocardial infarction (T2MI) is limited. The objective was to combine biomarkers to improve discrimination of different myocardial infarction (MI) aetiologies.MethodsWe determined levels of cardiac troponin T and I (cTnT, cTnI), cardiac myosin-binding protein C (cMyBP-C), NT-proBNP and ten miRNAs, known to be associated with cardiac pathology in a total of n = 495 serial plasma samples at three time points (on admission, after 1 h and 3 h) from 57 NSTEMI (non-ST-elevation myocardial infarction), 18 AI, and 31 STEMI patients, as defined by fourth universal definition of MI (UDMI4) and 59 control individuals. We then applied linear mixed effects model to compare the kinetics of all molecules in these MI sub-types.ResultsEstablished (cTnT, cTnI) and novel (cMyBP-C) cardiac necrosis markers failed in differentiating T1MI vs T2MI at early time points. All cardiac necrosis markers were higher in T1MI than in T2MI at 3 h after admission. Muscle-enriched miRNAs (miR-1 and miR-133a) were correlated with cardiac necrosis protein markers and did not offer better discrimination. Established cardiac strain marker NT-proBNP differentiated AI and T1MI at all time points but failed to discriminate T2MI from T1MI. However, the combination of NT-proBNP and cTnT along with age returned an overall AUC of 0.76 [95 % CI 0.67–0.84] for differentiating T1MI, T2MI and AI.ConclusionsRather than using single biomarkers of myocardial necrosis, a combination of clinical biomarkers for cardiac necrosis (troponin) and cardiac strain (NT-proBNP) might aid in differentiating T1MI, T2MI and AI.

Abstract P066: Short-term Outcomes Of Hypertensive Crises In Patients With Orthostatic Hypotension.

Introduction: Current recommendations in management of supine hypertension-orthostatic hypotension disease (SH-OH) are mainly derived from outpatient studies with the aim of controlling SH while minimizing OH symptoms rather than targeting a specific standing blood pressure value. Data on short term outcomes of patients with OH who are hospitalized with hypertensive (HTN) crises is lacking. Methods: The Nationwide Readmission Database 2016-2019 was queried for all hospitalizations of HTN crises. Hospitalizations were stratified according to whether OH was present or not. We employed propensity score to match hospitalizations for patients with OH to those without, at 1:1 ratio. Outcomes evaluated were 30-days readmission with HTN crises or falls, as well as hospital outcomes of in-hospital mortality, acute kidney injury (AKI), acute congestive heart failure (CHF), acute coronary syndrome (ACS), type 2 myocardial infarction (T2MI), aortic dissection, stroke, length of stay (LOS), discharge to nursing home and hospitalization costs. Results: We included a total of 9,451 hospitalization (4,735 in the OH group vs 4,716 in the control group). OH group was more likely to be readmitted with falls (Odds ratio [OR]:3.27, p&lt;0.01) but not with HTN crises(p=0.05). Both groups had similar likelihood of developing AKI (p=0.08), stroke/TIA (p=p=0.52), and aortic dissection(p=0.66). Alternatively, OH group were less likely to develop acute CHF (OR:0.54, p&lt;0.01) or ACS (OR:0.39,p&lt;0.01) in the setting of HTN crises than non-OH group. OH group were more likely to have longer LOS and have higher hospitalization costs. Conclusion: Patients with OH who are admitted with HTN crises tend to have similar or lower HTN-related complications to non-OH group while having higher likelihood of readmission with falls, LOS and hospitalization costs. Further randomized studies are needed to confirm such findings

Chest pain workup in the presence of atrial fibrillation: impacts on troponin testing, myocardial infarction diagnoses, and long-term prognosis.

Patients presenting to the emergency department (ED) with chest pain require evaluation for acute coronary syndrome (ACS). Atrial fibrillation (AF) can lead to troponin (cTn) elevation in the absence of ACS. There is limited evidence informing the impact of AF on the diagnostic performance of cTn testing for the diagnosis of Type 1 myocardial infarction (T1MI), or the association between AF and long-term outcomes in this context. This study used the IMPACT and ADAPT study databases to compile a combined cohort of 3496 adults presenting to ED with chest pain between 2007 and 2014, with early cTn testing during ED workup. The mean age was 56.6 years, and 40.2% were female. Outcomes included adjudicated diagnoses for the index admission and mortality to 1-year after presentation. The specificity of initial cTn testing for T1MI diagnosis was lower for patients in AF compared with those not in AF (79.2% vs. 95.4%, P < 0.001), largely due to a relative increase in Type 2 myocardial infarction diagnoses. Sensitivity for T1MI did not differ between patients with or without AF (88.5% vs. 91.5%, P = 0.485). AF was associated with increased 1-year mortality (10.4% vs. 2.3%, P < 0.001), although this was not significant on multivariable analysis. The specificity of serial cTn testing for the diagnosis of T1MI in patients presenting to ED with chest pain is reduced in the presence of AF. Further studies are needed to establish whether optimised cTn thresholds for patients with AF can improve workup and outcomes.

Cardiovascular and Renal Implications of Myocardial Infarction in the ISCHEMIA-CKD Trial.

ISCHEMIA-CKD (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches-Chronic Kidney Disease) reported an initial invasive treatment strategy did not reduce the risk of death or nonfatal myocardial infarction (MI) compared with a conservative treatment strategy in patients with advanced chronic kidney disease, stable coronary disease, and moderate or severe myocardial ischemia. The cumulative frequency of different MI type after randomization and subsequent prognosis have not been reported. MI classification was based on the Third Universal Definition for MI. For procedural MI, the primary MI definition used creatine kinase-MB as the preferred biomarker, whereas the secondary MI definition used cTn (cardiac troponin); both definitions included elevated biomarker-only events with higher thresholds than nonprocedural MIs. The cumulative frequency of MI type according to treatment strategy was determined. The association of MI with subsequent all-cause death and new dialysis initiation was assessed by treating MI as a time-dependent covariate. The 3-year incidence of type 1 or 2 MI with the primary MI definition was 11.2% in invasive treatment strategy and 13.6% in conservative treatment strategy (hazard ratio [HR], 0.66 [95% CI, 0.42-1.02]). Procedural MIs were more frequent in invasive treatment strategy and accounted for 9.8% and 28.3% of all MIs with the primary and secondary MI definitions, respectively. Patients had an increased risk of all-cause death after type 1 MI (adjusted HR, 4.35 [95% CI, 2.73-6.93]) and after procedural MI with the primary (adjusted HR, 2.75 [95% CI, 0.99-7.60]) and secondary MI definitions (adjusted HR, 2.91 [95% CI, 1.73-4.88]). Dialysis initiation was increased after a type 1 MI (HR, 6.45 [95% CI, 2.59-16.08]) compared with patients without an MI. In ISCHEMIA-CKD, the invasive treatment strategy had higher rates of procedural MIs, particularly with the secondary MI definition, and lower rates of type 1 and 2 MIs. Procedural MIs, type 1 MIs, and type 2 MIs were associated with increased risk of subsequent death. Type 1 MI increased the risk of dialysis initiation. URL: https://www. gov; Unique identifier: NCT01985360.

A Cross Sectional Study Assessing Prevalence of Depression and Associated Factors Among Post Myocardial Infarction Out-Patients at a Teaching Hospital, Addis Ababa, Ethiopia

Background: The World Bank and the World Health Organization (WHO) predict that depression and coronary heart disease will be the largest causes of global health burden and disability by the year 2020. Although no countrywide study has been done on the prevalence of Post myocardial infarction (MI) depression in Ethiopia; It is thought to be higher than the possibly conservative rates of major depression in the general population as reported by multiple studies. Objectives: To assess the prevalence of depression and associated factors among Post MI out- patients at a teaching hospital, Addis Ababa, Ethiopia. Methodology: A hospital based cross-sectional study was conducted among 164 MI patients on follow up at SPHMMC Cardiology OPD. Patient health questionnaire 9 was use to screen depression. Data was collected from September 1 to October 15 2020. The data was entered, analyzed and interpreted using SPSS version 25 software. Result: A total of 164 participants were enrolled in to the study, about 88(43.7%) of the participants were females. The mean age was 44.9 (S.DS±1) years. Prevalence of depression was found out to be (12.7%). Type of MI was the single independent factor found to have significant association with depression, having NSTEMI has 2.53-time hire risk of depression compared to STMI. (p &lt; 0.05). Conclusion: The study found a high prevalence of depression among MI patients. Therefore, developing early screening and detecting strategies and making it part of standard management for patients with MI is of a high value.

Association of Biochemical Anemic Markers in STEMI and NSTEMI Patients – A Retrospective Study

Body iron stores and its significant association with the increased risk of cardiac disease was first time reported by the National Health and Nutrition Examination Survey. There are several molecular mechanisms and discrete pathways involved in developing Myocardial Infarction (MI) as a result of increased body iron store. Various studies showed that there lies a significant association between serum iron and serum ferritin with the MI, but to the best of our knowledge studies have not focused on the difference in their levels in STEMI and NSTEMI patients. Hence, the aim of the study is to associate the levels of iron and ferritin with STEMI and NSTEMI patients and the objective of the study is to investigate and associate the iron, ferritin and lipid profile parameters among STEMI and NSTEMI patients. The cross-sectional study recruited 75 individuals who lie in the age group of 25-55 years. The participants were divided into three groups with 25 participants in STEMI, 25 in NSTEMI (based on the ECG findings and cardiologist findings) and 25 healthy participants who are age and sex-matched as controls. The blood sample was obtained from the participants and analysed for the following biochemical parameters: CK - MB, iron, ferritin, and lipid profile. The data was analysed using SPSS software and represented as mean and SD. One-way ANOVA, Pearson’s correlation and odds calculation were carried out. For all statistical test p value &lt;0.05 were considered as significant. It is found that serum iron and ferritin were significantly elevated in STEMI individuals compared to NSTEMI and controls. But the lipid profile levels were increased in NSTEMI individuals. It is found that individuals with increased levels of iron and ferritin are at high risk of developing STEMI and NSTEMI compared with controls. Iron and ferritin were significantly elevated in STEMI individuals compared to NSTEMI individuals. In NSTEMI group lipid profile levels were increased and is associated with ferritin levels compared to STEMI group. Independent to the type of MI, individuals with high levels of serum iron and ferritin are at higher risk of developing myocardial infarction.&#x0D;

Clinical variables for predicting type-1 and type-2 non-ST segment elevation myocardial infarction in those presenting with ischemic symptoms.

IntroductionThe accuracy of detecting myocardial infarction (MI) has greatly improved with the advent of more sensitive assays, and this has led to etiologic subtyping. Distinguishing between type 1 and type 2 non-ST-segment elevation myocardial infarction (NSTEMI) early in the clinical course allows for the most appropriate advanced diagnostic procedures and most efficacious treatments. The purpose of this study was to investigate the predictive effect of demographic and clinical variables on predicting NSTEMI subtypes in patients presenting with ischemic symptoms.Material and methodsWe performed a single institution retrospective cohort study of patients who presented to the emergency department (ED) with ischemic signs and symptoms consistent with non-ST-segment myocardial infarction, for whom results of coronary angiography were available. We analyzed demographic, laboratory, echocardiography and angiography data to determine predictors of NSTEMI sub-types.ResultsFive hundred and forty-six patients were enrolled; 426 patients were found on coronary angiography to have type 1 acute MI (T1AMI), whereas 120 patients had type 2 acute MI (T2AMI). Age (OR per year = 1.03 (1.00, 1.05), p = 0.03), prior MI (OR = 3.50 (1.68, 7.22), p = 0.001), L/H > 2.0 (OR = 1.55 (1.12, 2.13), p = 0.007), percentage change in troponin I > 25% (OR = 2.54 (1.38, 4.69), p = 0.003), and regional wall motion abnormalities (RWMA) (OR = 3.53 (1.46, 8.54), p = 0.004) were independent predictors of T1AMI, whereas sex, race, body mass index, hypertension, end-stage renal disease (ESRD), heart failure, family history (FH) of coronary artery disease (CAD), HbA1c, and left ventricular ejection fraction (LVEF) were not.ConclusionsKey clinical variables such as age, prior MI, L/H ratio, percentage change in troponin I, and presence of RWMA on echocardiogram may be utilized as significant predictors of T1AMI in patients presenting with ischemic symptoms to the ED.

Preexisting atrial fibrillation and myocardial infarction: only 10% of infarcts directly linked to atrial fibrillation.

The aim of the study was to evaluate the incidence and prognosis of type 1 myocardial infarction (T1MI) and type 2 MI (T2MI) in patients with acute MI and known atrial fibrillation (AF) to identify MI directly linked to AF. Among the 669 patients, four patients with hyperthyroidism were excluded, and among the remaining 665 patients, about two-thirds were diagnosed with T1MI, and the remaining third were diagnosed with T2MI. AF was the direct cause of MI in 9.8% of our overall population [1.8% of T1MI type C (coronary embolism), 4.9% of T2MI type A and 3.1% of T2MI type B]. Among patients with T2MI, 30-day mortality was lower when the trigger was AF than for the other triggers, for both type 2A (6% vs. 11%) and type 2B (0% vs. 13%). Most cases of AF-related MI are, thus, T2MI, for which therapeutic guidelines are lacking. Given the diverse triggers in T2MI, a specific approach using etiological patterns is needed to properly determine the optimal therapeutic.

Frequency, risk and predictors of type 2 myocardial infarction hospitalizations in young obese patients: A nationwide population-based analysis in the United States

Abstract Funding Acknowledgements Type of funding sources: None. Background Obesity in the young population is emerging as a challenging health concern. Though there is a rising prevalence of obesity and its potential association with demand ischemia-related myocardial infarction, data remains non-existent to evaluate the association of obesity or higher body mass index (BMI) with type 2 myocardial infarction (T2MI). We aim to identify the frequency, risk and predictors of T2MI in young hospitalized obese patients compared to non-obese patients in this population-based study. Methods We used National Inpatient Sample (2018, ICD-10 codes) to identify T2MI in young (18-44 years) hospitalized patients. Obesity was identified from comorbidities or using diagnostic codes for BMI&amp;gt;30 kg/m2. We performed multivariable regression analysis for the primary outcome of odds of T2MI in young obese patients compared to non-obese patients. The frequency of T2MI was compared between obese vs non-obese patients in overall and subgroup populations. Sociodemographic characteristics and comorbidities in T2MI-obese vs. T2MI-non-obese cohorts were also compared. A p&amp;lt;0.05 was considered a threshold for statistical significance. Results Out of 1,268,255 young hospitalized patients with obesity, 555 had T2MI. T2MI was significantly higher in young obese than non-obese (44 T2MI/100000 hospitalizations in young obese patients vs. 17 T2MI/100000 hospitalizations in young non-obese patients, overall 0.04% in obese vs. 0.02% in non-obese, p&amp;lt;0.001). Multivariate analysis revealed higher odds of T2MI in obese than nonobese when adjusted for demographics (aOR 2.65, 95% CI:2.42-2.90, p&amp;lt;0.001) and social demographics with comorbidities (aOR 1.60, 95% CI:1.24-2.07, p&amp;lt;0.001). In young obese, higher risk was found with advancing age (OR 1.07, 95% CI 1.03-1.11, p=0.001), in males than females (aOR 2.70, p&amp;lt;0.001), and blacks (aOR 2.22, p=0.011) and Native Americans (OR 3.91, 95% CI: 1.13-13.49, p=0.011) vs whites. Comorbidities including chronic obstructive pulmonary disease (OR 1.86), chronic kidney disease (CKD, OR 2.36), rheumatoid arthritis/collagen vascular disease (RA/CVD, OR 3.04) Iin young obese patients independently increased the risk of T2MI hospitalizations [Table 1]. The T2MI-obese cohort had a significantly higher rate of hyperlipidemia, hypertension, diabetes, COPD, and prior history of MI and TIA/stroke compared to the T2MI-nonobese cohort [Table 2]. Conclusion This nationwide analysis revealed a significantly higher risk of T2MI in young obese patients compared to nonobese after excluding patients with concomitant diagnoses of T1MI. Males, blacks compared to females and whites, and comorbidities including COPD, CKD and RA/CVD predicted a higher risk of T2MI in young obese patients. Future studies are warranted to evaluate the role of higher body mass index in myocardial oxygen demand-supply mismatch and short-term/long-term risk and outcomes of T2MI.

Nationwide frequency, risk and outcomes of type-2 myocardial infarction in patients with versus without previously revascularized myocardial infarction (type 1)

Abstract Funding Acknowledgements Type of funding sources: None. Background Type 2 myocardial infarction (T2MI), due to a mismatch between myocardial oxygen demand and supply, is being increasingly recognized with improved diagnostics. The upsetting concern of developing T2MI in patients with prior revascularized occlusive acute myocardial infarction (AMI) or type 1 MI (T1MI) makes it crucial to define the clinical profile and outcomes of T2MI in revascularized patients of ACS. Purpose To determine the risk and prognosis of T2MI in patients who had previously had coronary revascularization (PCI or CABG) Methods We used the National Inpatient Sample (2018) dataset from the United States to identify T2MI adult hospitalizations using ICD-10 codes and define our study arm as T2MI excluding secondary T1MI diagnoses but having prior revascularized (with percutaneous coronary intervention or coronary artery bypass grafting) AMI. We then compared demographics and comorbidities in T2MI cohort with vs without personal history of revascularized AMI. We used multivariate analysis to study the odds of T2MI hospitalizations with prior revascularized AMI and in-hospital outcomes (all-cause mortality, cardiogenic shock and resource utilization) adjusting for confounders. Results There were 33155 T2MI adult hospitalizations after excluding AMI (median age 71 years, 50.6% male, 67.3% white); 1435 (4.3%) had previously revascularized AMI. T2MI in the study arm had higher chances of hospitalization with prior revascularized AMI when adjusted for socio-demographics (aOR 6.92, 95% CI:6.50-7.36, p&amp;lt;0.001) and socio-demographics with comorbidities (aOR 5.70, 95%CI: 5.48-5.94, p&amp;lt;0.001) (Table 1). Study arm often had elderly (≥65 years old, 78.4% vs 65.8%), male (66.6% vs 49.9%), white (76.7% vs 66.9%), upper socio-economic class (20.2 vs 16.8%), patients who were often admitted to non-electively (99.3 vs 97.1%) and to rural (10.5 vs 9.3%) hospitalizations compared to control arm. The study arm had a significantly higher prevalence of diabetes mellitus, hyperlipidemia, peripheral vascular disease, chronic obstructive pulmonary disease, renal failure, deficiency anemias, prior TIA/stroke, depression and smoking. T2MI cohort with prior revascularized AMI did not show any significant association with in-hospital all-cause mortality (1.7 vs 3.0%, aOR 0.49, 95%CI 0.18-1.34, p=0.164) and cardiogenic shock (1.7% vs 2.1%, p=0.399) however, had lower hospital expenditure (median USD 31273 vs 36567) and fewer transfers to other facilities (19.5 vs 22.1%) than those without prior revascularized AMI (Table 2). Conclusion Population-based analysis of this nationally representative sample revealed up to six times higher risk of developing T2MI in patients with prior history of AMI (revascularized) but without any significant impact on all-cause in-hospital mortality or cardiogenic shock. Future studies are warranted to assess the short-term/long-term outcomes of T2MI in high risk patient population with previously revascularized AMI.

Frailty as a Predictor of In-Hospital Outcome in Patients with Myocardial Infarction.

(1) Background: Frailty is a condition associated with aging, co-morbidity, and disability. We aimed to investigate the relationship between frailty and in-hospital outcome in patients with myocardial infarction (MI), including the occurrence of delirium, hospital-acquired pneumonia (HAP), and length of hospital stay. (2) Methods: We analyzed 55 patients ≥ 75 years old with ST-elevation and non-ST-elevation MI. Assessment with Abbreviated Mental Test Score (AMTS), Activity of Daily Living (ADL), Instrumental Activity of Daily Living (IADL) and Clinical Frailty Scale (CFS) was performed. (3) Results: In ROC analysis, IADL and CFS presented good predictive values for the occurrence of delirium (AUC = 0.81, p = 0.023, and AUC = 0.86, p = 0.009, respectively). For predicting HAP, only AMTS showed a significant value (AUC = 0.69, p = 0.036). In regression analyses, all tests presented significant predictive values for delirium. For predicting HAP, only IADL and CFS presented significant values (in an analysis adjusted for age, gender and type of MI). Frail patients (≥5 points in CFS) had longer hospital stays (10 days IQR: 8–17 vs. 8 days IQR: 7–10; p = 0.03). (4) Conclusions: While recognizing the limitations of our study associated with the relatively low sample size, we believe that our analysis shows that frailty is a predictor of poorer in-hospital outcomes in patients with MI, including higher rates of delirium, HAP and longer hospital stay.

Inpatient myocardial perfusion imaging characteristics of patients admitted with suspected type 2 myocardial infarction

Abstract Funding Acknowledgements Type of funding sources: None. Background ESC defines a type 1 myocardial infarction (T1MI) as "MI caused by atherosclerotic coronary artery disease and usually precipitated by atherosclerotic plaque disruption" and type 2 myocardial infarction (T2MI) as "ischaemic myocardial injury in the context of a mismatch between oxygen supply and demand". In practice it can be difficult to differentiate between MI types and the role of myocardial perfusion imaging (MPI) in making this distinction remains unclear. Purpose To establish whether suspected T2MI has different characteristics on MPI compared to suspected T1MI. Methods All inpatient MPI scans at our institution between 01/03/2018 and 28/02/2020 were retrospectively reviewed. Patients were excluded if they had a previous diagnosis of coronary artery disease, an invasive coronary angiogram prior to MPI, or a maximal troponin T &amp;lt; 14ng/l. Diagnoses were categorised based on review of scan request information. Echocardiography images were reviewed if within 30 days of MPI. Results 58 patients were included: 28 with suspected type 2 MI and 30 with suspected type 1 MI (mean age 70 vs. 75). There was no statistically significant difference in maximal troponin T between groups (T2MI 394.0 ng/l, T1MI 415.6 ng/l; p=0.90). 50% T2MI patients and 53% T1MI patients had a territorial defect on MPI (fully reversible defect 25% vs. 17%, partially reversible defect 7% vs. 33%, irreversible defect 14% vs. 3% for T2MI vs T1MI respectively). 25% T2MI patients had an area &amp;gt;10% LV myocardium volume showing reversibility, compared with 33% T1MI (p=0.49). Both groups had similar proportions of left ventricular (LV) impairment (both had 65% of patients with normal LV ejection fraction) and prevalence of regional wall motion abnormalities ((RWMA) 39% for T2MI, 35% for T1MI, p=0.76) on echocardiography. Conclusions A clinically significant proportion of the suspected T2MI group had territorial ischaemia. Additionally, both patient groups demonstrated similar proportion of patients with reversible ischaemia and of LV systolic dysfunction. Therefore differentiation between T2MI and T1MI can be challenging both clinically and with MPI. Prospective studies are required to establish the optimal methods for making the distinction between types of MI.

Abstract 227: Long Term Outcomes In Patients With Type 2 Myocardial Infarction With And Without Significant Change In Troponin Levels

Background: It is well known that morbidity and mortality are higher in patients with Type 2 Myocardial Infarction (T2MI) compared to Type 1 MI. Few studies have compared outcomes in T2MI patients with significant increase in troponins (Tpn) (Myocardial infarction [Inf]) vs Tpn elevation with no or an insignificant Tpn increase (Myocardial Injury [Inj]). Method: Single center retrospective observational study evaluating patients admitted with an elevated Tpn-I and no evidence of obstructive coronary artery disease. Inj was defined as &lt;50% increase if Tpn-I ≤ 1.0 ng/mL or &lt;20% increase if Tpn-I &gt; 1.0 ng/mL. Inf was defined as Tpn increase ≥ 50% if Tpn-I ≤ 1.0 ng/mL or ≥ 20% increase if Tpn-I &gt; 1.0 ng/mL. Primary outcome was a composite of all-cause mortality, coronary revascularization, or admission for heart failure within 1 year. Results: The study included 3,123 patients with a hospital admission between March 2019 to September 2019: 1609 patients with Inj and 1514 patients with Inf. Adjusted primary outcome was higher with Inf than Inj (p=0.02), as was revascularization (p=0.0017). Readmission for heart failure was not significantly different (p=0.26). Risk factors for primary outcomes (history of stroke, diabetes, ESRD, hypertension, and heart failure) were higher in the Inj group with lower primary outcomes. (Table) Conclusion: Patients with T2MI (Inf pattern of Tpn) are more likely to have an adverse outcome within 1 year than patients with Inj. Clinical Implications: True T2MI (rise in Tpn) are more likely to have an adverse outcome and require catherization than patients with flat Tpn elevation who are more likely to have heart failure.

Brief Report: Insomnia and Risk of Myocardial Infarction Among People With HIV.

Insomnia is common among people with HIV (PWH) and may be associated with increased risk of myocardial infarction (MI). This study examines the association between insomnia and MI by MI type among PWH. Longitudinal cohort study of PWH at 5 Centers for AIDS Research Network of Integrated Clinical Systems sites. Clinical data and patient-reported measures and outcomes from PWH in care between 2005 and 2018 were used in this study. Insomnia, measured at baseline, was defined as having difficulty falling or staying asleep with bothersome symptoms. The Centers for AIDS Research Network of Integrated Clinical Systems centrally adjudicates MIs using expert reviewers, with distinction between type 1 MI (T1MI) and type 2 MI (T2MI). Associations between insomnia and first incident MI by MI type were measured using separate Cox proportional hazard models adjusted for age, sex, race/ethnicity, traditional cardiovascular disease risk factors (hypertension, dyslipidemia, poor kidney function, diabetes, and smoking), HIV markers (antiretroviral therapy, viral suppression, and CD4 cell count), and stimulant use (cocaine/crack and methamphetamine). Among 12,448 PWH, 48% reported insomnia. Over a median of 4.4 years of follow-up, 158 T1MIs and 109 T2MIs were identified; approximately half of T2MIs were attributed to sepsis or stimulant use. After adjustment for potential confounders, we found no association between insomnia and T1MI (hazard ratio = 1.05, 95% confidence interval: 0.76 to 1.45) and a 65% increased risk of T2MI among PWH reporting insomnia compared with PWH without insomnia (hazard ratio = 1.65, 95% confidence interval: 1.11 to 2.45). PWH reporting insomnia are at an increased risk of T2MI, but not T1MI, compared with PWH without insomnia, highlighting the importance of distinguishing MI types among PWH.

Abstract 164: Impact Of Chronic Kidney Disease On The Risk And Outcomes Of Type-2 Myocardial Infarction In Geriatric Patients With Prior Bypass Grafting

Background: Coronary artery disease associates with increasing age and correlates with CABG being more common in elderly. However, prognostic data of ischemic events post-CABG is limited especially in geriatric patients who are underrepresented in clinical-trials. Furthermore, CKD accelerates coronary atherosclerosis and although treatment practices improved, incidence of ischemic events remain high due to oxygen supple-demand mismatch. Thus, we aim to evaluate impact of CKD on risk of Type-2 Myocardial Infarction (T2MI) in geriatric patients post-bypass grafting. Methods: Data from National Inpatient Sample (2018) was used to identify T2MI-related hospitalizations in geriatric patients with prior history of CABG and CKD. Logistic regression was used to assess the odds of T2MI with CKD. In-hospital outcomes and co-morbidities were compared between CKD &amp; non-CKD cohorts. Results: T2MI-associated hospitalizations among studied population has higher odds when controlled for confounders (OR 1.48, 95%CI: 1.33-1.64, p&lt;0.001). The two cohorts, CKD(n=399485) vs non-CKD(n=676550), had comparable sociodemographics (Table 1b); age at admission (78 vs 77); males (70.6% vs 70%); race- white (77.9% vs 83.5%), black (8.7% vs 5.4%), Hispanic (7.8% vs 6.5%). The odds of adverse cardiac events (cardiac arrest, cardiogenic shock, and dysrhythmia), all-cause mortality, and hospital length-of-stay was higher in CKD cohort with an exception for stroke (Table 1c). Statistical significance was observed (p&lt;0.001) for all co-morbidities (except age) and outcomes. Conclusion: CKD confers an increased risk of T2MI-related hospitalizations and adverse in-hospital outcomes in geriatric patients post-bypass grafting. It finds significance in the need to mitigate risk factors of T2MI and adopt appropriate treatment practices in this population subset.

A-56 | Epidemiological Trends in Type 2 Compared with Type 1 Myocardial Infarction: A National Inpatient Sample Database Analysis (January 2018 to December 2019)

Type 2 myocardial infarction (T2MI) was designated as a unique pathophysiologic entity in 2007. Compared with type 1 MI (T1MI), the clinical phenotype, outcomes, and epidemiological trends of T2MI are poorly understood.