Type Of MI Research Articles

Increased arterial stiffness during acute myocardial infarction results in adverse cardiac remodelling: a two year follow-up study

Abstract Increased arterial stiffness is associated with adverse cardiac events. However, it not clear whether increased arterial stiffness at the early phase of acute myocardial infraction (AMI) is associated with adverse left ventricular remodelling. Methods We examined 80 patients with STEMI (53±16 years, 80% male, 42% anterior AMI, LVEF=49±15%) after successful revascularisation by echocardiography 48h after admission and 2 years after the index event. We measured a) left-ventricular end-diastolic (LVEDV) and end-systolic volumes (LVESV) using the Simpson Method b) global longitundinal strain (GLS) by speckle tracking imaging c) carotid-femoral pulse wave velocity (PWV, augmentation index and central Aortic pressures by Complior apparatus d) The ratio of PWV/GLS as a marker of ventricular-arterial interaction. Results LVEDV and LVESV were decreased while GLS was improved after the 2-year follow-up period (from 103.3±30 to 89.1±37ml, p=0.004, 58.3±25 to 57.6±25, p=0.05, −16.1±4.7 to 17.5±3.2%, p=0.03 respectively). Baseline PWV, GLS and the ratio PWV/GLS were associated with the percent change of LVESV at 2 years (p=0.033, p=0.04 and p=0.035 respectively) after adjustment for type of MI (anterior vs other location), baseline troponin blood pressure and medication. Patients with PWV >10.6 m/s (upper tercile) had similar baseline LVESV (56.5±18 to 57.2±24 ml, p=0.8) but higher LVESV at 2 years follow-up (74.4±35 to 55.9±24 ml, p=0.03) resulting in a greater percent increase of LVESV compared to patients with baseline PWV <10.6m/s (+26% vs −5% p=0.012). Conclusion Increased arterial stiffness in the early phase of AMI impairs ventricular-arterial coupling resulting in adverse LV remodeling despite successful revascularization. Funding Acknowledgement Type of funding source: None

Impact of concentration of apelin-13 and chosen proangiogenic factors on the left ventricle function in echocardiographic assessment after myocardial infarction

Abstract Introduction Myocardial infarction (MI) is one of the main factors of heart failure (HF) development, therefore it is essential to search possibilities of prevention of its occurance in that condition. Purpose The study aimed to determine the association between serum concentrations of apelin-13, vascular endothelial growth factor-A (VEGF-A), angiopoietin-1 (Ang-1), angiopoietin-2 (Ang-2) and systolic function of the left ventricle after MI. Methods Study group included 67 consecutive patients with acute MI (STEMI and NSTEMI) and lack of previous diagnosis of systolic HF. Venous blood samples were drawn prior to coronary intervention, on the third and fifth day of MI. The blood samples were centrifuged (3000g /15 minutes), serum was frozen and stored at −80°C before further analysis. Concentrations of the studied substances were determined by ELISA tests. Ejection fraction (Simpson's method) and mass (linear method) of the left ventricle were calculated in echocardiographic examination on the fifth day of MI. Cut off values for impaired left ventricular ejection fraction (LVEF) were 54% (women) and 52% (men). The concentrations of the studied factors were indexed to the left ventricle mass. In statistical analysis Mann-Whitney test and the logistic regression were used. Two models for proper LVEF occurance were tested. 1st model included time from pain onset to coronary intervention, type of MI, sex, eptifbatide use and heparin total dose; 2nd model included hypertension, diabetes mellitus, BMI, LDL concentration, smoking and age; each model included indexed concentration of one of the studied factors. Results STEMI was diagnosed in 45 (67%) patients. 53 patients (79%) did not achieve normal LVEF. Persons with normal LVEF exhibited statistically significant higher value of indexed concentrations of apelin-13 and VEGF-A on the first (respectively p=0.02 and p=0.03) and fifth (respectively p=0.004 and p=0.03) day of MI. In the logistic regression, odds ratio (OR) of indexed apelin-13 from the fifth day of MI, in the 1st model was 1.36 (95% CI: 1.04–1.78, p=0.02) and in the 2nd model was 1.43 (95% CI: 1.11–1.84, p=0.01); OR of indexed VEGF-A from the fifth day, in the 2nd model, was 13.65 (95% CI: 1.18–158.11, p=0.03). Indexed VEGF-A from the fifth day in the 1st model and indexed concentrations of both factors from the first day, notwithstanding type of model, did not obtain statistically significant OR. In the logistic regression inluded only indexed apelin-13 and VEGF-A from the fifth day of MI, OR was respctively 1.54 (95% CI: 1.15–2.06, p=0.003) and 22.39 (95% CI: 1.68–298.59, p=0.02). Ang-1 and Ang-2 did not exhibit statistically significant impact on LVEF. Conclusions Apelin-13 and VEGF-A exhibit properties, which may prevent deterioration of LVEF and thus avoid HF in patients with MI. Dose adjustment should be based on the left ventricle mass. Optimal time of administration of both substances is an issue of further studies. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Medical University of Silesia

Outcomes in patients with acute myocardial infarction and a history of illicit drug use: a nationwide analysis

Abstract Background Several reports suggest that illicit drug use may be a major cause of acute myocardial infarction (AMI) independently of smoking habits, and associated with a poorer prognosis. Purpose We sought to determine the frequency of history of illicit drug use in an AMI population and its impact on short- and mid-term prognosis. Methods Based on the administrative hospital-discharge database, we collected information for all patients treated with AMI between 2010 and 2018 in France. We identified patients with history of illicit drug use and the adverse outcomes were investigated during follow-up. Results Among 797,212 patients with ST-segment elevation myocardial infarction (STEMI) or non-STEMI (mean age 69 years, 66% male), 3827 patients (0.5%) had a known history of illicit drug use (cannabis, cocaine or opioid). Patients with illicit drug use were younger and had less comorbidities. They presented more frequently with STEMI and anterior localization compared to those with no history of illicit drug use. In univariate analysis, patients with illicit drug use had lower short-term mortality rates compared to those without history of illicit drug use: 4.9% vs 10.1% at one month (p<0.0001), respectively. However, this might be attributed to a younger age at the time of presentation. Using logistic multivariable analysis with adjustment on age, gender, other cardiovascular and non-cardiovascular comorbidities, type and localisation of MI and procedures of revascularization, history of illicit drug use was associated with a non-significant higher risk of death at one year (adjusted odds ratio OR 1.12 95% CI 0.98–1.29). This trend was supported by a significantly higher risk of death at one year in patients with a history of opioid use (OR 1.27 95% CI 1.04–1.29, p=0.01). Conclusion In a large and systematic nationwide analysis of patients with AMI, history of illicit drug use was associated with a non-significant higher overall odds of mortality, which was significant among those with opioid use. Funding Acknowledgement Type of funding source: None

The Lipid Paradox is present in ST-elevation but not in non-ST-elevation myocardial infarction patients: Insights from the Singapore Myocardial Infarction Registry

Lowering low-density lipoprotein (LDL-C) and triglyceride (TG) levels form the cornerstone approach of cardiovascular risk reduction, and a higher high-density lipoprotein (HDL-C) is thought to be protective. However, in acute myocardial infarction (AMI) patients, higher admission LDL-C and TG levels have been shown to be associated with better clinical outcomes - termed the ‘lipid paradox’. We studied the relationship between lipid profile obtained within 72 hours of presentation, and all-cause mortality (during hospitalization, at 30-days and 12-months), and rehospitalization for heart failure and non-fatal AMI at 12-months in ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) patients treated by percutaneous coronary intervention (PCI). We included 11543 STEMI and 8470 NSTEMI patients who underwent PCI in the Singapore Myocardial Infarction Registry between 2008–2015. NSTEMI patients were older (60.3 years vs 57.7 years, p < 0.001) and more likely to be female (22.4% vs 15.0%, p < 0.001). In NSTEMI, a lower LDL-C was paradoxically associated with worse outcomes for death during hospitalization, within 30-days and within 12-months (all p < 0.001), but adjustment eliminated this paradox. In contrast, the paradox for LDL-C persisted for all primary outcomes after adjustment in STEMI. For NSTEMI patients, a lower HDL-C was associated with a higher risk of death during hospitalization but in STEMI patients a lower HDL-C was paradoxically associated with a lower risk of death during hospitalization. For this endpoint, the interaction term for HDL-C and type of MI was significant even after adjustment. An elevated TG level was not protective after adjustment. These observations may be due to differing characteristics and underlying pathophysiological mechanisms in NSTEMI and STEMI.

TEMPORAL TRENDS IN INCIDENCE OF CARDIOGENIC SHOCK, REVASCULARIZATION, AND OUTCOMES OF STEMI FROM 2005-16

This study aimed to assess trends in outcomes associated with the type of ST-elevation myocardial infarction (STEMI). The principal diagnosis from the data of the US National Inpatient Sample 2005-16 was used to identify and stratify STEMI patients according to the type of MI into the anterior wall

2212Body mass index and its association to cardiovascular outcomes in patients with stable coronary heart disease - experiences from the STABILITY study

Abstract Background Obesity, assessed as body mass index (BMI), is an established risk factor for development of coronary heart disease (CHD). However, in patients with heart failure and atrial fibrillation there is an “obesity paradox” with better prognosis among obese patients. The association between BMI and cardiovascular outcomes in patients with stable CHD is unclear. Methods The prospective STABILITY trial included 15,828 patients with stable CHD with a follow-up of 3–5 years (median 3.7) on optimal secondary preventive treatment. BMI and waist circumference were measured at baseline (n=15,785). All cardiovascular outcomes were centrally adjudicated. Associations between obesity indices and outcomes were evaluated by multivariable Cox regression analyses with adjustments for age, sex, study treatment, and clinical risk factors. Results Mean age was 64 years and 19% were females. In total, 3250 (20.9%) patients had BMI &lt;25, 6628 (42.8%), BMI &gt;25 and &lt;30 and 5614 (36.3%), BMI &gt;30. Underweight (BMI &lt;18.5) was seen in 79 patients. Most risk markers (diabetes, hypertension, and levels of inflammatory biomarkers and triglycerides) showed a graded association with higher BMI. The frequency of smoking and levels of HDL, GDF-15 and NT-proBNP were higher at lower BMI. Lower BMI was associated with an increased risk of MACE, total and CV death, and heart failure (Figure). Higher BMI was associated with increased risk of the same outcomes and also with MI. BMI was not associated with the risk of stroke. There was no interaction with age, sex, diabetes or type of MI (type 1 vs type 2–5). Associations between waist circumference and outcomes were weaker and not significant in the fully adjusted model. Figure 1 Conclusion In patients with stable CHD on optimal secondary prevention BMI had a U-shaped association with the risk of MACE, death, and heart failure and a linear association with the risk of MI. The lowest risk for MACE was seen for BMI between 25 and 30, considered as overweight. The findings do not support current recommendations to achieve an ideal BMI of 20–25 for weight adjustments in patients with CHD. Acknowledgement/Funding The original STABILITY study was funded by GlaxoSmithKline

CORRELATION OF ABNORMAL ANKLE-BRACHIAL INDEX WITH SEVERITY OF CORONARY ARTERY DISEASE IN PATIENTS HOSPITALIZED FOR ACUTE MYOCARDIAL INFARCTION

Objective: The coexistence of peripheral artery disease in patients with coronary artery disease (CAD) has been associated with a poor cardiovascular outcome. The aim of this study was to assess the usefulness of ankle-brachial index (ABI) assessment in predicting the severity of coronary artery disease in patients with acute myocardial infraction (AMI). Design and method: We studied 101 patients [77.2% male; mean age 60.9 years; 63.4% hypertensives; 24.8% with diabetes mellitus (DM)] who were hospitalized because of ST-elevation MI (STEMI, 51.5%) and Non-ST–elevation MI (NSTEMI). All patients underwent baseline estimation of clinical and laboratory parameters during their hospitalization. The ABI was measured according to established methodology using a certified automated device and abnormal ABI was defined as a value <0.9. Severity of CAD was estimated by the number of affected main vessels. Results: In the entire population, mean ABI was 1.11 ± 0.19, while 15.8% of patients had abnormal ABI. NSTEMI patients compared to those with STEMI demonstrated relatively lower ABI (1.07 ± 0.18 vs 1.12 ± 0.16; p = 0.144) and had more often abnormal ABI (22.4% vs 9.6%; p = 0.103). Using univariate analysis in the entire population, severity of CAD was correlated with age (r = 0.133; p = 0.053), history of DM (r = 0.225; p = 0.01), abnormal ABI (r = 0.242; p = 0.015) and ABI value (r = 0.214; p = 0.029). In multivariate regression models, both ABI value (b = 0.212; p = 0.037) and abnormal ABI (b = 0.224; p = 0.036) remained significant predictors of CAD severity independently of gender, age, DM, smoking, low density lipoprotein (LDL-C), 24-h systolic BP and the type of MI. Conclusions: Estimation of ABI managed to predict multivessel CAD in patients with AMI. These findings in patients with ACS scheduled to undergo a cardiac catheterization may raise the suspicion of advanced disease, alerting the need for more aggressive diagnostic and therapeutic strategies.

Atherothrombotic risk stratification after acute myocardial infarction: The Thrombolysis in Myocardial Infarction Risk Score for Secondary Prevention in the light of the French Registry of Acute ST Elevation or non-ST Elevation Myocardial Infarction registries.

BackgroundGuidelines recommend using risk stratification tools in acute myocardial infarction (AMI) to assist decision‐making. The Thrombolysis in Myocardial Infarction Risk Score for Secondary Prevention (TRS‐2P) has been recently developed to characterize long‐term risk in patients with MI.HypothesisWe aimed to assess the TRS‐2P in the French Registry of Acute ST Elevation or non‐ST elevation MI registries.MethodsWe used data from three 1‐month French registries, conducted 5 years apart, from 2005 to 2015, including 13 130 patients with AMI (52% ST‐elevation myocardial infarction [STEMI]). Atherothrombotic risk stratification was performed using the TRS‐2P score. Patients were divided in to three categories: G1 (low‐risk, TRS‐2P = 0/1); G2 (intermediate‐risk, TRS‐2P = 2); and G3 (high‐risk, TRS‐2P ≥ 3). Baseline characteristics and outcomes were analyzed according to TRS‐2P categories.ResultsA total of 12 715 patients (in whom TRS‐2P was available) were included. Prevalence of G1, G2, and G3 was 43%, 24%, and 33% respectively. Clinical characteristics and management significantly differed according to TRS‐2P categories. TRS‐2P successfully defined residual risk of death at 1 year (C‐statistic 0.78): 1‐year survival was 98% in G1, 94% in G2, and 78.5% in G3 (P < 0.001). Using Cox multivariate analysis, G3 was independently associated with higher risk of death at 1 year (hazard ratio [HR] 4.61; 95% confidence interval [CI]: 3.61‐5.89), as G2 (HR 2.08; 95% CI: 1.62‐2.65) compared with G1. The score appeared robust and correlated well with mortality in STEMI and NSTEMI populations, as well as in each cohort separately.ConclusionsThe TRS‐2P appears to be a robust risk score, identifying patients at high risk after AMI irrespective of the type of MI and historical period.

Atherothrombotic risk stratification after acute myocardial infarction: The TIMI Risk Score for Secondary Prevention (TRS-2P) in the light of the FAST-MI registries

Guidelines recommend risk stratification tools for use in acute myocardial infarction (AMI) to assist decisions making. Few tools are, however, available to assist with decisions on long-term response to treatment. Thrombolysis In Myocardial Infarction (TIMI) Risk Score for Secondary Prevention (TRS-2P) has been recently propose for this indication. We aimed to assess the TRS-2P and to identify high-risk patients after AMI in the FAST-MI registries. We used data from 3 one-month French registries, conducted 5 years apart, from 2005 to 2015, including 13,130 patients with AMI [52% ST-elevation myocardial infarction (STEMI)] admitted to cardiac intensive care units. Atherothrombotic risk stratification was performed using the TRS-2P score. Patients were divided in 3 categories: G1 (Low-risk; TRS-2P = 0/1); G2 (Intermediate-risk; TRS-2P = 2); and, G3 (High-risk; TRS-2P ≥ 3). Baseline characteristics and outcomes were analyzed according to TRS-2P categories. A total of 12,715 patients (in whom TRS-2P was available) were included in this analysis. Prevalence of G1, G2, and G3 was 43%, 24% and 33% respectively. Clinical characteristics and management significantly differ according to TRS-2P categories. TRS-2P score successfully defined residual risk of death at one-year (C-statistic 0.78): 1-year survival was 98% in G1, 94% in G2, and 78.5% in G3 ( P < 0.001). Using Cox multivariate analysis, G3 was associated with higher rate of death at 1-year (HR = 4.61; 95% CI: 3.61–5.89), as G2 (HR = 2.08; 95% CI: 1.62–2.65) compared to G1. The score appeared robust and correlated well with mortality in STEMI and non-ST-elevation myocardial infarction (NSTEMI) populations, as well as in each cohort separately. The TRS-2P appears to be a robust risk score, identifying patients at high-risk after AMI irrespective of the type of MI and historical period.

Increased Physical Activity Post-Myocardial Infarction Is Related to Reduced Mortality: Results From the SWEDEHEART Registry.

BackgroundWith increasing survival rates among patients with myocardial infarction (MI), more demands are placed on secondary prevention. While physical activity (PA) efforts to obtain a sufficient PA level are part of secondary preventive recommendations, it is still underutilized. Importantly, the effect of changes in PA after MI is largely unknown. Therefore, we sought to investigate the effect on survival from changes in PA level, post‐MI.Methods and ResultsData from Swedish national registries were combined, totaling 22 227 patients with MI. PA level was self‐reported at 6 to 10 weeks post‐MI and 10 to 12 months post‐MI. Patients were classified as constantly inactive, increased activity, reduced activity, and constantly active. Proportional hazard ratios were calculated. During 100 502 person‐years of follow‐up (mean follow‐up time 4.2 years), a total of 1087 deaths were recorded. Controlling for important confounders (including left ventricular function, type of MI, medication, smoking, participation in cardiac rehabilitation program, quality of life, and estimated kidney function), we found lower mortality rates among constantly active (hazard ratio: 0.29, 95% confidence interval: 0.21–0.41), those with increased activity (0.41, 95% confidence interval: 0.31–0.55), and those with reduced activity (hazard ratio: 0.56, 95% confidence interval: 0.45–0.69) during the first year post‐MI, compared with those being constantly inactive. Stratified analyses indicated strong effect of PA level among both sexes, across age, MI type, kidney function, medication, and smoking status.ConclusionsThe present article shows that increasing the PA level, compared with staying inactive the first year post‐MI, was related to reduced mortality.

ATRIO-VENTRICULAR BLOCK

Objectives: The incidence of high degree atrioventricular block (HAVB) variesfrom 2.7 to 14% after acute STEMI. The aim of this study was to evaluate the incidence of highdegree atrioventricular block (HAVB) in patients of acute myocardial infarction. Study Design:Observational study. Setting: Sheikh Zayed Medical College/Hospital Rahim Yaar Khan. Period:March 2016 to May 2016. Material and Methods: Two hundred patients of acute myocardialInfarction were included in this study. Patients suffering from 2nd degree Mobitz type II or 3rddegree heart block were labelled as High Degree Atrioventricular Block (HAVB). Data Analysiswas made using Statistical Package for Social Sciences Software V17. Chi-square test wasused to compare in-hospital mortality between the groups taking p-value &lt;0.05 as significantdifference. Results: The mean age of patients who presented with myocardial Infarction inour hospital was 50.13+6.97 years. Out of 200 patients, 35 (17.5%) were smokers, 83 (41.5%)hypertensives, 69 (34.5%) diabetics and 48 (24.0%) were with positive family history of IschemicHeart Disease. Most common type of MI was anterior wall present in 50.5% patients and 2ndmost common was inferior wall MI presented in 26.5% patients. High degree atrio-ventricularblock was present in 9 (4.5%) patients. In-hospital mortality was significantly high in patientswith HAVB, in these patients in-hospital mortality was 2 (22.2%) as compared to only 8 (4.2%)in patients of without HAVB (p-value 0.01). Conclusion: Myocardial infarction complicated withhigh degree atrio-ventricular block (HAVB) is associated with higher rate of in-hospital mortality

BLOOD PRESSURE VARIABILITY AND CLINICAL CHARACTERISTICS OF PATIENTS HOSPITALIZED FOR ACUTE MYOCARDIAL INFARCTION

Objective: The aim of the present study was to assess blood pressure variability (BPV) in patients hospitalized for acute myocardial infarction. Design and method: We studied 75 patients (76% males, age 65 ± 13 years) who were hospitalized because of ST-elevation myocardial infarction (STEMI) and Non ST–elevation myocardial infarction (NSTEMI). All patients underwent baseline estimation of clinical and laboratory parameters during their hospitalization. Additionally, BPV was estimated based on double daily measurements of BP during hospitalization and with 24-hour ambulatory BP monitoring during the third day of hospital stay. The parameters of BPV analyzed were: a) standard deviation (SD) of systolic BP (24-h, daytime and nighttime), b) SD of diastolic BP (24-h, daytime and nighttime) and c) the coefficient of variation (CV) of systolic BP (24-h, daytime) and d) the average real variability (ARV) of systolic and diastolic BP across 24-h. Results: From the total population, 20% had family history of cardiovascular events, 72% were hypertensives, 32% had diabetes, 51% were smokers and 32% had previous history of coronary artery disease. Regarding the type of myocardial infarction, 37% were admitted for STEMI and 55% had coronary revascularization. Focusing on the mean systolic and diastolic BP and their SD the values were 72 ± 6.1mmHg, 127 ± 11.4mmHg and 74.5 ± 6.5mmHg, respectively. From the ambulatory BP the daytime, nighttime and total SD of systolic BP was 11.3 ± 2.8mmHg, 9.8 ± 3.1mmHg and 11.7 ± 2.9mmHg, respectively. Moreover, ARV was 9.31 ± 2.1mmHg while CV was 10.21 ± 26 %. The type of MI (STEMI and NSTEMI) was significantly related to systolic and diastolic ARV (r = 0.29, p = 0.012 and r = 0.28, p = 0.014, respectively). Conclusions: In patients admitted for acute myocardial infarction there is a relationship between the ARV and the type of myocardial infarction. These findings suggest differential impact of hemodynamic load on the cardiovascular system in patients with STEMI and NSTEMI.

IN-HOSPITAL MORTALITY IN PATIENTS OF ST ELEVATION MI PRESENTING WITH RIGHT BUNDLE BRANCH BLOCK

Objective: To determine the frequency of in-hospital mortality of patients havingST elevation MI with right bundle branch block (RBBB) after giving emergencytreatment, within 72-hours of hospital admission. Methodology: This observational cross-sectional study was conducted fromFebruary to August 2012 in casualty and medical wards at National Institute ofCardiovascular Diseases Karachi. All consecutive patients with ST elevation MI(STEMI) having right bundle branch block were included. In hospital mortality ofevery patient was assessed during 72-hrs of in-hospital admission. Dataregarding age, gender, co-morbidities, type of ST elevation MI, type of emergencytreatment and in-hospital mortality were documented. Frequencies andpercentages of categorical variables, mean and standard deviation of continuousvariables were calculated using SPSS version 17. Results: Out of 120 patients 80.8% were males . Of all the patients 38.3% werediabetic, 35% were hypertensive, 33.3% were smokers and 25.0% were thosewho had no co morbidities. Acute anterior wall MI was found in 87.5%, inferiorwall MI in 6.7% and acute lateral wall MI was found in 3.3% patients while in 2.5%patients both anterior wall and lateral wall MI was found. The mean age of thepatients was 56.59±9.92 years. The mean duration of diabetes andhypertension was 13.72±6.49 years and 17.12±.6.96 years respectively.About 75% patients received streptokinase, and 25% were treated with primaryPCI. The overall mortality rate was 28(23.3%) patients mostly males 23(82.1%).Mortality was high in 61-70 years age group 16(57.1%) while no mortality wasobserved in age groups < 40 years. Mortality rate was high in smokers15(53.6%). Mortality in acute anterior wall myocardial infarction was 27(96.4%)and 01(3.6%) with anteriolateral wall MI. Mortality rate was very high in patientstreated with streptokinase 23(82.1%) as compared to primary PCI (p <0.05). Conclusion: In STEMI, RBBB was an independent predictor of high in-hospitalmortality. Patients who have RBBB accompanying anterior AMI at presentation orwho develop new BBB early after fibrinolytic therapy independently have highermortality than patients without these conduction abnormalities. Key Words: Myocardial Infarction, ST elevation myocardial infarction, Mortality,Right bundle branch block

MYOCARDIAL INFARCTION;

Objectives: To determine the frequency of new onset heart failure after acutemyocardial infarction and factors contributing it. Methods: A total of 228 patients were studiedfor occurrence of new onset clinical heart failure within24 hours after admission with anacute Myocardial Infarction. Clinical parameters were used to diagnose heart failure. Variousrisk factors were analyzed which contributed to occurrence of heart failure after MI. Patientsundergoing primary angioplasty were not included into this study as medical thrombolysis wasthe most common mode of therapy (in &gt;90% of patients). Results: Among the 228 patientsstudied 77.2 %( 176) were males and 22.8 %(52) were females. Mean age of the populationwas 56.3(±12.1) years. Women were relatively older on presentation as compared to men(mean age 58.9±10.9yr vs 55.5±12.3yr). Similarly mean age for NSTEMI was higher ascompared to STEMI (58.59±11.1 vs 54.2±12.6yr.). A total of36.8 %( 84) patients exhibitedclinical signs of heart failure within24 hours of their admission. These patients tend to be olderthan patients without HF (mean age 60±11years vs 54±12 years). Females after MI showed agreater frequency for going into HF as compared to males (42.3% vs 35.2% respectively). Nowregarding the association of HF with various factors it was seen that, having a previous historyof MI was found to be the strongest factor associated with occurrence of HF, with HF beingnearly three times more common in these patients (i.e. 73% vs 26.1%, p value &lt; 0.05). Thecurrent type of MI on presentation also showed a direct relationship with HF, being highest inpatients with NSTEMI (i.e. up to 50 %) followed by AWMI (35.5%) and lowest in inferior wall MI (pvalue &lt; 0.05). Diabetes, hypertension and smoking also showed a higher but statistically nonsignificantrelationship with HF development (41.2% vs 34.3%, 41% vs 32.2% and 44% vs 32%respectively p value &gt; 0.05). The blood pressure on presentation however was significantlyassociated with HF in these patients. Patients having high BP (&gt; 140/80) on presentationdepicted an overall higher incidence of HF as compared to patients having BP equal to or lessthan 140/80 (45.2% vs 31.3% p value &lt; 0.05). Conclusion: Heart failure is a fairly commonentity after acute MI, being the commonest in patients suffering an NSTEMI. Previous history ofan MI showed to be the strongest coexisting factor associated with HF.

English

Objectives: The incidence of high degree atrioventricular block (HAVB) varies from 2.7 to 14% after acute STEMI. The aim of this study was to evaluate the incidence of high degree atrioventricular block (HAVB) in patients of acute myocardial infarction. Study Design: Observational study. Setting: Sheikh Zayed Medical College/Hospital Rahim Yaar Khan. Period: March 2016 to May 2016. Material and Methods: Two hundred patients of acute myocardial Infarction were included in this study. Patients suffering from 2 nd degree Mobitz type II or 3 rd degree heart block were labelled as High Degree Atrioventricular Block (HAVB). Data Analysis was made using Statistical Package for Social Sciences Software V17. Chi-square test was used to compare in-hospital mortality between the groups taking p-value <0.05 as significant difference. Results: The mean age of patients who presented with myocardial Infarction in our hospital was 50.13+6.97 years. Out of 200 patients, 35 (17.5%) were smokers, 83 (41.5%) hypertensives, 69 (34.5%) diabetics and 48 (24.0%) were with positive family history of Ischemic Heart Disease. Most common type of MI was anterior wall present in 50.5% patients and 2 nd most common was inferior wall MI presented in 26.5% patients. High degree atrio-ventricular block was present in 9 (4.5%) patients. In-hospital mortality was significantly high in patients with HAVB, in these patients in-hospital mortality was 2 (22.2%) as compared to only 8 (4.2%) in patients of without HAVB (p-value 0.01). Conclusion: Myocardial infarction complicated with high degree atrio-ventricular block (HAVB) is associated with higher rate of in-hospital mortality

Diabetic Patients with an Acute Myocardial Infarction in Terms of Risk Factors and Comorbidities Management: Characteristics of the Highest-Risk Individuals.

Patients with diabetes mellitus (DM) and acute myocardial infarction (AMI) are heterogeneous individuals with different clinical status compared to patients without DM. The aim of this study was to analyze the group of diabetic patients with ST-segment elevation MI (STEMI) or non-ST-segment elevation infarction (NSTEMI) including risk factors, medical history, laboratory findings, advancement of coronary vessel atherosclerosis, and diagnostics and therapeutic modalities performed. A comparison of groups according to the type of MI was also made. The study involved all (n = 130) patients with DM and AMI, hospitalized in the Department of Cardiology, Medical University of Silesia, Katowice, in 2012. Clinical presentation, medical history, laboratory tests, imaging studies and additional tests as well as treatment management data were collected. Statistical analysis of the data obtained was performed using STATISTICA® software. Coronary angiography was performed in 120 subjects (92.3%). NSTEMI almost doubled STEMI occurrence in the study group (65.4% vs. 34.6%). Left main disease (LMD) was more often diagnosed in the NSTEMI subgroup of patients (14.1% vs. 6.7%). There were no significant differences between the compared groups as far as clinical presentation and comorbidities are concerned; more frequent previous PCI in NSTEMI patients was noticed, however (37.7% vs. 17.8%; p = 0.0195). The STEMI subgroup was characterized by higher leukocytosis (13.2 vs. 10.0 × 103/μL; p < 0.001) and serum glucose concentration (217 vs. 182 mg%; p = 0.001); they were also treated with invasive methods more frequently (95.5% vs. 75%; p < 0.001) and the left anterior descending artery was delivered with stents more frequently (63.3% vs. 48.7%; p = 0.0426). Patients with DM and AMI are burdened with metabolic disorders and numerous risk factors. They require aggressive diagnostics and therapy including new revascularization techniques and optimal medical treatment. Regardless of the type of AMI (STEMI or NSTEMI), the study group was homogeneous in terms of complaints, comorbidities and metabolic profile.

0111: Evolution of incidence and one-year outcomes of cardiogenic shock in acute myocardial infarction from 1995 to 2010. The FAST-MI programme

Cardiogenic shock (CS) at the acute stage of MI remains a major concern. Information on its incidence over the past 20 years is discrepant, and little is known of the evolution of long-term mortality over the years. We analysed the incidence and one-year mortality of CS in 4 nationwide French survey carried out 5 years apart from 1995 to 2010. Consecutive STEMI and NSTEMI patients (≤48 hours from onset) were recruited over one-month periods. Among 10610 patients included in the 4 surveys, 614 (5.8%) had CS. Incidence of CS decreased (6.9% in 1995; 4.0% in 2010, p<0.001), both for STEMI and NSTEMI. Pts with CS were older than those without (74±12 vs 66±14y); mean age of CS pts remained unchanged. In CS pts, use of PCI increased from 20% to 73%, and in STEMI patients with CS, reperfusion therapy increased from 40% to 72%. Thirty-day mortality (56.2% vs 4.3%) and one-year mortality (66.6% vs 10.3%) were considerably higher in CS pts. Over the 15-year period, one-year mortality decreased for both pts with (75% to 51%, P<0.001) and without CS (15% to 7%, P<0.001). By Cox multivariate analysis in the whole population, both time period and presence of CS were independent predictors of one-year mortality. In CS pts, age, diabetes, higher BMI and type of MI (STEMI), were independent correlates of increased one-year death, while time period was associated with reduced mortality (HR:2010 vs 1995=0.57; 95% CI: 0.40-0.83, along with early use of PCI and medications at the acute stage. In these 4 nationwide surveys conducted 15 years apart, the incidence of CS decreased and one-year mortality of CS patients significantly decreased. Although improved survival was associated with a broader use of PCI and appropriate medications at the acute stage, the fact that time period remained an independent predictor of improved outcomes suggests improved overall process of care.

Thyroxine in acute myocardial infarction (ThyrAMI) - levothyroxine in subclinical hypothyroidism post-acute myocardial infarction: study protocol for a randomised controlled trial.

BackgroundCardiac disease is the most common cause of morbidity and mortality in the United Kingdom. Even minor changes in thyroid hormone concentration may impact adversely on the cardiovascular system. Subclinical hypothyroidism (SCH) after admission for an acute cardiac problem has been associated with an increase in cardiac mortality and overall death. We have designed protocols for a prospective observational study to assess the association of thyroid function at the time of acute myocardial infarction (AMI) with cardiovascular outcomes, and a double-blinded randomised placebo-controlled trial of levothyroxine to evaluate its effect on LV function and vascular health.Methods/DesignThyrAMI 1: This will be a prospective longitudinal observational study of patients with AMI that will be followed for 24 months to study the association between thyroid status at the time of AMI (within 24 hours of diagnosis) with vascular outcomes.ThyrAMI 2: This will be a prospective double-blinded randomised placebo-controlled trial of levothyroxine of 12 months duration in patients with AMI and SCH.Setting: Patients will be recruited from five hospitals in the North East of England.Participants: One hundred patients with thyroid function tests within the subclinical hypothyroid range upon admission with an AMI and no previous history of thyroid disease.Intervention: Levothyroxine will be administered at a starting dose of 25 mcg once daily, which will be increased at intervals if needed to maintain a TSH level between 0.4 to 2.5 mU/L, versus a placebo.Randomisation: Participants will be randomized with a computerised randomisation algorithm, stratified by type of MI (NSTEMI versus STEMI), in a 1:1 ratio to levothyroxine therapy or placebo (as container or bottle numbers), starting within 21 (+/− 7) days of AMI.Blinding: Assignment to either the LT4 or placebo arm will be double-blinded.Outcomes: The outcome will be the effect of levothyroxine on ventricular function, endothelial function and blood coagulability and rheology.DiscussionThere is evidence to suggest that treatment of SCH can improve cardiovascular parameters. Therefore, ThyrAMI 1 and ThyrAMI 2 will be the first trials investigating SCH in AMI to give a better insight into whether thyroid hormone levels are a key target for improving cardiovascular outcomes.Trial registrationISRCTN number: ISRCTN52505169. Date of registration: 09/01/2015

English

MATERIAL AND METHODS: The study was conducted for a period of 1 year starting from November 2006 to October 2007. Total of 100 cases of AMI admitted to ICCU of VIMS, Bellary were studied with special reference to tachyarrhythmias RESULTS & CONCLUSION: Incidence of AMI was higher in 6 th decade, male preponderance with M:F = 3.7:1, most common risk factors being smoking -60%, HTN – 44% and Hyperlipidemia 35%. Most common type of MI was AWMI (58%), followed by IWMI (35%). Tachyarrhythmias were the most common complications during first week of AMI (62%), LVF (35%) and cardiogenic shock 11%. Sinus tachycardias, VPB, VT and VF were common in AWMI, among them Ventricular premature beats were the commonest tachyarrhythmias following AMI followed by sinus tachycardia, which was followed by ventricular tachycardia. Overall mortality was 21%, tachyarrhythmias contributed to 42.85% of total mortality. Among tachyarrhythmias highest mortality was with VF (100%) followed those wi th VT (27.3%).

The impact of economic growth and good governance on misery index in Iranian economy

Potentially Speaking, Iranian economy is one of the wealthiest one in Middle East and even among other developing countries in the region. In practice, however, mismanagement and bad governance of public sector and some other infrastructural shortcomings have led this economy to its current inefficient situation in which we face with one of the highest misery index, MI, along with one of the lowest economic growth rate in the world. This article is investigating this subject. At, one hand it is analyzing the relationship between misery index, MI, and economic growth in Iran, and at the other hand it studies the impact of governance on MI for 1974–2011 periods. To achieve this goal, vector autoregressive model has been used. We have also used the government effectiveness as a proxy for good governance, which, we think, is meaningful in Iranian case. By using dickey-fuller test the stability of variables, has been examined. We also have applied the Granger causality and Johnson test for considering the convergence among variables. One finding of this paper is that, economic growth has had negative relation with MI. Another result is that there is a significant relationship between type of governance and MI. For instance, during recent administration (2005–2011), we are encountering with the worst good governance indexes, the lowest economic growth, and the highest MI as well.