Uncomplicated Myocardial Infarction Research Articles

Return to Work after Uncomplicated Acute Myocardial Infarction

Return to Work after Uncomplicated Acute Myocardial Infarction

Proposal for initial management of uncomplicated ST elevation myocardial infarction in centers without percutaneous coronary intervention capacity in Peru

ST-segment elevation myocardial infarction (STEMI) is a clinical entity whose adequate treatment will depend on its prompt recognition, accurate diagnosis, and management in reperfusion networks. The first contact with these patients is generally done in centers without reperfusion capacity, attended by non-cardiologist doctors, and in centers far from hospitals with greater resolution capacity, something that is well known in our country. This manuscript proposes a strategy for the diagnosis and treatment of STEMI in centers without percutaneous coronary intervention capacity of the public health system in Peru, emphasizing not losing sight of electrocardiographic patterns compatible with coronary artery occlusion, adequate fibrinolysis and management of its complications, the treatment of infarction in special populations and highlighting the importance of the pharmacoinvasive strategy as the main form of reperfusion treatment in our country.

Hospital discharge after uncomplicated ST elevation acute myocardial infarction: How early is safe?

Abstract Background International guidelines recommend that hospital discharge within 48–72h is appropriate in selected low-risk patients admitted for ST elevation acute myocardial infarction (STEMI). Objectives To assess the safety of hospital discharge after 24 hours of admission in patients with uncomplicated STEMI submitted to primary percutaneous coronary intervention (PPCI). Methods We conducted a single-centre retrospective study enrolling consecutive patients admitted for STEMI from 2016 to 2018 submitted to PPCI. We defined clinically uncomplicated STEMI (UMI) as the absence of cardiorespiratory arrest, mechanical complications, tachy- and bradyarrhythmias, heart failure (Killip class > 1 [HF]), reinfarction and types 2 or 3 Bleeding Academic Research Consortium. Additionally, we included the criterion of preserved left preserved ejection fraction (LVEF>50%). Patients referred for coronary surgery (CABG) were excluded. Cumulative rates of death and clinical events defining UMI were reported at days 1, 2, 3, and 4. Death, clinical events defining UMI or repeat coronary revascularization at 1-year were reported after days 1, 2, 3, and 4. Results A total of 356 patients submitted to PPCI were included, with 64±14 years, 73% male. Median in-hospital stay was 4 [3;7] days. Applying UMI criteria we identified 271 patients (76%) in day-1, 249 (70%) in day-2, 244 (69%) in day-3, and 240 (67%) patients in day 4. Using UMI criteria, discharge after day 1 would be associated with 2.0% of early clinical events, 1.6% after day-2, and 1% after day-3. Post-discharge 1-year incidence of death, clinical events defining UMI or repeat coronary revascularization was roughly similar after day-2 (Table). Adding LVEF>50% to UMI, we identified 176 patients (49%) in day-1, 168 (47%) in day-2, 165 (46%) in day-3 and 164 (46%) in day-4. Discharge after day 1 would be associated with 1.8% of early clinical events, 0.6% after day-2 and 0.6% after day-3. Post-discharge 1-year incidence of death, clinical events defining UMI or repeat coronary revascularization was similar after day-2. Conclusions In our cohort of patients with STEMI submitted to PPCI, clinically uncomplicated criteria identified 69% of patients eligible for safe discharge after day-3. The addition of preserved left ventricular ejection fraction criterion can anticipate a safe discharge after day-2 in almost 50% of patients.

Growth differentiation factor-15 — a new indicator of unfavorable prognosis in uncomplicated myocardial infarction

Aim. To evaluate the role of growth differentiation factor-15 (GDF-15) in long-term prognosis in patients with uncomplicated myocardial infarction (MI).Material and methods. The study included 118 patients with uncomplicated ST-elevation and non-ST-elevation MI. In addition to the routine examination, all patients were analyzed for GDF-15, as well as the N-terminal pro-brain natriuretic peptide (NT-proBNP) by enzyme immunoassay in the first 48 hours from the onset of MI symptoms. The changes in the patients' condition were assessed by questioning after 1, 3, 6, 12 months, as well as the analysis of medical records in the event of repeated cardiovascular events and deaths. The endpoints were cardiovascular death, hospitalization for recurrent MI, and/or unstable angina. To assess the value of quantitative variables in predicting recurrent cardiovascular events, the ROC analysis was used. The survival function of patients was assessed using the Kaplan-Meier method.Results. Twelve-month follow-up revealed 29 recurrent cardiovascular events, including 2 deaths and 8 recurrent MIs. GDF-15 was predictive of recurrent cardiovascular events with a sensitivity of 77,3% and a specificity of 56,2% (ROCAUC, 0,7±0,065 (95% confidence interval (CI), 0,572-0,827), p=0,004). Patients with GDF-15 ≥2,075 ng/mL had a higher risk of recurrent cardiovascular events (hazard ratio (HR), 3,4 (95% CI, 1,342-8,613), p=0,005). Another prognostic factor influencing the rate of recurrent cardiovascular events was NT-proBNP. An NTproBNP level ≥578 pg/mL was associated with an increased risk of cardiovascular death and rehospitalization for unstable angina and recurrent MI (HR, 4,3 (95% CI 1,828-10,239), p=0,00019).Conclusion. The combined increase in GDF-15 ≥2,075 ng/mL and NT-proBNP ≥578 pg/mL in patients with uncomplicated MI increases the risk of recurrent cardiovascular events over the next 12 months (HR, 4,5 (95% CI, 2,087-9,736), p=0,00018).

The role of growth differentiation factor-15 in assessing the prognosis of patients after uncomplicated myocardial infarction

Aim To study the role of growth differentiation factor 15 (GDF-15) in the long-term prognosis for patients after uncomplicated myocardial infarction (MI).Material and methods This study included 118 MI patients aged <70 years with and without ST-segment elevation on electrocardiogram (ECG). All patients underwent an examination that included ECG, echocardiography, Holter ECG monitoring, routine laboratory tests, and tests for plasma N-terminal pro-brain natriuretic peptide (NT-proBNT) and GDF-15. GDF-15 was measured by ELISA. The dynamics of patients was evaluated by interviews at 1, 3, 6, and 12 months. The endpoints were cardiovascular death and hospitalization for recurrent MI and/or unstable angina.Results Median concentration of GDF-15 in MI patients was 2.07 (1.55; 2.73) ng/ml. No significant dependence was found between GDF-15 concentration and age and gender, MI localization, smoking, body weight index, total cholesterol, and low-density lipoprotein cholesterol. During 12-month follow-up, 22.8 % of patients were hospitalized for unstable angina or recurrent MI. In 89.6 % of all cases of recurrent events, GDF-15 was ≥2.07 ng/ml. For patients with GDF-15 in the upper quartile, the time dependence of recurrent MI was logarithmic. High concentrations of NT-proBNP in MI patients were also associated with increased risk of cardiovascular death and recurrent cardiovascular events [RR, 3.3 (95 % CI, 1.87-5.96), р=0.046].Conclusion A combination of GDF-15 and NT-proBNP at high concentrations significantly reflects an adverse prognosis for patients with uncomplicated MI within 12 months [RR, 5.4 (95 % CI, 3.4-8.5), р=0.004].

βeta blocker interruption after uncomplicated myocardial infarction: rationale and design of the randomized ABYSS trial

The long-term use of β-blocker after myocardial infarction (MI) when global left ventricular ejection fraction (LVEF) is preserved has not been studied in the era of modern myocardial reperfusion and secondary prevention therapies. It is unknown whether β-blockers are useful in stable post-MI patients without reduced LVEF and without heart failure. The Assessment of β-blocker interruption 1 Year after an uncomplicated myocardial infarction on Safety and Symptomatic cardiac events requiring hospitalization (ABYSS) Trial enrolled in 49 centers in France, 3,700 patients with a prior (>6 months) history of MI and a LVEF >40%, chronically treated with a β-blocker and without any major cardiovascular event (MACE) in the past 6 months. These patients were randomized to interruption or continuation of their β-blocker therapy. The primary objective is to demonstrate the noninferiority of interruption vs continuation of the β-blocker therapy on the primary composite endpoint of all-cause death, stroke, MI, hospitalization for any cardiovascular reason at the end of follow-up (accrual follow-up) with a one-year minimum follow-up for the last randomized patient. Secondary objectives will focus on patient reported outcomes with the evaluation of the quality of life before and after randomization with the EQ5D-5L questionnaire. Enrolment has been completed. The ABYSS trial evaluates the cardiovascular safety of β-blocker interruption in stabilized post-MI patients without heart failure nor reduced LVEF. ABYSS trial is a reappraisal of β-blockers life-long therapy in stable post-MI patients without reduced LVEF. NCT03498066 (clinicaltrials.gov).

Length of stay and 30 day mortality in patients suffering an uncomplicated ST-elevation myocardial infarction treated with primary percutaneous coronary intervention in New York State

We studied the duration of hospitalization and clinical outcome of patients with an uncomplicated STEMI (ST-elevation myocardial infarction) treated with primary percutaneous coronary intervention (PCI) in New York State between 2007 and 2009. Among the 4,939 such patients, 1,818 were discharged after 2 nights, and 1,922 were discharged after 3 nights. There were no deaths on the day after discharge among patients discharged after 2 nights. There was also no significant difference in 30-day mortality or readmission between patients discharged after 2 and 3 nights. In conclusion, 24-hour mortality was very low in patients with an uncomplicated STEMI discharged after 2 nights in the hospital, based on physician judgment. Thirty-day mortality is also low and similar to that of patients discharged after 3 nights in the hospital.

Beta-blocker prescription and outcomes in uncomplicated acute myocardial infarction: Insight from the ePARIS registry

BackgroundSystematic prescription of beta-blockers after myocardial infarction remains an open question in the era of revascularization, especially for patients with uncomplicated myocardial infarction. ObjectiveTo evaluate in a real-life registry the proportion of patients with uncomplicated myocardial infarction (preserved left ventricular ejection fraction and no cardiovascular event within the first 6 months), and to report their characteristics, outcomes and beta-blocker use. MethodsWe included 1887 consecutive patients with ST-segment elevation myocardial infarction from the prospective ePARIS registry. Patients were divided into three groups: the “uncomplicated myocardial infarction” group (n=1060), defined by a left ventricular ejection fraction ≥ 40% and a 6-month period free from cardiovascular events; the “complicated myocardial infarction” group (n=366), defined by a left ventricular ejection fraction ≥ 40% and a recurrent cardiovascular event in the first 6 months; and the “left ventricular dysfunction” group (n=461), defined by a left ventricular ejection fraction<40%. ResultsDuring a median follow-up of 2.7 years (interquartile range 1.0–4.9 years), the “uncomplicated myocardial infarction” group was at low mortality risk compared with the “complicated myocardial infarction” group (hazard ratio 0.38, 95% confidence interval 0.25–0.58; P<0.01) and the “left ventricular dysfunction” group (hazard ratio 0.22, 95% confidence interval 0.15–0.32; P<0.01). Beta-blockers were prescribed at discharge predominantly in the “uncomplicated myocardial infarction” group (93%) compared with 87% in the “complicated myocardial infarction” group and 81% in the “left ventricular dysfunction” group. ConclusionsBeta-blockers are less prescribed in patients who may need them the most. The benefit of beta-blockers–largely prescribed in lower-risk patients–remains to be shown beyond the first 6 months for these patients with no left ventricular dysfunction and no recurrent events.

The impact of mild therapeutic hypothermia on platelet reactivity in comatose survivors of cardiac arrest with acute myocardial infarction treated with ticagrelor.

The aim of the study was to assess the antiplatelet effect of ticagrelor in patients with myocardial infarction (MI) after out-of-hospital cardiac arrest (OHCA) treated with percutaneous coronary intervention (PCI) and mild therapeutic hypothermia (MTH) vs. MI patients without OHCA treated with PCI. The study was designed and performed as a phase IV, single-center, investigator-initiated, prospective, observational study assessing the early pharmacodynamic effect (within first 24 h) of a ticagrelor loading dose (180 mg) in both groups of patients (MTH group vs. MI group). For assessment of ticagrelor pharmacodynamics Multiple Electrode Aggregometry (MEA) was applied. Compared with the MTH group, platelet inhibition was persistently stronger in the MI group over the entire observation period (up to 24 h), with the highest difference at 4 hours after loading with ticagrelor (25.8 ± 26.4 vs. 75.8 ± 40.9 U, p = 0.002). As a consequence, there was a higher prevalence of high platelet reactivity in the MTH group, with the most explicit difference at 6 hours after the loading dose of ticagrelor (78% vs. 7%, p < 0.001). In comparison with patients treated with primary PCI for uncomplicated MI, the antiplatelet effect of ticagrelor in patients with MI complicated with OHCA, undergoing MTH and primary PCI, is attenuated and delayed.

The Effectiveness of Case-management Rehabilitation Intervention in Facilitating Return to Work and Maintenance of Employment After Myocardial Infarction: Results of a Randomized Controlled Trial

Objective To study the long-term effectiveness of case-management rehabilitation intervention on vocational reintegration of patients after myocardial infarction (MI). Design Blinded simple randomization was used to construct an intervention and control groups that were followed up for two years. Subjects and setting 151 patients, aged 50.3 ± 5.9 years, who experienced uncomplicated MI and were enrolled in a cardiac rehabilitation program were recruited. Interventions included an early referral to an occupational physician, tailoring an occupational rehabilitation program, based on individual patient needs, coordination with relevant parties, psychosocial intervention, intensive follow-up sessions during a two-year follow-up. Main measures Return to work within six months of hospitalization and maintenance of employment at one and two years of follow-up. Results Return-to-work (RTW) rate in the intervention group was 89% and nearly all maintained employment at one year of follow-up (92%) and two years of follow-up (87%). Moreover, almost all of them returned to and maintained their previous jobs. The corresponding figures were: 98%, 94% and 98%, respectively. The figures for the RTW and employment maintenance for the control group were: 74%, 75%, and 72%, respectively. Only about 75%, in this group kept their previous job. The case-management intervention was associated with increased odds of maintaining employment at follow-up of one year (OR = 5.89, 95% CI 1.42–24.30) and two years (OR = 3.12, 95% CI 1.01–10.03). Conclusions The extended case-management rehabilitation intervention had a substantial positive impact on both the RTW of MI patients and their maintenance of employment at one and two years of follow-up. Trial Registration This trial is registered at US National Institutes of Health #NCT04934735.

Infarktbedingter kardiogener Schock

Cardiogenic shock as a complication of myocardial infarction (5-10%) increases the mortality of uncomplicated myocardial infarction from less than 10% to 40%. This is due to the development of multiple organ dysfunction syndrome triggered by the extensive shock-induced impairment of organ perfusion. Therefore, guideline-based treatment should not only be restricted to reopening of the occluded coronary artery and management of complications of the infarction: important for survival are also guideline-driven optimization of organ perfusion by inotropic and vasoactive substances and, with well-defined indications, by temporary mechanical circulatory support but not by intra-aortic counterpulsation. Equally important, however, are shock-specific intensive care measures to prevent or attenuate organ dysfunction, such as lung protective ventilation in cases where ventilation is obligatory.

PREVALENCE, CLINICAL AND FUNCTIONAL CHARACTERISTICS OF PATIENTS WITH ACUTE MYOCARDIAL INFARCTION COMPLICATED BY ACUTE HEART FAILURE.

The aim: The study was designed to establish the prevalence of acute heart failure in patients with acute myocardial infarction, to determine the sex-age characteristics of acute myocardial infarction course in case of complications by acute heart failure of high classes (Killip III and Killip IV). Materials and methods: We analyzed medical records of inpatients of the myocardial infarction department of the municipal non-profit enterprise Vinnytsia Regional Center for Cardiovascular Pathology in 2019. The survey covered 828 medical records of patients with acute myocardial infarction, average age (64.6 ± 0.38), including 569 (64.7%) males and 311 (35.3%) females. Results: 129 (15.6%) patients with acute myocardial infarction were diagnosed high-class acute heart failure. Patients with high-class acute heart failure were statistically significantly elderly individuals of the average age (69.0 ± 1.3), (p <0.001), including 53.7% of males, and 46.3% (p <0.001) female patients. Patients with acute myocardial infarction complicated by acute heart failure were hospitalized within 2 hours of symptoms` onset with statistically significantly higher probability (p = 0.004). Patients with acute myocardial infarction complicated by acute high-class heart failure were statistically significantly more likely diagnosed with concomitant hypertension, diabetes mellitus, chronic obstructive pulmonary disease, chronic kidney disease than individuals with uncomplicated acute myocardial infarction. Acute myocardial infarction patients` mortality was 3.4%, while the one in patients with acute heart failure was 38% (p <0.001). Conclusions: Patients with complicated myocardial infarction are characterized by statistically significantly higher comorbidity and increased lethality.

Abstract P187: Analysis Of Online Information On Lifestyle Modification For Post-Myocardial Infarction Patients

Background: With continual advancement of treatment modalities, uncomplicated myocardial infarction (MI) patients are being discharged after only one to two days of hospitalization. Though patient education routinely takes place prior to discharge, patients often rely on online information for further guidance. This study aimed to analyze the content and variability of information regarding lifestyle modification for post-MI patients on the internet. Methods: The lay terms 'lifestyle changes after heart attack' were queried using the Google search engine. The first 100 websites were reviewed by two independent investigators. Websites were categorized as either professional or informational depending on the target audience, with the former written for healthcare professionals and the latter for average consumers. Websites that were personal, non-accessible, required payments for access, or included videos were excluded. Statistical analyses were performed using the chi-squared test and Fisher's exact test with significance level set at p&lt;0.05. Results: A total of 86 websites (49 professional, 37 informational) met our inclusion criteria. The most frequently addressed changes were exercise (86.0%), nutrition (82.6%), smoking cessation (74.4%), mental health (50.0%), weight loss (38.4%), risk factor control (36.0%), adherence to cardiac rehabilitation (30.2%), compliance to prescribed medications (26.7%), alcohol abstinence (20.9%), and compliance to follow-up visits (11.6%). Smoking cessation was addressed significantly more often on informational websites (p=0.025), while alcohol abstinence was addressed significantly more often on professional websites (p=0.003). Conclusions: This study demonstrates the variability in information that post-MI patients will encounter on the internet. As it is difficult for patients to determine the credibility of different websites, it is crucial that online resources provide a full range of necessary information for their readers.

Development of 1- and 5-year outcomes between 2006 and 2018 in patients with uncomplicated ST-elevation myocardial infarctions and successful percutaneous coronary intervention

Abstract Introduction While modern P2Y12-inhibitors and drug eluting stents (DES) have changed therapeutic options in patients with ST-elevation mycoardial infarctions (STEMI) during the last decade, there is few data on their impact in real world registries. Aim of the present study was to analyze changes in mortality and major adverse cardiac and cererobrovascular event rates (MACCE: death, reinfarction,stroke) during the last 13 years in patients with uncomplicated STEMI after successful percutaneous coronary intervention (PCI). Methods All consecutive STEMI-patients, admitted between 2006 and 2018 and successfully treated with PCI (TIMI flow ≥2) in a large German heart center entered analysis. To reduce confounding pts. with STEMI complicated by heart failure and pts. &amp;gt;70 yrs. of age were excluded. Results A STEMI-cohort of 5016 pts. was analysed, with a mean age of 55.9±8 yrs., 19% females, 16% diabetics and 59% smokers. At the beginning of the study period (2006) no patient was treated with ticagrelor/prasugrel and only 5% had a DES implanted. In 2018 92% were treated with prasugrel or ticagrelor and 96% with a DES. The reduction in 1-year-mortality during the study period was not significant: 2006–11: 3.4%, 2012–19: 3.1%, p=0.4, however the reduction in 1-year-MACCE was: 2006–11: 8.3%, 2012–18: 5.7%, p&amp;lt;0.01. This could mainly be attributed to a reduction in reinfarctions: 2006–11: 4.9%, 2012–18: 2.8%, p&amp;lt;0.01. Subgroup analysis revealed that with the exception of diabetics all subgroups showed a significant decline in MACCE-rates during the study period. It was more pronounced in women, non-smokers and patients with a high socioeconomic status (SES) (Table). Analysis of 5-year-data revealed a significant reduction in both 5-year-mortality (2006–09: 9.1%, 2010–13: 6.8%, p&amp;lt;0.01) and 5-year-MACCE-rates: 2006–09: 19.3%, 2010–13: 14.5%, p&amp;lt;0.01. Conclusions This analysis of registry data over a study period of 13 years reveals, that for patients with uncomplicated STEMI and successful PCI a significantly better 1- and 5-year-outcome could be achieved during the last years. This improvement of prognosis was more pronounced in specific subgroups, such as women, non-diabetics and patients with higher SES. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Stiftung Bremer Herzen, Gesundheit Nord

Oncological and Reproductive Outcomes of Abdominal Radical Trachelectomy.

Background/Aim: There is an increasing demand for preserving the fertility of young women impacted with early-stage cervical cancer. The aim of this study is to evaluate the oncological and reproductive outcomes of abdominal radical trachelectomy (ART). Patients and Methods: We retrospectively reviewed patients with FIGO stageIA2-IB1 cervical cancer who underwent ART from 2007 to 2018. We also compared the oncological prognosis between the patients who underwent ART and radical hysterectomy (RH). Results: A total of 42 patients underwent ART. During median follow-up 62.5 months, there were 4 (9.5%) recurrences and 1 (2.4%) death. As for tumors ≤2 cm, the 5-year recurrence-free survival (RFS) rate and overall survival (OS) rate for patients who underwent ART was similar to those who underwent RH (89.8% vs. 92.7%, p=0.42 and 97.3% vs. 95.0%, p=0.44, respectively). Nineteen patients attempted to conceive and seven of them were successful. There was one case of a first-trimester miscarriage, two cases of preterm delivery, three cases of full-term delivery and one ongoing pregnancy. Conclusion: ART could be a feasible alternative to RH for patients with tumors ≤2 cm with comparable oncological outcome.

What are the effects of early mobilization (median 6 days) for people with acute uncomplicated myocardial infarction (MI)?

What are the effects of early mobilization (median 6 days) for people with acute uncomplicated myocardial infarction (MI)?

Asymmetric dimethylarginine level in patients with unstable angina and acute myocardial infarction

The aim of our research work was to study asymmetric dimethylarginine (ADMA) level in a comparative aspect in patients with unstable angina (UA) and acute myocardial infarction (MI) with an analysis of the frequency of normodimethylargininemia (NDAN) and hyperdimethylargininemia (HDAN). In total 104 patients with acute coronary syndrome (ACS) and 20 somatically healthy individuals as a control group were included in the study. From 104 patients with ACS, 63 patients had acute MI, 41 patients had UA. From 41 patients with UA, there were 15 patients with first-time angina and 26 patients with progressive angina. Enzyme-linked immunosorbent assay was used to determine ADMA level. Statistica program version 12.0 was used to data processing. As a result of the study , it was found that the level of ADMA was statistically significantly higher in all patients with ACS compared to somatically healthy individuals. At the same time, the value of the ADMA level in patients with acute MI was statistically significantly higher than in patients with UA, among whom the ADMA level was statistically significantly higher in patients with progressive angina than in patients with first-time angina. Based on the analysis of the frequency of NDAN and HDAN, only 33 % of patients with first-time angina were diagnosed with NDAN. HDAN was detected in 100 % of patients with progressive angina and acute MI. The value of the ADMA level in patients with Q-wave MI was statistically significantly higher than in patients with non Q-wave MI, in patients with complicated MI it was statistically significantly higher than in patients with uncomplicated MI, and in patients with cardiogenic shock it was statistically significantly higher than in patients with pulmonary edema.

Management and outcomes of uncomplicated ST-segment elevation myocardial infarction patients transferred after fibrinolytic therapy

BackgroundThis study sought to assess the contemporary outcomes of patients transferred after receiving fibrinolytic therapy (‘drip-and-ship’) for ST-segment elevation myocardial infarction (STEMI) in the United States. MethodsDuring 2009–2016, adults (>18 years) with STEMI (>18 years) without cardiac arrest and cardiogenic shock that received fibrinolytic therapy and were subsequently transferred were identified using the National Inpatient Sample (NIS). These admissions were divided into those undergoing fibrinolysis alone, subsequent coronary angiography (CA) without revascularization and subsequent CA with revascularization. Outcomes of interest included in-hospital mortality, resource utilization, and discharge disposition. ResultsA total of 27,454 STEMI admissions receiving a ‘drip-and-ship strategy’, 96.3% and 85.8% received subsequent coronary angiography and revascularization Admissions receiving CA and revascularization were younger, male, and with lower comorbidity. The fibrinolysis alone cohort had higher rates of organ failure, hemorrhagic sequelae, and intracranial hemorrhage. Compared to the fibrinolysis cohort, CA with revascularization (adjusted odds ratio [aOR] 0.17 [95% confidence interval {CI} 0.11–0.27]; p < .001) but not CA without revascularization (OR 0.72 [95% CI 0.42–1.21]; p = .21) was associated with lower in-hospital mortality. The fibrinolysis alone cohort had higher use of do-not-resuscitate status (12.8%) and fewer discharges to home (56.6%) compared to cohorts undergoing CA without (1.7%; 86.9%) and with (0.3% and 91.2%) revascularization, respectively. Presence of complications, do-not-resuscitate status, and higher comorbidity were predictive of lower CA and revascularization use. ConclusionFibrinolysis with subsequent revascularization is associated with excellent outcomes in STEMI. Admissions receiving fibrinolysis alone were systematically different, sicker and had poorer outcomes.

Leptin levels are not affected by enalapril treatment after an uncomplicated myocardial infarction, but associate strongly with changes in fibrinolytic variables in men

Leptin, an adipocyte-derived hormone, is involved in the regulation of body weight and is associated with obesity-related complications, notably cardiovascular disease (CVD). A putative link between obesity and CVD could be induction of plasminogen activator inhibitor-1 (PAI-1) synthesis by leptin. In this study, we hypothesized that the beneficial effect of the angiotensin-converting enzyme inhibitor (ACEi) enalapril on PAI-1 levels is mediated by effects on leptin levels. The association between leptin and components of the fibrinolytic system was evaluated in a non-prespecified post hoc analysis of a placebo-controlled randomized, double-blind trial where the effect of the ACEi enalapril on fibrinolysis was tested. A total of 46 men and 37 women were randomized to treatment with enalapril or placebo after (median 12 months) an uncomplicated myocardial infarction. At baseline, the participants were stable and had no signs of congestive heart failure. Leptin and fibrinolytic variables (mass concentrations of PAI-1, tissue plasminogen activator (tPA) and tPA–PAI complex) were measured at baseline, and after 10 days, 6 months and 12 months. Enalapril treatment did not change leptin levels, which increased significantly during 1 year of follow-up (p = .007). Changes in leptin levels were strongly associated with changes of tPA mass (p = .001), tPA–PAI complex (p = .003) and of PAI-1 (p = .006) in men, but not in women. Leptin levels are not influenced by treatment with an ACEi. In contrast, leptin associates strongly with changes in fibrinolytic variables notably with a sex difference, which could be of importance for obesity-related CVD.

Oxygen therapy versus conservative therapy in suspected uncomplicated myocardial infarction without hypoxemia: A meta-analysis of randomized controlled studies

Background:The effect of oxygen therapy in patients with suspected uncomplicated myocardial infarction and without hypoxemia at baseline was uncertain.Objectives:We aimed to perform a rigorous and comprehensive meta-analysis to robustly quantify the efficacy of oxygen therapy in patients with suspected uncomplicated myocardial infarction and without hypoxemia at baseline.Methods:We searched EMBASE, MEDLINE, Web of Science, and the Cochrane Library from inception to August 2018. Two researchers screened studies and collected the data independently. Randomized controlled trials were included. The main outcome was mortality at the longest duration of follow-up.Results:Seven studies involving 7732 patients (median = 157 patients; range = 72–6629 patients; interquartile range = 136–441 patients; oxygen therapy group = 3856 patients; conservative group = 3876 patients) were included. Compared with conservative therapy, oxygen therapy did not significantly reduce mortality at the longest follow-up (risk ratio = 0.97; 95% confidence interval = 0.68 to 1.40; z = 0.15; p = 0.88), at discharge (risk ratio = 1.04; 95% confidence interval = 0.48 to 2.26; z = 0.11; p = 0.91), 30 days (risk ratio = 1.08; 95% confidence interval = 0.78 to 1.49; z = 0.44; p = 0.66), and 6 months (risk ratio = 0.93; 95% confidence interval = 0.73 to 1.17; z = 0.66; p = 0.51) in patients with suspected uncomplicated myocardial infarction and without hypoxemia at baseline. Furthermore, there was no significant difference between two groups with regard to infarct size (standard mean difference = 0.15, confidence interval = –0.13 to 0.44; z = 1.07, p = 0.28), cardiac troponin levels (standard mean difference = 0.30, confidence interval = –0.09 to 0.69; z = 1.51, p = 0.13), in hospital reinfarction (risk ratio = 1.49, confidence interval = 0.80 to 2.78; z = 1.25, p = 0.21), and new-onset atrial fibrillation (risk ratio = 0.91, confidence interval = 0.69 to 1.18; z = 0.72, p = 0.47). Multiple subgroup analysis, sensitivity analysis, and trial sequential analysis were consistent with overall findings.Conclusion:Compared with conservative therapy, oxygen therapy did not decrease the mortality at the longest duration of follow-up, discharge, 30 days, and 6 months in patients with suspected uncomplicated myocardial infarction and without hypoxemia at baseline. Furthermore, large-scale, multicenter studies are needed to confirm our results.Registration:PROSPERO, number CRD42017078807.