Year Of Acute Myocardial Infarction Research Articles

Effect of Temperature Variation on the Incidence of Acute Myocardial Infarction.

Harsh temperature exposure has been associated with a high risk of cardiovascular events. We sought to investigate the influence of temperature change on long-term incidence of acute myocardial infarction (AMI) in Korean patients. From the National Health Insurance Service (NHIS) customized health information database (from 2005 to 2014), data from a total of 192,567 AMI patients was assessed according to the International Classification of Disease 10th edition code and matched with temperature reports obtained from the Korea Meteorological Administration database. We analyzed data for a 10-year period on a monthly and seasonal basis. The incidence rate per 100,000 year of AMI exhibited a downward trend from 69.1 to 56.1 over the period 2005 to 2014 (P < 0.005), and the seasonal AMI incidence rate per 100,000 year was highest in spring (63.1), and winter (61.3) followed by autumn (59.5) and summer (57.1). On a monthly basis, the AMI incidence rate per 100,000 year was highest during March (64.4) and December (63.9). The highest incidence of AMI occurred during temperature differences of 8-10° in each season. Moreover, AMI incidence tended to increase as the mean temperature decreased (r = -0.233, P = 0.001), and when the mean daily temperature difference increased (r = 0.353, P < 0.001). The AMI incidence rate per 100,000 year has a decreasing trend over the 10-year period, derived from the Korean NHIS database. Modest daily temperature differences (8-10°) and the spring season are related to higher AMI incidence, indicating that daily temperature variation is more important than the mean daily temperature.

Cluster analysis of extracellular matrix biomarkers predicts the development of impaired systolic function within 1 year of acute myocardial infarction

The clinical utility of combining extracellular matrix (ECM) biomarkers to predict the development of impaired systolic function following acute myocardial infarction (AMI) remains largely undetermined. A combination of ELISA and multiplexing assays were performed to measure matrix metalloproteinase (MMP)-2, MMP-3, MMP-8, MMP-9, periostin, N-terminal type I procollagen (PINP) and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) in plasma samples from 120 AMI patients. All patients had an echocardiogram within 1 year of AMI, and were divided into impaired (n = 37, LVEF < 50%) and preserved (n = 83, LVEF ≥ 50%) systolic function groups. Exploratory factor analysis was performed on log-transformed biomarkers using principle axis analysis with Oblimin rotation. Cluster analysis was performed on log-transformed and normalised biomarkers using Ward’s method of minimum variance and the squared Euclidean distance metric. Upon univariate analysis, current smoking, prescription of ACE inhibitors at discharge, peak hsTnT > 610 ng/L (median), MMP-8 levels, Factor 1 scores and Cluster One assignment were predictive of impaired systolic function. Upon multivariate analysis, Cluster One assignment (odds ratio [95% CI], 2.74 [1.04–7.23], p = 0.04) remained an independent predictor of systolic dysfunction in combination with clinical variables. These observations support the usefulness of combining ECM biomarkers using cluster analysis for predicting the development of impaired systolic function in AMI patients.

Abstract P121: Combining Extracellular Matrix Biomarkers Using Cluster Analysis More Accurately Predicts The Development Of Systolic Dysfunction In Acute Myocardial Infarction Compared To Single Biomarker Analysis

Introduction: The extracellular matrix (ECM) is central to cardiac repair following acute myocardial infarction (AMI), and pathological ECM activity may result in adverse ventricular remodeling. Systolic dysfunction is a manifestation of adverse remodeling, and the utility of combined biomarker analysis for prognosis remains undetermined. Cluster analysis is a statistical methodology that can combine biomarkers, while also accounting for collinearity. Hypothesis: In this study, we assessed the hypothesis that combining biomarkers using cluster analysis may more accurately predict the development of systolic dysfunction in AMI patients when compared to single biomarker analysis. Methods: In a cohort of 120 AMI patients, plasma levels of matrix metalloproteinase (MMP) -3, -8, -9 and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) were measured using ELISA and multiplexing assays during hospital admission. All patients had an echocardiogram within 1 year of AMI (median [IQR], 145 [89 - 252] days). Patients were divided into impaired (n=37, LVEF &lt;50%) and preserved (n=83, LVEF ≥50%) systolic function. Hierarchical clustering was performed using Ward’s method of minimum variance. Mann-Whitney U and Chi-Squared testing was performed for univariate analysis, and binary logistic regression was performed for multivariate analysis. Results: Upon univariate analysis, current smoking, prescription of ACE inhibitor at discharge, peak Troponin T &gt; 610 ng/L (median), and MMP-8 levels were predictive of impaired systolic function. Cluster analysis partitioned patients into two clusters (Cluster One, n=31; Cluster Two, n=89). Cluster One comprised a higher proportion of patients with impaired systolic function when compared to Cluster Two (15 out of 31 [48.4%] versus 22 out of 89 [24.7%]). Upon multivariate analysis, Cluster One assignment (odds ratio [95% CI], 2.74 [1.04-7.23], p=0.04) remained an independent predictor of systolic dysfunction in combination with clinical variables, while MMP-8 levels did not (3.43 [0.32-36.68], p=0.308). Conclusion: Findings from our study demonstrate a combined biomarker approach outperforms single biomarker analysis for predicting the development of systolic dysfunction following AMI.

Factors Associated With Emergency Services Use by Patients With Recurrent Myocardial Infarction: From the Monitoring Trends and Determinants in Cardiovascular Disease/Cooperative Health Research in the Region of Augsburg Myocardial Infarction Registry.

Although emergency medical services (EMS) use is the recommended mode of transport in case of acute coronary symptoms, many people fail to use this service. The objective of this study was to determine factors associated with EMS use in a population-based sample of German patients with recurrent acute myocardial infarction (AMI). The sample consisted of 998 persons with a first and recurrent AMI, recruited from 1985 to 2011. Logistic regression modeling adjusted for sociodemographic, situational, and clinical variables, previous diseases, and presenting AMI symptoms was applied. Emergency medical services was used by 48.8% of the patients at first, and 62.6% at recurrent AMI. In first AMI, higher age, history of hyperlipidemia, ST-segment elevation AMI, more than 4 presenting symptoms, symptom onset in daytime, and later year of AMI were significantly related with EMS use. Pain in the upper abdomen and pain between the shoulder blades were significantly less common in EMS users. In recurrent AMI, EMS use at first AMI, presence of any other symptom except chest pain, ST-segment elevation myocardial infarction, and later year of AMI were significantly related with EMS use. Significant predictors of EMS use in recurrent AMI in patients who failed to use EMS at first AMI were unmarried, experience of any symptom except chest symptoms at reinfarction, bundle branch block (first AMI), any in-hospital complication (first AMI), longer duration between first and recurrent AMI, and later year of reinfarction. Patients with AMI and their significant others may profit by education about the benefits of EMS use.

Temporal treatments and outcomes following acute myocardial infarction among cancer survivors: A population-based study, 1995-2013.

10058 Background: There is little contemporary information regarding cardiac care and mortality differences following an acute myocardial infarction (AMI) between cancer survivors (CS) and non-cancer patients (NCP). Methods: All patients with AMI (1995-2013) in Ontario, Canada were identified through administrative databases and stratified into CS (solid or hematologic) and NCP. Those with cancer within 1 year of AMI were excluded. We used inverse probability treatment weight of propensity scores to balance confounders. Coronary intervention use and survival following index AMI were compared between CS and NCP using Modified Poisson and Cox modeling, and their temporal trends were examined. Results: Of 270,089 AMI patients (62.1% men; 87.8% &gt;65 yrs old for CS vs. 56.2% for NCP), 22,907 were CS (prostate 26%, colorectal 17%, breast 16%) and 247,182 NCP. From 1995-2013, coronary interventions usage increased similarly for both groups (Table). The overall 30-day use did not differ between CS and NCP (angiogram unadjusted 36% vs. 50%, adjusted RR 0.96, 95% CI 0.96-1.00, p=.21; percutaneous coronary interventions unadjusted 21% vs. 31%, adjusted RR 0.98, 95% CI 0.94-1.01, p=.21; bypass surgery unadjusted 5% vs. 7%, adjusted RR 0.95, 95% CI 0.87-1.04, p=.25). Unadjusted 30-day mortality following AMI decreased similarly for CS and NCP (Table). However, adjusted 30-day mortality was worse in CS (HR 1.09, 95% CI 1.04-1.15, p&lt;0.001). Over median follow-up of 11 yrs, CS had worse survival than NCP (HR 1.22, 95% CI 1.18-1.26, p&lt;0.0001). CS had higher risk of heart failure than NCP (HR 1.10, 95% CI 1.05-1.15, p&lt;0.0001), while myocardial (re)-infarction and stroke were similar (HR 0.99, 95% CI 0.96-1.02, p=.46; HR 1.09, 95% CI 1.00-1.18, p=.052). Conclusions: Following AMI, coronary intervention use increased and early mortality decreased comparably between CS and NCP over time. However, CS had worse short-term and long-term survival, suggesting that continued emphasis on cancer and cardiovascular care is needed to improve outcomes. [Table: see text]

Association Between PM2.5 Exposure and the Prognosis of Patients with Acute Myocardial Infraction

Numerous case-crossover and time series studies of PM2.5 exposure and cardiovascular health effects have been conducted, fever studies have examined the effects of PM2.5 on the outcomes of CHD, especially on acute myocardial infarction (AMI). The objective of this research is to investigate the association between PM2.5 exposure in Tianjin City and the outcome of AMI. We conducted a retrospective analysis of a total of 598 patients with AMI in TEDA International Cardiovascular Hospital, from Oct 28th, 2013-Apr 30th 2014. All patients were divided into five groups according to the National Air Quality Classification Standard. Major adverse cardiovascular events (MACEs) including all-cause death, heart failure, myocardial infarction and target lesion revascularization (TLR) during one year follow-up were defined as endpoint. Furthermore, we divided the patients into two groups according to better and worse air quality, then examined the incidence of MACEs in the two groups. The prognostic was assessed by using multivariate Cox regression analysis. With the increase of the concentration of PM2.5, the incidence of MACEs were higher in patients after 1year of AMI (In the five groups, Hazard Ratio [HR] 1.622, 95% CI 1.352-1.947; p=0.000. In the two groups, HR 3.255, 95% CI 2.008-5.276; p=0.000). PM2.5 exposure was associated with the outcome of patients with AMI, especially, the poorer air quality it is, the worse prognosis of patients will be.

Long-term excess mortality associated with diabetes following acute myocardial infarction: a population-based cohort study

BackgroundThe long-term excess risk of death associated with diabetes following acute myocardial infarction is unknown. We determined the excess risk of death associated with diabetes among patients with ST-elevation myocardial...

Terapija glukoza-insulin-kalijum u akutnom infarktu miokarda - desetogodišnje praćenje

High-dose glucose-insulin-potassium (GIK) therapy in acute myocardial infarction (AMI) as a complementary with thrombolytic therapy, in a randomized clinical trial, shows the effect on major cardiovascular events (MACE) defined as cardiac mortality, reinfarction, malignant ventricular arrhythmias (ventricular fibrillation and /or ventricular tachycardia), and/or severe heart failure (Killip 3 and 4) and a reduced the relative risk 5.25 times of their occurrence (10.3% vs. 32.5%, p = 0.000) for the first month. The effect of GIK therapy was shown after one year of AMI, also and the relative risk for these events was reduced by 5.67 times. Long-term effects of GIK therapy on the incidence of heart failure and survival have not been analyzed. On the basis of the mechanisms that have so far been described, it can be expected that GIK therapy affects the long-term prognosis of patients with acute coronary syndrome, especially with STEMI myocardial infarction treated with thrombolytic therapy. Of great importance would be to determine the predictors of long-term survival in patients treated with this therapy, as well as major of cardiovascular adverse events. This prospective, randomized, clinical study included 120 patients with AMI and an indication for reperfusion therapy. Patients were randomized into treatment groups (TG) and were treated with solution according to the following protocol GIK: 25% glucose, 50 IU insulin per L, 80mmol KCl per L in infusion of 1 ml / kg / h, during the first 24 h AIM simultaneously with thrombolytic treatment and control group (CG) were treated only with thrombolytic therapy. The effect of GIK therapy on prognosis in the long-term follow-up of ten years after the AMI was not shown. The relative risk for major cardiovascular events (MACE): reinfarction, mortality, malignant rhythm disorders, was significantly lower in the group treated with GIK therapy (RR = 0.481, 95% CI 0206-1126, p = 0.078). Significant individual predictors of all-cause mortality in patients treated with this therapy were female gender, TIMI risk score ≥6, and the absence of beta blockers in the early phase of AMI.

Increased mortality after a first myocardial infarction in human immunodeficiency virus-infected patients; a nested cohort study.

AimsHIV infection may be associated with an increased recurrence rate of myocardial infarction. Our aim was to determine whether HIV infection is a risk factor for worse outcomes in patients with coronaray artery disease.MethodsWe compared data aggregated from two ongoing cohorts: (i) the Acute Myocardial Infarction in Switzerland (AMIS) registry, which includes patients with acute myocardial infarction (AMI), and (ii) the Swiss HIV Cohort Study (SHCS), a prospective registry of HIV-positive (HIV+) patients. We included all patients who survived an incident AMI occurring on or after 1st January 2005. Our primary outcome measure was all-cause mortality at one year; secondary outcomes included AMI recurrence and cardiovascular-related hospitalisations. Comparisons used Cox and logistic regression analyses, respectively.ResultsThere were 133 HIV+, (SHCS) and 5,328 HIV-negative [HIV-] (AMIS) individuals with incident AMI. In the SHCS and AMIS registries, patients were predominantly male (72% and 85% male, respectively), with a median age of 51 years (interquartile range [IQR] 46–57) and 64 years (IQR 55–74), respectively. Nearly all (90%) of HIV+ individuals were on successful antiretroviral therapy. During the first year of follow-up, 5 (3.6%) HIV+ and 135 (2.5%) HIV- individuals died. At one year, HIV+ status after adjustment for age, sex, calendar year of AMI, smoking status, hypertension and diabetes was associated with a higher risk of death (HR 4.42, 95% CI 1.73-11.27). There were no significant differences in recurrent AMIs (4 [3.0%] HIV+ and 146 [3.0%] HIV- individuals, OR 1.16, 95% CI 0.41-3.27) or in hospitalization rates (OR 0.68 [95% CI 0.42-1.11]).ConclusionsHIV infection was associated with a significantly increased risk of all-cause mortality one year after incident AMI.

Completeness and diagnostic validity of recording acute myocardial infarction events in primary care, hospital care, disease registry, and national mortality records: cohort study

Objective To determine the completeness and diagnostic validity of myocardial infarction recording across four national health record sources in primary care, hospital care, a disease registry, and mortality register. Design...

Influence of thrombolytic therapy on early and long term leftventricular systolic function in patients with ST-segment elevation myocardial infarction

Background and objectives: Left ventricular systolic dysfunction complicating acute myocardial infarction are responsible for significant morbidity and mortality. This study to assess the effect of thrombolytic therapy on the left ventricular systolic function during the first week and a year after ST- elevation myocardial infarction. Methods: In a study of 56 patients with first ST-Segment elevation myocardial infarction (42 men and 14 women; age range, 42-89 years (mean, 61 ± 10 ), who had been admitted to the Coronary Care Unit at Hawler Teaching Hospital from May 2008 to May 2009. study done to assess the left ventricular systolic function during the first week and first year after ST-elevation myocardial infarction. Twenty one patients received tissue plasminogen activator (Alteplase) 12 hour after the onset of symptoms labeled as group-I, the remaining patients (35), had no chance to receive thrombolytic therapy labeled as group II. Results: In group I the mean ejection fraction improved significantly from 51.6±9.4 during the first week to 55.14±11, P=0.034, at first year after acute myocardial infarction, while in group II there was no significant difference of mean ejection fraction during the first week (45.97±12.2) and first year of acute myocardial infarction (46.1±13.2),P=0.5. Conclusions: Thrombolytic therapy has a beneficial effect on left ventricular systolic function detected by echocardiography at the end of the first year of ST-elevation myocardial infarction

Changes in rates of β-blocker use between 1994 and 1997 among elderly survivors of acute myocardial infarction

Background Results of recent studies suggest that β-blockers are underused by elderly acute myocardial infarction (AMI) survivors. The goals of this study were to examine changes in post-AMI β-blocker use occurring between 1994 and 1997 and to identify factors associated with outpatient use of β-blockers. Methods Patients included 9534 individuals ≥65 years of age who were enrolled in Pennsylvania’s Pharmaceutical Assistance Contract for the Elderly (PACE) and who survived AMI between 1994 and 1997. With the use of outpatient prescription claims, β-blocker usage rates were examined by year, and multivariate logistic regression was used to identify predictors of β-blocker use. Results Post-AMI β-blocker use increased from 39.6% in 1994 to 58.6% in 1997. Controlling for AMI year, individuals who had any prescriptions written by a cardiologist were more likely to use a β-blocker than individuals who received all prescriptions from noncardiologists (odds ratio 1.52, P = .0001). Elderly patients who did not use β-blockers tended to have greater severity of illness, non–Q-wave infarctions, atrial fibrillation, and comorbidities such as congestive heart failure, chronic obstructive pulmonary disease, and asthma. Use of calcium channel blockers and diuretics was negatively associated with β-blocker use, but persons using lipid-lowering agents were more likely to use β-blockers. Conclusions Significant improvements in β-blocker use by elderly AMI survivors have occurred since 1994. Differences among physician specialties in β-blocker prescribing appear to remain. Across all prescriber specialties, historic contraindications constitute major factors in the choice of post-AMI therapy. Further efforts should be made to encourage the use of β-blockers in elderly survivors of AMI, particularly those with heart failure. (Am Heart J 2000;140:663-71.)

Anistreplase becomes financially beneficial within a year of acute myocardial infarction

Anistreplase becomes financially beneficial within a year of acute myocardial infarction

Echocardiographic Score Versus Wall Motion Index for Risk Stratification After Acute Myocardial Infarction

Two-dimensional echo cardiographic wall motion scores are potentially valuable prognostic indicators because of their association with subsequent mortality in patients with acute myocardial infarction. Because wall motion scores are relatively simple to obtain, they could come into widespread use. But wall motion scores have been found to have a low positive predictive accuracy in respect to one- or three-year survival and a low specificity in respect to pump failure. To clarify the value of wall motion scores in risk stratification the authors analyzed the ability of a wall motion index, in combination with other variables, to predict death within a year of acute myocardial infarction. Patients were 149 consecutive men with acute myocardial infarction. There were no exclusion criteria. By Cox regression, the variables most closely related to survival were the presence of a pericardial effusion, the age of the patient, alcoholism, and the E point septal separation. The wall motion index, by comparison, was only weakly related to survival and was therefore dropped from further analyses. The four variables most closely related to survival were then used to derive a predictive echocardiographic score. The score's negative predictive accuracy was 94%, although sensitivity and positive predictive accuracy were low. These data suggest that, even when applied nonselectively, the echocardiographic score, but not the wall motion index, appears to be an efficient way of characterizing the outcome of acute myocardial infarction, in that it reliably detects low-risk patients.