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Despite poor cardiovascular outcomes, there are no dedicated, validated risk stratification tools to guide investigation or treatment in type 2 myocardial infarction. The goal of this study was to derive and validate a risk stratification tool for the prediction of death or future myocardial infarction in patients with type 2 myocardial infarction. The T2-risk score was developed in a prospective multicenter cohort of consecutive patients with type 2 myocardial infarction. Cox proportional hazards models were constructed for the primary outcome of myocardial infarction or death at 1 year using variables selected a priori based on clinical importance. Discrimination was assessed by area under the receiving-operating characteristic curve (AUC). Calibration was investigated graphically. The tool was validated in a single-center cohort of consecutive patients and in a multicenter cohort study from sites across Europe. There were 1,121, 250, and 253 patients in the derivation, single-center, and multicenter validation cohorts, with the primary outcome occurring in 27% (297 of 1,121), 26% (66 of 250), and 14% (35 of 253) of patients, respectively. The T2-risk score incorporating age, ischemic heart disease, heart failure, diabetes mellitus, myocardial ischemia on electrocardiogram, heart rate, anemia, estimated glomerular filtration rate, and maximal cardiac troponin concentration had good discrimination (AUC: 0.76; 95% CI: 0.73-0.79) for the primary outcome and was well calibrated. Discrimination was similar in the consecutive patient (AUC: 0.83; 95% CI: 0.77-0.88) and multicenter (AUC: 0.74; 95% CI: 0.64-0.83) cohorts. T2-risk provided improved discrimination over the Global Registry of Acute Coronary Events 2.0 risk score in all cohorts. The T2-risk score performed well in different health care settings and could help clinicians to prognosticate, as well as target investigation and preventative therapies more effectively. (High-Sensitivity Troponin in the Evaluation of Patients With Suspected Acute Coronary Syndrome [High-STEACS]; NCT01852123) [Display omitted] [ABSTRACT FROM AUTHOR]

Many studies have shown that participation in cardiac rehabilitation reduces long-term morbidity and mortality after myocardial infarction. Therefore, both American and European evidence-based guidelines recommend cardiac rehabilitation. However, it is still unclear what the optimal dose of cardiac rehabilitation is. The study is a monocenter, retrospective cohort study. We identified patients with stable ischemic heart disease, who participated in at least one phase II center-based cardiac rehabilitation session between 2010 and 2015. A total of 609 patients were included in this study. We retrospectively reviewed the medical records of 609 patients. Statistically significant baseline differences between the four groups were observed for index coronary artery revascularization technique, age, dual antiplatelet therapy and smoking status. A total of number of 84 patients (13.8%) had a MACE in the four-year follow-up period. After adjustment for all significant predictors in the univariate analysis, patients who attended 36 or more sessions had a 47% lower risk of MACE (hazard ratio [HR], 0.54; 95% confidence interval [CI], 0.31 to 0.92), patients who attended 24 to 35 sessions had a 68% lower risk of MACE (hazard ratio [HR], 0.32; 95% confidence interval [CI], 0.15 to 0.67), patients who attended 12 to 23 sessions had a 56% lower risk of MACE (hazard ratio [HR], 0.44; 95% confidence interval [CI], 0.21 to 0.92) than those who attended 1 to 11 sessions. There is a clear clinical benefit from participating in more than 11 CR sessions. The best outcomes are achieved in patient who participated between 24 and 35 CR sessions. These results underline again the importance of improving participation and adherence to CR programmes in Europe. [ABSTRACT FROM AUTHOR]

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Abstract: The success of treatment for acute myocardial infarction and chronic myocardial ischemia has improved general medical care in Europe, resulting in an increasing population of patients with chronic and congestive heart failure. By applying currently available therapeutic options the quality of life and lifespan of these patients have both increased. However, amongst patients––predominantly the elderly––who remain symptomatic despite intensive medical treatment, autologous bone marrow-derived mononuclear cells may trigger attempts to repopulate lost tissues directly as a novel therapeutic option. In this concised paper the current understanding of stem cell therapy and early clinical experiences are discussed and related to the application of stem cells in elderly patients with myocardial ischemia. [Copyright &y& Elsevier]

Background Plasma apolipoprotein C-III (apoC-III) levels are associated with coronary artery disease (CAD) risk. Objective To assess whether lipoprotein-associated apoC-III levels predict risk of CAD events. Methods apoC-III associated with apoB, apoAI, and Lp(a) (apoCIII-apoB, apoCIII-apoAI, and apoCIII-Lp(a), respectively) were measured using high-throughput chemiluminescent enzyme-linked immunoassays in 2711 subjects (1879 controls and 832 cases with CAD) in the European Prospective Investigation into Cancer and Nutrition-Norfolk prospective population study with 7.4 years of follow-up. These measures were correlated with a variety of lipid measurements and the presence of CAD. The indices of "total apoCIII-apoB" and "total apoCIII-apoAI" were derived by multiplying plasma apoB and apoAI, respectively. Results apoCIII-apoB (P =.001), apoCIII-Lp(a) (P <.001), apoCIII-apoAI (P =.005) were higher in cases vs controls; tended to correlate positively with body mass index, hsCRP, apoC-III, low-density lipoprotein (LDL) cholesterol, triglycerides, remnant cholesterol, very low density lipoprotein, LDL and high-density lipoprotein particle number and very low density lipoprotein size; but negatively with LDL and high-density lipoprotein particle size (P <.001 for all). apoCIII-apoB, apoCIII-apoAI, apoCIII-Lp(a), total apoCIII-Lp(a), and total apoCIII-apoB were predictors of CAD after adjustment of age, sex, body mass index, smoking, diabetes, hypertensive and lipid-lowering drug use, but they lost their significance after further adjustment of lipid and lipoprotein variables. Conclusions This study suggests that enzyme-linked immunoassay–measured lipoprotein-associated apoC-III markers reflect atherogenic lipid particles but do not independently predict risk of CAD events. Highlights • High-throughput enzyme-linked immunoassays were developed to measure lipoprotein-associated apolipoprotein C-III (apoC-III) levels. • apoCIII-apoB, apoCIII-Lp(a), and apoCIII-apoAI were measured in EPIC-Norfolk. • apoCIII-apoB, apoCIII-Lp(a), and apoCIII-apoAI reflect atherogenic lipid particles. • apoCIII-apoB, apoCIII-Lp(a), and apoCIII-apoAI do not independently predict risk of coronary artery disease events. • Their role in patients with prior history of coronary artery disease needs to be evaluated. [ABSTRACT FROM AUTHOR]

Abstract: In France, the incidence of myocardial infarctions leading to hospitalisations can be estimated between 60,000 and 65,000 each year. With the addition of cases of unstable angina, about 80,000 to 100,000 hospital stays each year are caused by acute coronary syndromes. Cases of out-of-hospital cardiac arrest of ischaemic origin should also be taken into account when estimating the annual incidence of myocardial infarction. In Europe, a North-South gradient, and even more an East-West gradient is observed for the incidence of ischaemic heart disease, with the highest figures found in central and eastern European countries. A consistent trend to a decrease in the incidence of myocardial infarction is observed on both sides of the Atlantic. In parallel, progress in the management of acute coronary syndromes has led to a marked decrease in early case fatality rates. Overall, these trends explain the spectacular decrease in cardiovascular mortality observed over the past 25 years in most European countries. Acute coronary syndromes, however, remain severe clinical conditions, which carry a high mid-term and long-term morbi-mortality and deserve further efforts to develop new therapeutic tools. [ABSTRACT FROM AUTHOR]