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Background: Acute kidney injury (AKI) is a common complication following acute myocardial infarction (AMI) and associated with worse outcomes. Serum Potassium levels (K, mEq/L), which are regulated by the kidneys, are related with poor prognosis in patients with AMI., Objectiv: To evaluate whether K levels predict imminent AKI in patients with AMI., Methods: This retrospective nested case-control study was based on medical records of hospitalized AMI patients, 2002-2012. The cases (AKI group) were defined as an increase of ≥1.5-fold in serum creatinine level or a decrease of ≥25% in the estimated glomerular filtration rate (eGFR) during the hospitalization. The control group comprised of matched randomly selected patients that did not develop AKI. For both groups, all creatinine and K levels were obtained for up-to 72 h prior to the AKI diagnosis (index time)., Results: A total of 12,498/17,678 admissions met the inclusion criteria. The AKI and the control groups consisted of 430 and 1345 matched admission respectively. K levels, prior AKI diagnosis seemed to be higher in the AKI group. Multivariate analysis showed that K ≥ 4.5 within 36-56 h prior to the index time was an independent predictor of the subsequent AKI, OR = 2.3, p < .001. The c-statistic of the model was 0.859, p < .001. Predictivity of K for AKI was stronger among ST-elevation (STEMI) vs. Non-ST-elevation AMI (NSTEMI) patients (OR = 4, p < .001 vs. 1.7, p = .025 respectively; p-for-interaction = 0.038)., Conclusions: K ≥ 4.5 is an independent and incremental marker of imminent AKI in patients with AMI, predictivity is stronger in patients with STEMI than NSTEMI., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Acute myocardial infarction (AMI) is associated with significant systemic metabolic changes. These changes include increased plasma concentrations of counter-regulatory hormones and changes in potassium (K, mEq/L) and glucose (mg/dL) levels. The latter are associated with outcomes and investigated as potential focus for intervention; glucose-insulin‑potassium (GIK) solution., Objectives: To evaluate the associations of concomitant K and glucose (K/glucose) levels with in-hospital mortality in AMI patients., Methods: AMI patients hospitalized in a tertiary Medical Center through 2002-2012 were studied. K/glucose levels were divided into equally sized categories. The intermediate category (glucose 124-143 mg/dL, K 4-4.9 mEq/L) was the reference group. The associations of these tests with the outcome were assessed using Generalized Estimating Equations model which included the interaction of K and glucose levels, adjusted for the patient's baseline characteristics and other laboratory results., Results: 17,670 AMI admissions (mean age 67.8 ± 4.0 years, 66.6% males, mortality rate 7.7%) were included; 112,531 results of K/glucose tests were recorded. Univariate and multivariate analyses showed that K/glucose levels were significantly associated with in-hospital mortality, with highest risk being in patients with concomitant low K (<3.7 mEq/L) and high glucose (≥217 mg/dL), adjOR = 2.53. It seems that low-normal glucose levels attenuate the increased risk associated with low K., Conclusions: The highest independent risk for mortality is found with low K and concomitant high glucose levels. Additional studies evaluating mechanisms and therapeutic interventions in K/glucose levels in this setting are warranted., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Introduction & Objective: Recently we developed and internally-validated the Soroka Acute Myocardial Infarction (SAMI) Score for prediction of all-cause long-term mortality (c-statistic 0.83-0.94) among hospital-survivors of AMI. We aimed to perform an external-validation of the SAMI score for long-term risk-stratification of STEMI patients undergoing PCI., Methods & Settings: A prospective registry of 1273 STEMI patients treated using primary PCI and discharged alive from Rabin Medical Center in Israel between 2004 and 2014 (age 60.8 ± 12.5 years, 83% males) was utilized for the validation. Chi-square test and logistic regression were used for calibration, and c-statistic (ROC procedure) for discrimination assessment of the SAMI score., Results: All-cause mortality following one- and 5-years post-discharge was 3.8% and 8.1%, respectively. SAMI score values ranged between (-5) and (+15) points (median 2-points). In a univariate analysis the SAMI score variables were significantly associated with 1- and 5-years mortality. Higher SAMI score was associated with increased risk for dying: a one-point increase was associated with OR of 1.33 (95%CI: 1.24-1.42, p < 0.001) and 1.37 (95%CI: 1.29-1.44, p < 0.001) for 1- and 5-years mortality respectively. No statistically significant difference was found in the currently observed mortality rates by groups of SAMI score and the expected mortality rates as per the SAMI score index. The c-statistics were 0.82 and 0.83 for 1- and 5-year mortality, respectively., Conclusions: The SAMI score is a simple, robust and now also externally-validated prognostic tool for prediction of long-term all-cause mortality in hospital survivors of STEMI., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Reports from many countries have shown birthplace-associated disparities in the incidence and mortality following acute myocardial infarction (AMI). The aims of the study were to identify and compare short- and long-term post-AMI mortality according to birthplace., Methods: A retrospective analysis of Israeli AMI patients from a tertiary medical center in Southern Israel throughout 2002-2012., Data Source: the hospital's computerized systems. Patients were classified according to the country of birth (Israel, Southern Europe/Balkans, Northern Africa, Eastern/Central Europe, India/Pakistan, Middle-East, Yemen, and Ethiopia)., Study Outcomes: in-hospital and up to 10-years post-discharge all-cause mortality., Results: The study included 11,143 patients, age 67.4 ± 13.9 and 67.5% men. Israeli-born patients were significantly younger, with lower rate of diabetes mellitus and hypertension but significantly higher rate of obesity, smoking, history of coronary artery disease and male sex compared with immigrants. The rate of STEMI and administration of percutaneous coronary revascularization was higher, yet extent of coronary findings and severe left ventricular dysfunction was lower in Israeli-born patients. In-hospital as well as post-discharge 1-and 10-year mortality rates were approximately 65% lower in Israeli-born patients compared with immigrants. Following adjustment for potential confounders the inequalities in post-discharge mortality attenuated (Yemen OR = 2.3 [95%CI: 1.4-3.6], Southern Europe/Balkans 1.75 [1.2-2.5], Northern Africa 1.5 [1.3-1.8], Eastern/Central Europe 1.4 [1.2-1.7] and India/Pakistan 1.4 [1.1-1.9], for 10-years mortality, p < 0.05 for each) and those for in-hospital mortality disappeared., Conclusions: Immigrants are at increased risk for post-discharge, yet not in-hospital mortality following AMI. Appropriate targeted preventive programs are required for these groups of patients., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: Patient function is a risk factor of mortality following acute myocardial infarction (AMI). Norton scale (NS) was originally developed to estimate the risk for pressure ulcers. It contains 5 domains: mental condition, physical condition, mobility, activity in daily living and incontinence., Objective: To evaluate NS as long-term prognostic marker following AMI., Methods: A retrospective study based on computerized medical records of AMI patient hospitalized in a tertiary medical center in 2004-2012. NS scores and patients' characteristics were collected from computerized databases. The primary outcome was all-cause long-term (up-to 10-years) mortality., Results: Overall 6964 patients were included; mean age 67.3±14.1years, 68.1% males. Mean NS score was 17.8±3; of which 21.1% had low-NS (≤16). Patients with low-NS had increased prevalence of hypertension, diabetes and renal disease, 3-vessel coronary artery disease, more often Non ST-Elevation Myocardial Infarction (NSTEMI) and in-hospital complications. Throughout the follow-up period cumulative mortality rate in patients with low- and high-NS groups were 97.3% and 43% respectively (AdjHR 1.66; 95% CI: 1.521-1.826; p<0.001). Furthermore, a reduction in one point in the NS score inversely associated with increased risk for mortality (AdjHR 1.10; 95% CI: 1.12-1.22; p<0.001)., Conclusions: NS is an independent long-term prognostic marker for all-cause mortality in hospital survivors with a gradual "dose-response" effect. This data emphasizes the importance prognostic implication of the general functional status on the prognosis of AMI patients., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Background: Decreased serum albumin level (SAL) was reported to be associated with increased risk of cardiovascular events and short term-mortality in patients with acute myocardial infarction (AMI)., Objectives: To evaluate the association between SAL and long-term mortality in AMI hospital survivors., Methods: Retrospective analysis of patients admitted in a tertiary medical center for AMI 2002-2012 and discharged alive., Exclusion Criteria: active infections, inflammatory diseases, significant liver or kidney failure, malignancy, ejection-fraction <20%, severe heart valvular-disease and missing SAL. SAL was categorized as following: <3.4, 3.4-3.7, 3.7-3.9, 3.9-4.1 and >4.1g/dL. The primary outcome was all-cause mortality for up-to 10-years post-AMI., Results: Out of 12,535 patients, 8750 were included. Patients with reduced SAL were older, higher rate of women, increased prevalence of severe left ventricular dysfunction, chronic renal failure, diabetes mellitus and ST-elevation AMI, 3-vessel coronary artery disease, and in-hospital complications. While the prevalence of chronic ischemic coronary disease, dyslipidemia, smokers and obesity, was lower. Mortality rates throughout the follow-up period increased as SAL decreased with 17.6%, 24%, 28.5%, 38.6%, and 57.5% for SAL of >4.1, 3.9-4.1, 3.7-3.9, 3.4-3.7 and <3.4g/dL respectively (p-for-trend <0.001). Using the SAL category of >4.1g/dL as the reference group, Adjusted Hazard Ratio values were 1.14 (p=0.107), 1.23 (p=0.007), 1.39 (p<0.001) and 1.70 (p<0.001) for the SAL categories of 3.9-4.1, 3.7-3.9, 3.4-3.7 and <3.4g/dL respectively., Conclusions: Decreased SAL on admission, including levels within "normal" clinical range, is significantly associated with long-term all-cause mortality in hospital survivors of AMI with a "dose-response" type association., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Background: Ethnical disparities in presentation and outcomes following AMI were reported. We evaluated the temporal-trends of AMI hospitalizations and mortality of Bedouins (Muslims) and Jews in Israel., Methods: Retrospective analysis of 15,352 AMI admissions (10,652 patients; 11.3% Bedouins, 88.7% Jews) throughout 2002-2012. The trends in admission rates (AR) were compared using direct age-sex adjustment. The trends of in-hospital mortality (IHM) and 1-year post-discharge mortality (PDM) were adjusted for the patients' characteristics., Results: Bedouins were younger (61.7±14.3 vs. 68.8±13.7years, p<0.001), a higher rate of males. Different prevalence of cardiovascular risk factors was found. STEMI presentation, 3-vessel disease and PCI intervention were more frequently in Bedouins than Jews. Adjusted AR was lower among Jews (4.80/1000 and 3.24/1000 in 2002 and 2012 respectively) than in Bedouins (9.63/1000 and 5.13/1000). A significant decrease of adjusted AR was found in both ethnicities (p-for-trend<0.001 both), greater in Bedouins (p-for-disparity=0.017). The overall rate of IHM was higher for Jews (8.7% vs. 5.6%; p=0.001). The decline of IHM was found in both groups: an increase of one-year resulted in AdjOR=0.877; (p-for-trend<0.001) and 0.910 (p-for-trend=0.052) in Jews and Bedouins respectively (p-for-interaction=0.793). The rates of PDM were higher for Jews (13.6% vs. 9.9%; p=0.001). The risk for PDM increased in both groups: AdjOR=1.118; (p-for-trend<0.001) and 1.093; (p-for-trend=0.012) for one-year increase, for Jews and Bedouins respectively (p-for-interaction=0.927)., Conclusions: Throughout 2002-2012 Bedouin AMI patients differed from Jews. Adjusted incidence of AMI declined, greater in Bedouins. IHM declined and PDM increased in both groups. A culturally sensitive prevention program is warranted., (Copyright © 2016. Published by Elsevier Ireland Ltd.)

Objective: To determine the prevalence of epiretinal membrane (ERM) in patients with type 2 diabetes mellitus (T2DM) and to assess the associated risk factors., Design: Retrospective, cross sectional study., Methods: Patients with T2DM, seen for annual follow-up between 2009 and 2010, were evaluated by digital nonmydriatic retinal photography for the detection of diabetic retinopathy. Retinal photographs were assessed by a retina specialist., Results: ERM was present in 102 of 1550 patients with T2DM (6.5%). Of the participants, 1443 had sufficient documented data to conduct statistical analysis for variant risk factors. The prevalence of ERM was significantly associated with age (p < 0.001; 1.2% for <49 years, 4% for 50-59 years, 8.2% for 60-69 years, and 9.6% for >70 years), cataract surgery (p < 0.001), diabetic nephropathy (p < 0.001), and chronic renal failure (p = 0.039). Prevalence was similar for both sexes (53% females, 47% males; p = 0.33). In logistic regression models, the prevalence of ERM was significantly associated with increasing age (p = 0.018), cataract surgery (p < 0.001), and diabetic nephropathy (p = 0.011)., Conclusions: The prevalence of ERM in patients with T2DM in the present study was not significantly different than that of the general population. ERM was significantly associated with age, diabetic nephropathy, and cataract surgery., (Copyright © 2015 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

Background: Contemporary data on trends of acute myocardial infarction (AMI), particularly outcomes of hospital survivors by AMI type is sparse., Methods: Analysis of 11,107 consecutive AMI patients in a tertiary hospital in Israel throughout 2002-2012. The annual incidence of ST-segment elevation (STEMI) and non-ST-segment elevation (NSTEMI) admissions was calculated using age-gender-ethnicity direct adjustment. A multivariate prognostic model was built to evaluate in-hospital and 1-year post-discharge all-cause-mortality, adjusted for patients' risk factors., Results: A decline in the adjusted incidence of AMI admissions (per-1000 persons) was documented (2002 vs. 2012) for STEMI: 4.70 vs. 1.38 (p<0.001) and non-significant tendency of increase for NSTEMI: 1.86 vs. 2.37 (p=0.109). The prevalence of most cardiovascular risk-factors, some non-cardiovascular comorbidities and invasive interventions increased. In-hospital mortality declined significantly for STEMI: 10.8% vs. 7.7% (p<0.001) and with no change for NSTEMI: 5.0% vs. 5.5% (p=0.137). Consistently, 1-year post-discharge mortality declined for STEMI: 13% vs. 5.9% (p<0.001) and with a non-significant increase for NSTEMI: 12.6% vs. 17.0% (p=0.377). Adjusting for the risk factors, an increase of one year was associated with a decline of in-hospital mortality for STEMI: AdjOR=0.86 (p<0.001) and for NSTEMI: AdjOR=0.92 (p<0.001). However, the risk for post-discharge mortality increased for STEMI: AdjOR=1.11 (p<0.001) and for NSTEMI: AdjOR=1.12 (p<0.001)., Conclusions: Throughout 2002-2012 significant decline in the incidence and of in-hospital mortality of STEMI were found. However, adjusted post-discharge mortality rates increased significantly with time. Measures for improving incidence and outcomes of AMI patients focusing on NSTEMI and hospital-survivors are warranted., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Background: Cardiovascular diseases are the leading cause of death in elderly people. Over the past decades medical advancements in the management of patients with acute myocardial infarction (AMI) led to improved survival and increased life expectancy. As short-term survival from AMI improves, more attention is being shifted toward understanding and improving long-term outcomes., Aim: To evaluate age-associated variations in the long-term (up to 10 years) prognostic factors following AMI in "real world" patients, focusing on improving risk stratification of elderly patients., Methods: A retrospective analysis of 2763 consecutive AMI patients according to age groups: ≤65 years (n=1230) and >65 years (n=1533). Data were collected from the hospital's computerized systems. The primary outcome was 10-year postdischarge all-cause mortality., Results: Higher rates of women, non-ST-elevation AMI, and most comorbidities were found in elderly patients, while the rates of invasive treatment were lower. During the follow-up period, mortality rate was higher among the older versus the younger group (69.7% versus 18.6%). Some of the parameters included in the interaction multivariate model had stronger association with the outcome in the younger group (hyponatremia, anemia, alcohol abuse or drug addiction, malignant neoplasm, renal disease, previous myocardial infarction, and invasive interventions) while others were stronger predictors in the elderly group (higher age, left main coronary artery or three-vessel disease, and neurological disorders). The c-statistic values of the multivariate models were 0.75 and 0.74 in the younger and the elder groups, respectively, and 0.86 for the interaction model., Conclusions: Long-term mortality following AMI in young as well as elderly patients can be predicted from simple, easily accessible clinical information. The associations of most predictors and mortality were stronger in younger patients. These predictors can be used for optimizing patient care aiming at mortality reduction., (Copyright © 2014 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.)

Background: Risk stratification of patients following acute myocardial infarction (AMI), in order to identify patients whose clinical outcomes can be improved through specific medical interventions, is needed., Objectives: Development and validation of a prognostic tool comprising a variety of non-cardiovascular co-morbidities, to predict mortality of hospital survivors after AMI., Methods: The study cohort included 2773 consecutive patients with AMI who were discharged live from the Soroka University Medical Center between 2002 and 2004. Two-thirds were used obtain the model (training set) and one-third to validate it (validation set). Data were collected from the hospital's routine computerized information systems. The primary outcome was post-discharge 1-year all-cause mortality. The weight of each variable in the final score was computed based on the odds ratio values of the multivariate model. Additionally, the ability of the index to predict 5-year mortality was assessed., Results: These are comprised of the following parameters: 4 points - age >75 years, abnormal echocardiography findings; 3 points - at least one of following: gastro-intestinal hemorrhage, COPD, malignancy, alcohol or drug addiction, neurological disorders, psychiatric disorders; 2 points - no echocardiography results, renal diseases, anemia, hyponatremia; -3 points for PCI or thrombolytic therapy; -6 points - CABG; -2 points - obesity. The c-statistics for 1-year all-cause mortality were 0.86 and 0.83 in the training and validation sets, respectively. The c-statistics for 5-year mortality was 0.858 for both sets combined., Conclusions: The new score is a simple robust tool for predicting mortality in patients discharged alive following AMI., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)