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Healthcare resource utilization (HRU) peaks in the last year-of-life, and accounts for a substantial share of healthcare expenditure. We evaluated changes in HRU and costs throughout the last year-of-life among AMI survivors and investigated whether such changes can predict imminent mortality. This retrospective analysis included patients who survived at least one year following an AMI. Mortality and HRU data during the 10-year follow-up period were collected. Analyses were performed according to follow-up years that were classified into mortality years (one year prior to death) and survival years. Overall, 10,992 patients (44,099 patients-years) were investigated. Throughout the follow-up period, 2,885 (26.3%) patients died. The HRU parameters and total costs were strong independent predictors of mortality during a subsequent year. While a direct association between mortality and hospital services (length of in-hospital stay and emergency department visits) was observed, the association with ambulatory services utilization was reversed. The discriminative ability (c-statistics) of a multivariable model including the HRU parameters for predicting the mortality in the subsequent year, was 0.88. In conclusion, throughout the last year of life, hospital-centered HRU and costs of AMI survivors increase while utilization of ambulatory services decrease. HRUs are strong and independent predictors of an imminent mortality year among these patients. [ABSTRACT FROM AUTHOR]

Fasting throughout the Muslim month of Ramadan may impact cardiovascular health. This study examines the association between the Ramadan period and acute myocardial infarction (AMI)-related outcomes among a Muslim population. The data were retrospectively extracted from a tertiary hospital (Beer-Sheva, Israel) database from 2002–2017, evaluating Muslim patients who endured AMI. The study periods for each year were: one month preceding Ramadan (reference period (RP)), the month of Ramadan, and two months thereafter (1840 days in total). A comparison of adjusted incidence rates between the study periods was performed using generalized linear models; one-month post-AMI mortality data were compared using a generalized estimating equation. Out of 5848 AMI hospitalizations, 877 of the patients were Muslims. No difference in AMI incidence between the Ramadan and RP was found (p = 0.893). However, in the one-month post-Ramadan period, AMI incidence demonstrably increased (AdjIRR = 3.068, p = 0.018) compared to the RP. Additionally, the highest risk of mortality was observed among the patients that underwent AMI in the one-month post-Ramadan period (AdjOR = 1.977, p = 0.004) compared to the RP. The subgroup analyses found Ramadan to differentially correlate with AMI mortality with respect to smoking, age, sex, diabetes mellitus, and hypertension, suggesting the Ramadan period is a risk factor for adverse AMI-related outcomes among select Muslim patients. [ABSTRACT FROM AUTHOR]

Aims Many patients admitted with acute myocardial infarction (AMI) have considerable multimorbidity, sometimes associated with functional limitations. The Norton Scale Score (NSS) evaluates clinical aspects of well-being and predicts numerous clinical outcomes. We evaluated the association between NSS and long-term healthcare utilization (HU) following a non-fatal AMI. Methods and results A retrospective observational study including AMI survivors during 1 January 2004 to 31 December 2015 with a filled NSS report. Data were recouped from the electronic medical records of the hospital and two Health Maintenance Organizations. Norton Scale Score ≤16 or >16 was defined as low or high respectively. The outcome was annual HU, encompassing length of hospital stay (LOS), emergency department (ED) visits, primary care, and other ambulatory service utilization during up to 10 years of follow-up. HU costs were compared between groups. Two-level models were built: unadjusted and adjusted for patients' baseline characteristics. The study included 4613 patients, 784 (17%) had low NSS. Patients with low NSS compared with patients with high NSS were older, had a higher rate of multimorbidity, and had significantly lower coronary angiography and revascularization rates. In addition, low NSS patients presented higher annual HU costs (4879 vs. 3634 Euro, P <0.001), primarily due to LOS, ED visits, and less frequent ambulatory services usage. Conclusion In patients after non-fatal AMI, low NSS is a signal for higher long-term costs reflecting the presence of expensive comorbidities. Management disparity and impaired mobility may offset the real need of these patients. Therefore, the specific proactive nursing intervention in that population is recommended. [ABSTRACT FROM AUTHOR]

Patients with new-onset of atrial fibrillation (NOAF) during acute myocardial infarction (AMI) currently receive long-term oral anticoagulation. The risk for stroke of "early" versus "late" onset of atrial fibrillation (AF) has not been elucidated. Consecutively, AMI patients admitted to a tertiary medical center were analyzed. We excluded patients with preexisting AF, AMI onset ≥24 hours prior to admission, significant valvular disease, fever >38.5°C, in-hospital death, or coronary artery bypass graft. Atrial fibrillation was verified by electrocardiography and medical records. Overall 7061 patients were included, 1.4% developed "early-paroxysmal AF (PAF)" that resolved within 24 hours of admission and 2.5% had "late-AF" beyond the first 24 hours. Median follow-up was ≈6 years. Primary end points included ischemic stroke and all-cause mortality. Stroke rates were higher only in patients with late-AF versus no-AF but not in the early-PAF: 10.6% versus 4.2%, 5.3%, respectively (P <.001). Death rates were higher in patients with late-AF and early-PAF versus no-AF: 55.3%, 43.2%, and 29.2%, respectively (P <.001). Congestive heart failure, hypertension, age ≥75, diabetes mellitus, a stroke or transient ischemic attack, vascular disease, age 65-74, female (CHA2DS2-VASc) score underestimated stroke risk in the late-AF group. In conclusion, the study generates the hypothesis that patients with early-PAF may not have a high stroke risk questioning the indication for long-term anticoagulation. [ABSTRACT FROM AUTHOR]

New-onset atrial fibrillation (NOAF) during acute myocardial infarction (AMI) has significant consequences but is often misdiagnosed. The aim of the study was to evaluate predictors of NOAF throughout different phases of AMI. Patients with AMI admitted to a tertiary medical center were analyzed. Exclusion criteria were preexisting AF, AMI onset ≥24 hours prior to admission, in-hospital death, significant valvular disease, and in-hospital coronary artery bypass graft. Study population were AMI without-NOAF, early-AF (AF terminated within 24 hours of admission), and late-AF (beyond the first 24 hours). Overall 5946 patients were included, age: 64.8 ±14.8 years; 30% women. The incidence of NOAF was 4.6%: 1.6% early-AF, and 3% late-AF. Patients with NOAF comprised greater rate of women, cardiovascular risk-factors burden, severe left ventricular-dysfunction, pulmonary hypertension, valvular disorders, and left atrial enlargement compared with patients without-NOAF. Non-ST-elevation myocardial infarction and inferior-ST-elevation myocardial infarction (STEMI) were significantly more prevalent among early-AF group, while anterior-STEMI, in late-AF. The final multivariate models showed c-statistics of 0.73 and 0.76 for the prediction of new-onset early-AF and late-AF, respectively. In conclusion, there are different clinical predictors of early- versus late-NOAF. The study points out "high risk" AMI population for more meticulous heart rate monitoring for NOAF. [ABSTRACT FROM AUTHOR]

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. To evaluate the associations of concomitant K and glucose (K/glucose) levels with in-hospital mortality in AMI patients. 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. 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. 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. • Associations of plasma potassium and glucose levels with outcomes in AMI are investigated as potential focus for intervention. • Combined potassium and glucose levels are associated with in-hospital mortality in AMI patients. • The highest independent risk for mortality is associated with the combination of low potassium and high glucose levels. [ABSTRACT FROM AUTHOR]

Objective: Acute myocardial infarction (AMI) is associated with significant risk for long-term morbidity and healthcare expenditure. We investigated healthcare utilization and direct costs throughout 10 years following AMI. Methods: A retrospective study included AMI patients hospitalized in a tertiary medical center throughout 2002-2012. Data was obtained from computerized medical records. Hospitalizations, emergency department (ED), primary care and outpatient consulting clinic visits and other ambulatory services, following the AMI and their costs, were compared with the year preceding the AMI. Results: Overall 9548 patients were analyzed (age 66.6 ± 13.9 years, 67.8% men, 48.1% ST-elevation AMI). A significant increase in the utilization of all the evaluated services was observed in the first year following the AMI compared with the preceding year (p < .001 for each) and followed by a decline thereafter (p-for trend < .001 for each) except increased number of ED visits (p-for trend = .014). Annual per-patient costs throughout the first year following AMI (5592€) were significantly greater compared with the preceding year (3120€) and declined subsequently to 3216€ and 2760€ for years 2-5 and 6-10, respectively. Multivariate analysis showed that throughout the first half of the follow-up total costs were slightly higher and in the second half similar to the year preceding the AMI. Analysis of the relative costs showed that ambulatory services make up most of the expenditure. Conclusions: Healthcare utilization and economic expenditure peak throughout the first year and decline afterwards. For several services it remains higher for up to 10 years compared with the year preceding the AMI. [ABSTRACT FROM AUTHOR]

Cardiovascular (CV) patients are becoming older with a greater number of CV risk factors (CVRFs). The Framingham risk score (FRS) includes the major CVRFs and is used for CV risk stratification. We investigated temporal trends in burden of CVRFs among patients with acute myocardial infarction (AMI) throughout a decade. Patients with AMI hospitalized through 2002 to 2012 were studied. The baseline characteristics included age, sex, ethnicity, type of AMI (ST-segment elevation [STEMI] vs non-STEMI [NSTEMI]), coronary artery disease (CAD), diabetes mellitus (DM), dyslipidemia, hypertension, obesity, smoking, and blood lipid profile. The FRS was calculated for each patient. A total of 14 698 AMI admissions were included (age 66.9 ± 13.6 years, 68% males, 47.6% STEMI). Half of admitted cases had ≥4 CVRFs. The mean FRS was 17.1 ± 4.1. Throughout the study period, patients with AMI became older with increased burden of CVRFs. The mean FRS increased from 16.8 ± 4.0 (2002) to 17.3 ± 4.1 (2012; P <.001). Multivariate analysis demonstrated a significant increase in FRS among patients with NSTEMI and significant decrease for patients with STEMI. Conclusions: The last decade, patients with AMI became older with increased burden of CVRFs. Framingham risk score increased among patients with NSTEMI and decreased in patients with STEMI. These trends impact on risk stratification and secondary prevention programs. [ABSTRACT FROM AUTHOR]

Potassium levels (K, mEq/L) fluctuate in patients with acute myocardial infarction (AMI). Potassium was reported to be associated with prognosis in patients with AMI; however, studies evaluating the prognostic value of K fluctuations in this setting are scarce. We retrospectively analyzed patients with AMI hospitalized in a tertiary medical center, through 2002 to 2012. Patients on chronic dialysis or mechanical ventilation were excluded. Based on all K values during hospitalization, minimal, maximal, and fluctuation (gap between 2 consecutive K) were recorded. Primary outcome was inhospital all-cause mortality. Overall, 10 032 patients were studied (age 68.1+14.3 years, 65.4% males, 44.2% ST-segment elevation MI), of which 507 (3.7%) died in hospital. Potassium decreased during the first 2 to 3 days (P for trend <.001), followed by stabilization (P for trend = .807). Potassium in the extreme categories (<3.8 and >4.7) and absolute fluctuations >0.1 mEq/L were more common among nonsurvivors than survivors (P < .001 each). In a multivariate analysis, combinations of minimal K <3.8 with maximal K > 4.7 (odds ratio [OR] = 18.1), K > 4.4 with fluctuation >0.1 (OR = 1.74), or <0.1 (OR = 2.6) and minimal K after the first 2 admission days (OR = 2.07) were associated with increased risk of mortality (P < .001 each). Potassium fluctuations, peak and nadir K, and its timing independently predict inhospital mortality in patients with AMI. [ABSTRACT FROM AUTHOR]

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 > 4.1 g/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 < 3.4 g/dL respectively (p-for-trend < 0.001). Using the SAL category of > 4.1 g/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 < 3.4 g/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. [ABSTRACT FROM AUTHOR]

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 ± 13.7 years, 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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective: To assess the impact of the new American College of Cardiology/European Society of Cardiology definition of acute myocardial infarction (AMI) and the introduction of troponin measurement on the coronary care unit (CCU) Methods: This was a retrospective cohort study performed in a tertiary care university hospital. All admissions to the CCU during the year before (period 1, year 2000, n = 1,134) and the year after (period 2, year 2002, n = 1,360) the introduction of troponin measurement and the new AMI definition were studied. We studied baseline characteristics, case load, distribution of admission diagnoses, management and outcome of patients in the two periods. Results: There was a 20% increase in the number of CCU admissions, driven solely by a 141% increase in the burden of non-ST elevation AMI (NSTEMI) (p < 0.01). This increase was not a mere reflection of a change in diagnostic criteria, as the overall burden of non-ST elevation acute coronary syndromes (ACS) (NSTEMI + unstable angina) increased by 46%, suggesting referral of many more patients to the CCU. Despite a 42% increase in the number of angiograms performed, the proportion of ACS patients who had an angiogram declined. AMI patients in period 2 were older and had higher rates of coronary risk factors but had a higher chance of receiving a guideline-based therapy. Length of CCU stay decreased by a whole day for all ACS patients. 30-day mortality for AMI patients did not change significantly. Conclusions: The new AMI definition had a dramatic impact on the CCU case load, case mix and length of stay and on the ability to provide early coronary angiography. [ABSTRACT FROM AUTHOR]

Frequent fluctuations of hemoglobin A1c (HbA1C) values predict patient outcomes. However, data regarding prognoses depending on the long-term changes in HbA1C among patients after acute myocardial infarction (AMI) are scarce. We evaluated the prognostic significance of HbA1C levels and changes among diabetic patients (n = 4066) after non-fatal AMI. All the results of HbA1C tests up to the 10-year follow-up were obtained. The changes (∆) of HbA1C were calculated in each patient. The time intervals of ∆HbA1C values were classified as rapid (

Background: High levels of circulating cell free DNA (CFD) have been associated with poor prognosis in various diseases. Data pertaining to CFD in acute myocardial infarction (MI) are scarce. The available data have been obtained by either electrophoresis or polymerase chain reaction. We evaluated a novel method for the detection of CFD in patients with ST elevation myocardial infarction (STEMI) and examined its correlation with established markers of necrosis and ventricular function. Methods: Serum concentrations of CFD, troponin-T and creatine kinase (CK) were measured simultaneously in 16 randomly selected acute STEMI patients upon admission and at three more time points. 47 healthy subjects served as a control group. CFD was quantified by a novel rapid fluorometric assay. Ejection fraction (EF) was assessed by echocardiography. Results: Peak CFD levels were significantly higher in patients compared with controls ( P = 0.001) and correlated with peak levels of CK and troponin-T (R = 0.79, P <0.001); R = 0.65, P = 0.006, respectively). Peak CFD levels tended to be associated with lower EF ( P = 0.075). Conclusion: With this method, CFD levels correlated with the levels of established markers of myocardial necrosis but not with EF. The kinetic pattern of CFD release after STEMI and its prognostic value require further investigation. [ABSTRACT FROM AUTHOR]

Healthcare resource utilization peaks throughout the first year following acute myocardial infarction (AMI). Data linking the former and outcomes are sparse. We evaluated the associations between subsequent length of in-hospital stay (SLOS) and primary ambulatory visits (PAV) within the first year after AMI and long-term mortality. This retrospective analysis included patients who were discharged following an AMI. Study groups: low (0–1 days), intermediate (2–7) and high (≥8 days) SLOS; low (<10) and high (≥10 visits) PAV, throughout the first post-AMI year. All-cause mortality was set as the primary outcome. Overall, 8112 patients were included: 55.2%, 23.4% and 21.4% in low, intermediate and high SLOS groups respectively; 26.0% and 74.0% in low and high-PAV groups. Throughout the follow-up period (up to 18 years), 49.6% patients died. Multivariable analysis showed that an increased SLOS (Hazard ratio (HR) = 1.313 and HR = 1.714 for intermediate and high vs. low groups respectively) and a reduced number of PAV (HR = 1.24 for low vs. high groups) were independently associated with an increased risk for mortality (p < 0.001 for each). Long-term mortality following AMI is associated with high hospital and low primary ambulatory services utilization throughout the first-year post-discharge. Measures focusing on patients with increased SLOS and reduced PAV should be considered to improve patient outcomes. [ABSTRACT FROM AUTHOR]

In this article, the authors talks about the European Society of Cardiology guidelines which includes new-onset atrial fibrillation (NOAF); and potentially important parameters to be obtained, analyzed as potential predictors and compared between the 2 subgroups of NOAF.

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. To evaluate whether K levels predict imminent AKI in patients with AMI. 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). 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). 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. • Acute kidney injury (AKI) is a common complication of myocardial infarction (MI) • High K independently predict imminent AKI within the time window of 36–56 h • The study presents a simple and accurate model for prediction AKI after MI [ABSTRACT FROM AUTHOR]

Thrombolytic therapy is usually contraindicated after abdominal surgery because of the risk of bleeding. We report a case of a 73-year-old woman who was admitted because of anterior wall acute myocardial infarction (AMI) two weeks after laparoscopic cholecystectomy. She was treated with streptokinase, aspirin and heparin and subsequently developed a hematoma at the site of the removed gallbladder. Our observation suggests that thrombolytic therapy for anterior AMI, two weeks after laparoscopic cholecystectomy, should be considered as a relative contraindication and an optional treatment in this life-threatening situation.Copyright © 2000 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

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 ± 14.1 years, 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. [ABSTRACT FROM AUTHOR]

Abstract: 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 >75years, 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 &y& Elsevier]

Aim: Type 2 diabetes mellitus (T2DM) is a risk factor for mortality after acute myocardial infarction (AMI). We studied the impact of T2DM related to sex and age on post-AMI long-term mortality.Methods: A retrospective study included post-AMI patients. Data were obtained from electronic medical records. We defined the study groups by T2DM, stratified by age-sex.Outcome: up-to-10 years post-discharge all-cause mortality.Results: 16,168 patients were analyzed, 40.3% had T2DM. Ten-year mortality rates were 50.3% with T2DM vs. 33.1% without T2DM, adjHR = 1.622 (p < 0.001). Females (adjHR = 1.085, p = 0.052) and increased age (adjHR = 1.056 for one-year increase, p < 0.001) were associated with a higher risk of mortality (borderline statistical significance for sex). The relationship between T2DM and mortality was stronger in females than in males at < 50 and 60-69 years (p-for-interaction 0.025 and 0.009 respectively), but not for other age groups.Conclusions: The study implies heterogeneity in the impact of T2DM on mortality of post-AMI patients, being greater among young patients, particularly females, and no significant impact in octogenarians. That implies that young women with T2DM should have advanced measures for early detection of coronary artery disease and tight control of cardiovascular risk factors to lower the propensity to develop AMI. [ABSTRACT FROM AUTHOR]