Search

BackgroundSex and racial disparities in the presentation and management of chest pain persist, however, the impact of coronavirus disease 2019 (COVID-19) on these disparities have not been studied. We sought to determine whether the COVID-19 pandemic contributed to pre-existing sex and racial disparities in the presentation, management, and outcomes of patients presenting to the emergency department (ED) with chest pain.MethodsWe conducted an observational cohort study with retrospective data collection of patients between January 1, 2016, and May 1, 2022. This was a single study conducted at a quaternary academic medical center of all patients who presented to the ED with a complaint of chest pain or chest pain equivalent symptoms. Patient were further segregated into different groups based on sex (male, female), race, ethnicity (Asian, Black, Hispanic, White, and other), and age (18 - 40, 41 - 65, > 65). We compared diagnostic evaluations, treatment decisions, and outcomes during prespecified time points before, during, and after the COVID-19 pandemic.ResultsThis study included 95,764 chest pain encounters. Total chest pain presentations to the ED fell about 38% during the early pandemic months. Females presented significantly less than males during initial COVID-19 (48% vs. 52%, P < 0.001) and Asian females were least likely to present. There was an increase in the total number of troponins and echocardiograms ordered during peak COVID-19 across both sexes, but females were still less likely to have these tests ordered across all timepoints. The number of coronary angiograms did not increase during peak COVID-19, and females were less likely to undergo coronary angiogram during all timepoints. Finally, females with chest pain were less likely to be diagnosed with acute myocardial infarction (AMI) during all timepoints, while in-hospital deaths were similar between males and females during all timepoints.ConclusionsDuring COVID-19, females, especially Asian females, were less likely to present to the ED for chest pain. Non-White patients were less likely to present to the ED compared to White patients prior to and during the pandemic. Disparities in management and outcomes of chest pain encounters remained similar to pre-COVID-19, with females receiving less cardiac workup and AMI diagnoses than males, but in-hospital mortality remaining similar between groups and timepoints.

Purpose: Cardiomyocyte death is a major cytopathologic response in acute myocardial infarction (AMI) and involves complex inflammatory interactions. Although existing reports indicating that mixed lineage kinase domain-like protein (MLKL) is involved in macrophage necroptosis and inflammasome activation, the downstream mechanism of MLKL in necroptosis remain poorly characterized in AMI. Methods: MLKL knockout mice (MLKLKO), RIPK3 knockout mice (RIPK3KO), and macrophage-specific MLKL conditional knockout mice (MLKLM−KO) were established. AMI was induced by coronary artery ligation. The role of MLKL in regulating myocardial morphological necroptosis was evaluated using immunofluorescence staining, flow cytometry, qRT-PCR, Western blot, CCK-8 assay, and ELISA. Results: Our findings revealed that myocardial segmental necroptosis (MSN), a unique morphological characteristics of cell death observed post-AMI, was promoted by intercellular inflammatory adhesion mediated by MLKL. The key features of MSN included localized cytomembrane perforation, segmental attenuation of myofilaments, MLKL-mediated filling, and macrophage inflammatory adhesion. In a mouse model of AMI, we observed MSN, which was absent in immunosuppressed mice. Pharmacological depletion of macrophages or genetic knockout of macrophage-specific MLKL (MLKLM−KO) reduced the occurrence of MSN. This reduction was reversed upon reinfusion of wild-type macrophages. Additionally, myocardial injury was significantly ameliorated in MLKLM−KO mice following AMI. In a macrophage-cardiomyocyte co-culture system, MLKLM−KO attenuated hypoxia-induced MSN and inhibited macrophage-mediated inflammatory adhesion. Furthermore, MLKL was found to trigger the formation of membrane pores and the polymerization of integrin αvβ1, thereby enhancing inflammatory adhesion in the co-culture system. Notably, MLKL-enhanced inflammatory adhesion was not entirely dependent on RIPK3. Conclusion: Our study demonstrates that MLKL is directly involved in myocardial segmental necroptosis by interacting with macrophages through inflammatory adhesion, and possibly independently of RIPK3. [ABSTRACT FROM AUTHOR]

Background: Radical cystectomy constitutes the standard therapeutic approach for high-risk urothelial carcinomas of the bladder. Contemporary guidelines advise urologists to discontinue anticoagulation therapy during the perioperative period to mitigate the risk of significant intraoperative or postoperative hemorrhage. Nevertheless, in elderly patients with a history of coronary artery disease, the cessation of anticoagulant medication elevates the risk of acute myocardial infarction, thereby posing a substantial threat to their survival. Therefore, the necessity and optimal strategy for anticoagulation therapy in patients with acute myocardial infarction following radical cystectomy remains a subject of ongoing debate. This study aims to contribute clinical insights for clinicians to manage high-risk patients with acute myocardial infarction post-major surgery. Methods and results: The 64-year-old male patient was admitted for multiple high-grade urothelial carcinomas of the bladder. The preoperative computed tomography angiography revealed intra-luminal stenosis of the coronary arteries. However, the patient declined further assessment via preoperative coronary angiography, thereby precluding the accurate prediction of postoperative myocardial infarction risk. The patient subsequently underwent laparoscopic radical cystectomy with Bricker conduit urinary diversion and the postoperative pathological examination confirmed the diagnosis of high-grade urothelial carcinoma (T1N0M0, G3). Regrettably, on the first postoperative day, the patient experienced an acute anterior wall ST-segment elevation myocardial infarction. Consequently, the patient underwent emergency percutaneous coronary intervention and was administered dual antiplatelet therapy consisting of aspirin and ticagrelor. The daily pelvic fluid drainage, routine blood and coagulation parameters remained within normal ranges. Following the second percutaneous coronary intervention and dual antiplatelet therapy, the patient was discharged after 2 days. Over a 3-year follow-up period, all hematological parameters consistently remained within normal ranges, and there were no incidents of bleeding or anastomotic leakage. Conclusion: This study demonstrates that postoperative percutaneous coronary intervention, in conjunction with continued dual antiplatelet therapy, is a safe and effective antithrombotic strategy for managing perioperative acute myocardial infarction. This finding suggests a potential paradigm shift in the management of antithrombotic therapy for high-risk surgical patients, advocating for a tailored approach rather than the routine discontinuation of such therapy. [ABSTRACT FROM AUTHOR]

Early depressive symptoms within the first days after acute myocardial infarction (AMI) are mainly manifested with performance parameters (lack of energy, concentration difficulties, reduction in physical functioning). Homoarginine (hArg), a non-proteinogenic amino acid, might increase the availability of nitric oxide (NO). NO controls vasodilatation, blood flow, mitochondrial respiration and improves performance. Therefore, low plasma hArg levels after an AMI might impact performance-related early depressive symptoms. This longitudinal study aims to determine the course of plasma hArg concentrations immediately, on the fourth day and 6 months after AMI and investigates the associations between hArg and early depressive symptoms. A decrease in hArg levels, as observed in AMI patients on the fourth day after AMI, was independent of gender, age, body-mass-index and AMI type. After six months, hArg concentrations no longer differed significantly from baseline values. Females had lower hArg concentrations shortly after and also four days after the AMI compared to males. Within the first days after AMI HAMD-17 and BDI-II total depression scores and performance-related early depressive symptoms such as lack of energy, concentration difficulties and reduction in physical functioning correlated with low hArg concentrations. [ABSTRACT FROM AUTHOR]

The present multicenter study was designed to evaluate the analytical performance and the 99th percentile value of the reference healthy population i.e., 99th percentile upper reference limit of the MAGLUMI® CLIA high-sensitivity cardiac troponin I (hs-cTnI) method.Analytical performances and the 99th percentile URL value of the chemi-luminescent-immuno-assay (CLIA) method were evaluated using validated and standardized experimental protocols. Two cohorts including healthy adult individuals were enrolled. The first one included 989 blood donor volunteers (489 women and 500 men) aged 18–70 years (mean age 43 years, interquartile range 31–54 years). The second population included 47 healthy individuals (31 women and 16 men, mean age 78 years, interquartile range 73–81 years) aged≥71 years.The distributions of hs-cTnI levels in both sexes are highly right-skewed, and men show significantly (p=0.0028) higher biomarker values than women. Moreover, in both sexes the hs-cTnI levels progressively increase after the 55 years. In the multivariate analysis (n=958), hs-cTnI was found to be significantly associated to NT-proBNP (p<0.0001), sex (p<0.0001) and BMI (p=0.0424). The 99th percentile URL values, calculated using the bootstrap method in the total reference heathy population (age≥18 years), were: Females (n=521): 5.93 ng/L (CI 95 % 5.29–8.48), Males (n=516): 9.79 ng/L (CI 95 % 6.37–17.41 ng/L), Total Population (n=1,037): 7.18 ng/L (CI 6.08–12.20 ng/L).The MAGLUMI CLIA method met all the criteria for an hs-cTnI assay recommended by international guidelines. The hs-cTnI values measured with the CLIA method are higher in men compared to women at the same age, and also progressively increase after the age>55 years. [ABSTRACT FROM AUTHOR]

New-onset atrial fibrillation (NOAF) is associated with increased morbidity and mortality. Despite identifying numerous factors contributing to NOAF, the underlying mechanisms remain uncertain. This study introduces the triglyceride-glucose index (TyG index) as a predictive indicator and establishes a clinical predictive model. We included 551 patients with acute myocardial infarction (AMI) without a history of atrial fibrillation (AF). These patients were divided into two groups based on the occurrence of postoperative NOAF during hospitalization: the NOAF group (n = 94) and the sinus rhythm (SR) group (n = 457). We utilized a regression model to analyze the risk factors of NOAF and to establish a predictive model. The predictive performance, calibration, and clinical effectiveness were evaluated using the receiver operational characteristics (ROC), calibration curve, decision curve analysis, and clinical impact curve. 94 patients developed NOAF during hospitalization. TyG was identified as an independent predictor of NOAF and was significantly higher in the NOAF group. Left atrial (LA) diameter, age, the systemic inflammatory response index (SIRI), and creatinine were also identified as risk factors for NOAF. Combining these with the TyG to build a clinical prediction model resulted in an area under the curve (AUC) of 0.780 (95% CI 0.358–0.888). The ROC, calibration curve, decision curve analysis, and clinical impact curve demonstrated that the performance of the new nomogram was satisfactory. By incorporating the TyG index into the predictive model, NOAF after AMI during hospitalization can be effectively predicted. Early detection of NOAF can significantly improve the prognosis of AMI patients. [ABSTRACT FROM AUTHOR]

The Triglyceride glucose (TyG) index is a dependable indicator of IR, with numerous studies underscoring its influence on Cardiovascular disease. Nevertheless, the connection between the TyG index and prognosis in AMI patients after PCI is still uncertain. This investigation aims to explore the link in individuals who have received PCI for AMI. Upon admission, data regarding the patients' age, sex, concurrent diseases, TyG index, and laboratory findings were meticulously documented. To discern the link between the TyG index and the 30-day and 12-month ACM, we employed a multivariate Cox proportional hazard regression model and K-M survival curve. The concordance evaluation was also enhanced by subgroup analysis. The investigation encompassed data from 1410 AMI patients who received PCI. The 30-day ACM rate was observed to be 15.1% (214/1410), while the rate at 12 months escalated to 26.0% (368/1410). Upon adjusting for potential confounders, multivariate analysis delineated a dramatic link between high TyG index and heightened mortality risk at both 30 days (HR 1.233, 95% CI 1.086–1.399) and 12 months (HR 1.127, 95% CI 0.963–1.318). According to K-M survival curve, patients presenting with higher TyG indexes demonstrated a noticeably higher probability of ACM within both the 30-day and 12-month. In AMI patients after PCI, the TyG index demonstrates a substantial link with ACM at 30-day and 12-month marks. This finding suggests the effectiveness of the TyG index in detecting AMI patients who are at a higher risk of mortality after undergoing PCI. [ABSTRACT FROM AUTHOR]

The Siemens Point-of-Care Testing (POC) Atellica® VTLi high-sensitivity troponin I (hsTnI) device has been previously validated. Verification independently provides evidence that an analytical procedure fulfils concordance with laboratory assays, imprecision, and hemolysis interference requirements. Five whole blood samples spanning the measuring interval were analysed 20 times in succession. Hemolysis interference was assessed at three troponin concentrations by spiking five hemolysate concentrations to plasma to achieve free hemoglobin concentrations 35–1,000 mg/dL. Concordance between whole blood (VTLi) and plasma on laboratory analysers (Beckman, Roche, Siemens) was assessed by Pearson correlation and kappa statistics at the (LOQ) and upper reference limit (URL). This was repeated for frozen plasma samples. Coefficients of variation for whole blood were <10 % for whole blood troponin concentrations of 9.2 and 15.9 ng/L, thus below the URL. Hemolysis positively interfered; at 250 mg/dL affecting the low troponin sample (+3 ng/L; +60 %) and high troponin sample (+37 ng/L; +24 %). Correlation coefficients were 0.98, 0.90 and 0.97 between VTLi and Beckman, Roche and Siemens assays respectively. Corresponding kappa statistics were 0.80, 0.73 and 0.84 at the LOQ and 0.70, 0.44 and 0.67 at the URL. Concordances between VTLi and laboratory assays were at least non-inferior to those between laboratory assays. Imprecision met manufacturer claims and was consistent with a high sensitivity assay. There is potential for hemolysis interference, highlighting the need for quality samples. The results support performance characteristics previously reported in validation studies, and the device offers acceptable performance for use within intended medical settings. [ABSTRACT FROM AUTHOR]

Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Cardiovascular disease is the leading cause of maternal mortality in the United States. Pregnancy is associated with increased risk of acute myocardial infarction (AMI) and outcomes of pregnancy-associated AMI (PAMI) are poor. Spontaneous coronary artery dissection is the most common cause of PAMI. Pregnancy is not a contraindication to invasive coronary angiography or percutaneous coronary intervention (PCI) when indicated. When coronary angiography or PCI is needed, measures should be taken to minimize procedural and anesthetic risks specific to pregnancy. Multidisciplinary collaboration is imperative to optimizing maternal and fetal outcomes associated with PAMI. [ABSTRACT FROM AUTHOR]

We aimed to assess the efficacy and safety of sodium-glucose cotransporter-2 inhibitors (SGLT2i) versus placebo, initiated within the hospitalization period, in addition to habitual treatment, for treating adult patients with confirmed acute myocardial infarction (AMI). We also conducted subgroup analysis by diabetes mellitus (DM) status and type of AMI. We systematically searched PubMed, Embase, and Cochrane Library for randomized controlled trials (RCTs). The primary outcome was hospitalization for heart failure (HF). The secondary outcomes were all-cause death, cardiovascular death, and serious adverse events (AEs). We pooled risk ratios (RR) with a 95% confidence interval (CI) for binary outcomes. The between-study variance was assessed using tau2 statistics. We included five RCTs, encompassing 11,211 patients. SGLT2i significantly reduced the risk of hospitalization for HF compared to placebo (RR 0.73; 95% CI [0.61, 0.88]). However, the risk of all-cause death (RR 1.05; 95% CI [0.78, 1.41]) and cardiovascular death (RR 1.04; 95% CI [0.84, 1.29]) was similar between the groups, as well as the risk of serious AEs (RR 1.01; 95% CI [0.90, 1.14]). In the subgroup analysis by DM status and type of AMI, there were no significant subgroup differences for the outcomes of hospitalization for HF and all-cause death. In patients with AMI, treatment with SGLT2i is safe and significantly reduces the risk of hospitalization for HF, but it has no impact on all-cause death and cardiovascular death compared to placebo. [ABSTRACT FROM AUTHOR]

Purpose: Salvianolate for injection (SFI) is a widely used treatment for acute myocardial infarction (AMI). This study aims to assess the efficacy and safety of SFI in treating AMI by synthesizing evidence from published randomized controlled trials (RCTs). Methods: Seven databases were searched for relevant RCTs published up to 1 July 2024. Two investigators independently conducted the literature searches, data extraction, and quality assessment. Subgroup and sensitivity analyses were performed to address potential heterogeneity. Data analyses were conducted using RevMan 5.4 software. Result: Thirty RCTs with a total of 3,931 participants were included in the study and analyzed. The results revealed that SFI significantly reduced major adverse cardiac events (MACEs) (RR = 0.34, 95% CI: 0.24 to 0.49, p < 0.05). In addition, SFI lowered creatine kinase-MB (CK-MB) (MD = −5.65, 95% CI: −9.55 to −1.76, p < 0.05) and improved left ventricular ejection fraction (LVEF) (MD = 6.2, 95% CI: 4.82 to 7.57, p < 0.05). Further reductions were observed in C-reactive protein (CRP) (MD = −6.17, 95% CI: −8.11 to −4.23, p < 0.05), malondialdehyde (MDA) (MD = −1.95, 95% CI: −2.08 to −1.83, p < 0.05), and endothelin-1 (ET-1) (MD = −12.27, 95% CI: −17.13 to −7.40, p < 0.05). The incidence of adverse events did not significantly differ between the EG and CG [RR = 0.74, 95% CI: 0.42 to 1.33, p = 0.32]. Conclusion: This study suggests that SFI may be a promising alternative therapy for treating AMI without increasing the risk of adverse events. However, our findings may be limited by the quality of the existing studies. High-quality RCTs are needed to provide more robust evidence. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024567279. [ABSTRACT FROM AUTHOR]

Aims Methods and results Conclusion In the EMPACT‐MI trial, empagliflozin reduced heart failure (HF) hospitalizations but not mortality in acute myocardial infarction (MI). Contemporary reports of clinical event rates with and without type 2 diabetes mellitus (T2DM) in acute MI trials are sparse. The treatment effect of empagliflozin in those with and without T2DM in acute MI is unknown.A total of 6522 patients with acute MI with newly reduced left ventricular ejection fraction (LVEF) to <45%, congestion, or both, were randomized to empagliflozin 10 mg or placebo. The primary endpoint was time to first HF hospitalization or all‐cause death. Rates of endpoints with and without T2DM and the efficacy and safety of empagliflozin according to T2DM status were assessed. Overall, 32% had T2DM; 14% had pre‐diabetes; 16% were normoglycaemic; 38% had unknown glycaemic status. Patients with T2DM, compared to those without T2DM, were at higher risk of time to first HF hospitalization or all‐cause death (hazard ratio [HR] 1.44; 95% confidence interval [CI] 1.06–1.95) and all‐cause death (HR 1.70; 95% CI 1.13–2.56). T2DM did not confer a higher risk of first HF hospitalization (HR 1.22, 95% CI 0.82–1.83). Empagliflozin reduced first and total HF hospitalizations, but not all‐cause mortality, regardless of presence or absence of T2DM. The safety profile of empagliflozin was the same with and without T2DM.Patients with acute MI, LVEF <45% and/or congestion who had T2DM were at a higher risk of mortality than those without T2DM. Empagliflozin reduced first and total HF hospitalizations regardless of the presence or absence of T2DM. [ABSTRACT FROM AUTHOR]

Objective To observe the changes in serum long non-coding RNA H19 (lncRNA H19) and intergenic long non-coding RNA of cardiac remodeling (LIPCAR) levels in patients with acute myocardial infarction (AMI), and to analyze their predictive efficacy for major adverse cardiovascular events (MACE). Methods Totally 126 patients with AMI (observation group) and 60 healthy individuals who underwent physical examinations during the same period (control group) were selected. Real-time fluorescence quantitative PCR was used to detect serum lncRNA H19 and LIPCAR in both groups, and Pearson correlation analysis was used to analyze the relationships between serum lncRNA H19, LIPCAR and clinical parameters of AMI patients. Patients in the observation group were followed up for 6 months after percutaneous coronary intervention, and were divided into MACE patients (32 cases) and non-MACE patients (94 cases) based on whether MACE occurred. Logistic regression analysis was used to analyze the risk factors for MACE in AMI patients. Additionally, the predictive value of serum lncRNA H19 and LIPCAR levels for MACE in AMI patients was analyzed using the receiver operating characteristic curve. Results Compared with the control group, the levels of serum lncRNA H19 and LIPCAR increased in the observation group (both P<0. 05). The levels of serum lncRNA H19 and LIPCAR were related to LVEF (r=–0. 752, –0. 763, respectively; both P<0. 05), the number of coronary artery lesions (r=0. 672, 0. 731, respectively; both P<0. 05), and Killip grading (r=0. 667, 0. 712, respectively; both P<0. 05) in AMI patients, but not to LVFS or CO (all P>0. 05). Significant differences were found in the LIPCAR, lncRNA H19 levels, Killip grading, and LVEF between MACE and non-MACE individuals (all P<0. 05). Serum LIPCAR, lncRNA H19 levels, and Killip grading were risk factors for MACE in AMI patients, while LVEF was a protective factor (all P<0. 05). When the cut-off value of serum lncRNA H19 was 4. 22, the area under the curve in predicting MACE of AMI patients was 0. 877 (0. 835-0. 926), the Youden index was 0. 597, the sensitivity was 0. 791, and the specificity was 0. 806; when the cut-off value of serum LIPCAR was 5. 47, the area under the curve in predicting MACE in AMI patients was 0. 845 (0. 817-0. 892), the Youden index was 0. 581, the sensitivity was 0. 757, and the specificity was 0. 824; when we combined them, the area under the curve in predicting MACE in AMI patients was 0. 921 (0. 889-0. 941), the Youden index was 0. 668, the sensitivity was 0. 886, and the specificity was 0. 782. Conclusions Serum lncRNA H19 and LIPCAR increase in AMI patients, which are related to cardiac function indicators and are risk factors for MACE in AMI patients. Combined detection can help predict whether AMI patients will develop MACE. [ABSTRACT FROM AUTHOR]

Background: Acute myocardial infarction (AMI) remains a significant cause of global mortality, exacerbated by ischemia-reperfusion (IR) injury. Myocardial cell pyroptosis has emerged as a critical pathway influencing IR injury severity. Methods: We aimed to investigate the cardioprotective effects of aerobic exercise on IR injury by examining the modulation of IGFBP2 and its impact on GSDME-dependent myocardial cell pyroptosis. Mechanistic pathways were explored using western blot analysis, ELISA, immunofluorescence, and echocardiography. Results: Our findings demonstrate that aerobic exercise leads to increased circulating levels of IGFBP2, which effectively suppresses GSDME-dependent myocardial cell pyroptosis. This regulation occurs via the AKT-GSK3β signaling pathway, involving VDAC1 phosphorylation, thereby enhancing mitochondrial function and reducing oxidative stress. Conclusion: In conclusion, our study highlights the role of IGFBP2 in mitigating GSDME-dependent pyroptosis as a mechanism through which aerobic exercise exerts cardioprotective effects against IR injury. These insights suggest potential therapeutic targets for managing acute myocardial infarction. [ABSTRACT FROM AUTHOR]

Introduction: The activation of the plasmatic coagulation system is a significant contributor to acute myocardial infarction (AMI). This study aimed to investigate the association between the levels of tissue plasminogen activator-inhibitor complex (t-PAIC), thrombin-antithrombin complex (TAT), plasmin-α2 plasmin-inhibitor complex (PIC), and thrombomodulin (TM) with clinical outcomes in patients with AMI. Methods: Blood samples were collected from 368 patients presenting with acute myocardial infarction in the emergency department to assess levels of t-PAIC, TAT, PIC, and TM. Patients were subsequently followed up for a period of 6 months. Results: t-PAIC levels were significantly elevated in AMI patients who died compared to those who survived (P < 0.0001). Specifically, of the 368 patients, 48 died and had higher t-PAIC levels above the determined cut-off value of 15.3 ng/mL, while 320 survived and had levels below this threshold (P < 0.001). Furthermore, among the survivors, t-PAIC levels were greater in the major adverse cardiovascular events (MACE) group than in the non-MACE group throughout the 6-month follow-up. Linear regression analysis indicated that high levels of t-PAIC were linked to mortality following acute myocardial infarction and raised the likelihood of MACE in survivors. The ROC curve study revealed that t-PAIC has predictive value for mortality following AMI, with an AUC of 0.871 (95% CI: 0.833–0.904), sensitivity of 81.25%, and specificity of 88.75%. Analysis of the ROC curve and Kaplan–Meier survival curve demonstrated that t-PAIC was able to forecast MACE in individuals who had experienced an AMI, with an AUC of 0.671 (95% CI: 0.620—0.719) for 6-month MACE occurrences. Conclusion: Our findings suggest that increased t-PAIC levels are correlated with mortality in patients with AMI and the incidence of MACE within a six-month period in survivors. [ABSTRACT FROM AUTHOR]

Background: Acute myocardial infarction (AMI) remains a major cause of mortality and morbidity globally, with a high incidence of major adverse cardiovascular events (MACE) post-primary percutaneous coronary intervention (PPCI). The DETERMINE score, derived from electrocardiographic (ECG) markers, has shown promise as a predictor of adverse outcomes, but its clinical utility requires further validation. Objective: To evaluate the predictive value of the DETERMINE score for MACE and provide early clinical warnings for high-risk patients. Methods: This bidirectional cohort study included AMI patients from the Second Affiliated Hospital of Anhui Medical University between 2019 and 2023. The training cohort comprised 545 patients between January 2019 and January 2023, while the validation cohort consisted of 122 patients between February 2023 and July 2023. The primary endpoint was MACE within one-year post-PPCI. The relationship between the DETERMINE score and MACE was analyzed using Cox regression, trend tests, and restricted cubic splines to assess linear and nonlinear associations. Patients were stratified into risk groups based on tertiles or optimal cutoffs, and Kaplan-Meier survival curves compared MACE incidence across groups. Predictive accuracy was evaluated through time-dependent C-index, ROC curves, decision curve analysis, and calibration, and compared to other prognostic scores, including the Selvester, GRACE, and SYNTAX scores, as well as left ventricular ejection fraction (LVEF). Subgroup analyses by sex, age, and culprit artery involvement were also conducted. Results: Cox multivariate regression indicated that the DETERMINE score was an independent risk factor for MACE (HR = 1.56, 95% CI 1.38–1.75, P < 0.001). Trend test and RCS showed a positive correlation and non-linear relationship between the DETERMINE score and MACE (P-trend < 0.001, P-overall < 0.001, P-nonlinear: 0.003). Kaplan-Meier survival analysis revealed that, in both the training and validation datasets, groups with a higher DETERMINE score showed a higher cumulative risk of MACE. The DETERMINE score outperformed traditional prognostic scores (Selvester, GRACE, SYNTAX) in terms of predictive accuracy, with an AUROC of 0.840 at 12 months in the training cohort. The score also provided a substantial clinical net benefit, particularly over longer follow-up periods. Subgroup analyses confirmed its predictive power across different demographics and clinical presentations. Conclusion: The DETERMINE score has outstanding predictive power for MACE post-PPCI, which can guide the early identification of high-risk patients with poor prognosis of AMI in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Acute myocardial infarction (AMI) constitutes a major health problem with high mortality rates worldwide. In patients with ST-segment elevation myocardial infarction (STEMI), no-reflow phenomenon is a condition that adversely affects response to therapy. Previous studies have demonstrated that the CALLY index, calculated using C-reactive protein (CRP), albumin, and lymphocytes, is a reliable indicator of mortality in patients with non-cardiac diseases. The objective of this study is to investigate the potential utility of the CALLY index in detecting no-reflow patients and to determine the predictability of this phenomenon using machine learning (ML) methods. Methods: This study included 1785 STEMI patients admitted to the clinic between January 2020 and June 2024 who underwent percutaneous coronary intervention (PCI). Patients were in no-reflow status, and other clinical data were analyzed. The CALLY index was calculated using data on patients' inflammatory status. The Extreme Gradient Boosting (XGBoost) ML algorithm was used for no-reflow prediction. Results: No-reflow was detected in a proportion of patients participating in this study. The model obtained with the XGBoost algorithm showed high accuracy rates in predicting no-reflow status. The role of the CALLY index in predicting no-reflow status was clearly demonstrated. Conclusions: The CALLY index has emerged as a valuable tool for predicting no-reflow status in STEMI patients. This study demonstrates how machine learning methods can be effective in clinical applications and paves the way for innovative approaches for the management of no-reflow phenomenon. Future research needs to confirm and extend these findings with larger sample sizes. [ABSTRACT FROM AUTHOR]

A 48‐year‐old male with a history of hyperlipidemia presented to the emergency department with chest pain. Electrocardiographic abnormalities indicated an acute coronary syndrome. Urgent coronary angiography revealed nondominant right coronary artery (RCA) occlusion. During primary percutaneous coronary intervention (PCI), a 0.014‐inch floppy guidewire could not be easily advanced into the middle RCA due to poor backup support from the guiding catheter and the patient's breathing. The pressure was monitored several times after reinserting the guiding catheter. Nevertheless, the guidewire was inadvertently inserted into the false lumen from the ostium, leading to subsequent dissection during contrast injection. Intravascular ultrasound (IVUS) imaging confirmed dissection from the ostium to the middle RCA and passage of the guidewire into the false lumen. An additional guidewire was successfully inserted into the true lumen of the RCA using real‐time IVUS‐guided wiring. We demonstrated successful bailout stenting for catheter‐induced dissection of the nondominant small RCA. Our case highlights the risk of coronary artery dissection associated with guiding catheter use, especially in a nondominant small RCA, and the importance of optimal guiding catheter selection for primary PCI. The real‐time IVUS‐guided wiring technique can be applied to a single 6‐Fr guiding catheter and is useful for quickly inserting a guidewire into the true lumen. [ABSTRACT FROM AUTHOR]

Objective To evaluate the effect of extracorporeal membrane oxygenation combined with intraaortic balloon pump mechanical circulatory support for patients with cardiogenic shock complicating acute myocardial infarction during PCI process. Methods Patients with cardiogenic shock complicating myocardial infarction who underwent PCI in the hospital from January 2015 to December 2019 were selected. Those who were under support of extracorporeal membrane oxygenation combined with intra-aortic balloon pump were enrolled in the observation group, the patients under support of only intra-aortic balloon pump were selectedin the control group. The differences of clinical features and prognosis were compared. Results A total of 40 patients were enrolled, 11 were in the observation group and 29 in the control group. Compared with control group, more patients were complicated with old myocardial infarction (5/11 vs. 2/29, P = 0.016), more patients were diagnosed as non-ST elevated myocardial infarction (8/11 vs. 11/29, P = 0.049) and left ventricular ejecting fraction was lower [(38.5 ± 10.10)vs. (48.55 ± 8.86), P = 0.01］ in observation group. Moreover, the proportion of patients with EF < 35% was higher in the observation group (5/11 vs. 3/29, P = 0.01). The observation group has significantly higher rates of multi-vessel disease and Syntax scores compared to the control group (multi-vessel disease：10/11 vs. 11/29, P = 0.02；Syntax score：[(33.36 ± 13.37)vs. (25.74 ± 5.75), P = 0.015]；the observation group exhibited a higher proportion of patients achieving complete revascularization (9/11 vs. 8/29, P = 0.002). Mechanical complications were higher in observation group (6/11 vs. 5/29, P = 0.02), The survive rate in observation group is higher than that in control group (91.00% vs.55.17%, P = 0.03) at one-year follow-up. Conclusion Compared with only IABP, ECMO combined with IABP hemodynamic support during PCI process for patients with cardiogenic shock complicating acute myocardial infarction enjoys more complete revascularization and better mortality outcome, although it has relatively higher mechanical complications. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the association between the Endothelial Activation and Stress Index (EASIX) and 30-day mortality risk in acute myocardial infarction (AMI) patients. Methods: Using a retrospective cohort design, data were extracted from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database between 2008 and 2019. Patients diagnosed with AMI at intensive care unit (ICU) admission were included. EASIX score was calculated as follows: lactate dehydrogenase (LDH) level (U/L) × creatinine level (mg/dL)/platelet count (109/L). Cox regression models assessed the association between EASIX and 30-day mortality, with subgroup analyses based on age, gender, AMI subtype, and sepsis status. Results: A total of 1,036 patients were analyzed, among whom 323 did not survive beyond 30 days post-ICU admission. Higher EASIX scores were associated with increased 30-day mortality in AMI patients [Hazard ratio (HR): 1.70, 95% confidence interval (CI): 1.17–2.46, P = 0.005). Subgroup analyses supported these findings and revealed significant interactions between EASIX and variables such as gender and AMI subtype (P < 0.05). Conclusion: Elevated EASIX scores are significantly correlated with increased 30-day mortality risk in AMI patients, suggesting EASIX as a valuable prognostic tool that may inform clinical management strategies to improve outcomes in AMI. Clinical trial number: Not applicable. [ABSTRACT FROM AUTHOR]

Numerous cardioprotective interventions have been reported to reduce myocardial infarct size (IS) in pre-clinical studies. However, their translation for the benefit of patients with acute myocardial infarction (AMI) has been largely disappointing. One reason for the lack of translation is the lack of rigor and reproducibility in pre-clinical studies. To address this, we have established the European IMproving Preclinical Assessment of Cardioprotective Therapies (IMPACT) pig AMI network with centralized randomization and blinded core laboratory IS analysis and validated the network with ischemic preconditioning (IPC) as a positive control. Ten sites in the COST Innovators Grant (IG16225) network participated in the IMPACT network. Three sites were excluded from the final analysis through quality control of infarct images and use of pre-defined exclusion criteria. Using a centrally generated randomization list, pigs were allocated to myocardial ischemia/reperfusion (I/R, N = 5/site) or IPC + I/R (N = 5/site). The primary endpoint was IS [% area-at-risk (AAR)], as quantified by triphenyl-tetrazolium-chloride (TTC) staining in a centralized, blinded core laboratory (5 sites), or IS [% left-ventricular mass (LV)], as quantified by a centralized, blinded cardiac magnetic resonance (CMR) core laboratory (2 sites). In pooled analyses, IPC significantly reduced IS when compared to I/R (57 ± 14 versus 32 ± 19 [%AAR] N = 25 pigs/group; p < 0.001; 25 ± 13 versus 14 ± 8 [%LV]; N = 10 pigs/group; p = 0.021). In site-specific analyses, in 4 of the 5 sites, IS was significantly reduced by IPC when compared to I/R when quantified by TTC and in 1 of 2 sites when quantified by CMR. A pig AMI multicenter European network with centralized randomization and core blinded IS analysis was established and validated with the aim to improve the reproducibility of cardioprotective interventions in pre-clinical studies and the translation of cardioprotection for patient benefit. [ABSTRACT FROM AUTHOR]

Objective To explore the application value of 24-hour ambulatory electrocardiographic parameters in the clinical diagnosis of ventricular arrhythmia in patients with acute myocardial infarction (AMI). Methods A total of 200 AMI patients were performed by ambulatory electrocardiography ( AECG) examination, and related parameters were recorded. According to the presence or absence of ventricular arrhythmia, the enrolled patients were divided into ventricular arrhythmia group and non-ventricular arrhythmia group. The 24-hour AECG parameters of rMSSD, SDNN, SDANN-index and QT interval variability ( QTV) were compared between the two groups. Logistic regression analysis was used to explore the relationship between 24-hour AECG parameters and ventricular arrhythmia occurred in AMI patients; ROC curve analysis was utilized to investigate the efficiency of these parameters in the diagnosis of ventricular arrhythmia among AMI patients. Results Among the 200 AMI patients, 76 cases developed ventricular arrhythmia, with an incidence rate of 38. 0%. The indexes of rMSSD, SDNN, SDANN-index and QTV of the AMI patients in the ventricular arrhythmia group were all significantly lower than those in the non-ventricular arrhythmia group ( all P < 0. 05). Logistic regression analysis results showed that rMSSD, SDNN, SDANN-index and QTV were all related to the occurrence of ventricular arrhythmia among AMI patients (all P<0. 05). ROC curve analysis revealed that the AUC values of rMSSD, SDNN, SDANN-index and QTV in the diagnosis of ventricular arrhythmia among AMI patients were 0. 907, 0. 761, 0. 819 and 0. 906, respectively, with a certain predictive value. Conclusion The 24-hour AECG parameters of rMSSD, SDNN, SDANN-index and QTV have application values in the clinical diagnosis of ventricular arrhythmia among AMI patients. [ABSTRACT FROM AUTHOR]

Background: Recent studies have suggested an increased risk of acute myocardial infarction (AMI) following daylight saving time (DST) transitions in cohorts of American and European patients. We aim to validate this finding in a Canadian population. Methods: We performed a retrospective cohort study of patients admitted to the Hôpital du Sacré-Coeur de Montréal with a diagnosis of AMI requiring a coronary angiogram from 28 February 2016 to 3 December 2022. The transition period was defined as two weeks following DST, while the control periods were two weeks before and two weeks after the transition period. Patients aged 18 years or older were included. The primary endpoint was the incidence rate ratio (IRR) of AMI following DST transitions while the secondary endpoint was infarct size by biomarkers. A subgroup analysis compared the pre-COVID-19 period (2016–2019) to the post-COVID-19 period (2020–2022). Results: A total of 1058 patients were included (362 in the transition group and 696 in the control group). The baseline clinical characteristics were comparable between both groups. The rate of AMI per day following the DST transitions was 1.85 compared to 1.78 during control periods. The DST transitions were not associated with an increase in AMI (IRR = 1.04, 95% CI 0.91–1.18, p = 0.56) nor with infarct size. In the subgroup analysis, DST was associated with a significant increase in the incidence of AMI only in the pre-COVID-19 period, with a rate of 2.04 AMI per day in the transition group compared to 1.71 in the control group (IRR = 1.19, 95% CI 1.01–1.41, p = 0.041). In contrast, there was a significant increase in the size of AMI following DST in the post-COVID-19 period subgroup, with a creatine phosphokinase-MB (CK-MB) concentration of 137 ± 229 µg/L compared to 93 ± 142 µg/L (p = 0.013). Conclusions: In this Canadian cohort, there was a significant increase in the incidence of AMI in the pre-COVID-19 period, and infarct sizes were significantly larger following the DST transitions in the post-COVID-19 period. No significant associations emerged when pre- and post-COVID-19 periods were pooled. [ABSTRACT FROM AUTHOR]

Background: The study aimed to identify Mild Cognitive Impairment (MCI) as an alert clinical manifestation of increased probability of major acute vascular events (MVEs), such as Ischemic Stroke and heart attack. Methods: In a longitudinal study, 181 (M = 81, F = 100; mean age of 75.8 ± 8.69 years) patients were enrolled and divided into three groups based on diagnosis: Subjective Cognitive Impairment (SCI), amnestic MCI Single Domain (aMCI-SD), and amnestic MCI More Domain (aMCI-MD). Clinical assessment and the presence of vascular risk factors were collected. Results: The distribution of MVEs showed a higher incidence in the first two years of follow-up of 7.4% in SCI, 12.17% in aMCI-SD, and 8.57% in aMCI-MD. Acute Myocardial Infarction showed a major incidence in one year of follow-up (41%) and in two years of follow-up (29%). Also, Ischemic Stroke showed a major incidence in one year of follow-up (30%) and in two years of follow-up (40%). A statistically significant difference in the progression to dementia was shown (SCI 3.75%; aMCI-SD 10.43%; aMCI-MD 37%; p-value < 0.001). Conclusions: MCI is considered an expression of the systemic activation of mechanisms of endothelial damage, representing a diagnosis predictive of increased risk of MVEs. [ABSTRACT FROM AUTHOR]

This case report explores the management of a 56‐year‐old female oncology patient presenting with acute ST‐elevation myocardial infarction (STEMI) and an incidental atrial septal defect (ASD). The patient, with a history of rectal cancer and hypothyroidism, experienced acute chest pain and dyspnea. She was diagnosed with an inferior STEMI and underwent percutaneous coronary intervention (PCI) with the placement of three medicated stents in the right coronary artery. During hospitalization, an echocardiogram revealed a significant ostium secundum ASD. Angiography indicated thrombi, suggesting a potential paradoxical embolism. Percutaneous ASD closure was performed during the same hospital stay, leading to a favorable clinical course without immediate complications. This case highlights the importance of a multidisciplinary approach and comprehensive evaluation in managing complex cardiovascular conditions, particularly in patients with increased thrombotic risk due to malignancy. [ABSTRACT FROM AUTHOR]

Objective: To investigate the influences of Pinocembrin on inflammatory injury in rats with acute myocardial infarction (AMI) by regulating TLR4/NF-κB/NLRP3 signaling pathway. Methods: The AMI model was established by coronary ligation, and the rats were grouped into Sham group, AMI group, Pinocembrin group (5 mg/kg tail vein injection), TLR4 inhibitor group (TAK-242 group, 2.0 mg/kg tail vein injection), the levels of cardiac function indexes (LVEF, LVEDD, LVESD, FS) and serum LDH, cTnⅠ, IL-6, IL-β and TNF-α were detected in rats, TTC staining, HE staining and Masson staining were applied to observe myocardial infarction and myocardial histopathological changes in rats, cardiomyocyte apoptosis was detected by TUNEL method, immunohistochemistry and Western blot were applied to detect TLR4/NF-κB/NLRP3 pathway-related proteins in rat myocardial tissue. Results: Compared with Sham group, the myocardial infarction area increased, the number of myocardial cells decreased, some myocardial fibers were broken, inflammatory cells infiltrated, collagen fibers increased, and the apoptosis rate was obviously increased in AMI group (P<0.05), LVEDD, LVESD, serum LDH, cTnⅠ, IL-6, IL-β, TNF-α levels, myocardial tissue TLR4, MyD88, p-NF-κB p65, NLRP3, Caspase-1 expression levels were obviously increased (P<0.05), while LVEF and FS were obviously decreased (P<0.05); compared with AMI group, the myocardial infarction area of the Pinocembrin group and the TAK-242 group were reduced, the cell damage and inflammatory infiltration were reduced, the necrotic cells were obviously reduced, and the apoptosis rate was obviously reduced (P<0.05), LVEDD, LVESD, serum LDH, cTnⅠ, IL-6, IL-β, TNF-α levels, myocardial tissue TLR4, MyD88, p-NF-κB p65, NLRP3, Caspase-1 expression levels were decreased (P<0.05), LVEF and FS were obviously increased (P<0.05); there was no obvious difference in each index between Pinocembrin group and TAK-242 group(P>0.05). Conclusion: Pinocembrin may attenuate myocardial inflammatory injury caused by AMI by inhibiting TLR4/NF-κB/NLRP3 signaling pathway. [ABSTRACT FROM AUTHOR]

Objective: To investigate the efficacy of sacubitril/valsartan combined with dapagliflozin in diabetic patients suffering from heart failure following an acute myocardial infarction. Methods: This retrospective study included 80 diabetic patients who had heart failure after an acute myocardial infarction (AMI) and were hospitalised at First Hospital of Qinhuangdao between January 2021 and January 2023. They were randomly divided into the control and observation groups (each group n = 40). In addition to fundamental antiheart failure treatment, the control group was administered with sacubitril/valsartan, whereas the observation group received sacubitril/valsartan combined with dapagliflozin. The treatment lasted for six months, and the patient's glucose-associated targets and prognosis before and after treatment were compared in both groups. Results: Six months after the treatment, the fasting blood glucose, 2-h postprandial blood glucose and HbA1c levels of patients from both groups significantly decreased. The decrease was more prominent in the observation group than in the control group, with significant differences (P < 0.05). Additionally, the LVEF, CO, CI and NT-proBNP levels considerably decreased in both groups after treatment, with the observation group exhibiting a more notable decrease that was significantly different (P < 0.05). An inter-group comparison showed that the differences were not significant (P > 0.05). Conclusions: In diabetic patients suffering from heart failure after an AMI, treatment with sacubitril/valsartan combined with dapagliflozin may effectively control blood glucose levels and improve cardiac functions without increasing adverse reactions, indicating high clinical safety. [ABSTRACT FROM AUTHOR]

Long COVID-19 syndrome increases the risk of cardiovascular events. Although rare in young people, acute coronary syndromes occur more often in those recently infected with COVID-19. This report discusses a rare case of myocardial infarction in a 28-year-old male with no prior medical issues, occurring four weeks after a mild COVID-19. Initially, the patient refused invasive coronary angiography, so a coronary computed tomography angiography (CCTA) was conducted during an ST-elevation myocardial infarction (STEMI). The CCTA, using fat attenuation index (FAI) technology, revealed significant inflammation at the culprit lesion. This CCTA and FAI analysis were done shortly after the STEMI onset, before revascularization, highlighting the case's uniqueness. In patients with recent COVID-19, CCTA combined with FAI analysis of perivascular inflammation can help identify those at risk for acute coronary events. In this case, FAI analysis detected high inflammation, suggesting a potential cause for STEMI in a young patient with long COVID-19. [ABSTRACT FROM AUTHOR]

Background: Lipoprotein(a) [Lp(a)] is a well-established risk factor for incident atherosclerotic cardiovascular (CV) disease. However, evidence regarding its association with recurrent events is limited. To address this gap, we conducted a retrospective analysis of routine clinical data, focusing on patients hospitalized for acute myocardial infarction (AMI) between 2000 and 2022 with available admission Lp(a) results. Methods: Patients were stratified into three groups based on their Lp(a) level (≤50 mg/dL, 51–90 mg/dL, and >90 mg/dL). A multivariable-adjusted Cox regression analysis was performed to assess the associations of Lp(a) with recurrent AMI, CV mortality, and all-cause mortality. Results: A total of 2248 patients (31.5% women), with a mean age of 64.7 ± 12.2 years, were retrospectively followed until 31 December 2022, or death. The multivariable-adjusted hazard ratios (HRs) for recurrent AMI were 1.01 (p = 0.921) for levels 51–90 mg/dL and 1.51 (p = 0.013) for levels > 90 mg/dL, compared with levels ≤ 50 mg/dL. The corresponding HRs for CV mortality were 1.13 (p = 0.300) and 1.14 (p = 0.348), and those for all-cause mortality were 1.09 (p = 0.310) and 1.20 (p = 0.090), respectively. Stratification by sex and age revealed a significant association of Lp(a) with recurrent AMI only in women aged > 65 years, with adjusted HRs of 2.34 (p = 0.013) for levels 51–90 mg/dL and 3.94 (p < 0.001) for levels > 90 mg/dL, compared with levels ≤ 50 mg/dL. Conclusions: In the presented study, Lp(a) was associated with a significantly higher risk of recurrent AMI only in women aged > 65 years with Lp(a) levels > 50 mg/dL. We found no significant associations between Lp(a) and CV or all-cause mortality. [ABSTRACT FROM AUTHOR]

Background: Routine activated partial thromboplastin time (APTT) and prothrombin time (PT) measurements do not indicate hypercoagulability in patients with acute myocardial infarction (AMI) and acute cerebral infarction (ACI). Methods: Hypercoagulability in patients with AMI or ACI was evaluated using a clot waveform analysis of the APTT or a small amount of tissue factor activation assay (sTF/FIXa). In the CWA, the derivative peak time (DPT), height (DPH), width (DPW), and area the under the curve (AUC) were evaluated. Results: The APTT did not indicate hypercoagulability, but the second DPT of CWA-sTF/FIXa was significantly shorter in patients with ACI than in healthy volunteers (HVs). The first DPH values of CWA-APTT and CWA-sTF/FIXa in patients with ACI and AMI were significantly higher than in HVs. In the receiver operating characteristic (ROC) analyses of ACI or AMI vs. non-thrombosis, the AUC was >0.800 in the DPHs of CWA-APTT and CWA-sTF/FIXa. The AUC of CWA-APTT and CWA-sTF/FIXa in patients with AMI and ACI was significantly higher than in HVs. The AUC/second DPT of CWA-APTT and CWA-sTF/FIXa in patients with AMI and ACI was significantly higher than in HVs. Regarding the ROC analyses of ACI or AMI vs. HVs, the AUC of ROC was higher than 0.800 in the AUC and AUC/second DPT of CWA-APTT and CWA-sTF/FIXa. Conclusions: The AUC/second DPT of CWA-APTT and CWA-sTF/FIXa may be a useful parameter for detecting a hypercoagulable state in patients with AMI and ACI. [ABSTRACT FROM AUTHOR]

Background: It is essential to identify the risk factors for poor clinical outcomes in patients with acute myocardial infarction (AMI). The coronary artery calcium score (CACS) is gathering attention as a predictor for future cardiovascular events. This study aimed to (1) measure CACSs in patients with AMI by non-ECG-gated computed tomography (CT), (2) compare clinical outcomes between patients with a high CACS and a low–intermediate CACS and (3) to elucidate the association between high CACS and clinical outcomes. Methods: We defined the high CACS group as the highest quantile of CACS (Q4) and defined the low–intermediate CACS group as the other quantiles of CACS (Q1–Q3). The primary endpoint was major adverse cardiovascular events (MACE), which were defined as the composite of all-cause death, re-admission for heart failure, non-fatal MI and target vessel revascularization. We included 548 patients with AMI who underwent non-ECG-gated CT and divided them into the high CACS group (CACS ≥ 5346.5, n = 137) and the low–intermediate CACS group (CACS ≤ 5329.3, n = 411). Results: During the median follow-up duration of 535 days, 150 MACE were observed. The Kaplan–Meier curves showed that MACE occurred more frequently in the high CACS group than in the low–intermediate CACS group (p < 0.001). Multivariable Cox hazard analysis revealed that a high CACS was significantly associated with MACE (hazard ratio 1.597, 95% confidence interval 1.081–2.358, p = 0.019) after controlling for multiple confounding factors. Conclusions: Clinical outcomes were worse in AMI patients with a high CACS than in those with a low–intermediate CACS. A high CACS was significantly associated with MACE in multivariate analysis. [ABSTRACT FROM AUTHOR]

Background/Objectives: Increased lipoprotein(a) [Lp(a)] level is associated with elevated possibility of atherosclerosis progression. SYNTAX score enables to grade the anatomy of coronary arteries. To identify the impact of increased Lp(a) level on SYNTAX score in individuals with acute myocardial infarction (AMI). Methods: In our analysis, we enrolled 173 consecutive adult patients hospitalized for AMI in a tertiary cardiology center from December 2022 to August 2023. Patient characteristics were compared for patients with SYNTAX score ≥ 23 (64 patients) and SYNTAX score < 23 (109 patients). The SYNTAX score was estimated based on the results of coronary angiography. Logistic regression analyses were performed to evaluate the factors associated with SYNTAX score. Results: Individuals with the SYNTAX score ≥ 23 were more likely to have arterial hypertension, diabetes mellitus, significant stenosis in the left main coronary artery, and higher Lp(a) levels than those with SYNTAX < 23 (all p < 0.05). On univariate analysis, age (OR 1.05, 95% CI 1.02–1.08, p = 0.001), Lp(a) levels (OR 1.04, 95% CI 1.01–1.06, p = 0.001), and arterial hypertension (OR 2.69, 95% CI 1.26–5.74, p = 0.011) were associated with SYNTAX score ≥ 23. Multivariable determinants of SYNTAX score ≥ 23 were as follows: Lp(a) levels (OR 1.03, 95% CI 1.01–1.08, p = 0.029), and age (OR 1.04, 95% CI 1.01–1.07, p = 0.005). The cut-off value for Lp(a) 166.16 nmol/L identifies patients with SYNTAX score ≥ 23 with 97% sensitivity and 44% specificity (area under curve 0.78, p < 0.001). Conclusions: Elevated Lp(a) concentration is associated with a higher SYNTAX score. A cut-off value of Lp(a) above 166.16 nmol/L allows us to identify subjects with SYNTAX score ≥ 23 with good specificity and sensitivity. [ABSTRACT FROM AUTHOR]

Objectives. The aim of this study was to investigate the expression of long non-coding RNA (lncRNA) brain and reproductive organ-expressed protein (BRE) antisense RNA 1 (BRE-AS1) in patients with acute myocardial infarction (AMI) and its effect on ischemia/reperfusion (I/R)-induced oxidative stress and apoptosis of cardiomyocytes. Methods. Serum BRE-AS1 levels in patients with AMI was detected using quantitative real-time polymerase chain reaction (qRT-PCR). The diagnostic and prognostic values of BRE-AS1 were evaluated. H9c2 cells were treated with hypoxia/reoxygenation to establish an in vitro myocardial infarction cell model. The levels of inflammatory cytokines such as tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and IL-6 were detected by enzyme-linked immunosorbent assay (ELISA). Levels of lactate dehydrogenase (LDH), malondialdehyde (MDA), superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px) were determined by commercial kits. Cell counting kit-8 (CCK-8) and flow cytometry were used to evaluate the cell viability and cell apoptosis. Results. The expression of BRE-AS1 in serum of patients with AMI is upregulated, which shows the clinical diagnostic value for AMI. In the I/R injury cell model, the knockout of BRE-AS1 can significantly alleviate the increase in TNF-α, IL-1β, and IL-6 levels, inhibit the production of LDH and MDA, increase the activities of SOD and GSH-Px, promote the cell viability and suppress cell apoptosis. Conclusions. Abnormally elevated BRE-AS1 has a high diagnostic value for AMI as well as a prognostic value for major adverse cardiovascular events (MACEs). The elevation of BRE-AS1 promoted oxidative stress injury and cell apoptosis in vitro. [ABSTRACT FROM AUTHOR]

A 55-year-old male with hemophilia A came to the outpatient clinic with chest pain for several days after overdose injection of coagulation factor. He was a heavy smoker and a chronic alcoholic. An electrocardiogram (ECG) showed no specific change. A coronary computed tomography showed moderate stenosis with soft plaque at the distal segment of right coronary artery. His pain was improved with antianginal and reflux medications. Twenty days later, he ran to the emergency room complaining of squeezing chest pain. ECG showed mild ST segment elevation in inferior territories. Invasive coronary angiography via right radial artery revealed severe thrombotic occlusion at the same lesion. A bare metal stent was deployed and dual antiplatelet therapy including aspirin and clopidogrel had been maintained for 6 months under the conventional hemophilia management. The patient did not develop any coronary events just with single clopidogrel therapy for 5 years until he passed away from pancreatic cancer. Our case implicates that the invasive coronary intervention and post-procedural management could be safely performed with conventional standards of care while maintaining the usual dose of coagulation factors in a hemophilia patient with acute coronary syndrome. [ABSTRACT FROM AUTHOR]

Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: To investigate the prognostic value of human epididymis protein 4 (HE4) in patients with acute myocardial infarction (AMI). Patients and Methods: A total of 212 consecutive patients diagnosed with AMI in the Department of Cardiovascular Medicine of Hunan Provincial People's Hospital from June 2020 to May 2021 were enrolled. We determined plasma HE4 levels at baseline. The patients were followed up regularly and the occurrence of major adverse cardiac events (MACE) was recorded after discharge. Results: After a mean follow-up period of 242 (159– 427) days, 67 patients had MACE. Multivariate Cox regression analysis showed that HE4 was an independent predictor of MACE in patients with AMI [HR = 1.004 (1.002– 1.007), P = 0.002]. Kaplan-Meier survival curves showed that patients with HE4 levels > 532.9 pmol/L had higher MACE compared with patients with ≤ 532.9 pmol/L HE4 levels (HR=4.044, 95% CI 2.373– 6.890, P < 0.001). Receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) of HE4 for predicting MACE was 0.734 (95% CI: 0.669– 0.792, P < 0.001). Conclusion: Human epididymis protein 4 (HE4) might be a novel biomarker for predicting the prognosis of patients with AMI. [ABSTRACT FROM AUTHOR]

Background: There is lack of predictive models for the risk of severe complications during hospitalization in patients with acute myocardial infarction (AMI). In this study, we aimed to create a nomogram to forecast the likelihood of in-hospital severe complications in AMI. Methods: From August 2020 to January 2023, 1024 patients with AMI including the modeling group (n=717) and the validation group (n=307) admitted in Changsha Central Hospital's emergency department. Conduct logistic regression analysis, both univariate and multivariate, on the pertinent patient data from the modeling cohort at admission, identify independent risk factors, create a nomogram to forecast the likelihood of severe complications in patients with AMI, and assess the accuracy of the graph's predictions in the validation cohort. Results: Age, heart rate, mean arterial pressure, diabetes, hypertension, triglycerides and white blood cells were seven independent risk factors for serious complications in AMI patients. Based on these seven variables, the nomogram model was constructed. The nomogram has high predictive accuracy (AUC=0.793 for the modeling group and AUC=0.732 for the validation group). The calibration curve demonstrates strong consistency between the anticipated and observed values of the nomogram in the modeling and validation cohorts. Moreover, the DCA curve results show that the model has a wide threshold range (0.01– 0.73) and has good practicality in clinical practice. Conclusion: This study developed and validated an intuitive nomogram to assist clinicians in evaluating the probability of severe complications in AMI patients using readily available clinical data and laboratory parameters. [ABSTRACT FROM AUTHOR]

Background: While Cardiac Rehabilitation (CR) programs have shown effectiveness in improving cardiac outcomes, there is limited understanding of how patients perceive and adapt to these interventions. Furthermore, alternative modes of delivering CR that have received positive evaluations from participants remain underexplored, yet they have the potential to enhance CR uptake. Objectives: To explore the patient experience in CR programmes following Acute Myocardial Infarction (AMI) and describe their adaptive processing. Patients and Methods: This qualitative study was conducted at a nationally certified centre in China between July 2021 and September 2022, encompassing three stages: in-hospital, centre-based, and home-based CR programs. Purposive sampling was used to select eligible AMI patients for in-depth semi-structured interviews. The interview outline and analytical framework were aligned with the key concepts derived from the middle-range theory of adaptation to chronic illness and the normalization process theory. The findings were reported following the Consolidated Criteria for Reporting Qualitative Research checklist. Results: Forty AMI patients were recruited. Four main themes describing the process of AMI patients normalizing CR intervention were identified, including (1) experiencing CR service driving by role's responsibilities, (2) engaging in collaborative relationship based on interpersonal trust, (3) exploring a personalized rehabilitation plan by complex integration, and (4) expecting a promised outcome to shape decision-making. Conclusion: Integrated care interventions for AMI patients could benefit from a collaborative co-designed approach to ensure that CR interventions are normalized and fit into patients' daily lives. Organizational-level CR services should align with the rehabilitation needs and expectations of patients. [ABSTRACT FROM AUTHOR]

Aims/hypothesis: The aim of this study was to investigate how diabetes mellitus affects longer term outcomes in individuals presenting to hospital with non-ST segment elevation myocardial infarction (NSTEMI). Methods: We analysed data from 456,376 adults hospitalised between January 2005 and March 2019 with NSTEMI from the UK Myocardial Ischaemia National Audit Project (MINAP) registry, linked with Office for National Statistics death reporting. We compared outcomes and quality of care by diabetes status. Results: Individuals with diabetes were older (median age 74 vs 73 years), were more often of Asian ethnicity (13% vs 4%) and underwent revascularisation (percutaneous coronary intervention or coronary artery bypass graft surgery) (38% vs 40%) less frequently than those without diabetes. The mortality risk for those with diabetes compared with those without was significantly higher at 30 days (HR 1.19, 95% CI 1.15, 1.23), 1 year (HR 1.28, 95% CI 1.26, 1.31), 5 years (HR 1.36, 95% CI 1.34, 1.38) and 10 years (HR 1.39, 95% CI 1.36, 1.42). In individuals with diabetes, higher quality inpatient care, assessed by opportunity-based quality indicator (OBQI) score category ('poor', 'fair', 'good' or 'excellent'), was associated with lower mortality rates compared with poor care (good: HR 0.74, 95% CI 0.73, 0.76; excellent: HR 0.69, 95% CI 0.68, 0.71). In addition, compared with poor care, excellent care in the diabetes group was associated with the lowest mortality rates in the diet-treated and insulin-treated subgroups (diet-treated: HR 0.64, 95% CI 0.61, 0.68; insulin-treated: HR 0.69, CI 0.66, 0.72). Conclusion/interpretation: Individuals with diabetes experience disparities during inpatient care following NSTEMI. They have a higher risk of long-term mortality than those without diabetes, and higher quality inpatient care may lead to better long-term survival. [ABSTRACT FROM AUTHOR]

Copyright of Herz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background and Objectives: Percutaneous coronary intervention (PCI) is a proven therapy for acute myocardial infarction (AMI) cardiogenic shock (CS). Dual anti-platelet therapy (i.e., aspirin plus an oral P2Y12 inhibitor) is recommended in patients treated with PCI. However, CS patients present severe hemodynamic instability, deranged hemostatic balance, and the need for invasive mechanical circulatory support (MCS) alongside invasive procedures, resulting in an increased risk of both bleeding and thrombotic complications, leaving uncertainty about the best anti-thrombotic treatment. Recently, the parenteral short-acting P2Y12 inhibitor has been increasingly used in the acute cardiac care setting, mainly in light of its favourable pharmacokinetic profile and organ-independent metabolism. Materials and Methods: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we performed a systematic review and single-arm meta-analysis of the safety and efficacy outcomes (i.e., rates of major bleeding, occurrence of stent/any thrombosis, and hospital survival) of all existing original studies reporting on the intravenous administration of cangrelor in AMI-CS patients. Results: Ten studies (678 patients with CS) published between 2017 and 2023 were included in the present review: nine were observational and one had a randomized design. Percutaneous revascularization was performed in >80% of patients across the studies. Moreover, 26% of patients were treated with temporary MCS, and in all studies, concomitant systemic anticoagulation was performed. Cangrelor was administered intravenously at the dosage of 4 mcg/kg/min in 57% of patients, 0.75 mcg/kg/min in 37% of patients, and <0.75 mcg/kg/min in 6%. The pooled rate of major bleeding was 17% (11–23%, confidence interval [CI]), and the pooled rate of stent thrombosis and any thrombosis were 1% (0.3–2.3% CI) and 3% (0.4–7% CI), respectively. Pooled hospital survival was 66% (59–73% CI). Conclusions: Cangrelor administration in AMI-CS patients was feasible and safe with a low rate of thromboembolic complications. Haemorrhagic complications were more frequent than thrombotic events. Nevertheless, to date, the optimal dosage of cangrelor in this clinical context still remains not universally recognized. [ABSTRACT FROM AUTHOR]