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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.

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]

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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]