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e-Health, including the use of mobile smartphone applications combined with interactive computerized programs, offers a new range of possibilities to improve secondary prevention after an acute myocardial infarction (MI). ASTERIA (improve real-life therapeutic follow-up through artificial intelligence) interventional study aims to assess the efficacy of a new web-based application (i.e., e-health BFC app) designed to improve the risk factors control and adherence recommended medications after MI, through kidney function, cholesterol and diabetes monitoring. From 1st June 2022 to 25th April 2024, the E-health app was proposed to all consecutive patients hospitalized for acute MI in intensive care unit in CHU de Dijon Bourgogne and able to handle the software on their smartphone (n = 1702). An automatic comparison between the initial and last biological values was made to detect any abnormality in kidney function through creatinine, K+ levels and to check if the LDL-cholesterol target was reached. Treatments decision algorithms to monitor patients'cholesterol and diabetes were created according to ESC recommendations. If biological abnormalities are detected, medical research team is alerted and can acts quickly. Renal function at one and four weeks, lipids at one and three months and HbA1c every three month after hospitalization were followed. Patients receive regular text messages reminding them to perform the blood tests and enter the biological results into the app. Among the 313 (19.8%) patients included, most (74%) completed their test results (weight, kalemia and creatinine) at one week, 74% at four weeks and 48% at 12 weeks after discharge. Alerts, automatically generated by the app, led to a new blood test prescription to assess kidney function for 12 (3.8%) patients and to adapt lipid-lowering treatment for 41 patients (41%). Results for algorithm-derived adaptation of diabetes treatment will be presented. The evaluation of the app by the patients raised a good feasibility and adherence level and showed that the majority (94.9%) thought that the app was useful to improve medical monitoring. Although only a few proportion of MI patients can benefit from this smartphone-based interventions (less than ¼), this innovative intervention could enhance self-management of risk factors and improve the link between the hospital and post discharge phases. [ABSTRACT FROM AUTHOR]

Harmful effects of some non-illicit substances including tobacco, alcohol and caffeine may evoke sudden death, myocardial infarction and severe arrhythmias. Exercising is a keystone of cardiovascular prevention; however, substance use may impair these beneficial effects. To analyse knowledge and behaviours regarding non-illicit substances among a regional sport population participating in the French rugby championship. From April 8th to July 3rd 2023, an anonymous online questionnaire was displayed to the 8368 players aged 12 y and more, the coaches and referees from the Bourgogne-Franche-Comté region. Among the respondents, 1061 were players, 195 coaches and 68 referees. Among the 1061 players respondents (13%), most were men (82.9%), median age was 22 (IQR 16–30) y. Women were younger than men (21y, IQR (16–29) vs 24 y (IQR 18–33), P = 0.017). Almost one third (32.1%) thought that sport cleans the smoker's lungs. Among the whole population, half (50.5%) have experienced tobacco smoking, including 18.1% of the younger players (< 18y). Since the beginning of the sport season, prevalence of cigarette smoking was high, at 29.1%, with 15.4% of daily consumption. These rates were similar in men and women. Almost one third (31.7%) of smokers were not aware of the risk of their cigarette consumption. Among referees and coaches, respectively 17.6% and 16.4% smoke within the 2 hours before and after a rugby session, i.e. often in the presence of players. Alcohol intake within one hour before a match was declared by 35.6% of alcohol drinkers, mostly among male (P < 0.0001); aim to performance enhancing was declared by 17.8% of them. Binge drinking was common, up to 81.3% of users, mostly among male. Energy drink during the season was declared by 20.7% of players, significantly more often among male (P < 0.001). Among them, more than 3 upon 4 declared an intake in the hour before the rugby session of whom almost 50% to enhance their performance. Non-illicit substance consumption remains common among rugby players of this French region. Consumption patterns in the setting of a sport session may increase CV risk; moreover, these behaviours concerning tobacco smoking may be harmful for their peers through second hand smoke, and can be an incentive to smoke. Our findings highlight the urgent need of health education and prevention addressing substances consumption in this population; these actions must include referees and coaches as relevant targets. [ABSTRACT FROM AUTHOR]

Type 2 diabetes mellitus (T2DM) is a highly heterogeneous entity, with multiple subgroups differing by clinic presentation, disease progression and risk of complications such as myocardial infarction (MI). A new T2DM phenotyping classification has been recently proposed to help to improve treatment tailoring and target early treatments. We aimed to identify the prevalence and characteristics of the new T2DM phenotypes in patients with acute MI. All consecutive adults with a history T2DM hospitalized in a French Coronary Intensive Care Unit for an acute MI between February 1st, 2021 and January 31st, 2023 were included. Clusters were based on six variables (glutamate decarboxylase antibodies, age at diagnosis, BMI, HbA1c, and homoeostatic model assessment 2 estimates of β-cell function and insulin resistance). We stratified patients into five subgroups: 1/SAID = severe autoimmune diabetes; 2/SIDD = severe insulin-deficient diabetes; 3/SIRD = severe insulin-resistant diabetes; 4/MOD = mild obesity-related diabetes; and 5/MARD = mild age-related diabetes. Among the 266 patients included, characteristics according to diabetes phenotypes are summarized in Table 1. Our prospective study showed that in real-world T2DM patients with acute MI, unclassical phenotypes, i.e. hyperinsulinaemic and insulinopaenic were common. Given the large discrepancies in characteristics, our findings suggest the relevance of the new substratification. However, its clinical utility and translation in tailored treatment strategies and prognosis remains to be determined. [ABSTRACT FROM AUTHOR]

A significant rate of patients admitted for acute myocardial infarction (MI) are under chronic treatment with non-vitamin K antagonist oral anticoagulants (NOACs). Their initial anticoagulant management should be limited to an unfractionated heparin bolus during percutaneous coronary angiography (PCI), according to the new ESC guidelines. However, level of anticoagulants through standard laboratory tests or specific dosages could provide important information to adapt anticoagulation therapy and limit the early bleeding risk. We aimed to investigate the levels of NOACs in patients admitted for an acute MI. Between February 1st, 2021 and January 31st, 2023, all consecutive adults admitted in coronary care unit for an acute MI and chronically treated with NOACs were prospectively included. Blood sampling was made on admission for anticoagulant assessment. NOAC concentrations (expressed in ng/mL) were measured using Liquid anti-Xa (Stago, Asnières sur Seine, France) for rivaroxaban and apixaban, and ECA-2 (Stago, Asnières sur Seine, France) for dabigatran, with specific set-up tests, according to the manufacturer's recommendations. Calibrations were performed using rivaroxaban, apixaban, dabigatran plasma calibrators (Stago, Asnières sur Seine, France). Patients were divided into 3 ranges according to levels of NOAC (Group 1: < 50 ng/mL, Group 2: 50–100 ng/mL, Group 3: > 100 ng/mL) taking account the haemostatic threshold of 50 ng/mL for surgery (except neurosurgery) or use of antidote and the through concentration of 100 ng/mL observed before next dose of twice-daily treatments. Rate of MI patients under chronic NOAC was 8,5% (n = 155). Their median (IQR) anticoagulant concentration was at 98 (51–179) ng/mL and the time from the last dose of NOACs was 495 (240–660) min. The main indication for chronic NOAC was atrial fibrillation. Among the 155 patients, 39 (25%), were in group 1, 42 (27%) in group 2 and 74 (48%) in group 3. Baseline characteristics were similar for the 3 groups (Table 1), including age, risk factors, type of NOAC and rate of PCI. However, there was a trend toward a higher rate of ST segment elevation MI in patients with elevated levels of anticoagulant. Our prospective pilot study suggests that the dosage of NOACs could be a relevant guiding tool for anticoagulant strategy in patients with acute MI. However, its clinical utility and prognosis value remains to be determined in larger prospective multicentric studies. [ABSTRACT FROM AUTHOR]

Exercise is a keystone of cardiovascular prevention; however, it is also a powerful trigger of acute cardiovascular events including sudden cardiac arrest and acute myocardial infarction. Contemporary studies addressing these sport-related myocardial infarctions (SR-MI) are scarce. To describe clinical characteristics and follow-up of SR-MI. We conducted a regional multicentre prospective survey addressing patients admitted for a SR-MI in 2 intensive coronary units. SR-MI was defined as MI onset occurring during sport or within the 1st hour of recovery. A one-year follow-up was performed by phone call. From April 1st 2018 to February 23th 2023, 155 SRMI were included, of whom 13 (8.4%) were female, median age was 61-y (IQR 54–66) (Table 1). Cycling was the most frequent sport (32.5%) followed by fitness and hiking (12.6% each) then jogging (11.3%). Most were ST elevation MI (68.8%). The main risk factors were dyslipidaemia (33.8%), hypertension (27.3%) and tobacco smoking (24.5%). No cardiovascular risk factors other than age were identified in 38 patients (25.7%). Prodromal symptoms were reported by 66 subjects (42.6%). SR-MI occurred mostly during exercise (60.6%). Out of hospital cardiac arrest (OHCA) occurred in 20 (12.6%) patients, more commonly among patients with prior coronary artery disease (CAD) (P = 0.02) and tobacco smoking (P = 0.047). A significant single vessel disease was observed in 67 patients (43.2%); stenting was performed by stenting in 134 patients (86.5%) and surgery in 11 (7.1%). In-hospital death occurred in 4 patients and was associated to OHCA (P = 0.007). Among the 151 survivors at discharge, 141 were eligible to follow-up, none was lost: one patient died suddenly at home, one experienced a recurrent MI and one a cardioversion from his implantable cardioverter defibrillator (ICD); an ICD was implanted in 4 subjects. A cardiovascular rehabilitation was performed in 101 patients (65.2%); from the 30 smokers at the time of SRMI, 26 quitted. Among patients admitted for a SR-MI, prodromal symptoms were common and OHCA occurred in 1 patient out of 8, associated with history of CAD, tobacco smoking and in-hospital death. Such findings highlight the need for mass education to adopt safer behaviours, especially while exercising. In this population, rehabilitation rate was high and quitting tobacco was commonly achieved. [ABSTRACT FROM AUTHOR]