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Journal of the American College of... Jan 2023Despite poor cardiovascular outcomes, there are no dedicated, validated risk stratification tools to guide investigation or treatment in type 2 myocardial infarction.
BACKGROUND
Despite poor cardiovascular outcomes, there are no dedicated, validated risk stratification tools to guide investigation or treatment in type 2 myocardial infarction.
OBJECTIVES
The goal of this study was to derive and validate a risk stratification tool for the prediction of death or future myocardial infarction in patients with type 2 myocardial infarction.
METHODS
The T2-risk score was developed in a prospective multicenter cohort of consecutive patients with type 2 myocardial infarction. Cox proportional hazards models were constructed for the primary outcome of myocardial infarction or death at 1 year using variables selected a priori based on clinical importance. Discrimination was assessed by area under the receiving-operating characteristic curve (AUC). Calibration was investigated graphically. The tool was validated in a single-center cohort of consecutive patients and in a multicenter cohort study from sites across Europe.
RESULTS
There were 1,121, 250, and 253 patients in the derivation, single-center, and multicenter validation cohorts, with the primary outcome occurring in 27% (297 of 1,121), 26% (66 of 250), and 14% (35 of 253) of patients, respectively. The T2-risk score incorporating age, ischemic heart disease, heart failure, diabetes mellitus, myocardial ischemia on electrocardiogram, heart rate, anemia, estimated glomerular filtration rate, and maximal cardiac troponin concentration had good discrimination (AUC: 0.76; 95% CI: 0.73-0.79) for the primary outcome and was well calibrated. Discrimination was similar in the consecutive patient (AUC: 0.83; 95% CI: 0.77-0.88) and multicenter (AUC: 0.74; 95% CI: 0.64-0.83) cohorts. T2-risk provided improved discrimination over the Global Registry of Acute Coronary Events 2.0 risk score in all cohorts.
CONCLUSIONS
The T2-risk score performed well in different health care settings and could help clinicians to prognosticate, as well as target investigation and preventative therapies more effectively. (High-Sensitivity Troponin in the Evaluation of Patients With Suspected Acute Coronary Syndrome [High-STEACS]; NCT01852123).
Topics: Humans; Risk Assessment; Cohort Studies; Prospective Studies; Prognosis; Predictive Value of Tests; Troponin I; Myocardial Infarction; Risk Factors; Anterior Wall Myocardial Infarction; Diabetes Mellitus, Type 2
PubMed: 36631210
DOI: 10.1016/j.jacc.2022.10.025 -
Cardiovascular Diabetology Aug 2023Atherogenic index of plasma (AIP) has been confirmed as a novel marker for myocardial infarction (MI), but few evidence on the long-term AIP and MI risk in general...
BACKGROUND
Atherogenic index of plasma (AIP) has been confirmed as a novel marker for myocardial infarction (MI), but few evidence on the long-term AIP and MI risk in general populations. We thus aimed to evaluate the relationships of cumulative exposure to AIP and its accumulation time course with the risk of MI.
METHODS
A total of 54,440 participants were enrolled in the Kailuan study. Time-weighted cumulative AIP was calculated as the weighted sum of the mean AIP value for each time interval, then normalized by total exposure duration, the exposure duration was from 2006 to 2010. Duration of high AIP exposure was defined as the duration with high AIP and ranged from 0 to 6 years. The time course of AIP accumulation was categorized by the combination of time-weighted cumulative AIP < or ≥ median (- 0.12) and AIP slope.
RESULTS
After 11.05 years of follow-up, 766 incident MI cases were documented. After adjustment for potential confounders, higher risk of MI was observed in participants with the highest time-weighted cumulative AIP quartile (HR, 1.89; 95% CI 1.47-2.43), the longest exposure duration of high AIP (HR, 1.52; 95% CI 1.18-1.95), and those with high time-weighted cumulative AIP and negative slope (HR, 1.42; 95% CI 1.13-1.79).
CONCLUSIONS
Long-term cumulative exposure to AIP and the time course of AIP accumulation increased the risk of MI. High AIP earlier resulted in a greater risk increase than later in life with the same time-weighted cumulative AIP, emphasizing the importance of controlling atherogenic dyslipidemia early in life.
Topics: Humans; Myocardial Infarction
PubMed: 37592247
DOI: 10.1186/s12933-023-01936-y -
Current Opinion in Cardiology Nov 2022Various definitions of periprocedural myocardial infarction (MI) have been proposed by academic groups and professional societies differing in terms of biomarker... (Review)
Review
PURPOSE OF REVIEW
Various definitions of periprocedural myocardial infarction (MI) have been proposed by academic groups and professional societies differing in terms of biomarker thresholds and ancillary criteria for myocardial ischemia. The incidence and clinical significance of periprocedural MI substantially varies according to the definitions applied. In this review, we summarize available clinical data on the frequency and outcomes of periprocedural MI according to various MI definitions in patients undergoing percutaneous coronary intervention (PCI).
RECENT FINDINGS
Numerous clinical studies and meta-analyses have investigated the incidence and prognostic relevance of periprocedural MI following PCI. The incidence of periprocedural MI was higher when defined by universal definition of myocardial infarction (UDMI), which applies a lower biomarker threshold with broader ancillary criteria compared with the Society for Cardiovascular Angiography and Intervention (SCAI) and academic research consortium (ARC)-2. The prognostic impact of periprocedural MI defined by SCAI and ARC-2 on mortality was consistently greater compared with the UDMI definition.
SUMMARY
Among chronic coronary syndrome patients undergoing PCI, the frequency and prognostic value of periprocedural MI varies considerably based on definitions. Periprocedural MI defined by the ARC-2 and SCAI occurred 3-6 times less frequently and were prognostically more relevant as compared with the UDMI. Clinically relevant definitions should be used in daily practice and clinical trials.
Topics: Biomarkers; Coronary Artery Disease; Humans; Myocardial Infarction; Percutaneous Coronary Intervention; Risk Factors; Syndrome; Treatment Outcome
PubMed: 36094520
DOI: 10.1097/HCO.0000000000000995 -
Journal of the American College of... Oct 2020
Topics: Coronary Artery Bypass; Humans; Myocardial Infarction
PubMed: 33004128
DOI: 10.1016/j.jacc.2020.08.024 -
Cardiovascular Diabetology Oct 2022Diabetes mellitus (DM) is associated with an increased mortality risk in patients hospitalized with acute myocardial infarction (AMI); however, no studies have...
BACKGROUND
Diabetes mellitus (DM) is associated with an increased mortality risk in patients hospitalized with acute myocardial infarction (AMI); however, no studies have investigated the impact of the duration of DM on in-hospital mortality. In this study, we evaluated in-hospital mortality in AMI patients according to DM status and its duration.
METHODS
Using health administrative databases of Lombardy, DM patients≥50 years hospitalized with AMI from 2010 to 2019 were included in the analysis and were stratified according to the duration of DM: <5, 5-10, and > 10 years. The primary endpoint was mortality during AMI hospitalization and the secondary endpoint was 1-year mortality in comparison with No-DM patients. Logistic and Cox regressions analyses were used to estimate odds ratios (ORs, CI 95%) and hazard ratios (HRs, CI 95%) for the outcomes, according to DM status and duration and AMI type (STEMI and NSTEMI).
RESULTS
Our study cohort comprised 29,566 and 109,247 DM and No-DM patients, respectively. Adjusted ORs and HRs showed a significantly higher risk of in-hospital mortality (OR 1.50, 95% CI 1.43-1.58) and 1-year mortality (HR 1.51, 95% CI 1.46-1.55) in DM patients in comparison with those without. These risks increased progressively with the duration of DM, with the highest risk observed in patients with DM duration ≥ 10 years (OR 1.59, 95% CI 1.50-1.69 for in-hospital mortality and HR 1.59, 95% CI 1.53-1.64 for 1-year mortality). These findings were similar in STEMI and in NSTEMI patients.
CONCLUSIONS
Our study demonstrates that the duration of DM parallels mortality risk in patients hospitalized with AMI, highlighting that DM duration should be considered as an important early prognostic risk factor in patients with AMI.
Topics: Humans; Diabetes Mellitus; Hospital Mortality; Hospitalization; Myocardial Infarction; Non-ST Elevated Myocardial Infarction; Risk Factors; ST Elevation Myocardial Infarction
PubMed: 36309742
DOI: 10.1186/s12933-022-01655-w -
Frontiers in Immunology 2022Myocardial infarction is a well-established severe consequence of coronary artery disease. However, the lack of effective early biomarkers accounts for the lag time...
BACKGROUND
Myocardial infarction is a well-established severe consequence of coronary artery disease. However, the lack of effective early biomarkers accounts for the lag time before clinical diagnosis of myocardial infarction. The present study aimed to predict critical genes for the diagnosis of MI by immune infiltration analysis and establish a nomogram.
METHODS
Gene microarray data were downloaded from Gene Expression Omnibus (GEO). Differential expression analysis, single-cell sequencing, and disease ontology (DO) enrichment analysis were performed to determine the distribution of Differentially Expressed Genes (DEGs) in cell subpopulations and their correlation with MI. Next, the level of infiltration of 16 immune cells and immune functions and their hub genes were analyzed using a Single-sample Gene Set Enrichment Analysis (ssGSEA). In addition, the accuracy of critical markers for the diagnosis of MI was subsequently assessed using receiver operating characteristic curves (ROC). One datasets were used to test the accuracy of the model. Finally, the genes with the most diagnostic value for MI were screened and experimentally validated.
RESULTS
335 DEGs were identified in GSE66360, including 280 upregulated and 55 downregulated genes. Single-cell sequencing results demonstrated that DEGs were mainly distributed in endothelial cells. DO enrichment analysis suggested that DEGs were highly correlated with MI. In the MI population, macrophages, neutrophils, CCR, and Parainflammation were significantly upregulated compared to the average population. NR4A2 was identified as the gene with the most significant diagnostic value in the immune scoring and diagnostic model. 191 possible drugs for the treatment of myocardial infarction were identified by drug prediction analysis. Finally, our results were validated by Real-time Quantitativepolymerase chain reaction and Western Blot of animal samples.
CONCLUSION
Our comprehensive in silico analysis revealed that NR4A2 has huge prospects for application in diagnosing patients with MI.
Topics: Animals; Endothelial Cells; Myocardial Infarction; Coronary Artery Disease; Blotting, Western; Computational Biology
PubMed: 36618351
DOI: 10.3389/fimmu.2022.1061800 -
International Journal of Nanomedicine 2021Despite several recent advances, current therapy and prevention strategies for myocardial infarction are far from satisfactory, owing to limitations in their... (Review)
Review
Despite several recent advances, current therapy and prevention strategies for myocardial infarction are far from satisfactory, owing to limitations in their applicability and treatment effects. Nanoparticles (NPs) enable the targeted and stable delivery of therapeutic compounds, enhance tissue engineering processes, and regulate the behaviour of transplants such as stem cells. Thus, NPs may be more effective than other mechanisms, and may minimize potential adverse effects. This review provides evidence for the view that function-oriented systems are more practical than traditional material-based systems; it also summarizes the latest advances in NP-based strategies for the treatment and prevention of myocardial infarction.
Topics: Drug Delivery Systems; Humans; Myocardial Infarction; Nanoparticles
PubMed: 34621124
DOI: 10.2147/IJN.S328723 -
Journal of the American College of... Sep 2021
Topics: Humans; Myocardial Infarction; Percutaneous Coronary Intervention; Prospective Studies; ST Elevation Myocardial Infarction
PubMed: 34556315
DOI: 10.1016/j.jacc.2021.08.001 -
JACC. Cardiovascular Imaging Jun 2023
Topics: Humans; Predictive Value of Tests; Myocardial Infarction; Thrombosis; Molecular Imaging
PubMed: 36648044
DOI: 10.1016/j.jcmg.2022.10.015 -
International Journal of Medical... Apr 2023Rapid primary angioplasty is the most effective reperfusion strategy for acute ST-elevation myocardial infarction (STEMI) patients. Since not all hospitals have a...
BACKGROUND
Rapid primary angioplasty is the most effective reperfusion strategy for acute ST-elevation myocardial infarction (STEMI) patients. Since not all hospitals have a catheterization laboratory to perform this intervention, adequate coordination of all medical professionals involved in the management of STEMI patients from the emergency room to the hospital catheterization laboratory is necessary.
OBJECTIVE
Present the design and deployment of ODISEA (acronym of myOcarDial Infarction SafEtytrAnsfer), a web-based environment plus an application created to complement and support the transfer and management of STEMI patients from the first medical contact to the catheterization laboratory where the primary angioplasty will be carried out.
METHOD
ODISEA is an application that has been designed to improve the coordination of all health personnel involved in the management of STEMI patients, i.e., primary care hospitals, Emergency Medical Services [EMS] and cardiology departments. The application provides: (i) functionalities to register relevant information of the patients' and the administered medications, (ii) a chat to coordinate all involved personnel; (iii) treatment recommendations for the first medical contact; and (iv) a GPS-SATELLITE monitoring system to know the exact position of the ambulance during patient transfer. These features improve the coordination in the catheterization laboratory, and optimize the equipment preparation time, and also the patient accommodation procedures after primary angioplasty. ODISEA registers all treated cases for a proper follow-up. The application has been tested from September 2021 to January 2022 in the context of a pilot study in Girona that involved 98 patients and 42 professionals (11 from hospital without Cath lab availability, 21 from EMS, and 10 from the main hospital). Professionals answered a questionnaire using a five-point Likert scale (satisfaction level from 1 to 5) to assess ODISEA regarding patient management, care quality, transfer coordination, transfer effectiveness, and usefulness. Collected data was analyzed using chi-square or Fisher's exact test. Statistical significance has been considered p < 0.05. To evaluate times of first angioplasty, relevant data from 98 patients was collected and compared with data of 129 STEMI patients not treated with ODISEA.
RESULTS
For all the questions>70 % of answers are in the 3 to 5 range and from these, almost all the questions have 50 % of answers in the 4 and 5 range. Regarding groups of professionals only in the question related to coordination significant difference has been found for EMS professionals with respect to hospital without Cath lab availability and catheterization hospital professionals. Comparing ODISEA with no ODISEA patients it was observed an improvement in the times of first angioplasty as well as a reduction in the erroneous infarction codes activation. Patients treated with the ODISEA APP were further away from the PCI-capable center. A non-significant tendency was seen towards shorter primary angioplasty times (diagnostic electrocardiogram-guidewire passage) in the ODISEA compared to the NON ODISEA group (112 min vs 122 min; P =.3), a non-significant reduction of cases with times > 120 min (26.2 % vs 35.7 %, respectively; P =.1), and a tendency towards fewer cases eventually diagnosed as non-acute coronary syndrome (7.1 % vs 13.2 %; P =.1).
CONCLUSION
ODISEA is a very well-accepted application that improves the management of STEMI patients. The application is an appropriate complement to current infarction protocol.
Topics: Humans; Percutaneous Coronary Intervention; ST Elevation Myocardial Infarction; Pilot Projects; Myocardial Infarction; Emergency Medical Services
PubMed: 36780790
DOI: 10.1016/j.ijmedinf.2023.105020