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Journal of the American College of... Aug 2021Discrimination among patients with type 1 myocardial infarction (T1MI), type 2 myocardial infarction (T2MI), and myocardial injury is difficult.
BACKGROUND
Discrimination among patients with type 1 myocardial infarction (T1MI), type 2 myocardial infarction (T2MI), and myocardial injury is difficult.
OBJECTIVES
The aim of this study was to investigate the discriminative value of a 29-biomarker panel in an emergency department setting.
METHODS
Patients presenting with suspected myocardial infarction (MI) were recruited. The final diagnosis in all patients was adjudicated on the basis of the fourth universal definition of MI. A panel of 29 biomarkers was measured, and multivariable logistic regression analysis was used to evaluate the associations of these biomarkers with the diagnosis of MI or myocardial injury. Biomarkers were chosen using backward selection. The model was internally validated using bootstrapping.
RESULTS
Overall, 748 patients were recruited (median age 64 years), of whom 138 had MI (107 T1MI and 31 T2MI) and 221 had myocardial injury. In the multivariable model, 4 biomarkers (apolipoprotein A-II, N-terminal prohormone of brain natriuretic peptide, copeptin, and high-sensitivity cardiac troponin I) remained significant discriminators between T1MI and T2MI. Internal validation of the model showed an area under the curve of 0.82. For discrimination between MI and myocardial injury, 6 biomarkers (adiponectin, N-terminal prohormone of brain natriuretic peptide, pulmonary and activation-regulated chemokine, transthyretin, copeptin, and high-sensitivity troponin I) were selected. Internal validation showed an area under the curve of 0.84.
CONCLUSIONS
Among 29 biomarkers, 7 were identified to be the most relevant discriminators between subtypes of MI or myocardial injury. Regression models based on these biomarkers allowed good discrimination. (Biomarkers in Acute Cardiac Care [BACC]; NCT02355457).
Topics: Aged; Biomarkers; Cohort Studies; Female; Humans; Male; Middle Aged; Models, Cardiovascular; Myocardial Infarction
PubMed: 34412811
DOI: 10.1016/j.jacc.2021.06.027 -
International Journal of Environmental... Jun 2022The comprehensive care model after myocardial infarction (CCMI, in Polish: KOS-Zawał) has been in effect continuously since October 2017. Within the bundle of services... (Review)
Review
The comprehensive care model after myocardial infarction (CCMI, in Polish: KOS-Zawał) has been in effect continuously since October 2017. Within the bundle of services financed by the Polish National Health Fund (NHF), patients receive a diagnosis, conservative and invasive treatment, early cardiac rehabilitation and follow-up visits for 12 months. The existing model of managing patients after myocardial infarction (MI) implements all crucial aspects of care recommended by the European Society of Cardiology (ESC), emphasised many times. The purpose of this paper was to report and describe the course of the implementation of the unique concept-CCMI model, including the scope of the introduced changes and the implementation and structural evaluation of its effects over the period 2017-2021. Our preliminary study reported that the CCMI programme reduces the risk of patient death in the first year after MI by 29%. Furthermore, the authors point out the strict cause and effect relationship between the cardiovascular disease prevention programme since 2004 as the key instrument for the primary systemic prevention implemented outside the CCMI model.
Topics: Cardiac Rehabilitation; Cardiology; Comprehensive Health Care; Humans; Myocardial Infarction; Poland
PubMed: 35742767
DOI: 10.3390/ijerph19127518 -
The Journal of Invasive Cardiology Oct 2022In this review, the authors discuss a brief history of the Impella mechanical circulatory support device, a mechanistic role for the device in the context of the... (Review)
Review
In this review, the authors discuss a brief history of the Impella mechanical circulatory support device, a mechanistic role for the device in the context of the underlying pathophysiology of acute myocardial infarction cardiogenic shock (AMI-CS), the current body of literature evaluating its role in AMI-CS, and upcoming efforts to identify a role more clearly for the device in AMI-CS.
Topics: Heart-Assist Devices; Humans; Myocardial Infarction; Shock, Cardiogenic; Treatment Outcome
PubMed: 36001457
DOI: No ID Found -
PloS One 2022Ventricular septal rupture (VSR) is a rare complication after acute myocardial infarction (AMI) especially in the reperfusion era but its associated mortality has...
BACKGROUND
Ventricular septal rupture (VSR) is a rare complication after acute myocardial infarction (AMI) especially in the reperfusion era but its associated mortality has remained high. This case series evaluated in-hospital and intermediate-term mortality in VSR patients. Additionally, we also analyzed risk factors, clinical presentation, intervention, and predictors of in-hospital mortality in VSR patients.
METHODS
Data of 67 patients with echocardiography confirmed diagnosis of VSR from January 2011 to April 2020 was extracted from hospital medical records. Records were also reviewed to document 30 day and 1-year mortality, recurrent heart failure admission, repeat myocardial infarction, and revascularization. In addition, telephonic follow-up was done to assess health-related quality of life(HRQOL) assessed by KCCQ-12. SCAI shock classification was used to categorize severity of cardiogenic shock. Univariate and multivariable logistic regression was used to determine predictors of in-hospital mortality. Survival function was presented using the Kaplan-Meier survival curve.
RESULTS
Mean age of patients was 62.7 ± 11.1 years, 62.7% were males. 65.7% of the patients presented more than 24 hours after MI and did not receive reperfusion therapy. Median time from AMI to VSR diagnosis was 2 (1-5) days. VSR closure was attempted in 53.7% patients. In-hospital mortality was 65.7%. At univariate level, predictors of in-hospital mortality were non-surgical management, basal VSR, right ventricular dysfunction, early VSR post-MI, and severe cardiogenic shock at admission (class C, D, or E). Adjusted predictors of in-hospital mortality included non-surgical management, basal VSR and advanced cardiogenic shock. There were 5 deaths during median followup of 44.1 months. HRQOL in patients available on followup was good (54.5%) or excellent (45.5%).
CONCLUSION
High in-hospital mortality was seen in VSR patients. VSR closure is the preferred treatment to get long-term survival, however, timing of repair as well as severity of cardiogenic shock plays a significant role in determining prognosis.
Topics: Male; Humans; Middle Aged; Aged; Female; Ventricular Septal Rupture; Shock, Cardiogenic; Quality of Life; Retrospective Studies; Myocardial Infarction; Risk Factors; Treatment Outcome
PubMed: 36301909
DOI: 10.1371/journal.pone.0276615 -
Catheterization and Cardiovascular... Oct 2022To evaluate characteristics and outcomes of patients presenting with acute myocardial infarction and cardiogenic shock (AMICS) during the coronavirus disease 2019...
OBJECTIVES
To evaluate characteristics and outcomes of patients presenting with acute myocardial infarction and cardiogenic shock (AMICS) during the coronavirus disease 2019 (COVID-19) pandemic.
BACKGROUND
The COVID-19 pandemic has created challenges in delivering acute cardiovascular care. Quality measures and outcomes of patients presenting with AMICS during COVID-19 in the United States have not been well described.
METHODS
We identified 406 patients from the National Cardiogenic Shock Initiative (NCSI) with AMICS and divided them into those presenting before (N = 346, 5/9/2016-2/29/2020) and those presenting during the COVID-19 pandemic (N = 60, 3/1/2020-11/10/2020). We compared baseline clinical data, admission characteristics, and outcomes.
RESULTS
The median age of the cohort was 64 years, and 23.7% of the group was female. There were no significant differences in age, sex, and medical comorbidities between the two groups. Patients presenting during the pandemic were less likely to be Black compared to those presenting prior. Median door to balloon (90 vs. 88 min, p = 0.38), door to support (88 vs. 78 min, p = 0.13), and the onset of shock to support (74 vs. 62 min, p = 0.15) times were not significantly different between the two groups. Patients presented with ST-elevation myocardial infarction more often during the COVID-19 period (95.0% vs. 80.0%, p = 0.005). In adjusted logistic regression models, COVID-19 period did not significantly associate with survival to discharge (odds ratio [OR] 1.09, 95% confidence interval [CI] 0.54-2.19, p = 0.81) or with 1-month survival (OR 0.82, 95% CI 0.42-1.61, p = 0.56).
CONCLUSIONS
Care of patients presenting with AMICS has remained robust among hospitals participating in the NCSI during the COVID-19 pandemic.
Topics: COVID-19; Female; Heart-Assist Devices; Humans; Middle Aged; Myocardial Infarction; Pandemics; Percutaneous Coronary Intervention; ST Elevation Myocardial Infarction; Shock, Cardiogenic; Treatment Outcome; United States
PubMed: 36073018
DOI: 10.1002/ccd.30390 -
BMC Geriatrics Jan 2023Systematic review and meta-analysis of the association between sarcopenia and the development of myocardial infarction. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Systematic review and meta-analysis of the association between sarcopenia and the development of myocardial infarction.
METHODS
PubMed, Cochrane Library, and Embase were searched for studies on the association between sarcopenia and myocardial infarction from their inception until November 26, 2022. The fixed-effects model was used to calculate the combined risk ratio (RR) of sarcopenia in patients with myocardial infarction. Sensitivity analysis was used to test the robust of the combined result, and funnel plot were used to test publication bias.
RESULTS
Five studies were included finally. There was no significant association between sarcopenia and risk of developing myocardial infarction [RR = 1.01; 95% CI = 0.94, 1.08; P = 0.317]. The sensitivity analysis showed robust of the combined result. The funnel plot showed no significant publication bias.
CONCLUSION
Limited evidence suggests no definitive association between sarcopenia and risk of myocardial infarction.
Topics: Humans; Sarcopenia; Myocardial Infarction; Odds Ratio
PubMed: 36609231
DOI: 10.1186/s12877-022-03712-1 -
Heart (British Cardiac Society) Oct 2020
Topics: Humans; Limit of Detection; Myocardial Infarction; Patient Discharge; Troponin I
PubMed: 32747496
DOI: 10.1136/heartjnl-2020-317012 -
Frontiers in Immunology 2022The level of systemic inflammation correlates with the severity of the clinical course of acute myocardial infarction (AMI). It has been shown that circulating cytokines...
BACKGROUND
The level of systemic inflammation correlates with the severity of the clinical course of acute myocardial infarction (AMI). It has been shown that circulating cytokines and endothelial dysfunction play an important role in the process of clot formation. The aim of our study was to assess the concentration of various circulating cytokines, endothelial function and blood clotting in AMI patients depending on the blood flow through the infarction-related artery (IRA).
METHODS
We included 75 patients with AMI. 58 presented with ST-elevation myocardial infarction (STEMI) and 17 had non-ST-elevation myocardial infarction (non-STEMI). A flow-mediated dilation test (FMD test), thrombodynamics and rotational thromboelastometry as well as assessment of 14 serum cytokines using xMAP technology were performed.
FINDINGS
Non-STEMI-patients were characterized by higher levels of MDC, MIP-1β, TNF-α. Moreover, we observed that patients with impaired blood flow through the IRA (TIMI flow 0-1) had higher average and initial clot growth rates, earlier onset of spontaneous clots, C-reactive protein (CRP) and IL-10 compared to patients with preserved blood flow through the IRA (TIMI flow 2-3). Patients with TIMI 2-3 blood flow had higher level of IP-10. IL-10 correlated with CRP and pro-inflammatory cytokines levels, initial clot growth rate and clot lysis time in TIMI 0-1 patients. All these differences were statistically significant.
INTERPRETATION
We demonstrated that concentrations of the inflammatory cytokines correlate not only with the form of myocardial infarction (STEMI or non-STEMI), but also with the blood flow through the infarct-related artery. Inflammatory response, functional state of endothelium, and clot formation are closely linked with each other. A combination of these parameters affects the patency of the infarct-related artery.
Topics: Cytokines; Humans; Infarction; Interleukin-10; Myocardial Infarction; Non-ST Elevated Myocardial Infarction; ST Elevation Myocardial Infarction
PubMed: 35242141
DOI: 10.3389/fimmu.2022.837642 -
Medical Ultrasonography Dec 2022Despite medical and interventional advances, the mechanical complications of acute myocardial infarction are associated with high mortality. Timely surgical therapy...
Despite medical and interventional advances, the mechanical complications of acute myocardial infarction are associated with high mortality. Timely surgical therapy requires a prompt and accurate diagnosis. Multimodality imaging has become the standard of care in modern cardiology. Despite the widespread use and cost-effectiveness of cardiac ultrasound in the acute setting, the method is highly user-dependent. In complex cases a second imaging technique is often required. The case presents the key role of multimodal imaging in the evaluation of a patient with a very rare complication of an acute myocardial infarction, a pseudoaneurysm of the interventricular septum respectively. In addition to confirming the diagnosis assumed by echocardiography, cardiac computed tomography provides additional structural and functional information essential to proper management.
Topics: Humans; Myocardial Infarction; Echocardiography
PubMed: 35437530
DOI: 10.11152/mu-3491 -
Molecules (Basel, Switzerland) May 2024Myocardial infarction (MI) is one of the most prevalent types of cardiovascular disease. During MI, myocardial cells become ischemic and necrotic due to inadequate blood... (Review)
Review
Myocardial infarction (MI) is one of the most prevalent types of cardiovascular disease. During MI, myocardial cells become ischemic and necrotic due to inadequate blood perfusion, leading to irreversible damage to the heart. Despite the development of therapeutic strategies for the prevention and treatment of MI, their effects are still unsatisfactory. Nanoparticles represent a new strategy for the pre-treatment and treatment of MI, and novel multifunctional nanoparticles with preventive and therapeutic capabilities hold promise for the prevention and treatment of this disease. This review summarizes the common types and properties of nanoparticles, and focuses on the research progress of nanoparticles for the prevention and treatment of MI.
Topics: Myocardial Infarction; Humans; Nanoparticles; Animals
PubMed: 38893291
DOI: 10.3390/molecules29112415