scholarly journals Legumain is a predictor of all-cause mortality and potential therapeutic target in acute myocardial infarction

2020 ◽  
Vol 11 (11) ◽  
Author(s):  
Hui Yang ◽  
Yuhu He ◽  
Pu Zou ◽  
Yilei Hu ◽  
Xuping Li ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cox Regression ◽  
Interquartile Range ◽  
Prognostic Impact ◽  
Healthy Controls ◽  
Operating Characteristics ◽  
Cox Regression Analysis ◽  
All Cause Mortality ◽  
Ecm Degradation

AbstractThe prognostic impact of extracellular matrix (ECM) modulation and its regulatory mechanism post-acute myocardial infarction (AMI), require further clarification. Herein, we explore the predictive role of legumain—which showed the ability in ECM degradation—in an AMI patient cohort and investigate the underlying mechanisms. A total of 212 AMI patients and 323 healthy controls were enrolled in the study. Moreover, AMI was induced in mice by permanent ligation of the left anterior descending artery and fibroblasts were adopted for mechanism analysis. Based on the cut-off value for the receiver-operating characteristics curve, AMI patients were stratified into low (n = 168) and high (n = 44) plasma legumain concentration (PLG) groups. However, PLG was significantly higher in AMI patients than that in the healthy controls (median 5.9 μg/L [interquartile range: 4.2–9.3 μg/L] vs. median 4.4 μg/L [interquartile range: 3.2–6.1 μg/L], P < 0.001). All-cause mortality was significantly higher in the high PLG group compared to that in the low PLG group (median follow-up period, 39.2 months; 31.8% vs. 12.5%; P = 0.002). Multivariate Cox regression analysis showed that high PLG was associated with increased all-cause mortality after adjusting for clinical confounders (HR = 3.1, 95% confidence interval (CI) = 1.4–7.0, P = 0.005). In accordance with the clinical observations, legumain concentration was also increased in peripheral blood, and infarcted cardiac tissue from experimental AMI mice. Pharmacological blockade of legumain with RR-11a, improved cardiac function, decreased cardiac rupture rate, and attenuated left chamber dilation and wall thinning post-AMI. Hence, plasma legumain concentration is of prognostic value in AMI patients. Moreover, legumain aggravates cardiac remodelling through promoting ECM degradation which occurs, at least partially, via activation of the MMP-2 pathway.

scholarly journals RISK FACTORS ASSOCIATED WITH THE OCCURRENCE OF EARLY COMPLICATIONS OF ACUTE MYOCARDIAL INFARCTION AFTER CARDIO-INTERVENTION TREATMENT

2020 ◽  
Vol 73 (6) ◽  
pp. 1245-1251
Author(s):  
Iryna A. Holovanova ◽  
Grygori A. Oksak ◽  
Iryna M. Tkachenko ◽  
Maxim V. Khorosh ◽  
Mariia M. Tovstiak ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cox Regression ◽  
Risk Indicators ◽  
Interventional Treatment ◽  
Early Complications ◽  
Cox Regression Analysis ◽  
Intervention Treatment

The aim of our study was to identify the main risk factors for the occurrence of early complications of acute myocardial infarction after cardio-interventional treatment and to evaluate prognostic risk indicators. Materials and methods: Risk factors of myocardial infarction were determined by copying the case history data and calculating on their basis of the odds ratio and ±95% confidence interval. After it, we made a prediction of the risk of early complications of AMI with cardiovascular intervention by using a Cox regression that took into account the patient’s transportation time by ambulance. Results: Thus, the factors that increase the chances of their occurrence were: summer time of year; recurrent myocardial infarction of another specified localization (I122.8); the relevance of the established STEMI diagnosis; diabetes mellitus; renal pathology; smoking; high rate of BMI. Factors that reduce the chances of their occurrence: men gender – in 35%; the age over of 70 – by 50%; the timely arrival of an emergency medical team – by 55%. The factors that increase the chances of their occurrence were: age over 70 years; subsequent myocardial infarction of unspecified site; diabetes mellitus. Using of a Cox regression analysis, it was proved that the cumulative risk of early complications of AMI with cardio-intervention treatment increased from the 10th minute of ambulance arrival at place, when ECG diagnosis (STEMI), presence of diabetes mellitus, smoking and high BMI. Conclusions: As a result of the conducted research, the risk factors for early complications of AIM with cardio-interventional treatment were identified.

scholarly journals The association between plasma furin and cardiovascular events after acute myocardial infarction

2020 ◽  
Author(s):  
Zhi-wei Liu ◽  
Qiang Ma ◽  
Jie Liu ◽  
Jing-Wei Li ◽  
Yun-Dai Chen
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Regression Analysis ◽  
Cox Regression ◽  
Critical Role ◽  
Cardiac Events ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
Atheromatous Plaques ◽  
Key Enzyme

Abstract Background: Furin is the key enzyme to cleave pro-BNP and plays a critical role in the cardiovascular system through its involvement in the lipid metabolism, blood pressure and formation of atheromatous plaques. NT-proBNP and recently corin, which is also a key enzyme to cleave pro-BNP, have been approved as predictors of prognosis after acute myocardial infarction (AMI). We here conducted this cohort study to investigate the relationship between plasma furin and the prognosis outcome in patients after AMI. Methods: We enrolled 1100 AMI patients and measured their plasma furin concentration. The primary endpoint was the major adverse cardiac events (MACE), a composite of cardiovascular (CV) death, non-fatal myocardial infarction or non-fatal stroke. The association of plasma furin concentration with AMI outcomes was explored by using Kaplan–Meier curve and multivariate Cox regression analysis. Results: Our results showed that slight increase of mean cTNT in patients with higher furin concentration (P=0.016). Over a median follow-up of 31 months, multivariate Cox regression analysis suggested that plasma furin was not associated with MACE (HR: 1.01; 95% CI: 0.93-1.06; P=0.807) after adjustment for potential conventional risk factors. However, plasma furin was associated with non-fatal MI (HR: 1.09; 95% CI: 1.01-1.17; P=0.022) after fully adjustment. Subgroup analysis indicated no relationship between plasma furin and MACE in different subgroup populations.Conclusions: Our study demonstrated that plasma furin was not associated with risk of MACE and may not be used as a predictor of poor prognosis after AMI. But higher levels of plasma furin may be associated with higher risk of non-fatal MI.

scholarly journals Impact of pre-admission depression on mortality following myocardial infarction

2017 ◽  
Vol 210 (5) ◽  
pp. 356-361 ◽  
Author(s):  
Jens Sundbøll ◽  
Morten Schmidt ◽  
Kasper Adelborg ◽  
Lars Pedersen ◽  
Hans Erik Bøtker ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cox Regression ◽  
Population Based ◽  
Prognostic Impact ◽  
Depression Diagnosis ◽  
All Cause Mortality ◽  
History Of ◽  
Rate Ratios ◽  
First Time ◽  
History Of Depression

BackgroundThe prognostic impact of previous depression on myocardial infarction survival remains poorly understood.AimsTo examine the association between depression and all-cause mortality following myocardial infarction.MethodUsing Danish medical registries, we conducted a nationwide population-based cohort study. We included all patients with first-time myocardial infarction (1995–2014) and identified previous depression as either a depression diagnosis or use of antidepressants. We used Cox regression to compute adjusted mortality rate ratios (aMRRs) with 95% confidence intervals.ResultsWe identified 170 771 patients with first-time myocardial infarction. Patients with myocardial infarction and a previous depression diagnosis had higher 19-year mortality risks (87% v. 78%). The overall aMRR was 1.11 (95% CI 1.07–1.15) increasing to 1.22 (95% CI 1.17–1.27) when including use of antidepressants in the depression definition.ConclusionsA history of depression was associated with a moderately increased all-cause mortality following myocardial infarction.

The association of anemia with high-sensitive cardiac troponin and its influence on the ESC 0/1h and 0/3h algorithms to triage patients with suspected acute myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P.M Haller ◽  
J.T Neumann ◽  
N.A Soerensen ◽  
A Gossling ◽  
T.S Hartikainen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Predictive Value ◽  
Cox Regression ◽  
Similar Efficacy ◽  
Cardiovascular Death ◽  
Funding Source ◽  
Cardiovascular Research ◽  
Cox Regression Analysis ◽  
Suspected Acute Myocardial Infarction

Abstract Introduction According to the 4th Universal Definition of Myocardial Infarction (UDMI), anemia may cause acute and chronic myocardial injury indicated by elevated high-sensitive troponin (hs-cTn) concentrations, with unknown influence on triaging patients with suspected acute myocardial infarction (AMI). Purpose To investigate the influence of anemia on hs-cTnI and the diagnostic performance of the ESC 0/1 and 0/3 hour (h) algorithms. Methods Patients with suspected AMI were prospectively enrolled and stratified based on the hemoglobin (Hb) concentration at admission (females &lt;12 g/dl, males &lt;13g/dl). Hs-cTnI was measured at presentation, 1 and 3h later. Three independent cardiologists adjudicated the final diagnoses according to the 4th UDMI. Patients with ST-elevation AMI were excluded. Our primary endpoints were the safety to rule-out (negative predictive value [NPV]) and the efficacy to rule-in (positive predictive value [PPV]) AMI. Patients were followed for up to 4 years to assess all-cause mortality. Results We included 2,223 patients (64.1% males, age 65 [52; 75]) of whom 415 (18.7%) had anemia. The prevalence of AMI was numerically different for patients with and without anemia (16.4% and 12.9%, p=0.072). Hs-cTnI concentrations were significantly higher in patients with anemia and no AMI (p&lt;0.001 for baseline, 1h and 3h, respectively), but not in patients with AMI (Fig, 1A). Sex- and age-adjusted linear regression modelling in patients without AMI revealed a significant association of Hb with hs-cTnI (Beta −0.10 [95% CI: −0.14, −0.06]; p&lt;0.001; Fig. 1B). Safety and efficacy of both ESC algorithms were similar in patients with and without anemia; 0/1h (NPV 100.0% [95% CI: 94.7, 100.0]; PPV 52.7% [95% CI: 43.0, 62.3] vs. NPV 99.4% [95% CI: 98.5, 99.8]; PPV 55.7% [95% CI: 50.1, 61.1]); 0/3h (NPV 98.0% [95% CI: 95.3, 99.3]; PPV 48.4% [95% CI: 39.4, 57.5] vs. NPV 97.9 [95% CI: 97.0, 98.6], PPV 59.2 [95% CI: 53.7, 64.6]). During a median follow-up of 1.7 years and after stratification by either ESC algorithm, patients with compared to those without anemia experienced significantly worse outcome for all-cause death (p&lt;0.001; Fig. 1C). In sex-, age- and baseline hs-cTnI-adjusted Cox-regression analysis, anemia was an independent predictor for all-cause death (adjusted hazard ratio [adjHR] 3.6 [95% CI: 2.6, 5.0]), cardiovascular death (adjHR 3.0 [95% CI: 1.8, 5.2]) and rehospitalization (adjHR 1.2 [95% CI: 1.0, 1.5], but not for incidental AMI (adjHR 2.0 [95% CI: 0.8, 4.9]) or revascularization (adjHR 0.8 [95% CI: 0.5, 1.3]). Conclusion Despite the revealed association of Hb and hs-cTnI in the stable setting, the application of the ESC 0/1h and 0/3h algorithms in patients with suspected AMI and concomitant anemia is safe and provides similar efficacy. Patients with anemia experience considerable worse outcome and might therefore benefit from additional diagnostic measures and, potentially, treatment targeting anemia and its cause. Figure 1 Funding Acknowledgement Type of funding source: Other. Main funding source(s): German Center of Cardiovascular Research (DZHK) and an unrestricted grant by Abbott Diagnostics, Prevencio and Singulex.

scholarly journals Predicting efficacy of combined assessment with fragmented QRS and severely depressed heart rate variability on outcome of patients with acute myocardial infarction

2021 ◽  
Author(s):  
Yanling Xu ◽  
Yijun Yu ◽  
Li He ◽  
Yuting Wang ◽  
Ye Gu
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Cox Regression ◽  
Holter Monitoring ◽  
Major Adverse Cardiovascular Events ◽  
Cox Regression Analysis ◽  
Autonomic Nervous ◽  
Fragmented Qrs

AbstractThe association between fragmented QRS (fQRS) and autonomic nervous dysfunction, and major adverse cardiovascular events (MACE) is not fully clear in patients with acute myocardial infarction (AMI). This study aimed to observe whether combined assessment with fQRS and cardiac autonomic nervous function could enhance the predicting efficacy on outcome in AMI patients. A total of 153 consecutive hospitalized AMI patients were included in this retrospective study. Patients were divided into non-fQRS (nfQRS) group and fQRS group according to 12-lead electrocardiogram, into sHRV [severely depressed heart rate variability (HRV): standard deviation of NN intervals (SDNN) < 100 ms and very low frequency (VLF) < 26.7 ms] group and nsHRV (non-severely depressed HRV) group according to 24 h Holter monitoring, and into non-MACE (nMACE) group and MACE group according to 12 months’ follow-up results. The incidence of sHRV was significantly higher in the fQRS group than in the nfQRS group (71.9 vs. 39.3%, p < 0.05). The incidences of MACE were 7.4, 22.2, 25.7 and 56.5%, respectively, in nsHRV + nfQRS group, nsHRV + fQRS group, sHRV + nfQRS group and sHRV + fQRS group (p < 0.05). Multivariable Cox regression analysis showed that patients in the sHRV + fQRS group had a sixfold higher risk of MACE compared to patients in the nsHRV + nfQRS group (HR = 6.228, 95% CI 1.849–20.984, p = 0.003). The predicting sensitivity and specificity on MACE were 81.4 and 58.2% by sHRV, 69.8 and 69.1% by fQRS in these AMI patients. The specificity (81.8%) was the highest with the combination of sHRV and fQRS. Adding sHRV and fQRS to clinical data offered incremental prognostic value. Present results indicate that fQRS is closely related to sHRV, suggesting significant impairment of sympathetic nerve function in AMI patients with fQRS. Combined assessment with fQRS and sHRV enhances the predicting efficacy on outcome in AMI patients.

scholarly journals ONE-YEAR CARDIOVASCULAR OUTCOME IN PATIENTS ON CLOPIDOGREL ANTI-PLATELET THERAPY AFTER ACUTE MYOCARDIAL INFARCTION

2018 ◽  
pp. 55
Author(s):  
Dragana Stokanovic ◽  
Valentina N. Nikolic ◽  
Jelena Lilic ◽  
Svetlana R. Apostolovic ◽  
Milan Pavlovic ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Emergency Care ◽  
Cox Regression ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Cox Regression Analysis ◽  
Anti Platelet Therapy

The aim of this study was to determine the risk factors in patients on clopidogrel anti-platelet therapy after acute myocardial infarction, for cardiovascular mortality, re-hospitalization and admission to emergency care unit. We followed 175 patients on dual antiplatelet therapy, with clopidogrel and acetylsalicylic acid, for 1 year after acute myocardial infarction, both STEMI and NSTEMI. Beside demographic and clinical characteristics, genetic ABCB1, CYP2C19 and CYP2C9 profile was analyzed using Cox-regression analysis. End-points used were: mortality, re-hospitalization and emergency care visits, all related to cardiovascular system. During the accrual and follow-up period, 8 patients (4.6%) died, mostly as a direct consequence of an acute myocardial infarction. Re-hospitalization was needed in 27 patients (15.4%), in nine patients (33.3%) with the diagnosis of re-infarction. Thirty-two patients (18.3%) were admitted to emergency care unit due to cardiovascular causes, up to 15 times during the follow-up. NSTEMI was an independent predictor of all three events registered (mortality OR=7.4, p<0.05; re-hospitalization OR=2.8, p<0.05); emergency care visit OR=2.4, p<0.05). Other significant predictors were related to kidney function (urea and creatinine level, creatinine clearance), co-morbidities such as arterial hypertension and decreased left ventricular ejection fraction, as well as clopidogrel dosing regimen. As a conclusion, it may be suggested that one of the most significant predictors of cardiovascular events (mortality, re-hospitalization and emergency care visits) is NSTEMI. Besides, clopidogrel administration according to up-to-date guidelines, with high loading doses and initial doubled maintenance doses, improves 1-year prognosis in patients with AMI.

scholarly journals Prognostic Impact of the Symptom of New-Onset Atrial Fibrillation in Acute Myocardial Infarction: Insights From the NOAFCAMI-SH Registry

2021 ◽  
Vol 8 ◽  
Author(s):  
Jiachen Luo ◽  
Baoxin Liu ◽  
Hongqiang Li ◽  
Siling Xu ◽  
Mengmeng Gong ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Prognostic Impact ◽  
Term Survival ◽  
All Cause Mortality ◽  
Onset Atrial Fibrillation ◽  
New Onset

Background: New-onset atrial fibrillation (NOAF) is a common complication during acute myocardial infarction (AMI) and sometimes can be completely asymptomatic, but the clinical implications of these asymptomatic episodes require further characterization. The objective of this study was to investigate the short- and long-term prognostic impact of post-MI NOAF based on the presence of AF-related symptoms.Methods: The New-Onset Atrial Fibrillation Complicating Acute Myocardial Infarction in ShangHai (NOAFCAMI-SH) registry was a retrospective cohort including participants with AMI without a documented history of AF. Patients with NOAF were divided into two groups according to the AF-related symptoms. The primary endpoint was all-cause mortality.Results: Of 2,399 patients included, 278 (11.6%) developed NOAF of whom 145 (6.0%) with asymptomatic episodes and 133 (5.5%) with symptomatic ones. During hospitalization, 148 patients died [106, 10, and 32 in the sinus rhythm (SR), asymptomatic, and symptomatic NOAF groups, respectively]. After multivariable adjustment, only symptomatic NOAF was associated with in-hospital mortality [odds ratio (OR): 2.32, 95% confidence interval (CI): 1.36–3.94] compared with SR. Over a median follow-up of 2.7 years, all-cause mortality was 3.2, 12.4, and 11.8% per year in the SR, asymptomatic, and symptomatic NOAF groups, respectively. After adjustment for confounders, it was the asymptomatic NOAF [hazard ratio (HR): 1.61, 95% CI: 1.09–2.37) rather than the symptomatic one (HR: 1.37, 95% CI: 0.88–2.12) that was significantly related to mortality. Similar results were also observed for cardiovascular mortality [HRs and 95% CI were 1.71 (1.10–2.67) and 1.25 (0.74–2.11) for asymptomatic and symptomatic NOAF, respectively]. Both asymptomatic and symptomatic NOAF episodes were associated with heart failure, whereas only those with symptomatic NOAF were at heightened risk of ischemic stroke. Our exploratory analysis further identified patients with asymptomatic high-burden NOAF as the highest-risk population (mortality: 19.6% per year).Conclusion: Among patients with AMI, symptomatic NOAF is related to in-hospital mortality and asymptomatic NOAF is associated with poor long-term survival.Registration: URL: https://clinicaltrials.gov/; Unique identifier: NCT03533543.

scholarly journals The association between plasma furin and cardiovascular events after acute myocardial infarction

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zhi-Wei Liu ◽  
Qiang Ma ◽  
Jie Liu ◽  
Jing-Wei Li ◽  
Yun-Dai Chen
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Regression Analysis ◽  
Cox Regression ◽  
Critical Role ◽  
Cardiac Events ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
Atheromatous Plaques ◽  
Key Enzyme

Abstract Background Furin is the key enzyme involved in the cleavage of pro-BNP and plays a critical role in the cardiovascular system through its involvement in lipid metabolism, blood pressure regulation and the formation of atheromatous plaques. NT-proBNP and recently, corin, also a key enzyme in the cleavage of pro-BNP, have been accepted as predictors of prognosis after acute myocardial infarction (AMI). This cohort study was conducted to investigate the relationship between plasma furin and the prognostic outcomes of AMI patients. Methods In total, 1100 AMI patients were enrolled in the study and their plasma furin concentrations were measured. The primary endpoint was major adverse cardiac events (MACE), a composite of cardiovascular (CV) death, non-fatal myocardial infarction (MI) and non-fatal stroke. The associations between plasma furin concentration and AMI outcomes were explored using Kaplan–Meier curves and multivariate Cox regression analysis. Results The results showed a slight increase in mean cTNT in patients with higher furin concentrations (P = 0.016). Over a median follow-up of 31 months, multivariate Cox regression analysis indicated that plasma furin was not significantly associated with MACE (HR 1.01; 95% CI 0.93–1.06; P = 0.807) after adjustment for potential conventional risk factors. However, plasma furin was associated with non-fatal MI (HR 1.09; 95% CI 1.01–1.17; P = 0.022) in the fully adjusted model. Subgroup analyses indicated no relationship between plasma furin and MACE in different subgroups. Conclusions This study found no association between plasma furin and risk of MACE. Thus, plasma furin may not be a useful predictor of poor prognosis after AMI. However, higher levels of plasma furin may be associated with a higher risk of recurrent non-fatal MI.

Third-Generation P2Y12 Inhibitors in East Asian Acute Myocardial Infarction Patients: A Nationwide Prospective Multicentre Study

2018 ◽  
Vol 118 (03) ◽  
pp. 591-600 ◽  
Author(s):  
Jeehoon Kang ◽  
Jung-Kyu Han ◽  
Youngkeun Ahn ◽  
Shung Chull Chae ◽  
Young Jo Kim ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Regression Analysis ◽  
East Asian ◽  
Antiplatelet Agent ◽  
Third Generation ◽  
Bleeding Events ◽  
Cox Regression Analysis ◽  
P2y12 Inhibitors ◽  
All Cause Mortality

AbstractThird-generation P2Y12 inhibitors (prasugrel, ticagrelor) are recommended in acute myocardial infarction (AMI). We aimed to evaluate the efficacy and safety of third-generation P2Y12 inhibitors in East Asian AMI patients. From the Korean AMI Registry, 9,355 patients who received dual antiplatelet agent (aspirin with clopidogrel [AC], 6,444 [70.5%] patients; aspirin with prasugrel [AP], 1,100 [11.8%] patients; or aspirin with ticagrelor [AT], 1,811 [19.4%] patients) were analysed. In-hospital endpoints were all-cause mortality or bleeding events during admission and 1-year endpoints were major adverse cardiac and cerebrovascular events (MACCE) and major bleeding events. Regarding in-hospital events, AP and AT showed similar all-cause mortality rates but higher bleeding event rates compared with AC. This trend was extended to 1-year endpoints; Cox regression analysis showed that third-generation P2Y12 inhibitors had significantly higher bleeding risk (AP vs. AC: hazard ratio [HR], 2.14; 95% confidence interval [CI], 1.53–2.99; p < 0.001; AT vs. AC: HR, 2.26; 95% CI, 1.73–2.95; p < 0.001). A propensity score matched triplet of 572 patients showed similar 1-year MACCE and higher bleeding events with third-generation P2Y12 inhibitors (2.1 vs. 2.6 vs. 2.1%, p = 0.790 for MACCE and 3.1 vs. 8.0 vs. 8.0%, p < 0.001 for bleeding events, in AC, AP and AT groups, respectively). Inverse probability weighted regression analysis and pooled analysis after randomly imputing missing variables showed consistent results. Collectively, prasugrel and ticagrelor showed similar rates of 1-year MACCE, but a higher rate of bleeding events, compared with clopidogrel in Korean AMI patients. Further studies are warranted to adapt Western guidelines on third-generation P2Y12 inhibitors for East Asians.

Lipids, myocardial infarction and ischaemic stroke in patients with rheumatoid arthritis in the Apolipoprotein-related Mortality RISk (AMORIS) Study

2010 ◽  
Vol 69 (11) ◽  
pp. 1996-2001 ◽  
Author(s):  
A G Semb ◽  
T K Kvien ◽  
A H Aastveit ◽  
I Jungner ◽  
T R Pedersen ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Regression Analysis ◽  
Ischaemic Stroke ◽  
Mortality Risk ◽  
Predictive Value ◽  
Cox Regression ◽  
Cox Regression Analysis ◽  
Related Mortality

ObjectivesTo examine the rates of acute myocardial infarction (AMI) and ischaemic stroke (IS) and to examine the predictive value of total cholesterol (TC) and triglycerides (TG) for AMI and IS in patients with rheumatoid arthritis (RA) and people without RA.MethodsIn the Apolipoprotein MOrtality RISk (AMORIS) Study 480 406 people (including 1779 with RA, of whom 214 had an AMI and 165 an IS) were followed for 11.8 (range 7–17) years. Cox regression analysis was used to calculate HR per SD increase in TC or TG with 95% CI. All values were adjusted for age, diabetes and hypertension.ResultsThe levels of TC and TG were significantly lower in patients with RA than in people without RA. Despite this, the rate of AMI and IS per 1000 years was at least 1.6 times higher in RA than non-RA. TC was nearly significantly predictive for AMI (HR/SD 1.13 (95% CI 0.99 to 1.29), p=0.07) and significantly predictive for future IS in RA (HR/SD 1.20 (95% CI 1.03 to 1.40), p=0.02). TG had no relationship to development of AMI (1.07, 0.94 to 1.21, p=0.29), but was weakly related to IS (1.13, 0.99 to 1.27, p=0.06). In contrast, both TC and TG were significant predictors of AMI and IS in people without RA.ConclusionsPatients with RA had 1.6 times higher rate of AMI and IS than people without RA. TC and TG were significant predictors of AMI and IS in people without RA, whereas the predictive value in RA was not consistent.

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