No superiority of ticagrelor over prasugrel in remote myocardial inflammation in patients with acute myocardial infarction with ST elevation: a CMR T1 and T2 mapping study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D Zugwitz ◽  
H Everaars ◽  
N.W Van Der Hoeven ◽  
G.N Janssens ◽  
P Vart ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Statistical Difference ◽  
T2 Mapping ◽  
Remote Myocardium ◽  
Myocardial Inflammation ◽  
Funding Source ◽  
Myocardial Oedema ◽  
St Elevation ◽  
The Mean ◽  
T1 And T2

Abstract Background A number of studies suggest that acute myocardial ischaemia triggers a non-specific systemic inflammatory response of remote myocardium through the increase of plasma concentrations of acute-phase proteins, which causes myocardial oedema. As ticagrelor has been shown to significantly decrease the circulating levels of several pro-inflammatory cytokines in patients after acute myocardial infarction with ST elevation (STEMI), we sought to investigate a potential suppressive effect of ticagrelor over prasugrel on cardiac magnetic resonance (CMR) T1 and T2 values in remote myocardium. Methods Ninety patients presenting with acute STEMI were prospectively included and randomised to receive either ticagrelor or prasugrel maintenance treatment after successful primary percutaneous coronary intervention (PPCI). The patients underwent CMR 2–7 days after the PPCI. Studies were done on a 1.5 T clinical scanner, the protocol included long and short axis cine imaging, T1 mapping through the infarct core using a single breath-hold Shortened Modified Look-Locker Inversion Recovery (ShMOLLI), T2 mapping and late gadolinium enhancement imaging. Results After excluding 30 patients due to either missing images or insufficient quality of T1 or T2 maps, 60 patients were included in our analysis. Of those, 29 patients have been randomised to the ticagrelor arm and 31 patients to the prasugrel arm of the study. The mean age at inclusion was 61±10 years, 81.7% of included patients were men, the distribution was even between the two groups. There were no statistically significant differences between groups regarding past medical history and medication prior to the inclusion in the study. CMR scans were performed 5.03±1.96 days after successful PPCI in the ticagrelor group, and 5.10±0.87 days in the prasugrel group. Remote myocardium T1: The mean T1 value of the remote myocardium was 937±27 ms in the ticagrelor group and 936±23 ms in the prasugrel group, showing no statistical difference (p=0.85) between the groups receiving different P2Y12 inhibitor after PPCI. Remote myocardium T2: The mean T2 value of the remote myocardium was 53.8±4.6 ms in the ticagrelor group and 53.6±4.7 ms in the prasugrel group, showing no statistical difference (p=0.86) between compared groups. Both T1 and T2 values of the remote myocardium were above normal values published in literature. Conclusion In patients with STEMI after PPCI, ticagrelor maintenance therapy did not show superiority to prasugrel in preventing early remote myocardial inflammation as assessed by T1 and T2 mapping. Additionally, findings support the premise of remote myocardial oedema following STEMI. Funding Acknowledgement Type of funding source: Other. Main funding source(s): Presented abstract is from a sub-study of the REDUCE-MVI study, which was conducted with financial support from Astra Zeneca through an unrestricted research grant. In addition, the study was financed by the Ministry of Economic Affairs of the Netherlands by means of a PPP Allowance made available by the Top Sector Life Sciences & Health to stimulate public-private partnerships. The first author was awarded the ESC training grant in 2019; this research was conducted during the training for which the grant was awarded.

scholarly journals Remote Myocardium Characterisation by Pre-contrast T1 and T2* Mapping Post Myocardial Infarction

2013 ◽  
Vol 22 ◽  
pp. S195
Author(s):  
S. Azarisman ◽  
A. Li ◽  
D. Wong ◽  
J. Richardson ◽  
L. Samaraie ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
T2 Mapping ◽  
Remote Myocardium ◽  
Post Myocardial Infarction ◽  
T1 And T2

The effect of preloading statins prior to primary reperfusion on in-hospital mortality risk in a contemporary large-scale cohort of patients with ST-elevation myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Fu ◽  
C.X Song ◽  
X.D Li ◽  
Y.J Yang
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Mortality Risk ◽  
Large Scale ◽  
Reperfusion Therapy ◽  
St Elevation Myocardial Infarction ◽  
Control Group ◽  
Funding Source ◽  
St Elevation

Abstract Background The benefit of statins in secondary prevention of patients stabilized after acute coronary syndrome (ACS) has been well established. However, the benefit of preloading statins, i.e. high-intensity statins prior to reperfusion therapy remains unclear. Most previous studies included all types of ACS patients, and subgroup analysis indicated the benefit of preloading statins was only seen in ST-elevation myocardial infarction (STEMI) patients who underwent percutaneous coronary intervention (PCI). However, the sample size of subgroup population was relatively small and such benefit requires further validation. Objective To investigate the effect of loading dose of statins before primary reperfusion on 30-mortality in patients with STEMI. Methods We enrolled patients in China Acute Myocardial Infarction (CAMI) registry from January 2013 to September 2014. CAMI registry was a prospective multicenter registry of patients with acute acute myocardial infarction in China. Patients were divided into two groups according to statins usage: preloading group and control group. Patients in preloading group received loading does of statins before primary reperfusion and during hospitalization. Patients in control group did not receive statins during hospitalization or at discharge. Primary outcome was in-hospital mortality. Baseline characteristics, angiographic characteristics and outcome were compared between groups. Propensity score (PS) matching was used to mitigate baseline differences between groups and examine the association between preloading statins on in-hospital mortality risk. The following variables were used to establish PS matching score: age, sex, classification of hospitals, clinical presentation (heart failure at presentation, cardiac shock, cardiac arrest, Killip classification), hypertension, diabetes, prior angina, prior myocardial infarction history, prior stroke, initial treatment. Results A total of 1169 patients were enrolled in control group and 6795 in preloading group. A total of 833 patients (334 in control group and 499 in preloading group) died during hospitalization. Compared with control group, preloading group were younger, more likely to be male and present with Killip I classification. The proportion of hypertension and diabetes were higher in preloading group. After PS matching, all the variables used to generate PS score were well balanced. In the PS-matched cohort, 30-day mortality risk was 26.3% (292/1112) in the control group and 11.9% (132/1112) in the preloading group (p<0.0001). Conclusions The current study found preloading statins treatment prior to reperfusion therapy reduced in-hospital mortality risk in a large-scale contemporary cohort of patients with STEMI. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Chinese Academy of Medical Sciences

Socioeconomic status influences delays in the management of acute ST-elevation myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Cetran ◽  
E Lesaine ◽  
S Miganeh-Hadi ◽  
F Sevin ◽  
F Saillour-Glenisson ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Angiography ◽  
Symptom Onset ◽  
Public Institution ◽  
St Elevation Myocardial Infarction ◽  
Ecological Indicator ◽  
Low Ses ◽  
Funding Source ◽  
Acute Stemi ◽  
St Elevation

Abstract Background A prompt diagnosis to initiate the appropriate reperfusion therapy is crucial to improve clinical outcomes in acute ST-elevation myocardial infarction (STEMI) patients. Socio-economic status (SES) refers to parameters like income, educational status and occupation. A low SES negatively interferes with the prognosis of STEMI patients. However, the impact of SES on delay time in acute STEMI remains matter of debate. Methods We used databases from two French multicentric and prospective registries: ACIRA (patients undergoing coronary angiography in any catheterization laboratories of Aquitaine) and REANIM (acute STEMI patients supported by emergency medical system (EMS) in Aquitaine). An ecological indicator of social deprivation Fdep09 was calculated to describe geographical inequalities in health based on municipality of residence. The higher the value, the more disadvantaged the population. Low SES was defined as Fdep09 > median value. Results Two-thousand-eight-hundred-and-forty consecutive patients with acute STEMI undergoing coronary angiography from January 2017 to December 2018 in Aquitaine were included. Patients with lower SES were more often initially referred to emergency departments of non-percutaneous coronary intervention capable centers whereas patients with higher SES were more often directly transferred to PCI centers by the mobile emergency care units as recommended by the most recent European guidelines (p<10–4). Patients with low SES had longer delays from symptom onset to first medical contact (FMC) (116 [60–119] vs 98 [55–233] min, p=0.0078) and were more likely to receive fibrinolysis (9.9 vs 5.2%, p<10–4). Linear regression modeling showed that each point of the Fdep09 index was associated with increase in the delay from symptom onset to FMC by a factor 1.1 (95% CI: 1.04–1.17, p<10–3) after adjusting for potential confounders. Conclusion SES inequality has negative influence on the delays in the management of acute STEMI patients. Efforts to raise awareness of suspicious signs of acute MI among individuals in lower SES could be valuable. FDep09 distribution Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): ARS Nouvelle-Aquitaine

Cardiac tissue characterization with t1 and t2 mapping in anderson fabry patients: new pathophysiological concepts and early cardiac involvement

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Zanoni ◽  
V Ferrara ◽  
G Lanati ◽  
G Vitale ◽  
F Di Nicola ◽  
...  
Keyword(s):  
Cardiac Disease ◽  
Tissue Characterization ◽  
Cardiac Involvement ◽  
Late Onset ◽  
T2 Mapping ◽  
Serum Levels ◽  
Left Ventricular ◽  
Control Group ◽  
Funding Source ◽  
T1 And T2

Abstract Background Anderson Fabry (AF) disease is a X-linked lysosomal storage disorder with multiorgan involvement. Cardiac disease, mainly represented by left ventricular hypertrophy (LVH) and arrhythmias, is the most frequent cause of premature death. It is well know that specific therapy is less effective after the development of LVH and myocardial fibrosis, therefore early cardiac detection (before LVH) is important. New cardiac magnetic resonance (CMR) parametric imaging techniques (T1 and T2 maps) enable myocardial tissue changes associated with AF disease. Purpose To evaluate the relationship between CMR tissue characterization and clinical and instrumental manifestations of AF disease to find early markers of cardiac involvement. Methods 31 AF patients (9 males, mean age 49±16 years) underwent ECG, echocardiogram and contrast CMR. TnI, BNP, pro-BNP and serum lyso-Gb3 were dosed. T1 mapping was performed in a pre-contrast acquisition with the modified Look-Locker inversion recovery (MOLLI) sequences. CMR results were compared with those of 43 healthy age and gender-matched controls. Results In AF patients native septal T1 values were significantly lower compared to healthy controls (median 949 vs 991 msec, p=0.0137) and were inversely related to Lyso-Gb3 serum levels (p=0.003). Patients with LVH had lower T1 septal values in comparison with patients without LVH (892 vs 981 msec; p=0.0012). Patients with classic form had abnormal low T1 values more frequently than pts with late onset variant (78 vs 23%; p=0.038). In AF patients native septal T2 values were significantly higher compared to the control group (53 vs 49 msec; p=0.0004) and correlated with troponin I (p=0.008) and NT-pro BNP (p=0.006) serum levels. No difference was found between pts with and without LVH (53.5 vs 52.5 ms; p=0.797) and the prevalence of abnormal high T2 values was similar between patients with late onset AF and pts with classical form (53% vs 50%; p=1.000). All patients with late onset AF and high T2 values were females. Conclusions CMR T1 (low values) and T2 (high values) mapping are useful tools to detect early cardiac involvement before LVH and to better understand the pathophysiology of cardiac disease in AF patients. Subclinical tissue inflammation, detectable through T2 maps, seems to be an additional pathogenetic mechanism related to the Gb3 storage that contributes to organ damage and precedes LVH, particularly in females patients with late onset phenotype. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Sant'Orsola-Malpighi Hospital

Abstract P254: Dementia and Use of Cardiac Catheterization and Angioplasty in Elderly ST-Elevation Myocardial Infarction Patients

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Marianne Ketterl ◽  
James A Mortimer ◽  
Elizabeth B Pathak
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Catheterization ◽  
Coronary Intervention ◽  
Admission Diagnosis ◽  
Percutaneous Coronary ◽  
Treatment Disparities ◽  
St Elevation ◽  
The Mean ◽  
Definition Of ◽  
To Receive

Introduction_ Percutaneous coronary intervention (PCI) is the first line of treatment for ST-elevated myocardial infarction (STEMI). Few studies addressed dementia as a barrier to receiving PCI. We evaluated disparities in the use of cardiac catheterization and PCI in STEMI patients with dementia. Methods_ A retrospective analysis was performed of Florida's comprehensive inpatient surveillance system for the years 2006-2007 with admission diagnosis of STEMI (ICD-9-CM codes 410.0 - 410.6, 410.8). Data were limited to patients ≥65 years admitted to hospitals with a high annual volume of PCIs (≥400), and transfer patients were excluded. We used a broad definition of dementia (ICD-9-CM codes 294.0, 294.1, 294.8, 294.9, 331.0-331.2, 331.7, 331.81, 331.82, 331.89, 331.9, 780.93, 780.97, 797). Logistic regression analysis was used to identify disparities in the use of cardiac catheterization and PCI among all STEMI patients, and in the use of PCI only among STEMI patients who received cardiac catheterization. Results_ A total of 8,310 STEMI patients who met our inclusion criteria were identified. Of these, 77.2% were catheterized and 67.1% received PCI. The mean age of the cohort was 76.3 years (SD 7.8 yrs); with 43.3% female; 83.4% white, 4.6% black, and 12% Hispanic/other. A total of 605 (7.3%) were demented. After adjustment for age, gender, and race/ethnicity, patients with dementia were less likely to be catheterized (RR 0.4, 95% CI 0.3-0.5), and less likely to receive PCI (RR 0.4, 95% CI 0.4-0.5) than non-demented patients. However, among patients who were catheterized, there was no difference in the use of PCI for demented vs. non-demented patients (p=0.32).Women were less likely to be catheterized than males (RR 0.7, 95% CI 0.7-0.8), but if catheterized, were more likely to receive PCI then men (RR 1.3, 95% CI 1.1-1.6). After adjustment for age, gender, and dementia, blacks were less likely to be catheterized (RR 0.5, 95% CI 0.4-0.6) and less likely to receive PCI (RR 0.6, 95% CI 0.5-0.7) than whites. Conclusions_ STEMI patients with dementia were much less likely to receive cardiac catheterization and consequently PCI. Our study confirms that treatment disparities exist for elderly demented patients after controlling for age, gender and ethnicity.

European differences in characteristics, treatments and outcomes in patients with non-ST-elevation myocardial infarction – novel insights from four national real-world registries

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Edfors ◽  
T Jernberg ◽  
C Lewinter ◽  
J Eha ◽  
P Asser ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Real World ◽  
European Countries ◽  
High Rate ◽  
Lipid Lowering ◽  
Hospital Treatment ◽  
Funding Source ◽  
Term Survival ◽  
St Elevation

Abstract Background Large-scale collection of standardized variables in patients with myocardial infarction (MI) in national real-world registries are only available in a few European countries and there is lack of cross-country comparisons. Purpose To compare demography, risk factors, hospital treatment and short- and long-term survival in patients hospitalized for non-ST elevation MI (NSTEMI) in four different European countries. Methods NSTEMI patients hospitalized and enrolled in national MI registries; EMIR (Estonia), HUMIR (Hungary), NORMI (Norway (2013–2016)) and SWEDEHEART (Sweden) from 2014 to 2017 were included. Results In total 119,191 patients with NSTEMI were included. The mean age at admission ranged from 70 years (Hungary) to 75 years (Estonia). The proportion of women was 36% in Sweden and 44% in Estonia. In Norway 24% were smokers, as compared to 17% in Sweden. Patients in Hungary had a high rate of diabetes mellitus (37%) and antihypertensive treatment (84%) but a low rate of lipid lowering treatment (32%). The proportion of patients with prior MI ranged from 28% (Norway) to 37% (Sweden). The presence of previous peripheral artery disease ranged from 7% (Sweden) to 17% (Hungary). The absolute proportion of performed coronary angiographies (58% versus 75%) and percutaneous coronary interventions (38% versus 56%), differed most between Norway and Hungary. Dual antiplatelet therapy ranged from 60% (Estonia) to 81% (Hungary) and statins from 78% (Norway) to 89% (Hungary), at discharge. The crude mortality rates at 1 month and 1 year are listed in table 1. Conclusion Cross-comparison of four national European MI registries provide new insights in differences in risk factors, treatment and outcomes. Possible reasons for the observed differences, include differences in the underlying expected mortality in the populations, inclusion-criteria and coverage of the registries and variable definitions, that need to be further explored. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Estonian Research Council

Risk stratification of Asian patients after ST-elevation myocardial infarction using machine learning methods

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S.S Kasim ◽  
S Malek ◽  
K.K.S Ibrahim ◽  
M.F Aziz
Keyword(s):  
Machine Learning ◽  
Myocardial Infarction ◽  
Risk Stratification ◽  
Mortality Prediction ◽  
Public Institution ◽  
St Elevation Myocardial Infarction ◽  
Funding Source ◽  
Timi Score ◽  
Testing Data ◽  
St Elevation

Abstract Background Risk stratification in ST-elevation myocardial infarction (STEMI) that is population-specific is essential. Conventional risk stratification methods such Thrombolysis in Myocardial Infarction (TIMI) score is used to evaluate the risk associated with the acute coronary syndrome (ACS) which are derived from Western Caucasian cohort with a limited participant from the Asian region. In Malaysia, multi-ethnic developing country, patients presenting with STEMI are younger, have a much higher prevalence of diabetes, hypertension and renal failure, and present later to medical care than their western counterparts. Purpose We aim to investigate the predictors, predict mortality and develop a risk stratification tool for short and long term mortality in multi-ethnic STEMI patients using machine learning (ML) method. Methods We created three separate mortality prediction models using support vector machine (SVM) to identify predictors and predict mortality for in-hospital, 30-days and 1-year for STEMI patients. We used registry data from the National Cardiovascular Disease Database of 6299 patient's data for in-hospital, 3130 for 30-days and 2939 for 1-year for ML model development. Fifty parameters including demographics, cardiovascular risk, medications and clinical variables were utilised for training the models. The Area under the curve (AUC) was used as the primary performance evaluation metric. All models were validated against conventional method TIMI and tested using testing data. SVM variable importance method were used to select and rank important variables. We converted the final algorithm into an online tool with a database for continuous algorithm validation. We implemented the online calculator in selected hospitals for further testing using prospective patients data. Results The calculator is available at http://myheartstemi.uitm.edu.my. The calculator outperforms TIMI on testing data for in-hospital (15 predictors) (AUC=0.88 vs 0.81), 30 days (12 predictors) (AUC=0.90 vs 0.80) and 1-year (13 predictors) (AUC=0.84 vs 0.76). Common predictors for in-hospital, 30 days and 1-year mortality model identified in this study are; age, heart rate, Killip class, fasting blood glucose and diuretics. Invasive and less invasive treatments such as PCI pharmacotherapy drugs are also selected as important variables that improve mortality prediction. Our results also suggest that TIMI score underestimates patients risk of mortality. 90% of non-survival patients are classified as high risk (>30%) by the calculator compared 10–30% non-survival patients by TIMI. Conclusions In the multi-ethnicity population, patients with STEMI are better classified using ML method compared to the TIMI score. ML allows identification of distinct factors in unique ASIAN population for better mortality prediction. Availability of population-specific calculator and continuous testing and validation allows better risk stratification. Machine learning and TIMI performance Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): University of Malaya Grant

scholarly journals Serial native T1- and T2-mapping to quantitatively monitor resorption of myocardial edema following acute myocardial infarction

2015 ◽  
Vol 17 (S1) ◽  
Author(s):  
Enver Tahir ◽  
Martin R Sinn ◽  
Ulf K Radunski ◽  
Dennis Säring ◽  
Christian Stehning ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
T2 Mapping ◽  
Myocardial Edema ◽  
Native T1 ◽  
T1 And T2

scholarly journals The Relationship Between Family Support and the Quality of Post Primary PCI Patients’ Life

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Lailiyatul Munawaroh ◽  
Tuti Herawati
Keyword(s):  
Quality Of Life ◽  
Myocardial Infarction ◽  
Family Support ◽  
Coronary Intervention ◽  
Primary Pci ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
The Mean ◽  
The Relationship

<div><p class="Keywords"><strong>Objective: </strong>ST elevation myocardial infarction is the most common myocardial infarction cases. The main intervention of this case is primary percutaneous coronary intervention (PPCI). After PPCI, quality of life in STEMI patients depend on their ability to control the risk factors of reinfarction. In this condition, patients need family support. Therefore, this study aimed to identify the relationship between family support and quality of patients’ life after PPCI.<strong></strong></p><p class="Keywords"><strong>Methods: </strong>This was a descriptive study with cross sectional design. We recruited a purposive sample of 34 STEMI post- Primary PCI patients. We employed the modified family support questionnaire (Hensarling Diabetes Family Support Scale) and the quality of life questionnaire to collect data. Data, then, were analyzed using univariate and bivariate analyses.<strong></strong></p><p class="Keywords"><strong>Results: </strong>The mean score of the family support was 64.44, with the minimum score of 21 and maximum score of 75.  More patients received good family support than those who received poor family support. On the other hand, the mean score of patients’ life quality was 68.36, ranging from 25.1-98.43. There was a weak and positive correlation between family support and quality of patients’ life. However, the relationship was insignificant.<strong> </strong></p><p class="Keywords"><strong>Conclusion: </strong>Family support was not significantly related to quality of STEMI patients’ life. Further studies to identify factors contributing to the quality of STEI patients’ life are needed. </p><p class="Keywords"><strong>Key words: </strong>family support, percutaneous coronary intervention, quality of life, ST elevation myocardial infarction  <strong></strong></p></div>

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