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

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 <12 g/dl, males <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<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<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<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.

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

Annals of the Rheumatic Diseases ◽

10.1136/ard.2009.126128 ◽

2010 ◽

Vol 69 (11) ◽

pp. 1996-2001 ◽

Cited By ~ 81

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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Validation of a machine learned model to predict the diagnosis of myocardial infarction

European Heart Journal ◽

10.1093/ehjci/ehaa946.1669 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

D Doudesis ◽

J Yang ◽

A Tsanas ◽

C Stables ◽

A Shah ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Coronary Syndrome ◽

Predictive Value ◽

High Probability ◽

Cardiovascular Death ◽

Gradient Boosting ◽

Funding Source ◽

Coronary Syndrome ◽

Low Probability ◽

One Year

Abstract Introduction The myocardial-ischemic-injury-index (MI3) is a promising machine learned algorithm that predicts the likelihood of myocardial infarction in patients with suspected acute coronary syndrome. Whether this algorithm performs well in unselected patients or predicts recurrent events is unknown. Methods In an observational analysis from a multi-centre randomised trial, we included all patients with suspected acute coronary syndrome and serial high-sensitivity cardiac troponin I measurements without ST-segment elevation myocardial infarction. Using gradient boosting, MI3 incorporates age, sex, and two troponin measurements to compute a value (0–100) reflecting an individual's likelihood of myocardial infarction, and estimates the negative predictive value (NPV) and positive predictive value (PPV). Model performance for an index diagnosis of myocardial infarction, and for subsequent myocardial infarction or cardiovascular death at one year was determined using previously defined low- and high-probability thresholds (1.6 and 49.7, respectively). Results In total 20,761 of 48,282 (43%) patients (64±16 years, 46% women) were eligible of whom 3,278 (15.8%) had myocardial infarction. MI3 was well discriminated with an area under the receiver-operating-characteristic curve of 0.949 (95% confidence interval 0.946–0.952) identifying 12,983 (62.5%) patients as low-probability (sensitivity 99.3% [99.0–99.6%], NPV 99.8% [99.8–99.9%]), and 2,961 (14.3%) as high-probability (specificity 95.0% [94.7–95.3%], PPV 70.4% [69–71.9%]). At one year, subsequent myocardial infarction or cardiovascular death occurred more often in high-probability compared to low-probability patients (17.6% [520/2,961] versus 1.5% [197/12,983], P<0.001). Conclusions In unselected consecutive patients with suspected acute coronary syndrome, the MI3 algorithm accurately estimates the likelihood of myocardial infarction and predicts probability of subsequent adverse cardiovascular events. Performance of MI3 at example thresholds Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Medical Research Council

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Individuals with familial hypercholesterolemia have increased risk of re-hospitalization after acute myocardial infarction compared with controls

European Heart Journal ◽

10.1093/ehjci/ehaa946.2962 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

K Svendsen ◽

H.W Krogh ◽

J Igland ◽

G.S Tell ◽

L.J Mundal ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Familial Hypercholesterolemia ◽

Cox Regression ◽

Public Institution ◽

University Hospital ◽

Funding Source ◽

Hazard Ratios ◽

Increased Risk ◽

University Of Oslo

Abstract Background and aim We have previously reported that individuals with familial hypercholesterolemia (FH) have a two-fold increased risk of acute myocardial infarction (AMI) compared with the general population. The consequences of having an AMI on re-hospitalization and mortality are however less known. The aim of the present study was to compare the risk of re-hospitalization with AMI and CHD and risk of mortality after incident (first) AMI-hospitalization between persons with and without FH (controls). Methods The original study population comprised 5691 persons diagnosed with FH during 1992–2014 and 119511 age and sex matched controls randomly selected from the general Norwegian population. We identified 221 individuals with FH and 1947 controls with an incident AMI registered in the Norwegian Patient Registry (NPR) or the Cardiovascular Disease in Norway Project during 2001–2017. Persons with incident AMI were followed until December 31st 2017 for re-hospitalization with AMI or coronary heart disease (CHD) registered in the NPR, and for mortality through linkage to the Norwegian Cause of Death Registry. Risk of re-hospitalization was compared with sub-hazard ratios (SHR) from competing risk regression with death as competing event, and mortality was compared using hazard ratios (HR) from Cox regression. All models were adjusted for age. Results Risk of re-hospitalization was 2-fold increased both for AMI [SHR=2.53 (95% CI: 1.88–3.41)] and CHD [SHR=1.82 (95% CI: 1.44–2.28)]. However, persons with FH did not have increased 28-day mortality following an incident AMI (HR=1.05 (95% CI: 0.62–1.78), but the longer-term (>28 days) mortality after first AMI was increased in FH [HR=1.45 (95% CI: 1.07–1.95]. Conclusion This study yields the important finding that persons with FH have increased risk of re-hospitalization of both AMI and CHD after incident AMI. These findings call for more intensive follow-up of individuals with FH after an AMI. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): University of Oslo and Oslo University Hospital

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

Wiadomości Lekarskie ◽

10.36740/wlek202006132 ◽

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.

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Effect of beta blocker therapy following myocardial infarction in optimally treated patients in the reperfusion era – a Danish, nationwide, and registry-based cohort study

European Heart Journal ◽

10.1093/ehjci/ehaa946.3390 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

A Holt ◽

B Zareini ◽

D Rajan ◽

M Schou ◽

G.H Gislason ◽

...

Keyword(s):

Myocardial Infarction ◽

Cohort Study ◽

Beta Blocker ◽

Cox Regression ◽

Treatment Guidelines ◽

Cardiovascular Death ◽

Guideline Recommendation ◽

Prior History ◽

Chronic Obstructive ◽

Funding Source

Abstract Background and purpose European and American cardiovascular treatment guidelines advocate for two and three years of beta-blocker (BB) treatment, respectively, following myocardial infarction (MI). Contemporary continued efficacy of longer-term use of BB in stable coronary artery disease has been debated in the era of reperfusion. We aim to investigate the cardio-protective effect associated with BB treatment in patients following MI. Methods Using nationwide databases, we included optimally treated patients with first-time MI undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI) during admission and treated with both acetyl-salicylic acid and statins post-discharge between 2003 and 2017. Patients with prior history of MI, BB use or any other possible indication or contraindication for BB treatment (heart failure, cardiac arrhythmias or procedures, asthma, chronic obstructive pulmonary disease) were excluded. Continued BB exposure was defined as two redeemed prescriptions within the first 180 days following discharge, one of them within 90 days. Follow-up began 180 days following discharge in patients alive and with no further cardiovascular events or procedures prior. Patients were followed for a maximum of three years. Primary outcomes were cardiovascular death and recurrent MI in patients stratified by BB treatment using adjusted Cox regression models. Results A total of 27,068 patients optimally treated for MI were included (57% acute PCI, 26% sub-acute PCI, 17% CAG without intervention). At study start 180 days following MI, 79% of the patients were on BB treatment (median age 61 years, 75% male) and 21% were not (median age 62 years, 69% male). Cumulative incidence of cardiovascular death and recurrent MI did not differ significantly comparing patients on BB treatment with patients not on BB treatment (Figure). In multivariable analyses, BB treatment was associated with a similar risk of cardiovascular death and recurrent MI compared to the patients not receiving BB treatment (hazard ratios with [95% confidence intervals] correspondingly; 0.89 [0.68–1.17] and 1.02 [0.89–1.18]) (Figure 1). When stratifying the cohort according to calendar year and type of procedure during admission, we found similar results as the main analysis. No interaction for sex was found. Conclusions In this nationwide cohort study of optimally treated patients following MI at 180 days in the reperfusion era, we found a very good prognosis with only 1.2% suffering cardiovascular death and 4.7% suffering a recurrent MI within three years. In total 79% of patients were receiving BB treatment, but we found no difference suggesting BB to be associated with an improved cardiovascular prognosis. These findings challenge current clinical practice and guideline recommendation, suggesting that the role of long-term BB use may be obsolete among optimally treated MI patients. Further investigations, preferably a randomized trial, are warranted. Figure 1 Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Ib Mogens Kristiansens Almene Fond, Snedkermester Sophus Jacobsen og Hustru Astrid Jacobsens Fond

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

10.21203/rs.3.rs-41696/v2 ◽

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.

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Thrombolytics

AACN Advanced Critical Care ◽

10.4037/15597768-1992-2014 ◽

1992 ◽

Vol 3 (2) ◽

pp. 423-434

Author(s):

C. Lynne Ostrow

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Thrombolytic Therapy ◽

The United States ◽

Similar Efficacy ◽

Left Ventricular ◽

Bleeding Complications ◽

Thrombolytic Agents ◽

Suspected Acute Myocardial Infarction ◽

Careful Assessment

Thrombolytic therapy is the most recent advance in the treatment of acute myocardial infarction. Several research trials have been conducted worldwide in the last decade that have established that thrombolytic therapy has reduced mortality 50%, reduces the size of the infarction, improves left ventricular function, and reduces the incidence and severity of congestive heart failure. The three most commonly used thrombolytic agents at this time arc streptokinase, tissue plasminogen activator, and anisoylated plasminogen-streptokinase activator complex. All three agents can be administered through a peripheral intravenous. Recent research results have reported similar efficacy on 5-week mortality of all three agents. Careful assessment of prospective patients is essential since bleeding complications arc the most serious side effect of this therapy. Nursing care of a patient undergoing thrombolytic therapy includes careful assessment of the patient for contraindications in the patient’s medical history, assessment of potential allergic and bleeding complications, and evaluation of the reperfusion markers. Patients are subsequently treated with anticoagulants, aspirin, or dipyridamole. It appears that thrombolytic therapy will become increasingly available to all patients with a diagnosis of suspected acute myocardial infarction. At present, treatment with thrombolytic agents is less available in the United States compared to Europe

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Predictive value of routine point-of-care cardiac troponin T measurement for prehospital diagnosis and risk-stratification in patients with suspected acute myocardial infarction

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872617745893 ◽

2017 ◽

Vol 8 (4) ◽

pp. 299-308 ◽

Cited By ~ 13

Author(s):

Martin B Rasmussen ◽

Carsten Stengaard ◽

Jacob T Sørensen ◽

Ingunn S Riddervold ◽

Troels M Hansen ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Confidence Interval ◽

Predictive Value ◽

Cardiac Troponin ◽

Troponin T ◽

Point Of Care ◽

Hazard Ratio ◽

Cardiac Troponin T ◽

Suspected Acute Myocardial Infarction

Objective: The purpose of this study was to determine the predictive value of routine prehospital point-of-care cardiac troponin T measurement for diagnosis and risk stratification of patients with suspected acute myocardial infarction. Methods and results: All prehospital emergency medical service vehicles in the Central Denmark Region were equipped with a point-of-care cardiac troponin T device (Roche Cobas h232) for routine use in all patients with a suspected acute myocardial infarction. During the study period, 1 June 2012–30 November 2015, prehospital point-of-care cardiac troponin T measurements were performed in a total of 19,615 cases seen by the emergency medical service and 18,712 point-of-care cardiac troponin T measurements in 15,781 individuals were matched with an admission. A final diagnosis of acute myocardial infarction was confirmed in 2187 cases and a total of 2150 point-of-care cardiac troponin T measurements (11.0%) had a value ≥50 ng/l, including 966 with acute myocardial infarction (sensitivity: 44.2%, specificity: 92.8%). Patients presenting with a prehospital point-of-care cardiac troponin T value ≥50 ng/l had a one-year mortality of 24% compared with 4.8% in those with values <50 ng/l, log-rank: p<0.001. The following variables showed the strongest association with mortality in multivariable analysis: point-of-care cardiac troponin T≥50 ng/l (hazard ratio 2.10, 95% confidence interval: 1.90–2.33), congestive heart failure (hazard ratio 1.93, 95% confidence interval: 1.74–2.14), diabetes mellitus (hazard ratio 1.42, 95% confidence interval: 1.27–1.59) and age, one-year increase (hazard ratio 1.08, 95% confidence interval: 1.08–1.09). Conclusions: Patients with suspected acute myocardial infarction and a prehospital point-of-care cardiac troponin T ≥50 ng/l have a poor prognosis irrespective of the final diagnosis. Routine troponin measurement in the prehospital setting has a high predictive value and can be used to identify high-risk patients even before hospital arrival so that they may be re-routed directly for advanced care at an invasive centre.

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

Heart and Vessels ◽

10.1007/s00380-021-01930-y ◽

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.

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The plasma levels of free melatonin is not associated with cardiovascular events after acute myocardial infarction

10.21203/rs.2.11488/v1 ◽

2019 ◽

Author(s):

Jingwei Li ◽

Qiang Ma ◽

Zhi-Wei Liu ◽

Jie Liu ◽

Shun-Ying Hu ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Plasma Levels ◽

Cox Regression ◽

Blood Lipid ◽

Coronary Intervention ◽

Cardiovascular Death ◽

Unit Increase ◽

Lipid Control

Abstract Background Lower circulating levels of total melatonin is associated with adverse cardiovascular (CV) events in acute myocardial infarction (AMI) patients. Free melatonin is easier to measure in clinical practice compared with total melatonin. Whether free melatonin is associated with follow-up CV events in AMI patients has not been determined yet. Methods A total of 732 consecutive AMI patients treated with percutaneous coronary intervention between January 2013 and January 2015 participated in the study. Blood samples were collected as fast samples on the first morning after admission. The plasma levels of free melatonin were determined using non-extraction radioimmunoassays. The cox regression was used to explore the association between circulating melatonin and endpoints. The median follow-up was 31.6 months. Results Patients with high melatonin levels were more likely to be younger and to have poorer blood lipid control. Multivariate cox-regression analyses (adjusted for confounding variables) showed that one unit increase in log-transformed melatonin was not associated with increased risks of major adverse CV events (MACE, composite of cardiovascular death, myocardial infarction, stroke and heart failure, hazard ratio [HR], 1.74; 95% confidence interval [CI] 0.94 to 3.21; p =0.078). Conclusions Higher free melatonin levels on the onset of AMI is not associated with MACE in AMI patients, independent of established conventional risk factors.

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