scholarly journals Clinical risk factors and P wave indices in prediction of atrial fibrillation development during long-term follow-up after acute ST-segment elevation myocardial infarction

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Baturova ◽  
M.M Demidova ◽  
J Carlson ◽  
D Erlinge ◽  
P.G Platonov
Keyword(s):  
Myocardial Infarction ◽  
Cox Regression ◽  
P Wave ◽  
Cox Regression Analysis ◽  
St Segment Elevation ◽  
St Segment ◽  
Pr Interval ◽  
Long Term Follow Up ◽  
History Of

Abstract Introduction In patients with high thromboembolic risk detection of atrial fibrillation (AF) is crucial for implementation of proper anticoagulation therapy, which highlights the need for identification of patients at risk for AF. P wave indices reflect atrial structural abnormalities linked to AF development. Purpose We aimed to assess the value of clinical risk factors and P wave indices in prediction of incident AF after acute ST-segment elevation myocardial infarction (STEMI) in patients undergoing primary percutaneous intervention (PCI). Methods Study sample comprised of 2277 consecutive patients with STEMI admitted to a tertiary care hospital for primary PCI from 2007 to 2010. SWEDEHEART registry was used as the source of information regarding clinical characteristics and events during index admission. Patients without known AF at discharge were included in the current study (n=1837, mean age 65±12 years, 30% females). AF in follow-up (median 9, interquartile range 25–75% (IQR) 7–10 years) was documented by linkage with the Swedish National Patient Register and Swedish Cause-of-Death Register. The closest available ECGs prior to STEMI (median 448, interquartile rate 25–75% 112–1390 days before STEMI) were extracted from the regional electronic ECG databases and automatically processed using Glasgow algorithm. P-wave duration, PR interval, P-wave frontal axis and P terminal force in lead V1 (PTF-V1) were assessed. PTF-V1 >40 mm*ms was considered abnormal. Results In follow-up incident AF was documented in 285 patients (15.4%). In univariate Cox regression analysis age, hypertension, history of myocardial infarction, heart failure, history of stroke, smoking status, P wave duration >120 ms, PR interval and abnormal PTF-V1 predicted the AF development during follow-up (Table). In multivariate Cox regression analysis in which significantly associated variables were included only age (hazard ratio (HR) 1.07, 95% CI 1.05–1.08, p<0.001) and abnormal PTF-V1 (HR 1.49, 95% CI 1.08–2.05, p=0.015, Figure) remained independent predictors of incident AF. Conclusion In patients with acute STEMI incident AF developed during long-term follow-up after discharge from hospital was strongly associated with age and atrial structural abnormalities reflected as abnormal PTF-V1 on pre-STEMI ECG which might serve as a tool in risk stratification of STEMI patients in regard to AF development. FUNDunding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Scholarship grant from Swedish Institute. Table 1 Figure 1

scholarly journals MicroRNA-146a Serves as a Biomarker for Adverse Prognosis of ST-Segment Elevation Myocardial Infarction

2021 ◽  
Vol 2021 ◽  
pp. 1-13
Author(s):  
Shengjue Xiao ◽  
Tongneng Xue ◽  
Qinyuan Pan ◽  
Yue Hu ◽  
Qi Wu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cox Regression ◽  
Control Groups ◽  
Hub Genes ◽  
Cox Regression Analysis ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Low Levels ◽  
And Control

Objective. This study is aimed at exploring the underlying molecular mechanisms of ST-segment elevation myocardial infarction (STEMI) and provides potential clinical prognostic biomarkers for STEMI. Methods. The GSE60993 dataset was downloaded from the GEO database, and the differentially expressed genes (DEGs) between STEMI and control groups were screened. Enrichment analysis of the DEGs was subsequently performed using the DAVID database. A protein–protein interaction network was constructed, and hub genes were identified. The hub genes in patients were then validated by quantitative reverse transcription-PCR. Furthermore, hub gene-miRNA interactions were evaluated using the miRTarBase database. Finally, patient data on classical cardiovascular risk factors were collected, and plasma microRNA-146a (miR-146a) levels were detected. An individualized nomogram was constructed based on multivariate Cox regression analysis. Results. A total of 239 DEGs were identified between the STEMI and control groups. Expression of S100A12 and miR-146a was significantly upregulated in STEMI samples compared with controls. STEMI patients with high levels of miR-146a had a higher risk of major adverse cardiovascular events (MACEs) than those with low levels of miR-146a (log-rank P = 0.034 ). Multivariate Cox regression analysis identified five statistically significant variables, including age, hypertension, diabetes mellitus, white blood cells, and miR-146a. A nomogram was constructed to estimate the likelihood of a MACE at one, two, and three years after STEMI. Conclusion. The incidence of MACEs in STEMI patients expressing high levels of miR-146a was significantly greater than in those expressing low levels. MicroRNA-146a can serve as a biomarker for adverse prognosis of STEMI and might function in its pathogenesis by targeting S100A12, which may exert its role via an inflammatory response. In addition, our study presents a valid and practical model to assess the probability of MACEs within three years of STEMI.

P4614Predictor factors of microvascular obstruction in early presenters of ST-segment elevation myocardial infarction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A L Rivero Monteagudo ◽  
B Arroyo Rivera ◽  
C Garcia Talavera ◽  
M Cortes Garcia ◽  
J A Franco Pelaez ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Microvascular Obstruction ◽  
Cox Regression ◽  
Class Iii ◽  
Cox Regression Analysis ◽  
Killip Class ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
The Mean

Abstract Background Microvascular obstruction (MVO) is a phenomenon that occurs frequently even after primary coronary intervention with recanalization of the infarct-related artery (IRA) and it has been shown to increase the risk of adverse cardiovascular events in ST-segment elevation myocardial infarction (STEMI) patients. The most important clinical predictor of MVO is ischemia duration, but there is a lack of information regarding predictor factors in promptly revascularized patients. Methods From January 2007 to October 2017, 1022 patients with STEMI that underwent urgent coronary angiography were retrospectively enlisted. We included 760 patients that were revascularized in ≤6 hours from symptom onset. Clinical, echocardiographic and angiographic data were taken from hospital records. A multivariate Cox regression analysis was made to assess the relationship between MVO (defined as final TIMI <3 in IRA) and potential predictors. Results From the 760 patients included, 73.7% were male and the mean age was 64.8±14.2 years. LVEF at admission was 46.1±12% and Killip class at admission was III-IV in 12.8% of the cases. The mean time between symptom onset and wire crossing was 3.3±1.3 hours. MVO was found in 130 cases (17.2%). After the multivariate Cox regression analysis, Killip class III-IV at admission was associated with MVO (OR 2.87 [1.31–6.31]). No other clinical variables were independently associated with the occurrence of MVO. The angiographic and interventional variables with a significant association with MVO were: predilatation (OR 1.87 [1.003–3.49]), postdilatation (OR 0.49 [0.27–0.89]), stent length (OR 1.04 [1.001–1.08]), stent diameter (OR 1.89 [1.11–3.23]), thrombus burden of the culprit lesion (OR 2.69 [1.26–5.71]) and distal embolization (OR 5.52 [2.79–10.89]). Conclusions In early presenters of STEMI, angiographic and interventional variables were more important as predictors of MVO than clinical variables. Killip class III-IV at admission was a clinical predictor factor for MVO in this population. Prospective studies are needed to confirm these results.

scholarly journals Incidence and Long‐Term Outcomes of Stroke in Patients Presenting With ST‐Segment Elevation–Myocardial Infarction: Insights From the Midwest STEMI Consortium

2021 ◽  
Author(s):  
Michael Megaly ◽  
Mehmet Yildiz ◽  
Edward Tannenbaum ◽  
Brynn Okeson ◽  
Marshall W. Dworak ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Regression Analysis ◽  
Cox Regression ◽  
Cox Regression Analysis ◽  
St Segment Elevation ◽  
Incidence Trends ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Increased Risk

Background Contemporary real‐world data on stroke in patients presenting with ST‐segment–elevation myocardial infarction (STEMI) are scarce. Methods and Results We evaluated the incidence, trends, cause, and predictors of stroke from 2003 to 2019 in 4 large regional STEMI programs in the upper Midwest that use similar transfer and treatment protocols. We also evaluated the long‐term impact of stroke on 5‐year mortality. Multivariate logistic and Cox regression analysis was used to identify variables independently associated with stroke in patients presenting with STEMI and identify variables associated with 5‐year mortality. A total of 12 868 patients presented with STEMI during the study period. Stroke occurred in 98 patients (0.76%). The incidence of stroke remained stable over time (0.5% in 2003, 1.2% in 2019; P ‐trend=0.22). Most (75%) of strokes were ischemic, with a median time to stroke symptoms of 14 hours after primary percutaneous coronary intervention (interquartile range, 4–72 hours), which led to a small minority (3%) receiving endovascular treatment and high in‐hospital mortality (18%). On multivariate regression analysis, age (increment of 10 years) (odds ratio [OR], 1.32; 95% CI, 1.10–1.58; P ‐value=0.003) and preintervention cardiogenic shock (OR, 2.03; (95% CI, 1.03–3.78; P =0.032)) were associated with a higher risk of in‐hospital stroke. In‐hospital stroke was independently associated with increased risk of 5‐year mortality (hazard ratio, 2.01; 95% CI, 1.13–3.57; P =0.02). Conclusions In patients presenting with STEMI, the risk of stroke is low (0.76%). A stroke in patients presenting with STEMI is associated with significantly higher in‐hospital (18%) and long‐term mortality (35% at 5 years). Stroke was associated with double the risk of 5‐year death.

scholarly journals Markers of Poor Prognosis in Non-ST Segment Elevation Acute Coronary Syndromes Without Revascularization: A 3-Year Survival Analysis

2018 ◽  
Vol 2 (2) ◽  
pp. e000139
Author(s):  
Alexander Parkhomenko ◽  
Natalia Dovgan ◽  
Yaroslav Lutay ◽  
Sergey Kozhukhov
Keyword(s):  
Myocardial Infarction ◽  
Interventricular Septum ◽  
Cardiovascular Death ◽  
Silent Myocardial Ischemia ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Number Of Patients ◽  
History Of

Introduction: The non-ST elevation acute coronary syndrome (NSTE-ACS) account for more than 50% of the total number of patients with ACS. The mortality rates after NSTEMI are not significantly different when compared with patients with ST-segment elevation myocardial infarction. Aim: The aim of the present study was to investigate whether the assessment of clinical, laboratory and instrumental data during hospital stay provide any additional independent information in predicting the 3-year major cardiac events after NSTE-ACS. Methods: We observed 490 consecutive patients, who were admitted to the emergency cardiology department with NSTE-ACS. The patients' baseline characteristics, blood analysis, left ventricle (LV) and renal function data were assessed and analyzed. The median follow‑up time was 36 months. The endpoint was cardiovascular death. Results: The results of our study show that the risk of cardiovascular death during the three years follow-up after multivariate adjustment increases with older age (> 64 years), history of diabetes, prior myocardial infarction and history of angina pectoris, lower ejection fraction (<50%), degree of myocardial hypertrophy (the thickness of the interventricular septum >1.25 mm) of the LV and the degree of diastolic dysfunction (E-wave deceleration time (DT) < 150 ms), silent myocardial ischemia during first 24-hours, high pulse pressure on Day 1 (>49 mm Hg), glucose level > 7.5 mmol/l on admission and moderate kidney dysfunction (CrCl <60 ml/min). Conclusion: In patients with NSTE-ACS, we report the cardiovascular death risk factors within the 3-year follow-up period in the present study. We thus conclude that it is important to identify the patients with high risk of future cardiovascular complications.

scholarly journals The occurrence of new arrhythmias after catheter-ablation of accessory pathway: Delayed arrhythmic side-effect of curative radiofrequency lesion?

2011 ◽  
Vol 139 (7-8) ◽  
pp. 458-464 ◽  
Author(s):  
Nebojsa Mujovic ◽  
Miodrag Grujic ◽  
Stevan Mrdja ◽  
Aleksandar Kocijancic ◽  
Natasa Mujovic
Keyword(s):  
Cox Regression ◽  
Accessory Pathway ◽  
P Wave ◽  
Av Block ◽  
Qrs Complex ◽  
Cox Regression Analysis ◽  
History Of ◽  
Premature Beats ◽  
Wolff Parkinson White Syndrome

Introduction. New arrhythmias (NA) may appear late after accessory pathway (AP) ablation, but their relation to curative radiofrequency (RF) lesion is unknown. Objective. The aim of this study was to determine the prevalence and predictors for NA occurrence after AP ablation and to investigate pro-arrhythmic effect of RF. Methods. Total of 124 patients (88 males, mean age 43?14 years) with Wolff-Parkinson-White syndrome and single AP have been followed after successful RF ablation. Post-ablation finding of arrhythmia, not recorded before the procedure, was considered a NA. The origin of NA was assessed by analysis of P-wave and/or QRS-complex morphology, and, thereafter, it was compared with locations of previously ablated APs. Results. Over the follow-up of 4.3?3.9 years, NA was registered in 20 patients (16%). The prevalence of specific NAs was as follows: atrioventricular (AV) block 0.8%, atrial premature beats 1.6%, atrial fibrillation 5.4%, atrial flutter 0.8%, sinus tachycardia 4.8%, ventricular premature beats (VPBs) 7.3%. Multivariate Cox-regression analysis identified (1) pre-ablation history of pathway-mediated tachyarrhythmias >10 years (HR=3.54, p=0.016) and (2) septal AP location (HR=4.25, p=0.003), as the independent predictors for NA occurrence. In four NA cases (two cases of septal VPBs, one of typical AFL and one of AV-block) presumed NA origin was identified in the vicinity of previous ablation target. Conclusion. NAs were found in 16% of patients after AP elimination. In few of these cases, late on-site arrhythmic effect of initially curative RF lesion might be possible. While earlier intervention could prevent NA occurrence, closer follow-up is advised after ablation of septal AP.

scholarly journals Long-term follow-up of mesh-covered stent implantation in patients with ST-segment elevation myocardial infarction

2014 ◽  
pp. 140-145 ◽  
Author(s):  
Dariusz Dudek ◽  
Artur Dziewierz ◽  
Paweł Kleczyński ◽  
Dawid Giszterowicz ◽  
Tomasz Rakowski ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Stent Implantation ◽  
Covered Stent ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Long Term Follow Up
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