P3618Underweight predicts greater risk of cardiac mortality post acute myocardial infarction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
W Su ◽  
M Wang ◽  
J G Zhu ◽  
W P Li ◽  
H Chen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiac Death ◽  
Left Ventricular ◽  
Older Age ◽  
Left Ventricular Ejection ◽  
Proportional Hazard ◽  
Cardiac Mortality ◽  
Cox Proportional Hazard ◽  
To Receive

Abstract Background Increased body mass index (BMI) is a well-established risk factor for cardiovascular disease, however, patients with elevated BMI comparing to low BMI seem to have better survival, a phenomenon reported as “obesity paradox” which remains as a controversy. We investigated the effect of BMI, including underweight, normoweight, overweight and obese, on cardiac mortality post acute myocardial infarction (AMI). Methods This analysis included 3562 AMI patients with documented BMI. The baseline characteristics including clinical and laboratory parameters were collected at hospital admission for AMI. Patients were classified into 4 groups based on BMI values: underweight (BMI <18.5), normoweight (BMI 18.5 to 24.9), overweight (BMI 25 to 29.9) and obese (BMI ≥30). Patients were followed up for a median of 1.9 years. The rate of cardiac death (primary endpoint) was compared among the 4 BMI groups. Cox proportional hazard models were used to adjust for potential confounders. Results Of 3562, 110 (3%) were underweight, 1579 (44%) were normoweight, 1493 (42%) were overweight, and 380 (11%) were obese. Compared to the normoweight group, subjects in overweight and obese groups were younger, more men, more hypertension, more likely to receive percutaneous coronary intervention (PCI), and had higher levels of glucose and lipids, but, lower level of N-terminal pro-brain natriuretic peptide (NTproBNP). Subjects in underweight group were older, more women, fewer diabetes, less likely to receive PCI, lower levels of glucose and lipids, but, higher level of NTproBNP and higher rates of left ventricular ejection fraction (LVEF)<50%. Cardiac death over 1.9 years occurred significantly more in the underweight group (30.0%, 10.6%, 7.0% and 5.0% among the 4 groups from underweight to obese, p<0.001 for trend, Figure 1). The Cox proportional hazard model revealed that underweight was an independent predictor of subsequent cardiac death (OR=2.58, 95% CI: 1.52–4.39, p<0.001). Multivariate analysis identified that older age, higher levels of cardiac troponin I (cTnI) and LVEF<50% were independently associated with increased risk of cardiac death. PCI significantly and independently protected AMI patients against cardiac death (OR=0.34, 95% CI: 0.23–0.49, p<0.001). Conclusions Patients who were underweight were at greater risk of cardiac death post AMI. In addition, older age, higher levels of cTnI, LVEF<50%, and not receiving PCI also independently predicted cardiac mortality post AMI. Acknowledgement/Funding Beijing Natural Science Foundation (No. 7194253);Scientific Research Common Program of Beijing Municipal Commission of Education (KM201910025017)

scholarly journals Systematic Review of Compound Danshen Dropping Pill: A Chinese Patent Medicine for Acute Myocardial Infarction

2013 ◽  
Vol 2013 ◽  
pp. 1-15 ◽  
Author(s):  
Jing Luo ◽  
Hao Xu ◽  
Keji Chen
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Cardiac Death ◽  
Data Extraction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Quality Of Evidence

Objective. This paper systematically evaluated the efficacy and safety of compound Danshen dropping pill (CDDP) in patients with acute myocardial infarction (AMI).Methods. Randomized controlled trials (RCTs), comparing CDDP with no intervention, placebo, or conventional western medicine, were retrieved. Data extraction and analyses were conducted in accordance with the Cochrane standards. We assessed risk of bias for each included study and evaluated the strength of evidence on prespecified outcomes.Results. Seven RCTs enrolling 1215 patients were included. CDDP was associated with statistically significant reductions in the risk of cardiac death and heart failure compared with no intervention based on conventional therapy for AMI. In addition, CDDP was associated with improvement of quality of life and impaired left ventricular ejection fraction. Nevertheless, the safety of CDDP was unproven for the limited data. The quality of evidence for each outcome in the main comparison (CDDP versus no intervention) was “low” or “moderate.”Conclusion. CDDP showed some potential benefits for AMI patients, such as the reductions of cardiac death and heart failure. However, the overall quality of evidence was poor, and the safety of CDDP for AMI patients was not confirmed. More evidence from high quality RCTs is warranted to support the use of CDDP for AMI patients.

scholarly journals High triglyceride-glucose index is associated with adverse cardiovascular outcomes in patients with acute myocardial infarction

2020 ◽  
Author(s):  
Yue Zhang ◽  
Xiaosong Ding ◽  
Bing Hua ◽  
Qingbo Liu ◽  
Hui Gao ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiac Death ◽  
Left Ventricular ◽  
Cardiovascular Outcomes ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Tyg Index ◽  
Significant Difference

Abstract Background Triglyceride glucose (TyG) index is considered a new marker for metabolic disorders. Although recent studies have found an association between TyG index level and vascular disease development, the prognostic value of TyG index in patients with acute myocardial infarction (AMI) remains unclear. Methods A total of 3181 patients with AMI, who underwent coronary angiography, were identified from the Cardiovascular Center of Beijing Friendship Hospital Database Bank and included in the analysis. Patients were stratified into 2 groups according to their baseline TyG index levels: the TyG index < 8.88 group and the TyG index ≥ 8.88 group. Clinical characteristics,biochemical parameters, and the incidence of major adverse cardiovascular events (MACEs) during a median of 33.3-month follow-up were recorded. The TyG index was calculated using the following formula: ln [fasting triglycerides (mg/dL) × fasting plasma glucose (mg/dL)/2]. Results Kaplan-Meier analysis revealed no significant difference in the incidence of all-cause death and cardiac death between the 2 groups. Compared with the TyG index < 8.88 group, the TyG index ≥ 8.88 group had significantly higher incidences of non-fatal MI, revascularization, cardiac rehospitalization and composite MACEs. Multivariable Cox regression models revealed that the TyG index was positively associated with all-cause death [HR (95% CI): 1.51 (1.10,2.06), P = 0.010], cardiac death [HR (95%CI): 1.68 (1.19,2.38), P = 0.004], revascularization [HR (95%CI): 1.50 (1.16,1.94), P = 0.002], cardiac rehospitalization [HR (95%CI): 1.25 (1.05,1.49), P = 0.012], and composite MACEs [HR (95%CI): 1.19 (1.01,1.41), P = 0.046] in patients with AMI. The independent predictive effect of TyG index on all-cause death and cardiac death was mainly reflected in the subgroups of male gender, body mass index ≥ 25 kg/m2, smoker, diabetes mellitus, estimated glomerular filtration rate (eGFR) ≥ 60 ml/min/1.73 m2, high-density lipoprotein cholesterol ≥ 1.01 mmol/L and left ventricular ejection fraction (LVEF) ≥ 0.50. The results also revealed that diabetes mellitus, previous AMI, eGFR, LVEF, and multi-vessel/left main coronary artery lesions were independent predictors of MACEs in patients with AMI (all P < 0.05). Conclusions High TyG index levels appeared to be associated with an increased risk of MACEs in patients with AMI. The TyG index might be a valid predictor of cardiovascular outcomes of patients with AMI. Trial registration: retrospectively registered

scholarly journals High triglyceride-glucose index is associated with adverse cardiovascular outcomes in patients with acute myocardial infarction

2020 ◽  
Author(s):  
Yue Zhang ◽  
Xiaosong Ding ◽  
Bing Hua ◽  
Qingbo Liu ◽  
Hui Gao ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiac Death ◽  
Left Ventricular ◽  
Cardiovascular Outcomes ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Tyg Index ◽  
Increased Risk

Abstract Background Triglyceride glucose (TyG) index is considered a new marker for metabolic disorders. Although recent studies have found an association between TyG index level and vascular disease development, the prognostic value of TyG index in patients with acute myocardial infarction (AMI) remains unclear. Methods A total of 3181 patients with AMI, who underwent coronary angiography, were identified from the Cardiovascular Center of Beijing Friendship Hospital Database Bank and included in the analysis. Patients were stratified into 2 groups according to their baseline TyG index levels: the TyG index <8.88 group and the TyG index ≥8.88 group. Clinical characteristics,biochemical parameters, and the incidence of major adverse cardiovascular events (MACEs) during a median of 33.3-month follow-up were recorded. The TyG index was calculated using the following formula: ln [fasting triglycerides (mg/dL) ×fasting plasma glucose (mg/dL)/2]. Results Compared with the TyG index<8.88 group, the TyG index≥8.88 group had significantly higher incidences of non-fatal MI, revascularization, cardiac rehospitalization and composite MACEs. Multivariable Cox regression models revealed that the TyG index was positively associated with all-cause death [HR (95% CI): 1.51 (1.10,2.06), P=0.010], cardiac death [HR (95%CI): 1.68 (1.19,2.38), P=0.004], revascularization [HR (95%CI): 1.50 (1.16,1.94), P=0.002], cardiac rehospitalization [HR (95%CI): 1.25 (1.05,1.49), P=0.012], and composite MACEs [HR (95%CI): 1.19 (1.01,1.41), P=0.046] in patients with AMI. The independent predictive effect of TyG index on all-cause death and cardiac death was mainly reflected in the subgroups of male gender, body mass index ≥25kg/m 2 , smoker, diabetes mellitus, estimated glomerular filtration rate (eGFR) ≥60ml/min/1.73m 2 , high-density lipoprotein cholesterol ≥1.01mmol/L and left ventricular ejection fraction (LVEF) ≥0.50. The results also revealed that diabetes mellitus, previous AMI, eGFR, LVEF, and multi-vessel/left main coronary artery lesions were independent predictors of MACEs in patients with AMI (all P<0.05). Conclusions High TyG index levels appeared to be associated with an increased risk of MACEs in patients with AMI. The TyG index might be a valid predictor of cardiovascular outcomes of patients with AMI.

Abstract 16101: Factors Associated With Implantable Cardioverter-Defibrillator Placement Among U.S. Veterans With Left Ventricular Ejection Fraction ≤35% at Least 40 Days After Acute Myocardial Infarction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Gregory L Judson ◽  
Beth Cohen ◽  
Anoop Muniyappa ◽  
Merritt Raitt ◽  
Hui Shen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Factors Associated ◽  
Black Patients ◽  
To Receive

Introduction: Implantable cardioverter defibrillators (ICD) reduce the risk of sudden cardiac death among patients with persistently low (≤35%) left ventricular ejection fraction (LVEF) at least 40 days following acute myocardial infarction (AMI). There are limited data about clinical factors associated with ICD placement following AMI. Hypothesis: We hypothesized that increasing age and number of comorbidities would decrease the odds of ICD placement post-AMI among patients with low (≤35%) LVEF, while revascularization for AMI would increase odds of ICD use. Methods: We used ICD-9 and 10 codes to identify all Veterans hospitalized for AMI from 2004-2017 and excluded Veterans with prior ICD and those who died during AMI hospitalization. We used a validated natural language processing algorithm to determine LVEF from echocardiograms performed 40-365 days post-AMI and identified patients with LVEF ≤35%. Using multivariable logistic regression, we examined the association of demographics, comorbidities, revascularization status for AMI, and prescription of guideline-directed medical therapy (GDMT) with the primary outcome of ICD placement 41-365 days post-AMI. Results: Of 10,447 Veterans eligible for an ICD, 1,966 (18.8%) received an ICD. Of 1,966 patients who received an ICD 7.1% died within 1-year, compared with 26.8% of patients who did not receive an ICD. In multivariable analysis, younger age, fewer comorbidities, revascularization during AMI hospitalization, and use of GDMT were associated with increased odds of receiving an ICD (Table). Eligible Black patients were less likely (OR 0.78, 95% CI 0.67-0.90) to receive an ICD than White patients. Conclusions: Many factors affect ICD placement among patients with reduced LVEF post-AMI. In particular, Black patients were less likely to receive ICDs than White patients. Future qualitative work could provide a deeper understanding of how patient and clinician factors influence decisions around ICD use.

Randomized, double blind, placebo-controlled, safety and efficacy study of dutogliptin in combination with filgrastim in early recovery post-MI: rationale, design and first interim analysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D Von Lewinski ◽  
B Merkely ◽  
I Buysschaert ◽  
R.A Schatz ◽  
G.G Nagy ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Stem Cells ◽  
Adverse Events ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Funding Source ◽  
Early Recovery ◽  
Ventricular Ejection Fraction ◽  
Combined Application

Abstract Background Regenerative therapies offer new approaches to improve cardiac function after acute ST-elevation myocardial infarction (STEMI). Mobilization of stem cells and homing within the infarcted area have been identified as the key mechanisms for successful treatment. Application of granulocyte-colony stimulating factor (G-CSF) is the least invasive way to mobilize stem cells while DDP4-inhibitor facilitates homing via stromal cell-derived factor 1 alpha (SDF-1α). Dutogliptin, a novel DPP4 inhibitor, combined with stem cell mobilization using G-CSF significantly improved survival and reduced infarct size in a murine model. Purpose We initiated a phase II, multicenter, randomized, placebo-controlled efficacy and safety study (N=140) analyzing the effect of combined application of G-CSF and dutogliptin, a small molecule DPP-IV-inhibitor for subcutaneous use after acute myocardial infarction. Methods The primary objective of the study is to evaluate the safety and tolerability of dutogliptin (14 days) in combination with filgrastim (5 days) in patients with STEMI (EF &lt;45%) following percutaneous coronary intervention (PCI). Preliminary efficacy will be analyzed using cardiac magnetic resonance imaging (cMRI) to detect &gt;3.8% improvement in left ventricular ejection fraction (LV-EF). 140 subjects will be randomized to filgrastim plus dutogliptin or matching placebos. Results Baseline characteristics of the first 26 patients randomized (24 treated) in this trial reveal a majority of male patients (70.8%) and a medium age of 58.4 years (37 to 84). During the 2-week active treatment period, 35 adverse events occurred in 13 patients, with 4 rated as serious (hospitalization due to pneumonia N=3, hospitalization due to acute myocardial infarction N=1), and 1 adverse event was rated as severe (fatal pneumonia), 9 moderate, and 25 as mild. 6 adverse events were considered possibly related to the study medication, including cases of increased hepatic enzymes (N=3), nausea (N=1), subcutaneous node/suffusion (N=1) and syncope (N=1). Conclusions Our data demonstrate that the combined application of dutogliptin and G-CSF appears to be safe on the short term and feasible after acute myocardial infarction and may represent a new therapeutic option in future. Funding Acknowledgement Type of funding source: Other. Main funding source(s): This research is funded by the sponsor RECARDIO, Inc., 1 Market Street San Francisco, CA 94150, USA. RECARDIO Inc. is funding the complete study. The Scientific Board of RECARDIO designed the study. Data Collection is at the participating sites. Interpretation of the data by the Scientific Board and Manuscript written by the authors and approved by the Sponsor

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