P958Outcomes in nonagenarians with myocardial infarction who activate the primary PCI pathway

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M N U M Meah ◽  
T J Joseph ◽  
W Y D Ding ◽  
M S Shaw ◽  
J H Hasleton ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Mortality Risk ◽  
Statistical Significance ◽  
Left Ventricular ◽  
Life Tables ◽  
Risk Scores ◽  
P Value ◽  
Term Survival ◽  
Kaplan Meier ◽  
Admission Variables

Abstract Introduction Current guidelines recommend immediate revascularisation in patients with ST elevation myocardial infarction (STEMI). However it remains unclear whether PPCI reduces mortality in nonagenarians. We aimed to compare mortality in nonagenarians, presenting via the PPCI pathway, who were managed medically (MM) versus those who underwent PCI. Methods Electronic records of every nonagenarian who presented as a PPCI activation between 2013–2018 were reviewed. Patients were divided into those who had PCI and those MM. Standard univariate and Kaplan Meier survival analyses were performed. We compared outcomes to an age and sex matched cohort using life tables from the Office for National Statistics (ONS). Results There were 157 nonagenarians presenting via the PPCI pathway, of which 111 were “true” myocardial infarction. Table 1 summarises baseline variables and comorbidities. The cohorts were generally well matched. Both groups had similar BCIS PCI 30-day mortality risk scores. The commonest reason to treat medically was presentation 12 hours after symptom onset. There was a trend towards increased 30-day mortality in the MM group. Kaplan Meier analysis (Figure 1) show the survival curves diverge immediately and reach statistical significance at 3 years. Compared to a matched population from ONS life tables, outcomes are worse in MM. Table 1.S Admission variables & results PCI Group (n=42) Medically Managed Group (n=69) P-value Age 92 (91, 94) 93 (91, 95) 0.22 Female 21 (50.0%) 45 (65.2%) 0.11 Left ventricular failure (EF <45%) 27 (64.3%) 46 (66.6%) >0.99 Cardiogenic shock (Systolic BP <90mmHg) 4 (9.5%) 6 (8.7%) >0.99 Hx of hypertension 24 (57.1%) 45 (65.2%) 0.39 Hx of diabetes 5 (11.9%) 18 (26.1%) 0.07 Hx of chronic kidney disease 12 (28.6%) 25 (36.2%) 0.41 Hx of previous stroke 8 (19.1%) 15 (21.7%) 0.73 Hx of atrial fibrillation 1 (2.4%) 16 (23.2%) 0.003 Presented as non-STEMI 1 (2.4%) 12 (17.4%) 0.017 Presented as completed STEMI 2 (4.8%) 30 (43.5%) <0.001 BCIS PCI 30-day mortality risk 15.7 (14.3, 23.6) 17.5 (15.3, 22.3) 0.17 30-day mortality 10 (23.8%) 28 (40.6%) 0.07 Figure 1. Kaplan Meier Chart Conclusions Long term survival even in nonagenarians is significantly improved by timely PPCI when compared with medical management.

scholarly journals Longitudinal change in left ventricular 4D flow kinetic energy after myocardial infarction

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
H Ben-Arzi ◽  
A Das ◽  
C Kelly ◽  
RJ Van Der Geest ◽  
A Chowdhary ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Kinetic Energy ◽  
Left Ventricular ◽  
Three Dimensions ◽  
Longitudinal Change ◽  
P Value ◽  
4D Flow ◽  
Longitudinal Changes ◽  
Funding Sources ◽  
End Diastolic Volume

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): British Heart Foundation HRUK Background. Four-dimensional flow (4D flow) cardiovascular magnetic resonance (CMR) imaging provides quantification of intra-cavity left ventricular (LV) flow kinetic energy (KE) parameters in three dimensions. Myocardial infarction (MI) is known to cause acute alterations in intra-cardiac blood flow but assessments of longitudinal changes are lacking. Purpose. Assess longitudinal changes in LV flow post ST-elevation myocardial infarction (STEMI). Method. Twenty acutely reperfused STEMI patients (13 men, 7 women, mean age 54 ± 9 years) underwent 3T CMR acutely (within 5-7 days) and 3 months post-MI.  CMR protocol included functional imaging, late gadolinium enhancement and 4D flow. Using Q-MASS, LV KE parameters were derived and indexed to LV end-diastolic volume (LVKEiEDV). Based on acute ejection fraction (EF), patients were grouped as follows: preserved (pEF) EF &gt;50%, reduced (rEF) EF &lt;50% including mild (rEF= 40-49%), moderate to severe (EF &lt;40%) impairment.  Results. Out of 20 patients, 13 had rEF acutely (7 mild rEF, 6 moderate to severe rEF). Acute LVKEiEDV parameters varied significantly between pEF and rEF (Table). At 3 months, pEF and mild rEF patients showed a significant (P &lt; 0.05) reduction in average, systolic and peak-A wave LVKEiEDV. Mild rEF patients also had significant (P &lt; 0.05) reduction in minimal and peak-E wave LVKEiEDV. However in patients with moderate to severe rEF in the acute scan, there were no significant change by 3 months (Figure). Conclusion. Following MI, 4D flow LVKE derived biomarkers significantly decreased over time in pEF and mild rEF groups but not in moderate to severe rEF group. 4D flow assessment might provide incremental prognostic value beyond EF assessment alone. Table pEF (n = 7) rEF (n = 13) V1 V2 P-value V1 V2 P-value EF(%) 56 ± 5 55 ± 4 0.40 41 ± 7 47 ± 9 0.01 Infarct Size(%) 31 ± 20 15 ± 9 0.04 18 ± 13† 16 ± 11 0.41 LV KEiEDV parameters Average(µJ/ml) 9 ± 2 7 ± 2 0.02 10 ± 3† 8 ± 3 0.01 Minimal(µJ/ml) 1 ± 0.6 1 ± 0.5 0.46 1.3 ± 0.5 1 ± 0.6 0.03 Systolic(µJ/ml) 10 ± 4 7 ± 2 &lt;0.01 12 ± 4† 7 ± 3 &lt;0.01 Diastolic(µJ/ml) 8 ± 3 7 ± 2 0.13 9 ± 3 8 ± 3 0.09 Peak-E wave(µJ/ml) 22 ± 9 23 ± 8 0.44 20 ± 7 18 ± 10 0.23 Peak-A wave(µJ/ml) 18 ± 10 11 ± 4 0.04 17 ± 9 14 ± 7 0.02 †P &lt; 0.05 V1 comparison between pEF and rEF Abstract Figure

scholarly journals Gender-Related Differences of Cardiac Troponin-I Levels in Patients with Acute Myocardial Infarction at Time of Acute Chest Pain

2021 ◽  
pp. 199-205
Author(s):  
Mahir Abdulkadhum Khudhair Alzughaibi ◽  
Ammar Waheeb Obeiad ◽  
Nassar Abdalaema Abdalhadi Mera ◽  
Mohammed Sadeq Hamzah Al-Ruwaiee
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Chest Pain ◽  
Troponin I ◽  
Statistical Significance ◽  
Acute Chest Pain ◽  
Blood Analysis ◽  
P Value ◽  
Cross Sectional ◽  
Time Of Admission

Background: Cardiac Troponins-I (CTNI) are myoregulatory polypeptides that control the actin-myosin interface, considered specific to cardiomyocytes. Age and sex variances in the extent of CTNI levels have arisen a recent debatable emphasis. Existing revisions do not display a reliable clinical power of sex-specific CTNI 99th centiles, which actually might mirror procedural aspects. Nevertheless, from a biochemical viewpoint, the trends of sex-specific CTNI 99th centiles seem sensible for the ruling-in of acute myocardial infarction AMI. Vulnerable females may be missed when applying the male sex-specific threshold. This study aimed to determine whether gender differences in CTNI exist in patients with AMI presented with chest pain. Methodology: The study was a cross-sectional, single-center, included 236-patients with AMI diagnosis by cardiologists at Merjan teaching hospital during the period from April to July 2020 from patients attending the hospital for cardiac consultation complaining of acute chest pain suggestive of AMI. Blood analysis had initiated at the time of admission included serum creatinine, blood urea, R/FBS, WBCs, PCV, and serum CTNI. A p-value below 0.05 specifies statistical significance. All statistical bioanalyses had performed by IBM-SPSS, version-25 for Windows. Results: The mean age of participants was 67.5 years, the men were dominant 76.2%. The incidence of DM and hypertension were significantly high and 24.5% of the patients were current smokers. Biochemical serum analysis revealed mean creatinine, urea, sugar, and STI values were 79.8±4.2 mmol/l, 15.9±1.7 mmol/l, 10.9±0.9 mmol/l, and 7.9±0.6 ng/ml separately. Both hypertension and smoking were significantly (p-0.001) more among males compared to the females, which is not the case for the prevalence of DM. The males were heavier significantly than females (p-0.001). Almost, there was no impact of gender on most of the other study variables other than serum TNI levels, which were significantly higher among the males (p-0.001). Conclusion: In patients with AMI presented with acute chest pain, the routine of CTNI in the diagnosis of AMI is based on the patient's gender. The application of gender-dependent cutoff levels for CTNI analyses appears to be highly suggested.

87Effects of the chymase inhibitor fulacimstat on adverse cardiac remodelling after acute myocardial infarction - Results of the CHIARA MIA 2 trial

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H D Duengen ◽  
R J Kim ◽  
D Zahger ◽  
K Orvin ◽  
D Admon ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Mri ◽  
Left Ventricular ◽  
Cardiac Remodelling ◽  
Left Ventricular Ejection ◽  
Controlled Study ◽  
P Value ◽  
Tissue Remodelling ◽  
Ventricular Ejection Fraction ◽  
Chymase Inhibitor

Abstract Introduction Adverse cardiac remodelling represents the most important risk factor for the development of heart failure (HF) after myocardial infarction (MI). Chymase is a protease that generates locally pro-fibrotic factors such as angiotensin II, TGFβ, and matrixmetallproteases that contribute to tissue remodelling. Purpose This phase IIa study examined the effects of the chymase inhibitor fulacimstat on functional parameters of adverse cardiac remodelling after acute MI. Methods A double-blind, multinational, randomized, placebo-controlled study was performed in patients after first STEMI who were treated with primary percutaneous coronary intervention within 24h of symptom onset. To enrich for patients at risk of adverse remodelling, main inclusion criteria were a left-ventricular ejection fraction (LVEF)≤45% and an infarct size>10% on day 5 to 9 post MI as measured by cardiac MRI. On day 6 to 12 post MI, patients were randomized to treatment with either 25 mg fulacimstat (n=54) or placebo (n=53) twice daily on top of standard of care. The changes in LVEF, LVEDVI, and LVESVI from baseline to 6 months of treatment were analyzed by a central blinded cardiac MRI core laboratory. Results Fulacimstat was safe and well tolerated, 64.8% of patients treated with fulacimstat and 75.5% of patients treated with placebo reported treatment emergent adverse events. Fulacimstat achieved exposures that were approximately 10-fold higher than those predicted to be required for minimal therapeutic activity. After six months of treatment, there were no effects of fulacimstat compared to placebo on the changes in LVEF, LVEDVI, and LVESVI (see Table). Analysis of primary efficacy parameters Parameter Placebo Fulacimstat p-value LVEF (%) baseline 37.2±6.1 39.1±5.5 0.15 6 months 41.2±8.4 42.6±8.4 0.45 delta 4.0±5.0 3.5±5.4 0.69 LVEDVI (mL/m2) baseline 80.0±17.1 77.4±18.2 0.51 6 months 85.1±19.1 84.7±23.4 0.94 delta 5.1±18.9 7.3±13.3 0.54 LVESVI (mL/m2) baseline 50.5±13.0 47.3±12.3 0.26 6 months 51.1±16.9 49.6±18.1 0.71 delta 0.6±14.8 2.3±11.2 0.56 Data are given as mean ± standard deviation. Conclusion Fulacimstat was safe and well tolerated in patients with left-ventricular dysfunction (LVD) after first STEMI but had no effect on adverse cardiac remodelling in the experimental setting of this study. Acknowledgement/Funding The study was funded by its sponsor BAYER AG

scholarly journals Echocardiographic Evaluation of left Ventricular Function Following Late Percutaneous Coronary Intervention after Acute Anterior Myocardial Infarction with Left Ventricular Systolic Dysfunction

2018 ◽  
Vol 33 (2) ◽  
pp. 90-93
Author(s):  
Md Tufazzal Hossen ◽  
Sayed Ali Ahsan ◽  
Md Abu Salim ◽  
Khurshed Ahmed ◽  
Md Mukhlesur Rahman ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Coronary Stenting ◽  
Lv Function ◽  
P Value ◽  
Anterior Myocardial Infarction ◽  
Late Intervention ◽  
Percutaneous Coronary

Background: The effect of late percutaneous coronary intervention on left ventricular function is incompletely understood. Objectives: To evaluate the effect of late Percutaneous Coronary Intervention on LV systolic function following coronary stenting after acute anterior myocardial infarction. Methods: A total of 60 patients, > 24 hours to 6 weeks after anterior AMI who attended in UCC, BSMMU between July 2014 to June 2015 were included in this study. They underwent coronary stenting. After coronary stenting all patients were in TIMI flow-3. Serial echocardiographic assessment of LV function before and after late intervention with modified Simpson’s rule in apical 4 chamber view as well as comparison between baseline result with that of after intervention were done. The patients were on standard medical therapy in post intervention period. Result: Mean age was 54.3±8.91 years with minimum 30 years and maximum 75 years. Most of the patients were male (67%). LVESV was 60.0±14.4 ml before PCI and 58.3±15.3 ml at discharge (p value 0.091) & 44.1±17.6 ml after 3 months (p value <0.001). LVEF was 40.2±3.1% before PCI, 40.2±3.3% at discharge (p value 0.509) & 47.6±5.9% after 3 months (p value <0.001). There was no significant improvement of LV function from baseline till discharge but significant improvement occurred after 3months. Conclusion: Using echocardiographic techniques, our results showed that left ventricular volume decreased and the left ventricular ejection fraction increased significantly after three months of late intervention. Bangladesh Heart Journal 2018; 33(2) : 90-93

scholarly journals Mechanical Dispersion as a powerful echocardiographic predictor of outcomes after Myocardial Infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.P De Sousa Bispo ◽  
P Azevedo ◽  
P Freitas ◽  
N Marques ◽  
C Reis ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Survival Analysis ◽  
Primary Endpoint ◽  
Longitudinal Strain ◽  
Univariate Analysis ◽  
Global Longitudinal Strain ◽  
P Value ◽  
Peak Strain ◽  
Kaplan Meier

Abstract Introduction Several studies have addressed the importance of transthoracic echocardiography (TTE) in risk prediction of subsequent adverse events after ST elevation myocardial infarction (STEMI). While several traditional echo parameters have a well-established prognostic value, data derived from 2D-Speckle Tracking Echocardiography (2DSTE) needs further investigation. Objectives To determine if 2DSTE parameters provide additional information beyond conventional echocardiography to predict long-term adverse outcomes in patients admitted with STEMI Methods Retrospective, single-center study, that included all patients without previous cardiovascular events admitted with STEMI (who underwent primary coronary angioplasty) between 2015 and 2017. Patients with poor acoustic windows, severe valvular disease, irregular heart rhythm, and those who died during hospital stay were excluded. We reviewed all pre-discharge TTE to assess conventional parameters of LV systolic and diastolic function and data obtained by 2DSTE: global longitudinal strain (GLS) and peak strain dispersion (PSD), an index that is the standard deviation from time to peak strain of all segments over the entire cardiac cycle. Demographic and clinical data was obtained through electronic hospital records. Minimum follow-up was 2 years. The primary endpoint was a composite of all-cause mortality and cardiovascular re-admission at follow-up. Survival analysis was used to determine independent predictors of the primary endpoint. Results 377 patients were included, mean age 62±13 years, 72% male. Mean LVEF was 50±10% with 19% of patients having LVEF &lt;40%. Mean indexed left atrium volume (LAVi) was 33±10 ml/m2, mean GLS was −14±4%, and PSD was 60±22 msec. Average follow-up was 36±11 months, with a combined endpoint of mortality and hospitalization of 27% (n=102) Univariate analysis of echocardiographic variables revealed an association between heart rate, LVEF, indexed LV end-systolic volume, indexed stroke volume, LAVi, GLS and PSD with the endpoint. However, on multivariate analysis only LAVi [HR 1.030 (95% CI 1.009 - 1.051), p-value = 0.005] and PSD [HR 1.011 (95% CI 1.002 - 1.020), p-value = 0.012] remained independent predictors of the primary endpoint. We determined that a PSD value higher than 52 msec has a sensitivity of 76% and a negative predictive value of 83% for mortality and hospitalization, and that this cut-off point discriminates patients at a higher risk of events in Kaplan-Meier Survival analysis with a Log-Rank p-value=0.001. Conclusion PSD derived by longitudinal strain analysis is a promising prognostic predictor after STEMI. PSD outperformed conventional echocardiographic parameters in the risk stratification of STEMI patients at discharge. Kaplan-Meier Survival Curves Funding Acknowledgement Type of funding source: None

scholarly journals A Preliminary Study of microRNA-208b after Acute Myocardial Infarction: Impact on 6-Month Survival

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Mostafa Alavi-Moghaddam ◽  
Mohammad Chehrazi ◽  
Shamila D. Alipoor ◽  
Maryam Mohammadi ◽  
Alireza Baratloo ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Survival Time ◽  
Term Survival ◽  
Relative Expression ◽  
Kaplan Meier ◽  
Healthy Control ◽  
And Gender

Introduction. miRNAs contribute to a variety of essential biological processes including development, proliferation, differentiation, and apoptosis. Circulating microRNAs are very stable and have shown potential as biomarkers of cardiovascular disease. microRNA-208b expression was increased in the blood of patients with acute myocardial infarction (AMI) and has been proposed as a biomarker for early diagnosis. In this pilot study, we investigate the potential of circulating miR-208b as a prognostic biomarker of 6-month survival in AMI patients. Methods. Plasma samples from 21 patients and 8 age- and gender-matched healthy adults were collected, and circulating levels of miR-208b were detected using quantitative real-time PCR. Results. miR-208b levels were higher in healthy control subjects (9.6-fold; P≤0.05). Within the AMI patients, the levels of miR-208b were significantly lower in the survivor versus nonsurvivor group (fold change = 6.51 and 14.1, resp.; P≤0.05). The Kaplan-Meier curve revealed that the 6-month survival time was significantly higher among AMI patients with a relative expression of miR-208b lower than 12.38. The hazard ratio (HR) for the relative expression of miR-208b (<12.38 was the reference) was 5.08 (95% CI: 1.13–22.82; P=0.03). Conclusion. Our results showed that elevated miR-208b expression was associated with reduced long-term survival in AMI patients. These pilot data indicate the need for a large follow-up study to confirm whether miR-208b can be used as a predictor of 6-month survival time after AMI.

Myocardial Infarction with Normal Coronary Arteries: The Pathologic and Clinical Perspectives

Angiology ◽  
2001 ◽  
Vol 52 (5) ◽  
pp. 299-304 ◽  
Author(s):  
Aung Tun ◽  
Ijaz A. Khan
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Coronary Arteries ◽  
Beta Blockers ◽  
Coronary Thrombosis ◽  
Coronary Spasm ◽  
Left Ventricular ◽  
Coronary Vasospasm ◽  
Term Survival ◽  
Normal Coronary Arteries

Myocardial infarction with normal coronary arteries is a syndrome resulting from numerous conditions but the exact cause in a majority of the patients remains unknown. Cigarette smokers and cocaine users are more prone to develop this condition. The possible mechanisms causing myocardial infarction with normal coronary arteries are hypercoagulable states, coronary embolism, an imbalance between oxygen demand and supply, intense sympathetic stimulation, non-atherosclerotic coronary diseases, coronary trauma, coronary vasospasm, coronary thrombosis, and endothelial dysfunction. It primarily affects younger individuals, and the clinical presentation is similar to that of myocardial infarction with coronary atherosclerosis. Thrombolytics, aspirin, nitrates, and beta blockers should be instituted as a standard therapy for acute myocardial infarction. Once normal coronary arteries are identified on subsequent angiography, the calcium channel blockers could be added since coronary vasospasm appears to play a major role in the pathophysiology of this condition. The beta blockers should be avoided in cocaine-induced myocardial infarction because the coronary spasm may worsen. In myocardial infarction with normal coronary arteries, complications such as malignant arrhythmia, heart failure, and hypotension are generally less common, and prognosis is usually good. Recurrent infarction, postinfarction angina, heart failure, and sudden cardiac death are rare. Stress electrocardiography and imaging studies are not useful prognostic tests and long- term survival mainly depends on the residual left ventricular function, which is usually good.

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