scholarly journals A Sex-Specific Switch in Platelet Receptor Signaling Following Myocardial Infarction

2019 ◽  
Author(s):  
Beom Soo Kim ◽  
David A. Auerbach ◽  
Hamza Sadhra ◽  
Frederick S. Ling ◽  
Sandra Toth ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Platelet Activation ◽  
Healthy Subjects ◽  
Multivariate Regression ◽  
Regression Analyses ◽  
Men And Women ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Platelet Receptor

ABSTRACTBACKGROUNDA Sex-specific, personalized approach to anti-platelet therapy may be important in patients with myocardial infarction (MI).OBJECTIVESOur goal was to determine whether platelets activate differently in healthy men and women compared to following MI.METHODSBlood was obtained from healthy subjects or patients presenting acutely with ST-segment Elevation Myocardial Infarction (STEMI) and non-ST Segment Elevation Myocardial Infarction (NSTEMI). Platelet function through surface receptor activation was examined in healthy subjects, in patients with MI, and in age- and strain-matched mice before and after MI. Multivariate regression analyses revealed clinical variables associated with platelet receptor sensitivity at the time of MI.RESULTSPlatelets from healthy women are dose-dependently more active compared to men, particularly through the platelet thromboxane signaling pathway (7.8-fold increase in women vs. 3.0-fold in men, P=0.02). At the time of MI, platelet activation through surface protease-activated receptor 1 (PAR1) was less in women than men (3.5-fold vs. 8.5-fold, respectively, P=0.0001). Multivariate regression analyses revealed male sex (P=0.04) and NSTEMI (P=0.003) as independent predictors of enhanced platelet PAR1 signaling at the time of MI. Similar to humans, healthy female mice showed preferential thrombin-mediated platelet activation compared to male mice (8.7-fold vs. 4.8-fold, respectively; P<0.001). In the immediate post-MI environment, male mice showed preferential thrombin-mediated platelet activation compared to female mice (12.4-fold vs. 5.5-fold, respectively; P<0.001).CONCLUSIONSThese results outline a previously unrecognized sex-dependent platelet phenotype where inhibition of thrombin signaling in the peri-MI environment—particularly in males—may be an important consideration.CONDENSED ABSTRACTPreclinical studies evaluating anti-platelet drugs are generally conducted in platelets isolated from healthy individuals. Growing evidence suggests changes in platelet signaling properties in certain disease conditions compared to healthy platelets may alter the response to anti-platelet medications. This investigation revealed that platelets from men and women who are healthy and following MI signal differently, particularly through thromboxane and PAR1 receptors. This effect was especially noted in patients with NSTEMI compared to STEMI. These observations raise the possibility of considering a sex-specific anti-platelet regimen for males and females in atheroembolic vascular diseases such as NSTEMI.

scholarly journals Prevalence of ECGs Exceeding Thresholds for ST‐Segment–Elevation Myocardial Infarction in Apparently Healthy Individuals: The Role of Ethnicity

2020 ◽  
Vol 9 (13) ◽  
Author(s):  
C. Cato ter Haar ◽  
Jan A. Kors ◽  
Ron J. G. Peters ◽  
Michael W. T. Tanck ◽  
Marieke B. Snijder ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Healthy Subjects ◽  
Urban Setting ◽  
Healthy Individuals ◽  
European Descent ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Western European ◽  
Apparently Healthy

Background Early prehospital recognition of critical conditions such as ST‐segment–elevation myocardial infarction (STEMI) has prognostic relevance. Current international electrocardiographic STEMI thresholds are predominantly based on individuals of Western European descent. However, because of ethnic electrocardiographic variability both in health and disease, there is a need to reevaluate diagnostic ST‐segment elevation thresholds for different populations. We hypothesized that fulfillment of ST‐segment elevation thresholds of STEMI criteria (STE‐ECGs) in apparently healthy individuals is ethnicity dependent. Methods and Results HELIUS (Healthy Life in an Urban Setting) is a multiethnic cohort study including 10 783 apparently healthy subjects of 6 different ethnicities (African Surinamese, Dutch, Ghanaian, Moroccan, South Asian Surinamese, and Turkish). Prevalence of STE‐ECGs across ethnicities, sexes, and age groups was assessed with respect to the 2 international STEMI thresholds: sex and age specific versus sex specific. Mean prevalence of STE‐ECGs was 2.8% to 3.4% (age/sex‐specific and sex‐specific thresholds, respectively), although with large ethnicity‐dependent variability. Prevalences in Western European Dutch were 2.3% to 3.0%, but excessively higher in young (<40 years) Ghanaian males (21.7%–27.5%) and lowest in older (≥40 years) Turkish females (0.0%). Ethnicity (sub‐Saharan African origin) and other variables (eg, younger age, male sex, high QRS voltages, or anterolateral early repolarization pattern) were positively associated with STE‐ECG occurrence, resulting in subgroups with >45% STE‐ECGs. Conclusions The accuracy of diagnostic tests partly relies on background prevalence in healthy individuals. In apparently healthy subjects, there is a highly variable ethnicity‐dependent prevalence of ECGs with ST‐segment elevations exceeding STEMI thresholds. This has potential consequences for STEMI evaluations in individuals who are not of Western European descent, putatively resulting in adverse outcomes with both over‐ and underdiagnosis of STEMI.

scholarly journals Risks and Benefits of Thrombolytic, Antiplatelet, and Anticoagulant Therapies for ST Segment Elevation Myocardial Infarction: Systematic Review

2014 ◽  
Vol 2014 ◽  
pp. 1-11 ◽  
Author(s):  
Bruno Ramos Nascimento ◽  
Marcos Roberto de Sousa ◽  
Fábio Nogueira Demarqui ◽  
Antonio Luiz Pinho Ribeiro
Keyword(s):  
Myocardial Infarction ◽  
Multivariate Regression ◽  
Randomized Trials ◽  
Primary Angioplasty ◽  
Medline Search ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Risks And Benefits ◽  
St Segment ◽  
The Impact

Objectives. Assess the impact of associating thrombolytics, anticoagulants, antiplatelets, and primary angioplasty (PA) on death, reinfarction (AMI), and major bleeding (MB) in STEMI therapy. Methods. Medline search was performed to identify randomized trials comparing these classes in STEMI treatment, at least 500 patients, providing death, AMI, and MB rates. Similar arms were grouped. Correlation between number of drugs and PA and the outcomes was evaluated, as well as correlation between the year of the study and the outcomes. Results. Fifty-nine papers remained after exclusions. 404.556 patients were divided into 35 groups of arms. There was correlation between the number of drugs and rates of death (r=-0.466, P=0.005) and MB (r=0.403, P=0.016), confirmed by multivariate regression. This model also showed that PA is associated with lower mortality and increased MB. Year and period of publication correlated with the outcomes: death (r=-0.380, P<0.001), MB (r=0.212, P=0.014), and AMI (r=-0.231, P=0.009). Conclusion. The increasing complexity of STEMI treatment has resulted in significant reduction in mortality along with increased rates of MB. Overall, however, the benefits of treatment outweigh the associated risks of MB.

scholarly journals IMPACT OF ANEMIA IN MEN AND WOMEN WITH ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION: THE HORIZONS-AMI TRIAL

2010 ◽  
Vol 55 (10) ◽  
pp. A138.E1299
Author(s):  
Kenichi Tsujita ◽  
Eugenia Nikolsky ◽  
Alexandra J. Lansky ◽  
Louise Gambone ◽  
Lynn Vandertie ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Men And Women ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

scholarly journals The predictive value of soluble osteoclast-associated receptor for the prognosis of acute coronary syndrome

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Rong Wang ◽  
Jing Wang ◽  
Ling Xie ◽  
Hong-li Cai ◽  
Yi Zhang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Predictive Value ◽  
Multivariate Regression ◽  
Multivariate Regression Analysis ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
History Of

AbstractAt present, prognostic biomarkers of acute coronary syndrome (ACS) are fewer. The aim of this study was to explore the predictive value of soluble osteoclast-associated receptor (sOSCAR) level for the major adverse cardiovascular events (MACE) occurring within 30 days after ACS. From January to August 2020, a total of 108 patients with ACS who were admitted to our hospital, were enrolled in this study. Of the 108 patients, 79 were men and 29 women. Patient-related data, including age, sex, body mass index, history of type 2 diabetes, history of hyperlipidemia and serum sOSCAR level, were collected. All patients were followed up for 30 days. Based on MACE occurrence, the 108 patients were divided into MACE group (n = 17) and non-MACE group (n = 91). The baseline data were compared between the two groups, MACE-independent risk factors were identified by multivariate regression analysis, and the predictive value of sOSCAR for MACE occurring within 30 days after CAS was analyzed using receiver operating characteristic (ROC) curve. At the same time, according to the type of ACS, the 108 patients with ACS were divided into unstable angina (UA) group (n = 29), non ST-segment elevation myocardial infarction (USTEMI) group (n = 45) and ST-segment elevation myocardial infarction (STEMI) group (n = 34), and then the sOSCAR level and MACE incidence were observed in each group. The serum sOSCAR level was significantly lower in the MACE group [130(100,183)] than in the non-MACE group [301(220,370)] (P = 0.000). The area under ROC curve of sOSCAR level for MACE occurring within 30 days after CAS was 0.860 with 95%CI 0.782–0.919, P < 0.001. Multivariate regression analysis indicated that the sOSCAR level was an independent risk factor for the MACE occurring within 30 days after CAS (OR 0.26, 95%CI 0.087–0.777, P = 0.04). The MACE incidence (0%) was the lowest but the sOSCAR level was the highest in the UA group, while in the STEMI group, the MACE incidence (23.53%) was the higest but the sOSCAR level was the lowest among the UA, STEMI and NSTEMI groups. Serum sOSCAR level may be used as a predictor of MACE occurring within the short-term after ACS. The higher the sOSCAR level, the lower the MACE incidence.

Abstract 16624: Gender Disparities Based on Time to Revascularization in the Treatment of Non-st-segment Elevation Myocardial Infarction: An Analysis of 748,439 Nstemi Admissions

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Charan Yerasi ◽  
Brian C Case ◽  
Yanying Wang ◽  
Brian Forrestal ◽  
Joshua Hahm ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Randomized Clinical Trials ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
International Classification Of Diseases ◽  
Study Cohort ◽  
Men And Women ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Background: Multiple studies on Non-ST-segment elevation myocardial infarction (NSTEMI) have shown that women tend to have delayed revascularization, with associated worse outcomes, when compared to men. However, there are no studies to date, evaluating the clinical characteristics and outcomes of men versus (vs.) women based on time to revascularization. Methods: The study cohort was obtained from the 2016 Nationwide Readmissions Database. We used the International Classification of Diseases, Tenth Revision, to identify patients who underwent diagnostic angiography and subsequently received either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Finally, mortality and 30-day readmissions rates based on gender and time to revascularization were extracted. Results: In 2016, there were a total of 748,439 weighted admissions for NSTEMI (57% men and 43% women). Compared to men, women were older and had higher percentage of baseline comorbidities. Women tended to be managed less invasively with only 45% undergoing coronary angiogram as compared to 54% in men (p<0.001). Furthermore, there was a difference in revascularization rates, PCI (men 30% vs. women 21%, p<0.001) or CABG (men 10% vs. women 5%, p<0.001). Majority of men (34%) were revascularized by PCI on same day, while majority of women (30%) were revascularized next-day of admission. In both men and women, patients with more comorbidities tend to have delay in revascularization. Compared to men, in-hospital mortality and 30-day readmission is higher in women as the revascularization is delayed (Figure 1). Conclusions: Currently, there exists wide disparity among men and women in the treatment of NSTEMI. Women tend to have worse outcomes as the revascularization gets delayed. Randomized clinical trials are needed to evaluate if a strategy of urgent revascularization (<90 minutes) in women is associated with improved outcomes.

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