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.

Clinical factors associated with microvascular obstruction in early presenters of ST-segment elevation myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A.L Rivero Monteagudo ◽  
B Arroyo Rivera ◽  
C Garcia Talavera ◽  
M Cortes Garcia ◽  
J.A Franco Pelaez ◽  
...  
Keyword(s):  
Microvascular Obstruction ◽  
Cox Regression ◽  
Class Iii ◽  
Cox Regression Analysis ◽  
Killip Class ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
The Mean ◽  
Predictor Factors

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, 987 patients with STEMI that underwent urgent coronary angiography were retrospectively enlisted. We included 321 patients that were revascularized in ≤3 hours from symptom onset. Clinical and angiographic data were taken from hospital records. A univariate and multivariate Cox regression analysis was made to assess the relationship between MVO (defined as final TIMI &lt;3 in IRA) and potential predictors. Results From the 321 patients included, 76.9% were male and the mean age was 63.6±13.4 years. LVEF at admission was 46.2±12%. The mean time between symptom onset and wire crossing was 2.2±0.6 hours and MVO was found in 43 cases (13.4%). Descriptive data of predictor factors and their association with MVO are shown in Table 1. After the multivariate Cox regression analysis, smoking was a protector factor of MVO (OR 0.39 [0.16–0.96]). Age (OR 1.03 [1.01–1.06]) and Killip class III-IV at admission (OR 5.96 [2.1–16.4]) were directly associated with MVO. No other clinical variables were independently associated with the occurrence of MVO. Conclusions In very early presenters of STEMI, age and Killip class III-IV at admission were clinical predictor factors of MVO. Current smoking could carry a protector mechanism for MVO in this population, that is yet to be confirmed with prospective studies. Funding Acknowledgement Type of funding source: None

scholarly journals STEMI around-the-clock: how off-hours admissions impact door-to-balloon time and the long-term prognosis of ST-segment Elevation Myocardial Infarction

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Martinho ◽  
A Briosa ◽  
R Cale ◽  
E Pereira ◽  
A R Pereira ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Cox Regression ◽  
Clinical Severity ◽  
Cox Regression Analysis ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Door To Balloon ◽  
Long Term Mortality

Abstract Introduction The outcomes of reperfusion in ST-segment Elevation Myocardial Infarction (STEMI) are time-dependent, and percutaneous coronary intervention (PCI) should be performed within 60 minutes from hospital admission in PCI centers – door-to-balloon time (D2B). The association between Off-Hours Admission (OHA) and long-term outcomes is controversial when considering contemporary organized STEMI networks. Purpose This study aims to analyze how OHA influences D2B and long-term mortality. Methods Retrospective study of consecutive STEMI patients (pts), admitted in a PCI-centre with a local Emergency Department, between 2010 and 2015. Pts submitted to rescue-PCI were excluded. OHA was defined as admission at night (8p.m. to 8a.m), weekends and nonworking holidays. Predictors of OHA and D2B were studied by logistic regression analysis. Demographic, clinical, angiographic and procedural variables were evaluated using stepwise Cox regression analysis to determine independent predictors of 5-year all-cause mortality (5yM). The cumulative incidence of 5yM stratified by hours of admission was calculated according to the Kaplan-Meier method. Results Of 901 pts, 472pts (52.4%) were admitted during off-hours. These pts were younger (61±13 vs 64±12, p=0.002) and had a lower median patient-delay time (128min vs 157min, p=0.014). Clinical severity at presentation, defined by systolic arterial pressure and Killip-Kimball (KK) class, did not differ between groups. OHA did not impact D2B (89 min vs 88 min, p=0.550), which was in turn influenced by age ≥75y (OR 1.85, 95% CI 1.31–2.61, p&lt;0.001). Mean clinical follow-up (FUP) was 68±37 months, with 75.1% of pts achieving a FUP &gt;5 years. 5yM rate was 9.7%. After multivariate cox regression analysis, independent determinants of long-term mortality were age (HR 1.05, 95% CI 1.02–1.08, p&lt;0.001), previous history of heart failure (HR 6.76, 95% CI 1.32–34.72, p=0.022) and pulmonary disease (HR 3.79, 95% CI 1.16–12.33, p=0.027), presentation with KK ≥2 (HR 2.82, 95% CI 1.32–6.01, p=0.007) and radial artery access in catheterization (HR 0.39, 95% CI 0.18–0.83, p=0.014) – figure 1. Although there was an association between a higher D2B time and 5yM (87min vs 101min, p=0.024), neither OHA nor D2B were independent predictors of long-term mortality – figure 2. Conclusion OHA did not seem to influence D2B and long-term STEMI outcomes in our PCI-centre. 5yM was mostly influenced by patient characteristics and clinical severity at presentation. FUNDunding Acknowledgement Type of funding sources: None. Figure 1. Predictors of long-term mortality Figure 2. 5-year survival stratified by OHA

scholarly journals Trends in Short‐ and Long‐Term ST‐Segment–Elevation Myocardial Infarction Prognosis Over 3 Decades: A Mediterranean Population‐Based ST‐Segment–Elevation Myocardial Infarction Registry

2020 ◽  
Vol 9 (20) ◽  
Author(s):  
Cosme García‐García ◽  
Teresa Oliveras ◽  
Jordi Serra ◽  
Joan Vila ◽  
Ferran Rueda ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Ventricular Fibrillation ◽  
Cox Regression ◽  
Mediterranean Population ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
The Past ◽  
St Segment ◽  
All Cause Mortality ◽  
Multivariable Adjustment

Background Coronary artery disease remains a major cause of death despite better outcomes of ST‐segment–elevation myocardial infarction (STEMI). We aimed to analyze data from the Ruti‐STEMI registry of in‐hospital, 28‐day, and 1‐year events in patients with STEMI over the past 3 decades in Catalonia, Spain, to assess trends in STEMI prognosis. Methods and Results Between February 1989 and December 2017, a total of 7589 patients with STEMI were admitted consecutively. Patients were grouped into 5 periods: 1989 to 1994 (period 1), 1995 to 1999 (period 2), 2000 to 2004 (period 3), 2005 to 2009 (period 4), and 2010 to 2017 (period 5). We used Cox regression to compare 28‐day and 1‐year STEMI mortality and in‐hospital complication trends across these periods. Mean patient age was 61.6±12.6 years, and 79.3% were men. The 28‐day all‐cause mortality declined from period 1 to period 5 (10.4% versus 6.0%; P <0.001), with a 40% reduction after multivariable adjustment (hazard ratio [HR], 0.6; 95% CI, 0.46–0.80; P <0.001). One‐year all‐cause mortality declined from period 1 to period 5 (11.7% versus 9.0%; P =0.001), with a 24% reduction after multivariable adjustment (HR, 0.76; 95% CI, 0.60–0.98; P =0.036). A significant temporal reduction was observed for in‐hospital complications including postinfarct angina (−78%), ventricular tachycardia (−57%), right ventricular dysfunction (−48%), atrioventricular block (−45%), pericarditis (−63%), and free wall rupture (−53%). Primary ventricular fibrillation showed no significant downslope trend. Conclusions In‐hospital STEMI complications and 28‐day and 1‐year mortality rates have dropped markedly in the past 30 years. Reducing ischemia‐driven primary ventricular fibrillation remains a major challenge.

scholarly journals 251 Prognostic role of acute myocardial infarction diagnostic criteria in non-ST segment elevation myocardial infarction

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Angelo Sansonetti ◽  
Matteo Armillotta ◽  
Michele Fabrizio ◽  
Francesco Angeli ◽  
Luca Bergamaschi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Diagnostic Criteria ◽  
Cox Regression ◽  
Prognostic Role ◽  
Clinical Criteria ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Acute Myocardial Injury

Abstract Aims Although patients with ST segment elevation myocardial infarction (STEMI) and non-ST segment elevation myocardial infarction (NSTEMI) share similar risk factors and similar pathophysiology, their outcomes differ considerably. The Fourth Universal Definition of Myocardial Infarction (UDMI) defined acute myocardial infarction (AMI) by an acute myocardial injury together with clinical evidence of acute myocardial ischaemia. However, the prognostic role of each single diagnostic criteria has never been explored. To evaluate the prognostic role of the different diagnostic criteria of AMI according to the Fourth UDMI in patients with STEMI vs. NSTEMI. Methods and results We enrolled all consecutive patients with AMI undergoing coronary angiogram at our Centre. We used a combination of criteria, according to the current ESC guidelines, to meet the diagnosis, namely the detection of an increase and/or decrease of high-sensitivity cardiac troponin I, with at least one value above the 99th percentile of the upper reference limit and at least one of the following: symptoms of ischaemia; ECG changes (new ST-T changes or new left bundle branch block); development of pathological Q waves in the ECG; echocardiographic evidence of new loss of viable myocardium, or new regional wall motion abnormality. According to the ECG presentation at admission, patients with AMI were divided into STEMI and NSTEMI subgroups. All-cause mortality and a composite endpoint of all-cause mortality, re-hospitalization for heart failure, and myocardial re-infarction were collected. The predictive value of diagnostic criteria alone and their association was evaluated using Kaplan–Meier survival curves and subsequent Cox-regression analysis to find independent predictors of adverse events. 2345 patients were evaluated (41.6% STEMI and 58.4% NSTEMI). The two groups had similar baseline characteristics. The total number of events was 689 (292 in STEMI group and 397 in NSTEMI group). We found that clinical criteria alone showed a positive predictive value in NSTEMI (P &lt; 0.001). Moreover, electrocardiographic and echocardiographic criteria correlated with a worse prognosis in STEMI group (P &lt; 0.01). No other significant prognostic correlation was found. Multivariable Cox-regression model demonstrated that clinical criteria were the only independent predictors of better prognosis in patients with NSTEMI (HR = 0.48; 95% CI: 0.31–0.74; P &lt; 0.001). We did not find any predictor of outcome in patients with STEMI (HR = 0.6; 95% CI: 0.3–1.5, P = 0.3; HR = 1.1; 95% CI: 0.5–2.6, P = 0.7; HR = 0.6; 95% CI: 0.3–1.2, P = 0.2 for clinical and echocardiographic criteria alone and their combination, respectively). Conclusions Our data suggest that in NSTEMI the prognosis is considerably better if clinical criteria alone are present at admission. We hypothesize that the absence of electrocardiographic and echocardiographic alterations in NSTEMI could indirectly indicate smaller infarct sizes or other causes of acute myocardial injury.

scholarly journals Kisspeptin serum levels in acute myocardial infarction patients and healthy individuals

2018 ◽  
Vol 5 (3) ◽  
pp. 2111-2118 ◽  
Author(s):  
Mohammad Shojaei ◽  
Saeideh Erfanian ◽  
Abdolreza Sotoodeh Jahromi ◽  
Naeimeh Yusefi ◽  
Abdolhossein Madani ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Serum Levels ◽  
Serum Concentrations ◽  
Healthy Individuals ◽  
Control Groups ◽  
Blood Samples ◽  
St Segment Elevation ◽  
St Segment ◽  
And Control

Introduction: Acute myocardial infarction (AMI) is a leading cause of mortality worldwide for which several risk factors have been identified. Kisspeptin is a multifunctional peptide observed in atherosclerotic plaques. This study aimed to compare kisspeptin serum levels in AMI patients and healthy individuals. Methods: This case-control study was conducted on patients visiting the Cardiology department of Peymanieh Hospital, Jahrom University of Medical Sciences, Iran. Participants were randomly divided into a case and a control groups; the former consisting of 90 AMI patients and the latter of 90 healthy individuals with no cardiac diseases. Blood samples were collected from the participants who also completed the given questionnaire. The enzyme-linked immunosorbent assay (ELISA) test was used to determine kisspeptin levels following serum separation from collected blood samples. Data analysis was performed in SPSS-19 using descriptive (mean and standard deviation) and analytical (The Mann-Whitney U test) statistical tests. Results: The mean age of treatment and control groups was 60.91 and 61.72 years, respectively. The majority (73.3%) of participants in this study were men. Kisspeptin serum concentrations were demonstrated to be significantly lower in the case group than the control group (P<0.001). The results of Mann-Whitney U test revealed that kisspeptin serum concentrations of case and control groups did not have a significant relationship with such variables as gender, smoking, and ST-segment elevation and non-ST-segment elevation (P>0.05). Conclusion: The results revealed that kisspeptin serum concentrations of AMI patients were significantly lower than those of healthy individuals. Accordingly, kisspeptin deficiency appears to be a risk factor for AMI. However, due to the multifunctional nature of this peptide, further studies are necessary to discover its precise mechanism of action.

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 &gt;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 &gt;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&lt;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

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