Abstract 16297: Persistent and Delayed Depression Predict All-cause Unplanned Rehospitalisations Following Acute Myocardial Infarction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Samia R Toukhsati ◽  
David L Hare
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Risk Factor ◽  
Cox Regression ◽  
Hospital Readmissions ◽  
Depression Scale ◽  
Psychological Resilience ◽  
Cardiac Depression ◽  
Kaplan Meier ◽  
Period 2

Introduction: Depression following acute myocardial infarction (AMI) is a risk factor for future events and mortality. The aim of this study was to explore the post-AMI trajectory of depression as a risk factor for all-cause unplanned rehospitalisations. Methods: A total of 118 adults (101 men; mean±SD age = 64.76±11.16 years) completed the Cardiac Depression Scale (CDS) during and one month following AMI admission. On the basis of their CDS scores during index admission and 30 days post-AMI (≥ 95 = probable major depression) patients were categorized as having chronic; absent; recovered; or delayed depression. All-cause, unplanned rehospitalisations were sourced from electronic hospital databases (Cerner and TrakCare) from the time of the enrolment admission to census (11 th Dec 2019). Time in the study ranged from 61 days to 4.8 years. Results: A total of 41% of the sample (n = 48) had ≥ 1 all-cause unplanned rehospitalisation following their index AMI admission. Kaplan Meier Survival analyses revealed that worsening or persistent depression trajectories had earlier unplanned rehospitalisations (p < .05). Pairwise Log Rank tests showed that patients with delayed depression had significantly less time to their first all-cause unplanned rehospitalisation compared to those with absent or recovered depression (p < .05). Patients with chronic depression had significantly earlier unplanned rehospitalisations than those with recovered depression (p < .05). Cox Regression analyses revealed that chronic (HR = 9.62109 [95% CI 2.53, 36.62] and delayed depression (HR = 2.94 [95% CI 1.08, 7.97] significantly increased the risk of all-cause unplanned rehospitalisations, after adjusting for time in the study, demographic factors, illness severity, heart disease knowledge, state anxiety and psychological resilience. Conclusions: Persistent or delayed trajectories of depression from admission to 30 days following AMI independently increases the risk of all-cause unplanned hospital readmissions. Patients should be screened for depression during AMI admission and throughout the early adjustment period (2-3 months post-AMI). Further research to increase capacity to predict post-AMI depression trajectories is warranted.

scholarly journals The association between plasma furin and cardiovascular events after acute myocardial infarction

2020 ◽  
Author(s):  
Zhi-wei Liu ◽  
Qiang Ma ◽  
Jie Liu ◽  
Jing-Wei Li ◽  
Yun-Dai Chen
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Regression Analysis ◽  
Cox Regression ◽  
Critical Role ◽  
Cardiac Events ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
Atheromatous Plaques ◽  
Key Enzyme

Abstract Background: Furin is the key enzyme to cleave pro-BNP and plays a critical role in the cardiovascular system through its involvement in the lipid metabolism, blood pressure and formation of atheromatous plaques. NT-proBNP and recently corin, which is also a key enzyme to cleave pro-BNP, have been approved as predictors of prognosis after acute myocardial infarction (AMI). We here conducted this cohort study to investigate the relationship between plasma furin and the prognosis outcome in patients after AMI. Methods: We enrolled 1100 AMI patients and measured their plasma furin concentration. The primary endpoint was the major adverse cardiac events (MACE), a composite of cardiovascular (CV) death, non-fatal myocardial infarction or non-fatal stroke. The association of plasma furin concentration with AMI outcomes was explored by using Kaplan–Meier curve and multivariate Cox regression analysis. Results: Our results showed that slight increase of mean cTNT in patients with higher furin concentration (P=0.016). Over a median follow-up of 31 months, multivariate Cox regression analysis suggested that plasma furin was not associated with MACE (HR: 1.01; 95% CI: 0.93-1.06; P=0.807) after adjustment for potential conventional risk factors. However, plasma furin was associated with non-fatal MI (HR: 1.09; 95% CI: 1.01-1.17; P=0.022) after fully adjustment. Subgroup analysis indicated no relationship between plasma furin and MACE in different subgroup populations.Conclusions: Our study demonstrated that plasma furin was not associated with risk of MACE and may not be used as a predictor of poor prognosis after AMI. But higher levels of plasma furin may be associated with higher risk of non-fatal MI.

scholarly journals The association between plasma furin and cardiovascular events after acute myocardial infarction

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zhi-Wei Liu ◽  
Qiang Ma ◽  
Jie Liu ◽  
Jing-Wei Li ◽  
Yun-Dai Chen
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Regression Analysis ◽  
Cox Regression ◽  
Critical Role ◽  
Cardiac Events ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
Atheromatous Plaques ◽  
Key Enzyme

Abstract Background Furin is the key enzyme involved in the cleavage of pro-BNP and plays a critical role in the cardiovascular system through its involvement in lipid metabolism, blood pressure regulation and the formation of atheromatous plaques. NT-proBNP and recently, corin, also a key enzyme in the cleavage of pro-BNP, have been accepted as predictors of prognosis after acute myocardial infarction (AMI). This cohort study was conducted to investigate the relationship between plasma furin and the prognostic outcomes of AMI patients. Methods In total, 1100 AMI patients were enrolled in the study and their plasma furin concentrations were measured. The primary endpoint was major adverse cardiac events (MACE), a composite of cardiovascular (CV) death, non-fatal myocardial infarction (MI) and non-fatal stroke. The associations between plasma furin concentration and AMI outcomes were explored using Kaplan–Meier curves and multivariate Cox regression analysis. Results The results showed a slight increase in mean cTNT in patients with higher furin concentrations (P = 0.016). Over a median follow-up of 31 months, multivariate Cox regression analysis indicated that plasma furin was not significantly associated with MACE (HR 1.01; 95% CI 0.93–1.06; P = 0.807) after adjustment for potential conventional risk factors. However, plasma furin was associated with non-fatal MI (HR 1.09; 95% CI 1.01–1.17; P = 0.022) in the fully adjusted model. Subgroup analyses indicated no relationship between plasma furin and MACE in different subgroups. Conclusions This study found no association between plasma furin and risk of MACE. Thus, plasma furin may not be a useful predictor of poor prognosis after AMI. However, higher levels of plasma furin may be associated with a higher risk of recurrent non-fatal MI.

scholarly journals Incidence, predictors, and prognostic impact of recurrent acute myocardial infarction in China

Heart ◽  
2020 ◽  
pp. heartjnl-2020-317165
Author(s):  
Jiali Song ◽  
Karthik Murugiah ◽  
Shuang Hu ◽  
Yan Gao ◽  
Xi Li ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cox Regression ◽  
Early Period ◽  
Coronary Intervention ◽  
Rank Test ◽  
Prognostic Impact ◽  
Cardiac Events ◽  
Kaplan Meier ◽  
Multivariable Modelling

BackgroundIncidence, predictors, and prognostic impact of recurrent acute myocardial infarction (AMI) after initial AMI remain poorly understood. Data on recurrent AMI in China is unknown.MethodsUsing the China Patient-centred Evaluative Assessment of Cardiac Events (PEACE)-Prospective AMI Study, we studied 3387 patients admitted to 53 hospitals for AMI and discharged alive. The association of recurrent AMI with 1-year mortality was evaluated using time-dependent Cox regression. Recurrent AMI events were classified as early (1–30 days), late (31–180 days), and very late (181–365 days). Their impacts on 1-year mortality were estimated by Kaplan-Meier methodology and compared by the log-rank test. Multivariable modelling was used to identify factors associated with recurrent AMI.ResultsThe mean (SD) age was 60.7 (11.9) years and 783 (23.1%) were women. The observed 1-year recurrent AMI rate was 2.5% (95% CI 2.00 to 3.07) with 35.7% events occurring within the first 30 days. Recurrent AMI was associated with 1-year mortality with an adjusted HR of 25.42 (95% CI 15.27 to 42.34). Early recurrent AMI was associated with the highest 1-year mortality rate of 53.3% (log-rank p<0.001). Predictors of recurrent AMI included age 75–84, in-hospital percutaneous coronary intervention, heart rate >90 min/beats at initial admission, renal dysfunction, and not being prescribed any of guideline-based medications at discharge.ConclusionsOne-third of recurrent AMI events occurred early. Recurrent AMI is strongly associated with 1-year mortality, particularly if early. Heightened surveillance during this early period and improving prescription of recommended discharge medications may reduce recurrent AMI in China.

scholarly journals Hs-CRP to albumin ratio predicts mortality of acute myocardial infarction patients with chronic kidney disease undergoing coronary angiography

2021 ◽  
Author(s):  
Bo Zuo ◽  
Jiayu Li ◽  
Hui Chen
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Coronary Angiography ◽  
Cox Regression ◽  
Roc Curve Analysis ◽  
Albumin Ratio ◽  
Kaplan Meier ◽  
Hs Crp

Abstract Background The diagnosis and treatment of acute myocardial infarction (AMI) patients with chronic kidney disease (CKD) is still a challenging problem. The high sensitivity C-reactive protein (hs-CRP) to albumin ratio (HCAR) was proved to be a sensitive biomarker in predicting the prognosis of many diseases. The purpose of this study was to investigate the prognostic value of HCAR in postoperative 2-year mortality of AMI patients with CKD undergoing coronary angiography(CAG). Methods A total of 11933 patients underging CAG were collected in this retrospective study. Finally, 466 AMI patients with CKD undergoing CAG were enrolled. HCAR was calculated by dividing hs-CRP by albumin obtained from blood biochemical examination. Patients were divided into two groups according to the HCAR cutoff value in predicting 2-year mortality by Receiver operating characteristic (ROC) curve analysis. The primary endpoint was all-cause mortality at a 2-year follow-up. The Kaplan-Meier method and Cox regression analyses were used to analyze the survival of patients. Results A significant correlation was found between HCAR and NT-proBNP, LVEF, CK-MB, TnI and eGFR (P < 0.05). A cut-off value of 0.24 of HCAR predicted 2-year mortality, with a sensitivity of 66.18% and specificity of 52.21% (ROC area under the curve: 0.60, 95% CI: 0.53–0.68, P < 0.001). A higher HCAR was significantly associated with a higher 2-year mortality rate (45/236 (19%) vs. 23/230 (10%), P = 0.006). The Kaplan-Meier curve showed that the group with a higher HCAR had a worse prognosis (log-rank P < 0.001). HCAR was an independent risk factor for 2-year mortality (OR: 1.779, 95% CI: 1.017–3.112, P = 0.043). Conclusion HCAR might be a potential prognostic indicator of AMI patients with CKD undergoing CAG.

scholarly journals The Association Between Plasma Furin and Cardiovascular Events After Acute Myocardial Infarction

2020 ◽  
Author(s):  
Zhi-wei Liu ◽  
Qiang Ma ◽  
Jie Liu ◽  
Jing-Wei Li ◽  
Yun-Dai Chen
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Regression Analysis ◽  
Cox Regression ◽  
Critical Role ◽  
Cardiac Events ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
Atheromatous Plaques ◽  
Key Enzyme

Abstract Background: Furin is the key enzyme to cleave pro-BNP, and plays a critical role in the cardiovascular system through its involvement in the lipid metabolism, blood pressure and formation of atheromatous plaques. NT-proBNP and recently corin, which is also a key enzyme to cleave pro-BNP, have been approved as predictors of prognosis after acute myocardial infarction (AMI). We here conducted this prospective cohort study to investigate the relationship between plasma furin and the prognosis outcome in patients after AMI. Methods: We enrolled 1100 AMI patients and measured their plasma furin concentration. The primary endpoint was the major adverse cardiac events (MACE), a composite of cardiovascular (CV) death, non-fatal myocardial infarction or non-fatal stroke. The association of plasma furin concentration with AMI outcomes was explored by using Kaplan–Meier curve and multivariate Cox regression analysis. Results: Our results showed that slight increase of mean cTNT in patients with higher furin concentration (P=0.016). Over a median follow-up of 31 months, multivariate Cox regression analysis suggested that plasma furin was not associated with MACE (HR: 1.01; 95% CI: 0.93-1.06; P=0.807) after adjustment for potential conventional risk factors. However, plasma furin was associated with non-fatal MI (HR: 1.09; 95% CI: 1.01-1.17; P=0.022) after fully adjustment. Subgroup analysis indicated no relationship between plasma furin and MACE in different subgroup populations.Conclusions: Our study demonstrated that plasma furin was not associated with risk of MACE and may not be used as a predictor of poor prognosis after AMI. But higher levels of plasma furin may be associated with higher risk of non-fatal MI, future studies are needed to verify this.

scholarly journals 249 Prognostic role of diagnostic criteria of acute myocardial infarction

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Matteo Armillotta ◽  
Angelo Sansonetti ◽  
Francesco Angeli ◽  
Michele Fabrizio ◽  
Andrea Stefanizzi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Diagnostic Criteria ◽  
Predictive Value ◽  
Cox Regression ◽  
Prognostic Role ◽  
Clinical Criteria ◽  
Kaplan Meier ◽  
All Cause Mortality

Abstract Aims The term acute myocardial infarction (AMI) reflects cell death of cardiac myocytes caused by ischaemia. The Fourth Universal Definition of Myocardial Infarction (UDMI) defined AMI by a typical rise and fall in the level of biochemical markers of myocardial necrosis together with criteria of 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. Methods and results We enrolled all consecutive patients with AMI admitted from 2016 to 2019. 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; imaging evidence of new loss of viable myocardium or new regional wall motion abnormality, in our study evaluated by transthoracic echocardiogram. 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 its association were evaluated using Kaplan–Meier survival curves and subsequent Cox-regression analysis to find independent predictors of adverse events. 2386 patients were evaluated. The median follow-up time was 23.3 ± 14.5 months. The total number of events was 703 (29.5%). Kaplan–Meier curves showed that major adverse cardiac events (MACEs) were statistically different depending on the diagnostic criteria of AMI at admission. Particularly, clinical criteria alone showed a better predictive value (P &lt; 0.001) than other diagnostic AMI criteria. Multivariable Cox-regression model demonstrated that clinical criteria were the independent predictor of good prognosis in patients with AMI (HR = 0.43; 95% CI: 0.28–0.67; P &lt; 0.001). Conversely, the other diagnostic criteria (electrocardiographic and echocardiographic) and the combination of all diagnostic criteria were not independent prognostic factors of MACEs (HR = 1.1; 95% CI: 0.6–2.4, P = 0.6; HR = 1.1; 95% CI: 0.7–1.9, P = 0.6; HR = 0.9; 95% CI: 0.7–1.0, P = 0.2, respectively). Conclusions Our data suggest that the prognosis is considerably better among patients with a diagnosis of AMI if clinical criteria alone are present at admission. We also demonstrated that clinical criteria are a strong prognostic predictor of good outcomes in patients with AMI. We hypothesize that the absence of electrocardiographic and echocardiographic alterations could indirectly indicate a smaller infarct sizes that contribute to patients’ outcome.

scholarly journals Psychometric Evaluation of a Persian Version of the Cardiac Depression Scale in Iranian Patients With Acute Myocardial Infarction

2018 ◽  
Vol 26 (1) ◽  
pp. E1-E15
Author(s):  
Hamid Sharif Nia ◽  
Saeed Pahlevan Sharif ◽  
Erika Sivarajan Froelicher ◽  
Christopher Boyle ◽  
Amir Hossein Goudarzian ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Construct Validity ◽  
Depression Scale ◽  
Reliability And Validity ◽  
Psychometric Evaluation ◽  
Persian Version ◽  
Cardiac Depression ◽  
Cardiac Depression Scale ◽  
Iranian Patients

Purpose: The aim of this study was to validate a Persian version of the Cardiac Depression Scale (CDS) in Iranian patients with acute myocardial infarction (AMI). Methods: The CDS was forward translated from English into Persian and back-translated to English. Validity was assessed using face, content, and construct validity. Also Cronbach’s alpha (α), theta (θ), and McDonald’s omega coefficient were used to evaluate the reliability. Results: Construct validity of the scale showed two factors with eigenvalues greater than one. The Cronbach’s α, θ, McDonald’s omega, and construct reliability were greater than .70. Conclusion: The Persian version of the CDS has a two-factor structure (i.e., death anxiety and life satisfaction) and has acceptable reliability and validity. Therefore, the validated instrument can be used in future studies to assess depression in patients with AMI in Iranians.

scholarly journals Uveitis as a Risk Factor for Developing Acute Myocardial Infarction in Ankylosing Spondylitis: A National Population-Based Longitudinal Cohort Study

2022 ◽  
Vol 12 ◽  
Author(s):  
Yi-Fen Lai ◽  
Ting-Yi Lin ◽  
Wu-Chien Chien ◽  
Chien-An Sun ◽  
Chi-Hsiang Chung ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Risk Factor ◽  
Ankylosing Spondylitis ◽  
Systemic Inflammation ◽  
Hazard Ratio ◽  
Research Database ◽  
Kaplan Meier ◽  
Increased Risk

BackgroundAnkylosing spondylitis (AS) is a chronic inflammatory disease. Excess cardiovascular risks were well recognized in patients with AS and were attributed to prolonged systemic inflammation. Uveitis is one of the most common extra-articular symptoms of AS and is also considered an indicator of systemic inflammation. This study aimed to investigate whether uveitis was a risk factor for developing acute myocardial infarction (AMI) in patients with AS using the National Health Insurance Research Database (NHIRD).MethodsData were collected from the NHIRD over a fifteen-year period. Variables were analyzed using the Pearson chi-square test and Fisher’s exact test. Risk factors for the occurrence of AMI were examined by calculating hazard ratio. Kaplan-Meier analysis was performed to compare the cumulative incidence of AMI in the uveitis and non-uveitis cohorts.ResultsA total of 5905 patients with AS were enrolled, including 1181 patients with uveitis (20%) and 4724 patients without uveitis (80%). The Kaplan–Meier method with the log-rank test showed that the uveitis group had a significantly higher cumulative hazard for patients with AMI than the non-uveitis group (p &lt; 0.001). The adjusted hazard ratio (aHR) of AMI was higher in the uveitis group than in the non-uveitis group (aHR = 1.653, p &lt; 0.001). Stratified analysis revealed that patients with uveitis had an increased risk of developing AMI regardless of their sex (male/female aHR = 1.688/1.608, p &lt; 0.001). Patients with uveitis in all age groups were independently associated with an increased risk of developing AMI compared to those without uveitis (20–39 years/40–59 years/≥ 60 years, aHR = 1.550, 1.579, 3.240, p &lt; 0.001). Patients with uveitis had a higher probability of developing AMI regardless of comorbidities. Uveitis patients with comorbidities had a higher risk of developing AMI compared to uveitis patients without comorbidities.ConclusionUveitis is a significant risk factor for developing AMI in patients with AS. Physicians should be aware of the potential cardiovascular risk in AS patients with uveitis, especially simultaneously with other traditional risk factors of AMI. Further prospective studies are needed to elucidate the underlying mechanism between uveitis and AMI in patients with AS.

scholarly journals Uveitis as a potential predictor of acute myocardial infarction in patients with Behcet’s disease: a population-based cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e042201
Author(s):  
Yu-Yen Chen ◽  
Yun-Ju Lai ◽  
Yung-Feng Yen ◽  
Hsin-Hua Chen ◽  
Pesus Chou
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cohort Study ◽  
Behcet’S Disease ◽  
Cox Regression ◽  
Behçet's Disease ◽  
Skin Lesions ◽  
Cumulative Hazard ◽  
Potential Predictor ◽  
Kaplan Meier

ObjectivesTo investigate whether uveitis is a predictor of acute myocardial infarction (AMI) among patients with Behcet’s disease (BD).DesignRetrospective cohort study.SettingPatients with BD were retrieved from the whole population of the Taiwan National Health Insurance Research Database from 1 January 2001 to 31 December 2013.ParticipantsAmong the 6508 patients with BD, 2517 (38.7%) were in the uveitis group and 3991 were in the non-uveitis group.Primary and secondary outcome measuresKaplan-Meier curves were generated to compare the cumulative hazard of AMI in the uveitis and non-uveitis groups. Multivariate Cox regression analysis was used to estimate the adjusted HRs and 95% CI of AMI, and was adjusted for age, gender, systemic comorbidities (eg, hypertension, diabetes, hyperlipidaemia, smoking) and clinical manifestation of BD (eg, oral ulcers, genital ulcers, skin lesions, arthritis and gastrointestinal involvement).ResultsThe mean age of the BD cohort was 38.1±15.1 years. Compared with non-uveitis patients, uveitis patients were significantly younger and male predominant. There was no significant difference between the two groups for most proportions of systemic comorbidities and clinical manifestations. The Kaplan-Meier method with the log-rank test showed that the uveitis group had a significantly higher cumulative hazard for patients with AMI compared with the non-uveitis group (p<0.0001). In the multivariable Cox regression after adjustment for confounding factors, patients with uveitis had a significantly higher risk of AMI (adjusted HR 1.87; 95% CI 1.52 to 2.29). Other significant risk factors for AMI were age, hypertension, smoking, and skin lesions.ConclusionsStatistical analyses from the nationwide database demonstrated that uveitis is a potential predictor of AMI in patients with BD.

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