Abstract TP192: Four-Year Incidence of Major Adverse Cardiovascular Events in Patients With Established Cerebrovascular Disease

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Benjamin Miao ◽  
Adrian Hernandez ◽  
Mark Alberts ◽  
Yuani Roman ◽  
Craig Coleman
Keyword(s):  
Myocardial Infarction ◽  
Ischemic Stroke ◽  
Cerebrovascular Disease ◽  
Cardiovascular Events ◽  
Enzyme Inhibitor ◽  
Oral Anticoagulants ◽  
Data Availability ◽  
Major Adverse Cardiovascular Events ◽  
P2y12 Inhibitors

Introduction: Data on the contemporary risk of major adverse cardiovascular events (MACE) in patients with established cerebrovascular disease (CVD) are needed. Objective: To evaluate the 4-year incidence of MACE in patients with established CVD. Methods: Using US IBM MarketScan claims we identified patients ≥45-years old with billing codes indicating established CVD during the 2013 calendar year (baseline). Starting on January 1, 2014, patients identified as having CVD were followed for the occurrence of MACE (defined as the composite of cardiovascular death, ischemic stroke or myocardial infarction). To be included in this analysis patients had to have a minimum of 4-years (±3-months) of available follow up prior to the end-of-data availability (December 31, 2017). Secondary study outcomes included the incidence of individual MACE components. Results: We identified 48,160 patients with CVD with a minimum 4-years (±3-months) of follow up. At baseline, the median (25%, 75% range) age of patients was 71 years (59, 79), 47.6% were women and 27.9% had disease in at least 1 additional vascular bed (16.9% coronary, 14.9% peripheral, 25.7% carotid). Stroke risk factors included hypertension (90.4%), hypercholesterolemia (68.6%), heart failure (21.6%) and atrial fibrillation (21.0%). During 2013, CVD patients were receiving angiotensin-converting enzyme inhibitor/receptor blockers (57.5%), beta-blockers (50.5%), calcium antagonists (34.9%), diuretics (41.0%), oral anticoagulants (19.1%), P2Y12 inhibitors (27.0%) and statins (65.7%). During the 4-years of follow up, 11.5% of established CVD patients experienced MACE. Of these, 8.3% had an ischemic stroke, 4.9% had a myocardial infarction and 1.2% died of cardiovascular causes. Conclusions: Patients with established CVD possess a substantial 4-year risk of MACE, notably ischemic stroke.

P6424The association between long-term beta-blocker use and outcome in a contemporary large-scale cohort of patients with acute myocardial infarction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C X Song ◽  
R Fu ◽  
J G Yang ◽  
K F Dou ◽  
Y J Yang
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Beta Blocker ◽  
Cardiovascular Events ◽  
Beta Blockers ◽  
Left Ventricular Ejection ◽  
Major Adverse Cardiovascular Events ◽  
Baseline Characteristics

Abstract Background Controversy exists regarding the use of beta-blockers (BBs) among patients with acute myocardial infarction (AMI) in contemporary reperfusion era. Previous studies predominantly focused on beta-blockers prescribed at discharge, and the effect of long-term adherence to beta-blocker on major adverse cardiovascular events (MACE) remains unclear. Objective To explore the association between long-term beta-blocker use patterns and MACE among contemporary AMI patients. Methods We enrolled 7860 patients with AMI, who were discharged alive and prescribed with BBs based on CAMI registry from January 2013 to September 2014. Patients were divided into two groups according to BBs use pattern: Always users group (n=4476) were defined as patients reporting BBs use at both 6- and 12-month follow-up; Inconsistent users group were defined as patients reporting at least once not using BBs at 6- or 12-month follow-up. Primary outcome was defined as MACE at 24-month follow-up, including all-cause death, non-fatal MI and repeat-revascularization. Multivariable cox proportional hazards regression model was used to assess the association between BBs and MACE. Results Baseline characteristics are shown in table 1. At 2-year follow-up, 518 patients in inconsistent users group (15.6%) and 548 patients in always users group (12.3%) had MACE. After multivariable adjustment, inconsistent use of BBs was associated with higher risk of MACE (HR: 1.323, 95% CI: 1.171–1.493, p<0.001). Table 1 Baseline characteristics Variable Always user (N=4476) Inconsistent user (N=3384) P value Age (years) 60.6±12.0 61.2±12.2 <0.001 Male 3381 (75.7%) 2461 (74.3%) 0.084 Diabetes 892 (20.0%) 610 (18.4%) 0.003 Hypertension 2372 (53.2%) 1543 (46.6%) <0.001 Dyslipidemia 244 (5.5%) 126 (3.8%) <0.001 Prior myocardial infarction 351 (7.9%) 232 (7.0%) <0.001 Heart failure 88 (2.0%) 63 (1.9%) <0.001 Chronic obstructive pulmonary disease 66 (1.5%) 60 (1.8%) <0.001 Current smoker 2054 (46.1%) 1579 (47.8%) 0.179 Left ventricular ejection fraction (%) 53.7±11.48 54.0±10.9 <0.001 Major Adverse Cardiovascular Events 548 (12.3%) 518 (15.6%) <0.001 Conclusions Our results showed consistent BBs use was associated with reduced risk of MACE among patients with AMI managed by contemporary treatment. Acknowledgement/Funding CAMS Innovation Fund for Medical Sciences (CIFMS) (2016-I2M-1-009)

scholarly journals A soft voting ensemble classifier for early prediction and diagnosis of occurrences of major adverse cardiovascular events for STEMI and NSTEMI during 2-year follow-up in patients with acute coronary syndrome

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0249338
Author(s):  
Syed Waseem Abbas Sherazi ◽  
Jang-Whan Bae ◽  
Jong Yun Lee
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Events ◽  
Ensemble Classifier ◽  
Major Adverse Cardiovascular Events ◽  
Test Dataset ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Complete Dataset ◽  
St Segment

Objective Some researchers have studied about early prediction and diagnosis of major adverse cardiovascular events (MACE), but their accuracies were not high. Therefore, this paper proposes a soft voting ensemble classifier (SVE) using machine learning (ML) algorithms. Methods We used the Korea Acute Myocardial Infarction Registry dataset and selected 11,189 subjects among 13,104 with the 2-year follow-up. It was subdivided into two groups (ST-segment elevation myocardial infarction (STEMI), non ST-segment elevation myocardial infarction NSTEMI), and then subdivided into training (70%) and test dataset (30%). Third, we selected the ranges of hyper-parameters to find the best prediction model from random forest (RF), extra tree (ET), gradient boosting machine (GBM), and SVE. We generated each ML-based model with the best hyper-parameters, evaluated by 5-fold stratified cross-validation, and then verified by test dataset. Lastly, we compared the performance in the area under the ROC curve (AUC), accuracy, precision, recall, and F-score. Results The accuracies for RF, ET, GBM, and SVE were (88.85%, 88.94%, 87.84%, 90.93%) for complete dataset, (84.81%, 85.00%, 83.70%, 89.07%) STEMI, (88.81%, 88.05%, 91.23%, 91.38%) NSTEMI. The AUC values in RF were (98.96%, 98.15%, 98.81%), ET (99.54%, 99.02%, 99.00%), GBM (98.92%, 99.33%, 99.41%), and SVE (99.61%, 99.49%, 99.42%) for complete dataset, STEMI, and NSTEMI, respectively. Consequently, the accuracy and AUC in SVE outperformed other ML models. Conclusions The performance of our SVE was significantly higher than other machine learning models (RF, ET, GBM) and its major prognostic factors were different. This paper will lead to the development of early risk prediction and diagnosis tool of MACE in ACS patients.

scholarly journals Impact of type 2 diabetes mellitus and blood glucose admission levels in patients with myocardial infarction with non obstructive coronary artery disease (MINOCA)

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Paolisso ◽  
F Donati ◽  
L Bergamaschi ◽  
S Toniolo ◽  
E.C D'Angelo ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Events ◽  
Independent Predictor ◽  
Major Adverse Cardiovascular Events ◽  
Coronary Syndrome ◽  
Type 2 Dm ◽  
All Cause Mortality ◽  
Age And Sex

Abstract Background Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a heterogeneous clinically entity and represents 5% to 10% of all patients with myocardial infarction (MI). Besides type 2 diabetes mellitus (DM), which is a common comorbidity in patients hospitalized for an acute coronary syndrome, high glucose levels (HGL) at admission are frequently observed in this context. The risk of major adverse cardiovascular events following acute coronary syndrome is increased in people with DM and HGL. However, evidence regarding diabetes and high glucose level among MINOCA patients is lacking. Purpose To examine the incidence of major adverse cardiovascular events (MACEs) in diabetic and non-diabetic MINOCA patients as well as according to HGL at presentation. Methods Among 1995 patients with acute MI admitted to our coronary care unit from 2016 to 2018, we enrolled 186 consecutive MINOCA patients according to the current ESC diagnostic criteria. HGL at admission was defined as serum glucose level above 180 mg/dl. All-cause mortality and a composite end-point of all-cause mortality and myocardial re-infarction were compared. The median follow-up time was 19.6±12.9 months. Results Diabetic MINOCA patients were older (mean age 75.5±9.6 vs 66.5±14.7; p=0.002) and with higher prevalence of hypertension (p=0.016). Conversely, there were no significant differences in gender, BMI, dyslipidemia and atrial fibrillation. Similarly, no significant differences were observed regarding clinical and ECG presentation, echocardiographic features and laboratory tests. The rates of death (30.8% vs 8.3%; p=0.013) and MACEs (22.2% vs 6.8%; p=0.025) were significantly higher in MINOCA-DM patients; conversely, no significant differences were observed for re-MI (p=0.58). At multivariate regression model adjusted for age and sex, type 2 DM was not an independent predictor of all cause deaths (p=0.36) and MACE (p=0.24). Patients with admission HGL had similar baseline characteristics, cardiovascular risk factors, clinical presentations, echocardiographic features and troponin values as compared to patients with no-HGL. HGL at admission was associated with higher incidence of all-cause-death (p&lt;0.001) and MACE (p=0.003) during follow-up compared to patients with no HGL; conversely, no significant differences were observed in the incidence of re-MI (p=0.7). Multivariate analysis adjusted for age and sex demonstrated that HGL was an independent predictor of death (HR 6.25; CI 1.64–23.85; p=0.007) and MACEs (HR 6.17; CI 1.79–21.23, p=0.004). Conclusion In MINOCA patients, HGL was an independent risk factor for both MACEs and death while type 2 DM was not correlated with these hard endpoints. As a consequence, HGL could have a still unexplored pathophysiological role in MINOCA. Properly powered randomized trials are warranted. Funding Acknowledgement Type of funding source: None

scholarly journals Cardiovascular events in metabolically healthy obese. A nationwide cohort study

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
G Fauchier ◽  
A Bisson ◽  
C Semaan ◽  
J Herbert ◽  
A Bodin ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Ischemic Stroke ◽  
Cardiovascular Events ◽  
Cardiovascular Death ◽  
Metabolic Abnormalities ◽  
Metabolically Healthy Obese ◽  
Healthy Obese ◽  
Metabolically Healthy ◽  
New Onset

Abstract Background Obesity is a risk factor for cardiovascular disease (CVD) and has been increasing globally over the past 40 years in many countries worldwide. Metabolic abnormalities such as hypertension, dyslipidemia and diabetes mellitus are commonly associated and may mediate some of the deleterious effects of obesity. A subset of obese individuals without obesity-related metabolic abnormalities may be classified as being “metabolically healthy obese” (MHO). We aimed to evaluate the associations among MHO individuals and different types of incident cardiovascular events in a contemporary population at a nationwide level. Methods From the national hospitalization discharge database, all patients discharged from French hospitals in 2013 with at least 5 years or follow-up and without a history of major adverse cardiovascular event (myocardial infarction, heart failure [HF], ischemic stroke or cardiovascular death, MACE-HF) or underweight/ malnutrition were identified. They were categorized by phenotypes defined by obesity and 3 metabolic abnormalities (diabetes mellitus, hypertension, and hyperlipidemia). In total, 2,953,816 individuals were included in the analysis, among whom 272,838 (9.5%) were obese. We evaluated incidence rates and hazard ratios for MACE-HF, cardiovascular death, myocardial infarction, ischemic stroke, new-onset HF and new-onset atrial fibrillation (AF). Adjustments were made on age, sex and smoking status at baseline. Results During a mean follow-up of 4.9 years, obese individuals with no metabolic abnormalities had a higher risk of MACE-HF (multivariate-adjusted hazard ratio [HR] 1.22, 95% confidence interval [CI]: 1.19–1.24), new-onset HF (HR 1.34, 95% CI 1.31–1.37), and AF (HR 1.33, 95% CI 1.30–1.37) compared with non-obese individuals with 0 metabolic abnormalities. By contrast, risks were not higher for myocardial infarction (HR 0.92, 95% CI 0.87–0.98), ischemic stroke (HR 0.93, 95% CI 0.88–0.98) and cardiovascular death (HR 0.99, 95% CI 0.93–1.04). In the models fully adjusted on all baseline characteristics, obesity was independently associated with a higher risk of MACE-HF events (HR 1.13, 95% CI 1.12–1.14), of new-onset HF (HR 1.19, 95% CI 1.18–1.20) and new-onset AF (HR 1.29, 95% CI 1.28–1.31). This was not the case for the association of obesity with cardiovascular death (HR 0.96, 95% CI 0.94–0.98), myocardial infarction (HR 0.93, 95% CI 0.91–0.95) and ischemic stroke (HR 0.93, 95% CI 0.91–0.96). Conclusions Metabolically healthy obese individuals do not have a higher risk of myocardial infarction, ischemic stroke or cardiovascular death than metabolically healthy non-obese individuals. By contrast they have a higher risk of new-onset HF and new onset AF. Even individuals who are non-obese can have metabolic abnormalities and be at high risk of cardiovascular disease events. Our observations suggest that specific studies investigating different aggressive preventive measures in specific subgroups of patients are warranted. FUNDunding Acknowledgement Type of funding sources: None.

P6217Managed Care after Acute Myocardial Infarction (MC-AMI) reduces MACE by 45% in 3-month follow-up - results form Poland's National Health Fund program of post-MI care. A single center analysis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Kulach ◽  
K Wita ◽  
M Wita ◽  
M Wybraniec ◽  
K Wilkosz ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
National Health ◽  
Cardiovascular Events ◽  
Cox Regression ◽  
Major Adverse Cardiovascular Events ◽  
Control Group ◽  
Single Center ◽  
Post Discharge

Abstract Background Despite progress in the medical and interventional treatment of acute myocardial infarction (AMI) and low in-hospital mortality related to AMI, a post-discharge prognosis in MI survivors is still unacceptable. The Managed Care in Acute Myocardial Infarction (MC-AMI, KOS-zawal) is a program introduced by Poland's National Health Fund aiming at comprehensive care for patients with AMI to improve long-term prognosis. It includes acute intervention, complex revascularization, cardiac rehabilitation (CR), outpatient follow-up, and prevention of SCD. Aims To assess the effect of MC-AMI on major adverse cardiovascular events (MACE) in a 3-month follow-up. Methods In this single-center, retrospective observational study we enrolled 1211 patients, and compared them to 1130 subjects in the control group. After 1:1 propensity score matching two groups of 529 subjects each were compared. Cox regression was performed to assess the effect of MC-AMI and other variables on MACE. Results MC-AMI has been proved to reduce MACE rate by 45% in a 3-month observation. Multivariable Cox regression analysis revealed MC-AMI participation to be inversely associated with the occurrence MACE at 3 months (HR 0.476, 95% CI 0.283–0.799, p<0.005). Besides, older age, male sex (HR 2.0), history of unstable angina (HR 3.15), peripheral artery disease (HR 2.17), peri-MI atrial fibrillation (HR 1.87) and diabetes (HR 1.5), were significantly associated with the primary endpoint. Comparison of study endpoints between KO Total, n (%) MC-AMI group, n (%) Control Group, n (%) RR 95% CI NNT P n=1058 n=529 n=529 All-cause mortality 19 (1.8%) 7 (1.3%) 12 (2.3%) 0.583 0.232–1.470 105.8 0.247 Hospitalization for HF 31 (2.9%) 12 (2.3%) 19 (3.6%) 0.632 0.310–1.288 75.6 0.202 Myocardial infarction 25 (2.4%) 9 (1.7%) 16 (3.0%) 0.563 0.251–1.262 75.6 0.157 MACE 73 (6.9%) 26 (4.9%)# 47 (8.9%) 0.553 0.348–0.879 25.2 0.012 *Two-tailed Pearson's Chi-square test; MACE, Major Adverse Cardiovascular Events. #Number of patients with at least one MACE; in 2 patients 2 endpoints occurred. This explains why the total number of MACE is lower than the sum of all endpoints. MC-AMI vs. control - MACE in 3 months up Conclusions MC-AMI is the first program of a comprehensive. Participation in MC-AMI – a first comprehensive in-hospital and post-discharge care for AMI patients for AMI patients improves prognosis and reduces MACE rate by 45% as soon as in 3 months.

scholarly journals Reactive Hyperglycaemia Connected with Low Glycated Haemoglobin – Risk Factor for Cardiovascular Adverse Events

2021 ◽  
Vol 2 (2) ◽  
pp. 85-96
Author(s):  
Marek Andres ◽  
Tomasz Rajs ◽  
Ewa Konduracka ◽  
Jacek Legutko ◽  
Janusz Andres ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Creatine Kinase ◽  
Glucose Metabolism ◽  
Cardiovascular Events ◽  
Glycated Haemoglobin ◽  
Major Adverse Cardiovascular Events ◽  
Creatine Kinase Mb ◽  
Significant Difference ◽  
Study Population

Introduction: Concomitance of glucose metabolism disturbances and ischemic heart disease is well known and connected to several times higher incidence of cardiovascular events resulted from atherosclerosis. Aim of this study was to assess impact of reactive hyperglycaemia accompanying chronic and not always optimally treated hyperglycaemia assessed with glycated haemoglobin level on cardiovascular prognosis among patient hospitalised in the course of acute myocardial infarction. Methods: 92 patients diagnosed with ST – segment elevation myocardial infarction (STEMI) qualified to primary percutaneous coronary intervention (pPCI) was included in the study. Study population was divided into subgroups, depending glucose level on admission (reactive hyperglycaemia) and HbA1c concentration: subgroup A (HbA1c <6.5%, Glc<7.8 mmol/l: n = 37; 40,2%), subgroup B (HbA1c <6.5%, Glc ≥.,8 mmol/l: n = 27; 29,3%), subgroup C (HbA1c ≥6.5%, Glc ≥7.8 mmol/l: n = 20; 21,7%) and subgroup D (HbA1c ≥6.5% Glc<7.8 mmol/l: n = 8; 8.7%). Level of myocardium damage was assessed on the basis of concentration of myocardial necrosis enzymes: creatine kinase (CK) and creatine kinase MB fraction (CK-MB) in the 0 and 90th minute and thereafter 8, 16, 24 and 48 hours after hospital admission and also echocardiographic examination. Prognosis in long and short term observation was assessed by major adverse cardiovascular events (MACE) such as death, myocardial infarction, stroke, heart failure requiring hospitalisation and repeated revascularisation and level of glucose metabolism disturbances in intrahospital phase, 4 months and 4 years follow up observation. Results: Results in study population revealed significant change of average value of creatine kinase (p<0,001) and its MB fraction (p<0,001) during first 48 hours of hospitalisation in particular subgroups of patients. Mean values of CK and CK-MB assessed in subsequent hours of hospitalisation (1,5, 8, 16 and 48 hours) were significantly higher in subgroup B (CKp=0,034 and CK-MB p=0,01, respectively). It means that area under curve was significantly higher for subgroup B. In 4 months and 4 year follow up observation, statistically significant difference in frequency of MACE in particular subgroups of patients has been shown (p=0,016; p=0,01). Conclusions: Patients with STEMI undergoing pPCI, who were diagnosed with disturbed carbohydrate metabolism, have inferior clinical outcomes in long term follow up observation. Noticeable difference was observed particularly in subgroup B (HbA1c <6.5%, Glc ≥7.8 mmol/l).

scholarly journals Major adverse cardiovascular events after implantation of absorb bioresorbable scaffold: One-year clinical outcomes

2021 ◽  
Vol 52 (4) ◽  
pp. 249-257
Author(s):  
Tanja Šobot ◽  
Nikola Šobot ◽  
Zorislava Bajić ◽  
Nenad Ponorac ◽  
Rade Babić
Keyword(s):  
Myocardial Infarction ◽  
Clinical Outcomes ◽  
Cardiovascular Events ◽  
Major Adverse Cardiovascular Events ◽  
Timi Flow Grade ◽  
Timi Flow ◽  
Absorb Bvs ◽  
One Year ◽  
The One

Background/Aim: Bioresorbable vascular scaffold (BVS) represents a novel generation of intracoronary devices designed to be fully resorbed after healing of the stented lesion, delivering antiproliferative drug to suppress restenosis, providing adequate diameter of the coronary vessel and preserving the vascular endothelial function. It was supposed that BVS will reduce neointimal proliferation and that their late bioresorption will reduce the negative effects of traditional drug-eluting stents, including the late stent thrombosis, local vessel wall inflammation, loss of coronary vasoreactivity and the need for the long-term dual antiplatelet therapy. The purpose of this research was to investigate efficacy and safety of Absorb everolimus-eluting BVS implantation and the prevalence of major adverse cardiovascular events (MACE) at the mid-term follow-up. Methods: The study encompassed 42 patients selected for BVS implantation and fulfilling inclusion criteria - 37 male and 5 female - admitted to the Dedinje Cardiovascular Institute, Belgrade, Serbia over the one-year period (from January 2015 to January 2016) for percutaneous coronary intervention (PCI). Coronary vessel patency before and after stenting was assessed by the Thrombolysis in Myocardial Infarction flow (TIMI) grades. After the index PCI procedure with BVS all patients were clinically followed by regular (prescheduled or event-driven) visits during the next 12-month period. Results: In the intention-to-treat analysis, all Absorb BVS procedures were successful, without the need for conversion to other treatment modalities. The complete reperfusion (TIMI flow grade 3) after the intervention was established in 97.6 % of patients and 100 % of them achieved the TIMI flow grade ≥ 2. The presence of angina pectoris was reduced significantly by the BVS procedure: stable angina 57.1 % to 11.9 %, (p < 0.001) and unstable angina 31 % to 0 %, respectively (p < 0.001). After the one-year follow-up, the MACE rate was 11.9 %. Myocardial infarction occurred in 4.8 % and the need for PCI reintervention in 2.4 % of cases (not influenced by the gender or the age of patients). There were 4 cases of death (all patients were older and had lower values of left ventricular ejection fraction). Conclusion: The results of the current research demonstrated a high interventional success rate of the Absorb BVS implantation, followed by the early improvement of the anginal status. However, that was not translated into the favourable mid-term clinical outcomes, opening debate about the current status of Absorb BVS and the need for future refinements of stent design and implantation techniques.

scholarly journals Female sex impact on culprit plaque at optical coherence tomography analysis in the setting of acute coronary syndrome in OCT-FORMIDABLE registry

2020 ◽  
Vol 16 (2) ◽  
pp. 123-131
Author(s):  
Francesca Giordana ◽  
Daniele Errigo ◽  
Fabrizio D’Ascenzo ◽  
Antonio Montefusco ◽  
Roberto Garbo ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Optical Coherence Tomography ◽  
Cardiovascular Events ◽  
Major Adverse Cardiovascular Events ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
Female Sex ◽  
St Segment

Aim: To evaluate sex difference in culprit plaque features at optical coherence tomography (OCT) and major adverse cardiovascular events at follow-up. Patients and methods: We analyse data from the OCT-FORMIDABLE (OCT-Features Of moRphology, coMposItion anD instABility of culprit and pLaquE in acute coronary syndrome [ACS] patients) registry. A total of 285 patients (20%, 58 females) were included. Results: Females with ST segment elevation myocardial infarction showed a longer ruptured area of the plaque (8.6 ± 7.6 vs 4.6 ± 5.4; p = 0.003) and a major necrotic core macrophage infiltration (43 vs 17%; p = 0.017). Females with non-ST segment elevation-ACS had less lipidic plaques (62 vs 80%; p = 0.04). No between-group sex differences in major adverse cardiovascular events emerged at follow-up (5 vs 9%; p = 0.88 in ST segment elevation myocardial infarction group and 19 vs 15%; p = 0.6 in non-ST segment elevation-ACS group). At multivariate analysis, female sex was not a major risk of plaque rupture (hazard ratio [HR]: 1.59, CI: 0.44–5.67; p = 0.48). Conclusion: Female sex seems to have no significant impact. ClincalTrial. gov registration number: NCT02486861.

P848Prevalence and Prognosis of Familial Hypercholesterolemia (FH) with Acute Myocardial Infarction (AMI) in China: Chinese Acute Myocardial Infarction (CAMI) Registry

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
N Q Wu ◽  
J G Yang ◽  
J J Li ◽  
Q T Dong ◽  
Y L Guo ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Familial Hypercholesterolemia ◽  
Cardiovascular Events ◽  
Cox Regression ◽  
Age Of Onset ◽  
Composite Endpoint ◽  
Major Adverse Cardiovascular Events ◽  
First Onset

Abstract Background The prevalence and prognosis of familial hypercholesterolemia (FH) with acute myocardial infarction (AMI) in China is unclear. Purpose To invistigate the prevalence and prognosis of familial hypercholesterolemia (FH) with acute myocardial infarction (AMI) in China. Methods In China Acute Myocardial Infarction (CAMI) Registry, 13,002 patients with age 18–80 were consecutively enrolled with first-onset acute myocardial infarction who were naïve to statin before admission from Januanry 1st, 2013 to October 31st, 2014. According to Dutch Lipid Clinical Network Criteria (DLCNC), the patients were divided to heterozygous familial hypercholesterolemia (HeFH) (definite or probable HeFH, possible HeFH) or no HeFH group. All the patients were followed up (average follow-up period, 24 months) and composite major adverse cardiovascular events (ENDPOINT) were recorded which were defined as all-cause death, non-fatal myocardial reinfarction and stroke. Cox regression was performed to analyze the difference of composite endpoint occurrence between HeFH group and no HeFH group. Results The number of the patients in the three groups was as following, 62 in definite or probable HeFH group, 484 in possible HeFH group, 12456 in no HeFH group. The prevalence of HeFH is 4.2% (including 0.47% of definite or probable HeFH, 3.73% of possible FH). The average age of onset of first-time AMI was 54±12,56±12,63±12 years old (p<0.0001) in definite or probable HeFH group, possible HeFH group and no HeFH group, respectively. The percentage of Killip III or above (8.1% vs 4.3% vs 6.3%, p=0.1629), cardiac arrest (1.6% vs 0.6% vs 0.9%, p=0.6990), and TIMI 0–2 grade after primary percutaneous cardiac intervention (PCI) (0% vs 6.8% vs 4.3%, p=0.5866) was not significantly different in definite or probable HeFH group, possible HeFH group and no HeFH group, respectively. After Cox proportional analysis adjusting multiple factors, the rate of composite endpoint during follow-up period was not significantly different (definite or probable HeFH group vs no HeFH group, HR 0. 853, 95% CI 0.381–1.910, p=0.699, possible HeFH group vs no HeFH group, HR1.076, 95% CI 0.795–1.458, p=0.635). The prognosis of FH with AMI in China Conclusions In CAMI Registry, the prevalence of HeFH was 4.2%, the diagnosis of HeFH was not a dependent risk factor for the rate of composite cardiovascular events.

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