Acute myocardial infarction in the Covid-19 era: Incidence, clinical characteristics and in-hospital outcomes—A multicenter registry

Background We aimed to describe the characteristics and in-hospital outcomes of ST-segment elevation myocardial infarction (STEMI) patients during the Covid-19 era. Methods We conducted a prospective, multicenter study involving 13 intensive cardiac care units, to evaluate consecutive STEMI patients admitted throughout an 8-week period during the Covid-19 outbreak. These patients were compared with consecutive STEMI patients admitted during the corresponding period in 2018 who had been prospectively documented in the Israeli bi-annual National Acute Coronary Syndrome Survey. The primary end-point was defined as a composite of malignant arrhythmia, congestive heart failure, and/or in-hospital mortality. Secondary outcomes included individual components of primary outcome, cardiogenic shock, mechanical complications, electrical complications, re-infarction, stroke, and pericarditis. Results The study cohort comprised 1466 consecutive acute MI patients, of whom 774 (53%) were hospitalized during the Covid-19 outbreak. Overall, 841 patients were diagnosed with STEMI: 424 (50.4%) during the Covid-19 era and 417 (49.6%) during the parallel period in 2018. Although STEMI patients admitted during the Covid-19 period had fewer co-morbidities, they presented with a higher Killip class (p value = .03). The median time from symptom onset to reperfusion was extended from 180 minutes (IQR 122–292) in 2018 to 290 minutes (IQR 161–1080, p < .001) in 2020. Hospitalization during the Covid-19 era was independently associated with an increased risk of the combined endpoint in the multivariable regression model (OR 1.65, 95% CI 1.03–2.68, p value = .04). Furthermore, the rate of mechanical complications was four times higher during the Covid-19 era (95% CI 1.42–14.8, p-value = .02). However, in-hospital mortality remained unchanged (OR 1.73, 95% CI 0.81–3.78, p-value = .16). Conclusions STEMI patients admitted during the first wave of Covid-19 outbreak, experienced longer total ischemic time, which was translated into a more severe disease status upon hospital admission, and a higher rate of in-hospital adverse events, compared with parallel period.

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Acute myocardial infarction in the Covid-19 era: incidence, clinical characteristics and in-hospital outcomes – a multicenter registry

European Heart Journal ◽

10.1093/eurheartj/ehab724.1462 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

A Fardman ◽

D Zahger ◽

K Orvin ◽

N Kofman ◽

J Mohsen ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Severe Disease ◽

Admission Rate ◽

P Value ◽

Study Cohort ◽

Hospital Outcomes ◽

Ischemic Time ◽

Coronary Syndrome ◽

Increased Risk

Abstract Background A reduction in acute myocardial infarction (AMI) hospitalizations during the coronavirus pandemic has been previously documented. We aimed to describe the characteristics and in-hospital outcomes of AMI patients during the Covid-19 era compared to a recent previous registry. Methods We conducted a prospective, multicenter, observational study involving 13 intensive cardiac care units (ICCUs) to evaluate consecutive AMI patients admitted throughout an 8-week period during the Covid-19 outbreak. Data were compared to the corresponding period in 2018 using an acute coronary syndrome survey conducted in all ICCUs in Israel. The primary end-point was defined as a composite of sustained ventricular arrhythmia, pulmonary congestion, and/or in-hospital mortality. Results The study cohort comprised 1466 patients, of whom 774 (53%) were hospitalized during the Covid-19 outbreak. Overall, 841 patients were diagnosed with ST-elevation MI (STEMI): 424 (50.4%) during the Covid-19 era and 417 (49.6%) during the parallel period in 2018. No differences were detected in the admission rate of patients between the two study periods. STEMI patients admitted during the Covid-19 period tended to have fewer co-morbidities, but a higher Killip class (p value = 0.03). The median time from symptom onset to reperfusion was extended from 180 minutes (IQR 122–292) in 2018 to 290 minutes (IQR 161–1080, p<0.001) in 2020. Hospitalization during the Covid-19 era was independently associated with an increased risk of the combined endpoint of heart failure, malignant arrhythmia, or death in the multivariable logistic regression model (OR 1.63, 95% CI 1.02–2.65, p value = 0.05). Conclusion While the admission rate of AMI and STEMI in Israel remained similar during both the Covid-19 era and the corresponding period in 2018, total ischemic time extended significantly during the Covid-19 period, which translated into a more severe disease status upon hospital admission, and a higher rate of in-hospital adverse events. FUNDunding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): This work was supported by a grant from a Fefer foundation for medical research

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Circulating Levels of Dephosphorylated-Uncarboxylated Matrix Gla Protein in Patients with Acute Coronary Syndrome

Molecules ◽

10.3390/molecules26041108 ◽

2021 ◽

Vol 26 (4) ◽

pp. 1108

Author(s):

Admira Bilalic ◽

Tina Ticinovic Kurir ◽

Marko Kumric ◽

Josip A. Borovac ◽

Andrija Matetic ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Coronary Syndrome ◽

High Risk ◽

Hospital Mortality ◽

Vascular Calcification ◽

Matrix Gla Protein ◽

St Elevation Myocardial Infarction ◽

Coronary Syndrome ◽

Increased Risk ◽

St Elevation

Vascular calcification contributes to the pathogenesis of coronary artery disease while matrix Gla protein (MGP) was recently identified as a potent inhibitor of vascular calcification. MGP fractions, such as dephosphorylated-uncarboxylated MGP (dp-ucMGP), lack post-translational modifications and are less efficient in vascular calcification inhibition. We sought to compare dp-ucMGP levels between patients with acute coronary syndrome (ACS), stratified by ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) status. Physical examination and clinical data, along with plasma dp-ucMGP levels, were obtained from 90 consecutive ACS patients. We observed that levels of dp-ucMGP were significantly higher in patients with NSTEMI compared to STEMI patients (1063.4 ± 518.6 vs. 742.7 ± 166.6 pmol/L, p < 0.001). NSTEMI status and positive family history of cardiovascular diseases were only independent predictors of the highest tertile of dp-ucMGP levels. Among those with NSTEMI, patients at a high risk of in-hospital mortality (adjudicated by GRACE score) had significantly higher levels of dp-ucMGP compared to non-high-risk patients (1417.8 ± 956.8 vs. 984.6 ± 335.0 pmol/L, p = 0.030). Altogether, our findings suggest that higher dp-ucMGP levels likely reflect higher calcification burden in ACS patients and might aid in the identification of NSTEMI patients at increased risk of in-hospital mortality. Furthermore, observed dp-ucMGP levels might reflect differences in atherosclerotic plaque pathobiology between patients with STEMI and NSTEMI.

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Basic Clinical Characteristics and Hospital Outcomes of Acute Coronary Syndrome Patients-Sudan

Sudan Journal of Medical Sciences ◽

10.18502/sjms.v12i2.916 ◽

2017 ◽

Vol 12 (2) ◽

pp. 52

Author(s):

Taha AM ◽

Mirghani HO

Keyword(s):

Myocardial Infarction ◽

Acute Coronary Syndrome ◽

Clinical Characteristics ◽

P Value ◽

Case Report Form ◽

Percutaneous Coronary Angioplasty ◽

Hospital Outcomes ◽

St Segment Elevation ◽

Coronary Syndrome ◽

St Segment

Background: There are Variation in the presentation of the acute coronary syndrome between countries. The present study aimed to investigate the basic clinical characteristics and in-hospital outcomes among acute coronary syndrome patients in the Sudan.Material and Methods: A cross-sectional comparative study conducted among 202 consecutive acute coronary syndrome patients at a reference coronary care unit in Omdurman Teaching Hospital between July 2014 and August 2015. Participants signed a written informed consent, and then a case report form was filled. Information collected include vascular risk factors, vital signs, echocardiographic findings, and in Hospital complications. The local ethical committee approved the research, and the chi-square test was used to compare ST-segment Elevation (STSEACS) and None ST-Segment Elevation Acute coronary syndrome (NSTSEACS).Results: (out of 202 women (53.75%) in (NSEACS) P =0.009). Prior myocardial infarction, hypertension, diabetes mellitus, and, smoking were evident in 19.8%. 53.%, 30.2%, and 16.6% of acute coronary syndrome respectively, 97% of patients presented with chest pain, 54% presented to the hospital after 24 hours. Hypotension, heart failure, low ejection fraction, and in-hospital complications were more in (STSEACS) than (NSTSEACS), while (NSTEACS) patients received less Thrombolysis and Percutaneous coronary angioplasty P-value < 0.05Conclusions: Acute coronary syndrome patients were younger and had more complications than others in the West. ST-Segment Elevation Myocardial Infarction Patients are more likely to develop in-hospital complications and to receive reperfusion therapy. The limitation of the study is the lack of follow-up information after discharge.

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Abstract P320: Is Co-occurring Endometriosis Among Women With Myocardial Infarction Associated With Worse In-hospital Outcomes? Findings From the Nationwide Inpatient Sample

Circulation ◽

10.1161/circ.135.suppl_1.p320 ◽

2017 ◽

Vol 135 (suppl_1) ◽

Author(s):

Akintunde Akinjero ◽

Oluwole Adegbala ◽

Tomi Akinyemiju

Keyword(s):

Myocardial Infarction ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Hospital Mortality ◽

Nationwide Inpatient Sample ◽

Hospital Admissions ◽

Independent Effect ◽

Hospital Outcomes ◽

Increased Risk ◽

Artery Disease

Background: Recent studies have shown that patients with endometriosis have an increased risk of coronary artery disease. Inflammatory diseases that increase the risk of coronary artery disease have also been shown to worsen outcomes. We sought to evaluate the effect of co-occurring endometriosis among women with myocardial infarction (MI) on stroke, length of stay (LOS) and in-hospital mortality. Methods: Data was obtained from the Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample (NIS). We studied women ages 18 and above hospitalized for MI between 2007 and 2011. Admissions for endometriosis, MI and outcomes data were extracted using ICD-9 CM codes. We estimated weighted frequencies and proportions for all patients admitted for MI, co-occurring endometriosis and for all covariates. We then performed bivariate parametric tests of association as appropriate. In order to evaluate the independent effect of co-occurring endometriosis and MI on stroke, LOS and in-hospital mortality, we constructed multivariate regression models. Results: We found a total of 420,940 hospital admissions for myocardial infarction. Out of these, 80 had co-occurring endometriosis. Women with these co-occurring conditions were more likely to be white (67.5%) and privately insured (53.8%). In adjusted models, compared to those without, women with co-occurring endometriosis and MI did not have a significantly higher risk of stroke (aOR=1.10, 95% CI: 0.27- 4.56) or prolonged LOS (aOR=1.29, 95% CI: 0.45 - 3.04). Risk was not found to be increased for in-hospital mortality (aOR=0.71, 95% CI: 0.26 - 1.95). Conclusion: Our study shows that co-occurring endometriosis among women with MI was not significantly associated with worse in-hospital outcomes. Larger, prospective, studies with longer follow-up time after discharge are needed to further evaluate this association.

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Baseline T-lymphocyte subset absolute counts can predict both outcome and severity in SARS-CoV-2 infected patients: a single center study

Scientific Reports ◽

10.1038/s41598-021-90983-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Marco Iannetta ◽

Francesco Buccisano ◽

Daniela Fraboni ◽

Vincenzo Malagnino ◽

Laura Campogiani ◽

...

Keyword(s):

Hospital Mortality ◽

T Lymphocyte ◽

Lymphocyte Subsets ◽

Severe Disease ◽

Laboratory Data ◽

Lymphocyte Subset ◽

Multivariable Logistic Regression Analysis ◽

Double Positive ◽

Increased Risk ◽

T Lymphocyte Subset

AbstractThe aim of this study was to evaluate the role of baseline lymphocyte subset counts in predicting the outcome and severity of COVID-19 patients. Hospitalized patients confirmed to be infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) were included and classified according to in-hospital mortality (survivors/nonsurvivors) and the maximal oxygen support/ventilation supply required (nonsevere/severe). Demographics, clinical and laboratory data, and peripheral blood lymphocyte subsets were retrospectively analyzed. Overall, 160 patients were retrospectively included in the study. T-lymphocyte subset (total CD3+, CD3+ CD4+, CD3+ CD8+, CD3+ CD4+ CD8+ double positive [DP] and CD3+ CD4− CD8− double negative [DN]) absolute counts were decreased in nonsurvivors and in patients with severe disease compared to survivors and nonsevere patients (p < 0.001). Multivariable logistic regression analysis showed that absolute counts of CD3+ T-lymphocytes < 524 cells/µl, CD3+ CD4+ < 369 cells/µl, and the number of T-lymphocyte subsets below the cutoff (T-lymphocyte subset index [TLSI]) were independent predictors of in-hospital mortality. Baseline T-lymphocyte subset counts and TLSI were also predictive of disease severity (CD3+ < 733 cells/µl; CD3+ CD4+ < 426 cells/µl; CD3+ CD8+ < 262 cells/µl; CD3+ DP < 4.5 cells/µl; CD3+ DN < 18.5 cells/µl). The evaluation of peripheral T-lymphocyte absolute counts in the early stages of COVID-19 might represent a useful tool for identifying patients at increased risk of unfavorable outcomes.

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Procedural and remote outcome among patients undergoing urgent trans-catheter aortic valve implantation

European Heart Journal ◽

10.1093/ehjci/ehaa946.2586 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

A Berkovitch ◽

A Segev ◽

A Finkelstein ◽

R Kornowski ◽

H Danenberg ◽

...

Keyword(s):

Multivariate Analysis ◽

Hospital Mortality ◽

Mortality Rates ◽

P Value ◽

Complication Rates ◽

Increased Risk ◽

Procedural Complication ◽

Elective Procedure ◽

Aortic Valve Implantation ◽

Valve Implantation

Abstract Background Severe aortic stenosis patients suffer frequent heart failure decompensations events often requiring hospitalization. In extreme situations patients can be found with pulmonary edema and cardiogenic shock, unresponsive to medical treatment. Urgent trans-catheter aortic valve implantation (TAVI) has emerged as a treatment option for these high-risk patients. Methods We investigated 3,599 patients undergoing TAVI. Subjects were divided into two groups based on procedure urgency: patients who were electively hospitalized for the procedure (N=3,448) and those who had an urgent TAVI (N=151). Peri-procedural complications were documented according to the VARC-2 criteria. In hospital and 1-year mortality rates were prospectively documented. Results Mean age of the study population was 82±7, of whom 52% were female. Peri-procedural complication rates was significantly higher among patients with an urgent indication for TAVI compared to those having an elective procedure: valve malposition 3.6% vs. 0.6% (p-value=0.023), valve migration 3.2% vs. 0.9% (p-value=0.016), post procedure myocardial infarction 3.7% vs. 0.3% (p-value=0.004), and stage 3 acute kidney injury 2.6% vs. 0.5%, (p-value=0.02). Univariate analysis found that patients with urgent indication for TAVI had significantly higher in hospital mortality (5.8% vs. 1.4%, p-value<0.001). similarly, multivariate analysis adjusted for age, gender and cardio-vascular risk factors found that patients with urgent indication had more than 5-folds increased risk of in-hospital mortality (OR 5.94, 95% CI 2.28–15.43, p-value<0.001). Kaplan-Meier's survival analysis showed that patients undergoing urgent TAVI had higher 1-year mortality rates compared to patients undergoing an elective TAVI procedure (p-value log-rank<0.001, Figure). Multivariate analysis found they had more than 2-folds increased risk of mortality at 1-year (HR 2.27, 95% CI 1.53–3.38, p<0.001 compared to those having an elective procedure. Conclusions Patients with urgent indication for TAVI have higher in-hospital mortality and higher peri-procedural complication rates. However, if these patients survive the index hospitalization, they enjoy good prognosis. Kaplan-Meier's survival analysis Funding Acknowledgement Type of funding source: None

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Abstract 14652: Systolic Blood Pressure Trajectories and Cardiovascular Outcomes in SPRINT

Circulation ◽

10.1161/circ.142.suppl_3.14652 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Charles A German ◽

Tali Elfassy ◽

Matthew J Singleton ◽

Carlos J Rodriguez ◽

Walter T Ambrosius ◽

...

Keyword(s):

Myocardial Infarction ◽

Blood Pressure ◽

Systolic Blood Pressure ◽

Latent Class ◽

Stable Group ◽

Coronary Syndrome ◽

Average Blood Pressure ◽

Increased Risk ◽

All Cause Mortality ◽

Over Time

Introduction: Blood pressure trajectories have been associated with cardiovascular disease (CVD) in observational studies. It is unclear whether these associations are independent of average blood pressure over time. Methods: We used data from SPRINT to identify systolic blood pressure (SBP) trajectories among a cohort of 8901 participants by incorporating SBP measures during the first 12 months of the trial post randomization. Trajectories were identified using latent class based modeling. Study outcomes included incident CVD, defined as myocardial infarction, acute coronary syndrome not resulting in myocardial infarction, stroke, acute decompensated heart failure, or death attributable to CVD, and all-cause mortality. Cox proportional hazards models were used to evaluate associations between SBP trajectories and our outcomes of interest. Results: Four distinct SBP trajectories were identified: ‘low decline’ (40%), ‘high decline’ (6%), ‘low stable’ (48%), and ‘high stable’ (5%) (Figure 1). Relative to the low decline group, the low stable group was associated with a 29% increased risk of CVD (HR: 1.29, 95%CI: 1.06-1.57) and the high stable group was associated with a 76% increased risk of all-cause mortality (HR: 1.76, 95%CI: 1.15-2.68) after baseline multivariable adjustment. Relative to the low stable group, the high stable group was associated with a 54% increased risk of all-cause mortality (HR: 1.54, 95%CI: 1.05-2.28). When adjusting for average blood pressure across the 12 month time period, there were no significant differences in outcomes. Conclusion: We identified 4 SBP trajectories using data from SPRINT and found differences in the risk of CVD and all-cause mortality after baseline adjustment. However, there were no differences in the risk of these outcomes after adjusting for average blood pressure over time. These results suggest that the pattern of blood pressure control may not be relevant as long as the target blood pressure is achieved.

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Impact on hospital mortality and morbidity of right ventricular involvement among patients with acute left ventricular infarction

Sao Paulo Medical Journal ◽

10.1590/s1516-31802006000400003 ◽

2006 ◽

Vol 124 (4) ◽

pp. 186-191 ◽

Cited By ~ 6

Author(s):

Afonso Celso Pereira ◽

Roberto Alexandre Franken ◽

Sandra Regina Schwarzwälder Sprovieri ◽

Valdir Golin

Keyword(s):

Myocardial Infarction ◽

Hospital Mortality ◽

Right Ventricular ◽

Left Ventricular ◽

Hospital Death ◽

Inferior Wall ◽

Mortality And Morbidity ◽

Killip Class ◽

Increased Risk ◽

The Impact

CONTEXT AND OBJECTIVE: There is uncertainty regarding the risk of major complications in patients with left ventricular (LV) infarction complicated by right ventricular (RV) involvement. The aim of this study was to evaluate the impact on hospital mortality and morbidity of right ventricular involvement among patients with acute left ventricular myocardial infarction. DESIGN AND SETTING: Prospective cohort study, at Emergency Care Unit of Hospital Central da Irmandade da Santa Casa de Misericórdia de São Paulo. METHODS: 183 patients with acute myocardial infarction participated in this study: 145 with LV infarction alone and 38 with both LV and RV infarction. The presence of complications and hospital death were compared between groups. RESULTS: 21% of the patients studied had LV + RV infarction. In this group, involvement of the dorsal and/or inferior wall was predominant on electrocardiogram (p < 0.0001). The frequencies of Killip class IV upon admission and 24 hours later were greater in the LV + RV group, along with electrical and hemodynamic complications, among others, and death. The probability of complications among the LV + RV patients was 9.7 times greater (odds ratio, OR = 9.7468; 95% confidence interval, CI: 2.8673 to 33.1325; p < 0.0001) and probability of death was 5.1 times greater (OR = 5.13; 95% CI: 2.2795 to 11.5510; p = 0.0001), in relation to patients with LV infarction alone. CONCLUSIONS: Patients with LV infarction with RV involvement present increased risk of early morbidity and mortality.

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Comparison of In-hospital Major Adverse Cardiovascular Events in Patients of Acute Inferior Myocardial Infarction With or Without Precordial ST Segment Depression

Indonesian Journal of Cardiology ◽

10.30701/ijc.v37i4.582 ◽

2017 ◽

pp. 180-9

Author(s):

Jaya Suganti ◽

Abdullah Afif Siregar ◽

Harris Hasan

Keyword(s):

Myocardial Infarction ◽

Cardiovascular Events ◽

Multiple Logistic Regression Analysis ◽

Major Adverse Cardiovascular Events ◽

Bivariate Analysis ◽

P Value ◽

Inferior Myocardial Infarction ◽

St Segment ◽

Increased Risk ◽

Acute Inferior Myocardial Infarction

Background: The clinical implications of precordial ST segment depression (PSTD) during acute inferior myocardial infarction has been an area of debate, and still under investigation with conflicting results. Based on previous studies, the presence of PSTD defines a high risk subset of patients with acute inferior myocardial infarction due to a more extensive myocardial ischemia that lead to a higher incidence of major adverse cardiovascular events (MACE). Despite of these results, others still considered this ECG finding as a benign electrical phenomenon. The aim of this study is to compare the incidence of in-hospital MACE in patients of acute inferior myocardial infarction with or without PSTD and to know whether PSTD can be used as a predictor of in-hospital MACE in acute inferior myocardial infarction.Methods: A total of 96 acute inferior myocardial infarction patients admitted from December 2013-2015 at Cardiology Department of Haji Adam Malik General Hospital were retrospectively analyzed. Patients were divided into two groups based on the presence of PSTD on admission ECG. Bivariate and multivariate analyses were performed to study the association between PSTD and in-hospital MACE, p value<0.05 was considered statistically significant.Results: The bivariate analysis showed that in-hospital MACE was significantly higher in patients of acute inferior myocardial infarction with PSTD than without PSTD (92% vs 8%, p<0.001). On multiple logistic regression analysis, patients of acute inferior myocardial infarction with PSTD have a 5.4 fold increased risk of in-hospital MACE than patients without PSTD (OR 5.480; 95% CI 1.759-17.067, p=0.003).Conclusion: The presence of precordial ST segment depression on admission ECG in acute inferior myocardial infarction patients was associated with a higher in-hospital MACE and was an independent predictor of in-hospital MACE.

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The Study of Serum Calcium to Magnesium Ratio in Patients with Acute Coronary Syndrome in a Tertiary Hospital, Hubli, Karnataka

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/644 ◽

2021 ◽

Vol 8 (41) ◽

pp. 3553-3558

Author(s):

Uday Subhash Bande ◽

Kalinga Bommanakatte Eranaik ◽

Manjunath Shivalingappa Hiremani ◽

Basawantrao Kailash Patil ◽

Sushma Shankaragouda Biradar

Keyword(s):

Myocardial Infarction ◽

Acute Coronary Syndrome ◽

Roc Analysis ◽

St Elevation Myocardial Infarction ◽

P Value ◽

Operating Characteristics ◽

Coronary Syndrome ◽

Function Tests ◽

Creatine Kinase Mb ◽

St Elevation

BACKGROUND Cardiovascular diseases are one of the leading causes of morbidity and mortality worldwide. High Ca levels and low Mg levels are associated with increased cardiovascular risk in the general population.1 The balance between Ca and Mg seems to play an important role in homeostasis since Mg is considered as physiologic antagonist of Ca.2 Hence Ca/Mg ratio was considered to study its association with acute coronary syndrome (ACS). METHODS This is a case control study conducted in Karnataka Institute of Medical Sciences, Hubli over a period of 2 years, February 2019 to December 2020. 200 cases and 150 controls were included in the study. The biochemical measurements including complete blood count (CBC), cardiac biomarkers, liver function tests, renal function tests (RFT), serum electrolytes and lipid profile were measured using standard laboratory methods. Student ‘t’ test was used to compare the data. Optimum cut-offs for diagnosis of acute myocardial infarction was calculated using receiver operating characteristics (ROC) analysis. The association among markers was established by calculating Pearson’s correlation. RESULTS Serum Ca/Mg ratio was significantly higher (p value < 0.001) in ACS when compared to control groups. It was also found that Ca/Mg ratio was significantly lower (p value < 0.001) in non-ST elevation myocardial infarction (NSTEMI) when compared to STEMI group. Serum Mg was significantly lower (p value < 0.001) in ACS group when compared to control group. Significant correlation (p value < 0.05) was found between serum Ca/Mg ratio and cardiac markers (CKMB, Troponin-I). ROC analysis of Ca/Mg (4.19) ratios showed optimum cut-offs in diagnosis of AMI. CONCLUSIONS Serum Ca/Mg could be useful adjuvant marker in diagnosis of AMI. The ratio is higher in ST-segment elevation myocardial infarction when compared to non-STsegment myocardial infarction, which could be due to greater decrease in Mg levels when compared Ca in ACS. KEYWORDS ST Elevation Myocardial Infarction (STEMI), Non ST Elevation Myocardial Infarction (NSTEMI), Calcium (Ca), Magnesium (Mg), Acute Coronary Syndrome (ACS), Creatine Kinase-MB (CK-MB).

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