Role of etiotropic therapy in the treatment and prevention of influenza complications amidst the COVID-19 pandemic

Influenza remains one of the most common respiratory viral diseases with a high risk of complications. In the context of the COVID-19 pandemic, there is a possibility of simultaneous circulation of two viruses, which makes it necessary to conduct a differential diagnosis. Influenza and COVID-19 have common pathways of transmission of the pathogen and similar symptoms, so the optimal differential diagnosis is the use of test systems for both viruses. Against the background of influenza and COVID-19, complications from various organs and systems can develop. The article describes in detail the complications of influenza from the cardiovascular system. After infection with the flu virus, there is a 6-to 10-fold increase in the risk of acute myocardial infarction and a 3 - to 8-fold increase in the risk of stroke. COVID-19 is associated with arterial hypertension, diabetes mellitus, cardiac arrhythmias, myocarditis, high risk of acute myocardial infarction, and heart failure. The article presents the data of our own research, indicating that the transferred COVID-19 disease increases the risk of acute coronary syndrome, regardless of the presence of risk factors for cardiovascular events. Prevention of the development of influenza complications is the early administration of etiotropic antiviral therapy. Numerous studies confirm the effectiveness of the neuraminidase inhibitor oseltamivir in the treatment of influenza. The use of oseltamivir reduces the severity of clinical manifestations, reduces the duration of the disease, reduces the risk of complications and death. The most effective measure to prevent influenza and COVID-19 is specific immunization. In some cases, chemoprophylaxis can be used. The article discusses studies on the effectiveness of influenza chemoprophylaxis with the use of neuraminidase inhibitors.

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P3690Plasma levels of cardiac-specific micro-RNA mir-1 and mir-133a differ in patients with acute myocardial infarction and takotsubo cardiomyopathy

European Heart Journal ◽

10.1093/eurheartj/ehz745.0544 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

V Novosadov ◽

T N Vlasik ◽

M Y A Ruda ◽

D V Pevsner ◽

I N Rybalkin ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Differential Diagnosis ◽

Takotsubo Cardiomyopathy ◽

Plasma Levels ◽

Heart Attack ◽

Mrna Levels ◽

Coronary Syndrome ◽

Technical Specifications ◽

And Control

Abstract Background Takotsubo cardiomyopathy (TTC) is an acute, life-threatening condition which is typically induced by stress and manifested by chest pain and ECG changes. The TTC prevalence among patients (pts) with acute coronary syndrome is 1.7–2.2%. The mortality rate from TTC is up to 8%. TTC is clinically indistinguishable from acute myocardial infarction (AIM). Differential diagnosis of TTC and AIM remains an unresolved problem. Recent studies have shown the differences in profiles of plasma microRNAs inTTC and AIM. Purpose To evaluate the possibility of differentiating TTC and AIM using a PCR-based semi-quantitative analysis of mRNAs, the plasma levels of which had been shown to be increased in patients with AIM (miR-1, miR-208a, miR-133a, miR-499a) and TTC (miR-16, miR-26a). Methods Plasma from 38 pts was used: 13 pts with confirmed TTC (12 women, 1 man), 25 pts with AIM (9w, 16m). For 10 pts with AIM, blood was collected twice: at 6 and 24 hours after the heart attack. The control arm comprised 40 healthy people from the same age group (12w, 28m). Plasma was obtained using the Cell-Free DNA blood collection tubes. Nucleic acids were separated using a modified Boom method. A semi-quantitative assessment of the mRNA levels was performed using dCq method with stem-loop qRT-PCR. Normalization for spiked synthetic cel-miR-39 and endogenous miR-23a was performed. Control of hemolysis was performed by measuring the ratio of miR-451 (specific for RBCs) and miR-23a (absent from RBCs). The statistical significance of differences between mRNA levels was assessed using Mann–Whitney test. Results No significant differences in the levels of miR-16, miR-26a and miR-208a in TTC group and control group have been found. Pts with AIM significantly differed from pts with TTC (p=0.0038 and 0.0002, respectively) and control pts (p=3.1x10–9 and 2,66x10–10) with the increased levels of cardiac-specific miR-1 and miR-133a. As compared to plasma levels at 6 hours after the heart attack, at 24-hour point the levels of these mRNAs were markedly reduced in 9 of 10 pts (mean reduction was 22.3-fold for miR-133a and 7.5-fold for miR-1). The correlation between changes in the levels of these mRNAs was high (Spearman correlation coefficient=0.89). Significant differences in plasma levels of miR-133a between pts with AIM and TTC were maintained even if blood was collected after 24 hours (p=0.007). For miR-16 and miR-26a, no significant differences between pts with AIM and TTC were found. The results of analysis of these mRNAs are affected to a substantial degree by the residual hemolysis due to their high content in blood cells. Conclusions It was shown that measuring the plasma levels of mRNAs miR-1 and miR-133a allows to distinguish TTC from AIM by excluding the diagnosis of TTC. The differential diagnosis is possible only within several hours after acute clinical symptoms and requires proper normalization and full compliance with the technical specifications.

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Acute Coronary Syndrome

Mayo Clinic Critical and Neurocritical Care Board Review ◽

10.1093/med/9780190862923.003.0028 ◽

2019 ◽

pp. 190-196

Author(s):

Siva S. Ketha ◽

Juan Carlos Leoni Moreno

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Acute Coronary Syndrome ◽

Plaque Rupture ◽

Clinical Manifestations ◽

St Segment Elevation ◽

Coronary Syndrome ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

Atherosclerotic Plaque Rupture

Acute coronary syndrome (ACS) encompasses all clinical manifestations caused by active myocardial ischemia and includes 3 entities: unstable angina (UA), acute non–ST-segment elevation myocardial infarction (NSTEMI), and acute ST-segment elevation myocardial infarction (STEMI). Atherosclerotic plaque rupture is the most consistent pathophysiologic event in ACS. After plaque rupture, cardiac myocytes die as a consequence of continued occlusion, thereby causing acute myocardial infarction (MI). Prompt recognition of ACS is crucial because the greatest therapeutic effect is achieved if treatment is performed soon after presentation.

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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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Association of Dephosphorylated-Uncarboxylated Matrix Gla Protein and Risk of Major Bleeding in Patients Presenting with Acute Myocardial Infarction

Life ◽

10.3390/life11080733 ◽

2021 ◽

Vol 11 (8) ◽

pp. 733

Author(s):

Admira Bilalic ◽

Tina Ticinovic Kurir ◽

Josip A. Borovac ◽

Marko Kumric ◽

Daniela Supe-Domic ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Major Bleeding ◽

Plasma Levels ◽

Adverse Outcomes ◽

Matrix Gla Protein ◽

Coagulation Cascade ◽

Bleeding Tendency ◽

Coronary Syndrome ◽

Bleeding Score

The “Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines” (CRUSADE) score emerged as a predictor of major bleeding in patients presenting with the acute coronary syndrome. On the other hand, previous studies established the association of dephosphorylated-uncarboxylated Matrix Gla protein (dp-ucMGP) and vitamin K, as well as their subsequent impact on coagulation cascade and bleeding tendency. Therefore, in the present study, we explored if dp-ucMGP plasma levels were associated with CRUSADE bleeding score. In this cross-sectional study, physical examination and clinical data, including plasma dp-ucMGP levels, were obtained from 80 consecutive patients with acute myocardial infarction (AMI). A significant positive correlation was found between CRUSADE bleeding score and both dp-ucMGP plasma levels (r = 0.442, p < 0.001) and risk score of in-hospital mortality (r = 0.520, p < 0.001), respectively. In comparing the three risk groups of risk for in-hospital bleeding, the high/very high-risk group had significantly higher dp-ucMGP levels from both very low/low group (1277 vs. 794 pmol/L, p < 0.001) and the moderate group (1277 vs. 941 pmol/L, p = 0.047). Overall, since higher dp-ucMGP levels were associated with elevated CRUSADE score and prolonged hemostasis parameters, this may suggest that there is a biological link between dp-ucMGP plasma levels and the risk of bleeding in patients who present with AMI.

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Primary care physician services and the frequency of comorbidities in patients with acute myocardial infarction

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.265 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

R King ◽

D Giedrimiene

Keyword(s):

Myocardial Infarction ◽

Primary Care ◽

Acute Myocardial Infarction ◽

Primary Care Physician ◽

Care Physician ◽

Adverse Outcomes ◽

Coronary Syndrome ◽

Number Of Patients ◽

Significant Difference ◽

The Impact

Abstract Funding Acknowledgements Type of funding sources: None. Background The management of patients with multiple comorbidities represents a significant burden on healthcare each year. Despite requiring regular medical care to treat chronic conditions, a large number of these patients may not receive proper care. Significant disparities have been identified in patients with multiple comorbidities and those who experience acute coronary syndrome or acute myocardial infarction (AMI). Only limited data exists to identify the impact of comorbidities and utilization of primary care physician (PCP) services on the development of adverse outcomes, such as AMI. Purpose The primary objective was to analyze how PCP services utilization can be associated with comorbidities in patients who experienced an AMI. Methods This study was based on retrospective data analysis which included 250 patients admitted to the Hartford Hospital Emergency Department (ED) for an AMI. Out of these, 27 patients were excluded due to missing documentation. Collected data included age, gender, medications and recorded comorbidities, such as hypertension, hyperlipidemia, diabetes mellitus (DM), chronic kidney disease (CKD) and previous arrhythmia. Each patient was assessed regarding utilization of PCP services. Statistical analysis was performed in order to identify differences between patients with documented PCP services and those without by using the Chi-square test. Results The records allowed for identification of documented PCP services for 172 out of 223 (77.1%) patients. The most common comorbidities were hypertension and hyperlipidemia: in 165 (74.0%) and 157 (70.4%) cases respectively. The most frequent comorbidity was hypertension: 137 out of 172 (79.7%) in pts with PCP vs 28 out of 51 (54.9%) without PCP, and significantly more often in patients with PCP, p< 0.001. Hyperlipidemia was the second most frequent comorbidity: in 130 out of 172 (75.6%) vs 27 out of 51 (52.9%) accordingly, and also significantly more often (p< 0.002) in patients with PCP services. The number of comorbidities ranged from 0-5, including 32 (14.3%) patients without comorbidities: 16 (9.3%) with a PCP and 16 (31.4%) without PCP services. The majority of patients - 108 (48.5% of 223), had 2-3 documented comorbidities: 89 (51.8%) had two and 19 (34.6%) had three. The remaining 40 (17.9%) patients had 4-5 comorbidities: 37 (21.5%) of them with a PCP and 3 (10.3%) without, with a significant difference (p < 0.001) found for patients with a higher number of comorbidities who utilized PCP services. Conclusions Our study shows that the majority of patients who presented with an AMI had one or more comorbidities. Furthermore, patients who did not utilize PCP services had fewer identified comorbidities. This suggests that there may be a significant number of patients who experienced AMI with undiagnosed comorbidities due to not having access to PCP services.

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Long-Term Prognostic Value of Cognitive Impairment on Top of Frailty in Older Adults after Acute Coronary Syndrome

Journal of Clinical Medicine ◽

10.3390/jcm10030444 ◽

2021 ◽

Vol 10 (3) ◽

pp. 444

Author(s):

Juan Sanchis ◽

Clara Bonanad ◽

Sergio García-Blas ◽

Vicent Ruiz ◽

Agustín Fernández-Cisnal ◽

...

Keyword(s):

Myocardial Infarction ◽

Older Adults ◽

Acute Myocardial Infarction ◽

Acute Coronary Syndrome ◽

Cognitive Impairment ◽

Cognitive Function ◽

Prognostic Value ◽

Adult Survivors ◽

Prognostic Information ◽

Coronary Syndrome

Frailty is a marker of poor prognosis in older adults after acute coronary syndrome. We investigated whether cognitive impairment provides additional prognostic information. The study population consisted of a prospective cohort of 342 older (>65 years) adult survivors after acute coronary syndrome. Frailty (Fried score) and cognitive function (Pfeiffer’s Short Portable Mental Status Questionnaire—SPMSQ) were assessed at discharge. The endpoints were mortality or acute myocardial infarction at 8.7-year median follow-up. Patient distribution according to SPMSQ results was: no cognitive impairment (SPMSQ = 0 errors; n = 248, 73%), mild impairment (SPMSQ = 1–2 errors; n = 52, 15%), and moderate to severe impairment (SPMSQ ≥3 errors; n = 42, 12%). A total of 245 (72%) patients died or had an acute myocardial infarction, and 216 (63%) patients died. After adjustment for clinical data, comorbidities, and Fried score, the SPMSQ added prognostic value for death or myocardial infarction (per number of errors; HR = 1.11, 95%, CI 1.04–1.19, p = 0.002) and death (HR = 1.11, 95% 1.03–1.20, p = 0.007). An SPMSQ with ≥3 errors identified the highest risk subgroup. Geriatric conditions (SPSMQ and Fried score) explained 19% and 43% of the overall chi-square of the models for predicting death or myocardial infarction and death, respectively. Geriatric assessment after acute coronary syndrome should include both frailty and cognitive function. This is particularly important given that cognitive impairment without dementia can be subclinical and thus remain undetected.

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Impact of Morning Onset on the Incidence of Recurrent Acute Coronary Syndrome and Progression of Coronary Atherosclerosis in Acute Myocardial Infarction

Circulation Journal ◽

10.1253/circj.cj-16-0817 ◽

2017 ◽

Vol 81 (3) ◽

pp. 361-367 ◽

Cited By ~ 8

Author(s):

Hiroshi Nakashima ◽

Yuka Mashimo ◽

Masaya Kurobe ◽

Shigenori Muto ◽

Shinnosuke Furudono ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Acute Coronary Syndrome ◽

Coronary Atherosclerosis ◽

Coronary Syndrome

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Identification of high risk subsets of acute myocardial infarction

The American Journal of Cardiology ◽

10.1016/0002-9149(78)90156-x ◽

1978 ◽

Vol 41 (2) ◽

pp. 197-203 ◽

Cited By ~ 73

Author(s):

Karl T. Weber ◽

Joseph S. Janicki ◽

Richard O. Russell ◽

Charles E. Rackley ◽

H.J.C. Swan ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

High Risk

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Pre-hospital risk assessment in suspected non-ST-elevation acute coronary syndrome: A prospective observational study

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872618813846 ◽

2018 ◽

Vol 9 (1_suppl) ◽

pp. 5-12 ◽

Cited By ~ 12

Author(s):

Dominique N van Dongen ◽

Rudolf T Tolsma ◽

Marion J Fokkert ◽

Erik A Badings ◽

Aize van der Sluis ◽

...

Keyword(s):

Myocardial Infarction ◽

High Risk ◽

Risk Stratification ◽

Risk Group ◽

High Risk Group ◽

Low Risk ◽

Heart Score ◽

Coronary Syndrome ◽

Risk Patients ◽

St Elevation

Background: Pre-hospital risk stratification of non-ST-elevation acute coronary syndrome (NSTE-ACS) by the complete HEART score has not yet been assessed. We investigated whether pre-hospital risk stratification of patients with suspected NSTE-ACS using the HEART score is accurate in predicting major adverse cardiac events (MACE). Methods: This is a prospective observational study, including 700 patients with suspected NSTE-ACS. Risk stratification was performed by ambulance paramedics, using the HEART score; low risk was defined as HEART score ⩽ 3. Primary endpoint was occurrence of MACE within 45 days after inclusion. Secondary endpoint was myocardial infarction or death. Results: A total of 172 patients (24.6%) were stratified as low risk and 528 patients (75.4%) as intermediate to high risk. Mean age was 53.9 years in the low risk group and 66.7 years in the intermediate to high risk group ( p<0.001), 50% were male in the low risk group versus 60% in the intermediate to high risk group ( p=0.026). MACE occurred in five patients in the low risk group (2.9%) and in 111 (21.0%) patients at intermediate or high risk ( p<0.001). There were no deaths in the low risk group and the occurrence of acute myocardial infarction in this group was 1.2%. In the high risk group six patients died (1.1%) and 76 patients had myocardial infarction (14.4%). Conclusions: In suspected NSTE-ACS, pre-hospital risk stratification by ambulance paramedics, including troponin measurement, is accurate in differentiating between low and intermediate to high risk. Future studies should investigate whether transportation of low risk patients to a hospital can be avoided, and whether high risk patients benefit from immediate transfer to a hospital with early coronary angiography possibilities.

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Appropriate secondary prevention and clinical outcomes after acute myocardial infarction according to atherothrombotic risk stratification: The FAST-MI 2010 registry

European Journal of Preventive Cardiology ◽

10.1177/2047487318808638 ◽

2018 ◽

Vol 26 (4) ◽

pp. 411-419 ◽

Cited By ~ 3

Author(s):

Victoria Tea ◽

Marc Bonaca ◽

Chekrallah Chamandi ◽

Marie-Christine Iliou ◽

Thibaut Lhermusier ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

High Risk ◽

Secondary Prevention ◽

High Risk Patients ◽

Risk Patients ◽

St Elevation ◽

Group 3 ◽

Group 2 ◽

Group 1

Background Full secondary prevention medication regimen is often under-prescribed after acute myocardial infarction. Design The purpose of this study was to analyse the relationship between prescription of appropriate secondary prevention treatment at discharge and long-term clinical outcomes according to risk level defined by the Thrombolysis In Myocardial Infarction (TIMI) Risk Score for Secondary Prevention (TRS-2P) after acute myocardial infarction. Methods We used data from the 2010 French Registry of Acute ST-Elevation or non-ST-elevation Myocardial Infarction (FAST-MI) registry, including 4169 consecutive acute myocardial infarction patients admitted to cardiac intensive care units in France. Level of risk was stratified in three groups using the TRS-2P score: group 1 (low-risk; TRS-2P=0/1); group 2 (intermediate-risk; TRS-2P=2); and group 3 (high-risk; TRS-2P≥3). Appropriate secondary prevention treatment was defined according to the latest guidelines (dual antiplatelet therapy and moderate/high dose statins for all; new-P2Y12 inhibitors, angiotensin-converting-enzyme inhibitor/angiotensin-receptor-blockers and beta-blockers as indicated). Results Prevalence of groups 1, 2 and 3 was 46%, 25% and 29% respectively. Appropriate secondary prevention treatment at discharge was used in 39.5%, 37% and 28% of each group, respectively. After multivariate adjustment, evidence-based treatments at discharge were associated with lower rates of major adverse cardiovascular events (death, re-myocardial infarction or stroke) at five years especially in high-risk patients: hazard ratio = 0.82 (95% confidence interval: 0.59–1.12, p = 0.21) in group 1, 0.74 (0.54–1.01; p = 0.06) in group 2, and 0.64 (0.52–0.79, p < 0.001) in group 3. Conclusions Use of appropriate secondary prevention treatment at discharge was inversely correlated with patient risk. The increased hazard related to lack of prescription of recommended medications was much larger in high-risk patients. Specific efforts should be directed at better prescription of recommended treatment, particularly in high-risk patients.

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