scholarly journals Association between admission blood glucose and prognosis in non-diabetic patients with first-ever acute myocardial infarction

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Ramin Eskandari ◽  
Parisa Matini ◽  
Sepideh Emami ◽  
Yousef Rezaei
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Diabetic Patients ◽  
Ventricular Ejection Fraction ◽  
Cox Regression Analysis ◽  
Coronary Syndrome

Abstract Background: Admission hyperglycemia has been associated with major adverse cardiovascular and cerebrovascular events (MACCEs) in patients with acute coronary syndrome. Methods: In this study we sought to determine the association between admission blood sugar (ABS) and the outcomes of non-diabetic patients with first-ever acute myocardial infarction (MI). Non-diabetic patients with MI were evaluated from March 2016 to March 2019. Baseline characteristics, laboratories, electrocardiogram, and baseline left ventricular ejection fraction (LVEF) were recorded. All patients were followed up and outcomes were obtained. Follow-up data comprised of repeating electrocardiogram and echocardiography at 1 year, and MACCE, including re-MI, stroke, and mortality. Results: A total of 312 patients with a mean age of 54.2 ± 11.9 years were evaluated. All patients were followed up for a median of 38 months. The frequencies of in-hospital mortality and MACCE at late follow-up were higher in third tertile of ABS compared with those in first and second tertiles (both p <0.05). Based on the Cox regression analysis, the independent predictors of MACCE included age (hazard ratio [HR] 1.068, 95% confidence interval [CI] 1.033 – 1.105, p <0.001), third tertile of ABS >172 mg/dL (HR 21.257, 95% CI 2.832 – 159.577, p=0.003), and baseline LVEF (HR 0.947, 95% CI 0.901 – 0.995, p=0.031). Conclusion: Admission stress hyperglycemia is associated with increased rates of in-hospital mortality and MACCE at late follow-up in non-diabetic patients with MI. Moreover, elevated ABS, older ages, and a decreased value of baseline LVEF predicted MACCE during follow-up.

scholarly journals ONE-YEAR CARDIOVASCULAR OUTCOME IN PATIENTS ON CLOPIDOGREL ANTI-PLATELET THERAPY AFTER ACUTE MYOCARDIAL INFARCTION

2018 ◽  
pp. 55
Author(s):  
Dragana Stokanovic ◽  
Valentina N. Nikolic ◽  
Jelena Lilic ◽  
Svetlana R. Apostolovic ◽  
Milan Pavlovic ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Emergency Care ◽  
Cox Regression ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Cox Regression Analysis ◽  
Anti Platelet Therapy

The aim of this study was to determine the risk factors in patients on clopidogrel anti-platelet therapy after acute myocardial infarction, for cardiovascular mortality, re-hospitalization and admission to emergency care unit. We followed 175 patients on dual antiplatelet therapy, with clopidogrel and acetylsalicylic acid, for 1 year after acute myocardial infarction, both STEMI and NSTEMI. Beside demographic and clinical characteristics, genetic ABCB1, CYP2C19 and CYP2C9 profile was analyzed using Cox-regression analysis. End-points used were: mortality, re-hospitalization and emergency care visits, all related to cardiovascular system. During the accrual and follow-up period, 8 patients (4.6%) died, mostly as a direct consequence of an acute myocardial infarction. Re-hospitalization was needed in 27 patients (15.4%), in nine patients (33.3%) with the diagnosis of re-infarction. Thirty-two patients (18.3%) were admitted to emergency care unit due to cardiovascular causes, up to 15 times during the follow-up. NSTEMI was an independent predictor of all three events registered (mortality OR=7.4, p<0.05; re-hospitalization OR=2.8, p<0.05); emergency care visit OR=2.4, p<0.05). Other significant predictors were related to kidney function (urea and creatinine level, creatinine clearance), co-morbidities such as arterial hypertension and decreased left ventricular ejection fraction, as well as clopidogrel dosing regimen. As a conclusion, it may be suggested that one of the most significant predictors of cardiovascular events (mortality, re-hospitalization and emergency care visits) is NSTEMI. Besides, clopidogrel administration according to up-to-date guidelines, with high loading doses and initial doubled maintenance doses, improves 1-year prognosis in patients with AMI.

scholarly journals Elevated Plasma IL-37, IL-18, and IL-18BP Concentrations in Patients with Acute Coronary Syndrome

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Qingwei Ji ◽  
Qiutang Zeng ◽  
Ying Huang ◽  
Ying Shi ◽  
Yingzhong Lin ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Angina Pectoris ◽  
Unstable Angina ◽  
Left Ventricular ◽  
Unstable Angina Pectoris ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Coronary Syndrome

Objective.More recently, evidence showed that the novel anti-inflammatory cytokine interleukin- (IL-) 37 was expressed in the foam-like cells of atherosclerotic coronary and carotid artery plaques, suggesting that IL-37 is involved in atherosclerosis-related diseases. However, the plasma levels of IL-37 in patients with acute coronary syndrome (ACS, including unstable angina pectoris and acute myocardial infarction) have yet to be investigated.Methods.Plasma IL-37, IL-18, and IL-18BP levels were measured in 50 patients with stable angina pectoris (SAP), 75 patients with unstable angina pectoris (UAP), 67 patients with acute myocardial infarction (AMI), and 65 control patients.Results.The plasma IL-37, IL-18, and IL-18BP levels were significantly increased in ACS patients compared to SAP and control patients. A correlation analysis showed that the plasma biomarker levels were positively correlated with each other and with the levels of C-reactive protein (CRP),N-terminal probrain natriuretic peptide (NT-proBNP), and left ventricular end-diastolic dimension (LVEDD) but negatively correlated with left ventricular ejection fraction (LVEF). Furthermore, the plasma IL-37, IL-18, and IL-18BP had no correlation with the severity of the coronary artery stenosis.Conclusions.The results indicate that the plasma IL-37 levels are associated with the onset of ACS.

scholarly journals Risk Factors for Hospital Mortality in Acute ST-Segment Elevation Coronary Syndrome Complicated by Cardiogenic Shock

2021 ◽  
Vol 11 (4) ◽  
pp. 264-270
Author(s):  
O. V. Arsenicheva
Keyword(s):  
Risk Factors ◽  
Hospital Mortality ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Group I ◽  
Group Ii

The aim. To study the risk factors for hospital mortality in patients with acute coronary syndrome with ST-segment elevation (STEACS) complicated by cardiogenic shock (CS).Materials and methods. A total of 104 patients with STEACS complicated by CS were studied. The follow-up group (group I) included 58 (55,8%) patients who died in hospital (mean age 71,8±7,31 years), the comparison group (group II) – 46 patients, who have been treated and discharged (mean age 59,5±6,18 years). All patients underwent general clinical studies, the level of troponins, lipids, glucose, creatinine in plasma was determined, electrocardiography and echocardiography were performed. Coronary angiography and percutaneous coronary intervention (PCI) were urgently performed. The method of binary logistic regression with the determination of the odds ratio and its 95% confidence interval for each reliable variable was used to identify risk factors for hospital mortality.Results. In group I patients with CS, compared with group II, patients over the age of 70 (32 (55,2%) vs 10 (22,7%), р=0,0004), with concomitant chronic kidney disease (32 (55,2%) vs 9 (19,6%), p=0,0002), postinfarction cardiosclerosis (30 (51,7%) vs 9 (19,6%), р=0,001) and chronic heart failure of III-IV functional class (32 (55,1%) vs 11 (23,9%), p=0,001) were significantly more often observed. Baseline levels of plasma leukocytes, troponin and creatinine were significantly higher in deceased patients with CS. Left ventricular ejection fraction below 40% was observed more often in the follow-up group than in the comparison group (46 (79,3%) vs 27 (58,7%), p=0,022). In group I, compared with group II, there was a higher incidence of three-vessel coronary lesions (36 (75%) vs 12 (26,1%), p=0,0001) and chronic coronary artery occlusion unrelated to STEACS (25 (52,1%) vs 12 (26,1%), р=0,009). The same trend was observed when assessing the average number of stenoses and occlusions of the coronary arteries. PCI was performed in 43 (74,1%) of the deceased and 43 (93,5%) of the surviving STEACS patients with CS (p=0,009). The follow-up group had a higher rate of unsuccessful PCI (30,2%) vs 3 (7%), р=0,001) and performed later than 6 hours after the onset of an angina attack (28 (65,1%) vs 6 (14%), р=0,0001).Summary. Hospital mortality in patients with STEMI complicated by CS was associated with the presence left ventricular ejection fraction less than 40%, three-vessel coronary lesion and performing PCI later than 6 hours from the beginning of the pain attack.

scholarly journals Arylesterase activity of Paraoxonase 1 - prognostic factor for one-year survival in patients with acute myocardial infarction

2018 ◽  
Vol 26 (3) ◽  
pp. 283-292 ◽  
Author(s):  
Lorena Ciumărnean ◽  
Mihai Greavu ◽  
Ştefan C Vesa ◽  
Alina I Tanțău ◽  
Gabriela B Dogaru ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Prognostic Factor ◽  
Coronary Angiography ◽  
Left Ventricular ◽  
Paraoxonase 1 ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Coronary Syndrome ◽  
One Year

Abstract Introduction: Reduced serum levels of paraoxonase 1 (PON1) activities are associated with diseases involving increased oxidative stress, such as acute coronary syndrome. We aimed to determine whether serum PON1 activities are a prognostic factor for one-year survival following ST-elevation myocardial infarction (STEMI). Material and methods: We prospectively followed for one-year 75 patients diagnosed and treated for STEMI. Clinical, laboratory and imagistic data were gathered after coronary angiography. PON1 activities (paraoxonase, arylesterase, and lactonase) were assayed spectophotometrically on samples of heparinized plasma taken from the patients in a timeframe of maximum 20 minutes after coronary angiography. Results: Increased mortality was linked to age (patients over 68 years), permanent atrial fibrillation or left ventricular ejection fraction (LVEF) <40% (associated with global hypokinesia, apical or septal akinesia), trivascular disease atherosclerosis, reduced PON1 activities (paraoxonase <18.4 IU/mL, arylesterase <12.6 IU/mL, lactonase <27.6 IU/mL), and glomerular filtration rate levels <54 mL/min/1.73m2. Multivariate survival analysis showed the independent prognostic role of age (HR 3.92; 95%CI 1.08-14.16; p=0.03), LVEF (HR 9.93; 95%CI 2.20-44.86; p=0.003) and arylesterase (HR 4.25; 95%CI 0.94-19.18; p=0.05) for one-year mortality. Conclusion: Reduced arylesterase activity of PON1 is an independent predictor of one-year survival after acute myocardial infarction.

P3632Prognostic impact of aortic valve stenosis in patients with acute myocardial infarction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Mizutani ◽  
T Kurita ◽  
S Kasuya ◽  
T Mori ◽  
H Ito ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Aortic Valve ◽  
Aortic Valve Stenosis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
All Cause Mortality

Abstract Background Aortic valve stenosis (AS) is associated with the presence and severity of coronary artery disease independently of clinical risk factors, which leads to increased cardiovascular mortality. However, the prevalence of AS and its prognostic value among patients with acute myocardial infarction (AMI) remain unknown. Purpose The purpose of this study was to investigate the prevalence and prognostic impact of AS in AMI patients. Methods We studied 2,803 AMI patients using data from Mie ACS registry, a prospective and multicenter registry. Patients were divided into subgroups according to the presence and severity of AS based on maximal aortic flow rate by Doppler echocardiography before hospital discharge: non-AS <2.0 m/s, 2.0 m/s≤mild AS <3.0 m/s, 3.0 m/s≤moderate AS <4.0m/s and severe AS≥4.0 m/s. The primary outcome was defined as 2-year all-cause mortality. Results AS was detected in 79 patients (2.8%) including 49 mild AS, 23 moderate AS and 6 severe AS. AS patients were significantly older (79.9±9.8 versus 68.3±12.6 years), and higher killip classification than non-AS patients (P<0.01, respectively). However, left ventricular ejection fraction, and prevalence of primary PCI was similar between the 2 groups. During the follow-up periods (median 725 days), 333 (11.9%) patients experienced all-cause death. AS patients demonstrated the higher all-cause mortality rate compared to that of non-AS patients during follow up (47.3% versus 11.3%, P<0.0001, chi square). Kaplan-Meier curves showed that the probability of all-cause mortality was significantly higher among AS patients than non-AS patients, and was highest among moderate and severe AS (See figure A and B). Cox regression analyses for all-cause mortality demonstrated that the severity of AS was the strongest and independent poor prognostic factor (HR 1.71, 95% CI 1.30–2.24, P<0.001, See table). Cox hazard regression analysis Hazard ratio 95% Confidential interval P-value Severity of aortic valve stenosis 1.71 1.30–2.24 <0.001 Killip classification 1.63 1.46–1.82 <0.001 Age 1.07 1.06–1.09 <0.001 Serum creatinine level 1.05 1.03–1.08 <0.001 Max CPK level 1.00 1.00–1.01 <0.001 Left ventricular ejection fraction 0.96 0.95–0.97 <0.001 Primary percutaneous coronary intervention 0.67 0.47–0.96 0.03 CPK suggests creatinine phosphokinase. All cause mortality Conclusions The presence of AS of any severity contributes to worsening of patients' prognosis following AMI independently of other known risk factors. Acknowledgement/Funding None

scholarly journals The outcomes of acute myocardial infarction patients comorbidity with hypertension and hyperhomocysteinemia

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jumei Yan ◽  
Jiamin Zhou ◽  
Jun Huang ◽  
Hongyu Zhang ◽  
Zilin Deng ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Stay ◽  
Vital Signs ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Major Adverse Cardiovascular Events ◽  
Ventricular Ejection Fraction ◽  
Artery Disease

AbstractThis study investigated the outcomes and major adverse cardiovascular events (MACEs) incurred by acute myocardial infarction (AMI) patients comorbiding with hypertension and hyperhomocysteinemia (HHcy) during hospitalization and 1-year follow-up. 648 consecutive AMI patients were divided into four categories: (1) hypertension with Hcy ≥ 15 µmol/L; (2) hypertension with Hcy < 15 µmol/L; (3) no-hypertension with Hcy ≥ 15 µmol/L; (4) no-hypertension with Hcy < 15 µmol/L. Information taken from these case files included gender, past medical history, vital signs, laboratory examination, electrocardiogram, coronary angiography, cardiac ultrasound, and medicine treatment. The primary endpoints were duration of coronary care units (CCU) stay, duration of in-hospital stay, and MACEs during follow-up. Our data show that hypertension and HHcy have a synergistic effect in AMI patients, AMI comorbiding with hypertension and HHcy patients had more severe multi-coronary artery disease and more frequent non-culprit coronary lesions complete clogging, had a higher prevalence of pro-brain natriuretic peptide, and significant decreases in the left ventricular ejection fraction. These patients had significant increases in the duration of CCU stay and in-hospital stay, had significant increase in the rate of MACEs, had significant decreases in the survival rate during follow-up.

Abstract 14103: Lipoprotein (a) is an Important Factor to Determine Myocardial Viability and Left Ventricular Functional Recovery After Acute Myocardial Infarction

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Kazuto Hayasaka ◽  
Hiroyuki Hikita ◽  
Takatoshi Shigeta ◽  
Toru Misawa ◽  
Takafumi Mizusawa ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Myocardial Viability ◽  
Left Ventricular ◽  
High Serum ◽  
Adverse Outcomes ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Lipoprotein A

Introduction: High serum levels of lipoprotein (a) (Lp(a)) are associated with adverse outcomes after acute myocardial infarction (AMI). Lp(a) exerts its atherogenic and thrombogenic properties, which suggests greater lipid component of plaque and thrombi at the culprit lesion of AMI with elevated Lp(a). The risk of coronary artery disease is increased with a threshold serum Lp(a) level of 25 mg/dl. Purpose: We sought to evaluate impact of Lp(a) on myocardial viability and left ventricular function after AMI. Methods: The study included 156 patients (66±10.7 yrs, mean±sd, men 122, LAD/LCX/RCA 80/16/60) with first AMI within 24 hours from the onset who underwent emergent PCI. Serum Lp(a) was measured at admission. Serum CPK values were measured at admission and at intervals of 4 hours. Peak CPK value was determined. Within 2 weeks, Tl/BMIPP SPECT was performed to measure perfusion-metabolism mismatch score, an indicator of viable myocardium, from each total defect score of Tl/BMIPP using 17-segment model and semiquantitative visual score (0:normal, to 4:no uptake). Left ventricular ejection fraction (LVEF) was measured by two-dimensional echocardiography (2D trace) within 1 week (baseline LVEF) and at 6 months to 1 year (follow-up LVEF). Results: The study patients were divided into the group with serum Lp(a)≧25mg/dl at admission (n=42, Lp(a) 44.0±19.4mg/dl) and the group with Lp(a)<25 (n=114, Lp(a) 10.8±6.5). There were no significant differences between the two groups with respect to age, gender, peak CPK (2732±2060 IU/L (Lp(a)≧25), 2971±2254 (Lp(a)<25)). The mismatch score was significantly lower in Lp(a)≧25 group than in Lp(a)<25 (4.4±3.3 vs 5.9±3.9, p<0.05, respectively). Δ%LVEF (100*(follow-up LVEF - baseline LVEF)/ baseline LVEF) was significantly lower in Lp(a)≧25 than Lp(a)<25 (-2.0±11.0 vs 7.4±13.0, p<0.05, respectively). Conclusions: Elevated Lp(a) was associated with less myocardial viability and less LVEF recovery after AMI.

Acute myocardial infarction and cardiogenic shock in patient with COVID-19

Kardiologiia ◽  
2021 ◽  
Vol 61 (11) ◽  
pp. 104-107
Author(s):  
Yu. A. Schneider ◽  
V. G. Tsoi ◽  
M. S. Fomenko ◽  
P. A. Shilenko ◽  
I. I. Dimitrova ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Intensive Care ◽  
Cardiogenic Shock ◽  
Intensive Therapy ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Risk Of Death ◽  
Coronary Syndrome

The conditions of the pandemic caused by the novel coronavirus infection (COVID-19) are associated with overloading intensive care units, conversion of hospitals, and changes in routing of patients with acute cardiovascular pathology. At the same time, medical practice is still challenged to provide medical care to patients with acute coronary syndrome (ACS). Patients with COVID-19 and acute myocardial infarction (AMI) are at a higher risk of death while the incidence of this combination of diseases will be growing. This article describes a case of diagnosis and treatment of COVID-19 in a 69-year-old patient who was urgently hospitalized with cardiogenic shock associated with ACS, electrocardiographic signs of complete left bundle branch block, and left ventricular ejection fraction of 19 %. Coronary angiography with stenting was successfully performed in the conditions of extracorporeal membrane oxygenation. The patient received long-term intensive therapy in the intensive care unit followed by symptomatic treatment in the cardiac surgery unit. The patient’s condition gradually improved and he was discharged from the hospital on the 56th day. The strategy of intensive care and active follow-up helped saving life of the patient with COVID-19 and AMI.

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