HIGH ADMISSION PLASMA OSMOLALITY VALUE AS IN-HOSPITAL MAJOR ADVERSE CARDIOVASCULAR EVENTS PREDICTOR IN PATIENT WITH ACUTE MYOCARDIAL INFARCTION

Background: Elevated blood urea nitrogen (BUN), blood glucose, and alteration sodium levels are common among patients with acute myocardial infarction (AMI). These parameters to be widely investigated to assess the prognosis in AMI patients. However, the combination of these parameters (BUN, blood glucose, and sodium) calculated by a certain formula in the form of plasma osmolality has not been widely studied to assess the prognosis of patients with acute myocardial infarction. This study aims to assess plasma osmolality in predicting hospital major adverse cardiovascular events (MACEs) among AMI patients. Methods: Data were collected from 118 consecutive patients with AMI in Cardiac Centre Haji Adam Malik General Hospital Medan. We measured admission plasma osmolality [1,86 (Na+) + BUN/2,8 + Glucose/18+9]. Then we observed in hospital Major Adverse Cardiovascular Outcomes (MACEs) which consist of cardiovascular mortality, acute heart failure, malignant arrhythmia, and cardiogenic shock. Statistical analysis was performed using mean difference, logistic regression, and receiver operating curve (ROC). Result: Among 118 patients, MACEs were observed in 49 (41.5%) patients with the most common MACEs was acute heart failure (25.4%). Bivariate analysis showed a significant relationship between the plasma osmolality and in hospital MACEs (p < 0.001). The plasma osmolality AUC prediction value was 78.9%. The optimal cut-off value was 279.9 mOsm/kg (sensitivity 81.6%; specificity 75.4%). In multivariate logistic regression analysis, the plasma osmolality was the strongest predictor with an OR value of 10.542 (95% CI 2.694-41.255; p-value <0.001). Conclusions: Among AMI patients, high plasma osmolality value (≥280 mOsm/kg) is a better predictor of in-hospital MACEs than its components separately(BUN, glucose level, sodium).

Download Full-text

Elevated plasma Sirtuin2 level predicts heart failure after acute myocardial infarction

10.21203/rs.3.rs-26804/v1 ◽

2020 ◽

Author(s):

Meili Zheng ◽

Lei Zhao ◽

Hao Sun ◽

Mulei Chen ◽

Xinchun Yang

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Acute Myocardial Infarction ◽

Cardiovascular Events ◽

Left Ventricular Ejection ◽

Major Adverse Cardiovascular Events ◽

Low Level ◽

High Level Group ◽

High Level ◽

Level Group

Abstract Background and Objectives: There is currently no evidence regarding the role of plasma Sirtuin2 (SIRT2) level in heart failure after acute myocardial infarction (AMI) yet. This study assessed the relationship between plasma SIRT2 level and AMI, and also investigated the association of plasma SIRT2 level with major adverse cardiovascular events (MACE) and heart failure after AMI. Methods and Results: A total of 129 AMI patients were included in the present study. The major adverse cardiovascular events (MACE) and heart failure were recorded during hospitalization and follow-up (12 months) after discharge. According to the 75th percentile value of plasma SIRT2 level, we divided all the AMI patients into two groups: high level group (plasma SIRT2 level≥109.0pg/ml) and low level group (plasma SIRT2 level <109.0pg/ml). Compared with the low level group, the high level group had higher prercentage of Killip class≥3 (P<0.001), left ventricular ejection fraction(LVEF) <50% (P=0.007) or even <40% (P=0.012), use of breathing machine(P=0.003), and higher plasma brain natriuretic peptide (BNP) level (P=0.006). Multivariate regression analysis showed that there were higher risks of MACE (hazard ratio (HR)=11.20 [95% confidence interval (CI): 3.18-39.52, P<0.001]) and heart failure (HR=27.10 [95%CI 4.65-157.83, P<0.001]) in the high level group. Conclusions: The present study suggested that plasma SIRT2 level is a promising biomarker to predict heart failure and MACE after AMI.

Download Full-text

Major adverse cardiovascular events in patients after acute myocardial infarction treated invasively and different patterns of glucometabolic disturbances evaluated at mid-term follow-up

Journal of Medical Science ◽

10.20883/jms.2017.160 ◽

2017 ◽

Vol 86 (1) ◽

pp. 17

Author(s):

Paweł Francuz ◽

Tomasz Podolecki ◽

Monika Kozieł ◽

Zbigniew Kalarus ◽

Jacek Kowalczyk

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Acute Myocardial Infarction ◽

Glucose Tolerance ◽

Hospital Discharge ◽

Cardiovascular Events ◽

Decompensated Heart Failure ◽

Major Adverse Cardiovascular Events ◽

Abnormal Glucose Tolerance

Objective: To assess the impact of glucometabolic status (GS) evaluated at hospital discharge and at mid-term follow-up visit (FU-visit) on major adverse cardiovascular events (MACE) in patients (pts) with acute myocardial infarction (AMI) treated invasively.Material and Methods: Study encompassed 368 AMI-pts treated invasively, in whom GS was assessed by 2-hour post load glycemia at hospital discharge and at FU-visit after 6 months. Patients were divided into two groups with respect to GS at hospital discharge: abnormal glucose tolerance (AGT, n=149), normal glucose tolerance (NGT, n=219). Each of those groups was divided into two subgroups with respect to GS at FU-visit: persistent AGT (pAGT, n=101), transient AGT (tAGT, n=48), newly detected AGT (newAGT, n=114), persistent NGT (pNGT, n=105). Median follow-up duration after FU-visit was 24.5 months.Results: There was a trend towards more subjects with MACE in AGT than NGT group (24.2% vs. 16%; p=0.051). More AGT-pts were hospitalized due to decompensated heart failure (6% vs. 0.5%; p=0.002). However, there were no significant differences in MACE between subjects with pAGT and tAGT, including heart failure hospitalizations. Among NGT-pts there were no significant differences in particular MACE between newAGT-pts and pNGT-pts.Conclusions: In AMI-pts treated invasively, who had abnormal glucose tolerance at hospital discharge, the improvement in glucometabolic status after 6 months was not related to lower risk of hospitalization due to decompensated heart failure.

Download Full-text

Association of Stress hyperglycemia and adverse cardiac events in acute myocardial infarction – A cohort study

Cardiovascular & Haematological Disorders - Drug Targets ◽

10.2174/1871529x22666211221152546 ◽

2021 ◽

Vol 22 ◽

Author(s):

Annu Rajpurohit ◽

Bharat Sejoo ◽

Rajendra Bhati ◽

Prakash Keswani ◽

Shrikant Sharma ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Acute Myocardial Infarction ◽

Blood Glucose ◽

Clinical Outcomes ◽

P Value ◽

Cardiac Events ◽

Stress Hyperglycemia ◽

Adverse Cardiac Events ◽

Hba1c Levels

Background: Stress hyperglycemia is a common phenomenon in patients presenting with acute myocardial infarction (MI). We aim to evaluate the association of stress hyperglycemia at the time of hospital presentation and adverse cardiac events in myocardial infarction during the course of hospital stay. Methods: Subjects with age ≥18 years with acute MI were recruited on hospital admission and categorized based on admission blood glucose (<180 and ≥180 mg/dl, 50 patients in each group). Both groups were compared for clinical outcomes, adverse cardiac events and mortality. We also compared the adverse cardiac outcomes based on HbA1c levels (<6% and ≥6%). Results: Patients with high blood glucose on admission (stress hyperglycemia) had significant increased incidences of severe heart failure (Killip class 3 and 4), arrythmias, cardiogenic shock and mortality (p value = 0.001, 0.004, 0.044, and 0.008 respectively). There was no significant association between adverse cardiac events and HbA1c levels (heart failure 18.8% vs. 25%, p value = 0.609 and mortality 16.7% vs. 17.3%, p value = 0.856). Conclusions: Stress hyperglycemia is significantly associated with adverse clinical outcomes in patients with MI irrespective of previous diabetic history or glycemic control. Clinicians should be vigilant for admission blood glucose while treating MI patients.

Download Full-text

Methodological Perspectives from ‘Milrinone for the Treatment of Acute Heart Failure After Acute Myocardial Infarction: A Systematic Review and Meta-analysis’

Basic & Clinical Pharmacology & Toxicology ◽

10.1111/bcpt.12458 ◽

2015 ◽

Vol 117 (6) ◽

pp. 368-368

Author(s):

Rômulo Dias Novaes ◽

Reggiani Vilela Gonçalves

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Systematic Review ◽

Acute Myocardial Infarction ◽

Acute Heart Failure ◽

Meta Analysis

Download Full-text

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

European Heart Journal ◽

10.1093/eurheartj/ehz746.1018 ◽

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)

Download Full-text

Creatinine Levels at Admission as Predictors of In-Hospital Major Adverse Cardiovascular Events in Acute Heart Failure Patient

ACI (Acta Cardiologia Indonesiana) ◽

10.22146/jaci.v6i1.124 ◽

2020 ◽

Vol 6 (1) ◽

pp. 16-22

Author(s):

Farida Hanum Margolang ◽

Refli Hasan ◽

Abdul Halim Raynaldo ◽

Harris Hasan ◽

Ali Nafiah ◽

...

Keyword(s):

Heart Failure ◽

Acute Heart Failure ◽

Roc Curve ◽

Cardiovascular Events ◽

Major Adverse Cardiovascular Events ◽

High Morbidity ◽

Roc Curve Analysis ◽

Heart Failure Patients ◽

Long Term Prognosis

Background: Acute heart failure is a global health problem with high morbidity and mortality. Short term and long term prognosis of these patients is poor. Therefore, early identification of patients at high risk for major adverse cardiovascular events (MACEs) during hospitalization was needed to improve outcome. Creatinine levels at admission could be used as predictors of major adverse cardiovascular events in acute heart failure patients because creatinine is a simple and routine biomarker of renal function examined in patients with acute heart failure. This study aimed to determine whether creatinine can be used as a predictor of major adverse adverse cardiovascular events in patients with acute heart failure.Methods: This study is a prospective cohort study of 108 acute heart failure patients treated at H. Adam Malik Hospital from July 2018 to January 2019. Creatinine cut-off points were determined using the ROC curve, then bivariate and multivariate analyzes were performed to determine predictors of major adverse cardiovascular events during hospitalization.Results: From 108 study subjects, 24 (22.2%) subjects experienced major adverse cardiovascular events during hospitalization. The subjects who died were 20 people (83.4%), subjects with arrhythmia were 2 people (8.3%), and those who had stroke were 2 people (8.3 %). Through the ROC curve analysis, we found creatinine cut-off values of ≥1.7 mg / dl (AUC 0.899, 95% CI 0.840- 0.957, p <0.05). Creatinine ≥1.7 mg/dl could predict major adverse cardiovascular events with a sensitivity of 87.5% and specificity of 79.5%. Multivariate analysis showed that creatinine ≥1.7 mg / dl was an independent factor to predict MACEs during hospitalization in this study (OR 18,310, p 0.001) as well as creatinine clearance and heart rate.Conclusion: Creatinine levels at admission is an independent predictor for major adverse cardiovascular events during hospitalization in acute heart failure patients.

Download Full-text

S100a8/a9 Signaling Causes Mitochondrial Dysfunction and Cardiomyocyte Death in Response to Ischemic/Reperfusion Injury

Circulation ◽

10.1161/circulationaha.118.039262 ◽

2019 ◽

Vol 140 (9) ◽

pp. 751-764 ◽

Cited By ~ 20

Author(s):

Yulin Li ◽

Boya Chen ◽

Xinying Yang ◽

Congcong Zhang ◽

Yao Jiao ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Cardiovascular Events ◽

Ischemia Reperfusion ◽

Coronary Intervention ◽

Major Adverse Cardiovascular Events ◽

Mouse Heart ◽

Early Reperfusion ◽

Percutaneous Coronary

Background: Myocardial ischemia-reperfusion (MI/R) injury is a significant clinical problem without effective therapy. Unbiased omics approaches may reveal key MI/R mediators to initiate MI/R injury. Methods: We used a dynamic transcriptome analysis of mouse heart exposed to various MI/R periods to identify S100a8/a9 as an early mediator. Using loss/gain-of-function approaches to understand the role of S100a8/a9 in MI/R injury, we explored the mechanisms through transcriptome and functional experiment. Dynamic serum S100a8/a9 levels were measured in patients with acute myocardial infarction before and after percutaneous coronary intervention. Patients were prospectively followed for the occurrence of major adverse cardiovascular events. Results: S100a8/a9 was identified as the most significantly upregulated gene during the early reperfusion stage. Knockout of S100a9 markedly decreased cardiomyocyte death and improved heart function, whereas hematopoietic overexpression of S100a9 exacerbated MI/R injury. Transcriptome/functional studies revealed that S100a8/a9 caused mitochondrial respiratory dysfunction in cardiomyocytes. Mechanistically, S100a8/a9 downregulated NDUF gene expression with subsequent mitochondrial complex I inhibition via Toll-like receptor 4/Erk–mediated Pparg coactivator 1 alpha/nuclear respiratory factor 1 signaling suppression. Administration of S100a9 neutralizing antibody significantly reduced MI/R injury and improved cardiac function. Finally, we demonstrated that serum S100a8/a9 levels were significantly increased 1 day after percutaneous coronary intervention in patients with acute myocardial infarction, and elevated S100a8/a9 levels were associated with the incidence of major adverse cardiovascular events. Conclusions: Our study identified S100a8/a9 as a master regulator causing cardiomyocyte death in the early stage of MI/R injury via the suppression of mitochondrial function. Targeting S100a8/a9-intiated signaling may represent a novel therapeutic intervention against MI/R injury. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT03752515

Download Full-text