Leukocyte and platelet markers of blood in the dynamics of the hospital period in patients with acute myocardial infarction: the ability to predict the development of long-term adverse events

The aim – to create a new method of assessing the development of long-term complications in STEMI patients by studying blood cell composition and its adaptation to practical application in general clinical practice.Materials and methods. The study was involved 148 patients with acute myocardial infarction (AMI) who was admitted from January 2014 to June 2020 to the intensive care unit. Some patients were evaluated retrospectively and were in group 1 (n=92). Group 2 – 56 patients, who were studied prospectively. The groups of patients did not differ in clinical and anamnestic characteristics and treatment. The study provided an annual observation period. The endpoint in group 1 was: death, stroke, exacerbation of coronary heart disease – including the need for revascularization, the developement or decompensation for heart failure, which led to hospitalization (in addition, group 2 was analyzed for onset of cardiac death).Results and discussion. There complex indicators were built, based on the analysis of the clinical profile and dynamics of laboratory parameters in patients with the onset of the endpoint – a modified leukocyte index (mLI), which contains the values of the number and percentage of granulocytes, lymphocytes and monocytes on days 1, 3 and 10 of STEMI and leukocyte-platelet index (mLPI), which additionally includes indicators of platelet inhomogeneity in size (PDWc and P-LCR). These indices with their limit values (mLI > 140 units and mLPI > 242 units) were more informative in predicting distant cardiovascular events than other laboratory markers (including neutrophil-leukocyte ratio, NLR). In a prospective study branch (group 2), the mLI and mLPI indicators also turned out to be more informative than other markers (in particular, the NLR indicator) in determining the propensity to occur as a combined endpoint (area under the curve 0.71 for both; p>0.0001), so and death (areas under the curve 0.78 and 0.84, respectively; p>0.0001). Based on the data obtained, a computer algorithm has been created that simplifies the risk assessment in AMI patients using the developed indicators.Conclusions. Created leukocyte and leukocyte-platelet indices are highly informative in predicting the risk of complications in patients within a year after AMI.

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Abstract 901: Impact of Microvascular Dysfunction on Long-Term Cardiovascular Events after Primary Coronary Intervention for Acute Myocardial Infarction in Patients Achieving TIMI Grade 3 Reperfusion

Circulation ◽

10.1161/circ.118.suppl_18.s_628-b ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Koichi Tamita ◽

Atsushi Yamamuro ◽

Syuichiro Kaji ◽

Minako Katayama ◽

Tomoko Tani ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Microvascular Dysfunction ◽

Coronary Intervention ◽

Cardiovascular Outcomes ◽

Timi Grade ◽

Group 2 ◽

Grade 3 ◽

Group 1

It has been reported that even if TIMI 3 flow is achieved in epicardial coronary arteries after primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI), microvascular dysfunction results in insufficient reperfusion. Recent studies have shown that microvascular injury can be assessed from coronary flow velocity (CFV) pattern. The aim of this prospective study was to examine whether the CFV pattern predicts the long-term cardiovascular outcomes in AMI patients who achieved TIMI grade 3 reperfusion. The study population consisted of 161 consecutive patients with a first anterior AMI successfully treated with primary PCI (≤50% residual stenosis with TIMI grade 3). We examined the CFV pattern immediately after PCI using a Doppler guidewire. We defined microvascular dysfunction as a diastolic deceleration time ≤600 ms and the presence of systolic flow reversal. Patients were divided into two groups: those without microvascular dysfunction (n=126; group 1) and those with micriovascular dysfunction (n=35; group 2). We evaluated the association between the microvascular dysfunction and the long-term major adverse cardiovascular event (MACE) rates. The Kaplan-Meier survival curves showed that group 2 was poorer than group 1 in prognosis (p=0.0014). Risk-adjusted data by multivariate analysis showed that the microvascular dysfunction was the strongest predictor for long-term MACE (hazard ratio: 3.37; 95% CI, 1.59–7.15; p=0.0015). The CFV pattern immediately after PCI is an accurate predictor of the long-term cardiovascular outcomes in patients with AMI who achieved TIMI grade 3 reperfusion.

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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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Predictors of Left Ventricular Remodeling after Revascularized Acute Myocardial Infarction

Journal of Interdisciplinary Medicine ◽

10.1515/jim-2016-0013 ◽

2016 ◽

Vol 1 (1) ◽

pp. 62-70 ◽

Cited By ~ 1

Author(s):

Sorin Pop ◽

Roxana Hodaş ◽

Edvin Benedek ◽

Diana Opincariu ◽

Nora Rat ◽

...

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Mitral Regurgitation ◽

Ventricular Remodeling ◽

Left Ventricular Remodeling ◽

Interventricular Septum ◽

Left Ventricular ◽

Group 2 ◽

Group 1

AbstractBackground:The acute loss of myocardium, following an acute myocardial infarction (AMI) leads to an abrupt increase in the loading conditions that induces a pattern of left ventricular remodeling (LVR). It has been shown that remodeling occurs rapidly and progressively within weeks after the AMI.Study aim:The aim of our study was to identify predictors for LVR, and find correlations between them and the cardiovascular (CV) risk factors that lead to remodeling.Material and methods:One hundred and five AMI patients who underwent primary PCI were included in the study. A 2-D echocardiography was performed at baseline (day 1 ± 3 post-MI) and at 6 months follow-up. The LV remodeling index (RI), was defined as the difference between the Left Ventricular End-Diastolic diameter (LVEDD) at 6 months and at baseline. The patients were divided into 2 groups, according to the RI: Group 1 – RI >15% with positive remodeling (n = 23); Group 2 – RI ≤15% with no remodeling (n = 82).Results:The mean age was 63.26 ± 2.084 years for Group 1 and 59.72 ± 1.267 years for Group 2. The most significant predictor of LVR was the female gender (Group 1 – 52% vs. Group 2 – 18%, p <0.0001). Men younger than 50 years showed a lower rate of LVR (Group1 – 9% vs. Group 2 – 20%, p = 0.0432). In women, age over 65 years was a significant predictor for LVR (Group 1 – 26% vs. Group 2 – 9%, p = 0.0025). The CV risk factors associated with LVR were: smoking (p = 0.0008); obesity (p = 0.013); dyslipidemia (p = 0.1184). The positive remodeling group had a higher rate of LAD stenosis compared to the no-remodeling group (48% vs. 26%, p = 0.002). The presence of multi-vessel disease was shown to be higher in Group 1 (26% vs. 9%, p = 0.0025). The echocardiographic parameters that predicted LVR were: LVEF <45% (p = 0.048), mitral regurgitation (p = 0.022), and interventricular septum hypertrophy (p <0.0001).Conclusions:The CV risk factors correlated with LVR were smoking, obesity and dyslipidemia. A >50% stenosis in the LAD and the presence of multi-vessel CAD were found to be significant predictors for LVR. The most powerful predictors of LVR following AMI were: LVEF <45%, mitral regurgitation, and interventricular septum hypertrophy.

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Immediate and long-term results of carotid endarterectomy in different periods of ischemic stroke

I P Pavlov Russian Medical Biological Herald ◽

10.23888/pavlovj2020283312-322 ◽

2020 ◽

Vol 28 (3) ◽

pp. 312-322

Author(s):

Anton N. Kazantsev ◽

Konstantin P. Chernykh ◽

Nona E. Zarkua ◽

Roman Yu. Lider ◽

Ekaterina A. Burkova ◽

...

Keyword(s):

Myocardial Infarction ◽

Long Term Results ◽

Lethal Outcome ◽

Group 4 ◽

Hospitalization Period ◽

Rehabilitation Period ◽

Group 3 ◽

Group 2 ◽

Group 1

Aim. Analysis of hospital and long-term results of carotid endarterectomy (CEA) in different periods of acute cerebrovascular event (ACVE). Materials and Methods. The given study was retrospective and was conducted using the method of patients sampling. In the period from 2010 to 2019, 1113 patients with ACVE in history who were later conducted CEA, were selected. Depending on the time interval between the last ACVE and CAE, all the patients were divided into 4 groups: the 1st group in the acutest period of ACVE (1-3 days) (n=24; 2.2%); the 2nd group in the acute period of ACVE (up to 28 days) (n=493; 44.3%); the 3rd group in the early rehabilitation period of ACVE (up to 6 months) (n=481; 43.2%); the 4th group in the late rehabilitation period of ACVE (up to 2 years) (n=115; 10.3%). The long-term period was 34.812.5 months. Results. In the hospitalization period of observation the following complications were found: lethal outcome ((group 1 0%; group 2 0.4% (n=2); group 3 0.2% (n=1); group 4 0%; р=0.16)); myocardial infarction ((group 1 0%; group 2 0.4% (n=2); group 3 0%; group 4 0.9% (n=1); р=0.35)); ACVE/transient ischemic attack (TIA), ((group 1 4.2% (n=1); group 2 0.4% (n=2); group 3 0.2% (n=1); group 4 0%; р1-2=0.01; р1-3=0.009; р1-4=0.01)). By the end of hospitalization period the composite endpoint consisting of lethal outcome + myocardial infarction + ACVE/TIA made in group 1 4.2% (n=1), in group 2 1.2% (n=6), in group 3 0.4% (n=2), in group 4 2.6% (n=3), р=0.08. Complications of the long-term follow-up period were: lethal outcome from all causes ((group 1 25% (n=6); group 2 5.5% (n=27); group 3 7.3% (n=35); group 4 14% (n=16); р1-2=0.002; р1-3=0.008; р2-4=0.012)); lethal outcome from cardiovascular causes ((group 1 4.2% (n=1); group 2 3.6% (n=18); group 3 4.8% (n=23); group 4 5.2% (n=6); р=0.79)), myocardial infarction ((group 1 12.5% (n=3); group 2 3.6% (n=18); group 3 5.4% (n=26); group 4 6.1% (n=7); р=0.15)), ACVE/TIA ((group 1 16.6% (n=4); group 2 6.3% (n=31); group 3 6% (n=29); group 4 11.3% (n=13); р=0.05)); composite endpoint including lethal outcome + myocardial infarction + ACVE/TIA ((group 1 54.2% (n=13); group 2 15.4% (n=76); group 3 18.7% (n=90); group 4 31.3% (n=36); р1-2=0.0001; р1-3=0.0001; р1-4=0.005; р2-4=0.0006; р3-4=0.012)). Conclusion. Application of CEA demonstrated effectiveness and safety in the acute and early rehabilitation period of ACVE.

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Hybrid revascularization of the heart and brain: which carotid endarterectomy is preferable?

Annals of Clinical and Experimental Neurology ◽

10.54101/acen.2021.4.2 ◽

2021 ◽

Vol 15 (4) ◽

pp. 15-26

Author(s):

Anton N. Kazantsev ◽

Roman A. Vinogradov ◽

Sergey V. Artyukhov ◽

Lyudmila V. Roshkovskaya ◽

Vyacheslav V. Matusevich ◽

...

Keyword(s):

Myocardial Infarction ◽

Carotid Artery ◽

Ischaemic Stroke ◽

Intravenous Heparin ◽

Hybrid Revascularization ◽

Group 3 ◽

Group 2 ◽

Group 1

The aim of this study was to analyse the inpatient and long-term results of hybrid surgery, incorporating percutaneous coronary intervention (PCI) and different types of carotid endarterectomy (CEA). Materials and methods. A prospective, open-label cohort comparison study was conducted in 20182020 and included 363 patients with atherosclerosis of both the internal carotid artery (ICA) and coronary artery, who underwent hybrid revascularization of the brain and myocardium. All patients were divided into four groups based on the revascularization strategy: group 1 (n = 107; 29.5%) PCI + eversion CEA; group 2 (n = 98; 27%) PCI + classic CEA with patch angioplasty; group 3 (n = 72; 19.8%) PCI + glomus-sparing CEA according to R.A. Vinogradov; and group 4 (n = 86; 23.7%) PCI + glomus-sparing CEA according to A.N. Kazantsev. The follow-up period was 20.8 8.0 months. The patient received a loading dose of clopidogrel (300 mg) before the PCI, and the procedure was then performed in an endovascular operating room. A radial artery catheter was inserted, and the patient received 10,000 IU of intravenous heparin before the procedure. After the PCI, the patient was taken to the vascular operating room, where they underwent the CEA. The patient received 5,000 IU of intravenous heparin before artery clamping. Glomus-sparing CEA according to A.N. Kazantsev was performed as follows: an arteriotomy was conducted along the internal edge of the external carotid artery (ECA), adjacent to the carotid sinus and 23 cm above the ostium, and extending to the common carotid artery (CCA) (also 23 cm below the ECA ostium), depending on the size of the atherosclerotic plaque. The ICA was transected in the area bound by the ECA and CCA walls. Eversion CEA of the ICA was performed, followed by open CEA of the ECA and CCA. The ICA was implanted in its previous position in the preserved area. Results. No mortality was recorded during the inpatient follow-up period. All cases of myocardial infarction occurred after eversion and classic CEA: 3 in group 1 (2.8%) and 1 in group 2 (1.02%); р = 0.2. No ischaemic stroke was recorded only in patients who underwent CAE according to A.N. Kazantsev (р = 0.66); however, ischaemic stroke occurred in two patients in group 1 (1.8%), in two patients in group 2 (2.04%) and in one patient in group 3 (1.38%). The highest number of cardiovascular events occurred in group 1, due to carotid glomus injury, which led to poorly controlled hypertension during the inpatient stay. This tendency influenced the composite endpoints (death + myocardial infarction + ischaemic stroke), which were highest in group 1 (5 or 4.6%) compared to 3 (3.06%), 1 (1.38%) and 0 in groups 24, respectively (р = 0.18). The groups were comparable in the frequency of long-term complications. However, the incidence of ICA restenosis was lowest and no ECA thrombosis/occlusion was observed after glomus-sparing CEA according to R.A. Vinogradov and A.N. Kazantsev. Conclusion. A hybrid PCI + CEA for brain revascularization should be glomus-sparing. CEA according to A.N. Kazantsev was characterized by lack of procedural arteriotomy complications. This procedure enables blood pressure monitoring in the postoperative period, thus minimizing the risk of cardiovascular complications.

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Impact of Glomerular Filtration Rate on the Incidence and Prognosis of New-Onset Atrial Fibrillation in Acute Myocardial Infarction

Journal of Clinical Medicine ◽

10.3390/jcm9051396 ◽

2020 ◽

Vol 9 (5) ◽

pp. 1396 ◽

Cited By ~ 1

Author(s):

Nicola Cosentino ◽

Marco Ballarotto ◽

Jeness Campodonico ◽

Valentina Milazzo ◽

Alice Bonomi ◽

...

Keyword(s):

Myocardial Infarction ◽

Atrial Fibrillation ◽

Acute Myocardial Infarction ◽

Glomerular Filtration Rate ◽

Glomerular Filtration ◽

Filtration Rate ◽

Group 2 ◽

Long Term Mortality ◽

New Onset

Background: Atrial fibrillation (AF) is a frequent complication of acute myocardial infarction (AMI) and is associated with a worse prognosis. Patients with chronic kidney disease are more likely to develop AF. Whether the association between AF and glomerular filtration rate (GFR) is also true in AMI has never been investigated. Methods: We prospectively enrolled 2445 AMI patients. New-onset AF was recorded during hospitalization. Estimated GFR was estimated at admission, and patients were grouped according to their GFR (group 1 (n = 1887): GFR >60; group 2 (n = 492): GFR 60–30; group 3 (n = 66): GFR <30 mL/min/1.73 m2). The primary endpoint was AF incidence. In-hospital and long-term (median 5 years) mortality were secondary endpoints. Results: The AF incidence in the population was 10%, and it was 8%, 16%, 24% in groups 1, 2, 3, respectively (p < 0.0001). In the overall population, AF was associated with a higher in-hospital (5% vs. 1%; p < 0.0001) and long-term (34% vs. 13%; p < 0.0001) mortality. In each study group, in-hospital mortality was higher in AF patients (3.5% vs. 0.5%, 6.5% vs. 3.0%, 19% vs. 8%, respectively; p < 0.0001). A similar trend was observed for long-term mortality in three groups (20% vs. 9%, 51% vs. 24%, 81% vs. 50%; p < 0.0001). The higher risk of in-hospital and long-term mortality associated with AF in each group was confirmed after adjustment for major confounders. Conclusions: This study demonstrates that new-onset AF incidence during AMI, as well as the associated in-hospital and long-term mortality, increases in parallel with GFR reduction assessed at admission.

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ST Depression, No ST Change, or ST Elevation in Inferior Derivations: Which Has the Worst Outcomes in Acute Anterior Myocardial Infarction?

Cardiology ◽

10.1159/000481814 ◽

2017 ◽

Vol 139 (1) ◽

pp. 53-61

Author(s):

Mert İlker Hayıroğlu ◽

Ahmet Okan Uzun ◽

Ceyhan Türkkan ◽

Muhammed Keskin ◽

Edibe Betül Börklü ◽

...

Keyword(s):

Myocardial Infarction ◽

Hospital Death ◽

Anterior Myocardial Infarction ◽

St Depression ◽

St Segment ◽

St Elevation ◽

Group 3 ◽

Group 2 ◽

Group 1

Objective: The combination of electrical phenomena and remote myocardial ischemia is the pathophysiological mechanism of ST segment changes in inferior leads in acute anterior myocardial infarction (MI). We investigated the prognostic value of ST segment changes in inferior derivations in patients with first acute anterior MI treated with primary percutaneous coronary intervention (PCI). Methods: In this prospective single-center analysis, we evaluated the prognostic impact of ST segment changes in inferior derivations on 354 patients with acute anterior MI. Patients were divided into the following 3 groups according to admission ST segment changes in inferior derivations: ST depression (group 1), no ST change (group 2), and ST elevation (group 3). Results: In-hospital multivariate analysis revealed notably high rates of in-hospital death for patients in group 3 compared to patients in group 2 (OR 2.5; 95% CI 1.6-7.6, p < 0.001). Group 1 and group 2 had similar in-hospital and long-term mortality rates. After adjusting for confounding baseline variables, group 3 had higher rates of 18-month mortality (HR 3.3; 95% CI 1.5-8.2, p < 0.001). Conclusion: In patients with a first acute anterior MI treated with primary PCI, ST elevation in inferior leads had significantly worse short-term and long-term outcomes compared to no ST change or ST segment depression.

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Effectiveness and prognostic value of intravscular imaging in patients with left main coronary artery stenosis and heart failure

European Heart Journal ◽

10.1093/eurheartj/ehab724.2077 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

D Maximkin ◽

Z Shugushev ◽

A Chepurnoy ◽

J M Bolivougui ◽

A Faybushevich ◽

...

Keyword(s):

Myocardial Infarction ◽

Coronary Artery ◽

Prognostic Value ◽

Left Main Coronary Artery ◽

Terminal Part ◽

Left Main ◽

Cardiac Events ◽

Group 2 ◽

Group 1

Abstract Aims A comparative analysis and evaluate the effectiveness and prognostic value of optical coherence tomography (OCT) and fractional flow reserve (FFR) guiding measurement in patients with stenosis of the terminal part of the left main coronary artery (LMCA). Methods 222 patients were selected in the study. Inclusion criteria: true bifurcation stenosis of the LMCA according to quantitative coronary angiography (QCA) and classification by A. Medina. Criteria for determining the hemodynamic significance of stenosis: according OCT - minimal lumen area (MLA) in the terminal part of LMCA <6 mm2; according FFR guiding – <0.8 (in LCx or LAD or both). Patients, who have not been diagnosed hemodynamically significant stenosis, were further subjected to the dynamic observation. All received optimal medical therapy. The study continued to participate patients whose compliance to receive drugs was not lower than 80%. Primary endpoints: frequency of MACE (death, myocardial infarction, revascularizations). The follow-up were 12, 24, 36 months. Results The OCT was performed in 110 patients and FFR guiding measurement – in 112 patients. According to the OCT, were hemodynamically significant stenoses are determined in 36 (32.7%) patients and after FFR-guiding measurement – in 32 (28.6%) of patients (χ2=2.184 p>0.05). Patients without hemodynamically significant stenoses distributed into 2 groups: group 1 (n=74) – according to the OCT and group 2 (n=80) – according to the FFR. The long-term results were monitored in all patients. The frequency of myocardial infarction in group 1 were 1.4% and in group 2 – 7.5% (p<0.05).The frequency of revascularization in group 1 were 5.4% and in group 2 – 15% (p<0.05). The total frequency of major cardiac events were 6.75% in group I and 22.5% in group II (χ2=6.435; p<0.001). The survival without major cardiac events (Kaplan-Maier analysis) were significantly differ between the groups, of 93.25% in group 1 and 77.5% – in group 2 (χ2=7.162 p<0.001). Conclusions The effectiveness of the OCT imaging and the FFR-guiding measurement in determining the hemodynamic significance of the bifurcation stenosis of the LMCA, not different. However, in the long term period, patients with insignificant stenosis identified by the FFR, have a worse prognosis and are distinguished by a major cardiac events, compared with the OCT, which does not allow us to recommend the FFR method as the main one for determining the hemodynamic significance of LMCA. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Russian academic excellence project 5-100

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Inter-relation between Altered Nutritional Status and Clinical Outcomes in Patients with Acute Myocardial Infarction Admitted in a Tertiary Intensive Cardiac Care Unit

Journal Of Cardiovascular Emergencies ◽

10.2478/jce-2018-0005 ◽

2018 ◽

Vol 4 (1) ◽

pp. 32-40 ◽

Cited By ~ 2

Author(s):

Victoria Rus ◽

Diana Opincariu ◽

Roxana Hodas ◽

Tiberiu Nyulas ◽

Marian Hintea ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Nutritional Status ◽

Hemodynamic Instability ◽

Left Ventricular ◽

Cardiac Care ◽

Group 2 ◽

Conut Score ◽

Cardiac Care Unit ◽

Group 1

Abstract Background: The impact of nutritional status on the early outcome of subjects with acute myocardial infarction (AMI) is still not completely elucidated. This study aimed to assess the correlation between nutritional status, as expressed by the CONUT and PIN scores, and (1) clinical and laboratory characteristics, (2) complication rates, and (3) length of hospitalization, in patients with AMI. Materials and methods: We included 56 consecutive patients with AMI who underwent primary percutaneous intervention and stenting. Evaluation of the nutritional status was comprised in the calculation of the CONUT and PNI scores. The study population was divided into 2 groups according to the calculated CONUT score, as follows: group 1 – CONUT score <3 points (normal to mildly impaired nutritional status) and group 2 – CONUT score ≥3 points (moderate to severe malnutrition). The primary end-point of the study was the rate of in-hospital complications (left ventricular free wall rupture, hemodynamic instability requiring inotropic medication, high-degree atrioventricular block, the need for temporary cardiostimulation, supraventricular and ventricular arrhythmias and in-hospital cardiac arrest). The secondary end-points included the duration of hospitalization and the length of stay in the intensive cardiac care unit. Results: In total, 56 patients (44.64% with STEMI, 55.35% with NSTEMI) with a mean age of 61.96 ± 13.42 years, 58.92% males were included in the study. Group distribution was: group 1 – 76.78% (n = 43), group 2 – 23.21% (n = 23). There were no differences between the two groups regarding age, gender, cardiovascular risk factors, or comorbidities. PNI index in group 1 was 54.4 ± 10.4 and in group 2 41.1 ± 2.8, p <0.0001. Serum albumin was significantly lower in group 1 – 4.1 ± 0.3 vs. group 2 – 3.6 ± 0.3 (p <0.0001), similarly to total cholesterol levels (group 1 – 194.9 ± 41.5 vs. group 2 – 161.2 ± 58.2, p = 0.02). The complete blood cell count showed that group 2 presented lower levels of hematocrit (p = 0.003), hemoglobin (p = 0.002), and lymphocytes (p <0.0001) compared to group 1, but a significantly higher platelet count (p = 0.001), mean platelet volume (p = 0.03), neutrophil/lymphocyte (p <0.0001) and platelet/lymphocyte (p <0.0001) ratios, indicating enhanced blood thrombogenicity and inflammation. Regarding in-hospital complications, group 2 presented a higher rate of hemodynamic instability (group 1 – 11.6% vs. group 2 – 38.4%, p = 0.02). The overall hospitalization period was 7.7 ± 1.4 days in group 1 vs. 10.2 ± 4.8 days in group 2, p = 0.06; while the duration of stay in the intensive cardiac care unit was 2.6 ± 0.5 days in group 1 vs. 4.0 ± 2.5 days in group 2, p = 0.02. Conclusions: This study proved that nutritional deficit in acute myocardial patients who undergo revascularization is associated with an increased rate of in-hospital complications and with a longer observation time in a tertiary intensive cardiac care unit.

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Biomarkers of Systemic Versus Local Inflammation During the Acute Phase of Myocardial Infarction, as Predictors of Post-infarction Heart Failure

Journal Of Cardiovascular Emergencies ◽

10.2478/jce-2021-0014 ◽

2021 ◽

Vol 7 (3) ◽

pp. 70-76

Author(s):

Botond Matyas ◽

Stefania Polexa ◽

Imre Benedek ◽

Andreea Buicu ◽

Theodora Benedek

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Acute Myocardial Infarction ◽

Systemic Inflammation ◽

Cell Adhesion Molecules ◽

Ventricular Dysfunction ◽

Serum Biomarkers ◽

Group 2 ◽

Infarction Heart ◽

Group 1

Abstract Background: The aim of this study was to investigate the correlation between serum biomarkers of left ventricular dysfunction and systemic inflammation in the first days after the acute episode, and to investigate their role for early identification of patients at high risk for post-infarction heart failure. Materials and methods: In total, 123 subjects admitted to the Intensive Cardiovascular Care Unit of the Cardiology Clinic of the Târgu Mureș County Clinical Emergency Hospital, Romania, with acute myocardial infarction were retrospectively analyzed in this study. Based on the level of NT-proBNP, the study population was divided into 2 groups: Group 1 (n = 92), with NT-proBNP <3,000 pg/mL, and Group 2 (n = 31), with NT-proBNP >3,000 pg/mL. Results: Biomarkers reflecting systemic inflammation presented significantly higher values in patients with elevated NT-proBNP (hs-CRP – 12.3 ± 8.9 mg/L vs. 3.6 ± 6.7 mg/L, p <0.0001, and interleukin 6 – 27.6 ± 30.7 pg/mL vs. 8.6 ± 6.2 pg/mL, p <0.0001). However, cell adhesion molecules VCAM and ICAM were not significantly different between the groups. Patients in Group 2 presented significantly higher rates of major cardiovascular events and rehospitalizations in the first year after the acute coronary event, with 13.33% event rate for patients in Group 2 compared to 8.7% in Group 1 (p <0.05). Conclusions: Serum biomarkers of ventricular dysfunction are strongly associated with systemic inflammation and ventricular impairment in the immediate phase after an acute myocardial infarction. Systemic inflammation has a higher impact on the clinical outcomes and progression to heart failure than the local coronary inflammation expressed by cell adhesion molecules.

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