scholarly journals Hb Levels and Sex Differences in Relation to Short-Term Outcomes in Patients With Acute Myocardial Infarction

2021 ◽  
Vol 8 ◽  
Author(s):  
Junyu Pei ◽  
Xiaopu Wang ◽  
Pengfei Chen ◽  
Keyang Zheng ◽  
Xinqun Hu
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Regression Model ◽  
Major Bleeding ◽  
Piecewise Linear ◽  
Hemoglobin Level ◽  
Adverse Outcomes ◽  
Piecewise Linear Regression ◽  
The Relationship ◽  
Baseline Hemoglobin

Background: Women had worse outcomes after acute myocardial infarction (AMI), and physiologically, women had lower hemoglobin values. We examined whether there were sex-related differences in the relationship between hemoglobin levels and adverse outcomes in patients with acute myocardial infarction.Method: We conducted a post-hoc analysis of data from the Acute Coronary Syndrome Quality Improvement in Kerala (ACS-QUIK) Study. We explored the relationship between baseline hemoglobin level and 30-days adverse outcomes by logistic regression model, generalized additive model (GAM) and two-piecewise linear regression model. We used multiple imputation, based on five replications and a chained equation approach method in the R multiple imputation procedure, to account for missing data. The primary outcome were 30-day major adverse cardiovascular events (MACEs) defined as death, reinfarction, stroke, and major bleeding. The secondary outcomes were 30-day major bleeding, 30-day stroke and 30-day cardiovascular death (CVD death).Results: Twenty thousand, five hundred fifty-nine patients with AMI were included in our analysis. Baseline hemoglobin level was associated with major bleeding [OR: 0.74, 95%CI (0.60, 0.92) P < 0.01], CVD death [OR: 0.94, 95%CI (0.90, 0.99) P < 0.01], and MACEs [OR: 0.95, 95%CI (0.92, 0.99) P < 0.01]. There was no significant relationship between baseline hemoglobin level and stroke incidence in both men [OR: 1.02, 95%CI (0.90, 1.14) P = 0.77] and women [OR: 1.15, 95%CI (0.96, 1.37) P = 0.18]. Baseline hemoglobin level was associated with major bleeding [OR: 0.71, 95%CI (0.58, 0.85) P < 0.01] in male patients, however we did not find the same relationship in female patients [OR: 0.89, 95%CI (0.56, 1.41) P = 0.61]. GAM and two-piecewise linear regression model showed the relationships of hemoglobin level with major bleeding, CVD death, and MACEs were non-linear (non-linear P < 0.05), and the threshold value were 13, 14.8, and 14.3 g/dL for MACEs and CVD death, respectively.Conclusion: Baseline hemoglobin level was one of the independent predictors of prognosis in South Asia patients with acute myocardial infarction. Moreover, its impact on prognosis was largely different depending on the patients' sex.

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

Life ◽  
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.

Abstract 327: Gender Differences In The Association Between Hemoglobin Change After Acute Myocardial Infarction And Outcomes

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Lauren E Thompson ◽  
Frederick A Masoudi ◽  
Kensey L Gosch ◽  
Pamela N Peterson ◽  
Adam C Salisbury ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Similar Magnitude ◽  
Men And Women ◽  
Absolute Change ◽  
Hospitalization Rates ◽  
Lower Baseline ◽  
The Relationship ◽  
Baseline Hemoglobin

Background: Hemoglobin decline following acute myocardial infarction (AMI) is associated with long-term morbidity. Since women have lower baseline hemoglobin levels than men, whether the same absolute change in hemoglobin after AMI similarly affects outcomes in women and men is unknown. Methods: We examined patients discharged after AMI in the TRIUMPH registry between 2005 and 2008 who had admission and discharge hemoglobin levels. We compared the relationship between absolute change in hemoglobin during hospitalization with 6- and 12-month mortality and re-hospitalization by gender after adjusting for clinical variables including admission hemoglobin. Results: Of the 4,243 patients with AMI, 33% (1,400 of 4,243) were women. Women were older, had more co-morbidities, and were less likely to present with STEMI, or receive catheterization. Women had lower admission hemoglobin (12.9 g/dL ± 1.9 vs 14.5 ± 2.0, p= <0.01) and a smaller mean absolute change in hemoglobin during hospitalization (-1.5 g/dL ± 1.8 vs -1.6 ±1.8, p = 0.01) compared to men. The association between hemoglobin declines during hospitalization and mortality and re-hospitalization rates at 6 and 12-months were of a similar magnitude between men and women (all interaction p > 0.05). (Figure 1) Conclusion: Although women with AMI had lower admission hemoglobin values, similar declines in hemoglobin during hospitalization were associated with increases in mortality and re-hospitalization in women and men. These findings suggest that absolute change in hemoglobin is equally important at predicting outcomes in women and men, regardless of admission hemoglobin levels.

Accommodating Outliers and Nonlinearity in Decision Models

1992 ◽  
Vol 7 (2) ◽  
pp. 161-190 ◽  
Author(s):  
Duane Kennedy ◽  
Josef Lakonishok ◽  
Wayne H. Shaw
Keyword(s):  
Regression Model ◽  
Prediction Error ◽  
Piecewise Linear ◽  
Predictive Ability ◽  
Decision Models ◽  
Coefficient Estimates ◽  
Piecewise Linear Regression ◽  
Independent Variables ◽  
Ranking Procedures ◽  
The Relationship

This paper describes and compares six procedures that can be used in a regression model to adjust for outliers in the data and nonlinearities in the relationship between the dependent and independent variables. The data accommodation procedures are: (1) no-adjustment; (2) winsorizing; (3) trimming; (4) regression on ranks; (5) nonlinear regression; and (6) piecewise linear regression. The results show that the choice of data accommodation procedure has a major impact on the predictive ability and coefficient estimates of the regression model. The winsorizing and ranking procedures produce a regression model that fits the data well and has a low level of prediction error.

Abstract 5608: Prognostic Impact of the Baseline White Blood Cell Count in Patients with Acute Myocardial Infarction Undergoing Primary PCI: Results from the HORIZONS-AMI trial

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Roxana Mehran ◽  
George D Dangas ◽  
Helen Parise ◽  
Giulio Guagliumi ◽  
Bernard Witzenbichler ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Blood Cell ◽  
White Blood Cell ◽  
Major Bleeding ◽  
Adverse Outcomes ◽  
Prognostic Impact ◽  
Primary Pci ◽  
Cardiac Events ◽  
Wbc Count

Background: Inflammation plays a crucial role in atherosclerosis. Previous studies have suggested an association between elevated white blood cell (WBC) and adverse outcomes in patients with ST-elevation acute myocardial infarction (STEMI). We sought to determine the relationship between admission WBC count and mortality in patients with STEMI in the HORIZONS-AMI trial. Methods: HORIZONS-AMI enrolled 3602 patients with STEMI undergoing primary PCI. We compared rates of 30-day major adverse cardiac events (MACE: death, reinfarction, target vessel revascularization for ischemia, or stroke), non-CABG major bleeding, and net adverse clinical events (NACE: MACE or major bleeding) in patients with baseline WBC count >12,000 cells/mm 3 vs ≤12,000 cells/mm 3 . Results: Of the 3497 patients with baseline WBC data, 2206 (63.1%) had a WBC count of ≤12,000 and 1291 (38.9%) had a WBC of >12,000 (median 10,800 mm 3 , mean 11,700 mm 3 ). Patients with WBC ≤12,000 were older, had more hypertension, hyperlipidemia, diabetes, prior MI, and prior CABG. Compared to patients with WBC ≤12,000, those with WBC >12,000 had significantly higher rates of 30-day adverse outcomes (Table ). By multivariate analyses, WBC >12,000 was an independent predictor of 30-day mortality (HR [95% CI] = 2.51 [1.61–3.91], p30.001), MACE (1.82 [1.36, 2.44], p<0.0001), and major bleeding (1.52 [1.16 –1.99], p=0.003). Conclusions: In patients presenting with STEMI undergoing primary PCI, an elevated WBC count identifies a high risk cohort with significantly higher mortality, MACE and major bleeding at 30-days. These results further support the pivotal role of inflammation in ACS/AMI.

Abstract 3166: Blood Transfusion and Clinical Outcomes in Patients with Acute Myocardial Infarction

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Doron Aronson ◽  
Michael Kapeliovich ◽  
Walter Markiewicz ◽  
Haim Hammerman
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Acute Coronary Syndromes ◽  
Interquartile Range ◽  
Killip Class ◽  
Coronary Syndromes ◽  
To Receive ◽  
The Relationship ◽  
Baseline Hemoglobin

Introduction: The safety of red blood cells transfusion (RBC-T) in patients (pts) with acute coronary syndromes is controversial, with some studies suggesting that RBC-T may adversely affect outcome. Methods: We studied the relationship between RBC-T during hospitalization and 6-months mortality in 2325 pts with acute myocardial infarction (AMI).Propensity score for RBC-T was calculated based on a logistic regression model incorporating age, sex, baseline hemoglobin (Hb), creatinine, diabetes, smoking, blood pressure and heart rate, Killip class, thrombolytic therapy and coronary interventions. The association between RBC-T and mortality was assessed using Cox mode with RBC-T as a time-dependent covariate, adjusting for the propensity to receive RBC-T and nadir Hb prior to RBC-T. Results: One hundred and ninety one pts (8.2%) received RBC-T. Median nadir Hb was markedly lower in pts receiving RBC-T (8.8 gr/dL [interquartile range 8.2–9.3]) compared with pts not receiving RBC-T (12.8 gr/dL [interquartile range 11.6 –13.9]; P < 0.0001). Mortality increased progressively in pts receiving RBC-T over the 6-months follow-up (Figure ). The unadjusted hazard ratio (HR) for mortality in pts receiving RBC-T was 4.1 (95% CI 3.0 –5.7, P < 0.0001). The effect of RBC-T was attenuated but remained significant after adjustments for the propensity to receive RBC-T (HR 2.1; 95% CI 1.4 –3.2, P < 0.0001). However, after adjusting for nadir Hb, the association between RBC-T and mortality was not significant (HR 1.4; 95% 0.9 –2.1, P = 0.09). Conclusion: The transfusion-associated risk in patients with AMI reflects the severity of the anemia at the time of transfusion and associated comorbidities.

The combined impact of Type D personality and depression on cardiovascular events after acute myocardial infarction

2021 ◽  
pp. 1-11
Author(s):  
Yini Wang ◽  
Xueqin Gao ◽  
Zhenjuan Zhao ◽  
Ling Li ◽  
Guojie Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Significant Risk ◽  
Type D Personality ◽  
Adverse Outcomes ◽  
Combined Effect ◽  
Continuous Variables ◽  
Type D

Abstract Background Type D personality and depression are the independent psychological risk factors for adverse outcomes in cardiovascular patients. The aim of this study was to examine the combined effect of Type D personality and depression on clinical outcomes in patients suffering from acute myocardial infarction (AMI). Methods This prospective cohort study included 3568 patients diagnosed with AMI between February 2017 and September 2018. Type D personality and depression were assessed at baseline, while the major adverse cardiac event (MACE) rate (cardiac death, recurrent non-fatal myocardial infarction, revascularization, and stroke) and in-stent restenosis (ISR) rate were analyzed after a 2-year follow-up period. Results A total of 437 patients developed MACEs and 185 had ISR during the follow-up period. The Type D (+) depression (+) and Type D (+) depression (−) groups had a higher risk of MACE [95% confidence interval (CI) 1.74–6.07] (95% CI 1.25–2.96) and ISR (95% CI 3.09–8.28) (95% CI 1.85–6.22). Analysis of Type D and depression as continuous variables indicated that the main effect of Type D, depression and their combined effect were significantly associated with MACE and ISR. Moreover, Type D (+) depression (+) and Type D (+) depression (−) emerged as significant risk factors for MACE and ISR in males, while only Type D (+) depression (+) was associated with MACE and ISR in female patients. Conclusions These findings suggest that patients complicated with depression and Type D personality are at a higher risk of adverse cardiovascular outcomes. Individual assessments of Type D personality and depression, and comprehensive interventions are required.

The Role of Uric Acid in the Acute Myocardial Infarction: A Narrative Review

Angiology ◽  
2021 ◽  
pp. 000331972110125
Author(s):  
Atalay Demiray ◽  
Baris Afsar ◽  
Adrian Covic ◽  
Masanari Kuwabara ◽  
Charles J. Ferro ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Uric Acid ◽  
Adverse Outcomes ◽  
Narrative Review ◽  
Background Information ◽  
Pathophysiological Role ◽  
Artery Disease ◽  
Pathologic Processes

Increased serum uric acid (SUA) levels have been associated with various pathologic processes such as increased oxidative stress, inflammation, and endothelial dysfunction. Thus, it is not surprising that increased SUA is associated with various adverse outcomes including cardiovascular (CV) diseases. Recent epidemiological evidence suggests that increased SUA may be related to acute myocardial infarction (AMI). Accumulating data also showed that elevated UA has pathophysiological role in the development of AMI. However, there are also studies showing that SUA is not related to the risk of AMI. In this narrative review, we summarized the recent literature data regarding SUA and AMI after providing some background information for the association between UA and coronary artery disease. Future studies will show whether decreasing SUA levels is beneficial for outcomes related to AMI and the optimum SUA levels for best outcomes in CV diseases.

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