Does gender influence the impact of impaired renal function on prognosis after ST-segment elevated myocardial infarction?

Abstract Background Malnutrition and sarcopenia are common features of frailty. Prevalence of frailty among ST-segment elevation myocardial infarction (STEMI) patients is higher in women than men. Purpose Assess gender-based differences in the impact of nutritional risk index (NRI) and frailty in one-year mortality rate among STEMI patients following primary angioplasty (PA). Methods Cohort of 321 consecutive patients (64 years [54–75]; 22.4% women) admitted to a general ICU after PA for STEMI. NRI was calculated as 1.519 × serum albumin (g/L) + 41.7 × (actual body weight [kg]/ideal weight [kg]). Vulnerable and moderate to severe NRI patients were those with Clinical Frailty Scale (CFS)≥4 and NRI<97.5, respectively. We used Kaplan-Meier survival model. Results Baseline and mortality variables of 4 groups (NRI-/CFS-; NRI+/CFS-; NRI+/CFS- and NRI+/CFS+) are depicted in the Table. Prevalence of malnutrition, frailty or both were significantly greater in women (34.3%, 10% y 21.4%, respectively) than in men (28.9%, 2.8% y 6.0%, respectively; P<0.001). Women had greater mortality rate (20.8% vs. 5.2%: OR 4.78, 95% CI, 2.15–10.60, P<0.001), mainly from cardiogenic shock (P=0.003). Combination of malnutrition and frailty significantly decreased cumulative one-year survival in women (46.7% vs. 73.3% in men, P<0.001) Conclusion Among STEMI patients undergoing PA, the prevalence of malnutrition and frailty are significantly higher in women than in men. NRI and frailty had an independent and complementary prognostic impact in women with STEMI. Kaplan-Meier and Cox survival curves Funding Acknowledgement Type of funding source: None

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Temporal Course of Plasma Trimethylamine N-Oxide (TMAO) Levels in ST-Elevation Myocardial Infarction

Journal of Clinical Medicine ◽

10.3390/jcm10235677 ◽

2021 ◽

Vol 10 (23) ◽

pp. 5677

Author(s):

Mohammad A. Almesned ◽

Femke M. Prins ◽

Erik Lipšic ◽

Margery A. Connelly ◽

Erwin Garcia ◽

...

Keyword(s):

Myocardial Infarction ◽

Renal Function ◽

Infarct Size ◽

Impaired Renal Function ◽

Left Ventricular ◽

St Elevation Myocardial Infarction ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Temporal Course ◽

St Elevation

The gut metabolite trimethylamine N-oxide (TMAO) at admission has a prognostic value in ST-elevation myocardial infarction (STEMI) patients. However, its sequential changes and relationship with long-term infarct-related outcomes after primary percutaneous coronary intervention (PCI) remain elusive. We delineated the temporal course of TMAO and its relationship with infarct size and left ventricular ejection fraction (LVEF) post-PCI, adjusting for the estimated glomerular filtration rate (eGFR). We measured TMAO levels at admission, 24 h and 4 months post-PCI in 379 STEMI patients. Infarct size and LVEF were determined by cardiac magnetic resonance 4 months after PCI. TMAO levels decreased from admission (4.13 ± 4.37 μM) to 24 h (3.41 ± 5.84 μM, p = 0.001) and increased from 24 h to 4 months (3.70 ± 3.86 μM, p = 0.026). Higher TMAO values at 24 h were correlated to smaller infarct sizes (rho = −0.16, p = 0.024). Larger declines between admission and 4 months suggestively correlated with smaller infarct size, and larger TMAO increases between 24 h and 4 months were associated with larger infarct size (rho = −0.19, p = 0.008 and rho = −0.18, p = 0.019, respectively). Upon eGFR stratification using 90 mL/min/1.73 m2 as a cut-off, significant associations between TMAO and infarct size were only noted in subjects with impaired renal function. In conclusion, TMAO levels in post-PCI STEMI patients are prone to fluctuations, and these fluctuations could be prognostic for infarct size, particularly in patients with impaired renal function.

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Pattern of Arrhythmias in Patients of Acute ST Elevation Myocardial Infarction with Impaired Renal Function

Journal of Medical Science And clinical Research ◽

10.18535/jmscr/v6i8.203 ◽

2018 ◽

Vol 6 (8) ◽

Author(s):

Dr M. M. Abdus Shamim ◽

Keyword(s):

Myocardial Infarction ◽

Renal Function ◽

Impaired Renal Function ◽

St Elevation Myocardial Infarction ◽

St Elevation

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Abstract 380: Gender Differences in Glucose Metabolism Profile in Patients with ST Segment Elevation Myocardial Infarction

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.7.suppl_1.380 ◽

2014 ◽

Vol 7 (suppl_1) ◽

Author(s):

Gautam V Shah ◽

Bhuvnesh Aggarwal ◽

Mandeep Randhawa ◽

Sachin S Goel ◽

A. Micheal Lincoff ◽

...

Keyword(s):

Diabetes Mellitus ◽

Myocardial Infarction ◽

Insulin Resistance ◽

Gender Differences ◽

Cleveland Clinic ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

The Difference ◽

The Impact

Background: Presence of insulin resistance has been known to be a strong independent risk factor for coronary artery disease. However, there is limited data on gender differences in metabolic profile of patients that present with an acute ST segment elevation myocardial infarction (STEMI). Methods: All patients (N = 1,652) who underwent primary PCI for STEMI at the Cleveland Clinic Foundation between January 2005 to December 2012 were included. Insulin Resistance (IR) was defined as presence of diabetes mellitus (DM) or pre-DM. Further DM was identified if there was a known history of DM or hypoglycaemic therapy or if admission glycated hemoglobin (HbA1c) was ≥ 6.5 and pre-DM was defined for admission HbA1c ≥ 5.7 and < 6.5. Lastly, prevalence of IR in women was compared with similarly aged men presenting with STEMI at our institution. Results: IR was identified in 70% (n= 1,163/1,652) and DM in 30% (n = 487/1,652) of patients presenting with STEMI. Prevalence of IR was significantly higher in post menopausal women (age > 50 years) when compared with similarly aged men (79%; 344/435 vs. 69%; 603/871; p <0.0001) with majority of the difference contributed by difference in incidence of DM (38%; 163/435 in females vs 29%; 257/871 in males; p<0.0001; Figure 1). Conclusions: Our results indicate that prevalence of IR including diabetes mellitus may be higher in women as compared to similarly aged men who present with STEMI and the difference increases with increasing age. We also noted that Pre-DM contributes significantly to the high prevalence of IR in subjects with STEMI irrespective of gender. Larger studies are required to assess the impact of Pre-DM on adverse cardiovascular events in men as well as women.

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Abstract 13993: Impact of Prasugrel Pretreatment and Timing of Coronary Artery Bypass Grafting on Clinical Outcomes of Patients With Non-ST-Segment Elevation Myocardial Infarction: From the Accoast Study

Circulation ◽

10.1161/circ.130.suppl_2.13993 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Dariusz Dudek ◽

Petr Widimsky ◽

Leonardo Bolognese ◽

Patrick Goldstein ◽

Christian Hamm ◽

...

Keyword(s):

Myocardial Infarction ◽

Coronary Artery ◽

Clinical Outcomes ◽

Artery Bypass ◽

Bypass Grafting ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

Cabg Patients ◽

The Impact

Objectives: We evaluated the impact of prasugrel pretreatment and timing of coronary artery bypass grafting (CABG) on clinical outcomes of patients with non-ST-segment elevation myocardial infarction (NSTEMI) undergoing CABG based on data from ACCOAST. Methods: We evaluated the impact of troponin, prasugrel pretreatment and CABG timing on clinical outcomes of NSTEMI patients undergoing CABG through 30 days from ACCOAST. Results: CABG patients versus PCI or medically managed patients were more often male, diabetic, had peripheral arterial disease and a higher GRACE score. By randomization assignment, 157 patients received a 30-mg loading-dose of prasugrel before CABG; 157 patients did not. CABG patients were grouped by tertiles of time from randomization to CABG; baseline characteristics in the Table. Patients in the lowest tertile had significantly more events (cardiovascular death, MI, stroke, urgent revascularization or glycoprotein IIb/IIIa bailout) and all TIMI major bleeds than those in the other 2 groups (p<0.045, p<0.002 respectively), but the patients in the higher 2 groups were not significantly different from each other. No difference was detected in all cause death among the 3 groups (p>0.39). A multivariate model evaluated 5 possible predictors of the composite endpoint of all cause death, MI, stroke and TIMI major bleeding. Time from randomization to CABG (HR 0.84 for each 1 hour of delay), left main disease presence (HR 1.76), and region of enrollment (Eastern Europe vs other, HR 3.83) were significant predictors but not prasugrel pretreatment or baseline troponin level ≥3xULN. Conclusions: In this group of high-risk patients presenting with NSTEMI, early surgical revascularization carried an increased risk of bleeding and ischemic complications, without impact on all-cause mortality. No impact of baseline troponin or prasugrel pretreatment (important factors influencing time of CABG) on clinical outcomes was confirmed.

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