Impact of the covid pandemic on admission for acute heart disease in a level II coronary unit

Funding Acknowledgements Type of funding sources: None. Purpose and Methods The Covid-19 pandemic has led to an increase in demand for Critical Patient Care Units. For this reason, level III Coronary Units have become a very valuable resource in the care of seriously ill patients, especially those due to covid. Level II Coronary Units could have assumed a greater number of acute heart patients, especially coronary, during the pandemic in hospitals that have coronary units of different levels. Our objective has been to compare the profile of patients who have been admitted to our level II Coronary Unit, retrospectively analyzing and comparing the demographic data and the reason for admission of the patients who were admitted between March and November 2019 (group I) with those who did so between the same months of 2020 (group II). Results Group I patients were 518 patients compared to 625 in group II. There was no difference between the age of the patients admitted (65.2 + 13 vs 65.1 + 13.8 years old). In the covid period, there were no significant differences between the classic risk factors, such as hypertension, diabetes or dyslipidemia. There was a higher percentage of smoking among the patients. During the pandemic, the patients admitted had significantly less history of previous heart disease (40.2% vs 78%). There has been a significant increase in admissions for acute ischemic heart disease in our unit (60% vs 13.8% the previous year), at the expense of Acute coronary syndrome with ST elevation (STEMI), with a downward trend in pathologies such as arrhythmias (13.5% in 2020 vs 20.6% in 2019) and acute heart failure (11.1% in 2020 vs 12.1% in 2019). The average length of stay during the Covid-19 period was significantly shorter, 2.7 days, compared to 3.3 days in the 2019 period, at the expense of a higher turnover rate in the Unit (79.42 vs 74, 09). During the covid period, there were 36.67% more discharge. Conclusions During the Covid-19 pandemic, a significant increase in acute ischemic heart disease (STEMI) has been observed in our level II Coronary unit, which is responsible for the greater number of discharges and the decrease in our average length of stay. This has allowed level III Coronary Units the ability to assume the excess of patients in need of intensive care that has been significantly increased by the Covid-19 pandemic

CircSLC8A1 and circNFIX can be used as auxiliary diagnostic markers for sudden cardiac death caused by acute ischemic heart disease

Sudden cardiac death (SCD) caused by acute ischemic heart disease (IHD) is a major cause of sudden death worldwide. Circular RNAs (circRNAs) are abundant in the heart and play important roles in cardiovascular diseases, but the role of circRNAs as biomarkers in the forensic diagnosis of SCD caused by acute IHD remains poorly characterized. To investigate the potential of two heart-enriched circRNAs, circNFIX and circSLC8A1, we explored the expression of these two circRNAs in different kinds of commonly used IHD models, and further verified their expressions in forensic autopsy cases. The results from both the IHD rat and H9c2 cell models revealed that circSlc8a1 level was upregulated, while the circNfix level was elevated in the early stage of ischemia and subsequently downregulated. The time-dependent expression patterns of the two circRNAs suggested their potential as SCD biomarkers. In autopsy cases, the results showed that the expression of these two circRNAs in the myocardium with acute IHD-related SCDs corresponded to the observations in the ischemic models. Further analysis related to myocardial ischemia indicated that circSLC8A1 showed high sensitivity and specificity for myocardial infarction and was positively correlated with creatine kinase MB in pericardial fluid. Downregulated circNFIX level could indicate the ischemic myocardial damage, and it was negatively correlated with the coronary artery stenosis grade. The combination of circSLC8A1 and circNFIX had better performance to discriminate IHD-related SCDs. The results suggested that circSLC8A1 and circNFIX may be used as auxiliary diagnostic markers for SCD caused by acute IHD in forensic medicine.

Association between antipsychotic use and acute ischemic heart disease in women but not in men: a retrospective cohort study of over one million primary care patients

Background Research comparing sex differences in the effects of antipsychotic medications on acute ischemic heart disease (IHD) is limited and the findings ambiguous. This study aimed to investigate these associations within a primary care setting. Methods Hong Kong public general outpatient electronic records of patients aged 45+ during 2007–2010 were extracted, with the last consultation date as the baseline for a 4-year follow-up period to observe acute IHD hospitalizations (2011–2014). Antipsychotic use was defined as any prescription over the previous 12 months from a list of 16 antipsychotics, while acute IHD was defined by ICD-9: 410.00–411.89. Both sex-specific and sex-combined (both sexes) mixed-effects Cox models (random intercept across 74 clinics) were implemented to examine the association and test the interaction between antipsychotics and sex. Results Among 1,043,236 included patients, 17,780 (1.7%) were prescribed antipsychotics, and 8342 (0.8%) developed IHD. In sex-specific analyses, antipsychotic prescription was associated with a 32% increased hazard rate of acute IHD among women (95% CI 1.05–1.67) but not among men. A likelihood ratio test comparing sex-combined models with and without the interaction between antipsychotic use and sex suggested significant interaction (χ2 = 4.72, P = 0.030). The association between antipsychotic use and IHD among women attenuated and became non-significant when haloperidol was omitted from the operationalization of antipsychotic use (HR = 1.23, 95% CI 0.95–1.60). Conclusion Our results suggest that antipsychotic prescription is moderately associated with an increased risk of acute IHD among women in primary care and this relationship may be explained by specific antipsychotics. Further research should observe and capture the potential intermediary mechanisms and the dose-response relationship of this association to provide more rigorous evidence to establish causality and inform clinical practices.

Insulin resistance in prostate cancer patients and predisposing them to acute ischemic heart disease

Lack of insulin or insulin resistance (IR) plays a central role in diabetes mellitus and makes diabetics prone to acute ischemic heart disease (AIHD). It has likewise been found that many cancer patients, including prostate cancer patients die of AIHD. Previously it has been delineated from our laboratory that dermcidin could induce anomalous platelet aggregation in AIHD and also impaired nitric oxide and insulin activity and furthermore dermcidin was also found in a few types of cancer patients. To determine the role of this protein in prostatic malignancy, a retrospective case–control study was conducted and blood was collected from prostate cancer patients and healthy normal volunteers. So, we measured the level of dermcidin protein and analyzed the IR by Homeostasis Model Assessment (HOMA) score calculation. Nitric oxide was measured by methemoglobin method. HDL, glycated hemoglobin (HbA1c), BMI, hs-cTroponin-T were measured for the validation of the patients’ status in the presence of Dermcidin isoform-2 (DCN-2). Multiple logistic regression model adjusted for age and BMI identified that the HOMA score was significantly elevated in prostate cancer patients (OR = 7.19, P<0.001). Prostate cancer patients are associated with lower level of NO and higher level of both proteins dermcidin (OR = 1.12, P<0.001) and hs-TroponinT (OR = 1.76, P<0.001). From the results, it can be interpreted that IR plays a key role in the pathophysiology of prostate cancer where dermcidin was the cause of IR through NO inhibition leading to AIHD was also explained by high-sensitive fifth generation cTroponin-T (hs-cTroponinT) and HbA1c level which are associated with endothelial dysfunction.