Associations of comorbidity patterns and in-hospital outcomes in Chinese young females (<55 years) presenting with ST-segment elevation myocardial infarction: a nationwide registry study

Background

Recent evidence demonstrated an increasing trend for acute myocardial infarction (MI) incidence in young females globally. Identification of distinct clinical comorbidity patterns in this population may allow more precise therapy and improvement in clinical care.

Purpose

This study was designed to identify specific comorbidity patterns and to examine their associations with in-hospital outcomes in female ST-Segment Elevation Myocardial Infarction (STEMI) patients under 55 years of age based on the China Chest Pain Center (CCPC) Database.

Methods

From March 7, 2017, to December 29, a total of 267,405 STEMI patients (66,568 females, 24.9%) were admitted to CCPC. Comorbidity patterns were derived among 6,024 female patients (48.5±5.6 years old) under 55 years of age, using hierarchical clustering applied to 15 medical conditions/histories. The study outcome was defined as the composite of in-hospital adverse events (death, new-onset/worsening heart failure, mechanical complications, recurrent MI, and cerebral ischemic stroke). Associations between multimorbidity patterns and clinical outcomes were evaluated by multivariable-adjusted logistic regression models.

Results

Three comorbidity patterns were derived based on hierarchical clustering, including P1 (histories of hypertension, cerebrovascular disease, heart failure and coronary artery disease), P2 (histories peripheral arterial disease, atrial fibrillation, thyroid dysfunction, anemia, chronic kidney disease, cerebrovascular disease and peptic ulcer) and P3 (obesity, histories of hyperlipidemia, diabetes and smoking, family history of cardiovascular diseases). After adjustment for age, admission levels of systolic blood pressure and heart rate, receiving reperfusion treatment or not, and medical therapies in-hospital (antiplatelet drugs, statins, β-blockers and anticoagulants), compared with participants without multimorbidity, P1 (odds ratios [OR] = 1.60, 95% confidence interval [CI]: 1.26 to 2.04) and P3 (OR = 1.45, 95% CI: 1.10 to1.92) demonstrated relatively higher risks for in-hospital composite outcomes. Compared with patients without comorbidity patterns, the clustering of the above comorbidity patterns dose-dependently augmented the risks for in-hospital composite outcomes, from any one pattern (OR = 1.49, 95% CI: 1.23 to1.81), to any two patterns (OR = 2.46, 95% CI: 1.82 to 3.34) and to three patterns (OR = 4.51, 95% CI: 1.12 to 18.16).

Conclusion

In a nationwide STEMI registry, our results provided the proof-of-concept evidence that specific comorbidity patterns of young female STEMI were associated with differential in-hospital outcomes. Further work is needed to validate the utility and values in decision making of these multimorbidity patterns for appropriate management strategies in young female STEMI patients.

Funding Acknowledgement

Type of funding sources: None.

[Pneumatosis cystoides intestinalis in lung transplant recipients: three cases report and literature review]

Objective: To report the clinical characteristics and treatment courses of pneumatosis cystoides intestinalis(PCI) after lung transplantation(LT). Methods: We included all cases of PCI after LT from March 2017 to June 2021 in China-Japan Friendship Hospital. In addition to our cases, we searched literatures published in Chinese and English languages using China National Knowledge Infrastructure (CNKI), Wanfang Data and PubMed/MEDLINE with the search terms"pneumatosis intestinalis"and"lung transplantation". The clinical characteristics and treatment courses of all cases were summarized and analyzed. Results: Three cases of PCI occurred after LT in this study, with an incidence of 0.804% (3/373). Thirteen related literatures were retrieved, with 51 cases enrolled. The median age of the 54 patients was 55.4 years (22-79 years), with 33 males and 21 females. 64.81% (35/54) of the 54 patients underwent LT for interstitial lung disease and 90.74% (49/54) underwent bilateral LT. Twenty-two cases(40.7%) were asymptomatic when PCI occurred. Thirty-eight cases (38/54,70.37%)had involvement of ascending colon, and 35 cases(35/54,64.81%)had involvement of transverse colon. Forty-three cases(43/54, 79.63%) were treated conservatively. The average interval between transplantation and PCI was 210 (5-2 495) days. Conclusion: PCI is a rare complication after lung transplantation, most often occurring in the colon. Most patients were asymptomatic and could improve by conservative treatments.

[Exploration on teaching reform of cancer epidemiology course]

This study aims to explore optimized teaching mode of cancer epidemiology for undergraduates, and provide scientific ideas and basis for improving teaching quality. Non-randomized concurrent control study was used. Undergraduates, enrolled in 2018, from the department of preventive medicine in A and B medical universities were selected as research objects. Traditional teaching mode was used for cancer epidemiology course in A medical university, and innovative teaching mode named "one core, four dimensions" was adopted in B medical university. After the course, questionnaire method was used to investigate self-cognition of students, teaching satisfaction and class preparation time of teachers in B Medical University. The post-class test method was used to compare the students' grades of cancer epidemiology in the two universities. The results indicated that among the 58 students of B medical university, 94.83% (55/58) students were familiar with common types of epidemiological studies and 86.21% (50/58) mastered the evaluation indicators of screening research. Among the nine teaching faculties from B medical university, seven reported that the new teaching plan helped students to learn frontier knowledge of cancer epidemiology, and eight reported the new teaching model was conducive to the interaction between teachers and students. The text score of students in B medical university was 50.34±4.90, significantly higher than that in A medical university (46.21±4.91, t=5.20, P<0.001). The optimized teaching mode of cancer epidemiology is highly praised by students and teachers, which has the potential to improve students' grasp of cancer epidemiology, the ability to combine theory with practice, and the teaching effect of cancer epidemiology.

[Lipoprotein apheresis in patients with familial hypercholesterolemia: a single center research]

Objective: We evaluated the safety and efficacy of lipoprotein apheresis (LA) in patients with familial hypercholesterolemia (FH) who can't reach low-density lipoprotein cholesterol(LDL-C) target goals with the maximal tolerated dose of lipid-lowering agents. Methods: This was a retrospective cross-sectional study. Between February 2015 and November 2019, patients with FH who were admitted in Fuwai hospital and treated with LA were consecutively enrolled. Based on intensive lipid-lowering agents, these patients received LA by double filtration plasma pheresis (DFPP) method. The changes of lipid levels such as LDL-C and lipoprotein(a)[Lp(a)] were compared before and after LA treatment, and the changes of immunoglobulin (Ig) concentration and LA-related adverse effects were also discussed. Results: A total of 115 patients with FH were enrolled in this study, of which 8 cases were homozygous FH and 107 cases were heterozygous FH. The age was (43.9±12.2) years and there were 75 (65.2%) males, and 108 (93.8%) with coronary artery disease. For pre-and immediately after LA treatment, the LDL-C was (5.20±2.94) mmol/L vs. (1.83±1.08) mmol/L, Lp(a) concentration was 428.70(177.00, 829.50)mg/L vs. 148.90(75.90, 317.00) mg/L (P<0.001), with a decrease of 64.2% and 59.8% respectively. The levels of IgG and IgA measured 1 day after LA treatment were both in the normal range and IgM concentration was below the reference value, the reductions of which were 15.1%, 25.0% and 58.7% respectively (P<0.001). Six patients had mild symptoms of nausea, hypotension dyspnea and palpitation, the symptoms were relieved by symptomatic treatment. Conclusion: For patients with FH who do not achieve LDL-C target goal with the maximal tolerated lipid-lowering agents, especially those with elevated Lp(a) levels, LA, which can significantly further reduce LDL-C and Lp(a) levels, is an effective and safe option.

[Research advances on the clinical characteristics and diagnosis and treatment of autoimmune disease-related ulcers]

Studies have shown that autoimmune disease (AID)-related ulcers are disease complications that lead to serious poor prognosis such as infection and disability. It is difficult to make a clear diagnosis and there are contradictions between the applications of immunosuppressive therapy and anti-infectious therapy. Improper diagnosis and immunosuppressive therapy can easily delay the timing of anti-infectious therapy and surgery for patients, which bring adverse effects on the prognosis of patients. This paper reviews the concept, clinical characteristics and treatment suggestions of each subtype of AID-related ulcers, in order to provide more ideas for AID-related ulcers' clinical diagnosis and treatment.

POS1160 PROTECT: PEGLOTICASE TREATMENT FOR UNCONTROLLED GOUT IN KIDNEY TRANSPLANTED PATIENTS; RESULTS FROM A PHASE 4 TRIAL

Background

A phase 4 trial (NCT04087720) of kidney transplant (KT) recipients on stable immunosuppressants with uncontrolled gout previously reported that pegloticase produced a sustained decrease in serum uric acid (sUA) levels and was associated with clinically meaningful improvements in pain and disability without worsening of key kidney function markers. Pegloticase treatment was well tolerated overall with no infusion reactions or anaphylaxis. Here we report additional exploratory and secondary endpoints.

Objectives

To evaluate the results of clinically important efficacy endpoints as supportive evidence for the efficacy of pegloticase in kidney transplant patients on immunosuppression.

Methods

PROTECT a multicenter, open-label, efficacy and safety study of pegloticase in included kidney transplant recipients (KT>1 year prior) with uncontrolled gout (sUA ≥7 mg/dL, oral urate lowering therapy contraindication/inefficacy, and with either visible tophi, chronic gouty arthritis, or ≥2 flares in past year), who had a functioning graft (estimated glomerular filtration rate [eGFR] ≥15 ml/min/1.73m2), and were on a stable immunosuppressant regimen. Pegloticase (8 mg infusion) was administered biweekly for 24 weeks (12 infusions) followed by a final follow up visit 3 months post-treatment. The global health component of the Health Assessment Questionnaire (HAQ-Health), and the physician global assessment of gout (PGA) were assessed at baseline, weeks 6, 14, 20, 24, and the end of pegloticase infusions (EOI) visit (if applicable, when the final infusion occurred prior to week 22). Both were visual analog scales (VAS), where HAQ-health ranged from 0 (very well) to 100 (very poor) and PGA ranged from 0 (excellent) to 10 (very poor). Heart rate and blood pressure measurements were recorded at baseline, weeks 6, 12, 18, 24 and the EOI visit.

Results

20 patients received at least 1 dose of pegloticase and were included in the analysis with the majority (90.0%) 40 to 81 years of age. Most were male (85.0%), 45.0% white, and 35.0% black or African American. Median body weight (88.46 kg) and body mass index (29.68 kg/m2) were high. Median baseline eGFR and baseline Urine Albumin-Creatinine Ratio (UACR) were 41.70 mL/min/1.73m2 and 312.00 mg/g, respectively. An improvement from baseline to weeks 14 (n=18), and 24 (n=15 [PGA], n=14 [HAQ]) in mean PGA and HAQ-Health was observed. Change from baseline (Mean [SD]) at 14 and 24 weeks for PGA was -2.3 (1.94) and -2.3 (2.19), and for HAQ-Health was -32.74 (21.26) and -21.52 (27.47) respectively. Improvement was sustained at the 3-month post-treatment follow-up visit. Mean decreases from baseline in sitting systolic blood pressure, diastolic blood pressure, and mean arterial pressure were observed at weeks 6, 12, 18 and 24. Change from baseline values at 24 weeks (n=15) for systolic, diastolic and mean arterial pressures were (Mean [SD]) -11.01 (14.04), -4.37 (9.18), and -6.58 (9.675) mmHg respectively. Heart rate showed no clinically meaningful trends from baseline at any of the post-baseline timepoints.

Conclusion

Clinically important improvements in both HAQ and PGA were demonstrated for pegloticase treated kidney transplant patients. Improvements were also observed in systolic, diastolic, and mean arterial blood pressure. These data support the benefits of pegloticase treatment for uncontrolled gout in kidney transplant recipients using immunosuppression.

Disclosure of Interests

Abdul Abdellatif Speakers bureau: Amgen, Aurinia, Bayer, Horizon, Janssen, Keryx, Mallinckrodt, Merck, Natera, Opko, Rockwell and Vifor Pharma, Consultant of: Amgen, Horizon, Keryx Mallinckrodt, Opko, Pharmacosmos, and Rockwell, Lin Zhao Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Katya Cherny Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Brad Marder Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, John Scandling Consultant of: Horizon Therapeutics, Kenneth Saag Grant/research support from: Horizon Therapeutics, SOBI and Shanton

[Effect evaluation of "Smoking cessation: Doctor first"program in China]

Objective: To evaluate the effect of "Smoking cessation: Doctor first" program on smoking medical staff. Methods: From December 2016 to September 2019, 1 747 smoking medical staff from 54 units of China Tobacco Cessation Alliance were enrolled into"Smoking cessation: Doctor first"program. Demographic characteristics, smoking characteristics, degree of tobacco dependence, willingness to quit smoking and other related factors were collected during the baseline survey. Multivariate logistic regression model was used to analyze the related factors of willingness to quit. The subjects were given intensive smoking cessation intervention from October 2017 to September 2019, including education on the hazards of smoking, methods of smoking cessation and giving smoking cessation drugs. After intervention, the subjects were investigated about their smoking cessation progress and the effect of the project was evaluated. Results: The subjects were (41±11) years old, 91.9% (1 609/1 747) were male and 62.2% (1 086/1 747) were daily smokers. The main reasons for smoking included the influence of friends [697 (39.9%)], the need for social entertainment [629 (36.0%)], the relief of mental stress [589 (33.7%)] and the refreshment [459 (26.3%)]. At baseline, 52.9% (885/1 672) and 43.2% (755/1 747) smokers had intention to quit smoking and had planned to quit within one year, respectively. Multivariate logistic regression model analysis showed that: low education level [OR (95%CI) of high school and junior high school and below were 2.42 (1.61, 3.63) and 1.57 (1.18, 2.11)], daily smoking [OR (95%CI): 1.38 (1.06, 1.78)], thinking quitting smoking is not important [OR (95%CI): 4.15 (3.33, 5.18)] and having no quitting experience [OR (95%CI): 3.21 (2.53, 4.05)] were associated with no intention to quit smoking. After intensive smoking cessation intervention, 81.0% (1 415/1 747) smokers started to quit and 36.6% (518/1 415) quit smoking with drugs, both higher than the baseline level (all P values<0.001). By the end of the program, 60.2% (852/1 415) of the medical staff had quit smoking successfully. Conclusion: "Smoking cessation: Doctor first"program can improve the willingness to quit and the proportion of using smoking cessation drugs of medical staff.