Psychosocial Factors of Women Presenting With Myocardial Infarction With or Without Obstructive Coronary Arteries

Psychological Risk Factors on Hematopoietic Stem Cell Transplantation Patients: Insights From National Readmission Database Analysis

BACKGROUND

Psychosocial risk factors (PSRFs) have emerged as important nontraditional risk factors for poor medical outcomes but have not been well-studied in the field of hematopoietic stem cell transplantation (HSCT).

OBJECTIVES

In this study, we retrospectively examined in-hospital and short-term outcomes in patients with PSRFs who underwent HSCT.

METHODS

We used the National Readmission Database (NRD) to identify patients who underwent HSCT between 2011 and 2020. Patients were stratified based on the presence of either 0 or ≥ 1 PSRFs, which included factors such as mental illness, substance abuse, cognitive problems, a low income level, and an uninsured status. Patients were also classified into allogeneic-HSCT (allo-HSCT) and autologous-HSCT (auto-HSCT) groups. Our primary endpoints were in-hospital and short-term outcomes.

RESULTS

In this nationally representative cohort, 90,747 patients underwent auto-HSCT, while 26,600 patients underwent allo-HSCT. In the auto-HSCT group, individuals with PSRFs exhibited notably higher in-hospital mortality (2.4% vs. 2.8%; p < 0.001) and 30-day all-cause readmission rates (14.4% vs. 17.8%; p < 0.001) compared to those without PSRFs. Similarly, within the allo-HSCT group, patients with PSRFs had significantly higher in-hospital mortality (5.4% vs. 6.4%; p < 0.001) and 30-day all-cause readmission rates (27.3% vs. 31.2%; p < 0.001) compared to those without PSRFs. After adjusting for risk factors, the presence of PSRFs emerged as a substantial predictor for heightened 30-day readmission in allo-HSCT and auto-HSCT.

CONCLUSION

The presence of PSRFs is correlated with poorer in-hospital and short-term outcomes after both allo-HSCT and auto-HSCT, with a more pronounced effect observed in allo-HSCT. This research underscores the significance of pinpointing high-risk patients and implies support for merging PSRFs after HSCT is beneficial.

The complexity of cardiovascular risk in women. Descriptive review

OBJECTIVES

Cardiovascular diseases (CVD) are the greatest threat to the health of women and is the leading cause of death amongst women globally; however, cardiovascular disease in women remains understudied, under-recognized, underdiagnosed, and undertreated. The aim of this descriptive review is to summarize the existing problem and to identify the knowledge gaps in cardiovascular disease research, prevention, treatment, and access to care for women.

MATERIAL AND METHODS

This is a descriptive review of the literature based on numerous articles published in peer-reviewed journals since the beginning of this century related to the spectrum of cardiovascular disease in women.

RESULTS

There are several obstacles to improve cardiovascular disease outcomes in women. One of them is the lack of reliable, effective screening modalities since her participation in clinical trial is quite low. Other concern is the complexity of the female organism with several hormonal changes during her life and the hemodynamics stress during pregnancy. Moreover, in the last stage of their life several cardiometabolic risk factor may appear, most of them not recognized by the health team in primary care attention.

DISCUSSION

Effective strategies are required to address inequalities in the diagnosis, treatment and prevention of heart disease in women; to advance innovative solutions for early detection and oriented management; to clarify the underlying biological mechanisms that contribute to sex-specific differences in outcomes; and finally, reduce the global burden of cardiovascular disease in women.

MI and Non-obstructive Coronary Arteries

MI and non-obstructive coronary arteries (MINOCA) is recognized as an important contributor to adverse cardiovascular outcomes in both men and women but is particularly prevalent in young women. Multiple coronary mechanisms such as coronary plaque disruption, coronary artery spasm, coronary microvascular dysfunction, spontaneous coronary artery dissection, and coronary thromboembolism can trigger MINOCA. Beyond routine left heart catheterization, invasive intracoronary imaging and cardiac MRI can help to clarify the cause of MINOCA. Conditions such as myocarditis, takotsubo syndrome, and cardiomyopathy are on the differential as alternate explanations in those suspected of MINOCA. Identification of the underlying cause in a case of MINOCA has therapeutic implications. While long-term management of MINOCA is not standardized, angiotensin converting enzyme inhibitors and statins appear to be of benefit. In this review, we discuss the prevalence and pathophysiology of MINOCA, diagnostic considerations, and current treatment approaches to manage this high-risk group of patients.

Changes in Acute Coronary Syndrome Clinic after the Devastating Earthquake in Türkiye

BACKGROUND

We aimed to investigate the clinical and angiographic characteristics of patients with acute coronary syndrome (ACS) who survived this devastating earthquake and were admitted to our hospital in Antakya/Türkiye.

METHODS

We retrospectively examined the impact of the earthquake on the occurrences of acute coronary syndromes in Antakya/Türkiye. All 248 consecutive patients with ACS, also survivors of the earthquake in Antakya, were enrolled as the earthquake group. The earthquake group was created from patients hospitalized between February and June in 2023 after the earthquake. In total, 209 consecutive ACS patients who were hospitalized in our cardiology clinic in similar months of 2022 named as the control group.

RESULTS

Patients admitted before the earthquake were more hospitalized with multivessel disease compared to after the earthquake group (P <.001). Myocardial infarction with non-obstructive coronary artery disease (MINOCA) was the main reason for the significant increase rate of ACS after the earthquake. The earthquake patient group had lesser diabetes mellitus than the control group (P <.001). The risk of men suffering from ACS after an earthquake is approximately 2.1 times higher than women (P =.023). Those with a history of revascularization are approximately 1.8 times more likely to have ACS after an earthquake (P =.05). The risk of experiencing ACS after an earthquake is approximately 3.5 times higher for those with a family history than for those without (P <.001).

CONCLUSION

Effects of the devastating earthquake on the heart are the increase in MINOCA patients triggered by great sudden environmental stress and the decrease in diabetes due to worsening nutritional conditions, respectively.

Integrative bioinformatics analysis identifies APOB as a critical biomarker in coronary in-stent restenosis

Aim: Coronary artery disease (CAD) is a major contributor to the worldwide prevalence of cardiovascular disease. In-stent restenosis (ISR) is a common complication which can lead to stent implantation failure, necessitating repeated intervention and presenting a significant obstacle for CAD management. Methods: To accurately assess and determine the hub genes associated with ISR, CAD databases from the Gene Expression Omnibus were utilized and weighted gene coexpression network analysis was employed to identify key genes in blood samples. Results: APOB was identified as a risk gene for ISR occurrence. Subsequent correlation analysis of APOB demonstrated a positive association with ISR. Clinical validation further confirmed the predictive value of APOB in ISR detection. Conclusion: We have identified APOB as a critical predictive biomarker for ISR in CAD patients.