1
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Di Vito L, Di Giusto F, Bruscoli F, Scalone G, Silenzi S, Mariani L, Selimi A, Delfino D, Grossi P. Recurrent events after acute ST-segment elevation myocardial infarction: predictors and features of plaque progression and stent failure. Coron Artery Dis 2024; 35:277-285. [PMID: 38241028 DOI: 10.1097/mca.0000000000001331] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
OBJECTIVES Patients with acute ST-segment elevation myocardial infarction (STEMI) are at high risk for recurrent coronary events (RCE). Non-culprit plaque progression and stent failure are the main causes of RCEs. We sought to identify the incidence and predictors of RCEs. METHODS Eight hundred thirty patients with STEMI were enrolled and followed up for 5 years. All patients underwent blood test analysis at hospital admission, at 1-month and at 12-month follow-up times. Patients were divided into RCE group and control group. RCE group was further categorized into non-culprit plaque progression and stent failure subgroups. RESULTS Among 830 patients with STEMI, 63 patients had a RCE (7.6%). At hospital admission, HDL was numerically lower in RCE group, while LDL at both 1-month and 12-month follow-up times were significantly higher in RCE group. Both HDL at hospital admission and LDL at 12-month follow-up were independently associated with RCEs (OR 0.90, 95% CI 0.81-0.99 and OR 1.041, 95% CI 1.01-1.07, respectively). RCEs were due to non-culprit plaque progression in 47.6% of cases, while in 36.5% due to stent failure. The mean time frame between pPCI and RCE was significantly greater for non-culprit plaque progression subgroup as compared to stent failure subgroup (27 ± 18 months and 16 ± 14 months, P = 0.032). CONCLUSION RCEs still affect patients after pPCI. Low levels of HDL at admission and high levels of LDL at 12 months after pPCI significantly predicted RCEs. A RCE results in non-culprit plaque progression presents much later than an event due to stent failure.
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Affiliation(s)
| | | | | | | | | | - Luca Mariani
- University Hospital Riuniti of Ancona, Ancona, Italy
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2
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Uhm IA, Hwang SY. Effect of risk factor-tailored autonomy enhancement education in the first-time middle-aged patients undergoing percutaneous coronary intervention: a randomized controlled trial. BMC Nurs 2023; 22:479. [PMID: 38110911 PMCID: PMC10726554 DOI: 10.1186/s12912-023-01654-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 12/11/2023] [Indexed: 12/20/2023] Open
Abstract
PURPOSE It is important for middle-aged patients who have undergone acute treatment for coronary artery disease to voluntarily improve their lifestyle and risk factors based on their recognition as patients with chronic diseases. This study conducted individual education to improve risk factors and tried to verify its effectiveness. METHODS The hypothesis was verified by applying a randomized controlled pre- and post-test design through random assignment of two groups. Middle-aged (40-64 years) patients who underwent percutaneous coronary intervention for the first time were recruited from a university hospital in Seoul, Korea. For the experimental group, based on the Self-Determination Theory, risk factor- tailored counseling and education were provided individually for one hour based on the education booklet, and telephone counseling was conducted twice for 12 weeks. Differences in autonomous motivation, resilience, self-care compliance and biochemical indicators measured after 12 weeks in the experimental group and the control group were compared. Data were analyzed using SPSS/WIN ver. 22.0. RESULTS The autonomous motivation, resilience, and self-care compliance of the experimental group were significantly higher than those of the control group (p < .05). Body mass index (p = .005) and current smoking rate (p < .001) were also significantly decreased in the experimental group but there was no significant difference in other biochemical parameters. CONCLUSION For middle-aged patients with first coronary intervention, risk factor-tailored education emphasizing autonomy by nurses should be provided early after discharge. TRIAL REGISTRATION This study was retrospectively registered in the Clinical Research Information Service and the identification number is KCT0008698(11/08/2023).
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Affiliation(s)
- In Ae Uhm
- Inje University Sanggye Paik hospital, Seoul, South Korea
| | - Seon Young Hwang
- College of Nursing, The Hanyang University, 222 Wangsimniro, Seongdong-gu, Seoul, South Korea.
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3
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Jong CB, Lu TS, Chen TY, Chen CK, Liao MT, Lin IC, Chen JW. Subclinical myocardial injury increases the risk of heart failure in patients with and without type 2 diabetes post-acute coronary syndrome. Int J Cardiol 2023; 390:131195. [PMID: 37473816 DOI: 10.1016/j.ijcard.2023.131195] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 06/29/2023] [Accepted: 07/14/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Little is known about the effect of subclinical myocardial injury (sMi) on heart failure (HF) risk after acute coronary syndrome (ACS). We examined the frequency patterns of sMi after ACS among patients with and without diabetes mellitus (DM), and the influence of sMis on HF risk at 1 year. METHODS Fifty patients with ACS who underwent revascularization were prospectively enrolled. After discharge, serial study visits were conducted and high-sensitivity cardiac troponin T (hs-TnT) levels were checked at 3-month intervals for 1 year. sMi was defined as hs-TnT ≥14 ng/L without clinical symptoms. The primary endpoint was a composite of post-ACS chronic HF or significant left ventricular (LV) dysfunction without HF symptoms. A multivariable logistic regression model was used for risk evaluation. RESULTS The mean patient age was 58 years, and 90% were men. Overall, 44% of patients had DM, and the median LV ejection fraction at discharge was 56%. Patients with DM had a higher incidence of sMi than those without DM (63.6% vs. 32.1%, P < 0.05). sMi occurred at least twice in most patients, and the prevalence declined over time in DM, but not in non-DM. Fourteen patients (28%) met the primary endpoint at 1 year, and the risk was higher in patients with DM (odds ratio: 4.99) and patients with sMi (odds ratio: 6.26). However, sMi was not a mediator of the association between DM and HF risk. CONCLUSIONS Patients with DM had a higher incidence of sMi. Nonetheless, sMi increased the risk of HF after ACS, irrespective of diabetes status.
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Affiliation(s)
- Chien-Boon Jong
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tsui-Shan Lu
- Department of Mathematics, National Taiwan Normal University, Taipei, Taiwan
| | - Tsung-Yan Chen
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chun-Kai Chen
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Min-Tsun Liao
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan
| | - I-Chuan Lin
- Department of Nursing, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Jeng-Wei Chen
- College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
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4
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Alamaw AW, Asefa T, Abebe GK, Zemariam AB, Liyew B. Incidence and predictors of recurrent acute coronary syndrome among adult patients with acute coronary syndrome in West Amhara, Ethiopia: a multicenter retrospective follow-up study. Front Cardiovasc Med 2023; 10:1234239. [PMID: 37908501 PMCID: PMC10613636 DOI: 10.3389/fcvm.2023.1234239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 09/11/2023] [Indexed: 11/02/2023] Open
Abstract
Introduction Acute coronary syndrome (ACS) is the most common cause of morbidity and mortality in patients with coronary heart disease. Furthermore, the recurrence of this problem has significant adverse outcomes. However, there is insufficient information pertaining to this problem in Ethiopia; hence, this study aims to assess the incidence rate and identify the predictors of ACS recurrence in the West Amhara region. Methods A retrospective follow-up study was conducted among 469 patients diagnosed with primary ACS. Data from the patient chart were collected using a pre-tested structured data extraction tool. The study employed the Weibull regression analysis model, and the effect size was measured using an adjusted hazard ratio (HR) with a 95% confidence interval (CI). The statistical significance of the findings was established based on a p-value <0.05. Result A total of 429 patients were included in the final analysis [average age, 60 ± 13.9 years; and 245 (57.1%) men]. A total of 53 patients (12.35%; 95% CI: 9.55%-15.83%) experienced recurrent ACS. The overall risk time was found to be 93,914 days (3,130.47 months), and the recurrence rate was 17/1,000 patients/month. The identified predictors were the typical symptoms of ACS such as syncope (HR: 3.54, p = 0.013), fatigue (HR: 5.23, p < 0.001), history of chronic kidney disease (HR: 8.22, p < 0.001), left ventricular ejection fraction of <40% (HR: 2.34, p = 0.009), not taking in-hospital treatments [aspirin (HR: 9.22, p < 0.001), clopidogrel (HR: 4.11, p = 0.001), statins (HR: 2.74, p = 0.012)], and medication at discharge [statins (HR: 4.56, p < 0.001)]. Conclusion This study found a higher incidence rate of recurrent ACS. Hence, the implementation of guideline-recommended anti-ischemic treatment should be strengthened.
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Affiliation(s)
- Addis Wondmagegn Alamaw
- Department of Emergency and Critical Care Nursing, School of Nursing, College of Medicine and Health Sciences, Woldia University, Woldia, Ethiopia
| | - Tseganesh Asefa
- Department of Medical Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Gebremeskel Kibret Abebe
- Department of Emergency and Critical Care Nursing, School of Nursing, College of Medicine and Health Sciences, Woldia University, Woldia, Ethiopia
| | - Alemu Birara Zemariam
- Department of Pediatrics and Child Health, School of Nursing, College of Medicine and Health Science, Woldia University, Woldia, Ethiopia
| | - Bikis Liyew
- Department of Emergency and Critical Care Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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5
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Lu Y, Meng J, Yun M, Hacker M, Li X, Zhang X. Reduced hematopoietic-inflammatory response and worse outcomes in patients with recurrent myocardial infarction in comparison with primary myocardial infarction. EJNMMI Res 2023; 13:85. [PMID: 37749412 PMCID: PMC10519922 DOI: 10.1186/s13550-023-01035-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/19/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Recurrent myocardial infarction (RMI) portends an unfavorable outcome, which might be related to diminished hematopoietic-inflammatory activation. We aimed to investigate the hematopoietic-inflammatory activation and the outcome in categorized patients with primary myocardial infarction (PMI) versus RMI as well as chronic stable angina (CSA) by 18F-FDG PET. RESULTS A total of 105 patients (88 males; 60.1 ± 9.7 years) were included. Target-to-background ratio of bone marrow (TBRBM) was highest in the PMI group (n = 45), intermediate in the RMI group (n = 30), and lowest in the CSA group (n = 30) (P < 0.001). RMI group exhibited larger scar, significantly reduced left ventricular ejection fraction, and enlarged end systolic volume in comparison with the PMI and CSA groups, respectively (P < 0.05). Additionally, there was a significantly positive correlation between TBRBM and TBRaorta (P < 0.001). The cumulative major adverse cardiac events free survival of patients in the RMI group was lower than that in the PMI and CSA groups during a median follow-up of 16.6 months (P = 0.026). CONCLUSIONS RMI conferred relatively decreased hematopoietic-inflammatory activation compared with PMI. Patients with RMI presented subsequent enlarged myocardial scar, worsened cardiac dysfunction, aggravated remodeling, and worse outcomes than that in PMI patients.
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Affiliation(s)
- Yao Lu
- Department of Nuclear Medicine, Molecular Imaging Lab, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jingjing Meng
- Department of Nuclear Medicine, Molecular Imaging Lab, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Mingkai Yun
- Department of Nuclear Medicine, Molecular Imaging Lab, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Xiang Li
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.
| | - Xiaoli Zhang
- Department of Nuclear Medicine, Molecular Imaging Lab, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
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6
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Islek D, Alonso A, Rosamond W, Guild CS, Butler KR, Ali MK, Manatunga A, Naimi AI, Vaccarino V. Racial Differences in Fatal Out-of-Hospital Coronary Heart Disease and the Role of Income in the Atherosclerosis Risk in Communities Cohort Study (1987 to 2017). Am J Cardiol 2023; 194:102-110. [PMID: 36914508 PMCID: PMC10079596 DOI: 10.1016/j.amjcard.2023.01.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/16/2023] [Accepted: 01/22/2023] [Indexed: 03/16/2023]
Abstract
Black patients have higher incident fatal coronary heart disease (CHD) rates than do their White counterparts. Racial differences in out-of-hospital fatal CHD could explain the excess risk in fatal CHD among Black patients. We examined racial disparities in in- and out-of-hospital fatal CHD among participants with no history of CHD, and whether socioeconomic status might play a role in this association. We used data from the ARIC (Atherosclerosis Risk in Communities) study, including 4,095 Black and 10,884 White participants, followed between 1987 and 1989 until 2017. Race was self-reported. We examined racial differences in in- and out-of-hospital fatal CHD with hierarchical proportional hazard models. We then examined the role of income in these associations, using Cox marginal structural models for a mediation analysis. The incidence of out-of-hospital and in-hospital fatal CHD was 1.3 and 2.2 in Black participants, and 1.0 and 1.1 in White participants, respectively, per 1,000 person-years. The gender- and age-adjusted hazard ratios comparing out-of-hospital and in-hospital incident fatal CHD in Black with that in White participants were 1.65 (1.32 to 2.07) and 2.37 (1.96 to 2.86), respectively. The income-controlled direct effects of race in Black versus White participants decreased to 1.33 (1.01 to 1.74) for fatal out-of-hospital and to 2.03 (1.61 to 2.55) for fatal in-hospital CHD in Cox marginal structural models. In conclusion, higher rates of fatal in-hospital CHD in Black participants than in their White counterparts likely drive the overall racial differences in fatal CHD. Income largely explained racial differences in both fatal out-of-hospital CHD and fatal in-hospital CHD.
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Affiliation(s)
- Duygu Islek
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Department of Epidemiology, Laney Graduate School, Emory University, Atlanta, Georgia.
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Wayne Rosamond
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Cameron S Guild
- Department of Medicine, Division of Cardiology, School of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Kenneth R Butler
- Department of Medicine: Division of Geriatrics, School of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Mohammed K Ali
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia; Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia
| | - Amita Manatunga
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Ashley I Naimi
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Division of Cardiology, Department of Medicine, School of Medicine, Emory University, Atlanta, Georgia
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7
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Ravn PB, Falkentoft AC, Garred CAH, Bruhn J, Christensen DM, Sehested TSG, Gislason GH, Køber L, Olsen NT, Torp-Petersen C, Fosbøl E, Bruun NE, Schou M, Ruwald AC. Temporal trends in major cardiovascular events following first-time myocardial infarction in the reperfusion era - a Danish nationwide cohort study from 2000 to 2017. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2023; 9:268-280. [PMID: 36036480 DOI: 10.1093/ehjqcco/qcac033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/01/2022] [Accepted: 06/09/2022] [Indexed: 05/17/2023]
Abstract
AIM We investigated temporal trends in major cardiovascular events following first-time myocardial infarction (MI) and trends in revascularization and pharmacotherapy from 2000 to 2017. METHODS AND RESULTS Using nationwide registries, we identified 120 833 Danish patients with a first-time MI between 2000 and 2017. We investigated 30-day and 1-year mortality and the 1-year risk of first-time admission for heart failure (HF) and recurrent MI. Patients were younger with a higher prevalence of hypertension and diabetes in 2015-2017 compared with 2000-2002. The patients were predominantly male (65.6%), and the median age declined by 3 years through the periods. Percutaneous coronary interventions within 7 days after first-time MI increased significantly (2000: 11.4% vs. 2017: 68.6%; Ptrend < 0.001). Cardiovascular medication after first-time MI changed significantly in the same period. Absolute risks and adjusted rates of outcomes were significantly lower in 2015-2017 compared with 2000-2002: 30-day mortality: 6.5% vs. 14.1% [hazard ratio (HR) 0.52, 95% confidence interval (CI): 0.48-0.55); 1-year mortality 10.7% vs. 21.8% (HR 0.52, 95% CI: 0.50-0.55); recurrent MI: 4.0% vs. 7.8% (HR 0.56, 95% CI: 0.51-0.62); and first-time admission for HF: 2.9% vs. 3.7% (HR 0.82, 95% CI: 0.73-0.92). The rates of 30-day/1-year mortality and recurrent MI showed significantly decreasing trends (Ptrend < 0.001). The rates of first-time admission for HF were borderline significant (Ptrend = 0.045). CONCLUSION From 2000 to 2017, we observed a decreasing risk of recurrent MI, first-time admission for HF, and all-cause mortality in patients with a first-time MI. In the same period, we observed a high rate of guideline-recommended pharmacological treatment after first-time MI as well as increasing rate of early revascularization in Denmark. TRANSLATIONAL PERSPECTIVES The results from the current study portrait the risk of all-cause mortality, recurrent MI, and first-time admission for HF in a real-life setting with a very high utilization of early revascularization and guideline-recommended pharmacological therapy. We observed a temporal trend of improved survival, reduced risk of recurrent MI, as well as reduced risk of first-time admission for HF after first-time MI from 2000 through 2017. We observed an increase in the overall use of revascularization, as well as early revascularization and use of guideline-recommended pharmacotherapy. Our study reveals important results from real-life, nationwide data, showing a reduced risk of cardiovascular outcomes after first-time MI during the past 20 years. Current guidelines are based on results from clinical trials. Our real-life results add additionally important knowledge on patients' prognosis after first-time MI and underline the importance of treating MI according to guideline recommendations.
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Affiliation(s)
- Pauline Bohsen Ravn
- Department of Cardiology, Herlev and Gentofte University Hospital, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
- Department of Cardiology, Zealand University Hospital, Sygehusvej 10, 4000 Roskilde, Denmark
| | | | - Caroline A H Garred
- Department of Cardiology, Herlev and Gentofte University Hospital, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
| | - Jonas Bruhn
- Department of Cardiology, Herlev and Gentofte University Hospital, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
| | | | - Thomas S G Sehested
- Department of Cardiology, Zealand University Hospital, Sygehusvej 10, 4000 Roskilde, Denmark
- The Danish Heart Foundation, Vognmagergade 7, 1120 Copenhagen, Denmark
| | - Gunnar H Gislason
- Department of Cardiology, Herlev and Gentofte University Hospital, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
- The Danish Heart Foundation, Vognmagergade 7, 1120 Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Niels Thue Olsen
- Department of Cardiology, Herlev and Gentofte University Hospital, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
| | - Christian Torp-Petersen
- Department of Cardiology, Aalborg University Hospital, 9000 Aalborg, Denmark
- Department of Cardiology, Nordsjællands Hospital, 3400 Hillerød, Denmark
- Department of Biostatistics, University of Copenhagen, 1165 København, Denmark
| | - Emil Fosbøl
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Niels Eske Bruun
- Department of Cardiology, Zealand University Hospital, Sygehusvej 10, 4000 Roskilde, Denmark
| | - Morten Schou
- Department of Cardiology, Herlev and Gentofte University Hospital, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
| | - Anne-Christine Ruwald
- Department of Cardiology, Herlev and Gentofte University Hospital, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
- Department of Cardiology, Zealand University Hospital, Sygehusvej 10, 4000 Roskilde, Denmark
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8
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Mehran R, Steg PG, Pfeffer MA, Jering K, Claggett B, Lewis EF, Granger C, Køber L, Maggioni A, Mann DL, McMurray JJV, Rouleau JL, Solomon SD, Ducrocq G, Berwanger O, De Pasquale CG, Landmesser U, Petrie M, Leng DSK, van der Meer P, Lefkowitz M, Zhou Y, Braunwald E. The Effects of Angiotensin Receptor-Neprilysin Inhibition on Major Coronary Events in Patients With Acute Myocardial Infarction: Insights From the PARADISE-MI Trial. Circulation 2022; 146:1749-1757. [PMID: 36321459 DOI: 10.1161/circulationaha.122.060841] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND In patients who survive an acute myocardial infarction (AMI), angiotensin-converting enzyme inhibitors decrease the risk of subsequent major cardiovascular events. Whether angiotensin-receptor blockade and neprilysin inhibition with sacubitril/valsartan reduce major coronary events more effectively than angiotensin-converting enzyme inhibitors in high-risk patients with recent AMI remains unknown. We aimed to compare the effects of sacubitril/valsartan on coronary outcomes in patients with AMI. METHODS We conducted a prespecified analysis of the PARADISE-MI trial (Prospective ARNI vs ACE Inhibitors Trial to Determine Superiority in Reducing Heart Failure Events After MI), which compared sacubitril/valsartan (97/103 mg twice daily) with ramipril (5 mg twice daily) for reducing heart failure events after myocardial infarction in 5661 patients with AMI complicated by left ventricular systolic dysfunction, pulmonary congestion, or both. In the present analysis, the prespecified composite coronary outcome was the first occurrence of death from coronary heart disease, nonfatal myocardial infarction, hospitalization for angina, or postrandomization coronary revascularization. RESULTS Patients were randomly assigned at a median of 4.4 [3.0-5.8] days after index AMI (ST-segment-elevation myocardial infarction 76%, non-ST-segment-elevation myocardial infarction 24%), by which time 89% of patients had undergone coronary reperfusion. Compared with ramipril, sacubitril/valsartan decreased the risk of coronary outcomes (hazard ratio, 0.86 [95% CI, 0.74-0.99], P=0.04) over a median follow-up of 22 months. Rates of the components of the composite outcomes were lower in patients on sacubitril/valsartan but were not individually significantly different. CONCLUSIONS In survivors of an AMI with left ventricular systolic dysfunction and pulmonary congestion, sacubitril/valsartan-compared with ramipril-reduced the risk of a prespecified major coronary composite outcome. Dedicated studies are necessary to confirm this finding and elucidate its mechanism. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT02924727.
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Affiliation(s)
- Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.M.)
| | - Philippe Gabriel Steg
- Université Paris-Cité, AP-HP (Assistance Publique-Hôpitaux de Paris), FACT (French Alliance for Cardiovascular Trials) and INSERM U-1148, France (P.G.S.)
| | - Marc A Pfeffer
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (M.A.P., K.J., B.C., S.D.S., E.B.)
| | - Karola Jering
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (M.A.P., K.J., B.C., S.D.S., E.B.)
| | - Brian Claggett
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (M.A.P., K.J., B.C., S.D.S., E.B.)
| | - Eldrin F Lewis
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford University, Palo Alto, CA (E.F.L.)
| | | | - Lars Køber
- Professor of Cardiology, Department of Clinical Medicine, University of Copenhagen, Denmark (L.K.)
| | - Aldo Maggioni
- ANMCO Research Center, Heart Care Foundation, Florence, Italy (A.M.)
| | - Douglas L Mann
- Washington University Medical Center, St Louis, MO (D.L.M.)
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Scotland (J.J.V.M., M.P.)
| | | | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (M.A.P., K.J., B.C., S.D.S., E.B.)
| | - Gregory Ducrocq
- Département de Cardiologie, Hôpital Bichat Assistance Publique Hôpitaux de Paris. France (G.D.)
| | - Otavio Berwanger
- Academic Research Organization (ARO), Hospital Israelita Albert Einstein, São Paulo-SP, Brazil (O.B.)
| | - Carmine G De Pasquale
- Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, South Australia (C.G.D.P.)
| | - Ulf Landmesser
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Germany (U.L.)
| | - Mark Petrie
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Scotland (J.J.V.M., M.P.)
| | | | - Peter van der Meer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, The Netherlands (P.v.d.M.)
| | - Martin Lefkowitz
- Novartis Pharmaceutical Corporation, East Hanover, NJ (M.L., Y.Z.)
| | - Yinong Zhou
- Novartis Pharmaceutical Corporation, East Hanover, NJ (M.L., Y.Z.)
| | - Eugene Braunwald
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (M.A.P., K.J., B.C., S.D.S., E.B.)
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9
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Lee SH, Jeong MH, Ahn JH, Hyun DY, Cho KH, Kim MC, Sim DS, Hong YJ, Kim JH, Ahn Y, Hwang JY, Kim W, Park JS, Yoon CH, Hur SH, Lee SR, Cha KS, Investigators OBOTKAMIR(KAMIRNIH. Predictors of recurrent acute myocardial infarction despite successful percutaneous coronary intervention. Korean J Intern Med 2022; 37:777-785. [PMID: 35811366 PMCID: PMC9271730 DOI: 10.3904/kjim.2021.427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 02/07/2022] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND/AIMS Recurrent acute myocardial infarction (AMI) is an adverse cardiac event in patients with a first AMI. The predictors of recurrent AMI after the first AMI in patients who underwent successful percutaneous coronary intervention (PCI) have not been elucidated. METHODS We analyzed the data collected from 9,869 patients (63.2 ± 12.4 years, men:women = 7,446:2,423) who were enrolled in the Korea Acute Myocardial Infarction Registry-National Institute of Health between November 2011 and October 2015, had suffered their first AMI and had received successful PCI during the index hospitalization. Multivariable logistic regression analysis was performed to identify the independent predictors of recurrent AMI following the first AMI. RESULTS The cumulative incidence of recurrent AMI after successful PCI was 3.6% (359/9,869). According to the multivariable logistic regression analysis, the significant predictive factors for recurrent AMI were diabetes mellitus, renal dysfunction, atypical chest pain, and multivessel disease. CONCLUSION In this Korean prospective cohort study, the independent predictors of recurrent AMI after successful PCI for the first AMI were diabetes mellitus, renal dysfunction, atypical chest pain, and multivessel disease.
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Affiliation(s)
- Sang Hun Lee
- Department of Cardiology, Chonnam National University Hospital, Gwangju,
Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Hospital, Gwangju,
Korea
- Department of Cardiology, Chonnam National University Medical School, Gwangju,
Korea
| | - Joon Ho Ahn
- Department of Cardiology, Chonnam National University Hospital, Gwangju,
Korea
| | - Dae Young Hyun
- Department of Cardiology, Chonnam National University Hospital, Gwangju,
Korea
| | - Kyung Hoon Cho
- Department of Cardiology, Chonnam National University Hospital, Gwangju,
Korea
| | - Min Chul Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju,
Korea
- Department of Cardiology, Chonnam National University Medical School, Gwangju,
Korea
| | - Doo Sun Sim
- Department of Cardiology, Chonnam National University Hospital, Gwangju,
Korea
- Department of Cardiology, Chonnam National University Medical School, Gwangju,
Korea
| | - Young Joon Hong
- Department of Cardiology, Chonnam National University Hospital, Gwangju,
Korea
- Department of Cardiology, Chonnam National University Medical School, Gwangju,
Korea
| | - Ju Han Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju,
Korea
- Department of Cardiology, Chonnam National University Medical School, Gwangju,
Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University Hospital, Gwangju,
Korea
- Department of Cardiology, Chonnam National University Medical School, Gwangju,
Korea
| | - Jin Yong Hwang
- Department of Cardiology, Gyeongsang National University College of Medicine, Jinju,
Korea
| | - Weon Kim
- Department of Cardiology, Kyung Hee University Hospital, Seoul,
Korea
| | - Jong Seon Park
- Department of Cardiology, Yeungnam University Medical Center, Daegu,
Korea
| | - Chang-Hwan Yoon
- Department of Cardiology, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Seung Ho Hur
- Department of Cardiology, Keimyung University Dongsan Hospital, Daegu,
Korea
| | - Sang Rok Lee
- Department of Cardiology, Jeonbuk National University Hospital, Jeonju,
Korea
| | - Kwang Soo Cha
- Department of Cardiology, Pusan National University Hospital, Busan,
Korea
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10
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Nair RM, Johnson M, Kravitz K, Huded C, Rajeswaran J, Anabila M, Blackstone E, Menon V, Lincoff AM, Kapadia S, Khot UN. Relationship between Index Myocardial Infarction Type and Early Recurrent Myocardial Infarction. Am J Cardiol 2022; 169:160-162. [PMID: 35227501 DOI: 10.1016/j.amjcard.2022.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 01/26/2022] [Indexed: 11/01/2022]
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11
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Kim J, Shin N. Concept Analysis of the Empowerment of Patients With Coronary Artery Disease Using a Hybrid Model. ANS Adv Nurs Sci 2022; 45:E31-E46. [PMID: 34225284 DOI: 10.1097/ans.0000000000000368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study aimed to conceptualize the empowerment of patients with coronary artery disease (CAD) using a hybrid model. In the final phase, "perceived competence and knowledge on lifestyle management," "sense of control of one's own health care," "self-acceptance to change," and "motivation for voluntary behavior" were identified as intrapersonal aspects; "information search," "active communication between patients and health care professionals," and "supportive relationships" were identified as interactional aspects; "self-management in one's life" and "coping behavior with disease" were identified as behavioral aspects. A concept accurately reflecting CAD characteristics may facilitate the implementation of risk factor management.
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Affiliation(s)
- Jiyoung Kim
- Department of Nursing, Sangmyung University, Cheonan-si, Chungcheongnam-do, South Korea (Dr Kim); and Department of Nursing, CHA University, CHA Bundang Medical Center, Seongnamsi, Gyeonggido, South Korea (Dr Shin)
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12
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Ye X, Ma T, Blais JE, Yan VKC, Kang W, Chui CSL, Lai FTT, Li X, Wan EYF, Wong CKH, Tse HF, Siu CW, Wong ICK, Chan EW. OUP accepted manuscript. Cardiovasc Res 2022; 118:2329-2338. [PMID: 35732274 PMCID: PMC9278175 DOI: 10.1093/cvr/cvac068] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/30/2022] [Accepted: 04/20/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | - Joseph E Blais
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, General Office, L02-56 2/F, Laboratory Block, LKS Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - Vincent K C Yan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, General Office, L02-56 2/F, Laboratory Block, LKS Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - Wei Kang
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, General Office, L02-56 2/F, Laboratory Block, LKS Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - Celine S L Chui
- Laboratory of Data Discovery for Health (D24H), Hong Kong SAR, China
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Francisco T T Lai
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, General Office, L02-56 2/F, Laboratory Block, LKS Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong SAR, China
| | - Xue Li
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, General Office, L02-56 2/F, Laboratory Block, LKS Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong SAR, China
- Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Eric Y F Wan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, General Office, L02-56 2/F, Laboratory Block, LKS Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong SAR, China
- Department of Family Medicine and Primary Care, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Carlos K H Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, General Office, L02-56 2/F, Laboratory Block, LKS Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong SAR, China
- Department of Family Medicine and Primary Care, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Hung Fat Tse
- Cardiology Division, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Hong Kong-Guangdong Stem Cell and Regenerative Medicine Research Centre, The University of Hong Kong and Guangzhou Institutes of Biomedicine and Health, Hong Kong SAR, China
- Cardiac and Vascular Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Chung Wah Siu
- Cardiology Division, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ian C K Wong
- Corresponding authors. Tel: +852 2831 5110, E-mails: ,
| | - Esther W Chan
- Corresponding authors. Tel: +852 2831 5110, E-mails: ,
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13
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Tara S, Yamamoto T, Sakai S, Kimura T, Asano K, Fujimoto Y, Shiomura R, Matsuda J, Kadooka K, Takahashi K, Ko T, Sangen H, Saiki Y, Nakata J, Hosokawa Y, Takano H, Shimizu W. Clinical Characteristics, Achievement of Secondary Prevention Goals, and Outcomes of Patients with Recurrent Acute Coronary Syndrome. J NIPPON MED SCH 2021; 88:432-440. [PMID: 33692293 DOI: 10.1272/jnms.jnms.2021_88-601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Because development of acute coronary syndrome (ACS) worsens the prognosis of patients with coronary artery disease, preventing recurrent ACS is crucial. However, the degree to which secondary prevention treatment goals are achieved in patients with recurrent ACS is unknown. METHODS 214 consecutive ACS patients were classified as having First ACS (n=182) or Recurrent ACS (n=32), and the clinical characteristics of these groups were compared. Fifteen patients died or developed cardiovascular (CV) events during hospitalization, and the remaining 199 patients were followed from the date of hospital discharge to evaluate subsequent CV events. RESULTS Patients in the Recurrent ACS group were older than those in the First ACS group (76.8±10.8 years vs 68.8±13.4 years, p=0.002) and had a higher rate of diabetes mellitus (DM) (65.6% vs 36.8%, p=0.003). The rate of achieving a low-density lipoprotein cholesterol (LDL-C) level of <70 mg/dL in the Recurrent ACS group was only 28.1%, even though 68.8% of these patients were taking statins. An HbA1c level of <7.0% was achieved in 66.7% of patients with recurrent ACS who had been diagnosed with DM. Overall, 12.5% of patients with recurrent ACS had received optimal treatment for secondary prevention. CV events after hospital discharge were noted in 37.9% of the Recurrent ACS group and 21.2% of the First ACS group (log-rank test: p=0.004). However, recurrent ACS was not an independent risk factor for CV events (adjusted hazard ratio: 2.09, 95% confidence interval: 0.95 to 4.63, p=0.068). CONCLUSION Optimal treatment for secondary prevention was not achieved in some patients with recurrent ACS, and achievement of the guideline-recommended LDL-C goal for secondary prevention was especially low in this population.
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Affiliation(s)
- Shuhei Tara
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Takeshi Yamamoto
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Shin Sakai
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Tokuhiro Kimura
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Kazuhiro Asano
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Yuhi Fujimoto
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Reiko Shiomura
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Junya Matsuda
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Kosuke Kadooka
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Kenta Takahashi
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Toshinori Ko
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Hideto Sangen
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Yoshiyuki Saiki
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Jun Nakata
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Yusuke Hosokawa
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Hitoshi Takano
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Wataru Shimizu
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital.,Department of Cardiovascular Medicine, Nippon Medical School
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14
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Patil M, Saheera S, Dubey PK, Kahn-Krell A, Kumar Govindappa P, Singh S, Tousif S, Zhang Q, Lal H, Zhang J, Qin G, Krishnamurthy P. Novel Mechanisms of Exosome-Mediated Phagocytosis of Dead Cells in Injured Heart. Circ Res 2021; 129:1006-1020. [PMID: 34623174 DOI: 10.1161/circresaha.120.317900] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
[Figure: see text].
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Affiliation(s)
- Mallikarjun Patil
- Department of Biomedical Engineering, Schools of Medicine and Engineering, University of Alabama at Birmingham
| | - Sherin Saheera
- Department of Biomedical Engineering, Schools of Medicine and Engineering, University of Alabama at Birmingham
| | - Praveen K Dubey
- Department of Biomedical Engineering, Schools of Medicine and Engineering, University of Alabama at Birmingham
| | - Asher Kahn-Krell
- Department of Biomedical Engineering, Schools of Medicine and Engineering, University of Alabama at Birmingham
| | - Prem Kumar Govindappa
- Department of Biomedical Engineering, Schools of Medicine and Engineering, University of Alabama at Birmingham
| | - Sarojini Singh
- Department of Biomedical Engineering, Schools of Medicine and Engineering, University of Alabama at Birmingham
| | - Sultan Tousif
- Department of Biomedical Engineering, Schools of Medicine and Engineering, University of Alabama at Birmingham
| | - Qinkun Zhang
- Department of Biomedical Engineering, Schools of Medicine and Engineering, University of Alabama at Birmingham
| | - Hind Lal
- Department of Biomedical Engineering, Schools of Medicine and Engineering, University of Alabama at Birmingham
| | - Jianyi Zhang
- Department of Biomedical Engineering, Schools of Medicine and Engineering, University of Alabama at Birmingham
| | - Gangjian Qin
- Department of Biomedical Engineering, Schools of Medicine and Engineering, University of Alabama at Birmingham
| | - Prasanna Krishnamurthy
- Department of Biomedical Engineering, Schools of Medicine and Engineering, University of Alabama at Birmingham
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15
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Nair R, Johnson M, Kravitz K, Huded C, Rajeswaran J, Anabila M, Blackstone E, Menon V, Lincoff AM, Kapadia S, Khot UN. Characteristics and Outcomes of Early Recurrent Myocardial Infarction After Acute Myocardial Infarction. J Am Heart Assoc 2021; 10:e019270. [PMID: 34333986 PMCID: PMC8475017 DOI: 10.1161/jaha.120.019270] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background We aimed to understand the characteristics and outcomes of patients readmitted with a recurrent myocardial infarction (RMI) within 90 days of discharge after an acute myocardial infarction (early RMI). Methods and Results We analyzed the timing of reinfarction, etiology, and outcome for all patients admitted with an early RMI within 90 days of discharge after an acute myocardial infarction between January 1, 2010 and January 1, 2017. We identified 6626 admissions for acute myocardial infarction (index myocardial infarction) which led to 168 cases of RMI within 90 days of discharge. The mean patient age was 65.1±13.1 years, and 37% were women. The 90-day probability of readmission with an early RMI was 2.5%. Black race, medical management, higher troponin T, and shorter length of stay were independent predictors of early RMI. Medically managed group had a higher risk for early RMI compared with percutaneous coronary intervention (P=0.04) or coronary artery bypass grafting (P=0.2). Predominant mechanisms for reinfarction were stent thrombosis (17%), disease progression (12%), and unchanged coronary artery disease (11%). At 5 years, the all-cause mortality rate for patients with an early RMI was 49% (95% CI, 40%-57%) compared with 22% (95% CI, 21%-23%) for patients without an early RMI (P<0.0001). Conclusions Early RMI is a life-threatening condition with nearly 50% mortality within 5 years. Stent-related events and progression in coronary artery disease account for most early RMI. Medication compliance, aggressive risk factor management, and care transitions should be the cornerstone in preventing early RMI.
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Affiliation(s)
- Raunak Nair
- Cleveland Clinic Heart, Vascular and Thoracic Institute Cleveland OH.,Cleveland Clinic Heart, Vascular and Thoracic Institute Center for Healthcare Delivery Innovation Cleveland OH
| | - Michael Johnson
- Cleveland Clinic Heart, Vascular and Thoracic Institute Center for Healthcare Delivery Innovation Cleveland OH.,University Cardiology Associates Augusta GA
| | - Kathleen Kravitz
- Cleveland Clinic Heart, Vascular and Thoracic Institute Cleveland OH.,Cleveland Clinic Heart, Vascular and Thoracic Institute Center for Healthcare Delivery Innovation Cleveland OH
| | - Chetan Huded
- Cleveland Clinic Heart, Vascular and Thoracic Institute Center for Healthcare Delivery Innovation Cleveland OH.,Saint Luke's Mid America Heart Institute Kansas City MO
| | | | - Moses Anabila
- Cleveland Clinic Heart, Vascular and Thoracic Institute Cleveland OH
| | - Eugene Blackstone
- Cleveland Clinic Heart, Vascular and Thoracic Institute Cleveland OH
| | - Venu Menon
- Cleveland Clinic Heart, Vascular and Thoracic Institute Cleveland OH
| | - A Michael Lincoff
- Cleveland Clinic Heart, Vascular and Thoracic Institute Cleveland OH
| | - Samir Kapadia
- Cleveland Clinic Heart, Vascular and Thoracic Institute Cleveland OH
| | - Umesh N Khot
- Cleveland Clinic Heart, Vascular and Thoracic Institute Cleveland OH.,Cleveland Clinic Heart, Vascular and Thoracic Institute Center for Healthcare Delivery Innovation Cleveland OH
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16
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Abstract
Coronary artery disease is a leading cause of morbidity and mortality worldwide. Despite significant advances in revascularization strategies and antiplatelet therapy with aspirin and/or P2Y12 receptor antagonist, patients with acute coronary syndrome (ACS) continue to be at long-term risk of further cardiovascular events. Besides platelet activation, the role of thrombin generation (TG) in atherothrombotic complications is widely recognized. In this study, we hypothesized that there is an elevation of coagulation activation persists beyond 12 months in patients with ACS and chronic coronary syndrome (CCS) when compared with healthy controls. We measured TG profiles of patients within 72 h after percutaneous coronary intervention, at 6-month, 12-month and 24-month. Our results demonstrated that TG of patients with ACS (n = 114) and CCS (n = 40) were persistently elevated when compared to healthy individuals (n = 50) in peak thrombin (ACS 273.1 nM vs CCS 287.3 nM vs healthy 234.3 nM) and velocity index (ACS 110.2 nM/min vs CCS 111.0 nM/min vs healthy 72.9 nM/min) at 24-month of follow-up. Our results suggest a rationale for addition of anticoagulation to antiplatelet therapy in preventing long-term ischemic events after ACS. Further research could clarify whether the use of TG parameters to enable risk stratification of patients at heightened long-term procoagulant risk who may benefit most from dual pathway inhibition.
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17
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Park JJ, Lee HY, Kim KH, Yoo BS, Kang SM, Baek SH, Jeon ES, Kim JJ, Cho MC, Chae SC, Oh BH, Choi DJ. Heart failure and atrial fibrillation: tachycardia-mediated acute decompensation. ESC Heart Fail 2021; 8:2816-2825. [PMID: 33960144 PMCID: PMC8318460 DOI: 10.1002/ehf2.13354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 03/16/2021] [Accepted: 03/29/2021] [Indexed: 11/14/2022] Open
Abstract
Aims Tachycardia is a reversible event that may cause hemodynamic decompensation but may not necessarily cause direct damages to the myocardium. To evaluate the clinical outcomes of patients with heart failure (HF) and atrial fibrillation (AF), whose acute decompensation was tachycardia mediated. Methods and results The Korean Acute Heart Failure registry was a prospective registry that consecutively enrolled 5625 patients with acute HF. Patients were classified into three groups according to the rhythm and aggravating factor: (i) 3664 (65.1%) patients with sinus rhythm (SR), (ii) 1033 (18.4%) patients with AF whose decompensation was tachycardia‐mediated, AF‐TM (+), and (iii) N = 928 (16.5%) patients with AF whose decompensation was not tachycardia‐mediated, AF‐TM (−). The primary outcomes were in‐hospital and post‐discharge 1 year all‐cause mortality. At admission, the mean heart rate was 90.8 ± 23.4, 86.8 ± 26.8, and 106.3 ± 29.7 beats per minute for the SR, AF‐TM (−), and AF‐TM (+) groups, respectively. The AF‐TM (+) group had more favourable characteristics such as de novo onset HF, less diabetes, ischaemic heart disease, and higher blood pressure than the AF‐TM (−) group. In‐hospital mortality rates were 5.1%, 6.5%, and 1.7% for SR, AF‐TM (−), and AF‐TM (+) groups, respectively. In logistic regression analysis, the AF‐TM (+) group had lower in‐hospital mortality after adjusting the significant covariates (odds ratio, 0.49; 95% confidence interval, 0.26–0.93). The mortality rate did not differ between SR and AF‐TM (−) groups. During 1 year follow‐up, 990 (18.5%) patients died. In univariate and multivariate Cox proportional regression analyses, there was no difference in 1‐year all‐cause mortality between the three groups. Conclusions In patients with HF and AF, patients whose acute decompensation is tachycardia‐mediated have better in‐hospital, but similar post‐discharge outcomes compared with those with SR or those with AF whose decompensation is not tachycardia‐mediated. Clinical Trial Registration: ClinicalTrial.gov NCT01389843.
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Affiliation(s)
- Jin Joo Park
- Cardiovascular Center, Division of Cardiology, Seoul National University Bundang Hospital, Gumiro 166, Bundang, Seongnam, Republic of Korea
| | - Hae-Young Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kye Hun Kim
- Heart Research Center of Chonnam National University, Gwangju, Republic of Korea
| | - Byung-Su Yoo
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Seok-Min Kang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang Hong Baek
- Department of Internal Medicine, the Catholic University of Korea, Seoul, Republic of Korea
| | - Eun-Seok Jeon
- Department of Internal Medicine, Sungkyunkwan University College of Medicine, Seoul, Republic of Korea
| | - Jae-Joong Kim
- Division of Cardiology, Asan Medical Center, Seoul, Republic of Korea
| | - Myeong-Chan Cho
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Shung Chull Chae
- Department of Internal Medicine, Kyungpook National University College of Medicine, Daegu, Republic of Korea
| | - Byung-Hee Oh
- Mediplex Sejong Hospital, Incheon, Republic of Korea
| | - Dong-Ju Choi
- Cardiovascular Center, Division of Cardiology, Seoul National University Bundang Hospital, Gumiro 166, Bundang, Seongnam, Republic of Korea
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18
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Gevaert AB, Tibebu S, Mamas MA, Ravindra NG, Lee SF, Ahmad T, Ko DT, Januzzi JL, Van Spall HGC. Clinical phenogroups are more effective than left ventricular ejection fraction categories in stratifying heart failure outcomes. ESC Heart Fail 2021; 8:2741-2754. [PMID: 33934542 PMCID: PMC8318507 DOI: 10.1002/ehf2.13344] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/12/2021] [Accepted: 03/24/2021] [Indexed: 12/22/2022] Open
Abstract
Aims Heart failure (HF) guidelines place patients into 3 discrete groups according to left ventricular ejection fraction (LVEF): reduced (<40%), mid‐range (40–49%), and preserved LVEF (≥50%). We assessed whether clinical phenogroups offer better prognostication than LVEF. Methods and results This was a sub‐study of the Patient‐Centered Care Transitions in HF trial. We analysed baseline characteristics of hospitalized patients in whom LVEF was recorded. We used unsupervised machine learning to identify clinical phenogroups and, thereafter, determined associations between phenogroups and outcomes. Primary outcome was the composite of all‐cause death or rehospitalization at 6 and 12 months. Secondary outcome was the composite cardiovascular death or HF rehospitalization at 6 and 12 months. Cluster analysis of 1693 patients revealed six discrete phenogroups, each characterized by a predominant comorbidity: coronary heart disease, valvular heart disease, atrial fibrillation (AF), sleep apnoea, chronic obstructive pulmonary disease (COPD), or few comorbidities. Phenogroups were LVEF independent, with each phenogroup encompassing a wide range of LVEFs. For the primary composite outcome at 6 months, the hazard ratios (HRs) for phenogroups ranged from 1.25 [95% confidence interval (CI) 1.00–1.58 for AF] to 2.04 (95% CI 1.62–2.57 for COPD) (log‐rank P < 0.001); and at 12 months, the HRs for phenogroups ranged from 1.15 (95% CI 0.94–1.41 for AF) to 1.87 (95% 1.52–3.20 for COPD) (P < 0.002). LVEF‐based classifications did not separate patients into different risk categories for the primary outcomes at 6 months (P = 0.69) and 12 months (P = 0.30). Phenogroups also stratified risk of the secondary composite outcome at 6 and 12 months more effectively than LVEF. Conclusion Among patients hospitalized for HF, clinical phenotypes generated by unsupervised machine learning provided greater prognostic information for a composite of clinical endpoints at 6 and 12 months compared with LVEF‐based categories. Trial Registration: ClinicalTrials.gov Identifier: NCT02112227
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Affiliation(s)
- Andreas B Gevaert
- Research Group Cardiovascular Diseases, GENCOR Department, University of Antwerp, Antwerp, Belgium.,Department of Cardiology, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Semra Tibebu
- ICES, McMaster University, Hamilton, Ontario, Canada
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke on Trent, UK
| | - Neal G Ravindra
- Section of Cardiovascular Medicine, School of Medicine, Yale University, New Haven, CT, USA.,Department of Computer Science, Yale University, New Haven, CT, USA
| | - Shun Fu Lee
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.,Population Health Research Institute, Hamilton, Ontario, Canada
| | - Tariq Ahmad
- Section of Cardiovascular Medicine, School of Medicine, Yale University, New Haven, CT, USA.,Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, CT, USA
| | - Dennis T Ko
- ICES, University of Toronto, Hamilton, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - James L Januzzi
- Cardiology Division, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Baim Institute for Clinical Research, Boston, MA, USA
| | - Harriette G C Van Spall
- ICES, McMaster University, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.,Population Health Research Institute, Hamilton, Ontario, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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19
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Namiuchi S, Sunamura S, Tanita A, Ushigome R, Noda K, Takii T. Higher Recurrence Rate of Acute Coronary Syndrome in Patients with Multiple-Time Myocardial Infarction. Int Heart J 2021; 62:493-498. [PMID: 33952806 DOI: 10.1536/ihj.20-546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The recurrence rate of acute coronary syndrome (ACS) in patients after first-time myocardial infarction (MI) is over ten times higher than in the general population. However, it is unclear whether patients with multiple-time MI have an even higher recurrence rate of MI. This study aimed to compare the recurrence rate in patients with multiple-time MI with the rate in patients after first-time MI. We retrospectively studied 794 consecutive MI patients who were discharged. Recurrent ACS was investigated in patients with previous MI (n = 46) and without previous MI (n = 748). During the follow-up periods (mean ± SD: 757 ± 733 days), recurrent ACS occurred in 47 cases without previous MI and in 7 cases with previous MI. Kaplan-Meier analysis revealed that the risk of recurrent ACS was significantly higher in patients with previous MI than in patients without previous MI. ACS recurrence rates one year from the onset were 4.2% in patients without previous MI and 11.9% in patients with previous MI. Landmark analysis revealed that the higher recurrence rate in patients with previous MI was as high as 14.1% from 1 year after the onset to 2 years. In conclusion, the risk of recurrent ACS may be significantly higher in patients with multiple-time MI than in patients after first-time MI.
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Affiliation(s)
- Shigeto Namiuchi
- Department of Cardiology, Sendai City Medical Center, Sendai Open Hospital
| | | | - Atsushi Tanita
- Department of Cardiology, Sendai City Medical Center, Sendai Open Hospital
| | - Ryoichi Ushigome
- Department of Cardiology, Sendai City Medical Center, Sendai Open Hospital
| | - Kazuki Noda
- Department of Cardiology, Sendai City Medical Center, Sendai Open Hospital
| | - Toru Takii
- Department of Cardiology, Sendai City Medical Center, Sendai Open Hospital
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20
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Sia CH, Ko J, Zheng H, Ho AFW, Foo D, Foo LL, Lim PZY, Liew BW, Chai P, Yeo TC, Tan HC, Chua T, Chan MYY, Tan JWC, Bulluck H, Hausenloy DJ. Association between smoking status and outcomes in myocardial infarction patients undergoing percutaneous coronary intervention. Sci Rep 2021; 11:6466. [PMID: 33742073 PMCID: PMC7979717 DOI: 10.1038/s41598-021-86003-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/05/2021] [Indexed: 12/25/2022] Open
Abstract
Smoking is one of the leading risk factors for cardiovascular diseases, including ischemic heart disease and hypertension. However, in acute myocardial infarction (AMI) patients, smoking has been associated with better clinical outcomes, a phenomenon termed the “smoker’s paradox.” Given the known detrimental effects of smoking on the cardiovascular system, it has been proposed that the beneficial effect of smoking on outcomes is due to age differences between smokers and non-smokers and is therefore a smoker’s pseudoparadox. The aim of this study was to evaluate the association between smoking status and clinical outcomes in ST-segment elevation (STEMI) and non-STEMI (NSTEMI) patients treated by percutaneous coronary intervention (PCI), using a national multi-ethnic Asian registry. In unadjusted analyses, current smokers had better clinical outcomes following STEMI and NSTEMI. However, after adjusting for age, the protective effect of smoking was lost, confirming a smoker’s pseudoparadox. Interestingly, although current smokers had increased risk for recurrent MI within 1 year after PCI in both STEMI and NSTEMI patients, there was no increase in mortality. In summary, we confirm the existence of a smoker’s pseudoparadox in a multi-ethnic Asian cohort of STEMI and NSTEMI patients and report increased risk of recurrent MI, but not mortality, in smokers.
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Affiliation(s)
- Ching-Hui Sia
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Junsuk Ko
- MD Program, Duke-NUS Medical School, Singapore, Singapore
| | - Huili Zheng
- Health Promotion Board, National Registry of Diseases Office, Singapore, Singapore
| | - Andrew Fu-Wah Ho
- SingHealth Duke-NUS Emergency Medicine Academic Clinical Programme, Singapore, Singapore.,National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore.,Pre-Hospital and Emergency Care Research Centre, Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - David Foo
- Tan Tock Seng Hospital, Singapore, Singapore
| | - Ling-Li Foo
- Health Promotion Board, National Registry of Diseases Office, Singapore, Singapore
| | | | | | - Ping Chai
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tiong-Cheng Yeo
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Huay-Cheem Tan
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Terrance Chua
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Mark Yan-Yee Chan
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jack Wei Chieh Tan
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Heerajnarain Bulluck
- Norfolk and Norwich University Hospital, Norwich, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - Derek J Hausenloy
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. .,National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore. .,Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, 8 College Road, Level 8, Singapore, 169857, Singapore. .,The Hatter Cardiovascular Institute, University College London, London, UK. .,Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taichung City, Taiwan.
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21
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Cremer S, Schloss MJ, Vinegoni C, Foy BH, Zhang S, Rohde D, Hulsmans M, Fumene Feruglio P, Schmidt S, Wojtkiewicz G, Higgins JM, Weissleder R, Swirski FK, Nahrendorf M. Diminished Reactive Hematopoiesis and Cardiac Inflammation in a Mouse Model of Recurrent Myocardial Infarction. J Am Coll Cardiol 2020; 75:901-915. [PMID: 32130926 DOI: 10.1016/j.jacc.2019.12.056] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 12/02/2019] [Accepted: 12/16/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Recurrent myocardial infarction (MI) is common in patients with coronary artery disease and is associated with high mortality. Long-term reprogramming of myeloid progenitors occurs in response to inflammatory stimuli and alters the organism's response to secondary inflammatory challenges. OBJECTIVES This study examined the effect of recurrent MI on bone marrow response and cardiac inflammation. METHODS The investigators developed a surgical mouse model in which 2 subsequent MIs affected different left ventricular regions in the same mouse. Recurrent MI was induced by ligating the left circumflex artery followed by the left anterior descending coronary artery branch. The study characterized the resulting ischemia by whole-heart fluorescent coronary angiography after optical organ clearing and by cardiac magnetic resonance imaging. RESULTS A first MI-induced bone marrow "memory" via a circulating signal, reducing hematopoietic maintenance factor expression in bone marrow macrophages. This dampened the organism's reaction to subsequent events. Despite a similar extent of injury according to troponin levels, recurrent MI caused reduced emergency hematopoiesis and less leukocytosis than a first MI. Consequently, fewer leukocytes migrated to the ischemic myocardium. The hematopoietic response to lipopolysaccharide was also mitigated after a previous MI. The increase of white blood count in 28 patients was lower after recurrent MI compared with their first MI. CONCLUSIONS The data suggested that hematopoietic and innate immune responses are shaped by a preceding MI.
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Affiliation(s)
- Sebastian Cremer
- Center for Systems Biology, Massachusetts General Hospital Research Institute and Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Maximilian J Schloss
- Center for Systems Biology, Massachusetts General Hospital Research Institute and Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Claudio Vinegoni
- Center for Systems Biology, Massachusetts General Hospital Research Institute and Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Brody H Foy
- Center for Systems Biology, Massachusetts General Hospital Research Institute and Harvard Medical School, Boston, Massachusetts
| | - Shuang Zhang
- Center for Systems Biology, Massachusetts General Hospital Research Institute and Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - David Rohde
- Center for Systems Biology, Massachusetts General Hospital Research Institute and Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Maarten Hulsmans
- Center for Systems Biology, Massachusetts General Hospital Research Institute and Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Paolo Fumene Feruglio
- Center for Systems Biology, Massachusetts General Hospital Research Institute and Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Stephen Schmidt
- Center for Systems Biology, Massachusetts General Hospital Research Institute and Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Greg Wojtkiewicz
- Center for Systems Biology, Massachusetts General Hospital Research Institute and Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - John M Higgins
- Center for Systems Biology, Massachusetts General Hospital Research Institute and Harvard Medical School, Boston, Massachusetts
| | - Ralph Weissleder
- Center for Systems Biology, Massachusetts General Hospital Research Institute and Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Filip K Swirski
- Center for Systems Biology, Massachusetts General Hospital Research Institute and Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Matthias Nahrendorf
- Center for Systems Biology, Massachusetts General Hospital Research Institute and Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Cardiovascular Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Department of Internal Medicine I, University Hospital Wuerzburg, Wuerzburg, Germany.
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22
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The impact of optimal medical therapy on patients with recurrent acute myocardial infarction: Subanalysis from the BleeMACS study. Int J Cardiol 2020; 318:1-6. [PMID: 32598995 DOI: 10.1016/j.ijcard.2020.06.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/21/2020] [Accepted: 06/12/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Acute myocardial infarction (AMI) recurrence is still high despite great progress in secondary prevention. Patients with recurrent AMI suffer worse prognosis compared to those with first AMI. The objective was to evaluate the effect of optimal medical therapy (OMT) on these patients with recurrent AMI. METHODS AND RESULTS Sub-analysis was performed including 13,343 patients with AMI from the international multicenter Bleeding complications in a Multicenter registry of patients discharged with diagnosis of Acute Coronary Syndrome (BleeMACS) registry. OMT was defined as the combination of aspirin, any P2Y12 inhibitor, statin, angiotensin converting enzyme inhibitor/angiotensin receptor blocker, and beta-blocker. Among 1285 patients with prior AMI, 56.8% received OMT prescription. Patients receiving OMT suffered from less congestive heart failure, peripheral artery disease, malignancy, and bleeding history. Kaplan-Meier survival estimates revealed that OMT was strongly related to decreased in all-cause death (4.2% vs. 10.1%, p < .001) and the composite endpoint of death/re-AMI (11.1% vs. 16.9%, p = .005) at 1-year follow-up. OMT was the independent protect factor of primary endpoint even after adjusting for multiple possible confounders (HR, 0.46; 95% CI, 0.27-0.78; p = .004). However, no significant difference was observed regarding re-AMI between OMT and non-OMT groups. OMT also reduced all-cause death in patients with recurrent AMI after propensity score matching. CONCLUSIONS The prescription of OMT was seriously insufficient in patients with recurrent AMI, especially high-risk patients, even though OMT was associated with improved prognosis. Further improvements in pharmacological therapy are needed to reduce subsequent recurrent events.
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23
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Translation, Adaptation, and Validation of the Malay Version of the Cardiac Rehabilitation Barriers Scale. J Nurs Res 2020; 28:e64. [PMID: 31107774 DOI: 10.1097/jnr.0000000000000328] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The rate of cardiac rehabilitation attendance at the Sarawak Heart Centre was identified as very low, and the reason has not been investigated. A scale is needed to identify barriers to participation in cardiac rehabilitation among patients with heart disease in Sarawak, Malaysia. PURPOSE The purposes of this study were to translate, adapt, and evaluate the Malay-language version of the Cardiac Rehabilitation Barriers Scale (CRBS) and to measure the psychometric properties of the Malay-version CRBS to justify its use in Sarawak. METHODS A forward and back-translation method was used. Content validity was assessed by three experts. Psychometric testing was conducted on a sample of 283 patients who were eligible to participate in cardiac rehabilitation. A construct validity test was performed using factor analysis. Cronbach's alpha was used to examine the internal consistency. The test-retest reliability was calculated using the intraclass correlation coefficient on 22 participants. Independent-samples t test and analysis of variance were conducted to assess the criterion validity. Mean scores for total barriers of the scale and each individual factor were compared among the different patient characteristics. RESULTS The Malay-version CRBS showed an item level of content validity index of 1.00 for all of the items after improvements were made based on the experts' suggestions. The factor analysis, using principal component analysis with direct oblimin rotation, extracted four factors that differed from the original study. These four factors explained 52.50% of the cumulative percentage of variance. The Cronbach's alphas ranged from .74 to .81 for the obtained factors. Test-retest reliability was established using the intraclass correlation coefficient value of .78. Criterion validity was supported using the significant differences in the mean score for total barriers among educational level, driving distance, travel time to the hospital, and cardiac rehabilitation attendance. CONCLUSIONS/IMPLICATIONS FOR PRACTICE This study found the Malay-version CRBS to be a valid and reliable instrument. It may be used with inpatients to identify barriers to participation in cardiac rehabilitation to promote rehabilitation attendance and improve patient care.
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24
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Song J, Murugiah K, Hu S, Gao Y, Li X, Krumholz HM, Zheng X. Incidence, predictors, and prognostic impact of recurrent acute myocardial infarction in China. Heart 2020; 107:heartjnl-2020-317165. [PMID: 32938773 PMCID: PMC7873426 DOI: 10.1136/heartjnl-2020-317165] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 08/01/2020] [Accepted: 08/05/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Incidence, predictors, and prognostic impact of recurrent acute myocardial infarction (AMI) after initial AMI remain poorly understood. Data on recurrent AMI in China is unknown. METHODS Using the China Patient-centred Evaluative Assessment of Cardiac Events (PEACE)-Prospective AMI Study, we studied 3387 patients admitted to 53 hospitals for AMI and discharged alive. The association of recurrent AMI with 1-year mortality was evaluated using time-dependent Cox regression. Recurrent AMI events were classified as early (1-30 days), late (31-180 days), and very late (181-365 days). Their impacts on 1-year mortality were estimated by Kaplan-Meier methodology and compared by the log-rank test. Multivariable modelling was used to identify factors associated with recurrent AMI. RESULTS The mean (SD) age was 60.7 (11.9) years and 783 (23.1%) were women. The observed 1-year recurrent AMI rate was 2.5% (95% CI 2.00 to 3.07) with 35.7% events occurring within the first 30 days. Recurrent AMI was associated with 1-year mortality with an adjusted HR of 25.42 (95% CI 15.27 to 42.34). Early recurrent AMI was associated with the highest 1-year mortality rate of 53.3% (log-rank p<0.001). Predictors of recurrent AMI included age 75-84, in-hospital percutaneous coronary intervention, heart rate >90 min/beats at initial admission, renal dysfunction, and not being prescribed any of guideline-based medications at discharge. CONCLUSIONS One-third of recurrent AMI events occurred early. Recurrent AMI is strongly associated with 1-year mortality, particularly if early. Heightened surveillance during this early period and improving prescription of recommended discharge medications may reduce recurrent AMI in China.
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Affiliation(s)
- Jiali Song
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Karthik Murugiah
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, United States
- Yale-New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, Connecticut, United States
| | - Shuang Hu
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Yan Gao
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Xi Li
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Harlan M Krumholz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, United States
- Yale-New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, Connecticut, United States
- Yale School of Public Health, Yale University School of Medicine, and Yale-New Haven Hospital, New Haven, Connecticut, United States
| | - Xin Zheng
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
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25
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Perera K, Kam N, Ademi Z, Liew D, Zomer E. Bempedoic acid for high-risk patients with CVD as adjunct lipid-lowering therapy: A cost-effectiveness analysis. J Clin Lipidol 2020; 14:772-783. [PMID: 32994152 DOI: 10.1016/j.jacl.2020.08.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/29/2020] [Accepted: 08/31/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Bempedoic acid is a novel adenosine triphosphate citrate lyase inhibitor shown to reduce low density lipoprotein cholesterol when used as an adjunct lipid-lowering therapy in patients with high cardiovascular disease (CVD) risk. OBJECTIVE Our analysis aimed to determine the price at which bempedoic acid would be cost-effective from the Australian health care perspective. METHODS A Markov model was designed using data from the Cholesterol Lowering via Bempedoic Acid, an ACL-Inhibiting Regimen (CLEAR) Harmony trial, to model the clinical outcomes and costs of 1000 patients treated with bempedoic acid over a lifetime horizon. Relevant health states were "Alive with CVD," "Alive with recurrent CVD," and "Dead." With annual cycles, patients were at risk of a nonfatal myocardial infarction, coronary revascularization, and death from CVD or non-CVD causes. Costs and utilities were obtained from published sources. Outcomes of interest were the incremental cost-effectiveness ratios in terms of cost per quality-adjusted life year (QALY) gained and cost per year of life saved. Outcomes were discounted at 5% per annum. RESULTS Among 1000 individuals, bempedoic acid in addition to statin therapy was estimated to save 122 (discounted) years of life and 103 (discounted) QALYs compared with statin therapy alone. At an acquisition cost of AU$584.40 per year (USD$397.01), bempedoic acid would be considered cost-effective within the Australian setting, with an incremental cost-effectiveness ratio of AU$49,890 per QALY gained (USD$33,893) and AU$42,433 per year of life saved (USD$28,827). CONCLUSIONS Bempedoic acid may be cost-effective within the Australian health care setting at an annual acquisition price less than $600.
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Affiliation(s)
- Kanila Perera
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Ning Kam
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Ella Zomer
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
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26
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Kam N, Perera K, Zomer E, Liew D, Ademi Z. Inclisiran as Adjunct Lipid-Lowering Therapy for Patients with Cardiovascular Disease: A Cost-Effectiveness Analysis. PHARMACOECONOMICS 2020; 38:1007-1020. [PMID: 32789593 DOI: 10.1007/s40273-020-00948-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Inclisiran inhibits hepatic synthesis of proprotein convertase subtilisin-kexin type 9 (PCSK9). The comparison of inclisiran with statin versus statin alone in the ORION-10 trial demonstrated significant reductions in low-density lipoprotein cholesterol (LDL-C). Our study explored whether the use of inclisiran with statin versus statin alone for secondary prevention of cardiovascular events is cost effective from the Australian healthcare perspective, based on the price of currently available PCSK9 inhibitors. METHODS A Markov model was developed based on the ORION-10 trial to model outcomes and costs incurred by patients over a lifetime analysis. The three health states were 'alive with cardiovascular disease (CVD)', 'alive with recurrent CVD', and 'dead'. Cost and utilities were estimated from published sources. The cost of inclisiran was estimated from the annual cost of evolocumab, a PCSK9 inhibitor currently available in Australia (AU$6334, based on 2020 data). Outcomes of interest were incremental cost-effectiveness ratios (ICERs) in terms of cost per quality-adjusted life-year (QALY) and cost per year of life saved (YoLS). All costs, QALYs and YoLS were discounted at 5% per annum in line with Australian standards. RESULTS Among 1000 subjects followed-up over a lifetime analysis, inclisiran with statin compared with statin alone prevented 235 non-fatal myocardial infarctions (NFMIs; 151 NFMI and 84 repeat NFMI cases) and 114 coronary revascularisation cases, and increased years of life by 0.549 (discounted) and QALYs by 0.468 (discounted). At an annual price of AU$6334, the net marginal cost was AU$58,965 per person. The above values equated to ICERs of AU$107,402 per YoLS and AU$125,732 per QALY gained. Assuming a willingness-to-pay threshold of AU$50,000, inclisiran would have to be priced 60% lower than other available PCSK9 inhibitors to be considered cost effective. CONCLUSIONS As an adjunct therapy to statin treatment in those who have persistently elevated LDL-C despite optimal statin therapy, inclisiran is effective in reducing cardiovascular events in patients with atherosclerotic CVD. Inclisiran is not cost effective from the Australian healthcare perspective, assuming acquisition costs of current PCSK9 inhibitors. The cost of inclisiran would have to be 60% lower than that of evolocumab.
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Affiliation(s)
- Ning Kam
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Kanila Perera
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Ella Zomer
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
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Prescott E, Pernow J, Saraste A, Åkerblom A, Angerås O, Erlinge D, Grove EL, Hedman M, Jensen LO, Svedlund S, Kjaer M, Lagerström-Fermér M, Gan LM. Design and rationale of FLAVOUR: A phase IIa efficacy study of the 5-lipoxygenase activating protein antagonist AZD5718 in patients with recent myocardial infarction. Contemp Clin Trials Commun 2020; 19:100629. [PMID: 32875138 PMCID: PMC7451793 DOI: 10.1016/j.conctc.2020.100629] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/14/2020] [Accepted: 07/26/2020] [Indexed: 11/07/2022] Open
Abstract
Patients with coronary artery disease remain at increased risk of recurrent life-threatening cardiovascular events even after adequate guideline-based treatment of conventional risk factors, including blood lipid levels. Inflammation is a critical pathway in the pathogenesis of atherosclerosis and is independently associated with risk of recurrent cardiovascular events. Leukotrienes are potent pro-inflammatory and vasoactive mediators synthesized by leukocytes in atherosclerotic lesions. AZD5718 is a novel antagonist of 5-lipoxygenase activating protein that suppresses leukotriene biosynthesis. FLAVOUR is a phase IIa efficacy and safety study of AZD5718 in patients with myocardial infarction 1-4 weeks before randomization. Stenosis of the left anterior descending coronary artery after percutaneous intervention must be <50%, and Thrombolysis In Myocardial Infarction flow grade must be ≥ 2. Enrolled participants receive standard care plus oral AZD5718 200 mg, 50 mg, or placebo once daily for up to 12 weeks (extended from 4 weeks by protocol amendment). The planned sample size is 100 participants randomized to 12 weeks' treatment. Change in urine leukotriene E4 levels is the primary efficacy outcome. FLAVOUR also aims to evaluate whether AZD5718 can improve coronary microvascular function, as measured by transthoracic colour Doppler-assisted coronary flow velocity reserve. Centrally pretrained study sonographers use standardized protocols and equipment. Additional outcomes include assessment of comprehensive echocardiographic parameters (including coronary flow, global strain, early diastolic strain rate and left ventricular ejection fraction), arterial stiffness, biomarkers, health-related quality of life, and safety. Specific anti-inflammatory therapies may represent novel promising treatments to reduce residual risk in patients with coronary artery disease. By combining primary pharmacodynamic and secondary cardiovascular surrogate efficacy outcomes, FLAVOUR aims to investigate the mechanistic basis and potential benefits of AZD5718 treatment in patients with coronary artery disease.
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Affiliation(s)
- Eva Prescott
- Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - John Pernow
- Division of Cardiology, Department of Medicine, Karolinska Institute, Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Antti Saraste
- University of Turku and Heart Centre, Turku University Hospital, Turku, Finland
| | - Axel Åkerblom
- Department of Medical Sciences – Cardiology, and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Oskar Angerås
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, and Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - David Erlinge
- Cardiology, Department of Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden
| | - Erik L. Grove
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Marja Hedman
- Department of Cardiothoracic Surgery, Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Lisette O. Jensen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Sara Svedlund
- Department of Clinical Physiology, Sahlgrenska University Hospital, and Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Magnus Kjaer
- Early Biometrics and Statistical Innovation, Data Science & AI, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Maria Lagerström-Fermér
- Research and Early Development, Cardiovascular, Renal and Metabolic, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Li-Ming Gan
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, and Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Research and Early Development, Cardiovascular, Renal and Metabolic, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
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Houck P, Dandapantula H, Hardegree E, Massey J. Why We Fail at Heart Failure: Lymphatic Insufficiency Is Disregarded. Cureus 2020; 12:e8930. [PMID: 32760630 PMCID: PMC7392353 DOI: 10.7759/cureus.8930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Is the definition of heart failure too narrow, not allowing research into compensatory mechanisms, comorbidities, right heart function, and lymphatic function? A review of the absolute mortality of heart failure drugs and devices suggests a modest improvement in outcomes. Absolute mortality from common comorbidities, including renal insufficiency, arrhythmia, conduction deficits, pulmonary hypertension, anemia, obstructive sleep apnea, infection, inflammation, edema, ischemic heart disease, and diabetes II, is significant. The lymphatic function is involved in short, intermediate, and long-term compensation for a failing heart and plays a role in most of the comorbidities. A better definition of heart failure is: Heart failure is a complex clinical syndrome that results from any structural or functional impairment of right or left ventricular filling or ejection of blood and failure of peripheral compensatory mechanisms. Lymphatic function from the anatomic, fluid management, immune modification standpoints requires study. New therapies from this analysis will improve patients with congestive heart failure.
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Affiliation(s)
- Philip Houck
- Medicine/Cardiology, Baylor Scott & White Health, Temple, USA.,Medicine/Cardiology, Texas A&M Health Sciences Center, Temple, USA
| | - Hari Dandapantula
- Medicine/Cardiology, Baylor Scott & White Health, Temple, USA.,Medicine/Cardiology, Texas A&M Health Sciences Center, Temple, USA
| | - Evan Hardegree
- Medicine/Cardiology, Baylor Scott & White Health, Temple, USA
| | - Janet Massey
- Family Medicine/Lymphology, Praxis Dr. Jungkunz, Friedberg, DEU
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Ferlini M, Rossini R, Musumeci G, Cornara S, Somaschini A, Grieco N, Marino M, Calchera I, Cardile A, Colombo P, Martinoni A, Ielasi A, Castiglioni B, Lettieri C, Tarantini G, Oltrona Visconti L. Dual antiplatelet therapy prolongation in high-risk patients with prior myocardial infarction: insights from the post-PCI registry. J Cardiovasc Med (Hagerstown) 2020; 21:603-609. [PMID: 32520857 DOI: 10.2459/jcm.0000000000000988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Patients surviving a myocardial infarction (MI) are at a heightened risk for recurrent ischemic events that can be reduced with the long-term addition of a second antithrombotic drug to aspirin. However, data about real prescription of this therapy are lacking and sometimes controversial. METHODS We aimed to describe the incidence and the determinants of a dual antiplatelet therapy (DAPT) prolongation beyond 12 months in a cohort of consecutive patients undergoing percutaneous coronary intervention (PCI) with prior MI undergoing PCI and features of high ischemic risk intended as age more than 65 years, second MI, type 2 diabetes mellitus, multivessel coronary artery disease (MVCAD) and chronic kidney disease (CKD). We analysed patients enrolled in the prospective 'Post-PCI' registry that included patients treated with PCI for stable coronary artery disease (CAD) or acute coronary syndromes. At 12 months' follow-up, we collected data about DAPT prolongation in patients with prior MI and at least one of the previous features of high risk who did not experience ischemic and bleeding events during the follow-up. RESULTS Among 1113 patients included in the registry, 778 (72%) presented the inclusion criteria for the present study: 434 (66%) were more than 65 years old, 245 (37%) had a second MI, 189 (29%) diabetes mellitus, 480 (73%) MVCAD and 216 (33%) CKD. Despite a DAPT being prescribed for 1 year in 86% of the patients, it was prolonged for over 12 months in 105 (16%) of them. At multivariable analysis, only second MI and MVCAD were independent predictors of DAPT prolongation in a model including age more than 65 years, diabetes mellitus, CKD and PCI on left main/left anterior descending coronary artery. We found no significant difference in DAPT prolongation according to a DAPT-score value at least 2 or based on the physician who actually performed the follow-up (clinical cardiologist, interventional cardiologist or other). CONCLUSION In patients with prior MI and features of high ischemic risk undergoing PCI, the rate of DAPT prolongation beyond 12 months was low; recurrent MI and MVCAD appeared as its main determinants.
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Affiliation(s)
- Marco Ferlini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Roberta Rossini
- Dipartimento Emergenze e Aree Critiche, Ospedale Santa Croce e Carle, Cuneo
| | - Giuseppe Musumeci
- Dipartimento Emergenze e Aree Critiche, Ospedale Santa Croce e Carle, Cuneo
| | - Stefano Cornara
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia.,Department of Molecular Medicine, Unit of Cardiology, University of Pavia, Pavia
| | - Alberto Somaschini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia.,Department of Molecular Medicine, Unit of Cardiology, University of Pavia, Pavia
| | - Niccolò Grieco
- Cardiology Department, Niguarda Ca'Granda Hospital, Milan
| | | | | | | | - Paola Colombo
- Department of Clinical Governance, Niguarda Ca'Granda Hospital, Milano
| | | | | | | | - Corrado Lettieri
- Department of Cardiology, ASST Mantova-Ospedale Carlo Poma, Mantova
| | - Giuseppe Tarantini
- Interventional Cardiology UOSD, Department of Cardiac, Thoracic and Vascular Science, Padova University Hospital, Padova, Italy
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Kim YH, Her AY, Jeong MH, Kim BK, Hong SJ, Kim S, Ahn CM, Kim JS, Ko YG, Choi D, Hong MK, Jang Y. Effect of renin-angiotensin system inhibitors on major clinical outcomes in patients with acute myocardial infarction and prediabetes or diabetes after successful implantation of newer-generation drug-eluting stents. J Diabetes Complications 2020; 34:107574. [PMID: 32147394 DOI: 10.1016/j.jdiacomp.2020.107574] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 01/26/2020] [Accepted: 02/26/2020] [Indexed: 12/30/2022]
Abstract
AIM To investigate the comparative effectiveness of renin-angiotensin system inhibitor (RASI) therapy on major clinical outcomes in patients with acute myocardial infarction (AMI) and prediabetes or diabetes after successful percutaneous coronary intervention (PCI) with newer-generation drug-eluting stents (DESs). METHODS A total of 11,962 patients with AMI were divided into six groups according to glycemic status and the presence or absence of RASI therapy: normoglycemia (n = 3,080; RASI+ [n = 2,496], RASI- [n = 584]), prediabetes (n = 3,709; RASI+ [n = 2,944], RASI- [n = 765]), and diabetes (n = 5,173; RASI+ [n = 4,133], RASI- [n = 1,040]). The major endpoint was major adverse cardiac events (MACEs), defined as all-cause death, recurrent myocardial infarction (re-MI), or any repeat revascularization. RESULTS After adjustment, in RASI users, the cumulative incidence of re-MI of the diabetes group was significantly higher than that of the prediabetes group (aHR, 1.999; 95% CI, 1.153-3.467; p = 0.014). However, the cumulative incidences of MACEs, all-cause death, and any repeat revascularization were similar between the two groups during a 2-year follow-up period. CONCLUSIONS In the era of newer-generation DESs, RASI therapy did not reduce re-MI in patients with AMI and diabetes in this study.
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Affiliation(s)
- Yong Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea.
| | - Ae-Young Her
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Byeong-Keuk Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Republic of Korea
| | - Sung-Jin Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Republic of Korea
| | - Seunghwan Kim
- Division of Cardiology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Chul-Min Ahn
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Republic of Korea
| | - Jung-Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Republic of Korea
| | - Young-Guk Ko
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Republic of Korea
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Republic of Korea
| | - Myeong-Ki Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Republic of Korea
| | - Yangsoo Jang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Republic of Korea
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Implanted Monitor Alerting to Reduce Treatment Delay in Patients With Acute Coronary Syndrome Events. J Am Coll Cardiol 2020; 74:2047-2055. [PMID: 31623762 DOI: 10.1016/j.jacc.2019.07.084] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/16/2019] [Accepted: 07/17/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Increased pre-hospital delay during acute coronary syndrome (ACS) events contributes to worse outcome. OBJECTIVES The purpose of this study was to assess the effectiveness of an implanted cardiac monitor with real-time alarms for abnormal ST-segment shifts to reduce pre-hospital delay during ACS events. METHODS In the ALERTS (AngeLmed Early Recognition and Treatment of STEMI) pivotal study, subjects at high risk for recurrent ACS events (n = 907) were randomized to control (Alarms OFF) or treatment groups for 6 months, after which alarms were activated in all subjects (Alarms ON). Emergency department (ED) visits with standard-of-care cardiac test results were independently adjudicated as true- or false-positive ACS events. Alarm-to-door (A2D) and symptom-to-door (S2D) times were calculated for true-positive ACS ED visits triggered by 3 possible prompts: alarm only, alarms + symptoms, or symptoms only. RESULTS The Alarms ON group showed reduced delays, with 55% (95% confidence interval [CI]: 46% to 63%) of ED visits for ACS events <2 h compared with 10% (95% CI: 2% to 27%) in the Alarms OFF group (p < 0.0001). Results were similar when restricted to myocardial infarction (MI) events. Median pre-hospital delay for MI was 12.7 h for Alarms OFF and 1.6 h in Alarms ON subjects (p < 0.0089). Median A2D delay was 1.4 h for asymptomatic MI. Median S2D delay for symptoms-only MI (no alarm) in Alarms ON was 4.3 h. CONCLUSIONS Intracardiac monitoring with real-time alarms for ST-segment shift that exceeds a subject's self-normative ischemia threshold level significantly reduced the proportion of pre-hospital delays >2 h for ACS events, including asymptomatic MI, compared with symptoms-only ED visits in Alarms OFF. (AngeLmed for Early Recognition and Treatment of STEMI [ALERTS]; NCT00781118).
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Mallat Z, Hulot JS. Suppression of Hematopoiesis in Recurrent Myocardial Infarction: A Deadly Silence. J Am Coll Cardiol 2020; 75:916-918. [PMID: 32130927 DOI: 10.1016/j.jacc.2020.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 01/07/2020] [Accepted: 01/13/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Ziad Mallat
- Department of Medicine, Division of Cardiovascular Medicine, University of Cambridge, Cambridge, United Kingdom; Université de Paris, PARCC, INSERM, F-75015 Paris, France.
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Lunney M, Ruospo M, Natale P, Quinn RR, Ronksley PE, Konstantinidis I, Palmer SC, Tonelli M, Strippoli GFM, Ravani P. Pharmacological interventions for heart failure in people with chronic kidney disease. Cochrane Database Syst Rev 2020; 2:CD012466. [PMID: 32103487 PMCID: PMC7044419 DOI: 10.1002/14651858.cd012466.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Approximately half of people with heart failure have chronic kidney disease (CKD). Pharmacological interventions for heart failure in people with CKD have the potential to reduce death (any cause) or hospitalisations for decompensated heart failure. However, these interventions are of uncertain benefit and may increase the risk of harm, such as hypotension and electrolyte abnormalities, in those with CKD. OBJECTIVES This review aims to look at the benefits and harms of pharmacological interventions for HF (i.e., antihypertensive agents, inotropes, and agents that may improve the heart performance indirectly) in people with HF and CKD. SEARCH METHODS We searched the Cochrane Kidney and Transplant Register of Studies through 12 September 2019 in consultation with an Information Specialist and using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA We included randomised controlled trials of any pharmacological intervention for acute or chronic heart failure, among people of any age with chronic kidney disease of at least three months duration. DATA COLLECTION AND ANALYSIS Two authors independently screened the records to identify eligible studies and extracted data on the following dichotomous outcomes: death, hospitalisations, worsening heart failure, worsening kidney function, hyperkalaemia, and hypotension. We used random effects meta-analysis to estimate treatment effects, which we expressed as a risk ratio (RR) with 95% confidence intervals (CI). We assessed the risk of bias using the Cochrane tool. We applied the GRADE methodology to rate the certainty of evidence. MAIN RESULTS One hundred and twelve studies met our selection criteria: 15 were studies of adults with CKD; 16 studies were conducted in the general population but provided subgroup data for people with CKD; and 81 studies included individuals with CKD, however, data for this subgroup were not provided. The risk of bias in all 112 studies was frequently high or unclear. Of the 31 studies (23,762 participants) with data on CKD patients, follow-up ranged from three months to five years, and study size ranged from 16 to 2916 participants. In total, 26 studies (19,612 participants) reported disaggregated and extractable data on at least one outcome of interest for our review and were included in our meta-analyses. In acute heart failure, the effects of adenosine A1-receptor antagonists, dopamine, nesiritide, or serelaxin on death, hospitalisations, worsening heart failure or kidney function, hyperkalaemia, hypotension or quality of life were uncertain due to sparse data or were not reported. In chronic heart failure, the effects of angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB) (4 studies, 5003 participants: RR 0.85, 95% CI 0.70 to 1.02; I2 = 78%; low certainty evidence), aldosterone antagonists (2 studies, 34 participants: RR 0.61 95% CI 0.06 to 6.59; very low certainty evidence), and vasopressin receptor antagonists (RR 1.26, 95% CI 0.55 to 2.89; 2 studies, 1840 participants; low certainty evidence) on death (any cause) were uncertain. Treatment with beta-blockers may reduce the risk of death (any cause) (4 studies, 3136 participants: RR 0.69, 95% CI 0.60 to 0.79; I2 = 0%; moderate certainty evidence). Treatment with ACEi or ARB (2 studies, 1368 participants: RR 0.90, 95% CI 0.43 to 1.90; I2 = 97%; very low certainty evidence) had uncertain effects on hospitalisation for heart failure, as treatment estimates were consistent with either benefit or harm. Treatment with beta-blockers may decrease hospitalisation for heart failure (3 studies, 2287 participants: RR 0.67, 95% CI 0.43 to 1.05; I2 = 87%; low certainty evidence). Aldosterone antagonists may increase the risk of hyperkalaemia compared to placebo or no treatment (3 studies, 826 participants: RR 2.91, 95% CI 2.03 to 4.17; I2 = 0%; low certainty evidence). Renin inhibitors had uncertain risks of hyperkalaemia (2 studies, 142 participants: RR 0.86, 95% CI 0.49 to 1.49; I2 = 0%; very low certainty). We were unable to estimate whether treatment with sinus node inhibitors affects the risk of hyperkalaemia, as there were few studies and meta-analysis was not possible. Hyperkalaemia was not reported for the CKD subgroup in studies investigating other therapies. The effects of ACEi or ARB, or aldosterone antagonists on worsening heart failure or kidney function, hypotension, or quality of life were uncertain due to sparse data or were not reported. Effects of anti-arrhythmic agents, digoxin, phosphodiesterase inhibitors, renin inhibitors, sinus node inhibitors, vasodilators, and vasopressin receptor antagonists were very uncertain due to the paucity of studies. AUTHORS' CONCLUSIONS The effects of pharmacological interventions for heart failure in people with CKD are uncertain and there is insufficient evidence to inform clinical practice. Study data for treatment outcomes in patients with heart failure and CKD are sparse despite the potential impact of kidney impairment on the benefits and harms of treatment. Future research aimed at analysing existing data in general population HF studies to explore the effect in subgroups of patients with CKD, considering stage of disease, may yield valuable insights for the management of people with HF and CKD.
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Affiliation(s)
- Meaghan Lunney
- University of CalgaryDepartment of Community Health Sciences3330 Hospital Drive NWCalgaryAlbertaCanadaT2N 4N1
| | - Marinella Ruospo
- The University of SydneySydney School of Public HealthSydneyAustralia
- University of BariDepartment of Emergency and Organ TransplantationBariItaly
| | - Patrizia Natale
- The University of SydneySydney School of Public HealthSydneyAustralia
- University of BariDepartment of Emergency and Organ TransplantationBariItaly
| | - Robert R Quinn
- University of CalgaryDepartment of Community Health Sciences3330 Hospital Drive NWCalgaryAlbertaCanadaT2N 4N1
- Cumming School of Medicine, University of CalgaryDepartment of MedicineCalgaryCanada
| | - Paul E Ronksley
- University of CalgaryDepartment of Community Health Sciences3330 Hospital Drive NWCalgaryAlbertaCanadaT2N 4N1
| | - Ioannis Konstantinidis
- University of Pittsburgh Medical CenterDepartment of Medicine3459 Fifth AvenuePittsburghPAUSA15213
| | - Suetonia C Palmer
- Christchurch Hospital, University of OtagoDepartment of Medicine, NephrologistChristchurchNew Zealand
| | - Marcello Tonelli
- Cumming School of Medicine, University of CalgaryDepartment of MedicineCalgaryCanada
| | - Giovanni FM Strippoli
- The University of SydneySydney School of Public HealthSydneyAustralia
- University of BariDepartment of Emergency and Organ TransplantationBariItaly
- The Children's Hospital at WestmeadCochrane Kidney and Transplant, Centre for Kidney ResearchWestmeadNSWAustralia2145
| | - Pietro Ravani
- University of CalgaryDepartment of Community Health Sciences3330 Hospital Drive NWCalgaryAlbertaCanadaT2N 4N1
- Cumming School of Medicine, University of CalgaryDepartment of MedicineCalgaryCanada
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Suzuki K, Oikawa T, Nochioka K, Miura M, Kasahara S, Sato M, Aoyanagi H, Shiroto T, Takahashi J, Miyata S, Sakata Y, Shimokawa H. Elevated Serum Non-HDL (High-Density Lipoprotein) Cholesterol and Triglyceride Levels as Residual Risks for Myocardial Infarction Recurrence Under Statin Treatment. Arterioscler Thromb Vasc Biol 2020; 39:934-944. [PMID: 30866657 DOI: 10.1161/atvbaha.119.312336] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective- Secondary prevention for recurrent myocardial infarction (MI) is one of the most important therapeutic goals in patients with old MI (OMI). Although statins are widely used for this purpose, there remains considerable residual risk even after LDL (low-density lipoprotein cholesterol) is well controlled by statins. Approach and Results- We examined clinical impacts of nHDL (nonhigh-density lipoprotein cholesterol) and its major components triglyceride and LDL as residual risks for acute MI recurrence, using the database of our CHART (Chronic Heart Failure Analysis and Registry in the Tohoku District)-2 Study, the largest-scale cohort study of cardiovascular patients in Japan. We enrolled 1843 consecutive old MI patients treated with statins (mean age 67.3 years, male 19.2%) in the CHART-2 Study. The incidence of recurrent acute MI during the median 8.6-year follow-up was compared among the groups divided by the levels of nHDL (<100, 100-129, and ≥130 mg/dL), LDL (<70, 70-99, and ≥100 mg/dL), triglyceride (<84, 84-149, and ≥150 mg/dL), and combination of LDL and triglyceride. Kaplan-Meier curves and multiple Cox proportional hazards models showed that higher levels of nHDL, but not LDL or triglyceride alone, were associated with higher incidence of recurrent acute MI. Furthermore, higher triglyceride levels were associated with higher incidence of recurrent MI in patients with LDL <100 mg/dL but not in those with LDL ≥100 mg/dL. Conclusions- These results indicate that management of residual risks for acute MI recurrence should include nHDL management considering both LDL and triglyceride in old MI patients under statin treatment. Clinical Trial Registration- URL: http://www.clinicaltrials.gov . Unique identifier: NCT00418041.
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Affiliation(s)
- Kota Suzuki
- From the Department of Cardiovascular Medicine (K.S., T.O., K.N., M.M., S.K., M.S., H.A., T.S., J.T., Y.S., H.S.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takuya Oikawa
- From the Department of Cardiovascular Medicine (K.S., T.O., K.N., M.M., S.K., M.S., H.A., T.S., J.T., Y.S., H.S.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kotaro Nochioka
- From the Department of Cardiovascular Medicine (K.S., T.O., K.N., M.M., S.K., M.S., H.A., T.S., J.T., Y.S., H.S.), Tohoku University Graduate School of Medicine, Sendai, Japan.,Big Data Medicine Center, Tohoku University, Sendai, Japan (K.N., Y.S., H.S.)
| | - Masanobu Miura
- From the Department of Cardiovascular Medicine (K.S., T.O., K.N., M.M., S.K., M.S., H.A., T.S., J.T., Y.S., H.S.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shintaro Kasahara
- From the Department of Cardiovascular Medicine (K.S., T.O., K.N., M.M., S.K., M.S., H.A., T.S., J.T., Y.S., H.S.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masayuki Sato
- From the Department of Cardiovascular Medicine (K.S., T.O., K.N., M.M., S.K., M.S., H.A., T.S., J.T., Y.S., H.S.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hajime Aoyanagi
- From the Department of Cardiovascular Medicine (K.S., T.O., K.N., M.M., S.K., M.S., H.A., T.S., J.T., Y.S., H.S.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takashi Shiroto
- From the Department of Cardiovascular Medicine (K.S., T.O., K.N., M.M., S.K., M.S., H.A., T.S., J.T., Y.S., H.S.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jun Takahashi
- From the Department of Cardiovascular Medicine (K.S., T.O., K.N., M.M., S.K., M.S., H.A., T.S., J.T., Y.S., H.S.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoshi Miyata
- Department of Evidence-based Cardiovascular Medicine (S.M., H.S.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasuhiko Sakata
- From the Department of Cardiovascular Medicine (K.S., T.O., K.N., M.M., S.K., M.S., H.A., T.S., J.T., Y.S., H.S.), Tohoku University Graduate School of Medicine, Sendai, Japan.,Big Data Medicine Center, Tohoku University, Sendai, Japan (K.N., Y.S., H.S.)
| | - Hiroaki Shimokawa
- From the Department of Cardiovascular Medicine (K.S., T.O., K.N., M.M., S.K., M.S., H.A., T.S., J.T., Y.S., H.S.), Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Evidence-based Cardiovascular Medicine (S.M., H.S.), Tohoku University Graduate School of Medicine, Sendai, Japan.,Big Data Medicine Center, Tohoku University, Sendai, Japan (K.N., Y.S., H.S.)
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Jo E, Kim SR, Kim HY. Predictive model for quality of life in patients with recurrent coronary artery disease. Eur J Cardiovasc Nurs 2019; 18:501-511. [DOI: 10.1177/1474515119847544] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background: The aims of this study were to construct and verify a model that explains the quality of life in patients with recurrent coronary artery disease. Methods: Participants were 212 patients with recurrent coronary artery disease undergoing percutaneous coronary intervention. Data were collected through structured questionnaires from 21 December 2016–30 April 2017, and were analyzed using SPSS 23.0 and AMOS 23.0. Results: The model’s fit indices were adequate. Type D personality, symptom experience, and resilience had a direct effect on quality of life, while type D personality, cardiac function status, social support, and resilience had an indirect effect on quality of life. Type D personality, cardiac function status, social support, symptom experience, and resilience explained 55% of the total variance in quality of life. Thus, type D personality, cardiac function status, social support, symptom experience, and resilience affected the quality of life in patients with recurrent coronary artery disease. Conclusions: Systematic and integrated intervention programs considering factors related to quality of life may be useful for improving quality of life for patients with recurrent coronary artery disease.
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Affiliation(s)
- Eunhee Jo
- Department of Nursing, Kunsan College of Nursing, Korea
| | | | - Hye Young Kim
- College of Nursing, Research Institute of Nursing Science, Chonbuk National University, Korea
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Read SH, Fischbacher CM, Colhoun HM, Gasevic D, Kerssens JJ, McAllister DA, Sattar N, Wild SH. Trends in incidence and case fatality of acute myocardial infarction, angina and coronary revascularisation in people with and without type 2 diabetes in Scotland between 2006 and 2015. Diabetologia 2019; 62:418-425. [PMID: 30656362 PMCID: PMC7019674 DOI: 10.1007/s00125-018-4796-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 11/27/2018] [Indexed: 01/14/2023]
Abstract
AIMS/HYPOTHESIS The aim of the study was to examine trends in the incidence and case fatality of acute myocardial infarction (AMI) and in hospital admissions for angina and coronary revascularisation procedures in people with type 2 diabetes and in people without diabetes in Scotland between 2006 and 2015. METHODS In this retrospective cohort study, AMI, angina and revascularisation event data were obtained for adults from hospital admissions and death records linked to a population-based diabetes register. Incidence by diabetes status was estimated using negative binomial models with adjustment or stratification by age, sex, deprivation and calendar year. Logistic regression was used to estimate AMI case fatality by diabetes status. RESULTS There were 129,926 incident AMI events, 41,263 angina admissions and 69,875 coronary revascularisation procedures carried out during 34.9 million person-years of follow-up. The adjusted incidence of AMI, angina and revascularisation procedures declined by 2.0% (95% CI 1.73%, 2.26%), 9.62% (95% CI 9.22%, 10.01%) and 0.35% (95% CI -0.09%, 0.79%) per year, respectively. The rate of decline did not differ materially by diabetes status. RRs of AMI for type 2 diabetes were 1.86 (95% CI 1.74, 1.98) for men and 2.32 (95% CI 2.15, 2.51) for women. Of the 77,211 people admitted to hospital with a first AMI, 7842 (10.2%) died within 30 days of admission. Case fatality was higher in people with type 2 diabetes than in people without diabetes and declined in both groups by 7.93% (95% CI 7.03%, 8.82%) per year. CONCLUSIONS/INTERPRETATION The incidence of AMI, angina, revascularisation and AMI case fatality has declined over time, but the increased risk associated with type 2 diabetes has remained approximately constant.
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Affiliation(s)
- Stephanie H Read
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK.
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
| | - Colin M Fischbacher
- Information Services Division, NHS National Services Scotland, Edinburgh, UK
| | - Helen M Colhoun
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - Danijela Gasevic
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Joannes J Kerssens
- Information Services Division, NHS National Services Scotland, Edinburgh, UK
| | | | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Sarah H Wild
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
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Watanabe T, Hirooka K, Furukawa Y, Yabuki M, Hirata A, Kashiwase K, Shutta R, Mine T, Mizuno H, Tanaka T, Doi T, Yoshida A, Okuyama Y, Nanto S. Continuous ST-Monitoring Function of Implantable Cardioverter Defibrillator Detects Silent Ischemia in Patients With Coronary Artery Disease. J Am Heart Assoc 2018; 7:JAHA.118.009332. [PMID: 29960992 PMCID: PMC6064887 DOI: 10.1161/jaha.118.009332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background Newer implantable cardioverter defibrillators can monitor intracardiac ECGs , but their ability to detect ischemia is unclear. This study investigated the usefulness of implantable cardioverter defibrillators with an ST‐monitoring function in coronary artery disease patients. Methods and Results We conducted a prospective study of implantable cardioverter defibrillator patients with the ST‐monitoring function. One hundred seventy‐three patients who received implantable cardioverter defibrillators for primary or secondary prevention of sudden cardiac death. All patients underwent medical examinations at least every 6 months, with standard 12‐lead ECGs and device checks that included analysis of the ST‐monitoring function. Myocardial perfusion imaging or coronary angiography was performed during the follow‐up. The mean follow‐up duration was 23.3±7.7 months. Significant ST changes occurred in 15 patients (8.7%), of whom 14 were asymptomatic. The incidence of angina pectoris was significantly higher in the ST change (+) group than that in the ST change (−) group (28.6% versus 7.2%, P=0.03). In the patients who underwent myocardial perfusion imaging, the sensitivity, specificity, and negative predictive value of the ST‐monitoring feature to detect ischemia were 75.0%, 72.5%, and 93.5%, respectively. The sensitivity, specificity, and negative predictive value of the ST‐monitoring feature to predict residual stenosis evaluated using coronary angiography were 76.9%, 83.5%, and 97.5%, respectively. The percentage of patients with a septal right ventricular lead was significantly lower in the ST change (+) group than in the ST change (−) group (13.5% versus 33.5%, P=0.01). Conclusions If intracardiac ECGs ST changes are detected, it is necessary to use additional modalities even in asymptomatic patients. Clinical Trial Registration URL: http://upload.umin.ac.jp. Unique identifier: UMIN000011824.
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Affiliation(s)
- Tetsuya Watanabe
- Department of Cardiovascular Medicine, Yao Municipal Hospital, Osaka, Japan
| | - Keiji Hirooka
- Cardiovascular Division, Osaka National Hospital, Osaka, Japan
| | - Yoshio Furukawa
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Masanori Yabuki
- Department of Cardiovascular Medicine, Higashi Takarazuka Satoh Hospital, Hyogo, Japan
| | - Akio Hirata
- Cardiovascular Division, Osaka Police Hospital, Osaka, Japan
| | | | - Ryu Shutta
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | - Takanao Mine
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Hiroya Mizuno
- Department of Advanced Cardiovascular Therapeutics, Osaka University Graduate School of Medicine, Osaka, Japan
| | | | - Takahiro Doi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akihiro Yoshida
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Yuji Okuyama
- Department of Advanced Cardiovascular Therapeutics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shinsuke Nanto
- Department of Advanced Cardiovascular Therapeutics, Osaka University Graduate School of Medicine, Osaka, Japan
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Boas Z, Gupta P, Moheimani RS, Bhetraratana M, Yin F, Peters KM, Gornbein J, Araujo JA, Czernin J, Middlekauff HR. Activation of the "Splenocardiac Axis" by electronic and tobacco cigarettes in otherwise healthy young adults. Physiol Rep 2018; 5:5/17/e13393. [PMID: 28899908 PMCID: PMC5599858 DOI: 10.14814/phy2.13393] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 07/25/2017] [Accepted: 07/27/2017] [Indexed: 02/03/2023] Open
Abstract
The "Splenocardiac Axis" describes an inflammatory signaling network underlying acute cardiac ischemia, characterized by sympathetic nerve stimulation of hematopoietic tissues, such as the bone marrow and spleen, which then release proinflammatory monocytes that populate atherosclerotic plaques, thereby promoting ischemic heart disease. Electronic (e) cigarettes, like tobacco cigarettes trigger sympathetic nerve activation, but virtually nothing is known about their influence on hematopoietic and vascular tissues and cardiovascular risks. The objective of this study was to determine if the Splenocardiac Axis is activated in young adults who habitually use either tobacco or e-cigarettes. In otherwise healthy humans who habitually use tobacco cigarettes or e-cigarettes (not both), we used 18F-flurorodeoxyglucose positron emission tomography/computer tomography (FDG-PET/CT) to test the hypothesis that tobacco or e-cigarettes increased metabolic activity of the hematopoietic and vascular tissues. FDG uptake in the spleen increased from nonuser controls (1.62 ± 0.07), to the e-cigarette users (1.73 ± 0.04), and was highest in tobacco cigarette smokers (1.82 ± 0.09; monotone P = 0.05). Similarly, FDG uptake in the aorta increased from the nonuser controls (1.87 ± 0.07) to the e-cigarette users (1.98 ± 0.07), and was highest in tobacco cigarette smokers (2.10 ± 0.07; monotone P = 0.04). FDG uptake in the skeletal muscle, which served as a control tissue, was not different between the groups. In conclusion, these findings are consistent with activation of the Splenocardiac Axis by emissions from tobacco cigarettes and e-cigarettes. This activation suggests a mechanism by which tobacco cigarettes, and potentially e-cigarettes, may lead to increased risk of future cardiovascular events.
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Affiliation(s)
- Zachary Boas
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Pawan Gupta
- Department of Molecular and Medical Pharmacology, Ahmanson Translational Imaging Division, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Roya S Moheimani
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | - May Bhetraratana
- Department of Environmental Health Sciences, School of Public Health, Los Angeles, California
| | - Fen Yin
- Department of Environmental Health Sciences, School of Public Health, Los Angeles, California
| | - Kacey M Peters
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jeffrey Gornbein
- Department of Biomathematics, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jesus A Araujo
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California.,Department of Environmental Health Sciences, School of Public Health, Los Angeles, California
| | - Johannes Czernin
- Department of Molecular and Medical Pharmacology, Ahmanson Translational Imaging Division, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Holly R Middlekauff
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
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Prolonged hematopoietic and myeloid cellular response in patients after an acute coronary syndrome measured with 18F-DPA-714 PET/CT. Eur J Nucl Med Mol Imaging 2018; 45:1956-1963. [PMID: 29728748 PMCID: PMC6132543 DOI: 10.1007/s00259-018-4038-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 04/19/2018] [Indexed: 11/10/2022]
Abstract
Purpose An acute coronary syndrome (ACS) is characterized by a multi-level inflammatory response, comprising activation of bone marrow and spleen accompanied by augmented release of leukocytes into the circulation. The duration of this response after an ACS remains unclear. Here, we assessed the effect of an ACS on the multi-level inflammatory response in patients both acutely and after 3 months. Methods We performed 18F-DPA-714 PET/CT acutely and 3 months post-ACS in eight patients and eight matched healthy controls. DPA-714, a PET tracer binding the TSPO receptor and highly expressed in myeloid cells, was used to assess hematopoietic activity. We also characterized circulating monocytes and hematopoietic stem and progenitor cells (HSPCs) by flow cytometry in 20 patients acutely and 3 months post-ACS and in 19 healthy controls. Results In the acute phase, patients displayed a 1.4-fold and 1.3-fold higher 18F-DPA-714 uptake in, respectively, bone marrow (p = 0.012) and spleen (p = 0.039) compared with healthy controls. This coincided with a 2.4-fold higher number of circulating HSPCs (p = 0.001). Three months post-ACS, 18F-DPA-714 uptake in bone marrow decreased significantly (p = 0.002), but no decrease was observed for 18F-DPA-714 uptake in the spleen (p = 0.67) nor for the number of circulating HSPCs (p = 0.75). Conclusions 18F-DPA-714 PET/CT reveals an ACS- triggered hematopoietic organ activation as initiator of a prolonged cellular inflammatory response beyond 3 months, characterized by a higher number of circulating leukocytes and their precursors. This multi-level inflammatory response may provide an attractive target for novel treatment options aimed at reducing the high recurrence rate post-ACS. Electronic supplementary material The online version of this article (10.1007/s00259-018-4038-8) contains supplementary material, which is available to authorized users.
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Characterization of dysregulated lncRNA-mRNA network based on ceRNA hypothesis to reveal the occurrence and recurrence of myocardial infarction. Cell Death Discov 2018. [PMID: 29531832 PMCID: PMC5841419 DOI: 10.1038/s41420-018-0036-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Accumulating evidence has demonstrated that long non-coding RNAs (lncRNAs) acting as competing endogenous RNAs (ceRNAs) play important roles in initiation and development of human diseases. However, the mechanism of ceRNA regulated by lncRNA in myocardial infarction (MI) remained unclear. In this study, we performed a multi-step computational method to construct dysregulated lncRNA-mRNA networks for MI occurrence (DLMN_MI_OC) and recurrence (DLMN_MI_Re) based on “ceRNA hypothesis”. We systematically integrated lncRNA and mRNA expression profiles and miRNA-target regulatory interactions. The constructed DLMN_MI_OC and DLMN_MI_Re both exhibited biological network characteristics, and functional analysis demonstrated that the networks were specific for MI. Additionally, we identified some lncRNA-mRNA ceRNA modules involved in MI occurrence and recurrence. Finally, two new panel biomarkers defined by four lncRNAs (RP1-239B22.5, AC135048.13, RP11-4O1.2, RP11-285F7.2) from DLMN_MI_OC and three lncRNAs (RP11-363E7.4, CTA-29F11.1, RP5-894A10.6) from DLMN_MI_Re with high classification performance were, respectively, identified in distinguishing controls from patients, and patients with recurrent events from those without recurrent events. This study will provide us new insight into ceRNA-mediated regulatory mechanisms involved in MI occurrence and recurrence, and facilitate the discovery of candidate diagnostic and prognosis biomarkers for MI.
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Ju E, Choi J. [Identifying Latent Classes of Risk Factors for Coronary Artery Disease]. J Korean Acad Nurs 2018; 47:817-827. [PMID: 29326412 DOI: 10.4040/jkan.2017.47.6.817] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 11/28/2017] [Accepted: 12/02/2017] [Indexed: 11/09/2022]
Abstract
PURPOSE This study aimed to identify latent classes based on major modifiable risk factors for coronary artery disease. METHODS This was a secondary analysis using data from the electronic medical records of 2,022 patients, who were newly diagnosed with coronary artery disease at a university medical center, from January 2010 to December 2015. Data were analyzed using SPSS version 20.0 for descriptive analysis and Mplus version 7.4 for latent class analysis. RESULTS Four latent classes of risk factors for coronary artery disease were identified in the final model: 'smoking-drinking', 'high-risk for dyslipidemia', 'high-risk for metabolic syndrome', and 'high-risk for diabetes and malnutrition'. The likelihood of these latent classes varied significantly based on socio-demographic characteristics, including age, gender, educational level, and occupation. CONCLUSION The results showed significant heterogeneity in the pattern of risk factors for coronary artery disease. These findings provide helpful data to develop intervention strategies for the effective prevention of coronary artery disease. Specific characteristics depending on the subpopulation should be considered during the development of interventions.
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Affiliation(s)
- Eunsil Ju
- Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - JiSun Choi
- College of Nursing Science · East-West Nursing Research Institute, Kyung Hee University, Seoul, Korea.
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Cambier L, de Couto G, Ibrahim A, Echavez AK, Valle J, Liu W, Kreke M, Smith RR, Marbán L, Marbán E. Y RNA fragment in extracellular vesicles confers cardioprotection via modulation of IL-10 expression and secretion. EMBO Mol Med 2017; 9:337-352. [PMID: 28167565 PMCID: PMC5331234 DOI: 10.15252/emmm.201606924] [Citation(s) in RCA: 169] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Cardiosphere‐derived cells (CDCs) reduce myocardial infarct size via secreted extracellular vesicles (CDC‐EVs), including exosomes, which alter macrophage polarization. We questioned whether short non‐coding RNA species of unknown function within CDC‐EVs contribute to cardioprotection. The most abundant RNA species in CDC‐EVs is a Y RNA fragment (EV‐YF1); its relative abundance in CDC‐EVs correlates with CDC potency in vivo. Fluorescently labeled EV‐YF1 is actively transferred from CDCs to target macrophages via CDC‐EVs. Direct transfection of macrophages with EV‐YF1 induced transcription and secretion of IL‐10. When cocultured with rat cardiomyocytes, EV‐YF1‐primed macrophages were potently cytoprotective toward oxidatively stressed cardiomyocytes through induction of IL‐10. In vivo, intracoronary injection of EV‐YF1 following ischemia/reperfusion reduced infarct size. A fragment of Y RNA, highly enriched in CDC‐EVs, alters Il10 gene expression and enhances IL‐10 protein secretion. The demonstration that EV‐YF1 confers cardioprotection highlights the potential importance of diverse exosomal contents of unknown function, above and beyond the usual suspects (e.g., microRNAs and proteins).
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Affiliation(s)
- Linda Cambier
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Geoffrey de Couto
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Antonio K Echavez
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jackelyn Valle
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Weixin Liu
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | | | - Eduardo Marbán
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Chung WS, Lin HH. Sex Differences in the Risk of Developing Acute Coronary Syndrome in Patients With Sleep Disorders: A Population-Based Cohort Study. Am J Mens Health 2017; 11:1560-1568. [DOI: 10.1177/1557988316651260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Studies that focus on the relationship between sex and the risk of acute coronary syndrome (ACS) are scant. The current study investigated the effects of sex differences in the risk of developing ACS in patients with sleep disorders (SDs). This longitudinal population-based cohort study evaluated the incidence and risk of ACS development in 40,232 men and 65,519 women newly diagnosed with SDs between 2002 and 2008 from the Longitudinal Health Insurance Database. The follow-up period began from the entry date and ended on the date of an ACS event or December 31, 2010. Univariable and multivariable Cox proportional hazard regression models were conducted to estimate the sex differences in the risk of ACS. Men with SDs exhibited an increased incidence of ACS compared with women with SDs in all age- and comorbidity-specific subgroups. After covariates were adjusted, the men with SDs exhibited a 1.48-fold adjusted hazard ratio (aHR) of ACS compared with the women with SDs (95% confidence interval [CI] = 1.36-1.60). After age group stratification, the men with SDs in the young adult group exhibited the highest risk of subsequent ACS development compared with the women with SDs (aHR = 2.07, 95% CI = 1.69-2.55), followed by those in middle-aged adults (aHR = 1.52, 95% CI = 1.32-1.76) and older adults groups (aHR = 1.24, 95% CI = 1.11-1.39). This study determined that men with SDs, particularly young men, are at a higher risk of subsequent ACS development compared with women with SDs.
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Affiliation(s)
- Wei-Sheng Chung
- Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
- China Medical University, Taichung, Taiwan
- Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - Hsuan-Hung Lin
- Central Taiwan University of Science and Technology, Taichung, Taiwan
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Fanaroff AC, Hasselblad V, Roe MT, Bhatt DL, James SK, Steg PG, Gibson CM, Ohman EM. Antithrombotic agents for secondary prevention after acute coronary syndromes: A systematic review and network meta-analysis. Int J Cardiol 2017; 241:87-96. [PMID: 28320608 PMCID: PMC5469706 DOI: 10.1016/j.ijcard.2017.03.046] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 02/20/2017] [Accepted: 03/09/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND Nine oral antithrombotic medications currently available in the United States and Europe have been studied in clinical trials for secondary prevention of cardiac events following acute coronary syndrome (ACS). Few combinations of these medications have been directly compared, and studies have used multiple different comparator regimens. METHODS We performed a systematic review and network meta-analysis of randomized controlled trials evaluating one or more available oral antithrombotic therapies in patients with ACS or prior myocardial infarction (MI). Co-primary outcomes were all-cause and cardiovascular mortality compared with imputed placebo and aspirin monotherapy. RESULTS Forty-seven studies (196,057 subjects) met inclusion criteria and were included in the systematic review. Almost all studies tested either aspirin monotherapy compared with placebo or a combination of antithrombotic agents that included aspirin. Nearly all regimens reduced all-cause and cardiovascular mortality compared with imputed placebo. However, compared with imputed aspirin monotherapy, only combination therapy with aspirin plus ticagrelor was associated with lower cardiovascular mortality (OR 0.80, 95% CI 0.68-0.93), and triple therapy with aspirin, clopidogrel, and very low dose rivaroxaban was associated with lower all-cause mortality (OR 0.67, 95% CI 0.49-0.90). Major bleeding was increased 45-95% with dual antithrombotic therapy, and 2-6-fold with triple therapy. CONCLUSION Few combinations of antithrombotic therapy were associated with a reduction in mortality compared with aspirin monotherapy, highlighting the difficulty in clinical interpretation of composite ischemic endpoints. Future studies may need to focus on limiting the number of antithrombotic therapies tested in combination to best balance ischemic event reduction and bleeding.
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Affiliation(s)
- Alexander C Fanaroff
- Division of Cardiology, Duke University, Durham, NC, USA; Duke Clinical Research Institute, Duke University, Durham, NC, USA.
| | - Vic Hasselblad
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Matthew T Roe
- Division of Cardiology, Duke University, Durham, NC, USA; Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA, USA
| | - Stefan K James
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - Ph Gabriel Steg
- FACT (French Alliance for Cardiovascular Clinical Trials), DHU FIRE, INSERM Unité 1148, Université Paris-Diderot, Hôpital Bichat, Assistance-Publique-Hôpitaux de Paris, France; NHLI, Imperial College, Royal Brompton Hospital, London, UK
| | - C Michael Gibson
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - E Magnus Ohman
- Division of Cardiology, Duke University, Durham, NC, USA; Duke Clinical Research Institute, Duke University, Durham, NC, USA
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Choi H, Kim H. Analysis of the relationship between community characteristics and depression using geographically weighted regression. Epidemiol Health 2017; 39:e2017025. [PMID: 28728351 PMCID: PMC5668667 DOI: 10.4178/epih.e2017025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 06/21/2017] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Achieving national health equity is currently a pressing issue. Large regional variations in the health determinants are observed. Depression, one of the most common mental disorders, has large variations in incidence among different populations, and thus must be regionally analyzed. The present study aimed at analyzing regional disparities in depressive symptoms and identifying the health determinants that require regional interventions. METHODS Using health indicators of depression in the Korea Community Health Survey 2011 and 2013, the Moran’s I was calculated for each variable to assess spatial autocorrelation, and a validated geographically weighted regression analysis using ArcGIS version 10.1 of different domains: health behavior, morbidity, and the social and physical environments were created, and the final model included a combination of significant variables in these models. RESULTS In the health behavior domain, the weekly breakfast intake frequency of 1-2 times was the most significantly correlated with depression in all regions, followed by exposure to secondhand smoke and the level of perceived stress in some regions. In the morbidity domain, the rate of lifetime diagnosis of myocardial infarction was the most significantly correlated with depression. In the social and physical environment domain, the trust environment within the local community was highly correlated with depression, showing that lower the level of trust, higher was the level of depression. A final model was constructed and analyzed using highly influential variables from each domain. The models were divided into two groups according to the significance of correlation of each variable with the experience of depression symptoms. CONCLUSIONS The indicators of the regional health status are significantly associated with the incidence of depressive symptoms within a region. The significance of this correlation varied across regions.
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Affiliation(s)
- Hyungyun Choi
- Korea Centers for Disease Control and Prevention, Cheongju, Korea
| | - Ho Kim
- Graduate School of Public Health, Seoul National University, Seoul, Korea.,Asian Institute for Energy, Environment and Sustainability, Seoul, Korea
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Riccio C, Gulizia MM, Colivicchi F, Di Lenarda A, Musumeci G, Faggiano PM, Abrignani MG, Rossini R, Fattirolli F, Valente S, Mureddu GF, Temporelli PL, Olivari Z, Amico AF, Casolo G, Fresco C, Menozzi A, Nardi F. ANMCO/GICR-IACPR/SICI-GISE Consensus Document: the clinical management of chronic ischaemic cardiomyopathy. Eur Heart J Suppl 2017; 19:D163-D189. [PMID: 28533729 PMCID: PMC5421493 DOI: 10.1093/eurheartj/sux021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Stable coronary artery disease (CAD) is a clinical entity of great epidemiological importance. It is becoming increasingly common due to the longer life expectancy, being strictly related to age and to advances in diagnostic techniques and pharmacological and non-pharmacological interventions. Stable CAD encompasses a variety of clinical and anatomic presentations, making the identification of its clinical and anatomical features challenging. Therapeutic interventions should be defined on an individual basis according to the patient's risk profile. To this aim, management flow charts have been reviewed based on sustainability and appropriateness derived from recent evidence. Special emphasis has been placed on non-pharmacological interventions, stressing the importance of lifestyle changes, including smoking cessation, regular physical activity, and diet. Adherence to therapy as an emerging risk factor is also discussed.
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Affiliation(s)
- Carmine Riccio
- Cardiovascular Science Department, A.O. Sant’Anna e San Sebastiano, Via Palasciano, 1 81100 Caserta, Italy
| | - Michele Massimo Gulizia
- Department of Cardiology, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione “Garibaldi”, Catania, Italy
| | - Furio Colivicchi
- CCU Unit, Department of Cardiology, Presidio Ospedaliero San Filippo Neri, Rome, Italy
| | - Andrea Di Lenarda
- Cardiovascular Center, Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | | | | | | | - Roberta Rossini
- Cardiology Department, A.O. Santa Croce e Carle, Cuneo, Italy
| | | | - Serafina Valente
- Intensive Integrated Cardiology Department, AOU Careggi, Florence, Italy
| | - Gian Francesco Mureddu
- Cardiology and Cardiac Rehabilitation Department, A.O. San Giovanni-Addolorata, Rome, Italy
| | | | - Zoran Olivari
- Department of Cardiology, Ospedale Ca’ Foncello, Treviso, Italy
| | | | - Giancarlo Casolo
- Cardiology Unit, Nuovo Ospedale Versilia, Lido di Camaiore, Lucca, Italy
| | - Claudio Fresco
- Cardiology Unit, A.O.U. Santa Maria della Misericordia, Udine, Italy
| | - Alberto Menozzi
- Cardiology Unit, Azienda Ospedaliera Universitaria di Parma, Parma, Italy
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Examining the Impact of Rehospitalization on Healthcare Cost of Myocardial Infarction Patients in Beijing: A Retrospective Observational Study. Adv Ther 2017; 34:109-119. [PMID: 27864667 DOI: 10.1007/s12325-016-0445-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION To examine the impact of rehospitalization on the healthcare expenditure of myocardial infarction (MI) patients in Beijing. METHODS Retrospective data of MI patients were retrieved from the Beijing Medical Insurance Database, an administrative database of social medical reimbursement activities for the urban population in Beijing, China. Ten percent of patients diagnosed with MI from January 1 to December 31, 2012 were randomly selected and their first hospitalization was considered as the index event. Their hospital utilization after the index event was extracted till September 30, 2013. Rehospitalization was defined as an event of hospital admission due to the same diagnosis and with a time interval of at least 14 days from the most recent admission. The healthcare cost of patients was analyzed, including inpatient cost and outpatient cost. Patients' demographic characteristics, co-morbidities, and length of hospital stay were also collected from the database. RESULTS Of the 1235 MI patients identified, 335 (mean age of 66.14 ± 15.04 years; 84.18% males) had rehospitalization. The rate of MI recurrence was 27.13%. The annual healthcare expense was significantly higher for MI patients with rehospitalization compared to MI patients without rehospitalization (99,920.43 ± 84,113.52 CNY vs. 58,877.89 ± 93,942.90 CNY; P < 0.001). The significant positive predictors of incurring healthcare expenditure were male gender, age 45 years old or more, length of stay at first hospital admission, whether having rehospitalization (yes/no), co-morbidity (heart failure and diabetes), and admission to a tertiary hospital at first hospital admission. CONCLUSION There was a high risk of MI recurrence for patients in Beijing. The annual healthcare cost of MI patients with rehospitalization was significantly higher than MI patients without rehospitalization. Male patients of 45 years old or more with heart failure and diabetes are likely to incur higher healthcare expenditure.
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Radovanovic D, Maurer L, Bertel O, Witassek F, Urban P, Stauffer JC, Pedrazzini G, Erne P. Treatment and outcomes of patients with recurrent myocardial infarction: A prospective observational cohort study. J Cardiol 2016; 68:498-503. [DOI: 10.1016/j.jjcc.2015.11.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 11/24/2015] [Accepted: 11/28/2015] [Indexed: 11/17/2022]
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Popovic B, Girerd N, Rossignol P, Agrinier N, Camenzind E, Fay R, Pitt B, Zannad F. Prognostic Value of the Thrombolysis in Myocardial Infarction Risk Score in ST-Elevation Myocardial Infarction Patients With Left Ventricular Dysfunction (from the EPHESUS Trial). Am J Cardiol 2016; 118:1442-1447. [PMID: 27677387 DOI: 10.1016/j.amjcard.2016.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 08/09/2016] [Accepted: 08/09/2016] [Indexed: 10/21/2022]
Abstract
The Thrombolysis in Myocardial Infarction (TIMI) risk score remains a robust prediction tool for short-term and midterm outcome in the patients with ST-elevation myocardial infarction (STEMI). However, the validity of this risk score in patients with STEMI with reduced left ventricular ejection fraction (LVEF) remains unclear. A total of 2,854 patients with STEMI with early coronary revascularization participating in the randomized EPHESUS (Epleronone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study) trial were analyzed. TIMI risk score was calculated at baseline, and its predictive value was evaluated using C-indexes from Cox models. The increase in reclassification of other variables in addition to TIMI score was assessed using the net reclassification index. TIMI risk score had a poor predictive accuracy for all-cause mortality (C-index values at 30 days and 1 year ≤0.67) and recurrent myocardial infarction (MI; C-index values ≤0.60). Among TIMI score items, diabetes/hypertension/angina, heart rate >100 beats/min, and systolic blood pressure <100 mm Hg were inconsistently associated with survival, whereas none of the TIMI score items, aside from age, were significantly associated with MI recurrence. Using a constructed predictive model, lower LVEF, lower estimated glomerular filtration rate (eGFR), and previous MI were significantly associated with all-cause mortality. The predictive accuracy of this model, which included LVEF and eGFR, was fair for both 30-day and 1-year all-cause mortality (C-index values ranging from 0.71 to 0.75). In conclusion, TIMI risk score demonstrates poor discrimination in predicting mortality or recurrent MI in patients with STEMI with reduced LVEF. LVEF and eGFR are major factors that should not be ignored by predictive risk scores in this population.
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Li W, Li M, Gao C, Wang X, Qi D, Liu J, Jin Q. Impact of type 2 diabetes mellitus on recurrent myocardial infarction in China. Diab Vasc Dis Res 2016; 13:395-404. [PMID: 27390227 DOI: 10.1177/1479164116653606] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
To evaluate the influence of type 2 diabetes mellitus on the long-term outcomes of Chinese patients with previous myocardial infarction, we studied 864 patients with previous myocardial infarction, including 251 with type 2 diabetes mellitus and 613 without type 2 diabetes mellitus, over a median follow-up time of 2.9 years. The type 2 diabetes mellitus patients were subdivided into 95 insulin-treated diabetes mellitus and 156 non-insulin-treated diabetes mellitus subjects. The crude incidences (per 1000 patient-years) in the type 2 diabetes mellitus subjects versus the non-type 2 diabetes mellitus subjects were 43.7 versus 25.1 for recurrent myocardial infarction, 68.7 versus 28.3 for all-cause death and 99.8 versus 49.9 for the composite end point (i.e. recurrent myocardial infarction or all-cause death). Cox regression analysis showed that the adjusted hazard ratios for recurrent myocardial infarction, all-cause death and their combination were 1.67 (95% confidence interval: 1.06-2.74), 1.90 (1.25-2.90) and 1.72 (1.23-2.40), respectively. Significant associations were also observed between insulin treatment and all-cause death. Our findings suggested that type 2 diabetes mellitus is an independent risk factor for recurrent myocardial infarction, all-cause death and the composite end point among previous myocardial infarction patients.
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Affiliation(s)
- Wentao Li
- Department of Cardiology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Muwei Li
- Department of Cardiology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Chuanyu Gao
- Department of Cardiology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Xianpei Wang
- Department of Cardiology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Datun Qi
- Department of Cardiology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Jun Liu
- Department of Cardiology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Qiangsong Jin
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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