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Tannous C, Ghali R, Karoui A, Habeichi NJ, Amin G, Booz GW, Mericskay M, Refaat M, Zouein FA. Nicotinamide Riboside Supplementation Restores Myocardial Nicotinamide Adenine Dinucleotide Levels, Improves Survival, and Promotes Protective Environment Post Myocardial Infarction. Cardiovasc Drugs Ther 2023:10.1007/s10557-023-07525-1. [PMID: 37999834 DOI: 10.1007/s10557-023-07525-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/10/2023] [Indexed: 11/25/2023]
Abstract
AIMS Myocardial infarction (MI) is a major cause of death. Nicotinamide adenine dinucleotide (NAD+) is a coenzyme in oxidative phosphorylation and substrate of sirtuins and poly-ADP ribose polymerases, enzymes critical for cardiac remodeling post-MI. Decreased NAD+ is reported in several heart failure models with paradoxically an upregulation of nicotinamide riboside kinase 2, which uses nicotinamide riboside (NR) as substrate in an NAD+ biosynthetic pathway. We hypothesized that stimulating nicotinamide riboside kinase 2 pathway by NR supplementation exerts cardioprotective effects. METHODS AND RESULTS MI was induced by LAD ligation in 2-3-month-old male mice. NR was administered daily (1 µmole/g body weight) over 7 days. RT-PCR showed a 60-fold increase in nicotinamide riboside kinase 2 expression 4 days post-MI with a 60% drop in myocardial NAD+ and overall survival of 61%. NR restored NAD+ levels and improved survival to 92%. Assessment of respiration in cardiac fibers revealed mitochondrial dysfunction post-MI, and NR improved complexes II and IV activities and citrate synthase activity, a measure of mitochondrial content. Additionally, NR reduced elevated PARP1 levels and activated a type 2 cytokine milieu in the damaged heart, consistent with reduced early inflammatory and pro-fibrotic response. CONCLUSION Our data show that nicotinamide riboside could be useful for MI management.
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Affiliation(s)
- Cynthia Tannous
- Department of Pharmacology and Toxicology, Faculty of Medicine, American University of Beirut Medical Center, Riad El-Solh, Beirut, 1107 2020, Lebanon
- Department of Signaling and Cardiovascular Pathophysiology, UMR-S 1180, Université Paris-Saclay, Inserm, 17 avenue des Sciences, 91 400, Orsay, France
- The Cardiovascular, Renal and Metabolic Diseases Research Center of Excellence, American University of Beirut Medical Center, Riad El-Solh, Beirut, Lebanon
| | - Rana Ghali
- Department of Pharmacology and Toxicology, Faculty of Medicine, American University of Beirut Medical Center, Riad El-Solh, Beirut, 1107 2020, Lebanon
- The Cardiovascular, Renal and Metabolic Diseases Research Center of Excellence, American University of Beirut Medical Center, Riad El-Solh, Beirut, Lebanon
| | - Ahmed Karoui
- Department of Signaling and Cardiovascular Pathophysiology, UMR-S 1180, Université Paris-Saclay, Inserm, 17 avenue des Sciences, 91 400, Orsay, France
| | - Nada J Habeichi
- Department of Pharmacology and Toxicology, Faculty of Medicine, American University of Beirut Medical Center, Riad El-Solh, Beirut, 1107 2020, Lebanon
- Department of Signaling and Cardiovascular Pathophysiology, UMR-S 1180, Université Paris-Saclay, Inserm, 17 avenue des Sciences, 91 400, Orsay, France
- The Cardiovascular, Renal and Metabolic Diseases Research Center of Excellence, American University of Beirut Medical Center, Riad El-Solh, Beirut, Lebanon
- MatriceLab Innove Laboratory, Immeuble Les Gemeaux, 2 Rue Antoine Etex, 94000 Creteil, France
| | - Ghadir Amin
- Department of Pharmacology and Toxicology, Faculty of Medicine, American University of Beirut Medical Center, Riad El-Solh, Beirut, 1107 2020, Lebanon
- The Cardiovascular, Renal and Metabolic Diseases Research Center of Excellence, American University of Beirut Medical Center, Riad El-Solh, Beirut, Lebanon
- Department of Pharmacology and Toxicology, School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - George W Booz
- Department of Pharmacology and Toxicology, School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Mathias Mericskay
- Department of Signaling and Cardiovascular Pathophysiology, UMR-S 1180, Université Paris-Saclay, Inserm, 17 avenue des Sciences, 91 400, Orsay, France.
| | - Marwan Refaat
- Department of Cardiovascular Medicine, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fouad A Zouein
- Department of Pharmacology and Toxicology, Faculty of Medicine, American University of Beirut Medical Center, Riad El-Solh, Beirut, 1107 2020, Lebanon.
- Department of Signaling and Cardiovascular Pathophysiology, UMR-S 1180, Université Paris-Saclay, Inserm, 17 avenue des Sciences, 91 400, Orsay, France.
- The Cardiovascular, Renal and Metabolic Diseases Research Center of Excellence, American University of Beirut Medical Center, Riad El-Solh, Beirut, Lebanon.
- Department of Pharmacology and Toxicology, School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA.
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Hu M, Peng Y, Gao X, Yang J, Xu H, Wu Y, Song L, Qiao S, Hu F, Wang Y, Li W, Jin C, Yang Y. Coronary Intervention in ST-Segment Elevation Myocardial Infarction Patients With Symptom Onset >12 Hours: Data from China Acute Myocardial Infarction Registry. Angiology 2023; 74:171-180. [PMID: 35608524 DOI: 10.1177/00033197221098885] [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: 12/16/2022]
Abstract
To determine whether late percutaneous coronary intervention (PCI) of an infarct-related artery >12 h after ST-segment elevation myocardial infarction onset is beneficial, patients were included from the prospective, nationwide, multicenter China Acute Myocardial Infarction registry. The number of patients who underwent PCI or received drug therapy alone was 4791 and 1149, respectively. Hazard ratio (HR) and associated 95% confidence interval (CI) were calculated. Compared with drug therapy, PCI was associated with lower incidences of 2-year major adverse cardiac and cerebrovascular events (MACCE; 6.43 vs 20.19%; HR, .27; 95% CI, .23-.32; P < .001), all-cause death (4.13 vs 15.74%; HR, .24; 95% CI, .20-.30; P < .001), myocardial infarction (1.73 vs 3.31%; HR, .49; 95% CI, .33-.72; P = .0003), stroke (1.02 vs 2.00%; HR, .47; 95% CI, .28-.77; P = .0026), and revascularization (10.96 vs 27.56%; HR, .32; 95% CI, .26-.39; P < .001). Subgroup analysis consistently indicated that PCI was superior to drug therapy. Moreover, the left ventricular ejection fraction in the PCI group was increased after 2-year follow-up, whereas there was no significant increase in the drug therapy group. In conclusion, late PCI is common in Chinese clinical practice, and it is associated with significant improvements in cardiac function and survival compared with drug therapy alone.
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Affiliation(s)
- Mengjin Hu
- National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 569172State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China
| | - Ya Peng
- National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 569172State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China
| | - Xiaojin Gao
- National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 569172State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China
| | - Jingang Yang
- National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 569172State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China
| | - Haiyan Xu
- National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 569172State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China
| | - Yuan Wu
- National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 569172State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China
| | - Lei Song
- National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 569172State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China
| | - Shubin Qiao
- National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 569172State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China
| | - Fenghuan Hu
- National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 569172State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China
| | - Yang Wang
- National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 569172State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China
| | - Wei Li
- National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 569172State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China
| | - Chen Jin
- National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 569172State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China
| | - Yuejin Yang
- National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 569172State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China
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Zhou S, Xiao Y, Zhou C, Zheng Z, Jiang W, Shen Q, Zhu C, Pan H, Liu C, Zeng G, Ge L, Zhang Y, Ouyang Z, Fu G, Pan G, Chen F, Huang L, Liu Q. Effect of Rivaroxaban vs Enoxaparin on Major Cardiac Adverse Events and Bleeding Risk in the Acute Phase of Acute Coronary Syndrome: The H-REPLACE Randomized Equivalence and Noninferiority Trial. JAMA Netw Open 2023; 6:e2255709. [PMID: 36763358 PMCID: PMC9918885 DOI: 10.1001/jamanetworkopen.2022.55709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
IMPORTANCE Parenteral enoxaparin is a preferred anticoagulant used in the acute phase for patients with acute coronary syndrome (ACS). The safety and efficacy of short-term low-dose rivaroxaban in this clinical setting remain unknown. OBJECTIVE To compare the safety and efficacy of rivaroxaban vs enoxaparin in the acute phase of ACS. DESIGN, SETTING, AND PARTICIPANTS This multicenter, prospective, open-label, active-controlled, equivalence and noninferiority trial was conducted from January 2017 through May 2021 with a 6-month follow-up at 21 hospitals in China. Participants included patients with ACS missing the primary reperfusion window or before selective revascularization. Data were analyzed from November 2021 to November 2022. INTERVENTIONS Participants were randomized 1:1:1 to oral rivaroxaban 2.5 mg or 5 mg or 1 mg/kg subcutaneous enoxaparin twice daily in addition to dual antiplatelet therapy (DAPT; aspirin 100 mg and clopidogrel 75 mg once daily) for a mean of 3.7 days. MAIN OUTCOMES AND MEASURES The primary safety end point was bleeding events, as defined by the International Society on Thrombosis and Haemostasis, and the primary efficacy end point was major adverse cardiovascular events (MACEs), including cardiac death, myocardial infarction, rerevascularization, or stroke during the 6-month follow-up. RESULTS Of 2055 enrolled patients, 2046 (99.6%) completed the trial (mean [SD] age 65.8 [8.2] years, 1443 [70.5%] male) and were randomized to enoxaparin (680 patients), rivaroxaban 2.5 mg (683 patients), or rivaroxaban 5 mg (683 patients). Bleeding rates were 46 patients (6.8%) in the enoxaparin group, 32 patients (4.7%) in the rivaroxaban 2.5 mg group, and 36 patients (5.3%)in the rivaroxaban 5 mg group (rivaroxaban 2.5 mg vs enoxaparin: noninferiority hazard ratio [HR], 0.68; 95% CI, 0.43 to 1.07; P = .005; rivaroxaban 5 mg vs enoxaparin: noninferiority HR, 0.88; 95% CI, 0.70 to 1.09; P = .001). The incidence of MACEs was similar among groups, and noninferiority was reached in the rivaroxaban 5 mg group (HR, 0.60; 95% CI, 0.31 to 1.16, P = .02) but not in the rivaroxaban 2.5 mg group (HR, 0.68; 95% CI, 0.36 to 1.30; P = .05) compared with the enoxaparin group. CONCLUSIONS AND RELEVANCE In this equivalence and noninferiority trial, oral rivaroxaban 5 mg showed noninferiority to subcutaneous enoxaparin (1 mg/kg) for patients with ACS treated with DAPT during the acute phase. Results of this feasibility study provide useful information for designing future randomized clinical trials with sufficient sample sizes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03363035.
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Affiliation(s)
- Shenghua Zhou
- Department of Cardiology, Second Xiangya Hospital of Central South University, Changsha, People’s Republic of China
| | - Yichao Xiao
- Department of Cardiology, Second Xiangya Hospital of Central South University, Changsha, People’s Republic of China
| | - Chonglun Zhou
- Department of Cardiology, Xiangxiang People’s Hospital, Xiangxiang, People’s Republic of China
| | - Zhaofen Zheng
- Department of Cardiology, Hunan Provincial People’s Hospital, First Affiliated Hospital of Hunan Normal University, Changsha, People’s Republic of China
| | - Weihong Jiang
- Department of Cardiology, Third Xiangya Hospital of Central South University, Changsha, People’s Republic of China
| | - Qiang Shen
- Department of Cardiology, First People’s Hospital of Huaihua, Huaihua, People’s Republic of China
| | - Can Zhu
- Department of Cardiology, First Affiliated Hospital of Jishou University, Jishou, People’s Republic of China
| | - Hongwei Pan
- Department of Cardiology, Hunan Provincial People’s Hospital, First Affiliated Hospital of Hunan Normal University, Changsha, People’s Republic of China
| | - Changhui Liu
- Department of Cardiology, First Affiliated Hospital of University of South China, Hengyang, People’s Republic of China
| | - Gaofeng Zeng
- Department of Cardiology, Second Affiliated Hospital of University of South China, Hengyang, People’s Republic of China
| | - Liangqing Ge
- Department of Cardiology, First People’s Hospital of Changde City, Changde, People’s Republic of China
| | - Yumin Zhang
- Department of Cardiology, Third Hospital of Changsha, Changsha, People’s Republic of China
| | - Zewei Ouyang
- Department of Cardiology, Central Hospital of Shaoyang, Shaoyang, People’s Republic of China
| | - Guang Fu
- Department of Cardiology, First Hospital of Changsha, Changsha, People’s Republic of China
| | - Gang Pan
- Department of Cardiology, First People’s Hospital of Yueyang, Yueyang, People’s Republic of China
| | - Feng Chen
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Lihong Huang
- Department of Biostatistics, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Qiming Liu
- Department of Cardiology, Second Xiangya Hospital of Central South University, Changsha, People’s Republic of China
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Xiang J, Shen J, Zhang L, Tang B. Identification and validation of senescence-related genes in circulating endothelial cells of patients with acute myocardial infarction. Front Cardiovasc Med 2022; 9:1057985. [PMID: 36582740 PMCID: PMC9792765 DOI: 10.3389/fcvm.2022.1057985] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/22/2022] [Indexed: 12/15/2022] Open
Abstract
Background Acute myocardial infarction (AMI) is the main clinical cause of death and cardiovascular disease and thus has high rates of morbidity and mortality. The increase in cardiovascular disease with aging is partly the result of vascular endothelial cell senescence and associated vascular dysfunction. This study was performed to identify potential key cellular senescence-related genes (SRGs) as biomarkers for the diagnosis of AMI using bioinformatics. Methods Using the CellAge database, we identified cellular SRGs. GSE66360 and GSE48060 for AMI patients and healthy controls and GSE19322 for mice were downloaded from the Gene Expression Omnibus (GEO) database. The GSE66360 dataset was divided into a training set and a validation set. The GSE48060 dataset was used as another validation set. The GSE19322 dataset was used to explore the evolution of the screened diagnostic markers in the dynamic process of AMI. Differentially expressed genes (DEGs) of AMI were identified from the GSE66360 training set. Differentially expressed senescence-related genes (DESRGs) selected from SRGs and DEGs were analyzed using Gene Ontology (GO) enrichment, Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways, and protein-protein interaction (PPI) networks. Hub genes in DESRGs were selected based on degree, and diagnostic genes were further screened by gene expression and receiver operating characteristic (ROC) curve. Finally, a miRNA-gene network of diagnostic genes was constructed and targeted drug prediction was performed. Results A total of 520 DEGs were screened from the GSE66360 training set, and 279 SRGs were identified from the CellAge database. The overlapping DEGs and SRGs constituted 14 DESRGs, including 4 senescence suppressor genes and 10 senescence inducible genes. The top 10 hub genes, including FOS, MMP9, CEBPB, CDKN1A, CXCL1, ETS2, BCL6, SGK1, ZFP36, and IGFBP3, were screened. Furthermore, three diagnostic genes were identified: MMP9, ETS2, and BCL6. The ROC analysis showed that the respective area under the curves (AUCs) of MMP9, ETS2, and BCL6 were 0.786, 0.848, and 0.852 in the GSE66360 validation set and 0.708, 0.791, and 0.727 in the GSE48060 dataset. In the GSE19322 dataset, MMP9 (AUC, 0.888) and ETS2 (AUC, 0.929) had very high diagnostic values in the early stage of AMI. Finally, based on these three diagnostic genes, we found that drugs such as acetylcysteine and genistein may be targeted for the treatment of age-related AMI. Conclusion The results of this study suggest that cellular SRGs might play an important role in AMI. MMP9, ETS2, and BCL6 have potential as specific biomarkers for the early diagnosis of AMI.
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Affiliation(s)
- Jie Xiang
- Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China,Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China
| | - Jun Shen
- Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China,Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China
| | - Ling Zhang
- Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China,Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China,Ling Zhang,
| | - Baopeng Tang
- Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China,Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China,*Correspondence: Baopeng Tang,
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Kaplan A, Abidi E, Diab R, Ghali R, Al-Awassi H, Booz GW, Zouein FA. Sex differences in cardiac remodeling post myocardial infarction with acute cigarette smoking. Biol Sex Differ 2022; 13:36. [PMID: 35799275 PMCID: PMC9264586 DOI: 10.1186/s13293-022-00446-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/22/2022] [Indexed: 11/10/2022] Open
Abstract
Background Whether cigarette smoking affects the heart post-myocardial infarction (MI) in a sex-dependent way remains controversial. Using a mouse model, we investigated cardiac remodeling under the influence of acute cigarette smoke (CS) exposure following ischemic injury in both sexes. Methods Ten cigarettes were smoked twice daily for 2 weeks followed by MI and then 1 additional week post permanent LAD ligation. Cardiac function, histology, and infarct size were assessed, and inflammatory markers quantified by RT–PCR. Statistical comparisons were performed using an unpaired t test or ANOVA followed by Tukey post hoc test. Results We observed that cigarette smoking exacerbated both left and right ventricular remodeling only in males at an early stage of post-MI. Females did not display a significant structural and/or functional alteration within 7 days of cardiac remodeling post-MI upon CS exposure. Worsened right ventricular remodeling in males was independent of pulmonary congestion. CS-exposed males exhibited enhanced increases in left ventricular end systolic and diastolic volumes, as well as reductions in ejection fraction and fractional area changes of left ventricular base. At day 7, infarct size was increased by cigarette smoking in males only, which was accompanied by enhanced collagen deposition in both the infarcted and peri-infarcted areas. Both IL-6 and TNF-α mRNA expression significantly increased in CS-exposed MI male group only at day 7 post-MI suggestive of prolonged inflammation. Conclusions These findings indicate that CS exposure worsens the progression of cardiac remodeling post-MI in male sex in a significant manner compared to female sex at least at early stages.
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Affiliation(s)
- Abdullah Kaplan
- Department of Pharmacology and Toxicology, Medical Center, American University of Beirut, Faculty of Medicine, Riad El-Solh, Beirut, 1107 2020, Lebanon.,Department of Cardiology, Kemer Public Hospital, Hastane Cd. No: 9, 07980, Kemer, Antalya, Turkey.,The Cardiovascular, Renal, and Metabolic Diseases Research Center of Excellence, American University of Beirut Medical Center, Riad El-Solh, Beirut, Lebanon
| | - Emna Abidi
- Department of Pharmacology and Toxicology, Medical Center, American University of Beirut, Faculty of Medicine, Riad El-Solh, Beirut, 1107 2020, Lebanon.,The Cardiovascular, Renal, and Metabolic Diseases Research Center of Excellence, American University of Beirut Medical Center, Riad El-Solh, Beirut, Lebanon.,Department of Pharmacy, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Reine Diab
- Department of Pharmacology and Toxicology, Medical Center, American University of Beirut, Faculty of Medicine, Riad El-Solh, Beirut, 1107 2020, Lebanon.,The Cardiovascular, Renal, and Metabolic Diseases Research Center of Excellence, American University of Beirut Medical Center, Riad El-Solh, Beirut, Lebanon
| | - Rana Ghali
- Department of Pharmacology and Toxicology, Medical Center, American University of Beirut, Faculty of Medicine, Riad El-Solh, Beirut, 1107 2020, Lebanon.,The Cardiovascular, Renal, and Metabolic Diseases Research Center of Excellence, American University of Beirut Medical Center, Riad El-Solh, Beirut, Lebanon
| | - Hiam Al-Awassi
- Department of Pharmacology and Toxicology, Medical Center, American University of Beirut, Faculty of Medicine, Riad El-Solh, Beirut, 1107 2020, Lebanon.,The Cardiovascular, Renal, and Metabolic Diseases Research Center of Excellence, American University of Beirut Medical Center, Riad El-Solh, Beirut, Lebanon
| | - George W Booz
- Department of Pharmacology and Toxicology, School of Medicine, University of Mississippi Medical Center, Jackson, MS, 39216-4500, USA
| | - Fouad A Zouein
- Department of Pharmacology and Toxicology, Medical Center, American University of Beirut, Faculty of Medicine, Riad El-Solh, Beirut, 1107 2020, Lebanon. .,The Cardiovascular, Renal, and Metabolic Diseases Research Center of Excellence, American University of Beirut Medical Center, Riad El-Solh, Beirut, Lebanon. .,Department of Pharmacology and Toxicology, School of Medicine, University of Mississippi Medical Center, Jackson, MS, 39216-4500, USA. .,Department of Signaling and Cardiovascular Pathophysiology, UMR-S 1180, Inserm, Université Paris-Saclay, Paris, France.
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Dong H, Li X, Xiao D, Tang Y. Late Percutaneous Coronary Intervention is Associated with Better Prognosis of Patients with Acute Myocardial Infarction. Int J Gen Med 2022; 15:2621-2627. [PMID: 35300130 PMCID: PMC8922034 DOI: 10.2147/ijgm.s357330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/01/2022] [Indexed: 11/23/2022] Open
Abstract
Background The optimal timing of invasive coronary revascularization in patients with late presentation of acute myocardial infarction (AMI) remains unclear. Objective This study aimed to investigate whether late percutaneous coronary intervention (PCI) is associated with the prognosis of AMI patients with HFpEF presenting >24h after symptom onset. Methods We enrolled 680 AMI patients with HFpEF. Patients were divided into 3 groups: early-PCI strategy (defined as the time to open IRA from symptom onset <24 h), late-PCI strategy (defined as the time of PCI-mediated reperfusion was >24 h) and non-revascularization group. Results A total of 144 (21.2%) experienced a MACE, including 118 (17.4%) all-cause deaths and 26 (3.8%) re-hospitalization for HF during a follow-up period of 30.20±15.62 months. After adjusting for gender, age, smoking, diabetes mellitus, NT-proBNP and eGFR, late-PCI was a significant and independent predictor of MACE (hazard ratio 0.367; 95% confidence interval 0.202–0.665; p<0.001). Kaplan–Meier analysis showed that late-PCI decreased cumulative risk of MACE (p< 0.001). Conclusion Late-PCI and early-PCI strategies are associated with a reduced risk of MACE in AMI patients with HFpEF presenting >24 h after symptom onset, compared to conservative strategies.
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Affiliation(s)
- Hao Dong
- Department of Cardiology, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, 210000, People’s Republic of China
| | - Xuan Li
- Department of Gastroenterology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, People’s Republic of China
| | - Dongping Xiao
- Department of Cardiology, The First Hospital of Nanchang, Nanchang, 330000, People’s Republic of China
| | - Yong Tang
- Department of Cardiology, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, 210000, People’s Republic of China
- Correspondence: Yong Tang, Department of Cardiology, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, 210000, People’s Republic of China, Email
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The use of reperfusion therapy in transition countries without fully applicable pharmacoinvasive strategy. VOJNOSANIT PREGL 2022. [DOI: 10.2298/vsp190118090k] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background/Aim. The pharmacoinvasive (PI) therapy is a recommended strategy in patients (pts) with ST elevation myocardial infarction (STEMI) unable to undergo timely primary percutaneous coronary intervention (p-PCI). The aim of the study was to find out the cohorts of pts who are not treated by any reperfusion therapy (RT) as well to determine the outcome of the pts treated with RT in a transition country without fully applicable PI therapy. Methods. The study analyzed data from the Hospital National Registry for Acute Coronary Syndrome of Serbia (HORACS). Results. The significant predictors of the withdrawing of the application of any RT in the model [c 75.6%, SE 0.004, 95% CI 0.748?0.761)] were a ge ( ? 6 5 years), heart failure (Killip II-IV), diabetes mellitus, and the time to first medical contact (FMC) (> 360 min). In patients without RT, mortality was 15.7%, in pts treated with fibrinolytic therapy (FT) was 10.5%, and in pts treated with pPCI, it was 6.2% (p < 0.000). Within 3 hours to FMC, higher in-hospital mortality was in FT pts (FT 8.7% vs p-PCI 4.3%). FT treated patients were older, had more comorbidities and heart failure (HF). However, after propensity score matching, in order to ad-just the differences among the pts, the mortality rate remained higher in FT pts but not statistically significantly higher than in p-PCI pts (FT 8.8% vs p-PCI 6.4%). Conclusion. The balance of the best cost-benefit strategies for better use of RT is difficult to achieve in transition countries. The possibility for timely p-PCI and PI therapy is especially not applicable in high-risk patients, older pts, pts with HF, and those with diabetes mellitus.
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Identification of Featured Metabolism-Related Genes in Patients with Acute Myocardial Infarction. DISEASE MARKERS 2020; 2020:8880004. [PMID: 33354250 PMCID: PMC7737445 DOI: 10.1155/2020/8880004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/05/2020] [Accepted: 11/11/2020] [Indexed: 12/19/2022]
Abstract
Objective A growing body of emerging evidence indicates that metabolic processes play a pivotal role in the biological processes underlying acute myocardial infarction (AMI). The aim of the current study was to identify featured metabolism-related genes in patients with AMI using a support vector machine (SVM) and to further explore the value of these genes in the diagnosis of AMI. Methods Gene microarray expression data related to AMI were downloaded from the GSE66360 dataset in the Gene Expression Omnibus (GEO) database. This data set consisted of 50 AMI samples and 49 normal controls that were randomly classified into a discovery cohort (21 AMI samples and 22 normal controls) and a validation cohort (28 AMI and 28 normal controls). We applied a machine learning method that combined SVM with recursive feature elimination (RFE) to discriminate AMI patients from normal controls. Based on this, an SVM classifier was constructed. Receiver operating characteristic (ROC) analysis was used to investigate the predictive value for the early diagnosis of AMI in the two cohorts and was then further verified in an independent external cohort. Results Three metabolism-related genes were identified based on SVM-RFE (AKR1C3, GLUL, and PDE4B). The SVM classifier based on the three genes allowed for excellent discrimination between AMI and healthy samples in both the discovery cohort (AUC = 0.989) and the validation cohort (AUC = 0.964), and this was further confirmed in the GSE68060 dataset (AUC = 0.839). Additionally, the SVM classifier allowed for perfect discrimination between recurrent AMI events and nonrecurrent events in the GSE68060 cohort (AUC = 0.992). GO and KEGG pathway enrichment analysis of the identified featured genes revealed significant enrichment of specific metabolic pathways. Conclusion The identified metabolism-related genes may play important roles in the development of AMI and may represent diagnostic and therapeutic biomarkers of AMI.
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Abstract
BACKGROUND This study aimed to identify key genes associated with acute myocardial infarction (AMI) by reanalyzing microarray data. METHODS Three gene expression profile datasets GSE66360, GSE34198, and GSE48060 were downloaded from GEO database. After data preprocessing, genes without heterogeneity across different platforms were subjected to differential expression analysis between the AMI group and the control group using metaDE package. P < .05 was used as the cutoff for a differentially expressed gene (DEG). The expression data matrices of DEGs were imported in ReactomeFIViz to construct a gene functional interaction (FI) network. Then, DEGs in each module were subjected to pathway enrichment analysis using DAVID. MiRNAs and transcription factors predicted to regulate target DEGs were identified. Quantitative real-time polymerase chain reaction (RT-PCR) was applied to verify the expression of genes. RESULT A total of 913 upregulated genes and 1060 downregulated genes were identified in the AMI group. A FI network consists of 21 modules and DEGs in 12 modules were significantly enriched in pathways. The transcription factor-miRNA-gene network contains 2 transcription factors FOXO3 and MYBL2, and 2 miRNAs hsa-miR-21-5p and hsa-miR-30c-5p. RT-PCR validations showed that expression levels of FOXO3 and MYBL2 were significantly increased in AMI, and expression levels of hsa-miR-21-5p and hsa-miR-30c-5p were obviously decreased in AMI. CONCLUSION A total of 41 DEGs, such as SOCS3, VAPA, and COL5A2, are speculated to have roles in the pathogenesis of AMI; 2 transcription factors FOXO3 and MYBL2, and 2 miRNAs hsa-miR-21-5p and hsa-miR-30c-5p may be involved in the regulation of the expression of these DEGs.
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Cerrato E, Forno D, Ferro S, Chinaglia A. Characteristics, in-hospital management and outcome of late acute ST-elevation myocardial infarction presenters. J Cardiovasc Med (Hagerstown) 2017; 18:567-571. [DOI: 10.2459/jcm.0000000000000527] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Montone RA, Niccoli G, Minelli S, Fracassi F, Vetrugno V, Aurigemma C, Burzotta F, Porto I, Trani C, Crea F. Clinical outcome and correlates of coronary microvascular obstruction in latecomers after acute myocardial infarction. Int J Cardiol 2017; 236:30-35. [DOI: 10.1016/j.ijcard.2017.02.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 02/03/2017] [Indexed: 12/20/2022]
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Guha S, Sethi R, Ray S, Bahl VK, Shanmugasundaram S, Kerkar P, Ramakrishnan S, Yadav R, Chaudhary G, Kapoor A, Mahajan A, Sinha AK, Mullasari A, Pradhan A, Banerjee AK, Singh BP, Balachander J, Pinto B, Manjunath CN, Makhale C, Roy D, Kahali D, Zachariah G, Wander GS, Kalita HC, Chopra HK, Jabir A, Tharakan J, Paul J, Venogopal K, Baksi KB, Ganguly K, Goswami KC, Somasundaram M, Chhetri MK, Hiremath MS, Ravi MS, Das MK, Khanna NN, Jayagopal PB, Asokan PK, Deb PK, Mohanan PP, Chandra P, Girish CR, Rabindra Nath O, Gupta R, Raghu C, Dani S, Bansal S, Tyagi S, Routray S, Tewari S, Chandra S, Mishra SS, Datta S, Chaterjee SS, Kumar S, Mookerjee S, Victor SM, Mishra S, Alexander T, Samal UC, Trehan V. Cardiological Society of India: Position statement for the management of ST elevation myocardial infarction in India. Indian Heart J 2017; 69 Suppl 1:S63-S97. [PMID: 28400042 PMCID: PMC5388060 DOI: 10.1016/j.ihj.2017.03.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
| | - Rishi Sethi
- King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Saumitra Ray
- Vivekananda Institute of Medical Sciences, Kolkata, West Bengal, India
| | - Vinay K Bahl
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | - Prafula Kerkar
- Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | | | - Rakesh Yadav
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | - Aditya Kapoor
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ajay Mahajan
- Lokmanya Tilak Municipal Medical College & General Hospital, Mumbai, Maharashtra, India
| | | | | | | | - Amal Kumar Banerjee
- Institute of Post Graduate Medical Education & Research and Memorial Hospital, Kolkata, West Bengal, India
| | - B P Singh
- Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - J Balachander
- Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Brian Pinto
- Holy family Hospital, Mumbai, Maharashtra, India
| | - C N Manjunath
- Sri Jaydeva Institute of Cardiovascular Sciences & Research, Bangaluru, Karnataka, India
| | | | | | - Dhiman Kahali
- BM Birla Heart Research Center, Kolkata, West Bengal, India
| | | | - G S Wander
- Hero DMC Heart Institute, Ludhiana, Punjab, India
| | - H C Kalita
- Assam Medical College, Dibrugarh, Assam, India
| | | | - A Jabir
- Lisie Hospital, Kochi, Kerala, India
| | - JagMohan Tharakan
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Justin Paul
- Madras Medical College, Chennai, Tamil Nadu, India
| | - K Venogopal
- Pushpagiri Institute of Medical Sciences, Tiruvalla, Kerala, India
| | - K B Baksi
- Belle Vue Clinic, Kolkata, West Bengal, India
| | | | - Kewal C Goswami
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | - M K Chhetri
- IPGMER & SSKM Hospital, Kolkata, West Bengal, India
| | | | - M S Ravi
- Madras Medical College, Chennai, Tamil Nadu, India
| | | | | | | | - P K Asokan
- The Fatima Hospital, Calicut, Kerala, India
| | - P K Deb
- ESI Hospital, Manicktala, Kolkata, West Bengal, India
| | - P P Mohanan
- Westfort Hi-Tech Hospital, Thrissur, Kerala, India
| | | | - Col R Girish
- Command Hospital, Central Command, Lucknow, India
| | - O Rabindra Nath
- Apollo Gleneagles Heart Institute, Kolkata, West Bengal, India
| | | | - C Raghu
- Prime Hospitals, Hyderabad, India
| | | | | | - Sanjay Tyagi
- GB Pant Institute of Post Graduate Medical Education & Research, New Delhi, India
| | | | - Satyendra Tewari
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | | | | | | | - S S Chaterjee
- Indra Gandhi Institute of Cardiology, Patna, Bihar, India
| | - Soumitra Kumar
- Vivekananda Institute of Medical Sciences, Kolkata, West Bengal, India
| | | | | | - Sundeep Mishra
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | | | - Vijay Trehan
- Indo-US Super Speciality Hospital, Hyderabad, India
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Amann U, Kirchberger I, Heier M, Thilo C, Kuch B, Peters A, Meisinger C. Predictors of non-invasive therapy and 28-day-case fatality in elderly compared to younger patients with acute myocardial infarction: an observational study from the MONICA/KORA Myocardial Infarction Registry. BMC Cardiovasc Disord 2016; 16:151. [PMID: 27411983 PMCID: PMC4944313 DOI: 10.1186/s12872-016-0322-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 06/21/2016] [Indexed: 01/19/2023] Open
Abstract
Background A substantial proportion of patients with acute myocardial infarction (AMI) did not receive invasive therapy, defined as percutaneous coronary intervention and/or coronary artery bypass grafting. Aims of this study were to evaluate predictors of non-invasive therapy in elderly compared to younger AMI patients and to assess the association between invasive therapy and 28-day-case fatality. Methods From the German population-based registry, 3475 persons, consecutively hospitalized with an AMI between 2009 and 2012 were included. Data were collected by standardized interviews and chart review. All-cause mortality was assessed on a regular basis. Multivariable logistic regression analyses were conducted. Results The sample consisted of 1329 patients aged 28–65 years (age category [AC] 1), 1083 aged 65–74 years (AC 2), and 1063 aged 75–84 years (AC 3). The proportion of patients receiving non-invasive therapy was 10.7, 17.7, and 35.8 % in AC 1, 2, and 3, respectively. Predictors of non-invasive therapy in all ACs were non-ST segment elevation MI, bundle branch block, reduced left ventricular ejection fraction, prior stroke, absence of hyperlipidemia, and low creatine kinase. Elderly women (≥65 years) were less likely to receive invasive therapy. Stratifying the models by type of AMI revealed fewer predictors in patients with ST segment elevation MI. Regarding 28-day-case fatality, strong inverse relations with invasive therapy were seen in all AC: odds ratio of 0.35 (95 % confidence interval [CI] 0.15–0.84), 0.45 (95 % CI 0.22–0.92), and 0.39 (95 % CI 0.24–0.63) in AC 1, 2 and 3, respectively. Conclusion In today’s real-life patient care we found that predictors of non-invasive therapy were predominantly the same in all age groups, but differed particularly by type of AMI. Further research is necessary to investigate the real reasons for non-invasive therapy, especially among elderly women. Moreover, we confirmed that receiving invasive therapy was inversely associated with 28-day-case fatality independent of age.
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Affiliation(s)
- Ute Amann
- MONICA/KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany. .,Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany.
| | - Inge Kirchberger
- MONICA/KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany.,Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Margit Heier
- MONICA/KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany.,Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Christian Thilo
- Department of Internal Medicine I - Cardiology, Central Hospital of Augsburg, Augsburg, Germany
| | - Bernhard Kuch
- Department of Internal Medicine I - Cardiology, Central Hospital of Augsburg, Augsburg, Germany.,Department of Internal Medicine/Cardiology, Hospital of Nördlingen, Nördlingen, Germany
| | - Annette Peters
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Christa Meisinger
- MONICA/KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany.,Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
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Farshid A, Brieger D, Hyun K, Hammett C, Ellis C, Rankin J, Lefkovits J, Chew D, French J. Characteristics and Clinical Course of STEMI Patients who Received no Reperfusion in the Australia and New Zealand SNAPSHOT ACS Registry. Heart Lung Circ 2016; 25:132-9. [DOI: 10.1016/j.hlc.2015.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 08/08/2015] [Accepted: 08/17/2015] [Indexed: 12/22/2022]
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Dias A, Franco E, Janzer S, Koshkelashvili N, Bhalla V, Pressman GS, Hebert K, Figueredo VM. Performance of a novel clinic score in differentiating Takotsubo cardiomyopathy from ST elevation myocardial infarction within the first 24h. Int J Cardiol 2016; 203:12-4. [DOI: 10.1016/j.ijcard.2015.10.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 10/04/2015] [Indexed: 01/09/2023]
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Regueiro A, Bosch J, Martín-Yuste V, Rosas A, Faixedas MT, Gómez-Hospital JA, Figueras J, Curós A, Cequier A, Goicolea J, Fernández-Ortiz A, Macaya C, Tresserras R, Pellisé L, Sabaté M. Cost-effectiveness of a European ST-segment elevation myocardial infarction network: results from the Catalan Codi Infart network. BMJ Open 2015; 5:e009148. [PMID: 26656019 PMCID: PMC4679883 DOI: 10.1136/bmjopen-2015-009148] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To evaluate the cost-effectiveness of the ST-segment elevation myocardial infarction (STEMI) network of Catalonia (Codi Infart). DESIGN Cost-utility analysis. SETTING The analysis was from the Catalonian Autonomous Community in Spain, with a population of about 7.5 million people. PARTICIPANTS Patients with STEMI treated within the autonomous community of Catalonia (Spain) included in the IAM CAT II-IV and Codi Infart registries. OUTCOME MEASURES Costs included hospitalisation, procedures and additional personnel and were obtained according to the reperfusion strategy. Clinical outcomes were defined as 30-day avoided mortality and quality-adjusted life-years (QALYs), before (N=356) and after network implementation (N=2140). RESULTS A substitution effect and a technology effect were observed; aggregate costs increased by 2.6%. The substitution effect resulted from increased use of primary coronary angioplasty, a relatively expensive procedure and a decrease in fibrinolysis. Primary coronary angioplasty increased from 31% to 89% with the network, and fibrinolysis decreased from 37% to 3%. Rescue coronary angioplasty declined from 11% to 4%, and no reperfusion from 21% to 4%. The technological effect was related to improvements in the percutaneous coronary intervention procedure that increased efficiency, reducing the average length of the hospital stay. Mean costs per patient decreased from €8306 to €7874 for patients with primary coronary angioplasty. Clinical outcomes in patients treated with primary coronary angioplasty did not change significantly, although 30-day mortality decreased from 7.5% to 5.6%. The incremental cost-effectiveness ratio resulted in an extra cost of €4355 per life saved (30-day mortality) and €495 per QALY. Below a cost threshold of €30,000, results were sensitive to variations in costs and outcomes. CONCLUSIONS The Catalan STEMI network (Codi Infart) is cost-efficient. Further studies are needed in geopolitical different scenarios.
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Affiliation(s)
- Ander Regueiro
- Servicio de Cardiología, Hospital Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer IDIBAPS, Universitat de Barcelona, Barcelona, Spain
- Iniciativa Stent for Life, Spain
| | - Julia Bosch
- Centro de Investigación en Economía y Salud, Universidad Pompeu Fabra, Barcelona, Spain
| | - Victoria Martín-Yuste
- Servicio de Cardiología, Hospital Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Alba Rosas
- Departament de Salut, Generalitat de Catalunya, Catalonia, Spain
| | | | | | - Jaume Figueras
- Servicio de Cardiología, Hospital Vall d´Hebron, Barcelona, Spain
| | - Antoni Curós
- Servicio de Cardiología, Hospital Universitario Germans Trias i Pujol, Badalona, Spain
| | - Angel Cequier
- Servicio de Cardiología, Hospital Universitari Bellvitge, Barcelona, Spain
| | | | | | | | | | - Laura Pellisé
- Centro de Investigación en Economía y Salud, Universidad Pompeu Fabra, Barcelona, Spain
| | - Manel Sabaté
- Servicio de Cardiología, Hospital Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer IDIBAPS, Universitat de Barcelona, Barcelona, Spain
- Iniciativa Stent for Life, Spain
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Kholmukhamedov A, Logdon C, Hu J, McKinney RA, Spinale FG, Lemasters JJ, Mukherjee R. Cyclosporin A in left ventricular remodeling after myocardial infarction. Am J Physiol Heart Circ Physiol 2013; 306:H53-9. [PMID: 24163074 DOI: 10.1152/ajpheart.00079.2013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Recent studies suggest that an increase in apoptosis within the myocardium may be a contributing factor for the progression of late adverse left ventricular (LV) remodeling following myocardial infarction (MI). Given that apoptosis is often triggered by induction of the mitochondrial permeability transition (MPT) pore, the goal of this study was to evaluate the therapeutic efficacy of cyclosporin A (CsA), an MPT blocker, to prevent cells from undergoing apoptosis and consequently attenuate late LV remodeling post-MI. MI was induced in C57BL/6 mice and then randomized to either vehicle or CsA groups. Beginning 48 h after surgery after infarction had already occurred, mice were gavaged with CsA (2 mg/kg) or vehicle once daily. LV end-diastolic volume and LV ejection fraction were assessed by echocardiography before MI induction and terminally at either 7 days (n = 7) or 28 days (n = 8) post-MI. LV end-diastolic volume increased and LV ejection fraction decreased in all MI groups with no difference between the CsA-treated and untreated groups. After vehicle and CsA, areas of necrosis were present at 7 and 28 days post-MI with no difference between treatment groups. Caspase-3 activity and terminal deoxynucleotidyl transferase dUTP-mediated nick-end labeling in distal nonnecrotic LV both increased after MI but were lower in CsA-treated mice compared with vehicle (P < 0.05). In conclusion, CsA decreased apoptosis occurring late after MI, confirming involvement of a CsA-sensitive MPT in the cell death. However, CsA-mediated reduction in apoptosis in non-MI myocardium was not beneficial against late pump dysfunction occurring during post-MI remodeling.
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Affiliation(s)
- Andaleb Kholmukhamedov
- Department of Drug Discovery and Biomedical Sciences, Medical University of South Carolina, Charleston, South Carolina
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Berger PB, Williams JB, Hasselblad V, Chiswell K, Pieper KS, Califf RM. Would tirofiban have been shown non-inferior to abciximab had the TENACITY trial not been terminated for financial reasons? J Interv Cardiol 2013; 26:123-30. [PMID: 23379785 DOI: 10.1111/j.1540-8183.2013.12020.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To investigate whether tirofiban would have been non-inferior to abciximab had the trial completed enrollment and place the termination of this trial in a broader research ethics context. BACKGROUND TENACITY was terminated by the sponsor for financial reasons. At the time, event rates for the 2 treatment arms were unknown. METHODS TENACITY was designed to compare tirofiban with abciximab in approximately 8,000 patients; however, enrollment was terminated after 383 (4.8%) patients. The primary end-point was a composite of 30-day death, myocardial infarction, and urgent target vessel revascularization. Non-inferiority was defined as the likelihood that tirofiban would preserve at least 50% of the ability of abciximab to reduce the primary end-point at 30 days, based on abciximab's demonstrated ability to reduce such events by 43% (relative risk, 0.573; 95% confidence interval [CI], 0.507-0.648; P < 0.001). To determine the probability of non-inferiority given the patients already enrolled, a Bayesian approach was used. RESULTS The primary composite end-point occurred in 8.8% of patients randomized to abciximab versus 6.9% receiving high-bolus-dose tirofiban (odds ratio, 0.77; 95% CI, 0.37-1.64). The estimated conditional power for the test that tirofiban would be non-inferior to abciximab if all patients been enrolled is 93.7%. Using the estimated predictive power method, the likelihood was 84.8%. CONCLUSIONS TENACITY was well powered to identify non-inferiority with tirofiban versus abciximab, and the patients enrolled strengthened the probability that this would have been the outcome had the trial been completed. When a clinical trial is terminated solely for financial reasons, it is incumbent upon the sponsor to provide proper patient follow-up and publication of the findings.
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Devlin G, Reynolds HR, Mark DB, Rankin JM, Carvalho AC, Vozzi C, Sopko G, Caramori P, Džavík V, Ragosta M, Forman SA, Lamas GA, Hochman JS. Loss of short-term symptomatic benefit in patients with an occluded infarct artery is unrelated to non-protocol revascularization: results from the Occluded Artery Trial (OAT). Am Heart J 2011; 161:84-90. [PMID: 21167338 DOI: 10.1016/j.ahj.2010.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Accepted: 09/14/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND the OAT found that routine late (3-28 days post-myocardial infarction) percutaneous coronary intervention (PCI) of an occluded infarct-related artery did not reduce death, reinfarction, or heart failure relative to medical treatment (MED). Angina rates were lower in PCI early, but the advantage over MED was lost by 3 years. METHODS angina and revascularization status were collected at 4 months, then annually. We assessed whether non-protocol revascularization procedures in MED accounted for loss of the early symptomatic advantage of PCI. RESULTS seven per 100 more PCI patients were angina-free at 4 months (P < .001) and 5 per 100 at 12 months (P = .005) with the difference narrowing to 1 per 100 at 3 years (P = .34). Non-protocol revascularization was more frequent in MED (5-year rate 22% vs 19% PCI, P = .05). Indications for revascularization included acute coronary syndromes (39% PCI vs 38% MED), stable angina/inducible ischemia (39% in each group), and physician preference (17% PCI vs 15% MED). Revascularization rates among patients with angina at any time during follow-up (35% of cohort) did not differ by treatment group (5-year rates 26% PCI vs 28% MED). Most symptomatic patients were treated without revascularization during follow-up (77%). CONCLUSIONS in a large randomized clinical trial of stable post-myocardial infarction patients, the modest benefit on angina from PCI of an occluded infarct-related artery was lost by 3 years. Revascularization was slightly more common in MED during follow-up but was not driven by acute ischemia, and almost 1 in 5 procedures were attributed to physician preference alone.
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Fontanelli A, Bonanno C. Primary percutaneous coronary intervention in ‘early’ latecomers with ST-segment elevation acute myocardial infarction: the role of the infarct-related artery status. J Cardiovasc Med (Hagerstown) 2011; 12:13-8. [DOI: 10.2459/jcm.0b013e32834038d8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Upfront thrombus aspiration in primary coronary intervention for patients with ST-segment elevation acute myocardial infarction: report of the VAMPIRE (VAcuuM asPIration thrombus REmoval) trial. JACC Cardiovasc Interv 2009; 1:424-31. [PMID: 19463340 DOI: 10.1016/j.jcin.2008.06.004] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2008] [Revised: 04/23/2008] [Accepted: 06/12/2008] [Indexed: 01/03/2023]
Abstract
OBJECTIVES This study evaluated safety and efficacy of upfront thrombus aspiration during primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). BACKGROUND Distal embolization during primary PCI results in reduced myocardial perfusion and poor clinical outcomes. METHODS The VAMPIRE (VAcuuM asPIration thrombus REmoval) study was a prospective, randomized, controlled multicenter trial conducted in 23 institutions. Patients (N = 355) presenting within 24 h of STEMI symptoms onset were randomized to primary PCI with (n = 180) or without (n = 175) upfront thrombus aspiration using Nipro's TransVascular Aspiration Catheter (Osaka, Japan). RESULTS The TransVascular Aspiration Catheter reached the lesion in 100% of cases. It successfully crossed the target obstruction in 86% without any delay in procedure time or time to reperfusion; whereas macroscopic thrombi were removed in 75% of the cases. Procedure success was similar between groups (98.9% vs. 98.3%). There was a trend toward lower incidence of slow or no reflow (primary end point-defined as a Thrombolysis In Myocardial Infarction flow grade <3) in patients treated with aspiration versus conventional primary PCI (12.4% vs. 19.4%, p = 0.07). Rate of myocardial blush grade 3 was higher in the aspiration group (46.0% vs. 20.5%, p < 0.001). Aspiration was most effective in patients presenting after 6 h of symptoms onset (slow flow rate: 8.1% vs. 37.6%, p = 0.01). CONCLUSIONS This study suggested the safety of primary PCI with upfront thrombectomy using a novel device in patients with STEMI. The study showed a trend toward improved myocardial perfusion and lower clinical events in patients treated with aspiration. Patients presenting late after STEMI appear to benefit the most from thrombectomy.
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Menon V, Pearte CA, Buller CE, Steg PG, Forman SA, White HD, Marino PN, Katritsis DG, Caramori P, Lasevitch R, Loboz-Grudzien K, Zurakowski A, Lamas GA, Hochman JS. Lack of benefit from percutaneous intervention of persistently occluded infarct arteries after the acute phase of myocardial infarction is time independent: insights from Occluded Artery Trial. Eur Heart J 2008; 30:183-91. [PMID: 19028780 DOI: 10.1093/eurheartj/ehn486] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS The Occluded Artery Trial (OAT) (n = 2201) showed no benefit for routine percutaneous intervention (PCI) (n = 1101) over medical therapy (MED) (n = 1100) on the combined endpoint of death, myocardial infarction (MI), and class IV heart failure (congestive heart failure) in stable post-MI patients with late occluded infarct-related arteries (IRAs). We evaluated the potential for selective benefit with PCI over MED for patients enrolled early in OAT. METHODS AND RESULTS We explored outcomes with PCI over MED in patients randomized to the </=3 calendar days and </=7 calendar days post-MI time windows. Earlier, times to randomization in OAT were associated with higher rates of the combined endpoint (adjusted HR 1.04/day: 99% CI 1.01-1.06; P < 0.001). The 48-month event rates for </=3 days, </=7 days post-MI enrolled patients were similar for PCI vs. MED for the combined and individual endpoints. There was no interaction between time to randomization defined as a continuous (P = 0.55) or categorical variable with a cut-point of 3 days (P = 0.98) or 7 days (P = 0.64) post-MI and treatment effect. CONCLUSION Consistent with overall OAT findings, patients enrolled in the </=3 day and </=7 day post-MI time windows derived no benefit with PCI over MED with no interaction between time to randomization and treatment effect. Our findings do not support routine PCI of the occluded IRA in trial-eligible patients even in the earliest 24-72 h time window.
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Affiliation(s)
- Venu Menon
- Division of Cardiology, F-15, 9500 Euclid Avenue, Cleveland Clinic, Cleveland, OH 4419, USA
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Reperfusion therapy in ST-segment elevation myocardial infarction - data from a pilot registry of myocardial infarction. COR ET VASA 2008. [DOI: 10.33678/cor.2008.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Hochman JS, Lamas GA, Buller CE, Dzavik V, Reynolds HR, Abramsky SJ, Forman S, Ruzyllo W, Maggioni AP, White H, Sadowski Z, Carvalho AC, Rankin JM, Renkin JP, Steg PG, Mascette AM, Sopko G, Pfisterer ME, Leor J, Fridrich V, Mark DB, Knatterud GL. Coronary intervention for persistent occlusion after myocardial infarction. N Engl J Med 2006; 355:2395-407. [PMID: 17105759 PMCID: PMC1995554 DOI: 10.1056/nejmoa066139] [Citation(s) in RCA: 438] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND It is unclear whether stable, high-risk patients with persistent total occlusion of the infarct-related coronary artery identified after the currently accepted period for myocardial salvage has passed should undergo percutaneous coronary intervention (PCI) in addition to receiving optimal medical therapy to reduce the risk of subsequent events. METHODS We conducted a randomized study involving 2166 stable patients who had total occlusion of the infarct-related artery 3 to 28 days after myocardial infarction and who met a high-risk criterion (an ejection fraction of <50% or proximal occlusion). Of these patients, 1082 were assigned to routine PCI and stenting with optimal medical therapy, and 1084 were assigned to optimal medical therapy alone. The primary end point was a composite of death, myocardial reinfarction, or New York Heart Association (NYHA) class IV heart failure. RESULTS The 4-year cumulative primary event rate was 17.2% in the PCI group and 15.6% in the medical therapy group (hazard ratio for death, reinfarction, or heart failure in the PCI group as compared with the medical therapy group, 1.16; 95% confidence interval [CI], 0.92 to 1.45; P=0.20). Rates of myocardial reinfarction (fatal and nonfatal) were 7.0% and 5.3% in the two groups, respectively (hazard ratio, 1.36; 95% CI, 0.92 to 2.00; P=0.13). Rates of nonfatal reinfarction were 6.9% and 5.0%, respectively (hazard ratio, 1.44; 95% CI, 0.96 to 2.16; P=0.08); only six reinfarctions (0.6%) were related to assigned PCI procedures. Rates of NYHA class IV heart failure (4.4% vs. 4.5%) and death (9.1% vs. 9.4%) were similar. There was no interaction between treatment effect and any subgroup variable (age, sex, race or ethnic group, infarct-related artery, ejection fraction, diabetes, Killip class, and the time from myocardial infarction to randomization). CONCLUSIONS PCI did not reduce the occurrence of death, reinfarction, or heart failure, and there was a trend toward excess reinfarction during 4 years of follow-up in stable patients with occlusion of the infarct-related artery 3 to 28 days after myocardial infarction. (ClinicalTrials.gov number, NCT00004562 [ClinicalTrials.gov].).
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Affiliation(s)
- Judith S Hochman
- Cardiovascular Clinical Research Center, Leon Charney Division of Cardiology, New York University School of Medicine, New York 10016, USA
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Kalus JS, Moser LR. Evolving Role of Low-Molecular-Weight Heparins in ST-Elevation Myocardial Infarction. Ann Pharmacother 2005; 39:481-91. [PMID: 15701782 DOI: 10.1345/aph.1e177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE: To review the available literature on the efficacy and safety of low-molecular-weight heparin (LMWH) in the treatment of ST-elevation myocardial infarction (STEMI) in patients treated with fibrinolytic therapy or conservative medical management. DATA SOURCES: A MEDLINE search (1966–March 2004) using the key words myocardial infarction, STEMI, LMWH, enoxaparin, and dalteparin identified pertinent articles. The references of these articles were reviewed for additional pertinent references. STUDY SELECTION AND DATA EXTRACTION: All human trials of LMWH in STEMI were evaluated. All pertinent studies were included in the review. DATA SYNTHESIS: LMWH did not show a benefit in STEMI without fibrinolytic therapy. Enoxaparin is similar to intravenous unfractionated heparin (UFH) in combination with nonspecific fibrinolytic therapy with regard to invasive reperfusion markers and 30-day clinical outcomes. Enoxaparin decreases composite endpoints in combination with fibrin-specific fibrinolytic therapy compared with UFH, primarily through a reduction in the incidence of reinfarction at 30 days. Bleeding rates with LMWH in combination with fibrinolytic agents are not greater than those with UFH. CONCLUSIONS: Enoxaparin is a reasonable alternative to UFH in patients with STEMI treated with fibrin-specific fibrinolytic therapy. LMWH in patients managed with nonspecific fibrinolytic therapy or conservative medical treatment does not provide an advantage over standard management. Large clinical trials are ongoing which will provide more definitive recommendations.
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Affiliation(s)
- James S Kalus
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI 47201, USA
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Svilaas T, Zijlstra F. The benefit of an invasive approach in thrombolysis-ineligible patients with acute myocardial infarction. Am J Med 2005; 118:123-5. [PMID: 15694894 DOI: 10.1016/j.amjmed.2004.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Affiliation(s)
- Robert M Califf
- Duke Clinical Research Institute, P.O. Box 17969, Durham, NC 27710, USA.
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