After the triumph of cardiovascular medicine over acute myocardial infarction at the end of the 20th Century. -Can we predict the onset of acute coronary syndrome? (Con)-

Long-Term Effect of β-Blocker Use on Clinical Outcomes in Postmyocardial Infarction Patients: A Systematic Review and Meta-Analysis

Background

Prior studies provided inconsistent results regarding long-term effect of β-blocker use on clinical outcomes in postmyocardial infarction (MI) patients.

Methods

We searched for articles regarding long-term effect of β-blocker use on clinical outcomes in patients after MI and published them before July 2021 in the databases as follows: PubMed, Web of Science, MEDLINE, EMBASE, and Google Scholar. STATA 12.0 software was used to compute hazard ratios (HRs) and their 95% confidence intervals (CIs).

Results

The study indicated that β-blocker group had significantly lower long-term all-cause mortality, cardiovascular mortality, major adverse cardiac events (MACEs) in post-MI patients, compared to no β-blocker group (all-cause mortality: HR, 0.67; 95% CI: 0.56–0.80; cardiovascular mortality: HR, 0.62; 95% CI: 0.49–0.78; MACE: HR, 0.87; 95% CI: 0.75–1.00). The study indicated no significant long-term effect of β-blocker use on risk of hospitalization for heart failure (HF), risk of recurrent MI, risk of stroke, and risk of repeat revascularization in post-MI patients (risk of hospitalization for HF: HR, 0.82; 95% CI: 0.58–1.16; risk of recurrent MI: HR, 0.93; 95% CI: 0.78–1.11; risk of stroke: HR, 0.94; 95% CI: 0.79–1.12; risk of repeat revascularization: HR, 0.91; 95% CI: 0.80–1.04).

Conclusions

The meta-analysis demonstrated significant long-term effects of β-blocker use on all-cause mortality, cardiovascular mortality, and risk of MACE in post-MI patients, whereas no significant long-term effect was shown on risk of hospitalization for HF, risk of recurrent MI, risk of stroke, and risk of repeat revascularization in post-MI patients.

Exploring diagnostic and prognostic predictive values of microRNAs for acute myocardial infarction: A PRISMA-compliant systematic review and meta-analysis

OBJECTIVE

Previous investigations yielded inconsistent results for diagnostic and prognostic predictive values of MicroRNAs (miRNAs) for acute myocardial infarction (AMI).

METHODS AND RESULTS

We systematically searched on PubMed and Web of Science for articles explored association of miRNAs and AMI published from January 1989 to March 2019. For diagnostic studies, a summary of sensitivity, specificity, positive likelihood ratios (PLR), negative likelihood ratios (NLR), and diagnostic odds ratio (DOR), which indicated the accuracy of microRNAs in the differentiation of AMI and no AMI, were calculated from the true positive (TP), true negative (TN), false positive (FP), and false negative (FN) of each study. In addition, the summary receive-operating characteristics (SROC) curve was constructed to summarize the TP and FP rates. For follow-up study, we computed hazard ratios (HRs) and 95% confidence intervals (CIs) for individual clinical outcomes. The meta-analysis showed a sensitivity [0.72 (95% CI: 0.61--0.81)] and specificity [0.88 (95% CI: 0.79--0.94)] of miR-1 for AMI. In addition, miR-133 showed a sensitivity [0.73 (95% CI: 0.55--0.85)] and specificity [0.88 (95% CI: 0.74--0.95)] for AMI. Moreover, the present study showed a sensitivity [0.83 (95% CI: 0.74--0.89)] and specificity [0.96 (95% CI: 0.82--0.99)] of miR-208 for AMI. A significant association was found between miR-208 and mortality after AMI (HR 1.09, 95% CI 1.01--1.18). It also indicated a sensitivity [0.84 (95% CI: 0.70--0.92)] and specificity [0.97 (95% CI: 0.87--0.99)] of miR-499 for AMI.

CONCLUSIONS

Circulating miR-1, miR-133, miR-208, and miR-499 showed diagnostic values in AMI.

Proposal of quality indicators for cardiac rehabilitation after acute coronary syndrome in Japan: a modified Delphi method and practice test

OBJECTIVES

Cardiac rehabilitation is underused and its quality in practice is unclear. A quality indicator is a measurable element of clinical practice performance. This study aimed to propose a set of quality indicators for cardiac rehabilitation following an acute coronary event in the Japanese population and conduct a small-size practice test to confirm feasibility and applicability of the indicators in real-world clinical practice.

DESIGN AND SETTING

This study used a modified Delphi technique (the RAND/UCLA appropriateness method), a consensus method which involves an evidence review, a face-to-face multidisciplinary panel meeting and repeated anonymous rating. Evidence to be reviewed included clinical practice guidelines available in English or Japanese and existing quality indicators. Performance of each indicator was assessed retrospectively using medical records at a university hospital in Japan.

PARTICIPANTS

10 professionals in cardiac rehabilitation for the consensus panel.

RESULTS

In the literature review, 23 clinical practice guidelines and 16 existing indicators were identified to generate potential indicators. Through the consensus-building process, a total of 30 indicators were assessed and finally 13 indicators were accepted. The practice test (n=39) revealed that 74% of patients underwent cardiac rehabilitation. Median performance of process measures was 93% (IQR 46-100%). 'Communication with the doctor who referred the patient to cardiac rehabilitation' and 'continuous participation in cardiac rehabilitation' had low performance (32% and 38%, respectively).

CONCLUSIONS

A modified Delphi technique identified a comprehensive set of quality indicators for cardiac rehabilitation. The single-site, small-size practice test confirmed that most of the proposed indicators were measurable in real-world clinical practice. However, some clinical processes which are not covered by national health insurance in Japan had low performance. Further studies will be needed to clarify and improve the quality of care in cardiac rehabilitation.

Serum microRNAs profile from genome-wide serves as a fingerprint for diagnosis of acute myocardial infarction and angina pectoris

Background

In order to identify miRNAs expression profiling from genome-wide screen for diagnosis of acute myocardial infarction (AMI) and angina pectoris (AP), we investigated the altered profile of serum microRNAs in AMI and AP patients at a relative early stage.

Methods

Serum samples were taken from 117 AMI patients, 182 AP patients and 100 age-and gender-matched controls. An initial screening of miRNAs expression was performed by Solexa sequencing. Differential expression was validated using RT-qPCR in individuals samples, the samples were arranged in a two-phase selection and validation.

Results

The Solexa sequencing results demonstrated marked upregulation of serum miRNAs in AMI patients compared with controls. RT-qPCR analysis identified a profile of six serum miRNAs (miR-1, miR-134, miR-186, miR-208, miR-223 and miR-499) as AMI biomarkers. MiR-208 and miR-499 were elevated higher in AP cases than in AMI cases. The ROC curves indicated a panel of six miRNAs has a great potential to offer sensitive and specific diagnostic tests for AMI. More especially, the panel of six miRNAs presents significantly differences between the AMI and AP cases.

Conclusions

The six-miRNAs signature identified from genome-wide serum miRNA expression profiling may serves as a fingerprint for AMI and AP diagnosis.

Prediction of acute coronary syndrome by using multislice computed tomography. -Can we predict the onset of acute coronary syndrome? (Pro)-

Predicting the occurrence of acute coronary syndrome (ACS) is a major clinical challenge for cardiologists. Multi-slice computed tomography (CT) has enabled easy detection and assessment of atherosclerotic coronary plaque, and therefore has considerable potential in the prevention of ACS. The recent development of 64-slice cardiac CT enables detailed information on both plaque properties and characteristics to be obtained with excellent diagnostic accuracy. Cardiac CT therefore has great potential for detecting the unstable plaques that are prone to result in ACS.