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Anderson JL, Knight S, Dong L, May HT, Le VT, Bair TL, Knowlton KU. Coronary Calcium Is Elevated in Patients with Myocardial Infarction without Standard Modifiable Risk Factors. J Clin Med 2024; 13:2569. [PMID: 38731098 PMCID: PMC11084599 DOI: 10.3390/jcm13092569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/15/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
Objectives: Recent reports have highlighted myocardial infarction (MI) patients without standard modifiable risk factors (SMRF), noting them to be surprisingly common and to have a substantial risk of adverse outcomes. The objective of this study was to address the challenge of identifying at-risk patients without SMRF and providing preventive therapy. Methods: Patients presenting between 2001 and 2021 to Intermountain Health catheterization laboratories with a diagnosis of MI were included if they also had a coronary artery calcium (CAC) scan by computed tomography within 2 years. SMRF were defined as a clinical diagnosis or treatment of hypertension, hyperlipidemia, diabetes, or smoking. The co-primary endpoints in SMRF-less patients were: (1) proportion of patients with an elevated (>50%ile) CAC score, and (2) an indication for statin therapy (i.e., CAC ≥ 100 AU or ≥75%ile). The 60-day and long-term major adverse cardiovascular events were determined. A comparison set included MI patients with SMRF. Results: We identified 429 MI patients with a concurrent CAC scan, of which 60 had no SMRF. SMRF status did not distinguish most risk factors or interventions. No-SMRF patients had a high CAC prevalence and percentile (82% ≥ 50%ile; median, 80%ile), and 77% met criteria for preventive therapy. As expected, patients with SMRF had high CAC scores and percentiles. Outcomes were more favorable for No-SMRF status and for lower CAC scores. Conclusions: Patients without SMRF presenting with an MI have a high prevalence and percentile of CAC. Wider application of CAC scans, including in those without SMRF, is promising as a method to identify an additional at-risk population for MI and to provide primary preventive therapy.
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Affiliation(s)
- Jeffrey L. Anderson
- Intermountain Medical Center Heart Institute, Salt Lake City, UT 84107, USA; (S.K.); (L.D.); (H.T.M.); (V.T.L.); (T.L.B.); (K.U.K.)
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT 84112, USA
| | - Stacey Knight
- Intermountain Medical Center Heart Institute, Salt Lake City, UT 84107, USA; (S.K.); (L.D.); (H.T.M.); (V.T.L.); (T.L.B.); (K.U.K.)
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT 84112, USA
| | - Li Dong
- Intermountain Medical Center Heart Institute, Salt Lake City, UT 84107, USA; (S.K.); (L.D.); (H.T.M.); (V.T.L.); (T.L.B.); (K.U.K.)
| | - Heidi T. May
- Intermountain Medical Center Heart Institute, Salt Lake City, UT 84107, USA; (S.K.); (L.D.); (H.T.M.); (V.T.L.); (T.L.B.); (K.U.K.)
| | - Viet T. Le
- Intermountain Medical Center Heart Institute, Salt Lake City, UT 84107, USA; (S.K.); (L.D.); (H.T.M.); (V.T.L.); (T.L.B.); (K.U.K.)
- Rocky Mountain University of Health Professions, Provo, UT 84606, USA
| | - Tami L. Bair
- Intermountain Medical Center Heart Institute, Salt Lake City, UT 84107, USA; (S.K.); (L.D.); (H.T.M.); (V.T.L.); (T.L.B.); (K.U.K.)
| | - Kirk U. Knowlton
- Intermountain Medical Center Heart Institute, Salt Lake City, UT 84107, USA; (S.K.); (L.D.); (H.T.M.); (V.T.L.); (T.L.B.); (K.U.K.)
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT 84112, USA
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Chaudhry H, Bodair R, Mahfoud Z, Dargham S, Al Suwaidi J, Jneid H, Abi Khalil C. Overweight and obesity are associated with better survival in STEMI patients with diabetes. Obesity (Silver Spring) 2023; 31:2834-2844. [PMID: 37691173 DOI: 10.1002/oby.23863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/28/2023] [Accepted: 06/12/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE The relationship between obesity and in-hospital outcomes in individuals with type 2 diabetes mellitus (T2DM) who develop an ST-elevation myocardial infarction (STEMI) was assessed. METHODS Data from the National Inpatient Sample (NIS) from 2008 to 2017 were analyzed. Patients with STEMI and T2DM were classified as being underweight or having normal weight, overweight, obesity, and severe obesity. The temporal trend of those BMI ranges and in-hospital outcomes among different obesity groups were assessed. RESULTS A total of 74,099 patients with T2DM and STEMI were included in this analysis. In 2008, 35.8% of patients had obesity, and 37.3% had severe obesity. However, patients with obesity accounted for most of the study population in 2017 (57.8%). During the observation period, mortality decreased in underweight patients from 18.1% to 13.2% (p < 0.001). Still, it gradually increased in all other BMI ranges, along with cardiogenic shock, atrial fibrillation, and ventricular fibrillation (p < 0.001 for all). After the combination of all patients during the observation period, mortality was lower in patients with overweight and obesity (adjusted odds ratio = 0.625 [95% CI 0.499-0.784]; 0.606 [95% CI 0.502-0.733], respectively). CONCLUSIONS A U-shaped association governs the relationship between BMI and mortality in STEMI patients with diabetes, with those having overweight and obesity experiencing better survival.
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Affiliation(s)
- Hamza Chaudhry
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Ramez Bodair
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
- Department of Medicine, Virginia Commonwealth University Health, Richmond, Virginia, USA
| | - Ziyad Mahfoud
- Biostatistics Core, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Soha Dargham
- Biostatistics Core, Weill Cornell Medicine-Qatar, Doha, Qatar
| | | | - Hani Jneid
- Department of Cardiology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Charbel Abi Khalil
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
- Heart Hospital. Hamad Medical Corporation, Doha, Qatar
- Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, New York, USA
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Kim YH, Her AY, Rha SW, Choi CU, Choi BG, Park S, Kang DO, Cho JR, Park JY, Park SH, Jeong MH. The impact of sex differences on 3-year outcomes of patients with non-ST-segment elevation myocardial infarction after successful stent implantation according to symptom-to-balloon time. Hellenic J Cardiol 2023:S1109-9666(23)00189-6. [PMID: 37866718 DOI: 10.1016/j.hjc.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/27/2023] [Accepted: 09/29/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND Because no data are available, we compared the 3-year outcomes of patients with non-ST-elevation myocardial infarction (NSTEMI) based on sex and symptom-to-balloon time (SBT). METHODS This study included 4910 patients who were divided into two groups based on SBT: SBT <48 h (n = 3,293, 67.1%) and SBT ≥48 h (n = 1,617, 32.9%). The primary outcome was all-cause death during the 3-year follow-up period. The secondary outcome was major adverse cardiac events (MACE), defined as all-cause death, recurrent myocardial infarction, or repeat coronary revascularization. RESULTS After adjustment, the in-hospital mortality rates for males and females in the SBT <48 h and SBT ≥48 h groups were similar. During a 3-year follow-up period, females in the SBT <48 h group had significantly higher rates of all-cause death (adjusted hazard ratio [aHR], 1.482; P = 0.006), cardiac death (CD, aHR, 1.617; P = 0.009), and MACE (aHR, 1.268; P = 0.024) than those males in the same groups. Females and males in the SBT ≥48 h group did not differ significantly in the primary and secondary outcomes. In males, the rates of all-cause death (P = 0.008) and CD (P = 0.024) were significantly higher in the SBT ≥48 h group than in the SBT <48 h group. CONCLUSIONS This study has identified a higher 3-year mortality rate in female patients with NSTEMI and SBT <48 h compared to their male counterparts. As such, a more preventive approach may be required to reduce mortality in these female patients.
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Affiliation(s)
- Yong Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Kangwon National University College of Medicine, Kangwon National University School of Medicine, 24289, Chuncheon, Republic of Korea.
| | - Ae-Young Her
- Division of Cardiology, Department of Internal Medicine, Kangwon National University College of Medicine, Kangwon National University School of Medicine, 24289, Chuncheon, Republic of Korea
| | - Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, 08308, Seoul, Republic of Korea.
| | - Cheol Ung Choi
- Cardiovascular Center, Korea University Guro Hospital, 08308, Seoul, Republic of Korea
| | - Byoung Geol Choi
- Cardiovascular Research Institute, Korea University College of Medicine, 02841, Seoul, Republic of Korea
| | - Soohyung Park
- Cardiovascular Center, Korea University Guro Hospital, 08308, Seoul, Republic of Korea
| | - Dong Oh Kang
- Cardiovascular Center, Korea University Guro Hospital, 08308, Seoul, Republic of Korea
| | - Jung Rae Cho
- Cardiology Division, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 07441, Seoul, Republic of Korea
| | - Ji Young Park
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Nowon Eulji Medical Center, Eulji University, 01830, Seoul, Republic of Korea
| | - Sang-Ho Park
- Cardiology Department, Soonchunhyang University Cheonan Hospital, 31151, Cheonan, Republic of Korea
| | - Myung Ho Jeong
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, 61469, Gwangju, Republic of Korea
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Lange SA, Schliemann C, Engelbertz C, Feld J, Makowski L, Gerß J, Dröge P, Ruhnke T, Günster C, Reinecke H, Köppe J. Survival of Patients with Acute Coronary Syndrome and Hematologic Malignancies-A Real-World Analysis. Cancers (Basel) 2023; 15:4966. [PMID: 37894332 PMCID: PMC10605274 DOI: 10.3390/cancers15204966] [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: 09/11/2023] [Revised: 10/08/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND The impact of the encounter between coronary heart disease (CHD) and cancer, and in particular hematologic malignancies (HM), remains poorly understood. OBJECTIVE The aim of this analysis was to clarify how HM affects the prognosis of acute coronary syndrome (ACS). We analyzed German health insurance data from 11 regional Ortskrankenkassen (AOK) of patients hospitalized for ACS between January 2010 and December 2018, matched by age, sex and all comorbidities for short- and long-term survival and major adverse cardiac events (MACE). RESULTS Of 439,716 patients with ACS, 2104 (0.5%) also had an HM. Myelodysplastic/myeloproliferative disorders (27.7%), lymphocytic leukemias (24.8%), and multiple myeloma (22.4%) predominated. These patients were about 6 years older (78 vs. 72 years *). They had an ST-segment elevation myocardial infarction (STEMI, 18.2 vs. 34.9% *) less often and more often had a non-STEMI (NSTEMI, 81.8 vs. 65.1% *). With the exception of dyslipidemia, these patients had more concomitant and previous cardiovascular disease and a worse NYHA stage. They were less likely to undergo coronary angiography (65.3 vs. 71.6% *) and percutaneous coronary intervention (PCI, 44.3 vs. 52.0% *), although the number of bleeding events was not relevantly increased (p = 0.22). After adjustment for the patients' risk profile, the HM was associated with reduced long-term survival. However, this was not true for short-term survival. Here, there was no difference in the STEMI patients, * p < 0.001. CONCLUSION Survival in ACS and HM is significantly lower, possibly due to the avoidance of PCI because of a perceived increased risk of bleeding.
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Affiliation(s)
- Stefan A. Lange
- Department of Cardiology I—Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, D-48149 Muenster, Germany; (C.E.); (L.M.); (H.R.)
| | - Christoph Schliemann
- Department of Medicine A, University Hospital Muenster, D-48149 Muenster, Germany;
| | - Christiane Engelbertz
- Department of Cardiology I—Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, D-48149 Muenster, Germany; (C.E.); (L.M.); (H.R.)
| | - Jannik Feld
- Institute of Biostatistics and Clinical Research, University of Muenster, D-48149 Muenster, Germany; (J.F.); (J.G.); (J.K.)
| | - Lena Makowski
- Department of Cardiology I—Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, D-48149 Muenster, Germany; (C.E.); (L.M.); (H.R.)
| | - Joachim Gerß
- Institute of Biostatistics and Clinical Research, University of Muenster, D-48149 Muenster, Germany; (J.F.); (J.G.); (J.K.)
| | - Patrik Dröge
- AOK Research Institute (WIdO), D-10178 Berlin, Germany; (P.D.); (C.G.)
| | - Thomas Ruhnke
- AOK Research Institute (WIdO), D-10178 Berlin, Germany; (P.D.); (C.G.)
| | - Christian Günster
- AOK Research Institute (WIdO), D-10178 Berlin, Germany; (P.D.); (C.G.)
| | - Holger Reinecke
- Department of Cardiology I—Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, D-48149 Muenster, Germany; (C.E.); (L.M.); (H.R.)
| | - Jeanette Köppe
- Institute of Biostatistics and Clinical Research, University of Muenster, D-48149 Muenster, Germany; (J.F.); (J.G.); (J.K.)
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Basuliman AS, Malabarey MA, Abousamak FW, Alyousef BY, Alrabea SS, Alshabibi RA, Aseri ZAA. Predictive value of triglycerides to high density lipoprotein ratio in patients with first attack of acute coronary syndrome. Saudi Med J 2023; 44:379-384. [PMID: 37062558 PMCID: PMC10153615 DOI: 10.15537/smj.2023.44.4.20220928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 02/27/2023] [Indexed: 04/18/2023] Open
Abstract
OBJECTIVES To identify patients who are at risk for a first cardiovascular event, mitigate the risk, and institute early intervention. The triglyceride to high-density lipoprotein-C (TG/HDL-C) ratio has been found to be a very useful biomarker for directing treatment and prevention therapy. METHODS This retrospective cross-sectional study included adult patients (aged >18 years) experiencing first-time acute coronary syndrome (ACS). We examined all patient databases for a definite diagnosis of angina, non-ST segment elevation myocardial infarction (NSTEMI), or ST-segment elevation myocardial infarction (STEMI). Lipid profiles were obtained prior to or at the time of admission. RESULTS A total of 265 patients were included in the study (mean age 57.83 ± 11.4 years) and 79.2% were men. Male gender, presence of diabetes, raised total cholesterol, raised low-density lipoprotein (LDL), and raised troponin level on admission were significantly positively correlated with STEMI (p=0.004, p=0.001, p<0.001, and p<0.001), whereas TG/HDL-C ratio was significantly negatively correlated with STEMI (p=0.048), while there was no significant results with NSTEMI (p=0.264) and angina (p=0.326). Total cholesterol and raised low-density lipoprotein (LDL) were significantly positively correlated with NSTEMI (p=0.013 and p=0.024). CONCLUSION Patients with first-time ACS may not have an increased TG/HDL-C ratio. High LDL levels had the most significant association with an ACS event, along with total cholesterol and diabetes. Further research is needed on a larger scale to determine the association of TG/HDL-C ratio with ACS and differentiate the different types of ACS events according to their clinical and laboratory characteristics.
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Affiliation(s)
- Abdullah S. Basuliman
- From the College of Medicine (Basuliman, Alyousef, Alrabea), King Saud bin Abdulaziz University for Health Sciences; from the Departments of Emergency Medicine and Critical Care (Malabarey, Al Aseri), College of Medicine, King Saud University; from the Department of Clinical Sciences (Al Aseri), and from the College of Medicine (Abousamak, Alshabibi), Dar Al Uloom University; and from the Saudi Red Crescent Authority (Abousamak), Riyadh, Kingdom of Saudi Arabia.
| | - Mohammed A. Malabarey
- From the College of Medicine (Basuliman, Alyousef, Alrabea), King Saud bin Abdulaziz University for Health Sciences; from the Departments of Emergency Medicine and Critical Care (Malabarey, Al Aseri), College of Medicine, King Saud University; from the Department of Clinical Sciences (Al Aseri), and from the College of Medicine (Abousamak, Alshabibi), Dar Al Uloom University; and from the Saudi Red Crescent Authority (Abousamak), Riyadh, Kingdom of Saudi Arabia.
| | - Fahad W. Abousamak
- From the College of Medicine (Basuliman, Alyousef, Alrabea), King Saud bin Abdulaziz University for Health Sciences; from the Departments of Emergency Medicine and Critical Care (Malabarey, Al Aseri), College of Medicine, King Saud University; from the Department of Clinical Sciences (Al Aseri), and from the College of Medicine (Abousamak, Alshabibi), Dar Al Uloom University; and from the Saudi Red Crescent Authority (Abousamak), Riyadh, Kingdom of Saudi Arabia.
| | - Bader Y. Alyousef
- From the College of Medicine (Basuliman, Alyousef, Alrabea), King Saud bin Abdulaziz University for Health Sciences; from the Departments of Emergency Medicine and Critical Care (Malabarey, Al Aseri), College of Medicine, King Saud University; from the Department of Clinical Sciences (Al Aseri), and from the College of Medicine (Abousamak, Alshabibi), Dar Al Uloom University; and from the Saudi Red Crescent Authority (Abousamak), Riyadh, Kingdom of Saudi Arabia.
| | - Saleh S. Alrabea
- From the College of Medicine (Basuliman, Alyousef, Alrabea), King Saud bin Abdulaziz University for Health Sciences; from the Departments of Emergency Medicine and Critical Care (Malabarey, Al Aseri), College of Medicine, King Saud University; from the Department of Clinical Sciences (Al Aseri), and from the College of Medicine (Abousamak, Alshabibi), Dar Al Uloom University; and from the Saudi Red Crescent Authority (Abousamak), Riyadh, Kingdom of Saudi Arabia.
| | - Rakan A. Alshabibi
- From the College of Medicine (Basuliman, Alyousef, Alrabea), King Saud bin Abdulaziz University for Health Sciences; from the Departments of Emergency Medicine and Critical Care (Malabarey, Al Aseri), College of Medicine, King Saud University; from the Department of Clinical Sciences (Al Aseri), and from the College of Medicine (Abousamak, Alshabibi), Dar Al Uloom University; and from the Saudi Red Crescent Authority (Abousamak), Riyadh, Kingdom of Saudi Arabia.
| | - Zohair A. Al Aseri
- From the College of Medicine (Basuliman, Alyousef, Alrabea), King Saud bin Abdulaziz University for Health Sciences; from the Departments of Emergency Medicine and Critical Care (Malabarey, Al Aseri), College of Medicine, King Saud University; from the Department of Clinical Sciences (Al Aseri), and from the College of Medicine (Abousamak, Alshabibi), Dar Al Uloom University; and from the Saudi Red Crescent Authority (Abousamak), Riyadh, Kingdom of Saudi Arabia.
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Doganay B, Celebi OO. Prognostic role of the left ventricular global function index in predicting major adverse cardiovascular events in acute coronary syndrome patients. Biomark Med 2023; 17:5-16. [PMID: 36942625 DOI: 10.2217/bmm-2023-0063] [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: 03/23/2023] Open
Abstract
Aim: This study aimed to evaluate the prognostic role of the left ventricular (LV) global function index (LVGFI) in predicting major adverse cardiovascular events in patients with acute coronary syndrome after long-term follow-up. Methods: This retrospective study included 718 patients with ST-elevated myocardial infarction (STEMI) and 781 patients with non-ST-elevated myocardial infarction (NSTEMI). The LVGFI was calculated on echocardiography with the following formula: (LV stroke volume/[LV cavity volume + LV myocardial volume]) × 100. Results: Mean LVGFI was higher in the NSTEMI group than in the STEMI group. Decreased LVGFI levels were independent predictors of major adverse cardiovascular events in both the STEMI and the NSTEMI group. Conclusion: Echocardiographic LVGFI may be a useful prognostic screening tool for acute coronary syndrome cohorts.
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Affiliation(s)
- Birsen Doganay
- Department of Cardiology, Ankara City Hospital, University District Bilkent Street No: 1, 06800, Ankara, Turkey
| | - Ozlem Ozcan Celebi
- Department of Cardiology, Ankara City Hospital, University District Bilkent Street No: 1, 06800, Ankara, Turkey
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Case BC. Ice Ice Maybe… Not. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 47:16-17. [PMID: 36428158 DOI: 10.1016/j.carrev.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 11/17/2022] [Indexed: 11/21/2022]
Affiliation(s)
- Brian C Case
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America.
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