Dipeptidyl peptidase-4 inhibitors versus sulfonylureas on the top of metformin in patients with diabetes and acute myocardial infarction

Background

Recent trials have shown that both the extent of glycated hemoglobin reduction and the duration of enhanced glycemic control are major factors that may affect cardiovascular outcome results. We aimed to investigate the impact of metformin (MET) combined with dipeptidyl peptidase-4 (DPP4) inhibitors or sulfonylureas (SU) on long-term clinical outcomes in patients with acute myocardial infarction (AMI) and type 2 diabetes mellitus (DM).

Methods

This study was a prospective cohort trial. From November 2011 to December 2015, a total of 13,104 AMI patients were consecutively enrolled from the Korea AMI registry-National Institutes of Health. The patients were divided into the MET + DPP4 inhibitors group and the MET + SU group. The primary endpoint, major adverse cardiac events (MACE), was defined as the composite of all-cause death, recurrent myocardial infarction (MI), and any repeat revascularization up to 3-year follow-up. To adjust baseline potential confounders, an inverse probability weighting (IPTW) analysis was performed.

Results

Baseline well-matched two groups were generated (the MET + DPP4 inhibitors group, n=468 and the MET + SU group, n=468). During 3-year clinical follow-up, the cumulative incidence of MACE between the two groups was not significantly different after adjustment (16.8% for MET + DPP4 inhibitors group vs. 19.4% for MET + SU group, P=0.302). However, the MET + DPP4 inhibitors group was associated with reduced risk of MI [1.3% vs. 4.9%; hazard ratio (HR): 0.228, 95% confidence interval (CI): 0.090-0.580, P=0.001] than the MET + SU group.

Conclusions

In patients with AMI and type 2 DM, the use of MET combined with DPP4 inhibitors was associated with reduced incidence of recurrent MI than MET combined with SU during 3-year follow-up.

Association between triglyceride-glucose index and acute kidney injury in patients with acute myocardial infarction based on medical information mart for intensive care database: A cross-sectional study

Background

The relationship between triglyceride glucose (TyG) index and the incidence of acute kidney injury (AKI) in patients with acute myocardial infarction (AMI) is unclear. This study aims to explore the relationship between the two.

Methods

Participants were enrolled from Medical Information Mart for Intensive Care IV (MIMICIV) and grouping of subjects based on the quartile interval of the TyG index. With the presence of AKI as the main outcome, a logistic regression model was constructed. The correlation of the TyG index with the results obtained was examined by using a restricted cubic spline (RCS) model.

Long-term prognostic importance of high levels of sST2 in patient with AMI: a meta-analysis

OBJECTIVE

This meta-study aimed to assess the connection between soluble suppression of tumorigenicity 2 (sST2) and extended clinical outcomes in individuals diagnosed with acute myocardial infarction (AMI).

METHODS

We systematically collected pertinent literature from PubMed, Embase and Web of Science. The primary effect measures employed in this research were the hazard ratio and 95% confidence intervals. The quality and publication bias of included studies were evaluated. Subgroup analysis was conducted to explore the diversity in study outcomes.

RESULTS

This comprehensive meta-analysis ultimately encompassed thirteen studies, involving a total of 11,571 patients. Elevated levels of sST2 were identified as an adverse prognostic indicator, demonstrating a substantial association not only with overall mortality (combined HR 2.4, 95% CI 1.6-3.5, P < 0.01) but also with major adverse cardiovascular events (MACEs) (HR 2.5, 95% CI 1.5-4.2, P < 0.01). Subgroup analyses revealed that increased sST2 levels were linked to higher rates of all-cause mortality and MACEs in patients with ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI), and other unselected subcategories of AMI.

CONCLUSION

Increased sST2 could predict the long-term prognosis in patients suffering from AMI.

Association between lactate/albumin ratio and prognosis in patients with acute myocardial infarction

BACKGROUND

The association between the lactate/albumin ratio (L/A) as a diagnostic indicator and unfavourable clinical outcomes has been established in patients with community-acquired pneumonia, sepsis and heart failure, but the connection between L/A and all-cause mortality in patients with acute myocardial infarction (AMI) has yet to be fully understood.

METHODS

This was a retrospective cohort study using MIMIC-IV (v2.2) data, with 2816 patients enrolled and all-cause mortality during hospitalization as the primary outcome. Kaplan-Meier (KM) analysis was used to compare the all-cause mortality between high-level and low-level L/A groups. Receiver operating characteristic (ROC) curve, Restricted cubic splines (RCS) and Cox proportional hazards analysis were performed to investigate the relationship between L/A ratio and in-hospital all-cause mortality.

RESULTS

L/A values were significantly higher in the non-survivor groups than the survival groups (1.14 [.20] vs. .60 [.36], p < .05), and area under the ROC curve [.734 (95% confidence interval, .694-.775)] was better than other indicators. Data of COX regression analysis showed that higher L/A value supposed to be an independent risk factor for in-hospital mortality. RCS analysis showed evidence of an increasing trend and a non-linear relationship between L/A and in-hospital mortality (p-value was non-linear <.05). KM survival curves were significantly lower in the high L/A group than the low L/A group (p < .001), and the former group had an increased risk of in-hospital mortality compared with the latter one (Log Rank p < .001).

CONCLUSIONS

L/A demonstrates significant independent predictive power for elevated all-cause mortality during hospitalization in patients diagnosed with AMI.

Development of a prediction model for exercise tolerance decline in the exercise assessment of patients with acute myocardial infarction undergoing percutaneous coronary intervention revascularization in the acute phase

Background

Early cardiopulmonary exercise test (CPET) may predict the prognosis of patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). However, data from CPET to assess the exercise capacity of patients with AMI PCI are still scarce. This study aimed to evaluate the safety of the CPET and assess the predictors and clinical influence of exercise capacity measured by CPET in patients with AMI within 1 week after PCI.

Methods

A total of 275 patients with AMI who underwent PCI in the acute phase were selected. Reduced exercise capacity was defined as peak oxygen uptake (VO2peak) <16 mL/kg/min. According to VO2peak, patients were divided into a normal exercise tolerance group and a reduced exercise tolerance group. The general clinical conditions were compared between the 2 groups to investigate the safety of CPET and the influencing factors of exercise tolerance. A nomogram model for predicting patients' exercise capacity was further developed. Clinical outcomes were recorded.

Results

The median time of CPET in all patients was 5 days after PCI. Among the 275 patients, exercise tolerance decreased in 90 cases (32.72%). Multivariate logic analysis showed that E/e', age, glycosylated hemoglobin, and estimated glomerular filtration rate (eGFR) were independent predictors of early exercise capacity reduction in these patients. Utilizing the correlation coefficients from pre-assessment clinical and CPET indicators within the logistic regression framework, we constructed a nomogram model to forecast the diminishing exercise tolerance in AMI patients. The predictive accuracy of this model, as indicated by a C-index of 0.771 and an area under the receiver operating characteristic (ROC) curve of 0.771 (95% CI: 0.710-0.832), demonstrates its potential as a robust tool in clinical settings. During a follow-up of 24 months, the incidence of clinical outcomes in patients with low exercise tolerance was significantly higher than that in patients with normal exercise tolerance, among which all-cause mortality and reinfarction were statistically different (P=0.009 and P=0.043).

Conclusions

The reduced exercise capacity in patients with AMI after initial PCI is related to age, diastolic dysfunction, renal function, and blood glucose control, which may lead to poor clinical prognosis. The nomogram prediction model performed well in predicting the declining exercise tolerance of patients with AMI.

Compositional alterations of the gut microbiota in acute myocardial infarction patients with type 2 diabetes mellitus

Background

Type 2 diabetes mellitus (T2DM) is a risk factor for acute myocardial infarction (AMI) and a common comorbidity in patients with AMI. T2DM doubles the fatality rate of patients with AMI in the acute phase of AMI and the follow-up period. However, the mechanisms by which T2DM increases the fatality rate remain unknown. This study sought to investigate changes in the gut microbiota of patients with AMI and T2DM (AMIDM) to extend understandings of the relative mechanisms from the aspects of gut microbiota.

Methods

Patients were recruited and divided into 2 groups comprising 15 patients with AMIDM and 15 patients with AMI but without T2DM (AMINDM). Their stool samples and clinical information were collected. 16S ribosomal DNA sequencing was used to analyze the structure and composition of the gut microbiota based on the operational taxonomic units.

Results

A significant difference was observed in the gut microbiota β diversity between the 2 groups. At the phylum level, the AMIDM patients showed an increase in the abundance of Firmicutes and a decrease in the abundance of Bacteroidetes compared to the AMINDM patients. At the genus level, the AMIDM patients showed an increase in the abundance of Companilactobacillus, Defluvitaleaceae UCG-011 and UCG-009, and a decrease in the abundance of Phascolarctobacterium and CAG 56 compared to the AMINDM patients. At the species level, the AMIDM patients showed an increase in the abundance of species unclassified NK4A214 group, Bacteroides clarus, Coprococcus comes, unclassified Defluviltaleaceae UCG-011, uncultured rumen bacterium, unclassified CAG 56, Barnesiella intestinihominis, Lachnospiraceae bacterium, Bacteroides nordii, unclassified UCG-009, and the Family XIII AD3011 group compared to the AMINDM patients. The gut microbiota function predictions indicated that the nucleotide metabolism-related pathway was significantly more increase in the patients with AMIDM than those with AMINDM. Additionally, the patients with AMIDM showed an increase in gram-positive bacteria and a decrease in the proportion of gram-negative bacteria. Our correlation analysis results on the gut microbiota and clinical parameters might extend understandings of the progression of AMI.

Conclusions

Changes in the gut microbiota composition of patients with AMIDM affect the severity of the metabolic disturbance and may be responsible for poorer clinical outcomes and worse disease progression in patients with AMIDM compared to those with AMINDM.

Acute myocardial infarction after inactivated COVID-19 vaccination: a case report and literature review

A number of vaccines have been developed and deployed globally to restrain the spreading of the coronavirus disease 2019 (COVID-19). The adverse effect following vaccination is an important consideration. Acute myocardial infarction (AMI) is a kind of rare adverse event after COVID-19 vaccination. Herein, we present a case of an 83-year-old male who suffered cold sweat ten minutes after the first inactivated COVID-19 vaccination and AMI one day later. The emergency coronary angiography showed coronary thrombosis and underlying stenosis in his coronary artery. Type II Kounis syndrome might be a potential mechanism, which is manifested as coronary thrombosis secondary to allergic reactions in patients with underlying asymptomatic coronary heart disease. We also summarize the reported AMI cases post COVID-19 vaccination, as well as overview and discuss the proposed mechanisms of AMI after COVID-19 vaccination, thus providing insights for clinicians to be aware of the possibility of AMI following COVID-19 vaccination and potential underlying mechanisms.

The ratio of QRS/RV6-V1: a new electrocardiographic predictor of short- and long-term adverse clinical outcomes in patients with acute myocardial infarction combined with new-onset right bundle branch block

Background

A few studies have focused on electrocardiography (ECG) parameters correlating with clinical prognosis in patients with acute myocardial infarction (AMI) combined with new-onset right bundle branch block (RBBB).

Objective

To assess the prognostic value of a new ECG parameter, namely, the ratio of QRS duration/RV₆-V₁ interval (QRS/RV₆-V₁), in patients with AMI combined with new-onset RBBB.

Materials and methods

A total of 272 AMI patients combined with new-onset RBBB who received primary percutaneous coronary intervention (P-PCI) were retrospectively enrolled in the study. First, the patients were divided into survival group and non-survival group. Demographic, angiographic, and ECG characteristics were compared between the two groups. Receiver operating characteristic (ROC) curve was used to screen the best ECG parameter for predicting 1-year mortality. Second, the ratio of QRS/RV₆-V₁, a continuous variable, was converted to the high ratio group and low ratio group according to the optimal cutoff value point determined by the X-tile software. We compared the patient's demographic, angiographic, and ECG characteristics, in-hospital major adverse cardiovascular events (MACE), and 1-year mortality between the two groups. Multivariate logistic and Cox regressions were used to evaluate whether the ratio of QRS/RV₆-V₁ was an independent prognostic factor of in-hospital MACE and 1-year mortality.

Results

The ROC curve showed that the ratio of QRS/RV₆-V₁ had a higher value for predicting in-hospital MACE and 1-year mortality than the QRS duration, RV₆-V₁ interval, and RV₁ interval. The patients in the high ratio group had significantly higher CK-MB peak and Killip class, lower ejection fraction (EF%), higher ratio of the left anterior (LAD) descending artery as infarct-related artery (IRA), and longer total ischemia time (TIT) than those in the low ratio group. The QRS duration was wider in the high ratio group than that in the low ratio group, whereas RV₆-V₁ was narrower in the high ratio group compared with that in the low ratio group. The in-hospital MACE rate (93.3% vs. 31.0%, p < 0.001) and 1-year mortality rate (86.7% vs. 13.2%, p < 0.001) in the high ratio group were higher than those in the low ratio group. The higher ratio of QRS/RV₆-V₁ was an independent predictor of in-hospital MACE (odds ratio, 8.55; 95% CI, 1.40-52.37; p = 0.02) after adjusting other confounders. Cox regression showed that the higher ratio of QRS/RV₆-V₁ predicted higher 1-year mortality of the patients with AMI combined with new-onset RBBB [hazard ratios (HR), 12.4; 95% CI, 7.26-21.22); p < 0.001] than the lower ratio of QRS/RV₆-V₁, and the HR still stayed at 2.21 even after a multivariable adjustment (HR, 2.21; 95% CI, 1.05-4.64); p = 0.037).

Conclusion

According to the results of our study, the high ratio of QRS/RV₆-V₁ (>3.0) was a valuable predictor of short- and long-term adverse clinical outcomes in AMI patients combined with new-onset RBBB. The implications of the high ratio of QRS/RV₆-V₁ were severe ischemia and pseudo synchronization between bi-ventricle.

Chemiluminescence Biosensor for the Determination of Cardiac Troponin I (cTnI)

Cardiac vascular diseases, especially acute myocardial infarction (AMI), are one of the leading causes of death worldwide. Therefore cardio-specific biomarkers such as cardiac troponin I (cTnI) play an essential role in the field of diagnostics. In order to enable rapid and accurate measurement of cTnI with the potential of online measurements, a chemiluminescence-based immunosensor is presented as a proof of concept. A flow cell was designed and combined with a sensitive CMOS camera allowing sensitive optical readout. In addition, a microfluidic setup was established, which achieved selective and quasi-online cTnI determination within ten minutes. The sensor was tested with recombinant cTnI in phosphate buffer and demonstrated cTnI measurements in the concentration range of 2-25 µg/L. With the optimized system, a limit of detection (LoD) of 0.6 µg/L (23 pmol/L) was achieved. Furthermore, the selectivity of the immunosensor was investigated with other recombinant proteins, such as cTnT, and cTnC, at a level of 16 µg/L. No cross-reactivity could be observed. Measurements with diluted blood plasma and serum resulted in an LoD of 60 µg/L (2.4 nmol/L) and 70 µg/L (2.9 nmol/L), respectively.

Radioiodinated hypericin as a tracer for detection of acute myocardial infarction: SPECT-CT imaging in a swine model

PURPOSE

Hypericin (Hyp) is a natural compound with a newly discovered necrosis-avidity, which can be exploited as a necrosis-avid tracer once labeled with radioactive iodine as has been tested in rodent models. This study was to evaluate the effect of radioiodinated Hyp (131I-Hyp) for imaging detection of acute myocardial infarction (AMI) in conditions closer to clinical scenarios.

METHODS

We established swine AMI models (n = 6) which were intravenously given 131I-Hyp and 99mTc-sestamibi and underwent SPECT-CT imaging with high- and low-energy collimators. The acquired SPECT images were fused with cardiac CT images and correlated with postmortem autoradiography and macro- and microscopic pathology. Tissue γ counting was performed to determine biodistribution of 131I-Hyp.

RESULTS

131I-Hyp based SPECT indicated clearly hot regions on ventricular walls which were all histologically proved as AMI. Complementally, the hot AMI regions on 131I-Hyp SPECT (infarct/myoc ratio of 15.3 ± 7.7) were inversely cold regions on 99mTc-sestamibi SPECT (infarct/myoc ratio of 0.029 ± 0.021). Autoradiography of heart slices showed 9.8 times higher 131I-Hyp uptake in infarcted over normal myocardium. With γ counting, the mean 131I-Hyp uptake in infarcts was 10.69 ID%/g, 12.05 times of that in viable myocardium.

CONCLUSION

131I-Hyp shows a potential for clinical detection of AMI once I-131 is substituted by its isotope like I-124 or I-123 for PET or SPECT, respectively.

Five-years' prognostic analysis for coronary artery ectasia patients with coronary atherosclerosis: A retrospective cohort study

Background

Most of coronary artery ectasia (CAE) patients have comorbid coronary atherosclerosis. It was lack of prognostic data for CAE patients with coronary heart disease (CHD) and for whom with acute myocardial infarction (AMI).

Objective

To determine the overall prognosis for CAE patients.

Materials and methods

This study was a retrospective cohort study. Fifty-one patients with CAE and comorbid AMI (CAE + AMI) and 108 patients with CAE and comorbid CHD (CAE + CHD) were enrolled and matched to non-CAE subjects at a ratio of 1:3 using a propensity score method, respectively. Controls for CAE + AMI group were 153 AMI patients, controls for CAE group were 324 CHD patients and 329 participants with relatively normal coronary arteries (CON). We followed them up to observe major cardiovascular events (MACE).

Results

The Kaplan-Meier curves showed that the prognosis in CAE + AMI group was worse than in AMI group (5-year non-MACE rate: 62.70% vs. 79.70%, P = 0.010), the prognosis in CAE group was worse than in CHD and CON groups (5-year non-MACE rate: 74.10% vs. 85.80% and 96.70%, respectively, P = 0.000). The main MACEs in CAE + AMI and CAE groups were AMI reoccurrence (19.61% vs. 4.57%, P = 0.002) and re-hospitalization due to repeated angina pectoris (14.81% vs. 8.33% and 2.74%, P = 0.000), respectively. Additionally, the COX regression analysis revealed that the protective factors for preventing MACE in CAE + AMI group included antiplatelet agents (hazard ratio = 0.234, P = 0.016) and angiotensin-converting enzyme inhibitor/angiotensin receptor inhibitor (ACEI/ARB, hazard ratio = 0.317, P = 0.037). Whereas the main factor promoting MACE in CAE group was the degree of coronary stenosis (Gensini score, hazard ratio = 1.011, P = 0.022).

Conclusion

The prognosis of patients with CAE + AMI was worse than that of those with AMI. The overall prognosis of patients with CAE was worse than that of those with CHD. CAE + AMI and CAE groups had different characteristics; the former was prone to AMI reoccurrence, and the latter was prone to repeated angina pectoris. To prevent MACE, medications, including antiplatelets and ACEI/ARBs, are indicated for patients with CAE + AMI, whereas prevention of the progression of atherosclerotic lesions is indicated for patients with CAE.

Case report: What course to follow when left bundle branch pacing encounters acute myocardial infarction?

Compared with traditional right ventricular apical pacing, His-bundle pacing (HBP) provides more physiologic pacing by activating the normal conduction system. However, HBP has some limitations including higher pacing thresholds. In addition, disease in the distal His-Purkinje system may prevent the correction of abnormal conduction. Left bundle branch pacing (LBBP) may overcome these disadvantages by providing lower pacing thresholds and relatively narrow QRS duration that improve cardiac function. Here, we describe a rare case of a transient loss of ventricular capture due to acute anterior wall myocardial infarction in an LBB-paced patient. With the improvement of the ischemia, the function of the pacemaker partly recovered. We review the adaptations, advantages, and limitations, and long-term safety of LBBP.

Efficacy Evaluation of SDF-1α-Based Polypeptides in an Acute Myocardial Infarction Model Using Structure-Based Drug Design

Stromal cell-derived factor-1 alpha (SDF-1α, CXCL12) mediates the migration of circulating cells to desired sites for tissue development, homeostasis, and regeneration and can be used to promote cardiac regeneration by recruiting stem cells. However, the use of SDF-1α in the injured heart necessitates not only higher binding affinity to its receptor, CXCR4+, but also better robustness against enzymatic degradation than other SDF-1 isoforms. Here, we conduct a screening of SDF-1α analog peptides that were designed by structure-based drug design (SBDD), a type of computer-aided drug design (CADD). We have developed in vitro and in vivo methods that enable us to estimate the effect of peptides on the migration of human mesenchymal stem cells (hMSCs) and cardiac regeneration in acute myocardial infarction (AMI)-induced animals, respectively. We demonstrate that one type of SDF-1α analog peptide, SDP-4, among the four analog peptides preselected by SBDD, is more potent than native SDF-1α for cardiac regeneration in myocardial infarction. It is interesting to note that the migratory effects of SDP-4 determined by a wound healing assay, a Transwell assay, and a 2D migration assay are comparable to those of SDF-1α. These results suggest that in vivo, as well as in vitro, screening of peptides developed by SBDD is a quintessential process to the development of a novel therapeutic compound for cardiac regeneration. Our finding also has an implication that the SDP-4 peptide is an excellent candidate for use in the regeneration of an AMI heart.

Sex disparities in the association between acute myocardial infarction and colon cancer risk

BACKGROUND

Acute myocardial infarction (AMI) and colon cancer share similar risk factors. Studies have suggested an association between AMI and colon cancer; however, evidence is conflicting. Whether sex disparities exist in this association in the real world remains unknown.

METHODS

In this population-based retrospective cohort study, 94,780 and 97,987 male patients and 38,697 and 72,007 female patients with and without new-onset AMI, respectively, from January 1, 2001, to December 31, 2012, were enrolled from Taiwan's National Health Insurance Research Database. Inverse probability of treatment weighting (IPTW) was used to balance covariates across study groups. The primary outcome was a new diagnosis of colon cancer.

RESULTS

The incidence rate of colon cancer was 1.54 (95% confidence interval [CI] = 1.46-1.62) and 1.40 (95% CI = 1.32-1.48) per 1000 person-years in the male patients and 1.62 (95% CI = 1.50-1.74) and 1.22 (95% CI = 1.13-1.32) in the female patients, in the AMI and non-AMI groups, respectively. AMI was associated with a significantly higher risk of colon cancer in the female patients (hazard ratio [HR] = 1.31, 95% CI = 1.06-1.61) but not in the male patients (HR = 1.09, 95% CI = 0.95-1.26). In the subgroup analysis, the association between AMI and colon cancer in the female patients was stronger in those aged ≥65 years (HR = 1.28, 95% CI = 1.13-1.44).

CONCLUSIONS

An increased risk of colon cancer was observed only in the female patients with AMI. The association between AMI and colon cancer in the female patients was the most evident in those aged ≥65 years.

The value of N-terminal pro-brain natriuretic peptide and hs-CRP in predicting acute kidney injury after acute myocardial infarction

OBJECTIVE

To evaluate the value of combined detection of N-terminal pro-brain natriuretic peptide (NT-pro BNP) and high-sensitivity C-reactive protein (hs-CRP) in predicting acute kidney injury (AKI) after acute myocardial infarction (AMI).

METHOD

We retrospectively analyzed data of 107 patients with AMI admitted to our hospital from May 2020 to May 2021. The patients were assigned into an AKI group (AKIG) (n = 27) and a non-AKI group (NAKIG) (n = 80) according to whether AKI occurred within 1 week after admission. A total of 50 healthy people who underwent physical examination at the same duration were taken as control group (CG). Clinical data, expression of hs-CPR and NT-pro BNP were detected and compared between AKIG and NAKIG. Logistic regression model was applied to analyze risk factors of AKI after AMI, and Pearson linear correlation was used to analyze the correlation of hs-CRP and NT-pro BNP in patients with both AMI and AKI. Receiver operating characteristic (ROC) curve and area under the curve (AUC) were drawn and determined, and predictive value of hs-CRP and NT-pro BNP alone as well as in combination with AKI after AMI was analyzed respectively.

RESULTS

Compared with CG, hs-CRP and NT-pro BNP of AKIG and NAKIG were markedly increased (P<0.0001). In AKIG, the levels of uric acid, blood urea nitrogen, serum creatinine (SCr), hs-CRP, NT-pro BNP were higher compared to those in NAKIG, while the estimated glomerular filtration rate (eGFR) was evidently lower than that of NAKIG (P<0.01). Logistic regression model suggested that the use of diuretics, SCr, eGFR, hs-CRP and NT-pro BNP were the risk factors of AKI in patients with AMI (P<0.05). The level of hs-CRP was positively related with NT-pro BNP (P<0.05). ROC curve analysis indicated AUCs of hs-CRP and NT-pro BNP alone as well as in combination were all over 0.8 in predicting the occurrence of AKI after AMI.

CONCLUSION

The increase of hs-CRP and NT-pro BNP linked closely to the occurrence of AKI after AMI, and the combined detection of the two was of high value in predicting the occurrence of AKI among patients with AMI.

Expression of ATP-binding cassette subfamily B member 1 gene in peripheral blood of patients with acute myocardial infarction

This study aimed to determine the amount of expression of the ATP-binding cassette subfamily B member 1 (ABCB1) gene chip as a prospective diagnostic marker for acute myocardial infarction (AMI) in a wide population . In the AMI and control groups, 113 patients with AMI and 83 persons with non-coronary artery disease were selected for peripheral venous leukocyte collection. Western blot and real-time polymerase chain reaction (RT-PCR) were employed to detect relative ABCB1 expression in both groups. The results showed that the ABCB1 transcription and protein levels in the AMI group were higher than in the control. The relative mRNA expression of ABCB1 was 0.26 (0.03-0.79) in the AMI group and 0.13 (0.01-0.52) in the control group (P < 0.05). The expression of the ABCB1 gene at the protein level in the AMI group was 1.65 times that in the control (P < 0.05). Further, the subjects in the AMI group were older (P < 0.001), had lower levels of high-density lipoprotein cholesterol (P = 0.038), and had higher incidence of type II diabetes mellitus (P = 0.003) compared with the control. Logistic regression analysis showed that the expression of ABCB1 in peripheral blood was correlated with the occurrence of AMI (P = 0.003). High ABCB1 expression, type II diabetes, and advanced age were found to serve as potential independent risk factors for AMI, with a 4.88-fold, 2.99-fold, and 2.63-fold increased risk of AMI. Overall, the high expression of ABCB1 in peripheral blood might be related to the occurrence of AMI.

Level of von Willebrand factor to assess the occurrence and prognosis of acute myocardial infarction

BACKGROUND

To observe and compare the differences in von Willebrand factor antigen (vWF:Ag) levels between patients with acute myocardial infarction (AMI) and healthy residents, and to determine whether this measure can be used to evaluate the incidence of AMI and whether or not to undertake cardiac bypass surgery.

METHODS

A retrospective analysis was conducted using the clinical data of 110 patients with acute cardiovascular disease without bypass (no bypass group), 351 patients with AMI and bypass (bypass group), and 60 healthy volunteers (healthy group) who underwent physical examination between July 2018 and May 2019 in Tianjin Chest Hospital. The plasma vWF:Ag was measured and the receiver operating characteristic (ROC) curve was utilized to critically assess its efficacy in determining the occurrence and prognosis of AMI, and the Chi-square test was used to evaluate the correlation between vWF:Ag and clinicopathological factors.

RESULTS

The plasma vWF:Ag was 201% (139%, 250%) in the bypass group, 118% (107%, 134%) in the non-bypass group, and 95.5% (85.25%, 102.75%) in the control group, and the differences were statistically significant (P<0.05). The component status of the plasma vWF:Ag used in the bypass group was greater as compared to that of the normal group (P<0.05) and the non-bypass group (P<0.05). The area under the ROC curve of plasma vWF:Ag level was 0.797 (95% CI: 0.749-0.845). When the medical decision level of plasma vWF:Ag was set at 155.5%, the sensitivity and specificity of predicting AMI were 68.9% and 86.7%, respectively. The levels of plasma vWF:Ag in patients with AMI were correlated with hypertension, diabetes, age, and history of cerebral infarction (P<0.05).

CONCLUSIONS

The plasma vWF level can predict the occurrence of AMI and provides guidance for cardiac bypass surgery.

The Neutrophil-to-Lymphocyte Ratio Is an Important Indicator Predicting In-Hospital Death in AMI Patients

Objective: To explore the role of neutrophil-to-lymphocyte ratio (NLR) in predicting the short-term prognosis of NSTEMI and STEMI. Methods: This study was a single-center, retrospective and observational study. 2618 patients including 1289 NSTMI and 1329 STEMI patients were enrolled from June 2013 to February 2018 in Zhongda Hospital, Southeast University. The demographic information, clinical characteristics, medical history, laboratory examination, treatment, and outcome of individuals at admission and during hospitalization were extracted from the electronic medical record system. Outcome was defined as the all-cause death during hospitalization. Results: (1) In the NSTEMI group, the ability of NLR in predicting in-hospital death (AUC = 0.746) was higher than the neutrophil-monocyte ratio (NMR) (AUC = 0.654), the platelet-lymphocyte ratio (PLR) (AUC = 0.603) and the lymphocyte-monocyte ratio (LMR) (AUC = 0.685), and also higher than AST (AUC = 0.621), CK (AUC = 0.595), LDH (AUC = 0.653) and TnI (AUC = 0.594). The AUC of NLR in the STEMI group was only 0.621. (2) The optimal cut-off value of NLR in NSTEMI group was 5.509 (Youden index = 0.447, sensitivity = 77.01%, specificity = 67.72%). After adjusting variables including age, sex, diabetes history, smoking history, LDL-C and Cr, the logistic regression showed that the patients with NLR>5.509 had higher hazard risk of death (HR4.356; 95%CI 2.552-7.435; P < 0.001) than the patients with NLR ≤ 5.509. (3) Stratification analysis showed that the in-hospital mortality of patients with NLR > 5.509 was 14.611-fold higher than those with NLR ≤ 5.509 in patients aged <76, much higher than the ratio in patients aged ≥ 76. For patients with creatinine levels ≤ 71, the in-hospital death risk in high NLR group was 10.065-fold higher than in low NLR group (95%CI 1.761-57.514, P = 0.009), while the HR was only 4.117 in patients with creatinine levels > 71. The HR in patients with or without diabetes were 6.586 and 3.375, respectively. The HR in smoking or no smoking patients were 6.646 and 4.145, respectively. The HR in patients with LDL-C ≥ 2.06 or <2.06 were 5.526 and 2.967 respectively. Conclusion: Compared to NMR, PLR, and LMR, NLR had the best ability in predicting in-hospital death after NSTEMI. Age, creatinine, LDL-C, diabetes and smoking history were all important factors affecting the predictive efficiency in NSTEMI. NLR had the limited predictive ability in STEMI.

Effect of myeloperoxidase oxidation and N-homocysteinylation of high-density lipoprotein on endothelial repair function

Endothelial cell (EC) migration is essential for healing vascular injuries. Previous studies suggest that high-density lipoprotein (HDL) and apolipoprotein A-I (apoA-I), the major protein constituent of HDL, have endothelial healing functions. In cardiovascular disease, HDL is modified by myeloperoxidase (MPO) and N-homocysteine, resulting in apoA-I/apoA-II heterodimer and N-homocysteinylated (N-Hcy) apoA-I formation. This study investigated whether these modifications attenuate HDL-mediated endothelial healing. Wound healing assays were performed to analyze the effect of MPO-oxidized HDL and N-Hcy HDL in vitro. HDL obtained from patients with varying troponin I levels were also examined. MPO-oxidized HDL reduces EC migration compared to normal HDL in vitro, and N-Hcy HDL showed a decreasing trend toward EC migration. EC migration after treatment with HDL from patients was decreased compared to HDL isolated from healthy controls. Increased apoA-I/apoA-II heterodimer and N-Hcy apoA-I levels were also detected in HDL from patients. Wound healing cell migration was significantly negatively correlated with the ratio of apoA-I/apoA-II heterodimer to total apoA-II and N-Hcy apoA-I to total apoA-I. MPO-oxidized HDL containing apoA-I/apoA-II heterodimers had a weaker endothelial healing function than did normal HDL. These results indicate that MPO-oxidized HDL and N-Hcy HDL play a key role in the pathogenesis of cardiovascular disease.

Effect analysis of kinetic energy progressive exercise in patients with acute myocardial infarction after percutaneous coronary intervention: a randomized trial

BACKGROUND

Acute myocardial infarction (AMI) is the most common critical illness clinically. Percutaneous coronary intervention (PCI) can help patients with AMI by reopening their blocked blood vessels and improving clinical symptoms. Clinical practice has confirmed that rehabilitation training after PCI could significantly promote the recovery of patients' heart function, reduce cardiovascular events, and have a positive significance for prognosis. This study aimed to explore the effect of kinetic energy progressive exercise (PEKE) applied to patients with AMI after PCI.

METHODS

From April 2019 to April 2020, a total of 98 patients with AMI after PCI in our hospital were randomly allocated to PEKE group and routine intervention (RI) group. The RI group adopted routine intervention, while the PEKE group introduced PEKE intervention on the basis of the RI group. The incidence of adverse events (AEs), motor function, cardiac function, and quality of life (QoL) before and after intervention were compared between the two groups.

RESULTS

Compared with the RI group, the incidence of AEs in the PEKE group was significantly reduced (χ2=4.404, P=0.036). After 6 months of intervention, the maximum exercise load and metabolic equivalent of the PEKE group were greater than those of the RI group (t=7.114, 4.565; P=0.000, 0.000). After 6 months of intervention, the left ventricular ejection fraction (LVEF) of the PEKE group was greater than that of the RI group (t=6.826, P=0.000), and there were no significant differences in left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV) compared with the RI group (t=1.253, 1.147; P=0.213, 0.254). After 6 months of intervention, the PEKE group's symptoms, physical function, cognitive function, psychosocial function, and satisfaction scores were greater than those in the RI group (t=5.991, 4.612, 7.165, 5.731, 5.468; P=0.000, 0.000, 0.000, 0.000, 0.000).

CONCLUSIONS

We applied PEKE was to AMI patients with after PCI, and it was shown to effectively reduce AEs, improve the patients' exercise ability and cardiac function, and improve their QoL.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: ChiCTR2100046123.

Effects of mechanical circulatory support devices in patients with acute myocardial infarction undergoing stent implantation: a systematic review and meta-analysis of randomised controlled trials

OBJECTIVE

The survival benefit of using mechanical circulatory support (MCS) in patients with acute myocardial infarction (AMI) is still controversial. It is necessary to explore the impact on clinical outcomes of MCS in patients with AMI undergoing stenting.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Embase, Cochrane Library, Medline, PubMed, Web of Science, ClinicalTrials.gov and Clinicaltrialsregister.eu databases were searched from database inception to February 2021.

ELIGIBILITY CRITERIA

Randomised clinical trials (RCTs) on MCS use in patients with AMI undergoing stent implantation were included.

DATA EXTRACTION AND SYNTHESIS

Data were extracted and summarised independently by two reviewers. Risk ratios (RRs) and 95% CIs were calculated for clinical outcomes according to random-effects model.

RESULTS

Twelve studies of 1497 patients with AMI were included, nine studies including 1382 patients compared MCS with non-MCS, and three studies including 115 patients compared percutaneous ventricular assist devices (pVADs) versus intra-aortic balloon pump (IABP). Compared with non-MCS, MCS was not associated with short-term (within 30 days) (RR=0.90; 95% CI 0.57 to 1.41; I²=46.8%) and long-term (at least 6 months) (RR=0.82; 95% CI 0.57 to 1.17; I²=37.6%) mortality reductions. In the subset of patients without cardiogenic shock (CS) compared with non-MCS, the patients with IABP treatment significantly had decreased long-term mortality (RR=0.49; 95% CI 0.27 to 0.90; I²=0), but without the short-term mortality reductions (RR=0.51; 95% CI 0.22 to 1.19; I²=17.9%). While in the patients with CS, the patients with MCS did not benefit from the short-term (RR=1.09; 95% CI 0.67 to 1.79; I²=46.6%) or long-term (RR=1.00; 95% CI 0.75 to 1.33; I²=22.1%) survival. Moreover, the application of pVADs increased risk of bleeding (RR=1.86; 95% CI 1.15 to 3.00; I²=15.3%) compared with IABP treatment (RR=1.86; 95% CI 1.15 to 3.00; I²=15.3%).

CONCLUSIONS

In all patients with AMI undergoing stent implantation, the MCS use does not reduce all-cause mortality. Patients without CS can benefit from MCS regarding long-term survival, while patients with CS seem not.

The Radiologist as a Gatekeeper in Chest Pain

Chest pain is a symptom that can be found in life-threatening conditions such as acute coronary syndrome (ACS). Those patients requiring invasive coronary angiography treatment or surgery should be identified. Often the clinical setting and laboratory tests are not sufficient to rule out a coronary or aortic syndrome. Cardiac radiological imaging has evolved in recent years both in magnetic resonance (MR) and in computed tomography (CT). CT, in particular, due to its temporal and spatial resolution, the quickness of the examination, and the availability of scanners, is suitable for the evaluation of these patients. In particular, the latest-generation CT scanners allow the exclusion of diagnoses such as coronary artery disease and aortic pathology, thereby reducing the patient's stay in hospital and safely selecting patients by distinguishing those who do not need further treatment from those who will need more- or less-invasive therapies. CT additionally reduces costs by improving long-term patient outcome. The limitations related to patient characteristics and those related to radiation exposure are weakening with the improvement of CT technology.

A case report of acute simultaneous cardiocerebral infarction: possible pathophysiology

The occurrence of acute myocardial infarction (AMI) accompanied by ischemic cerebrovascular accidents has rarely been reported in previous articles. In this report, we present a 72-year-old female patient with massive cerebral infarction secondary to acute anterior and high lateral wall myocardial infarction, finally resulting in a deep coma. The patient ultimately failed to respond to aggressive resuscitation and succumbed to cardiogenic shock and fatal ventricular arrhythmias. We consider that the co-occurrence of these diseases is more than just a coincidence, and that there may be a connection between them. In this article, we performed an in-depth exploration and discussion of the explanation of this phenomenon. It is essential to recognize these situations in the early stages, which determines the follow-up treatment and prognosis. We suggest that decisions regarding patient management should be based on hemodynamic stability, close cardiac monitoring, and the site of cerebral infarction, and also emphasize that the evaluation of hemodynamic status in these patients is a prerequisite for deciding whether to treat the cerebral or coronary infarction first. The present report is written for the purpose of reminding readers of this rare and severe situation, and to emphasize the necessity for further research on how to deal with it best.

Long non-coding RNA SENCR alleviates hypoxia/reoxygenation-induced cardiomyocyte apoptosis and inflammatory response by sponging miR-1

Background

Myocardial cell apoptosis is one of the main reasons for the occurrence of acute myocardial infarction (AMI). The role of smooth muscle and endothelial cell enriched migration/differentiation-associated lncRNA (SENCR) in the cardiomyocyte apoptosis induced by hypoxia/reoxygenation (H/R) injury and its potential mechanism were investigated in this study to provide a novel biomarker for the development of AMI.

Methods

The expression levels of SENCR in the serum of AMI patients and non-AMI patients with chest pain (control) were detected by qRT-PCR. The function of SENCR in the cardiomyocyte apoptosis and inflammatory response induced by H/R injury was evaluated by MTT, cell apoptosis, and ELISA assay, respectively. The mechanism underlying the function of SENCR was investigated with the luciferase reporter assay.

Results

SENCR was significantly downregulated in AMI compared with the control volunteers, which showed negative correlations with the cardiac troponin I (cTnI) and creatine kinase-MB (CK-MB) level of patients. The H/R injury-induced cell apoptosis and inflammatory response in cardiomyocytes, which were attenuated by the overexpression of SENCR. The expression of miR-1 was suppressed by the overexpression of SENCR, while the overexpression of miR-1 could alleviate the cell apoptosis, enhance cell viability, and attenuate inflammatory response in cardiomyocyte. SENCR reversed H/R-induced myocardial cell injury by regulating the expression of miR-1.

Conclusions

SENCR was correlated with the clinicopathological features of patients and was revealed to alleviate the cardiomyocyte apoptosis and inflammatory response induced by H/R injury via sponging miR-1.

Observation of the effect of a 7-day gradual early functional exercise program in middle-aged and young patients with acute myocardial infarction after percutaneous coronary intervention

BACKGROUND

Acute myocardial infarction (AMI) is characterized by a critical condition, rapid progression, and a high fatality rate. Percutaneous coronary intervention (PCI) is the treatment of choice for AMI. The purpose of this study was to investigate the efficacy of a 7-day gradual early functional exercise program after PCI in young and middle-aged patients with AMI.

METHODS

A total of 106 young and middle-aged patients with AMI at the Affiliated Hospital of Jiangnan University from May 2018 to May 2019 were selected and divided into 2 groups according to the random number table method (n=53 per group). Both groups were treated with PCI, and the control group then received routine functional exercises after surgery, whilst the observation group received a 7-day gradual early functional exercise program after surgery. Functional exercise compliance, daily life ability before and after intervention, changes in quality of life, and postoperative complications after 1 year were compared between the 2 groups.

RESULTS

The functional exercise compliance of the observation group was significantly higher than that of the control group (P<0.05). The daily living ability of the observation group was also significantly better than that of the control group after the intervention (PP<0.05). The physical activity, emotional response, diet, adverse drug reactions, and anxiety medication scores of the observation group after the intervention were lower than those of the control group (PP<0.05). Furthermore, the postoperative complications and total complication rate after 1 year in the observation group was lower than the control group (PP<0.05).

CONCLUSIONS

The application of a 7-day gradual early functional exercise program in young and middle-aged patients with AMI after PCI can improve functional exercise compliance, daily life ability, quality of life, and reduce the incidence of complications.

Effects of alprostadil combined with tanshinone IIa injection on microcirculation disorder, outcomes, and cardiac function in AMI patients after PCI

BACKGROUND

Alprostadil can effectively dilate blood vessels, improve cardiac microcirculation, and reduce cardiac load. Tanshinone IIa injection can protect against atherosclerosis and reduce myocardial oxygen consumption. However, the effects of alprostadil combined with tanshinone IIa injection on microcirculation disorder, outcomes, and cardiac function in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI) are still not fully clear.

METHODS

A total of 300 AMI patients who underwent PCI in our hospital from January 2013 to June 2018 were randomly selected and divided into group A, B, C by using the random number table method, with 100 patients in each group. The group A was treated with alprostadil, the group B was treated with tanshinone IIa injection, and the group C was treated with alprostadil combined with tanshinone IIa injection. 7 days after treatment, the cardiac functions of all patients were observed by ultrasonic Doppler, as were the microcirculations by myocardial contrast echocardiography (MCE). The major adverse cardiac events (MACEs) in both groups were observed in the 12-month follow-up.

RESULTS

After treatment, the left ventricular end-diastolic diameter (LVEDD), end-diastolic left ventricular posterior wall thickness (LVPWD), left ventricular ejection fraction (LVEF), left ventricular end-systolic diameter (LVESD), interventricular septum thickness (IVST), and ratio of maximal early to late diastolic filling velocities (E/A) in the group C were superior to those in the group A and B, the differences were statistically significant (PP<0.05). After treatment, MCE showed that the Aβ value of the group aC was higher than that of the group A and B, the difference was statistically significant (P<0.05). The thrombolysis in myocardial infarction myocardial perfusion grade classification showed that the patients with grades 2‒3 were more abundant in the group C than the group A and B, the difference was statistically significant (PP<0.05). The incidences of MACEs, such as malignant arrhythmia, recurrent heart failure (HF), recurrent myocardial infarction, and death, in the group C were significantly lower than those in the group A and B (PP<0.05).

CONCLUSIONS

For AMI patients after PCI, alprostadil combined with tanshinone IIa injection can effectively improve microcirculation and ventricular remodeling, improve cardiac function and reduce the occurrence of MACEs. This combination can be widely used in clinical practice.

Evaluation of the 0 h/1 h high-sensitivity cardiac troponin T algorithm in diagnosis of non-ST-segment elevation myocardial infarction (NSTEMI) in Han population

OBJECTIVES

A rapid 0 h/1 h algorithm using high-sensitivity cardiac troponin T (hs-cTnT) for rule-out and rule-in of non-ST-segment elevation myocardial infarction (NSTEMI) is recommended by the European Society of Cardiology. We aim to prospectively evaluate the diagnostic performance of the algorithm in Chinese Han patients with suspected NSTEMI.

METHODS

In this prospective diagnostic cohort study, 577 patients presenting to the emergency department with suspected NSTEMI and recent (<12 h) onset of symptoms were enrolled. The levels of serum hs-cTnT were measured on admission, 1 h later and 4-14 h later. All patients underwent the initial clinical assessment and were triaged into three groups (rule-out, rule-in and observe) according to the 0 h/1 h algorithm. The major cardiovascular events (MACE) were evaluated at the 7-day and 30-day follow-ups.

RESULTS

Among 577 enrolled patients, NSTEMI was the final diagnosis for 106 (18.4%) patients. Based on the hs-cTnT 0 h/1 h algorithm, 148 patients (25.6%) were classified as rule-out, 278 patients (48.2%) as rule-in and 151 patients (26.2%) were assigned to the observe group. The rule-out approach resulted in a sensitivity of 100% and negative predictive value of 100%. The rule-in approach resulted in a specificity of 62.9% [95% CI (58.5-67.2%)] and positive predictive value of 37.1% [95%CI (31.3-42.8%)]. No MACE was observed in the rule-out group within 30-day follow-up.

CONCLUSIONS

The hs-cTnT 0 h/1 h algorithm is a safe tool for early rule-out of NSTEMI, while probably not an effective strategy for accurate rule-in of NSTEMI in Chinese Han population.

Rapid Distance-Based Cardiac Troponin Quantification Using Paper Analytical Devices for the Screening and the Follow-Up of Acute Myocardial Infarction, Using a Single Drop of Human Whole Blood

This work introduces the procedure of using non-immunoassay distance-based paper analytical devices (dPADs) to accurately measure any traces of the cardiac troponin I (TnI) in whole blood samples without the use of any external blood separation. This enables a rapid clinical diagnosis and the subsequent follow-up in regard to identifying acute myocardial infarction. These dPADs are designed and constructed to accommodate three parts: (1) a blood separation zone that is immobilized with a hemostatic agent, this no longer requires a blood separation membrane for the isolation of the plasma from the blood element, (2) a pretreatment zone, and (3) a detection zone coated with thymol blue. The quantitative TnI level in the whole blood was determined by measuring the blue color length found in the detection zone, which is proportional to the concentration, owing to the dry protein binding principle. Correspondingly, a mere single drop of human whole blood performs adequately within our proposed method. This reduces both the size of the collection process and the sample volumes needed in the respective medical fields. As we cover all of the optimization studies, our dPADs provide an evaluation of the linearity range from 0.025 to 2.5 ng/mL (R² = 0.9989) of TnI, with a detection limit as low as 0.025 ng/mL by use of an observation just using the naked eye. To validate the clinical utilities of our proposed method, our dPADs were then applied for the detection of TnI in humans using the whole blood sample of 15 volunteers. A great amount of accuracy was required in this assay because there was no significant difference between both methods, with the confidence level being as high as 95%. This technique also showed that the recoveries ranged from 99.40 to 104.27%, with the highest relative standard deviation being at 3.77%. Thus, our proposed dPADs offer more benefits for a rapid TnI determination.

Anti-IL-20 Antibody Protects against Ischemia/Reperfusion-Impaired Myocardial Function through Modulation of Oxidative Injuries, Inflammation and Cardiac Remodeling

Acute myocardial infarction (AMI) is the most critical event in the disease spectrum of coronary artery disease. To rescue cardiomyocytes in AMI, it is important to restore blood supply as soon as possible to reduce ischemia-induced injury. However, worse damage can occur during the reperfusion phase, called the reperfusion injury. Under ischemia/reperfusion (I/R) injury, elevated oxidative stress plays a critical role in regulation of apoptosis, inflammation and remodeling of myocardium. Our previous study has demonstrated that interleukin (IL)-20 is increased during hypoxia/reoxygenation stimulation and promotes apoptosis in cardiomyocytes. This study was, therefore, designed to investigate whether IL-20 antibody could reduce I/R-induced myocardial dysfunction. Results from this study revealed that IL-20 antibody treatment significantly suppressed I/R-induced nicotinamide adenine dinucleotide phosphate oxidase, oxidative stress, apoptosis, proinflammatory responses, cardiac fibrosis, and expression of cardiac remodeling markers in Sprague-Dawley rats. Plasma B-type natriuretic peptide level was also reduced by IL-20 antibody injection. IL-20 antibody treatment appeared to restore cardiac function under the I/R injury in terms of greater values of ejection fraction and fractional shortening compared to the control group. Two commonly used indicators of cardiac injury, lactate dehydrogenase and creatine kinase-MB, were also lower in the IL-20 antibody injection group. Taken together, our results suggested that IL-20 antibody holds the potential to reduce the I/R-elicited cardiac dysfunction by preventing cardiac remodeling.

Prognostic value of free triiodothyronine and N-terminal pro-B-type natriuretic peptide for patients with acute myocardial infarction undergoing percutaneous coronary intervention: a prospective cohort study

Background

Altered thyroid function and increased N-terminal pro-B-type natriuretic peptide (NT-proBNP) are prognostic factors in acute myocardial infarction (AMI). The study aims to investigate whether free triiodothyronine (fT3) and NT-proBNP are prognostic factors for long-term outcomes in patients with AMI undergoing percutaneous coronary intervention (PCI).

Methods

This was an observational, prospective, single-center study of consecutive patients enrolled at Fuwai Hospital between January, 2013 and December, 2013. The patients were divided into two groups according to fT3 levels: low fT3 (<2.5 pg/mL) and normal fT3 (2.50–4.09 pg/mL). The primary outcome of this study was the incidence of major adverse cardiovascular events (MACEs).

Results

There were 252 patients with low fT3 and 561 patients with normal fT3. After >2 years of follow-up, patients with low fT3 levels had higher rates of MACEs than those with normal fT3 (27.0% vs. 7.8%, P<0.001). Univariable Cox proportional hazards regression analyses showed that NT-proBNP >802.7 pg/mL [hazard ratio (HR) =5.063, 95% confidence interval (CI): 3.176–8.071, P<0.001] and fT3 <2.5 pg/mL (HR =3.867, 95% CI: 2.646–5.651, P<0.001) were the strongest predictors of MACEs. After adjustment for traditional risk predictors, fT3 <2.5 pg/mL (HR =2.570, 95% CI: 1.653–3.993, P<0.001) was one of the most important independent predictors of MACEs. Patients with NT-proBNP ≤802.7 pg/mL and fT3 ≥2.5 pg/mL had the best prognosis, while patients with NT-proBNP >802.7 pg/mL and fT3 <2.5 pg/mL had the worst outcomes (P<0.001).

Conclusions

Low fT3 is a strong predictor of poor prognosis after AMI. The fT3+NT-proBNP combination might be a valuable predictor of the long-term outcomes of PCI after AMI.

Evaluation of exosomal miRNAs as potential diagnostic biomarkers for acute myocardial infarction using next-generation sequencing

Background

Acute myocardial infarction (AMI) is one of the most common global causes of death. Although considerable progress has been made in AMI diagnosis, there remains an urgent need for novel diagnostic biomarkers for its prevention and treatment. Functional exosomal microRNAs (miRNAs) are recognized as potential biomarkers in many diseases. This study’s objective was to identify specific plasma exosomal miRNAs with biomarker potential for early AMI detection.

Methods

Exosomes from the plasma of 26 coronary artery disease (CAD) patients, 55 AMI patients, and 37 healthy controls were isolated and characterized by transmission electron microcopy (TEM), western blotting, and nanoparticle tracking analysis (NTA). The miRNAs were purified from exosomes, and unique molecular identifier (UMI) small RNA sequencing was performed. The random forest (RF) model was trained to predict potential biomarkers.

Results

NTA demonstrated that nanoparticle concentration did not change after AMI, while nanoparticle size distribution significantly decreased. The CAD and AMI groups’ miRNA expression profiles significantly differed from the healthy group’s profile. The RF classifier could be used to distinguish the healthy group from the AMI group, but could not be used to distinguish the CAD group from the other groups, which caused a high classification error rate. Eighteen miRNAs were selected as biomarkers based on their RF classifier significance. The diagnostic accuracy of 18 miRNAs was evaluated using AUC values of 0.93, 0.87, and 0.75 to detect healthy controls, AMI, and CAD, respectively.

Conclusions

Nanoparticle diameter and the 18 miRNAs may serve as simple and accessible fingerprints for early AMI diagnosis.

Prognosis and clinical characteristics of patients with early ventricular fibrillation in the 6-week guideline-offered time period: is it safe to wait 6 weeks with the assessment? (results from the VMAJOR-MI Registry)

Background

The most common, potentially fatal complication following an acute myocardial infarction (AMI) is early ventricular fibrillation (EVF). According to the guidelines, the assessment of implanting an implantable cardioverter defibrillator (ICD) is sufficient 6 weeks after the event, in patients with reduced left ventricular ejection fraction (LVEF), regardless of VF. The present study aimed to evaluate the 6-week prognosis of patients surviving an EVF. We divided the patients in two group based on their general condition at the time they left the hospital. We investigated the clinical characteristics of patients discharged in good general health but still dying within 6 weeks.

Methods

The present study comprised 12,270 patients with AMI following their primary revascularization in the first 12 h of symptom onset. Five hundred and forty-seven of them suffered EVF due to the AMI. Clinical and 6-week mortality data were examined.

Results

Poor general condition correlates with multiple comorbidities, higher troponin levels, more severe complications after the event. Patients leaving in good condition thought to be low risk, from dying. But low LVEF, high blood sugar, high cardiac biomarker level, poor renal function elevates the risk of dying within 6 weeks. However, there is no difference in clinical characteristics between EVF- cases and EVF+ cases in good condition who dies within 6 weeks.

Conclusions

According to our study we can select patients who are safe in the critical 6-week period and those who need closer follow-up despite leaving in good general condition.

Elevated plasma Sirtuin2 level predicts heart failure after acute myocardial infarction

Background

There is currently no evidence regarding the role of plasma Sirtuin2 (SIRT2) level in acute myocardial infarction (AMI) yet. This study assessed the role of plasma SIRT2 in AMI, and investigated the association of plasma SIRT2 level with major adverse cardiovascular events (MACE) and heart failure after AMI.

Methods

This is a prospective observational study. A total of 129 AMI patients (mean age: 62.2±12.7 years old, male/female: 96/33) were included. Cox proportional hazards regression models were used to estimate the association of different SIRT2 levels with MACE and heart failure after AMI.

Results

According to the 75th percentile value of plasma SIRT2 level, we divided all the AMI patients into two groups: high-level group (plasma SIRT2 level ≥109.0 pg/mL) and low-level group (plasma SIRT2 level <109.0 pg/mL). Compared with the low-level group, the high-level group had higher percentage of Killip class ≥3 (P<0.001), left ventricular ejection fraction (LVEF) <50% (P=0.007) or even <40% (P=0.012), use of breathing machine(P=0.003), and higher plasma brain natriuretic peptide (BNP) level (P=0.006). Multivariate Cox regression analysis showed that there were higher risks of MACE [hazard ratio (HR) 11.20, 95% confidence interval (CI): 3.18–39.52, P<0.001)] and heart failure (HR 27.10, 95% CI: 4.65–157.83, P<0.001) in the high-level group.

Conclusions

The present study suggested that plasma SIRT2 level is a promising biomarker to predict heart failure and MACE after AMI.

The impact of the Type D Personality pattern on prehospital delay in patients suffering from acute myocardial infarction

Background

The Type D Personality (TDP) has been specifically linked to acute myocardial infarction (AMI). However, the impact on prehospital delay of AMI patients is unclear. The aim of this study was to assess the relationship between TDP and pre-hospital delay time (PHT) in a Chinese population.

Methods

A total of 256 AMI patients (47 women and 209 men) were taken from the Multicenter Delay in Patients Experiencing AMI in Shanghai (MEDEA FAR-EAST) study. Sociodemographic and psycho-behavioral characteristics were assessed by bedside interviews and questionnaires. TDP was evaluated according to the Type D Personality Scale (DS14) subdivided in social inhibition (SI) and negative affectivity (NA). Based on a significant interaction analysis of TDP and sex on PHT, all analyses were stratified by sex.

Results

PHT of female patients with TDP were substantially shorter compared to non-TDP female patients (108 vs. 281 min, P=0.029). In male patients, no effect of TDT on PHT was found. Spearman correlation analysis suggests that NA was negatively correlated with PHT (r=−0.358, P=0.014). Further age-adjusted logistic regression analyses showed that female patients with TDP were generally less likely to prehospital delay compared with non-TDP patients (OR =0.28; 95% CI, 0.08–0.98) and had a lower risk of PHT >360 minutes (OR =0.10; 95% CI, 0.01–0.91). However, statistical significance disappeared after adjustment for psychological factors (anxiety, depression, suboptimal wellbeing, cardiac denial and stress event).

Conclusions

TDP is associated with less prehospital delay in female patients during AMI—an effect which may be particularly mediated by NA.

Transcatheter closure for the treatment of pseudoventricular aneurysm after acute myocardial infarction: a case report

Left ventricular free wall rupture (LVFWR) is a rare but lethal complication of acute myocardial infarction (AMI). Urgent surgery is essential but associated with high postoperative mortality. Even worse, LVFWR patients may experience sudden death without a chance for surgery. In this article, we report our successful transcatheter closure of a patient with the most extensive pseudoventricular aneurysm after AMI reported thus far. Cardiac magnetic resonance imaging (MRI) revealed a giant pseudoventricular aneurysm located in the inferior and lateral walls of the left ventricle; the rupture diameter was 28 mm, and the maximum tumor diameter was 90.2 mm. We used transcarotid approach (TCA) and atrial septal defect closure umbrella to complete the operation, which solved the lack of special interventional instruments to treat pseudoventricular aneurysm after AMI. In addition, we still needed to treat liver and kidney failure caused by hemolysis after operation, and undergone strict follow-up. In conclusion, transcatheter closure is practical and feasible for the treatment of pseudoventricular aneurysm after AMI, although hemolysis and decline of cardiac pumping function after the successful interventional treatment deserve special attention. Future multicenter studies are required to identify patients best suited for interventional treatment timing. And further developments in devices and delivery techniques are required in order to optimize interventional outcomes.

Retrograde transcatheter closure of ventricular septal perforation after acute myocardial infarction: a case report

The use of the Lunderquist exchange guide wire via the retrograde approach of the right femoral vein-inferior vena cava-right atrium-right ventricle-ventricular septal perforation-left ventricle-descending aorta can maintain guide wire tension and significantly reduce the operative time. The patient was admitted due to chest pain for 3 hours. The diagnosis was acute anterior septal myocardial infarction with ventricular septal perforation. One week after admission, a drug-eluting stent was implanted in the left anterior descending branch. Repeated echocardiography revealed that the diameter of the ventricular septal perforation had increased from 6 to 12 mm. During this period, the patient suffered from repeated episodes of shortness of breath that were progressively exacerbated. The patient was transferred to the intensive care unit (ICU) and underwent intra-aortic balloon pump (IABP) implantation. Twenty days after admission, the Lunderquist exchange guide wire was used via the retrograde approach of the right femoral vein-inferior vena cava-right atrium-right ventricle-ventricular septal perforation-left ventricle-descending aorta. A 26-mm occluder was released for transcatheter closure of the ventricular septal perforation. Shortness of breath was immediately relieved. The patient was discharged 3 days later. Retrograde transcatheter closure of ventricular septal perforation can effectively reduce operative time and is conducive to quick and stable improvement of the patient’s condition.

Effects of atorvastatin combined with bivalirudin on coagulation function, cardiac function, and inflammatory factors of percutaneous coronary intervention in elderly patients with acute myocardial infarction

BACKGROUND

Acute myocardial infarction (AMI) occurs when atherosclerotic lesions which present in the coronary arteries cause the intravascular plate to rupture and with the result of myocardial ischemia, hypoxia, and infarct. The preferred treatment for AMI is currently percutaneous coronary intervention (PCI), for which the key to the success is the choice of anticoagulant and thrombolytic drugs during surgery. Here, we aim to explore the effects of atorvastatin combined with bivalirudin on coagulation function, cardiac function, and inflammatory factors in elderly patients with AMI who underwent PCI.

METHODS

The clinical data of 86 AMI patients who were admitted to our hospital between February 2016 and May 2018 were retrospectively analyzed. Based on different treatments, the patients were divided into the control group and the observation group, with 43 patients in each group. The control group patients were treated with bivalirudin, and the observation group was treated with bivalirudin plus atorvastatin. Both groups of patients underwent PCI and the clinical efficacy, coagulation function, cardiac function, inflammatory factor levels and cardiovascular events (MACE), and other clinical data were compared between the groups.

RESULTS

The total clinical effective rate in the observation group was significantly higher than that in the control group (90.90% vs. 72.09%) (P<0.05). Fibrinogen (Fg) and D-dimer (D-D) levels were significantly decreased after treatment in both groups but were significantly lower in the observation group than in the control group. The prothrombin time (PT) was significantly prolonged after treatment in both groups but was significantly longer in the observation group than in the control group after treatment (P<0.05). Meanwhile, the left ventricular end-diastolic diameter (LVEDD) and left ventricular end-systolic diameter (LVESD) were significantly reduced after treatment in both groups but were significantly lower in the observation group than in the control group, whereas the left ventricular ejection fraction (LVEF) was significantly higher in the observation group compared with the control group after treatment (P<0.05). After treatment, serum levels of transforming growth factor-β1 (TGF-β1), tumor necrosis factor-α (TNF-α), and IL-6 were significantly reduced in both groups but the levels were significantly lower in the observation group than in the control group (P<0.05). The overall incidence of MACE in the observation group was significantly lower than that in the control group (9.30% vs. 30.23%) (P<0.05).

CONCLUSIONS

Atorvastatin combined with bivalirudin can improve the efficiency of clinical treatment in elderly AMI patients who undergo PCI, while simultaneously improving blood coagulation function and reducing the occurrence of bleeding, compared with bivalrudin alone. It can also decrease the level of inflammatory factors, promote vascular recanalization, and improve myocardial ischemia, thereby reducing the incidence of MACE and improving patient prognosis.

Long-term compound danshen dripping pills therapy reduces the no-reflow phenomenon in nondiabetes mellitus patients after primary percutaneous coronary intervention for acute myocardial infarction

BACKGROUND

Cases with no-reflow increased significantly and accounted for about 5-50% of cases in primary percutaneous coronary intervention (PPCI) patients in recent years. It is important to identify patients at high risk of no-reflow. Ingredients of compound danshen dripping pills (CDDP), a popular Chinese traditional medicine, can alleviate myocardial ischemia, inhibit inflammation and angiotensin convert enzyme, and reduce cell apoptosis, among other effects. In this study, we aimed to assess whether long-term treatment with CDDP (>1 year, could reduce the no-reflow phenomenon in non-diabetes mellitus (DM) patients after PPCI for acute myocardial infarction (AMI).

METHODS

We enrolled patients according to inclusion and exclusion criteria. Clinical and PPCI data were collected. Patients were divided into 2 groups according to history of CDDP therapy. Data of the CDDP group and non-CDDP group were compared. Single and multivariate analysis was used to find factors associated with no-reflow.

RESULTS

Among these 399 patients, the no-reflow phenomenon occurred in 96 patients (24.1%). The results showed that patients with long-term CDDP treatment had lower incidence of no-reflow than those without CDDP treatment within 1 year (9/68 vs. 87/331, 13.2% vs. 26.3%, P=0.0219). Univariate and multivariate stepwise logistic regression analysis identified a few admission parameters associated with the no-reflow phenomenon: prior myocardial infarction (MI) [odds ratio (OR) 3.13, 95% CI: 1.42-4.89], systolic blood pressure (SBP) <100 mmHg (OR 1.78, 95% CI: 1.28-4.06), cardiac troponin T (cTnT) (OR 1.78, 95% CI: 1.28-4.06), high-sensitivity C-reactive protein (hs-CRP) (OR 1.08, 95% CI: 1.01-1.15), brain natriuretic peptide (BNP) (OR 3.76, 95% CI: 1.31-9.75), interleukin-6 (IL-6) (OR 1.42, 95% CI: 1.17-3.29), ejection fraction (EF) (OR 1.39, 95% CI: 1.09-3.28), left ventricular end-diastolic diameter (LVEDD) (OR 1.28, 95% CI: 1.05-4.23), anterior wall infarction (OR 2.83, 95% CI: 1.69-5.76), and long-term CDDP treatment (OR 0.44, 95% CI: 0.89-0.21).

CONCLUSIONS

Prior MI, SBP, cTnT, hs-CRP, BNP, and IL-6 on admission, along with EF, LVEDD, and anterior wall infarction are all predictors for no-reflow phenomenon. Long-term treatment with CDDP can reduce no-reflow phenomenon.

MicroRNA-363-3p serves as a diagnostic biomarker of acute myocardial infarction and regulates vascular endothelial injury by targeting KLF2

Background

Acute myocardial infarction (AMI) is a serious cardiovascular disease. This study aimed to investigate the diagnostic value of microRNA-363-3p (miR-363-3p) in AMI patients and explore the effects of miR-363-3p on vascular endothelial injury in an AMI rat model.

Methods

The Expression of miR-363-3p was measured by quantitative real-time PCR. A receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic value of miR-363-3p in AMI patients. The biomarkers of endothelial injury were estimated using enzyme-linked immunosorbent assays, and the correlation of miR-363-3p with these markers was assessed. AMI rat model was constructed using coronary artery ligation, and the effects of miR-363-3p on endothelial injury and endothelial cell proliferation were analyzed.

Results

Serum expression of miR-363-3p was upregulated in the AMI patients compared with healthy controls. The increased serum miR-363-3p serves a candidate diagnostic biomarker of AMI. The correlation analysis indicated that serum miR-363-3p expression was positively correlated with the concentration of endothelial injury biomarkers in AMI patients. Furthermore, the increased endothelial injury biomarkers in AMI rats were all inhibited by the knockdown of miR-363-3p, and the cell proliferation of human umbilical vein endothelial cells was obviously enhanced by the reduction of miR-363-3p. The prediction results shown that Kruppel-like factor 2 (KLF2) is a target of miR-363-3p, and their interaction was proved using a luciferase reporter assay.

Conclusions

Collectively, overexpression of miR-363-3p acts as a diagnostic biomarker for patients with AMI, and the downregulation of miR-363-3p improves AMI-associated endothelial injury by targeting KLF2, which indicated that miR-363-3p has a potential to develop the treatment of AMI.

Danqi Pill Protects Against Heart Failure Post-Acute Myocardial Infarction via HIF-1α/PGC-1α Mediated Glucose Metabolism Pathway

Aim

Heart failure (HF) post-acute myocardial infarction (AMI) leads to a large number of hospitalizations and deaths worldwide. Danqi pill (DQP) is included in the 2015 national pharmacopoeia and widely applied in the treatment of HF in clinics in China. We examined whether DQP acted on glucose metabolism to protect against HF post-AMI via hypoxia inducible factor-1 alpha (HIF-1α)/peroxisome proliferator-activated receptor α co-activator (PGC-1α) pathway.

Methods and Results

In this study, left anterior descending (LAD) artery ligation induced HF post-AMI rats and oxygen-glucose deprivation-reperfusion (OGD/R)-induced H9C2 cell model were structured to explore the efficacy and mechanism of DQP. Here we showed that DQP protected the heart against ischemic damage as evidenced by improved cardiac functions and attenuated inflammatory infiltration. The expressions of critical proteins involved in glucose intake and transportation such as GLUT4 and PKM2 were up-regulated, while negative regulatory proteins involved in oxidative phosphorylation were attenuated in the treatment of DQP. Moreover, DQP up-regulated NRF1 and TFAM, promoted mitochondrial biogenesis and increased myocardial adenosine triphosphate (ATP) level. The protection effects of DQP were significantly compromised by HIF-1α siRNA, suggesting that HIF-1α signaling pathway was the potential target of DQP on HF post-AMI.

Conclusions

DQP exhibits the efficacy to improve myocardial glucose metabolism, mitochondrial oxidative phosphorylation and biogenesis by regulating HIF-1α/PGC-1α signaling pathway in HF post-AMI rats.

mRNA expression disturbance of complement system related genes in acute arterial thrombotic and paroxysmal atrial fibrillation patients

BACKGROUND

This study aimed to compare the characteristics of mRNA expression of genes in complement system between acute arterial thrombotic patients and paroxysmal atrial fibrillation (PAF) patients.

METHODS

Twenty acute myocardial infarction (AMI) patients and 20 PAF patients were assigned into the experiment groups, and 20 stable angina pectoris (SAP) patients were enrolled in the control group.

RESULTS

When compared with the control group, mRNA expression of C1QA, C1QB, C1QC, C1R, CFP, C5, CR1, ITGAM, ITGAX, ITGB2, C5AR1, CD46, CD55 and CD59 genes was significantly upregulated, and CR2 gene significantly downregulated in the AMI group (P<0.05); while mRNA expression of CFD, MBL2, MASP2, C5, C6, C8B, C9, C5AR1, CR2, CFI, CFHR1, CD46, CD55, VTN and CD59 genes was significantly downregulated in PAF patients (P<0.05). Results of the comparison between the AMI and PAF group showed that mRNA expression of C1QA, C1QB, C1QC, C1R, CFB, CFD, CFP, MBL2, MASP2, C5, C6, C8B, C9, CR1, ITGAM, ITGAX, ITGB2, C5AR1, CFI, CFHR1, CD46, CD55, CLU, VTN and CD59 genes was significantly upregulated in the AMI group (P<0.05).

CONCLUSIONS

Taken SAP patients as controls, the complement system is in a high-intensive disturbance with simultaneous activation and inhibition in AMI patients, indicating that the cascade response of complement system is disturbed, and then the membrane attack complex (MAC) cannot form finally. The mRNA expression of related genes in the complement system is under a status of downregulation in PAF patients, indicating that the functions of cascade response in the complement system decreased significantly in PAF patients, leading to significantly decreased MAC functions.

Osteocalcin in acute stress response: from the perspective of cardiac diseases

Osteocalcin is an osteoblast-derived peptide mainly found in the bone matrix but also in circulation. A recent investigation suggested that osteocalcin mediated acute stress response (ASR) by inhibiting parasympathetic tone in mice and humans. We propose a hypothesis that osteocalcin is regulated by the skeleton movement and glucocorticoids, and inhibition of the parasympathetic tone by osteocalcin may indicate a therapeutic target in the treatment of acute myocardial infarction (AMI).

A fitting machine learning prediction model for short-term mortality following percutaneous catheterization intervention: a nationwide population-based study

Background

A suitable multivariate predictor for predicting mortality following percutaneous coronary intervention (PCI) remains undetermined. We used a nationwide database to construct mortality prediction models to find the appropriate model.

Methods

Data were analyzed from the Taiwan National Health Insurance Research Database (NHIRD) covering the period from 2004 to 2013. The study cohort was composed of 3,421 patients with acute myocardial infarction (AMI) diagnosis undergoing PCI. The dataset of enrolled patients was used to construct multivariate prediction models. Of these, 3,079 and 342 patients were included in the training and test groups, respectively. Each patient had 22 input features and 2 output features that represented mortality. This study implemented an artificial neural network model (ANN), a decision tree (DT), a linear discriminant analysis classifier (LDA), a logistic regression model (LR), a naïve Bayes classifier (NB), and a support vector machine (SVM) to predict post-PCI patient mortality.

Results

The DT model was found to be the most suitable in terms of performance and real-world applicability. The DT model achieved an area under receiving operating characteristic of 0.895 (95% confidence interval: 0.865-0.925), F1 of 0.969, precision of 0.971, and recall of 0.974.

Conclusions

The DT model constructed using data from the NHIRD exhibited effective 30-day mortality prediction for patients with AMI following PCI.

Hyperuricemia and long-term mortality in patients with acute myocardial infarction undergoing percutaneous coronary intervention

Background

Although serum uric acid (UA) was regarded to be involved in cardiovascular disease, the role of serum UA (SUA) as a risk factor in acute myocardial infarction (AMI) is controversial. We investigated whether hyperuricemia was linked with long-term mortality in patients with AMI who underwent percutaneous coronary intervention (PCI).

Methods

Patients with AMI who received PCI were consecutively included. The definition of preprocedural hyperuricemia was a SUA level >7 mg/dL (417 mmol/L) in males and >6 mg/dL (357 mmol/L) in females. All-cause mortality was assessed during 2.3-year median follow up period.

Results

One thousand and five patients with AMI undergoing PCI were enrolled in a single center study, 307 (30.5%) patients had hyperuricemia. After adjusting for potential confounding factors, the multivariable analysis indicated that preprocedural hyperuricemia was related to an increased risk of all-cause mortality during the 2.3-year follow-up (HR: 1.97; 95% CI: 1.11-3.49; P=0.019).

Conclusions

Preprocedural hyperuricemia, independently from chronic kidney disease (CKD), is a significant and independent predictor of long-term mortality for patients with AMI who underwent PCI.

Discovery of potential plasma protein biomarkers for acute myocardial infarction via proteomics

Background

Acute myocardial infarction (AMI) is an acute disease with high mortality and seriously threatens human health. The identification of new effective biological markers for AMI is a prerequisite for treatment. Most proteomic studies have focused on atherosclerotic plaques, vascular cells, monocytes and platelets in the blood; however, the concentration of these factors in plasma is low, making it difficult to measure the complexity of plasma components. Moreover, some studies have examined the plasma protein of patients with acute coronary syndrome with histochemistry; however, the results are not consistent. Therefore, it is necessary to further investigate the differential proteins in the plasma of patients with AMI via proteomics to identify new biomarkers of AMI.

Methods

In this study, immunodepletion of high-abundance plasma proteins followed by an isobaric tagging for relative and absolute quantitation (iTRAQ)-based quantitative proteomic approach was used to analyze plasma samples from 5 control individuals and 10 AMI patients.

Results

Four hundred sixty-eight proteins were identified from two samples, and 33 proteins were differentially expressed in AMI patients compared to the controls. Among the 33 proteins, 12 proteins showed a ≥1.5-fold change between AMI and control samples. These proteins included fatty acid binding protein 3 (FABP3, ratio =6.36), creatine kinase-MB (CK-MB ratio =4.89), adenylate kinase1 (AK1 ratio =4.16), pro-platelet basic protein (PPBP ratio =3.29), creatine kinase (CK ratio =2.88), platelet factor 4 (PF4 ratio =2.62), peptidyl prolyl isomerase Cyclophilin A (PPIA ratio =2.05), Cofilin-1 (CFL1 ratio =1.81), coronin1A (CORO1A ratio =1.71), protein kinase M (PKM ratio =1.63), ribonuclease inhibitor (RNH1, ratio =1.67), and triose phosphate isomerase (TPI1 ratio =1.56). By contrast, there was a decrease of 19 proteins, such as adiponectin (ADIPOQ ratio =0.70), insulin-like growth factor binding protein6 (IGFBP6 ratio =0.70), Dickkopf-related protein 3 (DKK3 ratio =0.70) and complement 4B (C4B ratio =0.68). The most over-represented term was regulation of cell proliferation in the cellular component category of Gene Ontology (GO). The top 3 biological process terms were regulation of cell proliferation, response to wounding and wound healing. These proteins included immune proteins, blood coagulation proteins, lipid metabolism proteins, cytoskeleton proteins, energy metabolism proteins, gene regulation proteins, myocutaneous proteins, and myocardial remodeling proteins and were highly connected with each other, which indicates that the functional network of these processes contribute to the pathophysiology of AMI.

Conclusions

In conclusion, the present quantitative proteomic study identified novel AMI biomarker candidates and might provide fundamental information for the development of an AMI biomarker.

The prevalence of 30-day readmission after acute myocardial infarction: A systematic review and meta-analysis

Objective

The 30‐day readmission is associated with increased medical costs, which has become an important quality metric in several medical institutions. This current study is aimed at clarifying the prevalence, the underlying risk factors, and reasons of the 30‐day readmission after acute myocardial infarction (AMI).

Methods

PubMed, Cochrane Library, and EMBASE were systematically searched to identify eligible studies. Random‐effect models were employed to perform pooled analyses. Means and 95% confidence intervals (CIs) were used to estimate prevalence and reasons for 30‐day readmission. We also used Odds ratios (ORs) to explore the potential significant predictors of risk factors of 30‐day readmission after AMI. Potential publication bias was assessed using funnel plot and Begg'test.

Results

A total of 14 relevant studies were included in this systematic review and meta‐analysis. The pooled 30‐day readmission rate of AMI was 12% (95% CI 0.11‐0.14). Acute coronary syndrome (ACS), angina and acute ischemic heart disease, and heart failure (HF) were the principal cardiovascular reasons of 30‐day readmission. Meanwhile, non‐specific chest pain was regarded as the significant cause among non‐cardiovascular reasons. The common co‐morbidities kidney disease, HF and diabetes mellitus were significant risk factors for 30‐day readmission. No significant publication bias was found by funnel plot and statistical tests.

Conclusions

The 30‐day readmission rate of post‐AMI ranged from 11% to 14% and can be mainly attributed to cardiovascular and non‐cardiovascular events. The common co‐morbidities, such as kidney disease, HF, and diabetes mellitus were significant risk factors for 30‐day readmission.

A faster detection method for high-sensitivity cardiac troponin-POCT quantum dot fluorescence immunoassay

Background

High-sensitivity cardiac troponin (hs-cTn) is a significant biomarker of myocardial injury and necrosis, and has momentous clinical significance for the diagnosis and risk stratification of acute myocardial infarction (AMI). The purpose of this study is to determine the accuracy and sensitivity of hs-cTn detection in whole blood samples with a new faster method-Point of Care Testing (POCT) quantum dot fluorescence immunoassay.

Methods

Blood samples from 415 patients with chest pain suggestive of AMI from August to November 2017 in The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University were analyzed. We first performed hs-cTnI test with anticoagulated whole blood by POCT quantum dot fluorescence immunoassay. After the sample was centrifuged, the plasma sample was taken for detection of hs-cTnT by electrochemiluminescence immunoassay. The final diagnosis was determined by two independent cardiologists.

Results

Firstly, by measuring the receiver operating characteristic curve (ROC curve) and the area under the curve (AUC) of 32 patients with AMI, it was found that the measurement accuracy of the POCT quantum dot fluorescence immunoassay was relative high (AUC was 0.866, 95% confidence interval is 0.783 to 0.949). There was no statistical difference between POCT quantum dot fluorescence immunoassay and electrochemiluminescence troponin assay [Z value =1.527, P value =(0.063, 0.064)]. In addition, the study also calculated the performance evaluation index of POCT quantum dot fluorescence immunoassay (critical value 0.04 ng/mL) and analyzed the ROC curve to compare the diagnostic accuracy of both for cardiogenic diseases and the diagnostic efficacy of patients with AMI. Our study found that the new method-POCT quantum dot fluorescence immunoassay had high diagnostic efficiency, which was similar to the traditional electrochemiluminescence method.

Conclusions

The measurements of hs-cTn by the method of Vazyme POCT quantum dot immunofluorescence and Roche electrochemiluminescence method have a good correlation (Y=37.419+131.009X, r=0.935), and also have a good consistency in the diagnosis of AMI. In addition, compared with the traditional electrochemiluminescence method, quantum dot immunofluorescence is faster and more suitable for clinical needs.

Early β-blockers administration might be associated with a reduced risk of contrast-induced acute kidney injury in patients with acute myocardial infarction

BACKGROUND

Contrast-induced acute kidney injury (CI-AKI) is a common complication of coronary angiography (CAG), which is associated with worse prognosis. Some studies indicated β-blockers could preserve renal function among patients with acute myocardial infarction (AMI), but the relationship between β-blockers and CI-AKI has not been well documented among patients with AMI who were undergoing CAG or percutaneous coronary intervention (PCI).

METHODS

In this prospective, observational study, 1,309 AMI patients who were undergoing CAG or PCI were consecutively recruited between January 2010 and December 2013. Patients were assigned into β-blockers group (n=1,074) or non-β-blockers group (n=235) according to use or non-use of β-blockers (including metoprolol tartrate/metoprolol succinate/Bisoprolol Fumarate) within 24 hours of perioperative period. CI-AKI was defined as an absolute increase of >0.5 mg/dL from baseline serum creatinine (SCr) within 48-72 hours after contrast medium (CM) exposure.

RESULTS

The overall incidence of CI-AKI was 247/1,309 (18.9%).After multivariate adjusting, a total of 10 variables were related to CI-AKI, including β-blockers [β-blockers group vs. non-β-blockers group: odds ratio (OR) =0.520; 95% confidence interval (CI), 0.291-0.930; P=0.027], age, diabetes mellitus, estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, left ventricular ejection fraction (LVEF) <40%, use of intra-aortic balloon pump (IABP), peri-hypotension, emergent PCI, coronary lesions and CM dose >200 mL. During the mean follow-up of 2.35±0.99 years, the β-blockers group was significantly associated with lower rates of mortality [β-blockers group vs. non-β-blockers group: adjusted hazard ratio (HR) =0.43; 95% CI, 0.27-0.71; P=0.001] among patients with AMI.

CONCLUSIONS

Use of β-blockers within 24 hours of perioperative period may be associated with lower rates of CI-AKI and long-term mortality among patients with AMI who are undergoing CAG or PCI.

TRIAL REGISTRATION

PRECOMIN, ClinicalTrials.gov NCT01400295.