Clinical and Coronary Angiographic Insights Into Acute ST-Elevation Myocardial Infarction in Young Patients: A Study From a Tertiary Care Cardiac ICU.

Background This investigation addresses the major effects of early-onset coronary artery disease (CAD) on community health, noting its association with elevated incidences of recurrent ischemic events and mortality. The study specifically explores the contributing factors, clinical symptoms, angiographic findings, and management strategies for individuals aged 45 or younger who experience their initial ST-elevation myocardial infarction (STEMI). Methodology This observational study took place over a six-month period within the cardiology unit, involving 100 sequential patients diagnosed with STEMI. Results With a mean age of 42.5 years, the research had 100 patients, of which nine (9%) were under 25, 24 (24%) were between 26 and 35, and 67 (67%) were over 36. Of these, 89 (89%) were male. The following risk variables were found: obstructive CAD, smoking, being overweight, diabetes, hypertension, chest discomfort, and syncope. In 99 patients (99%), the most prevalent symptom was chest discomfort. Most often impacted was the left anterior descending (LAD) artery in 24 patients (24%), then the right coronary artery in 14 patients (14%). A total of 50 patients (50%) had percutaneous coronary intervention (PCI), with 15 patients (15%) undergoing elective PCI, 10 patients (10%) with pharmaco-invasive PCI, and 20 patients (20%) receiving primary PCI. In eight cases (8%), coronary artery bypass grafting (CABG) was required. Furthermore, 40 patients (40%) were under medical care, and 32 patients (32%) had recanalized and normal coronaries. No mortality was recorded in this study. Conclusions Acute myocardial infarction is most frequently seen in very young adult males, and the most common risk factor is smoking. The most common clinical manifestation, anterior wall myocardial infarction, was caused by the main source of involvement, the LAD artery.

Pharmacotherapy of acute ST-elevation myocardial infarction and the pharmacist's role, part 1: Patient presentation through revascularization.

DISCLAIMER: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE: Key pharmacotherapeutic modalities and considerations for the patient with ST-elevation myocardial infarction (STEMI) across the critical initial phases of care are reviewed. SUMMARY: Despite established value in the emergency department (ED), cardiac care, and intensive care settings, there is currently little published literature describing or supporting clinical pharmacist roles in the acute management of STEMI. The high-risk period from hospital presentation through revascularization and stabilization involves complex pharmacotherapeutic decision points, many operational medication needs, and multiple layers of quality oversight. While rife with opportunities for pharmacists to optimize care, this timeframe appears inconsistently targeted by clinical pharmacy services, which may halt after ED evaluation and then resume upon postcatheterization cardiac unit admission. Herein we review the key pharmacotherapeutic modalities and considerations for the patient with STEMI across the critical initial phases of care. These include supportive therapies prior to revascularization, the host of antithrombotics involved in revascularization by percutaneous coronary intervention and/or fibrinolysis, and other periprocedural medications. Important practice guidelines and clinical resources are summarized from the clinical pharmacist perspective, and roles and responsibilities of the responding pharmacist are suggested. A companion article will extend the review to periprocedural adverse event management, key early decision-making regarding long-term risk reduction, and pharmacist involvement in institutional quality improvement efforts. We aim to support inpatient pharmacy departments in advancing clinical services for this critical patient population, and we call for further research delineating pharmacist impact on patient and institutional STEMI outcomes. CONCLUSION: Patients presenting with STEMI rapidly traverse multiple phases of care and receive a host of antithrombotic and supportive medications during acute management, presenting many important pharmacotherapeutic decision points and roles for pharmacists.

A Unique Case of Pregnancy-Associated Spontaneous Coronary Artery Dissection Presenting As Generalized Tonic-Clonic Seizure.

Spontaneous coronary artery dissection (SCAD) is an uncommon form of non-atherosclerotic coronary artery disease, characterized by a sudden tear in coronary artery layers. Pregnancy-associated SCAD (P-SCAD) is a rare variant occurring during pregnancy or postpartum. We present a case of P-SCAD in a 31-year-old postpartum female who experienced generalized tonic-clonic seizures along with ventricular fibrillation. Despite its rarity, P-SCAD should be considered in postpartum females with atypical symptoms, such as seizures or ventricular fibrillation. This case underscores the need for heightened clinical suspicion and timely intervention to manage P-SCAD effectively. Early recognition can lead to improved patient outcomes and appropriate management strategies, ranging from conservative approaches to percutaneous interventions or implantable cardioverter-defibrillator placement.

Outcomes of STEMI Patients in COVID-19 Pandemic: A Systematic Review and Meta-Analysis.

Background: The global SARS-CoV-2 pandemic has disrupted health systems and put a huge strain on hospitals and healthcare workers. Prioritizing COVID-19 patients in hospitals caused irreversible harm to cardiac patients. Although multiple studies have shown that ST-segment elevation myocardial infarction (STEMI) patients have worse admission circumstances than before the pandemic, the hospital outcomes of these patients have remained limited. This systematic review and meta-analysis examined STEMI patient outcomes during the COVID-19 epidemic. Methods: We conducted systematic searches of MEDLINE (through PubMed), Web of Science, Scopus, and Embase through Jan 10, 2021. All studies with reporting in-hospital mortality, length of stay, and door-to-balloon time with over twenty participants were included. Articles without clear definitions or results were excluded. The study followed PRISMA guidelines. The outcomes of interest were door-to-balloon time, death, and hospital stay during COVID-19 pandemic compared prior. Results: Our meta-analysis included 12 studies and 21170 people (115-6609). The pooled analysis showed significantly more pandemic mortality (OR=1.24; 95% CI: 1.07-1.43). Ten studies (13,091) recorded door-to-balloon times. Door-to-balloon time (in minutes) significantly increased during the pandemic (Standardized Mean Difference [SMD]= 0.46; 95% CI: 0.03-0.89). The length of hospital stay was reported by five studies (n=9448). Length of hospital stay (in days) was not significantly longer during the pandemic than before the outbreak (SMD= 0.04; 95% CI: -0.19-0.26). Conclusion: The COVID-19 pandemic is associated with increased mortality and door-to-balloon delay that might be attributable to the strict infection control measures in outbreak. Studies with a longer follow-up time are needed to investigate the outcomes of STEMI patients.

Mortality rate of percutaneous coronary interventions in ST-segment elevation myocardial infarction patients under the public health insurance schemes of Thailand.

Background: In Thailand, access to specific pharmaceuticals and medical devices for ST-elevation myocardial infarction (STEMI) patients is restricted within certain healthcare systems, leading to inequalities in the quality of medical care among different healthcare systems. This study aims to compare mortality rates within one year of STEMI patients among the public health insurance schemes of Thailand. Methodology: This study is a single-center retrospective analysis of patients with STEMI treated with primary percutaneous coronary intervention (pPCI). It involves patients utilizing various state health insurance schemes in Thailand from January 1, 2010, to December 31, 2020. Data collection occurred through the hospital's computerized management system and the registration administration office of the Department of Provincial Administration. Results: The study involved 1,077 patients, categorized into three groups based on their state health insurance: Universal Health Coverage (UC) (546 patients, 50.7%), Social Security System (SS) (199 patients, 18.5%), and Civil Service Reimbursement (CS) (332 patients, 30.8%). The one-year mortality rates in these groups were 10.57%, 4.21%, and 6.47%, respectively (p = 0.010). In the unadjusted model, the SS group showed a lower risk of one-year mortality [Hazard Ratio (HR) 0.38, 95% CI 0.18-0.80, p = 0.011], and the CS group also demonstrated a lower risk (HR 0.59, 95% CI 0.35-0.99, p = 0.047) compared to the UC group. In the adjusted model, only the CS group significantly reduced the risk of one-year mortality. Other factors that affected one-year mortality were age ≥65 years, prior coronary artery diseases, Killip class 3-4, pre-discharge prescription of angiotensin-converting enzyme inhibitors, occlusion in the left anterior descending artery, multivessel disease, in-hospital atrial fibrillation/flutter and in-hospital pericardial effusion. Conclusion: Healthcare schemes play a significant role in influencing one-year mortality rates among STEMI patients treated with pPCI. This information would be crucial for developing strategies and programs to aid healthcare policymakers at both regional and international levels in reducing morbidity and mortality.

Advanced Lung Cancer Inflammation Index as Predictor of All-Cause Mortality in ST-Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention.

Background: The advanced lung cancer inflammation index (ALI) is an independent prognostic biomarker used to assess inflammation and nutritional status in various cancers, heart failure, and acute coronary syndromes. This study investigates the prognostic significance of ALI in patients experiencing ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI), comparing its predictive abilities with the established Neutrophil-Lymphocyte Ratio (NLR). Methods: We conducted a retrospective analysis of 1171 patients from the Matrix Registry, encompassing demographic and clinical data for STEMI cases treated with pPCI, and ALI was determined using the formula [serum albumin (g/dL) × body mass index (kg/m2)]/NLR at the time of hospital admission. The primary outcome was all-cause mortality. Results: Of the 1171 patients, 86 died during the follow-up period. Univariate analysis identified age, female gender, smoking, hypertension, diabetes, prior myocardial infarction (PMI), lower left ventricular ejection fraction (LVEF), and reduced ALI as factors associated with mortality. Multivariate analysis confirmed age (HR: 1.1, 95% CI: 1.05-1.11, p < 0.001) and PMI (HR: 2.4, 95% CI: 1.4-4.3, p = 0.001) as prominent independent predictors, alongside ALI (HR: 0.95, 95% CI: 0.92-0.97, p < 0.001) and LVEF (HR: 0.98, 95% CI: 0.97-0.99, p = 0.04). An ALI cut-off of ≤10 indicated a higher mortality risk (HR: 2.3, 95% CI: 1.5-3.7, p < 0.001). The area under the curve for ALI (0.732) surpassed that for NLR (0.685), demonstrating ALI's superior predictive capability. Conclusions: ALI is an independent prognostic factor for all-cause mortality in STEMI patients undergoing pPCI, showing greater discriminatory power than NLR, particularly in patients with ALI values ≤ 10, who face a 2.3-fold higher mortality risk.

Machine-learning based risk prediction of in-hospital outcomes following STEMI: the STEMI-ML score.

Background: Traditional prognostic models for ST-segment elevation myocardial infarction (STEMI) have limitations in statistical methods and usability. Objective: We aimed to develop a machine-learning (ML) based risk score to predict in-hospital mortality, intensive care unit (ICU) admission, and left ventricular ejection fraction less than 40% (LVEF < 40%) in STEMI patients. Methods: We reviewed 1,863 consecutive STEMI patients undergoing primary percutaneous coronary intervention (pPCI) or rescue PCI. Eight supervised ML methods [LASSO, ridge, elastic net (EN), decision tree, support vector machine, random forest, AdaBoost and gradient boosting] were trained and validated. A feature selection method was used to establish more informative and nonredundant variables, which were then considered in groups of 5/10/15/20/25/30(all). Final models were chosen to optimise area under the curve (AUC) score while ensuring interpretability. Results: Overall, 128 (6.9%) patients died in hospital, with 292 (15.7%) patients requiring ICU admission and 373 (20.0%) patients with LVEF < 40%. The best-performing model with 5 included variables, EN, achieved an AUC of 0.79 for in-hospital mortality, 0.78 for ICU admission, and 0.74 for LVEF < 40%. The included variables were age, pre-hospital cardiac arrest, robust collateral recruitment (Rentrop grade 2 or 3), family history of coronary disease, initial systolic blood pressure, initial heart rate, hypercholesterolemia, culprit vessel, smoking status and TIMI flow pre-PCI. We developed a user-friendly web application for real-world use, yielding risk scores as a percentage. Conclusions: The STEMI-ML score effectively predicts in-hospital outcomes in STEMI patients and may assist with risk stratification and individualising patient management.

Prognostic Value of Triglyceride Glucose Index in ST-Elevation Myocardial Infarction: A Key Predictor of Mortality and Thrombus Burden.

OBJECTIVES: We aimed to investigate the association between the triglyceride glucose index (TGI) and mortality in patients with ST-elevation myocardial infarction (STEMI). METHODS: This retrospective study utilized data from the records of patients diagnosed with STEMI who underwent primary percutaneous coronary intervention (PCI) at the Cardiology Department of Private Aktif International Hospital between 2020 and 2023. Demographic data, medical history, laboratory results, and treatment processes of the patients were obtained from retrospective records. Patients were divided into low (TGI ≤ 8.6)-, medium (TGI = 8.6-9.2)-, and high (TGI ≥ 9.2)-TGI groups according to their TGI levels. RESULTS: The average age of the patients was 62 ± 10 years, and 65% were men. The intracoronary thrombus burden of patients in the high-TGI group was found to be significantly higher compared to the low- and medium-TGI groups (p = 0.01). While the rate of patients with a thrombolysis in myocardial infarction (TIMI) thrombosis score of 3 or above was 45% in the high-TGI group, this rate was observed to be 20% in the low-TGI group. The short-term (30-day) mortality rate was found to be 15% in the high-TGI group, 8% in the medium-TGI group, and 5% in the low-TGI group (p = 0.02). Long-term (after 30 days) mortality rates were determined as 25% in the high-TGI group, 15% in the medium-TGI group, and 10% in the low-TGI group (p = 0.01). TGI was an independent risk factor for both short-term and long-term mortality. The hazard ratio (HR) of high TGI levels for short-term mortality was found to be 2.5 (95% CI: 1.5-4.1, p = 0.01), and the HR for long-term mortality was 2.0 (95% CI: 1.3-3.2, p < 0.02). CONCLUSIONS: Our results show that high TGI levels are associated with increased thrombus burden and high mortality rates in STEMI. TGI can be used not only in predicting STEMI but also in early risk stratification and treatment planning for STEMI patients.

The relationship between advanced lung cancer inflammation index and high SYNTAX score in patients with non-ST-elevation myocardial infarction.

Introduction: The advanced lung cancer inflammation index (ALI) is an independent prognostic biomarker of inflammation and nutrition in various types of cancer, acute heart failure and acute coronary syndrome. The SYNTAX (Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery) score (SXscore) is an angiographic scoring tool used to determine the extent and severity of coronary artery disease. Aim: To investigate the relationship between ALI and coronary artery lesion complexity assessed using the SXscore in patients with non-ST-segment elevation myocardial infarction (NSTEMI). Material and methods: Between February and November 2020, a total of 284 patients with NSTEMI were included consecutively. ALI was calculated with the formula body mass index (BMI) × serum albumin concentration/neutrophil-to-lymphocyte ratio (NLR). SXscore was calculated using the online calculator and divided into two groups - low (< 32) and high (≥ 33) - and then analyzed. Results: Patients with a high SXscore had lower ALI (22.4 ±7.3 vs. 58.5 ±44.3, p = 0.016). In the univariable analysis, age (p = 0.046), BMI (p = 0.021), C-reactive protein (p = 0.002), peak troponin I (p = 0.009), NLR (p = 0.025), serum albumin (p = 0.003) and ALI (p < 0.001) were significantly associated with a high SXscore. ALI emerged as an independent predictor of a high SXscore in multivariable analysis (95% CI: 0.931-0.984, p = 0.002). Conclusions: The ALI may be useful as a simple tool for predicting high SXscore in patients with NSTEMI. To our knowledge, this is the first study to examine the relationship between ALI and severity of CAD.

Survival and Recovery From Postmyocardial Infarction Apical Wall Rupture With a Complex Course.

Ventricular wall rupture is associated with poor outcomes subsequent to an acute myocardial infarction. We describe a case of postmyocardial infarction apical wall rupture following percutaneous coronary intervention. Our case emphasizes the importance of swift evaluation, diagnosis, and management to enhance survival in individuals confronting this critical condition.

Treatment of left main coronary artery thrombus during SARS-CoV-2: early surgical revascularization is key.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause a hypercoagulable state leading to coronary artery thrombosis. The optimal management of this phenomenon has not been well elucidated. We describe a 38-year-old male who developed an ST-elevation myocardial infarction secondary to a left main coronary artery thrombus after SARS-CoV-2. The patient failed anticoagulation and fibrinolysis and developed decompensated heart failure. Ultimately, the patient underwent surgical revascularization, which led to full recovery. This highlights the need for refinement in this population. We recommend that early surgical intervention be considered in patients with ST-elevation myocardial infarction secondary to left main coronary artery thrombus in the setting of SARS-CoV-2.

Addressing disparities in the long-term mortality risk in individuals with non-ST segment myocardial infarction (NSTEMI) by diabetes mellitus status: a nationwide cohort study.

AIMS/HYPOTHESIS: The aim of this study was to investigate how diabetes mellitus affects longer term outcomes in individuals presenting to hospital with non-ST segment elevation myocardial infarction (NSTEMI). METHODS: We analysed data from 456,376 adults hospitalised between January 2005 and March 2019 with NSTEMI from the UK Myocardial Ischaemia National Audit Project (MINAP) registry, linked with Office for National Statistics death reporting. We compared outcomes and quality of care by diabetes status. RESULTS: Individuals with diabetes were older (median age 74 vs 73 years), were more often of Asian ethnicity (13% vs 4%) and underwent revascularisation (percutaneous coronary intervention or coronary artery bypass graft surgery) (38% vs 40%) less frequently than those without diabetes. The mortality risk for those with diabetes compared with those without was significantly higher at 30 days (HR 1.19, 95% CI 1.15, 1.23), 1 year (HR 1.28, 95% CI 1.26, 1.31), 5 years (HR 1.36, 95% CI 1.34, 1.38) and 10 years (HR 1.39, 95% CI 1.36, 1.42). In individuals with diabetes, higher quality inpatient care, assessed by opportunity-based quality indicator (OBQI) score category ('poor', 'fair', 'good' or 'excellent'), was associated with lower mortality rates compared with poor care (good: HR 0.74, 95% CI 0.73, 0.76; excellent: HR 0.69, 95% CI 0.68, 0.71). In addition, compared with poor care, excellent care in the diabetes group was associated with the lowest mortality rates in the diet-treated and insulin-treated subgroups (diet-treated: HR 0.64, 95% CI 0.61, 0.68; insulin-treated: HR 0.69, CI 0.66, 0.72). CONCLUSION/INTERPRETATION: Individuals with diabetes experience disparities during inpatient care following NSTEMI. They have a higher risk of long-term mortality than those without diabetes, and higher quality inpatient care may lead to better long-term survival.

Colchicine effect on biomarkers of cardiac remodelling and atherosclerosis in ST-elevation myocardial infarction: A randomized controlled trial.

AIMS: Owing to its underlying inflammatory nature, atherosclerotic cardiovascular disease remains the leading global cause of mortality, particularly post-ST-elevation myocardial infarction (STEMI), a condition with significant risk for further cardiovascular events and mortality. This study aimed to investigate colchicine's effect on inflammation, cardiac remodelling and atherosclerotic risk in STEMI patients. METHODS: We conducted a randomized controlled study on 88 STEMI patients undergoing percutaneous coronary intervention. Eligible patients were randomly assigned to 1 of 2 groups. The control group received the guideline-directed medical therapy for STEMI, and the test group received guideline-directed medical therapy and 0.5 mg colchicine twice daily for 3 months. The soluble suppressor of tumorigenicity (sST2), interleukin-1ß, lipid profile parameters, triglyceride (TG)/high-density lipoprotein (HDL-C) ratio levels and left ventricular ejection fraction were evaluated for patients at baseline and the end of the 3 months. RESULTS: No significant effects were reported for colchicine on sST2, interleukin-1ß levels or left ventricular ejection fraction. Colchicine significantly lowered TG levels vs. controls, 134 (46-353) vs. 176 (72-825) respectively, P = .02, as well as TG/HDL-C ratio levels, 4.16 (2.75-5.24) vs. 5.11 (3.51-8.33),` respectively, P = .024. sST2 levels of the studied cohort were positively correlated with their TG/HDL-C ratio levels (R = .459, P < .001) at the end of follow-up. CONCLUSION: Our study highlights a promising impact of colchicine on atherosclerosis and cardiac remodelling factors in STEMI patients. Colchicine significantly reduced TG levels and TG/HDL-C ratio and was safe and well tolerated. Larger long-term studies powered to assess clinical outcomes of remodelling are necessary to confirm its beneficial effects in STEMI. GOV REGISTRATION ID: NCT06054100.

The contemporary management and coronary angioplasty outcomes in young patients with ST-Elevation myocardial infarction (STEMI) age < 40 years old: the insight from nationwide Thai PCI registry.

BACKGROUND: Cardiovascular disease (CVD) remains one of the major causes of death around the world in which ST elevation MI (STEMI) is in the lead. Although the mortality rate from STEMI seems to decline, this result might not be demonstrated in young adults who basically have different baseline characteristics and outcomes compared with older patients. METHODS: Data of the STEMI patients aged 18 years or older who underwent PCI during May 2018 to August 2019 from Thai PCI Registry, a prospective, multi-center, nationwide study, was included and aimed to investigate the predisposing factors and short-term outcomes of patients aged < 40 years compared with age 41-60, and > 61 years. RESULTS: Data of 5,479 STEMI patients were collected. The patients' mean age was 62.6 (SD = 12.6) years, and 73.6% were males. There were 204, 2,154, and 3,121 patients in the youngest, middle, and oldest groups. The young patients were mainly male gender (89.2% vs. 82.4% and 66.6%; p < 0.001), were current smokers (70.6%, 57.7%, 34.1%; p < 0.001), had BMI ≥ 25 kg/m2 more frequently (60.8%, 44.1%, 26.1%; p < 0.001), and had greater family history of premature CAD (6.9%, 7.2%, 2.9%; p < 0.001). The diseased vessel in the young STEMI patients was more often single vessel disease with the highest percentage of proximal LAD stenosis involvement. Interestingly, there were trends of higher events of procedural failure (2.9%, 2.1%, 3.3%; p = 0.028) and procedural complications (8.8%, 5.8%, 9.4%; p < 0.001) in both youngest and oldest groups compared to the middle-aged group. In-hospital death was found in 3.4% in the youngest group compared to 3.3% in the middle-aged patients and 9.2% in the older patients (p < 0.001). CONCLUSIONS: Despite experiencing higher rates of procedural failure and complications during treatment compared to middle-aged and older patients, young STEMI individuals demonstrate a significantly lower risk of death during hospitalization and within one year of the event. Younger patients might have a more robust physiological reserve or benefit from more aggressive post-procedure management. However, the higher prevalence of modifiable risk factors like smoking and obesity in younger individuals underscores the need for preventative measures. Encouraging smoking cessation and weight control in this demographic is crucial not only to prevent STEMI but also to potentially improve their long-term survival prospects.

Characterization of dynamic changes in cardiac microstructure after reperfused ST-elevation myocardial infarction by biphasic diffusion tensor cardiovascular magnetic resonance.

BACKGROUND AND AIMS: Microstructural disturbances underlie dysfunctional contraction and adverse left ventricular (LV) remodelling after ST-elevation myocardial infarction (STEMI). Biphasic diffusion tensor cardiovascular magnetic resonance (DT-CMR) quantifies dynamic reorientation of sheetlets (E2A) from diastole to systole during myocardial thickening, and markers of tissue integrity [mean diffusivity (MD) and fractional anisotropy (FA)]. This study investigated whether microstructural alterations identified by biphasic DT-CMR: (i) enable contrast-free detection of acute myocardial infarction (MI); (ii) associate with severity of myocardial injury and contractile dysfunction; and (iii) predict adverse LV remodelling. METHODS: Biphasic DT-CMR was acquired 4 days (n = 70) and 4 months (n = 66) after reperfused STEMI and in healthy volunteers (HVOLs) (n = 22). Adverse LV remodelling was defined as an increase in LV end-diastolic volume ≥ 20% at 4 months. MD and FA maps were compared with late gadolinium enhancement images. RESULTS: Widespread microstructural disturbances were detected post-STEMI. In the acute MI zone, diastolic E2A was raised and systolic E2A reduced, resulting in reduced E2A mobility (all P < .001 vs. adjacent and remote zones and HVOLs). Acute global E2A mobility was the only independent predictor of adverse LV remodelling (odds ratio .77; 95% confidence interval .63-.94; P = .010). MD and FA maps had excellent sensitivity and specificity (all > 90%) and interobserver agreement for detecting MI presence and location. CONCLUSIONS: Biphasic DT-CMR identifies microstructural alterations in both diastole and systole after STEMI, enabling detection of MI presence and location as well as predicting adverse LV remodelling. DT-CMR has potential to provide a single contrast-free modality for MI detection and prognostication of patients after acute STEMI.

Remote ischemic periconditioning suppresses cardiac sympathetic activation in acute myocardial infarction: a randomized controlled trial.

PURPOSE: Remote ischemic periconditioning (RIPC) has demonstrated cardioprotective effects and improved clinical outcomes as an adjunct to emergent percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI). However, whether RIPC affects the cardiac sympathetic nerve activity in patients with STEMI remains unclear. This study investigated the effects of RIPC on cardiac sympathetic nerve activity in patients with STEMI. METHODS: We prospectively assigned patients with STEMI who underwent emergent PCI to receive RIPC or no procedure (control group) upon arrival at the cardiac catheterization laboratory. The primary endpoint was cardiac sympathetic nerve activity assessed through the washout rate (WR) in cardiac 123I-metaiodobenzylguanidine (123I-MIBG) imaging. RESULTS: Patients in the RIPC (n = 62) and control (n = 60) groups had similar demographic and clinical characteristics at baseline. Multivariable linear regression models revealed that the culprit lesion of the left anterior descending artery and hemoglobin level were significantly and independently associated with WR at discharge. WRs of the groups differed insignificantly at discharge. However, the RIPC group (n = 49) showed significantly lower WR than the control group (n = 47) at 1 year after discharge (p = 0.027). In the single-photon emission computed tomography analysis at 1 year after discharge, the RIPC group demonstrated significantly higher late uptake (p = 0.021) and lower WR (p = 0.013) in the nonculprit lesion, with a non-significant decrease in WR for the culprit lesion. CONCLUSION: RIPC can suppress augmented cardiac sympathetic nerve activity in patients with STEMI, particularly in nonculprit lesions.

Evaluation of Inflammatory Markers in Predicting Coronary Complexity: Insights from the SYNTAX II Score in NSTEMI Patients.

Objectives: Non-ST-elevation myocardial infarction (NSTEMI) is characterized by the absence of pathological ST segment elevation but an increase in biological markers. The SYNTAX II score (SS-II) is calculated to evaluate the complexity of coronary artery disease and to guide treatment decisions between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). The aim of this study is to evaluate the relationship of socio-demographic data and biochemical markers with SS-II in NSTEMI patients. Materials and Methods: Six hundred patients who were admitted to the private Aktif International Hospital cardiology clinic between January 2020 and January 2024 and were diagnosed with NSTEMI were included in the study. Severity, extent, and clinical evaluation of atherosclerosis were determined using risk factors, laboratory tests, and coronary angiography. Patients were divided into two groups according to their SS-II score: low (≤ 22) and high SS-II (> 32). Socio-demographic data, neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and monocyte-to-HDL-C ratio (MHR) were compared between the two groups. Results: Group 1 (SS-II ≤ 22) included 380 patients, and group 2 (SS-II > 32) included 220 patients. There was a statistically significant difference in HDL, creatine value, white blood cell, troponin I, hs-TnT, and monocyte values in group 2 compared with group 1 (p = 0.001, p = 0.018, p = 0.031, and p = 0.001, respectively). NLR, MLR, MHR, and SS values were statistically significantly higher in group 2 compared with group 1 (p = 0.015, p = 0.002, p = 0.001, and p = 0.001, respectively). The risk factors were found to be significantly associated with high-risk NSTEMI (SS-II > 32) in a logistic regression analysis and included peripheral artery disease (PAD) (OR: 3.028, p = 0.040), troponin I (OR: 3.575, p = 0.015), hs-TnT (OR: 4.221, p = 0.010), NLR (OR: 1.528, p = 0.024). MLR (OR: 5.248, p = 0.012), and MHR (OR: 7.122, p = 0.010). ROC analysis revealed that NLR (AUC: 0.691, p = 0.016), MLR (AUC: 0.731, p = 0.004), and MHR (AUC: 0.824, p = 0.003) had higher predictive power than other parameters in patients with high-risk NSTEMI (SS-II > 32). Conclusions: We found that NLR, MLR, and MHR levels are associated with the severity of coronary artery disease. We think that adding these easily and quickly measurable parameters to routine laboratory results may support the clinician in evaluating the complexity of coronary artery disease and guiding treatment decisions in NSTEMI patients.

The association between trimethylamine N-oxide levels and coronary microvascular dysfunction and prognosis in patients with ST-elevation myocardial infarction.

BACKGROUND AND AIMS: Coronary microvascular dysfunction (CMD) is common after ST-elevation myocardial infarction (STEMI), leading to adverse clinical outcomes. However, its diagnosis remains difficult, and mechanisms elusive. This study explores the role of Trimethylamine N-oxide (TMAO), a gut microbiota metabolite, as a potential biomarker for diagnosing CMD in STEMI patients. METHODS: This prospective, observational study enrolled 210 STEMI patients with multivessel coronary artery disease who underwent primary percutaneous coronary intervention (PCI). TMAO levels were measured at baseline, 3 months, and 12 months post-PCI, whilst coronary physiology was assessed at 3 months. The primary endpoint was the incidence of CMD at 3 months, with the secondary endpoint being major adverse cardiovascular and cerebrovascular events (MACCE) at 12 months. An additional 59 consecutive patients were enrolled for validation. RESULTS: TMAO levels varied from baseline to 3 months, then stabilised. The areas under the ROC curve for baseline TMAO and TMAO at 3-month were 0.55 (95 % CI 0.46-0.64; p = 0.426), and 0.80 (95 % CI 0.73-0.87; p < 0.001), respectively. The optimal cut-off for TMAO at 3-month to diagnose CMD was 3.91, with similar sensitivity and specificity in the derivation and validation cohort. The incidence of MACCE was higher in patients with TMAO≥3.91 (41.4 % vs 10.7 %; p < 0.001). The addition of 3-month TMAO improved the diagnostic performance of traditional risk factors. CONCLUSION: TMAO is a robust biomarker for CMD and is significantly associated with the incidence of MACCE. TMAO has the potential in guiding clinical decision-making and suggests an interplay between gut microbiota and CMD.

Epidemiological and Prognostic Importance of New-Onset Cancer as a Net Adverse Clinical Outcome after ST-Elevation Myocardial Infarction.

The study assessed the epidemiological frequency and prognostic impact of new-onset cancer as an additional net adverse clinical outcome in patients after ST-elevation myocardial infarction (STEMI), considering its potential clinical significance alongside classical endpoints. This study was designed as a single-center observational study, including 1285 consecutive patients who were diagnosed as STEMI patients as the subject, and the frequency and prognosis of new-onset cancer after STEMI onset were assessed. The incidence of all-cause death, nonfatal myocardial infarction (MI), stroke, and bleeding were analyzed as classical endpoints. Throughout an average of a 1241.4 days observation period, cancers were observed in 7.0% of patients (n = 90), showing development at a constant rate throughout this period (incidence rate, 0.06/1000 person-years). The average duration from STEMI onset to cancer diagnosis was 1371.4 days. Death, MI, or stroke were observed in 21.3%, 4.0%, 6.5%, and 12.8%, giving incidence rates of 0.18, 0.03, 0.06, and 0.11/1000 person-years, respectively. Long-term mortality was higher in patients with newly diagnosed cancer than in patients without cancer (36.7% vs. 20.1%, p < 0.01). Cancer after STEMI should be considered as an additional major adverse clinical event because of its high incidence, constant development, and high mortality in comparison to classical endpoints.