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Background: Obesity hypoventilation syndrome (OHS) is a condition characterized by obesity, daytime hypercapnia, and sleep-disordered breathing. The impact of OHS on outcomes in patients with acute myocardial infarction (AMI) remains poorly understood., Methods: We conducted a retrospective analysis using data from the National Inpatient Sample (2016-2020) to evaluate the outcomes of patients with OHS admitted for ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI)., Results: Among STEMI and NSTEMI patients, 0.15 % and 0.37 % had OHS, respectively. After adjusting for confounders, OHS was associated with higher odds of in-hospital mortality, cardiac arrest, acute kidney injury, renal replacement therapy, and respiratory failure requiring intubation in NSTEMI patients. In STEMI patients, OHS was associated with higher odds of cardiac arrest, acute kidney injury, and respiratory failure., Conclusion: OHS is associated with worse clinical outcomes in patients admitted with AMI, particularly in those with NSTEMI., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Aims: The present acute myocardial infarction (AMI) rule-out strategies are challenged by the late temporal release of cardiac troponin. Copeptin is a non-specific biomarker of endogenous stress and rises early in AMI, covering the early period where troponin is still normal. An accelerated dual-marker rule-out strategy combining prehospital copeptin and in-hospital high-sensitivity troponin T could reduce length of hospital stay and thus the burden on the health care systems worldwide. The AROMI trial aimed to evaluate if the accelerated dual-marker rule-out strategy could safely reduce length of stay in patients discharged after early rule-out of AMI., Methods and Results: Patients with suspected AMI transported to hospital by ambulance were randomized 1:1 to either accelerated rule-out using copeptin measured in a prehospital blood sample and high-sensitivity troponin T measured at arrival to hospital or to standard rule-out using a 0 h/3 h rule-out strategy. The AROMI study included 4351 patients with suspected AMI. The accelerated dual-marker rule-out strategy reduced mean length of stay by 0.9 h (95% confidence interval 0.7-1.1 h) in patients discharged after rule-out of AMI and was non-inferior regarding 30-day major adverse cardiac events when compared to standard rule-out (absolute risk difference -0.4%, 95% confidence interval -2.5 to 1.7; P-value for non-inferiority = 0.013)., Conclusion: Accelerated dual marker rule-out of AMI, using a combination of prehospital copeptin and first in-hospital high-sensitivity troponin T, reduces length of hospital stay without increasing the rate of 30-day major adverse cardiac events as compared to using a 0 h/3 h rule-out strategy., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Background: Sudden cardiac death (SCD) risk is elevated following acute myocardial infarction (MI). The time course of SCD susceptibility post-MI requires further investigation., Methods: In this observational cohort study, we employed state-of-the-art noninvasive ECG techniques to track the daily time course of cardiac electrical instability and autonomic function following ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI). Preventice BodyGuardian MINI-EL Holters continuously recorded ECGs for 7 days at hospital discharge and at 40 days for STEMI (N = 5) or at 90 days for NSTEMI patients (N = 5). Cardiac electrical instability was assessed by T-wave alternans (TWA) and T-wave heterogeneity (TWH); autonomic tone was determined by rMSSD-heart rate variability (HRV)., Results: TWA was severely elevated (≥60 μV) in STEMI patients (80 ± 10.3 μV) at discharge and throughout the first recording period but declined by 50% to 40 ± 2.3 μV (p = .03) by Day 40 and remained in the normal range (<47 μV). TWH, a related phenomenon analyzed from 12-lead ECGs, was reduced by 63% in the five STEMI patients from discharge to normal (<80 μV) at follow-up (105 ± 27.3 to 39 ± 3.3 μV, p < .04) but increased by 65% in a STEMI case (89 to 147 μV), who received a wearable defibrillator vest and later implantable cardioverter defibrillator. In NSTEMI patients, TWA was borderline abnormal (47 ± 3.3 μV) at discharge and declined by 19% to normal (38 ± 1.2 μV) by Day 90 (p = .05). An overall reciprocal increase in rMSSD-HRV suggested recovery of vagal tone., Conclusions: This study provides proof-of-principle for tracking post-MI SCD risk in individual patients with implications for personalized therapy., (© 2022 The Authors. Annals of Noninvasive Electrocardiology published by Wiley Periodicals LLC.)

Background: Guidelines recommend early coronary angiography (CA) in patients with non-ST-elevation myocardial infarction (NSTEMI) irrespective of age. However, elderly patients are less likely to be treated according to these guidelines due to their perceived high risk and medical comorbidities. Whether an invasive strategy is associated with improved survival in patients aged ≥85 years remains uncertain due to their exclusion from randomised trials., Aims: Patients were stratified based on whether they underwent invasive management with CA with a view to revascularisation versus conservative management. The primary outcome was long-term mortality., Methods: Consecutive patients aged ≥85 years presenting to a tertiary centre with NSTEMI between 2008 and 2018 were included in this retrospective cohort study., Results: Of 7591 patients with NSTEMI, 1052 patients aged ≥85 years were included. Ninety-nine (9.4%) patients underwent CA. Those undergoing CA were more likely to be younger, male, live independently, without mobility or cognitive issues (all P < 0.01). Overall, 495 (47%) patients died during a mean follow up of 1.3 ± 1 year. On Cox regression, after adjusting for age, pre-morbid functional status, cognition and cardiovascular risk factors, invasive management was the strongest predictor for survival (hazard ratio 0.47; 95% confidence interval 0.26-0.85; P = 0.01). Invasive management was associated with a trend to increased risk of in-hospital bleeding (6.1% vs 2.6%; P = 0.054) with no significant difference in stroke (2.0% vs 3.8%; P = 0.37)., Conclusion: In patients aged ≥85 years who presented with NSTEMI, invasive management was associated with improved survival without significant differences in bleeding or stroke. A randomised controlled study assessing the efficacy and safety of invasive management in very elderly patients with NSTEMI is warranted., (© 2021 Royal Australasian College of Physicians.)

Objectives: To determine the anti-inflammatory effect and safety of hydroxychloroquine after acute myocardial infarction., Method: In this multicenter, double-blind, placebo-controlled OXI trial, 125 myocardial infarction patients were randomized at a median of 43 h after hospitalization to receive hydroxychloroquine 300 mg (n = 64) or placebo (n = 61) once daily for 6 months and, followed for an average of 32 months. Laboratory values were measured at baseline, 1, 6, and 12 months., Results: The levels of interleukin-6 (IL-6) were comparable at baseline between study groups (p = 0.18). At six months, the IL-6 levels were lower in the hydroxychloroquine group (p = 0.042, between groups), and in the on-treatment analysis, the difference at this time point was even more pronounced (p = 0.019, respectively). The high-sensitivity C-reactive protein levels did not differ significantly between study groups at any time points. Eleven patients in the hydroxychloroquine group and four in the placebo group had adverse events leading to interruption or withdrawal of study medication, none of which was serious (p = 0.10, between groups)., Conclusions: In patients with myocardial infarction, hydroxychloroquine reduced IL-6 levels significantly more than did placebo without causing any clinically significant adverse events. A larger randomized clinical trial is warranted to prove the potential ability of hydroxychloroquine to reduce cardiovascular endpoints after myocardial infarction., Competing Interests: Declaration of Competing Interest JS reports personal fees from Abbott, Amgen, and Bayer and a grant from AstraZeneca. PTK reports personal fees from Amgen, Novartis, Raisio Group, and Sanofi., (Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)

Diabetes mellitus (DM) is an important risk factor for acute myocardial infarction (AMI) and a frequent co-morbidity in patients hospitalized with AMI, being present in about 30% of cases. Although current treatment of AMI has considerably improved survival in both patients with and without DM, the presence of DM still doubles the case fatality rate during both the acute phase of AMI and at long-term follow-up. This higher mortality risk of DM patients strongly indicates a particular need for better treatment options in these patients and suggests that intensive medical treatment, prolonged surveillance, and stringent control of other risk factors should be carefully pursued and maintained for as long as possible in them.In this review, we will focus on the close association between DM and in-hospital and long-term mortality in AMI patients. We will also aim at providing current evidence on the mechanisms underlying this association and on emerging therapeutic strategies, which may reduce the traditional mortality gap that still differentiates AMI patients with DM from those without.

Background and Aims: The association between implanted stent types and heart failure in patients with non-ST-elevation myocardial infarction (NSTEMI) remains unknown. The current study aimed to investigate whether the implantation of a newer-generation drug-eluting stent (NG-DES) compared with that of a bare-metal stent (BMS) in patients with NSTEMI who receive an undefined duration of dual antiplatelet therapy (DAPT) reduces the risk of hospitalization for heart failure (HHF)., Methods: In this nationwide, population-based retrospective cohort study, propensity score matching was used on the Taiwan's National Health Insurance Research Database to select 8,644 pairs of patients with NSTEMI and similar baseline characteristics receiving NG-DES or BMS implantation between January 1, 2007 and December 31, 2016. A competing risk model was constructed to evaluate the risk of HHF in the NG-DES and BMS groups. Death was considered a competing risk., Results: Rates of cumulative incidence competing risk for HHF at 1, 2, 3, 4, and 5-year follow-ups were lower in the NG-DES group (4.11%, 5.63%, 6.72%, 7.65%, and 8.89%, respectively) than in the BMS group (5.89%, 7.81%, 9.25%, 10.8%, and 11.9%, respectively). After adjustment for all clinical variables, NG-DES implantation was associated with a lower risk of HHF than BMS implantation after 5 years, with an adjusted subdistribution hazard ratio of 0.71 (95% CI = 0.64-0.79, p < 0.001). These results are in agreement with those of patients who received DAPT for >6 months., Conclusions: NG-DESs may reduce HHF risk in patients with NSTEMI who receive an undefined duration of DAPT., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Introduction: Current assays based on the 0-hour/1-hour (0-/1-h) algorithm using high-sensitivity cardiac troponin (hs-cTn) are limited to only Abbott Architect hs-cTnI, Siemens Vista hs-cTnI, and Roche Elecsys hs-cTnT., Objective: This study aimed to evaluate this new hs-cTnI assay, LumipulsePresto hs Troponin I, for diagnosis of acute myocardial infarction (AMI) on admission and on 0-/1-h algorithm to stratify AMI patients precisely., Methods: This prospective cohort study included 442 patients with suspected non-ST-elevation myocardial infarction in three hospitals in Japan and Taiwan from June 2016 to January 2019. We enrolled patients presenting to the emergency department with symptoms suggestive of AMI and collected blood samples on admission and 1 hour later. Two independent cardiologists centrally adjudicated final diagnoses; all clinical information was reviewed twice: first, using serial hs-cTnT (Roche-Elecsys, primary analysis) and Lumipulse Presto Lumipulse Presto, second, using the Lumipulse Presto hs-cTnI measurements. At first, we compared diagnostic accuracy quantified using receiver operating characteristic (ROC) curves for AMI. Then, we evaluated major adverse cardiovascular events (cardiac death, AMI) in the rule-out group according to a 0-hour/1-hour algorithm at the 30-day follow-up., Results: Diagnostic accuracy at presentation by the ROC curve for AMI was very high and similar for the LumipulsePresto hs-cTnI and hs-cTnT,(area under the curve [AUC]: LumipulsePresto hs-cTnI, 0.89, 95% confidence interval [CI] 0.86-0.93; hs-cTnT, 0.89, 95% CI 0.85-0.93; p = 0.82). In early presenters, the LumipulsePresto hs-cTnI appeared to maintain the diagnostic performance of hs-cTn for patients with <3 h (AUC: LumipulsePresto hs-cTnI, 0.87, 95% CI 0.81-0.92; hs-cTnT, 0.86, 95% CI 0.80-0.92; p = 0.81). The algorithm using the LumipulsePresto hs-cTnI ruled out AMI in 200 patients with negative predictive value and sensitivity of 100% (95% CI 97.3%-100%) and 100% (95% CI 92.7%-100%), respectively, in the rule-out group., Conclusion: Diagnostic accuracy and clinical utility of the novel LumipulsePresto hs-cTnI assay are high and comparable with the established hs-cTn assays., (© 2021 The Author(s) Published by S. Karger AG, Basel.)

Aims: The prognostic significance of cardiac magnetic resonance (CMR)-derived infarct characteristics has been demonstrated in ST-elevation myocardial infarction (STEMI) cohorts but is undefined in non-ST-elevation myocardial infarction (NSTEMI) patients. We aimed to investigate determinants and the long-term prognostic impact of CMR imaging-derived infarct characteristics in patients with NSTEMI., Methods and Results: Infarct size (IS), myocardial salvage index (MSI), and microvascular obstruction were assessed using CMR imaging in 284 NSTEMI patients undergoing percutaneous coronary intervention (PCI) in three centres. CMR imaging was performed 3 [interquartile range (IQR) 2-4] days after admission. The primary clinical endpoint was defined as major adverse cardiac events during median follow-up of 4.4 (IQR 3.6-4.9) years. Median IS was 7.2% (IQR 2.2-13.7) of left ventricular (LV) myocardial mass (%LV) and MSI was 65.7 (IQR 39.3-84.9). Age (P ≤ 0.003), heart rate (P ≤ 0.02), the number of diseased coronary arteries (P ≤ 0.01), and Thrombolysis In Myocardial Infarction (TIMI) flow grade before PCI (P < 0.001) were independent predictors of IS and MSI. The primary endpoint occurred in 64 (22.5%) patients. CMR-derived infarct characteristics had no additional prognostic value beyond LV ejection fraction in multivariable analysis., Conclusion: In this prospective, multicentre NSTEMI cohort reperfused by PCI, age, heart rate, the number of diseased coronary arteries, and TIMI flow grade before PCI were independent predictors of IS and MSI assessed by CMR. However, in contrast to STEMI patients there was no additional long-term prognostic value of CMR-derived infarct characteristics over and above LV ejection fraction., Clinicaltrials.gov: NCT03516578., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.)

Background: Non-ST-segment elevation myocardial infarction (NSTEMI) has become the most frequently encountered type of myocardial infarction. The patient clinical profile and management has evolved over the past decade. As there is still a scarcity of data on the latest trends in NSTEMI, changes herein were observed and assessed in the treatment and outcomes in Poland between 2005 and 2014., Methods: A total of 197,192 patients with NSTEMI who enrolled in the Polish Registry of Acute Coronary Syndromes (PL-ACS) between 2005 and 2014 were analyzed. In-hospital and 12-month mortality were assessed., Results: Coronary angiography use increased from 35.8% in 2005-2007 to 90.7% in 2012-2014 (p < 0.05), whereas percutaneous coronary intervention increased from 25.7% in 2005-2007 to 63.6% in 2012-2014 (p < 0.05). There was a 50% reduction in in-hospital mortality (from 5.6% in 2005-2007 to 2.8% in 2012-2014; p < 0.05) and a 30% reduction in 1-year mortality (from 19.4% in 2005-2007 to 13.7% in 2012-2014; p < 0.05). A multivariate analysis confirmed an immense impact of invasive strategy on patient prognosis during in-hospital observation with an odds ratio (OR) of 0.31 (95% confidence interval [CI] 0.29-0.33; p < 0.05) as well as during the 12-month observation with an OR of 0.51 (95% CI 0.49-0.52; p < 0.05)., Conclusions: Over the past 10 years, an important advance in the management of NSTEMI has taken place in Poland. Routine invasive strategy resulted in a significant decrease in mortality rates in all groups of NSTEMI patients.

Cardiac biomarkers are an integral component of the diagnostic work-up of patients with suspected acute coronary syndrome (ACS). Cardiac troponin (cTn) is the most sensitive diagnostic biomarker for patients with ACS and enables the differentiation of acute non-ST-elevation myocardial infarction (NSTEMI) from unstable angina. All cardiac and non-cardiac differential diagnoses must be taken into consideration. The use of cTn has a prognostic value in a multitude of acute and chronic diseases apart from ACS. Highly sensitive cTn (hsTn) assays should be preferentially used. Point-of-care (POC) troponin assays can be used for rule-in of acute MI but are generally not useful for rule-out of MI due to their lack of sensitivity compared to hsTn assays. This, however, may change with recent developments of newer and improved POC troponin assays. For exclusion of MI using hsTn assays, there are various protocols available, such as the instant rule-out with undetectable hsTn levels at admission or normal hsTn/cTn levels combined with normal copeptin levels or rule-out with serial controls of hsTn after 1, 2 or 3 h. This article provides an overview of guideline-recommended rule-out protocols for patients with suspected ACS and discusses recent advances in POC troponin assays.

Background: Optimal timing for an invasive strategy in non-ST elevation myocardial infarction (NSTEMI) is unclear. Whether clinical outcomes are improved with a less than two (LT2) compared with greater than two hour (GT2) invasive strategy remains to be determined. We performed a meta-analysis of randomized controlled trials (RCTs) comparing LT2 vs GT2 for NSTEMI., Methods: A comprehensive literature search for RCTs comparing LT2 vs. GT2 in NSTEMI patients was performed. Three eligible studies consisting of 1,075 patients (LT2: 537, GT2: 538) with NSTEMI were identified. Follow-up ranged from 1 to 12 months., Results: Time from randomization to sheath insertion ranged from 0.5-2.2 and 14.0-85.0 hours in the LT2 and GT2 groups. More percutaneous coronary interventions and fewer coronary artery bypass grafting were performed in the LT2 vs. GT2 group. There was no significant difference in all-cause mortality, myocardial infarction (MI), and major bleeding between the two groups. LT2 was numerically, but not statistically superior to GT2 at preventing recurrent ischemia/urgent revascularization/refractory ischemia., Conclusion: Our meta-analysis found no significant difference in outcomes between less than two versus greater than two hours invasive strategy for NSTEMI. The differences observed in the mode of revascularization according to timing of catheterization deserve further study.

Background: The most recent joint guidelines from the American Heart Association (AHA) and American College of Cardiology (ACC) on the management of non-ST-elevation acute coronary syndromes (NSTE-ACS) are a result of a substantial and considered undertaking, and those involved deserve much recognition for their efforts. However, the handling of anticoagulants seems somewhat inadequate, and this is a highly-relevant matter when managing NSTE-ACS., Objective of the Review: Among areas of potential uncertainty, emergency medicine professionals might still be left wondering about the particulars of anticoagulant therapy when pursuing ischemia-guided management of NSTE-ACS (that is, managing NSTE-ACS without an intent for early invasive measures, such as coronary angiography and revascularization). This review seeks to provide insight into this question., Discussion: Relevant clinical trials are appraised and translated into clinical context for emergency medicine professionals, including the implications of noteworthy advancements in the management of NSTE-ACS., Conclusions: Although current guidelines from the AHA and ACC suggest enoxaparin has better evidence than other anticoagulants in the setting of NSTE-ACS management, careful review of the evidence shows this is not actually clearly supported by the available evidence in the era of contemporary management. Unless and until better contemporary data emerge, emergency medicine professionals must carefully weigh the available evidence, its limitations, and the possible clinical implications of the various anticoagulant options when managing NSTE-ACS., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Aims: Fondaparinux is an alternative to low molecular weight heparin (LMWH) for non-ST-elevation myocardial infarction (NSTEMI) with levels of recommendation that differ according to guidelines. The aim of this study was to assess outcomes in real world practice in NSTEMI patients participating in the French Registry of ST-elevation and non-ST-elevation Myocardial Infarction (FAST-MI) 2010 according to the use of fondaparinux, in comparison with patients receiving enoxaparin., Methods and Results: FAST-MI 2010 is a nationwide French registry that included 4,169 patients with acute myocardial infarction at the end of 2010 in 213 centres (76% of active centres in France); 1,734 had NSTEMI, with 240 receiving fondaparinux and 1,027 enoxaparin. Patients receiving enoxaparin vs. fondaparinux had essentially characteristics with a similar GRACE (Global Registry of Acute Coronary Events) score. Invasive strategy was used in 69% in both groups. In-hospital bleeding was similar with both anticoagulant strategies and 1-year survival was 94.6% and 91.7%, respectively. Using fully adjusted Cox multivariate analysis, the use of fondaparinux was not associated with a reduced risk of death (hazard ratio: 1.35; 95% confidence interval: 0.70-2.51). After propensity score matching (207 patients per group), 1-year survival was similar with both strategies. There was, however, an interaction between fondaparinux and unfractionated heparin, with higher survival in fondaparinux-treated patients who received UFH, compared with those who did not., Conclusions: In this French cohort of NSTEMI patients, predominantly managed invasively, there was no evidence that fondaparinux was superior to enoxaparin as regards bleeding events or 1-year mortality (FAST-MI 2010; NCT01237418)., (© The European Society of Cardiology 2014.)

Background/objectives: Non-ST segment elevation myocardial infarction (MI) poses similar detrimental long-term prognosis as ST-segment elevation MI. No marker on ECG is established to predict successful reperfusion in NSTEMI. QT dispersion is increased by myocardial ischemia and reduced by successful restoration of epicardial blood flow by PCI. Whether QT dispersion reduction translates to smaller infarcts and thus indicates successful reperfusion is unknown. We hypothesized that the relative reduction of QT dispersion (QTD-Rrel ) on a standard ECG in acutely reperfused NSTEMI is related to infarct size and infarct transmurality as assessed by delayed enhancement CMR (DE-CMR)., Methods and Results: 69 patients with a first acute NSTEMI were included. QTD-Rrel was stratified according to LV function and volumes, infarct transmurality and size as assessed by DE-CMR. Extensive myocardial infarction was defined as above median infarct size. LV function and end-systolic volume were only mildly related to QTD-Rrel . QTD-Rrel was inversely related to infarct size (r=-0.506,p=0.001) and infarct transmurality (r=-0.415, p=0.001). QTD-Rrel was associated with extensive myocardial infarction in univariate analysis (odds ratio (OR) 0.958, CI 0.935-0.982; p=0.001). Compared to clinical and angiographic data QTD-Rrel remained the only independent predictor of non-transmural infarcts (OR 1.110, CI 1.055-1.167; p=0.049)., Conclusion: In patients with acute Non-ST-Segment Myocardial infarction QTd-Rrel calculated on a surface ECG prior and post PCI for restoration of epicardial blood flow detects small, non-transmural infarcts as assessed by delayed enhancement CMR. Thus, QTd-Rrel can indicate successful reperfusion therapy.

Background: Takotsubo syndrome is an acute cardiovascular condition that predominantly affects women. In this study, we compared patients with takotsubo syndrome and those with acute myocardial infarction with respect to patient characteristics, angiographic findings, and short- and long-term mortality., Methods: From the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) and the Register of Information and Knowledge about Swedish Heart Intensive Care Admissions (RIKS-HIA), we obtained and merged data on patients undergoing coronary angiography in Västra Götaland County in western Sweden between January 2005 and May 2013. Short- and long-term mortality in patients with takotsubo (n=302) and patients with ST-elevation myocardial infarction (STEMI, n=6595) and non-ST-elevation myocardial infarction (NSTEMI, n=8207) were compared by modeling unadjusted and propensity score-adjusted logistic and Cox proportional-hazards regression., Results: The proportion of the patients diagnosed with takotsubo increased from 0.16% in 2005 to 2.2% in 2012 (P<0.05); 14% of these patients also had significant coronary artery disease. Cardiogenic shock developed more frequently in patients with takotsubo than NSTEMI (adjusted OR 3.08, 95% CI 1.80-5.28, P<0.001). Thirty-day mortality was 4.1% and was comparable to STEMI and NSTEMI. The long-term risk of dying from takotsubo (median follow-up 25 months) was also comparable to NSTEMI (adjusted HR 1.01, 95% CI 0.70-1.46, P=0.955) STEMI (adjusted HR 0.83, 95% CI 0.57-1.20, P=0.328)., Conclusions: The proportion of acute coronary syndromes attributed to takotsubo syndrome in Western Sweden has increased over the last decade. The prognosis of takotsubo syndrome is poor, with similar early and late mortality as STEMI and NSTEMI., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Background: Improved early outcome in non-ST elevation myocardial infarction (NSTEMI) patients has been mainly attributed to a broader use of invasive strategies. Little is known about the impact of other changes in early management., Methods: We aimed to assess 15-year trends in one-year mortality and their determinants in NSTEMI patients. We used data from 4 one-month French registries, conducted 5 years apart from 1995 to 2010 including 3903 NSTEMI patients admitted to intensive care units., Results: From 1995 to 2010, no major change was observed in patient characteristics, while therapeutic management evolved considerably. Early use of antiplatelet agents, β-blockers, ACE-inhibitors and statins increased over time (P < 0.001); use of newer anticoagulants (low-molecular-weight heparin, bivalirudin or fondaparinux) increased from 40.8% in 2000 to 78.9% in 2010 (P < 0.001); percutaneous coronary intervention (PCI)≤ 3 days of admission rose from 7.6% to 48.1% (P < 0.001). One-year death decreased from 20% to 9.8% (HR adjusted for baseline parameters, 2010 vs. 1995 = 0.47, 95% CI: 0.35-0.62). Early PCI (HR = 0.67; 95% CI: 0.49-0.90), use of newer anticoagulants (HR = 0.62; 95% CI: 0.48-0.78) and early use of evidence based medical therapy (HR = 0.54; 95% CI: 0.40-0.72) were predictors of improved one year-survival., Conclusions: One-year mortality of NSTEMI patients decreased by 50% in the past 15years. Our data support current guidelines recommending early invasive strategies and use of newer anticoagulants for NSTEMI, and also show a strong positive association between early use of appropriate medical therapies and one-year survival, suggesting that these medications should be used from the start., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

The objective of the study was to describe a very rare complication of foam ultrasound-guided sclerotherapy (FUGS). An unusual case of persisting chest discomfort following FUGS in a 61-year-old woman led to a diagnosis of non-ST-elevation myocardial infarction. The patient was found to have a patent foramen ovale (PFO). The differential diagnoses of paradoxical embolism, gas embolism or vasospasm are discussed, with reference to relevant literature. A hypothesis of post sclerotherapy release of endothelin-1 (in a patient with a known PFO) leading to sustained coronary artery spasm causing sufficient myocardial damage to be reflected in elevated troponin levels is suggested. Any episode of chest tightness or pain following FUGS should be considered as possibly cardiac in origin. Sustained symptoms warrant admission to hospital for troponin monitoring and ECG assessment., (© The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.)

Background: There has been a paradigm shift in the definition of timing of early invasive strategy (EIS) for patients admitted with non-ST-elevation myocardial infarction (NSTEMI) in the last decade. Data on trends of EIS for NSTEMI and associated in-hospital outcomes are limited. Our aim is to analyze temporal trends in the incidence, utilization of early invasive strategy, and in-hospital outcomes of NSTEMI in the United States., Methods and Results: We analyzed the 2002-2011 Nationwide Inpatient Sample databases to identify all patients ≥40 years of age with the principal diagnosis of acute myocardial infarction (AMI) and NSTEMI. Logistic regression was used for overall, age-, sex-, and race/ethnicity-stratified trend analysis. From 2002 to 2011, we identified 6 512 372 patients with AMI. Of these, 3 981 119 (61.1%) had NSTEMI. The proportion of patients with NSTEMI increased from 52.8% in 2002 to 68.6% in 2011 (adjusted odds ratio [OR; per year], 1.055; 95% confidence interval [CI], 1.054 to 1.056) in the overall cohort. Similar trends were observed in age-, sex-, and race/ethnicity-stratified groups. From 2002 to 2011, utilization of EIS at day 0 increased from 14.9% to 21.8% (Ptrend<0.001) and utilization of EIS at day 0 or 1 increased from 27.8% to 41.4% (Ptrend<0.001). Risk-adjusted in-hospital mortality in the overall cohort decreased during the study period (adjusted OR [per year], 0.976; 95% CI, 0.974 to 0.978)., Conclusions: There have been temporal increases in the proportion of NSTEMI and, consistent with guidelines, greater utilization of EIS. This has been accompanied by temporal decreases in in-hospital mortality and length of stay., (© 2014 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.)

Oxymetazoline is an alpha-1 adrenergic receptor agonist that is commonly used for nasal decongestion and is readily available without a prescription. We report the case of a 64-year-old woman who developed prolonged chest pain associated with elevation of cardiac biomarkers after using oxymetazoline., (Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.)

Introduction and Objectives: To analyze sex-based differences in clinical characteristics, management, and 28-day and 7-year prognosis after a first myocardial infarction., Methods: Between 2001 and 2003, 2042 first myocardial infarction patients were consecutively registered in 6 Spanish hospitals. Clinical characteristics, management, and 28-day case-fatality were prospectively recorded. Seven-year vital status was also ascertained by data linkage with the National Mortality Index., Results: The registry included 449 women and 1593 men with a first myocardial infarction. Compared with men, women were older, had a higher prevalence of hypertension and diabetes, and were more likely to receive angiotensin-converting enzyme (ACE) inhibitors but were less likely to receive beta-blockers or thrombolysis. No differences were observed in use of invasive procedures. More women had non-ST-segment elevation and unclassified myocardial infarction than men (37.9% vs 31.3% and 9.8% vs 6.1%, respectively; both P<.001). Case-fatality at 28 days was similar in women and men (5.57% vs 4.46%; P=.39). After multivariate adjustment, the odds ratio of 28-day mortality for men was 1.06 (95% confidence interval: 0.49-2.27; P=.883) compared with women. After multivariate adjustment, men had higher 7-year mortality than women, hazard ratio 1.93 (95% confidence interval: 1.46-2.56; P<.001)., Conclusions: There are demographic and clinical differences between men and women with a first myocardial infarction. The short-term prognosis of a first myocardial infarction in this century is similar in both sexes. However, the long-term vital prognosis after a first myocardial infarction is worse in men than in women. These results are observed in both ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction events., (Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.)

Background: Previous studies have demonstrated improved outcomes with an early invasive strategy in patients with unstable angina/non-ST-elevation myocardial infarction (UA/NSTEMI). However, there are limited data for patients ≥80 years of age in these studies., Methods: We used the 2003-2010 Nationwide Inpatient Sample databases to identify all patients ≥80 years of age (octogenarians) with UA/NSTEMI. Multivariable logistic regression was used to compare in-hospital outcomes in octogenarians with UA/NSTEMI undergoing early invasive (coronary angiography within 48 hours of admission, with or without revascularization) versus initial conservative treatment., Results: Among 968,542 octogenarians with UA/NSTEMI, 806,902 (83.3%) were managed using an initial conservative approach and 161,640 (16.7%) using an early invasive strategy. Patients in the early invasive group were more likely to be younger, men, white, and had a higher prevalence of smoking, dyslipidemia, obesity, hypertension, known coronary artery disease, carotid artery disease, and peripheral vascular disease. In-hospital mortality was significantly lower in octogenarians in the early invasive group (adjusted odds ratio [OR] 0.76; 95% confidence interval [CI], 0.74-0.78). Early invasive strategy was associated with lower rates of acute ischemic stroke (adjusted OR 0.63; 95% CI, 0.60-0.66), intracranial hemorrhage (adjusted OR 0.60; 95% CI, 0.510.70), gastrointestinal bleeding (adjusted OR 0.63; 95% CI, 0.60-0.65), and shorter average length of stay (5.3 vs 5.8 days, P <.001), but higher cardiogenic shock (adjusted OR 2.14; 95% CI, 2.06-2.23) and total hospital cost (23,584 vs 13,278 USD)., Conclusion: Compared with an initial conservative approach, an early invasive strategy in octogenarians with UA/NSTEMI was associated with lower in-hospital mortality, acute ischemic stroke, intracranial hemorrhage, gastrointestinal bleeding, and shorter length of stay, but higher cardiogenic shock and total hospital cost., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Rationale and Objectives: To quantitatively assess coronary atherosclerotic plaque composition in patients with acute non-ST elevation myocardial infarction (NSTEMI) and patients with stable coronary artery disease (CAD) by coronary computed tomography angiography (cCTA) correlated with virtual histology intravascular ultrasound (VH-IVUS)., Materials and Methods: Sixty patients (35 with NSTEMI) were included. Corresponding plaques were assessed by dual-source cCTA and VH-IVUS regarding volumes and percentages of fatty, fibrous, and calcified component; overall plaque burden; and maximal percent area stenosis. Possible differences between patient groups were investigated. Concordance between cCTA and VH-IVUS measurements was validated by Bland-Altman analysis., Results: Forty corresponding plaques (22 of patients with NSTEMI) were finally analyzed by cCTA and VH-IVUS. cCTA plaque analysis revealed no significant differences between plaques of patients with NSTEMI and stable CAD regarding absolute and relative amounts of any plaque component (fatty: 20 mm³/13% versus 17 mm³/14%; fibrous: 81 mm³/63% versus 80 mm³/53%; calcified: 16 mm³/14% versus 26 mm³/26%; all P > .05) or overall plaque burden (153 mm³ versus 165 mm³; P > .05), nor did VH-IVUS plaque analysis. VH-IVUS measured a higher area stenosis in patients with NSTEMI compared to patients with stable CAD (76% versus 68%, P = .01; in cCTA 69% versus 65%, P = .2). Volumes of fatty component were measured systematically lower in cCTA, whereas calcified and fibrous volumes were higher. No significant bias was observed comparing volumes of overall noncalcified component and overall plaque burden., Conclusion: Plaques of patients with acute NSTEMI and of patients with stable CAD cannot be differentiated by quantification of plaque components. cCTA and VH-IVUS differ in plaque component analysis., (Copyright © 2013 AUR. Published by Elsevier Inc. All rights reserved.)

As the first nationwide Korean prospective multicenter data collection registry, the Korea Acute Myocardial Infarction Registry (KAMIR) launched in November 2005. Through a number of innovative approaches, KAMIR suggested new horizons about acute myocardial infarction (AMI) which contains unique features of Asian patients from baseline characteristics to treatment strategy. Obesity paradox was existed in Korean AMI patients, whereas no gender differences among them. KAMIR score suggested new risk stratifying method with increased convenience and an enhanced accuracy for the prediction of adverse outcomes. Standard loading dose of clopidogrel was enough for Asian AMI patients. Triple antiplatelet therapy with aspirin, clopidogrel and cilostazol could improve clinical outcomes than dual antiplatelet therapy with aspirin and clopidogrel. Statin improved clinical outcomes even in AMI patients with very low LDL-C levels. The rate of percutaneous coronary intervention was higher and door-to-balloon time was shorter than the previous reports. Zotarolimus eluting stents as the 2nd generation drug-eluting stent (DES) was not superior to the 1st generation DES, in contrast to the western AMI studies. KAMIR made a cornerstone in the study of Korean AMI and expected to be new standards of care for AMI with the renewal of KAMIR design to overcome its pitfalls.

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. [ABSTRACT FROM AUTHOR]

Background: We used the Spanish national hospital discharge data from 2016 to 2022 to analyze procedures and hospital outcomes among patients aged ≥ 18 years admitted for ST-elevation myocardial infarction (STEMI) and non–ST-elevation myocardial infarction (NSTEMI) according to diabetes mellitus (DM) status (non-diabetic, type 1-DM or type 2-DM). Methods: We built logistic regression models for STEMI/NSTEMI stratified by DM status to identify variables associated with in-hospital mortality (IHM). We analyzed the effect of DM on IHM. Results: Spanish hospitals reported 201,950 STEMIs (72.7% non-diabetic, 0.5% type 1-DM, and 26.8% type 2-DM; 26.3% female) and 167,285 NSTEMIs (61.6% non-diabetic, 0.6% type 1-DM, and 37.8% type 2-DM; 30.9% female). In STEMI, the frequency of percutaneous coronary intervention (PCI) increased among non-diabetic people (60.4% vs. 68.6%; p < 0.001) and people with type 2-DM (53.6% vs. 66.1%; p < 0.001). In NSTEMI, the frequency of PCI increased among non-diabetic people (43.7% vs. 45.7%; p < 0.001) and people with type 2-DM (39.1% vs. 42.8%; p < 0.001). In NSTEMI, the frequency of coronary artery by-pass grafting (CABG) increased among non-diabetic people (2.8% vs. 3.5%; p < 0.001) and people with type 2-DM (3.7% vs. 5.0%; p < 0.001). In the entire population, lower IHM was associated with undergoing PCI (odds ratio [OR] [95% confidence interval] = 0.34 [0.32–0.35] in STEMI; 0.24 [0.23–0.26] in NSTEMI) or CABG (0.33 [0.27–0.40] in STEMI; 0.45 [0.38–0.53] in NSTEMI). IHM decreased over time in STEMI (OR = 0.86 [0.80–0.93]). Type 2-DM was associated with higher IHM in STEMI (OR = 1.06 [1.01–1.11]). Conclusions: PCI and CABG were associated with lower IHM in people admitted for STEMI/NSTEMI. Type 2-DM was associated with IHM in STEMI. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background and Aims: Several studies imply that influenza and other respiratory illnesses could lead to acute myocardial infarction (AMI), but data from low‐income countries are scarce. We investigated the prevalence of recent respiratory illnesses and confirmed influenza in AMI patients, while also exploring their relationship with infarction severity as defined by ST‐elevation MI (STEMI) or high troponin levels. Methods: This cross‐sectional study, held at a Dhaka tertiary hospital from May 2017 to October 2018, involved AMI inpatients. The study examined self‐reported clinical respiratory illnesses (CRI) in the week before AMI onset and confirmed influenza using baseline real‐time reverse transcription polymerase chain reaction (qRT‐PCR). Results: Of 744 patients, 11.3% reported a recent CRI, most prominently during the 2017 influenza season (35.7%). qRT‐PCR testing found evidence of influenza in 1.5% of 546 patients, with all positives among STEMI cases. Frequencies of CRI were higher in patients with STEMI and in those with high troponin levels, although these relationships were not statistically significant after adjusting for other variables. The risk of STEMI was significantly greater during influenza seasons in the unadjusted analysis (relative risk: 1.09, 95% confidence interval [CI]: 1.02–1.18), however, this relationship was not significant in the adjusted analysis (adjusted relative risk: 1.03, 95% CI: 0.91–1.16). Conclusion: In Bangladesh, many AMI patients had a recent respiratory illness history, with some showing evidence of influenza. However, these illnesses showed no significant relationship to AMI severity. Further research is needed to understand these relationships better and to investigate the potential benefits of infection control measures and influenza vaccinations in reducing AMI incidence. [ABSTRACT FROM AUTHOR]

Anticoagulants play a vital role as part of the antithrombotic therapy of myocardial infarction and are complementary to antiplatelet therapies. In the acute setting, the rationale for their use is to antagonize the ongoing clotting cascade including during percutaneous coronary intervention. Anticoagulation may be an important part of the longer-term antithrombotic strategy especially in patients who have other existing indications (e.g. atrial fibrillation) for their use. In this narrative review, the authors provide a contemporary summary of the anticoagulation strategies of patients presenting with NSTEMI, both in terms of anticoagulation during the acute phase as well as suggested antithrombotic regimens for patients who require long-term anticoagulation for other indications. Patients presenting with non-ST-elevation myocardial infarction (NSTEMI) should be initiated on anticoagulation (e.g. heparin/low molecular weight heparin) for the initial hospitalization period for those medically managed or until percutaneous coronary intervention. Longer term management of NSTEMI for patients with an existing indication for long-term anticoagulation should comprise triple antithrombotic therapy of anticoagulant (preferably DOAC) with aspirin and clopidogrel for up to 1 month (typically 1 week or until hospital discharge), followed by DOAC plus clopidogrel for up to 1 year, and then DOAC monotherapy thereafter. [ABSTRACT FROM AUTHOR]

Background: This article introduces the first national guidelines for the management including diagnosis, treatment, and secondary prevention of acute coronary syndrome (ACS) in Iran. Materials and Methods: The members of the guideline development group (GDG) were specialists and experts in fields related to ACS and were affiliated with universities of medical sciences or scientific associations in the country. They carefully examined the evidence and clinical concerns related to ACS management and formulated 13 clinical questions that were sent to systematic review group who developed related evidence using Grade method. Finally the GDG developed the recommendations and suggestions of the guideline. Results: The first three questions in the guideline focus on providing recommendations for handling a patient who experience chest pain at home, in a health house or center, during ambulance transportation, and upon arrival at the emergency department (ED) as well as the initial diagnostic measures in the ED. Subsequently, the recommendations related to the criteria for categorizing patients into low,intermediate and high-risk groups are presented. The guideline addressed primary treatment measures for ACS patients in hospitals with and without code 247 or having primary percutaneous coronary intervention (PCI) facilities, and the appropriate timing for PCI based on the risk assessment. In addition, the most efficacious antiplatelet medications for ACS patients in the ED as well as its optimal duration of treatment are presented. The guideline details the recommendations for therapeutic interventions in patients with ACS and acute heart failure, cardiogenic shock, myocardial infarction with nonobstructive coronary arteries (MINOCA), multivessel occlusion, as well as the indication for prescribing a combined use of anticoagulants and antiplatelet during hospitalization and upon discharge. Regarding secondary prevention, while emphasizing the referral of these patients to rehabilitation centers, other interventions that include pharmaceutical and nonpharmacological ones are addressed, In addition, necessary recommendations for enhancing lifestyle and posthospital discharge pharmaceutical treatments, including their duration, are provided. There are specific recommendations and suggestions for subgroups, such as patients aged over 75 years and individuals with heart failure, diabetes, and chronic kidney disease. Conclusion: Developing guidelines for ACS diagnosis, treatment and secondary prevention according to the local context in Iran can improve the adherence of our health care providers, patients health, and policy makers plans. [ABSTRACT FROM AUTHOR]

Background: Non-ST-elevation myocardial infarction (NSTEMI), a disease of mounting interest, continues to pose challenges and cast shadows of doubt on determining the optimal timing for revascularization. The current guidelines on NSTEMI recommend coronary angiography based on the GRACE score, emphasizing the critical need for early invasive assessment (within 24 h); very-high-risk patients have to undergo this intervention even sooner, within 2 h. We believe that a reality check of these assumptions is needed and that we should endeavor to update these strategies using new predictive markers. Materials and methods: Our study included patients hospitalized for NSTEMI over the course of 16 months. Simple blood parameters, namely MCV (mean corpuscular volume), MPV (mean platelet volume), RDW (red blood cell distribution width), and PDW (platelet distribution width), were analyzed in correlation with the extent of the myocardial infarction area and with complications during hospitalization and at 30-day follow-up. Results: The parameters mentioned above have been identified as statistically relevant indicators of prognosis in patients with NSTEMI. Conclusions: In the present day, living in the world of the blue sky concept allows us to search for new diagnostic algorithms. Therefore, the combination of these parameters can constitute the DNA strands of a new and up-to-date score stratification. [ABSTRACT FROM AUTHOR]

Background and aims: To evaluate the effect of hydroxychloroquine (HCQ) on serum and lipoprotein lipids and serum biomarkers of cholesterol synthesis and absorption in myocardial infarction patients with a high-dose statin. Methods: Myocardial infarction patients (n = 59) with a constant statin dose were randomized to receive hydroxychloroquine 300 mg (n = 31) or placebo (n = 28) daily for six months and followed up for one year. Results: Statin reduced total-c (−26 ± 22% in hydroxychloroquine and −28 ± 19% in placebo group, P = 0.931), LDL-c (−38 ± 26% vs. −44 ± 23%, respectively, P = 0.299), and cholesterol synthesis biomarkers zymostenol, desmosterol, and lathosterol ratios from baseline to one year (e.g., serum lathosterol ratio −17 ± 45% vs. −15 ± 41%, respectively, P

Purpose: Distinguishing ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) is crucial in acute myocardial infarction (AMI) research due to their distinct characteristics. However, the accuracy of International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes for STEMI and NSTEMI in Taiwan's National Health Insurance (NHI) database remains unvalidated. Therefore, we developed and validated case definition algorithms for STEMI and NSTEMI using ICD-10-CM and NHI billing codes.Patients and Methods: We obtained claims data and medical records of inpatient visits from 2016 to 2021 from the hospital's research-based database. Potential STEMI and NSTEMI cases were identified using diagnostic codes, keywords, and procedure codes associated with AMI. Chart reviews were then conducted to confirm the cases. The performance of the developed algorithms for STEMI and NSTEMI was assessed and subsequently externally validated.Results: The algorithm that defined STEMI as any STEMI ICD code in the first three diagnosis fields had the highest performance, with a sensitivity of 93.6% (95% confidence interval [CI], 91.7– 95.2%), a positive predictive value (PPV) of 89.4% (95% CI, 87.1– 91.4%), and a kappa of 0.914 (95% CI, 0.900– 0.928). The algorithm that used the NSTEMI ICD code listed in any diagnosis field performed best in identifying NSTEMI, with a sensitivity of 82.6% (95% CI, 80.7– 84.4%), a PPV of 96.5% (95% CI, 95.4– 97.4), and a kappa of 0.889 (95% CI, 0.878– 0.901). The algorithm that included either STEMI or NSTEMI ICD codes listed in any diagnosis field showed excellent performance in defining AMI, with a sensitivity of 89.4% (95% CI, 88.2– 90.6%), a PPV of 95.6% (95% CI, 94.7– 96.4%), and a kappa of 0.923 (95% CI, 0.915– 0.931). External validation confirmed these algorithms' efficacy.Conclusion: Our results provide valuable reference algorithms for identifying STEMI and NSTEMI cases in Taiwan's NHI database. [ABSTRACT FROM AUTHOR]

Objective: To compare the short term in-hospital outcomes in patients presenting with acute ST-Elevation Myocardial Infarction (STEMI) and Non-ST-Elevation Myocardial Infarction (NSTEMI). Study Design: Comparative Cross-sectional study. Place and Duration of Study: Adult cardiology department of tertiary care center, Rawalpindi Pakistan, from Aug 2022 to Feb 2023. Methodology: A sample of 323 patients of acute STEMI and NSTEMI were enrolled. Patients fulfilling the inclusion criteria were enrolled through non-probability consecutive sampling. Patients were divided into two groups. The data of short term in hospital outcomes was recorded. Data was entered and analyzed using SPSS version-26:00. Chi-square and t-test were used to find association and mean difference of study variables between study groups. Results: Out of total 317 patients, males were 262(82.6%) and females were 55(17.4%)) with an average age of 63.34±8.96 years in the study. 139(43.8%) patients had Diabetes Mellitus, 146(46.1%) were hypertensive and 73(23.0%) were smokers. 198(62.5%) patients had STEMI and 119(37.5%) had NSTEMI. Mortality within hospital was found in 10(3.2%) patients. There were significant findings with age (p

We compared the effects of sex differences in delayed hospitalization (symptom-to-door time [SDT], ≥24 h) on major clinical outcomes in patients with non-ST-segment elevation myocardial infarction after new-generation drug-eluting stent implantation. A total of 4593 patients were classified into groups with (n = 1276) and without delayed hospitalization (SDT < 24 h, n = 3317). Thereafter, these two groups were subdivided into male and female groups. The primary clinical outcomes were major adverse cardiac and cerebrovascular events (MACCE), defined as all-cause death, recurrent myocardial infarction, repeat coronary revascularization, and stroke. The secondary clinical outcome was stent thrombosis. After multivariable- and propensity score-adjusted analyses, in-hospital mortalities were similar between the male and female groups in both the SDT < 24 h and SDT ≥ 24 h groups. However, during a 3-year follow-up period, in the SDT < 24 h group, all-cause death (p = 0.013 and p = 0.005, respectively) and cardiac death (CD, p = 0.015 and p = 0.008, respectively) rates were significantly higher in the female group than those in the male group. This may be related to the lower all-cause death and CD rates (p = 0.022 and p = 0.012, respectively) in the SDT < 24 h group than in the SDT ≥ 24 h group among male patients. Other outcomes were similar between the male and female groups and between the SDT < 24 h and SDT ≥ 24 h groups. In this prospective cohort study, female patients showed higher 3-year mortality, especially in the SDT < 24 h, compared to male patients. [ABSTRACT FROM AUTHOR]

Objective: To assess the use of C-reactive protein in patients with STEMI and NSTEMI to differentiate between the type of myocardial infarction at our hospital. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Medicine, Pak Emirates Military Hospital, Rawalpindi and Armed Force Institute of Cardiology & National Institute of Heart Disease, from Mar 2020 to Feb 2022. Methodology: Patients diagnosed with MI by a consultant cardiologist were included in the study. They underwent all baseline investigations, including C reactive protein, at the time of presentation to a cardiac emergency. The treating consultant diagnosed MI (ST elevation or non-ST elevation) based on electrocardiogram findings. Values of C reactive protein and other socio-demographic variables were compared in both groups (patients with and without ST elevation MI). Results: A total of 3500 patients with myocardial infarction were included in the final analysis. 2219(63.4%) had NSTEMI, while 1281(36.6%) had STEMI. Statistical analysis showed that C-reactive protein levels were not statistically different in both groups (p-value-0.375), but gender and Creatinine kinase myocardial bound levels were different in patients with non-ST elevation myocardial infarction and ST-elevation myocardial infarction (p-value<0.001). Conclusion: Raised levels of C reactive protein were not statistically significantly different in ST-elevation myocardial infarction and non-ST elevation myocardial infarction patients. CKMB may give a better clue for differentiation between these two types of myocardial infarctions. [ABSTRACT FROM AUTHOR]

Using a new-generation drug-eluting stent, we compared the 2-year clinical outcomes of patients with diabetes mellitus (DM) and non-DM concomitant with a non-ST-segment elevation myocardial infarction (NSTEMI) and an ST-segment elevation myocardial infarction (STEMI) who underwent percutaneous coronary intervention. A total of 11,798 patients with acute myocardial infarction were classified into two groups: DM (NSTEMI, n = 2399; STEMI, n = 2693) and non-DM (NSTEMI, n = 2694; STEMI, n = 4012). The primary clinical outcome was the occurrence of major adverse cardiac events (MACE), defined as all-cause death, recurrent myocardial infarction, or any coronary repeat revascularization. The secondary outcome was the occurrence of definite or probable stent thrombosis. In all the patients, both multivariable and propensity score-adjusted analyses revealed that the incidence rates of MACE (adjusted hazard ratio (aHR), 1.214; p = 0.006 and aHR, 1.298; p = 0.002, respectively), all-cause death, cardiac death (CD), and non-CD rate were significantly higher in the NSTEMI group than in the STEMI group. Additionally, among patients with NSTEMI, there was a higher non-CD rate (aHR, 2.200; p = 0.007 and aHR, 2.484; p = 0.004, respectively) in the DM group and a higher CD rate (aHR, 2.688; p < 0.001 and 2.882; p < 0.001, respectively) in the non-DM group. In this retrospective study, patients with NSTEMI had a significantly higher 2-year mortality rate than those with STEMI did. Furthermore, strategies to reduce the non-CD rate in patients with DM and the CD rate in patients without DM could be beneficial for those with NSTEMI. [ABSTRACT FROM AUTHOR]

The identification of novel circulating biomarkers of acute coronary syndrome (ACS) may improve diagnosis and management. We conducted a systematic review and meta-analysis of ischaemia-modified albumin (IMA), an emerging biomarker of ischaemia and oxidative stress, in ACS. We searched PubMed, Web of Science, and Scopus from inception to March 2022, and assessed the risk of bias and certainty of evidence with the Joanna Briggs Institute Critical Appraisal Checklist and GRADE, respectively. In 18 studies (1654 ACS patients and 1023 healthy controls), IMA concentrations were significantly higher in ACS (standard mean difference, SMD = 2.38, 95% CI 1.88 to 2.88; p < 0.001; low certainty of evidence). The effect size was not associated with pre-defined study or patient characteristics, barring the country where the study was conducted. There were no significant differences in effect size between acute myocardial infarction (MI) and unstable angina (UA), and between ST-elevation (STEMI) and non-ST-elevation MI (NSTEMI). However, the effect size was progressively larger in UA (SMD = 1.63), NSTEMI (SMD = 1.91), and STEMI (3.26). Our meta-analysis suggests that IMA might be useful to diagnose ACS. Further studies are warranted to compare the diagnostic performance of IMA vs. established markers, e.g., troponin, and to determine its potential utility in discriminating between UA, NSTEMI, and STEMI (PROSPERO registration number: CRD42021324603). [ABSTRACT FROM AUTHOR]

Introduction: Standard of care after an acute myocardial infarction (AMI) includes high‐intensity statin therapy to lower the risk of future cardiovascular events. However, the use of high‐intensity statins post‐AMI remains suboptimal, presenting an opportunity for clinical pharmacist services to improve clinical care. Objective: To evaluate the impact of a cardiology clinical pharmacist intervention upon the rate of high‐intensity statins issued at hospital discharge after AMI. Methods: This was a single‐center, pre‐post study that included patients 18 to 75 years of age who were discharged from one investigative site with a primary diagnosis of AMI (as determined by ICD‐10 codes) between July 2019 to December 2020. The primary outcome was the proportion of patients prescribed high‐intensity statins, defined as atorvastatin 40 to 80 mg or rosuvastatin 20 to 40 mg daily, at discharge pre and postimplementation of a cardiology clinical pharmacist intervention. Patients were stratified into two groups for comparison: pre‐ (07/01/2019‐3/31/2020) and post‐ (04/01/2020‐12/31/2020) intervention, for which the latter included cardiology pharmacist‐driven communication and documentation via the electronic health record. Results: A total of 418 patients were included: 223 (53.3%) preintervention and 195 (46.7%) postintervention. The overall cohort was approximately two‐thirds men and 90% Caucasian, with a mean ± SD age of 61.4 ± 9.7 years; the pre and postintervention groups were similar in terms of demographics. The rate of high‐intensity statin prescribing at discharge improved from 83.0% preintervention to 95.4% postintervention (P <.0001). A total of 9.9%, 1.8%, and 5.4% of patients in the preintervention group received moderate‐intensity, low‐intensity, or no statin at discharge, respectively, lowering to 3.1%, 1.0%, and 0.5% postintervention. Conclusion: There was a statistically significant increase in the rate of high‐intensity statin prescribing post‐AMI after the implementation of targeted cardiology clinical pharmacist services. [ABSTRACT FROM AUTHOR]

A bioresorbable scaffold (BRS) has been used in the latest stages of stent technology and is a less -known material than drug-eluting stents (DES). In this study, we aimed to evaluate the long -term clinical outcomes of BRS in patients presenting with non-ST-segment elevation myocardial infarction (NSTEMI), a type of acute coronary syndrome (ACS). 39 patients and 53 lesions who applied to Istanbul Medipol University Faculty of Medicine Hospital between June 2015 and April 2016 with a diagnosis of NSTEMI and were treated with BRS were included in the study. The 4-year follow-up of the patients between 2016 and 2020 was recorded. Endpoints for the study were device success, treatment success, stent thrombosis, restenosis, and major adverse cardiac events (MACE). Operations were performed with a device success rate of 98.1% and a treatment success rate of 98.1%. No death or stent thrombosis was detected in any patient, and target lesion revascularization (TLR) occurred in one patient. The total rate of MACE was found to be 1.9%. Complications developed in two patients during the procedure and hospitalization and in four patients during the 4-year follow-up. If BRS are implanted by experienced surgeons in NSTEMI patients, it has been observed that the complication rate in the early period is low, and the complication rate increases depending on the type of stent chosen in the late period. To obtain better results, a BRS with good radial strength, thinner strut thickness, and rapid deployment should be achieved. [ABSTRACT FROM AUTHOR]

Objectives: Our aim was to evaluate the accuracy of emergency physicians (EPs) in the detection of regional wall motion abnormalities (RWMAs) using focused cardiac ultrasound (FOCUS) in patients suspected of non–having ST‐elevation myocardial infarction. Methods: We prospectively enrolled patients with chest pain. Three EPs underwent didactics and hands‐on‐training, of 3 hours each, by an experienced cardiologist, on detecting RWMAs using 2‐dimensional echocardiography. They performed a FOCUS examination to evaluate for RWMAs and recorded the echo images. Our reference standard for the detection of RWMAs was accepted as a blinded cardiologist review of the prerecorded video clips. We calculated the corrected sample size and inter‐rater agreement between the EPs (82 and 0.83, respectively). The analysis of the study was performed on 89 patients. Results: Eighty‐nine patients with chest pain were screened. Emergency physicians demonstrated the detection of RWMAs with good sensitivity and even excellent specificity: 76.9% (95% confidence interval [CI], 56.4%– 91.0%) and 92.1% (95% CI, 82.4%–97.4%), respectively. The accuracy of FOCUS was 87.6% (95% CI, 79.0%–93.7%). The area under the curve from a receiver operating characteristic curve analysis, which evaluated the EPs' rate of detecting the presence or absence of RWMAs, was 0.845 (95% CI, 0.753–0.913). Conclusions: Our study results suggest that EPs with training in bedside echocardiography can accurately rule in patients with RWMAs in suspected non–ST‐elevation myocardial infarction cases. [ABSTRACT FROM AUTHOR]

2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation

The article presents questions and answers related to the 2020 European Society of Cardiology (ESC) guidelines for acute coronary syndrome (ACS) management in patients without persistent ST-segment elevation, including topics such as differential diagnosis, biomarkers, and risk assessment.

The article discusses the 2020 guidelines presented by the European Society of Cardiology (ESC) for acute coronary syndrome (ACS) management in patients without persistent ST-segment elevation. Topics explored include the clinical characteristics and diagnosis of myocardial infarction, the administration of electrocardiogram to assess patients with suspected ACS, and the patients which may not be considered for invasive coronary angiography.

The article presents questions and answers related to the 2020 European Society of Cardiology (ESC) guidelines for acute coronary syndrome (ACS) management in patients without persistent ST-segment elevation, including topics such as antiplatelet therapy, anticoagulation, and revascularization.

Background: The early risk stratification for ST-segment Elevation Myocardial Infarction (STEMI) aims to provide early access to known therapies which will improve the outcome. The mainstay of treatment in STEMI is fibrinolysis in a patient who presents to the hospital with no Percutaneous Coronary Intervention (PCI) or could not be transferred to a PCI center and who has no contraindications for thrombolysis. Aim of the study: To find the association between platelet distribution width and white blood cell count on admission with ST-segment resolution in patients with ST-segment elevation myocardial infarction treated with streptokinase. Materials and methods: This single centered cross-sectional study was conducted in Comrade Jagdish Chander Freedom Fighter District Hospital, Sangrur in the year 2020. 100 Patients admitted in the casualty with ST-segment elevation myocardial infarction were taken a detailed history to find out the duration of symptoms, any contraindications for thrombolysis, any previous history of coronary artery heart disease, and any previous history of bleeding tendencies. Results: In the study group, 39% of patients presented within 3 hours of symptoms, and 61% of patients presented after 3 hours. Among 100 patients, the door to needle time was less than 15 minutes in 46% of patients and more than 15 minutes in 54%. In the study group, 49% of patients had platelet distribution width less than 12.85, and 51% of patients had platelet distribution width more than 12.85. Mean platelet distribution width: 12.35. In the study group, 50% of the patients had white blood cell count of less than 12650 per microlitre and 50% had white blood cells count of more than 12650 per microlitre. Conclusion: The relationship between platelet distribution width and white blood cell count on admission with ST-segment resolution in patients with acute ST-elevation myocardial infarction treated with streptokinase proved to be significant in terms of higher the indices, more chances of failed thrombolysis. So these patients can be identified early and can be referred for more aggressive treatment modalities. [ABSTRACT FROM AUTHOR]