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AimsThere is conflicting evidence on whether the type of atrial fibrillation (AF) is associated with risk of cardiovascular events, including acute myocardial infarction (MI) and ischemic stroke. The aim of the present study was to investigate whether the risk of MI and ischemic stroke differs between individuals with first-diagnosed paroxysmal vs. non-paroxysmal AF treated with anticoagulants.Methods and resultsDe-identified electronic medical records from the TriNetX federated research network were used. Individuals with a new diagnosis of paroxysmal AF who had no evidence of other types of AF in their records were 1:1 propensity score-matched with individuals with non-paroxysmal AF, defined as persistent or chronic AF, who had no evidence of other types of AF in their records. All patients were followed for three years for the outcomes of MI and ischemic stroke. Cox proportional hazard models were used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). In the propensity-matched cohort, among 24 848 well-matched AF individuals [mean age 74.4 ± 10.4; 10 101 (40.6%) female], 410 (1.7%) were diagnosed with acute MI and 875 (3.5%) with ischemic stroke during the three-year follow-up. Individuals with paroxysmal AF had significantly higher risk of acute MI (HR: 1.65, 95%CI: 1.35–2.01) compared to those with non-paroxysmal AF. First diagnosed paroxysmal AF was associated with higher risk of non-ST elevation MI (nSTEMI) (HR: 1.89, 95%CI: 1.44–2.46). No significant association was observed between the type of AF and risk of ischemic stroke (HR: 1.09, 95%CI: 0.95–1.25).ConclusionPatients with first-diagnosed paroxysmal AF had higher risk of acute MI compared to individuals with non-paroxysmal AF, attributed to the higher risk of nSTEMI among patients with first-diagnosed paroxysmal AF. There was no significant association between type of AF and risk of ischemic stroke.

BACKGROUND: Influenza vaccination early after myocardial infarction (MI) improves prognosis but vaccine effectiveness may differ dependent on type of MI.METHODS: A total of 2,571 participants were prospectively enrolled in the Influenza vaccination after myocardial infarction (IAMI) trial and randomly assigned to receive in-hospital inactivated influenza vaccine or saline placebo. The trial was conducted at 30 centers in eight countries from October 1, 2016 to March 1, 2020. Here we report vaccine effectiveness in the 2,467 participants with ST-segment elevation MI (STEMI, n = 1,348) or non-ST-segment elevation MI (NSTEMI, n = 1,119). The primary endpoint was the composite of all-cause death, MI, or stent thrombosis at 12 months. Cumulative incidence of the primary and key secondary endpoints by randomized treatment and NSTEMI/STEMI was estimated using the Kaplan-Meier method. Treatment effects were evaluated with formal interaction testing to assess for effect modification.RESULTS: Baseline risk was higher in participants with NSTEMI. In the NSTEMI group the primary endpoint occurred in 6.5% of participants assigned to influenza vaccine and 10.5% assigned to placebo (hazard ratio [HR], 0.60; 95% CI, 0.39-0.91), compared to 4.1% assigned to influenza vaccine and 4.5% assigned to placebo in the STEMI group (HR, 0.90; 95% CI, 0.54-1.50, P = .237 for interaction). Similar findings were seen for the key secondary endpoints of all-cause death and cardiovascular death. The Kaplan-Meier risk difference in all-cause death at one year was more pronounced in participants with NSTEMI (NSTEMI: HR, 0.47; 95% CI 0.28-0.80, STEMI: HR, 0.86; 95% CI, 0.43-1.70, interaction P = .028).CONCLUSIONS: The beneficial effect of influenza vaccination on adverse cardiovascular events may be enhanced in patients with NSTEMI compared to those with STEMI.

ispartof: CIRCULATION-HEART FAILURE vol:13 issue:5 ispartof: location:United States status: published

Introduction Les dernieres recommandations des societes europeennes et americaines de cardiologie preconisent de realiser une coronarographie dans les 24 heures suivant l’admission des patients hospitalises pour un infarctus du myocarde sans sus-decalage du segment ST (NSTEMI). Recemment, l'etude VERDICT a objective une diminution d’evenements cardiovasculaires chez les patients ayant beneficie d’une coronarographie dans les 12 heures suivant leur admission pour un NSTEMI par rapport a un delai de 48-72 heures. Nous avons souhaite evaluer si realiser une coronarographie dans les 12 premieres heures etait benefique par rapport a la realiser dans les 12 a 24 premieres heures. Methodes Les donnees des patients hospitalises pour un NSTEMI entre 2009 et 2017 ont ete extraites du registre SPUM-ACS incluant de patients hospitalises avec un syndrome coronarien aigu dans quatre hopitaux universitaires en Suisse. Des modeles de Cox ont evalue l'association entre le timing de coronarographie et la survenue des evenements cardiovasculaires majeurs a un an (mortalite cardiovasculaire, infarctus du myocarde et accident vasculaire cerebral). Resultats Parmi 2’672 patients hospitalises pour un NSTEMI, 1’832 remplissaient les criteres d'inclusion. Parmi eux, 1’464 patients ont beneficie d’une coronarographie dans les 12 heures (groupe 12h) et 368 patients entre 12 and 24 heures (groupe 12-24h). Le fait d’avoir ete hospitalise durant une nuit ou un week-end a ete identifie par regression multivariee comme le seul facteur associe a la realisation d’une coronarographie plus tardivement. Apres la realisation d’un matching 2:1 par score de propension pour corriger les differences significatives entre les groupes (736 patients dans le groupe 12h et 368 patients dans le groupe 12-24h), aucune difference statistiquement significative en ce qui concerne le taux d’evenements cardiovasculaire a un an n’a ete mis en evidence (7.7% vs. 7.3%, HR : 1.050, 95% CI 0.637- 1.733, p=0.847). En outre, meme apres stratification par score de GRACE (>140 vs. ≤140), aucune reduction significative des evenements cardiovasculaires n’a ete mise en evidence chez les patients a haut-risque dans le groupe 12h (p for interaction=0.601). Conclusion Notre etude demontre que dans une cohorte de patients « real world » hospitalises pour un NSTEMI, la realisation d’une coronarographie dans les 12 heures suivant l’hospitalisation n’est pas associee avec une reduction des evenements cardiovasculaires par rapport a la realisation d’une coronarographie entre 12 et 24 heures suivant l’hospitalisation, meme chez les patients a haut risque (score de GRACE >140). -- Objective. To obtain a real-world perspective of the optimal timing of angiography performed within 24 hours of admission with non-ST elevation myocardial infarction (NSTEMI). Background. Current guidelines recommend angiography within 24 hours of hospitalisation with NSTEMI. The recent VERDICT trial found that angiography within 12 hours of admission with NSTEMI was associated with improved cardiovascular outcomes among high-risk patients. We compared the outcomes of real-world NSTEMI patients undergoing angiography within 12 hours of admission with those of patients undergoing angiography 12 to 24 hours after admission. Methods. NSTEMI patients without life-threatening features who received angiography within 24 hours of admission were obtained from the SPUM-ACS registry, a cohort of consecutive patients admitted with acute coronary syndromes to four university hospitals in Switzerland. Cox models assessed for an association between door-to-catheter time and one-year major adverse cardiovascular events (MACE: cardiovascular mortality, myocardial infarction, and stroke). Results. Of 2672 NSTEMI patients, 1832 met the inclusion criteria. Among them, 1464 patients underwent angiography within 12 hours (12 h group) compared with 368 patients between 12 and 24 hours (12–24 h group). Multiple logistic regression identified out-of-hours admission as the only factor associated with delayed angiography. After 2 : 1 propensity score matching, 736 patients from the 12 h group and 368 patients from the 12–24 h group demonstrated no significant difference in rates of one-year MACE (7.7% vs. 7.3%, HR: 1.050, 95% CI 0.637–1.733, p 0.847). Stratification by GRACE score (>140 vs. ≤140) found no significant reduction in MACE among high-risk patients in the 12 h group (p for interaction 0.601). Conclusions. In an unselected real-world cohort of NSTEMI patients, angiography within 12 hours of admission was not associated with improved o ear cardiovascular outcomes when compared with angiography 12 and 24 hours after admission, even among high-risk patients.