Exosomal miR-152-5p and miR-3681-5p function as potential biomarkers for ST-segment elevation myocardial infarction

Abstract Background: The strain parameters of Real-Time Three-Dimensional Spot Tracking Echocardiography (RT3D-STE) are GLS, GAS, GRS, and GCS, while each index can significantly diagnose Acute Myocardial Infarction (AMI) patients, but none of them can distinguish between NSTEMI and STEMI. MicroRNAs (miRNAs) play essential roles in Acute Myocardial Infarction (AMI), but little is known about the value of exosome miRNA combined with RealTime Three-Dimensional Spot Tracking Echocardiography (RT3D-STE) between ST-segment Elevation Myocardial Infarction (STEMI) and Non-ST-segment Elevation Myocardial Infarction (NSTEMI). Aim: To estimate the exosomal miRNAs related to strain parameters of RT3D-STE as biomarkers for early detection of STEMI and NSTEMI. Methods: The present study collected plasma samples from thirty-four (34) patients with AMI (including STEMI and NSTEMI) and employed high-throughput sequence technology and real-time quantitative polymerase chain reaction (RT-qPCR) to identify the differentially expressed miRNAs. The Pearson correlation coefficient is used to measure the strength of a linear association between differentially expressed miRNAs and strain parameters of RT3D-STE. Results: Twenty-eight (28) differentially expressed exosomal miRNAs were universally identified between STEMI, NSTEM, and normal groups. Among them, there are 10 miRNAs (miR-152-5p, miR-3681-5p, miR-193a-5p, miR-193b-5p miR-345-5p, miR-125a-5p, miR-365a-3p, miR-4520-2-3p, hsa-miR-193b-3p and hsa-miR-5579-5p) with a Pearson correlation greater than 0.6 with RT3D-STE strain parameters. Especially, miR-152-5p and miR-3681-5p showed the most significant correlation with RT3D-STE strain parameters. Target genes of these 10 miRNAs are analyzed for Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways enrichment, and they were found to be mainly involved in the cellular metabolism processes and HIF-1 signaling pathway. RT-qPCR verified the significant differential expression of miR-152-5p and miR-3681-5p between STEMI and NSTEM groups. Conclusion: RT3D-STE and exosome miRNAs can be used as a hierarchical diagnostic system in AMI. If the RT3D-STE is abnormal, the exosome miRNAs can be detected again to obtain more detailed and accurate diagnostic results between STEMI and NSTEM groups. Exosomal miR-152-5p and miR-3681-5p may serve as potential biomarkers for ST-segment elevation myocardial infarction. HIGHLIGHTS RT3D-STE and exosome miRNAs can be used as a hierarchical diagnostic system in AMI. Exosomal miR-152-5p and miR-3681-5p function as potential biomarkers for ST-segment elevation myocardial infarction.

Acute myocardial infarction at a district hospital in KwaZulu-natal ­ management and outcomes

Acute myocardial infarction (AMI) following ischaemic heart disease (IHD) is associated with increased morbidity and mortality. The condition remains a management challenge in resource-constrained environments. This study analysed the management and outcomes of patients presenting with AMI at a district hospital in KwaZulu-Natal. Methods: A descriptive study that assessed hospital records of all patients diagnosed with AMI over a 2-year period (01 August 2016 to 31 July 2018). Data extracted recorded patient demographics, risk factors, timing of care, therapeutic interventions, follow up with cardiology and mortality of patients. Results: Of the 140 patients who were admitted with AMI, 96 hospital records were analysed. The mean (standard deviation [s.d.]) age of patients was 55.8 (±12.7) years. Smoking (73.5%) and hypertension (63.3%) were the most prevalent risk factors for patients with ST elevation myocardial infarction (STEMI) in contrast to dyslipidaemia (70.2%) and hypertension (68.1%) in patients with non-ST elevation myocardial infarction (NSTEMI). Almost 49.5% of patients arrived at hospital more than 6 h after symptom onset. Three (12.5%) patients received thrombolytic therapy within the recommended 30-min time frame. The mean triage-to-needle time was 183 min ­ range (3; 550). Median time to cardiology appointment was 93 days. The in-hospital mortality of 12 deaths considering 140 admissions was 8.6%. Conclusion: In a resource-constrained environment with multiple systemic challenges, in-hospital mortality is comparable to that in private sector conditions in South Africa. This entrenches the role of the family physician. There is need for more coordinated systems of care for AMI between district hospitals and tertiary referral centres.

An analytical Study to Evaluate the correlation between Serum Uric Acid Levels and Deaths in Acute Myocardial Infarction Patients At a Tertiary Level Institute Catering to Rural Population of Western Maharashtra

Background: Cardiovascular diseases are the number one cause of mortality all over the world. Elevated serum uric acid is highly predictive of mortality in patients with heart failure or coronary artery disease. We conducted this study to assess serum uric acid levels on admission as a potential predictor of short-term mortality (7 days) in acute myocardial infarction patients. Methodology: Total of 200 patients diagnosed with the myocardial infarction (MI) in our hospital along with 200 age and gender matched controls were selected for this study. The clinical history, examination, ECG changes and biochemical markers were evaluated on day 0, 3 and 7. Association with Killips class and mortality in STEMI / NSTEMI cases was done. Results:The study had 200 cases and 200 controls. The mean age of cases was 62.54 ± 18.24 years and controls were 61.94±17.25 years. There were majority males among both cases 114 (57%) and controls 112 (56%). The patients were classified using Killip's class. Majority belong to class I 98 (49%) followed by II 42 (21%). There were 26 (13%) of class III and 34 (17%) into class IV. There is significant difference seen between uric acid levels of cases and control on day 1, 3 and 7 (p<0.001). There was 25% mortality (50 deaths) seen among the cases. There was association seen between Killips class III & IVand mortality, there was higher mortality seen in STEMI as compared to NSTEMI (i.e. p<0.05). Conclusion:Our study concludes that the serum uric acid (SUA) levels have significant association with Killip's class and mortality in Acute Myocardial Infarction cases.

A Study Of Platelet Indices And Angiographic Profile In Patients With Acute Coronary Syndrome

Background:ISCHEMIC HEART DISEASES continues to be a major public health problem becoming an increasingly important problem in developing countries constitutes around 12.8% of total deaths (7.2 million).Objectives:To evaluate the clinical course of ACS patient’s admitted to KIMS HUBLI ICCU. Material & Methods:Patients admitting to ICCU KIMS, HUBLI diagnosed as Acute Coronary Syndrome.The study included 156 patients admitted to ICCU KIMS Hubli who diagnosed as ACUTE CORONORY SYNDROME. Results:There wassignificant difference in the platelet indices betweenthe three groups. The platelet Indices -mean platelet volume, platelet distribution width and platicrit were significantly higher in STEMI and NSTEMI groups when compared to the USA group and severity of CAD more in patients who were having higher platelet indices. Conclusion:The platelet indices: mean platelet volume (MPV), platelet distribution width (PDW) and platecrit are significantly higher in STEMI and NSTEMI groups when compared to USA group.

Clinical depression among patients after acute coronary syndrome: a prospective single-tertiary centre analysis

INTRODUCTION@#Clinical depression is a known consequence of acute coronary syndrome (ACS) and is associated with an adverse outcome among these patients, although this is often under-recognised. Through this study, we investigated the incidence of depression in post-ACS patients and its associated factors.@*METHODS@#We conducted a prospective cohort study in 95 patients with ACS admitted to University Malaya Medical Centre, Malaysia. Clinical depression was assessed during the index admission and at 30 days after discharge, using the Patient Health Questionnaire-9 (PHQ-9). Data was analysed using IBM SPSS Statistics, and binary logistic regression was used to determine the independent factors associated with depression, after adjusting for significant demographic variables and clinical characteristics. The strength of this association was presented as odds ratio and 95% confidence interval, and the significance level was set at 0.05.@*RESULTS@#The mean age of the study population was about 60 years, and 72.6% of the patients were male. Symptoms of depression were present in 88.4% of the patients at baseline. Depression at 30 days was more likely in female patients, patients with diabetes mellitus and patients on dialysis (p = 0.024, p < 0.001, p = 0.008, respectively). Patients with baseline moderate to severe depression were more likely to have moderate to severe depression at 30 days (p < 0.001). Baseline depression was the strongest predictor of depression at 30 days. An increment of one unit in PHQ-9 baseline score increased the risk of developing severe depression at 30 days by 31%.@*CONCLUSION@#Depression was prevalent in our post-ACS patients. The associated factors were female gender, diabetes mellitus and dialysis treatment.

Impacto de la contingencia sanitaria por COVID-19 en las estrategias de reperfusión del síndrome coronario agudo / Impact of COVID-19 on reperfusion strategies for acute coronary syndromes

Resumen Las terapias de reperfusión, tales como intervención coronaria y fibrinólisis, son las principales medidas de atención en pacientes con síndromes coronarios agudos. La angioplastia primaria se considera el estándar de oro, sin embargo, en pacientes con infección por coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2), la estrategia de reperfusión más recomendada es la terapia fibrinolítica, debido al menor tiempo requerido para realizarla y menor exposición al agente infeccioso. Esta pandemia representa una problemática de contagio en el personal de salud, ya que los casos van en aumento a nivel mundial, por lo cual es importante conocer las medidas que se deben seguir a fin de evitar la enfermedad por coronavirus 2019 (COVID-19).

Abstract Reperfusion therapy is a measure of care in patients with ST-elevation myocardial infarction (STEMI), which should be performed once we have the diagnosis. Percutaneous coronary intervention is considered the gold standard, however in patients with SARS-CoV-2 infection, the reperfusion strategy is more focused on fibrinolytic therapy due to the shorter time required to perform and less exposure. This pandemic represents a contact problem in health personnel, since cases are increasing worldwide, so it is important to know the measures that must be followed to avoid coronavirus disease (COVID-19).

Correlation of troponin-I level with left ventricular systolic dysfunction after first attack of non-ST segment elevation myocardial infarction

Background: Coronary Heart Disease (CHD) is the most common category of the heart disease and is found to be the single most important cause that leads to premature death in the developed world. Recognizing a patient with ACS is important because the diagnosis triggers both triage and management. cTnI is 100% tissue-specific for the myocardium and it has shown itself as a very sensitive and specific marker for AMI. Ventricular function is the best predictor of death after an ACS. It serves as a marker of myocardial damage and provides information on systolic function as well as diagnosis and prognosis. The study aimed at investigating the impact of LVEF on elevated troponin-I level in patients with first attack of NSTEMI.Methods: This cross-sectional analytical study was conducted in the department of cardiology in Mymensingh Medical College Hospital from December, 2015 to November, 2016. Total 130 first attack of NSTEMI patients were included considering inclusion and exclusion criteria. The sample population was divided into two groups: Group-I: Patients with first attack of NSTEMI with LVEF: ≥55%. Group-II: Patients with first attack of NSTEMI with LVEF: <55%. Then LVEF and troponin-I levels were correlated using Pearson’s correlation coefficient test.Results: In this study mean troponin-I of group-I and group-II were 5.53±7.43 and 16.46±15.79ng/ml respectively. It was statistically significant (p<0.05). The mean LVEF value of groups were 65.31±10.30% and 40.17±4.62% respectively. It was statistically significant (p<0.05). The echocardiography showed that patients with high troponin-I level had low LVEF and patients with low troponin-I level had preserved LVEF. Analysis showed that patients with highest level of troponin-I had severe left ventricular systolic dysfunction (LVEF <35%) and vice versa-the patients with the lowest levels of troponin-I had preserved systolic function (LVEF ≥55%). In our study, it also showed that the levels of troponin-I had negative correlation with LVEF levels with medium strength of association (r= -0.5394, p=0.001). Our study also discovered that Troponin-I level ≥6.6ng/ml is a very sensitive and specific marker for LV systolic dysfunction.Conclusions: The study has enabled the research team to conclude that the higher is the Troponin-I level the lower is the LVEF level and thus more severe is the LV systolic dysfunction in first attack of NSTEMI patients.

Short- and long-term follow-up of antithrombotic management patterns in patients hospitalized with acute coronary syndrome: Indian subgroup of EPICOR Asia study

Background Acute coronary syndrome (ACS) is associated with emergency hospitalizations, and there are limited real-world data on clinical outcomes in post-ACS Asian patients. This article presents data on the Indian subgroup from the Long-term Follow-up of Antithrombotic Management Patterns in Acute Coronary Syndrome Patients in Asia (EPICOR-Asia) study. Methods EPICOR included patients with ACS [ST-segment elevation myocardial infarction (STEMI), non–ST-segment elevation myocardial infarction (NSTEMI), or unstable angina (UA)]. The study had two phases: acute phase and follow-up phase. The primary objective was to describe short- and long-term antithrombotic management patterns. Results EPICOR-India enrolled 2468 patients (STEMI-1482; NSTEMI-562; and UA-424). Cardiovascular risk factors were present in 1362 (55.2%) patients. Prehospital care was received by 879 (35.6%) patients, and the median time from the symptom onset to the first medical attention was 3 h (0.08, 100.33). The most common drug regimen prescribed during the acute phase was ≥2 antiplatelet agents + anticoagulants with no glycoprotein IIb/IIIa inhibitors and at discharge were aspirin + clopidogrel. About 78.8% of patients were discharged on dual antiplatelet therapy (DAPT) and 16%, on single antiplatelet therapy (SAPT). At 23 months after discharge, 55.6% were on DAPT, while 16.4% were on SAPT. Postdischarge outcomes at 2 years included death in 165 (6.7%) patients, composite events of death, myocardial infarction (MI), or ischemic stroke in 182 (7.4%) patients, and bleeding events in seven (0.3%) patients. Conclusion This study showed a gap between international recommendations and implementation for managing ACS in Indian patients. Most of the patients prefer to undergo invasive management instead of non-invasive therapy. At the end of the 2-year follow-up, more than half of the population was receiving DAPT, with most patients on receiving a combination of aspirin and clopidogrel. The mortality along with composite events of death, MI, or ischemic stroke was highest for patients with NSTEMI.

Epidemiological profile and predictors of mortality in acute coronary syndrome: a prospective study

Background: India has shown a rising trend in the prevalence of coronary artery disease (CAD) in urban as well as in rural population. Acute coronary syndrome (ACS) is the main reason for the mortality in India. Study of risk factors and biomarkers is important to catch the diagnosis early in order to decrease the mortality. Objective was to study risk factors and brain natriuretic peptide (BNP), troponine I, and CKMB and their effect on outcome in ACS patients in tertiary hospital.Methods: One hundred and fifty ACS patients were studied in Emergency Department of Medicine, Nehru Hospital, BRD Medical College, Gorakhpur from January 2017 to December 2017. Data on age sex socioeconomic status, medical history, baseline clinical characteristics, time to reach hospital and treatment in hospital, along with biomarkers including BNP, Troponin Iand CKMB was estimated. Baseline ECG was obtained at admission and repeated at 12 -24 hours and every 24 hours thereafter. A 2D Echocardiogram was performed within initial 48-72 hours for analysis of LVEF and wall motion abnormalities.Results: Male (58.7%) preponderance was observed with mean age of 60.12±10.58 years. Most of the patients were from rural areas (87.3%) and had hypertension (44.7%). Chest pain was most common symptom (56%). Most of them had duration of symptoms for 6-12 hours (56%). NSTEMI, STEMI and unstable angina were equally distributed between the genders (p>0.05). Out of 150 patients, 15 (10%) were thrombolysed, 78.52% had RWMA. In-hospital mortality was higher; among the patients of age >75 years (38.5%) (p=0.008), male patient (12.5%) (p>0.05), rural patient (10.7%) (p>0.05), hypertensive patient (17.3%) (p>0.05), patients of Killip class IV (48.3%)(p=0.0001) and patients having severe LVD (33.3%) (p=0.0001). In-hospital mortality was 1.2% and 1.1% among those in whom beta blocker and ACE inhibitors was present (p>0.0001). BNP and CKMB was significantly higher among expired patients (1762.62±1444.89 vs 840.76±1294.82; p=0.001) similarly troponin I was significantly higher among expired patients (67.29±45.63 vs 43.99±41.73; p=0.006) than alive.Conclusions: ACS was more prevalent in male, living in fifth to sixth decade of life, had hypertension. STEMI was more common. Patients on ACE inhibitors and beta-blocker had better outcome. Mortality was higher in patients with Killip’s class IV, higher value of troponin I, age more than 75 years and had hypertension and dyslipidemia

Non-ST Elevation Myocardial Infarction (NSTEMI) – A Case Study

Polycythemia vera (PV) is a chronic myeloproliferative disorder characterized by a high risk of developing arterial and venous thromboembolic complications. In recent years, great insight has been gained into the understanding of the pathogenesis of thrombosis in PV. Diagnosing and managing a case of acute coronary syndrome (ACS) due to non-atherosclerotic causes is a challenge. In this case report, we share our experience in diagnosis, management and revascularization issues in non-ST-elevation myocardial infarction (NSTEMI) in a patient with polycythemia vera background.

Estimating the prevalence of elevated plasma neutrophil gelatinase associated lipocalin level in patients with acute coronary syndromes and its association with outcomes

Objectives The principal objective of this study was to estimate the plasma levels of neutrophil gelatinase associated lipocalin (NGAL) in a cohort of patients with acute coronary syndromes (ACS) across their entire spectrum, and to correlate them with outcomes. Methods 87 patients with acute coronary syndromes were included in the study. Apart from the routine work up and management, all patients underwent determination of plasma NGAL and serum high sensitivity C reactive protein (HSCRP) levels at admission. The patients were followed up through the hospital stay as well as for one month after discharge for clinical outcomes, and echocardiographic parameters of left ventricular function. Plasma NGAL was studied for its predictive power for various defined outcomes. Results Plasma NGAL levels were detectably elevated in 67% of patients with ACS without any significant proportion with renal dysfunction, sepsis or overt infection. Plasma NGAL was the strongest independent predictor of all cause hospital mortality in Cox regression multivariate analysis with an odds ratio of 8.353, p = 0.0237. Plasma NGAL did not correlate with HSCRP, or severity of coronary artery disease (CAD). Conclusion This is a small study that shows that plasma NGAL in patients admitted with ACS can predict hospital mortality and forms the basis for consideration of this molecule as a possible new risk marker in ACS meriting further and more extensive investigation.

Prevalence of ACS and Causal Relation of Hypomagnesaemia.

Magnesium is an important intracellular cation [1], actually the second most abundant cation after Potassium, which has gained an essential role in normal human homeostasis. Low serum magnesium has been detected commonly in around 12% hospitalized patients and even more commonly in Intensive Care Patients as high as 60 to 65%. The link of low serum magnesium with acute coronary syndrome is being discussed widely and its actual role is being scrutinized [2,3]. Recently, Hypomagnesaemia has also been found to play an important role in the pathogenesis of a variety of clinical disorders including Hypertension, Diabetes Mellitus, Atherosclerosis and Acute Coronary Syndromes [4-8]. Acute coronary syndrome (ACS) has been defined as a group of conditions due to decreased blood flow in the coronary arteries. Acute coronary syndrome includes a vast spectrum like: ST elevation myocardial infarction (STEMI / 30%), non ST elevation myocardial infarction (NSTEMI / 25%), or unstable angina (U.A. / 38%).These are described according to ECGs and Cardiac Biomarkers of myocardial necrosis (troponin T, troponin I, and CK MB), in patients presenting with acute cardiac chest pain (Medscape). Aim: To look for any association between Hypomagnesaemia and Acute Coronary Syndrome. Materials and Methods: It’s a retrospective study involving 1198 patients who presented to the Accident and Emergency department (A & E), Trauma Center, Rashid Hospital, Dubai, with Acute Coronary Syndrome (ACS) between April 2010 and May 2013. We reviewed the records of all patients including their clinical history and presentation. The Magnesium levels of all the patients in the ACS pathway were checked along with, Cardiac biomarkers - Troponin, CPK and CK MB and Lipid profiles were also analyzed. A Chi-Square test was performed at 5% level of significance to test the null hypothesis of no association between cardiac markers, lipid profile and magnesium level. Inclusion Criteria: All new patients presenting to A & E Department at Rashid Hospital with an acute coronary syndrome (both NSTEMI & STEMI). All new patients presenting with non-specific chest pain who test positive for cardiac markers. All the age groups presenting to A & E Department at Rashid Hospital from 11/04/2010- 30/05/2013 were included. Both the genders were included. Exclusion Criteria: Patients diagnosed initially with acute coronary syndrome that eventually had negative cardiac markers. Results: Out of 1198, 1087(91%) patients were male. 49% were between 50 and 75 years of age group whereas 46% were between 25 years and 50 years of age. 77% patients were Asians and 17% belonged to Arabic peninsula. The Magnesium level was normal in 1097(92%), low in 63(5.3%). Troponin was negative in 431(36%) and positive in 767(64%) patients with low, medium and high levels in 338(28.2%), 426(35.5%) and 03(0.3%) respectively. These results indicate that there is no statistically significant association between Magnesium levels and Troponin groups (positive and negative) (chi-square with two degree of freedom = 3.30, p = 0.192). Conclusion: Our study proves that there is no significant association between Hypomagnesaemia and Acute Coronary Syndrome.

Coronary Vasospasm Mimicking Acute Myocardial Infarction.

Chest pain frightens many people into thinking that they might be having a heart attack. There are many causes of chest pain, few of which are life-threatening. One of the causes of chest pain is vasospasms, which is transient in nature and prolonged episodes can lead to tissue necrosis. Therefore, a prompt diagnosis and treatment is vital to the management. We are reporting a case of a young female presented with chest pain with no history of drug use, previous episodes, palpitations, and hypertension being her only risk factor found to have elevated Troponin I and was diagnosed with non-ST elevation myocardial infarction (NSTEMI), later found to have coronary vasospasm.

A descriptive study on the initial management of patients with acute coronary syndrome in emergency rooms of Philippine hospitals

BACKGROUND: Morbidity and mortality from acute coronary syndrome (ACS) primarily depends on prompt evaluation and management of patients. Despite available recommendations on ACS management, there is limited data regarding Filipino physician's knowledge and adherence with these guidelines in the emergency room (ER).OBJECTIVES: To describe the initial management of ACS patients by Filipino physicians at the ER and to document their adherence with the 2007 American College of Cardiology/American Heart Association (ACC/AHA) ACS guidelines for the management of patients with unstable angina (UA)/ non-ST-segment elevation myocardial infraction (NSTEMI) and ST-segment elevation myocardial infraction (STEMI).METHODS: This was an open-label, descriptive, multicenter, non-interventional study that enrolled patients ? 18 years of age, seen at the ER and suspected to have UA or MI with or without ST-segment elevation. Patient demographics, medical history, physical and laboratory examinations, medications or interventions done at the ER and the specialty of physicians who provided the initial management were recorded. Adherence with the 2007 ACC/AHAACS guidelines was also assessed. Data were summarized using descriptive statistics.RESULTS: A total of 1,398 eligible patients (mean age 61.58+ 12.03 years) were included in the study. At least one cardiac enzyme test was requested in up to 93% of patients, with troponin I being the most common (72.53%). Upon diagnosis, 95.78% of patients were given antiplatelet therapy (16.95% clopidogrel alone, 15.31% aspirin alone and 1.07% other antiplatelet drugs), the combination therapy. Moreover, 86.27% were given anticoagulant therapy (75.75% enoxaparin, 5.94% fondaprinux and 3.97% IV UFH). Ninety-eight percent of patients we subsequently admitted in the hospital and 26.68% of patients were considered to undergo percutaneous coronary intervention (PCI). Majority of these patients were initially managed by ER physicians (52.22%).CONCLUSION: Filipino physicians at the ER provide an appropriate management strategy to individual ACS patients because their management adheres to the 2007 and the current ACC/AHA ACS guidelines. The outcome and impact of these strategies should be assessed to encourage more physicians to conform with available recommendations. Moreover, a review of adherence of physicians to other disease management guidelines should be conducted to further improve care and outcomes in ER.

The Differences of Left Ventricular Geometry in Acute Myocardial Infarction and the Effects on Short Term Mortality / 이화의대지

OBJECTIVES: This study designed to find the differences of left ventricular (LV) geometry in acute myocardial infarction (AMI) between ST elevation myocardial infarction (STEMI) and non ST elevation myocardial infarction (NSTEMI) and the occurrences of adverse outcome according to the LV geometry. METHODS: Comprehensive echocardiographic analyses were performed in 256 patients with AMI. The left ventricular mass index (LVMI) and relative wall thickness (RWT) were calculated. LV geometry were classified into 4 groups based on RWT and LVMI: normal geometry (normal LVMI and normal RWT), concentric remodeling (normal LVMI and increased RWT), eccentric hypertrophy (increased LVMI and normal RWT), and concentric hypertrophy (increased LVMI and increased RWT). Cox proportional hazards models were used to evaluate the relationships among LV geometry and clinical outcomes. RESULTS: Patients with NSTEMI were more likely to have diabetes mellitus, hypertension, heart failure, stroke and previous myocardial infarction. By the geometric type, patients with NSTEMI were more likely to have eccentric hypertrophy (n=51, 34.7% vs. n=24, 22.0%, P=0.028). There was no significantly different adverse outcome between STEMI and NSTEMI patients. Fifteen patients (5.9%, 7 female [46.7%]) died and the median duration of survival was 10 days (range, 1 to 386 days). Concentric hypertrophy carried the greatest risk of all cause mortality (hazard ratios, 5.83; 95% confidence interval, 1.04 to 32.7). CONCLUSION: NSTEMI patients had more likely to have eccentric hypertrophy but adverse outcome after AMI was not different between STEMI and NSTEMI patients. Concentric hypertrophy had the greatest risk of short term mortality.

Long Term Results of ST-Segment Elevation Myocardial Infarction versus Non-ST-Segment Elevation Myocardial Infarction after Off-Pump Coronary Artery Bypass Grafting: Propensity Score Matching Analysis

There is no consensus as to which acute myocardial infarction subtype poses a greater risk after coronary artery bypass grafting (CABG). We compared the early and the long term results of off-pump coronary artery bypass grafting (OPCAB) between patients with STEMI (group I, n = 83), and NSTEMI (group II, n = 237). Group I had higher EuroSCORE, prevalence of emergency surgery, preoperative intra-aortic balloon pump use, preoperative emergency percutaneous transluminal coronary angioplasty, and preoperative thrombolytic use than group II. There were no significant differences in 30-day mortality and major adverse cardiac and cerebrovascular event (MACCE) between groups. Overall 8-yr survival was 93% and 87% in groups I and II, respectively. Freedom from MACCE after 8 yr was 92% and 93% in groups I and II, respectively. After propensity score matching analysis, there were no significant differences in preoperative parameters, postoperative in-hospital outcomes, and long-term clinical outcomes. Surgical results of OPCAB in patients with acute myocardial infarction show good results in terms of long-term survival and freedom from MACCE, with no significant differences in clinical outcomes between STEMI and NSTEMI groups.

In Hospital Outcome of Myocardial Infarcton in Nondiabetic Patients with High on Admission Blood Glucose Level.

Background: Patients without a history of diabetes often develop hyperglycemia during an acute coronary syndrome (ACS). Our aim was to evaluate the impact of admission hyperglycemia on in hospital outcome of non-diabetic patients admitted for acute coronary syndromes. Methods: The retrospective study was conducted in National Institute of Cardiovascular Diseases among the patients with acute myocardial infarction without history of diabetes. 50 patients with ST elevation MI (STEMI) with complications, 50 patients with STEMI without complications, 50 patients with non-ST elevation MI (NSTEMI) with complications and 50 patients without complications were included in the study. Every patient got the treatment as per protocol of the institute. On admission blood glucose of the patients was recorded. Level of blood glucose was correlated with the frequency of complications. Results : Average on admission blood sugar level was higher in patients who developed complications with STEMI (11.4 vs 8.78 mmol/L). On admission blood sugar level was also significantly higher in patients with NSTEMI with complications (10.6 vs 8.6 mmol/L). The frequency of individual complications had no significant relation with the blood sugar level. Conclusion : Higher level of admission blood glucose is related to poor in hospital outcome in both STEMI & NSTEMI even in nondiabetic patients. It may be used as a predictor of poor outcome of patients with myocardial infarction.

Bleeding Risk Factors with Enoxaparin for Patients with NSTEMI/UA in HUKM / Jurnal Sains Kesihatan Malaysia

Low-molecular-weight heparins (LMWHs) are antithrombotic agents utilised in the treatment of acute coronary syndromes. They have been shown to be more effective than unfractionated heparins (UFHs) in reducing ischeamic events, which include death, myocardial infarction (MI) and urgent revascularisation. Enoxaparin is one of the products of LMWHs. Its safety and efficacy has been proven in the ESSENCE and TIMI IIB studies. This study was carried out to identify risk factors that may affect bleeding complications associated with the use of enoxaparin for non-ST-elevation MI (NSTEMI) or unstable angina (UA) in Universiti Kebangsaan Malaysia Hospital (HUKM). This observational, longitudinal study was conducted on patients who were admitted to the Coronary Care Unit (CCU), Coronary Rehabilitation Ward (CRW), Medical 1 and Medical 2 wards at HUKM and initiated on enoxaparin for NSTEMI/UA from 22nd of March until 22nd of April 2004. A total of 40 patients were included in the study with median age of 65 years, male to female ratio of 3:1, diagnosed with NSTEMI (55%) and UA (45%). 45% of patients developed an episode of bleeding and among them 83.3% (15 patients) characterised by haematuria. Higher percentages of women (80%) and those with creatinine clearance of < 30ml/min (100%) had incidence of bleeding as compared to men (50%) and those with creatinine clearance ≥ 30 ml/min, respectively (p <0.05 for both parameters). Age, enoxaparin dose and duration of therapy, smoking and concomitant aspirin/ticlopidine therapy did not significantly affect the incidence of bleeding. In conclusion, renal impairment and gender were associated with bleeding in relation with the use of enoxaparin that may require dose adjustments.