Incidence of Acute Myocardial Infarction and Hurricane Katrina: Sixteen Years after the Storm

Background We aimed to evaluate the incidence of acute myocardial infarction (AMI) in New Orleans in the sixteen years after Hurricane Katrina. Methods This was a single-center, retrospective study performed at Tulane University Health Sciences Center of patients admitted for AMI during two years prior to Hurricane Katrina and sixteen years after Hurricane Katrina. The pre-Katrina and post-Katrina cohorts were compared according to pre-specified demographic and clinical data. Results In the sixteen-year post-Katrina period, there were 3696 admissions for AMI out of a total census of 128,276 (2.9%) compared to 150 admissions out of a census of 21,079 (0.7%) in the pre-Katrina group (p<0.0001). The post-Katrina group had a higher prevalence of known coronary artery disease (CAD) (43.8% vs. 30.7%, p<0.0001), diabetes mellitus (40.7% vs. 28.7%, p<0.002), hypertension (80.1% vs. 74.0%, p<0.05), hyperlipidemia (54.2% vs. 44.7%, p<0.0001), smoking (54.2% vs. 39.3%, p<0.0002), drug abuse (18.7% vs. 6.7%, p<0.0002), and psychiatric disease (15.3% vs. 6.7%, p<0.0004). The post-Katrina group was more often prescribed aspirin (49.6% vs. 31.3%, p<0.0001), beta-blocker (46.9% vs. 34.0%, p<0.004), ACE inhibitor or ARB (51.9% vs. 36.0%, p<0.0004), and statin (52.6% vs. 28.0%, p<0.0001) but with higher medication non-adherence (15.8% vs. 7.3%, p<0.0001). The post-Katrina patients were also more likely to be unemployed (75.6% vs 22.7%, p<0.0001) and non-married (56.3% vs. 52.7%, p<0.0001). Rates of STEMI were lower in the post-Katrina group (29.1% vs 42.0%, p<0.002). There was no significant difference in terms of sex, being uninsured, or prior coronary artery bypass grafting. Four patients were COVID positive in the post-Katrina cohort. Conclusion There was a 4-fold increase in the incidence of AMI sixteen years after Hurricane Katrina. Psychosocial, behavioral, and traditional CAD risk factors were significantly higher among the post-Katrina group. These findings add to the growth of literature demonstrating the adverse cardiovascular outcomes that occur after a natural disaster. Further research is needed to explain the underlying mechanisms to help diminish future cardiac morbidity.Copyright © 2023 American College of Cardiology Foundation

Persistent Elevation of Troponin I in a Pediatric Patient Resulting From Macrotroponin Complex.

ABSTRACT: Although chest pain is a common chief complaint among pediatric patients, cardiac pathology historically has accounted for a small percentage of cases. However, the emergence of COVID-19 and particularly its potential for leading to multisystem inflammatory syndrome has changed the threshold for the evaluation of cardiac etiologies of chest pain. This evaluation often includes measurement of the serum cardiac troponin I level. We present a case of a 16-year-old male athlete who presented to an outside emergency department with chest pain and was found to have elevated serum troponin I levels. Despite sports restriction, his troponin level remained elevated for months in the absence of other clinical findings and he was subsequently referred to our outpatient pediatric cardiology clinic. Further laboratory evaluation revealed that, in addition to troponin I, the assay measured an immune complex of uncertain significance formed by anti-troponin I antibodies bound to troponin I, known as macrotroponin. Delayed clearance of this complex from the bloodstream can result in overestimation of troponin I levels that can affect clinical management and create anxiety for our patients and their families. Macrotroponin complex deserves increased recognition among the research and clinical communities, especially in the pediatric realm.

Incidence of acute myocardial infarction and Hurricane Katrina: Sixteen years after the storm

Purpose of Study:We aimed to evaluate the incidence of acute myocardial infarction (AMI) in New Orleans in the sixteen years after Hurricane Katrina. Methods Used: This was a single-center, retrospective study performed at Tulane University Health Sciences Center of patients admitted for AMI during two years prior to Hurricane Katrina and sixteen years after Hurricane Katrina. The pre-Katrina and post-Katrina cohorts were compared according to pre-specified demographic and clinical data. Summary of Results: In the sixteen-year post-Katrina period, there were 3696 admissions for AMI out of a total census of 128 276 (2.9%) compared to 150 admissions out of a census of 21 079 (0.7%) in the pre-Katrina group (p < 0.0001). The post-Katrina group had a higher prevalence of known coronary artery disease (CAD) (43.8% vs. 30.7%, p < 0.0001), diabetes mellitus (40.7% vs. 28.7%, p < 0.002), hypertension (80.1% vs. 74.0%, p < 0.05), hyperlipidemia (54.2% vs. 44.7%, p < 0.0001), smoking (54.2% vs. 39.3%, p < 0.0002), drug abuse (18.7% vs. 6.7%, p < 0.0002), and psychiatric disease (15.3% vs. 6.7%, p < 0.0004). The post-Katrina group was more often prescribed aspirin (49.6% vs. 31.3%, p < 0.0001), betablocker (46.9% vs. 34.0%, p < 0.004), ACE inhibitor or ARB (51.9% vs. 36.0%, p < 0.0004), and statin (52.6% vs. 28.0%, p < 0.0001) but with higher medication nonadherence (15.8% vs. 7.3%, p < 0.0001). The post- Katrina patients were also more likely to be unemployed (75.6% vs 22.7%, p < 0.0001) and non-married (56.3% vs. 52.7%, p < 0.0001). Rates of STEMI were lower in the post-Katrina group (29.1% vs 42.0%, p < 0.002). There was no significant difference in terms of sex, being uninsured, or prior coronary artery bypass grafting. Four patients were COVID positive in the post-Katrina cohort. Conclusion(s): There was a fourfold increase in the incidence of AMI sixteen years after Hurricane Katrina. Prevalent psychosocial, behavioral, and traditional CAD risk factors were significantly higher among the post- Katrina group. These findings will continue to add to the growing body of literature demonstrating the adverse cardiovascular outcomes that occur after a natural disaster. Despite this, further research is required to explain the underlying mechanisms to help mitigate future cardiac morbidity. This study will help enable cardiovascular clinicians to further understand the needs and dynamic changes that can occur following natural disasters. Copyright © 2023 Southern Society for Clinical Investigation.