Risultati per: Sindromi coronariche acute

Circulation, Volume 146, Issue Suppl_1, Page A9499-A9499, November 8, 2022. Introduction:Thoracic endovascular aortic repair (TEVAR) has increasingly been used for uncomplicated type B aortic dissection (uTBAD) despite limited supporting data. We compared outcomes after a strategy of initial TEVAR vs. initial medical therapy in patients with uTBAD.Methods:Index acute uTBAD admissions from 2011-2018 were identified using 100% Medicare inpatient claims. Initial TEVAR was defined as TEVAR within 30 days of admission. Complicated and non-acute TBAD were excluded. Outcomes included survival, cardiovascular hospitalizations, aorta-related and repeat aorta-related hospitalizations, and aortic interventions. Propensity score inverse probability weighting (IPW) was used to reduce the effects of treatment selection bias in the data. The primary analyses were landmarked at 30 days to avoid survival time bias; a sensitivity analysis used TEVAR status as a time-dependent variable to account for deaths in the first 30 days.Results:Of 7,105 patients with eligible index admissions for acute uTBAD, 1,140 (16.0%) underwent initial TEVAR. Receipt of initial TEVAR was significant associated with geographic region, non-Medicaid dual eligibility, and institutional TEVAR volume as well as certain comorbidities. After IPW, mortality was similar for the two strategies out to 5 years (HR 0.95, 95% CI 0.85 to 1.06), while aorta related hospitalizations were modestly increased with the TEVAR strategy (HR 1.12, 95% CI 0.99 to 1.27). In the sensitivity analysis including deaths within the first 30 days, initial TEVAR was associated with lower mortality over a period of 1 year (aHR 0.86, 95%CI 0.74-0.997, p=.045), 2 years (aHR 0.85, 95%CI 0.75-0.96, p=.01), and 5 years (aHR 0.87, 95%CI 0.79-0.97, p=.008).Conclusions:We found that a significant minority of uTBAD patients undergo initial TEVAR, which may be associated with lower risk of mortality when deaths within the first 30 days are included. These outcomes, and the reasons why some patients receive initial TEVAR while others do not, remain incompletely characterized. These findings, along with factors related to anatomy, peri-procedural complications, adequacy of medical therapy, patient preferences, and cost effectiveness, need to be assessed in a prospective trial in the US population.

Circulation, Volume 146, Issue Suppl_1, Page A15157-A15157, November 8, 2022. Introduction:There are limited data on the prevalence, management and outcomes associated with concomitant aortic stenosis (AS) and acute myocardial infarction (AMI).Methods:All adult hospitalizations with a primary diagnosis of AMI were identified from the HCUP-NIS database (2000-2017). Admissions with a concomitant diagnosis of AS were compared to AMI admissions without AS. Outcomes of interest included prevalence of AS, in-hospital mortality, use of in-hospital cardiac procedures, hospitalization costs, length of stay, and discharge disposition.Results:During the study period, there were a total of 11,622,528 AMI admissions. Among these 513,688 (4.4%) were identified with concomitant AS. Adjusted temporal trends revealed an increase in prevalence of AS among STEMI (adjusted odds ratio [AOR] in 2017 vs 2000 1.15) and NSTEMI (AOR 2017 vs 2000 1.28) hospitalizations. AMI admissions with concomitant AS were on average older (78.8 ± 10.9 vs 67.1 ± 14.1), of female sex, had higher comorbidity, higher rates of NSTEMI (78.9% vs 62.1%), acute non-cardiac organ failure (13.4% vs 9.2%), and cardiogenic shock (5.1% vs 4.8%)(all p

Circulation, Volume 146, Issue Suppl_1, Page A10412-A10412, November 8, 2022. Introduction:Malnutrition has been associated with inferior outcomes in patients admitted with acute myocardial infarction (AMI). However, there is a lack of data to assess if the degree of malnutrition correlates with outcome severity.Methods:We used Nationwide Readmission Database (NRD) for 2016-2019 in our cross-sectional study. First, we extracted all cases older than 18-years that include a primary diagnosis of AMI. Appropriate survey and domain analyses were applied to obtain national estimates using SAS 9.4.Results:We identified 2,280,393 discharges for AMI. Malnutrition was present in 4% of the study cohort (or 89,490 cases). Half of the patients with malnutrition (or 44,919) had moderate to severe malnutrition. The other 44,371 (or 50%) had a milder degree of malnutrition. Patients with malnutrition were younger than those without malnutrition (mean age 72-years vs. 75-years, p

Circulation, Volume 146, Issue Suppl_1, Page A12721-A12721, November 8, 2022. Introduction:Elderly patients (age > 75) sustain larger infarcts with greater mortality from STEMI despite successful TIMI III reperfusion. Elderly age is an independent risk despite correction for clinical and angiographic variables. Mitochondria (MITO) are key mediators of injury during ischemia (ISC) and reperfusion (R) in lab studies. The acute, transient blockade of the MITO electron transport chain (ETC) at complex I during R decreases infarct size in adult heart models. Metformin (MET) inhibits ETC complex I.Hypothesis:Acute, high dose MET given at R in high-risk aged STEMI model hearts will reduce infarct size.Methods:Young (3-6 mo) and aged (22-24 mo) C57BL/6J mice, male and female (NIA), underwent in vivo ISC-R surgeryvia45 min LAD ligation. At 5 min pre-R, 2 mM MET (or vehicle) was injected via jugular vein. At 24-hr R infarction size and area at risk (AAR) were measured. Echo was performed pre-ISC and end-R.Results:MET treatment at R improved contractile function [ejection fraction (EF) and fractional shortening (FS)] following 24 hr R in both male and female aged groups as well as in the young heart (Figure A)(mean ± SD). MET at R substantially decreased infarct size in both sexes in the aged heart (Figure B) to a similar extent as in the young hearts. AAR was similar in all groups.Conclusions:Acute, high dose MET treatment directly before R decreased infarction and improved contractile function at 24 hr R in aged murine hearts. This is the initial step to move acute MET toward consideration as a cath lab treatment via intracoronary infusion immediately following R via PCI for elders suffering STEMI to reduce injury and preserve function.

Circulation, Volume 146, Issue Suppl_1, Page A15242-A15242, November 8, 2022. Introduction:Although Chagas disease affects over 300,000 residents in the US, donor-derived Trypanosoma cruzi transmission is an uncommon complication after heart transplantation. We present a case of post-transplant Chagas cardiomyopathy.Results:A 68 year old male with history of heart failure with reduced ejection fraction secondary to ischemic cardiomyopathy, status post HeartMate III and subsequent orthotopic heart transplantation from a Hispanic donor, initially presented four months after transplant for routine right heart catheterization. Endomyocardial biopsy showed grade 2R acute cellular rejection. Patient was treated with IV steroids and discharged. One month later, he presented with one week of fevers, malaise, non-tender erythematous patches on his upper body and hemorrhagic bullae on his buccal mucosa. Initial workup was notable for pancytopenia with WBC 1.3 x10e9/L, hemoglobin 10.3g/dL, and platelets 77 x10e9/L, troponin 3.47 ng/mL, NT-proBNP 11,331 pg/mL, and new right bundle branch block on electrocardiogram. Cardiac MRI showed extensive multifocal late gadolinium enhancement and pericardial exudates, suggestive of atypical infection. Despite treatment with Filgrastim and IVIG, the patient progressed to cardiogenic shock complicated by complete heart block requiring transvenous pacing, and ventricular tachycardia. On hospital day 5, a peripheral smear confirmed Trypanosoma cruzi with high parasite burden and amastigotes were visualized on a shave biopsy of his rash. Patient was initiated on Benznidazole. He was treated in the intensive care unit, where his course was further complicated by recurrent VT, for which he received an implantable cardiac defibrillator, and renal failure requiring hemodialysis.Conclusions:We present a case of suspected donor-derived Chagas Disease. In retrospect, this patient’s initial episode of acute rejection was most likely due to Chagas Disease. Due to increasing globalization of endemic diseases and life-threatening complications associated with this disease, a high index of suspicion is required to diagnose and treat T. cruzi after heart transplantation in the setting of non-specific symptoms.

Circulation, Volume 146, Issue Suppl_1, Page A11761-A11761, November 8, 2022. Background:Acute myocardial infarction (AMI) in elderly patients who have previously undergone coronary artery bypass grafting (CABG) poses a diagnostic and therapeutic complexity. There is limited data on cardiovascular and mortality outcomes for this population.Methods:Using the National Inpatient Sample (NIS) from 2016-2019, we identified patients over 65 years with a prior CABG presenting with AMI, excluding those with a history of percutaneous coronary intervention. After assessing baseline characteristics, we analyzed trends in cardiovascular disease (CVD) risk and all-cause in hospital mortality (ACM) while stratifying for gender and race. Pearson’s chi-squared test was utilized to compare the CVD variables.Results:There were 266,365 hospitalizations included in the study with a median age of 77 years. They were predominantly males(69.5%), of Caucasian origin (81.7%), Medicare enrollees (91.4%) and were admitted in urban teaching hospitals (67.2%) located in the South of the US (39.5%) as non-elective cases (93.8%). Between 2016-19, Hyperlipidemia (HLD), smoking(Sm), and obesity(Ob) showed an increasing trend in males (2.8%, 1.3%, and 2% respectively) and females (2.1%, 2.4%, and 2% respectively), whereas hypertension (HTN) decreased by 4.5% in males and 6.3% in females.The length of stay remained constant at 4 days and the average cost of stay was 58963.5 USD. HTN among all races decreased from 2016 to 2019 except for Native Americans. HLD and obesity exhibited an upward trend among all races. Hispanics and Asians/Pacific Islanders(PI) had a consistent downtrend in mortality rates, with Native Americans showing the biggest drop in mortality rate (6.9%). All-cause mortality decreased from 2016 to 2019 by 1.4% except for Blacks which has increased by 2.6%, overtaking Asian/PI. All p

Circulation, Volume 146, Issue Suppl_1, Page A13402-A13402, November 8, 2022. Background:Racial differences in outcomes of STEMI patients continue to persist. Our study aimed to assess the difference in the incidence of acute kidney injury (AKI) post percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI), stratified by race into African Americans (AA) vs Caucasians.Methods:All STEMI patients who underwent PCI at the Cleveland Clinic main campus between January 1, 2011, to July 15, 2019, were included in our study. Patients were categorized into two groups depending on a diagnosis of the presence or absence of AKI post PCI. AKI was defined as >0.3mg/dl rise in post PCI creatinine from pre-procedure value. Relative risk of developing AKI depending on race was calculated with the help of a two by two table.Results:Overall, 1847 patients were admitted to our hospital with a STEMI and underwent PCI during the study period. Of these, 267 (15%) developed AKI post PCI. 19% of AA patients developed AKI compared to 13% of Caucasian. Comparison of baseline characteristics amongst patients who developed AKI revealed that AA patients with AKI were younger than their Caucasian counterparts (median age 63 vs 68, p=0.006), but were more likely to having smoking history (52% vs 35%, p=0.014). Upon analyzing the association between race and AKI, AA patients were 48% more likely to develop AKI post PCI compared to Caucasian patients (RR of 1.48, 95% CI 1.17-1.86, p=0.0015). This difference was observed in spite of no significant differences in radial access, contrast dose, or mechanical circulatory support use between the two races.Conclusion:African Americans STEMI patients are almost 50% more likely than Caucasians to develop AKI post PCI. Developing race-specific process measures and further optimization of procedural characteristics may be necessary to improve the outcomes of AA STEMI patients.

Circulation, Volume 146, Issue Suppl_1, Page A10914-A10914, November 8, 2022. Introduction:Rupture of an aortic aneurysm into the right atrium (RA) is extremely rare, while rupture into the thoracic cavity or pericardial sac is a common fatal complication. We describe a case of acute heart failure due to rupture of an aortic pseudoaneurysm with aorta-right atrial fistula.Case Summary:A 73-year-old man presented to the emergency department with dyspnea and abdominal distention. He had a history of ascending aortic replacement for type A aortic dissection 18 years ago. On arrival, physical examination revealed diminished breath sounds, leg edema but no cardiac murmurs. Investigations demonstrated abnormality of hepatic and kidney function, elevated BNP (490.9 pg/ml) in blood exam, and enlargement of ascending aortic aneurysm at the proximal anastomotic site with ascites/pleural effusion on computed tomography (CT), while left ventricular function was normal on transthoracic echocardiogram. We diagnosed acute heart failure with preserved ejection fraction and started to reduce fluid using diuretics. However, the response to diuretics was not good and the progression of lactic acidosis was observed regardless of using cardiotonic agent. Since it was becoming difficult to maintain systemic circulation, we performed further investigations before introducing mechanical support. The pulmonary artery catheterization revealed elevated RA pressure with wide pulse pressure (38/12 mmHg) and Oxygen step up in RA. An aortic root angiogram, contrast-enhanced CT and transesophageal echocardiogram showed a rupture of aortic pseudoaneurysm complicated with aorta-right atrial fistula (Figure). Although emergent surgery was performed, he unfortunately died the following day.Conclusions:This is a rare case of intracardiac perforation of aortic aneurysm diagnosed by various modalities. We should consider the possibility of developing shunt disease when we meet patients with rapidly progressive circulatory failure unresponsive to drugs.

Circulation, Volume 146, Issue Suppl_1, Page A14685-A14685, November 8, 2022. Introduction:Despite modern treatment methods, cardiogenic shock mortality complicates acute myocardial infarction (CS-AMI) remains high.Hypothesis:The study of factors affecting CS-AMI outcomes is essential.Methods:Data from the all-comers’ National Registry of Coronary Interventions from 2016 to 2020 were evaluated. Of 50,745 patients with AMI (STEMI/NSTEMI) 2,822 patients (5.6%) had initially CS (72.6% men, mean age 67.6 (12) yrs). The study analyzed the predictive value of such traditional cardiovascular risk factors related to the MI (sex, age, previous PCI or CABG, renal failure, localization of MI, time delay to reperfusion), comorbidities (expressed by the Deyo modification of Charlson comorbidity index), the severity of the condition on admission (mechanical ventilation, resuscitation), the extent of coronary artery disease and procedural success (the number of affected vessels, TIMI flow before and after PCI, LM disease), and such untraditional factors as season, weekday and day time. Multivariable analysis was used to identify independent predictors of prognosis in patients with CS-AMI.Results:The 30days mortality was 50.7%. As independent predictors of prognosis were identified age (older 80yrs, OR 4.97;95% CI 3.73-6.61), resuscitation (1.34; 1.07-1.67), mechanical ventilation (1.39;1.10-1.75), 3-vessel disease 1.39;1.12-1.72), left main disease (1.26; 1.01-1.57), and post-procedural TIMI flow lower 3 (1.14; 0.79-1.66). The independent predictive value of the comorbidity index was not confirmed (1.062;0.796-1.417). The numerically higher mortality rate was shown during a) autumn time (54.2%) and winter (51.8%), b) weekend (51.45%) (vs. working week (50.03%)), c) working hours (49.3%) (vs. the after-working hours (47.6%)). The multivariate analysis did not confirm the independent predictive value of these variables.Conclusions:Mortality of CS-AMI patients is significantly and independently influenced by factors confounding their circulatory instability, such as resuscitation and respiratory failure, the extent of coronary disease, and the success of reperfusion therapy. The independent impact of comorbidity and non-traditional factors on the prognosis of these patients has not been confirmed.

Circulation, Volume 146, Issue Suppl_1, Page A13473-A13473, November 8, 2022. Introduction:Atrial natriuretic peptide (ANP) is the most potent endogenous activator of the guanylyl cyclase A receptor (GC-A) mediating cardiorenal protective actions by increasing cGMP production. To test the hypothesis that acute decompensated heart failure (ADHF) is associated with increased circulating ANP but with reduced GC-A potency, we developed an ex-vivo precision medicine assay to quantify the potency of circulating ANP in plasma from healthy and ADHF subjects. Further, we assessed the ex-vivo potency of MANP, a novel ANP analog with greater cGMP activation than ANP, also using plasma of healthy and ADHF subjects.Methods:For the potency assay, we engineered HEK293 cells to overexpress human GC-A. Plasma from individual healthy (n=4) and ADHF (n=4) subjects was incubated in the assay and cGMP was assessed. The endogenous ANP derived cGMP was evaluated against the cGMP response of equimolar synthetic ANP (SANP) to assess potency of ANP from each cohort. MANP mediated cGMP generation was also assessed in the assay using healthy and ADHF plasma.Results:Healthy plasma, in which plasma ANP was 26±5 pg/mL, generated 10.3±0.7 pmol/mL of cGMP. SANPadded to the assay to mimic endogenous ANP levels in healthy subjects produced 7.8±0.5 pmol/mL of cGMP. ADHF plasma with markedly elevated ANP (350±57pg/mL) generated 23.5±3.1 pmol/mL of cGMP. SANPmimicking plasma ANP in ADHF produced 59.7±13.8 pmol/mL of cGMP, which was greater than cGMP generated from ADHF patient-derived plasma (p

Circulation, Volume 146, Issue Suppl_1, Page A9504-A9504, November 8, 2022. Introduction:The pathobiological mechanisms of coronary plaque erosion are unclear. Low endothelial shear stress (ESS) is a proinflammatory/proatherogenic stimulus associated with coronary plaque progression/destabilization. Intravascular imaging studies suggest that high ESS gradient (low ESS areas adjacent to high ESS areas), and steepness of plaque upslope/downslope correlate with plaque erosion. We investigated the relationship of local fluid hemodynamics to the inflammatory microenvironment at the culprit site of erosion in patients with an acute coronary syndrome.Hypothesis:ESS metrics associate with proinflammatory/proatherogenic cells and cytokines, and contribute to plaque erosion.Methods:We studied 30 patients with erosion from the OPTIcal-COherence Tomography in Acute Coronary Syndrome study (OPTICO-ACS). OCT images were segmented, co-registered with the angiogram to create a 3D-reconstruction of the coronary artery. ESS metrics were calculated by Computational Fluid Dynamics. Systemic and local blood samples and thrombectomy specimens were collected at the culprit lesion and analyzed by flow cytometry-based immunophenotyping and plasma cytokine and chemokine profiling, and statistically tested for correlations of continuous variables using Spearman rank correlation (r).Results:Proinflammatory cytokines (IL6, MIP-1, IL1β, IL2) and local concentration of T-cells, including subsets of T-cells (CD4+, CD8+, and NKT-cells), were significantly higher at the culprit site of erosion and correlate with local adverse ESS metrics (Min ESS, Max ESS, Plaque Topographical Slope) (Table).Conclusion:Biomechanical features likely trigger activation of the adaptive immune system, including T-lymphocytes and their cytotoxic effector molecules. These results provide novel insights into the links between fluid hemodynamics, inflammatory activation, and mechanisms involved in the pathogenesis of coronary plaque erosion.

Circulation, Volume 146, Issue Suppl_1, Page A11472-A11472, November 8, 2022. Background:Recent randomized controlled trials (RCTs) have demonstrated the superiority of treating patients with acute coronary syndrome (ACS) with dual antiplatelet therapy (DAPT) uniform de-escalation strategy (i.e., switching from potent P2Y12inhibitors to clopidogrel one month after the event). However, it remains unclear if this strategy would be effective in elderly patients. We aimed to assess the efficacy of the available DAPT strategies, including the uniform de-escalation strategy, in ACS patients older than 65.Methods:We searched the PubMed, EMBASE, and Cochrane CENTRAL databases up to December 2021 for RCTs or subgroup analyses investigating DAPT strategies for elderly ACS patients (age ≥65 years) and conducted a network meta-analysis. The endpoint was net clinical benefit outcome, defined as a composite of major adverse cardiovascular events and bleeding. The P-score was used to rank the treatments.Results:Seven RCTs with 5,079 patients were included. The uniform de-escalation strategy was associated with a better net clinical benefit outcome (hazard ratio: 0.62; 95% confidence interval [0.41-0.92]) compared with DAPT using potent P2Y12inhibitors, and it was similarly effective compared with other DAPT strategies. There was no significant heterogeneity (I2=0%;p=0.82) or inconsistency (p=0.40). The uniform de-escalation strategy was ranked as the most effective strategy (by P score) superior to DAPT using clopidogrel or low-dose prasugrel.Conclusions:The uniform de-escalation strategy was an effective strategy for older ACS patients. Compared with conventional DAPT using potent P2Y12inhibitors, this strategy decreased the composite of major adverse cardiovascular events and bleeding events.

Circulation, Volume 146, Issue Suppl_1, Page A9438-A9438, November 8, 2022. Introduction:Long-term prognostic implications of serial high-sensitivity troponin concentrations in patients with suspected myocardial infarction (MI) are unknown.Hypothesis:To determine short- and long-term risks of MI and revascularization (PCI or CABG) according to high-sensitivity troponin T (hsTnT) concentrations and their changes from baseline, in patients with suspected acute coronary syndrome.Methods:Retrospective cohort study based on Danish national registries. We identified all patients discharged from the hospital with either MI, unstable angina, suspected MI, or chest pain from January 2012 through December 2019 and merged them with records of two serial hsTnT measurements obtained 1-7 hours apart. Absolute risks of MI and revascularization were calculated through multivariable logistic regression with average treatment effect modeling (G-formula), with patients stratified in groups according to normal and elevated concentrations and relative changes of 20% and 50% from baseline.Results:Complete data were available in 28,902 individuals (median age [25th-75thpercentile] 65.2 [53.4-75.4] years, 11,632 [40.2%] women). The standardized risk of MI was highest in individuals with two elevated hsTnT concentrations (0-30 days: 54.1%, 31-365 days: 9.7%) and lowest in those with two normal values (0-30 days: 2.5%, 31-365 days: 0.4%). In the latter group, the risk of MI did not appear to depend on the relative hsTnT change between samples while in persons with two elevated hsTnT concentrations, the risks at both 0-30 days and 31-365 days increased in a stepwise fashion with more pronounced hsTnT rises. Individuals with a >20% to 50% fall also had a higher risk of MI than those with a less pronounced change while results were not significant for those with a >50% fall. Finally, individuals who went from a normal to an elevated hsTnT level and had a concomitant >50% rise had a significantly higher risk of MI at days 0-30 than those with a less pronounced rise. The standardized likelihood of undergoing coronary revascularization according to serial hsTnT concentrations followed the same pattern.Conclusions:Serial hsTnT measurements identify patients at long-term risk for both MI and revascularization.

Circulation, Volume 146, Issue Suppl_1, Page A11354-A11354, November 8, 2022. Introduction:The proprotein convertase subtilisin/Kexin type 9 (PCSK9) inhibitors have been guideline-approved for intolerant patients to statin therapy or unable to achieve target LDL levels with maximally tolerated therapies. The study aimed to determine whether early initiation of PCSK9 inhibitor with statin therapy in acute coronary syndromes (ACS) patients is beneficial in relation to low-density lipoprotein (LDL) reduction and short-term cardiovascular outcomes.MethodsThis pilot study included eighty ACS patients randomized to receive either PCSK9 inhibitor (Evolocumab) with statin therapy (n=40) or statin monotherapy (n=40). Patients were followed up for 6 months to assess for LDL levels, left ventricular ejection fraction (LVEF), and major adverse cardiovascular events (MACE) (a composite of myocardial infarction, heart failure, and cardiovascular death).ResultsEighty patients with ACS (mean age 59±11 years, 66.3% male) had LDL and LVEF measured at baseline, 3 months, and 6 months. There was no difference between baseline LDL levels (153.1±39.5 vs 146.1±32, p=0.39). LDL levels in PCSK9 inhibitor/statin group were significantly lower at 3 months and 6 months compared to statin monotherapy (76.2±27.7 vs 118.6±31, p

Circulation, Volume 146, Issue Suppl_1, Page A13104-A13104, November 8, 2022. Introduction:Reduced serum levels of glycosylated apolipoprotein J (ApoJ-Glyc) have been proposed as a marker for the early detection of myocardial ischemia with a potential prognostic value.Objective:The EDICA clinical trial assessed the performance of ApoJ-Glyc as a biomarker for the early detection of myocardial ischemia in patients attending the A&E department with chest pain suggestive of acute coronary syndrome (ACS) and investigated -as a secondary pilot objective- its prognostic value.Methods:EDICA -a multi-centre, international, diagnostic study (NCT04119882) assessed 404 patients. Based on clinical variables and diagnostic tests, 291 patients were considered to have had a “non-ischemic” event and 113 an “ischemic” event. Blood samples were obtained for the assessment of high-sensitivity troponin and ApoJ-Glyc at admission and at 1h and 3h thereafter. GRACE Risk Score was calculated in all ischemic patients. Patients were followed up for 6 months after presentation and the occurrence of MACE (cardiac death, recovered cardiac arrest, re-infarction, cardiac failure, new admission for ACS after discharge, or unplanned revascularization for cardiac ischemia after discharge) was recorded. ApoJ-Glyc serum levels were analyzed with a novel ELISA targeting a specific glycosylated variant of ApoJ (ApoJ-GlycA2).Results:Among the patients in the ischemic group, 8.8% had MACE at 6-months and these showed a 26% mean reduction in ApoJ-GlycA2 levels 3h post-admission compared with levels at presentation. This reduction was not observed in patients without MACE. Patients in the highest GRACE Risk Score tertile ( >118 points) showed a progressive decrease in ApoJ-GlycA2 levels after presentation compared with patients in the lower risk tertiles (mean decrease: 41% at 1h, P=0.01 and 35% at 3h, P=0.02 when compared with admission levels).Conclusions:A progressive decrease in ApoJ-Glyc levels after A&E admission appears to not only identify patients with ischemic events but also those at higher risk of suffering serious recurrent cardiovascular events at 6-months’ follow-up. Further studies in larger cohorts of patients are warranted to validate the potential role of ApoJ-Glyc in risk stratification in the context of cardiac ischemic events.

Circulation, Volume 146, Issue Suppl_1, Page A12969-A12969, November 8, 2022. Introduction:Disparities in healthcare outcomes are well described among patients of different races and ethnicities including pediatric cardiology. Multicenter studies examining these outcomes are lacking in pediatric acute care cardiology. We hypothesize that Black and Hispanic patients admitted to pediatric acute care cardiology units have increased hospital and acute care encounter length of stay (LOS) and complication rates compared to their White and non-Hispanic peers.Methods:Utilizing the Pediatric Acute Care Cardiology Collaborative registry, we examined all acute care cardiology unit encounters from 2/1/2019 to 7/30/2021 ending in discharge to home or death. Hospitalizations were categorized by race and ethnicity. In-hospital complications included health-care acquired infections, iatrogenic incidents, pneumonia, sepsis, seizures and stroke. Data were analyzed for differences in LOS and complication rates using chi-square and ANOVA testing. We used Bonferroni correction to establish a significance threshold of 0.007.Results:Analysis included 30,404 hospitalizations from 29 centers. There were 16,233 White (70%), 4,533 Black (19%), 919 Asian (4%) and 1,629 other races (7%) encounters. There were 23,592 (78%) non-Hispanic and 4,583 (15%) Hispanic encounters. Black patients had higher rates of premature birth (21.4%) and low birth weight (10.7%), compared to White patients (15.6% and 5.9% respectively, p