Risultati per: Sindromi coronariche acute

Circulation, Volume 146, Issue Suppl_1, Page A13524-A13524, November 8, 2022. Background:With the increasing recreational use of Cannabis in the United States, there is limited data on the impact of Cannabis use on young females. Therefore, we aimed to assess the risk and outcomes of cardiovascular and cerebrovascular events in young females with Cannabis use disorder (CUD).Method:The National Inpatient Sample (2019) was assessed to identify young, female hospitalizations (age 18-44 years) with CUD using relevant ICD-10 codes. Baseline characteristics and comorbidities were compared between two cohorts, CUD + and CUD -. The primary outcome was acute cardiovascular and cerebrovascular events evaluated using a multivariable regression analysis adjusting for confounders.Result:Of 1,72,36,228 young female hospitalizations, 2% had CUD+ (n=340560). CUD+ arm consisted of younger (median age-34 vs 59), black patients (28.2vs15.5%) and had a higher rate of drug abuse (62.1% vs 3%), smoking (50.7% vs 12.4%) and alcohol abuse (13.9% vs 2.5%) when compared to CUD- cohort (p

Circulation, Volume 146, Issue Suppl_1, Page A12393-A12393, November 8, 2022. Introduction:The American Heart Association and European Society of cardiology guidelines reclassified heart failure according to left ventricular ejection fraction, recognizing patients with mid-range EF (mrEF; 40% to 49%) as a distinct group. However, studies on the clinical characteristics of mid-range EF patients and the occurrence of cardiovascular events in acute MI patients are insufficient.Methods:We categorized 6,553 patients with acute myocardial infarction (AMI) from the Korea AMI-National Institutes of Health between November 2011 and December 2015 into three groups (reduced EF ; LVEF < 40% at admission, mild-reduced EF ; LVEF 40 to 49%, preserved EF ;LVEF ≥50%). The primary endpoint was defined as any death at two-year. Secondary endpoints were defined as any myocardial infarction, any revascularization, patient-oriented composite outcome(POCE).Results:Compared to patients with other two groups, the reduced EF group had a highest overall mortality, POCE, and any MI (24.7% vs 8.3% vs 4.6%, p < 0.0001, 33.0% vs 15.6% vs 12.4%, p

Circulation, Volume 146, Issue Suppl_1, Page A10765-A10765, November 8, 2022. Introduction:Whether prehospital Nitroglycerin use is associated with major adverse cardiac events (MACE) remains unknown in the era of primary percutaneous coronary intervention (PCI) using stents.Hypothesis:We hypothesized that prehospital Nitroglycerin use would be associated with MACE in acute coronary syndrome (ACS) patients who underwent primary PCI.Methods:This retrospective observational study enrolled 947 consecutive patients who received the emergent PCI. Patients were classified into the two groups, with and without prehospital Nitroglycerin use. 250 patients were given prehospital Nitroglycerin sublingually or via oral spray or intravenously. The clinical outcome was MACE defined as a composite of all-cause death, myocardial infarction, and stroke at a one-year follow-up.Results:The Systolic blood pressure at the emergency department was 132 (105, 141) mmHg in the prehospital Nitroglycerin, and 135 (113, 158) mmHg in the non-Nitroglycerin group (P < 0.001). Kaplan-Meier survival curves revealed that the MACE frequency was higher in the prehospital Nitroglycerin group (p = 0.021). Multivariate Cox regression analysis revealed that the prehospital Nitroglycerin use (hazard ratio, 1.65; 95% confidence interval [CI], 1.02-2.65; p = 0.002) was an independent predictor for MACE. Prehospital Nitrogricerin use, Killip classification, and Ejection fraction models resulted in a c-statistic with a statistically significant 95% PI and moderate discriminative performance (c-statistic=0.763; 95% CI, 0.7111-0.816, p

Circulation, Volume 146, Issue Suppl_1, Page A10865-A10865, November 8, 2022. Introduction and Hypothesis:Evaluation of the right heart function is known to have value in assessment of patients with acute pulmonary embolism (PE). The right atrium (RA) is directly impacted by right ventricular pressures. Strain analysis is an evolving area of echocardiography, and can be applied to evaluate the RA. To date, limited studies have evaluated RA strain in the setting of PE, and we hypothesized that RA strain analysis would be prognostic of outcomes in patients with acute PE.Methods:We performed a retrospective cohort study of 177 patients with acute pulmonary embolism. Strain analysis was performed on echocardiograms completed within 48 hours of admission. Peak longitudinal RA strain was applied using TomTec®. The primary outcome was 30-day all-cause mortality and in-hospital mortality. Receiver operating characteristic (ROC) curves and Kaplan-Meier curves were used for evaluation.Results:Study quality was sufficient to perform peak longitudinal RA strain analysis in 151 patients (86.8%). In-hospital mortality was 8.9% and 30-day mortality was 12.7%. Peak longitudinal RA strain was significantly reduced in patients with all-cause death up to 30 days and in-hospital death compared to survivors (30-day mortality: 20.9% ± 4.9% vs 30.7% ± 7.8%, p < 0.001. In-hospital mortality: 21.1% ± 5.0% vs 30.1% ± 8.0%, p < 0.001). Using ROC curves, we chose a peak longitudinal RA strain value of 26.5% (sensitivity 95%, specificity 73%) for detecting all-cause mortality up to 30 days. When dividing patients into 2 groups using this cut-off value, low peak longitudinal RA strain was associated with worse prognosis (HR 33.0, 95% CI= 4.4-248.8, p < 0.001. Figure).Conclusions:RA strain have significant prognostic value in patients with acute PE, and identifying those at increased risk of death which may indicate the need for more aggressive treatment. Assessment of RA strain has promise for clinical applications.

Circulation, Volume 146, Issue Suppl_1, Page A11986-A11986, November 8, 2022. Introduction:Patients with peripheral artery disease (PAD) are at high risk for adverse cardiovascular events, including acute myocardial infarction (AMI). Though AMI care has improved, in-hospital outcomes for patients experiencing an AMI with comorbid PAD are not well described in recent practice. We hypothesized that patients with PAD would have higher rates of bleeding and mortality during AMI hospitalization.Methods:We assessed clinical characteristics and in-hospital major bleeding and mortality rates of patients admitted with AMI and comorbid PAD at 646 hospitals in the NCDR Chest Pain MI Registry from 1/2019 to 9/2021. Major bleeding and mortality were compared for patients with vs. without PAD using multivariable logistic regression.Results:Compared with patients admitted for AMI without PAD (n = 307,550), those with PAD (n = 24,585) were older, had more comorbidities including tobacco use, diabetes, prior AMI and heart failure, and more frequently presented with NSTEMI vs. STEMI. Patients with PAD had higher crude rates of in-hospital major bleeding (9.7% vs. 6.3%) and mortality (8.1% vs. 4.7%); in exploratory analyses, rates of other adverse in-hospital events were also higher (Figure). After multivariable adjustment, PAD was associated with an increased risk of major bleeding (adjusted OR [aOR] 1.23 [95% CI 1.17-1.30]). PAD was also associated with greater risk of in-hospital mortality (aOR 1.28 [95% CI 1.21-1.37]), particularly among patients over age 65 (aOR 1.32 [95% CI 1.23-1.42] for ≥65 years vs. 1.06 [95% CI 0.96-1.18] for patients

Circulation, Volume 146, Issue Suppl_1, Page A9913-A9913, November 8, 2022. Introduction:Patients with hearing loss (HL) experience different levels of difficulties throughout their lives, impacting their quality of care. Little is known about the outcomes of patients with hearing loss following admission for Acute Myocardial Infarction (AMI).Method:Patients with a principal diagnosis of AMI and patients with any form of HL were recruited in our study from the 2019 National Inpatient Sample (NIS). Various comorbidities were studied.Results:Our analysis found 14,100(2.1%) AMI cases with HL diagnosis. The majority of the patients were Males (64.5%, p

Circulation, Volume 146, Issue Suppl_1, Page A12364-A12364, November 8, 2022. Our previous work has shown that chronic exposure to ceramide, a sphingolipid that when elevated in plasma is an independent risk factor major adverse cardiac events, causes microvascular endothelial dysfunction in arterioles collected from healthy adult patients. This presents as a change in the mediator of flow-induced dilation (FID) from the vasoprotective nitric oxide (NO) to the pro-atherosclerotic hydrogen peroxide (H2O2). Despite the known detrimental effects of ceramide, its metabolite sphingosine-1-phosphate (S1P) can promote NO formation. However, shear-induced ceramide formation is also necessary for maintaining NO-mediated FID, as arterioles from healthy individuals transition to H2O2-mediated FID during inhibition of the ceramide-forming enzyme neutral sphingomyelinase (NSmase). We hypothesize that the transition in mediator is due to the loss of acute S1P production, and thus addition of exogenous S1P can prevent microvascular endothelial dysfunction during inhibition of NSmase. Human arterioles (100-250μm) were dissected from otherwise discarded adipose tissue from healthy patients undergoing surgery. Videomicroscopy was used to assess vascular functionin vitro. Microvessels were pre-constricted with endothelin-1, and changes in internal diameter were measured following exposure to increased levels of flow. Dilation to flow was significantly impaired in the presence of the NO-synthase inhibitor L-NAME (100μM, 30 min) when healthy human arterioles were treated acutely with S1P (1μM, 30 min) in the presence of the NSmase inhibitor, GW4869 (10μM, 30 min), compared to GW4859 alone (% maximal diameter±SEM, 5.1±8.7, n=4 vs 70.1±5.3, n=4; p=0.001, 2-way ANOVA). Whereas, the presence of PEG-catalase, an enzyme that breaks down H2O2, had no effect (85.0±4.3; n=3). These data highlight the importance of S1P in maintaining NO signaling during exposure to shear and strengthens the concept that the conversion of ceramide to S1P is critical in promoting a quiescent endothelium.

Circulation, Volume 146, Issue Suppl_1, Page A9234-A9234, November 8, 2022. Background:Perceived discrimination is associated with several risk factors for acute myocardial infarction (AMI), but little is known about the association between discrimination and health status outcomes post-AMI.Methods:We analyzed the 1- and 12-month health status of 2,670 young (≤ 55 years) adults recovering from an AMI enrolled in the VIRGO study (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients). Perceived discrimination was assessed using the Everyday Discrimination Scale (EDS). General health status was measured using the Short Form 12 Physical and Mental Component Scores (PCS and MCS). Disease-specific health status was measured using the following domains of the Seattle Angina Questionnaire (SAQ): treatment satisfaction (TS), quality of life (QL) and dichotomous forms of the physical limitation and angina frequency domain scores (score < 100). Lower scores indicate worse health status. Multivariable linear regression of the PCS, MCS, TS, and QL scores and multivariable logistic regression of the dichotomous forms of physical limitation and angina frequency were used to assess their adjusted associations with perceived discrimination.Results:Nearly 35.0% of the cohort reported discrimination (EDS > 0). At 1-month post-AMI, increased EDS score was significantly associated with lower MCS, TS, and QL scores and higher odds of physical limitation and angina after adjustment(Figure). At 12-months post-AMI, increased EDS score retained its significant associations with lower MCS and QL scores and higher odds of physical limitation and angina, but not its association with TS(Figure). The EDS score was not associated with PCS at either 1- or 12-months post-AMI.Conclusions:Perceived discrimination was associated with worse mental health and disease-specific health status one year after AMI after adjusting important confounders. Further work to understand the source and how to mitigate perceived discrimination is needed.

Circulation, Volume 146, Issue Suppl_1, Page A11269-A11269, November 8, 2022. Introduction:There have been efforts to accurately measure adherence to ticagrelor to identify suboptimal medication therapy in the first year post-ACS as nonadherence during this crucial period is a major obstacle to optimizing clinical outcomes. Our study aims to examine ticagrelor adherence and persistence using different methods to better understand adherence patterns.Methods:We conducted a retrospective cohort study of patients aged ≥65 years who had filled a ticagrelor prescription within 7 days post-ACS discharge in Ontario, Canada between 4/2014-3/2018. We estimated mean proportion of days covered [PDC], the proportion of patients with “good” adherence of PDC≥80%, both at 1 year and the proportion of patients who were persistently taking ticagrelor at 1-year, using permissible gaps between prescriptions of 3, 7, 14 and 30 days.Results:There were 9,763 ticagrelor users (mean age 73.6; 65.4% men). The mean 1-year PDC (±SD) was 80.8±29.2, while only 73.0% of the cohort showed good adherence (PDC≥80%). Using a permissible gap definition of 14 days, only 55.7% of patients were persistent with ticagrelor in the year post-ACS. The 1-year persistence rates were as high as 62.6% with an allowable gap of 30 days and as low as 49.7% for a 7-day gap and 39.3% for a 3-day gap.Conclusions:Adherence and persistence estimates varied widely based on the definition used. While the PDC estimates implied reasonable 1-year ticagrelor adherence, PDC methods overestimated continuous use of ticagrelor, yet persistence methods with small gaps were likely too stringent. Readers of adherence and persistence studies should pay close attention to the methods and definitions used.

Circulation, Volume 146, Issue Suppl_1, Page A10864-A10864, November 8, 2022. Introduction:Right ventricular (RV) systolic dysfunction has been identified as a prognostic marker for adverse clinical events in patients presenting with acute pulmonary embolism (PE). However, problems exist in identifying RV dysfunction using conventional echocardiography. Strain echocardiography is an evolving imaging modality which measures myocardial deformation and can be used as an objective index of RV systolic function.Hypothesis:We hypothesized that RV strain analysis is prognostic of mortality in patients with acute PE.Methods:Retrospective cohort study of 177 patients with acute PE between 2010 and 2017. Strain analysis was retroactively applied. All echocardiograms were completed within 48 hours of diagnosis. RV global longitudinal strain (RVGLS) was applied using TomTec®. The primary outcome was all-cause mortality at 30 days and in-hospital mortality. T-test statistical analysis was performed. Receiver operating characteristic (ROC) curves and Kaplan-Meier curves were used for evaluation.Results:Study quality was sufficient to perform RVGLS analysis in 157 patients (90.2%). Mortality at 30 days and in-hospital mortality occurred in 12.7% and 8.9% of patients respectively. Comparing 30-day mortality, there was a significant reduction in RVGLS compared to survivors (13.0% ± 3.0% vs 19.6% ± 3.5%, p < 0.001). In-hospital mortality as well showed a significant difference (13.1% ± 3.3% vs 19.3% ± 3.7%, p < 0.001). Using ROC curves, we chose a RVGLS value of 17.5% (sensitivity 90%, specificity 74%) to predict 30-day mortality. Patients with RVGLS worse than 17.5% had 18 times higher risk of 30-day mortality compared to patients with RVGLS better than 17.5% (HR 18.4, 95% CI= 4.2-79.7, p < 0.001. Figure).Conclusions:RV strain have significant prognostic value in patients with acute PE, and identifying those at higher risk of death. Assessment of RV strain has promise for clinical applications.

Circulation, Volume 146, Issue Suppl_1, Page A13604-A13604, November 8, 2022. Introduction:Sodium-Glucose Cotransporter-2 inhibitor (SGLT2i) use during or immediately following Acute Heart Failure (AHF) exacerbation has shown clinical benefit including improved symptoms, lower frequencies of re-hospitalization for heart failure and death. However, effects of SGLT2i use immediately following acute kidney injury (AKI) on mortality and renal recovery in this setting are unknown.Hypothesis:Among patients admitted with AHF who sustain in-hospital AKI, exposure to SGLT2i in the immediate post-AKI period would be associated with better outcomes.Methods:Adult patients admitted across 5 hospitals between January, 2020 and April, 2022 with acute heart failure (NT-pro-BNP >500ng/L and receipt of IV diuretic within 24 hours of admission) and KDIGO-defined AKI during hospitalization were included. Advanced CKD (eGFR ≤15 ml/min/1.72m2) and those prescribed SGLT2i > 10 days after AKI were excluded. AKI recovery and death were compared between the exposed and unexposed cohorts using a time-varying Cox-regression analysis after adjusting for potential confounders.Results:In this retrospective cohort of 3599 individuals admitted with AHF that developed AKI during hospitalization, 293 patients received SGLT2i within the 10 days post-AKI. The median (IQR) time to AKI after admission was 24 (1.41-64.48) hours. 36.52% of the SGLT2i exposed had renal recovery pre-SGLT2i exposure. For the SGLT2i-exposed (pre-renal recovery) vs. unexposed groups, rates of 14-day renal recovery were not significantly different (adj. HR 0.99, 95% CI 0.82-1.19, p=0.90). However, the post-AKI SGLT2i-exposed group had a lower risk of death at 30 days (adj. HR 0.39, 95% CI 0.19-0.79, p=0.009) after adjustment for potential confounders.Conclusion:In a retrospective cohort of patients hospitalized with AHF with in-hospital AKI, exposure to SGLT2i within 10 days post-AKI was associated with decreased mortality and no significant delay in renal recovery.

Circulation, Volume 146, Issue Suppl_1, Page A14940-A14940, November 8, 2022. Introduction:Failure of multidrug therapy and the multifactorial nature of kidney injury has paved the path way regenerative medicine with over 45 clinical trials using stem cells-based therapy underway. Neonatal cardiac mesenchymal stem cells (nMSC) are one of the most potent stem cells due to their secretome. HYPOTHESIS: SOD2 and anti-inflammatory miRNAs (miR-214 & 95p) in paracrine secretions (secretome) of nMSC provides renoprotection in a rodent model of glycerol-induced AKI.Methods:nMSC were generated from neonatal myocardium using enzymatic digestion and antibodies-based selection. Secretome was collected by conditioning nMSCs for 72 hours in serum free basal medium. Human kidney cells (HKC) were used forin vitroanti-oxidation assays using cisplatin. THP-1 cells were used for anti-inflammatory assessment. CD1 mice were used for glycerol-induced AKI model. Mice were subjected to AKI via IM glycerol (9mg/kg). nMSC-derived secretome was intravenously administered immediately after, or 4 hours post-glycerol. Blood urea nitrogen (BUN) and creatinine were analyzed in serum. Cell survival/KIM1 was assessed by immunohistology/FACS. Other experiments utilized cisplatin toxicity in HKC.Results:Administration of nMSC secretome (5 or 10mg/kg) at the same time or 4-hours post-glycerol administration significantly reduced serum creatinine and BUN in a glycerol induced AKI animal model. Caspase-9 and KIM1 expression was significantly decreased in tubular cells as compared to placebo at a dose of 10mg/kg. KIM-1 was significantly downregulated as compared to placebo following nMSC-secretome administration. Western blot analysis of HKC treated with cisplatin in presence of nMSC-secretome showed significant reduction in NFkb and pERK expression (p

Circulation, Volume 146, Issue Suppl_1, Page A10643-A10643, November 8, 2022. Introduction:Many patients with incident atrial fibrillation (AF) are diagnosed in the setting of a potentially transient precipitant. Despite substantial rates of AF recurrence and stroke in this population, prior registries and survey data suggest lower usage of oral anticoagulants (OAC). Here, we examined use of OAC on the basis of precipitated versus non-precipitated AF among patients enrolled in the VITAL-AF trial.Methods:VITAL-AF (clinicaltrials.gov NCT03515057) was a cluster randomized trial of 16 primary care practices evaluating point-of-care AF screening using single-lead ECGs among individuals aged ≥ 65 years (n=30,715). The primary outcome of newly diagnosed AF at one year occurred in 503 patients. For each incident AF event, we performed manual chart review to classify if diagnosis occurred in the setting of an acute precipitant, if the episode was transient, and if OAC was initiated. AF was considered transient if there was documented return to sinus rhythm within three months of initial diagnosis. OAC initiation required both evidence of a new prescription and corresponding provider documentationResults:Of the 503 cases of incident AF diagnosed during the VITAL-AF study period, 125 (24.9%) occurred in the setting of an acute precipitant. The mean age of patients with newly diagnosed AF was 78.3 ± 9.0 years, 46% were female, 11% were non-white, and the mean CHA2DS2-VASc score was 4.2 ± 1.6, which were similar between those with and without a precipitant. Patients with acute precipitants of AF were more likely to have transient episodes (94% vs 76%, p=0.001) and less likely to be started on OAC (60% vs 82%, p

Circulation, Volume 146, Issue Suppl_1, Page A12335-A12335, November 8, 2022. Introduction:High sensitivity troponin (hs-cTnT and hs-cTnI) aimed to reduce costs, observation times and hospital stays. However, since their implementation in many hospital systems across the US many healthcare professionals still struggle in regards to their appropriate utility and interpretation.Hypothesis:We assessed the hypothesis that a web-based training interface is an effective tool to increase education about the proper utility and interpretation of High sensitivity troponin in an acute care setting.Methodology:A web-based training interface was designed with 2 pre-education questions, a slide show based on the 2021 guidelines for chest pain (ie ordering troponin based on presentation, 0+1/2/3 hour) and 2 post-education questions. This interface was sent out to healthcare professionals in a community hospital through email bursts and QR codes. 52 providers participated in the training interface: Internal Medicine residents (n=24), Hospital medicine attendings (n=13), Cardiology Attendings (n=3), Emergency medicine attendings (n=3) and Advanced practice providers (APPs), included nurse practioners and physician assistants (n=9). We measured change in awareness of appropriate and inappropriate troponin use. Fisher’s exact test was performed to compare all subgroups. P value

Circulation, Volume 146, Issue Suppl_1, Page A13880-A13880, November 8, 2022. Introduction:There are conflicting data on COVID-19 outcomes in pregnant women. Using the AHA COVID-19 CVD Registry we evaluated COVID-19 outcomes in pregnant vs non-pregnant women with COVID-19.Methods:Women 18-40 years old hospitalized from March 2020 to December 2021 with symptomatic COVID-19 were included (n=2,068), with 110 (5.3%) pregnant at admission. Women with unknown pregnancy status were excluded. Vaccine data were limited (2.8% of participants), therefore omitted from analysis. Baseline demographics and symptoms at presentation were compared between pregnant and non-pregnant women (Table). Rates of death, mechanical ventilation, ICU admission, hospital stay ≥5 days, myocardial infarction, stroke, DVT, PE, and a composite of all outcomes were determined. Multivariable Cox regression analyses were performed, adjusting for comorbidities and prior CVD.Results:Pregnant women hospitalized with COVID-19 had fewer comorbidities than non-pregnant women (Table). There were no deaths in the pregnant group and 44 (2.3%) in the non-pregnant group. Fewer pregnant women were hospitalized ≥5 days (29.1% vs 41.2% non-pregnant); this difference was not statistically significant after multivariable adjustment [adjusted HR (95% CI), 0.67 (0.43-1.02)]. There were no significant differences between the groups in the composite outcome [adjusted HR (95% CI), 0.72 (0.48-1.07)] or its components (Table).Conclusions:Pregnant women hospitalized with symptomatic COVID-19 had fewer comorbidities compared with non-pregnant women. There were fewer deaths and lower rates of hospitalization ≥5 days in pregnant vs non-pregnant women which was no longer statistically significant after multivariable adjustment. The potential for residual confounding due to healthier pregnant women presenting with milder COVID-19 illness or being admitted for non-COVID-19 indications compared to non-pregnant women must be considered when interpreting these findings.

Circulation, Volume 146, Issue Suppl_1, Page A9886-A9886, November 8, 2022. Introduction:Pancreatic cancer (PC) has induced a higher risk of a hypercoagulable state that can further lead to various complications such as Acute Myocardial Infarction (AMI). There is a lack of data on the outcomes of PC patients following an episode of AMI.Method:A retrospective analysis was performed via the 2019 National Inpatient Sample (NIS). We identified a principal diagnosis of AMI and a diagnosis of PC (ICD-10 ‘C25.x’) at any level. Patient characteristics (sex, race, diabetes, mean age, hypertension, hyperlipidemia, and smoking history) were compared, and the risk of mortality in PC patients was estimated via multivariable regression analysis.Results:In total, 555 (0.1%) PC cases were found among all hospitalized cases of AMI in the United States in 2019. We also found that 63.1% were males, 46.8% had diabetes, 85.6% had hypertension, 58.6% had hyperlipidemia, 45.9% reported a smoking history, and 73.0% were Whites. Among the PC patients, 120 (22.4%) patients underwent PCI. Unfortunately, 65 (11.7%) patients with PC died (aOR 2.595, 95% CI 1.995-3.375, p