Risultati per: Sindromi coronariche acute

Circulation, Volume 146, Issue Suppl_1, Page A10464-A10464, November 8, 2022. Introduction:There are scarce data in the literature analyzing, in patients with acute myocardial infarction (AMI), the impact of right (RBBB) and left bundle-branch block (LBBB) on mortality, especially in the long-run after hospital discharge.Hypothesis:RBBB and LBBB is associated with in-hospital and long-term mortality in patients with AMI.Methods:Retrospective analysis from an administrative databank of patients (pts) with acute coronary syndromes, collected prospectively between 1998 and 2016. From a total of 6466 pts, we selected 2895 with AMI (72% men, mean age 63.7 years, 50% with ST-segment-elevation AMI) and complete follow-up for up to 17 years (mean 5.5 years). In-hospital and long-term mortality was compared with RBBB (incidence=5.8%) and LBBB (incidence=3.9%) in models unadjusted and adjusted for 14 variables including age, type/location of AMI and in-hospital cardiogenic shock.Results:In-hospital mortality was 15.5% vs. 7.0% for pts with or without RBBB, respectively (OR=2.41, P

Circulation, Volume 146, Issue Suppl_1, Page A11840-A11840, November 8, 2022. Introduction:Coronary artery ectasia is associated with an increased risk of acute myocardial infarction.Hypothesis:This meta-analysis evaluates outcomes following acute myocardial infarction in patients with preexisting coronary artery ectasia.Methods:This meta-analysis was conducted according to PRISMA guidelines. A search strategy was designed to utilize PubMed/Medline, EMBASE, and Google scholar for studies showing the outcomes of acute myocardial infarction in patients with coronary artery ectasia from inception to February 10, 2022. We reported effect sizes as odds ratio (OR) with a 95% confidence interval (CI). We usedI2 statistics to estimate the extent of unexplained statistical heterogeneity:I2 greater than 50% was considered a high degree of between-study statistical heterogeneity.Results:Of 217 studies initially identified, 7 studies comprising 13499 patients were included in the final analysis. There was no significant difference between patients with coronary ectasia and patients without coronary ectasia in terms of all-cause mortality (OR 0.95; 95% CI 0.58 to 1.56; p = 0.79;I2=0%) , MACE (OR 4.04; 95% CI 0.34 to 47.57; p = 0.17;I2=95%), myocardial reinfarction (OR 2.13; 95% CI 0.83 to 5.47; p = 0.08;I2=59%), target vessel revascularization (OR 1.31; 95% CI 0.69 to 2.48; p = 0.21;I2=0%), or requiring mechanical supportive devices (OR 1.32; 95% CI 0.22 to 7.83; p = 0.57;I2=56%). (Figures 2-A, B, C, D)Conclusions:Acute myocardial infarction in the presence of coronary artery ectasia is not linked to an increased risk of death, major cardiovascular events, myocardial infarction, or the need for mechanical circulatory support.

Circulation, Volume 146, Issue Suppl_1, Page A11896-A11896, November 8, 2022. Introduction:Spontaneous heparin-induced thrombocytopenia (HIT) is a rare clinical variant that develops without prior exposure to heparin. We present a 40-year-old man who was diagnosed with spontaneous HIT after an acute ST-segment elevation myocardial infarction complicated by multiple acute stent thromboses and left ventricular (LV) thrombus.Case:A 40-year-old previously healthy man with no known history of heparin exposure presented to our emergency department with an acute ST-segment elevation myocardial infarction. Emergent coronary angiography revealed a severely thrombotic 100% occlusion of his distal left anterior descending artery for which thrombectomy and percutaneous coronary intervention (PCI) were performed with placement of a drug eluting stent. Prior to angiography, the patient received 4000 units of unfractionated heparin and an additional 2000 units intra-arterially during the case. Labs prior to PCI revealed thrombocytopenia and HIT enzyme-linked immunoassay testing was sent. He underwent repeat angiography two additional times during his course for recurrent chest pain which both revealed acute stent thrombosis. HIT testing eventually returned positive for the presence of platelet factor 4 antibodies. A subsequent serotonin release assay returned positive, confirming the diagnosis of HIT. A transthoracic echocardiogram during his hospitalization also revealed an LV thrombus.Discussion:Heparin-induced thrombocytopenia (HIT) is traditionally diagnosed after thrombocytopenia develops 5 to 10 days after exposure to heparin. However, there have been rare reports of a spontaneous form of HIT that can occur without prior exposure to heparin. This case highlights a rare presentation of spontaneous HIT. Although infrequent, cardiologists should be aware of atypical presentations of HIT, since almost all patients will receive heparin prior to or during coronary angiography and coronary interventions. Spontaneous HIT should be considered in all patients who present with unexplained thrombocytopenia with arterial and/or venous thrombi. Failure to recognize this clinical entity could lead to potentially life-threatening thrombotic complications from further administration of heparin.

Circulation, Volume 146, Issue Suppl_1, Page A13594-A13594, November 8, 2022. Introduction:Reports have shown socioeconomic healthcare disparities among patients with cardiovascular diseases. We studied the trends in AMI hospitalization burden and outcomes over a decade with a focus on disparities in outcomes. This would provide epidemiologic data to assess the impact of current guidelines and recommendations on the general population.Methods:This was a trend study of the National Inpatient database from 2010 to 2019. We searched for AMI as the reason for hospitalization using the ICD codes. We estimated trends, inpatient mortality, mean length of hospital stay (LOS) and mean total hospital charges (THC) over the period. We performed a stratified analysis in categories: sex (male and female), race (Caucasians, Blacks, Hispanics), and median household income for patient’s zip code (low-income quartile [LIQ] vs high-income quartile [HIQ]) to assess disparities in outcomes. Multivariable regression analysis adjusted for age and sex was used to obtain trend statistics on outcomes.Results:There were about 6,158,738 hospitalizations for AMI over the study period with females making up 38.2%. Yearly hospitalizations increased from 1,851 – 1,983 per 100,000 adult hospitalizations from 2010 to 2019 (p

Circulation, Volume 146, Issue Suppl_1, Page A9885-A9885, November 8, 2022. Introduction:Atrial septal defect (ASD) is one of the most common congenital cardiac defects. It can also allow paradoxical emboli to move into the cerebral vasculature leading to Acute Ischemic Stroke (AIS). As there is a lack of adequate information on the additional risk factors for mortality in ASD patients following AIS, we queried the largest inpatient database in the United States for answers.Methods:Patients with ASD were identified among patients of ages 25 and more admitted with a principal diagnosis of AIS ICD-10 code (I63.x) in 2019 from the National Inpatient Sample(NIS). Various patient characteristics and procedures were also studied. A Multivariate regression model adjusting for several factors allowed our study to further evaluate potential risk factors for mortality among ASD patients.Results:Our study found 551,385 cases of AIS, amongst which 19,670 (3.6%) also had a diagnosis of ASD. ASD patients had a higher risk of requiring mechanical thrombectomy (aOR 1.239, 95% CI 1.167- 1.316, p

Circulation, Volume 146, Issue Suppl_1, Page A14147-A14147, November 8, 2022. BackgroundAcute pulmonary embolism (PE) is associated with an increased risk of short- and long-term mortality. Since interventricular septal systolic function contributes to a third of right ventricular (RV) cardiac output, we sought to investigate the potential value of septal strain in PE.MethodsThis was a retrospective cohort study of patients admitted with acute pulmonary embolism. Patients underwent echocardiography during admission and included left ventricular (LV) speckle tracking, by which global longitudinal strain (GLS) and regional strain were acquired. Multivariable adjustments were made for age, sex, simplified PE index (sPESI), abnormal cardiac biomarkers (troponin or proBNP) and RV systolic function. The endpoint was all-cause death.ResultsThe cohort consisted of 186 patients (mean age 68 years, 54% men), of whom 49 (26%) died during a median follow up of 3.5 years (IQR: 2.9-6.7 years). All LV systolic measures were univariable predictors of death (LVEF: HR: 1.04 (1.02-1.06), per 1% decrease; GLS: HR: 1.15 (1.07-1.22), per 1% absolute decrease; septal strain: HR: 1.15 (1.08-1.23), per 1% absolute decrease] (figure). RV systolic function was also associated with death [TAPSE: HR: 1.06 (1.01-1.12), per 1mm decrease). After multivariable adjustments, only septal strain remained significantly associated with outcome (HR: 1.09 (1.01-1.19), p=0.029, per 1% absolute decrease).Furthermore, septal strain significantly increased C-statistics when added to a base model of sPESI score, abnormal biomarkers and presence of hypotension (base model C-stat: 0.76; base model and septal strain C-stat: 0.83, p for increment = 0.006).ConclusionSeptal strain is associated with death in acute PE and provides prognostic information beyond conventional risk assessment.

Circulation, Volume 146, Issue Suppl_1, Page A13934-A13934, November 8, 2022. Introduction:Although a higher protein intake has been related with lower mortality rates in general population, the association between protein intake and nutritional status/mortality in patients with acute heart failure has yet to be clarified.Methods and Results:We retrospectively analyzed 694 patients who were admitted due to acute heart failure in our hospital (mean age, 75±13 years; male 60%). The estimated protein intake was defined as a validated formula: [13.9 + 0.907*body mass index (kg/m2) + 0.0305*urinary urea nitrogen level (mg/dL)] using spot urine samples on admission. All patients were divided into three groups according to the estimated protein intake: low (≤43.6 g/day, n=232), middle (43.7 to 51.5 g/day, n=231), and high (≥51.6 g/day, n=231) group. The primary outcome of this study was regarded as all-cause mortality. Patients with low protein intake were older and had lower albumin compared with other two groups. A lower protein intake was associated with worse nutritional status evaluated using Geriatric Nutritional Risk Index (P

Circulation, Volume 146, Issue Suppl_1, Page A14850-A14850, November 8, 2022. Background:Acute kidney injury (AKI) is common in patients with COVID-19 and mediated, in part, by thromboinflammation. In non-critically ill patients with COVID-19, therapeutic-dose anticoagulation with heparin increased the probability of survival to hospital discharge with reduced use of cardiovascular or respiratory organ support. We investigated whether therapeutic-dose heparin reduces the incidence of AKI or death in non-critically ill patients hospitalized for COVID-19.Methods:Non-critically ill patients hospitalized for COVID-19 were enrolled in an open-label, multiplatform randomized trial of therapeutic-dose heparin versus usual-care pharmacologic thromboprophylaxis. The primary endpoint of this analysis was in-hospital diagnosis of AKI or death. AKI was defined as Kidney Disease Improving Global Outcomes stage 2 or 3 AKI (≥2-fold increase in serum creatinine or initiation of renal replacement therapy). A Bayesian statistical model estimated the risk of AKI or death between those randomized to therapeutic-dose anticoagulation versus usual-care thromboprophylaxis, adjusted for age, sex, D-dimer, time epoch, country, site, and platform.Results:Among 1922 enrolled from ACTIV4a and ATTACC, 23 were excluded due to ESRD at enrollment. Baseline or follow-up creatinine was missing for 205 individuals. Among 1694 participants analyzed, median age was 60, 58% were men, and median baseline creatinine was 0.9 mg/dL. The primary endpoint occurred in 83 participants (4.9%); 4.4% assigned to therapeutic-dose heparin and 5.5% assigned to thromboprophylaxis (adjusted relative risk [aRR] 0.72, 95% CrI 0.47-1.10; posterior probability of superiority [defined as relative risk < 1.0] was 93.6%). Therapeutic-dose anticoagulation was associated with a 97.7% probability of superiority to reduce the composite of stage 3 AKI or death (3.1% vs. 4.6%; aRR 0.64, 95% CrI 0.40-0.99) compared to usual-care thromboprophylaxis.Conclusions:Therapeutic-dose anticoagulation with heparin was associated with a high probability of superiority to reduce the incidence of in-hospital stage 3 AKI or death in non-critically ill patients hospitalized for COVID-19, compared with usual-care thromboprophylaxis.

Circulation, Volume 146, Issue Suppl_1, Page A331-A331, November 8, 2022. Background:Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is one of effective therapeutic modalities for patients with cardiogenic shock (CS) and acute coronary syndrome (ACS). While VA-ECMO maintains end-organ perfusion, it increases damaged left ventricular (LV) wall tension. Combined treatment of VA-ECMO and a micro-axial Impella pump, referred to as ECPELLA, simultaneously provides systemic circulatory support and LV unloading. However, it remains unknown whether LV unloading effect on ECPELLA support further reduces mortality compared to currently available VA-ECMO+IABP support.Purpose:Investigate whether ECPELLA can reduce mortality in ACS patients with severe cardiogenic shock who required VA-ECMO.Methods:From January 2012 to May 2022, 100 consecutive patients with ACS and CS who received VA-ECMO before or after percutaneous coronary intervention were enrolled. Patients were divided into two groups; 39 patients in the ECPELLA; and 61 patients in the VA-ECMO with IABP. We assessed peak serum CPK-MB levels and 30-day mortality.Results:There were no significant differences in age, rate of male sex, coronary risk factors, ST-elevated ACS, left main trunk (LMT) lesion, multi-vessel disease (MVD), number of coronary lesions, extracorporeal cardiopulmonary resuscitation, and the time from onset to reperfusion between two groups. The ECPELLA had lower peak CPK-MB levels compared to VA-ECMO with IABP, but the difference did not reach statistical significance (p=0.056). Kaplan-Meier analysis revealed that the ECPELLA had significantly lower 30-day mortality (p=0.0016). Multivariable Cox proportional hazard analysis revealed that ECPELLA (HR: 0.22 95% confidence interval:0.11-0.45; p

Circulation, Volume 146, Issue Suppl_1, Page A13760-A13760, November 8, 2022. BackgroundIncreased cancer risk has been reported in patients with acute coronary syndrome (ACS). We attempted to investigate the geographic differences in this risk.Methods:In this prospective study, we enrolled 525 ACS patients admitted to 3 hospitals in Veneto region of Italy and discharged alive and free from neoplasia. Patients’ residency was classified into 2 urban and 2 nearby rural areas. We report the risk of neoplasia associated with smoking as a comparison.Results:With 3 exceptions, all patients completed a 24-year follow-up unless pre-empted by death. Urban (46%) and rural (54%) residents shared most of their baseline demographic and clinical characteristics. During the follow-up period, which represented 5851 person-years, 114 (22%) patients developed cancer. The cancer incidence rate was 17 and 22 per1000 person-years for urban and rural areas, respectively. No difference in cancer onset risk was found between urban and rural areas or between southern and northern provinces (HR 1.3; 95%CI 0.9–1.9;p= 0.21 and HR 1.4; 95% CI 0.9–2.0;p= 0.08, respectively) according to the unadjusted Cox regression analysis. Geographic areas, however, showed a strong positive interaction, with risk increasing from the urban to rural areas from southern to northern provinces (HR 2.9; 95% CI 1.3–6.5;p= 0.01). The fully adjusted model provided similar results. The HR for malignancy onset after ACS by smoking habit was (1.3; 95% CI 0.8–2.0;p= 0.26) in the unadjusted Cox regression model.ConclusionThe present prospective study shows that the cancer onset risk among unselected ACS patients in Italy’s Veneto region significantly differs by geography with the northern rural area having the highest risk. The risk seems to be higher than that observed with smoking habits.Figure 1. Graphical representation of the interaction analysis.

Circulation, Volume 146, Issue Suppl_1, Page A11239-A11239, November 8, 2022. Introduction:Gender disparities in the utilization of catheter-directed thrombolytic (CDT) therapy vs. systemic thrombolytic (ST) therapy in patients with acute pulmonary embolism (PE) have not been studied before.Methods:Using the National Inpatient Sample database from 2012 to 2018, we identified all adult patients with acute PE who received any thrombolytic therapy. The primary outcome was the utilization of CDT vs. ST therapy in females compared to males. The secondary outcome was the mortality in females compared to males in all patients of acute PE who received any thrombolytic therapy.Results:We identified 45,950 patients who received CDT or ST therapy. The mean age was 59.7 years in females vs. 59 in males (p-value – .03). Males were more likely to have saddle PE (33% vs. 29%, p-value < .01) and less likely to have vasopressor use (3% vs. 5%, p-value < .01). Baseline characteristics are shown inTable 1.Females were less likely to have CDT vs. ST therapy on adjusted analysis (AOR - 0.85, p-value < .01), as shown inTable 2.Females also had 27% higher in-hospital mortality than males in the entire cohort who received any thrombolytic therapy even after adjustment for age, race, comorbidities, and hospital factors (AOR - 1.27, p-value < .01). CDT was associated with a 58% lower risk of in-hospital mortality than systemic thrombolytic therapy in the adjusted model (AOR - 0.42, p-value < .01).Conclusion:Gender disparities exist in the utilization of CDT in patients of acute PE who receive thrombolytic therapy, with lower utilization in females than males, despite significantly reduced in-hospital mortality associated with CDT vs. ST therapy.

Circulation, Volume 146, Issue Suppl_1, Page A13710-A13710, November 8, 2022. Introduction:The prognosis of reactive pulmonary hypertension (PH) due to left heart disease is poor, and the pathogenesis of the disease is not well understood. Rho-Kinase inhibitor, fasudil dilates vascular smooth muscle and may improve pulmonary hypertension. We evaluated the acute effects of fasudil on hemodynamic parameters in patients with pulmonary hypertension due to left heart disease prospectively.Methods:From 2016 June to 2022 May, 100 consecutive patients requiring hospitalization for worsening chronic heart failure were enrolled. All patients underwent invasive hemodynamic measurement though right heart catheterization.In patients with mean pulmonary arterial pressure greater than 25 mmHg at baseline, 30 mg of fasudil was administered intravenously for 30 minutes. The hemodynamic measurements were performed at baseline and after 30 minutes of fasudil. PH due to left heart disease is defined as mean pulmonary arterial pressure (mPAP) ≥25mmHg and mean pulmonary capillary wedge pressure (mPCWP) >15mmHg. Patients with PH were classified into 2 types, depending on the elevation of pulmonary vascular resistance (PVR) or the diastolic pressure gradient (DPG): Reactive-PH with elevated PVR ( >3.0 Wood units: WU) and/or DPG ( >7mmHg), and Passive-PH with normal PVR (≤3.0 WU) and DPG (≤7mmHg).Results:Fifty patients (mean age 70 years; 14 women and 36 men) received administration of fasudil. 30 patients had Passive-PH, and 20 patients had Reactive-PH. PVR significantly decreased after administration of fasudil in both Passive-PH and Reactive-PH group (1.7 to 1.4 WU, 3.5 to 2.7 WU, P

Circulation, Volume 146, Issue Suppl_1, Page A14124-A14124, November 8, 2022. Case Presentation:A 45-year-old man with history of Type I osteogenesis imperfecta (OI) presented with severe shortness of breath and worsening bilateral lower extremity edema for 6 weeks. Paternal family history was significant for Type I OI with early deaths in affected females. Physical examination revealed a distressed man with blue – gray sclerae and jugular venous distention. Cardiopulmonary examination was remarkable for tachycardia, grade IV holosystolic murmur radiating to the axilla, bilateral lung crackles with decreased air entry on the lower lung fields and pitting pedal edema up to mid thighs. TTE and TEE were significant for severe eccentric posterior MR with multiple vegetations versus ruptured chordae and normal systolic function. He underwent an emergency mitral valve replacement complicated by post-operative severe AR requiring redo sternotomy with aortic valve replacement. Histologically, aortic valve leaflets were suggestive of chronic endocarditis with dual negative sets of blood cultures drawn since admission. He was eventually discharged home after an intense cardiac rehabilitation with appropriate follow ups.Discussion:OI is a rare hereditary connective tissue disorder affecting the production of Type I collagen due to mutations in COL1A1 and COL1A2 genes. Although lesser known, OI valvulopathy is typically limited to the left sided structures, for unknown reasons, with the most common valvular anomaly being AR followed by MR. Despite the dramatic cardiac involvement in our patient and known mortality risk associated with surgical intervention, prompt evaluation and early intervention led to a successful outcome.

Circulation, Volume 146, Issue Suppl_1, Page A13593-A13593, November 8, 2022. Background:SGLT2 inhibitors (SGLT2i) decrease mortality and risk of hospitalizations in patients with HFrEF. SGLT2i have a natriuretic effect shortly after initiation, followed by a lasting osmotic diuretic effect. We sought to evaluate real-world rates of acute kidney injury (AKI) in our clinical setting that includes patients concurrently receiving high doses of loop diuretics.Methods:We abstracted patient level data on 200 patients with HFrEF initiated on a SGLT2i in the outpatient setting in the University of Michigan (1/7/2016 – 2/7/2022). Our co-primary endpoints were rate of AKI and discontinuation of SGLT2i. Secondary end points consisted of diuretic dose reduction, change in potassium, change in serum creatinine (SCr), and other side effects not requiring discontinuation.Results:The majority of patients were male (64%) with a mean LVEF of 27%. A total of 104 (52%) patients had diabetes mellitus. The majority of patients (54%) were taking an angiotensin-receptor neprilysin inhibitor. The mean daily furosemide equivalent diuretic dose was 93.3 mg. Twenty-two (11%) patients had AKI and 18 patients (9%) discontinued their SGLT2i. Yeast infection (3%), hypotension (2.5%), and AKI (2%) were the most common reasons for discontinuation. Using ROC curve analysis, the strongest predictors for AKI were A1C (AUC = 75.8, empirical confidence interval [ECI] 66.5-83.5); baseline SCr (AUC = 72.0 ECI 65.7-78.7); LVEF (AUC = 67.6 ECI 58.4-75.8); and furosemide equivalent diuretic dose (AUC = 66.0 ECI 57.5-74.6). Similarly, the strongest positive predictors for SGLT2i discontinuation were A1C (AUC = 81.1 ECI 74.8-87.2); baseline Scr (AUC = 67.4 ECI 58.7-75.5); LVEF (AUC = 68.7 ECI 58.9-76.5); and furosemide equivalent diuretic dose (AUC = 67.2 ECI 58.2-76.0).Conclusions:A1C was the strongest predictor of AKI and SGLT2i discontinuation in HFrEF patients started on SGLT2i. Glucosuria may be related to this effect. SCr, LVEF, and furosemide equivalents also predicted these outcomes.

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 A14384-A14384, November 8, 2022. Introduction:Epidemiological evidence suggests that obesity is associated with Acute myocardial infarction (AMI). Studies on the incidence and outcomes of patients with premature AMI who are obese are limited with attention to disparities are scarce.Hypothesis:Obesity and Morbid Obesity is associated with increasing premature AMIMethods:This was a trend study of the National Inpatient database from 2010 to 2019. We searched for AMI as primary reason for hospitalization with obesity or morbid obesity as a comorbidity using the ICD codes. We estimated trends, inpatient mortality, mean length of hospital stays (LOS) and mean total hospital charges (THC) over the period. We performed a stratified analysis in categories: sex (male and female), race (Caucasians, Blacks, Hispanics), and median household income for patient’s zip code (low-income quartile [LIQ] vs high-income quartile [HIQ]) to assess disparities in outcomes. Multivariable regression analysis adjusted for age and sex was used to obtain trend statistics on outcomes.Results:There was a total of 173,106 hospitalizations for obesity with early AMI with the proportion of females (63.7%). There was an increase in early MI by 60.9% among obese patients, with mean in-hospital mortality of 1.3%. Female obese patients had a 33% increase in inpatient mortality with premature AMI, with the highest increase among black women compared to white women (78.7% vs. 35.0%). Hospitalization for adult premature AMI in patients with morbid obesity was 64,926 with proportion of female 66.1% from 2010 to 2019. The incidence of hospitalization for premature AMI among morbidly obese patients increased by 120% from 2010 to 2019. The average mortality from 2010 to 2019 among morbidly obese patient with premature AMI was 2.0% in the decade studied. There was a trend toward decreased mortality over the years; however, on subgroup analysis, the decrease in mortality was significant among whites but not among blacks, LIQ, or HIQ in early MI with morbid obesity.Conclusions:Our study shows a significant increase in hospitalization for premature AMI in obese and morbidly obese patients. The female obese patient has higher inpatient mortality with highest among blacks compared to whites.