Risultati per: Caratterizzazione dell'asma in base all'età di insorgenza: uno studio di coorte multi-database

Circulation, Volume 150, Issue Suppl_1, Page A4143840-A4143840, November 12, 2024. Introduction:Transthyretin (TTR) dissolution into monomer form and subsequent misfolding causes amyloidosis through deposition of beta-pleated sheets in end organs. Genetic sequence variations can decrease the stability of TTR leading to earlier disease manifestation, a condition known as hereditary TTR amyloidosis (hATTR). The most common variant in the U.S. – V142I, is most prevalent in individuals of African descent. We sought to explore the relationship of V142I and cardiac manifestations of hATTR, using the Million Veteran Program (MVP) dataset.Methods:We identified all V142I carriers in the MVP dataset who had a first visit before January 2008. Carriers were matched with controls at a 1:5 ratio based on age, sex, and race. The outcome studied was development of heart failure (HF)/cardiomyopathy (CM). Cumulative incidence and multivariable Cox proportional hazards regression models were performed to compare V142I carriers with the matched control group.Results:A total of 2,658 V142I carriers (3.1% of veterans of African descent in MVP) and 13,467 matched control patients were included in our final study cohort. Carriers at baseline had a median age of 53 [46-60] years, 87.2% were male, 3.5% had HF, 34.0% had type 2 diabetes mellitus (T2DM), 8.0% had bilateral carpal tunnel syndrome (BCTS), 5.2% had spinal stenosis (SS), and 19.4% had neuropathy. Patients in the control group at baseline had a median age of 53 [46-60] years, 87.2% were male, 3.4% had HF, 33.6% had T2DM, 7.9% had BCTS, 5.0% had SS, and 19.6% had neuropathy. Cumulative incidence of HF/CM at age 70, 80 and 90 years was 23.8%, 48.0%, and 68.8% for cases, and 23.7%, 40.5%, and 56.7% for controls (p=0.006), respectively(Figure).In a multivariable Cox proportional hazards regression model, carrier status was associated with higher incidence of HF/CM – HR of 1.13 (CI: 1.03-1.23, p=0.004). T2DM, hypertension, Charleston comorbidity index and current smoking were also associated with the outcome.Conclusions:We report on higher risk of developing HF/CM in V142I variant carriers compared to controls in the MVP cohort. Further research is needed to determine the most effective diagnostic and treatment approaches in veterans who may be V142I carriers at risk of developing HF/CM.

Circulation, Volume 150, Issue Suppl_1, Page A4124446-A4124446, November 12, 2024. Introduction:One in five individuals have elevated lipoprotein(a) [Lp(a)], an inheritable risk factor that is causally associated with atherosclerotic cardiovascular disease (ASCVD). Whether individuals with elevated Lp(a) derive similar benefit from control of ASCVD risk factors has not been well-studied.Hypothesis:The magnitude of benefit associated with optimal cardiovascular health will be similar across the spectrum of Lp(a).Aim:To assess the association of traditional risk factor burden and Life’s Simple 7 (LS7) score with incident ASCVD across Lp(a) values.Methods:We studied 6,676 participants from the Multi-Ethnic Study of Atherosclerosis who underwent Lp(a) testing and were followed for incident ASCVD events (coronary heart disease and stroke). Elevated Lp(a) was defined as >50 mg/dL. As defined by the American Heart Association, LS7 metrics included smoking, physical activity, body mass index, diet, total cholesterol, blood pressure, and glucose. Multivariable Cox proportional hazards regression assessed the association of traditional risk factor burden and LS7 score (poor: 0-8, average: 9-10, optimal: 11-14) with incident ASCVD for individuals with and without elevated Lp(a) during a median follow-up of 17.7 years.Results:The mean age was 62.1 years, 53% were women, and 61% were non-white. The median Lp(a) was 17 mg/dL and 20% had Lp(a) >50 mg/dL. Individuals with Lp(a) >50 mg/dL had the highest burden of traditional risk factors except cigarette smoking. Compared to those with a poor LS7 score, those with an optimal LS7 score had a lower ASCVD risk that was significant for participants with Lp(a) 50 mg/dL (HR=0.41, 95% CI: 0.16-1.02). Individuals with Lp(a) >50 mg/dL had the highest absolute event rates across all LS7 categories, and there was no significant interaction between Lp(a) and LS7 score on incident ASCVD (p-interaction=0.64,Figure).Conclusions:Participants with an optimal LS7 score had similar reduction in ASCVD risk regardless of their Lp(a) burden. These results emphasize the importance of a healthy lifestyle and ASCVD risk factor control among patients with elevated Lp(a).

Circulation, Volume 150, Issue Suppl_1, Page A4140798-A4140798, November 12, 2024. Background:The renin angiotensin aldosterone system (RAAS) is crucial for circulatory homeostasis and multiple cardiovascular diseases. Despite research on key RAAS components, resulting in multiple therapeutics, the role of angiotensinogen, the sole substrate, remains less understood. We sought to elucidate the relationship between circulating angiotensinogen levels and single nucleotide polymorphisms (SNPs) in a multi-ethnic cohort study.Methods:Genome-wide association analyses of plasma angiotensinogen levels were conducted in 4,899 MESA participants (self-identified as White, n=1,868; Hispanic, n=1,115; Black, n=1,283; and Chinese, n=633). Plasma angiotensinogen levels were measured at the baseline using an enzyme-linked immunoassay. Linear models were adjusted for age, sex, comorbidities, and sex hormones, along with top principal components to account for population structure. Furthermore, we conducted conditional analysis identifying SNPs meeting genome-wide significance for population-specific associations conditioned on the lead SNP in each race/ethnicity.Results:We identified 115 SNPs associated with angiotensinogen levels (p< 5×10−8), including the lead SNP rs4762 (Thr174Met) in exon 2 (β=-0.159, p=1.51E-100) and SNP rs5050 (A-20C) in the promoter region (β=-0.109, p=2.26E-69) within theAGTgene. Strong Linkage Disequilibrium [LD (r2 >0.8)] was observed between rs4762 and rs35837081 for White, Black, and Hispanic ethnicities. Conversely, this level of LD was noted between rs4762 and rs3789657 specifically within Chinese. The LD between rs4762 and rs5050 was higher for White (r2=0.65), followed by Chinese (r2=0.56), Hispanic (r2=0.55), and Black (r2=0.29). Conditioned on rs4762 in the White population, we identified four secondary signals associated with angiotensinogen including rs2493151 (β=0.053, p=4.08E-9), implicated in transcription factor binding. Measured angiotensinogen levels were 9.7%, 12.8%, and 17.3% lower in Black, Hispanic, and Chinese, respectively, compared to White participants.Conclusions:These findings extend angiotensinogen research, highlighting the SNPs rs4762 and rs5050 as the key variants associated with angiotensinogen levels, both previously linked to hypertension.

Circulation, Volume 150, Issue Suppl_1, Page A4137177-A4137177, November 12, 2024. Background:Arrhythmia is always a concern in oncological treatments. The advent of immune checkpoint inhibitors (ICIs) has revolutionized cancer treatment, enhancing the immune system’s ability to combat malignancies. They are being more frequently used, revealing a range of immune-related adverse events (irAEs). This study aims to investigate the incidence of cardiac arrhythmias in patients receiving Pembrolizumab.Methods:We conducted a retrospective analysis of the FDA Adverse Event Reporting System (FAERS) database, focusing on reports submitted between 2006 to 2024. Cases involving patients treated with ICs were identified, and information related to cardiac arrhythmias was extracted using the Medical Dictionary for Regulatory Activities (MedDRA). Patients ≥ 18 years of age treated with ICIs were included in this study. A disproportionality analysis was conducted to identify arrhythmia events associated with pembrolizumab by comparing it with other immune checkpoint inhibitors (nivolumab, ipilimumab, and atezolizumab) and the entire FAERS database using the reporting odds ratio (ROR) and information component (IC).Results:A comprehensive analysis of 61,236 reported cases of pembrolizumab use revealed a total of 3,901 cases with cardiac complications. Among these, 672 cases (17.22 %) of arrhythmias were reported, with 452 individuals (67.26%) requiring hospitalization and 172 cases (25.59%) resulting in fatalities.Atrial fibrillation emerged as the most prevalent arrhythmia (49.7%). The occurrence of ventricular tachycardia with an ROR of 1.67 (1.18–2.35) and an IC of 0.44 (0.01–1.46) and complete atrio-ventricular block with an ROR of 1.57 (1.19–2.08) and an IC of 0.40 (0.04–1.24) were statistically significant. The reported arrhythmias associated with pembrolizumab are tabulated inTable 1. The majority of events were reported in males, as shown inFigure 1.Conclusion:This research offers significant insights into the connection between ICIs and cardiac arrhythmias, utilizing real-world data from the FAERS database. Healthcare providers should monitor cardiac events in patients receiving ICIs and aim to achieve a balance between anticancer effectiveness and cardiovascular safety. Further investigation is necessary to better understand the underlying mechanisms of arrhythmia and enhance risk stratification strategies for this specific patient group.

Circulation, Volume 150, Issue Suppl_1, Page A4140731-A4140731, November 12, 2024. Introduction:Myeloproliferative neoplasms (MPN) are stem cell disorders that include include polycythemia vera (PV), essential thrombocythemia (ET), chronic myeloid leukemia (CML), primary myelofibrosis (PMF), chronic neutrophilic leukemia, and less well defined entities such as chronic eosinophilic leukemia. MPN are associated with an increased cardiovascular risk including acute coronary syndrome. However, there is a lack of comprehensive data regarding the rate of coronary revascularization, as well as the in-hospital characteristics and outcomes for MPN patients.Objective:We aimed to evaluate the temporal trends and outcomes of percutaneous coronary intervention (PCI) among patients with MPN.Methods:The National Inpatient Sample database from 2016 to 2020 was queried to identify all PCI hospitalizations. Temporal trends and outcomes of patients with and without MPN following PCI were described. Propensity score matching (PSM) was implemented to compare outcomes between MPN and non-MPN groups.Results:Our study included 2,237,210 PCI hospitalizations with 7,560 (0.27%) patients having MPN. Throughout the study period, the prevalence of MPN among PCI admissions remained stable (p-value for trend = 0.12). Within the MPN subgroup, ET was the predominant condition (53.2%), followed by PV (24.2%), CML (19.6%) and PMF (3.0%), with no significant temporal variation in the distribution of these subtypes. Patients with MPN had higher prevalence of cardiovascular comorbidities than non-MPN patients. Following propensity score matching, MPNs were significantly associated with an higher risk of blood transfusions (OR: 1.66, 95% CI: 1.22-2.24, p=0.001) and AKI (OR: 1.39, 95% CI: 1.17-1.65, p

Circulation, Volume 150, Issue Suppl_1, Page A4141934-A4141934, November 12, 2024. Introduction:Heightened psychosocial stress is a CVD risk factor. While stressors are common and often co-occur, identifying sources and patterns of psychosocial stress exposure may provide insight into individual susceptibility to CVD. Therefore, we sought to identify and examine the longitudinal associations of baseline psychosocial stress subgroups with CVD events in MESA.Methods:Data from 6,349 adults (aged: 62.2±10.2 years; 52.9% women) from the MESA cohort with no prior CVD event at baseline (years 2000-2002) were used in this analysis. Latent class analysis (LCA) was used to specify distinct stress subgroups based on 6 variables: chronic burden, neighborhood safety, adequate food shopping, neighborhood noise, lifetime- and past-year discrimination. Five classes were determined after examining traditional fit indices. Adjudicated fatal and nonfatal CVD events were ascertained in annual follow-up visits through the year 2019. Cox proportional hazards models with sequential adjustment of baseline variables were used to examine the associations between subgroup membership and CVD events.Results:Five distinct stress subgroups were identified via LCA and were labeled “moderate neighborhood noise” (12.1%), “excessive noise/crime” (6.4%), “elevated on all” (6.3%), “high discrimination/safe neighborhood” (21.4%), “optimal” (53.8%) (see figure). By the year 2019, 1,121 participants had experienced a CVD event. Membership in the “elevated on all” and “high discrimination/safe neighborhood” subgroups (see table) were associated with higher risk of a CVD event when adjusted for sociodemographic characteristics and cardiovascular health metrics. However, when adjusted for measures of anxiety and depression, possible mediators, only membership in the “high discrimination/safe neighborhood” subgroup was associated with increased risk of a CVD event.Conclusions:Among 5 distinct stress subgroups those experiencing high discrimination had higher risk for CVD events.

Circulation, Volume 150, Issue Suppl_1, Page A4143848-A4143848, November 12, 2024. Introduction:Ischemic cardiomyopathy (IC) is a significant contributor to cardiovascular mortality, especially among older adults in the United States. Understanding mortality trends related to IC can help identify at-risk populations and make informed targeted healthcare strategies. This study investigates IC-related mortality trends and disparities among older adults aged ≥75 years in the US population.Methods:The CDC Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) was used to analyze the National Vital Statistics System data from 1999 to 2020. Deaths with IC as the primary cause of mortality were identified, and results were presented as age-adjusted mortality rates (AAMR) per 100,000 population. Joinpoint regression was used to assess changes in trends and annual percentage change (APC).Results:A total of 186,136 deaths occurred in patients with IC from 1999 to 2020 (AAMR = 42.9, 95% CI: 42.7 – 43.2). Males had higher mortality rates (AAMR = 67.8) compared to females (AAMR = 27.7). Non-Hispanic Whites (NHW) had the highest AAMR (45.2, 95% CI: 45-45.4), followed by Hispanics (29.8, 95% CI: 29.1-30.5), non-Hispanic Blacks (NHB) (29.6, 95% CI: 29-30.1), non-Hispanic American Indian/Alaska Native (NH-AIAN) (29.1, 95% CI: 26.8-31.3). Non-Hispanic Asian/Pacific Islanders (NH-API) had the lowest AAMR (16.9, 95% CI: 16.2-17.6). Regionally, the South had the highest mortality rates (47.8, 95% CI: 47.5-48.2), followed by the Midwest (47.4, 95% CI: 46.9-47.8), the West (36.7, 95% CI: 36.3-37.1), and the Northeast (36.3, 95% CI: 35.9-36.7). Mortality rates were higher in rural areas (44.1, 95% CI: 43.5-44.7) compared to urban areas (36.5, 95% CI: 36.1-36.8). Overall, the AAMR increased from 51.3 in 1999 to 51.9 in 2005, followed by a decline to 31.5 in 2020 (APC: -2.0, 95% CI: -2.2, -1.7). Noteworthy declines in AAMR were observed in both men (APC: -2.0) and women (APC: -2.9) throughout the study (Figure, Panel A). Moreover, significant downward trends were evident in NH-AIAN (APC: -3.5), NHB (APC: -1.2), NHW (APC: -2.7 since 2004), Hispanics (APC: -5.5 since 2016), and NH-API (APC: -2.4) racial groups (Figure, Panel B).Conclusion:Our study reveals disparities in IC-related mortality, highlighting males, NHW, and the residents in the South and Midwest as well as those living in rural areas are at increased risk. Targeted interventions and resource allocation are essential to improve outcomes for vulnerable populations.

Circulation, Volume 150, Issue Suppl_1, Page A4142443-A4142443, November 12, 2024. Introduction:Abdominal aortic aneurysm (AAA) is a significant cause of morbidity and mortality in older adults. The AAA screening guidelines from the Society of Vascular Surgery include risk factors such as sex, age, smoking, and family history. This study explored whether integration of a polygenic risk score (PRS) and proteomics with clinical data could improve AAA prediction in the ARIC Study.Methods:Over a median follow-up of 24 years from ARIC visit 2 (1990-92) baseline, we identified 487 clinical AAA cases among 9,373 ARIC participants (7,397 Whites and 1,976 Blacks) through hospital discharge diagnoses or death certificates. We selected AAA-associated clinical risk factors based on literature and our expertise, including age, gender, race, field center, smoking status, smoking pack-years, waist girth, BMI, levels of total and HDL cholesterols, hypertension, diabetes, and eGFR. We calculated the PRS[WT1] based on SNP dosage in ARIC and the latest genome-wide association study for AAA, which reported 141 independent associations from 14 discovery cohorts (PMID: 37845353). ARIC used SOMAscan v4 to measure 4,955 plasma proteins at baseline, of which 24 were significantly associated with clinical AAA (p < 1x10^-5) independent of the clinical risk factors. The prediction equation for AAA risk was constructed in 3 Cox regression models: 1) clinical risk factors measured at baseline, 2) model 1 variables plus PRS, and 3) model 2 variables plus the 24 AAA-associated proteins identified through proteomics analysis. We used the area under the curve (AUC) to evaluate the prediction performance of these models for AAA risk.Results:Participants in the top quintile of PRS showed significantly higher AAA risk compared to the lowest quintile (HR 1.41, 95% CI: 1.03 – 1.85) after adjustment for clinical risk factors. Adding the PRS to clinical risk factors did not improve the AUC: 0.890 (95% CI: 0.869 - 0.945) in model 1 vs 0.891 (95% CI: 0.853 - 0.961) in model 2. Further adding the 24 AAA-associated proteins substantially improved the performance of the prediction model [AL2] (AUC=0.950, 95% CI: 0.939 - 0.986 in model 3), with 289 AAA events in the top quintile of predicted risk compared to 12 in the lowest quintile.Conclusion:A proteomics-integrated approach that combined clinical risk factors and proteomics data enhanced AAA risk prediction and has the potential to improve risk stratification and early intervention for AAA.

Circulation, Volume 150, Issue Suppl_1, Page A4144067-A4144067, November 12, 2024. Background:Coronary artery calcium (CAC) scans contain valuable information beyond the Agatston score which is used for coronary artery disease prediction only. We have previously reported AI-enabled cardiac chambers volumetry in CAC scans (AI-CAC) predicts incident atrial fibrillation (AF), heart failure (HF), and stroke in the Multi-Ethnic Study of Atherosclerosis (MESA). Here we compare the distribution of cardiac chambers volumes vs. risk categories of ASCVD pooled cohorts’ equation (PCE) and PREVENTTMrisk scores.Methods:We applied the AutoChamberTMcomponent of AI-CAC to 5830 individuals (52.2% women, age 61.7±10.2 years) without known CVD that were previously obtained for CAC scoring at the baseline examination of MESA. We calculated 10-year estimated risk from the PCE and PREVENT Risk Scores based on 4 categories of risk: 20% using baseline risk factors. The PREVENT total CVD base model was used in analysis, which excludes urinary albumin to creatinine ratio and social depravity index. We compared the distribution of the quartiles of left atrial (LA) and left ventricle (LV) volumes to categories of both risk scores. We defined enlarged cardiac chambers as the top quartile of LA ( >82.7 cc) and LV ( >136.5 cc) volume, which corresponded to 33% and 21.1% incidence of all-CVD events over 10 years (CHD, HF, AF, stroke, CVD deaths), respectively. LA and LV volumes were standardized by adjusting for body surface area (BSA).Results:A substantial portion of cases categorized by PREVENT as low risk (10-year risk

Circulation, Volume 150, Issue Suppl_1, Page A4136776-A4136776, November 12, 2024. Introduction:Resting Heart Rate (HR) and Heart Rate Variability (HRV) reflect autonomic control, and are implicated as prognostic factors. We aimed to evaluate the prognostic value of HR and HRV in a cohort from a nationwide telemedicine network.Methods:We assessed unique ECGs recorded from patients ≥16 years-old, from the tele-ECG database of the Telehealth Network of Minas Gerais, Brazil, between 2010 and 2017. Variables of interest were HR and standard deviation of normal RR intervals (SDNN). Self-informed data were collected: sex, age, risk factors (hypertension, dyslipidemia, diabetes, smoking) and comorbidities (myocardial infarction, Chronic Obstructive Pulmonary Disease, and Chagas disease). Outcomes of interest were all-cause and cardiovascular mortality, assessed by ICD codes reported in death certificates, through linkage with the Mortality Information System. Cox regression was applied to evaluate the association between HR and HRV and the outcomes, in 4 models: 1. Unadjusted; 2. Adjusted for sex and age; 3. Model 2 + risk factors + clinical comorbidities; 4. Model 3 + HRV or HR, respectively.Results:At total 992.611 individuals were included, median age of 55 years, 60% women. In 6 years, there were 33.292 deaths (3,37%), 21% due to cardiovascular causes. Patients who died had higher prevalence of all risk factors and comorbidities, as well as higher HR: 76 (IQR 66-87) vs. 74 (IQR 65-83) bpm, p

Circulation, Volume 150, Issue Suppl_1, Page A4145554-A4145554, November 12, 2024. Background:Cancer and obstructive sleep apnea (OSA) individually elevate cardiovascular diseases (CVD) and stroke risk. However, it is unclear whether OSA contributes additional CVD risk in persons with pre-existing cancer.Methods:Using the TriNetX, an electronic healthcare records-based database from large healthcare organizations, we compared adverse CVD outcomes and ischemic stroke incidence between patients with and without OSA diagnosed with cancer between 01/2012 and 06/2023. Adverse CVD outcomes was defined as a composite of incident heart failure, incident atrial fibrillation / flutter, incident myocardial infarction or all-cause mortality. Patients were eligible to enter the cohort on the day of cancer diagnosis. The follow-up period for outcome events began one year after patients entered the cohort and patients contributed follow-up time till the outcome event occurred or till the end of the study period.After propensity risk score matching on demographics and comorbidities we conducted a time-to-event analyses.Results:A total of 509,477 patients with both cancer and OSA were propensity score matched to 509,477 patients with cancer but without OSA. The table shows the demographic and comorbidities of the matched groups. Among persons with cancer, OSA diagnosis was associated with increased risk of adverse CVD outcomes (HR: 1.37, 95% CI: 1.36 – 1.38). OSA in persons with cancer increased the risk of heart failure, atrial fibrillation / flutter and myocardial infarction. OSA also increased the risk of ischemic stroke. However, total mortality risk was reduced among those with OSA. See the table for details.Conclusion:OSA increases the risk of adverse CVD outcomes and ischemic stroke in persons with cancer. These analyses suggest that persons with cancer should be screened and treated for OSA. Future studies will need to determine the impact of OSA treatment e.g., positive airway pressure (PAP) therapy on CVD related outcomes in persons with cancer. Further investigation into the paradoxical reduction in all-cause mortality with OSA is warranted.

Circulation, Volume 150, Issue Suppl_1, Page A4146081-A4146081, November 12, 2024. Background:Long QT Syndrome (LQTS) is an inherited arrhythmia syndrome that predisposes patients to sudden death. Prior studies on racial disparities in LQTS have shown similar number of cardiac events, but longer QTc in Black patients compared to non-Hispanic Whites (NHW). There is limited data on cardiac events in Hispanic children with LQTS. We hypothesized that Hispanic children with LQTS have worse outcomes compared to NHW children.Methods:This retrospective cohort study of the Pediatric Health Information System (PHIS) database included children ages 0 – 17 years hospitalized from 2013-2024 with an International Classification of Disease 9thor 10thedition code for LQTS listed in the first five admission diagnoses. Patients with congenital heart disease and chromosomal abnormalities were excluded. The primary predictor variable was race/ethnicity, with covariables including age, sex, and insurance type. Our primary outcome variable was a documented lethal arrhythmia, and secondary outcomes included pacemaker and/or implantable cardioverter defibrillator (ICD) placement. Chi-square was used to assess patient characteristics. Univariable mixed-effect log-binomial regression was used to assess risk of outcomes by characteristics using hospital as a random effect with multivariable models generated via backward elimination.Results:We identified 6,476 children (24% Hispanic, 76% NHW). Compared to NHW children, Hispanic children were more often male and presented earlier (median age 11y vs 13y, 25-75 IQR 6-15; p

Circulation, Volume 150, Issue Suppl_1, Page A4144346-A4144346, November 12, 2024. Background:Stroke is a leading cause of death globally. Atrial fibrillation (AF) is an important modifiable risk factor for stroke. Ascertaining the burden of stroke in AF, its temporal trends and demographic disparities can inform public health policy measures.AimsTo describe national temporal trends of ischemic stroke-related mortality in patients with AF and identify any differences by gender, race, ethnicity, or region.Methods:In this cross-sectional analysis we used death certificate data from the national CDC Wide-Ranging ONline Data for Epidemiologic Research (WONDER) database for adults aged 35-84 years between 1999 and 2020. We queried for both ischemic stroke and AF as contributing or underlying cause of death. Crude and age-adjusted mortality rates (AAMR) were computed for the overall population and stratified by sex, race/ethnicity, geographic region, state, and rural/urban status. Joinpoint Regression Analysis software was used for trend analysis. Average annual percentage change (APC) in AAMR were computed using log-linear regression models.ResultsA total of 32,386 ischemic-stroke related deaths occurred in patients with AF between 1999 and 2020. Overall mortality trends were stable until 2014, sharply rose between 2014 and 2017 (APC 27.6% [95% confidence interval, CI, 18.8-33.4]), slowing down between 2017 and 2020 (APC 2.48 [95% CI, -4.81-7.03]). Overall AAMR per 100,000 was higher in men (1.00 vs 0.86 in women; Figure 1); Non-Hispanic Whites (0.98 versus 0.81 in Non-Hispanic Blacks and 0.70 in Hispanics; Figure 2), individuals in the Western census region (1.07 vs 0.95 in Southern, 0.92 in Midwestern and 0.78 in Northeast regions; Figure 3) and non-metropolitan areas (1.06 versus 0.91 in metropolitan). The rate of increase in AAMR over recent years was significantly greater in Black populations.Conclusion:Stroke mortality in AF rose sharply since 2014. Our findings underscore racial and geographic differences that exist in stroke-related deaths in the US.

Circulation, Volume 150, Issue Suppl_1, Page A4139732-A4139732, November 12, 2024. Background:Pulmonary embolism (PE) occurs in 1% of patients with nontraumatic intracranial hemorrhage (ICH) despite thromboprophylaxis. Anticoagulation is the primary treatment of hemodynamically stable PE; however, risks of bleeding complications in ICH exist. We investigated the optimal timing of anticoagulation in patients with PE and ICH using a large retrospective database.Methods:We included patients with nontraumatic ICH and PE without acute cor pulmonale or prior long-term anticoagulation from the TriNetX Research Network. Patients were then categorized as early (0-3 days after ICH), intermediate (4-14 days), late (15-60 days), or no anticoagulation. Chi-square and independentt-tests were used for bivariable analyses. Cohorts were 1:1 propensity score-matched by 17 covariables including demographic information and comorbidities. Outcomes were all-cause mortality, neurological deficits due to ICH, and extracranial hemorrhage 90 days after ICH.Results:Of 13,042 included patients, mean age was 65±16 and 45% were female. Those receiving early anticoagulation after ICH had higher risk of mortality (RR=1.29, 95% CI: 1.20-1.38), neurological deficits, and extracranial hemorrhage compared to no anticoagulation. Intermediate anticoagulation had similar outcomes to no anticoagulation. Late anticoagulation had lower risk of mortality (RR=0.78, 95% CI: 0.66-0.92) and no significant difference in other outcomes.Conclusions:In patients with ICH and PE without acute cor pulmonale, early anticoagulation was associated with increased mortality, neurological deficits, and extracranial hemorrhage compared to no anticoagulation. Late anticoagulation was associated with decreased mortality and similar risks of neurological deficits and extracranial hemorrhage.

Circulation, Volume 150, Issue Suppl_1, Page A4147410-A4147410, November 12, 2024. Introduction:Advancements in antiretroviral therapy (ART) have significantly increased the lifespan of patients living with HIV over the past decade. Studies have shown higher mortality and morbidity rates following acute coronary syndrome (ACS) in HIV patients, attributed to traditional cardiac risk factors, psychosomatic illness, metabolic effects of ART, and chronic immune activation caused by HIV.Hypothesis:We hypothesized that HIV patients presenting with ACS in the form of STEMI would have poorer in-hospital clinical outcomes compared to patients without HIV.Aims:We hypothesized that HIV patients presenting with ACS in the form of STEMI would have poorer in-hospital clinical outcomes compared to patients without HIV.Methods:We queried the National Inpatient Sample (NIS) Database from 2015-2019 using ICD-10 codes to identify STEMI patients with and without HIV. Propensity matching adjusted for confounders. The primary outcome was in-hospital mortality; secondary outcomes included major bleeding, the need for mechanical circulatory support (MCS), and net adverse clinical events (NACE). STATA was used for statistical analysis.Results:A total of 581,859 patients were included in the analysis. Baseline comorbidities are listed in Table 1. STEMI patients with HIV were younger (54±12 vs 63±18 years) and had higher rates of liver disease, renal failure, depression, polysubstance abuse, and a history of MI. After propensity matching, in-hospital mortality was similar between both subgroups (Table 2). No significant differences were found between the subgroups in NACE, need for MCS, and major bleeding.Conclusion:Despite being a strong risk factor for CAD, the presence of HIV did not influence in-hospital clinical outcomes in patients presenting with STEMI. This may reflect improved ACS protocols, advancements in ART, and a younger patient cohort. Additional studies are needed to further validate these findings.

Circulation, Volume 150, Issue Suppl_1, Page A4138486-A4138486, November 12, 2024. Introduction:Acute myocardial infarction (MI) is a leading cause of morbidity and mortality worldwide. Despite advances in treatment, readmissions within 30 days remain a significant concern, impacting both patient outcomes and healthcare costs. This study aims to analyze trends in 30-day readmission rates (30-dr) for patients discharged after an acute MI.Methods:We analyzed the 2016-2020 Nationwide Readmission Database for patients aged ≥ 18 years with initial admission of acute MI and were readmitted within 30 days. Variables were identified using ICD-10 codes. The primary outcome was trends in 30-dr; secondary outcomes included trends in complications, mortality rate, length of stay (LOS), and healthcare costs. Multivariate and descriptive bivariate analyses were conducted, with p-values