Risultati per: Nuovi farmaci per il danno renale acuto (Acute kidney injury – AKI)

Circulation, Volume 150, Issue Suppl_1, Page A4148020-A4148020, November 12, 2024. Background:More than 50% of deaths in advanced chronic kidney disease (CKD) are attributed to cardiovascular disease (CVD). The degree of heart failure (HF) correlates with severity of CKD. Clinical observations suggest that kidney-derived factors contribute to the development of HF in CKD, independent of the known co-morbidities such as hypertension and hyperglycemia. However, to date, no kidney-specific risk factor that triggers early damage to the heart has been identified, primarily due to a paucity of studies in patients with reno-cardiac disease. Here, we investigate the role of circulating extracellular vesicles (EVs) from CKD patients in pathological communication from the kidney to the heart, causing cardiotoxicity, impair cardiac function and leading to HF.Methods and Results:We isolated the plasma EVs from patients with CKD (hCKD-EVs) and healthy control (hCtr-EVs) and assayed for their cardiotoxicity both in vitro (human AC16 and rat primary cardiomyocytes (CMs) in culture) and in vivo (intramyocardial injection to Nod-Scid mice). hCKD-EVs significantly induced apoptosis in cultured CMs and in injected mice hearts and impaired the contractility of CMs, compared with hCtr-EVs. We also established an adenine-induced CKD mouse model that developed HF with reduced cardiac function. In line with hCKD-plasma EVs, kidney-derived EVs from CKD mice (mCKD-kidney EVs) induced cardiotoxicity both in vitro and in vivo. Moreover, decreasing the circulating EVs in CKD mice using an inhibitor of EV-biogenesis, GW4869, significantly improved the cardiac function in CKD mice. Small RNA sequencing and qPCR analysis revealed several highly expressed miRNAs in both human and mouse CKD-EVs, which are associated with CM apoptosis. MiRNA mimics treated to AC16 CMs induced their apoptosis, confirming the cardiotoxic function of miRNAs. To demonstrate the renal origin of these CKD-EV-miRNAs, we quantified the levels of corresponding endogenous primary miRNAs. We detected that several CKD-EV-miRNAs are originating from the kidney tissues and specific kidney cells, such as PTCs and podocytes in CKD mice.Conclusion:Our studies establish that both human and mouse CKD EVs are cardiotoxic and impair cardiac function. CKD-EVs carry pro-apoptotic miRNAs and are key contributors to humoral cardiotoxicity in CKD patients. Thus, they have the potential to serve as biomarkers for early diagnosis of and novel therapeutics for chronic reno-cardiac disease.

Circulation, Volume 150, Issue Suppl_1, Page A4144815-A4144815, November 12, 2024. Background:Natriuretic peptides (NP) are frequently employed in diagnosing heart failure (HF); however, their effectiveness in guiding HF treatment lacks sufficient evidence. To address this gap, we conducted an updated meta-analysis assessing the efficacy of NP-guided therapy versus usual care in decompensated HF.Methods:PubMed, Embase and Cochrane database were searched for randomized controlled trials (RCTs) that compared NP-guided treatment to usual care for patients with acute decompensated heart failure. The reported outcomes were (1) all-cause mortality; (2) cardiovascular death; and a (3) composite of all-cause mortality and HF hospitalizations. Heterogeneity was examined with I2statistics. A random-effects model was used for outcomes with high heterogeneity. Statistical analysis was done using R Studio 4.3.2.Results:We included 10 RCTs with 4122 patients, of whom 2072 (50.3%) underwent NP-guided treatment. Mean follow-up was 14.8 months. All-cause mortality (HR 1.03; 95% CI 0.81-1.32; p=0.79; figure 1A), cardiovascular death (HR 1.33; 95% CI 0.72-2.47; p=0.36; figure 1B), and the composite outcome of HF hospitalization or cardiovascular death (HR 0.92; 95% CI 0.77-1.11; p=0.4; figure 1C) were not significantly different between groups.Conclusion:These findings suggest that NP-guided therapy does not reduce mortality and heart failure readmissions in the management of patients with acute decompensated heart failure.

Circulation, Volume 150, Issue Suppl_1, Page A4145703-A4145703, November 12, 2024. Introduction:Acute coronary syndrome (ACS) is a leading cause of cardiovascular (CV) death. Sickle cell disease (SCD) is the most common inherited blood disorder in the United States and is associated with coronary microvascular dysfunction and impaired myocardial perfusion reserve. However, data on post-ACS outcomes in patients with SCD are scarce.Methods:Patients admitted with ACS from 2014-2020 with and without SCD were identified using the National Readmissions Database. In-hospital outcomes were death, major bleeding, stroke or arterial thromboembolism, and venous thromboembolism (VTE). Ninety-day readmission outcomes were CV-related, heart failure (HF) related, bleeding-related, and all-cause. Multivariable logistic or Cox proportional hazards were utilized with age, sex, chronic kidney disease, prior MI, prior stroke, prior VTE, pulmonary hypertension, STEMI, cardiogenic shock, revascularization, anemia, mechanical circulatory support use, hospital size and teaching status in addition to social factors as co-variables.Results:A total of 2,190,358 patients with ACS were included, of whom 1,471 (0.067%) had SCD. After multivariable adjustment, there was no difference in in-hospital mortality (OR 0.92; 95% CI 0.68-1.26) or major bleeding (OR 1.03; 95% CI 0.82-1.28) between patients with and without SCD. There was no significant difference in 90-day CV-related (HR 1.11; 95% CI 0.94-1.3) or bleeding-related (HR 0.86; 95% CI 0.49-1.52) readmissions between patients with and without SCD. However, SCD was associated with a higher rate of HF-related (HR 1.25; 95% CI, 1.04-1.52) and all-cause 90-day readmissions (HR 1.17; 95% CI, 1.04-1.32).Conclusion:Among patients admitted with ACS, SCD was not associated with increased risk of in-hospital outcomes though there was an association of increased HF-related and all-cause 90-day readmissions with SCD. Further investigation is needed to better characterize and improve outcomes of patients with SCD and ACS.

Circulation, Volume 150, Issue Suppl_1, Page A4145932-A4145932, November 12, 2024. Background:A new ESC guidelines in 2023, the International Lipid Expert Panel (ILEP) 2021 recommendations, and a subsequent statement by EAS have been published based on recent advances in lipid lowering treatments. However, real world data are lacking regarding the implementation among the community of French cardiologists.Objective:To determine the current approach and therapeutic strategies concerning lipid lowering treatments post-acute coronary syndromes in France.Methods:This national survey was performed during October and November 2023 in France with an online questionnaire on the websites of 2 national French Societies of Cardiologists.Four mailings were sent to cardiologists to invite them to answer to the questionnaire. A total of 400 answers of cardiologists were collected during this 2-month period.Results:For ASCVD patients, cardiologists agreed with an LDL-C goal below 55 mg/dL (1.4 mmol/L) in 69%, below 70 mg/dL (1.8 mmol/L) in 16.5%, and 14.5% between 70 mg/dL and 100 mg/dL (1.8-2.5 mmol/L). An upfront lipid lowering combination strategy using fixed dose combination (FDC) of statins and ezetimibe was prescribed in less than 5% of patients, whereas high-intensity statins were prescribed in more than 90% of patients. No significant differences were observed in terms of sex of patients, geographical area, or strategies followed by male and female cardiologists (p > 0.05). A combination of statins and ezetimibe was prescribed only for a minority of patients, especially as an early upfront strategy. The use of PCSK9i remains marginal and the interval between the ACS and initiation of these medicines remains high.Conclusion:In this contemporary national survey, we report an excellent agreement of lipid goals in secondary prevention by cardiologists. Despite the declared consensus recommending a low LDL-C target in ACS patients, lipid lowering strategies are suboptimal, mainly consisting of high intensity statins. The lack of recommended use of ezetimibe and PCSK9i to lower LDL-C levels highlights the importance of better implementation of intensive and early upfront strategies to reduce recurrent ischemic events.

Circulation, Volume 150, Issue Suppl_1, Page A4147575-A4147575, November 12, 2024. Introduction:Acute myocardial infarction (AMI) remains a leading cause of morbidity and mortality worldwide. In the quest for improved therapeutic strategies, the addition of Sodium Glucose Transporter Inhibitors (SGLTis) to the treatment regimen has garnered considerable attention. This meta-analysis endeavors to shed light on the efficacy of SGLTis in short-term cardio-renal protection post-AMI. By synthesizing evidence from diverse studies.Methods:Adhering to the PRISMA guidelines, a meticulous systematic review and meta-analysis were conducted. Comprehensive literature searches across PubMed, Web of Science, Scopes, and Google Scholar were performed. Inclusion criteria comprised four Randomized Controlled Trials (RCTs), one retrospective cohort, and one observational study, investigating the effects of SGLTis versus placebo on AMI patients, irrespective of diabetic status. Our analysis included the following outcomes: acute kidney injury, all-cause death, cardiovascular mortality, cardiac death, composite of cardiovascular death/hospitalization for heart failure, and NT-proBNP levels.Results:Our analysis encompassed six scientific articles involving 7238 patients. SGLTIs exhibited a notable favorable effect solely on acute kidney injury (P value=0.001, 95% CI [0.46-0.82]). Conversely, no significant benefit was observed in other short-term outcomes, including all-cause death, cardiovascular mortality, cardiac death, composite of cardiovascular death/hospitalization for heart failure, and NT-proBNP levels. These results align with previous studies suggesting the renal protective effects of SGLTIs but highlight the need for further research to clarify their overall cardiovascular benefits in AMI patients.Conclusion:Incorporating SGLTis into the therapeutic armamentarium of AMI patients, irrespective of diabetic status, demonstrated a discernible advantage solely concerning acute kidney injury. However, no appreciable benefit was discerned across other assessed metrics. These findings underscore the need for further exploration and tailored therapeutic strategies in the management of post-AMI patients.

Circulation, Volume 150, Issue Suppl_1, Page A4147592-A4147592, November 12, 2024. Introduction:Adderall, the brand name for a combination of dextroamphetamine and amphetamine salts, is used to treat attention deficit disorder and narcolepsy, but is widely abused for improving cognitive function and alertness in absence of a medical indication. While little is known of its acute cardiovascular (CV) physiologic effects, Adderall has been linked to acute CV events (myocardial infarction, tachyarrhythmias, heart failure, Takotsubo cardiomyopathy and sudden death) and to long term CV consequences including hypertension and arterial disease.Aim:To examine the acute CV responses to Adderall in healthy subjects not on stimulant therapy in a randomized double-blind placebo-controlled crossover study. (CT.gov NCT02979327)Methods:Thirty subjects were randomized to 25 mg Adderall versus placebo. We measured supine resting blood pressure (BP), heart rate (HR), and plasma catecholamines, before and 3 hours after consuming Adderall or placebo.Results:Twenty-nine subjects (16 females; aged 25±5 yrs) completed both Adderall and placebo conditions, with a median of 10 days between visits. Systolic BP (SBP) increased from 112±10 mmHg to 127±11 mmHg after use of Adderall but was unchanged before vs after placebo drug intake (112±8 mmHg and 112±9 mmHg respectively; group by time interaction p

Circulation, Volume 150, Issue Suppl_1, Page A4117085-A4117085, November 12, 2024. Background:Etripamil nasal spray (NS) is a fast acting, self-administered calcium channel blocker in development for the termination of AV-nodal-dependent supraventricular tachycardia (SVT). Prior randomized, placebo-controlled and open-label studies have demonstrated favorable safety and efficacy of etripamil in converting paroxysmal supraventricular tachycardia (PSVT) to sinus rhythm (SR) self-administered without direct medical supervision.Research Question/Hypothesis:To assess patterns and annualized PSVT episode frequency among patients opting to self-administer acute treatment with etripamil.Methods:NODE-303 was an event-driven, multi-center, open-label Phase 3 study, conducted in North and South America to evaluate the safety and efficacy of etripamil in patients with documented PSVT over multiple episodes. Test dosing was not performed prior to at-home use. Enrolled patients, upon perceiving symptoms of PSVT: applied an ambulatory ECG monitor, performed a previously trained vagal maneuver and, if symptoms persisted, self-administered etripamil NS 70 mg. During the study, the protocol was amended to allow a repeat dose (70 mg) if symptoms persisted 10 min after the first dose. Each patient could self-treat up to 4 episodes.Results:Of 1,116 enrolled patients, 503 (45.1%) treated ≥1 perceived PSVT episode (safety population). Etripamil achieved conversion to SR in 60% of patients by 30 minutes and 70% by 60 minutes. A total of 220, 118, 62, and 103 patients completed the study with 1, 2, 3, and 4 etripamil-treated perceived episodes of PSVT, respectively, with an average time on study of 440 days. Among these patients, the average number of annualized etripamil-treated PSVT episodes was 3.2 (standard deviation 3.8). Annualized use: etripamil was self-administered for 0-2 PSVT episodes per year, 2-6 episodes, 6-12 episodes, and >12 episodes, in 54%, 32%, 10%, and 4% of patients, respectively(Figure).Conclusions:This analysis aimed to assess the annualized use of etripamil NS in a real-world setting, by analyzing how often patients would self-administer the drug for PSVT episodes. Of patients that self-administered etripamil (n=503), the majority treated >1 episode and the annualized frequency of episodes treated with etripamil was 3.2 episodes/yr.

Circulation, Volume 150, Issue Suppl_1, Page A4144657-A4144657, November 12, 2024. Introduction:Seasonal variations, particularly cold weather, can increase the risk of acute coronary syndrome, as evidenced by various studies over the years. On the other hand, hot weather can cause dehydration, electrolyte imbalances, and thermoregulatory strain on the heart, leading to adverse cardiac events. In recent years with rising concerns about global warming, we aim to study the impact of climate changes during the summer on outcomes among people hospitalized with ACS.Methods:We used the National Inpatient Sample from 2016 to 2020 to identify young adults hospitalized with ACS using appropriate ICD-10 codes. Patients were categorized into two cohorts: summer (hospitalizations during June, July, and August) and non-summer (hospitalizations during other months). The outcomes studied were ACS hospitalizations and in-hospital mortality. Pearson chi-square tests and the Mann-Whitney U test were used for cohort comparisons.Results:Of 230,555 ACS hospitalizations, 26.2% (n=60,340) occurred during the summer months, with a median age of 40 years. White individuals had higher hospitalization rates compared to others (57.8% vs. 58%), and those from lower socioeconomic statuses had higher ACS hospitalizations in both cohorts (37.5% vs. 38.1%). Comorbidities like hypertension, diabetes, and hyperlipidemia were lower in the summer cohort (all p

Circulation, Volume 150, Issue Suppl_1, Page A4136033-A4136033, November 12, 2024. Background:Folic acid, a B vitamin, is essential for DNA synthesis and repair, and its role in reducing homocysteine levels has been linked to cardiovascular health. Elevated homocysteine is a risk factor for cardiovascular diseases, including acute myocardial infarction (MI) and coronary artery disease (CAD). Despite evidence suggesting that folic acid supplementation may lower homocysteine levels, its clinical benefits in reducing cardiovascular events remain unclear.Methods:A comprehensive literature search was conducted in PubMed/Medline, Google Scholar, and Cochrane Library databases for studies published from 2000 to 2024 using MeSH terms related to “folic acid,” “B vitamin,” “acute myocardial infarction,” “cardiac arrest,” “heart attack,” and “coronary heart disease.” Only randomized controlled trials (RCTs) and observational studies in English involving adult patients with acute MI or CAD were included. Exclusion criteria were applied to poor-quality studies, irrelevant outcomes, overlapping populations, and non-English texts. Data on study characteristics and patient demographics were extracted, and study quality was assessed using the RoB2 tool. Outcomes were pooled using RevMan 5.3.4 software.Results:Fourteen studies on all-cause mortality showed a risk ratio (RR) of 0.99 [95% CI: 0.94-1.04], indicating no significant difference between folic acid and control groups. Eight studies on cardiovascular mortality yielded a RR of 0.90 [95% CI: 0.82-0.99], suggesting a significant reduction in cardiovascular deaths with folic acid supplementation. Analyses of sudden death, coronary artery bypass graft (CABG) events, revascularization procedures, stroke, and recurrent MI found no significant associations with folic acid supplementation.Conclusions:High-dose folic acid supplementation appears to reduce cardiovascular mortality in post-MI patients but shows no significant impact on other clinical outcomes. This meta-analysis’s limitations include potential publication bias, heterogeneity among included studies, and variability in folic acid dosages and treatment durations. Furthermore, the lack of comprehensive homocysteine level data constrained the analysis. Future large-scale RCTs are needed to fully ascertain the therapeutic potential of folic acid supplementation in secondary prevention of cardiovascular events.

Circulation, Volume 150, Issue Suppl_1, Page A4145292-A4145292, November 12, 2024. INTRODUCTION:Current ACS guidelines suggest classifying patients according to the presence of persistent ST segment elevation, as a finding suggestive of acute thrombotic coronary occlusion. However, large series have documented that up to 15% of patients initially classified as NSTEMI will show evidence of total coronary occlusion on index angiography, increasing the length of stay, use of hospital resources, and short-term and long-term mortality. Therefore, prompt detection of Acute Coronary Occlusion Myocardial Infarction (ACOMI) is paramount.AIMS:We aimed to assess the performance of an AI-ECG based model capable of detecting ACOMI in the setting of patients with ACS.Methods:This is a prospective study based on the development of an AI-ECG based model capable of detecting ACOMI. A publicly available dataset (PTB-XL ECG) of 21,837 12-lead ECGs was used for training in recognizing ST-segment elevation. Regarding the detection of ACOMI, 12-lead ECGs from 361 patients who presented to the ED with an ACS (2017-2023) at our center were digitized with phone cameras of varying quality. ECGs were independently evaluated by two expert cardiologists blinded to clinical outcomes; each was asked to determine a) whether the patient had an STEMI, based on universal criteria or b) if STEMI criteria was not met, to identify any other ECG finding suggestive of ACOMI. ACOMI was defined as the presence of one of the following: TIMI V thrombus, TIMI thrombus grade 2 or higher + TIMI grade flow 1 or less, or the presence of a subocclusive ( >90%) lesion. Patients were classified into four groups: STEMI + ACOMI, NSTEMI + ACOMI, STEMI + non-ACOMI and NSTEMI + non-ACOMI. Performance of the AI model was evaluated using a comparison of multiple areas under the receiver operating characteristic curve (AUC-ROC). Sensitivity, specificity, positive and negative (PPV, NPV) predictive values and F1-score were also calculated.Results:The AI model accomplished an AUC of 0.8667 in identifying ACOMI, outperforming ECG experts (AUC: 0.3333) and the use of universal STEMI criteria (AUC: 0.5095). It also accomplished a sensitivity of 1, specificity of 0.733, a PPV of 0.846, an NPV of 1 and an F1-score of 0.92.Conclusion:Our AI-ECG model demonstrated a higher diagnostic precision for the detection of ACOMI compared with experts and use of STEMI criteria. Further research and external validation is needed to understand the role of AI-based models in the setting of ACS.:

Circulation, Volume 150, Issue Suppl_1, Page A4118380-A4118380, November 12, 2024. Introduction:Chronic lymphocytic leukemia (CLL) is prevalent among adults in Western countries, posing a significant health challenge due to its incurable nature and associated complications. Among these, cardiovascular disease, particularly heart failure (HF), has emerged as a major concern. Despite growing recognition, understanding of acute HF’s epidemiology, outcomes, and risk factors in CLL patients remains limited. To address these gaps, we conducted a large-scale study using the National Inpatient Sample (NIS) database, aiming to examine acute HF prevalence, trends, outcomes, and predictors among CLL hospitalizations.Methods:We employed a retrospective cohort design utilizing NIS data from 2016 to 2021. CLL hospitalizations with and without acute HF were identified using ICD-10 codes. Our analysis included demographic characteristics, in-hospital outcomes, and multivariable logistic regression to identify predictors of outcomes. Propensity score matching was performed to mitigate confounding factors.Results:Among 423,829 CLL hospitalizations, 27.8% presented with acute HF. Patients with acute HF were older and had higher rates of comorbidities. While acute HF prevalence remained stable, in-hospital mortality increased over time, contrasting with stable rates among patients without acute HF. Acute HF was associated with higher mortality, cardiogenic shock, cardiac arrest, and major adverse cardiovascular events. Propensity score-matched analysis confirmed these associations.Discussion:Our study highlights acute HF as a common complication in CLL hospitalizations, linked with worse outcomes. The multifactorial nature of HF in CLL involves disease-related factors, treatment toxicities, and traditional cardiovascular risk factors. Prompt recognition and multidisciplinary management are essential for improving outcomes. Future research should focus on developing risk stratification tools and interventions targeting acute HF in CLL patients.Conclusion:Acute HF poses a significant burden on CLL hospitalizations, emphasizing the need for heightened awareness and tailored management strategies. Our findings underscore the importance of early recognition and intervention to improve outcomes in this vulnerable population.

Circulation, Volume 150, Issue Suppl_1, Page A4140036-A4140036, November 12, 2024. Background:Heart failure with reduced ejection fraction (HFrEF), defined as a left ventricular ejection fraction (LVEF) of

Circulation, Volume 150, Issue Suppl_1, Page A4115231-A4115231, November 12, 2024. Background:Use of invasive coronary angiography (ICA) and the selection of other interventions in patients who present with NSTEMI should be guided by clinical risk stratification. National guidelines recommend ICA use in patients with intermediate and high risk scores. The Global Registry of Acute Coronary Events (GRACE) score is a commonly used risk score that is based on clinical characteristics available at the time of admission.Aim:Examine if patients with NSTEMI with higher risk stratification scores are more likely to have ICA.Methods:This cross-sectional study included all patients who presented with NSTEMI to an academic medical center that serves a rural population over a 12-month period. Data were derived from the American College of Cardiology Chest Pain – MI Registry data collected by trained abstractors at the facility and were verifed by the study team. Additional data needed to calculate the GRACE Score were abstracted by the study team. GRACE Scores were categorized into low (1-88), moderate (89-118), and high (119-263) risk. Multivariable logistic regression was used to test if higher GRACE scores are more associated with ICA use controlling for patient factors not included in the GRACE Score and further examined by GRACE score category.Results:The total sample size was 434 patients (Mean age 65±13.8, 36% female and 36% Black). Patients transferred from outlying facilities accounted for 40% of the sample. ICA was performed for 94% of the patients. Increasing GRACE score was associated with lower ICA use (aOR 0.98, 95% CI 0.97-0.99). Odds of ICA use between the low-risk group and the intermediate risk group (aOR 0.60, 95% CI 0.19-1.91) did not significantly differ. Patients in the high-risk category were less likely to undergo ICA compated to low-risk patients (aOR 0.22, 95% CI 0.07-0.62).Conclusions:Use of ICA decreased as GRACE score increased in this patient sample, suggesting that additional factors beyond GRACE score likely influence ICA use in patients who presented with NSTEMI during this time period. Influence of patient factors as well as provider and patient risk aversion on ICA selection must be explored to better understand incongruence with guideline recommendations.

Circulation, Volume 150, Issue Suppl_1, Page A4146331-A4146331, November 12, 2024. Background:Acute Myocardial Infarction (AMI) in malignancy is a significant cause of mortality globally. This study analyzed demographic trends and disparities in mortality rates due to AMI in malignancy among adults aged 65 and older from 1999 to 2020.Methods:A retrospective analysis was performed using death certificate data from the Centers for Disease Control and Prevention database from 1999 to 2020. The analysis utilized ICD* codes I21 for AMI and C00-C97 for malignancies. Age-adjusted mortality rates (AAMRs) were calculated per 100,000 persons, and trends were assessed using Average Annual Percentage Change (AAPC) and annual percent change (APC). Data were stratified by year, sex, race/ethnicity, and geographical regions.Results:Between 1999 and 2020, AMI in malignancy caused 172,691 deaths among U.S. older adults aged ≥65 years. The majority of deaths occurred in medical facilities (56.9%) and at decedents’ homes (24.2%). The overall AAMR for AMI in malignancy-related deaths decreased from 30.2 in 1999 to 14.2 in 2020, with an AAPC of -3.90 (p < 0.000001). Men showed higher AAMRs than women (28.6 vs. 12.3), with a more pronounced decrease in men (AAPC: -4.22, p < 0.000001) compared to women (AAPC: -3.78, p < 0.000001). Racial disparities were significant, with Black individuals having the highest AAMR (22.7), followed by Whites (19.3), American Indians or Alaska Natives (14.4), Hispanics (12.2), and Asians or Pacific Islanders (10.8). The decline in AAMR throughout the study was most pronounced in Black individuals (AAPC: -4.30, p < 0.000001). Geographically, the highest AAMRs were observed in Arkansas (32.3) and the lowest in Nevada (8.1). The Northeastern U.S. had the highest regional AAMR (20.2), followed by the Midwest (19.9), South (18.3), and West (17.4). Nonmetropolitan areas had higher AAMRs than metropolitan areas, though both saw significant declines from 1999 to 2020 (Metropolitan: AAPC: -3.97, p < 0.000001; Nonmetropolitan: AAPC: -2.64, p < 0.000001).Conclusion:This study reveals significant demographic disparities in mortality rates related to AMI in malignant older adults. These findings emphasize the need for targeted interventions and improved access to care to reduce mortality and enhance outcomes in this vulnerable population.

Circulation, Volume 150, Issue Suppl_1, Page A4138662-A4138662, November 12, 2024. Background:While mineralocorticoid antagonists (MRA) reduce mortality in patients developing heart failure post myocardial infarction (MI), it is unclear whether they are beneficial in an unselected post-MI population.Aims:Using a systematic review and meta-analysis, we aim to determine the effect of MRA treatment versus no MRA treatment on all-cause mortality in unselected post-MI patients from randomized data, simultaneously with the presentation of the largest randomized controlled trial on the topic, the CLEAR SYNERGY trial.Methods/Approach:We completed a systematic review of all randomized controlled trials comparing MRA treatment to no MRA treatment in post-MI patients. We will perform our primary analysis using fixed effects with the Peto odds ratio method and use random effects as a sensitivity analysis. The primary outcome will be all-cause mortality, and secondary outcomes will include cardiovascular mortality, new or worsening heart failure, recurrent myocardial infarction and stroke.Results/Data:Our systematic review of Pubmed, Embase, and CENTRAL from inception until April 30, 2024, yielded 456 records. A total of 11,199 participants from 11 randomized clinical trials will be included in addition to the late-breaking CLEAR SYNERGY trial. The CLEAR SYNERGY trial is a 2 x 2 factorial randomized controlled trial of low-dose colchicine 0.5mg daily versus placebo and spironolactone 25mg daily versus placebo in 7,062 post-MI patients who were within 72h of the index percutaneous coronary intervention. The results of the spironolactone factorial will be presented in the fall of 2024 with an expected median follow-up of 3.5 years. As the investigators of the CLEAR SYNERGY trial, we will combine our data with the other 11 trials for a total of 12 trials and 18,261 participants.Conclusions:CLEAR SYNERGY is the largest randomized controlled trial with the longest follow-up of spironolactone in the post-MI population. Our meta-analysis will provide updated effect estimates of post-MI MRA treatment, leveraging the late-breaking CLEAR SYNERGY data to reflect the totality of the evidence.

Circulation, Volume 150, Issue Suppl_1, Page A4146568-A4146568, November 12, 2024. Background:Type B aortic dissections (TBAD) develop from a tear in the intimal layer of the aorta, distal to the left subclavian artery. This tear separates the aorta into true (TL) and false lumens (FL), increasing the risk of dilation and rupture. In cases of surgical intervention, treatment for type B aortic dissections (TBAD) after the acute phase ( > 14 days) is associated with worse outcomes. Identification of those patients who will experience aortic growth could identify patients who would benefit from early intervention. This study aims to characterize blood flow for risk stratification using 4D flow MRI. We identified possible markers of interest: entry tear velocity, pulse wave velocity (PWV), and wall shear stress (WSS).Methods:TBAD patients (n = 7; 3 F) from Emory University Hospital were enrolled. We acquired 4D flow MRI during the acute phase (3T Prisma Fit; Siemens Healthcare). We created image-derived 3D models of lumens and measured velocity at entry tears. We estimated PWV using cross correlation of waveforms at perpendicular, evenly-spaced planes throughout the true lumens. We estimated WSS throughout the false lumen using a previously developed method (Matlab, Ansys EnSight). Growth rates were measured from at follow up computed tomography exams.Results:Three of the patients (P2, P3, P7) did not grow, while P1, P4-P6 grew 2.1, 1.2, 5.3, and 2 mm/month, respectively. Peak entry tear velocities were higher in growth (143 cm/s) than non-growth (90 cm/s) cases, with P5 having the highest (180 cm/s). Forward flow was greatest in the distal end of FL near visceral branches (growth = 17.1, non-growth = 11.0 ml/cycle). Pulse wave velocity measurements between growth and non-growth were similar (4.5 and 3.5 m/s). Both averages were lower than PWV for non-dissected aortas. Regions of high vorticity and WSS can be observed in the true and FL near tears, but no trends were found between growth and non-growth cases.Conclusion:We anticipate stronger trends as enrollment continues, but our preliminary findings demonstrate the first MRI study to enroll acute TBAD subjects and identify markers of interest.Sources of Funding:This study is supported by NIH R01HL155537 and the National Center for Advancing Translational Sciences under Award Numbers UL1TR002378 and TL1R002382.