Atrial fibrillation is associated with a marker of endothelial function and oxidative stress in patients with acute myocardial infarction

IF 4.066; International audience

Low Systolic Blood Pressure and Mortality in Elderly Patients After Acute Myocardial Infarction

Background Optimal blood pressure in elderly patients after acute myocardial infarction is still a matter of debate. In a prospective observational study, we aimed to identify optimal systolic blood pressure during the 48 first hours after admission for acute myocardial infarction and its prognostic value for cardiovascular mortality. Methods and Results From the Observatoire des Infarctus de Côte d'Or survey, all consecutive patients aged >75 years admitted for an acute myocardial infarction in a coronary care unit from 2012 to 2015 and discharged alive were included (n=814). Exclusion criteria were in‐hospital death, cardiogenic shock, and end‐stage renal disease. Average systolic blo…

Effet bénéfique de la transfusion à la phase aiguë de l’infarctus du myocarde du sujet âgé : étude prospective de 3316 cas

IF 0.905; International audience; IntroductionL’anémie est fréquente dans la population âgée à la phase aiguë d’un infarctus du myocarde (IDM) et est associée à une augmentation de la mortalité à long terme. Cependant, le bénéfice de la transfusion de concentrés de globules rouges (TCGR) dans ce contexte reste incertain.Patients et méthodesTous les patients de 65 ans et plus, hospitalisés pour un IDM dans notre centre hospitalier universitaire ont été inclus prospectivement. Ils ont été séparés en deux groupes d’âges : les plus jeunes (65–79 ans) et les plus âgés (80 ans et plus) et trois sous-groupes de nadir de taux d’hémoglobine (NH) (≤ 8,8–10 et > 10 g/dL). Nous avons étudié l’associati…

0128: CHA2DS2-VASc score estimates in-hospital mortality beyond GRACE score after acute myocardial infarction

International audience; Background and aimsCHA2DS2VASc score have recently been suggested to predict death in patients with Atrial Fibrillation (AF). In acute myocardial infarction (AMI), silent AF is more common than symptomatic AF and associated with poor prognosis. In patients with AMI, we aimed to assess the distribution of CHA2DS2VASc score in patients with silent or symptomatic AF and the association of the score with mortality.Methods849 consecutive AMI were prospectively analyzed by continuous ECG monitoring (CEM) 30 sec. Symptomatic AF was defined as any AF occurring on ECG during the hospital stay, resulting in clinical symptoms or need for urgent cardioversion. The population was…

Predictors and prognosis for complex coronary lesions in patients with acute myocardial infarction

Background We aimed to investigate the determinants and outcomes of multiple complex lesions (MCLs) on coronary angiography in patients with an acute myocardial infarction. Methods One thousand one hundred fifty-two consecutive nonselected myocardial infarction patients who underwent coronary angiography within 24 hours after admission were analyzed. A complex lesion was defined by the presence of thrombus, ulceration, irregular plaque, and flow impairment. Patients with ≤1 complex lesion were considered with single complex lesion (SCL), and patients with >1 complex lesions with MCLs. Results Multiple complex lesions were identified in 360 patients (31%). Patients from the MCL group were ol…

Prevalence and impact of metabolic syndrome on hospital outcomes in acute myocardial infarction.

The impact of metabolic syndrome after acute myocardial infarction (AMI) has not yet been studied. In a population-based sample of patients with AMI, we sought to determine the prevalence of metabolic syndrome in patients with AMI, its impact on hospital outcomes, and to assess the relative influence of each of the components of the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III definition of metabolic syndrome on the risk of death and heart failure.A total of 633 unselected, consecutive patients hospitalized with AMI were categorized according to the NCEP ATP III metabolic syndrome criteria (presence of/=3 of the following: hyperglycemia; triglyceride level/=…

Infections et infarctus du myocarde : étude prospective multicentrique

Introduction Un lien epidemiologique a ete demontre entre les infections aigues et l’infarctus du myocarde (IDM). Toutefois, la pathogenese et le pronostic des IDM associees aux infections n’a pas fait l’objet d’etude de grande ampleur. Materiels et methodes Tous les patients consecutifs admis pour IDM avec un diagnostic d’infection aigue ont ete prospectivement identifies a partir des donnees d’un observatoire regional des IDM. Le diagnostic d’infection aigue etait a l’appreciation du clinicien. Le diagnostic d’IDM de type 1 (rupture ou erosion de plaque) ou de type 2 (fonctionnel sur desequilibre entre apports et besoins myocardiques en oxygene) etait systematiquement adjudique selon les …

Impact of asymmetric dimethylarginine on mortality after acute myocardial infarction.

Objective— Asymmetrical dimethylarginine (ADMA) is an endogenous competitive inhibitor of nitric oxide (NO) synthases. From a prospective cohort of patients with acute myocardial infarction (MI), we aimed to analyze the predictive value of circulating ADMA concentrations on prognosis. Methods and Results— Blood samples from 249 consecutive patients hospitalized for acute MI <24 hours were taken on admission. Serum levels of ADMA and its stereoisomer, symmetrical dimethylarginine (SDMA), were determined using high-performance liquid chromatography. The independent predictors of ADMA were glomerular filtration rate, female sex, and SDMA ( R 2 =0. 25). Baseline ADMA levels were higher in p…

Prevalence, risk factor burden, and severity of coronary artery disease in patients with heterozygous familial hypercholesterolemia hospitalized for an acute myocardial infarction: Data from the French RICO survey

Individuals with heterozygous familial hypercholesterolemia (FH) are at high risk of early myocardial infarction (MI). However, coronary artery disease (CAD) burden of FH remains not well described, especially for French patients.The objective of this study was to assess the prevalence of FH and severity of CAD from a large database of a French regional registry of acute MI.All consecutive patients hospitalized for an acute MI in a multicenter database from 2001 to 2017 were considered. FH was diagnosed using an algorithm adapted from the Dutch Lipid Clinic Network criteria. The prevalence and clinical features of FH and the severity of CAD were assessed.Among the 11,624 patients included i…

P2485Log Book as a new tool for the secondary prevention of coronary artery disease

0432: Impact of admission hyperglycemia on one-year mortality in non-diabetic patients admitted for rescue PCI: Data from the “Observatoire des infarctus de Côte d’Or”

BackgroundRescue percutaneous coronary intervention (PCI) is associated with improved clinical outcomes for ST-segment myocardial infarction (STEMI) patients after failed fibrinolysis therapy. Hyperglycemia on admission has been shown to be a powerful predictor of mortality after acute myocardial infarction, particularly in non-diabetic patients. The aim of our study was to assess the predictive value of admission glucose levels on long-term mortality in patients with rescue PCI.Patients and MethodsFrom the “Observatoire des infarctus de Côte d’Or” (RICO) survey, 510 consecutive non-diabetic STEMI patients admitted to the intensive care unit for rescue PCI after failed fibrinolysis therapy …

0139 : Extrahospital troponin measurement before admission for a ST segment elevation myocardial infarction

International audience; Background and aimEarly and reliable triage of patients is of major importance to promote rapid and appropriate treatments of patients with ST segment elevation myocardial infarction (STEMI). Extrahospital troponin measurement is used in primary care setting to help the identification of patients with suspected MI. From a regional survey (RICO), we aimed to investigate the frequence and hospital prognosis of STEMI patients with prehospital troponin (PT) measurement.Methods and resultsProspective study on 799 consecutive patients with STEMI included in RICO from March 2013 – 31 may 2015. Among the 799 patients, 38(5%) were identified with PT, from source files and pat…

Association between silent atrial fibrillation and heart failure after acute myocardial infarction

The Free Oxygen Radicals Test (FORT) to assess circulating oxidative stress in patients with acute myocardial infarction

International audience; Background and aim: Reactive oxygen species (ROS) play an important role in the pathogenesis of many diseases including cardiovascular diseases. Several methods have been developed for the direct or indirect measurement of oxygen free radical and its by-products. The current study was designed to validate the new Free Oxygen Radicals Test (FORT) and to investigate the potential relationships between ROS and clinical or biological factors in male patients with acute myocardial infarction (AMI). Methods: We analysed FORT values in samples from 66 patients with AMI. Results: FORT values ranged from 324 to 1198 FORT units, with a median value of 581 (494-754) FORT units.…

Temporal trends in prehospital management of ST-segment elevation myocardial infarction from 2002 to 2010 in Cote d’Or: Data from the RICO registry (obseRvatoire des Infarctus de Cote d’Or)

Summary Background Myocardial infarction with ST-segment elevation (STEMI) is a medical emergency requiring specific management, with the main aim of achieving reperfusion as quickly as possible. Guidelines from medical societies have defined optimal management, with proven efficacy on morbi-mortality. Aims Our study aimed to evaluate trends in practices between 2002 and 2010 in the emergency management of STEMI in a single French department, namely Cote d’Or. Methods All patients admitted with a first STEMI to one of the six participating coronary care units (private or public) in Cote d’Or since January 2001 were included in a prospective registry (obseRvatoire des Infarctus de Cote d’Or …

Blood Transfusion in Elderly Patients with Acute Myocardial Infarction: Data from the RICO Survey.

Red blood cell transfusion benefit during acute myocardial infarction remains unclear in the elderly. We aimed to assess the transfusion impact on 1-year mortality in acute myocardial infarction patients aged ≥65 years, according to their age and hemoglobin nadir.We included 3316 consecutive patients with acute myocardial infarction aged ≥65 years from the "obseRvatoire des Infarctus de Côte d'Or" (RICO) survey. They were categorized according to their hemoglobin nadir (≤8,8 to ≤10, and10 g/dL) and age (80 or ≥80 years).A total of 1906 patients (57%) were 65-79 years old, and 1410 (43%) were aged ≥80 years, of whom 103 (5%) and 145 (10%) patients received red blood cell transfusion, respect…

P4570Prognostic interest of HbA1c and plasma glucose assessment on one-year mortality in non-diabetic patients after acute myocardial infarction

Abstract Background The usefulness of the combined assessment of HbA1c and plasma glucose (PG) in acute myocardial infarction (AMI) in nondiabetic patients remains unclear. Purpose In a large observational study, we aimed to identify the prognostic values of these biomarkers regarding one-year all-cause mortality in nondiabetic patients after AMI. Methods From the “obseRvatoire des Infarctus de Côte d'Or” (RICO) survey database, we included all consecutive nondiabetic patients with AMI (n=6617) from May 2001 to December 2016. Exclusion criteria were: admission known or unknown diabetes, in-hospital death. The primary endpoint was all-cause one-year mortality. The secondary endpoints were: M…

Impact of admission hyperglycemia on one-year mortality in non-diabetic patients admitted for rescue PCI

0134 : Atrial fibrillation is associated with a marker of endothelial function and oxidative stress in patients with acute myocardial infarction

Background Atrial fibrillation (AF), whether silent or symptomatic, is a frequent and severe complication of acute myocardial infarction (AMI). Asymmetric dimethylarginine (ADMA), an endogenous eNOS inhibitor, is a risk factor for endothelial dysfunction. We addressed the relationship between ADMA plasma levels and AF occurrence in AMI. Methods 273 patients hospitalized for AMI were included. Continuous electrocardiographic monitoring (CEM) e48 hours was recorded and ADMA was measured by High Performance Liquid Chromatography on admission blood sample. Results The incidence of silent and symptomatic AF was 39(14%) and 29 (11%), respectively. AF patients were markedly older than patients wit…

Socio-professional status as a major determinant of disparities in cardiovascular outcomes: contemporary data on the prognosis inof manual workersmen after an acute myocardial infarction

Introduction: Over the last decade in France, the early prognosis after acute myocardial infarction (AMI) has markedly improved. However, recent work suggests persistent socioeconomic disparities in outcomes after AMI. From a regional population-based study, we analyzed the prognosis in manual workers after AMI. Patients: Patients recorded in the ObservatoiRe des Infarctus du myocarde de Cote d'Or (RICO) between 2001 and 2011, < 65 y, with a current professional activity and follow-up at one year. Socio-professional categories (SPC) were collected according to INSEE definition. The primary endpoint was combined mortality and hospitalization for heart failure. Results: Among the 1671 patient…

Atrial Fibrillation Is Associated with a Marker of Endothelial Function and Oxidative Stress in Patients with Acute Myocardial Infarction

International audience; Background Atrial fibrillation (AF), whether silent or symptomatic, is a frequent and severe complication of acute myocardial infarction (AMI). Asymmetric dimethylarginine (ADMA), an endogenous eNOS inhibitor, is a risk factor for endothelial dysfunction. We addressed the relationship between ADMA plasma levels and AF occurrence in AMI.Methods 273 patients hospitalized for AMI were included. Continuous electrocardiographic monitoring (CEM) !48 hours was recorded and ADMA was measured by High Performance Liquid Chromatography on admission blood sample.Results The incidence of silent and symptomatic AF was 39(14%) and 29 (11%), respectively. AF patients were markedly o…

Impact of Fasting Glycemia on Short-Term Prognosis after Acute Myocardial Infarction

The prognosis of patients with acute myocardial infarction (MI), according to the new criteria for impaired fasting glucose (IFG) (FG 100-126 mg/dl), has not been evaluated.A total of 2353 patients with acute MI and surviving at d 5 after admission were analyzed for short-term morbidity and mortality. FG was obtained at d 4 and 5. Patients were classified as diabetes mellitus (known diabetes or FGor = 126 mg/dl), high IFG (110or = FG126 mg/dl), low IFG (100or = FG110 mg/dl), and normal fasting glucose (NFG) (FG100 mg/dl).Among the 2353 patients, 968 (41%) had diabetes mellitus, 262 (11%) had high IFG, 332 (14%) had low IFG, and 791 (34%) had NFG. Compared with NFG patients, 30-d cardiovascu…

P2482Prediction of in-hospital cardiogenic shock development among patients with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention

249 Validation of assessment of circulate oxidative stress markers by the Free Oxygen Radicals Testing (FORT) assay among patients with an acute myocardial infarction

BackgroundFree oxygen radicals play an important role in the pathogenesis of many diseases including cardiovascular diseases, diabetes, cancer and aging. Several methods were developed for the direct or indirect measurement of oxygen free radical and its by-products. Using a new Free Oxygen Radicals Testing (FORT) the current study is designed first to validate the device and to investigate the potential relationships between the ROS and clinical or biological factors in human serum from a population of men with an acute myocardial infarction (AMI).MethodsWe first determined the effect of storage, variability and reproducibility of the FORT test in serum. Then we used the test in 66 patient…

013 Pre-infarction angina and cardiovascular complications in non ST segment elevation myocardial infarction: Data from the RICO survey

BackgroundThe presence of preinfarction angina (PIA) has been shown to confer cardioprotection after ST segment elevation myocardial infarction (MI). However, the impact of PIA in non ST segment elevation (NSTEMI) remains to be determined.Patients and MethodsFrom the obseRvatoire des Infarctus de Côte d’Or (RICO) survey, 1541 consecutive patients admitted in intensive care unit with a first NSTEMI were included in the study. Patients who experienced chest pain 1) and 30-day mortality were collected.ResultsAmong the 1541 patients included in the study, 693 patients presented PIA. Baseline clinical characteristics were similar for the 2 groups. There was no significant difference for the GRAC…

Comparative epidemiology of stroke and acute myocardial infarction: the Dijon Vascular Project (DIVA)

Despite a common pathophysiological mechanism (ie, atherosclerosis) and similar vascular risk factors, few reliable studies have compared the epidemiology of stroke and acute myocardial infarction (AMI).All first ever cases of stroke and AMI in Dijon, France (151 846 inhabitants) from 2001 to 2006 were prospectively recorded. The 30 day case fatality rates (CFRs) and vascular risk factors were assessed in both groups.Over the 6 years, 1660 events (1020 strokes and 640 AMI) were recorded. Crude incidence of stroke was higher than that of AMI (112 vs 70.2/100 000/year; p0.001). With regard to sex, the relative incidence of stroke compared with AMI was 0.88 (95% CI 0.60 to 1.29; p = 0.51) in w…

0127: Atrial fibrillation is associated with a marker of endothelial function and oxidative stress in patients with acute myocardial infarction

Background Atrial fibrillation (AF), whether silent or symptomatic, is a frequent and severe complication of acute myocardial infarction (AMI). Asymmetric dimethylarginine (ADMA), an endogenous eNOS inhibitor, is a risk factor for endothelial dysfunction. We addressed the relationship between ADMA plasma levels and AF occurrence in AMI. Methods 273 patients hospitalized for AMI were included. Continuous electrocardiographic monitoring (CEM) ≥48 hours was recorded and ADMA was measured by High Performance Liquid Chromatography on admission blood sample. Results The incidence of silent and symptomatic AF was 39(14%) and 29 (11%), respectively. AF patients were markedly older than patients wit…

002 Impact of diverting general practitioner's after-hours calls to emergency medical dispatch centers on time delays and acute revascularization procedures for patients with STsegment-elevation myocardia

Jean Ferrieres [Orateur] (1), Guy Berkenboom (2), Zdenek Coufal (3), Stefan James (4), Attila MohaCsi (5), Gregory Pavlides (6), Kirsi Norrbacka (7), Magali Sartral (8), Marie-Ange Paget (8), Molly Tomlin (9), Uwe Zeymer (10) (1) CHU Rangueil, Cardiologie B, Toulouse, France – (2) ULB Erasme University Hospital, Department of Cardiology, Brussels, Belgium – (3) Batova Krajska Nemocnice Zlin, Department of Cardiology, Zlin, Republique Tcheque – (4) Uppsala University Hospital, Dept. of Cardiology and Uppsala Clinical Research Center, Uppsala, Suede – (5) Gottsegen Institute of Hungarian Cardiology, Budapest, Hungaria – (6) Onassis Cardiac Surgery Center, Kallithea, Grece – (7) Lilly Research…

Prognostic value of N-terminal pro-brain natriuretic peptide in elderly people with acute myocardial infarction: prospective observational study

Objective To examine the influence of age on the predictive value of N-terminal pro-brain natriuretic (NT-proBNP) peptide assay in acute myocardial infarction. Design Prospective observational study. Setting All intensive care units in one French region. Participants 3291 consecutive patients admitted for an acute myocardial infarction, from the RICO survey (a French regional survey for acute myocardial infarction). Main outcome measure Cardiovascular death at 1 year. Results Among the 3291 participants, mean age was 68 (SD 14) years and 2356 (72%) were men. In the study population, the median NT-proBNP concentration was 1053 (interquartile range 300-3472) pg/ml. Median values for age quart…

Pre-Infarction Angina and Outcomes in Non-ST-Segment Elevation Myocardial Infarction: Data from the RICO Survey

BACKGROUND: The presence of pre-infarction angina (PIA) has been shown to confer cardioprotection after ST-segment elevation myocardial infarction (STEMI). However, the clinical impact of PIA in non-ST-segment elevation myocardial infarction (NSTEMI) remains to be determined. METHODS AND RESULTS: From the obseRvatoire des Infarctus de Côte d'Or (RICO) survey, 1541 consecutive patients admitted in intensive care unit with a first NSTEMI were included. Patients who experienced chest pain <7 days before the episode leading to admission were defined as having PIA and were compared with patients without PIA. Incidence of in-hospital ventricular arrhythmias (VAs), heart failure and 30-day mortali…

Post-infectious myocardial Infarction: Does percutaneous coronary intervention improve outcomes? A propensity-score matched analysis

Acute infection is a frequent trigger of myocardial infarction (MI). However, whether percutaneous coronary intervention (PCI) improves post-infectious MI prognosis is a major but unsolved issue. In this prospective multicenter study from coronary care units, we performed propensity score-matched analysis to compare outcomes in patients with and without PCI for post-infectious MI with angiography-proven significant coronary stenosis (&gt

Silent atrial fibrillation during the acute phase of myocardial infarction

003 Pericardial effusion in acute myocardial infarction: new insights from the French regional RICO survey