Prognostic impact of incident left ventricular systolic dysfunction after myocardial infarction

Importance of reassessment to identify trajectories of chronic transition of clinical indicators in post-myocardial infarction management

Despite advances in multidisciplinary acute care for myocardial infarction (MI), the clinical need to manage heart failure and elevated mortality risks in the remote phase of MI remains unmet. Various prognostic models have been established using clinical indicators obtained during the acute phase of MI; however, most of these indicators also show chronic changes in the post-MI phase. Although relevant guidelines recommend follow-up assessments of some clinical indicators in the chronic phase, systematic reassessment has not yet been fully established and implemented in a real-world clinical setting. Therefore, clinical evidence of the impact of such chronic transitions on the post-MI prognosis is lacking. We speculate that post-MI reassessment of key clinical indicators and the impact of their chronic transition patterns on long-term prognoses can improve the quality of post-MI risk stratification and help identify residual risk factors. Several recent studies have investigated the impact of the chronic transition of some clinical indicators, such as serum albumin level, mitral regurgitation, and left-ventricular dysfunction, on post-MI prognosis. Interestingly, even in MI survivors with these indicators within their respective normal ranges in the acute phase of MI, chronic transition to an abnormal range was associated with worsening cardiovascular outcomes. On the basis of these recent insights, we discuss the clinical significance of post-MI reassessment to identify the trajectories of several clinical indicators and elucidate the potential residual risk factors affecting adverse outcomes in MI survivors.

Association Between Admission Systolic Blood Pressure and Cardiovascular Events in Acute Myocardial Infarction Patients with Different Left Ventricular Ejection Fractions

BACKGROUND

Among patients with acute heart failure, left ventricular ejection fraction (LVEF) is closely related with admission blood pressure. However, it is unclear whether the systolic blood pressure is associated with the LVEF in acute myocardial infarction (AMI) patients. we evaluated the predictive value of admission SBP in AMI patients with different LVEF status.

METHODS

Data were from our hospital database bank. 4114 patients were included in this analysis. Patients were divided into 2 groups according to their LVEF in the first echocardiography record after admission. Patients were categorized into 4 groups (SBP 90-99 mm Hg, SBP 100-119 mm Hg, SBP 120-139 mm Hg, and SBP ≥140 mm Hg) based on SBP level at admission.

RESULTS

The mean age was 64.9 ± 12.5 years and 28% were female. For patients of LVEF < 50% in the lowest SBP group (SBP 90-99 mm Hg), the incidence of in-hospital cardiovascular death was significantly higher than other SBP groups (reference: SBP 90-99 mm Hg) (adjusted OR = 0.267, 95% CI: 0.113-0.728 for SBP 120-139 mm Hg, P =.004 and OR = 0.241, 95% CI: 0.089-0.651 for SBP ≥ 140 mm Hg, P =.005). Patients of LVEF ≥50% in the highest SBP group (SBP ≥ 140 mm Hg) were at higher risk of cardiogenic mortality during long-term follow-up (reference: SBP ≥140 mm Hg) (adjusted HR = 0.313, 95% CI: 0.489-0.962 for SBP 100-119 mm Hg, P <.001, HR = 0.701, 95% CI: 0.488-0.987 for SBP 120-139 mm Hg, P =.003, and HR = 0.554, 95% CI: 0.198-0.837 for SBP 90-99 mm Hg, P =.001).

CONCLUSION

SBP 90-99 mm Hg were associated with increased in-hospital cardiovascular death in AMI population with LVEF < 50%, and SBP > 140 mm Hg were associated with increased long-term cardiovascular death in AMI subjects with LVEF >50%.

Empagliflozin and colchicine in patients with reduced left ventricular ejection fraction following ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: a study protocol for a randomized, double-blinded, three-arm parallel-group, controlled trial

BACKGROUND

Patients with acute myocardial infarction are at greater risk for chronic heart failure and mortality. Currently, there is limited evidence supporting the beneficial effects of sodium-glucose cotransporter-2 inhibitors on cardiovascular outcomes in non-diabetic patients with reduced left ventricular ejection fraction following acute myocardial infarction. Furthermore, the clinical effects of the combination of standard-dose sodium-glucose cotransporter-2 inhibitors with colchicine and high-dose sodium-glucose cotransporter-2 inhibitors in this setting have not been evaluated yet.

METHODS

A prospective, double-blinded, parallel-group, placebo control randomized trial will be carried out at Shahid Madani Heart Center, the largest teaching referral hospital for cardiovascular diseases, affiliated with Tabriz University of Medical Sciences. A total of 105 patients with reduced left ventricular ejection fraction (≤ 40%) following the first episode of ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention with stent insertion will be randomized 1:1:1 to receive empagliflozin 10 mg daily, a combination of empagliflozin 10 mg daily and colchicine 0.5 mg twice daily, or empagliflozin 25 mg daily for 12 weeks. The primary outcomes are changes in the New York Heart Association functional classification and high-sensitivity C-reactive protein from the randomization through week 4 and week 12.

DISCUSSION

The present study will be the first trial to evaluate the efficacy and safety of early treatment with the combination of standard-dose empagliflozin and colchicine as well as high-dose empagliflozin in non-diabetic patients with reduced left ventricular ejection fraction following ST-elevation myocardial infarction. The results of this research will represent a significant step forward in the treatment of patients with acute myocardial infarction.

TRIAL REGISTRATION

Clinical trial ID: IRCT20111206008307N39. Registration date: 27 October 2022.

Association of peak C-reactive protein with long-term clinical outcomes in patients with ST-segment elevation myocardial infarction

Peak C-reactive protein (CRP) levels following ST-segment elevation myocardial infarction (STEMI) are associated with left ventricular thrombus formation or cardiac rupture. However, the impact of peak CRP on long-term outcomes in patients with STEMI is not completely understood. The purpose of this retrospective study was to compare the long-term all-cause death after STEMI between patients with and without high peak CRP levels. We included 594 patients with STEMI, and divided them into the high CRP group (n = 119) and the low-moderate CRP group (n = 475) according to the quintile of peak CRP levels. The primary endpoint was all-cause death after the discharge of the index admission. The mean peak CRP level was 19.66 ± 5.14 mg/dL in the high CRP group, whereas that was 6.43 ± 3.86 mg/dL in the low-moderate CRP group (p < 0.001). During the median follow-up duration of 1045 days (Q1 284 days, Q3 1603 days), a total of 45 all-cause deaths were observed. The Kaplan-Meier curves showed that all-cause death was more frequently observed in the high CRP group than in the low-moderate CRP group (p = 0.002). The multivariate Cox hazard analysis revealed that high CRP was significantly associated with all-cause death (hazard ratio 2.325, 95% confidence interval 1.246-4.341, p = 0.008) after controlling for confounding factors. In conclusion, high peak CRP was significantly associated with all-cause death in patients with STEMI. Our results suggest that peak CRP may be useful to stratify patients with STEMI for the risk of future death.