Questing for Circadian Dependence in ST-Segment–Elevation Acute Myocardial Infarction

Rationale: Four monocentric studies reported that circadian rhythms can affect left ventricular infarct size after ST-segment-elevation acute myocardial infarction (STEMI). Objective: To further validate the circadian dependence of infarct size after STEMI in a multicentric and multiethnic population. Methods and Results: We analyzed a prospective cohort of subjects with first STEMI from the First Acute Myocardial Infarction study that enrolled 1099 patients (ischemic time <6 hours) in Italy, Scotland, and China. We confirmed a circadian variation of STEMI incidence with an increased morning incidence (from 6: 00 am till noon). We investigated the presence of circadian dependence of infarct size plotting the peak creatine kinase against time onset of ischemia. In addition, we studied the patients from the 3 countries separately, including 624 Italians; all patients were treated with percutaneous coronary intervention. We adopted several levels of analysis with different inclusion criteria consistent with previous studies. In all the analyses, we did not find a clear-cut circadian dependence of infarct size after STEMI. Conclusions: Although the circadian dependence of infarct size supported by previous studies poses an intriguing hypothesis, we were unable to converge toward their conclusions in a multicentric and multiethnic setting. Parameters that vary as a function of latitude could potentially obscure the circadian variations observed in monocentric studies. We believe that, to assess whether circadian rhythms can affect the infarct size, future study design should not only include larger samples but also aim to untangle the molecular time-dynamic mechanisms underlying such a relation.Cardiac & Cardiovascular SystemsHematologyPeripheral Vascular DiseaseSCI(E)10ARTICLE10E110-E11411

Applicability of the 2013 ACC/AHA Risk Assessment and Cholesterol Treatment Guidelines in the real world: Results from a multiethnic case-control study

© 2016 Informa UK Limited, trading as Taylor & Francis Group. Background: The 2013 ACC/AHA cholesterol treatment guidelines have introduced a new cardiovascular risk assessment approach (PCE) and have revisited the threshold for prescribing statins. This study aims to compare the ex ante application of the ACC/AHA and the ATP-III guideline models by using a multiethnic case-control study. Methods: ATP-III-FRS and PCE were assessed in 739 patients with first STEMI and 739 age- and gender-matched controls; the proportion of cases and controls that would have been eligible for statin as primary prevention therapy and the discriminatory ability of both models were evaluated. Results: The application of the ACC/AHA compared to the ATP-III model, resulted in an increase in sensitivity [94% (95%CI: 91%-95%) vs. 65% (61%-68%), p < 0.0001], a reduction in specificity [19% (15%-22%) vs. 55% (51%-59%), p < 0.0001] with similar global accuracy [0.56 (0.53-0.59) vs.0.59 (0.57-0.63), p ns] . When stratifying for ethnicity, the accuracy of the ACC/AHA model was higher in Europeans than in Chinese (p = 0.003) and to identified premature STEMI patients within Europeans much better compared to the ATP-III model (p = 0.0289). Conclusion: The application of the ACC/AHA model resulted in a significant reduction of first STEMI patients who would have escaped from preventive treatment. Age and ethnicity affected the accuracy of the ACC/AHA model improving the identification of premature STEMI among Europeans only. Key messagesAccording to the ATP-III guideline model, about one-third of patients with STEMI would not be eligible for primary preventive treatment before STEMI.The application of the new ACC/AHA cholesterol treatment guideline model leads to a significant reduction of the percentage of patients with STEMI who would have been considered at lower risk before the STEMI.The global accuracy of the new ACC/AHA model is higher in the Europeans than in the Chinese and, moreover, among the Europeans, the application of the new ACC/AHA guideline model also improved identification of premature STEMI patients

Identification and Predictive Value of IL6(+)IL10(+)Cytokine Patterns in ST-Elevation AcuteMyocardial Infarction

none19siE. Ammirati; C.V. Cannistraci; N.A.Cristell; V. Vecchio; A.G. Palini; P. Tornvall; A.M. Paganoni; E.A. Miendlarzewska; L.M. Sangalli; A. Monello; J. Pernow; M. Björnstedt Bennermo; G. Marenzi; D. Hu; N.G. Uren; T. Ravasi; D. Cianflone; A.A. Manfredi; A. Maseri;E., Ammirati; C. V., Cannistraci; N. A., Cristell; V., Vecchio; A. G., Palini; P., Tornvall; Paganoni, ANNA MARIA; E. A., Miendlarzewska; Sangalli, LAURA MARIA; A., Monello; J., Pernow; M., Björnstedt Bennermo; G., Marenzi; D., Hu; N. G., Uren; T., Ravasi; D., Cianflone; A. A., Manfredi; A., Maser