Short-Course High-Intensity Statin Treatment during Admission for Myocardial Infarction and LDL-Cholesterol Reduction-Impact on Tailored Lipid-Lowering Therapy at Discharge

[EN] We hypothesized that a short-course high-intensity statin treatment during admission for myocardial infarction (MI) could rapidly reduce LDL-C and thus impact the choice of lipid-lowering therapy (LLT) at discharge. Our cohort comprised 133 MI patients (62.71 +/- 11.3 years, 82% male) treated with atorvastatin 80 mg o.d. during admission. Basal LDL-C levels before admission were analyzed. We compared lipid profile variables before and during admission, and LLT at discharge was registered. Achieved theoretical LDL-C levels were estimated using LDL-C during admission and basal LDL-C as references and compared to LDL-C on first blood sample 4-6 weeks after discharge. A significant reduction in cholesterol from basal levels was noted during admission, including total cholesterol, triglycerides, HDL-C, non-HDL-C, and LDL-C (-39.23 +/- 34.89 mg/dL, p < 0.001). LDL-C levels were reduced by 30% in days 1-2 and 40-45% in subsequent days (R-2 0.766, p < 0.001). Using LDL-C during admission as a reference, most patients (88.7%) would theoretically achieve an LDL-C < 55 mg/dL with discharge LLT. However, if basal LDL-C levels were considered as a reference, only a small proportion of patients (30.1%) would achieve this lipid target, aligned with the proportion of patients with LDL-C < 55 mg/dL 4-6 weeks after discharge (36.8%). We conclude that statin treatment during admission for MI can induce a significant reduction in LDL-C and LLT at discharge is usually prescribed using LDL-C during admission as the reference, which leads to insufficient LDL-C reduction after discharge. Basal LDL-C before admission should be considered as the reference value for tailored LLT prescription.This work was supported by grants from Instituto de Salud Carlos III , Fondos Europeos de Desarrollo Regional FEDER , and Fondo Social Europeo Plus (FSE + ) (grant numbers PI20/00637, PI23/01150, and CIBERCV16/11/00486, and CM21/00175 and JR23/00032 to V.M.-G.), Conselleria de Educación Generalitat Valenciana (PROMETEO/2021/008) and GE 2023 grant by the Conselleria de Innovación, Universidades, Ciencia y Sociedad Digital of the Generalitat Valenciana (CIGE/2022/26). J.G. acknowledges financial support from the Agencia Estatal de Investigación (grant FJC2020-043981-I).Marcos-Garces, V.; Merenciano-Gonzalez, H.; Martinez Mas, ML.; Palau, P.; Climent Alberola, JI.; Pérez, N.; Lopez-Bueno, L.... (2024). Short-Course High-Intensity Statin Treatment during Admission for Myocardial Infarction and LDL-Cholesterol Reduction-Impact on Tailored Lipid-Lowering Therapy at Discharge. Journal of Clinical Medicine. 13(1). https://doi.org/10.3390/jcm1301012713

Clinical Predictors and Prognosis of Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA) without ST-Segment Elevation in Older Adults

A non-neglectable percentage of patients with non-ST elevation myocardial infarction (NSTEMI) show non-obstructive coronary arteries (MINOCA). Specific data in older patients are scarce. We aimed to identify the clinical predictors of MINOCA in older patients admitted for NSTEMI and to explore the long-term prognosis of MINOCA. This was a single-center, observational, consecutive cohort study of older (&ge;70 years) patients admitted for NSTEMI between 2010 and 2014 who underwent coronary angiography. Univariate and multivariate Cox regression were performed to analyze the association of variables with MINOCA and all-cause mortality and with major adverse cardiac events (MACE), defined as a combined endpoint of all-cause mortality and nonfatal myocardial infarction and a combined endpoint of cardiovascular mortality, nonfatal myocardial infarction, and unplanned revascularization. The registry included 324 patients (mean age 78.8 &plusmn; 5.4 years), of which 71 (21.9%) were diagnosed with MINOCA. Predictors of MINOCA were female sex, left bundle branch block, pacemaker rhythm, chest pain at rest, peak troponin level, previous MI, Killip &ge;2, and ST segment depression. Regarding prognosis, patients with obstructive coronary arteries (stenosis &ge;50%) and the subgroup of MINOCA patients with plaques &lt;50% had a similar prognosis; while MINOCA patients with angiographically smooth coronary arteries had a reduced risk of MACE. We conclude that the following: (1) in elderly patients admitted for NSTEMI, certain universally available clinical, electrocardiographic, and analytical variables are associated with the diagnosis of MINOCA; (2) elderly patients with MINOCA have a better prognosis than those with obstructive coronary arteries; however, only those with angiographically smooth coronary arteries have a reduced risk of all-cause mortality and MACE

Exercise ECG Testing and Stress Cardiac Magnetic Resonance for Risk Prediction in Patients With Chronic Coronary Syndrome

[EN] Purpose: Vasodilator stress cardiac magnetic resonance (VS-CMR) has become crucial in the workup of patients with known or suspected chronic coronary syndrome (CCS). Whether traditional exercise ECG testing (ExECG) contributes prognostic information beyond VS-CMR is unclear. Methods: We retrospectively included 288 patients with known or suspected CCS who had undergone ExECG and subsequent VS-CMR in our institution. Clinical, ExECG, and VS-CMR variables were recorded. We defined the serious adverse events (SAE) as a combined endpoint of acute coronary syndrome, admission for heart failure, or all-cause death. Results: During a mean follow-up of 4.2 +/- 2.15 yr, we registered 27 SAE (15 admissions for acute coronary syndrome, eight admissions for heart failure, and four all-cause deaths). Once adjusted for clinical, ExECG, and VS-CMR parameters associated with SAE, the only independent predictors were HRmax in ExECG (HR = 0.98: 95% CI, 0.96-0.99; P = .01) and more extensive stress-induced perfusion defects (PDs, number of segments) in VS-CMR (HR = 1.19: 95% CI, 1.07-1.34; P 130 bpm), 2% (if PD = 2 segments and HRmax > 130 bpm), and 6.3% (if PD >= 2 segments and HRmax <= 130 bpm), P < .01, for the trend. In patients on beta-blocker therapy, however, only PDs in VS-CMR, but not HRmax, predicted SAE. Conclusions: We conclude that ExECG contributes significantly to prognostic information beyond VS-CMR in patients with known or suspected CCS.This study was funded by "Instituto de Salud Carlos III" and "Fondos Europeos de Desarrollo Regional FEDER" (PIE15/00013, PI17/01836, PI20/00637, and CIBERCV16/11/00486 grants) and by Generalitat Valenciana (GV/2018/116 grant).Marcos-Garces, V.; Merenciano-Gonzalez, H.; Gabaldon-Perez, A.; Nuñez-Marin, G.; Lorenzo-Hernandez, M.; Gavara-Doñate, J.; Pérez, N.... (2022). Exercise ECG Testing and Stress Cardiac Magnetic Resonance for Risk Prediction in Patients With Chronic Coronary Syndrome. Journal of Cardiopulmonary Rehabilitation and Prevention. 42(1):E7-E12. https://doi.org/10.1097/HCR.0000000000000621E7E1242

Residual ST-segment elevation to predict long-term clinical and CMR-derived outcomes in STEMI

[EN] Residual ST-segment elevation after ST-segment elevation myocardial infarction (STEMI) has traditionally been considered a predictor of left ventricular (LV) dysfunction and ventricular aneurism. However, the implications in terms of long-term prognosis and cardiac magnetic resonance (CMR)-derived structural consequences are unclear. A total of 488 reperfused STEMI patients were prospectively included. The number of Q wave leads with residual ST-segment elevation> 1 mm (Q-STE) at pre-discharge ECG was assessed. LV ejection fraction (LVEF, %) and infarct size (IS, % of LV mass) were quantifed in 319 patients at 6-month CMR. Major adverse cardiac events (MACE) were defned as all-cause death and/or re-admission for acute heart failure (HF), whichever occurred frst. During a mean follow-up of 6.1 years, 92 MACE (18.9%), 39 deaths and 53 HF were recorded. After adjustment for baseline characteristics, Q-STE (per lead with> 1 mm) was independently associated with a higher risk of long-term MACE (HR 1.24 [1.07¿1.44] per lead, p = 0.004), reduced (< 40%) LVEF (HR 1.36 [1.02¿1.82] per lead, p = 0.04) and large (> 30% of LV mass) IS (HR 1.43 [1.11¿1.85] per lead, p = 0.006) at 6-month CMR. Patients with Q-STE¿ 2 leads (n= 172, 35.2%) displayed lower MACE-free survival, more depressed LVEF, and larger IS at 6-month CMR (p< 0.001 for all comparisons). Residual ST-segment elevation after STEMI represents a universally available tool that predicts worse longterm clinical and CMR-derived structural outcomes.This work was supported by the Instituto de Salud Carlos III and co-funded by Fondo Europeo de Desarrollo Regional (FEDER) (Grants PI20/00637 and CIBERCV16/11/00486, postgraduate contract FI18/00320 to C.R.-N. and CM21/00175 to V.M.-G.), Generalitat Valenciana (Grant PROMETEO/2021/008), and by Sociedad Espanola de Cardiologia (Grant SEC/FECINV-CLI 21/024). J. G. acknowledges financial support from the Agencia Estatal de Investigacion (Grant FJC2020-043981-I/AEI/).Merenciano-Gonzalez, H.; Marcos-Garces, V.; Gavara-Doñate, J.; Pedro-Tudela, A.; Lopez-Lereu, MP.; Monmeneu, JV.; Pérez, N.... (2022). Residual ST-segment elevation to predict long-term clinical and CMR-derived outcomes in STEMI. Scientific Reports. 12(1):1-12. https://doi.org/10.1038/s41598-022-26082-511212