Association between inflammation and left ventricular thrombus formation following ST-elevation myocardial infarction

Lechner, Ivan; Reindl, Martin; Tiller, Christina; Holzknecht, Magdalena; Fink, Priscilla; Plangger, Johannes; Mayr, Agnes; Klug, Gert; Bauer, Axel; Reinstadler, Sebastian Johannes; Metzler, Bernhard

doi:10.1016/j.ijcard.2022.05.009

Cited by 11 publications

(10 citation statements)

References 36 publications

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“…Also, relatively lower overall risk factors and lower coronary artery disease burden in STEMI patients, would represent lower chronic inflammatory state compared to those who need CABG. This makes CABG patients more likely to experience mortality due to various cause [26]. This study comes with some limitations.…”

Section: Discussionmentioning

confidence: 92%

Effects of opium use on one-year major adverse cardiovascular events (MACE) in the patients with ST-segment elevation MI undergoing primary PCI: a propensity score matched - machine learning based study

Jenab

Hedayat

Taaghi

et al. 2023

BMC Complement Med Ther

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Background Considerable number of people still use opium worldwide and many believe in opium’s health benefits. However, several studies proved the detrimental effects of opium on the body, especially the cardiovascular system. Herein, we aimed to provide the first evidence regarding the effects of opium use on one-year major adverse cardiovascular events (MACE) in the patients with ST-elevation MI (STEMI) who underwent primary PCI. Methods We performed a propensity score matching of 2:1 (controls: opium users) that yielded 518 opium users and 1036 controls. Then, we performed conventional statistical and machine learning analyses on these matched cohorts. Regarding the conventional analysis, we performed multivariate analysis for hazard ratio (HR) of different variables and MACE and plotted Kaplan Meier curves. In the machine learning section, we used two tree-based ensemble algorithms, Survival Random Forest and XGboost for survival analysis. Variable importance (VIMP), tree minimal depth, and variable hunting were used to identify the importance of opium among other variables. Results Opium users experienced more one-year MACE than their counterparts, although it did not reach statistical significance (Opium: 72/518 (13.9%), Control: 112/1036 (10.8%), HR: 1.27 (95% CI: 0.94–1.71), adjusted p-value = 0.136). Survival random forest algorithm ranked opium use as 13th, 13th, and 12th among 26 variables, in variable importance, minimal depth, and variable hunting, respectively. XGboost revealed opium use as the 12th important variable. Partial dependence plot demonstrated that opium users had more one-year MACE compared to non-opium-users. Conclusions Opium had no protective effects on one-year MACE after primary PCI on patients with STEMI. Machine learning and one-year MACE analysis revealed some evidence of its possible detrimental effects, although the evidence was not strong and significant. As we observed no strong evidence on protective or detrimental effects of opium, future STEMI guidelines may provide similar strategies for opium and non-opium users, pending the results of forthcoming studies. Governments should increase the public awareness regarding the evidence for non-beneficial or detrimental effects of opium on various diseases, including the outcomes of primary PCI, to dissuade many users from relying on false beliefs about opium’s benefits to continue its consumption.

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Section: Discussionmentioning

confidence: 92%

Effects of opium use on one-year major adverse cardiovascular events (MACE) in the patients with ST-segment elevation MI undergoing primary PCI: a propensity score matched - machine learning based study

Jenab

Hedayat

Taaghi

et al. 2023

BMC Complement Med Ther

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“…The description of the study design, number of participants, participant characteristics and patient inclusion criteria in the included studies are shown in Table 1. There were 4 prospective cohort studies [7,14,16,21], 10 retrospective cohort studies [5,17,19,20,22,24,26,28,30,31], 2 cross-sectional studies [9,15], 3 case–control studies [6,8,25] and 4 post-hoc analyses of existing studies [18,23,27,29]. These studies took place in the USA, China, Turkey, Australia, Germany, Denmark, Saudi Arabia and the UK between 2000 and 2019.…”

Section: Resultsmentioning

confidence: 99%

“…The type and timing of LV thrombus evaluation, rate of LV thrombus and description of predictors are shown in Table 2. Two studies [23,27] used CMR but all the other studies used echocardiography for evaluation of LV thrombus. The proportion of patients with LV thrombus ranged from 0.2% in the nationwide study in the USA to 36.1% in the cohort of patients with LV aneurysm.…”

Section: Resultsmentioning

confidence: 99%

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Predictors of left ventricular thrombus after acute myocardial infarction: a systematic review and meta-analysis

Kwok

Bennett

Borovac

et al. 2023

Coronary Artery Disease

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Left ventricular thrombus (LVT) is a recognized complication of acute myocardial infarction (AMI) which can cause significant morbidity and mortality from systemic embolism. We conducted a systematic review and meta-analysis of factors that have been shown in studies to be independently predictive of LVT post-AMI. A total of 23 studies met the inclusion criteria with 1 047 785 patients. The proportion of patients with LVT ranged from 0.2% in the nationwide study in the USA to 36.1% in the cohort of patients with LV aneurysm. Pooled results from nine studies suggest that greater values for left ventricular ejection fraction is associated with reduced odds of LVT formation [odds ratio (OR) 0.90; 95% confidence interval (CI), 0.86–0.93; I2 = 76%]. Left ventricular aneurysm was a significant predictor of LVT formation (OR 6.07; 95% CI, 2.27–16.19; I2 = 91%; seven studies) and anterior location of MI was also a significant predictor (OR 7.72; 95% CI, 2.41–24.74; I2 = 69%; four studies). Three studies suggest that there was an increase in odds of LVT formation with greater values of C-reactive protein (OR 2.06; 95% CI, 1.07–3.97; I2 = 89%; three studies). The use of glycoprotein IIb/IIIa inhibitors (OR 2.52; 95% CI, 1.55–4.10; I2 = 0%; two studies) and greater SYNTAX score (OR 1.21; 95% CI, 1.08–1.36; I2 = 46%; two studies) were associated with LVT. In conclusion, patients with reduced ejection fraction, AMI and with left ventricular aneurysm are at risk of LVT formation and careful imaging evaluation should be performed to identify LVT in these patients to prevent stroke or peripheral embolism.

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“…Inflammation plays a central role in the occurrence and development of AMI through the complex interactions between inflammatory cells and inflammatory mediators [12]. Some studies have shown that the inflammatory state after STEMI is associated with left ventricular thrombus [13].…”

Section: Discussionmentioning

confidence: 99%

The Systemic Immune Inflammatory Index Predicts No-Reflow Phenomenon after Primary Percutaneous Coronary Intervention in Older Patients with STEMI

Wang¹,

Zhang²,

Gao³

et al. 2023

CVIA

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Purpose: Coronary no-reflow phenomenon (NRP), a common adverse complication in patients with ST-segment elevation myocardial infarction (STEMI) treated by percutaneous coronary intervention (PCI), is associated with poor patient prognosis. In this study, the correlation between the systemic immune-inflammation index (SII) and NRP in older patients with STEMI was studied, to provide a basis for early identification of high-risk patients and improve their prognosis. Materials and methods: Between January 2017 and June 2020, 578 older patients with acute STEMI admitted to the Department of Cardiology of Hebei General Hospital for direct PCI treatment were selected for this retrospective study. Patients were divided into an NRP group and normal-flow group according to whether NRP occurred during the operation. Clinical data and the examination indexes of the two groups were collected. Logistic regression was used to analyze the independent predictors of NRP, and the receiver operating characteristic curve was used to further analyze the ability of SII to predict NRP in older patients with STEMI. Results: Multivariate logistic analysis indicated that hypertension (OR=2.048, 95% CI:1.252–3.352, P=0.004), lymphocyte count (OR=0.571, 95% CI:0.368–0.885, P=0.012), platelet count (OR=1.009, 95% CI:1.005–1.013, P<0.001), hemoglobin (OR=1.015, 95% CI:1.003–1.028, P=0.018), multivessel disease (OR=2.237, 95% CI:1.407–3.558, P=0.001), and SII≥1814 (OR=3.799, 95% CI:2.190–6.593, P<0.001) were independent predictors of NRP after primary PCI in older patients with STEMI. Receiver operating characteristic curve analysis demonstrated that SII had a high predictive value for NRP (AUC=0.738; 95% CI:0.686–0.790), with the best cut-off value of 1814, a sensitivity of 52.85% and a specificity of 85.71%. Conclusion: For older patients with STEMI undergoing primary PCI, SII is a valid predictor of NRP.

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Association between inflammation and left ventricular thrombus formation following ST-elevation myocardial infarction

Cited by 11 publications

References 36 publications

Effects of opium use on one-year major adverse cardiovascular events (MACE) in the patients with ST-segment elevation MI undergoing primary PCI: a propensity score matched - machine learning based study

Effects of opium use on one-year major adverse cardiovascular events (MACE) in the patients with ST-segment elevation MI undergoing primary PCI: a propensity score matched - machine learning based study

Predictors of left ventricular thrombus after acute myocardial infarction: a systematic review and meta-analysis

The Systemic Immune Inflammatory Index Predicts No-Reflow Phenomenon after Primary Percutaneous Coronary Intervention in Older Patients with STEMI

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