Risk of coronary artery disease in patients with idiopathic inflammatory myopathies: A systematic review and meta-analysis of observational studies

Objectives

To investigate the risk of coronary artery disease in patients with idiopathic inflammatory myopathies (IIM).

Methods

We conducted a systematic review and meta-analysis of observational studies that reported odds ratios, relative risks, hazard ratios, or standardized incidence ratios comparing the risk of coronary artery disease in patients with IIM versus non-IIM participants. We searched published studies indexed in MEDLINE, EMBASE, and the Cochrane database from inception to December 2013 using the terms “coronary artery disease” OR “coronary heart disease” OR “myocardial infarction” OR “atherosclerosis” combined with the terms “dermatomyositis” OR “polymyositis” OR “Idiopathic inflammatory myopathy.” Pooled risk ratio and 95% confidence interval were calculated using a random-effect, generic inverse variance method.

Result

Overall, four studies were identified and included for data analysis. The pooled risk ratio of CAD in patients with IIM was 2.24 (95% CI: 1.02–4.92). The statistical heterogeneity of this meta-analysis was high with an I² of 97%.

Conclusion

Our study demonstrated a statistically significant increased risk of CAD among patients with IIM.     

Significance of Comorbid Psychological Stress and Depression on Outcomes After Cardiac Rehabilitation

Background

Depression is associated with increased mortality in stable coronary heart disease. Cardiac rehabilitation and exercise training has been shown to decrease depression, psychological stress, and mortality after a coronary heart disease event. The presence of depression at completion of cardiac rehabilitation and exercise training is associated with increased mortality. However, it is unknown if depression with comorbid psychological risk factors such as anxiety or hostility confers an additional mortality disadvantage. We evaluated the mortality effect of anxiety and hostility on depression after cardiac rehabilitation and exercise training.

Patients and Methods

We studied 1150 patients with coronary heart disease following major coronary heart disease events who had completed formal cardiac rehabilitation and exercise training. Using Kellner questionnaires, stress levels were measured in 1 of 3 domains: anxiety, hostility, and depression (with an aggregated overall psychological stress score) and divided into 3 groups: nondepressed (n = 1072), depression alone (n = 18), and depression with anxiety or hostility (n = 60). Subjects were analyzed for all-cause mortality over 161 months of follow-up (mean 6.4 years) by National Death Index.

Results

Depression after cardiac rehabilitation was not common (6.8%; mortality 20.8%) but when present, frequently associated with either anxiety or hostility (77% of depressed patients; mortality 22.0%). After adjustment for age, sex, ejection fraction, and baseline peak oxygen consumption, depression alone (hazard ratio [HR] 1.73, P = .04), as well as depression with comorbid psychological stress, was associated with higher mortality (HR 1.98, P = .03). Furthermore, our data showed an increased mortality when both anxiety and hostility were present in addition to depression after cardiac rehabilitation (HR 2.41, P = .04).

Conclusions

After cardiac rehabilitation, depression, when present, is usually associated with other forms of psychological stress, which confers additional mortality. More measures are needed to address psychological stress after cardiac rehabilitation.     

Benefits of an “angina clinic” for patients with coronary artery disease: A demonstration of health status measures as markers of health care quality

Objective Our purpose was to determine the efficacy of health status measurement in quantifying improvements in quality of care provided by an “angina clinic.” Study Design In a pretest-posttest, nonequivalent control group design in the outpatient clinics of a Veterans Affairs Medical Center, 535 patients with coronary disease were followed up, without intervention, for 3 months and were defined as the “usual-care” group. Concurrently, a clinical trial that optimized the antianginal medications of 100 patients with chronic, stable coronary disease was conducted and defined as the “angina clinic” group. The 3-month change in scores for the Seattle Angina Questionnaire, a valid, reliable, and responsive disease-specific health status measure for patients with coronary disease, was used as the main outcome measure. Results After baseline differences between groups were controlled, the “angina clinic” conferred substantial improvement on patient symptom control (3-month benefit in angina frequency +9.4, P < .001; in angina stability +14.7, P < .001), treatment satisfaction (+8.6, P < .001), quality of life (+6.8, P < .001), and physical limitations resulting from coronary disease (+3.6, P = .047). Only the changes in physical limitation were not clinically significant. Conclusion Disease-specific health status measures can provide valuable insights into the quality of care associated with innovations in health care delivery. These results suggest that patients in a clinical trial optimizing antianginal medications had greater improvements in symptom control, treatment satisfaction, and quality of life compared with similar patients receiving “usual care” in a general medicine clinic. (Am Heart J 2002;143:145-50.)     

Prognostic value of heart rate adjustment of exercise-induced ST segment depression in the multiple risk factor intervention trial

Objectives.We sought to assess the effect of heart rate adjustment of ST segment depression on risk stratification for the prediction of death from coronary artery disease.Background.Standard analysis of the ST segment response to exercise based on a fixed magnitude of horizontal or downsloping ST segment depression has demonstrated only limited diagnostic sensitivity for the detection of coronary artery disease and has variable test performance in predicting coronary artery disease mortality. Heart rate adjustment of the magnitude of ST segment depression has been proposed as an alternative approach to increase the diagnostic and prognostic accuracy of the exercise electrocardiogram (ECG).Methods.Exercise ECGs were performed in 5,940 men from the Usual Care Group of the Multiple Risk Factor Intervention Trial at entry into the study. An abnormal ST segment response to exercise was defined according to standard criteria as ≥ 100 μV of additional horizontal or downsloping ST segment depression at peak exercise. The ST segment/heart rate index was calculated by dividing the change in ST segment depression from rest to peak exercise by the exercise-induced change in heart rate. An abnormal ST segment/heart rate index was defined as >1.60 μV/beats per min.Results.After a mean follow-up of 7 years there were 109 coronary artery disease deaths. Using a Cox proportional hazards model, a positive exercise ECG by standard criteria was not predictive of coronary mortality (age-adjusted relative risk [RR] 1.5,95% condence interval [CI] 0.6 to 3.6, p = 0.39). In contrast, an abnormal ST segment/heart rate index significantly increased the risk of death from coronary artery disease (age-adjusted RR 4.1, 95% CI 2.7 to 6.0, p < 0.0001). Excess risk of death was confined to the highest quintile of ST segment/heart rate index values, and within this quintile, risk was directly related to the magnitude of test abnormality. After multivariate adjustment for age, diastolic blood pressure, serum cholesterol and cigarettes smoked per day, the ST segment/heart rate index remained a significant independent predictor of coronary death (RR 3.6, 95% CI 2.4 to 5.4, p < 0.001).Conclusions.Simple heart rate adjustment of the magnitude of ST segment depression improves the prediction of death from coronary artery disease in relatively high risk, asymptomatic men. These findings strongly support the use of heart rate-adjusted indexes of ST segment depression to improve the predictive value of the exercise ECG.     

Impact of Physical Activity on Depression After Cardiac Surgery

Background

Physical activity is associated with a lower prevalence of depressive symptoms in cardiac patients. However, the benefits of physical activity on depression perioperatively are unknown. We sought to identify independent parameters associated with depression in patients undergoing cardiac surgery.

Methods

Patients awaiting nonemergent cardiac surgery (n = 436) completed the Patient Health Questionnaire-9 (PHQ-9) to quantify depression (PHQ-9 score > 9). Physical activity was assessed with the International Physical Activity Questionnaire (IPAQ-short) and accelerometry. Data collection occurred preoperatively (Q1, n = 436), at hospital discharge (Q2, n = 374), at 3 months (Q3, n = 318), and at 6 months (Q4, n = 342) postoperatively. Patients were categorized as “depression naive”, “at risk” or “depressed” preoperatively. Physical inactivity was defined as < 600 metabolic equivalent min/wk. Independent perioperative variables associated with depression were identified with univariate and multivariate logistic regression.

Results

Depression prevalence from Q1-Q4 was 23%, 37%, 21%, and 23%, respectively. Independent associations with depression were preoperative left ventricular ejection fraction < 50% (Q1, P < 0.05), physical inactivity (Q1, P < 0.05), baseline “at-risk” (Q2, P < 0.05), and baseline “depressed” groups (Q2-Q4, P < 0.05), hospital stay > 7 days (Q2, P < 0.05), postoperative stressful event (Q3 and Q4, P < 0.05), and cardiopulmonary bypass time > 120 minutes (Q4, P = 0.05). Newly depressed patients 6 months postoperatively reported lower IPAQ-short physical activity than depression-free patients (median change, −40 min/wk (interquartile range [IQR], −495 to +255) vs +213 min/wk (IQR, +150 to +830; P < 0.05).

Conclusions

Up to 40% of patients are depressed after cardiac surgery. Preoperative depression and postoperative stressful events were the strongest independent associations postoperatively. Physical inactivity was associated with preoperative depression and new depression 6 months postoperatively.     

Cognitive and somatic symptoms of depression are associated with medical comorbidity in patients after acute myocardial infarction

Background

Depression is common in patients with acute myocardial infarction (AMI) and is associated with adverse health outcomes. However, the extent to which clinical depression is related to comorbid medical conditions is unknown. This study examined the degree of association between clinical depression and medical comorbidity in patients hospitalized with AMI.

Methods

Two thousand four hundred and eighty-one depressed or socially isolated patients with AMI were enrolled, as part of the National Heart, Lung, and Blood Institute-sponsored Enhancing Recovery in Coronary Heart Disease clinical trial. A structured interview was used to diagnose major and minor depression and dysthymia; severity of depression was measured by the Hamilton Rating Scale for Depression and the Beck Depression Inventory. Level of social support was measured by the ENRICHD Social Support Instrument. A modified version of the Charlson Comorbidity Index was used to measure the cumulative burden of medical comorbidity.

Results

The adjusted odds ratios (ORs) for having major depression increased linearly with medical comorbidity (ORs 1.6, 2.2, 2.7 for each increasing medical comorbidity category). This relationship remained after adjusting for coronary heart disease severity (ORs 1.4, 1.7, 1.9, P < .001). The relationship between severity of depression and medical comorbidity was also maintained after excluding somatic symptoms of depression (F = 21.5, P < .0001).

Conclusions

Patients with AMI and clinical depression have significantly greater levels of medical comorbidity than nondepressed, socially isolated patients. Further research is needed to determine whether comorbid medical illness contributes to the more frequent rehospitalizations and increased risk of mortality associated with depression.     

Motivational interviewing in inflammatory bowel disease patients: A useful tool for outpatient counselling

Background

Most inflammatory bowel disease patients miss follow-up visits and are non-adherent to therapy due to the lack of an engaging patient–physician relationship. Motivational interviewing is a patient-centred counselling method used to elicit/strengthen motivation towards change. The aim of this study was to assess the role of motivational interviewing in patients affected by inflammatory bowel disease.

Methods

The study included consecutive patients with inflammatory bowel disease presenting for the first consultation (June 2012–February 2013). All consultations were carried out applying the motivational interviewing approach. After each consultation, patients filled out a questionnaire asking demographic data, and their past and current experience.

Results

Overall, 23 males (51.1%) and 22 females (48.9%), mean age 36.1 ± 15.2 years, were enrolled. Before and after experiencing the motivational interviewing approach (mean visit duration 41.5 ± 8.7 min) “overall satisfaction rate”, “physician's communication skills”, and “perceived empathy” were 60% vs 100%, 40% vs 95.6%, and 40% vs 100%, respectively. Satisfaction was lower in patients affected by indeterminate colitis (p = 0.004), and of younger age (p = 0.02).

Conclusion

The motivational interview approach is appreciated by inflammatory bowel disease patients. Despite being time-consuming, the motivational interview appears considerably worthwhile at the first visit and in younger patients. Motivational interviewing can help physicians to deal with their patients, moving from “cure” to “care”.     

Brugada electrocardiographic pattern due to tricyclic antidepressant overdose

The Brugada syndrome is an arrhythmogenic disease with characteristic coved ST-segment elevation 2 mm or greater in the right precordial leads (type 1 Brugada electrocardiogram [ECG] pattern or “Brugada sign”] and is estimated to be responsible for at least 20% of sudden deaths in patients with structurally normal hearts [Circulation 2005;111(5):659-70]. The Brugada sign has been described in asymptomatic patients after exposure to various drugs. As published reports of the drug-induced Brugada sign have become increasingly prevalent, there is growing interest in the mechanisms responsible for this acquired ECG pattern and its clinical significance.We report a case of a patient who developed the type 1 Brugada ECG pattern after intentional overdose of a tricyclic antidepressant agent, review the literature concerning tricyclic antidepressant agent-induced Brugada sign, discuss potential mechanisms, and evaluate the clinical significance of this ECG abnormality.     

Coronary Artery Diseasein Association withDepression or Anxiety among Patients Undergoing Angiography to Investigate Chest Pain

In search of associations between coronary artery disease and symptoms of depression and anxiety, we conducted a prospective cross-sectional study of 314 patients (age range, 19–79 yr) who had presented with chest pain. Coronary angiographic findings were classified into 5 categories (0–4), in which higher numbers indicated more severe disease. Symptoms of depression and anxiety were evaluated by the Beck depression and anxiety inventories, in which higher scores indicated more severe symptoms.Older age, male sex, diabetes mellitus, hypercholesterolemia, and high income were found in association with coronary artery disease. Woman patients exhibited significantly higher depression and anxiety scores (P < 0.001), even though they had coronary artery disease infrequently (P = 0.003). At first, no significant correlation was found between coronary artery disease levels 0, 1, 2, 3, or 4 and scores of depression or anxiety.After controlling for sex differences and other confounding variables, however, we found that every 1-point increase in the depression score was associated with an average 5% to 6% increase in abnormal coronary angiographic findings or definitive coronary artery disease, respectively (P = 0.01 and P = 0.002). Although there was no such association between anxiety score and coronary artery disease, the highest anxiety scores were encountered in patients with slow coronary flow.Key words: Angina pectoris, anxiety disorders, chest pain, confounding factors, coronary angiography, coronary disease/epidemiology/etiology, depression/complications, depressive disorder, interview, psychological, psychiatric status rating scales, sex factors, social environment, somatoform disorders, stress, psychological, Turkey/epidemiologyEpidemiologic studies have shown that depression or anxiety disorder can predict the incidence of coronary artery disease (CAD) in healthy populations.¹ Moreover, depression or anxiety disorder can also influence the course and prognosis of known CAD.^2–4 Although one study reported similar psychological variables in groups of patients with chest pain who had angiographically normal or abnormal coronary arteries,⁵ several other studies^6–9 reported that patients who had chest pain and normal coronary arteries exhibited more psychiatric illnesses than did patients with definitive CAD.Because we expected that symptoms of depression and anxiety would be associated with CAD in a consecutive population that had been referred for selective coronary angiography, we compared coronary angiographic findings with depression and anxiety scores that had been estimated in accordance with symptom scales. Our findings are discussed herein.     

Mapping and ablation of ventricular fibrillation—how and for whom?

The involvement of the Purkinje system in a subset of patients with idiopathic ventricular fibrillation or polymorphic VT/VF related to structural heart disease was first demonstrated in the pioneering work of Michel Haissaguerre and co-workers (Circulation 106:962–967, 2002 and Lancet 359:677–678, 2002). It is very important to identify these patients with recurrent episodes of ventricular fibrillation and/or ICD shocks with regard to the presence of triggering premature ventricular contractions (PVC), which may be amenable to mapping and catheter ablation by screening Holter and ICD recordings. The practical problem, which is frequently encountered, is the absence of these PVCs when the patients are brought to the EP lab. However, catheter ablation is an important adjunctive tool to antiarrhythmic drug treatment, beta blocker therapy, and general anesthesia in this setting. Local electrogram criteria related to this phenomenon have been identified guiding mapping and ablation (e.g., low amplitude, high-frequency Purkinje potentials preceding a closely coupled ventricular signal (Fig. 1a)). The favorable long-term follow-up after catheter ablation has been demonstrated in the setting of right and left ventricular Purkinje-related PVCs leading to polymorphic VT/VF (Leenhardt et al., Circulation 89:206–215, 1994) and also following myocardial infarction (Baensch et al., Circulation 108:3011–3016, 2003) and right ventricular outflow tract-associated VF (Noda et al., Journal of the American College of Cardiology 46:1288–1294, 2005). Most recently, epicardial ablation strategies leading to suppression of polymorphic VT/VF episodes related to the Brugada syndrome have been described irrespective to the presence of premature ventricular beats (Nademanee et al., Circulation 123:1270–1279, 2011).     

Patients with Depression are at Increased Risk for Secondary Cardiovascular Events after Lower Extremity Revascularization

Background For patients with peripheral arterial disease (PAD), depression is associated with worse patency and recurrent symptoms in the treated leg, but its association with death or cardiovascular events in other vascular beds is unknown. Objective To assess the association between depression and mortality or cardiovascular events outside the affected leg after PAD revascularization. Design Retrospective cohort study. Subjects Two hundred fifty-seven consecutive patients undergoing lower extremity revascularization for symptomatic PAD at a single institution between January 2000 and May 2005 were included in this study. By protocol, patients were previously screened for depression and diagnosed by the primary care provider. Measurements The outcomes evaluated included a composite of death or major adverse cardiovascular events (MACE; coronary heart disease, contralateral PAD, or cerebrovascular event) as well as major outcome categories of death, coronary heart disease, contralateral PAD, or cerebrovascular events. Results At revascularization, 35.0% patients had been diagnosed with depression. Those with depression were significantly younger and more likely to use tobacco. By life-table analysis, patients with depression had significantly increased risk for death/MACE, coronary heart disease, and contralateral PAD events, but not cerebrovascular events or death. By multivariate analysis, patients with depression were at significantly increased risk for death/MACE (hazard ratio [HR] = 2.05; p < .0001), contralateral PAD (HR = 2.20; p = .009), and coronary heart disease events (HR = 2.31; p = .005) but not cerebrovascular events or death. Conclusions Depression is common among patients undergoing revascularization for symptomatic PAD. After intervention, patients with depression are at significantly increased risk for coronary heart disease events and progression of contralateral PAD. Prospective analysis is required to confirm these results.     

Associations of serum androgens with coronary heart disease and interaction with age: The Henan Rural Cohort Study

Background and aimsWe aimed to investigate the associations of testosterone and androstenedione with coronary heart disease, and the interaction effect of testosterone or androstenedione and age on coronary heart disease.Methods and resultsA total of 6178 participants were included in this study. Serum testosterone and androstenedione were detected by liquid chromatography-tandem mass spectrometry. Logistic regression and restricted cubic splines were used to assess the independent effects of testosterone and androstenedione on coronary heart disease. Interactive plots were employed to examine the interaction effects of testosterone or androstenedione with age on coronary heart disease. After adjusting for multiple variables, serum testosterone and androstenedione levels were negatively associated with coronary heart disease in males (tertile 3 vs tertile 1, odd ratio (OR) = 0.56, 95% confidence interval (CI) (0.33, 0.96), and OR = 0.40, 95% CI (0.22, 0.74)). Per 1 unit increase in ln-testosterone and ln-androstenedione was associated with a 24% (OR = 0.76, 95% CI (0.63, 0.91)) and 30% (OR = 0.69, 95% CI (0.55, 0.86)) lower risk of coronary heart disease, respectively. Additionally, the positive association of age with coronary heart disease was attenuated by increasing concentrations of ln-testosterone and ln-androstenedione concentration in males.ConclusionsThe results indicated that serum testosterone and androstenedione were negatively associated with coronary heart disease risk in Chinese rural males. To some extent, this study supports the application of hormone therapy in males with coronary heart disease, which can contribute to reducing the burden of coronary heart disease and related cardiovascular disease.     

Does angina vary with the menstrual cycle in women with premenopausal coronary artery disease?

OBJECTIVE—To determine whether angina in women with established coronary heart disease varies with changes in hormone concentrations during the menstrual cycle.
DESIGN—Subjects were prospectively studied once a week for four weeks.
SETTING—Cardiology outpatient department of tertiary referral centre.
SUBJECTS—Nine premenopausal women, mean (SEM) age 38.89 (2.18) years, with established coronary heart disease, symptomatic angina, and a positive exercise test.
MAIN OUTCOME MEASURE—Myocardial ischaemia as determined by time to 1 mm ST depression during symptom limited exercise testing. Position in the menstrual cycle was established from hormone concentrations.
RESULTS—The early follicular phase, when oestradiol and progesterone concentrations were both low, was associated with the worst exercise performance in terms of time to onset of myocardial ischaemia, at 290 (79) seconds; the best performance (418 (71) seconds) was when oestrogen concentrations were highest in the mid-cycle (p < 0.05). Similar trends were observed in other measured variables. Progesterone concentrations did not influence exercise performance.
CONCLUSIONS—During the menstrual cycle myocardial ischaemia was more easily induced when oestrogen concentrations were low. This may be important for timing the assessment and evaluating treatment in women with coronary heart disease.


Keywords: myocardial ischaemia; exercise testing; oestradiol; progesterone     

Prevalence of Anxiety and Depression Symptoms in Patients with Myocardial Infarction with Non-Obstructive Coronary Arteries

Background

Myocardial infarction with non-obstructive coronary arteries is a working diagnosis for several heart disorders. Previous studies on anxiety and depression in patients with myocardial infarction with non-obstructive coronary arteries are lacking. Our aim was to investigate the prevalence of anxiety and depression among patients with myocardial infarction with non-obstructive coronary arteries.

Impact of Aspirin Dosing on the Effects of P2Y12 Inhibition in Patients with Acute Coronary Syndromes

The discovery of the antiplatelet effect of low-dose aspirin led to the hugely successful strategy of dual antiplatelet therapy in patients with acute coronary syndromes (ACS). Increasing the dose of aspirin beyond 75–100 mg has never been shown to offer additional efficacy in ACS patients but could possibly increase the risk of bleeding. In the Platelet Inhibition and Patients Outcome (PLATO) study, higher doses of aspirin appeared to neutralise the additional benefit of the potent P2Y₁₂ inhibitor ticagrelor compared to clopidogrel (Circulation 124: 544–554, 2011). However, higher doses of aspirin have not been shown to have an adverse interaction with the potent P2Y₁₂ inhibition provided by prasugrel and double-dose clopidogrel (Journal of the American College of Cardiology, 2013, in press; N Engl J Med 363: 930–942, 2010). This potentially suggests that the mechanism for this interaction is not related to the inhibition of platelet P2Y₁₂ receptors or could simply be a chance finding.     

Self-reported problems before and after prosthodontic treatments according to newly created Turkish version of oral health impact profile

The aim of the study was to assess patients’ socio-demographic factors with their removable prosthesis in general, as well as to assess their problems with the functional limitation, physical pain, psychological discomfort, physical disability, social disability, and handicap investigate impaired oral health-related quality of life (OHRQoL) in patient treated with removable dentures before treatment and at 1 and 12 months after treatment. The first part of the questionnaire was comprised of 20 questions. It was designed in four different sections as: (i) general socio-demographic factors, (ii) general health, (iii) experience and use of dental and denture care, and (iv) anamnestic sign and symptoms of temporomandibular disorders (TMD). A statistical analysis system (SAS) was used for data management and analysis. Patient-reported problems were studied using the item list contained in the Turkish version of the oral health impact profile (OHIP) in a convenience sample of 136 prosthodontic patients before (m₀), 1 month after (m₁), and 12 months (m₂) after treatment were then examined by using two-way ANOVA with repeated measurement. Differences in OHRQoL were present when item-specific prevalence was stratified by time of total scores; gender, residential area, working status, self-reported general health, smoking status, denture type, importance of the convenient dental care, trauma story, self-reported TMD/pain, and self-reported TMD/difficulty opening mouth wide. At baseline, the most prevalent frequently reported problems “difficulties chewing” (49.3%), “digestion worse” (40.4%), “take longer to complete a meal” (36%), “food catching” (30.9%), and “dentures not fitting” (29.4%), and m₂ the most prevalent frequently reported problems were “avoid going out” (25%), “difficulties chewing” (17.6), “sore jaw” (15.5%), and “take longer to complete a meal” (14%). The study confirmed that denture status is by far the strongest predictor of impaired OHRQoL compared to socio-demographic factors. Subjects with strong or moderate values had significantly fewer oral health-related problems (OHIP-extent) of time of total scores. The number of problems decreased substantially after prosthodontic treatment. The profile of pretreatment and post-treatment problems differed substantially, but in general, only a few problems remained after adaptation to new dentures.     

Statistical Inference in Abstracts Published in Cardiovascular Journals

BackgroundIn 2016, the American Statistical Association stated that the use of statistical significance leads to distortion of the scientific process. The principal alternative to significance or null hypothesis testing (NHT) is estimation with point estimates and confidence intervals (CIs).ObjectivesThe aim of this study was to determine the time trend of statistical inference and statistical reporting style in abstracts in major cardiovascular journals.MethodsA total of 84,250 abstracts published from 1975 to 2019 in 9 high-ranking cardiovascular journals (Circulation, Circulation Research, European Heart Journal, European Heart Journal: Cardiovascular Imaging, European Journal of Heart Failure, Journal of the American College of Cardiology, JACC: Cardiovascular Imaging, JACC: Cardiovascular Interventions, and JAMA Cardiology) were reviewed; in particular, proportions of abstracts containing statistical inference and its major variants (NHT, significance testing) were compared over time and among journals.ResultsOverall, 49,924 abstracts (59%) contained statistical inference. Among these abstracts, NHT was the most frequent reporting style of statistical inference (79% among all journals). Journals differed considerably in the prevalence of CI reporting (1% to 78% in 2017–2019). With the exception of 2 journals, the proportion of abstracts containing CIs was higher in the more recent period. From 2013–2015 to 2017–2019, the proportion of abstracts containing only CIs increased by 5 (95% CI: 0 to 10), 18 (95% CI: 15 to 21), and 9 (95% CI: 3 to 15) percentage points in the European Heart Journal, the Journal of the American College of Cardiology, and JACC: Cardiovascular Imaging, respectively.ConclusionsNHT is still the prevailing reporting style of statistical inference in major cardiovascular journals. Reporting of CIs in abstracts of major cardiovascular journals appears to be growing more popular.     

Impact of Changing Definitions for Myocardial Infarction: A Report from the AMIS Registry

Background

To assess the impact of the new definitions of myocardial infarction, we retrospectively analyzed 9190 patients from 63 hospitals with reported peak troponin values included between 2001 and 2007 in the Swiss AMIS (Acute Myocardial Infarction in Switzerland) Plus registry.

Methods

Patients were classified as belonging to the “classic” myocardial infarction group (peak total CK or CK-MB above the upper limit of normal, or troponin T [TnT] >0.1 μg/L or troponin I [TnI] >0.1-0.8 μg/L [depending on the assay]) or “new” myocardial infarction group (TnT >0.01 μg/L or TnI >0.01-0.07 μg/L).

Results

There were 489 patients in the “new” group who were similar to the 8701 “classic” patients in terms of age, sex, and prevalence of both diabetes and renal failure, but more frequently had a history of prior coronary artery disease, hypertension, and hyperlipidemia. At admission, they less frequently had ST elevation on their electrocardiogram, were more frequently in Killip class I, and received less primary percutaneous coronary intervention. Hospital mortality was 3.5% in the “new” and 6.7% in the “classic” myocardial infarction group (P = .004). In a subset of patients with a longer follow-up, mortality at 3 and 12 months was 1% and 5.6%, respectively, for “new” and 1.6% and 4%, respectively, for “classic” myocardial infarction (NS).

Conclusions

Patients with minimal elevation of serum troponin have smaller infarctions, less aggressive treatment, fewer early complications, and a better early prognosis than patients with higher serum biomarker levels. After discharge, however, their prognosis currently appears no different from that of patients with a “classic” myocardial infarction event.