Bolus Administration of Saruplase in Europe (BASE), a Pilot Study in Patients with Acute Myocardial Infarction

To study the safety and efficacy of the thrombolytic agent saruplase as a bolus, the angiographic and clinical outcomes of three bolus regimens were investigated in a pilot study conducted in 192 patients with an acute myocardial infarction and were compared with the standard regimen. Fifty-two patients received a double bolus of 40 mg and 40 mg after 30 minutes, 51 patients a bolus of 80 mg, and 36 patients a bolus of 60 mg. Fifty-three patients received the standard regimen (a bolus of 20 mg and 60 mg IV infusion over 1 hour). At 60 minutes TIMI 2 and 3 flow were, respectively, 9.6% and 61.5% with the 40/40-mg bolus, 15.7% and 51.0% with the 80-mg bolus, 16.7% and 30.6% with the 60-mg bolus, and 7.5% and 54.7% with the standard 20/60-mg infusion. At 90 minutes TIMI 2 and 3 flow improved to 9.6% and 73.1%, 15.7% and 56.9%, 13.9% and 36.1%, and 5.7% and 71.7%, respectively. The primary endpoint, persistent patency (TIMI 2 + 3) at 24–45 hours, was seen in 69.2%, 64.7%, 44.4%, and 67.9% of patients who had no rescue PTCA, respectively. Inclusion in the 60-mg bolus group was prematurely stopped because of their low patency rates. The 40/40-mg bolus group had the highest mortality rate (13.5%), whereas the 60-mg bolus group had no deaths. Other adverse event rates were similar in the four groups. This clinical outcome is highly influenced by rescue PTCA of patients with insufficient TIMI flow. This pilot study indicates that in patients with an acute myocardial infarction, a double bolus of 40/40 mg resulted in the highest patency but also had the highest complication rate. The 80-mg single bolus is an attractive alternative for further evaluation because of its acceptable patency and event profile, and its easy form of administration.     

急性心肌梗死患者中几种炎症因子与传统心肌损伤标志物的相关性研究

目的选取多个炎症因子—基质金属蛋白酶抑制剂1(TIMP1),基质金属蛋白酶9(MMP9),新蝶呤(Neopterin),观察其在急性心肌梗死(AMI),不稳定性心绞痛、稳定性心绞痛和正常人群中的不同表达水平以及与传统心肌损伤标志物之间的相互关系,以期探索其在AMI发病进展过程中的作用和用于预测急性心梗风险的可行性。方法从收住本院的患者中,入选AMI51例,不稳定性心绞痛48例,稳定性心绞痛54例,正常人44例。所有患者的确诊依据世界卫生组织诊断标准和中华医学会的相关指南。所有患者均接受冠脉造影检查,同时采集血标本。用ELISA法分别测定4组患者的MMP9,TIMP1和Neopterin浓度。所得数据使用SPSS统计软件处理,以P0.05作为有统计学意义的显著性差异。各个数据之间的相关采用单回归线性分析检验。结果 (1)基本临床资料:四组之间在年龄和高血脂,糖尿病发病率上无显著性差异,正常组男性,高血压和吸烟史相对其他组较少。稳定心绞痛和不稳定心绞痛高血压的发生率高于急性心梗。(2)传统的心肌损伤标志物和炎症因子检测结果:高敏C反应蛋白,肌酸激酶,肌酸激酶同工酶和肌钙蛋白I,急性心梗组皆高于其他3个组,有显著性差异。而其他三组之间并无显著性差异。(3)其他炎症因子检测结果:,MMP9、TIMP1、MMP9/TIMP1以及Neopterin各个指标,AMI组皆高于其他3组,有显著性差异。其他三个组相互之间并无显著性差异。(4)入选病人的Hs-CRP与Neopterin和CK呈良好的正相关性(P0.05),而MMP9/TIMP1与hs-CRP及CK皆无相关性。Neopterin与CK也无相关性。结论在AMI患者,炎症因子MMP9、TIMP1、Neopterin均明显升高,除Neopterin与Hs-CRP有良好相关性以外,其他的炎症因子与传统的心肌损伤标志物并无相关性。     

Saruplase Is a Safe and Effective Thrombolytic Agent; Observations in 1698 Patients: Results of the PASS Study

Saruplase (unglycosylated human-type high molecular weight single-chain urokinase-type plasminogen activator) was given to 1698 patients in the open-label Practical Applicability of Saruplase Study (PASS), which assessed the safety and efficacy of saruplase in the treatment of acute myocardial infarction. Thirty-seven hospitals in Europe participated in the study. All patients received 20 mg saruplase as a bolus followed by an infusion of 60 mg saruplase over 1 hour. Prior to the infusion of saruplase, 62% of the patients received a bolus of 5000 U of heparin, and after saruplase a 24-hour intravenous infusion of heparin was given to 95% of patients. The mean age of the patients was 59 years and 80.1% were male. The median delay from the onset of chest pain to the start of saruplase infusion was 145 minutes. Acute angiography was performed in 8 of the participating 37 centers in 350 patients (20.6%), on average 85 minutes (median) after the start of the saruplase infusion. TIMI 3 flow was obtained in 186 patients (53.1%) and TIMI 2 flow in 61 patients (17.4%). Patency rates were similar for patients with anterior and inferior infarction. ECG signs suggestive of reperfusion were seen in 63% of the patients. In-hospital mortality was low (92 patients; 5.4%), and nonfatal recurrent myocardial infarction was seen in 60 patients (3.5%). Severe bleeding complications occurred in 92 patients (5.4%), 21 of whom (1.2%) needed a blood transfusion. An intracerebral hemorrhage was observed in eight patients (0.5%), and seven patients (0.4%) suffered from a thromboembolic stroke. At discharge 85.9% of the patients were in NYHA functional class I. One-year mortality was low (142 patients; 8.4%). Mortality was high in patients with TIMI 0 or 1 flow at the acute angiography who did not undergo rescue PTCA (9/39; 23.1%), lower in patients with TIMI 0 or 1 flow followed by successful rescue PTCA (7/64; 10.9%), and low in patients with TIMI 2 flow (1/61; 1.6%) or with TIMI 3 flow (2/186; 1.1%). Patency rates and (bleeding) complications did not differ between patients with a body weight greater than or less than 70 kilograms. No antibodies against saruplase were detected in samples from 455 patients. In conclusion, it can be stated that saruplase, given in combination with aspirin and intravenous heparin, can be given safely and effectively to patients with acute myocardial infarction.     

Feasibility and Timing of Prehospital Administration of Reteplase in Patients with Acute Myocardial Infarction

Background: In myocardial infarction patients undergoing thrombolysis, treatment delays negatively impact outcomes. This pilot study was conducted to determine the feasibility and timing of field administration of intravenous double bolus reteplase in patients with ST-elevation myocardial infarction. Methods: Sixty three patients with symptoms and EKG changes consistent with acute myocardial infarction of less than six hours duration received the first bolus of reteplase before arriving at the emergency department. A second bolus of reteplase was given in the emergency department. Subsequent resolution of ST-segment elevation was measured. Mean time from symptom onset to paramedic dispatch, and paramedic arrivals to first bolus of reteplase were measured. The mean time from the first bolus of reteplase to heparin bolus in an emergency department was also measured. All patients with evidence of ST-elevation and suspected acute myocardial infarction gave consent for the thrombolytic therapy. There were no refusals of therapy among those candidates eligible for thrombolysis. Results: The mean times from the first bolus of reteplase to heparin bolus in the emergency department was substantially longer than the in-field times. Resolution of ST-segment elevation was recorded in 52 of the 63 patients and the times of resolution ranged from five minutes after the first bolus dose to 190 minutes after the second bolus of reteplase. Resolution of ST-segment elevation and relief of pain occurred almost simultaneously. Conclusions: These results demonstrated that in-field administration of thrombolytic therapy is a viable option to reduce the delay from symptom onset to initiation of thrombolysis. They demonstrated that satisfactory resolution of ST-segment elevation can be recorded in the field. The reduction in mortality observed in this study is comparable to previously published studies on inpatients. Abbreviated Abstract. This open-label pilot study was conducted to determine the feasibility and timing of field administration of intravenous double-bolus reteplase and to measure subsequent resolution of ST elevation in 63 patients with symptoms and ECG changes consistent with acute myocardial infarction for less than 6 hours. These results demonstrated that in-field administration of thrombolytic therapy is a viable option to reduce the delay from symptom onset to initiation of thrombolytic therapy.     

急性心肌梗塞患者的高胰岛素血症

检测１３例合并糖尿病的急性心肌梗塞（ＡＭＩ），２３例无糖尿病ＡＭＩ患者的空腹血胰岛素和Ｃ肽水平，并与２０例正常人作比较，发现两组均存在高胰岛素血症，合并糖尿病的ＡＭＩ组更为明显。１０例ＡＭＩ患者４周后复查，血胰岛素水平有显著下降。提示胰岛素在ＡＭＩ发病中有意义。     

多巴酚丁胺负荷超声心动图对急性心肌梗死后心肌存活性的评价

目的：采用多巴酚丁胺负荷超声心动图评价急性心肌梗死后梗死区域心肌的存活性。方法：３６例急性心肌梗死病人进入本研究，分别采用５μｇｋｇ－１／ｍｉｎ和１０μｇｋｇ－１／ｍｉｎ的多巴酚丁胺静脉滴注，体表超声心动图观察梗死区域心肌收缩心室壁运动和厚度的变化，以识别有无存活心肌。结果：对３６例病人分析了５７６段心肌，基础状态时９４段心肌运动消失；１１９段心肌运动减低；３６３段心肌为正常心肌。静脉滴注５μｇｋｇ－１／ｍｉｎ多巴酚丁胺后，运动消失的９４段心肌中，３０段心肌心室壁运动及收缩心室壁增厚率得到了改善，其中２３段心肌变为运动减弱心肌，７段心肌变为正常心肌，将多巴酚丁胺增量至１０μｇｋｇ－１／ｍｉｎ后，由第１次剂量无反应的运动消失的６４段心肌中，有５段心肌心室壁运动和收缩心室壁增厚率得到改善。结论：采用多巴酚丁胺负荷超声心动图对急性心肌梗死后存活心肌的识别是安全的，而且具有十分重要的临床意义。     

Randomized,Double-Blind Study Comparing Saruplase With Streptokinase Therapy in Acute Myocardial Infarction: The COMPASS Equivalence Trial

Objectives. This study sought to demonstrate the equivalence of saruplase and streptokinase in terms of 30-day mortality.Background. The use of thrombolytic agents in the treatment of acute myocardial infarction is well established and has been shown to substantially reduce post-myocardial infarction mortality.Methods. Three thousand eighty-nine patients with symptoms compatible with those of acute myocardial infarction for <6 h entered the study at a total of 104 centers and were randomized to receive streptokinase (1.5-MU infusion over 60 min) or saruplase (20-mg bolus and 60-mg infusion over 60 min). In the saruplase group, a bolus of heparin (5,000 IU) was administered before saruplase, and a corresponding blinded double-dummy placebo bolus was administered before streptokinase. All patients received intravenous heparin infusions for ≥24 h starting 30 min after the end of the thrombolytic infusions; the infusions were titrated to maintain an activated partial thromboplastin time at 1.5 to 2.5 times that of normal.Results. Death of any cause up to 30 days after randomization occurred in 88 (5.7%) of 1,542 patients randomized to receive saruplase and 104 (6.7%) of 1,547 patients randomized to receive streptokinase (odds ratio 0.84, p < 0.01 for equivalence). Hemorrhagic strokes occurred more often in patients receiving saruplase (0.9% vs. 0.3%), whereas thromboembolic strokes were more prevalent in the streptokinase-treated patients (0.5% vs. 1.0%). The rate of bleeding was similar in the two treatment groups (10.4% vs. 10.9%). Hypotension and cardiogenic shock occurred less frequently in the saruplase group. Reinfarction rates were similar.Conclusions. Saruplase is a clinically safe and effective thrombolytic medication. This profile ranks saruplase favorably among the currently available thrombolytic agents.     

Effects of Glucose‐Insulin‐Potassium Infusion on QT Dispersion in Patients with Acute Myocardial Infarction

Background: Increased QT dispersion during acute myocardial infarction (AMI) has been associated with the occurrence of ventricular arrhythmias. Also, serum potassium levels have been shown to be relevant to the arrhythmic risk in this group of patients. The aim of the present study was to assess changes in QT dispersion during infusion of glucose‐insulin‐potassium (GIK) during AMI. Methods: Patients from the Pol‐GIK study were analyzed retrospectively. The patients were selected from the placebo (1000 ml of 0.89% NaCI) and the GIK (1000 ml of 10% dextrose, 20–32 units of insulin, 80 mEq K+) groups (18 and 24 patients, respectively). QT interval duration and dispersion the difference between the longest and shortest QT intervals) were measured at baseline, 18–24 hours into placebo/GIK infusion and 24 hours after the end of infusion. Results: In the placebo group, plasma potassium levels changed from 4.1 ± 0.5 mmol/L at baseline to 4.6 ± 0.8 mmol/L during infusion (P < 0.05) and 4.6 ± 0.4 mmol/L after infusion, whereas in the GIK group the respective values were 4.0 ± 0.4, 4.6 ± 0.3 (P < 0.0001), and 4.5 ± 0.5 mmol/L. QT interval duration was stable throughout the study and there was no difference between the groups. The two groups did not differ in respect to QT dispersion at any time point, the respective values were 79 ± 28, 65 ± 25, and 77 ± 27 ms in the placebo group, and 61 ± 35, 60 ± 26, and 76 ± 43 ms in the GIK group. The incidence of arrhythmias was also similar in both groups. Conclusions: GIK, at the dose used, is unlikely to affect heterogeneity of ventricular repolarization during AMI. A.N.E. 2001;6(1)50–54     

Comparison of the pharmacokinetics and effects on the hemostatic system of saruplase and urokinase in patients with acute myocardial infarction

The aim of the study was to compare in a single trial, using identical methodology, the pharmacokinetic properties and the effect on the hemostatic system of saruplase (unglycosylated scu-PA) and urokinase (glycosylated tcu-PA). Twenty-four patients with an acute myocardial infarction were either treated with saruplase (n = 12; 20 mg IV bolus followed by a 60 mg infusion for 60 minutes) or urokinase (n = 12; 1.5 million IU IV bolus followed by 1.5 million IU infusion for 60 minutes). Blood samples from saruplase-treated patients were analyzed for u-PA antigen and total u-PA and tcu-PA activities; those from urokinase-treated patients for u-PA antigen and tcu-PA activity. The effect of treatment on, including recovery of, plasma ₂-antiplasmin, fibrinogen, and plasminogen was examined in both groups. The total clearance of urokinase (179 ± 55 ml/ min) is about half that of saruplase (406 ± 154 ml/min), and the mean residence time of urokinase (59.1 ± 22.5 minutes) is nearly twice that of saruplase (28.3 ± 7.8 minutes), which results in a slower elimination of urokinase from plasma. Whether differences in the pharmacokinetic behavior of the unglycosylated saruplase and the glycosylated urokinase observed in this study are due to the difference in glycosylation or to other factors is not resolved. The systemic effect of saruplase on ₂,-antiplasmin, fibrinogen, and plasminogen is similar to that of urokinase, although retarded.     

急性心肌梗死溶栓疗法临床分析

目的 分析溶栓疗法治疗急性心肌梗死的疗效.方法 选择发病在12h内的急性心肌梗死患者30例,在对症治疗的同时立即给予静脉滴注尿激酶100万U,分析患者的冠状动脉再通率情况.结果 30例患者中26例再通,再通率为86.67%,没有发生严重的不良反应.结论 心肌梗死后早期采用静滴尿激酶进行溶栓安全、有效,值得临床推广应用.     

Cardiac Dysrhythmias in Patients with Acute Myocardial Infarction

Abstract A series of 676 patients with acute myocardial infarction were evaluated with regard to initial serum potassium level, prior diuretic therapy and occurrence of cardiac dysrhythmias during their first 24 hours in a coronary care unit. Serious dysrhythmias (ventricular tachycardia, ventricular fibrillation, and asystole) were significantly more frequent in hypokalemic patients. In this regard no differences were observed between patients on or off prior diuretic therapy     

Acute Myocardial Infarction in Patients with Paraplegia: Characteristics,Management, and Outcomes

Background

Cardiovascular disease has become a leading cause of death for patients with paraplegia. Acute myocardial infarction in patients with paraplegia has not been described in the literature. This study investigates clinical features, management strategies, and outcomes of these patients.

Effects of Trimetazidine on Submaximal Exercise Test in Patients with Acute Myocardial Infarction

Background: It was demonstrated that the novel metabolic agent, trimetazidine, could lessen the incidence and severity of angina, whether used in monotherapy or combination. Although the animal studies demonstrated that trimetazidine reduces myocardial infarct size and improves recovery of mechanic function after ischemia, little is known on the potential benefits of trimetazidine in patients with acute myocardial infarction (AMI). The aim of this study was to evaluate the efficacy of trimetazidine on AMI by sub-maximal exercise test. Methods: A double-blind crossover trimetazidine versus placebo trial was carried out in 44 patients with AMI. Patients were randomly allotted into trimetazidine (23 patients) or placebo (21 patients) for 5 days and underwent an initial sub-maximal exercise test. Exercise tests according to the modified Bruce protocol were performed. Exercise end points included completion of stage II or 75% of maximum predicted heart rate whichever came first. An averaged 12-lead ECG was obtained at rest, every minute during exercise, at the onset of anginal symptoms, at the onset of 1-mm ST segment depression, at peak exercise and every 2-minute during recovery. After the initial exercise tests, study groups resumed the drugs in the opposite order for 4 to 5 days and underwent a second sub-maximal exercise test. Results: Exercise induced ST segment depression was noted in 17 patients (38.6%) receiving placebo. However, exercise induced ST-segment depression was observed in 8 patients (18.1%) taking TMZ. Positive exercise test results were significantly higher in placebo group than TMZ group (p = 0.018). Additionally, trimetazidine prolonged the time to 1-mm ST-segment depression (6.1 ± 0.5 vs 4.9 ± 0.4, p < 0.031) and exercise duration (7.2 ± 0.9 vs 5.8 ± 0.9, p < 0.025). Conclusion: Trimetazidine therapy improves the exercise capacity and reduces evidence of ischemia derived from sub-maximal post-infarction exercise testing.     

Effects of Trimetazidine Administration before Thrombolysis in Patients with Anterior Myocardial Infarction: Short-term and Long-term Results

Reperfusion may prevent or reduce the development and extent of necrosis, but may also lead to an increase in reperfusion damage. Experimental studies performed in various animal models of myocardial ischemia have demonstrated the anti-ischemic properties of trimetazidine (TMZ) and have suggested that TMZ has antioxidant properties, without any direct hemodynamic effects. Our study was aimed at investigating the effects of TMZ before thrombolysis in acute anterior myocardial infarction and included 81 patients, hospitalized within 4 hours of the onset of symptoms. Patients were randomly (double-blind) subdivided in two groups The first group (40 patients, Group A, TMZ-pretreatment), received 40 mg TMZ orally about 15 minute before thrombolysis and, subsequently, 20 mg every 8 hours. The second group (41 patients, Group B) received placebo before thrombolysis. Ventricular arrhythmias (VA) due to reperfusion were evaluated in the first 2 hours. VA occurred in 15 of patients in group A, versus 29 in group B, p < 0.05. Creatine kinase (CK) normalization time was achieved after 55.7 ± 12.5 hours in group A, versus 61.2 ± 12.1 hour in group B, p = 0.048. CK peak was 1772 ± 890 in group A vs 2285 ± 910 UI/1 in group B, (p = 0.012). In the follow-up (range 6–22 months), there were 4 deaths, two patients in each group. After 180 days from treatment, the TMZ group showed a smaller end systolic volume than the placebo group (echocardiographic data), 46.2 ± 12 and 52.8 ± 13 ml/m², respectively, p = 0.037. Our data suggest that TMZ probably reduces reperfusion damage and/or infarct size in patients with anterior AMI subjected to thrombolysis and affects the post-AMI remodeling. Our data must be interpreted with caution because of the selection of patients. These findings require further extensive trials.     

Coronary Stent Choice in Patients with Acute Myocardial Infarction

A prompt reperfusion with primary percutaneous coronary intervention represents the current gold standard treatment for patients with acute myocardial infarction. In this setting, coronary stents have been shown to improve outcomes compared to plain angioplasty and are routinely used. However, the stent selection among patients with acute myocardial infarction is still a matter of some debate. An increased risk of very late (>1-year) stent thrombosis has been associated with the use of early-generation drug-eluting stents (DES), leading to concerns regarding the long-term safety of these devices. Newer-generation DES were developed with the aim of addressing this safety issue, and were recently investigated in a few randomized studies in patients with acute myocardial infarction. The objective of the present review is to summarize the accumulated evidence, to guide the stent selection in patients with acute myocardial infarction.     

急性心肌梗死常见并发症的防治进展

随着生活水平的提高,冠心病的发病率呈逐年上升趋势。急性心肌梗死（AMI）为冠心病的严重类型,具有发病急、病情凶险、病死率高等特点,可出现心力衰竭、心源性休克、心律失常及心脏破裂等多种并发症,这些并发症是导致心肌梗死死亡的主要原因。尽管溶栓、冠脉介入治疗的广泛应用使得AMI住院病死率显著降低,但AMI并发症严重影响着冠心病患者的远期预后及生活质量。因此通过早期预测因素风险评估,积极采取预防措施,尽早防治严重并发症是降低AMI病死率的关键。     

急性心肌梗死急诊经皮冠状动脉介入治疗后评价心肌组织再灌注方法的对比研究

目的应用TIMI心肌灌注分级、单个导联ST段回落幅度、单个导联ST段最大偏移幅度和超声心动图四种方法评价急性心肌梗死急诊经皮冠状动脉介入治疗后心肌水平再灌注。方法50例急性心肌梗死患者急诊介入治疗后采用TIMI心肌灌注分级、单个导联ST段回落幅度、单个导联ST段最大偏移幅度及随访1个月超声心动图观察室壁运动改善四种方法评价心肌灌注,并于术后7±2天行核素心肌灌注显像。结果与核素心肌灌注显像比较,TIMI心肌灌注分级敏感性为94.7,特异性为16.7,准确性为76.0;单个导联ST段回落幅度敏感性为89.5,特异性为83.3,准确性为88.0;单个导联ST段最大偏移幅度敏感性为84.2,特异性为83.3,准确性为84.0;超声心动图敏感性为78.9,特异性为83.3,准确性为80.0。心电图(单个导联ST段回落幅度、单个导联ST段最大偏移幅度)和超声心动图与核素检查存在一致性,且一致性良好;TIMI心肌灌注分级未显示与核素检查存在一致性。结论心电图和超声心动图可较好地评价急性心肌梗死后心肌组织再灌注水平。     

急性心肌梗死患者白细胞增多的临床意义

观察急性心肌梗死 (ＡＭＩ) 172例发病时白细胞计数的变化 ,探讨其临床意义。资料与方法一般资料　经临床症状、心电图、心肌酶谱确诊的ＡＭＩ 172例 (男 12 2 ,女 5 0 ) ,男女之比为 2 .4∶1,男性 4 0～ 85岁 ,平均 6 3.4岁 ,女性 36～ 94岁 ,平均6 9 .2岁。死亡 2 5例 ,男性 16例 ,女性 9例。分组方法　以ＡＭＩ发病后 2 4ｈ内白细胞计数分为三组[1] :高组 (白细胞计数≥ 9× 10 9/Ｌ) 10 3例(5 9.9% ) ;低组 (白细胞计数≤ 6× 10 9/Ｌ) 2 5例(14 .5 % ) ;中组 (白细胞计数介于高低组之间 ) 4 4例(2 5 .6 % ) ;另按中性粒细胞计数≥ 70 %…     

Outcomes of Acute Myocardial Infarction in Patients with Familial Hypercholesteremia

BackgroundThere is a paucity of contemporary data regarding the outcomes of acute myocardial infarction among patients with familial hypercholesteremia.MethodsWe queried the Nationwide Readmissions Database (2016-2018) for hospitalizations with acute myocardial infarction. Multivariable regression analysis was used to compare in-hospital outcomes and 30-day readmissions among patients with and without familial hypercholesteremia.ResultsThe analysis included 1,363,488 hospitalizations with acute myocardial infarction. The prevalence of familial hypercholesteremia was 0.07% among acute myocardial infarction admissions. Compared with those without familial hypercholesteremia, admissions with familial hypercholesteremia were younger and had less comorbidities but were more likely to have had prior infarct and revascularization. Admissions with familial hypercholesteremia were more likely to present with ST-elevation myocardial infarction and undergo revascularization. After multivariable adjustment, there was no difference in in-hospital case fatality among patients with hypercholesteremia compared with those without it (adjusted odds ratio [aOR] = 0.76; 95% confidence interval [CI] 0.41-1.39). Admissions with acute myocardial infarction and familial hypercholesteremia had higher adjusted rates of cardiac arrest and utilization of mechanical support. There were no group differences in overall 30-day readmission (aOR 0.75; 95% CI 0.51-1.10) or 30-day readmission for acute myocardial infarction. However, a nonsignificant trend toward higher readmission for percutaneous coronary intervention was observed among patients with familial hypercholesteremia (aOR 1.89; 95% CI 0.98-3.64).ConclusionIn this contemporary nationwide observational analysis, patients with familial hypercholesteremia represent a small proportion of the overall population with acute myocardial infarction and have a distinctive clinical profile but do not appear to have worse in-hospital case fatality compared with those without familial hypercholesteremia.