Point-of-care testing (PoCT) devices are becoming increasingly essential for widespread disease diagnostics. Hence, it becomes necessary to develop solutions for detecting biomarkers from minimal-volume samples while remaining accessible and user-friendly. This study presents a new method called FoCUS (Forward scattering Correction Using a Single-bead). FoCUS combines tiny beads floating in liquid with a small chip to measure very small amounts of sample. It can analyze a single drop using just one bead. The platform employs a novel signal correction strategy to enhance fluorescence signal sensitivity using forward scattering signals obtained simultaneously. Compared to conventional methods, the FoCUS platform achieves a 1000-fold reduction in the required sample volume, a 2.7-fold decrease in the relative standard deviation of sample signals, and a 4.3-fold improvement in detection limits. The platform successfully detected relevant myoglobin levels from 0.1 μL of sample, demonstrating its potential for multiplex biomarker immunoassays in point-of-care applications where sample volumes are limited.

Although significant progress has been made in recent years, some important questions remain regarding the analytical performance, pathophysiological interpretation and clinical use of cardiac troponin I (cTnI) and T (cTnT) measurements. Several recent studies have shown that a progressive and continuous increase in circulating levels of cTnI and cTnT below the cut-off value (i.e. the 99th percentile upper reference limit) may play a relevant role in cardiovascular risk assessment both in the general population and in patients with cardiovascular or extra-cardiac disease. International guidelines recommend the use of standardized clinical algorithms based on temporal changes in circulating cTnI and cTnT levels measured by high-sensitivity (hs) methods to detect myocardial injury progressing to acute myocardial infarction. Some recent studies have shown that some point-of-care assays for cTnI with hs performance ensure a faster diagnostic turnaround time and thus significantly reduce the length of stay of patients admitted to emergency departments with chest pain. However, several confounding factors need to be considered in this setting. A novel approach may be the combined assessment of laboratory methods (including hs-cTn assay) and other clinical data, possibly using machine learning methods. In the present document of the Italian Study Group on Cardiac Biomarkers, the authors aimed to discuss these new trends regarding the analytical, pathophysiological and clinical issues related to the measurement of cardiac troponins using hs-cTnI and hs-cTnT methods.

Cardiac troponin (cTn) testing plays a crucial role in the diagnosis of cardiovascular diseases, particularly acute coronary syndrome (ACS), which includes acute myocardial infarction (AMI). However, conventional immunoassays may be subject to interference from autoantibodies, cross-reactivity, and biotin-related effects, compromising diagnostic accuracy. A thorough investigation of these interference mechanisms is necessary to improve assay methodologies, ensuring greater reliability and precision. In recent years, significant advancements in mass spectrometry (MS) technology have sparked increased interest in its application for cTn testing. For instance, liquid chromatography-tandem mass spectrometry (LC-MS/MS) employs multiple reaction monitoring (MRM) to accurately quantify cardiac troponin I (cTnI)-specific tryptic peptides along with their fragment ions. This technique effectively reduces immunoassay interference while improving analytical specificity. Compared to traditional immunoassays, MS-based approaches alleviate matrix effects and analytical interferences while achieving superior specificity. Nonetheless, clinical adoption remains constrained by technical complexity; thus clinicians can obtain more reliable diagnostic insights. This review summarizes the current landscape of cTn detection technologies by examining the prevalence of false-positive results across various methods. It further explores both the practical applications and challenges associated with MS-based techniques in cTn testing. Ultimately, this review aims to improve cTn testing reliability, enhance cardiovascular disease diagnosis, and guide personalized treatment strategies.

Frailty is a significant concern for older adults and can increase after a major health event. This study (a) examined the risk of incident frailty following a CVD event among community-dwelling older people aged ≥ 65 years and (b) explored whether sociodemographic factors, polypharmacy, and pre-event frailty influence their risk of developing frailty following a CVD event.

This study included a cohort of 738 participants (38.5% women) from the ASPREE study who were not classified as frail prior to their CVD event. Frailty was measured annually using the 64-item deficit-accumulation frailty index (FI).

Over an average of 2.6 years after a CVD event, 333 individuals had incident frailty. In logistic regression models, increased chronological age, being a woman, and having polypharmacy were associated with 4% to 83% increased odds of developing frailty following a CVD event. Individuals with CVD residing in the inner regional area had about 50% higher odds of having frailty than those living in cities. This association was more evident among stroke survivors, with both inner regional (adjusted-OR, 2.13) and outer regional/remote residents (adjusted-OR, 2.37) having greater odds of frailty. Individuals who were classified as pre-frail before their CVD event, had notably higher odds of progressing to frailty post CVD (adjusted-OR, 3.41).

Our community-based study provides robust evidence that women, older individuals who were pre-frail, polypharmacy, or living in regional/remote areas have a markedly greater odds of developing frailty following a CVD event.

Prognostic evaluation of canine myxomatous mitral valve disease (MMVD) using circulating biomarkers has been attempted, but comprehensive studies are still limited. The present study aimed to investigate the prognostic value of circulating cardiac and renal biomarkers and imaging data in 37 small-breed dogs with MMVD using retrospective data obtained from 2018 to 2022. The circulating cardiac biomarkers included N-terminal probrain natriuretic peptide (NT-proBNP), atrial natriuretic peptide (ANP), and troponin I. The renal biomarkers included blood urea nitrogen (BUN), creatinine, symmetric dimethylarginine, and cystatin C (Cys-C). The imaging data included vertebral heart score, vertebral left atrial size (VLAS), left-atrial-to-aortic ratio, and left ventricle internal diameter in diastole normalized to bodyweight (LVIDDN) from the medical records. The dogs were categorized into high and low groups based on the cutoff values obtained from the receiver-operating characteristic curves. Kaplan-Meier survival curves were generated, and 1-year MMVD-specific survival rates were compared using the restricted mean survival time (RMST) method. The dogs with high VLAS, LVIDDN, and NT-proBNP, ANP, troponin I, BUN, creatinine, or Cys-C levels had significantly shorter MMVD-specific survival times (p < 0.01). NT-proBNP had the largest RMST difference of 187.0 days (95 % confidence interval [CI]: 104.7-269.3 days), followed by Cys-C with 169.3 days (95 % CI: 98.2-240.5 days). Our study findings highlight the potential of NT-proBNP and Cys-C as key prognostic markers in dogs with MMVD. Incorporating the measurements of blood circulating biomarkers may enhance the accuracy of prognostic prediction in dogs with MMVD.

This study aims to evaluate the effect of dapagliflozin (DAPA) on malignant ventricular arrhythmias (MVA) after acute myocardial infarction (AMI).

A single-center, prospective and observational cohort study was conducted. We enrolled AMI patients from the ChangZhou Acute Myocardial Infarction Registry between January 2018 and November 2023. They were divided into two groups according to the use of dapagliflozin. The median follow-up time was 211 days. The primary endpoint of the study was the incidence of MVA during hospitalization, and the secondary endpoint was all-cause mortality rate during the follow-up period. Kaplan-Meier survival analysis and multifactorial logistic regression analysis were performed to assess the association between DAPA and the risk of MVA. Enrolled patients were matched on a 1:1 propensity score.

Of the 2607 AMI patients enrolled, MVA were reported postoperatively in 123 (4.7%)patients. Cardiovascular death occurred in 93 (3.6%) patients. The average age of the enrolled patients was 65.03 ± 0.27 years. Of participants assigned to dapagliflozin, 8 out of 363 patients (2.2%) experienced MVA compared with 115 out of 2244 patients (5.1%) in the control group (odds ratio, OR = 0.392; 95% confidence interval, 95% CI: 0.171-0.900; P = 0.027). After 1:1 propensity score matching, DAPA remained able to reduce the risk of MVA in patients with AMI. (OR = 0.340; 95% CI: 0.121-0.960; P = 0.042). At a median follow-up of 211 days, all-cause mortality remained lower in the DAPA group than in the control group after matching (P = 0.033).

Dapagliflozin may attenuate the risk of MVA and all-cause mortality in elderly AMI patients, highlighting its potential as a therapeutic adjunct. However, these findings require validation in large-scale randomized trials.

The skeletal muscle is highly susceptible to injury in daily life. Severe skeletal muscle injuries often result in incomplete regeneration, leading to functional impairment. In clinical practice, understanding the extent of skeletal muscle injury in limb trauma patients is crucial for selecting treatment modalities and assessing prognosis. Currently, there is a lack of specific indicators for evaluating the severity of mechanical skeletal muscle injury. Therefore, the aim of this study is to develop biomarkers for the early evaluation of different degrees of skeletal muscle injury. A rat model of skeletal muscle mechanical compression injury was established with varying degrees of injury severity, one control group, and two compression groups (Mild Injury and Severe Injury Group). LC-MS/MS-4D-DIA quantitative proteomics technology was used to detect the plasma proteome profile of rats in different injury groups at 3 hours post-injury, followed by bioinformatics analysis for data decoding. Rats in the mild and severe injury groups exhibited completely different degrees of injury and prognosis. The proteomic results of the plasma revealed that the relative quantification of 37 proteins increased along with the increase in injury, while 2 proteins decreased. These differentially expressed proteins (DEPs) included not only muscle-specific structural proteins but also metabolic-related proteins that might play crucial roles in tissue injury control, repair, and regeneration. Overall, the study has identified several potential protein biomarkers that can distinguish different degrees of skeletal muscle injury at an early stage. These protein biomarkers may be further developed to help clinicians identify patients with varying degrees of skeletal muscle injury, paving the way for personalized treatments.

Cardiac injury, encompassing a spectrum of heart muscle damage, requires prompt and accurate diagnosis to improve patient outcomes. Early detection using cardiac biomarkers is vital for timely intervention and reducing mortality. This review highlights the role of high-sensitivity cardiac troponins (hs-cTns) in diagnosing cardiac injury. This article offers an overview of cardiac injury, including its causes, diagnostic challenges, and the evolution of biomarkers, up to the development and commercialization of "high-sensitivity" (hs-) cTns. The molecular structure of cardiac isoforms cTnI and cTnT, release kinetics, guidelines incorporation, diagnostic performance, and clinical application will be analyzed. It is concluded that the advent of hs-cTn assays has further expanded diagnostic capabilities by enabling the detection of low-level cTn elevations, which were previously undetectable using conventional methods. This enhanced sensitivity allows earlier identification of even minor cardiac injuries, facilitating prompt intervention and improving patient outcomes. However, this increased sensitivity also introduces interpretive challenges in understanding the nature of cardiac involvement, especially in distinguishing mild cTn elevations that may signify non-ischemic cardiac injury or be associated with other non-cardiac conditions.

Cardiac troponin is the gold-standard biomarker for the evaluation of patients with suspected acute myocardial infarction (MI). Improvements in assay technology have led to high-sensitivity cardiac troponin assays that, when incorporated into accelerated diagnostic pathways, may rapidly diagnose or exclude acute MI more efficiently than conventional troponin assays.

In this narrative review, we provide practical suggestions for implementing high-sensitivity cardiac troponin assays, review accelerated diagnostic pathways incorporating these assays, and review the impact of these assays on resource utilization and cost-effectiveness in relation to the evaluation of individuals with possible acute MI.

An increasing number of hospitals are transitioning to high-sensitivity cardiac troponin assays. This narrative review provides an overview of the potential benefits of this transition.

Patients with lupus nephritis (LN), including those below age 50, face significantly higher risk of atherosclerotic cardiovascular disease (ASCVD) vs peers. This highlights the need for identifying specific ASCVD risk factors in LN. Renal arteriosclerosis in kidney biopsies (subclinical arteriosclerosis) may be able to predict future clinical ASCVD events. However, renal arteriosclerosis is under-reported in LN biopsies and is not taken into consideration when ASCVD risk is calculated. Therefore, we aimed to systematically grade renal arteriosclerosis in kidney biopsies at LN diagnosis and examined associations with 10-year and 20-year ASCVD occurrence.

Adults with biopsy-proven LN were included. Clinical ASCVD, including fatal and non-fatal events, were adjudicated. Utilizing standard Banff grading criteria, all biopsies at LN diagnosis were re-read to grade renal arteriosclerosis. Covariables (e.g. socio-demographics, comorbidities, med exposure) were abstracted. Using Cox models, factors (including renal arteriosclerosis) associated with 10-year and 20-year clinical ASCVD were examined.

Among 209 patients, 36 and 49 clinical ASCVD occurred within 10 and 20 years. Renal arteriosclerosis (>25%) was associated with 3× higher 10-year ASCVD. High area deprivation index (>80) and longer angiotensin converting enzyme inhibitor (ACEi) exposure were associated with 4× higher and 0.65× lower ASCVD occurrence. Adding renal arteriosclerosis >25% improved model performance for 10-year ASCVD risk estimation from 65% to 80%. Similar associations were seen with 20-year ASCVD.

Renal arteriosclerosis >25%, area deprivation and ACEi exposure could inform ASCVD risk stratification in LN. Prospective studies should validate findings and inform clinical use.

Background/Objectives: Influenza infection is associated with cardiovascular morbidity and mortality; however, the effect of influenza vaccination on cardiovascular outcomes is not fully understood. This clinical trial aimed to investigate the correlation between cardiovascular outcomes and influenza vaccine (FluVac) in coronary artery disease (CAD) subjects. Methods: This was a randomized single-blinded placebo-controlled trial. Enrolled CAD subjects received 0.5 mL of 2007-2008 trivalent FluVac (15 µg hemagglutinin of each of Solomon Islands/3/2006 (H1N1), Wisconsin/67/2005 (H3N2), and Malaysia/2506/2004 (B)). The subjects were followed up at 1 month (hemagglutinin (HA) antibody titers) and at 12 months post-vaccination for evaluation of outcomes (influenza-like episodes, acute coronary syndrome (ACS), myocardial infarction (MI), coronary revascularization, and death). Results: In total, 278 eligible CAD subjects were randomized to receive either FluVac (n = 137) or a placebo (n = 141), of which consequently 131 and 135 subjects completed the study. Cardiovascular deaths (3/131 [2.29%] vs. 3/135 [2.22%]) and all-cause deaths (4/131 [3.05%] vs. 4/135 [2.96%]) were similar in both groups. Adverse cardiovascular events, including ACS, MI, and coronary revascularization, were less frequent in the vaccine group but did not reach statistical significance. The magnitude of the antibody change and serologic response (≥4-fold HI titer rise) of all three antibodies were significantly higher in the vaccine group compared to the placebo but did not correlate with cardiovascular outcomes in the FluVac group. Conclusions: The influenza vaccine may improve cardiovascular outcomes, though this improvement is not correlated with post-vaccination antibody titers. Despite the controversy, influenza vaccination is recommended in the CAD population (clinicaltrials.gov; NCT00607178).

The optimal blood pressure (BP) in patients with chronic kidney disease (CKD) remains uncertain. Therefore, this cohort study aimed to investigate the prognostic value of ambulatory blood pressure (ABP) in patients with CKD and to determine the optimal range for ABP. In total, 1051 hospitalized patients with CKD were enrolled. The prognosis of patients with CKD was evaluated in terms of all-cause death, cardiovascular death, cardiovascular events, and renal events. Our results showed that systolic blood pressure (SBP) had a higher predictive value than diastolic blood pressure in the multivariate-adjusted models. Additionally, nighttime SBP was found to be the best predictor of prognosis in patients with CKD. Furthermore, when dividing the nighttime SBP into quartiles (quartile 1: <110 mmHg, quartile 2: 110-124 mmHg, quartile 3:124-139 mmHg, and quartile 4: ≥139 mmHg). Nighttime SBP ≥ 124 mmHg had an impact on prognosis in patients with CKD, nighttime SBP 124-139 mmHg: total mortality (hazard ratio [HR], 3.017 [95% confidence interval (CI): 1.367-6.660]), cardiovascular death (HR, 2.570 [95% CI, 1.744-6.151]), all cardiovascular events (HR, 2.401 [95% CI, 1.288-4.475]), and 110-124 mmHg had an impact on the renal prognosis (HR, 1.975 [95% CI, 1.311-2.976]). Therefore, nighttime SBP is an independent risk factor for CKD and a significant predictor of prognosis in patients with CKD. Furthermore, the prognosis of patients with CKD improved when the nighttime SBP was maintained below 124 mmHg; however, maintaining it below 110 mmHg can further lower the incidence of renal disease.

This study aimed to assess how diabetes influences the quality of care and longer-term outcomes in contemporary STEMI cohorts.

We analysed 283,658 adults hospitalised with STEMI from the United Kingdom Myocardial Ischaemia National Audit Project (MINAP) registry between 2005 and 2019. This was linked with Office of National Statistics data to provide out of hospital mortality outcomes. We compared longer-term outcomes depending on diabetes status and assessed the effect of quality of care using the opportunity-based quality-indicator score (OBQI).

Individuals with diabetes were older (median age 68.7 vs. 65.5), underwent percutaneous coronary intervention less frequently (60 % vs. 63 %) and were less likely to achieve a door-to-balloon time of < 60 min (69 % vs. 75 %) or < 120 min (89 % vs. 92 %). Their adjusted all-cause mortality risk was higher during follow-up, from 30 days (HR: 1.49, CI: 1.44-1.54), to up to 10 years of follow up (HR: 1.54, CI: 1.52-1.57), compared to individuals without diabetes. Excellent inpatient care was associated with lower mortality rates within individuals with diabetes (Diabetes: HR 0.56, CI: 0.50-0.64, No diabetes: HR 0.62, CI: 0.58-0.67).

Individuals with diabetes have a higher risk of long-term mortality after STEMI. They experience delays in angiography and receive lower quality inpatient care.

Current research suggests that microvascular obstruction (MVO) following the first percutaneous coronary intervention (PCI) in myocardial infarction patients is closely related to inflammatory responses. The lymphocyte-to-C-reactive protein (CRP) ratio (LCR), as a novel inflammatory marker, is associated with the prognosis of patients with ST-segment elevation myocardial infarction (STEMI). However, the relationship between LCR and MVO remains unclear. This study aims to investigate the correlation between LCR and MVO in STEMI patients undergoing PCI.

This was a single-center retrospective study. We consecutively enrolled STEMI patients who underwent PCI at Xuzhou Medical University Affiliated Hospital, Xuzhou, China, from September 2019 to December 2023. Cardiac magnetic resonance (CMR) imaging with late gadolinium enhancement (LGE) was used to assess infarct size and the presence of MVO.

A total of 551 patients were included in this study, with 267 (48.5%) experiencing MVO. The median time for CMR imaging-based detection of MVO was 5 days (interquartile range: 4, 6). Univariate regression analysis revealed that age, white blood cell count, neutrophil count, left ventricular ejection fraction (LVEF), peak N-terminal pro-B-type natriuretic peptide (NT-proBNP), peak high-sensitivity troponin T (hs-TnT), LCR, LGE percentage (LGE%), and MVO percentage (MVO%) were significantly associated with MVO (p < 0.05). Multivariate regression analysis identified LCR as an independent predictor of MVO [Odds Ratio = 0.18, 95% Confidence Interval (CI): 0.04-0.75, p = 0.019]. Receiver operating characteristic curve analysis demonstrated that LCR had predictive capability for MVO, with a sensitivity of 80.1% and specificity of 45.4% when the LCR value was 0.091 [area under the curve (AUC): 0.654, 95% CI: 0.609-0.700, p < 0.001]. A new predictive model incorporating LCR improved the prediction of MVO occurrence (AUC = 0.815, p < 0.001), with significant differences in net reclassification improvement (p = 0.004) and integrated discrimination improvement (p = 0.023) between the new and old models.

A low LCR is an independent risk factor for MVO after PCI in STEMI patients. The predictive model incorporating LCR enhances the ability to predict MVO occurrence in patients with STEMI post-PCI.

Contrast-induced acute kidney injury (CI-AKI) is a common complication in patients with ST-segment elevation myocardial infarction (STEMI) and is associated with an inflammatory response. Inflammatory burden index (IBI) is a novel inflammatory marker, and the relationship between IBI and CI-AKI in STEMI patients is currently unknown. The aim of this study was to investigate the effect of IBI on CI-AKI after percutaneous coronary intervention (PCI) in STEMI patients.

This was a single-center retrospective observational study consecutively enrolling patients diagnosed with STEMI and successful PCI between August 2022 and December 2024. Logistic regression analysis was used to identify risk factors associated with CI-AKI. Restricted cubic spline (RCS) was used to explore the dose-response relationship between IBI and CI-AKI. The predictive effectiveness of the models was assessed by the net reclassification index (NRI) and the integrated discriminant improvement index (IDI).

A total of 647 patients were included in this study and the incidence of CI-AKI during hospitalization was 78 (12.1%). After adjusting for possible confounding factors, the result showed that IBI > 18.89 (OR = 2.418, 95% CI: 1.331-4.392) was an independent factor for CI-AKI in STEMI patients. RCS results suggested that there was a non-linear dose-response relationship between IBI and CI-AKI. After integrating IBI, the ability of the new model to predict CI-AKI in STEMI patients was significantly improved (NRI = 0.315, IDI = 0.019, P < 0.05).

Elevated IBI is an independent risk factor for CI-AKI after PCI in STEMI patients, and there is a non-linear dose-response relationship between IBI and CI-AKI. Integrating IBI can improve the risk stratification of STEMI patients regarding CI-AKI.

This study aimed to analyse the correlation of endothelial cell specific molecule-1 (ESM-1), endothelial microparticles (EMPs) and hypoxia inducible factor-1α (HIF-1α) serum levels with the occurrence of acute myocardial infarction (AMI) and determine their short-term predictive value for major adverse cardiovascular events (MACE) following AMI treatment.

Retrospective data analysis was performed on the medical records of 106 patients with AMI admitted to our hospital between October 2020 and October 2022. The control group consisted of 106 healthy volunteers that received a physical examination at our hospital's physical examination centre within the same time frame. ESM-1, EMP and HIF-1α serum levels were compared between the two groups. Independent risk variables for AMI were examined. Furthermore, these individuals were separated into the poor prognosis group (n = 41) and good prognosis group (n = 65) according to the presence or absence of MACE. Finally, the ESM-1, EMPs and HIF-1α serum levels were correlated with the development of MACE in patients with AMI, and the predictive value of serum ESM-1, EMPs and HIF-1α for MACE was evaluated. The serum HIF-1α, EMP and ESM-1 levels were significantly different between the two groups (P < 0.05). Multivariate logistic regression analysis revealed the elevated serum levels of HIF-1α (odds ratio (OR) = 1.819), EMPs (OR = 1.071) and ESM-1 (OR = 14.655) as AMI risk variables. A substantially significant (P < 0.05) correlation was found between the elevated levels of serum HIF-1α (OR = 18.716), EMPs (OR = 26.185) and ESM-1 (OR = 13.992) and the development of MACE in patients with AMI. According to receiver operating characteristic (ROC) curve analysis, the combined evaluation value of HIF-1α, EMPs and ESM-1 serum levels in predicting MACE was high with an area under the curve (AUC) of 0.931.

Patients with AMI have abnormally high ESM-1, EMP and HIF-1α levels in their serum, all of which have been linked to the development of MACE. Together, these parameters have high sensitivity and specificity for early MACE identification.

Specialist cardiac care has been shown to reduce inpatient mortality following non-ST segment myocardial infarction (NSTEMI), but whether this benefit extends beyond index admission is unclear.

Using the linked Myocardial Ischaemia National Audit Project (MINAP) registry, and Office for National Statistics mortality recording, we included 425,205 NSTEMI patients admitted to UK hospitals, between January 2005 and March 2019 that survived to discharge. 217,964 (52 %) were admitted to a specialty cardiac ward. Multivariable Cox-regression models were applied to imputed data to estimate Hazard Ratios for mortality over our study period.

Patients admitted to specialty cardiology wards were younger (70 years vs. 75), less often female (32 % vs. 40 %) but more often received statins (86 % vs. 84 %) or beta-blockers (83 % vs. 77 %) (all P < 0.001). One-year (aHR:0.84, 95 % CI 0.83-0.86), and ten-year mortality (aHR: 0.88, 95 % CI 0.87-0.89) were lower in patients admitted to specialty cardiac wards, compared to admitted elsewhere (all P < 0.001). There was significant geographic variation in the proportion admitted to speciality cardiac wards (London 59 % vs. East of England 43 %), with over 1700 deaths potentially avoided if the MINAP target of 80 % was reached.

Patients admitted to a cardiac ward had significantly lower mortality compared to alternate wards persisting up to ten-years. There is wide regional variation in the proportion of patients who received specialist cardiology care during their admission and an opportunity exists for lives saved if the proportion of NSTEMI patients admitted to a cardiac ward were to reach the MINAP target of 80 %.

Heart injuries following polytrauma (PT) are identified as a predictor of poor outcome. The diagnostic algorithm of cardiac damage after trauma consists of the systemic measurement of cardiac damage markers, a 3-channel ECG and if there are any suspicious findings, the conduction of a transthoracic echocardiography (TTE). The aim of this study was to implement a systematic analysis of cardiac function using TTE in PT-patients.

This study is a prospective non-randomized study, conducted in a German Level 1 Trauma Centre between January and July 2024. All polytraumatized patients with an ISS ≥ 16 were included immediately after entering the emergency department. Blood samples were withdrawn at 6 timepoints, at the Emergency room, 24 h, 48 h, three, five and ten days after admission to the hospital. Cardiac damage was measured by Troponin T (TnT) ECLIA, as well as NT-proBNP measurements. Entering the intensive care unit, transthoracic echocardiography was performed at two time points (day 1 and 2), by an experienced Cardiologist.

During the pilot phase, cardiac contusion was detected in 14.3% of patients, with significantly elevated TnT levels on arrival, after 24 (**p ≤ 0.01) and 48 h (*p ≤ 0.05) compared to patients without cardiac contusion. Echocardiographic findings revealed that 25% of all patients had wall motion abnormalities, and 20% showed relaxation disorders. Right ventricular function, measured by TAPSE (tricuspid annular plane systolic excursion), RVEDD (right ventricular end diastolic diameter) and sPAP (systolic pulmonary arterial pressure), was slightly impaired in trauma patients, while the left ventricular function (ejection fraction (EF) and left ventricular end diastolic diameter (LVEDD)) was preserved. We observed the increase of TnT and an increase of the heart failure marker NT-proBNP over the time. These biomarkers were associated with pre-existing cardiac risk factors, the ISS and changes in the right or left ventricular function. Mitral valve insufficiency (grade 1) was present in 50% and tricuspid valve (grade 1) insufficiency in 30%.

Taken together, we conducted for the first time of our knowledge, a systematic TTE analysis in PT-patients. We observed a slightly reduced right ventricular function, as well as mitral and tricuspid valve regurgitations in the patients.

Clinical characteristics and outcomes of patients with myocardial infarction (MI) with nonobstructive coronary arteries (MINOCA) are not fully understood, particularly in Japan.

We enrolled a total of 8881 patients with acute MI from the Miyagi Acute Myocardial Infarction Registry Study (2012-2020), with a median age of 69 years. Among them, 239 patients (2.7%) were diagnosed with MINOCA. Compared with those with MI with obstructive coronary artery disease (MI-CAD), patients with MINOCA were more often women, had a higher incidence of non-ST-segment-elevation MI and a lower prevalence of dyslipidemia. Compared with patients with MI-CAD, patients with MINOCA in all age groups (<59, 60-69, 70-79, >80 years of age) had a higher incidence of non-ST-segment-elevation MI. Additionally, those ≤59 years of age were more often women and had a lower prevalence of diabetes and dyslipidemia. In-hospital mortality increased with age in patients with MI-CAD (3.9% for <59 years of age, 5.6% for 60-69 years of age, 8.3% for 70-79 years of age, and 15.2% for >80 years of age; P<0.01), but not in patients with MINOCA (4.5%, 7.4%, 6.0%, and 9.6%, respectively; P=0.36). Compared with patients with MI-CAD, patients with MINOCA had lower in-hospital mortality for Killip class IV (40.7% versus 20.0%; adjusted odds ratio [OR], 0.31 [95% CI, 0.10-0.94]; P=0.04) and renal dysfunction (20.0% versus 7.1%; adjusted OR, 0.29 [95% CI, 0.09-0.96]; P=0.04).

Patients with MINOCA exhibit distinct clinical characteristics and outcomes compared with those with MI-CAD, particularly in terms of age, sex, prevalence of comorbidities, and in-hospital mortality. These findings underscore the importance of tailored clinical approaches for patients with MINOCA.

Heterophile antibodies are immunoglobulins produced by the immune system in response to exposure to animal and bacterial antigens, blood transfusions, autoimmune disorders, hematologic malignancies, dialysis, and pregnancy. Recently, these antibodies have garnered significant attention due to their impact on the accuracy of laboratory test results. Heterophile antibodies can bind not only to specific antigens but also to those from different species, including the antibodies used in laboratory tests. This cross-reactivity with foreign proteins is the basis for their interference in immunological assays, such as those measuring cardiospecific troponins (cTn). This manuscript reviews the literature on cases of heterophile antibody interference in troponin testing and proposes an algorithm for identifying such interference when clinical discrepancies arise. Recognizing and addressing heterophile antibody interference is crucial, particularly for tests like those for troponins, which are key biomarkers in the diagnosis and management of emergency and intensive care patients. The literature emphasizes the need for accurate procedures to distinguish true cardiac damage from false positives, thereby preventing unnecessary additional tests and hospitalizations.

No-reflow following primary percutaneous coronary intervention (PPCI) is challenging to treat.

The objective of this study is to evaluate the efficacy and safety of upstream high-bolus-dose tirofiban administration in ST-segment elevation myocardial infarction (STEMI) cases undergoing PPCI on top of dual antiplatelet therapy, including ticagrelor, in comparison to selective bailout administration.

This hospital-based, randomized, single-blinded prospective interventional study was conducted on 150 patients at Assiut University Heart Hospital. Patients with STEMI within 12 h after symptom onset who underwent PPCI were randomized to an upstream group (n = 75) and a selective bailout group (n = 75) based on the timing of the tirofiban bolus administration (25 µg/kg intravenously over 5 min).

The bailout group's thrombolysis in myocardial infarction (TIMI) frame count was higher than the upstream group's, despite comparable TIMI flow and myocardial blush grade between the two groups, but only approached statistical significance [14.4 (4-36) vs 12.2 (5-55), P = 0.08]. The enzymatic infarct size tended to be lower in the upstream group. All echocardiographic findings were comparable between the two studied groups, with no significant difference (P > 0.05). There was no significant difference between the two groups regarding clinical outcomes.

Compared to selective bailout administration, upstream high bolus dose of tirofiban in STEMI patients undergoing primary coronary intervention did not significantly affect angiographic outcomes, left ventricular remodeling, or function, despite smaller infarction size.

The long-term outcomes of out of hospital cardiac arrest (OHCA) survivors are not well known.

Using the Myocardial Ischaemia National Audit Project (MINAP) registry, linked to Office for National Statistics mortality data, we analysed 661 326 England, Wales, and Northern Ireland acute myocardial infarction (AMI) patients; 14 127 (2%) suffered OHCA and survived beyond 30 days of hospitalization. Patients dying within 30 days of admission were excluded. Mean follow-up for the patients included was 1500 days. Cox regression models were fitted, adjusting for demographics and management strategy. OHCA survivors were younger (in years) {64 [interquartile range (IQR) 54-72] vs. 70 (IQR 59-80), P < 0.001}, more often underwent invasive coronary angiography (88% vs. 71%, P < 0.001) and percutaneous coronary intervention (72% vs. 45%, P < 0.001). Overall, the risk of mortality for OHCA patients that survived past 30 days was lower than patients that did not suffer cardiac arrest [adjusted hazard ratio (HR) 0.91; 95% CI; 0.87-0.95, P < 0.001]. 'Excellent care' according to the mean opportunity-based quality indicator (OBQI) score compared to 'Poor care', predicted a reduced risk of long-term mortality post-OHCA for all patients (HR: 0.77, CI; 0.76-0.78, P < 0.001), more for STEMI patients (HR: 0.73, CI; 0.71-0.75, P < 0.001), but less significantly in NSTEMI patients (HR: 0.79, CI; 0.78-0.81, P < 0.001).

OHCA patients remain at significant risk of mortality in-hospital. However, if surviving over 30 days post-arrest, OHCA survivors have good longer-term survival up to 10 years compared to the general AMI population. Higher-quality inpatient care appears to improve long-term survival in all OHCA patients, more so in STEMI.

Differential diagnosis of sudden cardiac death (SCD) remains challenging, particularly in cases lacking evident structural abnormalities. Cardiac markers have been proposed as useful tools for this differentiation in forensic contexts. However, key issues include the influence of postmortem interval (PMI) on marker stability and the limitations of traditional approaches that focus on pericardial fluid, which requires invasive sampling compared to peripheral blood. This study aimed to evaluate the potential of cardiac markers in peripheral blood for diagnosing SCD, addressing methodological concerns related to PMI, hemolysis, and sample handling.

This study analyzed 5 cardiac markers (creatine kinase-MB [CK-MB], myoglobin, troponin I [TnI], BNP, and D-dimer) in peripheral blood samples from 42 autopsied cadavers, divided into an SCD group and a control group. Marker levels were quantified using immunofluorescence, with cases meticulously selected to exclude confounding factors such as chronic diseases, pulmonary thromboembolism, and drowning. The study also accounted for potential degradation due to PMI, and evaluated the accuracy of point-of-care testing (POCT) in forensic samples.

The study identified statistically significant differences in myoglobin and TnI levels between the SCD group and the control group, though myoglobin's diagnostic reliability remains limited due to its lack of specificity for myocardial injury. TnI emerged as a more robust marker for SCD. Contrary to prior concerns, PMI showed no significant correlation with marker levels in samples handled without freeze-thaw cycles. Issues related to hemolysis were addressed, and no significant effects were observed from resuscitation maneuvers.

This study supports the potential use of cardiac markers, particularly TnI, in peripheral blood for postmortem SCD diagnosis, emphasizing the importance of rapid and systematic analysis to minimize hemolysis-related variability. While further validation is needed to confirm these findings, this approach offers a less invasive, economical, and practical method for forensic investigations.

Non-ST-segment elevation myocardial infarction (NSTEMI) is an entity which was defined as a type of a coronary syndrome with positive cardiac biomarker of myocardial necrosis with no ST-segment elevation in ECG. Currently, the centers for Medicare and Medicaid services (CMS) Hospital readmission reduction program assistance risk-adjusted 30-day readmission rates for five major clinical entities which includes acute myocardial infarction.

We performed this retrospective study to look into the current burden and predictors of NSTEMI readmission. Data were obtained from the Nationwide Readmission Database for the year 2020. We analyzed data on hospital readmission of 336 620 adults who were admitted for NSTEMI.

The 30-day readmission rate was 13.5% with NSTEMI being the most common cause of readmission. Mortality was higher in readmitted patients compared to index admission (5.4 vs 3.6%, P  = 0.000). Higher risk of readmission was associated with female sex, higher Charlson comorbidity index, and longer length of stay. Lower risk of admission was seen in patients from smaller communities, patients who underwent percutaneous coronary intervention, and discharged to rehabilitation facilities.

Although we found an improvement in readmission rates compared to prior studies, about 13% of patients continue to get readmitted within 30 days causing significant cost to the healthcare system and often these patients have worse outcomes. We need continuing large-scale studies to identify quality measures to prevent readmission, improve mortality during readmission, and make better use of financial resources.

Contemporary studies demonstrate that non-ST-segment elevation myocardial infarction (NSTEMI) processes of care vary according to sex. Little is known regarding variation in practice between geographical areas and centres.

We identified 305 014 NSTEMI admissions in the United Kingdom (UK) Myocardial Ischaemia National Audit Project (MINAP), 2010-17, including female sex (110 209). Hierarchical, multivariate logistic regression models were fitted, assessing for differences in primary outcomes according to sex. Risk-standardized mortality rates (RSMR) were calculated for individual hospitals to illustrate the correlation with variables of interest. 'Heat maps' were plotted to show regional and sex-based variation in the opportunity-based quality indicator score (surrogate for optimal processes of care).

Women presented older (77 years vs. 69 years, P < 0.001) and were more often Caucasian (93% vs. 91%, P < 0.001). Women were less frequently managed with an invasive coronary angiogram (58% vs. 75%, P < 0.001) or percutaneous coronary intervention (35% vs. 49%, P < 0.001). In our hospital-clustered analysis, we show a positive correlation between the RSMR and the increasing proportion of women treated for NSTEMI (R2 = 0.17, P < 0.001). There was a clear negative correlation between the proportion of women who had an optimum OBQI score during their admission and RSMR (R2 = 0.22, P < 0.001), with a weaker correlation in men (R2 = 0.08, P < 0.001). Heat maps according to the Clinical Commissioning Group (CCG) demonstrate significant regional variation in the OBQI score, with women receiving poorer quality care throughout the UK.

There was a significant variation in the management of patients with NSTEMI according to sex, with widespread geographical variation. Structural changes are required to enable improved care for women.

The aim of this study was to investigate how diabetes mellitus affects longer term outcomes in individuals presenting to hospital with non-ST segment elevation myocardial infarction (NSTEMI).

We analysed data from 456,376 adults hospitalised between January 2005 and March 2019 with NSTEMI from the UK Myocardial Ischaemia National Audit Project (MINAP) registry, linked with Office for National Statistics death reporting. We compared outcomes and quality of care by diabetes status.

Individuals with diabetes were older (median age 74 vs 73 years), were more often of Asian ethnicity (13% vs 4%) and underwent revascularisation (percutaneous coronary intervention or coronary artery bypass graft surgery) (38% vs 40%) less frequently than those without diabetes. The mortality risk for those with diabetes compared with those without was significantly higher at 30 days (HR 1.19, 95% CI 1.15, 1.23), 1 year (HR 1.28, 95% CI 1.26, 1.31), 5 years (HR 1.36, 95% CI 1.34, 1.38) and 10 years (HR 1.39, 95% CI 1.36, 1.42). In individuals with diabetes, higher quality inpatient care, assessed by opportunity-based quality indicator (OBQI) score category ('poor', 'fair', 'good' or 'excellent'), was associated with lower mortality rates compared with poor care (good: HR 0.74, 95% CI 0.73, 0.76; excellent: HR 0.69, 95% CI 0.68, 0.71). In addition, compared with poor care, excellent care in the diabetes group was associated with the lowest mortality rates in the diet-treated and insulin-treated subgroups (diet-treated: HR 0.64, 95% CI 0.61, 0.68; insulin-treated: HR 0.69, CI 0.66, 0.72).

Individuals with diabetes experience disparities during inpatient care following NSTEMI. They have a higher risk of long-term mortality than those without diabetes, and higher quality inpatient care may lead to better long-term survival.

In this study, the relationship between C-reactive protein-albumin-lymphocyte (CALLY) index, a novel composite indicator based on inflammation and nutrition, and major adverse cardiovascular events (MACEs) was investigated in patients with ST-segment elevation myocardial infarction (STEMI).

This retrospective study included 438 patients with STEMI who were treated at a single center between January 2017 and December 2020. The CALLY index was calculated for each patient on admission. The predictive value of the CALLY index for short- and long-term MACEs was evaluated using the area under the curve (AUC) analysis, and the corresponding AUC values were calculated. Clinical characteristics were analyzed after categorizing the population based on the optimal cut-off value of the CALLY index. Multivariate Cox regression analysis was used to determine factors independently associated with MACEs, while logistic regression analysis was used to identify factors independently associated with the severity of coronary artery lesions. Kaplan-Meier estimation and log-rank test were used to assess event-free survival rates among different CALLY index groups. Additionally, Spearman's correlation test was used to determine the association between the CALLY index and the Gensini score.

The AUC for predicting short-term MACEs in STEMI patients using the CALLY index was 0.758, while the AUC for predicting long-term MACEs was 0.740. Similarly, the AUC values were 0.815 and 0.819, respectively, when evaluating the short- and long-term mortality rates using the CALLY index. Multivariable Cox regression analysis revealed that a high CALLY index (threshold of 1.50) independently reduced the risk of short-term MACEs in patients with STEMI (hazard ratio [HR] = 0.274, 95 % confidence interval [CI] = 0.121-0.621, P=0.002). Multivariable Cox regression also demonstrated that a high CALLY index (threshold > 0.91) independently reduced the occurrence of long-term MACEs during follow-up in STEMI patients (HR=0.439, 95 % CI=0.292-0.659, P<0.001). Furthermore, multivariate logistic regression analysis revealed that a high CALLY index (threshold > 1.13) independently reduced the risk of severe coronary artery lesions in patients with STEMI (odds ratio = 0.299 [95 % CI=184-0.485], P<0.001). A positive correlation was observed between the CALLY index and the Gensini score (P<0.001).

The CALLY index is a novel, convenient, and valuable prognostic indicator exhibiting a protective effect against both short- and long-term MACEs in patients with STEMI, emphasizing the significance of inflammation/nutrition in this patient population.

Heterophile antibodies, which can arise from infections, autoimmune disorders, or exposure to animal antigens, can interfere with immunoassays. These antibodies can cross-react with the test reagents used in troponin assays, causing a false elevation in troponin levels. The paper describes a case of a 37-year-old male drug abuser admitted to the emergency room with chest pain. A series of troponin measurements performed using different assays gave discrepant results. Only thanks to the use of Scantibodies HBT tubes, which remove heterophile antibodies, was it possible to make a correct diagnosis of troponin negativity. In conclusion, a correct laboratory/clinical approach to the identification of heterophile antibody interference is essential for accurate troponin testing in order to avoid false positive results. Implementing neutralizing tests can significantly improve the reliability of these diagnostic assays, ensuring better patient outcome.

Venous thromboembolism (VTE) involves the formation of a blood clot in a vein, and includes deep venous thrombosis (DVT) or pulmonary embolism (PE). The annual incidence for VTE varies from 0.75 to 2.69 per 1000 individuals, with about 40 million people worldwide impacted by VTE. Statins, 3-hydroxy-3-methylglutaryl (HMG)-coenzyme A (CoA) reductase inhibitors, inhibit cholesterol biosynthesis and display several vascular-protective effects, including antithrombotic properties. However, the potential role of statins in the primary prevention of VTE is still not clear.

To evaluate the benefits and risks of statins in preventing venous thromboembolism (VTE) in individuals with no prior history of VTE.

We used standard Cochrane search methods. The search was last updated on 13 March 2023.

We included randomized controlled trials (RCTs) comparing statins with any control intervention (including placebo and usual care) in healthy individuals or participants with conditions other than VTE. There were no restrictions on the dose, duration, route, or timing of statins.

We used standard Cochrane methods. Our primary outcomes were VTE, DVT, and PE. Our secondary outcomes were serious adverse events, adverse events, and mortality. We used the trial sequential analysis (TSA) method to judge whether the evidence was sufficient, and we used the GRADE approach to assess the certainty of the evidence for each outcome.

We included 27 RCTs involving 122,601 adults (aged 18 years and above) who were healthy, had various medical conditions (e.g. hypercholesterolemia), or were at risk for cardiovascular disease. Both males and females were included in all studies. Two studies focused solely on participants over 60 years of age. We deemed four studies to have a low risk of bias overall, while 19 were at high risk of bias, and four were unclear. The 27 studies compared use of statins versus placebo or usual care in individuals who had never experienced VTE. The statins used in the studies were atorvastatin, rosuvastatin, pravastatin, lovastatin, fluvastatin, and simvastatin. Twenty-three studies followed up participants for over a year, with six of those extending follow-ups for over five years. Twenty-five studies were based in hospitals, and 24 studies were funded by industry. Only one study used VTE as a primary endpoint. The median incidence of VTE in the statins group was 0.72% (ranging from 0% to 10.53%), and in the control group it was 0.89% (ranging from 0% to 6.83%). Our pooled analysis of the 27 studies showed that, relative to control groups, statins may slightly reduce the overall incidence of VTE (odds ratio (OR) 0.86, 95% confidence intervals (CI) 0.76 to 0.98; 27 studies, 122,601 participants; low-certainty evidence). Of the statins we evaluated, only rosuvastatin seemed to be associated with a reduced incidence of VTE, albeit the reduction in incidence was very small. The evidence did not clearly indicate a difference between groups in the incidence of DVT (OR 0.70, 95% CI 0.41 to 1.18; six studies, 40,305 participants; low-certainty evidence), PE (OR 0.83, 95% CI 0.46 to 1.52; five studies, 28,427 participants; low-certainty evidence), or myopathy (OR 1.10, 95% CI 0.83 to 1.45; 10 studies, 75,551 participants; low-certainty evidence). Nonetheless, statin use might slightly decrease the incidence of any serious adverse event (OR 0.95, 95% CI 0.91 to 0.99; 13 studies, 67,020 participants; low-certainty evidence) and any death (OR 0.90, 95% CI 0.86 to 0.95; 24 studies, 116,761 participants; low-certainty evidence), compared to control.

Using statins for the primary prevention of VTE may slightly reduce the incidence of VTE and all-cause mortality. However, this effect is likely too weak to be considered significant. Statin use may not decrease the occurrence of DVT and PE. The current evidence is insufficient to draw strong conclusions because of the risk of bias in the studies, imprecision in the effect estimates, and potential publication bias. More evidence from well conducted and fully reported RCTs is needed to assess the preventive effects of different types of statins, as well as the effects of different dosages and treatment durations in various populations.

Cardiovascular disease, kidney health, and metabolic disease (CKM) syndrome is associated with significant morbidity and mortality, particularly from congestive heart failure (CHF). Guidelines recommend measurement of cardiac troponin (cTn) to identify subclinical heart failure (HF) in diabetics/CKM. However, appropriate thresholds and the impact from routine screening have not been elucidated.

cTnI was assessed using the Abbott high sensitivity (hs)-cTnI assay in outpatients with physician-ordered hemoglobin A1c (Hb A1c) and associated with cardiac comorbidities/diagnoses, demographics, and estimated glomerular filtration rate (eGFR). Risk thresholds used in CKM staging guidelines of >10 and >12 ng/L for females and males, respectively, were used. Multivariate logistic regression was applied. hs-cTnI was assessed in a high-fat-diet induced murine model of obesity and diabetes.

Of 1304 patients, 8.0% females and 15.7% males had cTnI concentrations above the risk thresholds. Thirty-one (4.2%) females and 23 (4.1%) males had cTnI above the sex-specific 99% upper reference limit. A correlation between hs-cTnI and Hb A1c (R = 0.2) and eGFR (R = -0.5) was observed. hs-cTnI concentrations increased stepwise based on A1C of <5.7% (median = 1.5, IQR:1.3-1.8), 5.7%-6.4% (2.1, 2.0-2.4), 6.5%-8.0% (2.8, 2.5-3.2), and >8% (2.8, 2.2-4.3). Male sex (P < 0.001), eGFR (P < 0.001), and CHF (P = 0.004) predicted elevated hs-cTnI. Obese and diabetic mice had increased hs-cTnI (7.3 ng/L, 4.2-10.4) relative to chow-fed mice (2.6 ng/L, 1.3-3.8).

A high proportion of outpatients with diabetes meet criteria for subclinical HF using hs-cTnI measurements. Glucose control is independently associated with elevated cTnI, a finding replicated in a murine model of metabolic syndrome.

Studies evaluating alterations in cardiac biomarkers in rapid sport-associated weight loss (RWL) and high-intensity sport-specific training (HISST) are lacking. This pilot study aimed to examine the effects of RWL and HISST on heart rate, blood pressure, cardiac biomarkers, and left ventricular systolic function. Nine elite male judokas participated in the presented survey.

The athletes underwent a baseline assessment and two testing protocols, the first phase with RWL where they had to lose 5% of their body weight simultaneously with HISST, and the second phase after 7 days, in which only HISST was performed. Participants underwent electrocardiogram, biomarker, and transthoracic echocardiogram evaluation after each phase.

In the first phase (RWL and HISST) athletes, heart rate increased significantly, 58.11 (7.78) versus 79 (9.25), P=0.001; as well as cardiac biomarkers: lactate dehydrogenase isoenzyme 175.33 (31.22) vs. 238.56 (56), P=0.003; aspartate aminotransferase 16.56 (4.61) vs. 29 (9.96), P=0.027; creatine kinase isoenzyme-MB 13 (11.5;24) vs. 29.11 (10.05), P=0.004; and high sensitivity cardiac troponin 10 (0) vs. 14.49 (6.4), P=0.045. In the second phase, only HISST was associated with a significant increase in the alanine aminotransferase isoenzyme, 37.78 (11.22) vs. 26 (8.03), P=0.024, together with creatine kinase 472 (185;654) vs. 166.88 (56.57), P=0.01, compared to the initial measurement.

RWL combined with HISST produced significant alterations in cardiac biomarkers without impairment of left ventricular systolic function.

For patients considering surgery, the preoperative evaluation allows physicians to identify and treat acute cardiac conditions before less-urgent surgery, predict the benefits and harms of a proposed surgery, and make temporary management changes to reduce operative risk. Multiple risk prediction tools are reasonable for use in estimating perioperative cardiac risk, but management changes to reduce risk have proven elusive. For all but the most urgent surgical procedures, patients with active coronary syndromes or decompensated heart failure should have surgery postponed.

Since 2000, the definition of myocardial infarction (MI) has evolved with reliance on cardiac troponin (cTn) tests. The implications of this change on trends of acute coronary syndrome (ACS) subtypes obtained from routinely collected hospital morbidity data are unclear. Using person-linked hospitalisation data, we compared International Classification of Diseases (ICD)-coded data with biomarker-classified admission rates for ST-segment elevation MI (STEMI), non-STEMI (NSTEMI) and unstable angina (UA) in Western Australia (WA).

We used linked hospitalisation data from all WA tertiary hospitals to identify patients with a principal diagnosis of STEMI, NSTEMI or UA between 2002 and 2016. Linked biomarker results were classified as 'diagnostic' for MI according to established criteria. We calculated age-standardised and sex-standardised rates (ASSRs) for ICD-coded versus biomarker-classified admissions by ACS subtypes and estimated annual change in admissions using Poisson regression adjusting for age and sex.

There were 37 272 ACS admissions in 30 683 patients (64.2% male), and 96% of cases had linked biomarker data, predominantly conventional cTn at the start and high-sensitive cTn from late 2013. Despite lower ASSRs, trends in MI classified with a diagnostic biomarker were concordant with ICD-coded admissions rates for both STEMI and NSTEMI. Between 2002 and 2010, STEMI rates declined by 4.1% (95% CI 5.0%, 3.1%) and 3.4% (95% CI 4.6%, 2.3%) in ICD-coded and biomarker-classified admissions, respectively, and both plateaued thereafter. For NSTEMI between 2002 and 2010, the ICD-coded and biomarker-classified rates increased 8.0% per year (95% CI 7.2%, 8.9%) and 8.0% (95% CI 7.0%, 9.0%), respectively, and both subsequently declined. For UA, both ICD-coded and biomarker-classified UA admission rates declined in a steady and concordant manner between 2002 and 2016.

The present study supports the validity of using administrative data to monitor population trends in ACS subtypes as they appear to generally reflect the redefinition of MI in the troponin era.

Cardiac troponin I (cTnI) monitoring is of great value in the clinical diagnosis of acute myocardial infarction (AMI). In this paper, a highly sensitive electrochemical aptamer sensor using polystyrene (PS) microspheres as the electrode substrate material in combination with Prussian blue (PB) and gold nanoparticles (AuNPs) was demonstrated for the sensitive and label-free determination of cTnI. PS microspheres were synthesized by emulsion polymerization and then dropped onto the glassy carbon electrode (GCE); PB and AuNPs were electrodeposited on the electrode in corresponding electrolyte solutions step by step. The PS microsphere substrate provided a large surface area for the loading mass of the biological affinity aptamers, while the PB layer improved the electrical conductivity of the modified electrode, and the electroactive AuNPs exhibited excellent catalytic performance for the subsequent electrochemical measurements. In view of the above mentioned AuNPs/PB/PS/GCE sensing platform, the fabricated label-free electrochemical aptamer sensor exhibited a wide detection range of 10 fg/mL~1.0 μg/mL and a low detection limit of 2.03 fg/mL under the optimal conditions. Furthermore, this biosensor provided an effective detection platform for the analysis of cTnI in serum samples. The introduction of this sensitive electrochemical aptamer sensor provides a reference for clinically sensitive detection of cTnI.

Patients with lower socioeconomic status (SES) have poorer outcomes following acute myocardial infarction (AMI) than patients with higher SES; however, how sex modifies socioeconomic differences is unclear. Using the United Kingdom (UK) Myocardial Ischaemia National Audit Project (MINAP) registry, alongside Office of National Statistics (ONS) mortality data, we analyzed 736,420 AMI patients between 2005 and 2018, stratified by Index of Multiple Deprivation (IMD) score Quintiles (most affluent [Q1] to most deprived [Q5]). There was no significant difference in probability of in-hospital mortality in our adjusted model according to sex. The probability of 30-day mortality in our adjusted model was similar between men and women throughout Quintiles, ((Q5; Men 7.6%; 95% CI 7.3-7.8% (P < .001), Women; 7.0%; 95% CI 6.8-7.3%, P < .001)) ((Q1; Men 7.1%; 95% CI 6.8-7.4%, P < .001, Women; 6.9%; 95% CI 6.6-7.1%, P < .001)). The probability of one-year mortality in our adjusted model was higher in men throughout all Quintiles (Q1; Men 15.0%; 95% CI 14.8-15.6%), P < .001, Women; 14.5%; 95% CI 14.2-14.9%, P < .001) (Q5; Men 16.9%; 95% CI 16.5-17.3%, P < .001, Women; 15.5%; 95% CI 15.1-15.9 by %, P < .001). Overall, female sex did not significantly influence the effect of deprivation on AMI processes of care and outcomes.

We present the case of a 57-year-old woman with a history of breast implants after augmentation mastopexy and persistent breast pain for six months. Despite a previous implant exchange with capsulectomy, the patient experienced a recurrence of symptoms for the last six months with a sudden worsening during the last night. Clinical examination revealed an asymmetry in favour of the left breast, but otherwise no clear evidence of implant-associated complication. The reported pain started retrosternally and radiated to the left scapula and arm. An acute myocardial infarction was suspected. Subsequent investigations confirmed a ST-elevation myocardial infarction. The patient received immediate cardiac catheterization, addressing an acute occlusion of the left anterior descending artery, followed by dual antiplatelet therapy. Despite successful treatment of the myocardial infarction, the patient continued to report pain in her left breast. In addition, inflammatory markers were significantly elevated. After excluding other possible sources of infection, sonography confirmed the suspicion of an implant infection. A multidisciplinary team approach guided therapeutic decision-making, balancing the high cardiovascular risk with the need to manage the implant-associated infection. Empirical antibiotic therapy and implant removal under sedoanalgesia facilitated resolution of symptoms and infection. This case highlights the importance of maintaining a broad differential diagnosis in patients presenting with breast implant-related concerns, particularly in those with concomitant cardiovascular risk factors.

Trials suggest patients with ST-elevation myocardial infarction (STEMI) without 'standard modifiable cardiovascular risk factors' (SMuRFs) have poorer outcomes, but the role of ethnicity has not been investigated. We analyzed 118,177 STEMI patients using the Myocardial Ischaemia National Audit Project (MINAP) registry. Clinical characteristics and outcomes were analyzed using hierarchical logistic regression models; patients with ≥1 SMuRF (n = 88,055) were compared with 'SMuRFless' patients (n = 30,122), with subgroup analysis comparing outcomes of White and Ethnic minority patients. SMuRFless patients had higher incidence of major adverse cardiovascular events (MACE) (odds ratio, OR: 1.09, 95% CI 1.02-1.16) and in-hospital mortality (OR: 1.09, 95% CI 1.01-1.18) after adjusting for demographics, Killip classification, cardiac arrest, and comorbidities. When additionally adjusting for invasive coronary angiography (ICA) and revascularisation (percutaneous coronary intervention (PCI) or coronary artery bypass grafts surgery (CABG)), results for in-hospital mortality were no longer significant (OR 1.05, 95% CI .97-1.13). There were no significant differences in outcomes according to ethnicity. Ethnic minority patients were more likely to undergo revascularisation with ≥1 SMuRF (88 vs 80%, P < .001) or SMuRFless (87 vs 77%, P < .001. Ethnic minority patients were more likely undergo ICA and revascularisation regardless of SMuRF status.