Nicola Olivito, Fabienne Foster Witassek, Hans Rickli
et al.
Abstract Aims Contemporary data on the impact of high-grade atrioventricular blocks (HAVB) in acute myocardial infarction (AMI) are scarce. Therefore, we investigated this in the Swiss national AMI registry (AMIS Plus) cohort. Methods and results We included all AMI patients enrolled from January 2005 to September 2024 with available ECG information. Primary outcome was in-hospital mortality; secondary outcomes included in-hospital major adverse cardiac or cerebrovascular events (MACCE) defined as cardiogenic shock, stroke, re-infarction or death. Among 50 279 AMI patients, 747 (1.5%) patients presented with HAVB and 407 (0.8%) developed HAVB during hospitalization. Patients presenting with HAVB had increased in-hospital mortality (15% vs. 4.9%; P < 0.001) and MACCE (17% vs. 6.0%; P < 0.001) compared with those without HAVB. High-grade atrioventricular blocks on admission was an independent predictor for in-hospital mortality (OR 1.89; 95% CI, 1.42–2.49; P < 0.001), with a stronger impact on mortality in the setting of anterior compared to non-anterior AMI (OR 3.69; 95% CI, 1.99–6.81; pinteraction = 0.02). Independent predictors for HAVB on admission included STEMI and female sex. Rates of permanent pacemaker implantation during hospitalization in patients with HAVB on admission were higher in NSTEMI than STEMI patients (20% vs. 4.4%; P < 0.001). High-grade atrioventricular blocks occurring during hospital stay was associated with higher mortality (20% vs. 15%; P = 0.031) and higher permanent pacemaker rate (25% vs. 8%; P < 0.001) than HAVB on admission. Conclusion High-grade atrioventricular blocks in AMI was associated with high in-hospital mortality, especially in anterior AMI or if occurring during hospitalization. Permanent pacemaker implantation was more frequent in the setting of NSTEMI and among patients developing HAVB during hospital stay.
Micha T Maeder, Fabienne Foster-Witassek, Dragana Radovanovic
et al.
Abstract Aims While the beneficial effect of beta-blocker (BB) therapy for acute coronary syndrome (ACS) patients with a left ventricular ejection fraction (LVEF) of 40% is established, its role in those with LVEF > 40% is controversial. We assessed the relationship between BB therapy at discharge and 1-year mortality according to LVEF in a large contemporary acute coronary syndrome (ACS) cohort. Methods and results Patients enrolled in the Acute Myocardial Infarction in Switzerland (AMIS) Plus registry between 2005 and 2024 with information on BB at discharge, LVEF, and 1-year mortality were studied. The association between BB therapy and 1-year mortality and the interaction with LVEF (>40% vs. ≤40%) were analysed. Among 7820 patients (65% with ST-segment elevation myocardial infarction), 1570 (20.1%) had LVEF ≤ 40%. At discharge, 6211/7820 (79.4%) patients were on BB (LVEF > 40%, 78.1%; LVEF ≤ 40%, 84.5%). One-year mortality was higher in patients with LVEF ≤ 40% vs. >40% (7.1% vs. 2.3%; P < 0.001). Overall, BB therapy was associated with reduced mortality [unadjusted odds ratio 0.67 (95% confidence interval 0.51–0.89); P = 0.005]. Among patients with LVEF ≤ 40%, mortality was lower in patients with BB compared with those without (5.9% vs. 14%; P < 0.001). In contrast, in patients with LVEF > 40%, mortality did not differ between patients with and without BB (2.1% vs. 2.6%; P = 0.3). A statistically significant interaction between BB therapy and LVEF stratum was identified (pinteraction = 0.02). Conclusion Data from our large, nationwide registry suggest an overall benefit of BB therapy at discharge on 1-year mortality in ACS with most of the survival advantage observed in patients with LVEF < 40%.
Marco Roberto, Dragana Radovanovic, Carmelo Buttà
et al.
Abstract OBJECTIVES Despite guideline recommendations, previous reports, coming mainly from outside Europe, showed low rates of prescriptions for dual antiplatelet therapy (DAPT) in patients with acute myocardial infarction (AMI) undergoing surgical revascularization. The present study assesses this issue in the era of potent P2Y12 inhibitors in Switzerland. METHODS All patients with a diagnosis of AMI included in the Acute Myocardial Infarction in Switzerland Plus Registry from January 2014 to December 2019 were screened; 9050 patients undergoing either percutaneous (8727, 96.5%) or surgical (323, 3.5%) revascularization were included in the analysis. RESULTS Surgically treated patients were significantly less likely to receive DAPT at discharge (56.3% vs 96.7%; P < 0.001). Even when discharged with a prescription for DAPT, those patients were significantly less likely to receive a regimen containing a new P2Y12 inhibitor (67/182 [36.8%] vs 6945/8440 [83.2%]; P < 0.001). At multivariate analysis, surgical revascularization was independently associated with a lower likelihood of receiving a prescription for DAPT at discharge (odds ratio 0.03, 95% confidence interval 0.02–0.06). CONCLUSIONS DAPT prescriptions for patients with AMI undergoing surgical revascularization are not in line with current guideline recommendations. Efforts are necessary to clarify the role of DAPT for secondary prevention in these patients and increase the confidence of treating physicians in guideline recommendations. Clinical trial registration Acute Myocardial Infarction in Switzerland Plus Registry; registration number at ClinicalTrials.gov: NCT01305785.
Raban V. Jeger, Otmar Pfister, Dragana Radovanovic
et al.
BackgroundData on temporal trends of heart failure (HF) in acute coronary syndrome (ACS) are scarce.HypothesisImproved treatment options may have led to lower case‐fatality rates (CFRs) during the last years in ACS complicated by HF.MethodsPatients of the nationwide Acute Myocardial Infarction in Switzerland (AMIS)–Plus ACS registry were analyzed from 2000 to 2014.ResultsOf 36 366 ACS patients, 3376 (9.3%) had acute or chronic HF, 2111 (5.8%) de novo acute HF (AHF), 964 (2.7%) chronic HF (CHF), and 301 (0.8%) acute decompensated CHF (ADCHF). In‐hospital CFRs were highest in patients with ADCHF (32.6%) and de novo AHF (29.7%), followed by patients with CHF (12.9%) and without HF (3.2%, P < 0.001). Although in‐hospital CFRs gradually decreased in CHF patients (14.3% to 4.5%, P = 0.003) and patients without HF (3.5% to 2.2%, P < 0.001), they remained high in patients with ADCHF (36.4% to 40.0%, P = 0.45) and de novo AHF (50.0% to 29.4%, P = 0.37). Although there was an increase in specific ACS therapies in the cohort over time, ACS patients with HF received significantly less pharmacological and interventional ACS therapies than patients without HF. There was no significant change in HF medication rates except less frequent use of β‐blockers and diuretics in de novo AHF patients in recent years.Conclusions HF is present in 1 out of 10 patients presenting with ACS and is associated with high in‐hospital CFRs, particularly in acute HF. Although advances in ACS therapy improved in‐hospital CFRs in patients with no HF or CHF, CFRs remained unchanged and high in patients with acute HF and ACS over the last decade.
Xiaomin Zhang, Gohar Azhar, Emmanuel D. Williams
et al.
The microRNAs and microRNA clusters have been implicated in normal cardiac development and also disease, including cardiac hypertrophy, cardiomyopathy, heart failure, and arrhythmias. Since a microRNA cluster has from two to dozens of microRNAs, the expression of a microRNA cluster could have a substantial impact on its target genes. In the present study, the configuration and distribution of microRNA clusters in the mouse genome were examined at various inter-microRNA distances. Three important microRNA clusters that are significantly impacted during adult cardiac aging, the miR-17-92, miR-106a-363, and miR-106b-25, were also examined in terms of their genomic location, RNA transcript character, sequence homology, and their relationship with the corresponding microRNA families. Multiple microRNAs derived from the three clusters potentially target various protein components of the cdc42-SRF signaling pathway, which regulates cytoskeleton dynamics associated with cardiac structure and function. The data indicate that aging impacted the expression of both guide and passenger strands of the microRNA clusters; nutrient stress also affected the expression of the three microRNA clusters. The miR-17-92, miR-106a-363, and miR-106b-25 clusters are likely to impact the Cdc42-SRF signaling pathway and thereby affect cardiac morphology and function during pathological conditions and the aging process.
Daniel K. White, Tuhina Neogi, Yuqing Zhang
et al.
Practice guidelines recommend addressing obesity for people with knee OA, however, the association of obesity with walking independent of pain is not known. We investigated this association within the Multicenter Osteoarthritis Study, a cohort of older adults who have or are at high risk of knee OA. Subjects wore a StepWatch to record steps taken over 7 days. We measured knee pain from a visual analogue scale and obesity by BMI. We examined the association of obesity with walking using linear regression adjusting for pain and covariates. Of 1788 subjects, the mean steps/day taken was8872.9±3543.4. Subjects with a BMI ≥35 took 3355 fewer steps per day independent of knee pain compared with those with a BMI ≤25 (95% CI −3899, −2811). BMI accounted for 9.7% of the variability of walking while knee pain accounted for 2.9%. BMI was associated with walking independent of knee pain.
This paper is a continuation of papers: arXiv:0707.1766 [math.AG] and arXiv:0912.1577 [math.AG]. Using the two-dimensional Poisson formulas from these papers and two-dimensional adelic theory we obtain the Riemann-Roch formula on a projective smooth algebraic surface over a finite field.
Using Galois Theory, we construct explicitly absolutely simple (principally polarized) Prym varieties that are not isomorphic to jacobians of curves even if we ignore the polarizations. Our approach is based on the previous papers math/0610138 [math.AG] and math/0605028 [math.AG] .
In math.AG/0108089, math.AG/0212090 and math.AG/0308247 we gave numerical conditions which ensure that an equisingular family is irreducible respectively T-smooth. Combining results by Greuel, Lossen and Shustin and an idea from math.AG/9802009 we give in the present paper series of examples of families of irreducible curves on surfaces in projective three-space with only ordinary multiple points which are reducible and where at least one component does not have the expected dimension. The examples show that for families of curves with ordinary multiple points the conditions for T-smoothness in math.AG/0308247 have the right asymptotics.
Let $X$ be a K3 surface, and $H$ its primitive polarization of the degree $H^2=8$. The moduli space of sheaves over $X$ with the isotropic Mukai vector $(2,H,2)$ is again a K3 surface, $Y$. In math.AG/0206158 we gave necessary and sufficient conditions in terms of Picard lattice of $X$ when $Y$ is isomorphic to $X$. The proof of sufficient condition in math.AG/0206158, when $Y$ is isomorphic to $X$, used Global Torelli Theorem for K3 surfaces, and it was not effective. Here we give an effective variant of these results: its sufficient part gives an explicit isomorphism between $Y$ and $X$. We hope that our similar results in math.AG/0304415, math.AG/0307355, math.AG/0309348 for arbitrary primitive isotropic Mukai vector on a K3 surface also can be made effective.
Based on the duality between open-string theory on noncompact Calabi-Yau threefolds and Chern-Simons theory on three manifolds, M Marino and C Vafa conjectured a formula of one-partition Hodge integrals in term of invariants of the unknot (hep-th/0108064). Many Hodge integral identities, including the lambda_g conjecture and the ELSV formula, can be obtained by taking limits of the Marino-Vafa formula. Motivated by the Marino-Vafa formula and formula of Gromov-Witten invariants of local toric Calabi-Yau threefolds predicted by physicists, J Zhou conjectured a formula of two-partition Hodge integrals in terms of invariants of the Hopf link (math.AG/0310282) and used it to justify physicists' predictions (math.AG/0310283). In this expository article, we describe proofs and applications of these two formulae of Hodge integrals based on joint works of K Liu, J Zhou and the author (math.AG/0306257, math.AG/0306434, math.AG/0308015, math.AG/0310272). This is an expansion of the author's talk of the same title at the BIRS workshop: "The Interaction of Finite Type and Gromov-Witten Invariants", November 15--20, 2003.
The aim of this paper is to clarify and generalize techniques of works alg-geom/9711024 (see also math.AG/9810097 and math.AG/9901004). Roughly speaking, we prove that for local Fano contractions the existence of complements can be reduced to the existence of complements for lower dimensional projective Fano varieties.
We produce a canonical filtration for locally free sheaves on an open p-adic annulus equipped with a Frobenius structure. Using this filtration, we deduce a conjecture of Crew on p-adic differential equations, analogous to Grothendieck's local monodromy theorem (also a consequence of results of Andre and of Mebkhout). Namely, given a finite locally free sheaf on an open p-adic annulus with a connection and a compatible Frobenius structure, the corresponding module admits a basis over a finite cover of the annulus on which the connection acts via a nilpotent matrix. Note: this preprint improves on results from our previous preprints math.AG/0102173, math.AG/0105244, math.AG/0106192, math.AG/0106193 but does not explicitly invoke any results from these preprints.
This is the fourth in a series of papers math.AG/0312190, math.AG/0503029, math.AG/0410267 on configurations in an abelian category A. Given a finite partially ordered set (I,<), an (I,<)-configuration is a finite collection of objects and morphisms in A satisfying some axioms. Configurations describe how an object X in A decomposes into subobjects. The first paper math.AG/0312190 defined configurations and studied moduli spaces Obj_A, M(I,<)_A of objects and (I,<)-configurations in A, using the theory of Artin stacks. The second math.AG/0503029 considered algebras of constructible functions and "stack functions" on Obj_A, using the theories developed in math.AG/0403305, math.AG/0509722. The third math.AG/0410267 introduced stability conditions (t,T,<) on A, and showed the moduli space Obj_{ss}^a(t) of t-semistable objects in class a in A is a constructible set in Obj_A, so its characteristic function d_{ss}^a(t) is constructible. It proved many identities on constructible and stack functions such as d_{ss}^a(t). This paper first studies how Obj_{ss}^a(t) changes as we vary the stability condition (t,T,<) to (t',T',<), by writing d_{ss}^a(t') as a sum of products of d_{ss}^b(t). Then we discuss invariants I_{ss}^a(t) or I_{ss}(I,<,k,t) 'counting' t-semistable objects and configurations in A, satisfying identities and transformation laws from (t,T,<) to (t',T',<). We compute the invariants when A is a category mod-KQ of representations of a quiver Q or coh(P) of coherent sheaves on a smooth projective curve P. We find special properties of the invariants when A=coh(P) for P a surface with K_P^{-1} nef, or P a Calabi-Yau 3-fold.