Risk in vulnerable groups 963 on MACEs. A total of 56,607 subjects were included, of whom 23,530 (41.6%) had concomitant OA. The crude MACE rates were significantly higher in hypertensive patients with OA than those without OA, except for ESRD (all p < 0.05). After adjusting the birth year and sex, the adjusted ORs (95% confidence interval (CI) and p-values) for MACE in patients with both OA and HTN were all significantly higher with 3.09 (2.69-3.54) in MI; 2.47 (2.22-2.75) in stroke; 2.40 (2.06-2.79) in CHF; 1.75 (1.48-2.08) in ESRD and 4.77 (4.38-5.19) in PVD (all p <0.0001), respectively. In the prospective study, when compared with controls and after adjusting the birth year and sex, the adjusted HRs of cases with OA for total MACEs, hospitalized MI, stroke, CHF, PVD and ESRD with dialysis were 2.13 (2.02-2.25), 2.11 (1.86-2.40), 2.07 (1.94-2.20), 2.34 (2.12-2.58), 2.72 (2.41-3.06) and 1.78 (1.542.04) (all p< 0.0001), respectively.In addition, the risks for developing traditional CV risk factors including hypertension, DM and dyslipidemia (all p <0.00001) were also significantly increased in OA patients. Conclusion: Results from this study highlight the risks for developing composite and each MACE (MI, stroke, CHF, ESRD and PVD) rates were significantly higher in patients with OA. Figure 1 P5174 | BEDSIDE The effect of LP(a) in patients with heterozygous familial hypercholesterolemia on coronary plaque burden and calcium score determined by CT S. Bos 1 , G.-J.R. Ten Kate 2 , E.J.G. Sijbrands 1 , M.T. Mulder 1 , J.E. Roeters Van Lennep 1 . 1 Erasmus Medical Center, Dpt Internal Medicine, Div. of Pharmacology, Vascular & Metabolic Diseases, Rotterdam, Netherlands; 2 Erasmus Medical Center, Department of Radiology, Rotterdam, Netherlands P5172 | BEDSIDE Maternal hypercholesterolemia during pregnancy is associated with severity of myocardial infarction in young adults Rationale: People with heterozygous familial hypercholesterolemia (FH) have a genetic predisposition for developing premature cardiovascular disease (CVD). However the clinical phenotype of FH has a high variability which is due to metabolic and environmental factors. One of the metabolic factors that increase the risk for pre-mature CVD might be Lp(a). Previous studies have identified Lp(a) as an independent risk factor for cardiovascular disease. The goal of our study was to analyze the association between calcium scores and coronary plaque burden in relation with plasma Lp(a) levels in patients with FH and to study whether this association was similar in men and women. Methods and results: From February 2008 until June 2011 145 (93 men, age 52±8) patients with a clinical diagnosis of FH visiting the outpatient clinic for lipid disorders in the Medical Centre were included. These patients underwent a CT coronary angiography to determine the coronary plaque burden and calcium score. From 131 (84 men, age 53±8) of these patients blood was collected and Lp(a) levels were measured. Lp(a) levels were subsequently related to total coronary calcium score(TCS) and coronary plaque burden. Coronary plaque burden is described as diseased coronary segment score per patient (DSS). DDS and TCS were analyzed in a group with low Lp(a) <0,300 g/L and with high Lp(a) >1,000 g/L levels, adjusted for sex, using the Mann-Whitney U test. In men no significant differences in DSS (p=0,960) and TCS (p=0,400) were found if Lp(a) was determined. In women significantly higher DSS (p=0,022) and TCS (p=0,004) were found in the high-Lp(a) group. Conclusion: Our data show a higher amount of DSS and TCS in women with high Lp(a) levels in comparison with women with a low Lp(a). In men no difference in DSS and TCS is found between high and low Lp(a) groups. We show that serum levels of Lp(a) is associated with disease severity in FH women and not in FH men. Clinical relevance: High LP(a) levels in FH women are associated with advanced subclinical atherosclerosis. Therefore, we can identify a high risk subgroup in which we should attain an even more strict cardiovascular risk reduction. A. Liguori 1 , G. Bruzzese 1 , F. Cacciatore 2 , F. De Nigris 3 , P. Abete 4 , L. Sommese 5 , W. Palinski 6 , C. Napoli 3 . 1 ASL NA1, Pellegrini Hospital, Department of Cardiology-UTIC, Naples, Italy; 2 Salvatore Maugeri Foundation, IRCCS, Department of Cardiac Rehabilitation, Telese Terme, Italy; 3 Second University of Naples, School of Medicine, Dept of Gen Pathol, Excellence Centre on CVD, Naples, Italy; 4 University of Naples Federico II, Dpt of Clinical Medicine, Cardiovascular & Immunological Science, Naples, Italy; 5 UOC of Immunohematology and Transplantation, Second University of Naples, Naples, Italy; 6 University of California, San Diego, Department of Medicine, San Diego, United States of America Background: Elevated Maternal Cholesterol during Pregnancy (MCP) enhances atherogenesis in childhood, but its impact on acute myocardial infarction (AMI) in adults is unknown. Methods: 89 AMI patients meeting narrow criteria (born after 1945, typical chest pain, transmural infarction Q-waves, elevated creatinine kinase, no cerebrovascular or terminal disease) were identified among patients admitted to coronary care unit in Naples, Italy. Patients were classified by MI severity (severe=involving 3 arteries, left ventricle ejection fraction ≤35, CK-peak >1200 mg/dl, or CK-MB >200 mg/dl). The association of MCP with AMI severity was tested by linear and multiple regression analysis that included conventional cardiovascular risk factors, gender, age, and treatment. Associations of MCP with BMI was assessed by linear correlation. Results: MCP correlated with four measures of AMI severity: number of vessels (β=0.382, p=0.001), ejection fraction (β=-0.315, p=0.003), CK (β=0.260, p=0.014) and CK-MB (β=0.334, p=0.001), as well as survival time (β=-0.252, p=0.031). In multivariate analysis of patients stratified by AMI severity, MCP predicted AMI severity independently of age, gender, and CHD risk factors (OR=1.304, 95% CI 1.107-1.559; p=0.004). Screening for point mutations ruled out that this was due to certain inherited differences in lipid metabolism. Survival was affected mainly by AMI severity. Conclusions: MCP is associated with adult BMI, atherosclerosis-related risk and severity of AMI. P5173 | BENCH Osteoarthritis is an independent risk factor for major adverse cardiovascular events-nationwide case-control studies K.-H. Cheng, C.-S. Chu, K.-T. Lee, Y.-H. Yang, W.-C. Tsai, W.-H. Tang, S.-H. Sheu, W.-T. Lai. Kaohsiung Medical University Hospital, Kaohsiung, Taiwan Purpose: The impact of osteoarthritis (OA) on major adverse cardiovascular events (MACEs) remains unclear. We examined the total and each risk of MACEs associated with OA in a nation-wide study. Methods: A retrospective, case-control study was designed among middle-aged patients (aged 30-60 years) with essential hypertension to alleviate the fundamental issue of hypertension relevant MACEs raised by the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and/or COX-2 selective inhibitor (coxibs). After that, a further prospective study could be designed to test the causality of OA to MACEs (MI, stroke, CHF, ESRD and PVD) Results: In the first retrosepective study, patients with hypertension, on at least 3 visits, without pre-defined MACEs at the first year (in 1996) were retrieved from Taiwan National Health Insurance Research Dataset to test the concomitant OA P5175 | BEDSIDE Albuminuria significantly predicts cardiovascular events in patients with type 2 diabetes independently from the baseline coronary artery state P. Rein 1 , C.H. Saely 1 , D. Zanolin 2 , A. Vonbank 3 , H. Drexel 4 . 1 Academic Teaching Hospital, Department of Internal Medicine, Fedlkirch, Austria; 2 VIVIT Institute, Feldkirch, Austria; 3 Private University of the Principality of Liechtenstein, Triesen, Liechtenstein; 4 Drexel University College of Medicine, Philadelphia, United States of America Purpose: Albuminuria is an important indicator of cardiovascular risk. We have recently shown that it is also associated with angiographically determined coronary artery disease (CAD). Whether albuminuria predicts cardiovascular events independently of the baseline coronary artery state in patients with type 2 diabetes (T2DM) has not been investigated yet. Methods: We measured urinary albumin and creatinine concentrations in 211 consecutive patients with T2DM undergoing coronary angiography for the evaluation of suspected or established stable CAD. Albuminuria was defined as a urinary albumin to creatinine ratio (ACR) of 30 μg/mg or greater. Prospectively, we recorded vascular events over 3.2±1.4 years. Results: During follow up, 24.6% of our patients suffered cardiovascular events. The cardiovascular event rate was significantly higher in patients with albuminuria (n=85) than in those with normoalbuminuria (35.3 vs. 17.5%; p=0.003). Cox regression analysis adjusting for age, gender, BMI, smoking, systolic and dias- Downloaded from by guest on November 20, 2014 Conclusions: Low levels of eGFR, females, and the presence of ulcer-like projection, but not the Stanford classification were predictive of long-term outcomes in patients with intensive medical treatment for acute aortic dissection. 964 Risk in vulnerable groups / Streaming the management of STEMI tolic blood pressure, LDL cholesterol, HDL cholesterol, eGFR, and use of ace inhibitors/angiotensin II antagonists confirmed that albuminuria significantly predicted cardiovascular events independently from conventional risk factors (adjusted HR 1.96 [1.11-3.46]; p=0.021). Further adjustment for the angiographically determined presence of CAD at baseline did not significantly attenuate the predictive power of the ACR (HR 1.84 [1.04-3.27]; p=0.037). Similar results were obtained when the ACR was entered into the final regression model as a continuous variable (standardized adjusted HR 1.30 [1.02-1.65]; p=0.037). Conclusions: Albuminuria significantly predicts cardiovascular events in patients with T2DM independently of established cardiovascular risk factors and of the baseline coronary artery state. STREAMING THE MANAGEMENT OF STEMI P5308 | BEDSIDE Leptin predicts independently a first-ever STEMI in men, data from a large prospective nested case-referent study S. Soderberg 1 , M. Eriksson 2 , P. Wennberg 3 , G. Hallmans 4 , L. Weinehall 5 , T. Olsson 2 , J.H. Jansson 2 . 1 Umea University, Department of Public Health and Clinical Medicine, Cardiology, and Heart Centre, Umea, Sweden; 2 Umea University, Department of Public Health and Clinical Medicine, Medicine, Umea, Sweden; 3 Umea University, Department of Public Health and Clinical Medicine, Family Medicine, Umea, Sweden; 4 Umea University, Department of Public Health and Clinical Medicine, Nutritional Research, Umea, Sweden; 5 Umea University, Department of Public Health and Clinical Medicine, Epidemiology, Umea, Sweden P5309 | BEDSIDE Comparison of infarct size and left ventricular ejection fraction as surrogate endpoints for STEMI trials: evaluating the strength of the evidence P5310 | BEDSIDE Increased 3-year-mortality after acute myocardial infarction in patients with newly diagnosed diabetes - results of SWEETHEART A.K. Gitt 1 , F. Towae 2 , A. Papp 2 , U. Zeymer 1 , R. Zahn 2 , S. Schneider 3 , O. Schnell 4 , D. Tschoepe 5 , J. Senges 3 on behalf of SWEETHEART Study Group. 1 Herzzentrum Ludwigshafen, Med. Klinik B, Kardiologie + Institut f. Herzinfarktforschung Ludwigshafen, Ludwigshafen am Rhein, Germany; 2 Herzzentrum Ludwigshafen, Med. Klinik B, Kardiologie, Ludwigshafen am Rhein, Germany; 3 Institut f. Herzinfarktforschung Ludwigshafen, Ludwigshafen am Rhein, Germany; 4 Diabetes Research Institute, Munich, Germany; 5 Heart and Diabetes Center NRW, Bad Oeynhausen, Germany Background: Many patients (pts) with coronary artery disease (CAD) suffer from diabetes. Joint guidelines of the ESC and the EASD recommend testing for diabetes using OGTT in pts with established CAD and without known diabetes. Methods: 2,767 consecutive pts with STEMI/NSTEMI were enrolled into the SWEETHEART-registry to identify abnormal glucose metabolism. In pts without diabetes, oral glucose tolerance test (OGTT) was performed at day 4 after the MI. We examined the impact of known and newly diagnosed diabetes, impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) on 3-year-mortality. Results: 689 pts (27.4%) had known diabetes. OGTT detected 417 pts with IFG (16.6%), 182 with IGT (7.2%) and 461 with new diabetes (18.3%). The relative risk for death and MACCE was increased in pts with diabetes (adjusted HR of 1.77 (95% CI 1.21-2.59) and 1.68 (95% CI 1.26-2.25) respectively). Pts with newly diagnosed diabetes had significantly increased 3-year-mortality as compared pts with IGT/IFG only or pts without any disturbances in glucose metabolism. Age (years, mean) Female gender STEMI NSTEMI Prior MI Prior PCI Prior CABG Renal failure Periph. art. dis. Coronary angio PCI Hospital Mortality 3-y-Mortality 3-y-MACCE Known diabetes (n=689) New diabetes (n=461) IFG/IGT (n=599) Normal glucose metabolism (n=769) p-value 71 30.9% 45.3% 54.7% 27.3% 25.6% 12.2% 27.0% 14.3% 91.0% 74.9% 2.9% 21.7% 28.6% 68 30.6% 53.8% 46.2% 12.8% 12.7% 6.3% 9.4% 7.2% 98.0% 87.0% 3.0% 12.4% 17.3% 64 21.0% 57.3% 42.7% 14.2% 14.7% 6.7% 9.0% 6.3% 96.8% 86.1% 0.5% 8.3% 13.8% 60 22.0% 61.9% 38.1% 13.6% 12.2% 4.6% 6.3% 6.6% 98.0% 86.8% 1.3% 6.1% 12.0% <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 J. Sackner-Bernstein, A. Pecora. NeoStem, New York, United States of America Purpose: Acute mortality is declining following myocardial infarction, yet those with ventricular dysfunction face substantial morbidity and mortality. We evaluated the associations between treatment effects on infarct size (IS) and left ventricular ejection fraction (EF) with treatment effects on survival after STEMI. Methods: Literature was reviewed for randomized controlled trials of STEMI patients in which assessments of IS or LVEF were performed after study intervention and in which survival to at least 30-days was reported. For univariate models, fixed effects and random effects meta-analyses were performed assum- Conclusion: Oral glucose tolerance testing in the setting of acute MI identified newly diagnosed pathologic glucose metabolism (diabetes mellitus/IGT/IFG) in 42.1% of consecutive MI-pts. Besides known diabetes, newly diagnosed diabetes was a significant predictor of 3-year mortality. Relationship of EF or IS to Mortality Downloaded from by guest on November 20, 2014 Purpose: The adipocyte derived hormone leptin could be a mediator between obesity and increased risk for cardiovascular disease (CVD), as leptin has been linked to the atherosclerotic process. We hypothesised that leptin predicted independently a myocardial infarction (MI). Methods: A prospective nested case-referent study was set up within the framework of the Northern Sweden MONitoring of Trends and Determinants in CArdiovascular Diseases (MONICA) project, the Västerbotten Intervention Program (VIP), and the Mammary Screening Program (MSP). Subjects (n=564, 40% women) with a first-ever acute MI that had participated in one of these surveys prior to the MI were selected. Age, sex, survey and location matched referents (n=1082, 40% women) were selected within the surveys. Leptin was measured in stored plasma. Conditional logistic regression was used to determine the risk for MI. Type of MI (STEMI and NSTEMI) was classified according to Minnesota codes. Results: The time period between survey and event was 3.9 years (interquartile range 3.6), and 51% of the cases had STEMI, 29% had NSTEMI, and 21% were unclassified. Male and female cases had higher levels of leptin (5.0 vs. 4.1 ng/mL, p<0.001 and 15.4 vs. 14.0 ng/mL, p=0.03), compared to referents. High leptin levels predicted MI independently in men (OR 2.17 [1.32-3.54], ptrend<0.001), but not in women (OR 1.10 [0.55-2.18], ptrend=0.05). The risk related to leptin in men was seen for STEMI in particular. Conclusions: High leptin predicts first–ever fatal and non–fatal MI, notably with a gender and MI-type difference. Leptin may affect the atherosclerotic process differentially in men and women and may promote plaque rupture and thrombus formation in larger coronary vessels. ing T-distribution random effects. Random-effects meta-regression models were used to investigate the association between log odds ratios of mortality and mean change in IS and EF. Results: 10 and 17 STEMI trials met inclusion criteria for EF and IS, respectively. Treatment effect on EF correlated significantly with mortality; a 5% placebocorrected difference in EF was associated with odds ratio (OR) for mortality of 0.37 (95% CI: 0.19, 0.68; P=0.038; Figure 1A), reflecting 57.7% of the between study variability in mortality. In contrast, the relationship between IS and mortality was not statistically significant (OR=0.81 per 5% difference in IS; 95% CI: 0.55, 1.20; P=0.1; Figure 1B), and responsible for 14.7% of between study variability. Conclusions: While infarct size has served as an acceptable surrogate endpoint for mortality in STEMI in prior randomized trials, EF correlates more strongly with mortality after STEMI, and may be useful as a surrogate endpoint in future STEMI trials of therapies intended to improve ventricular function and mortality.
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