Environmental factors including noise exposure are primary cardiovascular (CV) risk factors. ENVI MI project aimed to assess the impact of environmental noise at the home address in patients with acute myocardial infarction (MI). From the Côte d’Or infarction observatory (RICO) database, 867 consecutive MI patients living in an urban unit of Dijon (France), included from 2004 to 2008, without prior MI and discharged alive were analysed. Atherothrombotic risk stratification was performed using the TRS-2P score. Patients were divided in to 3 risk categories: G1 (low-risk, TRS-2P = 0/1); G2 (intermediate-risk, TRS-2P = 2); and G3 (high-risk, TRS-2P ≥ 3). Environmental noise prediction models were used to assess residential exposure. The relationship between TRS-2P categories were analyzed according to noise levels using ordinal logistic regression analysis; crude and adjusted odds ratios were estimated for an increase of 5 dB(A) in LDEN. Most patients were male (64%), with mean age at 68 ± 15 y, and LVEF was 55 ± 13%. Rate of CV risk factors were: smoking (57.2%), obesity (29.4%), hypertension (53.8%), hypercholesterolemia (46.4%), and diabetes (20.8%). TRS-2P categories were split in low (42%), intermediate (25%), and high (32%) risk. Most (51%) men were at low risk, while most women were at high risk (47%). Mean noise exposure was 60 ± 6 (min–max: 33-82) dB(A). Noise exposure was associated with atherothrombotic risk: OR(SD): 1.149(0.0142), P < 0.01). After adjustement, noise remains an independent estimate for atherothrombotic risk (OR(SD): 1.129(0.060), p < 0.05. Interestingly, the relationship was only significant for men (OR(SD): 1.220(0.075), p < 0.01), but not for women (OR(SD): 0.958(0.105), P = NS)). We found a significant association between noise exposure and atherosclerotic CV disease burden. If confirmed, these results could have major consequences in terms of public health, especially on post-MI management.

Background Optimal blood pressure in elderly patients after acute myocardial infarction is still a matter of debate. In a prospective observational study, we aimed to identify optimal systolic blood pressure during the 48 first hours after admission for acute myocardial infarction and its prognostic value for cardiovascular mortality. Methods and Results From the Observatoire des Infarctus de Côte d'Or survey, all consecutive patients aged >75 years admitted for an acute myocardial infarction in a coronary care unit from 2012 to 2015 and discharged alive were included (n=814). Exclusion criteria were in‐hospital death, cardiogenic shock, and end‐stage renal disease. Average systolic blood pressure ( aSBP ) values over the first 48 hours after admission were recorded, and the population was dichotomized into 2 groups: low aSBP group (<125 mm Hg) and control group ( aSBP ≥125 mm Hg). When compared with patients without cardiovascular death at 1‐year follow‐up, patients who died from a cardiovascular cause had higher rate of cardiovascular risks factors, including age, diabetes mellitus, comorbidities, and cardiovascular history. They had higher rates of low body mass index (<21 kg/m 2 ) and more elevated Global Registry of Acute Coronary Events risk score. Patients with aSBP <125 mm Hg had a 2‐fold risk of 1‐year cardiovascular death (47 [12.0%] versus 28 [6.6%]; P =0.008). By multivariable logistic regression analysis, low aSBP (odds ratio [95% CI ], 1.91 [1.07–3.41]) remained a strong and independent predictor of 1‐year cardiovascular mortality. Conclusions In our large population‐based study in elderly patients with acute myocardial infarction, low aSBP was an independent and powerful predictor of 1‐year cardiovascular mortality. Early aSBP measurement could help to improve risk stratification. Moreover, our results may suggest an optimal blood pressure target in elderly patients.

The usefulness of the combined assessment of HbA1c and plasma glucose (PG) in acute myocardial infarction (AMI) in non-diabetic patients remains unclear. In a large observational study, we aimed to identify the prognostic values of these biomarkers regarding one-year all-cause mortality in non-diabetic patients after AMI. From the “obseRvatoire des Infarctus de Côte d’Or” (RICO) survey database, we included all consecutive non-diabetic patients with AMI ( n = 6617) from 2001 to 2016. The primary endpoint was all-cause one-year mortality. The secondary endpoints were: MACE, infarct size, LVEF < 40% and GRACE risk score. Cut off levels (high/low) were determined by ROC curve analysis for the prediction of one-year death (HbA 1c 5.9% and PG 7.3 mmol/L) to set up 4 groups: low HbA 1c /low glucose ( n = 3158), low HbA 1c /high glucose ( n = 1264), high HbA 1c /low glucose ( n = 1378) and high HbA 1c /high glucose ( n = 817). Elevation of PG was associated with elevated rate of LVEF < 40%, STEMI, anterior wall location, DFG < 60 mL/min/m 2 and higher troponin Ic pic (all P < 0.001); HbA 1c > 5.9% was associated with elevated rate of CRP > 3 mg/L ( P < 0.001); High HbA 1C and high PG together were associated with higher rate of MACE ( P < 0.001). By multivariate logistic regression analysis, elevated admission PG remained a strong predictor of one-year all-cause (OR (95%CI): 1.64 (1.31–2.05)) mortality and cardiovascular mortality (OR (95%CI): 1.75 (1.33–2.31)), beyond GRACE score (OR (95%CI): 1.03 (1.03–1.04)), as well as elevated HbA 1c (OR (95%CI): 1.43 (1.15–1.78) and OR (95%CI): 1.83 (1.39–2.41) respectively). Admission PG and HbA 1c had strong independent predictive value regarding one-year all-cause mortality in our nondiabetic patients with AMI. These biomarkers could be useful to identify the most-at-risk patients after AMI in order to reduce residual risk in this target population.

Abstract Background High level of lipoprotein(a), Lp(a), is a well-recognized independent risk factor for atherosclerotic cardiovascular disease (ASCVD) including acute myocardial infarction (MI). However, limited data are available on the relationship between coronary artery disease (CAD) burden and Lp(a) levels in patients with acute MI. Methods CAD burden was addressed in 1213 consecutive patients hospitalized for an acute MI in 2019–2020 who underwent coronary angiography from the RICO survey. Patients were compared according to Lp(a) levels (Lp(a) <50 mg/dL (normal), ≥50 mg/dL and ≤100 mg/dL (high) and >100 mg/dL (very high)). Results The prevalence of high and very high Lp(a) was elevated (13% and 6%, respectively). Median (IQR) age (normal: 68 (58–79)y; high: 70 (61–80)y; very high: 69 (60–78)y, p=0.502) and rate of diabetes (p=0.448) were similar across the 3 groups. When compared with normal Lp(a), patients with very high Lp(a) had more frequently hypertension, were more often under chronic statin therapy and their corrected LDL-cholesterol was lower. There was a gradual increase in prior ASCVD rates across the 3 Lp(a) groups (p=0.001). When compared with patients with high or normal Lp(a), patients with very high Lp(a) levels had elevated SYNTAX score at coronary angiography, (17 (6–25) vs 12 (6–19) and 10 (5–18), p=0.006, respectively), and had more frequently multivessel disease (74% vs 64% and 56%, p=0.003). By multivariate analysis, very high Lp(a) (OR(95% CI): 1.879 (1.065–3.312)) remained associated with high CAD burden, beyond confounding including age, diabetes and dyslipidemia. Conclusion Among real world patients hospitalized for an acute MI, high Lp(a) levels are common (≈20%) and independently associated with a severe CAD burden, beyond traditional risk factors, identifying a subset of patients with features of high ASCVD risk. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): CHU Dijon Bourgogne ARS Bourgogne Franche Comté

Acute infection is a frequent trigger of myocardial infarction (MI). However, whether post-infectious MI require specific acute care is still unknown. We aimed to evaluate the prognostic impact of coronary angiography (CA) and MI drugs on cardiovascular (CV) and all-cause mortality in post-infectious MI patients. Among 4573 consecutive MI patients from the RICO Survey in intensive care units (ICU), 466 (10%) patients were diagnosed with a concurrent acute infection at admission. A Cox regression model was built including traditional MI prognosis factors and CV therapeutics, to evaluate their prognostic impact on one-year CV mortality. Among the 466 post-infectious MI patients, (mean age 78y), 313 (67%) had a respiratory tract infection, including 163 acute bronchitis (35%), 150 (32%) pneumonia and 150 (33%) had non-respiratory infection. Among the 365 patients who underwent CA, an atherothrombotic event (type 1 MI) was found in 130 (36%) patients. At one year follow-up, 108 patients were dead (23%), of whom 68 (15%) from CV cause. In Cox regression multivariable analysis, acute pneumonia was associated with a twice-higher risk of CV mortality (OR95% CI = 2.31(1.16–4.60)), when compared with other infections. After adjustment on confounders, aspirin (OR 95%CI = 0.23(0.11–0.52)), beta-blockers (OR95%CI = 0.34 (0.16–0.72)), and Angiotensin Converting Enzyme inhibitors (ACEi) (OR95%CI = 0.38(0.18–0.81) where associated with a lower CV mortality, whereas CA (OR95%CI = 0.98 (0.53–1.80)) or statins (OR95%CI = 0.78 (0.34–1.78)) were not significant estimates. Similar results were found after exclusion of type 1 MI. In this first prognostic study in post-infectious MI in ICU, 1-Y CV mortality was very high (15%), especially after pneumonia. Moreover, aspirin, beta-blockers and ACEi, but not CA or statins, were associated with a lower risk of mortality.

Abstract Background The usefulness of the combined assessment of HbA1c and plasma glucose (PG) in acute myocardial infarction (AMI) in nondiabetic patients remains unclear. Purpose In a large observational study, we aimed to identify the prognostic values of these biomarkers regarding one-year all-cause mortality in nondiabetic patients after AMI. Methods From the “obseRvatoire des Infarctus de Côte d'Or” (RICO) survey database, we included all consecutive nondiabetic patients with AMI (n=6617) from May 2001 to December 2016. Exclusion criteria were: admission known or unknown diabetes, in-hospital death. The primary endpoint was all-cause one-year mortality. The secondary endpoints were: MACE, infarct size, LVEF<40% and GRACE risk score. Cut off levels (high/low) were determined by ROC curve analysis for the prediction of one-year death (HbA1c 5.9% and PG 7.3mmol/L) to set up 4 groups: low HbA1c/low glucose (n=3158), low HbA1c/high glucose (n=1264), high HbA1c/low glucose (n=1378) and high HbA1c/high glucose (n=817). Results Elevation of PG was associated with elevated rate of LVEF<40%, STEMI, anterior wall location, DFG<60mL/min/m2 and higher troponin Ic pic (all p<0.001); HbA1c>5.9% was associated with elevated rate of CRP>3mg/L (p<0.001); High HbA1C and high PG together were associated with higher rate of MACE (p<0.001). By multivariate logistic regression analysis, elevated admission PG remained a strong predictor of one-year all-cause (OR (95% CI): 1.64 (1.31–2.05)) mortality and cardiovascular mortality (OR (95% CI): 1.75 (1.33–2.31)), beyond GRACE score (OR (95% CI): 1.03 (1.03–1.04)), as well as elevated HbA1c (OR (95% CI): 1.43 (1.15–1.78) and OR (95% CI): 1.83 (1.39–2.41) respectively). Conclusions Admission PG and HbA1c had strong independent predictive value regarding one-year all-cause mortality in our nondiabetic patients with AMI. These biomarkers could be useful to identify the most-at-risk patients after AMI in order to reduce residual risk in this target population. Acknowledgement/Funding University Hospital Center Dijon Bourgogne, France

Over the last decade, acute myocardial infarction (AMI) management has considerably evolved, but current management of sport-related AMI remains poorly investigated. We aimed to analyze the acute therapeutic strategies used in AMI occurring during sport activity. We retrospectively analyze consecutive patients from an AMI database (RICO survey) who underwent a coronary angiography (CA) in a university hospital after a sport-related AMI within 2011 to 2017 (n = 100). Most were male (86%), with median age at 58 (50–67) y. Out-of-hospital sudden cardiac arrest (OHSCA) was experienced by 20%; at admission. At the acute phase, 3% underwent ECMO and 2% had an IABP. Intravenous fibrinolysis was given in 14% (26% of the 54 STEMI patients), successfully in 64%. CA was performed through a radial approach in 89%; OCT or IVUS was used in 2 patients. Thromboaspiration was performed in 30%, balloon predilatation in 26% and direct stenting in 73%. Most PCI were performed using drug eluting stent (DES) (69%) with 1 stent (78%), 2 stents (15%), 3 stents (7%) or no stent (5%). Median time from symptoms to reperfusion was 145 (105–228) and to PCI 163 (126–240) min. A re-intervention during hospitalization was performed in 20% of patients, with implantation of 1 stent (39%) 2 stents (35%), 3 stents (17%), 4 stents (4%); all stents but one were DES. Seven patients underwent CABG surgery in addition to PCI. No ICD was implanted. During hospitalization, 10 patients died (all initially presented with OHSCA); all victims treated with ECMO died and only one with IABP survived (used for management of early stent thrombosis). From this large series, thrombolysis was rare, but thromboaspiration was performed in nearly one third of patients; culprit lesions were often treated by direct stenting, with a DES in more than 2/3 of cases. A re-intervention procedure was often needed to treat other lesions, more often with DES rather than CABG.

BACKGROUND:Individuals with heterozygous familial hypercholesterolemia (FH) are at high risk of early myocardial infarction (MI). However, coronary artery disease (CAD) burden of FH remains not well described, especially for French patients.OBJECTIVE:The objective of this study was to assess the prevalence of FH and severity of CAD from a large database of a French regional registry of acute MI.METHODS:All consecutive patients hospitalized for an acute MI in a multicenter database from 2001 to 2017 were considered. FH was diagnosed using an algorithm adapted from the Dutch Lipid Clinic Network criteria. The prevalence and clinical features of FH and the severity of CAD were assessed.RESULTS:Among the 11,624 patients included in the study, the proportion of "probable/definite", "possible", and "unlikely" FH in patients with MI was 2.1% (n = 249), 20.7% (n = 2405), and 77.2% (n = 8970), respectively. When compared with patients with "unlikely" FH, patients with "probable/definite" FH were 20 years younger (51 vs 71, P < .001), with a lower rate of diabetes (17% vs 25%, P = .007) and a higher prevalence of personal and familial history of CAD. Chronic statin treatment was only used in 48% of FH patients and ezetimibe in 8%. After adjustment for age, sex, and diabetes, patients with FH were characterized by increased extent of CAD (SYNTAX score 11 vs 7, P < .001) and multivessel disease (55% vs 40%, P < .001).CONCLUSIONS:In this large cohort of French individuals, FH was common in patients with MI, associated with markedly early age of MI and severity of CAD burden and limited use of preventive lipid-lowering therapy.

In diabetic patients with acute myocardial infarction (MI), prognostic value of glycosylated hemoglobin (HbA1c) remains debated. In a large observational study, we aimed to identify the prognostic value of HbA1c measured on admission for acute MI in diabetic patients regarding one-year major adverse cardiovascular events (MACE). From the RICO survey database, all consecutive patients with or without known diabetes with acute MI ( n = 3005) from January 2001 to June 2016 were included. We divided our population into 4 quartiles: HbA1c ≤ 6.5% ( n = 807), 6.5–7% ( n = 722), 7.2–8.1% ( n = 748), ≥ 8.2% ( n = 728) for the analysis. On admission, median age was 73 years old, median HbA1c and glucose were 7.0% and 9.6 mmol/L. Compared to HbA1c ≤ 6.5% group, HbA1c ≥ 8.2% group was made up of younger persons (74 vs. 70 years old, P < 0.001), had most important body mass index > 30 kg/m 2 (221 (28%) vs. 241 (33%), P = 0.041), had less important high blood pressure rate (610 (76%) vs. 508 (70%), P = 0.016) and had a stronger anti-diabetic treatment (insulin plus oral anti-diabetic medication: 44 (6%) vs. 176 (24%), P < 0.001). Regarding the clinical data, HbA1c ≥ 8.2% group had more STEMI [372 (46%) vs. 395 (54%), P = 0.002], more multi-vessel disease [446 (60%) vs. 455 (67%), P = 0.007] but lower GRACE score (156 vs. 150, P = 0.020) than HbA1c ≤ 6.5% group. We did not observed any difference concerning one year MACE between the 4 groups [HbA1c ≤ 6.5%: 243 (30.1%); 6.6–7.0%: 227 (31.4%); 7.1–8.1%: 246 (32.9%); ≥ 8.2%: 239 (32.8%), P = 0.6]. Even in case of extreme glycometabolic chronic derangement, our results showed that the initial HbA1c has no one-year prognostic significance value after acute MI in our large diabetic population. However, these patients remain in a high-risk cardiovascular population and need close multidisciplinary follow-up. The chronical hyperglycemia prognostic value should be studied over a much longer period.

Coronary artery disease (CAD) is involved in most acute cardiac events occurring during sport activities. We addressed clinical and coronary angiography characteristics of patients with acute myocardial infarction (AMI) during sport activities. From the RICO database, we retrospectively analyzed all the consecutive patients admitted in a university hospital for sport-related AMI and who underwent coronary angiography from 2011 to 2017 (n = 100). AMI occurred during or within the 1st hour after cycling (41%), jogging (14%), soccer (13%) and other team sports (7%). Median age was 58 (50–67) y, most were male (86%), with body mass index at 25 (24–28) kg/m2, a high rate of smoking (37%), hypercholesterolemia (31%), familial or personal history of CAD (29% and 10%, respectively), and diabetes (9%). Strikingly, 30% reported prodromal symptoms. Out-of-hospital (OH) sudden cardiac arrest (SCA) was experienced by 20%; at admission, 11% had Killip > 1 and 54% were STEMI. Most had one-vessel disease (50%) and 14% had no significant stenosis. SYNTAX score was 8 (5–14). More than half (52%) had associated non-significant stenosis. Culprit lesion (87%) was found on LAD or branches (43%) and on RCA (40%), proximal in 47% of patients. One culprit lesion was reported on LM (1%) artery. Thrombus, calcification and ulceration were often found on culprit lesion (53%, 17% and 34% respectively). An occlusion (TIMI 0) was observed in 55% of culprit lesions. Only 5% and 2% had chronic total occlusion and dissection, respectively. Only 26% had lesion length > 20 mm on culprit artery. One patient had an anomalous origin of LM and one had a small coronary fistula. Our works highlight a high rate of risk factors, history of CAD and prodromal symptoms. STEMI counted for 54% of cases and OHSCA occurred in 20% of patients. Their CAD extent was low to moderate, and characterized by a majority of single significant, proximal and short stenosis.

Familial hypercholesterolemia (FH) is at very high risk of early myocardial infarction (MI). However, coronary artery disease (CAD) burden of FH in acute MI remains unclear. From a large database of a regional registry of acute MI, we aimed to address FH prevalence and CAD characteristics. Consecutive patients with AMI in the multicentre database (RICO survey) from 2001–2017 were considered. An algorithm, adapted from Dutch lipid clinic network criteria, was built upon 4 variables [LDL-cholesterol (C) level and chronic lipid lowering agents, premature and family history of CAD] to identify FH probabilities. Among the 11,624 patients included in the RICO survey, 249(2.1%) had probable/definite FH (score ≥ 6), and 2405(20.7%) had possible FH (score 3–5). When compared with patients without FH (score 0–2), FH patients (score ≥ 6) were ≈ 20y younger [51(46–57) vs. 71(61–80)y, P < 0.001], with a lower rate of hypertension (47 vs. 59%, P < 0.001), diabetes (17 vs. 25%, P < 0.001) and prior stroke (4 vs. 8%, P < 0.001), but a higher prevalence of smokers (56 vs. 23%, P < 0.001), personal (20 vs. 15%, P < 0.001) or familial history of CAD (78 vs. 18%, P < 0.001). Moreover, median LDL-C was ≈ twice higher [2.07(1.75–2.41) vs. 1.12(0.88–1.36) g/L]. Chronic statin was only used in less than half FH patients (48%). Among patients who underwent coronary angiography, FH patients were characterized by increased extent of CAD [syntax score 11(5–19) vs. 10(5–18), P < 0.001], and multivessel disease (55 vs. 54%, P < 0.001). Rate of revascularisation was higher (percutaneous coronary intervention: 76 vs. 70%, P < 0.001 and coronary artery bypass graft: 7 vs. 6%, P < 0.001). In this large real world population of acute MI, a high prevalence of FH was found. Moreover, FH patients were characterized by their young age associated with the severity of CAD burden and limited use of preventive lipid lowering therapy, suggesting the opportunity for prevention strategies.

BACKGROUND: Red blood cell transfusion benefit during acute myocardial infarction remains unclear in the elderly. We aimed to assess the transfusion impact on 1-year mortality in acute myocardial infarction patients aged >= 65 years, according to their age and hemoglobin nadir. METHODS: We included 3316 consecutive patients with acute myocardial infarction aged >= 65 years from the "obseRvatoire des Infarctus de Cote d'Or" (RICO) survey. They were categorized according to their hemoglobin nadir (<= 8, > 8 to <= 10, and > 10 g/dL) and age (<80 or >= 80 years). RESULTS: A total of 1906 patients (57%) were 65-79 years old, and 1410 (43%) were aged >= 80 years, of whom 103 (5%) and 145 (10%) patients received red blood cell transfusion, respectively (P < .001). In Cox regression analysis, transfusion was associated with increased 1-year mortality for hemoglobin nadir > 10 g/dL but no significant effect for hemoglobin nadir between 8 and 10 g/dL. When hemoglobin nadir was <= 8 g/dL, transfusion did not influence 1-year mortality for younger patients (65-79 years). However, for older patients (>= 80 years), transfusion was associated with lower mortality (hazard ratio 0.43 [95% confidence interval, 0.22-0.86], P = .016). CONCLUSION: Among older patients with acute myocardial infarction, the effect of transfusion was largely dependent on hemoglobin threshold and age. Transfusion was associated with increased 1-year mortality when hemoglobin nadir was > 10 g/dL. However, in patients aged >= 80 years with hemoglobin nadir < 8 g/ dL, transfusion was associated with a 50% reduction in 1-year mortality. (C) 2018 Published by Elsevier Inc.

In nondiabetic patients with acute myocardial infarction (AMI), acute hyperglycemia is associated with high risk of cardiovascular (CV) mortality but the prognostic value of glycosylated hemoglobin (HbA1c) remains uncertain. In a large observational study, we aimed to identify the prognostic values of admission HbA1c and plasma glucose for acute MI in nondiabetic patients regarding in-hospital and one-year CV mortality. From the RICO survey database all the consecutive nondiabetic patients with AMI (n = 6884) from January 2001 to June 2016 were included. Cut off levels (high/low) were determined by ROC curve analysis for the prediction of CV one-year death (HbA1c: 5.9% and glucose: 156 mg/dL) to set up 4 groups: low HbA1c/low glucose (n = 3849), low HbA1c/high glucose (n = 734), high HbA1c/low glucose (n = 1802) and high HbA1c/high glucose (n = 499). Elevation of glucose or HbA1c was associated with elevated rate of hospital mortality, when compared to all other groups (Fig. 1). By multivariate logistic regression analysis, only high glucose remains a prognostic factor of hospital death [OR(95% CI): 1.59 (1.16–2.17)]. In survivors at discharge, group with elevated levels of both plasma glucose and HbA1c had a higher rate of one-year CV mortality compared to all other groups (P < 0.001). High HbA1c was an independent predictive factor of one-year CV mortality, beyond high glucose [OR(95% CI): 1.75 (1.35–2.27) and 1.98 (1.49–2.61), respectively] and covariates (Fig. 1). In our large population-based study in nondiabetic patients with AMI, high levels of admission HbA1c and/or plasma glucose give different prognostic information and were associated with increased risk of mortality at short or long term. Early mortality risk was mainly driven by acute hyperglycemia and one-year mortality by HbA1c, independently of plasma glucose. Our findings may help identifying high-risk patients to target for aggressive secondary prevention after AMI.

Acute infection has been suggested to be involved in acute myocardial infarction (MI) triggering. However, pathogenesis and prognosis of infection-related MI remains unknown. To characterize infection-related MI and determine factors of in-hospital mortality. All the consecutive patients with an acute infection on admission for an acute MI were prospectively identified from the RICO database. Acute infection was diagnosed on clinical and biological criteria. Type 1 (plaque rupture or erosion) or Type 2 (ischaemic imbalance) MI were systematically adjudicated according to the 3rd universal definition of MI. Among the 465 AMI patients with infection (mean age 74 y, 60% male), 312 (67%) had a respiratory tract infection, 78 (17%) urinary tract infection and 75 (16%) another or undetermined site of infection. Type 2 MI was much more frequent than Type 1 MI (72 vs. 28%, P < 0.001). Patients with Type 2 MI were significantly older (79[69–85] vs. 68 [57–81] y, P < 0.001), had more frequent cardiovascular history, more severe clinical presentation [KILLIP > 1: (59 vs. 40%, P < 0.001)] but less severe angiographic lesions (SYNTAX score: 10[0–20] vs. 13[6–20], P = 0.03) compared with T1MI patients. In-hospital mortality was similar for both groups (11%). In Cox regression multivariate analysis, type 1 MI (vs. type 2 MI) and pulmonary tract infections (vs. non-pulmonary tract infection) were strongly associated with mortality [HR (95% CI): 3.1 (1.3–7.5) and 2.3 (1.0–5.1) respectively], as well as C-reactive protein level [HR 1.004(1.001-1.008), per mg/L]. In this large prospective study of infection-related MI, the largest to date, respiratory tract infection was the main infectious factor and was associated with a worse hospital prognosis. Moreover, our findings show that type 1 MI with infection was frequent and associated with a higher risk of in-hospital mortality.

Atrial fibrillation (AF) is common after acute myocardial infarction (AMI), and associated with mortality. However, there is an unmet need in the understanding of the pathophysiology of AF in AMI. Heart rate variability (HRV) reflects the cardiovascular response to the autonomic nervous system (ANS). We investigated the relationship between ANS parameters and the occurrence of AF during AMI. From the RICO survey, all consecutive patients hospitalized for AMI in our university hospital between June 2001 and November 2014 were prospectively analysed by Holter ECG < 48 h following admission. HRV was measured using temporal and spectral analysis. Among the 2035 included patients, 168 (8.2%) developed AF during AMI. Compared to the sinus-rhythm group, patients who developed AF were older (77 ± vs. 64 ± y, P < 0.001), had more frequent hypertension (114 vs. 924, P < 0.001) and lower LVEF (47% vs. 55%, P < 0.001). On ANS Holter parameters, AF patients had higher pNN50 values (11% vs. 4%, P < 0.001) as for mean heart rate (73 ± vs. 66 ± bpm, P < 0.001). There was a marked difference regarding the sympathovagal balance as assessed by the median LH/HF ratio: 2.75 (1.46–4.58; P < 0.001) in sinus rhythm-group, compared to 0.88 (0.57–2.00); P < 0.001, respectively in AF-group. In ROC curve analysis, the optimal LF/HF cut-off for AF prediction was at 1.735. In our population, 75% of AF patients had a LF/HF ratio < 1.735, as compared to 30% of patients in the sinus-rhythm group. By multivariate analysis, low LF/HF [OR 3.562 (2.202–5.763)] was the strongest predictor of AF, beyond age [OR (95%CI) 1.040 (1.018–1.062)], and mean sinus-rhythm rate on Holter recording [OR 1.031 (1.016-1.045)]. Our large prospective HRV analysis in AMI shows that low LF-HF ratio is a major predictor of AF. Our study strongly suggests that AF in AMI primarily occurs on previous underlying atrial electrical remodelling, rather than acute sympathovagal imbalance.

Identifying underlying causes and characteristics of type 2 myocardial infarction (T2MI), defined by an imbalance between demand and supply of oxygen without plaque disruption, and its distinction with type 1 myocardial infarction (T1MI), due to plaque rupture or erosion, remains a critical step to diagnosis and therapeutic strategies. To comprehensively identify T2MI etiologic factors and to compare T2MI vs. T1MI characteristics. Large prospective study in patients included from 2007 to 2017 in the RICO database, a French regional survey of acute MI. Cases were systematically adjudicated according to the 3rd universal MI definition criteria and prespecified causes of T2MI. Among the 4572 patients included, 3710 (81%) had a T1MI and 862 (19%) a T2MI. Patients with T2MI were markedly older (77 vs. 67y, P < 0.001), more frequently female, and had more comorbidities and was less frequently STEMI (24 vs. 52%, P < 0.001) than in T1MI group. Clinical presentation was also more severe (median GRACE score: 171 vs. 143, P < 0.001) and left ventricular ejection fraction more altered (50 vs. 55%, P < 0.001). However, median troponin Ic peak was lower (3.5 vs. 17 μg/L, P < 0.001). Underlying mechanisms leading to T2MI highlighted 2 main patterns, characterized by 1) chronic predisposing factors including chronic anemia (10%) and severe aortic stenosis (7%) and 2) acute precipitating factors, of whom acute infections (39%), mainly respiratory tract infections, was the most frequent factor, followed by tachyarrhythmia (13%) and acute heart failure (10%). The most frequent acute or chronic causes were non-cardiogenic factors. Association of factors concerned 122 patients (14%). In our large contemporary study, one of the largest to date, with a prospective T2MI identification, chronic anemia and severe aortic stenosis frequently predisposed to T2MI, and respiratory infections were the most frequent triggers.

Optimal blood pressure (BP) in the elderly patients after acute myocardial infarction (AMI) is still a matter of debate and systolic blood pressure (SBP) target at the acute phase remains to be determined. In a prospective observational study, we aimed to identify optimal SBP during the 48 first hours in AMI and its prognostic value for one-year cardiovascular (CV) mortality. From the RICO survey database, all consecutive patients > 75 years admitted for an AMI in cardiology intensive care unit of the university hospital of Dijon from 01/02/2012 to 31/01/2015 and discharged alive were included (n = 814). Exclusion criteria were in-hospital death, cardiogenic shock and end-stage renal disease. The endpoints were one-year CV mortality and major adverse cardiac events (MACE). The mean SBP values over the first 48 hours following admission were recorded and analysed. mSBP cut-off value was determined by ROC curve analysis for the prediction of one-year CV mortality (125 mmHg). Patients were divided into 2 groups according to mSBP [< 125 mmHg (n = 391) vs. ≥ 125 mmHg (n = 423)]. The median age were 82 years. Patients with mSBP < 125 mmHg had a two-fold risk of one-year CV death compared to mSBP ≥ 125 mmHg patients [47 (12.0%) vs. 28 (6.6%), P = 0.008]. By multivariate logistic regression analysis, mSBP < 125 mmHg [OR(95% CI): 1.91(1.07–3.41)] remained a strong predictor of one-year CV mortality, beyond diabetes [OR(95% CI): 2.83(1.47–5.43)], LVEF < 40% [OR(95% CI): 2.44 (1.36–4.36)], BMI < 21 kg/m2 [OR(95% CI): 2.24(1.11–4.55)] and GRACE risk score [OR(95% CI): 1.04(1.02–1.05)]. In our large population-based study in elderly patients with AMI, low mSBP (< 125 mmHg) in the first 48 hours after admission was an independent and powerful predictor of one-year CV mortality. If confirmed by further cohort studies, early mSBP measurement could help to improve risk stratification. Our results may suggest an optimal blood pressure target in elderly patients.