Special Press Conference Explores Latest Research Involving Life-Threatening Scenarios

Research presented at a special press conference on Aug. 31 during ESC Congress 2015 in London focused on life-threatening cardiovascular scenarios ranging from ischemic stroke to respiratory infections.

In one study, retrieval of larger thrombi during intra-arterial treatment (IAT) was associated with improved neurological recovery after acute ischemic stroke. The study included 35 collections of thrombi from 35 patients enrolled in the MR CLEAN Trial who had undergone IAT after an acute ischemic stroke. Of these patients, 49 percent of strokes were of cardiac origin and 20 percent were due to atherosclerosis. Those patients whose stroke was caused by atherosclerosis had significantly longer and larger thrombi (p=0.0035 and p=0.045, respectively) than those with stroke from other causes. Additionally, patients with longer and wider thrombi had significantly improved neurological recovery at discharge after IAT compared to those with smaller thrombi (p=0.03 and p=0.04, respectively).

Anouchska Autar, PhD candidate at the Erasmus Medical Centre in Rotterdam, the Netherlands, notes that an increased number of particles retrieved during IAT showed a trend towards a worse neurological recovery at discharge, although the association was not significant (p=0.079).

Findings from a second study suggest that pain and depression may share a common neurochemical pathway. The study included 5,825 adults enrolled in the Emory Cardiovascular Biobank in Atlanta, GA, between 2004 and 2013. Prior to cardiac catheterization, patients completed the Patient Health Questionnaire-9 (PHQ-9) to assess depressive symptoms and the Seattle Angina Questionnaire to assess chest pain frequency in the past month. The presence and severity of coronary artery disease was determined by angiogram. Patients completed the same questionnaires at one and five years post-procedure. Researchers found that depression severity as measured by the PHQ-9 was independently associated with the frequency of chest pain, indicating that patients with more severe depression had more frequent chest pain. Even patients with mild depression had more frequent chest pain than patients with no depressive symptoms. The findings remained after adjusting for coronary artery disease severity, age, gender, race and traditional cardiovascular risk factors including smoking status, body mass index, blood pressure and blood lipid levels.

"Although depression is established as a risk factor for heart disease, there are no clear recommendations in the U.S. for depression screening in patients with cardiovascular disease," said Salim Hayek, MD, from Emory University School of Medicine in Atlanta. "ESC prevention guidelines recommend assessing patients for depression to prevent cardiovascular disease. Our results suggest that screening for depression in patients presenting with chest pain should be considered."

Meanwhile, a third study, found that respiratory infection is associated with a four-fold increased risk of in-hospital cardiovascular mortality after acute myocardial infarction (AMI). Researchers retrospectively analysed data from 1,907 patients admitted with AMI over a four-year period and found that respiratory infections were associated with older age, higher diabetes prevalence and a more severe clinical presentation. In addition, development of respiratory infections was associated with a worse disease course, longer length of stay, higher Killip Class, and higher incidence of malignant arrhythmias, ischemic stroke and reinfarction along with more frequent need for transfusional, circulatory and respiratory support. According to study investigators, patients with a respiratory infection had a 6.12 times higher in-hospital cardiovascular mortality than those without a respiratory infection (95 percent confidence interval [CI]=3.34-11.21, p<0.001).

A final study found that women ages 45 years and under with diabetes have a six-fold risk of heart attack. The study in more than 7,000 women also found that young women with myocardial infarction (MI) were more likely to be smokers than older women with MI. The study used data from three national registries: the Polish Registry of Acute Coronary Syndromes, the Multicentre Study of State National Population Health and the National Survey of Risk Factors for Cardiovascular Diseases.

Multivariate analysis showed that four out of five classic risk factors were independent predictors of MI in young women, with the strongest factor being diabetes. Arterial hypertension increased risk by four times while hypercholesterolemia tripled risk and current smoking increased risk by 1.6 times. There was no statistical significance for obesity expressed by body mass index (BMI). The researchers also found that young healthy women had an average of 1.1 risk factors, while young MI patients had 1.7 and older women with MI had 2.0. Compared to young healthy women, young women with MI more often had arterial hypertension, hypercholesterolemia and diabetes and were current or past smokers. In the population of older women with MI, the prevalence of nearly all individual risk factors was even greater than in young women with MI. Smoking was the only risk factor with a greater prevalence in the younger group.

"At present there are not enough global scientific reports focused on the problem of coronary heart disease in young populations, particularly in women," said Hanna Szwed, an author of the study and head of the 2nd Department of Coronary Artery Disease, Institute of Cardiology in Warsaw, Poland. "More research is needed into this growing problem to deepen our knowledge, improve prevention efforts and reduce mortality."

Clinical Topics: Acute Coronary Syndromes, Arrhythmias and Clinical EP, Clinical Topic Collection: Dyslipidemia, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Homozygous Familial Hypercholesterolemia, Hypertension, Smoking

Keywords: ESC Congress, Acute Coronary Syndrome, Angina Pectoris, Arrhythmias, Cardiac, Atherosclerosis, Blood Pressure, Cardiac Catheterization, Coronary Artery Disease, Coronary Disease, Depression, Depressive Disorder, Major, Diabetes Mellitus, Hypercholesterolemia, Hypertension, Myocardial Infarction, Registries, Respiratory Tract Infections, Risk Factors, Smoking, Stroke


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