Implementation of New Antithrombotic Treatment Strategies and Outcome Improvements in Patients with Myocardial Infarction and Atrial Fibrillation Over 20 Years: A Nationwide Cohort Study

Presenter:  Christian Losciale

In a nationwide Swedish cohort of 352,822 myocardial infarction (MI) survivors from 2000–2021, 20.3% had concomitant atrial fibrillation (AF). The use of oral anticoagulants, especially direct oral anticoagulants (DOACs), rose from 17% to 69%, often combined with single antiplatelet therapy int AF patients.

This shift correlated with reduced one-year risks of ischemic stroke/systemic embolism (5.9% to 2.1%) and cardiovascular death (19.6% to 10.5%). Major bleeding risk increased initially but declined in the later stage. Standardized analyses attributed improved outcomes to increased coronary revascularization and anticoagulant prescriptions along with the use of antiplatelet agent, underscoring the clinical impact of evolving antithrombotic strategies in MI patients with AF.

Prognostic Value of Excess Apolipoprotein B in Coronary Artery Disease: A Pooled Analysis of Nationwide Cohorts

Presenter: Xiaozhao Lu

The pooled analysis evaluated the link between excess apolipoprotein B (apoB; defined as levels exceeding those predicted by LDL-C) and the risk of all-cause & cardiovascular (CV) mortality in 68,616 statin-treated coronary artery disease (CAD) patients.

Excess apoB was independently associated with increased CV and all-cause mortality. Over a median 5.2-year follow-up, patients with excess apoB (≥11.5 mg/dL) had a 24% higher risk of CV death, and 12% higher risk of all-cause mortality compared to those with lower excess apoB. These associations persisted across LDL-C levels and were validated in the UK Biobank cohort. Findings suggest excess apoB offers prognostic value beyond LDL-C, highlighting its relevance in risk stratification for CAD patients.

Prevalence of Elevated Lipoprotein(a) in Premature ASCVD Patients and its Association with Major Adverse Cardiovascular Events: Analysis of a Large US Electronic Health Record Database

Presenter: Nishant P Shah

This retrospective analysis ascertained the prevalence of elevated lipoprotein(a) [Lp(a)] & its impact on major adverse cardiovascular events (MACE) in a cohort of 2,684 U.S. adults with premature atherosclerotic cardiovascular disease (ASCVD).

Approximately 25.3% of the patients had elevated Lp(a) (≥150 nmol/L). Over a median 3.75-year follow-up, elevated Lp(a) was significantly associated with increased incidence of MACE, including myocardial infarction and coronary revascularization. Patients with Lp(a) ≥150 nmol/L had 20–23% higher hazard ratios for MACE outcomes compared to those with Lp(a) <65 nmol/L. These findings underscore the genetic and independent role of Lp(a) in premature ASCVD and support routine Lp(a) screening to improve early risk stratification and guide preventive cardiovascular care in younger populations.

PROGNosis in Obstructive Sleep Apnea after Myocardial Infarction - The PROGNOSA-MI Study

Presenter: Maciej Olszowka

This retrospective analysis based on the SWEDEHEART registry reports the prevalence of obstructive sleep apnea (OSA) and its association with adverse prognosis in a cohort of 155,332 patients with first myocardial infarction (MI).  

Only 1.37% of the patients had a documented diagnosis of OSA prior to discharge. Despite low prevalence, OSA was independently associated with increased risks of all-cause mortality (HR 1.15), non-cardiovascular mortality (HR 1.28), and hospitalization for heart failure (HR 1.16) over a median 4.67-year follow-up. OSA patients were younger, predominantly male, and had higher rates of comorbidities and NSTEMI presentation. These findings suggest OSA may be an underrecognized contributor to residual cardiovascular risk following MI, warranting greater attention in post-MI management.

Regional and Demographic Variations in Diabetes Mellitus and Myocardial Infarction Mortality Among US Adults: A Retrospective Observational Analysis from 1999-2023

Presenter: Chavin Akalanka Ranasinghe

The temporal trends for diabetes mellitus (DM) and myocardial infarction (MI)-related deaths for the period of 1999 to 2023 were calculated using the CDC-WONDER database.

Overall, 712,921 DM and MI-related deaths occurred among U.S. adults aged ≥25 years. Age-adjusted mortality rates (AAMRs) declined from 18.99 in 1999 to 10.20 in 2018, rose to 12.27 in 2021 during the COVID-19 pandemic (APC: 7.2), then returned to 9.6 in 2023. Males consistently had higher AAMRs than females (16.5 vs. 10.2). Non-Hispanic (NH) Black individuals had the highest AAMR (19.5), followed by Hispanic (15.3), NH White (12.5), and NH Other (11.2). Mortality was elevated in southern and rural regions. These findings highlight persistent disparities and pandemic-related mortality shifts.

Ref: ESC Congress 2025, 29^thAug- 1^st Sept 2025, Madrid, Spain