2025
Coronary Artery Disease–Based Polygenic Risk Score in Early-Onset Acute Myocardial Infarction Subtypes
Dong W, Lu Y, Li S, Sawano M, Caraballo C, Liu Y, Khera A, Philippakis A, Dreyer R, Lichtman J, D'Onofrio G, Spatz E, Herrington D, Post W, Rich S, Rotter J, Krumholz H. Coronary Artery Disease–Based Polygenic Risk Score in Early-Onset Acute Myocardial Infarction Subtypes. JACC Advances 2025, 4: 101994. PMID: 40712269, PMCID: PMC12311502, DOI: 10.1016/j.jacadv.2025.101994.Peer-Reviewed Original ResearchAcute myocardial infarction subtypePolygenic risk scoresAcute myocardial infarctionRisk of acute myocardial infarctionRisk scoreCoronary artery diseaseAssociated with acute myocardial infarctionEstimated riskAssociated with higher riskAssociated with MIAcute myocardial infarction patientsMultinomial logistic regressionArtery diseaseNonobstructive coronary artery diseaseLogistic regressionFemale-to-male ratioYoung adultsCox regressionHigh riskInfarction subtypesYoung individualsMyocardial infarctionEarly-onsetScoresSexMarginalized Neighborhoods and Health Outcomes in Younger Myocardial Infarction Survivors
Akioyamen L, Sivaswamy A, Haldenby O, Abdel-Qadir H, Sud M, Alter D, Atzema C, Austin P, Jackevicius C, Kapral M, Krumholz H, Tu K, Wijeysundera H, Ko D. Marginalized Neighborhoods and Health Outcomes in Younger Myocardial Infarction Survivors. JAMA Network Open 2025, 8: e2518826. PMID: 40601315, PMCID: PMC12223890, DOI: 10.1001/jamanetworkopen.2025.18826.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionAMI survivorsUniversal health care systemCohort studyMarginalized neighborhoodsHealth service utilizationPopulation-based retrospective cohortPrimary care physiciansHealth care systemUniversal health careNeighbourhood marginalizationAdjusted hazard ratiosMyocardial infarction survivorsProportional hazards regression modelsAcute myocardial infarction patientsYears of follow-upNeighbourhood quintilesHazards regression modelsCare physiciansService utilizationHealth outcomesHealth careCare systemAdministrative databasesNeighborhood characteristicsJoint Exposure to Ozone and Temperature and Acute Myocardial Infarction Among Adults Aged 18 to 64 Years in the United States
Chu L, Wang R, Gross C, Wei J, Lu Y, Krumholz H, Ma X, Chen K. Joint Exposure to Ozone and Temperature and Acute Myocardial Infarction Among Adults Aged 18 to 64 Years in the United States. Circulation 2025, 152: 246-256. PMID: 40458867, PMCID: PMC12303734, DOI: 10.1161/circulationaha.124.073614.Peer-Reviewed Original ResearchIncident acute myocardial infarctionAcute myocardial infarctionIncreased oddsRisk of acute myocardial infarctionHigher risk of acute myocardial infarctionProbability of acute myocardial infarctionOccurrence of acute myocardial infarctionRandom-effects meta-analysisCase-crossover studyMultivariate random-effects meta-analysisExposure to ozoneRegion-specific estimatesMyocardial infarctionStatistical interaction termsAmbient ozone pollutionPrevention strategiesUnited StatesJoint exposureMeta-analysisAdult ageYoung adultsHigh riskAdultsOddsInteraction termsShort‐Term Associations Between Ambient Ozone and Acute Myocardial Infarction Onset Among Younger Patients: Results From the VIRGO Study
Zhang S, Chu L, Lu Y, Wei J, Dubrow R, Chaudhry S, Spatz E, Krumholz H, Chen K. Short‐Term Associations Between Ambient Ozone and Acute Myocardial Infarction Onset Among Younger Patients: Results From the VIRGO Study. GeoHealth 2025, 9: e2024gh001234. PMID: 39968338, PMCID: PMC11833228, DOI: 10.1029/2024gh001234.Peer-Reviewed Original ResearchAcute myocardial infarction subtypeShort-term associationsAcute myocardial infarctionAcute myocardial infarction onsetAMI riskEffect modificationAssociated with increased AMI riskParticipant's home addressNon-Hispanic blacksNon-ST-segment elevation acute myocardial infarctionNon-Hispanic whitesCase-crossover designType 1 AMIConditional logistic regressionIncreased AMI riskMyocardial infarction onsetType 2 AMIAcute myocardial infarction patientsST-segment elevation acute myocardial infarctionLifestyle factorsSociodemographic statusHome addressUS hospitalsStratified analysisSpatiotemporal deep learning approachDepression and Low Social Support Mediate the Association of Marital Stress and 12-Month Cardiac-Specific Quality of Life in Young Adults With Acute Myocardial Infarction
Zhu C, Dreyer R, Li F, Spatz E, Caraballo C, Mahajan S, Raparelli V, Leifheit E, Lu Y, Krumholz H, Spertus J, D’Onofrio G, Pilote L, Lichtman J. Depression and Low Social Support Mediate the Association of Marital Stress and 12-Month Cardiac-Specific Quality of Life in Young Adults With Acute Myocardial Infarction. Biopsychosocial Science And Medicine 2025, 87: 129-137. PMID: 39909011, DOI: 10.1097/psy.0000000000001363.Peer-Reviewed Original ResearchConceptsLow social supportCardiac-specific quality of lifeNatural direct effectSocial supportMonths post-AMIQuality of lifeAcute myocardial infarctionMarital stressComprehensive secondary preventive strategySignificant depressive symptomsPost-AMISecondary prevention strategiesYoung adultsMyocardial infarctionSociodemographic factorsDepressive symptomsAMI survivorsCovariate adjustmentPrevention strategiesSelf-ReportContinuous scoresQoLBaseline QOLCategorical depressionDepression
2024
Health status outcomes after acute myocardial infarction in patients without standard modifiable risk factors
Ikemura N, Chan P, Gosch K, Nguyen D, Iv C, Khan M, Lu Y, Sawano M, Krumholz H, Spertus J. Health status outcomes after acute myocardial infarction in patients without standard modifiable risk factors. American Heart Journal 2024, 281: 123-132. PMID: 39638274, PMCID: PMC11810589, DOI: 10.1016/j.ahj.2024.11.018.Peer-Reviewed Original ResearchSeattle Angina QuestionnaireModifiable risk factorsHealth status outcomesBaseline SAQ scoresAcute myocardial infarctionStatus outcomesHealth statusRisk factorsSequential adjustmentSAQ scoresModifiable cardiovascular risk factorsHistory of coronary diseaseSAQ Summary ScoreHierarchical linear mixed modelsAcute myocardial infarction patientsCardiovascular risk factorsMyocardial infarctionSummary scoreSociodemographic characteristicsAngina QuestionnaireLinear mixed modelsDepressive symptomsU.S. hospitalsLong-term mortalitySecondary preventionShort-term association between ambient ozone and onset of acute myocardial infarction of young patients: Results from the VIRGO study
Zhang S, Chu L, Lu Y, Krumholz H, Chen K. Short-term association between ambient ozone and onset of acute myocardial infarction of young patients: Results from the VIRGO study. ISEE Conference Abstracts 2024, 2024 DOI: 10.1289/isee.2024.0539.Peer-Reviewed Original ResearchReal-world evaluation of an algorithmic machine-learning-guided testing approach in stable chest pain: a multinational, multicohort study
Oikonomou E, Aminorroaya A, Dhingra L, Partridge C, Velazquez E, Desai N, Krumholz H, Miller E, Khera R. Real-world evaluation of an algorithmic machine-learning-guided testing approach in stable chest pain: a multinational, multicohort study. European Heart Journal - Digital Health 2024, 5: 303-313. PMID: 38774380, PMCID: PMC11104476, DOI: 10.1093/ehjdh/ztae023.Peer-Reviewed Original ResearchRisk of acute myocardial infarctionAssociated with lower oddsHospital health systemCoronary artery diseaseCardiac testingRisk of adverse outcomesUK BiobankHealth systemProvider-drivenLower oddsAssociated with better outcomesAcute myocardial infarctionBlack raceStable chest painFemale sexReal world evaluationDiabetes historyMulticohort studyFunction testsSuspected coronary artery diseaseYounger ageRisk profileAdverse outcomesMultinational cohortPost Hoc AnalysisAssociation of marital/partner status with hospital readmission among young adults with acute myocardial infarction.
Zhu C, Dreyer R, Li F, Spatz E, Caraballo C, Mahajan S, Raparelli V, Leifheit E, Lu Y, Krumholz H, Spertus J, D'Onofrio G, Pilote L, Lichtman J. Association of marital/partner status with hospital readmission among young adults with acute myocardial infarction. PLOS ONE 2024, 19: e0287949. PMID: 38277368, PMCID: PMC10817183, DOI: 10.1371/journal.pone.0287949.Peer-Reviewed Original ResearchConceptsMarital/partner statusPsychosocial factorsAcute myocardial infarctionYoung adultsHospital dischargeYear of hospital dischargeYoung acute myocardial infarctionAssociated with 1.3-foldCohort of young adultsLong-term readmissionCox proportional hazards modelsStatus interactionSimilar-aged menMyocardial infarctionProportional hazards modelUnpartnered statusPatient interviewsPhysician panelCardiovascular healthHospital readmissionSocioeconomic factorsAMI survivorsSequential adjustmentCardiac readmissionMultiple imputation
2023
Association of Neighborhood-Level Marginalization With Health Care Use and Clinical Outcomes Following Hospital Discharge in Patients Who Underwent Coronary Catheterization for Acute Myocardial Infarction in a Single-Payer Health Care System
Akioyamen L, Abdel-Qadir H, Han L, Sud M, Mistry N, Alter D, Atzema C, Austin P, Bhatia R, Booth G, Dhalla I, Ha A, Jackevicius C, Kapral M, Krumholz H, Lee D, McNaughton C, Roifman I, Schull M, Sivaswamy A, Tu K, Udell J, Wijeysundera H, Ko D. Association of Neighborhood-Level Marginalization With Health Care Use and Clinical Outcomes Following Hospital Discharge in Patients Who Underwent Coronary Catheterization for Acute Myocardial Infarction in a Single-Payer Health Care System. Circulation Cardiovascular Quality And Outcomes 2023, 16: e010063. PMID: 38050754, DOI: 10.1161/circoutcomes.123.010063.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionMyocardial infarctionHealth care systemHospital dischargeClinical outcomesSocioeconomic statusFirst acute myocardial infarctionProportional hazards regression modelsCare systemSecondary prevention medicationsWorse clinical outcomesHealth service usePopulation-based studyPrimary care physiciansHealth care useHazards regression modelsGreater long-term riskPrescription medication useSingle-payer health care systemUniversal health care systemLong-term riskLow socioeconomic statusCause mortalityDays postdischargePrevention medicationsClinical Phenotyping with an Outcomes-driven Mixture of Experts for Patient Matching and Risk Estimation
Hurley N, Dhruva S, Desai N, Ross J, Ngufor C, Masoudi F, Krumholz H, Mortazavi B. Clinical Phenotyping with an Outcomes-driven Mixture of Experts for Patient Matching and Risk Estimation. ACM Transactions On Computing For Healthcare 2023, 4: 1-18. PMID: 37908872, PMCID: PMC10613929, DOI: 10.1145/3616021.Peer-Reviewed Original ResearchSex‐Specific Associations of Obstructive Sleep Apnea Risk With Patient Characteristics and Functional Outcomes After Acute Myocardial Infarction: Evidence From the VIRGO Study
Gupta A, Barthel A, Mahajan S, Dreyer R, Yaggi H, Bueno H, Lichtman J, Krumholz H. Sex‐Specific Associations of Obstructive Sleep Apnea Risk With Patient Characteristics and Functional Outcomes After Acute Myocardial Infarction: Evidence From the VIRGO Study. Journal Of The American Heart Association 2023, 12: e027225. PMID: 37702090, PMCID: PMC10547292, DOI: 10.1161/jaha.122.027225.Peer-Reviewed Original ResearchConceptsObstructive sleep apneaAcute myocardial infarctionHigh OSA riskOSA riskSex-specific associationsFunctional outcomeHealth statusHigh riskVIRGO StudyMyocardial infarctionDepressive symptomsHistory of OSATime of AMIImpact of OSAObstructive sleep apnea riskLow-risk patientsSleep apnea riskMajority of patientsTime of presentationSex-specific outcomesWorse health statusHigh-risk menPoor health statusMental health statusPoor health outcomesImpact of Marital Stress on 1‐Year Health Outcomes Among Young Adults With Acute Myocardial Infarction
Zhu C, Dreyer R, Li F, Spatz E, Caraballo‐Cordovez C, Mahajan S, Raparelli V, Leifheit E, Lu Y, Krumholz H, Spertus J, D'Onofrio G, Pilote L, Lichtman J. Impact of Marital Stress on 1‐Year Health Outcomes Among Young Adults With Acute Myocardial Infarction. Journal Of The American Heart Association 2023, 12: e030031. PMID: 37589125, PMCID: PMC10547344, DOI: 10.1161/jaha.123.030031.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionCardiac-specific qualityGeneric health statusMyocardial infarctionBaseline healthMarital stressHealth outcomesHealth statusWorse patient-reported outcomesMental healthYoung adultsObservational cohort studyPatient-reported outcomesSocioeconomic factorsWorse mental healthReadmission 1Cause readmissionCohort studyYounger patientsRoutine screeningDepressive symptomsGreater oddsAnginaMale participantsOutcomesImpact of Sex‐ and Gender‐Related Factors on Length of Stay Following Non–ST‐Segment–Elevation Myocardial Infarction: A Multicountry Analysis
Bender U, Norris C, Dreyer R, Krumholz H, Raparelli V, Pilote L. Impact of Sex‐ and Gender‐Related Factors on Length of Stay Following Non–ST‐Segment–Elevation Myocardial Infarction: A Multicountry Analysis. Journal Of The American Heart Association 2023, 12: e028553. PMID: 37489737, PMCID: PMC10492965, DOI: 10.1161/jaha.122.028553.Peer-Reviewed Original ResearchConceptsSegment elevation myocardial infarctionMyocardial infarctionGender-related factorsLonger LOSSegment elevation myocardial infarction diagnosisConclusions Older ageObservational cohort studyAdverse clinical outcomesAdjusted multivariable modelAcute myocardial infarctionLength of stayImpact of sexHealth care expendituresGENESIS-PRAXYHospital lengthNon–STCause mortalityCohort studyIndependent predictorsMyocardial infarction diagnosisClinical outcomesShorter LOSMedical historyMultivariable modelUnivariate associationsDo PCI Facility Openings and Closures Affect AMI Outcomes Differently in High- vs Average-Capacity Markets?
Shen Y, Krumholz H, Hsia R. Do PCI Facility Openings and Closures Affect AMI Outcomes Differently in High- vs Average-Capacity Markets? JACC Cardiovascular Interventions 2023, 16: 1129-1140. PMID: 37225284, PMCID: PMC10229059, DOI: 10.1016/j.jcin.2023.02.010.Peer-Reviewed Original ResearchConceptsPercutaneous coronary interventionPCI hospitalsSame-day percutaneous coronary interventionHealth outcomesHigh-volume PCI hospitalsHospital PCI volumeRetrospective cohort studyAcute myocardial infarctionPercentage point decreasePatient health outcomesHospital revascularizationCohort studyCoronary interventionAMI outcomesPCI volumePoint decreasePoor outcomePCI facilitiesMyocardial infarctionRelative increaseHospital openingPatientsHospital availabilityHospitalHospital closuresSex Difference in Outcomes of Acute Myocardial Infarction in Young Patients
Sawano M, Lu Y, Caraballo C, Mahajan S, Dreyer R, Lichtman J, D'Onofrio G, Spatz E, Khera R, Onuma O, Murugiah K, Spertus J, Krumholz H. Sex Difference in Outcomes of Acute Myocardial Infarction in Young Patients. Journal Of The American College Of Cardiology 2023, 81: 1797-1806. PMID: 37137590, DOI: 10.1016/j.jacc.2023.03.383.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionNoncardiac hospitalizationsSubdistribution HRYounger patientsMyocardial infarctionSex differencesYoung womenCause-specific hospitalizationsCause of hospitalizationWorse health statusSignificant sex disparityNoncardiovascular hospitalizationsVIRGO StudyIndex episodeAdverse outcomesIncidence rateHospitalizationHigh riskSex disparitiesHealth statusPatientsU.S. hospitalsWomenInfarctionOutcomes
2022
Temporal trends in postoperative and ventilator-associated pneumonia in the United States
Metersky M, Wang Y, Klompas M, Eckenrode S, Mathew J, Krumholz H. Temporal trends in postoperative and ventilator-associated pneumonia in the United States. Infection Control And Hospital Epidemiology 2022, 44: 1247-1254. PMID: 36326283, DOI: 10.1017/ice.2022.264.Peer-Reviewed Original ResearchConceptsVentilator-associated pneumoniaMajor surgical proceduresPostoperative pneumoniaAcute myocardial infarctionSurgical proceduresHeart failureMyocardial infarctionMedicare Patient Safety Monitoring SystemAnnual riskRetrospective cohort studyPrior yearRisk-adjusted ratesAdverse event measuresCohort studyRetrospective reviewPneumoniaPatientsInfarctionUnited StatesRiskSignificant changesYearsTemporal trendsFailureTrends in Adverse Event Rates in Hospitalized Patients, 2010-2019
Eldridge N, Wang Y, Metersky M, Eckenrode S, Mathew J, Sonnenfeld N, Perdue-Puli J, Hunt D, Brady PJ, McGann P, Grace E, Rodrick D, Drye E, Krumholz HM. Trends in Adverse Event Rates in Hospitalized Patients, 2010-2019. JAMA 2022, 328: 173-183. PMID: 35819424, PMCID: PMC9277501, DOI: 10.1001/jama.2022.9600.Peer-Reviewed Original ResearchMeSH KeywordsAccidental FallsAdultAgedAged, 80 and overCross InfectionCross-Sectional StudiesDrug-Related Side Effects and Adverse ReactionsFemaleHeart FailureHospitalizationHumansMaleMedicareMiddle AgedMyocardial InfarctionPatient SafetyPneumoniaPostoperative ComplicationsPressure UlcerRisk AssessmentSurgical Procedures, OperativeUnited StatesConceptsMajor surgical proceduresAcute myocardial infarctionAdverse event ratesGeneral adverse eventsAdverse eventsHeart failureAdverse drug eventsAcute care hospitalsMyocardial infarctionHospital-acquired infectionsSurgical proceduresEvent ratesHospital dischargeCare hospitalDrug eventsMedicare Patient Safety Monitoring SystemSerial cross-sectional studyPatient safetyUS acute care hospitalsHospital adverse eventsSignificant decreaseSurgical procedure groupsCross-sectional studyRisk-adjusted ratesAdult patientsTrends in 10-Year Outcomes Among Medicare Beneficiaries Who Survived an Acute Myocardial Infarction
Wang Y, Leifheit EC, Krumholz HM. Trends in 10-Year Outcomes Among Medicare Beneficiaries Who Survived an Acute Myocardial Infarction. JAMA Cardiology 2022, 7: 613-622. PMID: 35507330, PMCID: PMC9069341, DOI: 10.1001/jamacardio.2022.0662.Peer-Reviewed Original ResearchConceptsRecurrent acute myocardial infarctionAcute myocardial infarctionHealth priority areasLong-term outcomesCause mortalityHazard ratioWhite patientsMyocardial infarctionMedicare feeMedicare-MedicaidService beneficiariesInitial acute myocardial infarctionTen-year mortalityShort-term outcomesDemographic subgroupsEligible patientsPatient characteristicsAMI survivorsAcute periodMean ageRecurrence rateSubgroup analysisMAIN OUTCOMEMortality riskAMI admissionsSex-Specific Risk Factors Associated With First Acute Myocardial Infarction in Young Adults
Lu Y, Li SX, Liu Y, Rodriguez F, Watson KE, Dreyer RP, Khera R, Murugiah K, D’Onofrio G, Spatz ES, Nasir K, Masoudi FA, Krumholz HM. Sex-Specific Risk Factors Associated With First Acute Myocardial Infarction in Young Adults. JAMA Network Open 2022, 5: e229953. PMID: 35503221, PMCID: PMC9066284, DOI: 10.1001/jamanetworkopen.2022.9953.Peer-Reviewed Original ResearchConceptsFirst acute myocardial infarctionAcute myocardial infarctionPsychosocial risk factorsRisk factor profilePopulation attributable fractionRisk factor associationsRisk factorsOdds ratioYoung womenAMI subtypesMyocardial infarctionPrevention of AMIType 1 acute myocardial infarctionFactor profileRisk of AMITraditional cardiovascular risk factorsSex-specific risk factorsFactor associationsYoung adultsRisk factor modificationCardiovascular risk factorsStrong associationNutrition Examination SurveyCase-control studyPopulation-based controls
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