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Study Objectives: Persons consuming a micronutrient rich diet (eg, vitamins) have lower cardiovascular disease risk and there is interest in how the micronutrient environment might influence cardiac recovery post-acute myocardial infarction (AMI) Accordingly, we sought to investigate the relationship between nicotinamide specifically, and micro-nutritional profiles generally and AMI recovery with a goal of identifying plausible biologic targets to improve post-AMI outcomes Since African Americans (AA) experience the highest rate of mortality and rehospitalization post-AMI, our study focuses on enrolling AA patients Methods: Study will recruit 100 patients at emergency departments (EDs) of Detroit Receiving (DRH), Sinai Grace (SGH), and Harper University Hospitals (HUH) with age > 18 and primary diagnosis of AMI defined by 4th Universal Definition of MI Comorbidities may alter micronutrient levels, excluding: active chronic alcohol/drug users, hepatic failure, renal failure, HIV;pregnant women, those with metabolic disorders except diabetes, and prisoners We record 30-day post-AMI cardiac-related rehospitalization and mortality by chart review, phone follow-up, and social security death index Procedures include collection of 2mL plasma stored at -80 C prior to micronutrient extraction and profiling Liquid chromatography-mass spectrometry analysis of vitamins are performed using QTrap 6500 mass spectrometer (AB Sciex, Singapore) with multi-reaction monitoring to detect molecular ion-daughter combinations Sample sizes (Table 1) calculation and power analysis (Table 2) were performed using G*Power software With 100 patients, we anticipate 18 readmissions and 12 deaths, with 0 81 power to evaluate the association of nicotinamide deficiency and post-AMI outcomes with significance of 0 05 (one tail, normal distribution) with R2=0 and odds ratio=2 in the logistic regression adjusted for age, sex, biomarker data, clinical intervention, and medical history Broad micronutrient profile and post-AMI outcomes assessed by principal component analysis (PCA) 15 individual micronutrients will be assayed Patient records will be normalized (mean 0, unit variance within each analyte), and PCA will identify the set of micronutrients responsible for the majority of patient variation Results: Our study enrollment is on hold because of COVID-19 since February 2020 With publicly reported AMI readmission and mortality rates from DRH, HUH, and SGH, we estimate 18% AMI patients readmitted and 12% die 30 days post-discharge (prevalence 30%) We assume 50% patients with reduced nicotinamide plasma concentrations, which may make them two times more likely to die than those with greater concentrations If their nicotinamide level increase one unit, adverse outcomes reduced by 5% Conclusions: Micronutrients may contribute to post-AMI outcomes Our study will be the first to evaluate this in an AA cohort of ED patients Our hypothesis is that individual variation in micronutrient concentrations will partition study participants into groups We will examine the prevalence of 30-day outcomes within groupings and identify which micronutrients contribute most robustly to the groupings [Formula presented]
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