Comparison of the Incidence and Risk Factors of Acute Coronary Syndrome in Japan and Thailand: A retrospective cohort study

BackgroundThere is strong evidence demonstrating the incidence of Acute Coronary Syndrome (ACS) among patients with cirrhosis, with the initiation of antiplatelet therapy being subject to debate due to an increased risk of bleeding. This study aimed to determine mortality among patients presenting with concomitant Acute Variceal Bleeding (AVB) and ACS at Index admission. Furthermore, the recurrence of AVB and ACS among patients discharged with or without antiplatelet therapy was determined.MethodsThis retrospective study was conducted at the Aga Khan University Hospital, Karachi, Pakistan on patients ≥ 18 years of age admitted to our ER with concomitant ACS and AVB between January 2002 to December 2017. Follow-up for 6 months or till death (if < 6 months), was observed, to help determine the incidence of recurrent AVB and ACS. The incidence of AVB and ACS was then compared amongst patient groups based on the usage of anti-platelet drugs on discharge.ResultsA total of 29 patients were included, with a mean age of 58.7 ± 11.0 years. Seven patients died on admission, having worse underlying liver disease. No mortality was reported among the remaining 22 patients. All 22 patients underwent surveillance endoscopy with variceal band ligation until obliteration, as needed. Only 7 patients from the surviving cohort received antiplatelet therapy. After 6.05 ± 1.1 months of follow-up, 1/22 (4.5%) developed recurrent AVB and 2/22 (9.1%) developed cardiovascular events. Importantly, there was no significant difference in the incidence of recurrent AVB (P = 1.000) and ACS (P = 0.091), depending on the use of antiplatelet therapy.ConclusionConcomitant AVB and ACS is a severe disorder with increased mortality among cirrhotic patients at presentation. The incidence of AVB does not seem to exacerbate with the use of antiplatelet agents, provided successful obliteration of varices is achieved using elective band ligation.

ObjectiveDiabetic patients with acute coronary syndrome (ACS) are at higher risk of poor outcome than are non-diabetic patients with ACS. Few studies have focused on sex-related ACS incidence, ACS-related mortality or risk factors to affects sex specific ACS in Chinese with Type 2 diabetes mellitus (T2DM). Based on a hospital-based cohort of Chinese patients with T2DM, we aimed to investigate whether there was sex difference in ACS or ACS-related mortality or risk factors of ACS.MethodsTotally 2,135 Hong Kong Chinese with T2DM were recruited during 1994-1996 and followed up until August 2012. We systematically analyzed sex-related ACS incidence and ACS-related mortality and risk factors with χ2-squared test, descriptive statistics and survival analysis.ResultsRegular follow-up was completed in 2,105 subjects (98.6%), with a median period of 14.53 years. The occurrence of ACS was recorded among 414 patients (19.7%) and ACS-related death among 104 patients (4.9%). ACS incidences increased with age in both men and women, and men had a higher prevalence of ACS than women across different age categories and different follow-up periods (log rank χ2=20.32, P<0.001). The transition of ACS incidences from slow to rapid increase were about 5 years earlier in men (at 51-55 years) than in women (55-60 years). Among ACS patients, cumulative ACS-related mortalities was similar between men and women (log rank χ2=0.063, P=0.802). Besides age and albuminuria, different profiles of risk factors accounted for the occurrence of ACS between men and women.ConclusionsOur findings demonstrated sex differences in ACS incidence and risk factors, but not in ACS-related mortality in Chinese patients withT2DM. These findings suggest that screening and prevention campaigns should be optimized for men and women, which may help to identify diabetic patients at higher risk of coronary heart disease.

Incidence and impact of acute coronary syndrome on outcomes in chimeric antigen receptor T-cell therapy: Insights from a six-year nationwide analysis

To evaluate the effects of pulmonary tuberculosis (PTB) on the risk of subsequent acute coronary syndrome (ACS) development. The incidence and risk factors of ACS were investigated in 10 168 newly diagnosed tuberculosis (TB) patients from Taiwan's National Health Insurance Research Database between 1997 and 2010, and 40 672 controls without TB from the general population. The follow-up period ran from the diagnosis of new TB to the date of the ACS event, censoring or 31 December 2010. During the follow-up period, the overall incidence of ACS was higher in TB patients than in non-TB patients (2.10 vs. 1.51 per 1000 person-years). The incidence of ACS increased by 40% in TB patients after adjusting for age, sex and co-morbidities. Male sex, age, hypertension and diabetes were independent factors for the risk of ACS development. The probability of ACS increased in the years following the TB diagnosis. This nationwide population-based cohort study provides compelling evidence that TB patients are at higher risk of developing ACS, and that the risk increases with age. Clinicians should be aware of this and strive to reduce ACS risk factors in TB patients.

Acute coronary syndrome during pregnancy and postpartum in France: the nationwide CONCEPTION study

New diagnostic and treatment options for emergency department (ED) patients with congestive heart failure (CHF) may facilitate the ED discharge of some patients. However, some patients require admission to exclude concurrent acute coronary syndrome (ACS) as the precipitant of CHF. The objective of this study was to identify the incidence, clinical characteristics, and hospital course of CHF patients who present to the ED with and without concurrent ACS. This was a prospective cohort study of consecutive patients >23 years of age who presented to the ED with chest pain, received an electrocardiogram (ECG), and either had a known history of CHF or presented with new-onset CHF, between July 1999 and April 2001. The hospital course of each patient was followed daily, and telephone follow-up occurred at 30 days. The main outcomes were the incidence of ACS and comparisons of lengths of hospital stay (LOSs), rates of admission to the intensive care unit (ICU), intubations, and death rates among patients with and without ACS. Two hundred ninety-eight CHF patients presented 380 times. The incidence of ACS in the 380 patient visits was 32% (95% CI = 27% to 36%). Compared with patients who did not have ACS, patients who had concurrent ACS were more likely to have known coronary artery disease (CAD) (67% vs. 42%; p < 0.0001) and hypercholesterolemia (36% vs. 18%; p = 0.0002). Patients with concurrent ACS were also more likely to be admitted to the hospital (97% vs 82%; p < 0.0001), had a longer LOS (5.2 [3.9-6.5] vs 3.2 [2.6-3.8] days; p = 0.006), had higher rates of ICU admission (44% vs. 13%; p < 0.0001), were more likely to be intubated (8% vs. 1%, p = 0.002), and were more likely to die (15 vs 7 deaths; p < 0.0001). The incidence of ACS in ED CHF patients with chest pain was 32%. Patients with CHF complicated by ACS had more prolonged hospital stays, required higher levels of care, and had a higher incidence of death than those patients without ACS. Strategies tailored to early identification and management of these patients would be desirable.

Objective: Very different estimated incidences have been reported concerning pregnancy-related acute coronary syndrome (ACS). The objective of our study was to assess the incidence of ACS during pregnancy, peripartum and postpartum, to compare it with the incidence of ACS in non-pregnant women of childbearing age and to study characteristics associated with pregnancy-related ACS. Design and method: All women without ischemic heart disease who delivered between 2010 and 2018 in France were included in the CONCEPTION cohort. We used Poisson regression to estimate the crude incidence of ACS and age-adjusted Poisson models to estimate the incidence risk ratio (IRR) of ACS in pregnant versus nonpregnant women, with 95% confidence interval (CI). Results: Among 6 298 967 pregnancies in France, 225 experienced a first ever ACS. The global ACS incidence in women giving birth was 4.34 per 100 000 person-years, stable between 2010 and 2018 (1 ACS every 23 000 pregnancies). Compared with nonpregnant women, age-adjusted incidence rates of ACS were lower during pregnancy IRR: 0.76 (95%CI: 0.57–0.98) (p &lt; 0.05). In a multivariate analysis, independent factors associated with ACS were age, social deprivation (OR = 1.91 (1.42–2.58)), obesity (OR = 1.73 (1.13–2.65)), tobacco use (OR = 3.43 (2.55–4.61)) (Table). The risk of ACS associated with chronic hypertension and hypertensive disorders of pregnancy was 4.5 (2.90–6.95) and 2.09 (1.43–3.06) respectively. Conclusions: Global incidence of pregancy-related ACS was 4.34 per 100 000 person-years. The pregnancy-related ACS incidence was 24% lower than the ACS incidence in age-adjusted non-pregnant women. More efforts should be made in terms of prevention, considering the frequency of treatable cardiovascular risk factors such as tobacco use and hypertensive disorders of pregnancy.

Síndrome coronario agudo sintomático en el seguimiento de una cohorte en el postoperatorio de cirugía no cardiaca

Introduction:Acute coronary syndrome (ACS) is one of the most common health problems in the world and the leading cause of death.Goal:The goals of this study are to determine: ACS type, risk factors, incidence and the seasonal distribution of occurrence Spring/Summer, Autumn/Winter, ACS incidence by age and gender, and complications (post-infarction angina and heart failure) and fatal outcomes of ACS per season.Material and methodology:This study is designed as retrospective-prospective and analytical, which included 250 patients hospitalized in the Intensive Cardiac care unit of the Clinic for heart disease, blood vessels and rheumatism in the period from June 2013 to July 2014. It was assumed that there is the influence of the seasons on the incidence and characteristics of ACS. Material used were the medical records and data from the history of illness.Results:The most common type of ACS was ST elevation myocardial infarction (STEMI), without statistical significant difference between seasons. Presence of risk factors is not significantly different between seasons, with the hypertension as the most common risk factor for ACS during both seasons. The highest incidence of ACS was recorded in December during the winter season, while the lowest incidence was recorded in March. The occurrence of ACS during the Spring/Summer, Autumn/Winter was different according to age, with more frequent occurrence of ACS in older patients during the winter months. ACS complications (postinfaction angina and cardiac insufficiency) were also statistically different between seasons (p=0.048). Fatal ACS is more often recorded during the season Autumn/Winter compared to Spring/Summer season (p=0.001).Conclusion:The results suggest seasonal meteorological impact on the incidence, complications and outcomes of ACS, so there is a necessity that patients adapt their lifestyle and health professionals to improve the ACS treatment.

Incidence, Clinical Characteristics, Risk Factors and Outcomes of Acute Coronary Syndrome in Patients With COVID-19: Results of the UMC-19-S1010

Background . Cardiovascular comorbidities associated with atrial fibrillation (AF) are also risk factors for acute coronary syndrome (ACS). We sought to determine the incidence of subsequent ACS in Medicare pts with newly diagnosed AF. Methods . The 5% Medicare database was used to identify pts (age 65+, no ESRD) with AF in 2006 without a prior diagnosis of ACS or AF. Medicare claims were used to identify patients hospitalized with ACS using ICD-9-CM codes for acute myocardial infarction (410) and unstable angina (411). The cumulative incidence of ACS and death was calculated during 3-year follow up using competing risk analysis and independent predictors of ACS were identified using a Cox proportional hazards model. Results . 18,445 Medicare pts were newly diagnosed with AF in 2006. The baseline characteristics of this population were: age 78 ± 7.8 yrs, hypertension (67%), CAD (33%), DM (26%), dyslipidemia (24%), CHF (21%), CVA/TIA (15%). 1392 (8%) patients from this cohort received an ACS diagnosis within 3 years (Figure). The rate of incident ACS was 11% in pts with prior CAD, CHF or DM. The rates of death at 3 years varied by age (49% for age ≥ 85, 26% for ages 75-84, 16% for ages 65-74). Independent risk factors for incident ACS included: female gender (HR 1.38, p==0.003), prior CAD (HR 1.78, p&lt;0.0001), DM (HR 1.48, p &lt;0.0001), CHF (HR 1.41, p &lt;0.0001). Conclusion . Pts with a new diagnosis of AF had an 8% incidence of ACS within 3 years of the diagnosis of AF; this risk was higher in the presence of comorbid conditions. These data have important implications in chronically anti-coagulated AF pts, as the subsequent diagnosis of ACS will entail additional antiplatelet therapy and increased hemorrhagic risk. In elderly pts with AF, however, mortality is much more frequent than subsequent ACS.

Objective To analyze the relationship between serum asymmetric dimethylarginine (ADMA) and initial acute coronary syndrome (ACS) after taking a proton pump inhibitor (PPI). Methods From January 2017 to October 2018, we enrolled 140 patients with initial ACS and 70 healthy subjects. Among them, 70 patients were included in a PPI group (administration of PPI+ initial ACS), 70 patients in an ACS group (non-PPI+ initial ACS), and 70 healthy subjects (non-PPI+ non-ACS) in a control group. Serum ADMA concentration was measured by enzyme linked immunosorbent assay, and cholesterol and triglyceride were measured routinely. General demographic information, biochemical indicators, and ADMA levels were compared by one-way ANOVA, nonparametric test, and chi-square test. Mann-Whitney U test was used for comparison between groups. Spearman correlation analysis was used to analyze the relationship between serum ADMA level and traditional risk factors of acute coronary syndrome. Multivariate logistic regression analysis was used to investigate the risk factors for ACS. Results Serum ADMA levels in the PPI group and the ACS group were both significantly higher than that in the control group (Z=-9.585, -4.793, P 0.05). Logistic regression analysis showed that serum ADMA level was an independent risk factor for patients with initial ACS (β=0.017, OR=1.017, P<0.001). Conclusions Serum ADMA levels in patients with initial ACS after taking proton pump inhibitors are significantly higher than those in initial ACS patients without taking proton pump inhibitors. Serum ADMA levels in patients with initial ACS are significantly higher than those in healthy controls. Elevated serum ADMA is an independent risk factor for initial ACS. Key words: Asymmetric dimethylarginine; Proton pump inhibitor; Acute coronary syndrome

ObjectivesTo compare the 1-year, 2-year and 5-year incidences of acute coronary syndrome (ACS) in patients with rheumatoid arthritis (RA) starting any of the biologic disease-modifying antirheumatic drugs (bDMARDs) currently available...

BackgroundStudies investigating the epidemiological relationship between scrub typhus and the subsequent development of acute coronary syndrome (ACS) are lacking. Therefore, we conducted a nationwide longitudinal cohort study in Taiwan to...

Cardiovascular diseases cause approximately one-third of all deaths in the world, of which 7.5 million deaths are estimated to be due to ischaemic heart disease (IHD). Acute coronary syndromes (ACS) and sudden death cause most IHD-related deaths, which represent 1.8 million deaths per year. The incidence of IHD in general, and of ACS, increases with age although, on average, this occurs 7–10 years earlier in men compared with women. ACS occurs far more often in men than in women below the age of 60 years but women represent the majority of patients over 75 years of age. The risk of acute coronary events in life is related to the exposure to traditional cardiovascular risk factors. This can be estimated using risk scores, such as the European Society of Cardiology SCORE system. Huge differences within European and world regions can be found in the incidence and prevalence of IHD and ACS as well as in case fatality rates. However, information on the incidence of ACS is still limited for Europe. While the incidence of non ST-segment elevation ACS has remained relatively stable, the incidence of ST-segment elevation myocardial infarction has suffered a significant decrease in recent years. Furthermore, the majority of European countries experienced substantial decreases in age-standardized death rates for cardiovascular diseases and IHD in the last decades, particularly for myocardial infarction. This is the consequence of the improvement in cardiovascular prevention and ACS treatment but this trend may be reverting due to population ageing and the increase in some risk factors.