Optical coherence tomography-guided percutaneous coronary intervention in acute coronary syndrome patients with complex lesions: a subgroup analysis of the randomised OCCUPI Trial

Acute coronary syndromes

Background: A comparative retrospective study has made to compare the distribution of risk factors and complications in acute coronary syndrome (ACS) patients and other cardiac patients.
 Methods: Records of 768 patients from Sana’a city and other cardiac patients in Yemen. To assess the risk factors for acute coronary syndrome (ACS); age, hypertension, diabetes mellitus, hyperlipidemia, cigarette smoking and reported history and family history of coronary artery disease (CAD). To assess the complications such as heart failure, arrhythmias and cerebro-vascular accident (CVA).
 Results: The mean age of acute coronary syndrome patients was significantly lower than other cardiac disease patients 56.8 year vs. 55.3 years; p= 0.007. History of hyperlipidemia was significantly higher acute coronary syndrome patients than other cardiac patients 49.2% vs. 38.3%; p=0.002. Reported history of coronary artery disease was also significantly higher among ACS patients. Hypertension, history of diabetes mellitus, cigarette smoking and reported family history of coronary artery disease were comparable among acute coronary syndrome patients and other cardiac patients. In-hospital complications: Cerebro-vascular accident was significantly higher among ACS patients than other cardiac patients 7.8 % vs. 4.4 %; p= 0.0001. Heart failure and arrhythmias rates were comparable. Wall motion abnormalities were comparable 79.2 vs. 73.2; p=0.51. While Ejection Fraction was lower in ACS patients than other cardiac patients 49.8.8% vs. 54.8; p=0.0001.
 Conclusions: The mean age was higher among acute coronary syndrome patients. History of hyperlipidemia and history of coronary artery disease were higher among acute coronary syndrome patients. Cerebro-vascular accident rate was higher in acute coronary syndrome patients.

Background: Kinetic signatures and physiologic states of circulating miR-186-5p in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) and their association with ACS prognosis have not been investigated. Methods: 92 ACS patients and 96 healthy controls were enrolled. Serum miR-186-5p levels in ACS patients (on admission and at different time points within one week after PCI) and controls were detected by quantitative reverse-transcription PCR. MiR-186-5p levels in serum and myocardium of rats following permanent ligation of left anterior descending coronary artery (LAD) were also measured. The predominant form of serum miR-186-5p was analyzed by comparing its absolute concentration in isolated exosomes and exosome-depleted supernatant. An average of one-year follow-up for ACS patients was performed and the incidence of major adverse cardiovascular events (MACE) was calculated. Findings: Serum miR-186-5p levels were significantly increased in ACS patients on admission compared with controls, but their high levels were gradually decreased within one week after PCI and returned to near control levels within 1~2 days after PCI. Increased serum miR-186-5p levels were negatively correlated with decreased myocardial miR-186-5p levels in rats after permanent LAD ligation. Serum miR-186-5p was mainly existed as exosome-free form rather than membrane-bound exosomes. Within one-year follow-up, ACS patients with higher miR-186-5p levels on admission exhibited a higher incidence of MACE. Cox regression analyses validated the potential values of serum miR-186-5p for prognostic evaluation in ACS patients after PCI. Interpretations: Serum miR-186-5p may act as a promising biomarker for monitoring and assessing prognosis of ACS patients after PCI. Funding Statement:This work was supported by grants from National Natural Science Foundation of China (no. 81572074 and no. 81871702) to J.-J. Wang, National Natural Science Foundation of China (no. 81401742) to J. Wu, and National Natural Science Foundation of China (no. 81572073) to J. Song. Declaration of Interests: The authors have no competing interests to declare. Ethics Approval Statement: This study was approved by the Research Ethics Committee of Jinling Hospital (2015NZGKJ-018) and was performed in accordance with the Declaration of Helsinki of 1975, as revised in 2013.

Pancoronary plaque characteristics and clinical outcomes in acute coronary syndrome patients with cancer history

Background: Percutaneous coronary intervention (PCI) is a cornerstone in the management of acute coronary syndrome (ACS) patients. Despite technological advancements, the occurrence of no-reflow phenomenon remains a significant concern among ACS patients. Atrial fibrillation (AF) is a common arrhythmia associated with cardiovascular events. We conducted a meta-analysis to investigate the potential influence of AF on the development of no-reflow in ACS patients following PCI. Methods: Relative risk (RR) with a 95% confidence interval (95%CI) served as the summary measure in our meta-analysis using the random-effects model to estimate the summary effect. The primary outcome is to investigate the potential influence of AF on the development of no-reflow in ACS patients following PCI. We assigned I2 > 50% as an indicator of statistical heterogeneity. P value <0.05 was considered significant. Data analysis was conducted using SPSS v.25. A comprehensive literature search was performed identifying relevant studies published up to January 2024 from October 2001 from PubMed, Google Scholar, Scopus databases. Studies reporting the baseline AF and no-reflow in ACS patients post-PCI were included. Case reports, duplicate studies, reviews and metaanalysis were excluded. Data screening and analysis were conducted independently by two reviewers. Results: The meta-analysis included 10 studies comprising a total of 11079 ACS patients who underwent PCI. No reflow developed in 2442 of these patients. In total, 653 patients had baseline AF and 10426 patients had not AF. No-reflow developed in 243 of the patients with baseline AF. Also, no-reflow developed in 2199 of the patients with non-AF. Our findings revealed a statistically significant association between AF and increased incidence of no-reflow in ACS patients following PCI (RR: 1.5 Cl %95) (p < 0.05). There was moderate statistical heterogeneity across the studies that evaluated no-reflow outcomes (I2= 61%) Conclusion: In this meta-analysis, we provide evidence suggesting that the presence of AF may have a deleterious effect on the development of no-reflow phenomenon in ACS patients following PCI. AF may have deleterious effects on the coronary microvasculature. Further research is warranted to elucidate the underlying mechanisms and to determine the clinical implications of these observations.

Circulating miR-186-5p is an emerging biomarker for acute coronary syndrome (ACS) patients. However, its kinetic signatures and prognostic values in ACS patients undergoing percutaneous coronary intervention (PCI) remain unclear. Levels of serum miR-186-5p were determined in 96 healthy controls and 92 ACS patients before and after PCI by qRT-PCR, and the physiologic state of miR-186-5p was analyzed by comparing its absolute concentrations in isolated exosomes and exosome-depleted supernatants. An average of 1 year of follow-up for ACS patients after PCI was performed. MiR-186-5p levels in the myocardium and serum of rats following left anterior descending coronary artery (LAD) ligation were measured. Serum miR-186-5p levels were found to be significantly increased in ACS patients upon admission compared with those of controls, but these high miR-186-5p levels gradually decreased within 1 week after PCI. Serum miR-186-5p was mainly present in an exosome-free form rather than membrane-bound exosomes. Within 1 year of follow-up, ACS patients with higher miR-186-5p levels upon admission exhibited a higher incidence of MACE after PCI. Different statistical analyzes further validated the independent prognostic values of serum miR-186-5p in ACS patients after PCI. Serum miR-186-5p levels in rats following LAD ligation were increased, and there was a decrease in myocardial miR-186-5p levels. Kyoto encyclopedia of genes and genomes (KEGG) analysis was performed to predict the related pathways of target genes of miR-186-5p, which suggested that miR-186-5p might be involved in ACS by regulating the inflammatory status and D-glucose metabolism. In conclusion, a distinctive expression signature of serum miR-186-5p may contribute to monitoring the clinical condition and assessing the prognosis of ACS patients undergoing PCI.

We hypothesized that matrix metalloproteinase (MMP)-2, -9, and tissue inhibitor metalloproteinase-1, -2 (TIMP-1, -2) would be abnormal in diabetes and in acute coronary syndromes (ACS). We measured MMP-2, -9, and TIMP-1, -2 plasma levels in healthy subjects (controls), in type 2 diabetic patients, in nondiabetic patients with ACS (ACS) and in diabetic patients with ACS (DACS). We enrolled 165 controls, 181 diabetic patients, 78 ACS, and 46 DACS. We measured also BMI (body mass index), HbA(1c) (glycated hemoglobin) FPG (fasting plasma glucosa), FPI (fasting plasma insulin), HOMA index (homeostasis model assessment index), SBP (systolic blood pressure), DBP (diastolic blood pressure), TC (total cholesterol), LDL-C (low density lipoprotein cholesterol), HDL-C (high-density lipoprotein cholesterol), Tg (triglycerides), Lp(a) (lipoprotein(a)) PAI-1 (plasminogen activator inhibitor-1), Hct (homocysteine), Fg (fibrinogen), and hs-CRP (high-sensitivity C-reactive protein). A significant increase of BMI was observed in the diabetic group, in ACS and DACS patients compared to controls. A significant increase of SBP and DBP resulted in the diabetic and DACS groups, while only SBP improvement was present in ACS patients with respect to controls. A decrease in SBP and DBP was observed in the ACS group, while SBP variation was present in DACS patients compared to diabetics, and DBP increase was obtained in the DACS group with respect to ACS patients. TC, LDL-C, Tg, and Lp(a) increase was present in diabetics, while TC, Tg, and Lp(a) improvement was present in ACS and DACS patients with a significant decrease of HDL-C levels in diabetic, ACS, and DACS groups compared to controls. A decrease in LDL-C was obtained in ACS and DACS groups, while HDL-C increase was observed in these patients with respect to diabetics. Tg levels were higher in the DACS group compared to diabetics and ACS patients, respectively. Increases in PAI-1, Hct, Fg, and hs-CRP were present in diabetic and DACS groups, while PAI-1, Hct, and hs-CRP improvement was obtained in ACS patients with respect to controls. Higher PAI-1 levels came about in ACS and DACS groups, while HCT and Fg levels were lower in ACS patients compared to diabetics. An increase in Fg was present in the DACS group with respect to ACS patients. A decrease in Hs-CRP was observed in DACS patients compared to diabetics and the ACS group, respectively. Higher MMP-2, MMP-9, TIMP-1, and TIMP-2 levels were present in diabetic, ACS, and DACS patients compared to controls. Significant MMP-2, TIMP-1, and TIMP-2 increases were observed in ACS and DACS groups, while MMP-9 decreased in these patients compared to diabetics. In conclusion, MMP-2, MMP-9, TIMP-1, and TIMP-2 plasma levels were higher in diabetic, ACS, and DACS patients, which may reflect abnormal extracellular matrix metabolism in diabetes and in acute coronary syndrome.

Ischemic heart disease is the second most significant health burden in Indonesia and the world. The prevalence of coronary heart disease patients in Yogyakarta is predicted to experience a continuous increase. In Sardjito Hospital, mortality rate of acute coronary syndrome (ACS) patients reaches 15%, with pneumonia infection identified as one of the predictors. Despite this high mortality rate, there is a lack of studies addressing the contribution of infectious comorbidities to mortality incidence among ACS patients. This study aimed to investigate the e ffect of infectious comorbidities on the incidence of mortality among ACS patients and its mortality rate in Sardjito Hospital. This study used a cross-sectional design in 794 patients diagnosed with ACS and registered in the SCIENCE registry from January to December 2022 at Sardjito Hospital. The analysis was conducted using the Chi-square method to determine the effect of infectious comorbidities on mortality among ACS patients and a logistic regression test to evaluate the correlation between variables. Based on bivariate analysis, it was found that infectious comorbidities increased mortality rate among ACS patients (p<0.001, OR=2.22[1.46-3.38]), reaching 5.2%. The bivariate analysis between confounding factors and outcome of patients showed that obesity, dyslipidemia, and revascularization significantly influenced the results of ACS patients. Based on multivariate analysis, it was discovered that infectious comorbidities, obesity, diabetes, dyslipidemia, and revascularization had a significant association with mortality of patients with ACS. Furthermore, infectious comorbidities increased the odds of mortality for ACS patients by 2.04 times. Infectious comorbidities increased the incidence of mortality in ACS patients by 2.04 times with mortality rate of 5.2%.

Background: Myeloperoxidase (MPO), an oxidative stress related enzyme is elevated in Coronary Artery Disease (CAD) and is involved in development of atherosclerotic plaque. Paraoxonase (PON) an enzyme protein associated with HDL serves as an antioxidant and plays an important role in preventing the formation of Oxidized LDL (OxLDL). This suggests a conflicting role of MPO and PON in development of cardiovascular disease and atherosclerosis.
 Aim: Present study was done to evaluate and compare MPO/PON ratio in Acute Coronary Syndrome (ACS) patients with controls. The study evaluates and compares the pro oxidant and pro inflammatory enzyme, MPO and anti-oxidant and anti-inflammatory enzyme, PON in ACS patients with controls. Oxidative marker, Malondialdehyde (MDA) and anti-oxidant marker, Reduced Glutathione (GSH) was assessed in ACS patients and compared with controls. An attempt was also made to correlate MPO/PON ratio to markers of oxidative stress (MDA and GSH).
 Methods: Cross-sectional study carried out in Dr. Somervell Memorial CSI Medical College, Trivandrum, Kerala, India.50 ACS patients from Cardiac Care Unit and 50 age and sex matched controls without CAD from Medical College Health Checkup was selected.
 Results: MPO and MPO/PON ratio were significantly high and PON was significantly lower in ACS patients compared to controls. Total cholesterol, Triglyceride, LDL, MDA were significantly high in ACS patients. Statistically significant positive correlation was observed between MPO/PON and MDA. Significant negative correlation was observed between MPO/PON and GSH.
 Conclusion: Myeloperoxidase and MPO/PON ratio was significantly high in ACS patients than controls. This is suggestive of the role of MPO in oxidative damage to lipoproteins in CAD patients. Prooxidant, Paraoxonase ,and antioxidant, GSH is lowered in ACS patients as a result of the increased oxidative stress. This study suggests that MPO/PON1 ratio can be used as a predictive marker of ACS.

Background: Inflammation is a significant residual risk factor for coronary artery disease. While intensive lipid-lowering therapy has reduced the prevalence of plaque rupture, plaque erosion in acute coronary syndrome (ACS) patients is increasing, with neutrophils playing a crucial role. It remains unclear whether varying low-density lipoprotein cholesterol (LDL-C) levels modify the relationship between neutrophil count and ischemic risk in ACS patients. Aim: To investigate the relationship between neutrophil counts and ischemic risk in ACS patients undergoing percutaneous coronary intervention (PCI) across different LDL-C levels. Methods: This large cohort study enrolled consecutive 10724 patients undergoing PCI at Fuwai Hospital (Peking Union Medical College) throughout the year of 2013. Patients were divided into subgroups according to baseline LDL-C levels, with cut-off points at 1.8mmol/L or 1.4mmol/L. The primary endpoint was major adverse cardiovascular event (MACE), and the secondary endpoint was revascularization. Results: Finally, 5717 ACS patients with PCI were included. The mean age was 58.43 ± 10.35 years, with 4399 (76.9%) being male. During the 5-year follow-up period, 1058 (18.5%) MACEs and 821 (14.4%) revascularizations were recorded. Restricted cubic spline analysis revealed a positive correlation between neutrophil and MACE and revascularizations only in patients with lower LDL-C levels (LDL-C <1.8 and LDL-C <1.4 mmol/L), but not in those with higher LDL-C levels (LDL-C ≥1.8 and LDL-C ≥1.4 mmol/L) (Figure 1). Multivariate Cox regression analysis showed that in the LDL-C <1.8 mmol/L group, each unit increase in neutrophil count was associated with a 1.129 times higher risk of MACE (HR 1.129; 95% CI 1.046-1.219) and a 1.130 times higher risk of revascularizations (HR 1.130; 95% CI 1.031-1.238). Similar findings were observed in the LDL-C <1.4 mmol/L group, where higher neutrophil was independent risk factors for MACE (HR 1.222; 95% CI 1.063-1.404) and revascularizations (HR 1.274; 95% CI 1.078-1.506). However, in patients with higher LDL-C levels (LDL-C ≥1.8 and LDL-C ≥1.4 mmol/L), neutrophil counts were not associated with outcomes (Table 1). Conclusions： High neutrophil counts are a significant risk factor for ischemic events in ACS patients with low LDL-C levels, highlighting the potential benefits of targeting neutrophils-related inflammatory pathway in the management of ACS patients with well-controlled LDL-C levels.

In current clinical practice, controversy remains regarding the clinical benefits of prolonged dual antiplatelet therapy (DAPT) in acute coronary syndrome (ACS) patients facing high risks of both ischemia and bleeding ("bi-risk") following percutaneous coronary intervention (PCI). This study aimed to investigate the feasibility of identifying a group of bi-risk ACS patients after PCI using the OPT-BIRISK criteria, emphasizing extended DAPT treatment safety and efficacy beyond 12 months in these bi-risk ACS after PCI in real-world conditions. This analysis compared extended DAPT and single antiplatelet therapy (SAPT) at 12-24 months in ACS patients undergoing PCI complicated with both ischemic and bleeding risk as defined by OPT-BIRISK criteria without premature DAPT discontinuation before 9 months or major clinical adverse events within 12 months. This was a post hoc analysis of the Optimal antiPlatelet Antiplatelet Therapy for Chinese Patients with Coronary Artery Disease (OPT-CAD) study. The main research outcome was the incidence of ischemic events within 12-24 months, which was determined as a composite of stroke, myocardial infarction, and cardiac death events. Through propensity score matching (PSM), groups were balanced. For the external validation of the OPT-BIRISK criteria to identify a bi-risk ACS patient, ischemic events, BARC 2, 3, 5 bleeding events, and BARC 3, 5 bleeding events at 5 years were analyzed. The total number of ACS patients analyzed in this analysis was 7,049, of whom 4,146 (58.8%) were bi-risk patients and 2,903 (41.2%) were not. The frequency of ischemic events was significantly different between the two groups at 5 years (11.70% vs. 5.55%, P < 0.001), and the incidence of BARC 2,3,5 bleeding was significantly higher in the bi-risk group (6.90% vs. 4.03%, P < 0.001) than in the non-bi-risk group. Among the bi-risk patients without any clinical adverse events within 12 months that underwent extended DAPT treatment (n = 2,374, 75.7%) exhibited a lower risk of stroke at 12-24 months (1.10% vs. 2.10%, P = 0.036) relative to those that underwent SAPT (n = 763, 24.3%), while bleeding risk did not differ significantly between these groups. PSM cohort analysis results were consistent with those of overall group analyses. In conclusion, the findings showed that using the OPT-BIRISK criteria could help physicians identify ACS patients at a high risk of developing recurrent ischemia and bleeding episodes after PCI. Compared to antiplatelet monotherapy, a strategy of extended DAPT may offer potential benefits in lowering the risk of stroke without carrying a disproportionately high risk of serious bleeding problems among these patients who were event-free after a year of DAPT.

Background and Objectives: This study aims to investigate the effect of Type 2 diabetes mellitus (DM) on nutritional status in acute coronary syndrome (ACS) patients and its relationship with various metabolic and hematologic parameters. Materials and Methods: A retrospective and cross-sectional design was used to analyze 485 acute coronary syndrome (ACS) patients who underwent angiography at Fethi Sekin City Hospital between 1 January 2020 and 1 January 2025. Clinical data, biochemical parameters (hemogram, glucose, creatinine, uric acid, lactate dehydrogenase (LDH), albumin, and cholesterol levels) were retrospectively analyzed. The Prognostic Nutrition Index (PNI) and CONUT score were calculated manually. Results: A total of 485 patients were included in this study. Patients were divided into two groups: patients with DM (n = 167) and patients without DM (n = 318). Glucose levels (p < 0.001) and triglyceride levels (p = 0.014) were significantly higher in patients with diabetes, while LDL cholesterol and total cholesterol levels were lower (p < 0.01). In addition, hemoglobin (p < 0.001), albumin (p = 0.010), and PNI scores (p = 0.014) were lower in patients with diabetes. Although CONUT scores were higher in patients with diabetes, this difference was not statistically significant (p = 0.267). Significant differences were observed in lipid profile and inflammation parameters in STEMI and NSTEMI subgroups, especially in patients with diabetes. In particular, triglyceride and neutrophil levels were found to be higher in NSTEMI patients among patients with diabetes. Conclusions: The PNI score may be a useful prognostic tool for predicting cardiovascular complications and determining treatment strategies in acute coronary syndrome patients with diabetes mellitus in whom nutritional status, inflammation, and lipid metabolism are significantly correlated.

AIMS Patients with acute coronary syndrome (ACS) might represent a specific subgroup, in which bioresorbable scaffold implantation in percutaneous coronary intervention, might lead to better outcomes when compared to conventional treatment. ACS patients (STE-ACS patients in particular) are generally younger, and most often have lesions with softer plaques, a lower plaque burden and less extensive coronary artery disease. In this pre-specified subgroup analysis of the AIDA trial, we evaluated the clinical outcomes of Absorb BVS versus Xience EES treated patients presenting with or without ACS. Methods and results This analysis includes the 2-year outcomes of all 1845 patients randomized in the AIDA trial subdivided by clinical presentation, a pre-specified subgroup analysis. We compared patients presenting with ACS with those presenting without ACS (ACS versus no-ACS patients). Patients presenting with ACS were further sub-categorized according to the presence or absence of ST-segment elevation at presentation (STE-ACS versus NSTE-ACS patients). Baseline status by clinical presentation was known in all patients, and 842 (45.6%) patients presented with ACS, 456 (25.2%) with STE-ACS and 377 (20.4%) with NSTE-ACS.The rate of the 2-year primary endpoint of target vessel failure (TVF) was similar after treatment with Absorb BVS or Xience EES in ACS patients (10.2% versus 9.0% respectively; p=0.49) and in no-ACS patients (11.7% versus 10.7% respectively; p=0.67) Definite or probable device thrombosis occurred more frequently with Absorb BVS compared to Xience EES in ACS patients (4.3% versus 1.7% respectively, p=0.03) as well as in no-ACS patients (2.4% versus 0.2% respectively; p=0.002). There were no statistically significant interactions between clinical presentation and randomized device modality for TVF (p=0.80) and for the endpoint of definite or probable device thrombosis (p=0.17). Conclusions In ACS patients within AIDA, we found no difference in rates of target vessel failure between the Absorb BVS and Xience EES groups. Rates of definite or definite/probable device thrombosis were higher in the Absorb BVS group throughout all clinical presentations. No significant interaction between ACS and no-ACS patients and the occurrence of TVF Acknowledgement/Funding The AIDA trial was financially supported by an unrestricted research grant from Abbott Vascular.

Cardiovascular disease (CVD) remains the leading global cause of death, with inflammation and glycolipid dysregulation as key drivers of atherosclerosis progression. While triglyceride-glucose index (TyG) and Atherogenic Index of Plasma (AIP) are linked to cardiovascular risk, their prognostic value in Acute Coronary Syndrome (ACS) patients, particularly Acute Myocardial Infarction (AMI) patients, and mediating role of systemic inflammation remain unclear. This study investigates the relationship between glycolipid metabolism, systemic inflammation, and mortality in ACS patients. In this single-center retrospective study, 3,861 ACS patients were analyzed. Glycolipid metabolism was assessed using the TyG and AIP index, while the systemic immune-inflammation index (SII) evaluated inflammatory status. Missing data were addressed with random forest multiple imputation. Statistical analyses included the Least Absolute Shrinkage and Selection Operator (LASSO) regression for variable selection, generalized linear modeling, restricted cubic splines (RCS) for nonlinear associations, and the Mantel test for correlations between glycolipid metabolism and inflammatory markers. Additionally, multivariable logistic regression, RCS models, and mediation analysis were used to assess associations and pathways. Elevated TyG index linearly increased mortality risk in ACS patients (Odds Ratio (OR) = 1.64, 95% Confidence Interval (CI):1.07-2.52) and AMI subgroups (OR = 1.56, 95% CI:1.00-2.42), with minimal SII mediation (ACS:3.97%; AMI: non-significant).The AIP index directly increased mortality risk (ACS: Beta coefficient (β) = 0.076; AMI: β = 0.091, p < 0.001), partially offset by SII's negative mediation (ACS:-6.6%; AMI:-7.8%). SII showed U-shaped mortality associations in ACS and AMI patients, with the lowest risk around 450-900 × 10⁹/L. Age ≥ 75 (ACS: OR = 8.35; AMI: OR = 10.12), STEMI diagnosis (ACS: OR = 1.46; AMI: OR = 1.53), and elevated total cholesterol (ACS: OR = 1.50; AMI: OR = 1.40) were independent mortality predictors. Increased HDL-C (ACS: OR = 0.198; AMI: OR = 0.280) was an independent protective factor. The TyG and AIP index independently predict mortality in ACS and AMI patients through direct metabolic toxicity rather than inflammatory mediation.SII exhibits a U-shaped mortality association, reflecting bidirectional immune regulation (tissue repair vs. damage), with an optimal threshold range of 450-900 × 109/L to guide anti-inflammatory strategies. Findings support metabolic-inflammatory risk stratification, prioritizing glycolipid metabolic dysregulation intervention in acute events while dynamically monitoring SII to balance immune homeostasis. Approved by Zhongda Hospital Ethics Committee (2020ZDSYLL164-P01); retrospectively registered.

Background Advances in oncology treatment have led to an increase in the number of cancer survivors. As a result, the number of acute coronary syndrome (ACS) patients with cancer is increasing and the outcomes of these patients are not well described. Purpose This study aimed to examine revascularisation strategies and all cause and cardiovascular death in ACS patients with and without cancer. Methods Hospitalised patients in New South Wales, Australia, from July 2006 to December 2020 with a primary diagnosis of ACS were identified from the statewide Admitted Patient Data Collection database. Patients were stratified into those with or without a history of cancer (non-melanoma skin cancers excluded). Propensity scoring matching (PSM) for the variables of age, gender and cardiovascular risk factors was performed with each cancer patient matched to two non-cancer patients. Cox proportional hazards regression model was used to evaluate the hazard ratios of all-cause mortality between individuals with a history of cancer in the 5 years preceding their hospital admission, and those without. Additionally, Fine-Gray competing risk analysis was performed for cardiovascular death with non-cardiovascular mortality as the competing event. Results During the study period, 193,848 patients were admitted with ACS. 12,543 patients had a history of cancer and were PSM to 25,085 patients without cancer. The median age was 75 (Q1-Q3 67-82) years with 69% male and hypertension the most prevalent risk factor (55%) (Table 1). ACS patients with cancer had clinically comparable, rates of percutaneous revascularisation (36 vs 37%, p=0.07) and coronary artery bypass grafting (11 vs 13%, p&amp;lt;0.001) with ACS patients without cancer. During a median follow up of 8.6 (95% CI 8.4-8.8) years, ACS patients with a history of cancer had a significant higher risk of all cause death (HR 1.42 95% CI [1.38-1.46]) and cardiovascular death (SHR 1.14 [1.11-1.18]). The cumulative incidence function demonstrated cardiovascular death in those with a cancer history occurred in 20% by approximately 1.4 years follow up compared to 2.5 years in those without cancer (Figure 1). Conclusion ACS patients with cancer have a higher risk of all cause death and cardiovascular death compared to those without a history of cancer with clinically comparably revascularisation rates. Further studies to determine the cause of increased cardiovascular death in ACS patients with cancer are required.Figure 1