Acute Coronary Syndrome Patients Research Articles

Body temperature, systemic inflammation and risk of adverse events in patients with acute coronary syndromes.

Inflammatory processes can trigger acute coronary syndromes (ACS) which may increase core body temperature (BT), a widely available low-cost marker of systemic inflammation. Herein, we aimed to delineate baseline characteristics of ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation ACS (NSTE-ACS) patients stratified by initial BT and to assess its predictive utility towards major adverse cardiovascular events (MACE) after the index ACS. From 2012 until 2017, a total of 1044 ACS patients, 517 with STEMI and 527 with NSTE-ACS, were prospectively recruited at the University Hospital Zurich. BT was measured by digital tympanic thermometer along with high-sensitivity C-reactive protein (hs-CRP) and cardiac troponin-T (hs-cTnT) levels prior to coronary angiography. Patients were stratified according to initial BT and uni- and multivariable regression models were fit to assess associations of BT with future MACE risk. Among patients with STEMI, BT was not predictive of 1-year MACE, but a U-shaped relationship between BT and MACE risk was noted in those with NSTE-ACS (p = .029), translating into a 2.4-fold (HR, 2.44, 95% CI, 1.16-5.16) increased 1-year MACE risk in those with BT >36.8°C (reference: 36.6-36.8°C). Results remained robust in multivariable-adjusted analyses accounting for sex, age, diabetes, renal function and hs-cTnT. However, when introducing hs-CRP, the BT-MACE association did not prevail. In prospectively recruited patients with ACS, initial BT shows a U-shaped relationship with 1-year MACE risk among those with NSTE-ACS, but not in those with STEMI. BT is a broadly available low-cost marker to identify ACS patients with high inflammatory burden, at high risk for recurrent ischaemic events, and thus potentially suitable for an anti-inflammatory intervention. ClinicalTrials.gov Identifier: NCT01000701.

Prevalence of Non-ST-Segment Elevation Myocardial Infarction in Acute Coronary Syndrome With Unremarkable Electrocardiogram: A Cross-Sectional Study From Lady Reading Hospital, Medical Teaching Institute, Peshawar.

Introduction Patients admitted to the cardiac care unit with non-ST-segment elevation myocardial infarction frequently have inconclusive electrocardiogram results. In individuals presenting with sudden central chest discomfort, non-ST-segment elevation myocardial infarction should be suspected until confirmed or ruled out by a cardiac biomarker analysis. This study aims to determine the prevalence of non-ST-elevation myocardial infarction among acute coronary syndrome patients who present with normal electrocardiogram findings. Materials and methods This study was conducted from October 24, 2022, to April 24, 2023, and involved 120 patients who came to the cardiac emergency department at Lady Reading Hospital, Peshawar. These patients experienced chest pain and symptoms of acute coronary syndrome, all within 24 hours of the onset of their symptoms. Demographic data and clinical histories were recorded for each patient. Electrocardiograms were performed, and non-ST-segment elevation was observed. The diagnosis of non-ST-segment elevation myocardial infarction was confirmed by measuring cardiac troponin T levels. A threshold value greater than 0.5 ng/mL was considered diagnostic. Data analysis was performed using the Statistical Package for the Social Sciences (SPSS) (IBM SPSS Statistics for Windows, Version 23, Armonk, NY), and grammar was checked using the Grammarly software (Grammarly, Inc., San Francisco, CA). Results The study participants had an average age of 53.96 years, with a standard deviation of 8.57. Most participants were male, comprising 65.83% of the total population, while 34.17% were female. Among the participants, 26.66% were diagnosed with non-ST-segment elevation myocardial infarction, affecting 32 individuals. The results showed a significant correlation between the occurrence of non-ST-segment elevation myocardial infarction and male gender, as well as with individuals who had pre-existing comorbidities. The p-values for these associations were 0.032 and 0.043, respectively, indicating statistically significant relationships. Conclusion In conclusion, a significant proportion of patients who presented to the emergency department with acute coronary syndrome symptoms and a normal electrocardiogram were diagnosed with non-ST-segment elevation myocardial infarction. This highlights the need for special attention to male patients and those with comorbidities.

Association of Perceived Stress with Acute Coronary Syndrome: A Matched Case Control Study

Background Acute Coronary Syndrome (ACS), a leading cause of morbidity and mortality globally. While traditional risk factors for ACS are well studied, the role of perceived stress remains underexplored in our context. Hence, we aimed to find the association of perceived Stress with Acute Coronary Syndrome.MethodsA hospital based case control study, matched with age and gender was conducted at Birat medical College teaching Hospital from 1st July to 28th November2023. Consecutive sampling techniques was employed to enroll 50 cases and 50 controls from the hospital. Data on demographics and risk factors were collected, and the Perceived Stress Scale-10 (PSS-10) was used to measure stress in both groups. Multivariate logistic regression analysis was conducted to determine the independent association of PSS-10 with ACS.ResultsPerceived stress had no statistical significant association with ACS (P=0.069, OR= 0.918, CI 0.837-1.007) when adjusting for other risk factors. However, hypertension (P=0.004, OR=4.59, CI=1.61-13.09), smoking (P=0.004, OR=8.48, CI=2.09-34.38), and a family history of cardiovascular disease (P=0.028, OR=4.97, CI=1.19-20.75) showed statistically significant associations with ACS, while controlling for other factors.Conclusions The study found higher perceived stress in ACS patients, but it wasn't an independent predictor of ACS. Significant associations with hypertension, smoking, and family history emphasize the need for comprehensive risk factor management in preventing cardiovascular disease.

CLINICAL OUTCOMES OF PRIMARY PERCUTANEOUS CORONARY INTERVENTION USING DES VS BMS In ACUTE CORONARY SYNDROME PATIENTS WITH LEFT ANTERIOR DESCENDING ARTERY INVOLVEMENT: A COMPARATIVE STUDY

Acute coronary syndrome (ACS) with left anterior descending (LAD) artery involvement often leads to more extensive myocardial infarction. Choosing between drug-eluting stents (DES) and bare-metal stents (BMS) for revascularisation in these patients is a topic of clinical relevance. While drug-eluting stents are the gold standard, bare-metal stents remain an essential option for patients with specific considerations such as an inability to complete the recommended duration of DAPT, advanced age, concomitant oral anticoagulation, cancer, affordability issues, increased bleeding risk, and planned noncardiac surgery within the next year. Objective: This study aimed to compare the clinical outcomes of ACS patients with LAD involvement treated with either DES or BMS during primary PCI.Methods: A retrospective cohort study was conducted between January 1, 2021, and December 31, 2023, at a tertiary care center. A total of 200 ACS patients with LAD involvement who underwent primary PCI were included. Patients were grouped based on the type of stent used (DES or BMS). Data on patient demographics, comorbidities, procedural details, and outcomes were collected. Major adverse cardiovascular events (MACE), including all-cause mortality, myocardial infarction (MI), and target lesion revascularisation (TLR), were assessed. Kaplan-Meier survival analysis and Cox proportional hazards models were used to analyse outcomes. Results: MACE occurred in 48 patients (24%) during the one-year follow-up. Patients treated with DES experienced significantly fewer events (p < 0.001) compared to those receiving BMS. Diabetes mellitus and chronic kidney disease were independent predictors of adverse outcomes (p = 0.006 and p < 0.001, respectively).Conclusion: Primary PCI using DES in ACS patients with LAD involvement is associated with better clinical outcomes compared to BMS, particularly in high-risk populations. These findings suggest that DES should be the preferred stent type for this patient group to reduce adverse events and improve long-term survival.

Investigating soluble CD40 ligand as a prognostic factor among acute coronary syndromes patients: A multi-center prospective case-control study.

Soluble CD40 ligand (sCD40L) is a protein that plays a crucial role in the inflammatory response associated with the development and progression of acute coronary syndrome (ACS). Recent studies have suggested that sCD40L may be a useful prognostic factor for ACS, but the data are conflicting. This study aimed to investigate the potential of sCD40L as a prognostic marker among ACS patients and provide valuable insights for clinical practice. To our knowledge, this is the first study of its type in the Arabic World. A multi-center prospective case-control study was conducted in Damascus, Syria, involving 158 participants with different ACS subtypes (STEMI, NSTEMI, UA) and a control group of healthy individuals. Sociodemographic data, medical history, and sCD40L levels were collected. The predictive ability of sCD40L for ACS, STEMI, NSTEMI, and UA was assessed using receiver operating characteristic (ROC) curves. Statistical analysis was performed using IBM SPSS version 25. The study included 58 STEMI, 33 NSTEMI, 36 UA patients, and 30 healthy individuals. The mean age of participants was 55 years (SD 10.7 years). Analysis of sCD40L levels revealed significantly higher concentrations in ACS patients compared to the control group (P < .001). ROC curve analysis demonstrated that sCD40L had a significant predictive ability for ACS, STEMI, and NSTEMI (P < .05), while its predictive value for UA was not statistically significant. This study provides evidence supporting the potential of sCD40L as a prognostic factor in ACS. The elevated levels of sCD40L observed in these subtypes indicate its potential usefulness in risk stratification and predicting adverse cardiovascular events. Further investigations are warranted to establish standardized sCD40L cutoff values and evaluate its clinical implications in the management of ACS patients.

Temporal trends in the treatment and outcome of nonagenarians with acute coronary syndrome.

Nonagenarians are a fast-growing age group among acute coronary syndrome (ACS) patients. While new therapeutic options have improved outcomes of ACS patients, data regarding very elderly ACS patients are limited. We aimed to evaluate temporal trends in the treatment and outcomes of nonagenarian ACS patients. Included were ACS patients aged below 90 years enrolled in ACS Israeli Survey. Patients were divided into two groups according to enrolment period: early (2000-2010) and recent (2012-2021). The primary endpoints were 30-day major adverse cardiovascular events and all-cause mortality. Secondary outcomes included in-hospital and 1-year all-cause mortality. Included were 316 elderly ACS patients. Of them, 184 were enrolled in the early and 132 in recent surveys. Patients enrolled in the recent period were more commonly referred for an invasive strategy and more commonly received guideline-based medical therapy. All-cause mortality at 30 days was significantly lower in the recent group compared with the early group (12.5 and 26.1%, respectively, P = 0.005). Rates of 30-day major adverse cardiovascular events were also significantly lower in the recent group (21.9 and 35.9%, respectively, P = 0.012). Patients in the recent group received more aggressive medical therapy in discharge but at 30-day follow-up, no difference in medical treatment was observed in the two groups. There were no significant differences in 1-year mortality rates. Treatment of nonagenarians with ACS has improved over the past decade. Treatment improvement was associated with a significant improvement in 30-day outcomes without any effect in 1 year. Nevertheless, even with contemporary treatment, nonagenarians with ACS remain a high-risk group with high mortality rates.

Triglyceride-glucose index as a predictor of cardiac adverse events in acute coronary syndrome patients undergoing percutaneous coronary intervention: role of diabetes

BackgroundTriglyceride-glucose index (TyG), a surrogate marker of insulin resistance (IR), could be a potential prognostic marker in patients with acute coronary syndromes (ACS). We evaluated the effect of the TyG index on major adverse cardiac and cerebrovascular events (MACCE) in patients with ACS undergoing percutaneous coronary intervention (PCI).MethodsThis registry-based cohort study was conducted at Tehran Heart Center from 2015 to 2021 and the median follow-up duration was 378 days. The primary outcome was MACCE and the secondary outcomes were MACCE components: all-cause mortality, myocardial infarction, stroke, target vessel revascularization, target lesion revascularization, and coronary artery bypass grafting. For comparison among TyG quartiles (Q), the log-rank test was used. Unadjusted and adjusted hazard ratios (HRs) and their 95% confidence intervals (CIs) were used to describe the association between TyG quartiles and MACCE. A subgroup of euglycemic patients was also evaluated.ResultsA total of 13,542 patients were included. Patients in the fourth TyG quartile (Q4) were younger, had higher mean BMI, and higher prevalence of hypertension, diabetes, and dyslipidemia. The adjusted Cox model showed that a 1-unit increment of the TyG index was associated with a significantly higher risk of MACCE (aHR 1.18, 95% CI 1.08 to 1.30, p < 0.001). Among TyG quartiles, there was a higher MACCE incidence in Q4 compared to Q1 (aHR 1.29, 95% CI 1.08 to 1.53, p = 0.005). In the euglycemic subgroup of the population, there was no significant association between MACCE incidence and a 1-unit increase in TyG or among TyG quartiles.ConclusionBased on our findings, while higher TyG levels and quartiles were associated with higher rates of MACCE in ACS, there was no such effect in the euglycemic population. If confirmed in future studies, these results can be beneficial for clinicians to risk stratify these patients with an easy-to-use index and determine clinical plans based on their risk.Graphical abstract

Validation of machine learning-based risk stratification scores for patients with acute coronary syndrome treated with percutaneous coronary intervention

Abstract Aims This study aimed to validate the machine learning-based Global Registry of Acute Coronary Events (GRACE) 3.0 score and PRAISE (Prediction of Adverse Events following an Acute Coronary Syndrome) in patients with acute coronary syndrome (ACS) treated with percutaneous coronary intervention (PCI) for predicting mortality. Methods and results Data of consecutive patients with ACS treated with PCI in a tertiary centre in the Netherlands between 2014 and 2021 were used for external validation. The GRACE 3.0 score for predicting in-hospital mortality was evaluated in 2759 patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) treated with PCI. The PRAISE score for predicting one-year mortality was evaluated in 4347 patients with ACS treated with PCI. Both risk scores were compared with the GRACE 2.0 score. The GRACE 3.0 score showed excellent discrimination [c-statistic 0.90 (95% CI 0.84, 0.94)] for predicting in-hospital mortality, with well-calibrated predictions (calibration-in-the large [CIL] −0.19 [95% CI −0.45, 0.07]). The PRAISE score demonstrated moderate discrimination [c-statistic 0.75 (95% CI 0.70, 0.80)] and overestimated the one-year risk of mortality [CIL −0.56 (95% CI −0.73, −0.39)]. Decision curve analysis demonstrated that the GRACE 3.0 score offered improved risk prediction compared with the GRACE 2.0 score, while the PRAISE score did not. Conclusion This study in ACS patients treated with PCI provides suggestive evidence that the GRACE 3.0 score effectively predicts in-hospital mortality beyond the GRACE 2.0 score. The PRAISE score demonstrated limited potential for predicting one-year mortality risk. Further external validation studies in larger cohorts including patients without PCI are warranted.

Exploring the characteristics changes of cardiopulmonary exercise testing in patients with acute coronary syndrome after PCI before and during the COVID-19 pandemic

Objective: To investigate the changes in cardiopulmonary exercise testing (CPET) characteristics before and after the outbreak of COVID-19 in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI). Methods: This is a cross-sectional study that included ACS patients who underwent PCI at the General Hospital of the Northern Theater Command from July 2018 to February 2023. Based on the timeline of the COVID-19 pandemic, patients were divided into two groups: the pre-pandemic group and the during-pandemic group, with January 2020 as the dividing line. Clinical data were collected from both groups, and a comparative analysis was performed on their postoperative CPET outcomes, including peak oxygen uptake (peak VO2), peak metabolic equivalents (peak MET), and other indicators. Weber's classification was used to assess cardiac function. In addition, the 7-tiem generalized anxiety disorder scale (GAD-7) and the patient health questionnaire-9 (PHQ-9) were used to assess the patients' psychological anxiety and depression states, respectively. Multivariate logistic regression was used to analyze the influencing factors of CPET after PCI. Results: A total of 4 310 post-PCI ACS patients were included, with an average age of (58.7±9.1) years, and 3 464 (80.37%) were male. There were 1 698 patients in the pre-pandemic group and 2 612 patients in the during-pandemic group. The main indicator of the CPET, peak VO2 (15.04±3.93) ml·min-1·kg-1 in the during-pandemic group, was lower than that in the pre-pandemic group (15.52±3.68) ml·min-1·kg-1, and the difference was statistically significant (P<0.001). Multivariate logistic regression analysis showed that advanced age, female gender, high body mass index, elevated high-sensitivity C-reactive protein, reduced high-density lipoprotein cholesterol, smoking history, history of myocardial infarction, more severe ACS classification, and mild to moderate degree of depression were related to poor cardiopulmonary outcomes (P<0.05). Conclusion: The COVID-19 pandemic had a negative impact on the cardiopulmonary outcomes of ACS patients after PCI. Reduced physical activity, and increased psychological stress should be given consideration and attention regarding their impact on patients' cardiopulmonary function.

Correlation between glycated albumin (GA) and CHA2DS2-VASc score in comparison to GRACE score regarding outcomes in acute coronary syndrome patients undergoing percutaneous coronary intervention

BackgroundAcute coronary syndrome (ACS) is responsible for one-third of total deaths in people older than 35 years old. Number of prognostic models aims to estimate the future risk of mortality, or the combined risk of all-cause mortality or MI has been developed, such as GRACE score.ObjectiveThe aim of our study is to assess the utility of GA and CHA2DS2-VASc score in predicting outcomes in patients admitted with acute coronary syndromes.Patients and methodsThis study was conducted on 90 patients diagnosed with acute coronary syndrome who were admitted receiving PCI, CHA2DS2-VASc score was calculated on admission, and a serum sample for GA was withdrawn within 24 h from admission.ResultsCombined GA and CHA2DS2-VASc score could significantly predict MACCE with sensitivity 100%, specificity 79%, and diagnostic accuracy 80.9% and significantly predict hospital mortality with sensitivity 100%, specificity 75.3%, and diagnostic accuracy 76.7%; on the other hand, GRACE score can predict MACCE using cutoff point 112.5 with sensitivity 75% and specificity 66%.ConclusionIt was concluded that GA and CHADSVASC score can significantly predict major adverse cardiovascular events, in-hospital mortality, and poor clinical outcomes.

Serum Klotho Is Elevated in Patients with Acute Myocardial Infarction and Could Predict Poor In-Hospital Prognosis.

Klotho has emerged as a potential protective factor for cardiovascular diseases recently. Nevertheless, the levels of serum Klotho in acute coronary syndrome (ACS) have not been reported. Hence, we undertook a study to investigate the potential correlation between serum Klotho and ACS patients. This observational cohort study was conducted at Peking University People's Hospital between May 2016 and April 2020. Upon admission, we collected the patients' clinical data and conducted ELISA tests to measure their serum Klotho levels. A total of 349 patients were enrolled in this study, including 14 patients with UA and 335 patients with AMI. We observed that serum Klotho levels were obviously higher in the AMI group compared to the UA group (median 479.8 vs. 233.8 pg/mL, p = 0.035). In addition, serum Klotho levels were positively correlated with cardiac function and more pronounced in patients who died in the hospital (median 721.1 vs. 468.3 pg/mL, p < 0.001). A logistic regression analysis indicated that age ≥ 78 years old, HR ≥ 90 bpm, Killip classification ≥ 3 grade, and serum Klotho > 645.0 pg/mL were risk factors for poor prognosis. Serum Klotho is obviously increased in patients with AMI and with a positive correlation with cardiac function, and its elevation could serve as a predictor of poor prognosis in ACS patients.

Incidence and predictors of acute coronary syndrome after transcatheter mitral valve repair

ABSTRACT Background Acute coronary syndrome (ACS) post-transcatheter mitral valve repair (TMVR) carries high mortality. We aim to study the incidence and predictors of ACS in patients who underwent TMVR. Research design and methods We queried the U.S. National Readmission Database to identify all cases of TMVR from 2016 to 2019. We further evaluated the incidence of ACS and used multivariable logistic regression to determine independent predictors of ACS in this population. Results Among 3,742 patients who underwent TMVR, 264 (7.05%) developed ACS. Among ACS patients, 204 (77%) had non-ST-segment elevation ACS and 66 (25%) had ST-segment elevation ACS. Independent predictors of ACS were acute limb ischemia, cardiogenic shock, history of coronary artery disease (CAD), smoking, cardiac arrest, respiratory failure requiring mechanical ventilation, and acute kidney injury. In-hospital mortality among ACS was three times higher in ACS patients than without ACS (16.76% vs. 5.45%, p-value < 0.01). Conclusions ACS is not an uncommon complication after TMVR. The occurrence of ACS after TMVR is associated with high in-hospital mortality, longer length of stay, and higher hospital charges. The strongest predictors of ACS in these patients are the development of acute limb ischemia, cardiogenic shock, and a history of CAD.

Glucose-Lowering Drugs with Proven Cardiovascular Benefit Following Acute Coronary Syndrome in Patients with Type 2 Diabetes: Treatment Gaps and Outcomes.

Background: Real-world data on the implementation and prognostic impact of glucose-lowering drugs with proven cardiovascular benefits in patients with type 2 diabetes (T2D) following acute coronary syndrome (ACS) are limited. We investigated the utilization and treatment patterns of sodium-glucose contrasporter-2 inhibitors (SGLT2Is) and glucagon-like peptide-1 recepto-agonists (GLP1RAs) in patients with T2D experiencing ACS and analyzed their association with mortality and major adverse cardiovascular events (MACEs) including recurrent ACS, acute revascularization, heart failure, or ischemic stroke. Methods: We carried out a retrospective analysis of 9756 patients with T2D from a nationwide healthcare organization in Israel who were hospitalized with ACS between 01/2019 and 01/2022. Drug prescriptions were estimated pre-hospitalization, 90 days, and 1 year following hospitalization. The association between SGLT2I and/or GLP1RA treatment with MACE and mortality was investigated using a time-dependent Cox regression analysis with multivariable adjustment. Results: The prescription rates (pre-hospitalization, 90 days, and 1 year post-hospitalization) of GLP1RAs were 13%, 13.2%, and 18%, and those of SGLT2Is were 23.9%, 33.6%, and 42.7%, respectively. At 1 year, 13.9% of patients were prescribed both treatments. The use of SGLT2Is and/or GLP1RAs was higher in younger age groups and increased from 2019 to 2021 (38.1% to 59.2%). The adjusted hazard ratio for the association of pre- or post-hospitalization SGLT2I and/or GLP1RA treatment with mortality and MACE was 0.724 (0.654-0.801) and 0.974 (0.909-1.043), respectively. Conclusions: In the real-world practice of treating patients with T2D experiencing ACS, the implementation of SGLT2Is, particularly GLP1RAs, was suboptimal when prescribed both early and 1 year following hospitalization, emphasizing the need to improve medical care. Treatment with SGLT2Is and/or GLP1RAs was associated with a favorable impact on mortality but not MACE.

Smoking and sudden cardiac death in patients with previous coronary artery disease.

Smoking is a known risk for sudden cardiac death (SCD) in the general population. However, its significance in patients with acute coronary syndrome (ACS), a condition that also elevates the risk of SCD, is disputable. A total of 9704 consecutive ACS patients with available smoking data were included in the analysis. Comprehensive patient data were obtained from the Mass Data in Detection and Prevention of Serious Adverse Events in Cardiovascular Disease research database. A composite endpoint of SCD, SCD aborted by successful resuscitation and accurate implantable cardioverter defibrillator therapy to otherwise potentially fatal ventricular fibrillation/ventricular tachycardia was used. Univariate, age- and sex-adjusted, and a multivariate fine-gray competing risk regression with adjustment to traditional risk factors was conducted. Median follow-up time was 6.8 years (IQR, 4.1-10.2), and 454 (4.7%) SCD cases were identified. At the baseline, 23.7% (N = 2444) were active smokers, and 20.8% (N = 2146) were ex-smokers. In the multivariate model, active smokers had an elevated risk of 1.79 (95% CI, 1.41-2.27; P < 0.001) for future SCD. Ex-smokers had no elevated risk for SCD in fine-gray subdistribution hazard. Also, active smokers were notably younger (mean age 58.7 years) than non- or ex-smokers (71.1 years and 68.9 years, respectively, P < 0.001 for both comparisons). Active smokers had a 79% higher risk of SCD when compared with nonsmokers. Smoking cessation should be heavily encouraged after ACS. Also, a person's smoking status should be considered in further studies developing SCD and implantable cardioverter defibrillator-benefit risk scores.

Efficacy and safety of ticagrelor monotherapy following a brief DAPT vs. prolonged 12-month DAPT in ACS patients post-PCI: a meta-analysis of RCTs.

As per current guidelines, acute coronary syndrome (ACS) patients who undergo percutaneous coronary intervention (PCI) should be started on dual antiplatelet therapy (DAPT) for a period of 12months. To assess the efficacy and safety of brief DAPT (up to 3months) succeeded by ticagrelor monotherapy compared with a 12-month DAPT in ACS patients following PCI. We systematically searched Cochrane, Embase, and PubMed to find relevant randomized clinical trials. Examined outcomes included the incidence of major adverse cerebrovascular and cardiovascular events (MACCE), bleeding events, and the composite incidence of net adverse clinical events (NACE). Our primary analysis included 21,927 ACS patients from six RCTs. Our pooled results indicate that following PCI in individuals with ACS, brief DAPT followed by ticagrelor did not increase the risk of MACCE (OR 0.92, 95% CI 0.79-1.07) but significantly reduced the risk of minor or major bleeding (OR 0.52, 95% CI 0.44-0.62) and NACE (OR 0.71, 95% CI 0.59-0.86) compared with a long-term DAPT within a follow-up of 12months. Brief DAPT followed by ticagrelor monotherapy is superior to a 12-month DAPT in offering a net clinical advantage in ACS patients following PCI.

Hypothermia for Cardioprotection in Acute Coronary Syndrome Patients: From Bench to Bedside.

Early revascularization for patients with acute myocardial infarction (AMI) is of outmost importance in limiting infarct size and associated complications, as well as for improving long-term survival and outcomes. However, reperfusion itself may further damage the myocardium and increase the infarct size, a condition commonly recognized as myocardial reperfusion injury. Several strategies have been developed for limiting the associated with reperfusion myocardial damage, including hypothermia. Hypothermia has been shown to limit the degree of infarct size increase, when started before reperfusion, in several animal models. Systemic hypothermia, however, failed to show any benefit, due to adverse events and potentially insufficient myocardial cooling. Recently, the novel technique of intracoronary selective hypothermia is being tested, with preclinical and clinical results being of particular interest. Therefore, in this review, we will describe the pathophysiology of myocardial reperfusion injury and the cardioprotective mechanics of hypothermia, report the animal and clinical evidence in both systemic and selective hypothermia and discuss the potential future directions and clinical perspectives in the context of cardioprotection for myocardial reperfusion injury.

Clinical features of acute coronary syndrome in elderly patients with chronic obstructive pulmonary disease

Aim. To study the clinical features of the course of acute coronary syndrome (ACS) in elderly patients with chronic obstructive pulmonary disease (COPD).Materials and methods. The study included 78 patients with ACS: 43 patients with ACS and COPD (group 1) and 35 patients with ACS without COPD (group 2). All patients underwent comprehensive clinical, instrumental, and laboratory examinations.Results. Among the risk factors for cardiovascular diseases (CVD), the most significant contributors to the development of ACS in patients with COPD were smoking, arterial hypertension, and elevated levels of C-reactive protein (CRP). Patients with ACS and COPD more frequently had non- ST-segment elevation myocardial infarction (NSTEMI). For patients with comorbid pathology, more pronounced changes in the coronary arteries were characteristic due to an increase in the total number of stenoses (p=0.02), hemodynamically significant stenosis (p=0.01), occlusions and critical stenoses (p=0.02), and extensive stenoses (p=0.04). Group 1 patients, compared to group 2, had hemodynamically significant stenosis located in the proximal (p=0.04) and distal (p=0.02) segments of the coronary arteries, as well as in second-order branches (p=0.02). No significant differences were found between the groups in the number of stenoses of the left main coronary artery and the middle segments of the major coronary arteries.Conclusion. In elderly patients with COPD, ACS development was more often preceded by angina symptoms and atypical myocardial infarction presentations, with NSTEMI predominating in the myocardial infarction structure. The main CVD risk factors in COPD patients were smoking, arterial hypertension, and elevated CRP levels. Atherosclerotic coronary artery disease in ACS patients with COPD was characterized by multivessel disease, predominance of middle and distal coronary artery stenosis. A significant feature of coronary artery disease in comorbid elderly patients was the increased total number of stenoses and the number of extensive stenoses.

Lipid-lowering therapy after acute coronary syndromes: a multinational European survey.

Recent guidelines on acute coronary syndromes (ACS) recommend initiating lipid-lowering therapy (LLT) as early as possible to obtain >50% low-density-lipoprotein cholesterol (LDL-c) reduction and an LDL-c < 1.4 mmol/l. A multinational European survey study of ACS patients between 2021-2022 and acquired data on LLT and lipid levels on admission and during 1-year posthospitalization. We compared plasma lipid changes and adherence to post-ACS lipid targets across two in-hospital LLT groups: high-intensity statin (HIS) monotherapy (mono-HIS) and a combination of HIS and ezetimibe (combo-HIS). Of 286 patients, 268 (94%) received in-hospital HIS and were included in the final analysis. Patients (median age: 61.1 years) had a median baseline LDL-c of 3.3 mmol/l. Mono-HIS was the predominant in-hospital LLT (72.4%). In-hospital combo-HIS was administered in 27.6% of the cases. Patients from high-income countries (n = 141) were more likely to receive in-hospital combo-HIS than patients from middle-income countries [n = 127; 38.3% vs. 15.7% patients, P < 0.001). One-year post-ACS, 50 (26.5%) patients from the mono-HIS group received ezetimibe. The target of LDL-c ≤ 55 mg/dl was reached in 85 patients (31.7%), without significant difference between study groups [mono-HIS: 56 (28.9%) and combo-HIS: 29 (39.2%) patients, P = 0.10]. The target of >50% reduction was achieved more frequently among the combo-HIS group than in the mono-HIS group (50.0% vs. 29.9%, respectively, P = 0.002). LDL-c targets were achieved in less than half of the patients post-ACS, regardless of the LLT regimen. Combo-HIS was initiated in-hospital post-ACS in only 28% and was associated with greater LDL-c reduction compared to a staged approach of mono-HIS with up-titration at follow-up.

Evaluation of Pericoronary Fat Attenuation Index to Better Identify Culprit Lesions in Acute Coronary Syndrome According to Stenosis Severity.

To investigate the incremental value of pericoronary fat attenuation index (FAI) in routine coronary artery computed tomography angiography (CCTA) to identify culprit lesions in acute coronary syndrome (ACS). We reviewed the CCTA data from 80 ACS patients and 40 individuals with stable coronary atherosclerosis. ACS patient plaques were categorized into culprit and nonculprit groups. The plaque-specific pericoronary FAI was assessed using the Perivascular Fat Analysis Tool. We applied a default prespecified window of -190 to -30 Hounsfield units (HU) and a broader prespecified window of -190 to 20 HU. FAI values within these prespecified windows and the types and severity of plaque stenosis were compared across the 3 groups. Additionally, we investigated high-risk characteristics of plaques in the ACS group and their correlation with FAI. The effectiveness and worthiness of FAI in identifying culprit lesions were analyzed based on the receiver operating characteristic curve. The FAI values under the 2 prespecified windows were higher in the culprit group than in the nonculprit and control groups (all P < 0.001). The culprit group showed the most mixed plaques and the most severe stenosis (all P < 0.001). In the ACS group, the FAI value was significantly lower around calcified lesions (-85.00 ± 9.97 HU) than around noncalcified (-78.00 ± 11.52 HU) and mixed plaques (-78.00 ± 9.24 HU) (both P < 0.001). The culprit group had more high-risk plaques, and high-risk plaques had higher FAI values than those without high-risk characteristics (-70.00 ± 7.67 HU vs -82.00 ± 10.16 HU, P < 0.001). The efficacy of FAI under the default prespecified window in identifying culprit lesions was higher compared than that under the broader prespecified window (area under the curve = 0.799 vs 0.761, P = 0.042), and the diagnostic cutoff values were -77 versus -58 HU. The FAI under the default prespecified window exhibited an incremental value for identifying culprit lesions, as compared with stenosis severity (area under the curve = 0.970 vs 0.939, P < 0.001). The culprit lesions have higher FAI than the nonculprit lesions and the controls. FAI is a worthy parameter for identifying culprit lesions in routine CCTA according to stenosis severity, and the default prespecified window is a better option.

Prehospital treatment-seeking for acute coronary syndrome in culturally and linguistically diverse immigrant populations: a scoping review.

Studies consistently report longer prehospital delays in culturally and linguistically diverse (CALD) patients experiencing acute coronary syndrome (ACS). A scoping review was conducted to describe terms and methods used to define and identify CALD populations and summarise available evidence on factors related to prehospital delays in ACS studies involving CALD populations. We searched six electronic databases for published studies and Google Scholar for grey literature to identify studies on prehospital treatment-seeking in CALD immigrants experiencing ACS. We followed the Joanna Briggs Institute methodological framework for scoping review. Twenty-three studies met our eligibility criteria (quantitative n=17; qualitative n=6; mixed n=1). Terms like ethnicity, migrant or expatriate defined CALD populations. Most studies used a single indicator (e.g., country of birth) to identify CALD cohorts, and only two studies used a theoretical model related to treatment-seeking delays to guide data collection. Most factors affecting prehospital delays in CALD populations were similar to those reported in general populations. A unique finding was a difference in the language used to describe symptoms, which, when translated, changes their meaning and resulted in misinterpretation by healthcare providers (e.g., asfixiarse [translates as asphyxiate/suffocate] used for dyspnoea/shortness of breath in Hispanics). Terms and methods used for defining and identifying CALD populations are inconsistent. Studies on factors affecting prehospital treatment-seeking in CALD ACS patients are limited. Future studies should use theoretical models related to treatment-seeking delays to comprehensively explore factors affecting prehospital delays. Additionally, researchers should consider self-reported or multiple indicators to determine CALD status.