Acute Coronary Syndrome Patients Research Articles

Discharge of Acute Coronary Syndrome Patients on Sub-Optimal Dual Anti-Platelet Therapy: A Single Center Experience.

To identify and quantify the reasons why acute coronary syndrome (ACS) patients undergoing stenting at the University of New Mexico Hospital (UNMH) were prescribed sub-optimal dual antiplatelet therapy (DAPT) at discharge, and to identify practice patterns that could potentially lead to improved DAPT treatment for these patients. We reviewed electronic medical records and cardiac catheterization records of 326 patients who underwent percutaneous coronary intervention (PCI) at UNMH between January 1, 2021, and June 30, 2022 and identified 229 ACS patients who survived until discharge. Demographic and clinical characteristics relevant to P2Y12 inhibitor selection were obtained from a review of medical records. Pharmacists' notes documenting their efforts to secure appropriate insurance coverage and reasons for discharging patients on clopidogrel rather than ticagrelor/prasugrel were reviewed. Patients discharged on aspirin and clopidogrel underwent review of medical records and cardiac catheterization lab records to determine if the discharge P2Y12 drug was appropriate. Reasons for inappropriate discharge on clopidogrel were categorized as cost/insurance, patient preference, concern for daily adherence to a twice-daily medication, and maintenance of pre-hospital clopidogrel therapy rather than switch to ticagrelor after PCI. The 229 ACS patients included 87 (38.0%) appropriately discharged on ticagrelor/prasugrel, 63 (27.5%) appropriately discharged on clopidogrel, 75 (32.8%) discharged on sub-optimal clopidogrel, and 4 (1.7%) not discharged on a P2Y12 inhibitor. For patients inappropriately discharged on clopidogrel (n = 75), the most common reasons were cost or lack of insurance (n = 56) and clinical inertia (taking clopidogrel before PCI and maintained on it afterward) (n = 17). Sub-optimal P2Y12 therapy at discharge was significantly associated with lack of insurance (odds ratio 21.5, 95% confidence interval 5.33-156,p < 0.001) but not with ethnicity, age, sex, or diabetes. At the University of New Mexico, a safety-net hospital, increasing financially restricted access to ticagrelor/prasugrel could help up to 24.5% of ACS patients reduce their risk of ischemic events. For patients admitted on clopidogrel DAPT, escalating to ticagrelor/prasugrel could reduce ischemic risk in 7.4%. Expanding and improving healthcare insurance coverage might reduce the frequency of discharge on sub-optimal P2Y12 therapy.

CHA2DS2-VASc score predicts periprocedural complications and mortality of percutaneous coronary intervention irrespective of atrial fibrillation: a systematic review and meta-analysis

Abstract Funding Acknowledgements None. Background Periprocedural complications of Percutaneous Coronary Intervention (PCI) are dreaded as they negatively impact prognosis, but they are hard to predict especially in resource-limited settings. CHA2DS2-VASc Score, apart from predicting thromboembolic risk in atrial fibrillation, has been reported to be associated with several complications of PCI. Purpose We aimed to assess the predictive value of CHA2DS2-VASc score for periprocedural complications and mortality in Acute Coronary Syndrome (ACS) patients treated with PCI. Methods Systematic search of the literature was conducted through Pubmed and Embase for all articles published from inception until 24th September 2023. Studies were included if they were observational studies conducted in ACS patients who received PCI during index hospital stay and evaluated the value of CHA2DS2-VASc score to predict at least one outcome of interest. Studies were excluded if they only used modified CHA2DS2-VASc score or did not conduct a separate analysis for ACS patients. Results Out of 1,783 manually reviewed unique studies, 34 studies involving a total of 342,141 ACS patients were included. Only 2 studies exclusively included patients with atrial fibrillation. Random effect meta-analyses found a significant association between high CHA2DS2-VASc score and Contrast-Induced Nephropathy/CIN (11 studies; OR 5.35; 95%CI 3.56–8.03; I2=94%), no-reflow phenomenon (14 studies; OR 3.21; 95%CI 2.20–4.68; I2 = 91%), acute stent thrombosis (3 studies; OR 5.23; 95%CI 3.85–7.10; I2=0%), in-hospital all-cause mortality (9 studies; OR 3.25; 95%CI 1.65–6.44; I2=91%), in-hospital cardiovascular mortality (3 studies; 3.05; 95%CI 1.58–5.87; I2=38%), post-discharge all-cause mortality (4 studies; 3.35; 95%CI 2.24–5.02; I2=0%), and post-discharge cardiovascular mortality (3 studies; 3.65; 95%CI 2.65–5.01; I2=35%). The CHA2DS2-VASc score cut-off with the highest OR for each outcome was used in bivariate random-effects meta-analysis model for diagnostic test accuracy. CHA2DS2-VASc score cut-off of ≥4 is a good predictor of CIN/AKI (5 studies) with AUC 0.81 (0.77–0.84), sensitivity 0.70 (0.51–0.84), specificity of 0.81 (0.54–0.94), while CHA2DS2-VASc score cut-off of ≥2 is good for screening no-reflow phenomenon (5 studies) with AUC 0.70 (0.66–0.74), sensitivity 0.86 (0.56–0.97), specificity 0.44 (0.20–0.71), and for screening in-hospital all-cause mortality (5 studies) with AUC 0.77 (0.73–0.81), sensitivity 0.88 (0.77–0.94), and specificity 0.35 (0.19–0.55). Conclusion CHA2DS2-VASc score is a rapid, non-invasive, and easily measurable tool that provides a good prediction of CIN/AKI, as well as a useful screening tool for no-reflow phenomenon and in-hospital all-cause mortality in ACS patients who received PCI regardless of their atrial fibrillation diagnosis.CHA2DS2-VASc score cut-off 4 for CIN/AKICHA2DS2-VASc cut-off 2 for no-reflow

Prognostic value of elevated lipoprotein (a) in patients with acute coronary syndromes: a systematic review and meta-analysis

BackgroundElevated lipoprotein (a) level was recognized as an independent risk factor for significant adverse cardiovascular events in acute coronary syndrome (ACS) patients. Despite this recognition, the consensus in the literature regarding the prognostic significance of elevated lipoprotein (a) in ACS was also limited. Consequently, we conducted a thorough systematic review and meta-analysis to evaluate the prognostic relevance of elevated lipoprotein (a) level in individuals diagnosed with ACS.Methods and resultsA thorough literature review was conducted by systematically searching PubMed, Embase, and Cochrane databases until September 2023. This review specifically examined cohort studies exploring the prognostic implications of elevated lipoprotein (a) level in relation to major adverse cardiovascular events (MACE), including death, stroke, non-fatal myocardial infarction (MI), and coronary revascularization, in patients with ACS. The meta-analysis utilized aggregated multivariable hazard ratios (HR) and their respective 95% confidence intervals (CI) to evaluate prognostic implications between high and low lipoprotein (a) levels [the cut-off of high lipoprotein (a) level varies from 12.5 to 60 mg/dl]. Among 18,168 patients in the identified studies, elevated lipoprotein (a) was independently associated with increased MACE risk (HR 1.26; 95% CI: 1.17–1.35, P &amp;lt; 0.00001) and all-cause mortality (HR 1.36; 95% CI: 1.05–1.76, P = 0.02) in ACS patients. In summary, elevated lipoprotein (a) levels independently forecast MACE and all-cause mortality in ACS patients. Assessing lipoprotein (a) levels appears promising for risk stratification in ACS, offering valuable insights for tailoring secondary prevention strategies.Systematic Review RegistrationPROSPERO (CRD42023476543).

What if youth is not enough? Acute coronary syndrome in young patients

Abstract Funding Acknowledgements None. Background Acute Coronary Syndromes (ACS) are the leading cause of mortality in Spain. Further research is needed in order to know risk factors and outcomes in young patients so that medicians could optimize their management and prevention. Purpose Identifying risk factors, clinical characteristics and short-term outcomes in Acute Coronary Syndrome in patients aged 40 and under. Methods A retrospective analysis of patients under 40 years of age who were admitted for ACS, out of 3,859 ACS admissions in Cardiology Intensive Care Unit (CICU) in our hospital between 2012 and 2022. Results 67 patients (1.73%) were included, most of them were males (83.6%). Baseline characteristics are summarized in Table 1. 77.6% had hypertension (HTA), 22.4% had diabetes (DM) and 34.3% had dyslipidemia (DLP). 79.1% were smokers, 9.1% had a history of alcoholism and 29.9% were cocaine users. None of them had a history of stroke, atrial fibrillation (AF). Only 3% had ischemic heart disease. 68.7% of them were ST-elevation myocardial infarction (STEMI) and inferior STEMI was the most common (38.7%). In anterior STEMI (22 patients), 15 had a severe lesion in the mid-left anterior descending artery (LAD), and 6 in the left main stem (LM). Single-vessel disease was the most common (70.8%), with 3-vessel disease in 4.6%. 75.8% received percutaneous coronary intervention (PCI), and 3% underwent bypass surgery. During admission, 10.5% progressed to Killip class III-IV. The ICU mortality was 1.5%. 9% received vasoactive drugs and 4.5% were intubated. Non-invasive ventilation was used in 3% and high-flow nasal cannula oxygen therapy in 5.3%. 3% received intra-aortic balloon pump support and 1.5% underwent dialysis or ultrafiltration. 4.5% received an implantable cardioverter-defibrillator (ICD), although none of them developed bundle branch block or atrioventricular node block, nor AF. After discharge, 11.1% had recurrent ACS, and up to 5.6% underwent PCI again, with a mortality rate of 11.8%. Conclusion Approximately 2% of ACS occur in people younger than 40 years of age. Substance abuse (smoking, cocaine and alcoholism) becomes more prevalent in this group. Prevalence of comorbidities (such as diabetes and nephropathy) are lower, making them less prone to short-term heart failure. However, they are more susceptible to recurrent ischemic events. There is a high incidence of inferior STEMI and LM-STEMI. For these reasons, medicians may need to find out a substance abuse in this group and further research into other risk factors, such as coronary disease family history.Basal characteristicsClinical evolution of patients

Admission plasma concentration of neutrophil gelatinase-associated lipocalin and -C-reactive protein have additive prognostic value in patients with STEMI

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): This work was supported by Righospitalets Forskningsfond (07IO) Lundbeck Foundation (R186-2015-2132). Background Inflammation plays an apparent critical role in patients with acute coronary syndrome (ACS) and is associated with mortality. However, the complex process is poorly understood. Neutrophil gelatinase-associated lipocalin (NGAL) is a novel biomarker originating from mature neutrophils and renal tubular cells. It has previously been shown to be associated with mortality and acute kidney injury in ACS patients. In this study we sought to assess the potential additive prognostic value of NGAL and its relation to other markers of inflammation. Methods In 1556 consecutive ST-elevation myocardial infarction (STEMI) patients, NGAL and C-reactive protein (CRP) plasma concentration were measured at hospital admission, before acute coronary angiography. Patients were stratified to plasma concentration of both biomarkers &amp;gt;/&amp;lt; the median concentration into 4 groups (low NGAL/ low CRP (group 1), low NGAL/high CRP (2), high NGAL/low CRP (3), high NGAL/high CRP(4)). Primary outcome was 30-day all-cause mortality. Results In total, 477 (31%), 324 (21%), 316 (20%), and 439 (28%) patients were stratified in group 1-4, respectively. With 0, 1, or 2 biomarker plasma concentration above the median (group 1 – 4), patients were older (61 – 67 years old, p&amp;lt;0.0001), had more comorbidity (hypertension (40 – 53%), p=0.002; previous stroke (4.0 – 9.9%), p=0.007; peripheral arterial disease (PAD) (2.6 – 10%), p&amp;lt;0.0001; chronic kidney dysfunction (CKD) (0.6 – 11%), p&amp;lt;0.0001) and more critical per-infarction circumstances (time from symptom debut to angiography (170 – 229 minutes), p&amp;lt;0.0001; cardiogenic shock (1.3 – 14%), p&amp;lt;0.0001, cardiac arrest (0.8 – 3.4%), p=0.0002) and lower left ventricular ejection fraction (LVEF) (48 – 43%, p&amp;lt;0.0001). Increased NGAL and CRP was associated with 30-day all-cause mortality (Figure A). Only high NGAL/high CRP was independently associated with 30-day mortality in a cox proportional hazard model when adjusting for age, hypertension, previous stroke, CKD, LVEF, and cardiogenic shock (HR (95% CI) 5.19 (1.20 – 22.52), p=0.03). Both CRP and NGAL had significant predictive value of 30-day mortality (AUC ROC 0.67, p&amp;lt;0.0001 and 0.78, p&amp;lt;0.0001, respectively). Combining NGAL and CRP did, however, not increase the predictive value of NGAL alone (AUC ROC 0.77, p=0.86) (Figure B). Conclusion Combined admission NGAL and CRP plasma concentration was independently associated with 30-day all-cause mortality in STEMI patients. Adding CRP to NGAL did, however, not increase the predictive value.Figure AFigure B

Acute kidney injury in patients with acute coronary syndrome - risk profile

Abstract Funding Acknowledgements None. Introduction Acute kidney injury (AKI) is a strong predictor of in-hospital adverse outcomes, which is a common complication of acute coronary syndrome (ACS). Aim To analyse the risk profile of patients treated for acute coronary syndrome who develop acute kidney injury. Material and methods This is a single-centre cross-sectional cohort study on 3507 patients with ACS. The main exclusion criteria was left ventricular dysfunction. Demographical and clinical characteristics, biochemical parameters, the anatomical distribution of coronary artery disease (CAD) and the final outcomes were analysed according to RF at the moment of the indexed event. The estimated glomerular filtration rate (eGFR) was calculated by the Modification of Diet in Renal Disease Study Group Equation (MDRD), where patients with eGFR&amp;lt;60ml/min 1.73 m2 had moderate to severe renal dysfunction. Results 74 (2.1%) out of 3507 patients developed acute kidney injury (AKI). Those were predominantly males [62.2% (46), OR 1.55 (95% CI 0.98-2.47), p=0.044], significantly older (68.95±9.9. vs 62.5±11.2; p &amp;lt;0.000001), more often with preexisting HBI (OR 4.72 (95% CI 2.20-10.30, p=0.000070), HTA(OR 1.89 95%CI 1.11-3.23, p=0.020), diabetes(OR 1.88 95%CI 1.18-3.00, p=0.008), cancer(OR 2.92 95%CI 1.15-7.44, p=0.024), anaemia (beta -.104, p=0.000032), while less often were smokers (OR 0.51, 95% CI 0.31-0.83, p=0.006). They had statistically significantly higher values of cardiac troponin (beta .075, p=0.000011), stress glycemia (beta .104, p=0. 0.000019), and WBC (beta .074, p=0.000013), higher BUN (beta .325, p=0.000011), creatinine (beta .268, p=0.000016), and lower eGFR at admission (beta -.211, p=0.000032), lower sodium (beta -.101, p=0.000012), and higher potassium levels (beta .087, p=0.0008). Vice versa, total cholesterol, LDL-C and non-HDL-C (beta -.051, p=0.002, -.049, p=0.003, and -.047, p=0.005 respectively), were lower, the same for Hgb (beta -.107, p=0.000021). It is worth mentioning that 18(11.5%), of AKI patients were not PCI treated. Independent variables associated with AKI were: preexisting renal failure, cancer, and WBC. Outcomes: AKI carried a significantly higher in-hospital mortality rate (4.2% in general population, and 21.1% of all deaths were AKI patients, OR 23.01 (95% CI 14.04-47.03, p=0.00002)]. It was significantly associated with the development of pulmonary oedema (OR 17.94, 95% CI 9.67-33.26, p=0.000012), cardiogenic shock (OR 21.59, 95% CI 12.79-36.47, p=0.00006), any type of dysrhythmia (OR 1.83, 95%CI 1.53-2.18, p=0.0001), and any type of bleeding complications (OR 1.61, 95%CI 1.14-2.27, p=0.007). Conclusion AKI is a relatively rare complication in ACS patients, however is associated with significant in-hospital morbidity and mortality. Patients with pre-existing renal failure, and cancer, as well as patients who developed more pronounced inflammatory reaction were more prone to AKI.

The Elevated Inflammatory Status of Neutrophils Is Related to In-Hospital Complications in Patients with Acute Coronary Syndrome and Has Important Prognosis Value for Diabetic Patients

Despite neutrophil involvement in inflammation and tissue repair, little is understood about their inflammatory status in acute coronary syndrome (ACS) patients with poor outcomes. Hence, we investigated the potential correlation between neutrophil inflammatory markers and the prognosis of ACS patients with/without diabetes and explored whether neutrophils demonstrate a unique inflammatory phenotype in patients experiencing an adverse in-hospital outcome. The study enrolled 229 ACS patients with or without diabetes. Poor evolution was defined as either death, left ventricular ejection fraction (LVEF) &lt;40%, Killip Class 3/4, ventricular arrhythmias, or mechanical complications. Univariate and multivariate analyses were employed to identify clinical and paraclinical factors associated with in-hospital outcomes. Neutrophils isolated from fresh blood were investigated using qPCR, Western blot, enzymatic assay, and immunofluorescence. Poor evolution post-myocardial infarction (MI) was associated with increased number, activity, and inflammatory status of neutrophils, as indicated by significant increase of Erythrocyte Sedimentation Rate (ESR), C-reactive protein (CRP), fibrinogen, interleukin-1β (IL-1β), and, interleukin-6 (IL-6). Among the patients with complicated evolution, neutrophil activity had an important prognosis value for diabetics. Neutrophils from patients with unfavorable evolution revealed a pro-inflammatory phenotype with increased expression of CCL3, IL-1β, interleukin-18 (IL-18), S100A9, intracellular cell adhesion molecule-1 (ICAM-1), matrix metalloprotease (MMP-9), of molecules essential in reactive oxygen species (ROS) production p22phox and Nox2, and increased capacity to form neutrophil extracellular traps. Inflammation is associated with adverse short-term prognosis in acute ACS, and inflammatory biomarkers exhibit greater specificity in predicting short-term outcomes in diabetics. Moreover, neutrophils from patients with unfavorable evolution exhibit distinct inflammatory patterns, suggesting that alterations in the innate immune response in this subgroup may exert detrimental effects on disease progression.

Impact of diabetes on short-term outcomes in patients undergoing coronary artery bypass grafting surgery in acute coronary syndrome.

Diabetes mellitus (DM) is associated with concomitant comorbidities, such as atherosclerosis and cardiovascular disease. Coronary artery bypass grafting (CABG) surgery is the optimal therapy in diabetic patients with triple vessel disease. DM is also known to be a relevant risk factor for higher morbidity and mortality in patients who underwent elective CABG procedures. Data regarding outcomes in diabetic patients in acute coronary syndrome (ACS) is heterogeneous. This study aimed to investigate the impact of DM on short-term outcomes in patients who underwent CABG surgery in ACS. A retrospective propensity score matched (PSM) analysis of 1370 patients who underwent bypass surgery for ACS between June 2011 and October 2019 was conducted. All patients were divided into two groups: non-diabetic group (n = 905) and diabetic group (n = 465). In-hospital mortality was the primary outcome. Secondary outcomes were perioperative myocardial infarction, new onset dialysis, reopening for bleeding and duration of intensive care unit (ICU) stay. A subgroup analysis of patients with insulin-dependent and non-insulin dependent DM was also performed. After performing PSM analysis, baseline characteristics and the preoperative risk profile were comparable between both groups. The proportion of patients who underwent total arterial revascularization (p = .048) with the use of both internal thoracic arteries (p < .001) was significantly higher in the non-diabetic group. The incidence of perioperative myocardial infarction (p = .048) and new onset dialysis (p = .008) was significantly higher in the diabetic group. In-hospital mortality was statistically (p = .907) comparable between the two groups. DM was associated with a higher incidence of adverse outcomes, however with comparable in-hospital mortality in patients who underwent CABG procedure for ACS.

The association between the triglyceride-glucose index and in-stent restenosis in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis

BackgroundInsulin resistance (IR) can lead to cellular metabolic disorders, activation of oxidative stress, and endothelial dysfunction, contributing to in-stent restenosis (ISR). The triglyceride-glucose index (TyG index), a new indicator reflecting IR, is extensively researched in the cardiovascular field. This study, through a meta-analysis, aimed to utilize a larger combined sample size and thereby enhance the overall test efficacy to explore the TyG index-ISR relationship.MethodsA thorough search was conducted in the PubMed, EMBASE, Web of Science, and Cochrane Library databases to find original papers and their references published between 1990 and January 2024. This search included both prospective and retrospective studies detailing the correlation between the TyG index and ISR in individuals with coronary heart disease (CHD).OutcomesThe five included articles comprised 3,912 participants, and the odds ratio (OR) extracted from each study was combined using the Inverse Variance method. Results showed that, in the context of CHD patients, each incremental unit in the TyG index, when treated as a continuous variable, corresponded to a 42% elevation in ISR risk (95% CI 1.26–1.59, I²=13%, p < 0.005). When analyzing the TyG index categorically, the results revealed a higher ISR risk in the highest TyG index group compared to the lowest group (OR: 1.69, 95% CI 1.32–2.17, I²=0). Additionally, in patients with chronic coronary syndrome (CCS), each unit increase in the TyG index, the risk of ISR in patients increased by 37% (95% CI 1.19–1.57, I²=0%, p < 0.005). This correlation was also observable in acute coronary syndrome (ACS) patients (OR:1.48, 95% CI 1.19–1.85, I²=0, p < 0.005).ConclusionsThe TyG index, an economical and precise surrogate for IR, is significantly linked with ISR. Furthermore, this correlation is unaffected by the type of coronary heart disease.

Acute coronary syndrome in young (≤45 Years) patients: a multicenter observational study

Introduction: Acute Coronary Syndrome (ACS) in young individuals (≤45 y) is increasingly recognized as a significant health concern, yet research in this demographic remains limited, particularly within the Palestinian context. This study aims to bridge this gap by comprehensively investigating the clinical characteristics, age-specific profiles, gender disparities, treatment modalities, and angiographic patterns of ACS in young patients compared to their older counterparts. Materials and Methods: A multicenter observational study was conducted, enrolling 468 participants aged 18-55 diagnosed with ACS and admitted to three prominent Palestinian hospitals. Data were collected from medical records, and statistical analysis was performed to assess demographic characteristics, clinical presentations, risk factors, treatment strategies, and outcomes. Results: The majority of participants were male (87%), with a higher proportion in the older age group (&gt;45 y). Clinical presentations varied, with Non-ST Segment Elevation Myocardial Infarction (NSTEMI) being the most common diagnosis (48%). Risk factors such as smoking, hypertension, and diabetes were prevalent, with notable gender and age-specific differences. Percutaneous Coronary Intervention (PCI) was the predominant treatment strategy (83%), with consistent medication use across age groups. Conclusion: ACS in young patients poses a significant public health challenge in Palestine, necessitating tailored preventive strategies and comprehensive management approaches. Understanding the unique demographic and clinical characteristics of young ACS patients is crucial for informing targeted interventions and policies aimed at reducing the burden of cardiovascular disease in this population. These findings contribute valuable insights to the existing literature and underscore the importance of further research in this area to improve outcomes and mitigate the impact of ACS in young individuals globally.

Medication discrepancies identified by medication reconciliation among patients with acute coronary syndrome.

Medication errors such as medication discrepancies are known as one of the leading cause of death. Medication discrepancies mostly occur during admission and at time transfer of care and discharge. Medication reconciliation process has pivotal role to avert medication discrepancies and improve patient safety and quality. Patients with acute coronary syndrome (ACS) are prone to medication discrepancies due to acute manifestations, simultaneous use of different medicines and having different co-morbidities. This study aimed to determine medication discrepancies identified by medication reconciliation among patients with ACS.In an observational study, patients with ACS admitted to a specialized Hospital in Baneh County, Kurdistan province during September 2023 and January 2024 were included. Medication reconciliation process was done when the patient was admitted. The history of medicine use was collected through interviews with the patient, their caregivers, as well as observing the medicines that were accompany with the patients. Number and type of unintentional medication discrepancies and related factors were evaluated.A total of 280 ACS patients (mean age: 63.8 ± 14.2, male gender: 59.3%) were included in the study. About 68% had at least 2 underlying diseases. The mean daily medicines taken by the patients during admission were 8.5 ± 1.54. The number (percentage) of unintentional inconsistency was observed in 78 (27.3%), and omission (39.7%) and changes in dosage (20.5%) had the highest frequency of unintentional medication discrepancies, respectively. Cardiovascular agents such as anti-dyslipidemia and antiplatelet had the highest frequency of unintentional medication discrepancies. The number of underlying diseases and daily medications before hospitalization increase the odds of discrepancies by 2.15 and 1.49 times, respectively (p-value < 0.05).Medication discrepancies identified by medication reconciliation among patients is relatively common. Unintentional medication discrepancies that have the potential to harm the ACS patients should be given more attention, especially in patients with multiple comorbidities and polypharmacy.

Acute coronary syndrome in elderly and senile diabetic patients

Acute coronary syndrome (ACS) remains a common cause of hospitalization in diabetes mellitus (DM) patients. It is believed that diabetic neuropathy patients have a high atypical course incidence of acute coronary syndrome, because of the frequent neuropathy development in diabetes patients, but the data on this are quite contradictory. Aim: The study aimed to determine the features of the pain syndrome and its severity in ACS and concomitant diabetes patients. Materials and Methods: The study involved 36 diabetes patients (22 men and 14 women) aged 62-86 years, hospitalized urgently for ACS. Pain syndrome was assessed during hospitalization and immediately after coronary artery revascularization using the following criteria: visual analogue scale (VAS), Numerical Rating Scale (NRS), clinical data, and biochemical markers. Results: Most of the patients (91.67%) complained of chest pain at the time of hospitalization, the rest were not bothered by any pain. Patients described pain as “burning” (30.56 %), “squeezing” (30.56 %), “tightness” (25.0 %), and “tingling” (5.56 %). There were also complaints of difficulty breathing (13.89 %), shortness of breath (11.1 %), and palpitations (41.67 %). The appearance of excessive sweating was noticed by 16.67% of patients. There was no statistically significant difference between the results of VAS and NRS pain scores (p &gt; 0.1). The mean blood glucose level at hospitalization was 8.19±3.45 mmol/l (in men – 8.17±3.61 mmol/l, in women – 8.28±3.13 mmol/L). Glycemia level higher than 10.0 mmol/l was detected in 8 patients, which accounted for 22.22% of all patients. Severe pain syndrome patients dominated in this category (62.5 %). Conclusions: In patients with myocardial infarction and diabetes, the typical clinical picture of ACS prevailed (91.67% of patients) over the painless form. Before revascularization, moderate to severe pain occurred with equal frequency; there were no statistical differences between blood pressure, heart rate, and blood glucose level (p&gt; 0.1) in patients with severe and moderate pain. Hyperglycemia (≥10.0 mmol/l) was detected in 22.22% of patients, among whom severe pain syndrome patients prevailed. _________________________________________________________________________________________ Keywords: elderly patients; diabetes mellitus; acute coronary syndrome; pain syndrome

P2Y12 Inhibitor Monotherapy after Short Term Dual Antiplatelet Therapy in Acute Coronary Syndrome

Recent studies have shown similar safety and efficacy of short-term dual antiplatelet therapy (DAPT) followed by P2Y12 inhibitor (P2Y12i) monotherapy when compared with standard DAPT. However, the optimal DAPT duration and regimen in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) is still unclear. Online databases were searched for randomized controlled trials (RCTs) evaluating P2Y12i monotherapy after short DAPT (≤3 months) vs standard DAPT (≥12 months) in ACS patients. The outcomes of interest were all cause death, cardiovascular (CV) death, myocardial infarction (MI), stent thrombosis (ST), target-vessel revascularization (TVR) and major bleeding. Random-effects model was used to calculate pooled odds ratios (OR) and 95% confidence intervals (CI). Six RCTs with a total of 23,884 patients (n=11,904 P2Y12i monotherapy, n=11,980 standard DAPT) were included. Compared with standard DAPT, P2Y12i monotherapy after short DAPT was associated with similar odds of all cause death (OR 0.86, 0.65-1.12, p = 0.26) and CV death (OR 0.75, 0.43-1.29, p = 0.29) at 1 year. Similarly, there were no significant differences in rates of MI (OR 1.09, 0.83-1.43, p = 0.53), ST (OR 1.09, 0.71-1.67, p = 0.70) and TVR (OR 0.81, 0.65-1.01, p = 0.07) between the P2Y12i monotherapy and standard DAPT arms. The P2Y12i monotherapy group had significantly lower major bleeding (OR 0.49, 0.38-0.64, p<0.001) when compared to standard DAPT. In conclusion, among patients with ACS undergoing PCI, P2Y12i monotherapy after short DAPT significantly reduces bleeding without increasing ischemic risk when compared to standard DAPT therapy.

The connection of hypovitaminose D and biomarkers of acute coronary syndrome in patients with COVID-19

The connection of hypovitaminose D and biomarkers of acute coronary syndrome in patients with COVID-19

Quantitative Detection of Multiple Cardiovascular Biomarkers by an Antibody Microarray-Based Metal-Enhanced Fluorescence Assay.

Accurate detection of multiple cardiovascular biomarkers is crucial for the timely screening of acute coronary syndrome (ACS) and differential diagnosis from acute aortic syndrome (AAS). Herein, an antibody microarray-based metal-enhanced fluorescence assay (AMMEFA) has been developed to quantitatively detect 7 cardiovascular biomarkers through the formation of a sandwich immunoassay on the poly(glycidyl methacrylate-co-2-hydroxyethyl methacrylate)-decorated GNR-modified slide (GNR@P(GMA-HEMA) slide). The AMMEFA exhibits high specificity and sensitivity, the linear ranges span 5 orders of magnitude, and the limits of detection (LODs) of cardiac troponin I (cTnI), heart-type fatty acid binding protein (H-FABP), C-reactive protein (CRP), copeptin, myoglobin, D-Dimer, and N-terminal pro-brain natriuretic peptide (NT-proBNP) reach 0.07, 0.2, 65.7, 0.6, 0.2, 8.3, and 0.3 pg mL-1, respectively. To demonstrate its practicability, the AMMEFA has been applied to quantitatively analyze 7 cardiovascular biomarkers in 140 clinical plasma samples. In addition, the expression levels of cardiovascular biomarkers were analyzed by the least absolute shrinkage and selector operator (LASSO) regression, and the area under receiver operator characteristic curves (AUCs) of healthy donors (HDs), ACS patients, and AAS patients are 0.99, 0.98, and 0.97, respectively.

OR6-9 | Recent Trends in PCI Outcomes for Older Acute Coronary Syndrome Patients with a History of CABG: 2016-2020

OR6-9 | Recent Trends in PCI Outcomes for Older Acute Coronary Syndrome Patients with a History of CABG: 2016-2020

A-31 | Percutaneous Coronary Intervention Access Site in Acute Coronary Syndrome Patients Treated with Glycoprotein IIb/IIIa Inhibitors During: A Contemporary Assessment

A-31 | Percutaneous Coronary Intervention Access Site in Acute Coronary Syndrome Patients Treated with Glycoprotein IIb/IIIa Inhibitors During: A Contemporary Assessment

Contemporary Outcomes of Acute Coronary Syndromes in Indigenous Compared with Non-Indigenous Patients: A Northern Saskatchewan Perspective

In patients presenting with an acute coronary syndrome (ACS), the impact of efforts leveraged at bridging historical care gaps between Indigenous and non-Indigenous patients remains limited. For consecutive ACS presentations (STEMI and NSTEMI/UA, respectively) at the Royal University Hospital, Saskatoon, we compared between self-identified Indigenous and non-Indigenous patients their demographics, treatments and all-cause mortality (in-hospital and 3-years). We used propensity score-inverse probability weighting to mitigate confounding, and Cox regression models to estimate the adjusted hazard (aHR, 95% confidence intervals) for all-cause mortality. Of 3946 ACS patients, 37.2% (n=1468) were STEMI of whom 11.3% (n=166) were Indigenous. Of the NSTEMI/UA (n=2478), 12.6% (n=311) were Indigenous. Overall, Indigenous compared with non-Indigenous patients were likely to be younger, female, have higher risk burden, and lived more remotely; Indigenous STEMI patients triaged to primary PCI had longer first medical contact-to-device times, while Indigenous NSTEMI/UA patients more likely to present with heart failure, cardiac arrest and/or cardiogenic shock. No significant differences were noted for in-hospital mortality (STEMI 8.4% vs 5.7%, p= 0.16; NSTEMI/UA 1.9% vs 1.6%, p=0.68), however, in follow-up, Indigenous STEMI patients associated with a higher all-cause mortality risk (aHR 1.98, 95% CI 1.19, 3.31, p=0.009) with no between-group differences evident for NSTEMI/UA (aHR 1.03, 95% CI 0.63 1.69, p=0.91). Indigenous compared with non-Indigenous patients presenting with an ACS had higher cardiovascular risk profiles, and consequently residual mortality risk. Improving primary care and intensifying secondary risk reduction, and particularly so for Indigenous patients, will substantially modify ACS outcomes in Saskatchewan.

Acute coronary syndromes in patients with cancer: Recent advances.

Coronary artery disease is presently one of the leading causes of death among cancer survivors. Due to the number of cancer survivors projected to reach 26 million by 2040 managing coronary disease in this population presents a unique challenge. Cancer patients face an elevated risk of atherosclerotic disease due to shared cardiovascular risk factors and the cardiotoxic effects of cancer therapies, predisposing them to acute coronary syndromes. Challenges in treating cancer patients presenting with acute coronary syndromes include atypical presentations, obscured symptoms, and the impact of cancer-related processes on traditional biomarkers. This review explores the complexities of acute coronary syndrome management in cancer patients, addressing challenges involved, recent advances in percutaneous strategies, pharmacology, and considerations for these high-risk individuals. This review discusses a balance between invasive vs. medical strategy, technical advances in multimodal imaging, intravascular physiology, intracoronary imaging, and evolving stent options, highlighting the need for tailored approaches in this complex patient population.

Treatment seeking experiences of ACS patients in Yogyakarta, Indonesia during COVID-19 pandemic: A qualitative study.

Delay in treatment seeking is recognized as a major contributor for Acute Coronary Syndrome (ACS) mortality in Indonesia. Despite the significance of timely treatment, decline in admission and delay in presentation of patients with ACS were consistently reported during the COVID-19 pandemic. These suggested that treatment seeking performance of patients during the pandemic might be different from the previous period. This qualitative study aimed to explore treatment seeking behaviour, barriers in seeking medical treatment, and experiences of patients with ACS in Yogyakarta, Indonesia during COVID-19 pandemic. In depth-interviews were carried out with 30 patients, who were hospitalized with ACS at one of the three selected hospitals in Yogyakarta during the pandemic period. Thematic analysis was performed to create vital explanations for treatment seeking practices of patients with ACS during pandemic. Three significant themes were identified: treatment seeking decisions, barriers in seeking medical treatment during COVID-19, and experiencing both good and bad impression from entering and staying in the hospital. The intensity of ACS symptoms and fear of COVID-19 infection dominated the delay in seeking medical treatment. Strict safety measures, religious belief, and fear of ACS helped patients overcome barriers and seek medical treatment during pandemic. ACS patients also had convenient medical care during the pandemic and believed medical staff would provide excellent care to them. However, visit restriction policy could cause psychological discomfort. Increase awareness of ACS symptoms and the risk of delays ACS treatment are essential to support patients' decisions to seek medical helps in a timely manner at any situations including pandemic. Interventions aim at alleviating psychological distress should also be designed and implemented to improve treatment experiences of ACS patients, who sought medical treatment during the pandemic crisis.