Risk Factor For Acute Coronary Syndrome Research Articles

Public Knowledge and Attitude Regarding Symptoms of Acute Coronary Syndrome and Its Related Risk Factors in Western Region, Saudi Arabia.

Acute coronary syndrome (ACS) is the leading cause of mortality and morbidity worldwide. Recognition of its symptoms affects the time-sensitive benefits of reperfusion therapy. Furthermore, lowering the risk factors can prevent long-term complications. To evaluate the public knowledge and perception of the symptoms and risk factors of ACS in the Saudi-Western region. A cross-sectional study was conducted on a convenience sample of 733 among the general population in the western region of Saudi Arabia by using the Acute Coronary Syndrome Response Index, with additional questions about risk factors for heart attack and physical activities. The research information was acquired through a self-administered questionnaire without any identifying personal information. Participants demonstrated awareness of certain ACS symptoms and risk factors. Chest pain was widely recognized (49.2%, n = 361), followed by shortness of breath (44.8%, n = 329), arm pain or shoulder pain (38.6%, n = 283), palpitation (37.3%, n = 274), and fatigue (22.2%, n = 163). A total of 544 (74.2%) and 474 (64.6%) respondents were aware that smoking and obesity are the most common risk factors for ACS, respectively. However, gaps persisted, particularly regarding the association between diabetes mellitus and ACS, with 31.6% (n = 232) reporting diabetes mellitus. A total of 331 (45.2%) and 322 (43.9%) study sample were unsure whether they could identify ACS in themselves or other people. However, 391 (53.3%) decided that they should go to the hospital as soon as possible when they have chest pain that does not stop after 15 minutes. Notably, female participants demonstrated substantially higher knowledge (OR = 2.40, p = 0.001). The study highlights the influence of gender, age, and education on ACS-related awareness. This study provides valuable insights into ACS awareness in the western region of Saudi Arabia. Relatively older respondents, female participants, and those with postgraduate education were more knowledgeable about ACS than the others. These findings emphasize the importance of tailored interventions for specific demographic groups in enhancing public health outcomes.

Sex Differences in Cardiovascular Disease-Related Hospitalization and Mortality in Japan - Analysis of Health Records From a Nationwide Claim-Based Database, the Japanese Registry of All Cardiac and Vascular Disease (JROAD).

The prevalence of cardiovascular disease (CVD) is rising in Japan with its aging population, but there is a lack of epidemiological data on sex differences in CVD, including acute coronary syndrome (ACS), acute heart failure (AHF), and acute aortic disease.Methods and Results: This retrospective study analyzed data from 1,349,017 patients (January 2012-December 2020) using the Japanese Registry Of All Cardiac and Vascular Diseases database. ACS patients were youngest on average (70.5±12.9 years) and had the lowest female proportion (28.9%). AHF patients had the oldest mean age (79.7±12.0 years) and the highest proportion of females (48.0%). Acute aortic disease had the highest in-hospital mortality (26.1%), followed by AHF (11.5%) and ACS (8.9%). Sex-based mortality differences were notable in acute aortic disease, with higher male mortality in Stanford Type A acute aortic dissection (AAD) with surgery (males: 14.2% vs. females: 10.4%, P<0.001) and similar rates in Type B AAD (males: 6.2% vs. females: 7.9%, P=0.52). Aging was a universal risk factor for in-hospital mortality. Female sex was a risk factor for ACS and acute aortic disease but not for AHF or Types A and B AAD. Sex-based disparities in the CVD-related hospitalization and mortality within the Japanese national population have been highlighted for the first time, indicating the importance of sex-specific strategies in the management and understanding of these conditions.

LncRNA TPRG1-AS1 Screened the Onset of Acute Coronary Syndromes and Predicted Severity and the Occurrence of MACE During Patients' Hospitalization.

Acute coronary syndrome (ACS) is a common acute myocardial ischemia syndrome and is one of the death-related causes of cardiovascular diseases. Identifying biomarkers to indicate disease severity and predict the occurrence of major adverse cardiovascular events (MACE) would benefit the clinical prognosis of ACS. This study estimated the expression and significance of lncRNA TPRG1-AS1 in the onset and development of ACS, aiming to explore a novel biomarker for the diagnosis and prognosis of ACS. A total of 109 ACS patients and 66 patients who received coronary angiography and excluded ACS were enrolled in this study. TPRG1-AS1 in the serum of study subjects was analyzed by PCR. The significance of TPRG1-AS1 in screening ACS was evaluated by ROC analysis. The association of TPRG1-AS1 with the disease severity of ACS was assessed by Pearson correlation analysis with patients' clinicopathological features. The potential of TPRG1-AS1 in predicting the occurrence of MACE was assessed by logistic regression analysis. Significant upregulation of TPRG1-AS1 was observed in ACS patients, which served as a risk factor for ACS and distinguish between ACS patients and the normal group. TPRG1-AS1 was positively correlated with Gensini score, cys-C, cTnI, and NT-proBNP levels of ACS patients, which indicate severe development of ACS. Additionally, increasing serum TPRG1-AS1 was associated with the high incidence of MACE during patients' hospitalization and was identified as a risk factor for MACE in ACS patients. Upregulated TPRG1-AS1 in ACS served as a diagnostic biomarker and predicted the severe development of patients.

A hybrid machine learning and natural language processing model for early detection of acute coronary syndrome

Acute coronary syndrome (ACS) is a leading cause of mortality and morbidity. Predicting the associated risks of patients with chest pain using electronic health record data can help identify those needing more tailored care. This study proposes the development of a reliable prediction framework to serve as a diagnostic support tool for preventing misdiagnoses among patients with clinical concerns for ACS. Data were collected from an urban, demographically diverse hospital in Detroit, Michigan, for patients presenting to the emergency department (ED) with primary chief complaints of chest pain from January 2017 to August 2020. This study incorporated term frequency-inverse document frequency features from free-text summaries, which contain anecdotal symptom descriptions and are among the first data points provided upon entering the ED. The analysis included 16,096 patients with clinical concerns for ACS and trained three machine learning models, logistic regression, AdaBoost, and linear discriminant analysis, across different data processing stages to predict patients with ACS from non-ACS etiology. The AdaBoost model outperformed the other two models with an accuracy of 94% and an F1-score of 0.943 in predicting ACS on the testing data. This study identified key independent factors from patient demographics, comorbidities, and clinical narrative data that predicted ACS in patients. The prediction framework can serve as a decision-support tool to classify ACS and inform physicians about better ACS risk factors.

Role of serum n-6 polyunsaturated fatty acids in the development of acute coronary syndromes.

n-3 polyunsaturated fatty acids (PUFAs) have an inhibitory effect on the development of coronary artery disease (CAD). However, whether n-6 PUFAs, dihomo-gamma-linolenic acid (DGLA), and arachidonic acid (AA) play a role in the development of CAD remains unclear. This study investigated the association between PUFAs and the risk of developing acute coronary syndrome (ACS) using the lipid and PUFAs data of patients who received percutaneous coronary intervention (PCI) for either non-emergent conditions (staged group) or ACS (ACS group). We retrospectively evaluated 433 patients who underwent PCI between 2014 and 2021. The patients were divided into the ACS group (n = 18) and the staged group (n = 132). The lipid and PUFA values of each patient between the two groups were compared. Moreover, to investigate the correlation between n-6 PUFA levels and ACS, the effects of confounding factors such as the use of strong statins and low-density lipoprotein cholesterol (LDL-C) levels were adjusted. The ACS group had higher n-6 PUFAs levels than the staged group (DGLA: 36.8 µg/mL vs 29.6 µg/mL; AA: 203.3 µg/mL vs 145.8 µg/mL). Furthermore, the analysis of covariance adjusted for LDL-C levels showed a significant difference between the two groups in terms of DGLA and AA levels. The n-3 PUFA levels did not significantly differ between the staged and ACS groups. Moreover, the ACS group had higher DGLA and AA levels and lower n-3 PUFAs/AA ratios than the staged group. Therefore, excess n-6 PUFAs may be a risk factor for ACS.

The Relationship Between Obesity and Coronary Artery Ectasia in Patients Presenting with Acute Coronary Syndromes

Introduction Obesity is a global health burden with an increasing worldwide incidence. Coronary artery ectasia (CAE) is frequently associated with obstructive coronary artery disease and acute coronary syndrome (ACS). Obesity and CAE are risk factors for ACS. Considering this linkage, we aimed to investigate the role of obesity in presence of CAE in patients presenting with ACS. Methods Patients hospitalized with a diagnosis of ACS in our tertiary center between January 2015 and May 2020 were included in this retrospective, case-control study. The patients presenting with ACS involving a coronary artery ectasia segment formed ‘CAE group’. On the other hand, patients who were undergone coronary angiography with a diagnosis of ACS without coronary ectasia formed ‘control group’. Results There was a total of 274 patients. Patients who were presented with ACS involving a CAE segment were in higher body mass index (BMI) tertials and BMI was an independent predictor for presence of CAE in patients presenting with ACS. Additionally advanced age, diabetes mellitus, hypertension, current smoking, increased neutrophil/lymphocyte ratio, higher fasting blood glucose, triglyceride and lower high-density lipoprotein (HDL) levels were found as independent risk factors for presence of CAE in patients presenting with ACS. Conclusion We detected obesity (being overweight or obese) as an independent risk factor associated with the presence of CAE in patients presenting with ACS. Higher triglyceride and fasting blood glucose and lower HDL levels detected in our study support the idea that metabolic syndrome plays a role and insulin resistance is the underlying mechanism for CAE presence in patients presenting with ACS.

Obesity Paradox in Coronary Thrombus Burden of Patients with Acute Coronary Syndrome.

Background: Acute coronary syndrome (ACS) remains a major cause of morbidity and mortality worldwide. Although obesity is a risk factor for ACS, decreased mortality has been shown in overweight individuals. This study aims to determine the association of body fat parameters such as body fat percentage (BFP), relative fat mass (RFM), and coronary thrombus burden with angiographic thrombotic grade in a series of patients presenting with ACS. Methods: Three hundred ninety patients who underwent percutaneous coronary intervention were enrolled in the study. BFP was calculated using the U.S. Navy formula. RFM index was calculated using gender, height, and waist circumference regardless of weight. Body mass index (BMI) is calculated as the weight in kilograms divided by the square of body length in meters (kg/m2). Two experienced interventional cardiologists reviewed coronary angiograms according to the TIMI thrombus scale. Patients were divided into groups according to thrombus classification and clinical status. Results: RFM, which is an anthropometric measurement parameter for obesity, was inversely related to thrombus burden in patients with ACS. There were no significant differences between ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) groups according to demographic, clinical characteristics, and coronary risk factors. Likewise, RFM, BFP, and BMI were comparable between the two groups. BFP and RFM were lower in patients with thrombus present STEMI group compared with no thrombus group. Thrombus presence was also compared in the NSTEMI group, and BMI, BFP, and RFM were lower in patients with thrombus present NSTEMI group. Conclusions: Our analysis demonstrated that RFM was better than BFP and BMI for predicting thrombus presence in patients with ACS.

Effects of Hypertension on the Incidence of Acute Coronary Syndrome and Severity of Coronary Artery Disease in Young Women

Abstract Background To investigate the effects of hypertension on the prevalence of acute coronary syndrome (ACS) and the severity of coronary artery disease in young women in northern China. Methods A retrospective analysis was performed on 840 young female patients (age &amp;lt;45 years old) underwent coronary angiography due to chest pain or chest discomfort between January 2007 and December 2016. The patients were divided into hypertension group (256 cases) and control group (584 cases). The risk factors and prevalence of ACS, and coronary stents implantation in the 2 groups were studied. Results The prevalence of ACS was higher in the hypertension group compared with the control group (80.9% vs. 36.5%, P &amp;lt; 0.05). The rates of hyperlipidemia (37.1% vs. 14.9%), hypercholesterolemia (8.6% vs. 3.4%), hyperuricemia (18.4% vs. 7.2%), and hyperhomocysteinemia (10.9% vs. 3.9%) were all significantly higher in the hypertensives compared with controls (all P &amp;lt; 0.05). The hypertension group had higher rates of overweight (63.7% vs. 29.5%), family history of early coronary heart disease (15.2% vs. 5.5%), smoking (5.5% vs. 4.3%), menopause (4.7% vs. 1.7%), and type 2 diabetes (24.2% vs. 8.9%) compared with the control group (all P &amp;lt; 0.05). Double branch lesions of coronary artery in hypertension and control groups were 14.1% and 5.7%, respectively (P &amp;lt; 0.05). Further, hypertensive patients with ACS had higher number (1.67 ± 1.05 vs. 1.41 ± 0.85) and longer (24.44 ± 6.97 vs. 22.85 ± 7.80 mm) stents implantation than the control group (P &amp;lt; 0.05). Conclusions Hypertension is the main risk factor of ACS in young women in northern China. Young women with hypertension have more risk factors for atherosclerotic cardiovascular disease.

Role of serum n-6 polyunsaturated fatty acids in the development of acute coronary syndromes

Abstract Funding Acknowledgements Type of funding sources: None. Background and Aims n-3 polyunsaturated fatty acids (PUFAs) have an inhibitory effect against the development of coronary artery disease (CAD). However, whether n-6 PUFAs, dihomo-gamma-linolenic acid (DGLA), and arachidonic acid (AA) play a role in the development of CAD remains unclear. This study investigated the association between PUFAs and the risk of developing acute coronary syndrome (ACS) using the lipid and PUFAs data of patients who received percutaneous coronary intervention (PCI) for either non-emergent conditions (staged group) or ACS (ACS group). Methods We retrospectively evaluated 433 patients who underwent PCI between 2014 and 2021. The patients were divided into the ACS group (n = 18) and the staged group (n = 132). The lipid and PUFAs values of each patient between the two groups were compared. Moreover, to investigate the correlation between n-6 PUFAs levels and ACS, the effects of confounding factors such as use of strong statins and low-density cholesterol (LDL-C) levels were adjusted. Results The ACS group had higher n-6 PUFAs levels than the staged group (DGLA: 36.8 ug/mL vs. 29.6 ug/mL; AA: 203.3 ug/mL vs. 145.8 ug/mL). Furthermore, the analysis of covariance adjusted for LDL-C levels showed a significant difference between the two groups in terms of DGLA and AA levels. Conclusions The n-3 PUFAs levels did not significantly differ between the staged and ACS groups. Moreover, the ACS group had higher DGLA and AA levels and lower n-3 PUFAs/AA ratios than the staged group. Therefore, excess n-6 PUFAs may be a risk factor for ACS.

Short-term, intermediate-term and long-term risks of acute coronary syndrome in cohorts of patients with RA starting biologic DMARDs: results from four Nordic countries

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

Disparity of risk factors and concordance of NLR with Gensini score in acute coronary syndrome in an Afro-Arab multiethnic nation

Background: Acute coronary syndrome (ACS), is ischemic heart disease of varying risk factors and clinical pattern and with immense health burden worldwide. Inflammation is believed to be an etiological factor in ACS, and neutrophil to lymphocyte ratio (NLR), to be a biomarker. Objectives: To describe the clinical pattern and risk factors of ACS in Afro-Arabs of Sudan and to evaluate the NLR as a severity marker. Method: In a total population, cross-sectional study, conducted in Al-Shaab Hospital- Sudan, clinical, laboratory and ECG data were used for ACS grouping into unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI) and STEMI. All patients underwent coronary angiography (CAG) and their Gensini score and NLR were calculated. Results: A total of 130 patients (62.3% men) of a median age of 58.0, 50.0-65.0 yrs., (range 32.0-82.0), were diagnosed with ACS; 44.6% STEMI, 37.7% NSTEMI and 17.7% UA. The median Gensini score was higher in STEMI (42.5, 12.0-71.0) and NSTEMI (40.0, 15.8-60.5) compared with UA (10.0, 5.0-23.0), p 0.002, similarly, was the NLR; 3.5, 1.6-4.6; 2.9, 1.5-3.8 and 0.9, 0.8-1.1, respectively p&lt;0.001. Furthermore, the NLR in concordance with CAG findings p&lt;0.001. Finally, hypertension, diabetes mellitus and dyslipidemia, respectively, were stronger ACS risk factors in women than in men unlike smoking, and family history imposed the least risk. Conclusion: While the ACS clinical pattern was in-line with literature, the risk factors order was different, and it was different between sexes. Importantly, the NLR strongly associated with ACS severity, but failed to distinguish between NSTEMI and STEMI.

CHEST PAIN IN WOMEN. IS IT ALWAYS ATHEROSCLEROTIC?

Patients both male and female with diagnosis of Acute Coronary Syndrome (ACS) present with chest pain as presenting complaint. Lichtman JH et al. in his study with ACS showed that 93% of women presented with chest pain or discomfort.1 As compared to men women experience more associated symptoms as primary complaint. The associated symptoms are fatigue, dyspnea, backache, flue like symptoms, indigestion, palpitations and most common is anxiety &amp; feeling scarry.2 Keeping these scenarios in mind one should inquire this associated presentation along with chest pain or discomfort in evaluating ACS in women. In continuation with symptoms there is quite a debate on pathophysiology of Acute Myocardial infraction in men and women regarding coronary pathologic features.3 Type 1 plaque rupture most common in both genders with plaque erosion most common in women in non-obstructive coronary artery disease.4 Spontaneous coronary artery dissection (SCAD) having high mortality exists in the absence of risk factor of ACS.5 It was found in women up to 35% of patients with mean age of 42 to 53 years with a MACE (Major acute coronary event) of 47.4% and 10 years mortality rate of 7.7%2 SCAD seen in peripartum cases, oral contraception use, lack of exercise, connective tissue disorders and vasculidites. It is important for the physician to have in mind these disorders to avoid complications of coronary interventions. In a scientific statement from AHA, Mehte LS et al. showed a lower prevalence of atheroscrotic CAD in women.3 These are certain scoring system,6 that under present women because of vague symptoms and presentation. These scoring systems lead to decrease hospital admission and less noninvasive cardiac testing. For risk satisfaction of chest pain female gender should not be taken as sole criteria for presence or absence of coronary events in presence of other multiple factors. The last but not the least is the psychosocial stress more in women than in men. It has been found that young women who present with early onset myocardial infarction have more psychosocial risk factors in comparison to men of similar age,3 probably having high rates of poverty and trauma exposure during childhood because of various reasons.7 Different studies are endorsing relationship between depression and ischemic heart disease as prognostic factor after ACS.7 In our population where there is lack of education, poverty, awareness of disease especially in women the physician should ponder on different factors mentioned above i.e. presentation perceptions, prevalence, pathophysiology and psychosocial stress for evaluation and management of chest pain.

Assessment of quality of life and drug prescription pattern in acute coronary syndrome

Objectives: To assess the health-related quality of life (QOL) in patients with acute coronary syndrome (ACS) and predict those patients who may have worsened QOL 6 months later and also observe the prescribing patterns of drugs given in their treatment. Materials and Methods: A prospective observational study was conducted at the cardiology department in a tertiary care hospital. The data were collected in both inpatient and outpatient cardiology departments based on our inclusion and exclusion criteria for a period of 6 months. A total of 240 patients were analyzed with a data collection form by interviewing the patients about their sociodemographic details, laboratory parameters, and diagnostic reports. The MacNew Heart Disease Questionnaire, Medical Research Council Breathlessness Scale, and New York Heart Association (NYHA) Functional Scale were used for assessing the QOL in patients with ACS. We calculated Global Registry of Acute Coronary Events Score and Thrombolysis in Myocardial Infarction Score for ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) patients for identifying the mortality risk. Results: Urban people were more prone to ACS than rural people, according to our data. According to the NYHA Functional Classification, ability to do physical activity was more considerably affected in NSTEMI patients than STEMI and angina. Most of the patients had Grade 2 shortness of breath. 35% of the patients had a high mortality risk. Based on the MacNew Questionnaire data, 23% of the patients with ACS were doing emotionally poor, 45% of the patients had shown physically impaired symptoms, 28% of the patients were socially dependent, 8% of the patients showed poor gastric condition. 49% of the patients were given reperfusion therapy with either percutaneous coronary intervention (PCI) or coronary artery bypass graft, 25% of the patients were managed with dual-anticoagulant therapy, and 6% of the patients were treated with single-anticoagulant therapy. Commonly prescribed drug classes were statins (90%), antiplatelets (86%), anticoagulants (75%), antianginal (55%), beta-blockers (50%), diuretics (35%), angiotensin-converting enzyme inhibitors (18%), and angiotensin receptor blockers (16%). Conclusion: QOL was significantly affected in ACS patients. Most of the patients had risk factors for ACS. Patients explained impairments in all the four domains used in the questionnaire such as emotional, physical, social, and gastric impairments. QOL was more affected in STEMI patients and they had a high mortality risk. Most of the patients had NSTEMI. Low-risk patients were given single-anticoagulant therapy and medium-risk patients were treated with dual-anticoagulant therapy. PCI was preferred in almost all the patients.

B-type natriuretic peptide as diagnostic and prognostic marker in various forms of acute coronary syndrome.

Objectives:This study was conducted to evaluate the diagnostic and prognostic value of B-type natriuretic peptide (BNP) in different categories of acute coronary syndrome (ACS) patients on arrival.Methods:This cohort study included 197 patients admitted in Coronary Care Unit (CCU) of Rehman Medical Institute (RMI) Peshawar from January 2020 to June 2020. Patients were categorized in two subgroups. Subgroup-I with BNP below 100pg/mL. Subgroup-II having BNP above 100pg/mL. Samples were obtained on admission from these patients for Cardiac Troponin I (Trop-i), BNP and serum creatinine. BNP samples were analyzed on Cobas® using chemiluminescence method. Descriptive statistics were derived for age; gender and cardiac biomarkers. Receiver-operating characteristic curves (ROC) were generated. Diagnostic accuracy parameters were determined for Non ST- segment elevation myocardial infarction (STEMI), ST- segment elevation myocardial infarction (STEMI) and unstable angina (UA).Result:One hundred fourteen patients (58.2%) were males and 82 were females (41.8%).Our of this 89 patients were NSTEMI in group II. Mean BNP was 1438±1463.Age distribution shows 120 individuals were over 55 years (61.2%). Hypertension, diabetes, smoking and previous infarcts were the risk factors for ACS. Sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive value (NPV), likelihood ratios, and overall accuracy of BNP at admission for the entire sub categories in ACS (cut-off value 100 pg/mL) were determined by using Trop-i the gold standard. ROC curve showed AUC = 0.557, (95% confidence interval: 0.476–0.638). When Pearson correlation was applied, BNP was found to be a noteworthy independent predictor.Conclusion:BNP can be a useful Biomarker along with standard cardiac biomarkers in various categories of patients with ACS.

Abstract 9442: Acute Coronary Syndrome Treatment Delay in Low to Middle-Income Countries: A Systematic Review

Introduction: Although morbidity and mortality rates are declining for acute coronary syndrome (ACS) in most high-income countries, it is rising at an alarming pace for low to middle-income countries (LMICs), largely due to pre-hospital treatment delays. Purpose: This systematic review was conducted to determine the mean length of time from symptom onset to treatment in LMICs and the sociodemographic, clinical, and health system characteristics that contribute to treatment delays. Methods: A comprehensive review of the English literature was conducted between January 1990 through May 2020 using predefined criteria. Time to treatment was defined from ACS symptom onset to first medical contact and then further dichotomized as less than (early) or greater than 12-hours (late) treatment. Twenty-nine peer-reviewed studies, which comprised 29,731 subjects with ACS symptoms residing in 14 LMICs. Sample sizes in the studies ranged from 50 to 20,937. Age ranged from 28-72 years and the majority were males. The Newcastle-Ottawa Assessment Scale was utilized to measure study quality. Results: The mean time from symptom onset to first medical contact was 12.7 hours, ranging from10-minutes to 96 hours. Being older age, female gender, illiterate, rural residence, having atypical chest pain and lack of ACS symptom knowledge were associated with longer delays. Those directly admitted to an emergency department with the capacity to provide coronary interventions received earlier treatment. Community facilities where ECG machines were available had lower prehospital delay time for referral to reperfusion therapy facilities. Lack of emergency medical systems, poor communication between the community and interventional facilities were also major contributors to ACS treatment delays. Conclusions: Pre-hospital delay time remains an important contributor to poorer clinical outcomes and higher mortality in LMICs. Country-wide referral plans are urgently needed to ensure timely transfer of patients from non-cardiac centers to interventional facilities. Health education through the different media outlets will raise awareness of ACS risk factors, accompanying signs and symptoms as well as the need to seek early treatment to improve clinical outcomes.

Association of total bilirubin levels with acute coronary syndrome and other risk factors: an observational study

Background: Acute coronary syndrome (ACS) refers to clinical symptoms pertaining to acute myocardial infarction. Bilirubin is an antioxidant that helps in removal of excessive heme. The aim of the study was to find the association of ACS and other risk factors for ACS with the total bilirubin levels in our setup.Methods: A cross sectional observational study was conducted on 100 cases attending the department of medicine in a Dr. Panjabrao Deshmukh Memorial Medical College, Amravati, Maharashtra. Patients fitting the eligibility criteria were subjected to data collection which was done using pre-designed case record form. The case record form had details of demography, detailed clinical history, physical examination and relevant investigations.Results: The mean age of the cases was 55.64±10.23 years with male preponderance. Majority of the patients presented with chest pain (83%) followed by shortness of breath (65%) and nausea/vomiting (33%). There was moderate significant correlation between total bilirubin levels and LDL levels (r=0.703; p value&lt;0.001) and There was mild significant correlation between total bilirubin levels and TGs (r=0.403, p value&lt;0.001) Based on the median value of 0.48 as cut off, 33% had bilirubin levels more than 0.48. Presence of diabetes and hyperlipidemias had significant association with the total bilirubin levels.Conclusions: Nearly 1/3rd of the patients in our study had high bilirubin levels. Higher bilirubin levels correlated well with presence of diabetes and presence of hyperlipidemias. There was significant correlation between the serum LDL and TG levels with total bilirubin levels in the present study.

Risk factor distribution features and trends of young adults with first acute coronary syndrome

Objective: To observe the characteristics and trends during the last 11 years of risk factors of young adults with first acute coronary syndrome (ACS). Methods: It was a cross-sectional study. We included young adults (18 to 44 years old) hospitalized for acute coronary syndrome in Beijing Anzhen Hospital for a first time from January 2007 to December 2017. Acute coronary syndromes include ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), and unstable angina (UA). The general information, medical history and laboratory test were recorded. Risk factors of ACS were smoking, dyslipidemia, overweight/obesity, hypertension and diabetes. Results: Data from 7 106 patients were analyzed, mean age was (39.8±4.2) years old and 6 593(92.8%)were men, including 2 254 (31.7%) STEMI, 704 (9.9%) NSTEMI and 4 148 (58.4%) UA. Most patients were male (6 593(92.8%)). Dyslipidemia (85.8%(6 094/7 106)), overweight/obesity (82.3%(5 850/7 106)), and smoking (63.9%(4 545/7 106)) were most prevalent. 98.3% (6 885/7 106) patients had at least 1 risk factor. The prevalence of hypertension, diabetes and overweight/obesity increased from 2007 to 2017. Rates of hypertension increased from 37.1%(111/299) to 48.1%(498/1 035) (Ptrend<0.01), diabetes from 12.0%(36/299) to 19.4%(201/1 035) (Ptrend<0.01), overweight/obesity from 74.2%(222/299) to 83.9%(868/1 035) (Ptrend<0.05), respectively. Conclusions: Dyslipidemia, overweight/obesity and smoking are most prevalent risk factors in young adults with a first ACS and most patients have at least 1 risk factor for ACS. Rates of hypertension, diabetes and overweight/obesity progressively increases over time in this patient cohort.

Influence of risk factors on in-hospital outcomes in women presenting with acute coronary syndrome in a tertiary care center

ObjectiveThe aim of this study is to assess the influence of risk factors on in-hospital outcomes in women presenting with acute coronary syndrome.BackgroundCardiovascular disease is the cause of death in 55% of women compared with 43% of men. Acute coronary syndrome risk factors increase the likelihood of disease. Clinical research studies have demonstrated that effective risk factor reduction results in decreases in acute coronary syndrome morbidity and mortality.Patients and methodsThis is a cross-sectional study in which data were collected from September 2015 to September 2016. The study included 207 patients admitted in Cardiology Department, National Heart Institute, Egypt, chosen by simple random sample technique. A case record form was used that included modifiable and nonmodifiable risk factors, physical findings, investigations, diagnosis, interventional procedures, and in-hospital outcome.ResultsIn this study, it was noticed that left ventricular (LV) dysfunction was the most frequent outcome: 13% for moderate reduction in LV function and 6% for severe reduction. Overall, 53.6% of those who developed mild to moderate LV dysfunction and 69.2% of those with severe LV dysfunction were diabetics. There was no statistically significant difference regarding death between ST-elevation myocardial infarction and non-ST-elevation myocardial infarction. There is a significant association between death and positive family history of ischemic heart disease (P = 0.05).ConclusionThe results of this study have demonstrated that there was a significant association between death and positive family history of ischemic heart disease (P = 0.05).

Abstract 13550: Understanding Associations of Hospital Admission or Observation With Patient Outcomes After Emergency Department Evaluation for Suspected Acute Coronary Syndrome

Introduction: Evaluation for suspected acute coronary syndrome (ACS) results in millions of emergency department (ED) visits annually, and accounts for billions in health care costs. Understanding the benefits of hospitalization among patients who ruled out for an acute myocardial infarction (AMI) will inform physician decision making and future health care policies. Hypothesis: Hospital admission does not improve 30-day patient outcomes (death/AMI) compared to those discharged after ED evaluation for suspected ACS. Methods: We compared the effectiveness of hospitalization vs outpatient follow-up for a cohort of patients with chest pain presenting to one of 13 EDs within the Kaiser Permanente Southern California region between January 1, 2015 and December 1, 2017. The primary outcome was AMI or all-cause mortality, and secondary outcomes included revascularization and a composite MACE outcome within 30-days of ED visit. Adjusting for patient age, gender, race, ACS risk factors and chronic co-morbidities an instrumental variable (IV) analysis was used to evaluate the effect of hospitalization on patient outcomes Results: Of 77,562 chest pain patient encounters not identified as an AMI during the ED encounter, 322 (0.4%) went on to have an AMI (n=193, 0.2%) or died (n=137, 0.2%) within 30-days of ED visit (1.5% admitted vs 0.2% discharged). This included 200 (0.3%) patients who underwent coronary revascularization (0.7% admitted vs 0.2% discharged). IV analysis found no adjusted differences in 30-day patient outcomes between the hospitalized cohort and those discharged (risk reduction 0.002, 95% CI -0.002 to 0.007). Similarly, there were no differences in coronary revascularization (risk reduction 0.003, 95% CI -0.002 to 0.007). Conclusions: Among ED patients with chest pain who are not identified with an AMI, there does not appear to be a benefit in 30-day outcomes for patients who are hospitalized compared to those discharged with outpatient follow-up.

Is rheumatoid arthritis a risk factor for acute coronary syndrome also among individuals at elevated risk, such as individuals presenting with acute chest pain?

BackgroundPatients with rheumatoid arthritis (RA) are, on average, at increased risk of acute coronary syndrome (ACS) compared to the general population, but it remains unknown whether RA remains an ACS...