Acute Coronary Syndrome Survivors Research Articles

Abstract 14: Post-Traumatic Stress Disorder Symptoms and Physical Activity Behavior After Hospitalization for Suspected Acute Coronary Syndromes

Background: An acute coronary syndrome (ACS) related event can induce post-traumatic stress disorder (PTSD), and post-ACS PTSD is associated with a greater risk for secondary clinical outcomes among ACS survivors. While moderate-vigorous physical activity (MVPA) has been shown to reduce the risk of adverse outcomes after ACS, its impact on PTSD symptoms remains largely unknown. There is a notable absence of empirical evidence, especially from large-scale observational cohort studies with device-based measures of physical activity, on this topic. Aim: To investigate the relationship between physical activity behaviors over the first month post-discharge with PTSD symptoms at one month among patients with suspected ACS. Methods: Patients (n = 434, 48.6% female, 62.6±12.4yrs) evaluated for ACS in the emergency department were fitted with a GENEActiv wrist accelerometer in-hospital and wore the device on their non-dominant wrist for 30 days post-discharge to measure MVPA. Presence and severity of PTSD symptoms were assessed at 1-month follow-up using the PCL-5. Multilevel structural equation modeling was used to simultaneously 1) fit a linear growth curve (GC) model to patients’ 30-day trajectories of MVPA and 2) predict total PTSD symptoms from a) mean daily MVPA, b) average daily change in MVPA (GC slope), and c) covariates (age, biological sex, education, and Charlson Comorbidity Index). Results: Patients engaged in an average of 20.8 (95% CI: 18.4, 23.3, p < 0.001) minutes of MVPA per day. MVPA levels increased at an average rate of 0.11 mins/day (95% CI: 0.05, 0.16, p < 0.001) over the 30 days post-discharge. There was substantial between-patient variability in both average MVPA minutes (SD = 26.0) and daily rate of change in MVPA minutes (SD = 0.38). The daily rate of change in MVPA was significantly associated with 1-month PTSD symptoms (β per 0.5 mins/day difference in daily rate of change in MVPA minutes = -4.5 points on the PCL-5; 95% CI: -6.5, -2.5, p < 0.001), controlling for the above-mentioned covariates. The association between average MVPA minutes and PCL-5 score was small and not statistically significant (β = 0.02; 95% CI: -0.04, 0.07, p = 0.60). Conclusion: PTSD symptoms appear to be mitigated in patients whose MVPA minutes increased over the 30 days post-discharge, whereas no evident association was observed between PTSD symptoms and average daily MVPA minutes. These findings suggest that progressively increasing MVPA by as little as .5 mins/day (i.e., ~1 SD above the mean rate of increase) within the immediate first month post-discharge, as opposed to maintaining a consistent daily average of MVPA, may impede the development of PTSD symptoms in ACS survivors.

Abstract 18923: Associations of Park Access With Physical Activity Levels During 1 Month Period After Acute Coronary Syndrome

Introduction: Physical activity (PA) is an important predictor of recovery after an acute coronary syndrome (ACS) event, and research has demonstrated the importance of neighborhood walkability on PA. Walkability is shaped by land use, density, and the development of parks and pedestrian spaces, which may be particularly important in urban areas. However, it is unclear whether discrete components of walkability, such as park access, independently impact PA levels in ACS survivors. The purpose of this study was to investigate how residential park proximity and percentage of park land use impact PA levels during the month following a suspected ACS event. Methods: This sample included patients (n=374, 49% female, 63 ± 11.9 y) who presented to the emergency department for suspected ACS. PA data (sedentary behavior [SB], light intensity [LPA], moderate-vigorous intensity [MVPA]) were collected using a wrist worn GENEActiv accelerometer for 30 days post-discharge. Park access was assessed using Geographic Information System and operationalized to include count of parks and percentage of land use covered by parks within a 1km radius area around each geocoded home address. Multiple linear regressions were conducted to determine the relationship between park access factors (count and land use), PA levels, and SB. Results: Models adjusted for demographics, comorbidities, and disease severity indicators (Grace risk score, length of hospitalization) found a statistically significant positive association between park land use and MVPA (B [95% CI]= 44.25 [4.55-83.94], p-value=0.029). Additionally, there was a statistically significant positive association between park count and SB (B [95% CI]= 1.97 [0.42-3.53], p-value=0.013). Conclusions: We found that residential park land use was positively associated with MVPA in the first month following suspected ACS. Additionally, there was a positive association between park count and SB. These findings suggest that greater park access in neighborhoods may play a significant role in activity levels during ACS recovery. Future research is needed to understand which aspects of urban park design/environment should be modified to enhance physical activity and reduce sedentary behavior in ACS survivors.

Abstract 18392: Sedentary Behavior and Risk of 1-Year Cardiac Events and Mortality After Suspected Acute Coronary Syndrome

Background: Patients hospitalized with acute coronary syndrome (ACS) remain at high risk for recurrent cardiac events in the first year after discharge, necessitating a need to identify modifiable targets to improve outcomes. While moderate-vigorous physical activity (MVPA) is a hallmark of secondary prevention in this population, sedentary behavior (SB) has emerged as a potentially unique aspect of the physical activity profile that may also have prognostic relevance. Yet little is known regarding whether SB confers risk independent from MVPA and what types of activity should be substituted for SB to impart health benefit among ACS patients in the first year after discharge. Aim: Examine the association between SB and risk of 1-year cardiac events and mortality among patients evaluated for ACS. Methods: Patients (n=609, 52% male, 62 ± 13 y) evaluated in the emergency room for ACS were fitted with a GENEActiv wrist accelerometer in-hospital and wore the device for 30 days post discharge to measure SB, light intensity physical activity (LIPA), MVPA, and sleep. Major adverse cardiovascular events 1-year post discharge were defined as the composite of unstable angina, myocardial infarction, or death. Results: Over follow up, 50 patients (8%) had a major adverse cardiovascular event. SB was associated with an increased risk of 1-year major adverse cardiovascular events after adjusting for demographic and disease severity indicators (HR per 1 h/d increase: 1.33, 95% CI: 1.12, 1.58). The association remained significant after adjusting for MVPA (HR per 1 h/d increase: 1.30, 95% CI: 1.06, 1.59). In isotemporal substitution analyses there were beneficial associations for replacing SB with sleep (per 30 min HR: 0.89, 95% CI: 0.81, 0.97), LIPA (per 30 min HR: 0.51, 95% CI: 0.34, 0.76), and MVPA (per 30 min HR: 0.32, 95% CI: 0.12, 0.85) on 1-year major adverse cardiovascular event risk. Conclusion: SB was associated with increased risk of 1-year cardiac events and mortality among patients evaluated for ACS, independent of MVPA. Replacing SB with sleep, LIPA, or MVPA was associated with lower risk. These findings suggest reducing SB may improve outcomes in ACS survivors and support the public health message that ACS patients should sit less and move or sleep more to mitigate risk.

Initial Implementation of the My Heart, My Life Program by the National Heart Foundation of Australia: Pilot Mixed Methods Evaluation Study.

Coronary heart disease (CHD) remains the leading cause of death in Australia, with a high residual risk of repeat events in survivors. Secondary prevention therapy is crucial for reducing the risk of both death and other major adverse cardiac events. The National Heart Foundation of Australia has developed a consumer-facing support program called My Heart, My Life (MHML) to address the gap in the secondary prevention of CHD in Australia. The MHML pilot program supplies advice and support for both patients and their caregivers, and it was conducted over 8 months from November 2019 to June 2020. This study aims to describe and examine the implementation of a novel multimodality secondary CHD prevention pilot program called MHML, which was delivered through booklets, text messages, emails, and telephone calls. This pilot study consists of a mixed methods evaluation involving surveys of participants (patients and caregivers) and health professionals, in-depth interviews, and digital communication (SMS text message, electronic direct mail, and call record analytics). This study was performed in people older than 18 years with acute coronary syndrome or angina and their caregivers in 38 Australian hospitals from November 2019 to June 2020 through the National Heart Foundation of Australia web page. The main outcome measures were reach, accessibility, feasibility, barriers, and enablers to implementation of this program. Of the 1004 participants (838 patients and 164 caregivers; 2 missing), 60.9% (608/1001) were males, 50.7% (491/967) were aged between 45 and 64 years, 27.4% (276/1004) were from disadvantaged areas, 2.5% (24/946) were from Aboriginal or Torres Strait Islander background, and 16.9% (170/1004) reported English as their second language. The participants (patients and their caregivers) and health professionals reported high satisfaction with the MHML program (55/62, 88.7% and 33/38, 87%, respectively). Of the 62 participants who took the survey, 88% (55/62) used the text messaging service and reported a very high level of satisfaction. Approximately 94% (58/62) and 89% (55/62) of the participants were satisfied with the quick guide booklets 1 and 2, respectively; 79% (49/62) were satisfied with the monthly email journey and 71% (44/62) were satisfied with the helpline calls. Most participants reported that the MHML program improved preventive behaviors, that is, 73% (45/62) of them reported that they maintained increased physical activity and 84% (52/62) reported that they maintained a healthy diet even after the MHML program. The findings of our pilot study suggest that a multimodal support program, including digital, print, phone, and web-based media, for the secondary prevention of CHD is useful and could be a potential means of providing customized at-scale secondary prevention support for survivors of acute coronary syndrome.

Abstract P327: Device-Measured Sedentary Behavior and Risk of 1-Year Hospital Readmission After Suspected Acute Coronary Syndrome

Background: Patients hospitalized with acute coronary syndrome (ACS) have an increased risk of a readmission during the first year after discharge; necessitating a need to identify modifiable therapeutic targets to improve outcomes. While moderate to vigorous physical activity (MVPA) has been a hallmark of secondary prevention efforts to prevent hospital readmission, sedentary behavior (SB) has emerged as a potentially unique and clinically important aspect of the physical activity profile. Yet, little is known regarding whether SB is associated with hospital readmission in ACS patients independent from or in addition to MVPA levels. Purpose: To examine the association between device-measured SB and risk of 1-year hospital readmission among patients evaluated for ACS, independent of MVPA. Methods: Patients (n=603, 47.8% female, 62.5±13.0 yrs) evaluated in the emergency department for ACS were fitted with a GENEActiv accelerometer in-hospital and were instructed to wear the device on their non-dominant wrist continuously in-hospital and for 30 days post-discharge. Hospital readmissions were ascertained by proactively searching medical records for any possible hospitalizations and by contacting participants or their closest contacts at 1- and 12-months follow-up; with supporting documentation secured from hospital medical records. Results: Over 1-year follow-up, 281 (46.6%) patients were readmitted. SB was associated with increased risk of 1-year hospital readmission after adjusting for socio-demographic factors, comorbidities, and disease severity indicators [HR per 1-hour per day increase in SB= 1.09, 95% CI: 1.01, 1.18]. The association remained significant after further adjusting for MVPA [HR per 1-hour per day increase in SB= 1.11, 95% CI: 1.02, 1.22]. In joint association analyses, high sedentary time in combination with low MVPA was associated with the greatest risk of 1-year hospital readmission in a fully adjusted model (HR: 2.18; 95%: CI: 1.44, 3.31) compared to the referent group (low SB/high MVPA). However, even among participants with higher levels of MVPA; high sedentary time was associated with a greater risk of 1-year re-hospitalization (HR: 1.54; 95% CI: 1.05, 2.27). For participants with low MVPA and low sedentary time, no significant association was observed (HR: 1.37; 95% CI: 0.84, 2.21). Conclusions: SB was associated with an increased risk of 1-year hospital readmission among patients evaluated for ACS. This increased risk was independent of MVPA and was not eliminated by high levels of MVPA. Implications of this study suggest that reducing SB should be considered as a modifiable therapeutic target in addition to MVPA to improve outcomes in ACS survivors.

Vitamin D deficiency in persons over 50 years of age with and without carotid artery atherosclerosis: a cross-sectional outpatient study

Highlights. The association between vitamin D levels and estimated glomerular filtration rate and triglyceride levels was revealed in people with cardiovascular risk factors aged older than 50 years. Vitamin D deficiency was more frequently noted in patients with acute coronary syndrome. They also were more likely to have abdominal obesity and type 2 diabetes mellitus, indicating the association between vitamin D deficiency and metabolic syndrome. The high prevalence of both vitamin D deficiency and metabolic syndrome in the population necessitates further larger-scale studies to identify the relationship between vitamin D levels and cardiovascular risk factors.Aim. To assess the level of vitamin D in people older than 50 years with the presence/ absence of carotid artery atherosclerosis.Methods. The single-stage observational study was conducted, the study included 70 outpatients over 50 years of age, of which 17 (24%) were men and 53 (76%) were women. The mean age of the patients was 66 (60; 72) years. All examined patients underwent history taking, anthropometry, biochemical examination of blood plasma with the determination of lipid spectrum, glucose, creatinine and estimated glomerular filtration rate, echocardiographic examination. The presence of carotid atherosclerosis was determined by ultrasound examination of the carotid arteries. The study of the level of 25-OH vitamin D in blood serum was carried out by enzyme immunoassay (25-OH vitamin D ELISA).Results. It was found that about half (46%) of the examined persons have insufficient levels of vitamin D in the blood plasma, while its deficiency (less than 20 ng/mL) was determined in 9% of patients. Individuals with carotid atherosclerosis had slightly lower levels of vitamin D than those without it, but the differences did not reach statistical significance. In acute coronary syndrome survivors, there was a statistically significant decrease in vitamin D levels, the vast majority of these patients had diabetes mellitus and abdominal obesity. Statistically significant moderate relationships were found between vitamin D levels and triglyceride levels (r = –0.33; p<0.05) and estimated glomerular filtration rate (r = 0.26; p<0.05), which confirms the association of vitamin D deficiency with metabolic syndrome. No statistical regularity was found between the level of vitamin D and other laboratory biochemical parameters, as well as morphological changes in the heart and blood vessels.Conclusion. Insufficient content of vitamin D in blood plasma is more common in individuals with a history of acute coronary syndrome, among them diabetes mellitus and abdominal obesity are more often detected, which confirms the relationship of vitamin D deficiency with metabolic syndrome.

Anticoagulation for Atrial Fibrillation in Acute Coronary Syndrome Survivors Reduces Major Cardiovascular Events and Mortality.

The prevalence of atrial fibrillation (AF) in acute coronary syndrome (ACS) patients is increasing. Data on outcomes of anticoagulation in ACS patients with AF are lacking. The aim of our study was to investigate the prevalence of stroke, myocardial infarction, bleeding complications, and all-cause mortality in this population. PL-ACS and AMI-PL registries gather an all-comer population of ACS patients in Poland, exceeding half a million records. We have selected ACS survivors with concomitant AF on admission, divided them into subgroups with regard to the administered anticoagulation, and followed up with them for a 12-month period ( n = 13,973). Subsequently, groups were propensity score matched for age, sex, ejection fraction, diabetes, heart failure, renal impairment, and type of ACS. The study population was divided with regard to the administration of anticoagulation. Anticoagulation was prescribed in 2,466 patients (17.6%). The (D)OAC+ patients were younger; however, comorbidities were more prevalent in this group. The 12-month follow-up showed that the (D)OAC+ patients had significantly lower rates of all-cause mortality, myocardial infarction, and ischemic stroke, with no significant increase in bleeding events. After matching, the study groups consisted of 2,194 patients each and showed no differences in baseline characteristics. The outcomes of the 12-month observation were similar to the findings before matching. This all-comer national registry analysis shows that the use of guideline-recommended therapy and anticoagulation in ACS survivors with AF is associated with a lower rate of all-cause mortality, recurrent myocardial infarction, and ischemic stroke.

ДИНАМИКА СМЕРТНОСТИ ОТ ИНФАРКТА МИОКАРДА В РОССИЙСКОЙ ФЕДЕРАЦИИ, СЕВЕРО-ЗАПАДНОМ ФЕДЕРАЛЬНОМ ОКРУГЕ И КАЛИНИНГРАДСКОЙ ОБЛАСТИ ЗА 10-ЛЕТНИЙ ПЕРИОД, С 2012 ПО 2021 Г.Г.

Significance. Among cardiovascular diseases, myocardial infarction is the most frequent cause of death in the majority of regions of the Russian Federation. Regional peculiarities of the cardiovascular condition development and clinical course have high impact on many aspects of its diagnosis and treatment. The purpose of the study: to determine patterns of mortality from myocardial infarction in the Russian Federation, the Northwestern Federal District and the Kaliningrad region in the period from 2012 to 2021. Material and methods. Mortality rates from myocardial infraction in the regions of the Northwestern Federal District over a 10-year period (2012 -2021) were analyzed and calculated based on data of the Unified Interdepartmental Information and Statistical System of the Russian Federation. Data calculations and graphical analysis were performed using the Microsoft Excel package of application programs. Results. The study has undertaken a comparative analysis of statistical indicators of myocardial infarction mortality in Russia as a whole and in the regions of the Northwestern Federal District, including the Kaliningrad region. Over ten years, from 2012 to 2021, the Russian Federation saw a stable reduction in the myocardial infarction mortality rates from 47.1 cases per 100 000 population in 2012 to 38.27 cases per 100 000 population in 2021. On average, mortality from myocardial infarction in the Northwestern Federal District is higher than in Russia as a whole during the period under study, there was a steady decline from 57.6 in 2012 to 42.48 per 100 000 population in 2021. Among the Northwestern Federal District regions, the highest mortality rate was registered in the Pskov region: on average, 58.32 per 100 000 population and in St. Petersburg: on average, 54.64 per 100 000 population over 10 years, while the lowest one - in the Kaliningrad region: on average, 25.38 per 100 000 population. In the Kaliningrad region, as well as in the whole Russian Federation, there is an increase in mortality from myocardial infarction registered in 2021, which is probably due to the COVID-19 epidemic. Conclusion. Since a high incidence of cardiovascular diseases and high mortality from myocardial infarction are mainly due to a low patient awareness, it is necessary to implement regional programs aimed at increasing public awareness of risk factors and symptoms of cardiovascular diseases, as well as long-term follow-up programs for acute coronary syndrome survivors. Scope of application. Comparative aspects of statistical indicators of mortality from myocardial infarction reflect effectiveness of primary and secondary prevention measures in patients with coronary atherosclerosis carried out in regional health care institutions and will contribute to better planning and implementation of regional programs aimed at reducing mortality from cardiovascular complications

Prognosis and antithrombotic practice patterns in recurrent and transient atrial fibrillation following acute coronary syndrome: a nationwide study

Abstract Background First-time detected atrial fibrillation (AF) during acute coronary syndrome (ACS) aggravates the prognosis and increases the risk of ischemic stroke. In this setting, AF may present as brief and transient or with recurrent episodes after discharge. However, data on the association between transient or recurrent AF and ischemic stroke in patients with ACS are sparse. Further, despite being associated with ischemic stroke, first-time detected AF patients have been reported with low oral anticoagulation (OAC) rates. Purpose To examine the associated rate of ischemic stroke and mortality in ACS survivors with transient or recurrent AF and to assess the antithrombotic practice patterns one year after ACS. Methods Using data from Danish nationwide registries, we identified all patients with first-time ACS, without known AF prior to ACS, from 2000–2017 who were alive one year after ACS discharge (index date). According to a grace period between ACS discharge and one year after ACS discharge, patients were categorized into: i) no AF; ii) first-time detected AF during ACS admission without AF recurrence (transient AF); and iii) first-time detected AF during ACS admission with a subsequent recurrent AF episode (recurrent AF). Patients who developed AF during the grace period were excluded. Patients were followed from one year post ACS discharge, and two-year rates of ischemic stroke and mortality were compared using multivariable adjusted Cox proportional hazards analysis. Further, we assessed the prescribed OAC rates in a three-month period following the index date. Results We included 116,793 patients surviving one year post ACS discharge: 111,708 (95.6%) without AF (64.9% male, median age 64 years), 2,671 (2.3%) with transient AF (58.0% male, median age 74 years), and 2,414 (2.1%) with recurrent AF (55.2% male, median age 76 years). The cumulative two-year incidence of ischemic stroke was 0.9%, 1.5%, and 2.3% for patients without AF, transient AF, and recurrent AF, respectively (Figure 1). The cumulative two-year incidence of mortality was 7.4%, 12.1%, and 20.3% for patients without AF, transient AF, and recurrent AF, respectively (Figure 1). Compared to those without AF, the adjusted two-year rates of outcomes were as follows: ischemic stroke: HR 1.15 (95% CI: 0.81–1.61) for patients with transient AF and HR 1.50 (95% CI: 1.14–1.98) for patients with recurrent AF; mortality: HR 0.98 (95% CI: 0.87–1.10) for patients with transient AF and HR 1.35 (95% CI: 1.23–1.49) for patients with recurrent AF (Figure). We identified that 20.9% for transient AF and 42.2% for recurrent AF were prescribed OAC therapy in the three-month period after one year. Conclusion In patients surviving one year after ACS with first-time detected AF, a recurrent AF episode was associated with an increased long-term rate of ischemic stroke and mortality, while transient AF yielded no statistically difference as compared with patients without AF. Funding Acknowledgement Type of funding sources: None.

“Just think of it as sexercise” – healthcare providers’ perceptions about sexual health education in cardiac rehabilitation programs

Purpose Sexual health education (SHE) is an important rehabilitation component for acute coronary syndrome (ACS) survivors but is not routinely provided. This study’s purpose was to explore healthcare providers’ experiences of providing SHE to ACS survivors in cardiac rehabilitation programs to identify best practices. Methods This qualitative study used convenience sampling and an interpretive descriptive design. Inclusion criteria were a healthcare provider employed within a cardiac rehabilitation program in a Western Canadian province. Eight cardiac rehabilitation healthcare providers volunteered to participate. The first author conducted semi-structured, digitally recorded interviews that were transcribed verbatim. The interviews were guided by a semi-structured interview guide anchored in the strengths-based, sex positive guiding frameworks. A reflective journal and socio-demographic forms served as additional data sources. Data were analyzed using open, axial, and selective coding as well as constant comparative analysis. Credibility was ensured through peer-reviewed evaluation criteria. Results Eight healthcare providers participated in the study. Participants equated sexuality and sexual health with physical activity and physical health. Findings identified philosophical perspectives and several barriers and facilitators that impact SHE provision. Participants offered strategies that may be used in practice and their recommendations provide a beginning foundation to improve cardiac rehabilitation programs and the health of ACS survivors. Conclusion Healthcare providers in cardiac rehabilitation programs described their SHE experiences as “just think of it as sexercise.” Facilitation of SHE is important as previous studies found that SHE may reduce fear, depression, and anxiety and increase the return to sexual activity among ACS survivors. IMPLICATIONS FOR REHABILITATION Sexual health doesn’t need to be a taboo topic. Approach sexual health conversations by thinking of it as “sexercise”. Don’t let silos stop sexual health education – talk to your coworkers and patients about sexual health. Knowledge about sexual health, timing of sexual health education, and communication between care providers and patients are important factors in delivery of sexual health education.

Incidence of ischaemic stroke and mortality in patients with acute coronary syndrome and first-time detected atrial fibrillation: a nationwide study.

The aim of this study was to examine contemporary data on the 1-year prognosis of patients surviving acute coronary syndrome (ACS) and concomitant first-time detected atrial fibrillation (AF). Using Danish nationwide registries, we identified all patients surviving a first-time admission with ACS from 2000 to 2018 and grouped them into (i) those without AF prior to or during ACS; (ii) those with a history of AF; and (iii) those with first-time detected AF during admission with ACS. With 1 year of follow-up, rates of ischaemic stroke, death, and bleeding were compared between study groups using multivariable adjusted Cox proportional hazards analysis. We included 161 266 ACS survivors: 135 878 (84.2%) without AF, 18 961 (11.8%) with history of AF, and 6427 (4.0%) with first-time detected AF at admission with ACS. Compared to those without AF, the adjusted 1-year rates of outcomes were as follows: ischaemic stroke [hazard ratio (HR) 1.38 (95% CI 1.22-1.56) for patients with history of AF and HR 1.67 (95% CI 1.38-2.01) for patients with first-time detected AF]; mortality [HR 1.25 (95% CI 1.21-1.31) for patients with history of AF and HR 1.52 (95% CI 1.43-1.62) for patients with first-time detected AF]; and bleeding [HR 1.22 (95% CI 1.14-1.30) for patients with history of AF and HR 1.28 (95% CI 1.15-1.43) for patients with first-time detected AF]. In patients with ACS, first-time detected AF appeared to be at least as strongly associated with the 1-year rates of ischaemic stroke, mortality, and bleeding as compared with patients with a history of AF.

Female sex as an independent predictor of high bleeding risk among East Asian percutaneous coronary intervention patients: A sex difference analysis

BackgroundSex differences in the outcomes following percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) have been identified in Western countries. However, data on the long-term outcomes for bleeding events, particularly in East Asia where the aging population is growing rapidly and consists predominantly of women, remain scarce. MethodsWe analyzed 2,494 ACS survivors from a multicenter PCI registry who underwent PCI between 2009 and 2012. The primary outcome was readmission for major bleeding at 2 years. Survival curves were generated with the cumulative incidence function. The adjusted hazard ratios were evaluated for the primary outcomes by sex using (1) Fine-Gray models and (2) Cox regression models. ResultsThere were 548 women (22.0%) in this cohort. The women were older (73.7 ± 10.8 years vs. 65.4 ± 11.8 years, p < 0.001), had a lower body mass index (23.0 ± 3.9 vs. 24.3 ± 3.6, p < 0.001), and had more comorbidities such as renal failure (49.4% vs. 36.3%, p < 0.001) and previous heart failure (8.4% vs. 4.5%, p < 0.001). Fewer women were discharged with statins (81.9% vs. 86.5%, p = 0.025) or beta blockers (70.6% vs. 77.1%, p = 0.007). During the 2-year follow-up, the unadjusted readmission rates for bleeding were higher among women (4.9% versus 2.4% at 2 years after discharge). Multivariable competing risk analysis with the Fine-Gray model and Cox regression model further demonstrated that female sex was associated with a higher risk of bleeding. ConclusionsAmong patients treated with PCI, women had a higher incidence of bleeding events requiring readmission. Sex disparities in the etiologies of readmission following PCI suggest the need for targeted treatment strategies. A strict follow-up after discharge could be beneficial for women to further reduce their risk.

Coronary stent technology and the role of inflammation in the atherogenesis: problems and prospects

Coronary artery disease (CAD) remains one of the leading causes of death in developed industrial countries. Timely and effective medical care for CAD patients depends on availability and application of endovascular methods for CAD treatment. Percutaneous coronary intervention (PCI) using drug- eluting stents allows to achieve good clinical results even in most severe patients. The issues of personalized invasive treatment for patients with chronic coronary syndrome and optimal prevention of recurrent clinical events in survivors of acute coronary syndrome and PCI remain relevant. One of most important and unresolved problems in the pathophysiology of CAD is assessment of the nature of the inflammatory reaction that develops in the coronary vessels and myocardium in response to ischemic damage and PCI. Clinical studies focused on exploring correlation between the pro-inflammatory parameters of the patient’s status and the rate of secondary adverse events and aimed at revealing triggers of systemic and local inflammation are of great interest. Such a trigger could be the intestinal endotoxin (ET) which is capable of inducing systemic inflammation and, therefore, plays a significant role in the atherogenesis. A relationship between the endotoxin and cytokine system parameters should be investigated to develop a therapeutic concept for supporting CAD patients, including individuals after PCI. Parameters of systemic endotoxemia could be used as additional factors in developing the biomarker-based approach to identify patients with active inflammation or fibrosis. This could result in development of specific therapy aimed at suppressing pro-inflammatory mediators and protecting the heart from inflammation.

Number of Antithrombotic Drugs Used Early and In-hospital Outcomes in Acute Coronary Syndromes.

Antithrombotic drug use for acute coronary syndromes (ACS) varies considerably. The number of antithrombotic drugs (excluding oral anticoagulants) used pre- and in-hospital was recorded in ACS survivors enrolled at hospital discharge in the long-tErm follow-uP of antithrombotic management patterns In acute CORonary syndrome patients (EPICOR) registry ( NCT01171404 ), a prospective cohort study. Among 10,568 patients, the number of antithrombotic drugs used early/patient ranged from 0 to 8 (interquartile range = 3-4). Overall, 250 patients (2.4%) experienced ≥ 1 in-hospital ischemic event and 343 (3.2%) ≥ 1 non-fatal bleeding event. While there was no difference in the rate of ischemic events (p = 0.75 for-trend) according to the number of antithrombotic drugs, a significantly higher incidence of non-fatal bleeds was observed (p < 0.0001 for-trend), with OR = 1.68 (95%CI = 1.51-1.88) per additional antithrombotic drug, which remained after adjustment by patient characteristics. In conclusion, careful balancing of the short-term risks for ischemic and bleeding events should be considered when adding new antithrombotic drugs.

Uptake of Secondary Prevention in Patients With ACS and LVEF≤40%

Survivors of Acute Coronary Syndrome (ACS) have increased risk of death, arrhythmias, heart failure, and repeat ACS, with the greatest risk to patients with left ventricular ejection fraction (LVEF) ≤40%. This research aimed to evaluate secondary prevention strategies for patients with ACS and LVEF ≤40% at discharge, at a tertiary referral hospital in Brisbane.

Risk factors for major adverse cardiovascular events after the first acute coronary syndrome

Aims To evaluate risk factors for major adverse cardiac event (MACE) after the first acute coronary syndrome (ACS) and to examine the prevalence of risk factors in post-ACS patients. Methods We used Finnish population-based myocardial infarction register, FINAMI, data from years 1993–2011 to identify survivors of first ACS (n = 12686), who were then followed up for recurrent events and all-cause mortality for three years. Finnish FINRISK risk factor surveys were used to determine the prevalence of risk factors (smoking, hyperlipidaemia, diabetes and blood pressure) in post-ACS patients (n = 199). Results Of the first ACS survivors, 48.4% had MACE within three years of their primary event, 17.0% were fatal. Diabetes (p = 4.4 × 10−7), heart failure (HF) during the first ACS attack hospitalization (p = 6.8 × 10−15), higher Charlson index (p = 1.56 × 10−19) and older age (p = .026) were associated with elevated risk for MACE in the three-year follow-up, and revascularization (p = .0036) was associated with reduced risk. Risk factor analyses showed that 23% of ACS survivors continued smoking and cholesterol levels were still high (>5mmol/l) in 24% although 86% of the patients were taking lipid lowering medication. Conclusion Diabetes, higher Charlson index and HF are the most important risk factors of MACE after the first ACS. Cardiovascular risk factor levels were still high among survivors of first ACS.

Lipid Management in Patients Presenting With Acute Coronary Syndromes: A Review.

Despite many improvements in its prevention and management, acute coronary syndrome (ACS) remains a major cause of morbidity and mortality in the developed world. Lipid management is an important part of secondary prevention after ACS, but many patients currently remain undertreated and do not attain guideline‐recommended levels of low‐density lipoprotein cholesterol reduction. This review details the current state of evidence on lipid management in patients presenting with ACS, provides directions for identification of patients who may benefit from early escalation of lipid‐lowering therapy, and discusses novel lipid‐lowering medication that is currently under investigation in clinical trials. Moreover, a treatment algorithm aimed at attaining guideline‐recommended low‐density lipoprotein cholesterol levels is proposed. Despite important advances in the initial treatment and secondary prevention of ACS, ≈20% of ACS survivors experience a subsequent ischemic cardiovascular event within 24 months, and 5‐year mortality ranges from 19% to 22%. Knowledge of the current state of evidence‐based lipid management after ACS is of paramount importance to improve outcomes after ACS.

Frailty Tools for Assessment of Long-term Prognosis After Acute Coronary Syndrome.

ObjectiveTo evaluate the 5 components of the Fried frailty phenotype (self-reported unintentional weight loss, physical activity questionnaire, gait speed, grip strength, and self-reported exhaustion) for long-term outcomes in elderly survivors of acute coronary syndrome.MethodsA total of 342 consecutive patients (from October 1, 2010, to February 1, 2012) were included. The 5 components of the Fried score and albumin concentration, as malnutrition index, were assessed before hospital discharge. Patients were followed up until April 2020 (median follow-up, 8.7 years). The end point was postdischarge all-cause mortality.ResultsMean ± SD age was 77±7 years and mean ± SD Fried score was 2.0±1.1 points. A total of 216 (63%) patients died. After adjusting for clinical covariates, the Fried phenotype was associated with mortality (per points, hazard ratio [HR], 1.35; 95% CI, 1.17 to 1.57; P<.001). Among Fried components, physical activity (HR, 2.21; 95% CI, 1.34 to 3.65; P=.002) and gait speed (HR, 1.77; 95% CI, 1.29 to 2.43; P<.001) were the deficits independendtly associated with mortality. Albumin level provided further prognostic information (per increase in g/dL; HR, 0.63, 95% CI, 0.45 to 0.88; P=.007). The model adding the components of the Fried score and albumin level to the clinical model showed the highest risk reclassification (integrated discrimination improvement, 0.040; 95% CI, 0.018 to 0.075; P=.001; continuous net reclassification improvement, 0.291; 95% CI, 0.132 to 0.397; P=.001) in comparison with the model using clinical covariates alone.ConclusionFrailty assessment using the Fried phenotype has prognostic value for long-term mortality in elderly survivors of acute coronary syndrome. Physical activity and gait speed are the predictive components of the Fried score. Albumin level provides incremental prognostic information.

Abstract 13152: Do Survivors of Acute Coronary Syndrome Due to Unprotected Left Main Coronary Artery Occlusion Treated With Extracorporeal Membrane Oxygenation Have Higher Mortality in Chronic Phase?

Introduction: Mortality in patients with acute coronary syndrome (ACS) due to unprotected left main coronary artery (LMA) occlusion is high. Extracorporeal membrane oxygenation (ECMO) could rapidly provide circulatory support. Hypothesis: This study aimed to verify the hypotheses that the patient who required circulatory support with ECMO in acute phase of LMA-ACS had greater cardiac function deterioration and had higher mortality in the chronic phase than those who did not require ECMO. Methods: Patients with LMA-ACS who underwent percutaneous coronary revascularization between 2000 and 2020 were enrolled in this study. The patients were divided into two groups based on whether or not they received ECMO. Thirty-day (acute phase) and 30-day to 6-year (chronic phase) survival curves were constructed by Kaplan-Meier method. The cause of death in acute and chronic phase were examined. Results: Among the 85 study patients, 23 (27%) were in the ECMO-group. Median age was younger in the ECMO-group (65 y [57 - 72] vs. 73 y [69 - 83], p &amp;lt; 0.01), and male sex (67% vs. 63%) were similar in ECMO group and non-ECMO groups respectively. The prevalence of ST elevation myocardial infarction (STEMI), non-STEMI, unstable angina were 52%, 48%, and 0% vs. 15%, 42%, and 44% in the ECMO group and non-ECMO group, respectively. The 30-day mortality was significantly higher in ECMO group (61% vs. 15%, p &amp;lt; 0.01); however, the 30-day to 6-year mortality was similar between the two groups (41% vs. 33%, p = 0.59) (Figure). The cause of death in the acute phase were cardiac failure (79% and 67%) and those in chronic phase were cardiac failure (50% and 25%), malignancy (0% and 13%), and infection (50% and 36%). Conclusions: The mortality in chronic phase in LMA-ACS patients who survived up to 30 days were similar in ECMO group and non-ECMO group. Moreover the patients whose cardiac function deteriorated severely and required ECMO in acute phase had similar prognosis to those that did not require ECMO.

Impact of cardiac rehabilitation on 3 year outcomes amongst patients after acute coronary syndrome: (ACS) SNAPSHOT ACS follow-up study

Abstract Background Cardiovascular disease is the leading cause of disease burden globally. With advancements in medical and surgical care more people are surviving initial acute coronary syndrome (ACS) and are in need of secondary prevention and cardiac rehabilitation (CR). Increasing availability of high quality individual-level data linkage provides robust estimates of outcomes long-term. Purpose To compare 3 year outcomes amongst ACS survivors who did and did not participate in Australian CR programs. Methods SNAPSHOT ACS follow-up study included 1806 patients admitted to 232 hospitals who were followed-up by data linkage (cross-jurisdictional morbidity, national death index, Pharmaceutical Benefit Schedule) at 6 and 36 months to compare those who did/not attend CR. Results In total, the cohort had a mean age of 65.8 (13.4) years, 60% were male, only 25% (461/1806) attended CR. During index admission, attendees were more likely to have had PCI (39% v 14%, p&amp;lt;0.001), CABG (11% v 2%, p&amp;lt;0.001) and a diagnosis of STEMI (21% v 5%, p&amp;lt;0.001) than those who did not attend. However, there was no significant difference between CR attendees/non-attendees for risk factors (LDL-cholesterol, smoking, obesity). Only 19% of eligible women attended CR compared to 30% of men (p&amp;lt;0.001). At 36 months, there were fewer deaths amongst CR attendees (19/461, 4.1%) than non-attendees (116/1345, 8.6%) (p=0.001). CR attendees were more likely to have repeat ACS, PCI, CABG at both 6 and 36 months (Table). At 36 months, CR attendees were more likely to have been prescribed antiplatelets (78% v 53%, p&amp;lt;0.001), statins (91% 73%, p&amp;lt;0.001), beta-blockers (11% v 13%, p=0.002) and ACEI/ARBs (72% v 61%, p&amp;lt;0.001) than non-attendees. Conclusions Amongst Australian ACS survivors, participation in CR was associated with less likelihood of death and increased prescription of pharmacotherapy. However, attendance at CR was associated with higher rates of repeat ACS and revascularisation. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): New South Wales Cardiovascular Research Network, National Heart Foundation