Type Of Acute Coronary Syndrome Research Articles

The influence of perceived stress in acute coronary syndromes presentation

Abstract Funding Acknowledgements None. Introduction Acute coronary syndrome (ACS) is the result of a complex pathophysiological process, influenced by multiple factors, including stress. The 10-item Perceived Stress Scale (PSS-10) is a validated instrument to estimate stress levels in clinical practice and may be useful in the assessment of ACS (Figure 1). Purpose We aimed to assess if perceived stress had influence on the presentation of an ACS as a ST-elevation myocardial infarction (STEMI) or a non-ST-elevation myocardial infarction (NSTEMI), at admission, during hospitalization for this event, and at follow-up. Methods Single-center prospective study engaging patients hospitalized for ACS from 20/03/2019 to 31/03/2020. The PSS-10 was completed during the hospitalization period. Patients were divided into two groups, according to the type of ACS: group A – STEMI patients - and group B - NSTEMI patients. Follow-up of these patients (regarding death, readmissions for cardiac causes and readmissions for other causes) was carried out until December 11, 2022. Logistic regression was performed to assess if stress was a predictor of NSTEMI. Results A total of 166 patients were included: 52 in group A and 94 in group B. In group A, mean age was 63 ± 18 years and 34.60% were women, while in group B mean age was 66 ± 20 years, and 38.70% were female. Group B presented more with preserved ejection fraction (79.30% vs 60.40% in group A, p=0.018). There were no other statistically significant differences regarding clinical presentation, or intrahospital complications between the two groups. PSS-10 score in group A was 17.17 ± 8.62, while group B scored 20.83 ± 6.10 (p=0.039). The follow-up of these two groups did not show significant differences in terms of death (7.70% in group A vs 16.10% in group B, p=0.149), readmissions for other causes (19.20% in group A vs 28.00% in group B, p=0.243) or readmissions for cardiac causes (group A 9.60% and group B 22.60%, p=0.051). Logistic regression revealed that perceived stress was a predictor of NSTEMI (odds ratio (OR) 1.006, p=0.025, confidence interval (CI) 1.001-1.011). There were no statistically significant differences in follow-up between the two groups. Conclusions This is the first prospective study carried out in the Portuguese population regarding this thematic, which showed that perceived stress was a predictor of NSTEMI and can influence patients with ACS manifestations.Figure 1

Clinical, Demographic, and Angiographic Profiles of Amarnath Pilgrims Presenting With Acute Coronary Syndrome.

The challenges posed by high altitude are particularly significant in terms of cardiovascular health. There are currently no data available on acute coronary syndrome (ACS) among Amarnath pilgrims. The objective of this study was to investigate the clinical and angiographic profiles of ACS among Amarnath pilgrims, focusing on demographic characteristics, risk factors, types of ACS, clinical presentation, angiographic findings, and in-hospital outcomes. By examining these aspects, we aimed to provide insights into the unique challenges faced by pilgrims during their spiritual journey and to identify potential strategies for improving the prevention and management of ACS in this population. Methods: This was a hospital-based, prospective, observational study that included patients who had participated in the pilgrimage and presented with ACS between 2022 and 2023. Results: Sixty patients were recruited for the study, with a mean age of 51.19 ± 11.17 years. Of these, 43 (71.7%) were male. Risk factors identified in the study included hypertension in 35 (58.3%), smoking in 23 (38.3%), diabetes mellitus in 18 (30%), and dyslipidemia in 25 (41.6%) patients. ST-elevation myocardial infarction (STEMI) was present in 46 (76.66%) patients, Anterior wall myocardial infarction (AWMI) occurred in 29 (48.3%), inferior wall myocardial infarction (IWMI) in 15 (25%), and high lateral wall myocardial infarction (HLWMI) in two (3.3%) patients. Of the 60 patients, 19 (31.6%) were in Killip class I, 16 (26.6%) were in class II, and 25 (41.6%) were in classes III or IV. The average time from the onset of symptoms to hospitalization was 7.6 ± 3.1 hours, significantly higher in those with Killip class III or IV (9.3 ± 3.6 vs. 5.4 ± 2.7 hours, p = 0.01). There were nine (15%) in-hospital deaths, and in the multivariate analysis, advanced Killip class (p = 0.04) and delays in hospitalization of more than six hours (p = 0.03) were found to be significant predictors of mortality. In conclusion, 40% of patients presented in the advanced Killip class, and 15% experienced in-hospital mortality. The average time from the onset of symptoms to hospitalization was significantly higher for those categorized in the advanced Killip classes. Our study highlights a significant association between advanced Killip class, delay in hospitalization, and in-hospital mortality among Amarnath pilgrims with ACS, underscoring the importance of timely intervention. It is recommended that appropriate measures be taken to improve patient outcomes in these cases.

Outcomes of Patients with Normal LDL-Cholesterol at Admission for Acute Coronary Syndromes: Lower Is Not Always Better.

There are few prospective data on the prognostic value of normal admission low-density lipoprotein cholesterol (LDL-C) in statin-naïve patients with acute coronary syndromes (ACS) who are treated with a preemptive invasive strategy. We aimed to analyze the proportion of patients with normal LDL-C at admission for ACS in our practice, and their characteristics and clinical outcomes in comparison to patients with high admission LDL-C. Two institutions' prospective registries of patients with confirmed ACS from Jan 2017 to Jan 2023 were used to identify 1579 statin-naïve patients with no history of prior coronary artery disease (CAD), and with available LDL-C admission results, relevant clinical and procedural data, and short- and long-term follow-up data. Normal LDL-C at admission was defined as lower than 2.6 mmol/L. All demographic, clinical, procedural, and follow-up data were compared between patients with normal LDL-C and patients with a high LDL-C level (≥2.6 mmol/L) at admission. There were 242 (15%) patients with normal LDL-C at admission. In comparison to patients with high LDL-cholesterol at admission, they were significantly older (median 67 vs. 62 years) with worse renal function, had significantly more cases of diabetes mellitus (DM) (26% vs. 17%), peripheral artery disease (PAD) (14% vs. 9%), chronic obstructive pulmonary disease (COPD) (8% vs. 2%), and psychological disorders requiring medical attention (19% vs. 10%). There were no significant differences in clinical type of ACS. Complexity of CAD estimated by coronary angiography was similar between the two groups (median Syntax score 12 for both groups). There were no significant differences in rates of complete revascularization (67% vs. 72%). Patients with normal LDL-C had significantly lower left ventricular ejection fraction (LVEF) at discharge (median LVEF 52% vs. 55%). Patients with normal LDL-C at admission had both significantly higher in-hospital mortality (5% vs. 2%, RR 2.07, 95% CI 1.08-3.96) and overall mortality during a median follow-up of 43 months (27% vs. 14%, RR 1.86, 95% CI 1.45-2.37). After adjusting for age, renal function, presence of diabetes mellitus, PAD, COPD, psychological disorders, BMI, and LVEF at discharge in a multivariate Cox regression analysis, normal LDL-C at admission remained significantly and independently associated with higher long-term mortality during follow-up (RR 1.48, 95% CI 1.05-2.09). A spontaneously normal LDL-C level at admission for ACS in statin-naïve patients was not rare and it was an independent risk factor for both substantially higher in-hospital mortality and mortality during long-term follow-up. Patients with normal LDL-C and otherwise high total cardiovascular risk scores should be detected early and treated with optimal medical therapy. However, additional research is needed to reveal all the missing pieces in their survival puzzle after ACS-beyond coronary anatomy, PCI optimization, numerical LDL-C levels, and statin therapy.

Free triiodothyronine to free thyroxine ratio as a marker of poor prognosis in euthyroid patients with acute coronary syndrome and diabetes after percutaneous coronary intervention.

In recent years, the free triiodothyronine/free thyroxine (FT3/FT4) ratio, a new comprehensive index for evaluating thyroid function, which could reflect thyroid function more stably and truly than serum thyroid hormone level, has been demonstrated to correlate with the risks of diabetes and cardiovascular disease in euthyroid adults. However, the correlation between thyroid hormone sensitivity and long-term prognosis in euthyroid patients with acute coronary syndrome (ACS) and diabetes after percutaneous coronary intervention (PCI) remains unclear. A total of 1,786 euthyroid patients with ACS who successfully underwent PCI at Beijing Anzhen Hospital from August 2021 to April 2022 were included in our study, which was divided into three groups according to tertiles of thyroid hormone sensitivity index. Cox regression, Kaplan-Meier, and receiver operating characteristic analyses were applied to analyze the associations between the FT3/FT4 ratio with ACS and diabetes after PCI. Our analysis indicated that a lower level of FT3/FT4 ratio in euthyroid patients with acute coronary syndrome (ACS) and diabetes after PCI showed significantly higher incidences of major adverse cardiac and cerebrovascular events (MACCE) when compared with a higher level of FT3/FT4 ratio. After adjusting for other covariates, patients with a lower level of FT3/FT4 ratio were negatively associated with the risk of MACCE than those with a higher level of FT3/FT4 ratio (adjusted OR =1.61, 95% CI 1.05-2.47, P = 0.028). In subgroup analyses, individuals were stratified by age, sex, BMI, ACS type, hypertension, and dyslipidemia, showing that there were no significant interactions between the FT3/FT4 ratio and all subgroups for MACCE. In addition, the FT3/FT4 ratio performed better on ROC analyses for cardiac death prediction [area under the curve (AUC), 0.738]. A reduced level of FT3/FT4 ratio was a potential marker of poor prognosis in euthyroid patients with ACS and diabetes after PCI.

Immediate Versus Staged Complete Revascularization in Patients With Acute Coronary Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

A strategy of complete revascularization (CR) is recommended in patients with acute coronary syndrome (ACS) and multivessel disease (MVD). However, the optimal timing of CR remains equivocal. We searched MEDLINE, Embase, the Cochrane Library, and ClinicalTrials.gov for randomized controlled trials (RCTs) comparing immediate CR (ICR) with staged CR (SCR) in patients with ACS and MVD. Our primary outcomes were all-cause and cardiovascular mortality. All outcomes were assessed at three time points: in-hospital or at 30 days, at 6 months-1 year, and at > 1 year. Data were pooled in RevMan 5.4 using risk ratio (RR) as the effect measure. A total of 9 RCTs (7506 patients) were included in our review. Seven trials enrolled ST-segment elevation myocardial infarction (STEMI) patients, one enrolled non-STEMI patients only, and one enrolled patients with all types of ACS. There was no difference between ICR and SCR regarding all-cause and cardiovascular mortality at any time window. ICR reduced the rate of myocardial infarction (MI) and decreased the rate of repeat revascularization at 6 months and beyond. The rates of cerebrovascular events and stent thrombosis were similar between the two groups. In conclusion, the current meta-analysis demonstrated a lower rate of MI and a reduction in repeat revascularization at and after 6 months with ICR strategy in patients with mainly STEMI and MVD. The two groups had no difference in the risk of all-cause and cardiovascular mortality. Further RCTs are needed to provide more definitive conclusions and investigate complete revascularization strategies in other ACS.

Correlation of neutrophil to lymphocyte ratio to severity of coronary artery disease and in-hospital clinical outcomes in patients with acute coronary syndrome: A prospective observational study

Objective: To explore correlation of neutrophil-to-lymphocyte ratio (NLR) to severity of coronary artery disease (CAD) and in-hospital clinical outcomes in patients with acute coronary syndrome (ACS). Methods: In this prospective and observational study, we recruited 500 patients with ACS. For all the eligible patients, demographic details were collected, and laboratory parameters were evaluated. The CAD severity was evaluated in terms of the number of involved vessels. The NLR was calculated based on neutrophils and lymphocytes and the correlation of various risk factors and severity and outcome of CAD was performed. Results: 77.2% of Patients was male, and 52% of the patients aged between 55-70 years. Based on the type of ACS, 396 out of 500 patients had ST-elevation myocardial infarction. An ascending trend in the white blood cell levels and NLR value was noted as the severity of the ACS increased and the highest white blood cell levels and NLR was noted among class IV patients. The mean NLR value among the non-survivors were higher compared to the survivors (9.52±5.72 vs. 4.76±2.36; P<0.01). Receiver operating curve showed that the cut-off NLR value was 5.76 with a sensitivity of 75.0% and a specificity of 77.3%. Conclusions: The NLR can be used as an independent prognostic marker in ACS. An elevated NLR value serves as a reliable predictor for short-term complications, notably in-hospital mortality.

Improved heart function and cardiac remodelling following sacubitril/valsartan in acute coronary syndrome with HF.

This study sought to assess the effect of treatment of sacubitril/valsartan (S/V) on improving cardiac function and reversing cardiac remodelling in patients with acute coronary syndrome (ACS) complicated with heart failure with reduced ejection fraction after percutaneous coronary intervention (PCI). We enrolled 275 ACS patients with reduced left ventricular ejection fraction after PCI. The patients were divided into the routine and S/V groups according to the treatment drugs. The symptoms, N-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations, echocardiographic parameters [left ventricular ejection fraction (LVEF), left ventricular mass index (LVMI), left ventricular end-diastolic volume index (LVEDVI), and left ventricular end-systolic volume index (LVESVI)], major adverse cardiac events (MACEs), and adverse reactions were recorded at baseline and 6months after treatment when a clinical follow-up was performed. The S/V group was further divided into prespecified subgroups including unstable angina (UA) group, non-ST-elevation myocardial infarction (NSTEMI) group, and ST-elevation myocardial infarction (STEMI) group according to the type of ACS. We analysed the changes in LVEF, LVMI, LVEDVI, LVESVI, and NT-proBNP in both groups and evaluated the correlation between the changes in the above variables (ΔLVEF, ΔLVMI, ΔLVEDVI, ΔLVESVI, and ΔNT-proBNP). Cox regression model was used to assess the independent risk factors of MACE. Prespecified subgroup analyses were also conducted. Compared with baseline, LVEF increased significantly (P<0.05), NT-proBNP, LVMI, and LVESVI decreased significantly in both groups after 6months (P<0.05), and LVEDVI decreased significantly in the S/V group (P=0.001). In the S/V group, ΔLVEF (t=-2.745, P=0.006), ΔNT-proBNP (P=0.009), ΔLVEDVI (t=4.203, P=0.001), and ΔLVESVI (t=3.907, P=0.001) were significantly improved than those in the routine group. In the S/V group, ΔLVEF was negatively correlated with ΔNT-proBNP (r=-0.244, P=0.004), ΔLVMI (r=-0.190, P=0.028), ΔLVEDVI (r=-0.173, P=0.045), and ΔLVESVI (r=-0.261, P=0.002). In Cox regression model analysis,ΔLVEF {hazard ratio [HR]=0.87 [95% confidence interval (CI) 0.80-0.95], P=0.003}, ΔLVEDVI [HR=1.04 (95% CI 1.01-1.06), P=0.013], and ΔLVESVI [HR=1.04 (95% CI 1.01-1.08), P=0.026] were independent risk factors for MACE. Subgroup analysis showed that ΔLVEF (t=6.290, P=0.001), ΔLVEDVI (t=2.581, P=0.011), and ΔNT-proBNP (P=0.019) in the NSTEMI group were significantly improved than those in the UA group, ΔLVEDVI in the NSTEMI group was significantly better than that in the STEMI group (t=-3.365, P=0.001), and ΔLVEF in the STEMI group was significantly better than that in the UA group (t=-3.928, P=0.001). There was a significant difference in the survival probability without MACE among the three groups in the analysis of the Kaplan-Meier curve (P=0.042). The incidence of MACE in the UA group was significantly higher than that in the NSTEMI group (32.4% vs. 6.3%, P=0.004). The cardiac function is improved and cardiac remodelling is reversed significantly after treatment of S/V in ACS patients with reduced left ventricular ejection fraction after PCI, and the improvement is more obvious than the routine group. There is a significant negative correlation between the change in LVEF and the changes in NT-proBNP, LVMI, LVEDVI, and LVESVI. The increase of LVEF and the decrease of LVEDVI and LVESVI are protective factors to improve the prognosis. Patients with myocardial infarction and reduced left ventricular ejection fraction might benefit more from the initiation of S/V as first-line heart failure treatment after PCI.

Dengue Fever Presenting with Concomitant Acute Coronary Syndrome (ACS) - A Series of 5 Cases At A Tertiary Care Hospital In Dhaka

Dengue fever may present with many cardiovascular manifestations contributing to death and disability. Acute Coronary Syndrome (ACS) during dengue is rare but poses important management dilemma. Here we present a series of 5 patients with dengue fever who developed different types of ACS during the ongoing dengue endemic in Bangladesh. Five patients admitted with dengue fever and who developed ACS between 1st July to 30th September 2023 at Medicine Department of Uttara Adhunik Medical College, Dhaka, Bangladesh were studied. All the patients had some co[1]morbidity like diabetes, hypertension, or both. Treatment of ACS was tailored according to their CBC report, most importantly, platelet count, and hematocrit. Four out of the 5 patients responded well to anti-ischemic therapy, even though anti-platelet and anti-coagulants could not be given in all cases. There was 1 fatality, but that was due to ARDS consequent due to severe bilateral pneumonia. Management of ACS in dengue is challenging. Physicians should have appropriate preparedness to deal with these cases. J Bangladesh Coll Phys Surg 2023; 41: 82-87

Current treatment of acute coronary syndromes in cancer patients: the need for improvement

Abstract Background Cancer patients can develop acute coronary syndromes (ACS) due to their oncological therapy exposure or shared risk factors between cancer and cardiovascular disease. Cancer patients have been reported to receive suboptimal treatment in this setting, with lower rates of coronary angiography and or primary percutaneous intervention, despite the clear benefit of these therapies in ACS. This disparity in the care of cancer patients can lead to worse cardiovascular outcomes. Purpose To describe the contemporary therapeutic approach in patients with a history of cancer or current cancer presenting with an acute coronary syndrome to a tertiary care cardiology hospital. Methods We performed an electronic chart review of patients admitted to the cardiac intensive coronary unit of a tertiary care Cardiology hospital in our city, from May 2021 to February 2023. Patients with a current or historical diagnosis of cancer and acute coronary syndrome (with and without ST segment elevation) were identified. We collected the following information: demographic data, oncological diagnosis, cancer treatment history, ACS type, and ACS management. Results Seventy-five patients had diagnosis of current or historical cancer in the selected period. Of them, 40 patients were admitted with diagnosis of acute coronary syndrome. Mean age was 69.8 + 10.0 years. Twenty-one patients (52.5%) had a historical diagnosis of cancer and nineteen patients had diagnosis of current cancer. Of patients with historical cancer the most common type was hematological, followed by prostate and renal cancer. The most common types of active malignancies were prostate, colon, and renal cancer. ST-segment elevation myocardial infarction (STEMI) was the most common type of ACS (27 patients). Notably, only half of the patients presenting with STEMI underwent primary percutaneous coronary intervention, four patients received fibrinolytic treatment, and one third of patients with STEMI did not receive reperfusion therapy. Among patients with STEMI, mean time from symptom onset to reperfusion therapy was 495 minutes. Regarding the 13 patients presenting with non-ST-segment elevation myocardial infarction (NSTEMI), eight underwent an invasive strategy (coronary angiography) in the first 48 hours, of whom six had percutaneous coronary intervention, and one underwent coronary artery bypass graft surgery. Five patients with NSTEMI (38.4%) did not undergo coronary angiography during their hospitalization. Conclusions Patients with active or historical cancer presenting with STEMI receive late reperfusion treatment and up to one out of three do not receive reperfusion therapy. An important proportion of cancer patients presenting with NSTEMI do not even undergo invasive strategy. It is imperative to provide optimal care of cancer patients presenting with ACS.

Systemic Coagulation Inflammation Index Associated With Bleeding in Acute Coronary Syndrome.

Assessment of the inflammatory component of acute coronary syndrome (ACS) and the degree of activation of the coagulation cascade may provide prognostic information. The systemic coagulation-inflammation index (SCI) assesses both inflammation and the coagulation system, and it has also been found to be associated with clinical outcomes. We investigated the relationship between SCI and in-hospital clinical events (acute kidney injury, cardiogenic shock, life-threatening arrhythmia, bleeding) and mortality. The study included 396 patients aged ≥18 yrs who were hospitalized with a diagnosis of ACS. The SCI was calculated using the formula: platelet count (103 / µl) X fibrinogen (g / l) / white blood cell (WBC) count (103 / µl). Patients were divided into two groups according to whether their SCI score was &gt;100 or &lt;100, and the relationship between clinical and laboratory characteristics was analyzed accordingly. The mean age of the patients was 61.4±12.2 years and 78.3 % (n=310) were male. The type of ACS was NSTEMI in 56.1 % (n=222). The responsible vessel was the left anterior descending artery (LAD) in 42.4 % of the patients (n=168). The mean SCI score was 97.5±47.1. WBC, neutrophil, and lymphocyte counts were higher in the SCI &lt;100 group, whereas fibrinogen, C-reactive protein, and platelet count were higher in the SCI &gt;100 group. Bleeding from any cause as an in-hospital complication was significantly higher in patients with SCI &gt;100 (p&lt;0.05). Other in-hospital events were not significantly associated with SCI (p&gt;0.05). Bleeding in ACS patients was significantly more common in the group with SCI &gt;100. Thus, SCI may be a useful parameter for predicting in-hospital bleeding complications in ACS. On the other hand, SCI was not associated with mortality and other in-hospital clinical events.

Abstract 14290: Prospective Clinical Validation of the STOPSHOCK Smartphone Application - Artificial Intelligence Model for Prediction of Cardiogenic Shock in Patients With Acute Coronary Syndrome

Background: Cardiogenic shock (CS) complicating acute coronary syndrome (ACS) is a life-threatening condition with mortality reaching 50% despite the use of mechanical circulatory support devices (MCS). It is hypothesized that early implantation of MCS before hemodynamic deterioration could prevent CS. For this purpose, we have developed and externally validated an AI model for CS prediction available as a smartphone application (STOPSHOCK app). Research question: Could the STOPSHOCK app identify ACS patients at high risk of CS development in contemporary clinical practice? Methods: The STOPSHOCK model was derived on a population of 3232 and validated on an external cohort of 5123 patients with high discrimination (c-statistics: 0.84 in external validation). The model was based on variables that were available at first medical contact. A dedicated app was developed to test the performance of the model in the clinical setting. 103 consecutive ACS patients were enrolled in intensive cardiac care units in 8 centers from USA, Europe, and Asia. Results: Heart rate, respiration rate, SpO2, blood glucose level, systolic BP, age, sex, shock index, heart rhythm, type of ACS, history of hypertension, congestive heart failure and hypercholesterolemia were used as input variables. Clinical outcome (presence of CS) was reported at hospital discharge. STOPSHOCK model had a c-statistics of 0.97. Conclusions: Our machine learning model for CS prediction in patients with ACS available at first medical contact showed high discrimination and feasibility in clinical settings as a smartphone app.

Abstract 15391: Five-Year Outcomes in Patients With Acute Coronary Syndrome and Myocardial Revascularization Treated With Prasugrel or Ticagrelor

Background: In patients with acute coronary syndrome (ACS) treated with coronary intervention, potent P2Y12 inhibitors are recommended for 1 year in addition to aspirin. The ISAR-REACT 5 (IR5) trial demonstrated superior efficacy of prasugrel over ticagrelor in reducing the composite of death, myocardial infarction (MI), and stroke at 1 year with comparable bleeding risk. However, long-term data on the relative efficacy of these drugs in real-world settings are lacking. Methods: We performed a comprehensive, retrospective cohort study based on German health insurance data. Patients with ACS who underwent percutaneous coronary intervention or coronary artery bypass graft surgery and received either prasugrel or ticagrelor were observed for 5 years. For 36,813 eligible patients, 1:1 propensity score matching was performed based on age, sex, risk factors and type of ACS. Primary endpoint was a composite of death, MI, or stroke. Safety outcome was bleeding. Results: After matching, 26,494 patients were included in the study. Mean age was 61.8 years, and 25,3% were female. The risk for the primary endpoint was lower in the prasugrel group compared with ticagrelor at 1 year (hazard ratio (HR): 0.79; 95% confidence interval (CI): 0,73-0.87), and 5 years (HR: 0.84; 95% CI: 0.79-0.89). Prasugrel was statistically superior in reducing individual components of the primary endpoint at 1 and 5 years, respectively. The risk of bleeding was lower in the prasugrel group, though not statistically significant. Conclusions: In patients with ACS, prasugrel was associated with a lower risk of the composite of death, MI or stroke, compared with ticagrelor over a 5-year period. While recognizing the limitations associated with secondary data, the strength of these findings lies in the extensive follow-up period involving a large ACS cohort in a real-world setting. The consistency of these results with the IR5 trial reinforces prasugrel's superiority over ticagrelor.

The state of the membrane potential of the mitochondria of blood leukocytes in acute coronary syndrome

Purpose: to assess the state of mitochondrial membrane potential of blood leukocytes in acute coronary syndrome (ACS) depending on the presence and absence of type 2 diabetes mellitus (T2DM).Material and Methods. The study involved 100 people hospitalized at the regional vascular center (RCC) of the Vladivostok Clinical Hospital No. 1 with a diagnosis of ACS, aged 35 to 65 years. The control group consisted of 30 apparently healthy volunteers of the same age and sex. At the time of admission, all patients underwent studies for the diagnosis of ACS, including an assessment of the content of troponin I (TrI), and the marker of the precursor of the cerebral natriuretic peptide (NTproBNP) and the membrane potential of mitochondria (MPM) of blood leukocytes were determined.Results. Indicators of the state MMP made it possible to assess the content of dead and living cells in the blood of the examined persons. An increase in non-viable leukocytes in the blood patients with all types of ACS, including myocardial infarction (MI) and unstable angina (UA), was established. A direct relationship was found between the increase in the number of these cells and the content of TrI in MI and a direct relationship between it and NTproBNP both in MI and NS. In patients with ACS, no significant difference was found between the MMP values of leukocytes depending on the presence of T2DM.Conclusion. An increase in the MPMP of blood leukocytes in patients accompanies of the redox balance disturbance in ACS. The established relationship between MPMP indices in MI and the content of TrI can be considered as a confirming fact of the participation of cells with mitochondrial dysfunction in the development of ischemic necrosis. The found relationship between the increase in blood leukocyte MPMP in patients with ACS and the level of NTproBNP indicates a certain contribution of mitochondrial dysfunction of leukocytes to the development of myocardial remodeling, regardless of the clinical form of ACS and the presence of DM2.

Cardiovascular Outcomes in Acute Coronary Syndrome and Malnutrition: A Meta-Analysis of Nutritional Assessment Tools

BackgroundThere is emerging evidence that malnutrition is associated with poor prognosis among patients with acute coronary syndrome (ACS). ObjectivesThis study seeks to elucidate the prognostic impact of malnutrition in patients with ACS and provide a quantitative review of most commonly used nutritional assessment tools. MethodsMedline and Embase were searched for studies reporting outcomes in patients with malnutrition and ACS. Nutritional screening tools of interest included the Prognostic Nutrition Index, Geriatric Nutritional Risk Index, and Controlling Nutritional Status. A comparative meta-analysis was used to estimate the risk of all-cause mortality and cardiovascular events based on the presence of malnutrition and stratified according to ACS type, ACS intervention, ethnicity, and income. ResultsThirty studies comprising 37,303 patients with ACS were included, of whom 33.5% had malnutrition. In the population with malnutrition, the pooled mortality rate was 20.59% (95% CI: 14.95%-27.67%). Malnutrition was significantly associated with all-cause mortality risk after adjusting for confounders including age and left ventricular ejection fraction (adjusted HR: 2.66, 95% CI: 1.78-3.96, P = 0.004). There was excess mortality in the group with malnutrition regardless of ACS type (P = 0.132), ethnicity (P = 0.245), and income status (P = 0.058). Subgroup analysis demonstrated no statistically significant difference in mortality risk between individuals with and without malnutrition (P = 0.499) when using Controlling Nutritional Status (OR: 7.80, 95% CI: 2.17-28.07, P = 0.011), Geriatric Nutritional Risk Index (OR: 4.30, 95% CI: 2.78-6.66, P < 0.001), and Prognostic Nutrition Index (OR: 4.67, 95% CI: 2.38-9.17, P = 0.023). ConclusionsMalnutrition was significantly associated with all-cause mortality risk following ACS, regardless of ACS type, ethnicity, and income status, underscoring the importance of screening and interventional strategies for patients with malnutrition.

Clinical profile and 30-day outcome of patients with acute coronary syndrome

Background: Acute coronary syndrome (ACS) accounts for a quarter of all-cause mortality, with substantial loss of productivity and socio-economic implications. Analyses of the clinical presentation, age- and gender-specific differences, and mortality pattern are decisive in determining the clinical outcome of a patient. Aims and Objectives: The primary objective was to determine the in-hospital and 30th day outcomes in patients with ACS. The secondary objectives were to study cardiometabolic risk factors, the clinical presentation, and the clinical course of the patients with ACS during hospitalization. Materials and Methods: The present study was conducted for 1-year duration involving 110 patients diagnosed with ACS. The patients’ data pertaining to socio-demographic information, clinical features, details of hospitalization, and treatment modalities were collected. The outcomes based on mortality and major adverse cardiovascular events (MACE) were evaluated in two phases: (a) in-hospital and (b) at the 30th day from the date of hospitalization. Results: Out of 110 patients hospitalized with a diagnosis of ACS, the majority were male (71.82%), and their mean age was 58.45±9.18 years. Hypertension, obesity, smoking, and family history of ACS were reported by 40%, 30%, 30%, and 27.27% of patients, respectively. Chest pain was the commonest symptom, followed by sweating and radiating pain. The mean duration of hospitalization was 6.345±2.46 days. ST-segment elevation myocardial infarction (STEMI) was the commonest type of ACS, with a predominance of anterior wall myocardial infarction (MI). The mean door-to-needle time was 43.53±7.75 min, and 29.1% of patients underwent thrombolysis. During hospitalization, improvement and MACE were observed in 73.64% and 26.36% of patients, respectively. 30-day outcome MACE was significantly higher among STEMI patients. Mortality was significantly higher in patients with &lt;30% left ventricular ejection fraction (LVEF), both during hospitalization and after 30 days. Conclusion: The present study revealed that the mean age of presentation was 58.45±9.18 years. Anterior wall MI was the commonest pattern of STEMI. Thus, the type of MACE and mortality were significantly higher among patients with either LVEF &lt;30% or STEMI. Thus, type and severity of ACS, along with clinical presentation, existing risk factors, and access to medical care, play a determining role in the clinical outcome of a patient.

The Effect of Daylight-Saving Time on Percutaneous Coronary Intervention Outcomes in Acute Coronary Syndrome Patients-Data from the Polish National Registry of Percutaneous Coronary Interventions (ORPKI) in the Years 2014-2022.

Many factors related to the switch to summer/winter time interfere with biological rhythms. This study aimed to analyze the impact of time change on clinical outcomes of patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI). Electronic data of 874,031 patients with ACS who underwent invasive procedures were collected from the Polish National Register of Interventional Cardiology Procedures (ORPKI) between 2014 and 2021. We determined the number of patients undergoing PCI and periprocedural mortality during the day of spring or autumn time change and within the first 3 and 7 days after the time change. We demonstrated the impact of time changes on the periprocedural mortality of ACS patients within 1 day and the period of 3 and 7 days from the time change. We observed that the occurrence of all ACS and NSTEMI on the first day was lower for both time changes and higher in the case of UA and spring time change. The autumn time change significantly reduced the occurrence of all types of ACS. A significant decrease in the number of invasive procedures was found after autumn transition in the period from the first day to 7 days for ACS, NSTEMI, and UA. The occurrence of ACS and the number of invasive procedures were lower for both changes over time. Autumn time change is associated with increased periprocedural mortality in ACS and a less frequent occurrence of UA and NSTEMI within 7 days.

Impact of recurrent ischaemic and bleeding events on quality of life in patients with acute coronary syndrome: Insights from the FORCE-ACS registry

ObjectivePatients with acute coronary syndrome (ACS) remain at high risk for recurrent ischaemic and bleeding events during follow-up. Our study aimed to quantify and compare the impact of these adverse...

Clinical characteristics, management, and 5-year survival compared between no standard modifiable risk factor (SMuRFless) and ≥ 1 SMuRF ACS cases: an analysis of 15,051 cases from Pakistan

BackgroundThere has been an increase in Acute Coronary Syndrome (ACS) patients without standard modifiable risk factors i.e. hypertension, diabetes, dyslipidemia, and tobacco use (SMuRFless) compared to the patients with ≥ 1 SMuRF but this has not been studied in South Asia despite them being a high-risk population. We conducted a comparative analysis of first episodes of ACS cases admitted to a tertiary cardiac center in Pakistan between SMuRFless and ≥ 1 SMuRF patients for clinical presentation, management, in-hospital, and 5-year mortality.MethodsWe undertook a retrospective study and data of 15,051 patients admitted at Tabba Heart Institute (THI) with the first episode of ACS was extracted from Chest Pain-MI™, and the CathPCI Registry® registry affiliated with the National Cardiovascular Data Registry (NCDR®), USA. Logistic regression and Cox proportional algorithm yielded odds ratio (OR) and hazard ratios (HR) with 95% confidence interval (CI) for associated factors of in-patient and 5-year mortality.ResultsThere were 15% SMuRFless cases and in-hospital mortality was 4.1% in SMuRFless vs. 3.9% in the ≥ 1 SMuRF group (p-0.59), the difference remained insignificant after adjusting for age, gender, Killip class, multivessel disease, type of ACS, percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) (Adjusted OR:1.1 [0.8, 1.3]. Unadjusted 5-year mortality was 40% lower in the SMuRFless group but the difference was insignificant after adjusting for age, gender, disease at presentation, its severity, and management (Adjusted HR 0.7 95% CI[0.5, 1.0]). STEMI, NSTEMI, Killip class, and multivessel disease increased the risk of overall 5-year mortality.ConclusionIn-hospital and 5-year mortality was not different between the SMuRFless and ≥ 1 SMuRF group, there is a need to understand mediators of immediate and long-term mortality risk in SMuRFless patients.

CCTA characteristics of vulnerable plaques preceding acute coronary syndromes-a comparative analysis between STE- and NSTE-ACS

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): This work was supported by the University of Medicine, Pharmacy, Science and Technology „George Emil Palade“ of Târgu Mureș Research Grant number 510/13/17.01.2022. Background CCTA adverse plaque features, that illustrate increased vulnerability, have been established as significant predictors for adverse events in patients with coronary artery disease. Decades of research have benchmarked the implication of vulnerable plaques (VP) in the occurrence of acute coronary syndromes (ACS). Still, there is little information concerning the interrelation between VP features and the subsequent type of ACS. Aim We sought to identify specific characteristics of future culprit vulnerable plaques, in a comparative analysis between the type of ACS they trigger, in patients undergoing CCTA and plaque analysis for stable chest pain. Material and Methods We conducted a prospective analysis, with a 3 year follow-up, on 50 subjects who underwent CCTA evaluation for stable chest pain. Coronary plaques were analyzed at baseline, for lesions that presented moderate stenosis, with at least one vulnerability marker (LAP, PR, NRS, SCs), which became culprit lesions during follow-up. Patients were initially divided into 2 groups (gr.1 – with STE-ACS, n=13) gr.2 – patients with NSTE-ACS, n=37). The secondary analysis divided the population in 3 groups gr.1-patients with UA (n=28); gr.2- with STEMI (n=13); gr.2 –with NSTEMI (n=9). Results The time to the occurrence of an ACS was higher for STE-ACS compared to NSTE-ACS (169.9±177.4, p&amp;lt;0.001), which was similar when comparing NSTEMI vs. UA vs. STEMI (p = 0.0001). The lowest degree of stenosis was present for VP that had triggered NSTEMI (p = 0.03). Evaluation of plaque composition revealed that the STE-ACS group presented higher non-calcified (171.6±63 vs. 130.6±80.1 mm3 p = 0.04) and lipid rich (19.9±16.7 vs. 11.42±10.5 mm3, p = 0.04) volumes, with no other differences regarding plaque composition and morphology. Plaques that had triggered STEMI during follow-up, presented highest non-calcified (p = 0.01) and lipid rich (p = 0.01) volumes. The greatest number of plaques with over 2 vulnerability markers per lesions were found in NSTEMI precursor lesions compared to UA and STEMI (77.8% vs. 53.8% ±25%, p = 0.01). Conclusions Compared to NSTE-ACS triggering lesions, vulnerable plaques that precede STEMI-ACS present a more lipid rich, non-calcified phenotype. NSTEMI precursor lesions are heterogeneous, with a low calcium volume and increased number of vulnerability markers, while VPs triggering unstable angina are calcified, with a low lipid rich volume and spotty calcifications.

Impact of standard modifiable cardiovascular risk factors on 2-year all-cause mortality: Insights from an international cohort of 23,489 patients with acute coronary syndrome

Controversial findings have been reported in the literature regarding the impact of the absence of standard modifiable cardiovascular risk factors (SMuRFs) on long-term mortality risk in patients with acute coronary syndrome (ACS). While the prognostic additive value of SMuRFs has been well described, the prognostic role of prior cardiovascular disease (CVD) by sex is less well-known in patients with and without SMuRFs. EPICOR and EPICOR Asia are prospective, observational registries conducted between 2010 and 2014, which enrolled ACS patients in 28 countries across Europe, Latin America, and Asia. Association between SMuRFs (diabetes, dyslipidaemia, hypertension, and smoking) and 2-year post-discharge mortality was evaluated using adjusted Cox models stratified by geographical region. Among 23,489 patients, the mean age was 60.9±11.9 years, 24.3% were women, 4582 (20.1%) presented without SMuRFs, and 16,055 (69.5%) without prior CVD. Patients with SMuRFs had a higher crude 2-year post-discharge mortality (HR 1.86; 95%CI, 1.56-2.22; p<0.001), compared to those without SMuRFs. After adjustment for potential confounding, the association between SMuRFs and 2-year mortality risk was substantially attenuated (HR 1.17, 95%CI 0.98-1.41; p=0.087), regardless of the type of ACS. The risk conferred by prior CVD was added to the underlying risk of SMuRFs to provide risk-specific phenotypes (e.g., women with SMuRFs and with prior CVD were at higher risk of dying than women without SMuRFs and without CVD; HR 1.67, 95%CI 1.34-2.06). In this large-scale international ACS cohort the absence of SMuRFs was not associated with a lower adjusted 2-year post-discharge mortality risk. Patients with both SMuRFs and prior CVD had a higher mortality irrespective of their sex.