Acute Coronary Syndrome Group Research Articles

Elevated Lp(a) and thrombophilic mutations : the experience of a general hospital

Abstract Funding Acknowledgements None. Background Thrombophilia and elevated Lp(a) levels have been studied as risk factors predisposing to cardiovascular events. There is no evidence suggesting that the common mutations causing thrombophilia or elevated Lp(a) alone could be regarded as independent risk factors for acute coronary syndromes. Purpose To compare the frequency of the simultaneous presence of thrombophilic mutations along with elevated Lp(a) levels in young patients presenting with acute coronary syndrome (ACS) compared with those without ACS. Methods We retrospectively analyzed the data from all the young patients (males<40yo, females <45yo) who were referred for thrombophilia testing to our hospital for a period of 10 years and divided them in two groups : those who presented with ACS (ACS group) and those who were referred for thrombophilia testing for other reason (non ACS group). Lp(a) level >30mg/dl was considered as elevated. We compared the frequency of elevated Lp(a) levels in patients carrying the same mutation in the two groups. P<0.01 was considered statistically significant. Results Of the 127 patients recorded in the ACS group, 25 were factor V Leiden homozygotes, 11 factor V Leiden heterozygotes, 17 PAI 4G/5G homozygotes, 8 PAI 4G/5G heterozygotes, 36 G20210A homozygotes and 12 G20210A heterozygotes. In the non ACS group, we analyzed data from 312 patients.Of them, 12 were factor V Leiden homozygotes, 29 factor V Leiden heterozygotes, 31 PAI 4G/4G homozygotes, 17 PAI 4G/5G heterozygotes, 66 G20210A homozygotes and 57 G20210A heterozygotes. Elevated Lp(a) levels were found as follows : (ACS vs non-ACS group) factor V Leiden homozygotes 14/25(56%) vs 1/12(8.33%) (p<0.01), factor V Leiden heterozygotes 7/11(8.66%) vs 2/29(6.89%), p<0.01), PAI 4G/4G homozygotes 1/17(5.88%) vs 0/31, PAI 4G/5G heterozygotes 0/8 vs 0/31), G20210A homozygotes 0/36 vs 1/66(1.51%), G20210A heterozygotes 1/12(9.44%) vs 0/57). Conclusions Lp(a) was elevated more frequently in patients carrying factor V Leiden mutation (either homozygotes or heterozygotes) who presented with ACS when compared with patients without ACS. Although it is not established, further studies are needed in order to identify any possible correlation of the combination of this mutation along with elevated Lp(a) levels with the occurrence of ACS in young patients.

One-year Outcomes of Biodegradable Polymer-coated Sirolimus-eluting Coronary Stent in Acute Coronary Syndrome - A Patient-level Pooled Analysis from Two Indian Registries.

This pooled analysis was conducted to assess the clinical safety and performance of the Supra family (Sahajanand Medical Technologies Ltd., Surat, India) of sirolimus-eluting stents (SES) in patients with acute coronary syndromes (ACS) including ST segment elevation myocardial infarction (STEMI) from two real-world all-comers Indian registries at one-year. We evaluated 1824 patients with ACS who underwent percutaneous coronary intervention with the Supra family of SES from two real-world Indian registries (891 patients from T-Flex registry and 933 patients from Tetriflex real-world registry). The primary endpoint was the incidence of target lesion failure (TLF) defined as a composite of cardiac death, target vessel myocardial infarction (TV-MI), and target lesion revascularization (TLR) at one-year follow-up. The safety endpoint was stent thrombosis at one-year follow-up. Among a total of 1824 patients with ACS, 689 (37.8%) patients presented with STEMI. In ACS and STEMI groups, 47.6% and 41.8% patients had multi-vessel disease, respectively. Of 2128 lesions in ACS group, 76.7% lesions were type B2/C and 16.2% lesions were totally occluded. In the STEMI group, out of 784 treated lesions, 76.7% were type B2/C lesions and 21.9% were totally occluded. At one-year follow-up, incidence of TLF was 5.3% (cardiac death: 0.9%, TV-MI: 2.5%, TLR: 1.9%) in patients with ACS and 6.2% (cardiac death: 1.4%, TV-MI: 2.1%, TLR: 2.7%) in patients with STEMI. The one-year rate of definite/probable stent thrombosis were 0.3% and 0.7% in patients with ACS and STEMI, respectively. This patient-level pooled analysis provides evidence for the safe and effective use of the Supra family of SES in complex patient populations such as ACS and even in STEMI with favourable rates of TLF and stent thrombosis at one-year follow-up.

Ten questions about myocardial infarction with non-obstructed coronary arteries

The term "MINOCA" refers to myocardial infarction with non-obstructed coronary arteries and has been used to define acute myocardial infarction with no angiographic evidence of significant epicardial coronary artery stenosis. Patients with MINOCA represent a rather heterogeneous group of acute coronary syndrome, and this may account for the wide variation in the incidence of MINOCA in different studies. Several pathogenic mechanisms have been suggested to underlie MINOCA, but the condition continues to represent a diagnostic and therapeutic challenge for the cardiologist. Therefore, an adequate diagnostic assessment, carefully characterizing the pathogenic mechanisms, and a selection of more targeted treatments are needed to improve clinical outcomes. In this focused review, we will try to provide answers to the most common questions on the causes, diagnosis, treatment, and outcomes of MINOCA.

Value of cardiodynamicsgram in early diagnosis of patients with acute coronary syndrome

To explore the value of cardiodynamicsgram (CDG) obtained from electrocardiogram (ECG) data by radial basis functionradial basis function (RBF) neural network in early diagnosis of patients with acute coronary syndrome (ACS). Retrospective analysis method was used. Patients with chest pain as the main initial symptom in the emergency department of Baoan District People's Hospital of Shenzhen from October 2021 to September 2022 were enrolled. Baseline data were collected, including gender, age, smoking history, family history of coronary heart disease and history of hypertension, diabetes, hyperlipidemia, and atherosclerosis. The first 12-lead ECG was recorded after admission to the emergency department, and electrocardiodynamics analysis was performed to generate CDG. Receiver operator characteristic curve (ROC curve) was plotted to analyze the value of CDG and ECG in the early diagnosis of ACS and non-ST segment elevation ACS (NSTE-ACS). Sensitivity, specificity, area under the ROC curve (AUC), and 95% confidence interval (95%CI) were calculated. CDG and coronary angiography results of 3 patients with ACS with normal ECG were observed and analyzed. Non-ACS patients with normal ECG but positive CDG were followed for 30 days for adverse cardiovascular events. A total of 384 patients with chest pain were included, including 169 patients with ACS and 215 patients without ACS. The proportion of male (87.0% vs. 53.0%), smoking history (37.9% vs. 12.1%), hypertension (46.2% vs. 22.3%), diabetes (24.3% vs. 7.9%), hyperlipidemia (55.0% vs. 14.0%) and history of atherosclerosis (22.5% vs. 2.3%) in ACS group were significantly higher than those in non-ACS group (all P < 0.05). The ROC curve showed that the AUC of CDG diagnosis of ACS was higher than that of ECG [AUC (95%CI): 0.88 (0.66-0.76) vs. 0.71 (0.84-0.92)], the sensitivity was 92.8%, 78.6%, and the specificity was 83.3%, 64.2%, respectively. The AUC of CDG diagnosis of NSTE-ACS was higher than that of ECG [AUC (95%CI): 0.85 (0.80-0.90) vs. 0.63 (0.56-0.69)], the sensitivity was 87.1%, 61.3%, and the specificity was 83.3%, 64.2%, respectively. CDG of 3 patients with ACS with normal ECG showed disordered state, and coronary angiography showed ≥70% stenosis of major coronary branches. Of 215 non-ACS patients, 20 had a normal ECG but positive CDG, and 3 developed ST segment elevation myocardial infarction (STEMI) within 30 days, and 2 developed unstable angina (UA) within 30 days. CDG has high value in early diagnosis of ACS patients and is expected to become an important means of early diagnosis of ACS in emergency.

Long-term outcomes of intravascular ultrasound-guided drug-eluting stents implantation in patients with acute coronary syndrome: ULTIMATE ACS subgroup

Objective: To explore the long-term effects of intravascular ultrasound (IVUS) guidance on patients with acute coronary syndrome (ACS) undergoing drug-eluting stents (DES) implantation. Methods: Data used in this study derived from ULTIMATE trial, which was a prospective, multicenter, randomized study. A total of 1 448 all-comer patients were enrolled between 2014 August and 2017 May. Primary endpoint of this study was target vessel failure (TVF) at 3 years, including cardiac death, target-vessel-related myocardial infarction, and clinically-driven target vessel revascularization. Results: ACS was present in 1 136 (78.5%) patients, and 3-year clinical follow-up was available in 1 423 patients (98.3%). TVF in the ACS group was 9.6% (109/1 136), which was significantly higher than 4.5% (14/312) in the non-ACS group (log-rank P=0.005). There were 109 TVFs in the ACS patients, with 7.6% (43/569) TVFs in the IVUS group and 11.6% (66/567) TVFs in the angiography group (log-rank P=0.019). Moreover, patients with optimal IVUS guidance were associated with a lower risk of 3-year TVF compared to those with suboptimal IVUS results (5.4% (16/296) vs. 9.9% (27/273),log-rank P=0.041). Conclusions: This ULTIMATE-ACS subgroup analysis showed that ACS patients undergoing DES implantation were associated with a higher risk of 3-year TVF. More importantly, the risk of TVF could be significantly decreased through IVUS guidance in patients with ACS, especially in those who had an IVUS-defined optimal procedure.

Severity of Coronary Artery Disease by Friesinger Score Among Women With Acute Coronary Syndrome in a Tertiary Care Hospital in Bangladesh.

The chance of coronary artery disease (CAD) is much higher in women who have gone through menopause than in those who have not, owing to hormonal defense against atherosclerosis. More advanced CADand several comorbidities were observed in postmenopausal women. Nevertheless, there is a paucity of information comparing the angiographic severity of acute coronary syndrome (ACS) in premenopausal and postmenopausal women of different ages. This research sought to determine the Friesinger score's use in evaluating the degree of CAD in premenopausal and postmenopausal women with ACS. A total of 145 female patients with ACS were included in this cross-sectional observational research. Depending on the stage of menopause, they were categorized into two groups: group I (premenopausal) and group II (postmenopausal). The study examined the differences in clinical data and the severity of coronary angiographic features based on the Friesinger score between the premenopausal and postmenopausal ACS groups. A statistically significant difference (p = 0.001) was found in the mean age of premenopausal ACS patients, which was 41.53 ± 5.45 years, and postmenopausal ACS patients, which was 57.23 ± 7.45 years. Between the premenopausal group (31.4% vs. 17.1%; p = 0.04 and 31.4% vs. 15.7%; p = 0.002) and postmenopausal group (48.6% vs. 20%; p = 0.001), there was a greater prevalence of normal coronary angiography, single-vessel disease, and triple-vessel disease. Comparing the postmenopausal group to the premenopausal group, the high to intermediate Friesinger score (11-15) was found to be considerably higher (2.9% vs. 1.4%; 72.9% vs. 50%; p = 0.003). Prior to menopause, single-vessel disease and normal coronary angiography were more common, whereas postmenopausal individuals had triple-vessel disease.The postmenopausal group's CAD was found to be more severe than the premenopausal group's according to the Friesinger score used for severity evaluation.

Predictive value of bilirubin and serum γ-glutamyltranspeptidase levels in type-2 diabetes mellitus patients with acute coronary syndrome.

Cardiovascular disease is a major complication of diabetes mellitus (DM). Type-2 DM (T2DM) is associated with an increased risk of cardiovascular events and mortality, while serum biomarkers may facilitate the prediction of these outcomes. Early differential diagnosis of T2DM complicated with acute coronary syndrome (ACS) plays an important role in controlling disease progression and improving safety. To investigate the correlation of serum bilirubin and γ-glutamyltranspeptidase (γ-GGT) with major adverse cardiovascular events (MACEs) in T2DM patients with ACS. The clinical data of inpatients from January 2022 to December 2022 were analyzed retrospectively. According to different conditions, they were divided into the T2DM complicated with ACS group (T2DM + ACS, n = 96), simple T2DM group (T2DM, n = 85), and simple ACS group (ACS, n = 90). The clinical data and laboratory indices were compared among the three groups, and the correlations of serum total bilirubin (TBIL) levels and serum γ-GGT levels with other indices were discussed. T2DM + ACS patients received a 90-day follow-up after discharge and were divided into event (n = 15) and nonevent (n = 81) groups according to the occurrence of MACEs; Univariate and multivariate analyses were further used to screen the independent influencing factors of MACEs in patients. The T2DM + ACS group showed higher γ-GGT, total cholesterol, low-density lipoprotein cholesterol (LDL-C) and glycosylated hemoglobin (HbA1c) and lower TBIL and high-density lipoprotein cholesterol levels than the T2DM and ACS groups (P < 0.05). Based on univariate analysis, the event and nonevent groups were significantly different in age (t = 3.3612, P = 0.0011), TBIL level (t = 3.0742, P = 0.0028), γ-GGT level (t = 2.6887, P = 0.0085), LDL-C level (t = 2.0816, P = 0.0401), HbA1c level (t = 2.7862, P = 0.0065) and left ventricular ejection fraction (LEVF) levels (t=3.2047, P = 0.0018). Multivariate logistic regression analysis further identified that TBIL level and LEVF level were protective factor for MACEs, and age and γ-GGT level were risk factors (P < 0.05). Serum TBIL levels are decreased and γ-GGT levels are increased in T2DM + ACS patients, and the two indices are significantly negatively correlated. TBIL and γ-GGT are independent influencing factors for MACEs in such patients.

Gut microbiome-based noninvasive diagnostic model to predict acute coronary syndromes.

Previous studies have shown that alterations in the gut microbiota are closely associated with Acute Coronary Syndrome (ACS) development. However, the value of gut microbiota for early diagnosis of ACS remains understudied. We recruited 66 volunteers, including 29 patients with a first diagnosis of ACS and 37 healthy volunteers during the same period, collected their fecal samples, and sequenced the V4 region of the 16S rRNA gene. Functional prediction of the microbiota was performed using PICRUSt2. Subsequently, we constructed a nomogram and corresponding webpage based on microbial markers to assist in the diagnosis of ACS. The diagnostic performance and usefulness of the model were analyzed using boostrap internal validation, calibration curves, and decision curve analysis (DCA). Compared to that of healthy controls, the diversity and composition of microbial community of patients with ACS was markedly abnormal. Potentially pathogenic genera such as Streptococcus and Acinetobacter were significantly increased in the ACS group, whereas certain SCFA-producing genera such as Blautia and Agathobacter were depleted. In addition, in the correlation analysis with clinical indicators, the microbiota was observed to be associated with the level of inflammation and severity of coronary atherosclerosis. Finally, a diagnostic model for ACS based on gut microbiota and clinical variables was developed with an area under the receiver operating characteristic (ROC) curve (AUC) of 0.963 (95% CI: 0.925-1) and an AUC value of 0.948 (95% CI: 0.549-0.641) for bootstrap internal validation. The calibration curves of the model show good consistency between the actual and predicted probabilities. The DCA showed that the model had a high net clinical benefit for clinical applications. Our study is the first to characterize the composition and function of the gut microbiota in patients with ACS and healthy populations in Southwest China and demonstrates the potential effect of the microbiota as a non-invasive marker for the early diagnosis of ACS.

Telomerase activity and hTERT gene expression in patients with acute coronary syndrome and stable coronary artery disease.

In this study, we aimed to examine the telomerase activity and hTERT gene expression in patients with acute coronary syndrome (ACS) and those with stable coronary artery disease (SCAD) and compare the results to controls. Additionally, we compared overall mortality rates relative to the telomerase activity. Atotal of 211 patients (78 ACS and 71 SCAD patients) were included in the study. The telomerase concentration was measured by ELISA and used to determine telomerase activity. The hTERT gene expression was determined by real-time PCR. The serum telomerase enzyme concentration was lower in ACS (36.61 ± 1.54) and SCAD (36.79 ± 1.57) when compared to the control group (37.03 ± 2.25). However, this difference did not reach statistical significance (p = 0.890). The hTERT gene expression acting in telomerase enzyme synthesis was 2.7-fold lower in ACS group (p = 0.070) and 2.2-fold lower in the SCAD group (p = 0.101) compared to the control group. Patients were followed for amedian of 32 months (minimum: 0.1, maximum: 46.8). The serum telomerase concentrations in patients who died and those survived in the SCAD group (35.98 ± 2.02 vs 36.86 ± 1.52 ng/ml, respectively; p= 0.529) were similar to those in the ACS group (36.39 ± 1.08 vs 36.63 ± 1.60 ng/ml, respectively p= 0.993). In the current study, telomerase activity or hTERT expression was similar in patients with ACS, SCAD, and controls. Moreover, telomerase activity was not associated with all- cause mortality during the 32-month follow-up (Tab. 3, Fig. 1, Ref. 29).

Comparison of Acute Coronary Syndromes in the Earthquake Zone before and in the First Month after the Earthquake: A Single-center and Retrospective Analysis.

Earthquakes can significantly impact both the occurrence and the management of acute coronary syndromes (ACS). This study aimed to investigate the effects of an earthquake on patients with ACS by comparing their clinical and angiographic features before and after the event. We utilized a retrospective observational cohort design, involving 260 ACS patients who underwent coronary angiography. Data on patient characteristics, clinical variables, and procedural details were extracted from medical records. Statistical analyses were conducted to compare the ACS groups pre- and post-earthquake and to assess outcomes, which included in-hospital mortality and complications. After the earthquake, the ACS patients were older and predominantly male. The distribution of ACS subtypes remained similar between the groups. The use of anticoagulation before the procedure decreased after the earthquake, while the usage of other medications remained stable. The incidence of non-critical coronary arteries decreased post-earthquake, and there was a higher frequency of non-intervention in this group. Intervention in the left anterior descending coronary artery was more common after the earthquake. In-hospital mortality was associated with post-earthquake ACS, certain ACS subtypes, shock at admission, bifurcation stenting, and the no-reflow phenomenon. Complete revascularization was found to reduce mortality. The duration of intensive care unit stays was longer before the earthquake, while in-hospital mortality was higher after the earthquake. Gender differences were observed in coronary ectasia, with females being more affected post-earthquake. Earthquakes significantly influence the clinical and angiographic features of ACS cases, thereby affecting mortality rates and revascularization outcomes.

Exosomal circSCMH1/miR-874 ratio in serum to predict carotid and coronary plaque stability.

To investigate the correlation between lg (circSCMH1/miR-874) and acute coronary syndrome (ACS), acute myocardial infarction (AMI), and carotid plaque stability. 701 patients were divided into stable coronary artery disease (SCAD), ACS, and control groups. Furthermore, 225 patients who underwent carotid ultrasound were selected from the above 701 patients and were divided into low-risk plaque, medium-to-high risk plaque, and control (without carotid plaques) groups. We collected their baseline characteristics and measured the contents of exosomal circSCMH1 and miR-874 in peripheral blood. Then lg(circSCMH1/miR-874) was calculated and statistical analysis was performed. The lg (circSCMH1/miR-874) values of ACS, SCAD, and the control group decreased successively (P < 0.05). Compared with the low-risk plaque and control groups, the lg (circSCMH1/miR-874) value of medium-high risk plaque group decreased (P < 0.05). Multivariate logistic regression analysis showed that with the decrease of lg (circSCMH1/miR-874), the risk of ACS, AMI, and medium-high risk plaques increased. ROC curve analysis demonstrated that lg (circSCMH1/miR-874) has a higher diagnostic value for ACS, AMI and medium-high risk plaques than previously used predictive ratios. Lg (circSCMH1/miR-874) is closely associated with coronary and carotid plaque stability.

Adverse Drug Effect Profiles of Gp2b/3a Inhibitors: A Comparative Review of the Last Two Decades.

ST-Elevation Myocardial Infarction and non-ST Elevation Myocardial Infarction belong to the acute coronary syndrome group of diseases. These conditions are characterized by the complete or partial blockage of one or several coronary arteries, resulting in myocardial injury or necrosis. Various medications are used in their treatment, with the most recent addition being Glycoprotein IIb/IIIa inhibitors. They work by hindering the activity of glycoprotein IIb/IIIa receptors, which, in turn, prevents the clumping of platelets. Some of the GpIIb/IIIa inhibitors available in this category include abciximab, tirofiban, eptifibatide, roxifiban, and orbofiban. With this comprehensive literature review, we aimed to explore the potential adverse effects of these medications and compare the three in terms of their side effects profile. We searched through PubMed and Google Scholar and pinpointed 13 articles aligned with our inclusion criteria: six articles utilized eptifibatide, four were related to abciximab, and three used tirofiban. In 85% of the cases, a severe drop in platelet count, reaching as low as 1000/μL, was reported. Additionally, several other side effects were noted: one case documented multiple bruising spots appearing around the patient's body, two cases reported diffuse alveolar hemorrhage, and one case described a cardiac tamponade resulting from hemorrhagic pericarditis. Our study highlights the crucial significance of keeping a watchful eye on and comprehending the potential drawbacks linked to these medications in cardiovascular treatment. The necessity of researching these medications and their side effects is also evident, as this will significantly enhance the quality of treatment provided.

Complete blood count, lipid profiles, and inflammatory markers associated with atherosclerotic cardiovascular disease in patients with diabetes

Background: Complete blood count (CBC) and inflammatory markers derived from hematology parameters, as well as lipid profiles, have emerged as novel biomarkers that aid in predicting the progression of atherosclerotic cardiovascular disease (ASCVD) in people with diabetes. This study aimed to evaluate the alterations in CBC, lipid profiles, and inflammatory markers derived from CBC in Type 2 diabetes mellitus (T2DM)-associated ASCVD and the associations between glycated hemoglobin and hematology, lipid profiles, and inflammatory markers. Methods: Overall, 75 patients with T2DM ASCVD from the National Cardiovascular Center Harapan Kita were investigated. Patients with diabetes were classified into high-risk (HR), very high-risk (VHR), and acute coronary syndrome (ACS) groups. VHR-ASCVD was defined as having ≥2 major ASCVD events, or one major ASCVD event and ≥2 high-risk conditions. HR-ASCVD were patients with &gt;3 major risk factors, diabetes, chronic kidney disease stage 3B or 4, and a very high LDL-C level. ECG and cardiac biomarker tests ensured an ACS diagnosis. CBC, lipid profiles, and IL-6 were estimated in all groups. Results: Patients with T2DM ACS demonstrated significantly different levels of red blood cell distribution width (RDW), leucocytes, basophils, eosinophils, lymphocytes, monocytes, segmented neutrophils, absolute lymphocytes, absolute monocytes, neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), platelet-lymphocyte ratio (PLR), total cholesterol, LDL, HDL/total cholesterol ratio, hemoglobin A1c (HbA1c), and IL-6. HbA1c was significantly correlated with leucocytes (p&lt;0.05), segmented neutrophils (p&lt;0.001), NLR (p&lt;0.05), PLR (p&lt;0,05), total cholesterol (p&lt;0.05), LDL (p&lt;0.05), total cholesterol/ HDL ratio (p&lt;0.05), and IL-6 (p&lt;0.001), eosinophils (p&lt;0.05), lymphocytes (p&lt;0.05), monocytes (p&lt;0.05), and absolute lymphocytes (p&lt;0.05). Logistic regression analysis showed that monocytes, MLR, leucocytes, eosinophils, and absolute monocytes were found to be valuable predictors for T2DM ACS (p&lt;0.05). Conclusions: CBC, inflammatory biomarkers derived from CBC, and lipid ratios were inexpensive parameters that could serve as inflammatory biomarkers of increased risks and complications in T2DM ASCVD.

Abstract 12829: Short- and Long-Term Outcomes of Takotsubo Syndrome and Acute Coronary Syndrome. A Meta-Analysis

Introduction: Takotsubo syndrome (TTS) is a condition characterized by reversible left ventricular dysfunction with typical regional wall motion abnormalities. Although the presentation mimics acute coronary syndrome (ACS), its exact pathophysiology is not known. Despite the transient nature of cardiac dysfunction in TTS, the prognosis remained uncertain, with mortality rates reportedly comparable to that of ACS. The aim of this study was to compare the outcomes between patients with TS and ACS through a meta-analysis. Methods: We systematically searched various electronic databases including PubMed, Embase, and Cochrane Library to identify relevant studies. The outcomes were pooled using the Hartung-Knapp-Sidik-Jonkman random effects model, and the results were presented as odds ratio (OR) with their corresponding 95% confidence interval (CI). Results: 11 studies with 3,455,862 (95,165 TTS and 3,360,697 ACS) patients were included in the final analysis. The risk of in-hospital mortality (OR, 0.61(95%CI: 0.42-0.89), P=0.01), 30-day mortality (OR, 0.62(95%CI: 0.48-0.81), P&lt;0.001) were significantly lower in the TTS group compared to the ACS group. There was no difference in the risk of cardiogenic shock (OR, 0.87(95%CI: 0.54-1.42), P=0.58) between both groups. The risk of long-term all-cause mortality (OR, 1.10(95%CI: 0.61-1.97), P=0.75) was comparable between both groups, with significantly higher non-cardiovascular cause of mortality (OR, 2.40(95%CI: 1.83-3.15), P&lt;0.001) among the TTS group compared to the ACS group. Conclusions: This study suggests a favorable short-term prognosis for TTS patients compared to ACS patients, but a comparable risk of long-term mortality. It is noteworthy that TTS patients have a higher risk of non-cardiovascular mortality. Further studies are warranted to explore the factors contributing to the increased risk of non-cardiovascular mortality in TTS patients in order to improve outcomes in this population.

The Prognostic Role of Platelet-to-Lymphocyte Ratio in Acute Coronary Syndromes: A Systematic Review and Meta-Analysis.

This study aimed to investigate the potential prognostic role of the platelet-to-lymphocyte (PLR) ratio in patients presenting with suspected acute coronary syndromes (ACS). A systematic search of PubMed Central, Scopus, EMBASE, and the Cochrane Library from conception through 20 August 2023 was conducted. We used odds ratios (OR) as the effect measure with 95% confidence intervals (CIs) for dichotomous data and mean differences (MD) with a 95% CI for continuous data. If I2 was less than 50% or the p value of the Q tests was less than 0.05, a random synthesis analysis was conducted. Otherwise, a fixed pooled meta-analysis was performed. Nineteen studies fulfilled the eligibility criteria and were included in the meta-analysis. PLR was higher in MACE-positive (164.0 ± 68.6) than MACE-negative patients (115.3 ± 36.9; MD = 40.14; 95% CI: 22.76 to 57.52; p < 0.001). Pooled analysis showed that PLR was higher in AMI patients who died (183.3 ± 30.3), compared to survivors (126.2 ± 16.8; MD = 39.07; 95% CI: 13.30 to 64.84; p = 0.003). It was also higher in the ACS vs. control group (168.2 ± 81.1 vs. 131.9 ± 37.7; MD = 39.01; 95% CI: 2.81 to 75.21; p = 0.03), STEMI vs. NSTEMI cohort (165.5 ± 92.7 vs. 159.5 ± 87.8; MD = 5.98; 95% CI: -15.09 to 27.04; p = 0.58), and MI vs. UAP populations (162.4 ± 90.0 vs. 128.2 ± 64.9; MD = 18.28; 95% CI: -8.16 to 44.71; p = 0.18). Overall, our findings confirmed the potential prognostic role of the plate-let-to-lymphocyte (PLR) ratio in patients presenting with suspected acute coronary syndromes (ACS). Its use as a risk stratification tool should be examined prospectively to define its capability for evaluation in cardiovascular patients.

The potential role of radiochemical analysis of CT images of epicardial adipose tissue in the prognosis of acute myocardial infarction

Introduction. Multispiral computed tomography (MSCT) coronary angiography (CAG) is a highly informative method of visualizing atherosclerotic plaques in the coronary arteries and assessing their structure. At the same time, this method has a few significant drawbacks associated with the intravenous administration of iodine-containing radiopaque agents as well as high radiation exposure. The radiomic analysis of contrast-free MSCT images allows calculating many additional quantitative parameters, which can potentially be associated with atherosclerotic plaque instability and the degree of coronary artery stenosis. At the same time, the prognostic and diagnostic value of radiomic characteristics has not been investigated.Aim: To assess whether there is an association between radiomic indexes of EAT on non-contrast MSCT cardiac images with the degree of atherosclerotic coronary artery stenosis in patients with stable CAD, as well as the incidence of acute coronary syndrome (ACS) within 5 years in this category of patients.Material and Methods. We retrospectively reviewed 100 MSCT-CAG studies performed to diagnose coronary heart disease in patients. 39 patients with signs of coronary stenosis up to 50% and registered in Tomsk medical information systems (MIS) for at least 5 years were selected, as well as 15 people without signs of coronary arteries (CA) atherosclerosis as a control group. Epicardial adipose tissue (EAT) volume was assessed and 837 radiomic characteristics were calculated on non-contrasted MSCT cardiac images of all patients (54 people). The presence or absence of ACS within 5 years after MSCT-CAG in each patient was monitored according to Tomsk MIS data. Statistical analysis and comparison of indices were performed in control group (group 2) and study group (group 1), as well as in subgroups of patients who had suffered AMI (group 1a) and those who had not (group 1b).Results. When comparing group 1 with the control group, significant differences (p &lt; 0.05) were found for all radiomic parameters, density, and volume of EAT. Correlation analysis did not reveal any relationship between the radiomic characteristics of EAT and the degree of coronary artery stenosis, as well as the calcium index. According to the results of the MIS of Tomsk analysis, group 1 was divided into 2 subgroups: without ACS (group 1a; n = 27 (50%)) and with ACS (group 1b; n = 12 (22%)). When comparing subgroups 1a and 1b, there were no significant differences in the volume and density of EAT (p &gt; 0.05), however, 8 out of 837 radiomic parameters differed significantly. Multiple regression analysis has shown that the Size Zone Nonuniformity gray level zone matrix (SZN-GLSZM) and Gray Level Variance (GLCM) gray co-occurrence matrix are independent predictors of the development of ACS within 5 years. According to the results of the ROC analysis, the logistic model with the inclusion of radiomic data showed high sensitivity and specificity in predicting the development of ACS (cut-off point &lt;8025.7; specificity 96%, sensitivity 75%, AUC = 0.806, p &lt; 0.001 for SZN; cut-off point &lt;4.08; specificity 93%, sensitivity 83%, AUC = 0.861 for GLV; p &lt; 0.001).Conclusion. SZN GLSZM and GLV GLCM radiomic features on non-contrast MSCT images of EAT are associated with the incidence of ASC in patients with coronary artery atherosclerosis. Radiomic analysis of EAT could potentially be used for personalized assessment of the ACS risk.

The clinical significance of ischaemia-modified albumin in acute coronary syndrome and hypertension.

Early diagnosis of acute coronary syndrome is more and more important because of its mortality and morbidity. Hypertension is one of the pathogenesis of acute coronary syndrome, which often leads to stenosis and ischaemia. Ischaemia-modified albumin is sensitive for the occurrence of ischaemia, which attracted us in the significance of ischaemia-modified albumin in patients with chest pain, especially patients complicated with hypertension. In total, 200 patients with acute chest pain were included in the study. According to the diagnostic criteria, patients were divided into acute coronary syndrome group and non-ischaemic chest pain group. Cardiac biomarkers were measured with 30 minutes in emergency department, including cardiac troponin T, creatine kinase MB, and ischaemia-modified albumin. Receiver operating characteristic curve (ROC) analysis was used for the sensitivity and specificity of ischaemia-modified albumin in the early diagnosis of acute coronary syndrome. Comparisons between ischaemia-modified albumin and cardiac Troponin T were done between groups. The demographics in two groups were not significantly different in most aspects. Compared with non-ischaemic chest pain group, serum levels of ischaemia-modified albumin and cardiac Troponin T were significantly higher in acute coronary syndrome group. ROC analysis showed that ischaemia-modified albumin had a good sensitivity and specificity in early diagnosis of acute coronary syndrome. The level of ischaemia-modified albumin in acute coronary syndrome patients with hypertension was higher than that in non-ischaemic chest pain patients. In patients complained with acute chest pain, the serum measurement of ischaemia-modified albumin is potential valuable for the early diagnosis of acute coronary syndrome, especially combined with ECG. The serum level of ischaemia-modified albumin in acute coronary syndrome patients is significantly associated with hypertension.

Diagnostic value of soluble urokinase-type plasminogen activator receptor in patients with acute coronary syndrome: A systematic review and meta-analysis.

In contemporary clinical practice, there is an increasing need for new clinically relevant biomarkers potentially optimizing management strategies in patients with suspected acute coronary syndrome (ACS). This study aimed to determine the diagnostic utility of soluble urokinase-type plasminogen activator receptor (suPAR) levels in individuals with suspected ACS. A literature search was performed in Web of Science, PubMed, Scopus, and the Cochrane Central Register of Controlled Trials databases, for studies comparing suPAR levels among patients with and without ACS groups. The methodological quality of the included papers was assessed using the Newcastle-Ottawa Scale (NOS). A fixed-effects model was used if I² < 50%; otherwise, the random-effects model was performed. Five studies with 3417 participants were included in the meta-analysis. Pooled analysis showed that mean suPAR levels in the ACS group were statistically significantly higher than in the control group (3.56 ± 1.38 vs. 2.78 ± 0.54 ng/mL, respectively; mean difference: 1.04; 95% confidence interval: 0.64-1.44; I² = 99%; p < 0.001). In the context of acute coronary syndrome, suPAR is a potential biomarker for the early identification of medical conditions in individuals who are being treated in emergency rooms.

Clinical and laboratory characteristics of perioperative patient's and follow-up after coronary artery bypass graft surgery with extracorporeal circulation

Objectives: Course of hospital stay post-coronary artery bypass graft (CABG) procedure has become increasingly shorter over the last few decades. However, after coronary artery bypass surgery, there is a certain rate of adverse events related to surgery and resuscitation. Therefore, we conducted this study with the goal of evaluating the clinical and subclinical characteristics of patients undergoing CABG surgery with extracorporeal circulation.&#x0D; Methods: A prospective method was used to study 171 consecutive patients undergoing CABG Surgery at Hanoi Heart Hospital from June 2016 to August 2018.&#x0D; Results: The group of stable coronary artery disease 119 (69.6%) patients, the group of acute coronary syndrome 52 (30.4%) patients. The men was 3.6 times higher than that of women (p&lt;0.05). The Euroscore II score (0.6 – 6.42) and typical chest pain were higher in the acute coronary syndrome group (p&lt;0.05). Acute coronary syndrome patient's had a higher rate of postoperative EF reduction than stable coronary artery disease patients (p &lt; 0.05). Stable coronary artery disease patients had CK, CKMB, Troponin T hs increased postop than acute coronary syndrome patient's, ProBnP increased postop in both groups (p&lt;0.05). The time of mechanical ventilation, use of inotropic drugs, and re-operating hemostasis were increased in the acute coronary syndrome group compared with stable coronary artery disease (p&lt;0.05). The rate of reoperation for hemostasis (3.5%), the group of acute coronary syndromes patients was higher (7.7% vs 1.7%), the postoperative mortality rate was 2.3% up to 30 days.&#x0D; Conclusion: The men was higher than that of women, and heart failure increased postop than preop in both echocardiography and laboratory tests. Acute coronary syndrome patients had a higher rate of bleeding re-operating hemostasis than stable coronary artery disease patient's.

High intake of sweet foods and low life satisfaction can act as risk factors for acute coronary syndrome through synergistic interaction.

Dietary and psychological status contributes to the development of coronary artery disease. However, these lifestyle factors may vary depending on ethnic and environmental background, and secondary prevention programs dealing with these factors in a specific population are not well-established. We aimed to assess dietary and psychological characteristics in Korean patients with acute coronary syndrome (ACS) and analyze their interactions as independent risk factors for ACS. Ninety-two patients with ACS (29 acute myocardial infarction and 63 unstable angina) and 69 controls were subjected to dietary and psychological analyses. Dietary intake was assessed by a food frequency questionnaire. Psychological depression and perceived stress were assessed using the Patient Health Questionnaire-9 and the Perceived Stress Scale, respectively. Eight domains of life satisfaction (marital/love relationship, leisure, standard of living, job, health, family life, sex life, and self) were assessed using the Domain Satisfaction Questionnaire (DSQ). The ACS group had a higher consumption of sweets and fish/seafood, as well as higher levels of depressive symptoms. Additionally, they had lower DSQ scores in total, and all eight individual domains compared with the control group. In multivariate logistic regression analysis, sweet intake (OR 4.57, 95% CI: 1.94-11.40) and total DSQ scores (OR 0.34, 95% CI: 0.14-0.81) were identified as independent risk factors for ACS. Furthermore, these factors, which displayed a significant inverse correlation (ρ = -0.23, p = 0.01), were determined as having a synergistic contribution to the development of ACS. High sweet food intake and low life satisfaction can act as risk factors for ACS through a synergistic interaction, which emphasizes a demand for a more comprehensive approach to secondary prevention of ACS. In addition, these data highlight the role of positive psychological wellbeing factors in cardiovascular health.