Acute Coronary Syndrome Patients Research Articles

Organisational management of the time-dependent network for the treatment of acute coronary syndrome.

Cardiovascular diseases are the leading cause of death in Italy, being responsible for 227,350 deaths in 2020, according to the National Institute of Statistics. The implementation of timely reperfusion therapy is crucial to improve patient outcomes, and time-dependent networks for the treatment of Acute Coronary Syndrome, particularly ST-elevation myocardial infarction, have been established. In Tuscany, the network for the treatment of Acute Coronary Syndrome-ST-elevation myocardial infarction covers a vast area encompassing three Local Health Authorities, including all of South-Eastern Tuscany. Key features include equity of access, patient safety, improving the quality of care, standardization, the enhancement of professional skills, technological innovation, increasing case volumes and multi-professional integration across emergency services, hospital facilities and primary care networks. The Tuscan Acute Coronary Syndrome network provides comprehensive treatment for Acute Coronary Syndrome-ST-elevation myocardial infarction in 12 hospitals with 24-hour hemodynamics laboratories and has been extended to new territories, namely Piombino and the Island of Elba. The aim of the present study was to assess the impact of an analytical system for monitoring times to reperfusion treatment and subsequent actions, in order to improve the performance of the network. In this retrospective study, we conducted an analytical evaluation of the network's performance, including reperfusion treatment times and factors causing delay. The study utilized data on patient transport, times from symptom onset to medical contact, and outcomes from the National Outcomes Program (NOP; "Programma Nazionale Esiti" in Italian). Analytical evaluations in 2021 measured the network's overall performance and identified the main causes of delay. The treatment process was divided into periods, from symptom onset to coronary reperfusion; interventions such as public awareness campaigns, electrocardiogram tele-transmission, and fast-track transfers were implemented in order to minimize delays. The lowest 30-day mortality rate in Acute Coronary Syndrome patients was recorded in hospitals that treated over 300 cases annually, according to the 2020 and 2021 National Outcomes Program of. Improvements continued into 2022 and 2023, with mortality rates also declining in patients initially admitted to peripheral hospitals. Among residents of Piombino and the Island of Elba, 30-day mortality decreased from 8.8% (2017-2020) to 5.7% in 2022. In 2022, the Grosseto Hub treated 80% of ST-elevation myocardial infarction patients within 90 minutes. The establishment of a well-organized time-dependent network for the treatment of Acute Coronary Syndrome-ST-elevation myocardial infarction in Tuscany significantly improved patient outcomes, thus demonstrating the critical role of timely and efficient care pathways. Our network's success is attributable to several factors, including improved accessibility, enhanced coordination among healthcare facilities, and the efficient use of technology and resources. These findings highlight the importance of structured clinical-care pathways in delivering high-quality care for Acute Coronary Syndrome patients.

Inflammatory and Bleeding Risks on Clinical Outcomes in Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention.

Objective This study aimed to evaluate the impact of systemic inflammation burden using high-sensitivity C-reactive protein (hsCRP) and long-term prognosis in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) stratified by bleeding risk status. Methods Consecutive patients admitted for ACS and who received PCI between March 2016 and March 2022 were enrolled in the analysis. Elevated systemic inflammation was defined as hsCRP>2 mg/L, and high bleeding risk (HBR) was defined the Academic Research Consortium (ARC)-HBR criteria. The primary outcome was ischemic events at 12 months, composed of cardiac death, myocardial infarction, and/or stroke. The main secondary outcomes included all-cause death, and Bleeding Academic Research Consortium (BARC) types 2, 3, and 5 bleeding and types 3, and 5 bleeding. Results Of 15,013 patients, 4606 (30.7%) were qualified as HBR and 8395 (55.9%) had hsCRP>2 mg/L. Elevated hsCRP were consistently associated with higher risk of ischemic events in both HBR (adjusted hazard ratio [aHR]: 1.20; 95% confidence interval [CI]: 0.91-1.58) and non-HBR (aHR: 1.34; 95% CI: 1.01-1.78) subgroups (P interaction=0.755). Although the bleeding events incidence was higher in HBR patients, an elevated hsCRP level was not associated with bleeding events regardless of HBR status. Restricted cubic spline regression represented an inverse J-shaped relation between hsCRP and non-HBR for ischemic events (P nonlinearity <0.001) and all-cause death (P nonlinearity = 0.003). Conclusion Regardless of HBR status, high levels of hsCRP were associated with an increased risk of ischemic events and all-cause death in ACS patients following PCI, but not for bleeding.

Non-culprit plaque healing on serial OCT imaging and future outcome in patients with acute coronary syndromes.

Histologic studies indicated that healed plaque, characterized by a multilayered pattern, is indicative of prior atherothrombosis and subsequent healing. However, longitudinal in vivo data on healed plaque formation in non-culprit plaques are limited. This study aimed to investigate serial changes and clinical significance of new layered pattern formation in non-culprit plaques in patients with acute coronary syndromes (ACS) using serial optical coherence tomography (OCT) imaging. ACS patients who underwent two OCTs at baseline and 1-year follow-up were included. Serial changes in morphologic characteristics of non-culprit plaques were evaluated. New layered pattern was defined as a new signal-rich layer on the plaque surface at follow-up that was not present at baseline. Among 553 non-culprit plaques observed in 222 patients, 82 (14.8%) exhibited a new layered pattern at follow-up. Thin-cap fibroatheroma, macrophage, and thrombus were identified as independent predictors of the new layered pattern. Plaques with new layered pattern formation showed a greater significant reduction in luminal area and lipid content, as well as a greater increase in fibrous cap thickness compared to those without. The incidence of 6-year non-culprit-related major adverse cardiac events was higher in patients with new layered pattern than in those without (25.4% vs. 10.8%, p=0.011), mainly due to clinically driven coronary revascularization. Plaque destabilization and subsequent healing frequently occur in non-culprit plaques after ACS. The formation of a new layered pattern may contribute to temporary plaque stabilization, but results in luminal stenosis and worse clinical outcomes.

Time Trends in Major Adverse Cardiovascular Events After Percutaneous Coronary Intervention: Meta-Analysis on Sex Differences.

Percutaneous coronary intervention (PCI) is considered the procedure of choice for patients with acute coronary syndrome (ACS), as it significantly improves cardiovascular outcomes. However, considerable uncertainty persists regarding the potential sex differences in PCI outcomes, due to conflicting results in previous studies. This meta-analysis aims to evaluate potential sex-related differences in cardiovascular adverse outcomes after PCI among ACS patients. The primary outcome was major adverse cardiovascular events (MACE) and its components. Outcomes were examined in various time frames including: short-term (within 1month after PCI), mid-term (within 1year), and long-term (within >1year). A random effects model was used to estimate risk ratios (RR) and 95%CIs. Among 32 trials, at short-term, PCI was associated with a higher risk of MACE (risk ratio [RR]: 1.43; 95%CI: 1.10-1.86), all-cause mortality (RR: 2.51; 95%CI: 1.70-3.71), and myocardial infarction (RR: 1.33; 95%CI: 1.00-1.77) in women compared with men. Over the long-term, women had a higher risk of MACE (RR: 1.11; 95%CI: 1.01-1.22), all-cause mortality (RR: 1.29; 95%CI: 1.17-1.42), and cardiovascular mortality (RR: 1.30; 95%CI: 1.11-1.52), when compared with men. However, the analysis for stroke and repeat revascularization showed no significant difference between the 2groups in the long- and short-term. In the meta-analysis of PCI-related trials in ACS, women have a higher risk of adverse cardiovascular outcomes compared with men.

Prognostic value of the monocyte-to-high-density lipoprotein-cholesterol ratio in acute coronary syndrome patients: A systematic review and meta-analysis.

Globally, diseases of the cardiovascular system stand as principal contributors to mortality and are expected to show an upward trajectory. The occurrence of acute coronary syndrome (ACS) has been linked to underlying inflammatory processes. The monocyte-to-high-density lipoprotein-cholesterol ratio (MHR) has garnered significant attention as a prognostic biomarker, encapsulating the synergistic roles of inflammation and lipid metabolism in the pathophysiology of cardiovascular diseases, including ACS. This meta-analysis examines the prognostic MHR ratio in ACS patients. We systematically searched PubMed, Embase, Scopus, Web of Science, and the Cochrane Library databases to identify the relevant meta-analyses published before February 26, 2024. The findings were aggregated into risk ratios with 95% confidence intervals. Eleven studies, with 7421 patients, were included. Low MHR levels compared to high MHR levels were associated with statistically significantly lower in-hospital mortality (0.9% vs. 5.5%; respectively; P <0.001), 3-month mortality (4.4% vs. 11.2%; P = 0.02), 6-month follow-up mortality (4.0% vs. 10.2%; P = 0.03), 1-year mortality (4.2% vs. 10.2%; P <0.001), as well as long-term follow-up mortality (7.5% vs. 13.7%; P <0.001). MHR has both good predictive properties for mortality and major adverse cardiovascular events (short- and long-term). Data indicate that MHR may improve in-hospital and long-term cardiovascular risk prediction. It may, therefore, be an effective tool for risk re-estimation and selection of patients for whom intensive lipid-lowering treatment may be particularly useful.

Use of SAPS 3, APACHE IV, and GRACE as prognostic scores for acute coronary syndrome patients in the cardiovascular care unit

A grading system based on disease severity has been widely used in intensive care units (ICUs) since around 1980. These systems are used to predict mortality and assess severity in clinical trials. Simplified Acute Physiology Score 3 (SAPS3) and Acute Physiology and Chronic Health Evaluation Score (APACHE IV) are prognosis ratings that can predict in-hospital mortality within the first hour of ICU care. Although these technologies have been widely employed in the ICU, they have yet to be commonly deployed in the cardiovascular care unit (CVCU) due to different patient populations. Intensive care doctors typically employ the standard prognostic scores, SAPS3 and APACHE IV, which were generated from diverse populations of critically ill patients. Although these scores are the most widely used early versions, APACHE IV and SAPS 3 do not include acute coronary syndrome patients. The Global Registry of Acute Coronary Events (GRACE) score has performed the best; this may be because of its straightforward design, which does not distinguish between individuals with SCA and those without ST-segment elevation. Our review article attempts to evaluate the performance of standard predictor scores, namely SAPS 3, APACHE IV, and GRACE, on patients with cardiovascular emergencies. Thus, these score systems can precisely assess the relationship between mortality prediction scores and outcomes of patients admitted to the CVCU rapidly and comprehensively. Keywords: Simplified Acute Physiology Score 3, Acute Physiology and Chronic Health Evaluation Score, Global Registry of Acute Coronary Events, intensive cardiovascular care unit

Cost-effectiveness of continuous real-time intracardiac recurrent event detection and alerting in high-risk acute coronary syndrome patients.

ALERTS was a pivotal randomized clinical trial (RCT) evaluating an intracardiac monitor with real-time alerting in high-risk acute coronary syndrome patients. The cost-effectiveness however is unknown. A decision model estimated health effects and costs of implanting a Guardian device in a target patient population, compared to current standard-of-care (SOC). Health and economic outcomes were modeled using ALERTS trial results and relevant literature. Base-case analysis indicated an incremental lifetime cost of $21,988 with Guardian as compared to SOC (increase of 0.18 life years or 0.37 quality-adjusted life years (QALY)). The incremental cost-effectiveness ratio (ICER) was $121,056/LY or $58,668/QALY. Real-time intracardiac monitoring with patient alerting was cost-effective using conventional thresholds in acute coronary syndrome (ACS) patients at high-risk for recurrent events.

Medication non-adherence in acute coronary syndrome patients in Duhok, Iraqi Kurdistan

Background: Adherence to long-term secondary preventive therapies is vital for improving outcomes in patients recovering from acute coronary syndrome (ACS). This study aims to quantify the extent of non-adherence to these therapies in Iraq and identify the main factors contributing to this issue, addressing a research gap in the Eastern Mediterranean region. Methods: This cross-sectional study was conducted from June 2023 to March 2024 in Cardiology Ward of Azadi Teaching Hospital and the Duhok Heart Center, Duhok, Kurdistan Region of Iraq, enrolling 400 patients diagnosed with (ACS). The Adherence in Chronic Diseases Scale (ACDS) was utilized to categorize patients into high, intermediate, or low adherence groups. The study questionnaire comprised three sections including clinicodemographic data, adherence assessment based on the ACDS, and patient-reported reasons for non-adherence. Results: The study revealed that the mean age of the participants was 65.78 ± 11.8 years. Within the sample, 24% reported low adherence, 39% reported medium adherence, and only 37% exhibited high adherence. Significant associations were observed between low adherence and older age (P = 0.026), lower education levels (P = 0.0051), and the presence of endocrine disorders (P = 0.029). Conversely, higher adherence was found among patients taking 3–5 different medication classes (P = 0.0003) and those who underwent coronary interventions (P = 0.014). The primary reason for non-adherence was forgetfulness (89.5%). Conclusion: The study concludes that a substantial portion of ACS patients in Iraq show low adherence to secondary preventive therapies. To increase adherence among patients with ACS, strategies should be developed to improve medication adherence and promote healthy behaviors simultaneously, Forgetfulness and lack of follow-up are the primary reasons for non-adherence.

Diagnosis and Management of Acute Coronary Syndrome Patients Without Obstructive Epicardial Stenosis.

What is the pathophysiology and clinical findings as well as management of patients presenting with INOCA/MINOCA (Ischemia/Myocardial Infarction with Non-Obstructive Coronary Arteries). INOCA/MINOCA has a complex pathophysiology. In this review article, we aim to summarize the complex pathophysiology and clinical diagnosis, and review the current management options.

Parsimonious versus extensive bleeding score: can we simplify risk stratification after percutaneous coronary intervention and reduce bleeding events by de-escalation of the antiplatelet strategy?

Background and aimsDue to the multitude of risk factors outlined in the guidelines, personalised dual antiplatelet therapy (DAPT) guidance after percutaneous coronary intervention (PCI) is complex. A simplified method was...

Current Status and Prospects of Regional Collaborative Pathways for Management of Acute Coronary Syndrome in Japan ― A Nationwide Survey ―

Comprehensive management of acute coronary syndrome (ACS) requires seamless treatment across institutions, including intensive care centers and local clinics. However, maintaining guideline-directed medical therapy remains challenging. One promising option to improve the situation may be the implementation of regional collaborative clinical pathways. This study evaluated the prevalence and functionality of such pathways for ACS in Japan. A nationwide survey was conducted through questionnaires and web searches, targeting all 47 prefectural managers of Japanese Circulation Association (JCA) branches. The study focused on pathways managed at the prefectural or regional levels, excluding inactive or institutional pathways. In all, 18 pathways were identified: 11 (23%) prefecture wide and 4 (9%) region wide. Most pathways included risk factor targets such as low-density lipoprotein cholesterol (LDL-C), HbA1c, and blood pressure, but only 8 pathways set an LDL-C target of <70 mg/dL. Pathways updated between 2022 and 2024 and incorporating LDL-C management protocols were considered functional. In all, 45 JCA branches viewed future ACS pathways established by the government or academic societies as potentially useful resources. Regional collaborative clinical pathways for ACS patients in Japan show variable implementation across prefectures, with approximately one-third of prefectures having established pathways. Future efforts should prioritize the establishment of comprehensive, sustainable, and standardized pathways to optimize ACS management and improve patient outcomes nationwide.

Quantitative Plaque Characteristics/Pericoronary Fat Attenuation Index and Acute Coronary Syndrome in Patients With Stable Angina Pectoris.

Vascular inflammation affects acute coronary syndrome (ACS) occurrence in patients with stable angina. Coronary inflammation can be represented by the pericoronary fat attenuation index (FAI).This study investigated the quantitative prognostic value of plaque characteristics and FAI in patients with stable angina. Risk factors for ACS occurrence in patients with stable angina pectoris were retrospectively analyzed. The diagnostic value of FAI and plaque characteristics for ACS occurrence in these patients were determined; Kaplan-Meier curves were used to predict ACS event incidence. After postpropensity score matching, data of 60 and 130 patients with and without ACS, respectively, were analyzed. Pericoronary FAI, lipid volume, and lipid percentage in the narrowest segment significantly improved ACS diagnosis in patients with stable angina. Luminal stenosis ≥50% and FAI >-88 Hounsfield units (HU) were independent risk factors for ACS occurrence in patients with stable angina. Perileft anterior descending artery (LAD) FAI >-88HU better predicted ACS occurrence in patients with stable angina than did peri-LAD FAI ≤-88HU. In patients with stable angina, lipid volume and percentage and pericoronary FAI improved the diagnostic ability of luminal stenosis for ACS occurrence. Furthermore, peri-LAD FAI >-88HU could predict ACS occurrence.

MAJOR ADVERSE CARDIOVASCULAR EVENTS IN PATIENTS PRESENTING WITH ACUTE CORONARY SYNDROME AT PAEC HOSPITAL, ISLAMABAD IN YEAR 2023

Background: Acute Coronary Syndrome (ACS) encompasses a range of serious cardiovascular conditions, including unstable angina, non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI)[ Objective: This study aimed to examine the frequency of major adverse cardiovascular events (MACE) in ACS patients at the Pakistan Atomic Energy Commission (PAEC) Hospital in Islamabad in 2023. Methodology: The study was carried out department of Cardiology, Pakistan Atomic Energy Commission (PAEC), during the period 1st Jan 2023 till 31st December 2023. Male and female patients diagnosed with ACS and received thrombolytic therapy or PCI were enrolled. The patients were followed till hospital discharge and occurrence of MACE during the hospital stay was noted. Results: A total of 215 individuals were registered. Patients were mostly male (65.11%) and with mean age 58.2 years. ST-elevation myocardial infarction (STEMI) was the most common type of ACS, at 40%, followed by NSTEMI at 34.89% and unstable angina at 25.11%. The most common symptom of ACS was chest pain (85.58%), followed by shortness of breath (30.23%). Hypertension, affecting 45.11% of the population, was followed by diabetes, 29.30% were the most prevalent risk factors. Treatment included antiplatelet drugs (90.23%) and beta-blockers (75.81%) for most patients. PCI was performed on 60.47 percent of patients, whereas thrombolysis was given to 20.47 percent. MACE was observed in 16 patients (7.4%). Conclusion: The results support earlier studies and emphasize the disease's substantial burden and the need for ongoing care and monitoring after thrombolysis and PCI.

Targeting Inflammation with Galectin-3 and PIIINP Modulation Among ST-Segment Elevation Acute Coronary Syndrome Patients Underwent Delayed Percutaneous Coronary Intervention

Targeting Inflammation with Galectin-3 and PIIINP Modulation Among ST-Segment Elevation Acute Coronary Syndrome Patients Underwent Delayed Percutaneous Coronary Intervention

Analysis of Platelet Morphological Parameters as Clinical Risk Stratification in Acute Coronary Syndrome.

Platelet activation plays a central role in the pathogenesis of acute coronary syndrome (ACS). Platelet morphological parameters, including MPV, PDW, and P-LCR, are emerging as biomarkers for predicting the severity of ACS and prognosis. This study aims to assess the relationship between these parameters and coronary severity and to evaluate their predicting adverse outcomes. A total of 134 ACS patients and 50 healthy controls were included in this prospective observational study. Platelet morphological parameters (MPV, PDW, and P-LCR) were measured at admission, and coronary artery lesion severity was determined using the Gensini score from coronary angiography. Multivariate logistic regression analysis assessed the predictive value of these platelet parameters for adverse outcomes, and ROC curve analysis was used to evaluate their diagnostic performance. MPV, PDW, and P-LCR were significantly higher in ACS patients compared to healthy controls (p < 0.001). A strong positive correlation was found between platelet parameters and the Gensini score (MPV: r = 0.778, PDW: r = 0.800, P-LCR: r = 0.761; p < 0.001). Multivariate logistic regression identified MPV (OR = 1.807, p < 0.001), PDW (OR = 1.700, p = 0.001), and P-LCR (OR = 1.287, p < 0.001) as independent predictors of advent prognosis. ROC curve analysis showed that the combined use of MPV, PDW, and P-LCR provided superior predictive accuracy (AUC = 0.927) compared to the individual parameters. Elevated platelet morphological parameters are strongly associated with coronary artery lesion severity and serve as independent predictors of adverse outcomes in ACS patients. The combined assessment of MPV, PDW, and P-LCR enhances risk stratification, offering a valuable tool for guiding therapeutics and improving prognosis in management.

Impact of geriatric nutritional risk index on clinical outcomes in acute coronary syndrome patients: a comprehensive meta-analysis.

The Geriatric Nutritional Risk Index (GNRI), derived from serum albumin levels and body weight relative to ideal body weight, is a novel tool for assessing nutritional status. This meta-analysis explored the association between GNRI and the clinical outcomes in patients with acute coronary syndrome (ACS). We systematically searched PubMed, Embase, and Web of Science for studies evaluating the GNRI in patients with ACS. Inclusion criteria were observational studies reporting all-cause mortality or major adverse cardiovascular events (MACEs) among ACS patients categorized by low versus normal GNRI. Data extraction and quality assessment were independently performed by two authors, utilizing a random-effects model to account for potential heterogeneity. Eleven cohort studies, encompassing 18 616 patients with ACS, were included. A low GNRI was associated with significantly increased risks of all-cause mortality (RR, 1.95; 95% CI, 1.63-2.34; P < 0.001; I² = 32%) and MACEs (RR, 1.93; 95% CI, 1.62-2.29; P < 0.001; I² = 25%). Subgroup analyses for the all-cause mortality outcome showed consistent findings across varied study designs, patient demographics, and follow-up periods (P for subgroup differences all >0.05). Sensitivity analyses conducted by sequentially excluding individual studies confirmed the stability of these results. A low GNRI at the time of admission is a significant predictor of increased all-cause mortality and MACEs in patients with ACS.

Knowledge, attitudes, and beliefs regarding acute coronary syndrome in patients with type 2 diabetes: a cross-sectional study

IntroductionCardiovascular diseases are one of the leading causes of mortality and disability among individuals with diabetes. Cardiac mortality in these patients is often associated with the prevalence of silent ischemia. Increasing awareness and changing patient behaviors and attitudes can reduce disease-related mortality. Therefore, this study aimed to determine the knowledge, attitudes, and beliefs regarding acute coronary syndrome in patients with type 2 diabetes mellitus (T2DM).MethodsThis cross-sectional study was conducted on 303 diabetic patients attending the Velayat and Bou Ali hospitals in Qazvin, Iran, in 2024. Inclusion criteria included a willingness to participate in the study, mental health status (based on existing records), and no history of myocardial infarction (MI). Data collection tools comprised a demographic questionnaire and the ACS Response questionnaire. Data analysis was performed using descriptive and analytical statistics, with a significance level of <0.05 for all tests.ResultsThe mean (standard deviation) scores for knowledge, attitudes, and performance of patients with T2DM were 67.46 (6.3), 62.11 (28.2), and 97.22 (5.4), respectively. In the knowledge section, the highest percentage of correct responses was related to awareness of facilities in the hospital to reduce heart attack-related damages (62.3%) and familiarity with the symptoms of arm or hand numbness (43.41%). Patients had a low attitude towards heart disease, with approximately 36.4% being somewhat or completely confident in their ability to assist others with a heart attack. Regarding performance, 45.7% of individuals believed that they should promptly go to the hospital during a heart attack. Additionally, 44.2% preferred others to transport them to the hospital during a heart attack instead of using an ambulance.ConclusionOur findings indicate that patients with T2DM lack sufficient knowledge, attitudes, and beliefs regarding the symptoms of acute coronary syndrome (ACS). Although ACS manifests through various symptoms, patients in this study primarily identified chest pain, arm pain, and shortness of breath as indicators of ACS. At the same time, over half of the participants were unaware of other symptoms. Therefore, it is essential to educate individuals about the full range of potential ACS symptoms.

The Association Between Left Ventricular Global Function Index and Major Adverse Cardiovascular Events Linked to Systemic Inflammation in Acute Coronary Syndrome.

We aimed to investigate the association between systemic inflammation and the left ventricular global function index (LVGFI) and evaluate the diagnostic performance of LVGFI for MACEs across the acute coronary syndrome (ACS) spectrum. A total of 1697 patients (794 with ST-segment elevation myocardial infarction [STEMI] and 903 with non-STEMI [NSTEMI]) were evaluated. The LVGFI was calculated using echocardiography. Inflammatory status was assessed with C-reactive protein (CRP) and the systemic immune inflammation index (SII). MACEs were defined as non-fatal re-infarction, repeated revascularization of the target vessel, and all-cause mortality at a 3-year follow-up. While the STEMI group exhibited lower LVGFI values compared with the NSTEMI group (P < .001), it had a higher SII level (P < .001) and CRP level (P = .021). The association between higher LVGFI quartiles and lower levels of systemic inflammation was more pronounced in the STEMI group. The threshold value of LVGFI to predict MACEs was <21.8% (Sensitivity = 79.2%, Specificity = 68.7%) for STEMI, while it was <25.4% (Sensitivity = 77.4%, Specificity = 70.8%) for NSTEMI. Considering both the inflammatory status and ACS spectrum when evaluating LVGFI could provide a more comprehensive assessment of cardiac function and prognosis in ACS patients.

Effect of high-quality nursing interventions on the quality of life and cardiac index in acute coronary syndrome patients treated with drug-eluting stents: a randomized trial study

BackgroundNursing care is important and necessary for Acute Coronary Syndrome patients who have undergone angiography and stenting, to minimize complications. The purpose of this study was to assess the effects of High-Quality Nursing Interventions on the quality of life and cardiac index of Acute Coronary Syndrome patients, treated with drug-eluting stents.MethodsIn this randomized trial, 70 patients of the cardiac intensive care units in one of Jahrom university of medical sciences hospitals (Iran) were selected from July 2023 to October 2023 by the available method, and randomly allocated (stochastic assignment) to two intervention (High-Quality Nursing Interventions) and control groups (routine nursing care). Quality of life and Cardiac Index were measured by cardiac index calculation formula and the McNew Cardiac Quality Questionnaire, respectively. Data were analysed using SPSS version 19 software, Mann‒Whitney, chi‒square and Wilcoxon tests, with a significance level at a p < .05.ResultsA statistically significant difference demonstrated between the mean of the quality of life and cardiac index in the intervention group(p < .05).ConclusionsHigh-Quality Nursing Interventions improved quality of life and cardiac index of Acute Coronary Syndrome patients, treated with drug-eluting stents. Therefore, it is recommended to use this nursing approach in special cardiac care units.Trial registrationIRCT79432(2024.10.08), “Retrospectively registered”.

The correlation between serum MHR and NLR and the severity of coronary lesions in NSTE-ACS patients of different genders.

To study the relationship between the monocyte/high-density lipoprotein cholesterol ratio (MHR) and neutrophil-to-lymphocyte ratio (NLR) and coronary artery stenosis in Non-st-elevation acute coronary syndromes (NSTE-ACS) patients of different genders. A total of 253 control and 800 NSTE-ACS patients were included, and clinic data (29 items) were also collected. NSTE-ACS patients were divided into low-risk (0-23) and high-risk (≥ 23) groups based on the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score. Then, Spearman correlation and multivariate logistic regression analyses were performed to study the associated factors of high-risk SYNTAX score in male and female NSTE-ACS patients, respectively. Finally, the receiver operating characteristic (ROC) curve was used to calculate the diagnostic value of MHR and NLR for predicting high-risk SYNTAX scores in male NSTE-ACS patients. Sixteen distinct factors differed between the high- and low-risk groups in male NSTE-ACS patients, a significantly higher number than female NSTE-ACS patients. Gout/hyperuricemia, smoking, NLR, and MHR are independent risk factors for arterial stenosis. At the same time, high-density lipoprotein and left ventricular ejection fraction (LVEF) are found to be protective factors in male NSTE-ACS patients. Fibrinogen, apolipoprotein B/A, and neutrophils are identified as independent risk factors for arterial stenosis in female NSTE-ACS patients, while LVEF and high-density lipoprotein are protective factors. Finally, combined NLR and MHR [p = 0.000, 95% confidence interval (CI) = 0.726-0.810] had better predictive efficacy on the degree of arterial vessel stenosis than NLR or MHR alone. The sensitivity and specificity of the ROC curve were 0.672 and 0.769, respectively. The combination of MHR and NLR shows potential for predicting and assessing the severity of coronary artery stenosis in male patients with NSTE-ACS.