Among Acute Coronary Syndrome Patients Research Articles

The Association between CHA2DS2-VASC Score with Increased Serum Creatinine Level in ACS Patients Undergoing PCI at RSUD Dr. Saiful Anwar Malang

Background: The current literature on the relationship between the congestive heart failure, hypertension, age, diabetes mellitus, prior stroke or TIA or thromboembolism, vascular disease, age, sex category (CHA2DS2-VASc) score and increased Serum Creatinine (SCr) among Acute coronary syndrome (ACS) patients is noticeably limited in scope. Objective: Therefore, the primary objective of this study was to assess the correlation between CHA2DS2-VASc score with increased of Serum Creatinine in patients with ACS undergoing Percutaneous coronary intervention (PCI) procedures. Material and Methods: In this study, a total of 527 participants were recruited, comprising two groups: Increased SCr level (n=159) and normal SCr level (n=368). Data pertaining to clinical information and demographic characteristics, such as gender, age, diabetes mellitus (DM), hypertension (HT), congestive heart failure (CHF), history of stroke or transient ischemic attack (TIA), and vascular disease, were gathered from various sources, including registry data and medical records, diagnostic physical examination, electrocardiography and laboratory records. Logistic regression analysis was employed to assess the association between the CHA2DS2-VASc score and the incidence of increased SCr level. Result: In our study, we observed that the CHA2DS2-VASc scores were significantly higher in the group of patients who increase SCr level compared to those who did not increase SCr level. Furthermore, our Receiver Operating Characteristic (ROC) analysis revealed that a CHA2DS2-VASc score cutoff of was determined to be the optimal threshold for estimating the increased SCr level (AUC= 0.805, 95% CI 0.762-0.848; p<0.01). Conclusion: The CHA2DS2-VASc score serves as a valuable tool for estimating the likelihood of SCr in patients undergoing PCI, offering a foundational assessment. Additionally, in PCI patients, an increase in the CHA2DS2-VASc score exceeding 3 is indicative of a heightened incidence of increased SCr level. Keyword: Acute Coronary Syndrome, CHA2DS2-VASc score, Percutaneous Coronary Intervention, Serum Creatinine Level.

Association of per- and polyfluoroalkyl substances with hepatic steatosis and metabolic dysfunction-associated fatty liver disease among patients with acute coronary syndrome

Etiology of hepatic steatosis and metabolic dysfunction-associated fatty liver disease (MAFLD) among acute coronary syndrome (ACS) remains unclear. Existing studies suggested the potential role of per- and polyfluoroalkyl substances (PFAS) in comorbidity of hepatic steatosis among ACS patients. Therefore, we conducted a cross-sectional study based on the ACS inpatients to assess the associations of plasma PFAS congeners and mixtures with hepatic steatosis and MAFLD. This study included 546 newly diagnosed ACS patients. Twelve PFAS were quantified using ultra-high-performance liquid chromatography-tandem mass spectrometry. Hepatic steatosis was defined by hepatic steatosis index (HSI). MAFLD was defined as the combination of hepatic steatosis based on the risk factor calculation with metabolic abnormalities. Generalized linear model was used to examine the associations of PFAS congeners with HSI and MAFLD. Adaptive elastic net (AENET) was further used for PFAS congeners selection. Mixture effects were also assessed with Bayesian kernel machine regression model (BKMR). Congeners analysis observed significant greater percent change of HSI for each doubling in PFOS (1.82%, 95% CI: 0.87%, 2.77%), PFHxS (1.17%, 95% CI: 0.46%, 1.89%) and total PFAS (1.84%, 95% CI: 0.56%, 3.14%). Moreover, each doubling in PFOS (OR=1.42, 95% CI: 1.13, 1.81), PFHxS (OR=1.31, 95% CI: 1.09, 1.59) and total PFAS (OR=1.43, 95% CI: 1.06, 1.94) was associated with increased risk of MAFLD. In AENET regression, only PFOS presented significant positive associations with HSI. Mixture analysis indicated significant positive associations between PFAS mixtures and HSI. This is the first study to demonstrate associations of PFAS congeners and mixtures with hepatic steatosis and MAFLD among ACS patients, which provides hypothesis into the mechanisms behind comorbidity of hepatic steatosis among ACS patients, as well as tertiary prevention of ACS.

Patterns of Dyslipidemia Among Acute Coronary Syndrome (ACS) Patients at a Tertiary Care Hospital in Lahore, Pakistan.

Dyslipidemia refers to the presence of abnormalities in lipid parameters. It has become a global issue with a high risk of cardiovascular diseases (CVDs). The aim of the investigation was to find out the pattern and prevalence of dyslipidemia among patients with the acute coronary syndrome (ACS). A cross-sectional study design was used. Data were collected using convenient sampling from 101 patients presenting with ACS, admitted at the critical care unit (CCU) / Rasheeda BegumCardiacCentre (RBCC) of Shalamar Hospital, during a 12-month period from January 2020 to December 2021. Dyslipidemia is diagnosed by testing the lipid profile when there are one or more abnormal readings of the lipid profile. Nearly 43 (42.6%) had ST-segment elevation myocardial infarction (STEMI), 27 (26.7%) had non-ST segment elevation myocardial infarction (NSTEMI), and 31 (30.7%) were categorized as unstable angina (USA). Overall dyslipidemia was present in 84 (83.2%) patients. The prevalence of dyslipidemia was 55 (65%) in male patients and 29 (34.5%) in female patients. Dyslipidemia was present in 39 (90.7%) patients with STEMI, 25 (80.6%) in the USA, and 20 (74.1%) with NSTEMI. The prevalence of dyslipidemia was quite high among ACS patients. The proportion of obese patients was also high in our study. However, dyslipidemia was more frequent in overweight patients.

Using a co-designed, self-delivered, Avatar-based patient discharge education application to improve acute coronary syndrome patient knowledge

Abstract Background 30-day rehospitalisation following heart event among acute coronary syndrome (ACS) patients remains high and is largely contributed by poor disease-related knowledge and self-management, especially in the disadvantaged patient groups such as those with low education levels and inadequate health literacy. Traditional patient education methods fail to address these issues. Purpose This study aimed to test a unique consumer co-designed discharge education application (app) on patients' knowledge and its acceptability. Methods ACS patients (unstable angina, non-STEMI or STEMI) were recruited from Royal Adelaide Hospital at South Australia during admission, provided with the app via tablet for one-month self-delivered education. The app has undergone a rigorous development process with the substantial engagement of consumers (Figure 1). App content includes the Heart Foundation Six Steps to Cardiac Recovery including disease-related knowledge, risk factor management, and ACS responses, assessed at baseline, followed by first use at discharge and one month later. Patients and cardiac nurses rated the acceptability of the app. Results Among 22 Participants 81.8% were male (n=18), with a mean age of 59.7 (10.3) years, 45.5% (n=10) had not completed high school and nearly a quarter of the participants had marginal or below marginal health literacy. The diagnosis included STEMI (n=16, 72.7%) and non-STEMI (n=5, 22.7%). The majority of participants underwent percutaneous coronary intervention (PCI) (n=21, 95.5%) Significant improvements were observed for overall coronary artery disease knowledge at one month (p=0.003) and the exercise and nutrition domains at discharge (p=0.029; p<0.001) and one month (p=0.02; p=0.003) (Figure 2). Significant improvements were also observed for ACS knowledge and beliefs at discharge (p=0.008; p=0.038) and one month (p<0.001; p=0.025) when ACS response attitude was also significantly improved at one month (p=0.036). Overall acceptability was high at 7.7/10 (n=22 nurses) and 8.3/10 (patients). The participants described the app as `clear, simple, easy to understand, as well as stimulating and interactive, better than a live person'. Conclusion This novel, self-delivered Avatar-based ACS discharge education App has the potential to provide discharge education for ACS patients even for those who have low education levels or inadequate health literacy. Results need to be confirmed in a randomised controlled trial. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): The National Heart Foundation Australia

Adherencia a la terapia antiplaquetaria y a las estatinas por pacientes con síndrome coronario agudo tras el alta

ObjectiveTo assess levels of medication adherence to antiplatelet and statins therapy among acute coronary syndrome (ACS) patients 30 days after hospital discharge and identify the main barriers to medication adherence and the main sociodemographic and clinical variables associated with treatment adherence. MethodThis was a quantitative longitudinal study. Patients admitted to hospital with ACS were included. Initially, data collection was conducted using a semi-structured interview during the hospital stay. Thirty days after hospital discharge, the Brief Medication Questionnaire was applied by phone to assess treatment adherence. Descriptive statistics were used and tests were applied to analyze the association between medication adherence and clinical and sociodemographic data. ResultsOne hundred and sixty-two patients were assessed. The Brief Medication Questionnaire test showed that 49.3% presented probable low adherence to treatment. Marital status, household income and alcohol intake showed an association with medication adherence. ConclusionsThe findings of the present study indicate high rates of probable nonadherence to medication among ACS patients 30 days after hospital discharge, this information could help nurses to choose specific nursing interventions that could improve adherence in patients’ daily routines.

Impact of prediabetes and duration of diabetes on radial artery atherosclerosis in acute coronary syndrome patients: An optical coherence tomography study

BackgroundPrediabetes (PDM) and diabetes mellitus (DM) are common among acute coronary syndrome (ACS) patients. The present study evaluated the association between diabetes status and radial artery (RA) atherosclerosis using optical coherence tomography (OCT) in ACS patients.MethodsA total of 335 ACS patients who underwent RA OCT were categorized into the DM group, the PDM group, and the normal glucose metabolism (NGM) group. OCT characteristics and clinical variables were compared.ResultsRA atherosclerotic plaques were more frequent in the PDM and DM groups than in the NGM group (38.7% vs. 33.3% vs. 16.1%, p = 0.001). Lipid and calcified plaque occurrence were significantly more common in the DM group, followed by the PDM and NGM groups (19.3% vs. 14.6% vs. 6.5%, p = 0.027; 11.8% vs. 6.5% vs. 1.1%, p = 0.009). The prevalence of microvessels in the PDM group was significantly higher (42.7% vs 23.7%, p = 0.017) than in the NGM group but was comparable to the DM group. Multivariate analysis revealed that HbA1c level and age were independent predictors of RA plaque formation and eccentric intimal hyperplasia (all p<0.05).ConclusionsRA atherosclerosis characteristics differ according to diabetes status. HbA1c level could be a useful marker for RA atherosclerosis progression in ACS patients.

A Randomized Controlled Trial on the Effect of VCO in Reducing Glucose and Body Weight in Post-Acute Coronary Syndrome Patients: A Pilot Study

The aims of this paper were to determine the effect of virgin coconut oil (VCO) on bodyweight and serum glucose level among acute coronary syndrome (ACS) patients. Various clinical trials on animal studies have found that the VCO has many beneficial effects on health. However, there have been limited published human studies on the pharmacological properties of VCO. Investigation on human subjects is extremely required in order to provide more empirical evidence to show the effect of VCO for ACS patients. Randomised single blind study conducted between March 2018 and April 2018. RCT was conducted among 70 ACS patients for 30 days. Participants in group A received their bottles containing 100 pieces of virgin coconut oil soft gels and were required to ingest 10 capsules per day (5 mL/5 gm) and continue routine treatment (diabetic diet and diabetic medication). Group B participants continued receiving routine treatment. Changes in serum fating blood sugar and body weight were identified using a paired t-test and independent t-test. A total of 70 patients participated with ages of 51 years old and older and were mostly male. The serum FBS and body weight of the intervention group that received VCO were reduced about 13.6% on day 30, from the baseline on day 1. They also had body weight reduction of about 2% with p value of less than 0.05. In contrast, the control group that only received routine treatment showed an increment of 12.1% in their serum FBS and had no changes in body weight. These reductions were noted within 30 days of consuming a daily dose of VCO (5 g every day). The properties of lauric acid and antioxidants present in the VCO composition were key players in the reduction of serum glucose levels and body weight. VCO can reduce serum glucose levels and body weight with 5 mL (5 g) of VCO per day for 30 days. Also, VCO may have a positive effect towards the glucose level and other cardiovascular risk factors.

The U-shape relationship between pulse pressure level on inpatient admission and long-term mortality in acute coronary syndrome patients undergoing percutaneous coronary intervention.

The association between pulse pressure and long‐term mortality was investigated among acute coronary syndrome (ACS) patients who received percutaneous coronary intervention (PCI). The study population included 5055 ACS patients in the Department of Cardiology of Beijing Friendship Hospital who were enrolled from January 2013 to July 2019. The median duration of follow‐up was 24 months. Multivariate Cox regression was used to analyze the relationships between PP on inpatient admission and mortalities. Non‐linear associations were studied by restricted cubic splines. Considering the heart function, the analyses were performed in the whole cohort and the LVEF > = 0.5 cohort separately. Subgroup analyses were performed according to the different diagnosis (the myocardial infarction subgroup and the unstable angina pectoris subgroup). When PP was used as categorical variable, the high PP group (≥61 mm Hg) significantly increased the risk of death compared with the intermediate PP group (50–60 mm Hg) in the both cohorts. When PP was used as continuous variable, a U‐shape relationship were found between PP and mortalities in the whole cohort (p (for nonlinearity) = .005 and .003, respectively), with reference PP level of 55 mm Hg. However, this U‐shape relationship disappeared in the LVEF > 0.5 cohort (p (for nonlinearity) = .111 and .117, respectively). The similar results were obtained in MI subgroup. From this study, the U‐shape relationships between PP level and all‐cause and cardiac mortalities were found in ACS patients who underwent PCI. The U‐shape relationships disappeared in the LVEF > 0.5 cohort. The reference PP level was 55 mm Hg.

A Novel Monocyte Subset as a Unique Signature of Atherosclerotic Plaque Rupture.

The evaluation of monocyte subset distribution among acute coronary syndrome (ACS) patients according to culprit coronary plaque morphology has never been explored. We evaluated whether there were significant differences in frequency of circulating monocyte subsets isolated from ACS patients according to optical coherence tomography (OCT) investigation of plaque erosion and rupture. We enrolled 74 patients with non-ST-elevation ACS (NSTE-ACS), 21 of them underwent OCT investigation of the culprit coronary plaque and local macrophage infiltration (MØI) assessment. As control, we enrolled 30 chronic coronary syndrome (CCS) patients. We assessed the frequency of monocyte subsets in the whole study population, in reliance on their CD14 and CD16 expression (classical, CM: CD14++CD16–; intermediates, IM: CD14++CD16+; non-classical, NCM: CD14+CD16++). Then, we tested the effect of lipopolysaccharide (LPS) (a CD14 ligand) on peripheral blood mononuclear cells (PBMCs) of NSTE-ACS patients, quantifying the inflammatory cytokine levels in cell-culture supernatants. Our data proved that monocyte subsets isolated from NSTE-ACS patients represent a peculiar biological signature of the pathophysiological mechanism lying beneath atherosclerotic plaque with a ruptured fibrous cap (RFC) as compared with plaque erosion. Moreover, the magnitude of LPS-mediated effects on IL-1β, IL-6, and IL-10 cytokine release in cell-culture supernatants appeared to be greater in NSTE-ACS patients with RFC. Finally, we described a fourth monocyte population never explored before in this clinical setting (pre-classical monocytes, PCM: CD14+CD16–) that was prevalent in NSTE-ACS patients as compared with CCS and, especially, in patients with RFC and culprit plaque with MØI.

A meta-analysis of randomised controlled trials investigating the impact of colchicine on major adverse cardiovascular events in acute coronary syndrome

Abstract Background/Introduction Colchicine has been shown to reduce inflammation and has a potential to stabilise atherosclerotic plaques. Prior meta-analyses on the topic suggest its role in reducing components of major adverse cardiovascular events (MACE). Purpose The aim of the present meta-analysis was to delineate the effect of colchicine on post-PCI (percutaneous intervention) MACE among acute coronary syndrome (ACS) patients. Methods We included randomised controlled trials (RCTs) comparing colchicine to placebo in ACS patients undergoing PCI. To identify potentially relevant trials a PUBMED search was undertaken using the MESH terms “colchicine” and “cardiovascular system”. Eligible RCTs published up to November 2020 were included. Our search strategy also included presentations from the proceedings of international meetings. The primary endpoint was MACE. However, definitions of MACE varied between included studies. Study level odds ratios (ORs) and 95% confidence intervals (CI) of MACE were pooled using the Mantel-Haenszel method and random effects model. Forest plots were generated using Review Manager (RevMan) 5.4 software. Results Our initial search identified 1,049 articles for potential inclusion. Of them, 4 RCTs were found to be eligible: COPS, COLCHICINE-PCI, COLCOT time-to-Initiation (TTI) 0–3 days and PODCAST-PCI. A pool of 2,709 patients were randomly allocated to treatment with either colchicine (n=1,367) or placebo (n=1,342). Patients received colchicine either prior to angiography or within 3 days post-procedure. Follow up duration ranged from 30 days to 3 years during which MACE were recorded. Mean age of the whole analysed cohort was 60.3±10.5 years. 73% were male. 51% had history of hypertension, 26% had diabetes mellitus, 38% were current smokers. There were 89 events in the colchicine group as opposed to 133 events in the placebo group. The risk of post-PCI MACE was lower in patients treated with colchicine as compared with placebo (OR 0.63, 95% CI 0.48–0.84, p=0.001) (see figure 1). Heterogeneity was not detectable (I2=0). Conclusions Our results indicate lower risk of MACE in patients treated with colchicine. This indicates a potential use of colchicine in patients undergoing PCI in an ACS setting. Further investigations in larger cohorts are warranted to test this effect. Funding Acknowledgement Type of funding sources: None. Figure 1

Greater Change in the Eicosapentaenoic Acid to Arachidonic Acid Ratio Is Associated With Decreased Incidence of Cardiovascular Events in Acute Coronary Syndrome Patients With Elevated Triglyceride Levels.

This study investigated whether the percentage change (%Δ) in the eicosapentaenoic acid to arachidonic acid (EPA/AA) ratio is associated with cardiovascular event rates among acute coronary syndrome (ACS) patients receiving contemporary lipid-lowering therapy other than polyunsaturated fatty acids (PUFAs).Methods and Results:This post hoc subanalysis of the HIJ-PROPER study included PUFA-naïve patients for whom EPA/AA ratio data were available at baseline and after 3 months. Patients were categorized into 2 groups based on the median %ΔEPA/AA ratio: Group 1, change less than the median; and Group 2, change greater than or equal to the median. The 3-year rates of the primary endpoint, a composite of all-cause death, non-fatal myocardial infarction, non-fatal stroke, and unstable angina pectoris, were compared between the 2 groups. The median %ΔEPA/AA ratio in Groups 1 and 2 was -26.2% (n=482 patients [49.9%]) and 42.2% (n=483 patients [50.1%]), respectively. At the 3-year follow-up, the occurrence of the primary endpoint was significantly lower in Group 2 than in Group 1 (29/483 [6.0%] vs. 53/482 [11.0%]; hazard ratio 0.53, 95% confidence interval 0.33-0.82; P=0.005). The same trend was observed after adjusting for patient factors (P=0.02). Among ACS patients receiving contemporary lipid-lowering therapy other than PUFAs, a greater change in the EPA/AA ratio was associated with a lower incidence of cardiovascular events.

Prasugrel versus ticagrelor in patients with acute coronary syndrome undergoing percutaneous coronary intervention; a meta-analysis of randomized controlled trials

Abstract Background Dual antiplatelet therapy (DAPT) with ASA and a P2Y12 inhibitor is the cornerstone of anti-thrombotic therapy for patients undergoing PCI. The 2014 European Society of Cardiology (ESC)/European Association for Cardio-Thoracic Surgery (EACTS) guidelines on myocardial revascularization recommend DAPT with prasugrel or ticagrelor over clopidogrel, however, a comparison between the efficacy in reducing all cause mortality and major bleeding of prasugrel versus ticagrelor is sparse. Objectives To perform a meta-analysis of randomized controlled trials (RCT) in the determination of the efficacy and safety of prasugrel as compared to ticagrelor among ACS patients undergoing PCI. Methods Extensive search of PubMed, Cochrane Library, Ovid, EMBASE, Google scholar, Medline and Herdin was done up to November 2019. Studies were limited to RCTs comparing ticagrelor vs. prasugrel among acute coronary syndrome (ACS) patients undergoing PCI. Outcome measures include all-cause mortality and major bleeding. Statistical analysis was done using Review manager V5.3. Results Thirteen RCTs with 6086 patients were included in this study. Pooled analysis using random effects model showed no difference in reduction of all-cause mortality between prasugrel versus ticagrelor (92 vs 107, RR of 0.77, 95% CI of 0.58–1.02, p-value of 0.07, I2 of 0%). Likewise, major bleeding (using BARC and TIMI as defined by the Bleeding Academic Research Consortium scale and Thrombolysis in Myocardial Infarction definitio) was similar between prasugrel and ticagrelor (91 vs 111, RR of 0.83, 95% CI of 0.63–1.09, p-value of 0.18, I2 of 0%). Conclusion There were no significant differences in the reduction of all cause mortality and major bleeding among ACS patients undergoing PCI receiving prasugrel versus ticagrelor. Our study may support the equal recommendation of both P2Y12 inhibitors as in the above guidelines. Funding Acknowledgement Type of funding source: None

Depression in Acute Coronary Syndrome Patients: A Cross-sectional Study in Malaysia

Background and purpose: Linked with high mortality rate, depression is common among acute coronary syndrome (ACS) patients. The current study sought to identify the factors associated with depression among ACS patients in Malaysia.&#x0D; Materials and Methods: A cross-sectional study was conducted on 400 ACS patients in two Malaysian hospitals: Hospital Universiti Sains Malaysia (USM), Kelantan and Hospital Sultanah Nur Zahirah (HSNZ), Terengganu. ACS patients were included if they were above 18 years of age, able to read and/or write in Bahasa Melayu language and had informed consent. Patients were excluded if they were intubated, had an altered mental status, mental retardation and had psychological problems prior to ACS. Depression in this study was defined as having dysphoria, hopelessness, devaluation of life, self-deprecation, lack of interest or involvement, anhedonia, and inertia among ACS patients. A questionnaire was distributed to all 400 ACS patients. Simple and multiple logistic regressions were used for data analysis.&#x0D; Results: The mean (standard deviation) age of ACS patients was 60.4 (11.3) years at Hospital USM and 61.2 (10.4) years at HSNZ. Nearly all of the depressive-ACS patients were Malay (79.4%), 85.9% were male, and 79.7% were married. Approximately 87.7% of depressive-ACS patients had ischemic heart disease, 87.1% had stroke, 83.4% had hyperlipidaemia, 81.8% had diabetes mellitus, and 80.7% had hypertension. The factors associated with depression were female gender (adjusted odd ratio (OR): 2.48, 95% confidence interval (CI): 1.50, 4.10, p&lt;0.001) and ischemic heart disease (adjusted OR: 2.44, 95% CI: 1.41, 4.25, p=0.002).&#x0D; Conclusion: The results showed that female gender and ischemic heart disease were the most significant associated factors of depression among ACS patients.

Sex Difference in Risk Factors, GRACE Scores, and Management among Post-Acute Coronary Syndrome Patients in Sri Lanka.

Objective To assess sex-based differences in the prevalence of risk factor, their management, and differences in the prognosis among acute coronary syndrome (ACS) in Sri Lanka. Methods Patients diagnosed with ACS were recruited from hospitals throughout the island. The Joint European Societies guidelines were used to assess recommended targets for coronary heart disease risk factors, and the GRACE score was used to assess the post-ACS prognosis. Age-adjusted regression was performed to calculate odds ratios for men versus women in risk factor control. Results A total of 2116 patients, of whom 1242 (58.7%) were men, were included. Significant proportion of women were nonsmokers; OR = 0.11 (95% CI 0.09 to 0.13). The prevalence of hypertension (p < 0.001), diabetes (p < 0.001), and dyslipidemia (p=0.004) was higher in women. The LDL-C target was achieved in a significantly higher percentage of women (12.6%); OR = 0.33 (95% CI 0.10 to 1.05). When stratified by age, no significant differences were observed in achieving the risk factor targets or management strategies used except for fasting blood sugar (p < 0.05) where more men achieved control target in both age categories. Majority of the ACS patients had either high or intermediate risk for one-year mortality as per the GRACE score. In-hospital and 1-year mean mortality risk was significantly higher among men of less than 65 years of age (p < 0.05). Conclusions Smoking is significantly lower among Sri Lankan women diagnosed with ACS. However, hypertension, diabetes, and dyslipidemia were more prevalent among them. There was no difference in primary and secondary preventive strategies and management in both sexes but could be further improved in both groups.

A Boosted Ensemble Algorithm for Determination of Plaque Stability in High-Risk Patients on Coronary CTA

ObjectivesThis study sought to identify culprit lesion (CL) precursors among acute coronary syndrome (ACS) patients based on qualitative and quantitative computed tomography–based plaque characteristics. BackgroundCoronary computed tomography angiography (CTA) has been validated for patient-level prediction of ACS. However, the applicability of coronary CTA to CL assessment is not known. MethodsUtilizing the ICONIC (Incident COroNary Syndromes Identified by Computed Tomography) study, a nested case-control study of 468 patients with baseline coronary CTA, the study included ACS patients with invasive coronary angiography–adjudicated CLs that could be aligned to CL precursors on baseline coronary CTA. Separate blinded core laboratories adjudicated CLs and performed atherosclerotic plaque evaluation. Thereafter, the study used a boosted ensemble algorithm (XGBoost) to develop a predictive model of CLs. Data were randomly split into a training set (80%) and a test set (20%). The area under the receiver-operating characteristic curve of this model was compared with that of diameter stenosis (model 1), high-risk plaque features (model 2), and lesion-level features of CL precursors from the ICONIC study (model 3). Thereafter, the machine learning (ML) model was applied to 234 non-ACS patients with 864 lesions to determine model performance for CL exclusion. ResultsCL precursors were identified by both coronary angiography and baseline coronary CTA in 124 of 234 (53.0%) patients, with a total of 582 lesions (containing 124 CLs) included in the analysis. The ML model demonstrated significantly higher area under the receiver-operating characteristic curve for discriminating CL precursors (0.774; 95% confidence interval [CI]: 0.758 to 0.790) compared with model 1 (0.599; 95% CI: 0.599 to 0.599; p < 0.01), model 2 (0.532; 95% CI: 0.501 to 0.563; p < 0.01), and model 3 (0.672; 95% CI: 0.662 to 0.682; p < 0.01). When applied to the non-ACS cohort, the ML model had a specificity of 89.3% for excluding CLs. ConclusionsIn a high-risk cohort, a boosted ensemble algorithm can be used to predict CL from non-CL precursors on coronary CTA.

Adherence to antiplatelet and statin therapy by patients with acute coronary syndrome following discharge.

To assess levels of medication adherence to antiplatelet and statins therapy among acute coronary syndrome (ACS) patients 30 days after hospital discharge and identify the main barriers to medication adherence and the main sociodemographic and clinical variables associated with treatment adherence. This was a quantitative longitudinal study. Patients admitted to hospital with ACS were included. Initially, data collection was conducted using a semi-structured interview during the hospital stay. Thirty days after hospital discharge, the Brief Medication Questionnaire was applied by phone to assess treatment adherence. Descriptive statistics were used and tests were applied to analyze the association between medication adherence and clinical and sociodemographic data. One hundred and sixty-two patients were assessed. The Brief Medication Questionnaire test showed that 49.3% presented probable low adherence to treatment. Marital status, household income and alcohol intake showed an association with medication adherence. The findings of the present study indicate high rates of probable nonadherence to medication among ACS patients 30 days after hospital discharge, this information could help nurses to choose specific nursing interventions that could improve adherence in patients' daily routines.

Relation of White Blood Cell Count to Bleeding and Ischemic Events in Patients With Acute Coronary Syndrome (from the ATLAS ACS 2-TIMI 51 Trial)

An elevated white blood cell (WBC) count is associated with an increased risk of ischemic events among acute coronary syndrome (ACS) patients, but the association between WBC count and bleeding in ACS patients is not well established. The aim of this analysis was to assess and compare the association between WBC count and the occurrence of short- and long-term bleeding and ischemic events. This was a post hoc analysis of the ATLAS ACS2-TIMI 51 trial. A subset of patients had a WBC count measurement at baseline (n = 14,231, 91.6%). Univariate and multivariable Cox proportional hazard models were constructed to determine if there is an association between WBC count at baseline and a composite outcome of Thrombolysis in Myocardial Infarction (TIMI) major and minor bleeds at 30 days and 1 year. Variables with a p <0.2 in the univariate analysis were included as potential parameters in the backward selection process A similar multivariable model was constructed to assess the association between WBC count and a composite ischemic endpoint of cardiovascular death, myocardial infarction and stroke. An increased risk of bleeding per a 1 × 109/L increase in WBC at baseline was observed at 30 days (Adjusted hazard ratio [HR] 1.08 95% confidence interval [CI] 1.01 to 1.17, p = 0.019) but not at 1 year (Adjusted HR 1.02 95% CI 0.97 to 1.08, p = 0.409). Additionally, an increased risk of ischemia per a 1 × 109/L increase in WBC at baseline was observed at 30 days (Adjusted HR 1.07, 95% CI: 1.03 to 1.12, p = 0.002) and at 1 year (Adjusted HR 1.05 95% CI 1.02 to 1.08, p = 0.001 at 1 year). In conclusion, a higher WBC count at baseline was associated with an increased risk of the composite bleeding endpoint by 30 days but not at 1 year. The association between WBC count and the risk of the composite ischemic endpoint was significant at 30 days and 1 year.

Prevalence of familial hypercholesterolemia in patients with acute coronary syndrome in Japan: Results of the EXPLORE-J study

Background and aimsPrevalence of familial hypercholesterolemia (FH), a common genetic disorder with a high risk for coronary artery disease (CAD), is high among CAD patients; however, data on FH prevalence among acute coronary syndrome (ACS) patients are limited. EXPLORE-J is the largest registry to diagnose FH among Japanese ACS patients using the 2012 Japan Atherosclerosis Society guidelines. MethodsThis prospective study consecutively recruited patients between April 2015 and August 2016 at 59 sites. Low-density lipoprotein cholesterol (LDL-C) levels, family history of premature CAD, presence of tendon xanthomas, and Achilles tendon radiograms were recorded at baseline. The prevalence rate of FH in patients with ACS was estimated with 95% CI. ResultsOf 1944 analyzed patients (mean age, 66.0 years; men, 80.3%), 52 (2.7% [95% CI: 2.0–3.5]) had FH. Thirty-one (1.6%) had LDL-C ≥180 mg/dL and Achilles tendon thickness (ATT) ≥9 mm, 8 (0.4%) had LDL-C ≥180 mg/dL and family history of premature CAD, 10 (0.5%) had ATT ≥9 mm and family history of premature CAD, and 3 (0.2%) met all the criteria. FH patients were younger than those without FH (59.5 [12.5] vs. 66.2 [12.1] years; p < 0.001). More patients with premature ACS (men, <55 years; women, <65 years) than without (4.7% [95% CI: 2.9–7.2] vs. 2.1% [1.4–3.0]) had FH. ConclusionsFH prevalence is at least five-fold higher in ACS patients than in the general population, especially in patients with premature ACS onset and ATT ≥9 mm. FH screening in ACS patients is therefore clinically important and critical.

Erectile dysfunction severity as a predictor of left main and/or three-vessel disease in acute coronary syndrome patients

BackgroundCoronary artery disease (CAD) is a leading cause of morbidity and death. Early diagnosis of patients with left main and/or three-vessel disease (LM/3VD) among acute coronary syndrome (ACS) patients is beneficial. The relation between erectile dysfunction (ED) and cardiovascular diseases was previously noticed. The aim of our work was to find out if the severity of ED could predict the presence of LM/3VD in ACS patients. Patients and methodsEighty-five male patients with ACS were included in the study. Clinical assessment, estimation of international index of erectile function (IIEF) score, and coronary angiography were performed in all patients. Gensini score was calculated to assess the severity of CAD. Based on IIEF score, the patients were divided into two groups: Group 1: patients with mild or no ED (IIEF score ≥17), Group 2: patients with moderate or severe ED (IIEF score <17). ResultsPatients with IIEF score <17 had significantly higher prevalence of LM CAD (4.3% versus 18.4%, p=0.035), 3VD (17% versus 39.5%, p=0.021) and LM/3VD (21.3% versus 55.3%, p=0.0012), as well as higher mean Gensini score (23.5±10.8 versus 34.1±12.7, p=0.0001). The independent predictors of LM/3VD in order of significance were: age, heart rate, IIEF <17, Killip class >1, and ST-depression or ST-elevation in lead aVR ≥1mV. There was a significant negative correlation between IIEF score and Gensini score (r=−0.383, p=0.0003). ConclusionThe presence of moderate or severe ED in men with ACS is associated with higher Gensini score and more incidence of LM/3VD. IIEF score <17 was an independent predictor of LM/3VD.

Pengaruh Kadar Gula Darah terhadap Kejadian Reinfart dan Kematian pada Penderita Sindroma Koroner Akut

Recent decades data relates between admission hyperglycemia and mortality that increase among acute coronary syndrome(ACS) patients. Aim of study is to assess relationship between hyperglycemia and Cardiac Event, i.e. death, reinfarction among ACS patients. This is a prospective cohort study, which was held on March to April 2014 among 83 ACS patients in CVCU Wahodin Sudorohusodo Hospital. Patients was grouped into two groups, hyperglycemic ACS group and normoglycemic one. Reinfarction and death events at each group was observed within first 30 days after infarction. In this study, it found death and reinfarction events were higher in hyperglycemic group than in normoglycemic group (22 vs 4, RR = 3.7, p=0.026 for death event, and 14 vs 1, RR =8.7, p=0.03 for reinfarction). Conclusion of this study was hyperglycemia is related to reinfartion and death events among ACS patients.