Artery Acute Coronary Syndrome Research Articles

An Observational Study of the Incidence and Risk Factors of Multivessel Coronary Artery Disease in Patients with Acute Coronary Syndrome Presenting at a Tertiary Care Hospital India.

To study the clinical and demographic characteristics of the patients with symptomatic acute coronary syndrome (ACS). To determine the outcomes in terms of single-vessel disease (SVD), double-vessel disease (DVD), and triple-vessel disease (TVD) among the patients. To determine the risk factors of TVD. A prospective observational study was conducted on 111 patients with ACS. Demographic and clinical profiles of the patients were noted. Patients with unstable angina (UA) and asymptomatic patients were excluded from the study. Outcomes were noted in terms of the involvement of the number of coronary vessels and the risk factors of TVD. The mean age of the patients was 55.7 ± 13.7 years, with 75.68% males and 24.32% females. Chest pain was the most common symptom in 69 (62.16%) cases. SVD, DVD, and TVD were seen in 64 (42.30%), 17 (23.40%), and 30 (34.20%) patients, with the most common vessel involved being the left anterior descending (LAD) artery. Fatigue was predominantly found in SVD, chest pain was predominantly found in DVD, and shortness of breath was the most common symptom in TVD, with a p-value of 0.049. Univariate logistic regression showed that none of the factors among age, gender, comorbidities, and family history were significant independent risk factors for TVD. It can be concluded that ACS patients are predominantly elderly males with comorbidities like diabetes, hypertension, a family history of heart disease, and dyslipidemia. The LAD was the most commonly involved coronary artery in ACS. The occurrence of SVD surpassed DVD and TVD among ACS patients. None of the risk factors was significantly associated with TVD independently.

Case report of spontaneous coronary artery dissection in a 50‑year‑old man

BackgroundSpontaneous Coronary Artery Dissection (SCAD) is an acute coronary event of uncertain origin. SCAD occurs when the coronary artery wall dissects non-traumatically and non-atherosclerotically, leading to the formation of an intramural hematoma or intimal tear, ultimately compressing and restricting the true lumen, or even occluding it. The management of SCAD remains controversial despite modern imaging techniques. In addition to supportive drug therapy, percutaneous coronary intervention (PCI) is another option that can be used as an effective treatment modality.Case presentationWe describe A 50-year-old male with SCAD presented to the hospital emergency department complaining of chest pain. Coronary angiography incidentally showed spiral dissection from the proximal to distal right coronary artery (RCA). Three overlapping coroflex stents were deployed from the distal to the proximal RCA.ConclusionsTo stabilize the coronary artery in Acute Coronary Syndrome (ACS) patients due to SCAD, prompt interventions such as stenting and angioplasty are needed. However, it is necessary to pay attention to the clinical condition of patients and quick diagnosis for the recovery of patients and reduction of complications.

Percutaneous coronary interventions for aneurysmatic right coronary artery in acute coronary syndrome: RIGHTMARE registry outcomes

BackgroundThe optimal strategy during percutaneous coronary intervention (PCI) of aneurysmatic right coronary artery (ARCA) remains uncertain and has never been tested in the acute setting. ObjectivesTo compare the in-hospital and long-term outcomes of immediate and staged PCI strategies for ARCA as culprit lesions during acute coronary syndrome (ACS). MethodsAmong 102.376 PCIs performed in 18 European centers, a total of 85 patients presenting with acute coronary syndrome undergoing ARCA PCI were finally included in the analysis. PCI strategy (stenting performed during the immediate vs staged procedure) and pharmacological approach adopted were collected. The primary outcome was procedural success (technical success without in-hospital MACE). ResultsThe primary outcome occurred in 48.2 % of cases, with no significant differences observed between the immediate and staged PCI groups (50.9 % vs 43.3 %, p = 0.504). Patients in the staged-PCI group had a significantly higher rate of intravenous anticoagulant use (83.3 % vs 48.1 %, p = 0.002), BARC type 3 and 5 bleedings (12.9 % vs 1.9 %, p = 0.037), and longer in-hospital stay (7.40 ± 5.11 vs 9.5 ± 5.25 days, p = 0.049). After multivariate analysis, no independent predictors for procedural success were found in either group. Target lesion failure occurred in 24.1 % of cases without differences between groups at a median follow-up of three years. ConclusionsAmong patients undergoing ARCA PCI in the setting of ACS, immediate or staged PCI were associated with similar in-hospital and long-term outcomes. However, staged PCI was associated with a higher risk of major bleeding events and longer length of stay compared to immediate PCI strategy.

Complete versus partial revascularization for older adults with acute coronary syndrome: a meta-analysis and systematic review of randomized and multivariable adjusted data.

Evidence from randomized studies support complete over culprit-only revascularization for patients with acute coronary artery syndrome (ACS) and multivessel coronary artery diseases (MVD). Whether these findings extend to elderly patients, however, has not been thoroughly explored. We conducted a systematic review and meta-analysis comparing clinical outcomes of elderly individuals (defined as age ≥75 years) with ACS and MVD submitted to complete vs partial-only percutaneous coronary intervention (PCI). PubMed, Embase, and Cochrane were searched. We computed pooled hazard ratios with 95% confidence intervals (CI) to preserve time time-to-event data. We included 7 studies, of which 2 were RCT and 5 were multivariable adjusted cohorts, comprising a total 10 147, of whom 43.8% underwent complete revascularization. As compared with partial-only PCI, complete revascularization was associated with a lower all-cause mortality (hazard ratio 0.71; 95% CI 0.60-0.85; P < 0.01), cardiovascular mortality (hazard ratio 0.64; 95% CI 0.52-0.79; P < 0.01), and recurrent myocardial infarction (hazard ratio 0.65; 95% CI 0.50-0.85; P < 0.01). There was no significant difference between groups regarding the risk of revascularizations (hazard ratio 0.80; 95% CI 0.53-1.20; P = 0.28). Among elderly patients with ACS and multivessel CAD, complete revascularization is associated with a lower risk of all-cause mortality, cardiovascular mortality, and recurrent myocardial infarction.

Differential Anxiety Responses in Acute Myocardial Infarction vs. COVID-19 Pneumonia Patients.

Background and Objectives: Amidst the COVID-19 pandemic, concerns about the psychological impact of disease-related anxiety on public health have risen. This study aims to compare general and death anxiety levels between acute coronary artery syndrome and COVID-19 pneumonia patients. Materials and Methods: A cross-sectional study of 132 individuals, including acute myocardial infarction (MI), COVID-19 pneumonia patients, and healthy volunteers from Trakya University Hospital (Turkey), was analyzed. Validated scales like the Beck Anxiety Inventory (BAI), Coronavirus Anxiety Scale Short Form, and Thorson-Powell Death Anxiety Scale (TPDAS) were employed. Demographic data such as age, gender, income levels, employment status, presence of a close relative with COVID-19, and whether participants followed COVID-19-related news were collected and compared across groups with significance level of 0.05 set for all analyses. Results: Among 41 COVID-19, 41 MI, and 50 healthy subjects, the pneumonia group showed highest COVID-19 anxiety (p = 0.01) and BAI scores (p = 0.008). Both COVID-19 and MI patients had significantly higher BAI and TPDAS scores compared to healthy controls (p < 0.001). Factors like female gender (p = 0.004), low education (p = 0.003), current employment (p = 0.008), and low income (p = 0.002) correlated with higher BAI scores. Low income (p = 0.001) and COVID-19 news exposure (p = 0.002) correlated with higher TPDAS scores. Males and married patients had lower anxiety scores (p = 0.008). High income, education, and employment reduced anxiety levels (p = 0.008). TPDAS scores decreased with higher income (p = 0.001), but increased in the MI group (p = 0.002) with COVID-19 news exposure. The multivariate linear regression analysis found that MI and COVID-19 pneumonia were associated with TPDAS; female gender, university education, and COVID-19 pneumonia with the Beck scale; and COVID-19 pneumonia with anxiety scores on the COVID-19 Anxiety scale. Conclusions: This research showcases differing anxiety patterns between illnesses such as MI and COVID-19 pneumonia amidst the pandemic, emphasizing the amplifying influence of media coverage on death-related anxieties. It underscores the imperative of targeted interventions and socioeconomic considerations in managing psychological consequences and formulating responsive public health strategies.

The Heart Does Not Itch, But it Feels Pain: Three Cases of Kounis Syndrome

Background: Kounis syndrome is defined as the occurrence of acute coronary artery syndrome as a result of activation of inflammatory cells after conditions such as allergy, hypersensitivity, anaphylaxis or anaphylactic reactions. This case reports were presented to provide the latest knowledge on Kounis syndrome, increase awareness of this disease among healthcare providers and researchers, and promote early and appropriate diagnosis and management of this syndrome. Summary of Cases: In the first case, a 45-year-old female patient with no history of coronary artery disease developed anaphylaxis due to a locally applied anesthetic drug. This led to transient coronary artery vasospasm and acute coronary syndrome. In the second case, a 70-year-old male patient with a history of coronary artery disease developed anaphylaxis due to a bee sting. This caused rupture of the coronary artery plaque, resulting in inferior myocardial infarction. In the third case, a 73-year-old male patient with a stent in his coronary artery developed an allergic reaction/anaphylaxis to midazolam, which was administered for sedation before the biopsy procedure. This reaction resulted in restenosis of the old stent and caused an anterior myocardial infarction. Conclusion: Kounis syndrome is a life-threatening condition that requires attention. Ensuring coronary artery patency in the treatment of ischaemia is important to protect cardiomyocyte health and prevent arrhythmias. Ischaemia caused by allergens can be resolved with a combination of antiallergenic treatments. Therefore, for effective management of suspected cases of Kounis syndrome, collaboration between cardiology and allergy-immunology clinics is essential.

Early β-blocker use and in-hospital outcomes in patients with chronic obstructive pulmonary disease hospitalized with acute coronary syndrome: findings from the CCC-ACS project.

Patients with chronic obstructive pulmonary disease (COPD) after acute coronary artery syndrome (ACS) are at an increased risk of heart failure and death. However, β-blockers have been underused in this population group due to concerns of adverse reactions. This study aims to investigate the β-blocker prescription at admission and its impact on the in-hospital outcomes in patients with COPD after ACS in a Chinese national cohort. Among 113,650 patients with ACS enrolled in the national registry of the Improving Care for Cardiovascular Disease in China between November 2014 and July 2019, a total of 1,084 ACS patients with COPD were included in this study. The primary endpoint was in-hospital mortality, and the secondary endpoint was the composite of in-hospital all-cause death and heart failure. Early oral β-blocker therapy was administered to 49.8% of patients. The Kaplan-Meier analysis showed that the early β-blocker treatment group had lower all-cause mortality (0.9% vs. 2.9%; P < 0.05) and lower combined endpoint event rate (8.2% vs. 12.0%; P < 0.05) compared to the those of the non-early β-blocker treatment group. The analysis of inverse probability of treatment weighting showed that the early β-blocker treatment group was associated with a significantly reduced incidence of all-cause death (risk ratio, 0.332, 0.119-0.923, P = 0.035), heart failure (risk ratio, 0.625, 95% CI 0.414-0.943, P = 0.025), and combined endpoint events (risk ratio: 0.616, 95% CI: 0.418-0.908, P = 0.014). In the subgroup of patients over 70 years of age, the corresponding hazard ratio was 0.268 (95% CI 0.077-0.938) for all-cause mortality and 0.504 (95% CI 0.316-0.805) for combined endpoint events. β-blockers have been underused in patients with COPD and ACS in China. Early β-blocker therapy is associated with an improvement in in-hospital outcomes in patients with COPD after ACS. ClinicalTrials.gov, identifier (NCT02306616).

Treatment of ectatic coronary arteries in acute coronary syndromes

Treatment of ectatic coronary arteries in acute coronary syndromes

Monocyte-to-High Density Lipoprotein Cholesterol Ratio Positively Predicts Coronary Artery Disease and Multi-Vessel Lesions in Acute Coronary Syndrome.

We investigated the hypothesis that MHR (monocyte-to-high density lipoprotein cholesterol ratio) is related to the severity of coronary artery in ACS (acute coronary syndrome). In this case-control study, we recruited 15,853 participants undergoing the first time percutaneous coronary intervention (PCI) including 4093 normal controls, 10,518 chronic coronary artery disease (CAD), and 1242 ACS cases. Examination of demographic clinical data and biochemical profiles, as well as MHR values, were performed before PCI. The relationship between MHR and severity of coronary artery lesion in ACS was analyzed. We also used a flow cytometric assay to distinguish CD14+/CD16- classical monocyte subsets in peripheral blood mononucleated cells from CAD patients. MHR was higher in patients with ACS compared with MHR in normal control and chronic CAD (normal control vs chronic CAD vs ACS: 0.46 ± 0.27 × 109/mmol vs 0.53 ± 0.29 × 109/mmol vs 0.73 ± 0.47 × 109/mmol, P < 0.001). MHR showed a significantly progressive increase as the angiographic severity of coronary lesions increased (single vessel lesion vs multi-vessel lesions in ACS: 0.54 ± 0.31 × 109/mmol vs 0.58 ± 0.35 × 109/mmol, P < 0.001), and classical monocyte subset to HDL-C ratio (CMHR) was increased in with CAD patients compared with control [4.69 (IQR, 1.06, 2.97) × 103/mmol vs 1.92 (IQR, 0.92, 3.04) × 103/mmol, P = 0.02]. Using a multivariate analysis, after adjusting for age, gender, body mass index (BMI), diabetes, and dyslipidemia, MHR was positively associated with multi-vessel lesions in ACS [OR (odds ratio): 1.28 (95% CI: 1.03-1.59, P = 0.029)]. MHR level could be a potential predictor of coronary artery lesion severity in ACS.

Case Study: Determination of Incidence of Hyperuricemia among patients suffering from Acute Coronary Artery Syndrome

In the vast majority of nations across the globe, coronary artery disease (CAD) remains the leading cause of mortality. It is among the most widely recognized global health concerns affecting both sexes. The worldwide impact of CAD is severe, and its consequences are particularly pronounced in countries with higher incidence rates. In Western nations, myocardial infarction outcomes are often linked to socioeconomic status, with those in lower socioeconomic positions disproportionately affected by the burden of this disease. Given the high rates of morbidity and mortality associated with acute myocardial infarction (MI), this condition continues to be a major focus of cardiovascular therapy. The present study sheds new light on the issue, as the findings differ from previous research due to demographic, nutritional, and lifestyle differences. The dissemination of these findings to the medical community will be critical to informing future research and better understanding how to recognize and treat hyperuricemia in ACS patients. This study has important implications for public health policy and clinical practice. By improving our understanding of the complex interplay between socioeconomic factors and cardiovascular health, we can develop more targeted interventions and improve outcomes for those at the highest risk of CAD and related conditions. This study was performed at the Cardiology Department of Khyber Teaching Hospital, Peshawar for six months, from 19th July 2022 to 19th January 2023. It was a cross-sectional study in which 360 male and female patients aged between 30-60 years were included with acute coronary syndrome. Clinical history, physical examination, and laboratory investigations, including troponin test and ECG results, were adequately monitored. At the time of admission, all patients’ blood samples were collected and biochemically analyzed to determine serum uric acid (SUA) levels at Khyber Teaching Hospital. Men with uric acid levels over 7 mg/dl and women with uric acid levels exceeding 6 mg/dl have hyperuricemia. This study reveals a mean age of 52 years with a SD ±11.74. 63 % of patients were male, and 37% were female. Moreover, 35% of patients had hyperuricemia, and 65% didn’t. Our study concludes that the frequency of hyperuricemia was 35% in patients presenting with acute coronary syndrome to the Cardiology Department of Khyber Teaching Hospital, Peshawar.

Prevention and Treatment of Acute Coronary Artery Syndrome

Acute coronary syndrome(ACS) refers to a group of clinical symptoms caused by acute myocardial ischemia, including unstable angina pectoris, acute myocardial infarction, and sudden ischemic death. In recent years, studies have shown that the main mechanism of its occurrence is the rupture of plaque and the consequent intravascular thrombosis. Multiple factors may lead to the occurrence of the disease. However, the mechanism of the histomorphological change from pre-fragmentation to post-fragmentation is still unclear. Vasospasm may also play an important role. Prevention of plaque formation and rupture or prevention of thrombosis by antithrombotic therapy is effective in reducing the incidence of acute coronary syndrome, and coronary intervention also reduces the mortality of acute coronary syndrome. Some new therapies, such as gene therapy, are still in the experimental stage. At the same time, people should improve the awareness of disease prevention, and the most active prevention is the best means of disease treatment.

Considering Both GLS and MD for a Prognostic Value in Non-ST-Segment Elevated Acute Coronary Artery Syndrome

Global longitudinal strain (GLS) and mechanical dispersion (MD), as determined by 2D speckle tracking echocardiography, have been demonstrated to be reliable indicators of prognosis in a variety of cardiovascular illnesses. There are not many papers that discuss the prognostic significance of GLS and MD in a population with non-ST-segment elevated acute coronary syndrome (NSTE-ACS). Our study objective was to examine the predictive utility of the novel GLS/MD two-dimensional strain index in NSTE-ACS patients. Before discharge and four to six weeks later, echocardiography was performed on 310 consecutive hospitalized patients with NSTE-ACS and effective percutaneous coronary intervention (PCI). Cardiac mortality, malignant ventricular arrhythmia, or readmission owing to heart failure or reinfarction were the major end points. A total of 109 patients (35.16%) experienced cardiac incidents during the follow-up period (34.7 ± 8 months). The GLS/MD index at discharge was determined to be the greatest independent predictor of composite result by receiver operating characteristic analysis. The ideal cut-off value was -0.229. GLS/MD was determined to be the top independent predictor of cardiac events by multivariate Cox regression analysis. Patients with an initial GLS/MD > -0.229 that deteriorated after four to six weeks had the worst prognosis for a composite outcome, readmission, and cardiac death according to a Kaplan-Meier analysis (all p < 0.001). In conclusion, the GLS/MD ratio is a strong indicator of clinical fate in NSTE-ACS patients, especially if it is accompanied by deterioration.

COVID-19 AND NEGLECT OF CARDIOVASCULAR DISEASES TREATMENT

Coronavirus was first reported as an acute respiratory syndrome in December 2019 in Wuhan, China. This infectious disease spreads rapidly in many countries , and humans worldwide, shows different symptoms of the disease. High fever, cough, and fatigue were the most common symptoms that patients with covid-19 showed.1 The COVID-19 pandemic has created unprecedented challenges for health care in many countries worldwide. In addition to patients, COVID-19 is very dangerous for health care staff at the frontline of fighting this disease. The large number of COVID-19 virus patients who need to be hospitalized puts a heavy burden on the health system of countries so the treatment of other diseases is seriously disrupted.2 Cardiovascular disease is one of the most important diseases that has been neglected due to the focus of the Covid-19 pandemic and its special conditions, including completing the capacity of clinical departments and full-time participation of hospital staff.3 Among various diseases, cardiovascular diseases are the most common and the main cause of death in the world (Estimated 17.9 million death each year) and the most important factor of disability (Generally, about eleven percent of the total disease burden).4 Despite significant advances in the field of medicine, one-third of patients who suffer from a heart attack (myocardial infarction) still die, and two-thirds of those who never survive fully recover and are unable to lead normal lives.5 There is a close relationship between COVID-19 and cardiovascular diseases so cardiovascular diseases are more common in patients with COVID-19, and these patients are at higher risk of death.6 Cardiovascular disease is associated with more severe symptoms of COVID-19 and higher mortality rates. COVID-19 can have primary cardiac involvement (arrhythmia, myocardial infarction, and myocarditis) and secondary cardiac involvement (myocardial damage/elevated biomarkers and heart failure). COVID-19 can have several effects on the cardiovascular system of patients. Acute cardiovascular complications can cause many challenges. For example, one of these challenges can be the need for a multidisciplinary heart and lung team to assess the condition of patients with severe symptoms.7,8 Currently, the outbreak of COVID-19 disease has created unprecedented pressure on patients, physicians, and in general, the health care systems of the world and led to delays in the treatment of cardiovascular patients. Delay or neglect of treatment of cardiovascular patients is associated with inevitable complications and mortality. Because the living conditions of many of them are threatening and dangerous.9 Some early signs of cardiovascular disease (shortness of breath, chest pain) in patients may be confused with COVID-19 symptoms, and the patient may be misdiagnosed.10 The COVID-19 pandemic has faced the world in a difficult position. Hospitals and health centers have been severely affected by treating patients with COVID-19. Governments are attempting to prevent further outbreak of this disease effectively. Of course, the important point is that governments should not neglect other health priorities, such as non-contagious diseases and cardiovascular diseases.11 While many efforts of medical staff to fight COVID-19 are understandable, hospitals should not forget their primary role in caring for other patients and neglecting their essential needs. Neglecting cardiovascular diseases such as congenital heart disease (CHD) and acute coronary artery syndrome will lead to irreparable damage.12 Health care systems must establish the right balance between treating patients with COVID-19 and treating cardiovascular diseases.13 It is suggested that to better control COVID-19 and balance the management of other diseases, only a certain hospital capacity should be allocated to this disease. Due to the lack of definitive treatment for COVID-19, treatment for other diseases should not be delayed.

Development and validation of a nomogram for predicting significant coronary artery stenosis in suspected non-ST-segment elevation acute coronary artery syndrome with low-to-intermediate risk stratification.

Patients with non-ST-segment coronary artery syndrome (NSTE-ACS) have significant heterogeneity in their coronary arteries. A better assessment of significant coronary artery stenosis (SCAS) in low-to-intermediate risk NSTE-ACS patients would help identify who might benefit from invasive coronary angiography (ICA). Our study aimed to develop a multivariable-based model for pretesting SCAS in suspected NSTE-ACS with low-to-intermediate risk. This prediction nomogram was constructed retrospectively in 469 suspected NSTE-ACS patients with low-to-intermediate risk. Patients were divided into a development group (n = 331, patients admitted to hospital before 1 May 2021) and a temporal validation group (n = 138, patients admitted to hospital since 1 May 2021). The outcome was existing SCAS, including left main artery stenosis ≥50% or any subepicardial coronary artery stenosis ≥70%, all confirmed by invasive coronary angiography. Pretest predictors were selected using Least Absolute Shrinkage and Selection Operator (LASSO) and stepwise logistic regression. Derivation analyses from the development group (n = 331, admitted before 1 May 2021) generated the 7 strongest predictors out of 25 candidate variables comprising smoker, diabetes, heart rate, cardiac troponin T, N-terminal pro-B-type natriuretic peptide, high-density lipoprotein cholesterol, and left atrial diameter. This nomogram model showed excellent discrimination ability with an area under the receiver operating characteristic curve (AUC) of 0.83 in the development set and 0.79 in the validation dataset. Good calibration was generally displayed, although it slightly overestimated patients' SCAS risk in the validation group. Decision curve analysis demonstrated the clinical benefit of this model, indicating its value in clinical practice. Furthermore, an optimal cut-off of prediction probability was assigned as 0.61 according to the Youden index. A prediction nomogram consisting of seven readily available clinical parameters was established to pretest the probability of SCAS in suspected NSTE-ACS patients with low-to-intermediate risk, which may serve as a cost-effective risk stratification tool and thus assist in initial decision making.

CORONARY ARTERY DISEASE IN YOUNG PAKISTANIS: RISK FACTORS AND PATTERN OF DISEASE

Objectives: To determine the distribution of risk factors and pattern of coronary artery disease among young Pakistanis presenting with acute coronary artery syndrome. A cross sectional study conducted from August 2018 to October 2019 at Department of Cardiology Jinnah Hospital Lahore.&#x0D; Methodology: Total of 150 young patients up to 40 years of age with acute coronary syndrome (ACS) was included in this study. Risk factors were evaluated on patient’s current medication history for diabetes mellitus, hypertension, lipid lowering drugs and recent reports HbA1c, total body lipids. Data was entered and analyzed in SPSS version 21.0. Socio-demographic, clinical profile and risk factors were evaluated and presented as frequency and percentages. Cross tabulation was for ACS and risk factors. Statistical significance was assessed using Chi-square test with significant value of p &lt; 0.05.&#x0D; Results: Among 150 subjects mean age was 34.20 + 4.246 with minimum age of 23 years and maximum age of 39 years. 92.0 % were male and 56.0% were having acute anterior wall STEMI, 36.0% had acute inferior Wall STEMI, 2.0% suffered from acute lateral wall STEMI, 2.7% had acute inferoposterior wall STEMI and 3.3% had NSTE-ACS. Risk factor analysis shows that 22.0% had diabetes mellitus, 20.7% had hypertension, 33.7% had a positive history of IHD in family, 71.3% were smokers, 44.0% had obesity, 66.0% had reduced HDL and 44.0 % had elevated LDL levels. Regarding pattern of coronary artery disease, 70.7% patients were having one vessel CAD, 28.0% two vessels CAD and 1.3% had three vessels CAD.&#x0D; Conclusion: Mean age of acute coronary syndrome is low amongst young Pakistani population with male predominance and acute anterior and inferior wall STEMI being most frequent diagnosis. Smoking, dyslipidemia particularly low HDL, positive family history of ischemic heart disease, hypertension, diabetes mellitus, obesity, was identified as important risk factors. Most of the patients had one vessel CAD.

ODP507 PREVALENCE OF CARDIOVASCULAR DISEASE IN PATIENTS WITH SUBCLINICAL HYPOTHYROISIM

Abstract Introduction Thyroid hormones play an essential role in maintaining cardiovascular homeostasis. Experimental studies have revealed that subtle changes in thyroid hormone levels, as observed in subclinical hypothyroidism, have adverse effects on the cardiovascular system due to predisposition to endothelial dysfunction, dyslipidemia and direct effects of thyroid hormones on the myocardium. We conducted a retrospective cohort study to elicit the role of subclinical hypothyroidism as an independent risk factor for cardiovascular diseases. Methods We conducted a retrospective analysis of 3 years of the National Inpatient Sample (NIS) database, 2016 to 2018. Study populations were selected using ICD-10 diagnosis code. Discharge-level weight analysis was used to produce a national estimate. We conducted multivariate regression analysis to calculate odds ratio with STATA 17. Results During the study period, 106,970,745 study population met the inclusion criteria and 37,215 of subclinical hypothyroidism (SCH) patients were discharged. SCH patients tended to be more female (63.48% v 56.40%), older (mean age 58.22± 0.25 v 49.48 ± 0. 01), diabetic (24.84% v 21.47%) and obese (18.63% v 13.54%). Prevalence of hyperlipidemia and hypertension were similar in both SCH and non-SCH groups (3.75% v 3.24% and 29. 09% v 29.35% each). Caucasian patients were predominant in both groups with similar ethnicity distribution (62.26% v 64.96%). 3.56% of SCH patient had acute coronary artery syndromes (ACS), whereas 2.78% of non-SCH patients developed the ACS. For the patients without history of heart failure (HF), 2.54% of SCH patients developed new onset of HF, whereas 1.11% of non-SCH patients developed HF. After adjusting for age, sex, race and comorbid burden, SCH is not associated with ACS (p = 0.375) or Afib (p= 0.74) but associated with elevated risk for new onset of HF (OR 1.88, 1.62–2.18, p &amp;lt; 0. 0001). Conclusion Our study shows that subclinical hypothyroidism is not associated with higher rates of ACS or Atrial fibrillation, however it is associated with statistically significant higher risk of new onset HF. Further research needs to be done to determine subclinical hyperthyroidism as a potential risk factor for HF and assess the benefit of lower threshold for treating subclinical hypothyroidism in preventing or delaying the onset of HF in patients with associated cardiac risk factors. Presentation: No date and time listed

Association between HBA1C and Coronary Artery Disease Severity in patients of Diabetes Mellitus Type 2 presented as Acute Coronary Artery Syndrome and Non Diabetic

Aim: to investigate the prevalence of diabetes mellitus type 2 (T2DM) and association of HbA1c with the severity of coronary artery disease (CAD) in patients presenting at tertiary care center as acute coronary syndrome and non-diabetic. Study Design: Prospective observational study Duration and Place Study was conducted at department of general medicine Nishter Hospital, Multan from January 2021 to January 2022 in 1 year duration. Methodology: A total of 200 patients were enrolled in study. Main variables of study were BMI, smoking status, dyslipidemia, hypertension, STEMI, angina, HbA1c and treatment strategy. SPSS version 23 was used for data analysis. P value below or equal to 0.05 was taken as significant. Results: Among total 83.5% patients intervened by therapeutic, whereas 48.0% used thrombolytic drug in STEMI. 70.7% patients were thrombolysis in therapeutic intervention and 44.8% were streptokinase in thrombolytic drug. In fasting blood sugar, 53.0% patients were diabetic, whereas in HbA1c levels, 52.3% patients were diabetic. Conclusion: This study highlights the significance of testing for diabetes in individuals in poor nations who report with non-diabetic acute coronary syndrome. One of manifestations of diabetes mellitus may be the acute coronary syndrome. Keywords: Acute coronary syndrome, Coronary angiography, Diabetes, HbA1c.

Etiology of Emergency Visit and In-Hospital Outcomes of Patients with COPD.

Backgrounds Patients with COPD often visit the emergency department (ED) due to exacerbation of respiratory symptoms (dyspnea, cough, and sputum production). Because manifestations of acute exacerbation of COPD (AECOPD) are nonspecific, differential diagnosis is critical in this acute setting. The causes for emergency visiting and the in-hospital outcomes are varied in patients with COPD. This study aimed to investigate the distributions of etiologies and the in-hospital outcomes of patients with COPD who presented to the ED because of exacerbation of respiratory symptoms. Methods This was a retrospective study on COPD patients who had visited the ED and been hospitalized in a tertiary hospital because of worsening respiratory symptoms including cough, sputum production, and dyspnea from January 2017 to April 2020. Demographics, clinical manifestations, and laboratory studies in the ED were collected as the baseline data. The primary diagnosis at discharge or death was recorded. The hospitalization settings (general wards and ICU), the in-hospital outcomes, and associated factors were analyzed. Results During the study period, 392 patients with COPD (male 302 (77.0%)), with a median age of 78 years, visited the ED and hospitalized in this hospital. The first 3 causes for emergency visit were AECOPD (n = 314, 80.1%), acute coronary artery syndrome with or without congestive heart failure (n = 24, 6.1%), and pulmonary embolism (n = 13, 3.3%). For patients with AECOPD (n = 314), 51.6% (n = 162) was admitted to ICU, and 6.4% (n = 20) died. Multivariate logistic analysis showed that age, atrial fibrillation, NT-pro BNP ≥300 pg/ml, and blood pH <7.3 were independent risk factors for ICU admission. Age, comorbid malignancy, NT-pro BNP ≥1800 pg/ml, and pneumonia on CT scan were independent risk factors for hospital mortality in patients with AECOPD. Conclusion In COPD patients visiting the ED because of worsening respiratory symptoms, nearly 20% were due to non-AECOPD causes. For those with AECOPD, age, atrial fibrillation, NT-pro BNP ≥300 pg/ml, and blood pH <7.3 were independent risk factors for ICU admission, while advanced age, underlying malignancy, elevated NT-pro BNP, and pneumonia on CT scan were risk factors for hospital mortality.

Impact of timing of morphine treatment on infarct size in experimental animal model of acute myocardial ischemia and reperfusion

Morphine is generally used in clinical treatment for the patients who have not been effectively alleviated for chest pain after the treatment with nitrites or who contraindicate nitrite drugs. However, it was reported that the treatment with morphine in acute myocardial infarction or acute coronary artery syndromes induced increase in myocardial injury even increase of the mortality of the patients. After comparing the reported laboratory studies showing the cardioprotective effects and the clinical observations presenting the harmful consequences, we query whether the timing of the morphine treatment makes the difference in the prognosis of the ischemic/infarct myocardium. We found that intravenous injections of morphine (0.3 mg/kg) at 15 min before the acute myocardial ischemia, at 5 min and 20 min or 60 min after ligation of the coronary artery in separate groups of rats scheduled for acute myocardial ischemia, for 30 min or 90 min followed by reperfusion for 120 min, induced different results, reduction in the size of infarction, no effect and increases of the infarct sizes, respectively. The opioid μ- and kappa-receptors mediated the detrimental effect of morphine on the myocardial injury. The findings of this study suggest that administration of morphine may cause different consequences when used at different time in the pathology of acute myocardial ischemia and reperfusion. The underlying mechanisms in the pathology of acute myocardial ischemia warrant further study.

Abstract #1180389: Hypoglycemia associated with Worse Outcome in Takotsubo Cardiomyopathy: Perspective from the National Inpatient Sample and National Readmission Database

Stress induced cardiomyopathy, Takotsubo cardiomyopathy (TC) is characterized by transient left ventricular (LV) wall motion abnormality beyond the territories perfused by a single coronary artery. LV dysfunction is reversible, but the complications and mortality of TC is severe enough to compete with acute coronary artery syndrome. Especially, the role of blood glucose level in prognosis of TC has been controversial. Here, we sought to national in-hospital outcome and readmission rate of TC associated with glycemic control.