Development Of Acute Coronary Syndrome Research Articles

Competitive Analysis of the Binding Affinity of Montelukast, Zafirlukast and Gemilukast to CysLTR1, P2Y12 and PPAR-γ and their Possible Cardioprotective Effect: Using in silico Methods

Background Asthma is a very common respiratory disorder, affecting more than 360 million people worldwide. It is a chronic inflammatory disorder of the airways with the symptoms of shortness of breath, coughing, chest tightness, wheezing, and sometimes chest pain. Leukotrienes play an important role in bronchoconstriction during the allergen or exercise-induced acute asthma attack. Aim The study aims to predict the interactions between leukotriene antagonist drugs and CysLT receptor-1 (CysLTR1), P2Y12 and peroxisome proliferator-activated receptor gamma (PPAR-γ) on a competitive basis. The study also has the objective of understanding the cardioprotective roles of the drugs. Introduction Asthma is strongly linked to the development of acute coronary syndrome by the leukotriene-induced activation of CysLTR1, platelet aggregation and thrombosis by activating P2Y12. PPAR-γ is considered to show benefits against atherosclerosis, diabetes, hypertension, obesity and dyslipidaemia, which are risk factors for the development of cardiovascular disorders. Leukotriene receptor inhibitors act with these three types of receptors to show therapeutic effects. Materials and Methods To predict the possible interactions between the drugs and the receptors, the study has used in silico methods. Results and Discussion Montelukast, Zafirlukast and Gemilukast are potential antagonists of CysLTR1 and P2Y12. They are also responsible for the upregulation of PPAR-γ. Thus, these drugs show a cardioprotective role in asthma-induced cardiac disorders. Conclusion A competitive in silico study of Montelukast, Zafirlukast and Gemilukast to predict their binding to CysLTR1, P2Y12 & PPAR-γ revealed that Montelukast is more effective than the other two drugs for showing a cardioprotective role.

The accuracy of detailed analysis of optical coherence tomography in detection of plaque lipid content: dual-imaging study with optical coherence tomography and near-infrared spectroscopy

Background Lipid-rich plaque covered by a thin fibrous cap (FC) has been identified as a frequent morphological substrate for the development of acute coronary syndrome. Optical coherence tomography (OCT) permits the identification and measurement of the FC. Near-infrared spectroscopy (NIRS) has been approved for detection of coronary lipids. Aims We aimed to assess the ability of detailed OCT analysis to identify coronary lipids, using NIRS as the reference method. Methods In total, 40 patients with acute coronary syndrome underwent imaging of a non-culprit lesion by both NIRS and OCT. For each segment, the NIRS-derived 4 mm segment with maximal lipid core burden index (maxLCBI4mm) was assessed. OCT analysis was performed using a semi-automated method including measurement of the fibrous cap thickness (FCT) of all detected fibroatheromas. Subsequent quantitative volumetric evaluation furnished FCT, FC surface area (FC SA), lipid arc, and FC (fibrous cap) volume data. OCT features of lipid plaques were compared with maxLCBI4mm. Predictors of maxLCBI4mm >400 was assessed by using univariable and multivariable analysis. Results OCT features (mean FCT, total FC SA, FC volume, maximal, mean, and total lipid arcs) strongly correlated with the maxLCBI4mm (p = 0.012 for the mean FCT, respectively p < 0.001 for all other aforementioned features). The strongest predictors of maxLCBI4mm >400 were the maximal (p = 0.002) and mean (p = 0.002) lipid arc, and total FC SA (p = 0.012). Conclusions We found a strong correlation between the OCT-derived features and NIRS findings. Detailed OCT analysis may be reliably used for detection of the presence of coronary lipids.

Elevated neutrophyl-to-lymphocyte ratioand smoking are associated with chronic total occlusion in patients with ST elevation myocardial infarction

BackgroundAtherosclerosis is a progressive disease characterized by the build-up of lipids and connective tissue in the large arteries. Some patients experience chronic total occlusion (CTO). Inflammation plays a key role in the development and complications of atherosclerosis. Neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation associated with the development of acute coronary syndrome (ACS). We aimed to assess the relationship between NLR and CTO in ACS patients with ST elevated myocardial infarction (STEMI) in Indonesia.MethodsThis cross-sectional study was performed with secondary data obtained from patient medical records at Cipto Mangunkusumo National Central Hospital, Jakarta. Inclusion criteria were patients with ACS and STEMI who underwent coronary angiography in 2015–2018.ResultsA total of 98 patients were enrolled in the analysis. Most subjects with CTO were male, elderly (> 60), smoking, had no history of diabetes mellitus (DM) or hypertension, no family history of coronary heart disease (CHD), but had a history of ACS and had never consumed statin or antiplatelet medications. Bivariate logistic regression analysis revealed that male gender (PR = 1.820; 95%CI 0.871–3.805; p = 0.025) and smoking (PR = 1.781; 95%CI 1.028–3.086; p = 0.004) were significantly correlated with CTO. Receiver operator characteristic (ROC) curve revealed that higher NLR (≥ 6.42) could predict a CTO diagnosis with positive predictive value (PPV) of 91%. Multivariate analysis revealed that NLR was correlated with an 11.2-fold increase in occurrence of CTO (95%CI 3.250-38.303; p < 0.001). Additionally, smoking was correlated with a 7-fold increase in CTO (95% CI 1.791–30.508; p = 0.006).ConclusionNLR value of ≥ 6.42 is potentially useful as a marker of CTO in STEMI patients. In addition, smoking increases the risk of CTO in ACS/STEMI patients.

The Characteristics of Chest Pain in the Emergency Setting among Patients with Chronic Kidney Disease

Background: Chronic kidney disease (CKD) is considered a major public health issue, not only due to the possibility of progressing to end-stage renal disease but also because it is closely related to the development of acute coronary syndrome (ACS). It is still unclear in the literature whether individuals with renal dysfunction present particularities in the clinical manifestations during acute myocardial infarction, similar to individuals with diabetes. Aims: To evaluate the characteristics of clinical manifestations in patients with CKD and ACS. Methods: The Chi-square test and Student's t-test were used to analyze the profile of patients with coronary syndrome and renal disease who were admitted for chest pain at the analyzed hospital. Results: The majority of individuals with renal disfunction present highly suspicious characteristics, with statistical significance by presenting a p-value equal to 0.01 and a 95% confidence interval (0.04-0.14). Conclusion: Individuals with kidney disease predominantly exhibit highly suspicious clinical manifestations for acute coronay syndrome.

Fragmented QRS as a Predictor of Cardiovascular Events in Patients with Type 2 Diabetes Mellitus: A 36-Month Follow-Up Data.

Major cardiovascular events (MACE) are more common in type 2 diabetes mellitus (T2DM) patients, and early diagnosis can prevent significant morbidity and mortality. The aim of this study was to investigate the predictiveness of fragmented QRS (fQRS) showing MACE in T2DM patients. A total of 227 T2DM patients (mean age 52, 51% male) without any cardiovascular disease who came to the cardiology outpatient clinic between March 01 and July 31, 2019, were included in the study. The patients were divided into 2 groups according to fQRS on electrocardiography (ECG), and 36 months of follow-up was done. The development of acute coronary syndrome, coronary revascularization, and cerebrovascular accident were accepted as MACE. More MACE was seen in the group with fQRS on ECG (P =.026). Although there were more fQRS in patients with proteinuria, it was not statistically significant (P =.069). More myocardial infarcts (7.9%) and more cerebrovascular events (6.3%) were seen in the group with fQRS. While revascularization was performed on 3 patients in the fQRS group, revascularization was not performed on the patients in the non-fqrs group. In multiple Cox regression analysis, fQRS showed an independent predictor of MACE [P =.025, hazard ratio = 2.42 (1.117-5.221)], more MACE was seen in the fQRS (+) group in the kaplan-meier analysis (P =.022). More MACE was seen in the fQRS group in T2DM patients without a previous history of cardiovascular events. Fragmented QRS was found to be an independent predictor in showing MACE. Care should be taken in terms of MACE development in T2DM patients with fQRS.

Percutaneous coronary intervention in patients admitted with acute coronary syndrome within 6 months after COVID-19 (retrospective single-center study)

BACKGROUND: Assessing clinical manifestations in patients during the period of destabilization of the course of coronary artery disease after COVID-19 coronavirus infection remains a clinical problem. Identifying features of coronary artery lesions in such patients will help to prevent the development of complications and may influence the tactics of active dynamic monitoring.&#x0D; AIM: To evaluate the structure of coronary artery lesions and clinical manifestations in patients with acute coronary syndrome that developed within 6 months after COVID-19 new coronavirus infection.&#x0D; MATERIALS AND METHODS: A comparative analysis of the results of coronary artery stenting in 157 patients admitted with acute coronary syndrome has been carried out. The 1st group included 69 patients who had COVID-19 (vaccinated — 24.6%) during the 6 months preceding acute coronary syndrome; in the 2nd — 88 patients without a history of COVID-19 (vaccinated — 42%). All the patients had drug-eluting stents implanted in the infarct-related artery. Long-term results have been observed in 151 (96.2%) patients.&#x0D; RESULTS: Before the development of acute coronary syndrome, dispnoe was more often observed in patients of the 1st group (36; 52%) than in patients of the 2nd group (13; 14.8%). There were no focal neurological symptoms in the patients of both groups. Dizziness more often preceded acute coronary syndrome in the patients of the 1st group (26; 38.2%) compared to the control group (5; 5.7%). Decreased motivation and fatigue were detected in 27 (67.5%) patients in the 1st group, which was more common than in the 2nd group (13; 32.5%). Acute coronary syndrome with ST elevation was treated in 47 % and 38.6% of the patients in the 1st groups and the 2nd, respectively. The development of acute coronary syndrome with ST segment elevation with previous clinical manifestations of post-covid syndrome in the 1st group was observed in 95.8%, whereas in the absence of post-covid syndrome in 53.3%. The mean value of LVEF in patients who had COVID-19 was 55.9 ± 14%, which was significantly lower than in the patients in the control group (63.2 ± 5.5%; р 0.001). During the course of coronavirus infection in the patients in the first group, lung damage of degrees I–II according to CT scan data was observed in 76.8% of the patients and in 23.2% of degrees III–IV. The frequency of lesions of the circumflex branch in the 1st group was 15.9%, in the 2nd — 11.4% (р = 0.403); of the right coronary artery — 33.3%, and 22.7% (р = 0.41); of the diagonal branch — 5.8%, and 3.4% (р = 0.47); of the left main coronary artery — 5.8%, and 6.8% (р = 0.79), of the left anterior descending branch — 52.2%, and 35.2% (р = 0.033), respectively. The incidence of vasospastic angina in the 1st group was 53.6%, in the 2nd — 15.9% (р 0.0001). ST segment elevation in lead AVR as a manifestation of subendocardial ischemia was registered in the 1st group — 40.6%, the 2nd — 11.4% (р 0.0001). All the patients had drug-eluting stents implanted in the infarct-related artery. Overall survival (in-hospital and long-term) was 100% for the first group and 100 % for the second one.&#x0D; CONCLUSIONS: In the structure of coronary arteries lesions after COVID-19 new coronavirus infection in patients with acute coronary syndrome, damage to the anterior interventricular artery dominates (52.2%). The likelihood of having a left anterior descending lesion during the development of acute coronary syndrome with ST segment elevation in patients who have had COVID-19 is 1.5 times higher. The structure of clinical manifestations after COVID-19 in patients before the development of acute coronary syndrome is dominated by shortness of breath (52 %) and decreased motivation and fatigue (67.5 %).

Analysis of risk factors for cardiovascular diseases in migrant workers with acute coronary syndrome

The flow of labor migrants to Russia is steadily growing. The rules for providing medical care to foreign citizens on the territory of the Russian Federation depend on their status. Among the morbidity of migrant workers, infectious diseases, venereal diseases, tuberculosis, injuries, intoxication are leading. This increases the risks to the health of Russians, and also puts an economic burden on the healthcare system of the Russian Federation. The purpose of our study was to study risk factors in migrant workers hospitalized with acute coronary syndrome. The study included 50 migrant workers and 107 Russian citizens hospitalized with acute coronary syndrome. Analysis of risk factors for cardiovascular diseases revealed that in migrant labor patients, the development of acute coronary syndrome occurred at a younger age. There were significantly more smokers among migrant labor patients, they had a lower body mass index, type 2 diabetes mellitus and a previous acute myocardial infarction were significantly less common in the anamnesis. Analysis of clinical and laboratory data of patients hospitalized with acute coronary syndrome revealed that the main risk factors for cardiovascular diseases among migrant workers are smoking and lipid metabolism disorders.

Relationship between Cardiovascular Risk Factors and Development of Acute Coronary Syndrome

Acute coronary syndrome (ACS) which known as subcategory of coronary heart disease is considered a major cause of death. In Saudi Arabia, the prevalence of ACS is 8.2%. Early recognition of risk factors (RFs) associated with ACS is essential to prevent its progression. Therefore, the goals of this study is to estimate the prevalence of cardiovascular RFs among ACS patients and to appraise its association with the development of ACS. This retrospective multi-center cross-sectional study involved 170 patients admitted to Prince Sultan cardiac center, King Saud Hospital, and Bukayriyah General Hospital in Al Qassim, KSA. The participants categorized into three groups UA, NSTEMI, and STEMI. Patients with stable angina or previous MI were excluded from the study. 73.5% were males and 26.5% were females with a mean age of 58.2 ± 11.9. The distribution of ACS subtypes was 51.2%, 27.6%, and 21.2% for STEMI, NSTEMI and UA, respectively. The most common RFs were diabetes mellitus (DM), hypertension (66% each), and dyslipidemia (58%). The prevalence of RFs among STEMI group was 65.6% active smokers, 54.5% dyslipidemia, and 52.2% ischemic heart disease (IHD). On the other hand, in NSTEMI group hypertension and DM were nearly the same (32% &amp; 30% respectively), however family history of IHD was 42.9%. UA revealed a strong association with IHD and family history of IHD (30.4%, 28.6%, respectively).To conclude, most of ACS patients presented with STEMI followed by NSTEMI and the least with UA. Among the cardiovascular risk factors, HTN, DM, and dyslipidemia, were presented in more than half of the patients which strongly suggests an association with developing ACS.

Spontaneous anterior coronary interventricular artery dissection in a young woman in the late postpartum period: clinical case

BACKGROUND: Cardiovascular complications during pregnancy and postpartum period are rare but often fatal. The causes and mechanisms of the development of such complications are not fully understood. Spontaneous dissection of the coronary artery against the background of the influence of sex hormones is one of the mechanisms for the development of acute coronary syndrome in the postpartum period. The false lumen of the intramural hematoma overlaps the true lumen, causing arterial obstruction, leading to acute myocardial hypoxia. Thus, awareness that the pathophysiology of spontaneous coronary artery dissection differs from that of acute coronary syndrome associated with atherosclerotic plaque rupture is important, and these patients require different treatment approaches. Currently, an unambiguous and precise strategy for this pathology has not been established, which is why difficulties remain in the management of these patients and choosing treatment strategies.&#x0D; CLINICAL CASE DESCRIPTION: The article describes a complex clinical case of the development of acute myocardial infarction in the postpartum period in a young woman without risk factors against the background of spontaneous dissection of the coronary artery, complicated by cardiogenic shock, which required emergency percutaneous coronary intervention and stenting of the infarct-dependent artery. The postoperative period proceeded with complications, and extracorporeal membrane oxygenation was required. However, an integrated approach and correctly chosen treatment strategies help stabilize the patients condition.&#x0D; CONCLUSION: Currently, no unambiguous and precise strategy of treatment has been established, so difficulties remain in the management of patients and decision making. In our opinion, an individual patient approach should be followed, taking into account the general state of the organism, type and volume of dissection, consequences and complications, and experience and technical capabilities of the clinic.

Role of serum n-6 polyunsaturated fatty acids in the development of acute coronary syndromes.

n-3 polyunsaturated fatty acids (PUFAs) have an inhibitory effect on the development of coronary artery disease (CAD). However, whether n-6 PUFAs, dihomo-gamma-linolenic acid (DGLA), and arachidonic acid (AA) play a role in the development of CAD remains unclear. This study investigated the association between PUFAs and the risk of developing acute coronary syndrome (ACS) using the lipid and PUFAs data of patients who received percutaneous coronary intervention (PCI) for either non-emergent conditions (staged group) or ACS (ACS group). We retrospectively evaluated 433 patients who underwent PCI between 2014 and 2021. The patients were divided into the ACS group (n = 18) and the staged group (n = 132). The lipid and PUFA values of each patient between the two groups were compared. Moreover, to investigate the correlation between n-6 PUFA levels and ACS, the effects of confounding factors such as the use of strong statins and low-density lipoprotein cholesterol (LDL-C) levels were adjusted. The ACS group had higher n-6 PUFAs levels than the staged group (DGLA: 36.8 µg/mL vs 29.6 µg/mL; AA: 203.3 µg/mL vs 145.8 µg/mL). Furthermore, the analysis of covariance adjusted for LDL-C levels showed a significant difference between the two groups in terms of DGLA and AA levels. The n-3 PUFA levels did not significantly differ between the staged and ACS groups. Moreover, the ACS group had higher DGLA and AA levels and lower n-3 PUFAs/AA ratios than the staged group. Therefore, excess n-6 PUFAs may be a risk factor for ACS.

Biomarkers in assessing the vulnerability of atherosclerotic plaques: a narrative review

Aim. To study the role of biomarkers in assessing the vulnerability of atherosclerotic plaques.Material and methods. A review of literature sources investigating the biomarker assessment of the vulnerability of atherosclerotic plaques published for the period 01.01.2016 to 31.12.2022 was carried out. Literature search was carried out in English and Russian in PubMed databases, in Google Academy, Elibrary.ru according to the following keywords: “biomarkers of plaque vulnerability”, “NLR and vulnerable plaque”, “CRP and vulnerable plaque”, ”MMP-9 and vulnerable plaque”, “TIMP-1 and vulnerable plaque”, ”galectin-3 and vulnerable plaque”, “NGAL and vulnerable plaque”. A total of 183 articles were found, of which 42 articles in full-text format containing original clinical studies were selected for the preparation of this review.Results. Numerous studies have shown that the vulnerability and rupture of the plaque, rather than its size and severity of stenosis, are the main cause of cardiovascular events in patients with coronary heart disease. Small plaques rich in lipids often become unstable due to an inflammatory reaction supported by the interaction between lipoproteins, monocytes, macrophages, T-lymphocytes and vascular wall cells. NLR, CRP, NGAL, Galectin-3, as well as markers of extracellular matrix degradation (MMP-9, TIMP-1) can play a special role in assessing the vulnerability of plaques.Conclusion. The development of acute coronary syndrome is based on the destabilization of the atherosclerotic plaque, which occurs not only due to changes in its lipid composition, but also infiltration by immuno-inflammatory cells, degradation of the extracellular matrix, as well as an active inflammatory reaction and neovascularization of the plaque. Therefore, traditional imaging methods that characterize the plaque by its appearance and size are not enough to predict the risk of rupture and the development of an acute thrombotic event. Thus, there is a need to identify new biomarkers that would correlate with the instability of plaque atheroma.

Are artificial intelligence derived coronary atherosclerotic characteristics associated with subsequent development of acute coronary syndrome (ACS)

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Scripps Health Krueger Wyeth Grant Background ACS results from unstable atherosclerotic plaques. Current measures to assess risk do not consider the patient’s coronary atherosclerotic composition. This was a case control study using a prospective single-center registry of patients undergoing CCTA (N=2,700) from 2017–2020 to assess the association between plaque characterization and the occurrence of ACS. Methods ACS cases were adjudicated independently by two cardiologists using data from the EMR. Patients with prior ACS prior to CCTA, were excluded. Controls were selected 1:1 by nearest neighbor propensity matching (R. v. 4.0.3.) based on age, sex, smoking, HTN, HLD, and DM. Plaque burden and stenosis features were calculated by a commercially available artificial intelligence (AI) coronary analysis (Figure 1). Results There were 21 cases and 21 controls. Mean age of 68, 43% women, 5% Hispanic, 29% smoking hx, 76% HTN, 81% HLD, 24% DM, CAD-RADS score 2.3, and CAC of 487. Median time from CT to ACS for cases was 329 days. Presence of total non-calcified plaque, calcified plaque, fibro-fatty plaque, maximum stenosis diameter percentage and total plaque were each associated with greater risk of ACS (Table 1). Conclusion AI assessment of CCTA plaque characteristics were associated with ACS. This study shows the association between AI derived coronary atherosclerotic features and development of ACS in patients undergoing CCTA and highlights the potential utility of using AI-driven plaque characterization to predict ACS.

Prognostic value of echocardiographic parameters of cardiac remodeling in patients with hypertension and obstructive sleep apnea

Objective. To study the prognostic value of echocardiographic parameters of early cardiac remodeling in patients with hypertension (HTN) and obstructive sleep apnea (OSA). Design and methods. The study included 59 men with HTN and OSA (with an apnea/hypopnea index &gt; 15 per hour). At baseline, all patients underwent polysomnography and echocardiography with an additional assessment of the global longitudinal strain (GLS). At baseline and at 12-month follow-up, a 6-minute walk test was performed. After 12 months, the clinical course of the disease was assessed. The criteria for an unfavorable course were episodes of hospitalization, the development of acute coronary syndrome, cerebral stroke, paroxysmal atrial fibrillation, worsening of chronic heart failure with a transition to a higher NYHA functional class. Results. In groups with favorable and unfavorable clinical course, some baseline echocardiographic parameters differed significantly: interventricular septal thickness (p = 0,037), left ventricular myocardial mass index (LVMI) (p = 0,003), tricuspid annular plane systolic excursion (TAPSE) (p &lt; 0.001), GLS (p = 0,019), peak tricuspid regurgitation (p = 0,027), left atrial volume index (p = 0,048). Regression analysis showed that baseline TAPSE and LVMI had predictive value for an unfavorable clinical course. Conclusions. Our results confirm that certain echocardiographic parameters, in particular, LVMI and TAPSE, are predictors of the development and progression of cardiovascular complications in OSA patients.

Prevention of Gastrointestinal Bleeding in Patients Operated on Coronary Arteries for Acute Coronary Syndrome

Introduction. Acute coronary syndrome is a collective concept that reflects any form of exacerbation of coronary heart disease from unstable angina to acute myocardial infarction. Modern principles for the diagnosis and treatment of this syndrome are coronary angiography and urgent stenting of the affected coronary artery. These patients, having survived a life-threatening condition and surgical treatment, have a high probability of acute erosive and ulcerative gastroduodenal lesions and dependent gastrointestinal lesions. As a result, conservative treatment of acute ulcers and erosions complicated by bleeding remains unsatisfactory, mortality ranges from 36.4 to 50-80%.The aim of the study was to evaluate effectiveness of the proposed measures to prevent erosive and ulcerative lesions of the stomach and duodenum and gastrointestinal bleeding in patients with acute coronary syndrome who underwent coronary artery stenting.Materials and methods. The study included 614 patients who underwent percutaneous coronary intervention and stenting of the arteries of the heart due to the development of acute coronary syndrome. The patients were divided into two groups. The first group included 284 patients treated in 2018. Prevention of acute erosive and ulcerative gastroduodenal lesions was not routinely performed in this group. The second group included 330 patients treated in 2019. All patients in this group underwent prophylaxis and included omeprozole 40 mg per day from the first hours of the patient's stay in the hospital.Results. During the entire study period, 31 patients died in the early and late postoperative period in the first group, 18 of them during the first hospitalization. In the second group, 35 patients died during the entire study period in the early and late postoperative period, 21 of them during the first hospitalization. With the development of gastrointestinal bleeding, the probability of a full recovery in a patient with acute coronary syndrome is extremely low, and the system of preventive measures avoids this problem.Conclusion. Prevention of stressful acute erosive and ulcerative gastroduodenal lesions due to use of intravenous proton pump inhibitors in increased dosages (omeprozole 40 mg per day) is indicated to the patients of the studied group; in the presence of additional risk factors, the prophylactic dosage of proton pump inhibitors is doubled (omeprozole 40 mg 2 times a day). Mandatory non-invasive diagnosis of Helicobacter pylori for all patients is also indicated; if the condition is detected, eradication therapy is to be carried out. It is also required to apply proton pump inhibitors for the entire period of dual antiplatelet or anticoagulant therapy.

The potential role of SARS‐CoV‐2 infection in acute coronary syndrome and type 2 myocardial infarction (T2MI): Intertwining spread

Coronavirus disease 2019 (COVID-19) is a novel pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It has been shown that SARS-CoV-2 infection-induced inflammatory and oxidative stress and associated endothelial dysfunction may lead to the development of acute coronary syndrome (ACS). Therefore, this review aimed to ascertain the link between severe SARS-CoV-2 infection and ACS. ACS is a spectrum of acute myocardial ischemia due to a sudden decrease in coronary blood flow, ranging from unstable angina to myocardial infarction (MI). Primary or type 1 MI (T1MI) is mainly caused by coronary plaque rupture and/or erosion with subsequent occlusive thrombosis. Secondary or type 2 MI (T2MI) is due to cardiac and systemic disorders without acute coronary atherothrombotic disruption. Acute SARS-CoV-2 infection is linked with the development of nonobstructive coronary disorders such as coronary vasospasm, dilated cardiomyopathy, myocardial fibrosis, and myocarditis. Furthermore, SARS-CoV-2 infection is associated with systemic inflammation that might affect coronary atherosclerotic plaque stability through augmentation of cardiac preload and afterload. Nevertheless, major coronary vessels with atherosclerotic plaques develop minor inflammation during COVID-19 since coronary arteries are not initially and primarily targeted by SARS-CoV-2 due to low expression of angiotensin-converting enzyme 2 in coronary vessels. In conclusion, SARS-CoV-2 infection through hypercytokinemia, direct cardiomyocyte injury, and dysregulation of the renin-angiotensin system may aggravate underlying ACS or cause new-onset T2MI. As well, arrhythmias induced by anti-COVID-19 medications could worsen underlying ACS.

Various Expressions of PIK3C2A and TXNIP Genes and Their Potential Role as Independent Risk Factors for Chronic Stable Angina and Acute Coronary Syndrome.

Genetic factors play a significant role in the onset and progression of coronary artery disease (CAD). PIK3C2A may contribute to the development of acute coronary syndrome (ACS) by affecting blood glucose levels and oxidative stress. The expression levels of TXNIP were significantly higher in patients with unstable angina pectoris. However, the situation is different in ACS. In the current study, we aim to investigate the role of PIK3C2A and TXNIP as independent risk factors for chronic stable angina (CSA) and ACS. This study involved 215 subjects (60 patients with CSA, 55 patients with ACS, and 100 controls). All subjects were exposed for assaying gene expressions of PIK3C2A and TXNIP by quantitative real-time polymerase chain reaction. It was found that TXNIP was upregulated, whereas PIK3C2A was downregulated in patients with CAD compared to the control group. PIK3C2A was significantly downregulated in patients with ACS compared to that in patients with CSA (p < 0.001), but TXNIP was not (p = 0.7). TXNIP was significantly upregulated in STEMI-ACS patients compared to CSA (p = 0.045) and NSTEMI ACS (p = 0.046), among non-diabetic (p = 0.023) smokers (p = 0.036) with hypertension (p = 0.005) and hypercholesterolemia (p = 0.001). ROC (receiver operating characteristic) curve analysis revealed that PIK3C2A (0.981; p < 0.001; 98.18) was the most sensitive mRNA for discriminating ACS from control, followed by TXNIP (0.775; p < 0.001; 70.91). However, for discriminating ACS from CSA combined mRNAs, (PIK3C2A + TXNIP) (0.893; p < 0.001; 98.18) and PIK3C2A (0.892; p < 0.001; 81.82) are promising biomarkers. On the other hand, the most sensitive mRNA for differentiating CSA from control is mRNAs (PIK3C2A + TXNIP) (0.963; p < 0.001; 95), then TXINP (81.3; p < 0.001; 93.33), and finally, PIK3C2A (0.782; p < 0.001; 81.67). In the multivariate regression model, PIK3C2A ((p = 0.002), 0.118 (0.031-0.445)) and smoking status ((p = 0.034); 0.151 (0.026-0.866)) were independent variables for ACS. Moreover, PIK3C2A ((p < 0.013); 0.706 (0.614-0.812)), Hb ((p = 0.013); 0.525 (0.317-0.871)), and total cholesterol ((p = 0.04); 0.865 (0.784-0.955)) were significantly (p < 0.05) and independently related to the prognosis of CSA. Furthermore, PIK3C2A ((p = 0.002), 0.923 (0.877-0.971)), TXNIP ((p = 0.001); 2.809 (1.558-5.064)) the body weight ((p = 0.033); 1.254 (1.018-1.544)) were independently associated with CSA. Our study concluded that the dysregulated mRNA PIK3C2A and TXNIP gene expressions may be useful in diagnosis of CAD and prediction of ACS development.

Pathogenetic and clinical aspects of the development of acute coronary syndrome in influenza and COVID-19: vaccination issues

Highlights. The new coronavirus infection necessitates mandatory vaccination of patients at high cardiovascular risk (in particular after myocardial infarction), including both COVID-19 vaccine and influenza vaccine, which represent an important condition for reducing mortality. At the same time, vaccination coverage among the population is still low, thus requiring a detailed analysis of clinical and pathogenetic components of this problem. The doctor's understanding of the most complex aspects of the problem will help achieve positive outcome in the treatment of patients who suffered from myocardial infarction, even before acquiring the data of specially planned studies.Abstract. This review contains current data on the relationship of viral infections with an increase in the incidence of cardiovascular diseases, as well as on the role of vaccination in improving the prognosis after myocardial infarction. The literature search was carried out by using the websites of cardiological societies, as well as the PubMed, EMBASE, eLibrary databases using the following keywords: flu, influenza, new coronavirus infection, SARS-CoV2, COVID-19, vaccination, acute coronary syndrome. The pandemic of COVID-19 (COronaVIrus Disease 2019) dictates the need for urgent vaccination against COVID-19 and influenza in patients with cardiovascular diseases. The importance of this measure, as a clear condition in preventing further increase in mortality from cardiovascular diseases, should not be doubted. At the same time, the still remaining low percentage of vaccinations is one of the causal factors of high rates of morbidity and mortality from cardiovascular pathology.

Gender Specificities of Cardiac Troponin Serum Levels: From Formation Mechanisms to the Diagnostic Role in Case of Acute Coronary Syndrome

Cardiac troponins T and I are the main (most sensitive and specific) laboratory indicators of myocardial cell damage. A combination of laboratory signs of myocardial cell damage (elevated levels of cardiac troponins T and I) with clinical (severe chest pain spreading to the left side of the human body) and functional (rise or depression of the ST segment, negative T wave or emergence of the Q wave according to electrocardiography and/or decrease in the contractility of myocardial areas exposed to ischemia according to echocardiography) signs of myocardial ischemia is indicative of the ischemic damage to cardiomyocytes, which is characteristic of the development of acute coronary syndrome (ACS). Today, with early diagnostic algorithms for ACS, doctors rely on the threshold levels of cardiac troponins (99th percentile) and on the dynamic changes in the serum levels over several hours (one, two, or three) from the moment of admission to the emergency department. That said, some recently approved highly sensitive methods for determining troponins T and I show variations in 99th percentile reference levels, depending on gender. To date, there are conflicting data on the role of gender specificities in the serum levels of cardiac troponins T and I in the diagnostics of ACS, and the specific mechanisms for the formation of gender differences in the serum levels of cardiac troponins T and I are unknown. The purpose of this article is to analyze the role of gender specificities in cardiac troponins T and I in the diagnostics of ACS, and to suggest the most likely mechanisms for the formation of differences in the serum levels of cardiac troponins in men and women.

Acute Coronary Syndrome after Percutaneous Coronary Intervention: State of the Problem and Clinical Practice Data

Aim. To study the prevalence, clinical and endovascular predictors, causes and timing of the development of acute coronary syndrome (ACS) in patients who had previously undergone percutaneous coronary intervention (PCI), as well as the clinical features of the disease and lipid spectrum parameters.Material and methods. The prospective study included 768 patients successively hospitalized from 01.01.2019 to 01.01.2020 in the Regional cardiovascular center, undergoing to emergency coronary angiography.Results. The main group included 768 patients who underwent emergency coronary angiography for ACS. 90 of them had previously undergone PCI (11.7%). Men prevailed (66.7%), the average age was 62 years. 25.5% of patients underwent ACS within a year after coronary stenting, the mean time from PCI to ACS was 43 months. Most often, there was ACS without ST segment elevation (80%). The results of a retrospective analysis of the first PCI showed that 89.7% of patients underwent urgent PCI, 77.8% of patients received bare metal stents. In 67.1% of patients, 1 stent was implanted, the average diameter was 3.2 mm, the average length was 22 mm. Thromboaspiration was performed in 12% of cases, predilatation in 25%, and NC postdilation in 41.3% of cases. Complications of PCI developed in 9% of patients. Stent thrombosis was diagnosed in 7.8% of cases, significant restenosis in 35.6%. Repeated stenting due to ACS was performed in 64.4% of patients, of which 74.6% received 1 stent; average diameter 3.4 mm, average length 24.0 mm. Predilatation was performed in 52.9% of cases, thromboaspiration – in 41.2%, and NC-postdilation – in 86.7% of cases. Complications of PCI developed in 10%. In addition, 99% of patients had significant dyslipidemia. The average cholesterol level was 4.91 mmol/L, the average low-density lipoprotein level was 2.94 mmol/L.Conclusion. Patients after PCI are 12% of group with ACS in clinical practice of the Regional Vascular Center. The most common predictor of recurrent atherothrombotic events is bare metal stent implantation as well as dyslipidemia.

Antithrombotic therapy in patients with diabetes mellitus

The study discussed various possibilities of antithrombotic therapy in patients with diabetes mellitus. Patients with diabetes mellitus, regardless of whether they have cardiovascular diseases, have a high risk of thrombosis. A feature of the response to antiplatelet therapy is the higher resistance to acetylsalicylic acid and clopidogrel of patients with diabetes mellitus than patients without diabetes mellitus, which can reach 71.4% and 57.1%, respectively. With a decrease in the functional ability of the kidneys in patients with diabetic nephropathy, acetylsalicylic acid is a safe antiplatelet drug; the use of clopidogrel in these patients leads to an increase in the risk of general and cardiovascular mortality. In the absence of contraindications, acetylsalicylic acid is recommended for patients with diabetes mellitus for the secondary prevention of cardiovascular diseases and may be recommended for primary prevention in patients with high and very high cardiovascular risk. Clopidogrel is recommended for patients with diabetes mellitus only for the secondary prevention of intolerance to acetylsalicylic acid. With the development of acute coronary syndrome, patients with diabetes mellitus received double antiplatelet therapy using acetylsalicylic acid and any P2Y12 receptor blocker. In patients who received percutaneous coronary intervention, prasugrel or ticagrelor is recommended as the second component. Double antiplatelet therapy extended for 12 months is indicated for patients with diabetes mellitus with a very high cardiovascular risk and good tolerability. In non-valvular atrial fibrillation, direct oral anticoagulants, in the absence of contraindications, are the drugs of choice in patients with diabetes and creatinine clearance 30 mL/min for dabigatran and 15 mL/min for rivaroxaban and apixaban. With the development of terminal renal insufficiency, only warfarin has proven effectiveness. Combined antiplatelet and anticoagulant therapy is indicated for diabetes mellitus with coexisting atherosclerotic diseases with a high risk of thrombotic and low risk of hemorrhagic complications.