Acute Coronary Syndrome Disease Research Articles

Utility of Serum Uric Acid Levels to detect Angiographic Severity of Coronary Artery Disease in Acute Coronary Syndrome

Utility of Serum Uric Acid Levels to detect Angiographic Severity of Coronary Artery Disease in Acute Coronary Syndrome

Case Series Study on Recovery of Left Ventricle Systolic Function After Percutaneous Coronary Intervention In ST-Segment Elevation Myocardial Infarction Patients at FMIC Hospital in Kabul, Afghanistan.

Background Left ventricle dysfunction is the most recurrent consequence of ST-elevated myocardial infarction, and still, it is a powerful predictor of mortality. The percutaneous coronary intervention of the culprit artery disease in acute coronary syndrome is related to a significant improvement of left ventricle segmental function. It is a retrospective case series study on a patient population with the diagnosis of ST-elevated myocardial infarction patients who presented to the hospital within 12 hours and underwent percutaneous coronary intervention at the French Medical Institute of Mother and Children Hospital. Data was collected retrospectively from the patient's medical record files and analyzed. We took the patients with Left ventricle dysfunction on echocardiography on the first presentation before percutaneous coronary intervention and saw the left ventricle function after three months of follow-up. We reviewed the charts of 102 patients (78.4% male and 21.6% female) with a diagnosis of St-elevated myocardial infarction who presented within 12 hours of chest pain. Of 102 patients, 55.9% had hypertension, 21.6% diabetes, 22.5% dyslipidemia, and 19.6% history of smoking, and their mean age was 58.11 ± 11.993 years. We noticed that percutaneous coronary intervention led to significant left ventricle dysfunction improvement in the patient population with ST-elevated myocardial infarction who presented within 12 hours of chest pain.

Biomarker-associated Monocyte Inflammatory Signaling in Myocardial Infarction

Background: Monocytes are essential components in inflammatory signaling, and their recruitment is crucial in the signaling pathway, which directs and determines cell adhesion to the activated endothelium. A better understanding of the correlation between monocyte subsets and inflammatory signaling in patients with atherosclerotic disease in acute coronary syndrome (ACS) is essential for the development of more effective therapies for the prevention and treatment of cardiovascular diseases. Objective: To analyze differences between biomarkers and monocyte activation in the setting of [...]

Correlation of TIMI score with severity of coronary artery disease in acute coronary syndrome

Background: ACS presents as wide range of clinical ailments that requires prompt treatment to avoid unforeseen circumstances. As noninvasive strategy, TIMI risk assessment is a widely accepted tool for risk stratification of ACS patient to initiate timely management. Purpose of the present study is to determine the association of TIMI score in predicting the severity of coronary artery disease in ACS.
 Methodology: A cross-sectional study was conducted in specialized tertiary care cardiac hospital on 255 patients from January 2021 to June 2021. For all patients, TIMI score calculated based on all the seven variables. Confidentiality of the participants was maintained. Ethical approval was obtained from review board of concerned hospital. Data was analyzed on SPSS version 23.0. One way ANOVA was used to compare categorical variables. Chi square test used to reveal difference in proportion to three TIMI groups.
 Results: Finding show that ST segment deviation was evident in 51.5% patients. Out of 37 patients in group-III with ST segment changes, 91.8% were found of having significant CAD. Results show that in group-III, 54.1% had significant three vessel CAD compared to 17.6% group-II & 7.5% group-I patients. Also, p-value of <0.001 depict significant association between TIMI score and severity of CAD.
 Conclusion: A significant association from this study gives a notion that TIMI score is valuable tool in clinical setting to make urgent decision regarding the management of CAD. Also, it was concluded from current study that patients with higher TIMI score had additional risk of three vessel CAD and left main vessel CAD in patients with ACS.

Association between triglyceride glucose index, coronary artery calcification and multivessel coronary disease in Chinese patients with acute coronary syndrome

BackgroundMultivessel coronary disease (MVCD) is the common type of coronary artery disease in acute coronary syndrome (ACS). Coronary artery calcification (CAC) has been confirmed the strong predictor of major adverse cardiovascular events (MACEs). Several studies have validated that triglyceride glucose (TyG) index can reflect the degree of coronary calcification or predict MACEs. However, no evidence to date has elucidated and compared the predictive intensity of TyG index or/and coronary artery calcification score (CACS) on multi-vascular disease and MACEs in ACS patients.MethodsA total of 935 patients, diagnosed with ACS and experienced coronary computed tomography angiography (CCTA) from August 2015 to March 2022 in the Second Hospital of Shandong University, were selected for retrospective analysis. The subjects were divided into TyG index quartile 1–4 groups (Q1-Q4 groups), non-multivessel coronary disease (non-MVCD) and multivessel coronary disease (MVCD) groups, respectively. The general data, past medical or medication history, laboratory indicators, cardiac color Doppler ultrasound, CACS, and TyG indexes were respectively compared among these groups. The ROC curve preliminarily calculated and analyzed the diagnostic value of TyG index, CACS, and the combination of the two indicators for MVCD. Univariate and multivariate logistic regression analysis discriminated the independent hazard factors for forecasting MVCD.ResultsCompared with the lower TyG index and non-MVCD groups, the higher TyG index and MVCD groups had higher values of age, smoking history, waist circumference, systolic blood pressure, low-density lipoprotein cholesterol(LDL-C), fasting blood glucose and glycosylated hemoglobin, and CACS, but lower values of high-density lipoprotein cholesterol(HDL-C) (all P < 0.01). Coronary artery calcification is more common in the left anterior descending artery. Compared with non-MVCD, each unit increase in TyG index was associated with a 1.213-fold increased risk of MVCD. Logistic regression analysis adjusted for potential confounders indicated that TyG index is an independent risk factor for MVCD. With the increase of TyG index, the incidence of MACEs, apart from all-cause death, cardiac death, unexpected re-hospitalization of heart failure, recurrent ACS or unplanned revascularization, and non-fatal stroke in coronary artery increased (P log-rank < 0.001).ConclusionTyG index could completely substitute for CACS as a reliable, practical, and independent indicator for predicting the severity and prognosis of MVCD in patients with ACS.

Experience with the use of combination antithrombotic therapy in a patient with acute coronary syndrome and underlying severe coronavirus infection

The paper presents the experience of treating a patient with acute coronary syndrome without ST segment elevation and underlying severe novel coronavirus infection (COVID-19) complicated by polysegmental viral pneumonia and significant respiratory events. Emphasis has been placed on the use of antithrombotic therapy after endovascular treatment. A 56-year-old patient underwent respiratory support (non-invasive face mask lung ventilation followed by high-flow oxygenation), urgent diagnostic coronary angiography followed by percutaneous coronary intervention (balloon angioplasty and stenting of the right coronary artery and anterior interventricular artery). In addition to the etiopathogenetic therapy for coronavirus infection, the patient received combination antithrombotic therapy, including acetylsalicylic acid, prasugrel, FRaMon monoclonal antibodies (single exposure, intraoperatively), sodium enoxaparin. The therapy resulted in normalization of hemodynamic parameters, stable normothermia, absence of catarrhal events, improvement of exercise tolerance. A chest ultrasound imaging showed consolidation events, inflammatory markers significantly decreased, circulatory deficiency events were compensated, anginal pains did not recur. On the 20th day of hospitalization, the patient was discharged home with outpatient follow-up. The use of potent antiplatelet agents such as prasugrel or ticagrelor combined with IIb/IIIa receptor inhibitors and prolonged anticoagulant therapy can potentially improve the outcome of the disease in acute coronary syndrome with underlying severe coronavirus infection. In the presented clinical example, the use of aggressive approaches to the antithrombotic therapy did not lead to the development of significant hemorrhagic or other complications.

Local Experience Using Intravascular Lithotripsy Treatment for Severe Calcific Coronary Disease in Acute Coronary Syndrome

Percutaneous treatment of heavily calcified coronary lesions remains a challenge with an increased risk of procedural failure and complications. Intravascular lithotripsy (IVL) can facilitate lesion preparation with trials in stable calcified lesions demonstrating favourable outcomes. The safety and efficacy of IVL in acute coronary syndrome (ACS) is unclear. We aim to assess the safety and efficacy of IVL in ACS compared with stable coronary artery disease (CAD).

Letter Circulating microRNA-221 and 222 for the Severity of Coronary Artery Disease in Acute Coronary Syndrome

Letter Circulating microRNA-221 and 222 for the Severity of Coronary Artery Disease in Acute Coronary Syndrome

1. DIFFERENCE BETWEEN TOTAL CHOLESTEROL-HDL RATIO AND GENSINI SCORE IN ACUTE CORONARY SYNDROME PATIENTS AT PROF. DR. R. D. KANDOU HOSPITAL

Background: Coronary artery disease is one of the most common diseases that endanger human health globally, its incidence has increased over the years and causes acute coronary syndrome disease. Research has found that the ratio of total cholesterol-HDL is a strong independent predictor of cardiovascular disease risk. Objective: To determine the difference between total cholesterol-HDL ratio and Gensini Score in patients with acute coronary syndrome. Method: Retrospective analytic study by looking at medical records patients with acute coronary syndrome who underwent cardiac catheterization at Prof. Dr. R. D. Kandou hospital from June-August 2020. Ages classified into non-elderly (18–59 years) and elderly (≥60 years). Inclusion criteria were patients who had a cardiac catheterization and had total cholesterol and HDL test results. The variable assessed was cholesterol total-HDL ratio with Gensini Score. The ratio of total cholesterol-HDL divided into below and above 4. Statistical analysis used independent t-test with a significance of p &lt;0.05. Result: Of the 63 patients with acute coronary syndrome who underwent cardiac catheterization 54 (86%) male, 9 (14%) female, non-elderly 36 (57%), elderly 27 (43%), patients with cholesterol-HDL ratio &lt;4 23 (36%) and &gt; 4 40 (64%). There is no difference between cholesterol total-HDL ratio below and above 4 and Gensini Score (44.47 ± 29.55 vs. 46.53 ± 31.85, p = 0.802). The average Gensini Score of patients with cholesterol-HDL ratio below 4 is lower than above 4 Conclusion: There is no significant difference between cholesterol total-HDL ratio below and above 4 and Gensini Score.

Beyond Atherothrombotic Disease in Acute Coronary Syndrome

Half of the global population over 20 years of age will be affected by cardiovascular disease. Cardiovascular events in young people is challenging. Spontaneous coronary artery dissection is a non-traumatic and non-iatrogenic separation of the coronary arterial wall and is an uncommon and underdiagnosed cause of acute myocardial infarction predominately found in young women. Medical management has been more widely accepted, with percutaneous and surgery treatment reserved for precise indications. Optimal control of individual risk factors is essential in [...]

Treatment Preferences for Cardiac Procedures of Patients With Chronic Kidney Disease in Acute Coronary Syndrome: Design and Pilot Testing of a Discrete Choice Experiment.

Background:Chronic kidney disease is associated with a high incidence of acute coronary syndrome and related morbidity and mortality. Treatment choices for patients with chronic kidney disease involve trade-offs in the potential benefits and harms of invasive management options.Objective:The objective was to quantify preferences of patients with chronic kidney disease toward invasive heart procedures.Design:Design and pilot a discrete choice experiment.Setting:We piloted the discrete choice experiment in 2 multidisciplinary chronic kidney disease clinics in Calgary, Alberta, using an 8-question survey.Patients:Eligible patients included those aged 18 years and older, an estimated glomerular filtration rate < 45 mL/min/1.73 m2, not currently receiving dialysis, and able to communicate in English.Measurements:Quantification of the average importances of key attributes of invasive heart procedures.Methods:We identified attributes most important to patients and physicians concerning invasive versus conservative management for acute coronary syndrome, using semi-structured qualitative interviews. Levels for each attribute were derived from analysis of early invasive versus conservative acute coronary syndrome management clinical trials and cohort studies, where subgroups of patients with chronic kidney disease were reported. We designed the pilot study with patient partners with relevant lived experience and considered statistical efficiency to estimate main effects and interactions, as well as response efficiency. Hierarchical Bayesian estimation was used to quantify average importances of attributes.Results:We recruited 43 patients with chronic kidney disease, mean (SD) age 67 (14) years, 67% male, and 35% with a history of cardiovascular disease, of whom 39 completed the survey within 2 weeks of enrollment. The results of the pilot revealed acute kidney injury requiring dialysis and permanent kidney replacement therapy, as well as death within 1 year were the most important attributes. Measures of internal validity for the pilot discrete choice experiment were comparable to those for other published discrete choice experiments.Limitations:Discrete choice experiments are complex instruments and often cognitively demanding for patients. This survey included multiple risk attributes which may have been challenging for some patients to understand.Conclusions:This pilot study demonstrates the feasibility of a discrete choice experiment to quantify preferences of patients with chronic kidney disease toward the benefits and trade-offs related to invasive versus conservative management for acute coronary syndrome. These preliminary findings suggest that patients with chronic kidney disease may be on average similarly risk averse toward kidney replacement therapy and death. This pilot information will be used to inform a larger discrete choice experiment that will refine these estimates of patient preferences and characterize subgroups with distinct treatment preferences, which should provide new knowledge that can facilitate shared decision-making between patients with chronic kidney disease and their care providers in the setting of acute coronary syndrome.

Electrocardiographic signs of the left main coronary artery disease in acute coronary syndrome

Myocardial infarction (MI) due to the left main coronary artery (LMCA) disease is a life-threatening condition. Evaluation of ECG signs of LMCA occlusion is important because of revascularization emergency. There is no single ECG pattern for LMCA occlusion. The purpose of the present literature review is to reveal ECG potential in diagnosing LMCA occlusion in acute coronary syndrome. Variability of ECG abnormalities was noted depending on the degree of LMCA occlusion, collateral blood flow from the right coronary artery, and concomitant stenosis. ST elevation in aVR is an evident predictor of LMCA lesion. Electrophysiological mechanisms of its formation were described. Diagnostic significance of additional ECG signs of LMCA disease was presented. Diagnostic and treatment strategies for patients with ECG signs of severe LMCA disease were summarized.

To study the association between platelet lymphocyte ratio (PLR) & neutrophil lymphocyte ratio (NLR) with angiographic severity of coronary artery disease in acute coronary syndrome

To study the association between platelet lymphocyte ratio (PLR) & neutrophil lymphocyte ratio (NLR) with angiographic severity of coronary artery disease in acute coronary syndrome

N-Terminal pro-brain natriuretic peptide level and association with severity of coronary artery disease in acute coronary syndrome

N-Terminal pro-brain natriuretic peptide level and association with severity of coronary artery disease in acute coronary syndrome

Fragmented QRS Complex as a Predictor of Multivessel Disease in Acute Coronary Syndrome

Background: The incidence of multivessel disease in acute coronary syndrome (ACS) is expected to be identified as early as possible in order to perform optimal management. The presence of multivessel disease can lead to ischemia or myocardial infarction. Fragmented QRS complex (fQRS) is a new electrocardiography (ECG) parameter that has been proven to be caused by ischemia or myocardial infarction.Methods: A cross-sectional study. Patients with ACS that admitted at Dr. Wahidin Sudirohusodo Makassar since December 2014 - March 2015 who are eligible were enrolled in this study.Presence of fQRS evaluated on first 12-lead ECG at hospital admission. Presence of multivessel disease based on coronary angiography. Data were analyzed by logistic regression. Data was significant if the p-value&lt;0.05.Results: There are 63 subjects (56 men and 7 women) included in this study. Older age, history of ACS before, presence of dyslipidemia, and presence of fQRS were significantly more often in group with multivessel disease. After analyzed with logistic regression, the fQRS was the only significant predictor of multivessel disease with p value 0.003 and odds ratio 13.28.Conclusion: Presence of fQRS in the first 12-lead ECG when admitted to the hospital was an independent predictor of multivessel disease in patients with ACS.

Can QT dispersion predict multi-vessel coronary artery disease in patients with acute coronary syndrome?

Objective. This study was planned to evaluate relation between QT dispersion (QTd) and multi-vessel coronary artery disease in acute coronary syndrome. Methods. This study included 225 consecutive patients with a diagnosis of non-ST segment elevation acute coronary syndrome. Three groups were defined as single vessel, two vessels, and three vessels. Echocardiographic, biochemical and electrocardiographic parameters of the three groups were compared. Results. QTd, corrected QT dispersion (QTcd) and corrected QT max values significantly increased in patients with three-vessel disease compared to the patients with single-vessel disease group (60±27 vs 45±28 ms, 68±32 vs 50±32 ms and 471±52 vs 443±48 ms; p =0.002, p = 0 .001 and p =0.001, respectively). In addition, QTd and QTcd were statistically more increased in patients with two-vessels disease than single-vessel disease group (57±29 vs 45±28 ms; p =0.045, and 63±32 vs 50±32 ms; p =0.046, respectively). Conclusion. In patient with acute coronary syndrome and diffuse vessel disease, changes in the myocardial cells due to ischemia cause more of the QT dispersion in the patients with multi-vessel disease than those with single-vessel disease.

Value of N-terminal pro brain natriuretic peptide in predicting prognosis and severity of coronary artery disease in acute coronary syndrome

BackgroundMeasurement of N-terminal pro brain natriuretic peptide (NT-proBNP) in the evaluation of patients with acute coronary syndrome has appeared to be a useful prognostic marker of cardiovascular risk. Aim of the workTo assess the in-hospital prognostic value of NT-proBNP in patients with acute coronary syndrome (ACS) and its relation to the severity of coronary artery disease. Patients and methodsThis study included 132 consecutive patients with ACS, 64 patients with unstable angina (UA), 46 patients with non-ST segment elevation myocardial infarction (NSTEMI), and 22 patients with ST segment elevation myocardial infarction (STEMI). ECG, echocardiography and pre and post coronary angiography measurement of troponin I, creatine kinase (Ck), C-reactive protein (CRP) and NT-proBNP were done. Patients were divided into two groups: Group A with NT-proBNP less than 474pg/ml and Group B with NT-proBNP equal or more than 474pg/ml. ResultsThere was a significant negative correlation between NT-proBNP and ejection fraction. Incidence of heart failure and duration of hospital stay were significantly higher in Group B (with NT-proBNP equal or more than 474pg/ml) than Group A (with NT-proBNP less than 474pg/ml). Moreover, there was a trend to an increased incidence of cardiogenic shock and mortality in Group B compared to Group A. The number of coronary vessels affected, severity of stenosis and proximal left anterior descending artery (LAD) disease were higher in Group B than in Group A. TIMI flow grade was significantly higher in Group A than in Group B. ConclusionNT-proBNP is a valuable marker for predicting prognosis and severity of coronary artery disease in patients with acute coronary syndrome.

High Serum Resistin Level may be an Indicator of the Severity of Coronary Disease in Acute Coronary Syndrome

To investigate the correlation between serum resistin level, cardiovascular risk factors and severity of coronary disease in acute coronary syndrome (ACS). After evaluated by clinical history, electrocardiography, exercise tolerance tests, laboratory tests, and coronary angiography, 220 consecutive patients with suspected chest pain were divided into normal control group, stable angina pectoris (SAP) group, and ACS group, respectively. Baseline clinical characteristics, including height, weight, waist circumference, hip circumference, white blood cell count, high-sensitive C-reactive protein (hsCRP), total cholesterol, triglyceride, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol, were compared among three groups. ELISA was used to detect serum resistin levels. Pearson's correlation coefficient analysis was used to assess association between resistin and other traditional cardiovascular risk factors. Multinomial logistic regression analyses were used to define the relationship between serum resistin level and SAP or ACS. Serum resistin level in ACS group (1.18+/-0.48 microg/L) was significantly higher than that in normal control and SAP groups (0.49+/-0.40 and 0.66+/-0.40 microg/L; P<0.01). Only in ACS group, increased serum resistin level was significantly correlated with hsCRP (r=0.262, P=0.004) and white blood cell count (r=0.347, P=0.001). Furthermore, serum resistin levels showed a stepwise increase with the number increase of > 50% stenosed coronary vessels. Multinomial logistic regression test demonstrated that serum resistin was a strong risk factor for ACS (OR=29.132, 95 % CI: 10.939-77.581, P<0.001). These findings suggested the potential role of resistin in atherosclerosis and especially its involvement in ACS.

Características clínicas, epidemiología y pronóstico del síndrome coronario agudo sin elevación del segmento ST con coronarias sanas

It has been estimated that up to 12% of patients with acute myocardial infarction do not present coronary atherosclerotic disease demonstrable with angiographic studies. We assessed the clinical characteristics and prognosis of acute coronary syndrome without ST-segment elevation with angiographically normal coronary arteries. Comparative retrospective analysis of 58 consecutive patients with this diagnosis and a sample (n = 59) with lesions in angiographic studies, analyzing demographic characteristics, analytical parameters, electrocardiogram, ventricular function and prognosis. The group represented 19% of the totality of acute coronary syndromes, showing a lower prevalence rates of hypercholesterolemia, diabetes mellitus and no record of ischemic heart disease (p = 0.043 to p = 0.005). The presence of regional wall motion abnormalities was significantly higher in the group with angiographic lesions (76.3% vs 41.4%; p < 0.01). In-hospital mortality rate showed a non significant trend toward to be lower in the group with normal angiogram (1.7% vs 8.4%). The absence of significant coronary artery disease in acute coronary syndrome without ST-segment elevation is not infrequent and was related to a lower cardiovascular risk profile and the absence of regional wall motion abnormalities showing a trend toward better in-hospital prognosis.