Elevation ACS Research Articles

Anomalous origin of Left Main coronary artery from right sinus presenting as non-ST elevation ACS: A case Report

Congenital anomalies of the coronary arteries are a cause of sudden cardiac death. Of the known anatomic variants, anomalous origination of a coronary artery from an opposite sinus of Valsalva (ACAOS) remains a major clinical issue and a challenging condition to treat. Congenital coronary anomalies are likely to be under-recognized, as completing an anatomic assessment in a very large portion of the population would seem unfeasible. However, we present a case report with image of a 54-year-old female presented with acute non-ST elevation ACS for which she underwent diagnostic angiography of the coronary system which revealed a common origin of both right and left main coronary artery from right sinus of Valsa.

Prevalence and Predictors of Occlusive Myocardial Infarction in Patients Presenting With Non-ST-Elevation Acute Coronary Syndrome in Duhok, Iraq: A Cross-Sectional Study.

Background and aim Myocardial infarction is a major global health issue and the leading cause of death. Non-ST segment elevation acute coronary syndrome (NSTE-ACS) could behave like ST-segment elevation ACS in terms of causing total or near total occlusion of the coronary artery and leading to occlusive myocardial infarction (OMI). This study aims to assess OMI prevalence and associated factors in NSTE-ACS patients in Duhok, Iraq, to improve diagnosis and treatment outcomes. Materials and methods This prospective cross-sectional study, conducted at Azadi Heart Center and Zakho Teaching Hospital from March 2023 to March 2024, included 189 NSTE-ACS patients undergoing coronary angiography. Data collection encompassed demographics, clinical profiles, electrocardiographic (ECG) patterns, cardiac biomarkers, and angiographic outcomes. Patients were categorized into those with and without occlusive myocardial infarction (OMI). Results A total of 189 NSTE-ACS patients with a mean age of 58.65 (±10.38 SD) years were enrolled in the study. The overall OMI rate was 29.63%. OMI patients were older and had a higher prevalence of hypertension, dyslipidemia, and a family history of ischemic heart disease (IHD). Significant ECG changes associated with OMI included biphasic T-wave inversion and ST depression in specific leads. Marked elevation in troponin levels was also noted in OMI patients. The left anterior descending (LAD) artery was the most common culprit artery. Conclusions About one-quarter of our study cohort exhibited OMI. The condition was linked to clinical, ECG, and elevated troponin levels. The study underscores the importance of promptly recognizing occlusive myocardial infarction (OMI) in NSTE-ACS patients for better outcomes. Regular audits are imperative to augment awareness among healthcare professionals at cardiac centers regarding updated protocols and guidelines.

Search for predictors of complications of acute coronary syndrome with ST segment elevation – protocol of a prospective open cohort study PROMETHEUS

During the first year after myocardial infarction, coronary artery restenosis, fatal arrhythmias, hospitalization for heart failure or cardiac death may occur. It is necessary to search for biomarkers to predict complications of myocardial infarction. As such predictors, it seems promising to introduce the ABCDE-SE echocardiographic protocol, as well as study the metabolism of vitamin D and proteins of the fibrinolysis system. Cardiospecific microRNAs-21, -29, -143 can be used as pathogenetic factors in the development of complications; it is proposed to study the ongoing pharmacotherapy and patients’ compliance with it as controllable factors.Aim: To search for predictors of complications of myocardial infarction based on the assessment of echocardiographic parameters, vitamin D metabolism, components of the fibrinolysis system and cardiac-specific microRNAs.Material and Methods. The PROMETHEUS study is designed as a prospective, open-label, non-randomized cohort study. It is planned to include 300 patients newly admitted to the vascular center with a preliminary diagnosis of ST-segment elevation ACS. All patients will have their vitamin D concentrations determined; genetic variants of polymorphisms of the vitamin D receptor gene and vitamin D binding protein; concentrations of urokinase and soluble urokinase receptor; microRNA-21, -29, -143, as well as echocardiography using the ABCDE-SE protocol at 1, 3, 6 and 12 months from inclusion. Pharmacotherapy will be assessed at all stages.Expected results: Based on the results of the study, a comprehensive algorithm for optimizing the prediction and prevention of complications of myocardial infarction will be developed and introduced into practical healthcare.

B-23 | Evaluating the Safety of High-Risk Percutaneous Coronary Intervention at Non-Cardiac Surgery Sites: An Observational Cohort Study

Contemporary data is needed to evaluate the safety of high-risk percutaneous coronary intervention (PCI) at non-CV surgery (CVS) sites compared to similar cases performed at CVS sites. Observational cohort study of high-risk patients undergoing PCI of select high-risk lesions in CVS and non-CVS sites, within a large integrated healthcare system in Northern California between 01/2011-03/2019. Using ICD-9/10 codes, we defined high-risk patients as those with decompensated heart failure, chronic kidney disease or an ejection fraction (EF) ≤30%. High risk or ‘type C’ lesions (diffuse disease ≥20mm, proximal lesions, moderate-severe calcification, degenerated vein grafts, and multi-vessel disease) were identified from validated procedural databases. We excluded patients with ST elevation myocardial infarction, cardiac arrest ≤24 hours, cardiogenic shock, or PCI transfers to CVS sites. Primary outcome was a composite of 12-month all-cause mortality and need for emergent bypass surgery. Crude hazard ratio (HR) and 95% confidence interval (CI) for the primary outcome, non-CVS sites versus CVS sites was estimated using Cox Proportional Hazards model without controlling for any baseline covariates. Propensity score method was used to evaluate the effect of CVS site on the composite outcome using Cox Proportional Hazards model controlling for baseline covariates fitted by inverse probability of treatment weighting (IPTW) estimation. Out of a total of 19,525 patients, 15,690 (80.4%) underwent high-risk PCI at a CVS site, whereas 3,835 (19.6%) at a non-CVS site. Mean age was 67 (SD 11.5) years, with 27.2% women. PCI indication was non-ST elevation ACS for 73.8% of patients. Compared to CVS sites, the crude HR for the composite outcome for non-CVS site was 1.009 (95%CI: 1.005-1.013); after IPTW the risk-adjusted HR was 0.999 (95%CI: 0.996-1.002). In select high-risk patients undergoing PCI of select high risk lesions, there is no significant difference in rates of emergent CABG and 12-month all-cause mortality between CVS and non-CVS sites. Limitations include the observational nature of the analysis which may not fully account for residual confounding.

FREQUENCY OF ACUTE HEART FAILURE IN NON ST ELEVATION ACUTE CORONARY SYNDROME; CAN WE PREDICT THE HEART FAILURE ON CLINICAL AND ELECTROCARDIOGRAPHY (ECG) BASIS?

Objectives: Non-ST elevation acute coronary syndrome (NSTE-ACS) comprises NSTE myocardial infarction (NSTEMI) and unstable angina. A common complexity of NSTE-ACS is heart failure (HF). The objective of this study was to assess the incidence of in-hospital HF in NSTE-ACS patients and to link clinical and electrocardiographic (ECG) abnormalities to HF. Methodology: This study was performed at National Institute of Cardiovascular Diseases (NICVD) Karachi, from January 1, 2018 to June 30, 2018. The study included all adult patients who were hospitalized with a diagnosis of non-ST elevation ACS. Their socio demographic profile, clinical findings, ECG findings, and occurrence of heart failure during hospital stay was recorded. Data was entered and analyzed using SPSS v.23. Results: In this study 265 patients with NSTE-ACS were included. Mean age of 55.39±10.40 years was observed. There were 195 (73.6%) male patients. T-wave inversion was observed in 73 (27.5%) patients, ST-segment depression in 77 (29.1%), and both T-wave inversion and ST-segment depression in 71 (26.8%) patients. During their stay in the hospital, 28 patients (10.6 percent) developed HF. Diabetes, hypertension, smoking, a genetic susceptibility of ischemic heart disease, and combination of T-wave inversion and ST-segment depression on ECG was significantly correlated with HF (P≤0.05). Conclusion: The determinants of HF were diabetes, hypertension, smoking, family history of ischemic heart disease, and combination of T-wave inversion and ST depression on ECG.

Current views on antiplatelet therapy in acute coronary syndrome patients: the place of clopidogrel

Clopidogrel is the most studied P2Y12 receptor blocker and still has no alternative in a number of categories of ACS patients in whom ticagrelor or prasugrel have not been studied or their use is associated with an unacceptably high risk of bleeding. The review is devoted to a detailed consideration of these clinical situations, both in the light of the evidence base for the benefits of clopidogrel andthe practical aspects of its use. Clopidogrel remains the drug of choice in ST-segment elevation ACS patients undergoing thrombolysis, pharmacoinvasive strategy is implemented, and reperfusion therapy is not used at all. In patients with ACS without ST-segment elevation, clopidogrel is preferable in high risk of bleeding. The article discusses in more detail some particular cases of high bleeding risk in ACS patients, in which it is advisable to use clopidogrel: concomitant use of oral anticoagulants, active cancer, chronic kidney disease stages IV-V. Relatively new data on the peculiarities of ACS antiplatelet therapy in the mongoloid race are discussed, which is relevantto the Russian Federation. In real clinical practice, clopidogrel is often used because of intolerance, contraindications or unavailability of more powerful P2Y12 receptor blockers. Affordability, good tolerability, greater safety (including in relation to the development of recurrent minor “annoying” bleedings), single dose clopidogrel and availability of fixed combinations with acetylsalicylic acid result in better adherence to treatment with this drug than with more powerful P2Y12 receptor blockers, which in real-world settings may provide a more optimal treatment outcome. The article discusses approaches to forced de-escalation of antiplatelet therapy – switching from a more potent P2Y12 receptor blocker to clopidogrel. Data is also presented on the study of routine de-escalation at the end of the acute ACS period, both empirical and controlled by functional or genetic tests characterizing the efficacy of clopidogrel. Although routine de-escalation is not currently recommended, randomized trials suggest that this treatment strategy is promising for preventing hemorrhagic complications and reducing the cost of managing patients with ACS.

Comparison of Clinical and Angiographic Profiles of Patients with or without Left Main Coronary Artery Disease

Background: Left main coronary artery disease constitutes highest risk lesion subset of CAD population. Flow dynamics and pathophysiology in the left main coronary artery are different from that of the other coronary arteries. So traditional risk factors might interact differently with left main artery resulting in different clinical and angiographic characteristics compared to others. Anatomic pattern evaluation in left main coronary artery disease is important in deciding best management options. However, their pattern and profiles were variably shown in different studies with discrepant Results suggesting geographic variation and lead to evaluation of characteristics in our own population. Better understanding this specific problem might lead to further improvement in its management. Methods: It was an observational cross-sectional study. Ninety-one adult coronary artery disease patients over the period of one year who underwent invasive coronary angiogram were studied. Study subjects were divided into two groups after coronary angiogram: Left main (Group 1) and Non-left main (Group 2) CAD. Demographic data, risk factor profiles and angiographic patterns of both groups were compared to see if any statistically significant difference present or not. Results: The mean age and standard deviation in group 1 is 55.2±9.4 and in group 2 is 55.5±12.9; the comparative analysis showed no statistically significant difference. Most of the patients were male 69 (76%) and the comparative study showed statistically significant differences (p=0.046) which showed left main disease tended to be higher in male. Majority (64%) had BMI in normal range with no significant difference. Among the risk factors comparison, diabetes and family history of CAD showed significant association with the left main cohort (p<0.05). Non-ST elevated ACS was the most common presentation and significantly associated with the left main group (p<0.05). On coronary angiogram, there were 80 patients (87.92%) who had no left main artery involvement while 11 patients (12.08%) had left main disease. The comparative study of coronary artery involvement among the two groups reveals no statistically significant differences (p>0.05) but triple vessel disease was found more commonly than single and double vessel disease. Distal lesions (64%) were found more frequently than other types of left main stenosis followed by ostio-proximal lesion (36%). Conclusion: In the patients with left main coronary artery disease, male gender, diabetes mellitus, positive family history and presentation with non-ST elevation ACS were found to be significantly associated. Distal left main lesion and triple vessel disease were commonly found. University Heart Journal 2022; 18(1): 3-9

P2Y12 inhibitors in patients with non-ST-segment elevation acute coronary syndrome: systematic review and network meta-analysis of randomized trials

Abstract Background Based on a recent randomized control trial (RCT), prasugrel is recommended in preference to ticagrelor for patients with non-ST-segment elevation ACS (NSTE-ACS), however, limited data exists. Objectives We aimed to investigate the effect of P2Y12 inhibitors on ischemic and bleeding events in NSTE-ACS patients. Methods Clinical trials enrolling NSTE-ACS patients were identified and relevant data was extracted. We performed a network meta-analysis on efficacy and safety outcomes. Results Our study including a total of 37, 268 patients with NSTE-ACS from 11 RCTs. Prasugrel decreased major adverse cardiovascular events (MACE) when compared to clopidogrel (Hazard ratio (HR): 0.84; 95% confidence interval (CI) [0.71–0.99]). For MACE, prasugrel showed the highest likelihood of event reduction (P-score=0.97) in comparison to ticagrelor (P-score=0.29) and clopidogrel (P-score=0.24). Prasugrel decreased myocardial infarction (HR: 0.82; 95% CI [0.68–0.99]) but increased major bleeding without statistical significance (HR: 1.30; 95% CI [0.97–1.74]) when compared to clopidogrel. Ticagrelor reduced cardiovascular death (HR: 0.79; 95% CI [0.66–0.94]) but increased major bleeding (HR: 1.33; 95% CI [1.00–1.77], p=0.049) in comparison to clopidogrel. There was no significant difference between prasugrel and ticagrelor for each endpoint, but prasugrel had higher likelihood of event reduction than ticagrelor for all endpoints except cardiovascular death. Conclusions Prasugrel and ticagrelor had comparable risk for each endpoint, but prasugrel had the highest probability being the best treatment in reducing the primary endpoint. This study highlights the need for further large-scale RCTs to investigate the optimal P2Y12 inhibitor selection in NSTE-ACS patients. Funding Acknowledgement Type of funding sources: None.

Widespread ST‐segment elevation due to diffuse coronary artery spasm: A case report

Coronary artery spasm (CAS) is considered an important mechanism of acute coronary syndrome but not very common in the clinical setting. We report a case of a 42‐year‐old woman with chest pain lasting for 4 h due to diffuse CAS, which led to widespread ST‐segment elevation in multiple leads of the electrocardiogram and elevated cardiac troponin T. Emergency coronary angiography at admission showed significantly different morphological results from the second angiography during hospitalization, indicating the patient's discomfort was due to CAS rather than stenosis. Our case illustrates that diffuse CAS can cause widespread ST‐segment elevation and severe ACS.

Results of an international crowdsourcing survey on the treatment of non-ST segment elevation ACS patients at high-bleeding risk undergoing percutaneous intervention

AimsChoosing an antiplatelet strategy in patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS) at high bleeding risk (HBR), undergoing post-percutaneous coronary intervention (PCI), is complex. We used a unique open-source approach (crowdsourcing) to document if practices varied across a small, global cross-section of antiplatelet prescribers in the post-PCI setting. Methods and resultsFive-hundred and fifty-nine professionals from 70 countries (the ‘crowd’) completed questionnaires containing single- or multi-option and free form questions regarding antiplatelet clinical practice in post-PCI NSTE-ACS patients at HBR. A threshold of 75% defined ‘agreement’. There was strong agreement favouring monotherapy with either aspirin or a P2Y12 inhibitor following initial DAPT, within the first year (94%). No agreement was reached on the optimal duration of DAPT or choice of monotherapy: responses were in equipoise for shorter (≤3 months, 51%) or longer (≥6 months, 46%) duration, and monotherapy choice (45% aspirin; 53% P2Y12 inhibitor). Most respondents stated use of guideline-directed tools to assess risk, although clinical judgement was preferred by 32% for assessing bleeding risk and by 46% for thrombotic risk. ConclusionThe crowdsourcing methodology showed potential as a tool to assess current practice and variation on a global scale and to achieve a broad demographic representation. These preliminary results indicate a high degree of variation with respect to duration of DAPT, monotherapy drug of choice following DAPT and how thrombotic and bleeding risk are assessed. Further investigations should concentrate on interrogating practice variation between key demographic groups.

Sex-gender disparities in nonagenarians with acute coronary syndrome.

BackgroundAcute coronary syndrome (ACS) remains one of the leading causes of mortality for women, increasing with age. There is an unmet need regarding this condition in a fast‐growing and predominantly female population, such as nonagenarians.HypothesisOur aim is to compare sex‐based differences in ACS management and long‐term clinical outcomes between women and men in a cohort of nonagenarians.MethodsWe included consecutive nonagenarian patients with ACS admitted at four academic centers between 2005 and 2018. The study was approved by the Ethics Committee of each center.ResultsA total of 680 nonagenarians were included (59% females). Of them, 373 (55%) patients presented with non‐ST‐segment elevation ACS and 307 (45%) with ST‐segment elevation myocardial infarction (STEMI). Men presented a higher disease burden compared to women. Conversely, women were frailer with higher disability and severe cognitive impairment. In the STEMI group, women were less likely than men to undergo percutaneous coronary intervention (PCI) (60% vs. 45%; p = .01). Overall mortality rates were similar in both groups but PCI survival benefit at 1‐year was greater in women compared to their male counterparts (82% vs. 68%; p = .008), persisting after sensitivity analyses using propensity‐score matching (80% vs. 64%; p = .03).ConclusionSex‐gender disparities have been observed in nonagenarians. Despite receiving less often invasive approaches, women showed better clinical outcomes. Our finding may help increase awareness and reduce the current gender gap in ACS management at any age.

ST-Segment Elevation ACS: Impact of Time to Diagnosis on Door-To- Balloon Time in the Real World. Data from the ARGEN-IAM-ST Registry

Background: Time elapsed from the onset of symptoms to diagnosis (TTD) can influence in achieving a door-to-balloon time<90 min (DBT <90 min). Methods: A retrospective analysis was performed on 1,518 patients prospectively and consecutively included in the ARGENAMI-ST registry. In 37.8% of cases. patients were treated with DBT <90 min and a median TTD of 120 min (IQR 60-266).The population was divided according to TTD above or below 120 min. A DBT <90 min was achieved more frequently inthose with TTD <120 min: 44% vs. 32.2% (p <0.001) respectively. Results: In patients with in situ percutaneous coronary intervention (PCI) and TTD 120 min (p 120 min (p: 0.003), as well as in patients admitted during non-working hours:41.9% vs. 30.4% (p <0.001). The independent predictors of achieving a DBT <90 min in the multivariate analysis were age<75 years: OR 1.57 (1.1-2.25; p: 0.01), PCI during working hours: OR 1.32 (1.04-1.67; p: 0.002), PCI in situ: OR 2.4 (1.9-3.0;p <0.001), having a pre-hospital ECG: OR 2.22 (1.73-2.86; p <0.001) and a TTD <120 min: OR 1.53 (1.23-1.9; p <0.001). Conclusions: In patients with TTD <120 minutes, a DBT <90 minutes is more frequently achieved, especially in those treated insitu and during working hours. In referred patients, only 1 in 3 achieves a DBT<90 min and there is no relationship with TTD.

Place of Prasugrel, P2Y12 receptor antagonist, in an early invasive treatment of patients with acute coronary syndrome (according to the results of multicenter randomized controlled trial ISAR-REACT 5)

The conclusion of the Expert Council reports an agreement on the place of the P2Y 12 receptor blocker prasugrel in the early invasive treatment of patients with acute coronary syndrome ACS, according to the results of the multicenter randomized controlled study ISAR-REACT 5. Prasugrel should be considered the preferred P2Y 12 receptor blocker in the planned primary percutaneous coronary intervention and early invasive management of patients with ST segment elevation ACS. Herewith, prasugrel intake in patients with non-ST segment elevation ACS is preferable after coronary angiography and decision for coronary stenting.

SCA sans sus ST chez le nonagénaire : expérience du CRAC

PurposeTo compare the clinical, angiographic, therapeutic and prognostic characteristics of nonagenarians presenting with non-ST elevation acute coronary syndrome with those of patients under 90 years of age. MethodsWe used the CRAC register database including 6 catheterization laboratories in the Center Val-de-Loire region. Only patients with positive-troponin non-ST elevation ACS included in the registry from 2014 to 2017 were selected for epidemiological and procedural data. Regarding antiplatelet therapy, hospital and one-year follow-up data, only patients in the 2014–2015 period were analyzed. ResultsFrom January 1st, 2014 to December 31st, 2017, 5.964 patients with a positive-troponin non-ST ACS, including 133 nonagenarians (2.2%) were included in the CRAC registry. Arterial hypertension and the history of coronary angioplasty were more common among nonagenarians. They present more multivessel and left main disease. The use of the bare metal stent was predominant in 2014–2015 and then became marginal in 2016–2017. Clopidogrel was the most widely used anti platelet and more than one in two nonagenarians remain on dual therapy after 12 months. One-year stroke and hospital and one-year mortality were higher in this age group. ConclusionsNonagenarians with a positive-troponin non-ST elevation ACS have more severe coronary artery disease and a poorer prognosis than those younger than 90 years of age.

Feasibility and accuracy of speckle tracking echocardiography in emergency department patients

BackgroundSpeckle tracking echocardiography (STE) is a novel technology that measures regional wall-motion abnormalities that may speed diagnosis and intervention of acute coronary occlusion in Emergency Department (ED) patients with non-ST elevation ACS (NSTE-ACS). STE provides an objective measurement of myocardial strain that is superior to visual assessment of wall motion when performed as part of a point-of-care (POC) echocardiogram. We determined the feasibility and preliminary accuracy of POC STE operated by emergency providers when compared to comprehensive echocardiography or final diagnosis of ACS. MethodsWe retrospectively reviewed 187 emergency provider POC echocardiograms with STE from 7/2014–5/2016 for suspected ACS at a large academic trauma center. Feasibility of POC STE was determined by calculating the percentage of complete exams (adequate apical 4-chamber and parasternal short axis views) out of all STE exams. We then used two different criterion standards for calculating diagnostic accuracy of STE: comprehensive echocardiograms with wall motion abnormalities or formal diagnosis of ACS based on elevated cardiac troponins, unstable angina, percutaneous coronary intervention, or coronary artery stenosis >70% on catheterization. ResultsOf 187 STE studies performed, 75 (40%) were considered complete. Ultrasound-experienced providers had higher rates of complete exams (65% vs. 35%, P = 0.01). 16 of 75 exams (21%) were positive for myocardial strain, and of these 16 (100%) were admitted, 12 (75%) had positive troponins, 6 (46%) had positive comprehensive echocardiograms, and 3 (19%) had PCI or >70% stenotic lesion on catheterization. Compared with comprehensive echocardiography, POC STE had 35% sensitivity, 70% specificity, 46% positive predictive value (PPV), and 59% negative predictive value (NPV). Compared with formal diagnosis of ACS, POC STE had 29% sensitivity, 88% specificity, 75% positive predictive value (PPV), and 51% negative predictive value (NPV). ConclusionSTE is a potentially feasible adjunct to standard bedside echocardiography in ED patients with suspected ACS when operated by experienced ultrasound-trained physicians in the ED. This data shows STE performed by emergency providers is not yet sensitive enough alone to diagnose ACS, and has low accuracy when compared to comprehensive echocardiography. However, the PPV and specificity improve when performed by expert ultrasound-trained providers. STE should be considered for inclusion in the Emergency Ultrasound Fellowship curriculum.

PRASUGREL FOR THE TREATMENT OF ACUTE CORONARY SYNDROMES AND PERCUTANEOUS CORONARY INTERVENTION: STATUS UPDATE ON THE PROBLEM

Prasugrel is a third-generation thienopyridine that provides earlier onset of action, has a reduced probability of insensitivity to the drug, a greater degree of inhibition of ADP-induced platelet aggregation compared to clopidogrel. Prasugrel should be proscribed to the following categories of patients: 1) patients with ST-segment elevation ACS who undergo primary percutaneous coronary interventions; 2) patients with ST-segment elevation ACS, who underwent thrombolysis, but scheduled to receive delayed PCI; 3) patients with non ST-segment elevation ACS with a known coronary anatomy, which are scheduled to receive PCI; 4) patients who had stent thrombosis due to clopidogrel resistance. Prasugrel may be considered in patients with stable coronary artery disease if they are at high risk of stent thrombosis after a planned PCI. One should avoid prescribing this drug to patients with a history of stroke or TIA, as well as to patients 75 years or older, with body weight less than 60 kg. The best results for the use of prasugrel are expected in patients younger than 60 years old, with ST segment elevation MI, concomitant diabetes mellitus, creatinine clearance of at least 60 ml / min. The article also discusses current ideas about the «de-escalation» of prasugrel therapy, presents recently published data on the comparative efficacy and safety of prasugrel and ticagrelor.

P4671Transradial diagnostic and therapeutic coronary catheterization of patients with non-st-segment elevation ACS using one sheath and one sheathless guide catheter via one puncture site: the 1-1-1 strate

P4671Transradial diagnostic and therapeutic coronary catheterization of patients with non-st-segment elevation ACS using one sheath and one sheathless guide catheter via one puncture site: the 1-1-1 strate

Tissue characterization of non-culprit intermediate coronary lesions in non ST elevation acute coronary syndromes.

BackgroundDisruption of vulnerable plaques is the most common cause of acute coronary syndromes. Intravascular ultrasound facilitates cross-sectional imaging of coronary arteries. We aimed at using IVUS to investigate the morphology and tissue characteristics of atherosclerotic plaques of non-culprit intermediate coronary lesions in non-ST elevation ACS setting.MethodsIVUS assessment of sixty-one intermediate coronary lesions in twenty-eight patients with the diagnosis of Non ST elevation acute coronary syndromes. Ultrasound signals were obtained by an IVUS system using a 40-MHz catheter.ResultsMean age was 53.2 ± 9.1 years. Males = 20 (71.4%). Smoking in 17 (60.7%), hypertension in 16 (57.1%), Dyslipidemia in 12 (42.9%) and DM in 8 (28.6%). Culprit vessels represent 42% of affected vessels. Sixty-one intermediate lesions were detected. Twenty-nine lesions in culprit vessels and thirty-two lesions in non-culprit vessels with higher lipidic content in lesions of culprit vessels (P < 0.001) while a higher calcific content in lesions of non-culprit vessels (P < 0.001). Higher calcific content of proximal more than distal lesions (P = 0.048). Negative remodeling in 55.7% of lesions.ConclusionsA higher lipidic content in lesions of culprit vessels, while the lesions of non-culprit vessels were more calcific. Higher calcific content of proximal more than distal lesions was defined as well.

Anti-thrombotic therapy in non-ST elevation acute coronary syndrome KAA Fox

Platelet activation and thrombin generation are implicated in the pathogenesis of acute coronary syndrome, in the development of major thrombotic complications of the condition, and in the interventional treatments to treat obstructive coronary lesions (principally, percutaneous coronary intervention). Despite treatment with aspirin and heparin there remained a clinically important risk of thrombotic complications both in hospital and following discharge. Newer anti-platelet therapies (thienopyridines and glycoprotein IIb/IIIa inhibitors) reduced platelet mediated complications, but with an increase in bleeding risk. Similarly, low molecular weight heparins reduced thrombotic complcations but with a modest increase in bleeding. Newer anti-thrombins (anti Xa inhibitors and direct thrombin inhibitors) demonstrate similar or improved efficacy, but with reduced bleeding. Insufficient attention has been paid to reducing bleeding complications and recent evidence suggests that major bleeding conveys a significant increase in the risk of death. In addition, clearance of antithrombotic agents by the kidney is impaired in those with renal dysfunction, including in the elderly, and this may contribute to the risks of bleeding. In unselected populations with non-ST elevation ACS more than half the population have a creatinine clearance below 60 ml/min. Reducing the doses of anti-thrombins in patients with renal dysfunction may reduce bleeding complications. The optimal anti-thrombotic strategy in patients with non-ST elevation ACS requires the clinician to consider not only the risk of the patient for thrombotic complcations, but also the hazards of bleeding. Newer anti-thrombotic agents, for the first time, offer potential benefits in bleeding risk with similar or improved efficacy.

Association of Monocyte/HDL-C Ratio with the Selvester QRS Score in Patients with ST Elevation Myocardial Infarction Undergoing Primary Coronary Intervention

Background and aim: Recently, monocyte to high density lipoprotein (MHR) has been recommended as a new prognostic factor of cardiovascular diseases. the value of this scoring system have been documented by previous studies in predicting prognosis ST elevation myocardial infarction (STEMA°). However, no study is currently available regarding the association of MHR and the selvester score in predicting the outcomes among patients with STEMA°. Materials and methods: We evaluated a cohort of 99 consecutive patients who were admitted to our tertiary referral centre with STEMA° and under-went first primary percutaneous coronary intervention (pPCI) between June and September in 2016. The Selvester QRS score was estimated on the first electrocardiogram (ECG) after hospital admission. MHR was calculated for all patients. A total of 99 patients with ST elevation ACS were included in the study. They were divided into two groups. These were 52 patients in the low selvester score and 44 patients in the high selvester group. We investigate the relationship between selvester score and MHR ratio in Results: MHR was positively correlated with the Selvester score (r=0.467, P<0.001). In multivariate logistic regression analysis, MHR was an independent predictor of high selvester scores in prognosis of STEMA° (odds ratio: 2.565, 95% CI: 1.509-4.361; P<0.001). The area under the receiver–operating characteristic curve of the MHR was 0.749 (0.647-0.852; P<0.001). Conclusion: The results of this study have indicated that MHR is associated independently and significantly with high selvester score system in prognosis of STEMI.