Elevation Acute Coronary Syndrome Patients Research Articles

Occurrence of Transient Myocardial Ischemic Events among Non-ST Segment Elevation Acute Coronary Syndrome Patients Before or After Invasive Coronary Angiography.

The occurrence of transient myocardial ischemia (TMI) is an important pathology in patients with non-ST elevation acute coronary syndrome (NSTE-ACS), yet studies are scarce regarding when TMI occurs during hospitalization, particularly in relation to invasive coronary angiography (ICA). This study examined: (1) TMI before or after ICA; (2) patient characteristics and ischemic burden by TMI group (before or after ICA); and (3) major in-hospital complications (transfer to critical care, death) and length of stay (LOS) by TMI group (before or after ICA). Secondary data analysis in hospitalized NSTE-ACS patients with TMI event(s) identified from 12-lead electrocardiographic (ECG) Holter. Patient records were reviewed to assess ischemic burden (TMI time [minutes] ÷ hours recording duration), outcomes and TMI timing, before or after ICA. In 38 patients, 3 (8%) had TMI before and after ICA. Of the remaining 35 patients (92%), TMI occurred before ICA (16; 46%), and after ICA (9; 26%), and 10 (28%) did not have ICA. Patient characteristics, untoward outcomes, and TMI duration (minutes) did not differ by group. Ischemic burden was higher in patients with TMI after ICA (7.29±8.82 min/hr) compared to before ICA (2.54±2.11 min/hr), p=0.039. Hospital LOS by TMI group was 113±113 (before), 226±244 (after), and 85±65 hr (no ICA); p=0.172. Almost half of the sample had TMI before ICA; one-third had TMI but did not have ICA. Patients with TMI after an ICA had higher ischemic burden. Future studies with larger sample sizes are needed to investigate further the short- and long-term clinical significance of TMI among NSTE-ACS patients.

Can prolonged P-R interval predict clinical outcomes in non-ST elevation acute coronary syndrome patients?

BackgroundThe present study aimed to respond to clinical question, can prolonged P-R interval predict clinical outcomes in non-ST elevation acute coronary syndrome patients?MethodsThis descriptive-analytical study was conducted on cardiac patients. All of the non-ST elevation acute coronary syndrome (NSTEACS) including non-ST elevation myocardial infarction (NSTEMI) and unstable angina patients included in the study. Then they divided into two groups: prolonged P-R interval and normal P-R interval. The patients who had a history of digoxin and calcium channel blocker use, using antiarrhythmic drugs, known valvular or congenital heart disease and connective tissue, unreadable P-R interval and cardiac block were excluded. Data were collected using the questionnaire consisted demographic data and clinical outcomes and a follow-up part was completed by one of the researchers.ResultsFinally, 248 patients completed the study. The results showed both of the two groups had significant differences in terms of the history of myocardial infarction (MI) (p = 0.018), the level of high-density lipoprotein (HDL) (p = 0.004), heart rate (p = 0.042), inverted T wave (p = 0.017), anterior ST- segment depression (p = 0.008), normal report of coronary angiography (CAG) (p = 0.003), three vessels disease (p = 0.043), left main lesion (p = 0.045) and SYNTAX score (p = 0.032) based on the CAG report. The results of six-month follow-up showed although, the frequency of ischemic stroke, coronary artery disease (CAD) and cardiovascular death were higher in prolonged P-R interval groups. The chi-square test showed this difference was statistically non-significant (p > 0.05). The multivariate logistic regression model revealed non-significant relationships between prolonged P-R interval and SYNTAX score, significant CAD, three-vessel disease, inverted T wave, anterior ST depression, heart rate and HDL.ConclusionsBased on the results of our study the six-month follow-up showed non-significant outcomes. Further studies are recommended to assess the long-term outcomes.

Clinical predictors of coronary artery bypass graft surgery in patients hospitalized for Non-ST acute coronary syndrome - Buenos Aires I and ReSCAR22 registries.

To identify predictors of coronary artery bypass graft surgery (CABG) requirement as a revascularization method in in real-world non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients. . An individual pre-specified analysis of patients with NSTE-ACS was performed from two prospective Argentine registries between 2017 and 2022. We analyzed the difference in baseline characteristics between patients who required CABG and those who did not require this intervention. Then, a logistic regression analysis was performed to determine independent predictors in patients who received CABG as a method of revascularization. A total of 1848 patients with a median age of 54.8 (interquartile range [IQR]: 53.7-56) years and an ejection fraction of 42.1% (IQR: 41.2-43.1) were included. A total of 233 patients required CABG (12.6%). Baseline characteristics between the two groups were similar, except in patients requiring CABG, who were younger (51.5 vs. 55.7 years; p=0.010), more frequently diabetic (38.2% vs. 25.7%; p=0.001) and male (90.1% vs. 73.7%; p=0.001). In addition, they had, to a lesser extent, previous cardiac surgery (2.1% vs. 11.2%; p=0.011). After multivariable analysis, the following were independently associated with CABG: age (Odds Ratio [OR]: 0.99, 95% confidence interval [CI]: 0.98-0.99; p=0.008), male sex (OR: 3.08, 95% CI: 1.87-5.1; p=0.001), history of previous CABG (OR: 0.14, 95% CI: 0.05-0.30; p=0.001) and diabetes (OR: 1.84, 95% CI: 1.31- 2.57; p=0.001). In this analysis of two NSTEACS registries, younger age, male sex, a diagnosis of diabetes and the absence of previous surgery were independent predictors of the requirement for inpatient CABG.

Is having a moderate or low history, electrocardiogram, age, risk factors, troponin risk score a handicap for long-term mortality?

History, electrocardiogram, age, risk factors, troponin risk score and troponin level follow-up are used to safely discharge low-risk patients with suspected non-ST elevation acute coronary syndrome from the emergency department for a 1-month period. We aimed to comprehensively investigate the 6-month mortality of patients with the history, electrocardiogram, age, risk factors, troponin risk score. A total of 949 non-ST elevation acute coronary syndrome patients admitted to the emergency department from 01.01.2019 to 01.10.2019 were included in this retrospective study. History, electrocardiogram, age, risk factors, troponin scores of all patients were calculated by two emergency clinicians and a cardiologist. We compared the 6-month mortality of the groups. The mean age of the patients was 67.9 (56.4-79) years; 57.3% were male and 42.7% were female. Six-month mortality was significantly lower in the high-risk history, electrocardiogram, age, risk factors, troponin score group than in the low- and moderate-risk groups: 11/80 (12.1%), 58/206 (22%), and 150/444 (25.3%), respectively (p=0.019). Patients with high history, electrocardiogram, age, risk factors, troponin risk scores are generally treated with coronary angioplasty as soon as possible. We found that the mortality rate of this group of patients was lower in the long term compared with others. Efforts are also needed to reduce the mortality of moderate and low-risk patients. Further studies are needed on the factors affecting the 6-month mortality of moderate and low-risk acute coronary syndrome patients.

Time to coronary catheterization in patients with non-ST-segment elevation acute coronary syndrome and high Global Registry of Acute Coronary Events score.

Current guidelines recommend an early (<24 h) invasive coronary angiography (ICA) strategy in non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients with Global Registry of Acute Coronary Events (GRACE) score over 140. Evidence for this recommendation is based on older trials. Between 1 February 2016 and 31 July 2021, 1767 patients with a primary diagnosis of NSTE-ACS without indication for urgent ICA underwent ICA during index hospitalization. Six hundred and fifty-five patients underwent early invasive ICA (within 24 h) and 1112 underwent late ICA (between 24 h and 1 week). One hundred and seven patients had a GRACE risk score of 140 or above and 1660 had a GRACE risk score under 140. The primary composite outcome was all-cause mortality, stroke, and recurrent myocardial infarction (MI). Median time from admission to ICA was 13.3 h (IQR 6.0-20.6) for the early group and 59.9 h for the late group (IQR 23.5-96.3). There was no difference between the early and late ICA groups in the primary composite outcome [late catheterization >24 h hazard ratio 1.196, 95% confidence interval (CI) 0.969-1.475, P -value 0.096]. A multivariable Cox regression model for the composite outcome revealed no difference between the early and late ICA groups (late catheterization >24 h hazard ratio 1.0735, 95% CI 0.862-1.327, P -value 0.512) with no effect for performing early ICA in patients with GRACE score over 140 (hazard ratio 1.291, 95% CI 0.910-1.831, P -value 0.151). An early ICA strategy in patients with NSTE-ACS patients and GRACE risk score over 140, compared with late ICA, was not associated with improved composite outcome of death, myocardial infarction, and stroke at 1 year.

Time to coronary catheterization in patients with NST-ACS and high GRACE score

Abstract Introduction Current European guidelines recommend early (&amp;lt;24 hours) invasive coronary angiography (ICA) strategy in certain high-risk non-ST segment elevation acute coronary syndrome (NSTE-ACS) patients, including those with GRACE score over 140. The evidence for this recommendation is based on older trials using pre high-sensitive troponin (HsTn) biomarkers and non-contemporary therapy. Purpose To assess the association between GRACE score over 140, timing of ICA and their interaction on clinical outcomes in patients with ACS with no ST elevation, using (HsTn) as part of the calculated GRACE risk score. Methods and results Between February 1st 2016 and July 31th 2021, 1767 patients with a primary diagnosis of NSTE-ACS without indication for urgent ICA, underwent ICA during index hospitalization. 655 (37%) patients underwent early-invasive ICA (within 24 hours) and 1112 (63%) underwent late ICA (between 24 hours and 1 week). 107 patients had a GRACE risk score of 140 or above and 1660 had a GRACE risk score under 140. The primary composite outcome was all-cause mortality, stroke, and recurrent MI. The median time from admission to ICA was 13.3 hours (IQR 6.0,20.6) for the early group and 59.9 hours for the late group (IQR 23.5,96.3). The vast majority of patients had re-vascularization (75.1%) performed, mostly by PCI (69.4%). There was no difference between the early and late ICA groups in the primary composite outcome (late Catheterization &amp;gt;24h HR 1.196, 95% CI 0.969-1.475, P-value 0.096). Using a multivariable cox regression model for the composite outcome revealed no difference between the early and late ICA groups (late Catheterization &amp;gt;24h HR 1.0735, 95% CI 0.862-1.327, P-value 0.512) with no effect for performing early ICA in patients with GRACE score over 140 (HR 1.291 95% CI 0.910-1.831, p-0.151). Conclusion Early ICA strategy in patients with NSTE-ACS patients and GRACE risk score over 140, compared with late ICA, was not associated with improved composite outcome of death, myocardial infarction, and stroke at 1 year.

Abstract 16613: Study of Modified HEART Score and HEART Pathway as Predictor of Major Adverse Cardiac Events (MACE) in Patients Presenting With Non ST Elevation- Acute Coronary Syndrome (NST-ACS)

Introduction: Among the various scores studied in literature, the modified HEART score and HEART pathway were found to have high discriminatory power of predicting major adverse cardiac events (MACE) in Non ST elevation acute coronary syndrome (NSTEACS) patients in various international studies. This warrants need for evaluation of these scores for better management of patients in hectic emergency departments of Indian healthcare system. Methods: This prospective observational study was conducted between January 2021 and May 2022 in a tertiary care hospital of New Delhi, India. Modified HEART score was calculated based on history, ECG, age, risk factors and highly sensitive troponin I (hsTrop I) values for 60 patients. Collected serum samples of hsTrop I at 0 and 3 hours were measured using ELISA kits. As per the score, patients in low risk group were discharged safely and intermediate and high risk groups were assessed with the help of stress testing and coronary angiography and managed accordingly. The occurrence of MACE was assessed at 30 days from presentation to healthcare facility. Results: The study showed that proportion of patients with MACE was significantly higher in high risk group (82.14%) as compared to low (0%) and intermediate risk group (20.83%) (p value &lt;0.001). Modified HEART score was the best predictor of MACE at cut off point of &gt;6 with 88.1% chances of correctly predicting MACE. Negative predictive value of HEART pathway was found to be 100% which enabled safe disposition of low risk group patients. Conclusions: Hence, when modified HEART score and HEART pathway were used together, it allowed efficient use of resources and prediction of MACE in NSTEACS. This was the first study done on Indian population where modified HEART score and HEART pathway were used simultaneously to predict the occurence of MACE.

Less bleeding by omitting aspirin in non-ST-segment elevation acute coronary syndrome patients: Rationale and design of the LEGACY study

Early aspirin withdrawal, also known as P2Y12-inhibitor monotherapy, following percutaneous coronary intervention (PCI) for non-ST-segment elevation acute coronary syndrome (NSTE-ACS) can reduce bleeding without a trade-off in efficacy. Still the average daily bleeding risk is highest during the first months and it remains unclear if aspirin can be omitted immediately following PCI. The LEGACY study is an open-label, multicenter randomized controlled trial evaluating the safety and efficacy of immediate P2Y12-inhibitor monotherapy versus dual antiplatelet therapy (DAPT) for 12 months in 3,090 patients. Patients are randomized immediately following successful PCI for NSTE-ACS to 75-100 mg aspirin once daily versus no aspirin. The primary hypothesis is that immediately omitting aspirin is superior to DAPT with respect to major or minor bleeding defined as Bleeding Academic Research Consortium type 2, 3, or 5 bleeding, while maintaining noninferiority for the composite of all-cause mortality, myocardial infarction and stroke compared to DAPT. The LEGACY study is the first randomized study that is specifically designed to evaluate the impact of immediately omitting aspirin, and thus treating patients with P2Y12-inhibitor monotherapy, as compared to DAPT for 12 months on bleeding and ischemic events within 12 months following PCI for NSTE-ACS.

Diagnostic potential of myocardial early systolic lengthening for patients with suspected non-ST-segment elevation acute coronary syndrome

BackgroundDuring early systole, ischemic myocardium with reduced active force experiences early systolic lengthening (ESL). This study aimed to explore the diagnostic potential of myocardial ESL in suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients with normal wall motion and left ventricular ejection fraction (LVEF).MethodsOverall, 195 suspected NSTE-ACS patients with normal wall motion and LVEF, who underwent speckle tracking echocardiography (STE) before coronary angiography, were included in this study. Patients were stratified into the coronary artery disease (CAD) group when there was ≥ 50% stenosis in at least one major coronary artery. The CAD patients were further stratified into the significant (≥ 70% reduction of vessel diameter) stenosis group or the nonsignificant stenosis group. Myocardial strain parameters, including global longitudinal strain (GLS), duration of early systolic lengthening (DESL), early systolic index (ESI), and post-systolic index (PSI), were analyzed using STE and compared between groups. Receiver operating characteristic curve (ROC) analysis was performed to determine the diagnostic accuracy. Logistic regression analysis was conducted to establish the independent and incremental determinants for the presence of significant coronary stenosis.ResultsThe DESL and ESI values were higher in patients with CAD than those without CAD. In addition, CAD patients with significant coronary stenosis had higher DESL and ESI than those without significant coronary stenosis. The ROC analysis revealed that ESI was superior to PSI for identifying patients with CAD, and further superior to GLS and PSI for predicting significant coronary stenosis. Moreover, ESI could independently and incrementally predict significant coronary stenosis in patients with CAD.ConclusionsThe myocardial ESI is of great value for the diagnosis and risk stratification of clinically suspected NSTE-ACS patients with normal LVEF and wall motion.

Single antiplatelet therapy directly after percutaneous coronary intervention in non-ST-segment elevation acute coronary syndrome patients: the OPTICA study.

Early P2Y12 inhibitor monotherapy has emerged as a promising alternative to 12 months of dual antiplatelet therapy following percutaneous coronary intervention (PCI). In this single-arm pilot study, we evaluated the feasibility and safety of ticagrelor or prasugrel monotherapy directly following PCI in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Patients received a loading dose of ticagrelor or prasugrel before undergoing platelet function testing and subsequent PCI using new-generation drug-eluting stents. The stent result was adjudicated with optical coherence tomography in the first 35 patients. Ticagrelor or prasugrel monotherapy was continued for 12 months. The primary ischaemic endpoint was the composite of all-cause mortality, myocardial infarction, definite or probable stent thrombosis or stroke within 6 months. The primary bleeding endpoint was Bleeding Academic Research Consortium type 2, 3 or 5 bleeding within 6 months. From March 2021 to March 2022, 125 patients were enrolled, of whom 75 ultimately met all in- and exclusion criteria (mean age 64.5 years, 29.3% women). Overall, 70 out of 75 (93.3%) patients were treated with ticagrelor or prasugrel monotherapy directly following PCI. The primary ischaemic endpoint occurred in 3 (4.0%) patients within 6 months. No cases of stent thrombosis or spontaneous myocardial infarction occurred. The primary bleeding endpoint occurred in 7 (9.3%) patients within 6 months. This study provides first-in-human evidence that P2Y12 inhibitor monotherapy directly following PCI for NSTE-ACS is feasible, without any overt safety concerns, and highlights the need for randomised controlled trials comparing direct P2Y12 inhibitor monotherapy with the current standard of care.

Clinical Decision Pathway for the Use of Fondaparinux in the Management of Acute Coronary Syndrome (ACS) in Hospitals with and Without Catheter Laboratories: An Expert Opinion from India.

The current recommendations by Indian experts who are focused on the challenges in the management of patients with acute coronary syndrome (ACS) in rural areas, due to limited catheterization (CATH) lab facilities and interventional cardiologist coverage across the country, are described. 120 cardiologist experts drafted recommendations during ten advisory board meetings conducted from April to May 2022. Experts framed statements based on experience, collective clinical judgment from practical experience, and available scientific evidence regarding ACS. The consensus positioned fondaparinux as highly useful in non-CATH-lab-based hospitals for patients diagnosed with non-ST elevation acute coronary syndrome (NSTE-ACS) and ST elevation acute coronary syndrome (STE-ACS) patients who cannot be shifted to percutaneous coronary intervention (PCI)-capable centres, or for patients who are thrombolysed at peripheral centres.

Association between P2Y12 inhibitor reloading and in-hospital outcomes for patients with non-ST-segment elevation acute coronary syndrome already on chronic P2Y12 receptor inhibitors therapy in China: findings from the CCC–ACS (improving care for cardiovascular disease in China-acute coronary syndrome) project

BackgroundThe association between P2Y12 receptor inhibitors reloading and in-hospital outcomes in non-ST-segment elevation acute coronary syndrome (NSTEACS) patients who were on chronic P2Y12 receptor inhibitors therapy remained underdetermined.MethodsThe Improving Care for Cardiovascular Disease in China–Acute Coronary Syndrome (CCC–ACS project) is a national registry active from November 2014 to December 2019. 4790 NSTEACS patients on chronic P2Y12 receptor inhibitors therapy were included. Cox proportional hazard models, Kaplan–Meier curves, and subgroup analyses were conducted.ResultsThe NSTEACS patients who received reloading of P2Y12 receptor inhibitors were younger and had fewer comorbid conditions. The reloading group had a lower risk of major adverse cardiac events (MACE) (0.51% vs. 1.43%, P = 0.007), and all-cause death (0.36% vs. 0.99%, P = 0.028), the risks of myocardial infarction and major bleeding were not significantly different between patients with and without reloading. In survival analysis, a lower cumulative risk of MACE could be identified (Log-rank test, P = 0.007) in reloading group. In the unadjusted Cox model, reloading P2Y12 receptor inhibitors was associated with a decreased risk of MACE [HR, 0.35; 95% CI 0.16–0.78; (P = 0.010)] and all-cause death [HR, 0.37; 95% CI 0.14–0.94; (P = 0.036)]. Reloading of P2Y12 receptor inhibitors was associated with a decreased risk of MACE in most of the subgroups.ConclusionsIn NSTEACS patients already taking P2Y12 receptor inhibitors, we observed a decreased risk of in-hospital MACEs and all-cause mortality and did not observe an increased risk of major bleeding, with reloading. The differential profile in the two groups might influence this association and further studies are warranted.Clinical trial registration: https://www.clinicaltrials.gov (Unique identifier: NCT02306616, date of first registration: 03/12/2014)

Predictive worth of estimated glucose disposal rate: evaluation in patients with non-ST-segment elevation acute coronary syndrome and non-diabetic patients after percutaneous coronary intervention

BackgroundMeasurement of estimated glucose disposal rate (eGDR) has been demonstrated to be an indicator of insulin resistance (IR) and a risk sign for long-term outcomes in those with ischemic heart disease and type 2 diabetes mellitus (T2DM) having coronary artery bypass grafting (CABG). After elective percutaneous coronary intervention (PCI), the usefulness of eGDR for prognosis in those with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and non-diabetes is yet unknown.Methods1510 NSTE-ACS patients with non-diabetes who underwent elective PCI in 2015 (Beijing Anzhen Hospital) were included in this study. Major adverse cardio-cerebral events (MACCEs), such as all-cause mortality, non-fatal myocardial infarction, non-fatal ischemic stroke, and also ischemia-driven revascularization, were the main outcome of follow-up. The average number of follow-up months was 41.84.ResultsAfter multivariate Cox regression tests with confounder adjustment, the occurrence of MACCE in the lower eGDR cluster was considerably higher than in the higher eGDR cluster, demonstrating that eGDR is an independent prognostic indicator of MACCEs. In particular, as continuous variate: hazard ratio (HR) of 1.337, 95% confidence interval (CI) of 1.201–1.488, P < 0.001. eGDR improves the predictive power of usual cardiovascular risk factors for the primary endpoint. Specifically, the results for the area under the receiver operating characteristic (ROC) curve, this is AUC, were: baseline model + eGDR 0.699 vs. baseline model 0.588; P for contrast < 0.001; continuous net reclassification improvement (continuous-NRI) = 0.089, P < 0.001; and integrated discrimination improvement (IDI) = 0.017, P < 0.001.ConclusionLow eGDR levels showed a strong correlation with poor NSTE-ACS prognosis for nondiabetic patients undergoing PCI.

To pretreat or not no pretreat with dual antiplatelet therapy in non-ST elevation acute coronary syndrome patients: that is the question

Abstract Background The timing for the initiation of dual antiplatelet treatment (DAPT) in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) is controversial and the 2020 ESC guidelines suppressed the recommendation of routine pre-treatment. The aim of our study was to assess the effect of pretreatment on clinical outcomes according to the available evidence. Methods We conducted a meta-analysis of the main studies on pretreatment with P2Y12 receptor inhibitors in patients with NSTE-ACS. After a systematic review, we included four randomized clinical trials (PCI-CURE, ACCOAST, ISAR-REACT 5, and DUBIUS), and one observational study (SCAAR). Data was analyzed using the inverse variance method, using a fixed effects model since no statistically significant heterogeneity was observed. Results A total of 75,345 patients were included, 65,134 patients who followed a systematic pretreatment strategy with DAPT and 10,211 patients with a simple antiplatelet strategy with acetylsalicylic acid (ASA) and administration of a second antiplatelet during angiography and prior to angioplasty. No significant differences were observed in cardiovascular mortality (odds ratio [OR] 1.20; 95% confidence interval [CI] 0.90 to 1.60; P=0.2184) or acute stent thrombosis (OR 0.88; 95% CI, 0.65 to 1.18; p=0.3866). However, a significant increase in major bleeding was observed (OR 1.42; 95% CI, 1.15 to 1.75; p=0.0011). Conclusions Routine pretreatment with DAPT in patients with suspected NSTE-ACS is not associated with a decrease in cardiovascular death or an increase in acute stent thrombosis and, however, it is associated with a significant increase in major bleeding. Funding Acknowledgement Type of funding sources: None.

Speckle Tracking in Acute Non-St Elevation Acute Coronary Syndromes Patients as a Factor of Risk Stratification

Background: Coronary artery disease (CAD) early diagnosis remains a clinical problem in patients with non-ST elevation acute coronary syndrome (NSTE-ACS), especially in the regional wall motion abnormalities’ absence on presentation by Echo. This study assessed the relationship between ECG changes and speckle Tracking in subjects with acute NSTE-ACS.&#x0D; Methods: This prospective trial was performed on 100 subjects with NSTE-ACS. All subjects were subjected to laboratory tests [complete blood picture, renal function test, liver test profile, lipid profile, RBS and cardiac biomarkers (cardiac troponin, creatinine kinase and CK-MB)], 12 lead ECG, Echocardiography (TTE, speckle tracking), Image analysis and coronary angiography.&#x0D; Results: regarding IVRT, TDI e`, TDI a`, a considerable difference between the two groups were found. DBP was considerably lower in STD group in comparison with TWI group (P value= 0.047). IVRT, TDI a` and GLS were considerably higher in STD group in comparison with TWI group (P value= 0.024, 0.031, 0.003 respectively).&#x0D; Conclusions: Speckle tracking could be used as part of standard echo for the examination of individuals suffering from NSTE-ACS.

TCT-17 Single Antiplatelet Therapy Directly After Percutaneous Coronary Intervention in Non–ST-Segment Elevation Acute Coronary Syndrome Patients: The OPTICA Pilot Study

TCT-17 Single Antiplatelet Therapy Directly After Percutaneous Coronary Intervention in Non–ST-Segment Elevation Acute Coronary Syndrome Patients: The OPTICA Pilot Study

Interaction Between Treatment and Age or Sex in Non-ST-Segment Elevation Acute Coronary Disease and Three-Vessel Disease.

AimsTo explore the effects of age and sex on the outcomes of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients with the three-vessel disease (TVD).Methods and ResultsThe study is a subanalysis of data from a prospective cohort of 8,943 patients with angiographically confirmed TVD at Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China. The primary end point was major adverse cardiac and cerebrovascular events (MACCEs), a composite of all-cause death, myocardial infarction, and stroke. In total, 2,819 patients with NSTE-ACS who received CABG (43.6%) or PCI (56.4%) were included, among whom 32.7% were of 65–74 years, 7.2% were ≥75 years, and 22.6% were women. The median follow-up duration was 6.8 years. The superiority of CABG relative to PCI in terms of MACCE was decreased with age (adjusted hazard ratio [HR] [95% confidence interval (CI)]: <65 years: 0.662 [0.495–0.885], p = 0.005; 65–74 years: 0.700 [0.512–0.956], p = 0.025; ≥75 years: 0.884 [0.529–1.479], p = 0.640) and was only seen in men (adjusted HR [95% CI]: men: 0.668 [0.526–0.848], p = 0.001; women: 0.713 [0.505–1.006], p = 0.054). Significant treatment-by-sex and treatment-by-age interactions were observed in patients ≥ 75 years and women, respectively, (pinteraction with sex = 0.001; pinteraction with age = 0.002).ConclusionCoronary artery bypass grafting is favorable for most NSTE-ACS patients with TVD. The preponderance of CABG over PCI disappeared in patients ≥ 75 years and women. PCI is superior in women ≥ 75 years.

Skor risiko kejadian kardiovaskular mayor di rumah sakit pada sindroma koroner akut dengan elevasi segmen ST yang menjalani intervensi koroner perkutan primer

Background&#x0D; Reduction of major cardiovascular events (MACE) in ST elevation acute coronary syndrome (STE-ACS) patients has been achieved by primary percutaneous coronary intervention (PCI) strategy and intensive care management. However, the intensive care unit bed availability and cost remain a problem for those patients, and thus risk stratification using an objective risk score instrument is required.&#x0D; Aim&#x0D; To develop a risk score of in-hospital MACE for patients with STE-ACS underwent primary PCI.&#x0D; Methods&#x0D; A cohort study of 208 patients with STE-ACS undergoing primary PCI at the Dr. Kariadi General Hospital Semarang. Predictor analysis was carried out using bivariate Chi-Square test and multivariate logistic regression. The obtained independent predictors were then used as risk score variables. The quality of the risk score was tested by the Hosmer and Lemeshow calibration test and AUC ROC analysis for discrimination test.&#x0D; Results&#x0D; Seven out of 13 independent predictors, i.e. Killip class (OR 20,04, p=0,0001), age (OR 3,02, p=0,04), renal insufficiency (OR 9,48, p=0,007), infark related artery final TIMI flow (OR 11,57, p=0,001), admission systolic blood pressure (OR 3,04, p=0,025), duration of total ischaemic time (OR 3,14,p=0,032) and increase of blood glucose levels (OR 3,04, p=0,029) were fulfilled the criteria for risk scores of in-hospital MACE. The risk scores had a good quality with the Hosmer and Lemeshow calibration test&gt; 0,05 and ROC AUC 0,886 (95% CI, 0,827-0,944, p &lt;0,005).&#x0D; Conclusions&#x0D; A risk scoring modele consisting of 7 independent predictor variables i.e. Killip class, age, renal insufficiency, infark related artery final TIMI flow, admission systolic blood pressure, duration of total ischaemic time, and increase of blood glucose levels (KARIADI) has a good calibration and discrimination in predicting the risk of in-hospital MACE in patients with STE-ACS underwent primary PCI.&#x0D; Keywords&#x0D; Predictors of in-hospital MACE, primary PCI, ST-segment elevation acute coronary syndromes, risk score.

Elevated TyG Index Predicts Incidence of Contrast-Induced Nephropathy: A Retrospective Cohort Study in NSTE-ACS Patients Implanted With DESs.

BackgroundTriglyceride-glucose (TyG) index is a reliable and specific biomarker for insulin resistance and is associated with renal dysfunction. The present study sought to explore the relationship between TyG index and the incidence of contrast-induced nephropathy (CIN) in non-ST elevation acute coronary syndrome (NSTE-ACS) patients implanted with drug-eluting stents (DESs).MethodsA total of 1108 participants were recruited to the study and assigned to two groups based on occurrence of CIN. TyG index was calculated as ln [fasting triglycerides (mg/dL) × fasting blood glucose (mg/dL)/2]. Baseline characteristics and incidence of CIN were compared between the two groups. Logistic regression analysis was performed to evaluate the relationship between TyG index and CIN.ResultsThe results showed that 167 participants (15.1%) developed CIN. Subjects in the CIN group had a significantly higher TyG index compared with subjects in the non-CIN group (8.9 ± 0.7 vs. 9.3 ± 0.7, P<0.001). TyG index was significantly correlated with increased risk of CIN after adjusting for confounding factors irrespective of diabetes mellitus status and exhibited a J-shaped non-linear association. Subgroup analysis showed a significant gender difference in the relationship between TyG index and CIN. Receiver operating characteristic (ROC) curve analysis indicated that the risk assessment performance of TyG index was superior compared with other single metabolic indexes. Addition of TyG index to the baseline model increased the area under the curve from 0.713 (0.672-0.754) to 0.742 (0.702-0.782) and caused a reclassification improvement of 0.120 (0.092-0.149).ConclusionThe findings from the present study show that a high TyG index is significantly and independently associated with incidence of CIN in NSTE-ACS patients firstly implanted with DESs. Routine preoperative assessment of TyG index can alleviate CIN and TyG index provides a potential target for intervention in prevention of CIN.

Echocardiographic assessment of diastolic function in non-ST elevation acute coronary syndrome patients and its association with in-hospital diagnosis

Objective: This study was conducted to evaluate the association of echocardiographic parameters used in left ventricular (LV) diastology with the early results of non-ST elevation acute coronary syndrome (NSTE-ACS) workup in the hospital.&#x0D; Methods: This cross-sectional study was performed on patients presenting with acute chest pain and a diagnosis of NSTE-ACS including only patients with unstable angina (UA) and non-ST elevation myocardial infarction (NSTEMI). All patients underwent transthoracic echocardiography in the emergency room (ER) within 12 hours of the last episode of chest pain. An invasive approach was not uniformly pursued in all of the patients so analysis was performed in two different settings. First, analysis was performed in the patients that underwent coronary angiography (CAG) and echocardiographic data were compared between those with normal and abnormal CAG results. Finally, echocardiographic data of the patients with normal diagnostic results (i.e., normal exercise tolerance test (ETT), myocardial perfusion imaging (MPI) or coronary angiography (CAG) results) were compared with the data of the patients with abnormal test results.&#x0D; Results: Eighty patients with a mean age of 54.43 ± 12.38 years were included in the study, of whom 57 (71.2%) were male. Fifty-three patients underwent CAG. In these 53 patients, there was significant difference in mitral annular velocity in early diastole (e’), ratio of mitral inflow velocity to e’ (E/e’), left ventricular end-diastolic diameter (LVEDD) and left ventricular end-diastolic pressure (LVEDP) between patients with coronary artery involvement and those with normal coronary artery (P&lt;0.05). The area under the receiver operating characteristic (ROC) curve to predict CAG results for e’, E/ e’, LVEDD and LVEDP was more than 0.65. The sensitivity and specificity of the LV diastolic dysfunction for predicting coronary involvement was 94.4% and 35.29%, respectively. Comparison of echocardiographic data between patients with normal test results (non-invasive and invasive) and those with abnormal diagnostic tests showed a significant difference in e’, E/e’, acceleration time of E, LV end-diastolic diameter index, size of interventricular septum and left atrial volume.&#x0D; Conclusion: The results suggest that diastolic dysfunction data can be used as an adjunctive method to evaluate ACS patients in the ER.