Elevation Acute Coronary Syndrome Research Articles

The outcomes of occlusive vs non-occlusive culprit coronary artery in non-ST-segment elevation acute coronary syndrome (NSTEACS): A descriptive prospective study in a tertiary cardiac centre in Sudan

The outcomes of occlusive vs non-occlusive culprit coronary artery in non-ST-segment elevation acute coronary syndrome (NSTEACS): A descriptive prospective study in a tertiary cardiac centre in Sudan

Impact of TIMI Risk Stratification on In-Hospital Mortality in Non-ST Elevation Acute Coronary Syndrome: Perspectives from a Coronary Intervention Facility

Background: Acute coronary syndrome (ACS) encompasses a range of conditions, including non-ST segment elevation myocardial infarction (NSTEMI), which is associated with substantial morbidity and mortality. Risk stratification is essential for guiding management strategies to improve patient outcomes. The Thrombolysis in Myocardial Infarction (TIMI) risk score is a validated tool for predicting mortality in NSTEMI patients, yet its applicability in South Asian populations requires further investigation. Objective: This study aimed to evaluate the association of the TIMI risk score with in-hospital mortality among NSTEMI patients in a tertiary care cardiac center and to assess the relevance of the TIMI score as a prognostic tool in a South Asian context. Methods: A cross-sectional study was conducted with 126 patients presenting with NSTEMI at the National Institute of Cardiovascular Disease, Karachi. Data were collected from June 2012 to June 2013 after the institutional review board's approval. Inclusion criteria were adults aged 18 to 85 with a TIMI score ≥5, while exclusion criteria were refusal to consent and a history of cardiac surgery. Demographics, clinical characteristics, and in-hospital outcomes were analyzed using SPSS version 25, employing Chi-square and Fisher's exact tests for categorical data, with a significance level set at p≤0.05. Results: The study found that 52 (41.3%) patients had diabetes mellitus, and 78 (61.9%) suffered from hypertension. A positive family history of coronary artery disease was observed in 29 (23.0%) patients. Among participants, 42 (33.3%) were smokers. The in-hospital mortality rate was 14.3%. No significant differences were noted in mortality regarding demographic and clinical variables. Conclusion: Elevated TIMI scores in NSTEMI patients are associated with significant in-hospital mortality. The findings underscore the importance of the TIMI risk score as a predictor of short-term outcomes in a South Asian population. The study highlights the need for further validation of the TIMI score in diverse populations and the optimization of risk stratification tools.

Exploring the Role of Non-HDL Cholesterol in Acute Coronary Syndrome: A Case-Control Study

Objectives: This case-control study aimed to investigate the association between non-high-density lipoprotein (non-HDL) cholesterol levels and acute coronary syndrome (ACS) among individuals not recently treated with statins. Methodology: A total of 100 participants with ACS, who had not received recent statin therapy, were selected from the Coronary Care Unit (CCU) at Al-Kadhimiyah Hospital in Baghdad, Iraq. Controls, matching the eligibility criteria of cases except for ACS symptoms, were randomly chosen from the same hospital. Both groups met criteria including age over 40, and a history of diabetes mellitus, hypertension, smoking, and obesity. Statistical significance was set at p < 0.05. Results: The study found a significant independent association between elevated non-HDL cholesterol levels and ACS, with an average non-HDL level of 154.2 mg/dl (normal: 130 mg/dl) among ACS cases (p < 0.001), compared to 120 mg/dl in controls. Elevated non-HDL levels were also correlated with increased BMI (p = 0.01, r = 0.3) and various lipid markers (p < 0.05), except HDL. Conclusion: Elevated non-HDL cholesterol levels upon admission may serve as a potential indicator of ACS risk. These findings underscore the importance of non-HDL cholesterol assessment in ACS risk stratification and management.

[MINOCA and Coronary Ectasia: a rare combination of causes of infarction]

to describe a patient with myocardial ischemia with multiple causes. This clinical case describes a 58-year-old man with a history of hypertension, dyslipidemia, COPD and previous myocardial infarction (AMI). He went to the emergency room with chest pain and dyspnea. Findings included bibasal crackles, electrocardiogram with old anterior fibrosis, elevated NT-ProBNP, and echocardiogram with septoapical akinesia. During hospitalization, he experienced tachyarrhythmia and hemodynamic deterioration, undergoing electrical cardioversion (CVE). Non-ST segment elevation acute coronary syndrome (NSTEACS) complicated with ventricular arrhythmia and acute pulmonary edema was diagnosed. Coronary angiography revealed coronary ectasias without obstructive lesions, but with mild stenosis in three vessels. The patient was successfully treated with non-invasive ventilation, diuretics, vasodilators and anticoagulation. The discharge was granted with the plan to further studies to optimize and guide treatment and finally the diagnosis of Myocardial Infarction with Non-Obstructive Arteries (MINOCA) and the presence of coronary ectasias was addressed. it is important to highlight the non-ischemic causes in MINOCA and the association between coronary ectasia and cardiovascular events, which is why we emphasize the need for more studies to better understand the relationship between these phenomena.

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.

Navigating the Risk: “Unraveling the Relationship between Thrombolysis in Myocardial Infarction (“TIMI” Risk Score) and Coronary Vessel Involvement in Non-ST-Elevated acute Coronary Syndrome with Respect to “Syntax” Score – A Cross-sectional Study”

Objectives: Patients with unstable angina and non-ST-elevated myocardial infarction (NSTEMI) present with a spectrum of cardiac events and death. Hence, early accurate management should be initiated. This can be achieved by risk stratifying the patients as early as possible on hospital admission. Thrombolysis in myocardial infarction (TIMI) risk score assessment is used widely for this purpose. It helps to standardize the approach of management and compare the extent and number of vessels involved in the coronary angiogram. This research aims to assess coronary artery disease (CAD) in individuals with NSTEMI by examining the extent of vessel involvement and the complexity of coronary artery blockages, using the SYNTAX score about the TIMI risk score. Materials and Methods: This cross-sectional observational study involved 60 participants who were selected based on specific inclusion and exclusion criteria. The TIMI risk score was computed for each individual, categorized as either <4 or ≥4, and the results of their coronary angiogram were analyzed to assess the degree of vessel involvement, categorizing it as either single-vessel disease (SVD) or multi-vessel disease (MVD). The Syntax score was computed for all angiograms and divided into two groups based on whether it was ≤22 or >22. Results: The average age of the participants in our study was 56 ± 10.64, with an age range of 34. Gender distribution revealed a higher proportion of males, constituting 68.3% (41 individuals), while females accounted for 31.7% (19 individuals). The angiogram results demonstrated that among the patients with TIMI score <4, 70% (14 individuals) had SVD, 30% (6 individuals) had MVD, and among those with score ≥4, 15% (6 individuals) had SVD while 75% (34 individuals) had MVD. In the subgroup analysis of TIMI <4, a Syntax score <22 was observed in 15 cases of SVD and a score >22 was observed in cases of MVD. Likewise, in the TIMI >4 group, a Syntax score <22 was observed in 12 cases of SVD and a score >22 was observed in 28 cases of MVD. Conclusion: This study noted that patients with non-ST-segment elevation acute coronary syndrome who underwent coronary angiogram and had a TIMI score of ≥4 were observed to have a 13-fold increased likelihood of having multi-vessel Coronary artery disease (CAD) compared to those with a TIMI score of <4. TIMI score of ≥4 had a 7 times higher chance of getting a SYNTAX score >22.

Correlation between Left Ventricular Pressure–Strain Loop and Severity in Patients with Non-ST-Segment Elevation Acute Coronary Syndrome and Its Application Value in Short-Term Prognosis Evaluation

Purpose To investigate the diagnostic value of nonintrusive left ventricular pressure–strain loop (LV-PSL) for assessing overall myocardial function in sufferers with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) with or without coronary stenosis. The results of this research might provide insights into the diagnosis and management of NSTE-ACS. Methods All 268 sufferers with NSTE-ACS who were received by the First Affiliated Hospital of Nanchang University between June 2019 and June 2021 were enrolled. Sufferers with single or multiple extramural coronary diameter stenosis ≥70% on coronary angiography were defined as the stenosis group. All sufferers underwent noninvasive LV-PSL construction by using cuff blood pressure as the left ventricular pressure before coronary angiography, and the resulting images were imported and analysed with offline analysis software to obtain global longitudinal strain (GLS), global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE). The correlation between severity Gensini score and myocardial work (MW) parameters was identified through Spearman analysis. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cut-off values for predicting coronary stenosis, and logistic regression analysis was used to identify independent factors affecting left ventricular myocardial function in sufferers of NSTE-ACS. The occurrence of adverse cardiac events during the follow-up period was recorded. Results Through the comparative analysis of general clinical data, significant differences were found between the stenosis and nonstenosis groups in terms of gender, hyperlipidaemia, hypertension and smoking. However, statistical difference was observed only for hypertension (stenosis group 54.2%; p < 0.05) and hypercholesterolaemia (stenosis group 53.5%; p < 0.05). GLS (tz value 3.063), GCW (tz value 11.494), GWI (tz value 9.627) and GWE (tz value 12.780) reduced and GWW (tz value 11.504) increased in the stenosis group compared with those in the nonstenosis group. All differences were statistically significant (all p < 0.05). Severity Gensini scores were negatively correlated with GLS, GCW, GWI and GWE but positively correlated with GWW (p < 0.001). The ROC curve and univariate and multivariate logistic regression analyses revealed that GWE (odds ratio (OR) 2.881; 95% confidence internal (95% CI) 2.176–3.816; p < 0.001) had the largest area under the curve and greatest sensitivity for coronary stenosis diagnosis. GWE was (OR 2.875; 95% CI 2.217–3.727; p < 0.001) and (OR 2.881; 95% CI 2.176–3.816; p < 0.001). During an average follow-up period of 26.7 months, 19 sufferers experienced adverse cardiac events. GWE exhibited high predictive ability for identifying such events. Conclusions Noninvasive LV-PSL can identify whether sufferers of NSTE-ACS have acute coronary stenosis regardless of the location or size of the stenosis and can detect varying degrees of left ventricular dysfunction in such sufferers. Amongst indices, GWE had the highest diagnostic efficiency for diagnosing sufferers of NSTE-ACS with coronary stenosis and highest predictive ability for adverse cardiac events.

STUDY OF DIETARY REMODELING OF THE INTESTINAL MICROBIOTA BY GRAPE POLYPHENOLS AT THE LEVEL OF TRIMETHYLAMINE N-OXIDE (TMAO) IN PATIENTS WITH ACUTE CORONARY SYNDROME WITH ELEVATION OF THE SEGMENT ST

The main cause of mortality and disability in the adult population of our planet is cardiovascular diseases caused by atherosclerosis. The relevance of research into new methods of treating atherosclerosis is only increasing. In addition to dyslipedemia, infections and inflammation, new predictors of atherogenesis are being sought, and one of them is the level of trimethylamine N-oxide (TMAO). Many large studies have shown that circulating TMAO levels correlate with the development of atherosclerosis. In turn, the formation of TMAO depends on the state of the intestinal microbiome. That is, the stages of development of atherosclerosis can be influenced by changes in the intestinal microbiome. Purpose: Based on domestic and foreign scientific publications, to determine the effect of dietary remodeling of the gut microbiota by grape polyphenols on trimethylamine N-oxide (TMAO) levels in patients with STsegment elevation acute coronary syndrome. Results and conclusions: It was revealed that in patients with STEMI, the use of the prebiotic Kainar with grape polyphenols changes the concentration of TMAO in the blood. It was confirmed that there were statistically significant differences in TMAO values in the control group and the group taking Kaynar after 3 months and after 12 months.

A biomarker for estimating no-reflow phenomenon in PCI-treated non-ST-segment elevation myocardial infarction patients: serum Cystatin C

Aims: Cystatin C (Cys-C) is a biochemical marker associated not only with renal function but also with inflammatory processes. We aimed to investigate the relationship between the post-percutaneous coronary intervention (PCI) no-reflow phenomenon (NRP) and Cys-C in patients with non-ST-segment elevation acute coronary syndrome (NST-ACS).
 Methods: This retrospective, single-center observational study consecutively enrolled patients who were hospitalized with a diagnosis of NST-ACS and underwent PCI between October 2021 and February 2022. Baseline characteristics, medications, admission laboratory parameters, and angiographic features were recorded. Logistic regression and sensitivity analyses were performed to identify parameters associated with NRP.
 Results: Out of 199 patients (mean age: 62.0±10.3, 59.8% male), 36 (18.1%) developed NRP. Patients who developed NRP had a lower ejection fraction (49.7±10.3% vs. 53.5±7.1%, p=0.046) and were less likely to be male (36.1% vs. 65.0%, p=0.001). Additionally, individuals with NRP exhibited higher blood urea and C-reactive protein levels than those without NRP (p1.1 mg/L for Cys-C determined NRP with 72.2% sensitivity and 66.9% specificity (area under the curve=0.711, p

Non-invasive vascular measures as prognostic predictors for older patients with non-ST elevation acute coronary syndrome.

Adverse cardiac events are common in older patients with non-ST elevation acute coronary syndrome (NSTEACS), yet prognostic predictors are still lacking. This study investigated the long-term prognostic significance of non-invasive measures including endothelial function, carotid intima-media thickness (CIMT), and vascular stiffness in older NSTEACS patients referred for invasive treatment. NSTEACS patients aged 75 years and older recruited to a multicentre cohort study (NCT01933581) were assessed for baseline endothelial function using endoPAT logarithm of reactive hyperemia index (LnRHI), CIMT using B-mode ultrasound, and vascular stiffness using carotid-femoral pulse wave velocity (cfPWV). Long-term outcomes included major adverse cardiovascular events (MACE), a composite of death, reinfarction, urgent revascularization, stroke/transient ischemic attack, and significant bleeding. Recruitment resulted in 214 patients assessed for LnRHI, 190 patients assessed for CIMT and 245 patients assessed for cfPWV. For LnRHI group (median follow-up 4.73 years [IQR: 1.41-5.00]), Cox regression analysis revealed a trend towards increased risk of MACE (HR: 1.24 [95% CI: 0.80-1.93]; P = 0.328) and mortality (HR: 1.49 [95% CI: 0.86-2.59]; P = 0.157), but no significance was reached. No difference for other components of MACE was found. For CIMT group (median follow up 4.74 years [IQR: 1.55-5.00]), no statistically significant difference in MACE was found (HR: 0.92 [95% CI: 0.53-1.59]; P = 0.754). Similarly, for cfPWV group (median follow-up 4.96 years [IQR: 1.55-5.00]), results did not support prognostic significance (for MACE, HR: 0.95 [95% CI: 0.65-1.39]; P = 0.794). Endothelial function, CIMT and vascular stiffness were proven unsuitable as strong prognostic predictors in older patients with NSTEACS. NCT01933581.

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.

Timing of Complete Multivessel Revascularization in Patients Presenting With Non-ST-Segment Elevation Acute Coronary Syndrome

BackgroundComplete revascularization of the culprit and all significant nonculprit lesions in patients with non–ST-segment elevation acute coronary syndrome (NSTE-ACS) and multivessel disease (MVD) reduces major adverse cardiac events, but optimal timing of revascularization remains unclear. ObjectivesThis study aims to compare immediate complete revascularization (ICR) and staged complete revascularization (SCR) in patients presenting with NSTE-ACS and MVD. MethodsThis prespecified substudy of the BIOVASC (Percutaneous Complete Revascularization Strategies Using Sirolimus Eluting Biodegradable Polymer Coated Stents in Patients Presenting With Acute Coronary Syndrome and Multivessel Disease) trial included patients with NSTE-ACS and MVD. Risk differences of the primary composite outcome of all-cause mortality, myocardial infarction (MI), unplanned ischemia-driven revascularization (UIDR), or cerebrovascular events and its individual components were compared between ICR and SCR at 1 year. ResultsThe BIOVASC trial enrolled 1,525 patients; 917 patients presented with NSTE-ACS, of whom 459 were allocated to ICR and 458 to SCR. Incidences of the primary composite outcome were similar in the 2 groups (7.9% vs 10.1%; risk difference 2.2%; 95% CI: −1.5 to 6.0; P = 0.15). ICR was associated with a significant reduction of MIs (2.0% vs 5.3%; risk difference 3.3%; 95% CI: 0.9 to 5.7; P = 0.006), which was maintained after exclusion of procedure-related MIs occurring during the index or staged procedure (2.0% vs 4.4%; risk difference 2.4%; 95% CI: 0.1 to 4.7; P = 0.032). UIDRs were also reduced in the ICR group (4.2% vs 7.8%; risk difference 3.5%; 95% CI: 0.4 to 6.6; P = 0.018). ConclusionsICR is safe in patients with NSTE-ACS and MVD and was associated with a reduction in MIs and UIDRs at 1 year.

[Value of cardiodynamicsgram in early diagnosis of patients with acute coronary syndrome].

To explore the value of cardiodynamicsgram (CDG) obtained from electrocardiogram (ECG) data by radial basis functionradial basis function (RBF) neural network in early diagnosis of patients with acute coronary syndrome (ACS). Retrospective analysis method was used. Patients with chest pain as the main initial symptom in the emergency department of Baoan District People's Hospital of Shenzhen from October 2021 to September 2022 were enrolled. Baseline data were collected, including gender, age, smoking history, family history of coronary heart disease and history of hypertension, diabetes, hyperlipidemia, and atherosclerosis. The first 12-lead ECG was recorded after admission to the emergency department, and electrocardiodynamics analysis was performed to generate CDG. Receiver operator characteristic curve (ROC curve) was plotted to analyze the value of CDG and ECG in the early diagnosis of ACS and non-ST segment elevation ACS (NSTE-ACS). Sensitivity, specificity, area under the ROC curve (AUC), and 95% confidence interval (95%CI) were calculated. CDG and coronary angiography results of 3 patients with ACS with normal ECG were observed and analyzed. Non-ACS patients with normal ECG but positive CDG were followed for 30 days for adverse cardiovascular events. A total of 384 patients with chest pain were included, including 169 patients with ACS and 215 patients without ACS. The proportion of male (87.0% vs. 53.0%), smoking history (37.9% vs. 12.1%), hypertension (46.2% vs. 22.3%), diabetes (24.3% vs. 7.9%), hyperlipidemia (55.0% vs. 14.0%) and history of atherosclerosis (22.5% vs. 2.3%) in ACS group were significantly higher than those in non-ACS group (all P < 0.05). The ROC curve showed that the AUC of CDG diagnosis of ACS was higher than that of ECG [AUC (95%CI): 0.88 (0.66-0.76) vs. 0.71 (0.84-0.92)], the sensitivity was 92.8%, 78.6%, and the specificity was 83.3%, 64.2%, respectively. The AUC of CDG diagnosis of NSTE-ACS was higher than that of ECG [AUC (95%CI): 0.85 (0.80-0.90) vs. 0.63 (0.56-0.69)], the sensitivity was 87.1%, 61.3%, and the specificity was 83.3%, 64.2%, respectively. CDG of 3 patients with ACS with normal ECG showed disordered state, and coronary angiography showed ≥70% stenosis of major coronary branches. Of 215 non-ACS patients, 20 had a normal ECG but positive CDG, and 3 developed ST segment elevation myocardial infarction (STEMI) within 30 days, and 2 developed unstable angina (UA) within 30 days. CDG has high value in early diagnosis of ACS patients and is expected to become an important means of early diagnosis of ACS in emergency.

Computed tomography angiography or invasive coronary angiography in patients with lowto intermediate risk acute coronary syndrome — a single-center study

Aim. To evaluate the strategy of using coronary computed tomography angiography (CCTA) in patients with low-to-intermediate risk of non-ST segment elevation acute coronary syndrome (NSTE-ACS) in relation to early (in-hospital) and long-term prognosis in comparison with standard management tactics.Material and methods. The study included 259 patients (men (M), 47,9%, mean age, 62,2±9,4 years). Patients in group 1 (n=148 people, M 46,6%, mean age 61,99±9,92 years) underwent CCTA to assess coronary involvement, and patients in group 2 (n=111 people, M 49,5%, mean age 62,4±8,6 years) — invasive coronary angiography (ICA). The follow-up lasted 18 months.Results. Patients in both groups were comparable in age, concomitant chronic diseases and smoking. Patients in the CCTA group compared with the ICA group had lower GRACE score and lower values of high-sensitivity Troponin I. In 85 patients (57,4%) of group 1 there was no coronary involvement, while 41 patients (27,7%) had &lt;50% stenosis, 22 patients (14,9%) — &gt;50% stenosis in at least one coronary artery. In group 2, the majority of patients also had non-involved coronary vessels (n=76; 68,5%), while hemodynamically insignificant (20-40%) and significant lesions were detected in 20 patients (12,3%) and 15 people (13,5%), respectively. In group 1, 20 patients were referred for ICA as follows: 10 patients underwent percutaneous coronary interventions; 2 patients had multivessel disease; in 4 patients, intraoperative fractional flow reserve revealed hemodynamically insignificant stenoses; in 4 remaining patients, no significant lesions were detected. All-cause mortality was 4,05% in the CCTA group, and 7,2% in the ICA group (p=0,28). In the CCTA group, cardiovascular mortality was 0%, and in the ICA group — 0,9% (p=0,43).Conclusion. CCTA in patients with low-to-intermediate risk ACS is not inferior to the standard tactics for managing these patients and significantly reduces the need for iCAG.

Myocardial infarction in a young woman without cardiovascular risk factors: a case report

Myocardial infarction usually occurs in people over 50 years of age, but younger patients can also be affected. The article presents a case of a young patient, 34 years old, who was admitted to the cardiology department with a diagnosis of lowrisk non-ST segment elevation acute coronary syndrome. The patient complained of anginal pain that occurred for the first time. However, she did not have typical risk factors for cardiovascular diseases. Coronary angiography showed a critical stenosis of 99% in the proximal third of the 2nd segment of the right coronary artery. A case clearly demonstrates the importance of a thorough examination of young patients with complaints of chest pain, which is often mistakenly interpreted as a pathology of other organs and systems other than the cardiovascular one. No risk factors in a patient does not guarantee low risk of myocardial infarction, and a detailed examination of the patient will help to avoid underdiagnosis of acute coronary syndrome.

Spontaneous Coronary Pseudoaneurysm Presenting As Non-St-Segment Elevation Acute Coronary Syndrome

Spontaneous Coronary Pseudoaneurysm Presenting As Non-St-Segment Elevation Acute Coronary Syndrome

Impact of Short-Term Exposure to Nitrogen Dioxide (NO2) and Ozone (O3) on Hospital Admissions for Non-ST-Segment Elevation Acute Coronary Syndrome.

In the context of recent climate change, global warming, industrial growth, and population expansion, air pollution has emerged as a significant environmental and human health risk. This study employed a multivariable Poisson regression analysis to examine the association between short-term exposure to atmospheric pollutants (nitrogen dioxide-NO2, sulfur dioxide -SO2, ozone-O3, and particulate matter with a diameter less than 10 μm-PM10) and hospital admissions for non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Daily data on NSTE-ACS admissions, air pollutants, and meteorological variables were collected from January 2019 to December 2021. Elevated NO2 concentrations were associated with a higher risk of NSTE-ACS hospitalization, notably in spring (OR: 1.426; 95% CI: 1.196-1.701). Hypertensive individuals (OR: 1.101; 95% CI: 1.007-1.204) and those diagnosed with unstable angina (OR: 1.107; 95%CI: 1.010-1.213) exhibited heightened susceptibility to elevated NO2 concentrations. A 10 μg/m3 increase in NO2 during spring at lag 07 (OR: 1.013; 95% CI: 1.001-1.025) and O3 in winter at lag 05 (OR: 1.007; 95% CI: 1.001-1.014) was correlated with an elevated daily occurrence of NSTE-ACS admissions. Short-term exposure to various air pollutants posed an increased risk of NSTE-ACS hospitalization, with heightened sensitivity observed in hypertensive patients and those with unstable angina. Addressing emerging environmental risk factors is crucial to mitigate substantial impacts on human health and the environment.

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.

Outcomes of management strategies in patients with prior coronary artery bypass grafting presenting with an acute coronary syndrome

BackgroundPatients with prior coronary artery bypass grafting (CABG) presenting with an acute coronary syndrome (ACS) have poor outcomes and the optimal treatment strategy for this population is unknown. MethodsUsing linked administrative databases, we examined patients with an ACS between 2008 and 2019, identifying patients with prior CABG. Patients were categorized by ACS presentation type and treatment strategy. Our primary outcome was the composite of death and recurrent myocardial infarction at one-year. ResultsOf 54,641 patients who presented with an ACS, 1670 (3.1%) had a history of prior CABG. Of those, 11.0% presented with an ST-elevation myocardial infarction (STEMI) of which, 15.3% were treated medically, 31.1% underwent angiography but were treated medically, 22.4% with fibrinolytic therapy and 31.1% with primary PCI. The primary outcome rate was the highest (36.8%) in patients who did not undergo angiography and was similar in the primary PCI (20.8%) and fibrinolytic group (21.9%). In patients presenting with a non-ST elevation acute coronary syndrome (NSTE-ACS) (89.0%), 33.2% were treated medically, 38.5% underwent angiography but were treated medically and 28.2% were treated with PCI. Compared to those who underwent PCI, patients treated conservatively demonstrated a higher risk of the composite outcome (14.8% vs 27.3%; adjusted hazard ratio 1.70, 95% confidence interval 1.22–2.37). ConclusionsPatients with prior CABG presenting with an ACS are often treated conservatively without PCI, which is associated with a higher risk of adverse events.

Neutrophil-Lymphocyte Ratio Value as a Predictor of Troponin Elevation in Patients with Non-ST Segment Elevation Acute Coronary Syndrome

Acute coronary syndrome (ACS) is a prominent contributor to mortality and morbidity on a global scale, consistently ranking within the top five primary causes. Inflammation is one of the many elements that have a role in the pathophysiology of the development and destabilization of plaque atherosclerosis in ACS. Troponin is a component of a biomarker that signals damage to the heart muscle in ACS patients; however, at the present time, not all medical facilities are able to perform troponin testing. An acute myocardial infarction begins with an initial inflammatory process that generates proinflammatory cytokines at the cellular level. This can be evaluated by the NLR through peripheral blood tests. The NLR as an indication of systemic inflammation has been demonstrated to be associated with poor clinical outcomes, an increased risk of complications, and mortality in ACS patients. In addition, several studies showed that the NLR has prognostic value in patients with ACS. The NLR is a mix of inflammatory markers, which can be a predictor of increased troponin in cases of non-ST segment elevation acute coronary syndrome (NSTEACS) in an emergency room.