First Event Of Acute Coronary Syndrome Research Articles

Risk factors for the primary effectiveness endpoint in secondary prevention of acute coronary syndrome with antiplatelet agents: A cohort in the nationwide French claims and hospitalisation database

The French HTA agency requested a real-life benefit-risk study of ticagrelor (T) compared to clopidogrel (C) and prasugrel (P) in the secondary prevention of acute coronary syndrome (ACS) (EUPAS5987). This study aimed to identify the risk factors associated with the primary effectiveness endpoint for patients with antiplatelet agents after a hospitalisation for ACS. Patients hospitalised in 2013 for STEMI, NSTEMI or unstable angina, with intensive care unit (ICU) stay, and followed for 1 year in the nationwide French claims and hospitalisation database, SNIIRAM. Treatment group (T, C, or P ± aspirin) was defined by the first drug dispensed in the month after discharge. The primary effectiveness endpoint was a composite of the first event of ACS with ICU stay, stroke, or all-cause death. Hazard ratios were estimated with Cox proportional hazard risk model (multivariate analysis). A total of 41,954 patients were included (19,796 C, 13,916 T, 8242 P) with different characteristics: mean age of 72, 63, 58 years, respectively; 68%, 76%, 86% male; 42%, 55%, 72% STEMI. A Charlson comorbidity index > 5 was associated with a risk increased by at least 50% for the primary effectiveness endpoint; age, a poverty index, ICU stay duration > 5 days and no PCI during index hospitalisation, and congestive heart failure, peripheral arterial disease, ischemic stroke, abnormal renal function, C and P before index hospitalisation were associated with a risk increased by 20–50%; diabetes, hypertension, aspirin before index hospitalisation, and C in the month after discharge (versus T) were associated with a risk increased by 10–20%. In this nationwide real-life study, the risk factor most associated with the primary effectiveness endpoint was a Charlson comorbidity index > 5.

Periodontitis: A Future Risk of Acute Coronary Syndrome? A Follow‐Up Study Over 3 Years

Periodontitis has been associated with cardiovascular disease. We assess if the recurrence of acute coronary syndrome (ACS) could be predicted by preceding medical and periodontal conditions. A total of 165 consecutive subjects with ACS and 159 medically healthy, matched control subjects were examined and followed for 3 years. Periodontitis was defined by alveolar bone loss. Subgingival microbial samples were studied by the checkerboard DNA-DNA hybridization method. The recurrence of ACS was found in 66 of 165 (40.0%) subjects, and a first ACS event was found in seven of 159 (4.4%) subjects among baseline control subjects. Subjects who later had a second ACS event were older (P <0.001). Significantly higher serum levels of high-density lipoprotein (P <0.05), creatinine (P <0.01), and white blood cell (WBC) counts (P <0.001) were found in subjects with future ACS. Periodontitis was associated with a first event of ACS (crude odds ratio [OR]: 10.3:1; 95% confidence interval [CI]: 6.1 to 17.4; P <0.001) and the recurrence of ACS (crude OR: 3.6:1; 95% CI: 2.0 to 6.6; P <0.001). General linear modeling multivariate analysis, controlling for age and the prediction of a future ACS event, identified that WBC counts (F = 20.6; P <0.001), periodontitis (F = 17.6; P <0.001), and serum creatinine counts (F = 4.5; P <0.05) were explanatory of a future ACS event. The results of this study indicate that recurrent ACS events are predicted by serum WBC counts, serum creatinine levels, and a diagnosis of periodontitis. Significantly higher counts of putative pathogens are found in subjects with ACS, but these counts do not predict future ACS events.

FcγRIIa genotype is associated with acute coronary syndromes as first manifestation of coronary artery disease

Objective Identification of clinically relevant determinants for acute coronary syndromes (ACS) promises reduction of ACS-associated mortality. C-reactive protein (CRP) has proved to be useful identifying people at risk for cardiovascular events. However, it is unknown whether genetic variants at Fcγ receptor IIa (FcγRIIa), the main receptor for CRP, are involved in CRP-related cardiovascular risk. We evaluated the potential impact of FcγRIIa through a genetic association study in patients with ACS. Methods and results We conducted a genetic association study among 701 consecutive patients with first event of ACS compared to 467 patients with stable angina pectoris. All patients were genotyped for a frequent functional variant at position 131 of the mature FcγRIIa, where the arginine (R) allele results in an increased signal transduction upon CRP binding. In our study, the R/R131 genotype was significantly associated with ACS as the first manifestation of coronary artery disease ( P = 1.2 × 10 −9, odds ratio 2.86, 95% CI: 2.06–3.99) compared to the non-R/R131 genotype. Conclusions Our data show a genetic association of the FcγRIIa R/R131 genotype with a more frequent occurrence of ACS as the first manifestation of coronary artery disease, probably mediated via its interaction with CRP. Genotyping of this FcγRIIa variant could help to improve risk stratification in the course of coronary disease in the future.

Sex-related characteristics in hospitalized patients with acute coronary syndromes – the Greek Study of Acute Coronary Syndromes (GREECS)

We studied the sex-specific distribution of various factors in hospitalized patients who presented with acute coronary syndromes (ACS), as well as the annual incidence and the in-hospital and short-term outcomes in males and females. A sample of six hospitals located in Greek urban and rural regions was selected. In these hospitals we recorded almost all nonfatal admissions with a first event of ACS, from October 2003 to September 2004. Sociodemographic, clinical, dietary, and other lifestyle characteristics were recorded. A total of 2,172 patients were included in the study (1,649, 76% male and 523, 24% female). The annual incidence rate was almost three times higher in males than in females (34 per 10,000 males and 10.9 per 10,000 females). The highest frequency of events was observed in winter, in both sexes. Females had higher in-hospital mortality rate as compared to males (5.7% vs 3.2%, P = 0.007), while the 30-day mortality and rehospitalization rate was 17% in male and 16% in female patients. The most common discharged diagnosis for males was Q-wave myocardial infraction (35%), while females were more likely to suffer from unstable angina (42%). Females were older than males, waited longer between seeking and receiving medical advice, and were more likely to have a history of hypertension, obesity, and diabetes mellitus as compared to males. On the other hand, males were more likely to be smokers, to follow a more typical Mediterranean diet, and to be more physically active (P < 0.05). We revealed a sex-related difference in the profile of clinical characteristics and other cardiovascular risk factors in hospitalized patients for ACS.

Cholesteryl Ester-Transfer Protein (CETP) Polymorphism and the Association of Acute Coronary Syndromes by Obesity Status in Greek Subjects: The CARDIO2000-GENE Study

Objective: Cholesterol ester transfer protein (CETP) regulates plasma lipid distribution. The present study aimed to investigate whether the CETP gene (Taq1B) polymorphism predisposes to Acute Coronary Syndromes (ACS) depending on obesity status. Methods: We studied demographic, lifestyle and clinical information in 237 hospitalized patients (185 males) with a first event of an ACS and 237 controls matched by age and sex. CETP Taq1B genotyping was performed by PCR-RFLP analysis. Results: Overall, the CETP genotype frequencies were, in patients: 14% (n = 33), 35% (n = 83) and 51% (n = 121) and in controls: 17% (n = 39), 33% (n = 78) and 50% (n = 120) for B2B2, B1B1 and B1B2 respectively (p = 0.72). A significant interaction (p for interaction <0.001) was observed between obesity status and CETP concerning the likelihood of having ACS. Therefore, we stratified our analysis by obesity status and observed that B2B2 was associated with a 0.27 times lower likelihood of having ACS among normal-weight people (OR = 0.27, p = 0.02). No significant relationships were observed among overweight or obese participants. Conclusions: These findings provide evidence of a protective effect of the B2B2 genotype of the CETP Taq1B polymorphism on the likelihood of having a first event of ACS in normal-weight persons.

The relationship between fish consumption and the risk of developing acute coronary syndromes among smokers: The CARDIO2000 case-control study

Background and aim We sought to investigate the relationship between fish consumption and the risk of developing non-fatal acute coronary syndromes (ACS) among current smokers. Methods and results During 2000–2001, we conducted the CARDIO2000 case-control study that included patients hospitalized for a first event of ACS and matched (age, sex) individuals without clinical evidence of CHD (controls), from all the Greek regions. In the present analysis we studied data from 519 men (59±10 years old) and 45 women (62±9 years old) patients, as well as 444 men and 90 women controls, matched for age with the patients that reported current smoking. To evaluate the hypothesis tested we applied conditional logistic regression analysis after controlling for several potential confounders. Overall, 94% of controls and patients reported fish consumption at least once a week. Compared to low fish consumption (<60 g/week), moderate (60–180 g/week) intake was associated with 15% ( p<0.05) lower risk of ACS, while increased (180–300 g/week, or >300 g/week) consumption was associated with 18% ( p<0.05) and 19% ( p=0.53) higher risk, respectively. Conclusion Moderate fish consumption seems to moderate the deleterious effect of smoking on the occurrence of ACS. However, increased intake does not seem to confer any benefit on coronary risk.

Fish consumption and the risk of developing acute coronary syndromes: the CARDIO2000 study

Objective The aim of this work was to investigate the association between fish consumption and the development of non-fatal acute coronary syndromes (ACS), in a Mediterranean population. Methods During 2000–2001, we randomly and stratified selected, from all Greek regions, 848 hospitalised patients (695 males, 58±10 years old and 153 females, 65±9 years old) who had a first event of ACS and 1078 paired, by region–sex–age, controls without any clinical symptoms or signs of coronary heart disease. Results On multivariate logistic regression analysis and, after controlling for several potential confounders, we found that fish consumption less than 150 g/week was associated with 38% lower odds of developing ACS as compared to no consumption (odds ratio=0.62, P-value<0.05). In contrast, moderate (150–300 g/week) and high (>300 g/week) fish consumption was not associated with the developing of the disease (odds ratios=1.10 and 1.01, respectively, P-value>0.1). The benefits from low fish consumption were also significant even amongst current smokers and diabetics. Conclusion Moderate fish consumption was independently associated with a significant reduction in the odds of developing ACS. The strength and consistency of this finding has implications for public health and should be explored further.

Association between exposure to environmental tobacco smoke and the development of acute coronary syndromes: the CARDIO2000 case–control study

Objective: To investigate the association between environmental tobacco smoke (ETS) exposure (at least 30 minutes a day) and the risk of developing acute coronary syndromes (ACS). Design and setting: The...

The association between secondhand smoke and the risk of developing acute coronary syndromes, among non-smokers, under the presence of several cardiovascular risk factors: The CARDIO2000 case-control study.

BackgroundThe purpose of this study was to investigate the association between secondhand smoke and the risk of developing a first event of acute coronary syndromes (ACS), i.e. acute myocardial infarction or unstable angina, among non-smokers, in relation to the presence of several other cardiovascular risk factors.MethodsEight hundred and forty-eight patients with first event of ACS and 1078 cardiovascular disease-free matched controls completed a detailed questionnaire regarding their exposure to secondhand smoke, among other investigated parameters.ResultsTwo hundred and ninety–seven (35%) of the patients and 259 (24%) of the controls were defined as secondhand smokers. After controlling for several potential confounders, the results showed that non-smokers occasionally (< 3 time per week) exposed to cigarette smoke were associated with 26% higher risk of ACS (OR = 1.26, P-value < 0.01) compared to non-smokers not exposed to smoke, while regular exposure is associated with 99% higher risk of developing ACS (OR = 1.99, P-value < 0.001). Moreover, the previous risk increases progressively from 15% to 256% if one or more of the classical cardiovascular risk factors (i.e. hypertension, hypercholesterolemia, diabetes mellitus, sedentary life and family history of premature coronary heart disease) are present.ConclusionsConsequently, this study supports the hypothesis that even occasional secondhand smoke increases the risk of developing acute coronary syndromes, especially when other risk factors are present. Given the high prevalence of cigarette smoking, the public health consequences of passive smoking with regard to coronary heart disease are important.