Impact Of Acute Coronary Syndrome Research Articles

Comparison between Imaging and Physiology in Guiding Coronary Revascularization: A Meta-Analysis.

Background: Percutaneous coronary intervention (PCI) is a widely used revascularization strategy for coronary artery disease. The choice between imaging-guided and physiology-guided PCI has been a subject of debate. This meta-analysis aims to systematically compare outcomes between imaging and physiology-guided PCI and management of intermediate coronary lesions (ICLs). Methods: A comprehensive literature search was conducted across major databases for studies published up to December 2023 following PRISMA guidelines. Seven eligible studies comparing imaging-guided and physiology-guided PCI were selected for the final analysis. Relevant outcome measures included major adverse cardiovascular events (MACE), target vessel revascularization (TVR), target vessel failure (TVF), and target lesion revascularization (TLR). Subgroup analysis was performed for ICLs. Results: A total of 5701 patients were included in the meta-analysis. After a mean follow-up of 2.1 years, imaging-guided PCI was associated with lower rates of TVR compared to physiology-guided PCI (OR 0.70, 95% CI 0.52-0.95, p = 0.02); concerning MACE, TVF, and TLR, no differences were found. When the analysis was restricted to studies considering ICLs management, there were no differences between the two techniques. Meta regression analysis did not show any impact of acute coronary syndromes (ACS) presentation on MACE and TVR. Conclusions: The findings suggest that imaging-guided PCI may reduce the need for future revascularization of the target vessel compared to the functional-guided approach, and this result was not influenced by ACS presentation. These results may have important implications for clinical practice, guiding interventional cardiologists in selecting the most appropriate guidance strategy.

TCT-669 Impact of Acute Coronary Syndromes on Long-Term Clinical Outcomes After Percutaneous Coronary Intervention With the Biolimus-Coated BioFreedom Stent or Biodegradable Polymer Sirolimus-Eluting Orsiro Stent: From the SORT OUT IX Trial

TCT-669 Impact of Acute Coronary Syndromes on Long-Term Clinical Outcomes After Percutaneous Coronary Intervention With the Biolimus-Coated BioFreedom Stent or Biodegradable Polymer Sirolimus-Eluting Orsiro Stent: From the SORT OUT IX Trial

Impact of Acute Coronary Syndrome on Clinical Outcomes in Patients With Thrombotic Thrombocytopenic Purpura.

Thrombotic thrombocytopenic purpura (TTP) is a life-threatening clinical syndrome characterized by microangiopathy and a variable degree of end-organ ischemic damage. Cardiac involvement has been recognized as a major cause of mortality in these patients. In this study, we queried the National Inpatient Sample (NIS) for all patients hospitalized with thrombotic microangiopathy from 2002 to 2017, who also received plasma exchange (PLEX) during the same admission. A total of 6,214 patients with TTP were identified. We stratified patients based on whether or not they had acute coronary syndrome (ACS) during admission. ACS was documented in 6.3% of patients. Compared with patients without ACS, those with ACS were relatively older (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.02-1.03) and had a relatively higher prevalence of heart failure (OR, 2.02; 95% CI, 1.53-2.67)and coronary artery disease (OR, 2.69; 95% CI, 2.03-3.57). Certain complications were more prevalent in the ACS group including acute cerebrovascular accident (OR, 3.33; 95% CI, 2.94-3.78), acute heart failure (OR, 1.91; 95% CI, 1.67-2.19), acute kidney injury (OR, 1.76; 95% CI, 1.59-1.95), cardiogenic shock (OR, 2.15; 95% CI, 1.72-2.69), and respiratory failure (OR, 1.48; 95% CI, 1.32-1.66). Despite wider utilization of therapeutic plasmapheresis and improved supportive management of patients with TTP, associated morbidity and mortality remain significant.We demonstrate from this large retrospective cohort that ACS is an independent predictor of higher morbidity and mortality in TTP patients.

Estimating the economic impact of acute coronary syndrome in New Zealand over time (ANZACS-QI 64): a national registry-based cost burden study

ObjectivesTo estimate the changes in costs associated with acute coronary syndrome (ACS) admissions in New Zealand (NZ) public hospitals over a 12-year period.DesignA cost-burden study of ACS in NZ was...

S3436 A Nationwide Analysis on the Impact of Acute Coronary Syndrome in Patients With Celiac Disease

S3436 A Nationwide Analysis on the Impact of Acute Coronary Syndrome in Patients With Celiac Disease

The potential impact of acute coronary syndromes on automatic sensing system in Subcutaneous-ICDs.

The Subcutaneous-ICD (S-ICD) is emerging as a suitable option for most ICD candidates, however some open issues regarding the sensing algorithm still remain. We aimed to examine the performance of the S-ICD sensing algorithm in patients hospitalized for ST elevation myocardial infarction (STEMI), non ST elevation acute coronary syndrome (NSTE-ACS) or chronic coronary syndrome (CCS), before and after revascularization. We performed a S-ICD automated screening on 75 patients, 21 hospitalized for STEMI, 23 for NSTE-ACS and 31 for CCS, before and after percutaneous revascularization, regardless their eligibility to ICD implantation. Patients did not differ in clinical, electrocardiographic and echocardiographic parameters. Rates of screening pass were significantly lower in STEMI patients compared to NSTE-ACS and CCS (5% vs 56.7% vs 81% respectively, p<.0001). The viability of the primary vector was lower in STEMI patients compared to NSTE-ACS and CCS (33% vs 56% vs 71%, p .027 respectively). After revascularization, there were no more significant differences between groups. Pairing subjects at baseline and after revascularization, STEMI subjects percentages of screening success were respectively 5% and 81% (p<.001) and the rates of primary vector viability were 33% and 81% (p .002). STEMI was the only independent predictor of screening failure at multivariate logistic regression analysis (odds ratio 10.68 confidence interval 2.77-41.38, p=.001). The performance of the S-ICD and possible malfunction detections in the context of an acute ischemic event deserve further evaluation. Adequate patient selection and the development of dynamic device programming are warranted.

Extracellular vesicles from patients with Acute Coronary Syndrome impact on ischemia-reperfusion injury

The relevance of extracellular vesicles (EV) as mediators of cardiac damage or recovery upon Ischemia Reperfusion Injury (IRI) and Remote Ischemic PreConditioning (RIPC) is controversial. This study aimed to investigate whether serum-derived EV, recovered from patients with Acute Coronary Syndrome (ACS) and subjected to the RIPC or sham procedures, may be a suitable therapeutic approach to prevent IRI during Percutaneous-Coronary-Intervention (PCI). A double-blind, randomized, sham-controlled study (NCT02195726) has been extended, and EV were recovered from 30 patients who were randomly assigned (1:1) to undergo the RIPC- (EV-RIPC) or sham-procedures (EV-naive) before PCI. Patient-derived EV were analyzed by TEM, FACS and western blot. We found that troponin (TnT) was enriched in EV, compared to healthy subjects, regardless of diagnosis. EV-naive induced protection against IRI, both in-vitro and in the rat heart, unlike EV-RIPC. We noticed that EV-naive led to STAT-3 phosphorylation, while EV-RIPC to Erk-1/2 activation in the rat heart. Pre-treatment of the rat heart with specific STAT-3 and Erk-1/2 inhibitors led us to demonstrate that STAT-3 is crucial for EV-naive-mediated protection. In the same model, Erk-1/2 inhibition rescued STAT-3 activation and protection upon EV-RIPC treatment. 84 Human Cardiovascular Disease mRNAs were screened and DUSP6 mRNA was found enriched in patient-derived EV-naive. Indeed, DUSP6 silencing in EV-naive prevented STAT-3 phosphorylation and cardio-protection in the rat heart. This analysis of ACS-patients’ EV proved: (i) EV-naive cardio-protective activity and mechanism of action; (ii) the lack of EV-RIPC-mediated cardio-protection; (iii) the properness of the in-vitro assay to predict EV effectiveness in-vivo.

Incidence, Clinical Characteristics, and Impact of Acute Coronary Syndrome Following Transcatheter Aortic Valve Replacement

ObjectivesThe authors sought to assess the incidence, predictors, management, and prognosis of acute coronary syndrome (ACS) following TAVR. BackgroundAbout one-half of the patients undergoing transcatheter aortic valve replacement (TAVR) have concurrent coronary artery disease (CAD). However, the occurrence and clinical impact of coronary events following TAVR remain largely unknown. MethodsConsecutive patients undergoing TAVR in our institution between May 2007 and November 2017 were included. Patients were followed at 1, 6, and 12 months, and yearly thereafter. ACS was diagnosed and classified according to the Third Universal Definition of Myocardial Infarction. ResultsA total of 779 patients (mean age 79 ± 9 years, 52% male, mean STS: 6.8 ± 5.1%) were included, 68% of which had a history of CAD. At a median follow-up of 25 (interquartile range: 10 to 44) months, 78 patients (10%) presented at least 1 episode of ACS, with one-half of the events occurring within the year following TAVR. Clinical presentation was type 2 non–ST-segment elevation myocardial infarction (35.9%), unstable angina (34.6%), type 1 non–ST-segment elevation myocardial infarction (28.2%), and ST-segment elevation myocardial infarction (1.3%). Male sex (hazard ratio [HR]: 2.19; 95% confidence interval [CI]: 1.36 to 3.54; p = 0.001), prior CAD (HR: 2.78; 95% CI: 1.50 to 5.18; p = 0.001), and nontransfemoral approach (HR: 1.71; 95% CI: 1.04 to 2.75; p = 0.035) were independently associated with ACS. Coronary angiography was performed in 53 (67.9%) patients with ACS, and 30 of them (56.6%) underwent percutaneous coronary intervention. In-hospital death rate at the time of the ACS episode was 3.8%. At a median follow-up of 21 (interquartile range: 8 to 34) months post-ACS, all-cause and cardiovascular death rates were 37.3% and 25.3%, respectively. ConclusionsApproximately one-tenth of patients undergoing TAVR were readmitted for an ACS after a median follow-up of 25 months. Male sex, prior CAD, and nontransfemoral approach were independent predictors of ACS. ACS was associated with high midterm mortality.

The impact of acute coronary syndrome on late drug-eluting stents restenosis: Insights from optical coherence tomography.

The aim of the study was to investigate the optical coherence tomography (OCT)-identified difference of in-stent restenosis (ISR) tissue characteristics between patients with and without acute coronary syndrome (ACS) at index intervention.The retrospective study included 80 patients with 85 drug-eluting stent (DES) restenosis lesions. Subjects were classified according to clinical presentation at the time of de-novo lesion intervention, namely ACS and non-ACS. OCT was performed at 5 years follow-up. The frequency of malapposition, neointimal characteristics, thrombus, and minimal stent area (MSA) were evaluated.ACS group consisted of 48 (60%) patients. The mean duration from initial intervention to OCT study was 66.15 months. Malapposition was more frequent in the ACS group (25.5% vs 2.9%, P = .006), as well as a higher prevalence of thrombus in the ACS group (21.6% vs 0%, P = .015). MSA of ACS group was significantly less than that of non-ACS group (4.99 ± 1.80 vs 5.62 ± 2.08 mm2, P = .018). Compared with non-ACS group, only MI group was related to smaller MSA (4.37 ± 1.39 vs 5.62 ± 2.08 mm2, P = .048); The unstable angina (UA) group was not associated with a decreased MSA. The occurrence of neoatherosclerosis tended to be higher in ACS group (60.8% vs 41.2%, P = .076).In DES restenosis, an ACS presentation at initial intervention is associated with a higher incidence of malapposition, thrombus, and smaller MSA.

Does acute coronary syndrome impact on the incidence of thrombosis after the implantation of an Absorb bioresorbable vascular scaffold?

In the drug-eluting stent (DES) era, patients with acute coronary syndrome (ACS) had a higher risk of early stent thrombosis compared with stable patients. The present study aimed to evaluate whether the same is true for the bioresorbable vascular scaffold (BVS) (Abbott Vascular, Santa Clara, CA, USA). We assessed the relationship between the incidence of definite/probable scaffold thrombosis (ScT) (overall ScT and early ScT) and ACS percentage with the latest publications, including the most recent large randomised controlled trials. Out of a total study population of 13,708 devices in 45 trials, overall ScT was observed in 185 devices (1.35%) at a weighted mean follow-up period of 9.4 months, while early ScT was reported in 125 devices (0.97%) out of 12,896 devices in 44 trials. Meta-regression analysis demonstrated no significant correlation between overall/early ScT and the percentage of patients with ACS (overall ScT: R2=0.030, p=0.255; early ScT: R2=0.067, p=0.090). ACS appeared to have little impact on the incidence of ScT after the implantation of BVS. Further clinical study is warranted to investigate the predictors of ScT using multivariate analysis with sufficient statistical power.

Impact of Acute Coronary Syndrome Complicated by Ventricular Fibrillation on Long-term Incidence of Sudden Cardiac Death

Introduction and objectivesThere is little information on the effect of acute coronary syndrome complicated by ventricular fibrillation on the long-term incidence of sudden cardiac death. We analyzed this effect in a contemporary cohort of patients with acute coronary syndrome. MethodsWe studied 5302 consecutive patients with acute coronary syndrome between December 2003 and December 2012. We compared mortality during and after hospitalization according to the presence or absence of ventricular fibrillation. ResultsVentricular fibrillation was observed in 163 (3.1%) patients, and was early onset in 72.4% of these patients. In-hospital mortality was 36.2% in the group with ventricular fibrillation and 4.7% in the group without (p<.001). After a mean follow-up of 4.7 years (standard deviation, 2.6 years), mortality was 30.7% in the ventricular fibrillation group and 24.7% in the other group (P=.23). After adjusting for confounding variables, the presence of ventricular fibrillation was not associated with an increased risk of death in the follow-up period (hazard ratio=1.29; 95% confidence interval, 0.90-1.87). The cause of death was established in 72% of patients. The incidence of sudden death was 12.9% in the ventricular fibrillation group and 11.9% in the other group (P=.71). Cardiovascular-cause mortality was also similar between the 2 groups (35.5% and 34.4%, respectively. ConclusionsPatients with acute coronary syndrome complicated by ventricular fibrillation who survive the in-hospital phase do not appear to be at an increased risk of sudden cardiac death or other cardiovascular-cause death.

Impact of acute coronary syndromes on survival of dialysis patients following surgical or percutaneous coronary revascularization in the United States.

We sought to evaluate survival of dialysis (chronic kidney disease (CKD) stage 5D) patients undergoing coronary revascularization procedures in the context of acute coronary syndrome (ACS) compared with absence of ACS. CKD 5D patients undergoing coronary revascularization, 2004-2009 (n = 23,033), were identified from the United States Renal Data System. Long-term survival was estimated by the Kaplan-Meier method and independent predictors of mortality using a comorbidity-adjusted Cox proportional hazards model. Among ACS patients (n = 12,473; 54%), revascularization procedures were coronary artery bypass grafting (CABG, n = 2910), drug-eluting stents (DESs, n = 6566), and bare metal stents (BMSs, n = 2997). All-cause survival rates following these procedures, respectively, were: in-hospital 90%, 96%, 93%; one-year: 66%, 67%, 58%; two-year: 53%, 48%, 43%. Among non-ACS patients (n = 10,560; 46%), procedures were CABG (n = 3268), DESs (n = 5278), and BMSs (n = 2014). Survival rates following these procedures, respectively, were: in-hospital 94%, 99%, 98%; one year: 73%, 77%, 70%; two year: 61%, 59%, 55%. DESs (versus CABG) independently predicted mortality among ACS (hazard ratio 1.08; 95% confidence interval 1.02-1.15) but not non-ACS patients (1.01, 0.95-1.07); BMSs (versus CABG) independently predicted mortality among ACS (1.30, 1.21-1.38) and non-ACS (1.13, 1.05-1.22) patients. Among CKD 5D patients, survival was lower for ACS versus non-ACS indications following all revascularization strategies. CABG (versus DESs) was associated with higher long-term survival in the context of ACS; in the absence of ACS, long-term survival was similar after CABG or DESs. BMSs were consistently associated with worse outcomes.

TCT-307: Impact of Acute Coronary Syndrome on Clinical Outcomes in Patients with Coronary Bifurcation Lesions Treated with Drug-Eluting Stents

TCT-307: Impact of Acute Coronary Syndrome on Clinical Outcomes in Patients with Coronary Bifurcation Lesions Treated with Drug-Eluting Stents

Psycho-emotional impact of acute coronary syndromes

Acute coronary syndromes can substantially disrupt the lives of our patients. However, patients' view of their illness is usually scarcely considered in routine medical practice. We aimed to investigate the psycho-emotional impact of acute coronary syndromes. We studied 30 patients with acute coronary syndrome, aged <70 years. Before discharge, each patient was interviewed by a psychologist using a semi-structured interview; data were collected in the form of verbal reports. After learning that they had had a heart attack, 16 patients (53%) reported a feeling of fear linked to the idea of death, sometimes real despair; 7 patients (23%) showed a weak emotional response, 4 (13%) reacted with denial, and 3 responded evasively. During the interview, 17 patients (57%) reported events relating to family life and 9 (30%) to work; all these events were negative and related to suffering, conflict, and stress. When compared to pre-admission status, 30% of patients experienced negative psychological changes, such as a sense of fragility, uncertainty and a redefinition of self-image, while 50% reported no change. Surprisingly, 6 patients (20%) referred positive psychological changes. This positive restructuring was related to the patients' ability/need to change their lifestyle. This process entails a different vision of the past and the future, and is associated with a feeling of rebirth and physical wellbeing. The psycho-emotional effects of acute coronary syndromes may be immense, and may radically change the way the patient relates to himself and to the world. We often remain detached from these changes, and are sometimes even unaware of them.

Impact of Acute Coronary Syndromes on Two-Year Clinical Outcomes in Patients With Unprotected Left Main Coronary Artery Stenosis Treated With Drug-Eluting Stents

In this study we investigated the impact of acute coronary syndromes (ACSs) on clinical outcomes in patients with unprotected left main coronary artery (ULMCA) stenosis treated with drug-eluting stents (DESs). In this multicenter, retrospective, observational study we enrolled 1,101 patients with ULMCA stenosis treated with DESs. Six hundred eleven patients presented with ACS and 490 had stable coronary artery disease. ACS was defined as the presence of unstable angina or non-ST-segment elevation myocardial infarction (MI). During 2-year follow-up, the adjusted hazard ratio of cardiac mortality and MI of patients with ACS versus stable patients was 2.42 (95% confidence interval 1.37 to 4.28, p = 0.002). We observed a stepwise risk increase, namely patients with stable coronary disease had the lowest risk, patients with unstable angina an intermediate risk, and patients with non-ST-segment elevation MI the highest risk. The increased risk of cardiac mortality and MI of patients with ACS was concentrated in the first year after DES implantation. In conclusion, patients with ULMCA stenosis and ACS treated with DESs have an increased risk of cardiac mortality and MI during the first year after the intervention compared to stable patients.

Impact of Acute Coronary Syndrome (ACS) on Work‐Relatedness Evaluation in Cerebrovascular and Cardiovascular Diseases among Workers

Globally, Japan, Taiwan, and South Korea are the countries recognizing cardiovascular diseases (CVDs) due to overwork as work-related diseases and compensate those who suffer from them. In Japan CVDs are considered to result from overwork. In addition, the underlying diseases (hypertension, atherosclerosis, and diabetes mellitus) of those who suffer from such diseases are recognized in Japan as being significantly facilitated and aggravated by overwork, especially the accumulation of fatigue from long working hours. Thus, the manifestation of CVDs is considered to be work-related. Initially, South Korea began with criteria for work-related CVDs (WR-CVDs) similar to those developed by the Japanese. However, South Korea has revised certain areas of the criteria many times for administrative and social reasons, without any basis of scientific evidence or support 1) . CVDs are the number one cause of death in the adult population, not only in Korea but globally. Although the patient may survive a stroke or myocardial infarction (MI), it can cause a permanent physical disablement, thus obstructing work ability. This disability can be tragic for the individual and the family, and may be a big loss for the company and the nation that loses a member of a skilled and important workforce. Due to the dramatic development of medical knowledge over the years, the pathophysiology of CVDs has been determined and new risk factors such as inflammation or stress have been included. In addition, what in the past has been collectively termed ischemic heart diseases has now been differentiated into coronary artery disease (CAD) and acute coronary syndrome (ACS). Following these clinical developments, there must be a process of verifying whether the many epidemiological studies that have presented scientific evidence for the association between stress and the causal risks of CVDs agree with the new medical knowledge. Moreover, South Korea is currently greatly influenced by both Japan and the West on the issue of WR-CVDs. There is therefore a need for a definite clarification of the difference between the West’s concept of job stress and Japan’s focus on overwork and how each factor influences health. Based on recent scientific evidence, the criteria on the work-relatedness of CVDs need to be revised, not only to improve the fairness and decision time for claims regarding work-related diseases, but also to prevent CVDs more effectively. Work-related diseases are preventable by controlling those work-related factors that are involved in the occurrence of such diseases, as well as in the facilitation or aggravation of CVDs. Workrelated causal factors should therefore be the subject of scientific investigation. Accordingly, this paper discusses 1) the differences between CAD and ACS, 2) the differences in how job stress and overwork influence CVDs, 3) the differences between cerebrovascular diseases and CVDs in terms of the etiopathogenesis, and 4) necessary revisions to the method for preventing workers’ CVDs and the criteria on the work-relatedness of CVDs.

The impact of acute coronary syndrome on clinical, economic, and cardiac-specific health status after coronary artery bypass surgery versus stent-assisted percutaneous coronary intervention: 1-year results from the stent or surgery (SoS) trial

Data are limited regarding the impact of acute coronary syndromes (ACSs) on the relative benefits of coronary artery bypass grafting (CABG) versus stent-assisted percutaneous coronary intervention (PCI). The SoS trial compared patients with multivessel disease who were randomly assigned to CABG (n = 500) or stent-assisted PCI (n = 488). The impact of treatment on 1-year outcomes was compared in ACS (n = 126, CABG; n = 116, PCI) and non-ACS (n = 374, CABG; n = 372, PCI) subgroups. Baseline characteristics were similar between treatment groups within ACS and non-ACS groups, as was the 1-year composite incidence of mortality and myocardial infarction (ACS, 5.2% for PCI vs 5.6% for CABG, P = .89; non-ACS, 7.0% vs 8.3%, P = .50). The need for repeat revascularizations was higher after PCI versus CABG within each subgroup (ACS, 15.5% vs 7.1%, P = .04; non-ACS, 18.0% vs 3.2%, P < .001). At 6 and 12 months, scores on the Seattle Angina Questionnaire improved significantly in patients with and without ACS. In patients without ACS, CABG was associated with greater improvement in physical limitation, angina frequency, and quality of life at 6 and 12 months. In patients with ACS, there was only a nonsignificant slight trend toward greater improvement with CABG at 1 year. The total 1-year costs for PCI and CABG in patients without ACS were 5760 pound sterling and 8509 pound sterling (Delta = 2749 pound sterling, 95% CI 1890 pound sterling - 3409 pound sterling), and in patients with ACS, 8014 pound sterling and 10080 pound sterling (Delta = 2066 pound sterling, 95% CI -690 pound sterling to 3487 pound sterling). In patients with and without ACS, CABG had similar clinical outcomes, less need for repeat revascularization and higher costs compared to PCI. The benefit of CABG relative to PCI in improving patients' health status tended to be greater in patients without ACS than in patients with ACS.

RBC Tranfusion Threshold and Outcomes in the Medical Intensive Care Uni

PURPOSE: We assessed the transfusion trigger for patients admitted to the medical intensive care unit (MICU), the impact of acute coronary syndromes or active bleeding on transfusion threshold, and ICU and hospital outcomes.