Incidence Of Acute Coronary Syndrome Research Articles

Temporal trends in acute coronary syndrome by subtype

Abstract Funding Acknowledgements None. Introduction Various studies reported different results in trends regarding acute coronary syndrome (ACS) subtypes over the last years. We performed a retrospective analysis to determine trends in ACS incidence, demographic characteristics of patients, invasive treatment as well as outcomes and mortality of patients with ST elevation myocardial infarction (STEMI); non-STEMI (NSTEMI) and unstable angina (UA) in our tertiary Cardiac Intensive Care Unit (CICU). Methods We collected data from medical records and our electronic hospital information system on all admissions that occured in March 2003, 2013 and 2023 and compared the data. Results Over the years, there was a significant increase in total number of patients in our CICU (74, 87 and 143 per month, respectively). Patients with ACS accounted for more than half of all patients in the investigated period, but without reaching statistical significance for increase (51.4%, 64.4% and 63.6%; p= 0.156). On the other hand, when considering patients with STEMI, there was a significant upgrowth of the number of such patients (6.8% vs 31% vs 28.7%; p<0.001) with a trend of a decrease in the number of NSTEMI (28.4%, 18.4% and 23.8%; p= 0.324) and patients with UA (16.2%, 14.9% and 11.2%; p= 0.528). Percutaneous interventional treatment significantly rose over time (35.6 vs 61.2 vs 67.8%, p<0.01), while application of ICU restricted therapies like vasopressors (1.7% vs 0 vs 6.3%; p= 0.072) and inotropes (6.8% vs 4.7% vs 8.5%; p= 0.356) showed increasing trend, but without reaching statistical significance. However, CICU length of stay (LOS) notably decreased (59h vs 43h vs 22h; p= <0,001) as well as mortality (9.5% vs 5.7% vs 2.8%; p= <0.001). Conclusion We observed a significant increase in the number of STEMI patients with a declining trend in NSTEMI and UA patients, as well as increase in coronary procedures and vasopressors and inotropes administration, all indicating growing acuity and complexity of our patients. On the other hand, LOS and mortality significantly decreased highlighting better outcomes and treatment success.

Acute coronary syndrome in elderly and senile diabetic patients

Acute coronary syndrome (ACS) remains a common cause of hospitalization in diabetes mellitus (DM) patients. It is believed that diabetic neuropathy patients have a high atypical course incidence of acute coronary syndrome, because of the frequent neuropathy development in diabetes patients, but the data on this are quite contradictory. Aim: The study aimed to determine the features of the pain syndrome and its severity in ACS and concomitant diabetes patients. Materials and Methods: The study involved 36 diabetes patients (22 men and 14 women) aged 62-86 years, hospitalized urgently for ACS. Pain syndrome was assessed during hospitalization and immediately after coronary artery revascularization using the following criteria: visual analogue scale (VAS), Numerical Rating Scale (NRS), clinical data, and biochemical markers. Results: Most of the patients (91.67%) complained of chest pain at the time of hospitalization, the rest were not bothered by any pain. Patients described pain as “burning” (30.56 %), “squeezing” (30.56 %), “tightness” (25.0 %), and “tingling” (5.56 %). There were also complaints of difficulty breathing (13.89 %), shortness of breath (11.1 %), and palpitations (41.67 %). The appearance of excessive sweating was noticed by 16.67% of patients. There was no statistically significant difference between the results of VAS and NRS pain scores (p > 0.1). The mean blood glucose level at hospitalization was 8.19±3.45 mmol/l (in men – 8.17±3.61 mmol/l, in women – 8.28±3.13 mmol/L). Glycemia level higher than 10.0 mmol/l was detected in 8 patients, which accounted for 22.22% of all patients. Severe pain syndrome patients dominated in this category (62.5 %). Conclusions: In patients with myocardial infarction and diabetes, the typical clinical picture of ACS prevailed (91.67% of patients) over the painless form. Before revascularization, moderate to severe pain occurred with equal frequency; there were no statistical differences between blood pressure, heart rate, and blood glucose level (p> 0.1) in patients with severe and moderate pain. Hyperglycemia (≥10.0 mmol/l) was detected in 22.22% of patients, among whom severe pain syndrome patients prevailed. _________________________________________________________________________________________ Keywords: elderly patients; diabetes mellitus; acute coronary syndrome; pain syndrome

The Association of Desert Dust with the Risk of Acute Coronary Syndrome in Subjects of a Younger Age.

Objectives: Recently, desert dust in Europe has been recognized as a cardiovascular health problem. In Spain, desert dust inflows in recent years have been associated with worsening air quality. The present study examines whether desert dust events are related to the incidence of acute coronary syndrome (ACS) in patients under 55 years of age. Methods: Data from 2416 consecutive patients admitted to a tertiary hospital due to ACS were prospectively analyzed. A case-crossover time-stratified design using Poisson conditional regression models was applied to estimate the impact of desert dust events involving particulate matter concentrations of an aerodynamic diameter <10 μm (PM10) on the incidence of ACS in patients under 55 years of age. Results: Desert dust intrusion on days 0 to 5 before ACS onset showed no significant association with the incidence of ACS in patients under 55 years of age. The incidence rate ratios of PM10 concentrations 1, 2, 3, 3, 4, and 5 days before ACS onset (for changes of 10 µg/m3) were 1.02 (95% CI 0.97-1.1; p = 0.41), 1.01 (95% CI 0.96-1.07; p = 0.66), 0.99 (95% CI 0.94-1.05; p = 0.78), 0.96 (95% CI 0.9-1.02; p = 0.18), and 0.97 (95% CI 0.91-1.04; p = 0.41). Conclusions: Our findings suggest that desert dust is unlikely to be related to the incidence of ACS in patients under 55 years of age.

Impact of Climate on the Incidence of Acute Coronary Syndrome - Differences Between Japan and Thailand.

Background: Although there are many reports of temperature being associated with the onset of acute coronary syndrome (ACS), few studies have examined differences in ACS due to climatic differences between Japan and Thailand. The aim of this joint Japan-Thailand study was to compare patients with myocardial infarction in Japanese and Thai hospitals in different climates. Methods and Results: We estimated the climate data in 2021 for the Wakayama Prefecture and Chonburi Province, two medium-sized cities in Japan and Thailand, respectively, and ACS patients who were treated at the Wakayama Medical University (WMU) and Burapha University Hospital (BUH), the two main hospitals in these provinces (ACS patient numbers: WMU, n=177; BUH, n=93), respectively. In the Chonburi Province, although the average temperature was above 25℃, the number of ACS cases in BUH varied up to threefold between months (minimum: July, 4 cases; maximum: October, 14 cases). In Japan and Thailand, there was a mild to moderate negative correlation between temperature-atmospheric pressure at the onset of ACS, but different patterns for temperature-humidity (temperature-atmospheric pressure, temperature-humidity, and atmospheric pressure-humidity: correlation index; r=-0.561, 0.196, and -0.296 in WMU vs. r=-0.356, -0.606, and -0.502 in BUH). Conclusions: The present study suggests that other climatic conditions and factors, not just temperature, might be involved in the mechanism of ACS.

Unusual Presentation of Acute Coronary Syndrome in a 22-Year-Old Male with Juvenile Idiopathic Arthritis: A Case Report

This case report documents the clinical journey of a 22-year-old male who was initially diagnosed with Rheumatoid Arthritis (RA) and later, at the age of 11, with Juvenile Idiopathic Arthritis (JIA). The patient manifested atypical symptoms, primarily marked by sudden and intense chest pain accompanied by sweating, leading to a collapse during his emergency room visit. Medical evaluation revealed an extensive myocardial infarction affecting the anterior wall. The patient underwent a successful percutaneous coronary intervention targeting the left anterior descending artery. This case underscores the rare incidence of acute coronary syndrome in young patients with a history of JIA.

Incidence and Predictors of Acute Coronary Syndrome in Patients on Maintenance Hemodialysis: A Prospective Cohort Study.

Cardiovascular diseases are the leading cause of death among patients on hemodialysis, with approximately 40% of the cardiovascular deaths linked to acute coronary syndrome. We aimed to investigate the incidence and risk factors of acute coronary syndrome in patients undergoing hemodialysis. Patients undergoing hemodialysis were prospectively enrolled from January 2018. Data regarding hospitalization due to acute coronary syndrome were collected at 3-month intervals through December 31, 2021. Cox regression model was used to estimate the association between baseline factors and incident acute coronary syndrome during follow-up. Patients' mean age was 66 years, 48% were men, and 16% had a history of coronary artery disease at enrolment. Over a median follow-up of 1,187 days, 85 patients were hospitalized due to acute coronary syndrome. Left main or triple vessel disease was identified in 67 patients. Risk factors associated with incident acute coronary syndrome included aging, male sex, smoking, low diastolic blood pressure, and baseline comorbidities, in addition to dialysis factors including low urea clearance, central venous catheter use, and history of dialysis access dysfunction. After multivariate analysis, age, diabetes, hyperlipidemia, smoking, and frequent interventions for vascular access remained significant risk factors. A high acute coronary syndrome incidence was observed in our cohort, with traditional risk factors playing a consistent role with that in the general population. A history of frequent dialysis access dysfunction was also associated with incident acute coronary syndrome.

Association between Homocysteine Level and Vitamin D Deficiency with Acute Coronary Syndrome in Indonesia

Background: Acute coronary syndrome (ACS) is an acute subset of coronary heart disease that requires immediate treatment. ACS is at a high prevalence in Indonesia. Homocysteine is another product of methionine metabolism. Hyperhomocysteinemia is known to cause ACS through several mechanisms, namely inducing oxidative stress, endothelial injury, and increased likelihood of plaque rupture. Vitamin D is a hormone needed by the body that comes from food or is produced through the metabolism of Vitamin D. Vitamin D functions as an anti-inflammatory, anti-thrombotic and anti-atherosclerotic agent. This study aimed to analyze the relationship between homocysteine level and Vitamin D deficiency with acute coronary syndrome incidence. Methods: This study was a cross-sectional, observational analysis study with 90 subjects. Subjects were enrolled into two groups; patients with ACS and patients with health control based on age. All subjects were selected from Universitas Airlangga Hospital, Surabaya. Serum homocysteine level and Vitamin D deficiency were calculated using an enzyme-linked immunosorbent assay (ELISA). The relationship between serum homocysteine level and Results: Ninety subjects were obtained in this study. The mean age was 62.1±10.9 years (among patients with ACS) and 60.1±10.3 years (healthy persons), with 55.6% male patients. The traditional risk factors i.e., diabetes, hypertension, and dyslipidemia were 62.2%, 91.1%, and 75.6%, respectively. The Chi-square analysis results showed homocysteine level and ACS obtained a contingency coefficient of 0.270 (p = 0.008) and Vitamin D with ACS had a contingency coefficient of 0.468 (p = &lt; 0.001). Conclusions: There was a weak association between homocysteine level and ACS and a moderate association between Vitamin D deficiency and ACS.

Prospective findings from the Dongfeng-Tongji cohort: Exposure to various metals, the expression of microRNA-4286, and the incidence of acute coronary syndrome

Mounting evidence suggests that metal/metalloid exposure is related to the adverse health effects. Our prior investigation revealed a positive relation between the plasma level of microRNA-4286 (miR-4286) and an increased risk of developing acute coronary syndrome (ACS). However, it is a lack of studies evaluating the connection between metal/metalloid exposure and miRNA expression on ACS. In the prospective Dongfeng-Tongji cohort, we performed a nested case-control study. A total of 480 ACS and 480 controls were carefully selected based on similar age, sex, and blood collection time. Using inductively coupled plasma mass spectrometry, we assessed the plasma concentrations of 24 different metals. Quantitative real-time polymerase chain reaction was used to analyze the plasma miR-4286. We examined the relations of plasma metals with miR-4286 levels, the incidence of ACS, and the potential interactions. Using the multivariate conditional logistic regression models, we observed that the adjusted odds ratios (95% confidence intervals [CI]) for incident ACS were 1.79 (1.03, 3.12; P-trend = 0.03), 0.60 (0.41, 0.87; P-trend = 0.008), and 0.66 (0.46, 0.93; P-trend = 0.02), when comparing the extreme tertiles of aluminum, rubidium, and selenium, respectively. There was a relation between the concentration of rubidium in plasma and a decrease in the level of plasma miR-4286 (percent difference [95% CI]: −13.36% [-22.74%, −2.83%]; P-trend = 0.01). Both multiplicative (P interaction = 0.009) and additive interactions (relative excess risk due to interaction [95% CI]: 0.82 [0.59, 1.06]) were noted in our observation regarding the relationship between plasma aluminum and miR-4286 in incident ACS. The findings indicated that plasma aluminum was positively while plasma rubidium and selenium were negatively linked to an increased risk of developing ACS. Plasma aluminum exposure and plasma miR-4286 expression might synergistically affect the incident ACS risk. Controlling aluminum exposure was important for ACS prevention, especially for individuals with high expression of plasma miR-4286.

Interactions Between Depression, Alcohol Intake, and Smoking on the Risk of Acute Coronary Syndrome.

Our study hypothesizes that the interaction between depression, alcohol intake, and smoking status can significantly influence the risk of acute coronary syndrome (ACS). We aim to investigate the magnitude of the association between depression and ACS risk and explore how alcohol intake and smoking status affect this association. We used data from the Korean Genome and Epidemiology Study. The primary exposure of interest was the presence of depression, as measured using the Beck Depression Inventory score at baseline. The primary outcome was the occurrence of ACS observed in the biennial follow-up surveys. We used Cox proportional regression analysis to estimate the effect of depression on ACS incidence. We conducted interaction and joint effect analyses to explore the interactions between depression and health-related habits including alcohol intake and smoking with regard to ACS incidence. During 16 years of follow-up among 3,254 individuals, we documented 88 cases of new-onset ACS (2.2 cases per 1,000 personyears). We found no association between depression and ACS risk; furthermore, the effect of depression on ACS risk by alcohol intake and smoking status did not differ significantly. In the analysis to observe the joint effect of smoking and depression, the multivariate hazard ratios of ACS were 1.26 (95% confidence interval [CI], 0.67-2.36) for non-smoking and depression, 1.52 (95% CI, 0.83-2.82) for smoking and non-depression, and 2.79 (95% CI, 1.21-6.41) for smoking and depression compared with non-smoking and non-depression. Our study reveals the combined effect of depression and smoking on ACS risk, highlighting the potential benefits of concurrent interventions for both depression and smoking for cardiovascular health.

The COVID-19 pandemic and the incidence of acute coronary syndromes at General Hospital of Veroia

Background: Although deaths from Acute Coronary Syndromes (ACS) are the most prevalent globally, during the outbreak of the new SARS-CoV-2 coronavirus pandemic, there was a declining trend in hospital admissions for ACS patients. Inevitably a reduction of invasive procedures in cardiac catheterization laboratories was observed. Moreover, an increase in sudden out-of-hospital cardiac deaths was recorded. On the other hand, patients that eventually treated in the hospital had a much worse outcome in terms of cardiac function. Inadequate treatment of acute myocardial infarction resulted in a further increase in mortality due to coronary artery disease. The aim of our study was the comparison of admissions of the patients with ACS before and during the COVID-19 pandemic. Methods: A retrospective single center study was conducted. We recorded all admissions with ACS underwent invasive interventions during the period of lockdown due to COVID-19 pandemic, in Greece, from 16 March 2020 to 1 May 2020 (study period A), as well as in the period of gradual withdraw of restrictions from 2 May 2020 to 1 June 2020 (study period B),. The data were compared with those of the periods of 2019 (control period A and B). Results: One hundred thirty eight patients were the group of study period and 158 were the group of the control period. The reduction rate was 12.7% in study period. The largest decrease in admissions concerned with elderly patients over 75 years old, as well as females (by 52% - 53% respectively). The severity of the restrictions but also the fear of the spread of the coronavirus may be relevant to the insufficient seek of help for these groups of patients. Conclusion: Our study showed that during the pandemic period, the invasive interventions were fewer than those of 2019. However, the expected reduction of catheterizations during this two and a half months period was mitigated by the increase of inter-hospital transfers of patients with ACS from neighboring hospitals, without a catheterization laboratory.

Заболеваемость острым коронарным синдромом в Российской Федера- ции и в Республике Башкортостан.

Purpose of the study. Based on an analysis of the medical and demographic situation and the incidence of acute coronary syndrome in the Russian Federation, in the federal districts and constituent entities of the Russian Federation, as well as in the pilot territory of the Republic of Bashkortostan, proposals are given for the development of management decisions at the regional and federal levels. Materials and methods: statistical, analytical. We used statistical materials of the Federal State Statistics Service (2014–2021), statistical materials: M., TsNIIOIZ of the Ministry of Health of the Russian Federation (2023) and the Republic of Bashkortostan MIAC, Ufa (2022). Results. The leading cause of mortality in the Republic of Belarus, as well as in the Russian Federation as a whole, is diseases of the circulatory system (CVD). In 2022, the mortality rate of the population from CVD in the Republic of Belarus was 459,5 per 100 thousand population, in the Russian Federation the figure was higher – 560,8‰oo. Fluctuations in indicators in the constituent entities of the Russian Federation are 7,6 times. The primary morbidity rate of the adult population in the Republic of Bashkortostan was BSK (2022) 4948,6‰oo. Acute coronary syndrome (ACS) is a group of clinical symptoms or signs suggestive of acute myocardial infarction (MI) or unstable angina (UA). The primary incidence rate of the adult population of the Republic of Belarus with unstable angina pectoris was (2022) 113,8‰oo, acute myocardial infarction – 97,7‰oo, in the Russian Federation the figures are higher – 106,7 and 140,8‰oo, respectively. The difference in the incidence of myocardial infarction among the adult population in the constituent entities of the Russian Federation is 9,3 times; the difference in unstable angina is huge – 54 times, which to a certain extent indicates the ambiguity of the coding of unstable angina. The study indicates the need for an in-depth analysis of the incidence of acute coronary syndrome in the constituent entities of the Russian Federation. Conclusions. It is necessary to develop management decisions, including improving the accessibility and quality of cardiac care to thepopulation, including patients with acute coronary syndrome, at the regional and federal levels.

Abstract 12100: Association Between Rheumatoid Arthritis and Cardiovascular Outcomes: A Systematic Review and Meta-Analysis

Background: Rheumatoid arthritis (RA) is an autoimmune disorder with a varying range of organs involved and leading to adverse outcomes. However, very little is known, with conflicting results about the association between RA and atrial fibrillation (AF) and the incidence of acute coronary syndrome (ACS). Objective: We aim to evaluate the incidence of atrial fibrillation (AF), ACS, and other clinical outcomes among RA patients. Methods: We performed a systematic literature search using PubMed, Embase, and Scopus for relevant articles from inception until 10th April 2023. Primary clinical outcomes were AF. Secondary endpoints were acute coronary syndrome (ACS), stroke, and all-cause of mortality. Results: A total of 4,667,199 patients were included in the analysis, with 77460 (xy%) patients in the RA group and 4589739 patients in the NRA group. The most common Comorbidity includes hypertension among RA and NRA groups (27% vs. 6%), respectively. Pooled analysis of primary outcomes shows that RA groups of patients had significantly higher odds AF (OR, 1.17(95%CI: 1.11-1.23), P&lt;0.00001, I2=34%) compared with NRA groups. Secondary Outcomes shows that the RA group of patients had significantly higher odds of ACS (OR, 1.37(95%CI: 1.23-1.53), P&lt;0.00001) compared with the NRA groups. However, the likelihood of stroke (OR, 1.02(95%CI: 0.95-1.08), P=0.65), and all cause mortality (OR, 1.25(95%CI: 0.84-1.87), P=0.27, I2=91%) was comparable between both the groups of patients. Conclusion: Our study shows that RA groups of patients are at increased risk of having atrial fibrillation and acute coronary syndrome. However, mortality risk was comparable between both groups.

Abstract 16963: A Nation-Wide Study on Incidence, Mortality and Case Fatality of Acute Coronary Syndrome Reveals Levelling Off of the Incidence Decrease Among Young Women Aged 35-54 Years in 1996-2021 in Finland

Introduction/background: Incidence and case fatality (CF) of acute coronary syndrome (ACS) have declined in the last decades, but cardiovascular disease remains one of the leading causes of death in the Western world. The knowledge of the current trends in incidence, mortality, and CF of ACS from Finland and even worldwide is sparse, though some studies have suggested slowed incidence decrease and even increase in younger age groups. Thus, we set out to investigate the changes in these event rates in Finland from 1996 to 2021. Research questions/hypothesis: To examine how the ACS burden has evolved in Finland from 1996 to 2021, especially after 2010. Methods/approach: We used Finnish country-wide registers, i.e., Hospital Discharges Register (HDR, from Care register for health care) and the National Causes of Death Register with complete coverage of non-fatal and fatal ACS events. We analyzed incidence and mortality rates, and CF, as well as the significance of their trends using negative binomial and logistic regression adjusting for age and sex. Results/data: Altogether, 186 489 non-fatal and 72 907 fatal incidents of ACS events were included in the analysis. ACS incidence decreased in men (Annual percentage change (APC) -2.0% [95% CI -2.2 to -1.8]) and in the older age groups of women (APC of 55-64-year-old -1.5% [-1.7 to -1.2] and 65-74-year-old -3.3% [-3.5 to -3.1]), but the decrease in incidence slowed down over the last decade. Importantly, in 35-54-year-old women ACS incidence decrease halted (APC of 35-44-year-old 0.4% [-0.3 to 1.0] and 45-54-year-old 0.2% [-0.1 to 0.5]). ACS mortality and case-fatality declined steadily in both sexes and all age groups throughout the study period (APC of the mortality in men -4.5% [-4.7 to -4.3] and in women -5.1% [-5.3 to -4.7]. APC of the CF in men -2.7% [-2.9 to -2.6] and in women -3.4% [-3.6 to -3.2]). Conclusions: In concordance with other recent reports, we showed that the ACS mortality in both men and women was steadily decreasing. However, we observed that ACS incidence decline slowed down in older age groups and even halted in women aged 35-54. These alerting results emphasize the need for cardiovascular prevention, particularly in young and middle-aged women.

Long-Term Follow-up Study of Hospitalizations for Acute Coronary Syndrome in Kobe-City and Other Districts Under the Hyogo Smoking Ban Legislation - A Nationwide Database Study.

Hyogo Prefecture has managed smoking ban legislation with partial restrictions in public places (Hyogo-L) since 2013. Previous studies have reported a significant decrease in admissions for acute coronary syndrome (ACS) in Kobe-city, but not in other districts of Hyogo Prefecture in the 2 years after Hyogo-L. The aim of the present study was to define the long-term effect of Hyogo-L.Methods and Results: The JROAD-DPC dataset was used to collect information on the number of hospitalizations for ACS in Hyogo Prefecture, and in Osaka-city without smoking ban legislation, from April 2013 to March 2020. Poisson regression analysis was performed to calculate incident rate ratios (IRRs) and 95% confidence intervals (CIs). ACS records of 3,101 in Kobe-city, 11,375 in areas of Hyogo Prefecture other than Kobe-city and 11,079 in Osaka-city were collected for admissions. The incidence of ACS reduced significantly over time in Kobe-city [IRR (95% CI); 0.96 (0.94-0.97)], but did not reduce in the others. The decrease in Kobe-city was observed in ACS patients without smoking, hypertension, and hyperlipidemia, but not in those with such risk factors. The long-term ACS reduction or non-reduction under Hyogo-L was determined at the initial period and the same scenario continued, supporting the importance of legislation and compliance with the smoking ban. The lowering effect was remarkable in ACS patients without risk factors such as non-smoking.

The potential role of radiochemical analysis of CT images of epicardial adipose tissue in the prognosis of acute myocardial infarction

Introduction. Multispiral computed tomography (MSCT) coronary angiography (CAG) is a highly informative method of visualizing atherosclerotic plaques in the coronary arteries and assessing their structure. At the same time, this method has a few significant drawbacks associated with the intravenous administration of iodine-containing radiopaque agents as well as high radiation exposure. The radiomic analysis of contrast-free MSCT images allows calculating many additional quantitative parameters, which can potentially be associated with atherosclerotic plaque instability and the degree of coronary artery stenosis. At the same time, the prognostic and diagnostic value of radiomic characteristics has not been investigated.Aim: To assess whether there is an association between radiomic indexes of EAT on non-contrast MSCT cardiac images with the degree of atherosclerotic coronary artery stenosis in patients with stable CAD, as well as the incidence of acute coronary syndrome (ACS) within 5 years in this category of patients.Material and Methods. We retrospectively reviewed 100 MSCT-CAG studies performed to diagnose coronary heart disease in patients. 39 patients with signs of coronary stenosis up to 50% and registered in Tomsk medical information systems (MIS) for at least 5 years were selected, as well as 15 people without signs of coronary arteries (CA) atherosclerosis as a control group. Epicardial adipose tissue (EAT) volume was assessed and 837 radiomic characteristics were calculated on non-contrasted MSCT cardiac images of all patients (54 people). The presence or absence of ACS within 5 years after MSCT-CAG in each patient was monitored according to Tomsk MIS data. Statistical analysis and comparison of indices were performed in control group (group 2) and study group (group 1), as well as in subgroups of patients who had suffered AMI (group 1a) and those who had not (group 1b).Results. When comparing group 1 with the control group, significant differences (p &lt; 0.05) were found for all radiomic parameters, density, and volume of EAT. Correlation analysis did not reveal any relationship between the radiomic characteristics of EAT and the degree of coronary artery stenosis, as well as the calcium index. According to the results of the MIS of Tomsk analysis, group 1 was divided into 2 subgroups: without ACS (group 1a; n = 27 (50%)) and with ACS (group 1b; n = 12 (22%)). When comparing subgroups 1a and 1b, there were no significant differences in the volume and density of EAT (p &gt; 0.05), however, 8 out of 837 radiomic parameters differed significantly. Multiple regression analysis has shown that the Size Zone Nonuniformity gray level zone matrix (SZN-GLSZM) and Gray Level Variance (GLCM) gray co-occurrence matrix are independent predictors of the development of ACS within 5 years. According to the results of the ROC analysis, the logistic model with the inclusion of radiomic data showed high sensitivity and specificity in predicting the development of ACS (cut-off point &lt;8025.7; specificity 96%, sensitivity 75%, AUC = 0.806, p &lt; 0.001 for SZN; cut-off point &lt;4.08; specificity 93%, sensitivity 83%, AUC = 0.861 for GLV; p &lt; 0.001).Conclusion. SZN GLSZM and GLV GLCM radiomic features on non-contrast MSCT images of EAT are associated with the incidence of ASC in patients with coronary artery atherosclerosis. Radiomic analysis of EAT could potentially be used for personalized assessment of the ACS risk.

Time-varying effect of postoperative cholesterol profile on long-term outcomes of isolated coronary artery bypass graft surgery

BackgroundControlling cholesterol levels is one of the primary goals of preventing atherosclerotic plaque progression in patients undergoing coronary artery bypass graft (CABG) surgery. This study aimed to investigate the impact of serum cholesterol profile at multiple time points following isolated CABG surgery on long-term patient outcomes.MethodThis retrospective cohort study was conducted on the admission and follow-up data of isolated CABG patients from the Tehran Heart Center registry between 2009 and 2016. The association of low-density lipoprotein (LDL), high-density lipoprotein (HDL), and their ratio as an atherogenic index with major adverse cardiac and cerebrovascular events (MACCE) and all-cause mortality were evaluated using time-varying survival analysis methods.ResultA total of 18657 patients were included in this analysis. After adjusting for known confounding factors, no significant difference in all-cause mortality and MACCE was observed at different LDL levels. The incidence of acute coronary syndrome (ACS) in patients with LDL > 100 mg/dl and LDL < 50 mg/dl was significantly higher than in the control group (P-value = 0.004 and 0.04, respectively). The incidence of cerebrovascular accidents (CVA) at LDL > 100 mg/dl was also significantly higher compared to the control group (P -value = 0.033). Lower HDL levels were significantly associated with a higher MACCE (P -value < 0.001), all-cause mortality (P -value < 0.001), ACS (P -value = 0.00), and CVA (P -value = 0.014). The atherogenic index was also directly related to MACCE and all its components (all P-values < 0.001).ConclusionLDL/HDL ratio is suggested as a better marker for secondary prevention goals compared to LDL alone in patients undergoing CABG surgery.

Impacts of Non-alcoholic Fatty Liver Disease on Acute Coronary Syndrome: Evidence and Controversies.

Acute coronary syndrome (ACS) and non-alcoholic fatty liver disease (NAFLD) are two clinically common disease entities that share numerous risk factors. This review aimed to discuss the impacts of NAFLD on ACS. In an era of improved control of traditional risk factors, the substantial burden of cardiometabolic abnormalities has caused widespread concern. NAFLD is considered the hepatic component of metabolic syndrome, which can exert an impact on human health beyond the liver. Accumulating studies have demonstrated that NAFLD is closely related to cardiovascular disease, especially coronary artery disease. Interestingly, although recent data have suggested an association between NAFLD and the incidence and outcomes of ACS, the results are not consistent. In this review, we comprehensively summarized evidence and controversies regarding whether NAFLD is a contributor to either the development of ACS or worse outcomes in patients with ACS. The potential pathophysiological and molecular mechanisms involved in the impacts of NAFLD on ACS were also elucidated.

The association between SGLT2 inhibitors and new-onset acute coronary syndrome in the elderly: a population-based longitudinal cohort study

BackgroundSeveral observational cohorts and meta-analytical studies on humans have shown that users of sodium-glucose cotransporter-2 inhibitors (SGLT2is) have a lower risk for new-onset acute coronary syndrome (ACS) than nonusers. However, some studies, including randomized clinical trials, reported the opposite results. This study aimed to investigate the impacts of a SGLT2i on new-onset ACS in a population.MethodsWe conducted a retrospective population-based cohort study involving 56,356 subjects who received SGLT2i therapy and 112,712 patients who did not receive SGLT2i therapy between May 1, 2016 and December 31, 2019. The outcome was the risk of new-onset ACS. Multivariable Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% confidence intervals for associations between SGLT2i use and ACS risk.ResultsA total of 670 and 1408 ACS events occurred in SGLT2i users and nonusers, respectively, during a follow-up of 3.7 years. SGLT2i use was associated with a nonsignificantly lower risk of ACS (adjusted HR 0.95, 95%confidence intervals (CI 0.87–1.04, P = 0.3218). We confirmed the robustness of these results through a propensity score 1:1 matching analysis. The results of the subgroup analysis of the subtype of the SGLT2i treatments were consistent with the main findings. An increased risk for the incidence of ACS in male and older (> 70 years) patients were also found.ConclusionsIn this population-based cohort study, we found that SGLT2i use is associated with a nonsignificantly decreased risk of ACS. No difference in the SGLT2i subtype was observed in subgroup analyses. However, the results of this study indicated an increased risk for the incidence of ACS in male and older (> 70 years) patients.

Time trends in income-related disparity in incidence of acute coronary syndrome.

Higher incidence of acute coronary syndrome (ACS), among those with lower income, has been recognized in the most recent decades. Still, there is a paucity of data on temporal changes. This study aims to investigate 20-year time trends in income-related disparity in the incidence of ACS in Denmark. This Population-based repeated cross-sectional study included all patients with first-time ACS, aged ≥20 years, registered in the Danish National Patient Registry 1998-2017. Aggregated sociodemographic data for the Danish population was accessed from Statistics Denmark. Yearly incidence rates (IR) and incidence rate ratios (IRR), with the highest-income quartile as a reference, were standardized using cell-specific personal equivalent income according to year, sex and age group with 95% confidence intervals. Interaction analysis was executed for differences in IR of ACS between the lowest- and highest-income quartile over time. A total of 220 070 patients hospitalized with ACS from 1998 to 2017 were identified. The yearly standardized ACS IRs decreased in all income quartiles. However, the IR remained higher in the lowest-income quartile compared to the highest for both men [1998: IRR 1.45 (95% confidence interval, CI 1.39-1.52) and 2017: 1.47 (1.40-1.54)] and women [1998: IRR 1.73 (1.64-1.82) and 2017: 1.76 (1.65-1.88)]. Interaction analysis showed that over the period the difference in IR between the lower- and the highest-income quartile decreased with 1-5 ACS cases per 100 000 person-year. Income-related disparity in the incidence of ACS was present in Denmark between 1998 and 2017. Despite a marked overall decrease in the yearly ACS incidence, the extent of income-related disparity remained unchanged.

Musculoskeletal corticosteroid injection and risk of acute coronary syndrome: a case control study.

Musculoskeletal corticosteroid injection (CSI) is a frequently used treatment, considered safe with a low incidence of minor side effects. To investigate whether the incidence of acute coronary syndrome (ACS) is increased following corticosteroid injection for musculoskeletal conditions. Data were reviewed from 41,276 patients aged over 40 years and hospitalised with ACS between January 2015 and December 2019. Each ACS case was allocated up to 10 control patients from their primary care clinic, matched for age and sex. The cases and controls were reviewed for orthopaedic or rheumatological consultation including a CSI procedure and occurring prior to the hospital admission date. The incidence of CSI was compared between the case and control groups. Data from a total of 413,063 patients were reviewed, 41,276 ACS cases and 371,787 controls. The mean age was 68.1, standard deviation (SD) = 13.1, 69.4% male. In the week prior to their hospital admission, 118 ACS patients were treated with CSI compared with 495 patients in the control group; odds ratio (OR) = 1.95 (1.56-2.43). In total, 98% of CSI procedures were carried out by orthopaedic specialists. An association between ACS and prior CSI was strongest in the days immediately prior to hospitalisation: OR = 3.11 (2.10-4.61) for patients who were injected 1 day before ACS. The association between ACS and CSI declined with increasing time between injection and hospital admission: at 90 days OR = 1.08 (0.98-1.18). The association remained robust when cardiovascular risk factors, history of rheumatological disease, and other co-morbidity were taken into consideration. Musculoskeletal corticosteroid injection appears to substantially increase the risk of acute coronary syndrome.