non-ST Elevation Acute Coronary Syndrome Research Articles

Coronary artery bypass grafting in acute coronary syndromes: modern indications and approaches.

Acute coronary syndromes (ACS) are a leading cause of morbidity and mortality worldwide, with approximately 1.2 million hospitalizations annually in the U.S. This review aims to explore the contemporary evidence regarding revascularization strategies, including percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), in ACS patients. It also addresses the unresolved questions concerning the optimal procedural aspects of surgery and antithrombotic therapy for secondary prevention postsurgery. Recent studies highlight that while PCI is generally preferred for its timeliness in high-risk non-ST-elevation ACS (NSTE-ACS) patients, CABG offers a benefit in terms of cardiovascular events in those with multivessel disease, particularly in the presence of diabetes and higher coronary disease complexity. For ST-elevation myocardial infarction (STEMI), CABG is less frequently utilized due to the preference for primary PCI, but it remains crucial for patients with complex anatomy or failed PCI. Furthermore, the optimal timing and type of antiplatelet therapy post-CABG remain controversial, with current evidence supporting the use of dual antiplatelet therapy (DAPT) to reduce ischemic events but necessitating careful management to balance bleeding risks. In patients with ACS, the choice between PCI and CABG depends on the complexity of coronary disease and patient comorbidities. CABG is particularly beneficial for multivessel disease in NSTE-ACS and specific STEMI cases where PCI is not feasible. The management of antiplatelet therapy postsurgery requires a nuanced approach to minimize bleeding risks while preventing thrombotic complications. Further randomized clinical trials are needed to solidify these findings and guide clinical practice.

Association of diastolic and renal dysfunctions in non-ST segment elevation acute coronary syndrome patients with heart failure with preserved ejection fraction and their impact on outcomes

Association of diastolic and renal dysfunctions in non-ST segment elevation acute coronary syndrome patients with heart failure with preserved ejection fraction and their impact on outcomes

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 by TMI group (before or after ICA). Secondary data analysis in hospitalized NSTE-ACS patients with TMI event(s) identified from 12-lead electrocardiographic Holter. Patient records were reviewed to assess ischemic burden [TMI time (min) ÷ 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/h) compared to before ICA (2.54 ± 2.11 min/h), P = 0.039. Hospital length of stay by TMI group was 113 ± 113 (before), 226 ± 244 (after), and 85 ± 65 hours (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 a 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.

Early coronary revascularization among "stable" patients with non-ST-segment elevation acute coronary syndromes: the role of diabetes and age.

To investigate the impact of an early coronary revascularization (<24 hours) compared with initial conservative strategy on clinical outcomes in diabetic patients with non-ST elevation acute coronary syndrome (NSTE-ACS) who are in stable condition at hospital admission. The ISACS-TC database was queried for a sample of diabetic and nondiabetic patients with diagnosis of NSTE-ACS. Patients with cardiac arrest, hemodynamic instability, and serious ventricular arrhythmias were excluded. The characteristics between groups were adjusted using logistic regression and inverse probability of treatment weighting models. Primary outcome measure was all cause 30-day mortality. Risk ratios (RRs) and odds ratios (ORs) with their 95% CIs were employed. Of the 7,589 NSTE-ACS patients identified, 2,343 were diabetics. The data show a notable reduction in mortality for the elderly (> 65 years) undergoing early revascularization compared to those receiving an initial conservative strategy both in the diabetic (3.3% versus 6.7%; RR: 0.48; 95% CI: 0.28-0.80) and nondiabetic patients (2.7% versus 4.7%: RR: 0.57; 95% CI: 0.36-0.90). In multivariate analyses, diabetes was a strong independent predictor of mortality in the elderly (OR: 1.43; 95% CI: 1.03-1.99), but not in the younger patients OR: 1.04; 95% CI: 0.53-2.06). Early coronary revascularization does not lead to any survival advantage within 30 days from admission in young NSTE-ACS patients who present to hospital in stable conditions with and without diabetes. An early invasive management strategy may be best reserved for the elderly. Factors beyond revascularization are of considerable importance for outcome in elderly diabetic subjects with NSTE-ACS. ClinicalTrials.gov: NCT01218776.

Clusters of patients with non-ST-segment elevation acute coronary syndrome depending on the laboratory data

Aim. To identify clusters of patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS) depending on the laboratory data, including platelet function tests.Material and methods. The study included 109 patients hospitalized in the cardiology department with NSTE-ACS. All patients underwent a standard examination, including a complete blood count. In addition, the platelet function was assessed using impedance aggregometry with various inducers (adenosine diphosphate (5 and 10 μmol/L), collagen (2 μmol/L)). We assessed the P-selectin expression level using flow cytometry. Patients were followed up for 6 months. As a statistical method, we performed сluster analysis by K-means algorithm.Results. We registered 18 adverse outcomes (myocardial infarction, unstable angina) during 6-month follow-up. Cluster analysis revealed 3 clusters. The first cluster included 39 (36%) patients with higher monocyte values and lower hemoglobin values, probably indicating chronic inflammation and a tendency towards anemia. The second cluster included 13 older patients (12%) with high comorbidity and high platelet function. Both the first and second clusters recorded 23% adverse outcomes. Third cluster, on the contrary, included mostly younger patients with fewer comorbidities, which had more favorable course of ACS (no signs of platelet hyperaggregation, chronic inflammation and anemia). This cluster included more than half (n=57, 52%) of all patients; adverse outcomes at 6 months in these patients developed 2-fold less frequently than in the other clusters (11% vs 23%).Conclusion. Among patients with NSTE-ACS, groups differing in laboratory parameters were identified, based on which clusters were formed using the k-means method. Clusters with high levels of platelet functional activity, monocyte count and low hemoglobin values included older patients with severe comorbidity and showed a tendency towards more frequent adverse outcomes of the disease.

Significance of Wellens Pattern in Electrocardiogram Revisited – Electrocardiogram and Angiographic Correlation

Abstract Background: In patients with non-ST elevation acute coronary syndrome (NSTEACS), electrocardiogram (ECG) may show deep or biphasic T-wave inversions in precordial leads. Previous reports had linked this ECG change with a lesion in the left anterior descending artery (LAD). However, it is often overlooked in the emergency department and is not included in the major scoring systems for risk stratification of acute coronary syndrome. Objectives: We assessed coronary angiogram (CAG) lesions in patients with biphasic T inversion and/or deep T inversions by ECG. Methods: From July 2019 to November 2021, ECGs of all NSTEACS patients were analyzed and 202 patients who satisfied the criteria were chosen. CAGs were analyzed for the site, severity, and type of lesion. Treatment modality advice was noted. Results: One hundred and ninety-five patients had severe disease in the LAD, of which 178 patients had a lesion proximal to the first septal perforator branch. LAD lesions were discrete in 98, tubular in 68, diffuse in 25, and total occlusion in 11 patients. One hundred and thirty-four patients were advised to have percutaneous coronary intervention (PCI) as treatment. Sixty-three patients with a severe lesion had no recurrent angina and 103 were negative for troponin. Conclusion: 96.5% of patients with NSTEACS and an ECG abnormality had a significant lesion in the LAD. In 88.1% of patients, the lesion was before the first septal perforator branch. Overall, 66.3% of patients were advised to undergo PCI. The sensitivity of troponin in predicting severe lesion was 47.7%, and the sensitivity of recurrent angina was 67.7% only. This ECG abnormality by itself, even without recurrent angina or troponin elevation, should be an indication for invasive evaluation such as CAG.

Pre-hospital admission of heparin in patients with suspected non-ST segment elevation acute coronary syndrome.

Evidence supporting pre-hospital heparin administration in patients with suspected non-ST segment elevation acute coronary syndrome (NSTE-ACS) is lacking. We aim to evaluate if pre-hospital heparin administration by emergency medical service improves clinical outcome in patients with suspected NSTE-ACS. Patients with suspected myocardial infarction (MI) presenting to the emergency department were prospectively enrolled from 2013 to 2021, excluding those with ST segment elevation MI. Patients with and without prehospital heparin administration were compared using propensity score matching. To assess the association between pre-hospital heparin loading, 30-day and 1-year mortality, Kaplan-Meier estimations and Cox regression models were used. Among 1,234 patients, median age was 69years, 755 (61.2%) were male, 867 (70.5%) with known hypertension, 177 (14.4%) had diabetes, 280 (23.1%) were current smokers, and 444 (36.0%) had a history of CAD. Compared to patients without pre-hospital heparin administration, heparin pre-treated patients were more often active smokers (26.5% vs. 20.8%). After propensity matching, 475 patients with vs. without pre-hospital heparin administration were compared, with no significant difference in 30-day mortality (no-heparin 1.3% vs. heparin 0.4%) and 1-year mortality (no-heparin 7.2% vs. heparin 5.5%, adjusted HR 0.98, CI 0.95-1.01, p = 0.22). Bleeding events occurred at a low frequency (< 2%) and did not differ between groups. In this study, pre-hospital heparin administration was not associated with improved clinical outcome in patients with suspected NSTE-ACS. These findings question pre-hospital heparin therapy in this patient population and might potentially warrant a more restricted utilization pending in-hospital risk assessment.

A Case Report of a 44-Year-Old Middle-Aged Woman with Acute Chest Pain

&lt;p&gt;胸痛是臨床常見的主訴，鑑別診斷必須配合心電圖，並優先考量會猝死的心血管疾病。本篇個案是一位44歲的中年女性，因急性胸痛至急診就醫，經連續追蹤心電圖與抽血檢驗，診斷為非ST節段上升之急性冠心症(non ST-elevation acute coronary syndrome, NSTE-ACS)，心導管冠狀動脈攝影檢查結果合乎自發性冠狀動脈剝離(spontaneous coronary artery dissection, SCAD)的變化。本文之目的在強調無冠狀動脈疾病危險因子的中年女性發生急性冠心症，須考慮SCAD的可能性。SCAD的病因為冠狀動脈內膜撕裂，血流進入血管內壁產生血腫，當假腔壓迫冠狀動脈血流會使心肌缺血而導致胸痛的症狀，與冠狀動脈阻塞型心肌梗塞成因不同，故治療與處理的方式有不同之處，必須視臨床病人情況做謹慎的評估，以降低侵入性治療的風險。照顧個案期間藉由最少的侵入性檢查給予正確診斷，並配合適當的藥物治療，達成緩解病人症狀、預防合併症與復發的治療目的。藉由這篇病例報告，希望醫護人員對照顧自發性冠狀動脈剝離的病人有更多的認知。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;Chest pain is a common clinical complaint. Electrocardiograms must be included in diagnosis, and the priority should be given to cardiovascular diseases that may lead to sudden death. The case described here is a 44-year-old middle-aged woman who presented to the emergency room with unendurable chest pain. After continuous follow-up ECG and blood tests, she was diagnosed with non-ST-elevation acute coronary syndrome (NSTE-ACS). The result of coronary angiography correspond to sponta-neous coronary artery dissection (SCAD). The purpose of this article is to emphasize the possibility of SCAD in acute coronary syndrome in middle-aged women without coronary artery disease risk fac-tors. SCAD is characterized by intimal tear, intramural hematoma, and false lumen formation, which can obstruct coronary blood flow and cause myocardial ischemia with chest pain. Since the etiology of SCAD is different from obstructive coronary artery myocardial infarction, their medical treatments must be carefully evaluated through clinical patient conditions to reduce the risks of invasive proce-dure. In this case, early and correct diagnosis was made to reduce invasive procedure, and appropriate medication therapy were applyed to achieve the purpose of relieving the patient&amp;rsquo;s symptoms, prevent-ing complications and recurrence. Through this case report, it is hoped that healthcare professionals will improve awareness of caring for patients with spontaneous coronary artery dissection.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Clinical profile of patients with non-ST segment elevation acute coronary syndrome: experience of a regional vascular center

Aim. To identify the main clinical and paraclinical characteristics of patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS) of various risk groups for adverse ischemic events, as well as to describe the in-hospital outcomes of the disease.Material and methods. The retrospective analysis included 600 patients who were hospitalized at the regional vascular center from January 2019 to January 2021 with a diagnosis of NSTE-ACS.Results. Patients were stratified into very high — 208 (34,7%), high — 196 (32,7%), moderate — 108 (18%) and low — 88 (14,6%) risk groups. In the highand very high-risk groups, patients were older, characterized by a significant comorbidity index, increased bleeding risk, decreased left ventricular ejection fraction and glomerular filtration rate in comparison with patients of other groups (p&lt;0,05). Very highrisk patients were characterized by associated clinical conditions, predominantly infectious diseases and decompensated heart failure. Unfavorable outcome of hospitalization was observed in 44 (7,3%) patients. The death probability in the very high-risk group (33; 15,9%) was higher than in the low-risk group (2; 2,3%) (Odds ratio 8,1 (95% confidence interval: 1,9-34,6); p=0,01). Regardless of the risk degree, there was a high (53,5%) likelihood of completing invasive coronary angiography as a diagnostic procedure. Most of the observed complications as a result of invasive coronary angiography were characteristic of the high(18,3%) and very high-risk groups (21,5%).Conclusion. NSTE-ACS patients at very high/high risk of adverse ischemic events represent a heterogeneous group with cardiac and noncardiac pathologies with high comorbidity and bleeding risks, decreased left ventricular ejection fraction and glomerular filtration rate, and associated clinical conditions.

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

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

Transluminal balloon angioplasty and stenting of coronary arteries after prior orthotopic heart transplantation: a case report

Introduction. Today, heart failure (HF) is the most common natural outcome of diseases that are not diagnosed and treated in time. Despite the advances in cardiovascular pharmacotherapy, orthotopic heart transplantation is a generally recognized gold standard for the treatment of end-stage heart failure.Brief description. The article describes a 55-year-old male patient admitted to the Cardiology Dispensary (Kabardino-Balkarian Republic) with a clinical picture of non-ST segment elevation acute coronary syndrome (ACS). Earlier in 2017, the patient underwent orthotopic heart transplantation (OHT) for end-stage HF due to dilated cardiomyopathy. Hypertension was registered 2,5 years after surgery, and clinical manifestations of HF were registered for 5 years. In 2024, coronary angiography revealed subtotal stenosis of 95% in the middle segment of the anterior descending artery. Intraoperatively, the consensus assessed the risk and made a decision on surgical endovascular treatment of the stenosis. The postoperative period was uneventful.Discussion. The presented case is an example of timely diagnosis of coronary artery disease in a transplanted heart and successful transluminal balloon angioplasty and stenting of the anterior descending artery.

Current Insight on Percutaneous Coronary Intervention in Non-ST Elevation Acute Coronary Syndrome

Percutaneous coronary intervention (PCI) is a cornerstone in the management of non-ST elevation acute coronary syndrome (NSTE-ACS), offering significant improvements in patient outcomes. Risk stratification is critical in guiding the urgency and timing of PCI, with invasive strategies recommended for high-risk patients identified by clinical, electrocardiographic, biomarker assessments, or validated scores. Multivessel coronary artery disease is frequently observed in patients with NSTE-ACS and is correlated with an increased likelihood of recurrent myocardial infarction and mortality. Preferably during the index procedure, complete revascularization should be considered in patients with stable hemodynamics. Functional invasive evaluation, including fractional flow reserve, may help assess the hemodynamic significance of coronary lesions and decide whether a non-culprit stenosed vessel prompts revascularization. Intravascular imaging techniques with optical coherence tomography and intravascular ultrasound are essential for evaluating lesion characteristics, optimizing stent deployment, and enhancing the precision of PCI. Overall, a personalized interventional approach in NSTE-ACS incorporating risk stratification, timely intervention, careful consideration of multivessel disease, and advanced diagnostic modalities is paramount in enhancing patient prognosis and minimizing recurrent ischemic events. Keyword: Percutaneous Coronary Intervention, Non-ST Elevation Acute Coronary Syndrome Multivessel Disease; Intravascular Imaging; Coronary Physiology; Complete Revascularization.

Current Insight on Percutaneous Coronary Intervention in Non-ST Elevation Acute Coronary Syndrome

Current Insight on Percutaneous Coronary Intervention in Non-ST Elevation Acute Coronary Syndrome

Neutrophil-Lymphocyte Ratio (NLR) as A Predictor for Non-ST Elevation Myocardial Infarction (NSTEMI) in the Emergency Room

Background: The usefulness of the NLR as an approach to identifying cases of acute coronary syndrome (ACS) needs to be improved. Objective: This research was designed to determine the effectiveness of the NLR in identifying individuals who presented to the emergency room complaining of anginal due to ACS. Material and Methods: The single-center cross-sectional study was performed at Saiful Anwar General Hospital in Malang, East Java, Indonesia, from July 2020 to December 2023. Patients were involved in this study with complaints of angina suspected of ACS. During further observation in the emergency room, based on the findings of the troponin I analysis, individuals were divided into unstable angina pectoris (UAP) and NSTEMI. Result: Study results were collected from 282 individuals diagnosed with Non-ST Elevation Acute Coronary Syndrome (NSTEACS), with 75.9% male and a mean age of 58.39 ± 10.27 years. The NLR threshold was 4.5 (AUC: 0.78, 95% CI: 0.765–0.867, P &lt;.001) assessed during admission, which showed a sensitivity of 79% and a specificity of 78% in accurately predicting the probability of subsequent troponin positivity. Multivariate analysis revealed that the NLR at hospitalization remained an essential marker of troponin positivity during follow-up. Conclusion: In the end, NLR could be considered an initial test in emergency services to predict the diagnosis of NSTEMI in people experiencing angina Keyword: Marker Inflammation, NLR, NSTEMI, Troponin I.

Multivessel revascularization in non-ST segment elevation acute coronary syndromes: A systematic review and meta-analysis of 182,798 patients

BackgroundPatients experiencing non-ST segment elevation acute-coronary-syndromes (NSTE-ACS) often present with multivessel-coronary-artery-disease (MVD). An immediate complete multivessel revascularization (MVR) - within the index hospitalization - may be considered the default therapeutic strategy, although its risk-to-benefit profile has not been definitively established through dedicated clinical trials. MethodsA systematic review and meta-analysis, adhering to MOOSE and PRISMA guidelines, was conducted to assess studies comparing immediate MVR versus a conservative culprit-only revascularization (COR) in NSTE-ACS with MVD. The main endpoints were all-cause death, major adverse cardiovascular events (MACE) and non-fatal myocardial infarction (MI). The incidence of any revascularization or further percutaneous-coronary-interventions (PCIs) were also collected. The primary analyses for the main endpoints were conducted on propensity-matched groups only. ResultsA total of 22 studies (182,798 patients) were identified. 7 studies, encompassing 11,372 patients, were included in the primary analysis of propensity score-matched groups. Immediate MVR significantly increased (28%) survival (OR 0.72, 95% CI 0.58–0.90, P < 0.01) along with a 35% reduction in MACE (OR 0.65, 95% CI 0.47–0.88, P = 0.01) and a 60% decrease in MI (OR 0.40, 95% CI 0.25–0.63, P < 0.01) during a mean 3-years follow-up compared to the propensity score-matched COR group. Results were consistent in the unmatched analyses. ConclusionsThis meta-analysis supports an immediate MVR for improving clinical outcomes in patients with NSTE-ACS and MVD as compared to a conservative immediate COR. These data prompt further evaluations regarding optimal strategies in the pursuit of MVR, including patient selection, revascularization modality, and assessment methods of revascularization completeness.

Prevalence and Predictors of Occlusive Myocardial Infarction in Patients Presenting With Non-ST-Elevation Acute Coronary Syndrome in Duhok, Iraq: A Cross-Sectional Study.

Background and aim Myocardial infarction is a major global health issue and the leading cause of death. Non-ST segment elevation acute coronary syndrome (NSTE-ACS) could behave like ST-segment elevation ACS in terms of causing total or near total occlusion of the coronary artery and leading to occlusive myocardial infarction (OMI). This study aims to assess OMI prevalence and associated factors in NSTE-ACS patients in Duhok, Iraq, to improve diagnosis and treatment outcomes. Materials and methods This prospective cross-sectional study, conducted at Azadi Heart Center and Zakho Teaching Hospital from March 2023 to March 2024, included 189 NSTE-ACS patients undergoing coronary angiography. Data collection encompassed demographics, clinical profiles, electrocardiographic (ECG) patterns, cardiac biomarkers, and angiographic outcomes. Patients were categorized into those with and without occlusive myocardial infarction (OMI). Results A total of 189 NSTE-ACS patients with a mean age of 58.65 (±10.38 SD) years were enrolled in the study. The overall OMI rate was 29.63%. OMI patients were older and had a higher prevalence of hypertension, dyslipidemia, and a family history of ischemic heart disease (IHD). Significant ECG changes associated with OMI included biphasic T-wave inversion and ST depression in specific leads. Marked elevation in troponin levels was also noted in OMI patients. The left anterior descending (LAD) artery was the most common culprit artery. Conclusions About one-quarter of our study cohort exhibited OMI. The condition was linked to clinical, ECG, and elevated troponin levels. The study underscores the importance of promptly recognizing occlusive myocardial infarction (OMI) in NSTE-ACS patients for better outcomes. Regular audits are imperative to augment awareness among healthcare professionals at cardiac centers regarding updated protocols and guidelines.

Diagnostic accuracy of point-of-care cardiac ultrasound for acute coronary syndromes in patients presenting with chest pain to the emergency department: a single-center prospective study.

The diagnostic accuracy of focused cardiac ultrasound (FoCUS) performed in patients presenting to the emergency department (ED) with chest pain is currently unknown. The objective of this study was to assess the diagnostic accuracy of regional wall motion abnormalities detected with FoCUS for non-ST-elevation acute coronary syndrome (NSTE-ACS) diagnosis. A Single-center prospective observational study conducted in 2022 in the ED of the University Hospital Careggi, Italy. Adult patients presenting to the ED with acute nontraumatic chest pain were enrolled, irrespective of the presence of previous regional wall motion abnormalities. Patients with ST-segment elevation myocardial infarctions and patients with hemodynamic instability were excluded. FoCUS was performed at presentation by a trained ED physician. The final diagnosis of NSTE-ACS vs. alternative diagnosis was adjudicated by an ED physician blinded to FoCUS results after a 30-day follow-up. To assess if regional wall motion abnormalities were an independent predictor of NSTE-ACS, a multivariable logistic regression model was built. Diagnostic performance measures were calculated. A sensitivity analysis considering only type-1 NSTEMIs (i.e. plaque rupture/thrombosis) was conducted. Among 686 patients, NSTE-ACS was adjudicated in 106 (15.5%) patients, 67 of which were NSTEMIs. A total of 87 (12.7%) patients had regional wall motion abnormalities detected by FoCUS, which were an independent predictor of NSTE-ACS in the multivariable logistic regression analysis. Regional wall motion abnormalities had a sensitivity of 42.5% (33.0-51.9), a specificity of 92.8% (90.6-94.9), a negative predictive value of 89.8% (87.4-92.2), and a positive predictive value of 51.7% (41.2-62.2), for NSTE-ACS. Results were consistent in the sensitivity analysis. In ED patients with chest pain and no ST elevation, the detection of regional wall motion abnormalities was a predictor of NSTE-ACS. Despite a high specificity, which indicated a possible role of FoCUS in the rule-in of NSTE-ACS, sensitivity was too low to allow a safe rule-out using FoCUS results alone.

Adaptability of prognostic prediction models for patients with acute coronary syndrome during the COVID-19 pandemic

BackgroundThe detrimental repercussions of the COVID-19 pandemic on the quality of care and clinical outcomes for patients with acute coronary syndrome (ACS) necessitate a rigorous re-evaluation of prognostic prediction models...

Safety and efficacy of PCSK9 inhibitor (evolocumab) in patients with non-ST segment elevation acute coronary syndrome and non-culprit artery critical lesions: a randomised controlled trial protocol (SPECIAL study)

IntroductionPatients with non-ST segment elevation acute coronary syndrome (NSTE-ACS) and concomitant multivessel coronary artery disease (CAD) are considered patients with extremely high-risk atherosclerotic cardiovascular disease (ASCVD), and current guidelines specify...

Simultaneous ST-elevation in lead augmented vector right (aVR) and III in non-ST-elevation acute coronary syndromes.

The value of ST-elevation in lead augmented vector right (aVR) remains controversial in clinical practice. This study aimed to investigate the association of simultaneous ST-elevation in lead aVR and III with angiographic findings and clinical outcomes in patients with non-ST-elevation acute coronary syndromes (NSTEACS). In this observational study, patients who had been diagnosed with NSTEACS and presented with ST-elevation in lead aVR and without ST-elevation in any other two contiguous leads were enrolled from January 2018 to June 2019. Demographic, baseline clinical, angiographic and interventional characteristics as well as clinical outcomes were collected and recorded on standardized case report forms. A total of 157 patients meeting the criteria were finally enrolled in this study and classified into two groups according to the presence of ST-elevation in lead III. Patients in the two groups were similar in average age and previous history of hypertension, diabetes mellitus, hyperlipidemia, chronic kidney disease, stroke, and peripheral vascular diseases (all P>0.05). Patients with ST-elevation in lead III tended to present with myocardial hypertrophy in the echocardiography (P=0.02). The cases with ST-elevation in lead III showed higher high sensitivity troponin T (hs-TnT; P=0.08) and creatinine kinase MB isoenzyme (CK-MB; P<0.01) whereas those without ST-elevation in lead III showed higher N-terminal pro brain natriuretic peptide (NT-proBNP; P=0.02). Of note, patients with ST-elevation in lead III presented with more ST-depression in multiple leads [especially in lead I, augmented vector left (aVL), V3-V6] as well as higher degree of ST-depression (all P<0.05) and were more likely to develop multi-vessel and left main trunk (LM) lesions (P=0.04), with 20% of the cases having a LM lesion and 60% having triple vessel lesions. Patients with ST-elevation in lead III were at increased risk of 3-year major adverse cardiovascular events (MACEs), despite no significant statistical difference between the two groups (hazard ratio =1.29; P=0.26). The NSTEACS cases with simultaneous ST-elevation in lead III and aVR tended to present with more multiple leads with ST-depression, higher degree of ST-depression, and more LM or multi-vessel lesions, suggesting a broader range of severe myocardial ischemia. The concurrent presentation of ST-elevation in lead III and aVR may play a vital role in the diagnosis, risk-stratification, and prediction of poor prognosis during the management of NSTEACS patients.