non-ST Elevation Acute Coronary Syndrome Research Articles

Wellens syndrome as an independent predictor of in-hospital cardiovascular complications

Introduction Wellens Syndrome was described for the first time in the eighties, as an equivalent pattern of a critical lesion of the anterior descending artery. Different risk factors have been associated with a worse prognosis during hospitalisation in patients with non-ST segment elevation acute coronary syndrome. However, it is unknown whether the presence of Wellens Syndrome alone contributes to an increase in in-hospital cardiovascular complications. Material and method Analytical prospective cohort study in 141 patients with the diagnosis of acute coronary syndrome without ST segment elevation who underwent coronary angiography between 2016 and 2020. Results Wellens syndrome was diagnosed in 64 patients with a mean age of 66.31 ± 12.54, of which 21 patients had a cardiac event during hospitalisation: hemodynamic complication 14 (21.9%), refractory or recurrent angina 4 (6.3%) and Acute myocardial infarction 3 (4.7%) confirming a relative risk (RR): 4.88 (95% confidence interval (CI) 1.92–12.45) p = 0.001. Conclusions The presence of Wellens Syndrome is independently associated with the appearance of cardiac complications during hospitalisation. Key points SW is now known to be a relatively frequent presentation of ACS, not addressed in depth in clinical practice guidelines for NSTEACS. This syndrome is generally caused by a severe ADA occlusion that, if not adequately treated, could evolve into a large infarction. According to the results of the different series published, the incidence of cardiovascular risk factors in SW is similar to other forms of presentation of ischaemic heart disease. At present, the exact relationship between the main cardiovascular risk factors and SW is unknown; in addition to the possible associations of this syndrome with in-hospital cardiovascular complications and its value as a predictor of the occurrence of cardiac complications, elements that are included in the results of the present study.

Balloon angioplasty for restenosis of coronary stents as a “bridge” to emergency coronary bypass grafting in non-ST segment elevation acute coronary syndrome

This case demonstrates the possibility of using balloon angioplasty in patients with non-ST segment elevation acute coronary syndrome and restenosis of previously implanted coronary stents as a measure to temporary stabilize coronary blood flow and the patient’s condition for preoperative preparation for subsequent emergency coronary bypass grafting.

A Combination of Heart Rate-Corrected QT Interval and GRACE Risk Score Better Predict Early Mortality in Patients with Non-ST Segment Elevation Acute Coronary Syndrome.

This study aimed to evaluate whether the addition of heart rate-corrected QT inter- val prolongation to the Global Registry of Acute Coronary Events risk score improves the pre- dictive value for early mortality in patients with non-ST segment elevation acute coronary syndrome. We retrospectively screened our database for consecutive non-ST-segment eleva- tion acute coronary syndrome patients between January 2017 and July 2019. The demographic and clinical parameters were acquired via chart review. All electrocardiograms were reviewed by 2 physicians. QT interval was measured using the tangent method. Early mortality was defined as all-cause death observed during the hospital stay or within 30 days after discharge. The final study population consisted of 283 patients, there were 17 early deaths. Ten of 59 patients with prolonged corrected QT intervals died (16.9%, P < .001). Both the Global Registry of Acute Coronary Events risk score (odds ratio: 1.032; 95% CI: 1.012-1.053; P = .002) and corrected QT interval (odds ratio: 1.026; 95% CI: 1.007-1.045; P = 0.007) independently predicted early mortality. The area under value was 0.769 (95% CI: 0.674-0.863, P < .001) for the corrected QT interval and 0.780 (95% CI:0.681-0.878; P < .001) for the Global Registry of Acute Coronary Events risk score alone. However, when the corrected QT interval and the Global Registry of Acute Coronary Events risk score were combined, it was found to be 0.808 (95% CI: 0.713-0.904, P < .001). This study is the first to report that prolonged corrected QT and the Global Registry of Acute Coronary Events risk score independently predict early mortality and a combina- tion of these 2 factors may improve the predictive value for early mortality in patients with ST-segment elevation acute coronary syndrome.

FREQUENCY OF ACUTE HEART FAILURE IN NON ST ELEVATION ACUTE CORONARY SYNDROME; CAN WE PREDICT THE HEART FAILURE ON CLINICAL AND ELECTROCARDIOGRAPHY (ECG) BASIS?

Objectives: Non-ST elevation acute coronary syndrome (NSTE-ACS) comprises NSTE myocardial infarction (NSTEMI) and unstable angina. A common complexity of NSTE-ACS is heart failure (HF). The objective of this study was to assess the incidence of in-hospital HF in NSTE-ACS patients and to link clinical and electrocardiographic (ECG) abnormalities to HF. Methodology: This study was performed at National Institute of Cardiovascular Diseases (NICVD) Karachi, from January 1, 2018 to June 30, 2018. The study included all adult patients who were hospitalized with a diagnosis of non-ST elevation ACS. Their socio demographic profile, clinical findings, ECG findings, and occurrence of heart failure during hospital stay was recorded. Data was entered and analyzed using SPSS v.23. Results: In this study 265 patients with NSTE-ACS were included. Mean age of 55.39±10.40 years was observed. There were 195 (73.6%) male patients. T-wave inversion was observed in 73 (27.5%) patients, ST-segment depression in 77 (29.1%), and both T-wave inversion and ST-segment depression in 71 (26.8%) patients. During their stay in the hospital, 28 patients (10.6 percent) developed HF. Diabetes, hypertension, smoking, a genetic susceptibility of ischemic heart disease, and combination of T-wave inversion and ST-segment depression on ECG was significantly correlated with HF (P≤0.05). Conclusion: The determinants of HF were diabetes, hypertension, smoking, family history of ischemic heart disease, and combination of T-wave inversion and ST depression on ECG.

Impact of multimorbidity on long-term outcomes in older adults with non-ST elevation acute coronary syndrome in the North East of England: a multi-centre cohort study of patients undergoing invasive care

ObjectivesOlder adults have a higher degree of multimorbidity, which may adversely affect longer term outcomes from non-ST elevation acute coronary syndrome (NSTE-ACS). We investigated the impact of multimorbidity on cardiovascular...

Diagnostic and prognostic significance of normal ECG in non-ST elevation acute coronary syndromes

Background: Admission electrocardiogram (ECG) give diagnostic data, prognostic information, and rapid risk evaluation for people who are suffering from acute coronary syndrome (ACS), in particular those who have had a myocardial infarction that does not include ST-segment elevation (NSTEMI). 1 Aim: In the context of non-ST elevation acute coronary syndrome, The significance of the admission ECG on the final prognosis is what we want to determine with this research. Methods: Observational study conducted at a single centre that involved the participation of 200 patients diagnosed with acute coronary syndromes that did not involve ST-elevation over the course of one year, with post-discharge clinical follow-up lasting for six months and a focus on the rates of all types of mortality as well as the rate of major unfavourable cardiovascular events. The population was divided into two groups based on the findings from the ECG that was performed upon admission. Patients who had normal ECG readings at the time of presentation were included in the Normal ECG Group, whereas patients who presented with abnormal ECGs are included in the Abnormal ECG Group.

The prediction role of TIMI score in correlation with coronary angiogram to determine the coronary artery disease severity and extent in patients presenting with Non-ST Elevation Acute Coronary Syndrome

Background: Accurate risk stratification in patient clinically presented as a case of Non-ST Elevation acute coronary syndrome (NSTE-ACS) is important to assess the prognosis as well as to estimate the possible adverse event especially in those patient who are at high risk. Of these scoring risk; Thrombolysis In Myocardial Infarction (TIMI) risk score have been well corroborated to predict the possible prognosis for patients with NSTE-ACS. However, their value in estimation the severity of coronary artery disease (CAD) has been less studied. Objective: To determine the role of TIMI score in prediction the severity of CAD and its extent by correlate the TIMI score with coronary angiography in patients have NSTE-ACS. Patients and Methods: A cross section study, conducted on 264 successive patients admitted with Non-ST Elevation acute coronary syndrome at Ibn-Albitar cardiac center, Baghdad, Iraq, from the 1st of October 2017 to the 1st of October 2018. Patients were rearranging into three groups according to the seven standard variables of TIMI score. The extent of CAD was examined on coronary angiography; a lesion defined significant if stenosis ≥70% in any artery of three major coronary arteries or ≥50% of left main coronary artery. Results: The total number of was 246 patients, mean age was 62.5±2.3 years. There were 67 (27.2%) of them belong to group 1 (low risk group), 142 (57.7%) of them belong to group 2 (intermediate risk group), and 37 (15.1%) of them belong to group 3 (high risk group). 54.1% of patients in group 3 had significant three-vessels coronary artery disease on comparing with 17.6% of group 2 patients and only 7.5% of group 1 patients had these lesions on coronary angiography (P-value &lt;0.01). On the other hand, one-vessel coronary artery disease occurs more commonly and significant statistically (P-value &lt;0.01) in group 2 (31.7%) than in patients in group 1 (26.9%) and group 3 (10.8%). Conclusion: High TIMI risk score patients were more probably to have significant multi-vessels coronary lesions in comparison with those with TIMI risk score in intermediate or low range which lead to help in stratify the risk and possibility of early intervention. Keywords: Coronary Angiography, Non-ST Elevation Acute Coronary Syndrome, Acute Coronary Syndrome risk stratification, TIMI score.

Cost-effectiveness of clopidogrel vs. ticagrelor in patients of 70 years or older with non-ST-elevation acute coronary syndrome.

The POPular AGE trial showed that clopidogrel significantly reduced bleeding risk compared with ticagrelor without any signs of an increase in thrombotic events. The aim of this analysis was to estimate the long-term cost-effectiveness of clopidogrel compared with ticagrelor in these patients aged 70 years or older with non-ST-elevation acute coronary syndrome (NSTE-ACS). A 1-year decision tree based on the POPular AGE trial in combination with a lifelong Markov model was developed to compare clopidogrel with ticagrelor in terms of clinical outcomes, costs, and quality-adjusted life years (QALYs) in elderly patients (above 70 year) with NSTE-ACS. Cost-effectiveness was assessed from a Dutch healthcare system perspective. Events rates and utility data observed in the POPular AGE trial were combined with lifetime projections to evaluate costs and effects for a fictional cohort of 1000 patients. Treatment with clopidogrel instead of ticagrelor led to a cost saving of €1484575 (€1485 per patient) and a decrease of 10.96 QALYs (0.011 QALY per patient) in the fictional cohort. In an alternative base case with equal distribution over health states in the first year, treatment with clopidogrel led to an increase in QALYs. In all scenario analyses, treatment with clopidogrel was cost-saving. Clopidogrel is a cost-saving alternative to ticagrelor in elderly patients after NSTE-ACS, though regarding overall cost-effectiveness clopidogrel was not superior to ticagrelor, as it resulted in a small negative effect on QALYs. However, based on the results of the alternative base case and clinical outcomes of the POPular AGE trial, clopidogrel could be a reasonable alternative to ticagrelor for elderly NSTE-ACS patients with a higher bleeding risk.

Association between Myocardial Performance Index (Tei- Index) and Severity of Coronary Artery Disease in Patients with Non-ST Segment Elevation Acute Coronary Syndrome

Background and objectives: Evaluation of ventricular systolic and diastolic functions is an essential part of echocardiographic evaluation in a patient of acute coronary syndrome (ACS). Myocardial Performance Index (MPI), also known as the Tei index, reflects both systolic and diastolic function of the left ventricle. The aim of this study was to see the association between myocardial performance index and severity of coronary artery diseases assessed by the gensini score (GS) in patients with non-ST segment elevation acute coronary syndrome. Methods: This cross-sectional study included a total 135 patients with NSTE ACS who underwent coronary angiography. MPI was measured using Pulse-Wave Doppler in all patients before coronary angiography. The patients were divided into three groups according to the Gensini score (GS); low GS &lt; 19 (n=23); mid GS ³19 and £96 (n= 76); high GS &gt; 96 (n=36) on CAG. Baseline characteristics, MPI parameters &amp; GS were then compared between the three groups. Results: MPI was obtained successfully in 135 patients. MPI parameter was significantly increased with increased GS. MPI was positively correlated with the GS (r = 0.40, p &lt; 0.001) Binary logistic regression analysis showed that MPI was strongly associated of severity of coronary artery disease assessed by GS (b = 3.766, p &lt; 0.001). Conclusion: Patients with NSTE-ACS with severe coronary artery disease may be identified by means of MPI measurement. Key words: Tei Index, Gensini Score, Non-ST Segment Elevation Acute Coronary Syndrome, Coronary Angiogram. Bangladesh Heart Journal 2022; 37(1): 16-26

Two-Dimensional Speckle Tracking Echocardiography as Predictor of Major Adverse Cardiac Events in Patients With Non–ST-Elevation Myocardial Infarction and Unstable Angina

INTRODUCTION: This study was conducted to determine the utility of two-dimensional speckle tracking echocardiography (2D STE) in predicting major adverse cardiac events (MACEs) in patients with non–ST-elevation acute coronary syndrome (NSTE-ACS). METHODOLOGY: This is a prospective cohort study that included 91 patients diagnosed to have NSTE-ACS. In-hospital and 6-month MACEs were evaluated in relation to their baseline echocardiographic parameters, 2D speckle strain, and strain rate analyses. RESULTS: Among the conventional echocardiographic parameters, only left ventricular end systolic diameter (LVESD) and wall motion scores showed significant difference between those with and without outcomes after 6 months. Significant higher wall motion scores (24.06 vs 20.91 P = 0.0320) and LVESD (3.36 vs 2.97 cm, P = 0.0125) were noted among those who had MACE after 6 months. There were no significant differences among the 2D STE strain and strain rate between those patients with and without MACE during their hospital admission. However, after 6-month follow-up, significantly lower mean left ventricular global longitudinal strain (GLS) −14.22% ± 4.45% vs −16.44% ± 4.19%, P = 0.0261) and strain rate (−0.69 ± 0.36 s-1 vs −0.94 ± 0.25 s-1, P = 0.009) were observed among patients with MACE compared with those without. Incidence of reduced GLS strain and strain rate was significantly higher in those with MACE after 6 months. Left ventricular GLS sensitivity and specificity were 64.64% and 61.70%, respectively, at a cutoff value of less than −15.0% for detecting MACE within 6 months. Left ventricular GLS cutoff point less than −12.0%, which detects severe LV dysfunction in previous studies, have a sensitivity of 40% but a high specificity of 82.98% for predicting MACE after 6 months. CONCLUSION: Both LV GLS strain and strain rate can be used to predict major adverse cardiovascular events after NSTE-ACS. KEYWORDS: speckle tracking echocardiography, non–ST-elevation acute coronary syndrome, cardiac events

EFFECT OF CHRONIC KIDNEY DISEASE ON PROGNOSIS OF PATIENTS WITH ACUTE CORONARY SYNDROME

Objective: Chronic kidney disease (CKD) is associated with worse prognosis in acute coronary syndromes (ACS). We sought to investigate the prognostic effect of conservative management of ACS in CKD patients in a tertiary University Hospital. Design and method: Two hundred and one patients (mean age 66.5 ± 13.6 years, 150 males) admitted to our Hospital with ACS from 2016–2017 were included in the study. CKD was defined by an estimated glomerular filtration rate (eGFR) &lt; 60 ml/min/m2, as assessed by the Modification of Diet in Renal Disease (MDRD) equation. We grouped patients into four groups according to their CKD status and whether they underwent coronary angiography or not. Patients were followed for a median of 2 years post the index event. The primary outcome was all-cause death and secondary outcomes were cardiovascular and non-cardiovascular death. Results: The majority of patients (n = 120, 60%) presented with non-ST elevation ACS (NSTE-ACS), whereas 81 patients as ST-elevation myocardial infarction (STEMI) (40%). 135 patients (68%) had history of hypertension. Fifty-four patients (27%) were identified as CKD patients. Overall, 29 patients (14.4%) did not undergo coronary angiography. Patients at a higher age and with CKD were more likely to not undergo angiography. Thirty-seven (18.4%) died during follow-up (25 non-cardiovascular deaths and 12 cardiovascular deaths). Patients with conservative treatment and CKD had the worse prognosis (Hazard ratio [HR] = 11.00, 95% Confidence intervals [CI] 4.00 to 30.24, p &lt; 0.001) followed by non-CKD patients with conservative treatment (HR = 4.37, 95% CI 1.20 to 15.90, p = 0.025) compared to non-CKD patients treated invasively (reference group) after adjusting for age, gender, STEMI/NSTE-ACS diagnosis. Results were similar for non-cardiovascular death, whereas regarding cardiovascular death only the group with CKD and conservative treatment had a lower survival compared to the reference group (HR = 26.5, 95% CI 2.9 to 241.7, p = 0.004) Conclusions: Patients with ACS and CKD have higher mortality from both cardiovascular and non-cardiovascular causes than patients without CKD. Regardless of CKD status, conservative management of ACS was associated with higher long-term mortality versus invasive management in all patients.

Gender Differences in Percutaneous Coronary Intervention Insights from the Coronary Angiography

Background: The data from the prior studies have reported inconsistencies in the comorbidity burden, and baseline risk profile. Objective: The data provide insights into the sex difference in percutaneous coronary interventions. Study design: It is a retrospective study with statistical approach, conducted in the Department of Cardiology, Rehman Medical Institute Peshawar. Material and Methods: The study was conducted from December 2021 to May 2022. The 400 patients visited the cardiology department of the hospital were included in the study. The selected patients were enrolled in the coronary angiography. The data was collected from cardiology department of two hospitals and analyzed. The ethical and review committee of the hospital approved the study. The informed consent was taken from the selected patients. The data contains demographic features, baselines characteristics, hospital complications and PCI course. The patients having residual stenosis of less than 50% after balloon angioplasty were included in the groups rated as successful PCI groups. Results: Out of 400 patients taken from two hospitals there were 50% female. The women included in the study were 5 years older than the male patients. Women were on average 67 years old and men were 72 years old. Women in general had more cases of coronary angiography, also women were reported with cases like diabetes mellitus, and some of the cases reported congestive heart failure. The success of the procedure was more successful in case of women with 95% of female patients receiving successful procedure. Conclusions: The overview of sex linked variations in PCI was observed in this study. The hospital mortality was found to be high in case of women, there was also not significant differences found between hospital mortalities for NSTE-2CS in case of cardiogenic problems Keywords: Percutaneous coronary interventions (PCI), coronary angiography, cardiogenic shock, Non-ST elevation acute coronary syndrome (NSTE-ACS) and myocardial infraction.

Valor predictivo de las alteraciones electrocardiográficas en la ocurrencia de complicaciones cardiovasculares en el síndrome coronario agudo sin elevación del segmento ST

IntroductionCardiovascular diseases cause approximately 18 million deaths annually, especially in developed or developing countries where life expectancy is usually higher. Material and methodProspective analytical cohort study in 598 patients diagnosed with non-ST segment elevation acute coronary syndrome who were admitted to a secondary level hospital between 2016 and 2020. ResultsST segment alteration was identified as a variable independent predictor of non-fatal cardiovascular complications with RR: 2.59 (95% CI: 1.64-4.10; p<.001) as well as haemodynamic complications, RR: 3.48 (95% CI: 2, 04-5.94, p<.001). In the particular case of patients with electrocardiographic abnormalities and cardiovascular complications, survival was significantly lower, HR: 3.01 (95% CI: 1.84-4.95; p<.001). ConclusionsAntecedent ST segment abnormalities were independent predictors of cardiovascular complications.

Five-year clinical outcomes in patients with frailty aged ≥75 years with non-ST elevation acute coronary syndrome undergoing invasive management.

AimFrailty is associated with adverse outcomes in older patients with acute coronary syndrome (ACS). The impact of frailty on long-term clinical outcomes following invasive management of non-ST elevation ACS (NSTEACS) is unknown.Methods and resultsThe multi-centre Improve Clinical Outcomes in high-risk patieNts with ACS 1 (ICON-1) prospective cohort study consisted of patients aged >75 years undergoing coronary angiography following NSTEACS. Patients were categorized by frailty assessed by Canadian Study of Health and Ageing Clinical Frailty Scale (CFS) and Fried criteria. The primary composite endpoint was all-cause mortality, unplanned revascularization, myocardial infarction, stroke, and bleeding. Of 263 patients, 33 (12.5%) were frail, 152 (57.8%) were pre-frail, and 78 (29.7%) were robust according to CFS. By Fried criteria, 70 patients (26.6%, mean age 82.1 years) were frail, 147 (55.9%, mean age 81.3 years) were pre-frail, and 46 (17.5%, mean age 79.9 years) were robust. The composite endpoint was more common at 5 years among patients with frailty according to CFS (frail: 22, 66.7%; pre-frail: 81, 53.3%; robust: 27, 34.6%, P = 0.003), with a similar trend when using Fried criteria (frail: 39, 55.7%; pre-frail: 72, 49.0%; robust: 16, 34.8%, P = 0.085). Frailty measured with both CFS and Fried criteria was associated with the primary endpoint [age and sex-adjusted hazard ratio (HR) compared with robust groups. CFS: 2.22, 95% confidence interval (CI) 1.23–4.02, P = 0.008; Fried: HR 1.81, 95% CI 1.00–3.27, P = 0.048].ConclusionIn older patients who underwent angiography following NSTEACS, frailty is associated with an increased risk of the primary composite endpoint at 5 years.Registration:Clinicaltrials.gov NCT01933581

Impact of Atrial Fibrillation and/or Flutter on in-Hospital Management and Outcomes in Non-ST Elevation Acute Coronary Syndromes

Abstract Funding Acknowledgements Type of funding sources: None. Background Atrial fibrillation is the most common arrhythmia in patients with acute coronary syndromes, and it is increasing in prevalence considering the aging of populations and the overlap of risk factors. It was reported by earlier studies that atrial fibrillation and/or flutter portend worse prognosis in patients with acute coronary syndromes. Yet there is no data from Iraq regarding impact of these arrhythmias on prognosis of patients with NSTE-ACS. Purpose This study aimed to evaluate the impact of pre-existing or new onset atrial fibrillation and/or flutter on in-hospital management and outcomes in an Iraqi cohort of patients with NSTE-ACS. Methods Patients with NSTE-ACS were prospectively included. GRACE risk score was calculated by the investigator with subsequent classification into low, intermediate and high GRACE risk class. Then the patients were classified into those who had pre-existing or new onset atrial fibrillation and/or atrial flutter (Patients with AF) group versus those with no atrial fibrillation nor atrial flutter (non-AF group). Results N=200, among whom AF was evident in 8.5%. Patients with AF were older (64.47±10.02 vs 58.22±11.79 years, p=0.025), they were females in 35.3% vs 29% in non-AF counterparts, p=0.58. There were no statistical differences between the two groups regarding presence of hypertension, diabetes, prior history of ischemic heart disease (IHD) nor family history of IHD, however, AF group were smokers in 11.8% vs 36.6% in non-AF group, p=0.039. Patients with AF reported dyspnoea at presentation in 47.1% vs 27.9%. Patients with AF were at high GRACE risk class at presentation in 76.5% vs 28.4% in non-AF group, p&amp;lt;0.001. Patients with AF were referred less for catheterisation during index hospitalisation compared to non-AF counterparts (35.3% vs 72.1%, p=0.002). There were no statistical differences between the two groups regarding days to catheterisation nor days of hospitalisation. There were no statistical differences between the two groups regarding developing in-hospital acute heart failure, cardiogenic shock, persistent ischemic chest pain, nor in-hospital ventricular life-threatening arrhythmia (VT, VF or Complete heart block), however, patients with AF developed higher in-hospital stroke (5.9% vs 0.5%, p=0.034) and higher in-hospital death (11.8% vs 1.6%, p=0.011). Conclusion Patients with NSTE-ACS and concurrent AF presented at higher risk class at presentation and higher in-hospital stroke and in-hospital death compared to patients with no AF, yet those patients were catheterised less frequently during index hospitalisation. Larger studies are needed to assess the impact of AF on longer term prognosis in the setting of NSTE-ACS. More attention should be paid for this high-risk category of NSTE-ACS patients with more emphasis on following evidence-based guidelines regarding decision and timing of catheterisation in order to improve their outcomes.

Electrocardiographic, echocardiographic and lipid parameters in predicting obstructive coronary artery disease in patients with non-ST elevation acute coronary syndrome

Aim. To assess the predictive potential of electrocardiographic (ECG), echocardiographic, and lipid parameters for predicting obstructive coronary artery disease (oCAD) in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) prior to invasive coronary angiography (CA).Material and methods. This prospective observational cohort study included 525 patients with NSTE-ACS with a median age of 62 years who underwent invasive coronary angiography. Two groups were distinguished, the first of which consisted of 351 (67%) patients with oCAD (stenosis 50%), and the second — 174 (33%) without oCAD (&lt;50%). Clinical and functional status of patients before CAG was assessed by 40 indicators. Mann-Whitney, Fisher, chi-squared, univariate logistic regression (LR) methods were used for data processing and analysis, while miltivariate LR (MLR), gradient boosting (XGBoost) and artificial neural networks (ANN) were used to develop predictive models. The quality of the models was assessed using 4 following metrics: area under the ROC curve (AUC), sensitivity (Se), specificity (Sp), and accuracy (Ac).Results. A comprehensive analysis of ECG, echocardiography and lipid profile parameters made it possible to identify factors that had linear and non-linear association with oCAD. LR were used to determine their weight coefficients and threshold values with the highest predictive potential. The quality metrics of the best predictive algorithm based on MLR were 0,81 for AUC, 0,74 for Sp and Ac, and 0,75 for Se. The predictors of this model were 4 categorical parameters (left ventricular (LV) ejection fraction of 42-60%, global LV longitudinal systolic strain &lt;19%, low-density lipoprotein cholesterol &gt;3,5 mmol/l, age &gt;55 years in men and &gt;65 years for women).Conclusion. The prognostic model developed on the basis of MLR made it possible to verify oCAD with high accuracy in patients with NSTE-ACS before invasive CA. Models based on XGBoost and ANN had less predictive value.

Timing of invasive strategy in non-ST-elevation acute coronary syndrome: a meta-analysis of randomized controlled trials.

AimsThe optimal timing of an invasive strategy (IS) in non-ST-elevation acute coronary syndrome (NSTE-ACS) is controversial. Recent randomized controlled trials (RCTs) and long-term follow-up data have yet to be included in a contemporary meta-analysis.Methods and resultsA systematic review of RCTs that compared an early IS vs. delayed IS for NSTE-ACS was conducted by searching MEDLINE, Embase, and Cochrane Central Register of Controlled Trials. A meta-analysis was performed by pooling relative risks (RRs) using a random-effects model. The primary outcome was all-cause mortality. Secondary outcomes included myocardial infarction (MI), recurrent ischaemia, admission for heart failure (HF), repeat re-vascularization, major bleeding, stroke, and length of hospital stay. This study was registered with PROSPERO (CRD42021246131). Seventeen RCTs with outcome data from 10 209 patients were included. No significant differences in risk for all-cause mortality [RR: 0.90, 95% confidence interval (CI): 0.78–1.04], MI (RR: 0.86, 95% CI: 0.63–1.16), admission for HF (RR: 0.66, 95% CI: 0.43–1.03), repeat re-vascularization (RR: 1.04, 95% CI: 0.88–1.23), major bleeding (RR: 0.86, 95% CI: 0.68–1.09), or stroke (RR: 0.95, 95% CI: 0.59–1.54) were observed. Recurrent ischaemia (RR: 0.57, 95% CI: 0.40–0.81) and length of stay (median difference: −22 h, 95% CI: −36.7 to −7.5 h) were reduced with an early IS.ConclusionIn all-comers with NSTE-ACS, an early IS does not reduce all-cause mortality, MI, admission for HF, repeat re-vascularization, or increase major bleeding or stroke when compared with a delayed IS. Risk of recurrent ischaemia and length of stay are significantly reduced with an early IS.

Clinical and angiographic characteristics and short-term outcomes of patients with non-ST elevation acute coronary syndrome with metabolic syndrome

Abstract Funding Acknowledgements Type of funding sources: None. Background Less evidence is available regarding clinical, angiographic characteristics and outcomes of patients with non-ST elevation acute coronary syndrome (ACS) with metabolic syndrome (MS). Purpose We aimed to assess the clinical, angiographic characteristics and short-term outcomes of patients admitted to our hospital with non-ST elevation ACS with MS. Methods 128 patients with non-ST elevation ACS were enrolled in the study (Aged 38-75 years; mean age 56.2±16.85 years; male 53%). Patients were divided into two groups according to concomitant metabolic syndrome. Group I consisted of 64 patients with MS and Group II (n=64) without MS. Anthropometric, laboratory and instrumental data were assessed at baseline together with clinical and angiographic characteristics. All statistical analysis were done with STATA software. Results Non-ST elevation ACS patients with MS (Group I) tended to be younger (52.5 vs. 58.6, P&amp;lt;0.05), female gender (57% vs. 46%, P&amp;lt;0.05), smoked less (21.0 vs. 28.2%, P&amp;lt;0.05), having greater BMI (30.4 vs 26.8, P&amp;lt;0.05), having less pronounced symptoms (P&amp;lt;0.05) and greater extensive lesions in coronary angiography (P&amp;lt;0.05) than those without MS. There were similar single-vessel (52% vs. 55%, P&amp;gt;0.05) and multi-vessel (28% vs 26%, P&amp;gt;0.05) lesions in both groups in coronary angiography. New revascularization was higher in Group I than Group II (72% vs. 65%, P&amp;lt;0.05). In 12% of patients non-ST elevation ACS was occurred due to vasospasm in Group I and in 11% in Group II. There were similar hospitalization days in both groups (P&amp;gt;0.05), however short-term outcomes was better in Group II in 6 months (P&amp;lt;0.05). Conclusion MS is associated with higher rate of revascularization and worse outcome in patients presenting non-ST elevation ACS.

Features of serum bilirubin in non ST elevation acute coronary syndrome

Abstract Funding Acknowledgements Type of funding sources: None. Background Even though, bilirubin is known to be an endogenous antioxidant, there is conflicting evidence whether level of serum bilirubin is associated with non-ST elevation acute coronary syndrome (NSTE ACS). Purpose We aimed to assess the possible impact of bilirubin level non-ST elevation acute coronary syndrome. Methods 128 patients with NSTEACS were enrolled in the study (Aged 38-75 years; mean age 56.2±16.85 years; male 53%). Patients were divided into two groups in terms of level of total bilirubin. Group I included 56 patients (total bilirubin was higher 19 mMol/L) and Group II 72 patients with NSTA ACS (total bilirubin was lower 19 mMol/L). Anthropometric, laboratory including serum total, direct, indirect bilirubin level and instrumental data were obtained at baseline while admission prior to percutaneous coronary intervention. Follow-up was conducted via telephone in six months. Statistical analysis were performed by STATA software. Results Patients presenting with NSTE ACS having high level of bilirubin tended to have more severe course of the disease (62% vs. 53%, P&amp;lt;0.05), high level of high sensitive troponin level (55ng/mL vs. 43 ng/mLK, P=0.001), multi-vessel disease (35% vs. 21%, P=0.001) and high rate of new revascularization (82% vs. 65%, P=0.001) than those ones with lower level of total bilirubin. Patients with high level of total bilirubin at admission with NSTE ACS had worse outcomes both in 1 month (1.24; 1.12-1.75; CI 95%; P&amp;lt;0.05) and 6 months follow-up period than those NSTE ACS patients with lower bilirubin level at admission (1.512; 1.24-1.95; CI 95%; P&amp;lt;0.05). Conclusion Total serum bilirubin level seems to be an independent predictor for severity of the disease and adverse outcomes in patients with NSTE ACS.

Analysis of adverse events in the elderly after acute myocardial infarction with reduced left ventricular ejection fraction

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Contract (CM19/00055) supported by the Instituto de Salud Carlos III in Spain (Co-funded by European Social Fund "Investing in your future"). Background Elderly patients present higher risk for developing complications after an acute myocardial infarction (AMI) and reduced left ventricular ejection fraction (rLVEF) constitutes an adverse prognostic factor. Purpose The main objective was to characterize elderly population with AMI and rLVEF and analyze prognostic factors. Methods Retrospective analysis of hospitalized elderly patients (&amp;gt; 75 years old) with AMI and rLVEF &amp;lt;40% between January 2018 and December 2019. We analyze the occurrence of adverse outcomes in the follow-up: combined event (death from any cause and/or hospitalization from heart failure (HF) and/or AMI and/or ventricular arrhythmias) and its relationship with different variables (Figure 1). Results Out of 179 patients, 100 &amp;gt;75 years old patients (55.9%) were included (Figure 1). After a mean follow-up of 3.8 [18.4] months, the combined event happened in 52% of them (figure 1, figure 2). Older age was associated with the combined event (86.8+8 years occurrence of event vs. 82.6+5.1 event-free, p=0.003). Variables significantly related with the occurrence of the combined event were chronic kidney disease (CKD) (72.7% occurrence of event vs. 46.2% event-free, p=0.032), higher values of creatinine (1.6+1 vs. 1.1+0.3, p=0.002), the presentation with acute pulmonary oedema (APO) (91.7% vs. 39.5%, p&amp;lt;0.001) and cardiogenic shock (93.2% vs. 41%, p&amp;lt;0.001), the need for noradrenaline (92.9% vs. 45.3%, p=0.001) and dobutamine (100% vs. 46.7%, p=0.001), the revascularization (completely percutaneous 43.5% of combined event, partial percutaneous 41.4%, partial surgical 100%, absence of revascularization 78.6%, p=0.034) and the presence of associated severe valvular disease (84.6% vs. 42%, p&amp;lt;0.001). We observed a trend although not statistically significant, to present higher values of NT-proBNP at the admission (16850 vs. 9044, p=0.71) and the initial presentation of non-ST elevation-acute coronary syndrome (NSTE-ACS) (28.6% of event in ST segment elevation myocardial infarction (STEMI) vs. 58.6% in NSTE-ACS, p=0.088) in patients who suffered the combined event in the follow-up. Conclusions More than half the patients with 75 years old or higher presented adverse outcomes in the short term after a hospitalization for AMI with rLVEF. The most advanced age, the presentation as APO or cardiogenic shock, CKD, absence of revascularization, need for drugs and the presence of concomitant severe valvular disease were related with the appearance of the combined event (death, HF, AMI, ventricular arrhythmias).