non-ST Elevation Myocardial Infarction Research Articles

The Relationship Between the Modified Glasgow Prognostic and SYNTAX Scores in Patients with Non-ST Elevation Myocardial Infarction.

This study investigated the modified Glasgow prognostic score (mGPS) to determine its predictive value and how it could be compared with various inflammatory markers, including C-reactive protein (CRP) to albumin ratio and neutrophil-to-lymphocyte ratio, for determining the extent and severity of coronary artery disease (CAD) in patients with non-ST-elevated myocardial infarction (NSTEMI). This study analyzed the cases of 295 patients with NSTEMI who had undergone coronary angiography. In an effort to determine the seriousness and scope of CAD in each patient, the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score was calculated and then assessed. The study sample was divided into two separate groups based on the SYNTAX score: moderate to high SYNTAX (>22) and low SYNTAX (≤22). There were 295 patients (23.1% female, 76.9% male) included in the research, with an average age being 61.2±10.9 years, and the mean SYNTAX score being 7.3±10.4 (range: 0-40). Those with a SYNTAX score >22 were observed to possess significantly higher levels of CRP, CRP/albumin ratio, and mean mGPS 1-2 ratios compared with those with a SYNTAX score ≤22 (all p<0.001). Smoking [odds ratio (OR): 3.341, 95% confidence interval (CI): 1.531-7.294; p=0.002], CRP/albumin ratio (OR: 4.958, 95% CI: 1.335-18.418; p=0.017), and mGPS score of 1-2 (OR: 3.121, 95% CI: 1.430-6.814; p=0.004) were independent factors used to help predict a high SYNTAX score. It seems possible to make use of the mGPS when estimating the degree and intricacies of CAD in patients with NSTEMI, as there appears to be a connection with higher SYNTAX scores.

Coagulation disorders in myocardial infarction with nonobstructive coronary arteries

Aim. To investigate the state of the platelet and plasma components of hemostasis in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA).Material and methods. The study included 42 patients with non-ST-segment elevation myocardial infarction (NSTEMI): MINOCA (n=24) and MI-CAD (n=18). Platelet aggregation ability in response to activation was evaluated using Solar AP2110 and LASCA aggregometers. Platelet functional activity and calcium signaling were assessed using flow cytometry methods. The plasma component of hemostasis, in addition to routine coagulation tests was evaluated using the global coagulation test "Thrombodynamics". The control groups for tests consisted of healthy volunteers.Results. When analyzing the ability of platelets to form aggregates by the aggregometry tests, it was found that platelets in the MINOCA group formed aggregates significantly worse upon ADP stimulation at various concentrations compared to the MI-CAD group. However, when platelets were stimulated with collagen, the opposite effect was observed: in the MI-CAD group, there was a noticeable decrease in aggregate formation in terms of light scattering amplitude compared to the MINOCA group. Flow cytometry using the functional platelet activity test protocol revealed that both groups showed a significantly increased platelet size after activation, reduced platelet granularity) both at rest and upon activation, significantly decreased number of procoagulant phosphatidylserine-positive platelets, and reduced dense granule release upon activation compared to healthy volunteers. The calcium signaling test showed a weakened calcium release in response to ADP in the MINOCA group compared to the MI-CAD group. In the study of the plasma component, no significant differences between the groups or deviations were found according to both routine tests and the "Thrombodynamics" test.Conclusion. Platelet activity did not differ significantly between the MINOCA and MI-CAD groups; however, in the MINOCA group, platelet activity was lower in some tests compared to the MI-CAD group. In the study of the plasma hemostasis component, normocoagulation was recorded in both groups.

A Study of Tpeak-Tend/QT Interval Ratio in Predicting Heart Failure in ST-Elevation Myocardial Infarction and Its Correlation With N-terminal Pro B-type Natriuretic Peptide (NT-proBNP).

Background Acute ST-elevation myocardial infarction (STEMI) is the most common cause of mortality across the world. The electrocardiogram (ECG) Tpeak-Tend/QT interval appears to be a measure of the left ventricle's transmural dispersion of repolarization (TDR). Prolongation of this time could indicate adverse cardiac events like heart failure, arrhythmias, etc. Heart failure is a clinical syndrome that includes signs and symptoms such as peripheral edema and high jugular vein pressure. N-terminal pro B-type natriuretic peptide (NT-proBNP) is an effective predictor of left ventricular function and also helps in predicting the disease prognosis. Elevated levels of NT-proBNP are seen in many cases of left ventricular dysfunction. This study aims to evaluate the predictive utility of the Tpeak-Tend/QT interval ratio in predicting major adverse cardiac events (MACEs), such as heart failure, by examining the Tend/QT interval ratio values with NT-proBNP in STEMI. Methodology This cross-sectional study was conducted at a tertiary hospital between April 2024 and June 2024. It included STEMI patients, excluding those with non-STEMI (NSTEMI), valvular heart diseases, bundle branch block, or pacemakers. The patients with a Tpeak-Tend/QT ratio < 0.3 were included in group A, and the Tpeak-Tend/QT ratio > 0.3 in group B. They were monitored for MACE-like heart failure during hospitalization and were compared with a study of the Tpeak-Tend/QT interval ratio in predicting heart failure in STEMI and its correlation with NT-proBNP levels. Results In this study, out of 45 patients, male predominance was observed, with 35 (78%) being men and 10 (22%) being women. In group A, the most common age group was 60-70 years, with 16 (51%) patients; in Group B, it was 50-60 years, with six (42.8%) patients. Out of 31 patients in group A, 25 were male, and six were female. In group B, out of 14 patients, 10 were male, and four were female. In this study, out of the 45 patients included, 12 (85%) among 14 patients who had MACEs like heart failure had a Tpeak-Tend/QT interval ratio of more than 0.3, and their measured NT-proBNP levels were also more than 900 pg/mL, thus showing a statistically significant association between Tpeak-Tend/QT interval ratio and NT-proBNP. Conclusion The present study showed an increased Tpeak-Tend/QT interval ratio and NT-proBNP in patients who developed heart failure in STEMI. As ECG is a readily available and affordable tool, the Tpeak-Tend/QT interval ratio can be used along with conventional markers like NT-proBNP to predict MACE in patients with STEMI.

Geriatric conditions and invasive management in frail patients with NSTEMI. A subgroup analysis of a randomized clinical trial

Introduction and objectivesInvasive management in frail patients with non–ST-segment elevation myocardial infarction (NSTEMI) remains controversial. We investigated the impact of various geriatric conditions. MethodsThe MOSCA-FRAIL trial included 167 adults aged ≥ 70 years with frailty (Clinical Frailty Scale [CFS] ≥ 4 points) and NSTEMI, who were randomized to either an invasive (n=84) or conservative (n=83) strategy. In addition to frailty, we measured activities of daily living (Barthel index), cognitive impairment (Pfeiffer test), and comorbidities (Charlson index). The primary endpoint was the difference (invasive minus conservative) in restricted mean survival time (RMST) for all-cause mortality at a median follow-up of 3.9 years. ResultsA total of 93 patients died. The RMST difference favored invasive management at the CFS 25th percentile (CFS=4; 157 days, 95%CI, 18-295; P=.027), which changed to a nonsignificant effect at the 50th and 75th percentiles. The RMST difference remained nonsignificant, irrespective of the severity of other geriatric assessments. In time-to-event analysis, invasive management was associated with an initially lower life expectancy, peaking at around 1 year, among all subgroups. However, patients with CFS=4 experienced a benefit at the end of follow-up (181 days, 95%CI, 19-343), whereas those with CFS >4 did not (−16 days, 95%CI, −217 to 186; interaction P=.16). Subgroups defined by other geriatric markers showed a similar time-dependent trend, albeit with weaker statistical interaction. ConclusionsAmong adults with frailty and NSTEMI, the CFS might be useful for evaluating the relative risks and benefits of invasive management. A CFS >4 could serve as a valuable threshold for decision-making.

Association Between Low Serum HDL Levels and Severity of Coronary Artery Disease Among Patients with Non-ST Elevated Myocardial Infarction

Introduction: Coronary artery disease is one of the leading causes of non-communicable diseases related deaths worldwide. Decreased serum high-density lipoprotein level are associated with an increased severity of coronary artery disease. Present study aims to evaluate the association between this low HDL level and the severity of coronary artery disease assessed by SYNTAX Score in patients with non-ST elevation Myocardial infarction. Materials &amp; Methods: This was a cross sectional study conducted in the Department of Cardiology at National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh, from May 2020 to April 2021, on 170 admitted adult patients of non-ST elevated myocardial infarction undergoing coronary angiogram. Study population was divided in two groups; Group-I: Respondents with HDL level ≥ 40 mg/dl, Group-II: Respondents with HDL level &lt; 40 mg/dl. Transthoracic echocardiography was done before coronary angiography. All coronary lesions with diameter stenosis &gt; 50% in vessels &gt; 1.5 mm was scored, using the SYNTAX algorithm. A low score was defined as ≤ 22, an intermediate score as 23 to 32, and a high score as ≥ 33. To determine statistical significance, Chi-square test and independent sample t-test were considered according to applicability. P value of &lt; 0.05 was considered statistically significant. Results: Highest proportion of respondents were from age group 51 – 60 years, 48.2% and 43.5% for group-I and group-II respectively. Study population was male predominant, 88.2% among patients from group-I and 83.5% among patients from group-II. Smoking was the most prevalent risk factor for group-I patients at 58.8%. Hypertension was the most prevalent risk factor for group-II patients at 45.9%. Mean total cholesterol, low-density lipoprotein and high-density lipoprotein were higher among patients from group-I than group-II and these differences were statistically significant (p &lt; 0.05). Mean triglycerides was higher among patients from group-II than group-I and this difference was statistically significant (p &lt; 0.05). Triple vessel was more prevalent (36.5% vs 22.4%) among patients from group-II than group-I and this difference was statistically significant (p &lt; 0.05). Mean SYNTAX score (SS) was higher among patients from group-II than group-I, 17.4 ± 8.6 and 11.5 ± 8.4 respectively, and this difference was statistically significant (p &lt; 0.05). There was strong negative correlation between HDL level and Syntax score (r = - 0.299, p &lt; 0.05). Conclusion: Present study demonstrated significant negative correlation between low serum HDL levels with severity of coronary artery disease among patients with non-ST elevated myocardial infarction. Serum HDL levels can be used as a predictor for the severity of coronary artery disease among such patients. Bangladesh Heart Journal 2024; 39(2): 138-143

Timing of percutaneous coronary intervention and risk of new-onset acute ischemic stroke in non-ST elevation myocardial infarction: A retrospective cohort study insight into the National Inpatient Sample Database (2016-2019).

For patients with high-risk non-ST elevation myocardial infarction (NSTEMI), current guidelines recommend an early invasive strategy within 24 h. New-onset acute ischemic stroke (NAIS) is a rare but fatal complication of percutaneous coronary intervention (PCI). However, the effect of the timing of PCI and the risk of NAIS in NSTEMI is poorly defined. Patients with NSTEMI who underwent PCI were queried from the National Inpatient Sample Database (2016-2019) and stratified into three groups: early (<24 h), medium (24-72 h), and late (>72 h) PCI. Multivariate logistic regression models were used to determine the association between timing of PCI and NAIS. Among 633,115 weighted hospitalizations, patients in the late PCI group had a higher incidence of NAIS (1.3%) than those in the early (0.67%) and medium (0.71%) PCI groups. Patients undergoing late PCI were older, more likely to be female, and had a greater incidence of comorbidities (e.g., diabetes mellitus, chronic pulmonary and renal illness, and atrial fibrillation) than those undergoing early or medium PCI. After adjustment, only late PCI was significantly associated with a 54% increased NAIS risk (adjusted odds ratio: 1.54 [95% confidence interval: 1.29-1.84]). Additionally, there was heterogeneity in the magnitude of risk by age and sex. Younger people (<65 years) (p for interaction <0.001) and men (interaction-value p = 0.040) were more likely to encounter NAIS. Late PCI was associated with a higher risk of NAIS than early PCI, particularly among men and those aged <65 years.

Short-Term Effects of Lower Air Temperature and Cold Spells on Myocardial Infarction Hospitalizations in Sweden

BackgroundLower air temperature and cold spells have been associated with an increased risk of various diseases. However, the short-term effect of lower air temperature and cold spells on myocardial infarction (MI) remains incompletely understood. ObjectivesThe purpose of this study was to investigate the short-term effects of lower air temperature and cold spells on the risk of hospitalization for MI in Sweden. MethodsThis population-based nationwide study included 120,380 MI cases admitted to hospitals in Sweden during the cold season (October to March) from 2005 to 2019. Daily mean air temperature (1 km2 resolution) was estimated using machine learning, and percentiles of daily temperatures experienced by individuals in the same municipality were used as individual exposure indicators to account for potential geographic adaptation. Cold spells were defined as periods of at least 2 consecutive days with a daily mean temperature below the 10th percentile of the temperature distribution for each municipality. A time-stratified case-crossover design incorporating conditional logistic regression models with distributed lag nonlinear models using lag 0 to 1 (immediate) and 2 to 6 days (delayed) was used to evaluate the short-term effects of lower air temperature and cold spells on total MI, non–ST-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI). ResultsA decrease of 1-U in percentile temperature at a lag of 2 to 6 days was significantly associated with increased risks of total MI, NSTEMI, and STEMI, with ORs of 1.099 (95% CI: 1.057-1.142), 1.110 (95% CI: 1.060-1.164), and 1.076 (95% CI: 1.004-1.153), respectively. Additionally, cold spells at a lag of 2 to 6 days were significantly associated with increased risks for total MI, NSTEMI, and STEMI, with ORs of 1.077 (95% CI: 1.037-1.120), 1.069 (95% CI: 1.020-1.119), and 1.095 (95% CI: 1.023-1.172), respectively. Conversely, lower air temperature and cold spells at a lag of 0 to 1 days were associated with decreased risks for MI. ConclusionsThis nationwide case-crossover study reveals that short-term exposures to lower air temperature and cold spells are associated with an increased risk of hospitalization for MI at lag 2 to 6 days.

Inpatient outcomes of NSTEMI among patients with immune thrombocytopenia: a propensity matched national study.

Patients with immune thrombocytopenia (ITP) admitted for non-ST elevation myocardial infarction (NSTEMI) present a unique therapeutic challenge due to the increased risk of bleeding with antiplatelet and anticoagulation therapies. There is limited evidence studying hospital mortality and complications in this population. The study included a patient cohort from the 2018-2021 National Inpatient Sample database. Propensity score matched NSTEMI patients with and without ITP using a 1:1 matching ratio. Outcomes analyzed were in-hospital mortality, rates of diagnostic angiogram, percutaneous coronary intervention (PCI), acute kidney injury (AKI), congestive heart failure (CHF), cardiogenic shock, cardiac arrest, mechanical ventilation, tracheal intubation, ventricular tachycardia (VT), ventricular fibrillation (VF), major bleeding, need for blood and platelet transfusion, length of stay (LOS), and total hospitalization charges. A total of 1,699,020 patients met inclusion criteria (660,490 females [39%], predominantly Caucasian 1,198,415 (70.5%); mean [SD] age 67, [3.1], including 2,615 (0.1%) patients with ITP. Following the propensity matching, 1,020 NSTEMI patients with and without ITP were matched. ITP patients had higher rates of inpatient mortality (aOR 1.98, 95% CI 1.11-3.50, p 0.02), cardiogenic shock, AKI, mechanical ventilation, tracheal intubation, red blood cells and platelet transfusions, longer LOS, and higher total hospitalization charges. The rates of diagnostic angiogram, PCI, CHF, VT, VF, and major bleeding were not different between the two groups. Patients with ITP demonstrated higher odds of in-hospital mortality for NSTEMI and need for platelet transfusion with no difference in rates of diagnostic angiogram or PCI.

Invasive Treatment Strategy for Older Patients with Myocardial Infarction

BackgroundWhether a conservative strategy of medical therapy alone or a strategy of medical therapy plus invasive treatment is more beneficial in older adults with non–ST-segment elevation myocardial infarction (NSTEMI) remains unclear.MethodsWe conducted a prospective, multicenter, randomized trial involving patients 75 years of age or older with NSTEMI at 48 sites in the United Kingdom. The patients were assigned in a 1:1 ratio to a conservative strategy of the best available medical therapy or an invasive strategy of coronary angiography and revascularization plus the best available medical therapy. Patients who were frail or had a high burden of coexisting conditions were eligible. The primary outcome was a composite of death from cardiovascular causes (cardiovascular death) or nonfatal myocardial infarction assessed in a time-to-event analysis.ResultsA total of 1518 patients underwent randomization; 753 patients were assigned to the invasive-strategy group and 765 to the conservative-strategy group. The mean age of the patients was 82 years, 45% were women, and 32% were frail. A primary-outcome event occurred in 193 patients (25.6%) in the invasive-strategy group and 201 patients (26.3%) in the conservative-strategy group (hazard ratio, 0.94; 95% confidence interval [CI], 0.77 to 1.14; P=0.53) over a median follow-up of 4.1 years. Cardiovascular death occurred in 15.8% of the patients in the invasive-strategy group and 14.2% of the patients in the conservative-strategy group (hazard ratio, 1.11; 95% CI, 0.86 to 1.44). Nonfatal myocardial infarction occurred in 11.7% in the invasive-strategy group and 15.0% in the conservative-strategy group (hazard ratio, 0.75; 95% CI, 0.57 to 0.99). Procedural complications occurred in less than 1% of the patients.ConclusionsIn older adults with NSTEMI, an invasive strategy did not result in a significantly lower risk of cardiovascular death or nonfatal myocardial infarction (the composite primary outcome) than a conservative strategy over a median follow-up of 4.1 years. (Funded by the British Heart Foundation; BHF SENIOR-RITA ISRCTN Registry number, ISRCTN11343602.)

Clinical and Angiographic Profile of Non-ST Elevation Myocardial Infarction Patients with Multivessel Disease: A Study in a Tertiary Care Hospital in Bangladesh

Background: Non-ST elevation myocardial infarction (NSTEMI) is a type of acute coronary syndrome without ST-segment elevation on electrocardiography. Many non-ST elevation myocardial infarction patients have multivessel disease, which leads to worse outcomes compared to single-vessel disease. Their clinical and angiographic profiles provide valuable insightf into the nature, severity, and treatment of this common cardiac condition. This study aimed to evaluate the clinical and angiographic profiles of non-ST elevation myocardial infarction patients with multivessel disease. Methods: This prospective study was conducted in the Department of Cardiology, National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh from September 2022 to August 2023. The study enrolled 270 consecutive patients with NSTEMI. Coronary angiography and electrocardiogram were used in assessing the disease condition. The data were analyzed using SPSS version 23.0. Results: The mean age of total participants was 54.31 ±10.54 years and most of them were male (77.8%). Majority of the patients had hypertension (68.1%), diabetes mellitus (59.3%), and dyslipidemia (58.5%). In the clinical assessment, 89.6% of patients had femoral access, 31.1% had a bifurcation lesion, 8.1% showed calcification, and 22.6% had a left main lesion. Stents were used in 41.9% of cases, with a mean total stent length of 55.8 ±26.9 mm. The mean left ventricular ejection fraction was 49.10 ±7.3%. Among the major culprit vessel involvements identified, 6% involved the left main (LM) artery, 56% involved the left anterior descending (LAD) artery, 34% involved the left circumflex (LCX) artery, and 39% involved the right coronary artery (RCA). Regarding the final angiographic findings among the total participants, double vessel disease (DVD) was observed in 40% of cases, while triple vessel disease was observed in 60% of cases. Conclusion: The increased prevalence of triple vessel disease among non-ST elevation myocardial infarction patients underscores the importance of heightened vigilance among healthcare providers and policymakers. Understanding the clinical and angiographic profiles of these patients is essential for effective management strategies.

Systemic immune-inflammation index, and neutrophilto-lymphocyte and platelet-to-lymphocyte ratios can predict clinical outcomes in patients with acute coronary syndrome.

Inflammatory mechanisms play an important role in the pathogenesis of atherosclerosis and myocardial infarction. The clinical and prognostic importance of inflammatory parameters, such as neutrophil-lymphocyte (NLR) and platelet-lymphocyte ratios (PLR) in complete blood counts in acute myocardial infarction and other cardiovascular diseases has been demonstrated. However, systemic immune-inflammation index (SII) calculated from neutrophils, lymphocytes and platelets in the complete blood cell count has not been studied sufficiently and is thought to provide a better prediction. This study investigated whether haematological parameters such as SII, NLR and PLR were associated with clinical outcomes in acute coronary syndrome (ACS) patients. We included 1 103 patients who underwent coronary angiography for ACS between January 2017 and December 2021. The association between major adverse cardiac events (MACE) that developed in hospital and at 50 months of follow up and SII, NLR and PLR was compared. Long-term MACE were defined as mortality, re-infarction and target-vessel revascularisation. SII was calculated using the formula: NLR × total platelet count in the peripheral blood (per mm3). Of the 1 103 patients, 403 were diagnosed with ST-elevation myocardial infarction and 700 with non-STelevation myocardial infarction. The patients were divided into a MACE and a non-MACE group. In hospital and during the 50-month follow up, 195 MACE were observed. SII, PLR and NLR were found to be statistically significantly higher in the MACE group (p < 0.001). SII, C-reactive protein level, age and white blood cell count were independent predictors of MACE in ACS patients. SII was found to be a strong independent predictor of poor outcomes in ACS patients. This predictive power was greater than that of PLR and NLR.

Complete vs Culprit-Only Revascularization in Older Patients With Myocardial Infarction With or Without ST-Segment Elevation

BackgroundThe effectiveness of complete revascularization is well established in patients with ST-segment elevation myocardial infarction (STEMI), but it is less investigated in those with non–ST-segment elevation myocardial infarction (NSTEMI). ObjectivesThis study aimed to assess whether complete revascularization, compared with culprit-only revascularization, was associated with consistent outcomes in older patients with STEMI and NSTEMI. MethodsIn the FIRE (Functional Assessment in Elderly MI Patients with Multivessel Disease) trial, 1,445 older patients with myocardial infarction (MI) were randomized to culprit-only or physiology-guided complete revascularization, stratified by STEMI (n = 256 culprit-only vs n = 253 complete) and NSTEMI (n = 469 culprit-only vs n = 467 complete). The primary outcome comprised a composite of death, MI, stroke, or revascularization at 1 year. The key secondary outcome included a composite of cardiovascular death or MI at 1 year. ResultsIn the overall study population, physiology-guided complete revascularization reduced both primary and key secondary outcomes. The primary outcome occurred in 54 (21.1%) STEMI patients randomized to culprit-only vs 41 (16.2%) STEMI patients of the complete group (HR: 0.75; 95% CI: 0.50-1.13) and in 98 (20.9%) NSTEMI patients randomized to culprit-only vs 72 (15.4%) NSTEMI patients of the complete group (HR: 0.71; 95% CI: 0.53-0.97), with negative interaction testing (P for interaction, 0.846). Similarly, no signal of heterogeneity with respect to the initial clinical presentation was observed for the key secondary endpoint (P for interaction, 0.654). ConclusionsPhysiology-guided complete revascularization, compared with culprit-only revascularization, provided consistent benefit across the whole spectrum of patients with MI. (FIRE [Functional Assessment in Elderly MI Patients With Multivessel Disease]; NCT03772743)

Optimal timing of revascularization for patients with non-ST segment elevation myocardial infarction and severe left ventricular dysfunction.

Optimal timing of revascularization for patients who presented with non-ST segment elevation myocardial infarction (NSTEMI) and severe left ventricular (LV) dysfunction is unclear. A total of 386 NSTEMI patients with severe LV dysfunction from the nationwide, multicenter, and prospective Korea Acute Myocardial Infarction Registry V (KAMIR-V) were enrolled. Severe LV dysfunction was defined as LV ejection fraction ≤ 35%. Patients with cardiogenic shock were excluded. Patients were stratified into two groups: PCI within 24 hours (early invasive group) and PCI over 24 hours (selective invasive group). Primary endpoint was major adverse cardiac and cerebrovascular events (MACCE) including all-cause death, non-fatal MI, repeat revascularization, and stroke at 12 months after index procedure. Early invasive group showed higher incidence of in-hospital death (9.4% vs 3.3%, P = .036) and cardiogenic shock (11.5% vs 4.6%, P = .030) after PCI. Early invasive group also showed higher maximum troponin I level during admission (27.7 ± 44.8 ng/mL vs 14.9 ± 24.6 ng/mL, P = .001), compared with the selective invasive group. Early invasive group had an increased risk of 12-month MACCE, compared with selective invasive group (25.6% vs 17.1%; adjusted HR = 2.10, 95% CI 1.17-3.77, P = .006). Among NSTEMI patients with severe LV dysfunction, the early invasive strategy did not improve the clinical outcomes. This data supports that an individualized approach may benefit high-risk NSTEMI patients rather than a routine invasive approach.

Serum Magnesium level with SOFA score in predicting the Prognosis among Acute Coronary Syndrome patients and its associated complications in tertiary care centre

Introduction: Magnesium is an essential element in functioning human body. Low magnesium is associated with membrane destabilization, whereas high concentrations are membrane stabilizing and therefore, antiarrhythmic. Acute coronary syndrome comprises of ST segment elevated myocardial infarction (STEMI), non-ST segment elevated myocardial infarction (NSTEMI) and unstable angina where the blood flow to the heart is decreased. Magnesium plays important role in Sepsis and attributed to its effects on Immune System. Hypomagnesemia is commonly observed in patients admitted to Intensive Care Unit Aim: To find the prevalence of Serum Magnesium levels with SOFA score in assessing the prognosis in Acute Coronary Syndrome patients and its associated complications. Methodology: This is hospital-based cross-sectional study. The sample size was calculated to be 77. All patients of age more than 18 years who are diagnosed to have Acute Coronary Syndromes were included in this study after screening for the exclusion criteria. After written consent, all patients were subjected into study. Clinical presentation and demographic profile and lab parameters were assessed. Results: In this study of 77 patients the mean age was 60 ± 10.8; age group between 51-70 had highest proportion of 57%. About 71.40% are male, while 29% are female. Chest pain observed in 100% of patients while palpitation seen in 98.7%. Highest proportion of comorbidity seen in Type 2 Diabetes 90%, followed by Systemic Hypertension at 64%. The majority of patients across most variables fall into the Normomagnesemia category. The differences in distribution of age, gender, comorbidities, Troponin I status, and ECG changes &amp; SOFA score across the magnesium levels categories are not statistically significant, as indicated by the P values being greater than 0.05. These patients did not develop any arrhythmic complications. Conclusion: This study showed no significant relationship between the Serum Magnesium and SOFA score and good prognosis among patients with acute coronary syndrome. However, further studies are required to increase the understanding of the association between Serum Magnesium and SOFA score in various study settings to diagnose the patient earlier and take necessary preventive measures and treatment to prevent the occurrence of complications. Keywords: Acute coronary syndrome, Serum Magnesium, SOFA score, Normomagnesemia

A Study on relationship between Red Cell Distribution Width and HighDensity Lipoprotein-Cholesterol in patients with Acute coronary syndrome in a tertiary care hospital

Introduction: Acute coronary syndrome is a spectrum of disease consisting of ST segment elevated myocardial infarction (STEMI), non-ST segment elevated myocardial infarction (NSTEMI) and unstable angina where the blood flow to the heart is decreased. According to WHO, India contributes to one-fifth of the world's deaths due to cardiovascular disease. In recent times, the RDW has been used as a helpful marker in the diagnosis and prognosis of patients with acute coronary syndrome. However, the relationship between RDW, HDL-C, and ACS has yet to be identified properly. Aim: To evaluate the association between HDL-C levels and the RDW among patients with ACS and to find its association with the various socio-demographic factors of the patient. Methods: This hospital-based cross-sectional study was conducted in a tertiary care hospital in Puducherry between October 2023 and February 2024. Patients aged more than 18 with a diagnosis of acute coronary syndrome were included in the study. All the patients were subjected to a complete history followed by laboratory investigations, including the RDW, HDL-C, and troponin-I. Results: A total of 62 patients participated in the study. The mean age of the patients with ACS was found to be 55.6 + 3.4 years. The study didn’t show any association between the age (p=0.753), gender (p=0.897), residence (p=0.517), Type-2 DM (p=-.924), hypertension (p=0.615), dyslipidemia (p=0.302), smoking (p=0.565), alcohol (p=0.593), ACS type (p=0.714), Troponin-I (p=0.916), HDL-C (p=0.517) and RBS (p=0.078) with the level of the RDW. However, the study showed a significant association between BMI and RDW levels (p&lt;0.001), and there is a significant and negative correlation was noted between the RDW and HDL-C levels (p=0.038). Conclusion: The study showed a significant and negative correlation between the HDL-C and the RDW among patients with acute coronary syndrome. The study recommends that the RDW be used as an additional marker in predicting the risk of ACS and diagnosing patients with ACS. Keywords: acute coronary syndrome, RDW, HDL-C, demographic factors.

Myocardial Ischemic Syndromes: A New Nomenclature to Harmonize Evolving International Clinical Practice Guidelines.

Since the 1960s, cardiologists have adopted several binary classification systems for acute myocardial infarction (MI) that facilitated improved patient management. Conversely, for chronic stable manifestations of myocardial ischemia, various classifications have emerged over time, often with conflicting terminology-eg, "stable coronary artery disease" (CAD), "stable ischemic heart disease," and "chronic coronary syndromes" (CCS). While the 2019 European guidelines introduced CCS to impart symmetry with "acute coronary syndromes" (ACS), the 2023 American guidelines endorsed the alternative term "chronic coronary disease." An unintended consequence of these competing classifications is perpetuation of the restrictive terms "coronary" and 'disease', often connoting only a singular obstructive CAD mechanism. It is now important to advance a more broadly inclusive terminology for both obstructive and non-obstructive causes of angina and myocardial ischemia that fosters conceptual clarity and unifies dyssynchronous nomenclatures across guidelines. We, therefore, propose a new binary classification of "acute myocardial ischemic syndromes" and "non-acute myocardial ischemic syndromes," which comprises both obstructive epicardial and non-obstructive pathogenetic mechanisms, including microvascular dysfunction, vasospastic disorders, and non-coronary causes. We herein retain accepted categories of ACS, ST-segment elevation MI, and non-ST segment elevation MI, as important subsets for which revascularization is of proven clinical benefit, as well as new terms like ischemia and MI with non-obstructive coronary arteries. Overall, such a more encompassing nomenclature better aligns, unifies, and harmonizes different pathophysiologic causes of myocardial ischemia and should result in more refined diagnostic and therapeutic approaches targeted to the multiple pathobiological precipitants of angina pectoris, ischemia, and infarction.

The CHA2DS2-VASc risk score in patients with Non-ST Elevation myocardial infarction to predict total occlusion in infarct-related arteries

The CHA2DS2-VASc risk score in patients with Non-ST Elevation myocardial infarction to predict total occlusion in infarct-related arteries

Outcomes among patients with non-ST-elevation myocardial infarction on chronic anticoagulation: Insights from the National Inpatient Sample.

Chronic systemic anticoagulation use is prevalent for various thromboembolic conditions. Anticoagulation (usually through heparin products) is also recommended for the initial management of non-ST-elevation myocardial infarction (NSTEMI). To evaluate the in-hospital outcomes of patients with NSTEMI who have been on chronic anticoagulation. Using the National Inpatient Sample (NIS) years 2016-2020, NSTEMI patients and patients with chronic anticoagulation were identified using the appropriate International Classification of Diseases, 10th version (ICD-10) appropriate codes. The primary outcome was all-cause in-hospital mortality while the secondary outcomes included major bleeding, ischemic cerebrovascular accident (CVA), early percutaneous coronary intervention (PCI) (i.e., within 24 h of admission), coronary artery bypass graft (CABG) during hospitalization, length of stay (LOS), and total charges. Multivariate logistic or linear regression analyses were performed after adjusting for patient-level and hospital-level factors. Among 2,251,914 adult patients with NSTEMI, 190,540 (8.5%) were on chronic anticoagulation. Chronic anticoagulation use was associated with a lower incidence of in-hospital mortality (adjusted odds ratio [aOR]: 0.69, 95% confidence interval [CI]: 0.65-0.73, p < 0.001). There was no significant difference in major bleeding (aOR: 0.95, 95% CI: 0.88-1.0, p = 0.15) or ischemic CVA (aOR: 0.23, 95% CI: 0.03-1.69, p = 0.15). Chronic anticoagulation use was associated with a lower incidence of early PCI (aOR: 0.78, 95% CI: 0.76-0.80, p < 0.001) and CABG (aOR: 0.43, 95% CI: 0.41-0.45, p < 0.001). Chronic anticoagulation was also associated with decreased LOS and total charges (adjusted mean difference [aMD]: -0.8 days, 95% CI: -0.86 to -0.75, p < 0.001) and (aMD:$-19,340, 95% CI: -20,692 to -17,988, p < 0.001). Among patients admitted with NSTEMI, chronic anticoagulation use was associated with lower in-hospital mortality, LOS, and total charges, with no difference in the incidence of major bleeding.

Impact of high triglyceride/high-density lipoprotein cholesterol ratio in non-st segment elevation myocardial infarction

Introductıon: Globally, cardiovascular disease (CVD) is the leading cause of death. Among these risk factors, dyslipidemia, hypertension, and diabetes mellitus (DM) are significant pathological disorders that lead to this illness. In addition to being a risk factor for cardiovascular disease, insulin resistance is a prevalent characteristic of metabolic syndrome, obesity, and diabetes mellitus. It has been demonstrated that the triglyceride/HDL ratio is a valid indicator of insulin resistance. In this study, we tried to emphasize the criticality of early intervention in NSTEMI patients by revealing whether the TG/HDL ratio indicating insulin resistance is different between NSTEMI and ST elevation myocardial infarction (STEMI) patients. Methods: Patients admitted to a training and research hospital with a prediagnosis of acute coronary syndrome and diagnosed as having NSTEMI or STEMI were included in the study. Our study included 113 NSTEMI and 166 STEMI patients. Results: In NSTEMI patients, the mean HDL value was 39 (25-65) mg/dl, the mean LDL value was 105 (29-244) mg/dl, the mean T. cholesterol value was 180 (78-356) mg/dl, and the mean triglyceride value was 136 (37-360) mg/dl. When NSTEMI patients were compared with STEMI patients in terms of TG/HDL ratio, NSTEMI patients were significantly higher. (p:0.027; p

An observational study of therapeutic procedures and in-hospital outcomes among patients admitted for acute myocardial infarction in Spain, 2016–2022: the role of diabetes mellitus

BackgroundWe used the Spanish national hospital discharge data from 2016 to 2022 to analyze procedures and hospital outcomes among patients aged ≥ 18 years admitted for ST-elevation myocardial infarction (STEMI) and non–ST-elevation myocardial infarction (NSTEMI) according to diabetes mellitus (DM) status (non-diabetic, type 1-DM or type 2-DM).MethodsWe built logistic regression models for STEMI/NSTEMI stratified by DM status to identify variables associated with in-hospital mortality (IHM). We analyzed the effect of DM on IHM.ResultsSpanish hospitals reported 201,950 STEMIs (72.7% non-diabetic, 0.5% type 1-DM, and 26.8% type 2-DM; 26.3% female) and 167,285 NSTEMIs (61.6% non-diabetic, 0.6% type 1-DM, and 37.8% type 2-DM; 30.9% female). In STEMI, the frequency of percutaneous coronary intervention (PCI) increased among non-diabetic people (60.4% vs. 68.6%; p < 0.001) and people with type 2-DM (53.6% vs. 66.1%; p < 0.001). In NSTEMI, the frequency of PCI increased among non-diabetic people (43.7% vs. 45.7%; p < 0.001) and people with type 2-DM (39.1% vs. 42.8%; p < 0.001). In NSTEMI, the frequency of coronary artery by-pass grafting (CABG) increased among non-diabetic people (2.8% vs. 3.5%; p < 0.001) and people with type 2-DM (3.7% vs. 5.0%; p < 0.001). In the entire population, lower IHM was associated with undergoing PCI (odds ratio [OR] [95% confidence interval] = 0.34 [0.32–0.35] in STEMI; 0.24 [0.23–0.26] in NSTEMI) or CABG (0.33 [0.27–0.40] in STEMI; 0.45 [0.38–0.53] in NSTEMI). IHM decreased over time in STEMI (OR = 0.86 [0.80–0.93]). Type 2-DM was associated with higher IHM in STEMI (OR = 1.06 [1.01–1.11]).ConclusionsPCI and CABG were associated with lower IHM in people admitted for STEMI/NSTEMI. Type 2-DM was associated with IHM in STEMI.