Outcomes Of Acute Coronary Syndrome Research Articles

Delta of Egypt Acute Coronary Syndrome Registry

Background: Acute coronary syndrome (ACS) is a main reason of morbidity and mortality in patients with coronary heart disease (CHD) in developed nations. It’s one of three coronary artery diseases (CAS): ST-segment elevation myocardial infarction (STEMI), or unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI). The production of sensitive indicators of myocardial necrosis (for example, troponins) is considered a suggestive indication of myocardial cell necrosis and so meets the criteria of myocardial infarction. The goal of the registry is to assess patient features, practice pattern and outcome of ACS in this region using a registry design.
 Methods: This prospective and observational registry was carried out on 1000 Patients with ACS (whatever its type) in the period of six months in cardiac centres in the region of middle delta of Egypt. The survey took place in (Tanta, Mahalla, Mansoura, Shebin-Elkom, Damanhor, Kafr-Elsheikh, Banha and Cairo).
 Results: There was an insignificant difference in the primary etiology of ACS between both sexes. Women got less ACE inhibitors, mineralocorticoid receptor antagonists, beta-blockers, antiplatelets, statins, and nitrates, but received more digoxin, amiodarone, anticoagulants, and calcium channel blockers. There was an insignificant association in in-hospital and 1 year mortality between female and male, respectively.
 Conclusions: Smoking and hypertension are significant risk factors among patients raising an alarming sign for primary and secondary inhibition for CAD. The delay in seeking medical help is related to unawareness of the public on what to do raising important questions about EMS role and public health education.

Demographic analysis and clinical outcomes of COVID-19 and myocardial infarction from a tertiary care centre in south India

Funding AcknowledgementsType of funding sources: None.Back ground – COVID-19 is reported in India from March 2020. It is known to cause myocarditis , arrythmias and heart failure. COVID-19 infection has been proposed to be associated with myocardial infarction.PURPOSE–We intent to study outcomes of acute coronary syndrome associated with COVID-19 patients .METHODS– This is a single center case-control study done in an University hospital in south India , from May 2020 to October 2020 . Data of patients who came with acute coronary syndrome (ACS) with COVID- 19 were collected retrospectively from the hospital database. The clinical outcomes of the these patients were compared with the patients who were admitted in the hospital for ACS without COVID -19 in the same period.RESULITS – 508 patients were admitted between May 2020 to October 2020 with ACS and out of which 58 patients were positive for COVID-19 and 450 patients were COVID-19 negative. In COVID positive group, most of the patients were above 50 years with 17 % of them being female sex. 60 % were having diabetes and 44.8 % had hypertension . 55% of them had STEMI with the rest being NSTE- ACS . 43.1 % patients were thrombolysed . 25% patients underwent revascularization either with PCI / CABG . 10.3% died in the COVID - 19 positive group , at the same time there were only 2.2 % deaths in the control group . Most the patients were asymptomatic COVID-19 at presentation . Among the symptomatic COVID-19 patients the onset of myocardial infarction after COVID-19 ranged from 9 – 90 days .CONCLUSION– Acute coronary syndrome in COVID-19 patients can present as late as 3 months after index infection, and these patients had higher mortality compared with those who did not have COVID -19 .

The use of bedside haemodynamic parameters to predict risk and in-hospital outcomes in non-ST elevation acute coronary syndromes: data from resource- limited settings in Iraq

Abstract Funding Acknowledgements Type of funding sources: None. Background There is lack of data on the value of bedside hemodynamic parameters in predicting risk and outcomes in NSTE-ACS. This study aimed to assess if the following bedside haemodynamic tests : mean arterial pressure (MAP) [DBP + 1/3(SBP-DBP)], shock index (SI) [heart rate/SBP], pulse pressure (PP) [SBP-DBP] and proportional PP (PPP) [PP/SBP] can predict risk and adverse in-hospital outcomes in NSTE-ACS. Purpose To assess if bedside haemodynamic tests like mean arterial pressure (MAP), shock index (SI), pulse pressure (PP) and proportional PP (PPP) can predict risk and adverse in-hospital outcomes in NSTE-ACS Methods Patients with NSTE-ACS were prospectively included, we calculate GRACE score, SI, MAP, PP and PPP. Patients were stratified into low, intermediate and high GRACE risk class Results n.=179. When stratifying patients according to SI ≥0.7 vs <0.7: 31% had SI≥0.7, those with SI ≥0.7 were at high GRACE risk class in 52.5% vs 24.3%, p < 0.001. AF was recorded in those with SI≥0.7 in 19.7% vs 3.7%, p < 0.001. Time to catheterization (days) was 3.26 ± 2.55 in SI ≥0.7 vs 3.23 ± 1.96, p = 0.9, hospitalization duration (days) 5.11 ± 2.8 in SI ≥0.7 vs 4.8 ± 2.7, p = 0.4. For those who developed cardiogenic shock; MAP was 86.1 ± 17.6 vs 100.04 ± 15.3, p = 0.03 and SI was 0.91 ± 0.3 vs 0.63 ± 0.2, p = 0.02 compared to those who did not develop cardiogenic shock. No significant differences observed in PP and PPP between two groups. There was significant correlation between SI and GRACE score, p < 0.001 as well as with EF%, p < 0.001. MAP correlated significantly with GRACE score, p = 0.001. On multiple regression analysis: high GRACE risk class [95% CI 0.002-0.056, p = 0.03] and SI≥0.7 [95%CI 0.007-0.12, p = 0.02] were significant predictors of in-hospital death, while high GRACE risk class predicted in-hospital AHF [95% CI 0.13-0.26, p < 0.001]. SI≥0.7 predicted in-hospital stroke [95% CI 0.008-0.082, P = 0.01]. While MAP, PP and PPP did not predict in-hospital outcomes Conclusions SI correlates with GRACE score and predicted in-hospital stroke and death in NSTE-ACS. MAP correlated with GRACE score, but MAP, PP and PPP did not predict in-hospital outcomes. SI is readily obtainable than GRACE score and can be used to guide management particularly in resources-limited settings where proper risk stratification is needed to choose those who will benefit the most from invasive strategy Abstract Figure.

Persistently elevated levels of sST2 after acute coronary syndrome are associated with recurrent cardiac events

Purpose Higher soluble ST2 (sST2) levels at admission are associated with adverse outcome in acute coronary syndrome (ACS) patients. We studied the dynamics of sST2 over time in post-ACS patients prior to a recurrent ACS or cardiac death. Methods We used the BIOMArCS case cohort, consisting of 187 patients who underwent serial blood sampling during one-year follow-up post-ACS. sST2 was batch-wise quantified after completion of follow-up in a median of 8 (IQR: 5–11) samples per patient. Joint modelling was used to investigate the association between longitudinally measured sST2 and the endpoint, adjusted for gender, GRACE risk score and history of cardiovascular diseases. Results Median age was 64 years and 79% were men. The 36 endpoint patients had systematically higher sST2 levels than those that remained endpoint free (mean value 29.6 ng/ml versus 33.7 ng/ml, p-value 0.052). The adjusted hazard ratio for the endpoint per standard deviation increase of sST2 was 1.64 (95% confidence interval: 1.09–2.34; p = 0.019) at any time point. We could not identify a steady or sudden increase of sST2 in the run-up to the combined endpoint. Conclusion Asymptomatic post-ACS patients with persistently higher sST2 levels are at higher risk of recurrent ACS or cardiac death during one-year follow-up.

Association of fasting blood glucose to high-density lipoprotein cholesterol ratio with short-term outcomes in patients with acute coronary syndrome

BackgroundBiochemical markers are crucial for determining risk in coronary artery disease (CAD) patients; however, the relationship between fasting blood glucose to high-density lipoprotein cholesterol (FG/HDL-C) ratio and short-term outcomes in acute coronary syndrome (ACS) patients remains unknown. Therefore, we have investigated the relationship between the FG/HDL-C ratio and short-term outcomes in ACS patients.MethodsWe used data from a pragmatic, stepped-wedge, cluster-randomized clinical trial to perform a post hoc analysis. A total of 11,284 individuals with ACS were subdivided into quartiles according to their FG/HDL-C ratios. We used a multivariate logistic regression model, two-piecewise linear regression model, and generalized additive model (GAM) to evaluate the relationship between the FG/HDL-C ratio and short-term outcomes (major adverse cardiovascular events [MACEs] and cardiovascular [CV] death within 30 days).ResultsThe FG/HDL-C ratio was remarkably linked to an enhanced risk of MACEs and CV death in individuals with ACS in the highest quartile (MACEs, odds ratio [OR]: 1.49; 95% confidence interval [CI], [1.11, 1.99]; P < 0.01; CV death, OR: 1.69; 95% CI, [1.01, 1.41]; P = 0.04). The GAM suggested that the relationship between the FG/HDL-C ratio and MACEs and CV death was non-linear. The two-piecewise linear regression model demonstrated that the threshold values were 3.02 and 3.00 for MACEs and CV death, respectively.ConclusionsA higher FG/HDL-C ratio is associated with a higher risk of MACEs and CV death in patients with ACS.

Use and outcomes of dual antiplatelet therapy for acute coronary syndrome in patients with chronic kidney disease: insights from the Canadian Observational Antiplatelet Study (COAPT).

Chronic kidney disease (CKD) increases the risk of adverse outcomes in acute coronary syndrome (ACS). The optimal regimen of dual antiplatelet therapy (DAPT) post-percutaneous coronary intervention (PCI) in CKD poses a challenge due to the increased bleeding and clotting tendencies, particularly since patients with CKD were underrepresented in randomized controlled trials. We examined the practice patterns of DAPT prescription stratified by the presence of CKD. The multicentre prospective Canadian Observational Antiplatelet Study (COAPT) enrolled patients with ACS between December 2011 and May 2013. The present study is a subgroup analysis comparing type and duration of DAPT and associated outcomes among patients with and without CKD (eGFR < 60ml/min/1.73m2, calculated by CKD-EPI). Patients with CKD (275/1921, 14.3%) were prescribed prasugrel/ticagrelor less (18.5% vs 25.8%, p = 0.01) and had a shorter duration of DAPT therapy versus patients without CKD (median 382 vs 402days, p = 0.003). CKD was associated with major adverse cardiovascular events (MACE) at 12months (p < 0.001) but not bleeding when compared to patients without CKD. CKD was associated with MACE in both patients on prasugrel/ticagrelor (p = 0.017) and those on clopidogrel (p < 0.001) (p for heterogeneity = 0.70). CKD was associated with increased bleeding only among patients receiving prasugrel/ticagrelor (p = 0.007), but not among those receiving clopidogrel (p = 0.64) (p for heterogeneity = 0.036). Patients with CKD had a shorter DAPT duration and were less frequently prescribed potent P2Y12 inhibitors than patients without CKD. Overall, compared with patients without CKD, patients with CKD had higher rates of MACE and similar bleeding rates. However, among those prescribed more potent P2Y12 inhibitors, CKD was associated with more bleeding than those without CKD. Further studies are needed to better define the benefit/risk evaluation, and establish a more tailored and evidence-based DAPT regimen for this high-risk patient group.

Atrial fibrillation incidence, prevalence, predictors, and adverse outcomes in acute coronary syndromes: A pooled analysis of data from 8 million patients.

To summarize data on the prevalence/incidence, risk factors and prognosis of atrial fibrillation (AF) in patients with acute coronary syndromes (ACS). MEDLINE, Embase, and Web of Science were searched to identify all published studies providing relevant data through August 23, 2020. Random-effects meta-analysis method was used to pool estimates. We included 109 studies reporting data from a pooled population of 8 239 364 patients. The prevalence rates were 5.8% for pre-existing AF, 7.3% for newly diagnosed AF, and 11.3% for prevalent (total) AF, in patients with ACS. Predictors of newly diagnosed AF included age (per year increase) (adjusted odds ratio [aOR]: 1.05), C-reactive protein (aOR: 1.49), left atrial (LA) diameter (aOR: 1.08), LA dilatation (aOR:2.32), left ventricular ejection fraction <40% (aOR: 1.82), hypertension (aOR: 1.87), and Killip ˃ 1 (aOR: 1.85), p < .01 in all analyzes. Newly diagnosed AF was associated with an increased risk of acute heart failure (adjusted hazard ratio [aHR]:3.20), acute kidney injury (aHR: 3.09), re-infarction (aHR: 1.96), stroke (aHR: 2.15), major bleeding (aHR: 2.93), and mortality (aHR: 1.80) in the short term; and with an increased risk of heart failure (aHR: 2.21), stroke (aHR: 1.75), mortality (aHR: 1.67), CV mortality (aHR: 2.09), sudden cardiac death (aHR: 1.53), and a composite of major adverse cardiovascular events (aHR: 1.54) in the long term (beyond 1 month), p < .05 in all analyzes. One in nine patients with ACS has AF, with a high proportion of newly diagnosed AF. AF, in particular newly diagnosed AF, is associated with poor short-term and long-term outcomes in patients with ACS.

Systemic Immune-inflammation Index in Acute Coronary Syndrome and its Role in Predicting Disease Severity: A Cohort Study

Introduction: Systemic Immune-inflammation Index (SII) is a novel marker of inflammation, used extensively in prognosticating various cancers. Recent studies have shown SII to be a predictor of adverse events and death in Acute Coronary Syndrome (ACS) patients who undergo intervention. The role of SII in medically managed SII patients has not been studied. There are no Indian studies available which study the prognosticative role of SII in ACS. Aim: To study systemic immune-inflammation index in acute coronary syndrome and its role in predicting disease severity and mortality. Materials and Methods: This prospective cohort study was conducted in Department of General Medicine at Father Muller Medical College Hospital, Mangaluru, India between February 2021 and July 2021. The study included 45 ST Elevation Myocardial Infarction (STEMI) and 45 Non ST Elevation Myocardial Infarction (NSTEMI)/Unstable Angina (UA) patients, aged 30 years or more. The SII, Neutrophil-to-Lymphocyte Ratio (NLR) and Total Leucocyte Count (TLC) were compared using independent sample t-test. Killip class, Thrombolysis In Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) 2.0 scores were used to determine disease severity. Pearson’s and Spearman’s correlation coefficient were used to determine correlation between parametric and non parametric parameters, respectively. Receiver Operator Curve (ROC) was used to see for predictability of outcomes. The role of SII to predict Major Adverse Cardiac Events (MACE) and death at one month follow- up period was assessed by Kaplan-Meier analysis and Cox regression analysis. Results: The mean SII was significantly higher in the STEMI group (20.9 vs 9.79; t-value= 3.65, p-value &lt;0.001). SII correlated significantly with Killip class (r=0.502), TIMI (r=0.417) and GRACE 2.0 scores (r=0.529), better than NLR or TLC. High SII were associated with a higher risk of MACE (Odds ratio=13.82, p-value &lt;0.001) and death (OR=4.413, p-value=0.015). The SII had an Area Under the Curve of 0.67 for predicting MACE and had a negative predictive value of 96%. Kaplan-Meier analysis showed that patients with higher SII had a lower survival at one month (median: 24.5 days vs 29.32 days, Log-rank=6.44, p-value=0.011). The SII predicted MACE and death better than left ventricular Ejection Fraction (EF) and troponin I. Conclusion: The SII is a cost-effective, novel marker of inflammation that can predict short term outcomes in ACS. This was the first cohort study which studied the role of SII in ACS in patients undergoing any type of intervention.

Outcomes of Very Elderly Patients with ST-Elevation or Non-ST-Elevation Acute Coronary Syndrome: Observational Study

Acute coronary syndromes (ACS) have been classified according to the finding of ST-segment elevation on the presenting electrocardiogram, with different treatment strategies and practice guidelines. However, a comparative description of the clinical characteristics and outcomes of acute coronary syndrome in elderly patients has not been published so far. To compare the baseline characteristics and outcomes of STEMI and NSTEMI patients. Retrospective, observational study of patients hospitalized for ACS between January 2018 and December 2019 in the cardiology department of the university hospital of Sfax. The main outcome measure was the incidence of major adverse cardiovascular events (MACE) including cardiovascular death, reinfarction, and stroke. Of 158 ACS patients aged ≥ 75 years (median age 79.72 years, interquartile range 75-97), 33% were classified as ST-elevation myocardial infarction (STEMI), and 67% had non-ST-elevation myocardial infarction (NSTEMI). As compared with those with NSTEMI, STEMI patients had more favorable baseline risk factors with a lower Charlson comorbidity index (3.48 ± 0.18 versus (vs.) 3,84 ± 0.96, P = 0.031), less kidney failure (19.2% vs. 44%, P = 0.005), less prior coronary events (15.7% vs. 44%, P = 0.006) but more severe coronary disease (double vessel disease and triple vessel disease were respectively (45.7% vs. 22%, P = 0.005) and (37% vs. 15.9%, P = 0.007). At a median follow-up of 12 months, MACE were more frequents in STEMI group (26% vs. 13.5%, P = 0.05). Despite more favorable baseline characteristics, elderly STEMI patients have a higher risk of major cardiovascular events compared with NSTEMI patients.

Management and Outcomes of Non-ST Elevation Acute Coronary Syndrome (NSTE-ACS) Patients Revascularised with Coronary Artery Bypass Grafting (CABG) Versus Percutaneous Coronary Intervention (PCI) in Australia

Management and Outcomes of Non-ST Elevation Acute Coronary Syndrome (NSTE-ACS) Patients Revascularised with Coronary Artery Bypass Grafting (CABG) Versus Percutaneous Coronary Intervention (PCI) in Australia

Usefulness of calcium and phosphorus metabolism biomarkers in predicting outcome in acute coronary syndrome

Usefulness of calcium and phosphorus metabolism biomarkers in predicting outcome in acute coronary syndrome

Comparison of Cardiovascular Safety for Smoking Cessation Pharmacotherapies in a Population-Based Cohort in Australia

Although concerns exist regarding a potential increased risk of cardiovascular events for smoking cessation pharmacotherapies, there is general consensus that any increased risk associated with their use would be outweighed by the benefits of smoking cessation; thus, clinical guidelines recommend that such pharmacotherapies be offered to everyone who wants to quit smoking. In the interest of minimizing risk to patients, prescribers need evidence indicating how these pharmacotherapies compare with one another in terms of cardiovascular safety. To compare the risk of major adverse cardiovascular events (MACE) among individuals initiating varenicline, nicotine replacement therapy (NRT) patches, or bupropion. This retrospective, population-based cohort study using linked pharmaceutical dispensing, hospital admissions, and death data was conducted in New South Wales, Australia. Participants included adults who were dispensed a prescription smoking cessation pharmacotherapy between 2008 and 2015 or between 2011 and 2015, depending on the availability of the pharmacotherapies being compared. Pairwise comparisons were conducted for risk of MACE among 122 932 varenicline vs 92 148 NRT initiators; 342 064 varenicline vs 10 457 bupropion initiators; and 102 817 NRT vs 6056 bupropion initiators. First course of the smoking cessation pharmacotherapy of interest. The primary outcome was MACE, defined as a composite of acute coronary syndrome, stroke, and cardiovascular death. Secondary outcomes were the individual components of MACE. Inverse probability of treatment weighting with high-dimensional propensity scores was used to account for potential confounding. Cox proportional hazards regression models with robust variance were used to estimate hazard ratios (HRs) and 95% CIs. Data were analyzed January 24, 2019, to September 1, 2021. The mean (SD) age of included individuals ranged from 41.9 (14.2) to 49.8 (14.9) years, and the proportion of women ranged from 42.8% (52 702 of 123 128) to 52.2% (53 693 of 102 913). The comparison of 122 932 varenicline initiators and 92 148 NRT patch initiators showed no difference in the risk of MACE (HR, 0.87; 95% CI, 0.72-1.07) nor in the risk of the secondary outcomes of acute coronary syndrome (HR, 0.96; 95% CI, 0.76-1.21) and stroke (HR, 0.72; 95% CI, 0.45-1.14). However, decreased risk of cardiovascular death was found among varenicline initiators (HR, 0.49; 95% CI, 0.30-0.79). The results of comparisons involving bupropion were inconclusive owing to wide confidence intervals (eg, risk of MACE: 342 064 varenicline vs 10 457 bupropion initiators, HR, 0.87 [95% CI, 0.53-1.41]; 102 817 NRT patch vs 6056 bupropion initiators, HR, 0.79 [95% CI, 0.39-1.62]). The finding of this cohort study that varenicline and NRT patch use have similar risk of MACE suggests that varenicline, the most efficacious smoking cessation pharmacotherapy, may be prescribed instead of NRT patches without increasing risk of major cardiovascular events. Further large-scale studies of the cardiovascular safety of varenicline and NRT relative to bupropion are needed.

Temporal Trends and Outcome of Patients with Acute Coronary Syndrome and Prior Myocardial Infarction.

Patients who have previously had a myocardial infarction (MI) are considered a high-risk group with increased risk for cardiovascular (CV) events. During the last decade, the outcome of acute coronary syndrome (ACS) patients has improved due to advances in medical therapy and interventional techniques. We aimed to examine temporal trends and outcomes of patients with prior MI admitted due to ACS from the Acute Coronary Syndrome Israeli Survey (ACSIS). Included were 16,934 ACS patients, of whom 31.4% had prior MI. For temporal trend analysis, the cohort was divided into an early period (2000–2008) and late period (2010–2018). For patients with prior MI, patients in the late period had a higher rate of CV risk factors and were treated more frequently with revascularization and guidelines-directed medical therapy. Recurrent MI (6.7% vs. 12%, p < 0.001), MACE (10.6% vs. 21%, p < 0.001) and 1-year mortality (10.7% vs. 14.6%, p < 0.001) were significantly lower in the late period. However, the mortality rate for patients with prior MI remained higher compared with patients without prior MI (10.7% vs. 6.8% p < 0.001) with an overall higher mortality rate in the STEMI group. Thus, despite significant improvement in outcome measures in the contemporary era, ACS patients with prior MI are still at increased risk for recurrent ischemic CV events and mortality.

Ticagrelor versus Prasugrel in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: Analysis from the Acute Coronary Syndrome Israeli Survey

Introduction: We aimed to compare the outcomes of acute coronary syndrome (ACS) patients undergoing in-hospital percutaneous coronary intervention treated with prasugrel versus ticagrelor. Methods: Among 7,233 patients enrolled to the Acute Coronary Syndrome Israeli Survey (ACSIS) between 2010 and 2018, we identified 1,126 eligible patients treated with prasugrel and 817 with ticagrelor. Comparison between the groups was performed separately in ST-elevation myocardial infarction (STEMI) patients, propensity score matched (PSM) STEMI patients, and non-ST-elevation ACS (NSTE-ACS) patients. Results: In-hospital complication rates, including rates of stent thrombosis, were not significantly different between groups. In PSM STEMI patients, 30-day re-hospitalization rate (p < 0.05), 30-day MACE (the composite of death, MI, stroke, and urgent revascularization, p = 0.006), and 1-year mortality rates (p = 0.08) were higher in the ticagrelor group compared to the prasugrel group; in NSTE-ACS patients, outcomes were not associated with drug choice. In Cox regression analysis applied on the entire cohort, prasugrel was associated with lower 1-year mortality in STEMI patients but not in NSTE-ACS patients (p for interaction 0.03). Conclusions: Compared to ticagrelor, prasugrel was associated with superior clinical outcomes in STEMI patients, but not in NSTE-ACS patients.

OR68. The impact of coronavirus disease 2019 pandemic on acute coronary syndrome hospitalizations, treatments, and outcomes: a dual-center observational study

Background and AimsSince March 2020, transmission of coronavirus disease 2019 (COVID-19) in Indonesia have led to substantial decline in non-COVID-19 hospitalizations and healthcare services. We ought to determine the impact of COVID-19 pandemic on acute coronary syndrome (ACS) hospitalizations, treatments, and outcomes.Methods and ResultsWe conducted a dual-center observational study in Bogor City General Hospital and Kediri General Hospital, Indonesia. We included all ACS patients between January-June 2020. Subjects were divided into two groups: pandemic period (admitted in March-June 2020) and pre-pandemic period (admitted in January-February 2020). 279 subjects were involved (107 pandemic vs 172 pre-pandemic). Monthly average ACS admissions reduced by 68.6% during pandemic period compared to pre-pandemic period. Proportion of STEMI subjects was significantly higher during pandemic compared to pre-pandemic (56.1% vs 38.4%; p = 0.004). Proportion of Killip 3-4 subjects was also significantly higher during pandemic compared to pre-pandemic (26.2% vs 14.5%; p = 0.016). However, reperfusion therapy (PCI or fibrinolytic) proportion for STEMI subjects was significantly lower during pandemic compared to pre-pandemic (16.7% vs 31.8%; p = 0.049), although there was no significant difference in onset time of ACS symptoms before hospitalization (p = 0.793). In-hospital mortality rate was significantly higher during pandemic compared to pre-pandemic (15.9% vs 8.1%; p = 0.045).ConclusionThere was a significant decline in ACS hospitalizations, increased proportion of STEMI and KILLIP 3-4 patients, and higher in-hospital mortality rate in the pandemic period compared to pre-pandemic period. Paradoxically, reperfusion therapy proportion in STEMI patients has reduced significantly during pandemic period.

Abstract 9777: Acute Anemia and Outcomes in ACS Treated with Mechanical Circulatory Support

Introduction: Anemia increases mortality in acute coronary syndromes (ACS). Mechanical circulatory devices (MCS) are known to cause anemia due to mechanical shearing, but there is limited data evaluating the prognostic significance of anemia in ACS patients treated with MCS. Methods: A single center retrospective cohort study included 210 consecutive ACS (56% STEMI) patients treated with MCS (IABP in 73%, 27% micro-axial pump Impella®) based on the clinical need. Clinical characteristics, hospital course details, and outcomes were obtained from the electronic health records. Results: The study cohort included 76% males, 66.9±10.9 years old, with atrial fibrillation (AF) in 9%, HTN in 43%, CHF in 37%, CAD in 42%, CABG in 40%, diabetes in 24%, COPD in 8%, and stroke in 6%. Average MCS duration was 4.0±2.8 days, with vascular complications in 17%, bleeding in 42%, transfusion in 40%, and kidney replacement therapy (KRT) in 15%. All-cause mortality was 16.2% with mean time to death of 11.2±1.2 days. There were no differences in pre-MCS Hgb between expired patients and survivors (12.3±2.6 vs. 12.8±2.2 g/dL, p=0.197). Post-MCS 24-hour Hgb was significantly lower in the expired patients (10.4+/-2.4 vs. 11.7+/-2.3, p=0.003) and in patients with prior CAD (11.1+/-2.1 vs. 11.8+/-2.5, p=0.037), while sex, AF, HTN, CABG, DM, COPD, or stroke did not affect Hgb. Admission shock (HR 4.7, 95%CI 2.087-10.783, p&lt;0.001) and KRT (HR 5.4, 95%CI 2.331-12.667, p&lt;0.001) decreased survival, while higher 24-hour Hgb (HR=0.74, 95% CI: 0.61-0.90, p=0.002) and higher presentation GFR (HR 0.968, 95%CI 0.948-0.989, p=0.003) improved survival. Transfusion did not affect mortality (18% vs. 15% in non-transfused patients, p=0.549). In a multivariate analysis, admission shock (HR 2.9, 95%CI 1.192-7.059) and KRT post MCS (HR 3.876, 95%CI 1.574-9.546, p=0.003) remained predictive of reduced survival, while Hgb and GFR were not important. Conclusion: Acute anemia in ACS patients treated with MCS is not prognostically significant. It remains unclear whether there is an optimal hemoglobin level which could alter the prognosis. Ongoing trials (MINT) are evaluating the optimal strategy of managing anemia in AMI.

Abstract 10148: Prevalence, Clinical Characteristics and Cardiovascular Outcomes of Acute Coronary Syndrome Attributable to Coronary Subclavian Steal Syndrome in Patients with a History of Coronary Artery Bypass Grafting

Introduction: Coronary subclavian steal syndrome (CSSS) is coronary steal phenomenon due to subclavian artery stenosis (SAS) in patients with a history of CABG using internal mammary artery (IMA). While CSSS could cause acute coronary syndrome (ACS), its frequency, clinical characteristics and cardiovascular outcomes remain unknown. Methods: The current study was a retrospective multi-center analysis of 142 ACS patients who previously received CABG from January 2007 to October 2020. CSSS was defined as myocardial ischemia due to SAS. Clinical characteristics and cardiovascular events (=cardiac-cause death + myocardial infarction + stroke) were compared in subjects with and without CSSS. Results: CSSS was identified in 7.0% (=10/142) of study subjects. Of these, 1, 6 and 3 CSSS cases had SAS at right, left and both subclavian arteries, respectively. The averaged pressure gradient at SAS site was 31±13mmHg. ACS subjects attributable to CSSS were more likely to exhibit NSTEMI (90% vs. 52%, p=0.02), a history of hemodialysis (40% vs. 14%, p=0.03) and peripheral artery disease (70% vs. 20%, p&lt;0.001). Of note, all of 4 CSSS subjects receiving hemodialysis had their arterial-venous fistula at the same side of SAS. With regard to revascularization procedure in CSSS subjects, primary endovascular treatment for SAS was performed in only 2 cases. Furthermore, despite SAS as a culprit lesion of ACS, primary PCI for native coronary lesion was conducted in other 6 cases. As a consequence, most of them (=5/6) required additional revascularization of SAS after primary PCI due to unresolved myocardial ischemia or chest pain. During 50-month observational period, CSSS was associated with a greater likelihood of cardiovascular (p=0.003) and stroke events (p&lt;0.001, Figure). Conclusions: A substantially elevated cardiovascular risk was observed in ACS patients attributable to CSSS. This finding suggests clinical needs to meticulously evaluate SAS before and after CABG using IMA.

Incidence, Clinical Characteristics, Risk Factors and Outcomes of Acute Coronary Syndrome in Patients With COVID-19: Results of the UMC-19-S1010

BackgroundThere is a lack of knowledge about the real incidence of acute coronary syndrome (ACS) in patients with COVID-19, their clinical characteristics, and their prognoses. ObjectiveWe investigated the incidence, clinical characteristics, risk factors, and outcomes of ACS in patients with COVID-19 in the emergency department. MethodsWe retrospectively reviewed all COVID-19 patients diagnosed with ACS in 62 Spanish emergency departments between March and April 2020 (the first wave of COVID-19). We formed 2 control groups: COVID-19 patients without ACS (control A) and non–COVID-19 patients with ACS (control B). Unadjusted comparisons between cases and control subjects were performed regarding 58 characteristics and outcomes. ResultsWe identified 110 patients with ACS in 74,814 patients with COVID-19 attending the ED (1.48% [95% confidence interval {CI} 1.21–1.78%]). This incidence was lower than that observed in non–COVID-19 patients (3.64% [95% CI 3.54–3.74%]; odds ratio [OR] 0.40 [95% CI 0.33–0.49]). The clinical characteristics of patients with COVID-19 associated with a higher risk of presenting ACS were: previous coronary artery disease, age ≥60 years, hypertension, chest pain, raised troponin, and hypoxemia. The need for hospitalization and admission to intensive care and in-hospital mortality were higher in cases than in control group A (adjusted OR [aOR] 6.36 [95% CI 1.84–22.1], aOR 4.63 [95% CI 1.88–11.4], and aOR 2.46 [95% CI 1.15–5.25]). When comparing cases with control group B, the aOR of admission to intensive care was 0.41 (95% CI 0.21–0.80), while the aOR for in-hospital mortality was 5.94 (95% CI 2.84–12.4). ConclusionsThe incidence of ACS in patients with COVID-19 attending the emergency department was low, around 1.48%, but could be increased in some circumstances. Patients with COVID-19 with ACS had a worse prognosis than control subjects with higher in-hospital mortality.

Association of Polycythemia with Outcomes of Acute Coronary Syndrome

Background: Polycythemia has not been extensively studied for its impact on acute coronary syndrome (ACS) outcomes. A previous study reported only 30-day outcomes to be worse in these patients. Methods: Data from the ACS Israeli survey between 2000 and 2018 were utilized to compare between 3 groups of patients with ACS: anemic group (hemoglobin <12 g/dL for women and <12.5 g/dL for men), normal hemoglobin group, and polycythemic group (>16 g/dL and >16.5 g/dL, respectively). Measured outcomes included 30-day major adverse cardiac events (MACE comprising all-cause mortality, recurrent ACS, need for urgent revascularization, and stroke) and 1- and 5-year all-cause mortality. Results: Of 14,746 ACS patients, 10,752 (72.9%) had normal hemoglobin levels, 3,492 (23.7%) were anemic, and 502 (3.4%) were polycythemic. In comparison with normal and anemic patients, polycythemic patients were younger (55.9 ± 10.5 vs. 61.9 ± 12.4 and 71.1 ± 12.2 for anemic, respectively, p < 0.001 for both), more frequently men (93.8% vs. 81.3% and 63.1%, respectively, p < 0.001), and less likely diabetic or hypertensive. Upon adjustment to baseline characteristics, compared with normal hemoglobin, polycythemia was not independently associated with 30-day MACE or 1-year mortality, but it was independently associated with higher risk for 5-year mortality (HR 1.76, 95% CI: 1.19–2.59, p = 0.005). Similar results were observed after propensity score matching. Conclusions: Although younger and with fewer comorbidities, polycythemic ACS patients are at increased risk for long-term all-cause mortality. Further study of this association is warranted to understand the causes and possibly to improve the outcomes of these patients.

Temporal trends in patient characteristics, presumed causes, and outcomes following cardiogenic shock between 2005 and 2017: a Danish registry-based cohort study.

Most cardiogenic shock (CS) studies focus on acute coronary syndrome (ACS). Contemporary data on temporal trends in patient characteristics, presumed causes, treatments, and outcomes of ACS- and in particular non-ACS-related CS patients are sparse. Using nationwide medical registries, we identified patients with first-time CS between 2005 and 2017. Cochrane-Armitage trend tests were used to examine temporal changes in presumed causes of CS, treatments, and outcomes. Among 14 363 CS patients, characteristics remained largely stable over time. As presumed causes of CS, ACS (37.1% in 2005 to 21.4% in 2017), heart failure (16.3% in 2005 to 12.0% in 2017), and arrhythmias (13.0% in 2005 to 10.9% in 2017) decreased significantly over time; cardiac arrest increased significantly (11.3% in 2005 to 24.5% in 2017); and changes in valvular heart disease were insignificant (11.5% in 2005 and 11.6% in 2017). Temporary left ventricular assist device, non-invasive ventilation, and extracorporeal membrane oxygenation use increased significantly over time; intra-aortic balloon pump and mechanical ventilation use decreased significantly. Over time, 30-day and 1-year mortality were relatively stable. Significant decreases in 30-day and 1-year mortality for patients presenting with ACS and arrhythmias and a significant increase in 1-year mortality in patients presenting with heart failure were seen. Between 2005 and 2017, we observed significant temporal decreases in ACS, heart failure, and arrhythmias as presumed causes of first-time CS, whereas cardiac arrest significantly increased. Although overall 30-day and 1-year mortality were stable, significant decreases in mortality for ACS and arrhythmias as presumed causes of CS were seen.