Outcomes In Acute Coronary Syndrome Patients Research Articles

Analysis of Platelet Morphological Parameters as Clinical Risk Stratification in Acute Coronary Syndrome.

Platelet activation plays a central role in the pathogenesis of acute coronary syndrome (ACS). Platelet morphological parameters, including MPV, PDW, and P-LCR, are emerging as biomarkers for predicting the severity of ACS and prognosis. This study aims to assess the relationship between these parameters and coronary severity and to evaluate their predicting adverse outcomes. A total of 134 ACS patients and 50 healthy controls were included in this prospective observational study. Platelet morphological parameters (MPV, PDW, and P-LCR) were measured at admission, and coronary artery lesion severity was determined using the Gensini score from coronary angiography. Multivariate logistic regression analysis assessed the predictive value of these platelet parameters for adverse outcomes, and ROC curve analysis was used to evaluate their diagnostic performance. MPV, PDW, and P-LCR were significantly higher in ACS patients compared to healthy controls (p < 0.001). A strong positive correlation was found between platelet parameters and the Gensini score (MPV: r = 0.778, PDW: r = 0.800, P-LCR: r = 0.761; p < 0.001). Multivariate logistic regression identified MPV (OR = 1.807, p < 0.001), PDW (OR = 1.700, p = 0.001), and P-LCR (OR = 1.287, p < 0.001) as independent predictors of advent prognosis. ROC curve analysis showed that the combined use of MPV, PDW, and P-LCR provided superior predictive accuracy (AUC = 0.927) compared to the individual parameters. Elevated platelet morphological parameters are strongly associated with coronary artery lesion severity and serve as independent predictors of adverse outcomes in ACS patients. The combined assessment of MPV, PDW, and P-LCR enhances risk stratification, offering a valuable tool for guiding therapeutics and improving prognosis in management.

ASSESSING THE PROGNOSTIC VALUE OF THE HEMOGLOBIN-TO-RED CELL DISTRIBUTION WIDTH RATIO IN EMERGENCY DEPARTMENT PATIENTS WITH ACUTE CORONARY SYNDROME

Objective: Acute coronary syndrome (ACS) is a critical condition requiring rapid evaluation in the emergency department. The hemoglobin-to-red cell distribution width ratio (HRR) has emerged as a potential prognostic biomarker, reflecting the combined effects of hemoglobin and red cell distribution width. This study aims to evaluate the prognostic value of HRR in patients presenting to the emergency department with ACS. Material and Methods: A retrospective cohort study was conducted at a single center, involving adult patients who were diagnosed with acute coronary syndrome upon presentation to the emergency department. HRR was calculated as the ratio of hemoglobin to red cell distribution width, and its association with 30-day cardiac mortality (CM), all-cause mortality (ACM), and major adverse cardiovascular events (MACE) was analyzed using Receiver Operating Characteristics (ROC) curve analysis. Results: The study included 688 patients, with a mean age of 61.9±12.3 years and 57% males. Lower HRR was significantly associated with higher 30-day CM, ACM, and MACE rates. ROC curve analysis showed HRR had acceptable discriminatory power with AUC values of 0.764 for 30-day CM, 0.718 for 30-day ACM, and 0.739 for 30-day MACE. An HRR cut-off value of 0.9 was determined, with sensitivities of 87.8%, 90.2%,and 88.7%, and specificities of 47.6%, 48.4%, and 48.9% for CM, ACM, and MACE, respectively. Conclusion: HRR is a useful prognostic marker for 30-day outcomes in ACS patients. Its easy accessibility and rapid availability makes it a practical tool for risk stratification in the emergency department.

Predictive role of CHA₂DS₂-VASc score in acute coronary syndrome patients and value of adding global longitudinal strain to CHA₂DS₂-VASc score.

Future clinical management would be improved by accurate and early identification of ACS patients at high CV risk. In non-valvular atrial fibrillation patients, the prognostic risk of thromboembolism has been evaluated using CHA₂DS₂-VASc scores. It has recently been shown to assess the severity of CAD and foresee patient outcomes. Also, LV global longitudinal strain is an independent predictor of outcome. Our study aimed to determine the added value of LV longitudinal strain (GLS) to CHA₂DS₂-VASc in predicting the outcome and severity of CAD in patients with acute coronary syndrome (ACS). A total of 577 patients with primary diagnosis of ACS were included between January and July 2021. All patients had evaluations based on history, clinical examination, 12-lead ECG, TTE, and coronary angiography. Six months follow-up had been provided to all patients. Syntax score was significantly higher among patients with high-risk CHA₂DS₂-VASc score (30.5±6.1 vs. 17.34±8.7 vs. 11.11±8.2), p-value <0. 001. GLS was significantly lower among high SYNTAX score (-10.97±2.68 vs. -12.61±3.46 vs. -17.81±2.89), p-value=0.0001. There was a significant negative correlation between the CHA₂DS₂-VASc score and GLS. Moreover, adding GLS to CHA₂DS₂-VASc score significantly improved overall accuracy for the prediction of outcome and severity of CAD in ACS patients. CHA₂DS₂-VASc score is an easy and simple parameter that can be used in predicting the severity of CAD & adverse clinical outcome in ACS patients and adding GLS to the CHA₂DS₂-VASc score significantly improved overall accuracy.

Impact of Nutritional Status and Cardiopulmonary Exercise Testing-Based Exercise Education on Long-Term Outcomes in Acute Coronary Syndrome - Insights From the Mie ACS Registry.

Exercise training based on cardiopulmonary exercise testing (CPET) improves outcomes in patients with acute coronary syndrome (ACS), while nutritional status is also crucial. This study evaluated CPET implementation and the impacts of clinical parameters, including CPET and nutritional status, on 2-year outcomes in ACS patients. Data from 2,621 ACS patients enrolled in the Mie ACS registry were analyzed. Of these, 938 were hospitalized in CPET-equipped facilities, while 1,683 were not. Nutritional status was assessed using controlling nutritional status (CONUT) score. Cox regression analysis evaluated the associations between nutritional status, CPET-based exercise education, and 2-year prognosis. Among the 938 patients in CPET facilities, 359 underwent CPET and received exercise education. During the 2-year follow up, 60 all-cause deaths occurred. Univariate Cox regression revealed that CPET implementation was associated with lower all-cause mortality. Other predictors included hemoglobin levels, age, hospitalization length, Killip class ≥2, mechanical support, and malnutrition. In multivariate Cox regression, CPET implementation remained an independent predictor of mortality (hazard ratio 0.47; P=0.04). However, when nutritional status was included, moderate to severe malnutrition emerged as an independent predictor of all-cause mortality (hazard ratio 2.47; P=0.02), diminishing the significance of CPET (P=0.058). Moderate to severe malnutrition is a powerful independent prognostic factor for mortality in the Mie ACS registry. CPET implementation may enhance survival in ACS patients.

Classification of 90-day mortality risk among patients with cardiogenic shock requiring advanced mechanical circulatory support

Abstract Background The SCAI shock classification aims to provide a simple and practical stratification of the severity of patients with cardiogenic shock (CS) and to immediately offer them crucial treatments such as mechanical circulatory support (MCS). Additionally, the IABP shock II risk score is designed to predict 30-day mortality in patients with CS following acute coronary syndrome (ACS), and the SAVE score can also predict in-hospital mortality for patients after veno-arterial extracorporeal membrane oxygenation (V-A ECMO) insertion due to refractory CS. However, previous studies on SCAI staging in patients with MCS have been inconsistent, and the association with prognosis remains unclear. Purpose The aim of this study is to investigate the correlation between the SCAI shock stage and prognosis in ACS patients requiring advanced MCS, and to compare it with other prognostic scores. Methods From January 2012 to July 2023, 137 ACS patients with advanced MCS (excluding IABP) were evaluated. Upon ICU admission, patients were categorized into SCAI stages B to E. The IABP shock II score and the SAVE score were also calculated to serve as prognostic tools. The type of MCS was categorized as Impella, VA-ECMO with IABP, and ECPELLA (VA-ECMO with Impella). We compared the 90-day survival rates with the SCAI shock stage and other prognostic tools. Result The distribution for SCAI classifications stage B to E was 13 (10%), 38 (28%), 21 (15%), and 65 (47%), respectively. There were no significant differences among the groups regarding age, gender, comorbidities, the ratio of ST-elevation myocardial infarction, door-to-balloon time, and onset-to-reperfusion time. In SCAI Stage E, a significantly higher proportion of patients (86%) underwent extracorporeal cardiopulmonary resuscitation, exhibiting elevated lactate and peak CK-MB levels, along with higher IABP Shock II and lower SAVE scores, compared to other stages. A Kaplan-Meier analysis of 90-day mortality, based on the SCAI, the IABP Shock II, the SAVE categories, and the type of MCS, demonstrated that outcomes deteriorated as the stage advanced across all classifications. In the univariate Cox regression analysis for 90-day mortality, significant differences in outcomes were observed across the four classifications. However, in the multivariate Cox regression analysis that incorporated all four classifications, only the type of MCS (Impella vs. ECMO with IABP; hazard ratio [HR] 0.36; 95% confidence interval [CI], 0.16 - 0.78, p = 0.012) and the SCAI classification (stage E vs. stage C; HR 3.03; 95% CI, 1.51 - 6.08, p = 0.002) demonstrated a significant association with 90-day mortality. Conclusion The SCAI shock stage upon ICU admission suggests the potential for convenient prediction of mid-term outcomes in ACS patients who received advanced MCS.

Clinical impact of performing esophagogastroduodenoscopy before percutaneous coronary intervention in patients with acute coronary syndrome patients and anaemia

Abstract Background In patients presenting with acute coronary syndrome (ACS) and anaemia, esophagogastroduodenoscopy (EGD) is commonly performed to exclude an upper gastrointestinal source of bleeding prior to perform percutaneous coronary intervention (PCI). However, the diagnostic yield and clinical impact of EGD in this setting is uncertain. Purpose We aimed to investigate the clinical yield and impacts of EGD on the 1-year clinical outcomes in ACS patients with concomitant anaemia who underwent PCI. Methods We retrospectively analysed electronic health records of ACS patients who underwent PCI at 16 public hospitals from 2014-2018. Patients with anaemia (defined as haemoglobin (Hb) &amp;lt;11dl/L) and EGD before PCI during the same admission were identified. The primary outcomes were bleeding events including clinical GIB (as diagnosed by EGD), need for urgent EGD, need for transfusion, Hb drop of &amp;gt;3 dl/L and Hb &amp;lt;8 dl/L. Secondary outcomes were 12-month 4-point MACE including myocardial infarction (MI), stroke, subsequent PCI or CABG, or cardiovascular-related death. Propensity-score models with inverse probability of treatment weighting (IPTW) against EGD were developed for the comparisons. A weighted Cox Proportional Hazard Model was performed to estimate adjusted hazards ratio (aHR) with corresponding 95% confidence intervals (CI). Results Of 13,793 patients, 3625 (25%) had anaemia on admission and 12.8% (n=466/3625) underwent EGD. Most EGD findings were not accountable for overt GIB, with gastritis, gastric polyps and gastric erosion being the 3 most common EGD diagnoses. After IPTW, clinical outcomes of 466 patients with EGD were compared with 3159 patients without EGD. 12-month bleeding event rates were higher among EGD patients compared to non-EGD patients (59.7% vs. 27.6%, p&amp;lt; 0.01; aHR = 3.01, 95% CI 2.58-3.52, p&amp;lt;0.005). Overall, 12-month GIB rate was low 1.0%, with 4.1% in EGD patients and 0.57% in non-EGD patients (aHR=7.99, 95% CI 4.13-15.45, p&amp;lt;0.005). The 12-month cumulative MACE rate overall was 39.9% and no significant difference between EGD and non-EGD patients. Conclusion Our real-world data demonstrated that the presence of anaemia is common among ACS patients. The yield of EGD in identifying sources of upper GI bleeding was low and there was no difference in 12-month clinical outcome among EGD patients. Although EGD was associated with higher rates of 12-month bleeding events, the cause was unclear with very low incidence of upper GI bleeding events. Therefore, the benefits of routine EGD prior to PCI in ACS patients with anaemic is unclear.

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.

Association Between Systemic Immune-Inflammation Index and Adverse Outcomes in Patients With Acute Coronary Syndrome: A Meta-Analysis.

The systemic immune-inflammation index (SII) has been developed for the risk prognostication of acute coronary syndrome (ACS) patients. This meta-analysis aimed to assess the value of SII for predicting adverse outcomes in ACS patients. Relevant studies were identified by searching the PubMed, Web of Science, and Embase databases. Studies that investigated the association of SII with all-cause mortality or major adverse cardiovascular events (MACEs) in ACS patients were eligible. The short-term outcomes were defined as adverse events occurring during the hospital and within 30days. 11 studies with 16,596 patients were eligible for analysis. A random effect meta-analysis indicated that a higher SII level significantly predicted short-term death (hazard ratios [HR] 2.60; 95% confidence intervals [CI] 1.29-5.25) and long-term all-cause mortality (HR 2.40; 95% CI 1.25-4.59), even after adjusting for traditional confounding factors. Additionally, a higher SII level was also significantly associated with an increased risk of short-term MACEs (HR 1.61; 95% CI 1.28-2.03) and long-term MACEs (HR 2.43; 95% CI 1.74-3.40). These findings suggest that SII level has a strong prognostic value for both MACEs and all-cause mortality in patients with ACS. Determining the SII level has the potential to improve risk prognostication in ACS patients.

Insulin resistance, coronary artery lesion complexity and adverse cardiovascular outcomes in patients with acute coronary syndrome

BackgroundInsulin resistance (IR) is linked to both the complexity of coronary artery lesions and the prognosis of acute coronary syndrome (ACS). However, the precise extent of this correlation and its impact on adverse cardiovascular outcomes in ACS patients remain unclear. Therefore, this study aims to investigate the intricate relationship between IR, coronary artery lesion complexity, and the prognosis of ACS through a cohort design analysis.MethodA total of 986 patients with ACS who underwent percutaneous coronary intervention (PCI) were included in this analysis. IR was assessed using the triglyceride-glucose (TyG) index, while coronary artery lesion complexity was evaluated using the SYNTAX score. Pearson’s correlation coefficients were utilized to analyze the correlations between variables. The association of the TyG index and SYNTAX score with major adverse cardiovascular events (MACEs) in ACS was investigated using the Kaplan-Meier method, restricted cubic splines (RCS), and adjusted Cox regression. Additionally, a novel 2-stage regression method for survival data was employed in mediation analysis to explore the mediating impact of the SYNTAX score on the association between the TyG index and adverse cardiovascular outcomes, including MACEs and unplanned revascularization.ResultsDuring a median follow-up of 30.72 months, 167 cases of MACEs were documented, including 66 all-cause deaths (6.69%), 26 nonfatal myocardial infarctions (MIs) (2.64%), and 99 unplanned revascularizations (10.04%). The incidence of MACEs, all-cause death, and unplanned revascularization increased with elevated TyG index and SYNTAX score. Both the TyG index (non-linear, P = 0.119) and SYNTAX score (non-linear, P = 0.004) displayed a positive dose-response relationship with MACEs, as illustrated by the RCS curve. Following adjustment for multiple factors, both the TyG index and SYNTAX score emerged as significant predictors of MACEs across the total population and various subgroups. Mediation analysis indicated that the SYNTAX score mediated 25.03%, 18.00%, 14.93%, and 11.53% of the correlation between the TyG index and MACEs in different adjusted models, respectively. Similar mediating effects were observed when endpoint was defined as unplanned revascularization.ConclusionElevated baseline TyG index and SYNTAX score were associated with a higher risk of MACEs in ACS. Furthermore, the SYNTAX score partially mediated the relationship between the TyG index and adverse cardiovascular outcomes.

Comparison of Effectiveness of High Dose Statin Monotherapy With Combination of Statin and Ezetimibe to Prevent Cardiovascular Events in Patients With Acute Coronary Syndrome: A Systematic Review and Meta-Analysis.

This meta-analysis aimed to compare the effectiveness of high statin monotherapy and a combination of statin and ezetimibe to prevent cardiovascular outcomes in patients with acute coronary syndrome (ACS). The study was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We conducted comprehensive searches across online databases, including MEDLINE/ PubMed, EMBASE, and the Web of Science, to find the relevant articles from the databases' inception to 10 Feb 2024. Outcomes assessed in the meta-analysis included major cardiovascular events (MACE), all-cause mortality, stroke, myocardial infarction, and unplanned revascularization. Data analysis was conducted utilizing RevMan Version 5.3.1. The comparison of outcomes between the two groups involved the calculation of risk ratios (RR) accompanied by 95% confidence intervals (CI) using either a random or fixed-effect model. Five studies were included in this meta-analysis, encompassing 48,668 patients. The pooled analysis showed that the risk of all-cause mortality was higher in patients receiving high statin monotherapy. However, no significant differences in MACE, myocardial infarction, stroke, and revascularization were reported. While acknowledging the limitations, including the lack of randomized controlled trials and the dominance of one study in the analysis, these findings underscore the importance of further research to clarify the comparative effectiveness of these treatment modalities in preventing cardiovascular outcomes in ACS patients.

Percutaneous Coronary Intervention in Acute Coronary Syndrome with Mild-to-Moderate Thrombocytopenia.

Baseline thrombocytopenia is commonly observed in patients with acute coronary syndrome (ACS) requiring percutaneous coronary intervention (PCI). The purpose of this analysis was to investigate safety and effectiveness of PCI in ACS patients with baseline mild-to-moderate thrombocytopenia. The data were collected from the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome project. A total of 50,009 ACS patients were recruited between July 2017 and December 2019. Among them, there were 6,413 patients with mild-to-moderate thrombocytopenia, defined as a platelet count of ≥50 × 109/L and <150 × 109/L on admission. The primary outcome was in-hospital net adverse clinical events (NACE), consisting of major adverse cardiac events (MACE) and major bleeding events. The associations between PCI and in-hospital outcomes were analyzed by inverse probability treatment weighting (IPTW) method. PCI was performed in 4,023 of 6,413 patients (62.7%). The IPTW analysis showed that PCI was significantly associated with a reduced risk of in-hospital MACE (odd ratio [OR]: 0.45; 95% confidence interval [CI]: 0.31-0.67; p < 0.01) and NACE (OR: 0.59; 95% CI: 0.42-0.83; p < 0.01). PCI was also associated with an increased risk of any bleeding (OR: 1.56; 95% CI: 1.09-2.22; p = 0.01) and minor bleeding (OR: 1.52; 95% CI: 1.00-2.30; p = 0.05), but not major bleeding (OR: 1.51; 95% CI: 0.76-2.98; p = 0.24). Compared with medical therapy alone, PCI is associated with better in-hospital outcomes in ACS patients with mild-to-moderate thrombocytopenia. Further studies with long-term prognosis are needed.

Association between cholesterol crystals and 6-month prognosis in patients with acute coronary syndrome: an optical coherence tomography study

Abstract Background Optical coherence tomography (OCT) guided percutaneous coronary intervention (PCI) has been demonstrated to improve short and long-term outcomes compared with standard angiography-guided PCI. However, little is known about the impact of cholesterol crystals on the prognosis of patients with acute coronary syndrome (ACS) in the setting of receiving OCT-guided PCI. Purpose This study aims to investigate the association between cholesterol crystals and 6-month outcomes in ACS patients who underwent OCT-guided PCI. Methods Patients with ACS who underwent OCT-guided PCI in a high-volume PCI center between July 2020 and June 2022 were retrospectively enrolled and were further divided into two groups according to the presence or absence of cholesterol crystals. OCT imaging characteristics including plaque morphology before the PCI procedure in target lesions were assessed. The primary outcome was a composite of all-cause death, ischemia-driven revascularization, or readmission for heart failure in a 6-month follow-up period. The association between cholesterol crystals and 6-month outcomes was evaluated using Kaplan-Meier curves. Independent predictors for cholesterol crystals and 6-month outcomes were evaluated by the logistic regression and Cox proportional hazards regression analyses, respectively. Results 403 patients were enrolled in this study. The mean age was 61 years old and 79.4% were men. Cholesterol crystals were presented in 224 (55.6%) target lesions in patients with ACS. Baseline characteristics were not statistically different between the two groups in age, sex, smoke, previous hyperlipidemia, and other clinical features, except for diabetes, multivessel disease, and ACS classification (p &amp;lt;0.05). In the multivariable logistic regression analysis, cholesterol crystals were associated with diabetes, plaque rupture, lipid length, calcification, macrophage infiltration, and thin-capped fibroatheroma (all p &amp;lt;0.05). Patients with cholesterol crystals had higher risks of poor 6-month composite outcomes when compared to those without cholesterol crystals (13.4% vs. 6.7%, HR 2.09, 95%CI 1.07-4.09, p = 0.031), even after confounders adjustment for age, sex, diabetes, multivessel disease and ACS classification using inverse probability of treatment weighting (p = 0.027). Subgroup analysis showed significant interactions between cholesterol crystals and 6-month outcomes with respect to the male (HR 2.82, 95%CI 1.22-6.51, p = 0.015), target lesions in LAD (HR 4.47, 95%CI 1.29-15.44, p = 0.018), and incomplete revascularization (HR 3.08, 95%CI 1.04-8.98, p = 0.042). The Cox regression analysis identified cholesterol crystal as an independent predictor for 6-month composite outcomes (HR 2.12, 95%CI 1.08-4.19, p = 0.030). Conclusions The presence of cholesterol crystals was associated with a poor 6-month prognosis in patients with ACS, even in the setting of receiving OCT-guided PCI.

Obstructive sleep apnea is associated with the long-term prognosis of patients in acute coronary syndromes with prior myocardial infarction: Insights from OSA-ACS study

ObjectiveThe prognostic significance of obstructive sleep apnea (OSA) in patients with acute coronary syndrome (ACS) according to prior myocardial infarction (MI) remains unclear. We aimed to investigate the association between OSA and long-term cardiovascular outcomes in ACS patients with or without prior MI. MethodsWe prospectively recruited eligible 2160 ACS patients with portable sleep monitoring in Beijing Anzhen Hospital between June 2015 and January 2020. OSA was defined as an apnea hypopnea index (AHI) ≥15 events/hour. The primary endpoint was major adverse cardiovascular and cerebrovascular event (MACCE), including cardiovascular death, myocardial infarction, stroke, ischemia-driven revascularization, or hospitalization for unstable angina or heart failure. ResultsAmong 1927 patients enrolled, 1014 (52.6%) had OSA and 316 (16.4%) had prior MI. During 2.9 (1.5, 3.6) years of follow-up, multivariate analysis showed that OSA was associated with 1.7 times the risk of MACCE in patients with prior MI (50 events [28.2%] vs 24 events [17.3%]; adjusted HR = 1.74, 95%CI 1.04–2.90, P = 0.034), but not in patients without prior MI group (177 events [21.1%] vs 138 events [17.8%]; adjusted HR = 1.19, 95%CI 0.94–1.51, P = 0.15). There was no significant interaction between prior MI and OSA for MACCE (interaction P = 0.14). ConclusionsOSA was independently associated with an increased risk of MACCE among ACS patients, particularly among ACS patients with prior MI. Further trials exploring the efficacy of OSA treatment in high-risk patients with ACS characterized by prior MI are warranted.

Outcomes of patients with acute coronary syndrome according to COVID-19 vaccination status.

COVID-19 vaccination has been associated with reduced risk of acute coronary syndrome (ACS); however, several studies have reported cardiovascular complications following vaccination. We aimed to investigate the effect of COVID-19 vaccination status on the treatment and outcome of ACS patients. The study was based on the 2021 Acute Coronary Syndrome Israeli Survey. Patients were stratified into two groups according to COVID-19 vaccination status, vaccinated compared to unvaccinated. Patients who had received at least 2 vaccination doses up to 1 week prior to ACS hospitalization were considered vaccinated. The primary endpoint was 1-year all-cause mortality. A total of 1261 patients with ACS were included, of whom 990 (78.5%) were vaccinated. Vaccinated patients were older and less frequently smokers. There were no significant differences in coronary reperfusion rates and treatment with guideline-based medical therapy during hospital stay and at discharge. The primary endpoint of 1-year all-cause mortality occurred in 38 (3.8%) and 14 (5.2%) patients in the vaccinated and unvaccinated groups respectively (P = 0.42). 30-day MACE occurred in 94 (9.5%) in the vaccinated patients compared to 31 (11.5%) in the unvaccinated group (P = 0.39). These results remained similar following adjustment for confounders. There was no association between COVID-19 vaccination status and the outcomes of patients with ACS. Our findings provide support for the cardiovascular safety of COVID-19 mRNA vaccines in patients at high cardiovascular risk.

Risk stratification and predictive value of serum sodium fluctuation for adverse prognosis in acute coronary syndrome patients

BackgroundSerum sodium fluctuation (SF) as an indicator of the extent of changes in serum sodium is associated with increased mortality in hospitalized patients. However, there is no consensus on diagnostic criteria for SF, and its impact on the outcome of patients with acute coronary syndrome (ACS) remains uncertain. We defined SF and assessed its association with adverse prognosis in hospitalized ACS patients. MethodsPatients diagnosed with ACS were consecutively recruited. The serum SF rate (SFR) was defined as the ratio of the difference between the highest and lowest serum sodium levels during hospitalization to the initial serum sodium level on admission. The Cox proportional hazards model was performed to evaluate the association between SFR and mortality. The dose–response relationships of SFR with mortality was characterized by restricted cubic splines (RCS) model. The predictive performance of SF for mortality was assessed by the area under the receiver operating characteristic curves (AUCs). ResultsThe study retrospectively enrolled 1856 ACS patients, of which 36 (1.94%) patients dead within 1 year. Multivariate Cox analysis showed that SFR was independently associated with higher risk of 1-year mortality (HR = 1.17, 95% CI: 1.111–1.244, P < 0.001). RCS analysis showed the optimal threshold for SFR was 5%, and the 1-year cumulative mortality was higher in the abnormal SF group (SFR ≥ 5%) compared with the normal SF group (SFR < 5%, P < 0.01). The AUCs of SF for predicting mortality within 1 month, 6 months, and 1 year were 0.842 (95% CI: 0.781–0.904), 0.830 (95% CI:0.736–0.926), 0.703 (95% CI:0.595––0.811), respectively. Even in patients with normal baseline serum sodium, abnormal SF group demonstrated a significantly higher 1-year mortality compared to normal SF group (HR = 4.955, 95% CI: 1.919–12.795). ConclusionThe SFR during hospitalization is an adequate predictor of adverse outcomes in ACS patients, independent of serum sodium level at admission. Additional research is warranted to ascertain whether interventions targeting SF confer measurable clinical benefits.

Impact of Coexisting Risk Factors on Outcomes in Patients with Acute Coronary Syndrome: A Real-World Analysis Using the Taiwan Chang Gung Research Database.

BACKGROUND Diabetes mellitus (DM), chronic kidney disease (CKD), and advanced age are associated with poor outcomes in patients with acute coronary syndrome (ACS). This real-world study utilized data from the Taiwan Chang Gung Research Database (CGRD) to compare outcomes in ACS patients with DM, CKD, and the elderly. MATERIAL AND METHODS The study enrolled 28,613 ACS patients diagnosed based on CGRD medical records between January 2005 and December 2019. Baseline characteristics and clinical outcomes were compared among groups based on patient characteristics. RESULTS Within the ACS cohort, 42.1% had DM, 48.2% had CKD, and 33.6% were elderly. Among them, 10.7% (3,070) were elderly patients with both DM and CKD. Elderly patients with DM and CKD had significantly higher risks of gastrointestinal bleeding (hazard ratio=11.32), cardiovascular events (HR=7.29), and all-cause mortality (HR=8.59). Patients with three or at least two of these risk factors had a 2.20-2.99-fold increased risk of recurrent ACS during the three-year follow-up period. CONCLUSIONS Patients with the combination of DM, CKD, and advanced age (elderly) experienced an 11.32-fold increased risk of gastrointestinal bleeding, 7.29-fold increased risk of cardiovascular events, and 8.59-fold increased risk of all-cause mortality compared to those without these risk factors. Furthermore, patients with two or more of these risk factors had a 2- to 3-fold increased risk of recurrent ACS. These findings emphasize the importance of managing multiple risk factors in ACS patients to improve outcomes.

The predictive value of atherogenic index of plasma for cardiovascular outcomes in patients with acute coronary syndrome undergoing percutaneous coronary intervention with LDL-C below 1.8mmol/L

BackgroundThe potential predictive significance of atherogenic index of plasma (AIP) for cardiovascular outcomes in patients with acute coronary syndrome (ACS) and who have undergone percutaneous coronary intervention (PCI), with low-density lipoprotein-cholesterol (LDL-C) below 1.8mmol/L, has not been well explored.MethodsThe retrospective cohort analysis included 1,133 patients with ACS and LDL-C levels below 1.8mmol/L who underwent PCI. AIP is calculated as log (triglyceride/high-density lipoprotein-cholesterol). Patients were divided into two groups according to the median value of AIP. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCEs), a composite of all-cause death, nonfatal myocardial infarction, ischemic stroke or unplanned repeat revascularization. The association between AIP and the prevalence of MACCE was evaluated using multivariable Cox proportional hazard models.ResultsOver a median follow-up of 26 months, the incidence of MACCE was higher in the high AIP group compared to the low AIP group (9.6% vs. 6.0%, P log-rank = 0.020), and the difference was mainly derived from an increased risk of unplanned repeat revascularization (7.6% vs. 4.6%, P log-rank = 0.028). After adjusting for multiple variables, elevated AIP was independently associated with an increased risk of MACCE, regardless of whether AIP was considered a nominal or continuous variable (hazard ratio [HR] 1.62, 95% confidence interval [CI] 1.04–2.53 or HR 2.01, 95% CI 1.09–3.73).ConclusionsThe present study demonstrates that AIP is a significant predictor of adverse outcomes in ACS patients undergoing PCI with LDL-C < 1.8mmol/L. These results suggest that AIP may offer supplementary prognostic information for ACS patients with optimally managed LDL-C levels.

Comparison of Characteristics among Suspected ACS Patients by Normal and Elevated Hs-Troponin Levels

Background: Acute coronary syndrome (ACS) is a life-threatening condition that requires prompt diagnosis and treatment. However, some patients with ACS may have normal levels of high-sensitivity cardiac troponin (hs-cTn), a biomarker of myocardial injury, at presentation. This study aimed to compare the characteristics and outcomes of ACS patients with normal and elevated hs-cTn levels using different assays and thresholds. Material &amp; Methods: This 2-year retrospective observational study was conducted in Bangladesh, using data from hospital records of 420 suspected ACS patients. Patients were divided into two groups based on their Hs-Troponin levels, with group 1 having 60 patients with Hs-Troponin ≤0.014 ug/L, and group 2 having 360 patients with Hs-Troponin &gt;0.014 ug/L. Patients less than 18 years old and those with incomplete records were excluded. Ethical approval was obtained, and SPSS v.25 was used for analysis. Results: Group 1 had a significantly younger mean age of 41.8±14.3 compared to Group 2’s mean age of 68.4±12.6, with a p-value less than 0.001. Group 2 had a higher percentage of male patients (70.56%) compared to Group 1 (31.67%), with a p-value of less than 0.01. Group 2 had a significantly higher mean heart rate of 80.18±20.64 beats per minute compared to Group 1’s mean heart rate of 71.02±12.21, with a p-value less than 0.001. There were no significant differences between the two groups in terms of systolic blood pressure, diastolic blood pressure, BMI, history of smoking, history of AMI, hypertension, and diabetes mellitus. Group 1 had a significantly lower percentage of patients with hypercholesterolemia (55.00%), but a higher percentage of patients with a history of ACS (25.00%), and a family history of CAD (70.00%) compared to Group 2, with p-values less than 0.001. Group 2 had a significantly higher percentage of patients with known renal failure (21.67%) compared to Group 1 (1.67%), with a p-value less than 0.001. Creatinine levels were significantly higher in Group 2 (98±53 µmol/L) compared to Group 1 (76±17 µmol/L) with a p-value of less than 0.001, and eGFR was significantly lower in Group 2 (76±27 mL/min/1.73 m2) compared to Group 1 (97±23 mL/min/1.73 m2) with a p-value of less than 0.001. The cardiac Troponin T (cTnT) levels were significantly higher in Group 2 (0.28±1.68 ug/L) compared to Group 1 (0.01±0.01 ug/L) with a p-value of less than 0.001, indicating worse kidney function and cardiac damage in Group 2 compared to Group 1. Conclusion: The study found that very few patients presenting with ACS symptoms had normal Hs-Troponin levels, and ultimate diagnosis proved that they did not have ACS, indicating the usability of Hs-Troponin as a biomarker for ACS. Significant differences were observed in age, gender, heart rate, hypercholesterolemia, family history of ACS, family history of CAD, and renal failure between the two groups. The study also found a consistent association between elevated creatinine levels and lower eGFR with higher Hs-Troponin levels.

Frequency Of CRP Levels In Patients Presenting With Acute Coronary Syndrome

Myocardial necrosis is thought to be the etiology of acute coronary syndrome (ACS) and elevated CRP levels in the first 12 hours after an intervention is linked to a higher risk of cardiovascular recurrence and death. Objectives: To evaluate if CRP has any predictive value in predicting cardiovascular outcomes in ACS patients. Methods: We conducted a cross-sectional study at Jinnah Post Graduate Medical Centre from Oct 2021 to March 2022. 117 patients of both gender aged between 40 to 80 years, presenting with chest pain were included in the study. Data were analyzed on SPSS Version 25. Chi-square was used to compare the outcomes of both groups. The age and gender were stratified to control the effect modifiers. The p-value of &lt;0.05 was considered significant. Results: There were a total of 117 patients enrolled in this study. Among them, there were 63 (53.85%) males, and 79 (67.52%) were above 60 years of age. There were 90(76.92%) patients who had a raised CRP level, and 78 (66.67%) had a duration of ACS &gt; 12 hours. Differences between the duration of elevated CRP and non-elevated CRP were statistically significant (p-value = 0.013). Conclusions: CRP levels may be indicative of suspected acute coronary syndrome. Physicians can identify such patients and provide them with more intensive health care and cardiac management. Resources are scarce in the developing world. Having such tools that are more economical can help with the diagnosis and provide better care.

Treatment Outcomes of Acute Coronary Syndrome Patients in Bangkok Dusit Medical Services (TOACS-BDMS)

OBJECTIVES: The research team analyzed an acute coronary syndrome (ACS) registry from a private hospital group in Thailand. We aimed to analyze patients’ characteristics, treatment outcomes in ACS patients and compare the outcomes between ST segment elevation acute coronary syndrome (STE-ACS) and non-ST segment elevation acute coronary syndrome (NSTE-ACS). MATERIALS AND METHODS: This is a multi-centered, retrospective review of an ACS registry with seven participating hospitals carried out between January 2017 to December 2020. Web-based data entry was used, and the data were centrally managed and analyzed. RESULTS: A total of 2,024 ACS patients were included. Of these, patients were predominantly male (81.07%), NSTE-ACS 52.17% and the mean age was 62.27 ± 13.08 years. Diabetes mellitus (DM), hypertension (HT), dyslipidemia, and current smokers were observed in 25.24%,54.89%,46.64% and 30.38%, respectively. Reperfusion rate in STE-ACS was 93.20 % and 73.80% was primary percutaneous coronary intervention (PCI). STE-ACS patients were significantly younger (59.03 ± 12.27 vs. 65.24 ± 13.09 years),more current smokers (39.77% vs. 21.78%), more cardiogenic shock (15.28%vs. 3.03%) and more cardiac arrest before reperfusion therapy (9.71% vs.1.79%). Meanwhile, NSTE-ACS patients presented significantly more DM(30.58% vs. 19.42%), HT (62.40% vs.46.69%), and dyslipidemia (53.78%vs.38.84%). In-hospital mortality rate was 2.91% and significantly higher in STE-ACS (STE-ACS 4.95% vs. NSTE-ACS 1.04%). CONCLUSION: Treatment outcomes of ACS patients in Bangkok Dusit Medical Services revealed high reperfusion rate and resulted in low inhospital mortality rate. STE-ACS patients were more severe and with a higher mortality rate compared to NSTE-ACS patients.