Patients Of ACS Research Articles

NT-proBNP as a Predictive Biomarker for Contrast-Induced Nephropathy in ACS Patients Undergoing Coronary Angiogram – An Observational Study

Objectives: 1. To assess the value of baseline NTproBNP at admission and to determine the levels of serum creatinine at 48 hours and 72 hours after procedure for evidence of contrast-induced nephropathy (CIN) for patients undergoing CAG. 2. To evaluate the relationship between the values of NTproBNP and evidence of CIN. Materials and Methods: This is an observational study performed between June 2021-November 2021 at Nizams Institute of Medical Sciences in 75 patients diagnosed with ACS. we assessed the role of nt pro bnp as a predictive biomarker for diagnosis of contrast induced nephropathy in patients of ACS undergoing coronary angiography. Serum creatinine is repeated at 48 h post procedure and compared to baseline. Results: Spearman’s correlation test was used to assess the correlation between NT-proBNP values and ejection fraction on the 2D echo. The rho value (-0.69) was suggestive of a strong negative correlation. P value & lt; 0.001 making it statistically significant. Simple linear regression analysis was used to predict the NT-proBNP levels by ejection fraction percentage among study patients, it showed that, for every 1% decrease in ejection fraction, the NT-proBNP levels will significantly increase by 102.90 pg/mL at P and lt; 0.001. Wilcoxon Signed Rank test was used to compare the baseline serum creatinine values with 48/72 h serum creatinine values after undergoing angiography with contrast, incidence of acute kidney injury (AKI) as shown by the resulting P value was and lt; 0.001, thus statistically significant. The ROC curve analysis to establish the association between NT-proBNP as a marker for incidence of AKI (CIN) shows shows that, NT-proBNP cut off and gt;1670 pg/mL has a sensitivity of 81.82% and specifity of 98.44% and is statistically significant with P value and lt; 0.001. Conclusion: It was observed that NT-proBNP >1670 pg/mL prior to the procedure, was significantly associated with the risk of development of contrast induced nephropathy. Measurement of serum NT-proBNP pre procedure aids in identifying at risk population for developing CIN.

Evaluation of Biomarkers in Patients of ACS

Millions of patients present annually with chest pain, but only 10% to 15% have myocardial infarction. Lack of diagnostic sensitivity and specificity of clinical and conventional markers prevents or delays treatment and leads to unnecessary costly admissions. Comparative data are lacking on the new markers, yet using all of them is inappropriate and expensive. The older markers like aspartate amino-transferase, creatine kinase, lactate dehydrogenase etc. lost their utility due to lack of specificity and limited sensitivities. Cardiac troponin levels but negative CK-MB who were formerly diagnosed with unstable angina or minor myocardial injury is now reclassified as non–ST-segment elevation MI (NSTEMI) even in the absence of diagnostic ECG changes. CK-MB is both a sensitive and specific marker for myocardial infarction. Cardiac troponin T is a cardio-specific, highly sensitive marker for myocardial damage. Cardiac troponin I is a contractile protein exclusively present in the cardiac muscle. The absolute cardiospecificity of cTnI allows the diagnosis of myocardial infarction distinct from muscle lesions and non-cardiac surgery.

Nationwide frequency, risk and outcomes of type-2 myocardial infarction in patients with versus without previously revascularized myocardial infarction (type 1)

Abstract Funding Acknowledgements Type of funding sources: None. Background Type 2 myocardial infarction (T2MI), due to a mismatch between myocardial oxygen demand and supply, is being increasingly recognized with improved diagnostics. The upsetting concern of developing T2MI in patients with prior revascularized occlusive acute myocardial infarction (AMI) or type 1 MI (T1MI) makes it crucial to define the clinical profile and outcomes of T2MI in revascularized patients of ACS. Purpose To determine the risk and prognosis of T2MI in patients who had previously had coronary revascularization (PCI or CABG) Methods We used the National Inpatient Sample (2018) dataset from the United States to identify T2MI adult hospitalizations using ICD-10 codes and define our study arm as T2MI excluding secondary T1MI diagnoses but having prior revascularized (with percutaneous coronary intervention or coronary artery bypass grafting) AMI. We then compared demographics and comorbidities in T2MI cohort with vs without personal history of revascularized AMI. We used multivariate analysis to study the odds of T2MI hospitalizations with prior revascularized AMI and in-hospital outcomes (all-cause mortality, cardiogenic shock and resource utilization) adjusting for confounders. Results There were 33155 T2MI adult hospitalizations after excluding AMI (median age 71 years, 50.6% male, 67.3% white); 1435 (4.3%) had previously revascularized AMI. T2MI in the study arm had higher chances of hospitalization with prior revascularized AMI when adjusted for socio-demographics (aOR 6.92, 95% CI:6.50-7.36, p<0.001) and socio-demographics with comorbidities (aOR 5.70, 95%CI: 5.48-5.94, p<0.001) (Table 1). Study arm often had elderly (≥65 years old, 78.4% vs 65.8%), male (66.6% vs 49.9%), white (76.7% vs 66.9%), upper socio-economic class (20.2 vs 16.8%), patients who were often admitted to non-electively (99.3 vs 97.1%) and to rural (10.5 vs 9.3%) hospitalizations compared to control arm. The study arm had a significantly higher prevalence of diabetes mellitus, hyperlipidemia, peripheral vascular disease, chronic obstructive pulmonary disease, renal failure, deficiency anemias, prior TIA/stroke, depression and smoking. T2MI cohort with prior revascularized AMI did not show any significant association with in-hospital all-cause mortality (1.7 vs 3.0%, aOR 0.49, 95%CI 0.18-1.34, p=0.164) and cardiogenic shock (1.7% vs 2.1%, p=0.399) however, had lower hospital expenditure (median USD 31273 vs 36567) and fewer transfers to other facilities (19.5 vs 22.1%) than those without prior revascularized AMI (Table 2). Conclusion Population-based analysis of this nationally representative sample revealed up to six times higher risk of developing T2MI in patients with prior history of AMI (revascularized) but without any significant impact on all-cause in-hospital mortality or cardiogenic shock. Future studies are warranted to assess the short-term/long-term outcomes of T2MI in high risk patient population with previously revascularized AMI.

Role of Vitamin D Supplementation in Improving Cytokine Profile in Patients of Non-ST-Elevation Acute Coronary Syndrome.

Sub endothelial infarcts leads to non-ST-elevation acute coronary syndrome. Proinflammatory cytokines are raised in serum, the severity of which is a poor prognostic sign. Vitamin D deficiency is prevalent among patients of ACS. Vitamin D has immunomodulatory roles having effects on various aspects of inflammation. A total of 40 patients were divided into experimental (n=20) and control (n=20) groups. Experimental group was given single dose of vitamin D 200,000 IU. They were assessed for baseline C-reactive protein, interleukin-6, tumor necrosis factor-α levels by using sandwich ELISA technique. Four months after intervention resampling was done for the same parameters. Findings were expressed as mean±SD. Independent sample t-test was used to compare effect of vitamin D intervention between control group and intervention group. p-value of ≤0.05 was considered to be significant. The serum C-reactive protein showed significant reduction (p=0.028*) after intervention with vitamin D. Serum interleukin-6 (p=0.848), tumor necrosis factor-α (p=0.20) were decreased non-significantly in experimental as compared to the control group. It was concluded that a single large dose of vitamin D was able to reduce the C-reactive protein in non-ST-elevation acute coronary syndrome patients while non-significant reductions in interleukin-6 and tumor necrosis factor-α were observed.

Observational study of Covid-19 patients presenting with acute coronary syndrome at a tertiary care center in India

Abstract Aim Patients with Covid-19 are theoretically at a higher risk of ACS, as respiratory infections can often lead to coronary endothelial damage and plaque rupture. Initial reports during start of pandemic suggested decrease in STEMI patients, however this has been explained by iatrophobia rather than actual decrease. Data on pathophysiology and outcome of patients presenting with ACS is scarce. We did a prospective observational study to study epidemiology and outcomes of Covid-19 patients with ACS. Methods A total of 654 patients were admitted with Covid-19 at PGIMER, Chandigarh from August 2020 to February 2021, 35 (5.3%) consecutive patients of ACS were enrolled into the study. Acute myocardial infarction was defined as per fourth universal definition of myocardial infarction. Diagnosis of Covid-19 was established using RT-PCR from nasopharyngeal swab. Angiographic assessment was done by two interventional cardiologists. Results Mean age of patients was 59.5±11.8 years, males comprised majority (80%) of study group. Most common risk factor was hypertension seen in around 70% followed by DM in 57% patients. Most common symptom at presentation was rest angina seen >90% while history of fever was present in only 31.4%. STEMI was most common ACS seen in 45.7% followed by USA in 23% patients. CS was present in 15% patients at presentation while another 5% developed shock in hospital. Oxygen requirement was required in over half the patients while 25% patients succumbed to illness in hospital.Thrombolysis was done in half the patients of STEMI. In view of Covid-19 disease 71.4% required dexamethasone and remdesivir. Coronary angiography was done in around 20% patients, which revealed obstructive CAD in 83% patients with 60% patients having 100% occlusion of IRA. Percutaneous intervention was done in 66% patients. Hypoalbuminemia was commonly seen patients with mean albumin of 3.3 gm/dL. Low T3 syndrome was most common thyroid function abnormality seen in 37.1%.On univariate analysis age, BNP levels and albumin were able to predict 30-day mortality. Conclusion ACS can be first presentation of patients with Covid-19 as shown by our study only 30% patients had prior history of fever. Our data reaffirms that patients with Covid-19 and ACS have worse prognosis. Interestingly mortality in our study was comparable to western study, despite low rate of angiography and intervention thus underscoring individualization of therapy. We believe Type-2 myocardial infarction is common in pathophysiology of patients who benefit most from medical therapy. Funding Acknowledgement Type of funding sources: None.

Estimation of gamma-glutamyl transferase with acute coronary syndrome

Introduction: Cardiovascular diseases (CVDs) are the leading cause of mortality in India attributing to a quarter of all mortality. Despite spectacular progress in disease prevention, detection and treatment over the last three decades; more CV deaths are caused by ischemic cardiac events. Considering the early mortality rate from acute myocardial infarction (AMI) (30-day), still, death from CVD Carries a higher burden. In several patients, the progressive phenomena of cardiac failure leading to ischemic cardiomyopathy reflects the burden of underlying coronary artery disease. Thus, identification of at risk patients who may be prone for future heart failure after the first myocardial infarction and detection of the extent of future heart failure is the cornerstone of secondary prevention strategies. This might help in prospective treatment in decreasing morbidity and mortality from heart failure following AMI. Aim & Objective: To study the correlation between the rise in GGT levels and different subsets of Acute Coronary Syndrome. To study the correlation between GGT and the Risk of Major Adverse Cardiovascular Events (MACE). Materials and Methods: This is a cross-sectional study conducted at Rajah Muthiah Medical College and Hospital. After obtaining clearance from institutional research and ethical committee, informed consent was obtained and patients of ACS in our CCU were selected. Using a standardized method GGT levels were measured and patients were followed up for five days in the hospital for adverse events. This study was done for some time between November 2019 to October 2021 and 75 patients with diagonized ACS were included. Results and Observations: In this study, there is a significant correlation between the presence of LV dysfunction and high GGT values. Serum levels of GGT were significantly higher in both the ST-elevation-MI and Non-ST-elevation-MI patients but not in unstable angina patients. The patients who suffered complications has a mean GGT Value of 90.22. (IU)/L (SI units). The mean value for patients without MACE is significantly less than 46.44 (IU)/L (SI units). Conclusion: Gamma-glutamyl transferase levels were significantly elevated above normal in cases of acute coronary syndrome. GGT levels were independently correlated with STEMI and NSTEMI but it did not correlate with unstable angina. There is a significant correlation between GGT levels and the incidence of left ventricular systolic LV dysfunction. The mean value of GGT was significantly higher in patients who suffered from major cardiovascular complications.

Clinical and electrocardiographic profile of patients presenting with acute coronary syndrome in emergency department in a Tertiary Care Hospital.

Objectives: To assess the clinical characteristics and diagnosis of ACS for timely, management and further prevention from coronary events. Study Design: Cross sectional study. Setting: Emergency Department (ED) of Punjab Institute of Cardiology (PIC) Lahore. Period: November 2017 to January 2018. Material & Methods: Included 170 diagnosed patients of ACS of both sexes presenting within approximately four hours of symptoms. At presentation ECG and initial blood samples were taken from all patients for base line and Troponin T estimation. All the patients included in the study were properly examined and complete history was taken. Blood samples of patients for diagnosis of NSTEMI were also drawn at 8hrs of arrival. The patients were categorized into STEMI, NSTEMI and UA on the basis of history, ECG and cardiac Troponin T. Results were analyzed statistically. A p-value ≤ 0.05 was considered statistically significant. Results: A total of 170 patients with established diagnosis of ACS were included. The mean age of the patients was 56 years. There was a very strong male predominance (81.76%). The major modifiable risk factors were hypertension (54.71%) and smoking (35.88%), followed by hyperlipidemia (35.29%) and diabetes (32.35%). A previous history of IHD in patients and family history of IHD were equally present (37.65%). A large proportion of patients belonged to middle class (54.12%) and lower (41.18%). Typical pain chest pain was present in 90% and majority of patients enrolled in this study had a diagnosis of myocardial infarction 77.05% and the remainder had unstable angina. We found a higher percentage of ST elevation MI in the patients with MI (84.73%), majority had anterior AMI. Of all patients, 1.77% expired during hospital stay. Conclusion: The majority of ACS patients in our country are male with STEMI. The major risk factors are hypertension, family history of IHD, smoking, hyperlipidemia and diabetes. 90% patients present with typical chest pain while remaining 10% atypical symptoms which must be of prime consideration to assess ACS.

METABOLIC SYNDROME IN PATIENTS OF ACUTE CORONARY SYNDROME

Objective: To determine the prevalence of metabolic syndrome (MetS) in patients of acute coronary syndrome. Methodology: This cross-sectional study was conducted in department of cardiology, CPE institute of cardiology Multan. A total of 150 patients of ACS who were admitted in the hospital from Oct-2018 to March-2019 were included. Patients demographics, reason for admission in hospital were noted. Waist circumference, body mass index (BMI), serum lipid profile, and fasting blood sugar was measured in all patients. Results: Metabolic syndrome (MetS) was diagnosed in 53 (35.3%). Frequency of heart failure was lower in Non-MetS group; 17 (17.5%) versus 15 (28.3%) in MetS group (p-value 0.12). STEMI was 10 (18.8%) in MetS group whereas it was 28 (28.8%) in Non-MetS group (p-value 0.18). Arrhythmias occurred in 5 (9.4%) in MetS group; as compared to 5 (5.15%) in Non-MetS group (p-value 0.32). Conclusion: The prevalence of MetS in present study was 35.3% and these patients were mostly female and obese. These were more likely admitted because of heart failure and arrhythmias. Key Words: Metabolic syndrome, Acute coronary syndrome, heart failure, myocardial infarction

Correlation of Hemoglobin & C-Reactive Protein Levels with In-hospital Outcome of Patient with Acute Coronary Syndrome

Background: Haemoglobina and CRP level may be related with the in-hospital outcome of acute coronary syndrome patients.
 Objective: The purpose of the present study was to correlate haemoglobin and CRP level with in-hospital outcome of patient with acute coronary syndrome.
 Methodology: This cross-sectional study was conducted in the Department of Cardiology at Mymensingh Medical College, Mymensingh, Bangladesh from December 2010 to November 2011 for a period of two (02) years. Patients of ACS who were presented within 12 hours of chest pain were included as study population. Study population were categorized in four groups according to the level of hemoglobin and C-reactive protein. Blood sample was collected for baseline laboratory investigations.
 Result: The mean age of the population was 52.18±8.88 years. Arrhythmia was more common in Group 1 which was 5(71.4%) cases and 6(46.2%) cases in VT and AF respectively. Arrhythmia was significantly correlated with age, sex, diabetes mellitus & CRP. Death was significantly correlated with age, diabetes mellitus, hypertension & CRP. Heart failure was significantly correlated with family history of IHD, CRP & Hemoglobin. Bleeding was only significantly correlated with CRP. No significant association was revealed between the types of arrhythmia and age, sex, smoking, diabetes, dyslipidaemia, family history of IHD and hypertension (P = 0.087). Only heart failure was strongly and significantly correlated with hemoglobin level (p=0.000). Bleeding (p=0.003), heart failure (p=0.022) and death (p=0.016) were significantly correlated with CRP level.
 Conclusion: In conclusion there is a correlation of haemoglobin and CRP level with in-hospital outcome of patient with acute coronary syndrome.
 Journal of Science Foundation 2019;17(1):3-8

Identification of risk factors of acute coronary syndrome in young patients between 18-40 years of age at a teaching hospital.

Objectives:To identify the risk factors in acute coronary syndrome.Methods:It was a case series study, conducted in coronary care unit of Jinnah Hospital, Lahore from January to December 2018. Convenient sampling was used for patients’ selection. The serum cardiac enzymes level was measured, and serial ECG was done at admission and repeated if required. Blood samples were collected after an overnight fast of 14 hours and tests were done for total cholesterol and HDL cholesterol.Results:Out of 300 patients of acute coronary syndrome, 100 (33.33%) were female and 200 (66.67%) were males. Majority of patients 180 (60%) belonged to age group of 25-40 years. Out of 300 patients 94 (31.33%) had diabetes mellitus, while 139 (46.3%) were suffering from hypertension. Out of 290 patients 95 (32.7%) had family history of coronary artery disease. Out of 298 patients 125 (41.9%) were smokers.Conclusion:Acute coronary syndrome in age group of 18- 40 Years showed a male predominance with major modifiable risk factors; Hypertension followed by Diabetes mellitus, smoking and Dyslipidemia. Positive family history a non-modifiable risk factor in patients of ACS was also a common finding.

Association of Haemoglobin and C-Reactive Protein level with Different Risk Factors among Acute Coronary Syndrome Patients

Background: Different risk factors may be related with the haemoglobin and CRP level among the acute coronary syndrome patients.
 Objective: The purpose of the present study was to see the association of haemoglobin and CRP level with different type of risk factors among the acute coronary syndrome patients.
 Methodology: This cross-sectional study was conducted in the Department of Cardiology at Mymensingh Medical College, Mymensingh, Bangladesh from December 2010 to November 2011 for a period of two (02) years. Patients of ACS who were presented within 12 hours of chest pain were included as study population. Study population were categorized in four groups according to the level of hemoglobin and C-reactive protein. Age, cardiovascular risks factor, history, family history of cardiovascular disease, treatment history and ECG were taken during admission. Blood sample was collected for baseline laboratory investigations like Troponin-I, Random Blood Sugar (RBS), Blood urea, Serum creatinine, lipid profile, Hemoglobin & CRP level. Sample were then send to standard laboratory/Biochemistry department of MMCH.
 Result: The mean age of the population was 52.18±8.88 years. Smoking was the highest percentage in Group 1 which was 54(50.0%) cases (P=0.001). Hypertension was found most common in group 1 (47.6%), Group 2 (33.3%), Group 3 (10.7%) and Group 4 (8.3%). Smoking (p=0.001) and hypertension (p=0.016) was found statistically significant. Diabetes was found in Group 1 (37.7%), Group 2 (43.5%), Group 3 (11.6%) and Group 4 (7.2%). Group 1 (50%) and Group 2 (50%) patients were dyslipidaemic. Family history of IHD was present group-1 (36.8%), Group 2 (44.7%), Group 3 (73.2%) and Group 4 (53%). Among the smoker patient 65.6% cases had CRP level ˃12 mg/l; 39.8% cases had CRP level ˂12mg/L. Among the nonsmoker 34.4% cases had CRP level ˃12mg/l and 60.2% cases had CRP level ˂12mg/L. The finding was statistically significant.
 Conclusion: In conclusion haemoglobin and CRP level is associated with different type of risk factors among the acute coronary syndrome patients.
 Journal of National Institute of Neurosciences Bangladesh, 2019;5(2): 156-160

Relationship of Haemoglobin and C Reactive Protein level with Different Types of Heart Failure Patients

Background: Initial level of haemoglobin and CRP level is important issue among the different type of heart failure patients for their in-hospital outcomes.
 Objective: The purpose of the present study was to see the relationship of haemoglobin (Hb) and CRP level with different types of heart failure patients.
 Methodology: This cross-sectional study was conducted in the Department of Cardiology at Mymensingh Medical College, Mymensingh, Bangladesh from December 2010 to November 2011 for a period of two (2) years. Patients of ACS who were presented within 12 hours of chest pain were included as study population. Study population were categorized in four groups according to the level of hemoglobin and C-reactive protein. Blood sample was collected for baseline laboratory investigations like Troponin-I, random blood sugar (RBS), blood urea, serum creatinine, lipid profile, Hemoglobin and CRP level. Sample were then send to standard laboratory/Biochemistry department of MMCH.
 Result: The mean age of the population was 52.18±8.88 years. Statistically non-significant mean age difference among the groups. Significant difference of mean left ventricular (LV) ejection fraction was found among the groups (p=0.005). Maximum patient in group 1 (48.5%) had ejection fraction in the range of 40 to 50%, compare to group 2(32.0%), group 3 (11.1%) and group 4 (5.8%). The heart failure was statistically significant in Killip class I (p=0.000) and Killip class II (p=0.000).
 Conclusion: In conclusion haemoglobin and CRP level of acute coronary syndrome patients is statistically significantly associated with different types of heart failure
 Journal of Current and Advance Medical Research 2019;6(2):101-105

Association of Myosin Light Chain 2 (MLC 2) with Troponin-I and Ejection Fraction in patients with Acute Coronary Syndrome

Background: Acute coronary syndrome (ACS) is a major health problem and represents a large number of hospitalizations annually. Myosin light chain (MLC2)isasensitive early marker (within four hours) of ACS that can be used to confirm or exclude a diagnosis of acute cardiac condition. The present study was undertaken for rapid diagnosis ACS with the help of elevated MLC-2and its relation with Troponin I and ventricular ejection fraction.Method: In this cross sectional study,60 patients ofACS were enrolled from coronary care unit (CCU), BIRDEM as case and 25 apparently healthy people from cardiac point of view as control. Selection of patients was done according to the inclusion and exclusion criteria.MLC-2was measured(within 3-4 hours by ELISA method and level of ventricular dysfunction and troponin I (in ACS group) was taken from hospital records.Results: The mean ± SEM of MLC-2 was higher in the ACS group (88.02±18.0 pgm/ml) compared to the healthy control group (41.4±2.2 pgm/ml) and difference was statistically significant (p<0.05). The inverse correlation between MCL-2 and ejection fraction was highly significant (r=-0.647, p=0.001). The correlation with MLC-2 and troponin I was also significant (r=0.831, p=0.01).Conclusion: Statistically significantMLC2level was found in the ACS group than the healthy control group. Positive correlation was also observed between MLC-2 with Troponin I and ventricular dysfunction. Therefore, MLC 2 may be used as a biomarker early diagnosis of ACS.Bangladesh Crit Care J March 2017; 5(1): 37-41

Safety of Prasugrel in Indian patients – Multicentric registry of 1000 cases

BackgroundClopidogrel has been the only available antiplatelet drug used along with aspirin in patients of ACS. In recent years 2 new antiplatelet drugs (Prasugrel and Ticagrelor) have become available. Prasugrel in the dose of 10 mg OD has been found to be more efficacious but with increased risk of major bleeding. For this reason it has not gained widespread usage in ACS patients undergoing PCI. There are no systematic data on the use of Prasugrel in Indian population. MethodThis is a prospective, multicentric, hospital registry of 1000 patients with ACS undergoing PCI who were administered Prasugrel. The primary safety endpoint of this study was major and minor bleeding while the efficacy endpoint is the composite of CV death, nonfatal MI, nonfatal stroke up to 30 days after PCI. Patients with high bleeding risk were excluded. ResultsMost patients (91%) received loading dose of Prasugrel along with the maintenance dose getting according to the defined protocol. Patients were followed up to 30 days post procedure. Primary efficacy end point was reached in 3 patients only with two of them dying due to possible stent thrombosis and the third requiring revascularization of the target vessel for stent thrombosis. One major and 19 minor bleeding complications were recorded, with access site bleeding in 0.7% & non-access site bleeding in 1.2% of the subjects. ConclusionPrasugrel was found to be effective & not associated with a high incidence of bleeding in the high risk ACS patients when those at a high bleeding risk were excluded.

CHAMPION PHOENIX Trial

Objective: The purpose of the study was to investigate the efficacy and safety of an intravenous ADP antagonist cangrelor, in the management of ischemic heart disease patients going for PCI. Background: Oral P2Y12 antagonist, clopidogrel has problems of slow onset of action and erratic absorption, difficulty in administering to patients unable to swallow (intubated, drowsy, sedated). Its long duration of action makes it more prone to cause increased risk of bleeding, especially in emergent CABG situations. Cangrelor, a new intravenous agent is likely to be safer and efficacious in these respects. Methods: The study was planned in 153 centers in 12 countries, randomizing 10,900 patients of Stable Angina, NSTE ACS or STEMI, who were planned for PCI. Patients were randomized in a double blind, double dummy manner. Patients were randomized to either IV cangrelor or oral clopidogrel 600 mg or 300 mg followed by maintenance dose clopidogrel. The primary efficacy endpoint (PEP) was death, myocardial infarction (MI), Ischemia Driven Revascularization (IDR), and stent thrombosis (ST) at 48 h as well as 30 days. The secondary end points included individual components of the PEP as well as stent thrombosis. Safety endpoint was GUSTO severe bleeding at 48 h. Results: The PEP was seen in 4.7% in cangrelor group while 5.9% in clopidogrel group OR 0.78 (0.66–0.93) p = 0.005. Stent thrombosis was 0.8% in cangrelor group while 1.4% in clopidogrel group OR 0.62 (0.43–0.90) p = 0.01. There was no difference in IDR, death or cardiac death. At 30 days, the benefits of cangrelor persisted with PEP 0.85 (0.73–0.99) p = 0.03; and ST 0.68 (0.50–0.92) p = 0.01. There was no significant increase in GUSTO major bleeding with cangrelor OR 1.5 (0.53–4.22) p = 0.44 NS. Conclusion: Intravenously administered cangrelor reduced primary efficacy end point of death, MI, IDR, ST in a variety of CAD patients (Stable angina, NSTEMI ACS, STEMI) by 22% in the background of PCI compared to clopidogrel loading. This benefit persisted over 30 days follow up. The SEP of ST was also reduced by 38%. There was no substantial increase in GUSTO major bleeding.

Prognostic importance of admission versus persistent glycemia in acute coronary syndrome

BackgroundWhether persistent hyperglycemia (PG) during hospitalisation has a greater impact on adverse outcomes in acute myocardial infarction (AMI) than a single random glucose measurement is not well defined. AimsTo find out the association of admission glycemia (AG) VS PG on outcomes in patients of ACS. Study design and methodsProspective, cohort, hospital-based. We evaluated 200 patients of ACS for admission and in-hospital glycemia and their impacts on outcomes. AG was defined as a plasma glucose >198mg/dl and PG as a random glucose >140mg/dl at any point during hospitalisation. Demographic and biochemistry including risk factors recorded. A multiple regression was done to evaluate association of various parameters with worse prognosis. ResultsOf the 200 patients evaluated, 35 (17.5%) presented with AG. 31 (15.5%) had PG. Males were predominant and 47 (23%) previously known diabetic patients. 62 (31%) had unstable angina, 52 (26%) NSTEMI and 86 (43%) STEMI, between PG and LEF, higher troponin levels and in-hospital mortality and between LEF and age (p<0.001), serum creatinine (p 0.023) and mean in-hospital glucose (p 0.005). F-indices were compared with AG for their ability to discriminate hospitalization survivors from non-survivors. All average glucose metrics performed better than AG. The ability of these models improved as the time window increased (F-indices for admission, mean 24h, 48h and 72h were 2.51, 12.05, 8.3 and 5.72, respectively). ConclusionThe present study demonstrates that PG is a better discriminator of prognosis than AG in patients of ACS.

Frequency of risk factors in male patients with acute coronary syndrome.

To determine the frequency of risk factors in male patients presenting with acute coronary syndrome. Observational study. Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi, from October 2007 to September 2008. Male patients with acute coronary syndrome were included in this study. Patients having angioplasty (PCI), coronary artery bypass surgery, chronic liver and kidney diseases were excluded. Presence of diabetes, smoking, hypertension, dyslipidemia, physical activity, stress, a family history of coronary artery disease (CAD) and medication was documented. Blood pressure, ECG, cardiac enzymes, fasting blood glucose, lipid profile and echocardiography were done within 24 hours of admission. Body mass index and waist circumference were measured. Data was analysed using SPSS-15. A total of 135 male patients of ACS were studied having mean age of 54.26±11.60 years. Maximum number of patients aged between 51 to 60 years, (n = 41, 31.9%). STEMI (ST-elevation myocardial infarction) was diagnosed in 96 (71.1%) patients, non-STEMI in 12 (8.9%) while 27 (20%) patients were having unstable angina. Smoking was documented in 60 (44%) patients, hypertension in 50 (37%), diabetes in 34 (25.2%) and a family history of premature CAD was recorded in 24 (17.8%) patients. Fifty one (37.8%) patients were overweight (BMI = 25-29.9) while 22 (16.3%) were obese (BMI ³ 30). Waist circumference > 90 cm was found in 86 (63.6%) subjects. Sixty four (47.4%) patients were active physically. Psychosocial stress was documented in 33 (23.75). Hypertension, diabetes and dyslipidemia were the most frequent combinations, observed in 24 (17.9%) subjects. Dyslipidemia, smoking, hypertension and diabetes were most frequent risk factors. Public awareness to control risk factors can reduce the prevalence of CAD.

E0325 Influence of probucol on endothelial dependent vasodilation reaction in patients with acute coronary syndrome

ObjectiveThe study tested the antioxidant probucol for endothelial dependent vasodilation reaction in the patients of ACS after received therapy.Methods51 ACS patients were divided randomly into a probucol treatment group (p)...

E0635 The evaluation to the efficacy and safety of tirofiban in acute coronary syndrome patients with clopidogrel resistance during percutaneous coronary intervention

ObjectiveTo assess the efficacy and safety of the tirofiban in acute coronary syndrome patients with clopidogrel resistance undergoing selective percutaneous coronary intervention (PCI).MethodsA total of 90 acute coronary syndrome patients...

The relationship between resting heart rate and acute coronary syndromes without ST-segment elevation

目的 探讨静息心率(RHR)增加与非S-T段抬高急性冠脉综合征(ACS)患者预后的关系.方法非S-T段抬高ACS患者167例,按RHR水平分为:RHR 1组,RHR＜65次/min;RHR 2组,65次/min≤RHR＜70次/min;RHR 3组,70次/min≤RHR＜75次/min;RHR 4组,75次/min≤RHR＜80次/min;RHR 5组,RHR≥80次/min.随访6个月复合心血管事件(包括心脏性死亡、非致命性心肌梗死、非致命性心力衰竭、因反复缺血性心绞痛发作住院)发生率.结果随访167例患者,6个月复合心血管事件发生率为31.1%,RHR 5组随访6个月时反复心绞痛发作住院事件(33.3%)和复合心血管事件(66.7%)均较RHR 1～4组明显增多(P＜0.05及P＜0.01).结论 RHR增加是非S-T段抬高ACS患者的高危因素。