Previous History Of Coronary Disease Research Articles

A Nomogram Model for Predicting Recurrent Coronary Thrombosis in Kawasaki Disease Patients.

Coronary thrombosis is a serious cardiovascular complication of Kawasaki disease (KD), and recurrence of coronary thrombosis increases the short-term risk of myocardial infarction and the long-term risk of coronary artery disease. However, there are currently no studies predicting the recurrence of coronary thrombosis, so the aim of this study was to develop and validate a nomogram to predict recurrent coronary thrombosis in KD patients. This was a retrospective study of data from 149 KD patients who had a history of previous coronary disease at the Children's Hospital of Chongqing Medical University from 2013 to 2020. Independent risk factors were identified using univariate and multivariate logistic regression analyses, and a nomogram was constructed to predict recurrent coronary thrombosis. Multivariate analysis showed that large coronary artery aneurysm(CAA) (Odds Ratio [OR] 4.28; 95% Confidence Interval [CI]1.39-13.12), saccular CAA (OR 5.03; 95% CI 1.55-16.29), first left anterior descending (LAD) thrombosis (OR 3.90; 95% CI 1.20-12.63), and persistent CAA (OR 43.27; 95% CI 12.23-153.12) were independent risk factors for recurrent coronary thrombosis. Based on these variables, a nomogram was constructed. The Area Under the Curve (AUC) of the nomogram was 0.943, and tenfold cross-validation (200 replicates) showed an average AUC of 0.929. Furthermore, the nomogram not only presented a favorable calibration curve but also demonstrated practical clinical utility. Large CAA, saccular CAA, first LAD thrombosis and persistent CAA were independent risk factors for recurrent coronary thrombosis. The nomogram can visually show these independent risk factors and predict probabilities.

Cardiac Manifestations of Post-Acute COVID-19 Infection.

There is emerging evidence that the post-acute and chronic phases of COVID-19 infection are associated with various significant cardiovascular sequelae. Long COVID has been shown to be associated with multiple cardiovascular sequelae including direct myocardial injury, arrhythmias, and cardiomyopathies. Hypotheses on the mechanism of myocardial injury include direct viral infiltration and autoimmune dysregulation. Long COVID is associated with persistent cardiac ischemia in patients with no previous history of coronary disease, atrial and ventricular arrhythmias, and the development of new-onset heart failure in previously healthy patients. Onset of long COVID may be related to severity of the initial SARS-CoV2 infection. Cardiac MRI is a valuable tool in assessing myocarditis and the development of cardiomyopathies in the setting of long COVID. Both patients with and without pre-existing cardiovascular disease are at risk of developing myocardial injury in the setting of long COVID. Future studies will elucidate both cardiovascular mortality and cardiac rehabilitation in the post-acute and chronic phases of COVID-19.

Coronavirus disease 2019 and cardiovascular disease: what we have learnt during the last 2 years.

Coronavirus disease 2019 and cardiovascular disease: what we have learnt during the last 2 years.

Impact of diabetes on clinical outcome among elderly patients with acute coronary syndrome treated with percutaneous coronary intervention: insights from the ELDERLY ACS 2 trial.

Despite recent improvements in percutaneous coronary revascularization and antithrombotic therapies for the treatment of acute coronary syndromes, the outcome is still unsatisfactory in high-risk patients, such as the elderly and patients with diabetes. The aim of the current study was to investigate the prognostic impact of diabetes on clinical outcome among patients included in the Elderly-ACS 2 trial, a randomized, open-label, blinded endpoint study carried out at 32 centers in Italy. Our population is represented by 1443 patients included in the Elderly-ACS 2 trial. Diabetes was defined as known history of diabetes at admission. The primary endpoint of this analysis was cardiovascular mortality, while secondary endpoints were all-cause death, recurrent myocardial infarction, Bleeding Academic Research Consortium type 2 or 3 bleeding, and rehospitalization for cardiovascular event or stent thrombosis within 12 months after index admission. Diabetes was present in 419 (29%) out of 1443 patients. Diabetic status was significantly associated with major cardiovascular risk factors and history of previous coronary disease, presentation with non-ST segment elevation myocardial infarction (P = 0.01) more extensive coronary disease (P = 0.02), more advanced Killip class at presentation (P = 0.003), use at admission of statins (P = 0.004) and diuretics at discharge (P < 0.001). Median follow-up was 367 days (interquartile range: 337-378 days). Diabetic status was associated with an absolute increase in the rate of cardiovascular mortality as compared with patients without diabetes [5.5 vs. 3.3%, hazard ratio (HR) 1.7 (0.99-2.8), P = 0.054], particularly among those treated with clopidogrel [HR (95% confidence interval (CI)) = 1.89 (0.93-3.87), P = 0.08]. However, this difference disappeared after correction for baseline differences [Adjusted HR (95% CI) 1.1(0.4-2.9), P = 0.86]. Similar findings were observed for other secondary endpoints, except for bleeding complications, significantly more frequent in diabetic patients [HR (95% CI) 2.02 (1.14-3.6), P = 0.02; adjusted HR (95% CI) = 2.1 (1.01-4.3), P = 0.05]. No significant interaction was observed between type of dual antiplatelet therapy, diabetic status and outcome. Among elderly patients with acute coronary syndromes, diabetic status was associated with higher rates of comorbidities, more severe cardiovascular risk profile and major bleeding complications fully accounting for the absolute increase in mortality. In fact, diabetes mellitus did not emerge as an independent predictor of survival in advanced age.

Determinants of participation and risk factor control according to attendance in cardiac rehabilitation programmes in coronary patients in Europe: EUROASPIRE IV survey.

Aim The purpose of this study was to describe the proportions of patients referred to and attending cardiac rehabilitation programmes in Europe and to compare lifestyle and risk factor targets achieved according to participation in a cardiac rehabilitation programme. Methods The EUROASPIRE IV cross-sectional survey was undertaken in 78 centres from 24 European countries. Consecutive patients aged <80 years with acute coronary syndromes and/or revascularization procedures were interviewed at least six months after their event. Results A total of 7998 patients (24% females) were interviewed. Overall, 51% were advised to participate in a cardiac rehabilitation programme and 81% of them attended at least half of the sessions; being 41% of the study population. Older patients, women, those at low socio-economic status or enrolled with percutaneous coronary intervention and unstable angina, as well as those with a previous history of coronary disease, heart failure, hypertension or dysglycaemia were less likely to be advised to follow a cardiac rehabilitation programme. People smoking prior to the recruiting event were less likely to participate. The proportions of patients achieving lifestyle targets were higher in the cardiac rehabilitation programme group as compared to the non-cardiac rehabilitation programme group: stopping smoking (57% vs 47%, p < 0.0001), recommended physical activity levels (47% vs 38%, p < 0.0001) and body mass index<30 kg/m2 (65% vs 61%, p=0.0007). However, there were no differences in the blood pressure, lipids and glucose control. Patients who attended a cardiac rehabilitation programme had significantly lower anxiety and depression scores and better medication adherence. Conclusions Only half of all coronary patients were referred and a minority attended a cardiac rehabilitation programme. Those attending were more likely to achieve lifestyle targets, had lower depression and anxiety, and better medication adherence. There is still considerable potential to further reduce cardiovascular risk by increasing uptake and fully integrating secondary prevention and cardiac rehabilitation to provide a modern preventive cardiology programme.

Impact of age on treatment and outcomes after acute myocardial infarction, particularly in very elderly patients

IntroductionThe elderly population admitted for acute myocardial infarction is increasing. This group is not well studied in international trials and is probably treated with a more conservative approach. ObjectivesTo evaluate the presentation and treatment of myocardial infarction according to age, particularly in very elderly patients. MethodsWe studied 1242 consecutive patients admitted with acute myocardial infarction, assessing in-hospital, 30-day and one-year mortality during follow-up for each age-group. Patients were divided into four groups according to age: <45 years (7.6%); 45–64 years (43.3%); 65–74 years (23.4%); and ≥75 years (25.7%). ResultsElderly patients had a worse risk profile (except for smoking), more previous history of coronary disease and a worse profile on admission, with the exception of lipid profile, which was more favorable. With regard to treatment of the elderly, although less optimized than in other age-groups, it was significantly better compared to other registries, including for percutaneous coronary angioplasty. Both complications and mortality were worse in the older groups. In elderly patients (≥75 years), adjusted risk of mortality was 4.9–6.3 times higher (p<0.001) than patients in the reference age-group (45–64 years). In these patients, the independent predictors of death were left ventricular function and renal function, use of beta-blockers being a predictor of survival. ConclusionsElderly patients represent a substantial proportion of the population admitted with myocardial infarction, and receive less evidence-based therapy. Age is an independent predictor of short- and medium-term mortality.

Impacto da idade no tratamento e resultados após enfarte agudo do miocárdio em particular nos muito idosos

Introduction The elderly population admitted for acute myocardial infarction is increasing. This group is not well studied in international trials and is probably treated with a more conservative approach. Objectives To evaluate the presentation and treatment of myocardial infarction according to age, particularly in very elderly patients. Methods We studied 1242 consecutive patients admitted with acute myocardial infarction, assessing in-hospital, 30-day and one-year mortality during follow-up for each age-group. Patients were divided into four groups according to age: <45 years (7.6%); 45-64 years (43.3%); 65-74 years (23.4%); and ≥75 years (25.7%). Results Elderly patients had a worse risk profile (except for smoking), more previous history of coronary disease and a worse profile on admission, with the exception of lipid profile, which was more favorable. With regard to treatment of the elderly, although less optimized than in other age-groups, it was significantly better compared to other registries, including for percutaneous coronary angioplasty. Both complications and mortality were worse in the older groups. In elderly patients (≥75 years), adjusted risk of mortality was 4.9-6.3 times higher (p < 0.001) than patients in the reference age-group (45-64 years). In these patients, the independent predictors of death were left ventricular function and renal function, use of beta-blockers being a predictor of survival. Conclusions Elderly patients represent a substantial proportion of the population admitted with myocardial infarction, and receive less evidenced-based therapy. Age is an independent predictor of short- and medium-term mortality.

Abstract 5592: In Acute Coronary Syndromes Being Totally Revascularized Is As Good As Having A Normal Coronary Angiogram

Background: Revascularization is a crucial therapy in acute coronary syndromes (ACS). Purpose: to assess ACS patients outcomes, stratified according to the coronary angiography and/or angioplasty. Population and methods: 786 consecutive ACS patients submitted to an invasive strategy, divided in 3 groups: A (n=111) normal coronary angiogram; B (n=327) fully revascularized; C (n=348) incomplete revascularization. A 1-year follow up targeting major adverse cardiovascular events (MACE) was performed. Results: Group A had more females (38.7 vs 21.1 vs 24.4% p&lt;0.01), patients were more admitted for unstable angina (37.3 vs 14.9 vs 17.9% p&lt;0.01) and had a higher left ventricular ejection fraction (LVEF). Group B were more on previous statin therapy, had more often an admission for ST elevation acute myocardial infarction (17.3 vs 51.7 vs 42.4% p&lt;0.001) and higher peak levels of cardiac biomarkers. Group C were older and had more frequently a previous history of coronary disease. Group C patients had a worse in-hospital mortality (1.8 vs 1.2 vs 7.5% p&lt;0.01) and morbidity. The MACE free survival rate was significantly lower for group C (92.9% vs. 92.9% vs. 78.2%; log rank p&lt;0.001). In a multivariate Cox regression analysis, incomplete revascularization remained an independent predictor of MACE at 1 year (HR 2.74, CI 1.50 – 4.94), in a model that included, age, gender, LVEF, diabetes, coronary anatomy, and admission diagnosis. Conclusion: Our data strongly support the use of an aggressive invasive strategy in ACS, aimed at achieving full revascularization, as these patients had the same medium term prognosis as those with normal coronary angiogram.

The "common soil" theory: coronary disease, diabetes and inflammation

The "common soil" theory: coronary disease, diabetes and inflammation

The Independent Association of Renal Dysfunction and Arrhythmias in Critically Ill Patients

The purpose of this study was to quantify the impact of baseline renal dysfunction on incidence and occurrence of cardiac arrhythmias in the coronary ICU. Renal dysfunction is an established predictor of all-cause mortality in the ICU setting. We set out to evaluate the independent contributory effect of renal dysfunction to arrhythmias and mortality in this population. We analyzed a prospective coronary care unit registry of 12,648 admissions by 9,557 patients over 8 years at a single, tertiary center. An admission serum creatinine level was available for 9,544 patients. Those patients not receiving long-term dialysis were classified into quartiles of corrected creatinine clearance with cutpoints of 46.2 mL/min/72 kg (group 1), 63.1 mL/min/72 kg, and 81.5 mL/min/72 kg. Dialysis patients (n = 527) were considered as a fifth comparison group (group 5). Baseline characteristics including older age, African-American race, diabetes, hypertension, history of previous coronary disease, and heart failure were incrementally more common with increasing renal dysfunction strata. There were graded, independent increased risks for accelerated idioventricular rhythm (relative risk [RR], 2.43; 95% confidence interval [CI], 1.40 to 4.20; p = 0.002), sustained ventricular tachycardia (RR, 2.07; 95% CI, 1.02 to 4.22; p = 0.04), ventricular fibrillation (RR, 2.42; 95% CI, 1.13 to 5.15; p = 0.02), and complete heart block (RR, 3.64; 95% CI, 1.77 to 7.48; p = 0.0004, group 5 vs group 1). We conclude that baseline renal function is a powerful, independent predictor of cardiac arrhythmias in the coronary ICU population.

Angioplastie coronaire en urgence au décours d'une cure de 5-fluoro-uracile

Introduction. - The incidence of cardiac toxicity due to 5-fluorouracil (5-FU) ranges from 1.2 to 18%. Most complications occur at the time of the first cure. Their mechanisms have not yet been clearly defined. Exegesis. - The authors report a case of unstable angina induced by 5-FU. A coronary angioplasty was performed on a previously ignored coronary lesion. Conclusion. - Recent studies support the hypothesis that 5-FU has endothelial toxicity resulting in thrombogenic effect and release of vasoactive substances. Unstable angina pectoris would be related to plaque rupture caused by 5-FU. Patients with previous history of coronary disease are at significantly increased risk for 5-FU-induced cardiotoxicity. The probably would benefit from continuous electrocardiographic monitoring. Rechallenge with 5-FU after cardiotoxicity problems should include only those patients for whom there is no alternative treatment.

Atherosclerosis, Acute Coronary Events, and Cholesterol-Lowering: A New Paradigm

Our current understanding of some mechanisms involved with the occurrence of acute coronary events indicates that coronary atherosclerotic plaques need not develop to the point of stenosis before resulting in an acute event. Recent studies show that the majority of myocardial infarctions result from lesions that are 30–60% stenotic, many of which are not associated with any overt clinical symptoms. Considering that every year in the United States, ≈ 200,000 persons with no previous history of coronary disease die from their first myocardial infarction, a major issue becomes identifying persons at risk for coronary disease. Risk assessment for coronary events is a critical area in terms of moving forward with decision-making for lipid-lowering therapies and developing strategies to reduce acute coronary events, and the morbidity and mortality related to them.

Large ventricular aneurysms occurring after myocardial infarction.

We have studied 33 patients with a large ventricular aneurysm complicating an anterior myocardial infarction. The features of myocardial infarction progressing towards an aneurysm were no previous history of coronary disease, severe infarction as shown by the severity of pain and the presence of pericardial rub and heart failure, and large increase in serum levels of cardiac enzymes. A large aneurysm usually follows a large infarction resulting from the total or partial occlusion of the left anterior descending artery, which is involved alone in about half the patients and is associated with lesions of the circumflex and right coronary arteries in the other half. In most cases, standard radiography showed an abnormal cardiac configuration, but in 7 patients (21%) there was no radiological evidence of aneurysm. ST segment elevation (mean 2.7 mm) was reported in all subjects but one. Heart failure was present in most patients and was an indication for surgical treatment in one-third of the patients. A large aneurysm was not a contraindication to operation even when at angiography the aneurysm seemed to occupy almost all the left ventricle. Twenty-one patients were operated upon for resection of the aneurysm with a mortality rate of 14 per cent.

CORONARY HEART-ATTACKS IN EAST LONDON

All cases of cardiac infarction, acute coronary insufficiency and sudden death occurring in residents of the London Borough of Tower Hamlets below age 65 were registered over nearly three years, and survivors were followed up for one year. The attack-rate in men aged 45-64 years was 1 per 100 per annum but the recurrence-rate in survivors was 1 per 100 per month. Immigrants from Asia had more than the average, and those from the Caribbean one tenth of the average attack-rate. Although it was unusual for general practitioners to manage cases at home by choice, nonetheless two-thirds of the deaths happened outside hospital and half of these were not witnessed. Half of those suffering coronary heart-attacks had a previous history of coronary disease and a sizeable minority were already unfit for work. Approximately half of those attacked were alive at one year.