Recurrent Unstable Angina Research Articles

Analysis of predictors of recurrent acute cardiovascular events in patients with acute coronary syndrome

Aim. To assess the prevalence of traditional risk factors and analyze the predictors of recurrent cardiovascular events in patients with acute coronary syndrome (ACS).Material and methods. A total of 482 patients with ACS were included. The follow-up lasted three years. The composite endpoint (CE) included recurrent unstable angina, nonfatal myocardial infarction, repeated percutaneous coronary intervention (PCI), nonfatal ischemic stroke, hospitalization for decompensated heart failure, and cardiovascular death.Results. A high prevalence of traditional risk factors was revealed (dyslipidemia — 467 (96,9%), hypertension — 464 (96,3%), consumption of junk food — 450 (93,4%), sedentary lifestyle — 416 (86,3%)). During the three-year follow-up period, 90 patients had CE. Compared with patients without CE (n=392), patients with CE were significantly more likely to have a long-term CAD (69 (76,7%) vs 241 (61,5%), p=0,007), ACS accompanied by shortness of breath (50 (55,6%) vs 160 (40,9%), p=0,013); they had previously undergone myocardial revascularization (38 (42,2%) vs 116 (29,6%), p=0,024), often by PCI (36 (40,0%) vs 100 (25,5%), p=0,009), especially in the left main coronary artery (LMCA) (6 (6,7%) vs 3 (0,8%), p=0,002); they were more likely to develop in-hospital acute left ventricular failure (11 (12,2%) vs 18 (4,6%), p=0,012), had a lower hemoglobin level and hematocrit (p<0,05 for all); they more often required intensification of lipid-lowering therapy (86 (100%) vs 334 (85,2%), p=0,002), compliance with which was lower (6 (6,7%) vs 105 (26,8%), p<0,001) than in patients without CE. Previous intervention on the left coronary artery, non-compliance with lipidlowering therapy, hematocrit level 3 months and hemoglobin level 1 year after ACS were predictors of recurrent events. The combination of surgery on left coronary artery and non-compliance with lipid-lowering therapy demonstrated significantly less freedom from CE compared with other patients (77,4% vs 94,6%, p<0,001).Conclusion. A high prevalence of traditional risk factors in the population of patients with ACS was revealed, and potential predictors of recurrent cardiovascular events were identified.

Transcutaneous Electrical Acupuncture Point Stimulation Is Cardioprotective for Patients With Stable Ischemic Heart Disease

We evaluated the effects of electroacupuncture (EA) at Neiguan and Ximen on the prognosis of patients with stable ischemic heart disease. A total of 240 patients symptomatic with suspected coronary artery disease referred for coronary angiography were analyzed, and 232 patients (62.3 ± 9.1years) with stable ischemic heart disease were included. The primary end point was major adverse cardiovascular events (MACEs), defined as a composite of recurrent angina requiring hospitalization, nonfatal acute myocardial infarction, cardiogenic death, and death from any other causes. Over a mean follow-up of 12months, 9 patients (8.4%) in the EA treatment group and 22 patients (19.3%) in the control group occurred. Patients treated with EA had a significantly smaller risk of MACE (p=0.021), recurrence of unstable angina (p=0.033), and nonfatal myocardial infraction (p=0.038) than that of those treated without EA. Kaplan-Meier analysis revealed that the EA and control groups began to separate at approximately 5months and continued to diverge up to study termination. Moreover, multivariate Cox analysis showed that treatment with EA was associated with decreased likelihood of MACE within 12months of follow-up. The circulating levels of cluster of differentiation 40 ligand but hypersensitive C-reactive protein were lower (166.0 ± 92.6pg/ml vs 197.3 ± 79.2pg/ml, p=0.012) in the EA group than in the control group and decreased significantly (-30.6 ± 47.2pg/ml vs -1.1 ± 50.4pg/ml, p <0.001) after 12months of treatment. EA is an effective treatment method for supporting patients with stable ischemic heart disease.

Abstract 14768: Contemporary Hospitalization and Thirty-Day Readmission Rates of Unstable Angina in the United States: Insights From Nationwide Readmissions Database 2016-2019

Introduction: There are limited data on the contemporary hospitalization rate and 30-day readmission characteristics of unstable angina (UA). Methods: Using Nationwide Readmissions Database from 2016 to 2019, we identified UA hospitalizations based on ICD-10-CM codes and analyzed the rate, trend, timing, causes, and costs of 30-day readmissions after UA in the United States. Multivariable regression analysis was conducted to determine the predictors of 30-day readmission. Results: A total of 498,008 patients were hospitalized with UA, resulting in the in-hospital mortality of 0.4%. During the study period, a significant decrease in the temporal trend of UA hospitalization rate was observed ( Figure 1 ). Among 458,823 patients who were discharged alive, 11.4% were readmitted within 30 days with a median time to readmission of 9 days. There was a significant reduction in the temporal trend of 30-day readmission rate ( Figure 2 ). The most common cause of readmission and procedure during the readmission were recurrent UA and left heart catheterization, respectively. While cardiovascular comorbidities, including congestive heart failure and atrial fibrillation, were associated with an increased likelihood of 30-day readmission, the ischemic evaluation performed during index hospitalization was associated with decreased odds of readmission ( Table ). The mortality during the readmission was 2%. The cumulative costs of hospitalization were $30,729 vs. $14,998 for UA patients with and without readmission, respectively. Conclusions: The index hospitalization and early readmission rates of UA have decreased over time. About 1/10 of UA patients were readmitted within 30 days of discharge, primarily due to recurrent UA. The early readmission may be reduced by a timely ischemic evaluation following UA.

Analysis of the Guiding Role of CYP2C19 Gene Combined With Platelet Function Detection in Antiplatelet Therapy in Patients With Complex Coronary Artery Disease After PCI.

ObjectiveTo explore the influence of CYP2C19 gene combined with platelet function test on clinical prognosis of patients with complex coronary artery disease receiving antiplatelet therapy after PCI.MethodsA total of 200 patients undergoing PCI in our hospital due to complex coronary artery disease from February 2019 to February 2021 were selected and divided into the control group and the observation group according to whether CYP2C19 gene detection was performed. The control group was treated with dual antiplatelet therapy of classical aspirin combined with clopidogrel, and the observation group was treated with individual antiplatelet therapy. The patients in the two groups were followed up for 1 year after PCI, and their quality of life was assessed using the Seattle Angina Questionnaire (SAQ score). The occurrence of major adverse cardiovascular events (MACE) during the follow-up period was also recorded.ResultsThe incidence of total MACE events in the observation group was slightly less than that in the control group, and the difference was statistically significant (P = 0.040). In particular, the observation group was superior to the control group in reducing the readmission rate of recurrent unstable angina pectoris, and the difference was statistically significant (P = 0.023). The location of coronary culprit lesions with recurrent ischemic events was commonly seen in non-interventional target lesions (interventional/non-interventional target sites: 12.9%: 77.1%). The SAQ score in the observation group was larger than that in the control group, and the difference was statistically significant (P = 0.012). There was no statistical difference in the incidence of major bleeding between the two groups (P = 0.352).ConclusionUsing CYP2C19 genotype combined with platelet function test to guide individualized antiplatelet therapy after complex coronary artery PCI is beneficial to reducing ischemic events in a short period (1 year), mainly due to reducing the risk of readmission for recurrent unstable angina pectoris, and improving the quality of daily life of patients without increasing the risk of massive hemorrhage, which can improve clinical prognosis.

Colchicine in patients with acute myocardial infarction: an updated meta-analysis of randomized controlled trials

Abstract Background Improvement in cardiovascular outcomes and treatment with anti-inflammatory agents have been the subject of many research. Colchicine inhibits tubulin polymerization and is used in treating pericarditis. Recent studies have shown its benefit when used for coronary events. The objective of this meta-analysis is to reexamine the role of colchicine in reducing cardiovascular events in acute coronary syndromes in light of more recent trials. Methods A systematic search for randomized controlled trials which involves use of colchicine and acute coronary syndrome was done using PubMed, Google Scholar, MEDLINE and Clinicaltrials.gov. Studies done in the last decade and those involving human subjects were included in the study. Results Seven RCT's (n: 11,282) were included in this meta-analysis comparing colchicine vs. placebo. Dose ranged from 0.5mg/day to 1mg/day. Among patients being treated for ACS, colchicine was associated with a significant reduction in composite cardiovascular outcomes (RR 0.69, 95% CI 0.60 – 0.79, P&amp;lt;0.ehab724.12731), unstable angina (RR 0.67, 95% CI 0.55 – 0.82, P&amp;lt;0.0001), and myocardial infarction (RR 0.75, 95% CI 0.62 – 0.92, P&amp;lt;0.005,). Gastrointestinal events were evident in the colchicine group with no statistical difference between the two (RR 1.28, 95% CI 0.98 – 1.67, P 0.07). Conclusion Use of colchicine reduces composite cardiovascular outcomes, recurrence of unstable angina and MI among patient who had ACS. There was no statistically significant difference between colchicine and placebo in terms of gastrointestinal events. It is possible that colchicine be part of the standard treatment in patients with acute coronary syndrome. Funding Acknowledgement Type of funding sources: None. Myocardial infarction forest plot

Characteristics and prognosis of patients with elevated triglycerides in acute myocardial infarction: observational data from a large database over a 17 years period

Abstract Background and aim From a large database of a regional registry, we aimed to address the prevalence, characteristics and prognosis of patients with elevated triglycerides (TG) in patients hospitalized for an acute myocardial infarction (MI). Methods From the multicenter database (RICO survey), all consecutive patients hospitalized for an acute MI (2001–2017) and alive at discharge were included. Patients with TG &amp;gt;500 mg/dL, lost to follow-up (FU), or under chronic fibrate treatment were excluded. Patients with high TG (&amp;gt;200 mg/dL) on admission were compared to those with TG ≤200 mg/dL. Endpoints were recurrent ischemic events (i.e. recurrent MI, angina, unstable angina, stroke or urgent revascularization (PCI or CABG)) at 1-year FU. Results Among the 10667 patients included, 1886 (17.7%) had elevated TG. When compared with patients with TG ≤200 mg/dL, patients with high TG were younger (59 vs 69 y, p&amp;lt;0.001), had a higher BMI (28 vs 26 kg/m2, p&amp;lt;0.001), were more frequently men (77 vs 68%, p&amp;lt;0.001), diabetic (27 vs 21%, p&amp;lt;0.001), and smokers (42 vs 28%, p&amp;lt;0.001). The rate of statin therapy at discharge was similar for the 2 groups (79 vs 77%, p=0.285), as well as SYNTAX score and rate of multivessel disease (p=0.368 and p=0.791). In high TG group, LDL cholesterol was higher (130 vs 120 mg/dL, p&amp;lt;0.001) and HDL-cholesterol was lower (37 vs 46 mg/dL). At 1-Y FU, recurrent ischemic events were more frequent in elevated TG patients (11.2 vs 9.1%, p=0.004). In multivariate logistic regression analysis, high TG (OR (95% CI): 1.356 (1.095–1.679)) remains an independent estimate for recurrent ischemic event, even after adjustment for confounding (GRACE score, diabetes, obesity). Conclusions In our large population-based cohort, elevated TG are common in acute MI, and associated with residual risk of recurrent ischemic events, beyond traditional prognostic markers. Our data may help to identify candidates for targeted therapies to reduce recurrent ischemic risk after MI. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Amarin

АНТИАГРЕГАНТНАЯ ТЕРАПИЯ И ВТОРИЧНАЯ ПРОФИЛАКТИКА ПОСЛЕ КОРОНАРНОГО ШУНТИРОВАНИЯ ПРИ ОСТРЫМ КОРОНАРНЫМ СИНДРОМЕ

Antiplatelet therapy with aspirin and clopidogrel has clear advantages in reducing serious adverse cardiovascular events and mortality following acute coronary syndrome. Although these drugs may pose an additional risk of bleeding in the small percentage of acute coronary syndrome patients who will undergo coronary artery bypass grafting, the benefits are vastly superior, and most bleeding can be reduced, if possible, by delaying coronary artery bypass grafting. Short-acting anticoagulants can be administered flexibly, allowing platelet function to be restored after clopidogrel is discontinued. The postoperative bleeding time may clarify the need for platelet transfusion in case of bleeding. Coronary artery bypass grafting without the use of a heart-lung machine may offer some benefits by avoiding heparinization and the inflammatory response associated with bypass surgery. Secondary prophylaxis with antiplatelet therapy, beta-blockers, lipid-lowering therapy, and ACE inhibitors or angiotensin-converting enzyme inhibitors is critical to the long-term success of revascularization. In this regard, it should be borne in mind that regardless of the method of revascularization, patients with acute coronary syndrome are characterized by the clinical benefit of taking antiplatelet agents such as aspirin and clopidogrel, since these drugs reduce the risk of serious adverse events. On the other hand, antiplatelet agents also increase the risk of bleeding in patients who will eventually undergo coronary artery bypass grafting. However, scientists indicate that in most cases, the benefits of early initiation of antiplatelet therapy outweigh the potential risks [1]. In addition, the beneficial effects of aspirin and clopidogrel in acute coronary syndrome are additive. In the study of clopidogrel, indicated for the prevention of recurrence of unstable angina and non-ST-segment elevation myocardial infarction, patients taking both clopidogrel and aspirin were less likely to die of cardiac death, non-fatal myocardial infarction, or stroke at 30 days and 1 year compared with patients who took only aspirin [22]. All these studies confirm that antiplatelet therapy with aspirin and clopidogrel should be carried out in the early stages of acute coronary syndrome. In patients with ST-segment elevation myocardial infarction, clopidogrel improves outcomes in addition to aspirin. In a trial of clopidogrel and metoprolol for myocardial infarction, clopidogrel, in addition to aspirin, was associated with a significant reduction in death, re-heart attack, or stroke compared with aspirin alone [14].

Pro-inflammatory Mediators and Oxidative Stress: Therapeutic Markers for Recurrent Angina Pectoris after Coronary Artery Stenting in Elderly Patients.

Pro-inflammatory mediators and oxidative stress are related to the severity of angina pectoris in patients with coronary heart disease. We evaluated the effects of pro-inflammatory mediators and oxidative stress on recurrent angina pectoris after coronary artery stenting in elderly patients. We determined the expression levels of malondialdehyde (MDA), acrolein (ACR), tumour necrosis factor-α (TNF-α), toll-like receptor 4 (TLR4), superoxide dismutase 3 (SOD3), paraoxonase-1 (PON-1), stromal cell-derived factor-1α (SDF-1α) and endothelial progenitor cells (EPCs) in elderly patients with recurrent angina pectoris after coronary artery stenting. Levels of MDA, ACR, TNF-α and TLR4 were significantly increased (p<0.001), and levels of SOD3, PON-1, SDF-1α and EPCs were significantly decreased (p<0.001) in the elderly patients with recurrent angina pectoris after coronary artery stenting. MDA, ACR, TNF-α and TLR4 as markers of oxidative stress and pro-inflammatory mediators may have suppressed SOD3, PON-1, SDF-1α and EPCs as markers of anti-oxidative stress/anti-inflammatory responses. Oxidative stress and proinflammatory mediators were important factors involved in recurrent angina pectoris of elderly patients after coronary artery stenting. Oxidative stress and pro-inflammatory mediators could be considered as potential noninvasive prognostic, predictive, and therapeutic biomarkers for stable recurrent angina and recurrent unstable angina in elderly patients after coronary artery stenting.

P5542Predictors of the risk of recurrent cardiovascular events in patients with unstable angina with conservative treatment strategy

Abstract Objective To identify independent predictors of the risk of recurrent cardiovascular events in patients (pts) with unstable angina (UA) in a conservative treatment strategy. Material and methods The study involved 236 patients with UA with low risk according to GRACE scale and conservative treatment strategy. The end points were: recurrent UA, myocardial infarction (MI), death. The mean age was 60.2±7.3 years. All pts were performed general blood analysis, determination of troponin I, BNP, C-reactive protein, myeloperoxidase, von Willebrand factor, fibrinogen, antithrombin III and also the performance of the thrombin generation test, aggregatogram on aggregometry Multiplate impedance and ECG, EchoCG, Holter ECG. Results Cardiovascular events developed in 104 (44%) pts during 5 years of follow-up, and in the first year of follow - up-in 58 people (24.6%), followed annually by 10–14% of events for the year. MI developed in 21 pts (8.9%), recurrent angina in 75 (31.8%) pts, 51 (21.6%) pts underwent coronary artery stenting, and 26 (11%) pts underwent coronary bypass surgery, 8 (3.4%) patients died. Having studied all the objective data of the observed patients, we concluded that independent predictors of the risk of recurrent cardiovascular events were: previous MI (RR=2,8; 95% CI 1,32–6,08; p=0,0028), type II Diabetes (RR=3,1; 95% CI 1,78- 5,37; p=0,0001), first-time angina pectoris (RR=3,7; 95% CI 2,68–5,85; p=0,001, smoking (RR=2,1; 95% CI 1,21–3,74; p=0,0129), baseline myeloperoxidase &gt;316 pmol/l (RR=3,1; 95% CI 1,29–4,74; p=0,029), high sensitive CRP &gt;3,8 g/l (RR=3,9; 95% CI 2, 44–6,14; p=0,0001), mean platelet volume &gt;9,6fl (RR=2,9; 95% CI 1,49–5,52; p=0,0006), area under the curve ADP- test AUC &gt;60 U (RR=3,4; 95% CI 2, 3–5,2; p=0,002). Conclusions Cardiovascular events developed in 44% of pts over 5 years of follow-up. Independent predictors of adverse outcomes in pts with UA with low risk according to GRACE scale were: previous MI, type II Diabetes mellitus, first-time angina pectoris, smoking, baseline myeloperoxidase levels&gt;316 pmol/l, highly sensitive CRP&gt;3.8 g/l, MPV&gt;9.6fl, and the area under the ADP test curve &gt;60 U.

Prediction of ong-term ardiac vents by 123I-meta-odobenzylguanidine maging after acute yocardial nfarction and eperfusion herapy.

Objective(s):In heart failure, the heart-to-mediastinum (H/M) ratio of the delayed image and washout rate (WR) are well-known as a powerful cardiac event predictors. H/M ratio quantifies the accumulation rate of MIBG in the myocardium and WR quantifies reduction of meta-iodobenzylguanidine (MIBG) accumulation in the heart from the early planar image to the delayed planar images in the 123I-MIBG scintigraphy. The present study was conducted to estimate the role of the parameters of cardiac sympathetic imaging by 123I-MIBG myocardial scintigraphy in subacute phase of acute myocardial infarction (AMI) in the prediction of cardiac events, particularly in patients who are successfully responded to reperfusion therapy.Methods:This study was conducted on 145 patients with initial AMI who underwent 123I-MIBG myocardial scintigraphy and myocardial single-photon emission computed tomography (SPECT) after successful response to reperfusion therapy. The 123I-MIBG myocardial scintigraphy was averagely performed 16±5.8 days after the onset of AMI. The early image was taken 15 min after the intravenous administration of 123I-MIBG. Three hours after 123I-MIBG administration, an anterior planar delayed SPECT image was obtained. The H/M ratio and WR were calculated based on planar images. In addition, the average WR, defect volume, and extent were calculated from the SPECT image. The end points of the cardiac event was defined as hospitalization due to unstable angina, heart failure progression, myocardial infarction recurrence, malignant arrhythmia and cardiac death. Results:The follow-up period was 18.4±8.5 months on average, during which 38 (26.2%) cases experienced cardiac events. The results revealed a significant difference between the groups with and without cardiac events in terms of WR and WR (SPECT). Based on the multivariate analysis, WR was the only relevant factor predicting cardiac events. The cumulative event-free rate was significantly lower in the group with the delayed H/M ratio of < 1.74. The cumulative event-free rate were significantly lower in the groups with WR and WR (SPECT) more than 25% and 21.8%, respectively. There was no significant relationship between the cumulative event-free survival rate and the defect size. Conclusion:In the subacute phase of myocardial infarction, the increased WR of 123I-MIBG from the myocardium in planar scintigraphy and SPECT is the predictor of heart failure and cardiac events such as myocardial infarction and recurrence of unstable angina.

Abstract P345: The Cost-Effectiveness of Home BP Telemonitoring in Patients With a Cerebrovascular Event

Background: Home BP telemonitoring, with pharmacist case management, leads to clinically important BP reductions. Our objective was to determine the incremental cost-effectiveness of this intervention compared with usual care BP control in patients with cerebrovascular disease in Alberta, Canada. Methods: A cost-utility analysis using a Markov decision model was created, examining a cohort of high-risk patients with a recent cerebrovascular event residing in their own residence. A lifetime time horizon and health care payer perspective was used. Achieved BP and risk of future cardiovascular events (recurrent stroke, myocardial infarction, unstable angina, or death) were modelled, with attendant consequences on quality adjusted life years and costs. BP telemonitoring was assumed to occur monthly until BP was controlled, then quarterly. Canadian life tables were used to determine overall mortality, adjusted by CVD mortality. Relative efficacy on intervention-associated BP lowering were obtained from published data. Reduction in BP of 9.7/5.1 mmHg at 12-months was used in the base case. Resource use and costs were obtained from Canadian published literature. Results: Telemonitoring with case management led to net health care savings of $2326, and an additional 0.83 QALYs (see Table). Results were robust in sensitivity analysis (see Table). Conclusion: Home BP telemonitoring and pharmacist case management was a dominant strategy, as it lowered costs and improved QALYs, and should be implemented.

Survival outcomes post percutaneous coronary intervention: Why the hype about stent type? Lessons from a healthcare system in India.

A prospective, multicenter study was initiated by the Government of Maharashtra, India, to determine predictors of long-term outcomes of percutaneous coronary intervention (PCI) for coronary artery disease, and to compare the effectiveness of drug-eluting stents (DESs) and bare-metal stents (BMSs) in patients undergoing PCI under government-funded insurance. The present analysis included 4595 patients managed between August 2012 and November 2016 at any of 110 participating centers. Using the classical multivariable regression and propensity-matching approach, we found age to be the most important predictor of 1-year mortality and target lesion revascularization at 1 year post-PCI. However, using machine learning methods to account for unmeasured confounders and bias in this large observational study, we determined total stent length and number of stents deployed as the most important predictors of 1-year survival, followed by age and employment status. The unadjusted death rates were 5.0% and 3.8% for the BMS and DES groups, respectively (p = 0.185, log-rank test). The rate of re-hospitalization (p<0.001) and recurrence of unstable angina (p = 0.08) was significantly lower for DESs than for BMSs. Increased use of DES after 2015 (following establishment of a price cap on DESs) was associated with a sharp decrease in adjusted hazard ratios of DESs versus BMSs (from 0.94 in 2013 to 0.58 in 2016), suggesting that high price was limiting DES use in some high-risk patients. Since stented length and stent number were the most important predictors of survival outcomes, adopting an ischemia-guided revascularization strategy is expected to help improve outcomes and reduce procedural costs. In the elderly, PCI should be reserved for cases where the benefits outweigh the higher risk of the procedure. As unemployed patients had poorer long-term outcomes, we expect that implementation of a post-PCI cardiovascular rehabilitation program may improve long-term outcomes.

TCTAP C-124 Recurrent Occlusion of Left Anterior Descending Artery During Intervention of Left Main Bifurcation

### Patient initials or identifier number STK ### Relevant clinical history and physical exam A 67-year-old man has experienced recurrent unstable angina pectoris (Canadian Cardiovascular Society angina class IV) in the last six months. He had a 30-year history of smoking twenty cigarettes per

Extraction of a fully deployed Left main stent after six weeks – Case report

Dislodgement or embolization of coronary stents, although rare, is a well-known complication.1 Successful retrieval with special devices is reported in literature.2–5 We managed a case where a previously deployed stent in the Left main coronary artery (LMCA) got dislodged but remained unnoticed for 6 weeks. When a repeat angiography was done 6 weeks later for recurrent unstable angina, the Left main stent was found to be dislodged from the left main and was partially overhanging into the aorta. This stent was successfully extracted using a Goose neck snare. The left main artery was then re-stented.

Predicting the long-term risk of repeat coronary events in patients with unstable angina

Aim. To stratify the patients with unstable angina (UA) by the levels of long-term (12 month) risk of repeat coronary events. Material and methods. The study included 180 UA patients, who were divided into two groups: with or without adverse outcomes (death, myocardial infarction, recurrent UA, urgent myocardial revascularisation, life-threatening cardiac arrhythmias and blockades) during the follow-up period. The levels of biomarkers of UA pathogenesis were also measured. Results. Independent risk predictors included mean platelet volume (MPV), fibrinogen, and left ventricular ejection fraction (LVEF). The risk of adverse UA outcomes in patients with MPV levels

CORRELATION BETWEEN ENDOTHELIAL DYSFUNCTION EVALUATED BY PERIPHERAL ARTERIAL TONOMETRY AND PROGNOSIS OF ACUTE MYOCARDIAL INFARCTION

ObjectivesTo explore whether the use of Peripheral Arterial Tonometry (PAT) in the evaluation of admission vascular endothelial function of acute myocardial infarction (AMI) patients can predict recurrence of major adverse...

CORRELATION BETWEEN ENDOTHELIAL DYSFUNCTION TESTED BY PERIPHERAL ARTERIAL TONOMETRY AND PROGNOSIS OF ACUTE MYOCARDIAL INFARCTION AND PLASMA ADIPONECTIN

ObjectivesTo explore whether the use of Peripheral Arterial Tonometry (PAT) in the evaluation of admission vascular endothelial function of acute myocardial infarction (AMI) patients can predict recurrence of major adverse...

Prognostic role of Helicobacter pylori infection in acute coronary syndrome : a prospective cohort study

In a prospective cohort study, we evaluated the effect of Helicobacter pylori seropositivity on the risk of future adverse cardiovascular outcomes among patients with acute coronary syndrome (ACS). In 433 patients, IgA and IgG antibodies to H pylori, along with classic risk factors, including hypertension, diabetes, hyperlipidaemia, smoking and family history of coronary artery disease (CAD) were determined. Short and long-term follow-up information on adverse outcomes, defined as recurrence of unstable angina, myocardial infarction, coronary angioplasty, coronary artery bypass graft surgery, and sudden cardiac death was obtained. None of the classic CAD risk factors correlated with incidence of either short- or long-term outcomes. Seropositivity for H pylori was significantly associated with risk of short-term adverse outcomes, and independently predicted their incidence in multivariate regression (R = 3.05, p < 0.001). Results failed to show such an association between H pylori seropositivity and long-term adverse outcomes. H pylori infection may affect short-term prognosis in patients with ACS. Randomised trials are needed to evaluate the role of H pylori eradication in these patients.

Platelet glycoprotein IIIa (platelet antigen 1/platelet antigen 2) polymorphism and 1-year outcome in patients with stable coronary artery disease

Platelet glycoprotein IIb/IIIa is a membrane receptor which plays a key role in coronary artery disease and thrombotic events. However, there is a considerable controversy regarding the clinical impact of glycoprotein IIIa platelet antigen 1 (PlA1)/platelet antigen 2 (PlA2) polymorphism as a risk factor for myocardial infarction. To evaluate the association between glycoprotein IIIa PlA1/PlA2 polymorphism and 1-year cardiovascular events occurrence in aspirin-treated patients with stable coronary artery disease. We prospectively included 188 postacute coronary syndrome patients (183 men) aged 59 ± 10 years and receiving aspirin (250 mg/day). The clinical outcome at 1 year was the composite end point of nonfatal myocardial infarction, stroke, recurrent unstable angina or cardiac death. Genotyping for PlA1/PlA2 polymorphism was conducted using PCR and restriction fragment length polymorphism analysis. The genotype distribution of glycoprotein IIIa PlA1/PlA2 polymorphism was PlA1/PlA1, 55.3%; PlA1/PlA2, 39.3% and PlA2/PlA2, 4%. Incidence of composite end point in homozygous PlA1/PlA1 carriers was significantly higher than in PlA2/PlA2 and PlA1/PlA2 patients [14.4 vs. 3.6% odds ratio 4.5 (1.2-16.6, 95% confidence interval); P = 0.012]. Multivariate analysis identified three strong predictive factors of cardiac death: age more than 65 years [odds ratio = 6.8, (1.4-34, 95% confidence interval); P = 0.018], ventricular ejection fraction less than 50% [odds ratio = 8.6, (1.7-42.6, 95% confidence interval); P = 0.008] and homozygous PlA1/PlA1 genotype [odds ratio = 8.8, (1.0-78.6, 95% confidence interval); P = 0.014]. Our results demonstrated that glycoprotein IIIa PlA1/PlA1 genotype carriers have a significantly increased risks of acute vascular ischemic events associated with a poor prognosis at 1 year. These postacute coronary syndrome patients might require an optimized secondary antithrombotic prophylaxis strategy.

HDL-cholesterol level provides additional prognosis in acute coronary syndromes

In the setting of acute coronary syndromes, plasma lipids have not been defined as prognostic variables, however little research has been dedicated to this specific issue. In order to test the independent predictive value for in-hospital events of low-density lipoprotein (LDL)-cholesterol, high-density lipoprotein (HDL)-cholesterol and triglycerides measured at hospital admission, 97 individuals with unstable angina or non-ST-elevation acute myocardial infarction were evaluated. In-hospital events, defined as death, non-fatal myocardial infarction or recurrent unstable angina, were significantly predicted by HDL-cholesterol (C-statistics = 0.69; 95% CI = 0.55–0.83, P = 0.018), contrary to LDL-cholesterol (C-statistics = 0.40; 95% CI = 0.24–0.56, P = 0.23) and triglycerides (C-statistics = 0.48; 95% CI = 0.31–0.65, P = 0.83). The best HDL-cholesterol cut-off point was 32 mg/dl, with a 33% incidence of events in patients with HDL-cholesterol ≤ 32 mg/dl, compared with only 9% in those with HDL-cholesterol > 32 mg/dl ( P = 0.003). Logistic regression analysis showed HDL-cholesterol ≤ 32 mg/dl (OR = 3.6; 95% CI = 1.0–14; P = 0.05) and TIMI Risk Score (OR = 2.3; 95% CI = 1.4–2.9, P = 0.001) as the independent predictors of events. Furthermore, the addition of HDL-cholesterol to TIMI Risk Score improved its C-statistic from 0.81 to 0.85. In conclusion, as opposed to LDL-cholesterol and triglycerides, HDL-cholesterol level adds prognostic value to the prediction of in-hospital recurrent events during non-ST-elevation acute coronary syndromes.