Risk Of Acute Coronary Syndrome Research Articles

Absolute Risk of Acute Coronary Syndrome after Severe Hypoglycaemia: A Population-Based 2-Year Cohort Study Using the National Database in Japan

Absolute Risk of Acute Coronary Syndrome after Severe Hypoglycaemia: A Population-Based 2-Year Cohort Study Using the National Database in Japan

Chest Pain Identified as Low Risk for Acute Coronary Syndrome (ACS). Can a HEART Score Pathway Identify More Patients for Early Safe Discharge than the Current TIMI Score Pathway?

Aim: We compared our current TIMI pathway with a HEART pathway in patients with undifferentiated chest pain in terms of adverse cardiac events and number safely identified as low risk. We audited our management of low risk patients. Method: We screened consecutive chest pain presentations to ED and ADU in 2 Auckland hospitals. We included 525 patients with TIMI score 0 or 1, and 0 and 2 hours negative contemporary Troponin I. TIMI score and chest pain history was recorded by admitting physician. HEART score and endpoints were captured from electronic data, GP and patient phone calls. The primary endpoint was Adverse Cardiac Events (ACE) within 3 months. The secondary endpoint was measurement of length of stay and further cardiac testing. Results: 398 had HEART score 0-3 and negative serial TI (low risk HEART) with adverse cardiac event rate of 0.5% (95% CI 0.14 – 1.81). 366 patients had TIMI 0 and negative TI (low risk TIMI) with event rate of 1.1% (0.4 – 2.8). The HEART pathway identified 9% more patients as low risk. 56% of our TIMI 0 cohort was referred for exercise treadmill test, 12% for CTCA and 1.6% for coronary angiogram. Average LOS was 8.69 hours Conclusion: The HEART pathway safely identifies significantly more patients as low risk compared to our TIMI pathway. WDHB do further cardiac investigation in the majority of our low risk patients, despite an acceptably low miss rate for cardiac events. We can reduce costs significantly by incorporating HEART score in the pathway and by re-education of our physicians.

Impact of a Shared Decision Making Intervention on Health Care Utilization: A Secondary Analysis of the Chest Pain Choice Multicenter Randomized Trial.

Patients at low risk for acute coronary syndrome are frequently admitted for observation and cardiac testing, resulting in substantial burden and cost to the patient and the health care system. The purpose of this investigation was to measure the effect of the Chest Pain Choice (CPC) decision aid on overall health care utilization as well as utilization of specific services both during the index emergency department (ED) visit and in the subsequent 45 days. This was a planned secondary analysis of data from a pragmatic multicenter randomized trial of shared decision making in adults presenting to the ED with chest pain who were being considered for observation unit admission for cardiac stress testing or coronary computed tomography angiography. The trial compared an intervention group engaged in shared decision making facilitated by the CPC decision aid to a control group receiving usual care. Hospital-level billing data were used to measure utilization for the index ED visit and during the following 45 days. Patients in both groups also were asked to keep a diary recording health care utilization over the same 45-day period. Outcomes assessed included length of time in the ED and observation, ED visits, office visits, hospitalizations, testing, imaging, and procedures. Of the 898 patients included in the original trial, we were able to contact 834 (92.9%) patients for 45-day health care diary review. There was no difference in patient-reported health care utilization between the study arms. Hospital-level billing data were obtained for all 898 (100%) patients. During the initial ED visit the length of stay (LOS) was similar, and there was no difference in the frequency of observation unit admission between study arms. However, the mean observation unit LOS was 95 minutes (95% confidence interval [CI]= 40.8-149.8) shorter in the CPC arm and the mean number of tests was lower in the CPC arm (decrease in 19.4 imaging studies per 100 patients, 95% CI= 15.5-23.3). When evaluating the entire encounter and follow-up period, the intervention arm underwent fewer tests (decrease in 125.6 tests per 100 patients, 95% CI= 29.3-221.6). More specifically, there were fewer advanced cardiac imaging tests completed (25.8 fewer per 100 patients, 95% CI= 3.74-47.9) in the intervention arm. Shared decision making in low-risk chest pain can lead to decreased diagnostic testing without worsening outcomes measured over 45 days.

High levels of lipoprotein (a) and premature acute coronary syndrome

Background and aimsHigh levels of lipoprotein(a) [Lp(a)] are associated with increased risk of acute coronary syndrome (ACS). We explored whether Lp(a) exhibits a stronger association with premature ACS. MethodsA case-control study was conducted; 1457 patients with a history of ACS (54.8 ± 13 years, 86% males) and 2090 age-sex matched adults free of cardiovascular disease were enrolled. Bio-clinical characteristics [risk factors, low-density lipoprotein-cholesterol, Lp(a)] were derived through standard procedures. ResultsA 10 mg/dL increase in Lp(a) was associated with 4% (95% CI, 1.01 to 1.02) higher likelihood of having ACS in younger (<45 years) and 2% (95% CI, 1.01 to 1.02) higher likelihood in middle-aged (45-60 years) individuals. Adjusting for common risk factors, elevated Lp(a), i.e. >50 mg/dL, was still associated with increased likelihood of ACS in younger adults (<45 years) (OR = 2.88, 95% CI, 1.7 to 4.6) and in middle aged ones (45 and 60 years) (OR = 2.06, 95% CI, 1.4 to 3.2), but not in older participants (>60 years) (OR = 1.31, 95% CI, 0.8 to 2.4). ConclusionsLp(a) seems to be an independent risk factor for ACS in individuals <45 years, and high Lp(a) levels increase by ∼3folds the risk for ACS. The association is preserved but is less in middle-aged individuals (45-60 years) and is abolished >60 years.

Immunologic burden links periodontitis to acute coronary syndrome

Background and aimsPeriodontitis, a common polymicrobial inflammatory disease in the tooth supporting tissues, is a risk factor for coronary artery disease. One of the proposed underlying mechanisms is the systemic immune response to periodontal infection. We studied how serum antibodies against seven periodontal pathogens and their subgingival levels associate with each other, periodontitis, and coronary artery disease. MethodsThe Parogene cohort included 505 Finnish patients (mean age 63 y) who underwent coronary angiography, and clinical and radiographic oral examinations. Coronary diagnosis was defined as no significant coronary artery disease (<50% stenosis, n = 152), stable coronary artery disease (≥50% stenosis, n = 184) and acute coronary syndrome (n = 169). Levels of subgingival Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Porphyromonas endodontalis, Prevotella intermedia, Tannerella forsythia, Campylobacter rectus, and Fusobacterium nucleatum were determined by checkerboard DNA-DNA hybridization. Serum antibody (IgA/IgG) levels were analyzed with enzyme-linked immunosorbent assay (ELISA). Aggregate IgA/IgG burdens were calculated by summing and standardizing the serum antibody levels. ResultsPatients with active periodontitis were characterized by higher levels of subgingival bacteria and corresponding IgA/IgG response. Quartiles 2–4 of serum IgA/IgG burden indicated higher risk for acute coronary syndrome (OR 1.84, 95%CI 1.01–3.35 for IgA; OR 1.87, 95%CI 1.01–3.46 for IgG) independently of established cardiovascular risk factors, body mass index, number of teeth, subgingival bacterial levels and periodontal diagnosis. ConclusionsOur findings support the hypothesis that the association between periodontitis and cardiovascular diseases is partly mediated by the immunologic response for periodontal pathogens.

Risk Factors Associated with Acute Coronary Syndrome after Successful Percutaneous Coronary Intervention

Abstract Objective: Admission for acute coronary syndrome after successful percutaneous coronary intervention is a delicate situation for the patient and doctor. Predictors of these cases are poorly described. Methods: We retrospectively analysed the files of post-percutaneous coronary intervention patients admitted to the Department of Cardiology of the Institute for Cardiovascular Disease and Heart Transplant in Tirgu Mures between January 2012 and December 2015. Analyses using the t-test, chi-square test, and Fisher test were performed to compare demographics, clinical and angiographic characteristics of patients with acute coronary syndrome, patients with stable angina, and those without symptoms. Results: One hundred eighty post-percutaneous coronary intervention patients were readmitted; 46 patients (25.55%) were readmitted for acute coronary syndrome. Histories of arterial hypertension and renal dysfunction at hospital admission were associated with acute coronary syndrome. Bare metal stent in-stent restenosis and localisation of bare metal stent in-stent restenosis of the left descendent coronary artery were angiographic predictors of acute coronary syndrome. Conclusion: Several clinical and angiographic factors identify patients at high risk for acute coronary syndrome after successful percutaneous coronary intervention. Recognition and treatment of these factors may prevent readmission for such a dangerous condition and may improve outcomes.

Young Acute Coronary Syndrome Risk Factors and Outcome

Young Acute Coronary Syndrome Risk Factors and Outcome

MRAS gene marker rs9818870 is not associated with acute coronary syndrome in the Czech population and does not predict mortality in males after acute coronary syndrome.

Genome-wide association studies (GWAs) focused on cardiovascular diseases reveal variants within genes which have not been analyzed through the pre-GWAs era, and whose function is often unknown. One of them is variant rs9818870 at the MRAS gene locus. To analyze if MRAS polymorphism is associated with acute coronary syndrome (ACS) risk in a Czech population and with mortality in male patients after myocardial infarction. 1,779 male patients with ACS (aged 55.3 ±7.9 years) and 673 female patients with ACS (aged 64.0 ±8.1 years) were genotyped for rs9818870 polymorphism using the PCR-RFLP method. In a subset of 1,221 patients, detailed diagnoses (901 subjects with STEMI, 280 subjects with NSTEMI, 40 cases with unstable angina pectoris) were recorded. In 1,614 males, records about total and cardiovascular mortality were available. Whether the entire populations or males and females have been analyzed separately or not, we have not confirmed the described association between DNA marker rs9818870 and ACS in Czechs (30.4% vs 29.4% carriers of the minor T allele [recessive model], p = 0.54; OR 1.05; 95% CI 0.89-1.24 for males and 32.1% vs 29.7% carriers of the minor T allele, p = 0.28; OR 1.12; 95% CI 0.91-1.37 for females). Types of the ACS (STEMI and NSTEMI) or mortality (in males only) were not associated with the analyzed polymorphism (all p > 0.34). The rs9818870 variant is not associated with ACS or mortality in ACS patients in the Czech Slavonic population.

Abstract 21185: Predictors of High Risk of Acute Coronary Syndrome in Diabetes: An Endothelial Damage Biomarker Approach

Background: Patients with diabetes mellitus (DM) are at increased risk of acute coronary syndrome (ACS); however, the factors predicting those at highest risk are not well-understood. We identified demographic and standard risk factors that best predict those at high risk based on a multiple biomarker algorithm. Methods: We studied adults with DM from a clinical registry who had measures of the PULS score (GD Biosciences, Irvine, CA), a biomarker algorithm identifying endothelial damage and predicting 5-year ACS risk consisting of HGF, sFAS, Fas Ligand, Eotaxin, CTACK, MCP3, Il-16, HbA1c, HDL-C, as well as age, sex, DM, and family history of CHD. We identified the proportion of patients with DM at low (&lt;3.5%), intermediate (3.5-&lt;7.5%), and high (≥7.5%) risk of ACS based on PULS. Stepwise logistic regression providing odds ratios and 95% confidence intervals (CIs) examined the relationship of age, gender, and individual risk factors not part of the PULS algorithm with the likelihood of a high risk PULS score. Results: There were 668 adults with DM (females: 39.5%, ages 30 to 100, mean age 66.5 years). Of these, 6.0% had a low, 12.9% intermediate, and 81.1% high risk PULS score. In the stepwise logistic regression, independent predictors of a high risk PULS score included age, sex, hypertension, body mass index (BMI), and current smoking (table). Other risk factors and biomarkers, including apolipoprotein A-1 (ApoA1), apolipoprotein B (ApoB), ratio ApoB to ApoA1, total or LDL-cholesterol, triglycerides, very low density lipoprotein cholesterol, lipoprotein (a), systolic or diastolic blood pressure, hs-CRP, and small dense LDL were not associated with a high PULS risk score. Conclusion: We demonstrated that age, male gender, hypertension, BMI, and current smoking are key factors potentially identifying persons with DM at high risk of ACS based on an algorithm identifying endothelial damage. Further validation through prospective studies with actual ACS events are needed.

Abstract 21108: Early Evidence That the Female Genome Does Matter for Acute Coronary Syndrome Risk

Introduction: Women of all ethnicities have the highest rates of Acute Coronary Syndrome (ACS) misdiagnosis, delayed treatment, and ACS-related near-term mortality. Known physiologic differences and traditional risk factors have failed to fully explain these ACS disparities among women. Our knowledge gap of genomic variation underlying women’s unique ACS phenotypes means that there is no female-derived ACS risk biomarker that reflects female-specific biology and phenotype features. Among 510 women, we previously identified 122 SNPs within 14 genomic regions that significantly predicted ‘survivorship in CAD’ (all-cause mortality among coronary artery disease cases; p&lt;10-5); none of which were significant in males or controls. Given the recent recognition of sex as a biological variable, our purpose was to identify female-specific genomic markers that predict ACS case status. Methods: We performed secondary case-control analysis for 1,382 females (796 ACS cases/586 non-ACS controls) of the Duke Catheterization Genetics (CATHGEN) Study (Illumina Human Infinium 1.0 platform). ACS was defined as having no previous MI history plus either documented unstable angina pain type or incident myocardial infarction. We employed logistic regression models of ACS case status for each SNP separately, assuming additive genetic models, and controlling for age and 3 PCAs of ethnicity. Results: Twenty-three SNPs among 3 biologically relevant candidates ( LPAGT1 , SLC9A9 , &amp; RAP1GAP2 ) significantly predicted women’s ACS (range p=7.43x10 -5 - 0.05) with positive and negative odds ratios observed. LPGAT1 is involved in cardiolipin synthesis; SLC9A9 is involved in endosome recycling; and, RAP1GAP2 regulates secretion of dense granules from platelets at endothelial damage sites. Additionally, 74 SNPs within the 11 novel survivorship with CAD candidates significantly predicted ACS (p&lt;0.05). Conclusions: We demonstrate proof of principal for unique , female-specific genomic effects on ACS case status; and, shared genomic variation with ACS and survivorship in CAD among women. Validation of this work is required. Future research is needed to identify female-derived genomic markers that may uniquely characterize women’s ACS and coronary disease expression.

Prognostic impact of multimorbidity in patients with type 2 diabetes and ST-elevation myocardial infarction.

IntroductionThere is an increasing body of evidence on the clinical importance of multimorbidity, which is defined as the coexistence of two or more chronic conditions. Type 2 diabetes (T2DM) is one of the most frequent chronic conditions. Most adults with type 2 diabetes have at least 1 coexisting chronic condition and approximately 40% have 3 or more. Prior studies have suggested that cardiovascular (CVD) and non-CVD comorbid conditions yield worse outcomes in patients hospitalized with ST-elevation myocardial infarction (STEMI). It is unclear, however, the extent to which multimorbidity has a cumulative effect on long-term risk. Therefore we have set out to determine the prognostic value of multiple comorbidity on long-term outcomes in this population of patients.MethodsA total of 277 patients with T2DM and STEMI undergoing primary percutaneous coronary intervention (PCI) were enrolled. Based on the number of comorbidities the study population was divided into two groups: group 1 (N=58) with ≤ 1 comorbidity and group 2 (N=219) with ≥ 2 comorbidities.ResultsComorbid conditions were prevalent among study participants (Figure 1). The median number of comorbidities was three. 15.9% of patients had one comorbidity and 22.0%, 34.3%, and 22.7% of patients had two, three or at least four comorbid conditions respectively. A majority of patients had at least one CVD comorbidity (6.1% of patients had none), whereas 53.1% of patients did not have any non-CVD comorbidity. During hospitalization 3 out of 58 patients (5.2%) died in group 1 and 25 of 219 patients (11.4%) died in group 2. The number of comorbid conditions was not an independent predictor of in-hospital death. During 12-month follow-up, 5 of 58 patients (8.6%) and 42 of 219 patients (19.9%) died, respectively in group 1 and 2 (P=0.05). The number of comorbid conditions proved in ROC analysis that for 12-month mortality, the prognostic value was modest, but for 12-month acute coronary syndromes the prognostic value was good. Increase in the number of comorbid conditions by one was associated with a 15% increase in the relative risk of 12-month mortality and a 41% increase in the relative risk of 12-month acute coronary syndromes (ACS).ConclusionsComorbid conditions are highly prevalent among these groups of patients. Majority of patients have at least 2 other cardiovascular comorbidities and one or two non-cardiovascular comorbidities. In terms of long-term follow-up, multimorbidity was associated with worse outcomes. The risk of both long-term mortality and ACS increased with the increasing number of comorbidities. In summary, our findings highlight the importance of indentifying patients with multimorbidity. This, in turn, could allow for provision of better care to these high-risk and complex group of patients.

Q192R polymorphism in the PON1 gene and familial hypercholesterolemia in a Saudi population.

BACKGROUNDFamilial hypercholesterolemia (FH) is an autosomal dominant condition characterized by abnormal levels of low-density lipoprotein (LDL) in the blood. FH is a risk factor for atherosclerosis and cardiovascular disease. The relationship between the paraoxonase 1 (PON1) gene, atherosclerosis and coronary artery disease has not been studied in Saudi patients.OBJECTIVETo investigate the genetic associations of the Q192R polymorphism in the PON1 gene with FH in Saudi patients.DESIGNCase-control study.SETTINGTertiary care center, Riyadh.METHODSTwo hundred Saudi patients were enrolled in this study, including 100 patients with FH and 100 healthy controls, during the period from January 2012 to March 2013. Serum was separated from coagulated blood (3 mL) and used for analysis of lipid profiles. Genomic DNA was isolated from anticoagulant-treated blood (2 mL). Genotyping for the Q192R polymorphism was performed by polymerase chain reaction-restriction fragment length polymorphism analysis, followed by 3% agarose gel electrophoresis.MAIN OUTCOME MEASUREThe strength of association between the Q192R polymorphism and FH in the Saudi population.RESULTSWe confirmed that QR versus QQ (odds ratio [OR]: 1.55; 95% confidence interval [CI]: 1.05–3.43; P=.03), QR+RR versus QQ (OR: 1.98; 95% CI: 1.13–3.49; P=.01), and R versus Q (OR: 1.68; 95% CI: 1.09–2.59; P=.01) in the Q192R polymorphism were associated with FH in the Saudi population.CONCLUSIONIn conclusion, the Q192R polymorphism in the PON1 gene is associated with FH in the Saudi population. Our results confirmed that the R allele, QR, and dominant model genotypes were associated with FH.LIMITATIONOnly a single variant (Q192R) was analyzed, and the medical and family histories of the patients were not known.

Evaluation of Carotid Plaque Neovascularization in Patients With Coronary Heart Disease on Contrast-Enhanced Ultrasonography.

To examine the repeatability of quantitative time-intensity curve analysis of neovascularization within carotid plaques with contrast-enhanced ultrasonography (US) and to investigate carotid plaque neovascularization in patients with coronary heart disease using contrast-enhanced US and the correlation between risk factors and acute coronary syndrome (ACS). Sixty patients with ACS and 60 with stable coronary artery disease (CAD) underwent conventional carotid and contrast-enhanced US, and plaque enhancement was observed and analyzed quantitatively. Carotid contrast-enhanced US was performed within 1 month of ACS occurrence. Interobserver and intraobserver variability of the measurements was assessed. The peak signal intensity was the maximum number of contrast microbubbles that local tissues could accumulate, reflecting the local microvascular density and representing the capillary volume. The ACS group had higher low-density lipoprotein cholesterol (mean ± SD, 3.21 ± 0.75 versus 2.53 ± 0.71 mmol/L; P < .01) and high-sensitivity C-reactive protein (CRP; 3.76 ± 0.19 versus 2. 93 ± 0.15 mg/L; P < .01) levels than the stable CAD group. The proportion of soft plaques in the ACS group (81%) was higher than in the stable CAD group (53%). The proportion of plaque enhancement, peak signal intensity, and plaque-to-carotid lumen enhancement intensity ratio were higher in the ACS group than the stable CAD group. The peak signal intensity was correlated with the high-sensitivity CRP value. Logistic regression analyses indicated that age (65-74 years), high-sensitivity CRP, and enhancement intensity were correlated with the occurrence of ACS. The sensitivity and specificity of the peak signal intensity in carotid plaques were 80.0% and 88.3%, respectively (cutoff value, 9.97 dB; area under the receiver operating characteristic curve, 0.865). The time-intensity curve measurements had good repeatability. Carotid plaque enhancement is a potential independent risk factor for ACS occurrence. These results illustrate the correlation of carotid plaque vulnerability with the coronary artery symptomatic state according to the common pathogenetic mechanism of atherosclerosis.

TCT-413 Clinical Relevance of Adverse Plaque and Hemodynamic Characteristics in Non-obstructive Lesions in the Prediction of Risk for Acute Coronary Syndrome

TCT-413 Clinical Relevance of Adverse Plaque and Hemodynamic Characteristics in Non-obstructive Lesions in the Prediction of Risk for Acute Coronary Syndrome

Risk factors for acute coronary events in patients with rheumatoid arthritis

ObjectivesThe aim of this study was to assess the role of disease activity, line of treatment, and carotid atherosclerosis in the risk for acute coronary syndrome (ACS) in rheumatoid arthritis (RA) patients.Patients and methodsIn this prospective study, we ascertained ACS on 124 patients with RA. Disease activity score 28 was used for the assessment of RA activity. Insulin resistance was evaluated using homeostasis model assessment-insulin resistance. Carotid atherosclerosis was measured using high-resolution ultrasound. We used Cox’s proportional hazards models to estimate the association between ACS and atherosclerosis, cardiovascular (CV) risk factors, and RA line of treatment.ResultsAmong the 124 RA patients without a history of previous ACS, 16 incident ACS events occurred over 30 months. Old age, long RA disease duration, high BMI, and 10-year cardiovascular disease risk were associated with an increased risk for ACS. High mean disease activity score 28, rheumatoid factor, and anticitrullinated peptide antibodies (ACPA) levels were significantly associated with ACS risk. Treatment with disease-modifying antirheumatic drugs or biological disease-modifying antirheumatic drugs (DMARDs) did not alter the ACS risk. Logistic regression analysis showed that carotid plaques were a good predictor for ACS in RA patients.ConclusionThe main finding of this study was a general tendency toward an association of disease activity, rheumatoid factor, and ACPA with the risk for ACS. In addition, subclinical atherosclerosis detected by means of carotid intima-media thickness and the presence of carotid plaques were good predictors for RA patients with ACS. Treatment with any DMARD or biologic DMARDs was not linked to an altered risk for ACS.

Ischaemic heart disease in cancer patients. Questions and problems

Cardiovascular and oncologic diseases are the causes of more than 50 percent of mortality in Europe. In 2015 oncologic and cardiovascular mortality reached 70 percent in Hungary. Patients who receive anticancer therapies are at a 2- to 7-fold greater long-term risk of acute coronary syndrome; also concomittant oncologic diseases further increase the mortality of myocardial infarction. Unfortunately there is not enough data concerning cardiovascular treatment of oncologic patients because they were excluded from most of the studies and registries. Because there is no clear protocol to treat such patients, only small studies and personal experiences could guide our medical therapies. The role of cardio-oncology is even more important, because due to the new treatments the number of tumor survivors rapidly increases. In the US more than 20 millions survivals are expected by 2025 who were treated by any kind of malignant tumors. It is not surprising that in 2014 the American Society of Cardiology declared cardio-oncology as a special and important field in cardiology, and in 2016 European Society of Cardiology released the first cardio-oncologic guideline. In this review we summarize questions and problems concerning the treatment of oncologic patient with ischaemic heart disease based on resent guidelines, published studies and local protocols. Orv Hetil. 2017; 158(43): 1691-1697.

Validity of GRACE Risk Score as a Prognostic Marker of In-hospital Mortality after Acute Coronary Syndrome.

To determine validity of GRACE risk score as a determinant of immediate death during hospitalization for Acute Coronary Syndrome (ACS) and analyze the percentage of cardiac deaths among high, intermediate and low risk groups. Cross-sectional study. Coronary Care Unit of Mayo Hospital, Lahore, from April to July 2015. Patients with acute chest pain were selected according to inclusion and exclusion criteria. Online GRACE risk score calculator was used to determine the predicted risk of death following ACS according to the score. Data was analyzed on SPSS 20. Quantitative data was in the form of median (IQR). Discrimination of GRS was evaluated by using c-statistics, area under the ROC curve. Calibration of GRS was tested by Hosmer-Lameshow test. The correlation between GRACE risk score category and predicted risk of death was determined using Kendall's tau-b bivariate correlation test. Shapiro-Wilk test was applied to check normality of data. The various parameters of GRACE score were studied in patients using Mann-Whitney U-test. The statistically significant p-value was <0.05. There were 165 cases in the study. Overall median GRS was 139 (54). In-hospital deaths were 12.2%. Discrimination of GRS evaluated by area under the ROC curve was 0.913 (95% CI 0.843-0.982; p<0.0001). Application of Hosmer-Lameshow test revealed a p-value of 0.236. Kendall's tau-b bivariate correlation coefficient was 0.384 (p<0.001). GRS is an excellent tool to stratify patients of ACS into different risk categories according to various parameters noted at the time of presentation. The risk of predicted death according to the score was variable among different cases, especially those with higher scores. Even though GRS is an effective and valid tool, but it has some tendency of overestimating probability of death following ACS and may require a fine tuning in some cases.

Excess psychosocial burden in women with diabetes and premature acute coronary syndrome.

Diabetes is a stronger risk factor for acute coronary syndrome for women than men. We investigate whether behavioural and psychosocial factors contribute to the disparity in acute coronary syndrome risk and outcomes among women with diabetes relative to women without diabetes and men. Among 939 participants in the GENESIS-PRAXY cohort study of premature acute coronary syndrome (age ≤ 55 years), we compared the prevalence of traditional and non-traditional factors by sex and Type 2 diabetes status. In a case-only analysis, we used generalized logit models to investigate the influence of traditional and non-traditional factors on the interaction of sex and diabetes. In 287 women (14.3% with diabetes) and 652 men (10.4% with diabetes), women and men with diabetes showed a heavier burden of traditional cardiac risk factors compared with individuals without diabetes. Women with diabetes were more likely to be the primary earner and have more anxiety relative to women without diabetes, and reported worse perceived health compared with women without diabetes and men with diabetes. The interaction term for sex and diabetes (odds ratio (OR) 1.40, 95% confidence intervals (95% CI) 0.83-2.36) was diminished after additional adjustment for non-traditional factors (OR 1.12, 95% CI 0.54-2.32), but not traditional factors alone (OR 1.41, 95% CI 0.84-2.36). We observed trends toward a more adverse psychosocial profile among women with diabetes and incident acute coronary syndrome compared with women without diabetes and men with diabetes, which may explain the increased risk of acute coronary syndrome in women with diabetes and may also contribute to worse outcomes.

Long-term outcomes and secondary prevention after acute coronary events in patients with rheumatoid arthritis

ObjectivesPatients with rheumatoid arthritis (RA) are at increased risk of acute coronary syndrome (ACS) and suffer from poorer short-term outcomes after ACS. The aims of this study were to assess...

A vulnerable plaque identified on CT coronary angiography: when should we act in stable coronary artery disease?

CT coronary angiography (CTCA) is increasingly being used to diagnose coronary artery disease (CAD). Recent technological advancements, including dual energy CT and improved gantry times, have led to the ability...