Risk Of Acute Coronary Syndrome Research Articles

Correlation of serum N-Acetylneuraminic acid with the risk and prognosis of acute coronary syndrome: a prospective cohort study

BackgroundN-acetylneuraminic acid (Neu5Ac) is a functional metabolite involved in coronary artery disease (CAD). We aimed to evaluate the relationship between serum Neu5Ac and the risk and prognosis of acute coronary syndrome (ACS) in a real-world prospective study.MethodsPatients with suspected ACS who underwent coronary angiography were included. Serum Neu5Ac was measured at admission. Coronary lesion severity was evaluated by Gensini Score. GRACE risk stratification was performed at admission. Major adverse cardiac events (MACEs) were recorded during follow-up.ResultsA total of 766 patients, including 537 with unstable angina (UAP), 100 with myocardial infarction (MI), and 129 without CAD were included. The circulating Neu5Ac level was significantly higher in patients with MI (median [1QR]: 297[220, 374] ng/ml) than in those with UAP (227 [114, 312] ng/ml) or without CAD (207 [114, 276] ng/ml; both p < 0.001). Serum level of Neu5Ac was positively correlated with age, hypertension, serum uric acid, creatinine, MB isoform of creatine kinase (CK-MB), and Gensini score (all p < 0.05). Receiver operating characteristic curve analysis showed that a higher serum Neu5Ac was potentially associated with MI and high-risk GRACE stratification in ACS patients. Logistic analysis identified only elevated serum Neu5Ac as an independent predictor of MACEs in these patients (odds ratio [OR]: 1.003, 95% confidence interval [CI]: 1.002–1.005, p < 0.001).ConclusionsSerum Neu5Ac is associated with myocardial injury, GRACE risk category, and prognosis in ACS patients.

Association between carbonyl stress markers and the risk of acute coronary syndrome in patients with type 2 diabetes mellitus–A pilot study

Background and aimsCarbonyl stress is one of the mechanisms responsible for diabetes and its complications. The study was planned to examine the relationship between carbonyl stress markers and the risk of acute coronary syndrome (ACS) in patients with type 2 diabetes mellitus (T2DM). MethodsForty T2DM patients with ACS and forty T2DM patients without ACS participated in this cross-sectional pilot study. Routine biochemical investigations, creatine kinase-total (CK-T), and creatine kinase-MB (CK-MB) levels were estimated. Serum carbonyl stress markers were analysed by enzyme-linked immunosorbent assay. Binary logistics regression was done to determine the predictive value of carbonyl stress markers for ACS. ResultsFasting plasma glucose, serum total methylglyoxal (MG), methylglyoxal derived hydroimidazolones-1 (MG-H1), and Nε-carboxymethyl-lysine (CML) levels were significantly higher in T2DM patients with ACS than in those without ACS. Serum glyceraldehyde-3-phosphate dehydrogenase (GAPDH) and glyoxalase-1 (GLO1) levels were significantly lower in T2DM patients with ACS than in those without ACS. Fasting plasma glucose level was significantly positively correlated with serum MG (r = 0.441, P < 0.001), CML (r = 0.649, P < 0.001), MG-H1 (r = 0.725, P < 0.001), and negatively correlated with serum GAPDH (r = – 0.268, P = 0.012) and GLO1 (r = – 0.634, P = 0.016). Receiver operating characteristic curve analysis showed that serum GAPDH and GLO1 could predict the risk of ACS in T2DM patients. ConclusionThese findings revealed that high carbonyl stress due to lower levels of GAPDH and GLO1 may predispose patients with T2DM for more risk of ACS.

Влияние наличия критериев метаболического синдрома на течение раннего и отдаленного постинфарктного периода у больных с инфарктом миокарда с элевацией сегмента ST

Цель работы – оценить клиническое значение наличия метаболического синдрома (МС) у больных с острым инфарктом миокарда (ОИМ) для течения постинфарктного периода и его влияния на прогноз на основе ретроспективного анализа сопоставимых пар пациентов. Материалы и методы. Ретроспективный анализ базы из 820 случаев ОИМ с элевацией сегмента ST включал: оценку наличия основных факторов риска согласно шкалам TIMI, GRACE, PURSUIT и компонентов МС при поступлении (наличие сахарного диабета и/или повышение уровня глюкозы &gt; 7 ммоль/л, избыточная масса тела, артериальная гипертензия, нарушение липидного спектра крови), а также оценку показателей клинического течения госпитального периода ОИМ, лечения и результатов отдаленного наблюдения за пациентами с учетом случаев кардиальной смерти.Результаты и обсуждение. Путем автоматизированного подбора пар были сформированы группа 1 (n=41, пациенты с МС) и группа 2 (n=123, пациенты без МС), сопоставимые по следующим 13 факторам риска: возраст, рост, наличие сердечной недостаточности, курение, снижение систолического артериального давления в 1-е сутки ОИМ, локализация поражения по ЭКГ, пиковый уровень МВ-фракции креатинфосфокиназы и АСТ, наличие в анамнезе стенокардии напряжения и периода нестабильной стенокардии перед ОИМ, наличие инфаркта миокарда в анамнезе, частота сокращений сердца в 1-е сутки ОИМ, скорость клубочковой фильтрации по формуле CKD-EPI в 1-е сутки ОИМ, мужской пол. Группа 1 характеризовалась более тяжелым клиническим течением ОИМ, а также более интенсивной госпитальной терапией (включавшей более частое назначение ингибиторов ангиотензинпревращающего фермента и статинов). К 10-м суткам заболевания больные группы 1 имели более низкие показатели конечнодиастолического индекса ((59,1±2,55) по сравнению с (66,50±2,38) мл/м2 в группе 2; p&lt;0,05), конечносистолического индекса ((31,90±1,79) по сравнению с (37,50±1,89) мл/м2 в группе 2; p&lt;0,05) и тенденцию к более низкой 3-летней смертности (4,9 % по сравнению с 17,1 %; p=0,05).Выводы. Наличие у больных с ОИМ сопутствующего МС сопряжено с более тяжелым течением острого периода заболевания, но в силу более интенсивной кардиальной терапии в этой группе больных отмечается более благоприятное течение постинфарктного периода.

Effects of tamoxifen and aromatase inhibitors on the risk of acute coronary syndrome in elderly breast cancer patients: An analysis of nationwide data

BackgroundAromatase inhibitors (AIs) are the preferred endocrine treatment for postmenopausal hormonal receptor-positive breast cancer. However, there is controversy on the long-term cardiovascular and cerebrovascular safety of AIs over that of tamoxifen. MethodsWe analyzed the National Health Information Database (NHID) of 281,255 women over a 20-year-old diagnosed with breast cancer between 2009 and 2016. Cardiovascular events (CVEs) were defined as the development of the following, acute coronary syndrome (ACS), ischemic and hemorrhagic stroke, defined by using insurance claim records. The model was constructed by Cox proportional hazard regression and this model was used to analyze the effects of AI and tamoxifen on CVE. ResultsWe included 47,569 women for the final analysis. Patients were classified into ‘No hormonal treatment (n = 18,807), ‘Switch (n = 2097)’, ‘Tamoxifen (n = 7081)’ and ‘AI (n = 19,584)’. There were 2147 CVEs in 2032 patients (4.1%). Univariate analysis showed that women with tamoxifen had significantly lower risk for CVEs compared to no-treatment (hazard ratio (HR) 0.84, 95% confidence interval (CI) 0.74–0.97) while AI showed no such effect (HR 0.93, 95% CI 0.84–1.02). After adjusting for other risk factors (hypertension, dyslipidemia, family history), the use of tamoxifen was associated with significant protective effect against ACS (HR 0.63, 95% CI 0.47–0.84). ConclusionsOur results, based on the NHID, supports the protective effect of tamoxifen against CVE in Korean breast cancer patients aged 55 and older that is not seen with AIs. Our results can guide the selection of adjuvant hormonal treatment agents for Korean breast cancer patients based on their risk of developing CVE.

Prevalence of Acute Coronary Syndrome and Various Risk Factors in Acute Stroke Patients.

BackgroundStroke is the second leading cause of death worldwide after acute coronary syndrome (ACS). Both diseases share many risk factors such as hypertension, diabetes, dyslipidemia, and smoking. Patients who experience acute coronary syndrome are at heightened risk of recurrent ischemic events such as ischemic strokes, one of the most feared cardiovascular events because of the risk of long-term disability. We tried to estimate the prevalence of underlying ACS among patients with acute stroke.MethodsThis cross-sectional study was done at the CPE Institute of Cardiology, Pakistan, and Nishtar Medical University and Hospital, Pakistan. A total of 160 acute stroke cases were selected by consecutive sampling technique and questionnaire forms were filled. Detailed history, investigations, and physical examinations were done. The primary outcome was the prevalence of ACS and secondary outcomes were the prevalence of hypertension, smoking, dyslipidemia, diabetes mellitus, and previous history of stroke in stroke patients.ResultsMost of the patients that presented to us were above 50 years of age with the mean age of 62 years (SD = 9.23 years). Male predominance was seen with a total of 115 (72%) cases. Out of 160 patients, 91 (57%, p < 0.05) had underlying ACS, with 45 cases (49%) with unstable angina, 20 (22%) with non-ST-elevation myocardial infarction (NSTEMI), and 26 (29%) with ST-elevation myocardial infarction (STEMI). Prevalence of risk factors in 160 cases were, hypertension (101, 63%), lack of exercise (91, 57%), smoking (70, 44%), diabetes mellitus (61, 38%), dyslipidemia (50, 31%). All these results were statistically significant (p < 0.05). Prevalence of obesity (35, 22%) and previous stroke history (19, 12%) was statistically insignificant (p > 0.05).ConclusionAcute coronary syndrome is still frequently present in patients with acute stroke. The need of the hour is to manage ACS efficiently so that its deadly complications such as stroke can be prevented.

Novel biomarkers to assess the risk for acute coronary syndrome: beyond troponins.

Current diagnostic biomarkers for ACS are mainly represented by troponin I and troponin T. Dosing of these two molecules often leads to false positive results, since their plasma levels can increase in several different systemic settings. Therefore, identification of new markers able to detect patients with acute coronary syndromes is an emerging priority. On this view, many studies have been performed on different microRNAs, mitochondrial peptides, inflammatory cytokines and adhesion molecules with very promising results. Besides their introduction in screening programs, further studies are now needed in the acute setting, beyond or in association with troponin levels. This will help to better discriminate the real occurrence of an ACS in many patients accessing the emergency department for chest pain.

Applying the CHA2DS2-VASc score to predict the risk of future acute coronary syndrome in patients receiving catheter ablation for atrial fibrillation.

It remains unknown whether catheter ablation for atrial fibrillation (AF) reduces future acute coronary syndrome (ACS) risk or whether the CHA2DS2-VASc score has a role in predicting this risk. We aimed to compare very long-term risk of ACS between patients who received catheter ablation to AF or antiarrhythmic medications and controls without AF. Propensity scores were calculated for each patient and used to assemble a cohort of 787 patients undergoing AF ablation in 2003-2012. Patients were compared to an equal number of AF patients treated with antiarrhythmic medications and a control group without AF. Patients with previous coronary events were excluded. The primary endpoint was ACS occurrence. Baseline clinical characteristics were comparable. After a mean 9.1±3.2-year follow-up, the ablation group had lower incidence of new onset ACS than the medication and non-AF control groups (annual incidence: 0.15%. 0.78%, and 0.35%; with 2.67, 4.16, and 10.44 cases/1000 person-years, respectively; P<0.001). After adjusting for multiple confounders, the ablation group had lower future ACS risk than the medication (hazard ratio [HR]: 0.20, 95% confidence interval [CI]: 0.13-0.30) and control groups (HR: 0.30, 95% CI: 0.20-0.45). The CHA2DS2-VASc score was a strong predictor of ACS (HR: 1.61, 95% CI: 1.47-1.76; AUC: 85.9%, 95% CI: 78.5-93.2%). A baseline CHA2DS2-VASc score≥4 predicted future ACS (positive predictive rate: 14.3%). This study suggested that catheter ablation for AF may be beneficial to reduce future ACS risk in AF patients, and a high baseline CHA2DS2-VASc score can predict future acute coronary events.

Mechanisms for the Risk of Acute Coronary Syndrome and Arrhythmia Associated With Phytogenic and Synthetic Cannabinoid Use.

Phytogenic cannabinoids from Cannabis sativa and synthetic cannabinoids are commonly used substances for their recreational and medicinal properties. There are increasing reports of cardiotoxicity in close temporal association with cannabinoid use in patients with structurally normal hearts and absence of coronary arterial disease. Associated adverse events include myocardial ischemia, conduction abnormalities, arrhythmias, and sudden death. This review details the effects of phytogenic and synthetic cannabinoids on diverse receptors based on evidence from in vitro, human, and animal studies to establish a molecular basis for these deleterious clinical effects. The synergism between endocannabinoid dysregulation, cannabinoid receptor, and noncannabinoid receptor binding, and impact on cellular ion flux and coronary microvascular circulation is delineated. Pharmacogenetic factors placing certain patients at higher risk for cardiotoxicity are also correlated with the diverse effects of cannabinoids.

Association of serum regenerating islet-derived protein 3-beta and oncostatin-M levels with the risk of acute coronary syndrome in patients with type 2 diabetes mellitus – A pilot study

Background and aimsRegenerating islet-derived protein 3-beta (Reg3β) and oncostatin-M (OSM), an inducer of Reg3β, are important for the recruitment of macrophages, tissue repair and survival after myocardial infarction. The study was planned to elucidate the diagnostic utility of serum Reg3β and OSM levels for the acute coronary syndrome (ACS). MethodsForty-two type 2 diabetes mellitus (T2DM) patients with ACS as cases and forty-two T2DM patients as controls were recruited. Routine biochemical investigations, creatine kinase-total (CK-T), and creatine kinase-MB (CK-MB) levels were estimated. Serum Reg3β and OSM levels were analysed by enzyme-linked immunosorbent assay. ResultsSerum Reg3β and OSM levels were significantly higher in cases as compared to controls. Serum Reg3β and OSM levels were positively correlated with random blood glucose, serum CK-total, CK-MB levels, and negatively correlated with serum high-density lipoprotein cholesterol (HDL-C) levels. Receiver operating characteristics curve analysis showed that serum OSM and Reg3β levels can be used for the diagnosis of ACS in patients with T2DM as compared to CK-MB levels. On regression analysis, serum Reg3β level was positively associated with body mass index and negatively with serum HDL-C levels and serum OSM level was positively associated with waist circumference and random blood glucose and negatively with serum HDL-C levels. ConclusionSerum Reg3β and OSM levels may be used as complementary markers besides traditional cardiac markers for the diagnosis of ACS in patients with T2DM. However, further studies are still needed to verify our claim.

Atrial fibrillation in elderly patients. Features of using rivaroxaban

The problem of anticoagulant treatment of elderly patients with atrial fibrillation (AF) is very topical for everyday medical practice because, on the one hand, the proportion of elderly patients among those who have AF is constantly increasing, and, on the other hand, there is no doubt that treatment of elderly patients involves many problems associated with a large number of complications. This material reviews the choice of optimal anticoagulant therapy for older AF patients and focuses on the use of rivaroxaban. Clinical research data show that rivaroxaban is one of the optimal drugs of choice for older patients. Thus, a comparative meta-analysis of the safety of various non-vitamin-K oral anticoagulants (NOAC) in patients of ≥75 years of age (in AF and deep vein thrombosis) showed that administration of rivaroxaban in comparison with warfarin was associated with an almost twofold significantly lower frequency of fatal bleedings (HR 0.53; 95% Cl 0.30-0.93; p = 0.03). According to the ROCKET-AF study, intake of rivaroxaban in elderly patients was comparable in efficiency and safety profile to warfarin. Since renal dysfunction is common in older patients with AF, safety issues are very important. In a ROCKET-AF study, the use of rivaroxaban in patients with moderate renal dysfunction was known to be associated with a lower frequency of fatal bleeding (0.28 vs. 0.74 per 100 patients/ year; HR 0.39; 95% CI 0.15-0.99; p = 0.047) than that of warfarin. Given the high probability of development of exacerbation of IHD in elderly patients with AF, they need an anticoagulant that maximally protects them from acute coronary complications. In the meta-analysis of 28 randomized trials with NOAC, only rivaroxaban was associated with a significant reduction by 22% in the risk of myocardial infarction and acute coronary syndrome compared to other control drugs. In conclusion, it can be stated that rivaroxaban may be a good choice for anticoagulant treatment specifically for elderly patients with AF, especially given its efficacy and safety profile and the adherence of patients to therapy.

Chest discomfort at night and risk of acute coronary syndrome: cross-sectional study of telephone conversations.

During telephone triage it is difficult to assign the adequate urgency to patients with chest discomfort. Considering the time of calling could be helpful. To assess the risk of acute coronary syndrome (ACS) in certain time periods and whether sex influences this risk. Cross-sectional study of 1,655 recordings of telephone conversations of patients who called the out-of-hours services primary care (OHS-PC) for chest discomfort. Call time, patient characteristics, symptoms, medical history and urgency allocation of the triage conversations were collected. The final diagnosis of each call was retrieved at the patient's general practice. Absolute numbers of patients with and without ACS were plotted and risks per hour were calculated. The risk ratio of ACS at night (0 am to 9 am) was calculated by comparing to the risk at other hours, and was adjusted for gender and age. The mean age of callers was 58.9 (SD ± 19.5) years, 55.5% were women and in total, 199 (12.0%) had an ACS. The crude risk ratio for an ACS at night was 1.80 (CI = 1.39 to 2.34, P<0.001); 2.33 (1.68 to 3.22, P<0.001) for men, and 1.29 (0.83 to 1.99, P = 0.256) for women. The adjusted risk ratio for ACS of all people at night was 1.82 (1.07 to 3.10, P = 0.039). Patients calling the OHS-PC for chest discomfort between 0-9 am have almost twice a higher risk of ACS than those calling other hours, a phenomenon more evident in men than in women. At night, dispatching ambulances more 'straightaway' could be considered for these patients with chest discomfort.

TicagRelor Or Clopidogrel in severe or terminal chronic kidney patients Undergoing PERcutaneous coronary intervention for acute coronary syndrome: The TROUPER trial

Chronic kidney disease (CKD) is associated with an increased risk of acute coronary syndrome (ACS) and cardiovascular death. CKD patients suffering from ACS are exposed to an increased risk of thrombotic recurrences and a higher bleeding rate than patients with normal renal function. However, CKD patients are excluded or underrepresented in clinical trials. Therefore, determining the optimal antiplatelet strategy in this population is of utmost importance. We designed the TicagRelor Or Clopidogrel in severe or terminal chronic kidney patients Undergoing PERcutaneous coronary intervention for acute coronary syndrome (TROUPER) trial: a prospective, controlled, multicenter, randomized trial to investigate the optimal P2Y12 antagonist in CKD patients with ACS. Patients with stage ≥3b CKD are eligible if the diagnosis of ACS is made and invasive strategy scheduled. Patients are randomized 1:1 between a control group with a 600-mg loading dose of clopidogrel followed by a 75-mg/d maintenance dose for 1 year and an experimental group with a 180-mg loading dose of ticagrelor followed by a 90-mg twice daily maintenance dose for the same duration. The primary end point is defined by the rate of major adverse cardiovascular events, including death, myocardial infarction, urgent revascularization, and stroke at 1 year. Safety will be evaluated by the bleeding rate (Bleeding Academic Research Consortium). To demonstrate the superiority of ticagrelor on major adverse cardiovascular events, we calculated that 508 patients are required. The aim of the TROUPER trial is to compare the efficacy of ticagrelor and clopidogrel in stage >3b CKD patients presenting with ACS and scheduled for an invasive strategy. RCT# NCT03357874.

Association between the Non-high-Density Lipoprotein Cholesterol to High-Density Lipoprotein Cholesterol Ratio and the Risk of Coronary Artery Disease.

Background The purpose of this study was to evaluate the association between the non-high-density lipoprotein cholesterol (non-HDL-C) to high-density lipoprotein cholesterol (HDL-C) ratio and the risk of coronary artery disease (CAD). We also explored the potential role of non-HDL-C/HDL-C in the prognosis of CAD. Methods We analyzed 930 consecutive patients with chest discomfort who underwent coronary angiography. Of these, 680 were diagnosed with CAD; the remaining 250 patients were normal. Multivariate logistic regression and receiver operating characteristic (ROC) curves were employed to evaluate the association between non-HDL-C/HDL-C and CAD. The effect of non-HDL-C/HDL-C on the progression of major adverse cardiovascular events (MACEs) was also explored. Results Increased non-HDL-C/HDL-C was associated with an increased risk of CAD (OR: 1.291; 95% CI: 1.039-1.561; P = 0.013). The results of stratified analyses by CAD subtype showed a correlation between high non-HDL-C/HDL-C and increased risk of acute coronary syndrome (OR: 1.661; 95% CI: 1.259-2.207; P = 0.013). The results of stratified analyses by CAD subtype showed a correlation between high non-HDL-C/HDL-C and increased risk of acute coronary syndrome (OR: 1.661; 95% CI: 1.259-2.207; P = 0.013). The results of stratified analyses by CAD subtype showed a correlation between high non-HDL-C/HDL-C and increased risk of acute coronary syndrome (OR: 1.661; 95% CI: 1.259-2.207; P = 0.013). The results of stratified analyses by CAD subtype showed a correlation between high non-HDL-C/HDL-C and increased risk of acute coronary syndrome (OR: 1.661; 95% CI: 1.259-2.207; P = 0.013). The results of stratified analyses by CAD subtype showed a correlation between high non-HDL-C/HDL-C and increased risk of acute coronary syndrome (OR: 1.661; 95% CI: 1.259-2.207; Conclusions The findings of this study indicated that non-HDL-C/HDL-C plays an important role in the risk and progression of CAD. These findings need verification by further large-scale prospective studies.

Prognosis of acute coronary syndromes after radiotherapy for breast cancer

Background and purposeBreast cancer patients treated with radiotherapy are at increased risk of subsequent acute coronary syndromes (ACS). We aimed to study if radiotherapy also influences the prognosis of these ACS. Materials and methodsWe included all 398 patients diagnosed with ACS following radiotherapy from our hospital-based cohort of early breast cancer patients aged <71 years, treated 1970–2009. Cardiovascular disease incidence and cause of death were acquired through questionnaires to general practitioners and cardiologists.Internal mammary chain (IMC) irradiation delivers the highest heart doses in breast cancer radiotherapy. Hence, we compared ACS prognosis between patients treated with/without IMC-irradiation. ACS prognosis was assessed through cardiac death, death due to ACS and cardiovascular disease incidence, using multivariable Cox proportional hazard models and by estimating cumulative incidence. ResultsIn total, 62% of patients with ACS had received IMC-irradiation and 38% did not (median age at ACS diagnosis, 67 years). Median time between breast cancer and ACS was 15 years.After ACS, ten-year cumulative risk of cardiac death was 35% for patients who had IMC-irradiation (95% confidence interval [95%CI] 29–41) compared to 24% (95%CI 17–31) for patients without IMC-irradiation (p = 0.04). After correction for confounders, IMC-irradiation remained associated with a less favourable prognosis of ACS compared to no IMC-irradiation (hazard ratio cardiac death = 1.7, 95%CI 1.1–2.5). ConclusionOur results suggest that radiotherapy, in case of substantial heart doses,may worsen ACS prognosis. This is an important, novel finding that may impact upon the risk-based care for breast cancer survivors with ACS.

Vulnerable atherosclerotic plaques of coronary arteries in patients with stable coronary artery disease: 12-months follow-up

A key objective of modern cardiology is the assessment of acute coronary syndrome (ACS) risk in patients with coronary artery disease (CAD) to develop preventive measures and choose optimal treatment strategies. Detect vulnerable plaques of non-target coronary arteries in patients with stable CAD during routine percutaneous coronary intervention using virtual-histology intravascular ultrasound (VH-IVUS) and view their morphology over time. The prospective observational cohort study included 58 patients with stable CAD. After stenting ofatarget vessel, VH-IVUS was carried out in proximal and middle segments (6-8 cm) of a non-target coronary artery with no significant stenosis according to coronary angiography. Twelve months later, all patients underwent coronary angiography with re-IVUS of previously detected lesions. Death, myocardial infarction, rehospitalization, and unplanned myocardial revascularization due to vulnerable plaques were the endpoints of the study. IVUS with virtual histology revealed 58 lesions of non-target coronary arteries in 56 (96.5 %) patients. Two patients had no lesions in non-target coronary arteries. A large necrotic core with thin cap (thin-cap fibroatheroma) was detected in 12 (20.7 %) plaques, six of which had additional ACS risk criteria (stenosis area &gt;70 % and / or lumen area &lt;4 mm2). Within the 12‑month follow-up period, three patients (one with a vulnerable plaque in IVUS) were hospitalized with a clinical picture of ACS. One cardiac death was registered in a patient with the IVUS vulnerable plaque. 7 of 12 vulnerable plaques stabilized in 12 months. 1) The data presented indicate a high rate (20.7 %) of vulnerable plaques of non-target coronary arteries in patients with stable CAD who underwent stenting; 2) Two (16.6 %) patients with vulnerable plaques reached endpoints (death and rehospitalization) within the 12‑month follow-up period; 3) An analysis ofatherosclerotic plaques in non-target coronary arteries over time showed that vulnerable plaques stabilized and did not cause ACS in more than half of cases (7 of 12); 4) Plaques that were not vulnerable according to IVUS were not likely to destabilize within the 12‑month follow-up period.

A cross-sectional validation study comparing the accuracy of different risk scores in assessing the risk of acute coronary syndrome among patients in a tertiary care hospital in Kerala

BackgroundThere are many cardiovascular disease (CVD) risk score calculators in practice, which are not based on Indian population data. ObjectivesTo identify the best CVD risk score calculator applicable in the Indian population. Materials and methodsA total of 1000 patients presenting with acute coronary syndrome (ACS) were included in the study and their CVD risk score, had they presented before the event, was calculated. The Framingham risk score (FRS–body mass index [BMI], FRS–fasting lipid profile [FLP]), the American College of Cardiology/American Heart Association pooled cohort equation risk calculator (ACC/AHA PCE), Joint British Society risk calculator 3 (JBS3) and the World Health Organization (WHO) risk prediction charts (WHO TC and WHO without TC [WHO NO TC]) were used. ResultsIt was seen that among the 1000 people included in the study, the FRS-BMI (59.2%), FRS-FLP (61.5%), ACC/AHA (70.1%) and the JBS3 (62.5%) identified a majority as having a risk of ≥20%, whereas both the WHO TC (65.3%) and the WHO NO TC (64.5%) identified a majority of the ACS patients as having a risk of <20%. The sensitivity was highest for the ACC/AHA (87.8%), FRS-FLP (85.1%) and then JBS3 (80.1%), whereas the specificity was highest for the WHO TC (83.6%) and the WHO NO TC (82.1%). When looking at the accuracy, the FRS-FLP was the most accurate with 80.1%, whereas the ACC/AHA and the JBS3 followed at 74.7% and 73.1%, respectively. ConclusionThe ACC/AHA seems to be an acceptable risk prediction system to be used in the Indian population and is also relatively easy and cheap to use.

ACUTE CORONARY SYNDROME AMONG YOUNG ADULTS WITH MODIFIABLE RISK FACTORS LINKED TO SEVERE CORONARY ARTERY DISEASE IN TRINIDAD & TOBAGO

There is an increased incidence of Acute Coronary Syndrome (ACS) and modifiable cardiovascular risk factors in developing countries. This study aimed to identify modifiable cardiovascular risk factors that had the most significant link with severe proximal Coronary Artery Disease(CAD) and describe

Machine Intelligence in Cardiovascular Medicine.

The computer science technology trend called artificial intelligence (AI) is not new. Both machine learning and deep learning AI applications have recently begun to impact cardiovascular medicine. Scientists working in the AI domain have long recognized the importance of data quality and provenance to AI algorithm efficiency and accuracy. A diverse array of cardiovascular raw data sources of variable quality-electronic medical records, radiological picture archiving and communication systems, laboratory results, omics, etc.-are available to train AI algorithms for predictive modeling of clinical outcomes (in-hospital mortality, acute coronary syndrome risk stratification, etc.), accelerated image interpretation (edge detection, tissue characterization, etc.) and enhanced phenotyping of heterogeneous conditions (heart failure with preserved ejection fraction, hypertension, etc.). A number of software as medical device narrow AI products for cardiac arrhythmia characterization and advanced image deconvolution are now Food and Drug Administration approved, and many others are in the pipeline. Present and future health professionals using AI-infused analytics and wearable devices have 3 critical roles to play in their informed development and ethical application in practice: (1) medical domain experts providing clinical context to computer and data scientists, (2) data stewards assuring the quality, relevance and provenance of data inputs, and (3) real-time and post-hoc interpreters of AI black box solutions and recommendations to patients. The next wave of so-called contextual adaption AI technologies will more closely approximate human decision-making, potentially augmenting cardiologists' real-time performance in emergency rooms, catheterization laboratories, imaging suites, and clinics. However, before such higher order AI technologies are adopted in the clinical setting and by healthcare systems, regulatory agencies, and industry must jointly develop robust AI standards of practice and transparent technology insertion rule sets.

DUAL VERSUS TRIPLE THERAPY IN ACUTE CORONARY SYNDROME PATIENTS WITH ANTICOAGULATION INDICATION: A META-ANALYSIS WITH TRIAL-SEQUENTIAL ANALYSIS

Current guidelines endorse short-term triple therapy (dual antiplatelet therapy and anticoagulant) for high risk acute coronary syndrome (ACS) patients with an indication for anticoagulation. We appraised the latest evidence in the form of a meta-analysis of all randomized controlled trials (RCTs

Outcomes Associated With Oral Anticoagulants Plus Antiplatelets in Patients With Newly Diagnosed Atrial Fibrillation

Patients with nonvalvular atrial fibrillation at risk of stroke should receive oral anticoagulants (OAC). However, approximately 1 in 8 patients in the Global Anticoagulant Registry in the Field (GARFIELD-AF) registry are treated with antiplatelet (AP) drugs in addition to OAC, with or without documented vascular disease or other indications for AP therapy. To investigate baseline characteristics and outcomes of patients who were prescribed OAC plus AP therapy vs OAC alone. Prospective cohort study of the GARFIELD-AF registry, an international, multicenter, observational study of adults aged 18 years and older with recently diagnosed nonvalvular atrial fibrillation and at least 1 risk factor for stroke enrolled between March 2010 and August 2016. Data were extracted for analysis in October 2017 and analyzed from April 2018 to June 2019. Participants received either OAC plus AP or OAC alone. Clinical outcomes were measured over 3 and 12 months. Outcomes were adjusted for 40 covariates, including baseline conditions and medications. A total of 24 436 patients (13 438 [55.0%] male; median [interquartile range] age, 71 [64-78] years) were analyzed. Among eligible patients, those receiving OAC plus AP therapy had a greater prevalence of cardiovascular indications for AP, including acute coronary syndromes (22.0% vs 4.3%), coronary artery disease (39.1% vs 9.8%), and carotid occlusive disease (4.8% vs 2.0%). Over 1 year, patients treated with OAC plus AP had significantly higher incidence rates of stroke (adjusted hazard ratio [aHR], 1.49; 95% CI, 1.01-2.20) and any bleeding event (aHR, 1.41; 95% CI, 1.17-1.70) than those treated with OAC alone. These patients did not show evidence of reduced all-cause mortality (aHR, 1.22; 95% CI, 0.98-1.51). Risk of acute coronary syndrome was not reduced in patients taking OAC plus AP compared with OAC alone (aHR, 1.16; 95% CI, 0.70-1.94). Patients treated with OAC plus AP also had higher rates of all clinical outcomes than those treated with OAC alone over the short term (3 months). This study challenges the practice of coprescribing OAC plus AP unless there is a clear indication for adding AP to OAC therapy in newly diagnosed atrial fibrillation.