Risk Of Acute Coronary Syndrome Research Articles

Biological DMARDs increase risk of acute coronary syndrome

Biological DMARDs increase risk of acute coronary syndrome

IDF21-0300 Acetic acid derivatives reduce the risk of acute coronary syndrome in patients with diabetes mellitus

IDF21-0300 Acetic acid derivatives reduce the risk of acute coronary syndrome in patients with diabetes mellitus

Major adverse cardiac event rates in moderate-risk patients: Does prior coronary disease matter?

BackgroundDespite negative troponins and nonischemic electrocardiograms (ECGs), patients at moderate risk for acute coronary syndrome (ACS) are frequently admitted. The objective of this study was to describe the major adverse cardiac event (MACE) rate in moderate‐risk patients and how it differs based on history of coronary artery disease (CAD).MethodsA secondary analysis of the HEART Pathway implementation study was conducted. This prospective interrupted time‐series study accrued adults with possible ACS from three sites (November 2013–January 2016). This analysis excluded low‐risk patients determined by emergency providers' HEART Pathway assessments. Non–low‐risk patients were further classified as high risk, based on elevated troponin measures or ischemic ECG findings or as moderate risk, based on HEAR score ≥ 4, negative troponin measures, and a nonischemic ECG. Moderate‐risk patients were then stratified by the presence or absence of prior CAD (MI, revascularization, or ≥70% coronary stenosis). MACE (death, myocardial infarction, or revascularization) at 30 days was determined from health records, insurance claims, and death index data. MACE rates were compared among groups using a chi‐square test and likelihood ratios (LRs) were calculated.ResultsAmong 4,550 patients with HEART Pathway assessments, 24.8% (1,130/4,550) were high risk and 37.7% (1715/4550) were moderate risk. MACE at 30 days occurred in 3.1% (53/1,715; 95% confidence interval [CI] = 2.3% to 4.0%) of moderate‐risk patients. Among moderate‐risk patients, MACE occurred in 7.1% (36/508, 95% CI = 5.1% to 9.8%) of patients with known CAD versus 1.4% (17/1,207, 95% CI = 0.9% to 2.3%) in patients without known prior CAD (p < 0.0001). The negative LR for 30‐day MACE among moderate‐risk patients without prior CAD was 0.08 (95% CI = 0.05 to 0.12).ConclusionMACE rates at 30 days were low among moderate‐risk patients but were significantly higher among those with prior CAD.

Barriers to Follow Up Care in the South Asian Immigrant Population at High Risk of Acute Coronary Syndrome at Elmhurst Hospital Center.

We studied South Asian immigrant patients who did not return to Elmhurst Hospital Center (EHC) after emergent cardiac catheterization in order to propose interventions to improve follow up care. We identified 74 eligible patients, interviewed 30 about follow up practices, and analyzed findings. Most patients are Bangladeshi and 77% preferred a foreign language. Some were visiting the US during the admission without intent to follow up. Half were dissatisfied with EHC providers, complications, and inadequate care at follow up appointments. Some patients were unaware of scheduled appointments or the necessity of follow up. Most follow with private providers due to language accessibility, availability, and proximity. We found that language barriers contribute to loss to follow up and the true loss to follow up rate is lower than reported at EHC. This can inform practices at hospitals with immigrant populations, minimize resource waste, and improve quality of care.

Prognostic Impact of Chronic Vasodilator Therapy in Patients With Vasospastic Angina.

BackgroundChronic vasodilator therapy with long‐acting nitrate is frequently used to treat vasospastic angina. However, the clinical benefits of this approach are controversial. We investigated the prognostic impact of vasodilator therapy in patients with vasospastic angina from the multicenter, prospective VA‐KOREA (Vasospastic Angina in KOREA) registry.Methods and ResultsWe analyzed data from 1895 patients with positive intracoronary ergonovine provocation test results. The patients were divided into 4 groups: no vasodilator (n=359), nonnitrate vasodilator (n=1187), conventional nitrate (n=209), and a combination of conventional nitrate and other vasodilators (n=140). The primary end point was a composite of cardiac death, acute coronary syndrome, and new‐onset arrhythmia at 2 years. Secondary end points were the individual components of the primary end point, all‐cause death, and rehospitalization due to recurrent angina.The groups did not differ in terms of the risk of the primary end point. However, the acute coronary syndrome risk was significantly higher in the conventional nitrate (hazard ratio [HR], 2.49; 95% CI, 1.01–6.14; P=0.047) and combination groups (HR, 3.34; 95% CI, 1.15–9.75, P=0.027) compared with the no‐vasodilator group, as assessed using the inverse probability of treatment weights. Subgroup analyses revealed prominent adverse effects of nitrate in patients with an intermediate positive ergonovine provocation test result and in those with low Japanese Coronary Spasm Association scores.ConclusionsLong‐acting nitrate‐based chronic vasodilator therapy was associated with an increased 2‐year risk of acute coronary syndrome in patients with vasospastic angina, especially in low‐risk patients.

Acute coronary syndromes in diabetes: Biomarkers of endothelial injury improve risk stratification and help identify predictors of risk

Background and aimsPatients with diabetes mellitus (DM) are at an increased risk of acute coronary syndrome (ACS); however, the factors predicting those at highest risk are not well understood. We identified risk factors in those with DM that best predict high ACS risk based on a multiple endothelial injury biomarker algorithm. MethodsWe studied adults with DM from a clinical registry with measures of a coronary artery disease prediction algorithm (CADPA) score identifying 5-year ACS risk from nine markers. Stepwise logistic regression provided odds ratios for the relationship of age, gender, and individual risk factors not part of the CADPA algorithm with the likelihood of a high risk CADPA score. ResultsWe studied 1,613 adults with DM (women: 47.3%, ages 22 to 100, mean age 63.2 years). Of these, 6.1% had a low, 13.2% intermediate, and 80.7% high risk CADPA score. From stepwise logistic regression, women were less likely to have a high risk CADPA score (odds ratio [OR] 0.21, 95% confidence intervals [CI] 0.15–0.29, p<.0001), while age (per standard deviation [SD]) (OR 5.04, [4.12–6.17], p<.0001), body mass index (BMI per SD) (OR 1.34, [1.14–1.58], p = 0.004), hypertension (OR 1.60, [1.15–2.24], p = 0.006), current smoking (OR 2.55, [1.56–4.16], p = 0.0002), hsCRP (per SD) (OR 1.24, [1.01–1.53], p = 0.04), and triglycerides (per SD) (OR 1.26, [1.04–1.54], p = 0.02) were more likely to have a high risk CADPA score. ConclusionsAge, men, hypertension, BMI, current smoking, hsCRP, and triglycerides are key factors in those with DM associated with higher ACS risk.

Climatic influences on cardiovascular diseases.

Classical risk factors only partially account for variations in cardiovascular disease incidence; therefore, also other so far unknown features, among which meteorological factors, may influence heart diseases (mainly coronary heart diseases, but also heart failure, arrhythmias, aortic dissection and stroke) rates. The most studied phenomenon is ambient temperature. The relation between mortality, as well as cardiovascular diseases incidence, and temperature appears graphically as a ‘‘U’’ shape. Exposure to cold, heat and heat waves is associated with an increased risk of acute coronary syndromes. Other climatic variables, such as humidity, atmospheric pressure, sunlight hours, wind strength and direction and rain/snow precipitations have been hypothesized as related to fatal and non-fatal cardiovascular diseases incidence. Main limitation of these studies is the unavailability of data on individual exposure to weather parameters. Effects of weather may vary depending on other factors, such as population disease profile and age structure. Climatic stress may increase direct and indirect risks to human health via different, complex pathophysiological pathways and exogenous and endogenous mechanisms. These data have attracted growing interest because of the recent earth’s climate change, with consequent increasing ambient temperatures and climatic fluctuations. This review evaluates the evidence base for cardiac health consequences of climate conditions, and it also explores potential further implications.

Dual Loading Antiplatelet Therapy in Patients With Acute Coronary Syndrome and High Bleeding Risk Undergoing Percutaneous Coronary Intervention: Findings From the Improving Care for Cardiovascular Disease in China Project.

ObjectiveLoading dose of dual antiplatelet therapy (LD) is supported by the guidelines for patients with acute coronary syndrome (ACS). However, limited data is provided in the series of high bleeding risk (HBR) patients with ACS and percutaneous coronary intervention (PCI).MethodsUsing data from the Improving Care for Cardiovascular Disease in China—Acute Coronary Syndrome registry, conducted between 2014 and 2019, we stratified all ACS patients with HBR and PCI according to LD used within 24 h of first medical contact or not. Inverse probability of treatment weighting (IPTW) and Cox proportional hazards model with hospital as random effect were used to analyze differences in in-hospital clinical outcomes: the primary efficacy endpoint was mortality, and the primary safety endpoint was bleeding.ResultsOf 21,654 evaluable patients 14,322 (66.2%) were treated with LD, and were on average older, less likely to have comorbidities and higher hemoglobin, more often treated GPI and anticoagulant during hospitalization than those without LD. After IPTW adjustment for baseline differences, LD was associated with significantly increased risk of in-hospital mortality [1.89 vs. 1.02%; hazard ratio (HR): 1.71 (95% confidence interval 1.12, 2.42); p < 0.001] and in-hospital bleeding [3.89 vs. 3.3%; HR: 1.25 (1.03, 1.53); p = 0.03].ConclusionsIn ACS patients with HBR, LD was associated with an increased risk of in-hospital mortality and bleeding complications after PCI. Dedicated randomized trials with contemporary ACS management are needed to confirm these findings.

Short-term, intermediate-term and long-term risks of acute coronary syndrome in cohorts of patients with RA starting biologic DMARDs: results from four Nordic countries

ObjectivesTo compare the 1-year, 2-year and 5-year incidences of acute coronary syndrome (ACS) in patients with rheumatoid arthritis (RA) starting any of the biologic disease-modifying antirheumatic drugs (bDMARDs) currently available...

Abstract EP42: Effects Of Bariatric Surgery On Acute Coronary Syndrome

Obesity is one of the most common and modifiable risk factors of cardiovascular diseases. Bariatric surgery (BS) is a fast-growing procedure being used to treat patients with morbid obesity, obesity with significant comorbidities or failed dietary and pharmacological therapy. We assessed the hypothesis that bariatric surgery has positive effects on acute coronary syndrome (ACS) in obese population. We conducted a retrospective analysis of 3 years of the National Inpatient Sample (NIS) database, 2016 to 2018. Study populations were selected using ICD-10 diagnosis code. Discharge-level weight analysis was used to produce a national estimate. We conducted multivariate regression analysis to calculate odds ratio with STATA 17. During the study period, 106,970,745 patients were discharged, and 2,996,629 patients experienced acute coronary artery syndrome during the hospitalization. Total 962,780 (0.90%) patients had history of bariatric surgery. Patients with BS tended to be female (77.84 % v 56.21 %), older (54.91± 0.30 v 49.43 ± 0.01), diabetic (28.47% v 22.50%) and hypertensive (42.60% v 29.23%) but prevalence of hyperlipidemia was similar in both groups (3.73% v 3.23%). The prevalence of ACS was significantly reduced with BS in patient with obesity (1.51% v 2.81%). After adjusting for age, sex, race and comorbid burden, obesity was associated with higher risk of ACS (OR 1.13, 1.13 - 1.15, p&lt;0.0001), whereas patients with obesity who underwent BS was associated with lower risk for ACS (OR 0.61, 0.59 - 0.64, p&lt; 0.0001). After adjusting for comorbidities, BS decreased the risk of in-hospital mortality (OR 0.67, 0.56-0.80, p&lt; 0.0001) and major cardiovascular events (OR 0.59, 0.48-0.72, p&lt; 0.0001). In conclusion, bariatric surgery is associated with lower risk of acute coronary syndrome as well as better outcomes including lower in-hospital mortality and lower major cardiovascular events in obese population.

Role of vitamin D and its receptor in regulation of mechanisms of immune inflammation in patients with ischemic heart disease

Coronary heart disease still underlies high morbidity and mortality in people of working age. Thus, today one of the most important tasks facing clinical cardiology is the search for new molecular genetic predictors of coronary artery disease associated with the unfavorable course of this disease and the development of complications. In the present review, we analyzed the available data on the mechanisms of vitamin D interrelation with the development of immune inflammation in patients with coronary heart disease. The role of vitamin D and its receptor in cardiovascular diseases and in the development of coronary heart disease, in particular, is considered.Recent studies showed that vitamin D deficiency is a new risk factor for the development of atherosclerosis and immune inflammation. Immune damage of the vascular wall increases the risk of acute coronary syndrome, especially in patients with a predisposition to atherothrombosis. Vitamin D has a multilevel effect on immune inflammation mechanisms by restoring the balance in the system of pro- and anti-inflammatory cytokines. The protective effects of vitamin D on immune inflammation in the vascular wall are realized through vitamin D receptors. The present work re-viewed the studies describing possible mechanisms of immune inflammation regulation by vitamin D and its receptor and activation of immune inflammation in patients with vitamin D deficiency. Further studies of mechanisms of influence of vitamin D receptor on the suppression of immune inflammation are needed.

The use of bedside haemodynamic parameters to predict risk and in-hospital outcomes in non-ST elevation acute coronary syndromes: data from resource- limited settings in Iraq

Abstract Funding Acknowledgements Type of funding sources: None. Background There is lack of data on the value of bedside hemodynamic parameters in predicting risk and outcomes in NSTE-ACS. This study aimed to assess if the following bedside haemodynamic tests : mean arterial pressure (MAP) [DBP + 1/3(SBP-DBP)], shock index (SI) [heart rate/SBP], pulse pressure (PP) [SBP-DBP] and proportional PP (PPP) [PP/SBP] can predict risk and adverse in-hospital outcomes in NSTE-ACS. Purpose To assess if bedside haemodynamic tests like mean arterial pressure (MAP), shock index (SI), pulse pressure (PP) and proportional PP (PPP) can predict risk and adverse in-hospital outcomes in NSTE-ACS Methods Patients with NSTE-ACS were prospectively included, we calculate GRACE score, SI, MAP, PP and PPP. Patients were stratified into low, intermediate and high GRACE risk class Results n.=179. When stratifying patients according to SI ≥0.7 vs &amp;lt;0.7: 31% had SI≥0.7, those with SI ≥0.7 were at high GRACE risk class in 52.5% vs 24.3%, p &amp;lt; 0.001. AF was recorded in those with SI≥0.7 in 19.7% vs 3.7%, p &amp;lt; 0.001. Time to catheterization (days) was 3.26 ± 2.55 in SI ≥0.7 vs 3.23 ± 1.96, p = 0.9, hospitalization duration (days) 5.11 ± 2.8 in SI ≥0.7 vs 4.8 ± 2.7, p = 0.4. For those who developed cardiogenic shock; MAP was 86.1 ± 17.6 vs 100.04 ± 15.3, p = 0.03 and SI was 0.91 ± 0.3 vs 0.63 ± 0.2, p = 0.02 compared to those who did not develop cardiogenic shock. No significant differences observed in PP and PPP between two groups. There was significant correlation between SI and GRACE score, p &amp;lt; 0.001 as well as with EF%, p &amp;lt; 0.001. MAP correlated significantly with GRACE score, p = 0.001. On multiple regression analysis: high GRACE risk class [95% CI 0.002-0.056, p = 0.03] and SI≥0.7 [95%CI 0.007-0.12, p = 0.02] were significant predictors of in-hospital death, while high GRACE risk class predicted in-hospital AHF [95% CI 0.13-0.26, p &amp;lt; 0.001]. SI≥0.7 predicted in-hospital stroke [95% CI 0.008-0.082, P = 0.01]. While MAP, PP and PPP did not predict in-hospital outcomes Conclusions SI correlates with GRACE score and predicted in-hospital stroke and death in NSTE-ACS. MAP correlated with GRACE score, but MAP, PP and PPP did not predict in-hospital outcomes. SI is readily obtainable than GRACE score and can be used to guide management particularly in resources-limited settings where proper risk stratification is needed to choose those who will benefit the most from invasive strategy Abstract Figure.

Association of Plaque Location and Vessel Geometry Determined by Coronary Computed Tomographic Angiography With Future Acute Coronary Syndrome–Causing Culprit Lesions

Distinct plaque locations and vessel geometric features predispose to altered coronary flow hemodynamics. The association between these lesion-level characteristics assessed by coronary computed tomographic angiography (CCTA) and risk of future acute coronary syndrome (ACS) is unknown. To examine whether CCTA-derived adverse geometric characteristics (AGCs) of coronary lesions describing location and vessel geometry add to plaque morphology and burden for identifying culprit lesion precursors associated with future ACS. This substudy of ICONIC (Incident Coronary Syndromes Identified by Computed Tomography), a multicenter nested case-control cohort study, included patients with ACS and a culprit lesion precursor identified on baseline CCTA (n = 116) and propensity score-matched non-ACS controls (n = 116). Data were collected from July 20, 2012, to April 30, 2017, and analyzed from October 1, 2020, to October 31, 2021. Coronary lesions were evaluated for the following 3 AGCs: (1) distance from the coronary ostium to lesion; (2) location at vessel bifurcations; and (3) vessel tortuosity, defined as the presence of 1 bend of greater than 90° or 3 curves of 45° to 90° using a 3-point angle within the lesion. Association between lesion-level AGCs and risk of future ACS-causing culprit lesions. Of 548 lesions, 116 culprit lesion precursors were identified in 116 patients (80 [69.0%] men; mean [SD], age 62.7 [11.5] years). Compared with nonculprit lesions, culprit lesion precursors had a shorter distance from the ostium (median, 35.1 [IQR, 23.6-48.4] mm vs 44.5 [IQR, 28.2-70.8] mm), more frequently localized to bifurcations (85 [73.3%] vs 168 [38.9%]), and had more tortuous vessel segments (5 [4.3%] vs 6 [1.4%]; all P < .05). In multivariable Cox regression analysis, an increasing number of AGCs was associated with a greater risk of future culprit lesions (hazard ratio [HR] for 1 AGC, 2.90 [95% CI, 1.38-6.08]; P = .005; HR for ≥2 AGCs, 6.84 [95% CI, 3.33-14.04]; P < .001). Adverse geometric characteristics provided incremental discriminatory value for culprit lesion precursors when added to a model containing stenosis severity, adverse morphological plaque characteristics, and quantitative plaque characteristics (area under the curve, 0.766 [95% CI, 0.718-0.814] vs 0.733 [95% CI, 0.685-0.782]). In per-patient comparison, patients with ACS had a higher frequency of lesions with adverse plaque characteristics, AGCs, or both compared with control patients (≥2 adverse plaque characteristics, 70 [60.3%] vs 50 [43.1%]; ≥2 AGCs, 92 [79.3%] vs 60 [51.7%]; ≥2 of both, 37 [31.9%] vs 20 [17.2%]; all P < .05). These findings support the concept that CCTA-derived AGCs capturing lesion location and vessel geometry are associated with risk of future ACS-causing culprit lesions. Adverse geometric characteristics may provide additive prognostic information beyond plaque assessment in CCTA.

Considerations for Cannabinoids in Perioperative Care by Anesthesiologists.

Increased usage of recreational and medically indicated cannabinoid compounds has been an undeniable reality for anesthesiologists in recent years. These compounds’ complicated pharmacology, composition, and biological effects result in challenging issues for anesthesiologists during different phases of perioperative care. Here, we review the existing formulation of cannabinoids and their biological activity to put them into the context of the anesthesia plan execution. Perioperative considerations should include a way to gauge the patient’s intake of cannabinoids, the ability to gain consent properly, and vigilance to the increased risk of pulmonary and airway problems. Intraoperative management in individuals with cannabinoid use is complicated by the effects cannabinoids have on general anesthetics and depth of anesthesia monitoring while simultaneously increasing the potential occurrence of intraoperative hemodynamic instability. Postoperative planning should involve higher vigilance to the risk of postoperative strokes and acute coronary syndromes. However, most of the data are not up to date, rending definite conclusions on the importance of perioperative cannabinoid intake on anesthesia management difficult.

Prehospital Translation of Chest Pain Tools (RESCUE Study): Completion Rate and Inter-rater Reliability.

IntroductionChest pain is a common reason for ambulance transport. Acute coronary syndrome (ACS) and pulmonary embolism (PE) risk assessments, such as history, electrocardiogram, age, risk factors (HEAR); Emergency Department Assessment of Chest Pain Score (EDACS); Pulmonary Embolism Rule-out Criteria (PERC); and revised Geneva score, are well validated for emergency department (ED) use but have not been translated to the prehospital setting. The objectives of this study were to evaluate the 1) prehospital completion rate and 2) inter-rater reliability of chest pain risk assessments.MethodsWe conducted a prospective observational cohort study in two emergency medical services (EMS) agencies (April 18, 2018 – January 2, 2019). Adults with acute, non-traumatic chest pain without ST-elevation myocardial infarction or unstable vital signs were accrued. Paramedics were trained to use the HEAR, EDACS, PERC, and revised Geneva score assessments. A subset of patients (a priori goal of N = 250) also had the four risk assessments completed by their treating clinicians in the ED, who were blinded to the EMS risk assessments. Outcomes were 1) risk assessments completion rate and 2) inter-rater reliability between EMS and ED assessments. An a priori goal for completion rate was set as >75%. We computed kappa with corresponding 95% confidence intervals (CI) for each risk assessment as a measure of inter-rater reliability. Acceptable agreement was defined a priori as kappa ≥ 0.60.ResultsDuring the study period, 837 patients with acute chest pain were accrued. The median age was 54 years, interquartile range 43–66, with 53% female and 51% Black. Completion rates for each risk assessment were above goal: the HEAR score was completed on 95.1% (796/837), EDACS on 92.0% (770/837), PERC on 89.4% (748/837), and revised Geneva score on 90.7% (759/837) of patients. We assessed agreement in a subgroup of 260 patients. The HEAR score had a kappa of 0.51 (95% CI, 0.41–0.61); EDACS was 0.60 (95% CI, 0.49–0.72); PERC was 0.71 (95% CI, 0.61–0.81); and revised Geneva score was 0.51 (95% CI, 0.39–0.62).ConclusionThe completion rate of risk assessments for ACS and PE was high for prehospital field personnel. The PERC and EDACS both demonstrated acceptable agreement between paramedics and clinicians in the ED, although assessments with better agreement are likely needed.

Association of Lipoprotein(a) Concentrations and Apolipoprotein(a) isoform with Coronary Artery Disease Stratification in Han Chinese.

The purpose of this study was to investigate the association between lipoprotein(a) [Lp(a)] concentrations, apolipoprotein(a) [apo(a)] isoform, and coronary artery disease (CAD) stratification in Han Chinese. Logistic regression analysis was performed to analyze the association between Lp(a) concentrations, apo(a) isoform and CAD stratification. Lp(a) concentrations and apo(a) isoforms were combined with other risk factors to establish the optimal prediction model of CAD risk. Individuals with the top quarter of Lp(a) concentrations had more than a two-fold higher risk of stable CAD and three-fold higher risk of acute coronary syndrome (ACS) compared with those in the bottom quarter. This association was no longer significant after adjustment for apo(a) isoforms in stable CAD (OR 2.198, 95% CI 0.991 - 4.875, p = 0.053), but remained significant in the ACS (OR 3.583, 95% CI 1.278 - 5.614, p < 0.05). Individuals with small apo(a) isoforms had more than a two-fold higher risk of stable CAD and almost three-fold higher risk of ACS compared with those carrying larger apo(a) isoforms; however, this association was significantly alleviated after adjustment for Lp(a) concentrations (OR 2.133, 95% CI 0.964 - 4.742, p = 0.098; OR 2.642, 95% CI 1.032 - 5.833, p = 0.298, respectively). A combination of Lp(a) concentrations and apo(a) isoforms with other risk factors was the optimal prediction model of CAD risk (AUC 0.800, 95% CI 0.752 - 0.848, p < 0.001). Elevated Lp(a) concentrations and small apo(a) isoforms were significant risk factors for CAD stratification, and their effects on CAD risk were mediated by each other. Combined application of Lp(a) concentrations and apo(a) isoform with conventional risk factors could aid in the assessment and prediction of CAD.

Fibrinogen with high-sensitivity C-reactive protein: A combined prediction biomarker for acute coronary syndrome risk assessment

Fibrinogen with high-sensitivity C-reactive protein: A combined prediction biomarker for acute coronary syndrome risk assessment

Quantitative plaque assessment by coronary computed tomography angiography: An up-to-date review

Abstract Coronary computed tomography angiography has an emerging role in the diagnostic workup of coronary artery disease. Due to its high sensitivity and negative predictive value, coronary computed tomography angiography can rule out obstructive coronary artery diseases and substitute invasive coronary angiography in many cases. In addition, coronary computed tomography angiography provides a unique information beyond stenosis grading as it can visualize atherosclerosis and quantify its extent. Qualitative and quantitative plaque assessment provides an incremental value in the prediction of future major adverse cardiac events. Moreover, determining adverse plaque features has a potential to identify advanced atherosclerosis and patients at increased risk of acute coronary syndrome. Nevertheless, challenges may emerge with the process of quantifying coronary plaques due to limited reproducibility, lack of automated, standardized and validated techniques. Therefore, reliable quantified data are scarce due to the various computed tomography scanners and software platforms and investigations with small sample sizes. Radiomics and machine learning-based image processing methods are relatively new in the field of cardiovascular plaque imaging. These techniques hold the promise to improve diagnostic performance, reproducibility and prognostic value of computed tomography based plaque assessment.

Screening Analysis of Platelet miRNA Profile Revealed miR-142-3p as a Potential Biomarker in Modeling the Risk of Acute Coronary Syndrome.

Transcriptome analysis constitutes one of the major methods of elucidation of the genetic basis underlying the pathogenesis of various diseases. The post-transcriptional regulation of gene expression is mainly provided by microRNAs. Their remarkable stability in biological fluids and their high sensitivity to disease alteration indicates their potential role as biomarkers. Given the high mortality and morbidity of cardiovascular diseases, novel predictive biomarkers are sorely needed. Our study focuses for the first time on assessing potential biomarkers of acute coronary syndrome (ACS) based on the microRNA profiles of platelets. The study showed the overexpression of eight platelet microRNAs in ACS (miR-142-3p; miR-107; miR-338-3p, miR-223-3p, miR-21-5p, miR-130b-3p, miR-301a-3p, miR-221-3p) associated with platelet reactivity and functionality. Our results show that the combined model based on miR-142-3p and aspartate transaminase reached 82% sensitivity and 88% specificity in the differentiation of the studied groups. Furthermore, the analyzed miRNAs were shown to cluster into two orthogonal groups, regulated by two different biological factors. Bioinformatic analysis demonstrated that one group of microRNAs may be associated with the physiological processes of platelets, whereas the other group may be linked to platelet–vascular environment interactions. This analysis paves the way towards a better understanding of the role of platelet microRNAs in ACS pathophysiology and better modeling of the risk of ACS.

Clinical and Anamnestic Characteristics of Acute Coronary Syndrome after Suffering COVID-19

Background. COVID-19 increases the risk of developing thromboembolic complications, including acute myocardial infarction, in the acute period of the disease. The long-term consequences of COVID-19 are poorly understood. At the same time, the available data on an increased risk of acute coronary syndrome after infectious diseases allow us to make an assumption about a similar risk in COVID-19. The aim of the study was to study the anamnestic and laboratory diagnostic data in patients with acute coronary syndrome after COVID-19. Methods. The study included 185 patients with acute coronary syndrome who were admitted to the State Clinical Hospital No. 13 in Moscow in the period from May to December 2020. 2 groups were identified: group 1 109 patients with ACS who had previously suffered COVID-19, group 2 76 patients with ACS without COVID-19 in the past. The patients were collected anamnesis, including: the fact of smoking and alcohol consumption, heredity, previous diseases, including diabetes mellitus, acute myocardial infarction, previously performed PCI. Information about the COVID-19 infection has been collected (the duration of the disease, the course of the disease). A clinical and laboratory examination was conducted, including the determination of body mass index (BMI), examination for antibodies to COVID-19, determination of the lipid profile level (total cholesterol, LDL, HDL, triglycerides), blood glucose level, C-RB. The analysis was performed on automatic biochemical analyzers Hitachi-902, 912 (Roche Diagnostics, Japan). All patients underwent coronary angiography. Results. In patients with ACS with previously transferred COVID-19, the development of the disease occurred at a younger age compared to patients without transferred COVID-19. Among the patients with COVID-19, body weight was significantly lower, there were fewer smokers, concomitant type 2 diabetes mellitus and transferred ONMC were less common. In laboratory parameters, lower triglyceride levels were observed in patients with ACS with COVID-19 compared with those of patients without COVID-19. In the laboratory parameters of blood clotting in patients with ACS with COVID-19, higher APTT, thrombin time, fibrinogen level, D-dimer were noted. The indicated laboratory parameters in the groups had statistically significant differences. In ACS patients with a previous COVID-19, compared with patients without COVID-19, the lesion of 2 or more coronary vessels was more common in the anamnesis. Conclusion. According to the results of our study, it was revealed that multivessel coronary artery damage in patients after COVID-19 in comparison with patients without COVID-19 develops significantly more often, while these patients are significantly less likely to have DM and previously suffered ONMC, the level of TG is significantly lower.