Segment Elevation Acute Coronary Syndrome Research Articles

MINOCA and Coronary Ectasia: a rare combination of causes of infarction

to describe a patient with myocardial ischemia with multiple causes. This clinical case describes a 58-year-old man with a history of hypertension, dyslipidemia, COPD and previous myocardial infarction (AMI). He went to the emergency room with chest pain and dyspnea. Findings included bibasal crackles, electrocardiogram with old anterior fibrosis, elevated NT-ProBNP, and echocardiogram with septoapical akinesia. During hospitalization, he experienced tachyarrhythmia and hemodynamic deterioration, undergoing electrical cardioversion (CVE). Non-ST segment elevation acute coronary syndrome (NSTEACS) complicated with ventricular arrhythmia and acute pulmonary edema was diagnosed. Coronary angiography revealed coronary ectasias without obstructive lesions, but with mild stenosis in three vessels. The patient was successfully treated with non-invasive ventilation, diuretics, vasodilators and anticoagulation. The discharge was granted with the plan to further studies to optimize and guide treatment and finally the diagnosis of Myocardial Infarction with Non-Obstructive Arteries (MINOCA) and the presence of coronary ectasias was addressed. it is important to highlight the non-ischemic causes in MINOCA and the association between coronary ectasia and cardiovascular events, which is why we emphasize the need for more studies to better understand the relationship between these phenomena.

Occurrence of Transient Myocardial Ischemic Events among Non-ST Segment Elevation Acute Coronary Syndrome Patients Before or After Invasive Coronary Angiography.

The occurrence of transient myocardial ischemia (TMI) is an important pathology in patients with non-ST elevation acute coronary syndrome (NSTE-ACS), yet studies are scarce regarding when TMI occurs during hospitalization, particularly in relation to invasive coronary angiography (ICA). This study examined: (1) TMI before or after ICA; (2) patient characteristics and ischemic burden by TMI group (before or after ICA); and (3) major in-hospital complications (transfer to critical care, death) and length of stay (LOS) by TMI group (before or after ICA). Secondary data analysis in hospitalized NSTE-ACS patients with TMI event(s) identified from 12-lead electrocardiographic (ECG) Holter. Patient records were reviewed to assess ischemic burden (TMI time [minutes] ÷ hours recording duration), outcomes and TMI timing, before or after ICA. In 38 patients, 3 (8%) had TMI before and after ICA. Of the remaining 35 patients (92%), TMI occurred before ICA (16; 46%), and after ICA (9; 26%), and 10 (28%) did not have ICA. Patient characteristics, untoward outcomes, and TMI duration (minutes) did not differ by group. Ischemic burden was higher in patients with TMI after ICA (7.29±8.82 min/hr) compared to before ICA (2.54±2.11 min/hr), p=0.039. Hospital LOS by TMI group was 113±113 (before), 226±244 (after), and 85±65 hr (no ICA); p=0.172. Almost half of the sample had TMI before ICA; one-third had TMI but did not have ICA. Patients with TMI after an ICA had higher ischemic burden. Future studies with larger sample sizes are needed to investigate further the short- and long-term clinical significance of TMI among NSTE-ACS patients.

Computed tomography angiography or invasive coronary angiography in patients with lowto intermediate risk acute coronary syndrome — a single-center study

Aim. To evaluate the strategy of using coronary computed tomography angiography (CCTA) in patients with low-to-intermediate risk of non-ST segment elevation acute coronary syndrome (NSTE-ACS) in relation to early (in-hospital) and long-term prognosis in comparison with standard management tactics.Material and methods. The study included 259 patients (men (M), 47,9%, mean age, 62,2±9,4 years). Patients in group 1 (n=148 people, M 46,6%, mean age 61,99±9,92 years) underwent CCTA to assess coronary involvement, and patients in group 2 (n=111 people, M 49,5%, mean age 62,4±8,6 years) — invasive coronary angiography (ICA). The follow-up lasted 18 months.Results. Patients in both groups were comparable in age, concomitant chronic diseases and smoking. Patients in the CCTA group compared with the ICA group had lower GRACE score and lower values of high-sensitivity Troponin I. In 85 patients (57,4%) of group 1 there was no coronary involvement, while 41 patients (27,7%) had <50% stenosis, 22 patients (14,9%) — >50% stenosis in at least one coronary artery. In group 2, the majority of patients also had non-involved coronary vessels (n=76; 68,5%), while hemodynamically insignificant (20-40%) and significant lesions were detected in 20 patients (12,3%) and 15 people (13,5%), respectively. In group 1, 20 patients were referred for ICA as follows: 10 patients underwent percutaneous coronary interventions; 2 patients had multivessel disease; in 4 patients, intraoperative fractional flow reserve revealed hemodynamically insignificant stenoses; in 4 remaining patients, no significant lesions were detected. All-cause mortality was 4,05% in the CCTA group, and 7,2% in the ICA group (p=0,28). In the CCTA group, cardiovascular mortality was 0%, and in the ICA group — 0,9% (p=0,43).Conclusion. CCTA in patients with low-to-intermediate risk ACS is not inferior to the standard tactics for managing these patients and significantly reduces the need for iCAG.

Myocardial infarction in a young woman without cardiovascular risk factors: a case report

Myocardial infarction usually occurs in people over 50 years of age, but younger patients can also be affected. The article presents a case of a young patient, 34 years old, who was admitted to the cardiology department with a diagnosis of lowrisk non-ST segment elevation acute coronary syndrome. The patient complained of anginal pain that occurred for the first time. However, she did not have typical risk factors for cardiovascular diseases. Coronary angiography showed a critical stenosis of 99% in the proximal third of the 2nd segment of the right coronary artery. A case clearly demonstrates the importance of a thorough examination of young patients with complaints of chest pain, which is often mistakenly interpreted as a pathology of other organs and systems other than the cardiovascular one. No risk factors in a patient does not guarantee low risk of myocardial infarction, and a detailed examination of the patient will help to avoid underdiagnosis of acute coronary syndrome.

Neutrophil-Lymphocyte Ratio Value as a Predictor of Troponin Elevation in Patients with Non-ST Segment Elevation Acute Coronary Syndrome

Acute coronary syndrome (ACS) is a prominent contributor to mortality and morbidity on a global scale, consistently ranking within the top five primary causes. Inflammation is one of the many elements that have a role in the pathophysiology of the development and destabilization of plaque atherosclerosis in ACS. Troponin is a component of a biomarker that signals damage to the heart muscle in ACS patients; however, at the present time, not all medical facilities are able to perform troponin testing. An acute myocardial infarction begins with an initial inflammatory process that generates proinflammatory cytokines at the cellular level. This can be evaluated by the NLR through peripheral blood tests. The NLR as an indication of systemic inflammation has been demonstrated to be associated with poor clinical outcomes, an increased risk of complications, and mortality in ACS patients. In addition, several studies showed that the NLR has prognostic value in patients with ACS. The NLR is a mix of inflammatory markers, which can be a predictor of increased troponin in cases of non-ST segment elevation acute coronary syndrome (NSTEACS) in an emergency room.

The Impact of Coronary Slow Flow Phenomenon on Diastolic Function Trajectory in Patients with Non-ST Segment Elevation Acute Coronary Syndrome

The Impact of Coronary Slow Flow Phenomenon on Diastolic Function Trajectory in Patients with Non-ST Segment Elevation Acute Coronary Syndrome

Retrospective review of non-ST segment elevation acute coronary syndrome presenting to the emergency department of a major tertiary center in Saudi Arabia.

Acute coronary syndrome (ACS) comprises a spectrum of diseases ranging from unstable angina (UA), non-ST elevation myocardial infarction (non-STEMI) and ST elevation myocardial infarction (STEMI). Treatment of ACS without STEMI (NSTEMI-ACS) can vary, depending on the severity of presentation and multiple other factors. Analyze the NSTEMI-ACS patients in our institution. Retrospective observational. A tertiary care institution with accredited chest pain center. The travel time from ED booking to the final disposition for patients presenting with chest pain was retrieved over a period of 6 months. The duration of each phase of management was measured with a view to identify the factors that influence their management and time from the ED to their final destination. The data was analyzed using descriptive statistics. Travel time from ED to final destination. 300 patients. The majority of patients were males (64%) between 61 and 80 years of age (45%). The median disposition time (from ED booking to admission order by the cardiology team) was 5 hours and 19 minutes. Cardiology admissions took 10 hours and 20 minutes from ED booking to the inpatient bed. UA was diagnosed in 153 (51%) patients and non-STEMI in 52 (17%). Coronary catheterization was required in 79 (26%) patients, 24 (8%) had coronary artery bypass grafting (CABG) and 8 (3%) had both catheterization and CABG. The time from ED booking to final destination for NSTEMI-ACS patients is delayed due to multiple factors, which caused significant delays in overall management. Additional interventional steps can help improve the travel times, diagnosis, management and disposition of these patients. Single center study done in a tertiary care center so the results from this study may not be extrapolated to other centers.

Time to coronary catheterization in patients with NST-ACS and high GRACE score

Abstract Introduction Current European guidelines recommend early (<24 hours) invasive coronary angiography (ICA) strategy in certain high-risk non-ST segment elevation acute coronary syndrome (NSTE-ACS) patients, including those with GRACE score over 140. The evidence for this recommendation is based on older trials using pre high-sensitive troponin (HsTn) biomarkers and non-contemporary therapy. Purpose To assess the association between GRACE score over 140, timing of ICA and their interaction on clinical outcomes in patients with ACS with no ST elevation, using (HsTn) as part of the calculated GRACE risk score. Methods and results Between February 1st 2016 and July 31th 2021, 1767 patients with a primary diagnosis of NSTE-ACS without indication for urgent ICA, underwent ICA during index hospitalization. 655 (37%) patients underwent early-invasive ICA (within 24 hours) and 1112 (63%) underwent late ICA (between 24 hours and 1 week). 107 patients had a GRACE risk score of 140 or above and 1660 had a GRACE risk score under 140. The primary composite outcome was all-cause mortality, stroke, and recurrent MI. The median time from admission to ICA was 13.3 hours (IQR 6.0,20.6) for the early group and 59.9 hours for the late group (IQR 23.5,96.3). The vast majority of patients had re-vascularization (75.1%) performed, mostly by PCI (69.4%). There was no difference between the early and late ICA groups in the primary composite outcome (late Catheterization >24h HR 1.196, 95% CI 0.969-1.475, P-value 0.096). Using a multivariable cox regression model for the composite outcome revealed no difference between the early and late ICA groups (late Catheterization >24h HR 1.0735, 95% CI 0.862-1.327, P-value 0.512) with no effect for performing early ICA in patients with GRACE score over 140 (HR 1.291 95% CI 0.910-1.831, p-0.151). Conclusion Early ICA strategy in patients with NSTE-ACS patients and GRACE risk score over 140, compared with late ICA, was not associated with improved composite outcome of death, myocardial infarction, and stroke at 1 year.

Abstract 14577: Electrocardiogram Parameters for Predicting the Severity of Coronary Artery Disease in Non-ST Segment Elevation Acute Coronary Syndrome

Background: Quantitative electrocardiogram (ECG) parameters have been found to correlate with severity of coronary artery disease (CAD). Thus, it may serve the purpose of risk stratifying patients with non-ST segment elevation acute coronary syndrome (NSTEACS). But little is known about the accuracy of each parameter.So, this study was done to assess the correlation of ECG parameters with severity of CAD in patients with NSTEACS and to compare the diagnostic accuracy among them. Methods: 178 patients with NSTEACS with left ventricular ejection fraction >50% were selected for the study after excluding patients with heart failure, arrhythmia, prior myocardial infarction or revascularisation. P wave peak time (PWPT), corrected QT dispersion (cQTd) and QT dispersion ratio (QTDR) was calculated in all patients. CAD severity was assessed visually by coronary angiography and calculating the syntax score. Results: PWPT, cQTd and QTDR were increased significantly in patients with left main (LM) or triple vessel disease (TVD) than others. These parameters also showed a strong positive correlation with the syntax score ( P<.001 ). Among these parameters, cQTd showed the best diagnostic accuracy (76% sensitivity and 64% specificity) to detect LM or TVD with a cut-ff value of 74 ms. Conclusion: PWPT, cQTd and QTDR may help to identify high risk patients with NSTEACS and early invasive procedure can be done to salvage a large area of myocardium at jeopardy. These may be particularly helpful to the physicians in periphery who have limited resources. Keywords: coronary artery disease, non-ST segment elevation acute coronary syndrome, P wave peak time, corrected QT dispersion, QT dispersion ratio

2023 Guidelines on Coronary Artery Disease: At a Glance

The guidelines have been released in the recent ESC congress held in Amsterdam, Netherlands. The summary is in two headings, new recommendations and change of recommendations compared to the previous guidelines. The wording to use classes of recommendations— is recommended – Class I, should be considered – Class IIa, may be considered – Class IIb, not recommended – Class III. In this guidelines of ACS, both ST segment elevation myocardial infarction and non ST segment elevation acute coronary syndrome diagnosis, management are addressed combinedly rather than separately as done in previous guidelines.Figures emphasizing the importance of evaluation of symptoms, diagnosis, and management are the highlights of the guidelines. Example: At initial assessment think ACS − Abnormal ECG, Clinical context, Stable patient?

The diagnostic accuracy of two-dimensional strain imaging echocardiography to detect the severity of coronary artery disease in non-ST segment elevation acute coronary syndrome

ObjectiveStrain imaging by two-dimensional speckle tracking echocardiography can detect severe coronary artery disease (CAD). This study aims to assess the diagnostic accuracy of various strain parameters in patients with non-ST segment acute coronary syndrome to detect the angiographic severity of CAD and also to compare among them. MethodsThis hospital-based observational study was conducted on 178 patients with NSTEACS and preserved left ventricular ejection fraction who presented in emergency or outdoor from July 2021 to December 2022. We excluded patients with prior coronary revascularization, heart failure, arrhythmia, more than trivial valvular heart disease, or poor acoustic window. Global longitudinal strain (GLS), peak systolic strain (SS), post systolic index (PSI), and systolic strain rate (SR) were calculated by speckle tracking with automated function imaging. Coronary angiography was done in all patients, and the syntax score was calculated. ResultsThe strain parameters showed a significant correlation with the syntax score. There was a statistically significant difference in strain parameters between patients with left main (LM) or triple vessel disease (TVD) and others. Receiver operating characteristic (ROC) curve analysis showed that GLS had a better diagnostic accuracy for detecting LM or TVD than other strain parameters. GLS with a cut-off value of −11.2% had a sensitivity of 85.7% and specificity of 53.5% for detecting LM or TVD. ConclusionStrain imaging can be a helpful bedside adjunct to conventional investigations for detecting severe CAD in patients with NSTEACS.

Artículo traducido] Cambios en el perfil lipídico asociados con las terapias antirretrovirales en una cohorte de vida real

ObjectiveTo compare lipid profile changes and cardiovascular events among HIV naïve and experienced patients from a real-world cohort treated with elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate or dolutegravir/abacavir/lamivudine. MethodA retrospective cohort study in HIV naïve and experienced people at a reference hospital in Spain was done. During the follow-up (March 2015-June 2019), patients were treated with elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate or dolutegravir/abacavir/lamivudine. Epidemiological, clinical and immunovirological variables were recorded. A statistical analysis of the lipid profile at baseline, 48 and 120 weeks after initiating the study therapy, cardiovascular events (myocardial infarction, heart failure, cerebrovascular accident, deep venous thrombosis, myocardiopathy, non-ST- segment elevation acute coronary syndrome, and ST-segment elevation myocardial infarction) and cardiovascular risks factors was performed. Data were analysed in naïve and experienced patients from each of the study treatments. The data was obtained from the medical history. The statistical analysis was performed with SPSS v.24 software. ResultsA total of 266 and 191 patients receiving treatment with elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate and dolutegravir/abacavir/lamivudine were included in the study, respectively. After 120 weeks of treatment, a worsening of the lipid profile was found in the elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate group, both in naïve and experienced patients, whereas not so conspicuously observed in the dolutegravir/abacavir/lamivudine group. Statistically significant differences between both groups were found in experienced patients favoring dolutegravir/abacavir/lamivudine; in total cholesterol (204.1 ± 38.2 vs. 187.3 ± 29.4, p < 0.001) and LDL-C (126.1 ± 31.9 vs. 113.5 ± 28.5, p = 0.001) at week 48, and in total cholesterol (201.1 ± 33.4 vs. 188.7 ± 33.9, p = 0.013) and HDL-C (54.2 ± 15.6 vs. 48.3 ± 14.3, p = 0.01) at week 120. No significant differences in cardiovascular events were found, neither in naïve nor in experienced patients. ConclusionsThe lipid profile among elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate group worsened throughout the follow-up, both in naïve and experienced patients, not so remarkable in the dolutegravir/abacavir/lamivudine group. Both regimens were well tolerated, with similar rates of cardiovascular events.

Temporal analysis of non-ST segment elevation-acute coronary syndrome (NSTEACS) outcomes in ‘young’ patients under the age of fifty: A nationwide cohort study

BackgroundThe characteristics and risk factor profile of young patients presenting with non-ST segment elevation acute coronary syndrome (NSTEACS) and how they may have changed over time is not well reported. MethodsWe identified 26,708 NSTEACS patients aged under 50 presenting to United Kingdom (UK) hospitals between 2010 and 2017 from Myocardial Ischaemia National Audit Project (MINAP). We calculated incidence of NSTEACS per 100,000 UK population, using Office of National Statistics (ONS) population estimates, prevalence of comorbidities, ethnicity, and in-hospital mortality. We formed biennial groups to enable comparison, 2010–2011, 2012–2013, 2014–2015 and 2016–2017. ResultsThe incidence of NSTEACS per 100,000 population showed minimal change between 2010 and 2017 (2010: 5.4 per 100,000 and 2017; 4.9 per 100,000). Rates of smoking (2010–11; 58% and 2016–17; 53%), and family history of coronary artery disease (CAD) (2010–11; 51% and 2016–17; 44%) fell, but the proportion of patients from an ethnic minority background (2010–11; 12% and 2016–17; 20%), with diabetes mellitus (DM) (2010–11; 14%, and 2016–17; 18%) and female patients (2010–11; 22% and 2016–17; 24%) increased over the study period. Mortality from NSTEACS remained unchanged (2010–11; 1% and 2016–17; 1%). ConclusionsThe incidence of NSTEACS in patients aged under fifty has not reduced despite reduction in prevalence of risk factors such as smoking hypercholesterolaemia in those admitted to UK hospitals. Despite improved rates of early invasive coronary angiography and percutaneous coronary intervention in ‘young’ NSTEACS patients, in-hospital mortality remains unchanged.

Coronary Artery Calcium Scoring by Computed Tomography and the GRACE Risk Score as Predictors of Obstructive Coronary Artery Disease in Patients with Non-ST Segment Elevation Acute Coronary Syndrome: A Comparative Study

Abstract Aim and objectives The aim of our study is to enhance patient risk stratification which can potentially influence the treatment strategy. Our objective is to evaluate the correlation of the Global Registry of Acute Coronary Events (GRACE) risk score, the coronary artery calcium (CAC) score and their use combined with the extent and severity of obstructive coronary artery disease (CAD) in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). Patients and Methods This study included two hundred and two patients who presented with NSTE-ACS and were planned for coronary angiography in Ain Shams University hospitals during the period from September 2020 to February 2021. The GRACE score was calculated for all patients and they were divided into 3 groups according to the predicted in-hospital and post-discharge to 6 months mortality risk. Patients then underwent coronary artery calcium scoring (CACS) using computed tomography (CT) and were divided into 4 groups according to their Agatston score. Following invasive coronary angiography, patients were divided into 2 groups depending on whether or not there was at least one significant stenosis. Patients who had significant stenosis were then divided into 4 subgroups according to the number of vessels affected; one-vessel disease, two-vessel disease, multi-vessel disease and left main CAD. A receiveroperating characteristic (ROC) curve was plotted for the CAC score, the GRACE score and for the CAC score combined with the GRACE score. It was used to suggest a cut-off value for each score below which obstructive CAD can be excluded in patients presenting with NSTE-ACS. Results The CAC score and the GRACE score were significantly higher in patients with obstructive CAD detected on invasive coronary angiography. Both, the CAC score and the GRACE score positively correlated with the number of affected coronaries. It was also detected that a CAC score of zero had a highly significant relationship with the absence of significant stenosis on invasive coronary angiography (p value &amp;lt;0.001). A CAC score of zero had a negative predictive value of 84.8% [95% Confidence Interval (CI): 72.4% to 92.2%], a positive predictive value of 73.7(95% CI: 69.3% to 77.7%), a sensitivity of 94.3 %( 95% CI: 88.5% to 97.7 %), and a specificity of 48.8% (95% CI: 37.4% to 60.2%). In addition, tested the use of zero CAC to exclude obstructive CAD in patients with low inhospital and post discharge mortality risk had a higher sensitivity, specificity, positive and negative predictive values. From the ROC curve, it could be concluded that the use of CACS in combination with the GRACE score improves the sensitivity, specificity, positive and negative predictive value in comparison to the use of the GRACE score alone. Conclusion CAC score as detected by CT is predictive of obstructive CAD and correlates with its extent or in other words, the number of affected coronaries. The low radiation dose and absence of contrast exposure in CACS make it an attractive candidate for the on-going research regarding the noninvasive tools for prediction of CAD. In addition to the role of GRACE score in predicting the risk of mortality in ACS, it can be also used to predict the severity and extent of obstructive CAD. It can be hypothesized that its combination with CAC score improves its reliability as a predictor of obstructive CAD.

Correlation of TIMI Risk Score and GRACE Risk Score with Lesion of Coronary Artery Disease in Patients with Non-ST Segment Elevation Acute Coronary Syndrome

Objective: To compare the correlation of “thrombolysis in myocardial infarction (TIMI)” and “Global Registry of Acute Coronary Events (GRACE)” risk score with lesion of coronary artery disease in patients with non-ST segment elevation acute coronary syndrome. Study Design: Cross-sectional study. Place and Duration: The Department of adult cardiology, “National Institute of Cardiovascular Diseases (NICVD)”, Karachi, Pakistan, from January 2021 to July 2021. Methodology: Demographics, weight, height, risk factors along with the required information needed for TIMI and GRACE score were obtained at the time of presentation in emergency department as per the scoring criteria. SYNTAX score was calculated after performing conventional angiography of the patients, using SYNTAX.com calculator. Results: In a total of 104 patients, the mean age was 57.21±12.22 years while 56 (53.8%) patients were male. Hypercholesterolemia was found in 33 (31.7%) patients. Mean score of TIMI was calculated as 4.680±2.064 while SYNTAX score was calculated as 26.45±12.94 and the correlation between TIMI risk score and SYNTAX score was noted as (r=0.109) and P value was found to be non-significant i.e. (P=0.270). Mean score of GRACE was noted as 135.38±90.88 while SYNTAX score was noted as 26.45±12.94 and the correlation between GRACE risk score and SYNTAX score was documented as (r=0.179) and P value was found to be non-significant i.e. (P=0.068). Practical Implications: Both TIMI and GRACE risk scoring systems showed weak correlations with SYNTAX scores. Conclusion: There is a weak correlation between TIMI risk score and SYNTAX score as well as GRACE risk score and SYNTAX score. Keywords: Acute coronary syndrome, coronary artery disease, GRACE score, myocardial infarction, thrombolysis.

COMPARISON OF GRACE (GLOBAL REGISTRY OF ACUTE CORONARY EVENTS) SCORE AND SERUM NT- pro BNP LEVEL IN PREDICTING 30 DAY MORTALITY IN PATIENTS WITH NON- ST- SEGMENT ELEVATION ACUTE CORONARY SYNDROME (NSTE-ACS) ATTENDING EMERGENCY DEPARTMENT.

Coronary Artery Disease (CAD) is the single most frequent cause of death worldwide. More than seven million people die from CAD every year, accounting for 12.8% of all deaths. Acute coronary syndrome (ACS) is a potentially life-threatening manifestation of CAD where time is crucial in initial management. Patients with ACS are divided into two groups to facilitate evaluation and management namely acute myocardial infarction (MI) with ST segment elevation (STEMI) on their presenting electrocardiogram(ECG) and those with non ST segment elevation acute coronary syndrome (NSTE-ACS) or non ST segment elevation myocardial infarct ion (NSTEMI).The incidence of NSTEMI is rising due to the increasing burden of obesity , chronic kidney disease and increasing detection of myocardial necrosis by raised hsTrop I (high sensitive Troponin I). We aimed to explore the utility of biomarker like serum NT-pro BNP level with the Global Registry of Acute Coronary Events (GRACE) risk calculationin patients presenting with non-ST-elevation acute coronary syndromes (NSTE-ACS) .A total no 33 patients were included in this study. From the comparison of GRACE SCORE and serum NT-proBNP, the difference in 30 day mortality in patients with NSTE-ACS it had been observed that based on optimal cut off from ROC curve ,the area under the curve(AUC) for GRACE score and serum NT-proBNPwere 99 vs 89.7 with a sensitivity and specicity of 98% vs 92.86%, 94.74% vs 73.68% respectively.

Treatment Outcomes of Acute Coronary Syndrome Patients in Bangkok Dusit Medical Services (TOACS-BDMS)

OBJECTIVES: The research team analyzed an acute coronary syndrome (ACS) registry from a private hospital group in Thailand. We aimed to analyze patients’ characteristics, treatment outcomes in ACS patients and compare the outcomes between ST segment elevation acute coronary syndrome (STE-ACS) and non-ST segment elevation acute coronary syndrome (NSTE-ACS). MATERIALS AND METHODS: This is a multi-centered, retrospective review of an ACS registry with seven participating hospitals carried out between January 2017 to December 2020. Web-based data entry was used, and the data were centrally managed and analyzed. RESULTS: A total of 2,024 ACS patients were included. Of these, patients were predominantly male (81.07%), NSTE-ACS 52.17% and the mean age was 62.27 ± 13.08 years. Diabetes mellitus (DM), hypertension (HT), dyslipidemia, and current smokers were observed in 25.24%,54.89%,46.64% and 30.38%, respectively. Reperfusion rate in STE-ACS was 93.20 % and 73.80% was primary percutaneous coronary intervention (PCI). STE-ACS patients were significantly younger (59.03 ± 12.27 vs. 65.24 ± 13.09 years),more current smokers (39.77% vs. 21.78%), more cardiogenic shock (15.28%vs. 3.03%) and more cardiac arrest before reperfusion therapy (9.71% vs.1.79%). Meanwhile, NSTE-ACS patients presented significantly more DM(30.58% vs. 19.42%), HT (62.40% vs.46.69%), and dyslipidemia (53.78%vs.38.84%). In-hospital mortality rate was 2.91% and significantly higher in STE-ACS (STE-ACS 4.95% vs. NSTE-ACS 1.04%). CONCLUSION: Treatment outcomes of ACS patients in Bangkok Dusit Medical Services revealed high reperfusion rate and resulted in low inhospital mortality rate. STE-ACS patients were more severe and with a higher mortality rate compared to NSTE-ACS patients.

The Prognostic Value of serum ST2 in Patients with non-ST segment elevation acute coronary syndrome

The Prognostic Value of serum ST2 in Patients with non-ST segment elevation acute coronary syndrome

Single spot albumin to creatinine ratio as an independent predictor of 12 years follow-up mortality in acute coronary syndromes without ST-segment elevation.

Background: Up to date there is no evidence of the association between microalbuminuria, measured as single spot urine albumin to creatinine ratio (ACR), with very long-term mortality in patients with non-ST segment Elevation Acute Coronary Syndromes (NSTE-ACS). Aim: To evaluate the association between admission ACR and very long-term all-cause mortality in an unselected cohort of NSTE-ACS patients. Methods: A prospective cohort study was conducted, including patients with NSTE- ACS admitted in the Intensive Care Unit. The ACR was determined in spontaneous urine samples during the first 24 hours after admission and analyzed by immunoturbidimetry. The primary endpoint was all-cause mortality during the follow-up. Actuarial survival curves were compared by log rank test and a logistical Cox regression analysis was performed to identify variables independently associated with mortality in the follow-up. Statistics were calculated using the IBM Statistics program SPSS version 26. Results: 600 patients were analyzed. The overall average ACR value was 7 mg/gr (95% CI 4-26). 76% had normoalbuminuria (ACR 0-30 mg/gr), 22% had microalbuminuria (ACR 30-300 mg/gr), and 1.5% had macroalbuminuria (ACR &gt; 300 mg/gr). The median and interquartile range of follow-up was 12 years (95% IC 11-14). The average IAC among those who met the primary endpoint was 59.15 mg/gr (95% CI 52-66) and among the survivors, 27.66 mg/gr (95 % CI 63-77), p 0,003. ACR terciles were defined by 33th and 66th percentiles: tercile 1: patients with IAC of 0 to 4 mg/gr, tercile 2: IAC from 4 to 17 mg/g and tercile 3 values greater than 17mg/gr. Strong associations were observed between ACR with age, hypertension, stroke and history of COPD, previous use of angiotensin II converter/blocking enzyme inhibitors, systolic blood pressure at admission, ST segment deviation, left ventricle ejection fraction and elevation of serum Troponin T and CPK MB. All cause-mortality during the follow-up was 14% (CI 95% 11-17). Elevation of ACR was significantly associated with long term mortality risk: log rank test chi square: 133.936, p = 0.0001. By multivariate Cox regression analysis adjusted by age, gender, diabetes, hypertension, serum creatinine, troponin T elevation, ST segment deviation, previous AMI, prior use of aspirin, statins and percutaneous coronary intervention after hospitalization, the ACR was independently associated with a 12-year follow-up mortality: OR 13 (95% IC 5-35; p 0.0001). Conclusion: Single spot urine ACR at admission is a strong predictor of 12-year follow- up mortality in an unselected cohort of patients with NSTE-ACS.

Epidemiological Aspects of Acute Coronary Syndromes in Saint-Louis, Senegal

Introduction: The prevalence of cardiovascular diseases has been rapidly increasing in developing countries, leading to an increasing incidence of acute coronary syndrome which is becoming a major health concern. Few studies have been conducted in hospital settings, which has led us to conduct this cross-sectional, descriptive study in Saint Louis in the north of Senegal, (250 km away from the capital) whose objective is to describe the epidemiological aspects of acute coronary syndrome (ACS) in hospital settings. Methodology: This is a cross-sectional descriptive and retrospective study lasting two years from January 1, 2018 to 31 December 2019 which included all patients hospitalized in the cardiology department of the regional hospital of salary for an ACS. Results: Out of 475 patients admitted to the department of cardiology, 47 presented with acute coronary syndrome which is a prevalence of 9.89%. The mean age was 63+/-13.14 years. There was a male predominance with a sex ratio of 1.5. The meantime between the beginnings of symptoms to hospitalization was 50 hours. The most frequent clinical presentation was acute coronary syndrome with ST segment elevation (STEMI: ST-segment Elevation Myocardial Infarction) in 39 patients. Hypertension was the most common cardiovascular risk factor in 23 patients and chest pain was the most common symptoms 72.3%. In STEMI patients, the ECG abnormalities were mainly in the anterior region and in NSTEMI (Non-ST-segment Elevation Myocardial Infarction) patients the ECG abnormalities were mainly in the inferior region. On echocardiography, 64% of patients had an altered left ventricular ejection function in STEMI patients whereas in NSTEMI patients, the left ventricular ejection function was preserved in 71% of cases. STEMI patients received within the first 12 hours represented 66% of our population of which 84% benefited from thrombolysis with streptokinase with a success rate of 52%. The mean time to thrombolysis was six hours. Six patients or 12.76% were sent for coronarography. The most common complication was cardiovascular collapse (11%), 15% of patients died. Conclusion: The prevalence of acute coronary syndrome is increasing in West Africa with a predominance of ST segment elevation acute coronary syndromes. The main issues encountered were long leading times between onset of symptoms and hospital admission along with limited availability of medical facilities.