ST-segment Elevation Acute Coronary Syndrome Research Articles

STUDY OF DIETARY REMODELING OF THE INTESTINAL MICROBIOTA BY GRAPE POLYPHENOLS AT THE LEVEL OF TRIMETHYLAMINE N-OXIDE (TMAO) IN PATIENTS WITH ACUTE CORONARY SYNDROME WITH ELEVATION OF THE SEGMENT ST

The main cause of mortality and disability in the adult population of our planet is cardiovascular diseases caused by atherosclerosis. The relevance of research into new methods of treating atherosclerosis is only increasing. In addition to dyslipedemia, infections and inflammation, new predictors of atherogenesis are being sought, and one of them is the level of trimethylamine N-oxide (TMAO). Many large studies have shown that circulating TMAO levels correlate with the development of atherosclerosis. In turn, the formation of TMAO depends on the state of the intestinal microbiome. That is, the stages of development of atherosclerosis can be influenced by changes in the intestinal microbiome. Purpose: Based on domestic and foreign scientific publications, to determine the effect of dietary remodeling of the gut microbiota by grape polyphenols on trimethylamine N-oxide (TMAO) levels in patients with STsegment elevation acute coronary syndrome. Results and conclusions: It was revealed that in patients with STEMI, the use of the prebiotic Kainar with grape polyphenols changes the concentration of TMAO in the blood. It was confirmed that there were statistically significant differences in TMAO values in the control group and the group taking Kaynar after 3 months and after 12 months.

Timing of Complete Multivessel Revascularization in Patients Presenting With Non-ST-Segment Elevation Acute Coronary Syndrome

BackgroundComplete revascularization of the culprit and all significant nonculprit lesions in patients with non–ST-segment elevation acute coronary syndrome (NSTE-ACS) and multivessel disease (MVD) reduces major adverse cardiac events, but optimal timing of revascularization remains unclear. ObjectivesThis study aims to compare immediate complete revascularization (ICR) and staged complete revascularization (SCR) in patients presenting with NSTE-ACS and MVD. MethodsThis prespecified substudy of the BIOVASC (Percutaneous Complete Revascularization Strategies Using Sirolimus Eluting Biodegradable Polymer Coated Stents in Patients Presenting With Acute Coronary Syndrome and Multivessel Disease) trial included patients with NSTE-ACS and MVD. Risk differences of the primary composite outcome of all-cause mortality, myocardial infarction (MI), unplanned ischemia-driven revascularization (UIDR), or cerebrovascular events and its individual components were compared between ICR and SCR at 1 year. ResultsThe BIOVASC trial enrolled 1,525 patients; 917 patients presented with NSTE-ACS, of whom 459 were allocated to ICR and 458 to SCR. Incidences of the primary composite outcome were similar in the 2 groups (7.9% vs 10.1%; risk difference 2.2%; 95% CI: −1.5 to 6.0; P = 0.15). ICR was associated with a significant reduction of MIs (2.0% vs 5.3%; risk difference 3.3%; 95% CI: 0.9 to 5.7; P = 0.006), which was maintained after exclusion of procedure-related MIs occurring during the index or staged procedure (2.0% vs 4.4%; risk difference 2.4%; 95% CI: 0.1 to 4.7; P = 0.032). UIDRs were also reduced in the ICR group (4.2% vs 7.8%; risk difference 3.5%; 95% CI: 0.4 to 6.6; P = 0.018). ConclusionsICR is safe in patients with NSTE-ACS and MVD and was associated with a reduction in MIs and UIDRs at 1 year.

Effectiveness of Primary Coronary Intervention for Patients With Delayed ST-Segment Elevation Myocardial Infarction: Insights from Moroccan Cardiology Intensive Care Units

The benefits of myocardial revascularization in ST-segment elevation acute coronary syndrome (ACS) after 12 to 24 hours from symptom onset remain a topic of debate, especially in stable, asymptomatic patients. We analyzed the benefit of late revascularization by PCI in patients admitted to Moroccan cardiac intensive care units (CICUs) with STEMI after 12 h of symptom onset. We included a total of 406 patients who met the inclusion criteria. 262 patients in the invasive strategy group and 144 patients in the conservative strategy group. A total of 74.6% were men and 25.4% were women. For the primary outcome, 46 all-cause deaths were observed at one-year, with 33 patients in the conservative strategy arm and 13 patients in the invasive strategy group, with a significant difference between the two groups (p<0.001). For secondary outcomes, there was no difference into readmitted for ACS, or acute heart failure, in the two groups (p=0.277, p=0.205). For in-CICU cardiogenic shock and EF<35% at discharge, more events are observed in the conservative strategy with a significant difference for both (p<0.001). In multivariable analysis, 1-year all-cause mortality was independently associated with Revascularization between 12h and 48h (HR at 0.372, 95%CI (0.182;0.762), p=0.007), EF<35% at discharge (HR at 1.92, 95%CI (1.22; 2.54), p=0.04) and cardiogenic shock in-CICU (HR at 2.69, 95%CI (1.82;3.78), p=0.005).Although no evidence exists to date on the true benefit of late PCI revascularization in STEMI patients, this practice remains common, as demonstrated by the results of the majority of registries.

Antithrombotic therapy in patients with acute coronary syndrome: similarities and differences between a European expert consensus document and the 2023 European Society of Cardiology guidelines.

Antithrombotic therapy represents the cornerstone of the pharmacological treatment in patients with acute coronary syndrome (ACS). The optimal combination and duration of antithrombotic therapy is still matter of debate requiring a critical assessment of patient comorbidities, clinical presentation, revascularization modality, and/or optimization of medical treatment. The 2023 European Society of Cardiology (ESC) guidelines for the management of patients with ACS encompassing both patients with and without ST segment elevation ACS have been recently published. Shortly before, a European expert consensus task force produced guidance for clinicians on the management of antithrombotic therapy in patients with ACS as well as chronic coronary syndrome. The scope of this manuscript is to provide a critical appraisal of differences and similarities between the European consensus paper and the latest ESC recommendations on oral antithrombotic regimens in ACS patients.

Endovascular prevention of distal embolism in pathogenesis of no-reflow phenomenon in percutaneous coronary interventions in patients with ST-segment elevation acute coronary syndrome

Endovascular prevention of distal embolism in pathogenesis of no-reflow phenomenon in percutaneous coronary interventions in patients with ST-segment elevation acute coronary syndrome

Long-Term Outcomes of Invasive vs Conservative Strategies for Older Patients With Non-ST-Segment Elevation Acute Coronary Syndromes.

Non-ST-segment elevation acute coronary syndrome (NSTE-ACS) is a frequent cause of hospital admission in older people, but clinical trials targeting this population are scarce. The After Eighty Study assessed the effect of an invasive vs a conservative treatment strategy in a very old population with NSTE-ACS. Between 2010 and 2014, the investigators randomized 457 patients with NSTE-ACS aged≥80 years (mean age 85 years) to an invasive strategy involving early coronary angiography with immediate evaluation for revascularization and optimal medical therapy or to a conservative strategy (ie, optimal medical therapy). The primary endpoint was a composite of myocardial infarction, need for urgent revascularization, stroke, and death. The long-term outcomes are presented. After a median follow up of 5.3 years, the invasive strategy was superior to the conservative strategy in the reduction of the primary endpoint (incidence rate ratio: 0.76; 95%CI: 0.63-0.93; P=0.0057). The invasive strategy demonstrated a significant gain in event-free survival of 276days (95%CI: 151-400days; P=0.0001) at 5 years and 337days (95%CI: 123-550days; P=0.0001) at 10 years. These results were consistent across subgroups of patients with respect to major cardiovascular prognostic factors. In patients aged≥80 years with NSTE-ACS, the invasive strategy was superior to the conservative strategy in the reduction of composite events and demonstrated a significant gain in event-free survival. (The After Eighty Study: a randomized controlled trial; NCT01255540).

Timing of coronary angiography and use of antiplatelet pretreatment in patients with NSTEACS in Spain

Introduction and objectivesThe optimal timing of coronary angiography in patients admitted with non–ST-segment elevation acute coronary syndrome (NSTEACS) as well as the need for pretreatment are controversial. The main objective of the IMPACT-TIMING-GO registry was to assess the proportion of patients undergoing an early invasive strategy (0-24hours) without dual antiplatelet therapy (no pretreatment strategy) in Spain. MethodsThis observational, prospective, and multicenter study included consecutive patients with NSTEACS who underwent coronary angiography that identified a culprit lesion. ResultsBetween April and May 2022, we included 1021 patients diagnosed with NSTEACS, with a mean age of 67±12 years (23.6% women). A total of 87% of the patients were deemed at high risk (elevated troponin; electrocardiogram changes; GRACE score>140) but only 37.8% underwent an early invasive strategy, and 30.3% did not receive pretreatment. Overall, 13.6% of the patients underwent an early invasive strategy without pretreatment, while the most frequent strategy was a deferred angiography under antiplatelet pretreatment (46%). During admission, 9 patients (0.9%) died, while major bleeding occurred in 34 (3.3%). ConclusionsIn Spain, only 13.6% of patients with NSTEACS undergoing coronary angiography received an early invasive strategy without pretreatment. The incidence of cardiovascular and severe bleeding events during admission was low.

TCT-139 Timing of Complete Multivessel Revascularization in Patients Presenting With Non–ST-Segment Elevation Acute Coronary Syndrome

TCT-139 Timing of Complete Multivessel Revascularization in Patients Presenting With Non–ST-Segment Elevation Acute Coronary Syndrome

TCT-165 Aspirin-Free Prasugrel Monotherapy: 30-Day Clinical Outcome After Percutaneous Coronary Intervention in Chronic Coronary Syndrome and Non–ST-Segment Elevation Acute Coronary Syndrome

TCT-165 Aspirin-Free Prasugrel Monotherapy: 30-Day Clinical Outcome After Percutaneous Coronary Intervention in Chronic Coronary Syndrome and Non–ST-Segment Elevation Acute Coronary Syndrome

TCT-368 Optimal Timing of Invasive Strategy in Patients With High-Risk Non–ST-Segment Elevation Acute Coronary Syndrome: A Meta-Analysis

TCT-368 Optimal Timing of Invasive Strategy in Patients With High-Risk Non–ST-Segment Elevation Acute Coronary Syndrome: A Meta-Analysis

Age and gender-based categorization of very premature, premature, and non-premature acute myocardial infarction: A comparison of clinical and angiographic profile and in-hospital outcomes

BackgroundIn this study, we aimed to assess and compare the distribution of demographic and clinical characteristics and composite adverse clinical outcomes after primary percutaneous coronary intervention (PCI) among “very premature”, “premature”, and “non-premature” patients with “ST-segment elevation acute coronary syndrome (STE-ACS)” presented at a tertiary care center. MethodsWe included consecutive patients diagnosed with STE-ACS undergoing primary PCI. The “very premature” was defined as ≤40 years for males and ≤ 45 years for females, “premature” as <55 years for males and < 65 years for females, and “non-premature” as ≥55 years for males and ≥ 65 years for females. Clinical characteristics, angiographic patterns, and hospital course were compared among the three groups. ResultsIn a sample of 4686 patients, 78.8%(3691) were male, and the average age was 55.6 ± 11 years. In total, 12%(561) were categorized as very premature, 38.3%(1797) as premature, and 49.7%(2328) as non-premature. The distribution of clinical characteristics in very premature, premature, and non-premature groups were as follows; hypertension in 44.6% vs. 53.5% vs. 54.9%; p < 0.001, diabetes in 30.3% vs. 36.8% vs. 35.5%; p = 0.018, smoking in 29.6% vs. 23.3% vs. 26.3%; p = 0.005, obesity in 19.4% vs. 18.4% vs. 15.3%; p = 0.008, single vessel diseases in 58.8% vs. 37.8% vs. 28.8%; p < 0.001, and composite adverse clinical outcomes in 14.1% vs. 16.7% vs. 21.8%; p < 0.001, respectively. ConclusionIn conclusion, we have a substantial burden of premature STE-ACS. Very premature STE-ACS was found to be associated with a better prognosis, but a substantial burden of composite adverse clinical outcomes was also observed.

Tiempos de cateterismo y uso de pretratamiento antiagregante plaquetario en pacientes con SCASEST en España

Introduction and objectivesThe optimal timing of coronary angiography in patients admitted with non–ST-segment elevation acute coronary syndrome (NSTEACS) as well as the need for pretreatment are controversial. The main objective of the IMPACT-TIMING-GO registry was to assess the proportion of patients undergoing an early invasive strategy (0-24hours) without dual antiplatelet therapy (no pretreatment strategy) in Spain. MethodsThis observational, prospective, and multicenter study included consecutive patients with NSTEACS who underwent coronary angiography that identified a culprit lesion. ResultsBetween April and May 2022, we included 1021 patients diagnosed with NSTEACS, with a mean age of 67±12 years (23.6% women). A total of 87% of the patients were deemed at high risk (elevated troponin; electrocardiogram changes; GRACE score>140) but only 37.8% underwent an early invasive strategy, and 30.3% did not receive pretreatment. Overall, 13.6% of the patients underwent an early invasive strategy without pretreatment, while the most frequent strategy was a deferred angiography under antiplatelet pretreatment (46%). During admission, 9 patients (0.9%) died, while major bleeding occurred in 34 (3.3%). ConclusionsIn Spain, only 13.6% of patients with NSTEACS undergoing coronary angiography received an early invasive strategy without pretreatment. The incidence of cardiovascular and severe bleeding events during admission was low.

Oxidative metabolism of neutrophils in acute coronary syndrome.

Inflammation in acute coronary syndrome (ACS) involves neutrophil activation and oxidative stress. Here, we studied the production of reactive oxygen species (ROS) by neutrophils in ACS. The study included 42 patients, men and women aged 46-91 years with ischaemic heart disease (IHD), non-ST-segment elevation ACS and ST-segment elevation ACS. Neutrophil-derived ROS were quantified with double-step stimulated luminol-enhanced chemiluminometry. The specific indices of spontaneous and double-step stimulated chemiluminescence did not differ in the subgroups of IHD, non-ST-segment elevation ACS and ST-segment elevation ACS. The total double-step stimulated ROS production by neutrophils was significantly higher in ST-segment elevation ACS than in non-ST-segment elevation ACS and IHD. In ACS, special activation mechanisms of peripherical neutrophils were not triggered in our study. The significant increase in free radical production by neutrophils in acute myocardial infarction was presumably a consequence of an increase in their number.

A correlation study between mean platelet volume and platelet aggregation study in acute coronary syndrome patients.

Platelets play an important role in cardiovascular disease mainly in the development of acute thrombotic events. Elevated platelet indices have been proposed as a risk factor for acute coronary syndrome (ACS). It remains uncertain whether increased platelet indices are the result or the cause of ACS. This study aimed to correlate mean platelet volume (MPV) and platelet aggregation response to know the functional status of platelets based on their size. A total of 50 patients with ST-segment elevation ACS (STE-ACS) or non-ST-segment elevation ACS (NSTE-ACS) were included and their MPV was measured and platelet aggregometry was performed. Patients were divided into two groups, patients with MPV ≤9.1 fl as group 1 and those with MPV >9.1 fl as group 2. The mean maximum platelet aggregation response (MMPAR) with ADP, Collagen, and Epinephrine, of both the groups, were compared. MMPAR to ADP, Collagen, and Epinephrine in group 1 was 74.47%, 66.13%, and 72.9%, respectively, and in group 2, 72.94%, 59.97%, and 72.43%, respectively. There was no statistically significant difference in the MMPAR to ADP, Collagen, and Epinephrine among the two groups. Increased MPV does not indicate the platelets are hyperreactive. An increase in MPV may be because of the increased release of immature platelets from bone marrow as there is increased consumption of platelets at the site of thrombus formation in ACS.

Lipoprotein associated- phospholipase A2 in STEMI vs. NSTE-ACS patients: a marker of cardiovascular atherosclerotic risk rather than thrombosis.

A consecutive cohort of patients undergoing coronary angiography for acute coronary syndrome (ACS) were included and divided according to presentation for non ST-segment elevation-ACS or ST-segment elevation Myocardial Infarction (STEMI). Lp-PLA2 activity was assessed in blood samples drawn at admission using the Diazyme Lp-PlA2 Activity Assay. We included in our study 117 patients, of whom 31 (26.5%) presented with STEMI. STEMI patients were significantly younger (p = 0.05), displayed a lower rate of hypertension (p = 0.002), previous MI (p = 0.001) and PCI (p = 0.01) and used less frequently statins (p = 0.01) and clopidogrel (p = 0.02). White blood cells and admission glycemia were increased in STEMI (p = 0.001, respectively). The prevalence and severity of CAD was not different according to ACS types, but for a higher prevalence of thrombus (p < 0.001) and lower TIMI flow (p = 0.002) in STEMI. The levels of Lp-PlA2 were significantly lower in STEMI as compared to NSTE-ACS patients, (132 ± 41.1 vs. 154.6 ± 40.9 nmol/min/mL, p = 0.01). In fact, the rate of patients with Lp-PlA2 above the median (148 nmol/min/mL) was significantly lower in STEMI patients as compared to NSTE-ACS (32.3% vs. 57%, p = 0.02, adjusted OR[95% CI] = 0.20[0.06-0.68], p = 0.010). Moreover, a direct linear relationship was observed between Lp-PlA2 and LDL-C (r = 0.47, p < 0.001), but not with inflammatory biomarkers. The present study shows that among ACS patients, the levels of Lp-PlA2 are inversely associated with STEMI presentation and thrombotic coronary occlusion, being instead increased in NSTE-ACS patients, therefore potentially representing a marker of more aggressive chronic cardiovascular disease with an increased risk of recurrent cardiovascular events.

Outcomes of coronary artery bypass grafting and percutaneous coronary intervention in high-risk non-ST-segment elevation acute coronary syndromes

Highlights. Despite high hospital mortality after coronary bypass grafting in patients with high-risk non–STsegment elevation acute coronary syndrome, surgical myocardial revascularization remains a preferable treatment modality since percutaneous coronary intervention in these patients is associated with high perioperative complications due to severely calcified coronary lesions.Background. The optimal revascularization strategy in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) remains the subject of many years of controversy. Coronary artery bypass grafting (CABG) improves the long-term prognosis through complete revascularization, however, percutaneous coronary intervention (PCI), due to its availability and low invasiveness, suggests an improvement in hospital outcomes.Aim. To compare hospital outcomes of CABG and PCI performed within 24 hours in high-risk NSTE-ACS patients.Methods. In the present study, the first group included 30 NSTE-ACS patients who underwent CABG in the first 24 hours (the CABG group), whereas 30 NSTE-ACS patients who underwent PCI were included in the second group (the PCI group).Results. The mean age was 64,4±7,3 years, it was comparable in both groups. The main clinical and anamnestic characteristics of patient in both groups were comparable as well. The severity of coronary atherosclerosis according to the Syntax score was 25,6±9,2 in the CABG group, and 21,7±5,7 in the PCI group (p = 0,054). After revascularization, the residual Syntax score did not differ between the groups (p = 0,42), indicating complete revascularization. Hospital mortality was relatively high in the CABG group (13,3%), while no such cases were noted in the PCI group. Most of the patients with adverse outcomes had a critical lesion of the left main coronary artery and a complicated postoperative course.Conclusion. The results of this study demonstrate promising outcome of CABG in patients with severe multivessel coronary disease at high risk of adverse events.

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.

Early Invasive Strategy Based on the Time of Symptom Onset of Non-ST-Segment Elevation Myocardial Infarction

BackgroundA limitation of the current guidelines regarding the timing of invasive coronary angiography for patients with non–ST-segment elevation acute coronary syndrome is the randomization time. To date, no study has reported the clinical outcomes of invasive strategy timing on the basis of the time of symptom onset. ObjectivesThe aim of this study was to investigate the effect of invasive strategy timing from the time of symptom onset on the 3-year clinical outcomes of patients with non–ST-segment elevation myocardial infarction (NSTEMI). MethodsAmong 13,104 patients from the Korea Acute Myocardial Infarction Registry–National Institutes of Health, 5,856 patients with NSTE myocardial infarction were evaluated. The patients were categorized according to symptom-to-catheter (StC) time (<48 or ≥48 hours). The primary outcome was 3-year all-cause mortality. ResultsOverall, 3,919 patients (66.9%) were classified into the StC time <48 hours group. This group had lower all-cause mortality than the group with StC time ≥48 hours (7.3% vs 13.4%; P < 0.001). The lower risk for all-cause mortality in the group with StC time <48 hours group was consistent in all subgroups. Notably, emergency medical service use (HR: 0.31; 95% CI: 0.19-0.52) showed a lower risk for all-cause mortality than no emergency medical service use (HR: 0.54; 95% CI: 0.46-0.65; P value for interaction = 0.008). ConclusionsAn early invasive strategy on the basis of StC time was associated with a decreased risk for all-cause mortality in patients with NSTEMI. Because the study was based on a prospective registry, the results should be considered hypothesis generating, highlighting the need for further research. (iCReaT Study No. C110016)

Comparative Study of Transradial Versus Transfemoral Route Percutaneous Coronary Intervention in Acute ST-Elevation Myocardial Infarction.

Introduction Percutaneous coronary intervention (PCI) is the first choice of treatment for myocardial infarction (MI). However, entry site failure is still one of the major complications faced by the interventionist. Hence the present study compared the efficacy and complications of radial and femoral approaches in PCI in ST-elevation myocardial infarction (STEMI). Methods A hospital-based prospective study was conducted on patients with acute STEMI. A total of 100 patients were enrolled that were randomly divided into two groups of 50 each, i.e., patients that had undergone PCI by radial approach (N=50) and those who had undergone PCI by femoral approach (N=50). Results The male-to-female ratio was 1.5:1 and 1.6:1 in the transradial (TR) and transfemoral (TF) groups, respectively. With respect to age, both the groups were dominated by the age group of 50-60 years, with 42% in the TR group and 34% in the TF group having an age >60 years. The mean access time, fluoroscopy time, and procedural time in the TR group were 6.0 ± 0.7 minutes, 5.9 ± 0.6 minutes, and 29.55 ± 0.9 minutes, respectively. In the TF group, the mean access time, fluoroscopy time, and procedural time were 5.1 ± 0.5 minutes, 5.5 ± 0.7 minutes, and 26.7 ± 2.1 minutes, respectively. In the TR group, ecchymosis and loss of radial pulse were observed in 10% of the patients, thrombophlebitis in 4%, and bleeding complications in 2%. While in the TF group, ecchymosis was observed in 26%, followed by thrombophlebitis (24%), minor hematoma, and bleeding complications (14%). Conclusion The present study emphasizes the use of radial access in patients with ST-segment elevation acute coronary syndrome, as this approach was associated with significant clinical benefits. Moreover, bleeding complications were more in patients undergoing TF intervention.

101 LIPOPROTEIN ASSOCIATED PHOSPHOLIPASE A2 IN STEMI VS NSTE-ACS PATIENTS: A MARKER OF CARDIOVASCULAR ATHEROSCLEROTIC RISK RATHER THAN THROMBOSIS

Abstract Background The precise role of Lipoprotein associated phospholipase A2 (Lp-PlA2) in the pathogenesis of acute coronary syndromes (ACS) and in the prediction of future cardiovascular events is still debated. So far, few data exist on the variations of Lp-PlA2 activity in ACS and especially in NSTE-ACS vs STEMI patients, where thrombotic and atherosclerotic mechanisms could play a differential role. The aim of the present study was, then, to compare Lp-PlA2 activity according to the type of ACS presentation. Methods A consecutive cohort of patients undergoing coronary angiography for acute coronary syndrome (ACS) were included and divided according to presentation for non ST-segment elevation-ACS or ST-segment elevation Myocardial Infarction (STEMI). Lp-PLA2 activity was assessed on blood samples drawn at admission using the Diazyme Lp-PlA2 Activity Assay. Results We included in our study 117 patients, of whom 31 (26.5%) presented with STEMI. STEMI patients were significantly younger (p=0.05), displayed a lower rate of hypertension (p=0.002), previous MI (p=0.001) and PCI (p=0.01) and used less frequently statins (p=0.01) and clopidogrel (p=0.02). White blood cells and admission glycemia were increased in STEMI (p=0.001, respectively). The prevalence and severity of CAD was not different according to ACS types, but for a higher prevalence of thrombus (p&amp;lt;0.001) and lower TIMI flow (p=0.002) in STEMI. The levels of Lp-PlA2 were significantly lower in STEMI as compared to NSTE-ACS patients, (132±41.1 vs 154.6 ±40.9 nmol/min/mL, p=0.01). In fact, the rate of patients with Lp-PlA2 above the median (148 nmol/min/mL) was significantly lower in STEMI patients as compared to NSTE-ACS (32.3% vs 57%, p=0.02, adjusted OR[95% CI]=0.20[0.06-0.68], p=0.010). Moreover, a direct linear relationship was observed between Lp-PlA2 and LDL-C (r=0.47, p&amp;lt;0.001), but not with inflammatory biomarkers. Conclusion The present study shows that among ACS patients, the levels of Lp-PlA2 are inversely associated with STEMI presentation and thrombotic coronary occlusion, being instead increased in NSTE-ACS patients, and with recurrent cardiovascular events, therefore potentially representing a marker of a more aggressive atherosclerotic disease and higher cardiovascular burden and risk.