scholarly journals Evaluating the Performance of the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/AHA Guidelines (CRUSADE) and the Reduction of Atherothrombosis for Continued Health (REACH) Bleeding Scores in the Australian and New Zealand (ANZ) Acute Coronary Syndrome (ACS) Population

2012 ◽  
Vol 21 ◽  
pp. S250
Author(s):  
L. Edwards ◽  
I. Ranasinghe ◽  
D. Brieger
Keyword(s):  
Acute Coronary Syndrome ◽  
New Zealand ◽  
Risk Stratification ◽  
Unstable Angina ◽  
Adverse Outcomes ◽  
Coronary Syndrome ◽  
Early Implementation

scholarly journals Prognostic Significance of B Type Natriuretic Peptide in Acute Coronary Syndrome

2014 ◽  
Vol 13 (2) ◽  
pp. 78-88 ◽  
Author(s):  
Nasreen Chowdhury ◽  
Md. Aminul Haque Khan ◽  
Md Mozammel Hoque
Keyword(s):  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Risk Stratification ◽  
Natriuretic Peptide ◽  
Prognostic Significance ◽  
Left Ventricular ◽  
Adverse Outcomes ◽  
Risk Of Death ◽  
Coronary Syndrome ◽  
Early Risk

Acute Coronary syndrome (ACS) is the most common cause of admission to the coronary care unit with highest risk of death and adverse outcomes. ACS accounts for 60–70% of all admissions in the hospital. Patients with ACS encompass a heterogeneous group that varies widely regarding severity of the underlying coronary artery disease, prognosis and response to treatment. Patients with the highest risk of subsequent events usually have the largest benefit of an intensified pharmacological treatment and early mechanical intervention. The prognosis for low-risk patients, on the other hand, is often difficult to improve further and these patients usually benefit more from a conservative management with a lower risk of side effects. Therefore, risk stratification is essential and should be initiated early and updated continuously throughout the hospital stay. Early risk stratification is usually performed by the use of clinical background factors, clinical presentation, electrocardiography and biochemical markers of myocardial damage. Levels of natriuretic peptides have been shown to reflect cardiac performance. The aim of this study was to review elaborately on B type Natriuretic Peptide (BNP) and its prognostic value in patient with ACS. This review focuses on the emerging role of these peptides in the early risk stratification of ACS patients. Elevation of BNP levels in acute MI and UA is predictive of a greater risk of death, post infarction heart failure, or  reinfarction. Post infarction studies demonstrate that elevated plasma BNP levels are associated with larger infarct size, increased probability of ventricular remodeling, lower ejection fraction, higher risk of heart failure, and increased mortality. This cardiac marker is a potent predictor of mortality in patients with all forms ACS. BNP measurements serve as an index of severity of the ischemic injury, as well as the degree of impairment in left ventricular function.DOI: http://dx.doi.org/10.3329/cmoshmcj.v13i2.21079

scholarly journals Acute coronary syndrome: pathogenesis, diagnosis, treatment, rehabilitation (part 1)

2016 ◽  
Vol 7 (1) ◽  
pp. 70-81
Author(s):  
N. B Perepech
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Risk Stratification ◽  
Unstable Angina ◽  
Clinical Manifestation ◽  
Laboratory Diagnostics ◽  
Coronary Syndrome ◽  
Definition Of

The lecture provides a definition of "acute coronary syndrome" and entities that united this term. The mechanisms of the development and clinical manifestation of acute coronary syndrome. The methods of instrumental and laboratory diagnostics, rules formulation diagnosis of myocardial infarction and unstable angina. Provides information on how to assess prognosis and risk stratification in patients with acute coronary syndrome.

scholarly journals Prediction of risk of major bleeding with using CRUSADE bleeding score in Acute coronary syndrome patients: A case series

2019 ◽  
Vol 10 (4) ◽  
pp. 3204-3208
Author(s):  
Castelino Renita Edwin ◽  
Jitha Thankachan ◽  
Lisa Mathew Adackapara ◽  
Aneena Suresh
Keyword(s):  
Acute Coronary Syndrome ◽  
Major Bleeding ◽  
Large Scale ◽  
Bleeding Event ◽  
Case Series ◽  
Bleeding Risk ◽  
Adverse Outcomes ◽  
Coronary Syndrome ◽  
Early Implementation ◽  
Bleeding Score

Use of intravenous heparin in Acute coronary syndrome possess a major risk of bleeding to patients. However, the estimation of risk using bleeding scores in Indian settings is yet to be established. These case series assess the risk of major bleeding associated with the use of Antithrombotic agents in patients with acute coronary syndrome using CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines) bleeding score. Relevant patient data was collected from hospital records and patients were followed up till discharge. All the four cases reported showed the risk of in-hospital bleeding with anti-thrombotic agents evident as two cases of hematuria, one case of gum bleeding and one case of hemorrhagic stools. All the patient presented with chest pain to the hospital; following a diagnosis of the acute coronary syndrome, they were prescribed with antiplatelets and anticoagulants. This accompanied a bleeding event which was categorized using CRUSADE bleeding risk score. In-hospital major bleeding imposes a burden on the patient's quality of life. Use of CRUSADE bleeding score helps to predict the severity of risk in a less expensive, non-invasive manner. Further, large scale studies will pave the way for using CRUSADE as an efficient bleeding predictor score.

scholarly journals Evaluation of Procalcitonin Levels in Patients with Various Forms of Acute Coronary Syndrome, Depending on the Presence of Adverse Hospital Outcomes

2021 ◽  
Vol 17 (3) ◽  
pp. 456-461
Author(s):  
O. M. Drapkina ◽  
V. A. Zakharova
Keyword(s):  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Unstable Angina ◽  
Acute Heart Failure ◽  
Cardiovascular Death ◽  
Adverse Outcomes ◽  
Hospital Outcomes ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Informed Consent Form

Aim. to study the levels of procalcitonin in patients with various forms of acute coronary syndrome (ACS), depending on the presence of adverse hospital outcomes.Materials and Methods. The study included 222 patients admitted to the emergency cardiology department with a diagnosis of ACS in the period from March 2014. until January 2017. Of these, 106 (47.7 %) patients were diagnosed with unstable angina (NS) and 116 (52.3%) with myocardial infarction (MI). Non ST segment elevation MI (NSTEMI) was diagnosed in 47 (40.5%) patients with MI, and ST elevation MI (STEMI) – in 69 (59.5%) patients with MI. After the assessment of the patient's compliance with the criteria for inclusion/exclusion in the study, the procedure for signing the patient's informed consent form was carried out. The protocol of the study was approved by the local Ethics committee of the M. E. Zhadkevich State Clinical Hospital. In each study subgroup, the presence of adverse outcomes during the current hospitalization was assessed: cardiovascular death, nonfatal MI, nonfatal acute cerebrovascular accident, acute heart failure, as well as a combined endpoint, including all of the listed adverse outcomes. All patients, in addition to routine laboratory methods of investigation, were examined for the level of procalcitonin at admission to the hospital, on 2-3 and 4-5 days.Results. Patients with MI compared to patients with NS were characterized by a large number of registered endpoints in general (24.1% vs. 6.6%, p<0.001), while in the group of patients with MI, cardiovascular death was more often recorded (10.3% vs. 0.9%, p<0.001) and acute heart failure (12.9% vs. 5.6%, p=0.009). Patients with MI, in particular with STEMI, who had adverse hospital outcomes, were characterized by statistically significantly higher levels of procalcitonin compared to patients without adverse hospital outcomes. Patients with STEMI showed significantly higher levels of procalcitonin at all stages of the disease, and patients with MI-only at 2-3 and 4-5 days. There were no statistically significant differences in the level of procalcitonin at all stages of the disease in patients with NSTEMI and with unstable angina, depending on the hospital outcomes.Conclusion. Elevated procalcitonin levels in patients with MI, in particular with STEMI, are associated with adverse hospital outcomes; for other forms of ACS, no statistically significant differences were observed with different hospital outcomes.

scholarly journals Point-of-Care i-STAT Cardiac Troponin I for Assessment of Patients with Symptoms Suggestive of Acute Coronary Syndrome,

2006 ◽  
Vol 52 (2) ◽  
pp. 322-325 ◽  
Author(s):  
Fred S Apple ◽  
Ranka Ler ◽  
Adrine Y Chung ◽  
Michael J Berger ◽  
MaryAnn M Murakami
Keyword(s):  
Acute Coronary Syndrome ◽  
Risk Stratification ◽  
Cardiac Troponin ◽  
Cardiac Death ◽  
Troponin I ◽  
Point Of Care ◽  
Adverse Outcomes ◽  
Rank Test ◽  
Coronary Syndrome ◽  
Kaplan Meier

Abstract Background: Few studies have investigated the role of cardiac troponin point-of-care (POC) testing for predicting adverse outcomes in acute coronary syndrome (ACS) patients. We investigated the use of a POC cTnI assay in ACS patients. Methods: We studied consecutive patients (n = 367) presenting with symptoms suggestive of ACS who were admitted through the emergency department. We measured plasma cTnI with the i-STAT assay. Patients were risk-stratified based on cTnI concentrations defined by the predetermined 99th percentile reference limit for plasma (0.04 μg/L). Patients were followed for 60 days. We computed survival and event curves with the Kaplan–Meier method and compared risk stratification groups with the log-rank test. Results: Acute myocardial infarction (MI) was diagnosed in 8.1% of patients. Odds ratios and 95% confidence intervals for all-cause death (ACD), MI or ACD, MI or cardiac death, and cardiac death at 60 days were all statistically significant after adjustment for age, diabetes, hypertension, and history of renal failure as follows: 2.54 (1.24–5.20), P = 0.009; 2.76 (1.37–5.58), P = 0.003; 5.98 (1.65–21.7), P = 0.008; and 2.54 (1.24–5.20), P = 0.009. Kaplan–Meier curves showed early separation between patients with increased vs. reference concentrations before 30 days for ACD, MI or ACD, and MI or cardiac death. Conclusion: The i-STAT POC cTnI assay can be added to the list of assays for risk stratification.

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