Clinical features and in-hospital mortality associated with different types of atrial fibrillation in patients with acute coronary syndrome with and without ST elevation

Vascular calcification contributes to the pathogenesis of coronary artery disease while matrix Gla protein (MGP) was recently identified as a potent inhibitor of vascular calcification. MGP fractions, such as dephosphorylated-uncarboxylated MGP (dp-ucMGP), lack post-translational modifications and are less efficient in vascular calcification inhibition. We sought to compare dp-ucMGP levels between patients with acute coronary syndrome (ACS), stratified by ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) status. Physical examination and clinical data, along with plasma dp-ucMGP levels, were obtained from 90 consecutive ACS patients. We observed that levels of dp-ucMGP were significantly higher in patients with NSTEMI compared to STEMI patients (1063.4 ± 518.6 vs. 742.7 ± 166.6 pmol/L, p < 0.001). NSTEMI status and positive family history of cardiovascular diseases were only independent predictors of the highest tertile of dp-ucMGP levels. Among those with NSTEMI, patients at a high risk of in-hospital mortality (adjudicated by GRACE score) had significantly higher levels of dp-ucMGP compared to non-high-risk patients (1417.8 ± 956.8 vs. 984.6 ± 335.0 pmol/L, p = 0.030). Altogether, our findings suggest that higher dp-ucMGP levels likely reflect higher calcification burden in ACS patients and might aid in the identification of NSTEMI patients at increased risk of in-hospital mortality. Furthermore, observed dp-ucMGP levels might reflect differences in atherosclerotic plaque pathobiology between patients with STEMI and NSTEMI.

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Treatment of patients with acute coronary syndrome in real clinical practice in the Republic of Karelia: 10-years registry results

Cardiosomatics ◽

10.26442/22217185.2020.4.200527 ◽

2021 ◽

Vol 11 (4) ◽

pp. 15-19

Author(s):

Inga S. Skopets ◽

Natalia N. Vezikova ◽

Tamazi D. Karapetian ◽

Andrew V. Malafeev ◽

Aleksandr N. Malygin ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Coronary Syndrome ◽

Clinical Practice ◽

Drug Therapy ◽

Hospital Mortality ◽

Coronary Syndrome ◽

Cardiovascular Center ◽

St Elevation ◽

The Republic ◽

Real Clinical Practice

Aim. To present the treatment of Acute coronary syndrome (ACS) in clinical practice in the Republic of Karelia and the results of Cardiovascular centers working. Material and methods. The prospective study included 9949 patients successively hospitalized from 01.01.2020 to 01.01.2020 in the Regional cardiovascular center (Petrozavodsk, Russia), 6335 were included in Federal register. Risk factors, clinical features, reperfusion strategy as well as the rate of clinical complications, drug therapy and outcomes were assessed. Results. 9949 patients were treated in Regional cardiovascular center from 01.01.2010 to 01.01.2020 due to acute coronary syndrome, and 6335 were included to the Federal registry. 40.2% of patients had ST-elevation Myocardial Infarction and 59.8% ACS without ST elevation. The first group was younger (the average age was 69) than the second (the average age was 74). The drug therapy of ACS in the hospital was following: 98.7% of patients took aspirin; b-blockers 92.3%, statins 97.4%. The outcomes of ACS during the hospital discharge were following: Q-wave myocardial infarction (MI) was diagnosed in 34.2% cases, non-Q-wave MI in 23.4%, unstable angina 20.5%, repeated MI 18.7% and 2.5% MI unspecified localization. The analysis of the clinical features of ACS shows that significant number of patients (24.8%) had severe complications. So, ventricle arrhythmias were diagnosed in 17.3% of cases, acute left ventricle insufficiency in 7.6%, cardiogenic shock in 3.0%, cardiac arrest in 1.9%, myocardial rupture in 0.4%. The hospital mortality rate reached 6.38%. Conclusion. The article presents data about treatment of patients with acute coronary syndrome in real clinical practice in the Republic of Karelia based on 10-years register. Difficulties of management and reperfusion interventions, the volume of drug therapy, the frequency of complications, as well as outcomes and hospital mortality are discussed. The presented data show the results of modernization of the medical care program for patients with acute coronary syndrome in practical healthcare in the region.

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Breast cancer patients have lower in-hospital mortality after acute coronary syndrome, a 5 year nationwide analysis

European Heart Journal ◽

10.1093/ehjci/ehaa946.1743 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

C Huang Lucas ◽

B Yue ◽

X Wei ◽

L Wu ◽

R Abed ◽

...

Keyword(s):

Breast Cancer ◽

Acute Coronary Syndrome ◽

Hospital Mortality ◽

Cancer Patients ◽

Breast Cancer Patients ◽

Female Population ◽

Female Patients ◽

Coronary Syndrome ◽

History Of ◽

St Elevation

Abstract Background Breast cancer and cardiovascular disease (CVD) share common risk factors, and breast cancer therapies are well known to cause cardiotoxicity. Prior studies highlighted the higher burden coronary artery disease and the importance to further assess its consequences on breast cancer patients. Purpose We sought to evaluate the revascularization rate and in-hospital short-term outcomes of breast cancer patients following acute coronary syndrome (ACS) compared to the general female population. Methods We reviewed the Nationwide Inpatient Sample from 2010 to 2014 to identify female patients with principal diagnosis of ACS (ST-elevation and non ST-elevation myocardial infarction, and unstable angina). Two subgroups were identified, women with a history of breast cancer and women without, and were propensity matched. Multivariate regression analyses were performed to evaluate the impact of breast cancer on primary outcome (in-hospital mortality) and secondary outcomes: occurrence of shock, acute kidney injury (AKI), mechanical ventilation (MV), and length of stay (LOS). We also compared the rate of cardiac procedures. Statistical significance of odd ratios (OR) is defined with p-value<0.05 and reported 95% confidence intervals (CI). Results We identified a total of 245,563 female patients with primary diagnosis of ACS, among them 10,625 (4.3%) had a history of breast cancer. The comorbidity of breast cancer was associated with statistically significant lower rates of mortality (OR 0.83, CI 0.74–0.94), shock (OR 0.87, CI 0.77–0.99), AKI (OR 0.90, CI 0.82–0.98), MV (OR 0.81, CI 0.71–0.92) and relative 5.4% decrease in LOS (CI: −7.8%, −3.0%). The cardiac procedural rates were similar for left heart catheterization (OR 0.96, CI 0.90–1.02), for percutaneous coronary intervention (OR 0.95, CI 0.89–1.02) and for CABG (OR 0.88, CI 0.78–1.00) compared to control group. Conclusion Breast cancer patients received a comparable catheterization and revascularization procedure rate and exhibited a statistically significant lower morbidity and mortality rates during hospitalization after an ACS event compared to the general female population. Funding Acknowledgement Type of funding source: None

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Prognostic value of GRACE score for in-hospital and 6 months outcomes after non-ST elevation acute coronary syndrome

The Egyptian Heart Journal ◽

10.1186/s43044-021-00146-9 ◽

2021 ◽

Vol 73 (1) ◽

Author(s):

Dileep Kumar ◽

Arti Ashok ◽

Tahir Saghir ◽

Naveedullah Khan ◽

Bashir Ahmed Solangi ◽

...

Keyword(s):

Diabetes Mellitus ◽

Acute Coronary Syndrome ◽

Family History ◽

Hospital Mortality ◽

Hospital Stay ◽

Predictive Value ◽

Coronary Syndrome ◽

St Elevation ◽

Elevation Acute Coronary Syndrome ◽

Grace Score

Abstract Background The aim of this study was to determine the predictive value of the Global Registry of Acute Coronary Events (GRACE) score for predicting in-hospital and 6 months mortality after non-ST elevation acute coronary syndrome (NSTE-ACS). Results In this observational study, 300 patients with NSTE-ACS of age more than 30 years were included; 16 patients died during the hospital stay (5.3%). Of 284 patients at 6 months assessment, 10 patients died (3.5%), 240 survived (84.5%), and 34 were lost to follow-up (12%) respectively. In high risk category, 10.5% of the patients died within hospital stay and 11.8% died within 6 months (p = 0.001 and p = 0.013). In univariate analysis, gender, diabetes mellitus, family history, smoking, and GRACE score were significantly associated with in-hospital mortality whereas age, obesity, dyslipidemia, and GRACE were significantly associated with 6 months mortality. After adjustment, diabetes mellitus, family history, and GRACE score remained significantly associated with in-hospital mortality (p ≤ 0.05) and age remained significantly associated with 6 months mortality. Conclusion GRACE risk score has good predictive value for the prediction of in-hospital mortality and 6 months mortality among patients with NSTE-ACS.

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The association between atrial fibrillation and in-hospital outcomes in chronic kidney disease patients with acute coronary syndrome: findings from the improving care for cardiovascular disease in China-acute coronary syndrome (CCC-ACS) project

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02125-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Lijiao Yang ◽

Nan Ye ◽

Guoqin Wang ◽

Weijing Bian ◽

Fengbo Xu ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cardiovascular Disease ◽

Chronic Kidney Disease ◽

Acute Coronary Syndrome ◽

Kidney Disease ◽

Hospital Mortality ◽

Major Adverse Cardiovascular Events ◽

Coronary Syndrome ◽

Risk Of Mortality ◽

Increased Risk

Abstract Background Atrial fibrillation (AF) is the most common cardiac arrhythmia in patients with chronic kidney disease (CKD) and acute coronary syndrome (ACS). This study aimed to explore the frequency and impact of AF on clinical outcomes in CKD patients with ACS. Methods CKD inpatients with ACS between November 2014 and December 2018 were included based on the improving care for cardiovascular disease in China-ACS (CCC-ACS) project. Included patients were divided into an AF group and a non-AF group according to the discharge diagnosis. Multivariable logistic regression was used to adjust for potential confounders. Results A total of 16,533 CKD patients with ACS were included. A total of 1418 (8.6%) patients had clinically recognized AF during hospitalization, 654 of whom had an eGFR of 45 to < 60 ml/min/1.73 m2, and 764 had an estimated glomerular filtration rate (eGFR) < 45 ml/min/1.73 m2. Compared with the non-AF group, the AF group had a higher risk of in-hospital mortality [OR 1.250; 95% CI (1.001–1.560), P = 0.049] and major adverse cardiovascular events (MACEs) [OR 1.361; 95% CI (1.197–1.547), P < 0.001]. We also found that compared with patients with eGFR 45 to < 60 ml/min/1.73 m2, patients with eGFR < 45 ml/min/1.73 m2 had a 1.512-fold increased risk of mortality and a 1.435-fold increased risk of MACEs. Conclusions AF was a risk factor affecting the short-term prognosis of ACS patients in the CKD population. Furthermore, the lower the eGFR, the higher the risk of in-hospital mortality and MACEs in CKD patients with ACS. Trial registry: Clinicaltrial.gov, NCT02306616. Registered 29 November 2014, https://clinicaltrials.gov/ct2/show/NCT02306616?term=NCT02306616&draw=2&rank=1

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PROGNOSTIC VALUE OF GRACE VERSUS TIMI SCORE FOR IN-HOSPITAL OUTCOMES AFTER NON-ST-ELEVATION ACUTE CORONARY SYNDROME

Pakistan Heart Journal ◽

10.47144/phj.v54i4.2081 ◽

2022 ◽

Vol 54 (4) ◽

pp. 361-366

Author(s):

Dileep Kumar ◽

Tahir Saghir ◽

Kamran Ahmed Khan ◽

Khalid Naseeb ◽

Gulzar Ali ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Hospital Mortality ◽

Predictive Value ◽

Clinical Decision Making ◽

Hospital Outcomes ◽

Coronary Syndrome ◽

Timi Score ◽

St Elevation ◽

Elevation Acute Coronary Syndrome ◽

Grace Score

Objectives: To compare the predictive value of TIMI and GRACE score for predicting in-hospital outcomes after non-ST elevation acute coronary syndrome (NSTE-ACS). Methodology: This study included prospectively recruited cohort of patients presented to a tertiary care cardiac center of Karachi, Pakistan who were diagnosed with NSTE-ACS. GRACE and TIMI score were obtained and in-hospital mortality was recorded. The receiver operating characteristic (ROC) curves analysis was performed and area under the curve (AUC) was obtained as indicative of predictive value for both scores. Results: A total of 300 patients were included, out of which 76.7%(230) were male and mean age was 58.04±10.71 years. Risk profile comprises of 84.3%(253) hypertensive, 42.0%(126) diabetic, 27.3%(82) smokers, 9.0%(27) obese, 15.3%(46) dyslipidemic, and 31%(93) with sedentary lifestyle. Mean GRACE and TIMI score were 120.19±33.17 and 3.18±0.85 respectively. In-hospital mortality rate was 5.3%(16). AUC for the GRACE score was 0.851 [0.767 - 0.934] with the optimal cut-off value of 150 with sensitivity of 68.8% and specificity of 84.9%. The AUC for the TIMI score was 0.781[0.671 - 0.891] with the optimal cut-off value of 4 with sensitivity of 75.0% and specificity of 67.6%. Conclusion: The GRACE score has high discriminating strength for predicting in-hospital mortality after NSTE-ACS. GRACE score should be used as risk stratification modality in clinical decision making for the management of NSTE-ACS.

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