Acute coronary syndrome – Still a valid contraindication to perform rotational atherectomy? Early and one-year outcomes

Abstract Introduction The myocardial-ischemic-injury-index (MI3) is a promising machine learned algorithm that predicts the likelihood of myocardial infarction in patients with suspected acute coronary syndrome. Whether this algorithm performs well in unselected patients or predicts recurrent events is unknown. Methods In an observational analysis from a multi-centre randomised trial, we included all patients with suspected acute coronary syndrome and serial high-sensitivity cardiac troponin I measurements without ST-segment elevation myocardial infarction. Using gradient boosting, MI3 incorporates age, sex, and two troponin measurements to compute a value (0–100) reflecting an individual's likelihood of myocardial infarction, and estimates the negative predictive value (NPV) and positive predictive value (PPV). Model performance for an index diagnosis of myocardial infarction, and for subsequent myocardial infarction or cardiovascular death at one year was determined using previously defined low- and high-probability thresholds (1.6 and 49.7, respectively). Results In total 20,761 of 48,282 (43%) patients (64±16 years, 46% women) were eligible of whom 3,278 (15.8%) had myocardial infarction. MI3 was well discriminated with an area under the receiver-operating-characteristic curve of 0.949 (95% confidence interval 0.946–0.952) identifying 12,983 (62.5%) patients as low-probability (sensitivity 99.3% [99.0–99.6%], NPV 99.8% [99.8–99.9%]), and 2,961 (14.3%) as high-probability (specificity 95.0% [94.7–95.3%], PPV 70.4% [69–71.9%]). At one year, subsequent myocardial infarction or cardiovascular death occurred more often in high-probability compared to low-probability patients (17.6% [520/2,961] versus 1.5% [197/12,983], P<0.001). Conclusions In unselected consecutive patients with suspected acute coronary syndrome, the MI3 algorithm accurately estimates the likelihood of myocardial infarction and predicts probability of subsequent adverse cardiovascular events. Performance of MI3 at example thresholds Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Medical Research Council

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TCT-469 One-year clinical outcome of biodegradable polymer sirolimus-eluting stent in patients with acute coronary syndrome. Insight from the ULISSE registry.

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2018.08.1641 ◽

2018 ◽

Vol 72 (13) ◽

pp. B188-B189

Author(s):

Elisabetta Moscarella ◽

Alfonso Ielasi ◽

Cosmo Godino ◽

Giuseppe Ferrante ◽

Carlo Andrea Pivato ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Clinical Outcome ◽

Biodegradable Polymer ◽

Coronary Syndrome ◽

Sirolimus Eluting Stent ◽

One Year

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Longitudinal associations of burnout with heart rate variability in patients following acute coronary syndrome: A one-year follow-up study

General Hospital Psychiatry ◽

10.1016/j.genhosppsych.2018.05.008 ◽

2018 ◽

Vol 53 ◽

pp. 59-64 ◽

Cited By ~ 2

Author(s):

Min Zhang ◽

Ling Liu ◽

Yunke Shi ◽

Yanfei Yang ◽

Xiaoju Yu ◽

...

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Acute Coronary Syndrome ◽

Coronary Syndrome ◽

Follow Up Study ◽

Longitudinal Associations ◽

One Year

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P3606Impact of diabetes mellitus on the selection of antiplatelet treatment and medium-term prognosis after acute coronary syndrome

European Heart Journal ◽

10.1093/eurheartj/ehz745.0465 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

L Nunez Martinez ◽

N V-Ibarra ◽

F Marin Ortuno ◽

V Pernias Escrig ◽

M Sandin Rollan ◽

...

Keyword(s):

Diabetes Mellitus ◽

Acute Coronary Syndrome ◽

Antiplatelet Therapy ◽

Coronary Disease ◽

Cardiovascular Events ◽

Diabetic Patients ◽

Medium Term ◽

Coronary Syndrome ◽

Diabetic Population ◽

One Year

Abstract Introduction Patients with diabetes mellitus (DM) have a higher atherothrombotic risk and higher rates of recurrent ischemic events compared with the non-diabetic population. Although current antiplatelet therapy strategies have been shown to be successful in improving outcomes in acute coronary syndrome (ACS), patients with DM continue to experience high rates of adverse cardiovascular events. Today, it is known that diabetic patients are characterized by a deregulation in different intracellular signaling pathways, which leads to an inadequate or suboptimal response to antiplatelets agents. The purpose of this study is to analyze the different therapeutic strategies, the use of new antiplatelet drugs and medium-term prognosis in diabetic patients compared with non-diabetic patients who have suffered an ACS. Methods It is an observational, prospective and multicenter registry of patients with ACS. The objective is to analyze the differences in the management of DM patients vs non-DM patients in the acute phase and their evolution during the first year after coronary event. Antiplatelet therapy administered will be evaluated, type of coronary injury and treatment performed, major adverse events as well as cardiovascular complications and mortality at one year of follow-up. Results Of a total of 1717 patients, 38% were diabetic. The diabetic population was older, with a higher prevalence of cardiovascular risk factors and higher rate of previous cardiovascular events (cerebrovascular, peripheral arterial disease and coronary disease). Patients with DM received less new antiplatelets drugs at admission (15.5% DM vs 26.5% non DM, p<0.001) and less in-hospital switch to new antiplatelet agents was performed. They were subjected to a lower number of catheterizations and at the time of revascularization, the drug-eluting stent was of choice. During admission, they developed more complications, both ischemic (refractory angina, reinfarction or CVA) and hemorrhagic. Following one year, DM had higher major cardiovascular events (MACE) and higher mortality (7.72% vs 5.14%, p=0.0039). Non-coronary revascularization, renal failure, and reduced ejection fraction were predictive variables of death in diabetic population. Treatment with new antiplatelet drugs was associated with a statistically significant decrease in total mortality an MACE without differences in major bleeding. Conclusion More than a third of patients with ACS are diabetic. These patients present with more severe coronary disease associating a greater number of cardiovascular events and a higher mortality rate after one year of ACS. However, despite this, they undergo less invasive tests and they were undertreated with the new antiplatelets therapies. Acknowledgement/Funding SEC

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Sex Difference in Risk Factors, GRACE Scores, and Management among Post-Acute Coronary Syndrome Patients in Sri Lanka

Cardiology Research and Practice ◽

10.1155/2020/4560218 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Priyadarshani Galappatthy ◽

Vipula Bataduwaarachchi ◽

Priyanga Ranasinghe ◽

Gamini Galappatthy ◽

Upul Senerath ◽

...

Keyword(s):

Risk Factors ◽

Acute Coronary Syndrome ◽

Risk Factor ◽

Sri Lanka ◽

Disease Risk ◽

Management Strategies ◽

Significant Proportion ◽

Coronary Syndrome ◽

One Year ◽

Grace Score

Objective. To assess sex-based differences in the prevalence of risk factor, their management, and differences in the prognosis among acute coronary syndrome (ACS) in Sri Lanka. Methods. Patients diagnosed with ACS were recruited from hospitals throughout the island. The Joint European Societies guidelines were used to assess recommended targets for coronary heart disease risk factors, and the GRACE score was used to assess the post-ACS prognosis. Age-adjusted regression was performed to calculate odds ratios for men versus women in risk factor control. Results. A total of 2116 patients, of whom 1242 (58.7%) were men, were included. Significant proportion of women were nonsmokers; OR = 0.11 (95% CI 0.09 to 0.13). The prevalence of hypertension (p<0.001), diabetes (p<0.001), and dyslipidemia (p=0.004) was higher in women. The LDL-C target was achieved in a significantly higher percentage of women (12.6%); OR = 0.33 (95% CI 0.10 to 1.05). When stratified by age, no significant differences were observed in achieving the risk factor targets or management strategies used except for fasting blood sugar (p<0.05) where more men achieved control target in both age categories. Majority of the ACS patients had either high or intermediate risk for one-year mortality as per the GRACE score. In-hospital and 1-year mean mortality risk was significantly higher among men of less than 65 years of age (p<0.05). Conclusions. Smoking is significantly lower among Sri Lankan women diagnosed with ACS. However, hypertension, diabetes, and dyslipidemia were more prevalent among them. There was no difference in primary and secondary preventive strategies and management in both sexes but could be further improved in both groups.

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