P3284 Ischaemia during electrocardiogram monitoring identifies patients with acute coronary syndromes at high risk of post-discharge adverse cardiac events: a 5-year prospective analysis

Background and Objectives: To investigate the effects of atorvastatin (ATV) and trimetazidine (TMZ) combination treatment in patients with non-ST segment elevation acute coronary syndromes (NSTE-ACS) undergoing percutaneous coronary intervention. Subjects and Methods: A total of 92 patients with NSTE-ACS were randomly divided into the pretreatment with ATV group (80mg 12h before PCI, with a further 20mg every day to 30th days after PCI, n=44) or the pretreatment with ATV (as the ATV group) and TMZ (60mg 30min before PCI, with a further 20mg tid to 30th days after PCI, n=48). Echocardiography was executed and plasma N-terminal pro brain natriuretic peptide (NT-pro-BNP) levels were measured just prior to the PCI and 30th days after PCI. The main end point was a 30-day incidence of major adverse cardiac events.Result: Major adverse cardiac events occurred in 9.1% of patients in the ATV group and 4.2% of those in the ATV+TMZ group (P=0.189). NT-pro-BNP of the two groups were decreased 30th days after PCI, however, NT-pro-BNP in the ATV+TMZ group were significantly lower than those in the ATV group (P<0.05). Cardiac function in NSTE-ACS patients, as reflected by the increased LVEF, FS as well as decreased LVEDd (P<0.05) in all groups at 30 days after intervention, but cardiac function parameters were more obviously improved in the group administered with ATV+TMZ (p<0.05).Conclusion: Short-term pretreatment with the combination of ATV and TMZ administration prior to PCI can prominently decrease NT-pro-BNP and improve cardiac function compared to a single administration of the ATV.

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Abstract 6088: Clinical and Angiographic Predictors of 30-Day and One-Year Cardiac Ischemic Events in Patients with Non-ST Elevation Acute Coronary Syndromes: Results from the ACUITY (Acute Catheterization and Urgent Intervention Triage strategY) Trial

Circulation ◽

10.1161/circ.118.suppl_18.s_1059-a ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Alexandra Lansky ◽

Kenji Goto ◽

Ecatarina Cristea ◽

Martin Fahy ◽

Roxana Mehran ◽

...

Keyword(s):

High Risk ◽

Acute Coronary Syndromes ◽

Multivariable Analysis ◽

Flow Characteristics ◽

Adverse Outcomes ◽

Cardiac Events ◽

Clinical Predictors ◽

Target Vessel Revascularization ◽

Coronary Syndromes ◽

One Year

An early invasive strategy is of clinical benefit in moderate and high-risk acute coronary syndromes (ACS). Clinical predictors of short and long-term ischemic outcomes in pts with ACS have been well studied, whereas the extent, location and characteristics of angiographic coronary disease in predicting outcome is not well defined. The ACUITY trial randomized 13,819 pts with moderate and high risk ACS to unfractionated heparin or enoxaparin + GP IIb/IIIa inhibitors (GPI), versus bivalirudin + GPI, vs. bivalirudin alone. The angiographic substudy of ACUITY included the first 7000 consecutive randomized US patients. All angiograms were reviewed by an independent core laboratory for complete 3 vessel assessment of CAD extent and burden (total mm length of lesions>30%DS), as well as baseline and final lesion and flow characteristics. Clinical and angiographic predictors of ischemic outcomes at 30 days and 1 year (death, MI, or ischemic target vessel revascularization) were identified by univariate and multivariable analysis using logistic regression analysis. Of 6921 pts with interpretable angiograms, 3826 pts (55.3%) were treated with PCI, 755 (10.9%) with CABG, and 2340 (33.8%) with medical therapy. Composite ischemia occurred in 595 (8.6%) pts at 30 days and 1153 (17.4%) pts at one year. Independent predictors of 30 day and 1 year ischemic cardiac events by multivariable analysis are shown in the table . Among moderate- to high-risk ACS patients, beyond the well recognized clinical risk factors of renal insufficiency and diabetes mellitus, angiographic manifestations of coronary atherosclerosis including greater burden and severity of disease, and presence of calcified lesions, are important independent predictors of 30 day and 1 year adverse outcomes. Table. Multivariate Predictors of Composite Ischemia

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PO19-582 ELEVATED SERUM NEOPTERIN LEVELS PREDICT ADVERSE CARDIAC EVENTS IN PATIENTS WITH NON-ST-SEGMENT ELEVATION ACUTE CORONARY SYNDROMES. THE SIESTA STUDY

Atherosclerosis Supplements ◽

10.1016/s1567-5688(07)71592-1 ◽

2007 ◽

Vol 8 (1) ◽

pp. 159-160

Author(s):

J.C. Kaski ◽

L. Consuegra ◽

D.J. Fernandez-Berges ◽

J.M. Cruz-Fernandez ◽

X. Garcia-Moll ◽

...

Keyword(s):

Acute Coronary Syndromes ◽

Elevated Serum ◽

Cardiac Events ◽

St Segment Elevation ◽

Serum Neopterin ◽

St Segment ◽

Adverse Cardiac Events ◽

Coronary Syndromes

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P2710Elevated microRNA-499 level in early phase of non-ST elevation acute coronary syndromes predicts increased long-term risk of major adverse cardiac events

European Heart Journal ◽

10.1093/eurheartj/ehx502.p2710 ◽

2017 ◽

Vol 38 (suppl_1) ◽

Author(s):

D. Miskowiec ◽

K. Kupczynska ◽

M. Simiera ◽

M. Ojrzanowski ◽

P. Wejner-Mik ◽

...

Keyword(s):

Early Phase ◽

Acute Coronary Syndromes ◽

Major Adverse Cardiac Events ◽

Cardiac Events ◽

Adverse Cardiac Events ◽

Coronary Syndromes ◽

St Elevation

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Anhedonia predicts adverse cardiac events in people with acute coronary syndromes

Evidence-Based Mental Health ◽

10.1136/ebmh1092 ◽

2010 ◽

Vol 13 (4) ◽

pp. 109-109 ◽

Cited By ~ 2

Author(s):

F. Doyle

Keyword(s):

Acute Coronary Syndromes ◽

Cardiac Events ◽

Adverse Cardiac Events ◽

Coronary Syndromes

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Trimethyllysine, a trimethylamine N-oxide precursor, provides near- and long-term prognostic value in patients presenting with acute coronary syndromes

European Heart Journal ◽

10.1093/eurheartj/ehz259 ◽

2019 ◽

Vol 40 (32) ◽

pp. 2700-2709 ◽

Cited By ~ 22

Author(s):

Xinmin S Li ◽

Slayman Obeid ◽

Zeneng Wang ◽

Benjamin J Hazen ◽

Lin Li ◽

...

Keyword(s):

Chest Pain ◽

Acute Coronary Syndromes ◽

Troponin T ◽

High Sensitivity ◽

Cardiac Events ◽

Adverse Cardiac Events ◽

All Cause Mortality ◽

Coronary Syndromes ◽

High Sensitivity Troponin T

AbstractAims Trimethyllysine (TML) serves as a nutrient precursor of the gut microbiota-derived metabolite trimethylamine N-oxide (TMAO) and is associated with incident cardiovascular (CV) events in stable subjects. We examined the relationship between plasma TML levels and incident CV events in patients presenting with acute coronary syndromes (ACS).Methods and results Plasma levels of TML were quantified in two independent cohorts using mass spectrometry, and its relationship with CV events was investigated. In a Cleveland Cohort (N = 530), comprised of patients presenting to the emergency department with chest pain and suspected ACS, TML was associated with major adverse cardiac events (MACE, myocardial infarction, stroke, need for revascularization, or all-cause mortality) over both 30 days [3rd tertile (T3), adjusted odds ratio (OR) 1.77, 95% confidence interval (CI) 1.04–3.01; P < 0.05] and 6 months (T3, adjusted OR 1.95, 95% CI 1.15–3.32; P < 0.05) of follow-up independent of traditional CV risk factors and indices of renal function. Elevated TML levels were also associated with incident long-term (7-year) all-cause mortality [T3, adjusted hazard ratio (HR) 2.52, 95% CI 1.50–4.24; P < 0.001], and MACE even amongst patients persistently negative for cardiac Troponin T at presentation (e.g. 30-day MACE, T3, adjusted OR 4.49, 95% CI 2.06–9.79; P < 0.001). Trimethyllysine in combination with TMAO showed additive significance for near- and long-term CV events, including patients with ‘negative’ high-sensitivity Troponin T levels. In a multicentre Swiss Cohort (N = 1683) comprised of ACS patients, similar associations between TML and incident 1-year adverse cardiac risks were observed (e.g. mortality, adjusted T3 HR 2.74, 95% CI 1.28–5.85; P < 0.05; and MACE, adjusted T3 HR 1.55, 95% CI 1.04–2.31; P < 0.05).Conclusion Plasma TML levels, alone and together with TMAO, are associated with both near- and long-term CV events in patients with chest pain and ACS.

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