AP040 Risk factors and early prognosis of cardiac arrest complicated acute coronary syndrome with ST-elevation in the emergency department

Resuscitation ◽  
2011 ◽  
Vol 82 ◽  
pp. S18-S19
Author(s):  
Bellili Sarra ◽  
Amira Feten ◽  
Souissi Sami ◽  
Ghazeli Hanen ◽  
Yahmadi Anour ◽  
...  
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Cardiac Arrest ◽  
Coronary Syndrome ◽  
St Elevation

scholarly journals Acute Coronary Syndrome in Pregnancy

2009 ◽  
Vol 3 ◽  
pp. CMC.S3284 ◽  
Author(s):  
Douglas Wright ◽  
Claire Kenny-Scherber ◽  
Alison Montgomery ◽  
Omid Salehian
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Present Report ◽  
Rare Event ◽  
Physiological Changes ◽  
Coronary Syndrome ◽  
Incidence Risk ◽  
St Elevation ◽  
In Pregnancy

Acute coronary syndrome (ACS) in pregnancy has traditionally been considered to be a rare event, but the combination of normal physiological changes of pregnancy and more prevalent cardiovascular risk factors are increasing its incidence in this population. The present report describes a 39 year-old woman that is seven weeks pregnant presenting with a non ST elevation myocardial infarction. The incidence, risk factors, pathophysiology and management of ACS in pregnancy are discussed.

scholarly journals Lowered anti-beta1 adrenergic receptor antibody concentrations may have prognostic significance in acute coronary syndrome

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Diana Ernst ◽  
Johan Westerbergh ◽  
Georgios Sogkas ◽  
Alexandra Jablonka ◽  
Gerrit Ahrenstorf ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Myocardial Infarct ◽  
Prognostic Significance ◽  
Cardiac Risk ◽  
Cardiovascular Death ◽  
Antibody Concentration ◽  
Coronary Syndrome ◽  
St Elevation ◽  
Prognostic Implications

Abstract Although several risk factors exist for acute coronary syndrome (ACS) no biomarkers for survival or risk of re-infarction have been validated. Previously, reduced serum concentrations of anti-ß1AR Ab have been implicated in poorer ACS outcomes. This study further evaluates the prognostic implications of anti-ß1AR-Ab levels at the time of ACS onset. Serum anti-ß1AR Ab concentrations were measured in randomly selected patients from within the PLATO cohort. Stratification was performed according to ACS event: ST-elevation myocardial infarct (STEMI) vs. non-ST elevation myocardial infarct (NSTEMI). Antibody concentrations at ACS presentation were compared to 12-month all-cause and cardiovascular mortality, as well as 12-month re-infarction. Sub-analysis, stratifying for age and the correlation between antibody concentration and conventional cardiac risk-factors was subsequently performed. Serum anti-ß1AR Ab concentrations were measured in 400/799 (50%) STEMI patients and 399 NSTEMI patients. Increasing anti-ß1AR Ab concentrations were associated with STEMI (p = 0.001). Across all ACS patients, no associations between anti-ß1AR Ab concentration and either all-cause cardiovascular death or myocardial re-infarction (p = 0.14) were evident. However among STEMI patients ≤60 years with anti-ß1AR Ab concentration <median higher rates of re-infarction were observed, compared to those with anti-ß1AR Ab concentrations > median (14/198 (7.1%) vs. 2/190 (1.1%)); p = 0.01). Similarly, the same sub-group demonstrated greater risk of cardiovascular death in year 1, including re-infarction and stroke (22/198 (11.1%) vs. 10/190 (5.3%); p = 0.017). ACS Patients ≤60 years, exhibiting lower concentrations of ß1AR Ab carry a greater risk for early re-infarction and cardiovascular death. Large, prospective studies quantitatively assessing the prognostic relevance of Anti-ß1AR Ab levels should be considered.

The utility of copeptin in the emergency department as a predictor of adverse outcomes in non-ST-elevation acute coronary syndrome: the COPED-PAO study

2013 ◽  
Vol 31 (4) ◽  
pp. 286-291 ◽  
Author(s):  
Miquel Sánchez ◽  
Pere Llorens ◽  
Pablo Herrero ◽  
F Javier Martín-Sanchez ◽  
Pascual Piñera ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Adverse Events ◽  
Adverse Outcomes ◽  
Troponin Level ◽  
Prognostic Information ◽  
Risk Of Death ◽  
Coronary Syndrome ◽  
St Elevation ◽  
Elevation Acute Coronary Syndrome

AimsTo test the utility of a single copeptin determination at presentation to the emergency department (ED) as a short-term prognosis marker in patients with non-ST-elevation acute coronary syndrome (NSTEACS). To compare the results with those achieved with conventional troponin.MethodsA multicentric, prospective, observational, longitudinal, cohort study involving 15 Spanish EDs. Inclusion: consecutive patients with chest pain (<12 h) finally diagnosed of NSTEACS. Measurements: copeptin and troponin at arrival. Cut-off point for copeptin: 25.9 pmol/l. Follow-up: within 2 months after ED attendance to identify 30-day adverse events. Discriminatory capacity of copeptin and troponin was compared by receiver operating characteristic (ROC) curves.ResultsWe included 377 patients with NSTEACS. Adverse events: 11 (2.9%) patients died, 27 (7.2%) had an adverse coronary event, 14 (3.7%) had a stroke, and 48 (12.7%) a composite endpoint. The initial copeptine value was over 25.9 pmol/l in 114 patients, and they presented a higher mortality rate (OR: 4.2, (95% CI 1.2 to 14.8); p=0.03). This association disappeared after adjusting by clinical variables or troponin level. No significant differences were found for the remaining endpoints. The area under the curve  of the ROC curve of 30-day mortality was 0.73 (95% CI 0.58 to 0.87) for copeptin, and 0.80 (95% CI 0.73 to 0.87) for troponin.ConclusionsIn patients with NSTEACS, determination of copeptin at presentation to the ED is associated with risk of death during the subsequent month. This association, however, disappears after adjusting by baseline features or troponin level, so copeptin does not add complementary prognostic information over that provided by troponin.

scholarly journals Patient Characteristics, Risk Factors, and Disease Outcomes in Young Adults With St-Elevation Myocardial Infarction: Insights From The Kermanshah Acute Coronary Syndrome Registry

2021 ◽  
Author(s):  
Soraya Siabani ◽  
Leila Gholizadeh ◽  
Hossein Siabani ◽  
Nahid Saleh
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Density Lipoprotein ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Younger Adults ◽  
Coronary Syndrome ◽  
Disease Outcomes ◽  
St Elevation

Abstract Background: Myocardial infarction in younger adults is an understudied research area. Objectives: This paper reports on characteristics, risk factors, and disease outcomes of young adults with St-elevation myocardial infarction (STEMI).Methods: This is a sub-analysis of data from the Kermanshah Acute Coronary Syndrome Registry, including all patients aged ≤45 with STEMI (n=247) registered in the registry from June 2017 to June 2019. Results: Patients aged ≤45 constituted 10.66% of all patients with STEM; the majority was male (91.8%), and the most common CVD risk factors included: smoking (56.7%), low high-density lipoprotein (55.5%), elevated triglyceride (44.4%), hypertension (38.2%), hypercholesterolemia (38.1%), elevated low-density lipoprotein (26.3%), and obesity (24.3%). Many patients (62.8%) received primary percutaneous coronary intervention (PCI), and in-hospital mortality was low at 0.8%. Conclusions: Younger adults should be screened for CVD risk factors, and are educated and supported to participate in programs that aim to reduce risk through risk factor modification.

Towards prompt electrocardiogram acquisition in triage: Preliminary testing of a symptom-based clinical prediction rule for the Android tablet

2019 ◽  
Vol 18 (4) ◽  
pp. 289-298
Author(s):  
Sharon O’Donnell ◽  
Peter Monahan ◽  
Gabrielle McKee ◽  
Geraldine McMahon ◽  
Elizabeth Curtin ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Prediction Rule ◽  
Clinical Prediction Rule ◽  
St Elevation Myocardial Infarction ◽  
Clinical Prediction ◽  
Coronary Syndrome ◽  
Significant Difference ◽  
St Elevation

Background: For patients with suspected acute coronary syndrome, international guidelines indicate that an Electrocardiogram (ECG) should be performed within 10 min of first medical contact, however success at achieving these guidelines is limited. Aims: The purpose of this study was to develop and perform initial testing of a clinical prediction rule embedded in a tablet application, and to expedite the identification of patients who require an electrocardiogram within 10 min. Methods: This derivation of the Acute Coronary Syndrome Application (AcSAP) comprised of three local studies, an unpublished audit and literature critique. The AcSAP was prospectively tested over four months in patients presenting to the Emergency Department (ED) of a Dublin teaching hospital. An audit form retrieved data pertaining to times of: registration to the emergency department, triage, first electrocardiogram and diagnosis. The AcSAP was subsequently evaluated by experienced triage nurses ( n=18) who had utilised it. Results: The AcSAP was activated 379 times. Patients with ST Elevation Myocardial Infarction (STEMI) and non-ST Elevation Myocardial Infarction (NSTEMI) were significantly more likely to return a categorisation of ‘immediate ECG’ or ‘ECG within 10 min’ ( p<0.001). There was a significant difference in ‘triage to ECG’ times across categories, the ‘immediate ECG’ categorisation resulting in the shortest time ( p=0.002). Evaluations suggest that staff found the tool quick and easy to use and results seemed accurate. Conclusion: Testing of the AcSAP suggests that it accurately identifies patients who require an ECG within 10 min. As such, it has the potential to support the meeting of clinical guidelines for ECG acquisition.

scholarly journals Epidemiology and risk factors of patients with types of acute coronary syndrome presenting to a tertiary care hospital in Sri Lanka

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Udaya Ralapanawa ◽  
Pallegoda Vithanage Ranjith Kumarasiri ◽  
Kushalee Poornima Jayawickreme ◽  
Prabashini Kumarihamy ◽  
Yapa Wijeratne ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Sri Lanka ◽  
Unstable Angina ◽  
Stable Angina ◽  
Strong Association ◽  
Coronary Syndrome ◽  
History Of ◽  
St Elevation

Abstract Background Acute Coronary Syndrome (ACS) is one of the leading causes of death worldwide and studies have shown higher mortality rates and premature death in South Asian countries. The occurrence and effect of risk factors differ by type ofACS.Epidemiological studies in the Sri Lankan population are limited. Methods This is a cross sectional descriptive study conducted at the Teaching Hospital Peradeniya, Sri Lanka among patients presenting with ACS. Data was collected by an interviewer administered structured questionnaire and epidemiological patterns and risk factors were analyzed. Results The sample of 300 patients had a mean age of 61.3+/− 12.6 and male sex showed higher association with all three type of ACS compared to female with a P value of 0.001. This study showed higher mean age of 62.2 ± 11.4 years amongst unstable angina (UA) patients and 61.9 ± 14.5 years amongst non ST elevation myocardial infarction (NSTEMI) patients compared to 59.2 ± 11.2 years for ST elevation myocardial infarction (STEMI) patients with no significant statistical difference (P = 0.246). Approximately 55.8% STEMI patients, 39.8% UA and 35.5% NSTEMI patients were smokers indicating a significant association between smoking and STEMI (P = 0.017). Nearly 54.5% STEMI, 35.4% UA and 32.7% NSTEMI patients consumed alcohol and there was a very strong association between alcohol consumption and STEMI (P = 0.006). Almost 51.8% NSTEMI patients, 47.8% UA patients and 29.9% STEMI patients had hypertension(HT) (P = 0.008) indicating significant association of HT with UA and NSTEMI. About 33.6% UA patients and 30.0% NSTEMI patients had DM whilst only 22.1% of STEMI patients had DM of no significance (p = 0.225). Around 15.0% patients with UA, 25.5% with NSTEMI and 11.7% with STEMI had dyslipidemia (P = 0.032). There was a very strong association between a past history of ACS or stable angina with NSTEMI and UA (P = 0.001). Conclusion Smoking and alcohol abuse are significantly associated with STEMI.Patients with NSTEMI or Unstable Angina had higher rates of hypertension and were more likely to have a history of ACS or stable angina than STEMI patients. Patients with NSTEMI were more likely than patients with STEMI or UA to have dyslipidemia.

scholarly journals Bleeding predictors in acute coronary syndrome: does the age or clinical presentation matters?

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
C Marques Pires ◽  
I Campos ◽  
P Medeiros ◽  
R Flores ◽  
F Mane ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Cardiac Arrest ◽  
Multivariate Analysis ◽  
Clinical Presentation ◽  
Cox Regression ◽  
Inhospital Mortality ◽  
Atypical Presentation ◽  
Coronary Syndrome ◽  
Previous Medication ◽  
St Elevation

Abstract Funding Acknowledgements Type of funding sources: None. INTRODUCTION Bleeding is a quite common non-cardiac complication of acute coronary syndrome (ACS) and is associated with a negative prognosis impact. AIMS To determine the predictors of inhospital major bleeding (IHMB) in ACS and to evaluate whether they differ according to age and clinical presentation. METHODS A multicentric retrospective study which analysed 25524 patients(pts) with ACS, 25141 without and 383 with IHMB. By multivariate analysis, we determined IHMB predictors and evaluated the differences between age groups (&lt;80 years; ≥80 years) and clinical presentation- ST elevation myocardial infarction (STEMI) or non-ST elevation ACS (NSTEACS). RESULTS By multivariate analysis we found 15 significant IHMB predictors (pvalue &lt; 0,05): age≥75years, hypertension, previous angina, pulmonary disease, previous bleeding, atypical presentation (without pain), cardiac arrest, admission heart rate (HR)&gt;100bpm, Killip4 at admission, ST-elevation, admission haemoglobin (Hb)&lt;10g/dL, aspirin or Vitamin K antagonist (VKA) or ivabradine as previous medication and  glycoprotein IIb/IIIa inhibitors (GPIIb/IIIa) use. Then, we made a sub-analysis in STEMI pts which revealed that IHMB predictors of pts &lt;80 years were: female gender, age≥75years, chronic kidney disease (CKD), active neoplasm, previous bleeding, atypical presentation, cardiac arrest, admission HR &gt; 100bpm, Killip IV on admission and GPIIb/IIIa use. By contrast, IHMB predictors of pts with ≥80 years were: valvular disease, atypical presentation, aspirin as previous medication and GPIIb/IIIa use. Finally, we made a sub-analysis in NSTACS pts which revealed that IHMB predictors of pts &lt;80years were: previous angina, CKD, previous bleeding, cardiac arrest, Killip≥2 at admission, admission Hb &lt; 10g/dL and VKA as previous medication. Conversely, IHMB predictors of pts with ≥80 years were previous bleeding, cardiac arrest and absence of normal QRS. In addition, by multivariate analysis we found that IHMB had an impact on inhospital mortality (OR = 2,2;pvalue &lt; 0,001), however, by Cox regression there wasn’t an impact on 1-year mortality. CONCLUSION This study suggests that IHMB has impact on inhospital mortality and that its predictors differ with age and clinical presentation. The most powerful predictor was previous bleeding. Considering the importance of IHMB, increased efforts are needed to tailor antithrombotic therapy according to age, renal function and other comorbidities.

scholarly journals Acute Coronary Syndrome in an Intensive Care Unit of a Tertiary Referral Centre in Central Nepal: The Spectrum and Coronary Risk Factors.

2013 ◽  
Vol 52 (190) ◽  
Author(s):  
Mani Prasad Gautam ◽  
Guruprasad Sogunuru ◽  
Gangapatnam Subramanyam ◽  
Lekhjung Thapa ◽  
Raju Paudel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Intensive Care Unit ◽  
Coronary Heart Disease ◽  
Acute Coronary Syndrome ◽  
Intensive Care ◽  
Heart Disease ◽  
St Elevation Myocardial Infarction ◽  
Coronary Syndrome ◽  
St Elevation

Introduction: Acute coronary syndrome is the major leading cause for coronary care unit admission. Its spectrum comprises a variety of disorders including unstable angina, non ST elevation and ST elevation myocardial infarction.Methods: An observational study was designed to study the spectrum of acute coronary syndrome and associated coronary heart disease risk factors in subjects admitted in intensive care unit from August 2009 to September 2010. Details including coronary risk factors and the categories and outcomes of acute coronary syndrome were analyzed.Results: A total of 57 subjects were included in the study. The majority (63.1%) were males. The mean age was 64.54±13.8 years.  Five (8.8%) patients were ≤45 years and 29 (50.88%) patients were ≥65 years. Majority of the patients were smokers (50.87%). The other major coronary heart disease risk factors were diabetes (43.85%), hypertension (36.87%), dyslipidemia (26.32%) and previous history of coronary heart disease (31.58%). Coronary heart disease figured prominently in the family history as well (26.32%). ST elevation myocardial infarction was the major category (42.11%) followed by non-ST elevation myocardial infarction and unstable angina (31.58% and 26.32% respectively). Myocardial infarction complicated with cardiogenic shock had very high mortality (83.33%).  Conclusions: The ST elevation myocardial infarction was the major clinical form of acute coronary syndrome admitted in intensive care unit. Prevention should be targeted on modifiable risk factors such as the management of risk factors. In addition, the improvement in cardiology service with the establishment of CCU and cathlab might alter the mortality and morbidity in ACS management.Keywords: acute coronary syndrome; coronary risk factors; intensive care unit.

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