scholarly journals Complementary prognostic values of ST segment deviation and Thrombolysis In Myocardial Infarction (TIMI) risk score in non-ST elevation acute coronary syndromes: Insights from the Platelet Receptor Inhibition in Ischemic Syndrome Management in Patients Limited by Unstable Signs and Symptoms (PRISM-PLUS) study

2009 ◽  
Vol 25 (12) ◽  
pp. e417-e421 ◽  
Author(s):  
Thao Huynh ◽  
James Nasmith ◽  
The Minh Luong ◽  
Martin Bernier ◽  
Chantal Pharand ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndromes ◽  
Signs And Symptoms ◽  
Receptor Inhibition ◽  
St Segment ◽  
Platelet Receptor ◽  
Coronary Syndromes ◽  
St Elevation ◽  
Timi Risk Score ◽  
Ischemic Syndrome

scholarly journals Surgical revascularization for acute coronary syndromes: a report from the North Rhine-Westphalia surgical myocardial infarction registry

2020 ◽  
Vol 58 (6) ◽  
pp. 1137-1144
Author(s):  
Oliver J Liakopoulos ◽  
Ingo Slottosch ◽  
Daniel Wendt ◽  
Hendryk Welp ◽  
Wolfgang Schiller ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Unstable Angina ◽  
Acute Coronary Syndromes ◽  
Left Ventricular Ejection ◽  
Logistic Euroscore ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Coronary Syndromes ◽  
St Elevation

Abstract OBJECTIVES The aim of this was to analyse current outcomes in patients referred to coronary artery bypass grafting (CABG) for acute coronary syndromes (ACSs), including ST-elevation or non-ST-elevation ACS (non-ST-segment elevation myocardial infarction) or unstable angina. METHODS Patients (n = 2432) undergoing CABG for ACS between January 2010 and December 2017 were prospectively entered into a surgical myocardial infarction registry in North Rhine-Westphalia, Germany. Key end points were in-hospital all-cause mortality (IHM) and major adverse cardio-cerebral events (MACCE). Predictors for IHM and MACCE were analysed by multivariable logistic regression. RESULTS Patients (78% males) were referred for CABG for unstable angina (25%), non-ST-segment elevation myocardial infarction (50%), and ST-segment elevation myocardial infarction (25%). The mean patient age was 68 ± 11 years, logistic EuroSCORE was 19 ± 18% and three-vessel and left main stem diseases were diagnosed in 81% and 45% of patients, respectively. On-pump CABG with cardiac arrest or beating heart was performed in 92% and 2%, respectively, with only 6% off-pump surgery and 6% multiple arterial revascularization (3.1 ± 1.0 grafts, 93% left internal thoracic artery). Emergency CABG was performed in 23% of patients (42% in ST-segment elevation myocardial infarction; P < 0.001). The total IHM and MACCE rates were 8.1% and 17.5% and were highest in ST-segment elevation myocardial infarction patients with 12.6% and 28.5%, respectively (P < 0.001). Key predictors for IHM and MACCE were female gender, elevated troponin, left ventricular ejection fraction, inotropic support, logistic EuroSCORE, cardiopulmonary bypass and aortic clamp time and the need for emergency CABG. CONCLUSIONS Surgical myocardial revascularization in patients with ACS is still linked to substantial in-hospital mortality. Emergency CABG for patients with ACS was associated with poorer outcomes.

scholarly journals Almanac 2013: acute coronary syndromes

2013 ◽  
Vol 19 (2) ◽  
pp. 30-38
Author(s):  
Pascal Meier ◽  
Alexandra J. Lansky ◽  
Andreas Baumbach
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Arrest ◽  
Acute Coronary Syndromes ◽  
Sudden Cardiac Arrest ◽  
Antiplatelet Agents ◽  
Coronary Artery Plaque ◽  
St Segment Elevation ◽  
St Segment ◽  
Coronary Syndromes ◽  
St Elevation

Summary Unstable coronary artery plaque is the most common underlying cause of acute coronary syndromes (ACS) and can manifest as unstable angina, non-ST segment elevation infarction (NSTE-ACS), and ST elevation myocardial infarction (STEMI), but can also manifest as sudden cardiac arrest due to ischaemia induced tachyarrhythmias. ACS mortality has decreased significantly over the last few years, especially from the more extreme manifestations of ACS, STEMI, and cardiac arrest. This trend is likely to continue based on recent therapeutic progress which includes novel antiplatelet agents such as prasugrel, ticagrelor and cangrelor.

Abstract 5584: Heart Failure Eliminates the Risk Gradient Defined by TIMI Risk Score in Non-st-segment Elevation Acute Coronary Syndromes

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Sara S Gonçalves ◽  
Pedro Amador ◽  
Lígia Mendes ◽  
Filipe Seixo ◽  
José F Santos
Keyword(s):  
Heart Failure ◽  
High Risk ◽  
Hospital Mortality ◽  
Risk Score ◽  
Acute Coronary Syndromes ◽  
Clinical Registry ◽  
St Segment Elevation ◽  
St Segment ◽  
Coronary Syndromes ◽  
Timi Risk Score

The TIMI Risk Score is a simple and effective tool for risk stratification in patients (pts) with non-ST-segment elevation acute coronary syndromes (NSTE-ACS). The presence of heart failure (HF) or a low ejection fraction (EF) has also been associated with a worse outcome. We sought to evaluate the interaction of heart failure on the risk gradient defined by the TIMI Risk Score in a NSTE-ACS population. We studied 9980 pts with NSTE-ACS included in a prospective nationwide clinical registry since 2002. Pts were stratified by TIMI Risk Score in low (0 to 2), intermediate (3 and 4) and high risk (5 to 7) groups. The population was divided in two groups according to the presence or absence of HF. HF was defined as the presence of a Killip class >1 or a systolic EF <30%. In-hospital mortality or re-infarction was assessed in both groups during the index hospitalization and according to TIMI Risk Score Stratification. Results: In-hospital mortality or re-infarction was 1,9% in low risk, 3,7% in intermediate and 6,3% in high risk pts (Qui-square trend p<0,001). The risk gradient defined by the TIMI risk score was not observed in patients without HF (Qui-Square for trend=ns). In pts with HF, the TIMI risk score maintains its predictor value (Qui-square trend=0,014), but the presence of HF identifies a higher risk subgroup. In this population, HF was a strong independent predictor for in-hospital mortality and re-infarction (OR 10,01). In NSTE-ACS pts, the presence of HF identifies the patients with higher risk for in-hospital risk and re-infarction within each TIMI Risk Score subgroup. There was no risk gradient assessed by the TIMI risk score in the absence of HF.

Treatment of ST-segment elevation acute coronary syndromes

ESC CardioMed ◽  
2018 ◽  
pp. 1255-1276
Author(s):  
Borja Ibanez ◽  
Sigrun Halvorsen
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Clinical Trials ◽  
Acute Coronary Syndromes ◽  
Real Life ◽  
Compelling Evidence ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Coronary Syndromes

Over the last 50 years, the treatment of acute ST-segment elevation myocardial infarction (STEMI) has been considerably improved. The widespread implementation of reperfusion (initially pharmacological and later mechanical) resulted in a magnificent reduction in the rates of in-hospital mortality from about 25% in the 1970s to 5% in the late 2010s. Mortality in real life, however, is higher than these figures shown in clinical trials. There is compelling evidence showing the association between duration of ischaemia and mortality. This is the basis for the timely reperfusion in STEMI. All actions should be made to reduce all components of the ischaemic time. Despite these advances, STEMI survivors are still at high risk for developing repetitive events, including reinfarctions, heart failure, and sudden death. Evolving therapies beyond timely reperfusion are contributing to further reduce the morbidity associated with STEMI.

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