117 A long term evaluation study of the impact of a nurse-led early triage service for chest pain patients, aimed at improving the management of those with non ST-elevation acute coronary syndromes

BACKGROUND: Cardiologists and surveys from all over the world have reported an important drop in admissions of patients with acute coronary syndromes (ACS) and related coronary procedures during the outbreak of coronavirus disease 19 (COVID 19) pandemic. AIM: We investigated the impact of the COVID 19 pandemic on hospitalizations for ACS and related invasive procedures in a country with low COVID 19 incidence. METHODS: We conducted a single-center, observational retrospective study including all consecutive patients admitted for ACS in the Cardiology Department of University Hospital Center Mother Theresa from March 9, 2020 (1st day of application of social distance measures) to April 30th (period of total lockdown). Patients admitted in the same time period in 2019 served as controls. All data were collected from the medical files. Admissions were classified as ST-elevation myocardial infarction (STEMI) or non-ST-elevation ACS (NSTEACS). Total and weekly admissions and invasive procedures were assessed. Mean incidence difference (MID) in weekly ACS admissions and procedures was also calculated. RESULTS: Overall, 781 patients were included in this analysis: 321 patients (37%) were admitted during study period and 550 patients (63%) were admitted during the control period (overall reduction of 41.6%; weekly MID of 28.6 (95% confidence interval [CI] 13.3 to 44.0; p = 0.001). The occurrence of all ACS types was reduced: STEMI, by 28.1%; weekly MID 7.3 [0.6-15.2]; p = 0.048]; NSTEACS by 50.5%, weekly MID 19.1 [13.9-24.4]; p < 0.001]. Invasive procedures were also reduced: coronary angiography by 42.5%, weekly MID 26.6 [13.4-39.2]; p = 0.001]; percutaneous coronary intervention (PCI) by 42.3%, weekly MID 16.1 [5.9-26.3], p = 0.004]. Compared to 2019, during the COVID-19 period, there was a 2.4 fold increase in the inhospital death (3% vs 7.2%) with a significant weekly MID 1.4 [0.2-2.7) P=0.032]. A 2.6-fold increase in the occurrence of cardiogenic shock was also observed (13.1% vs. 5.1%, p < 0.0001). CONCLUSIONS: The admissions for ACS and invasive revascularization procedures were significantly reduced, whereas the death rate was increased during COVID 19 pandemic outbreak in Albania compared with the same period in 2019.

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Impact of Postdilation on Intervention Success and Long-Term Major Adverse Cardiovascular Events (MACE) among Patients with Acute Coronary Syndromes

Cardiovascular Innovations and Applications ◽

10.15212/cvia.2019.0564 ◽

2020 ◽

Vol 4 (3) ◽

pp. 185-193

Author(s):

Turan Erdoğan ◽

Hakan Duman ◽

Mustafa Çetin ◽

Savaş Özer ◽

Göksel Çinier ◽

...

Keyword(s):

Acute Coronary Syndromes ◽

Cardiovascular Events ◽

Major Adverse Cardiovascular Events ◽

Drug Eluting Stent ◽

Timi Flow Grade ◽

Coronary Interventions ◽

Coronary Syndromes ◽

The Impact ◽

Myocardial Blush Grade

Postdilation is frequently used during coronary interventions to prevent stent malapposition. Currently there are contradictory findings regarding the benefits of postdilation for both intraprocedural and long-term outcomes. We evaluated the impact of postdilation among patients who presented with acute coronary syndromes (ACS) and underwent percutaneous coronary interventions (PCI). A total of 258 consecutive patients who presented with ACS and underwent PCI were included in the study. The patients were followed up for 25±1.7 months for the occurrence of major adverse cardiovascular events (MACE). During follow-up, 65 patients (25.2%) had MACE. Among patients without MACE, intracoronary nitrate infusion was less frequently used (P=0.005), myocardial blush grade was higher (P<0.001), and a drug-eluting stent was more frequently used (P=0.005). No significant differences were noted between groups regarding the predilation, recurrent dilation, postdilation, and other angiographic characteristics. In multivariate analysis, female sex (P=0.047), myocardial blush grade (P=0.038), previous coronary artery disease (P=0.030), and peak troponin level (P=0.002) were found to be predictors of MACE. In patients who were treated with PCI for ACS, performing postdilation did not predict final Thrombolysis in Myocardial Infarction (TIMI) flow grade, corrected TIMI frame count, myocardial blush grade, or MACE.

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P493 Extend of myocardial damage and long-term outcome after non-ST-elevation acute coronary syndromes treated with very early revascularization

European Heart Journal ◽

10.1016/s0195-668x(03)93931-5 ◽

2003 ◽

Vol 24 (5) ◽

pp. 75

Author(s):

H BUETTNER

Keyword(s):

Acute Coronary Syndromes ◽

Myocardial Damage ◽

Term Outcome ◽

Long Term Outcome ◽

Early Revascularization ◽

Coronary Syndromes ◽

St Elevation

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Abstract 11389: Presentation Symptoms and Outcomes in Diabetic Patients With Acute Coronary Syndromes: Insights From the Second Gulf Registry of Acute Coronary Events

Circulation ◽

10.1161/circ.130.suppl_2.11389 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Amar M Salam ◽

Khalid AlHabib ◽

Wael Almahmeed ◽

Alawi Alsheikh-Ali ◽

Kadhim Sulaiman ◽

...

Keyword(s):

Chest Pain ◽

Middle East ◽

Acute Coronary Syndromes ◽

Silent Myocardial Ischemia ◽

Diabetic Patients ◽

Prognostic Impact ◽

Cardiac Symptoms ◽

Increased Risk ◽

Coronary Syndromes

OBJECTIVES: It is well recognized that cardiac autonomic neuropathy associated with diabetes mellitus (DM) can cause silent myocardial ischemia, however there is limited research examining how the cardiac symptoms reported by patients with DM presenting with acute coronary syndromes (ACS) can affect the immediate and long term outcomes. The aim of the current study was to examine the prognostic impact of lack of chest pain symptoms in DM patients presenting with ACS and enrolled in a multicenter multinational ACS registry from the Middle East. METHODS: For a period of 9 months in 2008 to 2009, 7,930 consecutive patients with ACS were enrolled from 65 hospitals in 6 Middle East countries. A cohort of 3135 patients with DM were selected of whom 2686 (85.7%) presented with chest pain while 449 patients (14.3%) had no chest pain. Clinical features and outcomes were examined and compared among the two groups. RESULTS: Diabetic patients without chest pain were 5 years older and had significantly higher rates of hypertension (76.1% vs. 63.2%), prior myocardial infarction (35.9% vs. 24.3%), chronic kidney disease (CKD) (17.1% vs. 5.9%) and had significantly higher GRACE risk scores (55.3% vs. 21.4%) at presentation compared to patients with chest pain [All P <0.001]. Covariates independently associated with lack of chest pain in DM patients were; higher Killip class on presentation (OR, 6.2 [95%CI, 4.80-7.88]), female gender (OR, 1.50 [95%CI, 1.14-1.96]), CKD (OR, 1.8 [95%CI, 1.27-2.61]), tachycardia (OR, 2.50 [95%CI, 1.94-3.19]) and advanced age (OR, 1.03 [95%CI, 1.02-1.04]), [All P =0.001]. DM patients without chest pain had a significantly higher in-hospital and 1-year mortality rates (11.4% vs. 3.8%, P =0.001, and 25.7% vs. 12.2%, P =0.001, respectively). Lack of chest pain was an independent predictor of in-hospital and one year mortality (OR, 3.05 [95%CI, 2.05-4.54], P =0.001, and OR, 2.0 [95%CI, 1.52-2.75], P =0.001, respectively). CONCLUSIONS: DM patients with ACS presenting without chest pain are at an increased risk of immediate and long term mortality. Understanding the factors associated with atypical presentations of ACS in patients with DM may help in the earlier detection and more appropriate management of these high risk patients.

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Abstract 17143: Acute Coronary Syndromes Associated With SARS-CoV-2 Infection Admissions in a Medium Size Community Hospital

Circulation ◽

10.1161/circ.142.suppl_3.17143 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

ANDREEA-CONSTANTA STAN ◽

Momcilo Durdevic ◽

Rosario Florante ◽

Arshavir Artashesyan ◽

Henrik Elenius ◽

...

Keyword(s):

Myocardial Infarction ◽

Primary Care ◽

Chest Pain ◽

Unstable Angina ◽

Acute Coronary Syndromes ◽

St Elevation Myocardial Infarction ◽

Type Ii ◽

Primary Care Teams ◽

Coronary Syndromes ◽

St Elevation

Background: The presence of cardiovascular complications were reported in small studies of critical care patients admitted with SARS-CoV-2infection There is a dearth of data regarding presence of acute coronary syndromes (ACS) in patients admitted with symptomatic SARS-CoV-2 infection, the cause of the myocardial injury and particularities of management. Objectives: The aim of the study is to describe the presence and type ACS in patients admitted with symptomatic SARS-CoV-2 infection. Secondary outcomes were contributing factors, presenting symptoms and medical management. Methods: A descriptive, retrospective study of patients with a positive COVID-19 test and symptomatic infection admitted from 10 March 2020 to 10 April 2020 in our hospital. Results: There were a total of 127 patients admitted with symptomatic SARS-CoV-2 infection. The most common ACS was Type II Myocardial Infarction (MI). 16 patients were diagnosed with type II MI, 3 patients with Non ST elevation myocardial infarction (NSTEMI) and no patient was diagnosed with unstable angina and ST elevation myocardial infarction (STEMI). The most common cause of Type II MI was hypoxia followed by congestive heart failure and new onset atrial fibrillation. One patient has chest pain as presenting symptom. Except for Aspirin loading and use of beta blocker no other antischemic, statin or ACE/ARB medication was used for management of type II MI. All patients with Type II MI were managed by primary care teams. 3 patients developed NSTEMI and were managed by primary care teams with Cardiology consults. Anti-coagulation was considered for all patients. All patients received Aspirin loading, high intensity statin and beta blockers. Conclusions: Majority of patients with ACS had symptoms related to SARS-CoV-2 infection and chest pain was absent in 95% of cases. The most common ACS was type II MI- myocardial ischemia in context of hypoxia and the treatment was focused in treating the underlying cause rather than initiation of classical guideline directed therapy or invasive management. There were no cases of unstable angina and STEMI, results consistent with previous studies underlying the low incidence of STEMI cases during this pandemic.

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