Treatment Strategies and Risk Stratification in Acute Coronary Syndrome: How Do We Identify Patients Who Would Benefit From Early Invasive Treatment?

2010 ◽  
Vol 63 (8) ◽  
pp. 888-889
Author(s):  
Robbert J. de Winter
Keyword(s):  
Acute Coronary Syndrome ◽  
Risk Stratification ◽  
Treatment Strategies ◽  
Invasive Treatment ◽  
Coronary Syndrome

scholarly journals Acute coronary syndrome: treatment strategies (part 1)

2017 ◽  
Vol 8 (2) ◽  
pp. 74-80
Author(s):  
N. B Perepech
Keyword(s):  
Blood Flow ◽  
Acute Coronary Syndrome ◽  
Treatment Strategies ◽  
Antiplatelet Agents ◽  
Clinical Aspects ◽  
Percutaneous Coronary Interventions ◽  
Invasive Treatment ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Flow Through

Two cases of medical care for patients with acute coronary syndrome are discussed, in which conservative and invasive treatment strategies were applied. The clinical aspects of thrombolytic therapy and percutaneous coronary interventions, the use of antiplatelet agents and anticoagulants for the prevention of atherothrombotic events after the restoration of blood flow through the infarct-responsible coronary artery are considered.

scholarly journals Cystatin C for Enhancement of Risk Stratification in Non–ST Elevation Acute Coronary Syndrome Patients with an Increased Troponin T

2009 ◽  
Vol 55 (6) ◽  
pp. 1118-1125 ◽  
Author(s):  
Fons Windhausen ◽  
Alexander Hirsch ◽  
Johan Fischer ◽  
P Marc van der Zee ◽  
Gerard T Sanders ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Renal Function ◽  
Risk Stratification ◽  
Cystatin C ◽  
Treatment Strategy ◽  
Troponin T ◽  
Invasive Treatment ◽  
Coronary Syndrome ◽  
The Third ◽  
St Elevation

Abstract Background: We assessed the value of cystatin C for improvement of risk stratification in patients with non–ST elevation acute coronary syndrome (nSTE-ACS) and increased cardiac troponin T (cTnT), and we compared the long-term effects of an early invasive treatment strategy (EIS) with a selective invasive treatment strategy (SIS) with regard to renal function. Methods: Patients (n = 1128) randomized to an EIS or an SIS in the ICTUS trial were stratified according to the tertiles of the cystatin C concentration at baseline. The end points were death within 4 years and spontaneous myocardial infarction (MI) within 3 years. Results: Mortality was 3.4%, 6.2%, and 13.5% in the first, second, and third tertiles, respectively, of cystatin C concentration (log-rank P < 0.001), and the respective rates of spontaneous MI were 5.5%, 7.5%, and 9.8% (log-rank P = 0.03). In a multivariate Cox regression analysis, the cystatin C concentration in the third quartile remained independently predictive of mortality [hazard ratio (HR), 2.04; 95% CI, 1.02–4.10; P = 0.04] and spontaneous MI (HR, 1.95; 95% CI, 1.05–3.63; P = 0.04). The mortality rate in the second tertile was lower with the EIS than with the SIS (3.8% vs 8.7%). In the third tertile, the mortality rates with the EIS and the SIS were, respectively, 15.0% and 12.2% (P for interaction = 0.04). Rates of spontaneous MI were similar for the EIS and the SIS within cystatin C tertiles (P for interaction = 0.22). Conclusions: In patients with nSTE-ACS and an increased cTnT concentration, mild to moderate renal dysfunction is associated with a higher risk of death and spontaneous MI. Use of cystatin C as a serum marker of renal function may improve risk stratification.

scholarly journals Modified Strategies for Invasive Management of Acute Coronary Syndrome during the COVID-19 Pandemic

2020 ◽  
Vol 10 (1) ◽  
pp. 24
Author(s):  
Petr Toušek ◽  
Viktor Kocka ◽  
Petr Masek ◽  
Petr Tuma ◽  
Marek Neuberg ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Hospital Mortality ◽  
Odds Ratio ◽  
Reference Group ◽  
Treatment Strategies ◽  
High Volume ◽  
Invasive Treatment ◽  
Treatment Delays ◽  
Coronary Syndrome ◽  
Cardiovascular Interventions

The COVID-19 pandemic presents several challenges for managing patients with acute coronary syndrome (ACS). Modified treatment algorithms have been proposed for the pandemic. We assessed new algorithms proposed by The European Association of Percutaneous Cardiovascular Interventions (EAPCI) and the Acute Cardiovascular Care Association (ACCA) on patients with ACS admitted to the hospital during the COVID-19 pandemic. The COVID-19 period group (CPG) consisted of patients admitted into a high-volume centre in Prague between 1 February 2020 and 30 May 2020 (n = 181). The reference group (RG) included patients who had been admitted between 1 October 2018 and 31 January 2020 (n = 834). The proportions of patients with different types of ACS admitted before and during the pandemic did not differ significantly: in all ACS patients, KILLIP III-IV class was present in 13.9% in RG and in 9.4% of patients in CPG (p = 0.082). In NSTE-ACS patients, the ejection fraction was lower in the CPG than in the RG (44.7% vs. 50.7%, respectively; p < 0.001). The time from symptom onset to first medical contact did not differ between CPG and RG patients in the respective NSTE-ACS and STEMI groups. The time to early invasive treatment in NSTE-ACS patients and the time to reperfusion in STEMI patients were not significantly different between the RG and the CPG. In-hospital mortality did not differ between the groups in NSTE-ACS patients (odds ratio in the CPG 0.853, 95% confidence interval (CI) 0.247 to 2.951; p = 0.960) nor in STEMI patients (odds ratio in CPG 1.248, 95% CI 0.566 to 2.749; p = 0.735). Modified treatment strategies for ACS during the COVID-19 pandemic did not cause treatment delays. Hospital mortality did not differ.

scholarly journals Risk Stratification of Patients with Acute Coronary Syndrome

2021 ◽  
Vol 10 (19) ◽  
pp. 4574
Author(s):  
Dávid Bauer ◽  
Petr Toušek
Keyword(s):  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Risk Stratification ◽  
Clinical Data ◽  
Treatment Strategies ◽  
Risk Scores ◽  
Outcome Predictors ◽  
Factors Affecting ◽  
Coronary Syndrome ◽  
New Treatment

Defining the risk factors affecting the prognosis of patients with acute coronary syndrome (ACS) has been a challenge. Many individual biomarkers and risk scores that predict outcomes during different periods following ACS have been proposed. This review evaluates known outcome predictors supported by clinical data in light of the development of new treatment strategies for ACS patients during the last three decades.

scholarly journals Growth Differentiation Factor 15 for Risk Stratification and Selection of an Invasive Treatment Strategy in Non–ST-Elevation Acute Coronary Syndrome

Circulation ◽  
2007 ◽  
Vol 116 (14) ◽  
pp. 1540-1548 ◽  
Author(s):  
Kai C. Wollert ◽  
Tibor Kempf ◽  
Bo Lagerqvist ◽  
Bertil Lindahl ◽  
Sylvia Olofsson ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Confidence Interval ◽  
Risk Stratification ◽  
Treatment Strategy ◽  
Hazard Ratio ◽  
Invasive Treatment ◽  
Coronary Syndrome ◽  
End Point ◽  
St Elevation ◽  
Elevation Acute Coronary Syndrome

Background— An invasive treatment strategy improves outcome in patients with non–ST-elevation acute coronary syndrome at moderate to high risk. We hypothesized that the circulating level of growth differentiation factor 15 (GDF-15) may improve risk stratification. Methods and Results— The Fast Revascularization during InStability in Coronary artery disease II (FRISC-II) trial randomized patients with non–ST-elevation acute coronary syndrome to an invasive or conservative strategy with a follow-up for 2 years. GDF-15 and other biomarkers were determined on admission in 2079 patients. GDF-15 was moderately elevated (between 1200 and 1800 ng/L) in 770 patients (37.0%), and highly elevated (>1800 ng/L) in 493 patients (23.7%). Elevated levels of GDF-15 independently predicted the risk of the composite end point of death or recurrent myocardial infarction in the conservative group ( P =0.016) but not in the invasive group. A significant interaction existed between the GDF-15 level on admission and the effect of treatment strategy on the composite end point. The occurrence of the composite end point was reduced by the invasive strategy at GDF-15 levels >1800 ng/L (hazard ratio, 0.49; 95% confidence interval, 0.33 to 0.73; P =0.001), between 1200 and 1800 ng/L (hazard ratio, 0.68; 95% confidence interval, 0.46 to 1.00; P =0.048), but not <1200 ng/L (hazard ratio, 1.06; 95% confidence interval, 0.68 to 1.65; P =0.81). Patients with ST-segment depression or a troponin T level >0.01 μg/L with a GDF-15 level <1200 ng/L did not benefit from the invasive strategy. Conclusions— GDF-15 is a potential tool for risk stratification and therapeutic decision making in patients with non–ST-elevation acute coronary syndrome as initially diagnosed by ECG and troponin levels. A prospective randomized trial is needed to validate these findings.

Abstract 19018: Variation in Treatment and Outcomes in ACS: Insights from the Alberta Contemporary Acute Coronary Syndrome Patients Invasive Treatment Strategy (COAPT) Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Kevin R Bainey ◽  
Padma Kaul ◽  
Wei Liu ◽  
Collen Norris ◽  
Mouhieddin Traboulsi ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Artery Bypass ◽  
Treatment Strategies ◽  
Hospital Death ◽  
Study Cohort ◽  
Invasive Treatment ◽  
Invasive Strategy ◽  
Repeat Revascularization ◽  
Coronary Syndrome ◽  
One Year

Background: In a universal health care system, we examined variations in treatment strategies and clinical outcomes in a contemporary cohort of acute coronary syndrome (ACS) patients. Methods: Hospitalization claims of 15,264 patients with ACS between April 1, 2010 and March 2012 were deterministically linked to the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) angiographic database. We compared baseline characteristics and use of diagnostic and therapeutic procedures across 3 invasive sites. For patients who underwent an invasive strategy, we examined 1-year rates of death and repeat revascularization. Results: Of the study cohort, 14.3% were medically treated at 91 non-invasive hospitals without transfer to an invasive site and had a 9.3% rate of in-hospital death. The remaining patients were admitted or transferred to one of the three invasive sites (A 5935 pts [40.4% transfer]; B 3910 pts [47.1% transfer]; C 3243 pts [57.4% transfer]). The majority were treated with an invasive strategy: A 87.4%, B 88.9%, C 90.1%, p<0.001). Patient characteristics according to invasive site are reported below (Table). Most notable are the dissimilar rates of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) along with the different use of drug-eluting stents (DES). Mortality rates were similar (in-hospital and 1-year). However, significant differences in one-year repeat revascularization were observed. Conclusion: Results from this large contemporary Canadian study suggest variation in revascularization strategies exist resulting in differences in clinical outcome at one year. Further investigations are warranted to allow alignment of best practice and patient outcomes for patients with ACS.

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