Effect of Acute Heart Failure Following Discharge in Patients With Non-ST Elevation Acute Coronary Syndrome on the Subsequent Risk of Death or Acute Myocardial Infarction

2010 ◽  
Vol 63 (9) ◽  
pp. 1035-1044
Author(s):  
Julio Núñez ◽  
Juan Sanchis ◽  
Eduardo Núñez ◽  
Vicent Bodí ◽  
Luis Mainar ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Acute Heart Failure ◽  
Risk Of Death ◽  
Coronary Syndrome ◽  
St Elevation ◽  
Elevation Acute Coronary Syndrome ◽  
Subsequent Risk

scholarly journals Clinical Application of Optical Coherence Tomography in Patients with Non-ST-Elevation Acute Coronary Syndrome Combined with Intermediate Lesions

2017 ◽  
Vol 20 (1) ◽  
pp. 032
Author(s):  
Hua Yu ◽  
Likun Ma ◽  
Kefu Feng ◽  
Hongwu Chen ◽  
Hao Hu
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Optical Coherence Tomography ◽  
Acute Coronary Syndrome ◽  
Drug Treatment ◽  
Optical Coherence ◽  
Coronary Syndrome ◽  
St Elevation ◽  
Elevation Acute Coronary Syndrome

Objective: This study aimed to evaluate the clinical significance and safety of optical coherence tomography (OCT) in patients with non-ST-elevation acute coronary syndrome (NSTEACS) combined with intermediate lesions.Methods: Sixty-five NSTEACS patients with intermediate lesions confirmed with coronary angiography at our department were included in this study. Among them, 33 patients received only standardized drug treatment (drug group) and the other 32 patients received percutaneous coronary intervention (PCI) according to the OCT examination based on drug treatment (OCT group). Major adverse cardiovascular events (MACEs), revascularization, success rate of OCT examination, related complications, and other patient situations in the two groups during hospitalization and the 12-month follow-up period were compared.Results: No death or stroke occurred in either group during hospitalization and follow-up. In the drug treatment group, six patients experienced frequent angina, and five patients with acute myocardial infarction were rehospitalized and underwent PCI procedures. In the OCT group, although two patients underwent repeat revascularization, no additional acute myocardial infarction events occurred. There was a statistically significant difference between the two groups (P < .01). All patients in the OCT group successfully completed the related vessel examination, and 24 patients underwent PCI procedures because of unstable plaque diagnosed with OCT.Conclusion: OCT-guided PCI is safe and effective for the treatment of patients with NSTEACS combined with intermediate lesions.

Pro-oxidant HDL predicts poor outcome in patients with ST-elevation acute coronary syndrome

2015 ◽  
Vol 114 (07) ◽  
pp. 133-138 ◽  
Author(s):  
Klaus Distelmaier ◽  
Lore Schrutka ◽  
Veronika Seidl ◽  
Max P. Winter ◽  
Raphael Wurm ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Independent Predictor ◽  
Density Lipoprotein ◽  
Coronary Syndrome ◽  
Hdl Function ◽  
All Cause Mortality ◽  
St Elevation ◽  
Elevation Acute Coronary Syndrome

SummaryOxidative stress affects clinical outcome in patients with ST-elevation acute coronary syndrome (STE-ACS). Although high-density lipoprotein (HDL) particles are generally considered protective, deleterious properties of HDL have been observed in patients with acute myocardial infarction. Here, we analysed the association between pro oxidant HDL and all-cause mortality in STE-ACS patients. We determined the antioxidant function of HDL in 247 prospectively enrolled patients undergoing primary percutaneous coronary intervention for STE-ACS. Patients were stratified as by a pro-oxidant serum HDL oxidant index (HOI 1) or with an antioxidant serum HOI (HOL< 1) capacity. Multivariate regression analysis was used to relate HOI to survival. The median follow-up time was 23 months (IQR 14.4–40.0 months). Pro-oxidant HDL was observed in 44.1 % of STE-ACS patients and was independently associated with all-cause mortality with a hazard ratio of 3.30(95 %CI 1.50–7.27, p = 0.003). Mortality rates were higher in patients with baseline pro-oxidant HDL compared to patients with preserved HDL function at 30 days (11.9 % vs 2.2 %, p=0.002), and at 4 years (22.9 % vs 8.7 %, p=0.002). Elevated neutrophil counts were a strong and independent predictor for pro-oxidant HDL with an odds ratio per standard deviation of 1.50 (95 %CI 1.11–2.03, p=0.008), as was history of prior acute myocardial infarction, elevated triglycerides levels and reduced glomerular filtration rate. In conclusion, pro-oxidant HDL represents a strong and independent predictor of long-term as well as short-term all-cause mortality in STE-ACS patients. Elevated neutrophil counts predicted the presence of serum pro-oxidant HDL. The maintenance of HDL functions might be a promising therapeutic target in STE-ACS patients.

P3825Long-term prognostic value of growth differentiation factor-15 in acute coronary syndrome

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
O M Peiro Ibanez ◽  
J Ordonez ◽  
A Garcia ◽  
G Bonet ◽  
V Quintern ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Prognostic Value ◽  
Clinical Model ◽  
Growth Differentiation Factor 15 ◽  
Coronary Syndrome ◽  
St Elevation ◽  
Incremental Prognostic Value

Abstract Introduction Biomarkers plays a critical role in diagnostic, prognostication, and decision-making in cardiovascular medicine. Growth differentiation factor-15 (GDF-15) has been reported as a potential biomarker in acute coronary syndrome (ACS). However, there is limited data on the long-term prognostic value after an ACS. Purpose To study the long-term prognostic value of GDF-15 in ACS. Methods We included patients with ACS who underwent coronary angiography. During angiography an arterial blood sample was collected. Plasma GDF-15 were measured and clinical data and long-term events were obtained. As previously reported, risk categories were defined as low risk (<1200ng/L), intermediate (1200–1800ng/L) and high risk (>1800ng/L). Incremental prognostic value of GDF-15 for all-cause death was assessed on top of a clinical model (GRACE score, LVEF<40% and age). Results A total of 358 patients were included; 157 as a low risk, 85 as an intermediate and 116 as a high risk. The median (IQR) age was 65 (56–74) years and 27.4% were female. Of all patients, 61.5% were admitted with non-ST-elevation myocardial infarction, 24.0% with ST-elevation myocardial infarction and 14.5% with unstable angina. Higher values of GDF-15 were consistently associated with an increased prevalence of cardiovascular risk factors. During 6 years of follow-up 54 patients died. Of those patients, 7 (4.5%) had values of GDF-15 below 1200ng/L, 6 (7.1%) between 1200–1800ng/L and 41 (35.3%) above 1800ng/L. After adjustment for a multivariate Cox regression model, GDF-15 >1800ng/L were independently associated with all-cause death (HR 4.5; 95% CI 1.8–11.6; p=0.002) and the composite of major adverse cardiovascular events (MACE) which were identified as all-cause death, nonfatal MI and heart failure (HR 2.5; 95% CI 1.4–4.4; p=0.001). For long-term all-cause death a significant increase of the c-statistic was seen after addition of GDF-15 to the clinical model 0.871 (95% CI 0.817–0.924; p=0.019) as well as net reclassification improvement (0.769; 95% CI 0.487–1.051; p<0.001) and integrated discrimination improvement (0.117; 95% CI 0.062–0.172; p<0.001). Of 18 events of heart failure, 17 occurred in patients with GDF>1800ng/L. A multivariate competing risk model showed a significant association between GDF-15>1800ng/L and incidence of heart failure (adjusted HR 30.8; 95% CI 4.1–231.5; p=0.001) but non-significant association were found for myocardial infarction. KM figures and all-cause death ROC curve Conclusions In the setting of ACS GDF-15 can predict long-term all-cause death, MACE and heart failure and provides incremental prognostic value beyond traditional risks factors in the long-term all-cause death.

scholarly journals Adverse Cardiac Remodelling after Acute Myocardial Infarction: Old and New Biomarkers

2020 ◽  
Vol 2020 ◽  
pp. 1-21 ◽  
Author(s):  
Alexander E. Berezin ◽  
Alexander A. Berezin
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
New Technologies ◽  
Early Period ◽  
Cardiac Remodelling ◽  
Complete Revascularization ◽  
Coronary Syndrome

The prevalence of heart failure (HF) due to cardiac remodelling after acute myocardial infarction (AMI) does not decrease regardless of implementation of new technologies supporting opening culprit coronary artery and solving of ischemia-relating stenosis with primary percutaneous coronary intervention (PCI). Numerous studies have examined the diagnostic and prognostic potencies of circulating cardiac biomarkers in acute coronary syndrome/AMI and heart failure after AMI, and even fewer have depicted the utility of biomarkers in AMI patients undergoing primary PCI. Although complete revascularization at early period of acute coronary syndrome/AMI is an established factor for improved short-term and long-term prognosis and lowered risk of cardiovascular (CV) complications, late adverse cardiac remodelling may be a major risk factor for one-year mortality and postponded heart failure manifestation after PCI with subsequent blood flow resolving in culprit coronary artery. The aim of the review was to focus an attention on circulating biomarker as a promising tool to stratify AMI patients at high risk of poor cardiac recovery and developing HF after successful PCI. The main consideration affects biomarkers of inflammation, biomechanical myocardial stress, cardiac injury and necrosis, fibrosis, endothelial dysfunction, and vascular reparation. Clinical utilities and predictive modalities of natriuretic peptides, cardiac troponins, galectin 3, soluble suppressor tumorogenicity-2, high-sensitive C-reactive protein, growth differential factor-15, midregional proadrenomedullin, noncoding RNAs, and other biomarkers for adverse cardiac remodelling are discussed in the review.

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 N-Terminal Pro Brain Natriuretic Peptide in Assessment of Severity of Coronary Artery Disease in Patients with Non ST Elevation Acute Coronary Syndrome

2020 ◽  
Author(s):  
Hesham Mohammed El Ashmawy ◽  
Mohammed Ahmed Sadaka ◽  
Gehan Magdy Youssef ◽  
Abdulkarem Saeed Hassan
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Syntax Score ◽  
Gensini Score ◽  
Coronary Syndrome ◽  
St Elevation ◽  
The Mean ◽  
Artery Disease

Introduction: N-Terminal pro Brain Natriuretic Peptide (NT-pro BNP) is an important biomarker in the management of patients with heart failure. Several studies reported its importance as a predictor of morbidity and mortality in Acute Coronary Syndrome (ACS) patients. Aim: To compare serum NT-proBNP levels in Non ST Elevation Acute Coronary Syndrome (NSTE-ACS) patients and controls and to assess the relation between Nt-proBNP and the severity of Coronary Artery Disease (CAD) in patients with NSTE-ACS including unstable Angina (UA) and Non ST Elevation Myocardial Infarction (NSTEMI). Materials and Methods: Sixty NSTE-ACS patients and 20 matched control without significant obstructive CAD were included in the study. Cardiac enzymes, blood urea, serum creatinine, serum NT-proBNP were measured in all patients immediately before coronary angiography. Gensini score and Syntax score were calculated for all study patients. The NSTE-ACS patients were followed-up for six months for Major Adverse Cardiovascular Events (MACE) including mortality, myocardial infarction, heart failure, stroke, revascularisation by primary percutaneous coronary intervention or Coronary Artery Bypass Grafting (CABG). Results: The mean serum NT-proBNP in NSTE-ACS (UA and NSTEMI) patients was significantly higher (662.7±635.2) pg/mL than that in the control (102.3±96.4) pg/mL, p<0.001. The effective cut-off value for the diagnosis of CAD was 139 pg/mL, Area Under Curve (AUC)=0.950, 95% CI: 0.890-1.00). The serum NT-proBNP was correlated with the severity and complexity of CAD as measured by Gensini score (r=0.496, p<0.001) and Syntax score (r=0.443, p<0.001). The mean value of NT-proBNP in patients with six months MACE was insignificantly higher than in patients without six months MACE with Interquartile Range (IQR) of 418.5 (139-2037) vs. 366 (175-3237) pg/mL, p=0.970. Conclusion: NT-proBNP was correlated with the severity and complexity of CAD in NSTE-ACS with preserved left ventricular systolic function, but it has no impact on six months MACE.

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