Gap between guidelines and management of patients with acute coronary syndrome without persistent ST elevation. Finnish prospective follow-up survey

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.

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P935 Long-term follow-up from a national cohort of patients with acute coronary syndrome without ST-elevation: results from the prospective registry of acute ischaemic syndromes in the United Kingdom (PRAIS-UK)

European Heart Journal ◽

10.1016/s0195-668x(03)94227-8 ◽

2003 ◽

Vol 24 (5) ◽

pp. 154

Author(s):

A TANEJA

Keyword(s):

Acute Coronary Syndrome ◽

United Kingdom ◽

Coronary Syndrome ◽

The United Kingdom ◽

Long Term Follow Up ◽

National Cohort ◽

St Elevation

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5-year outcomes in the FRISC-II randomised trial of an invasive versus a non-invasive strategy in non-ST-elevation acute coronary syndrome: a follow-up study

The Lancet ◽

10.1016/s0140-6736(06)69416-6 ◽

2006 ◽

Vol 368 (9540) ◽

pp. 998-1004 ◽

Cited By ~ 177

Author(s):

Bo Lagerqvist ◽

Steen Husted ◽

Fredrik Kontny ◽

Elisabeth Ståhle ◽

Eva Swahn ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Randomised Trial ◽

Invasive Strategy ◽

Coronary Syndrome ◽

Non Invasive ◽

Follow Up Study ◽

St Elevation ◽

Elevation Acute Coronary Syndrome

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Prediction of major adverse cardiac events of patients with acute coronary syndrome by using TIMI risk index

Journal of Dhaka National Medical College & Hospital ◽

10.3329/jdnmch.v18i2.16024 ◽

2013 ◽

Vol 18 (2) ◽

pp. 52-57 ◽

Cited By ~ 1

Author(s):

Mohammad Abul Ehsan ◽

Md Manzoor Mahmood ◽

Laila Farzana Khan ◽

Md Abu Salim

Keyword(s):

Myocardial Infarction ◽

Acute Coronary Syndrome ◽

Risk Index ◽

Major Adverse Cardiac Events ◽

Cardiac Events ◽

Coronary Syndrome ◽

Adverse Cardiac Events ◽

St Elevation ◽

Group 1

Patient with acute coronary syndrome (ACS) has considerable variability in outcome and mortality risk. The Thrombolysis in Myocardial Infarction (TIMI) risk index (TRI) for unstable angina/non ST elevation myocardial infarction & ST elevation myocardial infarction were a convenient bedside clinical risk score for predicting 30 days mortality at presentation with ACS. This study was done to predict and validate major adverse cardiac events in patients of ACS thus it will help us to quantify risk, observe the prognostic value and to guide appropriate therapy by using TRI. This prospective study was carried out in the department of cardiology, BSMMU, Dhaka from April, 2011 to March, 2012. After considering all ethical issues, data were collected from 279 patients attending at cardiac emergency department with the presentation of ACS. History & physical examinations were done. TIMI risk index were calculated for each patient. The major adverse cardiac events (recurrent myocardial infarction, urgent revascularization, and all-cause mortality) were measured for next 30 days in hospital setting & outpatient department by follow up. After follow-up, Cox univariate and multivariate regression analysis were used to evaluate the influence of potential risk factors on duration of event-free survival, and likelihood ratio tests to assess the outcome. Major adverse events of TIMI risk index group 1, 2, 3, 4 & 5 were 0%, 0%, 3.7%, 12.9% & 19.2% respectively in UA/NSTEMI group. In STEMI group major adverse cardiac events of TIMI risk index group 1, 2, 3, 4 & 5 were 0%, 4.7%, 12.5%, 17.1% & 24.1% respectively. Increasing TRI were associated with increased risk of major adverse cardiac events. These score were a valid tool for risk assessment. DOI: http://dx.doi.org/10.3329/jdnmch.v18i2.16024 J. Dhaka National Med. Coll. Hos. 2012; 18 (02): 52-57

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ACEF performed better than other risk scores in non-ST-elevation acute coronary syndrome during long term follow-up

BMC Cardiovascular Disorders ◽

10.1186/s12872-020-01841-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ivica Kristić ◽

Nikola Crnčević ◽

Frane Runjić ◽

Vesna Čapkun ◽

Ozren Polašek ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Risk Score ◽

Treatment Strategies ◽

Risk Scores ◽

Coronary Syndrome ◽

Long Term Follow Up ◽

St Elevation ◽

All Treatment

Abstract Background Risk stratification of patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) is an important clinical method, but long-term studies on patients subjected to all-treatment strategies are lacking. Therefore, the aim was to compare several established risk scores in the all-treatment NSTE-ACS cohort during long-term follow-up. Methods Consecutive patients (n = 276) with NSTE-ACS undergoing coronary angiography were recruited between September 2012 and May 2015. Six risk scores for all patients were calculated, namely GRACE 2.0, ACEF, SYNTAX, Clinical SYNTAX, SYNTAX II PCI and SYNTAX II CABG. The primary end-point was Major Adverse Cardiovascular Events (MACE) which was a composite of cardiac death, nonfatal myocardial infarction, ischemic stroke or urgent coronary revascularization. Results During a median follow-up of 33 months, 64 MACE outcomes were recorded (23.2%). There was no difference between risk score categories, except in the highest risk group of ACEF and SYNTAX II PCI scores which exhibited significantly more MACE (51.6%, N = 33 and 45.3%, N = 29, P = 0.024, respectively). In the multivariate Cox regression analysis of individual variables, only age and atrial fibrillation were significant predictors for MACE (HR 1.03, 95% CI 1.00–1.05, P = 0.023 and HR 2.02, 95% CI 1.04–3.89, P = 0.037, respectively). Furthermore, multivariate analysis of the risk scores showed significant prediction of MACE only with ACEF score (HR 2.16, 95% CI 1.36–3.44, P = 0.001). The overall performance of GRACE, SYNTAX, Clinical SYNTAX and SYNTAX II CABG was poor with AUC values of 0.596, 0.507, 0.530 and 0.582, respectively, while ACEF and SYNTAX II PCI showed the best absolute AUC values for MACE (0.630 and 0.626, respectively). Conclusions ACEF risk score showed better discrimination than other risk scores in NSTE-ACS patients undergoing all-treatment strategies over long-term follow-up and it could represent a fast and user-friendly tool to stratify NSTE-ACS patients.

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The Effect of the Timing of Invasive Management on Cardiac Function in Patients with NSTE-ACS, Insights from the OPTIMA-2 Randomized Controlled Trial

Journal of Clinical Medicine ◽

10.3390/jcm10163636 ◽

2021 ◽

Vol 10 (16) ◽

pp. 3636

Author(s):

Nick D. Fagel ◽

Stefan G. J. Leuven ◽

Wouter J. Kikkert ◽

Michelle M. de Leau ◽

Loek van Heerebeek ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Left Ventricular Function ◽

Study Groups ◽

Left Ventricular ◽

Invasive Strategy ◽

Coronary Syndrome ◽

Randomized Controlled ◽

St Elevation ◽

Invasive Management

The timing of coronary angiography in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) remains a matter of debate. The relationship between the timing of invasive management and left ventricular function (LVF) is largely unknown. The An Immediate or Early Invasive Strategy in Non-ST-Elevation Acute Coronary Syndrome trial (OPTIMA-2) was a randomized controlled prospective open-label multicenter trial that randomized 249 NSTE-ACS patients to either an immediate (<3 h) invasive treatment strategy or an early strategy (12–24 h). Patients were pre-treated with a combination of aspirin, ticagrelor and fondaparinux. The aim of this prespecified sub-analysis was to assess (the recovery of) left ventricular function by analysing echocardiography data obtained <72 h after admission and at 30-day follow-up, for patients with a confirmed diagnosis of acute coronary syndrome. LVF was determined using ejection fraction (EF) and global longitudinal strain (GLS). Inter-observer variability was tested. No difference in the recovery of EF was found between an immediate and early strategy if the follow-up echocardiograms were compared to baseline: 2.5% (standard deviation (SD): 7.9) and 3.3% (SD: 8.5), p = 0.51, nor was there any difference in GLS recovery between the study groups: −0.8% (SD: 2.5) vs. −0.7% (SD 2.8) p = 0.82. If baseline and follow-up echocardiograms were compared, there was a similar but significant improvement in both EF and GLS in both separate study groups. An immediate invasive strategy in NSTE-ACS patients did not result in an improved left ventricular EF or GLS recovery compared with an early strategy.

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The Bleeding Safety of Ticagrelor in Patients With ST-Elevation Acute Coronary Syndrome Treated With Fibrinolytic Therapy

Kardiologiia ◽

10.18087/cardio.2020.6.n867 ◽

2020 ◽

Vol 60 (6) ◽

pp. 92-95

Author(s):

A. V. Bocharov ◽

D. V. Sidorov

Keyword(s):

Acute Coronary Syndrome ◽

Treatment Group ◽

Fibrinolytic Therapy ◽

Intracranial Hemorrhages ◽

St Segment Elevation ◽

Coronary Syndrome ◽

St Segment ◽

St Elevation ◽

Elevation Acute Coronary Syndrome

Aim To compare hemorrhagic safety of ticagrelor and clopidogrel in patients with ST-segment elevation acute coronary syndrome (STEACS) after thrombolytic therapy (TLT).Material and methods This nonrandomized study included 183 patients followed up for 30 days. Hemorrhagic safety was compared in a group of patients with STEACS (n=71) after a thrombolytic treatment with alteplase and early ticagrelor treatment (180 mg followed by switching to 90 mg twice daily) and in a group of patients (n=112) with STEACS receiving TLT with alteplase and clopidogrel (loading dose, 600 mg followed by switching to 75 mg daily). Primary endpoint was hemorrhage associated with TLT; patients were followed up for 30 days.Results During the follow-up period, TLT-associated hemorrhages were observed in 11.3% of patients in the ticagrelor treatment group and in 10.7% of patients in the clopidogrel treatment group (p=0.9; odds ratio, 1.06 at 95 % confidence interval, from 0.41 to 2.73). Intracranial hemorrhages and fatal hemorrhages were absent in both groups.Conclusion There were no significant differences in hemorrhagic safety between patients with STEACS after the TLT treatment with alteplase and early treatment with ticagrelor or clopidogrel.

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