High mortality rates in conservatively managed patients with acute coronary syndrome

Abstract Background While women≥80 years old have a high prevalence of coronary artery disease (CAD), little data exist regarding their outcome following acute coronary syndrome (ACS). Methods In a retrospective study based on data of 3518 ACS women patients who were enrolled in the ACS Israel Survey (ACSIS), we first evaluated and compared the clinical outcomes of 858 ACS women ≥80 years with 2660 ACS women <80 years, hospitalized during 2000–2016. Secondly, we evaluated the clinical outcome of 450 women ≥80 years hospitalized during 2000–2006 (“early period”) and compared them with 408 ACS women of the same age group hospitalized during 2008–2016 (“late period”). Results Implementation of the ACS AHA/ACC/ESC therapeutic guidelines was lower in ACS women ≥80 years compared with women <80 years. Multivariate Cox regression analysis demonstrated a worse 1-year survival rate in the ACS women ≥80 years compared with those <80 years. During the late period women >80 years were treated more frequently with guideline-recommended therapies compared with patients from the same age group who were hospitalized in the early period. A significant decline in in-hospital mortality rates in ACS women ≥80 years hospitalized in the late compared with the early period was demonstrated. However, 7-day, 30-day and 1-year mortality rates were not significantly changed. 1-year survival by age groups Conclusion Adverse outcome rates of ACS women ≥80 years were significantly higher compared with those <80 years. In-hospital survival rates of ACS women patients >80 years improved during the 2000–2016 period; however, long-term survival rates were not significantly changed. Acknowledgement/Funding None

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Akut coronariaszindróma ellátása – 2016

Orvosi Hetilap ◽

10.1556/650.2016.30574 ◽

2016 ◽

Vol 157 (38) ◽

pp. 1500-1506

Author(s):

Dávid Becker ◽

Béla Merkely

Keyword(s):

Acute Coronary Syndrome ◽

Mortality Rate ◽

High Mortality ◽

Coronary Intervention ◽

Continuous Development ◽

Coronary Syndrome ◽

Optimal Therapy ◽

European Guidelines ◽

Life Threatening ◽

Care System

Acute coronary syndrome is a life threatening disease with high mortality rate without optimal therapy. Due to the continuous development in the treatment of the disease, the prognosis has dramatically improved over the last 30 years. Apart from the improvement of the medication, the most important factor is the availability of an immediate coronary intervention for everyone, at any time. Currently, nineteen interventional centers provide this care in Hungary, 24 hours a day. Thanks to the European guidelines, the care system is now more efficient in determining who and when needs the treatment. This article summarises the principles of the treatment currently in use. Orv. Hetil., 2016, 157(38), 1500–1506.

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Multiple Biomarker Use for Detection of Adverse Events in Patients Presenting with Symptoms Suggestive of Acute Coronary Syndrome

Clinical Chemistry ◽

10.1373/clinchem.2006.080192 ◽

2007 ◽

Vol 53 (5) ◽

pp. 874-881 ◽

Cited By ~ 70

Author(s):

Fred S Apple ◽

Lesly A Pearce ◽

Adrine Chung ◽

Ranka Ler ◽

MaryAnn M Murakami

Keyword(s):

Acute Coronary Syndrome ◽

Adverse Events ◽

Cardiac Event ◽

Troponin I ◽

Mortality Rates ◽

Coronary Syndrome ◽

Increased Risk ◽

All Cause Mortality ◽

Multiple Biomarkers ◽

Event Rates

Abstract Background: We investigated multiple biomarkers of various pathophysiologic pathways to determine their relationships with adverse outcomes in patients presenting with symptoms of acute coronary syndrome. Methods: We obtained plasma specimens from 457 patients on admission and measured 7 biomarkers: myeloperoxidase (MPO), soluble CD40 ligand (CD40L), placental growth factor (PlGF), metalloproteinase-9 (MMP-9), high-sensitivity C-reactive protein (hsCRP), cardiac troponin I (cTnI), and N-terminal pro-B-type natriuretic peptide (NT-proBNP). We used the Modification of Diet in Renal Disease formula to calculate the estimated glomerular filtration rate (eGFR). Endpoints were cardiac events (myocardial infarction, percutaneous coronary intervention, coronary artery bypass graft, cardiac death) and all-cause mortality. We estimated cumulative event rates over a 4-month period with the Kaplan–Meier method and relative risk (RR) with the Cox proportional hazards model. Results: Patients with increased PlGF, NT-proBNP, hsCRP, or cTnI or decreased eGFR had 11% to 20% higher all-cause mortality rates than patients with concentrations within reference intervals: 20.4% (eGFR), 16.0% (PlGF), 15.8% (hsCRP), 12.7% (NT-proBNP), and 11.3% (cTnI; all P ≤0.03). No differences in mortality rates were observed between those with increased vs normal concentrations of MPO, CD40L, or MMP-9. Decreased eGFR (RR 3.4, P = 0.004) and increased NT-proBNP (RR 7.9, P = 0.04) were independently predictive of mortality, and PlGF (RR 2.0, P = 0.08) approached significance. Patients with increased NT-proBNP (12.3%) or cTnI (33.8%) had higher cardiac event rates (each P <0.02), with increased MPO (11.1%) showing a trend (P = 0.09). Patients in whom both cTnI and MPO were increased had a cardiac event rate of 43%. Conclusion: Multiple biomarkers that are likely indicative of different underlying pathophysiologic mechanisms are independently predictive of increased risk for adverse events in patients with acute coronary syndrome.

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Acute myocardial infarction trends in the population of the Nišava District

Acta Facultatis Medicae Naissensis ◽

10.5937/afmnai38-30381 ◽

2021 ◽

Vol 38 (1) ◽

pp. 56-63

Author(s):

Zorana Deljanin ◽

Nataša Rančić ◽

Mirko Ilić ◽

Ivana Janićijević ◽

Dejan Veljković

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Acute Coronary Syndrome ◽

Statistical Significance ◽

Premature Death ◽

Descriptive Study ◽

Mortality Rates ◽

Mortality Trend ◽

Coronary Syndrome ◽

Incidence And Mortality

Acute myocardial infarction is the leading cause of premature morbidity and premature death worldwide. The aim of the paper was to determine the trends of acute myocardial infarction in the period between 2006 and 2019 in the population of the Nišava District. A descriptive study was performed. Data about acute myocardial infarction incidence and mortality were obtained from the population registry for Acute Coronary Syndrome of Serbia. Crude, specific and age-standardized incidence and mortality rates per 100,000 persons were calculated as well as the trend lines. A total number of 12,142 new cases of acute myocardial infarction (7,595 in males and 4,547 in females) were registered. Men suffered 1.7 times more often than females. An insignificantly decreasing acute myocardial infarction incidence trend y = 0.4868x + 112.24, R² = 0.0029 was recorded. A total of 3,925 persons died (2,260 males and 1,665 females). Men died 1.4 times more often than women and a significant decreasing mortality trend was recorded both males (y = -1.6112x + 52.563, R² = 0.7779) and in females (y = -0.4956x + 22.81, R² = 0.3306). A significant increasing mortality trend of acute myocardial infarction by age was determined y = 11.152x - 34.519, R² = 0.7022. The trend of incidence tended to decrease however, without statistical significance, but insignificantly. The incidence and mortality rates were higher in men than in women for the whole observed period. Mortality trend significantly decreased both in men and in women and significantly increased with age.

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Can Platelet/Mean Platelet Volume ratio, Neutrophil/lymphocyte ratio, and Procalcitonin used for Predicting Prognosis in Acute Coronary Syndrome?

Journal of Anesthesiology and Pain Therapy ◽

10.29245/2768-5365/2020/1.1103 ◽

2020 ◽

Vol 1 (1) ◽

pp. 4-10

Author(s):

Sedat Özbay ◽

Abuzer Coskun ◽

Sevki Hakan Eren

Keyword(s):

Acute Coronary Syndrome ◽

Mean Platelet Volume ◽

Volume Ratio ◽

Mortality Rates ◽

Platelet Volume ◽

Mortality And Morbidity ◽

Neutrophil Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Coronary Syndrome ◽

Vessel Disease

Objective: This study aimed to evaluate acute coronary syndrome (ACS), serum procalcitonin levels, Platelet/Mean Platelet Volume ratio (PMR) and Neutrophil/lymphocyte ratio (NLR) concerning post-myocardial infarction (MI) complications, mortality, and morbidity. Material and Method: The study included a total of 913 patients with ACS who presented to the emergency department with chest pain between January 2013 and December 2017. The patients were categorized as ST-elevated MI (STEMI), non-ST elevated MI (NSTEMI) and unstable angina (UA) according to the diagnosis. The demographic and laboratory characteristics of the patients were compared for three-vessel disease (TVD) and mortality rates. Result: Post MI complications, TVD, and mortality were significant among acute coronary syndrome groups. The three-vessel disease was mostly observed in anterior MI with a maximum rate of 58 (39.7%). Mortality was found as 23 (16.3%) in anterior MI and 18 (12.2%) in NSTEMI. Serum procalcitonin levels were highest in anterior MI. Platelet to Mean Platelet Volume ratio was higher in UA, whereas it was lower in STEMI and NSTEMI. Neutrophil to lymphocyte ratio was the lowest in UA. The cTn I values of STEMIs at 0, 6, 12 hours were higher than UA, and the 12th-hour cTnI values in anterior MI were higher than NSTEMIs. It was found that procalcitonin and NLR had a positive correlation with post-MI complications, mortality, and TVD, whereas PMR exhibited a negative correlation. Conclusion: The levels of procalcitonin, PMR, and NLR may be significant in respect of post-complications, mortality, and morbidity in acute coronary syndrome.

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TRENDS IN MORTALITY RATES FROM ACUTE CORONARY SYNDROME OCTOGENARIAN PATIENTS IN ISRAEL DURING THE PERIOD 2000-2013

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(15)60077-8 ◽

2015 ◽

Vol 65 (10) ◽

pp. A77

Author(s):

Michael Shechter ◽

Ilan Goldenberg ◽

Shlomi Matetzky

Keyword(s):

Acute Coronary Syndrome ◽

Mortality Rates ◽

Coronary Syndrome

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