scholarly journals Clinical predictors and angiographic features of acute coronary syndromes caused by systemic embolism

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Jeronimo Baza ◽  
C Salazar ◽  
M.J Perez Vyzcaino ◽  
L Nombela ◽  
P Jimenez Quevedo ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Hospital Mortality ◽  
Acute Coronary Syndromes ◽  
Tertiary Hospital ◽  
Control Group ◽  
Systemic Embolism ◽  
Clinical Predictors ◽  
Coronary Syndrome ◽  
Valvular Surgery ◽  
Coronary Syndromes

Abstract Introduction Systemic embolism to coronary arteries is one of the mechanisms of acute myocardial infarction (AMI) of non-atherosclerotic cause. However, its clinical profile has not been properly established yet. Purpose To identify clinical predictors and angiographic characteristics of acute coronary syndromes caused by systemic embolism to a principal coronary artery (ACS-E), as well as to describe in-hospital mortality of these patients. Methods 40 patients with ACS-E, admitted between 2003 and 2018 in a tertiary hospital. Epidemiological, clinical and angiographic characteristics of these cases were compared with those from 4989 patients, attended for acute coronary syndrome of atherosclerotic cause (ACS-A) in the same hospital during the same period. Results Patients with ACS-E were younger (28% vs 10% were <45 years old, p<0.001) and had a higher proportion of women (43% vs 22%, p 0.003), atrial fibrillation (40% vs 5%, p<0.001) and neoplasia (18% vs 7%, p 0.009). They had also undergone previous valvular surgery more frequently than patients with ACS-A (13% vs 0.5%, p<0.001) and a higher proportion of them were under treatment with warfarin (15% vs 3%, p<0.001). Variables identified as independent predictors of ACS-E in the multivariate analysis are shown in the table. Regarding clinical presentation, ST elevation AMI was more frequent in ACS-E cases (83% vs 67%, p 0.04). Patients with ACS-E did not present any significative stenosis in other vessels apart from the culprit one (number of other vessels with at least 1 severe stenosis was 0 in the ACS-E group vs 1.33 + 1 in the ACS-A arm, p<0.001). PCI was attempted in 75% of the patients with ACS-E, resulting successful in 80% of the cases. On the other hand, 100% of SCA-A underwent PCI, with a success proportion of 99% (p<0.001). In-hospital mortality in ACS-E group was 15% and 4% in the control group (p<0.001). Conclusions ACS-E and ACS-A have different clinical and angiographic features. Atrial fibrillation, chronic warfarin treatment, previous valvular surgery, presence of any neoplasia and female sex are independent predictors for ACS-E. Funding Acknowledgement Type of funding source: None

scholarly journals Associations of Polymorphisms in the Apolipoprotein APOA1-C3-A5 Gene Cluster with Acute Coronary Syndrome

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Yan Ding ◽  
Ming An Zhu ◽  
Zhi Xiao Wang ◽  
Jing Zhu ◽  
Jing Bo Feng ◽  
...  
Keyword(s):  
Gene Cluster ◽  
Acute Coronary Syndromes ◽  
Lipid Homeostasis ◽  
Control Group ◽  
Nucleotide Polymorphisms ◽  
Chinese Han ◽  
Single Nucleotide ◽  
Coronary Syndrome ◽  
Minor Alleles ◽  
Coronary Syndromes

Background. Acute coronary syndromes (ACSs) are clinically cardiovascular events associated with dyslipidemia in common. Single nucleotide polymorphisms (SNPs) and haplotypes in the APOA1/C3/A5 gene cluster are associated with diabetes and familial combined hyperlipidaemia (FCH). Little is known about whether the polymorphisms in these genes affect lipid homeostasis in patients with ACSs. The present paper aimed to examine these associations with 4 SNPs in the APOA1 −75G>A, the APOC3 −455T>C, and APOA5 −1131T>C, c.553G>Tvariant to ACSs in Chinese Han.Methods. Chinese Han of 229 patients with ACSs and 254 unrelated controls were analyzed. Four SNPs in APOA1/C3/A5 cluster were genotyped and lipid was determined.Results. Our data show that minor allelic frequencies of APOC3 −455T>C, APOA5 −1131T>C, and c.553G>Tpolymorphisms in patients with ACSs were significantly higher than control group (P<0.05). Furthermore, the 3 polymorphic sites were strongly of linkage disequilibrium, and minor alleles of 3 SNP sites had higher TG level than wild alleles (P<0.05), APOC3 −455C and APOA5 c.553T allele carriers also had lower level of HDL-C.Conclusions. The minor alleles of APOC3 −455T>C, APOA5 −1131T>C, and c.553G>Tpolymorphisms are closely associated with ACSs.

Performance of acute coronary syndrome approaches in Brazil: a report from the BRACE (Brazilian Registry in Acute Coronary SyndromEs)

2019 ◽  
Vol 6 (4) ◽  
pp. 284-292 ◽  
Author(s):  
Marcelo Franken ◽  
Robert P Giugliano ◽  
Shaun G Goodman ◽  
Luciano Moreira Baracioli ◽  
Lucas Colombo Godoy ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Performance Measures ◽  
Acute Coronary Syndromes ◽  
Teaching Hospitals ◽  
Diagnostic Tools ◽  
Cluster Sampling ◽  
Performance Score ◽  
Cross Sectional ◽  
Coronary Syndrome ◽  
Coronary Syndromes

Abstract Aims Diagnostic and therapeutic tools have a significant impact on morbidity and mortality associated with acute coronary syndromes (ACS). Data about ACS performance measures are scarce in Brazil, and improving its collection is an objective of the Brazilian Registry in Acute Coronary syndromEs (BRACE). Methods and results The BRACE is a cross-sectional, observational epidemiological registry of ACS patients. Stratified ‘cluster sampling’ methodology was adopted to obtain a representative picture of ACS. A performance score (PS) varying from 0 to 100 was developed to compare studied parameters. Performance measures alone and the PS were compared between institutions, and the relationship between the PS and outcomes was evaluated. A total of 1150 patients, median age 63 years, 64% male, from 72 hospitals were included in the registry. The mean PS for the overall population was 65.9% ± 20.1%. Teaching institutions had a significantly higher PS (71.4% ± 16.9%) compared with non-teaching hospitals (63.4% ± 21%; P &lt; 0.001). Overall in-hospital mortality was 5.2%, and the variables that correlated independently with in-hospital mortality included: PS—per point increase (OR = 0.97, 95% CI 0.95–0.98, P &lt; 0.001), age—per year (OR = 1.06, 95% CI 1.03–1.09, P &lt; 0.001), chronic kidney disease (OR = 3.12, 95% CI 1.08–9.00, P = 0.036), and prior angioplasty (OR = 0.25, 95% CI 0.07–0.84, P = 0.025). Conclusions In BRACE, the adoption of evidence-based therapies for ACS, as measured by the performance score, was independently associated with lower in-hospital mortality. The use of diagnostic tools and therapeutic approaches for the management of ACS is less than ideal in Brazil, with high variability especially among different regions of the country.

Increased circulating erythrocyte-derived microparticles in patients with acute coronary syndromes

2021 ◽  
Author(s):  
Hai-xia Liao ◽  
Lin-lin Meng ◽  
Xin Yu ◽  
Ming Song ◽  
Guo-kai Shang ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Flow Cytometry ◽  
Acute Coronary Syndromes ◽  
Control Group ◽  
Gensini Score ◽  
Coronary Syndrome ◽  
Coronary Artery Disease Severity ◽  
Coronary Syndromes ◽  
Artery Disease ◽  
Group Flow

Objective: This study is to explore the predictive value of erythrocyte-derived microparticles (ErMPs) in patients with acute coronary syndrome (ACS). Materials & methods: Total 305 subjects were enrolled and divided into the control group and ACS group. Flow cytometry was used to detect the ErMPs. The Gensini score was calculated based on the results of the coronary angiography. Results: Compared with that in the control group, the ErMPs concentration in the ACS group increased significantly and the concentration of ErMPs was correlated with the ACS risk. The concentration of ErMPs and the percentage of ErMPs were positively correlated with the Gensini score. Conclusion: ErMPs may be a new biomarker for predicting the ACS risk and the coronary artery disease severity.

scholarly journals Atrial fibrillation in patients with acute coronary syndrome under clopidogrel versus ticagrelor

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
I Almeida ◽  
H Santos ◽  
M Santos ◽  
H Miranda ◽  
J Chin ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiovascular Disease ◽  
Acute Coronary Syndromes ◽  
De Novo ◽  
Cardiopulmonary Arrest ◽  
Ventilatory Support ◽  
Lower Systolic Blood Pressure ◽  
Coronary Syndrome ◽  
Premature Cardiovascular Disease ◽  
Coronary Syndromes

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf Portuguese Registry of Acute Coronary Syndromes (ProACS) Introduction  Ticagrelor is a drug widely used in patients with acute coronary syndromes (ACS) that increases the plasma level of adenosine, which can lead to the development of atrial fibrillation (AF). Objective Evaluation of AF development in patients medicated with clopidogrel versus ticagrelor. Material and methods Retrospective analysis of patients admitted with ACS included in the Portuguese Registry of Acute Coronary Syndromes (ProACS) between 2010-19. Patients were divided in two groups regarding the development of de novo AF. The role of ticagrelor vs clopidogrel in AF induction was compared. In-hospital outcomes were evaluated. Results 25727 patients were included, mean age 67 ± 14 years, 72.3% male. 3.6% (n = 1067) presented de novo AF (of which 18.1% at emergency department admission). They were older (75 ± 12 vs 66 ± 14, p &lt; 0.001), with more classic cardiovascular risk factors except for smoker status and family history of premature cardiovascular disease, with less previous cardiovascular disease although more cerebrovascular peripheral vascular disease. They presented more frequently with STEMI (53.4 vs 41.9%, p &lt; 0.001) vs NSTEMI/ unstable angina or indetermined infarction. They presented lower systolic blood pressure (131 ± 30 vs 139 ± 28mmHg, p &lt; 0.001), higher heart rate (85 ± 27 vs 77 ± 18bpm, p &lt; 0.001) and Killip-Kimball (KK) class (KK class &gt;I 35.6 vs 14.3%, p &lt; 0.001) and had less kidney dysfunction (maximum creatinine 1,1 ± 0,4 vs 0,9 ± 0,4mg/dl, p &lt; 0.001). Most patients (53.4%) were medicated with the clopidogrel P2Y12 inhibitor. However, 20.4% of patients who developed AF were medicated with ticagrelor versus 5.7% with clopidogrel. Left anterior descendent (LAD) was the most prevalent culprit vessel in both groups (40.9 vs 37.2%, p = 0.045). Multivessel disease was more prevalent in AF group (56.0 vs 51.5%, p = 0.011) and they needed more frequently advanced therapeutic devices and ventilatory support. In-hospital complications were also more frequent in AF patients: heart failure (45.7% vs 14.3%, p &lt; 0.001), cardiogenic shock (16.1% vs 3.6%, p &lt; 0.001), cardiopulmonary arrest (9.2 vs 2.4%, p &lt; 0.001) and death (11.0 vs 3.4%, p &lt; 0.001). Conclusion In our study, there was a trend to de novo AF development in patients admitted with ACS and medicated with ticagrelor versus clopidogrel.

Abstract 2603: Gender Is An Important Determinate For The Predictive Value Of NT-proBNP In Patients Presenting With An Acute Coronary Syndrome

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Michael W Weber ◽  
Eva Keil ◽  
Michael Stanisch ◽  
Holger Nef ◽  
Helge Moellmann ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Acute Coronary Syndrome ◽  
Predictive Value ◽  
Acute Coronary Syndromes ◽  
Age Groups ◽  
Prognostic Information ◽  
Coronary Syndrome ◽  
Coronary Syndromes ◽  
The Impact

Background BNP und NT-proBNP provide prognostic information in patients with acute coronary syndromes (ACS). Even though it is generally accepted, that gender, age and atrial fibrillation are important determinants for BNP respectively NT-proBNP values, there is no data available evaluating the impact of those factors on the predictive value of those biomarkers. Therefore it was our aim to evaluate the predictive value of NT-proBNP for mortality after an ACS in association to gender, age and rhythm Methods and results We included 1123 consecutive patients (age 64±12 years; 342 females) with an ACS within the last 48 hours. Follow up data after median of 204 days were available for 1115 (99%) patients. During the follow up 77 (6.8%) patients died. NT-proBNP values on admission were higher in patients who deceased compared to those who survived (2047 (576 –5624) pg/ml vs. 465 (127–1519) pg/ml; p<0,001). The AUC of the ROC curve for NT-proBNP as a predictor for mortality was 0.714 (p<0.001) and an optimised cut-off value of 1815 pg/ml could be calculated. Patients with NT-proBNP above this cut-off had a significantly higher mortality rate (16% vs. 4%; p<0,001; Log Rank 48; p<0,001)). Even though patients with AF had higher NT-proBNP values as those patients with SR (1952 (770 – 4070) pg/ml vs. 452 (121–1492) pg/ml) NT-proBNP at the same cut-off value of 1815 pg/ml was highly discriminative for mortality (27.9% vs. 7.5%; p<0.022; Log Rank 5.7; p=0,017). Patients with an age above 65 years had higher NT-proBNP values as compared to patients younger than 65 years (894 (255–2642) pg/ml vs. 279 (75–945) pg/ml; p<0,001). However the predictive value of NT-proBNP in both age groups was comparable. Women had higher NT-proBNP values as compared to men (966 (237–2549) pg/ml vs. 407 (102–1273) pg/ml; p<0,001). But in dissimilarity, in women NT-proBNP values above 1815 pg/ml were not associated with a higher mortality and thus were without predictive value (10,6% vs. 6,8%; p<0,304; Log Rank 1,556; p<0,212). Conclusion Gender, age and rhythm are important determinants for NT-proBNP values of patients presenting with an ACS. However, only gender had impact on the predictive value of NT-proBNP for mortality. In women cut-off values need to be adopted.

A Common Thrombomodulin Amino Acid Dimorphism Is Associated with Myocardial Infarction

1997 ◽  
Vol 77 (02) ◽  
pp. 248-251 ◽  
Author(s):  
Lena Norlund ◽  
Johan Holm ◽  
Bengt Zöller ◽  
Ann-Kristin Öhlin
Keyword(s):  
Myocardial Infarction ◽  
Amino Acid ◽  
Plasma Concentration ◽  
Acute Coronary Syndromes ◽  
Protein C ◽  
Integral Membrane Protein ◽  
Control Group ◽  
Healthy Controls ◽  
Coronary Syndromes ◽  
Premature Myocardial Infarction

SummaryEndothelial dysfunction and haemostatic imbalance are believed to be important aetiological factors in the development of acute coronary syndromes. Thrombomodulin (TM) is an integral membrane protein crucial for normal endothelial function and activation of the protein C anticoagulant pathway. We have investigated the importance of a common C/T dimorphism in the TM gene (nucleotide 1418) for development of premature myocardial infarction (MI). The C/T dimorphism predicts an Ala455 to Val replacement in the sixth EGF-like domain of TM. The dimorphism was investigated in 97 MI survivors and 159 healthy controls. The C allele was significantly more frequent among patients than controls (p = 0.035). The allele frequency for the C allele was 0.82 in the patients and 0.72 in the control group. The plasma concentration of TM was investigated among healthy controls but was not related to the C/T dimorphism. In conclusion, the association of the C allele with premature MI, suggests that the TM gene and the C/T dimorphism may be aetiological factors involved in the pathogenesis of MI. Possibly, the Ala455 to Val replacement may affect the function of the TM molecule and the activation of the protein C anticoagulant pathway.

Prevalence of Vitamin-D Deficiency in Patients with Acute Coronary Syndrome in Syria

2016 ◽  
Vol 9 (6) ◽  
pp. 3544-3548
Author(s):  
Aya Hallak ◽  
Malhis Mahmoud ◽  
Yaser Abajy Mohammad
Keyword(s):  
Vitamin D ◽  
Acute Coronary Syndrome ◽  
Vitamin D Deficiency ◽  
Hypovitaminosis D ◽  
Control Group ◽  
Coronary Syndrome ◽  
Normal Individuals ◽  
Vitamin D Levels ◽  
25 Hydroxy Vitamin D ◽  
Coronary Syndromes

The objectives of this study were to estimate the prevalence of vitamin D deficiency in patients with acute coronary syndrome in comparison with normal individuals and study the correlation between these two conditions. We measured the plasma 25-hydroxy vitamin D (25-OH-D) levels in 60 patients with acute coronary syndromes (ACS) of both gender and in 30 age matched control individuals of both gender without any known cardiovascular or systemic diseases. The levels of 25-OH-D were measured by ELISA method and the results were statically analyzed to find out any possible correlation. We classified the cases according to their plasma 25(OH)D levels. 25(OH)D levels of ≥ 30 ng/ml were considered normal, levels < 30 and > 20 ng/ml were classified as insufficient, while levels of ≤ 20 ng/ml were classified as deficient. In the current study the prevalence of hypovitaminosis D in the patients group was much higher than it was in the control group. Vitamin D deficiency was observed in 80% and insufficiency in 13% of total patients of ACS, there by bringing the total count to 93%. Whereas only 7% of the patients had adequate vitamin D levels. Thus, these results indicate the existence of a significant correlation between the vitamin D deficiency and ACS in comparison to healthy controls

Impact of frailty and atrial fibrillation in elderly patients with acute coronary syndromes

2021 ◽  
Vol 51 (5) ◽  
Author(s):  
María Asunción Esteve‐Pastor ◽  
Ernesto Martín ◽  
Oriol Alegre ◽  
Francesc Formiga ◽  
Juan Sanchís ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Elderly Patients ◽  
Acute Coronary Syndromes ◽  
Coronary Syndromes

scholarly journals Double-blind, placebo-controlled randomised clinical trial to evaluate the effect of ASPIRIN discontinuation after left atrial appendage occlusion in atrial fibrillation: protocol of the ASPIRIN LAAO trial

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e044695
Author(s):  
Mu Chen ◽  
Qunshan Wang ◽  
Jian Sun ◽  
Peng-Pai Zhang ◽  
Wei Li ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Ethics Committee ◽  
Aspirin Therapy ◽  
Atrial Appendage ◽  
Control Group ◽  
Coronary Syndrome ◽  
Left Atrial Appendage Occlusion ◽  
Increased Risk

IntroductionIt is the common clinical practice to prescribe indefinite aspirin for patients with non-valvular atrial fibrillation (NVAF) post left atrial appendage occlusion (LAAO). However, aspirin as a primary prevention strategy for cardiovascular diseases has recently been challenged due to increased risk of bleeding. Therefore, aspirin discontinuation after LAAO in atrial fibrillation (ASPIRIN LAAO) trial is designed to assess the uncertainty about the risks and benefits of discontinuing aspirin therapy at 6 months postimplantation with a Watchman LAAO device in NVAF patients.Methods and analysisThe ASPIRIN LAAO study is a prospective, multicentre, randomised, double-blinded, placebo-controlled non-inferiority trial. Patients implanted with a Watchman device within 6 months prior to enrollment and without pre-existing conditions requiring long-term aspirin therapy according to current guidelines are eligible for participating the trial. Subjects will be randomised in a 1:1 allocation ratio to either the Aspirin group (aspirin 100 mg/day) or the control group (placebo) at 6 months postimplantation. A total of 1120 subjects will be enrolled from 12 investigational sites in China. The primary composite endpoint is stroke, systemic embolism, cardiovascular/unexplained death, major bleeding, acute coronary syndrome and coronary or periphery artery disease requiring revascularisation at 24 months. Follow-up visits are scheduled at 6 and 12 months and then every 12 months until 24 months after the last patient recruitment.Ethics and disseminationEthics approval was obtained from the Ethics Committee of Xinhua Hospital, Shanghai, China (reference number XHEC-C-2018-065-5). The protocol is also submitted and approved by the institutional Ethics Committee at each participating centre. Results are expected in 2024 and will be disseminated through peer-reviewed journals and presentations at national and international conferences.Trial registration numberNCT03821883.

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