scholarly journals P193 Echocardiographic prognosis score and stratification of the risk of major cardiovascular events after acute coronary syndrome

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
F Menzou ◽  
N Laraba ◽  
M Ait Ali ◽  
M Krim
Keyword(s):  
Acute Coronary Syndrome ◽  
High Risk ◽  
Cardiovascular Event ◽  
Cardiovascular Events ◽  
Major Cardiovascular Event ◽  
Aggressive Approach ◽  
Clinical Prognosis ◽  
Coronary Syndrome ◽  
Major Cardiovascular Events ◽  
Echocardiographic Parameters

Abstract Introduction The stratification of the risk of a major cardiovascular event after an acute coronary syndrome by doppler echocardiography provides prognostic support to the different clinical models and allows a non-invasive evaluation of the risk, independent of comorbidities. The echo-score provides a better definition of the categories of high-risk and intermediate patients for whom a more aggressive approach improves outcomes. Purpose The aim of our study is to identify the echocardiographic parameters predictive of major cardiovascular events in the acute phase and after six months of follow-up of an acute coronary syndrome Methods To identify the echocardiographic parameters associated with major cardiovascular event, we recruited 302 patients in intensive care unit of cardiology for acute coronary syndrome consecutively on admission. Patients were assessed by clinical risk scores (GRACE, TIMI, CRUSADE) and resting echocardiography, Results We have 181 patients with major cardiovascular event. After studying the survival curves, univariate and multivariate analysis, acute coronary events echoscore (HR 1,95 ; p < 0,0001), has four echocardiographic variables (VG-Simpson - biplane ejection fraction, VD-surface - Simpson shortening fraction, M-strain longitudinal total deformation and pulmonary ultrasonic comet). Its discrimination capacity (AUC= 0,85) greater than that of the scores clinical prognosis, (GRACE; AUC = 0,72, TIMI; AUC = 0,71, HR 1,33; p < 0,0001) and (CRUSADE; AUC = 0,76; HR 1,03; p = 0,005) Conclusion The developed echocardiographic model could prove very useful in the decision-making process and optimization of the therapeutic strategy in some high-risk patients with acute coronary syndromes following an invasive strategy. It is appropriate for expert interpretation, yet relatively simple because it contains only four echocardiographic variables as predictors, (score 4 points for low risk with a probability of major cardiovascular event 3.4%, up to 16 points for risk high with a probability of 15.1%)

Long-Term Risk of Major Adverse Cardiovascular Events in Patients With Acute Coronary Syndrome: Prognostic Role of Complete Blood Cell Count

Angiology ◽  
2020 ◽  
Vol 71 (9) ◽  
pp. 831-839
Author(s):  
Nuccia Morici ◽  
Valentina Molinari ◽  
Silvia Cantoni ◽  
Andrea Rubboli ◽  
Laura Antolini ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
High Risk ◽  
Blood Cell ◽  
Cardiovascular Events ◽  
Major Adverse Cardiovascular Events ◽  
Blood Cell Count ◽  
Prognostic Role ◽  
Coronary Syndrome

Individual parameters of complete blood count (CBC) have been associated with worse outcome in patients with acute coronary syndrome (ACS). However, the prognostic role of CBC taken as a whole has never been evaluated for long-term incidence of major adverse cardiovascular events (MACEs). Patients were grouped according to their hematopoietic cells’ inflammatory response at different time points during hospital stay. Patients with admission white blood cell count >10 × 109/L, discharge hemoglobin <120 g/L, and discharge platelet count >250 × 109/L were defined as “high-risk CBC.” Among 1076 patients with ACS discharged alive, 129 (12%) had a “high-risk CBC” and 947 (88%) had a “low-risk CBC.” Patients with “high-risk CBC” were older and had more comorbidities. Over a median follow-up of 665 days, they experienced a higher incidence of MACE compared to “low-risk CBC” patients (18.6% vs 8.1%). After adjustment for age, age-adjusted Charlson comorbidity index, female sex, cardiac arrest, suboptimal discharge therapy, coronary artery bypass, and ejection fraction, a high-risk CBC was significantly associated with increased MACE occurrence (adjusted hazard ratio 1.80; 95% CI: 1.09-3.00). The CBC was a prognostic marker in patients with ACS, and its evaluation at admission and discharge could better classify patient’s risk and improve therapeutic management.

5132Effect of PCSK9 inhibitors treatment on acute coronary syndrome and stroke incidence: a metanalysis of currently available clinical trials

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Cordero ◽  
L Facila ◽  
M Rodriguez-Manero ◽  
M Gomez-Martinez ◽  
V Bertomeu-Gonzalez ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Cardiovascular Events ◽  
Meta Analysis ◽  
Density Lipoprotein ◽  
Cochrane Collaboration ◽  
Significant Heterogeneity ◽  
Pcsk9 Inhibitors ◽  
Stroke Incidence ◽  
Coronary Syndrome ◽  
Major Cardiovascular Events

Abstract Background Proprotein convertase subtilisin–kexin type 9 (PCSK9) inhibitors have demonstrated to induce large reductions in low-density lipoprotein cholesterol (LDLc) and major cardiovascular events but none of the studies was statistically powered to demonstrate reductions in specific endpoints rather than a combined end-point of major cardiovascular events. Methods We performed an intention-to-treat meta-analysis in line with recommendations from the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement using currently available studies involving PCSK9 inhibitors. The endpoint assessed were acute coronary syndrome (ACS) and stroke. Results We included 81,544 patients, 41,147 treated with a PSCK9 inhibitors: 17,179 with evolocumab; 13,718 with bococizumab and 10,250 with alirocumab (table 1). A total of 1,316 ACS were registered in the treatment group vs. 1,608 in controls, resulting in 18.0% reduction associated with PCSK9 treatment (figure 1). This result was reproduced exactly in the EBCT althougt a non-significant heterogeneity was detected (p=0.052). Metaregression analyses did not demonstrate the implication of the study (p=0.45), study drugs (p=0.26), age (p=0.89), hypertension (p=0.81) or diabetes (p=0.81) on such result. Results on stroke incidence are presented in figure 2. PCSK9 inhibitors treatment resulted in a 24% reduction of stroke when all studies were analyzed together; heterogeneity was statistically significant (p=0.021) but it was not observed in the EBCT analysis where PCSK9 inhibitors were associated with 24% stroke incidence reduction. Conclusions The meta-analysis of currently available studies demonstrates that PCSK9 inhibitors treatment reduces the incidence of ACS by 18% and stroke by 24%.

scholarly journals Budget impact analysis of PCSK9 inhibitors costs from a community payers’ perspective in Apulia, Italy

Open Heart ◽  
2019 ◽  
Vol 6 (2) ◽  
pp. e001018 ◽  
Author(s):  
Natale Daniele Brunetti ◽  
Luisa De Gennaro ◽  
Lucia Tricarico ◽  
Pasquale Caldarola
Keyword(s):  
High Risk ◽  
Cardiovascular Event ◽  
Cardiovascular Events ◽  
Impact Analysis ◽  
Budget Impact ◽  
Cardiovascular Outcomes ◽  
Budget Impact Analysis ◽  
Randomised Trials ◽  
Pcsk9 Inhibitors ◽  
Coronary Syndrome

IntroductionDespite established clinical efficacy of PCSK9 inhibitors (PCSK9i) in reducing cardiovascular events, their cost still represents a big matter of debate. We therefore sought to estimate possible impact of PCSK9i therapy from a community taxpayers’ perspective with a budget impact analysis based on data coming from two randomised trials (FOURIER (Further Cardiovascular Outcomes Research with PCSK9 Inhibition in Subjects with Elevated Risk), ODYSSEY OUTCOMES (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab)).MethodsThe analysis focused on Apulia region, South-Eastern Italy (4 million inhabitants). Costs per cardiovascular event saved were calculated from randomised trials data and annually indexed per Apulia’s inhabitants.ResultsOn the base of actual cost in Apulia, individual costs per saved adverse event ranged from €0.12 to €0.78, with just €1 annually spent per Apulia’s inhabitant, 2–8.3 events could be avoided thanks to the use of PCSK9i.When considering high-risk subgroups (baseline cholesterol levels >100 mg/dL, multivessel coronary disease), the annual cost per Apulia’s inhabitant for one death avoided was more than halved to €0.19 and the cost for a saved major adverse cardiovascular event was €0.07. With €1 annually spent per Apulia’s inhabitant, 10.9–15 major adverse cardiovascular events and 5.3 deaths could be saved.ConclusionsWhen considered from a large taxpayers’ community perspective, relevant costs per cardiovascular event saved with PCSK9i may turn into very small individual costs per year. The selection of high-risk subgroups may further reduce individual costs.

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