J-shaped relationship between admission diastolic blood pressure and 2-year cardiovascular mortality in elderly patients with acute coronary syndrome

Abstract Objective To investigate the relationship between admission diastolic blood pressure (DBP) and subsequent cardiovascular and all-cause mortality in elderly patients with acute coronary syndrome (ACS). Methods This is a retrospective observational study. Consecutive patients ≥65 years of age admitted for ACS at a 2,300-bed tertiary hospital from December 2012 to July 2019 were included. The association between admission DBP and cardiovascular and all-cause mortality during hospitalization and over the follow-up period among this population were analyzed using multivariate COX regression model. Results were presented according to DBP quartiles: Q1, less than 67 mm Hg; Q2, from 67 to 72 mm Hg; Q3, from 73 to 80 mm Hg; and Q4, above 80 mm Hg. Results A total of 6 785 patients were included in this cohort study. Mean (SD) patient age was 74.0 (6.5) years, and 47.6% were women. Mean (SD) follow-up time was 2.54 (1.82) years. A non-linear relation was observed between DBP at admission and cardiovascular and all-cause mortality during hospitalization and over the follow-up period using restricted cubic splines. After adjustment for potential confounders, patients in Q3 or Q2 had lower risk for 2-year cardiovascular death by Cox proportional hazard model compared with patients in Q4 (hazard ratio [HR] 0.66; 95% confidence interval [CI], 0.48–0.90, P=0.010, for Q3 vs Q4; and HR 0.72; 95% CI, 0.53–0.99, P=0.041, for Q2vs Q4), while patients in Q1 had similar risk for cardiovascular death with that of patients in Q4. Meanwhile, when compared with patients in Q1, patients in Q3 had lower risk for 2-year cardiovascular death (HR, 0.72; 95% CI, 0.53–0.97, P=0.033). However, lower or higher admission DBP was not an independent predictor of 2-year all-cause mortality in this population. Conclusion Among patients aged ≥65 years admitted for ACS, there is a J-curve relationship between supine admission DBP and risk for 2-year cardiovascular death, with a nadir at 73–80 mm Hg. FUNDunding Acknowledgement Type of funding sources: Other. Main funding source(s): the Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support Study population and selection Adjusted multivariate COX regression

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Relationship between diastolic blood pressure and the first ischaemic stroke in elderly patients with hypertension

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2019-137018 ◽

2019 ◽

Vol 96 (1139) ◽

pp. 525-529

Author(s):

Chao-Lei Chen ◽

Jia-Yi Huang ◽

Lin Liu ◽

Yu-Ling Yu ◽

Geng Shen ◽

...

Keyword(s):

Blood Pressure ◽

Elderly Patients ◽

Ischaemic Stroke ◽

Diastolic Blood Pressure ◽

Cox Regression ◽

Interaction Analysis ◽

Cox Regression Analysis ◽

Elder Patients ◽

Adjusted Model

BackgroundIt is uncertain how diastolic blood pressure (DBP) may associate with ischaemic stroke in elder patients with hypertension. We aimed to explore this relationship in a Chinese community.MethodsA total of 3315 participants aged ≥60 years with essential hypertension were enrolled between January 2010 and December 2011, and being followed up until 31 December 2016. DBP levels were categorised into five groups (<60, 60–70, 70–80, 80–90 and ≥90 mm Hg), using 70–80 mm Hg as referent. We performed Cox regression analysis and subgroup analyses to evaluate the relationship between DBP and the incidence of ischaemic stroke.ResultsAmong the 3315 participants, 44.49% were men and they were 71.4 years old on average. During a median follow-up period of 5.5 years, there were 206 onset cases of ischaemic stroke. The HRs for the first ischaemic stroke in the fully adjusted model were 1.32 (95% CI 0.73 to 2.40) for DBP <70 mm Hg, 1.50 (95% CI 1.13 to 2.73) for DBP between 80 and 89.9 mm Hg and 2.31 (95% CI 1.14 to 4.68) for DBP ≥90 mm Hg compared with DBP between 70 and 79.9 mm Hg (p=0.020 for trend). Subgroup and interaction analysis showed no significant findings.ConclusionsDBP had a non-linear association with the risk of ischaemic stroke among Chinese elderly patients with hypertension. DBP between 70 and 80 mm Hg may be an appropriate indicator for a lower stroke risk.

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P3612Validation of Charlson Comorbidity Index to predict adverse events in elderly patients with Atrial Fibrillation and Acute Coronary Syndrome: an analysis from LONGEVO-SCA Registry

European Heart Journal ◽

10.1093/eurheartj/ehz745.0471 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M A Esteve Pastor ◽

E Marin ◽

O Alegre ◽

J C Castillo Dominguez ◽

F Formiga ◽

...

Keyword(s):

Atrial Fibrillation ◽

Acute Coronary Syndrome ◽

Adverse Events ◽

Elderly Patients ◽

Predictive Performance ◽

Coronary Syndrome ◽

C Statistic ◽

All Cause Mortality ◽

Comorbidity Index

Abstract Background Aging is frequently characterized by the coexistence of several comorbid conditions that increase the adverse prognosis during hospitalization. There are few scores to analyze the impact of comorbidities in prognosis. Charlson Comorbidity Index (CCI). This score evaluates the burden of comorbidity in general population but the influence within cardiac diseases is unknown. Purpose The aim of this study was to analyze the relationship of CCI in adverse outcomes at short-term follow-up in elderly patients with atrial fibrillation (AF) admitted after an acute coronary syndrome (ACS). Methods The prospective multicenter LONGEVO-SCA included unselected elderly patients hospitalized after non-STACS. In this substudy, we analyze the influence of comorbidities in elderly AF patients, comparing high quartiles of CCI (Q3-Q4: high burden of comorbidities) to low quartiles (Q1-Q2) and the predictive performance of adverse events at 6 months follow-up of CCI. Results We analyzed 531 patients (mean age 84.4±3.6 years; 322 (60.6%) male). 128 (24.1%) had AF diagnosis. 91 (71.1%) patients were classified into Q1-Q2 and 37 (28.9%) patients into Q3-Q4. We analyzed the association of clinical factors and adverse events and, after Cox multivariate regression analysis, CCI was independently associated with readmissions [HR 1.19, 95% CI (1.02–1.39); p=0.020) and all-cause mortality [HR 1.32, 95% CI (1.09–1.59); p=0.003]. Patients into Q3-Q4 had higher risk of mortality than patients into Q1-Q2 [HR 5.52, 95% CI (1.01–30.3); p=0.049]. Kaplan Meier analysis showed that AF patients into Q3-Q4 had significantly worse prognosis during the follow-up with high risk of all-cause mortality (p=0.034) and readmissions due to ACS (p=0.027). We observed good predictive performance of CCI for mortality (c-statistic 0.705; p<0.001) and modest predictive performance for readmissions (c-statistic 0.627; p<0.001). Event Free Survival according Charlson Conclusions Patients into high quartiles of CCI had higher risk of adverse events during the follow-up. CCI was an independent predictor of all-cause mortality and readmissions in elderly patients. Indeed, this is the first time to validate CCI to predict adverse events in AF patients with ACS.

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Moderate coffee consumption associated with lower risk of mortality in prior Acute Coronary Syndrome patients: prospective analysis in ERICO cohort

Proceedings of The Nutrition Society ◽

10.1017/s0029665120006321 ◽

2020 ◽

Vol 79 (OCE2) ◽

Author(s):

Andreia Miranda ◽

Alessandra Goulart ◽

Isabela Benseñor ◽

Paulo Lotufo ◽

Dirce Marchioni

Keyword(s):

Acute Coronary Syndrome ◽

Lower Risk ◽

Coffee Consumption ◽

Positive Association ◽

Inverse Association ◽

Coffee Intake ◽

Coronary Syndrome ◽

Risk Of Mortality ◽

All Cause Mortality

AbstractCoffee is one of the most widely consumed beverages around the world. Several studies have observed an inverse association between coffee consumption and all-cause mortality in population-based studies. Nevertheless, little is known about these associations in patient populations with a prior Acute Coronary Syndrome (ACS). To examine the association between coffee consumption and the risk of mortality in patients with a prior acute myocardial infarction (MI) or unstable angina. Data were from the longitudinal prospective study “Strategy of Registry of Acute Coronary Syndrome Cohort - ERICO”. The cohort involved 1,085 patients diagnosed with ACS, between 2009 to 2013. For this analysis we used data after 180 days until 4 years’ follow-up, totalizing 928 participants. The coffee consumption was obtained using a questionnaire multiplying the reported frequency by the reported portion size. Subsequently was calculated the average of coffee intake (mL/day) and categorized (cups/day) into ≤ 1, 1–3, and > 3. Information on mortality was ascertained by medical registries and death certificates. Cox regression models to estimate hazard ratios (HRs) for mortality according to coffee consumption adjusted for potential confounders were performed. Kaplan-Meier survival curves with the log-rank test were analyzed. Most patients (99.0%) drank coffee, and the median total coffee intake was 125 mL/day. During a median follow-up of 4 years, a total of 111 deaths occurred, including 59 CVD-related and 24 MI-related deaths. Moderate coffee consumption was inversely associated with all-cause mortality. Participants who consumed 1–3 cups of coffee/day, showed an 81% lower risk of all-cause mortality than those who consumed ≤ 1 cup/day (adjusted HR 0.19; 95%CI: 0.11, 0.34). For patients with higher coffee consumption (> 3 cups/day), there was a positive association with mortality, with HR of 2.10 (95%CI: 1.05, 4.22). Corresponding HRs were 0.22 (95%CI: 0.11, 0.48) for 1–3 cups/day and 2.66 (95%CI: 1.04, 6.83) for > 3 cups/day for CVD mortality; and 0.23 (95%CI: 0.07, 0.71) and 1.59 (95%CI: 0.25, 10.0) for MI mortality, respectively. After stratification by smoking status the analysis revealed lower risk of all-cause mortality in never and former smokers drinking 1–3 cups/day (HRs 0.10; 95%CI: 0.04, 0.24 and 0.18; 0.08, 0.42, respectively). Among current smokers there was a positive association between > 3 cups/day and mortality (HR 8.50; 95%CI: 1.18, 16.35). The moderate consumption of coffee, impacted in a lower risk of all-cause, CVD and MI mortality in patients with a prior Acute Coronary Syndrome, particularly in nonsmokers.

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Hyperuricemia is a Risk Factor for One-Year Overall Survival in Elderly Female Patients with Acute Coronary Syndrome

Cardiovascular Therapeutics ◽

10.1155/2020/2615147 ◽

2020 ◽

Vol 2020 ◽

pp. 1-10 ◽

Cited By ~ 1

Author(s):

Shi Tai ◽

Xuping Li ◽

Zhaowei Zhu ◽

Liang Tang ◽

Hui Yang ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Risk Factor ◽

Elderly Patients ◽

Independent Risk Factor ◽

Female Patients ◽

Coronary Syndrome ◽

Elderly Female ◽

All Cause Mortality ◽

The Impact

Background. Hyperuricemia is a risk factor for cardiovascular diseases, but the impact of hyperuricemia and sex-related disparities is not fully clear in elderly patients with acute coronary syndrome (ACS). Objective. To investigate the association between hyperuricemia and 1-year all-cause mortality in elderly patients with ACS. Methods. This retrospective cohort study included 711 consecutive ACS patients aged ≥75 years, hospitalized in our center between January 2013 and December 2017. Serum uric acid (sUA), in-hospital events, and 1-year follow-up were analyzed. Multivariable logistic regression models were used to explore the risk factors for in-hospital events and 1-year all-cause mortality. Results. sUA levels were higher in males than in females (381.4 ± 110.1 vs. 349.3 ± 119.1 μmol/l, P<0.001). Prevalence of hypertension (80.5% vs. 72.6%, P=0.020), atrial fibrillation (16.2% vs. 9.5%, P=0.008), and severe heart failure (61.0% vs. 44.2%, P<0.001) were higher in patients with hyperuricemia than in patients with normal sUA. During the 1-year follow-up, 135 patients died (19.0%); all-cause mortality was higher in patients with hyperuricemia than in patients with normal sUA (23.1% vs. 16.7%, P=0.039). Hyperuricemia is related to in-hospital ventricular tachycardia and 1-year all-cause mortality (OR = 1.799, 95% CI 1.050–3.081, P=0.033; OR = 1.512, 95% CI 1.028–2.225, P=0.036, respectively). Multivariable regression analysis models showed that hyperuricemia was an independent risk factor of 1-year all-cause mortality in women (OR = 2.539, 95% CI 1.001–6.453, P=0.050), but not in men (OR = 0.931, 95% CI 0.466–1.858, P=0.839) after adjustment for confounding variables. Conclusions. Hyperuricemia is an independent risk factor for 1-year all-cause mortality in elderly female patients with ACS.

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Comparison of Safety and Efficacy Between Clopidogrel and Ticagrelor in Elderly Patients With Acute Coronary Syndrome: A Systematic Review and Meta-Analysis

Frontiers in Pharmacology ◽

10.3389/fphar.2021.743259 ◽

2021 ◽

Vol 12 ◽

Author(s):

Xiangkai Zhao ◽

Jian Zhang ◽

Jialin Guo ◽

Jinxin Wang ◽

Yuhui Pan ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Elderly Patients ◽

Meta Analysis ◽

Adenosine Diphosphate ◽

Cardiovascular Death ◽

Minor Bleeding ◽

Efficacy And Safety ◽

Coronary Syndrome ◽

All Cause Mortality ◽

Receptor Inhibitor

Background: Dual antiplatelet therapy combining aspirin with a P2Y12 adenosine diphosphate receptor inhibitor is a therapeutic mainstay for acute coronary syndrome (ACS). However, the optimal choice of P2Y12 adenosine diphosphate receptor inhibitor in elderly (aged ≥65 years) patients remains controversial. We conducted a meta-analysis to compare the efficacy and safety of ticagrelor and clopidogrel in elderly patients with ACS. Methods: We comprehensively searched in Web of Science, EMBASE, PubMed, and Cochrane databases through 29th March, 2021 for eligible randomized controlled trials (RCTs) comparing the efficacy and safety of ticagrelor or clopidogrel plus aspirin in elderly patients with ACS. Four studies were included in the final analysis. A fixed effects model or random effects model was applied to analyze risk ratios (RRs) and hazard ratios (HRs) across studies, and I2 to assess heterogeneity.Results: A total number of 4429 elderly patients with ACS were included in this analysis, of whom 2170 (49.0%) patients received aspirin plus ticagrelor and 2259 (51.0%) received aspirin plus clopidogrel. The ticagrelor group showed a significant advantage over the clopidogrel group concerning all-cause mortality (HR 0.78, 95% CI 0.63–0.96, I2 = 0%; RR 0.79, 95% CI 0.66–0.95, I2 = 0%) and cardiovascular death (HR 0.71, 95% CI 0.56–0.91, I2 = 0%; RR 0.76, 95% CI 0.62–0.94, I2 = 5%) but owned a higher risk of PLATO major or minor bleeding (HR 1.46, 95% CI 1.13–1.89, I2 = 0%; RR 1.40, 95% CI 1.11–1.76, I2 = 0%). Both the groups showed no significant difference regarding major adverse cardiovascular events (MACEs) (HR 1.06, 95% CI 0.68–1.65, I2 = 77%; RR 1.04, 95% CI 0.69–1.58, I2 = 77%).Conclusion: For elderly ACS patients, aspirin plus ticagrelor reduces cardiovascular death and all-cause mortality but increases the risk of bleeding. Herein, aspirin plus ticagrelor may extend lifetime for elderly ACS patients compared with aspirin plus clopidogrel. The optimal DAPT for elderly ACS patients may be a valuable direction for future research studies.

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Carotid Vascular Strain Predicts Cardiovascular Events in Patients with Hypertension

10.22541/au.162256869.92141960/v1 ◽

2021 ◽

Author(s):

Wei-Chuan Tsai ◽

Wen-Huang Lee ◽

Huey-Ru Tsai ◽

Mu-Shiang Huang

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Diastolic Blood Pressure ◽

Cardiovascular Events ◽

Speckle Tracking ◽

Cox Regression ◽

Cox Regression Analysis ◽

Coronary Syndrome ◽

Major Cardiovascular Events

Background: We aim to investigate prognostic effects of carotid strain (CS) and strain rate (CSR) in hypertension. Methods: We prospectively recruited 120 patients being treated for hypertension (65.8 ± 11.8 years, 58% male) in this observational study. Peak circumferential CS and peak CSR after ejection were identified using two-dimensional speckle tracking ultrasound. Major cardiovascular events were any admission for stroke, acute coronary syndrome, and heart failure. Results: After a mean follow-up period of 63.6 ± 14.5 months, 14 (12%) patients had cardiovascular events. Age (75.3 ± 9.2 vs. 64.6 ± 11.6 years; p = 0.001), systolic blood pressure (131.8 ± 15.5 vs. 143.1 ± 16.6 mmHg; p = 0.021), diastolic blood pressure (74.6 ±11.4 vs. 82.1 ± 12.2 mmHg; p = 0.039), use of diuretics (71 vs. 92 %; p = 0.014), carotid CS (2.17 ± 1.02 vs. 3.28 ± 1.14 %; p = 0.001), and CSR (0.28 ± 0.17 vs. 0.51 ± 0.18 1/s; p <0.001) were significantly different between the patients who did and did not reach the end-points. Multivariate Cox regression analysis controlling for age, systolic blood pressure, diastolic blood pressure, and use of diuretics showed that CS (HR 0.425, 95%CI 0.223-0.811, p = 0.009) and CSR (HR 0.001, 95%CI 0.000-0.072, p = 0.001) were independent predictors for cardiovascular events. Conclusion: In conclusions, decreased CS and CSR were associated with cardiovascular events in hypertension.

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P3613J-shaped relationship between cardiac mortality risk and admission systolic blood pressure in patients aged 65 years and over with acute coronary syndrome

European Heart Journal ◽

10.1093/eurheartj/ehz745.0472 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

C Y Jiang ◽

H W Li

Keyword(s):

Blood Pressure ◽

Acute Coronary Syndrome ◽

Systolic Blood Pressure ◽

Cardiac Death ◽

Cardiac Mortality ◽

Coronary Syndrome ◽

Kaplan Meier ◽

All Cause Mortality

Abstract Objective To observe the effects of different admission systolic blood pressure (SBP) levels on the in-hospital and long-term prognosis of elderly patients with acute coronary syndrome (ACS). Methods This retrospective cohort study included 5812 ACS patients aged 65 and over admitted from January, 2013 to September, 2018. Their blood pressure, medical history and laboratory examinations were recorded. The patients were divided into 5 groups according to the level of admission SBP (<100, 100–119, 120–139, 140–159, and ≥160 mmHg). The main endpoint of this study was cardiac death and all-cause death in hospital and during 6-year follow-up. Results Among the participants, the number of patients admitted with SBP <100, 100–119, 120–139, 140–159, and ≥160 mmHg were 143 (2.5%), 1014 (17.4%), 2456 (42.3%), 1607 (27.6%), and 592 (10.2%), respectively. The highest in-hospital cardiac mortality and all-cause mortality rate were found in the group with admission SBP <100 mmHg and the lowest were found in the group with SBP 140–159 mmHg (9.1% vs. 3.2% vs. 1.1% vs. 0.8% vs. 1.5%, P=0.000; 9.8% vs. 3.4% vs. 1.1% vs. 0.8% vs. 1.7%, P=0.000). Kaplan-Meier curve showed that patients with SBP 120–139 mmHg at admission had better prognosis (cardiac mortality: 3.9% vs. 10.9%, 5.6%, 5.1%, and 6.7% respectively, P=0.000; all-cause mortality: 7.6% vs. 14.7%, 9.7%, 9.1%, and 11.0%, respectively, P=0.000). Multivariate analysis showed that admission SBP <120 mmHg or ≥160 mmHg was a independent predictors of follow-up cardiac death (HR 1.747, 95% CI 1.066–2.861, P=0.027; HR 1.496, 95% CI 1.092–2.050, P=0.012; HR 1.630, 95% CI 1.120–2.372, P=0.011) compared with patients admitted with SBP 120–139 mmHg. In-hospital and 6-year follow-up outcomes of ACS patients ≥65y by admission SBP Admission SBP Level <100mmHg ≥100mmHg and <120mmHg ≥120mmHg and <140mmHg ≥140mmHg and <160mmHg ≥160mmHg P In-hospital (n=143) (n=1014) (n=2456) (n=1607) (n=592) Cardiac mortality, n (%) 13 (9.1) 32 (3.2) 28 (1.1) 13 (0.8) 9 (1.5) 0.000 All-cause mortality, n (%) 14 (9.8) 34 (3.4) 28 (1.1) 13 (0.8) 10 (1.7) 0.000 Follow-up (n=129) (n=980) (n=2428) (n=1594) (n=582) Cardiac mortality, n (%) 14 (10.9) 55 (5.6) 94 (3.9) 81 (5.1) 39 (6.7) 0.000 All-cause mortality, n (%) 19 (14.7) 95 (9.7) 185 (7.6) 144 (9.1) 64 (11.0) 0.000 Kaplan-Meier analyses Conclusion In ACS patients ≥65 y, a “J” relationship between admission SBP and cardiac mortality is observed. For ACS patients aged 65 years and over, admission SBP <120 mmHg or ≥160mmHg is a independent risk factor for long-term cardiac death. Acknowledgement/Funding National Natural Science Foundation of China (No. 81300333))

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Macrophage infiltrates in coronary plaque erosion portend a worse cardiovascular outcome in patients with acute coronary syndrome

European Heart Journal ◽

10.1093/ehjci/ehaa946.1250 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

R.A Montone ◽

V Vetrugno ◽

M Camilli ◽

M Russo ◽

M.G Del Buono ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Vulnerable Plaque ◽

Cardiac Death ◽

Cox Regression ◽

Plaque Rupture ◽

Culprit Lesion ◽

Coronary Syndrome ◽

Fibrous Cap ◽

Plaque Erosion

Abstract Background Plaque erosion (PE) is responsible for at least one-third of acute coronary syndrome (ACS). Inflammatory activation is considered a key mechanism of plaque instability in patients with plaque rupture through the release of metalloproteinases and the inhibition of collagen synthesis that in turns lead to fibrous cap degradation. However, the clinical relevance of macrophage infiltration has never been investigated in patients with PE. Purpose In our study, we aimed at assessing the presence of optical coherence tomography (OCT)-defined macrophage infiltrates (MØI) at the culprit site in ACS patients with PE, evaluating their clinical and OCT correlates, along with their prognostic value. Methods ACS patients undergoing OCT imaging and presenting PE as culprit lesion were retrospectively selected. Presence of MØI at culprit site and in non-culprit segments along the culprit vessel was assessed. The incidence of major adverse cardiac events (MACEs), defined as the composite of cardiac death, recurrent myocardial infarction and target vessel revascularization (TVR), was assessed [follow-up median (interquartile range, IQR) time 2.5 (2.03–2.58) years]. Results We included 153 patients [median age (IQR) 64 (53–75) years, 99 (64.7%) males]. Fifty-one (33.3%) patients presented PE with MØI and 102 (66.7%) PE without MØI. Patients having PE with MØI compared with PE patients without MØI had more vulnerable plaque features both at culprit site and at non-culprit segments. In particular, culprit lesion analysis demonstrated that patients with PE with MØI had a significantly thinner fibrous cap [median (IQR) 100 (60–120) μm vs. 160 (95–190) μm, p<0.001], higher prevalence of thrombus [41 (80.4%) vs. 64 (62.7%), p=0.028], lipid plaque [39 (76.5%) vs. 50 (49.0%), p<0.001], TCFA [20 (39.2%) vs. 14 (13.7%), p=0.001], and a higher maximum lipid arc [median [IQR] 250.0° (177.5°-290.0°) vs. 190.0° (150.0°-260.0°), p=0.018) at the culprit lesion compared with PE without MØI. MACEs were significantly more frequent in PE with MØI patients compared with PE without MØI [11 (21.6%) vs. 6 (5.9%), p=0.008], mainly driven by a higher risk of cardiac death and TVR. At multivariable Cox regression model, PE with MØI [HR=2.95, 95% CI (1.09–8.02), p=0.034] was an independent predictor of MACEs. Conclusion Our study demonstrates that among ACS patients with PE the presence of MØI at culprit lesion is associated with a more aggressive phenotype of coronary atherosclerosis with more vulnerable plaque features, along with a worse prognosis at a long-term follow-up. These findings are of the utmost importance in the era of precision medicine because clearly show that macrophage infiltrates may identify patients with a higher cardiovascular risk requiring more aggressive secondary prevention therapies and a closer clinical follow-up. Prognosis Funding Acknowledgement Type of funding source: None

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Baseline Diastolic Blood Pressure and Cardiovascular Outcomes in SPRINT Participants with Chronic Kidney Disease

Kidney360 ◽

10.34067/kid.0000982019 ◽

2020 ◽

Vol 1 (5) ◽

pp. 368-375

Author(s):

Tara I. Chang ◽

Guo Wei ◽

Robert Boucher ◽

Holly Kramer ◽

Glenn M. Chertow ◽

...

Keyword(s):

Blood Pressure ◽

Cox Regression ◽

Acute Decompensated Heart Failure ◽

Decompensated Heart Failure ◽

Cardiovascular Death ◽

Linear Interaction ◽

Coronary Syndrome ◽

End Point ◽

Interaction Terms ◽

Lower Baseline

BackgroundWe sought to determine whether intensive systolic BP (SBP) lowering was harmful in Systolic Blood Pressure Intervention Trial (SPRINT) participants with CKD (eGFR<60 ml/min per 1.73 m2) and lower baseline diastolic BP (DBP).MethodsWe related baseline DBP with the SPRINT primary composite end point (myocardial infarction, acute coronary syndrome, stroke, acute decompensated heart failure, or cardiovascular death) and all-cause death. We examined the effect of intensive SBP lowering on these outcomes across the range of baseline DBPs using Cox regression with treatment by baseline DBP interaction terms.ResultsAmong 2646 SPRINT participants with CKD, lower baseline DBP was associated with a higher adjusted hazard of the primary composite end point and all-cause death. For example, participants with baseline DBP of 61 mm Hg (mean baseline DBP in the lowest tertile) experienced a 37% (95% CI, 7% to 75%) higher hazard of the primary outcome relative to participants with baseline DBP of 75 mm Hg (mean baseline DBP for overall). The benefit of intensive SBP lowering was consistent across a range of baseline DBPs on rates of the primary composite end point (linear interaction P value =0.56) and all-cause death (linear interaction P value =0.20).ConclusionsAmong SPRINT participants with baseline CKD, lower DBP was associated with higher rates of the primary composite end point and all-cause death. However, DBP did not seem to modify the benefit of intensive SBP lowering on the primary composite end point or all-cause death. Our results suggest that lower DBP should not necessarily impede more intensive SBP lowering in patients with mild to moderate CKD.

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COMPARISON STUDY OF IVABRADINE WITH METOPROLOL IN MANAGEMENT OF ACUTE CORONARY SYNDROME

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i9.2201 ◽

2021 ◽

Vol 5 (9) ◽

Author(s):

Rishman Tandi ◽

Tanvi Kumar ◽

Amritpal Singh Kahlon ◽

Aaftab Sethi

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Acute Coronary Syndrome ◽

Systolic Blood Pressure ◽

Diastolic Blood Pressure ◽

Beta Blocker ◽

Beta Blockers ◽

Coronary Syndrome ◽

Group A ◽

Group B

Introduction: Acute coronary syndrome remains as one of the most important causes for morbidity and mortality in developed countries. Therefore, evidence-based management strategy is required to offset the loss of health during an acute coronary syndrome. An effective approach includes both medical and surgical methods. This study was conducted to evaluate the medical method of management. Objective: To study blood pressure and heart rate variability after administration of Ivabradine or metoprolol in cases with acute coronary syndrome. Materials and methods: The study was a Prospective single center observational study conducted in patients attending Cardiology Intensive Care Unit in Nayyar Heart and Superspecialty Hospital, a tertiary care centre located in an urban area. All patients with Acute coronary syndrome admitted to the emergency or cardiac care unit were analysed with ECG as a preliminary diagnostic test and confirmed with troponin markers. They were either given Ivabradine or Metoprolol. Baseline evaluation and follow up was done and necessary data was collected and analysed. Results: 100 patients were included in the study out of which 50 were given Metoprolol (Group A) and 50 were given Ivabradine (Group B). Themean age of studied cases was found to be 66.54 years in group A and 68.69 years in group B. It was observed that there was a fall in heart rate by 26.8 beats per minute with beta blocker and 24.4 beats per minute with Ivabradine. In case of blood pressure measurement, in patients with beta blocker administration, there was a fall of 25 mm Hg in systolic blood pressure and 17 mm Hg in diastolic blood pressure However, with Ivabradine there was only a fall of 8mm Hg in systolic Blood pressure and 6 mm Hg in diastolic blood pressure. Conclusion: Although Metoprolol is the drug of choice to decrease heart rate and blood pressure in acute coronary syndrome, Ivabradine is being increasingly used in cases where beta blockers are contraindicated as it has similar efficacy in lowering heart rate without compromising contractility of cardiac muscle, thereby maintaining LVEF and blood pressure. Keywords: Acute coronary syndrome, Beta Blockers, Metoprolol, Ivabradine.

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