Analysis of LpA levels in young patients after ACS: getting to know less famous risk factors

Abstract Introduction Lipoprotein A (LpA) has been shown to be an emerging risk factor, proposing that values greater than 60 mg/dl increases cardiovascular risk. There are few data about LpA values in young patients who have suffered a major cardiovascular event. Purpose The objective of this work was to describe the LpA values observed in young patients admitted for acute coronary syndrome in our center, and subsequently to compare these values according to the patients' previous cardiovascular risk. Methods This is a descriptive and observational study, in which all male patients under 65 years and women under 70 years who have suffered STEMI or NSTEMI from November 2019 to February 2021 admitted to our center were consecutively included. In addition to LpA values, the following variables were recollected: age, sex, high blood pressure, diabetes mellitus, dyslipidemia, stroke, chronic kidney injury, smoking, alcoholism, toxics, total cholesterol and SCORE risk. Results 159 patients were included. The mean of LpA value was 41,08 mg/dl (standard deviation 38, range 1–155, percentile 25th: 9,7; percentile 50th: 28,8; percentile 75th: 59,1). 24,5% presented levels of LpA greater than 60 mg/dl. The percentage of patients with LpA levels >60 mg was 32,4% in low SCORE group and 22,4% in greater than low SCORE group without significant differences. The table compares the LpA values according to the cardiovascular risk SCORE those patients presented before the acute coronary syndrome (low SCORE vs moderate, high or very high SCORE). As we can see in the table, we found a trend to present higher LpA values in patients with low SCORE risk compared to those with higher than low SCORE risk, without reaching statistical significance. Conclusions In a sample of young patients with acute coronary syndrome, the LpA mean was 41,08 mg/dl. 24,5% of patients had values of LpA greater than 60 mg/dl. No significant differences were found according to the SCORE prior to the event, although there was a non-significant trend towards a higher LpA in patients with low SCORE. FUNDunding Acknowledgement Type of funding sources: None. Table 1. LpA values

Download Full-text

Do You Know How Young Your Heart Is?

ARS Medica Tomitana ◽

10.2478/arsm-2018-0012 ◽

2018 ◽

Vol 24 (2) ◽

pp. 66-71

Author(s):

Tase Cristina Ramona ◽

Cojocaru Lucia ◽

Rusali Andrei ◽

Suta Cristina

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Acute Coronary Syndrome ◽

Cardiovascular Risk ◽

Chest Pain ◽

Young Patients ◽

Good Clinical Outcome ◽

Know How ◽

Coronary Syndrome ◽

First Time

Abstract We present the case of a 25 years old patient who was submitted to our unit with a first time acute coronary syndrome. Despite his young age he had multiple cardiovascular risk factors. Although the chest pain was atypical and the electrocardiogram on presentation had unspecific changes, repeated investigations established the diagnosis of anterolateral myocardial infarction. Per primam angioplasty with stent implantation in the proximal segment of left anterior descending artery was performed, with good clinical outcome. Awareness is the key in establishing the diagnosis of myocardial infarction in young patients.

Download Full-text

P4590Temporal trends of the characteristics, management, and clinical outcomes of patients with acute coronary syndrome and multi-vessel disease - the ACSIS registry

European Heart Journal ◽

10.1093/eurheartj/ehz745.0975 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

A Shiyovich ◽

N Shlomo ◽

Z Iakobishvili ◽

R Kornowski ◽

A Eisen

Keyword(s):

Risk Factors ◽

Acute Coronary Syndrome ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Clinical Outcomes ◽

Statistical Significance ◽

Temporal Trends ◽

Coronary Intervention ◽

Coronary Syndrome ◽

Vessel Disease

Abstract Introduction Multi-vessel coronary artery disease (MVD) is common among patients with acute coronary syndrome (ACS) and is associated with worse outcomes compared with single-vessel disease. Multiple studies focused particularly on patients with ACS and MVD and their results were incorporated into guidelines' recommendations. Objectives To examine temporal trends in clinical characteristics, treatment and outcomes of patients presenting with ACS and MVD. Methods Time- dependent analysis of patients enrolled in the biennial ACS Israeli Surveys (ACSIS) between 2000 and 2016 according to three time periods: early (2004–2006; n=2,111), mid (2008–2010; n=2,049), and late (2013–2016; n=2,010). MVD was defined as >50% stenosis in ≥2 separate major coronary territories at the index ACS. Clinical outcomes were 30-day MACE (death, unstable angina, myocardial infarction, stroke, stent thrombosis, urgent revascularization) and 30-days and 1-year mortality. Results Overall 6,170/15,000 patients (41.1%) had MVD (age 64.5±12.1, males 80%). Patients admitted in the later periods were older with a higher prevalence of cardiovascular risk factors and their treatment (i.e. statins, and hypoglycemic drugs) prior to admission. The rate of CABG has decreased and of MV percutaneous coronary intervention and guideline recommended medical treatment has increased with time. At 30 days, the rates of mortality, MACE and re-infarction have decreased (Figure). A trend of reduction in 1-year mortality was observed with time, yet it did not reach statistical significance (early=9.3%, mid=7.8%, late=7.7%, P=0.13). A multivariate adjusted analysis demonstrated that the mid and late periods were associated with significantly reduced risk for 30-day MACE (OR=0.65 [0.54–0.77] and 0.54 [0.45–0.65], respectively). Figure 1. Temporal trends in 30-day outcomes of patients with ACS and MVD Conclusions During the last decade, the burden of cardiovascular risk factors among ACS patients with MVD has increased, more extensive invasive and medical treatments were provided and significant improvements in 30-day outcomes were observed. Acknowledgement/Funding None

Download Full-text

Frequency and outcome of acute coronary syndrome during the Covid-19 pandemic

European Heart Journal ◽

10.1093/eurheartj/ehab724.1327 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

R A Mousavi ◽

C Wallmueller ◽

P Stratil ◽

G Pichler ◽

F Piringer ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Coronary Syndrome ◽

Statistical Significance ◽

Admission Rate ◽

Blood Parameters ◽

Hospital Death ◽

Admission Rates ◽

Coronary Syndrome ◽

Funding Sources ◽

Heart Center

Abstract Introduction In 2020 the Austrian government has ordered two complete lockdowns and two lockdown lights to maintain control over the infection rate of Covid-19. Several studies have analysed the frequency and outcome of patients with acute coronary syndrome (ACS) during the pandemic. Some have described a decrease in the admission rate of patients with ST-elevated-myocardial-infarction (STEMI) and no-ST-elevated-myocardial-infarction (NSTEMI), with the reasons still being discussed. Purpose The aim of this study is to analyse possible differences in frequency, comorbidities and outcome of all STEMI and NSTEMI admissions over various lockdown (L) periods in Austria and to provide a possible explanation for the results. Methods Analysis of prospectively gathered data on ACS patients in our heart center in the year 2020. Patients were split into 4 groups: no lockdown (NL): n=136; duration (dur): 36 weeks (w); lockdown 1 (L1): n=24; dur: 7w; lockdown 2 (L2): n=16; dur: 2.5w; lockdown light (LL): n=22; dur: 5.5w. To account for the different durations, we divided patients by lockdown duration (n/w). End of a L was defined as re-opening of shops; in LL period schools and restaurants were closed but shops were open. To compare the different groups, age, sex, BMI, comorbidities, cardiovascular risk factors (CVRF) duration of preclinical-symptomatic phase (onset of chest pain to PCI), blood parameters, indication, vascular access (femoral/radial) and target vessel were recorded. As outcome we defined CPR, shock and in hospital death. Results Out of 198 patients 126 were male (63.6%) and 72 female (36.4%), with a mean age of 65±12 years. There were no statistically significant differences in age, BMI or CVRF between the 4 groups. A 50% higher number of diabetics in the LL group as compared to 25.3% in the NL group (p=0.005) was noticed. STEMI admissions from 2.2 patients/week (n/w) without L decreased to 1.4/w during L1. During L2, the frequency rate rose to 3.2/w in the LL group and admission rates to 2/w, which is almost as high as in the NL group. No differences in NSTEMI admissions between the NL (1.3/w), the L1 (1.4/w) and the LL group (1.8/w) were found. During L2 the frequency of NSTEMI patients increased to 3.2/w. We found a rise in in-hospital death rates from 4.4% without L to 9.1% during LL, though with boarder line statistical significance (p=0.05). Conclusion Compared to the NL group, our data show a decrease of STEMI and NSTEMI admissions during L1. This trend was not confirmed during L2, despite identical government's restrictions. We, thus, postulate that the decrease of ACS admissions in L1 was caused by patients' concern regarding in-hospital Covid-19 infection rather than by actual restrictions. Funding Acknowledgement Type of funding sources: None.

Download Full-text