P1699Non-ST segment elevation miocardial infarction (NSTEMI) vs. Unstable angina (UA) in young women aged < 45 years - differences in symptomatology, clinical course, treatment and prognosis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Beckowski ◽  
M Gierlotka ◽  
L Polonski ◽  
M Gasior ◽  
R Dabrowski ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Unstable Angina ◽  
Young Women ◽  
Clinical Course ◽  
Killip Class ◽  
Diagonal Branch ◽  
St Segment Elevation ◽  
Atypical Symptoms ◽  
Stent Restenosis ◽  
In Stent Restenosis

Abstract Background Almost 50% of all ACS in young women are NSTEMI and UA. Due to the type of ACS we observed differences in the symptomatology, treatment and outcomes. The aim was to evaluate the differences in the clinical course and prognosis in young women aged ≤45 years with NSTEMI vs. UA. Methods We compared 1143 women aged ≤45y.o. with acute cardiac syndromes: 51% NSTEMI, 49% UA from the PL-ACS registry between 2007 - 2014. Results Chest pain was predominant in both group, with a higher incidence in NSTEMI group (91.7% vs. 84.7, p=0.0002). UA group was older (42y.o. vs. 41y.o p=0.003), more often presents atypical symptoms (8.0% vs. 1.5%, p<0,0001) mostly with dyspnea (3.9%vs. 1.7%, p=0.025). During NSTEMI more often occurred pre-hospital cardiac arrest (2.9% vs. 0.8%, p=0.0031). There was no difference between groups in general condition at admission expressed by Killip class. Onset-to-intervention time was longer in UA group (41.8 vs. 30.3 hour p=0.0053) resulted from longer door-to-intervention time only (3.3 vs. 1.5 hour, p<0.0001). In NSTEMI group more often the culprit artery was circumflex (17.1% vs. 9.3% p=0.0004) and diagonal branch (4.4% vs. 1.5%, p=0.0095) with a higher number of total occlusions (pre-procedural TIMI 0: 27.8% vs. 15.6% p=0,0023). Number of PCI was also higher in this group (50.9% vs. 36.1%, p<0.0001) without differences in completed revascularizations. In UA group in stent restenosis was found more often (2.8% vs. 1.5%, p=0.026). Drug eluting stents (DES) were often used in UA group (60.2% vs. 49.6% p=0.027). There were no difference in the incidence of PCI complications. We observed a lower usage of clopidogrel, GP IIb/IIIa inhibitors and parenteral anticoagulant in UA group during hospitalization (for all p<0.0001). Ejection fraction LVEF was higher in UA group (56% vs. 54% p=0.0026) at discharge. The 30-day and 1 year prognosis in both group was low with no statistical difference (Table 1). Table 1. Mortality rate in studied group NSTEMI group (N=580) UA group (N=563) P 30-day mortality 1.60% 0.70% 0.1799 6-month mortality 2.20% 0.90% 0.0662 One year mortality 3.10% 1.60% 0.0940 Conclusions Clinical course of ACS in young women is different regardless of the type of ACS (NSTEMI/UA) however with no difference in mortality rate. Typical symptoms increases the probability of unstable angina (UA) 2.8 times (p=0.0003). In the UA group, ACS was rarely related to circumflex and diagonal branch with more frequent in-stent restenosis. PCI delay in patients with UA results from a longer door-to-ballon time.

Depressed Inflammatory Response to Repeated Angioplasty in Unstable Angina Patients with an In-Stent Restenosis

2004 ◽  
Vol 34 (1) ◽  
pp. 41
Author(s):  
Sang Jin Han ◽  
Young Cheoul Doo ◽  
Goo Yung Cho ◽  
Kyung Soon Hong ◽  
Kyoo Rok Han ◽  
...  
Keyword(s):  
Inflammatory Response ◽  
Unstable Angina ◽  
Stent Restenosis ◽  
In Stent Restenosis

Abstract 5609: In-Stent Restenosis - Benign or Dangerous? Clinical Presentation of Coronary Restenosis in Sweden

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Elmir Omerovic ◽  
Truls Ramunddal ◽  
Lars Grip ◽  
Jan Boren ◽  
Goran Matejka ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Unstable Angina ◽  
Balloon Angioplasty ◽  
Stable Angina ◽  
Metal Stents ◽  
List Type ◽  
Coronary Restenosis ◽  
Coronary Syndrome ◽  
Stent Restenosis ◽  
In Stent Restenosis

Background Restenosis after percutaneous coronary intervention (PCI) was earlier thought to be a benign event clinically manifested as stable exertional angina. The aim of this prospective multicenter registry study was to investigate the incidence of acute coronary syndrome in patients with restenosis in Sweden. Methods Using data from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR), we analyzed all registered cases of PCI for restenosis (in-stent, after balloon angioplasty) from 1995 to 2005 in Sweden. Both multivessel and single vessel interventions were included. Restenosis presentations were classified as: stable angina; unstable angina/non-STEMI; STEMI; and other reasons. As routine angiographic screening was not performed, restenosis episodes were defined clinically based on symptoms. Results We identified 6642 cases of restenosis in 2978 patients (4790 in men, 1852 in women). Restenosis presented in 39.7% of cases as stable angina, in 46.0% as unstable angina/non-STEMI, in 11.5% as STEMI and in 2.8% as other reasons. Cardiogenic shock was reported in 48 patients. Women had a higher incidence of unstable angina/non-STEMI compared with men (52.3% v. 43.6%) but a lower incidence of STEMI (9.6% v. 12.2%). The frequency of STEMI was lower with restenosis after balloon angioplasty v. in-stent restenosis (6.9% v. 13.8%), and after drug-eluting stents v. bare metal stents (7.9% v. 18.5%). Mortality rate was 1.7% at 30 days, 3.2% at 6 months and 4.6% at one year in patients with restenosis. These covariates were independent predictors of acute coronary syndrome: gender, age, vessel diameter, smoking, stent type, number of stents, treated vessel, previous stroke and previous infarction. Conclusion The majority of patients with coronary restenosis present either with acute MI or unstable angina requiring hospitalization and new interventions. Women may have a higher risk of developing acute coronary syndrome due to restenosis. Prevention of restenosis may be an important target for improvement of “hard” clinical outcomes in patients undergoing coronary revascularization.

scholarly journals Gender-based difference in early mortality among patients with STsegment elevation myocardial infarction: insights from Kermanshah STEMI Registry

2020 ◽  
Vol 12 (1) ◽  
pp. 63-68 ◽  
Author(s):  
Soraya Siabani ◽  
Patricia M Davidson ◽  
Maryam Babakhani ◽  
Nahid Salehi ◽  
Yousef Rahmani ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Independent Predictor ◽  
Multivariable Analysis ◽  
Cvd Risk ◽  
Killip Class ◽  
St Segment Elevation ◽  
Gender Based

Introduction: This study aimed to evaluate the in-hospital mortality of patients with ST-segment elevation myocardial infarction (STEMI), according to gender and other likely risk factors.<br /> Methods: This study reports on data relating to 1,484 consecutive patients with STEMI registered from June 2016 to May 2018 in the Western Iran STEMI Registry. Data were collected using a standardized case report developed by the European Observational Registry Program (EORP). The relationship between in-hospital mortality and potential predicting variables was assessed multivariable logistic regression. Differences between groups in mortality rates were compared using chi-square tests and independent t-tests. <br /> Results: Out of the 1484 patients, 311(21%) were female. Women were different from men in terms of age (65.8 vs. 59), prevalence of hypertension (HTN) (63.7% vs. 35.4%), diabetes mellitus (DM) (37.7% vs. 16.2%), hypercholesterolemia (36.7% vs. 18.5%) and the history of previous congestive heart failure (CHF) (6.6% vs. 3.0%). Smoking was more prevalent among men (55.9% vs. 13.2%). Although the in-hospital mortality rate was higher in women (11.6% vs. 5.5%), after adjusting for other risk factors, female sex was not an independent predictor for in-hospital mortality. Multivariable analysis identified that age and higher Killip class (≥II) were significantly associated with in-hospital mortality rate.<br /> Conclusion: In-hospital mortality after STEMI in women was higher than men. However, the role of sex as an independent predictor of mortality disappeared in regression analysis. The gender based difference in in-hospital mortality after STEMI may be related to the poorer cardiovascular disease (CVD) risk factor profile of the women.

FIVE-YEAR-FOLLOW-UP OF PATIENTS WITH UNSTABLE ANGINA: SURGICAL VERSUS MEDICAL TREATMENT

1987 ◽  
Author(s):  
U Nellessen ◽  
S Jost ◽  
H Hecker ◽  
S Specht ◽  
V Danciu ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Unstable Angina ◽  
Clinical Course ◽  
Bypass Graft ◽  
Treated Group ◽  
Kaplan Meier ◽  
Acute Mi ◽  
Artery Disease ◽  
Initial Hospitalization

Among patients (pts) with coronary artery disease those with symptoms of an unstable angina pectoris form a subset particularly jeopardized with regard to threatening myocardial infarction (MI) or cardiac death (CD). We analyzed over 5.4±2.1 years (Y) the clinical course of 123 pts, who between 1977 and 1982 had to be admitted to the intensive care unit for reasons of persisting angina at rest. Within the first 24 hours no patient revealed a significant elevation of serum creatine kinase or typical alterations in the ECG due to acute MI (new Q-waves). During their stay in hospital (19±17 days) 43 pts (37 men, 6 women; age 58±7 Y) were subjected to bypass graft surgery, 80 pts (60 men, 20 women; age 58jh10 Y) were medically treated, 13 of whom underwent subsequent bypass graft surgery because of aggravation of symptoms. The table presents a survey of cardiac mortality and incidence of MI in the collectives with medical and surgical treatment during the stay in hospital and 1, 3 and 5 Y after dismissal (calculated according to the life-table method of Kaplan-Meier).Hence, during the initial hospitalization infarction and mortality rate in the medically treated group indeed were smaller than in the surgical collective; however, after dismissal this beneficial mortality rate turned into the opposite in the course of the following years. In this group nearly every MI was fatal.

scholarly journals Comparison of clinical outcomes after drug-eluting balloon and drug-eluting stent use for in-stent restenosis related acute myocardial infarction: a retrospective study

PeerJ ◽  
2018 ◽  
Vol 6 ◽  
pp. e4646 ◽  
Author(s):  
Chih-Yuan Fang ◽  
Hsiu-Yu Fang ◽  
Chien-Jen Chen ◽  
Cheng-Hsu Yang ◽  
Chiung-Jen Wu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Clinical Outcomes ◽  
Drug Eluting Stent ◽  
St Segment Elevation ◽  
Stent Restenosis ◽  
St Segment ◽  
Drug Eluting ◽  
Drug Eluting Balloon ◽  
In Stent Restenosis

Background Good results of drug-eluting balloon (DEB) use are achieved in in-stent restenosis (ISR) lesions, small vessel disease, long lesions, and bifurcations. However, few reports exist about DEB use in acute myocardial infarction (AMI) with ISR. This study’s aim was to evaluate the efficacy of DEB for AMI with ISR. Methods Between November 2011 and December 2015, 117 consecutive patients experienced AMI including ST-segment elevation MI, and non-ST-segment elevation MI due to ISR, and received percutaneous coronary intervention (PCI). We divided our patients into two groups: (1) PCI with further DEB, and (2) PCI with further drug-eluting stent (DES). Clinical outcomes such as target lesion revascularization, target vessel revascularization, recurrent MI, stroke, cardiovascular mortality, and all-cause mortality were analyzed. Results The patients’ average age was 68.37 ± 11.41 years; 69.2% were male. A total of 75 patients were enrolled in the DEB group, and 42 patients were enrolled in the DES group. The baseline characteristics between the two groups were the same without statistical differences except for gender. Peak levels of cardiac biomarker, pre- and post-PCI cardiac function were similar between two groups. The major adverse cardiac cerebral events rate (34.0% vs. 35.7%; p = 0.688) and cardiovascular mortality rate (11.7% vs. 12.8%; p = 1.000) were similar in both groups. Conclusions DEB is a reasonable strategy for AMI with ISR. Compared with DES, DEB is an alternative strategy which yielded acceptable short-term outcomes and similar 1-year clinical outcomes.

Abstract 3037: Immuno-inflammatory Cascade Activation and Restenosis in Stable and Unstable Angina Patients Undergoing Coronary Interventions

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Georgia Karabela ◽  
Stamatis Adamopoulos ◽  
George Karavolias ◽  
Antigoni Haidaroglou ◽  
Dimitrios Degiannis ◽  
...  
Keyword(s):  
Unstable Angina ◽  
Adhesion Molecule ◽  
Inflammatory Marker ◽  
Control Group ◽  
List Type ◽  
Inflammatory Cascade ◽  
Stent Restenosis ◽  
Plaque Disruption ◽  
Anti Inflammatory ◽  
In Stent Restenosis

Background: Inflammation is an important feature of atherosclerotic lesions and associated with the development of restenosis after coronary angioplasty. The purpose of this study was to investigate whether “active” coronary plaque disruption during percutaneous coronary intervention (PCI), further provokes the activation of immuno-inflammatory cascade and predisposes to restenosis, in stable and unstable angina patients. Methods and Results: We assessed the levels of soluble intercellular adhesion molecule (s-ICAM-1), vascular adhesion molecule (s-VCAM-1), metalloproteinase (MMP-9), metalloproteinase inhibitor (TIMP-2), monocyte chemoattractant proteine-1 (MCP-1), T cells chemoattractant proteine IP-10, interleukine-6 (IL-6), C-reactive proteine (CRP) and anti-inflammatory marker IL-10, in 43 stable angina (SA) and 46 unstable angina (UA) patients, before, 12 h and 40 h after PCI. As a control group, we studied 19 SA and 20 UA patients, after coronary angiography. After PCI, serum levels of VCAM-1, MMP-9, IL-6 and CRP increased significantly in both groups, in SA ( p < 0.01) and UA ( p < 0.001) , while levels of ICAM-1, MCP-1, IP-10, TIMP and IL-10, did not change significantly. After diagnostic angiography, a significant elevation in CRP was observed in SA patients ( p =0.04), while no difference in any inflammatory marker was detected in UA patients. At 6 months follow-up, 27 out of 89 pts underwent re-angiography because of: positive stress test in 25 pts and UA in 2 pts. Restenosis (lumen diameter stenosis ≥50%) was observed in 12 pts (14%). A positive correlation (p=0.04) was found between IL-10 levels at 12h post-PCI and in stent restenosis (Relative risk [RR]=1.14, 95% CI 1.006 –1.2933). We found no correlation between in-stent restenosis and all the other inflammatory markers. Conclusion: Our results provide further evidence of the role of iatrogenic plaque disruption inducing immunoinflammatory responses detectable in systemic circulation, especially in UA patients. The elevation of anti-inflammatory cytokine IL-10 after PCI is associated with in-stent restenosis. This anti-inflammatory marker, strong indicator of an activated inflammatory process, could probably be used as independent predictor of in-stent restenosis.

Late Outcomes of Carotid Artery Stenting for Radiation Therapy-Induced Carotid Stenosis

2022 ◽  
pp. 152660282110687
Author(s):  
Bahaa Nasr ◽  
Valentin Crespy ◽  
Edouard Penasse ◽  
Marine Gaudry ◽  
Eugenio Rosset ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Mortality Rate ◽  
Carotid Artery ◽  
Carotid Stenosis ◽  
Target Lesion ◽  
Long Term Outcomes ◽  
Stent Restenosis ◽  
In Stent Restenosis

Purpose: Carotid artery stenting (CAS) appears as a promising alternative treatment to carotid endarterectomy for radiation therapy (RT)-induced carotid stenosis. However, this is based on a poor level of evidence studies (small sample size, primarily single institution reports, few long-term data). The purpose of this study was to report the long-term outcomes of a multicentric series of CAS for RT-induced stenosis. Methods: All CAS for RT-induced stenosis performed in 11 French academic institutions from 2005 to 2017 were collected in this retrospective study. Patient demographics, clinical risk factors, elapsed time from RT, clinical presentation and imaging parameters of carotid stenosis were preoperatively gathered. Long-term outcomes were determined by clinical follow-up and duplex ultrasound. The primary endpoint was the occurrence of cerebrovascular events during follow-up. Secondary endpoints included perioperative morbidity and mortality rate, long-term mortality rate, primary patency, and target lesion revascularization. Results: One hundred and twenty-one CAS procedures were performed in 112 patients. The mean interval between irradiation and CAS was 15 ± 12 years. In 31.4% of cases, the lesion was symptomatic. Mean follow-up was 42.5 ± 32.6 months (range 1–141 months). The mortality rate at 5 years was 23%. The neurologic event-free survival and the in-stent restenosis rates at 5 years were 87.8% and 38.9%, respectively. Diabetes mellitus (p=0.02) and single postoperative antiplatelet therapy (p=0.001) were found to be significant predictors of in-stent restenosis. Freedom from target lesion revascularization was 91.9% at 5 years. Conclusion: This study showed that CAS is an effective option for RT-induced stenosis in patients not favorable to carotid endarterectomy. The CAS was associated with a low rate of neurological events and reinterventions at long-term follow-up.

scholarly journals Predictive Value of C-reactive Protein in Patients with Unstable Angina Pectoris Undergoing Coronary Artery Stent Implantation

2005 ◽  
Vol 33 (4) ◽  
pp. 389-396 ◽  
Author(s):  
I Karaca ◽  
K Aydin ◽  
M Yavuzkir ◽  
E Ilkay ◽  
M Akbulut ◽  
...  
Keyword(s):  
Angina Pectoris ◽  
Unstable Angina ◽  
Stent Implantation ◽  
Unstable Angina Pectoris ◽  
C Reactive Protein ◽  
Predictive Values ◽  
Reactive Protein ◽  
Stent Restenosis ◽  
Coronary Stent Implantation ◽  
In Stent Restenosis

In-stent restenosis is a major problem following coronary stent implantation, and inflammation plays an active role. We evaluated the effectiveness of the inflammatory marker C-reactive protein (CRP) as a predictor of in-stent restenosis after successful stent implantation, in 86 patients with unstable angina pectoris. Plasma CRP was measured in all patients before the procedure, and at 48-72 h and 1, 2 and 3 months post-procedure. An angiographic loss of 50% at follow-up was accepted as in-stent restenosis. We found negative and positive predictive values of the pre-procedural plasma CRP for determining 6-month in-stent restenosis of 34% and 61%, respectively. We also found a strong correlation between the 3-month post-procedural CRP value and 6-month in-stent restenosis; the negative and positive predictive values being 8% and 76%, respectively. In conclusion, we showed that a plasma CRP value > 3 mg/l in the third month after coronary stent implantation was a strong predictor of angiographic in-stent restenosis.

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