Risk Assessment in Acute Coronary Syndromes

2015 ◽  
Author(s):  
Wael AlJaroudi
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndromes ◽  
The United States ◽  
Left Ventricular ◽  
Risk Scores ◽  
Early Reperfusion ◽  
Coronary Syndrome ◽  
Therapeutic Decisions ◽  
Coronary Syndromes ◽  
St Elevation

Acute coronary syndromes (ACS) include unstable angina pectoris (UAP), non-ST elevation (NSTEMI), and ST elevation acute myocardial infarction (STEMI). Each year, more than 2 million people are hospitalized with ACS in the United States. The initial treatment has evolved over the last few decades from conservative management to early reperfusion therapy. Medical therapy has also significantly changed with the use of newer more potent antiplatelet agents, beta-blockers, angiotensin converting enzyme inhibitors, statins, and anti-anginal drugs, which have resulted in improvement of patient care and survival. There is no role for stress myocardial perfusion imaging (MPI) in the acute presentation; however, rest MPI may be used to identify the culprit lesion and risk stratify patients if injected during chest pain. In stable patients for ACS, submaximal exercise or vasodilator MPI can be performed as early as 48 hours after the event. Several gated MPI-derived variables such as left ventricular (LV) ejection fraction (EF), LV volumes, infarct size, mechanical dyssynchrony, and residual ischemic burden can risk stratify patients and provide prognostic data incremental to validated clinical risk scores such as GRACE (Global Registry of Acute Coronary Syndrome) and TIMI (Thrombolysis in Myocardial Infarction). Patients with depressed LVEF, remodeled LV, and large perfusion defects are at particularly high- risk for subsequent cardiac death or recurrent myocardial infarction. In such setting, MPI plays a pivotal role in the management of patients and guiding therapeutic decisions. The current chapter will review the clinical and MPI predictors of outcomes in patients presenting with ACS according to updated guidelines and a proposed algorithm integrating the role of MPI in guiding therapeutic decisions and management.

Anti-Platelet and Anti-Thrombotic Therapy Post-AMI

2011 ◽  
Author(s):  
Dana Dawson ◽  
Keith Fox
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Acute Coronary Syndromes ◽  
Myocardial Reperfusion ◽  
St Elevation Myocardial Infarction ◽  
Coagulation Cascade ◽  
Coronary Syndrome ◽  
Coronary Syndromes ◽  
St Elevation

• Acute coronary syndromes (ACS) encompass a spectrum of presentations which include unstable angina, non-ST-elevation myocardial infarction (NSTEMI or NSTE-ACS), and ST-elevation myocardial infarction (STEMI or STE-ACS)• Anti-platelet and anti-thrombotic agents are administered as ancillary therapy to myocardial reperfusion in patients presenting with an acute coronary syndrome, to maintain the patency of the infarct-related coronary artery• More specific and potent inhibitors of platelet activation and of the coagulation cascade are emerging with the aim being to further improve clinical outcomes in patients presenting with an acute coronary syndrome, without increasing the risks of major bleeding.

scholarly journals Anaemia in acute coronary syndrome patients: a study from rural tertiary care centre of India

2018 ◽  
Vol 6 (8) ◽  
pp. 2677
Author(s):  
Vivek Kumar Verma ◽  
Durga Prasad Singh ◽  
Dheeraj Kela ◽  
V. Vijayavarman ◽  
Geeta Singh
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Blood Loss ◽  
Unstable Angina ◽  
Acute Coronary Syndromes ◽  
Vitamin B12 Deficiency ◽  
Coronary Syndrome ◽  
B12 Deficiency ◽  
Coronary Syndromes ◽  
St Elevation

Background: Acute coronary syndromes (ACS) are an imbalance between myocardial oxygen supply and demand, and the presence of anaemia further potentiates this imbalance. The burden of anaemia in patients presenting with acute coronary syndromes (ACS) is significant. Anaemia has the potential to worsen myocardial ischemic insult by decreasing the oxygen content of the blood supplied to the jeopardized myocardium.Methods: A total of 148 patients with ACS were recruited in the study from October 2016 to December 2017 in Medicine and Cardiology Department of UPUMS Saifai, India. All patients were subjected to a detailed history and thorough clinical examination and investigations after obtaining informed consent. Patient having any other diseases known to cause anaemia were excluded.Results: Mean age of patients was 58.5 years. 72.97% were vegetarian and 27.03% were non-vegetarian. Most common morphological type of anaemia was dimorphic anaemia followed by macrocytic and microcytic hypochromic respectively. Iron deficiency anaemia was most common type of anaemia followed by vitamin B12 deficiency and mixed (Iron and vitamin B12 deficiency). 45.28% anaemic patients had no symptoms of blood loss. Most common symptom of blood loss was bleeding per rectum followed by malena. Severity of acute coronary syndrome was more in subjects having anaemia which was evident by higher incidence of anaemia in subjects having ST elevation myocardial infarction (STEMI). The incidence of anaemia was low in case of Non ST elevation Myocardial Infarction (NSTEMI) and Unstable angina (UA). The results of the present study have been compared to those from India.Conclusions: Higher incidence of anaemia was reported in subjects having acute coronary syndrome. Incidence of anaemia in STEMI patients was greater than NSTEMI and unstable angina patients. Severe form of acute coronary syndrome i.e. STEMI was associated with higher incidence of anaemia. 

scholarly journals Predominance of STEMI and severity of coronary artery disease in a cohort of patients hospitalized with acute coronary syndrome: a report from ABC Medical School

2015 ◽  
Vol 61 (3) ◽  
pp. 240-243 ◽  
Author(s):  
Marcelo Rodrigues Bacci ◽  
Fernando Luiz Affonso Fonseca ◽  
Leonardo Fernando Ferrari Nogueira ◽  
Felipe Ribeiro Bruniera ◽  
Felipe Moreira Ferreira ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Coronary Angiography ◽  
Emergency Room ◽  
Acute Coronary Syndromes ◽  
St Elevation Myocardial Infarction ◽  
Coronary Syndrome ◽  
Coronary Syndromes ◽  
St Elevation ◽  
The City

Summary Introduction: acute coronary syndromes (ACS) represent a widely prevalent health issue with high mortality in Brazil and worldwide. The severity of ACS is not known in patients in the city of São Bernardo do Campo a municipality contiguous and adjacent to the city of São Paulo. Objectives: to study the profile of coronary disease in patients hospitalized with ACS who underwent coronary angiography in the emergency room between 2012 and 2013. Methods: this is an observational study that included consecutive patients with ACS admitted to the emergency room of a hospital. Data collection was performed using medical records with the following variables: sex, age, risk factors for cardiovascular disease, coronary angiography. Results: the sample in this period included 131 patients, of which 64.8% were men. The most prevalent diagnosis was ST-elevation myocardial infarction (STEMI) (57.2%) followed by non-ST-elevation myocardial infarction (NSTEMI) (22.1%) and unstable angina (UA) (20.6%). There were no significant differences in the epidemiology and risk factors between the diagnoses, except that heart failure was more prevalent in patients with UA. Discussion: there were no differences between groups regarding the coronaries involved; however, STEMI patients showed similar numbers of multi- and singlevessel lesions, NSTEMI patients showed more multivessel lesions, and UA patients showed more multivessel lesions or lesion-free arteries. Although multivessel lesions were prevalent in all groups, STEMI patients showed a significantly higher number of single-vessel lesions compared with the other acute coronary syndromes. Conclusion: the study demonstrated a predominance of STEMI in the studied population, which differs from the usual results in ACS.

scholarly journals The Multi-Ethnic New Zealand Study of Acute Coronary Syndromes (MENZACS): Design and Methodology

2021 ◽  
Vol 11 (2) ◽  
pp. 84-97
Author(s):  
Malcolm. E. Legget ◽  
Vicky. A. Cameron ◽  
Katrina. K. Poppe ◽  
Sara Aish ◽  
Nikki Earle ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
New Zealand ◽  
Acute Coronary Syndromes ◽  
St Elevation Myocardial Infarction ◽  
Coronary Syndrome ◽  
Coronary Syndromes ◽  
St Elevation ◽  
Prospective Longitudinal ◽  
First Time

Background. Each year, approximately 5000 New Zealanders are admitted to hospital with first-time acute coronary syndrome (ACS). The Multi-Ethnic New Zealand Study of Acute Coronary Syndromes (MENZACS) is a prospective longitudinal cohort study embedded within the All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) registry in six hospitals. The objective of MENZACS is to examine the relationship between clinical, genomic, and cardiometabolic markers in relation to presentation and outcomes post-ACS. Methods. Patients with first-time ACS are enrolled and study-specific research data is collected alongside the ANZACS-QI registry. The research blood samples are stored for future genetic/biomarker assays. Dietary information is collected with a food frequency questionnaire and information about physical activity, smoking, and stress is also collected via questionnaire. Detailed family history, ancestry, and ethnicity data are recorded on all participants. Results. During the period between 2015 and 2019, there were 2015 patients enrolled. The mean age was 61 years, with 60% of patients aged <65 years and 21% were female. Ethnicity and cardiovascular (CV) risk factor distribution was similar to ANZACS-QI: 13% Māori, 5% Pacific, 5% Indian, and 74% NZ European. In terms of CV risk factors, 56% were ex-/current smokers, 42% had hypertension, and 19% had diabetes. ACS subtype was ST elevation myocardial infarction (STEMI) in 41%, non-ST elevation myocardial infarction (NSTEM) in 54%, and unstable angina in 5%. Ninety-nine percent of MENZACS participants underwent coronary angiography and 90% had revascularization; there were high rates of prescription of secondary prevention medications upon discharge from hospital. Conclusion. MENZACS represents a cohort with optimal contemporary management and will be a significant epidemiological bioresource for the study of environmental and genetic factors contributing to ACS in New Zealand’s multi-ethnic environment. The study will utilise clinical, nutritional, lifestyle, genomic, and biomarker analyses to explore factors influencing the progression of coronary disease and develop risk prediction models for health outcomes.

Alterations in serum neopterin correlate with thrombolysis in myocardial infarction risk scores in acute coronary syndromes

2006 ◽  
Vol 17 (6) ◽  
pp. 511-516 ◽  
Author(s):  
Douglas T. Johnston ◽  
Marios Gagos ◽  
Nicholas Raio ◽  
Louis Ragolia ◽  
David Shenouda ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndromes ◽  
Risk Scores ◽  
Serum Neopterin ◽  
Coronary Syndromes

scholarly journals High risk electrocardiographic patterns in patients with acute coronary syndrome.

2020 ◽  
Vol 2 (1) ◽  
pp. 25-34
Author(s):  
Diego Echeverri- Marín ◽  
Cristhian Felipe Ramirez Ramos ◽  
Andrés Miranda-Arboleda ◽  
Gustavo Castilla-Agudelo ◽  
Clara Saldarriaga-Giraldo
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Reperfusion Therapy ◽  
Early Reperfusion ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Acute Coronary Occlusion ◽  
St Segment ◽  
St Elevation ◽  
Electrocardiographic Findings

Acute myocardial infarction is the leading cause of death in the world and the electrocardiogram remains the diagnostic tool for determining an acute myocardial infarction with ST-segment elevation. In spite of this, only half of the patients present classic electrocardiogram findings compatible with the ST-elevation infarction criteria. There is a spectrum of electrocardiographic findings that may reflect a phenomenon of acute coronary occlusion, which should be promptly recognized by the clinician to offer early reperfusion therapy.

Abstract 14907: Clinically Feasible Electronic Health Record Tool for Stratification of 1- to 3-Year Post-Myocardial Infarction Risk of Cardiovascular Events: The Intermountain Acute Coronary Syndromes Risk Scores

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Benjamin D Horne ◽  
Joseph B Muhlestein ◽  
Durgesh Bhandary ◽  
Greta L Hoetzer ◽  
Naeem D Khan ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Electronic Health Record ◽  
Acute Coronary Syndromes ◽  
Troponin I ◽  
Risk Scores ◽  
Health Record ◽  
Additional Risk Factor ◽  
Lipid Panel ◽  
Coronary Syndromes ◽  
Electronic Health

Background: Randomized trials report that prolonged (>1 year) use of P2Y12 inhibitors with aspirin after myocardial infarction (MI) reduces stent thrombosis and cardiovascular (CV) events, including new MI, stroke, and CV death. Post-MI patients may benefit to a differing extent from long-term dual anti-platelet therapy (DAPT); thus, a method is needed to identify those at higher risk of CV events. Hypothesis: A low-cost, easy-to-use, and highly predictive risk stratification tool can be created to differentiate risk of CV events 1-3 years after MI. Methods: Patients surviving ≥1 year after an index MI who had ≥1 additional risk factor for MI were studied. Cox regression models were used to derive sex-specific Intermountain Acute Coronary Syndromes (IMACS) risk scores in 70% of patients (N=1,342 females; 3,047 males). Validation of IMACS scores was performed in the other 30% of patients (N=576 females; 1,290 males). Variables used in model creation were age, troponin I, B-type natriuretic peptide, hemoglobin A1c, and all components of the lipid panel, complete blood count, and comprehensive metabolic panel. The primary end point was a composite of CV death, MI, or stroke. Results: Age averaged 68.7±12 and 69.8±12 for females in the derivation and validation groups, respectively, and 63.6±12 and 63.9±12 for males. IMACS scores ranged from 0-11 for females (grouping scores of 0-2, 3-6, and 7-11 into low-, moderate-, and high-risk) and 0-14 for males (0-2, 3-7, 8-14). In the validation groups, IMACS categories stratified CV event risk (Figure). IMACS c-statistics for females were c=0.675 and c=0.734 in derivation and validation groups, respectively, and for males c=0.715 and c=0.672. Conclusion: Sex-specific IMACS risk scores strongly stratified 1- to 3-year post-MI risk of CV events. IMACS is an inexpensive electronic health record tool that empowers the evaluation of which post-MI patients may be the best candidates for more aggressive therapeutic management.

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