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 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.

scholarly journals Platelet Volume Indices in Patients with Acute Coronary Syndrome

2020 ◽  
pp. 1-5
Author(s):  
Ekta Paramjit ◽  
S. Sudhamani ◽  
Anita Sharan ◽  
Sonali Pitale ◽  
Prakash Roplekar
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
St Elevation Myocardial Infarction ◽  
Cardiac Care ◽  
Platelet Volume ◽  
Distribution Width ◽  
Coronary Syndrome ◽  
St Elevation ◽  
Cardiac Care Unit

Background & Aims: Acute coronary syndrome is one of the leading causes of morbidity and mortality in the world and platelet hyperactivity with local platelet activation plays a crucial role in its genesis. As there is discrepancy regarding the significance of deranged platelet parameters, we aimed to study the role of platelet volume indices in the spectrum of coronary artery syndrome and to correlate them clinically. Study Design: The study was conducted by collecting the data of patients with Myocardial infarction from the Cardiac care unit registry along with their clinical history and investigations. Stable coronary artery cases were collected from the Catheterization Lab and compared with Age and Sex matched controls. All CBCs of the above groups were processed by a 5-part counter and the data generated was transferred to a master chart for statistical analysis. Place and Duration of study: The study was conducted in the Central Laboratory & Department of Pathology at D.Y. Patil Hospital, Navi Mumbai, India in collaboration with the Cardiac Care Unit and Catheterisation Lab of the hospital for a period of two years. Methods: A total of 122 cases were studied and grouped into 5 groups according to presentation and the platelet volume indices of these were compared with 38 matched controls and statistically analysed. Results: Mean Platelet Volume and Platelet Distribution Width of patients with ST elevation Myocardial Infarction (STEMI) and Non ST elevation Myocardial Infarction(NSTEMI) were increased marginally in number when compared to Stable Coronary Artery Disease(SCAD) and Control group, however this was not statistically significant. Platelet Large Cell Ratio (PLCR) was significantly raised in STEMI cases only (P = 0.09), so it may prove to be a better marker for the disease (P = 0.09). Platelet counts in various groups when compared with controls gave inconsistent results i.e SCAD vs Control significantly decreased (P = 0.07) and STEMI vs Control significantly increased (P = 0.01). Conclusion: The platelet volume indices in suspected acute coronary syndrome cases showed various changes, but present data failed to be diagnostically significant. However this data may later help to characterise further relationship between Acute coronary syndrome and platelet function in subsequent studies.

Epidemiology and pathophysiology of coronary artery disease

2016 ◽  
Author(s):  
Demosthenes G. Katritsis ◽  
Bernard J. Gersh ◽  
A. John Camm
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Unstable Angina ◽  
Acute Coronary Syndromes ◽  
St Elevation Myocardial Infarction ◽  
Coronary Syndromes ◽  
St Elevation ◽  
Artery Disease

This chapter presents the epidemiology and pathophysiology of stable ischaemic heart disease and acute coronary syndromes, i.e. unstable angina/non-ST elevation myocardial infarction and ST elevation myocardial infarction.

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 Clinical characteristics, risk factors and angiographic profile of acute coronary syndrome patients in a tertiary care center of Nepal.

2019 ◽  
Vol 16 (1) ◽  
pp. 27-32 ◽  
Author(s):  
Abhishesh Shakya ◽  
Sunil Chandra Jha ◽  
Ratna Mani Gajurel ◽  
Chandra Mani Poudel ◽  
Ravi Sahi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
St Elevation Myocardial Infarction ◽  
Coronary Syndrome ◽  
Vessel Disease ◽  
St Elevation ◽  
Artery Disease

Background and Aims: Acute coronary syndrome (ACS) refers to a group of clinical symptoms consistent with new onset or worsening ischemic symptoms. ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI) and unstable angina (UA) are the three types of ACS. The objectives were to study the risk factors prevalence, angiographic distribution and severity of coronary artery stenosis in ACS among patients admitted in Cardiology Department of Manmohan Cardiothoracic Vascular and Transplant Center (MCVTC). Methods: This is a restrospective study of 419 ACS patients admitted and treated in MCVTC from November 2017 to October 2018. Patients were divided into STEMI, NSTEMI and UA then analyzed for various risk factors, angiographic patterns and severity of coronary artery disease. Results: Mean age of presentation was 59.3Å}12.8 years. Majority were male 317(75.7%). Most patients had STEMI 252 (60.1%) followed by NSTEMI 98 (23.4%) and UA 69 (16.5 %). Risk factors: smoking was present in 241 (57.5%), hypertension in 212 (50.6%), diabetes in 144 (34.4%), dyslipidemia in 58 (13.8%). Single-vessel disease was present in 34.6 % patients, double- vessel disease was present in 27.44 % patients and triple vessel disease was present in 26.3 % patients, left main disease in 1.4 % patients. Normal coronaries were present in 6.4% patients and minor coronary artery disease in 3.8 % patients. Conclusions: STEMI was the most common presentation. Three quarters of ACS were male patients. Smoking was most prevalent risk factor. Single vessel involvement was the most common CAG finding in all spectrum of ACS. Diabetic patients had more multivessel disease.

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 GAMBARAN HEMATOLOGI PADA PASIEN SINDROM KORONER AKUT YANG DIRAWAT DI BLU RSUP PROF. Dr. R.D. KANDOU MANADO TAHUN 2010

2013 ◽  
Vol 1 (1) ◽  
Author(s):  
Bagus Yuvi Setyo Ramadhani ◽  
Linda W.A Rotty ◽  
Frans Wantania
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Heart Disease ◽  
Hematological Parameters ◽  
Secondary Data ◽  
St Elevation Myocardial Infarction ◽  
Coronary Syndrome ◽  
Coronary Syndromes ◽  
St Elevation ◽  
Hematological Changes

Abstract: Acute coronary syndrome (ACS) is a series of clinical disorders caused by acute ischemic heart disease, including angina unstable, non-ST elevation myocardial infarction, and ST-elevation myocardial infarction. This study aimed to determine the relationship of routine hematological changes with the course of acute coronary syndromes. We used a descriptive method. Data were obtained from the secondary data of ACS patients in the ICCU RSUP Prof. Dr. R. D. Kandou Manado during 2010. The data were presented in distributive tables. The results showed that most patients did not experience decreases in hematological parameters such as hemoglobin, hematocrite, erythrocyte counts, and platelet counts. The leucocyte counts increased in 50% of cases. Conclusion: In general, there was no decrease in hematological parameters, except leukocyte counts, among the ACS patients in the ICCU RSUP Prof. Dr. R. D. Kandou Manado during 2010. Keywords: acute coronary syndrome, coronary heart disease, hematology, inflammation Abstrak: Sindrom koroner akut (SKA) merupakan rangkaian gangguan klinis yang disebabkan oleh penyakit akut iskemik jantung, termasuk angina tidak stabil, non-ST elevasi miocard infraction, dan ST-elevasi miocard infraction. Penelitian ini bertujuan untuk mengetahui hubungan perubahan hematologi rutin dengan perjalanan penyakit sindrom koroner akut. Penelitian ini memakai metode deskriptif dengan menggunakan data sekunder dari penderita SKA di ruang ICCU RSUP Prof. Dr. R. D. Kandou Manado selama tahun 2010. Data hasil penelitian disajikan dalam bentuk tabel distributif. Hasil penelitian  memperlihatkan bahwa sebagian besar pasien tidak memperlihatkan penurunan parameter hematologi. Jumlah leukosit meningkat pada 50% kasus. Simpulan: Umumnya tidak terdapat penurunan parameter hematologi, kecuali jumlah leukosit pada pasien SKA ruang ICCU RSUP Prof. Dr. R. D. Kandou Manado selama tahun 2010. Kata kunci: Sindrom koroner akut, penjakit jantung koroner, Hematologi, inflamasi

scholarly journals Circulating Levels of Dephosphorylated-Uncarboxylated Matrix Gla Protein in Patients with Acute Coronary Syndrome

Molecules ◽  
2021 ◽  
Vol 26 (4) ◽  
pp. 1108
Author(s):  
Admira Bilalic ◽  
Tina Ticinovic Kurir ◽  
Marko Kumric ◽  
Josip A. Borovac ◽  
Andrija Matetic ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
High Risk ◽  
Hospital Mortality ◽  
Vascular Calcification ◽  
Matrix Gla Protein ◽  
St Elevation Myocardial Infarction ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
St Elevation

Vascular calcification contributes to the pathogenesis of coronary artery disease while matrix Gla protein (MGP) was recently identified as a potent inhibitor of vascular calcification. MGP fractions, such as dephosphorylated-uncarboxylated MGP (dp-ucMGP), lack post-translational modifications and are less efficient in vascular calcification inhibition. We sought to compare dp-ucMGP levels between patients with acute coronary syndrome (ACS), stratified by ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) status. Physical examination and clinical data, along with plasma dp-ucMGP levels, were obtained from 90 consecutive ACS patients. We observed that levels of dp-ucMGP were significantly higher in patients with NSTEMI compared to STEMI patients (1063.4 ± 518.6 vs. 742.7 ± 166.6 pmol/L, p < 0.001). NSTEMI status and positive family history of cardiovascular diseases were only independent predictors of the highest tertile of dp-ucMGP levels. Among those with NSTEMI, patients at a high risk of in-hospital mortality (adjudicated by GRACE score) had significantly higher levels of dp-ucMGP compared to non-high-risk patients (1417.8 ± 956.8 vs. 984.6 ± 335.0 pmol/L, p = 0.030). Altogether, our findings suggest that higher dp-ucMGP levels likely reflect higher calcification burden in ACS patients and might aid in the identification of NSTEMI patients at increased risk of in-hospital mortality. Furthermore, observed dp-ucMGP levels might reflect differences in atherosclerotic plaque pathobiology between patients with STEMI and NSTEMI.

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