Neutrophils and clinical outcomes in patients with acute coronary syndromes and/or cardiac revascularisation

2011 ◽  
Vol 106 (10) ◽  
pp. 591-599 ◽  
Author(s):  
Luigina Guasti ◽  
Luana Castiglioni ◽  
Lorenzo Maroni ◽  
Franca Marino ◽  
Alessandro Squizzato ◽  
...  
Keyword(s):  
Systematic Review ◽  
Risk Factor ◽  
Clinical Outcomes ◽  
Acute Coronary Syndromes ◽  
Inflammatory Marker ◽  
Neutrophil Lymphocyte Ratio ◽  
Validity Assessment ◽  
Markers Of Inflammation ◽  
Coronary Syndromes

SummarySome studies have suggested that high levels of total white blood cell (WBC) count and C-reactive protein (CRP) may be considered as independent prognostic factors in patients with acute coronary syndromes (ACS) and/or after cardiac revascularisation by percutaneous coronary intervention or coronary artery bypass grafting surgery. Evidence on the role of neutrophils in cardiovascular disease is less compelling. Therefore, we conducted a systematic review of the literature with the aim of identifying all the available evidence to clarify the role of neutrophils (absolute or relative count, neutrophil/lymphocyte ratio) as a prognostic risk factor in patients with ACS and/or cardiac revascularisation. All published studies evaluating the role of neutrophils as a risk factor for clinical outcomes were assessed using the MEDLINE and EMBASE databases. Study selection, data extraction and validity assessment was performed independently by two reviewers. Twenty-one studies (17 of which had positive results) for a total of more than 34,000 patients were included. Ten of 13 studies in ACS patients found that neutrophils measured on-admission are related to mortality rate and/or to major adverse clinical events. A predictive value of neutrophils after cardiac revascularisation procedures was reported in seven out of eight studies. Most of the studies showed that neutrophils were independent predictors of cardiovascular outcomes when analysed concomitantly with other markers of inflammation (WBC, CRP). The findings of our systematic review highlight the potential application of this inexpensive and readily available inflammatory marker for risk stratification in patients with ACS and/or cardiac revascularisation.

The Role of Cardiac Risk Factor Burden in Diagnosing Acute Coronary Syndromes in the Emergency Department Setting

2007 ◽  
Vol 49 (2) ◽  
pp. 145-152.e1 ◽  
Author(s):  
Jin H. Han ◽  
Christopher J. Lindsell ◽  
Alan B. Storrow ◽  
Samuel Luber ◽  
James W. Hoekstra ◽  
...  
Keyword(s):  
Emergency Department ◽  
Risk Factor ◽  
Acute Coronary Syndromes ◽  
Cardiac Risk ◽  
Cardiac Risk Factor ◽  
Emergency Department Setting ◽  
Coronary Syndromes ◽  
Risk Factor Burden

scholarly journals Original research. The Assessment of Epicardial Adipose Tissue in Acute Coronary Syndrome Patients. A Systematic Review

2017 ◽  
Vol 3 (1) ◽  
pp. 18-29 ◽  
Author(s):  
Theodora Benedek ◽  
Nora Rat ◽  
Roxana Hodas ◽  
Diana Opincariu ◽  
András Mester ◽  
...  
Keyword(s):  
Systematic Review ◽  
Adipose Tissue ◽  
Transthoracic Echocardiography ◽  
Acute Coronary Syndromes ◽  
Cardiac Ct ◽  
Epicardial Adipose Tissue ◽  
Risk Scores ◽  
Coronary Syndromes

Abstract Background: This systematic review seeks to evaluate the role of epicardial adipose tissue (EAT), quantified either by thickness, assessed by transthoracic echocardiography, or by volume, assessed by cardiac computed tomography (CT), in the follow-up of patients with acute coronary syndromes (ACS). Method: One-hundred forty-four articles were screened, from which 56 were reviewed in full-text. From those, 47 studies were excluded for the following reasons: they did not meet the inclusion criteria; they were either reviews or meta-analyses; the study cohorts included only stable coronary artery disease patients; they did not state a clear and concise study design, endpoints, or follow-up. The final draft included nine studies for systematic evaluation. Results: Of the 2,306 patients included in the review, 170 underwent cardiac CT while the remaining 2,136 underwent transthoracic echocardiography for the measurement of EAT. The analysis found that the EAT thickness was significantly associated with major adverse cardiovascular events (MACE) rates during hospitalization (OR: -1.3, 95% CI: 1.05-1.62, p = 0.020) and at three years (HR: 1.524, 95% CI: 1.0-2.2, p = 0.038). The included studies found that EAT was correlated with the following clinical and angiographic risk scores for ACS: GRACE (r = 0.438, p <0.001), TIMI risk score (r = 0.363, p = 0.001), SYNTAX score (r = 0.690, p <0.0001; r = 0.610, p <0.01), and Gensini score (r = 0.438, p = 0.001). There was an inverse correlation between ST-segment resolution of <70% after revascularization and EAT (r = −0.414, p = 0.01), and the myocardial blush grade (r = −0.549, p <0.001). The EF aggregation ranged between 2.65 mm and 4.7 mm within the included studies. Conclusions: EAT, evaluated either by echocardiography or cardiac CT, correlates with the severity of coronary lesions, with the clinical and angiographic risk scores for acute coronary syndromes, with indicators for coronary reperfusion, and with short- and long-term MACE rates. Further studies are required to fully elucidate the role of this extensively studied but still novel cardiovascular biomarker as part of a risk prediction tool.

scholarly journals Role of community pharmacists in improving adherence and clinical outcomes after acute coronary syndromes (IM-ADHERENCE): six month-results

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Picariello ◽  
E Vighesso ◽  
R Ruzza ◽  
A Ferrarese ◽  
L Roncon
Keyword(s):  
Clinical Outcomes ◽  
Community Pharmacist ◽  
Acute Coronary Syndromes ◽  
Community Pharmacists ◽  
Health Costs ◽  
Drug Adherence ◽  
Index Event ◽  
Pill Counts ◽  
Coronary Syndromes

Abstract Background Acute coronary syndromes (ACS) are the leading cause of death from cardiovascular diseases (CVD) and are responsible for 8% of deaths in Italy. Available data evaluating patient long-term adherence show that about 20–30% of patients interrupts medical therapy within first six months from the index event. Although several strategies have been developed to improve adherence, there are few data evaluating the role of community pharmacist on patient adherence and its impact on clinical outcomes Purpose Our aim was to evaluate if involving community pharmacists could improve patients' adherence to medical prescriptions after ACS, reducing the rate of re-admissions due to CVD and related costs (IM-ADHERENCE study). We report the results of the first six months of the study. Methods Patients discharged for ACS from February to September 2018 in three main hospitals of our city area, in active therapy with at least one of the recommended drugs for secondary prevention (ASA, P2Y12, statin), were identified by a cardiologist to be included in the interventional arm. Patient's drug reconciliation was obtained by the hospital pharmacist before discharge. An adherence plan assessment was performed by the referral community pharmacist at 30 days, 3, 6, 9 and 12 months after discharge with 3 kinds of interventions: counseling, pill counts and self-administered questionnaire on adherence. The cardiologist also identified patients discharged within 6 months before the study beginning as historical control arm. The investigators collected the data from pill counts, questionnaire results on adherence (interventional arm) and administrative databases throughout 6 months from hospital discharge. Main outcome was the rate of adherent patients after 6 months, defined as a value of Proportion of Days Covered (PDC) &gt;80% (chi square test; p&lt;0.05). Secondary outcomes concerned re-admission rates due to CV events and related costs. Results A total of 128 patients were identified, 61 patients were enrolled in the interventional arm (age 68±12,3; 87% male; 15 drop-out included in the analysis). The interventional and control arms had the same sample size and were comparable. At 6 months, the interventional arm compared with control had a higher rate of adherent patients (51% vs 33%, p=0.046) and a lower rate of re-admission to hospital for CV events (46% vs 69%, p=0.01). A significant reduction in health costs was obtained as lower rate of hospitalizations (about € 207.501 in 6 months). Conclusions The intervention of community pharmacist in patient drug adherence after ACS reduced re-hospitalizations and health costs at 6 months from index event. This study was an opportunity to integrate hospital and community pharmacists with cardiologist work in treatment and outcome of ACS patients, achieving medication reconciliation and a higher drug adherence, with less re-hospitalizations. These data are waiting to be confirmed at 1-year analysis. Funding Acknowledgement Type of funding source: None

Is there Sex-related Outcome Difference According to oral P2Y12 Inhibitors in Patients with Acute Coronary Syndromes? A Systematic Review and Meta-Analysis of 107,126 Patients

2019 ◽  
Vol 17 (2) ◽  
pp. 191-203
Author(s):  
Oliver Brown ◽  
Jennifer Rossington ◽  
Gill Louise Buchanan ◽  
Giuseppe Patti ◽  
Angela Hoye
Keyword(s):  
Systematic Review ◽  
Acute Coronary Syndromes ◽  
Meta Analysis ◽  
Indirect Comparison ◽  
Bleeding Risk ◽  
Cardiovascular Death ◽  
P2y12 Inhibitors ◽  
Significant Difference ◽  
Coronary Syndromes ◽  
Randomised Controlled

Background and Objectives: The majority of patients included in trials of anti-platelet therapy are male. This systematic review and meta-analysis aimed to determine whether, in addition to aspirin, P2Y12 blockade is beneficial in both women and men with acute coronary syndromes. </P><P> Methods: Electronic databases were searched and nine eligible randomised controlled studies were identified that had sex-specific clinical outcomes (n=107,126 patients). Risk Ratios (RR) and 95% Confidence Intervals (CI) were calculated for a composite of cardiovascular death, myocardial infarction or stroke (MACE), and a safety endpoint of major bleeding for each sex. Indirect comparison analysis was performed to statistically compare ticagrelor against prasugrel. </P><P> Results: Compared to aspirin alone, clopidogrel reduced MACE in men (RR, 0.79; 95% CI, 0.68 to 0.92; p=0.003), but was not statistically significant in women (RR, 0.88; 95% CI, 0.75 to 1.02, p=0.08). Clopidogrel therapy significantly increased bleeding in women but not men. Compared to clopidogrel, prasugrel was beneficial in men (RR, 0.84; 95% CI, 0.73 to 0.97; p=0.02) but not statistically significant in women (RR, 0.94; 95% CI, 0.83 to 1.06; p=0.30); ticagrelor reduced MACE in both men (RR, 0.85; 95% CI, 0.77 to 0.94; p=0.001) and women (RR, 0.84; 95% CI, 0.73 to 0.97; p=0.02). Indirect comparison demonstrated no significant difference between ticagrelor and prasugrel in either sex. Compared to clopidogrel, ticagrelor and prasugrel increased bleeding risk in both women and men. </P><P> Conclusion: In summary, in comparison to monotherapy with aspirin, P2Y12 inhibitors reduce MACE in women and men. Ticagrelor was shown to be superior to clopidogrel in both sexes. Prasugrel showed a statistically significant benefit only in men; however indirect comparison did not demonstrate superiority of ticagrelor over prasugrel in women.

Temporal Changes in Pollen Grain Concentration Predict Short-Term Clinical Outcomes in Acute Coronary Syndromes

2021 ◽  
Vol 30 ◽  
pp. S112
Author(s):  
O. Al-mukhtar ◽  
S. Vogrin ◽  
S. Noaman ◽  
E. Lampugnani ◽  
D. Dinh ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Acute Coronary Syndromes ◽  
Temporal Changes ◽  
Pollen Grain ◽  
Short Term ◽  
Coronary Syndromes
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