Abstract 6088: Clinical and Angiographic Predictors of 30-Day and One-Year Cardiac Ischemic Events in Patients with Non-ST Elevation Acute Coronary Syndromes: Results from the ACUITY (Acute Catheterization and Urgent Intervention Triage strategY) Trial

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Alexandra Lansky ◽  
Kenji Goto ◽  
Ecatarina Cristea ◽  
Martin Fahy ◽  
Roxana Mehran ◽  
...  
Keyword(s):  
High Risk ◽  
Acute Coronary Syndromes ◽  
Multivariable Analysis ◽  
Flow Characteristics ◽  
Adverse Outcomes ◽  
Cardiac Events ◽  
Clinical Predictors ◽  
Target Vessel Revascularization ◽  
Coronary Syndromes ◽  
One Year

An early invasive strategy is of clinical benefit in moderate and high-risk acute coronary syndromes (ACS). Clinical predictors of short and long-term ischemic outcomes in pts with ACS have been well studied, whereas the extent, location and characteristics of angiographic coronary disease in predicting outcome is not well defined. The ACUITY trial randomized 13,819 pts with moderate and high risk ACS to unfractionated heparin or enoxaparin + GP IIb/IIIa inhibitors (GPI), versus bivalirudin + GPI, vs. bivalirudin alone. The angiographic substudy of ACUITY included the first 7000 consecutive randomized US patients. All angiograms were reviewed by an independent core laboratory for complete 3 vessel assessment of CAD extent and burden (total mm length of lesions>30%DS), as well as baseline and final lesion and flow characteristics. Clinical and angiographic predictors of ischemic outcomes at 30 days and 1 year (death, MI, or ischemic target vessel revascularization) were identified by univariate and multivariable analysis using logistic regression analysis. Of 6921 pts with interpretable angiograms, 3826 pts (55.3%) were treated with PCI, 755 (10.9%) with CABG, and 2340 (33.8%) with medical therapy. Composite ischemia occurred in 595 (8.6%) pts at 30 days and 1153 (17.4%) pts at one year. Independent predictors of 30 day and 1 year ischemic cardiac events by multivariable analysis are shown in the table . Among moderate- to high-risk ACS patients, beyond the well recognized clinical risk factors of renal insufficiency and diabetes mellitus, angiographic manifestations of coronary atherosclerosis including greater burden and severity of disease, and presence of calcified lesions, are important independent predictors of 30 day and 1 year adverse outcomes. Table. Multivariate Predictors of Composite Ischemia

Abstract 2001: Clinical and Angiographic Predictors of 30-Day and One-Year Ischemic Cardiac Events in Patients with Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention: An ACUITY Substudy

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Kenji Goto ◽  
Alexandra Lansky ◽  
Ecatarina Cristea ◽  
Michel E Bertrand ◽  
A. Michael Lincoff ◽  
...  
Keyword(s):  
Adverse Events ◽  
Acute Coronary Syndromes ◽  
Multivariable Analysis ◽  
Flow Characteristics ◽  
Coronary Vessels ◽  
Cardiac Events ◽  
Clinical Predictors ◽  
Coronary Syndromes ◽  
One Year ◽  
Ischemic Events

Background: Clinical predictors of short and long-term ischemic outcomes following PCI in acute coronary syndromes (ACS) have been well studied. However, the angiographic predictors of adverse events have not been defined. Methods: The ACUITY trial randomized 13,819 pts with moderate and high risk ACS to unfractionated heparin or enoxaparin + GP IIb/Iii inhibitors (GPI), versus bivalirudin + GPI, vs. bivalirudin alone. The angiographic substudy of ACUITY included the first 7000 consecutive randomized US patients, of which 3664 underwent PCI. All angiograms were reviewed by an independent core laboratory for complete 3 vessel assessment of extent and CAD burden (total mm length of lesions with >30%DS), as well as baseline and final lesion and flow characteristics. Clinical and angiographic predictors of composite ischemia (death, non-fatal MI, or ischemic target vessel revascularization) at 30 days and 1 year were identified by univariate and multivariable analysis using logistic regression analysis. Results: Coronary stents were used in 3429 (93.6%) pts, (84.4% DES). Composite ischemia occurred in 366 pts (10.0%) at 30 days and in 735 pts (21.0%) at one year. The independent predictors of 30 day and 1 year composite ischemic events by multivariable analysis are shown in the table . Conclusions: Beyond the clinical predictors of renal insufficiency and diabetes, CAD burden assessed by the number of diseased coronary vessels and the burden of CAD are independent predictor of 30 day and 1 year ischemic events in patients with ACS undergoing PCI. Baseline lesion specific characteristics including eccentric and calcified lesions, as well as angiographic PCI complications resulting in sustained no reflow, abrupt closure or thrombus were also independently predictive of adverse events. Table 7: Multivariate Predictors of Composite Ischemia

CHA2DS2-VASc score in acute coronary syndrome

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
H Santos ◽  
M Santos ◽  
I Almeida ◽  
H Miranda ◽  
C Sa ◽  
...  
Keyword(s):  
Logistic Regression ◽  
High Risk ◽  
Acute Coronary Syndromes ◽  
De Novo ◽  
Mortality Rates ◽  
Kaplan Meier ◽  
Risk Patients ◽  
Coronary Syndromes ◽  
One Year

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf Portuguese Registry of Acute Coronary Syndromes Background Acute coronary syndromes (ACS) are common and several scores were proposed to identify high-risk patients that presented worse prognosis in short and long-term follow up. CHA2DS2-VASc score is the score used to decide the initiation of anticoagulation therapy in atrial fibrillation (AF) patients. It is an easy and convenient score, used by physicians in clinical practice, which is helpful to apply in ACS predicting the high-risk patients. Objective CHA2DS2-VASc score as a prognosis method in ACS. Methods Multicenter retrospective study, based on the Portuguese Registry of ACS between 1/10/2010-4/09/2019. CHA2DS2-VASc test as a predictor of AF with a receiver operating characteristic curve. Logistic regression to access if the score was a predictor of AF. According with a punctuation of CHA2DS2-VASc as 0, 1 and ≥2, was performed a Kaplan-Meier test to establish the survival rates and cardiovascular admission at one year of follow-up. Results 25271 patients had ACS, 1023 patients (4.2%) presented de novo AF. CHA2DS2-VASc score was a median predictor of de novo AF (Area Under Curve: 0.642, confidence interval (CI) 0.625-0.659), with a 66.7% sensibility and 55.1% specificity. Logistic regression revealed that the CHA2DS2-VASc score was a predictor of de novo AF in ACS (odds ratio (OR) 2.07, p < 0.001, CI 1.74-2.47). Mortality rates at one year of follow-up, even showing higher mortality rates associated with higher CHA2DS2-VASc punctuation, do not revealed to be significant, p = 0.099. On the other hand, the score exhibited a significant value, p = 0.050, for re-admission for all causes, according to the classification as 0, 1 or ≥2. Regarding re-admission for cardiovascular causes at one year of follow-up was associated with the score classification, with a Kaplan-Meier test of p = 0.011. Conclusions CHA2DS2-VASc score was a predictor of de novo AF in ACS and can be used as a prognostic method for all causes of re-admission and, in special, for cardiovascular cause of re-admission.

Abstract 3220: Bivalirudin Monotherapy Provides Similar One-Year Survival Compared to Heparin plus GP IIb/IIIa Inhibitors in Diabetic Patients with Acute Coronary Syndromes: Results from the Randomized ACUITY Trial

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Frederick Feit ◽  
Stuart V Manoukian ◽  
George D Dangas ◽  
A. M Lincoff ◽  
E. M Ohman ◽  
...  
Keyword(s):  
Treatment Group ◽  
High Risk ◽  
Major Bleeding ◽  
Acute Coronary Syndromes ◽  
Diabetic Patients ◽  
Significant Difference ◽  
Coronary Syndromes ◽  
One Year ◽  
The Impact ◽  
Ischemic Events

Background: Among diabetic patients with acute coronary syndromes (ACS) in the ACUITY trial, bivalirudin (Biv) monotherapy (Mono) provided similar survival and protection from ischemic events with significantly less major bleeding compared to heparin (unfractionated or enoxaparin) plus GP IIb/IIIa inhibitors (Hep+GPI) at 30 days. Whether this protection from ischemic events persists to one year is unknown. Methods: In the ACUITY trial, patients with moderate and high risk (ACS) were randomized to Hep+GPI, Biv+gPI, or Biv Mono. We evaluated the impact of treatment group on composite ischemia (death, MI, or unplanned revascularization) and mortality at one year in diabetic patients using Kaplan Meier survival analysis and log rank tests. Results: Of patients enrolled in the ACUITY trial, 3852 were diabetic (28.1%) and 9857 (71.9%) were non-diabetic. Compared with non-diabetics, diabetics had higher rates of mortality at one year (6.1% vs 3.4%, p<0.001). There was no significant difference in the rate of composite ischemia at one year for diabetic patients who received Biv Mono vs Hep+GPI (19.7% vs 18.9%, p=0.39) or Biv+GPI vs Hep+GPI (20.9% vs 18.9%, p=0.16). Mortality rates for diabetic patients by treatment group are shown below. Conclusions: In the ACUITY Trial, diabetic patients had lower survival rates at one year than non-diabetics. Among diabetic patients, treatment with Biv Mono resulted in similar rates of composite ischemia and survival at one year compared to those treated with Hep+GPI. Combined with the early reduction in major bleeding, these findings indicate that Biv Mono is a suitable alternative to Hep + GPI for diabetic patients with moderate and high risk ACS.

scholarly journals Prediction of One-Year Survival in High-Risk Patients with Acute Coronary Syndromes: Results from the SYNERGY Trial

2008 ◽  
Vol 23 (3) ◽  
pp. 310-316 ◽  
Author(s):  
Kenneth W. Mahaffey ◽  
Qinghong Yang ◽  
Karen S. Pieper ◽  
Elliott M. Antman ◽  
Harvey D. White ◽  
...  
Keyword(s):  
High Risk ◽  
Acute Coronary Syndromes ◽  
High Risk Patients ◽  
Risk Patients ◽  
Coronary Syndromes ◽  
One Year

Plasma markers of endothelial damage/dysfunction, inflammation and thrombogenesis in relation to TIMI risk stratification in acute coronary syndromes

2005 ◽  
Vol 94 (11) ◽  
pp. 1077-1083 ◽  
Author(s):  
Kaeng Lee ◽  
Andrew Blann ◽  
Gregory Lip
Keyword(s):  
Myocardial Infarction ◽  
High Risk ◽  
Risk Stratification ◽  
Risk Score ◽  
Acute Coronary Syndromes ◽  
Endothelial Damage ◽  
Cardiac Events ◽  
Short Term ◽  
Coronary Syndromes ◽  
Timi Risk Score

SummaryRisk stratification at presentation with acute coronary syndromes (ACS) on the basis of theTIMI risk score for unstable angina and non-ST-elevation myocardial infarction (UAP/NSTEMI) identifies patients at high risk of recurrent cardiac events and those who benefit from more aggressive treatment strategy. We hypothesised the following: (a) that a high TIMI risk score brings a greater degree of acute changes in endothelial damage/dysfunction (circulating endothelial cells [CECs], von Willebrand factor [vWf]), inflammation (interleukin-6, IL-6) and blood thrombogenicity (plasma tissue factor, TF); and (b) that these indices are higher in those with high TIMI risk score who experienced recurrent cardiac event at day 14 and day 30. TIMI risk scores were determined at admission and 48 hours later in 88 ACS patients (60 male, age 67±12 yrs) with UAP or NSTEMI. CECs, IL-6 andTF levels were measured at both time points and the acute change (Δ) calculated. Patients were split into high (score ≥4) or low (<4) TIMI score groups. The composite end point of death, myocardial infarction, and refractory angina requiring revascularisation following 14 and 30 days’ follow-up was ascertained. Fifty-eight patients with high TIMI risk score (mean 4.7) had significantly higher baseline and 48 h CEC, vWf, IL-6, TF and ΔTF levels, compared to low TIMI risk score (mean 2.4) patients (all p<0.05). Multivariate Cox regression analysis adjusted for clinical variables and TIMI risk score expressed as either continuous or categorical variable identified baseline CECs and ΔvWf levels (both p≤0.01) as independent predictors of subsequent cardiac events at both 14 days and 30 days. TIMI risk score for UA/NSTEMI identifies those patients with more profound vascular insult, inflammation and thrombogenicity that, in the ‘high risk’ patient group, predicts short-term outcomes although vascular damage was the more sensitive predictor. These indices may further refine global risk stratification for short-term adverse cardiac events in these patients.

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