Abstract 1715: Prognosis of Patients Under Chronic Clopidogrel Therapy while Suffering an Acute Coronary Syndrome

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Laurent Bonello ◽  
Axel de Labriolle ◽  
Gilles Lemesle ◽  
Probal Roy ◽  
Daniel H Steinberg ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Cardiac Death ◽  
Major Adverse Cardiovascular Events ◽  
Coronary Syndrome ◽  
Clopidogrel Therapy ◽  
Artery Disease ◽  
Long Term Prognosis ◽  
Worse Prognosis

Background: Chronic clopidogrel therapy (CCT) has been shown to be beneficial in decreasing the frequency of major adverse cardiovascular events (MACE) in coronary artery disease. However, some patients suffer an acute coronary syndrome (ACS) despite CCT. Objective : To assess the prognosis of patients suffering an ACS while on CCT compared to patients naive to clopidogrel. Method: Retrospective analysis of propensity matched cohorts of patients undergoing PCI for an ACS was performed. Patients under CCT before the ACS were matched 1:2 with patients not under CCT before the ACS. The primary endpoint was a composite of cardiac death and myocardial infarction (MI) at 1-year follow-up. A cohort of 2325 patients undergoing PCI for an ACS was studied. Among them, 256 patients were taking CCT for > 1 month at the time of the ACS and 2069 weren’t taking clopidogrel prior to the ACS. After propensity score matching 1:2, the 2 groups included, respectively, 84 and 168 patients. Results: Patients in both groups had similar rates of previous MI (no CCT vs CCT 47.6 vs 48.8%; p = 0.86) or PCI (40.5 vs 40.5%; p = 1). There was no difference in drug use on discharge between the 2 groups; in particular for thienopyridines (94 vs 96.4%; p = 0.6). At 1-year follow-up, patients under CCT before the ACS exhibited a worse prognosis than patients who were not under CCT prior to the ACS, with a higher rate of cardiac death and MI (14.2 vs 5.5%; p = 0.015). Conclusions: This study suggests that patients suffering an ACS while under CCT have a poor long-term prognosis, which could be linked to clopidogrel low response.

P5524Influence of bundle branch block in the long-term outcome of patients with acute coronary syndrome

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J M Garcia Acuna ◽  
A Cordero Fort ◽  
A Martinez ◽  
P Antunez ◽  
M Perez Dominguez ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Right Bundle Branch Block ◽  
Coronary Revascularization ◽  
Bundle Branch Block ◽  
Coronary Syndrome ◽  
Worse Prognosis

Abstract The new European Society of Cardiology guideline for ST-segment elevation myocardial infarction recommends that left and right bundle branch block should be considered equal for recommending urgent angiography in patients with suspected myocardial infarction. This consideration is not taken into account in the management of patients with coronary syndrome without ST elevation (NSTEMI). We evaluate the evolution of patients with acute coronary syndrome and long-term bundle branch block. Patients and methods We included 8771 patients admitted to two tertiary hospitals between 2003 and 2017 with an acute coronary syndrome, 5673 NSTEMI (64.3%) and 3098 STEMI (35.7%). All patients had an ECG recorded immediately upon admission. Patients were classified as having right bundle branch block (RBBB), left bundle branch block (LBBB). Long-term follow-up was performed (median 55 months) to assess mortality. Results A total of 8771 patients were included with a mean age of 66.1 years, 72.5% males, 4.1% (362) with LBBB and 5% (440) with RBBB. Patients with BBB were older, with more previous history of myocardial infarction and coronary revascularization and higher prevalence of cardiovascular risk factors. Medical treatment was similar but they were less often submitted to angioplasty. During the acute phase, patients with RBBB and LBBB presented a higher rate of heart failure than those without branch block (4.8% vs 9.1% vs 3.5%, p=0.0001); higher mortality (8.4% vs 10.5% vs 3.0%, p=0.0001); higher stroke rate (2.5% vs 1.4% vs 0.8%, p=0.001); higher rate of renal failure (8.2% vs 9.7% vs 3.9%, p=0.0001) and higher rate of reinfarction (3.0% vs 4.1% vs 1.7%, p=0.001). Patients who had a RBBB or an LBBB had a worse prognosis throughout the follow-up. Heart failure was present in 17.7% of the group with RBBB, 29.6% of LBBB and 11% in the group without branch block (p=0.0001). Mortality during follow-up was 31% in RBBB, 40.6% in LBBB and 18.7% without branch block (p=0.0001). In multivariate analysis of Cox, both RBBB (HR 1.55, 95% CI 1.23–1.98, p=0.0001) and LBBB (HR 1.48, 95% CI 1.22–1.53, p=0.001) were an independent predictors of all-cause mortality (adjustment for GRACE score, gender, treatment with betablockers, angiotensin conversor enzym inhibitors, statin and coronary revascularization). Cox regression model multivariate Conclusions The presence of RBBB or LBBB in the ECG of patients with an ACS is associated with a worse prognosis both during the hospital phase and in the long term. In addition, both bundle branch blocks are independent predictors of long-term mortality in patients with ACS.

scholarly journals Relation of Fibrinogen-to-Albumin Ratio to Severity of Coronary Artery Disease and Long-Term Prognosis in Patients with Non-ST Elevation Acute Coronary Syndrome

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Mingkang Li ◽  
Chengchun Tang ◽  
Erfei Luo ◽  
Yuhan Qin ◽  
Dong Wang ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Albumin Ratio ◽  
Coronary Syndrome ◽  
St Elevation ◽  
Elevation Acute Coronary Syndrome ◽  
Artery Disease ◽  
Long Term Prognosis

Previous studies showed that fibrinogen-to-albumin ratio (FAR) regarded as a novel inflammatory and thrombotic biomarker was the risk factor for coronary artery disease (CAD). In this study, we sought to evaluate the relationship between FAR and severity of CAD, long-term prognosis in non-ST elevation acute coronary syndrome (NSTE-ACS) patients firstly implanted with drug-eluting stent (DES). A total of 1138 consecutive NSTE-ACS patients firstly implanted with DES from January 2017 to December 2018 were recruited in this study. Patients were divided into tertiles according to FAR levels (Group 1: ≤8.715%; Group 2: 8.715%~10.481%; and Group 3: >10.481%). The severity of CAD was evaluated using the Gensini Score (GS). The endpoints were major adverse cardiovascular events (MACE), including all-cause mortality, myocardial reinfarction, and target vessel revascularization (TVR). Positive correlation was detected by Spearman’s rank correlation coefficient analysis between FAR and GS (r=0.170, P<0.001). On multivariate logistic analysis, FAR was an independent predictor of severe CAD (OR: 1.060; 95% CI: 1.005~1.118; P<0.05). Multivariate Cox regression analysis indicated that FAR was an independent prognostic factor for MACE at 30 days, 6 months, and 1 year after DES implantation (HR: 1.095; 95% CI: 1.011~1.186; P=0.025. HR: 1.076; 95% CI: 1.009~1.147; P=0.026. HR: 1.080; 95% CI: 1.022~1.141; P=0.006). Furthermore, adding FAR to the model of established risk factors, the C-statistic increased from 0.706 to 0.720, 0.650 to 0.668, and 0.611 to 0.632, respectively. And the models had incremental prognostic value for MACE, especially for 1-year MACE (NRI: 13.6% improvement, P=0.044; IDI: 0.6% improvement, P=0.042). In conclusion, FAR was associated independently with the severity of CAD and prognosis, helping to improve risk stratification in NSTE-ACS patients firstly implanted with DES.

scholarly journals The correlation between traditional risk factors and the severity of acute coronary syndrome and long-term prognosis

2015 ◽  
Vol 6 (4) ◽  
pp. 6-10
Author(s):  
I. S Skopets ◽  
N. N Vezikova ◽  
I. M Marusenko ◽  
O. Yu Barysheva
Keyword(s):  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Family History ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
Life Threatening ◽  
Traditional Risk Factors ◽  
Long Term Prognosis

A number of studies demonstrate that patients with traditional risk factors (TRF) have not only increases primary risk of atherothrombotic events, but are also associated with many complicates and poor prognosis.Purpose: assessment of TRF effect on the incidence of complications and outcomes in patients with acute coronary syndrome (ACS).Materials and methods: in 255 patients hospitalized with ACS were retrospective determined the TRF prevalence, frequency of the complications and correlation between the presence of TRF and the risk of complications and long-term prognosis (follow-up 1 year).Results: patients had TRF very often, 80% patients had more than 3 TRFs. The presence of some TRFs (smoking, abdominal obesity, family history) was associated with a significantly increased risk of complications in patients with ACS, including life-threatening. Effect of TRF on long-term prognosis was not determined.Conclusion: the findings suggest the need to evaluation TRF not only in primary preventive and also to improve the effectiveness of risk stratification in patients with ACS.

Abstract 221: Prognostic Role of elevated Myeloperoxidase in Patients with Acute Coronary Syndrome: A Systemic Review and Meta-Analysis.

2014 ◽  
Vol 115 (suppl_1) ◽  
Author(s):  
Andrew R Kolodziej ◽  
Charles L Campbell ◽  
Richard Charnigo ◽  
Raphael Twerenbold ◽  
Christian Mueller ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Meta Analysis ◽  
Systemic Review ◽  
Major Adverse Cardiovascular Events ◽  
Poor Prognostic Factor ◽  
Coronary Syndrome ◽  
Prospective Trials ◽  
Long Term Prognosis

BACKGROUND: It has been shown that Myeloperoxidase (MPO) is intimately involved in pathogenesis of atherosclerosis and Acute Coronary Syndrome (ACS). Small studies have shown that high levels of MPO are a poor prognostic factor in patients presenting with ACS. However, due to the small nature of these studies, the relationship between MPO and outcomes has not been confirmed. Here we aimed to examine the prognostic value of MPO in patients with ACS. METHODS: We performed a meta-analysis to compare the long-term prognosis of ACS patients with high MPO and low MPO levels. The literature was retrieved by formal searches of electronic databases (PubMed, EMBASE, Medline, OVID, and web of knowledge) from inception to November 2013. A total of 16 trials were included in this meta-analysis involving 10572 patients. Data were analyzed using random-effects model and study quality was assessed using appropriate scales. RESULTS: High MPO group was associated with overall worse outcomes than low MPO group in terms of recurrent myocardial infarction (9% [211 of 2336] vs. 7.7% [240 of 3101], odds ratio [OR] 1.4, 95% confidence interval [CI]: 0.92-2.15, p 0.11); all cause mortality (8% [236 of 2920] vs. 5% [209 of 4263], OR 1.83, 95% CI: 1.31-2.54, p <0.0004) and Major Adverse Cardiovascular Events (MACE) (24% [334 of 1400] vs. 14% [133 of 949], OR 2.04, 95% CI: 1.46-2.85, p< 0.0001) (Figure). CONCLUSIONS: In this meta-analysis examining the long-term outcomes in ACS patients, high MPO levels were associated with worse outcomes. These observations support prospective trials tailoring more aggressive therapy to patients with suspected worse prognosis.

scholarly journals High-Sensitivity Troponin T vs I in Acute Coronary Syndrome: Prediction of Significant Coronary Lesions and Long-term Prognosis

2017 ◽  
Vol 63 (2) ◽  
pp. 552-562 ◽  
Author(s):  
Brede Kvisvik ◽  
Lars Mørkrid ◽  
Helge Røsjø ◽  
Milada Cvancarova ◽  
Alexander D Rowe ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Angiography ◽  
High Sensitivity ◽  
Coronary Syndrome ◽  
Prognostic Accuracy ◽  
All Cause Mortality ◽  
Coronary Lesions ◽  
Long Term Prognosis

Abstract BACKGROUND High-sensitivity cardiac troponin (hs-cTn) T and I assays are established as crucial tools for the diagnosis of acute myocardial infarction (AMI), as they have been found superior to old troponin assays. However, eventual differences between the assays in prediction of significant coronary lesions and long-term prognosis in patients with acute coronary syndrome (ACS) have not been fully unraveled. METHODS Serum concentrations of hs-cTnT (Roche), hs-cTnI (Abbott), and amino-terminal pro-B-type natriuretic peptide (NT-proBNP; Roche) in 390 non-ST-elevation (NSTE) ACS patients were evaluated in relation to significant coronary lesions on coronary angiography (defined as a stenosis &gt;50% of the luminal diameter, with need for revascularization) and prognostic accuracy for cardiovascular mortality, all-cause mortality, as well as the composite end point of cardiovascular mortality and hospitalizations for AMI or heart failure. RESULTS The mean (SD) follow-up was 2921 (168) days. Absolute hs-cTnI concentrations were significantly higher than the hs-cTnT concentrations. The relationship between analyzed biomarkers and significant coronary lesions on coronary angiography, as quantified by the area under the ROC curve (AUC), revealed no difference between hs-cTnT [AUC, 0.81; 95% CI, 0.77–0.86] and hs-cTnI (AUC, 0.81; 95% CI, 0.76–0.86; P = NS). NT-proBNP was superior to both hs-cTn assays regarding prognostic accuracy for both cardiovascular and all-cause mortality and for the composite end point during follow-up, also in multivariate analyses. CONCLUSIONS The hs-cTnT and hs-cTnI assays displayed a similar ability to predict significant coronary lesions in NSTE-ACS patients. NT-proBNP was superior to both hs-cTn assays as a marker of long-term prognosis in this patient group.

P3613J-shaped relationship between cardiac mortality risk and admission systolic blood pressure in patients aged 65 years and over with acute coronary syndrome

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Y Jiang ◽  
H W Li
Keyword(s):  
Blood Pressure ◽  
Acute Coronary Syndrome ◽  
Systolic Blood Pressure ◽  
Cardiac Death ◽  
Cardiac Mortality ◽  
Coronary Syndrome ◽  
Kaplan Meier ◽  
All Cause Mortality

Abstract Objective To observe the effects of different admission systolic blood pressure (SBP) levels on the in-hospital and long-term prognosis of elderly patients with acute coronary syndrome (ACS). Methods This retrospective cohort study included 5812 ACS patients aged 65 and over admitted from January, 2013 to September, 2018. Their blood pressure, medical history and laboratory examinations were recorded. The patients were divided into 5 groups according to the level of admission SBP (<100, 100–119, 120–139, 140–159, and ≥160 mmHg). The main endpoint of this study was cardiac death and all-cause death in hospital and during 6-year follow-up. Results Among the participants, the number of patients admitted with SBP <100, 100–119, 120–139, 140–159, and ≥160 mmHg were 143 (2.5%), 1014 (17.4%), 2456 (42.3%), 1607 (27.6%), and 592 (10.2%), respectively. The highest in-hospital cardiac mortality and all-cause mortality rate were found in the group with admission SBP <100 mmHg and the lowest were found in the group with SBP 140–159 mmHg (9.1% vs. 3.2% vs. 1.1% vs. 0.8% vs. 1.5%, P=0.000; 9.8% vs. 3.4% vs. 1.1% vs. 0.8% vs. 1.7%, P=0.000). Kaplan-Meier curve showed that patients with SBP 120–139 mmHg at admission had better prognosis (cardiac mortality: 3.9% vs. 10.9%, 5.6%, 5.1%, and 6.7% respectively, P=0.000; all-cause mortality: 7.6% vs. 14.7%, 9.7%, 9.1%, and 11.0%, respectively, P=0.000). Multivariate analysis showed that admission SBP <120 mmHg or ≥160 mmHg was a independent predictors of follow-up cardiac death (HR 1.747, 95% CI 1.066–2.861, P=0.027; HR 1.496, 95% CI 1.092–2.050, P=0.012; HR 1.630, 95% CI 1.120–2.372, P=0.011) compared with patients admitted with SBP 120–139 mmHg. In-hospital and 6-year follow-up outcomes of ACS patients ≥65y by admission SBP Admission SBP Level <100mmHg ≥100mmHg and <120mmHg ≥120mmHg and <140mmHg ≥140mmHg and <160mmHg ≥160mmHg P In-hospital (n=143) (n=1014) (n=2456) (n=1607) (n=592)   Cardiac mortality, n (%) 13 (9.1) 32 (3.2) 28 (1.1) 13 (0.8) 9 (1.5) 0.000   All-cause mortality, n (%) 14 (9.8) 34 (3.4) 28 (1.1) 13 (0.8) 10 (1.7) 0.000 Follow-up (n=129) (n=980) (n=2428) (n=1594) (n=582)   Cardiac mortality, n (%) 14 (10.9) 55 (5.6) 94 (3.9) 81 (5.1) 39 (6.7) 0.000   All-cause mortality, n (%) 19 (14.7) 95 (9.7) 185 (7.6) 144 (9.1) 64 (11.0) 0.000 Kaplan-Meier analyses Conclusion In ACS patients ≥65 y, a “J” relationship between admission SBP and cardiac mortality is observed. For ACS patients aged 65 years and over, admission SBP <120 mmHg or ≥160mmHg is a independent risk factor for long-term cardiac death. Acknowledgement/Funding National Natural Science Foundation of China (No. 81300333))

Single-center register of myocardial revascularization in patients with coronary artery disease and acute coronary syndrome in the context of COVID-19 pandemic

2021 ◽  
Vol 20 (6) ◽  
pp. 2876
Author(s):  
O. V. Kamenskaya ◽  
A. S. Klinkova ◽  
I. Yu. Loginova ◽  
V. N. Lomivorotov ◽  
A. M. Chernyavskiy ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Myocardial Revascularization ◽  
Coronary Syndrome ◽  
Short And Long Term ◽  
Artery Disease

Aim. To assess the short- and long-term outcomes of myocardial re- vascularization (MR) in patients with coronary artery disease (CAD) and acute coronary syndrome (ACS) in the context of coronavirus disease 2019 (COVID-19) pandemic.Material and methods. In the period from April to August 2020, 550 patients with CAD and ACS were included in the register. Emergency percutaneous transluminal coronary angioplasty (n=499) and on-pump coronary artery bypass grafting (CABG) (n=51) were performed. The follow-up period lasted 6 months. The pattern of complications after MR and effects of COVID-19 were analyzed.Results. The studied cohort is represented by patients with CAD >65 years old. ST segment elevation ACS was detected in 23%, acute myocardial infarction — in 59,1%, in other cases — unstable angina. During hospitalization after MR, atrial fibrillation prevailed among cardiovascular complications (4,7%). During this period, 29 (5,3%) patients was diagnosed with COVID-19. In the short-term period after MR, 3 (0,5%) people died due to COVID-19 complications-. In the long-term period after MR, 4 (0,7%) cases of non-fatal stroke were registered, while repeated MR — in 7,1%. The all-cause mortality rate was 1,3% (n=7), of which 57,1% of patients died due to COVID-19 complications. In the subgroup of patients who underwent CABG, the greatest number of in-hospital complications was noted, where exudative pleurisy, atrial fibrillation and anemia prevailed. Of the patients with COVID-19, pneumonia in the short-and long-term posto perative periods was recorded in 48,3 and 61,3%, respectively. Pneumonia is associated with respiratory failure, cardiac dysfunction, and anemia. The risk of COVID-19 pneumonia during the entire follow-up period was higher in patients with ACS who underwent CABG (odds ratio, 19,4; confidence interval: 13,3-26,1; p<0,001). The overall survival rate was 98,7%.Conclusion. COVID-19 infection in patients with ACS after MR effects pattern of postoperative complications. The proportion of COVID-19 pneumonia in patients with ACS in hospital, short-  and long-term postoperative periods after MR significantly exceeds that in the general population. The leading factor associated with COVID-19 pneumonia in patients with ACS is on-pump CABG.

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