Abstract 4192: Unrecognized Myocardial Infarctions are Common in Cardiac Asymptomatic Subjects at High Vascular Risk

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Matthijs F Meijs ◽  
Michiel L Bots ◽  
Maarten J Cramer ◽  
Evert J Vonken ◽  
Birgitta K Velthuis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
High Risk ◽  
Male Gender ◽  
History Of ◽  
Artery Disease ◽  
Asymptomatic Subjects ◽  
Q Wave

Unrecognized myocardial infarction (UMI), generally assessed by the presence of a Q-wave on the electrocardiogram, is commonly found. Furthermore, mortality associated with UMI appears to be similar as for recognized myocardial infarction. With delayed enhancement cardiac MRI (DE-CMR) both Q-wave and non-Q wave infarctions can be identified. The aim of this study was to investigate the prevalence and determinants of UMI in high risk subjects without symptomatic coronary artery disease using DE-CMR. A DE-CMR was performed in 502 subjects with clinically manifest non-coronary atherosclerotic disease or marked risk factors for atherosclerosis. As all subjects had no known history of coronary artery disease, subendocardial and transmural scar tissue on DE-CMR was considered an UMI. In all subjects information on atherosclerotic risk factors was collected. Multivariable logistic regression was used to study the relation of risk factors with UMI. DE-CMR was of sufficient image quality in 480 (95.6%) subjects. Interobserver agreement was excellent (weighted kappa = 95%). An UMI was present in 45 (9.4%) of all subjects, and in 38 (13.1%) of 291 men and in 7 (3.7%) of 189 women. The risk of UMI increased from 6.0% (95%CI 2.2 – 9.8%) in those with two risk factors up to 26.2% (95%CI 15.2 – 37.3%) in those with 4 or 5 risk factors (male gender, age above mean of 53 years, ever smoking, history of stroke, and history of aneurysm of the abdominal aorta (AAA)). In multivariable analysis the risk of UMI was related to male gender (OR 2.6 (95%CI 1.1– 6.3)), age (OR 1.0 (95%CI 1.0 –1.1) per year), ever smoking (OR 3.1 (95%CI 1.0 –9.0), history of stroke (OR 2.1 (95%CI 1.0 – 4.4)) and history of AAA (OR 2.3 (95%CI 0.9 –5.9)). In high risk cardiac asymptomatic subjects UMI is common. The risk of UMI increases with increasing presence of risk factors.

scholarly journals Prevalence and Clinical Correlates of Coronary Artery Disease among New Dialysis Patients in the United States: A Cross-Sectional Study

2001 ◽  
Vol 12 (7) ◽  
pp. 1516-1523 ◽  
Author(s):  
AUSTIN G. STACK ◽  
WENDY E. BLOEMBERGEN
Keyword(s):  
United States ◽  
Risk Factors ◽  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
The United States ◽  
Comorbid Conditions ◽  
Clinical Correlates ◽  
History Of ◽  
Artery Disease

Abstract. Despite the high prevalence of coronary artery disease (CAD) among patients with end-stage renal disease (ESRD), few studies have identified clinical correlates using national data. The purpose of this study was to determine the prevalence and clinical associations of CAD in a national random sample of new ESRD in the United States in 1996/1997 (n = 4025). Data on demographic characteristics and comorbidities were obtained from the Dialysis Morbidity and Mortality Study, Wave 2. The principal outcome was CAD, defined as the presence of a previous history of CAD, myocardial infarction, or angina, coronary artery bypass surgery, coronary angioplasty, or abnormal coronary angiographic findings. Multivariate logistic regression analysis was used to assess the relationship of conventional factors and proposed uremic factors to the presence of CAD. CAD was present in 38% of patients. Of the total cohort, 17% had a history of myocardial infarction and 23% had angina. Several conventional risk factors, including advancing age, male gender, diabetes mellitus, and smoking, were significantly associated with CAD. Of the proposed uremic factors, lower serum albumin levels but higher residual renal function and higher hematocrit values were significantly associated with the presence of CAD. Vascular comorbid conditions, structural cardiac abnormalities, white race, and geographic location were also strongly correlated with the presence of CAD. This national study suggests that several conventional CAD risk factors may also be risk factors for CAD among the ESRD population. This study identifies nonconventional factors such as serum albumin levels, vascular comorbid conditions, and structural cardiac abnormalities as important disease correlates. Future logitudinal studies are required to explore the relative importance of the relationships observed here.

P6162Difference in progression to obstructive lesions according to the presence of high-risk plaque features

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S E Lee ◽  
G Pontone ◽  
I Gottlieb ◽  
M Hadamitzky ◽  
J A Leipsic ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
High Risk ◽  
Obstructive Coronary Artery Disease ◽  
Clinical Risk Factors ◽  
Clinical Risk ◽  
Obstructive Lesion ◽  
History Of ◽  
Artery Disease

Abstract Background It is still debatable whether the so-called high-risk plaque (HRP) simply represents a certain phase during the natural history of coronary atherosclerotic plaques or the disease progression would differ according to the presence of HRP. Purpose We determined whether the pattern of non-obstructive lesion progression into obstructive lesions would differ according to the presence of HRP. Methods Patients with non-obstructive coronary artery disease, defined as % diameter stenosis (%DS) ≥50%, were enrolled from a prospective, multinational registry of consecutive patients who underwent serial coronary computed tomography angiography at an inter-scan interval of ≥2 years. HRP was defined as lesions with ≥2 of positive remodelling, spotty calcification, and low-attenuation plaque. The total and compositional percent atheroma volume (PAV) at baseline and annualized PAV change were compared between non-HRP and HRP lesions. Results A total of 1,115 non-obstructive lesions were identified from 327 patients (61.1±8.9 years old, 66.0% male). There were 690 non-HRP and 425 HRP lesions. HRP lesions possessed greater PAV and %DS at baseline compared to non-HRP lesions. However, the annualized total and non-calcified PAV change were greater in non-HRP lesions than in HRP lesions. On multivariate analysis, addition of baseline PAV and %DS to clinical risk factors improved the predictive power of the model (Table). When clinical risk factors, PAV, %DS, and HRP were all adjusted on Model 3, only baseline PAV and %DS independently predicted the development of obstructive lesions (hazard ratio (HR) 1.046 [95% confidence interval (CI): 1.026–1.066] and HR 1.087 [95% CI: 1.055–1.119], respectively, all p<0.001), while HRP did not (p>0.05). Comparison of C-statistics of per-lesion analysis to predict progression to obstructive lesion C-statistics (95% CI) P Model 1: Baseline PAV 0.880 (0.879–0.884) – Model 2: Model 1 + baseline %DS 0.938 (0.937–0.939) vs. Model 1: <0.001 Model 3: Model 2 + HRP 0.935 (0.934–0.937) vs. Model 2: 0.004 Adjusted for age, male sex, hypertension, diabetes mellitus, hyperlipidemia, family history of coronary artery disease, smoking, body mass index, and statin use. Conclusion The pattern of individual coronary atherosclerotic plaque progression differed according to the presence of HRP. Baseline PAV was the most important predictor for lesions developing into obstructive lesions rather than the presence of HRP features at baseline. Acknowledgement/Funding This work was supported by the National Research Foundation of Korea funded by the Ministry of Science and ICT (Grant No. 2012027176).

scholarly journals Dual Antiplatelet or Dual Antithrombotic Therapy for Secondary Prevention in High-Risk Patients with Stable Coronary Artery Disease?

2019 ◽  
Vol 119 (10) ◽  
pp. 1583-1589 ◽  
Author(s):  
Wael Sumaya ◽  
Tobias Geisler ◽  
Steen D. Kristensen ◽  
Robert F. Storey
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
High Risk ◽  
Secondary Prevention ◽  
Dual Antiplatelet Therapy ◽  
Stable Coronary Artery Disease ◽  
Risk Patients ◽  
History Of ◽  
Artery Disease

AbstractAntithrombotic treatment is a key component of secondary prevention following acute coronary syndromes (ACS). Although dual antiplatelet therapy is standard therapy post-ACS, duration of treatment is the subject of ongoing debate. Prolonged dual antiplatelet therapy in high-risk patients with history of myocardial infarction reduced the risk of recurrent myocardial infarction, stroke or cardiovascular death. Similarly, in patients with stable coronary artery disease, two-thirds of whom had a history of myocardial infarction, dual antithrombotic therapy with very-low-dose rivaroxaban and aspirin also resulted in improved ischaemic outcomes. In the absence of head-to-head comparison, choosing the most appropriate treatment strategy can be challenging, particularly when it comes to balancing the risks of ischaemia and bleeding. We aim to review the evidence for currently available antithrombotic treatments and provide a practical algorithm to aid the decision-making process.

scholarly journals Risk Factors Associated With the Extent of Coronary Vessel Involvement Across the Spectrum of Coronary Artery Disease

2021 ◽  
Vol 17 (4) ◽  
Author(s):  
Ali Moezi ◽  
Maryam Soltani ◽  
Toba Kazemi ◽  
Saeede Khosravi Bizahem ◽  
Nasrin Amirabadizadeh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Male Gender ◽  
Coronary Vessel ◽  
Factors Associated ◽  
Populations At Risk ◽  
History Of ◽  
Artery Disease ◽  
Vessel Involvement

Background: Cardiovascular Disease (CVD) is one of the most important causes of mortality and morbidity in developed and developing countries. Objectives: This study aimed to evaluate the risk factors associated with the extent of coronary vessel involvement across the spectrum of Coronary Artery Disease (CAD) in patients referring to the Cardiac Ward of Vali-Asr Hospital of Birjand, Iran. Methods: A cross-sectional study was conducted on 3,394 patients undergoing coronary angiography at the Cardiac Ward of Vali-Asr Hospital of Birjand, Iran, in 2011-2015. Subjects were assigned to four groups in terms of the extent of coronary vessel involvement: Normal CAD, non-significant CAD, CAD, and non-obstructive CAD. Adjusted odds ratios and 95% confident intervals were calculated by including all variables with P values < 0.05 into the multivariate model to control for confounding factors. Data were analyzed using SPSS version 22. Results: Among male and female patients, those aged 45-65 years needed angiography more than other groups. Multiple logistic regression analysis showed that diabetes, male gender, FBS, and history of hypertension significantly increased the likelihood of coronary vessel involvement (P ≤ 0.05). Conclusions: The findings of the present study imply that age, male gender, FBS, and history of hypertension are the independent risk factors for the extent of coronary vessel involvement in CAD and non-significant CAD groups. To reduce the rates and consequences of CAD, it is paramount to control cardiovascular risk factors, screen susceptible populations at risk, and improve coronary interventional services.

scholarly journals Impact of Coronary CT angiography in combination with CAD-RADS on the management of coronary artery disease patients

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
F Andre ◽  
S Seitz ◽  
P Fortner ◽  
R Sokiranski ◽  
F Gueckel ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Risk Stratification ◽  
Coronary Ct Angiography ◽  
Patient Management ◽  
Male Gender ◽  
Coronary Ct ◽  
History Of ◽  
Artery Disease ◽  
The Impact

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Siemens Healthineers Introduction Coronary CT angiography (CCTA) plays an increasing role in the detection and risk stratification of patients with coronary artery disease (CAD). The Coronary Artery Disease – Reporting and Data System (CAD-RADS) allows for standardized classification of CCTA results and, thus, may improve patient management. Purpose Aim of this study was to assess the impact of CCTA in combination with CAD-RADS on patient management and to identify the impact of cardiovascular risk factors (CVRF) on CAD severity. Methods CCTA was performed on a third-generation dual-source CT scanner in patients, who were referred to a radiology centre by their attending physicians. In a total of 4801 patients, CVRF were derived from medical reports and anamnesis. Results The study population consisted of 4770 patients (62.0 (54.0-69.0) years, 2841 males) with CAD (CAD-RADS 1-5), while 31 patients showed no CAD and were excluded from further analyses. Age, male gender and the number of CVRF were associated with more severe CAD stages (all p &lt; 0.001). 3040 patients (63.7 %) showed minimal or mild CAD requiring optimization of CVRF i.e. medical therapy but no further assessment at his time. A group of 266 patients (5.6 %) had a severe CAD defined as CAD-RADS 4B/5. In the multivariate regression analysis, age, male gender, history of smoking, diabetes mellitus and hyperlipidaemia were significant predictors for severe CAD, whereas arterial hypertension and family history of CAD did not reach significance. Of note, a subgroup of 28 patients (10.5 %) with a severe CAD (68.5 (65.5-70.0) years, 26 males, both p = n.s.) had no CVRF. Conclusions CCTA in combination with the CAD-RADS allowed for effective risk stratification of CAD patients. The majority of the patients showed non-obstructive CAD and, thus, could be treated conservatively without the need for further CAD assessment. CVRF out of arterial hypertension and family history had an impact on CAD severity reflected in higher CAD-RADs gradings. Of note, a relevant fraction of patients with CAD did not have any CVRF and, thus, may not be covered by risk stratification models. CAD-RADS n Age (years) Males (%) 1 1453 56.0 (50.0-62.0) 623 (42.9 %) 2 1587 62.0 (55.0-69.0) 918 (57.8 %) 3 1067 66.0 (59.0-71.0) 749 (70.2 %) 4A 397 66.0 (59.0-72.0) 317 (79.8 %) 4B 162 67.0 (61.0-74.0) 139 (85.8 %) 5 104 66.0 (58.5.0-77.0) 95 (91.3 %)

scholarly journals Waist-to-Height Ratio (WHtR) in Predicting Coronary Artery Disease Compared to Body Mass Index and Waist Circumference in a Single Center from Saudi Arabia

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Mostafa Q. Alshamiri ◽  
Faisal Mohd A Habbab ◽  
Saad Saeed AL-Qahtani ◽  
Khalil Abdullah Alghalayini ◽  
Omar Mohammed Al-Qattan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Body Mass Index ◽  
Coronary Artery ◽  
Cardiometabolic Risk ◽  
Height Ratio ◽  
History Of ◽  
Male Patients ◽  
Waist To Height Ratio ◽  
Artery Disease

This study aims to study the efficiency of the Waist-to-Height Ratio (WHtR) for determining coronary artery disease. It compares the frequency of abnormal WHtR, as a proxy for abdominal obesity, to that of body mass index (BMI) and waist circumference (WC). It also relates the findings to other cardiometabolic risk factors in University Hospital patients. A cross-sectional study design was used, where a sample of 200 patients (142 males and 58 females) who attended the adult cardiac clinic were purposively included. BMI, WC, and WHtR were measured, where frequencies of WHtR were compared to those of BMI and WC. The findings were related to the history of coronary artery disease (CAD) and history of cardiometabolic risk factors, including diabetes mellitus (DM), hypertension (HTN), and hyperlipidemia. Majority of the male patients were older, taller, and had a lower BMI value. It also showed that the prevalence of dyslipidemia and CAD was higher in male patients. No significant difference between both genders was noticed for weight, WC, WHtR, hypertension, or DM. BMI was least associated with high-risk cardiac population in both males and females (39.4% and 60.3%), followed by WC (84.5% and 96.6%, respectively). WHtR showed the highest association with gender (male 98.6% and females 98.3%). These findings were noticed in patients with all risk factors. WHtR is superior to BMI and WC for determining the elevated risk of diabetes, hypertension, dyslipidemia, and CAD in a single university institute. The role of WHtR in both normal and diseased Saudi population should be delineated.

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