Abstract P117: Episodes of Anger are Associated with a Higher Risk of Myocardial Infarction and Acute Coronary Syndrome: Systematic Review and Meta-Analysis

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Elizabeth Mostofsky ◽  
Elizabeth A Penner ◽  
Murray A Mittleman
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Recurrent Events ◽  
Disease Risk ◽  
Meta Analysis ◽  
Disease Onset ◽  
Anger Expression ◽  
Epidemiological Studies ◽  
Coronary Syndrome ◽  
Relative Risks

Introduction: Short-term psychological stress is associated with an immediate physiologic response. We assessed the hypothesis that brief episodes of anger may trigger the onset of acute myocardial infarction (MI) and other acute coronary syndromes (ACS). Methods: We performed a literature search of the CINAHL, Embase, PubMed and PsycInfo databases from January 1966 through June 2012 using the key words “anger”, “hostility”, “myocardial infarction” and “acute coronary syndrome” without restrictions. We also reviewed the reference lists of retrieved articles and spoke with authors of relevant work to identify unpublished data. We used an inverse-variance-weighted random effects model to perform a meta-analysis of all epidemiological studies that reported relative risks and 95% confidence intervals (CI) for the association between outbursts of anger and nonfatal MI or ACS. Results: The meta-analysis included four independent case-crossover studies of anger and risk of MI or ACS published between 1995 and 2007 and one unpublished report. Combined, there were 4546 MI cases (two studies) and 462 ACS cases (two studies), including 180 that experienced an episode of anger in the two hours prior to disease onset; two studies were restricted to first MI or ACS and two included first and recurrent events. All studies used the Onset Anger Scale to assess anger episodes, but the studies differed in the cutoff used to define exposure. The association between outbursts of anger and disease risk in the following two hours was 3.46 (95%CI 2.08-5.76; p<0.001). The results were similar for studies of first and recurrent events and were similar for studies of MI and ACS. Conclusions: There is a higher risk of MI and ACS shortly after outbursts of anger. Some of the between-study heterogeneity may be due to regional differences in the type of anger expression and the interpretation of the questions. Further research is necessary to evaluate whether the risk is lower among people who are regularly active.

scholarly journals The clinical and angiographic outcomes of post-dilation after percutaneous coronary intervention in patients with acute coronary syndrome: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Yan Li ◽  
Xiying Liang ◽  
Wenjiao Zhang ◽  
Xuan Qiao ◽  
Zhilu Wang
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Stent Thrombosis ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Target Vessel ◽  
Target Vessel Revascularization ◽  
Coronary Syndrome ◽  
No Reflow ◽  
Percutaneous Coronary

Abstract Background Optimal stent deployment is closely related to the prognosis of patients with coronary artery disease, but the effect of post-dilation on clinical and angiographic outcomes in patients with acute coronary syndrome is still controversial. This meta-analysis aims to analyze the clinical and angiographic outcomes of post-dilation after percutaneous coronary intervention in patients with acute coronary syndrome. Methods PubMed, Embase, The Cochrane Library, Web of Science, CNKI and WANGFANG date-bases were searched from inception to August 30, 2020. Eligible studies from acute coronary syndrome patients treated with post-dilation were included. The primary clinical outcome was major adverse cardiovascular events (MACE), the secondary clinical outcomes were comprised of all-cause death, stent thrombosis, myocardial infarction, and target vessel revascularization, the angiographic outcomes were no reflow and slow reflow. Results A total of 11 studies enrolling 5663 patients met inclusion criteria. Our pooled analysis demonstrated that the post-dilation did not have significant impact on MACE (OR = 0.76, 95% CI 0.50–1.17; P = 0.21), stent thrombosis (OR = 0.71, 95% CI 0.40–1.26; P = 0.24), myocardial infarction (OR = 0.14, 95% CI 0.51–3.83; P = 0.51), and target vessel revascularization of clinical outcomes (OR = 0.61, 95% CI 0.21–1.80; P = 0.37) between post-dilation and non-post-dilation groups, but increased the risk of all-cause death (OR = 1.49, 95% CI 1.05–2.19; P = 0.03). There were no significant difference in no reflow (OR = 1.19, 95% CI 0.54–2.65; P = 0.66) and slow reflow (OR = 1.12, 95% CI 0.93–1.35; P = 0.24) of angiographic outcomes between two groups. Conclusions The post-dilation can increase the risk of all-cause death, without affecting the risks of MACE, stent thrombosis, myocardial infarction, target vessel revascularization, no reflow and slow reflow. However, more randomized controlled trials are required for investigating the benefits of post-dilation for patients with acute coronary syndrome (Registered by PROSPERO, CRD42020160748).

scholarly journals The Clinical and Angiographic Outcomes of Postdilation after Percutaneous Coronary Intervention in Patients with Acute Coronary Syndrome: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
Yan Li ◽  
Xiying Liang ◽  
Wenjiao Zhang ◽  
Xuan Qiao ◽  
Zhilu Wang
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Stent Thrombosis ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Target Vessel ◽  
Target Vessel Revascularization ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Objective. The effect of postdilation in patients with acute coronary syndrome is still controversial. This meta-analysis aims to analyze the clinical and angiographic outcomes of postdilation after percutaneous coronary intervention in patients with acute coronary syndrome. Methods. PubMed, Embase, the Cochrane Library, Web of Science, CNKI, and Wangfang databases were searched from inception to August 30, 2020. Eligible studies from acute coronary syndrome patients treated with postdilation were included. The primary clinical outcome was major adverse cardiovascular events (MACE), the secondary clinical outcomes comprised all-cause death, stent thrombosis, myocardial infarction, and target vessel revascularization, and the angiographic outcomes were no reflow and slow reflow. Results. 11 studies met inclusion criteria. In clinical outcomes, our pooled analysis demonstrated that the postdilation had a tendency of decreasing MACE (OR = 0.67, 95% CI 0.45–1.00; P  = 0.05) but significantly increased all-cause death (OR = 1.49, 95% CI 1.05–2.12; P  = 0.03). No significant difference existed in stent thrombosis (OR = 0.71, 95% CI 0.40–1.26; P  = 0.24), myocardial infarction (OR = 1.40, 95% CI 0.51–3.83; P  = 0.51), and target vessel revascularization (OR = 0.61, 95% CI 0.21–1.80; P  = 0.37) between postdilation and non-postdilation groups. In angiographic outcomes, there were no significant differences in no reflow (OR = 1.19, 95% CI 0.54–2.65; P  = 0.66) and slow reflow (OR = 1.12, 95% CI 0.93–1.35; P  = 0.24) between two groups. Conclusions. The postdilation tends to reduce the risk of MACE but significantly increases all-cause death, without significantly affecting stent thrombosis, myocardial infarction, target vessel revascularization, and coronary TIMI flow grade. However, more randomized controlled trials are required for investigating the effect of postdilation for patients with acute coronary syndrome (registered by PROSPERO, CRD42020160748).

scholarly journals Prognostic value of HbA1c for in-hospital and short-term mortality in patients with acute coronary syndrome: a systematic review and meta-analysis

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Wenjun Pan ◽  
Haining Lu ◽  
Baotao Lian ◽  
Pengda Liao ◽  
Liheng Guo ◽  
...  
Keyword(s):  
Systematic Review ◽  
Acute Coronary Syndrome ◽  
Hospital Mortality ◽  
Meta Analysis ◽  
Hospital Death ◽  
Short Term ◽  
Coronary Syndrome ◽  
Relative Risks ◽  
Short Term Mortality ◽  
The Relationship

Abstract Background HbA1c, the most commonly used indicator of chronic glucose metabolism, is closely associated with cardiovascular disease. However, the relationship between HbA1c and the mortality of acute coronary syndrome (ACS) patients has not been elucidated yet. Here, we aim to conduct a systematic review assessing the effect of HbA1c on in-hospital and short-term mortality in ACS patients. Methods Relevant studies reported before July 2019 were retrieved from databases including PubMed, Embase, and Central. Pooled relative risks (RRs) and the corresponding 95% confidence interval (CI) were calculated to evaluate the predictive value of HbA1c for the in-hospital mortality and short-term mortality. Results Data from 25 studies involving 304,253 ACS patients was included in systematic review. The pooled RR of in-hospital mortality was 1.246 (95% CI 1.113–1.396, p: 0.000, I2 = 48.6%, n = 14) after sensitivity analysis in studies reporting HbA1c as categorial valuable. The pooled RR was 1.042 (95% CI 0.904–1.202, p: 0.57, I2 = 82.7%, n = 4) in random-effects model for studies reporting it as continuous valuable. Subgroup analysis by diabetic status showed that elevated HbA1c is associated increased short-term mortality in ACS patients without diabetes mellitus (DM) history and without DM (RR: 2.31, 95% CI (1.81–2.94), p = 0.000, I2 = 0.0%, n = 5; RR: 2.56, 95% CI 1.38–4.74, p = 0.003, I2 = 0.0%, n = 2, respectively), which was not the case for patients with DM and patients from studies incorporating DM and non-DM individuals (RR: 1.16, 95% CI 0.79–1.69, p = 0.451, I2 = 31.9%, n = 3; RR: 1.10, 95% CI 0.51–2.38), p = 0.809, I2 = 47.4%, n = 4, respectively). Conclusions Higher HbA1c is a potential indicator for in-hospital death in ACS patients as well as a predictor for short-term mortality in ACS patients without known DM and without DM.

scholarly journals Efficacy and safety of newer P2Y12 inhibitors for acute coronary syndrome: a network meta-analysis

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Yue Fei ◽  
Cheuk Kiu Lam ◽  
Bernard Man Yung Cheung
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Cardiovascular Events ◽  
Meta Analysis ◽  
Bleeding Risk ◽  
Antiplatelet Drug ◽  
Major Adverse Cardiovascular Events ◽  
Minor Bleeding ◽  
P2y12 Inhibitors ◽  
Coronary Syndrome

Abstract Whether newer P2Y12 inhibitors are more efficacious and safer than clopidogrel and whether there is a superior one remain uncertain. We compared the effect of P2Y12 inhibitors on clinical outcomes in patients with acute coronary syndrome (ACS). Randomized controlled trials comparing clopidogrel, prasugrel, ticagrelor, or cangrelor, in combination with aspirin were searched. Sixteen trials with altogether 77,896 patients were included. Compared to clopidogrel, cardiovascular mortality was reduced with prasugrel (OR 0.85, 95% CI 0.75–0.97) and ticagrelor (0.82, 0.73–0.93). Myocardial infarction (0.75, 0.63–0.89) and major adverse cardiovascular events (0.80, 0.69–0.94) were reduced by prasugrel. Stent thrombosis was reduced by prasugrel (0.49, 0.38–0.63), ticagrelor (0.72, 0.57–0.90), and cangrelor (0.59, 0.43–0.81). It was reduced more by prasugrel than ticagrelor (0.69, 0.51–0.93). There were more major bleeds with prasugrel (1.24, 1.05–1.48). Thrombolysis in Myocardial Infarction (TIMI) major bleeding was increased with prasugrel compared to clopidogrel (1.36, 1.11–1.66) and ticagrelor (1.33, 1.06–1.67). TIMI minor bleeding was increased with prasugrel (1.44, 1.16–1.77) and cangrelor (1.47, 1.01–2.16) compared to clopidogrel while it was increased with prasugrel compared to ticagrelor (1.32, 1.01–1.72). Prasugrel is preferable to those ACS patients at low bleeding risk to reduce cardiovascular events whereas ticagrelor is a relatively safe antiplatelet drug of choice for most patients.

scholarly journals BRIEF SUMMARY OF PATHOGENESIS, DIAGNOSIS AND MANAGEMENT OF SPONTANEOUS CORONARY ARTERY DISSECTION

2020 ◽  
Vol 30 (3) ◽  
pp. 136-140
Author(s):  
Algirdas Rėkus ◽  
Gediminas Jaruševičius
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Disease Risk ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Gold Standard Method ◽  
Coronary Syndrome

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS). It was first described 80 years ago. Pathogenetic me­chanisms are most likely to be associated with inti­mas tear or bleeding vasa-vasorum, which resulting in intramural haemorrhage. SCAD typically occurs in young women who do not have coronary heart disease risk factors and who have acute coronary syndrome. Half of all SCAD presents with ST – ele­vation myocardial infarction (STEMI), while the rest with non – ST – elevation myocardial infarction (NSTEMI). The gold standard method for diagnosis is interventional coronary artery angiography. After the acute ischemic onset syndrome, most patients have a stable, benign clinical course, and eventually expe­rience spontaneous vessel wall healing. Therefore, conservative treatment (a watchful strategy) is recom­mended as the initial treatment. For the majority of cases as interventional and surgical treatment in most cases seems to be suboptimal. In this extremely com­plex situation, several novel and attractive coronary interventions have been proposed. The risk factors, pathogenesis theories, diagnosis, management, pro­gnosis of SCAD will be summarized in this review.

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