Abstract 13735: Coronary Endothelial Dysfunction Plays Important Roles on Development of Acute Coronary Syndrome and Fatal Cardiovascular Events During Long-term Follow-up Over 10 Years

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Tatsuaki Murakami ◽  
Kazuo Ohsato
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Endothelial Dysfunction ◽  
Cardiovascular Events ◽  
Cardiovascular Death ◽  
Cardiac Events ◽  
Confidential Interval ◽  
Coronary Syndrome ◽  
Coronary Endothelial Dysfunction

Introduction: Although coronary endothelial dysfunction is thought to affect coronary atherothrombogenic processes, there has been little practical evidence for the relationship between clinical evolution of fatal or non-fatal acute coronary syndrome (ACS) and coronary endothelial dysfunction. Hypothesis: We assessed hypothesis that coronary endothelial dysfunction has clinical impacts on development of ACS and fatal cardiovascular events. Methods: Coronary endothelial dysfunction was practically graded by the flow-mediated endothelium-dependent reactive changes in coronary artery diameter (CFMD) to infusion of adenosine triphosphate (ATP ; 50μg) into the normal left coronary artery using quantitative coronary arteriography in 150 patients with stable coronary artery disease. The enrolled patients were categorized into tertile groups according to the values of CFMD, and we prospectively followed-up major adverse clinical cardiac events including ACS and cardiovascular death. Results: For a mean follow-up period of 132 months (range; 120 to 144) with complete follow-up, the patients in the lower third with severe coronary endothelial dysfunction (Group-L) more frequently developed ACS than those in the middle third with mild coronary endothelial dysfunction (Group-M) plus those in the higher third without coronary endothelial dysfunction (Group-H) [Group-L versus Group-M plus Group-H: 15(30%) versus 5(10%) plus 0(0%), p<0.001, by Kaplan-Meier analysis]. Majority of the patients who resulted in cardiovascular death belonged to Group-L, [6(12%) versus 1(2%) plus 0(0%), p=0.014]. Cox hazard proportional model analyses indicated that severe coronary endothelial dysfunction was the strong predictor for future ACS (hazard ratio=7.53, 95%confidential interval; 1.78-12.25, p<0.001) and future cardiovascular death (hazard ratio=13.50, 95%confidential interval; 1.55-25.25, p=0.005). Conclusions: This is the novel and longest follow-up investigation that demonstrates coronary endothelial dysfunction plays important roles on development of ACS and fatal cardiovascular events and therefore the strategies based on status of coronary endothelial dysfunction are required to prevent major adverse ischemic cardiac events.

Abstract 4009: Endothelial Dysfunction has Great Impacts on the Development of Acute Coronary Syndrome and Fatal Cardiovascular Events

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Tatsuaki Murakami ◽  
Ikuo Moriuchi
Keyword(s):  
Acute Coronary Syndrome ◽  
Endothelial Dysfunction ◽  
Endothelial Function ◽  
Cardiovascular Events ◽  
Suspected Coronary Artery Disease ◽  
Hazard Ratio ◽  
Confidential Interval ◽  
Coronary Syndrome ◽  
Kaplan Meier

Endothelial dysfunction is thought to contribute to atherothrombogenic process, however we identify little about practical relationship between clinical evolution of acute coronary syndrome (ACS) and endothelial dysfunction. This study investigated whether endothelial dysfunction has clinical impact on development of ACS. Endothelial dysfunction was graded by ultrasonic measured reactive changes in lumen diameter of right brachial artery following transient forearm occlusion for 5 minutes (FMD; flow-mediated endothelium-dependent vasodilation) in consecutive 518 patients with suspected coronary artery disease. The enrolled patients were categorized into three groups according to the values of FMD, and their cardiovascular events were prospectively followed-up for no less than 36 months. For a mean follow-up period of 60 months with 100% follow-up, the patients with severe endothelial dysfunction (FMD<4%; Group-L, n=174), more frequently developed ACS than Group-M with mild endothelial dysfunction (4%≤FMD<8%, n=171) plus Group-H with preserved endothelial function (FMD 8% or more, Group-H, n=173) (p<0.001, by Kaplan-Meier analysis] and majority of the patients with fatal cardiovascular events belonged to group-L. Cox proportional hazard model analysis showed that severe endothelial dysfunction was the most powerful predictor for future development of ACS (hazard ratio=5.77, 95%confidential interval; 2.52–13.22, p<0.001) and fatal cardiovascular events (hazard ratio=10.34, 95%confidential interval; 1.26 –72.25, p=0.022). These results suggest endothelial dysfunction plays important roles on development of ACS and fatal cardiovascular events in the near future, and strategies based on practical status of endothelial function are required to prevent ACS and fatal cardiovascular events. Cumulative Incidence

Spontaneous Coronary Artery Dissection: Does Being Unemployed Matter? Insights from the G‐SCAD registry

2020 ◽  
Vol 16 ◽  
Author(s):  
Amin Daoulah ◽  
Salem M. Al-Faifi ◽  
William T. Hurley ◽  
Abdulaziz Alasmari ◽  
Mohammed Ocheltree ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Cardiovascular Events ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Cardiac Events ◽  
Coronary Artery Dissection ◽  
Coronary Syndrome ◽  
Number Of Patients

Background: Spontaneous coronary artery dissection (SCAD) has emerged as an important cause of acute coronary syndrome (ACS) and sudden cardiac death. Physical or emotional stressors are the most commonly reported triggers for SCAD. Unemployment has been identified as a source of emotional stress and linked to poor mental and physical health. Objective: To examine the association between employment status and in-hospital and follow-up adverse cardiovascular events in patients with SCAD. Methods: We conducted a retrospective, multi-center, observational study of patients undergoing coronary angiography for ACS between January 2011 and December 2017. The total number of patients enrolled was 198,000. Patients were diagnosed with SCAD based on angiographic and intravascular imaging modalities whenever available. There were 83 patients identified with SCAD from 30 medical centers in 4 Arab gulf countries. In-hospital (myocardial infarction, percutaneous intervention, ventricular tachycardia/ventricular fibrillation, cardiogenic shock, death, internal cardioverter/defibrillator placement, dissection extension) and follow-up (myocardial infarction, de novo SCAD, death, spontaneous superior mesenteric artery dissection) cardiac events were compared among those who were employed and those who were not. Results: The median age of patients in the study was 44 (37- 55) years. There were 42 (50.6%) female patients, and 41 (49.4) male patients. Of the cohort, 50 (60%) of the patients were employed and the remaining 33 (40%) were unemployed. 66% of all men were employed and 76% of all women were unemployed. After adjusting for gender unemployment was associated with worse in-hospital and follow-up cardiac events (adjusted OR 7.1, [1.3, 37.9]), p = 0.021. Conclusion: Adverse cardiovascular events were significantly worse for patients with SCAD who were unemployed.

Endothelial function and 6-year outcomes following an acute coronary syndrome in patients with a history or presence of cancer

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y Matsuzawa ◽  
T.Y Yoshii ◽  
R.S Sato ◽  
H.N Nakahashi ◽  
E.A Akiyama ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Endothelial Dysfunction ◽  
Endothelial Function ◽  
Cardiovascular Events ◽  
Medical Center ◽  
Reactive Hyperemia ◽  
Cardiovascular Death ◽  
Established Coronary Artery Disease ◽  
Coronary Syndrome ◽  
Increased Risk

Abstract Background It has been reported that in the primary prevention settings, patients with cancer are exposed to an increased risk of cardiovascular disease through multiple mechanisms. However, among patients with established coronary artery disease, it is unknown whether cancer is an additional risk for endothelial dysfunction, mortality, and subsequent cardiovascular events. Purpose To determine endothelial function, mortality and cardiovascular events following acute coronary syndrome according to history/presence of cancer on (ACS). Methods Patients who were admitted to our university medical center for ACS were enrolled, and were divided according to the history/presence of cancer. We measured reactive hyperemia index before discharge in all patients to evaluate endothelial function. The logarithmic value of RHI (LnRHI) was used in the analyses. All patients were followed for cardiovascular death, non-cardiovascular death, myocardial infarction (MI), and stroke. Results Six-hundred and ninety patients with ACS were enrolled (mean age [SD] was 66 [12] years, male was 78%), and 73 patients (10.6%) had a history or presence of cancer. Endothelial function was not significantly different between ACS patients with and without the history/presence of cancer (LnRHI 0.64 (0.26) versus 0.59 (0.26), p=0.10). During the follow up period (the median 6.1 years), cardiovascular death occurred in 48 patients, non-cardiovascular death in 36, MI in 46, and Stroke in 31, respectively. The composite outcomes with all cause death, MI, and stroke occurred more frequently in the patients with the history/presence of cancer than those without (Figure A). However, the risk for cardiovascular death, MI, and stroke was similar between the two groups, and only non-cardiovascular mortality was significantly higher in the patients with the history/presence of cancer than those without (Figure B and C). Conclusion Among patients with ACS, the history/presence of cancer is associated with the risk of non-cardiovascular death, but not the risk for endothelial dysfunction and subsequent cardiovascular events. Figure 1 Funding Acknowledgement Type of funding source: None

IMMEDIATE AND 4-YEAR OUTCOME OF PATIENTS WITH ACUTE CORONARY SYNDROME UNDERGOING PERCUTANEOUS CORONARY INTERVENTION FOR LEFT MAIN CORONARY ARTERY DISEASE

2021 ◽  
pp. 8-11
Author(s):  
Saroj Mandal ◽  
Sidnath Singh ◽  
Kaushik Banerjee ◽  
Aditya Verma ◽  
Vignesh R.
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Ejection Fraction ◽  
Coronary Intervention ◽  
Left Ventricular Ejection ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
The Mean

Background: The treatment of LMCAD has shifted from coronary artery bypass grafting (CABG) to Percutaneous coronary intervention (PCI). However, data on long-term outcomes of PCI for LMCA disease, especially in patients with acute coronary syndrome (ACS) remains limited and conicting. This study aims to nd the association of the immediate and 4-year mortality in ACS patients with LMCA disease treated by PCI based on ejection fractions at admission. Methods: A retrospective analytical study was conducted. Patients were divided at admission into those with reduced left ventricular ejection fraction and those with preserved ejection fraction. Results: Forty (58.8%) of the patients presented with preserved EF. The mean age of the patients was 71.6±7.1 years. The mean LVEF of the preserved group was 61.6±4.3% and signicantly higher than that of the reduced group. Age and cardiovascular risk factor prole was similar between the two groups. Patients with reduced ejection fraction had signicantly higher levels of serum creatinine and signicantly lower levels of Hb and HDL. Mean hospital stay was signicantly longer for patients with preserved EF. In-hospital deaths were also similar between the two groups. The reduced EF group had a signicantly higher allcause mortality in the 4-year follow-up period. The mean years of follow-up for all participants was 4.2±1.3 years. Conclusion: It was seen that in patients presenting with ACS and undergoing PCI due to LMCAD, LVEF at admission, singly and in in multivariate regression is an important predictor of in hospital and 4-year mortality

Differential effects of dual antiplatelet therapy in patients presented with acute coronary syndrome vs. stable ischaemic heart disease after coronary artery bypass grafting

2020 ◽  
Author(s):  
Ki Hong Choi ◽  
Young Bin Song ◽  
Dong Seop Jeong ◽  
Yong Ho Jang ◽  
David Hong ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Heart Disease ◽  
Coronary Artery ◽  
Antiplatelet Therapy ◽  
Lower Risk ◽  
Dual Antiplatelet Therapy ◽  
Artery Bypass ◽  
Cardiovascular Death ◽  
Bypass Grafting ◽  
Coronary Syndrome

Abstract Aims The current study sought to evaluate whether long-term clinical outcomes according to the use of dual antiplatelet therapy (DAPT) or single antiplatelet therapy (SAPT) differed between acute coronary syndrome (ACS) and stable ischaemic heart disease (SIHD) patients who underwent coronary artery bypass grafting surgery (CABG). Methods and results Between January 2001 and December 2017, 3199 patients with ACS (55.3%) and 2583 with SIHD (44.7%) who underwent isolated CABG were enrolled. The study population was stratified using DAPT or SAPT in ACS patients and SIHD patients. The primary outcome was a cardiovascular death or myocardial infarction (MI) at 5 years. After CABG, DAPT was more frequently used in patients with ACS than in those with SIHD [n = 1960 (61.3%) vs. n = 1313 (50.8%), P &lt; 0.001]. Among patients with ACS, the DAPT group showed a significantly lower risk of cardiovascular death or MI at 5 years than the SAPT group [DAPT vs. SAPT, 4.0% vs. 7.8%, hazard ratio (HR) 0.521, 95% confidence interval (CI) 0.339–0.799; P = 0.003]. In contrast, among patients with SIHD, there was no significant difference in the rate of cardiovascular death or MI at 5 years between the use of DAPT and SAPT (4.0% vs. 4.0%, HR 0.991, 95% CI 0.604–1.626; P = 0.971). These findings were robust to multiple sensitivity analyses and competing risk analysis. In the subgroup analysis, the use of DAPT was associated with a significantly lower risk of cardiovascular death or MI among SIHD patients with a previous percutaneous coronary intervention (PCI), with a significant interaction between the use of DAPT and PCI history (interaction P = 0.011). Conclusion Among ACS patients who underwent CABG, the use of DAPT was associated with lower cardiovascular death or MI than the use of SAPT, but this was not the case in SIHD patients. Trial registration ClinicalTrials.gov, NCT03870815.

scholarly journals Long-term results of different approaches to revascularization in non-ST-segment elevation acute coronary syndrome and multiple coronary atherosclerosis

2017 ◽  
Vol 89 (4) ◽  
pp. 29-34 ◽  
Author(s):  
V I Ganyukov ◽  
R S Tarasov ◽  
Yu N Neverova ◽  
N A Kochergin ◽  
O L Barbarash ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Medical Treatment ◽  
Coronary Atherosclerosis ◽  
Long Term Results ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment

Aim. To assess the long-term results of different approaches to treating patients with non-ST-segment elevation acute coronary syndrome (NSTE ACS) and multivessel coronary artery disease (MVCAD). Subjects and methods. A total of 150 patients with NSTE ACS, in whom coronary angiography revealed MVCAD, were examined. The patients were divided into 3 groups according to the selected treatment policy: 1) percutaneous coronary intervention (PCI) (n=91 (60.6%)); 2) coronary artery bypass grafting (CABG) (n=40 (26.6%)); and 3) only medical treatment (n=9 (6%)). The mean follow-up was 27.6±3.5 months. Results. The medical treatment policy in this patient sample demonstrates the worst results, with the majority of cardiovascular events developing in the hospital period. PCI in patients with NSTE ACS and multiple coronary atherosclerosis has a number of objective limitations in this patient sample, leading to suboptimal treatment outcomes Conclusion. The use of CABG or PCI as a myocardial revascularization technique in patients with NSTE ACS and MVCAD is characterized by a comparable satisfactory survival in the hospital and long-term follow-up periods. 12% of patients do not receive revascularization due to the extremely high risk from any of coronary blood restoring methods, which results in very many deaths largely occurring during the hospital period.

scholarly journals P1512 Combination of mitral annular peak systolic and early diastolic velocities with early transmitral peak flow velocity: a new prognostic echo index in patients with acute coronary syndrome

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
K Nakamura ◽  
A Yamada ◽  
M Kato ◽  
S Jinno ◽  
A Takahashi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Flow Velocity ◽  
Peak Flow ◽  
Left Ventricular ◽  
Volume Index ◽  
Cardiac Events ◽  
Coronary Syndrome ◽  
Peak Flow Velocity

Abstract Background One of the novel echocardiographic indices reflecting left ventricular (LV) diastolic filling is the combination of mitral annular peak systolic (s’) and early diastolic velocities (e’) with early transmitral peak flow velocity (E); E/(e’ x s’). This index is reported to be useful to predict a prognosis of heart failure patients regardless of their LV ejection fraction (LVEF).Purpose: The aim of this study was to examine whether or not E/(e’ x s’) could predict cardiac events in patients with acute coronary syndrome (ACS).Methods: We studies consecutive ACS patients hospitalized in our institution between December 2009 and February 2012. They underwent echo examination within 7 days after admission. By use of Doppler tissue imaging, e’ and s’ were respectively calculated by averaging the peak velocities measured at both septal and lateral mitral annulus in 4-chamber view. The exclusion criteria were as follows: atrial fibrillation, significant valvular diseases and inadequate echo images. Cardiac events were defined as re-hospitalization due to recurrent ACS and/or heart failure, and cardiac mortality.Results: In total, 168 patients were eligible for this study (mean age 67 ± 11 years, mean LVEF 51.7 ± 10.3 %). Median follow-up period was 22.5 months. During the follow-up, cardiac events occurred in 27 patients (16.1%). Between the patients with cardiac events and those without, there were significant differences in LV end-systolic volume (44.2 ± 29.1 vs 33.2 ± 13.6 ml, p &lt; 0.05), LV mass index (122.4 ± 38.9 vs 107.5 ± 26.4 g/m², p &lt; 0.05), left atrial volume index (31.7 ± 9.2 vs 27.6 ± 9.4 ml/m², p &lt; 0.05), LVEF (45.7 ± 13.5 vs 52.9 ± 9.2 %, p &lt; 0.05), s’ (5.1 ± 1.6 vs 7.1 ± 1.7 cm/sec, p &lt; 0.001), e’ (4.8 ± 1.3 vs 6.0 ± 1.9 cm/sec, p &lt; 0.05), E/e’ (16.4 ± 6.6 vs 12.5 ± 4.9, p &lt; 0.05), E/(e’ x s’) (3.78 ± 2.52 vs 1.94 ± 1.08, p &lt; 0.001), and serum B-type natriuretic peptide (334.7 ± 420.1 vs 113.8 ± 177.2 pg/ml, p &lt; 0.05). While Cox proportional hazard multivariate analysis detected that E/(e’ x s’) and E/e’ were independent predictors of cardiac events, E/(e’ x s’) was more powerful than E/e’ (p = 0.0002 vs p = 0.0072). ROC analysis revealed that 2.35 of E/(e’ x s’) was the optimal cutoff values to predict cardiac events in ACS patients (AUC 0.79). Patients with E/(e’ x s’) &lt;2.35 had significantly better prognosis than the rest (p &lt; 0.0001, Log-rank; Figure)Conclusion: E/(e’ x s’) could be a useful echo marker to predict cardiac events in ACS patients. Abstract P1512 Figure.

A 6-Month Follow-Up Study of the Relation between Apolipoprotein E Gene Polymorphism and Major Adverse Cardiovascular Events in Patients with Acute Coronary Syndrome

Cardiology ◽  
2018 ◽  
Vol 140 (3) ◽  
pp. 187-193
Author(s):  
Jinggang Xia ◽  
Shaodong Hu ◽  
Chunlin Yin ◽  
Dong Xu
Keyword(s):  
Acute Coronary Syndrome ◽  
Gene Polymorphism ◽  
Cardiovascular Events ◽  
Ldl Cholesterol ◽  
Apoe Gene ◽  
Major Adverse Cardiovascular Events ◽  
Coronary Syndrome ◽  
Apoe4 Allele ◽  
E4 Allele

Objectives: This study aimed to investigate the relation between ApoE gene polymorphisms and major adverse cardiovascular events (MACE) in patients with acute coronary syndrome (ACS) during a 6-month follow-up. Methods: From October 2016 to July 2017, 211 patients were admitted to a cardiology clinic with a diagnosis of ACS. Blood samples were obtained from all patients on the first day. The primary end point was a 6-month incidence of MACE. ApoE gene polymorphism was genotyped by real-time PCR using TaqMan® SNP Genotyping Assay. Results: The patients with the E4 allele were associated with higher low-density lipoprotein (LDL) cholesterol and total cholesterol (TC) levels compared with the patients without the E4 allele (p = 0001 and p = 0.001). The patients with the E4 allele were associated with a higher rate of MACE compared with the patients without the E4 allele (ApoE4 allele(+) 23.1% vs. ApoE4 allele(−) 9.3%; p = 0.03). Multivariable analysis suggested that E4 allele carriers showed an 85% risk increment of 6-month MACE (odds ratio 2.48, 95% confidence interval 2.37–5.95; p = 0.01). Conclusions: The trial shows that E4 allele carriers were correlated with not only higher LDL cholesterol and TC levels, but also with a higher incidence of MACE during a 6-month follow-up.

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