Abstract 15529: Multimorbidity Clusters in Patients Presenting to the Emergency Department With Potential Acute Coronary Syndrome

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Katherine Breen ◽  
Lorna Finnegan ◽  
Karen M Vuckovic ◽  
Anne M Fink ◽  
Wayne D Rosamond ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Family History ◽  
Chronic Conditions ◽  
Latent Class ◽  
Secondary Analysis ◽  
Adverse Outcomes ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
Class 1

Introduction: The increasing prevalence of multimorbidity (> 2 chronic conditions) is a challenge for healthcare providers and systems. Multimorbidity complicates treatment and increases the risk of adverse outcomes. Objectives: To identify multimorbidity classes (clusters of > 2 specific chronic conditions) in a secondary analysis of a multi-site study about symptoms in patients presenting to the emergency department (ED) for potential acute coronary syndrome (ACS). Hypothesis: Specific multimorbidity classes can predict an ACS diagnosis. Methods: Chronic conditions were measured (Charlson Comorbidity Index and ACS Patient Information Questionnaire) in patients who underwent a cardiac evaluation in the ED. Latent class analysis was used to identify multimorbidity classes, and logistic regression determined whether multimorbidity classes were predictive of being ruled-in versus ruled-out for ACS. Results: The sample ( n = 935) was 38% female, with a mean age of 59 years. Four multimorbidity classes were identified and labeled: High multimorbidity (Class 1, hyperlipidemia, hypertension [HTN], obesity, diabetes, and respiratory disorders); Low multimorbidity (Class 2, obesity); Cardiovascular multimorbidity (Class 3, HTN, hyperlipidemia, and coronary heart disease); and Cardio-oncology multimorbidity (Class 4, HTN, hyperlipidemia, and cancer). Patients in Classes 3 and 4 had a 2.8-fold and 1.7-fold increased risk of ruling-in for ACS compared to those in Class 2 who were half as likely to rule-in for ACS (OR 0.45 95% CI 0.33 to 0.61 p=0.001). Class membership differed by sex, age, and family history. Females were more likely to be in Class 1 (44.2%), younger patients in Class 2 (mean age 43.4 ± 9.8 years), older patients in class 4 (mean age 80.0 ± 6.3 years), and those with a family history of sudden cardiac death (< age 55) in Class 3 (58.3%). Conclusion: Multimorbidity classes differed according to demographic and clinical variables. Membership in Classes 3 and 4 were predictive of an ACS diagnosis. Clustering patients by multimorbidity class may inform risk-stratification during evaluation for ACS.

Adverse outcomes following emergency department discharge of patients with possible acute coronary syndrome

2009 ◽  
Vol 21 (6) ◽  
pp. 455-464 ◽  
Author(s):  
Conrad Loten ◽  
Geoffrey Isbister ◽  
Melissa Jamcotchian ◽  
Carolyn Hullick ◽  
Patrick MacElduff ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Adverse Outcomes ◽  
Coronary Syndrome ◽  
Emergency Department Discharge

The utility of copeptin in the emergency department as a predictor of adverse outcomes in non-ST-elevation acute coronary syndrome: the COPED-PAO study

2013 ◽  
Vol 31 (4) ◽  
pp. 286-291 ◽  
Author(s):  
Miquel Sánchez ◽  
Pere Llorens ◽  
Pablo Herrero ◽  
F Javier Martín-Sanchez ◽  
Pascual Piñera ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Adverse Events ◽  
Adverse Outcomes ◽  
Troponin Level ◽  
Prognostic Information ◽  
Risk Of Death ◽  
Coronary Syndrome ◽  
St Elevation ◽  
Elevation Acute Coronary Syndrome

AimsTo test the utility of a single copeptin determination at presentation to the emergency department (ED) as a short-term prognosis marker in patients with non-ST-elevation acute coronary syndrome (NSTEACS). To compare the results with those achieved with conventional troponin.MethodsA multicentric, prospective, observational, longitudinal, cohort study involving 15 Spanish EDs. Inclusion: consecutive patients with chest pain (<12 h) finally diagnosed of NSTEACS. Measurements: copeptin and troponin at arrival. Cut-off point for copeptin: 25.9 pmol/l. Follow-up: within 2 months after ED attendance to identify 30-day adverse events. Discriminatory capacity of copeptin and troponin was compared by receiver operating characteristic (ROC) curves.ResultsWe included 377 patients with NSTEACS. Adverse events: 11 (2.9%) patients died, 27 (7.2%) had an adverse coronary event, 14 (3.7%) had a stroke, and 48 (12.7%) a composite endpoint. The initial copeptine value was over 25.9 pmol/l in 114 patients, and they presented a higher mortality rate (OR: 4.2, (95% CI 1.2 to 14.8); p=0.03). This association disappeared after adjusting by clinical variables or troponin level. No significant differences were found for the remaining endpoints. The area under the curve  of the ROC curve of 30-day mortality was 0.73 (95% CI 0.58 to 0.87) for copeptin, and 0.80 (95% CI 0.73 to 0.87) for troponin.ConclusionsIn patients with NSTEACS, determination of copeptin at presentation to the ED is associated with risk of death during the subsequent month. This association, however, disappears after adjusting by baseline features or troponin level, so copeptin does not add complementary prognostic information over that provided by troponin.

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.

scholarly journals Prognostic Value of Elevated Copeptin and High-Sensitivity Cardiac Troponin T in Patients with and without Acute Coronary Syndrome: The ConTrACS Study

2020 ◽  
Vol 9 (11) ◽  
pp. 3627
Author(s):  
Hanna Waldsperger ◽  
Moritz Biener ◽  
Kiril M. Stoyanov ◽  
Mehrshad Vafaie ◽  
Hugo A. Katus ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Cardiac Troponin ◽  
Cox Regression ◽  
Troponin T ◽  
High Sensitivity ◽  
Adverse Outcomes ◽  
University Hospital ◽  
Cardiac Troponin T ◽  
Coronary Syndrome

Aims: We aimed to assess the prognostic role of copeptin in patients presenting to the emergency department with acute symptoms and increased high-sensitivity cardiac troponin T. Methods: A total of 3890 patients presenting with acute symptoms to the emergency department of Heidelberg University Hospital were assessed for increased hs-cTnT (>14 ng/L) from three cohorts: the Heidelberg Acute Coronary Syndrome (ACS) Registry (n = 2477), the BIOPS Registry (n = 320), and the ACS OMICS Registry (n = 1093). In a pooled analysis, 1956 patients remained, comprising of 1600 patients with ACS and 356 patients with non-ACS. Results: Median follow-up was 1468 days in the ACS cohort and 709 days in the non-ACS cohort. Elevated copeptin levels (>10 pmol/L) were found in 1174 patients (60.0%) in the entire cohort (58.1% in ACS and 68.5% in non-ACS, respectively) and mortality rates were significantly higher than in patients with normal copeptin levels (29.0% vs. 10.7%, p < 0.001). In a multivariate Cox regression, elevated copeptin was independently associated with all-cause death in the ACS (HR = 1.7, 1.3–2.3, p = 0.002) and non-ACS cohort (HR = 2.7, 1.4–5.0, p = 0.0018). Conclusion: Copeptin may aid in identifying patients at risk for adverse outcomes in patients with increased levels of hs-cTnT in ACS patients and in non-ACS conditions.

COMPARATIVE EVALUATION OF SCALES FOR THE ASSESSMENT OF SENILE ASTHENIA SYNDROME IN PATIENTS WITH ACUTE CORONARY SYNDROME

2021 ◽  
pp. 1116-1121
Author(s):  
Л. В. Борисова ◽  
А. С. Пушкин ◽  
С. В. Ким ◽  
В. В. Яковлев ◽  
Н. М. Аничков ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Comparative Evaluation ◽  
Clinical Characteristics ◽  
Adverse Outcomes ◽  
Optimal Method ◽  
Coronary Syndrome ◽  
Increased Risk

Синдром старческой астении у пациентов с острым коронарным синдромом признается как один из факторов риска развития неблагоприятных исходов после перенесенных кардиохирургических вмешательств, и поиск оптимального метода оценки данного синдрома мог бы быть скринингом по выявлению пациентов с повышенным риском. В данном исследовании сравнивается два метода оценки синдрома старческой астении у пациентов с острым коронарным синдромом, его распространенность у данной категории больных, связь с клиническими характеристиками и смертностью через 1 год после госпитализации. По результатам исследования, синдром старческой астении наблюдали чаще в группе пациентов старше 75 лет. Больные со старческой астенией, определенной по шкале Green, имели выше риск по шкале GRACE, и наличие данного синдрома было независимым предиктором смертности через 1 год после госпитализации. The syndrome of senile asthenia (frailty) in patients with acute coronary syndrome is recognized as one of the risk factors for the development of adverse outcomes after undergoing cardiosurgical interventions, and the search for an optimal method for assessing this syndrome could be a screening to identify patients at increased risk. This study compares two methods for assessing senile asthenia syndrome in patients with acute coronary syndrome, its prevalence in this category of patients, its relationship with clinical characteristics and 1-year mortality after hospitalization. According to the results of the study, senile asthenia syndrome was observed more often in the group of patients older than 75 years. Patients with senile asthenia assessment using the Green scale had a higher risk on the GRACE scale and the presence of this syndrome was an independent 1-year mortality predictor after hospitalization.

scholarly journals Impact of admission serum acid uric levels on in-hospital outcomes in patients with acute coronary syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Centola ◽  
A Maloberti ◽  
S Persampieri ◽  
D Castini ◽  
N Morici ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Hospital Mortality ◽  
Prognostic Value ◽  
Risk Model ◽  
Adverse Outcomes ◽  
Hospital Death ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
Incremental Prognostic Value ◽  
Grace Score

Abstract Background Hyperuricemia has been associated with high mortality rates in patients with acute myocardial infarction. The role and the prognostic relevance of increased serum uric acid (SUA) in patients with acute coronary syndrome (ACS) are still under debate Aim We sought to assess the association between elevated admission levels of SUA and in-hospital adverse outcomes in a real-world patient population with ACS and to investigate the potential incremental prognostic value of SUA added to GRACE score Methods 1088 consecutive patients admitted with a diagnosis of ACS to the Coronary Care Unit of two Hospitals were enrolled. Medical history, clinical characteristic, biochemical and electrocardiographic findings, angiographic data, treatments administered during hospitalization were all collected on an electronic database. All patients' data were entered prospectively in the database of the two hospitals and retrospectively analysed. Results The mean age was 68 years (IQR 60–78). Less than one-third of the total population was female (24%). Diabetes mellitus was present in 308 (28%) patients. The proportion of patients with STEMI and NSTEMI/UA was quite similar: 504 (46%) patients had a diagnosis of STEMI and 584 (54%) patients had a diagnosis of NSTEMI/UA. The GRACE score was 133 (IQR 112–156). In-hospital mortality rate was 2.3% in the overall population. Two variables were associated with a significantly increased risk of in-hospital death at the multivariate analysis: SUA (OR 1.72 95% CI 1.33–2.22, p&lt;0.0001) and GRACE score (OR 1.04 95% CI 1.02–1.06, p&lt;0.0001). To investigate the potential incremental prognostic value of SUA added to GRACE score for in-hospital death, we analyzed the results of adding hyperuricemia as categorical variable to the original GRACE risk model (GRACE-SUA score). The areas under the ROC curve (AUC) for GRACE score and for SUA were 0.91 (95% CI 0.89–0.93, p&lt;0.0001) and 0.79 (95% CI 0.76–0.81, p&lt;0.0001) respectively. The AUC was larger for predicting in-hospital mortality with the GRACE-SUA score (0.94; 95% CI 0.93–0.95; p&lt;0.0001). The addition of hyperuricemia to the GRACE score led to reclassifying 18 of 211 (8.5%) patients without in-hospital deaths from high to low risk. No patients with o without events were incorrectly reclassified. The net-reclassification index (NRI) of the GRACE-SUA score was 1.7% (z value of 4.3; p&lt;0.001). Conclusions High admission levels of SUA are positively and independently associated with in-hospital adverse outcomes and mortality in a contemporary and unselected population of ACS patients. The inclusion of SUA to GRACE risk score seems to lead to a more accurate prediction of in-hospital mortality and to improve risk classification in this study population. Funding Acknowledgement Type of funding source: None

scholarly journals Exploring Triaging and Short-Term Outcomes of Early Invasive Strategy in Non-ST Segment Elevation Acute Coronary Syndrome: A Report from Japanese Multicenter Registry

2020 ◽  
Vol 9 (4) ◽  
pp. 1106
Author(s):  
Nobuhiro Ikemura ◽  
Yasuyuki Shiraishi ◽  
Mitsuaki Sawano ◽  
Ikuko Ueda ◽  
Yohei Numasawa ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Hospital Mortality ◽  
Risk Score ◽  
Mortality Risk ◽  
Adverse Outcomes ◽  
Invasive Strategy ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
Elevation Acute Coronary Syndrome ◽  
Early Invasive Strategy

This observational study aimed to examine the extent of early invasive strategy (EIS) utilization in patients with non-ST elevation acute coronary syndrome (NSTE-ACS) according to the National Cardiovascular Data Registry (NCDR) CathPCI risk score, and its association with clinical outcomes. Using a prospective multicenter Japanese registry, 2968 patients with NSTE-ACS undergoing percutaneous coronary intervention within 72 hours of hospital arrival were analyzed. Multivariable logistic regression analyses were performed to determine predictors of EIS utilization. Additionally, adverse outcomes were compared between patients treated with and without EIS. Overall, 82.1% of the cohort (n = 2436) were treated with EIS, and the median NCDR CathPCI risk score was 22 (interquartile range: 14–32) with an expected 0.3–0.6% in-hospital mortality. Advanced age, peripheral artery disease, chronic kidney disease or patients without elevation of cardiac biomarkers were less likely to be treated with EIS. EIS utilization was not associated with a risk of in-hospital mortality; yet, it was associated with an increased risk of acute kidney injury (AKI) (adjusted odds ratio: 1.42; 95% confidence interval: 1.02–2.01) regardless of patients’ in-hospital mortality risk. Broader use of EIS utilization comes at the cost of increased AKI development risk; thus, the pre-procedural risk-benefit profile of EIS should be reassessed appropriately in patients with lower mortality risk.

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