Abstract P119: Comparison of Treatment of Acute Coronary Syndrome in a Cohort of Medicare Patients With and Without Diabetes Mellitus

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Zhenxiang Zhao ◽  
Xiaomei Peng ◽  
Douglas Faries ◽  
Jay Bae ◽  
Patrick McCollam ◽  
...  
Keyword(s):  
Ace Inhibitors ◽  
Beta Blockers ◽  
Treatment Patterns ◽  
Renal Diseases ◽  
Diabetic Patients ◽  
Index Hospitalization ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Hospitalization Period ◽  
Cardiovascular Medications

Objective: This study compared real-world treatment patterns for ACS patients with and without DM in a cohort of Medicare population. Methods: A retrospective cohort study was conducted using the MarketScan Medicare claims database. Patients aged ≥65 years, hospitalized with a primary diagnosis of ACS between 01/01/2007 and 12/31/2007 were categorized into 2 groups: with and without DM. Patient characteristics, treatment patterns during the index hospitalization, and cardiovascular medications use 12 months pre- and post-index hospitalization were analyzed. (All p<.01 unless otherwise stated.) Results: Of 8,666 ACS patients identified, 2,407 (28%) were diabetic and 6,259 (72%) were non-diabetic. Patients with DM were more likely to be younger (77.6 vs. 79.6), male (58.8% vs. 54.6%), and have higher rates of previous MI (17.2% vs. 12.0%), congestive heart failure (28% vs. 16.1%), PVD (19.2% vs. 12.8%), TIA/stroke (10.0% vs. 7.3%), hypertension (54.4% vs. 49.6%), and renal diseases (17.1% vs. 7.0%). Patients with DM were significantly more likely to present with non-ST-segment elevation myocardial infarction at the index hospitalization compared to those without DM (66.4% vs. 61.2%). During the index hospitalization, DM patients underwent less PCI (27.8% vs. 34.6%) but more CABG (9.7% vs. 7.6%), and were more likely to have medical management during the index hospitalization compared to non-DM patients. Compared to their non-DM counterparts, patients with DM utilized more statins (66.9% vs. 48.0%), beta blockers (53.0% vs .42.4%), thienopyridine (24.5% vs. 13.2%), and ACE inhibitors (42.3% vs. 28.6%) during the 12-month pre-hospitalization period, while during the 12-month post-hospitalization period, they utilized slightly more statins (85.8% vs. 82.1%) and had similar level of beta blockers (86.1% vs. 85.6%, p=0.57) and thienopyridine (62.5% vs. 64.7%, p=0.12) and ACE inhibitors use (54.8% vs. 56.1%, p=0.37). Conclusion: ACS patients with DM presented additional clinical risks than those without DM. Observed treatment patterns varied correspondingly between the 2 groups. Differences in cardiovascular medications usage between the 2 groups narrowed after the ACS hospitalization.

scholarly journals Heart rate at admission is a predictor of in-hospital mortality in patients with acute coronary syndromes: Results from 58 European hospitals: The European Hospital Benchmarking by Outcomes in acute coronary syndrome Processes study

2016 ◽  
Vol 7 (2) ◽  
pp. 149-157 ◽  
Author(s):  
Magnus T Jensen ◽  
Marta Pereira ◽  
Carla Araujo ◽  
Anti Malmivaara ◽  
Jean Ferrieres ◽  
...  
Keyword(s):  
Heart Rate ◽  
Acute Coronary Syndrome ◽  
Hospital Mortality ◽  
Beta Blockers ◽  
Heart Rates ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Coronary Syndromes ◽  
The Relationship

Aims: The purpose of this study was to investigate the relationship between heart rate at admission and in-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Methods: Consecutive ACS patients admitted in 2008–2010 across 58 hospitals in six participant countries of the European Hospital Benchmarking by Outcomes in ACS Processes (EURHOBOP) project (Finland, France, Germany, Greece, Portugal and Spain). Cardiogenic shock patients were excluded. Associations between heart rate at admission in categories of 10 beats per min (bpm) and in-hospital mortality were estimated by logistic regression in crude models and adjusting for age, sex, obesity, smoking, hypertension, diabetes, known heart failure, renal failure, previous stroke and ischaemic heart disease. In total 10,374 patients were included. Results: In both STEMI and NSTE-ACS patients, a U-shaped relationship between admission heart rate and in-hospital mortality was found. The lowest risk was observed for heart rates between 70–79 bpm in STEMI and 60–69 bpm in NSTE-ACS; risk of mortality progressively increased with lower or higher heart rates. In multivariable models, the relationship persisted but was significant only for heart rates >80 bpm. A similar relationship was present in both patients with or without diabetes, above or below age 75 years, and irrespective of the presence of atrial fibrillation or use of beta-blockers. Conclusion: Heart rate at admission is significantly associated with in-hospital mortality in patients with both STEMI and NSTE-ACS. ACS patients with admission heart rate above 80 bpm are at highest risk of in-hospital mortality.

scholarly journals Effect of postprandial hyperglycaemia on culprit plaque rupture in diabetic patients with non-ST segment elevation acute coronary syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
G Su ◽  
S.W Zhuang ◽  
T Zhang ◽  
H.X Yang ◽  
W.L Dai ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Hemoglobin A1c ◽  
Plaque Rupture ◽  
Coronary Plaque ◽  
Postprandial Hyperglycemia ◽  
Diabetic Patients ◽  
Funding Source ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment

Abstract Background Postprandial hyperglycemia was reported to play a key role in established risk factors of coronary artery diseases (CAD) and cardiovascular events. Serum 1,5-anhydroglucitol (1,5-AG) levels are known to be a clinical marker of postprandial hyperglycemia and short-term glycemic excursions. Low serum 1,5-AG levels have been associated with occurrence of CAD; however, the relationship between 1,5-AG levels and coronary plaque rupture has not been fully elucidated. The aim of this study was to evaluate 1,5-AG as a predictor of coronary plaque rupture in diabetic patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS). Methods A total of 132 diabetic patients with NSTE-ACS were included in this study. All patients underwent intravascular ultrasound examination, which revealed 38 patients with plaque rupture and 94 patients without plaque rupture in the culprit lesion. Fasting blood glucose (FBS), hemoglobin A1c (HbA1c) and 1,5-AG levels were measured before coronary angiography. Fasting urinary 8-iso-prostaglandin F2α (8-iso-PGF2α) level was measured and corrected by creatinine clearance. Results Patients with ruptured plaque had significantly lower serum 1,5-AG levels and a tendency of higher hemoglobin A1c levels than patients without ruptured plaque in our study population. In multivariate analysis, low 1,5-AG levels were an independent predictor of plaque rupture (odds ratio 3.3; p=0.006) in diabetic patients with NSTE-ACS, but HbA1c was not. The area under the receiver-operating characteristic curve for 1,5-AG (0.678, p=0.001) to predict plaque rupture was superior to that for HbA1c (0.618, p=0.034). Levels of 1,5-AG were significantly correlated with urinary 8-iso-PGF2α (r=−0.224, p=0.010). Conclusions Postprandial hyperglycaemia appeared to be superior to long-term average blood glucose levels in predicting plaque rupture in culprit lesions, which may be useful to assess the cardiovascular outcomes in diabetic patients. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Outstanding Clinical Discipline Project of Shanghai Pudong, Beijing Health Special Foundation

Acute coronary syndrome without ST segment elevation: possibilities for predicting the clinical course at the posthospital (6 and 12 months) stage

2016 ◽  
Vol 94 (3) ◽  
pp. 205-210
Author(s):  
Zinaida D. Mikhailova ◽  
M. A. Shalenkova ◽  
P. F. Klimkin
Keyword(s):  
Acute Coronary Syndrome ◽  
Clinical Course ◽  
Regression Equations ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Logistic Analysis ◽  
St Segment ◽  
Increased Risk ◽  
Hospitalization Period ◽  
Sodium And Potassium

Aim. To measure blood IL-6, IL-10, creatinine levels, calcium, sodium and potassium in blood and saliva, melatonin in urine of patients with acute coronary syndrome without ST segment elevation for the prediction of the clinical course at the posthospital stage. Material and methods. The study included 93patients with complicated (n=46) and uncomplicated (n=47) coronary syndrome without ST segment elevation. Blood IL-6, IL-10, creatinine levels, calcium, sodium and potassium in blood and saliva, melatonin in urine were determined on days 1-3 after hospitalization. 6-hydroxymelatonin was measured by HPLC in urine collected between 23 p.m. and 8 a.m., melatonin i in urine collected between 8 a.m. and 23 p.m. Results. Complicated coronary syndrome was associated with increased levels of melatonin (night), blood IL-10 and Na, salivary Na and Ca while the uncomplicated condition with increased blood melatonin (daytime), IL-6, creatinine, Ca, Na, K, and salivary K. 90 patients were followed up within 12 months after discharge. End-points developed in 36 (40%) of Original investigations them. Logistic analysis yielded variables and 2 logistic regression equations The data on night melatonin +5 and +4 were included in ROC analysis. The night melatonin +5 values over 0.7453 were associated with increased risk of complications in the post-hospital period (6 months) and values of0.7453 or lower with the enhanced probability of uncomplicated clinical course. Prognostic sensitivity was estimated at 90%, specificity at -54.39%. The night melatonin +4 values over 0.2903 were associated with increased risk of complications in the post-hospital period (12 months) and values of 0.2903 or lower with the enhanced probability of uncomplicated clinical course. Prognostic sensitivity was estimated at 77.8%, specificity at -59.26%. Conclusion. The night melatonin +5 and +4 models can be used to predict the clinical course of acute coronary syndrome during 6 and 12 months of the post-hospitalization period.

scholarly journals Are there benefits of low doses of ACE inhibitors, MRAs, diuretics and statins in the treatment of heart failure?

2021 ◽  
Vol 14 (2) ◽  
pp. 226-231
Author(s):  
V. А. Lysenko
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Relative Risk ◽  
Ace Inhibitors ◽  
Cardiovascular Events ◽  
Beta Blockers ◽  
Scientific Data ◽  
Rank Test ◽  
Coronary Syndrome

Treatment of chronic heart failure (CHF) is very controversial. The issue of optimal doses of beta-blockers, ACE inhibitors, aldosterone receptor antagonists, statins in patients with CHF has not been conclusively addressed. Achieving the maximum tolerated doses of drugs, though related to reduced mortality, but is accompanied by an increase in adverse drug reactions. The aim. To present and discuss our own clinical and scientific data concerning the role of beta-blockers and inhibitors of the renin-angiotensin aldosterone system, diuretics, statins in the treatment of CHF patients and optimization of dosage schemes. Material and methods. The study included 88 patients with CHF of ischemic origin, with sinus rhythm, stage II AB, NYHA FC II–IV, 58 – with reduced LV EF (HFrEF) and 30 – with preserved LV EF (HFpEF). The mean age of patients was 69.18 ± 9.97 years, men 52 % (n = 46). The median follow-up of the CHF patients was 396 days, the maximum number of follow-up days was 1302. During the observation period, 14 endpoints were registered, which accounted for 15.91 % of events: 7 deaths (8.0 %), 2 strokes (2.3 %), 2 cases of acute coronary syndrome (2.3 %), 3 progressive heart failure cases (3.4 %). Kaplan–Mayer curves were drawn to assess survival rate, and the significance of difference between groups was calculated by the criteria of Gehan–Wilcoxon, Cox–Mantel and log-rank test. Risk factors were determined, and prognostic uni- and multi-variant Cox proportional hazards regression models were used. The cut-off values of quantitative risk factors were obtained by ROC analysis. Results. The increase in the relative risk of adverse cardiovascular events in the CHF patients regardless of LV EF was associated with a daily carvedilol dose of more than 25 mg (HR = 1.05; 95 % CI 1.009–1.093; P = 0.0171); eplerenone – more than 12.5 mg (HR = 1.073; 95 % CI 1.005–1.144; P = 0.034), torasemide – more than 5 mg (HR = 1.13; 95 % CI 1.021–1.255; P = 0.019); rosuvastatin – more than 10 mg (HR = 1.107; 95 % CI 1.007–1.203; P = 0.035), and the trend in using atorvastatin at a dose of less than 10 mg (HR = 1.05; 95 % CI 0.951–1.165; P = 0.327). The use of ramipril in a daily dose of less than 2.5 mg was accompanied by a trend towards the 22 % reduced relative risk of adverse cardiovascular events (HR = 0.78; 95 % CI 0.384–1.580; P = 0.491). Conclusions. Positive treatment outcomes in the CHF patients, regardless of the phenotype, were associated with low daily doses of ramipril (<2.5 mg), eplerenone/spironolactone (<12.5 mg), torasemide (<5.0 mg), rosuvastatin (<10.0 mg), but with high doses of atorvastatin (>10.0 mg).

scholarly journals Review on Coexistence of Hypertension with Diabetes Mellitus

2021 ◽  
pp. 220-223
Author(s):  
Nargis Saharan
Keyword(s):  
Diabetes Mellitus ◽  
Drug Therapy ◽  
Ace Inhibitors ◽  
Beta Blockers ◽  
Diabetic Patients ◽  
Beneficial Effects ◽  
Low Sodium ◽  
Target Organs ◽  
Effective Role ◽  
Common Target

The coexistence of both diabetes mellitus and hypertension affect the some major target organs. Their common target organ is heart and kidney. The primary goal in the management of the hypertensive diabetic patients is lowering blood pressure to less than 130/80mm Hg Beta- blockers have been reported to adversely affect the overall risk factor profile in the diabetic patient. Initially ACE inhibitors and ARB are initially can be given to diabetic hypertensive. Beta blockers also show great effects in preventing further cardiovascular diseases in diabetic hypertensive. Although combined drug therapy is usually required to achieve goal but in addition to drug therapy some other precautions should also plays effective role like exercise، low sodium chloride intake, lower lipids in diet, maintaining glucose level, stress less patients environment. Calcium channels blockers and diuretics in combination with ACE inhibitors and antidiabetic drugs will also exerts beneficial effects.

Abstract P366: Apical Ballooning Syndrome in Women and Outcome

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Jagdesh Kandala ◽  
Shanmugam Uthamalingam ◽  
Sarika Ballari ◽  
Marilyn Daley ◽  
Robert Capodilupo
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Ace Inhibitors ◽  
Beta Blockers ◽  
Apical Ballooning ◽  
Fisher Exact Test ◽  
Apical Ballooning Syndrome ◽  
Post Discharge ◽  
Reduced Ejection Fraction ◽  
Coronary Syndrome

Background: Apical ballooning syndrome (ABS) management has not been extensively studied. These patients are often managed as those with acute coronary syndrome. The objective of our study is to examine the role of medications like selective beta-blockers, statins, clopidogrel, and angiotensin converting (ACE) inhibitors post-discharge. Methods: From January, 2002 to December, 2007 18 consecutive patients were treated for ABS. Each patient was assessed by history, physical exam, electrocardiogram, laboratory investigations, telemetry, echocardiogram, coronary angiogram and later, by a follow up echo in 4-8 weeks. Results: All patients were female, the majority were caucasian and postmenopausal. The most common presentation was angina. Common EKG findings were T wave inversions, and prolonged QTc. Echocardiogram images demonstrated mid-ventricular and apical wall motion abnormalities and reduced ejection fraction, this was later confirmed by angiogram. All patients were alive at the time of discharge. Medications these patients received post discharge were selective beta-blockers 87.5 % (14/16), aspirin 100% (16/16), statins 62.5% (10/16), ACE inhibitors 81.2% ( 13/16), and clopidogrel 12.5% (2/16). After discharge from the hospital 31.2% (5/16) had recurrent chest pain on the above medical management. Recurrent chest pain developed in three out of five patients discharged on selective beta-blockers (p < 0.08, Fisher exact) and in three out of five patients who were discharged on statins (p < 0.65, Fisher exact). Patients who developed recurrent chest pain discharged on ACE inhibitors were four out of five (p<0.70, fisher exact test), and on clopidogrel were 0 out of five (p <0.45, fisher exact). Conclusion: Patients from our study have a higher rate of recurrent chest pain than previously reported. Chronic treatment with selective beta-blockers, ACE inhibitors, clopidogrel, and statins did not reduce the frequency of recurrent chest pain post-discharge. Although there is no evidence demonstrating a benefit, these patients are often treated as per guidelines for acute coronary syndrome. Our study demonstrates that ABS patients are subjected to ineffective treatment and there is an emergent need for management guidelines

scholarly journals Timing of Invasive Strategy in Diabetic and Non-Diabetic Patients with Non-St-Segment Elevation Acute Coronary Syndrome

Folia Medica ◽  
2013 ◽  
Vol 55 (2) ◽  
pp. 16-25
Author(s):  
Nikolay G. Dimitrov ◽  
Iana I. Simova ◽  
Hristo F. Mateev ◽  
Maria R. Kalpachka ◽  
Pavlin S. Pavlov ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Arteriography ◽  
Diabetic Patients ◽  
Strategy Group ◽  
Invasive Strategy ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Early Invasive Strategy

ABSTRACT INTRODUCTION: Patients with acute coronary syndrome without ST segment elevation are a heterogeneous group with respect to the risk of having a major adverse cardiac event (MACE). A history of diabetes mellitus (DM) is no doubt one of the factors that define a patient as being at a higher risk of having the syndrome. AIM: To compare early invasive strategy with selective invasive strategy indicated for patients with and without DM. PATIENTS AND METHODS: The study enrolled 178 patients with unstable angina or non-ST elevation myocardial infarction (UA/NSTEMI), and of these 52 (29.2%) had DM. Patients were randomly assigned to an early invasive strategy (these were scheduled to undergo coronary arteriography and percutaneous coronary intervention within 24 hours after admission) or to a selective invasive strategy (at first these were medically stabilized, with coronary arteriography required only in case of angina recurrence and/or evidence of inducible myocardial ischemia). The patients were followed up for a mean period of 22.8 ± 14 months. RESULTS: In the follow up the diabetics allocated to an early invasive strategy were found to have a significantly lower angina recurrence incidence (p = 0.005), rehospitalization rate (p = 0.001), fewer arteriographies (p = 0.001) and coronary interventions (p = 0.001) and low cumulative incidence of MACE (p = 0.008) in comparison with the diabetics assigned to selective invasive strategy. We also found, using the Kaplan-Meier curves survival analysis, that the time to MACE in patients assigned to an early invasive strategy was significantly longer than that in the group of selective invasive strategy. In the follow-up of non-diabetics we found no significant difference in MACE rate between the patients allocated to early invasive strategy and those assigned to selective invasive strategy. In the selective invasive strategy group, however, the cardiovascular adverse events tended to occur earlier than in the early invasive strategy group. CONCLUSIONS: Early invasive strategy in diabetic patients with non-ST-segment elevation acute coronary syndrome is associated with a reduced MACE rate compared with the selective invasive strategy used in these patients. Early invasive strategy applied in diabetic patients is also associated with a significantly longer time to MACE. In non-diabetics the advantages of early over selective invasive strategy are not so clearly differentiated.

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