Merits of Invasive Strategy in Diabetic Patients With Non‐ST Elevation Acute Coronary Syndrome

Non-ST-elevation acute coronary syndrome (NSTE-ACS) comprises a broad spectrum of disease ranging from unstable angina to myocardial infarction. International guidelines recommend a routine invasive strategy for managing patients with NSTE-ACS at high to very high-risk, supported by evidence of improved composite ischaemic outcomes as compared with a selective invasive strategy. However, accurate diagnosis of NSTE-ACS in the acute setting is challenging due to the spectrum of non-coronary disease that can manifest with similar symptoms. Heterogeneous clinical presentations and limited uptake of risk prediction tools can confound physician decision-making regarding the use and timing of invasive coronary angiography (ICA). Large proportions of patients with suspected NSTE-ACS do not require revascularisation but may unnecessarily undergo ICA with its attendant risks and associated costs. Advances in coronary CT angiography and cardiac MRI have prompted evaluation of whether non-invasive strategies may improve patient selection, or whether tailored approaches are better suited to specific subgroups. Future directions include (1) better understanding of risk stratification as a guide to investigation and therapy in suspected NSTE-ACS, (2) randomised clinical trials of non-invasive imaging versus standard of care approaches prior to ICA and (3) defining the optimal timing of very early ICA in high-risk NSTE-ACS.

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Contemporary practice and outcomes of an elderly cohort of Japanese patients with non-ST-elevation acute coronary syndrome in the era of routine early invasive strategy

International Journal of Cardiology ◽

10.1016/j.ijcard.2017.03.118 ◽

2017 ◽

Vol 240 ◽

pp. 49-54 ◽

Cited By ~ 2

Author(s):

Takuya Nagata ◽

Yohei Hyakuna ◽

Kenji Miyata ◽

Masahiro Mohri

Keyword(s):

Acute Coronary Syndrome ◽

Japanese Patients ◽

Invasive Strategy ◽

Coronary Syndrome ◽

St Elevation ◽

Elevation Acute Coronary Syndrome ◽

Early Invasive Strategy ◽

Elderly Cohort ◽

Contemporary Practice

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Prognostic benefit from an early invasive strategy in patients with non-ST elevation acute coronary syndrome (NSTEACS): evaluation of the new risk stratification in the NSTEACS European guidelines

Clinical Research in Cardiology ◽

10.1007/s00392-021-01829-8 ◽

2021 ◽

Author(s):

Jesús Martinón-Martínez ◽

Belén Álvarez Álvarez ◽

Teba González Ferrero ◽

Federico García-Rodeja Arias ◽

Óscar Otero García ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Risk Stratification ◽

Invasive Strategy ◽

Coronary Syndrome ◽

European Guidelines ◽

St Elevation ◽

Elevation Acute Coronary Syndrome ◽

Early Invasive Strategy

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PREVALENCE OF VITAMIN D DEFICIENCY IS MORE COMMON AMONG FRAIL OLDER (≥ 75 YEARS) PATIENTS WITH NON ST-ELEVATION ACUTE CORONARY SYNDROME MANAGED BY INVASIVE STRATEGY

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(15)60087-0 ◽

2015 ◽

Vol 65 (10) ◽

pp. A87

Author(s):

Murugapathy Veerasamy ◽

Hannah Sinclair ◽

Weiliang Qiu ◽

Dermot Neely ◽

Vijayalakshmi Kunadian

Keyword(s):

Vitamin D ◽

Acute Coronary Syndrome ◽

Vitamin D Deficiency ◽

Invasive Strategy ◽

Coronary Syndrome ◽

St Elevation ◽

Elevation Acute Coronary Syndrome

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Prognostic relations between inflammatory markers and mortality in diabetic patients with non-ST elevation acute coronary syndrome

Heart ◽

10.1136/hrt.2002.007443 ◽

2004 ◽

Vol 90 (3) ◽

pp. 264-269 ◽

Cited By ~ 25

Author(s):

P L Sanchez ◽

J L Morinigo ◽

P Pabon ◽

F Martin ◽

I Piedra ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Leucocyte Count ◽

Cardiovascular Death ◽

Diabetic Patients ◽

C Reactive Protein ◽

Reactive Protein ◽

Coronary Syndrome ◽

Inflammatory Status ◽

St Elevation ◽

Elevation Acute Coronary Syndrome

Objective: To determine the differences in the inflammatory status between diabetic and non-diabetic patients and to evaluate the usefulness of C reactive protein, fibrinogen, and leucocyte count as predictors of death in diabetic patients with unstable coronary disease.Design: Nested case-control comparisons of the inflammatory status between diabetic and non-diabetic patients. Prospective cohort analysis of C reactive protein concentration, fibrinogen concentration, and leucocyte count as predictors of cardiovascular death in diabetic patients.Setting: Coronary care unit in Spain.Participants: 83 diabetic patients with non-ST elevation acute coronary syndrome and 83 sex and aged matched patients selected from 361 non-diabetic patients with non-ST elevation acute coronary syndrome.Main outcome measures: Plasma concentrations of C reactive protein and fibrinogen, and leucocyte count. Investigators contacted patients to assess clinical events.Results: Concentrations of C reactive protein and fibrinogen, and leucocyte count on admission were higher in diabetic than in non-diabetic patients (7 mg/l v 5 mg/l, p = 0.020; 3.34 g/l v 2.90 g/l, p = 0.013; and 8.8 × 109/l v 7.8 × 109/l, p = 0.040). Among diabetic patients, these values were also higher in those who died during the 22 month follow up (13 mg/l v 6 mg/l, p = 0.001; 3.95 g/l v 3.05 g/l, p < 0.001; and 11.4 × 109/l v 8.4 × 109/l, p = 0.005). After adjustment for confounding factors, diabetic patients in the highest tertile of C reactive protein had a hazard ratio for cardiovascular death of 4.51 (95% confidence interval (CI) 1.62 to 12.55). Similar hazard ratios were for fibrinogen 3.74 (95% CI 1.32 to 10.62) and for leucocyte count 3.64 (95% CI 1.37 to 9.68).Conclusions: Inflammation appears more evident in diabetic than in non-diabetic patients with acute coronary syndrome. C reactive protein concentration, fibrinogen concentration, and leucocyte count constitute independent predictors of cardiovascular death in diabetics with unstable coronary disease.

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