scholarly journals Age and Phenotype of Patients With Plaque Erosion

2021 ◽  
Vol 10 (19) ◽  
Author(s):  
Makoto Araki ◽  
Taishi Yonetsu ◽  
Osamu Kurihara ◽  
Akihiro Nakajima ◽  
Hang Lee ◽  
...  
Keyword(s):  
Older Patients ◽  
Age Groups ◽  
Data Sets ◽  
Current Smoking ◽  
Younger Patients ◽  
St Segment Elevation ◽  
Plaque Erosion ◽  
St Segment ◽  
Lipid Rich Plaque ◽  
Coronary Syndromes

Background A recent study reported that the outcome of patients with plaque erosion treated with stenting is poor when the underlying plaque is lipid rich. However, the detailed phenotype of patients with plaque erosion, particularly as related to different age groups, has not been systematically studied. Methods and Results Patients with acute coronary syndromes caused by plaque erosion were selected from 2 data sets. Demographic, clinical, angiographic, and optical coherence tomography findings of the culprit lesion were compared between 5 age groups. Among 579 erosion patients, male sex and current smoking were less frequent, and hypertension, diabetes, and chronic kidney disease were more frequent in older patients. ST‐segment–elevation myocardial infarction was more frequent in younger patients. Percentage of diameter stenosis on angiogram was greater in older patients. The prevalence of lipid‐rich plaque (27.3% in age <45 years and 49.4% in age ≥75 years, P <0.001), cholesterol crystal (3.9% in age <45 years and 21.8% in age ≥75 years, P =0.027), and calcification (5.5% in age <45 years and 54.0% in age ≥75 years, P <0.001) increased with age. After adjusting risk factors, younger patients were associated with the presence of thrombus, and older patients were associated with greater percentage of diameter stenosis and the presence of lipid‐rich plaque and calcification. Conclusions The demographic, clinical, angiographic, and plaque phenotypes of patients with plaque erosion distinctly vary depending on age. This may affect the clinical outcome in these patients. Registration URL: https://www.clinicaltrials.gov . Unique identifiers: NCT03479723, NCT02041650.

Abstract 14178: Characteristics and Outcomes of Young ST Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Intervention

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Benjamin W Tung ◽  
Zhe Yan Ng ◽  
William Kristanto ◽  
Kalyar W Saw ◽  
winnie C sia ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Older Patients ◽  
Young Patients ◽  
Percutaneous Intervention ◽  
Old Patients ◽  
Younger Patients ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Primary Percutaneous Intervention

Introduction: ST-segment elevation myocardial infarction (STEMI) is associated with significant morbidity and mortality leading to loss of productivity and productive life years, especially in younger patients. Understanding the characteristics of younger patients with STEMI and their outcomes could help focus public health efforts in STEMI prevention within a population. Aim: This study aims to compare the characteristics and outcomes of younger versus older patients with STEMI undergoing primary percutaneous intervention (PPCI). Methods: Data from the Coronary Care Unit database of the National University Hospital between July 2015 to June 2019 was reviewed. Patients were divided into Young (<50 years old) or Old (≥50 years old) groups. Results: Of the 1818 consecutive patients with STEMI and underwent PPCI, 465 (25.6%) were Young patients with mean age 43±4.9 years old as compared to Old patients with mean age 63.2±9.4 years old. Young patients were more likely to be male (94% vs. 85%, p<0.0001), current smokers (61.1% vs. 42.6%, p<0.0001), of Indian ethnicity (32% vs. 16.3%, p<0.0001), and had family history of myocardial infarction (MI) (18.1% vs. 9.5%, p<0.0001). Compared to Old patients, Young patients had better post-MI left ventricular ejection fraction (49.5±10.7 vs. 47.8±11.6, p=0.007) with fewer of them suffered from cardiogenic shock (7.1% vs. 13.2%, p<0.0001), and had lower mortality at one year (3.4% vs. 10.4%, p<0.0001). Although diabetes, hypertension and hyperlipidemia was less common among the Young patients when compared to the Old, the prevalence was high in the range of 28 to 38% (Table 1). Conclusions: A sizable proportion of STEMI patients are younger than 50 years old. The risk profile of these younger patients can be attributed to constitutional factors and smoking but other cardiovascular risk factors are also prevalent among them. Although mortality is lower among the younger than the older patients, it is not negligible.

scholarly journals Women and elderly: do we delay treatment even after identifying ST-segment elevation?

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
P Araujo Leite Medeiros ◽  
J Martins ◽  
I Campos ◽  
C Oliveira ◽  
C Pires ◽  
...  
Keyword(s):  
Older Patients ◽  
Statistical Significance ◽  
Coronary Intervention ◽  
Younger Patients ◽  
St Segment Elevation ◽  
Delay In Diagnosis ◽  
Atypical Symptoms ◽  
Funding Sources ◽  
St Segment ◽  
Gender And Age

Abstract Funding Acknowledgements Type of funding sources: None. Introduction It is known that some subgroups (e.g. women or elderly) may experience a delay in diagnosis of acute myocardial infarction (AMI). This may be due to atypical symptoms that don’t trigger further evaluation as promptly as typical symptoms or due to underestimation of patient’s complaints. However, we don’t know if there is any delay in treatment after the diagnostic electrocardiogram (ECG). Aim To evaluate the association between patients’ gender and age and reperfusion (by percutaneous coronary intervention - PCI) time after ECG. Methods Single-center retrospective study of individuals that underwent primary PCI between June 2011 and December 2017. We included patients aged ≥ 18, with time registry of the first ECG with ST segment elevation (or equivalent) and time of PCI. No patients were excluded. We defined the time between the first ECG and reperfusion as the ECG-PCI time. Results A total of 1679 patients were included; 78% male (n = 1317) and 22% female (n = 362); 59% were younger than 65 (n = 985) and 41% were 65 or older (n = 694). Median ECG-PCI time was higher in females [104 minutes (IQR = 68)] than in males [94 minutes (IQR = 61)]; this association was statistically significant (U = 269124, p &lt; 0.001). Median ECG-PCI time was also higher in older (≥ 65 years) patients [101 minutes (IQR = 68)] than in younger patients [93 minutes (IQR = 55)], with statistical significance (U = 381141, p &lt; 0.001). After stratifying patients’ gender by age, we observed that, in male patients, median ECG-PCI time was lower in younger patients [91 minutes (IQR = 55)] than in older patients [100 minutes (IQR = 69)]; this association was also significant (U = 220025, p &lt; 0.001). On the other hand, the same analysis in female patients found no significant association between younger and older patients (U = 13799, p = 0.522). Conclusion Despite a median ECG-PCI time difference of only 9 minutes between males and females, this difference was found to be significant. Factors delaying evaluation after onset of symptoms in women may also delay PCI after diagnostic ECG; borderline ECG criteria may be devalued in women. Older patients may take longer to PCI due to the higher incidence of comorbidities, specially diabetes mellitus, which can mask typical AMI symptoms. Survival impact of these differences should be further studied. Abstract Figure. ECG-PCI time according to gender and age

scholarly journals Characteristics and outcomes of young patients with ST segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: retrospective analysis in a multiethnic Asian population

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001437
Author(s):  
Benjamin WL Tung ◽  
Zhe Yan Ng ◽  
William Kristanto ◽  
Kalyar Win Saw ◽  
Siew-Pang Chan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Patients ◽  
Young Patients ◽  
Coronary Intervention ◽  
Younger Patients ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Percutaneous Coronary ◽  
History Of

ObjectiveST segment elevation myocardial infarction (STEMI) is associated with significant mortality leading to loss of productive life years, especially in younger patients. This study aims to compare the characteristics and outcomes of young versus older patients with STEMI undergoing primary percutaneous coronary intervention (PPCI) to help focus public health efforts in STEMI prevention.MethodsData from the Coronary Care Unit database of the National University Hospital, Singapore from July 2015 to June 2019 were reviewed. Patients were divided into young (<50 years old) or older (≥50 years old) groups.ResultsOf the 1818 consecutive patients with STEMI who underwent PPCI, 465 (25.6%) were <50 years old. Young compared with older patients were more likely to be male, current smokers, of Indian ethnicity, have family history of ischaemic heart disease (IHD) and had lower 1 year mortality (3.4% vs 10.4%, p<0.0001). Although diabetes, hypertension or dyslipidaemia was less common among young patients, the prevalence of having any one of these risk factors was high in the range of 28% to 38%. Age was an independent predictor of mortality in the older but not younger patients with STEMI, and diabetes showed a trend towards mortality in both groups.ConclusionYoung patients with STEMI are more often smokers, of Indian ethnicity and had family history of IHD, although cardiometabolic risk factors are also prevalent. Mortality is lower, but not negligible, among the young patients with STEMI. Public health efforts are needed to reduce the prevalence of these risk factors among the constitutionally susceptible population.

scholarly journals Predictors of plaque erosion in current smokers and non-current smokers presented with ST-segment elevation myocardial infarction: an optical coherence tomography study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y Wang ◽  
J Dai ◽  
C Fang ◽  
S Zhang ◽  
J Wang ◽  
...  
Keyword(s):  
Smoking Status ◽  
Coronary Thrombosis ◽  
Funding Source ◽  
Current Smoking Status ◽  
Current Smoking ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Plaque Erosion ◽  
St Segment ◽  
Smoking Group

Abstract Background Plaque erosion with subsequent coronary thrombosis is considered as an important cause of ST-segment elevation myocardial infarction (STEMI). Smoking is a major risk factor for acute coronary thrombosis. However, the relationship between current smoking status and plaque erosion has not been systematically investigated. Purpose The present study aimed to investigate predictors of plaque erosion in current smokers and non-current smokers with STEMI by using optical coherence tomography (OCT). Methods Between January 2015 to December 2017, a total of 1313 STEMI patients underwent pre-intervention OCT of culprit lesion were enrolled and divided into two groups based on current smoking status: current smoking group (n=713) and non-current smoking group (n=600). Using established criteria, quantitative and qualitative underlying plaque characteristics were assessed by OCT. Clinical, angiographic and OCT characteristics of all enrolled patients were recorded. Univariable and multivariable logistic regression analyses were used to identify predictors of plaque erosion in two groups. Results Plaque erosion were found in 30.9% (220/713) culprit lesions in current smoking group and 20.8% (125/600) of those in non-current smoking group detected by OCT. In multivariate regression analysis, the predictors that strongly related to plaque erosion in the current smoking group were nearby bifurcation (OR: 4.84; 95% CI:2.38–9.87; p&lt;0.001); the minimum fiber cap thickness (FCT, OR:1.05; 95% CI:1.03–1.08; p&lt;0.001); thin-cap fibroatheroma (TCFA, OR: 0.22; 95% CI: 0.07–0.67; p=0.007) and lipid core length (OR: 0.91; 95% CI: 0.84–0.97; p=0.007). The predictors in the non-current smoking group were nearby bifurcation (OR: 4.84; 95% CI: 2.38–9.87; p=0.006); the minimal FCT (OR: 1.09; 95% CI: 1.06–1.13; p&lt;0.001); multi-vessel disease (MVD, OR: 0.43; 95% CI: 0.19–0.97; p=0.042) and dyslipidemia (OR: 0.34; 95% CI: 0.14–0.84; p=0.020). Conclusions Predictors of plaque erosion causing STEMI onset are different between current smokers and non-current smoker, with nearby bifurcation and thicker minimal FCT both predicting plaque erosion in two groups of patients. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Key Research and Development Program of China, National Natural Science Foundation of China.

VALUE OF ST-SEGMENT ELEVATION IN LEAD AVR IN PREDICTING LEFT MAIN AND OR 3-VESSEL DISEASE IN PATIENTS WITH ACUTE CORONARY SYNDROMES

2017 ◽  
pp. 59-63
Author(s):  
Thanh Hung Dieu ◽  
Anh Vu Nguyen
Keyword(s):  
Predictive Value ◽  
Acute Coronary Syndromes ◽  
Independent Predictor ◽  
Left Main ◽  
St Segment Elevation ◽  
Vessel Disease ◽  
St Segment ◽  
Coronary Syndromes ◽  
Lead Avr ◽  
Sensitivity Specificity

Objects: We assessed the ability of ST-segment elevation in lead aVR to predict left main and/or 3-vessel disease (LM/3VD) in patients with acute coronary syndromes (ACS). Meterial and Method: 410 patients with ACS, who underwent coronary angiography, were evaluated. Results: 131 (31.9%) patients have been LM/3VD. ST segment elevation > 0.05 mV in leads aVR have been an independent predictor LM/3VD with sensitivity, specificity, positive predictive value PPV) and negative predictive value (NPV) 74.0%, 78.1%, 61.4% and 86.5%, respectively (p<0.001). ST segment elevation > 0.05 mV in leads aVR with ST segment depression in leads V4-V6 have related LM/3VD with sensitivity, specificity, PPV and NPV 44.3%, 92.8%, 74.4% and 75.2%, respectively (p<0.001). ST segment elevation > 0.1 mV in leads aVR have related LM/3VD with sensitivity, specificity, PPV and NPV 51.9%, 87.1%, 65.1% and 79.4%, respectively (p<0.001). Conclusions: ST segment elevation > 0.05 mV in leads aVR have been an independent predictor LM/3VD in patients with ACS. Key words: Acute coronary syndromes, ST-segment elevation, aVR

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