scholarly journals Prediction of major adverse cardiac, cerebrovascular events in patients with diabetes after acute coronary syndrome

2019 ◽  
Vol 17 (1) ◽  
pp. 147916411989213
Author(s):  
Aurora Baluja ◽  
Moisés Rodríguez-Mañero ◽  
Alberto Cordero ◽  
Bahij Kreidieh ◽  
Diego Iglesias-Alvarez ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Competing Risks ◽  
Arterial Disease ◽  
Cerebrovascular Event ◽  
Killip Class ◽  
Coronary Syndrome ◽  
Competing Risks Model ◽  
Cerebrovascular Events ◽  
Patients With Diabetes ◽  
Peripheral Arterial

Background and objectives: The risk of major adverse cardiac and cerebrovascular events following acute coronary syndrome is increased in people with diabetes. Predicting out-of-hospital outcomes upon follow-up remains difficult, and no simple, well-validated tools exist for this population at present. We aim to evaluate several factors in a competing risks model for actionable evaluation of the incidence of major adverse cardiac and cerebrovascular events in diabetic outpatients following acute coronary syndrome. Methods: Retrospective analysis of consecutive patients admitted for acute coronary syndrome in two centres. A Fine–Gray competing risks model was adjusted to predict major adverse cardiac and cerebrovascular events and all-cause mortality. A point-based score is presented that is based on this model. Results: Out of the 1400 patients, there were 783 (55.9%) with at least one major adverse cardiac and cerebrovascular event (417 deaths). Of them, 143 deaths were due to non-major adverse cardiac and cerebrovascular events. Predictive Fine–Gray models show that the ‘PG-HACKER’ risk factors (gender, age, peripheral arterial disease, left ventricle function, previous congestive heart failure, Killip class and optimal medical therapy) were associated to major adverse cardiac and cerebrovascular events. Conclusion: The PG-HACKER score is a simple and effective tool that is freely available and easily accessible to physicians and patients. The PG-HACKER score can predict major adverse cardiac and cerebrovascular events following acute coronary syndrome in patients with diabetes.

Abstract TP314: Baseline Thrombocytopenia in Patients With Acute Coronary Syndrome: Does it Affect Following Cerebrovascular Event Rates?

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Chiehju Chao ◽  
Chiachun Chiang ◽  
Muhammad Khalid ◽  
David Fortuin
Keyword(s):  
Acute Coronary Syndrome ◽  
Final Analysis ◽  
P Value ◽  
Cerebrovascular Event ◽  
Bleeding Events ◽  
Patient Demographics ◽  
Coronary Syndrome ◽  
Cerebrovascular Events ◽  
Event Rates ◽  
And Control

Introduction: Baseline thrombocytopenia (TP) is a common condition in patients with acute coronary syndrome (ACS) and acute ischemic stroke and has been shown to increase mortality. The effect of baseline TP on cerebrovascular events following initial ACS event is not well studied. Methods: We retrospectively reviewed all patients identified from the institutional NCDR Chest Pain registry database at Mayo Clinic Arizona from Oct 2015 to Sep 2018. Patients were classified into TP (platelet <150) and control (platelet > 150) groups for clinical outcome (stroke/TIA and bleeding events) analysis. P-value < 0.05 is considered significant. Results: Five hundred and thirty-six patients were included for final analysis. Patient demographics and clinical outcomes are shown in Table 1. The rates of dual antiplatelet therapy (DAPT) prescription at discharge (TP vs. control: 68.1% and 75.4%, P=0.197), stroke/TIA (1.3% vs. 2.4%, P=1.000) and recurrent myocardial infarction (11.1% vs. 11.2%, P=1.000) were similar between the two groups. The TP group has more bleeding events compared to control (Figure 1). Conclusions: In patients with ACS, baseline TP does not affect stroke/TIA events but is associated with higher bleeding rate. The results could not be explained by the DAPT or anticoagulation use alone. Further studies are needed to investigate the pathophysiologic correlation of thrombocytopenia, DAPT, and stroke in ACS patients.

scholarly journals Peripheral Arterial Disease in Patients Presenting with Acute Coronary Syndrome in Six Middle Eastern Countries

2011 ◽  
Vol 2011 ◽  
pp. 1-8 ◽  
Author(s):  
Hassan A. Al-Thani ◽  
Ayman El-Menyar ◽  
Mohammad Zubaid ◽  
Wafa A. Rashed ◽  
Mustafa Ridha ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Peripheral Arterial Disease ◽  
Middle Eastern ◽  
Arterial Disease ◽  
High Risk Group ◽  
Hospital Death ◽  
Gulf Region ◽  
Coronary Syndrome ◽  
St Elevation ◽  
Peripheral Arterial

To describe prevalence and impact of peripheral arterial disease (PAD) in patients with acute coronary syndrome (ACS), data were collected over 5 months from 6 Middle Eastern countries. Patients were divided into 2 groups (with and without PAD). Out of 6705 consecutive ACS patients, PAD was reported in 177 patients. In comparison to non-PAD, PAD patients were older and more likely to have cardiovascular risk factors. They were more likely to have high Killip class, high GRACE risk score, and non-ST elevation ACS (NSTEACS) at presentation. Thrombolytics, antiplatelet use, and coronary intervention were comparable in both groups. When presented with ST-elevation myocardial infarction (STEMI), patients with PAD had worse outcomes, while in NSTEACS; PAD was associated with higher rate of heart failure in comparison to non-PAD patients. In diabetics, PAD was associated with 2-fold increase in mortality when compared to non-PAD (P=0.028). After adjustment, PAD was associated with high mortality in STEMI (adjusted OR 2.6; 95% CI 1.23–5.65,P=0.01). Prevalence of PAD in ACS in the Gulf region is low. Patients with PAD and ACS constitute a high risk group and require more attention. PAD in patients with STEMI is an independent predictor of in-hospital death.

scholarly journals Clopidogrel Induced Haematological Dyscrasia: A Case Report

1970 ◽  
Vol 5 (2) ◽  
pp. 89-90
Author(s):  
Abdul Wadud Chowdhury ◽  
Amanullah Bin Siddiq ◽  
AEM Masharul Islam ◽  
Amitav Saha
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Blood Count ◽  
Complete Blood Count ◽  
Coronary Intervention ◽  
Arterial Disease ◽  
Coronary Syndrome ◽  
Elective Percutaneous Coronary Intervention ◽  
Percutaneous Coronary ◽  
Peripheral Arterial

Clopidogrel is an analogue of ticlopidine, used for reduction of atherosclerotic events in patients with acute coronary syndrome (ACS), stroke, peripheral arterial disease and for elective percutaneous coronary intervention (PCI). It selectively and irreversibly blocks ADP binding to platelets. Its primary side effect is bleeding. However potentially fatal types of haematological dyscrasia such as aplastic anaemia, neutropenia, thrombocytopenia, pancytopenia may be associated with clopidogrel therapy. A 50 years old diabetic, hypertensive lady with angina was started to treat with clopidogrel along with other anti-ischaemic and anti-hypertensive drugs. Subsequently the patient developed leucopenia and thrombocytopenia after starting of clopidogrel. Five days later her complete blood count returned to normal after withdrawal of both anti platelets. Aspirin was re-introduced with great precaution. Later repeat leucocyte and platelet count were found to be normal. At follow- up 1 month after discharge patient found asymptomatic with normal blood count. To the best of our knowledge, clopidogrel induced haematological dyscrasia was not reported earlier in our country. Key words: Acute coronary syndrome; percutaneous coronary intervention. DOI: 10.3329/uhj.v5i2.4563 University Heart Journal Vol.5(2) July 2009 pp.89-90

scholarly journals A study to assess frequency of peripheral arterial disease in patients presenting with acute coronary syndrome

2017 ◽  
Vol 4 (5) ◽  
pp. 1276
Author(s):  
Somnath Mukherjee ◽  
Prashant Kumar ◽  
D. P. Sinha
Keyword(s):  
Acute Coronary Syndrome ◽  
Peripheral Arterial Disease ◽  
Past History ◽  
Systolic Dysfunction ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Observation Study ◽  
Cross Sectional ◽  
Coronary Syndrome ◽  
Peripheral Arterial

Background: To determine the frequency of peripheral arterial disease (PAD) in patients presenting with acute coronary syndrome (ACS) and association of PAD with different risk factors of coronary artery disease (CAD) and to look for in hospital outcome of ACS patients with or without PAD.Methods: This cross-sectional observation study was undertaken in the department of cardiology, IPGME&R Hospital, Kolkata from June 2015 to August 2016 to recruit 199 consecutive patients admitted with ACS and were evaluated with detailed clinical history, physical examination, ABI (Ankle Brachial Index) measurement, echocardiography and appropriate blood investigations.Results: Among 199 total ACS patients, STEMI was the predominant mode of presentation (71.86%) and majorities were male. PAD was seen in 26 patients and mean age was 56.68±8.84 years. Factors independently related with PAD in acute coronary syndromes are hypertension (OR- 1.49; 95% CI: 0.615-3.232), diabetes (OR- 2.55;95% CI : 0.9762-6.6665), smoking (OR-2.55; 95% CI: 1.055-6.19), past history of CVA (OR-11.15;95% CI: 1.77-70.32), LV systolic dysfunction (OR-1.388; 95% CI:0.607-3.1742). 2 and 13 patients died within 7 days of admission among 26 ACS-PAD group (7.69%) and 173 ACS-non-PAD group (7.5%) respectively and most of them had STEMI.Conclusions: Significant numbers of ACS patients are having PAD and older age, male sex, diabetes, hypertension, smoking and LV systolic dysfunction were found to be independent predictors for PAD in ACS patients. Early in hospital mortality was seem to be dependent on clinical presentation, not on presence or absence of PAD.

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