scholarly journals Prior Use of Medication for Primary Prevention in Patients with Coronary Syndrome

2020 ◽  
Vol 11 ◽  
pp. 215013272094694
Author(s):  
Andrés Gaviria-Mendoza ◽  
Julián Andrés Zapata-Carmona ◽  
Andrés Alirio Restrepo-Bastidas ◽  
Carmen Luisa Betancur-Pulgarín ◽  
Jorge Enrique Machado-Alba
Keyword(s):  
Acute Coronary Syndrome ◽  
Cardiovascular Risk ◽  
Primary Prevention ◽  
Risk Score ◽  
High Intensity ◽  
Real Life ◽  
Risk Scores ◽  
Coronary Syndrome ◽  
Cardiovascular Risk Score ◽  
Clinical Records

Background: Cardiovascular disease, especially coronary disease, represents one of the main causes of morbidity and mortality. Objective: To determine the drug prescription profile for primary cardiovascular prevention prior to a first acute coronary syndrome event. Methods: Cross-sectional study. We included adult patients of any sex affiliated with one healthcare insurer of the Colombian Health System, with a diagnosis of a first episode of acute coronary syndrome that occurred during the period of 2015 to 2016. Sociodemographic, clinical and pharmacological variables were evaluated from clinical records. The cardiovascular risk score prior to the event was calculated, and the need for the use of statins and aspirin in primary prevention was defined according to the recommendations of clinical practice guidelines. Results: Clinical records of 322 patients were reviewed with mean age of 61.9 ± 10.8 years, and 77.3% were men. The most frequent comorbidities were dyslipidemia (64.3%), arterial hypertension (62.7%) and diabetes mellitus (30.1%); 22% of the patients were obese, and 33.5% were smokers. The cardiovascular risk score was calculated in 211 patients (65.5%) who had the necessary variables complete. The median 10-year risk according to Framingham risk score was 21.4%, and it was 16.3% according to the American Heart Association. From the 211 patients with risk scores, there were 179 (84.8%) who needed statins (175 of high intensity, 97.8%), and 88 (27.3%) required aspirin as a primary prevention; however, 56 of these patients (31.3%) did not receive any statins, 127 (72.6%) did not receive the high intensity statin they needed, and 38 (43.2% of those with indication) lacked aspirin. Conclusion: Real-life data show that among a group of patients with high cardiovascular risk, a substantial proportion were not receiving medications for primary prevention necessary to reduce their risk and finally suffered an acute coronary event.

scholarly journals HIGH RISK STRATEGY EFFICACY IN PROGNOSIS OF PRIMARY ONSET OF ISCHEMIC HEART

2014 ◽  
Vol 13 (6) ◽  
pp. 38-43
Author(s):  
I. S. Skopets ◽  
N. N. Vesikova ◽  
L. L. Bershtein
Keyword(s):  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Cardiovascular Risk ◽  
Primary Prevention ◽  
Coronary Vessels ◽  
Ischemic Heart ◽  
Risk Scores ◽  
High Morbidity ◽  
Coronary Syndrome ◽  
Calculated Risk

High morbidity and mortality from ischemic heart disease (CHD) in RF presupposes the significance of individual prognosis of cardiovascular risk and of primary prevention.Aim.To analyze the level of risk that could be calculated in patients with CHD debut just before the manifest of the disease and therefore to evaluate the opportunities for the CHD debut by standard scores; to evaluate the relation of a real volume of primary prevention events to current Guidelines.Material and methods.In 122 patients hospitalized with CHD debut as an acute coronary syndrome, a retrospective cardiovascular risk evaluation, which could be found just before the onset of the disease.Results.The prevalence of traditional risk factors among persons with CHD onset was high: 88% patients had ≥3 risk factors. However, before the onset of acute coronary syndrome 68% patients at Framingham scale and 47% by SCORE could have been under the low and moderate calculated risk that shows low sensitivity for the real CHD risk. Calculated risk by the scores has not correlated with the severity of coronary vessels lesion. In analysis of primary prevention events in was found that in the studied group drug therapy of dyslipidemia was not being performed as primary prevention, though it is indicated by the standards for at least 82% patients.Conclusion.The data shows that the use of the main risk scores underestimates real chance of CHD development in the exact patient. Also even for the patients, who require statin prescription for the aim of primary prevention, this therapy is not prescribed. 

scholarly journals Experience of the use of the PCSK9 inhibitor Alirocumab in patients with extremely high cardiovascular risk

Kardiologiia ◽  
2020 ◽  
Vol 60 (8) ◽  
pp. 71-77
Author(s):  
V. A. Korneva ◽  
T. Yu. Kuznetsova ◽  
I. S. Scopetc ◽  
N. N. Vezikova
Keyword(s):  
Acute Coronary Syndrome ◽  
Cardiovascular Risk ◽  
Cerebrovascular Disease ◽  
Laboratory Data ◽  
Myocardial Revascularization ◽  
Real Life ◽  
Transient Ischemic Attacks ◽  
High Cardiovascular Risk ◽  
Pcsk9 Inhibitor ◽  
Coronary Syndrome

Aim To study the efficacy and safety of alirocumab in patients with high and very high cardiovascular risk in the Republic of Karelia and to evaluate their compliance with the alirocumab therapy.Materials and methods Study design: observational, noncomparative. The observation group consisted of 9 patients receiving alirocumab (Praluent®) (mean age, 48.6±4.7 years; 7 men). 7 patients had familial hypercholesterolemia of the type diagnosed by DLCN criteria; five patients had MI. Lipid profile, concentrations of transaminases, creatinine, glucose, and lipoprotein a (LP(a)) were measured at 3, 6, 12, and 18 months. Electrocardiography was performed, and the clinical picture (development of acute coronary syndrome, acute cerebrovascular disease, transient ischemic attacks, myocardial revascularization, and cardiovascular death) was evaluated. Efficacy criteria included the absence of these clinical conditions, the proportion of patients who achieved the LDL CS goal, and the decrease in LP(a). Safety was evaluated by clinical and laboratory data, such as levels of transaminases, total bilirubin, creatinine, and blood glucose. The observation lasted for 6 months to 1.5 years.Results LDL CS goals were achieved in 7 (77.8%) patients receiving alirocumab. The mean level of LP(a) decreased from 0.39 to 0.28 g/l; the degree of decrease ranged from 20 to 33 %. No cases of IHD instability (acute coronary syndrome) or new cases of acute cerebrovascular disease and transient ischemic attacks were observed. None of the patients had to stop the alirocumab treatment; adverse effects, including local ones, were not observed.Conclusion LDL CS goals were achieved in 7 (77.8%) patients. The level of LP(a) decreased by 20-33% in patients receiving the PCSK9 inhibitor. In real-life clinical practice, the alirocumab treatment was characterized with high compliance and good tolerability without side effects, including local ones.

scholarly journals Performance of cardiovascular risk scores in mortality prediction ten years after Acute Coronary Syndromes

2019 ◽  
Vol 65 (8) ◽  
pp. 1074-1079
Author(s):  
Amanda Aparecida Petek ◽  
Nara Aline Costa ◽  
Filipe Welson Leal Pereira ◽  
Ezequiel Aparecido dos Santos ◽  
Katashi Okoshi ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Risk Score ◽  
Framingham Risk Score ◽  
American Heart ◽  
Heart Association ◽  
Mortality Prediction ◽  
Risk Scores ◽  
Coronary Syndrome ◽  
Framingham Risk ◽  
Coronary Syndromes

SUMMARY BACKGROUND The objective of this study was to evaluate the performance of the Framingham risk score (FRS) and risk score by the American College of Cardiology/American Heart Association (SR ACC/AHA) in predicting mortality of patients ten years after acute coronary syndrome (ACS). METHODS This is a retrospective cohort study that included patients aged ≥ 18 years with ACS who were hospitalized at the Coronary Intensive Care Unit (ICU) of the Botucatu Medical School Hospital from January 2005 to December of 2006. RESULTS A total of 447 patients were evaluated. Of these, 118 were excluded because the mortality in 10 years was not obtained. Thus, 329 patients aged 62.9 ± 13.0 years were studied. Among them, 58.4% were men, and 44.4% died within ten years of hospitalization. The median FRS was 16 (14-18) %, and the ACC/AHA RS was 18.5 (9.1-31.6). Patients who died had higher values of both scores. However, when we classified patients at high cardiovascular risk, only the ACC/AHA RS was associated with mortality (p <0.001). In the logistic regression analysis, both scores were associated with mortality at ten years (p <0.001). CONCLUSIONS Both FRS and SR ACC/AHA were associated with mortality. However, for patients classified as high risk, only the ACC/AHA RS was associated with mortality within ten years.

External validation of PRECISE-DAPT score and PARIS bleeding risk score in a real-world cohort of patients with acute coronary syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D.R.P.P Chan Pin Yin ◽  
D.M.F Claassens ◽  
F.P Van Baal ◽  
G.J Vos ◽  
J Peper ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Risk Score ◽  
External Validation ◽  
Bleeding Risk ◽  
Risk Scores ◽  
Severe Bleeding ◽  
Coronary Syndrome ◽  
Kaplan Meier ◽  
One Year

Abstract Background In patients with acute coronary syndrome (ACS) shortened duration of dual antiplatelet therapy (DAPT) should be considered in those at high risk of bleeding. Risk scores may be used to assess the bleeding risk, but their predictive value remains unclear. Purpose To externally validate and compare the PRECISE-DAPT and the PARIS bleeding risk scores in patients with ACS. Methods From January 2015 to June 2018, all patients admitted with ACS were consecutively included in a single center, observational, prospective registry with follow-up of at least one year. In all patients, the PRECISE-DAPT and the PARIS risk-score were retrospectively assessed. Primary endpoint was moderate or severe bleeding defined as Bleeding Academic Research Consortium (BARC) 3 or 5 bleeding within one year after ACS. Kaplan-Meier curves showed the probabilty of bleeding during follow-up as assessed by both scores. Score discrimination using c-statistic were calculated and calibration curves were visually assessed. Results 2,729 patients were included for analysis. 93.6% were discharged with ≥2 antithrombotic drugs. At one year follow-up, the event rate of moderate or severe bleeding was 5.5%. High bleeding risk as stratified by both risk scores was associated with higher bleeding rates. Discriminative values for BARC 3 or 5 bleeding at one year were 0.67 [95% CI 0.61–0.72] for the PRECISE-DAPT score and 0.62 [95% CI 0.57–0.68] for the PARIS bleeding score (p=0.31). Conclusion The PRECISE-DAPT and the PARIS bleeding scores both showed adequate discriminative performances in predicting moderate or severe bleeding in this study. Kaplan-meier and ROC-curves Funding Acknowledgement Type of funding source: None

scholarly journals ACEF performed better than other risk scores in non-ST-elevation acute coronary syndrome during long term follow-up

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ivica Kristić ◽  
Nikola Crnčević ◽  
Frane Runjić ◽  
Vesna Čapkun ◽  
Ozren Polašek ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Risk Score ◽  
Treatment Strategies ◽  
Risk Scores ◽  
Coronary Syndrome ◽  
Long Term Follow Up ◽  
St Elevation ◽  
All Treatment

Abstract Background Risk stratification of patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) is an important clinical method, but long-term studies on patients subjected to all-treatment strategies are lacking. Therefore, the aim was to compare several established risk scores in the all-treatment NSTE-ACS cohort during long-term follow-up. Methods Consecutive patients (n = 276) with NSTE-ACS undergoing coronary angiography were recruited between September 2012 and May 2015. Six risk scores for all patients were calculated, namely GRACE 2.0, ACEF, SYNTAX, Clinical SYNTAX, SYNTAX II PCI and SYNTAX II CABG. The primary end-point was Major Adverse Cardiovascular Events (MACE) which was a composite of cardiac death, nonfatal myocardial infarction, ischemic stroke or urgent coronary revascularization. Results During a median follow-up of 33 months, 64 MACE outcomes were recorded (23.2%). There was no difference between risk score categories, except in the highest risk group of ACEF and SYNTAX II PCI scores which exhibited significantly more MACE (51.6%, N = 33 and 45.3%, N = 29, P = 0.024, respectively). In the multivariate Cox regression analysis of individual variables, only age and atrial fibrillation were significant predictors for MACE (HR 1.03, 95% CI 1.00–1.05, P = 0.023 and HR 2.02, 95% CI 1.04–3.89, P = 0.037, respectively). Furthermore, multivariate analysis of the risk scores showed significant prediction of MACE only with ACEF score (HR 2.16, 95% CI 1.36–3.44, P = 0.001). The overall performance of GRACE, SYNTAX, Clinical SYNTAX and SYNTAX II CABG was poor with AUC values of 0.596, 0.507, 0.530 and 0.582, respectively, while ACEF and SYNTAX II PCI showed the best absolute AUC values for MACE (0.630 and 0.626, respectively). Conclusions ACEF risk score showed better discrimination than other risk scores in NSTE-ACS patients undergoing all-treatment strategies over long-term follow-up and it could represent a fast and user-friendly tool to stratify NSTE-ACS patients.

PROCAM-, FRAMINGHAM-, SCORE- and SMART-risk score for predicting cardiovascular morbidity and mortality in patients with overt atherosclerosis

VASA ◽  
2010 ◽  
Vol 39 (4) ◽  
pp. 325-333 ◽  
Author(s):  
Uthoff ◽  
Staub ◽  
Socrates ◽  
Meyerhans ◽  
Bundi ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Risk Score ◽  
Cardiovascular Event ◽  
Cox Regression ◽  
Risk Scores ◽  
Framingham Score ◽  
Cox Regression Analysis ◽  
Coronary Syndrome ◽  
Cardiovascular Morbidity And Mortality

Background: The predictive value of PROCAM, FRAMINGHAM, SCORE and SMART-score to estimate the cardiovascular risk in patients with overt atherosclerosis had never been assessed. Patients and methods: 96 consecutive patients with clinically evident atherosclerosis (coronary, cerebrovascular, peripheral artery and renovascular disease) were enrolled in this preliminary observational study. At baseline, medical history and blood chemistry were obtained. Sonographic measurement of the intima-media thickness (IMT) in the common carotid artery was performed and risk estimations according to the above listed risk scores were calculated. During a 6 year follow-up the occurrence of cardiovascular death, acute coronary syndrome and stroke was assessed. Results: Mean (± SD) risk-scores were 10.9 ± 2.5, range 6 - 17 (SMART); 18.9 ± 18.2 %; range 0.2 - 94.1 % (PROCAM); 21.4 ± 13.1 %, range 4 - 56 % (FRAMINGHAM); and 4.8 ± 3.9 %, range 0.4 - 15.3 % (SCORE). Mean IMT was 0.84 ± 0.14 mm, range 0.51 - 1.20 mm. All scores correlate significantly with each other (r > 0.321; p < 0.01), but only SMART-score correlated significantly with baseline IMT(r = 0.372; p < 0.001). Within the median follow-up of 73 months, a cardiovascular endpoint was observed in 36 (42 %) patients. The AUC (95 % confidence interval) for SMART-risk-score predicting a cardiovascular event was 0.67 (0.54 - 0.77; p < 0.02); for PROCAM 0.60 (0.47 - 0.73; p = n.s.); for FRAMINGHAM 0.56 (0.43 - 0.69; p = n.s.); and for SCORE 0.60 (0.46 - 0.73; p = n.s.). Cox regression analysis showed a relative risk for a cardiovascular event per additional SMART score point of 1.15 (95 % CI 1.01 - 1.30 p = 0.03). Conclusions: PROCAM-, FRAMINGHAM- and SCORE-risk score seem to be barely useful in a secondary prevention setting. In patients with overt atherosclerosis, the cardiovascular risk seems to be better assessed by means of the SMART score.

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