Investigation of 89 candidate gene variants for effects on all-cause mortality following acute coronary syndrome

Introduction: Hyperglycemia is associated with unfavorable prognosis in patients with acute coronary syndrome (ACS). Studies with intensive glycemic control in ACS patients have provided inconsistent results. A meta-analysis was performed to evaluate the effectiveness and safety of intensive glycemic control in patients with ACS. Methods: Search of PubMed, Cochrane CENTRAL, EMBASE, EBSCO, Web of Science and CINAHL databases from their inception through April 2014, identifying randomized controlled trials (RCTs) comparing the effects of intensive versus standard glucose management in patients with ACS. We calculated summary random-effect odds ratios (OR) and 95% confidence intervals (CI). Results: Results from 10 RCTs comprising 2,621 patients were analyzed. All-cause mortality between intensive versus standard glucose management groups did not differ significantly (OR 1.00, 95% CI 0.75-1.34). Similarly, no significant differences were observed between the comparator groups for the odds of cardiac mortality (OR 0.87, 95% CI, 0.67 to 1.12), recurrent myocardial infarction (OR 1.07, 95% CI, 0.76 to 1.52), or stroke (OR 1.20, 95% CI, 0.60 to 2.40). The risk of hypoglycemia (OR 5.95, 95% CI, 2.73 to 12.97; p<0.001) was significantly higher with intensive compared with standard glucose management. Conclusions: Intensive glucose control compared with standard care in ACS patients did not reduce mortality or morbidity, but significantly increased the risk of hypoglycemia. These data from prior clinical trials should be interpreted in the context of their significant methodological limitations.

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Reply-Letter to the Editor-Nutritional status and all cause mortality in older adults with acute coronary syndrome

Clinical Nutrition ◽

10.1016/j.clnu.2019.09.002 ◽

2019 ◽

Vol 38 (6) ◽

pp. 2956-2957

Author(s):

Elisabetta Tonet ◽

Gianluca Campo

Keyword(s):

Older Adults ◽

Acute Coronary Syndrome ◽

Nutritional Status ◽

Coronary Syndrome ◽

Letter To The Editor ◽

All Cause Mortality

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Abstract 309: Is Right Bundle Branch Block Associated with Poor Outcomes in the Setting of an Acute Coronary Syndrome? A Systematic Review and Meta-analysis

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.7.suppl_1.309 ◽

2014 ◽

Vol 7 (suppl_1) ◽

Author(s):

Ahmad Hazem ◽

Sunita Sharma ◽

Amit Sharma ◽

Cameron Leitch ◽

Roopalakshmi Sharadanant ◽

...

Keyword(s):

Systematic Review ◽

Acute Coronary Syndrome ◽

Right Bundle Branch Block ◽

Risk Ratio ◽

Meta Analysis ◽

Forest Plot ◽

Bundle Branch Block ◽

Coronary Syndrome ◽

All Cause Mortality

Importance: Up to 10% of patients with acute myocardial infarction (AMI) have right bundle branch block (RBBB), and RBBB has been associated with a higher risk of mortality. We performed a systematic review and meta-analysis to determine the prognostic significance of RBBB for patients with AMI. Acute coronary syndrome (ACS) Data Sources: We have systematically searched Ovid, Scopus and Web of Science through January 2014. Study Selection: Reviewers working independently and in duplicate screened all eligible abstracts, selecting studies that described all-cause mortality or cardiovascular death in patients with RBBB and suspected ACS. We excluded studies that reported unadjusted outcomes. Knowledge synthesis: We pooled risk ratio with hazard ratio in studies reporting those outcomes. When reported, odds ratio was converted into risk ratio using reported event rate in each study’s unexposed -read: non RBBB- group. Main Outcomes: All-cause mortality and cardiovascular mortality (death). Results: Eighteen studies were found that reported eligible data. All were observational studies, involving over 89,000 patients. In short-term follow up (up to 30 days), RBBB on presentation was associated with higher all-cause mortality rate, compared to patients without RBBB (RR 2.23, 95% CI 1.76-2.82). There was a trend for higher mortality at long-term follow up (range: 6 months-16 years) that did not reach statistical significance (RR 1.45, 95% CI 0.93-2.25). Figure-1 demonstrates the forest plot. Risk of bias was assessed with the Newcastle-Ottawa scale and majority of included studied were deemed moderate to high quality. Conclusion and Relevance: RBBB is associated with a more than 2-fold higher risk of all-cause mortality in patients with AMI at 30 days follow up. Patients with AMI and RBBB represent a high risk group for adverse outcomes. A sentence on the differential findings for new vs. old RBBB and association with outcomes could follow here.

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The safety of morphine use in acute coronary syndrome: a meta-analysis

Heart Asia ◽

10.1136/heartasia-2018-011142 ◽

2019 ◽

Vol 11 (1) ◽

pp. e011142 ◽

Cited By ~ 1

Author(s):

Rugheed Ghadban ◽

Tariq Enezate ◽

Joshua Payne ◽

Haytham Allaham ◽

Ahmad Halawa ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Major Bleeding ◽

Pain Control ◽

Controlled Trial ◽

Cochrane Central Register ◽

Minor Bleeding ◽

Coronary Syndrome ◽

Increased Risk ◽

Significant Difference ◽

All Cause Mortality

BackgroundMorphine is widely used for pain control in patients with acute coronary syndrome (ACS). Several studies have questioned the safety of morphine in this setting with a concern of interaction with and reduced efficacy of antiplatelet agents.ObjectiveThis study aims to systematically review the safety of morphine use in ACS.MethodsMEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials were queried from inception through April 2018. Studies comparing morphine to nonmorphine use in ACS were included. Study endpoints included: in-hospital myocardial infarction (MI), all-cause mortality, stroke, major bleeding, minor bleeding and dyspnoea.ResultsA total of 64 323 patients with ACS were included from eight studies, seven of which were observational studies and one was a randomised controlled trial. The use of morphine was associated with increased risk of in-hospital recurrent MI (OR 1.30, 95% CI 1.18 to 1.43, p < 0.00001). There was, however, no significant difference in terms of all-cause mortality (OR 0.87, 95% CI 0.62 to 1.22, p = 0.44), stroke (OR 0.81, 95% CI 0.39 to 1.66, p = 0.57), major bleeding (OR 0.49, 95% CI 0.24 to 1.00, p = 0.05), minor bleeding (OR 0.98, 95% CI 0.41 to 2.34, p = 0.97), or dyspnoea (OR 0.55, 95% CI 0.16 to 1.83, p = 0.33).ConclusionThe use of morphine for pain control in ACS was associated with an increased risk of in-hospital recurrent MI. Randomised clinical trials are needed to further investigate the safety of morphine in ACS.

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Clinical Characteristics, Management, and Outcomes of Suspected Poststroke Acute Coronary Syndrome

Cardiology Research and Practice ◽

10.1155/2017/3762149 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Sylvia Marie Biso ◽

Marvin Lu ◽

Toni Anne De Venecia ◽

Supakanya Wongrakpanich ◽

Mary Rodriguez-Ziccardi ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Clinical Characteristics ◽

Clinical Decision Making ◽

Clinical Decision ◽

Morbidity And Mortality ◽

Troponin Level ◽

Older Individuals ◽

Coronary Syndrome ◽

All Cause Mortality ◽

Cardiac Evaluation

Background. Acute coronary syndrome (ACS) can complicate acute ischemic stroke, causing significant morbidity and mortality. To date, literatures that describe poststroke acute coronary syndrome and its morbidity and mortality burden are lacking. Methods. This is a single center, retrospective study where clinical characteristics, cardiac evaluation, and management of patients with suspected poststroke ACS were compared and analyzed for their association with inpatient mortality and 1-year all-cause mortality. Results. Of the 82 patients, 32% had chest pain and 88% had ischemic ECG changes; mean peak troponin level was 18, and mean ejection fraction was 40%. The medical management group had older individuals (73 versus 67 years, p<0.05), lower mean peak troponin levels (12 versus 49, p<0.05), and lower mean length of stay (12 versus 25 days, p<0.05) compared to those who underwent stent or CABG. Troponin levels were significantly associated with 1-year all-cause mortality. Conclusion. Age and troponin level appear to play a role in the current clinical decision making for patient with suspected poststroke ACS. Troponin level appears to significantly correlate with 1-year all-cause mortality. In the management of poststroke acute coronary syndrome, optimal medical therapy had similar inpatient and all-cause mortality compared to PCI and/or CABG.

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Impact of Normal Weight Central Obesity on Clinical Outcomes in Male Patients With Premature Acute Coronary Syndrome

Angiology ◽

10.1177/0003319719835637 ◽

2019 ◽

Vol 70 (10) ◽

pp. 960-968 ◽

Cited By ~ 1

Author(s):

Jindong Wan ◽

Peng Zhou ◽

Dan Wang ◽

Sen Liu ◽

Yi Yang ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Central Obesity ◽

Normal Weight ◽

Coronary Syndrome ◽

Cox Proportional Hazard ◽

Hazard Ratios ◽

Cerebrovascular Events ◽

All Cause Mortality ◽

Cox Proportional Hazard Models ◽

Male Patients

There is a lack of studies that evaluate the association between normal weight central obesity and subsequent outcomes in patients with premature acute coronary syndrome (ACS). We evaluated 338 consecutive male patients (aged ≤ 55 years) with premature ACS. The primary outcomes were all-cause mortality and major adverse cardiac and cerebrovascular events (MACCE). We compared the hazard ratios (HRs) in patients with and without normal weight central obesity using multivariable Cox proportional hazard models. All-cause mortality (16.8%) of patients with normal weight central obesity was much higher than those (7.1%) without normal weight central obesity ( P = .008). The incidence of MACCE in patients with and without normal weight central obesity were 40.7 and 23.6% ( P = .001), respectively. After multivariable adjustment, the risks of all-cause mortality and MACCE were significantly higher in patients with normal weight central obesity than those without normal weight central obesity (adjusted HR: 1.83; 95% confidence interval [CI]: 1.04-3.31; P = .004 and adjusted HR: 1.62; 95% CI: 1.18-2.27; P = .017, respectively). In conclusion, the risks of all-cause mortality and MACCE were significantly higher in male patients with premature ACS with normal weight central obesity than in those without normal weight central obesity.

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