scholarly journals The utility of SYNTAX score predictability by electrocardiogram parameters in patients with unstable angina

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Mohammad Reza Hatamnejad ◽  
Amir Arsalan Heydari ◽  
Maryam Salimi ◽  
Soodeh Jahangiri ◽  
Mehdi Bazrafshan ◽  
...  
Keyword(s):  
Unstable Angina ◽  
P Wave ◽  
Syntax Score ◽  
Cardiac Events ◽  
Coronary Syndrome ◽  
St Depression ◽  
Wave Inversion ◽  
St Elevation ◽  
The Right ◽  
Delayed Transition

Abstract Background SYNTAX score is one of the risk assessment systems to predict cardiac events in acute coronary syndrome patients. Despite the large number of SYNTAX score benefits, invasive methods such as coronary angiography are necessary to perform the scoring. We hypothesized that ECG parameters could predict the SYNTAX score in unstable angina patients. Methods During the retrospective cohort study, a total number of 876 patients were diagnosed with unstable angina. After applying the exclusion criteria, 600 patients were divided into tertiles based on the SYNTAX scores as low (0–22), intermediate (23–32), and high (≥ 33). The association between ECG parameters and SYNTAX score was investigated. Results The study included 65% men and 35% women with a mean age of 62.4 ± 9.97 years. The delayed transition zone of QRS complex, ST-depression in inferior-lateral territories or/and in all three territories, and T-wave inversion in lateral territory were significant (p < 0.05) independent predictors of intermediate SYNTAX score. High SYNTAX score was predicted by the presence of prolonged P wave duration, ST-depression in lateral territory or/and anterior-lateral territories, ST-elevation in aVR–III leads or/and aVR–III–V1 leads. Among those, all three territories ST-depression (AUC: 0.611, sensitivity: 75%, specificity: 51%) and aVR + III ST-elevation (AUC: 0.672, sensitivity: 50.12%, specificity: 80.50%) were the most accurate parameters to predict intermediate and high SYNTAX scores, respectively. Conclusion The present study demonstrates that accompanying the STE in the right side leads (aVR, III, V1) with ST-depression in other leads indicates the patients with high SYNTAX score; meanwhile, diffuse ST-depression without ST-elevation is a marker for intermediate SYNTAX score in unstable angina patients and can be applied for early risk stratification and intervention.

Acute coronary syndromes

2018 ◽  
Author(s):  
Cheerag Shirodaria ◽  
Sam Dawkins
Keyword(s):  
Myocardial Infarction ◽  
Unstable Angina ◽  
Myocardial Necrosis ◽  
St Elevation Myocardial Infarction ◽  
Coronary Syndrome ◽  
St Depression ◽  
Wave Inversion ◽  
Coronary Syndromes ◽  
St Elevation ◽  
The Difference

The term ‘acute coronary syndrome’ includes unstable angina, ST-elevation myocardial infarction (STEMI), and non-ST-elevation myocardial infarction (NSTEMI). The difference between these three syndromes is as follows. In STEMI and NSTEMI, there is evidence of myocardial necrosis, as evidenced by raised cardiac enzymes, specifically, the very sensitive cardiac biomarker troponin. STEMI is diagnosed when the ECG shows persisting ST elevation in an appropriate territory consistent with STEMI whereas, in NSTEMI, there can be any or no ECG changes, or very transient, self-limiting ST elevation. In unstable angina, there is no myocardial necrosis, and troponins are normal. The ECG is as for NSTEMI and often shows no change, ST depression, or T-wave inversion. The prognoses in STEMI and NSTEMI are identical; unstable angina has a better prognosis than either STEMI or NSTEMI.

scholarly journals A Score to differentiate Takotsubo syndrome from non-ST-elevation myocardial nfarction in women at the bedside

Open Heart ◽  
2020 ◽  
Vol 7 (1) ◽  
pp. e001197 ◽  
Author(s):  
Jen-Li Looi ◽  
Katrina Poppe ◽  
Mildred Lee ◽  
Jill Gilmore ◽  
Mark Webster ◽  
...  
Keyword(s):  
Area Under The Curve ◽  
Takotsubo Syndrome ◽  
Predictive Values ◽  
Derivation Cohort ◽  
Coronary Syndrome ◽  
T Wave ◽  
St Depression ◽  
Wave Inversion ◽  
Optimal Score ◽  
St Elevation

ObjectiveA score to distinguish Takotsubo syndrome (TS) from acute coronary syndrome would be useful to facilitate appropriate patient investigation and management. This study sought to derive and validate a simple score using demographic, clinical and ECG data to distinguish women with non-ST elevation myocardial infarction (NSTEMI) from NSTE-TS.MethodsThe derivation cohort consisted of women with NSTE-TS (n=100) and NSTEMI (n=100). Logistic regression was used to derive the score using ECG values available on the postacute ward round on day 1 post-hospital admission. The score was then temporally validated in subsequent consecutive patients with NSTE-TS (n=40) and NSTEMI (n=70).ResultsThe five variables in the score and their relative weights were: T-wave inversion in ≥6 leads (+3), recent stress (+2), diabetes (−1), prior cardiovascular disease (−2) and ST-depression in any lead (−3). When calculated using ECG values obtained at admission, discrimination between conditions was very good (area under the curve (AUC) 0.87 95% CI 0.83 to 0.92). The optimal score cut-point of ≥1 to predict NSTE-TS had 73% sensitivity and 90% specificity. When applied to the validation cohort at admission, AUC was 0.82 (95% CI 0.75 to 0.90) and positive and negative predictive values were 78% and 81%, respectively. On day 1 post-admission, AUC was 0.92 (95% CI 0.87 to 0.97), with positive and negative predictive values of 77% and 91%, respectively.ConclusionThis NSTE-TS score is easy to use and may prove useful in clinical practice to distinguish women with NSTE-TS from NSTEMI. Further validation in external cohorts is needed.

scholarly journals Electrocardiographic Effects of Propofol versus Etomidate in Patients with Brugada Syndrome

2020 ◽  
Vol 132 (3) ◽  
pp. 440-451 ◽  
Author(s):  
Panagiotis Flamée ◽  
Varnavas Varnavas ◽  
Wendy Dewals ◽  
Hugo Carvalho ◽  
Wilfried Cools ◽  
...  
Keyword(s):  
Brugada Syndrome ◽  
St Segment Elevation ◽  
St Depression ◽  
St Segment ◽  
Qrs Prolongation ◽  
Significant Difference ◽  
Electrocardiographic Changes ◽  
St Elevation ◽  
The Right ◽  
Double Blinded

Abstract Background Brugada Syndrome is an inherited arrhythmogenic disease, characterized by the typical coved type ST-segment elevation in the right precordial leads from V1 through V3. The BrugadaDrugs.org Advisory Board recommends avoiding administration of propofol in patients with Brugada Syndrome. Since prospective studies are lacking, it was the purpose of this study to assess the electrocardiographic effects of propofol and etomidate on the ST- and QRS-segments. In this trial, it was hypothesized that administration of propofol or etomidate in bolus for induction of anesthesia, in patients with Brugada Syndrome, do not clinically affect the ST- and QRS-segments and do not induce arrhythmias. Methods In this prospective, double-blinded trial, 98 patients with established Brugada syndrome were randomized to receive propofol (2 to 3 mg/kg-1) or etomidate (0.2 to 0.3 mg/kg-1) for induction of anesthesia. The primary endpoints were the changes of the ST- and QRS-segment, and the occurrence of new arrhythmias upon induction of anesthesia. Results The analysis included 80 patients: 43 were administered propofol and 37 etomidate. None of the patients had a ST elevation greater than or equal to 0.2 mV, one in each group had a ST elevation of 0.15 mV. An ST depression up to −0.15mV was observed eleven times with propofol and five with etomidate. A QRS-prolongation of 25% upon induction was seen in one patient with propofol and three with etomidate. This trial failed to establish any evidence to suggest that changes in either group differed, with most percentiles being zero (median [25th, 75th], 0 [0, 0] vs. 0 [0, 0]). Finally, no new arrhythmias occurred perioperatively in both groups. Conclusions In this trial, there does not appear to be a significant difference in electrocardiographic changes in patients with Brugada syndrome when propofol versus etomidate were administered for induction of anesthesia. This study did not investigate electrocardiographic changes related to propofol used as an infusion for maintenance of anesthesia, so future studies would be warranted before conclusions about safety of propofol infusions in patients with Brugada syndrome can be determined. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Abstract 2592: Clinical Events and MSCTA Anatomy in Anomalous Coronary Artery Arising from the Opposite Coronary Sinus (AOCOS): Relationship of the Pulmonary Valve, Slit-like Orifice, and Arterial Course

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Thomas Knickelbine ◽  
Niti Aggarwal ◽  
Bjorn Flygenring ◽  
Terrance F Longe ◽  
Barry J Maron ◽  
...  
Keyword(s):  
Pulmonary Valve ◽  
Multislice Ct ◽  
List Type ◽  
Cardiac Events ◽  
Conventional Angiography ◽  
Pulmonic Valve ◽  
Coronary Syndrome ◽  
Clinical Events ◽  
The Right ◽  
Anomalous Coronary

Background: Anomalous Orgin of a Coronary from the Opposite Sinus (AOCOS) is associated with myocardial infarction and sudden death. Proximal vessel variations and course can be difficult to assess by conventional angiography but can be easily imaged noninvasively by Multislice CT facilitating appropriate clinical management. Methods: We evaluated proximal vessel variations by MSCT in patients with AOCOS including the presence of a slit-like orifice, interarterial course between the aorta and pulmonary artery, relationship to the pulmonic valve, and the presence of spontaneous cardiac events. Results: 2500 cases were examined by MSCTA in pts referred for chest pain, abnormal stress testing, or acute coronary syndrome in a large volume clinical setting. There were 28 cases (1.1%) of AOCOS with 16/28 (58%) of RCA off the left cusp (2 single coronaries) and 12/28 (42%) of LCA off the right cusp (4 single coronaries). RCA off the left sinus : 14/16 with interarterial course, origin above the pulmonic valve with 2/16 interarterial but below the pulmonic valve. 9/16 had slit-like orifice, 2/16 highly angled ostium without slit-like orifice. 8/16 pts (50%) underwent CABG while 8/16 (50%) were treated medically. LCA off the right sinus : 1/12 (8%) was above the level of the pulmonic valve, none had a slit-like orifice. 5/12 (42%) had an intraseptal course below the pulmonic valve. Two pts underwent CABG. Spontaneous events : 3/28 (11%) pts initially presented with spontaneous clinical events (NSTEMI, sustained VT, acute inferior MI) attributed directly to the coronary anomaly. All three of these pts had a slit-like orifice, an origin at or above the level of the pulmonary valve, an interarterial course, and a RCA off the left sinus. Conclusion: Anomalous coronary arteries arising from the opposite sinus can be readily characterized by MSCT. MSCT can now be used to help select patients for revascularization with high risk characteristics All patients who presented with a spontaneous malignant event had a slit-like orifice, an interarterial course, and an origin at or above the pulmonic valve.

Abstract 2602: Elevated Serum Neopterin Levels and Adverse Cardiac Events in Patients with Non-ST-Segment Elevation Acute Coronary Syndrome

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Juan Carlos Kaski ◽  
Luciano Consuegra-Sanchez ◽  
Daniel J. Fernandez-Berges ◽  
Jose M Cruz-Fernandez ◽  
Xavier Garcia-Moll ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Unstable Angina ◽  
Elevated Serum ◽  
Cardiac Events ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Adverse Cardiac Events ◽  
Elevation Acute Coronary Syndrome

Objectives: We sought to assess whether plasma neopterin predicts adverse clinical outcomes in patients with NSTEACS. Background: Circulating C reactive protein (CRP), a marker of inflammation, correlates with events in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). High neopterin levels - a marker of macrophage activation - predict cardiovascular events in stable angina patients but their prognostic role in NSTEACS has not been systematically evaluated. Methods: We prospectively assessed 397 patients (74 % men) admitted with NSTEACS: 169 (42.5%) had unstable angina and 228 (57.5%) non-ST-segment elevation myocardial infarction (NSTEMI). Blood samples for neopterin and CRP assessment were obtained at admission. TIMI risk score was also assessed among other clinical and biochemical variables. The study end point was the composite of cardiac death, acute myocardial infarction and recurrent angina at 180-days. Results: Baseline neopterin concentrations (nmol/L) were similar in unstable angina and NSTEMI patients (8.3 [6.5–10.6] vs 8.0 [6.2–11.1], p = 0.54). Fifty-nine patients (14.9 %) had events during follow-up (highest third (%) 21.5 vs 1 st and 2 nd thirds 11.5, log rank 7.341, p = 0.007). On multivariable hazard Cox regression, only neopterin (highest vs 1 st and 2 nd thirds, HR 2.15, 95 % CI [1.21–3.81]) was independently associated with the combined endpoint.CRP levels, however, were not significantly different in patients with events compared to those without events (adjusted HR = 0.98, p = 0.89, 95% CI 0.80 –1.21). Conclusion: Increased neopterin levels are an independent predictor of 180-day adverse cardiac events in patients with NSTEACS.

Referral decisions based on a prehospital HEART score in suspected non-ST-elevation acute coronary syndrome: design of the FamouS Triage 3 study

2020 ◽  
Vol 16 (4) ◽  
pp. 217-226
Author(s):  
Dominique N van Dongen ◽  
Rudolf T Tolsma ◽  
Marion J Fokkert ◽  
Erik A Badings ◽  
Aize van der Sluis ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Risk Stratification ◽  
Major Adverse Cardiac Events ◽  
Cardiac Events ◽  
Heart Score ◽  
Coronary Syndrome ◽  
Referral Decisions ◽  
Adverse Cardiac Events ◽  
St Elevation ◽  
Elevation Acute Coronary Syndrome

Background: It is not yet investigated whether referral decisions based on prehospital risk stratification of non-ST-elevation Acute Coronary Syndrome (NSTE-ACS) by the complete History, ECG, Age, Risk factors and initial Troponin (HEART) score are feasible and safe. Hypothesis: Implementation of referral decisions based on the prehospital acquired HEART score in patients with suspected NSTE-ACS is feasible and not inferior to routine management in the occurrence of major adverse cardiac events within 45 days. Study design & methods: FamouS Triage 3 is a feasibility study with a before–after sequential design. The aim is to assess whether prehospital HEART-score management including point-of-care troponin measurement is feasible and noninferior to routine management. Primary end point is the occurrence of major adverse cardiac events within 45 days. Conclusion: If referral decisions based on prehospital acquired risk stratification are feasible and noninferior this can become the new prehospital management in suspected NSTE-ACS.

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