scholarly journals Relationship between coronary hyper-intensive plaques identified by cardiovascular magnetic resonance and clinical severity of acute coronary syndrome

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Wen Liu ◽  
Sijing Wu ◽  
Zhenjia Wang ◽  
Yanni Du ◽  
Zhaoyang Fan ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
High Risk ◽  
Unstable Angina ◽  
Stable Angina ◽  
Plaque Rupture ◽  
Clinical Severity ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Abstract Background Coronary hyper-intense plaque (CHIP) detected on T1-weighted cardiovascular magnetic resonance (CMR) has been shown to associate with vulnerable plaque features and worse outcomes in low- and intermediate-risk populations. However, the prevalence of CHIP and its clinical significance in the higher-risk acute coronary syndrome (ACS) population have not been systematically studied. This study aims to assess the relationship between CHIP and ACS clinical severity using intracoronary optical coherence tomography (OCT) as the reference. Methods A total of 62 patients with known or suspected coronary artery disease were prospectively enrolled including a clinically diagnosed ACS group (n = 50) and a control group with stable angina pectoris (n = 12). The ACS group consisted of consecutive patients including unstable angina pectoris (n = 27), non-ST-segment-elevation myocardial infarction (non-STEMI) (n = 8), and ST-segment-elevation myocardial infarction (STEMI) (n = 15), respectively. All patients underwent non-contrast coronary CMR to determine the plaque-to-myocardium signal intensity ratio (PMR). Results Among the four groups of patients, a progressive increase in the prevalence of CHIPs (stable angina, 8%; unstable angina, 26%; non-STEMI, 38%; STEMI, 67%; p = 0.009), and PMR values (stable angina, 1.1; unstable angina, 1.2; non-STEMI, 1.3; STEMI, 1.6; median values, P = 0.004) were observed. Thrombus (7/8, 88% vs. 4/22, 18%, p = 0.001) and plaque rupture (5/8, 63% vs. 2/22, 9%, p = 0.007) were significantly more prevalent in CHIPs than in plaques without hyper-intensity. Elevated PMR was associated with high-risk plaque features including plaque rupture, thrombus, and intimal vasculature. A positive correlation was observed between PMR and the number of high-risk plaque features identified by OCT (r = 0.44, p = 0.015). Conclusions The prevalence of CHIPs and PMR are positively associated with the disease severity and high-risk plaque morphology in ACS.

Unstable Angina and Other Acute Coronary Syndromes

2013 ◽  
Author(s):  
R Scott Wright ◽  
Joseph G Murphy
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Risk Stratification ◽  
Unstable Angina ◽  
The United States ◽  
Cardiac Biomarkers ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Patients with coronary artery disease (CAD) present clinically when their disease enters an unstable phase known as an acute coronary syndrome (ACS), in which the cap of a previously stable atheromatous coronary plaque ruptures or erodes, which in turn activates a thrombotic cascade that may lead to coronary artery occlusion, myocardial infarction (MI), cardiogenic shock, and patient death. There are nearly 2 million episodes of ACS in the United States annually; it is the most common reason for hospitalization with CAD and is the leading cause of death in the developed world. ACS patients include those with unstable angina (UA), non–ST segment elevation myocardial infarction (non-STEMI), and ST segment elevation myocardial infarction (STEMI) and patients who die suddenly of an arrhythmia precipitated by coronary occlusion. The distinction among various ACS subgroups reflects varying characteristics of clinical presentation (presence or absence of elevated cardiac biomarkers) and the type of electrocardiographic (ECG) changes manifested on the initial ECG at the time of hospitalization. This chapter focuses on UA and non-STEMI. A graph outlines mortality risks faced by patients with varying degrees of renal insufficiency. An algorithm describes the suggested management of patients admitted with UA or non-STEMI. Tables describe the risk stratification of the patient with chest pain, categories of Killip class, examination findings of a patient with high-risk ACS, diagnosis of MI, causes of troponin elevation other than ischemic heart disease, initial risk stratification of ACS patients, and long-term medical therapies and goals in ACS patients. This review contains 2 highly rendered figures, 11 tables, and 76 references.

scholarly journals Pregnancy-Associated Plasma Protein-A Levels and Coronary Angiographic Features in Acute Coronary Syndrome Patients

2014 ◽  
Vol 2014 ◽  
pp. 1-6
Author(s):  
Mohamed Shehata
Keyword(s):  
Myocardial Infarction ◽  
Plasma Protein ◽  
Plaque Rupture ◽  
Protein A ◽  
Study Cohort ◽  
Level Of Evidence ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Background. Pregnancy-associated plasma protein-A (PAPP-A) is a biomarker of plaque rupture, associated with adverse cardiac events in acute coronary syndromes (ACSs) patients. Aim. To identify coronary angiographic (CA) features related to PAPP-A level elevation in ACSs patients. Methods. Forty ACSs patients were enrolled in this prospective cohort study (level of evidence: III-prognostic). Serum samples for PAPP-A quantitation were obtained upon coronary care unit admission. All patients underwent CA and coronary intervention within 6 hours of sampling. Results. Mean age of the study cohort was 57 ± 11 years, (males: 55%, n=22). Patients with ST-segment elevation myocardial infarction (35%, n=14) showed significantly higher serum PAPP-A level (11.8 ± 2 µg/mL), compared to non-ST-segment elevation myocardial infarction (15%, n=6) and unstable angina (50%, n=20) patients (11 ± 2.6 µg/mL and 8.7 ± 2.3 µg/mL, resp., P<0.001). Higher PAPP-A levels were significantly associated with complex culprit lesion morphology (11.8 ± 2 µg/mL for type C lesions, 9.7± 2.5 µg/mL and 7.3 ± 3.5 µg/mL for type B and type A lesions, resp., P<0.001), while no relationship to number of diseased coronaries. Conclusion. Higher PAPP-A levels in ACSs patients are associated with unfavorable coronary anatomy and complex angiographic plaque features.

scholarly journals Immature Platelet Fraction (IPF) Levels in Acute Coronary Syndrome (ACS) Patients

2021 ◽  
Vol 8 (8) ◽  
pp. 682-688
Author(s):  
Enna Berkah Sari ◽  
Nizam Zikri Akbar ◽  
Herman Hariman
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Angina Pectoris ◽  
Unstable Angina ◽  
Unstable Angina Pectoris ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Immature Platelet Fraction

Background: Acute Coronary Syndrome (ACS) is a major cardiovascular problem because it causes high hospital admissions and mortality rates. Acute Coronary Syndrome is divided into 3 (three), namely: unstable angina pectoris (UAP), myocardial infarction without ST segment elevation (NSTEMI), and myocardial infarction with ST segment elevation (STEMI). In addition to changes in biomarkers of heart injury, the platelet index (IPF = immature platelet fraction) will also change the level difference between STEMI with NSTEMI/UAP. Objective: To determine the differences in IPF levels of ACS patients with STEMI and NSTEMI/UAP Method: Observational analytic with cross sectional approach. The subjects of this study were 80 patients who came to the emergency installation of integrated heart center Emergency Room Haji Adam Malik Hospital Medan from May 2019 to September 2019 and was diagnosed with ACS (STEMI or NSTEMI/UAP). The sample in the study was the patient's venous blood and put it in an EDTA tube, then immediately checked the IPF value/level using the automatic hematology analyzer. Patients with heart failure or patients with thrombocytopenia were not included in this study. Results: In this study, the demographic characteristics of the ACS patients based on gender were male 77.5% STEMI and 87.5% NSTEMI/UAP while women 22.5% STEMI and 12.5% ​​NSTEMI/UAP. The results of the STEMI patient's IPF levels Compared with NSTEMI/UAP, the median is 6.2 (3.5-16.8) VS 2.9 (0.7-12) with a p-value of 0.0001. Conclusion: The characteristics of ACS patients based on the results of sex were that there were more men with NSTEMI/UAP than those with STEMI. There was a significant difference in the IPF levels of STEMI with NSTEMI/UAP. Keywords: Immature Platelet Fraction (IPF), Acute Coronary Syndrome (ACS), ST-Segment Elevation Myocardial Infarction (STEMI), Non ST-Segment Elevation Myocardial Infarction (NSTEMI), Unstable Angina Pectoris (UAP).

Acute Coronary Syndrome

2019 ◽  
pp. 190-196
Author(s):  
Siva S. Ketha ◽  
Juan Carlos Leoni Moreno
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Plaque Rupture ◽  
Clinical Manifestations ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Atherosclerotic Plaque Rupture

Acute coronary syndrome (ACS) encompasses all clinical manifestations caused by active myocardial ischemia and includes 3 entities: unstable angina (UA), acute non–ST-segment elevation myocardial infarction (NSTEMI), and acute ST-segment elevation myocardial infarction (STEMI). Atherosclerotic plaque rupture is the most consistent pathophysiologic event in ACS. After plaque rupture, cardiac myocytes die as a consequence of continued occlusion, thereby causing acute myocardial infarction (MI). Prompt recognition of ACS is crucial because the greatest therapeutic effect is achieved if treatment is performed soon after presentation.

P5525Impact of clinical presentation at admission on long-term clinical outcomes in patients undergoing percutaneous coronary interventions - a contemporary registry data

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L Piatek ◽  
L Zandecki ◽  
J Kurzawski ◽  
A Janion-Sadowska ◽  
M Zabojszcz ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Unstable Angina ◽  
Stable Angina ◽  
Clinical Presentation ◽  
P Value ◽  
Cardiac Events ◽  
St Segment Elevation ◽  
St Segment ◽  
Adverse Cardiac Events ◽  
Percutaneous Coronary

Abstract Background Both unstable angina (UA) and non-ST-segment elevation myocardial infarction (NSTEMI) are still classified together in non-ST-elevation acute coronary syndromes despite the fact they substantially differ in both clinical profile and prognosis. Purpose The aim of the present study was to evaluate contemporary clinical characteristics and outcomes of UA patients after percutaneous coronary intervention (PCI) in comparison with stable angina (SCAD) and myocardial infarction (NSTEMI as well as STEMI) in Swietokrzyskie District of Poland in years 2014–2017. Methods A total of 7'187 patients after PCI from ORPKI Registry (38% with diagnosis of UA) were included into the analysis. Impact of clinical presentation (UA, SCAD, NSTEMI, STEMI) on 3-year outcomes were determined. Results UA patients were older that SCAD but younger than NSTEMI individuals. Diabetes and hypertension were more often encountered into UA group than in NSTEMI but less often than in SCAD cases. In UA group the percentage of previous myocardial infarction (MI), PCI or coronary artery bypass grafting (CABG) was the highest among all analyzed groups. In 3-year observation the risk of death as well as myocardial infarction (MI) and major adverse cardiac events (MACE) in unstable angina after PCI was higher than in stable angina but considerably lower than in NSTEMI group. Multivariate analysis confirmed that prognosis in NSTEMI was substantially worse in comparison with UA (RR 1.365, 95% CI: 1.126–1.655, p=0.0015). On the contrary there were no difference in mortality risk between UA and SCAD patients (RR 1.189, 95% CI: 0.932–1.518, p=0.1620). Parallel results were observed in respect of MI and MACE. Independ predictors of death were: age, kidney disease, hypertension, diabetes, previous stroke or previous PCI. Multivariate logistic regression analyse Clinical presentation Death Myocardial infarction MACE RR 95% CI p-value RR 95% CI p-value RR 95% CI p-value NSTEMI/UA 1.365 1.126–1.655 0.0015 1.822 1.076–3.055 0.0260 1.514 1.267–1.807 <0.0001 NSTEMI/SCAD 1.624 1.251–2.109 0.0003 1.882 0.982–3.789 0.0568 1.604 1.275–2.094 <0.0001 UA/SCAD 1.189 0.932–1.518 0.1620 1.033 0.557–2.034 0.9219 1.060 0.855–1.323 0.6023 MACE, major adverse cardiac events; NSTEMI, non-ST-segment elevation myocardial infarction; UA, unstable angina; SCAD, stable angina. Conclusion Unstable angina accounted for 38% of all cases and was the most common diagnosis in patients that underwent PCI in that time. 3-year prognosis in UA was considerable better in comparison with NSTEMI. On contrary there was no difference in outcomes (death, MI, MACE) between UA and SCAD patients.

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