In-hospital outcomes of treatment of patients with acute coronary syndrome using distal radial access

Endovascular methods are leading in the treatment of patients with acute coronary syndrome (ACS). Transradial access (TRA) is traditionally used, but there are some disadvantages. Distal transradial access (dTRA) is an alternative to conventional TRA, but its outcomes in patients with ACS are controversial.Aim. To evaluate the safety and efficacy of vascular accesses, as well as in-hospital outcomes of treatment of patients with ACS using conventional TRA versus dTRA.Material and methods. This single-center, prospective, randomized study included 264 patients with ACS, which were divided into 2 groups: group 1 (n=132) — dTRA, group 2 (n=132) — TRA. The groups were comparable in the initial clinical, laboratory and angiographic characteristics.Results. During percutaneous coronary intervention, 240 drug-eluting stents were implanted in 184 patients. In 10 patients, access was converted: from dTRA to TRA in 2,3% (n=3), from dTRA to femoral — 3,0% (n=4), from dTRA to femoral in 2,3% (n=3). The mean puncture time was 125,1±11,9 s in group 1 and 58,8±8,2 s in group 2 (p<0,00005). There was no difference in the total intervention duration as follows: 30,5±7,1 min and 29,4±4,6 min (p=0,1428), respectively. The time to hemostasis was significantly higher in the TRA group: 354,2±28,1 vs 125,4±15,3 min in group 1 (p<0,00005). When using dTRA, a lower incidence of hematomas (0,8 (n=1) vs 7,0% (n=9) (p=0,019)), spasm (5,6 (n=7) vs 13,2% (n=17) (p=0,039)) and radial artery occlusion (0,8 (n=1) vs 6,2% (n=8) (p=0,036)). The number of major adverse cardiac events (MACE) in both groups was comparable: 10,4% (n=13) and 10,1% (n=13) in group 1 and 2, respectively (p=0,932).Conclusion. The use of dTRA does not increase the total procedure duration compared to conventional TRA. The complication rate was comparable in both study groups. When dTRA was used, the incidence of local complications was significantly lower compared to conventional TRA. Thus, dTRA can be an alternative to conventional TRA, but large randomized trials are required for final conclusions.

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Comparison of the efficacy of half ticagrelor loading doses and clopidogrel in elderly acute coronary syndrome patients in China

Tropical Journal of Pharmaceutical Research ◽

10.4314/tjpr.v19i3.29 ◽

2020 ◽

Vol 19 (3) ◽

pp. 661-666

Author(s):

Jian Xue ◽

Mingming Li ◽

Lijie Wang ◽

Minjun Ma ◽

Jin Zhang

Keyword(s):

Acute Coronary Syndrome ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Cardiac Events ◽

Coronary Syndrome ◽

Therapeutic Benefits ◽

Proportional Hazards Regression ◽

Elder Patients ◽

Group 2 ◽

Group 1

Purpose: To evaluate the effects of half-load doses (HLD) of ticagrelor and clopidogrel on elderly acute coronary syndrome patients (ACS) over a period of 90 days. Methods: Seventy-four patients diagnosed as ACS were included in this trial. The patients were randomly distributed into group 1 (treated with HLD ticagrelor, 90 mg LD) and group 2 (treated with clopidogrel, 300 mg LD). The interaction of treatment effect was evaluated using Multivariate Cox proportional hazards regression models. Results: Within three months, a total of 12 patients (16.21 %) died of myocardial infarction or stroke. The endpoint of HLD ticagrelor-treated elderly ACS patients was 20 %, and the incidence of clopidogreltreated endpoints was 14.81 %. Conclusion: In the first 45 patients treated with HLD ticagrelor, their cumulative incidence of cardiac events was relatively high. However, there were no considerable changes in the therapeutic benefits of these two drugs in elderly ACS patients. Keywords: Elder patients, Acute coronary syndrome, Ticagrelor, Clopidogrel

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The Threshold of Admission Glycemia as a Predictor of Adverse Events in Diabetic and Non-Diabetic Patients with Acute Coronary Syndrome

Clinical medicine Cardiology ◽

10.4137/cmc.s2289 ◽

2009 ◽

Vol 3 ◽

pp. CMC.S2289 ◽

Cited By ~ 3

Author(s):

Taysir S. Garadah ◽

Salah Kassab ◽

Qasim M. Al-Shboul ◽

Abdulhai Alawadi

Keyword(s):

Acute Coronary Syndrome ◽

Adverse Events ◽

Diabetic Patients ◽

Stress Hyperglycemia ◽

Coronary Syndrome ◽

History Of ◽

Group 3 ◽

Group 2 ◽

High Level ◽

Group 1

Recent studies indicated a high prevalence of hyperglycemia in non-diabetic patients presenting with acute coronary syndrome (ACS). However, the threshold of admission glucose (AG) as a predictor of adverse events in ACS is unclear. Objective The aim of this study was to assess the threshold of admission glucose (AG) as a predictor of adverse events including Major Acute Cardiac Events (MACE) and mortality, during the first week of admitting patients presenting with ACS. Material and Methods The data of 551 patients with ACS were extracted and evaluated. Patients were stratified according to their blood glucose on admission into three groups: group 1: <7 mmol/L (n = 200, 36.3%) and group 2: >7 mmol/L and <15 mmol/L (n = 178, 32.3%) and group 3: ≥15 mmol/L (n = 173, 31.4%). Stress hyperglycemia was arbitrarily defined as AG levels > 7 mmol/L (group 2 and 3). Patients with ACS were sub-divided into two groups: patients with unstable angina (UA, n = 285) and those with ST segment elevation myocardial Infarction (STEMI, n = 266) and data were analyzed separately using multiple regression analysis. Results The mean age of patients was 59.7 ± 14.8 years and 63% were males. The overall mortality in the population was 8.5% (5.4% in STEMI and 3.1% in UA) patients. In STEMI patients, the odds ratio of stress hyperglycemia as predictor of mortality in group 3 compared with group 1 was 3.3 (CI 0.99-10.98, P < 0.05), while in group 2 compared with group 1 was 2.4 (CI: 0.75-8.07, P = 0.065) after adjustment for age and sex. Similarly, in UA patients, the odds ratio of stress hyperglycemia in group 3 compared with group 1 was 2.7 (CI 0.37-18.98, P < 0.05), while in group 2 compared with group 1 was 2.4 (CI: 0.4-15.2, P = 0.344) after adjustment for age and sex. The incidence of more than 2 MACE in both STEMI and UA patients was higher in group 3 compared with the other two groups. Regression analysis showed that history of DM, high level of LDL cholesterol, high level of HbA1c, and anterior infarction were significant predictors of adverse events while other risk factors such as BMI, history of hypertension and smoking were of no significance. Conclusion This study indicates that the stress hyperglycemia on admission is a powerful predictor of increased major adverse events and hospital mortality in patients with acute coronary syndrome.

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P4624Predictive performance of CRUSADE bleeding score in non ST elevation acute coronary syndrome patients treated with ticagrelor versus clopidogrel

European Heart Journal ◽

10.1093/eurheartj/ehz745.1006 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

L Graca Santos ◽

F Montenegro Sa ◽

C Ruivo ◽

R Ribeiro Carvalho ◽

J Correia ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Predictive Performance ◽

Roc Curves ◽

National Registry ◽

Red Blood Cell Transfusion ◽

Coronary Syndrome ◽

St Elevation ◽

Group 2 ◽

Risk Categories ◽

Group 1

Abstract Introduction CRUSADE score is commonly used for bleeding risk stratification in the context of acute coronary syndrome (ACS). However, the study validating it was performed before ticagrelor was available. Purpose To compare the predictive performance of CRUSADE score in two groups of non-ST elevation ACS (NSTEACS) patients, one treated with ticagrelor and another with clopidogrel. Methods Retrospective study of 2077 NSTEACS patients admitted between January 2014 and September 2017 and included in a multicentre national registry. Group 1 was composed by patients medicated with ticagrelor, and Group 2 with clopidogrel. Patients with bleeding history were excluded. The primary endpoint (PE) results from a composite which includes: in-hospital major bleeding (MB) according to the Registry criteria, need for red blood cell transfusion (RBCT), or haemoglobin drop ≥2g/dL (HbD). The groups were compared according to their demographic, clinical and laboratory characteristics. The occurrence of the PE (and its components) across CRUSADE risk categories was assessed by Chi-square for linear trend. The performance of CRUSADE score for PE prediction in each cohort was assessed by Receiver Operator Characteristics (ROC) curves. Results Group 1 included 662 (31.9%) and Group 2 1415 (68.1%) patients. Mean CRUSADE score was higher in Group 2 (23.1±14.7 versus (vs) 26.7±16.3, p=0.001). No difference was observed regarding the PE (14.8% vs 17.0%, p=0.200) and its components. With the exception of MB in Group 1 (p-trend=0.425), the relative occurrence of the PE and its components increased across CRUSADE risk categories [Figure 1. panel A]. In-hospital mortality was numerically superior in Group 2, but did not reach statistical significance (1.1% vs 1.6%, p=0.368). In both groups, the performance of CRUSADE score in predicting the PE was modest (Group 1 AUC=0.59 and p=0.006, Group 2 AUC=0.62 and p<0.001), and no difference was observed when comparing the two groups (P value for ROC curves comparison = 0.899) [Figure 1. panel B and C respectively]. Figure 1 Conclusion In this study based on a national registry of NSTEACS patients, the use of ticagrelor did not influence the occurrence of bleeding related events and it did not change the predictive performance of the CRUSADE score. According to this analysis, CRUSADE score may be applied without limitation to NSTEACS patients managed with ticagrelor.

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P977 CT phenotype of high-risk atherosclerotic plaques causing an acute coronary syndrome compared to silent vulnerable plaques

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.607 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

R I Hodas ◽

D Opincariu ◽

N Rat ◽

I Rodean ◽

M Chitu ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

High Risk ◽

Morphological Characteristics ◽

Plaque Morphology ◽

Atherosclerotic Plaques ◽

Plaque Instability ◽

Coronary Syndrome ◽

Atheromatous Plaques ◽

Group 2 ◽

Group 1

Abstract Funding Acknowledgements PlaqueImage.- research grant no. 103544/2016, contract number 26/01.09.2016 - Background Previous studies demonstrated that plaque morphology has a crucial role in the development of an acute coronary syndrome (ACS). However, not all vulnerable coronary plaques produce an ACS and the prediction power of various vulnerability features to predict an acute coronary event in a close future, has not been elucidated so far. Objective We aimed to use multi-slice computed tomography angiography (CTA) for assessment of morphological characteristics of culprit lesions producing an ACS in the next several months after CT assessment, in comparison with morphological characteristics of unstable coronary atherosclerotic plaques which did not trigger an ACS. Material and methods We analyzed 40 patients in whom CTA revealed presence of unstable coronary lesions, exhibiting at least one marker of vulnerability: napkin ring sign (NRS), spotty calcium (SC), positive remodeling (PR) or presence of low attenuation plaque (LAP), divided in 2 groups: group 1 - 20 patients who developed an ACS in the next 6 months following CTA examination, and group 2 – 20 patients matched for age, gender and risk factors, who did not present any cardiovascular event 6 month after CTA assessment. Post-processing of multi-slice CTA images was performed in order to assess morphological characteristics and CT-derived markers of atherosclerotic plaque instability. Results Similar mean values of plaque length (17.1 +/- 5.9 mm vs 16.9 +/- 3.4 mm; p = 0.6) and total atheroma volume (188.1 +/- 104.7 mm3vs 186.4 +/- 90.7 mm3; p = 0.8) were obtained for both groups. The mean number of vulnerability markers was 1.6 in group 1 vs 1.2 in group 2 (p = 0.07). However, atherosclerotic lesions in patients from group 1 presented significantly higher values of lipid-rich atheroma (9.8 +/- 10.8 mm3vs 2.6 +/- 1.0 mm3; p = 0.01) and remodeling index (1.14 +/- 0.3 in group 1 vs 0.89 +/- 0.19 in group 2, p = 0.04). At the same time, atheromatous plaques in patients who developed an ACS during the 6-months follow-up showed in a significantly higher proportion LAP (45% in group vs 10% in group 2, p = 0.03) and PR (15%in group 1 versus 5% in group 2, p = 0.04), but not NRS (30% vs 25%, p = ns) or SC (65% vs 40%, p = 0.2). Conclusions Atherosclerotic plaques producing an ACS exhibit a different phenotype than unstable plaques that remain silent. The CTA profile of atheromatous plaques producing an ACS includes the presence of low attenuation, positive remodeling, higher RI and lipid-rich atheroma. Presence of these features in high-risk coronary plaques identifies very high risk patients, who can benefit from adapted therapeutic strategy in order to prevent the development of an ACS.

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Association of Haemoglobin and C-Reactive Protein level with Different Risk Factors among Acute Coronary Syndrome Patients

Journal of National Institute of Neurosciences Bangladesh ◽

10.3329/jninb.v5i2.43022 ◽

2019 ◽

Vol 5 (2) ◽

pp. 156-160

Author(s):

Md Mahboob Morshed ◽

Md Joynul Islam ◽

ATM Ashadullah ◽

Khondker Shaheed Hussain ◽

Mohammad Ahtashamul Haque

Keyword(s):

Risk Factors ◽

Acute Coronary Syndrome ◽

Reactive Protein ◽

Coronary Syndrome ◽

Group 4 ◽

History Of ◽

Study Population ◽

Group 3 ◽

Group 2 ◽

Group 1

Background: Different risk factors may be related with the haemoglobin and CRP level among the acute coronary syndrome patients. Objective: The purpose of the present study was to see the association of haemoglobin and CRP level with different type of risk factors among the acute coronary syndrome patients. Methodology: This cross-sectional study was conducted in the Department of Cardiology at Mymensingh Medical College, Mymensingh, Bangladesh from December 2010 to November 2011 for a period of two (02) years. Patients of ACS who were presented within 12 hours of chest pain were included as study population. Study population were categorized in four groups according to the level of hemoglobin and C-reactive protein. Age, cardiovascular risks factor, history, family history of cardiovascular disease, treatment history and ECG were taken during admission. Blood sample was collected for baseline laboratory investigations like Troponin-I, Random Blood Sugar (RBS), Blood urea, Serum creatinine, lipid profile, Hemoglobin & CRP level. Sample were then send to standard laboratory/Biochemistry department of MMCH. Result: The mean age of the population was 52.18±8.88 years. Smoking was the highest percentage in Group 1 which was 54(50.0%) cases (P=0.001). Hypertension was found most common in group 1 (47.6%), Group 2 (33.3%), Group 3 (10.7%) and Group 4 (8.3%). Smoking (p=0.001) and hypertension (p=0.016) was found statistically significant. Diabetes was found in Group 1 (37.7%), Group 2 (43.5%), Group 3 (11.6%) and Group 4 (7.2%). Group 1 (50%) and Group 2 (50%) patients were dyslipidaemic. Family history of IHD was present group-1 (36.8%), Group 2 (44.7%), Group 3 (73.2%) and Group 4 (53%). Among the smoker patient 65.6% cases had CRP level ˃12 mg/l; 39.8% cases had CRP level ˂12mg/L. Among the nonsmoker 34.4% cases had CRP level ˃12mg/l and 60.2% cases had CRP level ˂12mg/L. The finding was statistically significant. Conclusion: In conclusion haemoglobin and CRP level is associated with different type of risk factors among the acute coronary syndrome patients. Journal of National Institute of Neurosciences Bangladesh, 2019;5(2): 156-160

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Glycemic variability in type 2 diabetes mellitus and acute coronary syndrome: liraglutide compared with insulin glargine: a pilot study

Journal of International Medical Research ◽

10.1177/0300060520926063 ◽

2020 ◽

Vol 48 (6) ◽

pp. 030006052092606

Author(s):

Maria Isabel del Olmo-García ◽

David Hervás Marín ◽

Jana Caudet Esteban ◽

Antonio Ballesteros Martin-Portugués ◽

Alba Cerveró Rubio ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Acute Coronary Syndrome ◽

Hospital Setting ◽

Glycemic Variability ◽

Coronary Syndrome ◽

Group 2 ◽

Group 1

Objective To explore the glucagon-like peptide-1 analogue liraglutide in the hospital setting in patients with type 2 diabetes mellitus (T2DM) and acute coronary syndrome and to evaluate the safety and efficacy and its impact on hospitalization and short-term glycemic variability (GV). Methods A 12-week, open-label, prospective, randomized pilot clinical study with parallel groups that compared liraglutide (group 1) with glargine (group 2) and its impact on glycemic control and GV. Results Thirteen patients were included. During hospitalization, mean glucose was 164.75 mg/dL (standard deviation [SD] 19.94) in group 1 and 166.69 mg/dL (38.22) in group 2. GV determined by CV and SD was 20.98 (7.68) vs. 25.48 (7.19) and 34.37 (13.05) vs. 43.56 (19.53) in groups 1 and 2, respectively. Group 1 prandial insulin requirements during hospitalization were lower compared with group 2. Follow-up A1c in group 1 was 6.9% (−1.51%) and 6.5% in group 2 (−1.27). GV after discharge and hypoglycemia were lower in group 1 compared with group 2. Conclusions Liraglutide seems to reduce GV in the acute phase of acute coronary syndrome, and patients achieved optimal control with a low incidence of hypoglycemia. These results support the need to explore liraglutide in a larger multicenter trial. Trial registration: The study was approved by the National Medical Ethics Committee of Spain. The study was registered at European Clinical Trials Database (EudraCT): 2014003298-40.

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Prediction of major adverse cardiac events of patients with acute coronary syndrome by using TIMI risk index

Journal of Dhaka National Medical College & Hospital ◽

10.3329/jdnmch.v18i2.16024 ◽

2013 ◽

Vol 18 (2) ◽

pp. 52-57 ◽

Cited By ~ 1

Author(s):

Mohammad Abul Ehsan ◽

Md Manzoor Mahmood ◽

Laila Farzana Khan ◽

Md Abu Salim

Keyword(s):

Myocardial Infarction ◽

Acute Coronary Syndrome ◽

Risk Index ◽

Major Adverse Cardiac Events ◽

Cardiac Events ◽

Coronary Syndrome ◽

Adverse Cardiac Events ◽

St Elevation ◽

Group 1

Patient with acute coronary syndrome (ACS) has considerable variability in outcome and mortality risk. The Thrombolysis in Myocardial Infarction (TIMI) risk index (TRI) for unstable angina/non ST elevation myocardial infarction & ST elevation myocardial infarction were a convenient bedside clinical risk score for predicting 30 days mortality at presentation with ACS. This study was done to predict and validate major adverse cardiac events in patients of ACS thus it will help us to quantify risk, observe the prognostic value and to guide appropriate therapy by using TRI. This prospective study was carried out in the department of cardiology, BSMMU, Dhaka from April, 2011 to March, 2012. After considering all ethical issues, data were collected from 279 patients attending at cardiac emergency department with the presentation of ACS. History & physical examinations were done. TIMI risk index were calculated for each patient. The major adverse cardiac events (recurrent myocardial infarction, urgent revascularization, and all-cause mortality) were measured for next 30 days in hospital setting & outpatient department by follow up. After follow-up, Cox univariate and multivariate regression analysis were used to evaluate the influence of potential risk factors on duration of event-free survival, and likelihood ratio tests to assess the outcome. Major adverse events of TIMI risk index group 1, 2, 3, 4 & 5 were 0%, 0%, 3.7%, 12.9% & 19.2% respectively in UA/NSTEMI group. In STEMI group major adverse cardiac events of TIMI risk index group 1, 2, 3, 4 & 5 were 0%, 4.7%, 12.5%, 17.1% & 24.1% respectively. Increasing TRI were associated with increased risk of major adverse cardiac events. These score were a valid tool for risk assessment. DOI: http://dx.doi.org/10.3329/jdnmch.v18i2.16024 J. Dhaka National Med. Coll. Hos. 2012; 18 (02): 52-57

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Prognostic impact of severe anemia (hemoglobin <10g/dL) during treatment with dual antiplatelet therapy after hospital discharge for acute coronary syndrome

European Heart Journal ◽

10.1093/ehjci/ehaa946.1621 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

I Campos ◽

C Oliveira ◽

C Pires ◽

P Medeiros ◽

R Flores ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Multivariate Analysis ◽

Antiplatelet Therapy ◽

Cardiovascular Events ◽

Dual Antiplatelet Therapy ◽

Severe Anemia ◽

Coronary Syndrome ◽

Increased Risk ◽

Group 2 ◽

Group 1

Abstract Introduction In recent years, the use of invasive strategies has become the generalized approach in the management of patients with acute coronary syndrome (ACS), justified by the associated prognostic benefit due to reduced mortality and the evolution of percutaneous coronary intervention (PCI). However, the benefits of an invasive approach in ACS are unclear in the population with significant anemia, as anemia is strongly associated with increased risk of morbidity and mortality in these patients. Aim To determine the ischaemic vs. bleeding risks from patients with severe anemia (hemoglobin <10 g/dL) during treatment with Dual Antiplatelet Therapy (DAPT) after an ACS undergoing PCI. Methods From a national multicentre registry, we analyzed 17 370 ACS pts. Pts were divided into two groups: group 1 - pts with severe anemia (hemoglobin <10g/dL) (n=557, 3.2%); group 2 - pts without severe anemia (hemoglobin 10g/dL) (n=16813, 96.8%). Primary endpoint was the occurrence of a composite of death and adverse cardiovascular events (stroke, reinfarction, and rehospitalization of cardiovascular etiology) at 1 year. Results The sample consisted in 73.4% men and 26.6% women, with mean age of 66±14 years. The incidence of severe anemia was 3.2%. Group 1 pts were older (75±12 vs 66±14, p<0.001), had a higher proportion of women (47.6% vs 25.9%, p<0.001), diabetes (55% vs 30.6%, p<0.001), hypertension (81.8% vs 68.2%, p<0.001) and chronic kidney disease (29.2% vs 5.2%, p<0.001). During hospitalization, group 1 had more heart failure (35.3% vs 15.1%, p<0.001), worst LVEF (27.3% vs 17.3%, p<0,001), bleeding (7.6%% vs 1.3%, p<0.001) and transfusion (23.4% vs 1%, p<0.001). During hospitalization, group 2 pts were more likely to undergo revascularization (82.9% vs 89.4%, p<0.001) and double antiaggregation (82.5% vs 95%, p<0.001). A multivariate analysis identified age [OR 1.48, 95% CI 1.32 to 1.89; p<0.001] and feminine sex [OR 2.21, 95% CI 1.89 to 3.61; p<0.001] as independent predictors of severe anemia during hospitalization. Patients with severe anemia had longer hospital stay (9 days vs 6 days; p<0.001), and higher 6-month mortality (8.7% vs. 2.9%; p<0.001). In multivariate analysis and after adjusting for different baseline characteristics, pts with severe anemia had higher occurrence of a composite of death and adverse cardiovascular events at 1-year compared to those without severe anemia [OR 3.04, 95% CI 1.21 to 5.04; p=0.029]. Conclusion We objected a low prevalence of ACS patients with severe anemia undergoing PCI (52.2%) but the incidence of ICP in these complex patients has increased in recent years, mainly due to the evolution of PCI over the last 40 years. Severe anemia was strongly associated with increased risk of morbidity and mortality in ACS pts. Funding Acknowledgement Type of funding source: None

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THE USING OF POLYPRENOL-CONTAINING DRUG IN PATIENTS WITH ACUTE CORONARY SYNDROME

Siberian Medical Journal ◽

10.29001/2073-8552-2018-33-2-21-25 ◽

2018 ◽

Vol 33 (2) ◽

pp. 21-25

Author(s):

E. I. Tsoi ◽

E. V. Vyshlov ◽

V. B. Trusov

Keyword(s):

Acute Coronary Syndrome ◽

Standard Therapy ◽

Control Group ◽

Study Group ◽

Double Blind ◽

Coronary Syndrome ◽

Group 3 ◽

Group 2 ◽

The Right ◽

Group 1

The article shows the results of the study using drug Ropren in the patients with acute coronary syndrome. Ropren is a plant drug containing polyprenols — dolichol precursors which take part in dolichol phosphate pathway. The pathology in this pathway leads to disbalance and glycoprotein deficiency. This is the reason of large group of diseases. This study is randomized double blind placebo controlled (No. NCT03122340 at ClinicalTrials.gov). Patients (n=68) with ACS taking standard therapy including atorvastatin 40 mg/day were randomized into to 2 groups: group 1 (n=34) took Ropren 8 drops 3 times per day for 3 week, then 5 drops 3 times per day for 5 weeks; group 2 (n=34) took placebo in the same dose regimen. After two — month therapy there was a positive dynamic (decreasing) in the level of interleukin-6 in the study group whereas in the control group there was no statistically significant change: 4.36 (2.61, 8.95) and 5.5 (3.3; 8.4) pg/ml, respectively (p<0.05). In the group of patients taking Ropren the reduction or cessation of statin was required significantly less than in the placebo group: 3 (8.8%) vs 9 (26.5%), respectively. One patient from the first group had a side effect in the form of gravity in the right hypochondrium. That is why the administration of Ropren in addition to standard therapy is reasonable in patients with ACS.

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Age related differences in acute coronary syndrome: An observation at a central hospital in Vietnam

Journal of Translational Internal Medicine ◽

10.2478/jtim-2021-0012 ◽

2021 ◽

Vol 9 (1) ◽

pp. 32-37

Author(s):

Dinh The Anh ◽

Huynh Van Minh ◽

Ho Anh Binh ◽

Tran Quang Bao ◽

Nguyen Thi Thai Hai ◽

...

Keyword(s):

Risk Factors ◽

Acute Coronary Syndrome ◽

Systolic Pressure ◽

Young Patients ◽

Mortality Prediction ◽

Central Hospital ◽

Coronary Syndrome ◽

Coronary Lesions ◽

Group 2 ◽

Group 1

Abstract Background and Objectives There is little data regarding the characteristics of young Vietnamese patients (<40 years old) who get acute coronary syndrome (ACS). This study aimed to compare the risk factors, clinical-subclinical characteristics, coronary lesions, and mortality prediction (based on the GRACE and TIMI scores) of young ACS patients with their older counterparts. Methods A cross-sectional descriptive study was conducted amongst 69 patients with ACS at the Cardiovascular Center of Hue Central Hospital from May 2017 to December 2018. These patients were divided into two groups: 33 patients were < 40 years old (group 1), and 36 patients were ≥ 40 years old (group 2). Demographic data, risk factors profile, clinical-subclinical characteristics, coronary lesions, and mortality prediction were compared between the two groups. Results Compared with group 2, group 1 had a higher proportion of severe angina (the prevalence of angina graded III-IV by CCS classification was 69.7% in group 1 versus 36.1% in group 2, P = 0.0108) and lower systolic pressure (median was 120 mmHg in group 1 versus 135 mmHg in group 2, P = 0.006). The prevalence of unstable angina and STEMI was higher in group 1 (51.5% and 36.4% in group 1 versus 30.6% and 11.1% in group 2, respectively), while NSTEMI was higher in group 2 (58.3% in group 2 versus 12.1% in group 1, P = 0.0002). The prevalence of single-vessel CAD, normal coronary angiography (CAG), nonobstructive CAD in group 1 was also higher and multi-vessel CAD was lower than group 2 (45.5%, 33.3%, 12.1% and 9.1% in group 1 versus 33.3%, 2.8%, 2.8% and 61.2% in group 2, respectively). The Gensini, GRACE, and TIMI scores were lower in group 1 (median was 5; medium was 78.55 and median was 2 in group 1 versus 37.5, 130.22 and 3 in group 2, respectively). Smoking was a risk factor for obstructive CAD in group 1 (OR = 7.12, 95% CI: 1.25–40.63, P < 0.05). Conclusion Young patients with ACS tended to be males, smokers, and with positive familial history; the grade of angina was more severe, and systolic pressure was lower; the prevalence of unstable angina and STEMI was higher. Smoking was a risk factor for obstructive CAD in young patients.

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