scholarly journals Estimation of metformin and other sugar reducing therapy influence on the outcomes in patients with acute coronary syndrome and diabetes mellitus type II

2021 ◽  
Vol 10 (4) ◽  
pp. 39-47
Author(s):  
K. Yu. Nikolaev ◽  
K. I. Bondareva ◽  
A. Ya. Kovaleva ◽  
G. I. Lifshits
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Cardiovascular Events ◽  
Diabetes Type 2 ◽  
Diabetes Type ◽  
Coronary Syndrome ◽  
Estimated Risk ◽  
Long Term Prognosis

Aim. To study the influence of hypoglycemic therapy on hospital and long-term prognosis in patients with acute coronary syndrome (ACS) and diabetes type 2.Methods. The study included 63 patients with ACS and type 2 diabetes. All patients had a clinical examination, assessment of mortality risk and myocardial infarction on GRACE scale (Global Registry of Acute Coronary Events) and TIMI (Thrombolisis In Myocardial Infarction) in-hospital and six months after hospitalization.Results. Metformin is associated with a lower estimated risk of in-hospital mortality and within 6 months after discharge in patients with acute coronary syndrome on the background of type 2 diabetes and with less risk of adverse cardiovascular events within 14 days of their occurrence in patients with unstable angina pectoris on the background of diabetes. High daily doses of metformin have also been associated with a decrease in the estimated risk of in-hospital mortality and within 6 months after discharge in patients with ACS associated with diabetes. The inverse association between the daily dosage of metformin and the presence of angina pectoris in patients with ACS and diabetes type 2 indicates a protective effect of metformin high daily dosages in relation to the risk of complications within six months after the discharge from hospital.Conclusion. One of the important aspects of ACS treatment, along with effective therapy, is the impact on concomitant risk factors, including blood glucose control. The main groups of hypoglycemic drugs have currently been identified; their effect on cardiovascular events, long-term effects and long-term prognosis are being investigated.

scholarly journals The importance of three-stage cardiac rehabilitation in patients with acute coronary syndrome and type 2 diabetes mellitus

2020 ◽  
pp. 12-18
Author(s):  
E. A. Nikitina ◽  
E. N. Chicherina ◽  
O. S. Elsukova ◽  
I. S. Metelev
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Acute Coronary Syndrome ◽  
Myocardial Revascularization ◽  
Diabetic Patients ◽  
Coronary Syndrome ◽  
Long Term Prognosis

Introduction. Acute coronary syndrome (ACS) patients with type 2 diabetes mellitus (T2DM) have worse prognosis than those without diabetes. Risk of adverse outcome in this cohort remains high despite the introduction of new methods of invasive treatment of ACS. The use of all-inclusive cardiac rehabilitation (CR) programs allows improving prognosis in patients with ACS and T2DM. Aim. The aim of the study was to evaluate impact of two- or three-stage CR on long-term prognosis in patients with ACS and T2DM. Methods. The study included 251 ACS patients hospitalized in the department of cardiology, of which 120 patients with T2DM. Management of ACS was carried out in accordance with the clinical recommendations of the European Society of Cardiology (2015, 2017). All patients underwent standard laboratory and instrumental examination. We analyzed prognostic parameters (myocardial revascularization, myocardial infarction and mortality) during 12 months of follow-up in diabetic and non-diabetic patients with ACS who underwent two or a three-stage CR. Additionally, the achievement of the combined endpoint, which include at least one of the ACE, was analyzed. Results. Long-term prognosis in ACS patients who underwent three-stage CR in diabetic and non-diabetic groups did not differ significantly. However, the frequency of repeated myocardial revascularization was higher in patients with T2DM in comparison with non-diabetic patients inside the two-stage CR subgroup. Conclusion. Three-stage CR should be recommended in diabetic patients with ACS to improve long-term prognosis.

scholarly journals Prediction of the long-term risk of adverse cardiovascular events after an episode of acute coronary syndrome in patients with type 2 diabetes

2020 ◽  
Vol 19 (3) ◽  
pp. 2357
Author(s):  
E. A. Nikitina ◽  
I. S. Meletev ◽  
O. V. Soloviev ◽  
E. N. Chicherina
Keyword(s):  
Type 2 Diabetes ◽  
Acute Coronary Syndrome ◽  
Logit Model ◽  
Diagnostic Tests ◽  
Cardiovascular Events ◽  
Surgical Revascularization ◽  
Factors Associated ◽  
Coronary Syndrome

Aim. To determine independent predictors of adverse cardiovascular events (ACE) and to develop a long-term (12 months) prognostic model after an episode of acute coronary syndrome (ACS) in patients with type 2 diabetes (T2D).Material and methods. The study included 120 T2D patients hospitalized due to ACS in the period from January 2016 to February 2017. All patients underwent standard diagnostic tests. Twelve months after ACS, the incidence of ACE in T2D patients was assessed: cardiovascular mortality, myocardial infarction, emergency surgical revascularization. Additionally, we analyzed composite endpoint (CEP), including all of the adverse outcomes listed. Patients were divided into 2 groups: group 1 (n=34) — patients with ACE; group 2 (n=86) — patients without ACE. Factors associated with the CEP were then included in the logistic regression to determine independent predictors of ACE. In order to predict the development of CEP in patients with ACS and T2D, a logit model was created. To process the model, a ROC analysis was performed.Results. Independent factors associated with ACE for 12 months in T2D patients after an ACS were established: MI of moderate severity (D.M. Aronov classification); hypertriglyceridemia; decreased heart rate variability (SDNN <0 ms); segments with significant coronary stenosis in the amount of ≥3; no surgical revascularization during acute MI. Based on independent factors, a logit model was developed for assessing 12-month risk of ACE in T2D patients after an ACS.Conclusion. The developed risk prediction model for T2D patients after ACS, based on accessible diagnostic tests, allows to determine the probability of ACE within 12 months.

THE ROLE OF THE SUPEROXIDE DISMUTASE FOR PREDICTING LONG-TERM ADVERSE EVENTS IN PATIENTS WITH ACUTE CORONARY SYNDROME

2019 ◽  
Vol 64 (8) ◽  
pp. 463-468
Author(s):  
Svetlana A. Berns ◽  
Evgeniya A. Schmidt ◽  
Olga A. Nagirnyak ◽  
Anastasiya V. Osokina ◽  
Alla V. Klimenkova ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Superoxide Dismutase ◽  
Acute Coronary Syndrome ◽  
Adverse Events ◽  
Blood Concentration ◽  
Cardiovascular Events ◽  
Left Ventricular Ejection ◽  
Coronary Syndrome

To study the relationship between the blood concentration of superoxide dismutase in at the end of the hospital period of acute coronary syndrome without ST-segment elevation (nonST-ACS) and the development of adverse events in the long-term follow-up period. 415 patients with nonST-ACS are included in the local register study. The follow-up period was 60 months. The blood concentration of superoxide dismutase (SOD) determined in 200 patients on the 10-13th day of hospitalization in addition to clinical procedures. Within five years after discharge in 178 (47 %) patients reported the development of adverse events. Patients with poor outcome were older, had a history of myocardial infarction (PICS), stenoses of extracranial arteries more than 30% and decreased left ventricular ejection fraction (LVEF). There were significant differences in the concentration of SOD10-13 day, which was lower in the patients with development of adverse cardiovascular events (p = 0.0003). Multivariate analysis identified the factors that are most strongly associated with the development of the adverse events during a 5-year follow-up period in patients with nonST-ACS: SOD blood concentration ≤ 175,4 ng / ml (OR-3,85; р=0,0008), myocardial infarction in anamnesis (OR-3,26; р=0,006), LVEF ≤ 52% (OR-2,8; р=0,035). The incidence of adverse cardiovascular events during five years follow-up in patients with nonST-ACS was 47 % of cases. Adverse factors associated with the development of an unfavorable outcome in the long-term period follow are: SOD blood concentration ≤ 175,4 ng / ml, myocardial infarction in anamnesis, LVEF ≤ 52%.

5-year outcomes in patients with acute coronary syndrome treated with biodegradable polymer sirolimus-eluting stents versus durable polymer everolimus-eluting stents

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.F Iglesias ◽  
D Heg ◽  
M Roffi ◽  
D Tueller ◽  
O Muller ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Cardiac Death ◽  
Target Lesion ◽  
Funding Source ◽  
Target Vessel ◽  
Coronary Syndrome ◽  
Durable Polymer ◽  
Stable Cad

Abstract Background Newest generation drug-eluting stents (DES) combining ultrathin cobalt chromium platforms with biodegradable polymers may reduce target lesion failure (TLF) as compared to second generation DES among patients with acute coronary syndrome (ACS). While previous studies indicated a potential benefit within the first two years after percutaneous coronary intervention (PCI), it remains uncertain whether the clinical benefit persists after complete degradation of the polymer coating. Purpose To compare the long-term effects of ultrathin-strut biodegradable polymer sirolimus-eluting stents (BP-SES) versus thin-strut durable polymer everolimus-eluting stents (DP-EES) for PCI in patients with ACS. Methods We performed a subgroup analysis of ACS patients included into the BIOSCIENCE trial (NCT01443104), a randomized trial comparing BP-SES with DP-EES. The primary endpoint of the present post-hoc analysis was TLF, a composite of cardiac death, target vessel myocardial infarction (MI) and clinically indicated target lesion revascularization (TLR), at 5 years. Results Among 2,119 patients enrolled between March 2012 and May 2013, 1,131 (53%) presented with ACS (ST-segment elevation myocardial infarction, 36%). Compared to patients with stable CAD, ACS patients were younger, had a lower baseline cardiac risk profile, including a lower prevalence of hypertension, hypercholesterolaemia, diabetes mellitus, and peripheral artery disease, and had a greater incidence of previous revascularization procedures. At 5 years, TLF occurred similarly in 89 patients (cumulative incidence, 16.9%) treated with BP-SES and 85 patients (16.0%) treated with DP-EES (RR 1.04; 95% CI 0.78–1.41; p=0.78) in patients with ACS, and in 109 patients (24.1%) treated with BP-SES and 104 patients (21.8%) treated with DP-EES (RR 1.11; 95% CI 0.85–1.45; p=0.46) in stable CAD patients (p for interaction=0.77) (Figure 1, Panel A). Cumulative incidences of cardiac death (8% vs. 7%; p=0.66), target vessel MI (5.2% vs. 5.8%; p=0.66), clinically indicated TLR (8.9% vs. 8.3%; p=0.63) (Figure 1, Panel B-D), and definite thrombosis (1.4% vs. 1.0%; p=0.57) at 5 years were similar among ACS patients treated with ultrathin-strut BP-SES or thin-strut DP-EES. Overall, there was no interaction between clinical presentation and treatment effect of BP-SES versus DP-EES. Conclusion In a subgroup analysis of the BIOSCIENCE trial, we found no difference in long-term clinical outcomes between ACS patients treated with ultrathin-strut BP-SES or thin-strut DP-EES at five years. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Unrestricted research grant to the institution from Biotronik AG, Switzerland

scholarly journals Comparison of Short- and Long-Term Prognosis between ST-Elevation and Non-ST-Elevation Myocardial Infarction

2021 ◽  
Vol 10 (2) ◽  
pp. 180
Author(s):  
Frédéric Bouisset ◽  
Jean-Bernard Ruidavets ◽  
Jean Dallongeville ◽  
Marie Moitry ◽  
Michele Montaye ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Mortality Rate ◽  
Confounding Factors ◽  
Coronary Syndrome ◽  
Short And Long Term ◽  
St Elevation ◽  
Probability Of Death ◽  
Long Term Prognosis

Background: Available data comparing long-term prognosis according to the type of acute coronary syndrome (ACS) are scarce, contradictory, and outdated. Our aim was to compare short- and long-term mortality in ST-elevated (STEMI) and non-ST-elevated myocardial infarction (non-STEMI) ACS patients. Methods: Patients presenting with an inaugural ACS during the year 2006 and living in one of the three areas in France covered by the Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) registry were included. Results: A total of 1822 patients with a first ACS—1121 (61.5%) STEMI and 701 (38.5%) non-STEMI—were included in the study. At the 28-day follow-up, the mortality rates were 6.7% and 4.7% (p = 0.09) for STEMI and non-STEMI patients, respectively, and after adjustment of potential confounding factors, the 28-day probability of death was significantly lower for non-STEMI ACS patients (Odds Ratio = 0.58 (0.36–0.94), p = 0.03). At the 10-year follow-up, the death rates were 19.6% and 22.8% (p = 0.11) for STEMI and non-STEMI patients, respectively, and after adjustment of potential confounding factors, the 10-year probability of death did not significantly differ between non-STEMI and STEMI events (OR = 1.07 (0.83–1.38), p = 0.59). Over the first year, the mortality rate was 7.2%; it then decreased and stabilized at 1.7% per year between the 2nd and 10th year following ACS. Conclusion: STEMI patients have a worse vital prognosis than non-STEMI patients within 28 days following ACS. However, at the 10-year follow-up, STEMI and non-STEMI patients have a similar vital prognosis. From the 2nd year onwards following the occurrence of a first ACS, the patients become stable coronary artery disease patients with an annual mortality rate in the 2% range, regardless of the type of ACS they initially present with.

scholarly journals Benefit and Harm of Extended Dual Antiplatelet Therapy After PCI in high-risk TWILIGHT-like patients with acute coronary syndrome

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
HY Wang ◽  
R Zhang ◽  
ZX Cai ◽  
KF Dou
Keyword(s):  
Acute Coronary Syndrome ◽  
High Risk ◽  
Antiplatelet Therapy ◽  
Cardiovascular Death ◽  
Secondary Outcome ◽  
Short Term ◽  
Bleeding Events ◽  
Coronary Syndrome

Abstract Funding Acknowledgements Type of funding sources: None. Background Recent emphasis on reduced duration and/or intensity of antiplatelet therapy following PCI irrespective of indication for PCI may fail to account for the substantial risk of subsequent nontarget lesion events in acute coronary syndrome (ACS) patients. This study sought to investigate the benefits and risks of extended-term (&gt;12-month) DAPT as compared with short-term DAPT in high-risk "TWILIGHT-like" ACS patients undergoing PCI. Methods All consecutive patients fulfilling the "TWILIGHT-like" criteria undergoing PCI from January 2013 to December 2013 were identified from the prospective Fuwai PCI Registry. High-risk "TWILIGHT-like" patients were defined by at least 1 clinical and 1 angiographic feature based on TWILIGHT trial selection criteria. The present analysis evaluated 4,875 high-risk "TWILIGHT-like" patients with ACS who were event-free at 12 months after PCI. The primary outcome was the composite of all-cause death, myocardial infarction (MI), or stroke at 30 months while BARC type 2, 3, or 5 bleeding was key secondary outcome. Results Extended DAPT compared with shorter DAPT reduced the composite outcome of all-cause death, MI, or stroke by 63% (1.5% vs. 3.8%; HRadj: 0.374, 95% CI: 0.256 to 0.548; HRmatched: 0.361, 95% CI: 0.221-0.590). The HR for cardiovascular death was 0.049 (0.007 to 0.362) and that for MI 0.45 (0.153 to 1.320) and definite/probable stent thrombosis 0.296 (0.080-1.095) in propensity-matched analyses. Rates of BARC type 2, 3, or 5 bleeding (0.9% vs. 1.3%; HRadj: 0.668 [0.379 to 1.178]; HRmatched: 0.721 [0.369-1.410]) did not differ significantly in patients treated with DAPT &gt; 12-month or DAPT ≤ 12-month. The effect of long-term DAPT on primary and key secondary outcome across the proportion of ACS patients with 1-3, 4-5, or 6-9 risk factors showed a consistent manner (Pinteraction &gt; 0.05). Conclusion Among high-risk "TWILIGHT-like" patients with ACS after PCI, long-term DAPT reduced ischemic events without increasing clinically meaningful bleeding events as compared with short-term DAPT, suggesting that extended DAPT might be considered in the treatment of ACS patients who present with a particularly higher risk for thrombotic complications. Abstract Figure.

scholarly journals Relation of Functional Activity of Platelets to Prognosis of Unfavorable Cardiovascular Events in Patients with Acute Coronary Syndrome. Results of a Registry Study

Kardiologiia ◽  
2019 ◽  
Vol 59 (10) ◽  
pp. 5-13
Author(s):  
N. V. Lomakin ◽  
L. I. Buryachkovskaya ◽  
A. B. Sumarokov ◽  
Z. A. Gabbasov ◽  
A. N. Gerasimov
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Coronary Syndrome ◽  
Platelet Aggregation ◽  
Kidney Disease ◽  
Functional Activity ◽  
Cardiovascular Events ◽  
Platelet Reactivity ◽  
Coronary Syndrome ◽  
C Statistic

Aim: to assess relation ofhigh functional activity ofplatelets to prognosis ofunfavorable cardiovascular events in patients with Acute Coronary Syndrome (ACS).Materials. The study was based on the data of a single center ACS registry conducted in the Central Clinical Hospital of the Presidential Affairs Department of Russian Federation. Of 529 included patients in 425 without contraindications to double antiplatelet therapy we carried out analysis of dependence of 30 days level of unfavorable events on parameters of functional activity of platelets.Results. High on-treatment platelet reactivity (HTPR) was found to be associated with 3.5 increase of mortality in the group of patients with high cardiovascular risk. Logistic model of prognosis of unfavorable events based on multifactorial analysis of data from patients with measured platelet aggregation included chronic kidney disease, type of myocardial infarction, and degree ofplatelet aggregation >45%. C -statistic was equal to 0.77. We also present in this paper discussion of problems related to studying approaches to individualization of anti-aggregation therapy in real clinical practice and problems of organization ofsimilar studies.Conclusion. The study showed that patients with ACS increased platelet aggregation, as well as chronic kidney disease and type 2 MI are associated with a 30 day prognosis of adverse events.

On-ticagrelor platelet reactivity and clinical outcome in patients undergoing percutaneous coronary intervention for acute coronary syndrome

2020 ◽  
Author(s):  
marc laine ◽  
Vassili PANAGIDES ◽  
Corinne Frère ◽  
thomas cuisset ◽  
Caroline Gouarne ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Clinical Outcome ◽  
Platelet Reactivity ◽  
Coronary Intervention ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
The Relationship

Background: A strong association between on-thienopyridines platelet reactivity (PR) and the risk of both thrombotic and bleeding events in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) has been demonstrated. However, no study has analyzed the relationship between on-ticagrelor PR and clinical outcome in this clinical setting. Objectives: We aimed to investigate the relationship between on-ticagrelor PR, assessed by the vasodilator-stimulated phosphoprotein (VASP) index, and clinical outcome in patients with ACS undergoing PCI. Methods: We performed a prospective, multicenter, observational study of patients undergoing PCI for ACS. PR was measured using the VASP index following ticagrelor loading dose. The primary study endpoint was the rate of Bleeding Academic Research Consortium (BARC) type ≥2 at 1 year. The key secondary endpoint was the rate of major cardiovascular events (MACE) defined as the composite of cardiovascular death, myocardial infarction and urgent revascularization. Results: We included 570 ACS patients, among whom 33.9% had ST-elevation myocardial infarction. BARC type ≥ 2 bleeding occurred in 10.9% and MACE in 13.8%. PR was not associated with BARC ≥ 2 or with MACE (p=0.12 and p=0.56, respectively). No relationship between PR and outcomes was observed, neither when PR was analyzed quantitatively nor qualitatively (low on-treatment PR (LTPR) vs no LTPR). Conclusion: On-ticagrelor PR measured by the VASP was not associated with bleeding or thrombotic events in ACS patients undergoing PCI. PR measured by the VASP should not be used as a surrogate endpoint in studies on ticagrelor.

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