scholarly journals CURRENT APPROACHES FOR THE DIAGNOSIS,RISK STRATIFICATION AND INTERVENTIONAL TREATMENT OF PATIENTS WITH ACUTE CORONARY SYNDROMES WITHOUT ST-SEGMENT ELEVATION

2015 ◽  
Vol 6 (3) ◽  
pp. 59-84 ◽  
Author(s):  
A V Ardashev ◽  
A V Staferov ◽  
A V Konev ◽  
N S Afonina ◽  
N I Negrun ◽  
...  
Keyword(s):  
Myocardial Revascularization ◽  
Individual Risk ◽  
Interventional Treatment ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Choice Of Treatment ◽  
Coronary Syndromes ◽  
Technical Features ◽  
The Individual

This article reviews current approaches to diagnosis and determination of the individual risk of patients with acute coronary syndrome without ST-segment elevation. Guidelines for determining the choice of treatment strategy and the time slots for its implementation are discussed. We describe the technical features of the implementation of interventional treatment in this group of patients; the choice of methods of myocardial revascularization is discussed.

scholarly journals Current approaches for the diagnosis, risk stratification and interventional treatment of patients with acute coronary syndromes without st-segment elevation

2015 ◽  
Vol 6 (4) ◽  
pp. 59-84
Author(s):  
Andrey V. Ardashev ◽  
Anton V. Staferov ◽  
Alexey V. Konev ◽  
Natalia S. Afonina ◽  
Natalia I. Negrun ◽  
...  
Keyword(s):  
Myocardial Revascularization ◽  
Individual Risk ◽  
Interventional Treatment ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Choice Of Treatment ◽  
Coronary Syndromes ◽  
Technical Features ◽  
The Individual

This article reviews current approaches to diagnosis and determination of the individual risk of patients with acute coronary syndrome without ST-segment elevation. Guidelines for determining the choice of treatment strategy and the time slots for its implementation are discussed. We describe the technical features of the implementation of interventional treatment in this group of patients; the choice of methods of myocardial revascularization is discussed.

03 The prehospital 12 lead electrocardiogram is associated with improved outcomes in patients with acute coronary syndromes presenting to emergency medical services: a nationwide linked cohort study

2021 ◽  
Vol 38 (9) ◽  
pp. A2.1-A2
Author(s):  
Tom Quinn ◽  
Timothy Driscoll ◽  
Lucia Gavalova ◽  
Mary Halter ◽  
Chris P Gale ◽  
...  
Keyword(s):  
Cohort Study ◽  
Emergency Medical Services ◽  
Population Based ◽  
Medical Services ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Emergency Medical ◽  
St Segment ◽  
Coronary Syndromes ◽  
Audit Project

BackgroundUse of the Pre-Hospital 12-lead Electrocardiogram (PHECG) is recommended in patients presenting to emergency medical services (EMS) with suspected acute coronary syndrome (ACS).ObjectivesTo investigate differences in mortality between those who did/did not receive PHECG.MethodsPopulation-based, linked cohort study using Myocardial Ischaemia National Audit Project (MINAP) data from 2010-2017.ResultsOf 330,713 patients, 263,420 (79.6%) had PHECG, 67,293 (20.3%) did not. 30-day mortality was 7.8% overall, 7.1% with PHECG vs 10.9% without PHECG (adjusted Odds Ratio [aOR] 0.772, 95% confidence interval [CI] 0.748-0.795, p<0.001). 1 year mortality was 16.1% overall, 14.2% with PHECG vs 23.2% without (aOR 0.692, 95% CI 0.676-0.708, p<0.001). 144,254 patients had ST segment elevation myocardial infarction (STEMI); 130,240 (90.2%) had PHECG, 30 day mortality 8.8% overall, 8.0% with PHECG vs 15.9% without (aOR 0.588, 95% CI 0.557-0.622, p<0.001), 1 year mortality 13.1% overall, 12.1% with PHECG vs 22.8% without (aOR 0.585, 95% CI 0.557-0.614, p<0.001). 186,459 patients had non-STEMI; 133,180 (71.4%) had PHECG. 30-day mortality 7.1% overall, 6.1% with PHECG vs 9.6% without (aOR 0.677, 95%CI 0.652-0.704, p<0.001), 1 year mortality 18.3% overall, 16.3% with PHECG vs 23.3% without (aOR 0.694, 95% CI 0.676-0.713, p<0.001). 110,571 STEMI patients received primary PCI, 103,741 (93.8%) had PHECG. 30 day mortality 5.4% overall, 5.3% with PHECG vs 7.0% without (aOR 0.739, 95% CI 0.667-0.829, p<0.001). 1 year mortality 8.5% overall, 8.4% with PHECG vs 9.8% without (aOR 0.833, 95% CI 0.762-0.911, p<0.001). 26,127 (18.1%) STEMI patients received no reperfusion; 19,873 (76%) had PHECG. Mortality at 30 days 22.1% overall, 21.3% with PHECG vs 24.7% without (aOR 0.911, 95% CI 0.847-0.980, p=0.013), 1 year mortality 32.2% overall, 30.9% with PHECG, 36.4% without (aOR 0.865, 95% CI 0.810-0.925, p<0.001).ConclusionPHECG was associated with lower mortality at 30 days and 1 year in both STEMI and non-STEMI patients.

Non–ST-Segment Elevation Acute Coronary Syndrome

2011 ◽  
Vol 22 (2) ◽  
pp. 113-124
Author(s):  
Susan D. Housholder-Hughes
Keyword(s):  
Critical Role ◽  
Long Term Outcomes ◽  
Recommended Care ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Coronary Syndromes ◽  
Pharmacologic Management ◽  
Short And Long Term

Of the nearly 1.4 million hospitalizations for acute coronary syndromes in 2006, approximately two-thirds were for unstable angina (UA) or non–ST-segment elevation myocardial infarction (NSTEMI). Given the high risk for in-hospital ischemic events and late mortality in patients with UA/NSTEMI, it is critical to accurately and rapidly diagnose these patients, stratify their level of risk, and provide appropriate pharmacologic and nonpharmacologic treatment that maximizes anti-ischemic benefit and minimizes risk of bleeding. Appropriate in-hospital care following intervention is critical for optimizing both short- and long-term outcomes. However, evidence suggests that up to 26% of opportunities to provide guidelines-recommended care are missed. Nurses can play a critical role in ensuring that patients receive guidelines-based care. This review examines the most recent recommendations for the diagnosis and pharmacologic management of patients with UA/NSTEMI and discusses ways in which nursing staff can contribute to minimizing patient risk and optimizing patient benefit.

scholarly journals Heart rate at admission is a predictor of in-hospital mortality in patients with acute coronary syndromes: Results from 58 European hospitals: The European Hospital Benchmarking by Outcomes in acute coronary syndrome Processes study

2016 ◽  
Vol 7 (2) ◽  
pp. 149-157 ◽  
Author(s):  
Magnus T Jensen ◽  
Marta Pereira ◽  
Carla Araujo ◽  
Anti Malmivaara ◽  
Jean Ferrieres ◽  
...  
Keyword(s):  
Heart Rate ◽  
Acute Coronary Syndrome ◽  
Hospital Mortality ◽  
Beta Blockers ◽  
Heart Rates ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Coronary Syndromes ◽  
The Relationship

Aims: The purpose of this study was to investigate the relationship between heart rate at admission and in-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Methods: Consecutive ACS patients admitted in 2008–2010 across 58 hospitals in six participant countries of the European Hospital Benchmarking by Outcomes in ACS Processes (EURHOBOP) project (Finland, France, Germany, Greece, Portugal and Spain). Cardiogenic shock patients were excluded. Associations between heart rate at admission in categories of 10 beats per min (bpm) and in-hospital mortality were estimated by logistic regression in crude models and adjusting for age, sex, obesity, smoking, hypertension, diabetes, known heart failure, renal failure, previous stroke and ischaemic heart disease. In total 10,374 patients were included. Results: In both STEMI and NSTE-ACS patients, a U-shaped relationship between admission heart rate and in-hospital mortality was found. The lowest risk was observed for heart rates between 70–79 bpm in STEMI and 60–69 bpm in NSTE-ACS; risk of mortality progressively increased with lower or higher heart rates. In multivariable models, the relationship persisted but was significant only for heart rates >80 bpm. A similar relationship was present in both patients with or without diabetes, above or below age 75 years, and irrespective of the presence of atrial fibrillation or use of beta-blockers. Conclusion: Heart rate at admission is significantly associated with in-hospital mortality in patients with both STEMI and NSTE-ACS. ACS patients with admission heart rate above 80 bpm are at highest risk of in-hospital mortality.

Prinzmetal Angina in Major Hemophilia a Patient: A Case Report

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4711-4711
Author(s):  
Mahutondji Romaric Massi ◽  
Bienvenu Houssou ◽  
Marième Camara ◽  
Khoubila Nisserine ◽  
Asmaa AQ Quessar ◽  
...  
Keyword(s):  
Acetylsalicylic Acid ◽  
Troponin I ◽  
Hemophilia A ◽  
Conflicts Of Interest ◽  
Bleeding Risk ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Coronary Syndromes ◽  
Chronic Smoking

Abstract Introduction: Prinzmetal anginais a special type ofacute coronary syndrome ST+ wich correspond to a transient occlusion of a coronary vessel secondary to spasm. This type of acute coronary syndrome is very rare and is characterized by the presence of signs of myocardial ischemia on electrocardiogram but coronary angiography and coroscaner are frequently normals. Its management in hemophilia patients is difficult because of the use of anticoagulant and antiplatelet drugs wich increase bleeding risk. We report the case of a major hemophilia A patient which presented Prinzmetal angina. Observation: It is a 64 years old patient, hemophilia A major, chronic smoking (40 pack-year), not diabetic, not hypertensive, which had a retro sternal constrictive pain radiating to the shoulders. At admission he was consciousness. No breath in cardiac auscultation. The electrocardiography showed a heart rate at 61bpm, the axis of the heart was normal. ST-segment elevation was noticed in DIII and AVF: ischemia in the cardiac lower area. Echocardiography was normal. The coroscaner was normal. The troponin I level was at 0.03 µg/L (Normal: 0-0.1µg/L). This patient had a variant Prinzmetal angina. Treatement: Diltiazem Hydrochloride 60 mg 1 tablet / 8 hours. Acetylsalicylic acid 160 mg IV and Clopidogrel 300 mg IV the first day; relay with acetylsalicylic acid 100 mg and clopidogrel 75 mg per day. Transfusion of factor VIII at the dose of 40UI / Kg. Simvastatin 20 mg 1 tablet per day. Perindopril 5 mg 1 tablet the day. The evolution was favorable. Discussion and conclusion: Coronary syndromes are not frequent in morocco hemophilia patients. Their management is complex and involves the presence of an hematologist. Disclosures No relevant conflicts of interest to declare.

scholarly journals Long-term risk of death and recurrent cardiovascular events following acute coronary syndromes

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254008
Author(s):  
Pishoy Gouda ◽  
Anamaria Savu ◽  
Kevin R. Bainey ◽  
Padma Kaul ◽  
Robert C. Welsh
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Coronary Syndromes ◽  
Cardiovascular Events ◽  
Residual Risk ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Coronary Syndromes

Estimates of the risk of recurrent cardiovascular events (residual risk) among patients with acute coronary syndromes have largely been based on clinical trial populations. Our objective was to estimate the residual risk associated with common comorbidities in a large, unselected, population-based cohort of acute coronary syndrome patients. 31,056 ACS patients (49.5%—non-ST segment elevation myocardial infarction [NSTEMI], 34.0%—ST segment elevation myocardial infarction [STEMI] and 16.5%—unstable angina [UA]) hospitalised in Alberta between April 2010 and March 2016 were included. The primary composite outcome was major adverse cardiovascular events (MACE) including: death, stroke or recurrent myocardial infarction. The secondary outcome was death from any cause. Cox-proportional hazard models were used to identify the impact of ACS type and commonly observed comorbidities (heart failure, hypertension, peripheral vascular disease, renal disease, cerebrovascular disease and diabetes). At 3.0 +/- 3.7 years, rates of MACE were highest in the NSTEMI population followed by STEMI and UA (3.58, 2.41 and 1.68 per 10,000 person years respectively). Mortality was also highest in the NSTEMI population followed by STEMI and UA (2.23, 1.38 and 0.95 per 10,000 person years respectively). Increased burden of comorbidities was associated with an increased risk of MACE, most prominently seen with heart failure (adjusted HR 1.83; 95% CI 1.73–1.93), renal disease (adjusted HR 1.52; 95% CI 1.40–1.65) and diabetes (adjusted HR 1.51; 95% CI 1.44–1.59). The cumulative presence of each of examined comorbidities was associated with an incremental increase in the rate of MACE ranging from 1.7 to 9.98 per 10,000 person years. Rates of secondary prevention medications at discharge were high including: statin (89.5%), angiotensin converting enzyme inhibitor/angiotensin receptor blocker (84.1%) and beta-blockers (85.9%). Residual cardiovascular risk following an acute coronary syndrome remains high despite advances in secondary prevention. A higher burden of comorbidities is associated with increased residual risk that may benefit from aggressive or novel therapies.

scholarly journals Spontaneous coronary artery dissection as a cause of ST-segment elevation myocardial infarction

2021 ◽  
Vol 29 ◽  
pp. 1-5
Author(s):  
Stéphany Bastos ◽  
Raquel Carbelin ◽  
José Francisco ◽  
Gustavo Matos ◽  
Evandro Matos Júnior ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery ◽  
Artery Dissection ◽  
Interventional Treatment ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Artery Disease

Spontaneous coronary artery dissection is an uncommon condition, and the patients’ clinical presentation is often underestimated due to few risk factors for atherosclerotic disease. Treatment must be individualized, with conservative therapy as the first option, respecting the criteria for referral for interventional treatment. We report a case of spontaneous coronary dissection, initially manifested as a non-ST segment elevation acute coronary syndrome, progressing to transmural infarction, in a young patient, with few risk factors for coronary artery disease, and give examples of difficulties related to the percutaneous approach.

Multichannel electrocardiograms obtained by a smartwatch for the diagnosis of acute coronary syndromes: the SMARTAMI TRIAL

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C.S Spaccarotella ◽  
A.P Polimeni ◽  
E.P Principe ◽  
A.C Curcio ◽  
S.M Migliarino ◽  
...  
Keyword(s):  
Acute Coronary Syndromes ◽  
Digital Health ◽  
Coronary Revascularization ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Depression ◽  
Smart Watch ◽  
St Segment ◽  
Coronary Syndromes ◽  
Good Agreement

Abstract Background Smartwatches are increasingly popular and used for digital health information. A new smart watch introduced an integrated ECG tool, which allows recording a single-lead ECG that has been used for atrial fibrillation detection. The aim of the present study was to prospectively investigate the feasibility and the accuracy of the Apple Watch in patients admitted in the CCU with the diagnosis of Acute Coronary Syndrome compared with a standard 12-lead ECG. Methods A commercially available smart watch series 4 was used and the posterior sensor of the watch was positioned in different standardized body positions to obtain nine bipolar ECGs (corresponding to Einthoven leads I, II and III and Precordial leads V1-V6) that were compared with a simultaneous standard 12-lead ECG. One hundred subjects were included in the study. Fifty-five patients had a STEMI, twenty-seven patients had an NSTEMI all treated with percutaneous coronary revascularization. Eighteen age-matched subjects were included as controls. Results A very good agreement was found between Smartwatch ECG and Standard ECG for the identification of normal ECG, ST segment elevation and NSTE alterations (Cohen's kappa 0.90 [95% CI 0.78 to 1], 0.88 [95% CI 0.78 to 0,97], 0.85 [95% CI 0.74 to 0.96]), respectively. The sensitivity and specificity of Smartwatch ECG for the diagnosis of normal ECG were 84% (95% CI 60 to 97) and 100% (95% CI 95 to 100), STE deviation were 93% (95% CI 82 to 99) and 95% (95% CI 85 to 99), NSTE ECG alterations were 94% (95% CI 81 to 99) and 92% (95% CI 83 to 97), respectively. No significant differences between Smartwatch ECG and Standard ECG for the amplitude of ST changes were reported for each lead (see Figure). Conclusions The Smart Ami Trial demonstrated a very good agreement between the Smartwatch ECG and Standard ECG for the identification of ST-segment elevation and ST depression in patients with acute coronary syndromes opening the possibility of using this tool when a standard ECG is not available. Figure 1 Funding Acknowledgement Type of funding source: None

Improved risk stratification of patients with acute coronary syndromes using a combination of hsTnT, NT-proBNP and hsCRP with the GRACE score

2016 ◽  
Vol 7 (2) ◽  
pp. 129-138 ◽  
Author(s):  
Roland Klingenberg ◽  
Soheila Aghlmandi ◽  
Lorenz Räber ◽  
Baris Gencer ◽  
David Nanchen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Risk Stratification ◽  
High Sensitivity ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Improve Risk Stratification ◽  
St Segment ◽  
All Cause Mortality ◽  
Coronary Syndromes ◽  
Grace Score

Background: Clinical scores and biomarkers improve risk stratification of patients with acute coronary syndromes. However, little is known about their value in patients referred for coronary angiography. Methods: Consecutive patients admitted at four Swiss university hospitals with a diagnosis of acute coronary syndrome were enrolled into the SPUM-ACS Biomarker Cohort between 2009 and 2012. Patients were followed at 30 days and 1 year with assessment of adjudicated events including all-cause mortality and the composite of all-cause mortality or non-fatal recurrent myocardial infarction. Results: Events and biomarkers were analysed in 1892 patients (52.4% with ST-segment elevation myocardial infarction, 43.3% with non-ST-segment elevation myocardial infarction and 4.3% with unstable angina). Death at 30 days occurred in 35 patients (1.9%) and at 1 year in 80 patients (4.3%). The choice of troponin assay (conventional versus high sensitivity) to calculate the Global Registry of Acute Coronary Events (GRACE) score did not affect risk prediction. The prognostic accuracy of the GRACE score was improved when combined with three individual biomarkers including high sensitivity troponin T (hsTnT), N-terminal-pro B-type natriuretic peptide (NT-proBNP) and high sensitivity C-reactive protein (hsCRP) to yield a 9% increment (C-statistic 0.73–>0.82) for the discrimination of short-term risk for all-cause mortality. In contrast, the novel biomarkers placental growth factor (PlGF), soluble fms-like tyrosine kinase-1 (sFlt-1) and the ratio sFlt-1/PlGF did not improve risk stratification. Conclusions: In patients with acute coronary syndrome referred for coronary angiography, combinations of biomarkers including hsTnT, NT-proBNP and hsCRP with the GRACE score enhanced risk discrimination. Clinical Trials Registration: NCT01000701

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