scholarly journals Periprocedural myocardial infarction enhances the predictive value of inflammatory biomarkers for patients with obstructive coronary artery disease after implantation of drug-eluting stent

2015 ◽  
pp. 17
Author(s):  
Anastasia Jesika ◽  
Zuo-Ying Hu ◽  
Jing Kan ◽  
Shao-Liang Chen
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Predictive Value ◽  
Obstructive Coronary Artery Disease ◽  
Inflammatory Biomarkers ◽  
Drug Eluting Stent ◽  
Drug Eluting ◽  
Periprocedural Myocardial Infarction ◽  
Artery Disease

scholarly journals THE PREDICTIVE UTILITY OF GRACE SCORE FOR OBSTRUCTIVE CORONARY ARTERY DISEASE IN PATIENTS WITH NON ST ELEVATION MYOCARDIAL INFARCTION

2021 ◽  
Vol 54 (3) ◽  
pp. 239-243
Author(s):  
Haroon Ishaq ◽  
Bilal Akhtar ◽  
Mukesh Kumar ◽  
Ghulam Shabbir Shar ◽  
Abdul Hakeem ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Predictive Value ◽  
Independent Predictor ◽  
Obstructive Coronary Artery Disease ◽  
Optimal Cutoff ◽  
Cutoff Value ◽  
Artery Disease ◽  
Grace Score

Objectives: The objective of this study was to determine the predictive value of GRACE score for predicting obstructive coronary artery disease in patients with non ST-segment elevation myocardial infarction (NSTEMI). Methodology: This cross-sectional study was conducted at the largest public sector cardiac care center of the Pakistan between January 2020 and June 2020. In this study, we included adult patients diagnosed with NSTEMI and correlation of GRACE score was assessed with angiographic finding of obstructive CAD defined as ≥50% stenosis in the left main or ≥70% stenosis in other coronary arteries. Results: A total of 227 patients were included in this study, out of whom 72.2% (164) were male patients and mean age was 55.77 ± 9.15 years. Mean GRACE score was found to be 95.89 ± 21.15. On coronary angiography obstructive CAD was present in 84.6% (192) of the patients. Area under the cure for predicting obstructive CAD was 0.669 [0.552 to 0.785]. The optimal cutoff value of GRACE score was ≥ 84 with sensitivity of 79.7% [73.3% to 85.1%] and specificity of 57.1% [39.3% to 73.7%]. GRACE score of ≥ 84 was found to be an independent predictor of obstructive CAD with odds ratio of 4.33 [1.61 - 11.64; p=0.004] adjusted for gender, age, hypertension, diabetes, family history of CAD, and smoking. Conclusion: GRACE score has a moderate predictive value in predicting obstructive CAD in patients with NSTEMI. The optimal cutoff value of 84 is an independent predictor with good sensitivity but moderate specificity in predicting obstructive CAD.

scholarly journals OCT Findings in MINOCA

2021 ◽  
Vol 10 (13) ◽  
pp. 2759
Author(s):  
Krzysztof Bryniarski ◽  
Pawel Gasior ◽  
Jacek Legutko ◽  
Dawid Makowicz ◽  
Anna Kedziora ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Imaging Modality ◽  
Obstructive Coronary Artery Disease ◽  
Coronary Artery Spasm ◽  
Morphological Characteristics ◽  
Artery Dissection ◽  
Plaque Disruption ◽  
Artery Disease

Myocardial infarction with non-obstructive coronary artery disease (MINOCA) is a working diagnosis for patients presenting with acute myocardial infarction without obstructive coronary artery disease on coronary angiography. It is a heterogenous entity with a number of possible etiologies that can be determined through the use of appropriate diagnostic algorithms. Common causes of a MINOCA may include plaque disruption, spontaneous coronary artery dissection, coronary artery spasm, and coronary thromboembolism. Optical coherence tomography (OCT) is an intravascular imaging modality which allows the differentiation of coronary tissue morphological characteristics including the identification of thin cap fibroatheroma and the differentiation between plaque rupture or erosion, due to its high resolution. In this narrative review we will discuss the role of OCT in patients presenting with MINOCA. In this group of patients OCT has been shown to reveal abnormal findings in almost half of the cases. Moreover, combining OCT with cardiac magnetic resonance (CMR) was shown to allow the identification of most of the underlying mechanisms of MINOCA. Hence, it is recommended that both OCT and CMR can be used in patients with a working diagnosis of MINOCA. Well-designed prospective studies are needed in order to gain a better understanding of this condition and to provide optimal management while reducing morbidity and mortality in that subset patients.

Abstract 13804: Clinical Profile and Outcomes of Myocardial Infarction With Non-obstructive Coronary Arteries in Older Adults

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ara H Rostomian ◽  
Derek Q Phan ◽  
Mingsum Lee ◽  
Ray X Zadegan
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Los Angeles ◽  
Coronary Arteries ◽  
Medical Center ◽  
Invasive Coronary Angiography ◽  
Obstructive Coronary Artery Disease ◽  
Kaiser Permanente ◽  
Artery Disease

Introduction: Myocardial Infarction with non-obstructive coronary artery disease (MINOCA) is found in 5%-6% of patients with acute myocardial infarction (AMI). As such, the diagnosis and management of AMI patients with non-obstructive coronary artery disease (NOCAD) poses a challenge as compared to patients with MI with coronary artery disease (MICAD). Hypothesis: To evaluate the characteristics and outcomes of MINOCA in older patients as compared with MICAD patients, with and without revascularization. Methods: This was a retrospective observational study of patients ≥80 years old who underwent invasive coronary angiography (ICA) for AMI between 2009-2019 at Kaiser Permanente Los Angeles Medical Center. MINOCA was defied as <50% stenosis of coronary arteries on angiography with a troponin level ≥0.05 ng/ml. Patients with MINOCA vs MICAD were compared. Multivariate logistic regression was used to identify independent predictors of MINOCA and Kaplan-Meier survival analysis was used to analyze all-cause mortality between cohorts. Results: A total of 259 patients with MINOCA (mean ± SD age 83.8±2.7 years, 68% female) and 687 patients with MICAD (84.7±3.4 years, 40% female) were analyzed. Younger age (odds ratio [OR]=1.11; 95% confidence interval [CI]=1.05-1.18), female sex (OR=3.14; CI=2.20-4.48), black race (OR=2.53; CI=1.61-3.98), no history of prior stroke (OR=1.56; CI=1.06-2.33), atrial fibrillation or flutter (OR=2.04; CI:1.38-3.02), lower troponin levels (OR=1.08; CI:1.03-1.11), and lower triglyceride levels per 10 mg/dl increments (OR=1.06; CI:1.03-1.11) increased the odds of having MINCOA as compared to MICAD. At median follow-up of 2.4 years, MINOCA was associated with a lower rate of death (44.8% vs 55.2%, p<0.01) compared to un-revascularized MICAD, but no difference (31.3% vs 40.4%, p=0.68) when compared to re-vascularized MICAD. Conclusions: Patients age ≥80 years with MINOCA have fewer traditional risk factors compared to their counterparts with MICAD and fewer deaths compared to un-revascularized MICAD, but similar mortality compared to revascularized MICAD

Safety and Efficacy of Drug-Coated Balloons Versus Drug-Eluting Stents in Acute Coronary Syndromes: A Prespecified Analysis of BASKET-SMALL 2

2022 ◽  
Author(s):  
Norman Mangner ◽  
Ahmed Farah ◽  
Marc-Alexander Ohlow ◽  
Sven Möbius-Winkler ◽  
Daniel Weilenmann ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Significant Interaction ◽  
Clinical Presentation ◽  
Small Vessel ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Drug Eluting ◽  
Artery Disease

Background: Drug-coated balloons (DCBs) are an established treatment strategy for coronary artery disease. Randomized data on the application of DCBs in patients with an acute coronary syndrome (ACS) are limited. We evaluated the impact of clinical presentation (ACS versus chronic coronary syndrome) on clinical outcomes in patients undergoing DCB or drug-eluting stent (DES) treatment in a prespecified analysis of the BASKET-SMALL 2 trial (Basel Kosten Effektivitäts Trial–Drug-Coated Balloons Versus Drug-Eluting Stents in Small Vessel Interventions). Methods: BASKET-SMALL 2 randomized 758 patients with small vessel coronary artery disease to DCB or DES treatment and followed them for 3 years regarding major adverse cardiac events (cardiac death, nonfatal myocardial infarction, and target vessel revascularization). Results: Among 758 patients, 214 patients (28.2%) presented with an ACS (15 patients [7%], ST-segment–elevation myocardial infarction; 109 patients [50.9%], non–ST-segment–elevation myocardial infarction; 90 patients [42.1%], unstable angina pectoris). At 1-year follow-up, there was no significant difference in the incidence of the primary end point by randomized treatment in patients with ACS (hazard ratio, 0.50 [95% CI, 0.19–1.26] for DCB versus DES) or chronic coronary syndrome (hazard ratio, 1.29 [95% CI, 0.67–2.47] for DCB versus DES). There was no significant interaction between clinical presentation and treatment effect ( P for interaction, 0.088). For cardiac death ( P for interaction, 0.049) and nonfatal myocardial infarction ( P for interaction, 0.010), a significant interaction between clinical presentation and treatment was seen at 1 year with lower rates of these secondary end points in patients with ACS treated by DCB. At 3 years, there were similar major adverse cardiac event rates throughout groups without significant interaction between clinical presentation and treatment ( P for interaction, 0.301). All-cause mortality was higher in ACS compared with chronic coronary syndrome; however, there was no difference between DCB and DES irrespective of clinical presentation. Conclusions: In this subgroup analysis of the BASKET-SMALL 2 trial, there was no interaction between indication for percutaneous coronary intervention (acute versus chronic coronary syndrome) and treatment effect of DCB versus DES in patients with small vessel coronary artery disease. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01574534.

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