Clinical case of acute coronary syndrome with ST segment elevation complicated by complete heart block, acute heart failure, and sudden cardiac arrest

There are limited data regarding the incidence and clinical significance of congestive heart failure (CHF) in patients with non-ST segment elevation acute coronary syndromes (ACS). The objectives of this study were to examine the incidence, predictors, and clinical outcomes in patients with ACS without ST elevation who develop CHF. We studied patients with unstable angina or non-ST segment elevation myocardial infarction (NSTEMI) randomized to hirudin or unfractionated heparin in the Organisation to Assess Strategies for Ischemic Syndromes (OASIS-2) trial. The diagnosis of CHF was based on a combination of clinical and radiographic features. Patients were followed for 6 months. Of 10 141 randomized patients, 501 (4.9%) developed CHF within the first week and 643 (6.3%) during 6 months of followup. Independent predictors for the development of CHF were older age, female sex, diabetes, prior MI, prior CHF, and NSTEMI at presentation. Compared with patients who did not develop CHF, patients who developed CHF were at increased risk of death (odds ratio (OR) 3.4, 95% CI 2.7–4.3), new MI (OR 2.8, 95% CI 2.2–3.6), and the need for intra-aortic balloon pump insertion (OR 5.4, 95% CI 3.5–8.4) at 7 days and 6 months. There was no increase in use of cardiac catheterization (OR 0.8, 95% CI 0.7–1.0) or revascularization (OR 0.9, 95% CI 0.7–1.1) in patients who developed CHF. CHF is a common complication in patients presenting with non-ST segment elevation ACS and is strongly associated with adverse clinical outcomes including new MI and death. Despite this worse prognosis, patients with ACS developing CHF are less likely to be referred for invasive management.Key words: unstable angina, acute coronary syndrome, congestive heart failure, prognosis.

Download Full-text

Contrast-induced nephropathy in patients with acute coronary syndrome with ST-segment elevation: risk factors and prognosis

The Clinician ◽

10.17650/1818-8338-2019-13-3-4-36-42 ◽

2020 ◽

Vol 13 (3-4) ◽

pp. 36-42

Author(s):

O. V. Arsenicheva ◽

N. N. Shchapovа

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Heart Failure ◽

Chronic Kidney Disease ◽

Acute Coronary Syndrome ◽

Contrast Induced Nephropathy ◽

St Segment Elevation ◽

Coronary Syndrome ◽

St Segment

Objective: to study the risk factors for acute renal injury, the dynamics of renal function and prognosis in patients with acute coronary syndrome with ST-segment elevation (STEACS) with contrast-induced nephropathy (CIN) after primary percutaneous coronary intervention (PCI).Materials and methods. We studied 20 patients with STEACS, who developed СIN after PCI (follow-up group), and 98 patients with STEACS without СIN (comparison group). All patients were measured plasma creatinine level and glomerular filtration rate by the formula CKD-EPI before and 48 hours after PCI. CIN was detected with an increase in creatinine levels in the blood by more than 26.5 µmol / l from the baseline 48 hours after administration of radiopaque drug (RCP). Endpoints were evaluated at the hospital stage and within 12 months after PCI.Results. CIN after PCI occurred in 16.9 % of patients with STEACS. Among patients with СIN, persons aged over 75 years (60 %), with diabetes mellitus (45 %), chronic kidney disease (75 %), postinfarction cardiosclerosis (50 %), chronic heart failure of functional class III–IV (80 %), developed acute heart failure T. Killip III–IV (90 %) were significantly more often observed. The left ventricular ejection fraction was lower in patients with СIN (p <0.05). The average increase in plasma creatinine 48 hours after PCI was higher in the follow-up group (p <0.05). In patients with СIN more often, than without СIN, three-vascular lesions of the coronary bed were detected (65 and 25.5 % respectively, p <0.001). The same trend was observed, when assessing the average number of coronary artery stenoses, the number of implanted stents and the volume of RCP used. Patients with СIN, than without СIN, were longer in hospital (12.1 ± 0.96 and 10.2 ± 1.11 days respectively, p <0.05) and more often needed re-hospitalization within 12 months after PCI (34 and 4.1 % respectively, p <0.05).Summary. CIN in patients with STEACS after primary PCI was more likely to develop, if the following symptoms were present: age over 75 years, diabetes mellitus, chronic heart failure, post-infarction cardiosclerosis, chronic kidney disease, low ejection fraction of the left ventricle, initially high creatinine level, development of acute heart failure, trisovascular coronary lesion and multiple coronary stenting. The duration of hospital stay and the frequency of re-hospitalizations within a year after PCI significantly increased in patients in the CIN group.

Download Full-text

Vascular remodeling after everolimus-eluting stent implantation in non-ST segment elevation acute coronary syndrome: optical coherence tomography

Complex Issues of Cardiovascular Diseases ◽

10.17802/2306-1278-2021-10-2-60-71 ◽

2021 ◽

Vol 10 (2) ◽

pp. 60-71

Author(s):

I. S. Trusov ◽

A. V. Biryukov ◽

E. M. Nifontov ◽

R. D. Ivanchenko ◽

E. I. Melioranskaia

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Acute Coronary Syndrome ◽

Stent Implantation ◽

Vascular Remodeling ◽

St Segment Elevation ◽

Coronary Syndrome ◽

St Segment ◽

Elevation Acute Coronary Syndrome ◽

Healing Score

Highlights. Vascular healing response after stenting depends on both, procedure- and patient-related factors. The patient's age, lipid metabolism, the presence of heart failure, myocardial infarction, and the thickness of epicardial adipose tissue affect vascular remodeling after everolimus-eluting stent implantation.Aim. To identify factors affecting vascular healing response after everolimus-eluting stent implantation in patients with non-ST segment elevation acute coronary syndrome.Methods. 45 patients with non-ST segment elevation acute coronary syndrome who underwent everolimus-eluting stent implantation were included in a study. Stenting was performed without intravascular imaging guidance. All patients underwent repeated coronary angiography and optical coherence tomography of the stented segment 6 (±2) months after the indexed procedure. 39,860 struts in 4,576 sections were analyzed. The number of uncovered and malapposed struts was estimated, and the healing score was calculated. Cardiovascular death, repeated myocardial infarction, and repeated revascularization of the stented segment 12 months after the stenting were evaluated as a combined endpoint.Results. 5 patients out of 45 reached the endpoint (11.1%), the main component of which was repeated revascularization. Patients who reached the endpoint had a lower healing score (4.5±2.6 and 19.9±17.9, respectively; p = 0.038). The healing score was lower in men (13.7±14.7 and 26.0±20.0, respectively; p = 0.041), those who had myocardial infarction at the time of stenting (5.5±6.7 for myocardial infarction and 19.8±17.9 for unstable angina, p = 0.045), and those who did not have heart failure (12.2±12.4 and 36.7±19.0, respectively; p = 0.0006). The healing score depended on the severity of the coronary lesion (24.8±19.4 for multivessel lesions, 10.0±8.7 for single-vessel lesions, and 7.3±6.3 for two-vessel lesions, respectively; p = 0.019). The linear regression reported the correlation of the healing score with age, atherogenicity coefficient, and the presence of chronic heart failure. The modified healing score depended on the epicardial fat thickness, atherogenicity coefficient, and blood urea level.Conclusion. The nature and degree of vascular remodeling after everolimus-eluting stent implantation depends on the patient's age, diagnosis, heart failure, lipid metabolism, and the severity of the coronary lesion. The evaluation of vascular healing response may influence the decision on the duration of dual antiplatelet therapy

Download Full-text