scholarly journals Factors associated with cardiac remodeling in the long-term period in patients with invasive treatment strategy for acute coronary syndrome

2020 ◽  
Vol 16 (4) ◽  
pp. 93-100
Author(s):  
V.Y. Tseluiko ◽  
T.V. Pylova
Keyword(s):  
Acute Coronary Syndrome ◽  
Cardiac Remodeling ◽  
Treatment Strategy ◽  
Invasive Treatment ◽  
Factors Associated ◽  
Coronary Syndrome

scholarly journals Cystatin C for Enhancement of Risk Stratification in Non–ST Elevation Acute Coronary Syndrome Patients with an Increased Troponin T

2009 ◽  
Vol 55 (6) ◽  
pp. 1118-1125 ◽  
Author(s):  
Fons Windhausen ◽  
Alexander Hirsch ◽  
Johan Fischer ◽  
P Marc van der Zee ◽  
Gerard T Sanders ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Renal Function ◽  
Risk Stratification ◽  
Cystatin C ◽  
Treatment Strategy ◽  
Troponin T ◽  
Invasive Treatment ◽  
Coronary Syndrome ◽  
The Third ◽  
St Elevation

Abstract Background: We assessed the value of cystatin C for improvement of risk stratification in patients with non–ST elevation acute coronary syndrome (nSTE-ACS) and increased cardiac troponin T (cTnT), and we compared the long-term effects of an early invasive treatment strategy (EIS) with a selective invasive treatment strategy (SIS) with regard to renal function. Methods: Patients (n = 1128) randomized to an EIS or an SIS in the ICTUS trial were stratified according to the tertiles of the cystatin C concentration at baseline. The end points were death within 4 years and spontaneous myocardial infarction (MI) within 3 years. Results: Mortality was 3.4%, 6.2%, and 13.5% in the first, second, and third tertiles, respectively, of cystatin C concentration (log-rank P < 0.001), and the respective rates of spontaneous MI were 5.5%, 7.5%, and 9.8% (log-rank P = 0.03). In a multivariate Cox regression analysis, the cystatin C concentration in the third quartile remained independently predictive of mortality [hazard ratio (HR), 2.04; 95% CI, 1.02–4.10; P = 0.04] and spontaneous MI (HR, 1.95; 95% CI, 1.05–3.63; P = 0.04). The mortality rate in the second tertile was lower with the EIS than with the SIS (3.8% vs 8.7%). In the third tertile, the mortality rates with the EIS and the SIS were, respectively, 15.0% and 12.2% (P for interaction = 0.04). Rates of spontaneous MI were similar for the EIS and the SIS within cystatin C tertiles (P for interaction = 0.22). Conclusions: In patients with nSTE-ACS and an increased cTnT concentration, mild to moderate renal dysfunction is associated with a higher risk of death and spontaneous MI. Use of cystatin C as a serum marker of renal function may improve risk stratification.

scholarly journals The Importance of the Treatment Strategy Changes in the Long-Term Evolution of Type 2 Diabetic Patients with Sub-Optimal Glycaemic Control After Acute Coronary Syndrome

2015 ◽  
Vol 22 (1) ◽  
pp. 29-37 ◽  
Author(s):  
Johann Trutz ◽  
Aurel Babeș ◽  
Katalin Babeș
Keyword(s):  
Acute Coronary Syndrome ◽  
Glycaemic Control ◽  
Treatment Strategy ◽  
Hba1c Level ◽  
Intervention Group ◽  
Control Group ◽  
Coronary Syndrome ◽  
Strategy Changes

AbstractBackground and Aims. Several factors are associated with a heightened risk of subsequent events, morbidity and mortality in patients with type 2 diabetes mellitus (T2DM) after an acute coronary syndrome (ACS). Improving the management of these patients is a challenge that requires urgent attention. We aimed to study the long-term effect of the change in treatment strategy depending on the HbA1c level detected during the hospitalization for ACS. Material and methods. The primary endpoints of this study were the major adverse cardiac events (MACE) at 12 months. From the originally included 221 patients 15 were lost (no response to follow-up phone calls). The suboptimal glycaemic control group (HbA1c>7.0%, n=84) was divided in two subgroups: patients who completed a diabetological consult with further treatment changes (intervention group) and patients without this referral (control group). Results. No significant differences in baseline characteristics were found between the 2 subgroups. The second subgroup had a triple risk for a MACE in 1 year (HR=2.8704, 95% CI: 1.109-7.423, p=0.0296) compared to the intervention group. No significant differences were found in secondary endpoints. Conclusion. This study suggests that, after hospitalization for an ACS, diabetologist referral and treatment strategy changes are recommended for all T2DM patients whose HbA1c level is over 7% before discharge.

scholarly journals Growth Differentiation Factor 15 for Risk Stratification and Selection of an Invasive Treatment Strategy in Non–ST-Elevation Acute Coronary Syndrome

Circulation ◽  
2007 ◽  
Vol 116 (14) ◽  
pp. 1540-1548 ◽  
Author(s):  
Kai C. Wollert ◽  
Tibor Kempf ◽  
Bo Lagerqvist ◽  
Bertil Lindahl ◽  
Sylvia Olofsson ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Confidence Interval ◽  
Risk Stratification ◽  
Treatment Strategy ◽  
Hazard Ratio ◽  
Invasive Treatment ◽  
Coronary Syndrome ◽  
End Point ◽  
St Elevation ◽  
Elevation Acute Coronary Syndrome

Background— An invasive treatment strategy improves outcome in patients with non–ST-elevation acute coronary syndrome at moderate to high risk. We hypothesized that the circulating level of growth differentiation factor 15 (GDF-15) may improve risk stratification. Methods and Results— The Fast Revascularization during InStability in Coronary artery disease II (FRISC-II) trial randomized patients with non–ST-elevation acute coronary syndrome to an invasive or conservative strategy with a follow-up for 2 years. GDF-15 and other biomarkers were determined on admission in 2079 patients. GDF-15 was moderately elevated (between 1200 and 1800 ng/L) in 770 patients (37.0%), and highly elevated (>1800 ng/L) in 493 patients (23.7%). Elevated levels of GDF-15 independently predicted the risk of the composite end point of death or recurrent myocardial infarction in the conservative group ( P =0.016) but not in the invasive group. A significant interaction existed between the GDF-15 level on admission and the effect of treatment strategy on the composite end point. The occurrence of the composite end point was reduced by the invasive strategy at GDF-15 levels >1800 ng/L (hazard ratio, 0.49; 95% confidence interval, 0.33 to 0.73; P =0.001), between 1200 and 1800 ng/L (hazard ratio, 0.68; 95% confidence interval, 0.46 to 1.00; P =0.048), but not <1200 ng/L (hazard ratio, 1.06; 95% confidence interval, 0.68 to 1.65; P =0.81). Patients with ST-segment depression or a troponin T level >0.01 μg/L with a GDF-15 level <1200 ng/L did not benefit from the invasive strategy. Conclusions— GDF-15 is a potential tool for risk stratification and therapeutic decision making in patients with non–ST-elevation acute coronary syndrome as initially diagnosed by ECG and troponin levels. A prospective randomized trial is needed to validate these findings.

scholarly journals Factors associated with actively working in the very long-term following acute coronary syndrome

Clinics ◽  
2021 ◽  
Vol 76 ◽  
Author(s):  
Jose C. Nicolau ◽  
Remo H.M. Furtado ◽  
Talia F. Dalçóquio ◽  
Livia M. Lara ◽  
Marcela G. Juliasz ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Factors Associated ◽  
Coronary Syndrome

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.

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