Redefining residual inflammatory risk after acute coronary syndrome

2021 ◽  
Author(s):  
Marco G Del Buono ◽  
Rocco A Montone ◽  
Giulia Iannaccone ◽  
Riccardo Rinaldi ◽  
Giulia La Vecchia ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Cardiovascular Events ◽  
Multimodality Imaging ◽  
Short Review ◽  
Local Inflammation ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
Atherosclerotic Plaque Formation ◽  
Long Term Follow Up ◽  
Coronary Syndromes

Over the last decades, inflammation proved to play a pivotal role in atherosclerotic plaque formation, progression and destabilization. Several studies showed that the patients presenting with acute coronary syndrome are at increased risk of adverse cardiovascular events at both short- and long-term follow-up. Results from different clinical trials highlighted that a residual inflammatory risk exist and targeting inflammation is a successful strategy in selected cases associated to an increased inflammatory burden. Recently, the optimization of intracoronary and multimodality imaging allowed to also assess the entity of local inflammation, thus encouraging the individuation of plaque characteristics that portend a higher risk of future cardiovascular events. In this short review, we aim to highlight the role of systemic and local inflammation in acute coronary syndromes, to provide a summarized overview of the possible medical strategies applicable in selected cases and to underline the diagnostic and prognostic potential of multimodality imaging.

scholarly journals Cessation of dual antiplatelet therapy and cardiovascular events following acute coronary syndrome

Heart ◽  
2018 ◽  
Vol 105 (1) ◽  
pp. 67-74 ◽  
Author(s):  
Wardati Mazlan-Kepli ◽  
Jesse Dawson ◽  
Colin Berry ◽  
Matthew Walters
Keyword(s):  
Acute Coronary Syndrome ◽  
Antiplatelet Therapy ◽  
Cardiovascular Events ◽  
Dual Antiplatelet Therapy ◽  
Early Period ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
Long Term Follow Up

ObjectiveTo assess whether cardiovascular events are increased after cessation of dual antiplatelet therapy (DAPT) following acute coronary syndrome (ACS) and to explore predictors for recurrent events after DAPT cessation during long-term follow-up.MethodsWe did a retrospective observational cohort study. We included consecutive people with ACS who were discharged from Scottish hospitals between January 2008 and December 2013 and who received DAPT after discharge followed by antiplatelet monotherapy. The rates of cardiovascular events were assessed during each 90-day period of DAPT treatment and 90-day period after stopping DAPT. Cardiovascular events were defined as a composite of death, ACS, transient ischaemic attack or stroke. Cox regression was used to identify predictors of cardiovascular events following DAPT cessation.Results1340 patients were included (62% male, mean age 64.9 (13.0) years). Cardiovascular events occurred in 15.7% (n=211) during the DAPT period (mean DAPT duration 175.1 (155.3) days) and in 16.7% (n=188) following DAPT cessation (mean of 2.7 years follow-up). Independent predictors for a cardiovascular event following DAPT cessation were age (HR 1.07; 95% CI 1.05 to 1.08; p<0.001), DAPT duration (HR 0.997; 95% CI 0.995 to 0.998; p<0.001) and having revascularisation therapy during the index admission (HR 0.58; 95% CI 0.39 to 0.85; p=0.005).ConclusionsThe rate of cardiovascular events was not significantly increased in the early period post-DAPT cessation compared with later periods in this ACS population. Increasing age, DAPT duration and lack of revascularisation therapy were associated with increased risk of cardiovascular events during long-term follow-up after DAPT cessation.

scholarly journals The 1-Year Safety and Efficacy Outcomes of Magmaris, Novel Magnesium Bioresorbable Vascular Scaffolds in Diabetes Mellitus Patients with Acute Coronary Syndrome

2021 ◽  
Vol 10 (14) ◽  
pp. 3166
Author(s):  
Adrian Włodarczak ◽  
Magdalena Łanocha ◽  
Marek Szudrowicz ◽  
Mateusz Barycki ◽  
Alicja Gosiewska ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Acute Coronary Syndrome ◽  
Coronary Intervention ◽  
Cardiovascular Death ◽  
Target Lesion ◽  
Bioresorbable Scaffold ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
Coronary Syndromes ◽  
Target Lesion Failure

Background: Diabetes mellitus (DM) is one of the major risk factors contributing to Acute Coronary Syndromes (ACS) and is associated with an increased risk of adverse clinical outcomes following percutaneous coronary intervention (PCI), even when the second generation of drug-eluting stents (DES) is used. In order to overcome the disadvantages of permanent caging of a vessel with metallic DES, bioresorbable scaffold (BRS) technology has been recently developed. However, the prognosis of patients with DM and ACS treated with PCI via subsequent implantation of Magmaris (Biotronik, Berlin, Germany)—a novel magnesium-bioresorbable scaffold—is poorly investigated. Methods: A total of 193 consecutive subjects with non-ST elevation acute coronary syndrome (NSTE-ACS) who, from October 2016 to March 2020, received one or more Magmaris scaffolds were enrolled in this study. The diabetic group was compared with non-diabetic subjects. Results: There were no significant differences in the occurrence of primary endpoints (cardiovascular death, myocardial infarction, and in-stent thrombosis) and principal secondary endpoints (target-lesion failure, scaffold restenosis, death from any reason, and other cardiovascular events) between the two compared groups in a 1-year follow-up period. Conclusions: The early 1-year-outcome of magnesium bioresorbable scaffold (Magmaris) seems to be favorable and suggests that this novel BRS is safe and effective in subjects with NSTE-ACS and co-existing DM.

scholarly journals Prognostic values of fasting hyperglycaemia in non-diabetic patients with acute coronary syndrome: A prospective cohort study

2018 ◽  
Vol 9 (6) ◽  
pp. 589-598 ◽  
Author(s):  
Baris Gencer ◽  
Fabio Rigamonti ◽  
David Nanchen ◽  
Roland Klingenberg ◽  
Lorenz Räber ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Confidence Interval ◽  
Diabetic Patients ◽  
Coronary Syndrome ◽  
University Medicine ◽  
Fasting Hyperglycaemia ◽  
Increased Risk ◽  
Coronary Syndromes ◽  
One Year

Background: Controversy remains regarding the prevalence of hyperglycaemia in non-diabetic patients hospitalised with acute coronary syndrome and its prognostic value for long-term outcomes. Methods and results: We evaluated the prevalence of hyperglycaemia (defined as fasting glycaemia ⩾10 mmol/l) among patients with no known diabetes at the time of enrolment in the prospective Special Program University Medicine-Acute Coronary Syndromes cohort, as well as its impact on all-cause death, myocardial infarction, stroke and incidence of diabetes at one year. Among 3858 acute coronary syndrome patients enrolled between December 2009–December 2014, 709 (18.4%) had known diabetes, while 112 (3.6%) of non-diabetic patients had hyperglycaemia at admission. Compared with non-hyperglycaemic patients, hyperglycaemic individuals were more likely to present with ST-elevation myocardial infarction and acute heart failure. At discharge, hyperglycaemic patients were more frequently treated with glucose-lowering agents (8.9% vs 0.66%, p<0.001). At one-year, adjudicated all-cause death was significantly higher in non-diabetic patients presenting with hyperglycaemia compared with patients with no hyperglycaemia (5.4% vs 2.2%, p=0.041) and hyperglycaemia was a significant predictor of one-year mortality (adjusted hazard ratio 2.39, 95% confidence interval 1.03–5.56). Among patients with hyperglycaemia, 9.8% had developed diabetes at one-year, while the corresponding proportion among patients without hyperglycaemia was 1.8% ( p<0.001). In multivariate analysis, hyperglycaemia at presentation predicted the onset of treated diabetes at one-year (odds ratio 4.15, 95% confidence interval 1.59–10.86; p=0.004). Conclusion: Among non-diabetic patients hospitalised with acute coronary syndrome, a fasting hyperglycaemia of ⩾10 mmol/l predicted one-year mortality and was associated with a four-fold increased risk of developing diabetes at one year.

Prognostic impact of severe anemia (hemoglobin <10g/dL) during treatment with dual antiplatelet therapy after hospital discharge for acute coronary syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
I Campos ◽  
C Oliveira ◽  
C Pires ◽  
P Medeiros ◽  
R Flores ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Multivariate Analysis ◽  
Antiplatelet Therapy ◽  
Cardiovascular Events ◽  
Dual Antiplatelet Therapy ◽  
Severe Anemia ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
Group 2 ◽  
Group 1

Abstract Introduction In recent years, the use of invasive strategies has become the generalized approach in the management of patients with acute coronary syndrome (ACS), justified by the associated prognostic benefit due to reduced mortality and the evolution of percutaneous coronary intervention (PCI). However, the benefits of an invasive approach in ACS are unclear in the population with significant anemia, as anemia is strongly associated with increased risk of morbidity and mortality in these patients. Aim To determine the ischaemic vs. bleeding risks from patients with severe anemia (hemoglobin &lt;10 g/dL) during treatment with Dual Antiplatelet Therapy (DAPT) after an ACS undergoing PCI. Methods From a national multicentre registry, we analyzed 17 370 ACS pts. Pts were divided into two groups: group 1 - pts with severe anemia (hemoglobin &lt;10g/dL) (n=557, 3.2%); group 2 - pts without severe anemia (hemoglobin 10g/dL) (n=16813, 96.8%). Primary endpoint was the occurrence of a composite of death and adverse cardiovascular events (stroke, reinfarction, and rehospitalization of cardiovascular etiology) at 1 year. Results The sample consisted in 73.4% men and 26.6% women, with mean age of 66±14 years. The incidence of severe anemia was 3.2%. Group 1 pts were older (75±12 vs 66±14, p&lt;0.001), had a higher proportion of women (47.6% vs 25.9%, p&lt;0.001), diabetes (55% vs 30.6%, p&lt;0.001), hypertension (81.8% vs 68.2%, p&lt;0.001) and chronic kidney disease (29.2% vs 5.2%, p&lt;0.001). During hospitalization, group 1 had more heart failure (35.3% vs 15.1%, p&lt;0.001), worst LVEF (27.3% vs 17.3%, p&lt;0,001), bleeding (7.6%% vs 1.3%, p&lt;0.001) and transfusion (23.4% vs 1%, p&lt;0.001). During hospitalization, group 2 pts were more likely to undergo revascularization (82.9% vs 89.4%, p&lt;0.001) and double antiaggregation (82.5% vs 95%, p&lt;0.001). A multivariate analysis identified age [OR 1.48, 95% CI 1.32 to 1.89; p&lt;0.001] and feminine sex [OR 2.21, 95% CI 1.89 to 3.61; p&lt;0.001] as independent predictors of severe anemia during hospitalization. Patients with severe anemia had longer hospital stay (9 days vs 6 days; p&lt;0.001), and higher 6-month mortality (8.7% vs. 2.9%; p&lt;0.001). In multivariate analysis and after adjusting for different baseline characteristics, pts with severe anemia had higher occurrence of a composite of death and adverse cardiovascular events at 1-year compared to those without severe anemia [OR 3.04, 95% CI 1.21 to 5.04; p=0.029]. Conclusion We objected a low prevalence of ACS patients with severe anemia undergoing PCI (52.2%) but the incidence of ICP in these complex patients has increased in recent years, mainly due to the evolution of PCI over the last 40 years. Severe anemia was strongly associated with increased risk of morbidity and mortality in ACS pts. Funding Acknowledgement Type of funding source: None

scholarly journals Clinical profile of patients with acute coronary syndrome and its association with biomarker troponin I

2018 ◽  
Vol 5 (2) ◽  
pp. 433
Author(s):  
Hemant S. Joshi ◽  
Samil Sajal ◽  
Nirmit V. Yagnik ◽  
Y. K. Bolya
Keyword(s):  
Acute Coronary Syndrome ◽  
Acute Coronary Syndromes ◽  
Troponin I ◽  
Clinical Profile ◽  
Prognostic Information ◽  
Risk Of Death ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
Acute Mi ◽  
Coronary Syndromes

Background: In patients with acute coronary syndromes, it is desirable to identify a sensitive serum marker that is closely related to the degree of myocardial damage, provides prognostic information, and can be measured rapidly. Author studied the clinical profile of patients with Acute MI and its relation with troponin I level.Methods: In this prospective study, 65 patients admitted with Acute MI were studied. Study patients were divided in Troponin I positive and Troponin I negative group. Patients were followed up to discharge or death in the hospital.Results: Most common symptom present in the patients with Acute Coronary Syndrome was chest pain (94%) and most common risk factor was dyslipidaemia (72.3%). Most common complication was recurrent angina (72.3%). Out of total patients with significant CAD, almost 70 % belong to Troponin I positive group and it is statistically highly significant (p<0.05). Total 30 patients (46.2%) have more than 10 episodes of angina in our study. There is statistically significant association between number of angina episode and Troponin I positivity (p<0.05). Out of total deaths, 73.3% have occurred among Troponin I positive study patients and it is statistically significant (p<0.05).Conclusions: In patients with acute coronary syndromes, cardiac troponin I levels provide useful prognostic information and permit the early identification of patients with an increased risk of death.  

Endothelial function and 6-year outcomes following an acute coronary syndrome in patients with a history or presence of cancer

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y Matsuzawa ◽  
T.Y Yoshii ◽  
R.S Sato ◽  
H.N Nakahashi ◽  
E.A Akiyama ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Endothelial Dysfunction ◽  
Endothelial Function ◽  
Cardiovascular Events ◽  
Medical Center ◽  
Reactive Hyperemia ◽  
Cardiovascular Death ◽  
Established Coronary Artery Disease ◽  
Coronary Syndrome ◽  
Increased Risk

Abstract Background It has been reported that in the primary prevention settings, patients with cancer are exposed to an increased risk of cardiovascular disease through multiple mechanisms. However, among patients with established coronary artery disease, it is unknown whether cancer is an additional risk for endothelial dysfunction, mortality, and subsequent cardiovascular events. Purpose To determine endothelial function, mortality and cardiovascular events following acute coronary syndrome according to history/presence of cancer on (ACS). Methods Patients who were admitted to our university medical center for ACS were enrolled, and were divided according to the history/presence of cancer. We measured reactive hyperemia index before discharge in all patients to evaluate endothelial function. The logarithmic value of RHI (LnRHI) was used in the analyses. All patients were followed for cardiovascular death, non-cardiovascular death, myocardial infarction (MI), and stroke. Results Six-hundred and ninety patients with ACS were enrolled (mean age [SD] was 66 [12] years, male was 78%), and 73 patients (10.6%) had a history or presence of cancer. Endothelial function was not significantly different between ACS patients with and without the history/presence of cancer (LnRHI 0.64 (0.26) versus 0.59 (0.26), p=0.10). During the follow up period (the median 6.1 years), cardiovascular death occurred in 48 patients, non-cardiovascular death in 36, MI in 46, and Stroke in 31, respectively. The composite outcomes with all cause death, MI, and stroke occurred more frequently in the patients with the history/presence of cancer than those without (Figure A). However, the risk for cardiovascular death, MI, and stroke was similar between the two groups, and only non-cardiovascular mortality was significantly higher in the patients with the history/presence of cancer than those without (Figure B and C). Conclusion Among patients with ACS, the history/presence of cancer is associated with the risk of non-cardiovascular death, but not the risk for endothelial dysfunction and subsequent cardiovascular events. Figure 1 Funding Acknowledgement Type of funding source: None

Sign in / Sign up

Export Citation Format

Share Document