scholarly journals Assessment of morbidity and fatal outcomes of Acute Coronary Syndrome in Scotland

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Grant Wyper ◽  
Samantha Alvarez-Madrazo ◽  
Kim Kavanagh ◽  
Martin Denvir ◽  
Marion Bennie
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Hospital Mortality ◽  
Secondary Care ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
Diagnostic Threshold ◽  
St Segment ◽  
One Year

ABSTRACTObjectivesThere have been a number of key changes in the clinical definition and diagnostic threshold of acute coronary syndromes in the last 10 years. We have characterised temporal and geographic changes in the incidence and outcomes following Acute Coronary Syndrome (ACS: Unstable Angina (UA), Non ST-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI)) between 2009 and 2013. Approach65,137 hospitals stays were identified involving ACS (ICD-10: I20.0, I21 and I22) relating to 55,369 individuals identified through secondary care primary diagnosis records during 2009-2013. All prior and subsequent secondary care diagnoses from 1981-2014 were sourced for these patients and records were deterministically matched on a pseudo patient identifier to obtain the cause and date of death for purposes of follow-up. An incident ACS case was defined as such if the patient had not suffered an ACS in the five years prior to the hospital admission and all co-morbidities were derived from hospital diagnostic codes accompanying the ACS codes. ResultsFor the entire cohort, patients with an incident ACS were predominantly male (61.5%) with mean age 68 (SD=13.7 years). Co-morbidities included: 65.5% Other Ischaemic Heart Disease; 5.2% Stroke; 7.5% Peripheral Artery Disease; 14.8% Atrial Fibrillation; 42.0% Hypertension; 18.0% Diabetes Mellitus and 8.4% Chronic Kidney Disease. The overall incidence of ACS in 2009 was 204/100,000 and fell by 8.1% to 188/100,000 in 2013. Subtypes of ACS comprised 9.4% UA, 50.9% NSTEMI, 29.0% STEMI and 10.8% MI unspecified in 2013. In-hospital mortality following an incident ACS was 9.7% (95% CI: 9.2-10.3%) in 2009 and varied from 7.9 to 19.0% across the NHS boards. In 2013, in-hospital mortality was 8.5% (95% CI: 7.9-9.0%) ranging from 4.5 to 10.5% across the NHS boards. One-year mortality following an incident ACS in 2009 was 18.6% (95% CI: 17.9-19.4%) falling to 16.8% (95% CI: 16.1-17.5%) in 2013. Stratified by NHS board, the one-year mortality rate in 2009 varied from 16.9 to 28.0% and in 2013 ranged from 11.9 to 20.0% across the NHS boards. ConclusionThese findings highlight the importance of a cohort based record linkage approach to routine healthcare datasets. While there appears to be changes in incidence of ACS and its subtypes and changes in mortality over time, these findings reflect significant changes in clinical practice with respect to definition and diagnosis. Cautious interpretation is needed combined with further research to fully understand the epidemiological implications of our findings.

scholarly journals Design and Rationale of Gulf locals with Acute Coronary Syndrome Events (Gulf Coast) Registry

2014 ◽  
Vol 8 (1) ◽  
pp. 88-93 ◽  
Author(s):  
Mohammad Zubaid ◽  
Khalid Bin Thani ◽  
Wafa Rashed ◽  
Alawi Alsheikh-Ali ◽  
Najib Alrawahi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Gulf Coast ◽  
Risk Profile ◽  
Gulf Region ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
One Year

Objectives: To describe the risk profile, management and one-year outcomes of patients hospitalized with acute coronary syndrome (ACS) in the Gulf region of the Middle East. Subjects and Methods: The Gulf locals with acute coronary syndrome events (Gulf COAST) registry is a prospective, multinational, longitudinal, observational, cohort-based registry of consecutive citizens, from the Gulf region of the Middle East, admitted from January 2012 to January 2013 to 29 hospitals with a diagnosis of ACS. Data entered online included patient demographics, cardiovascular risk profiles, past medical history, physical findings on admission, in-hospital diagnostic tests and therapeutic management, as well as one year outcomes. Results: 3188 patients were recruited. The mean age was 60.4 ± 12.6years (range: 22-112), 2104 (66%) were males and 1084 (34%) females. The discharge diagnosis was ST-segment elevation myocardial infarction (STEMI) in 741 (23.2%), new-onset left bundle branch block myocardial infarction (LBBBMI) in 30 (0.9%), non-ST-segment elevation myocardial infarction (NSTEMI) in 1486 (46.6%) and unstable angina in 931 (29.2%). At hospital presentation, 2105 (66%), 1779 (55.8%), 1703 (53.4%) and 740 (23.2%) had history of hypertension, dyslipidemia, diabetes mellitus and active smoking, respectively. Conclusion: Patients with ACS in our region are young with very high risk profile. The Gulf COAST registry is an example of successful regional collaboration and will provide information on contemporary management of ACS in the region.

scholarly journals Characteristics of In-Hospital Mortality among Patients with Acute Coronary Syndrome: A Single-Center Study in West Java, Indonesia

2021 ◽  
Vol 8 (2) ◽  
Author(s):  
Dennis Bonang Tessy ◽  
Miftah Pramudyo ◽  
Charlotte Johanna Cool
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Hospital Mortality ◽  
Class I ◽  
West Java ◽  
Killip Class ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Background: Acute Coronary Syndrome (ACS) is a severe manifestation of coronary artery disease, classified into unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI). In-hospital mortality in patients with ACS remains high despite the advancement of therapy. This study aimed to evaluate the characteristics of in-hospital mortality among ACS patients in West Java, Indonesia.Methods: This descriptive cross-sectional study analyzed retrospective secondary data of ACS patients who died during hospitalization in the period of July 2018 to June 2019 that were recorded in the ACS registry.Results: A total of 17 patients died during hospitalization in the study period. The mean age was 64.1 years, predominantly female (n=10). The prevalent diagnoses were STEMI (n=11) and NSTEMI (n=6). Interestingly, no patients had died from UA. Hypertension was the most frequent risk factor (11 of 17). Mortality among Killip Class I, II, III, and IV were 7, 5, 1, and 4 patients, respectively. The number of patients who died after underwent Percutaneous Coronary Intervention (PCI) was lower (n=6) than those who did not undergo PCI or those without revascularization (n=11).Conclusions: The incidence of in-hospital mortality with acute coronary syndrome is high in females, STEMI diagnosis, Killip Class I, and no revascularization.

scholarly journals Analysis of risk factors for different subtypes of acute coronary syndrome

2021 ◽  
Vol 49 (5) ◽  
pp. 030006052110083
Author(s):  
Lei Zhang ◽  
Juledezi Hailati ◽  
Xiaoyun Ma ◽  
Jiangping Liu ◽  
Zhiqiang Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Brain Natriuretic Peptide ◽  
Left Ventricular ◽  
St Segment Elevation ◽  
Amino Terminal ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Aims To investigate the different risk factors among different subtypes of patients with acute coronary syndrome (ACS). Methods A total of 296 patients who had ACS were retrospectively enrolled. Blood and echocardiographic indices were assessed within 24 hours after admission. Differences in risk factors and Gensini scores of coronary lesions among three groups were analyzed. Results Univariate analysis of risk factors for ACS subtypes showed that age, and levels of fasting plasma glucose, amino-terminal pro-brain natriuretic peptide, and creatine kinase isoenzyme were significantly higher in patients with non-ST-segment elevation myocardial infarction (NSTEMI) than in those with unstable angina pectoris (UAP). Logistic multivariate regression analysis showed that amino-terminal pro-brain natriuretic peptide and the left ventricular ejection fraction (LVEF) were related to ACS subtypes. The left ventricular end-diastolic diameter was an independent risk factor for UAP and ST-segment elevation myocardial infarction (STEMI) subtypes. The severity of coronary stenosis was significantly higher in NSTEMI and STEMI than in UAP. Gensini scores in the STEMI group were positively correlated with D-dimer levels (r = 0.429) and negatively correlated with the LVEF (r = −0.602). Conclusion Different subtypes of ACS have different risk factors. Our findings may have important guiding significance for ACS subtype risk assessment and clinical treatment.

Clots Kill: Hematologic Pharmacology for ST-Segment Elevation Myocardial Infarction

2012 ◽  
Vol 32 (6) ◽  
pp. 35-41
Author(s):  
Stacy H. James
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Antiplatelet Agents ◽  
Thrombin Inhibitors ◽  
Fibrinolytic Agents ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Drugs that work on the hematologic system play an important role in helping to limit the morbidity and mortality that can be associated with an acute coronary syndrome. The pharmacology of the fibrinolytic agents, thrombin inhibitors, and antiplatelet agents is described. A case study of a woman having an ST-segment elevation myocardial infarction is reviewed to highlight the importance of drugs that work on the hematologic system.

scholarly journals The prediction of cardiac events in patients with acute ST segment elevation myocardial infarction: A meta–analysis of serum uric acid

2018 ◽  
Vol 13 (1) ◽  
pp. 413-421
Author(s):  
Hailong Wang ◽  
Jianjun Yang ◽  
Jiang Sao ◽  
Jianming Zhang ◽  
Xiaohua Pang
Keyword(s):  
Myocardial Infarction ◽  
Uric Acid ◽  
Hospital Mortality ◽  
Serum Uric Acid ◽  
Meta Analysis ◽  
Systematic Analysis ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
One Year

AbstractObjectiveThe current study aimed to explore the predictive ability of serum uric acid (SUA) in patients suffering from acute ST segment elevation myocardial infarction (STEMI).MethodPubMed, EMBASE, Cochrane Library, and Medline databases were systematically searched from their respective inceptions to February 2018. Systematic analysis and random-effects meta–analysis of prognostic effects were performed to evaluate STEMI outcomes [i.e., in-hospital mortality, one-year mortality, in-hospital Major Adverse Cardiovascular Events (MACE)] in relation to SUA.ResultsA total of 12 studies (containing 7,735 patients with acute STEMI) were identified (5,562 low SUA patients and 3,173 high SUA patients). Systematic analysis of these studies showed that high SUA patients exhibited a higher incidence of in-hospital MACE (OR, 2.30; P < 0.00001), in-hospital mortality (OR, 3.03; P < 0.0001), and one-year mortality (OR, 2.58; P < 0.00001), compared with low SUA patients.ConclusionsAcute STEMI patients with high SUA exhibited an elevated incidence rate of in-hospital MACE, in-hospital mortality, and one-year mortality. Further randomized controlled trials will be needed to verify these results.

scholarly journals Factors Associated with In-hospital Mortality in Patients with Acute Coronary Syndrome

2015 ◽  
Vol 1 (2) ◽  
pp. 68-74 ◽  
Author(s):  
Andreea Barcan ◽  
Istvan Kovacs ◽  
Ciprian Blendea ◽  
Marius Orzan ◽  
Monica Chitu
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Culprit Lesion ◽  
Left Main ◽  
St Segment Elevation ◽  
Factors Associated ◽  
Coronary Syndrome ◽  
St Segment

Abstract Introduction: The recent development of large networks dedicated to ST-segment elevation myocardial infarction (STEMI) led to a significant increase in the number of primary percutaneous interventions (p-PCI) parallel with mortality reduction in Acute Coronary Syndrome (ACS). The number of non ST segment elevation myocardial infarction (NSTEMI) is increasing and the highest mortality rates are encountered in patients with cardiogenic shock and/or out of hospital cardiac arrest associated to ACS. The aim of this study was to identify the factors associated with a higher mortality rate in a global population with acute coronary syndromes presented in the emergency department of a county clinical hospital which serves as a regional center for a STEMI network. Material and method: This is a retrospective study including 684 patients with acute coronary syndrome admitted in the Clinic of Cardiology from the County Clinical Emergency Hospital Tîrgu Mureș in 2014. In all the cases, the factors that correlated with in hospital mortality were identified and analyzed. Results: The incidence of arterial hypertension was significantly higher in patients admitted with unstable angina (75.0%) and STEMI cases with less than 12 hours onset of symptomatology (68.1%), while impaired renal function correlated with the presence of NSTEMI (66.6%). The presence of a multivessel disease was significantly correlated with cardiogenic shock. The localisation of the culprit lesion in the left anterior descending artery (LAD) significantly correlated with the development of cardiogenic shock, LAD culprit lesions being present in 44.4% of CS cases as compared with 21.7% of noCS cases in STEMI patients. In NSTEMI patients, the localisation of the culprit lesion in the left main artery (LM) significantly correlated with the development of cardiogenic shock, culprit lesions in the left main being present in 47.0% of CS cases as compared with 28.5% of noCS cases in STEMI patients. Conclusion: Patients presenting with out-of-hospital resuscitated cardiac arrest due to Acute Myocardial Infarction associate higher in-hospital mortality rates. In-hospital mortality seems to be highly correlated with the female gender, STEMI myocardial infarction and the presence of multivascular lesions.

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