The meaning of early percutaneous coronary intervention in acute coronary syndrome with preserved ST elevation

Open Medicine ◽  
2009 ◽  
Vol 4 (3) ◽  
pp. 265-271 ◽  
Author(s):  
Magdalena Wierzbicka ◽  
Maciej Kośmider ◽  
Agata Bielecka-Dąbrowa ◽  
Jan Goch
Keyword(s):  
Acute Coronary Syndrome ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Coronary Intervention ◽  
Risk Of Death ◽  
Coronary Syndrome ◽  
St Elevation ◽  
Group 2 ◽  
Group 1

AbstractTo determine if delaying the primary precutaneous coronary intervention (PCI) for >6 hours for acute coronary syndrome with preserved ST elevation (STE-ACS) affects the PCI angiography effectiveness and clinical prognosis. The PCI was performed: for 71% of patients <6h (group 1), for 29% of patients >6h from the beginning of pain (group 2). For 1% of patients from group 1 and 3.4% of patients from group 2, no passage has been opened in the artery after STE-ACS. In spite of opening the passage mechanically, the phenomenon of lack of tissue reflow occurred in 2.7% of patients from group 1 and 12% of patients from group 2. Dangerous ventricular arrhythmias occurred more frequently in patients from group 2, including VF, asystole, haemodynamic complications classed 4° according to the Killip-Kimball scale and death. In an univariate logistic regression analysis, the following risk factors for death during the hospital phase were identified: delayed PCI >6 hours, 4° haemodynamic complications according to the Killip-Kimball scale, LVEF <40%, FV, p-k III block, TIMI <3, and no-reflow. In a multivariate logistic regression analysis, 4° according to the Killip-Kimball scale turned out to be the only risk factor for death during the hospital phase. Delaying PCI during STE-ACS for >6 hours significantly lowers the statistical chance to recover both full permeability and effective tissue reflow in the artery responsible for STE-ACS, which is connected with a significantly higher risk of serious complications, as well as with 8.5% risk of death during the hospital phase. The most significant, independent factor determining the survival of patients with STE-ACS after PCI is lack of cardiogenic shock.

P4624Predictive performance of CRUSADE bleeding score in non ST elevation acute coronary syndrome patients treated with ticagrelor versus clopidogrel

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L Graca Santos ◽  
F Montenegro Sa ◽  
C Ruivo ◽  
R Ribeiro Carvalho ◽  
J Correia ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Predictive Performance ◽  
Roc Curves ◽  
National Registry ◽  
Red Blood Cell Transfusion ◽  
Coronary Syndrome ◽  
St Elevation ◽  
Group 2 ◽  
Risk Categories ◽  
Group 1

Abstract Introduction CRUSADE score is commonly used for bleeding risk stratification in the context of acute coronary syndrome (ACS). However, the study validating it was performed before ticagrelor was available. Purpose To compare the predictive performance of CRUSADE score in two groups of non-ST elevation ACS (NSTEACS) patients, one treated with ticagrelor and another with clopidogrel. Methods Retrospective study of 2077 NSTEACS patients admitted between January 2014 and September 2017 and included in a multicentre national registry. Group 1 was composed by patients medicated with ticagrelor, and Group 2 with clopidogrel. Patients with bleeding history were excluded. The primary endpoint (PE) results from a composite which includes: in-hospital major bleeding (MB) according to the Registry criteria, need for red blood cell transfusion (RBCT), or haemoglobin drop ≥2g/dL (HbD). The groups were compared according to their demographic, clinical and laboratory characteristics. The occurrence of the PE (and its components) across CRUSADE risk categories was assessed by Chi-square for linear trend. The performance of CRUSADE score for PE prediction in each cohort was assessed by Receiver Operator Characteristics (ROC) curves. Results Group 1 included 662 (31.9%) and Group 2 1415 (68.1%) patients. Mean CRUSADE score was higher in Group 2 (23.1±14.7 versus (vs) 26.7±16.3, p=0.001). No difference was observed regarding the PE (14.8% vs 17.0%, p=0.200) and its components. With the exception of MB in Group 1 (p-trend=0.425), the relative occurrence of the PE and its components increased across CRUSADE risk categories [Figure 1. panel A]. In-hospital mortality was numerically superior in Group 2, but did not reach statistical significance (1.1% vs 1.6%, p=0.368). In both groups, the performance of CRUSADE score in predicting the PE was modest (Group 1 AUC=0.59 and p=0.006, Group 2 AUC=0.62 and p<0.001), and no difference was observed when comparing the two groups (P value for ROC curves comparison = 0.899) [Figure 1. panel B and C respectively]. Figure 1 Conclusion In this study based on a national registry of NSTEACS patients, the use of ticagrelor did not influence the occurrence of bleeding related events and it did not change the predictive performance of the CRUSADE score. According to this analysis, CRUSADE score may be applied without limitation to NSTEACS patients managed with ticagrelor.

scholarly journals Level of serum matrix metalloproteinase-9 in patients with acute coronary syndrome in Vietnam

2018 ◽  
Vol 15 (1) ◽  
pp. 15-21
Author(s):  
Đỗ Hữu Chí ◽  
Nguyễn Thị Minh Phương ◽  
Bùi Thị Huyền ◽  
Nguyễn Tiến Dũng ◽  
Phạm Đình Minh ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Matrix Metalloproteinase ◽  
Logistic Regression Analysis ◽  
Basement Membranes ◽  
Atherosclerotic Plaques ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment

Acute Coronary Syndrome (ACS) is one of the foremost causes of mortality and morbidity worldwide as well as Vietnam. ACS was evoked by rupture or erosion of atherosclerotic plaques that was divided into Non–ST-segment elevation Acute Coronary Syndrome (NSTEACS) and ST-segment elevation myocardial infarction groups (STEMI). The matrix metalloproteinase (MMPs) is an enzyme family with fucntioning in the degradation of extracellular matrix and disruption of basement membranes. Of the MMPs, MMP-9 is expressed in the atherosclerotic plaques and plays a key role in the rupture of vulnerable atherosclerotic plaques. In this work, we measured the serum MMP-9 level in 205 patients with acute coronary syndrome (including 103 of NSTE-ACS and 102 of STEMI patients) and 101 healthy participants by sandwich Elisa method. The results showed that the MMP-9 level was significantly higher in NSTE-ACS and STEMI compared to the control group (208.59 ± 100.47 ng/mL, 189.98 ± 112.81 ng/mL vs 168.50 ± 79.52 ng/mL, respectively, P=0.014). However, a logistic regression analysis indicated that the MMP-9 level was only significantly higher in patients with NSTE ACS (OR= 1.0048, CI 95%= 1.000-1.009; P= 0.018). The serum MMP-9 level is correlated with traditional risk factors such as glucose, Cholesterol and Triglyceride by multiple logistic regression analysis. Conclusion: Our study suggests that the serum MMP-9 level is significantly associated with the NSTEACS and is a potential marker for dianogsis of ACS in the Vietnamese patients

Can free PSA be used as a biomarker in biochemical recurrence after surgery to predict castrate resistant prostate cancer?

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 177-177
Author(s):  
Hanan Goldberg ◽  
Ally Hoffman ◽  
Teck Sing Woon ◽  
Zachary William Abraham Klaassen ◽  
Thenappan Chandrasekar ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Median Survival ◽  
Logistic Regression Analysis ◽  
Biochemical Recurrence ◽  
Multivariable Logistic Regression Analysis ◽  
Group 2 ◽  
Castrate Resistant ◽  
Group 1

177 Background: PSA produced from prostate cancer (PC) cells escapes proteolytic processing, resulting in a more complexed PSA and a lower %fPSA. Higher %fpsa correlates with lower PC risk. However, the role of fPSA in biochemical recurrence (BCR) after radical prostatectomy (RP) is unknown. Methods: All patients who had BCR after RP and at least one fPSA test, were included. Patients were stratified according to the %fPSA cut-off of 0.15. Multivariable logistic regression analysis was performed to predict covariates associated with a higher %fPSA. Results: A total of 81 men with BCR were found (Table 1). Interestingly, 20% (group 1) vs. 60% (groups 2) become castrate resistant (CRPC), p<0.0001 and the time to reach CRPC state was much shorter in group 2 (33.5 months) vs. group 1 (57.9 months), p=0.05. Additionally, 60% of group 2 patients vs. 32.5% of group 1 patients developed metastasis, p=0.014. Lastly, median survival of 193 months for group 2 patients with no median survival for group 1, Log Rank test p=0.023. Multivariable logistic regression analysis demonstrated that secondary Gleason score of 5 (compared to 3) and %fPSA>0.15 predicted CRPC status (OR 11.63, CI 95% 1.38-97.4, p=0.024, OR 7.99, CI 95% 2-31.95, p=0.003, respectively). Conclusions: %fPSA>0.15 in the setting of BCR confers a more aggressive disease, manifesting in a faster development of CRPC, metastasis and death. Our findings suggest a reversal in the significance of % fPSA values in BCR patients, and should be validated in larger cohorts. [Table: see text]

scholarly journals The Threshold of Admission Glycemia as a Predictor of Adverse Events in Diabetic and Non-Diabetic Patients with Acute Coronary Syndrome

2009 ◽  
Vol 3 ◽  
pp. CMC.S2289 ◽  
Author(s):  
Taysir S. Garadah ◽  
Salah Kassab ◽  
Qasim M. Al-Shboul ◽  
Abdulhai Alawadi
Keyword(s):  
Acute Coronary Syndrome ◽  
Adverse Events ◽  
Diabetic Patients ◽  
Stress Hyperglycemia ◽  
Coronary Syndrome ◽  
History Of ◽  
Group 3 ◽  
Group 2 ◽  
High Level ◽  
Group 1

Recent studies indicated a high prevalence of hyperglycemia in non-diabetic patients presenting with acute coronary syndrome (ACS). However, the threshold of admission glucose (AG) as a predictor of adverse events in ACS is unclear. Objective The aim of this study was to assess the threshold of admission glucose (AG) as a predictor of adverse events including Major Acute Cardiac Events (MACE) and mortality, during the first week of admitting patients presenting with ACS. Material and Methods The data of 551 patients with ACS were extracted and evaluated. Patients were stratified according to their blood glucose on admission into three groups: group 1: <7 mmol/L (n = 200, 36.3%) and group 2: >7 mmol/L and <15 mmol/L (n = 178, 32.3%) and group 3: ≥15 mmol/L (n = 173, 31.4%). Stress hyperglycemia was arbitrarily defined as AG levels > 7 mmol/L (group 2 and 3). Patients with ACS were sub-divided into two groups: patients with unstable angina (UA, n = 285) and those with ST segment elevation myocardial Infarction (STEMI, n = 266) and data were analyzed separately using multiple regression analysis. Results The mean age of patients was 59.7 ± 14.8 years and 63% were males. The overall mortality in the population was 8.5% (5.4% in STEMI and 3.1% in UA) patients. In STEMI patients, the odds ratio of stress hyperglycemia as predictor of mortality in group 3 compared with group 1 was 3.3 (CI 0.99-10.98, P < 0.05), while in group 2 compared with group 1 was 2.4 (CI: 0.75-8.07, P = 0.065) after adjustment for age and sex. Similarly, in UA patients, the odds ratio of stress hyperglycemia in group 3 compared with group 1 was 2.7 (CI 0.37-18.98, P < 0.05), while in group 2 compared with group 1 was 2.4 (CI: 0.4-15.2, P = 0.344) after adjustment for age and sex. The incidence of more than 2 MACE in both STEMI and UA patients was higher in group 3 compared with the other two groups. Regression analysis showed that history of DM, high level of LDL cholesterol, high level of HbA1c, and anterior infarction were significant predictors of adverse events while other risk factors such as BMI, history of hypertension and smoking were of no significance. Conclusion This study indicates that the stress hyperglycemia on admission is a powerful predictor of increased major adverse events and hospital mortality in patients with acute coronary syndrome.

scholarly journals Long-Term Clinical Outcomes for Non-ST Elevation Acute Coronary Syndrome Patients with High-Risk Angiographic Findings Undergoing Percutaneous Coronary Intervention

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Sida Jia ◽  
Ce Zhang ◽  
Yue Liu ◽  
Deshan Yuan ◽  
Xueyan Zhao ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
High Risk ◽  
Coronary Intervention ◽  
Coronary Anatomy ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
Angiographic Findings

Objective. We aim to evaluate the long-term prognosis of non-ST elevation acute coronary syndrome (NSTE-ACS) patients with high-risk coronary anatomy (HRCA). Background. Coronary disease severity is important for therapeutic decision-making and prognostication among patients presenting with NSTE-ACS. However, long-term outcome in patients undergoing percutaneous coronary intervention (PCI) with HRCA is still unknown. Method. NSTE-ACS patients undergoing PCI in Fuwai Hospital in 2013 were prospectively enrolled and subsequently divided into HRCA and low-risk coronary anatomy (LRCA) groups according to whether angiography complies with the HRCA definition. HRCA was defined as left main disease >50%, proximal LAD lesion >70%, or 2- to 3- vessel disease involving the LAD. Prognosis impact on 2-year and 5-year major adverse cardiovascular and cerebrovascular events (MACCE) is analyzed. Results. Out of 4,984 enrolled patients with NSTE-ACS, 3,752 patients belonged to the HRCA group, while 1,232 patients belonged to the LRCA group. Compared with the LRCA group, patients in the HRCA group had worse baseline characteristics including higher age, more comorbidities, and worse angiographic findings. Patients in the HRCA group had higher incidence of unplanned revascularization (2 years: 9.7% vs. 5.1%, p<0.001; 5 years: 15.4% vs. 10.3%, p<0.001), 2-year MACCE (13.1% vs. 8.8%, p<0.001), and 5-year death/MI/revascularization/stroke (23.0% vs. 18.4%, p=0.001). Kaplan–Meier survival analysis showed similar results. After adjusting for confounding factors, HRCA is independently associated with higher risk of revascularization (2 years: HR = 1.636, 95% CI: 1.225–2.186; 5 years: HR = 1.460, 95% CI: 1.186–1.798), 2-year MACCE (HR = 1.275, 95% CI = 1.019–1.596) and 5-year death/MI/revascularization/stroke (HR = 1.183, 95% CI: 1.010–1.385). Conclusion. In our large cohort of Chinese patients, HRCA is an independent risk factor for long-term unplanned revascularization and MACCE.

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