scholarly journals The correlation between traditional risk factors and the severity of acute coronary syndrome and long-term prognosis

2015 ◽  
Vol 6 (4) ◽  
pp. 6-10
Author(s):  
I. S Skopets ◽  
N. N Vezikova ◽  
I. M Marusenko ◽  
O. Yu Barysheva
Keyword(s):  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Family History ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
Life Threatening ◽  
Traditional Risk Factors ◽  
Long Term Prognosis

A number of studies demonstrate that patients with traditional risk factors (TRF) have not only increases primary risk of atherothrombotic events, but are also associated with many complicates and poor prognosis.Purpose: assessment of TRF effect on the incidence of complications and outcomes in patients with acute coronary syndrome (ACS).Materials and methods: in 255 patients hospitalized with ACS were retrospective determined the TRF prevalence, frequency of the complications and correlation between the presence of TRF and the risk of complications and long-term prognosis (follow-up 1 year).Results: patients had TRF very often, 80% patients had more than 3 TRFs. The presence of some TRFs (smoking, abdominal obesity, family history) was associated with a significantly increased risk of complications in patients with ACS, including life-threatening. Effect of TRF on long-term prognosis was not determined.Conclusion: the findings suggest the need to evaluation TRF not only in primary preventive and also to improve the effectiveness of risk stratification in patients with ACS.

scholarly journals Impact of Diabetes Mellitus on Antithrombotic Management Patterns and Long‐Term Clinical Outcomes in Patients With Acute Coronary Syndrome: Insights From the EPICOR Asia Study

2020 ◽  
Vol 9 (22) ◽  
Author(s):  
Shaoyi Guan ◽  
Xiaoming Xu ◽  
Yi Li ◽  
Jing Li ◽  
Mingzi Guan ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Acute Coronary Syndrome ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Antiplatelet Agents ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
Antithrombotic Management

Background Long‐term use of antiplatelet agents after acute coronary syndrome in diabetic patients is not well known. Here, we describe antiplatelet use and outcomes in such patients enrolled in the EPICOR Asia (Long‐Term Follow‐up of Antithrombotic Management Patterns in Acute Coronary Syndrome Patients in Asia) registry. Methods and Results EPICOR Asia is a prospective, observational study of 12 922 patients with acute coronary syndrome surviving to discharge, from 8 countries/regions in Asia. The present analysis included 3162 patients with diabetes mellitus (DM) and 9602 patients without DM. The impact of DM on use of antiplatelet agents and events (composite of death, myocardial infarction, and stroke, with or without any revascularization; individual components, and bleeding) was evaluated. Significant baseline differences were seen between patients with DM and patients without DM for age, sex, body mass index, cardiovascular history, angiographic findings, and use of percutaneous coronary intervention. At discharge, ≈90% of patients in each group received dual antiplatelet therapy. At 2‐year follow‐up, more patients with DM tended to still receive dual antiplatelet therapy (60% versus 56%). DM was associated with increased risk from ischemic but not major bleeding events. Independent predictors of the composite end point of death, myocardial infarction, and stroke in patients with DM were age ≥65 years and use of diuretics at discharge. Conclusions Antiplatelet agent use is broadly comparable in patients with DM and patients without DM, although patients with DM are more likely to be on dual antiplatelet therapy at 2 years. Patients with DM are at increased risk of ischemic events, suggesting an unmet need for improved antithrombotic treatment. Registration URL: https://www.clini​caltr​ials.gov ; Unique identifier: NCT01361386.

scholarly journals Evaluation of the long-term prognostic ability of triglyceride-glucose index for elderly acute coronary syndrome patients: a cohort study

2022 ◽  
Vol 21 (1) ◽  
Author(s):  
Yang Jiao ◽  
Yongkang Su ◽  
Jian Shen ◽  
Xiaoling Hou ◽  
Ying Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Adverse Events ◽  
World Population ◽  
Coronary Syndrome ◽  
Tyg Index ◽  
All Cause Mortality ◽  
The Mean ◽  
Traditional Risk Factors

Abstract Background With the advancement of the world population aging, more attention should be paid to the prognosis of elderly patients with acute coronary syndrome (ACS). Triglyceride-glucose (TyG) index is a reliable indicator of insulin resistance (IR) and is closely related to traditional risk factors of cardiovascular disease (CVD). However, the effect of TyG index on the prognosis of long-term adverse events in elderly ACS patients has not been reported. This study evaluated the prognostic power of TyG index in predicting adverse events in elderly ACS patients. Methods In this study, 662 ACS patients > 80 years old who were hospitalized from January 2006 to December 2012 were enrolled consecutively and the general clinical data and baseline blood biochemical indicators were collected. The follow-up time after discharge was 40–120 months (median, 63 months; interquartile range, 51‒74 months). In addition, the following formula was used to calculate the TyG index: Ln [fasting TG (mg/dL) × FBG (mg/dL)/2], and patients were divided into three groups according to the tertile of the TyG index. Results The mean age of the subjects was 81.87 ± 2.14 years, the proportion of females was 28.10%, and the mean TyG index was 8.76 ± 0.72. The TyG index was closely associated with the traditional risk factors of CVD. In the fully-adjusted Cox regression model, the Hazard ratio (95% CI) of all-cause mortality (in tertile 3) was 1.64 (1.06, 2.54) and major adverse cardiac event (MACE) (in tertile 3) was 1.36 (1.05, 1.95) for each SD increase in the TyG index. The subgroup analyses also confirmed the significant association of the TyG index and long-term prognosis. Conclusion The TyG index is an independent predictor of long-term all-cause mortality and MACE in elderly ACS patients.

Long-term prognosis

2018 ◽  
Author(s):  
Halvor Naess
Keyword(s):  
Risk Factors ◽  
Cerebral Infarction ◽  
First Year ◽  
Modified Rankin Scale ◽  
Annual Average ◽  
Long Term Follow Up ◽  
Traditional Risk Factors ◽  
Long Term Prognosis

Knowledge of prognosis is important for patients in the prime of life in order to make informed decisions about treatment, choice of education, and profession. Median first-year mortality after first-ever cerebral infarction among young adults is about 4% while median annual average mortality after the first year is about 1.7%. Likewise, median first-year recurrence rate of cerebral infarction is 2% and thereafter 1.5% per year. Risk factors for recurrent cerebral infarction include hypertension, diabetes mellitus, symptomatic atherosclerosis, and smoking. Recurrent cerebral infarction and mortality are associated with increasing number of traditional risk factors. About 10% of patients develop post-stroke seizures within 6 years of the acute stroke. Almost 90% of patients report good functional outcome (modified Rankin Scale score ≤2) on long-term follow-up, but up to 30–50% of patients do not resume employment. Many patients have cognitive impairment. Fatigue and depression are also common on long-term follow-up.

scholarly journals High-Sensitivity Troponin T vs I in Acute Coronary Syndrome: Prediction of Significant Coronary Lesions and Long-term Prognosis

2017 ◽  
Vol 63 (2) ◽  
pp. 552-562 ◽  
Author(s):  
Brede Kvisvik ◽  
Lars Mørkrid ◽  
Helge Røsjø ◽  
Milada Cvancarova ◽  
Alexander D Rowe ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Angiography ◽  
High Sensitivity ◽  
Coronary Syndrome ◽  
Prognostic Accuracy ◽  
All Cause Mortality ◽  
Coronary Lesions ◽  
Long Term Prognosis

Abstract BACKGROUND High-sensitivity cardiac troponin (hs-cTn) T and I assays are established as crucial tools for the diagnosis of acute myocardial infarction (AMI), as they have been found superior to old troponin assays. However, eventual differences between the assays in prediction of significant coronary lesions and long-term prognosis in patients with acute coronary syndrome (ACS) have not been fully unraveled. METHODS Serum concentrations of hs-cTnT (Roche), hs-cTnI (Abbott), and amino-terminal pro-B-type natriuretic peptide (NT-proBNP; Roche) in 390 non-ST-elevation (NSTE) ACS patients were evaluated in relation to significant coronary lesions on coronary angiography (defined as a stenosis >50% of the luminal diameter, with need for revascularization) and prognostic accuracy for cardiovascular mortality, all-cause mortality, as well as the composite end point of cardiovascular mortality and hospitalizations for AMI or heart failure. RESULTS The mean (SD) follow-up was 2921 (168) days. Absolute hs-cTnI concentrations were significantly higher than the hs-cTnT concentrations. The relationship between analyzed biomarkers and significant coronary lesions on coronary angiography, as quantified by the area under the ROC curve (AUC), revealed no difference between hs-cTnT [AUC, 0.81; 95% CI, 0.77–0.86] and hs-cTnI (AUC, 0.81; 95% CI, 0.76–0.86; P = NS). NT-proBNP was superior to both hs-cTn assays regarding prognostic accuracy for both cardiovascular and all-cause mortality and for the composite end point during follow-up, also in multivariate analyses. CONCLUSIONS The hs-cTnT and hs-cTnI assays displayed a similar ability to predict significant coronary lesions in NSTE-ACS patients. NT-proBNP was superior to both hs-cTn assays as a marker of long-term prognosis in this patient group.

The feasibility of a newly developed local network system for cardiac rehabilitation (the CR-GNet) in disease management and physical fitness after acute coronary syndrome

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
T Ando ◽  
T Watanabe ◽  
S Matsuo ◽  
T Samejima ◽  
J Yamagishi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Disease Management ◽  
Oxygen Uptake ◽  
Peak Oxygen Uptake ◽  
Coronary Risk Factors ◽  
Coronary Risk ◽  
Coronary Syndrome

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Grant-in-aid from.jpgu Prefecture Background The newly developed Cardiac Rehabilitation.jpgu Network (CR-GNet) has been implemented to create a regional alliance network and to provide periodic follow-up examinations to enhance the disease management in patients with cardiovascular disease. The effectiveness of a network like this support system has not yet been evaluated in Japan. Purpose We aimed to examine the feasibility of the CR-GNet in disease management, assisting patients in attaining physical fitness and its impact on long-term outcomes after acute coronary syndrome (ACS). Methods We enrolled 47 patients with ACS in the CR-GNet between February 2016 and September 2019; of these, 37, 29, and 21 patients underwent follow-up assessments for exercise capacity (peak oxygen uptake) at 3 months, 6 months, and 1 year after discharge, respectively. Major adverse cardiac events (MACE) were defined as the composite of death from cardiac causes, cardiac arrest, myocardial infarction, and rehospitalization due to unstable or progressive angina. MACE were compared with controls who were not registered in the CR-GNet. Results The coronary risk factors, except blood pressure, improved at 3 and 6 months, and 1 year after discharge. These risk factors in each patient significantly reduced from 2.9 at admission to 1.6, 1.4, and 1.9 at 3 months, 6 months, and 1 year after discharge (p < 0.05), respectively. Peak oxygen uptake was significantly higher at 3 months, 6 months, and 1 year after discharge to 17.5 ± 4.9 ml/kg/min, 17.9 ± 5.1 ml/kg/min, and 17.5 ± 5.5 ml/kg/min, respectively, than that at discharge (14.7 ± 3.6 ml/kg/min) (p < 0.05). During follow-up, there was no significant difference; MACE did not occur in any patients in the CR-GNet but occurred in controls. Conclusions The CR-GNet is a feasible option for long-term management of ACS patients. The prognostic impact of the CR-GNet needs further investigation with a larger sample size and longer follow-up. Table1 At admission 3 months 6 months 1 year Average number 2.9 1.6* 1.4** 1.9*** † Average number of coronary risk factors for all patients (n = 21) p = 0.004, vs. at admission; **p = 0.001, vs. at admission; ***p = 0.011, vs. at admission; †p = 0.035, vs. at 6 months

Association Between Metabolic Syndrome and All-Cause Mortality in Patients with Acute Coronary Syndrome: A Meta-Analysis

2021 ◽  
Author(s):  
Yong Yang ◽  
Haili Shen ◽  
Zhigeng Jin ◽  
Dongxing Ma ◽  
Qing Zhao ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Acute Coronary Syndrome ◽  
Hospital Mortality ◽  
Meta Analysis ◽  
Survival Outcome ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
All Cause Mortality

AbstractThe association between metabolic syndrome (MetS) and survival outcome after acute coronary syndrome (ACS) remains controversial. This meta-analysis sought to examine the association of MetS with all-cause mortality among patients with ACS. Two authors independently searched PubMed and Embase databases (from their inception to June 27, 2020) for studies that examined the association of MetS with all-cause mortality among patients with ACS. Outcome measures were in-hospital mortality and all-cause mortality during the follow-up. A total of 10 studies involving 49 896 ACS patients were identified. Meta-analysis indicated that presence of MetS was associated with an increased risk of long-term all-cause mortality [risk ratio (RR) 1.25; 95% CI 1.15–1.36; n=9 studies] and in-hospital mortality (RR 2.35; 95% CI 1.40–3.95; n=2 studies), respectively. Sensitivity and subgroup analysis demonstrated the credibility of the value of MetS in predicting long-term all-cause mortality. MetS is associated with an increased risk of long-term all-cause mortality among patients with ACS. However, additional studies are required to investigate the association of MetS with in-hospital mortality.

P6412The AKR1D1*36 (rs1872930) allelic variant is independently associated with adverse cardiac events during Clopidogrel treatment

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
P Ugurov ◽  
A Kapedanovska-Nestorovska ◽  
R A Rosalia ◽  
A Dimovski ◽  
Z K Mitrev
Keyword(s):  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Antiplatelet Therapy ◽  
Allelic Variant ◽  
Time To Event ◽  
P2y12 Inhibitor ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
Cyp2c19 Polymorphisms

Abstract Background The treatment of acute coronary syndrome (ACS) includes dual antiplatelet therapy (DAPT) comprising of aspirin and a P2Y12 inhibitor; clopidogrel is usually the P2Y12 inhibitor of choice in patients with ACS. However, its efficacy has been questioned because of the relatively high incidence of Major Adverse Cardiovascular and Cerebrovascular Events (MACCE) among ACS patients despite adherence to clopidogrel-DAPT. Several risk factors for MACCE following intervention in ACS patients have been described, among others, mutations in the CYP2C19 gene, a member of the cytochrome P450 (CYP450) network. The CYP2C19 enzyme is involved in the metabolism of clopidogrel Interindividual response variability to clopidogrel-DAPT and the increased risk for MACCE have been strongly linked to the CYP2C19*2 and CYP2C19*3 loss-of-function (LOF) allelic variants. Nonetheless, the known CYP2C19 polymorphisms fail to account for all adverse events related to clopidogrel insensitivity. Recent studies point to a putative role of the AKR1D1 gene as a trans-genetic regulator of the CYP450 network. The AKR1D1*36 (rs1872930) minor allelic variant was shown to augment hepatic CYP450 mRNA expression, consequently, increasing the CYP2C19 enzyme activity. To this end, we hypothesise that the AKR1D1*36 polymorphism contributes to the observed incidence of MACCE during clopidogrel antiplatelet therapy. Purpose To determine the association between the AKR1D1*36 (rs1872930) allele and MACCE in Acute Coronary Syndrome (ACS) patients on clopidogrel-DAPT Methods We evaluated 198 consecutive ACS patients indicated for coronary angiography from October to November 2010. We performed a 5-year retrospective medical record review and screened for AKR1D1 and CYP2C19 polymorphisms; 118 patients had a complete medical history and were included in the study. The study participants were prospectively followed for five years or until the first incidence of MACCE. The Median follow up time was 38.5 months (IQR 24–48 months) Results The median age of the cohort was 62.5 years (IQR 57–66), and 55% were females. Follow-up was complete, there were no mortality cases. ACS patients carrying the AKR1D1*36 had a significantly shorter event-free-survival compared to wildtype patients, Hazard Ratio = 2.193 [CI95% 1.091 to 4.406], p=0.0155 (Figure 1). Median time-to-event was 36 months. Evaluation of additional candidate risk predictors in a Cox Proportional Hazards Model confirmed the AKR1D1*36 allele as an independent risk factor (HR = 2.36; 95% CI, 1.34 to 4.18) and identified 3 additional risk factors for MACCE; previous percutaneous interventions (PCI), HR = 2.78; (95% CI, 1.34 to 5.78), a history of Myocardial Infarction, HR = 2.62; (95% CI, 1.48 to 4.64), at baseline and presence of the CYPC19*2 allele (HR = 2.33; 95% CI, 1.33 to 4.06). Figure 1. Time-to-Event curve of MACCE Conclusions The AKR1D1*36 (rs1872930) minor variant allele is independently associated with a higher risk for MACCE. Acknowledgement/Funding None

P0278CARDIOVASCULAR RISK FACTORS AND THE LONG TERM OUTCOME OF LUPUS NEPHRITIS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Marwa Omrane ◽  
Raja Aoudia ◽  
Mondher Ounissi ◽  
Soumaya Chargui ◽  
Mouna Jerbi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Renal Failure ◽  
Cardiovascular Risk ◽  
Lupus Nephritis ◽  
Cardiovascular Risk Factors ◽  
Increased Risk ◽  
Traditional Risk Factors

Abstract Background and Aims Systemic Lupus Erythematosus (SLE) is associated with an increased risk of cardiovascular morbidity and cardiovascular mortality. The risk of cardiovascular events is 1.3–2.7 times higher in SLE patients than in the general population, and even higher in patients with lupus nephritis (LN). Traditional risk factors as well as SLE-specific and treatment-related factors all contribute to the increased risk of cardiovascular disease. The primary aim of the present study was to evaluate cardiovascular risk factors, morbidity and mortality in patients with LN. Method This is a retrospective study of patients over the age of 16, with LN proved by kidney biopsy and followed up in our department over a period of 17 years. The diagnosis of lupus was made according to criteria of The American College of Rheumatology revised in 1997. Demographic, clinical and para-clinical data were collected from medical observations. Results We collected 155 women and 19 men with a sex ratio F / H of 8.2. The mean age at the time of the discovery of LN was 32.6 years [15-45 years]. Overall median follow-up time was 81.2 months. Renal symptomatology was dominated by proteinuria noted in all patients with an average proteinuria at 3.3 g / 24h, associated to a nephrotic syndrome in 68% of patients, hematuria was present in 69% of patients and renal failure was present in half of cases with an average serum creatinine of 110 µmol / l. At the time of diagnosis of LN, hypertension was noted in 48.9% of cases, diabetes in 2.8% of cases and obesity in 57.4% of cases with an index average body mass of 28.5 Kg / m2. Smoking was reported in 17.2% of the cases. The average cholesterol level was 5,5±2,1 mmol/l, the average triglycerid level was 2,5±1,1 mmol/. Antiphospholipid syndrome was found in 14.9% of cases. We performed 243 renal biopsies with 174 initial and 69 iterative biopsies. The histological lesions were polymorphic dominated by LN class IV (54.3%), arteriolosclerosis was observed in 47.7% and lesions of thrombotic microangiopathy in 29.8%. Corticosteroid therapy was prescribed in all patients combined with immunosuppressive therapy in 54.6% of cases. The overall survival of the patients at 10 years was 85%. During follow-up, cardiovascular complications found in our series were mainly strokes (6.3%) and coronary insufficiency (5.2%) and transient ischemic attack (6.9%). After a univariate analysis, the additional cardiovascular risk factors identified in our study were antiphospholipid syndrome (p = 0.01), renal failure (p = 0.01), long-term corticosteroid therapy (p = 0.009), the chronicity of the disease (evolution of lupus> 10 years) (p = 0.014), proliferative forms (p=0.001), arteriolosclerosis (p=0.0002) and lesions of thrombotic microangiopathy (p=0.018). Survival in patients without cardiovascular risk factors was better (96% vs 88%). Conclusion In conclusion, in addition to traditional risk factors SLE patients have several disease related risk factors that explain increase cardiovascular disease. A careful control for this risk factors is essential to continuously improve survival in SLE.

Abstract 1715: Prognosis of Patients Under Chronic Clopidogrel Therapy while Suffering an Acute Coronary Syndrome

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Laurent Bonello ◽  
Axel de Labriolle ◽  
Gilles Lemesle ◽  
Probal Roy ◽  
Daniel H Steinberg ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Cardiac Death ◽  
Major Adverse Cardiovascular Events ◽  
Coronary Syndrome ◽  
Clopidogrel Therapy ◽  
Artery Disease ◽  
Long Term Prognosis ◽  
Worse Prognosis

Background: Chronic clopidogrel therapy (CCT) has been shown to be beneficial in decreasing the frequency of major adverse cardiovascular events (MACE) in coronary artery disease. However, some patients suffer an acute coronary syndrome (ACS) despite CCT. Objective : To assess the prognosis of patients suffering an ACS while on CCT compared to patients naive to clopidogrel. Method: Retrospective analysis of propensity matched cohorts of patients undergoing PCI for an ACS was performed. Patients under CCT before the ACS were matched 1:2 with patients not under CCT before the ACS. The primary endpoint was a composite of cardiac death and myocardial infarction (MI) at 1-year follow-up. A cohort of 2325 patients undergoing PCI for an ACS was studied. Among them, 256 patients were taking CCT for > 1 month at the time of the ACS and 2069 weren’t taking clopidogrel prior to the ACS. After propensity score matching 1:2, the 2 groups included, respectively, 84 and 168 patients. Results: Patients in both groups had similar rates of previous MI (no CCT vs CCT 47.6 vs 48.8%; p = 0.86) or PCI (40.5 vs 40.5%; p = 1). There was no difference in drug use on discharge between the 2 groups; in particular for thienopyridines (94 vs 96.4%; p = 0.6). At 1-year follow-up, patients under CCT before the ACS exhibited a worse prognosis than patients who were not under CCT prior to the ACS, with a higher rate of cardiac death and MI (14.2 vs 5.5%; p = 0.015). Conclusions: This study suggests that patients suffering an ACS while under CCT have a poor long-term prognosis, which could be linked to clopidogrel low response.

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