scholarly journals Thyroid profile as a marker of poor prognostic factor in patients with acute coronary syndrome: a tertiary care hospital based observational study

2018 ◽  
Vol 15 (1) ◽  
pp. 39-41 ◽  
Author(s):  
Navaraj Paudel ◽  
Vijay Madhav Alurkar ◽  
Ramchandra Kafle ◽  
Abhishek Maskey ◽  
Subash Sapkota
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Unstable Angina ◽  
Tertiary Care ◽  
Care Hospital ◽  
Hormonal Changes ◽  
Poor Prognostic Factor ◽  
Coronary Syndrome ◽  
St Segment ◽  
Significant Difference

Background and aims: Serum thyroid hormonal changes can occur in acute or chronic non-thyroidal systemic illness including acute coronary syndrome in otherwise euthyroid individuals. In this study we aimed to assess thyroid hormonal profile in patients presenting with acute coronary syndromes (ACS) and compare between ST segment elevated myocardial infarction and unstable angina/Non ST segment elevated myocardial infarction.Methods: A hospital based, retrospective, observational comparative study was designed. Data of all patients with acute coronary syndrome presenting to hospital were collected from July 2015 through June 2017 in a pre-structured proforma and analyzed.Results: A total of 200 ACS patients between 23 years to 88 years with mean age of 61.33 ± 12.30 years were studied. One hundred and twenty seven (63.5%) were males. Among them 116 (58%) was ST segment elevated myocardial infarction (STEMI) patients while 84 (42%) were unstable angina/ non-ST elevated myocardial infarction (UA/ NSTEMI) patients. Total 47 (23.5%) patients had abnormal TFT of which 28(59.5%) had Euthyroid Sick Syndrome, 12(25.5%) had subclinical hypothyroidism, 5(10.6%) had subclinical hyperthyroidism and 2(4.25%) had low fT4 with normal fT3 and normal TSH. There was significant difference in TFT in patients with STEMI and UA/NSTEMI (P=0.006).There were higher rates of heart failure (p= 0.001 & 0.003 in STEMI & UA/NSTEMI respectively), longer length of hospital stay (3+0.17 days) and high mortality (more than 4 fold) in all types of ACS patients with abnormal TFT than ACS patients with normal TFT.Conclusion: There is higher prevalence of abnormal thyroid hormonal findings in ACS causing significant morbidity and mortality.

Abstract 14415: Management, Characteristics, and Outcomes of Patients With Acute Coronary Syndrome in a Developing Country

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Muhammed K Elfaituri ◽  
Mohamed Abrahim Bin Zarti ◽  
Hazem Abdelkarem Faraj ◽  
Ahmed Khaled ◽  
Mohammed Abdulhameed Zendah ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Hospital Mortality ◽  
Unstable Angina ◽  
Developing Country ◽  
Tertiary Care ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Care Hospital ◽  
Coronary Syndrome

Introduction: Acute coronary syndrome (ACS) encompasses a variety of coronary artery disorders involving myocardial infarction with ST-segment-elevation (STEMI), unstable angina (UA), and myocardial infarction with non-ST elevation (NSTEMI). Hypothesis: To gain insight into the epidemiology, evaluation, in-hospital treatment, and commitment to current management guidance of ACS for patients admitted to a tertiary care hospital in a developing country. Methods: We performed a retrospective observational study of 50 consecutive patients presenting with ACS between October 2019 and December 2019, and followed for in-hospital mortality at a tertiary care general medical unit. We collected and analysed patient reports on presentation, treatment, in-hospital mortality, and major adverse cardiovascular events (MACE). Results: Patients diagnosed with ACS had a mean (SD) age of 59.3 (13.1) years, and were predominantly men (58%). Alcohol and drug consumption, smoking, and morbid obesity were significantly associated with STEMI (P < 0.05). Discharge diagnoses included STEMI (40%), NSTEMI, and unstable angina. Mean (SD) duration of hospital stay was 5.5 (5.8) days. Left ventricular ejection fraction (LVEF) was below 40% in 28% of patients, with a mean (SD) LVEF of 46.0 (15.3) ml. Median time (interquartile range) from the onset of pain to hospital admission was 80 (423) minutes for STEMI and 138 (480) minutes for NSTEMI (P > 0.05). About 72% of patients were admitted to the cardiac intensive care unit, and 34% of STEMI patients received a fibrinolytic. All patients received anti-platelet drugs. MACE were identified in 16.3% of STEMI patients and 10.6% of NSTEMI patients. Body mass index, history of cardiac disease, longer hospital duration, diabetes, and hypertension were significant predictors of in-hospital MACE. All patients were discharged and alive at the study end. All patients received standard of care treatment after discharge. Conclusions: Delays in the delivery and application of thrombolytic are coronary therapy require attention in developing countries to improve the care of patients with ACS.

Abstract 2602: Elevated Serum Neopterin Levels and Adverse Cardiac Events in Patients with Non-ST-Segment Elevation Acute Coronary Syndrome

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Juan Carlos Kaski ◽  
Luciano Consuegra-Sanchez ◽  
Daniel J. Fernandez-Berges ◽  
Jose M Cruz-Fernandez ◽  
Xavier Garcia-Moll ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Unstable Angina ◽  
Elevated Serum ◽  
Cardiac Events ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Adverse Cardiac Events ◽  
Elevation Acute Coronary Syndrome

Objectives: We sought to assess whether plasma neopterin predicts adverse clinical outcomes in patients with NSTEACS. Background: Circulating C reactive protein (CRP), a marker of inflammation, correlates with events in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). High neopterin levels - a marker of macrophage activation - predict cardiovascular events in stable angina patients but their prognostic role in NSTEACS has not been systematically evaluated. Methods: We prospectively assessed 397 patients (74 % men) admitted with NSTEACS: 169 (42.5%) had unstable angina and 228 (57.5%) non-ST-segment elevation myocardial infarction (NSTEMI). Blood samples for neopterin and CRP assessment were obtained at admission. TIMI risk score was also assessed among other clinical and biochemical variables. The study end point was the composite of cardiac death, acute myocardial infarction and recurrent angina at 180-days. Results: Baseline neopterin concentrations (nmol/L) were similar in unstable angina and NSTEMI patients (8.3 [6.5–10.6] vs 8.0 [6.2–11.1], p = 0.54). Fifty-nine patients (14.9 %) had events during follow-up (highest third (%) 21.5 vs 1 st and 2 nd thirds 11.5, log rank 7.341, p = 0.007). On multivariable hazard Cox regression, only neopterin (highest vs 1 st and 2 nd thirds, HR 2.15, 95 % CI [1.21–3.81]) was independently associated with the combined endpoint.CRP levels, however, were not significantly different in patients with events compared to those without events (adjusted HR = 0.98, p = 0.89, 95% CI 0.80 –1.21). Conclusion: Increased neopterin levels are an independent predictor of 180-day adverse cardiac events in patients with NSTEACS.

scholarly journals High-Sensitivity Cardiac Troponin T for Early Prediction of Evolving Non–ST-Segment Elevation Myocardial Infarction in Patients with Suspected Acute Coronary Syndrome and Negative Troponin Results on Admission

2010 ◽  
Vol 56 (4) ◽  
pp. 642-650 ◽  
Author(s):  
Evangelos Giannitsis ◽  
Meike Becker ◽  
Kerstin Kurz ◽  
Georg Hess ◽  
Dietmar Zdunek ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Unstable Angina ◽  
Predictive Value ◽  
Cardiac Troponin ◽  
Troponin T ◽  
High Sensitivity ◽  
Cardiac Troponin T ◽  
Coronary Syndrome ◽  
St Segment

Abstract Background: We sought to determine the diagnostic performance of the new high-sensitivity cardiac troponin T (hs-cTnT) assay for early detection of non–ST-segment myocardial infarction (NSTEMI) in patients with acute coronary syndrome. Methods: We enrolled patients with retrospectively confirmed unstable angina or NSTEMI and an initially negative cTnT concentration and compared the performance of baseline concentrations and serial changes in concentration within 3 and 6 h. Percentage change criteria included ≥20% δ change and ROC-optimized value. Results: Based on the standard fourth-generation cTnT result of ≥0.03 μg/L, an evolving NSTEMI was diagnosed in 26 patients, and 31 patients were classified as having unstable angina. With the use of the hs-cTnT assay at the 99th-percentile cutoff, the percentage of NSTEMI cases detected increased gradually from 61.5% on presentation to 100% within 6 h, and the overall number of MI diagnoses increased by 34.6% (35 vs 26 cases). A δ change ≥20% or ≥ROC-optimized value of &gt;117% within 3 h or ≥243% within 6 h yielded a specificity of 100% at sensitivities between 69% and 76%. The standard cTnT at the 99th percentile was less sensitive than hs-cTnT for early diagnosis of MI on presentation, and follow-up samples obtained within the initial 3 h demonstrated very low specificity of cTnT compared with hs-cTnT. Conclusions: The high-sensitivity cTnT assay increases the number of NSTEMI diagnoses and enables earlier detection of evolving NSTEMI. A doubling of the hs-cTnT concentration within 3 h in the presence of a second concentration ≥99th percentile is associated with a positive predictive value of 100% and a negative predictive value of 88%.

scholarly journals Presentation, Treatment and Outcomes of Acute Coronary Syndrome in a Tertiary Care Hospital in Central Nepal

2015 ◽  
Vol 2 (4) ◽  
pp. 11-14
Author(s):  
Murari Prasad Barakoti ◽  
S R Regmi ◽  
B M Dhital
Keyword(s):  
Acute Coronary Syndrome ◽  
Hospital Mortality ◽  
Unstable Angina ◽  
Treatment Options ◽  
Tertiary Care ◽  
Antiplatelet Agents ◽  
Coronary Intervention ◽  
Care Hospital ◽  
Adverse Cardiovascular Event ◽  
Coronary Syndrome

INTRODUCTION: Nepal is facing with increasing rate of coronary artery disease, yet little is known about presentation, treatment and outcome of this disease in our population and our setting. We aimed to document the characteristics in consecutive cases in a tertiary level hospital.  MATERIAL AND METHODS: Seventy eight total cases were documented in six months period and evaluated the data on presentation, management, in-hospital mortality and non-fatal adverse cardiovascular event (MACE).  RESULTS: Mean (SD) age at presentation was 65 (13) years and did not differ among acute coronary syndrome (ACS) types (STEMI= 23%, Non ST Elevation Myocardial Infarction (NSTEMI)= 28%, UA= 49%). ACS is still a disease prevalent in >50 years of age (88%). Dual antiplatelet agents and statin were used >90% cases and coronary angiography was performed in ~50% cases. Unstable angina patients has significantly higher number of normal coronaries or non- critical stenosis. Percutaneous coronary intervention rates were significantly higher among STEMI admissions (38% vs 22 % vs 13%, P= 0.003). Unadjusted in-hospital mortality rate was 11%, significantly higher than NSTEMI (5%) and UA (5%). Non-fatal major MACE rate including reinfarction, heart failure or cardiogenic shock was also high in STEMI and NSTEMI patients than in unstable angina patients.  CONCLUSION: This study represents contemporary practice of ACS care and provides opportunity to improve care for symptom recognition, treatment options and medical therapy.DOI: http://dx.doi.org/10.3126/jucms.v2i4.12036Journal of Universal College of Medical Sciences (2014) Vol.02 No.04 Issue 08Page: 11-14

scholarly journals Immature Platelet Fraction (IPF) Levels in Acute Coronary Syndrome (ACS) Patients

2021 ◽  
Vol 8 (8) ◽  
pp. 682-688
Author(s):  
Enna Berkah Sari ◽  
Nizam Zikri Akbar ◽  
Herman Hariman
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Angina Pectoris ◽  
Unstable Angina ◽  
Unstable Angina Pectoris ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Immature Platelet Fraction

Background: Acute Coronary Syndrome (ACS) is a major cardiovascular problem because it causes high hospital admissions and mortality rates. Acute Coronary Syndrome is divided into 3 (three), namely: unstable angina pectoris (UAP), myocardial infarction without ST segment elevation (NSTEMI), and myocardial infarction with ST segment elevation (STEMI). In addition to changes in biomarkers of heart injury, the platelet index (IPF = immature platelet fraction) will also change the level difference between STEMI with NSTEMI/UAP. Objective: To determine the differences in IPF levels of ACS patients with STEMI and NSTEMI/UAP Method: Observational analytic with cross sectional approach. The subjects of this study were 80 patients who came to the emergency installation of integrated heart center Emergency Room Haji Adam Malik Hospital Medan from May 2019 to September 2019 and was diagnosed with ACS (STEMI or NSTEMI/UAP). The sample in the study was the patient's venous blood and put it in an EDTA tube, then immediately checked the IPF value/level using the automatic hematology analyzer. Patients with heart failure or patients with thrombocytopenia were not included in this study. Results: In this study, the demographic characteristics of the ACS patients based on gender were male 77.5% STEMI and 87.5% NSTEMI/UAP while women 22.5% STEMI and 12.5% ​​NSTEMI/UAP. The results of the STEMI patient's IPF levels Compared with NSTEMI/UAP, the median is 6.2 (3.5-16.8) VS 2.9 (0.7-12) with a p-value of 0.0001. Conclusion: The characteristics of ACS patients based on the results of sex were that there were more men with NSTEMI/UAP than those with STEMI. There was a significant difference in the IPF levels of STEMI with NSTEMI/UAP. Keywords: Immature Platelet Fraction (IPF), Acute Coronary Syndrome (ACS), ST-Segment Elevation Myocardial Infarction (STEMI), Non ST-Segment Elevation Myocardial Infarction (NSTEMI), Unstable Angina Pectoris (UAP).

scholarly journals Dyslipidemia and Conventional Risk Factors in Patients with Acute Coronary Syndrome Admitted in a CCU of a Tertiary Care Hospital of Bangladesh

2021 ◽  
Vol 14 (1) ◽  
pp. 24-29
Author(s):  
Md Mahfuzur Rahman ◽  
Farid Uddin Ahmed ◽  
Sanjida Sharmin ◽  
Tanvir Hyder ◽  
Saifuddin Nehal
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Risk Factor ◽  
Tertiary Care ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Conventional Risk Factors

Background: Coronary artery disease (CAD) is the single largest cause of death in the developed countries and is one of the leading causes of disease burden in developing countries. The prevalence of dyslipidemia and conventional risk factors profile at the time of admission in patients with Acute Coronary Syndrome (ACS) is not well described in our context. The aim of this study was to investigate the prevalence of dyslipidemia and conventional risk factors profiles of patients with ACS in a tertiary care center of Bangladesh. Methods: This descriptive cross-sectional study included 96 admitted patients of ACS [30 cases of Unstable Angina, 25 cases of Non ST segment Elevation Myocardial Infarction and 41 cases of ST segment Elevation Myocardial Infarction] from the Department of Cardiology, Abdul Malek Ukil Medical College Hospital, Noakhali, Bangladesh from January 2019 to June 2019. Fasting serum lipid profile was obtained within 24 hours of hospitalization and demographic and other cardiovascular risk factors were documented. Results: The mean age of the subjects were 57.7±14.4 years with majority (71.9%) being male. The most frequent reported risk factor was smoking, present in 55.2% of patients, followed by hypertension (47.9%), diabetes (37.5%), dyslipidemia (27.1%) and family history of CAD (15.6%). Based on Body Mass index 50% patients were obese (≥25kg/m2) and 69.8% had central obesity based on waist circumference. The lipid profile analysis revealed that 99% of patients had some type of dyslipidemia, and the most frequent was high level of triglyceride and low levels of high-density lipoprotein cholesterol (68.8% of cases in each). Conclusion: Dyslipidemia is a significant risk factor in patients with ACS and high TG and low HDL-C were more prevalent. Careful attention to its management may help to reduce further events. Cardiovasc j 2021; 14(1): 24-29

scholarly journals Trends and in-hospital mortality of Acute Coronary Syndrome at Shahid Gangalal National Heart Centre, Kathmandu, Nepal during 2001-2012

2014 ◽  
Vol 3 (1) ◽  
pp. 23-26
Author(s):  
Chandra Mani Adhikari ◽  
Deewakar Sharma ◽  
Rabi Malla ◽  
Sujeeb Rajbhandari ◽  
Roshan Raut ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Hospital Mortality ◽  
Unstable Angina ◽  
St Elevation Myocardial Infarction ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
National Heart ◽  
St Segment ◽  
St Elevation

Background and aims: Acute coronary syndrome (ACS), which comprises acute ST-segment elevation myocardial infarction, non-ST segment elevation myocardial infarction and unstable angina is a major health problem and represents a large number of hospitalizations annually worldwide. We aim to describe pattern of the ACS admission and in-hospital mortality at tertiary national heart centre of the country. Methods: A hospital database was used to analyze all 7424 patients admitted in coronary care unit of the centre for ACS from September 2001 till December 2012. We evaluated trend of ACS admission and in-hospital mortality. Results: Five thousand three hundred ninety one (72.6%) were male and two thousand thirty three (27.4%) were female. Patient of 21years to 98 years were admitted for ACS .Four thousand five hundred and ninety nine(61.9%) patient were admitted due to ST elevation myocardial infarction, whereas one thousand nine hundred and thirteen (25.8%) were admitted for Unstable angina and nine hundred twelve (12.3%) were admitted for Non ST elevation myocardial infarction. In-hospital mortality was 5.74% for acute coronary syndrome. There was significant difference in in-hospital mortality between ST elevation myocardial infarction (7.76%), Non ST segment elevation acute coronary syndrome (3.61%) and Unstable Angina (1.88%).There is a gradual increase in Primary Percutaneous Coronary intervention as a mode of reperfusion therapy whereas there is a decrease in the rate of thrombolysis. Conclusion: Our study provides us some important information about the trend and in-hospital mortality rate in national heart centre. Though it is a single centre study can provide us the insight of the ACS outcome. DOI: http://dx.doi.org/10.3126/jaim.v3i1.10698 Journal of Advances in Internal Medicine 2014;03(01):23-26

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