scholarly journals Clinical characteristics, risk factors and angiographic profile of acute coronary syndrome patients in a tertiary care center of Nepal.

2019 ◽  
Vol 16 (1) ◽  
pp. 27-32 ◽  
Author(s):  
Abhishesh Shakya ◽  
Sunil Chandra Jha ◽  
Ratna Mani Gajurel ◽  
Chandra Mani Poudel ◽  
Ravi Sahi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
St Elevation Myocardial Infarction ◽  
Coronary Syndrome ◽  
Vessel Disease ◽  
St Elevation ◽  
Artery Disease

Background and Aims: Acute coronary syndrome (ACS) refers to a group of clinical symptoms consistent with new onset or worsening ischemic symptoms. ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI) and unstable angina (UA) are the three types of ACS. The objectives were to study the risk factors prevalence, angiographic distribution and severity of coronary artery stenosis in ACS among patients admitted in Cardiology Department of Manmohan Cardiothoracic Vascular and Transplant Center (MCVTC). Methods: This is a restrospective study of 419 ACS patients admitted and treated in MCVTC from November 2017 to October 2018. Patients were divided into STEMI, NSTEMI and UA then analyzed for various risk factors, angiographic patterns and severity of coronary artery disease. Results: Mean age of presentation was 59.3Å}12.8 years. Majority were male 317(75.7%). Most patients had STEMI 252 (60.1%) followed by NSTEMI 98 (23.4%) and UA 69 (16.5 %). Risk factors: smoking was present in 241 (57.5%), hypertension in 212 (50.6%), diabetes in 144 (34.4%), dyslipidemia in 58 (13.8%). Single-vessel disease was present in 34.6 % patients, double- vessel disease was present in 27.44 % patients and triple vessel disease was present in 26.3 % patients, left main disease in 1.4 % patients. Normal coronaries were present in 6.4% patients and minor coronary artery disease in 3.8 % patients. Conclusions: STEMI was the most common presentation. Three quarters of ACS were male patients. Smoking was most prevalent risk factor. Single vessel involvement was the most common CAG finding in all spectrum of ACS. Diabetic patients had more multivessel disease.

scholarly journals Neutrophil Phenotypes in Coronary Artery Disease

2020 ◽  
Vol 9 (5) ◽  
pp. 1602
Author(s):  
Patrick Maréchal ◽  
Julien Tridetti ◽  
Mai-Linh Nguyen ◽  
Odile Wéra ◽  
Zheshen Jiang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Plasma Levels ◽  
Stable Coronary Artery Disease ◽  
St Elevation Myocardial Infarction ◽  
Multivariable Logistic Regression Analysis ◽  
Coronary Syndrome ◽  
St Elevation ◽  
Artery Disease

Clinical evidence indicates that innate immune cells may contribute to acute coronary syndrome (ACS). Our prospective study aimed at investigating the association of neutrophil phenotypes with ACS. 108 patients were categorized into chronic stable coronary artery disease (n = 37), unstable angina (UA) (n = 19), Non-ST-Elevation Myocardial Infarction (NSTEMI) (n = 25), and ST-Elevation Myocardial Infarction (STEMI) (n = 27). At the time of inclusion, blood neutrophil subpopulations were analysed by flow cytometry. Differential blood cell count and plasma levels of neutrophilic soluble markers were recorded at admission and, for half of patients, at six-month follow-up. STEMI and NSTEMI patients displayed higher neutrophil count and neutrophil-to-lymphocyte ratio than stable and UA patients (p < 0.0001), which normalized at six-month post-MI. Atypical low-density neutrophils were detected in the blood of the four patient groups. STEMI patients were characterized by elevated percentages of band cells compared to the other patients (p = 0.019). Multivariable logistic regression analysis revealed that plasma levels of total myeloperoxidase was associated with STEMI compared to stable (OR: 1.434; 95% CI: 1.119–1.837; P < 0.0001), UA (1.47; 1.146–1.886; p = 0.002), and NSTEMI (1.213; 1.1–1.134; p = 0.0001) patients, while increased neutrophil side scatter (SSC) signal intensity was associated with NSTEMI compared to stable patients (3.828; 1.033–14.184; p = 0.045). Hence, changes in neutrophil phenotype are concomitant to ACS.

scholarly journals Coronary artery disease: Acute coronary syndrome

2010 ◽  
pp. 45-70
Author(s):  
Juan Carlos Kaski
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
St Elevation Myocardial Infarction ◽  
Atheromatous Plaque ◽  
Coronary Syndrome ◽  
Plaque Disruption ◽  
Prevention Therapy ◽  
St Elevation ◽  
Artery Disease

Background 46 Management of ST elevation myocardial infarction (STEMI) 48 Non-ST elevation myocardial infarction (NSTEMI) 52 Unstable angina 52 Therapeutic agents 56 Drugs for secondary prevention therapy after ACS 66 Further reading 70 Acute coronary syndrome (ACS) encompasses a spectrum of disorders resulting from severe acute myocardial ischaemia. The most common pathogenic mechanism is acute intracoronary thrombosis resulting from atheromatous plaque disruption or erosion. Platelet activation, thrombosis, and coronary vasoconstriction are all important pathogenic mechanisms in ACS....

scholarly journals Relationship between the Severity of Coronary Artery Disease and Cardiovascular Risk Factors in Acute Coronary Syndrome: Based on Tehran Heart Center’s Data Registry

2021 ◽  
Author(s):  
Negar Omidi ◽  
Saeed Sadeghian ◽  
Mojtaba Salarifar ◽  
Arash Jalali ◽  
Seyed Hesameddin Abbasi ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Family History ◽  
Gensini Score ◽  
Coronary Syndrome ◽  
Artery Disease

Background: Acute coronary syndrome (ACS) is one of the main causes of mortality worldwide. We sought to evaluate the correlation between the severity of coronary artery disease (CAD) and conventional coronary artery risk factors in a large cohort of patients with ACS. Methods: This study included all patients admitted to the coronary care unit with a diagnosis of ACS between 2003 and 2017. The patients were divided into 2 groups: 1) unstable angina and 2) myocardial infarction. The aims of this study were to evaluate the effects of the risk factors and extension of coronary artery stenosis in patients with ACS according to the Gensini score. Results: Of a total 40 319 patients who presented with ACS, 18 862 patients (mean age =60.4±11.14 y, male: 67.2%) underwent conventional coronary angiography and met our criteria to enter the final analysis. The median of the Gensini score was 50 (25–88) in the study population. The multivariable analysis showed that age, sex, diabetes mellitus, hypertension, dyslipidemia, family history, cigarette smoking, opium consumption, and myocardial infarction increased the risk of positive Gensini scores. All the aforementioned risk factors, except cigarette smoking and opium consumption, increased the severity of stenosis in those with positive Gensini scores. The strongest relationship was seen vis-à-vis myocardial infarction, sex, and diabetes mellitus. Conclusion: Our findings suggest that age, sex, diabetes mellitus, dyslipidemia, hypertension, family history, and myocardial infarction have significant effects on the severity of CAD. The obesity paradox in relation to CAD should be taken into consideration and needs further investigation in patients with ACS.

scholarly journals Caronary Artery Disease in Women

2014 ◽  
Vol 15 (2) ◽  
pp. 135-140
Author(s):  
NS Neki
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Cardiovascular Disease ◽  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Coronary Disease ◽  
Coronary Syndrome ◽  
Artery Disease ◽  
Prevalent Form

Coronary artery disease (CAD) - which includes coronary atherosclerotic disease, myocardial infarction (MI), acute coronary syndrome and angina - is the most prevalent form of cardiovascular disease and is the largest subset of this mortality. Coronary artery disease (CAD) is a leading cause of death of women and men  worldwide. CAD’s impact on women traditionally has been underappreciated due to higher rates at younger ages in men. Microvascular coronary disease disproportionately affects women. Women have unique risk factors for CAD, including those related to pregnancy and autoimmune disease.DOI: http://dx.doi.org/10.3329/jom.v15i2.20687 J MEDICINE 2014; 15 : 135-140

scholarly journals A Study on Angiographic profile of Acute Coronary Syndrome in Smokers

2020 ◽  
Vol 3 (1) ◽  
pp. 32-41
Author(s):  
Hemasundar Korrapati ◽  
B.V. Narayana Reddy ◽  
Supraja Chegireddy
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Killip Class ◽  
Medical College ◽  
Coronary Syndrome ◽  
Vessel Disease ◽  
Artery Disease ◽  
Type 3

Background: Coronary artery disease is a devastating disease precisely because an otherwise healthy person in the prime of life may die or become disabled without warning. The objectives were to study the clinical profile, risk factors prevalence, angiographic distribution and severity of coronary artery stenosis in acute coronary syndrome (ACS) patients admitted in Cardiology Department of Cardiology Katuri Medical College & Hospital, Guntur.Subjects and Methods:A total of 208 patients of ACS were analyzed for various risk factors, angiographic patterns and severity of coronary artery disease in smokers vs non-smokers at Katuri Medical College, Andhra Pradesh.Results:Study group consisted of 208 subjects, of which 108(51.9%) subjects were smokers including all forms of tobacco use and 100(48.1 Out of 108 study subjects in  the  smokers group, family history of CAD  was present in 21(19.4%) subjects. Killip class is not applicable to 13 (12%) study groups as they presented with Unstable Angina with ECG changes. Killip class 1 was most common presentation (67.6%) in smokers. 28 patients (25.9%) had LV dysfunction with EF < 50% by echocardiography. 80 patients (74.1%) had normal LV function. The mean EF was 55.56+/-10.16%. The median EF was 56.5%. LAD was type 3 in 100 (92.6%) patients and type 4 in 8 (7.4%) patients   out of 108 study subjects.LAD type 3 was statistically significant with P value < 0.05 when compared with LAD type 4. No statistically significant difference was seen with respect to the Normal coronary arteries as CAG diagnosis between smokers and non-smokers(6.7% versus 8%,p>0.1,Not significant).Conclusion: Smokers were predominantly male and around 3 years younger than non-smokers. Diabetes mellitus and hypertension were less common among smokers and single-vessel disease was the more common angiographic finding for smokers as compared to 3-vessel disease for non-smokers. ST-segment elevation myocardial infarction in smokers despite younger age and the low atherosclerotic risk profile, in our region, emphasize the need for nicotine addiction management and smoking cessation campaigns at large and for pre-discharge counseling.

scholarly journals Prevalence of Conventional Risk Factors in ST Segment Elevation Myocardial Infarction Patients in Shahid Gangalal National Heart Centre, Nepal

1970 ◽  
Vol 52 (195) ◽  
pp. 914-919 ◽  
Author(s):  
Chandra Mani Adhikari ◽  
Dipanker Prajapati ◽  
Bibek Baniya ◽  
Sudhir Regmi ◽  
Amrit Bogati ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
St Elevation Myocardial Infarction ◽  
Inferior Wall ◽  
Common Diagnosis ◽  
St Elevation ◽  
Artery Disease ◽  
Conventional Risk Factors

Introduction: Smoking, diabetes mellitus, hypertension, and dyslipidemia are labelled as conventional risk factors for coronary artery disease. Prevalence of these risk factors varies across populations. This study aimed to assess the prevalence of these conventional risk factors in patients, who were discharged from our hospital, with the diagnosis of ST elevation myocardial infarction. Methods: Medical records of 495 ST elevation myocardial infarction patients discharged from our centre in between January 2012 to December 2012 were retrospectively reviewed to evaluate the prevalence of conventional risk factors. Results: Clear dominance (75%) of male patients was seen. Inferior wall myocardial infarction (29.9%) was the most common diagnosis followed by anterior wall myocardial infarction (25.1%). Hypertension (65%), smoking (57.8%) and dyslipidemia (45.5%) were the most common risk factors. Diabetes (31.1%) was the least common. Prevalence of hypertension, dyslipidemia was similar among male and female. Smoking was statistically common in male (76.8%vs 49.5%),though diabetes was common in female (36.5%vs.29.3%) not statistically significant. Conclusions: Conventional risk factors are common among ST elevation myocardial infarction patients. Early detection and treatment of these risk factors play a vital role for the prevention of coronary artery disease. Much more focus should be stressed on preventive programs throughout the country. Keywords: coronary artery disease; diabetes; dyslipidemia; hypertension; smoking; ST elevation myocardial infarction.

Cardiac surgery

2016 ◽  
Author(s):  
Maria Kisiel ◽  
Alison Smith
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Treatment Options ◽  
Signs And Symptoms ◽  
St Elevation Myocardial Infarction ◽  
Surgical Interventions ◽  
Coronary Syndrome ◽  
St Elevation ◽  
Artery Disease

Coronary heart disease is caused by the build-up of atherosclerotic plaques which, over time, narrow the lumen of the coronary arteries. Acute coronary syndrome describes a spectrum of conditions caused by coronary artery disease; these are unstable angina, ST-elevation myocardial infarction (STEMI), and non-ST-elevation myocardial infarction (NSTEMI). Coronary artery disease is the leading cause for cardiac surgical interventions, but other causes are hypertension, valve disease, arrhythmias, cardiomyopathies, infections, and congenital abnormalities. This chapter provides an overview of the signs and symptoms of these conditions, as well as the diagnosis and treatment options available.

scholarly journals Management of multivessel coronary artery disease in patients with non-ST-elevation myocardial infarction: a complex path to precision medicine

2020 ◽  
Vol 11 ◽  
pp. 204062232093852
Author(s):  
Angus A. W. Baumann ◽  
Aashka Mishra ◽  
Matthew I. Worthley ◽  
Adam J. Nelson ◽  
Peter J. Psaltis
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Stable Coronary Artery Disease ◽  
St Elevation Myocardial Infarction ◽  
Complete Revascularization ◽  
Multivessel Coronary Artery Disease ◽  
Coronary Syndrome ◽  
St Elevation ◽  
Artery Disease

Recent analyses suggest the incidence of acute coronary syndrome is declining in high- and middle-income countries. Despite this, overall rates of non-ST-elevation myocardial infarction (NSTEMI) continue to rise. Furthermore, NSTEMI is a greater contributor to mortality after hospital discharge than ST-elevation myocardial infarction (STEMI). Patients with NSTEMI are often older, comorbid and have a high likelihood of multivessel coronary artery disease (MVD), which is associated with worse clinical outcomes. Currently, optimal treatment strategies for MVD in NSTEMI are less well established than for STEMI or stable coronary artery disease. Specifically, in relation to percutaneous coronary intervention (PCI) there is a paucity of randomized, prospective data comparing multivessel and culprit lesion-only PCI. Given the heterogeneous pathological basis for NSTEMI with MVD, an approach of complete revascularization may not be appropriate or necessary in all patients. Recognizing this, this review summarizes the limited evidence base for the interventional management of non-culprit disease in NSTEMI by comparing culprit-only and multivessel PCI strategies. We then explore how a personalized, precise approach to investigation, therapy and follow up may be achieved based on patient-, disease- and lesion-specific factors.

scholarly journals Etiology of Acute Coronary Syndrome after Noncardiac Surgery

2018 ◽  
Vol 128 (6) ◽  
pp. 1084-1091 ◽  
Author(s):  
Mohammad A. Helwani ◽  
Amit Amin ◽  
Paul Lavigne ◽  
Srikar Rao ◽  
Shari Oesterreich ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Noncardiac Surgery ◽  
St Elevation Myocardial Infarction ◽  
Coronary Syndrome ◽  
St Elevation ◽  
Artery Disease

Abstract Background The objective of this investigation was to determine the etiology of perioperative acute coronary syndrome with a particular emphasis on thrombosis versus demand ischemia. Methods In this retrospective cohort study, adult patients were identified who underwent coronary angiography for acute coronary syndrome within 30 days of noncardiac surgery at a major tertiary hospital between January 2008 and July 2015. Angiograms were independently reviewed by two interventional cardiologists who were blinded to clinical data and outcomes. Acute coronary syndrome was classified as ST–elevation myocardial infarction, non–ST–elevation myocardial infarction, or unstable angina; myocardial infarctions were adjudicated as type 1 (plaque rupture), type 2 (demand ischemia), or type 4b (stent thrombosis). Results Among 215,077 patients screened, 146 patients were identified who developed acute coronary syndrome: 117 were classified as non–ST–elevation myocardial infarction (80.1%); 21 (14.4%) were classified as ST–elevation myocardial infarction, and 8 (5.5%) were classified as unstable angina. After coronary angiography, most events were adjudicated as demand ischemia (type 2 myocardial infarction, n = 106, 72.6%) compared to acute coronary thrombosis (type 1 myocardial infarction, n = 37, 25.3%) and stent thrombosis (type 4B, n = 3, 2.1%). Absent or only mild, nonobstructive coronary artery disease was found in 39 patients (26.7%). In 14 patients (9.6%), acute coronary syndrome was likely due to stress-induced cardiomyopathy. Aggregate 30-day and 1-yr mortality rates were 7 and 14%, respectively. Conclusions The dominant mechanism of perioperative acute coronary syndrome in our cohort was demand ischemia. A subset of patients had no evidence of obstructive coronary artery disease, but findings were consistent with stress-induced cardiomyopathy.

Sex disparities in completeness of revascularisation and outcomes in patients with ST-elevation myocardial infarction and multivessel coronary artery disease

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N Mahdi ◽  
B Har ◽  
M.M Graham ◽  
A Basha ◽  
A Bizios
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
St Elevation Myocardial Infarction ◽  
Multivessel Coronary Artery Disease ◽  
Risk Of Death ◽  
Coronary Syndrome ◽  
St Elevation ◽  
Artery Disease ◽  
Complete Revascularisation

Abstract Background In patients with ST-elevation myocardial infarction (STEMI) and multivessel coronary artery disease (CAD), complete revascularisation is associated with reduced mortality compared to culprit only revascularisation. However, there are limited data regarding the relationship between sex and revascularisation strategy in STEMI with multivessel CAD and outcomes. Purpose Our aim is to evaluate sex related differences in treatment strategies and outcomes in patients with STEMI and multi-vessel CAD. Methods We included all consecutive patients from a provincial registry presenting with STEMI and multivessel CAD treated with percutaneous coronary intervention (PCI) from 2008–2015. The study population consisted of 856 females and 3152 males who were treated with culprit vessel only PCI or complete revascularisation using staged-PCI. The outcomes were death, admission for acute coronary syndrome (ACS), and admission for heart failure (HF). Multivariate Cox proportional hazard models were used to examine the association between treatment strategy and outcomes. Backward stepwise logistic regression was used to identify predictors of patients undergoing staged-PCI versus culprit vessel only PCI. Results At 3 years, the incidence of death was higher in females than males (15.9% vs. 8.2%, p&lt;0.001), as were HF admissions (10.3% vs. 5.0%, p&lt;0.001). Females underwent less staged-PCI than males (10.4% vs. 14.8%; adjusted odds ratio 0.75; 95% CI 0.57–0.97). Younger age and increasing Duke jeopardy score were also associated with performing staged-PCI. After adjusting for baseline characteristics, females had a higher risk of death (HR 1.35; 95% CI 1.07–1.71), ACS admission (HR 1.27; 95% CI 1.00–1.60), and HF admission (HR 1.38; 95% CI 1.03–1.85). Following additional adjustment for revascularisation strategy, only death and HF admission remained significant. Females undergoing staged-PCI had similar survival to males (figure), with no significant interaction between revascularisation strategy and sex (p for interaction = 0.19) Conclusion Females with STEMI and multivessel CAD were less likely to be treated with complete revascularisation by staged-PCI and had worse outcomes when compared to males. Survival in both males and females treated with staged-PCI was similar. Our study suggests that addressing the lack of complete revascularisation in females presenting with STEMI may improve outcomes. Figure 1 Funding Acknowledgement Type of funding source: None

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