Characteristic of the coronary vascular system, structural and functional state of the heart and endothelium-dependent vasodilation in young patients with acute coronary syndrome and ST elevation

The aim – to reveal features of the coronary vascular system, structural and functional state of the heart and endothelium-dependent vasodilatation in ST-elevation acute coronary syndrome (STEMI) patients of different age groups. Materials and methods. We analyzed the data of instrumental examination of patients who were admitted to the emergency departments from 2000 to 2015, with STEMI. Patients were distributed into two groups depending on age: 1 group – patients < 45 years, 2 group ≥ 45 years. Coronary angiography (CAG) was performed within the first hours after the admission. Endothelium-dependent, flow-mediated vasodilation (FMD) test and echocardiography were performed within 24 hours of admission and again on the 7th day. Results and discussion. According to сoronary angiography, elder patients were more likely to have infarction-dependent coronary artery disease (33.3 vs. 20.3 %; p=0.037), and multi-vessel coronary artery disease (12.0 vs. 4.8 %; p=0.048). Patients in the 1st group demonstrated a lower frequency of hemodynamically significant lesions of coronary vessels (p<0.001) and less marked disorders of the lipid spectrum. Patients of the group 1 had less thickness of the interventricular septum. 10.7±1.5 mm versus 11.6±1.6 mm, p=0.024). Young patients had initially better diastolic function (Е/А) (1.29±0.40 versus 1.00±0.52, p=0.008). At day 7 in patients of the 1st group there was a more marked increase in the left ventricular ejection fraction and end-diastolic diastolic index of the left ventricle (7.6 versus 3.4 %; p<0.05) than in the patients of the 2nd group. Young patients demonstrated a tendency to increase of end-diastolic index > 10 %, in dynamics, at 39.7 versus 27.8 % elder patients (p=0.053), lower growth of the diameter of the brachial artery (4.7±4.1 vs. 6.7±5.1 %; p<0.05), but more rapid improvement of endothelial function in the dynamics of observation (104 vs. 23 %; p<0.05). Conclusions. The percentage of damage of coronary artery disease in STEMI young patients did not differ from elder patients but insignificant coronary artery stenosis is detected more often (р<0.001) and acute myocardial infarction in the right coronary artery is less common (р<0.037). Young patients with multi-vessel coronary disease have significant violations of the lipid blood spectrum (increased levels of total cholesterol, low density lipoprotein cholesterol). Indicators of intracardiac hemodynamic did not differ between age groups initially, however, the course of acute myocardial infarction in young patient was characterized by the tendency to develop early post-infarction dilatation (p=0.053). According to the FMD test young patients at the onset had a worse indicator of than elder patients (p<0.043), however the diameter of the brachial artery in the dynamics of observation, significantly increased (p<0.05).

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Neutrophil Phenotypes in Coronary Artery Disease

Journal of Clinical Medicine ◽

10.3390/jcm9051602 ◽

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.

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

Nepalese Heart Journal ◽

10.3126/njh.v16i1.23895 ◽

2019 ◽

Vol 16 (1) ◽

pp. 27-32 ◽

Cited By ~ 1

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.

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Cardiac surgery

10.1093/med/9780199642663.003.0026 ◽

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.

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

Therapeutic Advances in Chronic Disease ◽

10.1177/2040622320938527 ◽

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.

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

European Heart Journal ◽

10.1093/ehjci/ehaa946.1745 ◽

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<0.001), as were HF admissions (10.3% vs. 5.0%, p<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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