scholarly journals Presentation, Management Practices and In-hospital Outcomes of Patients with Acute Coronary Syndrome in a Tertiary Cardiac Centre in Bangladesh

2018 ◽  
Vol 32 (2) ◽  
pp. 106-113
Author(s):  
Fathima Aaysha Cader ◽  
M Maksumul Haq ◽  
Sahela Nasrin ◽  
CM Shaheen Kabir
Keyword(s):  
Myocardial Infarction ◽  
Management Practices ◽  
Bypass Graft ◽  
Left Ventricular ◽  
St Elevation Myocardial Infarction ◽  
Treatment Modalities ◽  
Interventional Treatment ◽  
Hospital Outcomes ◽  
Coronary Syndrome ◽  
St Elevation

Background: There is no large-scale data on the management practices and in-hospital outcomes of acute coronary syndromes (ACS) in Bangladesh. This study aimed to document the presentation characteristics, treatment practices and in-hospital outcomes of ACS patients presenting to a specialized tertiary cardiac care institute in Bangladesh.Methods: This retrospective observational study included all ACS patients presenting to Ibrahim Cardiac Hospital & Research Institute (ICHRI), Dhaka, Bangladesh, over the period of January 2013 to December 2013. Data were collected from hospital discharge records and catheterization laboratory database, and analysis was carried out using Statistical Package for Social Sciences (SPSS) version 16.0 (Chicago, Illinois, USA).Result: A total of 1914 ACS patients were included. The mean age was 57.8 ± 12.1 years. 71.4% were male. 39.8% presented with ST-elevation myocardial infarction (STEMI), 39.7% with non- ST-elevation myocardial infarction (NSTEMI) and 20.5% presented with unstable angina (UA). 68.91% were diabetic, 74.24% hypertensive, 53.23% were dyslipidaemic, 25.75% were smokers and 20.72% had chronic kidney disease (CKD).1022 (53.4%) of all admitted ACS patients underwent coronary angiography, among whom 649 (33.9%) were advised percutaneous coronary intervention (PCI), and 198 (10.3%) and 207 (10.8%) were advised coronary artery bypass graft (CABG) surgery and medical management respectively. PCI was performed in 509 patients (26.6%)during the index admission. The majority of these patients were those of STEMI (39.23%), among whom 47 (6.2%) underwent primary PCI. 146 (7.6%) of the patients presenting with ACS expired during hospital stay. Mortality was highest among STEMI (10.5%), followed by NSTEMI (8.3%) and UA (1%). 501 (26.2%) patients developed left ventricular failure, 108 (5.6%) patients developed shock and 265 (13.8%) developed acute kidney injury.Conclusion: This study represents one of the larger single-centre analyses of ACS patients in Bangladesh thus far. Our patients have high prevalence of cardiovascular risk factors, particularly diabetes and hypertension. There is room for further improvement in terms of guideline-directed medical and interventional treatment modalities, in order to improve outcomes.Bangladesh Heart Journal 2017; 32(2) : 106-113

P6256Revascularisation for acute coronary syndrome: are we offering elderly patients the correct treatment?

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Al-Othman ◽  
Y Zheng ◽  
N Malik
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Intervention Group ◽  
St Elevation Myocardial Infarction ◽  
P Value ◽  
Coronary Syndrome ◽  
St Elevation ◽  
One Year

Abstract Purpose Acute coronary syndrome (ACS) is treated with revascularisation procedures such as percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG). Whilst reasonable clinical exclusion criteria exist, age is not one of them and patients of advanced years have been shown to have better outcomes with both treatments than with medical management. We set out to investigate the management and outcomes of patients age seventy five and over, with ACS. Methods A retrospective data analysis of all patients age seventy five and above, prescribed dual antiplatelet therapy (DAPT - aspirin plus clopidogrel or aspirin plus ticagrelor), admitted to our institution over a one year period (April 2015 to April 2016). We analysed electronic records and discharge documents and excluded patients without a diagnosis of ACS. Results 207 patients over 75 years old were treated for ACS; 83.6% (173) were diagnosed with non ST elevation myocardial infarction (NSTEMI), 9.6% (20) diagnosed with ST elevation myocardial infarction (STEMI) and 6.8% (14) diagnosed with unstable angina. 73.4% (152) of patients were managed medically, 14.5% (30) had an angiogram, 11.1% (23) had PCI and 1.0% (2) had CABG. 74.0% (153) of patients were treated with aspirin plus clopidogrel, 26.0% (54) with aspirin plus ticagrelor. Major bleeds were reported in 21 patients (10.1%), 18 of the medically managed patients (8.7%) and 3 in the intervention group (5.5%) (P value 0.30). There were 17 major bleeds in the aspirin and clopidogrel group (11.1%) and 4 in the aspirin and ticagrelor group (7.4%) (P value 0.60). 93 (61.2%) of the medically treated group were alive at one year compared to 47 (85.5%) of the intervention group (P value 0.0008). Conclusion Our data show a clear survival benefit in the intervention group, although comparisons between the groups are challenging given confounding factors, such as co-morbidities and patient preference. However, the high proportion (73.4%) of over 75-years old treated medically warrants further evaluation, given the evidence of benefit for patients in this age group, treated with PCI. We feel there is a need for further research in to the ideas and practice surrounding the management of ACS in the over 75's, and their relation to the available evidence.

scholarly journals Utility of shock index in 24,636 patients presenting with acute coronary syndrome

2019 ◽  
Vol 9 (6) ◽  
pp. 546-556 ◽  
Author(s):  
Ayman El-Menyar ◽  
Khalid F Al Habib ◽  
Mohammad Zubaid ◽  
Alawi A Alsheikh-Ali ◽  
Kadhim Sulaiman ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Hospital Mortality ◽  
Left Ventricular ◽  
St Elevation Myocardial Infarction ◽  
Shock Index ◽  
Coronary Syndrome ◽  
High Shock ◽  
St Elevation

Background: Shock index is a bedside reflection of integrated response of the cardiovascular and nervous systems. We aimed to evaluate the utility of shock index (heart rate/systolic blood pressure) in patients presenting with acute coronary syndrome (ACS). Methods: We analyzed pooled data from seven Arabian Gulf registries; these ACS registries were carried out in seven countries (Qatar, Bahrain, Kuwait, UAE, Saudi Arabia, Oman and Yemen) between 2005 and 2017. A standard uniform coding strategy was used to recode each database using each registry protocol and clinical research form. Patients were categorized into two groups based on their initial shock index (low vs. high shock index). Optimal shock index cutoff was determined according to the receiver operating characteristic curve (ROC). Primary outcome was hospital mortality. Results: A total of 24,636 ACS patients met the inclusion criteria with a mean age 57±13 years. Based on ROC analysis, the optimal shock index was 0.80 (83.5% had shock index <0.80 and 16.5% had shock index ≥0.80). In patients with high shock index, 55% had ST-elevation myocardial infarction and 45% had non-ST-elevation myocardial infarction. Patients with high shock index were more likely to have diabetes mellitus, late presentation, door to electrocardiogram >10 min, symptom to Emergency Department > 3 h, anterior myocardial infarction, impaired left ventricular function, no reperfusion post-therapy, recurrent ischemia/myocardial infarction, tachyarrhythmia and stroke. However, high shock index was associated significantly with less chest pain, less thrombolytic therapy and less primary percutaneous coronary intervention. Shock index correlated significantly with pulse pressure ( r= −0.52), mean arterial pressure ( r= −0.48), Global Registry of Acute Coronary Events score ( r =0.41) and Thrombolysis In Myocardial Infarction simple risk index ( r= −0.59). Shock index ≥0.80 predicted mortality in ACS with 49% sensitivity, 85% specificity, 97.6% negative predictive value and 0.6 negative likelihood ratio. Multivariate regression analysis showed that shock index was an independent predictor for in-hospital mortality (adjusted odds ratio (aOR) 3.40, p<0.001), heart failure (aOR 1.67, p<0.001) and cardiogenic shock (aOR 3.70, p<0.001). Conclusions: Although shock index is the least accurate of the ones tested, its simplicity may argue in favor of its use for early risk stratification in patients with ACS. The utility of shock index is equally good for ST-elevation myocardial infarction and non-ST-elevation acute coronary syndrome. High shock index identifies patients at increased risk of in-hospital mortality and urges physicians in the Emergency Department to use aggressive management.

scholarly journals Coronary artery ectasia presenting with ST-elevation myocardial infarction in a young indigenous man: a case report

2020 ◽  
Vol 4 (5) ◽  
pp. 1-5
Author(s):  
John Lee ◽  
Satish Ramkumar ◽  
Nancy Khav ◽  
Benjamin K Dundon
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Incidental Finding ◽  
Bypass Graft ◽  
St Elevation Myocardial Infarction ◽  
Coronary Artery Ectasia ◽  
Indigenous Australian ◽  
Coronary Syndrome ◽  
First Case ◽  
St Elevation

Abstract Background Coronary artery ectasia (CAE) is often an incidental finding on angiography, however, patients can present with acute coronary syndrome due to a large thrombus burden requiring treatment with percutaneous coronary intervention or with emergency surgery. Case summary A 26-year-old Indigenous Australian male was admitted with anterior ST-elevation myocardial infarction associated with an out of hospital ventricular fibrillation arrest. Coronary angiography demonstrated thrombotic occlusion of the proximal left anterior descending (LAD) artery with heavy thrombus burden and prominent vascular ectasia of all three coronary arteries. He was managed with surgical thrombectomy and coronary artery bypass graft of his LAD. Discussion This is the first case of triple CAE in an Indigenous Australian. The case highlights the lack of consensus approach in the management of CAE due to paucity of prospective studies.

scholarly journals Clinical profile of ST-elevation myocardial infarction patients from a tertiary care hospital in Northern India

2021 ◽  
Author(s):  
Prakhar Kumar ◽  
Shazia Durdana
Keyword(s):  
Myocardial Infarction ◽  
Cardiogenic Shock ◽  
Left Ventricular ◽  
St Elevation Myocardial Infarction ◽  
Left Ventricular Ejection ◽  
Inferior Wall ◽  
Care Hospital ◽  
Coronary Syndrome ◽  
Northern India ◽  
St Elevation

Background: Our aim was to the study clinical and epidemiological profile of patients presenting with ST-elevation myocardial infarction (STEMI).Methods: We did a single centre cross-sectional observational study of 200 patients presented with STEMI to a tertiary referral centre in Northern India from January 2016 to November 2017. All patients above 18 years of age admitted with diagnosis of STEMI were included in the study.Results: The mean age of study population was 55.75±12.5. The most common chief compliant was chest pain (95.1%). The anterior wall myocardial infarction (AWMI) accounted for 60.5% of all STEMI patients. The median duration from onset of symptoms to presentation to hospital was 7.93±6.58 hours. Cardiogenic shock was observed in 10.5% patients. Most common risk factor noted was smoking (63%). Mean left ventricular ejection fraction (LVEF) was less in AWMI (47±9.09) as compared to inferior wall myocardial infarction (IWMI) (50.72±7.14) (p<0.05). Among 200 cases studied, 11.5% cases developed post MI-Angina. Among arrhythmic complications, sinus bradycardia was most common (17.5%).Conclusions: Our study represents the predominance of AWMI as the initial acute coronary syndrome (ACS) presentation with a considerable delay in first medical contact. Complications like cardiogenic shock, arrhythmia were frequently observed. The biggest barrier to uniform STEMI care in developing nations is nonexistence of regional systems of care and this need to be improved.

scholarly journals Circulating Levels of Dephosphorylated-Uncarboxylated Matrix Gla Protein in Patients with Acute Coronary Syndrome

Molecules ◽  
2021 ◽  
Vol 26 (4) ◽  
pp. 1108
Author(s):  
Admira Bilalic ◽  
Tina Ticinovic Kurir ◽  
Marko Kumric ◽  
Josip A. Borovac ◽  
Andrija Matetic ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
High Risk ◽  
Hospital Mortality ◽  
Vascular Calcification ◽  
Matrix Gla Protein ◽  
St Elevation Myocardial Infarction ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
St Elevation

Vascular calcification contributes to the pathogenesis of coronary artery disease while matrix Gla protein (MGP) was recently identified as a potent inhibitor of vascular calcification. MGP fractions, such as dephosphorylated-uncarboxylated MGP (dp-ucMGP), lack post-translational modifications and are less efficient in vascular calcification inhibition. We sought to compare dp-ucMGP levels between patients with acute coronary syndrome (ACS), stratified by ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) status. Physical examination and clinical data, along with plasma dp-ucMGP levels, were obtained from 90 consecutive ACS patients. We observed that levels of dp-ucMGP were significantly higher in patients with NSTEMI compared to STEMI patients (1063.4 ± 518.6 vs. 742.7 ± 166.6 pmol/L, p < 0.001). NSTEMI status and positive family history of cardiovascular diseases were only independent predictors of the highest tertile of dp-ucMGP levels. Among those with NSTEMI, patients at a high risk of in-hospital mortality (adjudicated by GRACE score) had significantly higher levels of dp-ucMGP compared to non-high-risk patients (1417.8 ± 956.8 vs. 984.6 ± 335.0 pmol/L, p = 0.030). Altogether, our findings suggest that higher dp-ucMGP levels likely reflect higher calcification burden in ACS patients and might aid in the identification of NSTEMI patients at increased risk of in-hospital mortality. Furthermore, observed dp-ucMGP levels might reflect differences in atherosclerotic plaque pathobiology between patients with STEMI and NSTEMI.

scholarly journals Reducing Cardiac Injury during ST-Elevation Myocardial Infarction: A Reasoned Approach to a Multitarget Therapeutic Strategy

2021 ◽  
Vol 10 (13) ◽  
pp. 2968
Author(s):  
Alessandro Bellis ◽  
Giuseppe Di Gioia ◽  
Ciro Mauro ◽  
Costantino Mancusi ◽  
Emanuele Barbato ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Reperfusion Injury ◽  
Therapeutic Strategy ◽  
Ventricular Remodeling ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Left Ventricular ◽  
St Elevation Myocardial Infarction ◽  
Ischemic Time ◽  
St Elevation

The significant reduction in ‘ischemic time’ through capillary diffusion of primary percutaneous intervention (pPCI) has rendered myocardial-ischemia reperfusion injury (MIRI) prevention a major issue in order to improve the prognosis of ST elevation myocardial infarction (STEMI) patients. In fact, while the ischemic damage increases with the severity and the duration of blood flow reduction, reperfusion injury reaches its maximum with a moderate amount of ischemic injury. MIRI leads to the development of post-STEMI left ventricular remodeling (post-STEMI LVR), thereby increasing the risk of arrhythmias and heart failure. Single pharmacological and mechanical interventions have shown some benefits, but have not satisfactorily reduced mortality. Therefore, a multitarget therapeutic strategy is needed, but no univocal indications have come from the clinical trials performed so far. On the basis of the results of the consistent clinical studies analyzed in this review, we try to design a randomized clinical trial aimed at evaluating the effects of a reasoned multitarget therapeutic strategy on the prevention of post-STEMI LVR. In fact, we believe that the correct timing of pharmacological and mechanical intervention application, according to their specific ability to interfere with survival pathways, may significantly reduce the incidence of post-STEMI LVR and thus improve patient prognosis.

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