Patient with diabetes after acute coronary event. How to improve forecast?

2019 ◽  
Vol 1 (3) ◽  
pp. 6-11
Author(s):  
O. L. Barbarash
Keyword(s):  
Treatment Strategy ◽  
Coronary Event ◽  
High Reactivity ◽  
Acute Coronary Event ◽  
Invasive Treatment ◽  
Coronary Syndrome ◽  
Reduced Dose ◽  
Patients With Diabetes ◽  
History Of

Patients with diabetes mellitus are characterized by a higher risk of developing atherothrombotic events than patients without diabetes. One of the reasons for this is the high reactivity and rate of platelet metabolism. The role of aspirin in the prevention of cardiovascular events in patients with diabetes without a history of atherothrombotic events is unclear. In patients with a history of thromboischemic events, aspirin is useful for cardiovascular prophylaxis. Available data suggest that patients with diabetes and acute coronary syndrome (ACS) will benefit more from using more aggressive antiplatelet drugs than clopidogrel (in addition to aspirin), which will reduce the ischemic risk for patients with diabetes of equal or greater degree compared with patients without diabetes. These drugs include ticagrelor (in patients with ACS, regardless of the initial treatment strategy) and prasugrel (in patients with an invasive treatment strategy). For patients with diabetes, high ischemic and low hemorrhagic risks, prolonging double antiplatelet therapy for more than a year with a reduced dose of ticagrelor (60 mg twice a day) can be accompanied by a decrease in ischemic risk.

Evidence for cardiac rehabilitation in the modern era

2020 ◽  
pp. 1-10
Author(s):  
Constantinos H. Davos ◽  
Bernhard Rauch
Keyword(s):  
Cardiovascular Disease ◽  
Life Expectancy ◽  
Cardiac Rehabilitation ◽  
Meta Analysis ◽  
Coronary Event ◽  
Controlled Trials ◽  
Acute Coronary Event ◽  
Coronary Syndrome ◽  
Modern Era

Management of cardiovascular disease (CVD) has rapidly improved during recent decades and is still changing with the introduction of novel medication and advanced invasive procedures and devices. Notwithstanding these developments, cardiac rehabilitation (CR) is still a cornerstone of secondary prevention. Its effectiveness in improving the physical condition of chronic coronary syndrome (CCS) patients is beyond doubt, but its effectiveness on extending life expectancy is still a matter of debate. This chapter provides insights into the latest evidence (mainly presented in a recent meta-analysis of randomized controlled trials (RCTs) or controlled cohort studies) on the role of CR on morbidity and mortality in patients after an acute coronary event.

Abstract 3667: Comparison of Risk Profiles between Survivors and Victims of Sudden Cardiac Death of an Acute Coronary Event

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Kari S Kaikkonen ◽  
Marja-Leena Kortelainen ◽  
Heikki V Huikuri
Keyword(s):  
Risk Factors ◽  
Family History ◽  
Sudden Cardiac Death ◽  
Cardiac Hypertrophy ◽  
Odds Ratio ◽  
Cardiac Death ◽  
Coronary Event ◽  
Acute Coronary Event ◽  
Risk Profiles ◽  
History Of

Introduction. There is little information on the specific risk factors leading to sudden cardiac death (SCD) during an acute coronary event, because the risk variables may overlap with those of non-fatal coronary event. This study was designed to compare the risk profiles of SCD victims and survivors of an acute coronary event. Methods and Results. A case-control study included consecutive victims of SCD (n=425, mean age 64±11 years) verified to be due to an acute coronary event at medicolegal autopsy and consecutive patients surviving an acute myocardial infarction (AMI, n=644, mean age 62±10 years). Common cardiovascular risk factors, cardiac hypertrophy, and severity of coronary artery disease (CAD) were assessed in both groups. Family history of SCD (odds ratio 1.5, 95% CI 1.0 to 2.2, p=0.03), male gender (odds ratio 1.8, 95% CI 1.3 to 2.4, p<0.001), current smoking (odds ratio 2.0, 95% CI 1.5 to 2.6, p<0.001), cardiac hypertrophy (odds ratio 3.0, 95% CI 2.3 to 3.9, p<0.001) and 3-vessel CAD (odds ratio 5.4, 95% CI 3.6 to 8.2, p<0.001) were more common among the victims of SCD as compared to survivors of AMI. On the contrary, history of hypercholesterolemia (p<0.001) was less common among the SCD victims. There was a cumulative increase of risk of being a SCD victim vs. AMI survivor when more than one risk factor was present, the odds ratio being 44.3 (95% CI 8.0 to 246.7) in a current male smoker with a family history of SCD and cardiac hypertrophy. When 3-vessel CAD was added to the combined risk score, all subjects (7% of the SCD victims) were in the group of SCD giving a 100% sensitivity and specificity, respectively, in differentiating between the SCD victims and AMI survivors. Conclusions. There are specific features that differentiate the victims of SCD from survivors of an acute coronary event. Clustering of several variables, such as family history of SCD, smoking, cardiac hypertrophy, and 3-vessel CAD indicate a very high risk of SCD.

Abstract 14365: The Role of Alcohol Abuse and Tobacco Use in the Incidence of Early Acute Coronary Syndrome

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Hassan Alkhawam ◽  
Raef Madanieh ◽  
Mariya Fabisevich ◽  
Robert Sogomonian ◽  
Mohammed El-Hunjul ◽  
...  
Keyword(s):  
Risk Factor ◽  
Alcohol Abuse ◽  
Tobacco Use ◽  
Healthcare Intervention ◽  
Coronary Syndrome ◽  
Younger Age ◽  
History Of ◽  
Acute Mi ◽  
The Mean

Objective: To investigate the synergistic role of alcohol abuse/dependence and tobacco use in the early incidence of ACS. Methods: A retrospective chart analyses of 8076 patients diagnosed with ACS between 2000 to 2014, defined by ICD-9 codes for acute MI, alcohol abuse/dependence and tobacco use. Average age of ACS was calculated for the general population. Patients were then divided into 4 subgroups based on alcohol abuse/dependence and tobacco use status as follows: non-alcoholic non-smokers, non-alcoholic smokers, alcoholic non-smokers and alcoholic smokers. Results: The mean age of our 8076 ACS patients population was ~59.5 (95% CI 59.2-59.8). Patients with history of alcohol abuse/dependence appeared to develop ACS ~8.7 years younger than their non-alcoholic counterparts. When tobacco use is incorporated as a risk factor, those with both alcohol abuse/dependence and tobacco use seemed to develop ACS ~5 years earlier than those with history of either alone, and ~20 years earlier when compared to those with neither alcohol abuse/dependence nor tobacco use. (Table 1 summarizes mean age of ACS incidence in our study subgroups) Conclusion: Alcohol abuse/dependence appears to be a risk factor for earlier ACS. In our population, the average age of ACS incidence in alcoholic patients was significantly earlier than non-alcoholic patients. Furthermore, alcoholic patients who also used tobacco developed ACS at an even younger age when compared to those who had history of either alcohol abuse/dependence or tobacco use alone, suggesting a possible synergistic effect of these two risk factors in developing early ACS. Healthcare intervention in this population through screening, counseling and education regarding alcohol abuse/dependence and smoking cession is warranted to reduce early ACS morbidity and mortality.

Abstract 15794: Role of Endothelial Shear Stress and Endothelial Shear Stress Gradient in Plaques Associated With Acute Erosion vs. Stable Control Plaques

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Diaa A Hakim ◽  
Zhongyue Pu ◽  
Ahmet U Coskun ◽  
Natalia Pinilla-Echeverri ◽  
Olli A Kajander ◽  
...  
Keyword(s):  
Shear Stress ◽  
Stress Gradient ◽  
Coronary Event ◽  
Plaque Disruption ◽  
Plaque Erosion ◽  
Luminal Area ◽  
History Of ◽  
Endothelial Shear Stress ◽  
And Control

Introduction: The role of endothelial shear stress (ESS) in the natural history of plaque growth and TCFA formation/destabilization has been studied, but the role in plaque erosion is unknown. High ESS gradient (ESSG) has been hypothesized to promote plaque erosion, but no studies have included matched “control” stable plaques with the same minimal luminal area (MLA) and reference luminal area (RLA) but no adverse coronary event. Hypothesis: To compare ESS and ESSG between coronary plaques that developed erosion and similar morphology plaques that remain stable. Methods: We studied a subset of patients from both TOTAL and COMPLETE trials who underwent angiography and OCT evaluation: 27 patients (27 arteries: 18 LAD, 3 LCX, 6 RCA). Plaques were divided into Plaque Erosion (n=16) from TOTAL study with OCT features of plaque erosion and Control (n=11) plaques (non-culprit lesions from COMPLETE) with matched MLA and RLA and no OCT evidence of plaque disruption. Orthogonal angiographic views were used to generate a 3-D arterial reconstruction, and angio centerline was merged with OCT centerline. Local ESS distribution was assessed by computational flow dynamics and reported in consecutive 3-mm segments. Results: Table 1 shows differences in ESS between Plaque Erosion and Control Plaques Conclusions: In coronary plaques with similar severe obstruction (MLA) and reference area (RLA), plaque erosion is associated with higher coronary flow, max ESS, and ESSG in any direction, in the proximal-to-distal direction, and in the circumferential direction compared to plaques that remain stable. Future studies will determine which "feature (s)" of high ESS or ESSG are independently associated with erosion.

scholarly journals Association of Vitamin D Deficiency and Degree of Coronary Artery Disease in Cardiac Patients with Type 2 Diabetes

2017 ◽  
Vol 2017 ◽  
pp. 1-11 ◽  
Author(s):  
Ewelina A. Dziedzic ◽  
Jakub S. Gąsior ◽  
Mariusz Pawłowski ◽  
Marek Dąbrowski
Keyword(s):  
Type 2 Diabetes ◽  
Vitamin D ◽  
Coronary Artery ◽  
Coronary Arteries ◽  
Cardiac Patients ◽  
Coronary Syndrome ◽  
Patients With Diabetes ◽  
History Of ◽  
Artery Disease

Several modifiable factors may influence cardiac function in diabetic patients. The aim of the study was to evaluate the influence of vitamin D level on the stage of coronary atherosclerosis in cardiac patients diagnosed with type 2 diabetes. The study was performed in 337 consecutive patients undergoing coronarography. The stage of atherosclerosis was evaluated using Coronary Artery Surgery Study Score. The plasma 25(OH)D concentration was determined by an electrochemiluminescence method. Patients without significant lesions in coronary arteries presented the highest 25(OH)D level, significantly higher than patients with one-, two-, and three-vessel coronary artery disease (CAD) (p<0.01). Significantly lower level of the 25(OH)D was observed in patients hospitalized due to acute coronary syndrome (ACS) in comparison to patients hospitalized due to stable CAD (p<0.001). Lower 25(OH)D levels were observed in patients with the history of myocardial infarction (MI) in comparison to patients without previous MI (p<0.001). In cardiac patients with diabetes, the higher number of stenotic coronary arteries is associated with lower values of the 25(OH)D. A group of male cardiac patients with diabetes with significant stenosis in three coronary arteries, hospitalized due to acute coronary syndrome, with a history of previous MI and hyperlipidemia presented the lowest vitamin D level.

scholarly journals The role of strict metabolic control by insulin infusion on fibrinolytic profile during an acute coronary event in diabetic patients

2000 ◽  
Vol 23 (3) ◽  
pp. 160-164 ◽  
Author(s):  
Andreas Melidonis ◽  
Simeon Tournis ◽  
Alexander Stefanidis ◽  
Stavros Manoussakis ◽  
Stilianos Handanis ◽  
...  
Keyword(s):  
Metabolic Control ◽  
Insulin Infusion ◽  
Coronary Event ◽  
Diabetic Patients ◽  
Acute Coronary Event

scholarly journals Cystatin C for Enhancement of Risk Stratification in Non–ST Elevation Acute Coronary Syndrome Patients with an Increased Troponin T

2009 ◽  
Vol 55 (6) ◽  
pp. 1118-1125 ◽  
Author(s):  
Fons Windhausen ◽  
Alexander Hirsch ◽  
Johan Fischer ◽  
P Marc van der Zee ◽  
Gerard T Sanders ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Renal Function ◽  
Risk Stratification ◽  
Cystatin C ◽  
Treatment Strategy ◽  
Troponin T ◽  
Invasive Treatment ◽  
Coronary Syndrome ◽  
The Third ◽  
St Elevation

Abstract Background: We assessed the value of cystatin C for improvement of risk stratification in patients with non–ST elevation acute coronary syndrome (nSTE-ACS) and increased cardiac troponin T (cTnT), and we compared the long-term effects of an early invasive treatment strategy (EIS) with a selective invasive treatment strategy (SIS) with regard to renal function. Methods: Patients (n = 1128) randomized to an EIS or an SIS in the ICTUS trial were stratified according to the tertiles of the cystatin C concentration at baseline. The end points were death within 4 years and spontaneous myocardial infarction (MI) within 3 years. Results: Mortality was 3.4%, 6.2%, and 13.5% in the first, second, and third tertiles, respectively, of cystatin C concentration (log-rank P &lt; 0.001), and the respective rates of spontaneous MI were 5.5%, 7.5%, and 9.8% (log-rank P = 0.03). In a multivariate Cox regression analysis, the cystatin C concentration in the third quartile remained independently predictive of mortality [hazard ratio (HR), 2.04; 95% CI, 1.02–4.10; P = 0.04] and spontaneous MI (HR, 1.95; 95% CI, 1.05–3.63; P = 0.04). The mortality rate in the second tertile was lower with the EIS than with the SIS (3.8% vs 8.7%). In the third tertile, the mortality rates with the EIS and the SIS were, respectively, 15.0% and 12.2% (P for interaction = 0.04). Rates of spontaneous MI were similar for the EIS and the SIS within cystatin C tertiles (P for interaction = 0.22). Conclusions: In patients with nSTE-ACS and an increased cTnT concentration, mild to moderate renal dysfunction is associated with a higher risk of death and spontaneous MI. Use of cystatin C as a serum marker of renal function may improve risk stratification.

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