scholarly journals Endothelial Cells Strengthening: Improving Functions in Management of Acute Coronary Syndrome (A Double Blind Randomized Interventional Control Trial)

2019 ◽  
pp. 17-22 ◽  
Author(s):  
Tarun Saxena ◽  
Sanjay Patidar ◽  
Shailesh Verma ◽  
Azeema Ozefa Ali ◽  
Manjari Saxena
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Endothelial Dysfunction ◽  
Sympathetic Skin Response ◽  
Lipid Lowering ◽  
Current Therapy ◽  
Control Group ◽  
Double Blind ◽  
Spike Response ◽  
Coronary Syndrome

Objective: Endothelial dysfunction/injury is the main reason for Acute Coronary Syndrome (ACS). Current therapy includes antiplatelet, lipid lowering and thrombus removal by drugs/ intervention. Endothelial strengthening in management of ACS is less narrated in literature. This study describes endothelial strengthening and clinical outcome in ACS with Triphala powder, a mixture of Amla (Phyllanthus emblica), Harad (Terminalia chebula), and Behda (Terminalia bellirica). Methods: This is a double blind randomized interventional control trial. 80 cases coming to the emergency department were selected for study, divided into two groups. Group 1 (n=40, control), group 2 (n=40, study). Further subdivided into subgroup 1A and 2A ST-Elevation Myocardial Infarction (STEMI) and subgroup 1B and 2B Unstable Angina (UA). All subgroups were given clopidogrel, aspirin and atorvastatin and subjected to thrombolysis or Coronary Angiography (CAG) according to requirement. In addition study group was given Triphala powder 10 grams in a cup of water. Outcome was observed for relief in chest pain, ECG, Echocardiography changes at 50 minutes; (SSR) Sympathetic Skin Response was done initially. Statistical analysis was done by SPSS 20 software. Results: In intervention subgroups 2A and 2B there was significant relief in chest pain, settling down of ECG changes, and improvement in regional wall motion in echocardiography (p<0.001). There was increased sympathetic activity in all subgroups (spike response in SSR). Conclusion: Sudden mismatch in ATP (Adenosine Triphosphate) supply results in endothelial dysfunction. It occurs primarily due to increase in sympathetic discharge. Endothelial dysfunction results in UA/STEMI. Triphala increases ATP synthesis by increasing mitochondrial capacity to maximum; strengthens endothelium which behaves like normal endothelium and resolves symptoms and signs of ACS.

Long-Term Experience With an Accelerated Protocol for Diagnosis of Chest Pain

2000 ◽  
Vol 124 (10) ◽  
pp. 1434-1439
Author(s):  
Timothy E. Caragher ◽  
Balbino B. Fernandez ◽  
Lawrence A. Barr
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Troponin I ◽  
Cost Savings ◽  
Test Group ◽  
Control Group ◽  
Coronary Syndrome ◽  
Diagnostic Sensitivity And Specificity ◽  
Group B ◽  
Accelerated Protocol

Abstract Context.—More than 6 million patients present annually with chest pain suggestive of acute coronary syndrome. Rapid and accurate diagnosis is essential for best clinical outcomes, for optimal management of hospital resources, and for minimizing medicolegal exposure. Objective.—To evaluate the clinical and cost outcomes of an accelerated protocol for chest pain triage in a community-based hospital of moderate size. Methods.—One hundred successive patients with chest pain were diagnosed according to the Traditional Chest Pain Protocol, which included testing of serial blood samples for creatine kinase (CK)-MB and total CK. These patients were also subjected to the Accelerated Chest Pain Protocol under evaluation, which included testing at shortened intervals for myoglobin and cardiac troponin I in addition to CK and CK-MB. Diagnostic sensitivity and specificity were compared versus the final assigned diagnosis. The Accelerated Chest Pain Protocol was implemented for routine use. Follow-up evaluations were conducted at 1 month (test group A, N = 180) and 22 months (test group B, N = 180). Costs for diagnosis and treatment of the 2 test groups were compared with those for the control group. Results.—The 2 protocols had equivalent specificity values (99%). The sensitivity of the Accelerated Chest Pain Protocol was higher than that of the Traditional Chest Pain Protocol (95% vs 58%). Cost savings of 29% and a reduction in length of stay of 33% were achieved in test group B versus the control group. Conclusions.—The Accelerated Chest Pain Protocol improved the accuracy and timeliness of diagnosis of acute coronary syndrome while reducing costs.

scholarly journals Plasma Homocysteine Level And C677T Polymorphism In MTHFR Gene In Patients With Acute Coronary Syndrome

2015 ◽  
Vol 8 (1) ◽  
pp. 46-51
Author(s):  
Andrey V. Grek ◽  
Lyudmyla N. Prystupa ◽  
Tatiana V. Sytnik
Keyword(s):  
Acute Coronary Syndrome ◽  
Endothelial Dysfunction ◽  
Homocysteine Level ◽  
Mthfr C677t ◽  
Mthfr Gene ◽  
Control Group ◽  
C677t Polymorphism ◽  
Mthfr Polymorphism ◽  
Mthfr C677t Polymorphism ◽  
Coronary Syndrome

SummaryCardiovascular diseases (CVD) of atherosclerotic origin and accompanying complications are a major cause of mortality in the world and Ukraine, in particular. Endothelial dysfunction is the key cause of atherosclerosis and atherothrombosis. One of the causes of endothelial dysfunction is hyperhomocysteinemia that may occur on the background of MTHFR (methylenetetrahydrofolate reductase) mutation.Thus, the goal of the study was to investigate the interrelation between homocysteine (Hc) level and MTHFR polymorphism in patients with acute coronary syndrome (ACS).161 patients with ischemic heart disease and ACS have been examined. The control group comprised 87 healthy individuals. Homocysteine level was the highest in the patients having ACS with ST-segment elevation and complicated course, and was 1.8 times higher than Hc level in the control group. The patients with the most severe ACS course comprised 27 % of homozygotes for the major allele C and 41 % of homozygotes for the minor allele T. Comparing the distribution of MTHFR gene C677T polymorphism in patients with ACS that were stratified by plasma Hc level, we observed a statistically significant association, P < 0.030 by chi-square test. We confirmed that these patients had a high T/T genotype frequency of MTHFR C677T polymorphism. The obtained data proved the association of T/T genotype of MTHFR C677T polymorphism with increased Hc level as well as ACS severity.

scholarly journals Elevated Plasma Soluble Triggering Receptor Expressed on Myeloid Cells-1 Level in Patients with Acute Coronary Syndrome (ACS): A Biomarker of Disease Severity and Outcome

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Shachaf Shiber ◽  
Vitaly Kliminski ◽  
Katia Orvin ◽  
Iftach Sagy ◽  
Mordehay Vaturi ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Disease Severity ◽  
Plasma Levels ◽  
Cell Activation ◽  
Immune Cell ◽  
Myeloid Cells ◽  
Major Adverse Cardiovascular Events ◽  
Control Group ◽  
Coronary Syndrome

Background and Aims. Plasma levels of soluble triggering receptor expressed on myeloid cells (sTREM-1) reflect innate immune cell activation. We sought to evaluate sTREM-1 levels in patients with acute coronary syndrome (ACS) and their predictive value for disease severity and outcome. Methods. Plasma sTREM-1 levels were prospectively measured by ELISA in 121 consecutive patients with new-onset (≤24 h) chest pain at arrival to the emergency department (ED) and 73 healthy controls. Secondary endpoints were the association of plasma levels of sTREM-1 with day 30 and month 6 major adverse cardiovascular events (MACE) defined as death, ACS, stroke, and need for coronary revascularization, as well as with CAD severity. The primary endpoint of the study was the association of plasma sTREM-1 level at the time of admission to the ED with a diagnosis of ACS at day 30. Results. Fifty-nine patients (48.7%) were diagnosed with ACS and 62 (51.3%) with nonspecific chest pain (NSCP). Median plasma sTREM-1 level at admission was significantly higher in the ACS group than the NSCP group and the control group ( 539.4 ± 330.3  pg/ml vs. 432.5 ± 196.4  pg/ml vs. 230.1 ± 85.5  pg/ml, respectively; P < 0.001 ) and positively correlated with the number of stenosed/occluded coronary arteries on angiography ( P < 0.001 ). On logistic regression analysis, higher sTREM-1 levels predicted definite ACS vs. NSCP determined on day 30 (OR 1.29, 95% CI 1.07-1.54, P = 0.01 ) as well as with recurrent ACS ( P = 0.04 ) and stroke ( P = 0.02 ) at 6 months. Conclusions. Plasma sTREM-1 levels are significantly elevated in patients with ACS and might serve as a biomarker differentiating ACS from NSCP in the ED as well as an inflammatory biomarker for coronary artery disease severity and outcome.

Danhong Injection in the Treatment of Acute Coronary Syndrome: A Systematic Review and Meta-Analysis

2015 ◽  
Vol 43 (02) ◽  
pp. 199-214 ◽  
Author(s):  
Jia-Rui Wu ◽  
Xiao-Meng Zhang ◽  
Bing Zhang
Keyword(s):  
Systematic Review ◽  
Acute Coronary Syndrome ◽  
Large Scale ◽  
Meta Analysis ◽  
Effective Rate ◽  
Plasma Viscosity ◽  
Control Group ◽  
Double Blind ◽  
Coronary Syndrome ◽  
Danhong Injection

To systematically evaluate the efficacy and safety of Danhong injection (DH) in treating acute coronary syndrome (ACS), randomized controlled trials (RCTs) regarding ACS treated by DH were searched in Chinese and English electronic databases from inception until June 2013. Two reviewers independently retrieved RCTs and extracted information. The Cochrane risk of bias method was used to assess the quality of the included studies, and a meta-analysis was conducted with Review Manager 5.2 software. About 26 RCTs with 2660 participants were included. The methodological quality was usually not high, and only one study used a randomized, double-blinded method. The meta-analysis indicated that on the basis of conventional therapy with Western medicine (WM), DH was more effective in increasing the total effective rate [RR = 1.24, 95%CI (1.17, 1.32), p < 0.00001]. Additionally, DH can decrease inflammatory cytokines, including high sensitive C-reactive protein (Hs-CRP) and interleukin-6 (IL-6), lower plasma viscosity, plasma endothelin-1 (ET-1) and brain natriuretic peptide (BNP), reduce the generation of myeloperoxidase (MPO), and decrease the number of T-wave inversion. There were no adverse drug reactions (ADR) reported in the experimental group, while one case occurred in the control group. Based on the systematic review, DH combined with WM was effective in the treatment of ACS. However, the safety of DH in the treatment of ACS should be further carefully interpreted by more large-scale and double-blind RCTs.

scholarly journals Treatment of Danhong Injection Combined with Naoxintong Capsule in Acute Coronary Syndrome Patients Undergoing PCI Operation: Study for a Randomized Controlled and Double-Blind Trial

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Shuai Zhao ◽  
Yong Tang ◽  
Hairong Cai ◽  
Weifeng Liu ◽  
Lieyuan Zhang ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Treatment Group ◽  
Clinical Efficacy ◽  
Cardiovascular Events ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Double Blind ◽  
Coronary Syndrome ◽  
Danhong Injection

Objective. This double-blind and randomized placebo-controlled trial evaluated the safety and efficacy of Danhong injection combined with Naoxintong capsule in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI). Methods. ACS patients scheduled to undergo PCI (n=130) were equally and randomly apportioned to either a treatment or control group. After PCI, the treatment group received Danhong injection combined with Naoxintong capsule for 12 weeks, while the control group was given placebo. Both groups were otherwise treated with conventional secondary prevention of coronary artery disease. The groups were primarily evaluated for clinical efficacy and cardiovascular events. Evaluative indicators of safety included adverse events, platelet count, and liver, renal, and blood coagulation functions. Result. No cardiovascular events or adverse reactions were observed in either group. The treatment group demonstrated better signs of clinical efficacy, including left ventricular ejection fraction, higher nitric oxide levels, and lower levels of endothelin-1 (ET-1) and von Willebrand factor (VWF). Conclusion. ACS patients treated with Danhong injection combined with Naoxintong capsule after PCI demonstrated better improvement with regard to markers associated with atherosclerosis and adverse cardiovascular events, without apparent adverse effects. Thus, Danhong injection combined with Naoxintong capsule was safe and effective for treating ACS patients after PCI.

scholarly journals THE USING OF POLYPRENOL-CONTAINING DRUG IN PATIENTS WITH ACUTE CORONARY SYNDROME

2018 ◽  
Vol 33 (2) ◽  
pp. 21-25
Author(s):  
E. I. Tsoi ◽  
E. V. Vyshlov ◽  
V. B. Trusov
Keyword(s):  
Acute Coronary Syndrome ◽  
Standard Therapy ◽  
Control Group ◽  
Study Group ◽  
Double Blind ◽  
Coronary Syndrome ◽  
Group 3 ◽  
Group 2 ◽  
The Right ◽  
Group 1

The article shows the results of the study using drug Ropren in the patients with acute coronary syndrome. Ropren is  a plant drug containing polyprenols — dolichol precursors which take part in dolichol phosphate pathway. The pathology in this pathway leads to disbalance and glycoprotein deficiency. This is the reason of large group of diseases. This study is randomized double blind placebo controlled (No. NCT03122340 at ClinicalTrials.gov). Patients (n=68) with ACS taking standard therapy including atorvastatin 40 mg/day were randomized into to 2 groups: group 1 (n=34) took Ropren  8 drops 3 times per day for 3 week, then 5 drops 3 times per day for 5 weeks; group 2 (n=34) took placebo in the same dose regimen. After two — month therapy there was a positive dynamic (decreasing) in the level of interleukin-6 in the study group whereas in the control group there was no statistically significant change: 4.36 (2.61, 8.95) and 5.5 (3.3; 8.4) pg/ml, respectively (p<0.05). In the group of patients taking Ropren the reduction or cessation of statin was required significantly less than in the placebo group: 3 (8.8%) vs 9 (26.5%), respectively. One patient from the first group had a side effect in the form of gravity in the right hypochondrium. That is why the administration of Ropren in addition to standard therapy is reasonable in patients with ACS.

scholarly journals 239 Role of eNOS genetic variants on ischaemic heart disease susceptibility and acute coronary syndrome presentation

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Andrea D'Amato ◽  
Paolo Severino ◽  
Silvia Prosperi ◽  
Michele Magnocavallo ◽  
Marco Valerio Mariani ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Endothelial Dysfunction ◽  
Clinical Manifestation ◽  
Clinical Presentation ◽  
Microvascular Dysfunction ◽  
Control Group ◽  
Coronary Microvascular Dysfunction ◽  
Gene Encoding ◽  
Allelic Variants ◽  
Coronary Syndrome

Abstract Aims IHD is determined by inadequate coronary blood supply to myocardium and endothelial dysfunction may represent one of the main pathophysiological mechanisms involved. Genetic predisposition to endothelial dysfunction has been associated with IHD and its clinical manifestation. However, studies are often confounding and inconclusive for several reasons, such as interethnic differences. Results validation on larger cohorts and new population is needed. The aim of the study is to evaluate the association among the allelic variants of eNOS rs1799983 single-nucleotide polymorphism, IHD susceptibility, and its clinical presentation. Methods A total of 362 consecutive patients with suspected myocardial ischemia were enrolled. Patients were divided into three groups: G1, coronary artery disease (CAD); G2, coronary microvascular dysfunction (CMD); G3, control group with anatomically and functionally normal coronary arteries. Analysis of three allelic variants, GT, GG, and TT of rs1799983 for NOS3 gene, encoding for eNOS has been performed. Results rs1799983_GT is significantly more expressed by ischaemic groups (G1 and G2) compared with G3. The TT variant is significantly more expressed by G1 group, compared with G2 group. Among ischaemic patients, GT is significantly more expressed in patients with acute coronary syndrome (ACS) presentation, compared to other clinical presentation. At multivariate analysis, the allelic variant GT may represent an independent predictor of IHD and ACS presentation. Conclusions The SNP rs1799983_GT, encoding for eNOS, is an independent risk factor for IHD and, remarkably, for ACS presentation, independently from cardiovascular risk factors. These results may be useful for the prediction of IHD development, in particular with acute clinical manifestation. It may allow the early identification of patients at high risk to develop IHD with an ACS, promoting a genetic-based prevention strategy against IHD.

scholarly journals The Effect of Dhikr Therapy on the Cardiac Chest Pain of Acute Coronary Syndrome (ACS) Patients

2020 ◽  
Vol 10 (2) ◽  
pp. 200-210
Author(s):  
Destiya Dwi Pangestika ◽  
Yanny Trisyani ◽  
Aan Nuraeni
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Rating Scale ◽  
Intervention Group ◽  
Pain Reduction ◽  
Pharmacological Therapy ◽  
Control Group ◽  
Control Group Design ◽  
Coronary Syndrome ◽  
Significant Difference

Background: Cardiac chest pain is a typical complaint experienced by patients with Acute Coronary Syndrome (ACS) in Emergency Departments (EDs). Pharmacological therapy is one major intervention used to reduce cardiac chest pain due to ACS. However, this therapy does not optimally and completely reduce cardiac chest pain; therefore, additional therapy is greatly required.Purpose: This study aimed to examine the effect of Dhikr therapy as one of the additional therapies for the cardiac chest pain experienced by patients with ACS in EDs.Methods: This quasi-experimental research was conducted using a pretest-posttest control group design. As many as 52 patients with ACS were recruited using a consecutive sampling technique and then equally divided to the intervention and control group. The intervention group received both pharmacological and Dhikr therapy approximately for 17 minutes, while the control group only received the pharmacological therapy based on the hospital’s protocol. The Numeric Pain Rating Scale (NPRS) was used to measure the intensity of cardiac chest pain, and both paired and independent t-tests were utilized to analyze the data.Results: The results showed that there was a significant difference in pain reduction in both groups (p=0.000), although the decrease in the intervention group was higher than that in the control group. Furthermore, the pain reduction was significantly different between groups (p=0.021)Conclusion: Dhikr combined with the pharmacological therapy reduced the intensity of cardiac chest pain in ACS patients better than the use of pharmacological therapy alone. Therefore, this study recommends the combination of pharmacological and Dhikr therapy for patients with ACS.

Prevalence of Vitamin-D Deficiency in Patients with Acute Coronary Syndrome in Syria

2016 ◽  
Vol 9 (6) ◽  
pp. 3544-3548
Author(s):  
Aya Hallak ◽  
Malhis Mahmoud ◽  
Yaser Abajy Mohammad
Keyword(s):  
Vitamin D ◽  
Acute Coronary Syndrome ◽  
Vitamin D Deficiency ◽  
Hypovitaminosis D ◽  
Control Group ◽  
Coronary Syndrome ◽  
Normal Individuals ◽  
Vitamin D Levels ◽  
25 Hydroxy Vitamin D ◽  
Coronary Syndromes

The objectives of this study were to estimate the prevalence of vitamin D deficiency in patients with acute coronary syndrome in comparison with normal individuals and study the correlation between these two conditions. We measured the plasma 25-hydroxy vitamin D (25-OH-D) levels in 60 patients with acute coronary syndromes (ACS) of both gender and in 30 age matched control individuals of both gender without any known cardiovascular or systemic diseases. The levels of 25-OH-D were measured by ELISA method and the results were statically analyzed to find out any possible correlation. We classified the cases according to their plasma 25(OH)D levels. 25(OH)D levels of ≥ 30 ng/ml were considered normal, levels < 30 and > 20 ng/ml were classified as insufficient, while levels of ≤ 20 ng/ml were classified as deficient. In the current study the prevalence of hypovitaminosis D in the patients group was much higher than it was in the control group. Vitamin D deficiency was observed in 80% and insufficiency in 13% of total patients of ACS, there by bringing the total count to 93%. Whereas only 7% of the patients had adequate vitamin D levels. Thus, these results indicate the existence of a significant correlation between the vitamin D deficiency and ACS in comparison to healthy controls

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