scholarly journals A Novel Computed Tomography-Based Imaging Approach for Etiology Evaluation in Patients With Acute Coronary Syndrome and Non-obstructive Coronary Angiography

2021 ◽  
Vol 8 ◽  
Author(s):  
Runjianya Ling ◽  
Lihua Yu ◽  
Zhigang Lu ◽  
Yuehua Li ◽  
Jiayin Zhang
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Angiography ◽  
Intramural Hematoma ◽  
Final Analysis ◽  
Microvascular Dysfunction ◽  
Diagnostic Value ◽  
Side Branch ◽  
Dynamic Ct ◽  
Coronary Syndrome ◽  
Plaque Disruption

Objective: This study sought to investigate the diagnostic value of dynamic CT myocardial perfusion imaging (CT-MPI) combined with coronary CT angiography (CCTA) in acute coronary syndrome (ACS) patients without obstructive coronary angiography.Methods: Consecutive ACS patients with normal or non-obstructive coronary angiography findings who had cardiac magnetic resonance (CMR) contraindications or inability to cooperate with CMR examinations were prospectively enrolled and referred for dynamic CT-MPI + CCTA + late iodine enhancement (LIE). ACS etiology was determined according to combined assessment of coronary vasculature by CCTA, quantified myocardial blood flow (MBF) and presence of LIE.Results: Twenty two patients were included in the final analysis. CCTA revealed two cases of side branch occlusion and one case of intramural hematoma which were overlooked by invasive angiography. High risk plaques were observed in 6 (27.3%) patients whereas myocardial ischemia was presented in 19 (86.4%) patients with varied extent and severity. LIE was positive in 13 (59.1%) patients and microvascular obstruction was presented in three cases with side branch occlusion or spontaneous intramural hematoma. The specific etiology was identified in 20 (90.9%) patients, of which the most common cause was cardiomyopathies (41%), followed by microvascular dysfunction (14%) and plaque disruption (14%).Conclusion: Dynamic CT-MPI + CCTA was able to reveal the potential etiologies in majority of patients with ACS and non-obstructive coronary angiography. It may be a useful alternative to CMR for accurate etiology evaluation.

scholarly journals Brain Natriuretic Peptide for Predicting Contrast-Induced Acute Kidney Injury in Patients with Acute Coronary Syndrome Undergoing Coronary Angiography: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Xiaoming Li ◽  
Chao Liu ◽  
Zhi Mao ◽  
Shuang Qi ◽  
Renjie Song ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Acute Coronary Syndrome ◽  
Coronary Angiography ◽  
Early Diagnosis ◽  
Natriuretic Peptide ◽  
Characteristic Curve ◽  
Kidney Injury ◽  
Diagnostic Value ◽  
Cochrane Library ◽  
Coronary Syndrome

Objective. To assess the diagnostic value of B-type natriuretic peptide (BNP) or N-terminal pro-B-type natriuretic peptide (NT-proBNP) for contrast-induced acute kidney injury (CI-AKI) in patients with acute coronary syndrome (ACS) undergoing coronary angiography. Background. ACS remains a major cause of death worldwide. Patients with ACS undergoing coronary angiography are more likely to develop CI-AKI, which correlates highly with poor clinical outcomes. Early diagnosis of CI-AKI remains a challenge. Many recent studies have suggested that BNP or NT-proBNP may be a useful biomarker for the early diagnosis of CI-AKI. Methods. We searched databases (PubMed, EMBASE, and Cochrane Library) to identify eligible studies. Two authors independently screened the studies and extracted data. We used the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) criteria to assess the methodological quality of the included studies and STATA to perform all statistical analyses. Results. Nine studies including 2832 patients were identified. The pooled sensitivity of 0.73 (95% CI 0.65–0.79), specificity of 0.79 (95% CI 0.70–0.85), and area under the summary receiver operating characteristic curve of 0.81 (95% CI 0.77–0.84) suggested that BNP or NT-proBNP had a good diagnostic value for CI-AKI in patients with ACS undergoing coronary angiography. Conclusions. Our findings suggest that BNP or NT-proBNP may be an effective predictive marker for CI-AKI. However, additional high-quality studies are required to find the optimal cutoff value and the diagnostic value of BNP or NT-proBNP in combination with other biomarkers.

A Young Woman Case of Acute Coronary Syndrome Caused by Extensive Coronary Intramural Hematoma with Hyperthyroidism

2012 ◽  
Vol 4 (3) ◽  
pp. 200-207
Author(s):  
Toshimitsu Takagi ◽  
Yuki Horita ◽  
Naoto Tama ◽  
Hidenobu Terai ◽  
Isao Inoki ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Young Woman ◽  
Intramural Hematoma ◽  
Coronary Syndrome

scholarly journals THE RESULTS OF URGENT CORONARY ANGIOGRAPHY AND STENTING IN THE ACUTE CORONARY SYNDROME

2016 ◽  
Vol 26 (1) ◽  
pp. 098-121
Author(s):  
VI Davydkin ◽  
◽  
MD Romanov ◽  
MF Yerzin ◽  
AA Kovalev ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Angiography ◽  
Coronary Syndrome

scholarly journals MI with Non-obstructive Coronary Artery Presenting with STEMI: A Review of Incidence, Aetiology, Assessment and Treatment

2020 ◽  
Vol 15 ◽  
Author(s):  
Ying X Gue ◽  
Rahim Kanji ◽  
Sabiha Gati ◽  
Diana A Gorog
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Correct Diagnosis ◽  
Correct Treatment ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Plaque Disruption ◽  
Methodical Approach ◽  
St Segment ◽  
Assessment And Treatment

MI with non-obstructive coronary artery (MINOCA) is a condition previously thought to be benign that has recently been shown to have comparable mortality to that of acute coronary syndrome with obstructive coronary disease. The heterogeneity of the underlying aetiology makes the assessment, investigation and treatment of patients with MINOCA challenging. The majority of patients with MINOCA presenting with ST-segment elevation MI generally have an underlying coronary or myocardial cause, predominantly plaque disruption or myocarditis. In order to make the correct diagnosis, in addition to the cause of the presentation, a meticulous and methodical approach is required, with targeted investigations. Stratification of patients to guide investigations that are more likely to provide the diagnosis will allow the correct treatment to be initiated promptly. In this article, the authors review the contemporary incidence, aetiology, recommended assessment and treatment of patients with MINOCA presenting with ST-segment elevation MI.

Association of Prediabetes With Higher Coronary Atherosclerotic Burden Among Patients With First Diagnosed Acute Coronary Syndrome

Angiology ◽  
2018 ◽  
Vol 70 (2) ◽  
pp. 174-180 ◽  
Author(s):  
Burak Açar ◽  
Ozcan Ozeke ◽  
Mustafa Karakurt ◽  
Yasin Ozen ◽  
Mustafa Bilal Özbay ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Angiography ◽  
Coronary Atherosclerosis ◽  
Scoring Systems ◽  
Diabetic Patients ◽  
Coronary Syndrome ◽  
Atherosclerotic Burden ◽  
First Occurrence ◽  
And Control ◽  
The Impact

Diabetes mellitus (DM) is associated with more extensive coronary atherosclerosis and more vulnerable plaque phenotypes. However, DM should not be considered a homogeneous and purely binary entity in terms of risk assessment. We evaluated the impact of prediabetic status on coronary atherosclerosis burden in patients with first-time acute coronary syndrome (ACS) who underwent urgent coronary angiography. The patients were divided into DM, prediabetes, and control groups. The 3-vessel disease (TVD) rates and SYNTAX and Gensini scoring systems for defining atherosclerotic burden were compared. The study was conducted in 469 consecutive patients admitted with a diagnosis of ACS. Of these, 250 patients were admitted at the first occurrence of ACS undergoing diagnostic coronary angiography. SYNTAX and Gensini scores and TVD rates were higher in prediabetic patients than in nondiabetic patients ( P = .004, P = .008, and P = .014, respectively), but similar in prediabetic and diabetic patients ( P = .912, P = .773, and P = 1.000, respectively). Coronary atherosclerosis burden is more advanced in prediabetic patients than in nondiabetic patients and is comparable between prediabetic and diabetic patients at first presentation of ACS. Cardiologists should not miss the opportunity to diagnose prediabetes and DM when patients present with an ACS.

Abstract TP314: Baseline Thrombocytopenia in Patients With Acute Coronary Syndrome: Does it Affect Following Cerebrovascular Event Rates?

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Chiehju Chao ◽  
Chiachun Chiang ◽  
Muhammad Khalid ◽  
David Fortuin
Keyword(s):  
Acute Coronary Syndrome ◽  
Final Analysis ◽  
P Value ◽  
Cerebrovascular Event ◽  
Bleeding Events ◽  
Patient Demographics ◽  
Coronary Syndrome ◽  
Cerebrovascular Events ◽  
Event Rates ◽  
And Control

Introduction: Baseline thrombocytopenia (TP) is a common condition in patients with acute coronary syndrome (ACS) and acute ischemic stroke and has been shown to increase mortality. The effect of baseline TP on cerebrovascular events following initial ACS event is not well studied. Methods: We retrospectively reviewed all patients identified from the institutional NCDR Chest Pain registry database at Mayo Clinic Arizona from Oct 2015 to Sep 2018. Patients were classified into TP (platelet <150) and control (platelet > 150) groups for clinical outcome (stroke/TIA and bleeding events) analysis. P-value < 0.05 is considered significant. Results: Five hundred and thirty-six patients were included for final analysis. Patient demographics and clinical outcomes are shown in Table 1. The rates of dual antiplatelet therapy (DAPT) prescription at discharge (TP vs. control: 68.1% and 75.4%, P=0.197), stroke/TIA (1.3% vs. 2.4%, P=1.000) and recurrent myocardial infarction (11.1% vs. 11.2%, P=1.000) were similar between the two groups. The TP group has more bleeding events compared to control (Figure 1). Conclusions: In patients with ACS, baseline TP does not affect stroke/TIA events but is associated with higher bleeding rate. The results could not be explained by the DAPT or anticoagulation use alone. Further studies are needed to investigate the pathophysiologic correlation of thrombocytopenia, DAPT, and stroke in ACS patients.

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