scholarly journals The Role of Uric Acid in Acute and Chronic Coronary Syndromes

2021 ◽  
Vol 10 (20) ◽  
pp. 4750
Author(s):  
Alessandro Maloberti ◽  
Marco Biolcati ◽  
Giacomo Ruzzenenti ◽  
Valentina Giani ◽  
Filippo Leidi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Uric Acid ◽  
Acute Coronary Syndromes ◽  
Significant Determinant ◽  
Purine Nucleotides ◽  
General Role ◽  
Coronary Syndrome ◽  
Long Time ◽  
Coronary Syndromes

Uric acid (UA) is the final product of the catabolism of endogenous and exogenous purine nucleotides. While its association with articular gout and kidney disease has been known for a long time, new data have demonstrated that UA is also related to cardiovascular (CV) diseases. UA has been identified as a significant determinant of many different outcomes, such as all-cause and CV mortality, and also of CV events (mainly Acute Coronary Syndromes (ACS) and even strokes). Furthermore, UA has been related to the development of Heart Failure, and to a higher mortality in decompensated patients, as well as to the onset of atrial fibrillation. After a brief introduction on the general role of UA in CV disorders, this review will be focused on UA’s relationship with CV outcomes, as well as on the specific features of patients with ACS and Chronic Coronary Syndrome. Finally, two issues which remain open will be discussed: the first is about the identification of a CV UA cut-off value, while the second concerns the possibility that the pharmacological reduction of UA is able to lower the incidence of CV events.

The Extended Role of the Clinical Pharmacist in the Management of Heart Failure and Acute Coronary Syndromes

2002 ◽  
Vol 32 (1) ◽  
pp. 17-23 ◽  
Author(s):  
Ian D Coombes ◽  
Daniela CJ Sanders ◽  
Justine M Thiele ◽  
W Neil Cottrell ◽  
Danielle A Stowasser ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Pharmacist ◽  
Acute Coronary Syndromes ◽  
Coronary Syndromes

scholarly journals Long-term risk of death and recurrent cardiovascular events following acute coronary syndromes

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254008
Author(s):  
Pishoy Gouda ◽  
Anamaria Savu ◽  
Kevin R. Bainey ◽  
Padma Kaul ◽  
Robert C. Welsh
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Coronary Syndromes ◽  
Cardiovascular Events ◽  
Residual Risk ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Coronary Syndromes

Estimates of the risk of recurrent cardiovascular events (residual risk) among patients with acute coronary syndromes have largely been based on clinical trial populations. Our objective was to estimate the residual risk associated with common comorbidities in a large, unselected, population-based cohort of acute coronary syndrome patients. 31,056 ACS patients (49.5%—non-ST segment elevation myocardial infarction [NSTEMI], 34.0%—ST segment elevation myocardial infarction [STEMI] and 16.5%—unstable angina [UA]) hospitalised in Alberta between April 2010 and March 2016 were included. The primary composite outcome was major adverse cardiovascular events (MACE) including: death, stroke or recurrent myocardial infarction. The secondary outcome was death from any cause. Cox-proportional hazard models were used to identify the impact of ACS type and commonly observed comorbidities (heart failure, hypertension, peripheral vascular disease, renal disease, cerebrovascular disease and diabetes). At 3.0 +/- 3.7 years, rates of MACE were highest in the NSTEMI population followed by STEMI and UA (3.58, 2.41 and 1.68 per 10,000 person years respectively). Mortality was also highest in the NSTEMI population followed by STEMI and UA (2.23, 1.38 and 0.95 per 10,000 person years respectively). Increased burden of comorbidities was associated with an increased risk of MACE, most prominently seen with heart failure (adjusted HR 1.83; 95% CI 1.73–1.93), renal disease (adjusted HR 1.52; 95% CI 1.40–1.65) and diabetes (adjusted HR 1.51; 95% CI 1.44–1.59). The cumulative presence of each of examined comorbidities was associated with an incremental increase in the rate of MACE ranging from 1.7 to 9.98 per 10,000 person years. Rates of secondary prevention medications at discharge were high including: statin (89.5%), angiotensin converting enzyme inhibitor/angiotensin receptor blocker (84.1%) and beta-blockers (85.9%). Residual cardiovascular risk following an acute coronary syndrome remains high despite advances in secondary prevention. A higher burden of comorbidities is associated with increased residual risk that may benefit from aggressive or novel therapies.

scholarly journals Natriuretic peptides and multimarker approach to risk stratification of patients with acute coronary syndromes

2006 ◽  
Vol 59 (5-6) ◽  
pp. 248-252 ◽  
Author(s):  
Radomir Matunovic ◽  
Aleksandar Stojanovic ◽  
Zdravko Mijailovic ◽  
Zoran Cosic
Keyword(s):  
Heart Failure ◽  
Risk Stratification ◽  
Natriuretic Peptides ◽  
Acute Coronary Syndromes ◽  
Cardiac Biomarkers ◽  
Therapeutic Implications ◽  
Coronary Syndrome ◽  
Brain Natriuretic Peptides ◽  
Coronary Syndromes ◽  
St Elevation

Natriuretic peptides in acute coronary syndromes Brain natriuretic peptides (BNP) and N-terminal prohormone brain natriuretic peptides (N-proBNP) have been shown to provide important prognostic information in patients with acute coronary syndrome (ACS). Ischemia may be an important stimulus for BNP release. This does not imply, however, that BNP is useful for diagnosing ischemia, and BNP is unlikely to prove sensitive or specific enough for this purpose. Significance of natriuretic peptides in assessing prognosis in patients with acute coronary syndromes In patients with ST-elevation and non-ST-elevation myocardial infarction, higher BNP and N-proBNP levels have been shown to predict a grater likelihood of death or heart faiulure, independent of other prognostic factors. Therapeutic implications of BNP elevation in acute coronary syndromes Patients with BNP or NT-proBNP elevation following ACS are clearly at high risk for death and for developement of heart failure, but specific therapeutic implications of BNP elevation have not been defined. In particular, it is not known how patients with BNP elevation should be treated considering the fact that they have normal troponin levels and no clinical evidence of heart failure. Multimarker strategies for risk stratification in acute coronary syndromes It has been shown recently that in patients with acute coronary syndromes the risk increased sequentially among those with one, two or three elevated biomarkers. Therapeutic applications of cardiac biomarkers in acute coronary syndromes Multimarker strategies, that incorporate panels of cardiac bio?markers, are likely to be used in the future for risk stratification and for pathophysiologically-guided treatement of patients with ACS.

Cardiac Arrhythmias, Acute Coronary Syndromes, and Heart Failure in the Surgical Patient

2018 ◽  
Author(s):  
Glen Franklin ◽  
Amirreza Motameni ◽  
Johnson Walker
Keyword(s):  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Cardiac Arrhythmias ◽  
Acute Coronary Syndromes ◽  
Acute Decompensated Heart Failure ◽  
Management Strategies ◽  
Decompensated Heart Failure ◽  
Surgical Patient ◽  
Coronary Syndrome ◽  
Coronary Syndromes

Cardiac arrhythmias and events, such as acute coronary syndrome and acute decompensated heart failure, are becoming increasingly common with an aging population. Much is written regarding the evaluation and management of these conditions in the cardiac and vascular patient populations; however, there is less literature to discuss the management strategies in the critically ill noncardiac postoperative and polytrauma patients. Factors such as physiologic stress, electrolyte imbalances, neurologic derangement, infection, and massive fluid shifts create an environment that promotes cardiopulmonary instability. Appropriate recognition of cardiac arrhythmias, acute coronary syndromes, and heart failure coupled with accurate and timely intervention can reduce morbidity and mortality in these patients. This review discusses the assessment and management of cardiac tachy- and brady-arrhythmias, acute coronary syndromes, and acute decompensated heart failure in the surgical patient. This review contains 4 figures, 5 tables and 45 references Key Words: acute coronary syndrome, angina, arrhythmia, bradycardia, cardiac ischemia, dieresis, fluid overload, heart failure, infarction, tachycardia

scholarly journals 348 Uric acid is associated with acute heart failure and cardiogenic shock at presentation in acute coronary syndrome patients

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Alessandro Maloberti ◽  
Paola Rebora ◽  
Marco Centola ◽  
Nuccia Morici ◽  
Alice Sacco ◽  
...  
Keyword(s):  
Heart Failure ◽  
Uric Acid ◽  
Cardiogenic Shock ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Cross Sectional ◽  
Ventricular Ejection Fraction ◽  
Coronary Syndrome ◽  
Non Invasive Ventilation ◽  
Coronary Syndromes

Abstract Aims we focused on the role of Uric Acid (UA) as a possible determinant of Heart Failure (HF) related issues in Acute Coronary Syndromes (ACS) patients. Main outcome were acute HF and cardiogenic shock at admission, secondary outcomes were the need of Non Invasive Ventilation (NIV) use and the admission Left Ventricular Ejection Fraction (LVEF). Methods and results we consecutively enrolled 1269 ACS patients admitted to the cardiological Intensive Care Unit of the Niguarda and San Paolo hospitals (Milan, Italy) from June 2016 to June 2019. Hyperuricaemia was defined as a value higher than 6 mg/dl for females and 7 mg/dl for males. All the evaluated outcomes occurred more frequently in the hyperuricemic subjects (n = 292): acute HF 35.8 vs. 11.1% (P < 0.0001), cardiogenic shock 10 vs. 3.1% (P < 0.0001), NIV 24.1 vs. 5.1% (P < 0.0001) with lower admission LVEF (42.9 ± 12.8 vs. 49.6 ± 9.9, P < 0.0001). By multivariable analyses, UA was confirmed to be significantly associated with all the outcomes with the following odds ratio (OR): acute HF OR = 1.119; 95% CI: 1.019–1.229; cardiogenic shock OR = 1.157; 95% CI: 1.001–1.337; NIV use OR = 1.208; 95% CI: 1.078–1.354; LVEF β = −0.999; 95% CI: −1.413 to − 0.586. Conclusions The main result of our study was the finding of a significant association between UA and acute HF, cardiogenic shock, NIV use and LVEF. Due to the cross-sectional nature of our study no definite answer on the direction of these relationship can be drawn and further longitudinal study on UA changes over time during an ACS hospitalization are needed.

Cardiac Arrhythmias, Acute Coronary Syndromes, and Heart Failure in the Surgical Patient

2018 ◽  
Author(s):  
Glen Franklin ◽  
Amirreza Motameni ◽  
Johnson Walker
Keyword(s):  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Cardiac Arrhythmias ◽  
Acute Coronary Syndromes ◽  
Acute Decompensated Heart Failure ◽  
Management Strategies ◽  
Decompensated Heart Failure ◽  
Surgical Patient ◽  
Coronary Syndrome ◽  
Coronary Syndromes

Cardiac arrhythmias and events, such as acute coronary syndrome and acute decompensated heart failure, are becoming increasingly common with an aging population. Much is written regarding the evaluation and management of these conditions in the cardiac and vascular patient populations; however, there is less literature to discuss the management strategies in the critically ill noncardiac postoperative and polytrauma patients. Factors such as physiologic stress, electrolyte imbalances, neurologic derangement, infection, and massive fluid shifts create an environment that promotes cardiopulmonary instability. Appropriate recognition of cardiac arrhythmias, acute coronary syndromes, and heart failure coupled with accurate and timely intervention can reduce morbidity and mortality in these patients. This review discusses the assessment and management of cardiac tachy- and brady-arrhythmias, acute coronary syndromes, and acute decompensated heart failure in the surgical patient. This review contains 4 figures, 5 tables and 45 references Key Words: acute coronary syndrome, angina, arrhythmia, bradycardia, cardiac ischemia, dieresis, fluid overload, heart failure, infarction, tachycardia

Cardiac Arrhythmias, Acute Coronary Syndromes, and Heart Failure in the Surgical Patient

2018 ◽  
Author(s):  
Glen Franklin ◽  
Amirreza Motameni ◽  
Johnson Walker
Keyword(s):  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Cardiac Arrhythmias ◽  
Acute Coronary Syndromes ◽  
Acute Decompensated Heart Failure ◽  
Management Strategies ◽  
Decompensated Heart Failure ◽  
Surgical Patient ◽  
Coronary Syndrome ◽  
Coronary Syndromes

Cardiac arrhythmias and events, such as acute coronary syndrome and acute decompensated heart failure, are becoming increasingly common with an aging population. Much is written regarding the evaluation and management of these conditions in the cardiac and vascular patient populations; however, there is less literature to discuss the management strategies in the critically ill noncardiac postoperative and polytrauma patients. Factors such as physiologic stress, electrolyte imbalances, neurologic derangement, infection, and massive fluid shifts create an environment that promotes cardiopulmonary instability. Appropriate recognition of cardiac arrhythmias, acute coronary syndromes, and heart failure coupled with accurate and timely intervention can reduce morbidity and mortality in these patients. This review discusses the assessment and management of cardiac tachy- and brady-arrhythmias, acute coronary syndromes, and acute decompensated heart failure in the surgical patient. This review contains 4 figures, 5 tables and 45 references Key Words: acute coronary syndrome, angina, arrhythmia, bradycardia, cardiac ischemia, dieresis, fluid overload, heart failure, infarction, tachycardia

scholarly journals Diabetes and baseline glucose are associated with inflammation, left ventricular function and short- and long-term outcome in acute coronary syndromes: role of the novel biomarker Cyr 61

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Patric Winzap ◽  
Allan Davies ◽  
Roland Klingenberg ◽  
Slayman Obeid ◽  
Marco Roffi ◽  
...  
Keyword(s):  
Acute Coronary Syndromes ◽  
Left Ventricular ◽  
The Novel ◽  
Short Term ◽  
Coronary Syndrome ◽  
History Of ◽  
Coronary Syndromes ◽  
Short And Long Term

Abstract Background Hyperglycemia in the setting of an acute coronary syndrome (ACS) impacts short term outcomes, but little is known about longer term effects. We therefore designed this study to firstly determine the association between hyperglycemia and short term and longer term outcomes in patients presenting with ACS and secondly evaluate the prognostic role of diabetes, body mass index (BMI) and the novel biomarker Cyr61 on outcomes. Methods The prospective Special Program University Medicine-Acute Coronary Syndrome (SPUM-ACS) cohort enrolled 2168 patients with ACS between December 2009 and October 2012, of which 2034 underwent PCI (93.8%). Patients were followed up for 12 months. Events were independently adjudicated by three experienced cardiologists. Participants were recruited from four tertiary hospitals in Switzerland: Zurich, Geneva, Lausanne and Bern. Participants presenting with acute coronary syndromes and who underwent coronary angiography were included in the analysis. Patients were grouped according to history of diabetes (or HbA1c greater than 6%), baseline blood sugar level (BSL; < 6, 6–11.1 and > 11.1 mmol/L) and body mass index (BMI). The primary outcome was major adverse cardiac events (MACE) which was a composite of myocardial infarction, stroke and all-cause death. Secondary outcomes included the individual components of the primary endpoint, revascularisations, bleeding events (BARC classification) and cerebrovascular events (ischaemic or haemorrhagic stroke or TIA). Results Patients with hyperglycemia, i.e. BSL ≥ 11.1 mmol/L, had higher levels of C-reactive protein (CRP), white blood cell count (WBC), creatinine kinase (CK), higher heart rates and lower left ventricular ejection fraction (LVEF) and increased N-terminal pro-brain natriuretic peptide. At 30 days and 12 months, those with BSL ≥ 11.1 mmol/L had more MACE and death compared to those with BSL < 6.0 mmol/L or 6.0–11.1 mmol/L (HR-ratio 4.78 and 6.6; p < 0.001). The novel biomarker Cyr61 strongly associated with high BSL and STEMI and was independently associated with 1 year outcomes (HR 2.22; 95% CI 1.33–3.72; Tertile 3 vs. Tertile 1). Conclusions and relevance In this large, prospective, independently adjudicated cohort of in all comers ACS patients undergoing PCI, both a history of diabetes and elevated entry glucose was associated with inflammation and increased risk of MACE both at short and long-term. The mediators might involve increased sympathetic activation, inflammation and ischemia as reflected by elevated Cyr61 levels leading to larger levels of troponin and lower LVEF. Trial registration Clinical Trial Registration Number: NCT01000701. Registered October 23, 2009

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