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 Trends and in-hospital mortality of Acute Coronary Syndrome at Shahid Gangalal National Heart Centre, Kathmandu, Nepal during 2001-2012

2014 ◽  
Vol 3 (1) ◽  
pp. 23-26
Author(s):  
Chandra Mani Adhikari ◽  
Deewakar Sharma ◽  
Rabi Malla ◽  
Sujeeb Rajbhandari ◽  
Roshan Raut ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Hospital Mortality ◽  
Unstable Angina ◽  
St Elevation Myocardial Infarction ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
National Heart ◽  
St Segment ◽  
St Elevation

Background and aims: Acute coronary syndrome (ACS), which comprises acute ST-segment elevation myocardial infarction, non-ST segment elevation myocardial infarction and unstable angina is a major health problem and represents a large number of hospitalizations annually worldwide. We aim to describe pattern of the ACS admission and in-hospital mortality at tertiary national heart centre of the country. Methods: A hospital database was used to analyze all 7424 patients admitted in coronary care unit of the centre for ACS from September 2001 till December 2012. We evaluated trend of ACS admission and in-hospital mortality. Results: Five thousand three hundred ninety one (72.6%) were male and two thousand thirty three (27.4%) were female. Patient of 21years to 98 years were admitted for ACS .Four thousand five hundred and ninety nine(61.9%) patient were admitted due to ST elevation myocardial infarction, whereas one thousand nine hundred and thirteen (25.8%) were admitted for Unstable angina and nine hundred twelve (12.3%) were admitted for Non ST elevation myocardial infarction. In-hospital mortality was 5.74% for acute coronary syndrome. There was significant difference in in-hospital mortality between ST elevation myocardial infarction (7.76%), Non ST segment elevation acute coronary syndrome (3.61%) and Unstable Angina (1.88%).There is a gradual increase in Primary Percutaneous Coronary intervention as a mode of reperfusion therapy whereas there is a decrease in the rate of thrombolysis. Conclusion: Our study provides us some important information about the trend and in-hospital mortality rate in national heart centre. Though it is a single centre study can provide us the insight of the ACS outcome. DOI: http://dx.doi.org/10.3126/jaim.v3i1.10698 Journal of Advances in Internal Medicine 2014;03(01):23-26

ACTION and NCDR risk models outperform GRACE for prediction of in-hospital mortality in acute coronary syndrome – a retrospective analysis from a German Heart Center

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Parco ◽  
L Kosejian ◽  
J Quade ◽  
S Bader ◽  
Y Lin ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Hospital Mortality ◽  
Risk Model ◽  
Discrimination Performance ◽  
St Elevation Myocardial Infarction ◽  
Superior Performance ◽  
Risk Models ◽  
Coronary Syndrome ◽  
St Elevation

Abstract Background Risk prediction with the GRACE risk model is guideline-recommended clinical practice in acute coronary syndrome (ACS). However, more modern risk models such as ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry–GWTG (Get With the Guidelines) and National Cardiovascular Data Registry (NCDR) risk models are available. We aimed to compare these models to the established GRACE risk model in ACS. Methods and results In-hospital mortality was retrospectively assessed in 1,138 patients undergoing cardiac catheterization for Non-ST-Elevation Myocardial Infarction (NSTEMI, 566 patients, 70.7% male) or ST-Elevation Myocardial Infarction (STEMI, 572 patients, 69.1% male) at a German University Hospital from 2014 to 2017. In-hospital mortality was 14.7% for STEMI and 3.7% for NSTEMI, respectively. GRACE, ACTION and NCDR risk models for prediction of in-hospital mortality were calculated for individual patients, 0.75% missing data were imputed. ACTION risk model showed a good discrimination of risk (c-index 0.85, 95% confidence interval (CI) 0.83–0.87) with a slight numerical advantage in NSTEMI (c-index 0.92, 95% CI 0.86–0.98) over STEMI patients (c-index 0.83, 95% CI 0.79–0.88). The NCDR risk model showed comparable performance in the overall cohort (c-index 0.86, 95% CI 0.84–0.88; NCDR vs. ACTION p=0.4097), also with superior performance in NSTEMI (c-index 0.89, 95% CI 0.86–0.91) vs. STEMI (c-index 0.81, 95% CI 0.78–0.84). The GRACE risk model showed significantly worse performance in the overall cohort (c-index 0.76, 95% CI 0.74–0.79; vs ACTION p&lt;0.0001; vs. NCDR p&lt;0.0001) and in STEMI patients (c-index 0.72, 95% CI 0.69–0.76; vs ACTION p&lt;0.0001; vs. NCDR p=0.0018). In NSTEMI patients, GRACE discrimination performance was comparable to NCDR (c-index 0.87, 95% CI 0.84–0.90, p=0.73), but still inferior to ACTION (p=0.04). The ACTION risk model showed a good calibration whereas NCDR and GRACE models lacked accuracy in our cohort. Conclusion In a contemporary German patient population with acute coronary syndrome, ACTION and NCDR risk models outperform the established GRACE risk model for prediction of in-hospital mortality. This performance difference was more pronounced in STEMI than in NSTEMI. Funding Acknowledgement Type of funding source: None

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 Culprit vessel: impact on short-term and long-term prognosis in patients with ST-elevation myocardial infarction

Open Heart ◽  
2018 ◽  
Vol 5 (2) ◽  
pp. e000852 ◽  
Author(s):  
Artin Entezarjou ◽  
Moman Aladdin Mohammad ◽  
Pontus Andell ◽  
Sasha Koul
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
High Risk ◽  
Left Ventricular ◽  
St Elevation Myocardial Infarction ◽  
Clinical Event ◽  
Left Ventricular Ejection ◽  
Increased Risk ◽  
St Elevation ◽  
The Impact

BackgroundST-elevation myocardial infarction (STEMI) occurs as a result of rupture of an atherosclerotic plaque in the coronary arteries. Limited data exist regarding the impact of culprit coronary vessel on hard clinical event rates. This study investigated the impact of culprit vessel on outcomes after primary percutaneous coronary intervention (PCI) of STEMI.MethodsA total of 29 832 previously cardiac healthy patients who underwent primary PCI between 2003 and 2014 were prospectively included from the Swedish Coronary Angiography and Angioplasty Registry and the Registry of Information and Knowledge about Swedish Heart Intensive care Admissions. Patients were stratified into three groups based on culprit vessel (right coronary artery (RCA), left anterior descending artery (LAD) and left circumflex artery (LCx)). The primary outcome was 1-year mortality. The secondary outcomes included 30-day and 5-year mortality, as well as heart failure, stroke, bleeding and myocardial reinfarction at 30 days, 1 year and 5 years. Univariable and multivariable analyses were done using Cox regression models.ResultsOne-year analyses revealed that LAD infarctions had the highest increased risk of death, heart failure and stroke compared with RCA infarctions, which had the lowest risk. Sensitivity analyses revealed that reduced left ventricular ejection fraction on discharge partially explained this increased relative risk in mortality. Furthermore, landmark analyses revealed that culprit vessel had no significant influence on 1-year mortality if a patient survived 30 days after myocardial infarction. Subgroup analyses revealed female sex and multivessel disease (MVD) as significant high-risk groups with respect to 1-year mortality.ConclusionsLAD and LCx infarctions had a relatively higher adjusted mortality rate compared with RCA infarctions, with LAD infarctions in particular being associated with an increased risk of heart failure, stroke and death. Culprit vessel had limited influence on mortality after 1 month. High-risk patient groups include LAD infarctions in women or with concomitant MVD.

The Study of Serum Calcium to Magnesium Ratio in Patients with Acute Coronary Syndrome in a Tertiary Hospital, Hubli, Karnataka

2021 ◽  
Vol 8 (41) ◽  
pp. 3553-3558
Author(s):  
Uday Subhash Bande ◽  
Kalinga Bommanakatte Eranaik ◽  
Manjunath Shivalingappa Hiremani ◽  
Basawantrao Kailash Patil ◽  
Sushma Shankaragouda Biradar
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Roc Analysis ◽  
St Elevation Myocardial Infarction ◽  
P Value ◽  
Operating Characteristics ◽  
Coronary Syndrome ◽  
Function Tests ◽  
Creatine Kinase Mb ◽  
St Elevation

BACKGROUND Cardiovascular diseases are one of the leading causes of morbidity and mortality worldwide. High Ca levels and low Mg levels are associated with increased cardiovascular risk in the general population.1 The balance between Ca and Mg seems to play an important role in homeostasis since Mg is considered as physiologic antagonist of Ca.2 Hence Ca/Mg ratio was considered to study its association with acute coronary syndrome (ACS). METHODS This is a case control study conducted in Karnataka Institute of Medical Sciences, Hubli over a period of 2 years, February 2019 to December 2020. 200 cases and 150 controls were included in the study. The biochemical measurements including complete blood count (CBC), cardiac biomarkers, liver function tests, renal function tests (RFT), serum electrolytes and lipid profile were measured using standard laboratory methods. Student ‘t’ test was used to compare the data. Optimum cut-offs for diagnosis of acute myocardial infarction was calculated using receiver operating characteristics (ROC) analysis. The association among markers was established by calculating Pearson’s correlation. RESULTS Serum Ca/Mg ratio was significantly higher (p value < 0.001) in ACS when compared to control groups. It was also found that Ca/Mg ratio was significantly lower (p value < 0.001) in non-ST elevation myocardial infarction (NSTEMI) when compared to STEMI group. Serum Mg was significantly lower (p value < 0.001) in ACS group when compared to control group. Significant correlation (p value < 0.05) was found between serum Ca/Mg ratio and cardiac markers (CKMB, Troponin-I). ROC analysis of Ca/Mg (4.19) ratios showed optimum cut-offs in diagnosis of AMI. CONCLUSIONS Serum Ca/Mg could be useful adjuvant marker in diagnosis of AMI. The ratio is higher in ST-segment elevation myocardial infarction when compared to non-STsegment myocardial infarction, which could be due to greater decrease in Mg levels when compared Ca in ACS. KEYWORDS ST Elevation Myocardial Infarction (STEMI), Non ST Elevation Myocardial Infarction (NSTEMI), Calcium (Ca), Magnesium (Mg), Acute Coronary Syndrome (ACS), Creatine Kinase-MB (CK-MB).

The Reduction of Cardiac Patients in the Coronary Care Unit of the Santa Izabel Hospital During the COVID-19 Pandemic

2021 ◽  
Vol 4 (3/4) ◽  
pp. 131-134
Author(s):  
Gilson Feitosa ◽  
Leandro Cavalcanti ◽  
Amanda Fraga ◽  
Milana Prado ◽  
Gilson Feitosa Filho ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Angina Pectoris ◽  
Coronary Care Unit ◽  
Myocardial Revascularization ◽  
St Elevation Myocardial Infarction ◽  
Coronary Syndrome ◽  
The World ◽  
St Elevation ◽  
Coronary Care

The coronary care unit by Santa Izabel Hospital (Salvador, Bahia, Brazil) made a comparison of admitted patients with coronary disease cases admitted between two equivalent periods ranging from April through July in 2019 and 2020. There was a striking reduction in 2020 of cases of ST-elevation myocardial infarction (39%); non-ST elevation myocardial infarction (19%); and unstable angina pectoris (21%). This occurred in parallel with what happened in many parts of the world and hampered offering the best treatment strategy to these patients with an acute coronary syndrome such as invasive stratification and myocardial revascularization.  

Abstract 18710: Added Value of Electrocardiographic Signs and Symptoms to Improve Early Detection of Acute Coronary Syndrome in the Emergency Department

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Jessica K Zègre-Hemsey ◽  
Larisa A Burke ◽  
Holli A DeVon
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Signs And Symptoms ◽  
Symptom Distress ◽  
St Elevation Myocardial Infarction ◽  
Specific Symptom ◽  
Arm Pain ◽  
Coronary Syndrome ◽  
Cardiac Symptoms ◽  
St Elevation

Background: Early identification and diagnosis are critical in the management of patients with acute coronary syndrome (ACS) since time-dependent therapies reduce patient mortality and morbidity. Objective: The aims of this study were to describe differences in presenting symptoms by individual ACS diagnoses and determine the prognostic value of both signs (electrocardiographic evidence of ischemia) and symptoms for an ACS diagnosis. Method: Patients > 21 years old, with any ECG ischemic changes (ST-elevation, ST-depression, T-wave inversion), elevated serum troponin, and ACS symptoms presenting to one of five emergency departments (ED) were eligible for the study. Patients completed the ACS Symptom Checklist, a validated 13-item instrument that measures cardiac symptoms (typical and atypical). Pearson Chi-square tests were used for bivariate analyses and logistic regression was used for multivariate modeling. Results: A total of 1,031 patients (mean age 60 + 14, 62% male, 70% White) were enrolled; 450 (43.7%) were diagnosed with ACS. One hundred eleven (11%) had ST-elevation myocardial infarction (STEMI), 236 (23%) had non-ST elevation myocardial infarction (NSTEMI), 103 (10%) had unstable angina (UA), and 581 (56%) were ruled-out for ACS. Patients with STEMI were more likely to report chest pain, diaphoresis, and higher symptom distress (p<0.05) at presentation than those without. Patients with NSTEMI were more likely to report arm pain and patients with UA were more likely to report lightheadedness (p<0.05). The presence of any chest symptoms (OR 2.24; 95% CI 1.27-3.97), higher symptom distress (OR 1.07; 95% CI 1.0-1.15), and a lower number of symptoms (OR 0.92; 95% CI 0.86-0.98) were independent predictors of an ACS diagnosis (p<0.05). The strongest predictor of an ACS diagnosis was the presence of ECG ischemic changes (OR 4.51, 95% CI 3.20-6.36) adjusting for symptoms, age, gender, heart rate, arrhythmia, and troponin levels (p<0.001). Conclusion: ECG signs of ischemia combined with specific symptom characteristics may enhance timely triage and detection of ACS in the ED. Predictive models that incorporate presenting signs and symptoms should be explored for this vulnerable population.

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