scholarly journals Impact of Age on Risk Factors and Clinical Manifestations of Acute Coronary Syndrome: Observations From the Coronary Care Unit of Sulaimani, Iraq

2020 ◽  
Vol 5 (1) ◽  
pp. 28-34
Author(s):  
Amanj Abubakr Jalal Khaznadar ◽  
Rebin Wahid Salh
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Physical Inactivity ◽  
Coronary Care Unit ◽  
St Segment Elevation ◽  
Atypical Symptoms ◽  
Coronary Syndrome ◽  
St Segment ◽  
Coronary Care

Background: ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI ) are common types of acute coronary syndrome which are associated with the risk factors of age, obesity, hypertension, and diabetes. Objective: The present study aimed to examine the effects of age on the risk factors and clinical symptoms of acute coronary syndrome. Methods: A cross-section prospective study was conducted on 125 patients with acute coronary syndrome chosen by non-probability convenience sampling method in the coronary care unit in Sulaimani, the Kurdistan region of Iraq. Acute coronary syndrome types were diagnosed through clinical presentations, electrocardiography (ECG), and troponin test. Data was collected using a researcherbased checklist through face-to-face interviews. Results: The results indicated that males were the dominant group. The age group 45-65 had the highest prevalence rate of acute coronary syndrome. The most frequent risk factors for acute coronary syndrome were hypertension (54.4%), dyslipidemia (52%), smoking (42.4%), and diabetes mellitus (38.4%). Typical chest pain was found to be the most frequent clinical presentation (88%). There was a significant difference between the age groups in terms of the effect of age on typical and atypical symptoms; however, neither age nor typical/atypical symptoms had a significant effect on type of acute coronary syndrome. Similarly, family history, hypertension, diabetes mellitus, obesity, smoking, physical inactivity, and dyslipidemia had no effect on type of acute coronary syndrome. Conclusion: Age is a predictive factor for acute coronary syndrome, but family history, hypertension, diabetes mellitus, obesity, smoking, physical inactivity, and dyslipidemia cannot predict acute coronary syndrome.

Abstract 9406: ST-Segment Elevation in Lead AVR Strongly Predicts Long-Term Adverse Outcomes in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Masami Kosuge ◽  
Toshiaki Ebina ◽  
Kiyoshi Hibi ◽  
Kengo Tsukahara ◽  
Noriaki Iwahashi ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Adverse Outcomes ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Lead Avr ◽  
Timi Risk Score

Introduction: In non-ST-segment elevation acute coronary syndrome (NSTE-ACS), ST-elevation in lead aVR (ST↑aVR) on admission ECG has been shown to be associated with severe coronary artery disease, but its impact on long-term clinical outcomes is unclear. Methods: We studied 454 patients with NSTE-ACS who underwent coronary angiography during initial hospitalization. Patients were divided into the 3 groups according to the degree of ST↑aVR on admission ECG: no ST↑aVR (n=301, G-A); ST↑aVR <1.0 mm (n=82, G-B); and ST↑aVR ≥1.0 mm (n=71, G-C). Troponin T (TnT), hemoglobin (Hb), estimated glomerular filtration rate (eGFR), brain natriuretic peptide (BNP), high-sensitivity C-reactive protein (hsCRP), TIMI risk score, and summed ST-segment depression in other leads were also measured on admission. Results: There were no differences in sex or coronary risk factors except for diabetes mellitus in the 3 groups. In G-A, G-B, and G-C, age was 66±11, 68±11, and 70±11 years; the rates of diabetes mellitus were 30%, 48%, and 51%; Killip class ≥2 was 7%, 20%, and 34%; positive TnT was 30%, 46%, and 56%; TIMI risk score was 2.8±1.4, 3.6±1.3, and 3.8±1.2; the levels of Hb were 13.4±1.9, 13.2±1.9, and 12.2±2.3 g/dl; eGFR was 65±24, 59±27, and 53±28 ml/min/1.73 m2; BNP was 155±249, 386±338, and 455±507 pg/ml; hsCRP was 0.339±1.499, 0.654±1.899, and 0.842±1.788 mg/dl; summed ST-segment depression was 2.0±2.6, 5.6±3.5, and 13.0±6.6 mm; the rates of left main or 3-vessel disease were 9%, 44%, and 75%; and major adverse events (death, [re]infarction, urgent revascularization, or heart failure requiring hospitalization) at 5 years were 19%, 43%, and 58%, respectively (all p<0.01). After adjusting for baseline characteristics, multivariate analysis showed that as compared with no ST↑aVR, the hazard ratios (95% CI) for 5-year adverse events associated with ST↑aVR <1.0 mm and ST↑aVR ≥1.0 mm were 2.16 (1.10-5.59; p=0.019) and 3.90 (1.44-9.76; p=0.001), respectively. Conclusions: In patients with NSTE-ACS, greater ST↑aVR on admission ECG strongly predicted 5-year adverse outcomes, even after adjusting for traditional risk factors, biomarker profiles, and ST-segment depression in other leads. Our findings suggest the importance of ST↑aVR in risk stratification for NSTE-ACS.

scholarly journals Contrast-induced nephropathy in patients with acute coronary syndrome with ST-segment elevation: risk factors and prognosis

The Clinician ◽  
2020 ◽  
Vol 13 (3-4) ◽  
pp. 36-42
Author(s):  
O. V. Arsenicheva ◽  
N. N. Shchapovа
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Acute Coronary Syndrome ◽  
Contrast Induced Nephropathy ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment

Objective: to study the risk factors for acute renal injury, the dynamics of renal function and prognosis in patients with acute coronary syndrome with ST-segment elevation (STEACS) with contrast-induced nephropathy (CIN) after primary percutaneous coronary intervention (PCI).Materials and methods. We studied 20 patients with STEACS, who developed СIN after PCI (follow-up group), and 98 patients with STEACS without СIN (comparison group). All patients were measured plasma creatinine level and glomerular filtration rate by the formula CKD-EPI before and 48 hours after PCI. CIN was detected with an increase in creatinine levels in the blood by more than 26.5 µmol / l from the baseline 48 hours after administration of radiopaque drug (RCP). Endpoints were evaluated at the hospital stage and within 12 months after PCI.Results. CIN after PCI occurred in 16.9 % of patients with STEACS. Among patients with СIN, persons aged over 75 years (60 %), with diabetes mellitus (45 %), chronic kidney disease (75 %), postinfarction cardiosclerosis (50 %), chronic heart failure of functional class III–IV (80 %), developed acute heart failure T. Killip III–IV (90 %) were significantly more often observed. The left ventricular ejection fraction was lower in patients with СIN (p <0.05). The average increase in plasma creatinine 48 hours after PCI was higher in the follow-up group (p <0.05). In patients with СIN more often, than without СIN, three-vascular lesions of the coronary bed were detected (65 and 25.5 % respectively, p <0.001). The same trend was observed, when assessing the average number of coronary artery stenoses, the number of implanted stents and the volume of RCP used. Patients with СIN, than without СIN, were longer in hospital (12.1 ± 0.96 and 10.2 ± 1.11 days respectively, p <0.05) and more often needed re-hospitalization within 12 months after PCI (34 and 4.1 % respectively, p <0.05).Summary. CIN in patients with STEACS after primary PCI was more likely to develop, if the following symptoms were present: age over 75 years, diabetes mellitus, chronic heart failure, post-infarction cardiosclerosis, chronic kidney disease, low ejection fraction of the left ventricle, initially high creatinine level, development of acute heart failure, trisovascular coronary lesion and multiple coronary stenting. The duration of hospital stay and the frequency of re-hospitalizations within a year after PCI significantly increased in patients in the CIN group.

scholarly journals Analysis of risk factors for different subtypes of acute coronary syndrome

2021 ◽  
Vol 49 (5) ◽  
pp. 030006052110083
Author(s):  
Lei Zhang ◽  
Juledezi Hailati ◽  
Xiaoyun Ma ◽  
Jiangping Liu ◽  
Zhiqiang Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Brain Natriuretic Peptide ◽  
Left Ventricular ◽  
St Segment Elevation ◽  
Amino Terminal ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Aims To investigate the different risk factors among different subtypes of patients with acute coronary syndrome (ACS). Methods A total of 296 patients who had ACS were retrospectively enrolled. Blood and echocardiographic indices were assessed within 24 hours after admission. Differences in risk factors and Gensini scores of coronary lesions among three groups were analyzed. Results Univariate analysis of risk factors for ACS subtypes showed that age, and levels of fasting plasma glucose, amino-terminal pro-brain natriuretic peptide, and creatine kinase isoenzyme were significantly higher in patients with non-ST-segment elevation myocardial infarction (NSTEMI) than in those with unstable angina pectoris (UAP). Logistic multivariate regression analysis showed that amino-terminal pro-brain natriuretic peptide and the left ventricular ejection fraction (LVEF) were related to ACS subtypes. The left ventricular end-diastolic diameter was an independent risk factor for UAP and ST-segment elevation myocardial infarction (STEMI) subtypes. The severity of coronary stenosis was significantly higher in NSTEMI and STEMI than in UAP. Gensini scores in the STEMI group were positively correlated with D-dimer levels (r = 0.429) and negatively correlated with the LVEF (r = −0.602). Conclusion Different subtypes of ACS have different risk factors. Our findings may have important guiding significance for ACS subtype risk assessment and clinical treatment.

scholarly journals Bleeding risk factors in patients with acute coronary syndrome: data from observational studies ORACUL II

2019 ◽  
Vol 24 (3) ◽  
pp. 7-16 ◽  
Author(s):  
V. A. Brazhnik ◽  
L. O. Minushkina ◽  
R. R. Guliev ◽  
A. O. Averkova ◽  
A. A. Rogozhina ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Roc Analysis ◽  
Bleeding Risk ◽  
Killip Class ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Risk Scale

Aim.To identify the risk factors for bleeding of BARC scale 2-5 types in patients after acute coronary syndrome (ACS).Material and methods.The data of 1502 patients from the open multicenter study, ORACUL II, were used — 894 men (59,5%) and 608 women (40,5%), mean age — 65,7±12,9 years. Five hundred sixty (37,3%) patients had ACS with ST-segment elevation and 942 (62,7%) — ACS without ST-segment elevation. Bleeding was recorded in 164 patients (10,9%), including index admission — in 39 (2,6%) patients, of which severe (types 3-5) — 0,5%, significant — 1,7% (types 2-5).Results.Within a year after discharge, bleeding was observed in 126 (8,4%) patients, large — 0,8%, significant — 2,4%. The development of bleeding type 2-5 was associated with the presence of gastric ulcer and duodenal ulcer, gastrointestinal bleeding in history, decreased creatinine, hemoglobin clearance, age of patients, the use of anticoagulants in the composition of triple or double antithrombotic therapy, conducting of percutaneous interventional procedures, the presence of heart failure 2-4 Killip class at admission. ROC analysis showed that the predictive value of the ORACLE bleeding risk scale is 0,762, sensitivity — 62%, specificity — 78%.Conclusion.Thus, we based on routine clinical practice have created a simple scale for assessing the risk of bleeding in patients with ACS.

scholarly journals Risk Stratification and in Hospital Morality in Patients Presenting with Acute Coronary Syndrome (ACS) in Bahrain

2018 ◽  
Vol 12 (1) ◽  
pp. 7-17 ◽  
Author(s):  
Taysir S Garadah ◽  
Khalid Bin Thani ◽  
Leena Sulibech ◽  
Ahmed A Jaradat ◽  
Mohamed E Al Alawi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Hospital Mortality ◽  
Systolic Hypertension ◽  
Cardiac Events ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Positive Serum ◽  
Grace Score

Background: Risk factors and short-term mortality in patients presented with Acute Coronary Syndrome (ACS) in Bahrain has not been evaluated before. Aim: In this prospective observational study, we aim to determine the clinical risk profiles of patients with ACS in Bahrain and describe the incidence, pattern of presentation and predictors of in-hospital clinical outcomes after admission. Methods: Patients with ACS were prospectively enrolled over a 12 month period. The rate of incidence of risk factors in patients was compared with 635 non-cardiac patient admissions that matched for age and gender. Multiple logistic regression analysis was used to predict poor outcomes in patients with ACS. The variables were ages >65 years, body mass index (BMI) >28 kg/m2, GRACE (Global Registry of Acute Coronary Events) score >170, history of diabetes mellitus (DM), systolic hypertension >180 mmHg, level of creatinine >160 μmol/l and Heart Rate (HR) on admission >90 bpm, serum troponin rise and ST segment elevation on the ECG. Results: Patients with ACS (n=635) were enrolled consecutively. Mean age was 61.3 ± 13.2 years, with 417 (65.6%) male. Mean age for patients with ST-segment elevation myocardial infarction (STEMI, n=156) compared with non-STEMI (NSTEMI, n=158) and unstable angina (UA, n=321) was 56.5± 12.8 vs 62.5±14.0 years respectively. In-hospital mortality was 5.1%, 3.1% and 2.5% for patients with STEMI, NSTEMI, and UA, respectively. In STEMI patients, thrombolytic therapy was performed in 88 (56.5%) patients and 68 (43.5%) had primary coronary angioplasty (PCI). The predictive value of different clinical variables for in-hospital mortality and cardiac events in the study were: 2.8 for GRACE score >170, 3.1 for DM, 2.2 for SBP >180 mmHg, 1.4 for age >65 years, 1.8 for BMI >28, 1.7 for creatinine >160 μmol/L, 2.1 for HR >90 bpm, 2.2 for positive serum troponin and 2.3 for ST elevation. Conclusion: Patients with STEMI compared with NSTEMI and UA were of younger age. There was higher in-hospital mortality in STEMI compared with NSTEMI and UA patients. The most significant predictors of death or cardiac events on admission in ACS were DM, GRACE Score >170, systolic hypertension >180 mmHg, positive serum troponin and HR >90 bpm.

Abstract 16471: Illness Perception in Patients Hospitalized for Acute Coronary Syndrome

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Mariana Suarez-Bagnasco ◽  
Ariel O Estevez ◽  
Claudio Higa ◽  
Maria Laura Monsalvo
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Risk Factor ◽  
Heart Disease ◽  
Positive Family History ◽  
Illness Perception ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment

Introduction: Studies of Illness perception in patients with acute coronary syndrome (ACS) conducted in Canada and Finland showed that genetic factors, stress and lifestyle behaviors are the most common perceived cause of ACS (unstable angina, myocardial infarction). As illness perception is influenced by the personal experience of the illness and its management, as well as by cultural and social factors, we conducted a study to assess illness perception in patients with acute coronary syndrome in Argentina. Methods: Descriptive, cross-sectional, multicenter study. Adults over 18 years old hospitalized for ACS participated in the study. The day of discharge from the Coronary Care Unit, each subject completed a questionnaire generated and validated in Argentina aimed at assessing illness perception. Clinical data were collected by the treating physician at each participating institution. Results: 109 patients between 33 and 84 years old (mean [SD] age = 61 [12] years, 70% male) were enrolled; 57% was diagnosed with ACS without ST-segment elevation and 37% was diagnosed with acute myocardial infarction (MI) with ST-segment elevation; in 6% the acute MI was indeterminate. Many patients attributed the heart disease to their traditional cardiovascular risk factors: 93% to hypertension, 81% to cholesterol, 71% to diabetes mellitus, 69% to physical inactivity, 67% to obesity, 63% to smoking. Only 30% of patients with a positive family history identified it as a risk factor. Stress, anxiety, and personality were identified as the cause for their heart disease in 71%, 64%, and 42% of patients, respectively. The majority of patients (74%) considered that they should improve the adherence to medications after discharge and 80% that should attend the medical follow-ups. Conclusion: Most patients identified their modifiable risk factors as causal for coronary heart disease. Only 30% of participants with a positive family history recognized it as a risk factor. A high percentage of patients recognized suboptimal behaviors in relation to medication adherence and medical follow-ups.

scholarly journals Prognosis and follow-up of young patients admitted to a critical coronary care unit with acute coronary syndrome

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
DF Arroyo Monino ◽  
C Barea Gonzalez ◽  
MP Ruiz Garcia ◽  
T Seoane Garcia ◽  
JC Garcia Rubira
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Coronary Artery ◽  
Hospital Mortality ◽  
Coronary Care Unit ◽  
Young Patients ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Coronary Care

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The presence of young patients admitted to a Critical Coronary Care Unit (CCCU) with the diagnosis of Acute Coronary Syndrome (ACS) is very common nowadays. The prognosis of these patients seems to be better than the elderly ones, although there are few records that endorse this statement. Objective Our aim is to carry out a follow-up of this population and study their prognosis during the index hospitalization and the follo-up. Methods Retrospective, descriptive, unicentric and observational registry of young patients (&lt;45 years old) admitted to one CCCU with the diagnosis of ACS between January 2.010 and November 2.020. The follow-up of these patients was performed using the electronic platform of Andalusian Health Security System. Results A total number of 252 patients were included in the registry, with a mean age of 40 years old, being male 206 (81,7%). The main reason of the admission was ACS with persistent ST segment elevation (STEMI) (177 patients – 70,2%). The most prevalent risk factor in this population was active smoking (198 patients – 78,6%). The main underlying mechanism of the ACS was the rupture of an atherosclerotic plaque (194 patients – 77%) and in most cases, there was only 1 coronary artery affected (153 patients – 60,7%). Intra-hospital mortality was low (2 patients died of cardiovascular cause – 0,8%, and 1 died of non-cardiovascular cause – 0,4%). Left ventricle ejection fraction (LVEF) at the discharge was preserved in 166 patients (65,9% - mean 58%), and reduced (&lt;40%) in 37 patients (14,7%). The median of the follow-up was 77 months (minimum 1 month and maximum 132 months). A total number of 5 patients died during this follow-up (2%, 3 during the first year), 3 of them of cardiovascular cause; these 3 patients had reduced LVEF at the discharge. During this follow-up, 64 (25,4%) patients were re-admitted to the hospital due to cardiovascular causes, most of them (30 – 11,9%) with the diagnosis of chest pain and 20 of them (7,9%) with the diagnosis of a new ACS. Conclusions Young patients admitted to our CCCU with the diagnosis of ACS presented most frequently with STEMI, affecting predominantly one coronary artery. Most of them had preserved LVEF at the discharge. The prognosis of this group of patients is good, with a low intra-hospital mortality and during the follow-up, with clear relation with the presence of reduced LVEF at the discharge. Re-admission was relatively frequent, mostly due to chest pain.

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