scholarly journals Statin Utilization among Patients with Acute Coronary Syndrome: Systematic Review

2021 ◽  
Vol 9 (T4) ◽  
pp. 267-278
Author(s):  
Pramitha Esha Nirmala Dewi ◽  
Montarat Thavorncharoensap
Keyword(s):  
Acute Coronary Syndrome ◽  
Current Practice ◽  
Utilization Rate ◽  
Cross Sectional ◽  
Coronary Syndrome ◽  
Early Use ◽  
Risk Patients ◽  
Almost All ◽  
Intensive Regimen

BACKGROUND: The early use of statin with intensive regimen has been recommended by the recent guidelines as the prevention of acute coronary syndrome (ACS) related events among the high-risk patients. Meanwhile, the inconsistent statin utilization for targeted patient in current practice is still an issue. AIM: This study aims to review the utilization rate of statin among patients with ACS. METHODS: A systematic search of relevant studies published between inceptions to June 2020 was conducted in PubMed. Patients and intervention domains were used to build up the searching formula. A study was eligible for inclusion if it was an original study of patients with ACS and it examined the utilization of statin. The risk of bias was assessed using Axis and NOS checklist. RESULTS: Among the 49 eligible studies, 38 were cohort studies while the others were cross-sectional studies. The utilization rate of statin at hospital admission ranged from 16% to 61% while 25% to 75% during the hospitalization. Of the total studies, 35 studies reported the statin rate at discharge ranging from 58% to 99%. Almost all studies revealed the reduction of statin utilization rate along the follow-up period. The number of statins prescribed was found to be lower among female and elderly patients. CONCLUSION: Despite the established benefits of statin among patients with ACS, our study revealed that statin was underutilized for secondary prevention after ACS. To improve patients’ clinical outcomes with ACS, efforts should be made to increase optimal treatment and compliance with a statin.

scholarly journals Factors Affecting Nursing Ability To Know Acute Coroner Syndrome In Emergency Installation

2018 ◽  
Vol 2 (1) ◽  
pp. 64-72
Author(s):  
Agus Riyadi ◽  
Karmiati Karmiati
Keyword(s):  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Emergency Services ◽  
P Value ◽  
Cross Sectional ◽  
Factors Affecting ◽  
Research Education ◽  
Coronary Syndrome ◽  
Coronary Syndromes ◽  
Almost All

Background: Coronary heart disease is the most cardiovascular disease that causes death in the world. The ability of nurses to recognize acute coronary syndromes is very necessary as part of the emergency services team. Purpose : The purpose of this study was to determine the description of the factors that influence the ability of nurses to know acute coronary syndrome in the emergency department of dr. Iskak Tulungagung. Methods : The design of this research is descriptive analytic with a cross sectional approach with the population of all nurses who work in the Emergency Department of dr. Iskak Tulungagung. The population is 55 nurses. The sample is all of the population, namely 55 respondents with total sampling sampling techniques. The data that has been collected is processed by a statistical test of Multivariate Analysis, Ordinal Regression with significance α = 0.05. Result : The results showed that most of the respondents with D3 education were 33 respondents (60.0%), almost all respondents had never attended ECG training in the amount of 50 respondents (90.9%) and almost half of the respondents had a working period of 2-5 year is 25 respondents (45.5%). The results of the regression regression analysis showed that the p-value = 0.855 on the education factor which means that H0 was accepted, the p-value = 0.041 in the training factor which means H1 is received, the p-value = 0.003 on the working period, which means that H1 is accepted Conclusion : Based on research, education does not affect the ability to recognize acute coronary syndrome. The education obtained will develop according to the increase in the work period and the frequent training that is obtained and practiced directly in real situations

scholarly journals Chest pain symptoms differences between diabetes mellitus and non-diabetes mellitus patients with acute coronary syndrome: A pilot study

2021 ◽  
Vol 10 (2) ◽  
Author(s):  
Halidah Manistamara ◽  
Yurike Olivia Sella ◽  
Sony Apriliawan ◽  
Mifetika Lukitasari ◽  
Mohammad Saifur Rohman
Keyword(s):  
Diabetes Mellitus ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Total Sample ◽  
Cross Sectional ◽  
Coronary Syndrome ◽  
Adequate Knowledge ◽  
Late Treatment ◽  
Risk Patients ◽  
Pain Symptoms

Background: Chest pain is considered one of the crucial indicators in detecting acute coronary syndrome (ACS), and one of the most common complaints frequently found in hospitals. Atypical characteristics of chest pain have prevented patients from being aware of ACS. Chest pain symptoms have become ambiguous, particularly for specific parameters, such as gender, diabetes mellitus (DM), or other clinical conditions. Therefore, it is critical for high-risk patients to have adequate knowledge of specific symptoms of ACS, which is frequently associated with late treatment or prehospital delay. Therefore, this study aims to identify the particular characteristics of chest pain symptoms in DM and non-DM patients with ACS.Design and Methods: This is a quantitative and non-experimental research, with the cross-sectional approach used to carry out the analytical observation at a general hospital from January-April 2019. Data were obtained from a total sample of 61 patients, comprising 33 ACS with DM and 28 ACS non-DM patients.Results: The result showed that the characteristic of patients with chest pain symptoms has a significant relation to DM and ACS. Therefore, non-DM patients with ACS are more likely to feel chest pain at moderate to a severe level, while ACS-DM patients are more likely to have low to moderate chest pain levels.Conclusion: The significant differences in the characteristics of chest pain in DM and non-DM patients suffering from acute coronary syndrome are the points of location of chest pain radiating to the neck and quality of pain.

scholarly journals Secondary prevention after acute coronary syndrome - can we achieve dyslipidemia guideline targets?

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
M Martins De Carvalho ◽  
T Proenca ◽  
RA Pinto ◽  
S Torres ◽  
CX Resende ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
High Risk ◽  
Coronary Disease ◽  
Rehabilitation Program ◽  
High Risk Patients ◽  
Coronary Syndrome ◽  
Risk Patients ◽  
Lipid Control ◽  
Very High

Abstract Funding Acknowledgements Type of funding sources: None. Lipid control is one of the most important secondary cardiovascular prevention targets. The 4S trialin 1994 was the first study to demonstrate the benefit of statin therapy in coronary artery disease patients. More recently, the FOURIER trial (2017) and the ODYSSEY Outcomes (2018) demonstrated the cardiovascular benefit of adding a PCSK9 inhibitor to optimized antidyslipidemic therapy. Owing to the growing number of evidence showing the importance of aggressive lipid control, the European Society of Cardiology (ESC) 2019 Dyslipidemia Guidelines changed the recommendation of LDL targets from below 70 mg/dL to below 55 mg/dL in very high risk patients. In the light of this new recommendation, we retrospectively analysed all patients who participated in a Coronary Rehabilitation Program (CRP) after an Acute Coronary Syndrome at a tertiary center from May 2008 to June 2019. The CRP consisted in a multi-disciplinary approach to these patients, including 8 to 12 weekly sessions of phase II rehabilitation, exercise prescription, nutrition counselling and life-style intervention, with Cardiology follow-up at the end of the CRP (3 months), 6 months and 12 months after the event. Lipid profile was requested at baseline, 3 months and 12 months after the event. Dyslipidemia was defined using the ESC Guidelines definition. In total, 989 patients were enrolled: the mean age was 54 ± 10 years and 15% were female. Concerning to cardiovascular risk factors, 56.7% of patients had dyslipidaemia, 41.5% had hypertension, 18.1% were diabetic, 73.1% were smokers or previous smokers, 26.0% had family history of coronary disease and 14.0% had previous coronary disease. At hospital admission, mean LDL concentration was 121,7 ± 38,8 mg/dL with 2,9% of the patients with values below 55 mg/dL and 7,6% below 70 mg/dL. The vast majority of patients were medicated with statin at hospital discharge and maintained the prescription during the follow-up (97.5% and 97.1%, respectively). At the end of the CRP, there was a significant decrease of LDL values (p < 0.001) with 18.7% patients with LDL below 55 mg/dL and 46.3% below 70 mg/dL (mean LDL 76.6 ±23.6 mg/dL). At 1-year follow-up, the lipid control was better than at admission, but inferior than at the end of the rehabilitation program, both findings statistically significant (11.0% patients were below 55 mg/dL and 33.1% were below 70 mg/dL, with a mean LDL of 82.7 ± 28.3 mg/dL; p < 0.001). In conclusion, our real-life observational cohort showed that guideline recommended LDL target is not achieved in most of very high-risk patients even in a structured coronary rehabilitation program. Of note, the number of patients at LDL-target decreased from 3 months to 1-year follow-up. This state the importance of a sustained healthy lifestyle and therapy adherence, with aggressive pharmacologic therapy.

scholarly journals Is the use of two versus one long-acting bronchodilator by patients with COPD associated with a higher risk of acute coronary syndrome in real-world clinical practice?

2021 ◽  
Vol 8 (1) ◽  
pp. e000840
Author(s):  
Lianne Parkin ◽  
Sheila Williams ◽  
David Barson ◽  
Katrina Sharples ◽  
Simon Horsburgh ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Clinical Practice ◽  
Real World ◽  
Chronic Obstructive ◽  
Treatment Intensification ◽  
Cardiovascular Comorbidity ◽  
Coronary Syndrome ◽  
Long Acting ◽  
The Impact

BackgroundCardiovascular comorbidity is common among patients with chronic obstructive pulmonary disease (COPD) and there is concern that long-acting bronchodilators (long-acting muscarinic antagonists (LAMAs) and long-acting beta2 agonists (LABAs)) may further increase the risk of acute coronary events. Information about the impact of treatment intensification on acute coronary syndrome (ACS) risk in real-world settings is limited. We undertook a nationwide nested case–control study to estimate the risk of ACS in users of both a LAMA and a LABA relative to users of a LAMA.MethodsWe used routinely collected national health and pharmaceutical dispensing data to establish a cohort of patients aged >45 years who initiated long-acting bronchodilator therapy for COPD between 1 February 2006 and 30 December 2013. Fatal and non-fatal ACS events during follow-up were identified using hospital discharge and mortality records. For each case we used risk set sampling to randomly select up to 10 controls, matched by date of birth, sex, date of cohort entry (first LAMA and/or LABA dispensing), and COPD severity.ResultsFrom the cohort (n=83 417), we identified 5399 ACS cases during 281 292 person-years of follow-up. Compared with current use of LAMA therapy, current use of LAMA and LABA dual therapy was associated with a higher risk of ACS (OR 1.28 (95% CI 1.13 to 1.44)). The OR in an analysis restricted to fatal cases was 1.46 (95% CI 1.12 to 1.91).ConclusionIn real-world clinical practice, use of two versus one long-acting bronchodilator by people with COPD is associated with a higher risk of ACS.

scholarly journals Bone marrow-derived NGFR+ cells regulate arterial remodeling and those poor mobilizations in peripheral blood in acute coronary syndrome predicts plaque progression at the non-targeted lesion

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Takashima ◽  
S Usui ◽  
S Matsuura ◽  
C Goten ◽  
O Inoue ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Acute Coronary Syndrome ◽  
Peripheral Blood ◽  
Funding Source ◽  
Arterial Remodeling ◽  
Plaque Progression ◽  
Wild Type ◽  
Plaque Volume ◽  
Coronary Syndrome

Abstract Background In our previous 5-year cohort study, we demonstrated that low gene expression of nerve growth factor receptor (NGFR) in peripheral leucocytes in acute coronary syndrome (ACS) predicted repetitive coronary interventions at the de novo lesions. An NGFR-positive cell has been demonstrated to reside in bone marrow (BM) stromal fraction and to be increased in peripheral blood mononuclear cell (MNCs) fraction in patients with ischemic heart disease. Purpose To investigate whether the BM-NGFR+ cell is associated with arterial remodeling and the relationship between the levels of peripheral NGFR+ cells after ACS and coronary plaque progression in an experimental and prospective clinical study. Methods and results In an experimental study, 8-week-old C57B6/J wild type male mice were subjected to irradiation with 9.6 Gy and transplantation with BM (BMT) isolated from GFP-transgenic NGFR wild type (WT) or knock-out (KO) mice at day 1. Four weeks after BMT, the right carotid artery was ligated for 4 weeks. Induced neointimal area was increased (p<0.05), where cells under apoptosis were decreased (p<0.05) in NGFR-KO-BMT group compared to WT-BMT group (n=4). NGFR+ cells were not detected in wild type sham-operated artery, whereas in the ligated artery in WT-BMT group NGFR+ cells assembled in the developed neointima and exclusively presented double positive with GFP, but absent in NGFR-KO-BMT group (p<0.05, n=4). In a clinical study, thirty patients with ACS who underwent primary percutaneous coronary intervention (PCI) were enrolled. The peripheral blood sample was collected on days 0, 3 and 7, and 9 months follow-up and the number of NGFR+MNCs were measured by flowcytometric analysis. The plaque volume at non-targeted coronary lesion (non-TL:>5 mm proximal or distal to the implanted stents) were quantitatively analysed using gray-scale intravascular ultrasound (IVUS) and Q-IVUS™ software at the acute phase and 9 months follow-up. The number of NGFR+MNCs in peripheral blood was 1.5-fold increased at day 3 (0.064±0.056%) compared to day 0 (0.042±0.030%) (p<0.05). The change in normalized total plaque volume (TAVN) at non-TL at 9 months was negatively correlated with the number of NGFR+MNCs at day 0 (r=−0.51), day 3 (r=−0.51) and 9 months (r=−0.59) after ACS (p<0.05). Multiple regression analysis showed that NGFR+MNCs at day 0 (β=−0.48, p=0.01) and CRP (β=−0.53, P<0.01) are independent factors associating with TAVN change at non-TL at 9 months, regardless of LDL-cholesterol control level. ROC analysis revealed that NGFR+MNCs <0.049 at day 0 predicted the increase of TAVN with AUC 0.78; sensitivity 0.82 and specificity 0.67. Conclusions Bone marrow-derived peripheral NGFR+ cells negatively regulate arterial remodeling through appropriate apoptosis of neointimal cells and the peripheral level of NGFR+ cells in ACS predicts plaque progression at the non-targeted lesion. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): KAKENHI

Macrophage infiltrates in coronary plaque erosion portend a worse cardiovascular outcome in patients with acute coronary syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R.A Montone ◽  
V Vetrugno ◽  
M Camilli ◽  
M Russo ◽  
M.G Del Buono ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Vulnerable Plaque ◽  
Cardiac Death ◽  
Cox Regression ◽  
Plaque Rupture ◽  
Culprit Lesion ◽  
Coronary Syndrome ◽  
Fibrous Cap ◽  
Plaque Erosion

Abstract Background Plaque erosion (PE) is responsible for at least one-third of acute coronary syndrome (ACS). Inflammatory activation is considered a key mechanism of plaque instability in patients with plaque rupture through the release of metalloproteinases and the inhibition of collagen synthesis that in turns lead to fibrous cap degradation. However, the clinical relevance of macrophage infiltration has never been investigated in patients with PE. Purpose In our study, we aimed at assessing the presence of optical coherence tomography (OCT)-defined macrophage infiltrates (MØI) at the culprit site in ACS patients with PE, evaluating their clinical and OCT correlates, along with their prognostic value. Methods ACS patients undergoing OCT imaging and presenting PE as culprit lesion were retrospectively selected. Presence of MØI at culprit site and in non-culprit segments along the culprit vessel was assessed. The incidence of major adverse cardiac events (MACEs), defined as the composite of cardiac death, recurrent myocardial infarction and target vessel revascularization (TVR), was assessed [follow-up median (interquartile range, IQR) time 2.5 (2.03–2.58) years]. Results We included 153 patients [median age (IQR) 64 (53–75) years, 99 (64.7%) males]. Fifty-one (33.3%) patients presented PE with MØI and 102 (66.7%) PE without MØI. Patients having PE with MØI compared with PE patients without MØI had more vulnerable plaque features both at culprit site and at non-culprit segments. In particular, culprit lesion analysis demonstrated that patients with PE with MØI had a significantly thinner fibrous cap [median (IQR) 100 (60–120) μm vs. 160 (95–190) μm, p<0.001], higher prevalence of thrombus [41 (80.4%) vs. 64 (62.7%), p=0.028], lipid plaque [39 (76.5%) vs. 50 (49.0%), p<0.001], TCFA [20 (39.2%) vs. 14 (13.7%), p=0.001], and a higher maximum lipid arc [median [IQR] 250.0° (177.5°-290.0°) vs. 190.0° (150.0°-260.0°), p=0.018) at the culprit lesion compared with PE without MØI. MACEs were significantly more frequent in PE with MØI patients compared with PE without MØI [11 (21.6%) vs. 6 (5.9%), p=0.008], mainly driven by a higher risk of cardiac death and TVR. At multivariable Cox regression model, PE with MØI [HR=2.95, 95% CI (1.09–8.02), p=0.034] was an independent predictor of MACEs. Conclusion Our study demonstrates that among ACS patients with PE the presence of MØI at culprit lesion is associated with a more aggressive phenotype of coronary atherosclerosis with more vulnerable plaque features, along with a worse prognosis at a long-term follow-up. These findings are of the utmost importance in the era of precision medicine because clearly show that macrophage infiltrates may identify patients with a higher cardiovascular risk requiring more aggressive secondary prevention therapies and a closer clinical follow-up. Prognosis Funding Acknowledgement Type of funding source: None

scholarly journals Protein Intake and Physical Activity in Newly Diagnosed Patients with Acute Coronary Syndrome: A 5-Year Longitudinal Study

Nutrients ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 634 ◽  
Author(s):  
Andrea Greco ◽  
Agostino Brugnera ◽  
Roberta Adorni ◽  
Marco D’Addario ◽  
Francesco Fattirolli ◽  
...  
Keyword(s):  
Physical Activity ◽  
Acute Coronary Syndrome ◽  
Protein Intake ◽  
Processed Meat ◽  
High Morbidity ◽  
Newly Diagnosed ◽  
Healthy Behaviors ◽  
Coronary Syndrome ◽  
Over Time

Cardiovascular disease is one of the most common causes of hospitalization and is associated with high morbidity and mortality rates. Among the most important modifiable and well-known risk factors are an unhealthy diet and sedentary lifestyle. Nevertheless, adherence to healthy lifestyle regimes is poor. The present study examined longitudinal trajectories (pre-event, 6-, 12-, 24-, 36-, and 60-month follow-ups) of protein intake (fish, legumes, red/processed meat) and physical activity in 275 newly-diagnosed patients with acute coronary syndrome. Hierarchical Generalized Linear Models were performed, controlling for demographic and clinical variables, the season in which each assessment was made, and the presence of anxiety and depressive symptoms. Significant changes in protein intake and physical activity were found from pre-event to the six-month follow-up, suggesting the adoption of healthier behaviors. However, soon after the six-month follow-up, patients experienced significant declines in their healthy behaviors. Both physical activity and red/processed meat intake were modulated by the season in which the assessments took place and by anxiety symptoms over time. The negative long-term trajectory of healthy behaviors suggests that tailored interventions are needed that sustain patients’ capabilities to self-regulate their behaviors over time and consider patient preference in function of season.

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