scholarly journals Cocaine consumption and acute coronary syndromes: a cross sectional study from the Swiss registry AMIS Plus

2021 ◽  
Author(s):  
Giorgia Garzoli ◽  
Luigi Biasco ◽  
Dragana Radovanovic ◽  
Marco Moccetti ◽  
Hans Rickli ◽  
...  
Keyword(s):  
Acute Coronary Syndromes ◽  
Cocaine Abuse ◽  
Cardiovascular Events ◽  
Positive Family History ◽  
Public Health Issue ◽  
Hospital Death ◽  
Cocaine User ◽  
Coronary Syndrome ◽  
Coronary Syndromes ◽  
Cocaine Users

INTRODUCTION Cocaine abuse is a relevant public health issue which causes medical, psychological and social drawbacks. Only limited data are currently available on outcomes of acute coronary syndromes (ACS) in cocaine-addicted patients. The aim of this study was to evaluate the cardiovascular impact of cocaine in a population of patients enrolled in the Swiss nationwide AMIS Plus registry, with a focus on in-hospital outcomes. METHODS We retrospectively analysed data of patients enrolled in the Swiss AMIS Plus registry from 1 January 2007 to 31 December 2018. Baseline and in-hospital data of ACS patients with self-reported regular cocaine abuse were compared with the remaining AMIS Plus population and a sex and age-matched group of non-cocaine user ACS patients (ratio 1:5, 540 patients). Primary endpoints were in-hospital death and major adverse cardiac and cardiovascular events (MACCEs). RESULTS A total of 20,036 patients were included in the AMIS Plus registry for ACS in the study period, of whom 110 (0.5%) reported regular cocaine abuse. As compared with the remaining AMIS population, cocaine users were significantly younger (46.4 ± 10.8 vs 66.4 ± 13.2 years, p <0.001), presented more frequently with out-of-hospital cardiac arrest (11.8% vs 4.7%, p <0.001) and ST-elevation myocardial infarction (68.2% vs 54.7%, p = 0.007). Of the traditional cardiovascular risk factors, there was a higher incidence of positive family history and active smoking, but a lower incidence of arterial hypertension, diabetes and obesity. In-hospital mortality (3.6% vs 4.4%, p = 1) and MACCEs (5.4% vs 5.5%, p = 0.83) were comparable. When compared with an age-matched non-cocaine user ACS population, cocaine users were more frequently smokers (87.6% vs 63.6%, p <0.001) but less frequently obese (10.4% vs 25.6%, p = 0.001). Clinical presentation was comparable between the two groups. However, cocaine abuse was associated with a higher incidence of in-hospital death (3.7% vs 0.7%, p <0.05) and MACCEs (5.6% vs 1.3%, p <0.05). CONCLUSION Cocaine abuse increases the risk of mortality by a factor of 5 and the risk of major adverse cardiac and cardiovascular events by a factor of 4 as compared with a sex and age-matched population hospitalised after an acute coronary syndrome.

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.

P3625Cocaine consumption and acute coronary syndrome: an analysis from the Swiss registry AMIS Plus

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
G Garzoli ◽  
L Biasco ◽  
D Radovanovic ◽  
G Pedrazzini
Keyword(s):  
Cocaine Abuse ◽  
Cardiovascular Events ◽  
Clinical Presentation ◽  
Hospital Data ◽  
Cocaine User ◽  
Coronary Syndrome ◽  
Primary Endpoints ◽  
Risk Of Mortality ◽  
History Of ◽  
Hospital Cardiac Arrest

Abstract Introduction The aim of this study is to evaluate the cardiovascular impact of cocaine in a population of patients enrolled in the Swiss nationwide AMIS Plus registry with a focus on in-hospital outcomes. Methods We retrospectively analysed data of patients enrolled in the Swiss AMIS Plus registry from 2007 to 2018. Baseline and in-hospital data of patients with ACS and cocaine use were compared with the remaining AMIS population as well as to a sex and aged matched ACS patients (1:5 ratio, 540 patients) without history of cocaine consumption. Primary endpoints were death and major adverse cardiac and cardiovascular events (MACCE). Results A total of 20'981 patients had been included in the AMIS Plus registry for ACS in the study period, of them 110 (0.5%) were cocaine user. As compared to the remaining AMIS population, cocaine abusers were significantly younger (46.4±10.8 vs 66.4±13.2 years; p<0.001), presented more frequently with out of hospital cardiac arrest (11.8% vs 4.7%, p<0.001) and STEMI (68,2% vs 54.7%, p=0.007). Apart from active smoke and family history, had a lower burden of CV risk factors. In hospital mortality (3.6% vs 4.4%; p=1) and MACCE (5.4% vs 5.5%; p=0.83) were comparable. When compared to the age matched ACS population without history of cocaine consumption, cocaine abusers were more frequently smokers (87.6% vs 63.6%, p<0.001) but less frequently obese (10.4% vs 25.6%, p=0,001). Clinical presentation was comparable among the two groups, nonetheless cocaine abuse was associated with a higher incidence of death (3.7% vs 0.7%, p<0.05) and MACCE (5.6% vs 1.3%, p<0.05). Conclusion This analysis presents the largest series of cocaine associated ACS available in literature. Cocaine abuse increases by 5 the risk of mortality and by 4 the risk of MACCE as compared to an age matched ACS population. No differences where observed in outcomes when compared to a 20 years older population.

scholarly journals Clinical predictors and angiographic features of acute coronary syndromes caused by systemic embolism

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Jeronimo Baza ◽  
C Salazar ◽  
M.J Perez Vyzcaino ◽  
L Nombela ◽  
P Jimenez Quevedo ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Hospital Mortality ◽  
Acute Coronary Syndromes ◽  
Tertiary Hospital ◽  
Control Group ◽  
Systemic Embolism ◽  
Clinical Predictors ◽  
Coronary Syndrome ◽  
Valvular Surgery ◽  
Coronary Syndromes

Abstract Introduction Systemic embolism to coronary arteries is one of the mechanisms of acute myocardial infarction (AMI) of non-atherosclerotic cause. However, its clinical profile has not been properly established yet. Purpose To identify clinical predictors and angiographic characteristics of acute coronary syndromes caused by systemic embolism to a principal coronary artery (ACS-E), as well as to describe in-hospital mortality of these patients. Methods 40 patients with ACS-E, admitted between 2003 and 2018 in a tertiary hospital. Epidemiological, clinical and angiographic characteristics of these cases were compared with those from 4989 patients, attended for acute coronary syndrome of atherosclerotic cause (ACS-A) in the same hospital during the same period. Results Patients with ACS-E were younger (28% vs 10% were &lt;45 years old, p&lt;0.001) and had a higher proportion of women (43% vs 22%, p 0.003), atrial fibrillation (40% vs 5%, p&lt;0.001) and neoplasia (18% vs 7%, p 0.009). They had also undergone previous valvular surgery more frequently than patients with ACS-A (13% vs 0.5%, p&lt;0.001) and a higher proportion of them were under treatment with warfarin (15% vs 3%, p&lt;0.001). Variables identified as independent predictors of ACS-E in the multivariate analysis are shown in the table. Regarding clinical presentation, ST elevation AMI was more frequent in ACS-E cases (83% vs 67%, p 0.04). Patients with ACS-E did not present any significative stenosis in other vessels apart from the culprit one (number of other vessels with at least 1 severe stenosis was 0 in the ACS-E group vs 1.33 + 1 in the ACS-A arm, p&lt;0.001). PCI was attempted in 75% of the patients with ACS-E, resulting successful in 80% of the cases. On the other hand, 100% of SCA-A underwent PCI, with a success proportion of 99% (p&lt;0.001). In-hospital mortality in ACS-E group was 15% and 4% in the control group (p&lt;0.001). Conclusions ACS-E and ACS-A have different clinical and angiographic features. Atrial fibrillation, chronic warfarin treatment, previous valvular surgery, presence of any neoplasia and female sex are independent predictors for ACS-E. Funding Acknowledgement Type of funding source: None

Redefining residual inflammatory risk after acute coronary syndrome

2021 ◽  
Author(s):  
Marco G Del Buono ◽  
Rocco A Montone ◽  
Giulia Iannaccone ◽  
Riccardo Rinaldi ◽  
Giulia La Vecchia ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Cardiovascular Events ◽  
Multimodality Imaging ◽  
Short Review ◽  
Local Inflammation ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
Atherosclerotic Plaque Formation ◽  
Long Term Follow Up ◽  
Coronary Syndromes

Over the last decades, inflammation proved to play a pivotal role in atherosclerotic plaque formation, progression and destabilization. Several studies showed that the patients presenting with acute coronary syndrome are at increased risk of adverse cardiovascular events at both short- and long-term follow-up. Results from different clinical trials highlighted that a residual inflammatory risk exist and targeting inflammation is a successful strategy in selected cases associated to an increased inflammatory burden. Recently, the optimization of intracoronary and multimodality imaging allowed to also assess the entity of local inflammation, thus encouraging the individuation of plaque characteristics that portend a higher risk of future cardiovascular events. In this short review, we aim to highlight the role of systemic and local inflammation in acute coronary syndromes, to provide a summarized overview of the possible medical strategies applicable in selected cases and to underline the diagnostic and prognostic potential of multimodality imaging.

Abstract 3553: Effect of Resolution of Metabolic Syndrome on Endothelial Function and Cardiovascular Events after Acute Coronary Syndromes

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Shin-ichiro Miyazaki ◽  
Yoshikazu Hiasa ◽  
Takefumi Takahashi ◽  
Riyo Ogura ◽  
Naoki Suzuki ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Endothelial Function ◽  
Logistic Regression Analysis ◽  
Acute Coronary Syndromes ◽  
Cardiovascular Events ◽  
Multivariate Logistic Regression Analysis ◽  
Multivariate Logistic Regression ◽  
Coronary Syndromes

Background: Metabolic syndrome (MetS) is associated with endothelial dysfunction, and recognized as a risk factor of cardiovascular events after acute coronary syndromes (ACS). We examined whether the resolution of MetS would improve endothelial function and provide a beneficial effect on clinical outcome after ACS. Methods: We studied 60 patients with MetS who underwent a percutaneous revascularization procedure for ACS. MetS was defined using modified International Diabetes Federation criteria. Brachial artery flow-mediated dilation (FMD) and several risk parameters related to metabolic disorders were assessed at baseline and at 6 months. Each patient was given basic spoken advice on lifestyle modification and optimal medications before discharge. Patients were divided into 2 groups according to whether the criteria for MetS were fulfilled at 6 months: resolved MetS (R-MetS, n=35) and persistent MetS (P-MetS, n=25). Cardiovascular events were defined as cardiac death, stroke, myocardial infarction, unstable angina, and target vessel revascularization. Results: During the 1-year follow-up, 3 patients with R-MetS (8.6%) and 14 patients with P-MetS (56%) had cardiovascular events (p=0.0002). The extent of improvement in FMD was significantly greater in patients with R-MetS than those with P-MetS (change in FMD: 1.5 vs −1.2: p=0.007; respectively). In a multivariate logistic regression analysis, P-MetS was an independent predictor of cardiovascular events (odds ratio 18.4, 95%CI 1.67–28.5, p=0.025). Conclusion: The resolution of MetS is associated with the recovery of endothelial function and prevents cardiovascular events after ACS. Multivariate logistic regression analysis

Abstract 18945: Baseline Myocardium At-Risk Predicts Subsequent Myocardial Injury in Non ST-Segment Elevation Acute Coronary Syndrome

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Henry Chang ◽  
Jennifer A Dickerson ◽  
David Verhaert ◽  
Orlando P Simonetti ◽  
Giuseppe Ambrosio ◽  
...  
Keyword(s):  
At Risk ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Acute Coronary Syndromes ◽  
Myocardial Injury ◽  
Coronary Syndrome ◽  
St Segment ◽  
Coronary Syndromes ◽  
Myocardium At Risk

BACKGROUND: Increased myocardial injury visualized by late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) portends worse outcomes in patients with acute coronary syndromes (ACS). Although non ST-segment acute coronary syndromes (NSTE-ACS) comprise 70% of all ACS and 1-year mortality rates are similar to the more readily-diagnosed and uniformly-treated ST-elevation myocardial infarction, ischemic changes and treatment strategies in NSTE-ACS are not well-defined, Studies have shown that T2-weighted (T2W) cardiac magnetic resonance (CMR) may be a marker of acute myocardial injury in ACS. We hypothesized that the presence of at-risk myocardium, identified by T2W CMR at presentation, predicts increased subsequent myocardial injury by LGE beyond traditional risk predictors in NSTE-ACS. METHODS & RESULTS: 48 patients enrolled in a prospective study of NSTE-ACS underwent CMR with short tau inversion recovery (T2W STIR) imaging and LGE prior to intervention and repeat CMR 61 ± 27 days later. Baseline presence/absence of increased myocardial signal intensity by T2W STIR was determined by consensus of two expert reviewers blinded to other data. In 13 patients (27%), follow-up LGE images showed more extensive injury compared to baseline. Peak troponin at time of event, baseline TIMI risk score and baseline LGE score did not predict subsequent LGE score increase (p=0.13, p=0.48, p=0.55, respectively). Conversely, a much higher proportion of patients with vs. without increased T2W STIR SI at baseline demonstrated increased myocardial injury by LGE at follow-up (12/31 vs. 1/17, p<0.01; Figure). CONCLUSION: Myocardium at-risk by T2-weighted STIR CMR in patients with NSTE-ACS predicts subsequent myocardial injury, more so than clinical predictors or extent of baseline myocardial damage. Prospective studies that intensify care for patients with at-risk myocardium may help identify strategies to improve myocardial salvage and reduce mortality in NSTE-ACS.

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