Acute coronary syndromes and atherosclerotic plaque burden distribution in coronary arteries among patients with valvular heart disease (BIA-WAD registry)

Abstract Background Elderly patients with acute coronary syndromes (ACS) represent a group seldom included in clinical trials and in whom robust data regarding mid-term impact of significant concomitant valvular heart disease are lacking. Purpose Our aim was to evaluate the impact of moderate-to-severe mitral regurgitation (MR), moderate-to-severe aortic stenosis (AS), or both conditions combined on a primary composite endpoint of mortality, myocardial infarction, disabling stroke and re-hospitalization for cardiovascular causes or bleeding within one year in a population of ACS patients included in the Elderly ACS 2 trial. Methods In the multicenter Elderly II ACS Study, 1,443 patients aged >74 y undergoing percutaneous coronary intervention (PCI) for ACS, were randomly assigned to receive prasugrel (5 mg) or clopidogrel (75 mg) and were prospectively followed for 1 year. Amongst these, 1,102 patients received full echocardiographic assessment and were included in the post-hoc analysis (Table 1). Results Survival analysis showed that patients presenting with moderate-to-severe MR, AS or both (Figure 1A), had worse outcome in terms of primary endpoint (p<0.001) as compared to no valve disease. A multivariable Cox regression model revealed that the presence of moderate-to-severe MR, AS or both were independent predictors of primary endpoint (HR 1.84; HR 2.8; HR 2.9 and p<0.001; p=0.004; p=0.01, respectively), regardless of age, gender, left ventricular ejection fraction, diabetes mellitus, history of cancer and total number of diseased vessels (Figure 1B). Table 1 Overall No residual valvular heart disease Moderate-to-severe MR Moderate-to-severe AS Both Age (y) 80.68±4.50 80.40±4.42 81.47±4.45 82.92±5.42 83.23±5.42 Male gender 652 (59.2) 538 (61.6) 92 (48.4) 19 (73.1) 3 (23.1) STE-ACS 420 (38.1) 319 (36.5) 91 (47.9) 6 (23.1) 4 (30.8) Diabetes mellitus 203 (18.4) 158 (18.1) 35 (18.4) 5 (19.2) 5 (38.5) LVEF (%) 48.30±9.58 49.26±9.27 44.61±9.45 48.50±11.22 38.31±10.87 History of cancer 32 (2.9) 26 (3.0) 3 (1.6) 2 (7.7) 1 (7.7) Tot number of diseased vessel 2.31±1.05 2.28±1.04 2.49±1.05 2.04±0.87 2.54±1.13 Data are expressed as mean ± SD or count (valid %). Figure 1 Conclusions Moderate-to-severe MR and AS represent significant predictors of 1-year outcome in elderly patients hospitalized for ACS, even when other well-established prognostic factors are taken into account and after revascularization with PCI. Therefore, these patients should be carefully screened for the presence of valvular heart disease at the time of presentation and the need for surgical or percutaneous correction should be assessed accordingly. Acknowledgement/Funding None

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Therapy for acute coronary syndromes in valvular heart disease

PharmacoEconomics & Outcomes News ◽

10.1007/bf03276185 ◽

2003 ◽

Vol 410 (1) ◽

pp. 17-17

Keyword(s):

Heart Disease ◽

Valvular Heart Disease ◽

Acute Coronary Syndromes ◽

Coronary Syndromes

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ASSA13-01-5 Coronary Atherosclerotic Plaque Burden and Characteristics in Women with Acute Coronary Syndromes

Heart ◽

10.1136/heartjnl-2013-303992.005 ◽

2013 ◽

Vol 99 (Suppl 1) ◽

pp. A2.1-A2

Author(s):

Liu Chuanfen ◽

Liu Jian ◽

Wang Weimin ◽

Lu Mingyu ◽

Ma Yuliang ◽

...

Keyword(s):

Atherosclerotic Plaque ◽

Acute Coronary Syndromes ◽

Plaque Burden ◽

Coronary Atherosclerotic Plaque ◽

Coronary Syndromes

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Abstract 681: Characteristics of Atherosclerotic Plaque Burden in Patients With and Without Acute Coronary Syndrome Presenting With Acute Chest Pain to the Emergency Department

Circulation ◽

10.1161/circ.118.suppl_18.s_597 ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Fabian Bamberg ◽

Maros Ferecik ◽

Quynh Truong ◽

Ian Rogers ◽

Michael Shapiro ◽

...

Keyword(s):

Emergency Department ◽

Chest Pain ◽

Coronary Arteries ◽

Atherosclerotic Plaque ◽

Acute Chest Pain ◽

Coronary Plaque ◽

Plaque Burden ◽

Coronary Syndrome ◽

Coronary Ct ◽

Calcified Plaque

Background: Coronary computed tomography (CT) may improve the early triage of patients with acute chest pain in the emergency department (ED). The aim of this study was to compare the presence and extent of coronary atherosclerotic plaque as detected by coronary CT in patients with and without acute coronary syndromes (ACS). Methods: The study was designed as a prospective, observational cohort study in patients with acute chest pain but negative cardiac biomarkers and no diagnostic ECG changes, admitted to rule out myocardial ischemia. All patients underwent coronary CT prior to hospital admission. The presence of coronary plaque was treated as a dichotomous outcome, and the extent of CAD was defined as number of (1) coronary segments with plaque, or (2) major coronary arteries with plaque detected by MDCT as assessed by two independent observers. The clinical outcome (ACS) was adjudicated by a review committee using established AHA criteria; subjects with history of CAD (stent placement, bypass) were excluded. Results : Among 368 patients with acute chest pain (mean age 53±12 years, 61% male) 31 patients were determined to have ACS (8%). None of the 183 subjects without plaque (50%) had an ACS. Among the remaining 185 subjects (mean age 58.0±11.5 years, 68% male) in whom coronary plaque was detected, patients with ACS had a significantly more plaque (7.2±3.7 vs. 4.2±3.4, p<0.0001 segments) as compared to subjects without ACS. Similar results were seen for calcified plaque and non-calcified plaque (6.5±3.7 vs. 3.6±3.5 segments, p<0.0001; and 3.6±3.2 vs. 1.8±2.2 segments, p<0.0001, respectively). In addition, the rate of ACS increased with the number of major coronary arteries with plaque (1-vessel: 6.8%, 2-vessels: 10.6%, 3 vessels: 30.8%, and 4-vessels: 25%; p<0.01). In contrast, the ratio of non-calcified to calcified plaque was not different between patients with and without ACS (0.68±0.6 vs. 0.54±0.72, p=0.31). Conclusions: The extent of coronary plaque differs between subjects with and without ACS among patients presenting with acute chest pain. Detailed assessment of the extent and composition of coronary plaque may be helpful to assess risk of ACS among patients with acute chest pain but inconclusive initial ED evaluation.

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4 Troponin positive acute coronary syndromes and unobstructed coronary arteries: Improved diagnostic and clinical impact by performing cardiovascular magnetic resonance early after presentation

Heart ◽

10.1136/heartjnl-2016-309668.4 ◽

2016 ◽

Vol 102 (Suppl 3) ◽

pp. A3-A4

Author(s):

A Ghosh Dastidar ◽

J Rodrigues ◽

T Johnson ◽

E De Garate ◽

P Singhal ◽

...

Keyword(s):

Cardiovascular Magnetic Resonance ◽

Magnetic Resonance ◽

Coronary Arteries ◽

Acute Coronary Syndromes ◽

Clinical Impact ◽

Coronary Syndromes

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Management of Structural Heart Disease and Acute Coronary Syndromes in the COVID-19 Pandemic

Current Atherosclerosis Reports ◽

10.1007/s11883-020-00849-5 ◽

2020 ◽

Vol 22 (7) ◽

Author(s):

Arturo Giordano ◽

Giuseppe Biondi-Zoccai ◽

Giacomo Frati ◽

Antonio L. Bartorelli

Keyword(s):

Heart Disease ◽

Acute Coronary Syndromes ◽

Structural Heart Disease ◽

Coronary Syndromes

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Impact of the National Service Framework for coronary heart disease on treatment and outcome of patients with acute coronary syndromes

Heart ◽

10.1136/hrt.2004.051466 ◽

2005 ◽

Vol 92 (3) ◽

pp. 301-306 ◽

Cited By ~ 5

Author(s):

J J Graham

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Acute Coronary Syndromes ◽

National Service ◽

National Service Framework ◽

Coronary Syndromes ◽

Service Framework

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Prior Beta-Blocker Therapy for Hypertension and Sex-Based Differences in Heart Failure Among Patients With Incident Coronary Heart Disease

Hypertension ◽

10.1161/hypertensionaha.120.15323 ◽

2020 ◽

Vol 76 (3) ◽

pp. 819-826 ◽

Cited By ~ 1

Author(s):

Raffaele Bugiardini ◽

Jinsung Yoon ◽

Sasko Kedev ◽

Goran Stankovic ◽

Zorana Vasiljevic ◽

...

Keyword(s):

Heart Failure ◽

Coronary Heart Disease ◽

Heart Disease ◽

Odds Ratio ◽

Acute Coronary Syndromes ◽

Relative Risk Ratio ◽

Blocker Therapy ◽

Coronary Syndromes ◽

Β Blocker ◽

Β Blockers

The usefulness of β-blockers has been questioned for patients who have hypertension without a prior manifestation of coronary heart disease or heart failure. In addition, sex-based differences in the efficacy of β-blockers for prevention of heart failure during acute myocardial ischemia have never been evaluated. We explored whether the effect of β-blocker therapy varied according to the sex among patients with hypertension who have no prior history of cardiovascular disease. Data were drawn from the ISACS (International Survey of Acute Coronary Syndromes)-Archives. The study population consisted of 13 764 patients presenting with acute coronary syndromes. There were 2590 patients in whom hypertension was treated previously with β-blocker (954 women and 1636 men). Primary outcome measure was the incidence of heart failure according to Killip class classification. Subsidiary analyses were conducted to estimate the association between heart failure and all-cause mortality at 30 days. Outcome rates were assessed using the inverse probability of treatment weighting and logistic regression models. Estimates were compared by test of interaction on the log scale. Among patients taking β-blockers before admission, there was an absolute difference of 4.6% between women and men in the rate of heart failure (Killip ≥2) at hospital presentation (21.3% versus 16.7%; relative risk ratio, 1.35 [95% CI, 1.10–1.65]). On the opposite, the rate of heart failure was approximately similar among women and men who did not receive β-blockers (17.2% versus 16.1%; relative risk ratio, 1.09 [95% CI, 0.97–1.21]). The test of interaction identified a significant ( P =0.034) association between sex and β-blocker therapy. Heart failure was predictive of mortality at 30-day either in women (odds ratio, 7.54 [95% CI, 5.78–9.83]) or men (odds ratio, 9.62 [95% CI, 7.67–12.07]). In conclusion, β-blockers use may be an acute precipitant of heart failure in new-onset coronary heart disease among women, but not men. Heart failure increases the risk of death. Registration URL: https://www.clinicaltrials.gov . Unique identifier: NCT04008173.

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