Impact of Diabetes Mellitus on in Hospital Adverse Outcomes after First Episode of Acute Coronary Syndrome

2021 ◽  
Vol 15 (12) ◽  
pp. 3343-3344
Author(s):  
Muhammad Fahim ul Hassan ◽  
Nasir Iqbal ◽  
Muhammad Ijaz Bhatti ◽  
M. I. Hanif ◽  
H. A. Abdullah ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Adverse Outcomes ◽  
Diabetic Group ◽  
First Episode ◽  
Diabetic Patients ◽  
Coronary Syndrome ◽  
Group A ◽  
Typical Chest Pain

Objective: To determine the impact of diabetes on adverse outcomes amongst patients presenting for the first time with acute coronary syndrome. Study design: Cohort Study Methodology: A total of 340 patients were enrolled in this study. At presentation patients were divided in two equal age and gender matched groups with 170 patients in Group-A having diabetes and another 170 being non-diabetics in Group-B. Patients were followed up for period of index hospitalization and all adverse outcomes were noted in both groups as per operational definition. Results: Mean age in Group-A with diabetes was 54±12.7 years whereas in non diabetics it was56±13.12 years. In both groups there was male predominance with approximately 60% males and 40% females. In diabetic group, 38% patients had typical chest pain, 62% patients had dyspnea, 20% patients had cardiogenic shock while in non diabetic group, 20% patients had typical chest pain, 40% patients had dyspnea, 10% patients had cardiogenic shock. In diabetic group, 38% patients had heart failure, 10% patients died while in non diabetics 20% had heart failure and 5% patients died. Conclusion: This study concluded that in hospital adverse outcomes after first episode of acute coronary syndrome were more frequent in diabetic patients as compare to non diabetic patients. Keywords: Acute coronary syndrome, Adverse outcomes, First attack

scholarly journals Association of Short term Outcomes of Acute Coronary Syndrome with Prediabetes

2018 ◽  
Vol 9 (2) ◽  
pp. 54-58
Author(s):  
S Begum ◽  
J Chowdhury ◽  
N Sultana ◽  
S Ahmed ◽  
N Sultana
Keyword(s):  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Blood Glucose ◽  
Cardiogenic Shock ◽  
Fasting Blood Glucose ◽  
Adverse Outcomes ◽  
Coronary Syndrome ◽  
Fasting Glycemia ◽  
Group A ◽  
Group B

The global incidence and prevalence of prediabetes are rapidly increasing with a parallel increase in the proportion of patients suffering from acute coronary ischemic events with prediabetes. Impaired glucose metabolism (IGM), comprising impaired glucose tolerance and impaired fasting glycemia (IFG), is also associated with an increase risk of Acute coronary syndrome (ACS). This study was aimed to assess the adverse outcomes of Acute Coronary Syndrome (ACS) with and without prediabetes. This prospective observational study was conducted with 132 patients admitted in coronary care unit and cardiology departments of Dhaka medical college and NICVD, Dhaka from January 2010 to December 2010. The patients were grouped into prediabetic ACS group (Group A) and non-diabetic ACS group (Group B) by estimating fasting blood glucose and 2 hours postparandial blood glucose. Mean (±SD) age of prediabetic ACS group (56.73±8.19 years) was higher than non-diabetic ACS group (53.16±8.92 years) and it was statistically significant. In this study 85 (64.4%) patients were male and 47 (35.6%) patients were female. The presence of risk factors, such as smoking (65.9% vs 48.9%), dyslipidemia (86.4% vs 68.2%), family history of IHD (20.5% vs 14.8%) and hypertension (65.9% vs 43.2%) was higher in group A study subjects in comparison to group B. Overall final outcome results of study subjects during hospital stay in group A and group B respectively were heart failure 14 (31.8%) and 10 (11.4% (P<0.01), cardiogenic shock 9 (20.5%) and 4 (4.5%) (P<0.01), arrhythmia 4 (9.1%) and 5 (5.7%) (P=0.480), recurrent angina 2 (4.5%) and 0 (0%) (P=0.109), need for urgent revascularization 1 (2.3%) and 0 (0%) (P=0.333), and death 2 (4.5%) and 3 (3.4%) (P=1.000). Significantly higher number of study subjects of group A suffered cardiogenic shock (P<0.01) and heart failure (P<0.01) than those in group B. The study shows that acute coronary syndrome patients with prediabetes have more risk to develop adverse effects like cardiogenic shock and heart failure than non-diabetic ACS patients.Bangladesh J Med Biochem 2016; 9(2): 54-58

scholarly journals Prognostic Significance of B Type Natriuretic Peptide in Acute Coronary Syndrome

2014 ◽  
Vol 13 (2) ◽  
pp. 78-88 ◽  
Author(s):  
Nasreen Chowdhury ◽  
Md. Aminul Haque Khan ◽  
Md Mozammel Hoque
Keyword(s):  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Risk Stratification ◽  
Natriuretic Peptide ◽  
Prognostic Significance ◽  
Left Ventricular ◽  
Adverse Outcomes ◽  
Risk Of Death ◽  
Coronary Syndrome ◽  
Early Risk

Acute Coronary syndrome (ACS) is the most common cause of admission to the coronary care unit with highest risk of death and adverse outcomes. ACS accounts for 60–70% of all admissions in the hospital. Patients with ACS encompass a heterogeneous group that varies widely regarding severity of the underlying coronary artery disease, prognosis and response to treatment. Patients with the highest risk of subsequent events usually have the largest benefit of an intensified pharmacological treatment and early mechanical intervention. The prognosis for low-risk patients, on the other hand, is often difficult to improve further and these patients usually benefit more from a conservative management with a lower risk of side effects. Therefore, risk stratification is essential and should be initiated early and updated continuously throughout the hospital stay. Early risk stratification is usually performed by the use of clinical background factors, clinical presentation, electrocardiography and biochemical markers of myocardial damage. Levels of natriuretic peptides have been shown to reflect cardiac performance. The aim of this study was to review elaborately on B type Natriuretic Peptide (BNP) and its prognostic value in patient with ACS. This review focuses on the emerging role of these peptides in the early risk stratification of ACS patients. Elevation of BNP levels in acute MI and UA is predictive of a greater risk of death, post infarction heart failure, or  reinfarction. Post infarction studies demonstrate that elevated plasma BNP levels are associated with larger infarct size, increased probability of ventricular remodeling, lower ejection fraction, higher risk of heart failure, and increased mortality. This cardiac marker is a potent predictor of mortality in patients with all forms ACS. BNP measurements serve as an index of severity of the ischemic injury, as well as the degree of impairment in left ventricular function.DOI: http://dx.doi.org/10.3329/cmoshmcj.v13i2.21079

scholarly journals ACUTE CORONARY SYNDROME;

2017 ◽  
Vol 24 (03) ◽  
pp. 409-413
Author(s):  
Naveed Aslam Lashari ◽  
Nadia Irum Lakho ◽  
Sarfaraz Ahmed Memon ◽  
Ayaz Ahmed ◽  
Muhammad Fahad Waseem
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Cross Sectional Study ◽  
P Value ◽  
Cross Sectional ◽  
Coronary Syndrome ◽  
Study Results ◽  
Artery Obstruction ◽  
Conventional Risk Factors ◽  
Typical Chest Pain

Introduction: ACS is defined as the cluster of symptoms arising due to the rapiddrop of blood flow to the heart because of coronary artery obstruction. It is stated that worldwidearound 17 million people die due to cardiovascular diseases of which half of the deaths arereported due to ACS. Chest pain is known to be the most leading factor associated with ACS.Objectives: To determine the frequency of acute coronary syndrome, its types and commoncontributing factors in patients presenting with typical chest pain in a secondary care hospital.Study Design: Cross sectional study. Setting: Medical Unit, PAF Hospital Mushaf Sargodha.Period: October 2013 to March 2014. Methodology: A total of 280 patients of either gender,aged 20 to 80 years presented with typical chest pain with or without conventional risk factorswere included in the study. Results: Majority (68.9%) was males and 31.1% were female. Acutecoronary syndrome was observed in 131(46.8%) patients. Out of these 131 patients, 55% hadNSTEMI, 28.2% had unstable angina and 16.8% had STEMI. A higher proportion of femaleswere found to have ACS as compared to males (75.9% vs 33.7%, P-value<0.0001). Out of131 patients, 40.5% were diabetic, 29.8% were hypertensive 16% were hyperlipidemic, while13.7% were smokers. Conventional risk factors except smoking were observed more in femalesas compared to males. Conclusion: Majority of patients with acute coronary syndrome werefemales and diabetic. NSTEMI was the most common type of ACS. Prevalence of conventionalrisk factors was found more in females with ACS.

P5656Heart failure clinical phenotypes and outcomes in patients with atrial fibrillation: an analysis from the eurobservational research programme in atrial fibrillation long-term general registry

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Proietti ◽  
C Laroche ◽  
A Tello-Montoliu ◽  
R Lenarczyk ◽  
G A Dan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Acute Coronary Syndrome ◽  
Regression Analysis ◽  
Cox Regression ◽  
Adverse Outcomes ◽  
Cox Regression Analysis ◽  
Coronary Syndrome

Abstract Introduction Heart failure (HF) is a well-known risk factor for atrial fibrillation (AF). Moreover, HF is associated with worse clinical outcomes in patients with known AF. Recently, phenotypes of HF have been redefined according to the level of ejection fraction (EF). New data are needed to understand if a differential risk for outcomes exists according to the new phenotypes' definitions. Purpose To evaluate the risk of major adverse outcomes in patients with AF and HF according to HF clinical phenotypes. Methods We performed a subgroup analysis of AF patients enrolled in the EORP-AF Long-Term General Registry with a history of HF at baseline, available EF and follow-up data. Patients were categorized as follows: i) EF<40%, i.e. HF reduced EF [HFrEF]; ii) EF 40–49%, i.e. HF mid-range EF [HFmrEF]; iii) EF ≥50%, i.e. HF preserved EF [HFpEF]. Any thromboembolic event (TE)/acute coronary syndrome (ACS)/cardiovascular (CV) death, CV death and all-cause death were recorded. Results A total of 3409 patients were included in this analysis: of these, 907 (26.6%) had HFrEF, 779 (22.9%) had HFmrEF and 1723 (50.5%) had HFpEF. An increasing proportion with CHA2DS2-VASc ≥2 was found across the three groups: 90.4% in HFrEF, 94.6% in HFmrEF and 97.3% in HFpEF (p<0.001), while lower proportions of HAS-BLED ≥3 were seen (28.0% in HFrEF, 26.3% in HFmrEF and 23.6% in HFpEF, p=0.035). At discharge patients with HFpEF were less likely treated with antiplatelet drugs (22.0%) compared to other classes and were less prescribed with vitamin K antagonists (VKA) (57.0%) and with any oral anticoagulant (OAC) (85.7%). No differences were found in terms of non-vitamin K antagonist oral anticoagulant use. At 1-year follow-up, a progressively lower rate for all study outcomes (all p<0.001), with an increasing cumulative survival, was found across the three groups, with patients with HFpEF having better survival (all p<0.0001 for Kaplan-Meier curves). After full adjustment, Cox regression analysis showed that compared to HFrEF, HFmrEF and HFpEF were associated with risk of all study outcomes (Table). Cox Regression Analysis HR (95% CI) Any TE/ACS/CV Death CV Death All-Cause Death HFmrEF 0.65 (0.49–0.86) 0.53 (0.38–0.74) 0.55 (0.41–0.74) HFpEF 0.50 (0.39–0.64) 0.42 (0.31–0.56) 0.45 (0.35–0.59) ACS = Acute Coronary Syndrome; CI = Confidence Interval; CV = Cardiovascular; EF = Ejection Fraction; HF = Heart Failure; HR = Hazard Ratio. Conclusions In this cohort of AF patients with HF, HFpEF was the most common phenotype, being associated with a profile related to an increased thromboembolic risk. Compared to HFrEF, both HFmrEF and HFpEF were associated with a lower risk of all major adverse outcomes in AF patients.

scholarly journals ACUTE CORONARY SYNDROME; FREQUENCY, CONTRIBUTING FACTORS AND TYPES IN PATIENT WITH TYPICAL CHEST PAIN

2017 ◽  
Vol 24 (03) ◽  
pp. 409-413 ◽  
Author(s):  
Dr. Naveed Aslam Lashari ◽  
Dr. Nadia Irum Lakho ◽  
Dr. Sarfaraz Ahmed Memon ◽  
Dr. Ayaz Ahmed ◽  
Dr. Muhammad Fahad Waseem
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Contributing Factors ◽  
Coronary Syndrome ◽  
Typical Chest Pain

scholarly journals Elevated troponin levels and typical chest pain: Is always acute coronary syndrome?

2016 ◽  
Vol 9 (4) ◽  
pp. 503
Author(s):  
Altug Osken ◽  
TugbaKemaloglu Oz ◽  
Gokturk Ipek ◽  
Isil Atasoy ◽  
SennurUnal Dayi ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Elevated Troponin ◽  
Coronary Syndrome ◽  
Typical Chest Pain

scholarly journals PEMBERIAN TERAPI OKSIGEN PADA PASIEN ACUTE CORONARY SYNDROME DENGAN CHEST PAIN DI INSTALASI GAWAT DARURAT

2017 ◽  
Vol 13 (3) ◽  
Author(s):  
Dewi Rachmawati
Keyword(s):  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Respiratory Distress ◽  
Oxygen Saturation ◽  
Oxygen Therapy ◽  
Supplemental Oxygen ◽  
Pain Patient ◽  
Coronary Syndrome ◽  
Chest Pain Patient

Emergency nurses’s somehow actually routine use of supplemental oxygen theraphy in chest pain patient because of acute coronary syndrome is done, without know that routine oxygen theraphy may potentially cause harm. The used method was by collecting and analyzing related textbook and articles with the use of supplemental oxygen theraphy in chest pain patient because of acute coronary syndrome. The literatures were obtained from textbook and electronic articles such as ScienceDirect, World Health Organization, Google Scholar, PubMed and ClinicalKey with textbook and article criteria that were published from 2000 to 2015. The result is routine use of supplemental oxygen theraphy for Acute Coronary Syndrome (ACS) with chest pain based on physical assessment and level of oxygen saturation. The patient of ACS with chest pain without sign and symtoms hypoxia or respiratory distress, syok and heart failure with oxygen saturation ≥94% then without oxygen theraphy, if the patient with one or all of sign and symtoms above with oxygen saturation <94% then oxygen therapy can be given with initial administration is 4 L/minute and in titration until oxygen saturation ≥94% with administered more than than 6 hours. The next reassessment is done to the patient. If the condition of the airway patent, the patient can breathe spontaneously, normal breathing (especially rhythm, depth and no respiratory muscle use), respiratory or oxygenation problems minimally and oxygen saturation > 94% then oxygen therapy can be given with nasal cannul 4-6L / minute or simple mask from 6- 10L / minute. If the patient is emergency condition with airway patent, spontaneous breathing with adequate depth ventilation and requiring oxygen in high concentrations may then be provided with a non-rebreathing mask. The conclucion is routine use of supplemental oxygen theraphy in acute coronary syndrom with chest pain not recommended and the oxygen theraphy can be given if the patient with oxygen saturation <94% or sign and symtoms hypoxia or respiratory distress, breathlessness, syok and heart failure Key word :Acute Coronary Syndrome, Chest Pain, Emergency Unit, Oxygen Therapy 

scholarly journals Evaluation of Procalcitonin Levels in Patients with Various Forms of Acute Coronary Syndrome, Depending on the Presence of Adverse Hospital Outcomes

2021 ◽  
Vol 17 (3) ◽  
pp. 456-461
Author(s):  
O. M. Drapkina ◽  
V. A. Zakharova
Keyword(s):  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Unstable Angina ◽  
Acute Heart Failure ◽  
Cardiovascular Death ◽  
Adverse Outcomes ◽  
Hospital Outcomes ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Informed Consent Form

Aim. to study the levels of procalcitonin in patients with various forms of acute coronary syndrome (ACS), depending on the presence of adverse hospital outcomes.Materials and Methods. The study included 222 patients admitted to the emergency cardiology department with a diagnosis of ACS in the period from March 2014. until January 2017. Of these, 106 (47.7 %) patients were diagnosed with unstable angina (NS) and 116 (52.3%) with myocardial infarction (MI). Non ST segment elevation MI (NSTEMI) was diagnosed in 47 (40.5%) patients with MI, and ST elevation MI (STEMI) – in 69 (59.5%) patients with MI. After the assessment of the patient's compliance with the criteria for inclusion/exclusion in the study, the procedure for signing the patient's informed consent form was carried out. The protocol of the study was approved by the local Ethics committee of the M. E. Zhadkevich State Clinical Hospital. In each study subgroup, the presence of adverse outcomes during the current hospitalization was assessed: cardiovascular death, nonfatal MI, nonfatal acute cerebrovascular accident, acute heart failure, as well as a combined endpoint, including all of the listed adverse outcomes. All patients, in addition to routine laboratory methods of investigation, were examined for the level of procalcitonin at admission to the hospital, on 2-3 and 4-5 days.Results. Patients with MI compared to patients with NS were characterized by a large number of registered endpoints in general (24.1% vs. 6.6%, p<0.001), while in the group of patients with MI, cardiovascular death was more often recorded (10.3% vs. 0.9%, p<0.001) and acute heart failure (12.9% vs. 5.6%, p=0.009). Patients with MI, in particular with STEMI, who had adverse hospital outcomes, were characterized by statistically significantly higher levels of procalcitonin compared to patients without adverse hospital outcomes. Patients with STEMI showed significantly higher levels of procalcitonin at all stages of the disease, and patients with MI-only at 2-3 and 4-5 days. There were no statistically significant differences in the level of procalcitonin at all stages of the disease in patients with NSTEMI and with unstable angina, depending on the hospital outcomes.Conclusion. Elevated procalcitonin levels in patients with MI, in particular with STEMI, are associated with adverse hospital outcomes; for other forms of ACS, no statistically significant differences were observed with different hospital outcomes.

Katz index of independence in activities of daily living and its association with adverse outcomes in elderly and senile patients with acute coronary syndrome

MedAlliance ◽  
2021 ◽  
Vol 9 (1) ◽  
pp. 68-72
Keyword(s):  
Acute Coronary Syndrome ◽  
Activity Index ◽  
Maximum Level ◽  
Adverse Outcomes ◽  
Myocardial Infarctions ◽  
Coronary Syndrome ◽  
Katz Index ◽  
Group A ◽  
Group D

Introduction. The article focuses on the study of the prevalence of frailty main manifestations in elderly and senile patients with acute coronary syndrome (ACS). Aim. To study the relationship between the severity of violations of basic activities, as well as their influence on the development of adverse outcomes in the long-term period after ACS in elderly and senile patients using the Katz method of calculating the activity index of daily life. Methods. The study included 302 patients. The average age was 74.52±8.56 years. The patients were divided into 2 main groups: conservative treatment n=165 (54.6%) and surgical revascularization n=137 (45.4%). On the basis of a comprehensive geriatric assessment, the proportion of "frail" patients was 53.3%, and "not frail" ones — 46.7%. All patients completed the Katz questionnaire. The prima- ry endpoints were mortality within the first 12 months, readmission to hospital, need for daily care by another person, and recurrent myocardial infarction (MI). Results. The incidence of repeated myocardial infarctions in the groups did not differ significantly and amounted to 4.7% in both groups. The need for care increased from group A to group F, achieving maximum level (75.5%) in group F versus 36% (p=0.045) in group D, and versus 37.5% in group C (p=0.04). The highest frequency of rehospitali- zations was observed in group F — 89 patients (81.6%) versus group E — 75 patients (68.8%) (p=0.3), group D — 13 patients (26%) (p=0.02), and group C — 3 patients (37.5%) (p=0.02). Mortality from all causes was highest in group E — 16 patients out of 109 (4.6%), but it did not dif- fer significantly from mortality in group F — 17 patients (12.5%) (p=0.3). Conclusion. The Katz questionnaire was a valuable predictor of adverse outcomes in elderly and senile patients after ACS.

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