The invasive approach to acute coronary syndrome: true promise or false premise?

2010 ◽  
Vol 192 (12) ◽  
pp. 694-695
Author(s):  
Peter L Thompson
Keyword(s):  
Acute Coronary Syndrome ◽  
Invasive Approach ◽  
Coronary Syndrome ◽  
False Premise

Impact of Early Invasive Approach on Outcomes of Patients With Acute Coronary Syndrome and Baseline Anemia: Analysis From the ACSIS Registry

2015 ◽  
Vol 28 (4) ◽  
pp. 315-325 ◽  
Author(s):  
Doron Sudarsky ◽  
Merav Sudarsky ◽  
Shlomi Matezky ◽  
Ilan Goldenberg ◽  
Ateret Farcas ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Invasive Approach ◽  
Coronary Syndrome

Statin Treatment and Prognosis of Elderly Patients Discharged after Non-ST Segment Elevation Acute Coronary Syndrome

Cardiology ◽  
2019 ◽  
Vol 143 (1-2) ◽  
pp. 14-21 ◽  
Author(s):  
Lourdes Vicent ◽  
Albert Ariza-Solé ◽  
Pablo Díez-Villanueva ◽  
Oriol Alegre ◽  
Juan Sanchís ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Elderly Patients ◽  
Ldl Cholesterol ◽  
Statin Treatment ◽  
Invasive Approach ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Cholesterol Levels ◽  
St Segment ◽  
Elevation Acute Coronary Syndrome

Background: Statins are recommended for secondary prevention. Our aims were to describe the proportion of very elderly patients receiving statins after non-ST segment elevation acute coronary syndrome (NST-ACS) and to determine the prognostic implications of statins use. Methods: This prospective registry was performed in 44 hospitals that included patients ≥80 years discharged after a NST-ACS from April 2016 to September 2016. Results: We included 523 patients, the mean age was 84.2 ± 4.0 years and 200 patients (38.2%) were women. Previous statin treatment was recorded in 282 patients (53.4%), and 135 (32.5%) had LDL cholesterol levels >2.6 mmol/L. Mean LDL cholesterol levels during admission were 2.3 ± 0.9 mmol/L. Statins were prescribed at discharge to 474 patients (90.6%). Compared with patients discharged on statins, those that did not receive statins were more often frail (22 [47.8%] vs. 114 [24.4%], p < 0.01) and underwent an invasive approach less frequently (30 [61.2%] vs. 374 [78.9%], p = 0.01). During a 6-month follow-up, 50 patients died (9.5%). There was a nonsignificant trend to higher mortality in patients not treated with statins (6 [15%] vs. 44 [9.6%], p = 0.30), but statins were not independently associated with lower mortality (hazard ratio [HR] 0.79; 95% confidence interval [CI] 0.30–2.11, p = 0.65), nor with a reduction in the combined endpoint mortality/hospitalizations (HR 0.89; 95% CI 0.52–1.55, p = 0.69). Conclusions: Although most octogenarians presenting a NST-ACS are already on statins before the episode, their LDL cholesterol is frequently >2.6 mmol/L. Octogenarians who do not receive statins have a high-risk profile, with significant frailty and comorbidity.

Women and the management of acute coronary syndrome

2012 ◽  
Vol 90 (9) ◽  
pp. 1151-1159 ◽  
Author(s):  
Petr Ostadal ◽  
Bohuslav Ostadal
Keyword(s):  
Acute Coronary Syndrome ◽  
Beta Blockers ◽  
Coronary Intervention ◽  
Developed Countries ◽  
Bleeding Complications ◽  
Invasive Approach ◽  
Coronary Syndrome ◽  
The Developed Countries ◽  
Female Specific ◽  
Event Rates

Coronary heart disease (CHD) is the leading cause of morbidity and mortality in both men and women in the developed countries. Despite this fact, females are still under-represented in the majority of clinical trials. At the present time, only limited evidence is available with respect to the female-specific aspects of pathogenesis, management, and outcomes in acute coronary syndrome (ACS). Women less frequently undergo coronary intervention, and a lower proportion of women receive evidence-based pharmacotherapy, compared with men. It has been shown that women benefit from an invasive approach and coronary intervention in ACS as much as men, despite their advanced age and higher rate of bleeding complications. Also, administration of beta-blockers, ACE-inhibitors, and intensive statin therapy is associated with a comparable reduction of cardiovascular event rates in women and men. On the other hand, women may profit less than men from fibrinolytic or glycoprotein IIb/IIIa inhibitor therapy. Both sexes benefit equally from aspirin therapy, whereas contradictory data are available on the efficacy of clopidogrel in women. There is an urgent need for intensive research in the development of female-specific therapeutic strategy in ACS, even though the detailed mechanisms of sex differences are still unknown.

scholarly journals Prognosis Impact of Diabetes in Elderly Women and Men with Non-ST Elevation Acute Coronary Syndrome

2021 ◽  
Vol 10 (19) ◽  
pp. 4403
Author(s):  
Pablo Díez-Villanueva ◽  
Jose María García-Acuña ◽  
Sergio Raposeiras-Roubin ◽  
Jose A. Barrabés ◽  
Alberto Cordero ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Elderly Patients ◽  
Elderly Women ◽  
Prior History ◽  
Invasive Approach ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
History Of ◽  
Elevation Acute Coronary Syndrome ◽  
One Year

Few studies have addressed to date the interaction between sex and diabetes mellitus (DM) in the prognosis of elderly patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). Our aim was to address the role of DM in the prognosis of non-selected elderly patients with NSTEACS according to sex. A retrospective analysis from 11 Spanish NSTEACS registries was conducted, including patients aged ≥70 years. The primary end point was one-year all-cause mortality. A total of 7211 patients were included, 2,770 (38.4%) were women, and 39.9% had DM. Compared with the men, the women were older (79.95 ± 5.75 vs. 78.45 ± 5.43 years, p < 0.001) and more often had a history of hypertension (77% vs. 83.1%, p < 0.01). Anemia and chronic kidney disease were both more common in women. On the other hand, they less frequently had a prior history of arteriosclerotic cardiovascular disease or comorbidities such as peripheral artery disease and chronic pulmonary disease. Women showed a worse clinical profile on admission, though an invasive approach and in-hospital revascularization were both more often performed in men (p < 0.001). At a one-year follow-up, 1090 patients (15%) had died, without a difference between sexes. Male sex was an independent predictor of mortality (HR = 1.15, 95% CI 1.01 to 1.32, p = 0.035), and there was a significant interaction between sex and DM (p = 0.002). DM was strongly associated with mortality in women (HR: 1.45, 95% CI = 1.18–1.78; p < 0.001), but not in men (HR: 0.98, 95% CI = 0.84–1.14; p = 0.787). In conclusion, DM is associated with mortality in older women with NSTEACS, but not in men.

scholarly journals Regarding the choice of Р2У12 platelet receptor blocker in the early invasive approach to acute coronary syndrome treatment in patients without indications for long-term anticoagulant use

2020 ◽  
pp. 66-74
Author(s):  
I. S. Yavelov
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Intervention ◽  
Invasive Approach ◽  
Coronary Syndrome ◽  
St Segment ◽  
Platelet Receptor ◽  
Percutaneous Coronary ◽  
European Society Of Cardiology ◽  
Expert Community

In case of early invasive approach to the treatment of acute coronary syndrome in patients without indications forlong-term anticoagulants, double antithrombocytic therapy is recommended - a combination of acetylsalicylic acid with one of the blockers of P2Y12 platelet receptor (clopidogrel, prasugrel or ticagrelor). In this case, patients who do not have an excessively high risk of bleeding, there is evidence in favor of the choice of prasugrel or ticagrelor. Which of them is preferable in cases where in the first hours after hospitalization it is planned to perform coronary stenting is not fully clarified.The drawbacks of the randomized open PRAGUE-18 study do not allow us to judge the comparative effectiveness and safety of prasugrel and ticagrelor in primary percutaneous coronary intervention.ц The ISAR-REACT 5 study was relatively small and has its strengths as well as weaknesses. However, the European expert community considers the results to be sufficient to change the practical approaches to acute coronary syndrome treatment. Thus, according to the recommendations of the European Society of Cardiology for the treatment of acute coronary syndrome without stable ST segment elevations on ECG, which were updated in September 2020, prasugrel is proposed to be considered as a preferred treatment for ticagrelor in cases where the patient is directed to percutaneous coronary intervention (class IIa recommendation, degree of evidence B). 

Temporal Trends and Outcomes Associated with Major Bleeding in Acute Coronary Syndromes: A Decade-Long Perspective from the Acute Coronary Syndrome Israeli Surveys 2000-2010

Cardiology ◽  
2015 ◽  
Vol 132 (3) ◽  
pp. 163-171 ◽  
Author(s):  
Avi Sabbag ◽  
Victor Guetta ◽  
Paul Fefer ◽  
Shlomi Matetzky ◽  
Shmuel Gottlieb ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Major Bleeding ◽  
Temporal Trends ◽  
Blood Pressure Level ◽  
Bleeding Events ◽  
Access Site ◽  
Systolic Blood Pressure Level ◽  
Invasive Approach ◽  
Coronary Syndrome ◽  
Increased Risk

Objectives: The implementation of an early invasive approach and the increased use of potent anti-thrombotic drugs have resulted in higher rates of major bleeding events (MBE) in patients with acute coronary syndrome (ACS). There are limited data on the temporal trends for the rates of MBE over the last decade and associated outcomes. Methods: Rates, characteristics, risk factors and clinical outcomes associated with MBE were assessed among 11,538 patients enrolled in the biennial Acute Coronary Syndrome Israeli Surveys (ACSIS) 2000-2010. Results: A total of 143 patients (1.2%) experienced MBE during the index hospitalization for ACS. There was a significant increase in the risk of MBE in the late (2006-2010) versus the early (2000-2004) surveys (0.9 and 1.6% respectively, adjusted OR 1.86, p < 0.001). In the multivariate analysis, factors independently associated with a significant increase in the risk of MBE included undergoing primary percutaneous coronary intervention (OR 2.21, p < 0.005), experiencing renal failure (OR 4.19, p < 0.001) and systolic blood pressure level at admission (OR 1.12, per 10- mm Hg decrement, p = 0.011). Patients who experienced MBE had a >3.5-fold increased risk for 1-year mortality (adjusted HR = 3.52, p < 0.001). Interestingly, the mortality risk associated with MBE was evident only among those who experienced non-access-site bleeding (HR = 1.9; p = 0.001). Conclusions: In the past decade, there has been a significant increase in the rate of MBE. However, we found that only major bleeding that was not related to the vascular access site affected subsequent mortality.

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