Atypical ST-Segment-Elevation Myocardial Infarction Presentation in Patients With COVID-19 at a High-Volume Center in New York City

Atypical presentations of ST-segment-elevation myocardial infarction (STEMI) have been reported in patients who have COVID-19. We have seen this occurrence in our center in Bronx, New York, where multitudes of patients sought treatment for the coronavirus. We studied the prevalence of atypical STEMI findings among patients with COVID-19 who presented during the first 2 months of the pandemic. Consistent with previous reports, 4 of our 10 patients with COVID-19 and STEMI had no identifiable culprit coronary lesion; rather, they often had diffuse ST-segment elevations on surface electrocardiograms along with higher levels of D-dimer and inflammatory markers. In contrast, 32 of 33 patients without COVID-19 (97%) had a culprit lesion. The patients with COVID-19 and a culprit lesion more often needed thrombectomy catheterization and administration of glycoprotein IIb/IIIa inhibitors. Our study confirms that patients with COVID-19 often have atypical STEMI presentations, including the frequent absence of a culprit coronary lesion. Our findings can help clinicians prepare for these atypical clinical presentations.

Plasma apoC-III levels predict coronary severity and cardiovascular risks in stable coronary artery disease patients with diabetes or pre-diabetes: a prospective cohort study

Background Apolipoprotein C-III (apoC-III) has been proposed to be involved in lipid and glucose metabolism and related to cardiovascular risks. The aim of this study is to investigate the association of apoC-III levels with coronary severity and cardiovascular outcomes in coronary artery disease (CAD) patients under different glucose metabolism status. Methods A total of 4342 consecutive patients with newly angiography-proven stable CAD were enrolled and categorized into three groups according to apoC-III levels and further stratified by glucose metabolism status [diabetes mellitus (DM), pre-DM, normal glucose regulation (NGR)]. Patients were followed for the occurrence of cardiovascular events (CVEs). Plasma apoC-III concentration was measured by enzyme immunoassay and coronary severity was assessed by number of diseased vessels, Gensini score and syntax score. The relationships of apoC-III levels with coronary severity and CVEs were evaluated. Results 389 (9.0%) CVEs were developed during a follow-up of 5.1 years. Plasma apoC-III levels were increased in prediabetic and diabetic patients with stable CAD. Elevated apoC-III levels were associated with more severe coronary lesion and the risk for CVEs. No significant differences in incident CVEs and coronary severity were observed between pre-DM and NGR groups. When combined glucose metabolism status and apoC-III levels as stratifying factors, patients with the highest apoC-III levels and pre-diabetic or diabetic patients with any levels of apoC-III had more sever coronary lesion and higher risk of subsequent CVEs compared to those with the lowest apoC-III levels and NGR. Conclusion Our data firstly found that elevated apoC-III levels were greatly associated with coronary severity and adverse cardiovascular events in stable CAD patients with pre-DM and DM, which suggested apoC-III may be a prognostic predictor among CAD patient with impaired glucose metabolism. FUNDunding Acknowledgement Type of funding sources: None.

Morphology of Coronary Artery Disease in a Patient with, Psoriasis Presenting with an Acute Coronary Syndrome

Background: This study was designed to evaluate the patterns of coronary artery disease in patients with Psoriasis presenting with acute coronary syndrome (ACS). Methods: This was a prospective, observational study, conducted on 28 patients with Psoriasis, presenting with acute coronary syndrome undergoing coronary angiogram from September 2017 to March 2021. All patients had undergone coronary angiogram; severity and morphology of coronary lesion were analyzed. Echocardiography was used to analyze LV wall motion and LV function. Results: The study showed that of 28 patients with Psoriasis who presented with ACS, 45.8% of patients were presented with NSTEMI, 39.2% % STEMI, and Unstable angina 15%. The average time of presentation after the onset of the symptom was 14.8 hours. 66 % of patients were a smoker. Coronary involvement 50% had TVD, 40% DVD, and 10% had SVD. In 77.6% culprit vessel was LAD, 10.4% LCX, and 12% RCA. In 75% of patient's coronary lesion was located in the proximal LAD. Chronic total occlusion was found in almost 26% of patients. Extensive LV wall motion abnormality with severe LV systolic dysfunction was noted in Psoriasis patients at the time of presentation (mean LVEF=28%). Conclusions: Psoriasis patients presenting with ACS, associated with increased severity of coronary lesions, multivessel involvement, and depressed LV systolic function.

Particles and corrected particles of LDL and non-HDL are stronger predicters of coronary lesion in postmenopausal women

Background The optimum lipid indexes, predicting the coronary lesion in postmenopausal women are not clear. Objective To evaluate the optimum lipid predicter for coronary lesion in routine and advanced lipid tests. Method 300 postmenopausal women were enrolled and assigned into coronary heart disease (CHD) Group (242), and non-CHD Group (58). Routine and advanced lipid indexes were measured with standard laboratory test and nuclear magnetic resonance (NMR) spectroscopy. The correlation and predictivities for CHD of routine and advanced lipid indexes were performed with Logistic regression, Spearman correlation analysis and receiver operating characteristic (ROC). Results Age (hazard ratio (HR) 2.58, 95% confidence interval (CI) 1.08–5.86, P = 0.03), apolipoprotein B (ApoB) (HR 1.35, 95% CI 1.15–1.59, P < 0.001), corrected particles of low-density lipoprotein (LDL-p-corr) (HR 1.05, 95% CI 1.03–1.06, P < 0.001) and corrected particles of non-high-density lipoprotein (non-HDL-p-corr) (HR 1.02, 95% CI 1.01–1.03, P < 0.001) were the risk factors of CHD. LDL cholesterol (LDL-C), LDL-p, LDL-p-corr, HDL cholesterol (HDL-C), non-HDL cholesterol (non-HDL-C), non-HDL-p and non-HDL-p-corr were in linear correlation with Gensini score. Advanced lipid indexes LDL-p (area under curve (AUC) = 0.750, P = 0.02), LDL-p-corr (AUC = 0.759, P = 0.02), non-HDL-p (AUC = 0.693, P = 0.03) and non-HDL-p-corr (AUC = 0.699, P = 0.03) were more predictive for CHD than the routine ones (LDL-C and non-HDL-C). Conclusion In postmenopausal women, age, ApoB, LDL-p-corr and non-HDL-p-corr were risk factors of CHD. Compared with traditional lipid items, LDL-p, LDL-p-corr, non-HDL-p and non-HDL-p-corr may be better lipid indexes for CHD in postmenopausal women.