Concordance between Triglyceride Glucose Index and Admission Insulin Resistance Index in Non-diabetic Subjects of Acute Coronary Syndrome

BACKGROUND: Acute coronary syndrome (ACS) is the leading cause of death in the world and is closely related to insulin resistance (IR). The examination of the triglyceride glucose (TyG) Index and admission IR index (AIRI) can be an alternative examination to assess IR. AIM: The aim of the study was to analyze the concordance between the TyG index and AIRI in assessing IR in nondiabetic subjects of ACS. METHODS: This study was a cross-sectional study using secondary data from ACS patient medical records in Wahidin Sudirohusodo Hospital Makassar from September 2020 until April 2021. An examination of RBG, TyG, and fasting insulin was performed. The statistical test results were considered significant if the p < 0.05. RESULTS: This study included 67 subjects, of which 54 were male and 13 were female, there were 24 people aged <50 years, 43 people aged 50 years old, with a mean of 55.15 ± 12.71 years, a diagnosis of ST-elevation myocardial infarction (STEMI) 25 people, non STEMI 34 people and unstable angina pectoris 8 people, p < 0.05. The receiver operating characteristic curve showed that the cut-off value of the TyG index in predicting AIRI was 3141, with a sensitivity of 88.98% and specificity of 59.09%. The OR value revealed that subjects with a TyG index of >9.06 indicated an 11-time greater risk for IR than subjects with a TyG index ≤9.06. CONCLUSIONS: There was a significant concordance between the TyG index and the AIRI in non-diabetic acute coronary syndrome patient.

CHECKING THE ASSOCIATION OF FIVE SNP WITH UNVALVED ATRIAL FIBRILLATION IN PATIENTS WITH ACUTE CORONARY SYNDROME

Вackground. It is known that 5–21% of patients with acute coronary syndrome (ACS) develop atrial fibrillation (AF), which entails an increased risk of recurrence of myocardial infarction, heart failure, and increased mortality. The genetic predisposition to AF has been actively studied in recent years, but the data on the association of certain single nucleotide polymorphisms (SNPs) in the development of AF are contradictory, which determines the relevance of this study. Purpose of the study. To study five SNPs for associations with the development of non-valvular atrial fibrillation in patients with acute coronary syndrome Patient Characterization and Research Methods. The study included female and male patients not younger than 18 years old with ACS and AF (n = 133) and ACS without AF (n = 133) ACS was diagnosed according to the criteria of the European Society of Cardiology (2015; 2017). The study was approved by the Ethics Committee (Minutes No. 102 dated November 24, 2017). The observation period was 12 months. In addition to the standard examination, all patients underwent a SNP study: rs6795970 (Scn10a), rs2200733 (4th stage), rs11556924 (ZC3HC1), rs599839 (PSRC1), rs10824026 (10th stage). Statistical analysis was performed using Statistica 12.1 StatSoft. Results. The results of the rs599839 study showed that the GG genotype was significantly less common in the ACS + AF group compared to the ACS group without AF (OR 0.11 CI 95% 0.01; 0.86 p = 0.0163). A reliable connection was lost when divided by sex and by age (older and younger than 55). Allele G rs599839 significantly correlates with AF (p = 0.0043; OR 1.56). The T allele rs11556924 is highly reliably associated with a predisposition to atrial fibrillation (p = 0.0043; OR 1.93). Genotype GG rs10824026 is conditionally protective in terms of the risk of AF in patients with ACS. For rs6795970 (p = 0.290) and rs2200733 (p = 0.30), there were no statistically significant differences between the study groups. Conclusion. The study verified the association of rs6795970 (Scn10a), rs2200733, rs11556924, rs599839, rs10824026 with AF associated with ACS. The genotypes GG rs599839 and GG rs10824026 were found to be conditionally protective in relation to the risk of AF in patients with ACS.

Results From an Early Economic Evaluation of the Use of a Novel Point of Care Device for Diagnosis of Suspected Acute Coronary Syndrome Patient Within the Emergency Department in the National Health Service in England.

Background: The objective of this study was to undertake an early economic evaluation to analyse the potential costs and benefits associated with adopting a high sensitivity troponin (hs-cTn) at the Point of Care (POC) in the emergency department (ED) diagnostic pathway for suspected Acute Coronary Syndrome (ACS) patients in line with National Institute for Health and Care Excellence (NICE) Diagnostics Guidance (DG15) and NICE Clinical Guideline (CG95) as practised in the NHS in England. Methods: A decision tree analysis was undertaken to compare the current 60 to 90 minutes turnaround time for the standard laboratory hs-cTn test with an expected 20-minute turnaround time for a POC hs-cTn test. Three routes through the chest pain pathway were modelled based on the hs-cTn pathway used in Oxford University Hospitals (OUH) NHS Foundation Trust. Sensitivity analysis was performed. Results: The results indicate that if a hs-cTn POC test is used to diagnose patients in routes 1 to 3 of the diagnostic pathway for suspected ACS patients at ED, it potentially saves per patient costs of £53.36 in Route 1, £76.72 in Route 2 and £64.72 in Route 3. Moreover, it can also help in easing the pressure at ED as it enables diagnosis to be made between 55 to 70 minutes earlier across the 3 pathway routes. A hs-cTn POC test also has potential in achieving a ‘rule-in’ diagnosis for patients to speed up the treatment pathway for improved prognosis. The sensitivity analysis results indicate that savings per patient increase as the turnaround time of the lab result goes from 60 minutes to 90 minutes in the standard care pathway.Conclusions: Use of a hs-cTn test at POC can save between £53.36 and £76.72 per patient in ED when compared to the standard laboratory test. When such a POC test is developed, an evaluation validating the accuracy of the device will be needed together with a study of its clinical performance in a health care setting. The study should include a formal economic evaluation with real-world data alongside an efficacy/effectiveness study.

COMPARATIVE CHARACTERISTICS OF PATIENTS WITH ACUTE CORONARY SYNDROME WITHOUT ST SEGMENT ELEVATION DEPENDING ON EXTENT OF CORONARY ARTERY STENOSIS (RECORD-3 DATA)

The aimof the study was to create a patient portrait, to evaluate prognosis, and establish the principles of therapy in patients with acute coronary syndrome without ST elevation with non-obstructive coronary atherosclerosis in comparison with the obstructive coronary atherosclerosis group.Material and Methods. Data come from the acute coronary syndrome register REСORD-3 that was implemented in the Emergency Cardiology Department of Cardiology Research Institute, Tomsk National Research Medical Centre, along with 45 other centers in Russia. Patients with myocardial infarction without ST segment elevation who were exposed to coronary angiography were separated into two independent groups based on whether they had MINОСА or not: 148 persons with non-obstructive coronary atherosclerosis and 537 persons with obstructive coronary atherosclerosis.Results. Non-obstructive coronary atherosclerosis group, compared to obstructive coronary atherosclerosis, comprised 75 women (50.7%) compared to 177 men (32.9%). Hypertension was detected less often in this group: 120 (81.1%) versus 475 (88.5%). The rates of diabetes mellitus were 16 (10.8%) versus 115 (21.4%) and the rates of smoking were 162 patients (30.2%) versus 32 (21.6%), respectively, in patients with and without non-obstructive coronary atherosclerosis. Non-obstructive coronary atherosclerosis group had significantly lower rate of individuals with diagnostic increase in cardiospecific enzymes. This may be indicative of non-prolonged myocardial ischemia that, in some cases, does not lead to necrosis. The final diagnosis of non-ST segment elevation myocardial infarction was significantly less confirmed in patients with non-obstructive coronary atherosclerosis (14.8 vs. 45.3%). However, in this group, the “other cardiac cause of hospitalization” was more frequent (29.7 vs. 2.2% of cases), which explains the need to continue the diagnostic search to exclude all possible causes of the chest pain. The variety of final diagnoses in patients with acute coronary syndrome with non-obstructive coronary atherosclerosis and “clean” coronary arteries should encourage a thorough analysis of the pathogenesis in each of these patients.Conclusion. A typical acute coronary syndrome patient with non-obstructive coronary atherosclerosis without ST segment elevation was represented by a 59 (53:65)-year-old woman with traditional risk factors for coronary heart disease, but the incidence of each of these factors was less than in the obstructive coronary atherosclerosis group. Final diagnosis of non-ST segment elevation myocardial infarction was confirmed significantly less often in patients with non-obstructive coronary atherosclerosis. The mortality rates did not differ between groups and were minimal. Acute coronary syndrome patients with non-obstructive coronary atherosclerosis without ST segment elevation were less likely to receive ticagrelor and statins in hospital, but they were administered more often with fondaparinux. Patients with non-obstructive coronary atherosclerosis at discharge were less likely to be recommended to take antiplatelet agents, statins, and nitrates.

Update in Spontaneous Coronary Artery Dissection

There has been increased awareness in the understanding and recognition of spontaneous coronary artery disease. Diagnosing this condition is of paramount importance as the treatment strategy differs greatly from traditional acute coronary syndrome patient. We review here the current state of management of spontaneous coronary artery disease.