Pericoronary Fat Attenuation Index Is Associated With Vulnerable Plaque Components and Local Immune‐Inflammatory Activation in Patients With Non‐ST Elevation Acute Coronary Syndrome

Background The pericoronary fat attenuation index (FAI) is assessed using standard coronary computed tomography angiography, and it has emerged as a novel imaging biomarker of coronary inflammation. The present study assessed whether increased pericoronary FAI values on coronary computed tomography angiography were associated with vulnerable plaque components and their intracellular cytokine levels in patients with non‐ST elevation acute coronary syndrome. Methods and Results A total of 195 lesions in 130 patients with non‐ST elevation acute coronary syndrome were prospectively included. Lesion‐specific pericoronary FAI, plaque components and other plaque features were evaluated by coronary computed tomography angiography. Local T cell subsets and their intracellular cytokine levels were detected by flow cytometry. Lesions with pericoronary FAI values >−70.1 Hounsfield units exhibited spotty calcification (43.1% versus 25.0%, P =0.015) and low‐attenuation plaques (17.6% versus 4.2%, P =0.016) more frequently than lesions with lower pericoronary FAI values. Further quantitative plaque compositional analysis showed that increased necrotic core volume (Pearson’s r=0.324, P <0.001) and fibrofatty volume (Pearson’s r=0.270, P <0.001) were positively associated with the pericoronary FAI, and fibrous volume (Pearson’s r=−0.333, P <0.001) showed a negative association. An increasing proinflammatory intracellular cytokine profile was found in lesions with higher pericoronary FAI values. Conclusions The pericoronary FAI may be a reliable indicator of local immune‐inflammatory response activation, which is closely related to plaque vulnerability. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04792047.

PROGNOSTIC VALUE OF GRACE VERSUS TIMI SCORE FOR IN-HOSPITAL OUTCOMES AFTER NON-ST-ELEVATION ACUTE CORONARY SYNDROME

Objectives: To compare the predictive value of TIMI and GRACE score for predicting in-hospital outcomes after non-ST elevation acute coronary syndrome (NSTE-ACS). Methodology: This study included prospectively recruited cohort of patients presented to a tertiary care cardiac center of Karachi, Pakistan who were diagnosed with NSTE-ACS. GRACE and TIMI score were obtained and in-hospital mortality was recorded. The receiver operating characteristic (ROC) curves analysis was performed and area under the curve (AUC) was obtained as indicative of predictive value for both scores. Results: A total of 300 patients were included, out of which 76.7%(230) were male and mean age was 58.04±10.71 years. Risk profile comprises of 84.3%(253) hypertensive, 42.0%(126) diabetic, 27.3%(82) smokers, 9.0%(27) obese, 15.3%(46) dyslipidemic, and 31%(93) with sedentary lifestyle. Mean GRACE and TIMI score were 120.19±33.17 and 3.18±0.85 respectively. In-hospital mortality rate was 5.3%(16). AUC for the GRACE score was 0.851 [0.767 - 0.934] with the optimal cut-off value of 150 with sensitivity of 68.8% and specificity of 84.9%. The AUC for the TIMI score was 0.781[0.671 - 0.891] with the optimal cut-off value of 4 with sensitivity of 75.0% and specificity of 67.6%. Conclusion: The GRACE score has high discriminating strength for predicting in-hospital mortality after NSTE-ACS. GRACE score should be used as risk stratification modality in clinical decision making for the management of NSTE-ACS.

Effect of Admission Hyperglycemia on Short-Term Prognosis of Patients with Non-ST Elevation Acute Coronary Syndrome without Diabetes Mellitus

Objective. To evaluate the effect of admission hyperglycemia on the short-term prognosis of patients with non-ST elevation acute coronary syndrome (NSTE-ACS) without diabetes mellitus. Methods. The clinical data of 498 patients with NSTE-ACS admitted to the Department of Cardiology of the First Affiliated Hospital of Henan University of Science and Technology between March 2018 and November 2020 were analyzed. Based on the blood glucose (BG) level at admission, patients were divided into three groups: A ( BG < 7.8 mmol/L), B ( 7.8 mmol / L ≤ BG < 11.1 mmol / L ), and C ( BG ≥ 11.1 mmol/L). The clinical data of the three groups were compared. Results. There was no significant difference between the three groups in terms of age, sex, hypertension, hyperlipidemia, smoking, and history of myocardial infarction ( p > 0.05 ). However, there were significant differences in the incidences of multivessel disease, renal insufficiency, pump failure, and emergency percutaneous coronary intervention, and levels of high-sensitivity C-reactive protein, cardiac troponin T, and creatine kinase isoenzyme MB among the three groups ( p < 0.05 for all). The incidences of severe pump failure, malignant arrhythmias, and death were significantly higher in groups B and C compared to group A ( p < 0.05 ). Additionally, the incidences of severe pump failure, malignant arrhythmias, and death were significantly higher in group C compared to group B ( p < 0.05 ). Multivariate logistic regression analysis showed that hyperglycemia, renal insufficiency, Killip grade III/IV, and age were risk factors of in-hospital death. Conclusion. Hyperglycemia at admission is a risk factor for adverse in-hospital clinical outcomes in patients with NSTE-ACS.

Prognostic Implication of Serum Glycated Albumin for Patients With Non-ST-segment Elevation Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Background: It has been demonstrated that glycated albumin (GA) is significantly associated with diabetes complications and mortality. However, among patients diagnosed with non-ST-elevation acute coronary syndrome (NSTE-ACS) administered percutaneous coronary intervention (PCI), the predictive value of GA for poor prognosis is unclear.Methods: This study eventually included 2247 NSTE-ACS patients in Beijing Anzhen Hospital, Capital Medical University in January-December 2015 who received PCI. All patients were followed up until death or for 48 months post-discharge. The primary endpoint was major adverse cardio-cerebral events (MACCEs), including all-cause death, non-fatal myocardial infarction, ischemia-induced revascularization and non-fatal ischemic stroke.Results: In total, 547 (24.3%) MACCEs were recorded during the follow-up period. Upon adjusting for potential confounders, GA remained an important risk predictor of MACCEs (hazard ratio [HR]=1.051, 95% confidence interval [CI] 1.026-1.077; P<0.001). GA addition significantly enhanced the predictive ability of the traditional risk model (Harrell’s C-index, GA vs. Baseline model, 0.691 vs. 0.678, comparison P=0.001; continuous net reclassification improvement (continuous-NRI)=0.099, P=0.027; integrated discrimination improvement (IDI)=0.008, P=0.020).Conclusion: GA is highly correlated with poor prognosis in NSTE-ACS patients undergoing PCI, suggesting that it may be a major predictive factor of adverse events among these individuals.

6 The role of speckle tracking echocardiography in the identification of culprit lesion in patients with non-ST-segment elevation acute coronary syndrome

Aims An early evaluation of patients with non-ST elevation acute coronary syndrome patients (NSTE-ACS) is important to choose the appropriate treatment strategy. In this setting of patients, conventional echocardiographic assessment may reveal normal myocardial kinesis in 25–76% of cases. Global and territorial longitudinal strain (GLS and TLS, respectively) may be an early and accurate non-invasive tool for prediction of multivessel CAD in patients with NSTE-ACS. To evaluate the ability of TLS to predict culprit lesions in patients with NSTE-ACS. Methods and results We studied 183 patients diagnosed with NSTE-ACS, in our Institution over 2 years of time. Conventional echocardiography and 2 D speckle tracking echocardiography (STE) imaging were performed by two experienced echocardiographers, who were blinded to patient characteristics. The TLS was identified as the mean value of the segments’ strain as respect to each vessel territory. Coronary angiography was performed in all patients. Significant CAD (luminal stenosis more than 70% in a major epicardial coronary vessel) and culprit lesion were identified and threated by PTCA when appropriate. A significant difference between mono- and tri-vessel CAD in the variation of WMSI has been demonstrated. There was a statistically significant difference between both 3-vessels vs. 1-vessel disease and 2-vessels vs. 1-vessel disease in changing of TLS-LAD, TLS-RCA, and TLS-Cx values (P-value &lt;0.001). There was a significant difference between 3-vessels vs. 2-vessels disease for TLS-RCA values. There was a statistically significant difference for WMSI-LAD, WMSI-CX, and WMSI-RCA values whether the respective artery was involved or not. Variations of TLS were statistically significant both when the territorial tributary artery was involved and also if the artery represented the culprit lesion (P-value TLS-LAD &lt;0.001, TLS-LAD culprit &lt;0.001, TLS-CX &lt; 0.001, TLS-cx culprit &lt;0.001, TLS-RCA &lt;0.001, P-value TLS-RCA culprit 0.022). A regression model was performed comparing the variation of WMSI as respect to the variation of WMSI+TLS in the territory of culprit lesions. For WMSI-LAD the OR was 0.94 and for TLS-LAD the OR was 1.19 and the P-value of the addition was 0.001. The OR of WMSI-CX was 1.76 and for TLS-CX the OR was 1.40 and the P-value of the addition was 0.001. The OR of WMSI-RCA was 0.71 and for TLS-RCA the OR was 1.17, the P-value of the addition was 0.019. Conclusions TLS allows an accurate identification of the culprit lesion in patients presenting with NSTE-ACS. TLS can be considered as part of routine echocardiography on top of WMSI in early evaluation for a better clinical assessment in this subset of patients.