[ESC guidelines 2020: acute coronary syndrome without persistent ST-segment elevation : What is new?]

Effect of ticagrelor combined with metoprolol extended-release tablets on cardiac function and clinical prognosis in elderly patients with acute coronary syndrome after percutaneous coronary intervention

Background

Acute coronary syndrome (ACS) poses significant risks to older individuals. This study sought to assess the impact of combining ticagrelor and metoprolol extended-release tablets on clinical prognosis and cardiac function in elderly ACS patients following percutaneous coronary intervention (PCI).

Methods

From February 2022 to February 2023, 90 elderly ACS patients who underwent PCI at our institution were retrospectively enrolled and divided into two groups: an observation group (OG) and a control group (CG), with 45 patients in each group. The CG received oral metoprolol extended-release tablets, while the OG received both oral metoprolol extended-release tablets and ticagrelor. Prognostic indicators and cardiac function were evaluated before and after treatment.

Results

The treatment effectiveness rate in the OG was 97.78%, significantly higher than the CG's rate of 77.78% (P < 0.05). Post-treatment, the OG displayed notable improvements in cardiac function, including significantly higher left ventricular ejection fraction (LVEF), stroke volume (SV), cardiac output (CO), and cardiac index (CI) compared to the CG (P < 0.05). Both groups experienced enhanced exercise capacity, as evidenced by longer exercise duration (ED) and improved 6-min walking test (6MWT) results, with the OG showing superior gains (P < 0.05). Additionally, the OG had significantly higher serum levels of cardiac troponin T (cTnT) and creatine kinase isoenzyme (CK-MB) than the CG (P < 0.05). Decreases in serum levels of sICAM-1, MMP-9, and hs-CRP were observed in both groups, with more pronounced improvements in the OG (P < 0.05). The incidence of adverse prognostic events in the OG was significantly lower at 8.89%, compared to 37.78% in the CG (P < 0.05).

Conclusion

Ticagrelor combined with metoprolol extended-release tablets can significantly improve cardiac function, motor performance, and quality of life in ACS patients after PCI. Additionally, it effectively increases myocardial injury markers and reduces serum inflammatory factor levels.

Antiplatelet and Antithrombotic Properties of Compound L-36, a 6H-1,3,4-Thiadiazine Derivative

Compound L-36, a new derivative of 6H-1,3,4-thiadiazine, was studied in in vitro and in vivo experiments. This compound exhibits high antiplatelet and antithrombogenic activity. In in vitro experiments, compound L-36 by its antiplatelet activity (by IC50) was superior to acetylsalicylic acid by 9.4 times. In in vivo experiments, compound L-36 by its ED50 value was close to the comparison drug. On the model of pulmonary artery thrombosis, compound L-36 ensured better survival of experimental animals than acetylsalicylic acid. Morphological studies showed that compound L-36 effectively attenuated the thrombosis processes in the pulmonary tissue induced by intravenous injection of a thrombogenic mixture (epinephrine and collagen).

Ethnic disparities in care and outcomes of non-ST-segment elevation myocardial infarction: a nationwide cohort study

AIMS

Little is known about ethnic disparities in care and clinical outcomes of patients admitted with non-ST-segment elevation myocardial infarction (NSTEMI) in national cohorts from universal healthcare systems derived from Europe.

METHODS AND RESULTS

We identified 280 588 admissions with NSTEMI in the UK Myocardial Infarction National Audit Project (MINAP), 2010-2017, including White patients (n = 258 364) and Black, Asian, and Minority Ethnic (BAME) patients (n = 22 194). BAME patients were younger (66 years vs. 73 years, P < 0.001) and more frequently had hypertension (66% vs. 54%, P < 0.001), hypercholesterolaemia (49% vs. 34%, P < 0.001), and diabetes (48% vs. 24%, P < 0.001). BAME patients more frequently received invasive coronary angiography (80% vs. 68%, P < 0.001), percutaneous coronary intervention (PCI) (52% vs. 43%, P < 0.001), and coronary artery bypass graft surgery (9% vs. 7%, P < 0.001). Following propensity score matching, BAME compared with White patients had similar in-hospital all-cause mortality [odds ratio (OR) 0.91, confidence interval (CI) 0.76-1.06; P = 0.23], major bleeding (OR 0.99, CI 0.75-1.25; P = 0.95), re-infarction (OR 1.15, CI 0.84-1.46; P = 0.34), and major adverse cardiovascular events (MACE) (OR 0.94, CI 0.80-1.07; P = 0.35).

CONCLUSION

BAME patients with NSTEMI had higher cardiometabolic risk profiles and were more likely to undergo invasive angiography and revascularization, with similar clinical outcomes as those of their White counterparts. Among the quality indicators assessed, there is no evidence of care disparities among BAME patients presenting with NSTEMI.

Therapeutic Peptides to Treat Myocardial Ischemia-Reperfusion Injury

Cardiovascular diseases (CVD) including acute myocardial infarction (AMI) rank first in worldwide mortality and according to the World Health Organization (WHO), they will stay at this rank until 2030. Prompt revascularization of the occluded artery to reperfuse the myocardium is the only recommended treatment (by angioplasty or thrombolysis) to decrease infarct size (IS). However, despite beneficial effects on ischemic lesions, reperfusion leads to ischemia-reperfusion (IR) injury related mainly to apoptosis. Improvement of revascularization techniques and patient care has decreased myocardial infarction (MI) mortality however heart failure (HF) morbidity is increasing, contributing to the cost-intense worldwide HF epidemic. Currently, there is no treatment for reperfusion injury despite promising results in animal models. There is now an obvious need to develop new cardioprotective strategies to decrease morbidity/mortality of CVD, which is increasing due to the aging of the population and the rising prevalence rates of diabetes and obesity. In this review, we will summarize the different therapeutic peptides developed or used focused on the treatment of myocardial IR injury (MIRI). Therapeutic peptides will be presented depending on their interacting mechanisms (apoptosis, necroptosis, and inflammation) reported as playing an important role in reperfusion injury following myocardial ischemia. The search and development of therapeutic peptides have become very active, with increasing numbers of candidates entering clinical trials. Their optimization and their potential application in the treatment of patients with AMI will be discussed.

[The AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guidelines 2021 on thoracic pain]

The AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guidelines 2021 on thoracic pain focusses on chest pain as a single but important symptom. The guidelines fall back on many guidelines on cardiac disease entities, such as myocardial infarction with (STEMI) or without ST segment elevation (NSTEMI), chronic coronary artery disease (CAD), pericarditis and aortic dissection. They also refer to guidelines on cardiac syndromes, such as acute coronary syndrome (ACS) or ACS without persisting ST segment elevation (NSTE-ACS), in which angina pectoris is an integral component. The guideline separates acute from stable angina pectoris. It gives a comprehensive overview on risk stratification and clinical work-up of chest pain. It stretches the main theme to angina equivalents, such as dyspnoe. They meticulously weigh up the noninvasive against the invasive diagnostic methods under the aspects of a cost-benefit analysis. In this context, a clear trend towards evidence-based, cost-effective noninvasive methods in recent years is unmistakable.