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Tucker B, Goonetilleke N, Patel S, Keech A. Colchicine in atherosclerotic cardiovascular disease. Heart 2024; 110:618-625. [PMID: 38331560 DOI: 10.1136/heartjnl-2023-323177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/07/2023] [Indexed: 02/10/2024] Open
Abstract
Inflammation has a direct role in the development of atherosclerotic vascular disease, and oral colchicine displays broad anti-inflammatory properties. Several large, randomised controlled trials (RCTs) have evaluated colchicine's impact on cardiovascular outcomes. Results from a meta-analysis of these trials demonstrate that colchicine reduces the risk of recurrent major adverse cardiovascular events (MACEs) by 25%, leading to its recent approval by the Food and Drug Administration for the treatment and prevention of cardiovascular disease. Despite this, colchicine has not been shown to confer any survival benefit in these trials. The non-significant reduction in cardiovascular death of 18% (95% CI: 45% decrease to 23% increase) is outweighed by a more prominent, borderline non-significant increase in the risk of non-cardiovascular death by 38% (95% CI: 1% decrease to 92% increase). Key populations including those with heart failure, those undergoing surgical revascularisation, women, elderly individuals and non-Caucasians are under-represented in completed trials, which limits generalisability. C reactive protein has been proposed as a biomarker for colchicine response and shows promise for identifying a high-risk population where the benefit on MACE reduction and specifically reduced cardiovascular death might outweigh any real increased risk of non-cardiovascular death; however, this approach is still to be validated in ongoing RCTs. In conclusion, while colchicine shows promise in reducing MACE, its net risk-benefit profile requires further elucidation before its widespread adoption into clinical practice for the secondary prevention of atherosclerotic cardiovascular disease. Much more large-scale, long-term trial data are still needed in this space.
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Affiliation(s)
- Bradley Tucker
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | | | - Sanjay Patel
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Anthony Keech
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
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2
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Plakogiannis FA, Weidmann J, Fraser B, Kwong J, Asi D, Kumar P, Baldock M, Naamo J, Baluja R, Catanzariti R, Yeung S, Pont L, Williams K, De Rubis G, Dua K, Bukhari NI. Investigation of smoking on the antiplatelet response to clopidogrel: Unravelling the smoker's paradox. Pathol Res Pract 2024; 257:155290. [PMID: 38640781 DOI: 10.1016/j.prp.2024.155290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/20/2024] [Accepted: 04/02/2024] [Indexed: 04/21/2024]
Abstract
The intricate relationship between smoking and the effects of the antiplatelet drug clopidogrel has been termed the "smoker's paradox". This paradox details the enhanced efficacy of clopidogrel in smokers compared to non-smokers. This review begins with an exploration of the proposed mechanisms of the smoker's paradox, particularly drawing attention to the induction of cytochrome P450 (CYP) isoenzymes via tobacco smoke, specifically the enzymes CYP1A2 and CYP2C19. Moreover, an investigation of the effects of genetic variability on the smoker's paradox was undertaken from both clinical and molecular perspectives, delving into the effects of ethnicity and genetic polymorphisms. The intriguing role of CYP1A2 genotypes and the response to clopidogrel in smoking and non-smoking populations was examined conferring insight into the individuality rather than universality of the smoker's paradox. CYP1A2 induction is hypothesised to elucidate the potency of smoking in exerting a counteracting effect in those taking clopidogrel who possess CYP2C19 loss of function polymorphisms. Furthermore, we assess the comparative efficacies of clopidogrel and other antiplatelet agents, namely prasugrel and ticagrelor. Studies indicated that prasugrel and ticagrelor provided a more consistent effect and further reduced platelet reactivity compared to clopidogrel within both smoking and non-smoking populations. Personalised dosing was another focus of the review considering patient comorbidities, genetic makeup, and smoking status with the objective of improving the antiplatelet response of those taking clopidogrel. In summation, this review provides insight into multiple areas of research concerning clopidogrel and the smoker's paradox taking into account proposed mechanisms, genetics, other antiplatelet agents, and personalised dosing.
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Affiliation(s)
- Frank A Plakogiannis
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney, NSW 2007, Australia
| | - Jakob Weidmann
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney, NSW 2007, Australia
| | - Blake Fraser
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney, NSW 2007, Australia
| | - Justin Kwong
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney, NSW 2007, Australia
| | - Diana Asi
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney, NSW 2007, Australia
| | - Pratham Kumar
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney, NSW 2007, Australia
| | - Madeleine Baldock
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney, NSW 2007, Australia
| | - Jasmine Naamo
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney, NSW 2007, Australia
| | - Ruhani Baluja
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney, NSW 2007, Australia
| | - Rachelle Catanzariti
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney, NSW 2007, Australia
| | - Stewart Yeung
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney, NSW 2007, Australia; Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, Australia
| | - Lisa Pont
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney, NSW 2007, Australia
| | - Kylie Williams
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney, NSW 2007, Australia
| | - Gabriele De Rubis
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney, NSW 2007, Australia; Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, Australia.
| | - Kamal Dua
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney, NSW 2007, Australia; Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, Australia.
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3
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Povsic TJ, Korjian S, Bahit MC, Chi G, Duffy D, Alexander JH, Vinereanu D, Tricoci P, Mears SJ, Deckelbaum LI, Bonaca M, Ridker PM, Goodman SG, Cornel JH, Lewis BS, Parkhomenko A, Lopes RD, Aylward P, Lincoff AM, Heise M, Sacks F, Nicolau JC, Merkely B, Trebacz J, Libby P, Nicholls SJ, Pocock S, Bhatt DL, Kastelein J, Bode C, Mahaffey KW, Steg PG, Tendera M, Bainey KR, Harrington RA, Mehran R, Duerschmied D, Kingwell BA, Gibson CM. Effect of CSL112 on Recurrent Myocardial Infarction and Cardiovascular Death: Insights from the AEGIS-II Trial. J Am Coll Cardiol 2024:S0735-1097(24)06702-0. [PMID: 38588930 DOI: 10.1016/j.jacc.2024.03.396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 03/20/2024] [Accepted: 03/20/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND The AEGIS-II trial hypothesized that CSL112, an intravenous formulation of human apoA-I, would lower the risk of plaque disruption, decreasing the risk of recurrent events such as myocardial infarction (MI) among high-risk patients with MI. OBJECTIVES This exploratory analysis evaluates the effect of CSL112 therapy on the incidence of CV death and recurrent MI. METHODS The AEGIS-II trial was an international, multicenter, randomized, double-blind, placebo-controlled trial that randomized 18,219 high-risk acute MI patients to 4 weekly infusions of apoA-I (6g CSL112) or placebo. RESULTS The incidence of the composite of cardiovascular death and type 1 MI was 11-16% lower in the CSL112 group over the study period (HR of 0.84 [95% CI 0.7-1.0; p=0.056] day 90, HR 0.86, [95% CI 0.74-0.99; p=0.048] day 180, and HR 0.89, [95% CI 0.79-1.01 p=0.07; p=0.07] day 365). Similarly, the incidence of CV death or any MI was numerically lower in CSL112 treated patients throughout the follow-up period (HR 0.92 [95% CI 0.8-1.05], 0.89 [95% CI 0.79-0.996], 0.91 [0.82-1.01]. The effect of CSL112 treatment on MI was predominantly observed for type 1 MI and type 4b (MI due to stent thrombosis). CONCLUSION While CSL112 did not significantly reduce the occurrence of the primary study endpoints, patients treated with CSL112 infusions had numerically lower rates of CV death and MI, type-1 MI, and stent thrombosis-related MI compared to placebo. These findings could suggest a role of apoA-I in reducing subsequent plaque disruption events via enhanced cholesterol efflux. Further prospective data would be needed to confirm these observations.
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Affiliation(s)
- Thomas J Povsic
- Duke Clinical Research Institute/Duke University Medical Center, Durham, NC, USA
| | - Serge Korjian
- PERFUSE Study Group, Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | | | - Gerald Chi
- PERFUSE Study Group, Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | | | - John H Alexander
- Duke Clinical Research Institute/Duke University Medical Center, Durham, NC, USA
| | - Dragos Vinereanu
- University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Romania
| | | | | | | | - Marc Bonaca
- University of Colorado School of Medicine, Anschutz Medical Campus, USA
| | - Paul M Ridker
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Shaun G Goodman
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, St. Michael's Hospital, Unity Health Toronto, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Jan H Cornel
- Radboud University Medical Center, Nijmegen and Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Basil S Lewis
- Lady Davis Carmel Medical Center and the Technion-Israel Institute of Technology, Israel
| | | | - Renato D Lopes
- Duke Clinical Research Institute/Duke University Medical Center, Durham, NC, USA
| | - Philip Aylward
- South Australian Health and Medical Research Institute/SAHMRI, Adelaide, AUS
| | - A Michael Lincoff
- Cleveland Clinic Coordinating Center for Clinical Research, Cleveland, OH, USA
| | | | - Frank Sacks
- Department of Nutrition, Harvard School of Public Health, Harvard Medical School, Boston, MA
| | - Jose C Nicolau
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Brazil
| | - Bela Merkely
- Heart and Vascular Center of Semmelweis University, Hungary
| | | | - Peter Libby
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Stuart Pocock
- London School of Hygiene and Tropical Medicine, London, UK
| | - Deepak L Bhatt
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John Kastelein
- Academic Medical Centre/University of Amsterdam, Amsterdam, The Netherlands
| | | | - Kenneth W Mahaffey
- Stanford Center for Clinical Research, Stanford University School of Medicine, Stanford, CA, USA
| | - P Gabriel Steg
- Universite Paris-Cité, INSERM 1148, FACT, and AP-HP, Hôpital Bichat, Paris, France
| | - Michal Tendera
- Department of Cardiology and Structural Heart Disease, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Kevin R Bainey
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, St. Michael's Hospital, Unity Health Toronto, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Daniel Duerschmied
- Cardiology, Angiology, Haemostaseology, and Medical Intensive Care, Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | | | - C Michael Gibson
- PERFUSE Study Group, Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA;.
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4
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Couch LS, Garrard JW, Henry JA, Kotronias RA, Alaour B, De Maria GL, Channon KM, Banning AP, Lyon AR, Marber M, Kaier TE. Comparison of troponin and natriuretic peptides in Takotsubo syndrome and acute coronary syndrome: a meta-analysis. Open Heart 2024; 11:e002607. [PMID: 38508657 PMCID: PMC10952941 DOI: 10.1136/openhrt-2024-002607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 01/16/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVE Takotsubo syndrome (TTS) is an acute heart failure syndrome which resembles acute coronary syndrome (ACS) at presentation. Differentiation requires coronary angiography, but where this does not occur immediately, cardiac biomarkers may provide additional utility. We performed a meta-analysis to compare troponin and natriuretic peptides (NPs) in TTS and ACS to determine if differences in biomarker profile can aid diagnosis. METHODS We searched five literature databases for studies reporting NPs (Brain NP (BNP)/NT-pro-BNP) or troponin I/T in TTS and ACS, identifying 28 studies for troponin/NPs (5618 and 1145 patients, respectively). RESULTS Troponin was significantly lower in TTS than ACS (standardised mean difference (SMD) -0.86; 95% CI, -1.08 to -0.64; p<0.00001), with an absolute difference of 75 times the upper limit of normal (×ULN) higher in ACS than TTS. Conversely, NPs were significantly higher in TTS (SMD 0.62; 95% CI, 0.44 to 0.80; p<0.00001) and 5.8×ULN greater absolutely. Area under the curve (AUC) for troponin in ACS versus TTS was 0.82 (95% CI, 0.70 to 0.93), and 0.92 (95% CI, 0.80 to 1.00) for ST-segment elevation myocardial infarction versus TTS. For NPs, AUC was 0.69 (95% CI, 0.48 to 0.89). Combination of troponin and NPs with logistic regression did not improve AUC. Recursive Partitioning and Regression Tree analysis calculated a troponin threshold ≥26×ULN that identified 95% cases as ACS where and specificity for ACS were 85.71% and 53.57%, respectively, with 94.32% positive predictive value and 29.40% negative predictive value. CONCLUSIONS Troponin is lower and NPs higher in TTS versus ACS. Troponin had greater power than NPs at discriminating TTS and ACS, and with troponin ≥26×ULN patients are far more likely to have ACS.
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Affiliation(s)
- Liam Steven Couch
- King's College London BHF Centre, The Rayne Institute, St Thomas' Hospital, London, UK
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - James W Garrard
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - John A Henry
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Rafail A Kotronias
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Bashir Alaour
- King's College London BHF Centre, The Rayne Institute, St Thomas' Hospital, London, UK
| | - Giovanni Luigi De Maria
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Keith M Channon
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Adrian P Banning
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | | | - Michael Marber
- King's College London BHF Centre, The Rayne Institute, St Thomas' Hospital, London, UK
| | - Thomas Edward Kaier
- King's College London BHF Centre, The Rayne Institute, St Thomas' Hospital, London, UK
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5
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Serenelli M, Dal Passo B, Biscaglia S, Tolomeo P, Di Ienno L, Cantone A, Sanguettoli F, Campana R, Marchini F, Arzenton M, Maio D, Santori V, Campo G. Diagnostic accuracy of baseline troponin and troponin change for the diagnosis of myocardial infarction complicated with heart failure. Open Heart 2024; 11:e002538. [PMID: 38485286 PMCID: PMC10941125 DOI: 10.1136/openhrt-2023-002538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/11/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND The diagnosis of myocardial infarction (MI) in the presence of heart failure (HF) presents a clinical problem. While diagnostic algorithms using high-sensitivity cardiac troponin have been established for suspected MI, their accuracy in patients with HF remains uncertain. This study aims to assess the diagnostic accuracy of high-sensitivity troponin I (TnI) levels in identifying acute MI among patients with HF, focusing on baseline, absolute and relative TnI changes. METHODS Data from 562 individuals admitted to the emergency department with suspected MI were retrospectively analysed. Two-point TnI and baseline brain natriuretic peptide (BNP) test results were available. HF status was determined based on clinical, laboratory and instrumental criteria. RESULTS Among the 562 patients, 299 (53.2%) were confirmed having MI. Baseline TnI demonstrated predictive capability for MI in the overall population (area under the curve (AUC) 0.63), while TnI relative change exhibited superior performance (AUC 0.83). Baseline TnI accuracy varied significantly by group, notably decreasing in the third group (severe HF) (AUC 0.54) compared with the first and second groups (AUC 0.67 and AUC 0.71, respectively). TnI relative change demonstrated consistent accuracy across all groups, with AUCs of 0.79, 0.79 and 0.89 for the first, second and third groups, respectively, even after adjustment for age, sex and glomerular filtration rate. DISCUSSION Troponin relative change is a reliable predictor of MI, even in patients with acute HF. Baseline TnI accuracy is influenced by HF severity. It is essential to consider HF status and BNP levels when employing high-sensitivity cardiac troponin testing to rule out suspected MIs.
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Affiliation(s)
- Matteo Serenelli
- Department of Cardiology, University Hospital Arcispedale Sant'Anna of Ferrara, Ferrara, Italy
| | - Beatrice Dal Passo
- Department of Cardiology, University Hospital Arcispedale Sant'Anna of Ferrara, Ferrara, Italy
| | - Simone Biscaglia
- Department of Cardiology, University Hospital Arcispedale Sant'Anna of Ferrara, Ferrara, Italy
| | - Paolo Tolomeo
- Department of Cardiology, University Hospital Arcispedale Sant'Anna of Ferrara, Ferrara, Italy
| | - Luca Di Ienno
- Department of Cardiology, University Hospital Arcispedale Sant'Anna of Ferrara, Ferrara, Italy
| | - Anna Cantone
- Department of Cardiology, University Hospital Arcispedale Sant'Anna of Ferrara, Ferrara, Italy
| | - Federico Sanguettoli
- Department of Cardiology, University Hospital Arcispedale Sant'Anna of Ferrara, Ferrara, Italy
| | - Roberta Campana
- Department of Cardiology, University Hospital Arcispedale Sant'Anna of Ferrara, Ferrara, Italy
| | - Federico Marchini
- Department of Cardiology, University Hospital Arcispedale Sant'Anna of Ferrara, Ferrara, Italy
| | - Matteo Arzenton
- Department of Cardiology, University Hospital Arcispedale Sant'Anna of Ferrara, Ferrara, Italy
| | - Daniele Maio
- Department of Cardiology, University Hospital Arcispedale Sant'Anna of Ferrara, Ferrara, Italy
| | - Valentino Santori
- Department of Statistics, Informatics, Applications 'Giuseppe Parenti' (DISIA), University of Florence Unit of Methodological and Statistical Support to Clinical Research, AOU of Modena, Modena, Italy
| | - Gianluca Campo
- Department of Cardiology, University Hospital Arcispedale Sant'Anna of Ferrara, Ferrara, Italy
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6
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Lemesle G, Schurtz G, Verdier B, Bonello L. Very early invasive strategy in patients with non-ST-elevation myocardial infarction: should we go for it? Heart 2024; 110:461-462. [PMID: 38103914 DOI: 10.1136/heartjnl-2023-323688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Affiliation(s)
- Gilles Lemesle
- USIC et Centre Hemodynamique, Centre Hospitalier Universitaire de Lille, Institut Coeur Poumon, Lille, France
| | - Guillaume Schurtz
- Centre Hospitalier Universitaire de Lille, Institut Coeur Poumon, Lille, France
| | - Basile Verdier
- Centre Hospitalier Universitaire de Lille, Institut Coeur Poumon, Lille, France
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7
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Millard MJ, Ashburn NP, Snavely AC, Hashemian T, Supples M, Allen B, Christenson R, Madsen T, McCord J, Mumma B, Stopyra J, Wilkerson RG, Mahler SA. European Society of Cardiology 0/1-hour algorithm (high-sensitivity cardiac troponin T) performance across distinct age groups. Heart 2024:heartjnl-2023-323621. [PMID: 38471727 DOI: 10.1136/heartjnl-2023-323621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/06/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND To determine if the European Society of Cardiology 0/1-hour (ESC 0/1-h) algorithm with high-sensitivity cardiac troponin T (hs-cTnT) meets the ≥99% negative predictive value (NPV) safety threshold for 30-day cardiac death or myocardial infarction (MI) in older, middle-aged and young subgroups. METHODS We conducted a subgroup analysis of adult emergency department patients with chest pain prospectively enrolled from eight US sites (January 2017 to September 2018). Patients were stratified into rule-out, observation and rule-in zones using the hs-cTnT ESC 0/1-h algorithm and classified as older (≥65 years), middle aged (46-64 years) or young (21-45 years). Patients had 0-hour and 1-hour hs-cTnT measures (Roche Diagnostics) and a History, ECG, Age, Risk factor and Troponin (HEART) score. Fisher's exact tests compared rule-out and 30-day cardiac death or MI rates between ages. NPVs with 95% CIs were calculated for the ESC 0/1-h algorithm with and without the HEART score. RESULTS Of 1430 participants, 26.9% (385/1430) were older, 57.4% (821/1430) middle aged and 15.7% (224/1430) young. Cardiac death or MI at 30 days occurred in 12.8% (183/1430). ESC 0/1-h algorithm ruled out 35.6% (137/385) of older, 62.1% (510/821) of middle-aged and 79.9% of (179/224) young patients (p<0.001). NPV for 30-day cardiac death or MI was 97.1% (95% CI 92.7% to 99.2%) among older patients, 98.4% (95% CI 96.9% to 99.3%) in middle-aged patients and 99.4% (95% CI 96.9% to 100%) among young patients. Adding a HEART score increased NPV to 100% (95% CI 87.7% to 100%) for older, 99.2% (95% CI 97.2% to 99.9%) for middle-aged and 99.4% (95% CI 96.6% to 100%) for young patients. CONCLUSIONS In older and middle-aged adults, the hs-cTnT ESC 0/1-h algorithm was unable to reach a 99% NPV for 30-day cardiac death or MI unless combined with a HEART score. TRIAL REGISTRATION NUMBER NCT02984436.
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Affiliation(s)
- Marissa J Millard
- Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Nicklaus P Ashburn
- Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Anna C Snavely
- Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Tara Hashemian
- Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Michael Supples
- Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Brandon Allen
- Department of Emergency Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Robert Christenson
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Troy Madsen
- Department of Emergency Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - James McCord
- Department of Cardiology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Bryn Mumma
- Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, California, USA
| | - Jason Stopyra
- Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Richard Gentry Wilkerson
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Simon A Mahler
- Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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8
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Warren J, Ellims A, Bloom J, Sutherland N, Lew P, Kavnoudias H, Paleri S, Stub D, Taylor A. Mixed plaque on coronary CT angiography predicts atherosclerotic events in asymptomatic intermediate-risk individuals. Open Heart 2024; 11:e002609. [PMID: 38458771 DOI: 10.1136/openhrt-2024-002609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 01/26/2024] [Indexed: 03/10/2024] Open
Abstract
OBJECTIVE Coronary CT angiography (CCTA) permits both qualitative and quantitative analysis of atherosclerotic plaque and may be a suitable risk modifier in assessing patients at intermediate risk of atherosclerotic cardiovascular disease. We sought to determine the association of plaque components with long-term major adverse cardiovascular events (MACEs) in asymptomatic intermediate-risk patients, compared with conventional coronary artery calcium (CAC) score. METHODS 100 intermediate-risk patients underwent double-blinded CCTA. Follow-up was conducted at 10 years and data were cross-referenced with the National Death Index. The primary outcome was MACE, which was a composite of death, acute coronary syndrome (ACS), revascularisation and stroke. RESULTS The median time from CCTA to follow-up was 9.5 years. 83 patients completed follow-up interview and mortality data were available on all 100 patients. MACE occurred in 17 (20.5%) patients, which included 2 (2%) deaths, 8 (10%) ACS, 3 (4%) strokes and 5 (6%) revascularisation procedures. 47 (57%) patients had mixed plaque, which was predictive of MACE (OR 4.68 (95% CI 1.19 to 18.5) p=0.028). The burden of non-calcified and mixed plaque, defined by non-calcified plaque segment stenosis score, was also a predictor of long-term MACE (OR 1.59 (95% CI 1.18 to 2.13) p=0.002). Neither calcified plaque (OR 3.92 (95% CI 0.80 to 19.3)) nor CAC score (OR 1.01 (95% CI 0.999 to 1.02)) was associated with long-term MACE. CONCLUSION The presence and burden of mixed plaque on CCTA is associated with an increased risk of long-term MACE among asymptomatic intermediate-risk patients and is a superior predictor to CAC score.
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Affiliation(s)
- Josephine Warren
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Andris Ellims
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Jason Bloom
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Nigel Sutherland
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Philip Lew
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Helen Kavnoudias
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Neuroscience and Surgery, Monash University, Clayton, Victoria, Australia
| | - Sarang Paleri
- Department of Cardiology, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Dion Stub
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
- Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Andrew Taylor
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
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9
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Buia V, Ciotola F, Bastian D, Stangl D, Walascheck J, Rittger H, Vitali-Serdoz L. Expanded application of wearable cardioverter defibrillators beyond current guidelines: proposal for a European register explained through single clinical scenarios. Open Heart 2024; 11:e002597. [PMID: 38458770 DOI: 10.1136/openhrt-2023-002597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 03/10/2024] Open
Abstract
The wearable cardioverter defibrillator (WCD) is becoming a more and more widely used instrument for the prevention of sudden cardiac death of patients either with a secondary prevention implantable cardioverter defibrillator indication or with a transient high risk of sudden cardiac death. Although clinical practice has demonstrated a benefit of protecting patients for a period as long as 3-6 months with such devices, the current European guidelines concerning ventricular arrhythmias and sudden cardiac death are still extremely restrictive in the patient selection in part because of the costs derived from such a prevention device, in part because of the lack of robust randomised trials.To illustrate expanded use cases for the WCD, four real-life clinical cases are presented where patients received the device slightly outside the established guidelines. These cases demonstrate the broader utility of WCDs in situations involving acute myocarditis, thyrotoxicosis, pre-excited atrial fibrillation and awaiting staging/prognosis of a lung tumour. The findings prompt expansion of the existing guidelines for WCD use to efficiently protect more patients whose risk of arrhythmic cardiac death is transient or uncertain. This could be achieved by establishing a European register of the patients who receive a WCD for further analysis.
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10
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Zhang G, Cui J, Zhang X, Chair SY, Liu W, Liu YJ, Cheng YX, Liu Q, Yang BX, Zou H. Relationships between disease severity, psychological stress, and health-related quality of life among patients with acute coronary syndrome: Mediation of illness perception. Eur J Cardiovasc Nurs 2024:zvae030. [PMID: 38422226 DOI: 10.1093/eurjcn/zvae030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 03/02/2024]
Abstract
AIMS Patients with acute coronary syndrome (ACS) often experience reduced health-related quality of life (HRQOL), which may be attributable to the disease severity and psychological stress. While illness perception is speculated to be a potential pathway underlying these relationships, evidence supporting this mechanism remains limited. This study aimed to investigate the relationships between disease severity, psychological stress, and HRQOL and whether these relationships are mediated by illness perception in patients with ACS. METHODS AND RESULTS Data were collected from June to July 2019 and June to September 2020 in the cardiology departments of four public hospitals in China. Eligible patients completed measures of disease severity, psychological stress, illness perception, HRQOL, and sociodemographic and clinical characteristics. Data were analyzed employing hierarchical multiple regression and structural equation modeling. This study included 405 participants (mean age 60.63 years, 67.4% male). After controlling for sociodemographic and clinical covariates, higher levels of disease severity (β=0.115, P=0.024) and psychological stress (β=-0.209, P<0.001) were associated with poorer HRQOL; however, the relationships became non-significant after adding illness perception into the regression model. Structural equation modeling analysis suggested that illness perception played a mediating role between disease severity, psychological stress, and HRQOL, accounting for 45.95% and 65.79% of the total effects, respectively. CONCLUSION This study found that illness perception mediated the relationships between disease severity, psychological stress, and HRQOL among patients with ACS. Improving patients' HRQOL should consider its important influencing factors with a focus on promoting positive illness perception.
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Affiliation(s)
- Guiqin Zhang
- Center for Wise Information Technology of Mental Health Nursing Research, School of Nursing, Wuhan University, Wuhan, China
| | - Jiatong Cui
- Center for Wise Information Technology of Mental Health Nursing Research, School of Nursing, Wuhan University, Wuhan, China
| | - Xiaohong Zhang
- Nursing Department, Xiangyang Central Hospital, Affiliated Hospital of Hubei, Xiangyang, Hubei, China
| | - Sek Ying Chair
- The Nethersole School of Nursing, The Chinese University of Hong Kong, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China
| | - Wei Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yu Jia Liu
- Center for Wise Information Technology of Mental Health Nursing Research, School of Nursing, Wuhan University, Wuhan, China
| | - Yu Xin Cheng
- Center for Wise Information Technology of Mental Health Nursing Research, School of Nursing, Wuhan University, Wuhan, China
| | - Qian Liu
- Center for Wise Information Technology of Mental Health Nursing Research, School of Nursing, Wuhan University, Wuhan, China
| | - Bing Xiang Yang
- Center for Wise Information Technology of Mental Health Nursing Research, School of Nursing, Wuhan University, Wuhan, China
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
- Population and Health Research Center, Wuhan University, Wuhan, China
| | - Huijing Zou
- Center for Wise Information Technology of Mental Health Nursing Research, School of Nursing, Wuhan University, Wuhan, China
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11
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Dirjayanto VJ, Alkhalil M, Dodson J, Mills G, Pompei G, Rubino F, Kunadian V. Cognitive impairment and outcomes in older adults with non-ST-elevation acute coronary syndrome. Heart 2024; 110:416-424. [PMID: 37813562 DOI: 10.1136/heartjnl-2023-323224] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 09/08/2023] [Indexed: 10/17/2023] Open
Abstract
OBJECTIVE This study aimed to explore the prognostic impact of cognitive impairment on the long-term risk of major adverse cardiovascular events (MACEs) in older patients with non-ST-elevation acute coronary syndrome (NSTEACS) undergoing invasive treatment. METHODS Patients aged ≥75 years with NSTEACS undergoing an invasive strategy were included in the multicentre prospective study (NCT01933581). Montreal Cognitive Assessment was used to evaluate cognitive status at baseline (scores ≥26 classified as normal, <26 as cognitive impairment). Long-term follow-up data were obtained from electronic patient care records. The primary endpoint was MACE as a composite of all-cause deaths, reinfarction, stroke/transient ischaemic attack, urgent revascularisation and significant bleeding. RESULTS 239 patients with baseline cognitive assessment completed long-term follow-up. Median age was 80.9 years (IQR 78.2-83.9 years) and 62.3% were male. On 5-year follow-up, there was no significant difference in the occurrence of MACE between the cognitively impaired group and the normal cognition group (p=0.155). Cognition status was not associated with MACE (HR 1.37 (95% CI 0.96 to 1.95); p=0.082). However, there was significantly more deaths (p=0.005) in those with cognitive impairment. Kaplan-Meier survival analysis (log-rank p=0.003) and Cox regression analysis (aHR 1.85 (95% CI 1.11 to 3.08); p=0.018) revealed increased risk of all-cause mortality, even after adjusting for frailty and GRACE (Global Registry of Acute Coronary Events) score. CONCLUSION Cognitive impairment in older patients with NSTEACS undergoing an invasive strategy was associated with long-term all-cause mortality. Routine cognitive screening may aid risk stratification and further studies are needed to identify how this should influence management strategies and individual decision-making in this patient group. TRIAL REGISTRATION NUMBER NCT01933581.
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Affiliation(s)
- Valerie Josephine Dirjayanto
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Mohammad Alkhalil
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundations Trust, Newcastle upon Tyne, UK
| | - John Dodson
- The Leon H. Charney Division of Cardiology, NYU Langone Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Gregory Mills
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Graziella Pompei
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, UK
| | - Francesca Rubino
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundations Trust, Newcastle upon Tyne, UK
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12
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Demandt J, Koks A, Sagel D, van Hattem VAE, Haest RJ, Heijmen E, Thijssen H, Otterspoor LC, van Veghel D, Eerdekens R, El Farissi M, Teeuwen K, Wijnbergen I, van der Harst P, Pijls NHJ, van 't Veer M, Tonino PAL, Dekker LRC, Vlaar PJ. Prehospital risk assessment and direct transfer to a percutaneous coronary intervention centre in suspected acute coronary syndrome. Heart 2024; 110:408-415. [PMID: 38040452 DOI: 10.1136/heartjnl-2023-323346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/16/2023] [Indexed: 12/03/2023] Open
Abstract
OBJECTIVE Prehospital risk stratification and triage are currently not performed in patients suspected of non-ST-segment elevation acute coronary syndrome (NSTE-ACS). This may lead to prolonged time to revascularisation, increased duration of hospital admission and higher healthcare costs. The preHEART score (prehospital history, ECG, age, risk factors and point-of-care troponin score) can be used by emergency medical services (EMS) personnel for prehospital risk stratification and triage decisions in patients with NSTE-ACS. The aim of the current study was to evaluate the effect of prehospital risk stratification and direct transfer to a percutaneous coronary intervention (PCI) centre, based on the preHEART score, on time to final invasive diagnostics or culprit revascularisation. METHODS Prospective, multicentre, two-cohort study in patients with suspected NSTE-ACS. The first cohort is observational (standard care), while the second (interventional) cohort includes patients who are stratified for direct transfer to either a PCI or a non-PCI centre based on their preHEART score. Risk stratification and triage are performed by EMS personnel. The primary endpoint of the study is time from first medical contact until final invasive diagnostics or revascularisation. Secondary endpoints are time from first medical contact until intracoronary angiography (ICA), duration of hospital admission, number of invasive diagnostics, number of inter-hospital transfers and major adverse cardiac events at 7 and 30 days. RESULTS A total of 1069 patients were included. In the interventional cohort (n=577), time between final invasive diagnostics or revascularisation (42 (17-101) hours vs 20 (5-44) hours, p<0.001) and length of hospital admission (3 (2-5) days vs 2 (1-4) days, p=0.007) were shorter than in the observational cohort (n=492). In patients with NSTE-ACS in need for ICA or revascularisation, healthcare costs were reduced in the interventional cohort (€5599 (2978-9625) vs €4899 (2278-5947), p=0.02). CONCLUSION Prehospital risk stratification and direct transfer to a PCI centre, based on the preHEART score, reduces time from first medical contact to final invasive diagnostics and revascularisation, reduces duration of hospital admission and decreases healthcare costs in patients with NSTE-ACS in need for ICA or revascularisation. TRIAL REGISTRATION NCT05243485.
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Affiliation(s)
- Jesse Demandt
- Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands
| | - Arjan Koks
- GGD Brabant-Zuidoost, Eindhoven, Netherlands
| | - Dennis Sagel
- Cardioresearch, Faculty of Medical Sciences, University of Groningen, Groningen, Netherlands
| | | | - Rutger J Haest
- Cardiology, St. Anna Hospital, Geldrop, Netherlands
- Netherlands Heart Network, Helmond, Netherlands
| | - Eric Heijmen
- Netherlands Heart Network, Helmond, Netherlands
- Cardiology, Elkerliek Hospital, Helmond, Netherlands
| | - H Thijssen
- Netherlands Heart Network, Helmond, Netherlands
- Cardiology, Maxima Medical Centre, Veldhoven, Netherlands
| | - Luuk C Otterspoor
- Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands
| | - Dennis van Veghel
- Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands
- Netherlands Heart Network, Helmond, Netherlands
| | - Rob Eerdekens
- Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands
| | | | - Koen Teeuwen
- Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands
| | - Inge Wijnbergen
- Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands
| | - Pim van der Harst
- Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands
| | - Nico H J Pijls
- Faculty of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Marcel van 't Veer
- Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands
- Cardioresearch, Faculty of Medical Sciences, University of Groningen, Groningen, Netherlands
| | - Pim A L Tonino
- Faculty of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Lukas R C Dekker
- Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands
- Faculty of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Pieter J Vlaar
- Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands
- Netherlands Heart Network, Helmond, Netherlands
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13
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Irfan A, Haider SH, Nasir A, Larik MO, Naz T. Assessing the Efficacy of Omega-3 Fatty Acids + Statins vs. Statins Only on Cardiovascular Outcomes: A Systematic Review and Meta-Analysis of 40,991 Patients. Curr Probl Cardiol 2024; 49:102245. [PMID: 38040215 DOI: 10.1016/j.cpcardiol.2023.102245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Clinical guidelines recommend statin use in patients with a vast array of cardiovascular disturbances. However, there is insufficient evidence regarding the concomitant use of omega-3 fatty acids in addition to statins. This meta-analysis aims to uncover the complete effects of this combination therapy on cardiovascular outcomes, lipid biomarkers, inflammatory markers, and plaque markers. METHODS A detailed literature search was conducted using PubMed, Cochrane, and MEDLINE databases, and all the relevant studies found up to September 2023 were included. The primary outcomes assessed in this meta-analysis was 1) Composite of fatal and non-fatal myocardial infarction, 2) Composite of fatal and non-fatal stroke, 3) Coronary revascularization, 4) Death due to cardiovascular causes, 5) MACE (Major Adverse Cardiovascular Events), 6) Unstable angina, 7) Hospitalization due to unstable angina, 8) and lipid volume index. Secondary outcomes included lipid markers, hsCRP, EPA levels, and EPA/AA ratio. RESULTS 14 RCTs were included, featuring a total of 40,991 patients. Patients receiving the omega-3 + statin regimen were associated with a statistically significant decrease in the incidence of MI, MACE, unstable angina, hospitalization due to unstable angina, Total cholesterol levels, triglycerides, hsCRP, and lipid volume index in comparison to their counterparts receiving placebo + statin (P < 0.05). In contrast, our analysis found no statistically significant difference in the incidence of fatal and non-fatal stroke, coronary revascularization, and cardiovascular mortality. CONCLUSION Our research reinforces that all patients, regardless of their cardiovascular health, may benefit from adding omega-3 fatty acids to their statin therapy.
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Affiliation(s)
- Areeka Irfan
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
| | - Syed Hamza Haider
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Aiman Nasir
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Muhammad Omar Larik
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Turba Naz
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
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14
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Kanaan CN, Kassis N, Nair RM, Kumar A, Huded CP, Kravitz K, Reed GW, Krishnaswamy A, Lincoff AM, Khatri J, Puri R, Ziada K, Nair R, Kapadia S, Khot U. Implementing a comprehensive STEMI protocol to improve care metrics and outcomes in patients with in-hospital STEMI: an observational cohort study. Open Heart 2024; 11:e002505. [PMID: 38290731 PMCID: PMC10828835 DOI: 10.1136/openhrt-2023-002505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/08/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Patients who experience in-hospital ST-segment elevation myocardial infarction (iSTEMI) represent a uniquely high-risk cohort owing to delays in diagnosis, prolonged time to reperfusion and increased mortality. Quality initiatives aimed at improving the care of this vulnerable, yet understudied population are needed. METHODS This study included consecutive patients with iSTEMI treated with percutaneous coronary intervention (PCI) between 1 January 2011 and 15 July 2019 at a single, tertiary referral centre. A comprehensive iSTEMI protocol (CSP) was implemented on 15 July 2014, incorporating: (1) cardiology fellow activation of the catheterisation lab using standardised criteria, (2) nursing chest pain protocol, (3) improved electronic access to electrocardiographic studies, (4) checklist for initial triage and management, (5) 24/7/365 catheterisation lab readiness and (6) radial-first PCI approach. Key metrics and clinical outcomes were compared before and after CSP implementation. RESULTS Among 125 total subjects, the post-CSP cohort (n=81) was younger, had more males and were more likely to be hospitalised for cardiac-related reasons relative to the pre-CSP cohort (n=44) who were more likely hospitalised for operative-related aetiologies. After CSP adoption, median ECG-to-first-device-activation time decreased from 113 min to 64 min (p<0.001), goal ECG-to-first-device-activation time increased from 36% to 76% of patients (p<0.001), administration of guideline-directed medical therapy prior to PCI increased from 27.3% to 65.4% (p<0.001), trans-radial access increased from 16% to 70% (p<0.001) and rates of discharge home increased from 56.8% to 76.5% (p=0.04). Statistically insignificant numerical reductions were observed post-CSP in in-hospital mortality (18.2% vs 9.9%, p=0.30), 30-day mortality (15.9% vs 12.3%, p=0.78) and 1-year mortality (27.3% vs 21.0%, p=0.57). CONCLUSIONS The implementation of a CSP was associated with marked enhancements in key care metrics among patients with iSTEMI. Among a larger cohort, the use of a CSP yielded a significant reduction in ECG-to-first-device-activation time in a particularly vulnerable population at high risk of death.
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Affiliation(s)
| | - Nicholas Kassis
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Raunak M Nair
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | | | - Kathleen Kravitz
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Grant W Reed
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | | | | | | | - Khaled Ziada
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Ravi Nair
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | - Umesh Khot
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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15
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Benenati S, Montorfano M, Pica S, Crimi G, Ancona M, Montone RA, Rinaldi R, Gramegna M, Esposito A, Palmisano A, Tavano D, Monizzi G, Bartorelli A, Porto I, Ambrosio G, Camici PG. Coronary physiology thresholds associated with microvascular obstruction in myocardial infarction. Heart 2024; 110:271-280. [PMID: 37879880 DOI: 10.1136/heartjnl-2023-323169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/15/2023] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVES To ascertain whether invasive assessment of coronary physiology soon after recanalisation of the culprit artery by primary percutaneous coronary intervention is associated with the development of microvascular obstruction by cardiac magnetic resonance in patients with ST-segment elevation myocardial infarction (STEMI). METHODS Between November 2020 and December 2021, 102 consecutive patients were prospectively enrolled in five tertiary centres in Italy. Coronary flow reserve (CFR) and index of microvascular resistance (IMR) were measured in the culprit vessel soon after successful primary percutaneous coronary intervention. Optimal cut-off points of IMR and CFR to predict the presence of microvascular obstruction were estimated, stratifying the population accordingly in four groups. A comparison with previously proposed stratification models was carried out. RESULTS IMR>31 units and CFR≤1.25 yielded the best accuracy. Patients with IMR>31 and CFR≤1.25 exhibited higher microvascular obstruction prevalence (83% vs 38%, p<0.001) and lower left ventricular ejection fraction (45±9% vs 52±9%, p=0.043) compared with those with IMR≤31 and CFR>1.25, and lower left ventricular ejection fraction compared with patients with CFR≤1.25 and IMR≤31 (45±9% vs 54±7%, p=0.025). Infarct size and area at risk were larger in the former, compared with other groups. CONCLUSIONS IMR and CFR are associated with the presence of microvascular obstruction in STEMI. Patients with an IMR>31 units and a CFR≤1.25 have higher prevalence of microvascular obstruction, lower left ventricular ejection fraction, larger infarct size and area at risk. TRIAL REGISTRATION NUMBER NCT04677257.
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Affiliation(s)
- Stefano Benenati
- Cardiovascular Disease Chair, Department of Internal Medicine (Di.M.I.), University of Genova, Genova, Liguria, Italy
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, UK
| | - Matteo Montorfano
- Interventional Cardiology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Silvia Pica
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiology Network, Genova, Italy
| | - Gabriele Crimi
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiology Network, Genova, Italy
| | - Marco Ancona
- Cardiology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Rocco A Montone
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Riccardo Rinaldi
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Antonio Esposito
- Diagnostic Radiology, IRCCS San Raffaele Hospital and Vita University San Raffaele, Milan, Italy
- Radiology, Università Vita e Salute San Raffaele, Milan, Italy
| | | | - Davide Tavano
- Cardiology, IRCCS MultiMedica, Sesto San Giovanni, Italy
| | | | | | - Italo Porto
- Cardiovascular Disease Chair, Department of Internal Medicine (Di.M.I.), University of Genova, Genova, Liguria, Italy
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiology Network, Genova, Italy
| | - Giuseppe Ambrosio
- Cardiology, University of Perugia School of Medicine, Perugia, Italy
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Bergman I, Gelikas S, Wexler Y, Braver O, Boyle D, Nussinovitch U. Effect of ischaemic postconditioning on markers of myocardial injury in ST-elevation myocardial infarction: a meta-analysis. Open Heart 2024; 11:e002281. [PMID: 38286569 PMCID: PMC10826564 DOI: 10.1136/openhrt-2023-002281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/31/2023] [Indexed: 01/31/2024] Open
Abstract
OBJECTIVES This study aimed to perform a meta-analysis of the short-term impact of ischaemic postconditioning (IPoC) on myocardial injury in ST elevation myocardial infarction (STEMI) using surrogate cardiac biomarkers. METHODS Eligible studies were identified using several article databases. Randomised controlled trials published between 1 January 2000 and 1 December 2021 comparing IPoC to standard of therapy in STEMI patients were included in the search. Outcomes included surrogates of myocardial injury, specifically peak troponin, creatine-kinase (CK) and CK myoglobin binding (CK-MB) enzyme levels. RESULTS 11 articles involving 1273 patients reported on CK-MB and 8 studies involving 505 patients reported on CK. Few studies used troponin as an outcome, thus, a subanalysis of troponin dynamics was not performed. Meta-regression analysis demonstrated no significant effect of IPoC on peak CK-MB (effect size -0.41, 95% CI -1.15 to 0.34) or peak CK (effect size -0.42, 95% CI -1.20 to 0.36). Linear regression analysis demonstrated a significant correlation between a history of smoking and CK-MB in the IPoC group (p=0.038). CONCLUSIONS IPoC does not seem to protect against myocardial injury in STEMI, except possibly in smokers. These results resonate with some studies using imaging techniques to ascertain myocardial damage. More research using troponin and cardiac imaging should be pursued to better assess the effects of IPoC on cardiovascular outcomes in STEMI.
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Affiliation(s)
- Idan Bergman
- Rabin Medical Center Beilinson Hospital, Petah Tikva, Israel
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | | | - Yehuda Wexler
- Technion Israel Institute of Technology The Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Omri Braver
- Barzilai Medical Center, Ashkelon, Israel
- Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Dennis Boyle
- Westchester Medical Center, Valhalla, New York, USA
| | - Udi Nussinovitch
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
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17
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Boeddinghaus J, Chapman AR, Henriksen PA. Acute chest pain in a young man with low cardiovascular risk profile. Heart 2024; 110:234-306. [PMID: 38286519 DOI: 10.1136/heartjnl-2023-323398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2024] Open
Affiliation(s)
- Jasper Boeddinghaus
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Andrew R Chapman
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
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18
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Le Bras A, Hildick-Smith D, Nze Ossima A, Supplisson O, Egred M, Brunel P, Banning AP, Morice MC, Durand-Zaleski I. Cost-effectiveness of stepwise provisional versus systematic dual stenting strategies in patients with distal bifurcation left main stem lesions: economic analysis of the EBC MAIN trial. Open Heart 2024; 11:e002479. [PMID: 38242557 PMCID: PMC10806460 DOI: 10.1136/openhrt-2023-002479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/13/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND In patients with distal bifurcation left main stem lesions requiring intervention, the European Bifurcation Club Left Main Coronary Stent Study trial found a non-significant difference in major adverse cardiac events (MACEs, composite of all-cause death, non-fatal myocardial infarction and target lesion revascularisation) favouring the stepwise provisional strategy, compared with the systematic dual stenting. AIMS To estimate the 1-year cost-effectiveness of stepwise provisional versus systematic dual stenting strategies. METHODS Costs in France and the UK, and MACE were calculated in both groups to estimate the incremental cost-effectiveness ratio (ICER). Uncertainty was explored by probabilistic bootstrapping. The analysis was conducted from the perspective of the healthcare provider with a time horizon of 1 year. RESULTS The cost difference between the two groups was €-755 (€5700 in the stepwise provisional group and €6455 in the systematic dual stenting group, p value<0.01) in France and €-647 (€6728 and €7375, respectively, p value=0.08) in the UK. The point estimates for the ICERs found that stepwise provisional strategy was cost saving and improved outcomes with a probabilistic sensitivity analysis confirming dominance with an 80% probability. CONCLUSION The stepwise provisional strategy at 1 year is dominant compared with the systematic dual stenting strategy on both economic and clinical outcomes.
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Affiliation(s)
- Alicia Le Bras
- URCEco DRCI, Assistance Publique - Hopitaux de Paris, Paris, France
| | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | | | | | - Mohaned Egred
- Cardiology, Freeman Hospital, Newcastle upon Tyne, UK
| | | | | | | | - Isabelle Durand-Zaleski
- URCEco DRCI, Assistance Publique - Hopitaux de Paris, Paris, France
- University of Paris, Paris, France
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19
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Komaki S, Matsuura Y, Tanaka H, Moribayashi K, Yamamura Y, Kurogi K, Ideguchi T, Yamamoto N, Nakai M, Tsuruda T, Kaikita K. Nitroglycerin use and adverse clinical outcomes in elderly patients with acute coronary syndrome. Open Heart 2024; 11:e002494. [PMID: 38216173 PMCID: PMC10806511 DOI: 10.1136/openhrt-2023-002494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/27/2023] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVE The primary care for acute coronary syndrome (ACS) includes the administration of nitroglycerin (GTN). This study aimed to investigate the association between the use of GTN before percutaneous coronary intervention (PCI) for ACS and clinical outcomes. METHODS Nine-hundred and forty-seven patients who underwent PCI for ACS were examined and classified into two groups: those who were treated with GTN before PCI (GTN group) and those who were not (non-GTN group). The incidence of major adverse cardiovascular events (MACE), which consist of all-cause mortality, non-fatal myocardial infarction, stroke and rehospitalisation for heart failure at 1 year, was compared between the two groups. RESULTS This study identified 289 patients with ACS who used GTN preceding PCI. Pre-PCI systolic blood pressure was significantly lower in the GTN group than in the non-GTN group (median (IQR); 132.0 (110.0-143.5) mm Hg vs 134.0 (112.0-157.0) mm Hg, respectively, p=0.03). Multivariate Cox regression analysis indicated that GTN use preceding PCI showed an independent association with the incidence of MACE (HR 1.57; 95% CI 1.09-2.28; p=0.016). Overall, the incidence of MACE 1 year after PCI for ACS was significantly higher in the GTN group than in the non-GTN group (log-rank test, p=0.024); however, this trend was consistently found in elderly patients aged ≥75 years (p=0.002) but not in non-elderly patients aged <75 years (p=0.773). CONCLUSIONS GTN use preceding PCI for ACS is associated with lower blood pressure and adverse clinical outcomes in elderly patients.
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Affiliation(s)
- Soichi Komaki
- Division of Cardiovascular Medicine and Nephrology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
- Department of Cardiovascular Medicine, Miyazaki Prefectural Nobeoka Hospital, Nobeoka, Miyazaki, Japan
| | - Yunosuke Matsuura
- Division of Cardiovascular Medicine and Nephrology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Hiroki Tanaka
- Division of Cardiovascular Medicine and Nephrology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Kohei Moribayashi
- Division of Cardiovascular Medicine and Nephrology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Yoshimasa Yamamura
- Division of Cardiovascular Medicine and Nephrology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Kazumasa Kurogi
- Department of Cardiovascular Medicine, Miyazaki Prefectural Nobeoka Hospital, Nobeoka, Miyazaki, Japan
| | - Takeshi Ideguchi
- Division of Cardiovascular Medicine and Nephrology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Nobuyasu Yamamoto
- Department of Cardiovascular Medicine, Miyazaki Prefectural Nobeoka Hospital, Nobeoka, Miyazaki, Japan
| | - Michikazu Nakai
- Clinical Research Support Center, University of Miyazaki Hospital, Miyazaki, Japan
| | - Toshihiro Tsuruda
- Department of Hemo-Vascular Advanced Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Koichi Kaikita
- Division of Cardiovascular Medicine and Nephrology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
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20
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Feder JM, Sigal AR, Seoane LA, Rivero M, Perez G, Zaidel EJ, Procopio FG, Conde D, Costabel JP. Clinical predictors of coronary artery bypass graft surgery in patients hospitalized for Non-ST acute coronary syndrome - Buenos Aires I and ReSCAR22 registries. Arch Peru Cardiol Cir Cardiovasc 2024; 5:1-6. [PMID: 38596606 PMCID: PMC10999314 DOI: 10.47487/apcyccv.v5i1.333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 03/07/2024] [Indexed: 04/11/2024]
Abstract
Objectives To identify predictors of coronary artery bypass graft surgery (CABG) requirement as a revascularization method in in real-world non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients. Materials and methods . An individual pre-specified analysis of patients with NSTE-ACS was performed from two prospective Argentine registries between 2017 and 2022. We analyzed the difference in baseline characteristics between patients who required CABG and those who did not require this intervention. Then, a logistic regression analysis was performed to determine independent predictors in patients who received CABG as a method of revascularization. Results A total of 1848 patients with a median age of 54.8 (interquartile range [IQR]: 53.7-56) years and an ejection fraction of 42.1% (IQR: 41.2-43.1) were included. A total of 233 patients required CABG (12.6%). Baseline characteristics between the two groups were similar, except in patients requiring CABG, who were younger (51.5 vs. 55.7 years; p=0.010), more frequently diabetic (38.2% vs. 25.7%; p=0.001) and male (90.1% vs. 73.7%; p=0.001). In addition, they had, to a lesser extent, previous cardiac surgery (2.1% vs. 11.2%; p=0.011). After multivariable analysis, the following were independently associated with CABG: age (Odds Ratio [OR]: 0.99, 95% confidence interval [CI]: 0.98-0.99; p=0.008), male sex (OR: 3.08, 95% CI: 1.87-5.1; p=0.001), history of previous CABG (OR: 0.14, 95% CI: 0.05-0.30; p=0.001) and diabetes (OR: 1.84, 95% CI: 1.31- 2.57; p=0.001). Conclusions In this analysis of two NSTEACS registries, younger age, male sex, a diagnosis of diabetes and the absence of previous surgery were independent predictors of the requirement for inpatient CABG.
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Affiliation(s)
- Julián M. Feder
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina.Instituto Cardiovascular de Buenos AiresBuenos AiresArgentina
| | - Alan R. Sigal
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina.Instituto Cardiovascular de Buenos AiresBuenos AiresArgentina
| | - Leonardo A. Seoane
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina.Instituto Cardiovascular de Buenos AiresBuenos AiresArgentina
| | - Mirza Rivero
- CEMIC, Buenos Aires, Argentina.CEMICBuenos AiresArgentina
| | - Gonzalo Perez
- Clínica Olivos, Buenos Aires, Argentina. Clínica OlivosBuenos AiresArgentina
| | - Ezequiel J. Zaidel
- Sanatorio Güemes, Buenos Aires, Argentina.Sanatorio GüemesBuenos AiresArgentina
| | - Fabricio G. Procopio
- Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina.Hospital Universitario Fundación FavaloroBuenos AiresArgentina
| | - Diego Conde
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina.Instituto Cardiovascular de Buenos AiresBuenos AiresArgentina
| | - Juan P. Costabel
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina.Instituto Cardiovascular de Buenos AiresBuenos AiresArgentina
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21
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Antonovna BA, Sergeevich PD, Vitalievich AR, Albertovna VB, Konstantinovich TS. Comparison of Brain Activation According to fMRI Data in Patient with Depression (After Acute Coronary Syndrome and Somatically Healthy) and Healthy Volunteers. Iran J Psychiatry 2024; 19:11-20. [PMID: 38420280 PMCID: PMC10896755 DOI: 10.18502/ijps.v19i1.14335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/27/2023] [Accepted: 08/24/2023] [Indexed: 03/02/2024]
Abstract
Objective: The present study is devoted to the study of brain activation using fMRI in patients with depression (after acute coronary syndrome and somatically healthy) and in healthy volunteers. Method : The study enrolled a total of 51 patients: 11 with depression after acute coronary syndrome, 16 with primary depressive episode and recurrent depression without prior coronary event, and 24 with ACS without depression. The groups were matched by sex and age. The emotional information processing was evaluated with the Pennsylvania Test of Emotion Recognition. All patients underwent fMRI at the time of this test. The data processing was performed with SPM12 and xjView applications. Results: During the processing of emotional information in the depressed patients after ACS, specific activation zones in the frontal cortex (P < 0.001), right fusiform gyrus (P < 0.001), and right insular lobe were identified (P = 0.017). In the patients with primary depressive episode and recurrent depression without ACS, certain zones of activation were identified in frontal cortex (P < 0.001; 0.001), left fusiform gyrus (P < 0.001), occipital cortex (P < 0.001). In the patients who had ACS, without depression, some zones of activation were specified in the right middle occipital gyrus (P < 0.001), the right superior frontal gyrus (P = 0.088), and the putamen projection on the right (P < 0.001) and on the left (P = 0.009), as well as the left insular lobe (P = 0.015). Conclusion: The pathogenesis of depression is significantly associated with the peculiarities of processing emotionally significant information, regardless of the conditions under which it develops.
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Affiliation(s)
| | | | - Akhapkin Roman Vitalievich
- Research Institute of Psychiatry, Branch of the Serbsky State Scientific Center for Social and Forensic Psychiatry, Moscow, Russia
| | - Volel Beatrice Albertovna
- Department of Psychiatry and Psychososmatics, Sechenov University, Moscow, Russia
- FSBSI Mental Health Research Center, Moscow, Russia
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22
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Narváez Orozco A, Navarro Navajas A, Cardona Buitrago C, Senior-Sánchez JM, Ortiz Uribe JC, Delgado Restrepo JA. Coronary Artery Embolism and Myocardial Infarction, case report. Arch Peru Cardiol Cir Cardiovasc 2024; 5:45-49. [PMID: 38596603 PMCID: PMC10999311 DOI: 10.47487/apcyccv.v5i1.347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 02/25/2024] [Indexed: 04/11/2024]
Abstract
Coronary embolism (CE) is a rare cause of non-atherosclerotic acute coronary syndrome (ACS). The clinical presentation is similar to ACS, and the diagnosis is supported by Shibata criteria. Atrial fibrillation is the main reported etiology in CE cases. Management includes percutaneous intervention with thromboaspiration and anticoagulation. The following case is a description of a patient with acute chest pain and recently diagnosed atrial fibrillation (AF) with a rapid ventricular response, is described. A thrombotic lesion in the distal right coronary artery (RCA) of embolic origin, was documented. Successful mechanical thromboaspiration was performed; intravascular ultrasound (IVUS) showed no thrombus, dissection, or atherosclerotic plaque. CE is an underdiagnosed cause of ACS; diagnosis relies on Shibata criteria, and patients experience worse outcomes in follow-up.
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Affiliation(s)
- Alejandro Narváez Orozco
- Universidad de Antioquia, Hospital Universitario San Vicente Fundación, Antioquia, Colombia.Universidad de AntioquiaUniversidad de AntioquiaHospital Universitario San Vicente FundaciónAntioquiaColombia
| | - Alberto Navarro Navajas
- Universidad de Antioquia, Hospital Universitario San Vicente Fundación, Antioquia, Colombia.Universidad de AntioquiaUniversidad de AntioquiaHospital Universitario San Vicente FundaciónAntioquiaColombia
| | - Carolina Cardona Buitrago
- Universidad de Antioquia, Hospital Universitario San Vicente Fundación, Antioquia, Colombia.Universidad de AntioquiaUniversidad de AntioquiaHospital Universitario San Vicente FundaciónAntioquiaColombia
| | - Juan M. Senior-Sánchez
- Sección de Cardiología, Departamento de Medicina Interna, Grupo para el Estudio de las Enfermedades Cardiovasculares, Universidad de Antioquia. Antioquia, Colombia.Universidad de AntioquiaSección de Cardiología, Departamento de Medicina Interna, Grupo para el Estudio de las Enfermedades CardiovascularesUniversidad de AntioquiaAntioquiaColombia
- Servicio de Hemodinamia, Unidad Funcional Integrada Cardiopulmonar y Vascular Periférica, Hospital Universitario San Vicente Fundación, Antioquia, Colombia.Servicio de Hemodinamia, Unidad Funcional Integrada Cardiopulmonar y Vascular PeriféricaHospital Universitario San Vicente FundaciónAntioquiaColombia
| | - Juan Camilo Ortiz Uribe
- Sección de Cardiología, Departamento de Medicina Interna, Grupo para el Estudio de las Enfermedades Cardiovasculares, Universidad de Antioquia. Antioquia, Colombia.Universidad de AntioquiaSección de Cardiología, Departamento de Medicina Interna, Grupo para el Estudio de las Enfermedades CardiovascularesUniversidad de AntioquiaAntioquiaColombia
- Servicio de Hemodinamia, Unidad Funcional Integrada Cardiopulmonar y Vascular Periférica, Hospital Universitario San Vicente Fundación, Antioquia, Colombia.Servicio de Hemodinamia, Unidad Funcional Integrada Cardiopulmonar y Vascular PeriféricaHospital Universitario San Vicente FundaciónAntioquiaColombia
| | - Juan Andrés Delgado Restrepo
- Sección de Cardiología, Departamento de Medicina Interna, Grupo para el Estudio de las Enfermedades Cardiovasculares, Universidad de Antioquia. Antioquia, Colombia.Universidad de AntioquiaSección de Cardiología, Departamento de Medicina Interna, Grupo para el Estudio de las Enfermedades CardiovascularesUniversidad de AntioquiaAntioquiaColombia
- Servicio de Hemodinamia, Unidad Funcional Integrada Cardiopulmonar y Vascular Periférica, Hospital Universitario San Vicente Fundación, Antioquia, Colombia.Servicio de Hemodinamia, Unidad Funcional Integrada Cardiopulmonar y Vascular PeriféricaHospital Universitario San Vicente FundaciónAntioquiaColombia
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23
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Lawless M, Damluji A, Dirjayanto VJ, Mills G, Pompei G, Rubino F, Kunadian V. Differences in treatment and clinical outcomes in patients aged ≥75 years compared with those aged ≤74 years following acute coronary syndromes: a prospective multicentre study. Open Heart 2023; 10:e002418. [PMID: 38151262 PMCID: PMC10753737 DOI: 10.1136/openhrt-2023-002418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 12/08/2023] [Indexed: 12/29/2023] Open
Abstract
OBJECTIVE This study describes the differences in treatment and clinical outcomes in patients aged ≥75 years compared with those aged ≤74 years presenting with acute coronary syndrome (ACS) and undergoing invasive management. METHODS A large-scale cohort study of patients with ST-elevation/non-ST-elevation myocardial infarction (MI)/unstable angina underwent coronary angiography (January 2015-December 2019). Patients were classified as older (≥75 years) and younger (≤74 years). Regression analysis was used to yield adjusted risks of mortality for older versus younger patients (adjusted for history of heart failure, hypercholesterolaemia, peripheral vascular disease, chronic obstructive pulmonary disease, ischaemic heart disease, presence of ST-elevation MI on presenting ECG, female sex and cardiogenic shock at presentation). RESULTS In total, 11 763 patients were diagnosed with ACS, of which 39% were aged ≥75 years. Percutaneous coronary intervention was performed in fewer older patients than younger patients (81.2% vs 86.2%, p<0.001). At discharge, older patients were prescribed less secondary-prevention medications than younger patients. Median follow-up was 4.57 years. Older patients had a greater risk of in-hospital mortality than younger patients (adjusted OR (aOR) 2.12, 95% CI 1.62 to 2.78, p<0.001). Older patients diagnosed with ST-elevation MI had greater adjusted odds of dying in-hospital (aOR 2.47, 95% CI 1.79 to 3.41, p<0.001). Older age was not an independent prognostic factor of mortality at 1 year (adjusted HR (aHR) 0.95, 95% CI 0.82 to 1.09, p=0.460) and at longer term (aHR 0.98, 95% CI 0.87 to 1.10, p=0.684). CONCLUSIONS Older patients are discharged with less secondary prevention. Patients aged ≥75 years are more likely to die in-hospital than younger patients.
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Affiliation(s)
- Michael Lawless
- Newcastle University Translational and Clinical Research Institute, Newcastle upon Tyne, UK
| | - Abdulla Damluji
- Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | | | - Gregory Mills
- Newcastle University Translational and Clinical Research Institute, Newcastle upon Tyne, UK
| | - Graziella Pompei
- Newcastle University Translational and Clinical Research Institute, Newcastle upon Tyne, UK
| | - Francesca Rubino
- Newcastle University Translational and Clinical Research Institute, Newcastle upon Tyne, UK
| | - Vijay Kunadian
- Newcastle University Translational and Clinical Research Institute, Newcastle upon Tyne, UK
- Cardiothoracic Directorate, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
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McCaughey CJ, Murphy G, Jones J, Mirza KB, Hensey M. Safety and efficacy of e-cigarettes in those with atherosclerotic disease: a review. Open Heart 2023; 10:e002341. [PMID: 38065586 PMCID: PMC10711928 DOI: 10.1136/openhrt-2023-002341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 10/11/2023] [Indexed: 12/18/2023] Open
Abstract
Smoking cessation is the most effective intervention to reduce mortality in patients with established atherosclerotic cardiovascular disease (ASCVD), with 'e-cigarettes' becoming an increasingly used intervention to achieve smoking cessation. The current review aims to summarise the current evidence base for their efficacy and safety in the ASCVD cohort. A search of the PUBMED and MEDLINE databases using the terms 'e-cigarette', 'cessation', 'safety' and 'efficacy' since 2012 yielded 706 results. Both observational and experimental studies were included, while those with an unavailable full text, non-English or duplicates were excluded, yielding 78 relevant articles, with 13 subsequent additional articles included from a search of reference lists, for a total of 91 included papers. E-cigarette vapour contains many known pro-atherosclerotic substances and has been demonstrated to potentiate traditional atherosclerotic mechanisms. While e-cigarettes may be more effective in promoting smoking cessation in the general population over a medium term (>6 months), when compared with nicotine replacement therapy (NRT), few studies specifically examined those with ASCVD, despite the latter having a higher baseline quit rate (52% vs 2%). Most studies compare e-cigarettes with NRT alone and do not include pharmacotherapy, which may be more effective in the ASCVD cohort. The single randomised controlled trial addressing the research question favoured traditional methods. Those that successfully quit smoking using e-cigarettes are more likely to continue to use the intervention at 1 year (90% vs 9%). Conflicting advice exists regarding the utilisation of e-cigarettes for smoking cessation. E-cigarettes may be inferior to standard care for smoking cessation in those with ASCVD, and their use is likely to promote the key drivers of the atherosclerotic process already active in this cohort.
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Affiliation(s)
| | - Greg Murphy
- Cardiology, St James Hospital, Dublin, Ireland
| | - Jennifer Jones
- National Institute of Preventive Cardiology, National University of Ireland Galway, Galway, Ireland
| | | | - Mark Hensey
- Cardiology, St James Hospital, Dublin, Ireland
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Dang Q, Othman F, Sheahen B, Marschner S, Psaltis P, Al-Lamee RK, Szirt R, Chong J, Zaman S. Regional and temporal variations of spontaneous coronary artery dissection care according to consensus recommendations: a systematic review and meta-analysis. Open Heart 2023; 10:e002379. [PMID: 38056913 DOI: 10.1136/openhrt-2023-002379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 11/01/2023] [Indexed: 12/08/2023] Open
Abstract
AIM The first expert consensus documents on management of patients with spontaneous coronary artery dissection (SCAD) were published in 2018. Worldwide quality of care, as measured by adherence to these recommendations, has not been systematically reviewed. We aim to review the proportion of patients with SCAD receiving consensus recommendations globally, regionally and, determine differences in practice before and after 2018. METHODS AND RESULTS A systematic review was performed by searching four main databases (Medline, Embase, SCOPUS, CINAHL) from their inception to 16 June 2022. Studies were selected if they included patients with SCAD and reported at least one of the consensus document recommendations. 53 studies, n=8456 patients (mean 50.1 years, 90.6% female) were included. On random effects meta-analysis, 92.1% (95% CI 89.3 to 94.8) received at least one antiplatelet, 78.0% (CI 73.5 to 82.4) received beta-blockers, 58.7% (CI 52.3 to 65.1) received ACE inhibitors or aldosterone receptor blockers (ACEIs/ARBs), 54.4% (CI 45.4 to 63.5) were screened for fibromuscular dysplasia (FMD), and 70.2% (CI 60.8 to 79.5) were referred to cardiac rehabilitation. Except for cardiac rehabilitation referral and use of ACEIs/ARBs, there was significant heterogeneity in all other quality-of-care parameters, across geographical regions. No significant difference was observed in adherence to recommendations in studies published before and after 2018, except for lower cardiac rehabilitation referrals after 2018 (test of heterogeneity, p=0.012). CONCLUSION There are significant variations globally in the management of patients with SCAD, particularly in FMD screening. Raising awareness about consensus recommendations and further prospective evidence about their effect on outcomes may help improve the quality of care for these patients.
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Affiliation(s)
- Quan Dang
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead, New South Wales, Australia
| | - Farrah Othman
- The University of Western Australia, Perth, Western Australia, Australia
- Department of Cardiology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Brodie Sheahen
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead, New South Wales, Australia
| | - Simone Marschner
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead, New South Wales, Australia
| | - Peter Psaltis
- Vascular Research Centre, Lifelong Health Theme, South Australian Medical and Health Research Institute, Adelaide, South Australia, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | | | - Richard Szirt
- St George Hospital, Kogarah, New South Wales, Australia
| | - James Chong
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Sarah Zaman
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead, New South Wales, Australia
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
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D'Ascenzo F, De Filippo O. Novel risk score to predict ischaemic and bleeding risk after acute coronary syndrome: new tools for an upcoming new era? Heart 2023; 109:1805-1807. [PMID: 37591687 DOI: 10.1136/heartjnl-2023-323127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/19/2023] Open
Affiliation(s)
- Fabrizio D'Ascenzo
- Department of Medical Sciences, University of Turin, Turin, Italy
- Division of Cardiology, Cardiovascular and Thoracic Department, Citta della Salute e della Scienza" Hospital, Turin, Italy
| | - Ovidio De Filippo
- Division of Cardiology, Cardiovascular and Thoracic Department, Citta della Salute e della Scienza" Hospital, Turin, Italy
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Kerr AJ, Choi Y, Williams MJ, Stewart RA, White HD, Devlin G, Selak V, Lee MAW, El-Jack S, Adamson PD, Fairley S, Jackson RT, Poppe K. Paired risk scores to predict ischaemic and bleeding risk twenty-eight days to one year after an acute coronary syndrome. Heart 2023; 109:1827-1836. [PMID: 37558394 DOI: 10.1136/heartjnl-2023-322830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 07/03/2023] [Indexed: 08/11/2023] Open
Abstract
OBJECTIVE The recommended duration of dual anti-platelet therapy (DAPT) following acute coronary syndrome (ACS) varies from 1 month to 1 year depending on the balance of risks of ischaemia and major bleeding. We designed paired ischaemic and major bleeding risk scores to inform this decision. METHODS New Zealand (NZ) patients with ACS investigated with coronary angiography are recorded in the All NZ ACS Quality Improvement registry and linked to national health datasets. Patients were aged 18-84 years (2012-2020), event free at 28 days postdischarge and without atrial fibrillation. Two 28-day to 1-year postdischarge multivariable risk prediction scores were developed: (1) cardiovascular mortality/rehospitalisation with myocardial infarction or ischaemic stroke (ischaemic score) and (2) bleeding mortality/rehospitalisation with bleeding (bleeding score). FINDINGS In 27 755 patients, there were 1200 (4.3%) ischaemic and 548 (2.0%) major bleeding events. Both scores were well calibrated with moderate discrimination performance (Harrell's c-statistic 0.75 (95% CI, 0.74 to 0.77) and 0.69 (95% CI, 0.67 to 0 .71), respectively). Applying these scores to the 2020 European Society of Cardiology ACS antithrombotic treatment algorithm, the 31% of the cohort at elevated (>2%) bleeding and ischaemic risk would be considered for an abbreviated DAPT duration. For those at low bleeding risk, but elevated ischaemic risk (37% of the cohort), prolonged DAPT may be appropriate, and for those with low bleeding and ischaemic risk (29% of the cohort) short duration DAPT may be justified. CONCLUSION We present a pair of ischaemic and bleeding risk scores specifically to assist clinicians and their patients in deciding on DAPT duration beyond the first month post-ACS.
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Affiliation(s)
- Andrew J Kerr
- Department of Medicine, The University of Auckland, Auckland, New Zealand
- Cardiology Department, Middlemore Hospital, Auckland, New Zealand
- Epidemiology and Biostatistics, The University of Auckland, Auckland, New Zealand
| | - Yeunhyang Choi
- Epidemiology and Biostatistics, The University of Auckland, Auckland, New Zealand
| | | | - Ralph Ah Stewart
- Cardiology Department, Greenlane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - Harvey D White
- Cardiology Department, Greenlane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | | | - Vanessa Selak
- Epidemiology and Biostatistics, The University of Auckland, Auckland, New Zealand
| | | | | | - Philip D Adamson
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | - Sarah Fairley
- Cardiology Department, Wellington Hospital, Wellington, New Zealand
| | - Rodney T Jackson
- Epidemiology and Biostatistics, The University of Auckland, Auckland, New Zealand
| | - Katrina Poppe
- Epidemiology and Biostatistics, The University of Auckland, Auckland, New Zealand
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González-Jasso JG, Montero-Pola YL, Toledo-Salinas O, Schlie-Villa W, Muñóz-López A, García-Hernández E. [Takotsubo cardiomyopathy associated with abnormal birth of the coronary arteries]. Rev Med Inst Mex Seguro Soc 2023; 61:882-887. [PMID: 37995560 PMCID: PMC10727765 DOI: 10.5281/zenodo.10064743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/03/2023] [Indexed: 11/25/2023]
Abstract
Background Takotsubo cardiomyopathy (TM) is a form of non-ischemic cardiomyopathy. It is characterized by transient regional systolic dysfunction of the left ventricle that mimics acute myocardial infarction. The main objective of this article is to report the case of a patient with TM associated with abnormal birth of the left coronary trunk. Clinical case A 76-year-old woman with typical angina at rest, with an electrocardiogram that showed dynamic changes in the T wave and elevation of biomarkers. Coronary angiography showed epicardial coronary arteries without significant lesions and abnormal birth of the left coronary trunk from the proximal segment of the right coronary artery. The patient progressed favorably, and the transthoracic echocardiogram showed no mobility disorders 3 months after the event. Conclusions TM and abnormal birth of the coronary arteries are rare diseases whose simultaneous presentation is extraordinary. The diagnosis of both clinical entities is made by coronary angiography and echocardiogram, and their treatment is similar to that of patients with acute coronary syndrome. Abnormal birth of the left coronary trunk with retroaortic switch reaching the contralateral site has a good clinical prognosis and echocardiographic follow-up should be performed 4 weeks after the onset of the condition.
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Affiliation(s)
- Jesús Guadalupe González-Jasso
- Instituto Mexicano del Seguro Social, Centro Médico Nacional “La Raza”, Hospital de Especialidades “Dr. Antonio Fraga Mouret”, Servicio de Cardiología. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Yuyi Lizeth Montero-Pola
- Instituto Mexicano del Seguro Social, Centro Médico Nacional “La Raza”, Hospital de Especialidades “Dr. Antonio Fraga Mouret”, Unidad de Cuidados Coronarios. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Otoniel Toledo-Salinas
- Instituto Mexicano del Seguro Social, Centro Médico Nacional “La Raza”, Hospital de Especialidades “Dr. Antonio Fraga Mouret”, Unidad de Cuidados Intensivos. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Werner Schlie-Villa
- Instituto Mexicano del Seguro Social, Centro Médico Nacional “La Raza”, Hospital de Especialidades “Dr. Antonio Fraga Mouret”, Servicio de Cardiología. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Alexander Muñóz-López
- Instituto Mexicano del Seguro Social, Centro Médico Nacional “La Raza”, Hospital de Especialidades “Dr. Antonio Fraga Mouret”, Servicio de Cardiología. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Ernesto García-Hernández
- Instituto Mexicano del Seguro Social, Centro Médico Nacional “La Raza”, Hospital de Especialidades “Dr. Antonio Fraga Mouret”, Unidad de Cuidados Coronarios. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
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Inoue A, Mizobe M, Takahashi J, Funakoshi H. Factors for delays in door-to-balloon time ≤ 90 min in an electrocardiogram triage system among patients with ST-segment elevation myocardial infarction: a retrospective study. Int J Emerg Med 2023; 16:77. [PMID: 37919686 PMCID: PMC10621087 DOI: 10.1186/s12245-023-00562-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/26/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Door to balloon time is a crucial factor of mortality in patients with ST-segment elevation myocardial infarction. However, the factors that contribute to failure of achieving door to balloon time ≤ 90 min in an electrocardiogram triage system remain unknown. METHODS This single-center retrospective observational study collected data from consecutive patients with ST-segment elevation myocardial infarction from April 2016 to March 2021. The primary outcome was the failure to achieve door to balloon time ≤ 90 min. A multivariate logistic regression model was performed to predict factors associated with failure to achieve door to balloon time ≤ 90 min. RESULTS In total, 190 eligible patients were included. Of these, the 139 (73.2%) patients with door to balloon time ≤ 90 min were significantly younger compared to those with door to balloon time > 90 min (p = 0.02). However, there was no significant difference in sex and timing of hospital arrival between the door to balloon time ≤ 90 and > 90 min groups. Presence of chest pain and ambulance usage were significantly more frequent in patients with door to balloon time ≤ 90 min (p ≤ 0.01, p = 0.02, respectively). Multivariate analysis showed that absence of chest pain (adjusted odds ratio 4.76; 95% confidence interval, 2.04-11.1; p < 0.01) and non-ambulance usage (adjusted odds ratio 3.53; 95% confidence interval, 1.57-7.94; p < 0.01) are predictive factors of failure to achieve door to balloon time ≤ 90 min. CONCLUSION Patients without chest pain as the chief complaint or non-ambulance usage were significantly associated with the failure to achieve door to balloon time ≤ 90 min.
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Affiliation(s)
- Atsuhito Inoue
- Department of Emergency and Critical Care Medicine, Tokyobay Urayasu Ichikawa Medical Center, 3-4-32 Todaijima, Urayasu, Chiba, 279-0001, Japan.
| | - Michiko Mizobe
- Department of Emergency and Critical Care Medicine, Tokyobay Urayasu Ichikawa Medical Center, 3-4-32 Todaijima, Urayasu, Chiba, 279-0001, Japan
| | - Jin Takahashi
- Department of Emergency and Critical Care Medicine, Tokyobay Urayasu Ichikawa Medical Center, 3-4-32 Todaijima, Urayasu, Chiba, 279-0001, Japan
| | - Hiraku Funakoshi
- Department of Emergency and Critical Care Medicine, Tokyobay Urayasu Ichikawa Medical Center, 3-4-32 Todaijima, Urayasu, Chiba, 279-0001, Japan
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30
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Lopez J, Mark J, Duarte GJ, Shaban M, Sosa F, Mishra R, Jain S, Tran A, Khizar A, Karpel D, Acosta G, Rodriguez-Guerra M. Role of genetic polymorphisms in clopidogrel response variability: a systematic review. Open Heart 2023; 10:e002436. [PMID: 37963685 PMCID: PMC10649851 DOI: 10.1136/openhrt-2023-002436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/31/2023] [Indexed: 11/16/2023] Open
Abstract
INTRODUCTION Clopidogrel is a P2Y12 inhibitor that has become a mainstay treatment following percutaneous intervention with drug-eluting stent placement to decrease restenosis and its potential complications, including sudden cardiac death and ischaemic strokes in patients with significant vascular disease. AREAS COVERED As a prodrug, the metabolism and efficacy of clopidogrel are contingent on the presence of wild-type CYP450 (CYP2C19) alleles. Genetic polymorphisms and variants are well known to impair its ability to prevent major adverse cardiovascular events in these patients, with inadequate response rates as high as 30% in previous publications. Patterns of allelic frequencies are expected to exhibit similarities between individuals of the same ancestry, ethnic group or geographic region. Accordingly, we seek to further elucidate worldwide prevalence rates for genetic polymorphisms in the CYP2C19-dependent metabolism of clopidogrel and review the potential of personalised CYP2C19 genotyping in clinical practice to mitigate this high treatment resistance and its associated burden on patients. EXPERTS' COMMENTARY Our findings support the consideration of genotyping before initiation of therapy to guide adequate dosage or substitutions of other P2Y12 inhibitors to promote personalised, precision medicine and to prevent adverse events when these therapies may inevitably fail in patients with variants of the CYP450 (CYP2C19) system.
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Affiliation(s)
- Jose Lopez
- Division of Cardiovascular Disease, University of Miami Miller School of Medicine, Lantana, Florida, USA
| | - Justin Mark
- Department of Internal Medicine, University of Miami Miller School of Medicine, Fort Lauderdale, Florida, USA
| | - Gustavo J Duarte
- Division of Cardiology, Cleveland Clinic Florida, Weston, Florida, USA
| | - Mohammed Shaban
- Department of Internal Medicine, BronxCare Health System, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Franklin Sosa
- Department of Internal Medicine, BronxCare Health System, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rishabh Mishra
- Department of Internal Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Swati Jain
- Department of Internal Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York, USA
| | - An Tran
- Department of Internal Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Asma Khizar
- Department of Internal Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Daniel Karpel
- Department of Internal Medicine, HCA Florida Aventura Hospital and Medical Center, Aventura, Florida, USA
| | - Giancarlo Acosta
- Division of Cardiology, Georgia Heart Institute, Gainesville, Florida, USA
| | - Miguel Rodriguez-Guerra
- Department of Internal Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York, USA
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Zaka A, Mridha N, Subhaharan D, Jones M, Niranjan S, Mohsen W, Ramaswamy PK. Inflammatory bowel disease patients have an increased risk of acute coronary syndrome: a systematic review and meta-analysis. Open Heart 2023; 10:e002483. [PMID: 37940332 PMCID: PMC10632902 DOI: 10.1136/openhrt-2023-002483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/03/2023] [Indexed: 11/10/2023] Open
Abstract
OBJECTIVES Systemic inflammation is increasingly being recognised as a possible mechanism for acute arterial thrombotic events, including acute coronary syndrome (ACS). Despite this, there is conflicting data on the risk of ACS in patients with inflammatory bowel disease (IBD). We performed a contemporary systematic review and meta-analysis to identify the risk of ACS in patients with IBD. METHODS PubMed, MEDLINE, EMBASE, CENTRAL and Web of Science were searched up to 27 October 2022. Multivariable-adjusted or propensity matched studies with a non-IBD control cohort were included. HRs were pooled using a random-effects model. Subgroup and sensitivity analyses were conducted in order to explore sources of heterogeneity. RESULTS Twelve retrospective cohort studies were included (225 248 IBD patients). Patients with IBD were associated with an increased risk of ACS in both adjusted (HR 1.23; 95% CI 1.08 to 1.41) and unadjusted analyses (HR 1.50; 95% CI 1.16 to 1.92). Substantial heterogeneity was observed (i2=88, p=0.002 and i2=98%, p=0.002, respectively). Subgroup analysis of age revealed a greater association of ACS in IBD patients <40 years of age (relative HR 1.50; 95 CI 1.15 to 1.96). CONCLUSION Patients with IBD demonstrated an independently increased risk of ACS. Prospective studies are required to explore the relationship with disease activity and duration, concomitant medication use and angiographic characteristics and outcomes. PROSPERO REGISTRATION NUMBER CRD42022367846.
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Affiliation(s)
- Ammar Zaka
- Department of Cardiology, Gold Coast University Hospital, Southport, Queensland, Australia
- Faculty of Medicine, Griffith University, Nathan, Queensland, Australia
| | - Naim Mridha
- Department of Cardiology, The Prince Charles Hospital, Chermside, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Deloshaan Subhaharan
- Department of Digestive Health, Gold Coast University Hospital, Southport, Queensland, Australia
- Bond University, Robina, Queensland, Australia
| | - Mark Jones
- Bond University, Robina, Queensland, Australia
| | - Selvanayagam Niranjan
- Department of Cardiology, Gold Coast University Hospital, Southport, Queensland, Australia
- Bond University, Robina, Queensland, Australia
| | - Waled Mohsen
- Department of Digestive Health, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Pradeep K Ramaswamy
- Department of Digestive Health, Gold Coast University Hospital, Southport, Queensland, Australia
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32
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Choudry FA, Jones DA, Archbold RA. Hospitalisation due to acute cardiovascular conditions: is screening for recreational drug use justified? Heart 2023; 109:1582-1583. [PMID: 37582634 DOI: 10.1136/heartjnl-2023-322808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/17/2023] Open
Affiliation(s)
- Fizzah A Choudry
- General & Invasive Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK
- Centre for Cardiovascular Medicine and Devices, Queen Mary University of London, London, UK
| | - Daniel A Jones
- General & Invasive Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK
- Centre for Cardiovascular Medicine and Devices, Queen Mary University of London, London, UK
| | - R Andrew Archbold
- General & Invasive Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK
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Carreras-Mora J, Simón-Ramón C, Vidal-Burdeus M, Rodríguez-Sotelo L, Sionis A, Giralt-Borrell T, Izquierdo-Marquisá A, Rodríguez-González C, Farré N, Cainzos-Achirica M, Tizón-Marcos H, Garcia-Picart J, Milà-Pascual L, Vaquerizo B, Rivas-Lasarte M, Ribas-Barquet N. Subclinical congestion assessed by lung ultrasound in ST segment elevation myocardial infarction. Heart 2023; 109:1602-1607. [PMID: 37268410 DOI: 10.1136/heartjnl-2023-322690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 05/17/2023] [Indexed: 06/04/2023] Open
Abstract
OBJECTIVE We evaluated the prognostic value of subclinical congestion assessed by lung ultrasound (LUS) in patients admitted for ST segment elevation myocardial infarction (STEMI). METHODS This was a multicentre study that prospectively enrolled 312 patients admitted for STEMI without signs of heart failure (HF) at admission. LUS was performed during the first 24 hours after revascularisation and classified patients as having either wet lung (three or more B-lines in at least one lung field) or dry lung. The primary endpoint was a composite of acute HF, cardiogenic shock or death during hospitalisation. The secondary endpoint was a composite of readmission for HF or new acute coronary syndrome or death during 30-day follow-up. Zwolle score was calculated in all patients to assess predictive improvement by adding the result of the LUS to this score. RESULTS 14 patients (31.1%) in the wet lung group presented the primary endpoint vs 7 (2.6%) in the dry lung group (adjusted RR 6.0, 95% CI 2.3 to 16.2, p=0.007). The secondary endpoint occurred in five patients (11.6%) in the wet lung group and in three (1.2%) in the dry lung group (adjusted HR 5.4, 95% CI 1.0 to 28.7, p=0.049). Addition of LUS improved the ability of the Zwolle score to predict the follow-up composite endpoint (net reclassification improvement 0.99). LUS showed a very high negative predictive value in predicting in-hospital and follow-up endpoints (97.4% and 98.9%, respectively). CONCLUSION Early subclinical pulmonary congestion identified by LUS in patients with Killip I STEMI at hospital admission is associated with adverse outcomes during hospitalisation and 30-day follow-up.
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Affiliation(s)
- José Carreras-Mora
- Department of Cardiology, Hospital del Mar, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Clara Simón-Ramón
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - María Vidal-Burdeus
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Alessandro Sionis
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- IIB-Sant Pau, Barcelona, Spain
| | - Teresa Giralt-Borrell
- Department of Cardiology, Hospital del Mar, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | | | | | - Núria Farré
- Department of Cardiology, Hospital del Mar, Barcelona, Spain
- Heart Diseases Biomedical Research Group, Institut Hospital del Mar d'Investigacions Mediques (IMIM), Barcelona, Spain
| | - Miguel Cainzos-Achirica
- Department of Cardiology, Hospital del Mar, Barcelona, Spain
- Heart Diseases Biomedical Research Group, Institut Hospital del Mar d'Investigacions Mediques (IMIM), Barcelona, Spain
| | - Helena Tizón-Marcos
- Department of Cardiology, Hospital del Mar, Barcelona, Spain
- CIBERCV, Madrid, Spain
| | - Joan Garcia-Picart
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Laia Milà-Pascual
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Beatriz Vaquerizo
- Department of Cardiology, Hospital del Mar, Barcelona, Spain
- Heart Diseases Biomedical Research Group, Institut Hospital del Mar d'Investigacions Mediques (IMIM), Barcelona, Spain
| | - Mercedes Rivas-Lasarte
- CIBERCV, Madrid, Spain
- Advanced Heart Failure and Cardiac Transplantation Unit, Puerta de Hierro University Hospital of Majadahonda, Madrid, Spain
| | - Núria Ribas-Barquet
- Department of Cardiology, Hospital del Mar, Barcelona, Spain
- Heart Diseases Biomedical Research Group, Institut Hospital del Mar d'Investigacions Mediques (IMIM), Barcelona, Spain
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Kusunose K, Toma Y. Value and challenges of lung ultrasound in stratifying ST-elevation myocardial infarction risk. Heart 2023; 109:1580-1581. [PMID: 37423741 DOI: 10.1136/heartjnl-2023-322949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Affiliation(s)
- Kenya Kusunose
- Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Nakagami-gun, Japan
| | - Yuichiro Toma
- Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Nakagami-gun, Japan
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Esparham A, Shoar S, Mehri A, Modukuru VR. Bariatric Surgery and Cardiovascular Disease Risk in Patients with Pulmonary Hypertension: A Propensity Score Matched Analysis of US National Inpatient Sample. Obes Surg 2023; 33:3230-3236. [PMID: 37639208 DOI: 10.1007/s11695-023-06799-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 08/29/2023]
Abstract
PURPOSE Previous research has suggested the ameliorating effect of bariatric surgery (BaS) on patients with pulmonary hypertension (PH), but there is a lack of data on the effect of bariatric surgery on the odds of cardiovascular diseases in PH patients. The current study aims to evaluate the association of BaS and coronary artery diseases (CAD), heart failure with reduced ejection fraction (HFrEF), heart failure with preserved ejection fraction (HFpEF), cardiac valve diseases, cardiac rhythm disorders, acute pulmonary embolism, and in-hospital mortality in patients with PH. METHODS The national inpatient sample (NIS) data from 2016 to 2019 were analyzed by using ICD-10 codes. A propensity score matching in a 3:1 ratio was performed to match the BaS and non-BaS groups. RESULTS A total of 3605 patients with a history of BaS and 501419 patients without a history of BaS were included. After propensity matching, BaS was independently associated with a lower CAD hospital admission and a lower rate of in-hospital mortality. On the contrary, BaS was associated with a higher prevalence of atrial fibrillation (AF) and acute pulmonary embolism in patients with PH. HFpEF, HFrEF, other cardiac rhythm disorders, complete heart block, cardiac valve diseases, and ischemic stroke were not significantly different between the two groups in patients with PH. CONCLUSION BaS is independently associated with a reduced rate of in-hospital mortality and CAD hospital admission in patients with PH. However, the risk of atrial fibrillation and acute pulmonary embolism was higher in these patients.
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Affiliation(s)
- Ali Esparham
- Student Research Committee, College of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Saeed Shoar
- Department of Clinical Research, ScientificWriting Corp, Houston, TX, USA
| | - Ali Mehri
- Endoscopic and Minimally Invasive Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Venkat R Modukuru
- Bariatric and Metabolic Surgery Program, Newark Beth Israel Medical Center, RWJ Barnabas Health, Rutgers NJ Medical School, Newark, NJ, USA
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Sandoval Y. Type 2 myocardial infarction: the need to operationalise diagnostic criteria and shift towards clinical trials. Heart 2023; 109:1504-1505. [PMID: 37399290 DOI: 10.1136/heartjnl-2023-322838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2023] Open
Affiliation(s)
- Yader Sandoval
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
- Center for Coronary Artery Disease, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
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Tindale A, Panoulas V. The BE-ALIVE score: assessing 30-day mortality risk in patients presenting with acute coronary syndromes. Open Heart 2023; 10:e002313. [PMID: 37634901 PMCID: PMC10462941 DOI: 10.1136/openhrt-2023-002313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/27/2023] [Indexed: 08/29/2023] Open
Abstract
AIM To create and validate a simple scoring system for predicting 30-day mortality in patients presenting with acute coronary syndromes (ACS) at their moment of admission. METHODS AND RESULTS 2407 consecutive patients presenting to Harefield Hospital with measured arterial blood gases, from January 2011 to December 2020, were studied to build the training set. 30-day mortality in this group was 17.2%. A scoring algorithm that was built using binary logistic regression of variables available on admission was then converted to an additive risk score. The resultant scoring system is the BE-ALIVE score, which incorporates the following factors:Base Excess (1 point for <-2 mmol/L), Age (<65 years: 0 points, 65-74: 1 point, 75-84: 2 points, ≥85: 3 points), Lactate (<2 mmol/L: 0 points, 2-4.9: 1 point, 5-9.9: 3 points, ≥10: 6 points), Intubated (2 points), Left Ventricular function (mildly impaired or better: -1 point, moderately impaired: 1 point, severely impaired: 3 points) and External/out of hospital cardiac arrest 2 points).The scoring system was validated using a testing set of 515 patients presenting to Harefield Hospital in 2021. The validation metrics were excellent with a c-statistic of 0.9, Brier's score 0.06 vs a naïve classifier of 0.15, Spiegelhalter's z-statistic probability of 0.267 and a calibration slope of 1.08. CONCLUSION The BE-ALIVE score is a simple and accurate scoring system to predict 30-day mortality in patients presenting with ACS. Appreciating this mortality risk can allow prompt involvement of appropriate care such as the shock team.
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Affiliation(s)
- Alexander Tindale
- National Heart and Lung Institute, Imperial College London, London, UK
- Department of Cardiology, Harefield Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Vasileios Panoulas
- National Heart and Lung Institute, Imperial College London, London, UK
- Department of Cardiology, Harefield Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
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van der Sangen NMR, Azzahhafi J, Chan Pin Yin DRPP, Rayhi S, van Weede VM, Walhout RJ, Tjon Joe Gin M, Pisters R, Nicastia DM, Langerveld J, Vlachojannis GJ, van Bommel RJ, Appelman Y, Henriques JPS, Ten Berg J, Kikkert W. Impact of recurrent ischaemic and bleeding events on quality of life in patients with acute coronary syndrome: Insights from the FORCE-ACS registry. Open Heart 2023; 10:e002405. [PMID: 37527905 PMCID: PMC10394548 DOI: 10.1136/openhrt-2023-002405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 07/17/2023] [Indexed: 08/03/2023] Open
Abstract
OBJECTIVE Patients with acute coronary syndrome (ACS) remain at high risk for recurrent ischaemic and bleeding events during follow-up. Our study aimed to quantify and compare the impact of these adverse events on quality of life (QoL). METHODS Data from patients with ACS prospectively enrolled in the FORCE-ACS registry between January 2015 and December 2019 were used for this study. The primary ischaemic and bleeding events of interest were hospital readmission for ACS and Bleeding Academic Research Consortium type 2 or 3 bleeding during 12 months follow-up. QoL was measured using the EQ-5D Visual Analogue Scale (VAS) score and the 12-item Short Form Survey version 2 derived Physical Component Summary (PCS) and Mental Health Component Summary (MCS) scores at 12 months follow-up. RESULTS In total, 3339 patients (mean age 66.8 years, 27.9% women) were included. During follow-up, ischaemic events occurred in 202 patients (6.0%) and bleeding events in 565 patients (16.9%). After adjustment for demographic and clinical characteristics, ischaemic events remained independently associated with lower QoL regardless of metric used. Bleeding was also independently associated with lower EQ-5D VAS and PCS scores, but not with a lower MCS score. The QoL decrement associated with ischaemic events was numerically larger than the decrement associated with bleeding. CONCLUSIONS Ischaemic and bleeding events remain prevalent and are independently associated with lower QoL at 12 months follow-up in patients previously admitted for ACS. The incidence and impact of these adverse events should be considered when balancing individual ischaemic and bleeding risks.
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Affiliation(s)
- Niels M R van der Sangen
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Jaouad Azzahhafi
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Senna Rayhi
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Victoria M van Weede
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Ronald J Walhout
- Department of Cardiology, Hospital Gelderse Vallei, Ede, The Netherlands
| | | | - Ron Pisters
- Department of Cardiology, Rijnstate Hospital, Arnhem, The Netherlands
| | | | - Jorina Langerveld
- Department of Cardiology, Rivierenland Hospital, Tiel, The Netherlands
| | | | | | - Yolande Appelman
- Department of Cardiology, Amsterdam UMC, VU University, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - José P S Henriques
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Jurriën Ten Berg
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
- Department of Cardiology, Maastricht UMC+, Maastricht, The Netherlands
| | - Wouter Kikkert
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
- Department of Cardiology, Tergooi MC, Hilversum, The Netherlands
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Barbosa MF, Canan A, Xi Y, Litt H, Diercks DB, Abbara S, Kay FU. Comparative Effectiveness of Coronary CT Angiography and Standard of Care for Evaluating Acute Chest Pain: A Living Systematic Review and Meta-Analysis. Radiol Cardiothorac Imaging 2023; 5:e230022. [PMID: 37693194 PMCID: PMC10483255 DOI: 10.1148/ryct.230022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 06/26/2023] [Accepted: 07/03/2023] [Indexed: 09/12/2023]
Abstract
Purpose To perform a living systematic review and meta-analysis of randomized controlled trials comparing the effectiveness of coronary CT angiography (CCTA) and standard of care (SOC) in the evaluation of acute chest pain (ACP). Materials and Methods Multiple electronic databases were systematically searched, with the most recent search conducted on October 31, 2022. Studies were stratified into two groups according to the pretest probability for acute coronary syndrome (group 1 with predominantly low-to-intermediate risk vs group 2 with high risk). A meta-regression analysis was also conducted using participant risk, type of SOC used, and the use or nonuse of high-sensitivity troponins as independent variables. Results The final analysis included 22 randomized controlled trials (9379 total participants; 4956 assigned to CCTA arms and 4423 to SOC arms). There was a 14% reduction in the length of stay and a 17% reduction in immediate costs for the CCTA arm compared with the SOC arm. In group 1, the length of stay was 17% shorter and costs were 21% lower using CCTA. There was no evidence of differences in referrals to invasive coronary angiography, myocardial infarction, mortality, rate of hospitalization, further stress testing, or readmissions between CCTA and SOC arms. There were more revascularizations (relative risk, 1.45) and medication changes (relative risk, 1.33) in participants with low-to-intermediate acute coronary syndrome risk and increased radiation exposure in high-risk participants (mean difference, 7.24 mSv) in the CCTA arm compared with the SOC arm. The meta-regression analysis found significant differences between CCTA and SOC arms for rate of hospitalization, further stress testing, and medication changes depending on the type of SOC (P < .05). Conclusion The results support the use of CCTA as a safe, rapid, and less expensive in the short term strategy to exclude acute coronary syndrome in low- to intermediate-risk patients presenting with acute chest pain.Keywords: Acute Coronary Syndrome, Chest Pain, Emergency Department, Coronary Computed Tomography, Usual Care Supplemental material is available for this article. Published under a CC BY 4.0 license.
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Affiliation(s)
- Maurício F. Barbosa
- From the Department of Radiology, Cardiothoracic Division (M.F.B.,
A.C., S.A., F.U.K.), Department of Radiology (Y.X.), and Department of Emergency
Medicine (D.B.D.), UT Southwestern Medical Center at Dallas, 5323 Harry Hines
Blvd, Dallas, TX 75390; and Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (H.L.)
| | - Arzu Canan
- From the Department of Radiology, Cardiothoracic Division (M.F.B.,
A.C., S.A., F.U.K.), Department of Radiology (Y.X.), and Department of Emergency
Medicine (D.B.D.), UT Southwestern Medical Center at Dallas, 5323 Harry Hines
Blvd, Dallas, TX 75390; and Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (H.L.)
| | - Yin Xi
- From the Department of Radiology, Cardiothoracic Division (M.F.B.,
A.C., S.A., F.U.K.), Department of Radiology (Y.X.), and Department of Emergency
Medicine (D.B.D.), UT Southwestern Medical Center at Dallas, 5323 Harry Hines
Blvd, Dallas, TX 75390; and Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (H.L.)
| | - Harold Litt
- From the Department of Radiology, Cardiothoracic Division (M.F.B.,
A.C., S.A., F.U.K.), Department of Radiology (Y.X.), and Department of Emergency
Medicine (D.B.D.), UT Southwestern Medical Center at Dallas, 5323 Harry Hines
Blvd, Dallas, TX 75390; and Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (H.L.)
| | - Deborah B. Diercks
- From the Department of Radiology, Cardiothoracic Division (M.F.B.,
A.C., S.A., F.U.K.), Department of Radiology (Y.X.), and Department of Emergency
Medicine (D.B.D.), UT Southwestern Medical Center at Dallas, 5323 Harry Hines
Blvd, Dallas, TX 75390; and Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (H.L.)
| | - Suhny Abbara
- From the Department of Radiology, Cardiothoracic Division (M.F.B.,
A.C., S.A., F.U.K.), Department of Radiology (Y.X.), and Department of Emergency
Medicine (D.B.D.), UT Southwestern Medical Center at Dallas, 5323 Harry Hines
Blvd, Dallas, TX 75390; and Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (H.L.)
| | - Fernando U. Kay
- From the Department of Radiology, Cardiothoracic Division (M.F.B.,
A.C., S.A., F.U.K.), Department of Radiology (Y.X.), and Department of Emergency
Medicine (D.B.D.), UT Southwestern Medical Center at Dallas, 5323 Harry Hines
Blvd, Dallas, TX 75390; and Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (H.L.)
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Noaman S, Kaye DM, Nanayakkara S, Dart AM, Yong ASC, Ng M, Vizi D, Duffy SJ, Cox N, Chan W. Haemodynamic and metabolic adaptations in coronary microvascular disease. Heart 2023; 109:1166-1174. [PMID: 36931716 DOI: 10.1136/heartjnl-2022-322156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 03/06/2023] [Indexed: 03/19/2023] Open
Abstract
OBJECTIVE We aimed to evaluate the microcirculatory resistance (MR) and myocardial metabolic adaptations at rest and in response to increased cardiac workload in patients with suspected coronary microvascular dysfunction (CMD). METHODS Patients with objective ischaemia and/or myocardial injury and non-obstructive coronary artery disease underwent thermodilution-derived microcirculatory assessment and transcardiac blood sampling during graded exercise with adenosine-mediated hyperaemia. We measured MR at rest and following supine cycle ergometry. Patients (n=24) were stratified by the resting index of MR (IMR) into normal-IMR (IMR<22U, n=12) and high-IMR groups (IMR≥22U, n=12). RESULTS The mean age was 57 years; 67% were males and 38% had hypertension. The normal-IMR group had increased IMR response to exercise (16±5 vs 23±12U, p=0.03) compared with the high-IMR group, who had persistently elevated IMR at rest and following exercise (38±19 vs 33±15U, p=0.39) despite similar exercise duration and rate-pressure product between the groups, both p>0.05. The normal-IMR group had augmented oxygen extraction ratio following exercise (53±18 vs 64±11%, p=0.03) compared with the high-IMR group (65±14 vs 59±11%, p=0.26). The postexercise lactate uptake was greater in the high-IMR (0.04±0.05 vs 0.11±0.07 mmol/L, p=0.004) compared with normal-IMR group (0.08±0.06 vs 0.09±0.09 mmol/L, p=0.67). The high-IMR group demonstrated greater troponin release following exercise compared with the normal-IMR group (0.13±0.12 vs 0.001±0.05 ng/L, p=0.03). CONCLUSIONS Patients with suspected CMD appear to have distinctive microcirculatory resistive and myocardial metabolic profiles at rest and in response to exercise. These differences in phenotypes may permit individualised therapies targeting microvascular responsiveness (normal-IMR group) and/or myocardial metabolic adaptations (normal-IMR and high-IMR groups).
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Affiliation(s)
- Samer Noaman
- Cardiology, Alfred Health, Melbourne, Victoria, Australia
- Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Western Health, Footscray, Victoria, Australia
| | - David M Kaye
- Cardiology, Alfred Health, Melbourne, Victoria, Australia
- Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Shane Nanayakkara
- Cardiology, Alfred Health, Melbourne, Victoria, Australia
- Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Anthony M Dart
- Cardiology, Alfred Health, Melbourne, Victoria, Australia
| | - Andy S C Yong
- Cardiology, Concord Hospital, Sydney, New South Wales, Australia
| | - Martin Ng
- Medicine, The University of Sydney, Sydney, New South Wales, Australia
- Cardiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Donna Vizi
- Cardiology, Alfred Health, Melbourne, Victoria, Australia
| | | | | | - William Chan
- Cardiology, Alfred Health, Melbourne, Victoria, Australia
- Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
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Ain QU, Dewi TI, Kurniati NF. Plasma Levels of Interleukin-6 and -18 Significantly Increase in Patients with Acute Coronary Syndrome. Oman Med J 2023; 38:e532. [PMID: 37727149 PMCID: PMC10505690 DOI: 10.5001/omj.2023.94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/23/2023] [Indexed: 09/21/2023] Open
Abstract
Objectives Inflammatory pathways play a significant role in atherosclerosis that leads to acute coronary syndrome (ACS). The initial stages of atherosclerosis are often asymptomatic; when atherosclerotic plaques become unstable it leads to ACS. Therefore, early detection, diagnosis, and treatment of atherosclerosis must be sought. These circumstances underpin the need for diagnostic values of inflammatory markers, warranting their routine clinical application to develop anti-atherosclerotic therapeutic approaches. The aim of this case-control observational study was to evaluate the plasma levels of interleukin (IL)-6, IL-18, IL-1β, and IL-10. Methods The research was conducted at Hasan Sadikin Hospital from September to December 2021. Patients were recruited based on the typical clinical history of ACS (non-ST-elevation myocardial infarction, ST-elevation myocardial infarction, and unstable angina) and electrocardiographic and cardiac enzyme data. Healthy subjects having no more than one cardiovascular disease risk factor at admission were included. A total of 43 subjects were included in the study, of which 23 subjects were patients diagnosed with ACS and 20 were healthy controls. Results The results showed that the mean plasma levels of IL-6 (298.6±432.9 pg/mL) in ACS patients were significantly higher than the mean concentration of IL-6 (33.7±96.6 pg/mL) in the control group (p < 0.05). Similarly, the mean plasma level of IL-18 (181.4±81.4 pg/mL) in ACS patients was significantly higher compared to the mean concentration (125.0±29.8 pg/mL) in the control group (p < 0.05), suggesting that both IL-6 and IL-18 were associated with ACS. However, there is no statistically significant difference between IL-1β and IL-10 levels. A Pearson's correlation analysis showed that a positive correlation exists between IL-6 and IL-18. Conclusions Both IL-6 and IL-18 are associated with ACS.
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Affiliation(s)
- Qurrat Ul Ain
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, Bandung Institute of Technology, Bandung, Indonesia
- Department of Pharmacy, The University of Faisalabad, Faisalabad, Pakistan
| | - Triwedya Indra Dewi
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Neng Fisheri Kurniati
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, Bandung Institute of Technology, Bandung, Indonesia
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Choi Y, Lee H. Factors related to under-triage of patients with acute coronary syndrome in the emergency department: A retrospective study. Int Emerg Nurs 2023; 69:101316. [PMID: 37348241 DOI: 10.1016/j.ienj.2023.101316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 05/13/2023] [Accepted: 05/31/2023] [Indexed: 06/24/2023]
Abstract
INTRODUCTION This study aimed to provide fundamental data to avoid under-triage in the initial severity classification of patients with suspected acute coronary syndrome (ACS) by analyzing factors associated with patients who visited the emergency department (ED). METHODS This retrospective study identified factors related to under-triage by comparing the characteristics of participants diagnosed with ACS and appropriately classified those who were under-triaged. RESULTS The probability of under-triage increased 5.402 times in patients who visited the ED immediately than in those who visited the ED through an outpatient clinic. The probability of under-triage decreased in patients who visited the ED by ambulance rather than using their personal vehicle. Furthermore, when patients experienced chest pain, the tendency for under-triage decreased. The under-triage tendency increased 8.315 times in patients with dementia. CONCLUSIONS Medical staff training on the classification of non-specific symptoms accompanying diseases is needed. Patients with ACS need to be aware of the symptoms that require visiting the ED and the appropriate route and method. Therefore, it is possible to avoid under-triage for possible ACS during the initial triage, and triage can be performed quickly and accurately.
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Affiliation(s)
- Yeonghwan Choi
- Emergency Medical Center, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Hyeongsuk Lee
- College of Nursing, Gachon University, Incheon, South Korea.
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Helleryd E, Rawshani A, Rawshani A, Hjärtstam N, Myredal A, Skoglund K. Association between exercise load, resting heart rate, and maximum heart rate and risk of future ST-segment elevation myocardial infarction (STEMI). Open Heart 2023; 10:e002307. [PMID: 37460270 DOI: 10.1136/openhrt-2023-002307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/30/2023] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVE This study aimed to examine the association between exercise workload, resting heart rate (RHR), maximum heart rate and the risk of developing ST-segment elevation myocardial infarction (STEMI). METHODS The study included all participants from the UK Biobank who had undergone submaximal exercise stress testing. Patients with a history of STEMI were excluded. The allowed exercise load for each participant was calculated based on clinical characteristics and risk categories. We studied the participants who exercised to reach 50% or 35% of their expected maximum exercise tolerance. STEMI was adjudicated by the UK Biobank. We used Cox regression analysis to study how exercise tolerance and RHR were related to the risk of STEMI. RESULTS A total of 66 949 participants were studied, of whom 274 developed STEMI during a median follow-up of 7.7 years. After adjusting for age, sex, blood pressure, smoking, forced vital capacity, forced expiratory volume in 1 s, peak expiratory flow and diabetes, we noted a significant association between RHR and the risk of STEMI (p=0.015). The HR for STEMI in the highest RHR quartile (>90 beats/min) compared with that in the lowest quartile was 2.92 (95% CI 1.26 to 6.77). Neither the maximum achieved exercise load nor the ratio of the maximum heart rate to the maximum load was significantly associated with the risk of STEMI. However, a non-significant but stepwise inverse association was noted between the maximum load and the risk of STEMI. CONCLUSION RHR is an independent predictor of future STEMI. An RHR of >90 beats/min is associated with an almost threefold increase in the risk of STEMI.
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Affiliation(s)
- Edvin Helleryd
- Department of Molecular and Clinical Medicine, University of Gothenburg, Goteborg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Araz Rawshani
- Department of Molecular and Clinical Medicine, University of Gothenburg, Goteborg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Aidin Rawshani
- Department of Molecular and Clinical Medicine, University of Gothenburg, Goteborg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Nellie Hjärtstam
- Department of Molecular and Clinical Medicine, University of Gothenburg, Goteborg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Anna Myredal
- Department of Cardiology, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Kristofer Skoglund
- Department of Molecular and Clinical Medicine, University of Gothenburg, Goteborg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Goteborg, Sweden
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Bouillon-Minois JB, Saget F, Peschanski N. [Coronary anaphylaxis or Kounis syndrome]. Rev Med Liege 2023; 78:399-402. [PMID: 37560948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Although not well known, Kounis syndrome represents 3.4 % of anaphylactic reactions and has a high level of mortality (7 %). Its main clinical presentation looks like an acute coronary syndrome. We report the case of a 61-year old patient who was admitted in the emergency department because of a malaise with loss of consciousness due to a Kounis syndrome that occurred after the ingestion of amoxycilline.
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Affiliation(s)
| | | | - Nicolas Peschanski
- Service des Urgences-SAMU-SMUR, CHU Rennes, France
- Faculté de Médecine, Université Rennes-1, France
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Vongbunyong K, Chua F, Ghashghaei R. Pregnancy-related spontaneous coronary artery dissection: a rare cause of acute coronary syndrome in the third trimester. BMC Cardiovasc Disord 2023; 23:292. [PMID: 37291481 PMCID: PMC10251557 DOI: 10.1186/s12872-023-03323-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 05/26/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Spontaneous Coronary Artery Dissection (SCAD) is a rare cause of myocardial infarction and sudden cardiac death that is mostly seen in younger patients without significant cardiac risk factors. The mechanism by which SCAD causes an acute coronary event is related to the compromise of the coronary artery lumen as a result of hematoma within the vessel wall. In comparison to their non-pregnant counterparts, when SCAD is associated with pregnancy, it has been associated with an increased risk of life-threatening arrhythmias, cardiogenic shock, and death. The underlying mechanism behind SCAD is not yet fully understood, and despite the condition's high mortality rate, it remains underdiagnosed. CASE PRESENTATION Our case features a 38-year-old woman at 29 weeks of gestation presenting with chest pain that persisted despite initial management. Coronary angiography revealed a Type 2a spontaneous dissection of the left anterior descending artery. Given the risks of percutaneous coronary intervention in SCAD management and overall clinical stability, the patient was treated with conservative management. CONCLUSION SCADs are a rare cause of acute coronary syndrome that can be found in patients without any prior cardiac risk factors. It is important to have a high index of suspicion when diagnosing SCADs given, they can cause life-threatening arrhythmias, cardiogenic shock, and death. This case highlights considerations that must be taken into account when treating P-SCAD, as opposed to SCAD in the postpartum period.
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Affiliation(s)
- Kenny Vongbunyong
- Department of Medicine, University of California, 333 The City Blvd. West, Suite 400, Orange, Irvine, CA, 92868, USA.
| | - Frederick Chua
- Department of Medicine, University of California, 333 The City Blvd. West, Suite 400, Orange, Irvine, CA, 92868, USA
| | - Roxana Ghashghaei
- Department of Medicine, Division of Cardiology, University of California, Irvine, CA, USA
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Bhasin D, Kashyap JR, Reddy S. A woman with inferior wall myocardial infarction. Heart 2023; 109:904-966. [PMID: 37236646 DOI: 10.1136/heartjnl-2022-322191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Affiliation(s)
- Dinkar Bhasin
- Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jeet Ram Kashyap
- Cardiology, Government Medical College and Hospital, Chandigarh, India
| | - Sreenivas Reddy
- Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Cardiology, Government Medical College and Hospital, Chandigarh, India
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Muscoli S, Andreadi A, Tamburro C, Russo M, Rosenfeld R, Oro P, Ifrim M, Porzio F, Barone L, Barillà F, Lauro D. Prevalence of Cardiovascular Risk Factors and Coronary Angiographic Findings in High-Risk Immigrant Communities in Italy. J Pers Med 2023; 13:882. [PMID: 37373871 DOI: 10.3390/jpm13060882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/11/2023] [Accepted: 05/19/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The prevalence of coronary artery disease (CAD) considerably varies by ethnicity. High-risk populations include patients from Eastern Europe (EEP), the Middle East and North Africa (MENAP) and South Asia (SAP). METHODS This retrospective study aims to highlight cardiovascular risk factors and specific coronary findings in high-risk immigrant groups. We examined the medical records and coronary angiographies of 220 patients from the above-mentioned high-risk ethnic groups referred for Acute Coronary Syndrome (ACS) and compared them with 90 Italian patients (IP) from 2016 to 2021. In the context of high-risk immigrant populations, this retrospective study aims to shed light on cardiovascular risk factors and particular coronary findings. We analyzed the medical records of 220 patients from the high-risk ethnic groups described above referred for ACS and compared them with 90 IPs between 2016 and 2021. In addition, we assessed coronary angiographies with a focus on the culprit lesion, mainly evaluating multi-vessel and left main disease. RESULTS The mean age at the first event was 65.4 ± 10.2 years for IP, 49.8 ± 8.5 years for SAP (Relative Reduction (ReR) 30.7%), 51.9 ± 10.2 years for EEP (ReR 26%) and 56.7 ± 11.4 years for MENAP (ReR 15.3%); p < 0.0001. The IP group had a significantly higher prevalence of hypertension. EEP and MENAP had a lower prevalence of diabetes. EEP and MENAP had a higher prevalence of STEMI events; SAP showed a significant prevalence of left main artery disease (p = 0.026) and left anterior descending artery disease (p = 0.033) compared with other groups. In SAP, we detected a higher prevalence of three-vessel coronary artery disease in the age group 40-50. CONCLUSIONS Our data suggest the existence of a potential coronary phenotype in several ethnicities, especially SAP, and understate the frequency of CV risk factors in other high-risk groups, supporting the role of a genetic influence in these communities.
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Affiliation(s)
- Saverio Muscoli
- Division of Cardiology, Fondazione Policlinico "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
| | - Aikaterini Andreadi
- Department of Systems Medicine, University of Rome "Tor Vergata", 00133 Rome, Italy
- Division of Endocrinology and Diabetology, Department of Medical Sciences, Fondazione Policlinico "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
| | - Claudia Tamburro
- Division of Cardiology, Fondazione Policlinico "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
| | - Massimo Russo
- Division of Cardiology, Fondazione Policlinico "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
| | - Roberto Rosenfeld
- Department of Systems Medicine, University of Rome "Tor Vergata", 00133 Rome, Italy
| | - Pietro Oro
- Division of Cardiology, Fondazione Policlinico "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
| | - Mihaela Ifrim
- Division of Cardiology, Fondazione Policlinico "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
| | - Federica Porzio
- Division of Cardiology, Fondazione Policlinico "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
| | - Lucy Barone
- Division of Cardiology, Fondazione Policlinico "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
| | - Francesco Barillà
- Division of Cardiology, Fondazione Policlinico "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
- Department of Systems Medicine, University of Rome "Tor Vergata", 00133 Rome, Italy
| | - Davide Lauro
- Department of Systems Medicine, University of Rome "Tor Vergata", 00133 Rome, Italy
- Division of Endocrinology and Diabetology, Department of Medical Sciences, Fondazione Policlinico "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
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48
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Viana-Rojas JA, Argaiz E, Robles-Ledesma M, Arias-Mendoza A, Nájera-Rojas NA, Alonso-Bringas AP, De Los Ríos-Arce LF, Jennifer AR, Gopar-Nieto R, Briseño-De la Cruz JL, González-Pacheco H, Sierra-Lara Martinez D, Gonzalez-Salido J, Lopez-Gil S, Araiza-Garaygordobil D. Venous Excess Ultrasound Score and Acute Kidney Injury in Patients with Acute Coronary Syndrome. Eur Heart J Acute Cardiovasc Care 2023:7156625. [PMID: 37154067 DOI: 10.1093/ehjacc/zuad048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/13/2023] [Accepted: 05/04/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Systemic venous congestion is associated with an increased risk of acute kidney injury (AKI) in critically ill patients. Venous Excess Ultrasound Score (VExUS) has been proposed as a non-invasive score to assess systemic venous congestion. We aimed to evaluate the association between VExUS score and AKI in patients with acute coronary syndrome (ACS). METHODS A prospective study including patients with the diagnosis of ACS (both STE/NSTE ACS). VExUS was performed during the first 24 hours of hospital stay. Patients were classified according to the presence of systemic congestion (VExUS 0/ ≥ 1). The primary objective of the study was the occurrence of AKI, defined by KDIGO criteria. RESULTS A total of 77 patients were included. After ultrasound assessment, 31 (40.2%) patients were categorized as VExUS ≥1. VExUS ≥1 was more frequently found in inferior vs. anterior MI/NSTEMI (48.3 vs 25.8 & 22.5%, p = 0.031). At each increasing degree of VExUS, a higher proportion of patients developed AKI: VExUS = 0 (10.8%), VExUS = 1 (23.8%), VExUS = 2 (75.0%) & VExUS = 3 (100%) (p < 0.001). A significant association between VExUS ≥1 and AKI was found (OR: 6.75, 95%CI: 2.21-23.7, p = 0.001). After multivariable analysis, only VExUS ≥1 (OR 6.15; 95% CI: 1.26-29.94, p = 0.02) remained significantly associated with AKI. CONCLUSIONS In patients hospitalized with ACS, VExUS score is associated with the occurrence of AKI. Further studies are needed to clarify the role of VExUS assessment in patients with ACS.
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Affiliation(s)
| | - Eduardo Argaiz
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, México
| | - Mariana Robles-Ledesma
- Coronary Care Unit, Instituto Nacional de Cardiología "Ignacio Chávez", Mexico City, México
| | | | | | | | | | | | - Rodrigo Gopar-Nieto
- Coronary Care Unit, Instituto Nacional de Cardiología "Ignacio Chávez", Mexico City, México
| | | | | | | | - Jimena Gonzalez-Salido
- Coronary Care Unit, Instituto Nacional de Cardiología "Ignacio Chávez", Mexico City, México
| | - Salvador Lopez-Gil
- Nephrology Department, Instituto Nacional de Cardiología "Ignacio Chávez", Mexico City, México
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49
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Gutiérrez-Díaz GI, Buenrostro-Jiménez AD, Rojas-Castillo R, Amador-Avendaño V, Jaime-Zúñiga AY, Zambada-Gamboa ADJ, Velázquez-García MA, Gudiño-Amezcua DA. [ Acute coronary syndrome provoked by a coronary intramural hematoma]. Rev Med Inst Mex Seguro Soc 2023; 61:380-385. [PMID: 37216693 PMCID: PMC10437236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 12/12/2022] [Indexed: 05/24/2023]
Abstract
Background Intramural coronary hematoma (ICH) is an unusual cause of acute coronary syndrome, and it represents a diagnostic challenge, especially in young patients in which it is not considered among the differential causes of acute myocardial ischemia. Clinical case 40-year-old female, with type 2 diabetes and no other cardiovascular risk factors, who assisted to the Emergency Room with chest pain. In her first evaluation, electrocardiographic abnormalities, and troponin I elevation were found. A cardiac catheterization was performed, in which a proximal obstruction of the left anterior descending artery was observed, and then an optical coherence tomography (OCT) confirmed the presence of an ICH without a dissection flap. A stent was implanted in the obstruction area, with adequate angiographic outcome. The patient had a satisfactory evolution and was discharged to home without evidence of systolic dysfunction and is free of cardiovascular symptoms at 6-month follow-up. Conclusions ICH must be considered within the differential diagnosis of acute myocardial ischemia in young patients, especially females. Intravascular image diagnosis is essential for the adequate diagnosis and treatment. Treatment must be individualized considering the extent of ischemia.
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Affiliation(s)
- Gonzalo Israel Gutiérrez-Díaz
- Instituto Mexicano del Seguro Social, Centro Médico Nacional del Noroeste, Hospital de Especialidades No. 2 “Luis Donaldo Colosio Murrieta”, Servicio de Cardiología. Ciudad Obregón, Sonora, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Arturo David Buenrostro-Jiménez
- Instituto Mexicano del Seguro Social, Centro Médico Nacional del Noroeste, Hospital de Especialidades No. 2 “Luis Donaldo Colosio Murrieta”, Servicio de Cardiología Intervencionista. Ciudad Obregón, Sonora, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Roberto Rojas-Castillo
- Instituto Mexicano del Seguro Social, Centro Médico Nacional de Occidente, Hospital de Especialidades “Lic. Ignacio García Téllez”, Servicio de Hemodinamia. Guadalajara, Jalisco, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Víctor Amador-Avendaño
- Instituto Mexicano del Seguro Social, Centro Médico Nacional de Occidente, Hospital de Especialidades “Lic. Ignacio García Téllez”, Servicio de Hemodinamia. Guadalajara, Jalisco, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Alma Yaneth Jaime-Zúñiga
- Instituto Mexicano del Seguro Social, Centro Médico Nacional del Noroeste, Hospital de Especialidades No. 2 “Luis Donaldo Colosio Murrieta”, Servicio de Cardiología. Ciudad Obregón, Sonora, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Anahí de Jesús Zambada-Gamboa
- Instituto Mexicano del Seguro Social, Centro Médico Nacional del Noroeste, Hospital de Especialidades No. 2 “Luis Donaldo Colosio Murrieta”, Servicio de Cardiología Intervencionista. Ciudad Obregón, Sonora, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Manuel Alejandro Velázquez-García
- Instituto Mexicano del Seguro Social, Centro Médico Nacional del Noroeste, Hospital de Especialidades No. 2 “Luis Donaldo Colosio Murrieta”, Servicio de Cardiología Intervencionista. Ciudad Obregón, Sonora, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Diego Armando Gudiño-Amezcua
- Instituto Mexicano del Seguro Social, Centro Médico Nacional de Occidente, Hospital de Especialidades “Lic. Ignacio García Téllez”, Servicio de Gabinete de Cardiología. Guadalajara, Jalisco, MéxicoInstituto Mexicano del Seguro SocialMéxico
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50
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Gürgöze MT, Akkerhuis KM, Oemrawsingh RM, Umans VAWM, Kietselaer B, Schotborgh CE, Ronner E, Lenderink T, Aksoy I, van der Harst P, Asselbergs FW, Maas AC, Ophuis AJO, Krenning B, de Winter RJ, The SHK, Wardeh AJ, Hermans WRM, Cramer GE, van Gorp I, de Rijke YB, van Schaik RHN, Boersma E. Serially Measured hs-cTnT, NT-proBNP, hs-CRP and GDF-15 for Risk Assessment After Acute Coronary Syndrome: the BIOMArCS Cohort. Eur Heart J Acute Cardiovasc Care 2023:7140575. [PMID: 37096818 DOI: 10.1093/ehjacc/zuad042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 04/09/2023] [Accepted: 04/17/2023] [Indexed: 04/26/2023]
Abstract
AIMS Evidence regarding the role of serial measurements of biomarkers for risk assessment in post-acute coronary syndrome (ACS) patients is limited. The aim was to explore the prognostic value of four, serially measured biomarkers in a large, real-world cohort of post-ACS patients. METHODS AND RESULTS BIOMArCS is a prospective, multicentre, observational study in 844 post-ACS patients in whom 12,218 blood samples (median 17/patient) were obtained during one year follow-up. The longitudinal patterns of hs-cTnT, NT-proBNP, hs-CRP and GDF-15 were analysed in relation to the primary endpoint (PE) of CV mortality and recurrent ACS using multivariable joint models. Median age was 63 years, 78% were men and the PE was reached by 45 patients. The average biomarker levels were systematically higher in PE compared to PE-free patients. After adjustment for 6-months post-discharge GRACE score, 1 standard deviation increase in log[hs-cTnT] was associated with a 61% increased risk of the PE (hazard ratio[HR] 1.61, 95% confidence interval[CI] 1.02-2.44, P = 0.045) while for log[GDF-15] this was 81% (HR 1.81, 95% CI 1.28-2.70, P = 0.001). These associations remained significant after multivariable adjustment, while NT-proBNP and hs-CRP were not. Furthermore, GDF-15 level showed an increasing trend prior to the PE. (Structured Graphical Abstract). CONCLUSIONS Longitudinally measured hs-cTnT and GDF-15 concentrations provide prognostic value in the risk assessment of clinically stabilized patients post-ACS. CLINICAL TRIAL REGISTRATION The Netherlands Trial Register. Currently available at URL https://trialsearch.who.int/; Unique Identifiers: NTR1698 and NTR1106.
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Affiliation(s)
- Muhammed T Gürgöze
- Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | | | | | | | - Bas Kietselaer
- Zuyderland Hospital, Heerlen, the Netherlands
- Mayo Clinic, Rochester, Minnesota, United States of America
| | | | - Eelko Ronner
- Reinier de Graaf Hospital, Delft, the Netherlands
| | | | - Ismail Aksoy
- Admiraal de Ruyter Hospital, Goes, the Netherlands
| | - Pim van der Harst
- University Medical Centre Groningen, Groningen, the Netherlands
- University Medical Centre Utrecht, the Netherlands
| | - Folkert W Asselbergs
- Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, the Netherlands
- Health Data Research UK and Institute of Health Informatics, University College London, London, United Kingdom
| | | | | | - Boudewijn Krenning
- Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
- Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Robbert J de Winter
- Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, the Netherlands
| | | | | | | | | | - Ina van Gorp
- Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Yolanda B de Rijke
- Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Ron H N van Schaik
- Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Eric Boersma
- Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
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