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Caselli C, Ragusa R, Liga R, Prontera C, Gimelli A, Scholte A, Knuuti J, Clerico A, Neglia D. Comparison of high-sensitive cardiac troponin T and I in patients with chronic coronary syndrome. Eur J Clin Invest 2023; 53:e14010. [PMID: 37097123 DOI: 10.1111/eci.14010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/18/2023] [Accepted: 04/23/2023] [Indexed: 04/26/2023]
Affiliation(s)
- Chiara Caselli
- Institute of Clinical Physiology CNR, Pisa, Italy
- Fondazione Toscana G. Monasterio, Pisa, Italy
| | | | - Riccardo Liga
- Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | | | - Arthur Scholte
- Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Leiden, the Netherlands
| | - Juhani Knuuti
- PET Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Aldo Clerico
- Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Danilo Neglia
- Fondazione Toscana G. Monasterio, Pisa, Italy
- Sant'Anna School of Advanced Studies, Pisa, Italy
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152
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Tao S, Tang X, Yu L, Li L, Zhang G, Zhang L, Huang L, Wu J. Prognosis of coronary heart disease after percutaneous coronary intervention: a bibliometric analysis over the period 2004-2022. Eur J Med Res 2023; 28:311. [PMID: 37658418 PMCID: PMC10472664 DOI: 10.1186/s40001-023-01220-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/10/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND As the complexity and diversity of the percutaneous coronary intervention (PCI) are being explored and reported, burgeoning research has progressed in this field. However, there is no comprehensive analysis available on PCI-related studies published in the literature. This study aimed to analyze and visualize the changes of scientific output regarding prognosis of coronary heart disease (CHD) after PCI over the past 20 years and to reveal the knowledge domain and development trends in this field by using CiteSpace software. METHODS Relevant articles published over the period 2004-2022 were retrieved from the Web of Science Core Collection database. After manual selection, qualified documents were included and recorded with the information of their title, abstract, keyword, author, descriptor, citation, identifier, publishing year and publishing organization. We transferred the data to CiteSpace V5.8.R2 (Version 5.8.R2) to draw knowledge maps and to conduct co-occurrence analysis, cluster analysis, timeline analysis, burst term detection and citation analysis. RESULTS A total of 14,699 literature records were found relating prognosis of CHD after PCI in the past 20 years (2004-2022), including 14,212 original articles and reviews, and they were published in 153 different journals. Publication production has increased annually and a total of 1182 authors, 796 institutes and 147 countries have contributed to these publications. Moreover, the most representative author was Gregg W Stone from the CardioVascular Research Foundation (CVRF) with 368 publications, whose team mainly focused on exploring the efficacy and safety of revascularization and the characteristics of susceptible population. The global productivity ranking was led by the USA with 3326 published papers, followed by Italy (n = 1355), Japan (n = 1080), China (n = 1075) and Germany (n = 937). And the keywords of these publications were "percutaneous coronary intervention" (n = 2271), "outcome" (n = 1756), "mortality" (n = 1730) and "impact" (n = 1334). Other commonly-used words were "predictor" (n = 1324), "intervention" (n = 1310), "angioplasty" (n = 1299), "risk" (n = 1144), "acute myocardial infarction" (n = 1136) and "artery disease" (n = 1098). Cluster analysis showed that 15 high connected clusters were generated with a modularity Q of 0.831 and a weighted mean silhouette of 0.9388 by applying the log-likelihood ratio algorithm, and the top 5 clusters were #0 optical coherence tomography, #1 dual antiplatelet therapy, #2 bleeding, #3 clopidogrel and #4 thrombus aspiration. Furthermore, the frontiers in the field of prognosis of CHD after PCI mainly involved "decision making", "reperfusion", "angioplasty", "balloon", "unstable angina", "dual antiplatelet therapy", "cardiac surgical score", "restenosis", "reperfusion", "thrombolytic therapy", etc. CONCLUSIONS: To sum up, efficacy and safety of different types of stents, the risk factors of restenosis and thrombotic events after PCI, early risk assessment, and secondary prevention and complications of patients with CHD after PCI were research hotspots and frontier topics in the area by bibliometric analysis. The results could provide a comprehensive overview of the research hotspots and frontier topics relating prognosis of CHD after PCI, promoting a better understanding of the knowledge domain and development trends in this field during the past 20 years.
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Affiliation(s)
- Shiyi Tao
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Xianwen Tang
- Department of Cardiology, Beijing University of Chinese Medicine Shenzhen Hospital (Longgang), Shenzhen, Guangdong, China
| | - Lintong Yu
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Lingling Li
- The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Gaoyu Zhang
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Lanxin Zhang
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Li Huang
- Department of Integrative Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Jiayun Wu
- Department of Cardiology, Beijing University of Chinese Medicine Shenzhen Hospital (Longgang), Shenzhen, Guangdong, China.
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153
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He Z, Xu X, Zhao Q, Ding H, Wang DW. Vasospastic angina: Past, present, and future. Pharmacol Ther 2023; 249:108500. [PMID: 37482097 DOI: 10.1016/j.pharmthera.2023.108500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/22/2023] [Accepted: 07/18/2023] [Indexed: 07/25/2023]
Abstract
Vasospastic angina (VSA) is characterized by episodes of rest angina that are responsive to short-acting nitrates and are attributable to coronary artery vasospasm. The condition is underdiagnosed as the provocation test is rarely performed. VSA, the most important component of non-obstructive coronary artery disease, can present with angina, be asymptomatic, or can even present with fatal arrhythmias and cardiac arrest. Although most patients with VSA respond well to vasodilating medications, prognosis does not improve as expected in most patients, suggesting the existence elusive prognostic factors and pathogenesis that warrant further exploration. Moreover, patients with either severe or refractory VSA barely respond to conventional treatment and may develop life-threatening arrhythmias or suffer sudden cardiac death during ischemic attacks, which are associated with immune-inflammatory responses and have been shown to achieve remission following glucocorticoid and immunoglobulin treatments. Our recent work revealed that inflammation plays a key role in the initiation and development of coronary spasms, and that inflammatory cytokines have predictive value for diagnosis. In contrast to the existing literature, this review both summarizes the theoretical and clinical aspects of VSA, and also discusses the relationship between inflammation, especially myocarditis and VSA, in order to provide novel insights into the etiology, diagnosis, and treatment of VSA.
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Affiliation(s)
- Zuowen He
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan 430030, China
| | - Xin Xu
- Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan 430030, China
| | - Qu Zhao
- Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan 430030, China
| | - Hu Ding
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan 430030, China
| | - Dao Wen Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan 430030, China.
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154
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Liu Y, Feng X, Yang J, Zhai G, Zhang B, Guo Q, Zhou Y. The relation between atherogenic index of plasma and cardiovascular outcomes in prediabetic individuals with unstable angina pectoris. BMC Endocr Disord 2023; 23:187. [PMID: 37653411 PMCID: PMC10469417 DOI: 10.1186/s12902-023-01443-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 08/24/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND The atherogenic index of plasma (AIP) is a novel biomarker associated with atherosclerosis, and an important risk factor for atherosclerosis, but its relation with cardiovascular prognosis in prediabetic patients with unstable angina pectoris (UAP) is still uncertain. METHODS This study included 1096 prediabetic patients with UAP who were subjected to follow-up for a maximum of 30 months, with cardiac death, refractory angina, and non-fatal myocardial infarction (MI) being the primary cardiovascular endpoints. RESULTS A significantly increased AIP was observed for the group with primary cardiovascular endpoints. Kaplan-Meier curves corresponding to these endpoints revealed pronounced differences between these two AIP groups (Log-rank P < 0.001). Multivariate Cox proportional hazards analyses highlighted AIP as being independent related to this primary endpoint (HR 1.308, 95% CI: 1.213-1.412, P < 0.001). AIP addition to the baseline risk model improved the prediction of the primary endpoint (AUC: baseline model, 0.622, vs. baseline model + AIP, 0.739, P < 0.001). CONCLUSIONS AIP could be used to predict cardiovascular events in prediabetic individuals with UAP.
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Affiliation(s)
- Yang Liu
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Capital Medical University, Beijing, China
| | - Xunxun Feng
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Capital Medical University, Beijing, China
| | - Jiaqi Yang
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Capital Medical University, Beijing, China
| | - Guangyao Zhai
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Capital Medical University, Beijing, China
| | - Bin Zhang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Qianyun Guo
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Capital Medical University, Beijing, China.
| | - Yujie Zhou
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Capital Medical University, Beijing, China.
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155
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Chen R, Huang M, Xu P. Polyphosphate as an antithrombotic target and hemostatic agent. J Mater Chem B 2023; 11:7855-7872. [PMID: 37534776 DOI: 10.1039/d3tb01152f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
Polyphosphate (PolyP) is a polymer comprised of linear phosphate units connected by phosphate anhydride bonds. PolyP exists in a diverse range of eukaryotes and prokaryotes with varied chain lengths ranging from six to thousands of phosphate units. Upon activation, human platelets and neutrophils release short-chain PolyP, along with other components, to initiate the coagulation pathway. Long-chain PolyP derived from cellular or bacterial organelles exhibits higher proinflammatory and procoagulant effects compared to short-chain PolyP. Notably, PolyP has been identified as a low-hemorrhagic antithrombotic target since neutralizing plasma PolyP suppresses the thrombotic process without impairing the hemostatic functions. As an inorganic polymer without uniform steric configuration, PolyP is typically targeted by cationic polymers or recombinant polyphosphatases rather than conventional antibodies, small-molecule compounds, or peptides. Additionally, because of its procoagulant property, PolyP has been incorporated in wound-dressing materials to facilitate blood hemostasis. This review summarizes current studies on PolyP as a low-hemorrhagic antithrombotic target and the development of hemostatic materials based on PolyP.
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Affiliation(s)
- Ruoyu Chen
- College of Biological Science and Engineering, Fuzhou University, Fuzhou, Fujian, 350108, P. R. China.
| | - Mingdong Huang
- College of Biological Science and Engineering, Fuzhou University, Fuzhou, Fujian, 350108, P. R. China.
- College of Chemistry, Fuzhou University, Fuzhou, Fujian, 350108, P. R. China
| | - Peng Xu
- College of Biological Science and Engineering, Fuzhou University, Fuzhou, Fujian, 350108, P. R. China.
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156
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Wei ZY, Lai JY, Li YT, Yu XY, Liu YH, Hu JX, Gao BB, Wu JG. Colchicine efficacy comparison at varying time points in the peri-operative period for coronary artery disease: a systematic review and meta-analysis of randomized controlled trials. Front Cardiovasc Med 2023; 10:1156980. [PMID: 37600022 PMCID: PMC10438985 DOI: 10.3389/fcvm.2023.1156980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/21/2023] [Indexed: 08/22/2023] Open
Abstract
Objectives Over the years, it has been found that colchicine offers substantial benefits in secondary prevention in patients with coronary artery disease (CAD). We studied the effects of colchicine timing because there are no guidelines about when to provide it during the perioperative period for patients with CAD. Methods Up to January 1, 2023, seven electronic literature databases were screened (including three English databases and four Chinese databases). Randomized controlled trials included only treatment with colchicine in the perioperative period of CAD. The Cochrane Evaluation Tool was used to judge the risk of bias in research. Statistical analysis was performed by Stata 16.0 software. Results We evaluated twelve studies that found colchicine to be effective in decreasing the occurrence of major adverse cardiac events (MACEs) (p < 0.00001), but it also raised the rate of adverse events (p = 0.001). Subgroup analysis showed the same benefit in lowering the incidence of MACE with continuous administration of a total daily dose of 0.5 mg postoperatively while minimizing drug-related side effects in the patients (p = 0.03). When it comes to preventing surgical stroke occurrences, postoperative administration is more effective (p = 0.006). While the effect of simultaneous preoperative and postoperative administration was marginally greater than other periods in reducing postoperative hs-CRP levels (p = 0.02). Conclusion Colchicine, a traditional anti-inflammatory drug, also reduces the risk of MACE by reducing inflammation after PCI. Administration at different periods had no significant effect on decreasing the occurrence of MACE, but when administered postoperatively, we advise continuous administration with a total daily dose of 0.5 mg to obtain the same benefit while minimizing the drug's side effects. Postoperative administration is the better measure to prevent postoperative stroke events. Due to the effective anti-inflammatory effect of colchicine, we recommend its use as early as possible in the perioperative period and its continued use at low doses in the postoperative period. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=316751, identifier CRD42022316751.
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Affiliation(s)
- Zhi-Yang Wei
- Department of Postgraduate, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Jun-Yu Lai
- Cardiology Department, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Ya-Ting Li
- Department of Postgraduate, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Xiao-Yan Yu
- Department of Postgraduate, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Yan-Hong Liu
- Department of Postgraduate, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Jing-Xuan Hu
- Department of Postgraduate, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Bei-Bei Gao
- Department of Postgraduate, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Jian-Guang Wu
- Cardiology Department, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
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157
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Solà-Muñoz S, Jorge M, Jiménez-Fàbrega X, Jiménez-Delgado S, Azeli Y, Marsal JR, Jordán S, Mauri J, Jacob J. Prehospital stratification and prioritisation of non-ST-segment elevation acute coronary syndrome patients (NSTEACS): the MARIACHI scale. Intern Emerg Med 2023; 18:1317-1327. [PMID: 37131092 DOI: 10.1007/s11739-023-03274-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/11/2023] [Indexed: 05/04/2023]
Abstract
OBJECTIVE The objective of this study was to develop and validate a risk scale (MARIACHI) for patients classified as non-ST-segment elevation acute coronary syndrome (NSTEACS) in a prehospital setting with the ability to identify patients at an increased risk of mortality at an early stage. METHODS A retrospective observational study conducted in Catalonia over two periods: 2015-2017 (development and internal validation cohort) and Aug 2018-Jan 2019 (external validation cohort). We included patients classified as prehospital NSTEACS, assisted by an advanced life support unit and requiring hospital admission. The primary outcome was in-hospital mortality. Cohorts were compared using logistic regression and a predictive model was created using bootstrapping techniques. RESULTS The development and internal validation cohort included 519 patients. The model is composed of five variables associated with hospital mortality: age, systolic blood pressure, heart rate > 95 bpm, Killip-Kimball III-IV and ST depression ≥ 0.5 mm. The model showed good overall performance (Brier = 0.043) and consistency in discrimination (AUC 0.88, 95% CI 0.83-0.92) and calibration (slope = 0.91; 95% CI 0.89-0.93). We included 1316 patients for the external validation sample. There was no difference in discrimination (AUC 0.83, 95% CI 0.78-0.87; DeLong Test p = 0.071), but there was in calibration (p < 0.001), so it was recalibrated. The finally model obtained was stratified and scored into three groups according to the predicted risk of patient in-hospital mortality: low risk: < 1% (-8 to 0 points), moderate risk: 1-5% (+ 1 to + 5 points) and high risk: > 5% (6-12 points). CONCLUSION The MARIACHI scale showed correct discrimination and calibration to predict high-risk NSTEACS. Identification of high-risk patients may help with treatment and low referral decisions at the prehospital level.
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Affiliation(s)
| | - Morales Jorge
- Sistema d'Emergències Mèdiques de Catalunya, Catalonia, Spain
| | - Xavier Jiménez-Fàbrega
- Sistema d'Emergències Mèdiques de Catalunya, Catalonia, Spain
- Universitat de Barcelona, Barcelona, Spain
| | | | - Youcef Azeli
- Sistema d'Emergències Mèdiques de Catalunya, Catalonia, Spain
- Emergency Department, Hospital Universitari Sant Joan de Reus, Tarragona, Spain
- Institut d'Investigació Sanitària Pere i Virgili (IISPV), Tarragona, Spain
| | - J Ramon Marsal
- RTI Health Solutions, Research Triangle Park, Spain
- Epidemiology Unit of the Cardiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Sara Jordán
- Sistema d'Emergències Mèdiques de Catalunya, Catalonia, Spain
| | - Josepa Mauri
- Cardiology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
- Pla Director de Malalties Cardiovasculars (PDMCV), Health Department of the Government of Catalonia, Catalonia, Spain
| | - Javier Jacob
- Universitat de Barcelona, Barcelona, Spain
- Emergency Department, Hospital Universitari de Bellvitge, Barcelona, Spain
- IDIBELL, L'Hospitalet de Llobregat, Spain
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158
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Promes SB, Gemme S, Westafer L, Wolf SJ, Diercks DB. Use of high-sensitivity cardiac troponin in the emergency department: A policy resource and education paper (PREP) from the American College of Emergency Physicians. J Am Coll Emerg Physicians Open 2023; 4:e12999. [PMID: 37426553 PMCID: PMC10324464 DOI: 10.1002/emp2.12999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 07/11/2023] Open
Abstract
This Policy Resource and Education Paper (PREP) from the American College of Emergency Physicians (ACEP) discusses the use of high-sensitivity cardiac troponin (hs-cTn) in the emergency department setting. This brief review discusses types of hs-cTn assays as well as the interpretation of hs-cTn in the setting of various clinical factors such as renal dysfunction, sex, and the important distinction between myocardial injury versus myocardial infarction. In addition, the PREP provides one possible example of an algorithm for the use of a hs-cTn assay in patients in whom the treating clinician is concerned about potential acute coronary syndrome.
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Affiliation(s)
- Susan B Promes
- Department of Emergency MedicinePenn State College of MedicineHersheyPennsylvaniaUSA
| | - Seth Gemme
- Department of Emergency MedicineUMass Chan Medical School‐BaystateSpringfieldMassachusettsUSA
| | - Lauren Westafer
- Department of Emergency MedicineUMass Chan Medical School‐BaystateSpringfieldMassachusettsUSA
| | - Stephen J. Wolf
- Department of Emergency MedicineDenver Health Medical CenterDenverColoradoUSA
| | - Deborah B. Diercks
- Department of Emergency MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
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159
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Baldasseroni S, Silverii MV, Herbst A, Orso F, Di Bari M, Pratesi A, Burgisser C, Ungar A, Marchionni N, Fattirolli F. Predictors of physical frailty improvement in older patients enrolled in a multidisciplinary cardiac rehabilitation program. Heart Vessels 2023; 38:1056-1064. [PMID: 36991137 PMCID: PMC10289976 DOI: 10.1007/s00380-023-02254-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 02/16/2023] [Indexed: 03/31/2023]
Abstract
Cardiac rehabilitation (CR) improves clinical and functional recovery in older patients after acute cardiac syndromes, whose outcome is influenced by cardiac disease severity, but also by comorbidity and frailty. The aim of the study was to analyze the predictors of physical frailty improvement during the CR program. Data were collected in all patients aged > 75 years consecutively admitted from 1 January to December 2017 to our CR, consisting of 5-day-per-week of 30-min session of biking or calisthenics on alternate days for 4 weeks. Physical frailty was measured with short physical performance battery (SPPB) at the entry and the end of CR. Outcome was represented by an increase of at least 1 point in the SPPB score from baseline to the end of the CR program. In our study population of 100 patients, mean age 81 years, we demonstrated that a strong predictor of improvement in SPPB score was the poorer performance in the test at baseline; for Δ-1 point of score, we registered an OR 2.50 (95% CI = 1.64-3.85; p = 0.001) of probability to improve the physical performance at the end of CR. Interestingly those patients with worse performance at SPPB balance and chair standing task showed greater probability of ameliorating their physical frailty profile at the end of CR. Our data strongly suggest that CR program after acute cardiac syndrome produces a significant physical frailty improvement in those patients with worse frailty phenotype with an impairment in chair standing or balance at entry.
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Affiliation(s)
- Samuele Baldasseroni
- Department of Experimental and Clinical Medicine, University of Florence and Cardiac Rehabilitation Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Maria Vittoria Silverii
- Department of Experimental and Clinical Medicine, University of Florence and Cardiac Rehabilitation Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Andrea Herbst
- Department of Experimental and Clinical Medicine, University of Florence and Cardiac Rehabilitation Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Francesco Orso
- Department of Experimental and Clinical Medicine, University of Florence and Cardiac Rehabilitation Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Mauro Di Bari
- Department of Experimental and Clinical Medicine, University of Florence and Cardiac Rehabilitation Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Alessandra Pratesi
- Department of Experimental and Clinical Medicine, University of Florence and Cardiac Rehabilitation Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Costanza Burgisser
- Department of Experimental and Clinical Medicine, University of Florence and Cardiac Rehabilitation Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Andrea Ungar
- Department of Experimental and Clinical Medicine, University of Florence and Cardiac Rehabilitation Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Niccolò Marchionni
- Department of Experimental and Clinical Medicine, University of Florence and Cardiac Rehabilitation Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Francesco Fattirolli
- Department of Experimental and Clinical Medicine, University of Florence and Cardiac Rehabilitation Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy.
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160
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Krackhardt F, Jörnten-Karlsson M, Waliszewski M, Knutsson M, Niklasson A, Appel KF, Degenhardt R, Ghanem A, Köhler T, Ohlow MA, Tschöpe C, Theres H, Vom Dahl J, Karlson BW, Maier LS. Results from the "Me & My Heart" (eMocial) Study: a Randomized Evaluation of a New Smartphone-Based Support Tool to Increase Therapy Adherence of Patients with Acute Coronary Syndrome. Cardiovasc Drugs Ther 2023; 37:729-741. [PMID: 35441926 PMCID: PMC10397150 DOI: 10.1007/s10557-022-07331-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE This study evaluated whether patient support, administered via an electronic device-based app, increased adherence to treatment and lifestyle changes in patients with acute coronary syndrome (ACS) treated with ticagrelor in routine clinical practice. METHODS Patients (aged ≥ 18 years) with diagnosed ACS treated with ticagrelor co-administered with low-dose acetylsalicylic acid were randomized into an active group (with support tool app for medication intake reminders and motivational messages) and a control group (without support tool app), and observed for 48 weeks (ClinicalTrials.gov Identifier: NCT02615704). Patients were asked to complete the 36-item Short-Form Health Survey (SF-36) and Lifestyle Changes Questionnaire (LSQ), and were assessed for blood pressure and body mass index (BMI) at baseline (visit 1) and at the end of the study (visit 2). Medication adherence was measured using the Brilique Adherence Questionnaire (BAQ). RESULTS Patients (N = 676) were randomized to an active (n = 342) or a control (n = 334) group. BAQ data were available for 174 patients in the active group and 174 patients in the control group. Over the 48-week period, mean (standard deviation) adherence for the active and control groups was 96.4% (13.2%) and 91.5% (23.1%), respectively (effect of app intervention, p < 0.05). There were no significant differences in blood pressure and BMI between visits. General improvements in SF-36 and LSQ scores were observed for both groups. CONCLUSION The patient support tool app was associated with significant improvements in patient-reported treatment adherence compared with a data collection app alone in patients prescribed ticagrelor for ACS.
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Affiliation(s)
- Florian Krackhardt
- Department of Internal Medicine and Cardiology, Charité Campus Virchow-Klinikum, Charité University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | | | - Matthias Waliszewski
- Department of Internal Medicine and Cardiology, Charité Campus Virchow-Klinikum, Charité University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Mikael Knutsson
- Late Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Anna Niklasson
- Late Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | | | | | | | - Till Köhler
- Herzzentrum Wuppertal, Helios-Universitätsklinikum, Wuppertal, Germany
| | | | - Carsten Tschöpe
- Berlin Institute of Health at Charité; BIH Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Björn W Karlson
- Late Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lars S Maier
- Department of Internal Medicine II, Universitätsklinikum Regensburg, Regensburg, Germany
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Boriani G, Venturelli A, Imberti JF, Bonini N, Mei DA, Vitolo M. Comparative analysis of level of evidence and class of recommendation for 50 clinical practice guidelines released by the European Society of Cardiology from 2011 to 2022. Eur J Intern Med 2023; 114:1-14. [PMID: 37169634 DOI: 10.1016/j.ejim.2023.04.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 04/11/2023] [Accepted: 04/22/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND The European Society of Cardiology (ESC) clinical practice guidelines are essential tools for decision-making. AIM To analyze the level of evidence (LOE) and the class of recommendations in the ESC guidelines released in the last 12 years. METHODS We evaluated 50 ESC guidelines released from 2011 to 2022, related to 27 topics and categorized them into seven macro-groups. We analyzed every recommendation in terms of LOE and class of recommendation, calculating their relative proportions and changes over time in consecutive editions of the same guideline. RESULTS A total of 6972 recommendations were found, with an increase in number per year over time. Among the 50 ESC guidelines, the proportional distribution of classes of recommendations was 49% for Class I, 29% for Class IIa, 15% for Class IIb, and 8% for Class III. Overall, 16% of the recommendations were classified as LOE A, 31% LOE B and 53% LOE C. The field of preventive cardiology had the largest proportion of LOE A, while the lowest was in the field of valvular, myocardial, pericardial and pulmonary diseases. The overall proportion of LOE A recommendations in the most recent guidelines compared to their prior versions increased from 17% to 20%. CONCLUSIONS The recommendations included in the ESC guidelines widely differ in terms of quality of evidence, with only 16% supported by the highest quality of evidence. Although a slight global increase in LOE A recommendations was observed in recent years, further scientific research efforts are needed to increase the quality of evidence.
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Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, Modena 41124, Italy.
| | - Andrea Venturelli
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, Modena 41124, Italy
| | - Jacopo F Imberti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, Modena 41124, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Niccolò Bonini
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, Modena 41124, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Davide A Mei
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, Modena 41124, Italy
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, Modena 41124, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
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Kim J, Park J, Kwon JH, Lee JH, Yang K, Min JJ, Lee SC, Park SW, Lee SH. Antiplatelet therapy and long-term mortality in patients with myocardial injury after non-cardiac surgery. Open Heart 2023; 10:e002318. [PMID: 37620101 PMCID: PMC10450040 DOI: 10.1136/openhrt-2023-002318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 07/27/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUNDS Myocardial injury after non-cardiac surgery (MINS) has recently been accepted as a common complication associated with increased mortality. However, little is known about the treatment of MINS. The aim of this study was to investigate an association between antiplatelet therapy and long-term mortality after MINS. METHODS From 2010 to 2019, patients with MINS, defined as having a peak high-sensitivity troponin I higher than 40 ng/L within 30 days after non-cardiac surgery, were screened at a tertiary centre. Patients were excluded if they had a history of coronary revascularisation before or during index hospitalisation. Clinical outcomes at 1 year were compared between patients with and without antiplatelet therapy at hospital discharge. The primary outcome was death, and the secondary outcome was major bleeding. RESULTS Of the 3818 eligible patients with MINS, 940 (24.6%) received antiplatelet therapy at hospital discharge. Patients with antiplatelet therapy had a significantly lower mortality at 1 year than those without antiplatelet therapy (7.5% vs 15.9%, adjusted HR 0.60, 95% CI 0.45 to 0.79, p<0.001). A risk of major bleeding at 1 year was not significantly different between the patients with and without antiplatelet therapy (6.6% vs 7.6%, adjusted HR 0.85, 95% CI 0.62 to 1.17, p=0.324). In propensity score-matched analysis of 886 pairs, patients with antiplatelet therapy had a significantly lower risk of 1-year mortality (adjusted HR 0.53, 95% CI 0.39 to 0.73, p<0.001) than those without antiplatelet therapy. CONCLUSIONS In patients with MINS, antiplatelet therapy at discharge was associated with decreased 1-year mortality.
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Affiliation(s)
- Jihoon Kim
- Division of Cardiology, Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, South Korea
| | - Jungchan Park
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Seoul, South Korea
| | - Ji-Hye Kwon
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Seoul, South Korea
| | - Jong Hwan Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Seoul, South Korea
| | - Kwangmo Yang
- Centers for Health Promotion, Samsung Medical Center, Seoul, South Korea
| | - Jeong Jin Min
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Seoul, South Korea
| | - Sang-Chol Lee
- Division of Cardiology, Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, South Korea
| | - Seung Woo Park
- Division of Cardiology, Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, South Korea
| | - Seung-Hwa Lee
- Division of Cardiology, Wiltse Memorial Hospital, Suwon-si, Gyeonggi-do, South Korea
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Orji C. Analysis of Sensitivity, Specificity, and Predictive Values of High-Sensitivity Troponin T in a Secondary Care Setting: A Retrospective Cohort Study. Cureus 2023; 15:e44446. [PMID: 37680409 PMCID: PMC10481764 DOI: 10.7759/cureus.44446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2023] [Indexed: 09/09/2023] Open
Abstract
Background High-sensitivity cardiac troponin (hs-cTn) assays have significantly improved the early detection of myocardial injury and the diagnosis of acute coronary syndrome (ACS). Different diagnostic algorithms exist for the interpretation of hs-cTn in the management of patients with suspected ACS. This study analysed the diagnostic efficacy of hs-cTn using serial and single measurements while also shedding light on the challenges associated with the use of this assay. Methods We reviewed 189 results belonging to 120 unique patient episodes and records for troponin tests performed in a two-week period obtained from the West Cumberland Hospital, North Cumbria Integrated Care (NCIC), Whitehaven, England. These troponin tests were carried out based on the NCIC trust guidelines for the use of troponin assays in the management of acute coronary syndrome (ACS). A positive troponin test is defined using the NCIC trust guidelines and the National Academy of Clinical Biochemistry (NACB) guidelines. The case notes of the unique patients were reviewed to determine the outcome, which is defined as the clinical diagnosis on discharge of the patient following a cardiologist review. These outcomes were then used to calculate the sensitivity, specificity, and predictive values. We also determined the alternate diagnosis for false-positive tests. Results Using both guidelines to assess the clinical effectiveness of the troponin assay yields slightly varying results, with the single positive test of NACB demonstrating a higher sensitivity of 92.8% (>71.4%) and a slightly better negative predictive value of 97.8% (>96%). However, using the serial troponin measurements as per the NCIC trust guideline demonstrates a better specificity of 95.2% (>42.4%) and a positive predictive value of 66% (>17.5%). False positive results are identified, which are due to alternate diagnoses such as stable angina, myocarditis, heart failure, sepsis, and malignancy. Conclusion High-sensitivity troponin (hs-cTn) assays play a crucial role in the early detection and management of patients with suspected ACS. This study supports evidence that serial troponin measurements are more diagnostically accurate than single troponin measurements. Although hs-cTn assays offer significant advantages, there remain challenges and limitations that require careful interpretation and clinical correlation.
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Affiliation(s)
- Chinedu Orji
- Cardiology, North Cumbria Integrated Care, Whitehaven, GBR
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Lu ZF, Yin WH, Schoepf UJ, Abrol S, Ma JW, Yu XB, Zhao L, Su XM, Wang CS, An YQ, Xiao ZC, Lu B. Residual Risk in Non-ST-Segment Elevation Acute Coronary Syndrome: Quantitative Plaque Analysis at Coronary CT Angiography. Radiology 2023; 308:e230124. [PMID: 37606570 DOI: 10.1148/radiol.230124] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
Background Lipid-rich plaques detected with intravascular imaging are associated with adverse cardiovascular events in patients with non-ST-segment elevation (NSTE) acute coronary syndrome (ACS). But evidence about the prognostic implication of coronary CT angiography (CCTA) in NSTE ACS is limited. Purpose To assess whether quantitative variables at CCTA that reflect lipid content in nonrevascularized plaques in individuals with NSTE ACS might be predictors of subsequent nonrevascularized plaque-related major adverse cardiovascular events (MACEs). Materials and Methods In this multicenter prospective cohort study, from November 2017 to January 2019, individuals diagnosed with NSTE ACS (excluding those at very high risk) were enrolled and underwent CCTA before invasive coronary angiography (ICA) within 1 day. Lipid core was defined as areas with attenuation less than 30 HU in plaques. MACEs were defined as cardiac death, myocardial infarction, hospitalization for unstable angina, and revascularization. Participants were followed up at 6 months, 12 months, and annually thereafter for at least 3 years (ending by July 2022). Multivariable analysis using Cox proportional hazards regression models was performed to determine the association between lipid core burden, lipid core volume, and future nonrevascularized plaque-related MACEs at both the participant and plaque levels. Results A total of 342 participants (mean age, 57.9 years ± 11.1 [SD]; 263 male) were included for analysis with a median follow-up period of 4.0 years (IQR, 3.6-4.4 years). The 4-year nonrevascularized plaque-related MACE rate was 23.9% (95% CI: 19.1, 28.5). Lipid core burden (hazard ratio [HR], 12.6; 95% CI: 4.6, 34.3) was an independent predictor at the participant level, with an optimum threshold of 2.8%. Lipid core burden (HR, 12.1; 95% CI: 6.6, 22.3) and volume (HR, 11.0; 95% CI: 6.5, 18.4) were independent predictors at the plaque level, with an optimum threshold of 7.2% and 10.1 mm3, respectively. Conclusion In NSTE ACS, quantitative analysis of plaque lipid content at CCTA independently predicted participants and plaques at higher risk for future nonrevascularized plaque-related MACEs. Chinese Clinical Trial Registry no. ChiCTR1800018661 © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Tavakoli and Duman in this issue.
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Affiliation(s)
- Zhong-Fei Lu
- From the Department of Radiology (Z.F.L., W.H.Y., J.W.M., L.Z., Y.Q.A., B.L.), NHC Key Laboratory of Clinical Research for Cardiovascular Medications (X.M.S.), and Medical Research & Biometrics Center (C.S.W.), State Key Laboratory of Cardiovascular Disease, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, #167 Bei-Li-Shi Street, Beijing 100037, People's Republic of China; Departments of Radiology (Z.F.L.) and Cardiology (Z.C.X.), Yantai Yuhuangding Hospital, Qingdao University, Yantai, People's Republic of China; Department of Radiology and Radiological Science and Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (U.J.S., S.A.); and CT Collaboration, Siemens Healthineers, Beijing, People's Republic of China (X.B.Y.)
| | - Wei-Hua Yin
- From the Department of Radiology (Z.F.L., W.H.Y., J.W.M., L.Z., Y.Q.A., B.L.), NHC Key Laboratory of Clinical Research for Cardiovascular Medications (X.M.S.), and Medical Research & Biometrics Center (C.S.W.), State Key Laboratory of Cardiovascular Disease, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, #167 Bei-Li-Shi Street, Beijing 100037, People's Republic of China; Departments of Radiology (Z.F.L.) and Cardiology (Z.C.X.), Yantai Yuhuangding Hospital, Qingdao University, Yantai, People's Republic of China; Department of Radiology and Radiological Science and Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (U.J.S., S.A.); and CT Collaboration, Siemens Healthineers, Beijing, People's Republic of China (X.B.Y.)
| | - U Joseph Schoepf
- From the Department of Radiology (Z.F.L., W.H.Y., J.W.M., L.Z., Y.Q.A., B.L.), NHC Key Laboratory of Clinical Research for Cardiovascular Medications (X.M.S.), and Medical Research & Biometrics Center (C.S.W.), State Key Laboratory of Cardiovascular Disease, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, #167 Bei-Li-Shi Street, Beijing 100037, People's Republic of China; Departments of Radiology (Z.F.L.) and Cardiology (Z.C.X.), Yantai Yuhuangding Hospital, Qingdao University, Yantai, People's Republic of China; Department of Radiology and Radiological Science and Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (U.J.S., S.A.); and CT Collaboration, Siemens Healthineers, Beijing, People's Republic of China (X.B.Y.)
| | - Sameer Abrol
- From the Department of Radiology (Z.F.L., W.H.Y., J.W.M., L.Z., Y.Q.A., B.L.), NHC Key Laboratory of Clinical Research for Cardiovascular Medications (X.M.S.), and Medical Research & Biometrics Center (C.S.W.), State Key Laboratory of Cardiovascular Disease, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, #167 Bei-Li-Shi Street, Beijing 100037, People's Republic of China; Departments of Radiology (Z.F.L.) and Cardiology (Z.C.X.), Yantai Yuhuangding Hospital, Qingdao University, Yantai, People's Republic of China; Department of Radiology and Radiological Science and Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (U.J.S., S.A.); and CT Collaboration, Siemens Healthineers, Beijing, People's Republic of China (X.B.Y.)
| | - Jing-Wen Ma
- From the Department of Radiology (Z.F.L., W.H.Y., J.W.M., L.Z., Y.Q.A., B.L.), NHC Key Laboratory of Clinical Research for Cardiovascular Medications (X.M.S.), and Medical Research & Biometrics Center (C.S.W.), State Key Laboratory of Cardiovascular Disease, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, #167 Bei-Li-Shi Street, Beijing 100037, People's Republic of China; Departments of Radiology (Z.F.L.) and Cardiology (Z.C.X.), Yantai Yuhuangding Hospital, Qingdao University, Yantai, People's Republic of China; Department of Radiology and Radiological Science and Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (U.J.S., S.A.); and CT Collaboration, Siemens Healthineers, Beijing, People's Republic of China (X.B.Y.)
| | - Xian-Bo Yu
- From the Department of Radiology (Z.F.L., W.H.Y., J.W.M., L.Z., Y.Q.A., B.L.), NHC Key Laboratory of Clinical Research for Cardiovascular Medications (X.M.S.), and Medical Research & Biometrics Center (C.S.W.), State Key Laboratory of Cardiovascular Disease, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, #167 Bei-Li-Shi Street, Beijing 100037, People's Republic of China; Departments of Radiology (Z.F.L.) and Cardiology (Z.C.X.), Yantai Yuhuangding Hospital, Qingdao University, Yantai, People's Republic of China; Department of Radiology and Radiological Science and Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (U.J.S., S.A.); and CT Collaboration, Siemens Healthineers, Beijing, People's Republic of China (X.B.Y.)
| | - Li Zhao
- From the Department of Radiology (Z.F.L., W.H.Y., J.W.M., L.Z., Y.Q.A., B.L.), NHC Key Laboratory of Clinical Research for Cardiovascular Medications (X.M.S.), and Medical Research & Biometrics Center (C.S.W.), State Key Laboratory of Cardiovascular Disease, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, #167 Bei-Li-Shi Street, Beijing 100037, People's Republic of China; Departments of Radiology (Z.F.L.) and Cardiology (Z.C.X.), Yantai Yuhuangding Hospital, Qingdao University, Yantai, People's Republic of China; Department of Radiology and Radiological Science and Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (U.J.S., S.A.); and CT Collaboration, Siemens Healthineers, Beijing, People's Republic of China (X.B.Y.)
| | - Xiao-Ming Su
- From the Department of Radiology (Z.F.L., W.H.Y., J.W.M., L.Z., Y.Q.A., B.L.), NHC Key Laboratory of Clinical Research for Cardiovascular Medications (X.M.S.), and Medical Research & Biometrics Center (C.S.W.), State Key Laboratory of Cardiovascular Disease, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, #167 Bei-Li-Shi Street, Beijing 100037, People's Republic of China; Departments of Radiology (Z.F.L.) and Cardiology (Z.C.X.), Yantai Yuhuangding Hospital, Qingdao University, Yantai, People's Republic of China; Department of Radiology and Radiological Science and Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (U.J.S., S.A.); and CT Collaboration, Siemens Healthineers, Beijing, People's Republic of China (X.B.Y.)
| | - Chuang-Shi Wang
- From the Department of Radiology (Z.F.L., W.H.Y., J.W.M., L.Z., Y.Q.A., B.L.), NHC Key Laboratory of Clinical Research for Cardiovascular Medications (X.M.S.), and Medical Research & Biometrics Center (C.S.W.), State Key Laboratory of Cardiovascular Disease, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, #167 Bei-Li-Shi Street, Beijing 100037, People's Republic of China; Departments of Radiology (Z.F.L.) and Cardiology (Z.C.X.), Yantai Yuhuangding Hospital, Qingdao University, Yantai, People's Republic of China; Department of Radiology and Radiological Science and Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (U.J.S., S.A.); and CT Collaboration, Siemens Healthineers, Beijing, People's Republic of China (X.B.Y.)
| | - Yun-Qiang An
- From the Department of Radiology (Z.F.L., W.H.Y., J.W.M., L.Z., Y.Q.A., B.L.), NHC Key Laboratory of Clinical Research for Cardiovascular Medications (X.M.S.), and Medical Research & Biometrics Center (C.S.W.), State Key Laboratory of Cardiovascular Disease, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, #167 Bei-Li-Shi Street, Beijing 100037, People's Republic of China; Departments of Radiology (Z.F.L.) and Cardiology (Z.C.X.), Yantai Yuhuangding Hospital, Qingdao University, Yantai, People's Republic of China; Department of Radiology and Radiological Science and Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (U.J.S., S.A.); and CT Collaboration, Siemens Healthineers, Beijing, People's Republic of China (X.B.Y.)
| | - Zhi-Cheng Xiao
- From the Department of Radiology (Z.F.L., W.H.Y., J.W.M., L.Z., Y.Q.A., B.L.), NHC Key Laboratory of Clinical Research for Cardiovascular Medications (X.M.S.), and Medical Research & Biometrics Center (C.S.W.), State Key Laboratory of Cardiovascular Disease, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, #167 Bei-Li-Shi Street, Beijing 100037, People's Republic of China; Departments of Radiology (Z.F.L.) and Cardiology (Z.C.X.), Yantai Yuhuangding Hospital, Qingdao University, Yantai, People's Republic of China; Department of Radiology and Radiological Science and Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (U.J.S., S.A.); and CT Collaboration, Siemens Healthineers, Beijing, People's Republic of China (X.B.Y.)
| | - Bin Lu
- From the Department of Radiology (Z.F.L., W.H.Y., J.W.M., L.Z., Y.Q.A., B.L.), NHC Key Laboratory of Clinical Research for Cardiovascular Medications (X.M.S.), and Medical Research & Biometrics Center (C.S.W.), State Key Laboratory of Cardiovascular Disease, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, #167 Bei-Li-Shi Street, Beijing 100037, People's Republic of China; Departments of Radiology (Z.F.L.) and Cardiology (Z.C.X.), Yantai Yuhuangding Hospital, Qingdao University, Yantai, People's Republic of China; Department of Radiology and Radiological Science and Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (U.J.S., S.A.); and CT Collaboration, Siemens Healthineers, Beijing, People's Republic of China (X.B.Y.)
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Rocheleau S, Eng-Frost J, Lambrakis K, Khan E, Chiang B, Wattchow N, Steele S, Lorensini S, Lehman SJ, Papendick C, Chew DP. Twelve-Month Outcomes of Patients With Myocardial Injury not Due to Type-1 Myocardial Infarction. Heart Lung Circ 2023; 32:978-985. [PMID: 37225600 DOI: 10.1016/j.hlc.2023.04.299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 03/14/2023] [Accepted: 04/20/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Diagnosis of acute myocardial infarction (AMI) requires a combination of elevated cardiac troponins, and clinical or echocardiographic evidence of coronary ischaemia. Identification of patients with a high likelihood of coronary plaque rupture (Type 1 myocardial infarction [MI]) is crucial as it is these patients for whom coronary intervention has been well-established to provide benefit and reduce subsequent coronary ischemic events. However, high-sensitivity cardiac troponin (hs-cTn) assays have increasingly identified patients with hs-cTn elevations not due to Type 1 MI where recommendations for ongoing care are currently limited. Understanding the profile and clinical outcomes for these patients may inform the development of an emerging evidence-base. METHODS Using two previously published studies (hs-cTnT study n=1,937, RAPID-TnT study n=3,270) and the Fourth Universal Definition of MI, index presentations of patients to South Australian emergency departments with suspected AMI, defined by high sensitivity cardiac troponin T (hs-cTnT) greater than the upper reference limit (14 ng/L) and without obvious corresponding ischaemia on electrocardiogram (ECG), were classified as either Type 1 MI (T1MI), Type 2 MI (T2MI), acute myocardial injury (AI), or chronic myocardial injury (CI). Patients with non-elevated hs-cTnT (defined as <14 ng/L) were excluded. Outcomes assessed included death, MI, unstable angina, and non-coronary cardiovascular events within 12 months. RESULTS In total, 1,192 patients comprising 164 (13.8%) T1MI, 173 (14.5%) T2MI/AI, and 855 (71.7%) CI were included. The rate of death or recurrent acute coronary syndrome was greatest in patients with T1MI, but also occurred with moderate frequency in Type 2 MI/AI and CI (T1MI: 32/164 [19.5%]; T2MI/AI: 24/173 [13.1%]; CI:116/885 [13.6%]; p=0.008). Of all the deaths observed, 74% occurred among those with an initial index diagnostic classification of CI. After adjusting for age, gender and baseline comorbidities, the relative hazard ratios for non-coronary cardiovascular readmissions were similar across all groups: Type 2 MI/AI: 1.30 (95% confidence interval 0.99-1.72, p=0.062); CI: 1.10 (95% confidence interval 0.61-2.00, p=0.75). CONCLUSIONS Non-T1MI accounted for the majority of patients presenting with elevated hs-cTnT without ischaemia on ECG. Patients with T1MI had the highest rates of death or recurrent AMI; however patients with T2MI/AI and CI experienced a substantial rate of non-coronary cardiovascular re-hospitalisations.
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Affiliation(s)
- Simon Rocheleau
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, SA, Australia
| | - Joanne Eng-Frost
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, SA, Australia
| | - Kristina Lambrakis
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, SA, Australia; South Australian Department of Health, Adelaide, SA, Australia
| | - Ehsan Khan
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, SA, Australia
| | - Brian Chiang
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, SA, Australia
| | - Naomi Wattchow
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, SA, Australia
| | - Simon Steele
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, SA, Australia
| | - Scott Lorensini
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, SA, Australia
| | - Sam J Lehman
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, SA, Australia; South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | | | - Derek P Chew
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, SA, Australia; South Australian Health and Medical Research Institute, Adelaide, SA, Australia; South Australian Department of Health, Adelaide, SA, Australia.
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Xu M, Yang F, Shen B, Wang J, Niu W, Chen H, Li N, Chen W, Wang Q, HE Z, Ding R. A bibliometric analysis of acute myocardial infarction in women from 2000 to 2022. Front Cardiovasc Med 2023; 10:1090220. [PMID: 37576112 PMCID: PMC10416645 DOI: 10.3389/fcvm.2023.1090220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 06/01/2023] [Indexed: 08/15/2023] Open
Abstract
Background Plenty of publications had been written in the last several decades on acute myocardial infarction (AMI) in women. However, there are few bibliometric analyses in such field. In order to solve this problem, we attempted to examine the knowledge structure and development of research about AMI in women based on analysis of related publications. Method The Web of Science Core Collection was used to extract all publications regarding AMI in women, ranging from January 2000 to August 2022. Bibliometric analysis was performed using VOSviewer, Cite Space, and an online bibliometric analysis platform. Results A total of 14,853 publications related to AMI in women were identified from 2000 to 2022. Over the past 20 years, the United States had published the most articles in international research and participated in international cooperation the most frequently. The primary research institutions were Harvard University and University of Toronto. Circulation was the most cited journal and had an incontrovertible academic impact. 67,848 authors were identified, among which Harlan M Krumholz had the most significant number of articles and Thygesen K was co-cited most often. And the most common keywords included risk factors, disease, prognosis, mortality, criteria and algorithm. Conclusion The research hotspots and trends of AMI in women were identified and explored using bibliometric and visual methods. Researches about AMI in women are flourishing. Criteria and algorithms might be the focus of research in the near future, which deserved great attentions.
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Affiliation(s)
- Ming Xu
- Department of Cardiology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
- Shanghai Cardiovascular Institute of Integrative Medicine, Shanghai, China
- Department of Cardiology, Shanghai Navy Feature Medical Center, Naval Medical University, Shanghai, China
| | - Fupeng Yang
- Department of Cardiology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
- Shanghai Cardiovascular Institute of Integrative Medicine, Shanghai, China
| | - Bin Shen
- Department of Cardiology, Shanghai Navy Feature Medical Center, Naval Medical University, Shanghai, China
| | - Jiamei Wang
- Department of Cardiology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
- Shanghai Cardiovascular Institute of Integrative Medicine, Shanghai, China
| | - Wenhao Niu
- Department of Cardiology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
- Shanghai Cardiovascular Institute of Integrative Medicine, Shanghai, China
| | - Hui Chen
- Department of Cardiology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
- Shanghai Cardiovascular Institute of Integrative Medicine, Shanghai, China
| | - Na Li
- Department of Cardiology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
- Shanghai Cardiovascular Institute of Integrative Medicine, Shanghai, China
| | - Wei Chen
- Department of Cardiology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
- Shanghai Cardiovascular Institute of Integrative Medicine, Shanghai, China
| | - Qinqin Wang
- Department of Cardiology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
- Shanghai Cardiovascular Institute of Integrative Medicine, Shanghai, China
| | - Zhiqing HE
- Department of Cardiology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
- Shanghai Cardiovascular Institute of Integrative Medicine, Shanghai, China
| | - Ru Ding
- Department of Cardiology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
- Shanghai Cardiovascular Institute of Integrative Medicine, Shanghai, China
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167
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Lyu YS, Oh S, Kim JH, Kim SY, Jeong MH. Comparison of SGLT2 inhibitors with DPP-4 inhibitors combined with metformin in patients with acute myocardial infarction and diabetes mellitus. Cardiovasc Diabetol 2023; 22:185. [PMID: 37481509 PMCID: PMC10362625 DOI: 10.1186/s12933-023-01914-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 07/03/2023] [Indexed: 07/24/2023] Open
Abstract
BACKGROUND Although sodium-glucose cotransporter 2 inhibitors (SGLT2i) have demonstrated cardiovascular benefits in patients with type 2 diabetes mellitus, real-world evidence regarding their benefits to diabetic patients with acute myocardial infarction (AMI) is insufficient. This study evaluated cardiovascular outcomes by comparing SGLT2i with dipeptidyl peptidase-4 inhibitors (DPP-4i) in combination with metformin in diabetic patients with AMI. METHODS This study involved 779 diabetic participants with AMI from a Korean nationwide multicenter observational cohort, who were divided into two groups: (1) metformin plus SGLT2i group (SGLT2i group, n = 186) and (2) metformin plus DPP-4i (DPP-4i group, n = 593). The primary endpoint was one year of major adverse composite events (MACEs), a composite outcome of all-cause mortality, non-fatal myocardial infarction, any revascularization, cerebrovascular accident, and stent thrombosis. To balance the baseline differences, inverse probability of treatment weighting (IPTW) was performed. RESULTS After IPTW, the rate of MACEs in the SGLT2i group was not significantly lower than that in the DPP-4i group (hazard ratio [HR], 0.99; 95% confidence interval [Cl], 0.46 to 2.14, p = 0.983). In the unadjusted and adjusted analyses, all items for clinical outcomes were comparable between the two groups. In our exploratory analysis, the left ventricular ejection fraction showed a significant improvement in the SGLT2i group than in the DPP-4i group before achieving statistical balancing (6.10 ± 8.30 versus 2.95 ± 10.34, p = 0.007) and after IPTW adjustment (6.91 ± 8.91 versus 3.13 ± 10.41, p = 0.027). CONCLUSIONS Our findings demonstrated that SGLT2i did not influence the rate of MACEs compared with DPP-4i in combination with metformin in diabetic patients with AMI but did improve left ventricular ejection fraction. TRIAL REGISTRATION Not applicable (retrospectively registered).
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Affiliation(s)
- Young Sang Lyu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chosun University Hospital, Gwangju, Republic of Korea
| | - Seok Oh
- Departmnent of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Jin Hwa Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chosun University Hospital, Gwangju, Republic of Korea
| | - Sang Yong Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chosun University Hospital, Gwangju, Republic of Korea
| | - Myung Ho Jeong
- Departmnent of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea.
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Republic of Korea.
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168
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Sun L, Zhao L, Yang K, Li Z, Wang Y, Wang T, Wang M, Zeng Y, Zhou X, Yang W. Serum total bilirubin and one-year prognosis of patients with coronary artery disease and psoriasis. iScience 2023; 26:107106. [PMID: 37416466 PMCID: PMC10320203 DOI: 10.1016/j.isci.2023.107106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 05/31/2023] [Accepted: 06/08/2023] [Indexed: 07/08/2023] Open
Abstract
To evaluate the potential predictive value of total bilirubin (TBIL) for one-year prognosis in patients with coronary artery disease (CAD) and psoriasis. 278 psoriasis patients who underwent coronary angiography and were diagnosed as CAD were recruited. Baseline TBIL was measured at admission. Patients were divided into three groups according to the third tertiles of TBIL. The coronary angiography showed that lower TBIL was associated with the severity of lesion calcification. After a mean follow-up of 315 days, major adverse cardiac and cerebrovascular events (MACCEs) were reported in 61 patients. Compared with patients with higher TBIL tertiles, the incidence of MACCEs increased significantly in patients with middle and lower TBIL tertiles. The incidence of MACCEs in one-year follow-up was significantly different between higher and lower tertiles. The findings indicate that decreased TBIL is a potential predictor of poor prognosis in patients with psoriasis and CAD.
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Affiliation(s)
- Lin Sun
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kunqi Yang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zuozhi Li
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tianjie Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Man Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Zeng
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xianliang Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weixian Yang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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169
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Friedman T, Leviner DB, Chan V, Yanagawa B, Orbach A, Natour AEH, Weis A, Sharoni E, Bolotin G. High sensitivity troponin-I threshold to predict perioperative myocardial infarction. J Cardiothorac Surg 2023; 18:234. [PMID: 37461085 PMCID: PMC10351123 DOI: 10.1186/s13019-023-02323-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 06/28/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND High-sensitivity Troponin I (hs-cTnI) has largely replaced conventional troponin assays in an effort to improve detection of myocardial infarction. However, the mean displacement of hs-cTnI following coronary artery bypass graft (CABG) and the optimal threshold to detect perioperative myocardial infarction (MI) is unclear. Our objective is to describe mean hs-cTnI values at 6-12 h post-CABG and to determine the highest specificity while maintaining 100% sensitivity hs-cTnI cut-off values for diagnosis of perioperative or type-5 MI. METHODS Between 2016 and 2018, 374 patients underwent non-emergent, isolated CABG. Pre-operative and 6 h post-operative hs-cTnI values were recorded as well as ECG, echocardiographic and angiographic data. RESULTS Of 374 patients, 151 (40.3%) had normal and 224 (59.7%) had elevated preoperative hs-cTnI. Patients with normal preoperative hs-cTnI had a mean 6 h hs-cTnI of 9193 ng/l or 270X the upper normal value. Eleven patients (7.3%) presented with post-operative MI with a mean 6 h hs-cTnI of 50,218 ng/l or 1477X the upper normal value. Patients with elevated preoperative hs-cTnI had a mean 6 h hs-cTnI of 9449 ng/l or 292X the upper normal value. Eleven patients (4.9%) who presented with post-operative MI had a mean 6 h hs-cTnI of 26,823 ng/l or 789X the upper normal value. CONCLUSIONS We suggest hs-cTnI threshold of 80-fold in patients with normal pre-operative hs-cTnI and 2.7-fold in patients with elevated pre-operative hs-cTnI. These results have important implications for perioperative care and for surgical trial reporting.
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Affiliation(s)
- Tom Friedman
- Department of Cardiac Surgery, Rambam Health Care Campus, Haifa, Israel.
| | - Dror B Leviner
- Department of Cardiothoracic Surgery, Carmel Medical Center, Haifa, Israel
| | - Veronica Chan
- Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Bobby Yanagawa
- Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Ady Orbach
- Department of Cardiology, Rambam Health Care Campus, Haifa, Israel
| | | | - Anastasia Weis
- Department of Cardiac Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Erez Sharoni
- Department of Cardiothoracic Surgery, Carmel Medical Center, Haifa, Israel
| | - Gil Bolotin
- Department of Cardiac Surgery, Rambam Health Care Campus, Haifa, Israel
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170
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Demirci G, Şahin AA, Aktemur T, Demir AR, Çetin İ, Arslan E, Işık A, Gürbak İ, Ertürk M. Relationship between systemic immune-inflammation index and no-reflow in percutaneous coronary intervention for saphenous grafts. Biomark Med 2023. [PMID: 37449860 DOI: 10.2217/bmm-2023-0208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Abstract
Objective: In this study, we investigated the occurrence of no-reflow (NR) in percutaneous coronary intervention (PCI) for saphenous vein grafts (SVGs) and its relationship with a new systemic immune-inflammation index (SII) that determines inflammation. Methods: We studied 303 patients with acute coronary syndrome without ST elevation who underwent PCI for SVG disease. Results: NR formation during SVG PCI was significantly higher in patients with high SII (p < 0.001). NR occurrence was 12.8% when SII was ≤548 and 41.9% when SII was >548. Conclusion: Our study is the first to investigate SII as the state of inflammation and its effect on the SVG PCI. Patients with higher SII have a higher risk of NR during an SVG for PCI.
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Affiliation(s)
- Gökhan Demirci
- University of Health Sciences, Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ahmet A Şahin
- Department of Cardiology, Istinye University, Liv Bahçeşehir Hospital, Istanbul, 34303, Turkey
| | - Tuğba Aktemur
- University of Health Sciences, Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ali R Demir
- University of Health Sciences, Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - İlyas Çetin
- University of Health Sciences, Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Enes Arslan
- University of Health Sciences, Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ayan Işık
- University of Health Sciences, Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - İsmail Gürbak
- University of Health Sciences, Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Ertürk
- University of Health Sciences, Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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171
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Akodad M, Meunier PA, Padovani C, Cayla G, Zitouni W, Macia JC, Robert P, Steinecker M, Roubille F, Leclercq F. Identification of Low- versus High-Risk Acute Coronary Syndrome for a Selective ECG Monitoring Strategy. J Clin Med 2023; 12:4604. [PMID: 37510718 PMCID: PMC10380550 DOI: 10.3390/jcm12144604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/13/2023] [Accepted: 07/09/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND While admission of patients with acute coronary syndromes (ACS) in cardiology intensive care unit (CICU) is usual, in-hospital major outcomes in lower risk patients may be evaluated after early coronary angiography according to the European guidelines. METHODS Consecutive ACS patients were prospectively included after coronary angiography evaluation within 24 h and percutaneous coronary intervention (PCI), when required. Patients were classified as high- or low-risk according to hemodynamics, rhythmic state, ischemic and bleeding risks. Major in-hospital outcomes were assessed. RESULTS From January to June 2021, 277 patients were enrolled (62.8% with ST-segment elevation myocardial infarction (STEMI) (n = 174); 37.2% with non-NSTEMI (NSTEMI) (n = 103). PCI was required for 260 patients (93.9%). Seventy-four patients (26.7%) were classified as low-risk (n = 47 NSTEMI; n= 27 STEMI) and 203 patients (73.3%) as high-risk of events. All patients were monitored in CICU. While 38 patients (18.7%) from the high-risk group reached the primary endpoint, mainly related to rhythmic or conduction disorder (n = 24, 11.8%) or unstable hemodynamics (n = 17; 8.4%), only 1 patient (1.3%) in the low-risk group had one major outcome (no fatal bleeding); p < 0.01. The negative predictive value of our patient stratification for the absence of major in-hospital outcome was 100% (CI95%: 100-100%) for STEMI and 97.9% [CI95%: 93.2-100%] for NSTEMI patients. CONCLUSIONS Stratification of ACS patients after early coronary angiography and most of the time PCI, identify a population with very low risk of in-hospital events (1/4 of all ACS and 1/2 of NSTEMI) who may probably not require ECG monitoring and/or CICU admission. (NCT04378504).
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Affiliation(s)
- Mariama Akodad
- South Paris Cardiovascular Institute, Jacques Cartie Hospital, 91300 Massy, France
| | - Pierre-Alain Meunier
- Department of Cardiology, University Hospital of Montpellier, 34295 Montpellier, France
| | - Caroline Padovani
- Department of Cardiology, University Hospital of Montpellier, 34295 Montpellier, France
| | - Guillaume Cayla
- Department of Cardiology, University Hospital of Nîmes, 30900 Nîmes, France
| | - Wassim Zitouni
- Department of Cardiology, University Hospital of Montpellier, 34295 Montpellier, France
| | - Jean-Christophe Macia
- Department of Cardiology, University Hospital of Montpellier, 34295 Montpellier, France
| | - Pierre Robert
- Department of Cardiology, University Hospital of Nîmes, 30900 Nîmes, France
| | - Matthieu Steinecker
- Department of Cardiology, University Hospital of Montpellier, 34295 Montpellier, France
| | - François Roubille
- Department of Cardiology, University Hospital of Montpellier, 34295 Montpellier, France
| | - Florence Leclercq
- Department of Cardiology, University Hospital of Montpellier, 34295 Montpellier, France
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172
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Christensen DM, Strange JE, Falkentoft AC, El-Chouli M, Ravn PB, Ruwald AC, Fosbøl E, Køber L, Gislason G, Sehested TSG, Schou M. Frailty, Treatments, and Outcomes in Older Patients With Myocardial Infarction: A Nationwide Registry-Based Study. J Am Heart Assoc 2023:e030561. [PMID: 37421279 PMCID: PMC10382124 DOI: 10.1161/jaha.123.030561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 05/30/2023] [Indexed: 07/10/2023]
Abstract
Background Guidelines recommend that patients with myocardial infarction (MI) receive equal care regardless of age. However, withholding treatment may be justified in elderly and frail patients. This study aimed to investigate trends in treatments and outcomes of older patients with MI according to frailty. Methods and Results All patients aged ≥75 years with first-time MI during 2002 to 2021 were identified through Danish nationwide registries. Frailty was categorized using the Hospital Frailty Risk Score. One-year risk and hazard ratios (HRs) for days 0 to 28 and 29 to 365 were calculated for all-cause death. A total of 51 022 patients with MI were included (median, 82 years; 50.2% women). Intermediate/high frailty increased from 26.7% in 2002 to 2006 to 37.1% in 2017 to 2021. Use of treatment increased substantially regardless of frailty: for example, 28.1% to 48.0% (statins), 21.8% to 33.7% (dual antiplatelet therapy), and 7.6% to 28.0% (percutaneous coronary intervention) for high frailty (all P-trend <0.001). One-year death decreased for low frailty (35.1%-17.9%), intermediate frailty (49.8%-31.0%), and high frailty (62.8%-45.6%), all P-trend <0.001. Age- and sex-adjusted 29- to 365-day HRs (2017-2021 versus 2002-2006) were 0.53 (0.48-0.59), 0.62 (0.55-0.70), and 0.62 (0.46-0.83) for low, intermediate, and high frailty, respectively (P-interaction=0.23). When additionally adjusted for treatment, HRs attenuated to 0.74 (0.67-0.83), 0.83 (0.74-0.94), and 0.78 (0.58-1.05), respectively, indicating that increased use of treatment may account partially for the observed improvements. Conclusions Use of guideline-based treatments and outcomes improved concomitantly in older patients with MI, irrespective of frailty. These results indicate that guideline-based management of MI may be reasonable in the elderly and frail.
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Affiliation(s)
| | - Jarl Emanuel Strange
- Department of Cardiology Herlev and Gentofte University Hospital Copenhagen Denmark
- Department of Cardiology Rigshospitalet Copenhagen Denmark
| | | | | | - Pauline B Ravn
- Department of Cardiology Zealand University Hospital Roskilde Roskilde Denmark
| | | | - Emil Fosbøl
- Department of Cardiology Rigshospitalet Copenhagen Denmark
| | - Lars Køber
- Department of Cardiology Rigshospitalet Copenhagen Denmark
| | - Gunnar Gislason
- Danish Heart Foundation Copenhagen Denmark
- Department of Cardiology Herlev and Gentofte University Hospital Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
- The National Institute of Public Health University of Southern Denmark Copenhagen Denmark
| | - Thomas S G Sehested
- Danish Heart Foundation Copenhagen Denmark
- Department of Cardiology Zealand University Hospital Roskilde Roskilde Denmark
| | - Morten Schou
- Department of Cardiology Herlev and Gentofte University Hospital Copenhagen Denmark
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173
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Hogea T, Suciu BA, Chinezu L, Brinzaniuc K, Arbănași EM, Ungureanu A, Kaller R, Carașca C, Arbănași EM, Vunvulea V, Hălmaciu I, Mureșan AV, Russu E, Ciucanu CC, Radu CM, Radu CC. Pregnancy-Associated Spontaneous Coronary Acute Dissection as a Cause of Sudden Cardiac Death-Autopsy Findings and Literature Review: Is COVID-19 Related? MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1257. [PMID: 37512074 PMCID: PMC10386237 DOI: 10.3390/medicina59071257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/25/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023]
Abstract
Sudden cardiac death (SCD) is the leading cause of mortality globally (violent or non-violent), with few to no feasible remedies. The etiopathogenesis of SCD involves a complex and multilayered substrate in which dynamic factors interact with a preexistent cardiovascular pathology, which is often undiagnosed and untreated, leading to the rapid development of cardiac rhythm disorders and cardiac arrest. Cardiovascular disease is a rare but emerging factor in maternal mortality that can be justified by an upward trend in the mean age of pregnant individuals. Spontaneous coronary artery dissection (SCAD) is defined as a non-traumatic and non-iatrogenic separation of the coronary arterial wall by intramural hemorrhage with or without an intimal tear. The resulting intramural hematoma compresses the coronary arteries, reducing blood flow and causing myocardial ischemia. SCAD continues to be misdiagnosed, underdiagnosed, and managed as an atherosclerotic acute coronary syndrome, which may harm patients with SCAD. The latest research shows that individuals who have or have had coronavirus disease 2019 (COVID-19) may also present coagulation abnormalities, so infection with COVID-19 during pregnancy can increase this hypercoagulable condition, thus increasing the risk of SCAD and SCD. This present study reports two cases over 35 years, one being infected with SARS-COV2 one month before the event and the other being tested positive during admission, both asymptomatic, who were declared healthy on periodic clinical evaluations, with pregnancies over 35 weeks, with normal fetal development, which suddenly caused chest pain, dyspnea, and loss of consciousness, required emergency c-sections, and died suddenly after they were performed. In both cases, the cause of death was SCAD on the anterior-descending artery. In both cases, emergency percutaneous coronary intervention was performed. The second part of the study represents a literature overview of SCAD during COVID-19. In addition to pregnancy hormonal changes, other potential hormone-mediated SCAD triggers are still under discussion.
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Affiliation(s)
- Timur Hogea
- Department of Forensic Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
- Institute of Forensic Medicine, 540141 Targu Mures, Romania
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Bogdan Andrei Suciu
- Department of Anatomy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Laura Chinezu
- Institute of Forensic Medicine, 540141 Targu Mures, Romania
- Department of Histology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Klara Brinzaniuc
- Department of Anatomy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Emil Marian Arbănași
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
- Department of Anatomy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
- Department of Vascular Surgery, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Ancuța Ungureanu
- Epidemiology Clinic, Mures County Hospital, 540072 Targu Mures, Romania
| | - Réka Kaller
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
| | - Cosmin Carașca
- Department of Forensic Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
- Institute of Forensic Medicine, 540141 Targu Mures, Romania
| | - Eliza Mihaela Arbănași
- Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Vlad Vunvulea
- Department of Anatomy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
- Department of Radiology, Mures County Emergency Hospital, 540136 Targu Mures, Romania
| | - Ioana Hălmaciu
- Institute of Forensic Medicine, 540141 Targu Mures, Romania
- Department of Radiology, Mures County Emergency Hospital, 540136 Targu Mures, Romania
| | - Adrian Vasile Mureșan
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
- Department of Vascular Surgery, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Eliza Russu
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
- Department of Vascular Surgery, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
| | | | - Casandra Maria Radu
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 1 University Street, 410087 Oradea, Romania
| | - Carmen Corina Radu
- Department of Forensic Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
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Bordin DS, Livzan MA, Gaus OV, Mozgovoi SI, Lanas A. Drug-Associated Gastropathy: Diagnostic Criteria. Diagnostics (Basel) 2023; 13:2220. [PMID: 37443618 DOI: 10.3390/diagnostics13132220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/30/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
Drugs are widely used to treat different diseases in modern medicine, but they are often associated with adverse events. Those located in the gastrointestinal tract are common and often mild, but they can be serious or life-threatening and determine the continuation of treatment. The stomach is often affected not only by drugs taken orally but also by those administered parenterally. Here, we review the mechanisms of damage, risk factors and specific endoscopic, histopathological and clinical features of those drugs more often involved in gastric damage, namely NSAIDs, aspirin, anticoagulants, glucocorticosteroids, anticancer drugs, oral iron preparations and proton pump inhibitors. NSAID- and aspirin-associated forms of gastric damage are widely studied and have specific features, although they are often hidden by the coexistence of Helicobacter pylori infection. However, the damaging effect of anticoagulants and corticosteroids or oral iron therapy on the gastric mucosa is controversial. At the same time, the increased use of new antineoplastic drugs, such as checkpoint inhibitors, has opened up a new area of gastrointestinal damage that will be seen more frequently in the near future. We conclude that there is a need to expand and understand drug-induced gastrointestinal damage to prevent and recognize drug-associated gastropathy in a timely manner.
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Affiliation(s)
- Dmitry S Bordin
- A.S. Loginov Moscow Clinical Scientific Center, Department of Pancreatic, Biliary and Upper Digestive Tract Disorders, 111123 Moscow, Russia
- Department of Propaedeutic of Internal Diseases and Gastroenterology, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, 127473 Moscow, Russia
- Department of Outpatient Therapy and Family Medicine, Tver State Medical University, 170100 Tver, Russia
| | - Maria A Livzan
- Department of Faculty Therapy and Gastroenterology, Omsk Sate Medical University, 644099 Omsk, Russia
| | - Olga V Gaus
- Department of Faculty Therapy and Gastroenterology, Omsk Sate Medical University, 644099 Omsk, Russia
| | - Sergei I Mozgovoi
- Department of Pathological Anatomy, Omsk Sate Medical University, 644099 Omsk, Russia
| | - Angel Lanas
- Digestive Diseases Service, Aragón Health Research Institute (IIS Aragón), University Clinic Hospital, University of Zaragoza, 50009 Zaragoza, Spain
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175
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Padmanabhan S, du Toit C, Dominiczak AF. Cardiovascular precision medicine - A pharmacogenomic perspective. CAMBRIDGE PRISMS. PRECISION MEDICINE 2023; 1:e28. [PMID: 38550953 PMCID: PMC10953758 DOI: 10.1017/pcm.2023.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/24/2023] [Accepted: 06/12/2023] [Indexed: 05/16/2024]
Abstract
Precision medicine envisages the integration of an individual's clinical and biological features obtained from laboratory tests, imaging, high-throughput omics and health records, to drive a personalised approach to diagnosis and treatment with a higher chance of success. As only up to half of patients respond to medication prescribed following the current one-size-fits-all treatment strategy, the need for a more personalised approach is evident. One of the routes to transforming healthcare through precision medicine is pharmacogenomics (PGx). Around 95% of the population is estimated to carry one or more actionable pharmacogenetic variants and over 75% of adults over 50 years old are on a prescription with a known PGx association. Whilst there are compelling examples of pharmacogenomic implementation in clinical practice, the case for cardiovascular PGx is still evolving. In this review, we shall summarise the current status of PGx in cardiovascular diseases and look at the key enablers and barriers to PGx implementation in clinical practice.
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Affiliation(s)
- Sandosh Padmanabhan
- BHF Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Clea du Toit
- BHF Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Anna F. Dominiczak
- BHF Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
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Savovic Z, Pindovic B, Nikolic M, Simic I, Davidovic G, Ignjatovic V, Vuckovic J, Zornic N, Nikolic Turnic T, Zivkovic V, Srejovic I, Bolevich S, Jakovljevic V, Iric Cupic V. Prognostic Value of Redox Status Biomarkers in Patients Presenting with STEMI or Non-STEMI: A Prospective Case-Control Clinical Study. J Pers Med 2023; 13:1050. [PMID: 37511663 PMCID: PMC10381258 DOI: 10.3390/jpm13071050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/26/2023] [Accepted: 06/21/2023] [Indexed: 07/30/2023] Open
Abstract
(1) Background: The aim of our study was to determine the role of oxidative stress (OS) during early evaluation of acute ST-elevated myocardial infarction (STEMI) and non-ST-elevated myocardial infarction (NSTEMI) patients in order to define the role of redox balance in profiling the development of myocardial infarction (MI). (2) Methods: This prospective observational case-control study included 40 consecutive STEMI and 39 NSTEMI patients hospitalized in the coronary care unit of the cardiology clinic at the Kragujevac Clinical Center, Serbia, between 1 January 2016 and 1 January 2017. Blood samples were collected from all patients for measuring cardio-specific enzymes at admission and 12 h after admission to evaluate systemic oxidative stress biomarkers and the activity of antioxidant enzymes. (3) Results: In this study, participants were predominately female (52%), with a mean age of 56.17 ± 1.22 years old in the STEMI group and 69.17 ± 3.65 in the non-STEMI group. According to the Killip classification, the majority of patients (>50%) were at the second and third level. We confirmed the elevation of superoxide anion radicals in the non-STEMI group 6 h after admission in comparison with the STEMI and CTRL groups, but levels had decreased 12 h after admission. Levels of hydrogen peroxide were statistically significantly increased in the NSTEMI group. A positive correlation of superoxide anion radicals and levels of troponin I at admission was observed (r = 0.955; p = 0.045), as well as an inverse correlation between reduced glutathione and levels of NT-pBNP measured 6 h after admission (r = -0.973; p = 0.027). (4) Conclusions: We confirmed that superoxide anion radicals and reduced glutathione observed together with hs-troponin I at admission and NT-pBNP during hospital treatment could be predictors of ST evolution.
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Affiliation(s)
- Zorica Savovic
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (Z.S.)
| | - Bozidar Pindovic
- Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Maja Nikolic
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Ivan Simic
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (Z.S.)
- Department of Cardiology, University Clinical Center Kragujevac, 34000 Kragujevac, Serbia
| | - Goran Davidovic
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (Z.S.)
- Department of Cardiology, University Clinical Center Kragujevac, 34000 Kragujevac, Serbia
| | - Vladimir Ignjatovic
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (Z.S.)
- Department of Cardiology, University Clinical Center Kragujevac, 34000 Kragujevac, Serbia
| | - Jelena Vuckovic
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (Z.S.)
- Department of Cardiology, University Clinical Center Kragujevac, 34000 Kragujevac, Serbia
| | - Nenad Zornic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Tamara Nikolic Turnic
- Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
- N.A. Semashko Public Health and Healthcare Department, F. F. Erismann Institute of Public Health, I. M. Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia
- Center of Excellence for Redox Balance Research in Cardiovascular and Metabolic Disorders, 34000 Kragujevac, Serbia
| | - Vladimir Zivkovic
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
- Center of Excellence for Redox Balance Research in Cardiovascular and Metabolic Disorders, 34000 Kragujevac, Serbia
- Department of Clinical Pharmacology, I. M. Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia
| | - Ivan Srejovic
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
- Center of Excellence for Redox Balance Research in Cardiovascular and Metabolic Disorders, 34000 Kragujevac, Serbia
- Department of Clinical Pharmacology, I. M. Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia
| | - Sergej Bolevich
- Department of Human Pathology, 1st Moscow State Medical, University I. M. Sechenov, 119991 Moscow, Russia
| | - Vladimir Jakovljevic
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
- Center of Excellence for Redox Balance Research in Cardiovascular and Metabolic Disorders, 34000 Kragujevac, Serbia
- Department of Human Pathology, 1st Moscow State Medical, University I. M. Sechenov, 119991 Moscow, Russia
| | - Violeta Iric Cupic
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (Z.S.)
- Department of Cardiology, University Clinical Center Kragujevac, 34000 Kragujevac, Serbia
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177
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Gou Q, Liang L, Liu D, Jia J, Dong M, Chen H, Shou X. Clinical performance of 0/1 h cardiac troponin algorithm for diagnosing non-ST-segment elevation myocardial infarction in an emergency setting. Am J Emerg Med 2023; 71:139-143. [PMID: 37392513 DOI: 10.1016/j.ajem.2023.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/12/2023] [Accepted: 06/17/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND Non-ST-segment elevation myocardial infarction (NSTEMI) is a common form of acute myocardial infarction and rapid and accurate diagnosis is crucial for timely treatment. Current guidelines recommend using high-sensitivity cardiac troponin (hs-cTn) assays to determine circulating cTnI or cTnT levels. While the accuracy of the 0 h/1 h algorithm for diagnosing NSTEMI in different regions and patient populations remains controversial. Additionally, point-of-care testing (POCT) cTn assays have the potential to provide troponin readings to physicians within 15 min, but their accuracy in diagnosing NSTEMI in the emergency department (ED) requires further investigation. METHODS A single-center prospective observational cohort study was conducted at Shaanxi Provincial People's Hospital to assess the analytical and diagnostic performance of the laboratory-based Roche Modular E170 hs-cTnT using the 0 h/1 h algorithm with Radiometer AQT90-flex POCT cTnT assay in undifferentiated chest pain patients presenting to the ED. Whole-blood samples were collected and hs-cTnT and POCT cTnI were measured simultaneously at baseline and after 1 h. RESULTS The study results showed that the POCT cTnT assay using the 0 h/1 h algorithm had comparable diagnostic accuracy to the laboratory-based Roche Modular E170 hs-cTnT assay in diagnosing NSTEMI in patients with chest pain. CONCLUSION The laboratory-based Roche Modular E170 hs-cTnT using the 0 h/1 h algorithm is reliable and accurate method for diagnosing NSTEMI in undifferentiated chest pain patients presenting to the ED. POCT cTnT assay has comparable diagnostic accuracy to the hs-cTnT assay and its rapid turnaround time makes it a valuable tool in expediting the diagnostic workup of chest pain patients.
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Affiliation(s)
- Qiling Gou
- Department of Cardiovascular Medicine, Shaanxi Provincial People's Hospital, Xi'an 710032, Shaanxi, China
| | - Linyuan Liang
- Department of Cardiovascular Medicine, Xi'an international medical center hospital, Xi'an 710032, Shaanxi, China
| | - Danping Liu
- Department of Emergency Medicine, Shaanxi Provincial People's Hospital, Xi'an 710032, Shaanxi, China
| | - Jia Jia
- Department of Emergency Medicine, Shaanxi Provincial People's Hospital, Xi'an 710032, Shaanxi, China
| | - Mengya Dong
- Department of Cardiovascular Medicine, Shaanxi Provincial People's Hospital, Xi'an 710032, Shaanxi, China
| | - Haichao Chen
- Department of Cardiovascular Medicine, Shaanxi Provincial People's Hospital, Xi'an 710032, Shaanxi, China.
| | - Xiling Shou
- Department of Cardiovascular Medicine, Shaanxi Provincial People's Hospital, Xi'an 710032, Shaanxi, China.
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178
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Gale CP, Stocken DD, Aktaa S, Reynolds C, Gilberts R, Brieger D, Carruthers K, Chew DP, Goodman SG, Fernandez C, Sharples LD, Yan AT, Fox K. Effectiveness of GRACE risk score in patients admitted to hospital with non-ST elevation acute coronary syndrome (UKGRIS): parallel group cluster randomised controlled trial. BMJ 2023; 381:e073843. [PMID: 37315959 PMCID: PMC10265221 DOI: 10.1136/bmj-2022-073843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/10/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To determine the effectiveness of risk stratification using the Global Registry of Acute Coronary Events (GRACE) risk score (GRS) for patients presenting to hospital with suspected non-ST elevation acute coronary syndrome. DESIGN Parallel group cluster randomised controlled trial. SETTING Patients presenting with suspected non-ST elevation acute coronary syndrome to 42 hospitals in England between 9 March 2017 and 30 December 2019. PARTICIPANTS Patients aged ≥18 years with a minimum follow-up of 12 months. INTERVENTION Hospitals were randomised (1:1) to patient management by standard care or according to the GRS and associated guidelines. MAIN OUTCOME MEASURES Primary outcome measures were use of guideline recommended management and time to the composite of cardiovascular death, non-fatal myocardial infarction, new onset heart failure hospital admission, and readmission for cardiovascular event. Secondary measures included the duration of hospital stay, EQ-5D-5L (five domain, five level version of the EuroQoL index), and the composite endpoint components. RESULTS 3050 participants (1440 GRS, 1610 standard care) were recruited in 38 UK clusters (20 GRS, 18 standard care). The mean age was 65.7 years (standard deviation 12), 69% were male, and the mean baseline GRACE scores were 119.5 (standard deviation 31.4) and 125.7 (34.4) for GRS and standard care, respectively. The uptake of guideline recommended processes was 77.3% for GRS and 75.3% for standard care (odds ratio 1.16, 95% confidence interval 0.70 to 1.92, P=0.56). The time to the first composite cardiac event was not significantly improved by the GRS (hazard ratio 0.89, 95% confidence interval 0.68 to 1.16, P=0.37). Baseline adjusted EQ-5D-5L utility at 12 months (difference -0.01, 95% confidence interval -0.06 to 0.04) and the duration of hospital admission within 12 months (mean 11.2 days, standard deviation 18 days v 11.8 days, 19 days) were similar for GRS and standard care. CONCLUSIONS In adults presenting to hospital with suspected non-ST elevation acute coronary syndrome, the GRS did not improve adherence to guideline recommended management or reduce cardiovascular events at 12 months. TRIAL REGISTRATION ISRCTN 29731761.
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Affiliation(s)
- Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Deborah D Stocken
- Leeds Institute of Clinical Trials Research, University of Leeds, UK
| | - Suleman Aktaa
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Catherine Reynolds
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Leeds Institute of Clinical Trials Research, University of Leeds, UK
| | - Rachael Gilberts
- Leeds Institute of Clinical Trials Research, University of Leeds, UK
| | - David Brieger
- Cardiology Department, Concord Repatriation General Hospital, Sydney, Australia
| | - Kathryn Carruthers
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Derek P Chew
- College of Medicine and Public Health of Medicine, Flinders University of South Australia, Adelaide, Australia
| | - Shaun G Goodman
- Canadian VIGOUR Centre, Department of Medicine, University of Alberta, Edmonton, Canada
| | | | - Linda D Sharples
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Andrew T Yan
- St Michael's Hospital, Department of Medicine, University of Toronto, Toronto, Canada
| | - Keith Fox
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
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179
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Elfar S, Onsy A, Farouk MA. Clinical and Radiographic Predictors of Successful Coronary Angiography Through Right Radial Artery Access. Interv Cardiol 2023; 18:e21. [PMID: 37435602 PMCID: PMC10331560 DOI: 10.15420/icr.2023.04] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/23/2023] [Indexed: 07/13/2023] Open
Abstract
Background: One of the limitations of the right radial access approach is complex vessel anatomy, such as subclavian tortuosity. Several clinical predictors have been proposed for tortuosities, such as older age, female sex and hypertension. In this study, we hypothesised that chest radiography would add predictive value to the traditional predictors. Methods: This prospective blinded study included patients who underwent transradial access coronary angiography. They were classified into four groups according to difficulty: Group I, Group II, Group III and Group IV. Different groups were compared according to clinical and radiographic characteristics. Results: The study included 108 patients (54, 27, 17 and 10 patients in Groups I, II, III and IV, respectively). The rate of crossover to transfemoral access was 9.26%. Age, hypertension and female sex were associated with a greater difficulty and failure rates. Regarding radiographic parameters, a higher failure rate was associated with a higher diameter of the aortic knuckle (Group IV, 4.09 ± 1.32 cm versus Groups I, II and III combined, 3.26 ± 0.98 cm; p=0.015) and the width of the mediastinum (Group IV, 8.96 ± 2.88 cm versus Groups I, II and III combined, 7.28 ± 1.78 cm; p=0.009). The cut-off value for prominent aortic knuckle was 3.55 cm (sensitivity 70% and specificity 67.35%) and the width of mediastinum was 6.59 cm (sensitivity 90% and specificity 42.86%). Conclusion: Radiographic prominent aortic knuckle and wide mediastinum are valuable clinical parameters and useful predictors for transradial access failure caused by tortuosity of the right subclavian/brachiocephalic arteries or aorta.
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Affiliation(s)
- Sohil Elfar
- Cardiology Department, Faculty of Medicine, Port Said UniversityPort Said, Egypt
| | - Ahmed Onsy
- Cardiology Department, Faculty of Medicine, Ain Shams UniversityCairo, Egypt
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180
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Huang M, Han T, Nie X, Zhu S, Yang D, Mu Y, Zhang Y. Clinical value of perivascular fat attenuation index and computed tomography derived fractional flow reserve in identification of culprit lesion of subsequent acute coronary syndrome. Front Cardiovasc Med 2023; 10:1090397. [PMID: 37332594 PMCID: PMC10272850 DOI: 10.3389/fcvm.2023.1090397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 05/16/2023] [Indexed: 06/20/2023] Open
Abstract
Purpose To explore the potential of perivascular fat attenuation index (FAI) and coronary computed tomography angiography (CCTA) derived fractional flow reserve (CT-FFR) in the identification of culprit lesion leading to subsequent acute coronary syndrome (ACS). Methods Thirty patients with documented ACS event who underwent invasive coronary angiography (ICA) from February 2019 to February 2021 and had received CCTA in the previous 6 months were collected retrospectively. 40 patients with stable angina pectoris (SAP) were matched as control group according to sex, age and risk factors. The study population has a mean age of 59.3 ± 12.3 years, with a male prevalence of 81.4%. The plaque characteristics, perivascular fat attenuation index (FAI), and coronary computed tomography angiography-derived fractional flow reserve (CT-FFR) of 32 culprit lesions and 30 non-culprit lesions in ACS patients and 40 highest-grade stenosis lesions in SAP patients were statistically analyzed. Results FAI around culprit lesions was increased significantly (-72.4 ± 3.2 HU vs. -79.0 ± 7.7 HU, vs. -80.4 ± 7.0HU, all p < 0.001) and CT-FFR was decreased for culprit lesions of ACS patients [0.7(0.1) vs. 0.8(0.1), vs.0.8(0.1), p < 0.001] compared to other lesions. According to multivariate analysis, diameter stenosis (DS), FAI, and CT-FFR were significant predictors for identification of the culprit lesion. The integration model of DS, FAI, and CT-FFR showed the significantly highest area under the curve (AUC) of 0.917, compared with other single predictors (all p < 0.05). Conclusions This study proposes a novel integrated prediction model of DS, FAI, and CT-FFR that enhances the diagnostic accuracy of traditional CCTA for identifying culprit lesions that trigger ACS. Furthermore, this model also provides improved risk stratification for patients and offers valuable insights for predicting future cardiovascular events.
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181
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Holzmann MJ, Andersson T, Doemland ML, Roux S. Recurrent myocardial infarction and emergency department visits: a retrospective study on the Stockholm Area Chest Pain Cohort. Open Heart 2023; 10:e002206. [PMID: 37385732 DOI: 10.1136/openhrt-2022-002206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 05/23/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Patients who experience acute myocardial infarction (AMI) are at risk of recurrent AMI. Contemporary data on recurrent AMI and its association with return emergency department (ED) visits for chest pain are needed. METHODS This Swedish retrospective cohort study linked patient-level data from six participating hospitals to four national registers to construct the Stockholm Area Chest Pain Cohort (SACPC). The AMI cohort included SACPC participants visiting the ED for chest pain diagnosed with AMI and discharged alive (first primary diagnosis of AMI during the study period not necessarily the patient's first AMI). The rate and timing of recurrent AMI events, return ED visits for chest pain and all-cause mortality were determined during the year following index AMI discharge. RESULTS Among 1 37 706 patients presenting to the ED with chest pain as principal complaint from 2011 to 2016, 5.5% (7579/137 706) were hospitalised with AMI. In total, 98.5% (7467/7579) of patients were discharged alive. In the year following index AMI discharge, 5.8% (432/7467) of AMI patients experienced ≥1 recurrent AMI event. Return ED visits for chest pain occurred in 27.0% (2017/7467) of index AMI survivors. During a return ED visit, recurrent AMI was diagnosed in 13.6% (274/2017) of patients. One-year all-cause mortality was 3.1% in the AMI cohort and 11.6% in the recurrent AMI cohort. CONCLUSIONS In this AMI population, 3 in 10 AMI survivors returned to the ED for chest pain in the year following AMI discharge. Furthermore, over 10% of patients with return ED visits were diagnosed with recurrent AMI during that visit. This study confirms the high residual ischaemic risk and associated mortality among AMI survivors.
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Affiliation(s)
- Martin J Holzmann
- Theme of Acute and Reparative Medicine, Karolinska University Hospital, and, Global Clinical Development, Karolinska Institutet, Stockholm, Sweden
| | - Tomas Andersson
- Institute of Environmental Medicine, Karolinska Institutet, and, Center for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
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Wang G, Miao H, Hao W, Zhao G, Yan Y, Gong W, Fan J, Ai H, Que B, Wang X, Nie S. Association of obstructive sleep apnoea with long-term cardiovascular events in patients with acute coronary syndrome with or without hypertension: insight from the OSA-ACS project. BMJ Open Respir Res 2023; 10:e001662. [PMID: 37369551 PMCID: PMC10410951 DOI: 10.1136/bmjresp-2023-001662] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND A close relationship exists between obstructive sleep apnoea (OSA) and hypertension. However, the impact of hypertension on the prognostic significance of OSA in patients with acute coronary syndrome (ACS) remains unclear. METHODS This is a post hoc analysis of the OSA-ACS project, which consecutively included patients with ACS and receiving overnight sleep study from June 2015 to January 2020. OSA was defined as AHI ≥15 events/hour. The primary outcome was major adverse cardiovascular and cerebrovascular events (MACCE), including a composite of cardiovascular death, myocardial infarction, stroke, ischemia-driven revascularisation or hospitalisation for unstable angina or heart failure. RESULTS A total of 1927 patients with ACS were finally enrolled in this study. The mean patient age was 56.4±10.5 years. Among them, 1247 (64.7%) patients had hypertension, and 1014 (52.6%) patients had OSA. During 2.9 (1.5, 3.6) years of follow-up, OSA was associated with an increased risk of MACCE among patients with hypertension (HR=1.35, 95% CI 1.04 to 1.75, p=0.02), but not in patients without hypertension (HR=1.15, 95% CI 0.79 to 1.68, p=0.47). The interaction between OSA and hypertension for MACCE was not statistically significant (interaction p=0.29). For patients with pre-existing hypertension, OSA was associated with an increased risk of MACCE only among those with grade 3 hypertension (HR 1.54, 95% CI 1.12 to 2.13, p=0.008), but not those with grade 1 or 2 hypertension. CONCLUSIONS OSA was associated with an increased risk of MACCE following ACS in patients with hypertension, especially in patients with pre-existing severe hypertension. These findings highlight the importance of identifying OSA in ACS patients with hypertension. TRIAL REGISTRATION NUMBER NCT03362385.
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Affiliation(s)
- Ge Wang
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Huangtai Miao
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wen Hao
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Guanqi Zhao
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yan Yan
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wei Gong
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jingyao Fan
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hui Ai
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Bin Que
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiao Wang
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shaoping Nie
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Chenna VSH, Anam H, Hassan M, Moeez A, Reddy R, Chaudhari SS, Sapkota K, Usama M. Ticagrelor Versus Clopidogrel in Patients With Acute Coronary Syndrome and on Dialysis: A Meta-Analysis. Cureus 2023; 15:e40211. [PMID: 37435247 PMCID: PMC10332118 DOI: 10.7759/cureus.40211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2023] [Indexed: 07/13/2023] Open
Abstract
This study aims to compare the safety and efficacy of clopidogrel and ticagrelor in patients with acute coronary syndrome (ACS) and undergoing dialysis. This study was conducted per the guidelines of the Preferred Reporting of Systematic Reviews and Meta-Analyses (PRISMA). A comprehensive search was performed using electronic databases, including PubMed, EMBASE, and Web of Science, to identify relevant studies comparing clopidogrel and ticagrelor in patients undergoing dialysis. To ensure the inclusion of all relevant articles, a combination of the following keywords, along with medical subject heading (MeSH) terms, was used: "clopidogrel," "ticagrelor," "acute coronary syndrome," and "dialysis." The primary endpoint of this meta-analysis was the incidence of major adverse cardiovascular events (MACE), which consisted of cardiovascular death, myocardial infarction, stroke, and revascularization. The secondary endpoint was all-cause mortality. The occurrence of any bleeding events (including major and nonmajor bleeding events) and major bleeding events was chosen as the safety endpoints. A total of four studies were included in the pooled analysis. The pooled sample size was 5,417 patients, including 892 in the ticagrelor group and 4525 in the clopidogrel group. The findings indicate that ticagrelor, compared to clopidogrel, is associated with a significantly higher risk of MACEs, all-cause death, and major bleeding events. The findings suggest that clopidogrel may be a better choice for individuals with ACS undergoing dialysis due to its lower risk of MACE, all-cause death, and major bleeding events compared to ticagrelor.
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Affiliation(s)
| | - Hemalatha Anam
- Medicine, Apollo institute of Medical Sciences and Research, Hyderabad, IND
| | - Majid Hassan
- Medicine, Universidad Autonoma de Guadalajara, Sacramento, USA
| | - Abdul Moeez
- Medicine, Services Hospital Lahore, Lahore, PAK
| | - Raja Reddy
- Medicine, MNR Medical College and Hospital, Hyderabad, IND
| | - Sandipkumar S Chaudhari
- General Practice, Lions General Hospital, Mehsana, IND
- General Practice, Gujarat Medical Education and Research Society (GMERS) Medical College and Hospital, Vadnagar, IND
| | - Koushik Sapkota
- Medicine, All India Institute of Medical Sciences (AIIMS) Bathinda, Bathinda, IND
| | - Muhammad Usama
- Neurology, Sheikh Zayed Medical College/Hospital Rahim Yar Khan, Rahim Yar Khan, PAK
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Weizman O, Tea V, Marijon E, Eltchaninoff H, Manzo-Silberman S, Leclercq F, Albert F, Bataille V, Drouet E, Naccache N, Puymirat E, Ferrières J, Schiele F, Simon T, Danchin N. Very long-term outcomes after acute myocardial infarction in young men and women: Insights from the FAST-MI program. Arch Cardiovasc Dis 2023; 116:324-334. [PMID: 37391340 DOI: 10.1016/j.acvd.2023.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/27/2023] [Accepted: 05/02/2023] [Indexed: 07/02/2023]
Abstract
AIMS Conflicting data exists about long-term outcomes in young women and men experiencing acute myocardial infarction (AMI). METHODS The FAST-MI program consists of three nationwide French surveys carried out 5years apart from 2005 to 2015, including consecutive patients with AMI over a 1-month period with up to 10-year follow-up. The present analysis focused on adults≤50 yo according to their gender. RESULTS Women accounted for 17.5% (335) of the 1912 patients under 50 yo and had a similar age as men (43.9±5.1 vs. 43.9±5.5years, P=0.92). They received less percutaneous coronary interventions (PCI) than men (85.9% vs. 91.3%, P=0.005), even in ST-elevation myocardial infarction (83.6% vs. 93.5%, P<0.001). Recommended secondary prevention medications were less frequently prescribed at discharge in women (40.6% vs. 52.8%, P<0.001), a trend that persisted in 2015 (59.1% vs. 72.8% in 2015, P<0.001). Still, ten-year survival was similar in men (90.5%) and women (92.3%) (crude HR: 0.86 [95% CI: 0.55-1.35], P=0.52, adjusted HR: 0.63 [95% CI: 0.38-1.07], P=0.09); similar results were found for ten-year survival among hospital survivors (91.2% in men vs. 93.7% in women, adjusted HR: 0.87 [95% CI: 0.45-1.66], P=0.66). Of the 1684 patients alive at hospital discharge with morbidity follow-up≥6months available, death, AMI or stroke at 8years occurred in 12.9% men and 11.2% in women (adjusted HR: 0.90 [95% CI: 0.60-1.33], P=0.59). CONCLUSIONS Young women with AMI undergo less cardiac interventions and are less often prescribed secondary prevention treatment than men, even when significant coronary artery disease is present, but keep a similar long-term prognosis after AMI. Optimal management of these young patients, regardless of gender, is necessary to ensure best outcomes after this major cardiovascular event.
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Affiliation(s)
- Orianne Weizman
- Assistance publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou (HEGP), Department of Cardiology, Paris, France; Université Paris-Descartes, Paris, France
| | - Victoria Tea
- Assistance publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou (HEGP), Department of Cardiology, Paris, France; Université Paris-Descartes, Paris, France
| | - Eloi Marijon
- Assistance publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou (HEGP), Department of Cardiology, Paris, France; Université Paris-Descartes, Paris, France
| | - Hélène Eltchaninoff
- Normandie Université, UNIROUEN, U1096, CHU Rouen, Department of Cardiology, 76000 Rouen, France
| | - Stéphane Manzo-Silberman
- Institut de Cardiologie, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France; Sorbonne Université, ACTION Study Group, Paris, France
| | - Florence Leclercq
- Centre Hospitalier Universitaire Arnaud-de-Villeneuve, Montpellier, France
| | | | - Vincent Bataille
- Toulouse University Hospital, Department of Cardiology B and Epidemiology, Toulouse, France; UMR INSERM 1027, Toulouse, France
| | - Elodie Drouet
- AP-HP, Hôpital Saint-Antoine, Department of Clinical Pharmacology and Unité de Recherche Clinique (URCEST), Paris, France; Université Pierre-et-Marie-Curie (UPMC-Paris 06), INSERM U-698, Paris, France
| | | | - Etienne Puymirat
- Assistance publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou (HEGP), Department of Cardiology, Paris, France; Université Paris-Descartes, Paris, France
| | - Jean Ferrières
- Toulouse University Hospital, Department of Cardiology B and Epidemiology, Toulouse, France; UMR INSERM 1027, Toulouse, France
| | - François Schiele
- University Hospital Jean-Minjoz, Department of Cardiology, Besançon, France
| | - Tabassome Simon
- AP-HP, Hôpital Saint-Antoine, Department of Clinical Pharmacology and Unité de Recherche Clinique (URCEST), Paris, France; Université Pierre-et-Marie-Curie (UPMC-Paris 06), INSERM U-698, Paris, France
| | - Nicolas Danchin
- Assistance publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou (HEGP), Department of Cardiology, Paris, France; Université Paris-Descartes, Paris, France.
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185
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Takahashi K, Arai T, Asai T, Okuda Y. A fragmented segment of a central venous catheter caused delayed ventricular fibrillation: a case report. JA Clin Rep 2023; 9:27. [PMID: 37193904 DOI: 10.1186/s40981-023-00615-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Central venous port systems may be safely used for chemotherapy of patients with cancer, but several complications may occur associated with their use. CASE PRESENTATION An 83-year-old man with heat stroke was transferred to our emergency department, where he was treated and became able to eat on the same day. He had been fit and healthy, except for colorectomy and chemotherapy using a central venous access port placed in the right upper jugular vein 8 years ago. The next day, he suddenly had ventricular fibrillation. Cardiopulmonary resuscitation was successful. Emergency coronary angiography showed a catheter-like foreign body in the coronary sinus. Physicians failed to remove the foreign body using catheter therapy, and ventricular fibrillation occurred repeatedly. After induction of general anesthesia, the fractured catheter was removed surgically. Postoperative course was uneventful. CONCLUSIONS A fragmented segment of a catheter may suddenly cause ventricular fibrillation years later.
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Affiliation(s)
- Kei Takahashi
- Department of Anesthesiology, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya City, Saitama, 343-8555, Japan.
| | - Takero Arai
- Department of Anesthesiology, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya City, Saitama, 343-8555, Japan
| | - Takashi Asai
- Department of Anesthesiology, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya City, Saitama, 343-8555, Japan
| | - Yasuhisa Okuda
- Department of Anesthesiology, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya City, Saitama, 343-8555, Japan
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186
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Bruno TC, Bittencourt MS, Quidim AVL, Santos IS, Lotufo PA, Benseñor IM, Goulart AC. Prognosis Related to Reperfusion Therapy Post-Acute Coronary Syndrome in Secondary Care: Long-Term Survival Analysis in the ERICO Study. Arq Bras Cardiol 2023; 120:e20220849. [PMID: 37194831 PMCID: PMC10263393 DOI: 10.36660/abc.20220849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/15/2023] [Accepted: 02/15/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Relationship between reperfusion therapy post-acute coronary syndrome (ACS) and mortality in secondary care is not well-known. OBJECTIVES To evaluate the impact of three therapeutic strategies: (1) exclusive medical therapy, (2) percutaneous coronary intervention (PCI) and (3) coronary artery bypass grafting (CABG) on long-term survival of participants in the Strategy of Registry of Acute Coronary Syndrome (ERICO) study. METHODS Survival analyses for all-cause, cardiovascular (CVD) and coronary artery disease (CAD) mortality were performed according to three therapeutic strategies (exclusive medical therapy, PCI or CABG). Cox regression models were used to estimate the hazard ratio (HR) with respective 95% confidence interval (95%CI) from 180 days to four years of follow-up after ACS. Models are presented as crude, age-sex adjusted and further adjusted for previous CAD, ACS subtype, smoking, hypertension, dyslipidemia, left ventricular ejection fraction and according to the number of obstructed (≥ 50%) major coronary arteries. RESULTS Among 800 participants, the lowest crude survival rates were detected among individuals who underwent CABG (all-cause and CVD). CABG was correlated to CAD (HR: 2.19 [95% CI: 1.05-4.55]). However, this risk lost significance in the full model. PCI was associated to lower probability of fatal events during four-year follow-up: all-cause [multivariate HR: 0.42 (95% CI: 0.26-0.70)], CVD [HR: 0.39 (95% CI: 0.20-0.73)] and CAD [multivariate HR: 0.24 (95% CI: 0.09-0.63)] compared to those submitted to exclusive medical therapy. CONCLUSION In the ERICO study, PCI after ACS was associated to better prognosis, particularly CAD survival.
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Affiliation(s)
- Tatiana C. Bruno
- Centro de Pesquisa Clínica e EpidemiológicaHospital UniversitárioUniversidade de São PauloSão PauloSPBrasil Centro de Pesquisa Clínica e Epidemiológica – Hospital Universitário – Universidade de São Paulo , São Paulo , SP – Brasil
| | - Márcio S. Bittencourt
- Centro de Pesquisa Clínica e EpidemiológicaHospital UniversitárioUniversidade de São PauloSão PauloSPBrasil Centro de Pesquisa Clínica e Epidemiológica – Hospital Universitário – Universidade de São Paulo , São Paulo , SP – Brasil
| | - Alessandra V. L. Quidim
- Centro de Pesquisa Clínica e EpidemiológicaHospital UniversitárioUniversidade de São PauloSão PauloSPBrasil Centro de Pesquisa Clínica e Epidemiológica – Hospital Universitário – Universidade de São Paulo , São Paulo , SP – Brasil
| | - Itamar S. Santos
- Centro de Pesquisa Clínica e EpidemiológicaHospital UniversitárioUniversidade de São PauloSão PauloSPBrasil Centro de Pesquisa Clínica e Epidemiológica – Hospital Universitário – Universidade de São Paulo , São Paulo , SP – Brasil
- Universidade de São PauloFaculdade de MedicinaSão PauloSPBrasil Universidade de São Paulo , Faculdade de Medicina , São Paulo , SP – Brasil
| | - Paulo A. Lotufo
- Centro de Pesquisa Clínica e EpidemiológicaHospital UniversitárioUniversidade de São PauloSão PauloSPBrasil Centro de Pesquisa Clínica e Epidemiológica – Hospital Universitário – Universidade de São Paulo , São Paulo , SP – Brasil
- Universidade de São PauloFaculdade de MedicinaSão PauloSPBrasil Universidade de São Paulo , Faculdade de Medicina , São Paulo , SP – Brasil
| | - Isabela M. Benseñor
- Centro de Pesquisa Clínica e EpidemiológicaHospital UniversitárioUniversidade de São PauloSão PauloSPBrasil Centro de Pesquisa Clínica e Epidemiológica – Hospital Universitário – Universidade de São Paulo , São Paulo , SP – Brasil
- Universidade de São PauloFaculdade de MedicinaSão PauloSPBrasil Universidade de São Paulo , Faculdade de Medicina , São Paulo , SP – Brasil
| | - Alessandra C. Goulart
- Centro de Pesquisa Clínica e EpidemiológicaHospital UniversitárioUniversidade de São PauloSão PauloSPBrasil Centro de Pesquisa Clínica e Epidemiológica – Hospital Universitário – Universidade de São Paulo , São Paulo , SP – Brasil
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Wilmé V, Harscoat S, Séverac F, Carmona A, Le Borgne P, Bilbault P, Morel O, Kepka S. Occurrence of Severe Arrhythmias in Patients with Non-ST Elevation Acute Coronary Syndrome (NSTE-ACS): A Retrospective Study. J Clin Med 2023; 12:jcm12103456. [PMID: 37240561 DOI: 10.3390/jcm12103456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/07/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Non-ST elevation acute coronary syndrome (NSTE-ACS) is one of the most frequent manifestations of coronary artery disease. The occurrence of serious heart rhythm disorders (SHRDs) in NSTE-ACS is not well documented. However, continuous heart rhythm monitoring is recommended during the initial management of NSTE-ACS. The targeted monitoring of patients at greater risk for SHRDs could facilitate patients' care in emergency departments (EDs) where the flow of patients is continuously increasing. METHODS This retrospective single-center study included 480 patients from emergency and cardiology departments within the Strasbourg University Hospital between 1 January 2019 and 31 December 2020. The objective was to estimate the frequency of the occurrence of SHRDs among patients with NSTE-ACS. The secondary objective was to highlight the factors associated with a higher risk of SHRDs. RESULTS The proportion of SHRDs during the first 48 h of hospital care was 2.3% (CI95%: 1.2-4.1%, n = 11). Two time periods were considered: before coronary angiography (1.0%), and during, or after coronary angiography (1.3%). In the first group, two patients required immediate treatment (0.4% of the patients) and no death occurred. In the univariate analysis, the variables significantly associated with SHRDs were age, anticoagulant medication, a decrease in glomerular filtration rate, plasmatic hemoglobin, and left ventricle ejection fraction (LVEF), and an increase in plasmatic troponin, BNP, and CRP levels. In the multivariable analysis, plasmatic hemoglobin > 12 g/dL seemed to be a protective factor for SHRDs. CONCLUSIONS In this study, SHRDs were rare and, most often, spontaneously resolved. These data challenge the relevance of systematic rhythm monitoring during the initial management of patients with NSTE-ACS.
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Affiliation(s)
- Valérie Wilmé
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France
| | - Sébastien Harscoat
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France
| | - François Séverac
- Public Health Department, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France
| | - Adrien Carmona
- Interventional Cardiology Department, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France
| | - Pierrick Le Borgne
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France
- French National Institute of Health and Medical Research (INSERM), UMR 1260, Regenerative NanoMedicine (RNM), Fédération de Médecine Translationnelle (FMTS), University of Strasbourg, 67000 Strasbourg, France
| | - Pascal Bilbault
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France
- French National Institute of Health and Medical Research (INSERM), UMR 1260, Regenerative NanoMedicine (RNM), Fédération de Médecine Translationnelle (FMTS), University of Strasbourg, 67000 Strasbourg, France
| | - Olivier Morel
- Interventional Cardiology Department, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France
- French National Institute of Health and Medical Research (INSERM), UMR 1260, Regenerative NanoMedicine (RNM), Fédération de Médecine Translationnelle (FMTS), University of Strasbourg, 67000 Strasbourg, France
| | - Sabrina Kepka
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France
- Public Health Department, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France
- ICube, UMR 7357 CNRS, 67400 Illkirch-Graffenstaden, France
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188
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Di Santo P, Abdel-Razek O, Jung R, Parlow S, Poulin A, Bernick J, Morgan B, Robinson L, Feagan H, Wade J, Goh CY, Singh K, Froeschl M, Labinaz M, Fergusson DA, Coyle D, Kyeremanteng K, Abunassar J, Wells GA, Simard T, Hibbert B. Rationale and Design of the Rivaroxaban Post-Transradial Access for the Prevention of Radial Artery Occlusion Trial (CAPITAL-RAPTOR). BMJ Open 2023; 13:e070720. [PMID: 37173116 DOI: 10.1136/bmjopen-2022-070720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
INTRODUCTION Transradial access (TRA) has rapidly emerged as the preferred vascular access site for coronary angiography and percutaneous coronary intervention. Radial artery occlusion (RAO) remains as an important complication of TRA as it precludes future ipsilateral transradial procedures. While intraprocedural anticoagulation has been studied extensively, the definitive role of postprocedural anticoagulation has not yet been established. METHODS AND ANALYSIS The Rivaroxaban Post-Transradial Access for the Prevention of Radial Artery Occlusion trial is a multicentre, prospective, randomised, open-label, blinded-endpoint design study investigating the efficacy and safety of rivaroxaban to reduce the incidence of RAO. Eligible patients will undergo randomisation to receive either rivaroxaban 15 mg once daily for 7 days or to no additional postprocedural anticoagulation. Doppler ultrasound to assess radial artery patency will be performed at 30 days. ETHICS AND DISSEMINATION The study protocol has been approved by the Ottawa Health Science Network Research Ethics Board (approval number 20180319-01H). The study results will be disseminated via conference presentations and peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT03630055.
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Affiliation(s)
- Pietro Di Santo
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Department of Critical Care, University of Ottawa, Ottawa, Ontario, Canada
| | - Omar Abdel-Razek
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Richard Jung
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Simon Parlow
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Anthony Poulin
- Division of Cardiology, Quebec Heart and Lung Institute, Quebec, Québec, Canada
| | - Jordan Bernick
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Baylie Morgan
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Lisa Robinson
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Hannah Feagan
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Jilliane Wade
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Cheng Yee Goh
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Kuljit Singh
- Department of Cardiology, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Michael Froeschl
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Marino Labinaz
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Doug Coyle
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Joseph Abunassar
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - George A Wells
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Trevor Simard
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Benjamin Hibbert
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
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189
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Haller PM, Sörensen NA, Hartikainen TS, Goßling A, Lehmacher J, Toprak B, Twerenbold R, Richter J, Banko T, Korschid S, Schmidt J, Keller T, Zeller T, Blankenberg S, Westermann D, Neumann JT. Rising and Falling High-Sensitivity Cardiac Troponin in Diagnostic Algorithms for Patients With Suspected Myocardial Infarction. J Am Heart Assoc 2023; 12:e027166. [PMID: 37158171 DOI: 10.1161/jaha.122.027166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Background High-sensitivity cardiac troponin (hs-cTn)-based diagnostic algorithms are recommended for the management of patients with suspected myocardial infarction (MI) without ST elevation. Although mirroring different phases of myocardial injury, falling and rising troponin patterns (FPs and RPs, respectively) are equally considered by most algorithms. We aimed to compare the performance of diagnostic protocols for RPs and FPs, separately. Methods and Results We pooled 2 prospective cohorts of patients with suspected MI and stratified patients to stable, FP, and RP during serial sampling separately for hs-cTnI and hs-cTnT and applied the European Society of Cardiology 0/1- and 0/3-hour algorithms comparing the positive predictive values to rule in MI. Overall, 3523 patients were included in the hs-cTnI study population. The positive predictive value for patients with an FP was significantly reduced compared with patients with an RP (0/1-hour: FP, 53.3% [95% CI, 45.0-61.4] versus RP, 76.9 [95% CI, 71.6-81.7]; 0/3-hour: FP, 56.9% [95% CI, 42.2-70.7] versus RP, 78.1% [95% CI, 74.0-81.8]). The proportion of patients in the observe zone was larger in the FP using 0/1-hour (31.3% versus 55.8%) and 0/3-hour (14.6% versus 38.6%) algorithms. Alternative cutoffs did not improve algorithm performances. Compared with stable hs-cTn, the risk for death or MI was highest in those with an FP (adjusted hazard ratio [HR], hs-cTnI 2.3 [95% CI, 1.7-3.2]; RP adjusted HR, hs-cTnI 1.8 [95% CI, 1.4-2.4]). Findings were similar for hs-cTnT tested in 3647 patients overall. Conclusions The positive predictive value to rule in MI by the European Society of Cardiology 0/1- and 0/3-hour algorithms is significantly lower in patients with FP than RP. These are at highest risk for incident death or MI. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifiers: NCT02355457, NCT03227159.
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Affiliation(s)
- Paul M Haller
- Department of Cardiology University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf Hamburg Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck Hamburg Germany
| | - Nils A Sörensen
- Department of Cardiology University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf Hamburg Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck Hamburg Germany
| | - Tau S Hartikainen
- Department of Cardiology University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf Hamburg Germany
| | - Alina Goßling
- Department of Cardiology University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf Hamburg Germany
| | - Jonas Lehmacher
- Department of Cardiology University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf Hamburg Germany
| | - Betül Toprak
- Department of Cardiology University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf Hamburg Germany
| | - Raphael Twerenbold
- Department of Cardiology University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf Hamburg Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck Hamburg Germany
- University Center of Cardiovascular Science University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf Hamburg Germany
| | - Janine Richter
- Department of Cardiology University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf Hamburg Germany
| | - Thorben Banko
- Department of Cardiology University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf Hamburg Germany
| | - Solaf Korschid
- Department of Cardiology University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf Hamburg Germany
| | - Jakob Schmidt
- Department of Cardiology University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf Hamburg Germany
| | - Till Keller
- Department of Internal Medicine I, Cardiology Justus-Liebig-University Gießen Gießen Germany
| | - Tanja Zeller
- Department of Cardiology University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf Hamburg Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck Hamburg Germany
- University Center of Cardiovascular Science University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf Hamburg Germany
| | - Stefan Blankenberg
- Department of Cardiology University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf Hamburg Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck Hamburg Germany
| | - Dirk Westermann
- Department of Cardiology University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf Hamburg Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck Hamburg Germany
- Department of Cardiology University Heart Center Freiburg Bad Krotzingen Bad Krotzingen Germany
| | - Johannes T Neumann
- Department of Cardiology University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf Hamburg Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck Hamburg Germany
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine Monash University Melbourne Australia
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Lee K, Han S, Lee M, Kim DW, Kwon J, Park GM, Park MW. Evidence-Based Optimal Medical Therapy and Mortality in Patients With Acute Myocardial Infarction After Percutaneous Coronary Intervention. J Am Heart Assoc 2023; 12:e024370. [PMID: 37158100 DOI: 10.1161/jaha.121.024370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Background The secondary prevention with pharmacologic therapy is essential for preventing recurrent cardiovascular events in patients experiencing acute myocardial infarction. Guideline-based optimal medical therapy (OMT) for patients with acute myocardial infarction consists of antiplatelet therapy, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, β-blockers, and statins. We aimed to determine the prescription rate of OMT use at discharge and to evaluate the impact of OMT on long-term clinical outcomes in patients with acute myocardial infarction who underwent percutaneous coronary intervention in the drug-eluting stent era using nationwide cohort data. Methods and Results Using the National Health Insurance claims data in South Korea, patients with acute myocardial infarction who had undergone percutaneous coronary intervention with a drug-eluting stent between July 2013 and June 2017 were enrolled. A total of 35 972 patients were classified into the OMT and non-OMT groups according to the post-percutaneous coronary intervention discharge medication. The primary end point was all-cause death, and the 2 groups were compared using a propensity-score matching analysis. Fifty-seven percent of patients were prescribed OMT at discharge. During the follow-up period (median, 2.0 years [interquartile range, 1.1-3.2 years]), OMT was associated with a significant reduction in the all-cause mortality (adjusted hazard ratio [aHR], 0.82 [95% CI, 0.76-0.90]; P<0.001) and composite outcome of death or coronary revascularization (aHR, 0.89 [95% CI, 0.85-0.93]; P<0.001). Conclusions OMT was prescribed at suboptimal rates in South Korea. However, our nationwide cohort study showed that OMT has a benefit for long-term clinical outcomes on all-cause mortality and composite outcome of death or coronary revascularization after percutaneous coronary intervention in the drug-eluting stent era.
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Affiliation(s)
- Kyusup Lee
- Cardiovascular Research Institute for Intractable Disease, College of Medicine The Catholic University of Korea Seoul Republic of Korea
- Department of Cardiology, Daejeon St. Mary's Hospital, College of Medicine The Catholic University of Korea Daejeon Republic of Korea
| | - Seungbong Han
- Department of Biostatistics, College of Medicine Korea University Seoul Republic of Korea
| | - Myunhee Lee
- Cardiovascular Research Institute for Intractable Disease, College of Medicine The Catholic University of Korea Seoul Republic of Korea
- Department of Cardiology, Daejeon St. Mary's Hospital, College of Medicine The Catholic University of Korea Daejeon Republic of Korea
| | - Dae-Won Kim
- Cardiovascular Research Institute for Intractable Disease, College of Medicine The Catholic University of Korea Seoul Republic of Korea
- Department of Cardiology, Daejeon St. Mary's Hospital, College of Medicine The Catholic University of Korea Daejeon Republic of Korea
| | - Jongbum Kwon
- Department of Thoracic and Cardiovascular Surgery, Daejeon St. Mary's Hospital The Catholic University of Korea Daejeon Republic of Korea
| | - Gyung-Min Park
- Department of Cardiology, Ulsan University Hospital University of Ulsan College of Medicine Ulsan Republic of Korea
| | - Mahn-Won Park
- Cardiovascular Research Institute for Intractable Disease, College of Medicine The Catholic University of Korea Seoul Republic of Korea
- Department of Cardiology, Daejeon St. Mary's Hospital, College of Medicine The Catholic University of Korea Daejeon Republic of Korea
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191
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Xie Q, Zhou L, Li Y, Zhang R, Wei H, Ma G, Tang Y, Xiao P. Comparison of prognosis between coronary computed tomography angiography versus invasive coronary angiography for stable coronary artery disease: a systematic review and meta-analysis. Front Cardiovasc Med 2023; 10:1010536. [PMID: 37215543 PMCID: PMC10196209 DOI: 10.3389/fcvm.2023.1010536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 04/21/2023] [Indexed: 05/24/2023] Open
Abstract
Background The impact of using invasive coronary angiography (ICA) or coronary computed tomography angiography (CCTA) as an initial examination on the incidence of major adverse cardiovascular events (MACEs) in patients with stable coronary artery disease and the occurrence of major operation-related complications is uncertain. Objective This study aimed to explore the effects of ICA vs. CCTA on MACEs, all-cause death, and major operation-related complications. Methods A systematic search of electronic databases (PubMed and Embase) was conducted for randomized controlled trials and observational studies comparing MACEs between ICA and CCTA from January 2012 to May 2022. The primary outcome measure was analyzed using a random-effects model as a pooled odds ratio (OR). The main observations were MACEs, all-cause death, and major operation-related complications. Results A total of six studies, comprising 26,548 patients, met the inclusion criteria (ICA n = 8,472; CCTA n = 18,076). There were statistically significant differences between ICA and CCTA for MACE [OR 1.37; 95% confidence interval (CI), 1.06-1.77; p = 0.02], all-cause death (OR 1.56; 95% CI, 1.38-1.78; p < 0.00001), and major operation-related complications (OR 2.10; 95% CI, 1.23-3.61; p = 0.007) among patients with stable coronary artery disease. Subgroup analysis demonstrated statistically significant results in the impact of ICA or CCTA on MACEs according to the length of follow-up. Compared to CCTA, ICA was related to a higher incidence of MACEs in the subgroup with a short follow-up (≤3 years) (OR 1.74; 95% CI, 1.54-1.96; p < 0.00001). Conclusions Among patients with stable coronary artery disease, an initial examination with ICA was significantly associated with the risk of MACEs, all-cause death, and major procedure-related complications compared to CCTA in this meta-analysis.
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Affiliation(s)
- Qingya Xie
- Department of Cardiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China
| | - Lingling Zhou
- Department of Orthopaedic Surgery, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Ying Li
- State Key Laboratory of Natural Medicines, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Ruizhe Zhang
- Department of Cardiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China
| | - Han Wei
- Department of Cardiology, Nanjing Drum Tower Hospital Group Suqian Hospital, Suqian, China
| | - Gaoxiang Ma
- State Key Laboratory of Natural Medicines, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Yuping Tang
- Department of Orthopaedic Surgery, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Pingxi Xiao
- Department of Cardiology, The Forth Affiliated Hospital, Nanjing Medical University, Nanjing, China
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Li P, Chen M, Huang Y, Wang R, Chi J, Hu J, Huang J, Wu N, Cai H, Yuan H, Li M, Xu L. Prognostic impact of in-hospital hemoglobin decline in non-overt bleeding ICU patients with acute myocardial infarction. BMC Cardiovasc Disord 2023; 23:231. [PMID: 37138214 PMCID: PMC10158222 DOI: 10.1186/s12872-023-03251-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 04/19/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND The prognostic value of in-hospital hemoglobin drop in non-overt bleeding patients with acute myocardial infarction (AMI) admitted to the intensive care unit (ICU) remains insufficiently investigated. METHODS A retrospective analysis was performed based on the Medical Information Mart for Intensive Care (MIMIC)-IV database. 2,334 ICU-admitted non-overt bleeders diagnosed with AMI were included. In-hospital hemoglobin values (baseline value on admission and nadir value during hospitalization) were available. Hemoglobin drop was defined as a positive difference between admission and in-hospital nadir hemoglobin. The primary endpoint was 180-day all-cause mortality. The time-dependent Cox proportional hazard models were structured to analyze the connection between hemoglobin drop and mortality. RESULTS 2,063 patients (88.39%) experienced hemoglobin drop during hospitalization. We categorized patients based on the degree of hemoglobin drop: no hemoglobin drop (n = 271), minimal hemoglobin drop (< 3 g/dl; n = 1661), minor hemoglobin drop (≥ 3 g/dl & < 5 g/dl, n = 284) and major hemoglobin drop (≥ 5 g/dl; n = 118). Minor (adjusted hazard ratio [HR] = 12.68; 95% confidence interval [CI]: 5.13-31.33; P < 0.001) and major (adjusted HR = 13.87; 95% CI: 4.50-42.76; P < 0.001) hemoglobin drops were independently associated with increased 180-day mortality. After adjusting the baseline hemoglobin level, a robust nonlinear relationship was observed in the association between hemoglobin drop and 180-day mortality, with 1.34 g/dl as the lowest value (HR = 1.04; 95% CI: 1.00-1.08). CONCLUSION In non-overt bleeding ICU-admitted patients with AMI, in-hospital hemoglobin drop is independently associated with higher 180-day all-cause mortality.
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Affiliation(s)
- Pengfei Li
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Geriatric Cardiology, General Hospital of Southern Theater Command, Guangzhou, China
| | - Meixiang Chen
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Geriatric Cardiology, General Hospital of Southern Theater Command, Guangzhou, China
| | - Yuekang Huang
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Geriatric Cardiology, General Hospital of Southern Theater Command, Guangzhou, China
| | - Ruixin Wang
- Department of Geriatric Cardiology, General Hospital of Southern Theater Command, Guangzhou, China
| | - JiaNing Chi
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Geriatric Cardiology, General Hospital of Southern Theater Command, Guangzhou, China
| | - Jiaman Hu
- Department of Geriatric Cardiology, General Hospital of Southern Theater Command, Guangzhou, China
| | - Jianyu Huang
- Department of Geriatric Cardiology, General Hospital of Southern Theater Command, Guangzhou, China
| | - Ningxia Wu
- Department of Geriatric Cardiology, General Hospital of Southern Theater Command, Guangzhou, China
| | - Hua Cai
- Department of Geriatric Cardiology, General Hospital of Southern Theater Command, Guangzhou, China
| | - Hui Yuan
- Department of Geriatric Cardiology, General Hospital of Southern Theater Command, Guangzhou, China
| | - Min Li
- Department of Geriatric Cardiology, General Hospital of Southern Theater Command, Guangzhou, China
| | - Lin Xu
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.
- Department of Geriatric Cardiology, General Hospital of Southern Theater Command, Guangzhou, China.
- Branch of National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Guangzhou, China.
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Jehn S, Roggel A, Dykun I, Balcer B, Al-Rashid F, Totzeck M, Risse J, Kill C, Rassaf T, Mahabadi AA. Epicardial adipose tissue and obstructive coronary artery disease in acute chest pain: the EPIC-ACS study. EUROPEAN HEART JOURNAL OPEN 2023; 3:oead041. [PMID: 37143611 PMCID: PMC10152391 DOI: 10.1093/ehjopen/oead041] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/01/2023] [Accepted: 04/14/2023] [Indexed: 05/06/2023]
Abstract
Aims We tested the hypothesis that epicardial adipose tissue (EAT) quantification improves the prediction of the presence of obstructive coronary artery disease (CAD) in patients presenting with acute chest pain to the emergency department. Methods and results Within this prospective observational cohort study, we included 657 consecutive patients (mean age 58.06 ± 18.04 years, 53% male) presenting to the emergency department with acute chest pain suggestive of acute coronary syndrome between December 2018 and August 2020. Patients with ST-elevation myocardial infarction, haemodynamic instability, or known CAD were excluded. As part of the initial workup, we performed bedside echocardiography for quantification of EAT thickness by a dedicated study physician, blinded to all patient characteristics. Treating physicians remained unaware of the results of the EAT assessment. The primary endpoint was defined as the presence of obstructive CAD, as detected in subsequent invasive coronary angiography. Patients reaching the primary endpoint had significantly more EAT than patients without obstructive CAD (7.90 ± 2.56 mm vs. 3.96 ± 1.91 mm, P < 0.0001). In a multivariable regression analysis, a 1 mm increase in EAT thickness was associated with a nearby two-fold increased odds of the presence of obstructive CAD [1.87 (1.64-2.12), P < 0.0001]. Adding EAT to a multivariable model of the GRACE score, cardiac biomarkers and traditional risk factors significantly improved the area under the receiver operating characteristic curve (0.759-0.901, P < 0.0001). Conclusion Epicardial adipose tissue strongly and independently predicts the presence of obstructive CAD in patients presenting with acute chest pain to the emergency department. Our results suggest that the assessment of EAT may improve diagnostic algorithms of patients with acute chest pain.
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Affiliation(s)
- Stefanie Jehn
- The West German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Anja Roggel
- The West German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Iryna Dykun
- The West German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Bastian Balcer
- The West German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Fadi Al-Rashid
- The West German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Matthias Totzeck
- The West German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Joachim Risse
- Center of Emergency Medicine, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Clemens Kill
- Center of Emergency Medicine, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Tienush Rassaf
- The West German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Amir A Mahabadi
- Corresponding author. Tel: +49 (0)201/723 84822, Fax: +49 (0)201/723 5401,
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194
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Haskiah F, Khaskia A. Lipid treatment status and goal attainment among patients with premature acute coronary syndrome in Israel. J Clin Lipidol 2023; 17:367-375. [PMID: 37120357 DOI: 10.1016/j.jacl.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND There are significant health gaps between Arabs and Jews in Israel. However, there are limited data on the management and treatment of dyslipidemia among Israeli adults who experience premature acute coronary syndrome (ACS). This study aimed to assess the differences between Arabs and Jews with regard to lipid-lowering therapy administration and low-density lipoprotein cholesterol (LDL-C) levels goal attainment at 1 year post-ACS. METHODS This study included patients aged ≤55 years who had been hospitalized for ACS at Meir Medical Center between 2018 and 2019. Outcomes included the rate of use of lipid-lowering medications, LDL-C levels 1 year post-admission, and major adverse cardiovascular and cerebrovascular events (MACCE) during 30 months of follow-up. RESULTS The study population comprised 687 young adults with a median age of 48.5 years. 81.9% of the Arab patients and 79.8% of the Jewish patients were discharged on high intensity statins. At 1 year of follow-up, the proportions of Arab patients who had LDL-C levels <70 mg/dL and <55 mg/dL were lower than those of Jewish patients (43.8% vs. 58%, p < 0.001 and 34.5% vs. 45.3%, p < 0.001, respectively). At 1 year of follow-up, only 25% and 4% of both groups were treated with ezetimibe and proprotein convertase subtilisin/kexin type 9 inhibitor. The incidence of MACCE was significantly higher among Arab patients. CONCLUSION Our study highlighted the need for a more aggressive lipid-lowering strategy in both Arab and Jewish populations. Culturally adapted interventions are required to reduce gaps between Arab and Jewish patients.
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Affiliation(s)
- Feras Haskiah
- Department of Internal Medicine D, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Abid Khaskia
- Department of Cardiology, Meir Medical Center, Kfar Saba, Israel
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195
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Foà A, Canton L, Bodega F, Bergamaschi L, Paolisso P, De Vita A, Villano A, Mattioli AV, Tritto I, Morrone D, Lanza GA, Pizzi C. Myocardial infarction with nonobstructive coronary arteries: from pathophysiology to therapeutic strategies. J Cardiovasc Med (Hagerstown) 2023; 24:e134-e146. [PMID: 37186564 DOI: 10.2459/jcm.0000000000001439] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a heterogeneous group of clinical entities characterized by clinical evidence of acute myocardial infarction (AMI) with normal or near-normal coronary arteries on coronary angiography (stenosis < 50%) and without an over the alternative diagnosis for the acute presentation. Its prevalence ranges from 6% to 11% among all patients with AMI, with a predominance of young, nonwhite females with fewer traditional risks than those with an obstructive coronary artery disease (MI-CAD). MINOCA can be due to either epicardial causes such as rupture or fissuring of unstable nonobstructive atherosclerotic plaque, coronary artery spasm, spontaneous coronary dissection and cardioembolism in-situ or microvascular causes. Besides, also type-2 AMI due to supply-demand mismatch and Takotsubo syndrome must be considered as a possible MINOCA cause. Because of the complex etiology and a limited amount of evidence, there is still some confusion around the management and treatment of these patients. Therefore, the key focus of this condition is to identify the underlying individual mechanisms to achieve patient-specific treatments. Clinical history, electrocardiogram, echocardiography, and coronary angiography represent the first-level diagnostic investigations, but coronary imaging with intravascular ultrasound and optical coherent tomography, coronary physiology testing, and cardiac magnetic resonance imaging offer additional information to understand the underlying cause of MINOCA. Although the prognosis is slightly better compared with MI-CAD patients, MINOCA is not always benign and depends on the etiopathology. This review analyzes all possible pathophysiological mechanisms that could lead to MINOCA and provides the most specific and appropriate therapeutic approach in each scenario.
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Affiliation(s)
- Alberto Foà
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), IRCCS Policlinico St. Orsola-Malpighi, Alma Mater Studiorum University of Bologna, Bologna
| | - Lisa Canton
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), IRCCS Policlinico St. Orsola-Malpighi, Alma Mater Studiorum University of Bologna, Bologna
| | - Francesca Bodega
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), IRCCS Policlinico St. Orsola-Malpighi, Alma Mater Studiorum University of Bologna, Bologna
| | - Luca Bergamaschi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), IRCCS Policlinico St. Orsola-Malpighi, Alma Mater Studiorum University of Bologna, Bologna
| | - Pasquale Paolisso
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | - Antonio De Vita
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome
| | - Angelo Villano
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome
| | | | - Isabella Tritto
- Università di Perugia, Dipartimento di Medicina, Sezione di Cardiologia e Fisiopatologia Cardiovascolare, Perugia
| | - Doralisa Morrone
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine-Cardiology Division, University Hospital of Pisa, Italy
| | - Gaetano Antonio Lanza
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome
| | - Carmine Pizzi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), IRCCS Policlinico St. Orsola-Malpighi, Alma Mater Studiorum University of Bologna, Bologna
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Kodeboina M, Piayda K, Jenniskens I, Vyas P, Chen S, Pesigan RJ, Ferko N, Patel BP, Dobrin A, Habib J, Franke J. Challenges and Burdens in the Coronary Artery Disease Care Pathway for Patients Undergoing Percutaneous Coronary Intervention: A Contemporary Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095633. [PMID: 37174152 PMCID: PMC10177939 DOI: 10.3390/ijerph20095633] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/24/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023]
Abstract
Clinical and economic burdens exist within the coronary artery disease (CAD) care pathway despite advances in diagnosis and treatment and the increasing utilization of percutaneous coronary intervention (PCI). However, research presenting a comprehensive assessment of the challenges across this pathway is scarce. This contemporary review identifies relevant studies related to inefficiencies in the diagnosis, treatment, and management of CAD, including clinician, patient, and economic burdens. Studies demonstrating the benefits of integration and automation within the catheterization laboratory and across the CAD care pathway were also included. Most studies were published in the last 5-10 years and focused on North America and Europe. The review demonstrated multiple potentially avoidable inefficiencies, with a focus on access, appropriate use, conduct, and follow-up related to PCI. Inefficiencies included misdiagnosis, delays in emergency care, suboptimal testing, longer procedure times, risk of recurrent cardiac events, incomplete treatment, and challenges accessing and adhering to post-acute care. Across the CAD pathway, this review revealed that high clinician burnout, complex technologies, radiation, and contrast media exposure, amongst others, negatively impact workflow and patient care. Potential solutions include greater integration and interoperability between technologies and systems, improved standardization, and increased automation to reduce burdens in CAD and improve patient outcomes.
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Affiliation(s)
- Monika Kodeboina
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy
- Clinic for Internal Medicine and Cardiology, Marien Hospital, 52066 Aachen, Germany
| | - Kerstin Piayda
- Cardiovascular Center Frankfurt, 60389 Frankfurt, Germany
- Department of Cardiology and Vascular Medicine, Medical Faculty, Justus-Liebig-University Giessen, 35392 Giessen, Germany
| | | | | | | | | | | | | | | | | | - Jennifer Franke
- Cardiovascular Center Frankfurt, 60389 Frankfurt, Germany
- Philips Chief Medical Office, 22335 Hamburg, Germany
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197
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Wang B, Liu X, Hao W, Fan J, Que B, Ai H, Wang X, Nie S. Comorbid obstructive sleep apnea is associated with adverse cardiovascular outcomes in female patients with acute coronary syndrome complicating metabolic syndrome. Clin Cardiol 2023. [PMID: 37060185 DOI: 10.1002/clc.24020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 03/18/2023] [Accepted: 03/28/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) and metabolic syndrome (MetS) are each increasingly common in patients with acute coronary syndrome (ACS). Whether OSA increases cardiovascular consequences in ACS patients with MetS has not been investigated. HYPOTHESIS OSA increases cardiovascular risk in ACS patients with MetS. We aimed to examine the association between OSA and cardiovascular consequences in ACS patients with MetS. METHODS In this prospective cohort study, we consecutive recruited 2160 ACS patients who underwent portable sleep breathing monitoring. OSA is defined as an apnea-hypopnea index (AHI) ≥ 15 events/h. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE), including cardiovascular death, myocardial infarction, stroke, ischemia-driven revascularization, or hospitalization for unstable angina or heart failure. RESULTS A total of 1927 patients with ACS were enrolled. Among them, 1486 (77.1%) had MetS and 1014 (52.6%) had OSA. During 2.9 years of follow-up, the cumulative incidence of MACCE was similar between OSA and non-OSA groups in patients with MetS (21.9% vs. 17.9%, adjusted hazard ratio [HR] = 1.29 95% confidence interval [CI]: 0.99-1.67, p = .06) and patients without MetS (24.4% vs. 17.3%, adjusted HR = 1.21 95% CI: 0.73-2.03, p = .46). Patients with MetS and OSA had a significantly higher risk of MACCE than patients with MetS and without OSA in women (27.8% vs. 18.1%, adjusted HR = 1.70, 95% CI: 1.01-3.09, p = .04) but not in men (21.0% vs. 17.9%, adjusted HR = 1.19, 95% CI: 0.91-1.59, p = .21). CONCLUSIONS In hospitalized ACS patients with MetS, comorbid OSA was associated with increased risk of cardiovascular consequences among women.
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Affiliation(s)
- Bin Wang
- Division of Cardiology, Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Xiaogang Liu
- Division of Cardiology, Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
- Department of Cardiology, Wuhan Fourth Hospital, Wuhan, China
| | - Wen Hao
- Division of Cardiology, Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Jingyao Fan
- Division of Cardiology, Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Bin Que
- Division of Cardiology, Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Hui Ai
- Division of Cardiology, Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Xiao Wang
- Division of Cardiology, Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Shaoping Nie
- Division of Cardiology, Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
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198
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Diletti R, den Dekker WK, Bennett J, Schotborgh CE, van der Schaaf R, Sabaté M, Moreno R, Ameloot K, van Bommel R, Forlani D, van Reet B, Esposito G, Dirksen MT, Ruifrok WPT, Everaert BRC, Van Mieghem C, Elscot JJ, Cummins P, Lenzen M, Brugaletta S, Boersma E, Van Mieghem NM. Immediate versus staged complete revascularisation in patients presenting with acute coronary syndrome and multivessel coronary disease (BIOVASC): a prospective, open-label, non-inferiority, randomised trial. Lancet 2023; 401:1172-1182. [PMID: 36889333 DOI: 10.1016/s0140-6736(23)00351-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND In patients with acute coronary syndrome and multivessel coronary disease, complete revascularisation by percutaneous coronary intervention (PCI) is associated with improved clinical outcomes. We aimed to investigate whether PCI for non-culprit lesions should be attempted during the index procedure or staged. METHODS This prospective, open-label, non-inferiority, randomised trial was done at 29 hospitals across Belgium, Italy, the Netherlands, and Spain. We included patients aged 18-85 years presenting with ST-segment elevation myocardial infarction or non-ST-segment elevation acute coronary syndrome and multivessel (ie, two or more coronary arteries with a diameter of 2·5 mm or more and ≥70% stenosis based on visual estimation or positive coronary physiology testing) coronary artery disease with a clearly identifiable culprit lesion. A web-based randomisation module was used to randomly assign patients (1:1), with a random block size of four to eight, stratified by study centre, to undergo immediate complete revascularisation (PCI of the culprit lesion first, followed by other non-culprit lesions deemed to be clinically significant by the operator during the index procedure) or staged complete revascularisation (PCI of only the culprit lesion during the index procedure and PCI of all non-culprit lesions deemed to be clinically significant by the operator within 6 weeks after the index procedure). The primary outcome was the composite of all-cause mortality, myocardial infarction, any unplanned ischaemia-driven revascularisation, or cerebrovascular events at 1 year after the index procedure. Secondary outcomes included all-cause mortality, myocardial infarction, and unplanned ischaemia-driven revascularisation at 1 year after the index procedure. Primary and secondary outcomes were assessed in all randomly assigned patients by intention to treat. Non-inferiority of immediate to staged complete revascularisation was considered to be met if the upper boundary of the 95% CI of the hazard ratio (HR) for the primary outcome did not exceed 1·39. This trial is registered with ClinicalTrials.gov, NCT03621501. FINDINGS Between June 26, 2018, and Oct 21, 2021, 764 patients (median age 65·7 years [IQR 57·2-72·9] and 598 [78·3%] males) were randomly assigned to the immediate complete revascularisation group and 761 patients (median age 65·3 years [58·6-72·9] and 589 [77·4%] males) were randomly assigned to the staged complete revascularisation group, and were included in the intention-to-treat population. The primary outcome at 1 year occurred in 57 (7·6%) of 764 patients in the immediate complete revascularisation group and in 71 (9·4%) of 761 patients in the staged complete revascularisation group (HR 0·78, 95% CI 0·55-1·11, pnon-inferiority=0·0011). There was no difference in all-cause death between the immediate and staged complete revascularisation groups (14 [1·9%] vs nine [1·2%]; HR 1·56, 95% CI 0·68-3·61, p=0·30). Myocardial infarction occurred in 14 (1·9%) patients in the immediate complete revascularisation group and in 34 (4·5%) patients in the staged complete revascularisation group (HR 0·41, 95% CI 0·22-0·76, p=0·0045). More unplanned ischaemia-driven revascularisations were performed in the staged complete revascularisation group than in the immediate complete revascularisation group (50 [6·7%] patients vs 31 [4·2%] patients; HR 0·61, 95% CI 0·39-0·95, p=0·030). INTERPRETATION In patients presenting with acute coronary syndrome and multivessel disease, immediate complete revascularisation was non-inferior to staged complete revascularisation for the primary composite outcome and was associated with a reduction in myocardial infarction and unplanned ischaemia-driven revascularisation. FUNDING Erasmus University Medical Center and Biotronik.
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Affiliation(s)
- Roberto Diletti
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Wijnand K den Dekker
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Johan Bennett
- Department of Cardiovascular Medicine, University Hospital Leuven, Leuven, Belgium
| | | | - Rene van der Schaaf
- Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
| | - Manel Sabaté
- Interventional Cardiology Department, Hospital Clinic, Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Raúl Moreno
- Interventional Cardiology Unit, Cardiology Department, La Paz University Hospital, Madrid, Spain
| | - Koen Ameloot
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos, Genk, Belgium
| | | | - Daniele Forlani
- Department of Cardiology, Santo Spirito Hospital, Pescara, Italy
| | - Bert van Reet
- Department of Cardiology, AZ Turnhout, Turnhout, Belgium
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Maurits T Dirksen
- Department of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, Netherlands
| | | | | | | | - Jacob J Elscot
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Paul Cummins
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Mattie Lenzen
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Salvatore Brugaletta
- Interventional Cardiology Department, Hospital Clinic, Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Eric Boersma
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Nicolas M Van Mieghem
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, Netherlands.
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Madsen AR, Skaarup KG, Iversen AZ, Jørgensen PG, Pedersson PR, Biering-Sørensen T. Echocardiographic Measures of Left Atrial Structure and Function and the Association with Atrial Fibrillation following Acute Coronary Syndrome. Cardiology 2023; 148:207-218. [PMID: 37015197 DOI: 10.1159/000529980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 02/20/2023] [Indexed: 04/06/2023]
Abstract
INTRODUCTION Acute coronary syndrome (ACS) is associated with an increased risk of developing atrial fibrillation (AF). This arrhythmia is associated with adverse outcomes, making it important to identify high-risk patients. The aim was to evaluate the prognostic value of measures of left atrial (LA) structure and function in AF prediction following ACS. METHODS Three hundred and eighty-one patients who had a percutaneous coronary intervention for ACS were included in the study. Our endpoint was new-onset AF. RESULTS With a median follow-up time of 5.4 [3.9-6.8] years, 56 patients (14.7%) developed AF. Patients developing AF had significantly (p ≤ 0.05) increased maximal and minimal LA volumes (LAVmax and LAVmin, respectively). LAVmax and LAVmin remained significantly increased in AF patients when indexing to either body surface area (LAVmax/BSA and LAVmin/BSA, respectively), left ventricle length in end diastole (LAVmax/LVLd and LAVmin/LVLd, respectively), or late mitral annular diastolic velocity (LAVmax/a' and LAVmin/a', respectively), while LA expansion index (LAEi), LA emptying fraction (LAEF), and peak LA longitudinal strain (PALS) were decreased. In univariable Cox regressions, all LA measures were found to be predictors of AF. After multivariable adjustment for clinical and echocardiographic parameters, all measures reflecting atrial function (LAVmin, LAVmin/BSA, LAVmin/LVLd, LAVmin/a', LAVmax/a', LAEF, LAEi, and PALS) (p ≤ 0.05) but no structural measures (LAVmax, LAVmax/BSA, and LAVmax/LVLd) remained significant independent predictors of AF. CONCLUSION Echocardiographic measures of LA function are independent predictors of AF following ACS. Evaluation of LA function might improve the prognostic workup, aid in risk stratification for AF, and improve selection for further examinations.
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Affiliation(s)
- Andreas Ruhvald Madsen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - Allan Zeeberg Iversen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Peter Godsk Jørgensen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Philip Rüssell Pedersson
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
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200
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Ashburn NP, Snavely AC, O’Neill JC, Allen BR, Christenson RH, Madsen T, Massoomi MR, McCord JK, Mumma BE, Nowak R, Stopyra JP, in’t Veld MH, Wilkerson RG, Mahler SA. Performance of the European Society of Cardiology 0/1-Hour Algorithm With High-Sensitivity Cardiac Troponin T Among Patients With Known Coronary Artery Disease. JAMA Cardiol 2023; 8:347-356. [PMID: 36857071 PMCID: PMC9979014 DOI: 10.1001/jamacardio.2023.0031] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/29/2022] [Indexed: 03/02/2023]
Abstract
Importance The European Society of Cardiology (ESC) 0/1-hour algorithm is a validated high-sensitivity cardiac troponin (hs-cTn) protocol for emergency department patients with possible acute coronary syndrome. However, limited data exist regarding its performance in patients with known coronary artery disease (CAD; prior myocardial infarction [MI], coronary revascularization, or ≥70% coronary stenosis). Objective To evaluate and compare the diagnostic performance of the ESC 0/1-hour algorithm for 30-day cardiac death or MI among patients with and without known CAD and determine if the algorithm could achieve the negative predictive value rule-out threshold of 99% or higher. Design, Setting, and Participants This was a preplanned subgroup analysis of the STOP-CP prospective multisite cohort study, which was conducted from January 25, 2017, through September 6, 2018, at 8 emergency departments in the US. Patients 21 years or older with symptoms suggestive of acute coronary syndrome without ST-segment elevation on initial electrocardiogram were included. Analysis took place between February and December 2022. Interventions/Exposures Participants with 0- and 1-hour high-sensitivity cardiac troponin T (hs-cTnT) measures were stratified into rule-out, observation, and rule-in zones using the ESC 0/1-hour hs-cTnT algorithm. Main Outcomes and Measures Cardiac death or MI at 30 days determined by expert adjudicators. Results During the study period, 1430 patients were accrued. In the cohort, 775 individuals (54.2%) were male, 826 (57.8%) were White, and the mean (SD) age was 57.6 (12.8) years. At 30 days, cardiac death or MI occurred in 183 participants (12.8%). Known CAD was present in 449 (31.4%). Among patients with known CAD, the ESC 0/1-hour algorithm classified 178 of 449 (39.6%) into the rule-out zone compared with 648 of 981 (66.1%) without CAD (P < .001). Among rule-out zone patients, 30-day cardiac death or MI occurred in 6 of 178 patients (3.4%) with known CAD and 7 of 648 (1.1%) without CAD (P < .001). The negative predictive value for 30-day cardiac death or MI was 96.6% (95% CI, 92.8-98.8) among patients with known CAD and 98.9% (95% CI, 97.8-99.6) in patients without known CAD (P = .04). Conclusions and Relevance Among patients with known CAD, the ESC 0/1-hour hs-cTnT algorithm was unable to safely exclude 30-day cardiac death or MI. This suggests that clinicians should be cautious if using the algorithm in patients with known CAD. The negative predictive value was significantly higher in patients without a history of CAD but remained less than 99%.
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Affiliation(s)
- Nicklaus P. Ashburn
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Anna C. Snavely
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - James C. O’Neill
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Brandon R. Allen
- Department of Emergency Medicine, University of Florida College of Medicine, Gainesville
| | | | - Troy Madsen
- Department of Emergency Medicine, University of Utah School of Medicine, Salt Lake City
| | - Michael R. Massoomi
- Department of Cardiology, University of Florida College of Medicine, Gainesville
| | - James K. McCord
- Department of Cardiology, Henry Ford Health System, Detroit, Michigan
| | - Bryn E. Mumma
- Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento
| | - Richard Nowak
- Department of Emergency Medicine, Henry Ford Health System, Detroit, Michigan
| | - Jason P. Stopyra
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Maite Huis in’t Veld
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore
| | - R. Gentry Wilkerson
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore
| | - Simon A. Mahler
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
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