151
|
Yang E, Stokes M, Johansson S, Mellström C, Magnuson E, Cohen DJ, Hunt P. Clinical and economic outcomes among elderly myocardial infarction survivors in the United States. Cardiovasc Ther 2017; 34:450-459. [PMID: 27564212 DOI: 10.1111/1755-5922.12222] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Longitudinal data are limited regarding outcomes and costs beyond 1 year after acute myocardial infarction (MI) among elderly (≥65 years old) US patients. This study examined long-term outcomes and healthcare costs among elderly MI survivors. METHODS Retrospective analysis of 2002-2009 Medicare healthcare claims (5% random sample). Patients were ≥65 years old and survived ≥1 year without recurrent MI after MI hospitalization. Mortality, incidence of hospitalizations for stroke, major bleeding, MI, a composite endpoint (death, MI, or stroke), and nonpharmacy healthcare costs were determined. RESULTS Eligible patients included 16 244 STEMI, 34 576 NSTEMI, and 3109 unspecified MI. NSTEMI and unspecified MI patients had significantly higher prevalence of comorbidities than STEMI patients, except for hypertension and dyslipidemia. MI incidence declined 36% over the follow-up (3.82/100 person-years [PY] to 2.45/100 PY). Mortality, stroke, and bleeding decreased until the third year of follow-up and then increased. NSTEMI and unspecified MI patients had a significantly higher incidence of death, MI, the composite, and bleeding than STEMI patients throughout follow-up. All-cause inpatient costs during follow-up were 2.6- and 1.9-fold higher than baseline for STEMI and NSTEMI, respectively; cardiovascular-related inpatient costs were 3.5- and 2.2-fold higher, respectively. CONCLUSIONS Risks of mortality and cardiovascular events remain high in a Medicare population surviving >1 year after a MI. Continuing healthcare costs are doubled over pre-MI levels up to 5 years after an MI. Secondary prevention measures beyond the acute post-MI period may be indicated to reduce risk and cost in this chronic disease phase.
Collapse
Affiliation(s)
| | | | | | | | - Elizabeth Magnuson
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - David J Cohen
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | | |
Collapse
|
152
|
Lavery T, Greenslade JH, Parsonage WA, Hawkins T, Dalton E, Hammett C, Cullen L. Factors influencing choice of pre-hospital transportation of patients with potential acute coronary syndrome: An observational study. Emerg Med Australas 2017; 29:210-216. [PMID: 28122419 DOI: 10.1111/1742-6723.12735] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 08/25/2016] [Accepted: 10/11/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine factors associated with ambulance use in patients with confirmed and potential acute coronary syndrome presenting to the ED. METHODS A convenience sample of patients (n = 247) presenting to the ED from April 2014 to January 2015 with suspected acute coronary syndrome were included in the study. Data on mode of transport and patient demographics were collected from the Emergency Department Information System database. Clinical data were collected from chart records and information systems. A questionnaire assessed reasons for using a chosen method of transport, symptom timing and characteristics, acute coronary syndrome knowledge, and awareness of the National Heart Foundation Early Warning Symptoms campaign. RESULTS Approximately half the patients (49.4%) assessed with symptoms of potential acute coronary syndrome used ambulance transport to the ED. Patients who arrived by ambulance were older than those not arriving by ambulance (mean 56.7 years vs 51.7 years, P = 0.01). Risk factors were not associated with ambulance use. Dizziness (P < 0.01), sweating (P = 0.03), nausea (P = 0.03) and vomiting (P = 0.04) were associated with increased ambulance use. Mean systolic blood pressure was lower in the ambulance group (136 mmHg, standard deviation [SD] = 19.8) than in the non-ambulance group (143 mmHg, SD = 25.9). Awareness of the National Heart Foundation Heart Attack Warning Signs campaign was not associated with ambulance use. CONCLUSIONS Patients with possible ischaemic symptoms who are at a high risk of cardiac disease do not utilise ambulance services more than low risk patients. In general, transport to hospital using ambulance services by patients with symptoms of possible acute coronary syndrome is low despite community campaigns.
Collapse
Affiliation(s)
- Tim Lavery
- Toowoomba Rural Clinical School, The University of Queensland, Brisbane, Queensland, Australia
| | - Jaimi H Greenslade
- Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,School of Public Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - William A Parsonage
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,School of Public Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Tracey Hawkins
- Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Emily Dalton
- Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Christopher Hammett
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Louise Cullen
- Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,School of Public Health, Queensland University of Technology, Brisbane, Queensland, Australia
| |
Collapse
|
153
|
Abstract
Acute myocardial infarction has traditionally been divided into ST elevation or non-ST elevation myocardial infarction; however, therapies are similar between the two, and the overall management of acute myocardial infarction can be reviewed for simplicity. Acute myocardial infarction remains a leading cause of morbidity and mortality worldwide, despite substantial improvements in prognosis over the past decade. The progress is a result of several major trends, including improvements in risk stratification, more widespread use of an invasive strategy, implementation of care delivery systems prioritising immediate revascularisation through percutaneous coronary intervention (or fibrinolysis), advances in antiplatelet agents and anticoagulants, and greater use of secondary prevention strategies such as statins. This seminar discusses the important topics of the pathophysiology, epidemiological trends, and modern management of acute myocardial infarction, focusing on the recent advances in reperfusion strategies and pharmacological treatment approaches.
Collapse
Affiliation(s)
- Grant W Reed
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Jeffrey E Rossi
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Christopher P Cannon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Executive Director Cardiometabolic Trials, Harvard Clinical Research Institute, Boston, MA, USA.
| |
Collapse
|
154
|
Liu HL, Jin ZG, Yang SL, Han W, Jing QM, Zhang L, Luo JP, Ma DX, Liu Y, Yang LX, Jiang TM, Qu P, Li WM, Li SM, Xu B, Gao RL, Han YL. Five-year outcomes of ST-elevation myocardial infarction versus non-ST-elevation acute coronary syndrome treated with biodegradable polymer-coated sirolimus-eluting stents: Insights from the CREATE trial. J Cardiol 2017; 69:149-155. [DOI: 10.1016/j.jjcc.2016.02.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 02/02/2016] [Accepted: 02/07/2016] [Indexed: 11/26/2022]
|
155
|
Liu CH, Yeh MK, Wang JH, Weng SC, Bai MY, Chang JC. Acute Coronary Syndrome and Suicide: A Case-Referent Study. J Am Heart Assoc 2016; 5:JAHA.116.003998. [PMID: 27927631 PMCID: PMC5210439 DOI: 10.1161/jaha.116.003998] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background The high prevalence of acute coronary syndrome (ACS) represents a significant burden on healthcare resources. A robust association exists between depression and increased morbidity and mortality after ACS. This study examined the relationship between suicide and ACS after adjusting for depression and other comorbidities. Methods and Results In this case‐referent study conducted in Taiwan, the cases were people aged 35 years or older who died from suicide between 2000 and 2012 and 4 live referents, each matched by age, sex, and area of residence. The covariates adjusted for in the analysis were sociodemographic characteristics, physical comorbidities, and psychiatric disorders. We identified 41 050 persons who committed suicide and 164 200 referents. In the case and referent groups, 1027 (2.5%) and 2412 (1.5%) patients had ACS, respectively. After potential confounders were adjusted, ACS was significantly associated with increased odds of suicide (aOR=1.15, 95% confidence interval [CI]=1.05‐1.26). The odds of suicide were highest during the initial 6 months post‐ACS diagnosis (OR=3.05, 95% CI=2.55‐3.65) and remained high for at least 4 years after ACS diagnosis. Conclusions ACS patients are at an increased risk of suicide compared with otherwise healthy people. The risk of suicide is particularly high in the 6 months after ACS diagnosis. Our results suggest that we need to identify efficacious methods to recognize those at risk for suicide and to develop effective interventions to prevent such deaths.
Collapse
Affiliation(s)
- Chao-Han Liu
- Biomedical Engineering Program, Graduate Institute of Applied Science and Technology, Taipei, Taiwan.,E-Da Hospital, Kaohsiung, Taiwan
| | - Ming-Kung Yeh
- Taipei Hospital, Ministry of Health and Welfare, Taipei, Taiwan.,School of Pharmacy, National Defense Medical Center, Taipei, Taiwan
| | - Ji-Hung Wang
- School of Medicine, Tzu Chi University, Hualien, Taiwan.,Division of Cardiology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Shu-Chuan Weng
- Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan
| | - Meng-Yi Bai
- Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan .,Adjunct Appointment to the National Defense Medical Center, Taipei, Taiwan (ROC)
| | - Jung-Chen Chang
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| |
Collapse
|
156
|
Platelets miRNA as a Prediction Marker of Thrombotic Episodes. DISEASE MARKERS 2016; 2016:2872507. [PMID: 28042196 PMCID: PMC5155104 DOI: 10.1155/2016/2872507] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 10/04/2016] [Indexed: 11/18/2022]
Abstract
The blood platelets are crucial for the coagulation physiology to maintain haemostatic balance and are involved in various pathologies such as atherosclerosis and thrombosis. The studies of recent years have shown that anucleated platelets are able to succeed protein synthesis. Additionally, mRNA translation in blood platelets is regulated by miRNA molecules. Recent works postulate the possibility of using miRNAs as biomarkers of atherosclerosis and ischemic episodes. This review article describes clinical studies that presented blood platelets miRNAs expression profile changes in different thrombotic states, which suggest use of these molecules as predictive biomarkers.
Collapse
|
157
|
Central Sleep Apnoea Is Related to the Severity and Short-Term Prognosis of Acute Coronary Syndrome. PLoS One 2016; 11:e0167031. [PMID: 27880845 PMCID: PMC5120829 DOI: 10.1371/journal.pone.0167031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 11/08/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate the relation of central sleep apnoea (CSA) to the severity and short-term prognosis of patients who experience acute coronary syndrome (ACS). METHODS Observational study with cross-sectional and longitudinal analyses. Patients acutely admitted to participating hospitals because of ACS underwent respiratory polygraphy during the first 24 to 72 h. CSA was defined as an apnoea-hypopnoea index (AHI) >15 events•h-1 (>50% of central apnoeas). ACS severity (Killip class, ejection fraction, number of diseased vessels and peak plasma troponin) was evaluated at baseline, and short-term prognosis (length of hospitalization, complications and mortality) was evaluated at discharge. RESULTS A total of 68 CSA patients (AHI 31±18 events•h-1, 64±12 years, 87% males) and 92 controls (AHI 7±5 events•h-1, 62±12 years, 84% males) were included in the analyses. After adjusting for age, body mass index, hypertension and smoking status, patients diagnosed with CSA spent more days in the coronary unit compared with controls (3.7±2.9 vs. 1.5±1.7; p<0.001) and had a worse Killip class (Killip I: 16% vs. 96%; p<0.001). No differences were observed in ejection fraction estimates. CONCLUSIONS CSA patients exhibited increased ACS severity as indicated by their Killip classification. These patients had a worse prognosis, with longer lengths of stay in the coronary care units. Our results highlight the relevance of CSA in patients suffering ACS episodes and suggest that diagnosing CSA may be a useful strategy to improve the management of certain ACS patients.
Collapse
|
158
|
Noites A, Freitas CP, Pinto J, Melo C, Vieira Á, Albuquerque A, Teixeira M, Ribeiro F, Bastos JM. Effects of a Phase IV Home-Based Cardiac Rehabilitation Program on Cardiorespiratory Fitness and Physical Activity. Heart Lung Circ 2016; 26:455-462. [PMID: 27743855 DOI: 10.1016/j.hlc.2016.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 08/01/2016] [Accepted: 08/16/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cardiovascular diseases are the leading cause of death globally and sedentary lifestyle is one of the main risk factors. Home-based cardiac rehabilitation (CR) programs appear to be effective to improve exercise tolerance. The aim of the study, therefore, was to evaluate the effects of a phase IV (maintenance) home-based CR program on cardiorespiratory fitness and daily physical activity of patients recovering from an acute myocardial infarction. METHODS This pilot study, with a sub-group randomised controlled trial, included 32 individuals recovering from a myocardial infarction, randomly divided into the experimental group (EG, n=16) and the control group (CG, n=16). The EG performed an exercise program, three times per week, at home during eight weeks. The two groups received health education sessions. Baseline and final assessments included cardiorespiratory fitness, resting and peak heart rate, blood pressure and rate pressure, heart rate recovery and daily physical activity. (ClinicalTrials.gov: NCT01887080). RESULTS At baseline no significant differences were observed between groups. After eight weeks of exercise, the EG significantly increased peak oxygen uptake (p=0.02), test duration (p=0.019), peak rate pressure (p=0.003), peak heart rate (p=0.003) and heart rate recovery (0.025) when compared to the CG. No changes were observed on daily physical activity in both groups. CONCLUSION This specific phase IV home-based exercise program seems to improve cardiorespiratory fitness, haemodynamics at peak exercise and heart rate recovery, an indicator of cardiac autonomic function.
Collapse
Affiliation(s)
- Andreia Noites
- Department of Physiotherapy, School of Allied Health Technologies, Polytechnic Institute of Porto, Porto, Portugal.
| | | | - Joana Pinto
- Department of Physiotherapy, School of Allied Health Technologies, Polytechnic Institute of Porto, Porto, Portugal
| | - Cristina Melo
- Department of Physiotherapy, School of Allied Health Technologies, Polytechnic Institute of Porto, Porto, Portugal
| | - Ágata Vieira
- Department of Physiotherapy, School of Allied Health Technologies, Polytechnic Institute of Porto, Porto, Portugal
| | - Aníbal Albuquerque
- Serviço de Cardiologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Portugal
| | - Madalena Teixeira
- Serviço de Cardiologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Portugal
| | - Fernando Ribeiro
- School of Health Sciences and Institute of Biomedicine - iBiMED, University of Aveiro, Aveiro, Portugal
| | | |
Collapse
|
159
|
Borzecki AM, Chen Q, Mull HJ, Shwartz M, Bhatt DL, Hanchate A, Rosen AK. Do Acute Myocardial Infarction and Heart Failure Readmissions Flagged as Potentially Preventable by the 3M Potentially Preventable Readmissions Software Have More Process-of-Care Problems? Circ Cardiovasc Qual Outcomes 2016; 9:532-41. [PMID: 27601460 DOI: 10.1161/circoutcomes.115.002509] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 06/15/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND The 3M Potentially Preventable Readmissions (3M-PPR) software matches clinically related index admission and readmission diagnoses that may signify in-hospital or postdischarge quality problems. To assess whether the PPR algorithm identifies preventable readmissions, we compared processes of care between PPR software-flagged and nonflagged cases. METHODS AND RESULTS Using 2006 to 2010 national VA administrative data, we identified acute myocardial infarction and heart failure discharges associated with 30-day all-cause readmissions, then flagged cases (PPR-Yes/PPR-No) using the 3M-PPR software. To assess care quality, we abstracted medical records of 100 readmissions per condition using tools containing explicit processes organized into admission work-up, in-hospital evaluation/treatment, discharge readiness, postdischarge period. We derived quality scores, scaled to a maximum of 25 per section (maximum total score=100) and compared cases on total and section-specific mean scores. For acute myocardial infarction, 77 of 100 cases were flagged as PPR-Yes. Section quality scores were highest for in-hospital evaluation/treatment (20.5±2.8) and lowest for postdischarge care (6.8±9.1). Total and section-related mean scores did not differ by PPR status; respective PPR-Yes versus PPR-No total scores were 61.6±11.1 and 60.4±9.4; P=0.98. For heart failure, 86 of 100 cases were flagged as PPR-Yes. Section scores were highest for discharge readiness (18.8±2.4) and lowest for postdischarge care (7.3±8.1). Like acute myocardial infarction, total and section-related mean scores did not differ by PPR status; PPR-Yes versus PPR-No total scores were 61.2±10.8 and 63.4±7.0, respectively; P=0.47. CONCLUSIONS Among VA acute myocardial infarction and heart failure readmissions, the 3M-PPR software does not distinguish differences in case-level quality of care. Whether 3M-PPR software better identifies preventable readmissions by using other methods to capture poorly documented processes or performing different comparisons requires further study.
Collapse
Affiliation(s)
- Ann M Borzecki
- From the Center for Healthcare Organization and Implementation Research (CHOIR), Bedford VAMC Campus, Bedford, MA (A.M.B.); Department of Health Policy and Management, Boston University School of Public Health, MA (A.M.B.); Department of Medicine (A.M.B., A.H.) and Department of Surgery (H.J.M., A.K.R.), Boston University School of Medicine, MA; CHOIR, Boston VA Campus, MA (Q.C., H.J.M., M.S., A.H., A.K.R.); Boston University Questrom School of Business, MA (M.S.); Brigham and Women's Hospital Heart & Vascular Center, Boston, MA (D.L.B.); and Department of Medicine, Harvard Medical School, Boston, MA (D.L.B.).
| | - Qi Chen
- From the Center for Healthcare Organization and Implementation Research (CHOIR), Bedford VAMC Campus, Bedford, MA (A.M.B.); Department of Health Policy and Management, Boston University School of Public Health, MA (A.M.B.); Department of Medicine (A.M.B., A.H.) and Department of Surgery (H.J.M., A.K.R.), Boston University School of Medicine, MA; CHOIR, Boston VA Campus, MA (Q.C., H.J.M., M.S., A.H., A.K.R.); Boston University Questrom School of Business, MA (M.S.); Brigham and Women's Hospital Heart & Vascular Center, Boston, MA (D.L.B.); and Department of Medicine, Harvard Medical School, Boston, MA (D.L.B.)
| | - Hillary J Mull
- From the Center for Healthcare Organization and Implementation Research (CHOIR), Bedford VAMC Campus, Bedford, MA (A.M.B.); Department of Health Policy and Management, Boston University School of Public Health, MA (A.M.B.); Department of Medicine (A.M.B., A.H.) and Department of Surgery (H.J.M., A.K.R.), Boston University School of Medicine, MA; CHOIR, Boston VA Campus, MA (Q.C., H.J.M., M.S., A.H., A.K.R.); Boston University Questrom School of Business, MA (M.S.); Brigham and Women's Hospital Heart & Vascular Center, Boston, MA (D.L.B.); and Department of Medicine, Harvard Medical School, Boston, MA (D.L.B.)
| | - Michael Shwartz
- From the Center for Healthcare Organization and Implementation Research (CHOIR), Bedford VAMC Campus, Bedford, MA (A.M.B.); Department of Health Policy and Management, Boston University School of Public Health, MA (A.M.B.); Department of Medicine (A.M.B., A.H.) and Department of Surgery (H.J.M., A.K.R.), Boston University School of Medicine, MA; CHOIR, Boston VA Campus, MA (Q.C., H.J.M., M.S., A.H., A.K.R.); Boston University Questrom School of Business, MA (M.S.); Brigham and Women's Hospital Heart & Vascular Center, Boston, MA (D.L.B.); and Department of Medicine, Harvard Medical School, Boston, MA (D.L.B.)
| | - Deepak L Bhatt
- From the Center for Healthcare Organization and Implementation Research (CHOIR), Bedford VAMC Campus, Bedford, MA (A.M.B.); Department of Health Policy and Management, Boston University School of Public Health, MA (A.M.B.); Department of Medicine (A.M.B., A.H.) and Department of Surgery (H.J.M., A.K.R.), Boston University School of Medicine, MA; CHOIR, Boston VA Campus, MA (Q.C., H.J.M., M.S., A.H., A.K.R.); Boston University Questrom School of Business, MA (M.S.); Brigham and Women's Hospital Heart & Vascular Center, Boston, MA (D.L.B.); and Department of Medicine, Harvard Medical School, Boston, MA (D.L.B.)
| | - Amresh Hanchate
- From the Center for Healthcare Organization and Implementation Research (CHOIR), Bedford VAMC Campus, Bedford, MA (A.M.B.); Department of Health Policy and Management, Boston University School of Public Health, MA (A.M.B.); Department of Medicine (A.M.B., A.H.) and Department of Surgery (H.J.M., A.K.R.), Boston University School of Medicine, MA; CHOIR, Boston VA Campus, MA (Q.C., H.J.M., M.S., A.H., A.K.R.); Boston University Questrom School of Business, MA (M.S.); Brigham and Women's Hospital Heart & Vascular Center, Boston, MA (D.L.B.); and Department of Medicine, Harvard Medical School, Boston, MA (D.L.B.)
| | - Amy K Rosen
- From the Center for Healthcare Organization and Implementation Research (CHOIR), Bedford VAMC Campus, Bedford, MA (A.M.B.); Department of Health Policy and Management, Boston University School of Public Health, MA (A.M.B.); Department of Medicine (A.M.B., A.H.) and Department of Surgery (H.J.M., A.K.R.), Boston University School of Medicine, MA; CHOIR, Boston VA Campus, MA (Q.C., H.J.M., M.S., A.H., A.K.R.); Boston University Questrom School of Business, MA (M.S.); Brigham and Women's Hospital Heart & Vascular Center, Boston, MA (D.L.B.); and Department of Medicine, Harvard Medical School, Boston, MA (D.L.B.)
| |
Collapse
|
160
|
Zaky DSE, Mabrouk FM, Zaki ER, Hendy OM. The value of YKL-40 in ischemic heart disease patients. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2016. [DOI: 10.4103/1110-7782.193891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
161
|
Masuda A, Yoshinaga K, Naya M, Manabe O, Yamada S, Iwano H, Okada T, Katoh C, Takeishi Y, Tsutsui H, Tamaki N. Accelerated (99m)Tc-sestamibi clearance associated with mitochondrial dysfunction and regional left ventricular dysfunction in reperfused myocardium in patients with acute coronary syndrome. EJNMMI Res 2016; 6:41. [PMID: 27169534 PMCID: PMC4864798 DOI: 10.1186/s13550-016-0196-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 04/28/2016] [Indexed: 12/02/2022] Open
Abstract
Background Accelerated clearance of 99mtechnetium-sestamibi (MIBI) has been observed after reperfusion therapy in patients with acute coronary syndrome (ACS), but the mechanisms have not been fully investigated. MIBI retention may depend on mitochondrial function. The clearance rate of 11carbon-acetate reflects such mitochondrial functions as oxidative metabolism. The purpose of this study was to examine the mechanisms of accelerated MIBI clearance in ACS. We therefore compared it to oxidative metabolism estimated using 11C-acetate positron emission tomography (PET). Methods Eighteen patients [mean age 69.2 ± 8.7 years, 10 males (56 %)] with reperfused ACS underwent MIBI single-photon emission computed tomography (SPECT), echocardiography, and 11C-acetate PET within 3 weeks of the onset of ACS. MIBI images were obtained 30 min and 3 h after MIBI administration. Regional left ventricular (LV) function was evaluated by echocardiography. The measurement of oxidative metabolism was obtained through the mono-exponential fitting of the 11C-acetate time-activity curve (kmono). Results Among 95 segments of reperfused myocardium, MIBI SPECT showed 64 normal segments (group N), 14 segments with accelerated MIBI clearance (group AC), and 17 segments with fixed defect (group F). Group AC showed lower kmono than group N (0.041 ± 0.009 vs 0.049 ± 0.010, p = 0.02). Group F showed lower kmono than group N (0.039 ± 0.012 vs 0.049 ± 0.010, p = 0.01). However, kmono was similar in group AC and group F (p = 0.99). Conclusions Segments with accelerated MIBI clearance showed reduced oxidative metabolism in ACS. Loss of MIBI retention may be associated with mitochondrial dysfunction.
Collapse
Affiliation(s)
- Atsuro Masuda
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.,Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan
| | - Keiichiro Yoshinaga
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan. .,Molecular Imaging Research Center, National Institute of Radiological Sciences, 4-9-1 Anagawa, Inage-Ku, Chiba, 263-8555, Japan.
| | - Masanao Naya
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Osamu Manabe
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Satoshi Yamada
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hiroyuki Iwano
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Tatsuya Okada
- Department of Natural Sciences, Fukushima Medical University, Fukushima, Japan
| | - Chietsugu Katoh
- Department of Health Sciences, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yasuchika Takeishi
- Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Nagara Tamaki
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| |
Collapse
|
162
|
Jia K, Shi P, Han X, Chen T, Tang H, Wang J. Diagnostic value of miR-30d-5p and miR-125b-5p in acute myocardial infarction. Mol Med Rep 2016; 14:184-94. [PMID: 27176713 PMCID: PMC4918561 DOI: 10.3892/mmr.2016.5246] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 02/02/2016] [Indexed: 11/18/2022] Open
Abstract
Rapid and accurate differential diagnosis of acute myocardial infarction (AMI) is crucial for timely interventions and the improvement of prognosis. However, this is difficult to achieve using current methods. Therefore, the present study aimed to evaluate the suitability of circulating microRNAs (miRNAs) as AMI biomarkers in patients with acute coronary syndrome (ACS). miRNA profiling in plasma samples from patients with AMI (n=3) and healthy controls (n=3) was performed using microarrays. Results were then validated in five patients and five healthy controls. miRNA-125b-5p and miR-30d-5p expression levels were quantified in plasma samples from 230 patients with ACS and 79 healthy controls using reverse transcription-quantitative polymerase chain reaction. Routine diagnostic parameters were assessed, including creatinine kinase MB, cardiac troponin I (cTnI) and myoglobin. A total of 33 miRNAs were differentially expressed in patients with AMI and healthy controls. Following validation based on the previously established roles for these miRNAs, six miRNAs were validated. miR-125b-5p and miR-30d-5p were selected for further investigation. Expression levels of miR-125b-5p and miR-30d-5p in plasma were higher in patients with ACS compared with the healthy controls (P<0.001). Receiver operating characteristic curve analysis revealed that the area under the curve of miR-30d-5p was higher than that of cTnI (0.915 and 0.899). miR-125b-5p (sensitivity, 0.808; specificity, 0.845) and miR-30d-5p (sensitivity, 0.855; specificity, 0.810) were suitable diagnostic predictors of AMI. Kaplan-Meier survival analysis indicated that miR-125b-5p levels were associated with 6 month cardiovascular events in patients with AMI, but not miR-30d-5p. miR-125b-5p and miR-30d-5p presented a diagnostic value for early diagnosis of AMI, and miR-30d-5p may have a higher diagnostic value than cTnI.
Collapse
Affiliation(s)
- Kegang Jia
- Department of Clinical Laboratory, TEDA International Cardiovascular Hospital, Tianjin 300457, P.R. China
| | - Ping Shi
- Department of Clinical Laboratory, TEDA International Cardiovascular Hospital, Tianjin 300457, P.R. China
| | - Xuejing Han
- Department of Clinical Laboratory, TEDA International Cardiovascular Hospital, Tianjin 300457, P.R. China
| | - Tienan Chen
- Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Tianjin 300457, P.R. China
| | - Hongxia Tang
- Department of Clinical Laboratory, TEDA International Cardiovascular Hospital, Tianjin 300457, P.R. China
| | - Jing Wang
- Department of Clinical Laboratory, TEDA International Cardiovascular Hospital, Tianjin 300457, P.R. China
| |
Collapse
|
163
|
Qanitha A, de Mol BA, Pabittei DR, Mappangara I, van der Graaf Y, Dalmeijer GW, Burgner DP, Uiterwaal CS. Infections in early life and premature acute coronary syndrome: A case-control study. Eur J Prev Cardiol 2016; 23:1640-8. [PMID: 27006417 DOI: 10.1177/2047487316640656] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 03/03/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Infections in young children may affect the vasculature and initiate early atherosclerosis. Whether infections experienced in childhood play a part in adult clinical cardiovascular disease remains unclear. We investigated the association between infections in early life and the occurrence of premature coronary heart disease. METHODS We conducted a population-based case-control study of 153 patients with a first acute coronary syndrome before the age of 56 years and 153 age- and sex-matched controls. Any history of severe infections in childhood and adolescence was obtained, together with clinical and laboratory measurements and other cardiovascular risk factors. We developed an infection score for the overall burden of early life infections. Conditional logistic regression was used to assess the associations. RESULTS Infections experienced in early life increased the risk of acquiring acute coronary syndrome at a young age with an odds ratio (OR) of 2.67 (95% confidence interval (CI) 1.47-4.83, p = 0.001). After adjustments for traditional risk factors, lifestyle, dietary patterns, socio-economic status and parental history of cardiovascular events, these associations remained significant and changed only slightly. There was an indication for an interaction between infections in early life and current cardiovascular risk (Framingham Risk Score (FRS); p-interaction = 0.052). Within participants with a low FRS (<10%), the OR of early life infection for acute coronary syndrome was 1.49 (95% CI 0.72-3.08, p = 0.283); within participants with an intermediate FRS (10-20%), the OR was 4.35 (95% CI 1.60-11.84, p = 0.004); and within participants with a high FRS (>20%), the OR 10.00 (95% CI 1.21-82.51, p = 0.032). CONCLUSION Infections in early life may partly explain premature coronary heart disease in adulthood and may potentiate traditional cardiovascular risk factor effects.
Collapse
Affiliation(s)
- Andriany Qanitha
- Department of Cardio-thoracic Surgery, Academic Medical Centre, University of Amsterdam, the Netherlands Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, the Netherlands Faculty of Medicine, University of Hasanuddin, Makassar, Indonesia
| | - Bastianus Ajm de Mol
- Department of Cardio-thoracic Surgery, Academic Medical Centre, University of Amsterdam, the Netherlands
| | - Dara R Pabittei
- Department of Cardio-thoracic Surgery, Academic Medical Centre, University of Amsterdam, the Netherlands Faculty of Medicine, University of Hasanuddin, Makassar, Indonesia
| | - Idar Mappangara
- Faculty of Medicine, University of Hasanuddin, Makassar, Indonesia
| | - Yolanda van der Graaf
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, the Netherlands
| | - Geertje W Dalmeijer
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, the Netherlands
| | - David P Burgner
- Department of Paediatrics, University of Melbourne, Australia
| | - Cuno Spm Uiterwaal
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, the Netherlands
| |
Collapse
|
164
|
Estimation of frequency and pretest probability of CAD in patients presenting with recent onset chest pain by multi-detector CT angiography. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2015.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
165
|
Nordmann A, Schwartz G, Vale N, Bucher HC, Briel M. Cochrane corner: early statin therapy in acute coronary syndromes—what is the clinical benefit? Heart 2016; 102:653-4. [DOI: 10.1136/heartjnl-2015-307781] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 02/01/2016] [Indexed: 11/04/2022] Open
|
166
|
Khoshchehreh M, Groves EM, Tehrani D, Amin A, Patel PM, Malik S. Changes in mortality on weekend versus weekday admissions for Acute Coronary Syndrome in the United States over the past decade. Int J Cardiol 2016; 210:164-72. [PMID: 26950171 DOI: 10.1016/j.ijcard.2016.02.087] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 02/11/2016] [Accepted: 02/14/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND We assessed in-hospital mortality and utilization of invasive cardiac procedures following Acute Coronary Syndrome (ACS) admissions on the weekend versus weekdays over the past decade in the United States. METHODS We used data from the Nationwide Inpatient Survey (2001-2011) to examine differences in all-cause in-hospital mortality between patients with a principal diagnosis of ACS admitted on a weekend versus a weekday. Adjusted and hierarchical logistic regression model analysis was then used to identify if weekend admission was associated with a decreased utilization of procedural interventions and increased subsequent complications as well. RESULTS 13,988,772 ACS admissions were identified. Adjusted mortality was higher for weekend admissions for Non-ST-Elevation Acute Coronary Syndromes [OR: 1.15, 95% CI, 1.14-1.16] and only somewhat higher for ST-Elevation Myocardial Infarction [OR: 1.03; 95% CI, 1.01-1.04]. Additionally, patients were significantly less likely to receive coronary revascularization intervention/therapy on their first day of admission [OR: 0.97, 95% CI: 0.96-0.98 and OR: 0.75, 95% CI: 0.75-0.75 for STEMI and NSTE-ACS respectively]. For ACS patients admitted during the weekend who underwent procedural interventions, in-hospital mortality and complications were higher as compared to patients undergoing the same procedures on weekdays. CONCLUSION For ACS patients, weekend admission is associated with higher mortality and lower utilization of invasive cardiac procedures, and those who did undergo these interventions had higher rates of mortality and complications than their weekday counterparts. This data leads to the possible conclusion that access to diagnostic/interventional procedures may be contingent upon the day of admission, which may impact mortality.
Collapse
Affiliation(s)
- Mahdi Khoshchehreh
- Division of Cardiology, University of California, Irvine, USA; Department of Preventive Medicine, Division of Biostatistics, Keck School of Medicine, University of Southern California, USA
| | - Elliott M Groves
- Scripps Clinic, Division of Interventional Cardiology, La Jolla, CA, USA
| | - David Tehrani
- Division of Cardiology, University of California, Irvine, USA
| | - Alpesh Amin
- Department of Internal Medicine, University of California, Irvine, USA
| | - Pranav M Patel
- Division of Cardiology, University of California, Irvine, USA; Department of Internal Medicine, University of California, Irvine, USA
| | - Shaista Malik
- Division of Cardiology, University of California, Irvine, USA; Department of Internal Medicine, University of California, Irvine, USA.
| |
Collapse
|
167
|
Potential Diagnostic and Prognostic Biomarkers of Epigenetic Drift within the Cardiovascular Compartment. BIOMED RESEARCH INTERNATIONAL 2016; 2016:2465763. [PMID: 26942189 PMCID: PMC4749768 DOI: 10.1155/2016/2465763] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 11/02/2015] [Accepted: 11/24/2015] [Indexed: 12/15/2022]
Abstract
Biomarkers encompass a wide range of different measurable indicators, representing a tangible link to physiological changes occurring within the body. Accessibility, sensitivity, and specificity are significant factors in biomarker suitability. New biomarkers continue to be discovered, and questions over appropriate selection and assessment of their usefulness remain. If traditional markers of inflammation are not sufficiently robust in their specificity, then perhaps alternative means of detection may provide more information. Epigenetic drift (epigenetic modifications as they occur as a direct function with age), and its ancillary elements, including platelets, secreted microvesicles (MVs), and microRNA (miRNA), may hold enormous predictive potential. The majority of epigenetic drift observed in blood is independent of variations in blood cell composition, addressing concerns affecting traditional blood-based biomarker efficacy. MVs are found in plasma and other biological fluids in healthy individuals. Altered MV/miRNA profiles may also be found in individuals with various diseases. Platelets are also highly reflective of physiological and lifestyle changes, making them extremely sensitive biomarkers of human health. Platelets release increased levels of MVs in response to various stimuli and under a plethora of disease states, which demonstrate a functional effect on other cell types.
Collapse
|
168
|
Amalia L, Anggadireja K, Aprami TM, Septiani V. Prevalence of Adverse Drug Reactions in CAD STEMI Patients Treated in the Cardiac Intensive Care Unit at the Public Hospital in Bandung, Indonesia. Sci Pharm 2016; 84:167-79. [PMID: 27110507 PMCID: PMC4839262 DOI: 10.3797/scipharm.isp.2015.08] [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: 09/05/2015] [Accepted: 12/15/2015] [Indexed: 11/22/2022] Open
Abstract
Adverse drug reactions (ADRs) are associated with morbidity, mortality, and can contribute to increased healthcare costs. This study was conducted to identify the occurence, types, and management of ADRs, as well as analyze the causal relationship, severity, and preventability of ADRs. The study was observational analysis with concurrent data collection from patients with Coronary Artery Disease-ST segment Elevation Myocardial Infarction (CAD-STEMI) treated in the Cardiac Intensive Care Unit (CICU) at a hospital in Bandung Indonesia, during the period of December 2013 to March 2014. The occurence of identified ADRs was assessed using the probability scale of Naranjo, while the severity by the scale of Hartwig and their preventability was evaluated using the scale of Schumock-Thornton. 49 ADRs were identified in 29 patients. Organ systems most affected by the ADRs were the cardiovascular and body electrolyte, each accounting for 20.41%. The hematology and gastrointestinal systems each contributed 18.37% to ADR occurrences. The causal relationship was mostly classified as "probable," accounting for 69.39%. With regard to severity, most ADRs were classified as "moderate" at level 3, contributing to 53.06% of the occurence. In terms of preventability, most of the ADRs fell into the "non-preventable" category (79.59%). The most widely applied ADRs management was administration of an antidote or other treatments (40.82%). Further analysis revealed that the average number of drug types and duration of hospitalization significantly affected the presence of ADRs. Taken together, most patients with CAD STEMI treated in the CICU of the studied hospital experienced non-preventable ADRs and were treated with antidote or other treatments.
Collapse
Affiliation(s)
- Lia Amalia
- School of Pharmacy, Institut Teknologi Bandung, Indonesia
| | | | | | - Vina Septiani
- School of Pharmacy, Institut Teknologi Bandung, Indonesia
| |
Collapse
|
169
|
|
170
|
Weinstein SA, White J, Ou J, Haiart S, Galluccio S. Reply to Isbister and Page: Further discussion of an illuminated case of presumed brown snake (Pseudonaja spp.) envenoming. Clin Toxicol (Phila) 2015; 53:926-7. [PMID: 26503791 DOI: 10.3109/15563650.2015.1096369] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Scott A Weinstein
- a Toxinology Department , Women's and Children's Hospital , North Adelaide , South Australia , Australia
| | - Julian White
- a Toxinology Department , Women's and Children's Hospital , North Adelaide , South Australia , Australia
| | - Judy Ou
- b Departments of Emergency Medicine and Intensive Care , Flinders University Medical Center , Bedford Park , Adelaide , South Australia , Australia
| | - Sebastien Haiart
- b Departments of Emergency Medicine and Intensive Care , Flinders University Medical Center , Bedford Park , Adelaide , South Australia , Australia
| | - Steven Galluccio
- b Departments of Emergency Medicine and Intensive Care , Flinders University Medical Center , Bedford Park , Adelaide , South Australia , Australia
| |
Collapse
|
171
|
Hwang SY, Kim JS. Risk Factor–tailored Small Group Education for Patients with First-time Acute Coronary Syndrome. Asian Nurs Res (Korean Soc Nurs Sci) 2015; 9:291-7. [DOI: 10.1016/j.anr.2015.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 06/15/2015] [Accepted: 07/20/2015] [Indexed: 10/22/2022] Open
|
172
|
Umman B, Cakmakoglu B, Cincin Z, Kocaaga M, Emet S, Tamer S, Gokkusu C. Identification of gene variants related to the nitric oxide pathway in patients with acute coronary syndrome. Gene 2015; 574:76-81. [DOI: 10.1016/j.gene.2015.07.081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 07/20/2015] [Accepted: 07/28/2015] [Indexed: 12/13/2022]
|
173
|
Sandoval-Pinto E, Padilla-Gutiérrez JR, Valdés-Alvarado E, García-González IJ, Valdez-Haro A, Muñoz-Valle JF, Flores-Salinas HE, Brennan-Bourdon LM, Valle Y. Association of the -1031T>C polymorphism and soluble TNF-α levels with Acute Coronary Syndrome. Cytokine 2015; 78:37-43. [PMID: 26618233 DOI: 10.1016/j.cyto.2015.11.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 10/10/2015] [Accepted: 11/12/2015] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Inflammation has gained a pivotal role in the pathophysiology of Acute Coronary Syndrome (ACS). TNF-α is a pro-inflammatory cytokine that could be a potential biomarker in ACS due to its multiple functions. The rs1799964 TNFA polymorphism (-1031T>C) has been associated with a decrease in gene transcription and cytokine levels. OBJECTIVE To determine the association of rs1799964 TNFA polymorphism and TNF-α soluble levels in ACS. METHODS A total of 251 patients diagnosed with ACS and 164 individuals without cardiovascular diseases classified as the reference group (RG), were included. The rs1799964 polymorphism was genotyped by PCR-RFLP. Soluble protein levels were determined by ELISA. Statistical analyses were performed using chi square and U-Mann Whitney tests. RESULTS The genotype and allele frequencies were different between ACS and RG (OR=0.317, p=0.01; OR=0.688, p=0.03 respectively). ACS patients had higher soluble TNF-α levels compared with the RG (31.08 vs 23.00pg/mL, p<0.001); according genotype significant differences were observed (T/T: 24.06 vs T/C: 34.95pg/mL, p=0.0001) in patients. In the RG, T/T carriers showed discrete lower levels than C/C genotype (22.14 vs 27.83pg/mL, p=0.04). CONCLUSIONS The -1031C allele of the TNFA polymorphism confers protection for the development of ACS. The T/C genotype carriers had higher TNF-α serum levels compared to the T/T genotype in ACS. In addition, the -1031T>C TNFA polymorphism was associated with dyslipidemia in ACS in a Western Mexican population.
Collapse
Affiliation(s)
- Elena Sandoval-Pinto
- Instituto de Investigación en Ciencias Biomédicas, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico; Doctorado en Ciencias Biomédicas, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - Jorge Ramón Padilla-Gutiérrez
- Instituto de Investigación en Ciencias Biomédicas, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - Emmanuel Valdés-Alvarado
- Instituto de Investigación en Ciencias Biomédicas, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico; Doctorado en Ciencias Biomédicas, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - Ilian Janet García-González
- Instituto de Investigación en Ciencias Biomédicas, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico; Doctorado en Genética Humana, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - Angélica Valdez-Haro
- Instituto de Investigación en Ciencias Biomédicas, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico; Doctorado en Genética Humana, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - José Francisco Muñoz-Valle
- Instituto de Investigación en Ciencias Biomédicas, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - Hector Enrique Flores-Salinas
- Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, Mexico
| | - Lorena Michele Brennan-Bourdon
- Instituto de Investigación en Ciencias Biomédicas, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - Yeminia Valle
- Instituto de Investigación en Ciencias Biomédicas, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico.
| |
Collapse
|
174
|
Abstract
Although recent advances in noninvasive imaging technologies have potentially improved diagnostic efficiency and clinical outcomes of patients with acute chest pain, controversy remains regarding much of the accumulated evidence. This article reviews the role of coronary computed tomography (CT) angiography in the assessment of coronary risk, and its usefulness in the emergency department in facilitating appropriate disposition decisions. Also discussed is coronary artery calcification incidentally found on CT scans when done for indications such as evaluation of pulmonary embolism or lung cancer. The evidence base and clinical applications for both techniques are described, together with cost-effectiveness and radiation exposure considerations.
Collapse
Affiliation(s)
- Swapnesh Parikh
- Internal Medicine Department, Los Angeles Biomedical Research Institute, 1124 West Carson Street, Torrance, CA 90502, USA
| | - Matthew J Budoff
- Internal Medicine Department, Los Angeles Biomedical Research Institute, 1124 West Carson Street, Torrance, CA 90502, USA.
| |
Collapse
|
175
|
Goto K, Zhao Z, Matsumura M, Dohi T, Kobayashi N, Kirtane AJ, Rabbani LE, Collins MB, Parikh MA, Kodali SK, Leon MB, Moses JW, Mintz GS, Maehara A. Mechanisms and Patterns of Intravascular Ultrasound In-Stent Restenosis Among Bare Metal Stents and First- and Second-Generation Drug-Eluting Stents. Am J Cardiol 2015; 116:1351-7. [PMID: 26341188 DOI: 10.1016/j.amjcard.2015.07.058] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 07/30/2015] [Accepted: 07/30/2015] [Indexed: 11/17/2022]
Abstract
The most common causes of in-stent restenosis (ISR) are intimal hyperplasia and stent under expansion. The purpose of this study was to use intravascular ultrasound (IVUS) to compare the ISR mechanisms of bare metal stents (BMS), first-generation drug-eluting stents (DES), and second-generation DES. There were 298 ISR lesions including 52 BMS, 73 sirolimus-eluting stents, 52 paclitaxel-eluting stents, 16 zotarolimus-eluting stents, and 105 everolimus-eluting stent. Mean patient age was 66.6 ± 1.1 years, 74.2% were men, and 48.3% had diabetes mellitus. BMS restenosis presented later (70.0 ± 66.7 months) with more intimal hyperplasia compared with DES (BMS 58.6 ± 15.5%, first-generation DES 52.6 ± 20.9%, second-generation DES 48.2 ± 22.2%, p = 0.02). Although reference lumen areas were similar in BMS and first- and second-generation DES, restenotic DES were longer (BMS 21.8 ± 13.5 mm, first-generation DES 29.4 ± 16.1 mm, second-generation DES 32.1 ± 18.7 mm, p = 0.003), and stent areas were smaller (BMS 7.2 ± 2.4 mm(2), first-generation DES 6.1 ± 2.1 mm(2), second-generation DES 5.7 ± 2.0 mm(2), p <0.001). Stent fracture was seen only in DES (first-generation DES 7 [5.0%], second-generation DES 8 [7.4%], p = 0.13). In conclusion, restenotic first- and second-generation DES were characterized by less neointimal hyperplasia, smaller stent areas, longer stent lengths, and more stent fractures than restenotic BMS.
Collapse
Affiliation(s)
- Kosaku Goto
- Cardiovascular Research Foundation, New York, New York; Columbia University Medical Center, New York, New York
| | - Zhijing Zhao
- Cardiovascular Research Foundation, New York, New York; Columbia University Medical Center, New York, New York
| | | | - Tomotaka Dohi
- Cardiovascular Research Foundation, New York, New York; Columbia University Medical Center, New York, New York
| | | | - Ajay J Kirtane
- Cardiovascular Research Foundation, New York, New York; Columbia University Medical Center, New York, New York
| | | | | | - Manish A Parikh
- Cardiovascular Research Foundation, New York, New York; Columbia University Medical Center, New York, New York
| | - Susheel K Kodali
- Cardiovascular Research Foundation, New York, New York; Columbia University Medical Center, New York, New York
| | - Martin B Leon
- Cardiovascular Research Foundation, New York, New York; Columbia University Medical Center, New York, New York
| | | | - Gary S Mintz
- Cardiovascular Research Foundation, New York, New York
| | - Akiko Maehara
- Cardiovascular Research Foundation, New York, New York; Columbia University Medical Center, New York, New York.
| |
Collapse
|
176
|
Role of multi-slice CT coronary angiography in evaluating the different patterns of coronary artery disease in patients with unstable angina. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2015.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
177
|
Evaluation of the diagnostic and prognostic use of gated myocardial perfusion single-photon emission computed tomography in patients with acute chest pain. Nucl Med Commun 2015; 36:945-51. [DOI: 10.1097/mnm.0000000000000336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
178
|
Nguyen TT, Ngo LQ, Promsudthi A, Surarit R. Salivary Lipid Peroxidation in Patients With Generalized Chronic Periodontitis and Acute Coronary Syndrome. J Periodontol 2015; 87:134-41. [PMID: 26313018 DOI: 10.1902/jop.2015.150353] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Lipid peroxidation is a major consequence of oxidative stress and can be evaluated via malondialdehyde (MDA) levels. The present study aims to assess MDA levels in the saliva of patients with chronic periodontitis (CP) and acute coronary syndrome (ACS) and establish their correlation with periodontal clinical parameters, serum high-sensitivity C-reactive protein (hsCRP), and plasma fibrinogen. METHODS The study enrolled 64 patients stratified into four age- and sex-matched groups: both ACS and CP, ACS only, CP only, and healthy controls. All patients were examined, periodontal clinical parameters were recorded, and saliva and blood samples were collected. Salivary MDA levels were measured using a spectrophotometric assay. A quantitative turbidimetric test was used for the measurement of serum hsCRP levels, and plasma fibrinogen levels were determined using an automated analyzer. RESULTS Salivary MDA levels were significantly higher in patients with both ACS and CP than in those with only ACS or only CP and healthy controls (P <0.05). There were significant positive correlations between salivary MDA levels and periodontal clinical parameters as well as biomarkers for cardiovascular events (P <0.001). CONCLUSIONS To our knowledge, this study is the first to investigate salivary MDA levels in patients with ACS and their correlations with serum hsCRP and plasma fibrinogen levels. The results indicate that salivary MDA levels could be a biomarker for cardiovascular and/or periodontal disease.
Collapse
Affiliation(s)
- Thuy T Nguyen
- Department of Oral Biology, Faculty of Dentistry, Mahidol University, Bangkok, Thailand.,Department of Periodontology, Faculty of Odonto-Stomatology, University of Medicine and Pharmacy Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Lan Q Ngo
- Department of Dental Basic Sciences, Faculty of Odonto-stomatology, University of Medicine and Pharmacy Ho Chi Minh City
| | - Ananya Promsudthi
- Department of Oral Medicine and Periodontology, Faculty of Dentistry, Mahidol University
| | - Rudee Surarit
- Department of Oral Biology, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| |
Collapse
|
179
|
Begum N, Stephens S, Schoeman O, Fraschke A, Kirsch B, Briere JB, Verheugt FWA, van Hout BA. Cost-effectiveness Analysis of Rivaroxaban in the Secondary Prevention of Acute Coronary Syndromes in Sweden. Cardiol Ther 2015; 4:131-53. [PMID: 26099515 PMCID: PMC4675751 DOI: 10.1007/s40119-015-0041-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Worldwide, coronary heart disease accounts for 7 million deaths each year. In Sweden, acute coronary syndrome (ACS) is a leading cause of hospitalization and is responsible for 1 in 4 deaths. OBJECTIVE The aim of this analysis was to assess the cost-effectiveness of rivaroxaban 2.5 mg twice daily (BID) in combination with standard antiplatelet therapy (ST-APT) versus ST-APT alone, for the secondary prevention of ACS in adult patients with elevated cardiac biomarkers without a prior history of stroke/transient ischemic attack (TIA), from a Swedish societal perspective, based on clinical data from the global ATLAS ACS 2-TIMI 51 trial, literature-based quality of life data and costs sourced from Swedish national databases. METHODS A Markov model was developed to capture rates of single and multiple myocardial infarction (MI), ischemic and hemorrhagic stroke, thrombolysis in myocardial infarction (TIMI) major, minor, and "requiring medical attention" bleeds, revascularization events, and associated costs and utilities in patients who were stabilized after an initial ACS event. Efficacy and safety data for the first 2 years came from the ATLAS ACS 2-TIMI 51 trial. Long-term probabilities were extrapolated using safety and effectiveness of acetylsalicylic acid data, which was estimated from published literature, assuming constant rates in time. Future cost and effects were discounted at 3.0%. Univariate and probabilistic sensitivity analyses were conducted. RESULTS In the base case, the use of rivaroxaban 2.5 mg BID was associated with improvements in survival and quality-adjusted life years (QALYs), yielding an incremental cost per QALY of 71,246 Swedish Krona (SEK) (€8045). The outcomes were robust to changes in inputs. The probabilistic sensitivity analysis demonstrated rivaroxaban 2.5 mg BID to be cost-effective in >99.9% of cases, assuming a willingness-to-pay threshold of SEK 500,000 (€56,458). CONCLUSION Compared with ST-APT alone, the use of rivaroxaban 2.5 mg BID in combination with ST-APT can be considered a cost-effective treatment option for ACS patients with elevated cardiac biomarkers without a prior history of stroke/TIA in Sweden. FUNDING Bayer Pharma AG.
Collapse
Affiliation(s)
- Najida Begum
- Pharmerit Ltd, Enterprise House, Innovation Way, Heslington, York, YO10 5NQ, UK
| | - Stephanie Stephens
- Pharmerit Ltd, Enterprise House, Innovation Way, Heslington, York, YO10 5NQ, UK.
| | | | | | | | | | | | - Ben A van Hout
- Pharmerit Ltd, Enterprise House, Innovation Way, Heslington, York, YO10 5NQ, UK.,University of Sheffield, School of Health and Related Research, Sheffield, UK
| |
Collapse
|
180
|
Qi LP, Chen LF, Dang AM, Li LY, Fang Q, Yan XW. Association between the ABCA1-565C/T gene promoter polymorphism and coronary heart disease severity and cholesterol efflux in the Chinese Han population. Genet Test Mol Biomarkers 2015; 19:347-52. [PMID: 26090796 DOI: 10.1089/gtmb.2015.0011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND ABCA1 -565C/T gene promoter variants have been associated with the severity of coronary artery disease in Western populations. The purpose of our study was to investigate the association between the -565C/T gene polymorphism and coronary artery disease severity and cholesterol efflux in the Chinese Han population. METHODS A cohort of 298 acute coronary syndrome (ACS) patients and 541 healthy controls was genotyped using the highly sensitive ligase detection reaction. ABCA1 -565C/T genotype was correlated with the clinical features of 164 acute myocardial infarction (AMI) patients. Monocytes from patients with various -565C/T gene polymorphisms were isolated and differentiated into foam cells by coincubation with [(3)H]-labeled acetyl-low-density lipoprotein cholesterol. ABCA1 mRNA and protein expression levels were evaluated, as well as cellular cholesterol efflux. RESULTS The frequency of the TT genotype in the -565C/T polymorphism of ACS patients was significantly increased when compared with controls (0.211 vs. 0.162, p<0.05). The TT genotype, but not the CT or CC genotypes, in the -565C/T gene polymorphism correlated with the severity of the coronary lesion observed in AMI patients. Patients with the TT homozygote genotype also exhibited significantly lower cellular cholesterol efflux (TT [6.37%±0.554%]) levels than controls and also had the lowest levels of ABCA1 mRNA and protein expression among the group of variants. In contrast, cholesterol efflux levels in AMI patients with CT [11.35%±3.975%] and CC ([15.32%±6.293%]) genotypes were not significantly different from controls. CONCLUSIONS Impaired ABCA1-mediated cholesterol efflux in macrophages may be associated with the severity of the coronary lesions in AMI patients with the TT genotype at the -565C/T gene polymorphism.
Collapse
Affiliation(s)
- Li-Ping Qi
- 1 Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College , Chinese Academy of Medicine Science, Beijing, China
- 2 Department of Second Geriatric Cardiology, The People's Liberation Army General Hospital , Beijing, China
| | - Lian-Feng Chen
- 1 Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College , Chinese Academy of Medicine Science, Beijing, China
| | - Ai-Min Dang
- 3 Department of Cardiology, FuWai Cardiovascular Disease Hospital, Peking Union Medical College , Chinese Academy of Medicine Science, Beijing, China
| | - Li-Yun Li
- 1 Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College , Chinese Academy of Medicine Science, Beijing, China
| | - Quan Fang
- 1 Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College , Chinese Academy of Medicine Science, Beijing, China
| | - Xiao-Wei Yan
- 1 Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College , Chinese Academy of Medicine Science, Beijing, China
| |
Collapse
|
181
|
Gheddouchi S, Mokhtari-Soulimane N, Merzouk H, Bekhti F, Soulimane F, Guermouche B, Meziane Tani A, Narce M. Low SOD activity is associated with overproduction of peroxynitrite and nitric oxide in patients with acute coronary syndrome. Nitric Oxide 2015; 49:40-6. [PMID: 26047756 DOI: 10.1016/j.niox.2015.05.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 05/20/2015] [Accepted: 05/26/2015] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The present study was undertaken to evaluate the variation of the oxidative/nitrosative stress status in a population of subjects; with acute coronary syndrome (ACS), and examine its possible implication in plaque rupture which is the main mechanism in the pathophysiology of ACS. PATIENTS AND METHODS We made this study on 50 men with ACS and 50 age and sex matched healthy controls. Nitrosative/oxidative stress markers including; nitric oxide, superoxide anion levels, superoxide dismutase (SOD) activity and peroxynitrite levels were evaluated in blood samples of patients and controls. RESULTS Compared with healthy subjects, coronary patients had significantly higher nitric oxide, peroxynitrite and superoxide anion concentrations in both plasma and erythrocytes associated to significant decrease of SOD activity. Erythrocytes peroxynitrite concentration was negatively correlated with the antioxidant enzyme activity (SOD). CONCLUSION Our results show a significant accumulation of both intracellular and plasma pro-oxidants with a concomitant decrease in the SOD scavenging activity in ACS patients. Both seem to be associated with plaque rupture and ischemia observed in ACS.
Collapse
Affiliation(s)
- Sabah Gheddouchi
- Laboratory of Physiology, Physiopathology and Biochemistry of Nutrition(PPABIONUT), Department of Biology, Faculty of Natural and Life Sciences, Earth and Universe, Abou-Bekr Belkaïd University, Tlemcen 13000, Algeria
| | - Nassima Mokhtari-Soulimane
- Laboratory of Physiology, Physiopathology and Biochemistry of Nutrition(PPABIONUT), Department of Biology, Faculty of Natural and Life Sciences, Earth and Universe, Abou-Bekr Belkaïd University, Tlemcen 13000, Algeria.
| | - Hafida Merzouk
- Laboratory of Physiology, Physiopathology and Biochemistry of Nutrition(PPABIONUT), Department of Biology, Faculty of Natural and Life Sciences, Earth and Universe, Abou-Bekr Belkaïd University, Tlemcen 13000, Algeria
| | - Fadia Bekhti
- Laboratory of Physiology, Physiopathology and Biochemistry of Nutrition(PPABIONUT), Department of Biology, Faculty of Natural and Life Sciences, Earth and Universe, Abou-Bekr Belkaïd University, Tlemcen 13000, Algeria
| | - Fayçal Soulimane
- Cardiology Department of Tlemcen University Hospital Center, Tlemcen 13000, Algeria
| | - Baya Guermouche
- Laboratory of Physiology, Physiopathology and Biochemistry of Nutrition(PPABIONUT), Department of Biology, Faculty of Natural and Life Sciences, Earth and Universe, Abou-Bekr Belkaïd University, Tlemcen 13000, Algeria
| | | | - Michel Narce
- INSERM UMR 866, "Lipids Nutrition Cancer", Faculty of Life, Earth, and Environment Sciences, University of Burgundy, Dijon 21000, France
| |
Collapse
|
182
|
Al Jumaily T, Rose'Meyer RB, Sweeny A, Jayasinghe R. Cardiac damage associated with stress hyperglycaemia and acute coronary syndrome changes according to level of presenting blood glucose. Int J Cardiol 2015; 196:16-21. [PMID: 26070178 DOI: 10.1016/j.ijcard.2015.05.143] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 05/12/2015] [Accepted: 05/26/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To determine the prevalence of stress hyperglycaemia in people presenting with acute coronary syndrome (ACS), and the relationships between admission glucose and cardiac damage, cardiovascular mortality and morbidity. METHODS In a prospective observational study people presenting with ACS at the Gold Coast Hospital had their admission glucose (AG) level tested to determine stress hyperglycaemia. A range of measurements supplemented this data including troponin levels, category of ACS and major adverse coronary events (MACEs) were obtained through hospital records and patient follow-up post-discharge. RESULTS One hundred eighty-eight participants were recruited. The prevalence of stress hyperglycaemia in ACS was 44% with 31% having a previous diagnosis of type 2 diabetes and 7.7% had undiagnosed diabetes. The stress hyperglycaemic group had a significantly higher median troponin levels compared to participants with normal blood glucose levels on admission (p<0.05) however the highest presenting glucose group (>15 mmol/L) had troponin levels similar to people presenting with normal blood glucose levels and ACS (p>0.05). CONCLUSIONS Cardiac necrosis as measured by troponin levels is significantly increased in people with ACS and stress hyperglycaemia. This study found that one in four participants presenting with ACS and an admission glucose of >7.0 had no previous diagnosis for diabetes. PRACTICE IMPLICATION Consistently ordering HbA1C testing on patients with high AG can enable earlier diagnosis and treatment of diabetes.
Collapse
Affiliation(s)
- Talib Al Jumaily
- Cardiology Department, Gold Coast University Hospital, Parkwood, Queensland, Australia; School of Medical Sciences, Griffith University, Southport, Queensland, Australia
| | - Roselyn B Rose'Meyer
- School of Medical Sciences, Griffith University, Southport, Queensland, Australia.
| | - Amy Sweeny
- Cardiology Department, Gold Coast University Hospital, Parkwood, Queensland, Australia
| | - Rohan Jayasinghe
- Cardiology Department, Gold Coast University Hospital, Parkwood, Queensland, Australia; School of Medicine, Griffith University, Southport, Queensland, Australia
| |
Collapse
|
183
|
Azmi S, Goh A, Fong A, Anchah L. Quality of life among Patients with Acute Coronary Syndrome in Malaysia. Value Health Reg Issues 2015; 6:80-83. [PMID: 29698198 DOI: 10.1016/j.vhri.2015.03.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 03/16/2015] [Accepted: 03/20/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES This study's objectives were to estimate the quality of life (QOL) of Malaysian patients with acute coronary syndrome (ACS) during admission and at 12 months, to explore the factors associated with the QOL, and to compare utility scores derived from tariffs from local and foreign populations. METHODS Data collected from patients with ACS between 2008 and 2009 for a study on cardiac rehabilitation at the Sarawak General Hospital were used for this study. QOL data were obtained using a validated version of the EuroQol five-dimensional questionnaire at baseline and at 12 months. Health utility scores were calculated using visual analogue scale scores and utility tariffs from Malaysia and the United Kingdom. RESULTS Data from 104 subjects from the earlier study was used. The mean age was 56.1 years, with 88.5% being men. The mean hospitalization duration was 6.3 days. The mean utility score was 0.75 at baseline and 0.82 at 12 months. There was a statistically significant improvement in utility from baseline to 12 months based on the Malaysian tariff (P = 0.014) but not with the UK tariff (P = 0.086). The QOL of patients was associated with sex and diagnosis of ST-segment elevation myocardial infarction. CONCLUSIONS Our results showed that there was a significant improvement in the QOL from baseline to 12 months. Only sex and diagnosis affected the QOL score at baseline because of limited variables available for testing. It also reconfirms the importance of applying the appropriate, country-specific utility tariffs in QOL studies. Despite limitations, the study is useful toward describing QOL among a group of Malaysian patients with ACS.
Collapse
Affiliation(s)
- Soraya Azmi
- Azmi Burhani Consulting, Petaling Jaya, Malaysia; Veras Research, Petaling Jaya, Malaysia.
| | - Adrian Goh
- Azmi Burhani Consulting, Petaling Jaya, Malaysia; Veras Research, Petaling Jaya, Malaysia
| | - Alan Fong
- Sarawak General Hospital Heart Centre, Sarawak, Malaysia; Clinical Research Centre, Sarawak General Hospital, Sarawak, Malaysia; Faculty of Medicine and Health Sciences, Universiti Malaysia, Sarawak, Malaysia
| | | |
Collapse
|
184
|
Chung WS, Chu YH, Lin CL, Kao CH. Increased risk of acute coronary syndrome among leptospirosis patients: A nationwide cohort analysis. Int J Cardiol 2015; 184:576-580. [PMID: 25769002 DOI: 10.1016/j.ijcard.2015.03.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 03/01/2015] [Accepted: 03/02/2015] [Indexed: 01/17/2023]
Abstract
BACKGROUND Studies on the association between leptospirosis and acute coronary syndrome (ACS) are lacking. Therefore, this study identifies the effects of leptospirosis on the risks of developing ACS with a nationwide retrospective cohort study. METHODS We identified adult patients aged ≥20 years who were newly diagnosed with leptospirosis. We also randomly selected a comparison cohort from the general population by using a propensity score matching method. We analyzed the risks of ACS by using Cox proportional hazard regression models. RESULTS Among the 23.74 million people in the cohort, 3690 patients with leptospirosis (68% men, mean age of 52.2 years) and 3690 controls were followed for 13,677 and 15,652 person-years, respectively. The overall incidence of ACS was higher in the leptospirosis cohort than in the nonleptospirosis cohort (4.68 vs 3.71 per 1000 person-years), with a hazard ratio (HR) of 1.69 (95% confidence interval [CI]=1.12-2.56). Men exhibited a 1.88-fold greater HR of ACS than women did (95% CI=1.20-2.94). The risk of developing ACS was highest for leptospirosis patients aged ≥65 years (HR=7, 51% CI=4.35-12.9) compared with patients aged ≤49 years. CONCLUSION Leptospirosis is not a previously identified risk factor for ACS. The findings of this nationwide retrospective cohort study indicate that leptospirosis may become an independent risk factor for ACS. Future research to investigate the mechanism is warranted.
Collapse
Affiliation(s)
- Wei-Sheng Chung
- Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan; Department of Health Services Administration, China Medical University, Taichung, Taiwan; Department of Healthcare Administration, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - Yung-Hua Chu
- Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.
| |
Collapse
|
185
|
Clark MG, Beavers C, Osborne J. Managing the acute coronary syndrome patient: Evidence based recommendations for anti-platelet therapy. Heart Lung 2015; 44:141-9. [DOI: 10.1016/j.hrtlng.2014.11.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 11/18/2014] [Accepted: 11/20/2014] [Indexed: 12/01/2022]
|
186
|
Effectiveness of practices for improving the diagnostic accuracy of Non ST Elevation Myocardial Infarction in the Emergency Department: A Laboratory Medicine Best Practices™ systematic review. Clin Biochem 2015; 48:204-12. [PMID: 25661303 DOI: 10.1016/j.clinbiochem.2015.01.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 01/26/2015] [Accepted: 01/28/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVES This article is a systematic review of the effectiveness of four practices (assay selection, decision point cardiac troponin (cTn) threshold selection, serial testing, and point of care testing) for improving the diagnostic accuracy Non-ST-Segment Elevation Myocardial Infarction (NSTEMI) in the Emergency Department. DESIGN AND METHODS The CDC-funded Laboratory Medicine Best Practices (LMBP) Initiative systematic review method for quality improvement practices was used. RESULTS The current ACC/AHA guidelines recommend using cardiac troponin assays with a 99th percentile upper reference limit (URL) diagnostic threshold to diagnose NSTEMI. The evidence in this systematic review indicates that contemporary sensitive cTn assays meet the assay profile requirements (sensitivity, specificity, PPV, and NPV) to more accurately diagnose NSTEMI than alternate tests. Additional biomarkers did not increase diagnostic effectiveness of cTn assays. Sensitivity, specificity, and NPV were consistently high and low PPV improved with serial sampling. Evidence for use of point of care cTn testing was insufficient to make recommendation, though some evidence suggests that use may result in reduction to patient length of stay and costs. CONCLUSIONS Based on the review of and the LMBP(TM) A-6 Method criteria, we recommend the use of cardiac troponin assays without additional biomarkers using the 99th percentile URL as the clinical diagnostic threshold for the diagnosis of NSTEMI. We recommend serial sampling with one sample at presentation and at least one additional second sample taken at least 6h later to identify a rise or fall in the troponin level. No recommendation is made either for or against the use of point of care tests. DISCLAIMER The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention/the Agency for Toxic Substances and Disease Registry (CDC/ATSDR).
Collapse
|
187
|
Hamed GM, Fattah MFA. Clinical Relevance of matrix metalloproteinase 9 in patients with acute coronary syndrome. Clin Appl Thromb Hemost 2015; 21:705-11. [PMID: 25616488 DOI: 10.1177/1076029614567309] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We measured levels of matrix metalloproteinase 9 (MMP-9) as a potential risk factor in 75 patients with acute coronary syndrome (ACS) compared to 25 patients with stable angina (SA) and 20 healthy participants. Patients were studied stressing on smoking, hypertension, diabetes, lipid profile, cardiac enzymes, MMP-9, and electrocardiography. Patients with ACS had higher MMP-9 levels than the SA group. The highest MMP-9 levels were found among ST-elevated myocardial infarction (MI), while the lowest levels were found among the control group. The MMP-9 level was significantly higher among patients with ACS having poor disease outcome (recurrent ischemic attacks, congestive heart failure, or death). The MMP-9 cutoff value of 3100 pg/mL was able to discriminate MI from unstable angina (UA), while the best prognostic utility was established at 4700 pg/mL. We suggest that serum MMP-9 could be an early marker that discriminates MI from UA and predicts poor outcome in terms of disease severity and extent of disease complications.
Collapse
Affiliation(s)
- Gehan Mostafa Hamed
- Clinical Pathology Department, Faculty of Medicine, Ain Shams University, Heliopolis, Cairo, Egypt
| | - Mona Fathey Abdel Fattah
- Clinical Pathology Department, Faculty of Medicine, Ain Shams University, Heliopolis, Cairo, Egypt
| |
Collapse
|
188
|
Non-ST Elevation Myocardial Infarction with Occluded Artery and its Clinical Implications. Heart Lung Circ 2014; 23:1132-40. [DOI: 10.1016/j.hlc.2014.05.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 05/19/2014] [Accepted: 05/21/2014] [Indexed: 11/18/2022]
|
189
|
Bohensky M, Tacey M, Brand C, Sundararajan V, Wicks I, Van Doornum S. Statin initiation and treatment non-adherence following a first acute myocardial infarction in patients with inflammatory rheumatic disease versus the general population. Arthritis Res Ther 2014; 16:443. [PMID: 25256139 PMCID: PMC4201728 DOI: 10.1186/s13075-014-0443-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 08/28/2014] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION To compare statin initiation and treatment non-adherence following a first acute myocardial infarction (MI) in patients with inflammatory rheumatic disease (IRD) and the general population. METHODS We conducted a retrospective cohort study using a population-based linked database. Cases of first MI from July 2001 to June 2009 were identified based on International Classification of Diseases (ICD-10-AM) codes. Statin initiation and adherence was identified based on pharmaceutical claims records. Logistic regression was used to assess the odds of statin initiation by IRD status. Non-adherence was assessed as the time to first treatment gap using a Cox proportional hazards model. RESULTS There were 18,518 individuals with an index MI over the time period surviving longer than 30 days, of whom 415 (2.2%) were IRD patients. The adjusted odds of receiving a statin by IRD status was significantly lower (OR =0.69, 95% CI: 0.55 to 0.86) compared to the general population. No association between IRD status and statin non-adherence was identified (hazard ratio (HR) =1.12, 95% CI: 0.82 to 1.52). CONCLUSIONS Statin initiation was significantly lower for people with IRD conditions compared to the general population. Once initiated on statins, the proportion of IRD patients who adhered to treatment was similar to the general population. Given the burden of cardiovascular disease and excess mortality in IRD patients, encouraging the use of evidence-based therapies is critical for ensuring the best outcomes in this high risk group.
Collapse
Affiliation(s)
- Megan Bohensky
- />Melbourne EpiCentre, Department of Medicine, Royal Melbourne Hospital, Level 7 E Block, Parkville, VIC 3050 Australia
| | - Mark Tacey
- />Melbourne EpiCentre, Department of Medicine, Royal Melbourne Hospital, Level 7 E Block, Parkville, VIC 3050 Australia
| | - Caroline Brand
- />Melbourne EpiCentre, Department of Medicine, Royal Melbourne Hospital, Level 7 E Block, Parkville, VIC 3050 Australia
- />Melbourne EpiCentre, Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Vijaya Sundararajan
- />Department of Medicine, St. Vincent’s Hospital, University of Melbourne, Melbourne, Australia
- />Department of Medicine, Southern Clinical School, Monash University, Melbourne, Australia
| | - Ian Wicks
- />Rheumatology Unit, Melbourne Health & University of Melbourne, Melbourne, Australia
- />Inflammation Division, Walter & Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Sharon Van Doornum
- />Melbourne EpiCentre, Department of Medicine, Royal Melbourne Hospital, Level 7 E Block, Parkville, VIC 3050 Australia
| |
Collapse
|
190
|
Akyürek Ö, Akbal E, Güneş F. Increase in the risk of ST elevation myocardial infarction is associated with homocysteine level. Arch Med Res 2014; 45:501-6. [PMID: 25193877 DOI: 10.1016/j.arcmed.2014.08.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 08/20/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND AIMS The present study aimed to investigate the relationship between coagulation defects and ST elevation myocardial infarction (STEMI) in patients without any known coronary artery risk factors and considered low risk according to the Framingham risk classification. METHODS This study included 76 (73.6% male) STEMI patients without any known risk factors for coronary artery disease and 56 healthy controls (67.8% male) with similar characteristics. RESULTS Factor V Leiden mutation was noted in two patients and in one control. There were no significant differences in protein C, protein S, or antithrombin 3 values between the patient and control groups (p = 0.405, p = 0.476, and p = 0.221, respectively). None of the participants had antiphospholipid syndrome, factor V deficiency, or factor VII deficiency. Plasma homocysteine level was significantly higher in the patient group (19.0 ± 3.6) μmol/L than in the control group (15.8 ± 4.2) μmol/L (p = 0.008). Homocysteine levels in both groups were higher in males without a statistically significant difference. Vitamin B12 and folate levels, which are directly related to homocysteine metabolism, did not differ significantly between groups. Correlation analysis showed that the homocysteine level was not correlated with lipid parameters, folate, or vitamin B12. CONCLUSION Homocysteine level was significantly higher in acute MI in patients without any risk factors and were considered low risk according to the Framingham risk score. The findings support the hypothesis that homocysteine level may be an independent risk factor for coronary artery disease.
Collapse
Affiliation(s)
- Ömer Akyürek
- Department of Internal Medicine, Mevlana University Faculty of Medicine, Konya, Turkey.
| | - Erdem Akbal
- Department of Gastroenterology, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Fahri Güneş
- Department of Internal Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
| |
Collapse
|
191
|
Wechkunanukul K, Grantham H, Damarell R, Clark R. The association between ethnicity (culturally and linguistically diverse migrants) and the time taken in seeking medical care for chest pain: a systematic review protocol. ACTA ACUST UNITED AC 2014. [DOI: 10.11124/jbisrir-2014-1467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
192
|
Vale N, Nordmann AJ, Schwartz GG, de Lemos J, Colivicchi F, den Hartog F, Ostadal P, Macin SM, Liem AH, Mills EJ, Bhatnagar N, Bucher HC, Briel M. Statins for acute coronary syndrome. Cochrane Database Syst Rev 2014; 2014:CD006870. [PMID: 25178118 PMCID: PMC11126893 DOI: 10.1002/14651858.cd006870.pub3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The early period following the onset of acute coronary syndrome (ACS) represents a critical stage of coronary heart disease, with a high risk of recurrent events and deaths. The short-term effects of early treatment with statins on patient-relevant outcomes in patients suffering from ACS are unclear. This is an update of a review previously published in 2011. OBJECTIVES To assess the effects, both harms and benefits, of early administered statins in patients with ACS, in terms of mortality and cardiovascular events. SEARCH METHODS We updated the searches of CENTRAL (2013, Issue 3), MEDLINE (Ovid) (1946 to April Week 1 2013), EMBASE (Ovid) (1947 to 2013 Week 14), and CINAHL (EBSCO) (1938 to 2013) on 12 April 2013. We applied no language restrictions. We supplemented the search by contacting experts in the field, by reviewing the reference lists of reviews and editorials on the topic, and by searching trial registries. SELECTION CRITERIA Randomized controlled trials (RCTs) comparing statins with placebo or usual care, with initiation of statin therapy within 14 days following the onset of ACS, follow-up of at least 30 days, and reporting at least one clinical outcome. DATA COLLECTION AND ANALYSIS Two authors independently assessed risk of bias and extracted data. We calculated risk ratios (RRs) for all outcomes in the treatment and control groups and pooled data using random-effects models. MAIN RESULTS Eighteen studies (14,303 patients) compared early statin treatment versus placebo or no treatment in patients with ACS. The new search did not identify any new studies for inclusion. There were some concerns about risk of bias and imprecision of summary estimates. Based on moderate quality evidence, early statin therapy did not decrease the combined primary outcome of death, non-fatal myocardial infarction, and stroke at one month (risk ratio (RR) 0.93, 95% confidence interval (CI) 0.80 to 1.08) or four months (RR 0.93, 95% CI 0.81 to 1.06) of follow-up when compared to placebo or no treatment. There were no statistically significant risk reductions from statins for total death, total myocardial infarction, total stroke, cardiovascular death, revascularization procedures, and acute heart failure at one month or at four months, although there were favorable trends related to statin use for each of these endpoints. Moderate quality evidence suggests that the incidence of unstable angina was significantly reduced at four months following ACS (RR 0.76, 95% CI 0.59 to 0.96). There were nine individuals with myopathy (elevated creatinine kinase levels more than 10 times the upper limit of normal) in statin-treated patients (0.13%) versus one (0.015%) in the control groups. Serious muscle toxicity was mostly limited to patients treated with simvastatin 80 mg. AUTHORS' CONCLUSIONS Based on moderate quality evidence, due to concerns about risk of bias and imprecision, initiation of statin therapy within 14 days following ACS does not reduce death, myocardial infarction, or stroke up to four months, but reduces the occurrence of unstable angina at four months following ACS. Serious side effects were rare.
Collapse
Affiliation(s)
- Noah Vale
- St Mary's Hospital, McGill UniversityFamily Medicine377 Rue Jean BrilliantMontrealQCCanadaH3T 1M5
| | - Alain J Nordmann
- University Hospital BaselInstitute for Clinical Epidemiology and BiostatisticsHebelstrasse 10BaselSwitzerland4031
| | - Gregory G Schwartz
- VA Medical Center and University of Colorado1055 Clermont StDenverColoradoUSA
| | - James de Lemos
- University of Texas Southwestern Medical SchoolCardiology/Internal Medicine5909 Harry Hines BlvdDallasTexasUSA
| | - Furio Colivicchi
- S. Filippo Neri HospitalCardiovascular Department330 Viale Gorgia da LeontiniRomeItaly00124
| | - Frank den Hartog
- Gelderse Vallei HospitalCardiology Departmentpostbus 9025EdeNetherlands6710 HN
| | - Petr Ostadal
- Na Homolce HospitalDepartment of CardiologyPragueCzech Republic
| | - Stella M Macin
- Instituto de CardiologiaCoronary Intensive Care UnitJuana F CabrelCorrientesArgentina
| | - Anho H Liem
- Franciscus Gasthuis RotterdamDepartment of CardiologyRotterdamNetherlands
| | - Edward J Mills
- University of OttawaFaculty of Health Sciences451 Smyth RoadOttawaONCanadaK1H 8M5
| | - Neera Bhatnagar
- McMaster UniversityDepartment of Clinical Epidemiology and Biostatistics1200 Main Street WestHamiltonONCanadaL8N 3Z5
| | - Heiner C Bucher
- University Hospital Basel (USB)Basel Institute for Clinical Epidemiology and BiostatisticsBaselSwitzerland
| | - Matthias Briel
- University Hospital Basel (USB)Basel Institute for Clinical Epidemiology and BiostatisticsBaselSwitzerland
| | | |
Collapse
|
193
|
Chung WS, Lin CL, Hsu WH, Kao CH. Scrub typhus increases the risk of developing acute coronary syndrome: a nationwide cohort study. Heart 2014; 100:1844-50. [PMID: 25147287 DOI: 10.1136/heartjnl-2014-306181] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Studies investigating the epidemiological relationship between scrub typhus and the subsequent development of acute coronary syndrome (ACS) are lacking. Therefore, we conducted a nationwide longitudinal cohort study in Taiwan to explore whether patients with scrub typhus are at an increased risk of developing ACS. METHODS This study investigated the incidence and risk factors for ACS in 5215 patients newly diagnosed with scrub typhus from the Taiwan National Health Insurance Research Database between 2000 and 2011. The comparison cohort contained 20 860 persons from the general population without scrub typhus. The follow-up period ran from the time of the initial diagnosis for scrub typhus to the date of an ACS event, censoring, or 31 December 2011. We used Cox proportional hazard regression models to analyse the risk of ACS by including the variables of sex, age and comorbidities. RESULTS The incidence of ACS was higher in patients with scrub typhus than in the comparison cohort (3.10 vs 1.92 per 1000 person-years). The HR of developing ACS increased by 37% in patients with scrub typhus after adjusting for age, sex and comorbidities. Men, increased age, hypertension, diabetes, hyperlipidaemia, chronic obstructive pulmonary disease and coronary artery disease were identified as independent risk factors of developing ACS after controlling for covariates. The prominent effect of scrub typhus on subsequent ACS development appeared within 1 year after infection. CONCLUSIONS This nationwide study determined that patients with scrub typhus exhibited a 37% increase in the risk of subsequently developing ACS compared with that of the general population.
Collapse
Affiliation(s)
- Wei-Sheng Chung
- Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan Department of Healthcare Administration, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan College of Medicine, China Medical University, Taichung, Taiwan
| | - Wu-Huei Hsu
- Department of Respiratory and Critical Care, China Medical University Hospital, Taichung, Taiwan Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
| |
Collapse
|
194
|
Vengoechea F. Management of acute coronary syndrome in the hospital: a focus on ACCF/AHA guideline updates to oral antiplatelet therapy. Hosp Pract (1995) 2014; 42:33-47. [PMID: 25255405 DOI: 10.3810/hp.2014.08.1116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The 3 main clinical manifestations of acute coronary syndrome (ACS) are unstable angina, non-ST-segment myocardial infarction, and ST-segment myocardial infarction. Together they comprise a major cause of emergency care and hospitalization in the United States. Consequently, all hospital-based physicians should be familiar with current recommendations regarding the diagnosis and management of ACS. Effective inhibition of platelet activation and aggregation is central to the treatment of ACS, and dual antiplatelet therapy with aspirin and a P2Y12 inhibitor is recommended in all patients with ACS. Recently, the American Heart Association and American College of Cardiology Foundation published focused updates to their guidelines for the management of ACS patients. These updates included changes in antiplatelet therapy arising from the introduction of prasugrel and ticagrelor as alternatives to clopidogrel for the P2Y12 inhibitor component of dual antiplatelet therapy. Among the P2Y12 inhibitors recommended for each indication, the guidelines do not advocate any one P2Y12 inhibitor over another, but instead recommend that therapy is individualized based on each patient's demographic and clinical characteristics. This article presents a clinical case study to illustrate the hospital management of ST-segment myocardial infarction and unstable angina/non-ST-segment myocardial infarction with particular reference to the latest changes in antiplatelet therapy guidelines. This article outlines key differences in the indications and recommendations for P2Y12 inhibitors and summarizes clinical data from the pivotal studies of prasugrel and ticagrelor.
Collapse
|
195
|
|
196
|
A multicentre retrospective study to understand anti-platelet treatment patterns and outcomes of acute coronary syndrome patients in India (TRACE). Indian Heart J 2014; 66:334-9. [PMID: 24973840 DOI: 10.1016/j.ihj.2014.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 08/21/2013] [Accepted: 03/23/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND There is limited available information for treatment of acute coronary syndrome (ACS) with respect to outcomes, therapeutic agents and treatment practices. Our retrospective registry study collected and evaluated varying anti-platelet treatment strategies and outcomes of ACS patients who were admitted to 9 different tertiary care hospitals in India. This study was carried out to provide an insight to anti-platelet treatment patterns and analyze outcomes of ACS patients in India. METHODS All the relevant data, including anti-platelet treatment strategies, outcomes and patient treatment compliance were collected from 500 ACS (defined as STEMI, NSTEMI and unstable angina [UA]) cases from January 2007 to December 2009. These ACS cases were randomly collected from the hospital records and included in the analysis. The patient follow up data was acquired either from the hospital records or via telephonic contact for a period of one year following the event. RESULTS Out of 500 ACS patients, 59.8% had UA/NSTEMI and 40.2% had STEMI. On hospital admission, aspirin, clopidogrel, statins, beta-blockers and angiotensin converting enzyme inhibitors (ACE-Is) were used by 83%, 83%, 68%, 43.2% and 31.6% patients, respectively. On discharge, aspirin, clopidogrel, statins and beta-blockers were used by 90.2%, 88%, 80.6%, and 59% patients, respectively. The average patient compliance to statins, clopidogrel and aspirin was recorded as 74.28%, 69.7% and 68.66%, respectively during discharge and follow-up visits. Greater than 50% of ACS patients after discharge were lost to follow-up and as a result there was significant drop in the number of clinical events reported. CONCLUSION This pilot study conducted in tertiary care centers in India showed that patients with ACS were more often diagnosed with UA/NSTEMI as compared to STEMI and reported maximum compliance to statins, clopidogrel and aspirin after discharge over 1 year follow-up. More ACS patients were lost to follow up that resulted in low reporting of clinical outcomes, following discharge upto 1 year.
Collapse
|
197
|
Pharmacokinetic Interaction Study of Ticagrelor and Cyclosporine in Healthy Volunteers. Clin Drug Investig 2014; 34:529-36. [DOI: 10.1007/s40261-014-0205-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
198
|
López-Reyes A, Rodríguez-Pérez JM, Fernández-Torres J, Martínez-Rodríguez N, Pérez-Hernández N, Fuentes-Gómez AJ, Aguilar-González CA, Alvarez-León E, Posadas-Romero C, Villarreal-Molina T, Pineda C, Vargas-Alarcón G. The HIF1A rs2057482 polymorphism is associated with risk of developing premature coronary artery disease and with some metabolic and cardiovascular risk factors. The Genetics of Atherosclerotic Disease (GEA) Mexican Study. Exp Mol Pathol 2014; 96:405-10. [PMID: 24769354 DOI: 10.1016/j.yexmp.2014.04.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 04/15/2014] [Indexed: 02/08/2023]
Abstract
The aim of the present study was to establish the role of HIF1A gene polymorphisms in the risk of developing premature coronary artery disease (CAD) in a well-characterized clinical cohort. Three polymorphisms in HIF1A (rs11549465, rs11549467, rs2057482) gene were genotyped in 949 patients with premature CAD, and 676 healthy controls (with negative calcium score by computed tomography). Under a dominant model adjusted for age, visceral to subcutaneous adipose tissue (VAT/SAT) ratio, hypertension, type 2 diabetes mellitus (T2DM), HDL-C levels, hypercholesterolemia and hypertriglyceridemia, the rs2057482 T allele was associated with decreased risk of premature CAD when compared to healthy controls (OR = 0.616, P(dom) = 0.020). The effect of the studied polymorphisms on various metabolic parameters and cardiovascular risk factors was explored. In this analysis, the rs2057482 T allele was associated with decreased risk of obesity, central obesity, hypertension, hypercholesterolemia, hypertriglyceridemia and increased risk of T2DM. Under a dominant model adjusted by age, the HIF1A rs2057482 T polymorphism was associated with high VAT/SAT ratio (P = 0.009) and HDL-C levels (P = 0.04) in healthy controls. The results suggest that HIF1A rs2057482 polymorphism is involved in the risk of developing CAD and is associated with some metabolic parameters and cardiovascular risk factors.
Collapse
Affiliation(s)
- Alberto López-Reyes
- Molecular Synovioanalisis Laboratory, Instituto Nacional de Rehabilitación, Mexico City, Mexico
| | | | - Javier Fernández-Torres
- Molecular Synovioanalisis Laboratory, Instituto Nacional de Rehabilitación, Mexico City, Mexico
| | - Nancy Martínez-Rodríguez
- Department of Molecular Biology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Nonanzit Pérez-Hernández
- Department of Molecular Biology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | | | | | - Edith Alvarez-León
- Department of Molecular Biology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Carlos Posadas-Romero
- Department of Endocrinology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | | | - Carlos Pineda
- Molecular Synovioanalisis Laboratory, Instituto Nacional de Rehabilitación, Mexico City, Mexico
| | - Gilberto Vargas-Alarcón
- Department of Molecular Biology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.
| |
Collapse
|
199
|
Prevalence of thrombophilic gene polymorphisms (FVL G1691A and MTHFR C677T) in patients with myocardial infarction. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2014. [DOI: 10.1016/j.ejmhg.2014.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
|
200
|
The 14 bp Del/Ins HLA-G polymorphism is related with high blood pressure in acute coronary syndrome and type 2 diabetes mellitus. BIOMED RESEARCH INTERNATIONAL 2014; 2014:898159. [PMID: 24689061 PMCID: PMC3933038 DOI: 10.1155/2014/898159] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 12/19/2013] [Accepted: 12/23/2013] [Indexed: 12/31/2022]
Abstract
Immunologic and inflammatory processes are involved in the pathogenesis of acute coronary syndrome (ACS) and type 2 diabetes mellitus (DM2). Human leukocyte antigen-G (HLA-G) is a negative regulator of the immune response. This study evaluates the 14 bp Del/Ins HLA-G polymorphism in ACS and DM2. Three hundred and seventy individuals from Western Mexico were recruited and categorized into three groups: ACS (86), DM2 without coronary complications (70), and healthy subjects (214). Genotyping of the 14 bp Del/Ins HLA-G polymorphism was performed by PCR and Native-PAGE. The most common risk factors were hypertension and overweight in ACS and DM2, respectively. The genetic distribution of the 14 bp Del/Ins HLA-G polymorphism showed no significant differences between groups (P ≥ 0.23). Nonetheless, the Ins/Ins genotype was associated with high blood pressure (HBP) in the DM2 group (ORc = 1.65, P = 0.02). The genetic recessive model showed similar findings (ORc = 3.03, P = 0.04). No association was found in ACS, with a P of 0.05; nevertheless, the prevalence of Ins/Ins carriers was quite similar to that found in the DM2-HBP group. The 14 bp Del/Ins HLA-G polymorphism was not a susceptibility factor for ACS or DM2; however, the Ins/Ins genotype might have contributed to the development of HBP in the studied groups.
Collapse
|