2601
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Nadarajah R, Gale C. The management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: key points from the ESC 2020 Clinical Practice Guidelines for the general and emergency physician. Clin Med (Lond) 2021; 21:e206-e211. [PMID: 33762388 PMCID: PMC8002777 DOI: 10.7861/clinmed.2020-0879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
There have been significant advances in the diagnosis and management of non-ST-segment elevation myocardial infarction over recent years, which has been reflected in an international decline in mortality rates. This article provides an overview of the 2020 European Society of Cardiology Clinical Practice Guidelines for the topic, concentrating on areas relevant to the general or emergency physician. The recommendations and underlying evidence basis are analysed in three key areas: diagnosis (the recommendation to use high sensitivity troponin and how to apply it), pathways (the recommendation to facilitate early invasive coronary angiography to improve outcomes and shorten hospital stays) and treatment (a paradigm shift in the use of early intensive platelet inhibition). Gaps in the evidence base are highlighted, including the optimal management strategy for older people and the antiplatelet regime to consider when angiography may be delayed.
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Affiliation(s)
- Ramesh Nadarajah
- Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, UK and Leeds General Infirmary, Leeds, UK
| | - Chris Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, UK and Leeds General Infirmary, Leeds, UK
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2602
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Węgiel M, Rakowski T. Circulating biomarkers as predictors of left ventricular remodeling after myocardial infarction. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2021; 17:21-32. [PMID: 33868414 PMCID: PMC8039920 DOI: 10.5114/aic.2021.104764] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/19/2020] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION The main impact of myocardial infarction is shifting from acute mortality to adverse remodeling and chronic left ventricle dysfunction. Several circulating biomarkers are explored for better risk stratification of these patients. Biomarker testing is a very attractive idea, since it is non-invasive, not operator-dependent and widely available. AIM In the present paper we analyze data from the years 2005-2020 about circulating biomarkers of remodeling after myocardial infarction. MATERIAL AND METHODS We assessed 53 articles, which examined 160 relations between biomarkers and remodeling. We analyze inclusion criteria for individual studies, time points of serum collection and remodeling assessment as well as imaging methods. RESULTS The main groups of assessed biomarkers included B-type natriuretic peptides, markers of cardiomyocyte injury and necrosis, markers of inflammatory response, markers of extracellular matrix turnover, microRNAs and hormones. The most common method of remodeling assessment was echocardiography and the most frequent time point for remodeling evaluation was 6 months. CONCLUSIONS The present analysis shows that although a relatively large number biomarkers were tested, selecting one ideal marker is still a challenge. A combination of biomarkers from different groups might be appropriate for predicting remodeling. Data presented in this analysis might be helpful for designing future studies, evaluating clinical use of an individual biomarker or a combination of different biomarkers.
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Affiliation(s)
- Michał Węgiel
- 2 Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Rakowski
- 2 Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
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2603
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Huisman MV. Antithrombotic treatment in atrial fibrillation patients needing percutaneous coronary intervention. Neth Heart J 2021; 29:119-120. [PMID: 33566280 PMCID: PMC7904999 DOI: 10.1007/s12471-021-01546-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- M V Huisman
- Department of Medicine-Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands.
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2604
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Elgebaly SA, Christenson RH, Kandil H, El-Khazragy N, Rashed L, Yacoub B, Eldeeb H, Ali M, Sharafieh R, Klueh U, Kreutzer DL. Nourin-Dependent miR-137 and miR-106b: Novel Early Inflammatory Diagnostic Biomarkers for Unstable Angina Patients. Biomolecules 2021; 11:368. [PMID: 33670982 PMCID: PMC7997347 DOI: 10.3390/biom11030368] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/19/2021] [Accepted: 02/23/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Currently, no blood biomarkers exist that can diagnose unstable angina (UA) patients. Nourin is an early inflammatory mediator rapidly released within 5 min by reversible ischemic myocardium, and if ischemia persists, it is also released by necrosis. Nourin is elevated in acute coronary syndrome (ACS) patients but not in symptomatic noncardiac and healthy subjects. Recently, circulating microRNAs (miRNAs) have been established as markers of disease, including cardiac injury and inflammation. OBJECTIVES To profile and validate the potential diagnostic value of Nourin-dependent miR-137 (marker of cell damage) and miR-106b-5p (marker of inflammation) as early biomarkers in suspected UA patients and to investigate the association of their target and regulating genes. METHODS Using Nourin amino acid sequence, an integrated bioinformatics analysis was conducted. Analysis indicated that Nourin is a direct target for miR-137 and miR-106b-5p in myocardial ischemic injury. Two linked molecular networks of lncRNA/miRNAs/mRNAs were also retrieved, including CTB89H12.4/miR-137/FTHL-17 and CTB89H12.4/miR-106b-5p/ANAPC11. Gene expression profiling was assessed in serum samples collected at presentation to an emergency department (ED) from: (1) UA patients (n = 30) (confirmed by invasive coronary angiography with stenosis greater than 50% and troponin level below the clinical decision limit); (2) patients with acute ST elevation myocardial infarction (STEMI) (n = 16) (confirmed by persistent ST-segment changes and elevated troponin level); and 3) healthy subjects (n = 16). RESULTS Gene expression profiles showed that miR-137 and miR-106b-5p were significantly upregulated by 1382-fold and 192-fold in UA compared to healthy, and by 2.5-fold and 4.6-fold in STEMI compared to UA, respectively. Healthy subjects showed minimal expression profile. Receiver operator characteristics (ROC) analysis revealed that the two miRNAs were sensitive and specific biomarkers for assessment of UA and STEMI patients. Additionally, Spearman's correlation analysis revealed a significant association of miRNAs with the associated mRNA targets and the regulating lncRNA. CONCLUSIONS Nourin-dependent gene expression of miR-137 and miR-106b-5p are novel blood-based biomarkers that can diagnose UA and STEMI patients at presentation and stratify severity of myocardial ischemia, with higher expression in STEMI compared to UA. Early diagnosis of suspected UA patients using the novel Nourin biomarkers is key for initiating guideline-based therapy that improves patients' health outcomes.
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Affiliation(s)
- Salwa A. Elgebaly
- Research & Development, Nour Heart, Inc., Vienna, VA 22180, USA
- Department of Surgery, School of Medicine, UConn Health, Farmington, CT 06032, USA; (R.S.); (D.L.K.)
| | - Robert H. Christenson
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
| | - Hossam Kandil
- Department of Cardiology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo 11562, Egypt; (H.K.); (B.Y.); (H.E.); (M.A.)
| | - Nashwa El-Khazragy
- Department of Clinical Pathology-Hematology, Ain Shams Medical Research Institute (MASRI), Faculty of Medicine, Ain Shams University, Cairo 11566, Egyp;
| | - Laila Rashed
- Department of Biochemistry and Molecular Biology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo 11562, Egypt;
| | - Beshoy Yacoub
- Department of Cardiology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo 11562, Egypt; (H.K.); (B.Y.); (H.E.); (M.A.)
| | - Heba Eldeeb
- Department of Cardiology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo 11562, Egypt; (H.K.); (B.Y.); (H.E.); (M.A.)
| | - Mahmoud Ali
- Department of Cardiology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo 11562, Egypt; (H.K.); (B.Y.); (H.E.); (M.A.)
| | - Roshanak Sharafieh
- Department of Surgery, School of Medicine, UConn Health, Farmington, CT 06032, USA; (R.S.); (D.L.K.)
- Cell & Molecular Tissue Engineering, LLC Farmington, CT 06032, USA;
| | - Ulrike Klueh
- Cell & Molecular Tissue Engineering, LLC Farmington, CT 06032, USA;
- Integrative Biosciences Center (IBio), Department of Biomedical Engineering, Wayne State University, Detroit, MI 48202, USA
| | - Donald L. Kreutzer
- Department of Surgery, School of Medicine, UConn Health, Farmington, CT 06032, USA; (R.S.); (D.L.K.)
- Cell & Molecular Tissue Engineering, LLC Farmington, CT 06032, USA;
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2605
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Grassl N, Baumann S, Kruska M, Fatar M, Akin I, Platten M, Borggrefe M, Alonso A, Szabo K, Fastner C. [Acute ischemic stroke and elevated troponin: Diagnostic work-up and therapeutic consequences]. Dtsch Med Wochenschr 2021; 146:534-541. [PMID: 33636737 DOI: 10.1055/a-1308-7490] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Elevated troponin values are frequently detected in patients with acute ischemic stroke, requiring adequate diagnostic work-up due to the high cardiac mortality after stroke. Since dual platelet inhibition can cause secondary intracerebral hemorrhage careful consideration of invasive coronary intervention is mandatory. Based on three case reports, this review article presents a diagnostic algorithm taking into account latest findings from the literature.
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Affiliation(s)
- Niklas Grassl
- Neurologische Klinik, Universitätsmedizin Mannheim (UMM), Medizinische Fakultät Mannheim, Ruprecht-Karls-Universität Heidelberg, Mannheim Center for Translational Neuroscience (MCTN) und European Center for AngioScience (ECAS), Mannheim, Deutschland
| | - Stefan Baumann
- I. Medizinische Klinik, Universitätsmedizin Mannheim (UMM), Medizinische Fakultät Mannheim, Ruprecht-Karls-Universität Heidelberg, European Center for AngioScience (ECAS) und Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK) Standort Heidelberg/Mannheim, Mannheim, Deutschland
| | - Mathieu Kruska
- I. Medizinische Klinik, Universitätsmedizin Mannheim (UMM), Medizinische Fakultät Mannheim, Ruprecht-Karls-Universität Heidelberg, European Center for AngioScience (ECAS) und Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK) Standort Heidelberg/Mannheim, Mannheim, Deutschland
| | - Marc Fatar
- Neurologische Klinik, Universitätsmedizin Mannheim (UMM), Medizinische Fakultät Mannheim, Ruprecht-Karls-Universität Heidelberg, Mannheim Center for Translational Neuroscience (MCTN) und European Center for AngioScience (ECAS), Mannheim, Deutschland
| | - Ibrahim Akin
- I. Medizinische Klinik, Universitätsmedizin Mannheim (UMM), Medizinische Fakultät Mannheim, Ruprecht-Karls-Universität Heidelberg, European Center for AngioScience (ECAS) und Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK) Standort Heidelberg/Mannheim, Mannheim, Deutschland
| | - Michael Platten
- Neurologische Klinik, Universitätsmedizin Mannheim (UMM), Medizinische Fakultät Mannheim, Ruprecht-Karls-Universität Heidelberg, Mannheim Center for Translational Neuroscience (MCTN) und European Center for AngioScience (ECAS), Mannheim, Deutschland
| | - Martin Borggrefe
- I. Medizinische Klinik, Universitätsmedizin Mannheim (UMM), Medizinische Fakultät Mannheim, Ruprecht-Karls-Universität Heidelberg, European Center for AngioScience (ECAS) und Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK) Standort Heidelberg/Mannheim, Mannheim, Deutschland
| | - Angelika Alonso
- Neurologische Klinik, Universitätsmedizin Mannheim (UMM), Medizinische Fakultät Mannheim, Ruprecht-Karls-Universität Heidelberg, Mannheim Center for Translational Neuroscience (MCTN) und European Center for AngioScience (ECAS), Mannheim, Deutschland
| | - Kristina Szabo
- Neurologische Klinik, Universitätsmedizin Mannheim (UMM), Medizinische Fakultät Mannheim, Ruprecht-Karls-Universität Heidelberg, Mannheim Center for Translational Neuroscience (MCTN) und European Center for AngioScience (ECAS), Mannheim, Deutschland
| | - Christian Fastner
- I. Medizinische Klinik, Universitätsmedizin Mannheim (UMM), Medizinische Fakultät Mannheim, Ruprecht-Karls-Universität Heidelberg, European Center for AngioScience (ECAS) und Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK) Standort Heidelberg/Mannheim, Mannheim, Deutschland
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2606
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Giannitsis E, Blankenberg S, Christenson RH, Frey N, von Haehling S, Hamm CW, Inoue K, Katus HA, Lee CC, McCord J, Möckel M, Chieh JTW, Tubaro M, Wollert KC, Huber K. Critical appraisal of the 2020 ESC guideline recommendations on diagnosis and risk assessment in patients with suspected non-ST-segment elevation acute coronary syndrome. Clin Res Cardiol 2021; 110:1353-1368. [PMID: 33635437 PMCID: PMC8405476 DOI: 10.1007/s00392-021-01821-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/08/2021] [Indexed: 10/27/2022]
Abstract
Multiple new recommendations have been introduced in the 2020 ESC guidelines for the management of acute coronary syndromes with a focus on diagnosis, prognosis, and management of patients presenting without persistent ST-segment elevation. Most recommendations are supported by high-quality scientific evidence. The guidelines provide solutions to overcome obstacles presumed to complicate a convenient interpretation of troponin results such as age-, or sex-specific cutoffs, and to give practical advice to overcome delays of laboratory reporting. However, in some areas, scientific support is less well documented or even missing, and other areas are covered rather by expert opinion or subjective recommendations. We aim to provide a critical appraisal on several recommendations, mainly related to the diagnostic and prognostic assessment, highlighting the discrepancies between Guideline recommendations and the existing scientific evidence.
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Affiliation(s)
- Evangelos Giannitsis
- Medizinische Klinik III, Department of Cardiology, Angiology and Pulmology, University Hospital of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
| | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | | | - Norbert Frey
- Medizinische Klinik III, Department of Cardiology, Angiology and Pulmology, University Hospital of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Christian W Hamm
- Department of Cardiology, Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany
| | - Kenji Inoue
- Department of Cardiovascular Biology and Medicine, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Hugo A Katus
- Medizinische Klinik III, Department of Cardiology, Angiology and Pulmology, University Hospital of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Chien-Chang Lee
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - James McCord
- Henry Ford Heart and Vascular Institute Detroit, Detroit, MI, USA
| | - Martin Möckel
- Department of Emergency Medicine, Charité-Universitätsmedizin Berlin, Campus Mitte and Virchow, Berlin, Germany
| | - Jack Tan Wei Chieh
- Department of Cardiology, National Heart Centre and Sengkang General Hospital, Singapore, Singapore
| | | | - Kai C Wollert
- Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Kurt Huber
- 3rd Department of Internal Medicine, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria.,Medical School, Sigmund Freud University, Vienna, Austria
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2607
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Iglesias JF, Heg D, Roffi M, Degrauwe S, Tüller D, Muller O, Brinkert M, Cook S, Weilenmann D, Kaiser C, Cuculi F, Valgimigli M, Jüni P, Windecker S, Pilgrim T. Five-year outcomes with biodegradable polymer sirolimus-eluting stents versus durable polymer everolimus-eluting stents in patients with acute coronary syndrome: A subgroup analysis of the BIOSCIENCE trial. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 34:3-10. [PMID: 33653633 DOI: 10.1016/j.carrev.2021.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 02/03/2021] [Accepted: 02/05/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Thin-strut biodegradable polymer sirolimus-eluting stents (BP-SES) have been shown to reduce target lesion failure (TLF) at one-year follow-up compared with durable polymer everolimus-eluting stents (DP-EES) among patients with acute coronary syndrome (ACS). The long-term clinical benefits of thin-strut BP-SES over DP-EES in ACS patients after complete degradation of the polymer coating remain uncertain. METHODS We performed a post-hoc subgroup analysis of ACS patients included into the BIOSCIENCE randomized trial (NCT01443104). The primary endpoint was target lesion failure (TLF), a composite of cardiac death, target-vessel myocardial infarction or clinically indicated target lesion revascularization, at 5 years. RESULTS Among 2119 patients enrolled between March 2012 and May 2013, 1131 (53%) presented with ACS. The 5-year cumulative incidence of TLF was significantly lower in patients with ACS compared to chronic coronary syndrome [16.5% vs. 22.9%; rate ratio (RR), 0.69; 95% confidence interval (CI), 0.57-0.85; p < 0.001]. At 5 years, TLF occurred similarly in ACS patients treated with BP-SES and DP-EES (16.9% vs. 16.0%; RR, 1.04; 95% CI, 0.78-1.41; p = 0.78). The individual components of the primary endpoint did not differ between ACS patients treated with BP-SES or DP-EES at 5 years. Overall, there was no interaction between clinical presentation and treatment effect. CONCLUSIONS In a subgroup analysis of the BIOSCIENCE trial, we found no difference in long-term outcomes between ACS patients treated with BP-SES or DP-EES at 5 years.
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Affiliation(s)
- Juan F Iglesias
- Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - Dik Heg
- CTU Bern, University of Bern, Bern, Switzerland
| | - Marco Roffi
- Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - Sophie Degrauwe
- Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - David Tüller
- Department of Cardiology, Triemlispital, Zurich, Switzerland
| | - Olivier Muller
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Miriam Brinkert
- Department of Cardiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Stéphane Cook
- Department of Cardiology, University and Hospital Fribourg, Fribourg, Switzerland
| | - Daniel Weilenmann
- Department of Cardiology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Christoph Kaiser
- Department of Cardiology, Basel University Hospital, Basel, Switzerland
| | - Florim Cuculi
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Marco Valgimigli
- Department of Cardiology, Inselspital, University of Bern, Bern University Hospital, Bern, Switzerland
| | - Peter Jüni
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Stephan Windecker
- Department of Cardiology, Inselspital, University of Bern, Bern University Hospital, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, University of Bern, Bern University Hospital, Bern, Switzerland.
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2608
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Johannessen TR, Atar D, Vallersnes OM, Larstorp ACK, Mdala I, Halvorsen S. Comparison of a single high-sensitivity cardiac troponin T measurement with the HEART score for rapid rule-out of acute myocardial infarction in a primary care emergency setting: a cohort study. BMJ Open 2021; 11:e046024. [PMID: 33627355 PMCID: PMC7908281 DOI: 10.1136/bmjopen-2020-046024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/28/2021] [Accepted: 02/04/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study aims to compare the rule-out safety of a single high-sensitivity cardiac troponin T (hs-cTnT) with the History, ECG, Age, Risk factors and Troponin (HEART) score in a low-prevalence primary care setting of acute myocardial infarction (AMI). PARTICIPANTS Patients with non-specific symptoms suggestive of AMI were consecutively enroled at a primary care emergency clinic in Oslo, Norway from November 2016 to October 2018. METHODS After initial assessment by a general practitioner, hs-cTnT samples were drawn. AMI was ruled-out by a single hs-cTnT <5 ng/L measured ≥3 hours after symptom onset. The HEART score was calculated retrospectively; a score ≤3 of 10 points was considered low risk. We also calculated a modified HEART score using more sensitive hs-cTnT thresholds. The primary outcome was the diagnostic performance for the rule-out of AMI at the index event; the secondary the composite of AMI or all-cause death at 90 days. RESULTS Among 1711 patients, 61 (3.6%) were diagnosed with AMI, and 569 (33.3%) patients were assigned to single rule-out (<5 ng/L). With no AMIs in this group, the negative predictive value (NPV) and sensitivity were both 100.0% (95% CI 99.4% to 100.0% and 94.1% to 100.0%, respectively), and the specificity 34.5% (32.2% to 36.8%). The original HEART score triaged more patients as low risk (n=871), but missed five AMIs (NPV 99.4% (98.7% to 99.8%); sensitivity 91.8% (81.9% to 97.3%) and specificity 52.5% (50.0% to 54.9%)). The modified HEART score increased the low-risk sensitivity to 98.4% (91.2% to 100.0%), with specificity 38.7% (36.3% to 41.1%). The 90-day incidence of AMI or death in the single rule-out and the original and modified low-risk HEART groups were 0.0%, 0.7%, and 0.2%, respectively. CONCLUSION In a primary care emergency setting, a single hs-cTnT strategy was superior to the HEART score in ruling out AMI. This rapid and safe approach may enhance the assessment of patients with chest pain outside of hospitals. TRIAL REGISTRATION NUMBER NCT02983123.
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Affiliation(s)
- Tonje R Johannessen
- Department of General Practice, University of Oslo, Oslo, Norway
- Department of Emergency General Practice, Oslo Accident and Emergency Outpatient Clinic, Oslo, Norway
| | - Dan Atar
- Department of Cardiolgy, Oslo University Hospital, Ullevaal, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Odd Martin Vallersnes
- Department of General Practice, University of Oslo, Oslo, Norway
- Department of Emergency General Practice, Oslo Accident and Emergency Outpatient Clinic, Oslo, Norway
| | - Anne Cecilie K Larstorp
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Section of Cardiovascular and Renal Research, Oslo University Hospital, Ullevaal, Oslo, Norway
| | - Ibrahimu Mdala
- Department of General Practice, University of Oslo, Oslo, Norway
| | - Sigrun Halvorsen
- Department of Cardiolgy, Oslo University Hospital, Ullevaal, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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2609
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Hu C, Liu J, Han H, Sun Y, Cheng Y, Liu Y, Gao A, Zhou Y, Zhang J, Zhao Y. A Synergistic Effect of Lp(a) and GRACE Score on Cardiovascular Risk in Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention: A Cohort Study From China. Front Cardiovasc Med 2021; 8:637366. [PMID: 33681307 PMCID: PMC7933013 DOI: 10.3389/fcvm.2021.637366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 01/08/2021] [Indexed: 12/24/2022] Open
Abstract
Objectives: Lipoprotein(a) [Lp(a)] has been thought as an independent risk factor for atherosclerotic cardiovascular disease (ASCVD). The Global Registry of Acute Coronary Events (GRACE) score is used to predict the risk of death or death/non-fatal myocardial infarction in patients with acute coronary syndromes (ACS). It suggests that there may be a synergism between Lp(a) and the GRACE risk score on predicting cardiovascular events. Accordingly, this study aimed to test the hypothesis that Lp(a)-related cardiovascular risk could be significantly modulated by the GRACE risk score in patients with ACS undergoing percutaneous coronary intervention (PCI). Methods: Patients hospitalized with ACS undergoing PCI were enrolled and followed up for 18 months. The primary outcome was the composite of death, non-fatal myocardial infarction, non-fatal stroke, and unplanned repeat revascularization. A Cox proportional hazard regression model was used to determine the relationship between Lp(a) and cardiovascular events. Results: A total of 6,309 patients were included (age: 60.1 ± 10.06 years, male: 75.2%, BMI: 26.2 ± 10.57 kg/m2). A total of 310 (4.9%) cardiovascular events occurred. When the overall population was stratified by a GRACE score of 91 or less vs. more than 91 and by tertiles of Lp(a), higher Lp(a) was significantly associated with cardiovascular events only when the GRACE score was <91(tertile 2 vs. tertile 1: HR 1.31, 95% CI: 0.86-1.98, P = 0.205; tertile 3 vs. tertile 1: HR 1.94, 95% CI: 1.32-2.84, P = 0.001; P = 0.002). However, no such significant correlation between cardiovascular events and Lp(a) emerged in the case of a GRACE score 91 or less, and there was a significant interaction for cardiovascular events between Lp(a) tertiles and dichotomized GRACE scores (P < 0.001). Conclusions: In ACS patients undergoing PCI, there was a synergistic effect between the GRACE risk score and on-statins Lp(a) on predicting cardiovascular events. This finding could help us more accurately identify patients who would benefit most from Lp(a)-lowering treatment.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jianwei Zhang
- Department of Cardiology, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yingxin Zhao
- Department of Cardiology, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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2610
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Bilalic A, Ticinovic Kurir T, Kumric M, Borovac JA, Matetic A, Supe-Domic D, Bozic J. Circulating Levels of Dephosphorylated-Uncarboxylated Matrix Gla Protein in Patients with Acute Coronary Syndrome. Molecules 2021; 26:1108. [PMID: 33669806 PMCID: PMC7922740 DOI: 10.3390/molecules26041108] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/14/2021] [Accepted: 02/17/2021] [Indexed: 12/20/2022] Open
Abstract
Vascular calcification contributes to the pathogenesis of coronary artery disease while matrix Gla protein (MGP) was recently identified as a potent inhibitor of vascular calcification. MGP fractions, such as dephosphorylated-uncarboxylated MGP (dp-ucMGP), lack post-translational modifications and are less efficient in vascular calcification inhibition. We sought to compare dp-ucMGP levels between patients with acute coronary syndrome (ACS), stratified by ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) status. Physical examination and clinical data, along with plasma dp-ucMGP levels, were obtained from 90 consecutive ACS patients. We observed that levels of dp-ucMGP were significantly higher in patients with NSTEMI compared to STEMI patients (1063.4 ± 518.6 vs. 742.7 ± 166.6 pmol/L, p < 0.001). NSTEMI status and positive family history of cardiovascular diseases were only independent predictors of the highest tertile of dp-ucMGP levels. Among those with NSTEMI, patients at a high risk of in-hospital mortality (adjudicated by GRACE score) had significantly higher levels of dp-ucMGP compared to non-high-risk patients (1417.8 ± 956.8 vs. 984.6 ± 335.0 pmol/L, p = 0.030). Altogether, our findings suggest that higher dp-ucMGP levels likely reflect higher calcification burden in ACS patients and might aid in the identification of NSTEMI patients at increased risk of in-hospital mortality. Furthermore, observed dp-ucMGP levels might reflect differences in atherosclerotic plaque pathobiology between patients with STEMI and NSTEMI.
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Affiliation(s)
- Admira Bilalic
- Department of Cardiology, University Hospital of Split, Split 21000, Croatia; (A.B.); (A.M.)
| | - Tina Ticinovic Kurir
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia; (T.T.K.); (M.K.); (J.A.B.)
- Endocrinology Clinic, University Hospital of Split, 21000 Split, Croatia
| | - Marko Kumric
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia; (T.T.K.); (M.K.); (J.A.B.)
| | - Josip A. Borovac
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia; (T.T.K.); (M.K.); (J.A.B.)
- Institute of Emergency Medicine of Split-Dalmatia County (ZHM SDZ), 21000 Split, Croatia
| | - Andrija Matetic
- Department of Cardiology, University Hospital of Split, Split 21000, Croatia; (A.B.); (A.M.)
| | - Daniela Supe-Domic
- Department of Medical Laboratory Diagnostics, University Hospital of Split, 21000 Split, Croatia;
| | - Josko Bozic
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia; (T.T.K.); (M.K.); (J.A.B.)
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2611
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Reiner MF, Baumgartner P, Wiencierz A, Coslovsky M, Bonetti NR, Filipovic MG, Montrasio G, Aeschbacher S, Rodondi N, Baretella O, Kühne M, Moschovitis G, Meyre P, Bonati LH, Lüscher TF, Camici GG, Osswald S, Conen D, Beer JH. The Omega-3 Fatty Acid Eicosapentaenoic Acid (EPA) Correlates Inversely with Ischemic Brain Infarcts in Patients with Atrial Fibrillation. Nutrients 2021; 13:651. [PMID: 33671288 PMCID: PMC7922349 DOI: 10.3390/nu13020651] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/06/2021] [Accepted: 02/09/2021] [Indexed: 02/04/2023] Open
Abstract
The omega-3 fatty acid (n-3 FA) eicosapentaenoic acid (EPA) reduces stroke in patients with atherosclerotic cardiovascular disease. Whether EPA affects stroke or cerebral small vessel dis-ease in patients with atrial fibrillation (AF) remains uncertain. EPA, docosahexaenoic acid (DHA), docosapentaenoic acid (DPA), and alpha-linolenic acid (ALA) were determined by gas chromatography in 1657 AF patients from the Swiss Atrial Fibrillation study. All patients underwent brain MRI to detect ischemic brain infarcts, classified as large noncortical or cortical infarcts (LNCCIs); markers of small vessel disease, classified as small noncortical infarcts (SNCIs), number of microbleeds, and white matter lesion (WML) volumes. Individual and total n-3 FAs (EPA + DHA + DPA + ALA) were correlated with LNCCIs and SNCIs using logistic regression, with numbers of microbleeds using a hurdle model, and WML volumes using linear regression. LNCCIs were detected in 372 patients (22.5%). EPA correlated inversely with the prevalence of LNCCIs (odds ratio [OR] 0.51 per increase of 1 percentage point EPA, 95% confidence interval [CI] 0.29-0.90). DPA correlated with a higher LNCCI prevalence (OR 2.48, 95%CI 1.49-4.13). No associations with LNCCIs were found for DHA, ALA, and total n-3 FAs. Neither individual nor total n-3 FAs correlated with markers of small vessel disease. In conclusion, EPA correlates inversely with the prevalence of ischemic brain infarcts, but not with markers of small vessel disease in patients with AF.
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Affiliation(s)
- Martin F. Reiner
- Department of Internal Medicine, Cantonal Hospital of Baden, 5404 Baden, Switzerland; (M.F.R.); (N.R.B.); (G.M.)
| | - Philipp Baumgartner
- Department of Neurology, University Hospital of Zurich, 8091 Zurich, Switzerland;
| | - Andrea Wiencierz
- Clinical Trial Unit University Hospital of Basel, 4031 Basel, Switzerland; (A.W.); (M.C.)
| | - Michael Coslovsky
- Clinical Trial Unit University Hospital of Basel, 4031 Basel, Switzerland; (A.W.); (M.C.)
| | - Nicole R. Bonetti
- Department of Internal Medicine, Cantonal Hospital of Baden, 5404 Baden, Switzerland; (M.F.R.); (N.R.B.); (G.M.)
- Center for Molecular Cardiology, Laboratory for Platelet Research, University of Zurich, 8952 Schlieren, Switzerland; (T.F.L.); (G.G.C.)
| | - Mark G. Filipovic
- Institute of Anesthesiology, Cantonal Hospital Winterthur, 8400 Winterthur, Switzerland;
| | - Giulia Montrasio
- Department of Internal Medicine, Cantonal Hospital of Baden, 5404 Baden, Switzerland; (M.F.R.); (N.R.B.); (G.M.)
| | - Stefanie Aeschbacher
- Department of Cardiology, University Hospital of Basel, 4031 Basel, Switzerland; (S.A.); (M.K.); (P.M.); (S.O.)
- Cardiovascular Research Institute Basel, University Hospital of Basel, 4031 Basel, Switzerland;
| | - Nicolas Rodondi
- Department of General Internal Medicine, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (N.R.); (O.B.)
- Institute of Primary Health Care (BIHAM), University of Bern, 3010 Bern, Switzerland
| | - Oliver Baretella
- Department of General Internal Medicine, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (N.R.); (O.B.)
- Institute of Primary Health Care (BIHAM), University of Bern, 3010 Bern, Switzerland
| | - Michael Kühne
- Department of Cardiology, University Hospital of Basel, 4031 Basel, Switzerland; (S.A.); (M.K.); (P.M.); (S.O.)
- Cardiovascular Research Institute Basel, University Hospital of Basel, 4031 Basel, Switzerland;
| | - Giorgio Moschovitis
- Division of Cardiology, Ospedale Regionale di Lugano, 6900 Ticino, Switzerland;
| | - Pascal Meyre
- Department of Cardiology, University Hospital of Basel, 4031 Basel, Switzerland; (S.A.); (M.K.); (P.M.); (S.O.)
- Cardiovascular Research Institute Basel, University Hospital of Basel, 4031 Basel, Switzerland;
| | - Leo H. Bonati
- Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, 4031 Basel, Switzerland;
| | - Thomas F. Lüscher
- Center for Molecular Cardiology, Laboratory for Platelet Research, University of Zurich, 8952 Schlieren, Switzerland; (T.F.L.); (G.G.C.)
- Royal Brompton and Harefield Hospitals, London SW3 6NP, UK
- Imperial College, London SW7 2BU, UK
| | - Giovanni G. Camici
- Center for Molecular Cardiology, Laboratory for Platelet Research, University of Zurich, 8952 Schlieren, Switzerland; (T.F.L.); (G.G.C.)
| | - Stefan Osswald
- Department of Cardiology, University Hospital of Basel, 4031 Basel, Switzerland; (S.A.); (M.K.); (P.M.); (S.O.)
- Cardiovascular Research Institute Basel, University Hospital of Basel, 4031 Basel, Switzerland;
| | - David Conen
- Cardiovascular Research Institute Basel, University Hospital of Basel, 4031 Basel, Switzerland;
- Population Health Research Institute, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Jürg H. Beer
- Department of Internal Medicine, Cantonal Hospital of Baden, 5404 Baden, Switzerland; (M.F.R.); (N.R.B.); (G.M.)
- Center for Molecular Cardiology, Laboratory for Platelet Research, University of Zurich, 8952 Schlieren, Switzerland; (T.F.L.); (G.G.C.)
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2612
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Reynolds HR, Maehara A, Kwong RY, Sedlak T, Saw J, Smilowitz NR, Mahmud E, Wei J, Marzo K, Matsumura M, Seno A, Hausvater A, Giesler C, Jhalani N, Toma C, Har B, Thomas D, Mehta LS, Trost J, Mehta PK, Ahmed B, Bainey KR, Xia Y, Shah B, Attubato M, Bangalore S, Razzouk L, Ali ZA, Merz NB, Park K, Hada E, Zhong H, Hochman JS. Coronary Optical Coherence Tomography and Cardiac Magnetic Resonance Imaging to Determine Underlying Causes of Myocardial Infarction With Nonobstructive Coronary Arteries in Women. Circulation 2021; 143:624-640. [PMID: 33191769 PMCID: PMC8627695 DOI: 10.1161/circulationaha.120.052008] [Citation(s) in RCA: 174] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Myocardial infarction with nonobstructive coronary arteries (MINOCA) occurs in 6% to 15% of myocardial infarctions (MIs) and disproportionately affects women. Scientific statements recommend multimodality imaging in MINOCA to define the underlying cause. We performed coronary optical coherence tomography (OCT) and cardiac magnetic resonance (CMR) imaging to assess mechanisms of MINOCA. METHODS In this prospective, multicenter, international, observational study, we enrolled women with a clinical diagnosis of myocardial infarction. If invasive coronary angiography revealed <50% stenosis in all major arteries, multivessel OCT was performed, followed by CMR (cine imaging, late gadolinium enhancement, and T2-weighted imaging and T1 mapping). Angiography, OCT, and CMR were evaluated at blinded, independent core laboratories. Culprit lesions identified by OCT were classified as definite or possible. The CMR core laboratory identified ischemia-related and nonischemic myocardial injury. Imaging results were combined to determine the mechanism of MINOCA, when possible. RESULTS Among 301 women enrolled at 16 sites, 170 were diagnosed with MINOCA, of whom 145 had adequate OCT image quality for analysis; 116 of these underwent CMR. A definite or possible culprit lesion was identified by OCT in 46.2% (67/145) of participants, most commonly plaque rupture, intraplaque cavity, or layered plaque. CMR was abnormal in 74.1% (86/116) of participants. An ischemic pattern of CMR abnormalities (infarction or myocardial edema in a coronary territory) was present in 53.4% (62/116) of participants undergoing CMR. A nonischemic pattern of CMR abnormalities (myocarditis, takotsubo syndrome, or nonischemic cardiomyopathy) was present in 20.7% (24/116). A cause of MINOCA was identified in 84.5% (98/116) of the women with multimodality imaging, higher than with OCT alone (P<0.001) or CMR alone (P=0.001). An ischemic cause was identified in 63.8% of women with MINOCA (74/116), a nonischemic cause was identified in 20.7% (24/116) of the women, and no mechanism was identified in 15.5% (18/116). CONCLUSIONS Multimodality imaging with coronary OCT and CMR identified potential mechanisms in 84.5% of women with a diagnosis of MINOCA, 75.5% of which were ischemic and 24.5% of which were nonischemic, alternate diagnoses to myocardial infarction. Identification of the cause of MINOCA is feasible and has the potential to guide medical therapy for secondary prevention. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02905357.
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Affiliation(s)
- Harmony R. Reynolds
- Sarah Ross Soter Center for Women’s Cardiovascular Research, New York University Grossman School of Medicine, NY,Leon H. Charney Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, NY
| | - Akiko Maehara
- Cardiovascular Research Foundation, New York, NY,Columbia University, New York, NY
| | | | - Tara Sedlak
- Vancouver General Hospital, British Columbia, Canada
| | | | - Nathaniel R. Smilowitz
- Sarah Ross Soter Center for Women’s Cardiovascular Research, New York University Grossman School of Medicine, NY,Leon H. Charney Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, NY
| | | | - Janet Wei
- Barbra Streisand Women’s Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Kevin Marzo
- New York University Winthrop Hospital, New York University Long Island School of Medicine, Mineola
| | | | - Ayako Seno
- Brigham and Women’s Hospital, Boston, MA
| | - Anais Hausvater
- Sarah Ross Soter Center for Women’s Cardiovascular Research, New York University Grossman School of Medicine, NY,Leon H. Charney Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, NY
| | | | | | - Catalin Toma
- University of Pittsburgh Department of Medicine, PA
| | - Bryan Har
- University of Calgary, Alberta, Canada
| | | | | | | | | | - Bina Ahmed
- Santa Barbara Cardiovascular Medical Group, CA
| | - Kevin R. Bainey
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Yuhe Xia
- Department of Population Health, New York University Grossman School of Medicine, NY
| | - Binita Shah
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, NY
| | - Michael Attubato
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, NY
| | - Sripal Bangalore
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, NY
| | - Louai Razzouk
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, NY
| | - Ziad A. Ali
- Cardiovascular Research Foundation, New York, NY,Columbia University, New York, NY
| | - Noel Bairey Merz
- Barbra Streisand Women’s Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Ki Park
- University of Florida, Gainesville
| | - Ellen Hada
- Sarah Ross Soter Center for Women’s Cardiovascular Research, New York University Grossman School of Medicine, NY
| | - Hua Zhong
- Department of Population Health, New York University Grossman School of Medicine, NY
| | - Judith S. Hochman
- Sarah Ross Soter Center for Women’s Cardiovascular Research, New York University Grossman School of Medicine, NY,Leon H. Charney Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, NY
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2613
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Antoniades C, Asselbergs FW, Vardas P. The year in cardiovascular medicine 2020: digital health and innovation. Eur Heart J 2021; 42:732-739. [PMID: 33388767 PMCID: PMC7882364 DOI: 10.1093/eurheartj/ehaa1065] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/26/2020] [Accepted: 12/18/2020] [Indexed: 12/20/2022] Open
Affiliation(s)
- Charalambos Antoniades
- Acute Vascular Imaging Centre, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX39DU, UK
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, L6 West Wing, John Radcliffe Hospital, Headley Way, Oxford OX39DU, UK
| | - Folkert W Asselbergs
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, Utrecht University, Heidelberglaan 8, 3584 CX , Utrecht, the Netherlands
- Institute of Cardiovascular Science and Institute of Health Informatics, Faculty of Population Health Sciences, University College London, 222 Euston Road, NW1 2DA, London, UK
| | - Panos Vardas
- Heart Sector, Hygeia Hospitals Groups, Erithrou Stavrou 4, Marousi 151 23, Athens, Greece
- Cardiology Department, Medical School, University of Crete, University Campus of Voutes, 700 13, Heraclion, Greece
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2614
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Chatzis G, Syntila S, Markus B, Ahrens H, Patsalis N, Luesebrink U, Divchev D, Parahuleva M, Al Eryani H, Schieffer B, Karatolios K. Biventricular Unloading with Impella and Venoarterial Extracorporeal Membrane Oxygenation in Severe Refractory Cardiogenic Shock: Implications from the Combined Use of the Devices and Prognostic Risk Factors of Survival. J Clin Med 2021; 10:747. [PMID: 33668590 PMCID: PMC7918629 DOI: 10.3390/jcm10040747] [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: 01/22/2021] [Revised: 02/07/2021] [Accepted: 02/08/2021] [Indexed: 12/01/2022] Open
Abstract
Since mechanical circulatory support (MCS) devices have become integral component in the therapy of refractory cardiogenic shock (RCS), we identified 67 patients in biventricular support with Impella and venoarterial Extracorporeal Membrane Oxygenation (VA-ECMO) for RCS between February 2013 and December 2019 and evaluated the risk factors of mortality in this setting. Mean age was 61.07 ± 10.7 and 54 (80.6%) patients were male. Main cause of RCS was acute myocardial infarction (AMI) (74.6%), while 44 (65.7%) were resuscitated prior to admission. The mean Simplified Acute Physiology Score II (SAPS II) and Sequential Organ Failure Assessment Score (SOFA) score on admission was 73.54 ± 16.03 and 12.25 ± 2.71, respectively, corresponding to an expected mortality of higher than 80%. Vasopressor doses and lactate levels were significantly decreased within 72 h on biventricular support (p < 0.05 for both). Overall, 17 (25.4%) patients were discharged to cardiac rehabilitation and 5 patients (7.5%) were bridged successfully to ventricular assist device implantation, leading to a total of 32.8% survival on hospital discharge. The 6-month survival was 31.3%. Lactate > 6 mmol/L, vasoactive score > 100 and pH < 7.26 on initiation of biventricular support, as well as Charlson comorbity index > 3 and prior resuscitation were independent predictors of survival. In conclusion, biventricular support with Impella and VA-ECMO in patients with RCS is feasible and efficient leading to a better survival than predicted through traditional risk scores, mainly via significant hemodynamic improvement and reduction in lactate levels.
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Affiliation(s)
- Georgios Chatzis
- Department of Cardiology, Angiology and Intensive Care, Philipps University Marburg, 35037 Marburg, Germany; (S.S.); (B.M.); (H.A.); (N.P.); (U.L.); (D.D.); (M.P.); (H.A.E.); (B.S.); (K.K.)
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2615
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Omarov YA, Veselova TN, Shakhnovich RM, Sukhinina TS, Zhukova NS, Merkulova IN, Pevzner DV, Arutunyan GK, Mironov VM, Merkulov EV, Samko AN, Ternovoy SK, Staroverov II. Computed Tomography Myocardial Perfusion Imaging With Transesophageal Atrial Pacing Stress Test in Patients With Borderline Stenoses in the Coronary Arteries: a Comparison With Fractional Flow Reserve. ACTA ACUST UNITED AC 2021; 61:4-11. [PMID: 33734050 DOI: 10.18087/cardio.2021.1.n1343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/23/2020] [Accepted: 10/26/2020] [Indexed: 11/18/2022]
Abstract
Aim To evaluate the diagnostic accuracy of cardiac perfusion computed tomography (PCT) with transesophageal electrocardiostimulation (TE ECS) for detection of ischemia in patients with borderline coronary stenosis (50-75 %) compared to measurements of fractional flow reserve (FFR).Material and methods The study included 25 patients with borderline (50-75 %) coronary stenosis as per data of computed tomography angiography (CTA) or coronary angiography (CAG). Later the patients underwent invasive measurement of FFR and cardiac PCT on a 320-row detector tomograph in combination with the TE ECS stress test. FFR values <0.8 indicated the hemodynamic significance of stenosis. Myocardial perfusion was evaluated visually based on consensus of two experts.Results All patients completed the study protocol. Cardiac pacing duration was 6 min for all patients. Four patients required intravenous administration of atropine sulphate. PCT with TE ECS detected significant for FFR stenoses with sensitivity, specificity, and predictive value of a positive result and predictive value for a negative result of 47, 90, 87, and 53 %, respectively.Conclusion PCT with TE ECS in combination with CTA can be considered as an informative method for simultaneous evaluation of the condition of coronary arteries and detection of myocardial ischemia. This method is particularly relevant for assessing the hemodynamic significance of borderline coronary stenoses.
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Affiliation(s)
- Yu A Omarov
- National medical research center of cardiology» of the Ministry of healthcare of the Russian Federation, Moscow
| | - T N Veselova
- National medical research center of cardiology» of the Ministry of healthcare of the Russian Federation, Moscow
| | - R M Shakhnovich
- National medical research center of cardiology» of the Ministry of healthcare of the Russian Federation, Moscow
| | - T S Sukhinina
- National medical research center of cardiology» of the Ministry of healthcare of the Russian Federation, Moscow
| | - N S Zhukova
- National medical research center of cardiology» of the Ministry of healthcare of the Russian Federation, Moscow
| | - I N Merkulova
- National medical research center of cardiology» of the Ministry of healthcare of the Russian Federation, Moscow
| | - D V Pevzner
- National medical research center of cardiology» of the Ministry of healthcare of the Russian Federation, Moscow
| | - G K Arutunyan
- National medical research center of cardiology» of the Ministry of healthcare of the Russian Federation, Moscow
| | - V M Mironov
- National medical research center of cardiology» of the Ministry of healthcare of the Russian Federation, Moscow
| | - E V Merkulov
- National medical research center of cardiology» of the Ministry of healthcare of the Russian Federation, Moscow
| | - A N Samko
- National medical research center of cardiology» of the Ministry of healthcare of the Russian Federation, Moscow
| | - S K Ternovoy
- National medical research center of cardiology» of the Ministry of healthcare of the Russian Federation, Moscow; I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow
| | - I I Staroverov
- National medical research center of cardiology» of the Ministry of healthcare of the Russian Federation, Moscow
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2616
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Son MJ, Yoo SM, Lee D, Lee HY, Song IS, Chun EJ, White CS. Current Role of Computed Tomography in the Evaluation of Acute Coronary Syndrome. Diagnostics (Basel) 2021; 11:266. [PMID: 33572267 PMCID: PMC7914414 DOI: 10.3390/diagnostics11020266] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/07/2021] [Accepted: 02/07/2021] [Indexed: 02/07/2023] Open
Abstract
This review article provides an overview regarding the role of computed tomography (CT) in the evaluation of acute chest pain (ACP) in the emergency department (ED), focusing on characteristic CT findings.
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Affiliation(s)
- Min Ji Son
- Department of Radiology, CHA University Bundang Medical Center, Bundang 13497, Korea;
| | - Seung Min Yoo
- Department of Radiology, CHA University Bundang Medical Center, Bundang 13497, Korea;
| | - Dongjun Lee
- Military Service in Korean Army, Hongcheon 25117, Korea;
| | | | - In Sup Song
- Department of Radiology, Chun Ju Jesus General Hospital, Chun Ju 54987, Korea;
| | - Eun Ju Chun
- Department of Radiology, Seoul National University Bundang Medical Center, Seongnam 13620, Korea;
| | - Charles S White
- Department of Radiology, University of Maryland, Baltimore, MD 21201, USA;
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2617
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Thiele H, Jobs A. [ESC guidelines 2020: acute coronary syndrome without persistent ST-segment elevation : What is new?]. Herz 2021; 46:3-13. [PMID: 33236199 DOI: 10.1007/s00059-020-05002-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The European Society of Cardiology (ESC) guidelines for the management of acute coronary syndrome without persistent ST-segment elevation (NSTE-ACS) published in August 2020, replace the former NSTE-ACS guidelines published in 2015. These updated guidelines have some relevant changes for the clinical practice, which include the diagnostic work-up, risk stratification, antithrombotic therapy, invasive or noninvasive coronary diagnostics and also long-term treatment. New sections deal with spontaneous coronary artery dissection (SCAD), myocardial infarction with nonobstructive coronary arteries (MINOCA) and also newly introduced quality indicators for NSTE-ACS treatment. The diagnostic work-up using highly sensitive cardiac troponin (hs-cTn) assays is emphasized with the recommendation to use fast triage decisions that enable an early rule-in (no STEMI) or rule-out (NSTEMI probable) in the emergency room or chest pain unit. In antiplatelet therapy a greater individualization of the treatment concept is recommended based on the individual ischemic/thrombotic events and bleeding complications. Some new aspects were introduced for timing of invasive coronary angiography; however, principally the very high-risk group should still immediately undergo coronary angiography and the high-risk group should undergo an invasive angiography within 24 h. In risk stratification, the former intermediate risk group has been removed, instead it is now emphasized that low-risk patients should be treated similarly to patients with chronic coronary syndrome.
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Affiliation(s)
- Holger Thiele
- Klinik für Innere Medizin/Kardiologie, Herzzentrum Leipzig - Universität Leipzig, Strümpellstr. 39, 04289, Leipzig, Deutschland.
| | - Alexander Jobs
- Klinik für Innere Medizin/Kardiologie, Herzzentrum Leipzig - Universität Leipzig, Strümpellstr. 39, 04289, Leipzig, Deutschland
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2618
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Joner M, Sager H. Mechanical circulatory support-assisted percutaneous coronary intervention: have we reached the point of no return? EUROINTERVENTION 2021; 16:e1211-e1212. [PMID: 33551376 PMCID: PMC9707467 DOI: 10.4244/eijv16i15a218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Michael Joner
- German Heart Centre Munich, Technical University of Munich, Lazarettstraße 36, 80636 Munich, Germany
| | - Hendrik Sager
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
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2619
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Lunardi M, Gao C, Hara H, Ono M, Kawashima H, Wang R, Wijns W, Serruys PW, Onuma Y. Coronary interventions in 2020: the year in review. EUROINTERVENTION 2021; 16:e1215-e1226. [PMID: 33478939 PMCID: PMC9724941 DOI: 10.4244/eij-d-20-01343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Mattia Lunardi
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland,Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Charlie Gao
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland,Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Hironori Hara
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland,Amsterdam UMC, University of Amsterdam, Heart Center; Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Masafumi Ono
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland,Amsterdam UMC, University of Amsterdam, Heart Center; Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Hideyuki Kawashima
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland,Amsterdam UMC, University of Amsterdam, Heart Center; Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Rutao Wang
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland,Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - William Wijns
- The Lambe Institute for Translational Medicine (Floor 2), University Road, National University of Ireland Galway, Galway, Ireland, H91 TK33
| | - Patrick W. Serruys
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland,NHLI, Imperial College London, London, United Kingdom
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland
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2620
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Koc L, Mikolaskova M, Novotny T, Parenica J, Kanovsky J, Ondrus T, Holicka M, Poloczek M, Jarkovsky J, Malik M, Kala P. Primary percutaneous coronary intervention is appropriate in transient ST-elevation myocardial infarction. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2021; 166:180-186. [PMID: 33542543 DOI: 10.5507/bp.2021.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 01/08/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Reperfusion therapy by primary percutaneous coronary intervention (PPCI) is generally indicated in patients suffering from acute myocardial infarction (MI) with ST-segment elevation (STEMI). Prior to hospital admission, full ST-segment resolution (fSTR) may occur. Optimal management of such patients with transient STEMI (TSTEMI) is potentially challenging. Our aim was to evaluate the hypothesis that in TSTEMI patients, patency of infarct related artery (IRA) is achieved before PPCI, and to compare the outcome of TSTEMI and STEMI patients during a prolonged follow-up. MATERIAL AND METHODS Three hundred consecutive adult STEMI patients were referred to catheterization laboratory. In all patients, standard 12 lead ECGs were obtained both at the time of the first medical contact, and on catheterization laboratory admission. RESULTS TSTEMI occurred in 20 patients (6.7%). Despite fSTR (isoelectric ST segment), occluded IRA was found in 5 of these patients (25%). Pre-PPCI TIMI flow grade 2 was found in 6 TSTEMI patients (30%). Troponin T value at 24 h after symptom onset was lower in the TSTEMI group (1.8±2.5 mg/L vs. 3.6±3.5 mg/L, P=0.008). These patients also had a lower value of brain natriuretic peptide (156.3±119.5 ng/L vs. 438.5±429.0 ng/L, P<0.001) and higher left ventricular ejection fraction (59.9±6.3% vs. 51.6±10.2%, P<0.001). All patients were followed for a median of 5.6 years during which the overall survival did not differ between the TSTEMI and STEMI groups. CONCLUSION Primary PCI is strongly recommended in TSTEMI patients because of a relatively high incidence of occluded infarct related arteries. The rate of patients with TSTEMI is relatively low.
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Affiliation(s)
- Lumir Koc
- Department of Internal Medicine and Cardiology, University Hospital Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Monika Mikolaskova
- Department of Internal Medicine and Cardiology, University Hospital Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Tomas Novotny
- Department of Internal Medicine and Cardiology, University Hospital Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jiri Parenica
- Department of Internal Medicine and Cardiology, University Hospital Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jan Kanovsky
- Department of Internal Medicine and Cardiology, University Hospital Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Tomas Ondrus
- Department of Internal Medicine and Cardiology, University Hospital Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Maria Holicka
- Department of Internal Medicine and Cardiology, University Hospital Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Martin Poloczek
- Department of Internal Medicine and Cardiology, University Hospital Brno, Czech Republic
| | - Jiri Jarkovsky
- Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Marek Malik
- National Heart and Lung Institute, Imperial College of London, London, United Kingdom.,Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Petr Kala
- Department of Internal Medicine and Cardiology, University Hospital Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic
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2621
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Kristić I, Crnčević N, Runjić F, Čapkun V, Polašek O, Matetic A, Vrsalovic M. ACEF performed better than other risk scores in non-ST-elevation acute coronary syndrome during long term follow-up. BMC Cardiovasc Disord 2021; 21:70. [PMID: 33535979 PMCID: PMC7860189 DOI: 10.1186/s12872-020-01841-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 12/27/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Risk stratification of patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) is an important clinical method, but long-term studies on patients subjected to all-treatment strategies are lacking. Therefore, the aim was to compare several established risk scores in the all-treatment NSTE-ACS cohort during long-term follow-up. METHODS Consecutive patients (n = 276) with NSTE-ACS undergoing coronary angiography were recruited between September 2012 and May 2015. Six risk scores for all patients were calculated, namely GRACE 2.0, ACEF, SYNTAX, Clinical SYNTAX, SYNTAX II PCI and SYNTAX II CABG. The primary end-point was Major Adverse Cardiovascular Events (MACE) which was a composite of cardiac death, nonfatal myocardial infarction, ischemic stroke or urgent coronary revascularization. RESULTS During a median follow-up of 33 months, 64 MACE outcomes were recorded (23.2%). There was no difference between risk score categories, except in the highest risk group of ACEF and SYNTAX II PCI scores which exhibited significantly more MACE (51.6%, N = 33 and 45.3%, N = 29, P = 0.024, respectively). In the multivariate Cox regression analysis of individual variables, only age and atrial fibrillation were significant predictors for MACE (HR 1.03, 95% CI 1.00-1.05, P = 0.023 and HR 2.02, 95% CI 1.04-3.89, P = 0.037, respectively). Furthermore, multivariate analysis of the risk scores showed significant prediction of MACE only with ACEF score (HR 2.16, 95% CI 1.36-3.44, P = 0.001). The overall performance of GRACE, SYNTAX, Clinical SYNTAX and SYNTAX II CABG was poor with AUC values of 0.596, 0.507, 0.530 and 0.582, respectively, while ACEF and SYNTAX II PCI showed the best absolute AUC values for MACE (0.630 and 0.626, respectively). CONCLUSIONS ACEF risk score showed better discrimination than other risk scores in NSTE-ACS patients undergoing all-treatment strategies over long-term follow-up and it could represent a fast and user-friendly tool to stratify NSTE-ACS patients.
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Affiliation(s)
- Ivica Kristić
- Department of Cardiology, University Hospital of Split, Split, Croatia
| | - Nikola Crnčević
- Department of Cardiology, University Hospital of Split, Split, Croatia
| | - Frane Runjić
- Department of Cardiology, University Hospital of Split, Split, Croatia
| | - Vesna Čapkun
- University Department of Health Studies, University of Split, Split, Croatia
| | - Ozren Polašek
- Department of Public Health, School of Medicine, University of Split, Split, Croatia
| | - Andrija Matetic
- Department of Cardiology, University Hospital of Split, Split, Croatia
| | - Mislav Vrsalovic
- Department of Cardiology, Sestre Milosrdnice University Hospital Center, Vinogradska cesta 29, 10000, Zagreb, Croatia.
- University of Zagreb School of Medicine, Zagreb, Croatia.
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2622
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Pastore MC, Mandoli GE, Contorni F, Cavigli L, Focardi M, D'Ascenzi F, Patti G, Mondillo S, Cameli M. Speckle Tracking Echocardiography: Early Predictor of Diagnosis and Prognosis in Coronary Artery Disease. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6685378. [PMID: 33623788 PMCID: PMC7875622 DOI: 10.1155/2021/6685378] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/12/2020] [Accepted: 01/23/2021] [Indexed: 01/24/2023]
Abstract
Echocardiography represents a first level technique for the evaluation of coronary artery disease (CAD) which supports clinicians in the diagnostic and prognostic workup of these syndromes. However, visual estimation of wall motion abnormalities sometimes fails in detecting less clear or transient myocardial ischemia and in providing accurate differential diagnosis. Speckle tracking echocardiography (STE) is a widely available noninvasive tool that could easily and quickly provide additive information over basic echocardiography, since it is able to identify subtle myocardial damage and to localize ischemic territories in accordance to the coronary lesions, obtaining a clear visualization with a "polar map" useful for differential diagnosis and management. Therefore, it has increasingly been applied in acute and chronic coronary syndromes using rest and stress echocardiography, showing good results in terms of prediction of CAD, clinical outcome, left ventricular remodeling, presence, and quantification of new/residual ischemia. The aim of this review is to illustrate the current available evidence on STE usefulness for the assessment and follow-up of CAD, discussing the main findings on bidimensional and tridimensional strain parameters and their potential application in clinical practice.
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Affiliation(s)
- Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
- University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | - Francesco Contorni
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | - Luna Cavigli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | - Marta Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | - Giuseppe Patti
- University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Sergio Mondillo
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
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2623
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Ortega‐Paz L, Capodanno D, Montalescot G, Angiolillo DJ. Coronavirus Disease 2019-Associated Thrombosis and Coagulopathy: Review of the Pathophysiological Characteristics and Implications for Antithrombotic Management. J Am Heart Assoc 2021; 10:e019650. [PMID: 33228447 PMCID: PMC7955431 DOI: 10.1161/jaha.120.019650] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus-2, which has posed a significant threat to global health. Although the infection is frequently asymptomatic or associated with mild symptoms, in a small proportion of patients it can produce an intense inflammatory and prothrombotic state that can lead to acute respiratory distress syndrome, multiple organ failure, and death. Angiotensin-converting enzyme 2, highly expressed in the respiratory system, has been identified as a functional receptor for severe acute respiratory syndrome coronavirus-2. Notably, angiotensin-converting enzyme 2 is also expressed in the cardiovascular system, and there are multiple cardiovascular implications of COVID-19. Cardiovascular risk factors and cardiovascular disease have been associated with severe manifestations and poor prognosis in patients with COVID-19. More important, patients with COVID-19 may have thrombotic and coagulation abnormalities, promoting a hypercoagulable state and resulting in an increased rate of thrombotic and thromboembolic events. This review will describe the pathophysiological characteristics of the cardiovascular involvement following infection by severe acute respiratory syndrome coronavirus-2, with a focus on thrombotic and thromboembolic manifestations and implications for antithrombotic management.
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Affiliation(s)
- Luis Ortega‐Paz
- Cardiovascular InstituteInstitut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaSpain
| | - Davide Capodanno
- Division of Cardiology, Azienda Ospedaliero Universitaria "Policlinico‐Vittorio Emanuele"University of CataniaCataniaItaly
| | - Gilles Montalescot
- ACTION Study GroupInstitut de CardiologieAssistance Publique ‐ Hôpitaux de ParisHôpital Pitié‐SalpêtrièreUniversity Paris 6INSERM UMRS 1166ParisFrance
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2624
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Hamm CW, Schneck E, Buerke M, Darius H, Gaede L, Bergmann M, Hoffmeister M, Schneck F, Gräsner JT, Dirkmann D, Sander M. Empfehlungen zur prähospitalen Behandlung des akuten Koronarsyndroms bei Patienten unter Dauertherapie mit neuen oralen Antikoagulanzien (NOAKs). DER KARDIOLOGE 2021. [DOI: 10.1007/s12181-020-00439-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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2625
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Huang Q, Wang J, Li D, Zhao J, Feng X, Zhou N. Exercise electrocardiography combined with stress echocardiography for predicting myocardial ischemia in adults. Exp Ther Med 2021; 21:130. [PMID: 33376512 PMCID: PMC7751467 DOI: 10.3892/etm.2020.9562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 11/20/2020] [Indexed: 12/12/2022] Open
Abstract
Myocardial ischemia (MI) has the highest mortality rate in the world. Traditional noninvasive MI examinations include exercise electrocardiography tests (EETs) and stress echocardiography (SE). Treadmill and dobutamine tests are commonly used as stress protocols. In the present study, 278 patients with suspected MI were examined, 66 of whom were diagnosed with MI and 212 did not show evidence of MI by coronary angiography (CAG)/coronary CT angiography (CCTA). All patients underwent clinical EET and SE evaluations prior to CAG/CCTA. All groups were compared based on specific clinical parameters including age, sex, blood pressure, heart rate, blood oxygen saturation, underlying conditions and ejection fraction/fraction shortening. The data indicated superior diagnostic efficiency of the combined EET+SE method for the diagnosis of suspected MI compared with either EET or SE alone. The sensitivity/specificity/positive predictive value and negative predictive value for detecting MI were excellent compared with those of traditional examinations. The diagnostic efficiency of the combination analysis may reduce the prevalence of MI and medical costs. The present study provided novel insight for the development of methods that may be used for MI detection and prediction.
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Affiliation(s)
- Qiong Huang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210000, P.R. China
| | - Junhong Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210000, P.R. China
| | - Dianfu Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210000, P.R. China
| | - Jihong Zhao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210000, P.R. China
| | - Xiangjun Feng
- Department of Geriatric General Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650000, P.R. China
| | - Ningtian Zhou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210000, P.R. China
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2626
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Gaede L, Herchenbach A, Tröbs M, Marwan M, Achenbach S. Left ventricular contraction patterns in Takotsubo Syndrome and their correlation with long-term clinical outcome. IJC HEART & VASCULATURE 2021; 32:100708. [PMID: 33457494 PMCID: PMC7797942 DOI: 10.1016/j.ijcha.2020.100708] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 12/08/2020] [Accepted: 12/16/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Takotsubo Syndrome (TTS) is diagnosed in 1-2% of all patients presenting with acute coronary syndrome. Next to the typical apical manifestation, other locations of left ventricular contraction abnormality are possible, but their relationship to patient characteristics, clinical correlates as well as long-term outcome are poorly understood. METHODS & RESULTS We retrospectively analyzed 126 patients presenting TTS. Cases were categorized according to left ventricular contraction abnormality patterns: typical apical pattern (71%, n = 89) vs. atypical patterns (29%, n = 37). Cases with typical TTS showed significantly higher levels of troponin I (3.12 ng/ml vs. 1.32 ng/ml, p = 0.013) and creatin kinase (CK) on admission (461 (±1207)U/l vs. 173 (±177) U/l, p = 0.03) as well as peak CK (973 (±2860)U/l vs. 301 (±328) U/l, p = 0.03) and more often ischemia related ECG changes (p = 0.02). Follow-up data was available for 85% of the patients. Median FU time was 4.4 years (IQR 1.4-7.7 years). All-cause mortality during follow-up was 39%, with no significant difference between patients with typical or atypical TTS (43% vs. 29%, p = 0.17). In multivariate logistic regression analysis, only anemia was predictive for long-term mortality (OR 3.93, 95%CI 1.02-2.08, p = 0.015). The majority of surviving patients (69%) reported good quality of life, even though only 56% reported being symptom-free. CONCLUSION Patients with TTS have poor long-term prognosis with an overall mortality of 39.1% within 4 years and nearly half of all patients report persisting symptoms. Even though the apical contraction pattern is associated with higher elevation of serum markers for myocardial damage, it was not associated with higher long-term mortality.
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Affiliation(s)
- Luise Gaede
- Corresponding author at: Friedrich-Alexander-Universität Erlangen-Nürnberg, Medizinische Klinik 2, Ulmenweg 18, 91054 Erlangen, Germany.
| | | | - Monique Tröbs
- Friedrich Alexander Universität Erlangen-Nürnberg (FAU), Medizinische Klinik 2, Universitätsklinikum Erlangen, Germany
| | - Mohamed Marwan
- Friedrich Alexander Universität Erlangen-Nürnberg (FAU), Medizinische Klinik 2, Universitätsklinikum Erlangen, Germany
| | - Stephan Achenbach
- Friedrich Alexander Universität Erlangen-Nürnberg (FAU), Medizinische Klinik 2, Universitätsklinikum Erlangen, Germany
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2627
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Szabó GT, Ágoston A, Csató G, Rácz I, Bárány T, Uzonyi G, Szokol M, Sármán B, Jebelovszki É, Édes IF, Czuriga D, Kolozsvári R, Csanádi Z, Édes I, Kőszegi Z. Predictors of Hospital Mortality in Patients with Acute Coronary Syndrome Complicated by Cardiogenic Shock. SENSORS (BASEL, SWITZERLAND) 2021; 21:969. [PMID: 33535491 PMCID: PMC7867036 DOI: 10.3390/s21030969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/21/2021] [Accepted: 01/26/2021] [Indexed: 11/17/2022]
Abstract
As demonstrated by earlier studies, pre-hospital triage with trans-telephonic electrocardiogram (TTECG) and direct referral for catheter therapy shows great value in the management of out-of-hospital chest pain emergencies. It does not only improve in-hospital mortality in ST-segment elevation myocardial infarction, but it has also been identified as an independent predictor of higher in-hospital survival rate. Since TTECG-facilitated triage shortens both transport time and percutaneous coronary intervention (PCI)-related procedural time intervals, it was hypothesized that even high-risk patients with acute coronary syndrome (ACS) and cardiogenic shock (CS) might also benefit from TTECG-based triage. Here, we decided to examine our database for new triage- and left ventricular (LV) function-related parameters that can influence in-hospital mortality in ACS complicated by CS. ACS patients were divided into two groups, namely, (1) hospital death patients (n = 77), and (2) hospital survivors (control, n = 210). Interestingly, TTECG-based consultation and triage of CS and ACS patients were confirmed as significant independent predictors of lower hospital mortality risk (odds ratio (OR) 0.40, confidence interval (CI) 0.21-0.76, p = 0.0049). Regarding LV function and blood chemistry, a good myocardial reperfusion after PCI (high area at risk (AAR) blush score/AAR LV segment number; OR 0.85, CI 0.78-0.98, p = 0.0178) and high glomerular filtration rate (GFR) value at the time of hospital admission (OR 0.97, CI 0.96-0.99, p = 0.0042) were the most crucial independent predictors of a decreased risk of in-hospital mortality in this model. At the same time, a prolonged time interval between symptom onset and hospital admission, successful resuscitation, and higher peak creatine kinase activity were the most important independent predictors for an increased risk of in-hospital mortality. In ACS patients with CS, (1) an early TTECG-based teleconsultation and triage, as well as (2) good myocardial perfusion after PCI and a high GFR value at the time of hospital admission, appear as major independent predictors of a lower in-hospital mortality rate.
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Affiliation(s)
- Gábor Tamás Szabó
- Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (I.R.); (T.B.); (M.S.); (D.C.); (R.K.); (Z.C.); (I.É.); (Z.K.)
| | - András Ágoston
- The III: Department of Internal Medicine, Szabolcs–Szatmár–Bereg County Hospitals and University Teaching Hospital, 4400 Nyíregyháza, Hungary;
| | - Gábor Csató
- Hungarian National Ambulance Service, 1024 Budapest, Hungary;
| | - Ildikó Rácz
- Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (I.R.); (T.B.); (M.S.); (D.C.); (R.K.); (Z.C.); (I.É.); (Z.K.)
| | - Tamás Bárány
- Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (I.R.); (T.B.); (M.S.); (D.C.); (R.K.); (Z.C.); (I.É.); (Z.K.)
| | - Gábor Uzonyi
- Department of Cardiology, Uzsoki Hospital, 1145 Budapest, Hungary; (G.U.); (B.S.)
| | - Miklós Szokol
- Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (I.R.); (T.B.); (M.S.); (D.C.); (R.K.); (Z.C.); (I.É.); (Z.K.)
| | - Balázs Sármán
- Department of Cardiology, Uzsoki Hospital, 1145 Budapest, Hungary; (G.U.); (B.S.)
| | - Éva Jebelovszki
- Department of Cardiology, Faculty of Medicine, University of Szeged, 6725 Szeged, Hungary;
| | - István Ferenc Édes
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary;
| | - Dániel Czuriga
- Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (I.R.); (T.B.); (M.S.); (D.C.); (R.K.); (Z.C.); (I.É.); (Z.K.)
| | - Rudolf Kolozsvári
- Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (I.R.); (T.B.); (M.S.); (D.C.); (R.K.); (Z.C.); (I.É.); (Z.K.)
| | - Zoltán Csanádi
- Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (I.R.); (T.B.); (M.S.); (D.C.); (R.K.); (Z.C.); (I.É.); (Z.K.)
| | - István Édes
- Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (I.R.); (T.B.); (M.S.); (D.C.); (R.K.); (Z.C.); (I.É.); (Z.K.)
| | - Zsolt Kőszegi
- Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (I.R.); (T.B.); (M.S.); (D.C.); (R.K.); (Z.C.); (I.É.); (Z.K.)
- The III: Department of Internal Medicine, Szabolcs–Szatmár–Bereg County Hospitals and University Teaching Hospital, 4400 Nyíregyháza, Hungary;
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2628
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Dörr R, Maisch B. [2020 ESC guidelines in the shadow of the COVID-19 pandemic]. Herz 2021; 46:1-2. [PMID: 33319312 PMCID: PMC7735397 DOI: 10.1007/s00059-020-05009-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2020] [Indexed: 10/26/2022]
Affiliation(s)
- Rolf Dörr
- Praxisklinik Herz und Gefäße, Heinrich-Cotta-Str. 12, 01324, Dresden, Deutschland.
| | - Bernhard Maisch
- Philipps-Universität und Herz- und Gefäßzentrum Marburg, Marburg, Deutschland
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2629
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Tan JW, Chew DP, Abdul Kader MAS, Ako J, Bahl VK, Chan M, Park KW, Chandra P, Hsieh IC, Huan DQ, Johar S, Juzar DA, Kim BK, Lee CW, Lee MKY, Li YH, Almahmeed W, Sison EO, Tan D, Wang YC, Yeh SJ, Montalescot G. 2020 Asian Pacific Society of Cardiology Consensus Recommendations on the Use of P2Y 12 Receptor Antagonists in the Asia-Pacific Region. Eur Cardiol 2021; 16:e02. [PMID: 33708263 PMCID: PMC7941380 DOI: 10.15420/ecr.2020.40] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 11/04/2020] [Indexed: 01/01/2023] Open
Abstract
The unique characteristics of patients with acute coronary syndrome in the Asia-Pacific region mean that international guidelines on the use of dual antiplatelet therapy (DAPT) cannot be routinely applied to these populations. Newer generation P2Y12 inhibitors (i.e. ticagrelor and prasugrel) have demonstrated improved clinical outcomes compared with clopidogrel. However, low numbers of Asian patients participated in pivotal studies and few regional studies comparing DAPTs have been conducted. This article aims to summarise current evidence on the use of newer generation P2Y12 inhibitors in Asian patients with acute coronary syndrome and provide recommendations to assist clinicians, especially cardiologists, in selecting a DAPT regimen. Guidance is provided on the management of ischaemic and bleeding risks, including duration of therapy, switching strategies and the management of patients with ST-elevation and non-ST-elevation MI or those requiring surgery. In particular, the need for an individualised DAPT regimen and considerations relating to switching, de-escalating, stopping or continuing DAPT beyond 12 months are discussed.
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Affiliation(s)
- Jack Wc Tan
- National Heart Centre Singapore
- Sengkang General Hospital Singapore
| | - Derek P Chew
- College of Medicine and Public Health, Flinders University Adelaide, Australia
| | | | - Junya Ako
- Kitasato University and Hospital Tokyo, Japan
| | - Vinay K Bahl
- All India Institute of Medical Sciences New Delhi, India
| | - Mark Chan
- National University Hospital Singapore
| | - Kyung Woo Park
- Seoul National University Hospital Internal Medicine Seoul, South Korea
| | | | | | - Do Quang Huan
- Heart Institute of Ho Chi Minh City Ho Chi Minh, Vietnam
| | | | | | | | - Cheol Whan Lee
- Asan Medical Center, University of Ulsan Seoul, South Korea
| | | | - Yi-Heng Li
- National Cheng King University Hospital Tainan, Taiwan
| | | | - Eric Oliver Sison
- University of the Philippines-Philippine General Hospital Manila, Philippines
| | | | - Yu-Chen Wang
- China Medical University Hospital Taichung City, Taiwan
| | | | - Gilles Montalescot
- Sorbonne University Paris, France
- ACTION Study Group France
- Pitié-Salpêtrière Hospital (AP-HP) Paris, France
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2630
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Tantry US, Rout A, Bliden KP, Gurbel PA. Is a personalized pharmacotherapeutic approach closed for acute coronary syndrome? Expert Opin Pharmacother 2021; 22:527-529. [PMID: 33517805 DOI: 10.1080/14656566.2021.1877659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Udaya S Tantry
- Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Amit Rout
- Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Baltimore, MD, USA.,Division of Cardiology, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kevin P Bliden
- Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Paul A Gurbel
- Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Baltimore, MD, USA
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2631
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Karagiannidis E, Papazoglou AS, Stalikas N, Deda O, Panteris E, Begou O, Sofidis G, Moysidis DV, Kartas A, Chatzinikolaou E, Keklikoglou K, Bompoti A, Gika H, Theodoridis G, Sianos G. Serum Ceramides as Prognostic Biomarkers of Large Thrombus Burden in Patients with STEMI: A Micro-Computed Tomography Study. J Pers Med 2021; 11:89. [PMID: 33572568 PMCID: PMC7911549 DOI: 10.3390/jpm11020089] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/21/2021] [Accepted: 01/28/2021] [Indexed: 12/17/2022] Open
Abstract
ST-elevation myocardial infarction (STEMI) remains one of the leading causes of mortality worldwide. The identification of novel metabolic and imaging biomarkers could unveil key pathophysiological mechanisms at the molecular level and promote personalized care in patients with acute coronary syndromes. We studied 38 patients with STEMI who underwent primary percutaneous coronary intervention and thrombus aspiration. We sought to correlate serum ceramide levels with micro-CT quantified aspirated thrombus volume and relevant angiographic outcomes, including modified TIMI thrombus grade and pre- or post-procedural TIMI flow. Higher ceramide C16:0 levels were significantly but weakly correlated with larger aspirated thrombus volume (Spearman r = 0.326, p = 0.046), larger intracoronary thrombus burden (TB; p = 0.030) and worse pre- and post-procedural TIMI flow (p = 0.049 and p = 0.039, respectively). Ceramides C24:0 and C24:1 were also significantly associated with larger intracoronary TB (p = 0.008 and p = 0.001, respectively). Receiver operating characteristic analysis demonstrated that ceramides C24:0 and C24:1 could significantly predict higher intracoronary TB (area under the curve: 0.788, 95% CI: 0.629-0.946 and 0.846, 95% CI: 0.706-0.985, respectively). In conclusion, serum ceramide levels were higher among patients with larger intracoronary and aspirated TB. This suggests that quantification of serum ceramides might improve risk-stratification of patients with STEMI and facilitate an individualized approach in clinical practice.
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Affiliation(s)
- Efstratios Karagiannidis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece; (E.K.); (A.S.P.); (N.S.); (G.S.); (D.V.M.); (A.K.)
| | - Andreas S. Papazoglou
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece; (E.K.); (A.S.P.); (N.S.); (G.S.); (D.V.M.); (A.K.)
| | - Nikolaos Stalikas
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece; (E.K.); (A.S.P.); (N.S.); (G.S.); (D.V.M.); (A.K.)
| | - Olga Deda
- Laboratory of Forensic Medicine and Toxicology, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (O.D.); (E.P.); (H.G.)
- Biomic_AUTh, Center for Interdisciplinary Research and Innovation (CIRI-AUTH), Balkan Center, B1.4, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001 Thessaloniki, Greece; (O.B.); (G.T.)
| | - Eleftherios Panteris
- Laboratory of Forensic Medicine and Toxicology, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (O.D.); (E.P.); (H.G.)
- Biomic_AUTh, Center for Interdisciplinary Research and Innovation (CIRI-AUTH), Balkan Center, B1.4, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001 Thessaloniki, Greece; (O.B.); (G.T.)
| | - Olga Begou
- Biomic_AUTh, Center for Interdisciplinary Research and Innovation (CIRI-AUTH), Balkan Center, B1.4, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001 Thessaloniki, Greece; (O.B.); (G.T.)
- Laboratory of Analytical Chemistry, Department of Chemistry, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Georgios Sofidis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece; (E.K.); (A.S.P.); (N.S.); (G.S.); (D.V.M.); (A.K.)
| | - Dimitrios V. Moysidis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece; (E.K.); (A.S.P.); (N.S.); (G.S.); (D.V.M.); (A.K.)
| | - Anastasios Kartas
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece; (E.K.); (A.S.P.); (N.S.); (G.S.); (D.V.M.); (A.K.)
| | - Evangelia Chatzinikolaou
- Institute of Marine Biology, Biotechnology and Aquaculture (IMBBC), Hellenic Centre for Marine Research (HCMR), 71500 Heraklion, Crete, Greece; (E.C.); (K.K.)
| | - Kleoniki Keklikoglou
- Institute of Marine Biology, Biotechnology and Aquaculture (IMBBC), Hellenic Centre for Marine Research (HCMR), 71500 Heraklion, Crete, Greece; (E.C.); (K.K.)
- Biology Department, University of Crete, 71003 Heraklion, Crete, Greece
| | | | - Helen Gika
- Laboratory of Forensic Medicine and Toxicology, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (O.D.); (E.P.); (H.G.)
- Biomic_AUTh, Center for Interdisciplinary Research and Innovation (CIRI-AUTH), Balkan Center, B1.4, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001 Thessaloniki, Greece; (O.B.); (G.T.)
| | - Georgios Theodoridis
- Biomic_AUTh, Center for Interdisciplinary Research and Innovation (CIRI-AUTH), Balkan Center, B1.4, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001 Thessaloniki, Greece; (O.B.); (G.T.)
- Laboratory of Analytical Chemistry, Department of Chemistry, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Georgios Sianos
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece; (E.K.); (A.S.P.); (N.S.); (G.S.); (D.V.M.); (A.K.)
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2632
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Cameli M, Pastore MC, Mandoli GE, D'Ascenzi F, Focardi M, Biagioni G, Cameli P, Patti G, Franchi F, Mondillo S, Valente S. COVID-19 and Acute Coronary Syndromes: Current Data and Future Implications. Front Cardiovasc Med 2021; 7:593496. [PMID: 33585577 PMCID: PMC7876078 DOI: 10.3389/fcvm.2020.593496] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 12/07/2020] [Indexed: 12/13/2022] Open
Abstract
Coronavirus disease-2019 (COVID-19) pandemic is a global healthcare burden, characterized by high mortality and morbidity rates all over the world. During the outbreak period, the topic of acute coronary syndromes (ACS) has raised several clinical issues, due to the risks of COVID-19 induced myocardial injury and to the uncertainties about the management of these cardiologic emergency conditions, which should be organized optimizing the diagnostic and therapeutic resources and ensuring the maximum protection to healthcare personnel and hospital environment. COVID-19 status should be assessed as soon as possible. Moreover, considerably lower rates of hospitalization for ACS have been reported all over the world, due to patients' hesitations to refer to hospital and to missed diagnosis. As a result, short- and long-term complications of myocardial infarction are expected in the near future; therefore, great efforts of healthcare providers will be required to limit the effects of this issue. In the present review we discuss the impact of COVID-19 pandemic on ACS diagnosis and management, with possible incoming consequences, providing an overview of the available evidence and suggesting future changes in social and clinical approach to ACS.
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Affiliation(s)
- Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
- University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Marta Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Giulia Biagioni
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Paolo Cameli
- Department of Clinical Medical and Neurosciences, Respiratory Disease and Lung Transplantation Section, Le Scotte Hospital, University of Siena, Siena, Italy
| | - Giuseppe Patti
- University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Federico Franchi
- Department of Medical Biotechnologies, Anesthesia and Intensive Care, University of Siena, Siena, Italy
| | - Sergio Mondillo
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Serafina Valente
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
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2633
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Guedeney P, Collet JP. Antithrombotic Therapy in Acute Coronary Syndromes: Current Evidence and Ongoing Issues Regarding Early and Late Management. Thromb Haemost 2021; 121:854-866. [PMID: 33506483 DOI: 10.1055/s-0040-1722188] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
A few decades ago, the understanding of the pathophysiological processes involved in the coronary artery thrombus formation has placed anticoagulant and antiplatelet agents at the core of the management of acute coronary syndrome (ACS). Increasingly potent antithrombotic agents have since been evaluated, in various association, timing, or dosage, in numerous randomized controlled trials to interrupt the initial thrombus formation, prevent ischemic complications, and ultimately improve survival. Primary percutaneous coronary intervention, initial parenteral anticoagulation, and dual antiplatelet therapy with potent P2Y12 inhibitors have become the hallmark of ACS management revolutionizing its prognosis. Despite these many improvements, much more remains to be done to optimize the onset of action of the various antithrombotic therapies, for further treating and preventing thrombotic events without exposing the patients to an unbearable hemorrhagic risk. The availability of various potent P2Y12 inhibitors has opened the door for individualized therapeutic strategies based on the clinical setting as well as the ischemic and bleeding risk of the patients, while the added value of aspirin has been recently challenged. The strategy of dual-pathway inhibition with P2Y12 inhibitors and low-dose non-vitamin K antagonist oral anticoagulant has brought promising results for the early and late management of patients presenting with ACS with and without indication for oral anticoagulation. In this updated review, we aimed at describing the evidence supporting the current gold standard of antithrombotic management of ACS. More importantly, we provide an overview of some of the ongoing issues and promising therapeutic strategies of this ever-evolving topic.
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Affiliation(s)
- Paul Guedeney
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Pitié Salpêtrière (AP-HP), Paris, France
| | - Jean-Philippe Collet
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Pitié Salpêtrière (AP-HP), Paris, France
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2634
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Lizano-Díez I, Paz Ruiz S. Analysis of the Financial Impact of Using Cangrelor on the Safety and Efficacy Outcomes in Patients Undergoing Percutaneous Coronary Intervention in Whom Oral Therapy with P2Y 12 Inhibitors is Not Feasible or Desirable, in Spain. CLINICOECONOMICS AND OUTCOMES RESEARCH 2021; 13:77-87. [PMID: 33536769 PMCID: PMC7850430 DOI: 10.2147/ceor.s290377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/01/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Cangrelor is an intravenous, direct-acting, reversible P2Y12 inhibitor indicated for the reduction of thrombotic cardiovascular events in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) in whom oral P2Y12 inhibitors are not feasible or desirable. The objective was to assess the financial impact of introducing cangrelor into the hospital formulary in Spain. PATIENTS AND METHODS A budget impact model was developed to calculate the cost difference between two scenarios (without and with cangrelor) to treat CAD patients undergoing PCI in whom oral P2Y12 inhibitors are not feasible or desirable, over 3 years. Intravenous P2Y12 inhibitor (cangrelor), oral P2Y12 inhibitors (clopidogrel, prasugrel, and ticagrelor), and glycoprotein IIb-IIIa inhibitors (GPIs) for bail-out use were considered. Epidemiological, efficacy (thrombotic events including cardiac death), safety (bleeding events), and costs (€, 2019) data were based on Spanish registries, clinical trials, and meta-analyses. One-way sensitivity analysis established the effect of uncertainty on results. RESULTS For years 1, 2, and 3, the target population to receive cangrelor was 607, 1,822, and 3,340 patients, and cangrelor uptake was 23.70%, 58.30%, and 51.30%, respectively. The 3-year budget impact was 1,021,717€ varying from 50,245€ in year 1 to 599,272€ in year 3. The results were sensitive to the number of patients treated with GPIs in Spanish hospitals. CONCLUSION Based on our results, the financial effort needed to introduce the use of cangrelor in patients undergoing PCI in whom antiplatelet therapy with oral P2Y12 inhibitors is not feasible or desirable barely exceeds one million € over three years, in Spain.
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2635
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Bossard M, Gao P, Boden W, Steg G, Tanguay JF, Joyner C, Granger CB, Kastrati A, Faxon D, Budaj A, Pais P, Di Pasquale G, Valentin V, Flather M, Moccetti T, Yusuf S, Mehta SR. Antiplatelet therapy in patients with myocardial infarction without obstructive coronary artery disease. Heart 2021; 107:1739-1747. [PMID: 33504513 DOI: 10.1136/heartjnl-2020-318045] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/23/2020] [Accepted: 12/29/2020] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE Approximately 10% of patients with myocardial infarction (MI) have no obstructive coronary artery disease. The prognosis and role of intensified antiplatelet therapy in those patients were evaluated. METHODS We analysed data from the Clopidogrel and Aspirin Optimal Dose Usage to Reduce Recurrent Events-Seventh Organisation to Assess Strategies in Ischaemic Symptoms trial randomising patients with ACS referred for early intervention to receive either double-dose (600 mg, day 1; 150 mg, days 2-7; then 75 mg/day) or standard-dose (300 mg, day 1; then 75 mg/day) clopidogrel. Outcomes in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) versus those with obstructive coronary artery disease (CAD) and their relation to standard-dose versus double-dose clopidogrel were evaluated. The primary outcome was cardiovascular (CV) death, MI or stroke at 30 days. RESULTS We included 23 783 patients with MI and 1599 (6.7%) with MINOCA. Patients with MINOCA were younger, presented more frequently with non-ST-segment elevation MI and had fewer comorbidities. All-cause mortality (0.6% vs 2.3%, p=0.005), CV mortality (0.6% vs 2.2%, p=0.006), repeat MI (0.5% vs 2.3%, p=0.001) and major bleeding (0.6% vs 2.4%, p<0.0001) were lower among patients with MINOCA than among those with obstructive CAD. Among patients with MINOCA, 2.1% of patients in the double-dose clopidogrel group and 0.6% in the standard-dose group experienced a primary outcome (HR 3.57, 95% CI 1.31 to 9.76), whereas in those with obstructive CAD, rates were 4.3% and 4.7%, respectively (HR 0.91, 95% CI 0.80 to 1.03; p value for interaction=0.011). CONCLUSIONS Patients with MINOCA are at lower risk of recurrent CV events compared with patients with MI with obstructive CAD. Compared with a standard clopidogrel-based dual antiplatelet therapy (DAPT) regimen, an intensified dosing strategy appears to offer no additional benefit with a signal of possible harm. Further randomised trials evaluating the effects of potent DAPT in patients with MINOCA are warranted. TRIAL REGISTRATION NUMBER NCT00335452.
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Affiliation(s)
- Matthias Bossard
- Cardiology Division, Heart Center - Luzerner Kantonsspital, Luzern, Switzerland
| | - Peggy Gao
- Population Health Research Institute (PHRI), Hamilton, Ontario, Canada
| | - William Boden
- Medicine, VA Boston Health Care System West Roxbury Campus, West Roxbury, Massachusetts, USA.,Boston University School of Medicine, Boston, Massachusetts, USA
| | - Gabriel Steg
- Cardiology Department, Hôpital Bichat-Claude Bernard, Paris, France
| | | | - Cam Joyner
- Sunnybrook Health Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Christopher B Granger
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | | | - David Faxon
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Andrzej Budaj
- Department of Cardiology, Grochowski Hospital, Warsaw, Poland
| | - Prem Pais
- Division of Clinical Research & Training, St John's Medical College and Research Institute, Bangalore, India
| | - Giuseppe Di Pasquale
- Department of Cardiology, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Emilia-Romagna, Italy
| | - Vicent Valentin
- Unidad Coronaria, Hospital Universitario Dr Peset, Valencia, Comunitat Valenciana, Spain
| | - Marcus Flather
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Salim Yusuf
- Population Health Research Institute (PHRI), Hamilton, Ontario, Canada.,Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Shamir R Mehta
- Population Health Research Institute (PHRI), Hamilton, Ontario, Canada .,Division of Cardiology, Hamilton General Hospital, Hamilton, Ontario, Canada
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2636
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Bellis A, Mauro C, Barbato E, Ceriello A, Cittadini A, Morisco C. Stress-Induced Hyperglycaemia in Non-Diabetic Patients with Acute Coronary Syndrome: From Molecular Mechanisms to New Therapeutic Perspectives. Int J Mol Sci 2021; 22:E775. [PMID: 33466656 PMCID: PMC7828822 DOI: 10.3390/ijms22020775] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/08/2021] [Accepted: 01/10/2021] [Indexed: 01/08/2023] Open
Abstract
Stress-induced hyperglycaemia (SIH) at hospital admission for acute coronary syndrome is associated with poor outcome, especially in patients without known diabetes. Nevertheless, insulin treatment in these subjects was not correlated with the reduction of mortality. This is likely due to the fact that SIH in the context of an acute coronary syndrome, compared to that in known diabetes, represents an epiphenomenon of other pathological conditions, such as adrenergic and renin-angiotensin system over-activity, hyperglucagonaemia, increase of circulating free fatty acids and pancreatic beta-cell dysfunction, which are not completely reversed by insulin therapy and so worsen the prognosis. Thus, SIH may be considered not only as a biomarker of organ damage, but also as an indicator of a more complex therapeutic strategy in these subjects. The aim of this review is to analyse the molecular mechanisms by which SIH may favour a worse prognosis in non-diabetic patients with acute coronary syndrome and identify new therapeutic strategies, in addition to insulin therapy, for a more appropriate treatment and improved outcomes.
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Affiliation(s)
- Alessandro Bellis
- Unità Operativa Complessa Cardiologia con UTIC ed Emodinamica-Dipartimento Emergenza Accettazione, Azienda Ospedaliera “Antonio Cardarelli”, 80131 Napoli, Italy; (A.B.); (C.M.)
| | - Ciro Mauro
- Unità Operativa Complessa Cardiologia con UTIC ed Emodinamica-Dipartimento Emergenza Accettazione, Azienda Ospedaliera “Antonio Cardarelli”, 80131 Napoli, Italy; (A.B.); (C.M.)
| | - Emanuele Barbato
- Dipartimento di Scienze Biomediche Avanzate, Università Federico II, 80131 Napoli, Italy;
| | - Antonio Ceriello
- Department of Cardiovascular and Metabolic Diseases, IRCCS Multimedica, Sesto San Giovanni, 20099 Milan, Italy;
| | - Antonio Cittadini
- Dipartimento di Scienze Mediche Traslazionali, Università Federico II, 80131 Napoli, Italy;
| | - Carmine Morisco
- Dipartimento di Scienze Biomediche Avanzate, Università Federico II, 80131 Napoli, Italy;
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2637
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[It's a question of timing-does every patient with NSTEMI require immediate coronary angiography?]. Med Klin Intensivmed Notfmed 2021; 116:74-75. [PMID: 33427906 DOI: 10.1007/s00063-020-00766-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2020] [Indexed: 10/22/2022]
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2638
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Apple FS, Fantz CR, Collinson PO. Implementation of High-Sensitivity and Point-of-Care Cardiac Troponin Assays into Practice: Some Different Thoughts. Clin Chem 2021; 67:70-78. [PMID: 33279984 PMCID: PMC7799201 DOI: 10.1093/clinchem/hvaa264] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/12/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND The primary role of the International Federation of Clinical Chemistry (IFCC) Committee on Clinical Application of Cardiac Bio-Markers (C-CB) is to provide educational materials about cardiac biomarker use, emphasizing high-sensitivity cardiac troponin assays. CONTENT This mini-review, regarding high-sensitivity cardiac and point-of-care troponin assays, addresses 1) new IFCC C-CB/AACC Academy laboratory practice recommendations; 2) new and updated concepts from the Fourth Universal Definition of Myocardial Infarction; 3) the role of point-of-care assays in practice and research; 4) regulatory challenges concerning point-of-care assays; e) testing in the COVID-19 world. SUMMARY Implementation of high-sensitivity cardiac troponin assays makes a difference now and into the future in clinical practice and research. Providing point-of-care high-sensitivity cardiac troponin assays and optimizing studies to allow clearance of these assays by regulatory agencies, in a timely fashion, may provide improved patient management and outcomes.
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Affiliation(s)
- Fred S Apple
- Department of Laboratory Medicine and Pathology, Hennepin County Medical Center of Hennepin Healthcare and University of Minnesota, Minneapolis, MN
| | - Corinne R Fantz
- Medical and Scientific Affairs - POC, Roche Diagnostics Corporation, Indianapolis, IN
| | - Paul O Collinson
- Department of Clinical Blood Sciences and Cardiology, St George's University Hospitals NHS Foundation Trust and St George’s University of London, London, UK
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2639
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Bouisset F, Ruidavets JB, Dallongeville J, Moitry M, Montaye M, Biasch K, Ferrières J. Comparison of Short- and Long-Term Prognosis between ST-Elevation and Non-ST-Elevation Myocardial Infarction. J Clin Med 2021; 10:E180. [PMID: 33430516 PMCID: PMC7826729 DOI: 10.3390/jcm10020180] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 12/23/2020] [Accepted: 12/31/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Available data comparing long-term prognosis according to the type of acute coronary syndrome (ACS) are scarce, contradictory, and outdated. Our aim was to compare short- and long-term mortality in ST-elevated (STEMI) and non-ST-elevated myocardial infarction (non-STEMI) ACS patients. METHODS Patients presenting with an inaugural ACS during the year 2006 and living in one of the three areas in France covered by the Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) registry were included. RESULTS A total of 1822 patients with a first ACS-1121 (61.5%) STEMI and 701 (38.5%) non-STEMI-were included in the study. At the 28-day follow-up, the mortality rates were 6.7% and 4.7% (p = 0.09) for STEMI and non-STEMI patients, respectively, and after adjustment of potential confounding factors, the 28-day probability of death was significantly lower for non-STEMI ACS patients (Odds Ratio = 0.58 (0.36-0.94), p = 0.03). At the 10-year follow-up, the death rates were 19.6% and 22.8% (p = 0.11) for STEMI and non-STEMI patients, respectively, and after adjustment of potential confounding factors, the 10-year probability of death did not significantly differ between non-STEMI and STEMI events (OR = 1.07 (0.83-1.38), p = 0.59). Over the first year, the mortality rate was 7.2%; it then decreased and stabilized at 1.7% per year between the 2nd and 10th year following ACS. CONCLUSION STEMI patients have a worse vital prognosis than non-STEMI patients within 28 days following ACS. However, at the 10-year follow-up, STEMI and non-STEMI patients have a similar vital prognosis. From the 2nd year onwards following the occurrence of a first ACS, the patients become stable coronary artery disease patients with an annual mortality rate in the 2% range, regardless of the type of ACS they initially present with.
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Affiliation(s)
- Frédéric Bouisset
- Department of Cardiology, Rangueil University Hospital, 31059 Toulouse, France;
- Department of Epidemiology, INSERM UMR 1027, 31000 Toulouse, France;
| | | | - Jean Dallongeville
- Institut Pasteur de Lille, Department of Epidemiology and Public Health, Inserm-U1167, 59000 Lille, France; (J.D.); (M.M.)
| | - Marie Moitry
- Faculty of Medicine, Department of Epidemiology and Public Health, University of Strasbourg, 67081 Strasbourg, France; (M.M.); (K.B.)
- Department of Public Health, Strasbourg University Hospital, 67085 Strasbourg, France
| | - Michele Montaye
- Institut Pasteur de Lille, Department of Epidemiology and Public Health, Inserm-U1167, 59000 Lille, France; (J.D.); (M.M.)
| | - Katia Biasch
- Faculty of Medicine, Department of Epidemiology and Public Health, University of Strasbourg, 67081 Strasbourg, France; (M.M.); (K.B.)
| | - Jean Ferrières
- Department of Cardiology, Rangueil University Hospital, 31059 Toulouse, France;
- Department of Epidemiology, INSERM UMR 1027, 31000 Toulouse, France;
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2640
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Kook H, Kim HD, Shim J, Kim YH, Kim JS, Pak HN, Lee HJ, Choi RK, Kang WC, Shin ES, Park JW, Yu CW, Lim DS. Comparison of clinical outcomes between multiple antithrombotic therapy versus left atrial appendage occlusion with dual antiplatelet therapy in patients with atrial fibrillation undergoing drug-eluting stent implantation. PLoS One 2021; 16:e0244723. [PMID: 33411816 PMCID: PMC7790384 DOI: 10.1371/journal.pone.0244723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 12/15/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Complex antithrombotic regimens are recommended for patients with atrial fibrillation (AF) undergoing drug-eluting stent (DES) implantation but carry high bleeding risk. HYPOTHESIS We aimed to evaluate whether left atrial appendage occlusion (LAAO) with dual antiplatelet therapy (DAPT) improve clinical outcomes when compared with multiple antithrombotic therapy (MAT) in patients with AF undergoing DES implantation. METHODS Among 475 AF patients who underwent DES, 41 patients treated by LAAO with DAPT and 434 patients on MAT were compared. MAT was defined as any combination of warfarin-based antithrombotic therapy. Among the MAT group, 34.8% were on triple antithrombotic therapy. The primary endpoint was a net adverse clinical event (NACE), a composite of cerebrovascular accident (CVA) and major bleeding. Secondary endpoints were CVA, major bleeding, major adverse cardiac and cerebral event (MACCE), MI, cardiovascular death, and all-cause death. Additional analysis between the new oral anticoagulant (NOAC)-based antithrombotic therapy group (n = 45) and the LAAO group was performed for the same endpoints. To adjust the confounding factors, inverse probability of treatment weighting (IPTW) was applied during the endpoint analysis. RESULTS The LAAO group showed higher incidences of diabetes mellitus, prior CVA, higher CHA2DS2-VASc score (4.56±1.55 vs. 2.96±1.60; P<0.0001), and higher HAS-BLED score (3.24±1.20 vs. 2.13±0.75; P<0.0001). NACE occurred less frequently in the LAAO group than the MAT group at 24 months (9.4% vs. 15.3%; hazard ratio 0.274; 95% confidence interval 0.136 - 0.553; P = 0.0003), mainly driven by the reduction in major bleeding (2.4% vs. 9.3%; hazard ratio 0.119; 95% confidence interval 0.032 - 0.438; P = 0.001). The LAAO group with greater thrombotic and hemorrhagic risks showed comparable primary/secondary outcomes with the NOAC-based anti-thrombotic therapy group. CONCLUSIONS Among patients with AF who underwent DES implantation, the LAAO group had better net clinical outcomes for preventing CVA and major bleeding than the MAT group. Further large-scale trials including comparisons with NOACs are warranted.
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Affiliation(s)
- Hyungdon Kook
- Cardiovascular Center, Korea University Anam Hospital, Seoul, Korea
| | - Hee-Dong Kim
- Cardiovascular Center, Korea University Anam Hospital, Seoul, Korea
| | - Jaemin Shim
- Cardiovascular Center, Korea University Anam Hospital, Seoul, Korea
| | - Young-Hoon Kim
- Cardiovascular Center, Korea University Anam Hospital, Seoul, Korea
| | - Jung-Sun Kim
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hui-Nam Pak
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | | | | | | | - Eun-Seok Shin
- Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jai-Wun Park
- Department of Cardiology, Charite University Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Cheol Woong Yu
- Cardiovascular Center, Korea University Anam Hospital, Seoul, Korea
| | - Do-Sun Lim
- Cardiovascular Center, Korea University Anam Hospital, Seoul, Korea
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2641
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Nabavizadeh P, Steen DL. Highlights from the European society of cardiology congress 2020. J Thromb Thrombolysis 2021; 51:232-236. [PMID: 33403568 PMCID: PMC7785397 DOI: 10.1007/s11239-020-02365-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/02/2020] [Indexed: 12/02/2022]
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2642
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Jeong YH, Oh JH, Yoon HJ, Park Y, Suh J, Lee SW, Lee K, Kim JS, Chun WJ, Park YH, Nam CW, Kim JH, Ahn JH, Hwang SJ, Hwang JY, Tantry US, Gurbel PA, Shin ES. Pharmacodynamic Profile and Prevalence of Bleeding Episode in East Asian Patients with Acute Coronary Syndromes Treated with Prasugrel Standard-Dose versus De-escalation Strategy: A Randomized A-MATCH Trial. Thromb Haemost 2021; 121:1376-1386. [PMID: 33401330 DOI: 10.1055/a-1346-3300] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Compared with Caucasian patients, East Asian patients have the unique risk-benefit trade-off and different responsiveness to antithrombotic regimens. The aim of this study was to compare pharmacodynamic profile in East Asian patients with acute coronary syndromes (ACSs) treated with prasugrel standard-dose versus a de-escalation strategy. Before discharge, ACS patients with age <75 years or weight ≥60 kg (n = 255) were randomly assigned to the standard-dose (10-mg group) or de-escalation strategy (5-mg group or platelet function test [PFT]-guided group). After 1 month, VerifyNow P2Y12 assay-based platelet reactivity (P2Y12 reaction unit [PRU]) and bleeding episodes were evaluated. Primary endpoint was the percentage of patients with the therapeutic window (85 ≤ PRU ≤ 208). The 250 patients completed 1-month treatment. The percentage of patients within the therapeutic window was significantly lower in the 10-mg group (n = 85) compared with the 5-mg (n = 83) and PFT-guided groups (n = 82) (35.3 vs. 67.5 vs. 65.9%) (odds ratio [OR]: 3.80 and 3.54; 95% confidence interval [CI]: 2.01-7.21 and 1.87-6.69, respectively). Compared with the 10-mg group, the bleeding rate was tended to be lower with de-escalation strategies (35.3 vs. 24.1% vs. 23.2%) (hazard ratio [HR]: 0.58 and 0.55; 95% CI: 0.30-1.14 and 0.28-1.09, respectively). "PRU < 127" was the optimal cut-off for predicting 1-month bleeding events (area under the curve: 0.616; 95% CI: 0.543-0.689; p = 0.005), which criteria was significantly associated with early discontinuation of prasugrel treatment (HR: 2.00; 95% CI: 1.28-3.03; p = 0.001). In conclusion, compared with the standard-dose prasugrel, the prasugrel de-escalation strategy in East Asian patients presented with ACS showed a higher chance within the therapeutic window and a lower tendency toward bleeding episodes. REGISTRATION: URL: https://clinicaltrials.gov. Unique identifier:NCT01951001.
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Affiliation(s)
- Young-Hoon Jeong
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Cardiovascular Center, Gyeongsang National University Changwon Hospital, Changwon, South Korea.,Institute of the Health Sciences, Gyeongsang National University, Jinju, South Korea
| | - Ju-Hyeon Oh
- Division of Cardiology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | - Hyuck-Jun Yoon
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea
| | - Yongwhi Park
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Cardiovascular Center, Gyeongsang National University Changwon Hospital, Changwon, South Korea.,Institute of the Health Sciences, Gyeongsang National University, Jinju, South Korea
| | - Jon Suh
- Division of Cardiology, Department of Internal Medicine, Soon Chun Hyang University Bucheon Hospital, Bucheon, South Korea
| | - Se-Whan Lee
- Department of Cardiology, Soonchunhyang University Cheonan Hospital, Cheonan, South Korea
| | - Kyounghoon Lee
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Jeong-Su Kim
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Woo-Jung Chun
- Division of Cardiology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | - Yong-Hwan Park
- Division of Cardiology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | - Chang-Wook Nam
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea
| | - June-Hong Kim
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Jong-Hwa Ahn
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, South Korea
| | - Seok-Jae Hwang
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, South Korea
| | - Jin-Yong Hwang
- Institute of the Health Sciences, Gyeongsang National University, Jinju, South Korea.,Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, South Korea
| | - Udaya S Tantry
- Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Baltimore, Maryland, United States
| | - Paul A Gurbel
- Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Baltimore, Maryland, United States
| | - Eun-Seok Shin
- Division of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
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2643
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Artificial Intelligence in Medicine (AIM) in Cardiovascular Disorders. Artif Intell Med 2021. [DOI: 10.1007/978-3-030-58080-3_170-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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2644
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Haley HA, Ghobrial M, Morris PD, Gosling R, Williams G, Mills MT, Newman T, Rammohan V, Pederzani G, Lawford PV, Hose R, Gunn JP. Virtual (Computed) Fractional Flow Reserve: Future Role in Acute Coronary Syndromes. Front Cardiovasc Med 2021; 8:735008. [PMID: 34746253 PMCID: PMC8569111 DOI: 10.3389/fcvm.2021.735008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/22/2021] [Indexed: 12/17/2022] Open
Abstract
The current management of acute coronary syndromes (ACS) is with an invasive strategy to guide treatment. However, identifying the lesions which are physiologically significant can be challenging. Non-invasive imaging is generally not appropriate or timely in the acute setting, so the decision is generally based upon visual assessment of the angiogram, supplemented in a small minority by invasive pressure wire studies using fractional flow reserve (FFR) or related indices. Whilst pressure wire usage is slowly increasing, it is not feasible in many vessels, patients and situations. Limited evidence for the use of FFR in non-ST elevation (NSTE) ACS suggests a 25% change in management, compared with traditional assessment, with a shift from more to less extensive revascularisation. Virtual (computed) FFR (vFFR), which uses a 3D model of the coronary arteries constructed from the invasive angiogram, and application of the physical laws of fluid flow, has the potential to be used more widely in this situation. It is less invasive, fast and can be integrated into catheter laboratory software. For severe lesions, or mild disease, it is probably not required, but it could improve the management of moderate disease in 'real time' for patients with non-ST elevation acute coronary syndromes (NSTE-ACS), and in bystander disease in ST elevation myocardial infarction. Its practicability and impact in the acute setting need to be tested, but the underpinning science and potential benefits for rapid and streamlined decision-making are enticing.
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Affiliation(s)
- Hazel Arfah Haley
- Department of Infection Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- Insigneo Institute for in silico Medicine, Sheffield, United Kingdom
- Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, United Kingdom
| | - Mina Ghobrial
- Department of Infection Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- Insigneo Institute for in silico Medicine, Sheffield, United Kingdom
| | - Paul D. Morris
- Department of Infection Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- Insigneo Institute for in silico Medicine, Sheffield, United Kingdom
- Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, United Kingdom
| | - Rebecca Gosling
- Department of Infection Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- Insigneo Institute for in silico Medicine, Sheffield, United Kingdom
| | - Gareth Williams
- Department of Infection Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- Insigneo Institute for in silico Medicine, Sheffield, United Kingdom
| | - Mark T. Mills
- Department of Infection Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, United Kingdom
| | - Tom Newman
- Department of Infection Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, United Kingdom
| | - Vignesh Rammohan
- Department of Infection Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- Insigneo Institute for in silico Medicine, Sheffield, United Kingdom
| | - Giulia Pederzani
- Department of Infection Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- Insigneo Institute for in silico Medicine, Sheffield, United Kingdom
| | - Patricia V. Lawford
- Department of Infection Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- Insigneo Institute for in silico Medicine, Sheffield, United Kingdom
| | - Rodney Hose
- Department of Infection Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- Insigneo Institute for in silico Medicine, Sheffield, United Kingdom
| | - Julian P. Gunn
- Department of Infection Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- Insigneo Institute for in silico Medicine, Sheffield, United Kingdom
- Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, United Kingdom
- *Correspondence: Julian P. Gunn
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2645
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Yilmaz A, Kahraman F, Ergül E, Çetin M. Left atrial volume index to left ventricular ejection fraction ratio predicted major adverse cardiovascular event in ST-Elevated myocardial infarction patients during 8 years of follow-up. J Cardiovasc Echogr 2021; 31:227-233. [PMID: 35284216 PMCID: PMC8893117 DOI: 10.4103/jcecho.jcecho_38_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/26/2021] [Accepted: 08/07/2021] [Indexed: 11/04/2022] Open
Abstract
Objective: Methods: Results: Conclusion:
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2646
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Yang J, Tang YD, Zheng Y, Li C, Zhou Q, Gao J, Meng X, Zhang K, Wang W, Shao C. The Impact of the Triglyceride-Glucose Index on Poor Prognosis in NonDiabetic Patients Undergoing Percutaneous Coronary Intervention. Front Endocrinol (Lausanne) 2021; 12:710240. [PMID: 34489866 PMCID: PMC8417234 DOI: 10.3389/fendo.2021.710240] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 07/28/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The triglyceride-glucose index (TyG index) is a valuable marker for predicting adverse cardiovascular events in diabetic patients. However, for nondiabetic patients, whether the TyG index is independently related to poor prognosis remains unclear. This cohort study assessed the association of the TyG index with future cardiovascular risk in nondiabetic subjects who received percutaneous coronary intervention (PCI). METHODS We consecutively enrolled 5,489 nondiabetic patients who underwent PCI. All experimental subjects were divided into three groups based on their TyG index, which was determined by the equation ln (fasting triglyceride (mg/dl) × fasting blood glucose (mg/dl)/2). The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE), including all-cause death, nonfatal myocardial infarction (MI), nonfatal stroke, and target vessel revascularization (TVR). RESULTS A total of 386 MACCE were documented during a median 29-month follow-up. The Kaplan-Meier survival results indicated that among the three groups, there was no obvious difference in any endpoints. Further Cox regression analyses suggested that the TyG index was not independently related to adverse cardiovascular outcomes for nondiabetic patients who underwent PCI (HR: 0.77, 95% CI 0.56-1.16, P = 0.210 for MACCE). Subgroup analysis suggested that the TyG index was independently relevant to MACCE for patients with low-density lipoprotein cholesterol (LDL-C) lower than 1.8 mmol/L. CONCLUSION The TyG index is not an effective predictive factor for adverse cardiovascular prognosis in nondiabetic patients who underwent PCI. However, in subjects with LDL-C lower than 1.8mmol/L, it may predict future cardiovascular risk.
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Affiliation(s)
- Jie Yang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi-Da Tang
- Department of Cardiology, Institute of Vascular Medicine, Peking University Third Hospital, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, China
| | - Yitian Zheng
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chen Li
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qing Zhou
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Gao
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiangbin Meng
- Department of Cardiology, Zhengzhou University People's Hospital, Zhengzhou, China
- Department of Cardiology, Central China Fuwai Hospital, Central China Branch of the National Cardiovascular Center, Zhengzhou, China
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Kuo Zhang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenyao Wang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chunli Shao
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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2647
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Uskach TM, Tereshchenko AS. Modern Antiplatelet Therapy for Percutaneous Coronary Intervention. How to Make the Right Choice? RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2020. [DOI: 10.20996/1819-6446-2020-11-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Dual antiplatelet therapy is the most important step in acute coronary syndrome (ACS) treatment. The new generation of inhibitors of P2Y12 platelet receptors (prasugrel and ticagrelor) provide more pronounced platelet inhibition than clopidogrel. The drugs differ in pharmacodynamics and platelet reactivity tests due to different mechanisms of binding to P2Y12 receptors. The antiplatelet effect of prasugrel and ticagrelor provides clinical benefit and better prognosis in patients with various forms of ACS. In patients with ST-segment elevation ACS prasugrel and ticagrelor are preferred over clopi-dogrel due to their higher efficacy and better clinical outcomes, and currently have preferential positions in guidelines compared to clopidogrel. The comparison of prasugrel versus ticagrelor (ISAR-REACT 5 trial) demonstrated superiority of prasugrel over ticagrelor in patients with ST-segment elevation ACS, for whom an invasive evaluation is planned and in early invasive treatment non-ST-segment elevation ACS. The choice of a drug for dual antiplatelet therapy in various clinical situations remains controversial. The latest ESC guidelines on non-ST elevation ACS (2020) [1] demonstrate the possible preference for prasugrel in patients with ACS without ST-segment elevation undergoing percutaneous coronary intervention. Current article demonstrates the results of recent clinical studies and the real clinical data regarding antiplatelet therapy in patients with coronary interventions. The indications for the use of P2Y12 platelet inhibitors in certain groups of patients are outlined. Treatment selection of the most effective and safe drugs in patients with ACS is highlighted according to the updated European guidelines.
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Affiliation(s)
- T. M. Uskach
- National Medical Research Center of Cardiology; Russian Medical Academy of Continuous Professional Education
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2648
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Kow CS, Zaihan AF, Hasan SS. Has it come to the time to recommend routine use of alirocumab in patients with acute coronary syndrome? Eur J Prev Cardiol 2020; 29:e77-e78. [PMID: 33624099 DOI: 10.1093/eurjpc/zwaa148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Chia Siang Kow
- School of Postgraduate Studies, International Medical University, No. 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000 Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia
| | | | - Syed Shahzad Hasan
- Department of Pharmacy, University of Huddersfield, Huddersfield, UK.,School of Biomedical Sciences & Pharmacy, University of Newcastle, Callaghan, Australia
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2649
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Tscharre M, Wadowski PP, Weikert C, Pultar J, Eichelberger B, Panzer S, Gremmel T. Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Acute Coronary Syndrome: Implications for Platelet Reactivity? Cardiovasc Drugs Ther 2020; 35:1183-1190. [PMID: 33337519 PMCID: PMC8578055 DOI: 10.1007/s10557-020-07128-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND In patients with acute coronary syndrome (ACS), angiotensin-converting enzyme (ACE) inhibitors are preferred over angiotensin receptor blockers (ARBs). However, in a recent pilot study, treatment with ACE inhibitors was associated with increased platelet reactivity compared to ARBs. Therefore, we sought to investigate the impact of renin-angiotensin-aldosterone system (RAAS) blockade with ACE inhibitors and ARBs on platelet aggregation in patients with ACS undergoing percutaneous coronary intervention. METHODS On-treatment residual platelet reactivity in response to arachidonic acid (AA), adenosine diphosphate (ADP), SFLLRN, AYPGKF, and collagen was assessed by multiple electrode aggregometry (MEA) in 197 ACS patients on dual antiplatelet therapy (DAPT) with aspirin and either prasugrel or ticagrelor. RESULTS One hundred sixty-five (83.7%) patients were treated with ACE inhibitors, 32 (16.3%) with ARBs. On-treatment residual AA- and ADP-inducible platelet reactivity was significantly higher in patients with ACE inhibitors (both p < 0.05). Likewise, SFLLRN was significantly higher in patients with ACE inhibitors (p = 0.036) and there was a trend for higher AYPGKF- and collagen-inducible platelet reactivity (p = 0.053 and p = 0.082). The incidence of high on-treatment residual platelet reactivity AA was significantly higher in patients with ACE inhibitors (52 [31.5%] vs. 3 [9.4%] patients; p = 0.019). CONCLUSION ACE inhibitors are associated with increased on-treatment residual platelet reactivity in ACS patients with potent DAPT. Further clinical trials are needed to elucidate the role of RAAS blockade with ACE inhibitors and ARBs in ACS patients treated according to current standards.
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Affiliation(s)
- Maximilian Tscharre
- Department of Internal Medicine, Cardiology and Nephrology, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria.,Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Patricia P Wadowski
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Constantin Weikert
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Joseph Pultar
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Beate Eichelberger
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria
| | - Simon Panzer
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria
| | - Thomas Gremmel
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. .,Department of Internal Medicine I, Cardiology and Intensive Care Medicine, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria.
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Gresnigt FM, Gubbels NP, Riezebos RK. The current practice for cocaine-associated chest pain in the Netherlands. Toxicol Rep 2020; 8:23-27. [PMID: 33384944 PMCID: PMC7770504 DOI: 10.1016/j.toxrep.2020.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 12/08/2020] [Accepted: 12/10/2020] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Cocaine is considered a cardiovascular risk factor, yet it is not included in the frequently used risk stratification scores. Moreover, many guidelines provide limited advice on how to diagnose and treat cocaine-associated chest pain (CACP). This study aimed to determine the current practice for CACP patients in emergency departments and coronary care units throughout the Netherlands. METHODS An anonymous online questionnaire-based survey was conducted among Dutch emergency physicians and cardiologists between July 2015 and February 2016. The questionnaire was based on the American Heart Association CACP treatment algorithm. RESULTS A total of 214 subjects were enrolled and completed the questionnaire. All responders considered cocaine use a risk factor for developing acute coronary syndrome (ACS), nevertheless 74.4 % of emergency physicians and 81.1 % of cardiologists do not always question chest pain patients about drug use. Of all responders, 73.6 % never perform toxicology screening. Most responders (60 %) observe patients with CACP according to the European Society of Cardiology ACS guideline, and 24.3 % give these patients ß-blockers. CONCLUSION The current practice for CACP patients in most emergency departments and coronary care units in the Netherlands is not in line with the AHA scientific statement. Emergency physicians and cardiologists should be advised to routinely question all chest pain patients on drug history and be aware that the risk stratifications scores are not validated for CACP. Despite the AHA scientific statement of 2008, many respondents utilize ß-blockers for CACP patients, which is supported by published evidence since the statement appeared.
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Affiliation(s)
- Femke M.J. Gresnigt
- Emergency Physician, Emergency Department, OLVG Hospital, Oosterpark 9, 1091AC, Amsterdam, the Netherlands
| | - Nanda P. Gubbels
- Emergency Medicine Resident, Emergency Department, OLVG Hospital, Oosterpark 9, 1091AC, Amsterdam, the Netherlands
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