Demographics of Acute Coronary Syndrome (ACS) Egyptian patients admitted to Assiut University Hospital: Validation of TIMI and GRACE scores

Impact of CYP2D6*2A, CYP2D6*4 and CYP3A5*3 genetic polymorphisms on Bisoprolol peak concentration and clinical response in acute coronary syndrome patients

AIMS

Acute coronary syndrome (ACS) represents a major cause of death. Bisoprolol is commonly used in the management of ACS. This study aims to investigate the impact of CYP2D6*2A, CYP2D6*4 and CYP3A5*3 genetic polymorphisms on pharmacokinetics and clinical response of bisoprolol in ACS patients.

METHODS

This is an open-label cohort study that included 127 ACS patients and studied the effect of CYP3A5*3, CYP2D6*2A and CYP2D6*4 genotyping using real-time polymerase chain reaction on steady state bisoprolol plasma peak concentration analysed by high performance liquid chromatography-fluorescence detector.

RESULTS

Regarding CYP3A5*3, the mean peak bisoprolol concentration for CC, CT and TT genotypes were 4.25 ± 1.20, 3.93 ± 1.10 and 1.79 ± 0.69 ng/mL, respectively (P < .001). Higher systolic (126 ± 5.47 mmHg), diastolic blood pressure (82 ± 2.73 mmHg) and heart rate (97.80 ± 3.03 beats/min) were also observed in CYP3A5*3 TT carriers (P < .05). In CYP2D6*2A, the peak concentration of bisoprolol was lower in CC carriers (3.54 ± 1 ng/mL) compared to GG (4.38 ± 1.25 ng/mL) and GC carriers (4.07 ± 1.29 ng/mL, P = .019). In CYP2D6*4, the mean bisoprolol peak concentration in CC carriers was 3.98 ± 1.31 ng/mL, which was lower than T allele carriers (4.5 ± 0.8, P = .02). No differences in heart rate, systolic, diastolic blood pressure or bisoprolol dose were observed among CYP2D6*2A or CYP2D6*4 variants. Smokers exhibited lower bisoprolol peak concentration (3.96 ± 1.2 ng/mL) compared to nonsmokers (4.55 ± 1.34 ng/mL, P = .037).

CONCLUSION

There is an association between CYP3A5*3, CYP2D6*4, CYP2D6*2A variants and bisoprolol peak concentration, which may serve as a guide in the future in choosing the optimum dose of bisoprolol in ACS patients.

In-hospital mortality from acute coronary syndrome in Africa: a systematic review and meta-analysis

Objective

There is an increasing recognition of the burden of cardiovascular disease in Africa. However, little is known about the pooled prevalence of acute coronary syndrome (ACS)-associated in-hospital mortality and contributing factors.

Methods

PubMed, Medline, Embase, Web of Science (Core Collection), and supplementary sources including Google Scholar, World Cat, Research Gate, and Cochrane Library were searched. Chi-square test and I ²-statistic were used to assess heterogeneity. Egger's and Begg's tests and funnel plots were used to assess publication bias. Data were analyzed using Stata software (version 15.0).

Result

Twenty nine studies with a total sample of 11,788 were included. The pooled estimate of all-cause in-hospital mortality was 22% (pooled proportion (PP) = 0.22; 95% confidence interval (CI): 0.17-0.27. The In-hospital mortality rate was lower at the cardiac centers (PP = 0.14; CI: 0.05-0.23) compared to referral hospitals (PP = 0.24; CI: 0.17-0.31]) The mortality rate was comparable in Eastern (PP = 0.23; CI: 0.19-0.27) and Northern Africa (PP = 0.22; CI: 0.16-0.28). The incidence of in-hospital heart failure, cardiogenic shock, arrhythmia, bleeding, acute stroke, and reinfarction were 42, 17.0, 20.0, 16.0, 4.0, and 5.0%, respectively.

Conclusion

All-cause in-hospital mortality rate associated with ACS is high in Africa. The mortality rate at cardiac centers was 10% lower when compared with referral hospitals. Establishing coronary units, strengthening existing cardiac services, and improving availability and access to cardiovascular medicines could help in reducing the burden of ACS in the continent.

Presentation, management, and outcomes of STEMI in Egypt: results from the European Society of Cardiology Registry on ST elevation myocardial infarction

Background

Apart from few small single-center studies, there are limited data about STEMI patients in Egypt. Nineteen Egyptian centers (with and without PCI facilities) participated in this registry with 1356 patients who were compared to 7420 patients from other ESC countries. The aims of this study were to describe the characteristics of patients with STEMI, to assess STEMI management patterns particularly the current use of reperfusion therapies, to evaluate the organization of STEMI networks across Egypt, to evaluate in-hospital patient outcome, and to compare Egyptian patients with other ESC countries.

Results

Compared to other ESC countries, Egyptian patients were younger (mean age 55.4 ± 11.3 vs. 62.9 ± 12.4; p < 0.001 and 4.36% vs. 19.41%% were ≥ 75 years old; p < 0.001) with fewer females (18.44% vs. 25.63%; p < 0.001). Egypt had longer median time between symptoms onset and first medical contact: 120.0 (60.0; 240.0) vs.100.0 (50.0; 240.0) p < 0.001. Self-presentation rather than EMS presentation was the mode of admission in 86.06% in Egypt vs. 25.83% in EU countries (p < 0.001). On qualifying ECG, anterior STEMI was in 57.08% in Egypt vs. 45.98% in other countries (p < 0.001). Initial reperfusion therapy was 49.12%, 43.07%, and 7.26% for primary PCI, thrombolytic therapy and no reperfusion in Egypt vs. 85.42%, 7.26%, and 7.82% for EU countries, respectively. In-hospital mortality was 4.65% in Egypt vs. 3.50% in other countries p 0.040 and was 18.87% in no reperfusion vs. 2.10% in primary PCI vs. 4.97% in thrombolysis (p < 0.001) among Egyptians. Patients were discharged on aspirin in 98.61%, clopidogrel in 91.07%, ticagrelor in 7.31%, DAPT in 97.69%, beta blockers in 82.83%, ACE inhibitors in 84.76%, MRAs in 10.01%, and statins in 99.77%.

Conclusion

Compared to other ESC countries, Egyptian STEMI patients were younger, more frequently current smokers and diabetics, and had longer time between symptoms onset and first medical contact with more self-presentation rather than EMS presentation. Thrombolytic therapy is still a common reperfusion therapy in Egypt while primary PCI was offered to half of the patients. In-hospital mortality was significantly higher in Egypt and was highest among no reperfusion patients and lowest among PPCI patients.

[Evolution profiles of acute coronary syndromes and GRACE, TIMI and SRI risk scores in Burkina Faso. A monocentric study of 111 patients]

OBJECTIVES

The aims of this study was to assess evolution profile of acute coronary syndrome (ACS) based on risk level by GRACE, TIMI and SRI scores in the cardiology department, Yalgado Ouedraogo university hospital.

PATIENTS AND METHODS

This was a prospective study of 111 consecutive patients admitted for ACS (mean age 57.61 years, 77.5% male) between January 1st and 2010 to May 31st 2015 in the department of cardiology. For each patient, risk scores were calculated and they were divided into risk group. Global survival at one month was described by Kaplan Meier method and prognostic factors were analyzed by multivariable Cox regression.

RESULTS

The prevalence of ACS was 4.2%. Patients were admitted for ST-elevation ACS and non-ST-elevation ACS in 88.3% and 11.7%, respectively. Nineteen patients (17.1%) were admitted before the 12th hour. Hospital mortality was 8.1% and increased to 16.2% in one month. After risk stratification, one-month survival of patients with high risk, was shorter than patients at low-risk regardless of the score GRACE (log-rank=9.93, P=0.007), TIMI (log-rank=14.91, P=0.001) and SRI (log-rank=10.01, P=0.006). GRACE score (HR=1.01; P=0.002), TIMI (HR=1.33; P=0.01) and SRI (HR=1.02; P=0.01) were major prognostic factors for overall survival.

CONCLUSION

ACS remains a serious disease with high morbidity and mortality in the days following the initial accident. These risk scores are applicable tools in Burkina Faso as evidenced statistic C (GRACE=0.75, TIMI=0.78 and SRI=0.74).