Clinical effects of hypertension on the mortality of patients with acute myocardial infarction

Recognition of Early Cardiovascular Disease Symptoms in Hypertensive and Dyslipidemic Individuals of Icheon, Korea: Insights into Educational Levels and Health Literacy

The study aimed to explore the relationship between the presence of hypertension or dyslipidemia and the recognition of early symptoms of cardiovascular diseases (CVD), particularly acute myocardial infarction (AMI) and stroke. It is crucial for individuals with hypertension or dyslipidemia to recognize early symptoms of AMI and stroke, as timely and appropriate intervention can lead to favorable health outcomes. The study enrolled 104 participants aged 19 and above who are current residents of the Icheon region, Gyeonggi, Korea. The assessment of early symptoms of AMI and stroke utilized adapted items from the Korea Community Health Survey. In consideration of health literacy and education attainment, logistic regression analyses were conducted. While there was no significant association between hypertension and awareness of AMI or stoke symptoms, individuals with dyslipidemia demonstrated enhanced recognition of specific AMI symptoms, such as 'sudden chest pain or pressure' and 'sudden feeling of breathlessness'. No significant associations were observed between hypertension or dyslipidemia and awareness of stroke symptoms. The study emphasized the significance of targeted health education programs for individuals with chronic conditions to enhance their awareness of early symptoms of AMI and stroke.

Effect of Antecedent Hypertension on Mortality After Acute Coronary Syndromes in the Coronary Intervention Era: A Meta-analysis

BACKGROUND

The effect of antecedent hypertension on mortality after acute coronary syndromes (ACS) in the percutaneous coronary intervention era is unclear. Therefore, this meta-analysis aimed to assess the effect of antecedent hypertension on short-term and long-term mortality after ACS in the coronary intervention era.

METHODS

PubMed, Medline, EMBASE, and the Cochrane library were systematically searched up to July 2023. Ten studies with a total of 64,989 of patients met the inclusion criteria. The outcomes of interest were all-cause in-hospital mortality and long-term all-cause mortality.

RESULTS

No significant difference was observed in in-hospital mortality between the antecedent hypertension and non-antecedent hypertension groups in the ACS patients (pooled OR 1.07; 95% CI 0.79-1.45; I2=82%), which was the same as the ST elevation myocardial infarction group (pooled OR 1.01; 95% CI 0.73-1.39; I2=66%). However, the result was statistically significant for non-ST elevation myocardial infarction patients (pooled OR 0.67; 95% CI 0.55-0.82; p=0.0001; I2=0%). Antecedent hypertension was related to increased long-term mortality in patients with ACS (pooled OR 1.28; 95% CI 1.16-1.40; p=0.0001; I2=0%), which was the same as the ST elevation myocardial infarction subgroup.

CONCLUSION

In the percutaneous coronary intervention era, antecedent hypertension is associated with higher long-term mortality in ACS patients. This meta-analysis found no significant difference in in-hospital mortality between the hypertension and non-hypertension groups. However, antecedent hypertension may be a protective factor related to in-hospital mortality for non-ST elevation myocardial infarction patients.

Association of Admission Systolic Blood Pressure on long-Term Outcomes after ST-Segment Elevation Myocardial Infarction

INTRODUCTION

Hypertension is widely known as a significant factor in the development of cardiovascular diseases. However, there is increasing interest in the potential link between low admission systolic blood pressure (SBP) and higher mortality rates. Therefore, this study aimed to investigate the relationship between admission SBP and the probability of one-year mortality in patients with ST-segment elevation myocardial infarction (STEMI).

METHOD

This study, which used data from registries, focused on patients diagnosed with STEMI between July 2018 and December 2019. The patients were divided into three groups based on their admission SBP: normal (< 112 mm Hg), elevated (112-140 mm Hg), and hypertension (≥140 mm Hg), and were followed for one year. The researchers used Cox proportional models to analyze the data, which allowed them to estimate crude and fully adjusted hazard ratios, along with their corresponding 95% confidence intervals (HR, 95% CI).

RESULTS

This study, which included 1159 patients with a mean age of 60.71±12.19, 914 (78.86%) were male, and 108 (9.32%) died within one year. Among the patients, 276 had a normal admission SBP, 338 had elevated SBP, and 545 had hypertension. Those with hypertension had a higher-risk profile, including factors such as hyperlipidemia, BMI, LDL levels, anterior myocardial infarction, and a higher prevalence of females. The crude and fully adjusted hazard ratios (HR) for the relationship between elevated admission SBP and mortality were calculated as 0.36 (95% CI: 0.23-0.56) and 0.43 (95% CI: 0.23-0.81), respectively.

CONCLUSION

The study's findings indicate a connection between increased admission SBP and a decreased probability of one-year mortality among patients with STEMI. Unlike the general population, where there is a direct linear correlation between SBP and the risk of future cardiovascular events, this research demonstrates an inverse relationship between SBP and one-year mortality.

Impact of the caFFR-Guided Functional SYNTAX Score on Ventricular Tachycardia/Fibrillation Development in Patients With Acute Myocardial Infarction

Aims

To explore the relationship between the severity of coronary artery disease (CAD) and the occurrence of ventricular tachycardia/ventricular fibrillation (VT/VF) in patients with acute myocardial infarction (AMI).

Methods

We retrospectively enrolled 705 patients with AMI, who were hospitalized and underwent percutaneous coronary intervention (PCI), in Nanfang Hospital from July 2017 to July 2020. Logistic regression analysis and backward stepwise approach were taken to select the correlation factors. The left and the receiver operating characteristic curves (ROC) analysis were plotted to observe the discriminative power of the SYNTAX score (SS)/caFFR-guided functional SS (FSS_caFFR) on the incident VT/VF.

Results

About 58 (8.2%) patients experienced life-threatening VT/VF. The FSS_caFFR (OR: 1.155; 95% CI: 1.047 to 1.273; p = 0.004) was an independent predictor of VT/VF after AMI. The ROC analysis showed that the discriminative power of FSS_caFFR on the incident VT/VF was significantly better than SS (0.759 vs.0.695, p < 0.0001). Patients with VT/VF were categorized into 2 groups according to the interval between the onset of AMI and the VT/VF. The logistic regression analysis revealed that FSS_caFFR was a significant independent correlation of early- and late-VT/VF.

Conclusion

The incident VT/VF in patients with AMI is closely associated with the severity of CAD evaluated by SS and FSS_caFFR. Compared to SS, FSS_caFFR has a higher correlation with VT/VF, and FSS_caFFR was demonstrated to be an independent correlation factor of incident VT/VF after AMI.

Impact of the Main Cardiovascular Risk Factors on Plasma Extracellular Vesicles and Their Influence on the Heart's Vulnerability to Ischemia-Reperfusion Injury

The majority of cardiovascular deaths are associated with acute coronary syndrome, especially ST-elevation myocardial infarction. Therapeutic reperfusion alone can contribute up to 40 percent of total infarct size following coronary artery occlusion, which is called ischemia-reperfusion injury (IRI). Its size depends on many factors, including the main risk factors of cardiovascular mortality, such as age, sex, systolic blood pressure, smoking, and total cholesterol level as well as obesity, diabetes, and physical effort. Extracellular vesicles (EVs) are membrane-coated particles released by every type of cell, which can carry content that affects the functioning of other tissues. Their role is essential in the communication between healthy and dysfunctional cells. In this article, data on the variability of the content of EVs in patients with the most prevalent cardiovascular risk factors is presented, and their influence on IRI is discussed.

Evaluation of the tolerability and effectiveness of Tenecteplase in patients with ST-Segment-Elevation Myocardial Infarction in a Secondary Hospital in Malaysia: A Retrospective Case Series

Background

In Malaysia, knowledge regarding the clinical efficacy of tenecteplase (TNK), a fibrin-specific tissue-plasminogen activator, is limited.

Objectives

To evaluate the effectiveness and tolerability of TNK in patients with ST-segment-elevation myocardial infarction in a secondary referral Malaysian hospital.

Methods

This was a single-center retrospective case series based on the medical records of patients with ST-segment-elevation myocardial infarction admitted to the cardiac care unit between January 2016 and May 2019. Data regarding the mortality status and date of death were collected from the database of the National Registration Department of Malaysia.

Results

Data for 30 patients with ST-segment-elevation myocardial infarction, who received weight-adjusted doses of TNK, were analyzed. The patients’ mean (SD) age was 62 (14) years, and 77% were men. The median time to treatment was 265 minutes (interquartile range = 228–660 minutes), and the clinical success rate of thrombolysis was 79%. The overall all-cause in-hospital mortality rate was 33%. The 1-year survival rates were higher in patients achieving a time to treatment ≤360 minutes (P = 0.03), with a trend toward greater survival in this group at 30 days. Similarly, a trend toward lower in-hospital all-cause mortality was observed in this group (21% vs 50%; P = 0.12). Only 1 patient (3%), who had a HAS-BLED score based on hypertension, abnormal liver/renal function, stroke history, bleeding history or predisposition, labile international normalized ratio, old age, drug/alcohol use of 5, developed major bleeding that required blood transfusion. No cases of ischemic stroke, nonmajor bleeding, in-hospital reinfarction, or TNK-induced allergic reaction were identified.

Conclusions

We hypothesized that the mortality-related outcomes of TNK in patients with ST-segment-elevation myocardial infarction were influenced by TTT, with TTT ≤360 minutes indicating a better prognosis than TTT >360 minutes. TNK-induced bleeding-related complications were minimal in low-risk patients. Further local studies are needed to compare TNK's profile with that of streptokinase, which is a common agent currently used in clinical practice in Malaysian public hospitals. (Curr Ther Res Clin Exp. 2021; 82:XXX–XXX)

Estimating the Cutoff Points of Time-Dependent Risk Factors by Using Joint Modeling of Longitudinal and Time-to-Event Data: A 14-Year Follow-up Study-Tehran Lipid and Glucose Study

Diagnostic accuracy and optimal cutoff points of risk factors is one of the important issues in medical decisions. In order to reassess the cutoff points of markers, longitudinal and time-to-event data of elderly individuals were collected repeatedly through 3 follow-up stages in the Tehran Lipid and Glucose Study. Time-dependent area under the ROC (receiver operating characteristic) curves (AUCs) based on the joint modeling of longitudinal and time-to-event data technique were measured. AUCs were considered to evaluate the discriminative potential of the models. The joint model produced higher AUC values than the Cox model; therefore, accuracy was improved although it is computationally complicated. The results had some differences with the thresholds reported in guidelines due to specificity to the population and/or the means of estimation methods. The estimated cutoff points with regard to sex can be used as a guideline for the Iranian elderly population.

Blood Pressure Targets and Clinical Outcomes in Patients with Acute Myocardial Infarction

BACKGROUND AND OBJECTIVES

The optimal blood pressure (BP) target in patients with a history of acute myocardial infarction (MI) remains as a subject of debate. The 'J curve phenomenon' has been suggested as a target for BP control, however, it is unclear whether this phenomenon can be applied to MI patients. We analyzed patients with acute MI and investigated whether the 'J curve phenomenon' exists in this population.

SUBJECTS AND METHODS

Data were obtained from a nationwide prospective Korea Acute Myocardial Infarction Registry, which included 10337 patients with acute MI who underwent percutaneous coronary intervention (PCI) between 2011 and 2014. The patients were divided into quintiles according to systolic blood pressure (SBP) and diastolic blood pressure (DBP), which were measured during a two-year clinical follow up. Two-year cumulative incidence of major adverse cardiac events (MACE) was analyzed among the groups.

RESULTS

MACE was defined as a composite of cardiac death, need for recurrent revascularization (repeated PCI or coronary arterial bypass graft due to recurrent anginal symptoms or reoccurrence of MI), ischemic cerebrovascular accident, and need for hospitalization due to heart failure. During the two-year follow up, the total cumulative incidence of MACE was 9.7% (n=1005). BP-MACE analysis showed a U-shaped curve for both SBP and DBP, with the lowest MACE rate in quintiles with an average SBP of 112.2 mmHg and DBP of 73.3 mmHg. On Cox regression analysis, the U-shaped relation was statistically significant.

CONCLUSION

In patients with acute MI, a 'U curve phenomenon' was observed when assessing patient BP control versus MACE rate.

Integrated ST Segment Elevation Scores and In-hospital Mortality in STEMI Patients Undergoing Primary PCI

The objective of this study was to study the integrated score of ST-segment resolution (ISSTE) and in-hospital death in patients undergoing primary percutaneous intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI).

Material and Methods: This prospective study included 586 consecutive patients admitted with STEMI to the Cardiology Clinic of the County Emergency Clinical Hospital of Tîrgu Mureș, between January 1st, 2013 and December 31, 2014, who underwent pPCI in less than twelve hours after the onset of symptoms. Clinical and demographic data were analyzed in 539 (91.9%) survivors (Group 1) and 47 (8.1%) nonsurvivors (Group 2). The Integrated Score of ST elevation (ISSTE) was calculated by summing the amplitude of the ST segment elevation in all the 12 leads, before and at 2 hours after revascularization.

Results: The ISSTE score calculated at baseline, immediately before the primary percutaneous coronary intervention, was significantly higher in Group 2 as compared to Group 1 (13.9 ± 1.2 vs. 11.0 ± 0.2, p = 0.026). At the same time, the ISSTE score calculated at 2 hours after the coronary intervention was significantly higher for patients in Group 2 (7.36 ± 1.12 vs. 2.9 ± 0.1, p <0.0001). Analysis of the dynamics of the ISSTE score indicated that patients who survived presented a more expressed reduction in the ISSTE score following pPCI, as compared to those who subsequently died (73.5% reduction in Group 1 compared to 47.2% reduction in Group 2, p <0.0001). In-hospital mortality was significantly higher in the group of patients with >50% reduction in the ISSTE score. The in-hospital death rate was 5.4% in patients with >50% reduction in the ISSTE score, compared to 19.4% for those who presented less than 50% reduction in the ISSTE score following pPCI (p <0.0001). The rate of successful reperfusion rate, expressed by the reduction in ISSTE score, was 83.8% in Group 1, compared to 55.3% in Group 2 (p <0.0001), indicating that the absence of an efficient reperfusion after pPCI is associated with a higher mortality in STEMI patients, and could be evaluated using regression of the ISSTE score, which proved to be directly associated with mortality.

Conclusion: The ISSTE score is shown to be an effective ECG-derived marker of myocardial damage in STEMI patients. A high ISSTE score is associated with higher mortality, while a reduction in the ISSTE score after pPCI may indicate an efficient reperfusion and a decrease in mortality in the first days after infarction.

Morbidity and mortality risk among patients with screening-detected severe hypertension in the Malmö Preventive Project

OBJECTIVE

Screening of hypertension has been advocated for early detection and treatment. Severe hypertension (grade 3 hypertension) is a strong predictor for cardiovascular disease. This study aimed to evaluate not only the risk factors for developing severe hypertension, but also the prospective morbidity and mortality risk associated with severe hypertension in a population-based screening and intervention programme.

RESEARCH DESIGN AND METHODS

In all, 18,200 individuals from a population-based cohort underwent a baseline examination in 1972-1992 and were re-examined in 2002-2006 in Malmö, Sweden. In total, 300 (1.6%) patients with severe hypertension were identified at re-examination, and predictive risk factors from baseline were calculated. Total and cause-specific morbidity and mortality were followed in national registers in all severe hypertension patients, as well as in age and sex-matched normotensive controls. Cox analyses for hazard ratios were used.

RESULTS

Men developing severe hypertension differed from matched controls in baseline variables associated with the metabolic syndrome, as well as paternal history of hypertension (P < 0.001). Women with later severe hypertension were characterized by elevated BMI and a positive maternal history for hypertension at baseline. The risk of mortality, coronary events, stroke and diabetes during follow-up was higher among severe hypertension patients compared to controls. For coronary events, the risk remained elevated adjusted for other risk factors [hazard ratio 2.31, 95% confidence interval (CI) 1.22-4.40, P = 0.011].

CONCLUSION

Family history and variables associated with metabolic syndrome are predictors for severe hypertension after a long-term follow-up. Severe hypertension is associated with increased mortality, cardiovascular morbidity and incident diabetes in spite of treatment. This calls for improved risk factor control in patients with severe hypertension.

Impact of Admission Systolic Blood Pressure and Antecedent Hypertension on Short-Term Outcomes After ST-Segment Elevation Myocardial Infarction: Strobe-Compliant Article

We evaluated the combined effect of admission systolic blood pressure (SBP) and antecedent hypertension on short-term outcomes in patients with ST-segment elevation myocardial infarction (STEMI). Data were derived from a multicenter survey of 7303 consecutive patients with STEMI. Patients were divided into 4 groups according to different blood pressure status: high SBP without hypertension, high SBP with hypertension, low SBP without hypertension, and low SBP with hypertension. The primary endpoints were 7 and 30-day all-cause mortality. The prevalence of hypertension was 40.7%, and the best cutoff of admission SBP for predicting 30-day mortality was 108 mmHg by receiver-operating characteristic curve. Patients with hypertension were older, more often female, also had longer onset-to-admission time, more comorbidities, and higher Killip class. Patients with both low SBP (≤108 mmHg) and hypertension group had significantly higher 7 and 30-day mortality than those in other groups (all P < 0.001). After multivariate adjustment, low SBP with hypertension group was still an independent risk factor for predicting 7-day mortality (hazard ratios [HR] 1.86, 95% confidence interval [CI] 1.41-2.46; P < 0.001) and 30-day mortality (HR 1.88, 95% CI 1.46-2.43; P < 0.001). In patients with SBP > 108 mmHg, a history of hypertension could increase the risk of 30-day mortality by 27% (HR 1.00 vs 1.27, P = 0.012), while in patients with SBP ≤ 108 mmHg, this increased risk reached to 37% (HR 1.51 vs 1.88, P < 0.001). In conclusion, low admission SBP was the relatively dominant contributor for predicting 7 and 30-day all-cause mortality, and a concurrent antecedent hypertension increased the corresponding risk of mortality.

Systolic hypertension: an increasing clinical challenge in Asia

Systolic hypertension, the predominant form of hypertension in patients aged over 50-60 years, is a growing health issue as the Asian population ages. Elevated systolic blood pressure is mainly caused by arterial stiffening, resulting from age-related vascular changes. Elevated systolic pressure increases the risk of cardiovascular disease, mortality and renal function decline, and this risk may increase at lower systolic pressure levels in Asian than Western subjects. Hence, effective systolic pressure lowering is particularly important in Asians yet blood pressure control remains inadequate despite the availability of numerous antihypertensive medications. Reasons for poor blood pressure control include low awareness of hypertension among health-care professionals and patients, under-treatment, and tolerability problems with antihypertensive drugs. Current antihypertensive treatments also lack effects on the underlying vascular pathology of systolic hypertension, so novel drugs that address the pathophysiology of arterial stiffening are needed for optimal management of systolic hypertension and its cardiovascular complications.

Impact of hypertension on postreperfusion left ventricular recovery in patients with ST-segment elevation myocardial infarction and multivessel coronary artery disease

OBJECTIVE

The aim of this study was to investigate the impact of admission systolic blood pressure (ASBP) and left ventricular (LV) mass on the postreperfusion LV recovery in patients with ST-segment elevation myocardial infarction (STEMI) and concomitant coronary multivessel disease (MVD).

MATERIALS AND METHODS

A retrospective analysis of 12-month postreperfusion LV recovery was performed in 104 patients after primary percutaneous coronary intervention (PPCI). Patients with elevated ASBP (>140mmHg) were assigned to the first group (n=58); with normal ASBP (<140mmHg), to the second group (n=46); with increased myocardial mass index (MMI) (>100g/m(2)), to the third group (n=70); and with normal MMI (<100g/m(2)), to the fourth group (n=34). Severity of MVD was evaluated by the Syntax score. The LV recovery was assessed by evolution of quantitative characteristics of electrocardiography (QRS score, ST score, ECG STEMI stage) and echocardiography (LV ejection fraction, volume and mass indices) registered before and after PPCI, at discharge, and after 1, 6, and 12 months.

RESULTS

There were no significant differences in the baseline QRS and ST scores, ECG STEMI stage, LVEF, MMI, and Syntax score comparing all the patients' groups. The serial ECG criteria showed only a very small impact of ASBP on postreperfusion LV recovery. Only ECG STEMI stage progression was slower in the patients with elevated ASBP. In patients with different MMI, the QRS and ST scores were higher and ECG STEMI stage was lower in patients with increased MMI. LVEF after 1 year was significantly lower in the third group as compared to the fourth group (42.58%±8.25% vs. 46.8%±7.13%, P=0.018).

CONCLUSION

Postreperfusion LV recovery was more related not to ASBP but to the increased LV mass assessed by echocardiography in patients with STEMI and MVD.

Current trend of acute myocardial infarction in Korea (from the Korea Acute Myocardial Infarction Registry from 2006 to 2013)

Although the incidence of acute myocardial infarction (AMI) in Korea has been rapidly changed because of westernization of diet, lifestyle, and aging of the population, the recent trend of the myocardial infarction have not been reported by classification. We investigated recent trends in the incidence and mortality associated with the 2 major types of AMI. We reviewed 39,978 patients registered in the Korea Acute Myocardial Infarction Registry for either ST-segment elevation acute myocardial infarction (STEMI) or non-ST-segment elevation acute myocardial infarction (NSTEMI) from 2006 to 2013. When the rate for AMI were investigated according to each year, the incidence rates of STEMI decreased markedly from 60.5% in 2006 to 48.1% in 2013 (p <0.001). In contrast, a gradual increase in the incidence rates of NSTEMI was observed from 39.5% in 2006 to 51.9% in 2013 (p <0.001). As risk factors, hypertension, diabetes mellitus, and dyslipidemia were much more common in patients with NSTEMI than STEMI. Among medical treatments, the use of β blockers, angiotensin receptor blocker, and statin were increased from 2006 to 2013 in patients with STEMI and NSTEMI. Patients with STEMI and NSTEMI were more inclined to be increasingly treated by invasive treatments with percutaneous coronary intervention. In conclusion, this study demonstrated that the trend of myocardial infarction has been changed rapidly in the aspect of risk factors, ratio of STEMI versus NSTEMI, and therapeutic strategies during the recent 8 years in Korea.

The scientific achievements of the decades in Korean Acute Myocardial Infarction Registry

The Korea Acute Myocardial Infarction Registry (KAMIR) was the first nationwide registry data collection designed to track outcomes of patients with acute myocardial infarction (AMI). These studies reflect the current therapeutic approaches and management for AMI in Korea. The results of KAMIR could help clinicians to predict the prognosis of their patients and identify better diagnostic and treatment tools to improve the quality of care. The KAMIR score was proposed to be a predictor of the prognosis of AMI patients. Triple antiplatelet therapy, consisting of aspirin, clopidogrel and cilostazol, was effective at preventing major adverse clinical outcomes. Drug-eluting stents were effective and safe in AMI patients with no increased risk of stent thrombosis. Statin therapy was effective in Korean AMI patients, including those with very low levels of low density cholesterol. The present review summarizes the 10-year scientific achievements of KAMIR from admission to outpatient care during long-term clinical follow-up.

Hypertension and acute myocardial infarction: an overview

History of hypertension is a frequent finding in patients with acute myocardial infarction (AMI) and its recurring association with female sex, diabetes, older age, less frequent smoking and more frequent vascular comorbidities composes a risk profile quite distinctive from the normotensive ischemic counterpart.Antecedent hypertension associates with higher rates of death and morbid events both during the early and long-term course of AMI, particularly if complicated by left ventricular dysfunction and/or congestive heart failure. Renin-angiotensin-aldosterone system blockade, through either angiotensin-converting enzyme inhibition, angiotensin II receptor blockade or aldosterone antagonism, exerts particular benefits in that high-risk hypertensive subgroup.In contrast to the negative implications carried by antecedent hypertension, higher systolic pressure at the onset of chest pain associates with lower mortality within 1 year from coronary occlusion, whereas increased blood pressure recorded after hemodynamic stabilization from the acute ischemic event bears inconsistent relationships with recurring coronary events in the long-term follow-up.Whether antihypertensive treatment in post-AMI hypertensive patients prevents ischemic relapses is uncertain. As a matter of fact, excessive diastolic pressure drops may jeopardize coronary perfusion and predispose to new acute coronary events, although the precise cause-effect mechanisms underlying this phenomenon need further evaluation.

The impact of hypertension on patients with acute coronary syndromes

Arterial chronic hypertension (HTN) is a well-known cardiovascular risk factor for development of atherosclerosis. In order to explain the relation between HTN and acute coronary syndromes the following factors should be considered: (1) risk factors are shared by the diseases, such as genetic risk, insulin resistance, sympathetic hyperactivity, and vasoactive substances (i.e., angiotensin II); (2) hypertension is associated with the development of atherosclerosis (which in turn contributes to progression of myocardial infarction). From all the registries and the data available up to now, hypertensive patients with ACS are more likely to be older, female, of nonwhite ethnicity, and having a higher prevalence of comorbidities. Data on the prognostic role of a preexisting hypertensive state in ACS patients are so far contrasting. The aim of the present paper is to focus on hypertensive patients with ACS, in order to better elucidate whether these patients are at higher risk and deserve a tailored approach for management and followup.

The impact of generic form of Clopidogrel on cardiovascular events in patients with coronary artery stent: results of the OPCES study

BACKGROUND

To compare the early and late cardiovascular events as well as side effects of Osvix, a generic form of Clopidogrel versus Plavix regimens in patients with chronic stable angina, undergoing bare metal stent (BMS) or drug eluting stent (DES) placement, this study was carried out.

METHODS

A total of 442 patients with chronic stable angina who were scheduled for elective percutaneous coronary intervention (PCI) were included in a randomized, double blind, multi-centric clinical trial being performed in 6 distinct university hospitals in 5 cities of Iran from March 2007 to November 2009. Baseline, demographic and history of risk factors were recorded using the patients' medical charts. Stenting procedure was performed via transfemoral approach using low osmolar contrast agents. Patients underwent BMS or DES placements based on the physician selection and were randomly assigned to Osvix or Plavix groups. Patients were followed by telephone in 0 and 6 months intervals regarding the major adverse cardiovascular events (MACE) including death, myocardial infarction, in-stent thrombosis, stroke, target lesion revascularization, and target vascular revascularization. Angina episodes, bleeding, liver enzymes, neutrophils and platelets count were also assessed in these intervals.

RESULTS

There was not any significant difference between these two groups regarding the baseline characteristics. In the DES group, the 6-month mortality rate and the incidence of MACE in Osvix and Plavix groups were 0.9% and 1.9% (p = 0.61) and 1.8% and 4.9% (p = 0.26), respectively. During the follow up period after DES or BMS placement, there wasn't any significant difference regarding neutrophil and platelet counts or liver enzymes between study groups.

CONCLUSIONS

Using Osvix and Plavix are followed by similar major cardiovascular events and side-effect profile in patients undergoing PCI.

The prevalence and outcome of hypertension in patients with acute coronary syndrome in six Middle-Eastern countries

AIMS

The aim was to report the prevalence and significance of hypertension (HTN) in patients with acute coronary syndrome (ACS).

METHODS AND MAJOR FINDINGS

Over a 6-month period in 2007, 8171 consecutive patients (49.4% hypertensive and 50.6% non-hypertensive) presenting with ACS were enrolled in a prospective, multicenter study from six Middle Eastern adjacent countries. Patients with HTN were older (59.2 vs 53.1 years, p<0.001), and more likely to be female (34% vs 14.4%, p<0.001) when compared with patients without HTN. Patients with HTN were also more likely to have diabetes mellitus, hyperlipidemia, cerebrovascular disease, prior history of coronary artery disease, peripheral artery disease but less likely to be cigarette smokers. At admission, HTN patients had higher Killip class, heart rate and GRACE risk scoring. In-hospital mortality was higher in hypertensive patients with ST-elevation myocardial infarction (STEMI) but not in patients with non-STEMI or unstable angina. The incidence of heart failure complications was significantly higher among patients with HTN in overall ACS type (OR = 1.2, 95% CI 1.001-1.338, p= 0.04).

MAIN CONCLUSION

In this large cohort of patients with ACS, HTN was an independent predictor of heart failure and was associated with an increased rate of in-hospital mortality in STEMI only.