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Alsanosy R, Mahfouz MS, Arishi AM, Abdelwahab SI, Taha M, Albasheer O, Daghriri HM, Majrashi KA, Farasani A, Altraifi AAA, Medani IE, Hakami N. Risk of acute coronary syndrome and relationship with the use of khat and tobacco products in the Jazan region, Saudi Arabia: A prospective case-control study. Tob Induc Dis 2024; 22:TID-22-125. [PMID: 38978613 PMCID: PMC11229089 DOI: 10.18332/tid/189950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 06/11/2024] [Accepted: 06/14/2024] [Indexed: 07/10/2024] Open
Abstract
INTRODUCTION Previous studies have identified several risk factors for acute coronary syndrome (ACS). This study was intended to examine the potential risk of ACS associated with khat and tobacco use. METHODS A case-control study of 344 people (172 cases and 172 controls) was conducted at Prince Mohammed Bin Nasser Hospital in Jazan, Saudi Arabia, from April to September 2019. The cases and controls were matched for age (±5 years) and gender. Data were analyzed using descriptive, inferential, and modeling analyses. We utilized the adjusted odds ratio (AOR) to express the results. RESULTS The prevalence of ever khat chewing among all study participants was 29.1%, significantly higher for the cases with ACS than for the control group (43.6% vs 14.5%, p<0.001). Cigarette smokers accounted for 33.4% of the study participants, and 22.1% were ACS cases, which is a significantly higher percentage than the control group. The prevalence of smokeless tobacco was 20.3% among ACS cases and 14.5% among controls, with no statistically significant differences (p>0.05). In the final model, tobacco use was more likely to be reported among cases with myocardial infarction (MI) (AOR=4.58; 95% CI: 1.01-4.73, p<0.05) as was khat chewing (AOR=3.4; 95% CI: 1.55-7.46, p<0.05), after controlling for other traditional risk factors. CONCLUSIONS Khat chewing was reported more by those who reported ACS. ACS cases were more likely to be frequent khat users with chewing sessions of five or more days per week. Regular tobacco use was also reported in those who reported ACS, and this increases with the amount of tobacco used. Implementing early intervention strategies can help mitigate the impact of khat chewing and smoking on the development of ACS.
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Affiliation(s)
- Rashad Alsanosy
- Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Mohamed Salih Mahfouz
- Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | | | | | - Manal Taha
- Health Research Centre, Jazan University, Jazan, Saudi Arabia
| | - Osama Albasheer
- Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | | | | | - Abdullah Farasani
- Department of Medical Laboratory Technology, College of Applied Medical Science, Jazan University, Jazan, Saudi Arabia
| | - Ahmed A A Altraifi
- Obstetrics and Gynecology Department, College of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Isameldin E Medani
- Obstetrics and Gynecology Department, College of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Nasser Hakami
- Surgical Department, College of Medicine, Jazan University, Jazan, Saudi Arabia
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Jian M, Sun X, Li S, Wang H, Zhang H, Li X, He Y, Wang Z. Quantitative Detection of Multiple Cardiovascular Biomarkers by an Antibody Microarray-Based Metal-Enhanced Fluorescence Assay. Anal Chem 2024; 96:7353-7359. [PMID: 38690857 DOI: 10.1021/acs.analchem.4c00266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
Accurate detection of multiple cardiovascular biomarkers is crucial for the timely screening of acute coronary syndrome (ACS) and differential diagnosis from acute aortic syndrome (AAS). Herein, an antibody microarray-based metal-enhanced fluorescence assay (AMMEFA) has been developed to quantitatively detect 7 cardiovascular biomarkers through the formation of a sandwich immunoassay on the poly(glycidyl methacrylate-co-2-hydroxyethyl methacrylate)-decorated GNR-modified slide (GNR@P(GMA-HEMA) slide). The AMMEFA exhibits high specificity and sensitivity, the linear ranges span 5 orders of magnitude, and the limits of detection (LODs) of cardiac troponin I (cTnI), heart-type fatty acid binding protein (H-FABP), C-reactive protein (CRP), copeptin, myoglobin, D-Dimer, and N-terminal pro-brain natriuretic peptide (NT-proBNP) reach 0.07, 0.2, 65.7, 0.6, 0.2, 8.3, and 0.3 pg mL-1, respectively. To demonstrate its practicability, the AMMEFA has been applied to quantitatively analyze 7 cardiovascular biomarkers in 140 clinical plasma samples. In addition, the expression levels of cardiovascular biomarkers were analyzed by the least absolute shrinkage and selector operator (LASSO) regression, and the area under receiver operator characteristic curves (AUCs) of healthy donors (HDs), ACS patients, and AAS patients are 0.99, 0.98, and 0.97, respectively.
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Affiliation(s)
- Minghong Jian
- State Key Laboratory of Electroanalytical Chemistry, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, 130022, P. R. China
| | - Xudong Sun
- State Key Laboratory of Electroanalytical Chemistry, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, 130022, P. R. China
- School of Applied Chemistry and Engineering, University of Science and Technology of China, Hefei, 230026, P. R. China
| | - Shasha Li
- State Key Laboratory of Electroanalytical Chemistry, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, 130022, P. R. China
- School of Applied Chemistry and Engineering, University of Science and Technology of China, Hefei, 230026, P. R. China
| | - Haodong Wang
- Department of Cardiovascular, The China-Japan Union Hospital of Jilin University, Changchun 130033, China
| | - Hua Zhang
- State Key Laboratory of Electroanalytical Chemistry, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, 130022, P. R. China
| | - Xiaotong Li
- State Key Laboratory of Electroanalytical Chemistry, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, 130022, P. R. China
- School of Applied Chemistry and Engineering, University of Science and Technology of China, Hefei, 230026, P. R. China
| | - Yuquan He
- Department of Cardiovascular, The China-Japan Union Hospital of Jilin University, Changchun 130033, China
| | - Zhenxin Wang
- State Key Laboratory of Electroanalytical Chemistry, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, 130022, P. R. China
- School of Applied Chemistry and Engineering, University of Science and Technology of China, Hefei, 230026, P. R. China
- National Analytical Research Center of Electrochemistry and Spectroscopy, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun 130022, P. R. China
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Akhan O, Boz M, Guzel T, Kis M. Discrimination of the acute pulmonary embolism subtypes based on the novel MAPH score. J Thromb Thrombolysis 2024; 57:683-690. [PMID: 38416307 DOI: 10.1007/s11239-024-02952-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/14/2024] [Indexed: 02/29/2024]
Abstract
Acute pulmonary embolism (APE) is a thromboembolism situation that can be central or peripheral. APE risk analysis and classification are essential for therapy planning. Our aim is to determine the novel MAPH score (including age, mean platelet volume (MPV), total protein, and hematocrit parameters) that can distinguish APE subtypes. Our retrospective cohort analysis includes 97 APE patients referred to the emergency medicine department who underwent pulmonary computed tomography angiography (CTA) in 24 h from 2020 to 2022. The hospital information system provided demographic, clinical, laboratory, and pulmonary CTA data. APE was classified into central (46 patients) and peripheral (51 patients) depending on the area of vascular involvement. The central APE group had higher hypertension (HT) (67.4%) and atrial fibrillation (AF) (39.1%) incidence than the peripheral APE group (all p values > 0.05). The central APE had higher total protein and platelet counts (p = 0.003 and p = 0.036), but peripheral APE had higher troponin values (p = 0.029). Central APE had 2.17 ± 0.85 MAPH and peripheral APE 1.76 ± 0.95 (p = 0.029). HT, AF, platelet count, and MAPH score differed significantly in univariate logistic regression (all p values < 0.05). However, only platelet count varied in multivariate logistic regression (p = 0.042). ROC curve analysis revealed that the MAPH score predicts central APE with 83% sensitivity and 45% specificity at a cut-off level of 1.5. The new MAPH score as an indicator of blood viscosity may distinguish between central and peripheral APE. Our result is significant, especially for centers with limited examinations, as it may accelerate the diagnosis and treatment processes. We think that our results might guide future investigations.
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Affiliation(s)
- Onur Akhan
- Cardiology Department, Bilecik Training and Research Hospital, Floor 2, 11230, Bilecik, Turkey.
| | - Mustafa Boz
- Emergency Medicine, Bilecik Training and Research Hospital, Bilecik, Turkey
| | - Tuncay Guzel
- Cardiology, Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Mehmet Kis
- Cardiology, Dokuz Eylul University, Izmir, Turkey
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Pan G, Chen J, Lv C, Lin X, Huang J, Lin B, Wu Z. The clinical significance of ischaemia-modified albumin in acute coronary syndrome and hypertension. Cardiol Young 2024; 34:748-753. [PMID: 37814585 DOI: 10.1017/s104795112300330x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
BACKGROUND Early diagnosis of acute coronary syndrome is more and more important because of its mortality and morbidity. Hypertension is one of the pathogenesis of acute coronary syndrome, which often leads to stenosis and ischaemia. Ischaemia-modified albumin is sensitive for the occurrence of ischaemia, which attracted us in the significance of ischaemia-modified albumin in patients with chest pain, especially patients complicated with hypertension. METHODS In total, 200 patients with acute chest pain were included in the study. According to the diagnostic criteria, patients were divided into acute coronary syndrome group and non-ischaemic chest pain group. Cardiac biomarkers were measured with 30 minutes in emergency department, including cardiac troponin T, creatine kinase MB, and ischaemia-modified albumin. Receiver operating characteristic curve (ROC) analysis was used for the sensitivity and specificity of ischaemia-modified albumin in the early diagnosis of acute coronary syndrome. Comparisons between ischaemia-modified albumin and cardiac Troponin T were done between groups. RESULTS The demographics in two groups were not significantly different in most aspects. Compared with non-ischaemic chest pain group, serum levels of ischaemia-modified albumin and cardiac Troponin T were significantly higher in acute coronary syndrome group. ROC analysis showed that ischaemia-modified albumin had a good sensitivity and specificity in early diagnosis of acute coronary syndrome. The level of ischaemia-modified albumin in acute coronary syndrome patients with hypertension was higher than that in non-ischaemic chest pain patients. CONCLUSIONS In patients complained with acute chest pain, the serum measurement of ischaemia-modified albumin is potential valuable for the early diagnosis of acute coronary syndrome, especially combined with ECG. The serum level of ischaemia-modified albumin in acute coronary syndrome patients is significantly associated with hypertension.
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Affiliation(s)
- Guoyan Pan
- Department of Cardiology, The First Hospital of Putian City, Putian, China
| | - Jinzao Chen
- Department of Cardiology, The First Hospital of Putian City, Putian, China
| | - Congying Lv
- Department of Internal Medicine, Licheng District Hospital of Putian, Putian, China
| | - Xueping Lin
- Department of Cardiology, The First Hospital of Putian City, Putian, China
| | - Junwei Huang
- Department of Cardiology, The First Hospital of Putian City, Putian, China
| | - Bin Lin
- Department of Cardiology, The First Hospital of Putian City, Putian, China
| | - Zhiwei Wu
- Department of Cardiology, The First Hospital of Putian City, Putian, China
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Shariefuddin WWA, Pramudyo M, Martha JW. Shock index creatinine: a new predictor of mortality in acute coronary syndrome patients. BMC Cardiovasc Disord 2024; 24:87. [PMID: 38310219 PMCID: PMC10838412 DOI: 10.1186/s12872-024-03730-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 01/16/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND The Shock Index Creatinine (SIC) scoring is a recently developed tool for risk stratification patients. These updated scoring was already used in ST-Elevation Myocardial Infarction (STEMI) patients. However its utility in predicting outcomes for patients with Acute Coronary Syndrome (ACS) remains unclear. This study aims to evaluate and update the current SIC score to predict in-hospital mortality among patients with ACS. PATIENTS AND METHODS A retrospective cohort, Single-centered study enrolled 1349 ACS patients aged ≥ 18 years old diagnosed with ACS was conducted between January 2018 to January 2022 who met for inclusion and exclusion criteria. Study subjects were analyzed for in-hospital mortality and evaluated using binary linear regression analysis. The area under the curve (AUC) of SIC score was obtain to predict the sensitivity and specificity. RESULTS Multivariate analysis showed that SIC score was significantly associated with in-hospital mortality. High SIC score (SIC ≥ 25) had significantly higher in-hospital mortality (p < 0.001) with odds ratio for (95% CIs) were 2.655 (1.6-4.31). Receiver operating characteristics (ROC) curve analysis determine the predictive power of SIC score for in-hospital mortality. SIC had an acceptable predictive value for in-hospital mortality (AUC = 0.789, 95% CI: 0.748-0.831, p < 0.001). The SIC score for sensitivity and specificity were, respectively, 71.5% and 74.4%, with optimal cutoff of SIC ≥ 25. CONCLUSION SIC had acceptable predictive value for in-hospital mortality in patients with all ACS spectrums. SIC was a useful parameter for predicting in-hospital mortality, particularly with a score ≥ 25. This is the first study to evaluate SIC in all spectrums of ACS.
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Affiliation(s)
| | - Miftah Pramudyo
- Department of Cardiology and Vascular Medicine, Hasan Sadikin General Hospital, Universitas Padjadjaran, Bandung, Indonesia
| | - Januar Wibawa Martha
- Department of Cardiology and Vascular Medicine, Hasan Sadikin General Hospital, Universitas Padjadjaran, Bandung, Indonesia
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Zheng S, Xu Y, Jie Q, Mu H, Zhang X, Zhu J, Zhu Y, Chen X, Chen S. A systematic study to evaluate the safety of ticagrelor combined with aspirin in the treatment of PCI patients in Chinese population: A single nucleotide polymorphisms study. Drug Metab Pharmacokinet 2023; 53:100468. [PMID: 38029471 DOI: 10.1016/j.dmpk.2022.100468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/12/2022] [Accepted: 07/31/2022] [Indexed: 11/29/2022]
Abstract
The aim of this study was to identify genes and their associated loci related to ticagrelor pharmacokinetics and pharmacodynamics in Chinese patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI). The study included 1115 patients with ACS who received a drug-eluting stent implantation between October 2019 and January 2021. Among them, 98 cases of adverse reactions were observed; thus, 97 cases without adverse reactions were selected as the comparison group. The steady-state serum drug concentration was determined via high-performance liquid chromatography-mass spectrometry, and 15 single nucleotide polymorphism (SNP) loci were genotyped using the SNaPshot SNP Multiplex System. Our results showed that age and sex may affect ticagrelor serum concentration in patients with ACS. In particular, the SNPs CYP3A4∗1 (rs2242480 C > T), IGT2B (rs5911 A > C), P2Y12 (rs6787801) and CYP3A5 (rs776746 C > T) may affect the steady-state blood concentration of ticagrelor after PCI in ACS patients, and CYP3A4∗1 may also be related to adverse events. In addition, we found that the SNPs PEAR1 (rs4661012 T > G) and P2Y12 (rs6787801 A > G) may be associated with dyspnea. These findings can provide a useful reference to establish guidelines for future clinical individualized dosage regimens of ticagrelor after PCI.
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Affiliation(s)
- ShaoJun Zheng
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China.
| | - YiFan Xu
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Qiong Jie
- Nanjing First Hospital, Nanjing, China
| | - HuiWen Mu
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Xing Zhang
- The State Key Laboratory of Translational Medicine and Innovative Drug Development, Jiangsu Simcere Diagnostics Co., Ltd., Nanjing, China; Department of Medicine, Nanjing Simcere Medical Laboratory Science Co., Ltd., Nanjing, China
| | | | | | - XiJing Chen
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
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Jain M, Sawant R, Panchal H, S A, Jena A, Gupta R, Kumar K, Jambunathan R, Modi S, Mullasari A, Sinha N, Shetty K, Kawatra P. Evaluating LDL-C control in Indian acute coronary syndrome (ACS) patients- A retrospective real-world study LDL-C control in ACS. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2023; 19:200210. [PMID: 37771607 PMCID: PMC10523158 DOI: 10.1016/j.ijcrp.2023.200210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/31/2023] [Accepted: 09/07/2023] [Indexed: 09/30/2023]
Abstract
Background Low-density lipoprotein-cholesterol (LDL-C) is an independent risk factor for atherosclerotic cardiovascular disease (ASCVD) progression. Although lipid lowering therapies remain the cornerstone of secondary ACSVD prevention, there exists residual dyslipidemia. The current study aimed to evaluate the real-world experience related to the treatment patterns and LDL-C control in Indian Acute Coronary Syndrome (ACS) patients. Methods This was a real-world, descriptive, retrospective, observational, and multicentric study conducted across India. The data was collected for 1 year following the ACS event. The change in the levels of LDL-C from the baseline to the follow-up visits and the control of LDL-C, the change in lipid profile, lipoprotein levels, treatment patterns for lipid-lowering, and tolerability of existing treatments were evaluated. Results Overall, 575 patients were included from 11 centers across India. The mean age of the patients was 52.92 years, with male predominance (76.35%). Although there was a significant reduction in the mean levels of LDL-C from the baseline [(122.64 ± 42.01 mg/dl to 74.41 ± 26.45 mg/dl (p < 0.001)], it was observed that despite high-intensity statin therapy, only 20.87% patients managed to achieve target LDL-C of <55 mg/dL and 55.65% were unable to reach LDL-C levels of <70 mg/dl one year after the event. Six patients reported adverse events without treatment discontinuation. Conclusion The majority of the patients received high-intensity statins and did not attain target LDL-C levels, suggesting LDL-C control after an ACS event requires management with novel therapies having better efficacy as recommended by international and national guidelines.
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Affiliation(s)
| | | | | | - Anand S
- Kauvery Heart City, Tamil Nadu, India
| | | | | | | | | | - Sunil Modi
- Indraprasatha Apollo Hospital, New Delhi, India
| | | | | | - Kimi Shetty
- Medical Lead, Novartis Healthcare Private Limited, Mumbai, India
| | - Pallavi Kawatra
- Franchise Medical Head, Novartis Healthcare Private Limited, Mumbai, India
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Hasan N, Jauregui W, Zubair M, Pushparajan VK, Carson BJ, Attaluri DM, Dixon D, Jaisinghani A, Chuecos A, Ravichandran D. Adverse Drug Effect Profiles of Gp2b/3a Inhibitors: A Comparative Review of the Last Two Decades. Cureus 2023; 15:e49332. [PMID: 38143693 PMCID: PMC10748847 DOI: 10.7759/cureus.49332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2023] [Indexed: 12/26/2023] Open
Abstract
ST-Elevation Myocardial Infarction and non-ST Elevation Myocardial Infarction belong to the acute coronary syndrome group of diseases. These conditions are characterized by the complete or partial blockage of one or several coronary arteries, resulting in myocardial injury or necrosis. Various medications are used in their treatment, with the most recent addition being Glycoprotein IIb/IIIa inhibitors. They work by hindering the activity of glycoprotein IIb/IIIa receptors, which, in turn, prevents the clumping of platelets. Some of the GpIIb/IIIa inhibitors available in this category include abciximab, tirofiban, eptifibatide, roxifiban, and orbofiban. With this comprehensive literature review, we aimed to explore the potential adverse effects of these medications and compare the three in terms of their side effects profile. We searched through PubMed and Google Scholar and pinpointed 13 articles aligned with our inclusion criteria: six articles utilized eptifibatide, four were related to abciximab, and three used tirofiban. In 85% of the cases, a severe drop in platelet count, reaching as low as 1000/μL, was reported. Additionally, several other side effects were noted: one case documented multiple bruising spots appearing around the patient's body, two cases reported diffuse alveolar hemorrhage, and one case described a cardiac tamponade resulting from hemorrhagic pericarditis. Our study highlights the crucial significance of keeping a watchful eye on and comprehending the potential drawbacks linked to these medications in cardiovascular treatment. The necessity of researching these medications and their side effects is also evident, as this will significantly enhance the quality of treatment provided.
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Affiliation(s)
- Naziha Hasan
- Emergency Department, Derriford Hospital, Plymouth, GBR
| | - Walter Jauregui
- General Medicine, Universidad Nacional Autónoma de Honduras, Tegucigalpa, HND
| | - Mahrukh Zubair
- General Medicine, Mohi-ud-Din Islamic Medical College, Azad Jammu Kashmir, PAK
| | | | - Bryan J Carson
- Emergency Medicine, Northern Health and Social Care Trust, Coleraine, GBR
| | | | - Diny Dixon
- General Medicine, Jubilee Mission Medical College and Research Institute, Thrissur, IND
| | | | - Andres Chuecos
- General Medicine, La Universidad de los Andes, Mérida, VEN
| | - Deepika Ravichandran
- General Medicine, American University of Antigua College of Medicine, St John's, ATG
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Cordero D, Schmidt P, Sosa F, Patel M, Sklyar E. Hiccups: Nerve Irritation or Masquerading as Acute Coronary Syndrome. Cureus 2023; 15:e48069. [PMID: 38046484 PMCID: PMC10689209 DOI: 10.7759/cureus.48069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 12/05/2023] Open
Abstract
The typical clinical presentation of acute coronary syndrome (ACS) includes chest pain that may radiate to the left arm, shoulder, jaw, and neck, accompanied by diaphoresis, dyspnea, nausea, vomiting, and hiccups, which have been observed as the sole symptom of presentation. The mechanism of hiccups involves the activation of the vagus and phrenic nerves, leading to the activation of the diaphragm and intercostal muscles. Several hypotheses link hiccups to ACS, associating irritation of the left anterior descending artery with activation of sympathetic phrenic and vagal nerves. This case report highlights the occurrence of hiccups in patients with inferior and right ventricular myocardial infarction (MI), indicating possible nerve synapse involvement. Timely recognition of hiccups as a possible atypical symptom of ACS can facilitate early evaluation and management, preventing delays in patient care and ensuring better outcomes.
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Affiliation(s)
- Dessiree Cordero
- Internal Medicine, BronxCare Hospital Center, Icahn School of Medicine at Mt. Sinai, New York, USA
| | - Patrik Schmidt
- Internal Medicine, BronxCare Health System, New York, USA
| | - Franklin Sosa
- Internal Medicine, BronxCare Health System, New York, USA
| | - Maulin Patel
- Cardiology, Mount Sinai Hospital/Bronxcare Health System, New York, USA
| | - Eduard Sklyar
- Electrophysiology, BronxCare Health System, New York, USA
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Vukašinović A, Klisic A, Ostanek B, Kafedžić S, Zdravković M, Ilić I, Sopić M, Hinić S, Stefanović M, Bogavac-Stanojević N, Marc J, Nešković AN, Kotur-Stevuljević J. Redox Status and Telomere-Telomerase System Biomarkers in Patients with Acute Myocardial Infarction Using a Principal Component Analysis: Is There a Link? Int J Mol Sci 2023; 24:14308. [PMID: 37762611 PMCID: PMC10531660 DOI: 10.3390/ijms241814308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/09/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
In the present study, we examined redox status parameters in arterial and venous blood samples, its potential to predict the prognosis of acute myocardial infarction (AMI) patients assessed through its impact on the comprehensive grading SYNTAX score, and its clinical accuracy. Potential connections between common blood biomarkers, biomarkers of redox status, leukocyte telomere length, and telomerase enzyme activity in the acute myocardial infarction burden were assessed using principal component analysis (PCA). This study included 92 patients with acute myocardial infarction. Significantly higher levels of advanced oxidation protein products (AOPP), superoxide anion (O2•-), ischemia-modified albumin (IMA), and significantly lower levels of total oxidant status (TOS) and total protein sulfhydryl (SH-) groups were found in arterial blood than in the peripheral venous blood samples, while biomarkers of the telomere-telomerase system did not show statistical significance in the two compared sample types (p = 0.834 and p = 0.419). To better understand the effect of the examined biomarkers in the AMI patients on SYNTAX score, those biomarkers were grouped using PCA, which merged them into the four the most contributing factors. The "cholesterol-protein factor" and "oxidative-telomere factor" were independent predictors of higher SYNTAX score (OR = 0.338, p = 0.008 and OR = 0.427, p = 0.035, respectively), while the ability to discriminate STEMI from non-STEMI patients had only the "oxidative-telomere factor" (AUC = 0.860, p = 0.008). The results show that traditional cardiovascular risk factors, i.e., high total cholesterol together with high total serum proteins and haemoglobin, are associated with severe disease progression in much the same way as a combination of redox biomarkers (pro-oxidant-antioxidant balance, total antioxidant status, IMA) and telomere length.
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Affiliation(s)
- Aleksandra Vukašinović
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, 11000 Belgrade, Serbia; (A.V.); (M.S.); (N.B.-S.); (J.K.-S.)
| | - Aleksandra Klisic
- Faculty of Medicine, University of Montenegro, 81000 Podgorica, Montenegro
- Center for Laboratory Diagnostics, Primary Health Care Center, 81000 Podgorica, Montenegro
| | - Barbara Ostanek
- Department of Clinical Biochemistry, Faculty of Pharmacy, University of Ljubljana, 1000 Ljubljana, Slovenia; (B.O.); (J.M.)
| | - Srdjan Kafedžić
- Department of Cardiology, Clinical Hospital Center Zemun, 11070 Belgrade, Serbia; (S.K.); (I.I.); (M.S.); (A.N.N.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Marija Zdravković
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
- Department of Cardiology, Clinical Hospital Center Bezanijska Kosa, 11070 Belgrade, Serbia;
| | - Ivan Ilić
- Department of Cardiology, Clinical Hospital Center Zemun, 11070 Belgrade, Serbia; (S.K.); (I.I.); (M.S.); (A.N.N.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Miron Sopić
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, 11000 Belgrade, Serbia; (A.V.); (M.S.); (N.B.-S.); (J.K.-S.)
| | - Saša Hinić
- Department of Cardiology, Clinical Hospital Center Bezanijska Kosa, 11070 Belgrade, Serbia;
| | - Milica Stefanović
- Department of Cardiology, Clinical Hospital Center Zemun, 11070 Belgrade, Serbia; (S.K.); (I.I.); (M.S.); (A.N.N.)
| | - Nataša Bogavac-Stanojević
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, 11000 Belgrade, Serbia; (A.V.); (M.S.); (N.B.-S.); (J.K.-S.)
| | - Janja Marc
- Department of Clinical Biochemistry, Faculty of Pharmacy, University of Ljubljana, 1000 Ljubljana, Slovenia; (B.O.); (J.M.)
| | - Aleksandar N. Nešković
- Department of Cardiology, Clinical Hospital Center Zemun, 11070 Belgrade, Serbia; (S.K.); (I.I.); (M.S.); (A.N.N.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Jelena Kotur-Stevuljević
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, 11000 Belgrade, Serbia; (A.V.); (M.S.); (N.B.-S.); (J.K.-S.)
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11
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Ahsan L, Zheng WQ, Kaur G, Kadakuntla A, Remaley AT, Sampson M, Feustel P, Nappi A, Mookherjee S, Lyubarova R. Association of Lipoprotein Subfractions With Presence and Severity of Coronary Artery Disease in Patients Referred for Coronary Angiography. Am J Cardiol 2023; 203:212-218. [PMID: 37499601 DOI: 10.1016/j.amjcard.2023.06.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/13/2023] [Accepted: 06/29/2023] [Indexed: 07/29/2023]
Abstract
Lipoprotein subfractions (LS) can be used for better risk stratification in subjects deemed not at high risk for coronary artery disease (CAD). In this study, we evaluated the correlation between LS with CAD presence and severity. This is a prospective case-control study of 157 patients referred for coronary angiography who were not on lipid-lowering therapy and had LS measured by nuclear magnetic resonance spectroscopy. Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) scores were calculated to estimate CAD severity. Univariate and multivariable regression analysis was performed to determine correlation of LS with CAD presence and severity and acute coronary syndrome (ACS). There was significant association of certain LS (positive for total low-density lipoprotein particle [LDL-P], small LDL-P and apolipoprotein B, negative for large high-density lipoprotein particle [HDL-P] and apolipoprotein A1 [ApoA1]) with the presence of obstructive CAD and CAD severity. Small LDL-P and HDL-P were still predictive for obstructive CAD after adjusting for traditional risk factors, 10-year atherosclerotic cardiovascular disease risk score and in those with low-density lipoprotein cholesterol <100 mg/100 ml. Total LDL-P and ApoA1 were predictive of CAD severity on multivariable analysis. Higher small LDL-P and lower large HDL-P were associated with ACS presence, although only large HDL-P had a significant inverse correlation with ACS on adjusted analysis (odds ratio 0.74 95% confidence interval 0.58, 0.95) In conclusion, in our cohort of patients referred for coronary angiography, total LDL-P, small LDL-P, and apolipoprotein B had significant direct correlation, and large HDL-P and ApoA1 had significant inverse correlation with obstructive CAD and CAD severity.
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Affiliation(s)
- Lusana Ahsan
- Department of Medicine, Albany Medical College, Albany, New York
| | - Wen Qian Zheng
- Department of Medicine, Albany Medical College, Albany, New York
| | - Gurleen Kaur
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Alan T Remaley
- Lipoprotein Metabolism Laboratory, National Heart, Lung and Blood Institute, National Institute of Health, Bethesda, Maryland
| | - Maureen Sampson
- Department Laboratory Medicine, Clinical Center, National Institute of Health, Bethesda, Maryland
| | - Paul Feustel
- Department of Medicine, Albany Medical College, Albany, New York
| | - Anthony Nappi
- Department of Medicine, Albany Medical College, Albany, New York
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12
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Bernardus R, Pramudyo M, Akbar MR. A Revised PADMA Scoring System for Predicting in-Hospital Mortality in Acute Coronary Syndrome Patient. Int J Gen Med 2023; 16:3747-3756. [PMID: 37645590 PMCID: PMC10460679 DOI: 10.2147/ijgm.s421913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023] Open
Abstract
Background In order to predict in-hospital mortality in ACS (Acute Coronary Syndrome) patients based solely on clinical examination, this study compares the shock index (heart rate divided by systolic blood pressure) variable in PADMA (PADjadjaran Mortality in Acute Coronary Syndrome) with the modified shock index (heart rate divided by mean arterial pressure) score. The predictive efficacy of the PADMA score in predicting in-hospital mortality in ACS patients has been in doubt up until recently. Methods All ACS patients above the age of 18 who were admitted to Dr. Hasan Sadikin Central General Hospital between January 2018 and January 2023 were included in this retrospective observational cohort study. This study did not involve any interventions, and verbal informed permission was obtained with the Hasan Sadikin Hospital Ethic Committee's approval. Multivariate logistic regression was used to gather and evaluate patient demographic, comorbidity, and clinical presentation data in order to provide two scoring systems (probability and cut-off models) that can be used to predict in-hospital all-cause death. The Fisher Z test was used to assess the area under the curve (AUC) between the PADMA SI (shock index) and PADMA MSI (modified shock index). Results Killip classifications III and IV, tachycardia, a high shock index, and older age were found to be independent mortality predictors and were included to the PADMA MSI score by multivariate regression analysis of 1504 people. PADMA SI score >8 has a sensitivity of 67.92% and a specificity of 84.01% for predicting all-cause death. The range of the PADMA SI score is 0 to 19. The AUC between the PADMA MSI and PADMA SI scores did not differ significantly (p=0.022). Conclusion Similar to the PADMA SI score, the PADMA MSI score >8 demonstrated an accurate discriminative power to forecast in-hospital mortality though it did not have significant statistic difference.
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Affiliation(s)
- Raymond Bernardus
- Department of Cardiology and Vascular Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Miftah Pramudyo
- Department of Cardiology and Vascular Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Mohammad Rizki Akbar
- Department of Cardiology and Vascular Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia
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13
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Park JY, Kim JW, Kang HJ, Choi W, Lee JY, Kim SW, Shin IS, Ahn Y, Jeong MH, Kim JM. Effect Modification of Cortisol on the Associations Between Obsessive-Compulsive Symptoms on Suicidality in Patients With Acute Coronary Syndrome. Psychiatry Investig 2023; 20:707-713. [PMID: 37559479 PMCID: PMC10460972 DOI: 10.30773/pi.2023.0085] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 04/25/2023] [Accepted: 05/13/2023] [Indexed: 08/11/2023] Open
Abstract
OBJECTIVE Obsessive-compulsive symptoms (OCS) and suicidal ideation (SI) are common in patients with acute coronary syndrome (ACS). This study investigated the associations of OCS and serum cortisol levels with SI, and further evaluated the possible modifying effects of cortisol on the associations between OCS and SI in acute and chronic phases of ACS. METHODS In total, 969 ACS patients were recruited from a tertiary university hospital in Korea within 2 weeks of disease onset and evaluated in terms of OCS (using the OCS dimension of the Symptom Checklist-90-Revised), serum cortisol levels, and SI (using the "suicidal thoughts" item of the Montgomery-Åsberg Depression Rating Scale). Covariates included sociodemographics, depression, vascular risk factors, and disease severity. After 1 year, 711 patients were re-evaluated in terms of SI. Logistic regression analysis was performed with adjustment for covariates. RESULTS Higher OCS was significantly associated with SI both at baseline and follow-up. Serum cortisol showed no such association, but modified the association between OCS and SI. That was the associations were significant only in the higher but not in the lower serum cortisol levels, with significant interaction terms after adjusted for relevant covariates. CONCLUSION Evaluating OCS and serum cortisol levels at the acute phase could improve the accuracy of clinical predictions of SI both in the acute and chronic phases of ACS.
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Affiliation(s)
- Jin-Young Park
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ju-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hee-Ju Kang
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Wonsuk Choi
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Republic of Korea
| | - Ju-Yeon Lee
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Il-Seon Shin
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
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14
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Shenouda R, Bytyçi I, El Sharkawy E, Hisham N, Sobhy M, Henein MY. Strain Rate Changes during Stress Echocardiography Are the Most Accurate Predictors of Significant Coronary Artery Disease in Patients with Previously Treated Acute Coronary Syndrome. Diagnostics (Basel) 2023; 13:diagnostics13101796. [PMID: 37238281 DOI: 10.3390/diagnostics13101796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/06/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND AND AIMS Dobutamine stress echocardiography (DSE) is a well-established non-invasive investigation for the detection of ischemic myocardial dysfunction. The aim of this study was to evaluate the accuracy of myocardial deformation parameters measured by speckle tracking echocardiography (STE) in predicting culprit coronary artery lesions in patients with prior revascularization and acute coronary syndrome (ACS). METHODS We prospectively studied 33 patients with ischemic heart disease, a history of at least one episode of ACS and prior revascularization. All patients underwent a complete stress Doppler echocardiographic examination, including the myocardial deformation parameters of peak systolic strain (PSS), peak systolic strain rate (SR) and wall motion score index (WMSI). The regional PSS and SR were analyzed for different culprit lesions. RESULTS The mean age of patients was 59 ± 11 years and 72.7% were males. At peak dobutamine stress, the change in regional PSS and SR in territories supplied by the LAD showed smaller increases compared to those in patients without culprit LAD lesions (p < 0.05 for all). Likewise, the regional parameters of myocardial deformation were reduced in patients with culprit LCx lesions compared to those with non-culprit LCx lesions and in patients with culprit RCA legions compared to those with non-culprit RCA lesions (p < 0.05 for all). In the multivariate analysis, the △ regional PSS (1.134 (CI = 1.059-3.315, p = 0.02)) and the △ regional SR (1.566 (CI = 1.191-9.013, p = 0.001)) for LAD territories predicted the presence of LAD lesions. Similarly, in a multivariable analysis, the △ regional PSS and the △SR predicted LCx culprit lesions and RCA culprit lesions (p < 0.05 for all). In an ROC analysis, the PSS and SR had higher accuracies compared to the regional WMSI in predicting culprit lesions. A △ regional SR of -0.24 for the LAD territories was 88% sensitive and 76% specific (AUC = 0.75; p < 0.001), a △ regional PSS of -1.20 was 78% sensitive and 71% specific (AUC = 0.76, p < 0.001) and a △ WMSI of -0.35 was 67% sensitive and 68% specific (AUC = 0.68, p = 0.02) in predicting LAD culprit lesions. Similarly, the △ SR for LCx and RCA territories had higher accuracies in predicting LCx and RCA culprit lesions. CONCLUSIONS The myocardial deformation parameters, particularly the change in regional strain rate, are the most powerful predictors of culprit lesions. These findings strengthen the role of myocardial deformation in increasing the accuracy of DSE analyses in patients with prior cardiac events and revascularization.
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Affiliation(s)
- Rafik Shenouda
- Institute of Public Health and Clinical Medicine, Umea University, 90187 Umea, Sweden
- International Cardiac Centre, Alexandria 21526, Egypt
| | - Ibadete Bytyçi
- Institute of Public Health and Clinical Medicine, Umea University, 90187 Umea, Sweden
- Clinic of Cardiology, University Clinical Centre of Kosovo, 10000 Prishtina, Kosovo
| | - Eman El Sharkawy
- International Cardiac Centre, Alexandria 21526, Egypt
- Cardiology Department, Faculty of Medicine, Alexandria University, Alexandria 21500, Egypt
| | - Noha Hisham
- International Cardiac Centre, Alexandria 21526, Egypt
- Cardiology Department, Faculty of Medicine, Alexandria University, Alexandria 21500, Egypt
| | - Mohamed Sobhy
- International Cardiac Centre, Alexandria 21526, Egypt
- Cardiology Department, Faculty of Medicine, Alexandria University, Alexandria 21500, Egypt
| | - Michael Y Henein
- Institute of Public Health and Clinical Medicine, Umea University, 90187 Umea, Sweden
- Molecular and Clinic Research Institute, St. George University, London SW17 0QT, UK
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15
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Kunnumakkara AB, Hegde M, Parama D, Girisa S, Kumar A, Daimary UD, Garodia P, Yenisetti SC, Oommen OV, Aggarwal BB. Role of Turmeric and Curcumin in Prevention and Treatment of Chronic Diseases: Lessons Learned from Clinical Trials. ACS Pharmacol Transl Sci 2023; 6:447-518. [PMID: 37082752 PMCID: PMC10111629 DOI: 10.1021/acsptsci.2c00012] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Indexed: 03/08/2023]
Abstract
Turmeric (Curcuma longa) has been used for thousands of years for the prevention and treatment of various chronic diseases. Curcumin is just one of >200 ingredients in turmeric. Almost 7000 scientific papers on turmeric and almost 20,000 on curcumin have been published in PubMed. Scientific reports based on cell culture or animal studies are often not reproducible in humans. Therefore, human clinical trials are the best indicators for the prevention and treatment of a disease using a given agent/drug. Herein, we conducted an extensive literature survey on PubMed and Scopus following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The keywords "turmeric and clinical trials" and "curcumin and clinical trials" were considered for data mining. A total of 148 references were found to be relevant for the key term "turmeric and clinical trials", of which 70 were common in both PubMed and Scopus, 44 were unique to PubMed, and 34 were unique to Scopus. Similarly, for the search term "curcumin and clinical trials", 440 references were found to be relevant, of which 70 were unique to PubMed, 110 were unique to Scopus, and 260 were common to both databases. These studies show that the golden spice has enormous health and medicinal benefits for humans. This Review will extract and summarize the lessons learned about turmeric and curcumin in the prevention and treatment of chronic diseases based on clinical trials.
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Affiliation(s)
- Ajaikumar B. Kunnumakkara
- Department
of Biosciences and Bioengineering, Indian
Institute of Technology Guwahati, Assam-781039, India
| | - Mangala Hegde
- Department
of Biosciences and Bioengineering, Indian
Institute of Technology Guwahati, Assam-781039, India
| | - Dey Parama
- Department
of Biosciences and Bioengineering, Indian
Institute of Technology Guwahati, Assam-781039, India
| | - Sosmitha Girisa
- Department
of Biosciences and Bioengineering, Indian
Institute of Technology Guwahati, Assam-781039, India
| | - Aviral Kumar
- Department
of Biosciences and Bioengineering, Indian
Institute of Technology Guwahati, Assam-781039, India
| | - Uzini Devi Daimary
- Department
of Biosciences and Bioengineering, Indian
Institute of Technology Guwahati, Assam-781039, India
| | - Prachi Garodia
- Integrative
Research Center, Miami, Florida 33125, United States
| | - Sarat Chandra Yenisetti
- Department
of Zoology, Drosophila Neurobiology Laboratory, Nagaland University (Central), Lumami, Nagaland-798627, India
| | - Oommen V. Oommen
- Department
of Computational Biology and Bioinformatics, University of Kerala, Kariavattom, Thiruvananthapuram, Kerala-695581, India
| | - Bharat B. Aggarwal
- Inflammation
Research Center, San Diego, California 92109, United States
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16
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Nabovati E, Farzandipour M, Sadeghi M, Sarrafzadegan N, Noohi F, Sadeqi Jabali M. A Global Overview of Acute Coronary Syndrome Registries: A Systematic Review. Curr Probl Cardiol 2023; 48:101049. [PMID: 34780868 DOI: 10.1016/j.cpcardiol.2021.101049] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 11/05/2021] [Indexed: 12/16/2022]
Abstract
The present study was conducted with the aim of identifying, and summarizing the characteristics of ACS registries at national, multinational and international levels. Literature was searched using keywords in the title and/or abstract without any time limit ending in March, 2021. After excluding duplicates, 2 reviewers independently reviewed the titles and/or abstracts and full text for inclusion. Each reviewer independently extracted the characteristics of the registries from included papers. Finally, the extracted characteristics were confirmed by a second reviewer. Out of the 1309 papers included, 71 ACS registries were identified (including 60 national and 11 multinational and international registries). Most national registries were being used in Europe. Most registries focused on measuring quality. In more than half of the registries, all types of ACS patients were enrolled. The diagnostic and drug classification systems were mentioned in eight and five registries, respectively. The design of 55 registries was hospital-based. The ability of computerized audit checks was made for 34 registries. More than half of the registries had patient consent and had a web-based design. In all the ACS registries, patient characteristics, clinical characteristics and treatment characteristics were recorded and post-discharge follow-up information was recorded in 45 registries. In the current situation and given that a limited number of countries in the world have national ACS registries, reviewing the results of this study and modeling the registries implemented in the leading countries can help countries without a registry to design it.
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Affiliation(s)
- Ehsan Nabovati
- Health Information Management Research Center, Department of Health Information Management and Technology, Kashan University of Medical Sciences, Kashan, Iran
| | - Mehrdad Farzandipour
- Health Information Management Research Center, Department of Health Information Management and Technology, Kashan University of Medical Sciences, Kashan, Iran.
| | - Masoumeh Sadeghi
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Feridoun Noohi
- Iranian Network of Cardiovascular Research, Iran; Cardiovascular Intervention Research Center, Shaheed Rajaie Cardiovascular Medical and Research Center, Tehran, Iran
| | - Monireh Sadeqi Jabali
- Health Information Management Research Center, Department of Health Information Management and Technology, Kashan University of Medical Sciences, Kashan, Iran.
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17
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Tonkin D, Yee-Goh A, Katare R. Healing the Ischaemic Heart: A Critical Review of Stem Cell Therapies. Rev Cardiovasc Med 2023; 24:122. [PMID: 39076280 PMCID: PMC11273058 DOI: 10.31083/j.rcm2404122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/16/2023] [Accepted: 03/20/2023] [Indexed: 07/31/2024] Open
Abstract
Ischaemic heart disease (IHD) remains the leading cause of mortality worldwide. Current pharmaceutical treatments focus on delaying, rather than preventing disease progression. The only curative treatment available is orthotopic heart transplantation, which is greatly limited by a lack of available donors and the possibility for immune rejection. As a result, novel therapies are consistently being sought to improve the quality and duration of life of those suffering from IHD. Stem cell therapies have garnered attention globally owing to their potential to replace lost cardiac cells, regenerate the ischaemic myocardium and to release protective paracrine factors. Despite recent advances in regenerative cardiology, one of the biggest challenges in the clinical translation of cell-based therapies is determining the most efficacious cell type for repair. Multiple cell types have been investigated in clinical trials; with inconsistent methodologies and isolation protocols making it difficult to draw strong conclusions. This review provides an overview of IHD focusing on pathogenesis and complications, followed by a summary of different stem cells which have been trialled for use in the treatment of IHD, and ends by exploring the known mechanisms by which stem cells mediate their beneficial effects on ischaemic myocardium.
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Affiliation(s)
- Devin Tonkin
- Department of Physiology, HeartOtago, School of Biomedical Sciences, University of Otago, 9010 Dunedin, New Zealand
| | - Anthony Yee-Goh
- Department of Physiology, HeartOtago, School of Biomedical Sciences, University of Otago, 9010 Dunedin, New Zealand
| | - Rajesh Katare
- Department of Physiology, HeartOtago, School of Biomedical Sciences, University of Otago, 9010 Dunedin, New Zealand
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18
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Motamed H, Mohammadi M, Tayebi Z, Rafati Navaei A. The diagnostic utility of creatine kinase-MB versus total creatine
phosphokinase ratio in patients with non-ST elevation myocardial infarction from
unstable angina. SAGE Open Med 2023; 11:20503121221148609. [PMID: 36969724 PMCID: PMC10034342 DOI: 10.1177/20503121221148609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/16/2022] [Indexed: 03/24/2023] Open
Abstract
Objective: The present study seeks to find a way to quickly and correctly differentiate
myocardial infarction from unstable angina by measuring the creatine
kinase-MB/creatine phosphokinase ratio and comparing in non-ST elevation
myocardial infarction patients with unstable angina at different time
intervals, to improve the health quality of patients with coronary artery
disease. Methods: The present study is a retrospective epidemiological analysis of 260 patients
with non-ST elevation myocardial infarction and 260 patients with unstable
angina, including age, sex, creatine kinase-MB, and creatine phosphokinase
biomarkers at two-time intervals, including referral (4–8 h from the onset
of pain) as the first interval, and 8 h after the first sampling was
extracted as the second interval. Moreover, the delta of the creatine
kinase-MB/creatine phosphokinase ratio during two interval times was
measured. Results: In non-ST elevation myocardial infarction patients in the first and second
intervals, creatine kinase-MB/creatine phosphokinase ratio was 32.7 and
33.8% higher than the normal laboratory cutoff (positive), respectively, and
in the group of unstable angina patients, this index was positive in 31.9
and 30.4% of patients, respectively. There was no significant difference
between the mean creatine kinase-MB to creatine phosphokinase index between
the patients with non-ST elevation myocardial infarction and unstable angina
(p = 0.507). In the first interval, the sensitivity and
specificity of this index in differentiating non-ST elevation myocardial
infarction from unstable angina were 51.5 and 57.3% (area under the
curve = 0.518), respectively. While in the second interval, the sensitivity
and specificity of this index were 17.7 and 87.8% (area under the
curve = 0.519), respectively. The creatine kinase-MB/creatine phosphokinase
delta in the non-ST elevation myocardial infarction group was significantly
higher than in patients with unstable angina during different time intervals
(p = 0.01). Conclusion: According to our results, creatine kinase-MB/creatine phosphokinase index
cannot help differentiate the two groups of non-ST elevation myocardial
infarction and unstable angina. However, the findings show that higher
levels of creatine kinase-MB enzyme and creatine kinase-MB/creatine
phosphokinase delta in the early hours, 4–16 h after the onset of pain in
non-ST elevation myocardial infarction patients, can be used to
differentiate between non-ST elevation myocardial infarction and unstable
angina.
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Affiliation(s)
- Hassan Motamed
- Department of Emergency Medicine,
Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz,
Iran
| | - Mohammad Mohammadi
- Atherosclerosis Research Centre, Ahvaz
Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Zahra Tayebi
- Department of Emergency Medicine,
Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz,
Iran
| | - Alireza Rafati Navaei
- Department of Emergency Medicine,
Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz,
Iran
- Alireza Rafati Navaei, Department of
Emergency, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, 61357-15794,
Iran.
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19
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Proteomic profiling for prediction of recurrent cardiovascular event in patients with acute coronary syndrome and obstructive sleep apnea: A post-hoc analysis from the ISAACC study. Biomed Pharmacother 2023; 158:114125. [PMID: 36549084 DOI: 10.1016/j.biopha.2022.114125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/28/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is associated with a recurrent cardiovascular event (CVE) risk in patients with a first acute coronary syndrome (ACS). However, the pathological pathways by which OSA promotes this deleterious role are unknown. We aim to explore the proteomic profile associated with OSA that promote the recurrent CVE risk in severe OSA patients with ACS without previous cardiovascular diseases. METHODS This post-hoc analysis from the ISAACC study (NCT01335087) included 86 patients admitted for ACS. Patients underwent respiratory polygraphy for the first 24-72 h to OSA diagnosis. We analyzed of 276 cardiovascular and inflammatory related proteins in baseline fasting plasma samples using proximity expression assay technology (Olink®, Sweden). Protein levels were compared between severe OSA patients with/without recurrent CVEs during follow-up. Random forest was conducted to select relevant proteins and generate a predictive model of recurrent CVE. RESULTS We included 86 patients (median age: 61 years, median BMI: 29.4 kg/m2 and 86 % males) admitted for ACS with severe OSA (56 without recurrent CVE/30 with recurrent CVE). The plasma levels of 38 proteins were differentially expressed between groups. Additionally, 12 proteins had a significant association with respiratory polygraphy parameters. Three proteins discriminate with an AUC of 0.81 (95 % CI of 0.71-0.9) between severe OSA patients with and without recurrent CVE. These proteins were implicated in cell proliferation, communication and apoptosis, and regulation/response to the inflammatory and immune systems. CONCLUSION In ACS patients with severe OSA, a proteomic profile was associated with recurrent CVEs. This proteomic profile was correlated with specific OSA parameters from respiratory polygraphy. Proteomic profiling may provide an new direction for patient risk stratification and clinical management.
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Abstract
ABSTRACT Coronary artery disease (CAD) is the number one cause of death in the United States, and it is estimated that every 40 seconds one person experiences a heart attack. Among patients with chronic CAD, many will experience a potentially fatal complication known as acute coronary syndrome (ACS). Wellens syndrome is a rare form of ACS that indicates critical left anterior descending coronary artery occlusion and can be identified by its characteristic T-wave patterns on ECG. This syndrome also may go unrecognized by clinicians because of a lack of familiarity with the ECG findings. This article describes the Wellens ECG pattern and its significance in patients with chest pain.
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21
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Bansal T, Shukla A, Parikh R, Singh G, Mishra A, Singh L, Patel K, Patel I, Patel U. Predictive significance and diagnostic accuracy of plasma fibrinogen levels for coronary stenting outcomes. HEART, VESSELS AND TRANSPLANTATION 2022. [DOI: 10.24969/hvt.2022.365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective: The advancement in percutaneous transluminal coronary angioplasty (PTCA) has led to it becoming the predominant mode of revascularization. Post PTCA adverse events in the form of stent thrombosis, recurrent ischemia, unplanned revascularization, recurrent hospitalization etc. result in morbidity as well as mortality. Biomarkers predicting such outcomes can be useful in initiating more aggressive medical therapy and greater modification of risk factors. This study was undertaken to study the predictive significance of periprocedural plasma fibrinogen levels for coronary stenting outcomes.
Methods: 80 patients diagnosed as either chronic stable angina (CSA), unstable angina (UA), Non ST Elevation Myocardial Infarction (NSTEMI) or late presentation ST Elevation Myocardial Infarction (STEMI) undergoing planned PTCA were included in study. Patients were evaluated for clinical history, electrocardiogram (ECG), two dimensional echocardiography (2D-echo) and cardiac biomarkers (Creatinine Phorphokinase-MB isomer (CK-MB) and Troponin I). Serum fibrinogen level was measured 24 hours prior to PTCA along with routine pre-operative investigations; and also 24 hours after coronary stenting. Patients were followed for six months. Outcome measure was taken to be freedom from cardiac related adverse events, including rehospitalisation, unplanned repeat revascularization, definite stent thrombosis, transient ischemic attack, stroke and all-cause mortality.
Results: Fibrinogen level ≥393 mg/dL, 24 hours prior to percutaneous transluminal coronary angioplasty, was associated with higher major adverse cardiac and cerebrovascular events (MACCE) rates (60%) as compared to those with fibrinogen level <393 mg/dL (3.6%). Fibrinogen level ≥427 mg/dL 24 hours after percutaneous transluminal coronary angioplasty, was associated with higher major adverse cardiac and cerebrovascular events rates (65%) as compared to those with fibrinogen level <427 mg/dL (6.7%).
Conclusion: The current study demonstrates that higher baseline and post procedural fibrinogen, is an independent predictor of 6 months major adverse cardiac and cerebrovascular events after elective percutaneous coronary intervention.
Key words: Coronary stent outcomes, major adverse cardiac and cerebrovascular events, plasma fibrinogen, stent diameter
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22
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Kasim S, Malek S, Song C, Wan Ahmad WA, Fong A, Ibrahim KS, Safiruz MS, Aziz F, Hiew JH, Ibrahim N. In-hospital mortality risk stratification of Asian ACS patients with artificial intelligence algorithm. PLoS One 2022; 17:e0278944. [PMID: 36508425 PMCID: PMC9744311 DOI: 10.1371/journal.pone.0278944] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 11/25/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Conventional risk score for predicting in-hospital mortality following Acute Coronary Syndrome (ACS) is not catered for Asian patients and requires different types of scoring algorithms for STEMI and NSTEMI patients. OBJECTIVE To derive a single algorithm using deep learning and machine learning for the prediction and identification of factors associated with in-hospital mortality in Asian patients with ACS and to compare performance to a conventional risk score. METHODS The Malaysian National Cardiovascular Disease Database (NCVD) registry, is a multi-ethnic, heterogeneous database spanning from 2006-2017. It was used for in-hospital mortality model development with 54 variables considered for patients with STEMI and Non-STEMI (NSTEMI). Mortality prediction was analyzed using feature selection methods with machine learning algorithms. Deep learning algorithm using features selected from machine learning was compared to Thrombolysis in Myocardial Infarction (TIMI) score. RESULTS A total of 68528 patients were included in the analysis. Deep learning models constructed using all features and selected features from machine learning resulted in higher performance than machine learning and TIMI risk score (p < 0.0001 for all). The best model in this study is the combination of features selected from the SVM algorithm with a deep learning classifier. The DL (SVM selected var) algorithm demonstrated the highest predictive performance with the least number of predictors (14 predictors) for in-hospital prediction of STEMI patients (AUC = 0.96, 95% CI: 0.95-0.96). In NSTEMI in-hospital prediction, DL (RF selected var) (AUC = 0.96, 95% CI: 0.95-0.96, reported slightly higher AUC compared to DL (SVM selected var) (AUC = 0.95, 95% CI: 0.94-0.95). There was no significant difference between DL (SVM selected var) algorithm and DL (RF selected var) algorithm (p = 0.5). When compared to the DL (SVM selected var) model, the TIMI score underestimates patients' risk of mortality. TIMI risk score correctly identified 13.08% of the high-risk patient's non-survival vs 24.7% for the DL model and 4.65% vs 19.7% of the high-risk patient's non-survival for NSTEMI. Age, heart rate, Killip class, cardiac catheterization, oral hypoglycemia use and antiarrhythmic agent were found to be common predictors of in-hospital mortality across all ML feature selection models in this study. The final algorithm was converted into an online tool with a database for continuous data archiving for prospective validation. CONCLUSIONS ACS patients were better classified using a combination of machine learning and deep learning in a multi-ethnic Asian population when compared to TIMI scoring. Machine learning enables the identification of distinct factors in individual Asian populations to improve mortality prediction. Continuous testing and validation will allow for better risk stratification in the future, potentially altering management and outcomes.
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Affiliation(s)
- Sazzli Kasim
- Cardiology Department, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Shah Alam, Malaysia
- Cardiac Vascular and Lung Research Institute, Universiti Teknologi MARA (UiTM), Shah Alam, Malaysia
- National Heart Association of Malaysia, Heart House, Kuala Lumpur, Malaysia
- Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh Campus, Sungai Buloh, Malaysia
| | - Sorayya Malek
- Bioinformatics Division, Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia
- * E-mail:
| | - Cheen Song
- Bioinformatics Division, Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia
| | - Wan Azman Wan Ahmad
- National Heart Association of Malaysia, Heart House, Kuala Lumpur, Malaysia
- Division of Cardiology, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Alan Fong
- Sarawak Heart Centre, Kota Samarahan, Sarawak, Malaysia
- Clinical Research Centre, Sarawak General Hospital, Institute for Clinical Research, National Institutes of Health, Jalan Hospital, Kuching, Sarawak, Malaysia
- Swinburne University of Technology, Sarawak Campus, Kuching, Malaysia
| | - Khairul Shafiq Ibrahim
- Cardiology Department, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Shah Alam, Malaysia
- Cardiac Vascular and Lung Research Institute, Universiti Teknologi MARA (UiTM), Shah Alam, Malaysia
- National Heart Association of Malaysia, Heart House, Kuala Lumpur, Malaysia
| | - Muhammad Shahreeza Safiruz
- Department of Artificial Intelligence, Faculty of Computer Science and Information Technology, University of Malaya, Kuala Lumpur, Malaysia
| | - Firdaus Aziz
- Bioinformatics Division, Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia
| | - Jia Hui Hiew
- Bioinformatics Division, Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia
| | - Nurulain Ibrahim
- Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh Campus, Sungai Buloh, Malaysia
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Herscovici DM, Boggs KM, Cash RE, Espinola JA, Sullivan AF, Hasegawa K, Nagurney JT, Camargo CA. Development of a unified national database of primary percutaneous coronary intervention centers with co-located emergency departments, 2020. Am Heart J 2022; 254:149-155. [PMID: 36099978 DOI: 10.1016/j.ahj.2022.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 08/18/2022] [Accepted: 08/21/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Although primary percutaneous coronary intervention (pPCI) is the preferred intervention for ST-elevation myocardial infarction (STEMI), not all patients are admitted directly to an emergency department (ED) with 24/7/365 pPCI capabilities. This is partly due to a lack of a national system of known pPCI-capable EDs. Our objective was to create a unified, national database of confirmed 24/7/365 pPCI centers co-located in hospitals with EDs. METHODS We compiled all hospitals designated as Chest Pain Centers with Primary PCI by the American College of Cardiology's (ACC) National Clinical Data Registry (NCDR), all STEMI Receiving Centers designated by the American Heart Association's (AHA) Mission: Lifeline registry, and all state-designated pPCI-capable hospitals and designation criteria from state departments of health. We matched ACC, AHA, and state-designated facilities to those in the 2019 National ED Inventory (NEDI)-USA database to identify all EDs in pPCI-capable hospitals. RESULTS Overall, 467 hospitals were recognized as Chest Pain Centers with Primary PCI by ACC, 293 hospitals were recognized as being STEMI Receiving Centers by AHA, and 827 hospitals were confirmed to be pPCI-capable by state designations and operated 24/7/365. Together, there were 1,178 EDs (21% of 5,587 total) co-located in pPCI-capable hospitals operating 24/7/365. CONCLUSIONS There is substantial heterogeneity in cardiac systems of care, with large regional systems existing alongside local state-led initiatives. We created a unified national database of confirmed 24/7/365 pPCI centers co-located in hospitals with EDs. This data set will be valuable for future cardiac systems research and improving access to pPCI.
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Affiliation(s)
- Darya M Herscovici
- From the Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Krislyn M Boggs
- From the Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Rebecca E Cash
- From the Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Janice A Espinola
- From the Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Ashley F Sullivan
- From the Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Kohei Hasegawa
- From the Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - John T Nagurney
- From the Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Carlos A Camargo
- From the Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA.
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24
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Agha AM, Pacor J, Grandhi GR, Mszar R, Khan SU, Parikh R, Agrawal T, Burt J, Blankstein R, Blaha MJ, Shaw LJ, Al-Mallah MH, Brackett A, Cainzos-Achirica M, Miller EJ, Nasir K. The Prognostic Value of CAC Zero Among Individuals Presenting With Chest Pain: A Meta-Analysis. JACC Cardiovasc Imaging 2022; 15:1745-1757. [PMID: 36202453 DOI: 10.1016/j.jcmg.2022.03.031] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 03/17/2022] [Accepted: 03/31/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND There is little consensus on whether absence of coronary artery calcium (CAC) can identify patients with chest pain (CP) who can safely avoid additional downstream testing. OBJECTIVES The purpose of this study was to conduct a systematic review and meta-analysis investigating the utility of CAC assessment for ruling out obstructive coronary artery disease (CAD) among patients with stable and acute CP, at low-to-intermediate risk of obstructive CAD undergoing coronary computed tomography angiography (CTA). METHODS The authors searched online databases for studies published between 2005 and 2021 examining the relationship between CAC and obstructive CAD (≥50% coronary luminal narrowing) on coronary CTA among patients with stable and acute CP. RESULTS In this review, the authors included 19 papers comprising 79,903 patients with stable CP and 13 papers including 12,376 patients with acute CP undergoing simultaneous CAC and coronary CTA assessment. Overall, 45% (95% CI: 40%-50%) of patients with stable CP and 58% (95% CI: 50%-66%) of patients with acute CP had CAC = 0. The negative predictive values for CAC = 0 ruling out obstructive CAD were 97% (95% CI: 96%-98%) and 98% (95% CI: 96%-99%) among patients with stable and acute CP, respectively. Additionally, the prevalence of nonobstructive CAD among those with CAC = 0 was 13% (95% CI: 10%-16%) among those with stable CP and 9% (95% CI: 5%-13%) among those with acute CP. A CAC score of zero predicted a low incidence of major adverse cardiac events among patients with stable CP (0.5% annual event rate) and acute CP (0.8% overall event rate). CONCLUSIONS Among over 92,000 patients with stable or acute CP, the absence of CAC was associated with a very low prevalence of obstructive CAD, a low prevalence of nonobstructive CAD, and a low annualized risk of major adverse cardiac events. These findings support the role of CAC = 0 in a value-based health care delivery model as a "gatekeeper" for more advanced imaging among patients presenting with CP.
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Affiliation(s)
- Ali M Agha
- Baylor College of Medicine, Houston, Texas, USA
| | - Justin Pacor
- Yale New Haven Hospital, New Haven, Connecticut, USA
| | | | - Reed Mszar
- Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Safi U Khan
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Roosha Parikh
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Tanushree Agrawal
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Jeremy Burt
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ron Blankstein
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | | | | | - Edward J Miller
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Khurram Nasir
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA.
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25
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Zhang T, Hou D, He J, Zeng X, Liu R, Liu L, Li T, Xiao Y, Ma R, Huang H, Duan C. Oxidative-Damaged Mitochondria Activate GABARAPL1-Induced NLRP3 Inflammasomes in an Autophagic-Exosome Manner after Acute Myocardial Ischemia. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:7958542. [PMID: 36238641 PMCID: PMC9553392 DOI: 10.1155/2022/7958542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/12/2022] [Indexed: 12/02/2022]
Abstract
Objective This study is aimed at identifying the potential diagnostic markers for circulating endothelial cells (CECs) for acute myocardial ischemia (AMI) and exploring the regulatory mechanisms of the selected biomarker in mitochondrial oxidative damage and vascular inflammation in AMI pathology. Methods Utilizing the Gene Expression Omnibus dataset GSE66360, we scanned for differentially expressed genes (DEGs) in 49 AMI patients and 50 healthy subjects. To discover possible biomarkers, LASSO regression and support vector machine recursive feature elimination examinations were conducted. Using the GSE60993 and GSE123342 datasets and AMI rat models, the expression levels and diagnostic accuracy of the biomarkers in AMI were thoroughly verified. CIBERSORT was employed to evaluate the compositional patterns of 22 distinct immunological cell percentages in AMI according to combined cohorts. The oxidative-damaged mitochondria were detected by confocal microscopy observation of MitoTracker, ROS-DCFH-DA, and mCherry-GFP-LC3B. Results In total, 122 genes were identified. The identified DEGs primarily contributed in arteriosclerosis, arteriosclerotic cardiovascular disorders, bacterial infectious disorder, coronary artery disease, and myocardial infarction. Nine features (NR4A2, GABARAPL1 (GEC1), CLEC4D, ITLN1, SNORD89, ZFP36, CH25H, CCR2, and EFEMP1) of the DEGs were shared by two algorithms, and GABARAPL1 (GEC1) was identified and verified as a diagnostic mitochondrial biomarker for AMI. Confocal results showed that there existed mitochondrial damage and oxidative stress in cardiac CMECs after AMI, and the blocked autophagy flux could be released by exosome burst in cardiac CMECs and blood CECs. Immune cell infiltration testing declared that elevated GEC1 expression in blood CECs was linked to the rise of monocytes and neutrophils. Functional tests revealed that high GEC1 expression in CMECs and CECs could activate the vascular inflammatory response by stimulating NLRP3 inflammasome production after AMI. Conclusion Oxidative-damaged mitochondria in cardiac CMECs activate GEC1-mediated autophagosomes but block autophagy flux after AMI. The exfoliated cardiac CMECs evolve into abnormal blood CECs, and the undegraded GEC1 autophagosomes produce a large number of NLRP3 inflammasomes by exosome burst, stimulating the increase in monocytes and neutrophils and ultimately triggering vascular inflammation after AMI. Therefore, GEC1 in blood CECs is a highly specific diagnostic mitochondrial biomarker for AMI.
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Affiliation(s)
- Tiechun Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
- Department of Rehabilitation, the Fifth People's Hospital of Chongqing, Chinese Academy of Sciences, Chongqing 400062, China
| | - Dongyao Hou
- Department of Anesthesiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Jianrong He
- Department of Anesthesiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Xue Zeng
- Department of Anesthesiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Ruixue Liu
- Department of Anesthesiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Liangming Liu
- Department of Shock and Transfusion, State Key Laboratory of Trauma, Burns and Combined Injury, Daping Hospital, Army Medical University, Chongqing 400042, China
| | - Tao Li
- Department of Shock and Transfusion, State Key Laboratory of Trauma, Burns and Combined Injury, Daping Hospital, Army Medical University, Chongqing 400042, China
| | - Yingbin Xiao
- Department of Cardiovascular Surgery, Xinqiao Hospital, Army Medical University, Chongqing 400037, China
| | - Ruiyan Ma
- Department of Cardiovascular Surgery, Xinqiao Hospital, Army Medical University, Chongqing 400037, China
| | - He Huang
- Department of Anesthesiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Chenyang Duan
- Department of Anesthesiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
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26
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Wan Kim J, Monlezun D, Kun Park J, Chauhan S, Balanescu D, Koutroumpakis E, Palaskas N, Kim P, Hassan S, Botz G, Crommett J, Reddy D, Cilingiroglu M, Marmagkiolis K, Iliescu C. Post-Cardiac Arrest PCI is Underutilized Among Cancer Patients: Machine Learning Augmented Nationally Representative Case-Control Study of 30 Million Hospitalizations. Resuscitation 2022; 179:43-49. [PMID: 35933056 DOI: 10.1016/j.resuscitation.2022.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/05/2022] [Accepted: 07/25/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cancer patients are less likely to undergo percutaneous coronary intervention (PCI) after cardiac arrest, although they demonstrate improved mortality benefit from the procedure. We produced the largest nationally representative analysis of mortality of cardiac arrest and PCI for patients with cancer versus non-cancer. METHODS Propensity score adjusted multivariable regression for mortality was performed in this case-control study of the United States' largest all-payer hospitalized dataset, the 2016 National Inpatient Sample. Regression models of mortality and PCI weighted by the complex survey design were fully adjusted for age, race, income, cancer metastases, NIS-calculated mortality risk by Diagnosis Related Group (DRG), acute coronary syndrome, and likelihood of undergoing PCI RESULTS: Of the 30,195,722 hospitalized adult patients, 15.43% had cancer, and 0.79% of the whole sample presented with cardiac arrest (of whom 20.57% underwent PCI). In fully adjusted regression analysis among patients with cardiac arrest, PCI significantly reduced mortality (OR 0.15, 95%CI 0.13-0.19; p<0.001) among patients with cancer greater than those without it (OR 0.21, 95%CI 0.20-0.23; p<0.001). CONCLUSIONS This nationally representative study suggests that post-cardiac arrest PCI is underutilized among patients with cancer despite its significant mortality reduction for such patients (independent of clinical acuity).
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Affiliation(s)
- Jin Wan Kim
- Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - Dominique Monlezun
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jong Kun Park
- Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Siddharth Chauhan
- Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Dinu Balanescu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Nicolas Palaskas
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Peter Kim
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Saamir Hassan
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gregory Botz
- Department of Critical Care Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - John Crommett
- Department of Critical Care Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Dereddi Reddy
- Department of Critical Care Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mehmet Cilingiroglu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Cezar Iliescu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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27
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Chunawala ZS, Qamar A, Arora S, Pandey A, Fudim M, Vaduganathan M, Bhatt DL, Mentz RJ, Caughey MC. Prevalence and Prognostic Significance of Polyvascular Disease in Patients Hospitalized With Acute Decompensated Heart Failure: The ARIC Study. J Card Fail 2022; 28:1267-1277. [PMID: 35045321 PMCID: PMC9287495 DOI: 10.1016/j.cardfail.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/30/2021] [Accepted: 01/10/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Polyvascular disease is associated with increased mortality rates and decreased quality of life. Whether its prevalence or associated outcomes differ for patients hospitalized with heart failure with reduced vs preserved ejection fraction (HFrEF vs HFpEF, respectively) is uncertain. METHODS The Atherosclerosis Risk in Communities (ARIC) study conducted hospital surveillance of acute decompensated heart failure (ADHF) from 2005-2014. Polyvascular disease (coexisting disease in ≥ 2 arterial beds) was identified based on the finding of prevalent coronary artery disease, peripheral artery disease or cerebrovascular disease. Mortality risks associated with polyvascular disease were analyzed separately for HFpEF and HFrEF, with adjustment for potential confounders. All analyses were weighted by the inverse of the sampling probability. RESULTS Of 24,937 weighted (5460 unweighted) hospitalizations due to ADHF (52% female, 32% Black, mean age 75 years), polyvascular disease was prevalent in 22% with HFrEF and in 17% with HFpEF. One-year mortality risks increased sequentially with 0, 1 and ≥ 2 arterial bed involvement, both for patients with HFrEF (29%-32%-38%; P trend = 0.0006) and for those with HFpEF (26%-32%-37%; P trend < 0.0001). After adjustments, polyvascular disease was associated with a 26% higher mortality hazard for patients with HFrEF (HR = 1.26; 95% CI: 1.07-1.50) and a 29% higher hazard for patients with HFpEF (HR = 1.29; 95% CI: 1.03-1.62), with no interaction by HF type (P interaction = 0.9). CONCLUSION Patients hospitalized with ADHF and coexisting polyvascular disease have an increased risk of death, irrespective of HF type. Clinical attention should be directed toward polyvascular disease, with implementation of secondary prevention strategies to improve the prognosis of this high-risk population. SUMMARY Polyvascular disease is known to be associated with myocardial infarction, stroke or cardiovascular death and is a major risk factor for decreased quality of life. This study sought to evaluate the relationship between polyvascular disease and mortality in patients hospitalized with acute decompensated heart failure (ADHF), and to understand whether the associations differ based on ejection fraction. Patients hospitalized with ADHF and coexisting polyvascular disease had an increased risk of death, irrespective of heart failure type, implying the need for increased clinical attention directed toward polyvascular disease, along with implementation of secondary prevention strategies to improve prognosis. TWEET Patients hospitalized with acute HF and coexisting polyvascular disease face an increased risk of death, irrespective of HF type.
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Affiliation(s)
- Zainali S Chunawala
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Arman Qamar
- Section of Interventional Cardiology and Vascular Medicine, Northshore University HealthSystem; Chicago, Illinois
| | - Sameer Arora
- Division of Cardiology, University of North Carolina School of Medicine; Chapel Hill, North Carolina
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Marat Fudim
- Division of Cardiology, Duke University School of Medicine, Duke Clinical Research Institute; Durham, North Carolina
| | - Muthiah Vaduganathan
- Divison of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School; Boston, Massachusetts
| | - Deepak L Bhatt
- Divison of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School; Boston, Massachusetts
| | - Robert J Mentz
- Division of Cardiology, Duke University School of Medicine, Duke Clinical Research Institute; Durham, North Carolina
| | - Melissa C Caughey
- Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University; Chapel Hill, North Carolina.
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28
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Binti NN, Ferdausi N, Anik MEK, Islam LN. Association of albumin, fibrinogen, and modified proteins with acute coronary syndrome. PLoS One 2022; 17:e0271882. [PMID: 35881574 PMCID: PMC9321412 DOI: 10.1371/journal.pone.0271882] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 07/10/2022] [Indexed: 11/19/2022] Open
Abstract
Acute coronary syndrome (ACS) comprises a pathophysiological spectrum of cardiovascular diseases related to atherosclerotic coronary plaque erosion. Oxidative stress and inflammation play pivotal roles in the development and progression of atherosclerosis, which affects circulatory proteins, including albumin and fibrinogen, thereby causing an imbalance in albumin to globulin and fibrinogen to albumin ratios. This study aimed to assess the effect of oxidative stress on circulatory proteins, correlate these parameters, and investigate their significance in patients with ACS. In this case-control study, the major blood proteins in patients with ACS and a control group were evaluated using standard methods. Out of 70 ACS cases, 75.7% had ST-elevation myocardial infarction (STEMI), 18.6% had non-STEMI, and 5.7% had unstable angina. The mean cardiac troponin I level in patients was 12.42 ng/mL. The patients demonstrated a significantly reduced level of human serum albumin (HSA), 3.81 ± 0.99 g/dL, compared to controls, 5.33 ± 0.66 g/dL. The albumin to globulin ratio (AGR) was significantly depressed in patients while their mean fibrinogen level and the fibrinogen to albumin ratio (FAR) were significantly higher. Multivariate logistic regression analysis showed that albumin and fibrinogen were significantly associated with the risk of ACS, showing the potential of these parameters to be used for risk assessment of ACS. The ischemia modified albumin (IMA) and protein carbonyls were significantly higher in patients which showed significant positive correlations with FAR. Albumin, IMA and protein carbonyls were found to have high diagnostic sensitivity and specificity for ACS. Overall, these circulatory and modified proteins in ACS patients, particularly lower HSA, AGR, and higher IMA and protein carbonyls may help assess risk.
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Affiliation(s)
- Nabila Nawar Binti
- Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka, Bangladesh
| | - Nourin Ferdausi
- Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka, Bangladesh
| | | | - Laila Noor Islam
- Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka, Bangladesh
- * E-mail:
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29
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Kesgün M, Yavuz BG, Satilmis D, Colak S. Comparison of the T-MACS score with the TIMI score in patients presenting to the emergency department with chest pain. Am J Emerg Med 2022; 60:24-28. [PMID: 35878571 DOI: 10.1016/j.ajem.2022.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/27/2022] [Accepted: 07/07/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Guidelines recommend the use of risk scoring in patients with chest pain. In this study, we aimed to compare the thrombolysis in myocardial infarction risk index (TIMI) score with the Troponin Only Manchester Acute Coronary Syndrome Score (T-MACS) score and to investigate the usability of the T-MACS score in the emergency department. METHODS In our study; The TIMI and T-MACS scores of 310 patients with suspected NSTEMI who applied to the emergency department with chest pain and met the inclusion and exclusion criteria were prospectively evaluated. The primary outcome was MACE at 30 days including acute coronary syndromes, need for revascularization and deaths. Descriptive data and TIMI and T-MACS scores for predicting MACE and ACS was evaluated by calculating sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). ROC (Receiver Operating Characteristic) analysis was also performed to determine TIMI and T-MACS risk class. RESULTS In our study, the mean age of the patients was 49.7 ± 19.4 years, the 1-month mortality rate was 1.3%, majör adverse cardiac event (MACE) rate was 6.5%, and acute coronary syndrome (ACS) rate was 5.5%. T-MACS risk class for predicting MACE sensitivity 100%, selectivity 51.72, PPV 12.5% (for very low risk), NPV was calculated as 100%; sensitivity for TIMI risk class low risk 35%, selectivity 88.97%, PPV was calculated as 17.9%, NPV was calculated as 95.2%. T-MACS high risk class for predicting MACE; sensitivity was 60%, selectivity 99.66%, PPV 92.3% and NPV was 97.3%; TIMI high risk class for predicting MACE; sensitivity was 10%, selectivity was 97.93%, PPV was 25% and NPV was 94%. CONCLUSIONS The findings obtained in this study suggest that the T-MACS score is more successful than the TIMI score in determining the low risk (very low risk for T-MACS score), high risk, and estimated 1-month MACE risk in cases who presented to the emergency department with chest pain.
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Affiliation(s)
- Mücahit Kesgün
- Diyarbakır Dagkapı Hospital, Department of Emergency Medicine, Diyarbakır, Turkey
| | - Burcu Genc Yavuz
- University of Health Sciences, Haydarpasa Numune Training and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey.
| | - Dilay Satilmis
- University of Health Sciences, Sultan 2. Abdulhamit Han Training and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey
| | - Sahin Colak
- University of Health Sciences, Haydarpasa Numune Training and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey
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Zapater A, Solelhac G, Sánchez-de-la-Torre A, Gracia-Lavedan E, Benitez ID, Torres G, De Batlle J, Haba-Rubio J, Berger M, Abad J, Duran-Cantolla J, Urrutia A, Mediano O, Masdeu MJ, Ordax-Carbajo E, Masa JF, De la Peña M, Mayos M, Coloma R, Montserrat JM, Chiner E, Mínguez O, Pascual L, Cortijo A, Martínez D, Dalmases M, Lee CH, McEvoy RD, Barbé F, Heinzer R, Sánchez-de-la-Torre M. Respiratory Polygraphy Patterns and Risk of Recurrent Cardiovascular Events in Patients With Acute Coronary Syndrome. Front Med (Lausanne) 2022; 9:870906. [PMID: 35833104 PMCID: PMC9271863 DOI: 10.3389/fmed.2022.870906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Obstructive sleep apnea (OSA) severity is based on the apnea-hypopnea index (AHI). The AHI is a simplistic measure that is inadequate for capturing disease severity and its consequences in cardiovascular diseases (CVDs). Deleterious effects of OSA have been suggested to influence the prognosis of specific endotypes of patients with acute coronary syndrome (ACS). We aim to identify respiratory polygraphy (RP) patterns that contribute to identifying the risk of recurrent cardiovascular events in patients with ACS. Methods Post hoc analysis of the ISAACC study, including 723 patients admitted for a first ACS (NCT01335087) in which RP was performed. To identify specific RP patterns, a principal component analysis (PCA) was performed using six RP parameters: AHI, oxygen desaturation index, mean and minimum oxygen saturation (SaO2), average duration of events and percentage of time with SaO2 < 90%. An independent HypnoLaus population-based cohort was used to validate the RP components. Results From the ISAACC study, PCA showed that two RP components accounted for 70% of the variance in the RP data. These components were validated in the HypnoLaus cohort, with two similar RP components that explained 71.3% of the variance in the RP data. The first component (component 1) was mainly characterized by low mean SaO2 and obstructive respiratory events with severe desaturation, and the second component (component 2) was characterized by high mean SaO2 and long-duration obstructive respiratory events without severe desaturation. In the ISAACC cohort, component 2 was associated with an increased risk of recurrent cardiovascular events in the third tertile with an adjusted hazard ratio (95% CI) of 2.44 (1.07 to 5.56; p-value = 0.03) compared to first tertile. For component 1, no significant association was found for the risk of recurrent cardiovascular events. Conclusion A RP component, mainly characterized by intermittent hypoxemia, is associated with a high risk of recurrent cardiovascular events in patients without previous CVD who have suffered a first ACS.
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Affiliation(s)
- Andrea Zapater
- Precision Medicine in Chronic Diseases, Hospital Universitari Arnau de Vilanova-Santa Maria, IRB Lleida, Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Geoffroy Solelhac
- Center for Investigation and Research in Sleep, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alicia Sánchez-de-la-Torre
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Translation Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, IRBLleida, Lleida, Spain
| | - Esther Gracia-Lavedan
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Translation Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, IRBLleida, Lleida, Spain
| | - Ivan David Benitez
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Translation Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, IRBLleida, Lleida, Spain
| | - Gerard Torres
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Translation Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, IRBLleida, Lleida, Spain
| | - Jordi De Batlle
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Translation Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, IRBLleida, Lleida, Spain
| | - José Haba-Rubio
- Center for Investigation and Research in Sleep, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Mathieu Berger
- Center for Investigation and Research in Sleep, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jorge Abad
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Respiratory Department, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Joaquín Duran-Cantolla
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Servicio de Investigación OSI, IIS Bioaraba, Hospital Universitario Araba, Vitoria-Gasteiz, Spain
| | - Amaia Urrutia
- Servicio Neumologia, Hospital Universitario Cruces, Bizkaia, Spain
| | - Olga Mediano
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Respiratory Department, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - María José Masdeu
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Respiratory and Sleep Department, Hospital Universitari Parc Taulí, Institut Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Juan Fernando Masa
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Respiratory Department, Hospital San Pedro Alcántara, Cáceres, Spain
| | - Mónica De la Peña
- Clinic Analysis and Respiratory Services, Institut de Investigació Sanitaria de Palma, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Mercé Mayos
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Sleep Unit, Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ramon Coloma
- Respiratory Department, Hospital General Universitario de Albacete, Albacete, Spain
| | - Josep María Montserrat
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Respiratory Department, Hospital Clinic, Barcelona, Spain
| | - Eusebi Chiner
- Respiratory Department, Hospital Universitari Sant Joan d'Alacant, Alicante, Spain
| | - Olga Mínguez
- Translation Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, IRBLleida, Lleida, Spain
| | - Lydia Pascual
- Translation Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, IRBLleida, Lleida, Spain
| | - Anunciación Cortijo
- Translation Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, IRBLleida, Lleida, Spain
| | - Dolores Martínez
- Translation Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, IRBLleida, Lleida, Spain
| | - Mireia Dalmases
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Translation Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, IRBLleida, Lleida, Spain
| | - Chi-Hang Lee
- Cardiovascular Research Institute, National University of Singapore, Singapore, Singapore
| | - R Doug McEvoy
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Ferran Barbé
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Center for Investigation and Research in Sleep, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Raphael Heinzer
- Center for Investigation and Research in Sleep, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Pulmonary Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Manuel Sánchez-de-la-Torre
- Precision Medicine in Chronic Diseases, Hospital Universitari Arnau de Vilanova-Santa Maria, IRB Lleida, Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
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Attar R, Valentin JB, Andell P, Nielsen RE, Jensen SE. Major adverse cardiovascular events following acute coronary syndrome in patients with bipolar disorder. Int J Cardiol 2022; 363:1-5. [PMID: 35716946 DOI: 10.1016/j.ijcard.2022.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 05/19/2022] [Accepted: 06/10/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Persons with bipolar disorder (BD) have a higher cardiovascular mortality compared to the general population, partially explained by the increased burden of cardiovascular risk factors. Research regarding outcomes following acute coronary syndrome (ACS) in this population remains scarce. DESIGN This Danish register-based study included patients diagnosed with BD and ACS in the period between January 1st, 1995, to December 31st, 2013. Study participants were matched 1:2 to patients without BD on sex, date of birth, time of ACS diagnosis and comorbidities. The primary outcome of interest was major adverse cardiovascular events (MACE) a composite of all-cause mortality, reinfarction or stroke. MACE and its individual components were compared between patients with and without BD. RESULTS 796 patients with BD were compared to 1592 patients without BD, both groups had a mean age of first ACS of 66.5 years. MACE was 38% increased (HR 1.38 95% CI 1.25-1.54), all-cause mortality was 71% increased (HR 1.71 95% CI 1.52-1.92), stroke was 94% increased (HR 1.94 95% CI 1.56-2.41) and reinfarction rates were 17% lower (HR 0.83 95% CI 0.69-1.00) in the BD population compared to the population without BD. We also found higher prevalences of heart failure (9.1% vs. 6.5%), valve disease (5.3% vs. 3.5%), anemia (8.7% vs. 5.8%), chronic obstructive pulmonary disease (13.4% vs. 9.3%) and stroke (11.8% vs. 7.8%) in the population with BD at baseline, all p-values <0.05. CONCLUSION Bipolar disorder was associated with a higher risk of composite MACE, all-cause mortality, and stroke, after ACS compared to patients without BD.
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Affiliation(s)
- Rubina Attar
- Department of Cardiology, Department of Cardiology and Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden; Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
| | - Jan Brink Valentin
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Pontus Andell
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, and Heart and Vascular Division, Karolinska University Hospital, Stockholm, Sweden..
| | | | - Svend Eggert Jensen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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Lasica R, Djukanovic L, Mrdovic I, Savic L, Ristic A, Zdravkovic M, Simic D, Krljanac G, Popovic D, Simeunovic D, Rajic D, Asanin M. Acute Coronary Syndrome in the COVID-19 Era-Differences and Dilemmas Compared to the Pre-COVID-19 Era. J Clin Med 2022; 11:jcm11113024. [PMID: 35683411 PMCID: PMC9181081 DOI: 10.3390/jcm11113024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/06/2022] [Accepted: 05/17/2022] [Indexed: 01/08/2023] Open
Abstract
The COVID-19 pandemic has led to numerous negative implications for all aspects of society. Although COVID-19 is a predominant lung disease, in 10-30% of cases, it is associated with cardiovascular disease (CVD). The presence of myocardial injury in COVID-19 patients occurs with a frequency between 7-36%. There is growing evidence of the incidence of acute coronary syndrome (ACS) in COVID-19, both due to coronary artery thrombosis and insufficient oxygen supply to the myocardium in conditions of an increased need. The diagnosis and treatment of patients with COVID-19 and acute myocardial infarction (AMI) is a major challenge for physicians. Often the presence of mixed symptoms, due to the combined presence of COVID-19 and ACS, as well as possible other diseases, nonspecific changes in the electrocardiogram (ECG), and often elevated serum troponin (cTn), create dilemmas in diagnosing ACS in COVID-19. Given the often-high ischemic risk, as well as the risk of bleeding, in these patients and analyzing the benefit/risk ratio, the treatment of patients with AMI and COVID-19 is often associated with dilemmas and difficult decisions. Due to delays in the application of the therapeutic regimen, complications of AMI are more common, and the mortality rate is higher.
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Affiliation(s)
- Ratko Lasica
- Department of Cardiology, Emergency Center, Clinical Center of Serbia, 11000 Belgrade, Serbia; (L.D.); (I.M.); (L.S.); (G.K.); (D.R.); (M.A.)
- Correspondence:
| | - Lazar Djukanovic
- Department of Cardiology, Emergency Center, Clinical Center of Serbia, 11000 Belgrade, Serbia; (L.D.); (I.M.); (L.S.); (G.K.); (D.R.); (M.A.)
| | - Igor Mrdovic
- Department of Cardiology, Emergency Center, Clinical Center of Serbia, 11000 Belgrade, Serbia; (L.D.); (I.M.); (L.S.); (G.K.); (D.R.); (M.A.)
| | - Lidija Savic
- Department of Cardiology, Emergency Center, Clinical Center of Serbia, 11000 Belgrade, Serbia; (L.D.); (I.M.); (L.S.); (G.K.); (D.R.); (M.A.)
| | - Arsen Ristic
- Department of Cardiology, Clinical Center of Serbia, 11000 Belgrade, Serbia; (A.R.); (D.S.); (D.P.); (D.S.)
| | | | - Dragan Simic
- Department of Cardiology, Clinical Center of Serbia, 11000 Belgrade, Serbia; (A.R.); (D.S.); (D.P.); (D.S.)
| | - Gordana Krljanac
- Department of Cardiology, Emergency Center, Clinical Center of Serbia, 11000 Belgrade, Serbia; (L.D.); (I.M.); (L.S.); (G.K.); (D.R.); (M.A.)
| | - Dejana Popovic
- Department of Cardiology, Clinical Center of Serbia, 11000 Belgrade, Serbia; (A.R.); (D.S.); (D.P.); (D.S.)
| | - Dejan Simeunovic
- Department of Cardiology, Clinical Center of Serbia, 11000 Belgrade, Serbia; (A.R.); (D.S.); (D.P.); (D.S.)
| | - Dubravka Rajic
- Department of Cardiology, Emergency Center, Clinical Center of Serbia, 11000 Belgrade, Serbia; (L.D.); (I.M.); (L.S.); (G.K.); (D.R.); (M.A.)
| | - Milika Asanin
- Department of Cardiology, Emergency Center, Clinical Center of Serbia, 11000 Belgrade, Serbia; (L.D.); (I.M.); (L.S.); (G.K.); (D.R.); (M.A.)
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Whittier M, Bautista Sanchez R, Arora S, Manadan AM. Systemic Lupus Erythematosus and Antiphospholipid Antibody Syndrome as Risk Factors for Acute Coronary Syndrome in Young Patients: Analysis of the National Inpatient Sample. J Clin Rheumatol 2022; 28:143-146. [PMID: 35293887 DOI: 10.1097/rhu.0000000000001824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to compare the odds of acute coronary syndrome (ACS) in patients aged 18 to 40 years to patients older than 40 years with and without secondary diagnoses of systemic lupus erythematosus (SLE) or antiphospholipid antibody syndrome (APLS) while controlling for traditional cardiovascular (CV) risk factors. METHODS Data were extracted from the National Inpatient Sample database from 2016 to 2018. The National Inpatient Sample was searched for hospitalizations of adult patients with ACS as the principal diagnosis, with and without SLE or APLS as secondary diagnoses. Age was divided categorically into 2 groups: adults aged 18 to 40 years and those older than 40 years. The primary outcome was the development of ACS. Multivariate logistic regression analyses were used to adjust for confounders. RESULTS There were 90,879,561 hospital discharges in the 2016 to 2018 database. Of those, 55,050 between the ages of 18 to 40 years and 1,966,234 aged older than 40 years were hospitalized with a principal diagnosis of ACS. Traditional CV risk factors were associated with ACS hospitalizations in both age groups. In multivariate analysis of the 18 to 40 years age group, both SLE (odds ratio, 2.18; 95% confidence interval, 1.814-2.625) and APLS (odds ratio, 2.18; 95% confidence interval, 1.546-3.087) were strongly associated with ACS hospitalizations. After the age of 40 years, there were no increased odds of ACS hospitalizations for SLE or APLS. CONCLUSIONS In the younger population, SLE and APLS were strongly associated with ACS hospitalizations in addition to the traditional CV risk factors. In the older age group, traditional CV risk factors dominated and diluted the effect of SLE and APLS.
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Lupu L, Taha L, Banai A, Shmueli H, Borohovitz A, Matetzky S, Gabarin M, Shuvy M, Beigel R, Orvin K, Minha S, Shacham Y, Banai S, Glikson M, Asher E. Immediate and early percutaneous coronary intervention in very high-risk and high-risk non-ST segment elevation myocardial infarction patients. Clin Cardiol 2022; 45:359-369. [PMID: 35266561 PMCID: PMC9019882 DOI: 10.1002/clc.23781] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 12/18/2021] [Accepted: 01/03/2022] [Indexed: 12/12/2022] Open
Abstract
Background The European Society of Cardiology (ESC) guidelines for the management of acute coronary syndromes in patients presenting without persistent ST‐segment elevation (non‐ST‐segment elevation myocardial infarction [NSTEMI]) has recommended immediate (<2 h) percutaneous coronary intervention (PCI) in very‐high risk patients and early (<24 h) PCI in high‐risk patients. Hypothesis To examine the ESC NSTEMI guidelines adherence in a nationwide survey in Israel using the Acute Coronary Syndrome Israeli Survey (ACSIS). We hypothesized that adherence to the guidlines' recommnded PCI timing in NSTEMI pateints will be inadequate, partly due to the inconsistent evidence regarding its effect on clinical outcomes. Methods All NSTEMI patients who underwent PCI during the ACSIS surveys in 2016 and 2018 were included in the analysis. Results Out of 1793 NSTEMI patients, 1643 (92%) patients underwent PCI, and door to balloon time was documented in 1078 of them. One hundred and fifty‐six (14.5%) patients and 922 (85.5%) patients were defined as very high‐risk and high‐risk NSTEMI patients, respectively. Of the very high‐risk NSTEMI patients, only 10 (6.4%) underwent immediate coronary angiography, and 50 (32.1%) underwent early coronary angiography. Acute heart failure 139 (89.1%) was the main reason for including NSTEMI patients in the very high‐risk category. Of the high‐risk patients, early coronary angiography was performed in only 405 (43.9%) patients. Patients in whom coronary angiography was postponed were older and had more comorbidities. Conclusions Despite guidelines recommendations for immediate and early PCI in very high‐risk and high‐risk NSTEMI patients, respectively, most patients do not undergo immediate or early PCI according to contemporary guidelines. Further studies are needed to better understand the reasons for guidelines' nonadherence in those high‐risk patients.
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Affiliation(s)
- Lior Lupu
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Louay Taha
- Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Ariel Banai
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hezzy Shmueli
- Department of Cardiology, Soroka Medical Center, Beer-Sheva, Israel and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ariel Borohovitz
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomi Matetzky
- Department of Cardiology, Sheba Medical Center, Ramat Gan, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mustafa Gabarin
- Dep-artment of Cardiology, Meir Medical Center, Kfar Saba, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mony Shuvy
- Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Roy Beigel
- Department of Cardiology, Sheba Medical Center, Ramat Gan, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Katia Orvin
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sa'ar Minha
- Department of Cardiology, Shamir Medical Center, Be'er Ya'akov, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yacov Shacham
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shmuel Banai
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Glikson
- Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Elad Asher
- Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
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The Assessment of Maternal and Fetal Intima-Media Thickness in Perinatology. J Clin Med 2022; 11:jcm11051168. [PMID: 35268257 PMCID: PMC8911195 DOI: 10.3390/jcm11051168] [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: 12/05/2021] [Revised: 01/30/2022] [Accepted: 02/17/2022] [Indexed: 12/10/2022] Open
Abstract
Intima-media thickness (IMT) measurement is a non-invasive method of arterial wall assessment. An increased IMT is a common manifestation of atherosclerosis associated with endothelial dysfunction. In the course of pregnancy, various maternal organs, including the endothelium, are prepared for their new role. However, several pre-gestational conditions involving endothelial dysfunction, such as diabetes, chronic hypertension, and obesity, may impair the adaptation to pregnancy, whereas vascular changes may also affect fetal development, thus, influencing the fetal IMT. In the conducted studies, a correlation was found between an increased fetal abdominal aorta IMT (aIMT) and placental dysfunctions, which may subsequently impact both the mother and the fetus, and contribute to gestational hypertension, preeclampsia (PE), and fetal growth restriction (FGR). In fact, data indicate that following the delivery, the endothelial dysfunction persists and influences the future health of the mother and the newborn. Hypertensive disorders in pregnancy increase the maternal risk of chronic hypertension, obesity, and vascular events. Moreover, individuals born from pregnancies complicated by preeclampsia or fetal growth restriction are at high risk of obesity, diabetes, hypertension, and cardiovascular disease. Therefore, understanding the pathomechanism underlying an increased aIMT in preeclampsia and FGR, as well as subsequent placental dysfunctions, is essential for developing targeted therapies. This review summarizes recent publications regarding IMT and demonstrates how IMT measurements affect predicting perinatal complications.
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What the near Future Holds for Sacubitril/Valsartan: A Summary of Major Ongoing Studies. J Cardiovasc Dev Dis 2022; 9:jcdd9020054. [PMID: 35200707 PMCID: PMC8875386 DOI: 10.3390/jcdd9020054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/03/2022] [Accepted: 02/07/2022] [Indexed: 12/11/2022] Open
Abstract
Early research on neprilysin inhibition showed that sacubitril/valsartan, a combination of the valsartan and the neprilysin inhibitor sacubitril, was superior to enalapril in patients with heart failure with reduced ejection fraction (HFrEF) in the PARADIGM-HF study in 2014. Therefore, for patients with HFrEF, worldwide recommendations have been reformed to include sacubitril/valsartan. In addition, sacubitril/valsartan has been investigated in other cardiovascular disease states, such as patients with heart failure and preserved ejection fraction (HFpEF) and following myocardial infarction (MI) events. In February 2021, the FDA expanded the indication use of sacubitril/valsartan to include the HFpEF patient population based on the results of the PARAGON-HF trial. However, randomized clinical trials post-MI did not show promising results. Sacubitril/valsartan is currently being investigated in many other cardiovascular and non-cardiovascular conditions. This review aims to shed light and summarize the ongoing sacubitril/valsartan registered studies on the United States National Library of Medicine clinical trials registry.
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Marei I, Chidiac O, Thomas B, Pasquier J, Dargham S, Robay A, Vakayil M, Jameesh M, Triggle C, Rafii A, Jayyousi A, Al Suwaidi J, Abi Khalil C. Angiogenic content of microparticles in patients with diabetes and coronary artery disease predicts networks of endothelial dysfunction. Cardiovasc Diabetol 2022; 21:17. [PMID: 35109843 PMCID: PMC8812242 DOI: 10.1186/s12933-022-01449-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/20/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Elevated endothelial microparticles (EMPs) levels are surrogate markers of vascular dysfunction. We analyzed EMPs with apoptotic characteristics and assessed the angiogenic contents of microparticles in the blood of patients with type 2 diabetes (T2D) according to the presence of coronary artery disease (CAD). METHODS A total of 80 participants were recruited and equally classified as (1) healthy without T2D, (2) T2D without cardiovascular complications, (3) T2D and chronic coronary artery disease (CAD), and (4) T2D and acute coronary syndrome (ACS). MPs were isolated from the peripheral circulation, and EMPs were characterized using flow cytometry of CD42 and CD31. CD62E was used to determine EMPs' apoptotic/activation state. MPs content was extracted and profiled using an angiogenesis array. RESULTS Levels of CD42- CD31 + EMPs were significantly increased in T2D with ACS (257.5 ± 35.58) when compared to healthy subjects (105.7 ± 12.96, p < 0.01). There was no significant difference when comparing T2D with and without chronic CAD. The ratio of CD42-CD62 +/CD42-CD31 + EMPs was reduced in all T2D patients, with further reduction in ACS when compared to chronic CAD, reflecting a release by apoptotic endothelial cells. The angiogenic content of the full population of MPs was analyzed. It revealed a significant differential expression of 5 factors in patients with ACS and diabetes, including TGF-β1, PD-ECGF, platelet factor 4, serpin E1, and thrombospondin 1. Ingenuity Pathway Analysis revealed that those five differentially expressed molecules, mainly TGF-β1, inhibit key pathways involved in normal endothelial function. Further comparison of the three diabetes groups to healthy controls and diabetes without cardiovascular disease to diabetes with CAD identified networks that inhibit normal endothelial cell function. Interestingly, DDP-IV was the only differentially expressed protein between chronic CAD and ACS in patients with diabetes. CONCLUSION Our data showed that the release of apoptosis-induced EMPs is increased in diabetes, irrespective of CAD, ACS patients having the highest levels. The protein contents of MPs interact in networks that indicate vascular dysfunction.
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Affiliation(s)
- Isra Marei
- Department of Pharmacology, Weill Cornell Medicine-Qatar, Doha, Qatar
- National Heart and Lung Institute, Imperial College London, London, UK
- Department of Genetic Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Omar Chidiac
- Department of Genetic Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Binitha Thomas
- Department of Genetic Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Jennifer Pasquier
- Department of Genetic Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Soha Dargham
- Biostatistics Core, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Amal Robay
- Department of Genetic Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Muneera Vakayil
- Department of Genetic Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | | | | | - Arash Rafii
- Department of Genetic Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Amin Jayyousi
- Department of Endocrinology, Hamad Medical Corporation, Doha, Qatar
| | | | - Charbel Abi Khalil
- Department of Genetic Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar.
- Heart Hospital, Hamad Medical Corporation, Doha, Qatar.
- Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, USA.
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Ghanem YM, Ayad MW, Kareem AA, Guirguis MO, Alkafafy AM, Badrah MH. Glycemic gap and the outcome of diabetic patients presenting with acute coronary syndrome. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2022. [DOI: 10.1186/s43162-022-00099-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Abstract
Background
Acute hyperglycemia is a common finding in both diabetic and non-diabetic patients with acute coronary syndrome (ACS) who present to the emergency department (ED). The prognostic role of hyperglycemia in diabetic patients with ACS remains controversial at least on the short-term basis. The aim of the present study was to find the relation between the glycemic gap and clinical outcome in diabetic patients with ACS.
Methods
The study included 100 diabetic patients with ACS to who were prospectively followed during their hospital stay. Admission blood glucose was measured and glycemic gap was calculated.
Results
In diabetic patients suffering ACS, there was a significant relation between the glycemic gap value, occurrence of major adverse cardiovascular events (MACE) and length of hospital stay.
Conclusion
Glycemic gap is a better marker than admission blood glucose alone in diabetic patients presenting with ACS. This study added the optimal cut-off value for this important biomarker.
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KOBAT MA, DÜNDAR S, BOZOĞLAN A, GELEN MA, KIVRAK T, ARTAŞ G, AYDIN S. The effects of dual anti-platelet therapy on titanium implant osseointegration: an experimental study. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1013209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Abacioglu OO, Yildirim A, Karadeniz M, Abacioglu S, Koyunsever NY, Dindas F, Dogdus M, Kaplangoray M. A New Score for Determining Thrombus Burden in STEMI Patients: The MAPH Score. Clin Appl Thromb Hemost 2022; 28:10760296211073767. [PMID: 35018837 PMCID: PMC8761881 DOI: 10.1177/10760296211073767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Aim to investigate whether the MAPH score, which is a new score that combines blood viscosity biomarkers such as mean platelet volume (MPV), total protein and hematocrit, can be used to predict thrombus burden in ST-segment elevation myocardial infarction (STEMI) patients. Methods A total of 473 consecutive patients with STEMI were included in the study. Intracoronary tirofiban/abciximab infusion was applied to patients with thrombus load ≥3 and these patients (n = 71) were defined as the patient group with high thrombus load. MPV, age, hematocrit and total protein values of the patients were recorded. High shear rate (HSR) and low shear rate (LSR) were calculated from total protein and hematocrit values. Cut-off values were determined for high thrombus load by using Youden index, and score was determined as 0 or 1 according to cut-offs. The sum of the scores was calculated as the MAPH score. Results The mean age of the patients included in the study was 59.6 ± 12.6 (n = 354 male, 74.8%). There was no difference between the groups in terms of gender, HT and DM (P = .127, P = .402 and P = .576, respectively). In the group with high thrombus load; total protein, MPV and hematocrit values were higher (P < .001, P = .001 and P = .03, respectively). Comparison of receiver operating characteristic (ROC) curve analysis revealed that the MAPH score had better performance in predicting higher thrombus load than both other self-containing parameters and HSR and LSR. Conclusion The MAPH score may be a new score that can be used to determine thrombus burden in STEMI patients.
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Aljabery MA, Rajeh Saifan A, Alrimawi I, Alzoubi AM, Atout M. The Associations Between Patients' Characteristics and the Quality of Life Among Acute Coronary Syndrome Patients in Jordan: A Cross-Sectional Study. SAGE Open Nurs 2022; 8:23779608221129129. [PMID: 36187078 PMCID: PMC9523843 DOI: 10.1177/23779608221129129] [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: 02/04/2022] [Accepted: 09/10/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Acute coronary syndrome (ACS) is one of the most significant leading causes of death and disability in the world. The quality of life (QoL) score is used to evaluate the impact of ACS treatments on the patients' physical, emotional, and social functioning. It is considered a significant indicator of the progress of the patients' health status and is useful in predicting patients' needs for continuing, modifying, or changing their treatment plans. Objective To identify the associations between patients' characteristics and the QoL among ACS patients in Jordan. Methods A descriptive cross-sectional study was conducted using a convenience sample of 372 participants with ACS from six referral hospitals in Jordan. Results Jordanian patients with higher educational level and exercise had significant and positive association with QoL (β = 0.257, p < .001), (β = 0.191, p < .001), respectively. Also, patients who reported having dyslipidaemia and having unstable angina (UA) had lower score of QoL (β = -0.165, p < .001), (β = -0.149, p < .001), respectively. Finally, gender and working status did not significantly appear to have an association with the total QoL. Conclusions This study sheds light on the importance of increasing the level of patients' awareness about their illness by educating them about it and encouraging them to engage in physical activity programs.
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Affiliation(s)
| | | | - Intima Alrimawi
- Department of Professional Nursing Practice, Georgetown University, Washington, DC, USA
| | | | - Maha Atout
- Nursing School, Philadelphia University, Amman, Jordan
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Myocardial ischemia and its complications. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00022-0] [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: 11/17/2022] Open
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Edigin E, Ojemolon PE, Eseaton PO, Jamal S, Shaka H, Akuna E, Asemota IR, Manadan A. Systemic Sclerosis Is Associated With Increased Inpatient Mortality in Patients Admitted for Acute Coronary Syndrome: Analysis of the National Inpatient Sample. J Clin Rheumatol 2022; 28:e110-e117. [PMID: 33264253 DOI: 10.1097/rhu.0000000000001634] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aims to compare the outcomes of patients primarily admitted for acute coronary syndrome (ACS) with and without systemic sclerosis (SSc). The primary outcome was odds of inpatient mortality. Hospital length of stay, total hospital charges, rates of cardiovascular procedures, and treatments were secondary outcomes of interest. METHODS Data were abstracted from the National Inpatient Sample (NIS) 2016 and 2017 Database. The NIS was searched for hospitalizations for adult patients with ACS (ST-segment elevation myocardial infarction [STEMI], non-ST-segment elevation myocardial infarction [NSTEMI], and unstable angina) as principal diagnosis with and without SSc as secondary diagnosis using International Classification of Diseases, Tenth Revision codes. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. RESULTS There were more than 71 million discharges included in the combined 2016 and 2017 NIS database. There were 1,319,464 hospitalizations for adult patients with a principal International Classification of Diseases, Tenth Revision code for ACS. There were 1155 (0.09%) of these hospitalizations that had SSc. The adjusted odds ratios for inpatient mortality for ACS, STEMI, and NSTEMI hospitalizations with coexisting SSc compared with those without SSc were 2.02 (95% confidence interval [CI], 1.19-3.43; p = 0.009), 2.47 (95% CI, 1.05-5.79; p = 0.038), and 2.19 (95% CI, 1.14-4.23; p = 0.019), respectively. CONCLUSIONS Acute coronary syndrome hospitalizations with SSc have increased inpatient mortality compared with those without SSc. ST-segment elevation myocardial infarction and NSTEMI hospitalizations with SSc have increased inpatient mortality compared with STEMI and NSTEMI hospitalizations without SSc, respectively. Acute coronary syndrome hospitalizations with SSc have similar hospital length of stay, total hospital charges, rates of revascularization strategies (percutaneous coronary intervention, coronary artery bypass surgery, and thrombolytics), and other interventions (such as percutaneous external assist device and intra-aortic balloon pump) compared with those without SSc.
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Affiliation(s)
- Ehizogie Edigin
- From the Department of Internal Medicine, John H Stroger Jr. Hospital of Cook County, Chicago, IL
| | - Pius Ehiremen Ojemolon
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada, West Indies
| | - Precious Obehi Eseaton
- Department of Internal Medicine, University of Benin Teaching Hospital, Benin, Edo State, Nigeria
| | - Shakeel Jamal
- Department of Internal Medicine, Central Michigan University, College of Medicine, Saginaw, MI
| | - Hafeez Shaka
- From the Department of Internal Medicine, John H Stroger Jr. Hospital of Cook County, Chicago, IL
| | - Emmanuel Akuna
- From the Department of Internal Medicine, John H Stroger Jr. Hospital of Cook County, Chicago, IL
| | | | - Augustine Manadan
- Division of Rheumatology, Rush University Medical Center, Chicago, IL
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Bharath R, Nair KKM, Gupta D, Vijayan R. Assessment of Lewis negative phenotype as a risk factor for multivessel disease in patients with acute coronary syndrome. Transfus Clin Biol 2021; 29:129-133. [PMID: 34974187 DOI: 10.1016/j.tracli.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/20/2021] [Accepted: 12/26/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Acute coronary syndrome is a manifestation of coronary artery disease caused by decreased blood flow to the heart musculature resulting in ischaemia and infarction of the heart. The Lewis (Le) blood group system comprise mainly Lewis a & b antigens which are secreted in plasma and are expressed on red cells, platelets and endothelium. This study assesses the risk of multivessel disease in acute coronary patients with lewis negative (a- b-) phenotype. MATERIALS AND METHODS The study included 183 patients diagnosed with acute coronary syndrome and who underwent coronary angiography to detect stenosis of the coronary vessels. The severity of the disease was classified based upon the number of vessels stenosed and their blood sample was phenotyped for Lewis antigens. The patients' risk factors, GRACE score and management were included for the study and multivariate logistic regression was carried out for analysis. RESULTS The prevalence of Lewis (a- b-) was 27.4% and there was a significant association with multivessel disease (P<0.05). However, there was no association of lewis (a- b-) with any of the risk factors causing coronary disease. The adjusted odds ratio of triple vessel disease in lewis (a- b-) was 2.6, female gender was 0.6 and patients with diabetes mellitus was 3.1, respectively. The GRACE score showed a significant association with ABO blood group (P<0.05) but not with lewis (a- b-). DISCUSSION Lewis negative patients are more likely to develop triple vessel disease compared to other lewis blood groups. This warrants further studies to investigate the link between lewis system and atherothrombosis.
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Affiliation(s)
- Raj Bharath
- Department of transfusion medicine, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695011, Kerala, India.
| | - Krishna Kumar Mohanan Nair
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695011, Kerala, India
| | - Debasish Gupta
- Department of transfusion medicine, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695011, Kerala, India
| | - Reshma Vijayan
- Department of transfusion medicine, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695011, Kerala, India
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Predictive Value of Hematological Parameters in Non-ST Segment Elevation Myocardial Infarction and Their Relationship with the TIMI Risk Score. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2021. [DOI: 10.2478/jce-2021-0018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT
Background: Hematological parameters, such as white blood cell count (WBC), mean platelet volume (MPV), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and WBC to MPV ratio (WMR), could provide data in prognosis, risk stratification, and optimal management in patients with acute coronary syndromes. Aim: We aimed to investigate the prognostic value of hematological parameters and their relationship with the TIMI risk score in non-ST elevation myocardial infarction (NSTEMI) patients. Material and Methods: A total of 259 adult patients with NSTEMI were included in this retrospective and observational cohort study. During a 1-year follow-up period, the efficacy of the main hematological parameters in predicting major adverse cardiovascular events (MACE) and their correlation with the TIMI risk score was analyzed. Results: Among the 259 patients, 188 (72.6%) were male, and the mean age was 60.4 ± 11.9 years. MACE was observed in 60 patients (23.2%). Elevated baseline levels of WBC, neutrophils, NLR, PLR, and WMR were associated with MACE development throughout the 1-year follow-up. Moreover, WBC, WMR, and NLR were correlated with the TIMI risk score. When the predictive power of these parameters for MACE was evaluated by ROC analysis, the AUC values for WBC, WMR, and NLR were 0.670 (95% CI 0.590–0.750), 0.666 (95% CI 0.582–0.746), and 0.689 (95% CI 0.610–0.767), respectively. Conclusion: WBC, NLR, and WMR predicted MACE in NSTEMI patients and were consistent with the TIMI risk score. On this basis, they could provide supportive data for early risk stratification and optimized therapeutic approach, particularly in high-risk patients.
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Screening Analysis of Platelet miRNA Profile Revealed miR-142-3p as a Potential Biomarker in Modeling the Risk of Acute Coronary Syndrome. Cells 2021; 10:cells10123526. [PMID: 34944034 PMCID: PMC8700136 DOI: 10.3390/cells10123526] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/04/2021] [Accepted: 12/11/2021] [Indexed: 12/18/2022] Open
Abstract
Transcriptome analysis constitutes one of the major methods of elucidation of the genetic basis underlying the pathogenesis of various diseases. The post-transcriptional regulation of gene expression is mainly provided by microRNAs. Their remarkable stability in biological fluids and their high sensitivity to disease alteration indicates their potential role as biomarkers. Given the high mortality and morbidity of cardiovascular diseases, novel predictive biomarkers are sorely needed. Our study focuses for the first time on assessing potential biomarkers of acute coronary syndrome (ACS) based on the microRNA profiles of platelets. The study showed the overexpression of eight platelet microRNAs in ACS (miR-142-3p; miR-107; miR-338-3p, miR-223-3p, miR-21-5p, miR-130b-3p, miR-301a-3p, miR-221-3p) associated with platelet reactivity and functionality. Our results show that the combined model based on miR-142-3p and aspartate transaminase reached 82% sensitivity and 88% specificity in the differentiation of the studied groups. Furthermore, the analyzed miRNAs were shown to cluster into two orthogonal groups, regulated by two different biological factors. Bioinformatic analysis demonstrated that one group of microRNAs may be associated with the physiological processes of platelets, whereas the other group may be linked to platelet-vascular environment interactions. This analysis paves the way towards a better understanding of the role of platelet microRNAs in ACS pathophysiology and better modeling of the risk of ACS.
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Kumar A, Harsha C, Parama D, Girisa S, Daimary UD, Mao X, Kunnumakkara AB. Current clinical developments in curcumin-based therapeutics for cancer and chronic diseases. Phytother Res 2021; 35:6768-6801. [PMID: 34498308 DOI: 10.1002/ptr.7264] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 06/16/2021] [Accepted: 08/14/2021] [Indexed: 12/19/2022]
Abstract
The last decade has seen an unprecedented rise in the prevalence of chronic diseases worldwide. Different mono-targeted approaches have been devised to treat these multigenic diseases, still most of them suffer from limited success due to the off-target debilitating side effects and their inability to target multiple pathways. Hence a safe, efficacious, and multi-targeted approach is the need for the hour to circumvent these challenging chronic diseases. Curcumin, a natural compound extracted from the rhizomes of Curcuma longa, has been under intense scrutiny for its wide medicinal and biological properties. Curcumin is known to manifest antibacterial, antiinflammatory, antioxidant, antifungal, antineoplastic, antifungal, and proapoptotic effects. A plethora of literature has already established the immense promise of curcuminoids in the treatment and clinical management of various chronic diseases like cancer, cardiovascular, metabolic, neurological, inflammatory, and infectious diseases. To date, more than 230 clinical trials have opened investigations to understand the pharmacological aspects of curcumin in human systems. Still, further randomized clinical studies in different ethnic populations warrant its transition to a marketed drug. This review summarizes the results from different clinical trials of curcumin-based therapeutics in the prevention and treatment of various chronic diseases.
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Affiliation(s)
- Aviral Kumar
- Cancer Biology Laboratory and DBT-AIST International Center for Translational and Environmental Research (DAICENTER), Department of Biosciences and Bioengineering, Indian Institute of Technology (IIT) Guwahati, Guwahati, India
| | - Choudhary Harsha
- Cancer Biology Laboratory and DBT-AIST International Center for Translational and Environmental Research (DAICENTER), Department of Biosciences and Bioengineering, Indian Institute of Technology (IIT) Guwahati, Guwahati, India
| | - Dey Parama
- Cancer Biology Laboratory and DBT-AIST International Center for Translational and Environmental Research (DAICENTER), Department of Biosciences and Bioengineering, Indian Institute of Technology (IIT) Guwahati, Guwahati, India
| | - Sosmitha Girisa
- Cancer Biology Laboratory and DBT-AIST International Center for Translational and Environmental Research (DAICENTER), Department of Biosciences and Bioengineering, Indian Institute of Technology (IIT) Guwahati, Guwahati, India
| | - Uzini Devi Daimary
- Cancer Biology Laboratory and DBT-AIST International Center for Translational and Environmental Research (DAICENTER), Department of Biosciences and Bioengineering, Indian Institute of Technology (IIT) Guwahati, Guwahati, India
| | - Xinliang Mao
- Institute of Clinical Pharmacology, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ajaikumar B Kunnumakkara
- Cancer Biology Laboratory and DBT-AIST International Center for Translational and Environmental Research (DAICENTER), Department of Biosciences and Bioengineering, Indian Institute of Technology (IIT) Guwahati, Guwahati, India
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Stewart J, Lu J, Goudie A, Bennamoun M, Sprivulis P, Sanfillipo F, Dwivedi G. Applications of machine learning to undifferentiated chest pain in the emergency department: A systematic review. PLoS One 2021; 16:e0252612. [PMID: 34428208 PMCID: PMC8384172 DOI: 10.1371/journal.pone.0252612] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 03/26/2021] [Indexed: 12/13/2022] Open
Abstract
Background Chest pain is amongst the most common reason for presentation to the emergency department (ED). There are many causes of chest pain, and it is important for the emergency physician to quickly and accurately diagnose life threatening causes such as acute myocardial infarction (AMI). Multiple clinical decision tools have been developed to assist clinicians in risk stratifying patients with chest. There is growing recognition that machine learning (ML) will have a significant impact on the practice of medicine in the near future and may assist with diagnosis and risk stratification. This systematic review aims to evaluate how ML has been applied to adults presenting to the ED with undifferentiated chest pain and assess if ML models show improved performance when compared to physicians or current risk stratification techniques. Methods and findings We conducted a systematic review of journal articles that applied a ML technique to an adult patient presenting to an emergency department with undifferentiated chest pain. Multiple databases were searched from inception through to November 2020. In total, 3361 articles were screened, and 23 articles were included. We did not conduct a metanalysis due to a high level of heterogeneity between studies in both their methods, and reporting. The most common primary outcomes assessed were diagnosis of acute myocardial infarction (AMI) (12 studies), and prognosis of major adverse cardiovascular event (MACE) (6 studies). There were 14 retrospective studies and 5 prospective studies. Four studies reported the development of a machine learning model retrospectively then tested it prospectively. The most common machine learning methods used were artificial neural networks (14 studies), random forest (6 studies), support vector machine (5 studies), and gradient boosting (2 studies). Multiple studies achieved high accuracy in both the diagnosis of AMI in the ED setting, and in predicting mortality and composite outcomes over various timeframes. ML outperformed existing risk stratification scores in all cases, and physicians in three out of four cases. The majority of studies were single centre, retrospective, and without prospective or external validation. There were only 3 studies that were considered low risk of bias and had low applicability concerns. Two studies reported integrating the ML model into clinical practice. Conclusions Research on applications of ML for undifferentiated chest pain in the ED has been ongoing for decades. ML has been reported to outperform emergency physicians and current risk stratification tools to diagnose AMI and predict MACE but has rarely been integrated into practice. Many studies assessing the use of ML in undifferentiated chest pain in the ED have a high risk of bias. It is important that future studies make use of recently developed standardised ML reporting guidelines, register their protocols, and share their datasets and code. Future work is required to assess the impact of ML model implementation on clinical decision making, patient orientated outcomes, and patient and physician acceptability. Trial registration International Prospective Register of Systematic Reviews registration number: CRD42020184977.
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Affiliation(s)
- Jonathon Stewart
- School of Medicine, The University of Western Australia, Crawley, Western Australia, Australia
- Harry Perkins Institute of Medical Research, Murdoch, Western Australia, Australia
- * E-mail:
| | - Juan Lu
- Harry Perkins Institute of Medical Research, Murdoch, Western Australia, Australia
- School of Physics, Mathematics and Computing, University of Western Australia, Crawley, Western Australia, Australia
| | - Adrian Goudie
- Department of Emergency Medicine, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Mohammed Bennamoun
- School of Physics, Mathematics and Computing, University of Western Australia, Crawley, Western Australia, Australia
| | - Peter Sprivulis
- School of Medicine, The University of Western Australia, Crawley, Western Australia, Australia
- Department of Health Western Australia, East Perth, Western Australia, Australia
| | - Frank Sanfillipo
- School of Population and Global Health, University of Western Australia, Crawley, Western Australia, Australia
| | - Girish Dwivedi
- School of Medicine, The University of Western Australia, Crawley, Western Australia, Australia
- Harry Perkins Institute of Medical Research, Murdoch, Western Australia, Australia
- Department of Cardiology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
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OZTURK S, ERDOĞAN M, TURAN Y. Systemic immune-inflammation index and high-sensitivity cardiac troponin T in acute coronary syndromes. ACTA MEDICA ALANYA 2021. [DOI: 10.30565/medalanya.936506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Effects of atorvastatin doses on serum level of procalcitonin and predictors for major adverse cardiovascular events in patients with acute myocardial infarction: a pilot study and post hoc analysis. Coron Artery Dis 2021; 31:e87-e93. [PMID: 34292180 DOI: 10.1097/mca.0000000000001084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Inflammation plays an important role in acute myocardial infarction (AMI). Procalcitonin levels rise in response to proinflammatory stimuli. This study aimed to investigate the effects of different doses of atorvastatin on the serum inflammatory profiles, especially procalcitonin and major adverse cardiovascular events (MACEs) in patients with AMI during hospitalization. METHODS The patients who were admitted to the Coronary Care Unit of The Third Medical Center of PLA General Hospital (Beijing, China) between January 2015 and December 2015 with a diagnosis of AMI were enrolled, and randomized to atorvastatin 20 mg/day postoperatively (20-mg group), 40 mg/day postoperatively (40-mg group) and 80 mg preoperatively+40 mg/day postoperatively (80/40-mg group). Serum procalcitonin and high-sensitivity C-reactive protein (hs-CRP) were evaluated before and at 1 and 3 days after percutaneous coronary intervention (PCI). RESULTS A total of 112 patients with AMI (23 women and 89 men) were prospectively eligible for the study. There were no significant differences in most clinical data among the three groups. The 80/40-mg group showed significantly reduced serum procalcitonin levels at 1 and 3 days after PCI (P < 0.001) and reduced hs-CRP levels at 3 days P = 0.001) compared with 20-mg and 40-mg groups. Serum procalcitonin (OR, 4.593; 95% CI, 1.476-8.387; P = 0.005), hs-CRP (OR, 1.149; 95% CI, 1.012-1.338; P = 0.018), highly sensitive cardiac troponin T (OR, 1.255; 95% CI, 1.004-1.569, P = 0.009) and Gensini score (OR, 1.022; 95% CI, 1.045-1.062; P = 0.013) were independently associated with MACEs during hospitalization. CONCLUSION The use of atorvastatin 80 mg before and 40 mg/day after PCI in patients with AMI can effectively reduce serum inflammatory factors. procalcitonin and hs-CRP were independently associated with in-hospital MACEs.
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