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Papadopoulos GE, Arvanitaki A, Markidis E, Mouratoglou SA, Farmakis IT, Gourgiotis P, Chrysochoidis Trantas T, Feloukidis C, Kouparanis A, Didagelos M, Grosomanidis V, Ziakas A, Giannakoulas G. Temporal Trends in Diagnostic Hemodynamics and Survival of Patients with Pulmonary Hypertension: A Single-Center Study. Life (Basel) 2023; 13:2225. [PMID: 38004365 PMCID: PMC10672085 DOI: 10.3390/life13112225] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/15/2023] [Accepted: 11/18/2023] [Indexed: 11/26/2023] Open
Abstract
Advances in the diagnosis and treatment of pulmonary hypertension (PH) have gradually improved the disease course. This retrospective cohort study aims to explore the diagnostic hemodynamic profile and survival of PH patients and their temporal changes, as well as investigate potential prognostic factors. Overall, 257 adult patients were diagnosed with PH following right heart catheterization (RHC) from January 2008 to June 2023 according to the hemodynamic cut-off values proposed by the corresponding ESC/ERS guidelines at the time RHC was performed. Of these patients, 46.3% were Group 1, 17.8% Group 2, 14.0% Group 3, 18.0% Group 4, and 3.0% Group 5 PH. Temporal improvement in both diagnostic hemodynamic profile and survival of patients with PH and pulmonary arterial hypertension (PAH) was identified after 2013. Survival analysis demonstrated 5-year survival rates of 65% in Group 1 PH (90.3% in idiopathic PAH) and 77% in Group 4 PH. PAH patients being at low risk at diagnosis presented a similar 1-year all-cause mortality rate (12.4%) with high-risk ones (12.8%), primarily due to non-PH-related causes of death (62%), while high-risk patients died mostly due to PH (67%). The observed improvements in diagnostic hemodynamic profiles and overall survival highlight the importance of timely diagnosis and successful treatment strategies in PH.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - George Giannakoulas
- Pulmonary Hypertension and Congenital Heart Disease Unit, AHEPA University Hospital, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece; (G.E.P.); (A.A.); (E.M.); (S.A.M.); (P.G.); (T.C.T.); (C.F.); (A.K.); (M.D.); (V.G.); (A.Z.)
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Sinanis T, Markidis E, Mavroudeas SE, Sideras E, Vittorakis E, Vittorakis E. Isovolumetric Contraction as a Marker of Ventricular Performance in Patients with Afterload Mismatch. Diagnostics (Basel) 2023; 13:1366. [PMID: 37189467 PMCID: PMC10137270 DOI: 10.3390/diagnostics13081366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/14/2023] [Accepted: 03/24/2023] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION The evaluation of myocardial contractility is essential in cardiology practice. The gold standard for this evaluation is the end-systolic elastance, but it the method involved is complex. Echocardiographic measurement of the ejection fraction (EF) is the most commonly used parameter in clinical practice, but it has significant limitations, especially in patients with afterload mismatch. In this study, the area under the curve (AUC) of the isovolumetric contraction was measured to evaluate the myocardial contractility in patients with pulmonary arterial hypertension and severe aortic stenosis. METHODS 110 patients with severe aortic stenosis and pulmonary arterial hypertension were included in this study. The AUC of the isovolumetric contraction was measured using pressure curves of the right ventricle-pulmonary artery and left ventricle-aorta ascendens. This AUC was then correlated with the echocardiographically measured EF, stroke volume (SV), and total ventricular work. RESULTS The AUC of the isovolumetric contraction showed a statistically significant correlation with the EF of the corresponding ventricle (p < 0.0001). Both the AUC of the isovolumetric contraction and the EF showed a statistically significant correlation with the total work of the ventricle (AUC: R2 0.49, p < 0.001; EF: R2 0.51, p < 0.001). However, the SV only showed a statistically significant correlation with the EF. A statistically significant one-sample t-test could be found for the EF (decreased, p < 0.001) and for the AUC of the isovolumetric contraction (increased, p < 0.001), but not for the total work of the ventricle. CONCLUSION The AUC space of the isovolumetric contraction is a useful marker of ventricular performance in patients with afterload mismatch, showing a statistically significant correlation with the EF and the total ventricular work. This method may have potential for use in clinical practice, especially in challenging cardiological cases. However, further studies are needed to evaluate its usefulness in healthy individuals and in other clinical scenarios.
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Affiliation(s)
- Theodoros Sinanis
- Cardiology Department and Cardiology Intensive Care Unit, “Agios Georgios” General Hospital of Chania, p.c. 73100 Chania, Greece (E.V.)
| | - Eleftherios Markidis
- Cardiology Department and Cardiology Intensive Care Unit, “Agios Georgios” General Hospital of Chania, p.c. 73100 Chania, Greece (E.V.)
| | - Symeon Evangelos Mavroudeas
- Cardiology Department and Cardiology Intensive Care Unit, “Agios Georgios” General Hospital of Chania, p.c. 73100 Chania, Greece (E.V.)
| | - Emmanouil Sideras
- Cardiology Department and Cardiology Intensive Care Unit, “Agios Georgios” General Hospital of Chania, p.c. 73100 Chania, Greece (E.V.)
| | - Evangelos Vittorakis
- Cardiology Department and Cardiology Intensive Care Unit, “Agios Georgios” General Hospital of Chania, p.c. 73100 Chania, Greece (E.V.)
| | - Eftychios Vittorakis
- Cardiology Department and Cardiology Intensive Care Unit, “Agios Georgios” General Hospital of Chania, p.c. 73100 Chania, Greece (E.V.)
- Department of Microbiology, “Iuliu-Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, p.c. 400349 Cluj-Napoca, Romania
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Sinanis T, Markidis E, Mavroudeas S, Sideras E, Vittorakis E. The isovolumetric contraction as marker of ventricular performance in patients with afterload mismatch. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
The gold standard for the evaluation of ventricular function is currently the echocardiographic measured ejection fraction (EF). However, the use of this parameter has limitations, which are more important in populations with afterload mismatch and especially when this mismatch is severe. On the other hand, the assessment of a pump function in fluid dynamics is done using the head pressure, which is product of pressure when the flow is zero. During the cardiac cycle, this situation occurs during the isovolumetric contraction.
Purpose
The aim of this study is to assess the clinical and pathophysiological importance of the isovolumentric contraction in the evaluation of the ventricular performance.
Method
110 patients with severe aortic stenosis and pulmonary arterial hypertension were investigated. The area under the curve (AUC) of the isovolumetric contraction was measured using the pressure curves of the right ventricle-pulmonary artery and left ventricle-aorta ascendens. This AUC was then correlated with the echocardiographic measured ejection fraction (EF), the stroke volume (SV) and the total ventricular work, defined as the product of pressure and flow.
Results
The AUC of the isovolumetric contraction correlates statistically significant with the ejection fraction of the corresponding ventricle (p 0.0001). Both AUC of the isovolumetric contraction and the ejection fraction showed a statistic significance with the total work of the ventricle (AUC with R2 0.49, p 0.0001, EF R2 0.51, p 0.0001). Stroke volume was significant only in the correlation with the ejection fraction. A statistic significant one sample t test could be found for the EF (decreased, p 0.001) and for the AUC of the isovolumetric contraction (increased, p 0.001) but not for the total work of the ventricle.
Conclusion
The AUC of the isovolumetric contraction correlates statistically significant with the ejection fraction and the total ventricular work but not the stroke volume in patients with afterload mismatch. Especially in these populations it demonstrates a significant increase when compared with normal values.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- T Sinanis
- General Hospital St. George , Chania , Greece
| | - E Markidis
- General Hospital St. George , Chania , Greece
| | | | - E Sideras
- General Hospital St. George , Chania , Greece
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Zafeiropoulos S, Farmakis I, Kartas A, Arvanitaki A, Pagiantza A, Boulmpou A, Tampaki A, Kosmidis D, Nevras V, Markidis E, Papadimitriou I, Vlachou A, Arvanitakis K, Miyara SJ, Ziakas A, Molmenti EP, Kassimis G, Zanos S, Karvounis H, Giannakoulas G. Reinforcing adherence to lipid-lowering therapy after an acute coronary syndrome: A pragmatic randomized controlled trial. Atherosclerosis 2021; 323:37-43. [PMID: 33780749 DOI: 10.1016/j.atherosclerosis.2021.03.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/13/2021] [Accepted: 03/10/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIMS Achieving the low-density lipoprotein cholesterol (LDL-C) goal following an acute coronary syndrome (ACS) is a milestone often missed due to suboptimal adherence to secondary prevention treatments. Whether improved adherence could result in reduced LDL-C levels is unclear. We aimed to evaluate whether an educational-motivational intervention increases long-term lipid-lowering therapy (LLT) adherence and LDL-C goal attainment rate among post-ACS patients. METHODS IDEAL-LDL was a parallel, two-arm, single-center, pragmatic, investigator-initiated randomized controlled trial. Hospitalized patients for ACS were randomized to a physician-led integrated intervention consisting of an educational session at baseline, followed by regular motivational interviewing phone sessions or usual care. Co-primary outcomes were the LLT adherence (measured by Proportion of Days Covered (PDC); good adherence defined as PDC>80%), and LDL-C goal (<70 mg/dl or 50% reduction from baseline) achievement rate at one year. RESULTS In total, 360 patients (mean age 62 years, 81% male) were randomized. Overall, good adherence was positively associated with LDL-C goal achievement rate at one year. Median PDC was higher in the intervention group than the control group [0.92 (IQR, 0.82-1.00) vs. 0.86 (0.62-0.98); p = 0.03] while the intervention group had increased odds of good adherence (odds ratio: 1.76 (95% confidence interval 1.02 to 2.62; p = 0.04). However, neither the LDL-C goal achievement rate (49.6% in the intervention vs. 44.9% in the control group; p = 0.49) nor clinical outcomes differed significantly between the two groups. CONCLUSIONS Α multifaceted intervention improved LLT adherence in post-ACS patients without a significant difference in LDL-C goal attainment.
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Affiliation(s)
- Stefanos Zafeiropoulos
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; Elmezzi Graduate School of Molecular Medicine and Feinstein Institutes for Medical Research at Northwell Health, Manhasset, NY, USA
| | - Ioannis Farmakis
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasios Kartas
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Alexandra Arvanitaki
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer-Campus 1, Muenster, Germany
| | - Areti Pagiantza
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; Department of Internal Medicine, Serres General Hospital, Serres, Greece
| | - Aristi Boulmpou
- 3rd Department of Cardiology, Ippokrateion University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athina Tampaki
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Diamantis Kosmidis
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vassileios Nevras
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleftherios Markidis
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Papadimitriou
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasia Vlachou
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Arvanitakis
- Laboratory of Biomathematics, University of Thessaly, School of Medicine, Papakyriazi 22, Building "Katsigra", Larissa, Greece
| | - Santiago J Miyara
- Elmezzi Graduate School of Molecular Medicine and Feinstein Institutes for Medical Research at Northwell Health, Manhasset, NY, USA
| | - Antonios Ziakas
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ernesto P Molmenti
- Department of Surgery, North Shore University Hospital, Manhasset, NY, USA
| | - George Kassimis
- 2nd Department of Cardiology, Ippokrateion University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stavros Zanos
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Haralambos Karvounis
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Giannakoulas
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Farmakis I, Zafeiropoulos S, Pagiantza A, Boulmpou A, Arvanitaki A, Tampaki A, Kosmidis D, Nevras V, Markidis E, Papadimitriou I, Karvounis H, Giannakoulas G. Low-density lipoprotein cholesterol target value attainment based on 2019 ESC/EAS guidelines and lipid-lowering therapy titration for patients with acute coronary syndrome. Eur J Prev Cardiol 2020; 27:2314-2317. [DOI: 10.1177/2047487319891780] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Zafeiropoulos S, Farmakis I, Kartas A, Arvanitaki A, Pagiantza A, Boulmpou A, Tampaki A, Kosmidis D, Nevras V, Markidis E, Papadimitriou I, Arvanitakis K, Ziakas A, Karvounis H, Giannakoulas G. Risk for recurrent cardiovascular events and expected risk reduction with optimal treatment one year after an acute coronary syndrome. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
According to the latest ESC Guidelines for chronic coronary syndromes (CCS), patients who suffered an acute coronary syndrome (ACS) pass to a chronic stable phase after one year. In these patients the estimated 10-year risk for recurrent cardiovascular (CV) events varies considerably. We estimated this risk and the expected risk reduction after optimal control.
Methods
We applied the SMART risk score in 211 patients one year after an ACS to estimate the 10-year risk for recurrent CV events (subsequent non-fatal myocardial infarction, non-fatal stroke, or cardiovascular death). We assessed the distribution of the estimated risk and the potential risk reduction that might be achieved with an optimal guideline-directed management of modifiable risk factors (systolic blood pressure, low-density lipoprotein cholesterol, smoking and body mass index).
Results
In our cohort, the median SMART score was 16% [interquartile range (IQR), 9.5–26]. If all modifiable risk factors met guideline-recommended targets, median SMART risk score would be 9.4% (IQR, 5.9–17.1), with 52% of the patients at a 10-year risk <10%, while 10% and 11% at 20–30% and >30% risk respectively. The total median reducible risk was 4.7% (IQR, 1.7–8.8).
Conclusions
The SMART score had a wide distribution among patients with CCS. Noteworthy, one out of five patients will remain at a >20% 10-year risk, even with optimal risk factors management, clearly underlining that residual risk is an unmet clinical issue, which demands individualized patient care.
Baseline and total residual risk score
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- S Zafeiropoulos
- Ahepa University Hospital, 1st Cardiology Department, Thessaloniki, Greece
| | - I.T Farmakis
- Ahepa University Hospital, 1st Cardiology Department, Thessaloniki, Greece
| | - A Kartas
- Ahepa University Hospital, 1st Cardiology Department, Thessaloniki, Greece
| | - A Arvanitaki
- University Hospital of Munster, Department of Cardiology III - Adult Congenital and Valvular Heart Disease, Muenster, Germany
| | - A Pagiantza
- Ahepa University Hospital, 1st Cardiology Department, Thessaloniki, Greece
| | - A Boulmpou
- Hippokration General Hospital of Thessloniki, 3rd Department of Cardiology, Thessaloniki, Greece
| | - A Tampaki
- Ahepa University Hospital, 1st Cardiology Department, Thessaloniki, Greece
| | - D Kosmidis
- Ahepa University Hospital, 1st Cardiology Department, Thessaloniki, Greece
| | - V Nevras
- Ahepa University Hospital, 1st Cardiology Department, Thessaloniki, Greece
| | - E Markidis
- Ahepa University Hospital, 1st Cardiology Department, Thessaloniki, Greece
| | - I Papadimitriou
- Ahepa University Hospital, 1st Cardiology Department, Thessaloniki, Greece
| | - K Arvanitakis
- Ahepa University Hospital, 1st Cardiology Department, Thessaloniki, Greece
| | - A Ziakas
- Ahepa University Hospital, 1st Cardiology Department, Thessaloniki, Greece
| | - H Karvounis
- Ahepa University Hospital, 1st Cardiology Department, Thessaloniki, Greece
| | - G Giannakoulas
- Ahepa University Hospital, 1st Cardiology Department, Thessaloniki, Greece
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Farmakis I, Zafeiropoulos S, Pagiantza A, Boulmpou A, Arvanitaki A, Nevras V, Tampaki A, Markidis E, Papadimitriou I, Karvounis H, Giannakoulas G. Guideline adherence is associated with long-term all-cause mortality in patients after an acute coronary syndrome. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
Guideline-directed medical therapy (GDMT) remains the mainstay in the long-term management of patients after an acute coronary syndrome (ACS). Data on the association of adherence to GDMT with clinical outcomes are scarce.
Purpose
To assess the adherence to GDMT and its relation to all-cause mortality in a population of patients after an ACS.
Methods
In this post-hoc analysis of the prospective, randomised IDEAL-LDL trial (NCT02927808) we analyzed data of 360 ACS patients discharged from a cardiology clinic. Median follow-up period was 35.9 (IQR 25.7–41.6) months. GDMT was assessed at discharge and at the 1-year follow-up, at which time data was collected by telephone interviews or ambulant visits. GDMT was defined as compliance with secondary prevention therapies (statin, antiplatelet, b-blocker, angiotensin-converting enzyme inhibitor (ACE-i) or angiotensin II receptor blocker (ARB)), as per their respective indication in the 2017 STEMI and 2015 NSTE-ACS ESC Guidelines. Extended follow-up data for mortality was collected from the national health insurance electronic prescription system.
Results
Median age of the entire cohort was 60 (IQR-53–71) years, 18.6% were female and 55.6% suffered a STEMI. At discharge, 342 patients (95%) received statins, 331 (91.9%) proper antithrombotic therapy (86.4% on dual antiplatelet therapy (DAPT), 2.5% on antiplatelet plus anticoagulant and 3% on triple therapy), 309 (85.8%) β-blockers and 217 (60.3%) ACE-i or ARB. GDMT at discharge was prescribed to 272 (75.6%) patients. The 1-year mortality rate was 4.7% (IQR, 2.5–6.9) and there was no mortality benefit for GDMT (HR=0.77 95% CI 0.27 - 2.2) (Figure 1a). At the one-year follow up, 323 (94.2%) of 343 alive patients received statin treatment (72.4% of which a high-intensity statin), 330 (96.2%) any antithrombotic therapy (59.8% on DAPT, 5.2% on any anticoagulant), 263 (76.7%) a β-blocker and 194 (56.6%) an ACE-I or ARB. GDMT at one-year follow up was prescribed to 248 (72.3%) patients. Beyond one year, all-cause mortality was significantly reduced in patients receiving GDMT adjusted for age, STEMI, revascularization with percutaneous coronary angioplasty, history of diabetes mellitus and arterial hypertension. (1.6% vs 9.5%, aHR 0.3 95% CI 0.08 - 0.92) (Figure 1b).
Conclusions
Adherence to GDMT remains stable one year after an ACS. GDMT was associated with a significant decrease in long-term mortality, but not associated with one-year mortality.
Figure 1. GDMT at baseline, at 1 year and mortality
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- I.T Farmakis
- Ahepa University Hospital, 1st Cardiology Department, Thessaloniki, Greece
| | - S Zafeiropoulos
- Ahepa University Hospital, 1st Cardiology Department, Thessaloniki, Greece
| | - A Pagiantza
- Ahepa University Hospital, 1st Cardiology Department, Thessaloniki, Greece
| | - A Boulmpou
- Hippokration General Hospital of Thessloniki, 3rd Department of Cardiology, Thessaloniki, Greece
| | - A Arvanitaki
- University Hospital of Munster, Department of Cardiology III - Adult Congenital and Valvular Heart Disease, Muenster, Germany
| | - V Nevras
- Ahepa University Hospital, 1st Cardiology Department, Thessaloniki, Greece
| | - A Tampaki
- Ahepa University Hospital, 1st Cardiology Department, Thessaloniki, Greece
| | - E Markidis
- Ahepa University Hospital, 1st Cardiology Department, Thessaloniki, Greece
| | - I Papadimitriou
- Ahepa University Hospital, 1st Cardiology Department, Thessaloniki, Greece
| | - H Karvounis
- Ahepa University Hospital, 1st Cardiology Department, Thessaloniki, Greece
| | - G Giannakoulas
- Ahepa University Hospital, 1st Cardiology Department, Thessaloniki, Greece
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Zafeiropoulos S, Farmakis I, Kartas A, Arvanitaki A, Pagiantza A, Boulmpou A, Tampaki A, Kosmidis D, Nevras V, Markidis E, Papadimitriou I, Arvanitakis K, Sianos G, Makedou K, Ziakas A, Tzikas A, Karvounis H, Giannakoulas G. Risk for Recurrent Cardiovascular Events and Expected Risk Reduction With Optimal Treatment 1 Year After an Acute Coronary Syndrome. Am J Cardiol 2020; 133:7-14. [PMID: 32828524 DOI: 10.1016/j.amjcard.2020.07.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/09/2020] [Accepted: 07/13/2020] [Indexed: 02/08/2023]
Abstract
According to the latest European Society of Cardiology Guidelines for the diagnosis and management of chronic coronary syndromes, patients who suffered an acute coronary syndrome fall into a chronic stable phase after 1 year. In these patients, the estimated 10-year risk for recurrent cardiovascular events varies considerably. We applied the SMART (Second Manifestations of Arterial Disease) risk score in 281 patients 1 year after an acute coronary syndrome to estimate the 10-year risk for recurrent cardiovascular events (subsequent nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death). We assessed the distribution of the estimated risk and the potential risk reduction that might be achieved with optimal guideline-directed management of modifiable risk factors (systolic blood pressure, low-density lipoprotein cholesterol, smoking, and body mass index). In our cohort, the median SMART score was 16.1% (interquartile range [IQR] 9.7 to 27.3), particularly increased in patients with older age, diabetes, polyvascular disease or chronic kidney disease (median 28.6%, IQR 20.8 to 52.9; 23.8%, 4.8 to 41.6; 29.4%, 18.8 to 49.7; 53.8%, 26.5 to 71.6, respectively). If all modifiable risk factors met guideline-recommended targets, the median SMART risk score would be 9.6% (IQR 6.3 to 20.9), with 51% of the patients at a 10-year risk <10%, while 11% and 15% at 20% to 30% and >30% risk, respectively. In conclusion, the SMART score had a wide distribution in patients with chronic coronary syndromes. A quarter of patients remained at a >20% 10-year risk, even with optimal risk factor management, clearly underlining that residual risk is an unmet clinical challenge.
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Farmakis I, Zafeiropoulos S, Kartas A, Boulmpou A, Nevras V, Papadimitriou I, Tampaki A, Vlachou A, Markidis E, Koutsakis A, Ziakas A, Karvounis H, Giannakoulas G. Treatment practices and lipid profile of patients with acute coronary syndrome: results from a tertiary care hospital. Acta Cardiol 2020; 75:527-534. [PMID: 31219734 DOI: 10.1080/00015385.2019.1626087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background: Considering the increasing burden of cardiovascular risk factors and recent advances on the management of acute coronary syndromes (ACS), we studied the epidemiological characteristics and treatment strategies of patients presenting with ACS. We also evaluated the lipid profile and attainment of lipid goals in a 'real world' clinical setting.Methods: This was a substudy of IDEAL-LDL (Motivational interviewing to support low-density lipoprotein cholesterol (LDL-C) therapeutic goals and lipid-lowering therapy compliance in patients with acute coronary syndromes), a single-centre, prospective, randomised controlled trial. Baseline data from a total of 357 ACS patients were gathered using standardised methods.Results: Median age of patients was 60 years and 81.2% were males. Arterial hypertension and smoking were the most prevalent risk factors for coronary artery disease (CAD). Patients with ST-elevation myocardial infarction (STEMI) were heavier smokers, but were younger and exercised more compared to those with non-ST-elevation acute coronary syndrome (NSTE-ACS). Conversely, more NSTE-ACS patients had arterial hypertension, dyslipidaemia and diabetes mellitus. One-fifth of ACS patients was treated conservatively without a percutaneous coronary intervention (PCI). A combination of statin, dual antiplatelet therapy and beta-blockers were prescribed to 79.6% of patients upon discharge. A renin-angiotensin-aldosterone system inhibitor and a beta-blocker were prescribed to 67.3 and 91.8% of patients with LVEF ≤40%, respectively. Of patients with prior history of CAD, 63.1%, 71.4% and 58.3% received regularly statins, antiplatelets and beta-blocker treatment, respectively. Only 22.3% of these CAD patients had an optimal LDL-C of <70 mg/dl at admission.Conclusions: In hospitalised patients with ACS, management practices differed by ACS type and discharge medication was, mostly, in line with the latest guidelines. However, medication adherence and lipid lowering goals of secondary CAD prevention were largely unachieved.
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Affiliation(s)
- Ioannis Farmakis
- Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stefanos Zafeiropoulos
- Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasios Kartas
- Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aristi Boulmpou
- Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasileios Nevras
- Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Papadimitriou
- Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athina Tampaki
- Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasia Vlachou
- Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleftherios Markidis
- Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athanasios Koutsakis
- Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonios Ziakas
- Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Haralambos Karvounis
- Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Giannakoulas
- Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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