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Morgan H, Ezad SM, Rahman H, De Silva K, Partridge JSL, Perera D. Assessment and Management of Ischaemic Heart Disease in Non-Cardiac Surgery. Heart Int 2023; 17:19-26. [PMID: 38419719 PMCID: PMC10898586 DOI: 10.17925/hi.2023.17.2.19] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/18/2023] [Indexed: 03/02/2024] Open
Abstract
In the setting of non-cardiac surgery, cardiac complications contribute to over a third of perioperative deaths. With over 230 million major surgeries performed annually, and an increasing prevalence of cardiovascular risk factors and ischaemic heart disease, the incidence of perioperative myocardial infarction is also rising. The recent European Society of Cardiology guidelines on cardiovascular risk in noncardiac surgery elevated practices aiming to identify those at most risk, including biomarker monitoring and stress testing. However the current evidence base on if, and how, the risk of cardiac events can be modified is lacking. This review focuses on patient, surgical and cardiac risk assessment, as well as exploring the data on perioperative revascularization and other risk-reduction strategies.
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Affiliation(s)
- Holly Morgan
- British Heart Foundation Centre of Research Excellence at the School of Cardiovascular and Metabolic Medicine and Sciences, King's College, London, UK
| | - Saad M Ezad
- British Heart Foundation Centre of Research Excellence at the School of Cardiovascular and Metabolic Medicine and Sciences, King's College, London, UK
| | - Haseeb Rahman
- British Heart Foundation Centre of Research Excellence at the School of Cardiovascular and Metabolic Medicine and Sciences, King's College, London, UK
| | - Kalpa De Silva
- British Heart Foundation Centre of Research Excellence at the School of Cardiovascular and Metabolic Medicine and Sciences, King's College, London, UK
| | - Judith S L Partridge
- British Heart Foundation Centre of Research Excellence at the School of Cardiovascular and Metabolic Medicine and Sciences, King's College, London, UK
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Divaka Perera
- British Heart Foundation Centre of Research Excellence at the School of Cardiovascular and Metabolic Medicine and Sciences, King's College, London, UK
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
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Lapostolle F, Loyeau A, Bataille S, Moiteaux B, Lambert Y. [e-MUST Registry - Evaluation of prehospital medical management of STEMI in Île-de-France]. Ann Cardiol Angeiol (Paris) 2023; 72:101687. [PMID: 37948923 DOI: 10.1016/j.ancard.2023.101687] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 10/09/2023] [Indexed: 11/12/2023]
Abstract
The e-MUST registry has continuously and comprehensively documented ST-segment elevation myocardial infarctions (STEMIs) managed in the prehospital setting by the 39 Mobile Emergency and Resuscitation Services (SMUR) of the 8 Emergency Medical Assistance System (SAMU) and subsequently managed in the 36 interventional cardiology services in Île-de-France since 2000. This encompasses a population of over 12 million residents. To date, nearly 44,000 patients have been enrolled. The analysis of these findings reflects the real-world management of these patients and the evolution of their care. The results are shared annually with the investigators' teams and have led to around twenty publications. The latest acquired results have demonstrated, in a series of over 630 patients aged over 90, that nonagenarians particularly benefit from prehospital coronary reperfusion decisions, resulting in a nearly 60% reduction in mortality.
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Affiliation(s)
- Frédéric Lapostolle
- SAMU 93, UF Recherche-Enseignement-Qualité, Hôpital Avicenne, Bobigny, Université Paris 13, France.
| | - Aurélie Loyeau
- SAMU 93, UF Recherche-Enseignement-Qualité, Hôpital Avicenne, Bobigny, Université Paris 13, France
| | - Sophie Bataille
- Département de l'offre de soins, Agence Régionale de Santé d'Île-de-France, Paris, France
| | - Brice Moiteaux
- Département Traitement de l'information, GIP SESAN, Paris , France
| | - Yves Lambert
- SAMU 78, Centre Hospitalier de Versailles, Le Chesnay, France
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Abstract
More than a decade after the Clinical Outcomes Utilising Revascularization and Aggressive Drug Evaluation (COURAGE) trial, International Study of Comparative Health Effectiveness With Medical And Invasive Approaches (ISCHEMIA) is the second large clinical trial to challenge the concept of revascularization in chronic coronary syndromes whilst addressing some of the shortfalls of its predecessor.
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Affiliation(s)
- Sadeek S Kanoun Schnur
- Graz University Heart Center Graz, Medical University Graz, Graz Austria; South West Peninsula Deanery, University Plymouth Hospitals NHS Trust, Plymouth, UK.
| | - Alexandru Achim
- Graz University Heart Center Graz, Medical University Graz, Graz Austria; Medicala 1 Invasive Cardiology Department, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania; Doctoral School of Clinical Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary"
| | - Gabor G Toth
- Graz University Heart Center Graz, Medical University Graz, Graz Austria
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Hesselbarth D, Gjermeni D, Szabo S, Siegel PM, Diehl P, Moser M, Bode C, Olivier CB. Time from blood draw to multiple electrode aggregometry and association with platelet reactivity. J Thromb Thrombolysis 2023; 55:134-140. [PMID: 36344849 PMCID: PMC9925483 DOI: 10.1007/s11239-022-02720-7] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/13/2022] [Indexed: 11/09/2022]
Abstract
Results from multiple electrode aggregometry (MEA) may vary according to pre-analytic factors. This study aimed to analyze the association of time from blood draw to MEA in patients undergoing percutaneous coronary intervention (PCI). In this observational single-center cohort study, platelet aggregation (aggregation units, U) was quantified by MEA (Multiplate Analyzer) after stimulation with adenosine diphosphate (ADP; final concentration [Fc] 6.4 μM), thrombin receptor activating peptide (TRAP; Fc 32 μM), or arachidonic acid (AA; Fc 0.5 mM) in patients treated with ASA and clopidogrel following PCI. High on-clopidogrel platelet reactivity (HPR) was defined as ADP-induced platelet aggregation ≥ 46 U. The manufacturer recommends performing the analysis within 30-180 min after blood draw. Patients were grouped according to the time from blood draw to MEA: 30-180 min, < 30 min, or > 180 min. Platelet function of 273 patients with coronary artery disease undergoing PCI with dual antiplatelet therapy was analyzed. The median age was 72 years (interquartile range, IQR 62-79) and 179 (66%) were male. Median ADP-, TRAP-, and AA-induced aggregation was 25 (IQR 18-36) U, 79 (IQR 63-96) U, and 12 (IQR 7-18) U, respectively. For those analyzed within 30-180 min from blood draw, no significant correlation of time from blood draw to MEA was observed 1) ADP (r = - 0.04, p = 0.51); 2) TRAP (r = - 0.06, p = 0.32); 3) AA (r = - 0.03, p = 0.67). In patients undergoing percutaneous coronary intervention and treated with dual antiplatelet therapy, the time from blood draw to multiple electrode aggregometry does not correlate with ADP- induced aggregation when the measurement occurred within the recommended time interval of 30-180 min after blood draw.
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Affiliation(s)
- David Hesselbarth
- grid.5963.9Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, Freiburg, 79106 Germany
| | - Diona Gjermeni
- grid.5963.9Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, Freiburg, 79106 Germany
| | - Sofia Szabo
- grid.5963.9Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, Freiburg, 79106 Germany
| | - Patrick M. Siegel
- grid.5963.9Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, Freiburg, 79106 Germany
| | - Philipp Diehl
- grid.5963.9Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, Freiburg, 79106 Germany ,Department of Cardiology, Pneumology, Angiology, Geriatrics & Intensive Care Medicine, Ortenau Hospital, Lahr-Ettenheim, Germany
| | - Martin Moser
- grid.5963.9Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, Freiburg, 79106 Germany
| | - Christoph Bode
- grid.5963.9Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, Freiburg, 79106 Germany
| | - Christoph B. Olivier
- grid.5963.9Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, Freiburg, 79106 Germany
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Popova V, Geneva-Popova M, Kraev K, Batalov A. Assessment of TNF-α expression in unstable atherosclerotic plaques, serum IL-6 and TNF-α levels in patients with acute coronary syndrome and rheumatoid arthritis. Rheumatol Int 2022. [PMID: 35614271 DOI: 10.1007/s00296-022-05113-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
Abstract
The role of inflammatory cytokines is well researched in acute coronary syndrome (ACS) and rheumatoid arthritis (RA), but not in the presence of both conditions. This study aimed to compare TNF-α expression, serum TNF-α, IL-6, and hs-CRP in ACS patients with RA (n = 46) with ACS patients without RA (n = 49) and healthy controls (n = 50). TNF-α expression was assessed from coronary artery samples, taken during coronary artery bypass surgery. Serum levels TNF-α, IL-6, and hs-CRP were measured 24 and 48 h after cardiac surgery. Stronger TNF-α expression was observed in the ACS patients with RA versus the ACS patients without RA, p = 0.001. Serum TNF-α, IL-6, and hs-CRP at the 24th h were significantly elevated in both patient groups and distinguished them from the healthy controls with accuracy ranging from 80 to 99%. At the 48th h, serum TNF-α and IL-6 in the ACS group without RA decreased to those of the healthy controls but remained high in the group with RA. ACS cases with RA could be correctly identified from the levels of IL-6 (AUC = 0.885, 95% CI 0.791 to 0.938) and TNF-α (AUC = 0.852, 95%CI 0.720 to 0.922). Our results suggest that the presence of RA in ACS cases is likely to provoke stronger TNF-α expression on atherosclerotic plaques, aggravate the pro-inflammatory response, and sustain it even after the cardiac stress is lowered. In ACS cases with RA, long-term monitoring and control of TNF-α and IL-6 levels can be a useful preventive strategy.
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Rapoport EA, Chidharla A, Mortoti SS. A case of cardiac sarcoidosis with concurrent myocardial ischemia. HeartRhythm Case Rep 2021; 7:479-483. [PMID: 34307035 PMCID: PMC8283541 DOI: 10.1016/j.hrcr.2021.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Eliot A Rapoport
- University of Illinois College of Medicine Peoria, Peoria, Illinois
| | - Anusha Chidharla
- University of Illinois College of Medicine Peoria, Peoria, Illinois.,OSF St. Francis Medical Center, UICOMP, Peoria, Illinois
| | - Samuel S Mortoti
- University of Illinois College of Medicine Peoria, Peoria, Illinois.,OSF St. Francis Medical Center, UICOMP, Peoria, Illinois
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Calim A, Turkoz FP, Ozturkmen YA, Mazi EE, Cetin EG, Demir N, Borlu F. The Relation between Homocysteine Levels in Patients with Acute Coronary Syndrome and Grace Score. Sisli Etfal Hastan Tip Bul 2020; 54:346-50. [PMID: 33312034 DOI: 10.14744/SEMB.2018.77864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 12/10/2018] [Indexed: 11/20/2022]
Abstract
Objectives This study investigated the correlation between homocysteine levels in patients with Acute Coronary Syndrome and GRACE Score. Methods This study included 191 cases -140 Non-ST MI cases and 51 MI with ST-elevation cases in Şişli Etfal Training and Research Hospital Coronary Intensive Care Unit between December 2008 and March 2010. Homocysteine was measured by immulite 2000 device, using kemiluminesans method and competitive immunoassay principle and a kit by DPC was used during the measurement. The reference range given by the producing company was between 5-15 Mmol/L for male and female adults. The patients were classified into three risk groups as low, medium and high on the basis of the criteria identified in GRACE risk score: age, heart rate, systolic blood pressure, serum creatine levels, Killip classification, cardiac arrest on admission, increased cardiac enzymes and ST segment depression. The relation between homocysteine levels in patients with Acute Coronary Syndrome and GRACE risk score was evaluated. Results In the Non-ST MI group, a statistically-moderate positive correlation was seen between homocysteine and GRACE risk score during the study (p<0.05). However, in the MI with ST-elevation group, no correlation was found between homocysteine and GRACE risk score (p>0.05). Overall, despite the low figures, a meaningful positive relation was observed between homocysteine and GRACE risk score in all cases. Conclusion Homocysteine is independent of other classic risk factors for cardiovascular diseases. Therefore, we believe that routine plasma homocysteine levels should be checked when evaluating risk factors for Atherosclerotic Coronary Artery disease.
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Kim SW, Kang HJ, Bae KY, Shin IS, Hong YJ, Ahn YK, Jeong MH, Berk M, Yoon JS, Kim JM. Interactions between pro-inflammatory cytokines and statins on depression in patients with acute coronary syndrome. Prog Neuropsychopharmacol Biol Psychiatry 2018; 80:250-4. [PMID: 28689006 DOI: 10.1016/j.pnpbp.2017.07.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 07/05/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Pro-inflammatory cytokines are associated with the development of depression and statins exert anti-inflammatory and antidepressant effects. The present study aimed to investigate associations between interleukin (IL)-6 and IL-18 and depression in patients with acute coronary syndrome (ACS) and potential interactions between statin use and pro-inflammatory cytokines on depression in this population. METHODS We used pooled datasets from 1-year follow-up data from a 24-week randomized double-blind placebo-controlled trial (RCT) of escitalopram for treatment of depressive disorder and data from a naturalistic, prospective, observational cohort study in patients with ACS. IL-6 and IL-18 levels were measured at baseline. Logistic regression models were used to investigate independent associations of IL-6/IL-18 levels with depressive disorder at baseline and at 1year. We repeated all analyses by reference to statin use to determine whether any significant association emerged. RESULTS Of the 969 participants, 378 (39.0%) had major or minor depression at baseline. Of 711 patients followed-up at 1year, 183 (25.7%) had depression. Logistic regression analysis showed that higher IL-6 and IL-18 levels at baseline were significantly associated with baseline depression after adjusting for other variables (adjusted p-values=0.005 and 0.001, respectively). IL-6 and IL-18 levels were also significantly higher in patients with depression at the 1-year follow-up after adjusting for other variables amongst those not taking statins (adjusted p-values=0.040 and 0.004, respectively); but this was not the case in patients taking statins. CONCLUSION Levels of pro-inflammatory cytokines appear to predict development of depression after ACS and statins attenuate the effects of cytokines on depression.
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Abstract
Takotsubo syndrome (TS) is characterized by severe reversible left ventricular (LV) wall motion abnormality in the absence of explanatory coronary lesion. Despite an increasing number of patients diagnosed with TS worldwide, there are no randomized clinical trials. In mild cases, no treatment or a short course of limited anticoagulation therapy may be sufficient. Positive inotropic and vasodilating agents should be avoided. In severe cases with refractory cardiogenic shock, early treatment with mechanical support using venoarterial extracorporeal membrane oxygenation or a LV assist device should be considered.
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Affiliation(s)
- Elmir Omerovic
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Bruna stråket 16, Gothenburg, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Bruna stråket 16, Gothenburg 413 45, Sweden.
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Abstract
Hymenoptera stings are common reasons for emergency visits. The admissions for the hymenoptera stings occur for systemic or unusual reactions. We are reporting a man with multiple bee stings, who presented with dizziness and palpitations and was found to have ECG findings of the Wolff-Parkinson-White syndrome. He had no worsening of symptoms or new ECG changes during his hospitalization. The hymenoptera related cardiac effects have also been reviewed and summarized.
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Affiliation(s)
- Shanmuga Ravi Santhosh M
- Intern, Department of Internal Medicine Pondicherry Institute of Medical Sciences, Pondicherry, India
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