Association of Serum Gamma Glutamyl Transferase Level with Acute Coronary Syndrome and Its Correlation with Major Adverse Cardiovascular Outcomes - A Single Center Cross Sectional Study from a Tertiary Care Centre in Kerala

2021 ◽  
Vol 8 (25) ◽  
pp. 2155-2161
Author(s):  
Baiju Rajan ◽  
Praveen Velappan ◽  
Abdul Salam ◽  
Sivaprasad Kunjukrishnapillai ◽  
Kapil Rajendran ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Unstable Angina ◽  
Acute Coronary Syndromes ◽  
St Elevation Myocardial Infarction ◽  
Gamma Glutamyl Transferase ◽  
Gamma Glutamyl ◽  
Study Population ◽  
Coronary Syndromes ◽  
St Elevation ◽  
Glutamyl Transferase

BACKGROUND Gamma glutamyl transferase (GGT) is a biomarker elevated in various cardiovascular diseases due to oxidation mediated free radical damage. It has been recently used in patients presenting with acute coronary syndromes (ACS) for predicting major adverse cardiovascular events and in hospital adverse outcomes. The application of gamma glutamyl transferase to the traditional set of biomarkers like troponin I and T, creatinine kinase-MB (CKMB) adds to the value that it helps in reclassifying the patients into high and low risk and plan the appropriate treatment strategy. METHODS Patients presenting with acute coronary syndromes were classified into STEMI (ST elevation myocardial infarction), NSTEMI (Non-ST elevation myocardial infarction) and unstable angina based on cardiac biomarkers and electrocardiographic changes. Serum gamma glutamyl transferase of these patients were measured by photo spectrometry and were monitored for 5 days for major adverse cardiovascular events. RESULTS Of the study population (N = 210), 41 % presented with STEMI, 24 % unstable angina, 25 % NSTEMI. The normal range of GGT in our study population was 15 - 70 U/l. values more than 70 U/l was considered raised GGT major adverse cardiac events (MACE) was present in 35 % of the study population. 58 % of the patients with MACE had raised GGT (> 70 U/l) which was statistically significant (P < 0.001). The ROC (receiver operator characteristic curve) for GGT to predict MACE was to the left of the reference line and the area under the curve (AUC) was 0.915. The optimal cut-off for GGT to predict MACE from our study was 50.5 with a sensitivity and specificity of 0.813 and 0.868 respectively. CONCLUSIONS Raised GGT was significantly associated with MACE and in hospital adverse outcomes (ventricular arrythmias, heart failure, recurrent angina). GGT can be used as a prognostic marker in patients presenting with ACS. KEYWORDS Gamma Glutamyl Transferase, Acute Coronary Syndromes, St Elevation Myocardial Infarction, Non-ST Elevation Myocardial Infarction, Unstable Angina

Abstract 17143: Acute Coronary Syndromes Associated With SARS-CoV-2 Infection Admissions in a Medium Size Community Hospital

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
ANDREEA-CONSTANTA STAN ◽  
Momcilo Durdevic ◽  
Rosario Florante ◽  
Arshavir Artashesyan ◽  
Henrik Elenius ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Primary Care ◽  
Chest Pain ◽  
Unstable Angina ◽  
Acute Coronary Syndromes ◽  
St Elevation Myocardial Infarction ◽  
Type Ii ◽  
Primary Care Teams ◽  
Coronary Syndromes ◽  
St Elevation

Background: The presence of cardiovascular complications were reported in small studies of critical care patients admitted with SARS-CoV-2infection There is a dearth of data regarding presence of acute coronary syndromes (ACS) in patients admitted with symptomatic SARS-CoV-2 infection, the cause of the myocardial injury and particularities of management. Objectives: The aim of the study is to describe the presence and type ACS in patients admitted with symptomatic SARS-CoV-2 infection. Secondary outcomes were contributing factors, presenting symptoms and medical management. Methods: A descriptive, retrospective study of patients with a positive COVID-19 test and symptomatic infection admitted from 10 March 2020 to 10 April 2020 in our hospital. Results: There were a total of 127 patients admitted with symptomatic SARS-CoV-2 infection. The most common ACS was Type II Myocardial Infarction (MI). 16 patients were diagnosed with type II MI, 3 patients with Non ST elevation myocardial infarction (NSTEMI) and no patient was diagnosed with unstable angina and ST elevation myocardial infarction (STEMI). The most common cause of Type II MI was hypoxia followed by congestive heart failure and new onset atrial fibrillation. One patient has chest pain as presenting symptom. Except for Aspirin loading and use of beta blocker no other antischemic, statin or ACE/ARB medication was used for management of type II MI. All patients with Type II MI were managed by primary care teams. 3 patients developed NSTEMI and were managed by primary care teams with Cardiology consults. Anti-coagulation was considered for all patients. All patients received Aspirin loading, high intensity statin and beta blockers. Conclusions: Majority of patients with ACS had symptoms related to SARS-CoV-2 infection and chest pain was absent in 95% of cases. The most common ACS was type II MI- myocardial ischemia in context of hypoxia and the treatment was focused in treating the underlying cause rather than initiation of classical guideline directed therapy or invasive management. There were no cases of unstable angina and STEMI, results consistent with previous studies underlying the low incidence of STEMI cases during this pandemic.

Epidemiology and pathophysiology of coronary artery disease

2016 ◽  
Author(s):  
Demosthenes G. Katritsis ◽  
Bernard J. Gersh ◽  
A. John Camm
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Unstable Angina ◽  
Acute Coronary Syndromes ◽  
St Elevation Myocardial Infarction ◽  
Coronary Syndromes ◽  
St Elevation ◽  
Artery Disease

This chapter presents the epidemiology and pathophysiology of stable ischaemic heart disease and acute coronary syndromes, i.e. unstable angina/non-ST elevation myocardial infarction and ST elevation myocardial infarction.

Non-ST elevation acute coronary syndromes

2016 ◽  
Author(s):  
Demosthenes G. Katritsis ◽  
Bernard J. Gersh ◽  
A. John Camm
Keyword(s):  
Myocardial Infarction ◽  
Unstable Angina ◽  
Acute Coronary Syndromes ◽  
St Elevation Myocardial Infarction ◽  
Interventional Management ◽  
Coronary Syndromes ◽  
St Elevation

Diagnosis and current pharmacological and interventional management of unstable angina/non-ST elevation myocardial infarction are presented in this chapter. Recent recommendations by the ACC/AHA and the ESC have been summarized and tabulated.

Changes in Hemoglobin and Hematocrit May Predict Mortality in Patients with Acute Coronary Syndromes.

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3171-3171
Author(s):  
Zaid Alirhayim ◽  
Waqas Qureshi ◽  
Vijaya Donthireddy ◽  
Syed Hassan ◽  
Fatima Khalid
Keyword(s):  
Myocardial Infarction ◽  
Plasma Volume ◽  
Acute Coronary Syndromes ◽  
St Elevation Myocardial Infarction ◽  
Receiver Operating Curve ◽  
Mortality Data ◽  
Volume Changes ◽  
Social Security Death Index ◽  
Coronary Syndromes ◽  
St Elevation

Abstract Abstract 3171 Introduction: Changes in plasma volume, the intravascular portion of the extracellular fluid volume, can be estimated by measuring changes in the levels of hemoglobin and hematocrit in the blood. In addition to hemoglobin & hematocrit levels, we are also able to use standard dilution techniques with radiolabeled albumin to accurately measure plasma volume changes. It is not known if plasma volume changes influence outcomes in patients with acute coronary syndromes. The aim of this study was to evaluate the effects of plasma volume changes in patients presenting with the acute coronary syndromes. Methods: Consecutive patients presenting to a single tertiary care center from January 2001 to December 2010 with non ST elevation myocardial infarction (NSTEMI) or ST elevation myocardial infarction (STEMI) were enrolled. Admission hemoglobin (Hbpre) & hematocrit (Hctpre) and discharge hemoglobin (Hbpost) and hematocrit levels (Hctpost) were obtained. Plasma volume changes were measured and a validated formula (ΔPV = ((Hbpre/Hbpost) × (100-Hctpost/100-Hctpre)-1) × 100%) was used to calculate the changes in plasma volumes. A detailed chart review was performed to collect information about baseline variables such as age, gender, hypertension, diabetes, hyperlipidemia, smoking status, and congestive heart failure. The Framingham Risk score was also calculated for each individual. Survival analysis was carried out for plasma volume changes of -20% - 0%, 0 – 20%, and ≥20%. Mortality data was collected from the social security death index for the first 60 days post-discharge. Results: A total of 9770 patients with confirmed NSTEMI or STEMI (mean age 61.8 ± 4.8 years, 48.8% women) were included in the final analysis. Mean pre admission hemoglobin (Hbpre) was 10.2 ± 1.4 g/dl and post admission hemoglobin (Hbpost) was 10.4 ± 1.3 g/dl. Change in plasma volume, ΔPV, was categorized into one of four categories, with 131 (1.3%) ≤20%, 6126 (62.7%) -20% - 0%, 3393 (34.7%) 0 – 20%, and 120 (1.2%) ≥20%. There were 509 deaths within 60 days of discharge. Change in plasma volume was found to be an independent predictor of mortality (HR 5.71; 95% CI 4.75 – 6.86, p = 0.0001) in a Cox proportional hazard model. Most of the deaths occurred during the first thirty days as demonstrated by the Kaplan – Meier's survival curve (Figure 1). Receiver operating curve showed an area under the curve of 0.876 for changes in plasma volume. Conclusion: This study shows that hemoglobin and hematocrit, although simple tests, can provide important prognostic information strongly predictive of short term mortality in patients with acute coronary syndromes. Further studies are required to see if monitoring of plasma volume and correction with pharmacological agents such as diuretics may lead to better outcomes. Disclosures: No relevant conflicts of interest to declare.

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