scholarly journals Predictors of the extent and severity of coronary artery disease for prognosis of patients with non-ST-segment elevation acute coronary syndromes

2018 ◽  
Vol 3 (4) ◽  
pp. 74-79
Author(s):  
Chirag Patel ◽  
Jayesh Prajapati ◽  
Iva V Patel ◽  
Roopesh Singhal ◽  
Ashish Mishra ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Acute Coronary Syndromes ◽  
St Segment Elevation ◽  
St Segment ◽  
Coronary Syndromes ◽  
Artery Disease

P4572Lipoprotein(a) is not associated with survival after acute coronary syndromes

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Roth ◽  
D Dalos ◽  
C Gangl ◽  
K Krychtiuk ◽  
L Schrutka ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Acute Coronary Syndromes ◽  
Total Mortality ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Coronary Syndromes ◽  
Artery Disease

Abstract Aims Lipoprotein(a) [Lp(a)] is associated with coronary artery disease in population studies, however studies on its predictive value in patients with established cardiovascular disease, in particular after acute coronary syndromes (ACS), are conflicting. The aim of this study was to investigate whether Lp(a) is associated with survival after ACS. Methods and results We analyzed 4469 consecutive patients that underwent coronary angiography for ACS. Lp(a) measurement at time of ACS was available in 1245 patients and median follow-up for cardiovascular and total mortality was 5.0 (IQR 3.2–8.0) years. 655 (52.6%) presented with ST-segment elevation myocardial infarction (STEMI), 424 (34.1%) with Non-ST-segment elevation myocardial infarction (NSTEMI) and 166 (13.3%) underwent coronary angiography for unstable angina. Cardiovascular mortality was 9.1% and total mortality was 15.7%. Patients were stratified into four groups to their Lp(a) levels. (≤15 mg/dL, >15–30 mg/dL, >30–60 mg/dL, and >60 mg/dL). Multivessel disease was significantly more common in patients with Lp(a) >60 mg/dL (p<0.05). Increased levels of Lp(a) were not associated with cardiovascular mortality (HR compared with Lp(a) ≤15 mg/dL were 1.2, 1.2, and 1.0, respectively; p=0.69) and not with total mortality (HR compared with Lp(a) ≤15 mg/dL were 1.2, 1.2, and 1.2, respectively; p=0.46). Central Figure Conclusion Lp(a) levels at time of ACS were neither associated with cardiovascular nor with total mortality. Although Lp(a) has been shown to be associated with incidence of coronary artery disease, this study does not support any role of Lp(a) as a risk factor after ACS. This should be taken into account for development of outcome studies for agents targeting Lp(a) plasma levels.

Abstract 5598: Angiographic Evidence of Early Coronary Artery Disease and Inceased Risk of Mortality in Smokers with Non-ST-Segment Elevation Acute Coronary Syndromes: An Analysis of the ACUITY Trial

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Jason O Robertson ◽  
Ramin Ebrahimi ◽  
Alexandra J Lansky ◽  
Roxana Mehran ◽  
Gregg W Stone ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Major Bleeding ◽  
Acute Coronary Syndromes ◽  
Smoking Status ◽  
St Segment Elevation ◽  
St Segment ◽  
Acute Mi ◽  
Coronary Syndromes ◽  
Artery Disease

To determine the relationship between smoking and outcomes in a contemporary population of patients with non-ST-elevation acute coronary syndromes (NSTE-ACS). Smoking has been associated with the “paradox” of reduced mortality following acute MI. This is thought to be due to favorable baseline characteristics and less diffuse CAD of smokers. In the ACUITY trial, 13,819 patients (29.1% smokers) with moderate- to high-risk NSTE-ACS underwent angiography and, if indicated, revascularization. Smokers were significantly younger and had fewer co-morbidities than nonsmokers. Incidence of death and MI were comparable at 30-days, although smokers had significantly reduced risks of 30-day major bleeding (HR=0.80, 95% CI=0.67– 0.96, p=0.016) and 1-year mortality (HR=0.797, 95% CI=0.65– 0.97, p=0.027). After multivariate correction for baseline and clinical differences, however, smoking status was no longer predictive of major bleeding (OR=1.06, 95% CI=0.85–1.32, p =0.59) and was associated with higher 1-year mortality (HR=1.38, 95% CI=1.07–1.78, p =0.013). This pattern of reversed risk following multivariable correction held true, as well, for those smokers requiring PCI. Core laboratory angiographic analysis showed that smokers and nonsmokers were comparable in terms of the extent of coronary artery disease, TIMI flow, myocardial blush and the presence of thrombi, but smokers had significantly less coronary artery calcification and fewer collaterals. In contrast to the paradox previously described in STEMI, our analysis finds smoking to be an independent predictor of higher 1-year mortality in patients presenting with NSTE-ACS, and our angiographic study demonstrates CAD disease in smokers that is comparable to nonsmokers but evident approximately one decade earlier.

Platelet reactivity among patients with acute coronary syndromes and multivessel coronary artery disease

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Furtado ◽  
R Salsoso ◽  
T.F Dalcoquio ◽  
A.A Domingues ◽  
C.A.K Nakashima ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Acute Coronary Syndromes ◽  
Platelet Reactivity ◽  
Funding Source ◽  
Platelet Aggregability ◽  
St Segment Elevation ◽  
Vessel Disease ◽  
St Segment ◽  
Coronary Syndromes ◽  
Artery Disease

Abstract Background Patients with multivessel or complex coronary artery disease (CAD) are at increased risk of atherothrombotic events. It has been suggested that these patients may derive an incremental benefit with more intense antiplatelet strategies, according to prior subgroup analyses from randomized clinical trials. However, whether there is any association between the presence and extension of multivessel CAD and platelet aggregability (PA) in patients with acute coronary syndromes (ACS) is unknown. Purpose To analyze the independent association between PA and presence of multivessel CAD in patients with ACS. Methods Patients with ACS on dual antiplatelet therapy (aspirin plus clopidogrel) were included in this study. Multivessel CAD was defined as the presence of significant ≥50% stenosis at two or more major epicardic vessels. Platelet aggregability was assessed by VerifyNow P2Y12 assay expressed in P2Y12 Reactivity Units (PRU) on the day of discharge from the coronary care unit. High On-treatment platelet reactivity (HPR) was defined as PRU ≥208. Stepwise linear and logistic regression models were applied to adjust for confounders. Models were adjusted for: age, sex, race, diabetes, hypertension, smoking, dyslipidemia, prior MI, prior PCI, prior CABG, prior HF, prior stroke and ACS phenotype (STEMI vs. Non-ST-segment elevation ACS). Results A total of 237 patients were included, among whom 143 (60.3%) had multivessel CAD at the coronary angiogram and 175 (73.8%) were submitted to PCI during index hospitalization. Patients with multivessel disease were older (mean age 64.8±12.1 vs. 58.9±11.2 years; p&lt;0.001) and more likely to have a history of diabetes (47.6% vs. 29.8%; p=0.006) and non-ST-segment elevation ACS as the index event (55.2% vs. 28.7%; p&lt;0.001), compared to patients without multivessel CAD. After adjustments, presence of multivessel CAD was associated with higher PA (mean 161.4±74 PRU in patients with versus 140.3±70.9 PRU in patients without multivessel CAD; adjusted mean difference 23.7 PRU; 95% CI 4.8 to 42.5; p=0.014). Additionally, there was an incremental of 12.5 PRU (95% CI 2.8 to 22.3; adj p=0.012) for each diseased vessel and of 4.67 PRU (95% CI 0.11 to 9.22; adj p=0.045) for each diseased coronary segment. Compared to patients with single-vessel disease, patients with three-vessel disease had higher rates of HPR. (Figure). Conclusion In patients with ACS, the presence and extension of multivessel CAD were associated with higher levels of platelet aggregability and higher rates of high on-treatment platelet reactivity with clopidogrel. This finding may explain the incremental benefit with more intense antiplatelet therapies seen in this particular subgroup in prior clinical trials. Prevalence of HPR and extension of CAD Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Sao Paulo Research Foundation (FAPESP)

scholarly journals Acute Coronary Syndromes in Chronic Kidney Disease: Clinical and Therapeutic Characteristics

Medicina ◽  
2020 ◽  
Vol 56 (3) ◽  
pp. 118 ◽  
Author(s):  
Mădălina Ioana Moisi ◽  
Marius Rus ◽  
Simona Bungau ◽  
Dana Carmen Zaha ◽  
Diana Uivarosan ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Acute Coronary Syndromes ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Coronary Syndromes ◽  
Artery Disease

Background and Objectives: This study evaluated the clinical characteristics of the acute coronary syndromes (ACS) in chronic kidney disease (CKD) patients and established prognostic values of the biomarkers and echocardiography. Materials and Methods: 273 patients admitted to the cardiology department of the Clinical County Emergency Hospital of Oradea, Romania, with ACS diagnosis were studied. Two study groups were formed according to the presence of CKD (137 patients with ACS + CKD and 136 with ACS without CKD). Kidney Disease: Improving Global Outcomes (KDIGO) threshold was used to assess the stages of CKD. Results: Data regarding the medical history, laboratory findings, biomarkers, echocardiography, and coronary angiography were analysed for both groups. ACS parameters were represented by ST-segment elevation myocardial infarction (STEMI), which revealed a greater incidence in subjects without CKD (43.88%); non-ST-segment elevation myocardial infarction (NSTEMI), characteristic for the CKD group (28.47%, with statistically significance p = 0.04); unstable angina and myocardial infarction with nonobstructive coronary arteries (MINOCA). Diabetes mellitus, chronic heart failure, previous stroke, and chronic coronary syndrome were more prevalent in the ACS + CKD group (56.93%, p < 0.01; 41.61%, p < 0.01; 18.25%, p < 0.01; 45.26%, p < 0.01). N-terminal pro b-type natriuretic peptide (NT-proBNP) was statistically higher (p < 0.01) in patients with CKD; Killip class 3 was evidenced more frequently in the same group (p < 0.01). Single-vessel coronary artery disease (CAD) was statistically more frequent in the ACS without CKD group (29.41%, p < 0.01) and three-vessel CAD or left main coronary artery disease (LMCA) were found more often in the ACS + CKD group (27.01%, 14.6%). Conclusions: Extension of the CAD in CKD subjects revealed an increased prevalence of the proximal CAD, and the involvement of various coronary arteries is characteristic in these patients. Biomarkers and echocardiographic elements can outline the evolution and outcomes of ACS in CKD patients.

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