scholarly journals Development of one-year major adverse cardiac events risk index in patients with acute coronary syndrome and diabetes mellitus who underwent percutaneous coronary intervention

2020 ◽  
Vol 77 (11) ◽  
pp. 1192-1200
Author(s):  
Marija Mirkovic ◽  
Milan Nedeljkovic ◽  
Dusan Ruzicic ◽  
Mira Vukovic
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Percutaneous Coronary Intervention ◽  
Risk Index ◽  
Coronary Intervention ◽  
Syntax Score ◽  
Coronary Syndrome ◽  
C Statistic ◽  
Percutaneous Coronary ◽  
One Year

Background/Aim. Patients with acute coronary syndrome (ACS) and diabetes mellitus (DM) have an increased risk of major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI), which is not estimated sufficiently-multidimensionally in terms of type and severity of the ACS and/or DM and angiographic findings. The study was intended to validate and develop an index of metabolic, angiographic, anatomic and clinical risk factors for one-year MACE after conducted PCI in patients with ACS and DM. Methods. A prospective cross-sectional study was performed in patients with DM and ACS. In the PCI period the following risk factors were recorded: 1) age and metabolic variables ? glycosylated hemoglobin (HbA1c), total cholesterol, and triglycerides levels in the blood; 2) endocrinological variables ? DM therapy and type of DM; 3) ACS modality; 4) radiological/anatomical variable ? SYNTAX score, and 5) clinical variables in modified age, creatinine, ejection fraction (ACEF) score. One-year MACE were recorded. Results. From a total of 136 consecutive patients, 55 of them developed at least one MACE in one-year follow-up. A high predictive risk index was evaluated that assessed particular or associated risks for one-year MACE (c statistic = 0.879) in the study population, defined by: SYNTAX score > 21, modified ACEF score > 1.38, HbA1c ? 8%, triglyceridemia ? 2.3 mmol/L in patients with insulin therapy, and ACS modality ? unstable angina pectoris. The constructed risk index for one-year MACE (MACERI) had better predictive characteristics than SYNTAX score (c statistic = 0.798), as well as ACF score (c statistic = 0.744). Conclusion. MACERI can potentially have great application in future risk factors studies for one-year MACE in patients with DM and ACS who underwent PCI, because with it the effects of these factors are measured multidimensionally at valid and accurate manner.

scholarly journals HbA1C modified Clinical SYNTAX score as a prognostic tool in patients with diabetes mellitus and multi-vessel coronary artery disease treated with primary percutaneous coronary intervention

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D Ruzicic ◽  
M.M Mirkovic
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Risk Index ◽  
Coronary Intervention ◽  
Syntax Score ◽  
Clinical Value ◽  
Coronary Syndrome ◽  
C Statistic ◽  
Percutaneous Coronary ◽  
One Year

Abstract Introduction Patients with acute coronary syndrome (ACS) and diabetes mellitus (DM) have an increased risk of major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI), which is not estimated sufficiently-multidimensionally in terms of type and severity of the ACS and/or DM and angiographic findings. Aim The study was intended to estimate and compare the predictive clinical value of the modified SYNTAX score versus the predictive clinical value of the SYNTAX score to the one-year appearance of MACE after conducted PCI in patients with DM (with diagnosis longer than one year and multivessel disease) and acute coronary syndrome (ACS). Material and methods A prospective cross-section study was performed in patients with DM and ACS. In the PCI period the following risk factors where were recorded: 1) age and metabolic variables – glycosylated hemoglobin (HbA1c), total cholesterol, triglyceridemia; 2) endocrinological variables – DM therapy, tip of DM; 3) ACS modality; 4) radiological / anatomical variable – SYNTAX score and 5) clinical variables in modified ACEF score and clinical SYNTAX score. One-year MACE were recorded. Results From a total of 136 consecutive patients, 55 of them developed at least one MACE in one-year follow-up. Two highly predictable MACE risk indexes (MACERI) were constructed. The first risk index – MACERI (c statistic = 0.879) was defined by: SYNTAX score >21, modified ACEF >1.38, HbA1c ≥8 (%), triglyceridemia ≥2.3 (mmol / L) in patients on insulin therapy and ACS modality – unstable angina pectoris. MACERI has better predictive characteristics than SYNTAX score (c statistic = 0.798) as well as ACF score, but not in relation to clinical SYNTAX score (c statistic = 0.820). The second risk index – MACERI II (c statistic = 0.923), defined the same risk factors as MACERI, except HbA1c ≥8 (%),which additionally contains a risk factor – the presence of three-vessel disease. MACERI II had significantly better predictive characteristics than all mentioned scores, but also in relation to MACERI. Conclusions MACERI and MACERI II can potentially have great application in future risk factors studies for one-year MACE in patients with DM and ACS who underwent PCI, because with them the effects of these factors measure multidimensionally at valid and accurate manner. Funding Acknowledgement Type of funding source: None

scholarly journals Good Practices in the Clinical Management of Patients with Acute Coronary Syndrome: Retrospective Analysis in a Third-Level Hospital in Mexico

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Héctor E. Flores-Salinas ◽  
Fidel Casillas-Muñoz ◽  
Yeminia Valle ◽  
Cesar M. Guzmán-Sánchez ◽  
Jorge Ramon Padilla-Gutiérrez
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Heart Surgery ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Percutaneous Coronary

Introduction and Objective. In Mexico, there has been an increase in the risk of cardiovascular disease due to rising life expectancy, westernized lifestyle, lack of prevention, and industrialized exposure. This article describes the pharmacological treatment, surgical interventions, and associated clinical complications in patients diagnosed with acute coronary syndrome (ACS) and their impact on in-hospital mortality frequency in a Cardiology Unit in Instituto Mexicano del Seguro Social. Methods. This is a retrospective study including male and female patients aged ≥18 years who were diagnosed with ACS. The collected data included demographic characteristics, risk factors, medications, electrocardiograms, surgical procedures, and in-hospital deaths. Results. There are at least 20% more diagnoses of ST-segment elevation myocardial infarction in this hospital compared to the latest national reports in Mexico. The most common risk factors were type 2 diabetes mellitus, hypertension, smoking, and dyslipidaemia. Diabetic patients with a clinical history of percutaneous coronary intervention had a higher risk of non-ST-segment elevation myocardial infarction than nondiabetics (OR: 2.34; p=0.013), also smoking patients with previous heart surgery than nonsmokers (OR: 7.73; p=0.0007). The average in-hospital mortality was 3.6% for ACS. Conclusions. There is a higher percentage of coronary interventionism and improvement in pharmacological treatment, which is reflected in lower mortality. The substantial burden of T2DM could be related to a higher number of cases of STEMI. Diabetics with precedent percutaneous coronary intervention and smokers with previous heart surgery have an increased risk of subsequent infarction.

scholarly journals Incidence and Predictors of Unplanned Hospital Readmission after Percutaneous Coronary Intervention

2020 ◽  
Vol 9 (10) ◽  
pp. 3242
Author(s):  
Sinjini Biswas ◽  
Diem Dinh ◽  
Mark Lucas ◽  
Stephen J. Duffy ◽  
Angela L. Brennan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Percutaneous Coronary Intervention ◽  
Healthcare System ◽  
Hospital Readmission ◽  
Hospital Admissions ◽  
Coronary Intervention ◽  
Disease Diagnosis ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Significant Burden

Unplanned readmissions to hospital after percutaneous coronary intervention (PCI) pose a significant burden to the healthcare system and are potentially preventable. In this study, we sought to determine the incidence of, and risk factors for, unplanned hospital readmissions within 30 days following PCI. We prospectively collected data on 28,488 patients undergoing PCI between 2013 and 2019, who were enrolled in the state-wide multi-centre Victorian Cardiac Outcomes Registry. Patients’ data were then linked to data from the Victorian Department of Health administrative database that records statewide hospital admissions. Disease diagnosis codes were used to identify cause of readmission. Patients who had an unplanned readmission were further divided into those who had a cardiac vs. non-cardiac cause for readmission. Overall, 3059 patients (10.7%) had an unplanned hospital readmission within 30 days of PCI, of which 1848 patients (60.4%) were readmitted for primarily cardiac diagnoses. Independent predictors of both 30-day unplanned cardiac and non-cardiac readmissions post-PCI were female sex, having ≥1 admission in the 12 months prior to PCI, acute coronary syndrome presentation, having any in-hospital complication and being discharged on an oral anticoagulant (all p < 0.05). A stepwise increase in readmission risk was observed with increasing number of admissions from 1 to ≥4 admissions in the 12 months prior to PCI. In conclusion, a substantial proportion of patients undergoing PCI have unexpected readmissions to hospital in the 30 days following PCI. Targeted strategies for patients with risk factors for readmission may be useful to reduce this significant burden to the healthcare system.

scholarly journals Gender Differences in Clinical, Angiographic and Procedural Profiles between Young Patients with Acute Coronary Syndrome undergoing Percutaneous Coronary Intervention

2018 ◽  
Vol 10 (2) ◽  
pp. 113-120
Author(s):  
Fathima Aaysha Cader ◽  
Afzalur Rahman ◽  
Mohammad Ullah ◽  
Mohammad Arifur Rahman ◽  
Md Sarwar Alam ◽  
...  
Keyword(s):  
Risk Factors ◽  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Young Women ◽  
Young Patients ◽  
Coronary Intervention ◽  
Young Males ◽  
Young Females ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Background: Acute coronary syndrome (ACS) is increasingly prevalent among young patients, particularly in South Asia, where young patients are known to present with multiple risk factors and gender-based differences in angiographic profiles. This study aimed to compare gender differences in clinical, angiographic and procedural profiles between young patients with ACS undergoing percutaneous coronary intervention (PCI).Methods: This prospective observational study was done at the National Institute of Cardiovascular Diseases (NICVD) from April 2016 to March 2017. 190 young patients with ACS undergoing PCI were included. Clinical, angiographic and procedural variables were compared and statistically analyzed.Results: The mean age of young females and males was 43.8±6.9 years and 40.1±4.3 years respectively (p<<0.001). Young women had significantly more risk factors of hypertension (62.1% vs 33.7%, p<0.001) and diabetes (57.9% vs 31.6%, p<0.001) in comparison to young men. Smoking was significantly greater among young males (70.5% vs 0%, p<0.001). Young females had significantly better mean ejection fraction (EF) (48.4±9.3% vs 45.1±10.4%, p=0. 02). Left main coronary artery (3.2% vs. 1.1%, p=0.61) and left anterior descending artery (51.6% vs. 45.3%, p=0.38) were more frequently involved among young females. Young males showed angiographically more severe CAD and greater frequency of multivessel CAD with higher DVD (22.1%vs 18.9%, p=0.58) and TVD (18.9%vs 11.6%, p=0.15).Conclusion: Significantly more young women with ACS presented with hypertension and diabetes than young males. However, they had better ejection fraction and less severe angiographic profiles.Cardiovasc. j. 2018; 10(2): 113-120

scholarly journals Prognostic impact of the atherogenic index of plasma in type 2 diabetes mellitus patients with acute coronary syndrome undergoing percutaneous coronary intervention

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Xiaoteng Ma ◽  
Yan Sun ◽  
Yujing Cheng ◽  
Hua Shen ◽  
Fei Gao ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Percutaneous Coronary Intervention ◽  
Cardiovascular Events ◽  
Coronary Intervention ◽  
Atherogenic Index ◽  
Atherogenic Index Of Plasma ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Abstract Background The association of the atherogenic index of plasma (AIP), an emerging lipid index that can predict the risk for cardiovascular disease, with adverse outcomes in type 2 diabetes mellitus (T2DM) patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) has not been determined. Therefore, the aim of this study was to investigate whether the AIP could independently predict adverse cardiovascular events in T2DM patients with ACS undergoing PCI. Methods This study was a retrospective analysis of a single-centre prospective registry involving 826 consecutive T2DM patients who underwent primary or elective PCI for ACS from June 2016 to November 2017. This study ultimately included 798 patients (age, 61 ± 10 years; male, 72.7%). The AIP was calculated as the base 10 logarithm of the ratio of the plasma concentration of triglycerides to high-density lipoprotein-cholesterol (HDL-C). All the patients were divided into 4 groups based on the AIP quartiles. The primary endpoint was a composite of death from any cause, non-fatal spontaneous myocardial infarction (MI), non-fatal ischaemic stroke, and unplanned repeat revascularization. The key secondary endpoint was a composite of cardiovascular death, non-fatal MI, and non-fatal ischaemic stroke. Results During a median follow-up period of 927 days, 198 patients developed at least one event. An unadjusted Kaplan-Meier analysis showed that the incidence of the primary endpoint increased gradually with rising AIP quartiles (log-rank test, P = 0.001). A multivariate Cox proportional hazards analysis revealed that compared with the lowest AIP quartile, the top AIP quartile was associated with significantly increased risk for the primary and key secondary endpoints (hazard ratio [HR]: 2.249, 95% confidence interval [CI]: 1.438 to 3.517, P < 0.001; and HR: 2.571, 95% CI: 1.027 to 6.440, P = 0.044, respectively). Conclusions A higher AIP value on admission was independently and strongly associated with adverse cardiovascular events in T2DM patients with ACS undergoing PCI.

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