In hospital Mortality and correlates among patients admitted for Acute Coronary Syndrome in South India

2018 ◽  
Vol 8 (3) ◽  
Author(s):  
Vinoth Khanna ◽  
◽  
Priya Anbarasan ◽  
Abhinaya Shanmugasundaram ◽  
◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Hospital Mortality ◽  
South India ◽  
Coronary Syndrome

scholarly journals Circulating Levels of Dephosphorylated-Uncarboxylated Matrix Gla Protein in Patients with Acute Coronary Syndrome

Molecules ◽  
2021 ◽  
Vol 26 (4) ◽  
pp. 1108
Author(s):  
Admira Bilalic ◽  
Tina Ticinovic Kurir ◽  
Marko Kumric ◽  
Josip A. Borovac ◽  
Andrija Matetic ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
High Risk ◽  
Hospital Mortality ◽  
Vascular Calcification ◽  
Matrix Gla Protein ◽  
St Elevation Myocardial Infarction ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
St Elevation

Vascular calcification contributes to the pathogenesis of coronary artery disease while matrix Gla protein (MGP) was recently identified as a potent inhibitor of vascular calcification. MGP fractions, such as dephosphorylated-uncarboxylated MGP (dp-ucMGP), lack post-translational modifications and are less efficient in vascular calcification inhibition. We sought to compare dp-ucMGP levels between patients with acute coronary syndrome (ACS), stratified by ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) status. Physical examination and clinical data, along with plasma dp-ucMGP levels, were obtained from 90 consecutive ACS patients. We observed that levels of dp-ucMGP were significantly higher in patients with NSTEMI compared to STEMI patients (1063.4 ± 518.6 vs. 742.7 ± 166.6 pmol/L, p < 0.001). NSTEMI status and positive family history of cardiovascular diseases were only independent predictors of the highest tertile of dp-ucMGP levels. Among those with NSTEMI, patients at a high risk of in-hospital mortality (adjudicated by GRACE score) had significantly higher levels of dp-ucMGP compared to non-high-risk patients (1417.8 ± 956.8 vs. 984.6 ± 335.0 pmol/L, p = 0.030). Altogether, our findings suggest that higher dp-ucMGP levels likely reflect higher calcification burden in ACS patients and might aid in the identification of NSTEMI patients at increased risk of in-hospital mortality. Furthermore, observed dp-ucMGP levels might reflect differences in atherosclerotic plaque pathobiology between patients with STEMI and NSTEMI.

scholarly journals Impact of age on the obesity paradox in acute coronary syndrome: a nationwide analysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
B Narasimhan ◽  
K Ho ◽  
L Wu ◽  
M Amreia ◽  
A Isath ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Hospital Mortality ◽  
Hospital Admissions ◽  
Obesity Paradox ◽  
Index Admission ◽  
Multivariate Logistic Regression Model ◽  
Obese Patients ◽  
Readmission Rates ◽  
Coronary Syndrome ◽  
Hospitalization Costs

Abstract Background The obesity paradox – indicating improved short term mortality in obese individuals has been widely explored in a number of cardiovascular conditions. However, its validity in an elderly population and the possible physiological impact of aging on this phenomenon in Acute Coronary syndrome (ACS) remain unclear. In this study, we aim to determine the relationship between obesity and in-hospital mortality, morbidity, and health care resource utilization in this cohort of patients. Methods A retrospective study was conducted using the AHRQ-HCUP National Inpatient Sample for the year 2014. Elderly adults (≥65 years) with a principal diagnosis of ACS and a secondary diagnosis of obesity were identified using ICD-9 diagnosis codes as described in the literature. The primary outcome of in-hospital mortality and secondary outcomes like length of hospital stay (LOS), and total hospitalization costs were analyzed. Propensity score (PS) using the next neighbor method without replacement with 1:1 matching was utilized to adjust for confounders. Independent risk factors for mortality were identified using a multivariate logistic regression model. Results In total, 1,137,108 hospital admissions with a primary diagnosis of ACS were identified, of which 7.46% were obese. In-hospital morality during the index admission was lower among obese patients with ACS compared to non-obese patients (4.62 vs 6.87%, p&lt;0.001) with significantly lower 30-day readmission rates as well (p&lt;0.001). However, in-hospital mortality rates during readmission were statistically equivalent between the obese and non-obese groups (5.6 vs 8.3%, p=0.72). LOS during the index admission was longer for obese patients (6.39 vs 5.36 days, p=0.65) but equivalent to non-obese patients during subsequent readmissions (p=0.12). The total cost of these admissions was significantly more in the obese cohort as well (p&lt;0.001). Conclusion In this study, obese elderly patients admitted with ACS were found to have significantly reduced in-hospital mortality and 30-day readmission rates when compared to non-obese patients - reinforcing the obesity paradox independent of patient age. Funding Acknowledgement Type of funding source: None

scholarly journals Demographic and angiographic profile in premature cases of acute coronary syndrome: analysis of 820 young patients from South India

2016 ◽  
Vol 6 (3) ◽  
pp. 193-198 ◽  
Author(s):  
Surender Deora ◽  
Tarun Kumar ◽  
Rangaraj Ramalingam ◽  
Chollenhalli Nanjappa Manjunath
Keyword(s):  
Acute Coronary Syndrome ◽  
South India ◽  
Young Patients ◽  
Coronary Syndrome ◽  
Syndrome Analysis

scholarly journals Higher in-hospital mortality during weekend admission for acute coronary syndrome

2019 ◽  
Vol 20 (2) ◽  
pp. 74-80 ◽  
Author(s):  
Giovanni Malanchini ◽  
Giulio Giuseppe Stefanini ◽  
Margherita Malanchini ◽  
Federico Lombardi
Keyword(s):  
Acute Coronary Syndrome ◽  
Hospital Mortality ◽  
Coronary Syndrome

Prehospital tele-electrocardiographic triage improves the management of acute coronary syndrome in rural populations: A systematic review and meta-analysis

2020 ◽  
pp. 1357633X2096062
Author(s):  
Gilbert Lazarus ◽  
HL Kirchner ◽  
Bambang B Siswanto
Keyword(s):  
Acute Coronary Syndrome ◽  
Hospital Mortality ◽  
Rural Areas ◽  
Emergency Services ◽  
Meta Analysis ◽  
Coronary Syndrome ◽  
Evidence Quality ◽  
Poor Outcomes ◽  
Long Term Mortality

Introduction Acute coronary syndrome (ACS) patients residing in rural areas are predisposed to higher risk of poor outcomes due to substantial delays in disease management, emphasising the importance of emerging telecardiology technologies in delivering emergency services in such settings. This meta-analysis aimed to investigate the impacts of prehospital telecardiology strategies on the clinical outcomes of rural ACS patients. Methods A literature search was performed of articles published up to April 2020 through six databases. Included studies were assessed for bias risk using the ROBINS-I tool, and a random-effects model was utilised to estimate effect sizes. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Results Twelve studies with a total of 3989 patients were included in this review. Prehospital telecardiology in the form of tele-electrocardiography (tele-ECG) enabled prompt diagnosis and triage, resulting in a decreased door-to-balloon (DTB) time (mean difference = –25.53 minutes, 95% confidence interval (CI) –36.08 to –14.97 minutes; I2 = 98%), as well as lower in-hospital mortality (odds ratio (OR) = 0.57, 95% CI 0.36–0.92) and long-term mortality (OR = 0.52, 95% CI 0.39–0.69) rates, both with negligible heterogeneity ( I2 = 0%). GRADE assessment yielded very low to moderate certainty of evidence. Conclusion Prehospital tele-ECG appeared to be an effective and worthwhile approach in the management of rural ACS patients, as shown by moderate quality evidence on lower long-term mortality. Given the uncertainties of the evidence quality on DTB time and in-hospital mortality, future studies with a higher quality of evidence are required to confirm our findings.

scholarly journals Heart rate at admission is a predictor of in-hospital mortality in patients with acute coronary syndromes: Results from 58 European hospitals: The European Hospital Benchmarking by Outcomes in acute coronary syndrome Processes study

2016 ◽  
Vol 7 (2) ◽  
pp. 149-157 ◽  
Author(s):  
Magnus T Jensen ◽  
Marta Pereira ◽  
Carla Araujo ◽  
Anti Malmivaara ◽  
Jean Ferrieres ◽  
...  
Keyword(s):  
Heart Rate ◽  
Acute Coronary Syndrome ◽  
Hospital Mortality ◽  
Beta Blockers ◽  
Heart Rates ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Coronary Syndromes ◽  
The Relationship

Aims: The purpose of this study was to investigate the relationship between heart rate at admission and in-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Methods: Consecutive ACS patients admitted in 2008–2010 across 58 hospitals in six participant countries of the European Hospital Benchmarking by Outcomes in ACS Processes (EURHOBOP) project (Finland, France, Germany, Greece, Portugal and Spain). Cardiogenic shock patients were excluded. Associations between heart rate at admission in categories of 10 beats per min (bpm) and in-hospital mortality were estimated by logistic regression in crude models and adjusting for age, sex, obesity, smoking, hypertension, diabetes, known heart failure, renal failure, previous stroke and ischaemic heart disease. In total 10,374 patients were included. Results: In both STEMI and NSTE-ACS patients, a U-shaped relationship between admission heart rate and in-hospital mortality was found. The lowest risk was observed for heart rates between 70–79 bpm in STEMI and 60–69 bpm in NSTE-ACS; risk of mortality progressively increased with lower or higher heart rates. In multivariable models, the relationship persisted but was significant only for heart rates >80 bpm. A similar relationship was present in both patients with or without diabetes, above or below age 75 years, and irrespective of the presence of atrial fibrillation or use of beta-blockers. Conclusion: Heart rate at admission is significantly associated with in-hospital mortality in patients with both STEMI and NSTE-ACS. ACS patients with admission heart rate above 80 bpm are at highest risk of in-hospital mortality.

scholarly journals Prognostic impact of alkaline phosphatase for in-hospital mortality in patients with acute coronary syndrome: a prospective cohort study in China

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e025648
Author(s):  
Tongtong Yu ◽  
Yundi Jiao ◽  
Jia Song ◽  
Dongxu He ◽  
Jiake Wu ◽  
...  
Keyword(s):  
Alkaline Phosphatase ◽  
Acute Coronary Syndrome ◽  
Cohort Study ◽  
Hospital Mortality ◽  
Continuous Variable ◽  
Prognostic Performance ◽  
Coronary Syndrome ◽  
C Statistic ◽  
Grace Score ◽  
Multivariable Adjustment

ObjectivesAlkaline phosphatase (ALP) can promote vascular calcification, but the association between ALP and in-hospital mortality in patients with acute coronary syndrome (ACS) is not well defined.DesignA prospective cohort study.Setting and participantsA total of 6368 patients with ACS undergoing percutaneous coronary intervention (PCI) from 1 January 2010 to 31 December 2017 were analysed.Main outcome measuresIn-hospital mortality was used in this study.ResultsALP was analysed both as a continuous variable and according to three categories. After multivariable adjustment, in-hospital mortality was significantly higher in Tertile 3 group (ALP＞85 U/L) (OR: 2.399, 95% CI 1.080 to 5.333, p=0.032), compared with other two groups (Tertile 1: ＜66 U/L; Tertile 2: 66–85 U/L). When ALP was evaluated as a continuous variable, after multivariable adjustment, the ALP level was associated with an increased risk of in-hospital mortality (OR: 1.011, 95% CI 1.002 to 1.020, p=0.014). C-statistic of ALP for predicting in-hospital mortality was 0.630 (95% CI 0.618 to 0.642, p=0.001). The cut-off value was 72 U/L with a sensitivity of 0.764 and a specificity of 0.468. However, ALP could not significantly improve the prognostic performance of Global Registry of Acute Coronary Events (GRACE) score (GRACE score+ALP vs GRACE score: C-statistic: z=0.485, p=0.628; integrated discrimination improvement: 0.014, p=0.056; net reclassification improvement: 0.020, p=0.630).ConclusionsIn patients with ACS undergoing PCI, ALP was an independent predictor of in-hospital mortality. But it could not improve the prognostic performance of GRACE score.

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