VALUE OF SERUM IMA (ISCHEMIA MODIFIED ALBUMIN) IN DIAGNOSIS OF NON-ST SEGMENT ELEVATION ACUTE CORONARY SYNDROMES

2017 ◽  
pp. 197-202
Author(s):  
Quang Tuan Pham ◽  
Ta Dong Nguyen ◽  
Nguyen Tuong Van Ha ◽  
Van Minh Huynh
Keyword(s):  
Acute Coronary Syndromes ◽  
Statistical Significance ◽  
High Sensitivity ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Coronary Syndromes ◽  
Sensitivity Specificity

Background: Early diagnosis in ACS is significant to treatment and prognosis. It helps to reduce death and complications. What is the value of IMA concentration for diagnosing non-ST segment elevation acute coronary syndromes. Objective: Studying the IMA concentration in blood serum in patients with non-ST segment elevation acute coronary syndromes; determining sensitivity, specificity and cut off point of IMA in diagnosis of non-ST segment elevation acute coronary syndromes. Subject and Method: 75 patients hospitalized in Hue Central Hospital with breast pang, presenting non-ST segment elevation acute coronary syndromes. Based-on the ESC Guidelines 2015, diagnosis of non-ST segment elevation acute coronary syndromes is made on 37 of those as in a patients group; 38 others are chosen as a controls group. Cross-sectional study with comparison is applied. Result: (i) Concentration of enzymes CK-MB and of hs-TnT in the patients group is higher compared with that in the controls group. Average IMA concentration in patients group is 93.49± 89.56 IU/mL (median: 58.57IU/mL) and higher compared with the controls group which reaches 15.01 ± 9.87 IU/mL (median: 11.735IU/mL). It results in a statistical significance p<0,001. (ii) The cut off point for diagnosing non-ST segment elevation acute coronary syndromes > 28.68IU/mL, reaching a sensitivity at 91.9% and a specificity at 86.8%, AUC = 0.98, 95% CI=0.95-1.00, p<0.001, OR= 74.8, 95% CI =16.54 - 338.38, p<0.001. Conclusion: IMA has high sensitivity and specificity in diagnosis of non-ST segment elevation acute coronary syndromes. Key words: iMA, NSTEMi, Acute coronary syndrome without ST elevation

ROLE OF SERUM ISCHEMIC MODIFIED ALBUMIN COMBINED WITH HS-TROPONIN T (HS-TNT) IN DIAGNOSIS NON-ST SEGMENT ELEVATION ACUTE CORONARY SYNDROMES

2017 ◽  
pp. 64-69
Author(s):  
Quang Tuan Pham ◽  
Ta Dong Nguyen ◽  
Van Minh Huynh
Keyword(s):  
Acute Coronary Syndromes ◽  
Troponin T ◽  
Statistical Significance ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
St Segment Elevation ◽  
St Segment ◽  
Coronary Syndromes

Background: Early diagnosis in ACS is significant to treatment and prognosis. It helps to reduce death and complications. What is the value from a combination of IMA and hs-TnT for diagnosing non-ST segment elevation acute coronary syndromes. Objective: To determine the serum concentration of IMA and hs-TnT in patients with non-ST segment elevation acute coronary syndromes. To define sensitivity and specificity when combining IMA and hs-TnT in diagnosis non-ST segment elevation acute coronary syndromes. Subject and Method: 75 patients hospitalized in Hue Central Hospital with breast pain. Diagnosis of non-ST segment elevation acute coronary syndromes is done on 37 of those as in a patients group (ESC in 2015); 38 others are chosen as a controls group. Cross-sectional study with comparison is applied. Result: In 2 tests at different time points, the concentration of hs-TnT and IMA in patients group with non-ST segment elevation acute coronary syndromesis higher compared with that in the controls group (median: 0,065ng/mL > 0,006ng/mL and 0,162ng/mL > 0,0055ng/mL). Average IMA concentration in patients group is 93,49± 89,56 IU/mL (median: 58,57IU/mL) and higher compared with the controls group which reaches15,01 ± 9,87 IU/mL (median:11,735IU/mL). It results in a statistical significance p<0,001. The cut off point of hs-TnT > 0,014ng/mL and IMA>28,68 IU/ML, reaching a sensitivity at 88,9% and a specificity at 100%, AUC = 0,97, p < 0,001, 95% CI= 0,915 – 1,00. Conclusion: Combination of IMA and hs-TnT results in a high value for diagnosis of non-ST segment elevation acute coronary syndromes. Key words: hs-Troponin T, IMA, NSTE-ACS

VALUE OF ST-SEGMENT ELEVATION IN LEAD AVR IN PREDICTING LEFT MAIN AND OR 3-VESSEL DISEASE IN PATIENTS WITH ACUTE CORONARY SYNDROMES

2017 ◽  
pp. 59-63
Author(s):  
Thanh Hung Dieu ◽  
Anh Vu Nguyen
Keyword(s):  
Predictive Value ◽  
Acute Coronary Syndromes ◽  
Independent Predictor ◽  
Left Main ◽  
St Segment Elevation ◽  
Vessel Disease ◽  
St Segment ◽  
Coronary Syndromes ◽  
Lead Avr ◽  
Sensitivity Specificity

Objects: We assessed the ability of ST-segment elevation in lead aVR to predict left main and/or 3-vessel disease (LM/3VD) in patients with acute coronary syndromes (ACS). Meterial and Method: 410 patients with ACS, who underwent coronary angiography, were evaluated. Results: 131 (31.9%) patients have been LM/3VD. ST segment elevation > 0.05 mV in leads aVR have been an independent predictor LM/3VD with sensitivity, specificity, positive predictive value PPV) and negative predictive value (NPV) 74.0%, 78.1%, 61.4% and 86.5%, respectively (p<0.001). ST segment elevation > 0.05 mV in leads aVR with ST segment depression in leads V4-V6 have related LM/3VD with sensitivity, specificity, PPV and NPV 44.3%, 92.8%, 74.4% and 75.2%, respectively (p<0.001). ST segment elevation > 0.1 mV in leads aVR have related LM/3VD with sensitivity, specificity, PPV and NPV 51.9%, 87.1%, 65.1% and 79.4%, respectively (p<0.001). Conclusions: ST segment elevation > 0.05 mV in leads aVR have been an independent predictor LM/3VD in patients with ACS. Key words: Acute coronary syndromes, ST-segment elevation, aVR

scholarly journals Long-term risk of death and recurrent cardiovascular events following acute coronary syndromes

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254008
Author(s):  
Pishoy Gouda ◽  
Anamaria Savu ◽  
Kevin R. Bainey ◽  
Padma Kaul ◽  
Robert C. Welsh
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Coronary Syndromes ◽  
Cardiovascular Events ◽  
Residual Risk ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Coronary Syndromes

Estimates of the risk of recurrent cardiovascular events (residual risk) among patients with acute coronary syndromes have largely been based on clinical trial populations. Our objective was to estimate the residual risk associated with common comorbidities in a large, unselected, population-based cohort of acute coronary syndrome patients. 31,056 ACS patients (49.5%—non-ST segment elevation myocardial infarction [NSTEMI], 34.0%—ST segment elevation myocardial infarction [STEMI] and 16.5%—unstable angina [UA]) hospitalised in Alberta between April 2010 and March 2016 were included. The primary composite outcome was major adverse cardiovascular events (MACE) including: death, stroke or recurrent myocardial infarction. The secondary outcome was death from any cause. Cox-proportional hazard models were used to identify the impact of ACS type and commonly observed comorbidities (heart failure, hypertension, peripheral vascular disease, renal disease, cerebrovascular disease and diabetes). At 3.0 +/- 3.7 years, rates of MACE were highest in the NSTEMI population followed by STEMI and UA (3.58, 2.41 and 1.68 per 10,000 person years respectively). Mortality was also highest in the NSTEMI population followed by STEMI and UA (2.23, 1.38 and 0.95 per 10,000 person years respectively). Increased burden of comorbidities was associated with an increased risk of MACE, most prominently seen with heart failure (adjusted HR 1.83; 95% CI 1.73–1.93), renal disease (adjusted HR 1.52; 95% CI 1.40–1.65) and diabetes (adjusted HR 1.51; 95% CI 1.44–1.59). The cumulative presence of each of examined comorbidities was associated with an incremental increase in the rate of MACE ranging from 1.7 to 9.98 per 10,000 person years. Rates of secondary prevention medications at discharge were high including: statin (89.5%), angiotensin converting enzyme inhibitor/angiotensin receptor blocker (84.1%) and beta-blockers (85.9%). Residual cardiovascular risk following an acute coronary syndrome remains high despite advances in secondary prevention. A higher burden of comorbidities is associated with increased residual risk that may benefit from aggressive or novel therapies.

scholarly journals Anaemia in acute coronary syndrome: a cross-sectional study

2019 ◽  
Vol 7 (8) ◽  
pp. 2915
Author(s):  
Muhammad Dilawaer Khan ◽  
Jahan Tab Qazi ◽  
Hamza Maqsood ◽  
Shaheryar Qazi ◽  
Khurram Irshad ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Acute Coronary Syndromes ◽  
Supply And Demand ◽  
Cross Sectional Study ◽  
Severe Form ◽  
Cross Sectional ◽  
Coronary Syndrome ◽  
Patients With Diabetes ◽  
Coronary Syndromes ◽  
Myocardial Oxygen Supply

Background: Acute coronary syndromes (ACS) are an imbalance between myocardial oxygen supply and demand, and the presence of anaemia further potentiates this imbalance. The burden of anaemia in patients presenting with acute coronary syndromes (ACS) is significant. Anaemia has the potential to worsen myocardial ischemic insult by decreasing the oxygen content of the blood supplied to the jeopardized myocardium. Present study investigates the prevalence of anaemia in ACS patients attending a tertiary health care institute.Methods: A total of 148 patients with ACS were recruited in the study from July 2018 to October 2018 in Multan institute of cardiology, Pakistan. All patients were subjected to a detailed history and thorough clinical examination and investigations after obtaining informed consent. Patient having any other diseases known to cause anaemia were excluded.Results: Mean age of patients was 49 years. Out of 148, 114 (77%) were males and 34(23%) were females. Prevalence of anaemia was 38% in Male and 58.8% in Female. Among Male, 18.8% were microcytic, 4.54% were macrocytic and 77.27% were normocytic. Among Female, 50% were microcytic and 50%% were normocytic. Prevalence of ACS was higher is patients with diabetes and hypertension combined (31%) than in patient with diabetes alone (17.56%) or hypertension alone (21.62%). 13.51% were pure vegetarians  while 78.37% were on mixed diet consisting of vegetables+meat+pulses.Conclusions: Higher incidence of anaemia was reported in subjects having acute coronary syndrome. Incidence of anaemia in STEMI patients was greater than NSTEMI and unstable angina patients. Severe form of acute coronary syndrome i.e. STEMI was associated with higher incidence of anaemia.

Multichannel electrocardiograms obtained by a smartwatch for the diagnosis of acute coronary syndromes: the SMARTAMI TRIAL

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C.S Spaccarotella ◽  
A.P Polimeni ◽  
E.P Principe ◽  
A.C Curcio ◽  
S.M Migliarino ◽  
...  
Keyword(s):  
Acute Coronary Syndromes ◽  
Digital Health ◽  
Coronary Revascularization ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Depression ◽  
Smart Watch ◽  
St Segment ◽  
Coronary Syndromes ◽  
Good Agreement

Abstract Background Smartwatches are increasingly popular and used for digital health information. A new smart watch introduced an integrated ECG tool, which allows recording a single-lead ECG that has been used for atrial fibrillation detection. The aim of the present study was to prospectively investigate the feasibility and the accuracy of the Apple Watch in patients admitted in the CCU with the diagnosis of Acute Coronary Syndrome compared with a standard 12-lead ECG. Methods A commercially available smart watch series 4 was used and the posterior sensor of the watch was positioned in different standardized body positions to obtain nine bipolar ECGs (corresponding to Einthoven leads I, II and III and Precordial leads V1-V6) that were compared with a simultaneous standard 12-lead ECG. One hundred subjects were included in the study. Fifty-five patients had a STEMI, twenty-seven patients had an NSTEMI all treated with percutaneous coronary revascularization. Eighteen age-matched subjects were included as controls. Results A very good agreement was found between Smartwatch ECG and Standard ECG for the identification of normal ECG, ST segment elevation and NSTE alterations (Cohen's kappa 0.90 [95% CI 0.78 to 1], 0.88 [95% CI 0.78 to 0,97], 0.85 [95% CI 0.74 to 0.96]), respectively. The sensitivity and specificity of Smartwatch ECG for the diagnosis of normal ECG were 84% (95% CI 60 to 97) and 100% (95% CI 95 to 100), STE deviation were 93% (95% CI 82 to 99) and 95% (95% CI 85 to 99), NSTE ECG alterations were 94% (95% CI 81 to 99) and 92% (95% CI 83 to 97), respectively. No significant differences between Smartwatch ECG and Standard ECG for the amplitude of ST changes were reported for each lead (see Figure). Conclusions The Smart Ami Trial demonstrated a very good agreement between the Smartwatch ECG and Standard ECG for the identification of ST-segment elevation and ST depression in patients with acute coronary syndromes opening the possibility of using this tool when a standard ECG is not available. Figure 1 Funding Acknowledgement Type of funding source: None

Comparison of prognostic value of high-sensitivity and conventional troponin T in patients with non-ST-segment elevation acute coronary syndromes

2011 ◽  
Vol 412 (15-16) ◽  
pp. 1350-1356 ◽  
Author(s):  
Gjin Ndrepepa ◽  
Siegmund Braun ◽  
Stefanie Schulz ◽  
Robert A. Byrne ◽  
Jürgen Pache ◽  
...  
Keyword(s):  
Acute Coronary Syndromes ◽  
Prognostic Value ◽  
Troponin T ◽  
High Sensitivity ◽  
St Segment Elevation ◽  
St Segment ◽  
Coronary Syndromes

Improved risk stratification of patients with acute coronary syndromes using a combination of hsTnT, NT-proBNP and hsCRP with the GRACE score

2016 ◽  
Vol 7 (2) ◽  
pp. 129-138 ◽  
Author(s):  
Roland Klingenberg ◽  
Soheila Aghlmandi ◽  
Lorenz Räber ◽  
Baris Gencer ◽  
David Nanchen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Risk Stratification ◽  
High Sensitivity ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Improve Risk Stratification ◽  
St Segment ◽  
All Cause Mortality ◽  
Coronary Syndromes ◽  
Grace Score

Background: Clinical scores and biomarkers improve risk stratification of patients with acute coronary syndromes. However, little is known about their value in patients referred for coronary angiography. Methods: Consecutive patients admitted at four Swiss university hospitals with a diagnosis of acute coronary syndrome were enrolled into the SPUM-ACS Biomarker Cohort between 2009 and 2012. Patients were followed at 30 days and 1 year with assessment of adjudicated events including all-cause mortality and the composite of all-cause mortality or non-fatal recurrent myocardial infarction. Results: Events and biomarkers were analysed in 1892 patients (52.4% with ST-segment elevation myocardial infarction, 43.3% with non-ST-segment elevation myocardial infarction and 4.3% with unstable angina). Death at 30 days occurred in 35 patients (1.9%) and at 1 year in 80 patients (4.3%). The choice of troponin assay (conventional versus high sensitivity) to calculate the Global Registry of Acute Coronary Events (GRACE) score did not affect risk prediction. The prognostic accuracy of the GRACE score was improved when combined with three individual biomarkers including high sensitivity troponin T (hsTnT), N-terminal-pro B-type natriuretic peptide (NT-proBNP) and high sensitivity C-reactive protein (hsCRP) to yield a 9% increment (C-statistic 0.73–>0.82) for the discrimination of short-term risk for all-cause mortality. In contrast, the novel biomarkers placental growth factor (PlGF), soluble fms-like tyrosine kinase-1 (sFlt-1) and the ratio sFlt-1/PlGF did not improve risk stratification. Conclusions: In patients with acute coronary syndrome referred for coronary angiography, combinations of biomarkers including hsTnT, NT-proBNP and hsCRP with the GRACE score enhanced risk discrimination. Clinical Trials Registration: NCT01000701

scholarly journals MODERN METHODS TO DIFFERENTIATE BETWEEN CHEST PAIN AND CARDIAC ISCHEMIA

2020 ◽  
Vol 49 (06) ◽  
pp. 43-43
Author(s):  
Giorgi Javakhishvili ◽  
Rusudan Sujashvili
Keyword(s):  
Acute Coronary Syndrome ◽  
Acute Coronary Syndromes ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
T Wave ◽  
Fibrous Cap ◽  
St Segment ◽  
Coronary Syndromes ◽  
St Elevation ◽  
Elevation Acute Coronary Syndrome

Acute coronary syndrome (ACS) is a group of conditions which often present with similar signs and symptoms while having different outcomes and complications. Therefore it is essential to differentiate between them as soon as possible and provide appropriate management. Acute coronary syndromes are classified into two categories: STE-ACS (ST segment Elevation Acute Coronary Syndrome) and NSTE-ACS (Non ST segment Elevation Acute Coronary Syndrome). STE-ACS stands for ST Elevation Acute Coronary Syndrome all of which demonstrate significant ST elevations on ECG due to complete blockage of artery by thrombus, while NSTE-ACS is due to partial occlusion of artery which exhibit ST segment depression and/or T wave inversions. Patients with NSTE-ACS who do not develop infarction are diagnosed with unstable angina, which itself is a precursor of myocardial infarction. Acute coronary syndromes are considered multifactorial and risk factors most commonly associated with development of acute coronary syndromes include: hypertension, smoking, diabetes, obesity, sedentary life-style, hereditary conditions etc. Chronic stress to the coronary endothelium eventually leads to inflammation and atherosclerotic plaque formation. Plaque at some point with additional stress will rupture and trigger thrombus formation. Probability of plaque rupture depends on its composition: stable plaques contain small fatty core and thick fibrous cap, unstable plaque have larger fatty cores and thin fibrous cap. Patients with acute coronary syndromes present with chest pain and/or discomfort and may experience tightness and pressure sensation; pain may radiate to left or both arms, jaw, back or stomach, sweating, dyspnea and dizziness are also common complaints. Whenever we suspect ACS first diagnostic tests is always ECG (Electrocardiography). If ST segment is persistently elevated STEMI (ST Elevation Myocardial Infarction) can be diagnosed and reperfusion therapy is indicated; but if ST segment is depressed and/or T wave inversion is present laboratory tests are necessary for diagnosis. Cardiac biomarkers mainly used in the clinic are Troponins and CK-MB (Creatine Kinase MB), yet LDH (lactate dehydrogenase), B-type natriuretic peptide and C-reactive protein can be used additionally. Several studies have been conducted in hopes to find other myocardial markers useful for diagnosis of ACS, one of which tested candidate biomarkers such as hFABP (Heart-type fatty acid binding protein), GPBB (Glycogen Phosphorylase Isoenzyme BB), S100, PAPP-A (Pregnancy-associated plasma protein A), TNF (Tumor Necrosis Factor), IL6 (Interleukin 6), IL18 (Interleukin 18), CD40 (Cluster of differentiation 40) ligand, MPO (Myeloperoxidase), MMP9 (Matrix metallopeptidase 9), cell-adhesion molecules, oxidized LDL (Low Density Lipoprotein), glutathione, homocysteine, fibrinogen, and D-dimer, procalcitonin. The idea of this study was to estimate usefulness of combining enzymatic markers with nonenzymatic ones in the clinical settings.

scholarly journals Critical appraisal of the 2020 ESC guideline recommendations on diagnosis and risk assessment in patients with suspected non-ST-segment elevation acute coronary syndrome

2021 ◽  
Author(s):  
Evangelos Giannitsis ◽  
Stefan Blankenberg ◽  
Robert H. Christenson ◽  
Norbert Frey ◽  
Stephan von Haehling ◽  
...  
Keyword(s):  
Acute Coronary Syndromes ◽  
Critical Appraisal ◽  
Scientific Evidence ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Scientific Support ◽  
Prognostic Assessment ◽  
St Segment ◽  
Coronary Syndromes ◽  
Esc Guidelines

AbstractMultiple new recommendations have been introduced in the 2020 ESC guidelines for the management of acute coronary syndromes with a focus on diagnosis, prognosis, and management of patients presenting without persistent ST-segment elevation. Most recommendations are supported by high-quality scientific evidence. The guidelines provide solutions to overcome obstacles presumed to complicate a convenient interpretation of troponin results such as age-, or sex-specific cutoffs, and to give practical advice to overcome delays of laboratory reporting. However, in some areas, scientific support is less well documented or even missing, and other areas are covered rather by expert opinion or subjective recommendations. We aim to provide a critical appraisal on several recommendations, mainly related to the diagnostic and prognostic assessment, highlighting the discrepancies between Guideline recommendations and the existing scientific evidence.

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