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Magnus T Jensen, Marta Pereira, Carla Araujo, Anti Malmivaara, Jean Ferrieres, Irene R Degano, Inge Kirchberger, Dimitrios Farmakis, Pascal Garel, Marina Torre, Jaume Marrugat, Ana Azevedo
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)...
September 30, 2016: European Heart Journal. Acute Cardiovascular Care
Zekun Cai, Jianwei Dai, Dan Wu, Jian Qiu, Jun Ma, Guoying Li, Wei Zhu, Hongqiang Lei, Wenhua Huang, Heye Zhang, Lin Xu
The aim of this study is to investigate the value of 3-dimensional global peak longitudinal strain (GPLS) derived from the 3-dimensional speckle-tracking echocardiography (3D-STE) in the diagnosis of the complex non-ST-segment elevation acute coronary syndromes (NSTE-ACS) by comparing GPLS to the synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) score.A total of 59 inpatients with NSTE-ACS in our hospital between October 2014 and January 2015 were enrolled into our study...
September 2016: Medicine (Baltimore)
Arman Qamar, Deepak L Bhatt
Thrombotic events such as myocardial infarction or stent thrombosis are the major cause of adverse outcomes in patients undergoing percutaneous coronary intervention (PCI). While current antiplatelet agents, anticoagulants, and PCI techniques have reduced the risk of thrombotic events in PCI-treated patients, a considerable hazard still remains. Cangrelor is an intravenous P2Y12 receptor antagonist that provides a rapid onset and maximal platelet inhibition, which is quickly reversible. In the large-scale CHAMPION PHOENIX trial, cangrelor was shown to reduce ischemic events significantly, including myocardial infarction and stent thrombosis, without increasing the risk of severe bleeding across the full spectrum of patients undergoing PCI, with substantial benefits in all patient subgroups examined...
September 27, 2016: American Journal of Cardiovascular Drugs: Drugs, Devices, and Other Interventions
Tomomi Watanabe, Yoshiyuki Furuse, Yasutoshi Ohta, Masahiko Kato, Toshihide Ogawa, Kazuhiro Yamamoto
Non-ST segment elevation acute coronary syndrome (NSTE-ACS) can be difficult to diagnose accurately, especially in the hyper-acute phase. Non-ECG-gated contrast-enhanced computed tomography (non-ECG-gated CE-CT) has been used in many institutions for screening acute chest pain. Although early defects (EDs) observed in non-ECG-gated CE-CT have been reported as a sign of acute myocardial ischemia, the precise diagnostic value of this sign for acute coronary syndrome has not been fully elucidated. We investigated the usefulness of non-ECG-gated CE-CT for the diagnosis of NSTE-ACS...
September 28, 2016: International Heart Journal
Li Zhang, Wei-Chun Wu, Hong Ma, Hao Wang
BACKGROUND: Layer-specific strain allows the assessment of the function of every layer of myocardium. OBJECTIVES: To evaluate the changes of non-ST-segment elevation acute coronary syndrome(NSTE-ACS) patients with and without complex coronary artery disease(CAD) by layer-specific strain and determine if myocardial strain can identify complex CAD and assess the severity of coronary lesions as defined by Syntax score (SS). METHODS: A total of 139 patients undergoing coronary angiography due to suspected NSTE-ACS were prospectively enrolled...
November 15, 2016: International Journal of Cardiology
Erik A Badings, Wouter S Remkes, Salem H K The, Jan-Henk E Dambrink, Geert Tjeerdsma, Saman Rasoul, Jorik R Timmer, Marloes L J van der Wielen, Dirk J A Lok, Rik Hermanides, Jan van Wijngaarden, Harry Suryapranata, Arnoud W J van 't Hof
OBJECTIVES: To investigate incidence and patient characteristics of transient ST-segment elevation (TSTE) ACS and to compare outcome of early versus late invasive treatment. BACKGROUND: Optimal timing of treatment in TSTE-ACS patients is not outlined in current guidelines and no prospective randomized trials have been done so far. METHODS: Post hoc subgroup analysis of patients with TSTE randomized in the ELISA 3 trial. This study compared early (<12 h) versus late (>48 h) angiography and revascularization in 542 patients with high-risk NSTE-ACS...
August 27, 2016: Catheterization and Cardiovascular Interventions
Selçuk Yazıcı, Tuncay Kırış, Ufuk S Ceylan, Sait Terzi, Aysun Erdem, Işıl Atasoy, Ayşe Emre, Kemal Yeşilçimen
BACKGROUND: Low T3 which is defined as decreased triiodothyronine (T3) and normal thyroid-stimulating hormone (TSH) and thyroxin (T4) levels is present in many acute diseases and is related to increased mortality. We studied low T3 level's relation to long-term mortality in non-ST-elevation acute coronary syndrome (NSTE-ACS) patients. METHODS: T3, T4, and TSH levels of consecutive NSTE-ACS patients were measured. Patients with normal T4 and TSH levels, but low T3 level were defined as low T3 group...
August 27, 2016: Journal of Clinical Laboratory Analysis
James Gunton, Trent Hartshorne, Jeremy Langrish, Anthony Chuang, Derek Chew
Current guidelines recommend initiation of a P2Y12 inhibitor for all patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) at the time of diagnosis (pre-treatment); however, there are no randomized trials directly comparing pre-treatment with initiation at the time of angiography to support this practice. We explore clinical and institutional parameters potentially associated with benefit with this strategy in a decision-analytic model based on available evidence from randomised trials. A decision analysis model was constructed comparing three P2Y12 inhibitors in addition to aspirin in patients with NSTE-ACS...
2016: Journal of Clinical Medicine
Giuseppe Andò, Italo Porto, Gilles Montalescot, Leonardo Bolognese, Carlo Trani, Giuseppe Oreto, Robert A Harrington, Deepak L Bhatt
BACKGROUND: Consistent evidence of benefit exists for radial access (RA) in ST-elevation acute myocardial infarction (STEMI). Patients with non ST-elevation acute coronary syndrome (NSTE-ACS) have a more varied ischemic and bleeding profile. No randomized trial of vascular access ever focused on NSTE-ACS and landmark studies did not provide conclusive results in this heterogeneous subset of patients. METHODS: We assessed in a meta-analysis whether RA is associated with improved outcomes in NSTE-ACS patients...
November 1, 2016: International Journal of Cardiology
Uwe Zeymer, Petr Widimsky, Nicolas Danchin, Maddalena Lettino, Alfredo Bardaji, Jose A Barrabes, Angel Cequier, Marc J Claeys, Leonardo De Luca, Jakob Dörler, David Erlinge, Paul Erne, Patrick Goldstein, Sasha M Koul, Gilles Lemesle, Thomas F Lüscher, Christian M Matter, Gilles Montalescot, Dragana Radovanovic, Jose Lopez Sendón, Petr Tousek, Franz Weidinger, Clive F M Weston, Azfar Zaman, Pontus Andell, Jin Li, J Wouter Jukema
AIMS: Non-ST-elevation acute coronary syndrome (NSTE-ACS) is present in about 60-70% of patients admitted with acute coronary syndromes in clinical practice. This study provides a 'real-life' overview of NSTE-ACS patient characteristics, dual antiplatelet therapy clinical practice, and outcomes at both the time of discharge from hospital and up to 1-year post-discharge. METHODS AND RESULTS: A total of 10 registries (documenting 84 054 NSTE-ACS patients) provided data in a systematic manner on patient characteristics and outcomes for NSTE-ACS in general, and 6 of these (with 52 173 NSTE-ACS patients) also provided more specific data according to P2Y12 receptor inhibitor used...
October 2016: European Heart Journal. Cardiovascular Pharmacotherapy
Chong Liu, Jing Li, Min Ren, Zhen-Zhen Wang, Zi-Yao Li, Fei Gao, Jia-Wei Tian
Two-dimensional speckle tracking echocardiography (2D-STE) multilayer analysis of myocardial deformation is a non-invasive method that enables discrimination of transmural differences owing to myocardial ischemia or necrosis. We wished to ascertain if multilayer longitudinal strains at rest are associated with significant (≥70 %) stenosis of the left anterior descending coronary artery (LAD) in patients with suspected non-ST-elevation acute coronary syndrome (NSTE-ACS). Our cohort comprised 113 consecutive patients with suspected NSTE-ACS and preserved ejection fraction (EF)...
August 13, 2016: International Journal of Cardiovascular Imaging
Islam Y Elgendy, Dharam J Kumbhani, Ahmed N Mahmoud, Xuerong Wen, Deepak L Bhatt, Anthony A Bavry
OBJECTIVES: To perform an updated systematic review comparing a routine invasive strategy with a selective invasive strategy for patients with non-ST-elevation acute coronary syndromes (NSTE-ACS) in the era of stents and antiplatelet therapy. BACKGROUND: Recent meta-analyses comparing both strategies have shown conflicting results. METHODS: Electronic databases were searched for randomized trials that compared a routine invasive strategy (i...
August 12, 2016: Catheterization and Cardiovascular Interventions
Edina Cenko, Beatrice Ricci, Sasko Kedev, Zorana Vasiljevic, Maria Dorobantu, Olivija Gustiene, Božidarka Knežević, Davor Miličić, Mirza Dilic, Olivia Manfrini, Akos Koller, Lina Badimon, Raffaele Bugiardini
BACKGROUND: We explored benefits and risks of an early invasive compared with a conservative strategy in women versus men after non-ST elevation acute coronary syndromes (NSTE-ACS) using the ISACS-TC database. METHODS: From October 2010 to May 2014, 4145 patients were diagnosed as having a NSTE-ACS. We excluded 258 patients managed with coronary bypass surgery. Of the remaining 3887 patients, 1737 underwent PCI (26% women). The primary endpoint was the composite of 30-day mortality and severe left ventricular dysfunction defined as an ejection fraction <40% at discharge...
November 1, 2016: International Journal of Cardiology
Luciana V Armaganijan, Karen P Alexander, Zhen Huang, Pierluigi Tricoci, Claes Held, Frans Van de Werf, Paul W Armstrong, Philip E Aylward, Harvey D White, David J Moliterno, Lars Wallentin, Edmond Chen, Robert A Harrington, John Strony, Kenneth W Mahaffey, Renato D Lopes
BACKGROUND: Antithrombotic therapy plays an important role in the treatment of non-ST-segment elevation acute coronary syndromes (NSTE ACS) but is associated with bleeding risk. Advanced age may modify the relationship between efficacy and safety. METHODS: Efficacy and safety of vorapaxar (a protease-activated receptor 1 antagonist) was analyzed across ages as a continuous and a categorical variable in the 12,944 patients with NSTE ACS enrolled in the TRACER trial...
August 2016: American Heart Journal
Satchana Pumprueg, Warangkna Boonyapisit, Jareethip Wongsa, Nongnuch Naekaew, Daranee Decha
BACKGROUND: Acute coronary syndrome (A CS) is a leading health burden worldwide. The Siriraj non-ST-segment elevation acute coronary syndrome (NST E-A CS) registry was established in 2012. Here, we report in-hospital outcomes and one-year outcomes from patients in the registry. OBJECTIVE: To investigate and report characteristics and outcomes of treatment for NSTE-ACS at one year from a single center MATERIAL AND METHOD: All patients admitted to Siriraj Hospital with diagnosis of NSTE-ACS were enrolled...
January 2016: Journal of the Medical Association of Thailand, Chotmaihet Thangphaet
Paul L Hess, Daniel M Wojdyla, Sana M Al-Khatib, Yuliya Lokhnygina, Lars Wallentin, Paul W Armstrong, Matthew T Roe, E Magnus Ohman, Robert A Harrington, John H Alexander, Harvey D White, Frans Van de Werf, Jonathan P Piccini, Claes Held, Philip E Aylward, David J Moliterno, Kenneth W Mahaffey, Pierluigi Tricoci
IMPORTANCE: In the current therapeutic era, the risk for sudden cardiac death (SCD) after non-ST-segment elevation acute coronary syndrome (NSTE ACS) has not been characterized completely. OBJECTIVE: To determine the cumulative incidence of SCD during long-term follow-up after NSTE ACS, to develop a risk model and risk score for SCD after NSTE ACS, and to assess the association between recurrent events after the initial ACS presentation and the risk for SCD. DESIGN, SETTING, AND PARTICIPANTS: This pooled cohort analysis merged individual data from 48 286 participants in 4 trials: the Apixaban for Prevention of Acute Ischemic Events 2 (APPRAISE-2), Study of Platelet Inhibition and Patient Outcomes (PLATO), Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome (TRACER), and Targeted Platelet Inhibition to Clarify the Optimal Strategy to Medically Manage Acute Coronary Syndromes (TRILOGY ACS) trials...
April 1, 2016: JAMA Cardiology
Mustafa Ozturk, Lutfu Askın, Emrah Ipek, Selami Demirelli, Oguzhan Ekrem Turan, Erkan Yıldırım, Emrah Ermis, Kamuran Kalkan, Orhan Delice
Data are scant regarding serum bilirubin levels in non-ST-segment elevation acute coronary syndrome (NSTE-ACS). In this study, we evaluated the role of serum bilirubin levels in NSTE-ACS. We enrolled 782 patients who presented to the emergency department with acute chest pain. Patients were divided into 2 groups based on the troponin positivity. Patients with NSTE-ACS who had troponin positivity were included in group 1 (n = 382), and group 2 consisted of the control patients (n = 400). Direct bilirubin (DB) levels (group 1: 0...
July 18, 2016: Angiology
Marco Roffi, Christian Müller, Marco Valgimigli, Stephan Windecker, Baris Gencer
The 2015 non-ST-segment elevation acute coronary syndromes guidelines of the European Society of Cardiology have been published 4 years after the previous edition. A new algorithm was presented for the diagnosis of acute myocardial infarction based on the measurement of high-sensitivity cardiac troponin levels at presentation and at 1 hour, including a guidance on the duration of cardiac rhythm monitoring. New recommendations address the management of antiplatelet therapy regarding duration of dual antiplatelet therapy, in patients requiring long-term anticoagulation or undergoing urgent coronary artery bypass surgery as well as of acute bleeding events related to antithrombotics...
May 25, 2016: Revue Médicale Suisse
Fatima Rodriguez, Kenneth W Mahaffey
Non-ST-segment elevation acute coronary syndromes (NSTE-ACS) are the leading cause of morbidity and mortality from cardiovascular disease worldwide. The American Heart Association/American College of Cardiology and the European Society of Cardiology periodically release practice guidelines to guide clinicians in the management of NSTE-ACS, most recently in in 2014 and 2015, respectively. The present review compares and contrasts the 2 guidelines, with a focus on the strength of recommendation and level of evidence in the approach to initial presentation and diagnosis of NSTE-ACS, risk assessment, treatments, and systems of care...
July 19, 2016: Journal of the American College of Cardiology
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