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With Non-ST-Elevation Acute Coronary Syndromes

Gerard Pasterkamp, Hester M den Ruijter, Peter Libby
The concept of the 'vulnerable plaque' originated from pathological observations in patients who died from acute coronary syndrome. This recognition spawned a generation of research that led to greater understanding of how complicated atherosclerotic plaques form and precipitate thrombotic events. In current practice, an increasing number of patients who survive their first event present with non-ST-segment elevation myocardial infarction (NSTEMI) rather than myocardial infarction (MI) with ST-segment elevation (STEMI)...
October 20, 2016: Nature Reviews. Cardiology
Giovanni Teruzzi, Giuseppe Calligaris, Paolo Ravagnani, Daniela Trabattoni, Luca Grancini, Giovanni Monizzi, Alessandro Lualdi, Antonio L Bartorelli
Spontaneous coronary artery dissection (SCAD) accounts approximately for 0.2% of cases of acute coronary syndrome. It is defined "spontaneous" in absence of any coronary wall damage. This disease affects primarily young women in good health, with no risk factors for coronary artery disease, especially during the postpartum period. Since the clinical presentation varies widely from no symptoms to typical angina and sudden cardiac death, SCAD incidence is underestimated.A 40-year-old woman, in the 8th week after delivery, was admitted to our emergency department because of acute chest pain, and a diagnosis of inferior and posterior non-ST-elevation myocardial infarction was made...
October 2016: Giornale Italiano di Cardiologia
Kyyak Hryhoriy
INTRODUCTION: type 2 diabetes mellitus is one of the most important medical and social problems in the world. Patients with diabetes are prone to coronary artery disease, in particular acute coronary syndrome, with atypical clinical signs and susceptibility to tachycardia. Elevated heart rate is an important factor of premature mortality in all patients with acute coronary syndrome. The aim of the investigation was to reveal the heart rate peculiarities in unstable angina and non-ST elevation myocardial infarction patients suffering from diabetes mellitus type 2 for more effective treatment of these patients...
2016: Wiadomości Lekarskie: Organ Polskiego Towarzystwa Lekarskiego
Jarosław Karwowski, Lech Poloński, Marek Gierlotka, Andrzej Ciszewski, Michał Hawranek, Maciej Bęćkowski, Mariusz Gąsior, Ilona Kowalik, Hanna Szwed
BACKGROUND: Prevalence and impact of total coronary occlusion of an Infarct-Related Artery (IRA) on outcomes in patients with Non-ST-Elevation Myocardial Infarction (NSTEMI) remain unclear. AIM: We evaluated the clinical significance of total coronary occlusion in NSTEMI patients. METHODS: A total of 2767 patients with NSTEMI enrolled in the Polish Registry of Acute Coronary Syndromes who underwent percutaneous coronary interventions were analyzed...
October 7, 2016: Kardiologia Polska
Mandeep Singh, Deepak L Bhatt, Gregg W Stone, Charanjit S Rihal, Bernard J Gersh, Ryan J Lennon, Jagat Narula, Valentin Fuster
It is estimated that in the United States, each year, approximately 620,000 persons will experience an acute coronary syndrome and approximately 70% of these will have non-ST-elevation acute coronary syndrome. Cardiovascular disease still accounts for 1 of every 3 deaths in the United States, and there is an urgent need to improve the prognosis of patients presenting with acute coronary syndrome. Cardiovascular mortality and ischemic complications are common after acute coronary syndrome, and the advent of newer antithrombotic therapies has reduced ischemic complications, but at the expense of greater bleeding...
October 2016: Mayo Clinic Proceedings
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
O Nallet, N Ketata, N Ferrier, X Marcaggi
Acute chest pain is a common reason of consultation in the emergency department. The difficulty lies in discriminating patients with acute coronary syndrome or other life-threatening conditions from those non-cardiovascular, non-life-threatening chest pain. Only 15 to 25 % of patients with acute chest pain actually have acute coronary syndrome. Algorithms using high sensitivity troponin at admission and a second assessment 1 or 3hours later are validated to "rule in" or "rule out" the diagnosis of non ST-elevation myocardial infarction...
September 29, 2016: Annales de Cardiologie et D'angéiologie
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
Paweł Burchardt, Janusz Rzeźniczak, Joanna Dudziak, Anna Dzumak, Tomasz Marchlewski, Teresa Ganowicz-Kaatz, Monika Popiak, Marek Słomczyński, Marcin Jezierski, Witold Laskowski, Tomasz Łuczak, Robert Plewa
BACKGROUND: Before our study, there were no data concerning complex evaluation of: plasma PCSK9 concentrations, transcript LDL receptor (LDLR), as well as the total amount of monocytes' LDLR in acute coronary syndrome (ACS) patients. PCSK9 levels in a few cohort studies were found to correlate with the number of white blood cells or platelets. The study aims to evaluate PCSK9-LDLR concentrations, as well as to find any association between PCSK9 and white blood cells (WBC) or platelets (PLT)...
September 26, 2016: Cardiology Journal
John J Wang, Olle Pahlm, Galen S Wagner, James W Warren, B Milan Horáček, John L Sapp
BACKGROUND: Existing criteria recommended by ACC/ESC for identifying patients with ST elevation myocardial infarction (STEMI) from the 12-lead ECG perform with high specificity (SP) but low sensitivity (SE). In our previous studies, we found that the SE of acute ischemia detection can be markedly improved without any loss of SP by calculating, from the 12-lead ECG, ST deviation in 3 "optimal" vessel-specific leads (VSLs). To further validate the method, we evaluated the SP performance using a dataset with non-ischemic ST-segment changes...
August 18, 2016: Journal of Electrocardiology
Jérémie Abtan, P Gabriel Steg, Gregg W Stone, Kenneth W Mahaffey, C Michael Gibson, Christian W Hamm, Matthew J Price, Freddy Abnousi, Jayne Prats, Efthymios N Deliargyris, Harvey D White, Robert A Harrington, Deepak L Bhatt
OBJECTIVES: The purpose of this study was to examine the safety and efficacy of cangrelor in patients with stable angina (SA) or acute coronary syndrome (ACS). BACKGROUND: The CHAMPION PHOENIX (A Clinical Trial Comparing Cangrelor to Clopidogrel Standard Therapy in Subjects Who Require Percutaneous Coronary Intervention) trial demonstrated that cangrelor significantly reduced periprocedural ischemic events in all-comer percutaneous coronary intervention with a modest increase in mild and moderate bleeding...
September 26, 2016: JACC. Cardiovascular Interventions
Pilar Calmarza, Carlos Lapresta, Sandra García-Castañón, Carlos López-Perales, Ainhoa Pérez-Guerrero, Ana Portolés
OBJECTIVES: This study was conducted in order to evaluate the usefulness of copeptin (a stable fragment of the precursor of arginine vasopressin) in the differential diagnosis of acute chest pain of probable coronary origin. MATERIAL AND METHODS: The study includes 82 patients who were initially evaluated according to the protocol of a patient with suspected acute coronary syndrome (ACS) in our Emergency Department, including the determination of troponin and copeptin with specimens taken on admission (time 0) and at 6h...
September 2016: Clínica e Investigación en Arteriosclerosis
Fan Kee Hoo, Yoke Loong Foo, Sazlyna Mohd Sazlly Lim, Siew Mooi Ching, Yang Liang Boo
BACKGROUND AND OBJECTIVE: Acute coronary syndrome (ACS) is one of the leading cause of morbidity and mortality worldwide. It is relatively uncommon in young adults as compared to the older population. Our objective was to assess the prevalence, demographic distribution, and risk factors for acute coronary syndrome (ACS) in patients less than 45 years of age admitted to a Malaysian tertiary care centre. METHODS: This is a cross-sectional, retrospective, and single centre study with random sampling of the patients admitted for ACS to hospital from January 2005 to December 2013...
July 2016: Pakistan Journal of Medical Sciences Quarterly
Abdelmajid Bouzerda, Ali Khatouri
Takayasu's disease is a rare inflammatory vascular disease, preferentially affecting young woman with predominant involvement of the aorta and its first division branches. We here report the case of a patient with ostial left main trunk involvement following non-ST elevation acute coronary syndrome revealing Takayasu's disease and we highlight the various cardiovascular manifestations of this disease.
2016: Pan African Medical Journal
Penta Bhavanadhar, Vangipuram Rangacharyulu Srinivasan, Sai Satish Oruganti, Krishna Prasad Adiraju
INTRODUCTION: Anaemia is a contributor for adverse prognosis in Acute Coronary Syndrome (ACS), but the epidemiology and causes of anaemia in such patients is not defined. AIM: To study the prevalence and aetiology of anaemia in hospitalized patients with ACS. MATERIALS AND METHODS: All consecutive patients admitted with ACS from January to March, 2010 were included. Their clinical information was recorded. RESULTS: Of 130 (87 males) consecutive admissions for ACS, 47...
July 2016: Journal of Clinical and Diagnostic Research: JCDR
Cæcilie Larsen Bang, Celeste Michala Porsbjerg
Heart involvement is the most critical and potentially lethal systemic manifestation in eosinophilic granulomatosis with polyangiitis (EGPA). We present a case of acute chest pain in a 58-year-old male with severe asthma, which regressed after sublingual administration of nitroglycerine. At the time of hospital admission, there were non-specific ST-changes on the ecg, coronary enzymes were increased, and the patient was concluded to have a non-ST-elevation myocardial infarction, and treated as such. A subacute cardiac catheterization showed no signs of significant coronary stenosis...
2016: Respiratory Medicine Case Reports
Krzysztof Milewski, Paweł Gąsior, Stefan Samborski, Piotr P Buszman, Aleksandra Błachut, Adam Wojtaszczyk, Adam Młodziankowski, Artur Mendyk, Marek Król, Wojciech Wojakowski, Paweł E Buszman
INTRODUCTION: Despite the dominance of drug-eluting stents in modern interventional cardiology, there is still a niche for bare metal stents. AIM: The aim of the Polish NexGen registry was to evaluate the safety and efficacy of a new generation cobalt-chromium NexGen stent in a real life patient population. MATERIAL AND METHODS: A prospective multi-center registry was conducted in five clinical sites of American Heart of Poland. Three hundred and eighty-three patients who underwent percutaneous coronary intervention (PCI) with NexGen stent implantation were included...
2016: Postępy W Kardiologii Interwencyjnej, Advances in Interventional Cardiology
Fernando Gondim, Ana Caribé, Karine Ferreira Vasconcelos, Alexandre Dantas Segundo, Francisco Bandeira
BACKGROUND: Vitamin D deficiency has been associated with cardiovascular risk factors, including type 2 diabetes mellitus (T2DM). Evidence shows that patients with low serum 25-hydroxyvitamin D (25OHD) concentrations have a higher risk of developing coronary artery disease. OBJECTIVE: The objective of this study was to assess vitamin D as a predictor of the severity in diabetics with acute coronary syndrome (ACS). METHODS: A total of 166 patients were diagnosed with ACS...
2016: Clinical Medicine Insights. Endocrinology and Diabetes
Lucy McGrath-Cadell, Pamela McKenzie, Sam Emmanuel, David W M Muller, Robert M Graham, Cameron J Holloway
BACKGROUND: Spontaneous coronary artery dissection (SCAD) is an uncommon but serious condition presenting as an acute coronary syndrome (ACS) or cardiac arrest. The pathophysiology and outcomes are poorly understood. We investigated the characteristics and outcomes of patients presenting with SCAD. METHODS: In a retrospective study of a large cohort of patients with SCAD, data were collected regarding clinical presentation, patient characteristics, vascular screening, coronary artery involvement and clinical outcomes...
2016: Open Heart
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