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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
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
Elena Conti, Maria B Musumeci, Jasmine P Desideri, Martina Ventura, Danilo Fusco, Luigi Zezza, Marco De Giusti, Andrea Berni, Pietro Francia, Massimo Volpe, Camillo Autore
BACKGROUND: As benefits of revascularization in non-ST elevation acute coronary syndromes (NSTEACSs) in the elderly are still unproven, we sought to assess the association between invasive or conservative management of NSTEACS and short-, mid- and long-term mortality or composite outcome of all-cause mortality and myocardial infarction in a cohort of consecutive elderly patients. METHODS AND RESULTS: Consecutive NSTEACS patients older than 75 years discharged between 2006 and 2010 from a single intensive cardiac care unit, and managed with invasive or conservative strategy according to available guidelines were retrospectively surveyed...
October 2016: Journal of Cardiovascular Medicine
Abdulhalim Jamal Kinsara, Jamilah Saad Alrahimi, Oyindamola B Yusuf
OBJECTIVES: To compare the clinical features, management, and in-hospital outcomes of patients with ST elevation myocardial infarction (STEMI) and non-ST elevation acute coronary syndrome (NSTEACS), in the Western Region of Saudi Arabia. METHODS: A total of 71 patients were enrolled in a longitudinal study at a tertiary hospital without cardiac catheterization facility. These data were collected from Saudi Project for Assessment of Coronary Events registry. RESULTS: Twenty-three patients with STEMI were compared to 48 patients with NSTEACS...
July 2016: Indian Heart Journal
Ming Cui, Chen Chen Tu, Er Zhen Chen, Xiao Li Wang, Seng Chuen Tan, Can Chen
INTRODUCTION: There are a number of economic evaluation studies of clopidogrel for patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) published from the perspective of multiple countries in recent years. However, relevant research is quite limited in China. We aimed to estimate the long-term cost effectiveness for up to 1-year treatment with clopidogrel plus acetylsalicylic acid (ASA) versus ASA alone for NSTEACS from the public payer perspective in China. METHODS: This analysis used a Markov model to simulate a cohort of patients for quality-adjusted life years (QALYs) gained and incremental cost for lifetime horizon...
September 2016: Advances in Therapy
S Koganti, N Patel, A Seraphim, T Kotecha, M Whitbread, R D Rakhit
OBJECTIVE: To assess whether a novel 'direct access pathway' (DAP) for the management of high-risk non-ST-elevation acute coronary syndromes (NSTEACS) is safe, results in 'shorter time to intervention and shorter admission times'. This pathway was developed locally to enable London Ambulance Service to rapidly transfer suspected high-risk NSTEACS from the community to our regional heart attack centre for consideration of early angiography. METHODS: This is a retrospective case-control analysis of 289 patients comparing patients with high-risk NSTEACS admitted via DAP with age-matched controls from the standard pan-London high-risk ACS pathway (PLP) and the conventional pathway (CP)...
2016: BMJ Open
Levent Cerit
BACKGROUND: ST-segment elevation in lead aVR (STEaVR) anticipates left main and/or three-vessel disease (LM/3VD) in patients with acute coronary syndromes. STEaVR is generally reciprocal to and accompanied by ST-segment depression (STD) in the precordial leads. SYNTAX score (SS) is an angiographic scoring system and is widely used to evaluate the severity and complexity of coronary artery disease. The purpose of our study was to assess the relationship between STEaVR and SS. METHODS: We performed a retrospective analysis of 117 patients with non-ST-segment elevation acute coronary syndrome (NSTEACS)...
June 8, 2016: Cardiovascular Journal of Africa
Phillip Freeman, James Berrill, John Green, Richard Anderson
This review outlines the priorities from cardiology and gastroenterology perspectives, resolves some of the misconceptions, and uses the evidence available to suggest strategies for optimizing management of these patients. The dual presentation of acute active gastrointestinal (GI) blood loss together with an acute coronary syndrome (NSTEACS or STEMI) is outside the remit of this review but has been previously reviewed by our group. The review covers NSTEACS together with chronic or sub-acute anemia, anemia that cannot be accounted for by chronic kidney disease, heart failure, or inflammatory disorders...
September 2016: Current Medical Research and Opinion
András Komócsi, Mihály Simon, Béla Merkely, Tibor Szűk, Róbert G Kiss, Dániel Aradi, Zoltán Ruzsa, Péter Andrássy, Lajos Nagy, Géza Lupkovics, Zsolt Kőszegi, Péter Ofner, András Jánosi
BACKGROUND: Data are limited on the real-life use of coronary intervention (PCI) and on its long-term efficacy and safety in elderly patients with acute myocardial infarction (AMI). METHODS: Data from a nation-wide registry of patients treated due to an AMI event in centers of invasive cardiology were analyzed for the potential interaction of age on the utilization of invasive therapy and outcome. Follow-up data of consecutive patients between March 1, 2013, and March 1, 2014 were analyzed...
July 1, 2016: International Journal of Cardiology
Matias B Yudi, Andrew E Ajani, Nick Andrianopoulos, Stephen J Duffy, Omar Farouque, Jay Ramchand, Ronen Gurvitch, Jeffrey Lefkovits, Melanie Freeman, Angela Brennan, David J Clark, Christopher Reid, David Eccleston
BACKGROUND: The optimal timing of angiography and percutaneous coronary intervention (PCI) in patients with non-ST elevation acute coronary syndromes (NSTEACS) remains uncertain. We sought to assess clinical characteristics and outcomes of patients in real-world contemporary practice who have early versus delayed PCI for NSTEACS. METHODS: We analyzed baseline clinical and procedural characteristics of 4307 patients with NSTEACS who underwent PCI from the Melbourne Interventional Group registry...
August 2016: Coronary Artery Disease
Shamir R Mehta, John W Eikelboom, Purnima Rao-Melacini, Jeffrey I Weitz, Sonia S Anand, Guillaume Pare, Andrezj Budaj, Janice Pogue, Keith A A Fox, Salim Yusuf
BACKGROUND: Several biomarkers have been shown to improve risk stratification in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS); however, they have not been integrated into risk prediction tools. METHODS: C-reactive-protein, N-terminal-pro-brain natriuretic peptide (NT-proBNP), and haemoglobin A1C were measured in 6447 patients with NSTEACS who were enrolled in the Clopidogrel in Unstable Angina to Prevent Recurrent Events trial. A risk score to predict cardiovascular (CV) death, myocardial infarction (MI), or stroke at 1 year was developed by incorporating biomarkers that were independently predictive of events with traditional variables, electrocardiogram, and troponin-T...
February 2, 2016: Canadian Journal of Cardiology
O A Alabas, R A Brogan, M Hall, S Almudarra, M J Rutherford, T B Dondo, R Feltbower, N Curzen, M de Belder, P Ludman, C P Gale
OBJECTIVE: For percutaneous coronary intervention (PCI) to the unprotected left main stem (UPLMS), there are limited long-term outcome data. We evaluated 5-year survival for UPLMS PCI cases taking into account background population mortality. METHODS: A population-based registry of 10 682 cases of chronic stable angina (CSA), non-ST-segment elevation acute coronary syndrome (NSTEACS), ST-segment elevation myocardial infarction with (STEMI+CS) and without cardiogenic shock (STEMI-CS) who received UPLMS PCI from 2005 to 2014 were matched by age, sex, year of procedure and country to death data for the UK populace of 56...
August 15, 2016: Heart: Official Journal of the British Cardiac Society
Alberto Dominguez-Rodriguez, Pedro Abreu-Gonzalez, Pablo Avanzas, Luciano Consuegra-Sanchez
Growth differentiation factor-15 (GDF-15) is produced by cardiomyocytes and atherosclerotic lesions under stress conditions, but little is known about its relation with severity and complexity of coronary lesions. The aim of this study was to investigate the association between GDF-15 and the syntax score for risk prediction of major adverse cardiovascular events (MACE) at 2-year follow-up in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). This is a prospective cohort study of 502 patients with NSTEACS...
May 15, 2016: American Journal of Cardiology
Alparslan Kurtul, Mikail Yarlioglues, Mustafa Duran, Sani Namik Murat
BACKGROUND: A higher neutrophil-to-lymphocyte ratio (NLR) is associated with poor clinical outcomes in various cardiovascular diseases, including acute coronary syndromes. However, the relationship between NLR and contrast-induced nephropathy (CIN) in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) undergoing percutaneous coronary intervention (PCI) has not been known. Hence, we investigated whether admission NLR is associated with CIN after PCI in patients with NSTE-ACS...
July 2016: Heart, Lung & Circulation
Gerry Devlin, Michael Williams, John Elliott, Harvey Douglas White, John French, Greg Gamble, Philip Matsis, Richard Troughton, Mark Richards, Chris Ellis
AIMS: The first New Zealand Acute Coronary Syndrome (ACS) national audit of 2002 was a collaborative effort between clinicians and nurses, and demonstrated important limitations to Non ST-elevation ACS patient (NSTEACS) care. A momentum for change was created. Subsequent audits in 2007 and 2012 allow assessment over time. METHODS: Over 14 days in May 2002, 2007 and 2012, patients with suspected ACS admitted to a hospital in New Zealand were audited. 'Definite' ACS was determined at discharge, after in-hospital investigations; we reviewed NSTEACS patients...
January 8, 2016: New Zealand Medical Journal
M B Yudi, D J Clark, O Farouque, D Eccleston, N Andrianopoulos, S J Duffy, A Brennan, J Lefkovits, J Ramchand, T Yip, E Oqueli, C M Reid, A E Ajani
BACKGROUND: Guidelines recommend prasugrel or ticagrelor instead of clopidogrel in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary interventions (PCI). AIM: We sought to describe the trends in uptake of the newer agents and analyse the clinical characteristics and short-term outcomes of patients treated with clopidogrel, prasugrel or ticagrelor. METHODS: We analysed the temporal trends of antiplatelet use since the availability of prasugrel (2009-2013) in patients with ACS from the Melbourne Interventional Group registry...
May 2016: Internal Medicine Journal
Jiannan Dai, Jinwei Tian, Jingbo Hou, Lei Xing, Shengliang Liu, Lijia Ma, Huai Yu, Xuefeng Ren, Nana Dong, Bo Yu
BACKGROUND: Cholesterol Crystals (ChCs) are recognized as a hallmark of advanced atherosclerotic lesions. Previous animal and histopathology studies have revealed that Cholesterol crystallization trigger a local inflammatory response and plaque rupture. We sought to investigate the in vivo relationship between ChCs and culprit lesion vulnerability in patients with acute coronary syndrome (ACS). METHODS: 206 culprit lesions from 206 patients with ACS who underwent optical coherence tomography (OCT) imaging were divided into 2 groups based on the presence or absence of ChCs...
April 2016: Atherosclerosis
Fernando Bassan, Roberto Bassan, Roberto Esporcatte, Braulio Santos, Bernardo Tura
BACKGROUND: BNP has been extensively evaluated to determine short- and intermediate-term prognosis in patients with acute coronary syndrome, but its role in long-term mortality is not known. OBJECTIVE: To determine the very long-term prognostic role of B-type natriuretic peptide (BNP) for all-cause mortality in patients with non-ST segment elevation acute coronary syndrome (NSTEACS). METHODS: A cohort of 224 consecutive patients with NSTEACS, prospectively seen in the Emergency Department, had BNP measured on arrival to establish prognosis, and underwent a median 9...
March 2016: Arquivos Brasileiros de Cardiologia
Kevin Liou, Nigel Jepson, Nicolas Buckley, Vivien Chen, Shane Thomas, Elizabeth Anne Russell, Sze-Yuan Ooi
PURPOSE: Peri-procedural myocardial infarction (PMI) occurs in a small but significant portion of patients undergoing percutaneous intervention (PCI). The underlying mechanisms are complex and may include neurohormonal activation and release of vasoactive substances resulting in disruption of the coronary microcirculation. Endothelin in particular has been found in abundance in atherosclerotic plaques and in systemic circulation following PCI, and may be a potential culprit for PMI through its action on microvascular vasoconstriction, and platelet and neutrophil activation...
April 2016: Cardiovascular Drugs and Therapy
Sorin J Brener, Roxana Mehran, Alexandra J Lansky, Girma M Ayele, Gregg W Stone
BACKGROUND: Aspirin is promptly administered to patients presenting with acute coronary syndromes. It is not known whether aspirin pretreatment in acute coronary syndrome patients is beneficial, particularly because some, but not all, prior studies identified aspirin pretreatment as an independent risk factor for adverse ischemic events. OBJECTIVE: To study the effect of aspirin pretreatment in patients with acute coronary syndromes enrolled in two large randomized clinical trials...
September 2016: European Heart Journal. Acute Cardiovascular Care
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