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Despite the known protective cardiovascular effect of aspirin, former studies identified its prior exposure to an acute coronary syndrome (ACS) as an independent risk factor for adverse events. However, those studies did not refle...
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Despite the known protective cardiovascular effect of aspirin, former studies identified its prior exposure to an acute coronary syndrome (ACS) as an independent risk factor for adverse events. However, those studies did not reflect contemporary approaches. In the current study, we determine whether patients exposed to aspirin before an ACS have a worse cardiovascular risk profile and if it predicts higher risk of recurrent cardiovascular events or mortality. A cohort of patients enrolled in a national registry of ACS was analyzed according to prior exposure to aspirin. A propensity score standardized patients according to baseline comorbidities. Multivariable COX regression analysis was performed in unmatched and matched populations for a primary endpoint (composite of all-cause mortality and/or cardiovascular rehospitalization) and two secondary endpoints (all-cause mortality and cardiovascular rehospitalization, separately) at 1-year follow-up. Among 5533 ACS patients, 1763 were previously exposed to aspirin. They were older and had more comorbidities; contemporary approaches, both coronary angiography and percutaneous coronary angioplasty were less likely to be performed. Before matching the population, prior exposure to aspirin was an independent predictor of primary composite endpoint (p = 0.002) and cardiovascular rehospitalization as the secondary endpoint (p = 0.001). There were no statistically significant differences between both groups in the multivariable model for the primary or secondary endpoints after matching. Previous exposure to aspirin identified ACS patients with worse baseline characteristics, establishing its role as a cardiovascular risk marker. However, our data do not support including aspirin pretreatment in risk stratification scores as an adverse prognostic variable.
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Aims: Approximately half of cases of cardiovascular disease (CVD) worldwide occur in Asia, with acute coronary syndrome (ACS) a leading cause ofmortality. Long-term ACS-related outcomes data in Asia are limited. This analysis exam...
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Aims: Approximately half of cases of cardiovascular disease (CVD) worldwide occur in Asia, with acute coronary syndrome (ACS) a leading cause ofmortality. Long-term ACS-related outcomes data in Asia are limited. This analysis examined 2-year ACS-related outcomes in patients enrolled in the EPICOR Asia study, and the association between patient characteristics and management on outcomes.
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Background/purpose: Patients with acute coronary syndrome (ACS) are at high-risk for recurrent coronary syndromes, heart failure and death. Early coronary intervention combined with medications reduces these risks. The ACS Israeli...
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Background/purpose: Patients with acute coronary syndrome (ACS) are at high-risk for recurrent coronary syndromes, heart failure and death. Early coronary intervention combined with medications reduces these risks. The ACS Israeli Survey (ACSIS) is conducted over a 2-month period, every 2-3 years. ACSIS includes all patients discharged with a diagnosis of ACS from the 24 coronary care units and cardiology departments in Israel. We compared clinical profiles and 1-year survival between ACS patients who did and did not undergo coronary angiography.
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BACKGROUND: Post-myocardial infarct depression includes both somatic depressive symptoms and nonsomatic cognitive symptoms. Their respective relationships to long-term survival are unclear.
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Aims: We sought to describe the differential effect of bleeding events in acute coronary syndromes (ACS) on short- and long-term mortality according to their type and severity.
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Background There is very limited guidance in regard to how biological age should be estimated and how different comorbid-ity conditions influence the benefit-risk ration of interventions. Frailty is an important health-related pro...
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Background There is very limited guidance in regard to how biological age should be estimated and how different comorbid-ity conditions influence the benefit-risk ration of interventions. Frailty is an important health-related problem in patients, especially in older adults. It is a reflection of biologic rather than chronologic age; frailty may explain why there remains substantial heterogeneity in clinical outcomes within the older patients' population. Aims We aimed to review the prognostic value of frailty for adverse outcomes in older patients with acute coronary syndrome (ACS). Methods Studies published until December 31, 2018, identified by systematic Medline, Embase, and Cochrane Controlled Register of Trials (CENTRAL) searches were reviewed for the association between frailty and mortality in older patients with ACS. We used the Newcastle-Ottawa Quality Assessment Scale to assess the quality of the included studies. We extracted the information of hazard ratios (HR) and odds ratios (OR) with accompanying 95% confidence intervals (CI), and P values of multivariable analysis. Heterogeneity across studies was determined using the Cochran Q value by Review Manager 5.3. Results A total of 11 articles involving 7212 patients were included in this meta-analysis. Two studies (Sujino, Y 2015 and Alonso, S.GL 2016; n = 264) reported that frailty was significantly associated with in-hospital mortality in patients with ACS (range of reported OR between 6.38 and 12.0). We performed a subgroup analysis of the other nine studies based on differences in the follow-up time. Pooled meta-analysis demonstrates that frailty was associated with short-term, medium-term, and long-term mortality (HR = 3.67, 4.09, 1.66). There was no association between frailty and bleeding in older patients with ACS. Conclusions Frailty measured by Canadian Study of Health and Aging Clinical Frailty Scale (CSHA-CFS), the Edmonton Frail Scale (EFS), Fried score, Green scores, frailty instrument from the Survey of Health, Ageing and Retirement in Europe (SHARE-FI) index, and FRAIL (Fatigue, Resistance, Ambulation, Illnesses, Loss of weight) scale, leads to significantly higher mortality rates in older patients with ACS.
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Background: Weaimed to assess sex difference in developing major adverse cardiovascular events (MACEs) after discharge and factors associated with the gender disparity among AMI survivors.
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Background: Elevated admission plasma glucose levels >140 mg/dl are associated with adverse clinical outcomes in both diabetic and non-diabetic patients admitted with acute coronary syndrome (ACS). We aimed to evaluate the associa...
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Background: Elevated admission plasma glucose levels >140 mg/dl are associated with adverse clinical outcomes in both diabetic and non-diabetic patients admitted with acute coronary syndrome (ACS). We aimed to evaluate the association between admission plasma glucose levels Methods: The study population consisted of patients with acute coronary syndrome included in the Acute Coronary Syndrome Israeli Survey during 2000–2013. Diabetic patients were excluded. The primary endpoint was all-cause mortality at one year. Results: The 452 0 patients had a mean age of 61.7±13.5 years and were stratified into four quartiles according to admission plasma glucose (60–94, 95–105, 106–119, 120–140 mg/dl). Patients with higher admission plasma glucose were older and included a higher percentage of smokers. In addition, the higher the glucose so also did they have a poorer risk factor profile including a higher body mass index, total and low-density lipoprotein cholesterol and triglyceride levels, and lower high-density lipoprotein cholesterol levels. During the first year 5.2% of patients died. A comparison of one-year mortality according to admission plasma glucose quartiles demonstrated a significant and progressive increase in mortality risk as admission plasma glucose rose (3.5%, 4.1%, 6.1%, 6.4%, respectively, p =0.001). However, this association lost its clinical significance following a multivariate analysis ( p =0.08). Conclusions: High admission plasma glucose levels within the normal to mildly impaired range are associated with increased one-year mortality in non-diabetic acute coronary syndrome patients. However, the higher glucose level is probably not the cause for the adverse outcome but rather a marker for high risk. Our findings support the definition of 140 mg/dl as the cutoff for clinically acceptable admission glucose levels in patients with acute coronary syndrome.
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Background: Patients with end-stage renal disease (ESRD) on dialysis have poor outcomes after acute coronary syndrome (ACS). Epidemiological data for Asian patients are scarce. Methods: This longitudinal cohort study investigated ...
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Background: Patients with end-stage renal disease (ESRD) on dialysis have poor outcomes after acute coronary syndrome (ACS). Epidemiological data for Asian patients are scarce. Methods: This longitudinal cohort study investigated the incidence, risk factors, and outcomes of ACS in 19,974 ESRD incident dialysis patients in the Taiwan National Health Insurance research Database between January 1999 and December 2001. The follow-up period was from the start of dialysis to the date of death, end of dialysis, or December 31, 2008. Results: ACS was diagnosed in 1785 patients during follow-up (1.78/100 person-years): 832 (46.6%) had acute myocardial infarction (AMI), 681 (38.2%) underwent cardiac catheterization, 398 (22.3%) underwent percutaneous transluminal coronary angioplasty (PTCA), and 50 (2.8%) underwent coronary artery bypass grafting. Male (HR 1.35, 95% CI: 1.23-1.49) and elderly (HR 3.289, 95% CI: 2.71-4.00) patients had a high rate of ACS. Patients with baseline comorbidities (diabetes mellitus, hypertension, congestive heart failure, coronary artery disease, dysrhythmia, and other cardiac and chronic obstructive lung diseases) had a higher incidence of ACS than did those without. Overall in-hospital mortality was 9.7%. The cumulative 6-month post-hospitalization survival rate was 79.3%; the 1-year rate was 72.3%. Being elderly (≥ 65 years old), and having DM or AMI were associated with an increased risk for mortality; PTCA was associated with a decreased risk (HR 0.77, 95% CI: 0.66-0.91). Conclusion: ESRD dialysis patients had a high incidence of ACS and mortality. Being male, elderly and having baseline comorbidities were independent risk factors for ACS. Coronary intervention is the possible benefits for dialysis patients.
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Background: East Lancashire Hospitals NHS Trust reorganized its services in October 2007 with acute admissions sent to one site which allowed the development of a 24/7 Consultant delivered cardiology service. Methods: A retrospect...
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Background: East Lancashire Hospitals NHS Trust reorganized its services in October 2007 with acute admissions sent to one site which allowed the development of a 24/7 Consultant delivered cardiology service. Methods: A retrospective analysis of all patients admitted with an acute coronary syndrome between two periods: Group 1: October 2006 to September 2007 and Group 2: October 2007 and September 2008. We looked at the following end points-length of stay, in-hospital and 30 day all cause mortality. Results: 633 patients in group 1 and 748 patients in group 2. There was significant reduction in length of stay from a median (IQ range) 7 (511) days to 5 (39) days; P < 0.0001. The in-hospital mortality reduced from 15.8% (n = 100) to 7.6% (n = 56); P < 0.0001. The mortality at 30 days reduced from 15.2% (n = 96) to 8.3% (n = 62); P < 0.0001. These reductions remained significant after adjustment for demographic and risk factor variables. Conclusion: A 24/7 Consultant Cardiologist delivered cardiac care is associated with marked reductions in all cause mortality following admission with acute coronary syndromes. This improvement occurred with a significant reduction in hospital length of stay.
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