Prognostic impact of coronary collaterals in acute coronary syndrome (PICC-ACS): A meta-analysis of observational studies

@#<p style="text-align: justify;"><strong>INTRODUCTION:</strong> The coronary collateral circulation (CCC) is an alternative source of blood supply in coronary artery disease (CAD). The prognostic value of the presence of CCC at the time of acute coronary syndrome (ACS) is undefined with regards to hard outcomes, particularly reduction in mortality. The study's aim is to determine if the presence of CCC demonstrated by coronary angiography during an ACS is associated with a reduction in mortality. </p><p style="text-align: justify;"><strong>METHODS:</strong> We conducted a systematic search of studies using MEDLINE, EMBASE, ScienceDirect, Scopus, and Cochrane Central Register of Controlled Trials databases in all languages and examined reference lists of studies. The inclusion criteria were 1) observational; 2) population included adults >19 years old with an acute coronary syndrome; 3) reported data on mortality in association with the presence or absence of CCC on angiography; and 4) should have controlled for confounders by using logistic regression analysis. Study quality was assessed using the Newcastle-Ottawa Quality Assessment Scale for observational studies. The outcome of interest was reduction in all-cause mortality, assessed using Mantel-Haenzel analysis of random effects to compute for risk ratios.</p><p style="text-align: justify;"><strong>RESULTS:</strong> Pooled analysis from 11 identified trials with 8,370 subjects showed that among patients with ACS who underwent coronary angiography, the presence of CCC showed a trend towards benefit in terms of mortality, but was not statistically different from those without CCC [RR 0.65, (95% CI 0.38 to 1.12), p<0.0001, I2=74%]. In those ACS patients with CCC treated with PCI, a significant reduction in mortality was found [RR 0.43, (95% CI 0.29 to 0.64), p< 0.0001, I2=0%].</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> The presence of CCC during ACS showed a trend towards mortality reduction. Further, among patients treated with PCI, those with CCC had an incrementally significant reduction in mortality compared to those without CCC.</p>

Four-year clinical outcomes of Filipino patients with or at risk for atherothrombotic events from the REACH registry

@#<p style="text-align: justify;"><strong>INTRODUCTION: </strong>Patients with established atherothrombotic disease (EAD) or those with only atherothrombotic risk factors are at high risk for cardiovascular events and death. There are scant data on the clinical profile of stable Filipino patients with or at risk for atherothrombosis and their long-term outcomes. The authors'objective is to present the baseline clinical profile and four-year cardiovascular outcomes in Filipino outpatients with EAD and those with multiple atherothrombotic risk factors in comparison to the Asian and Global populations</p><p style="text-align: justify;"><strong>METHODS:</strong> The Reduction of Atherothrombosis for Continued Health (REACH) registry is an international, prospective cohort of 68,236 patients aged at least 45 years old with either EAD or at least three atherothrombotic risk factors enrolled from 44 countries in 2003-2004. The Philippine cohort consists of 1040 outpatients with EAD (N=913) or at least three atherothrombotic risk factors (N=127) consecutively enrolled and followed up for at least one to four years for the occurrence of cardiovascular death (CVD), myocardial infarction (MI) and stroke.</p><p style="text-align: justify;"><strong>RESULTS:</strong> Nine hundred fifty-five Filipino outpatients (96)% completed the four-year follow-up. Mean age is 65.5 years with similar sex distribution. Common risk factors included diabetes (46%), hypertension (87.4%), hypercholesterolemia (62.9%), and smoking history (29.7%). Ninety-two percent had EAD-- 43% with coronary artery disease, 45% with cerebrovascular disease (CVD) and four percent with peripheral artery disease (PAD). The combined primary endpoint of CVD/MI/stroke was 14.7%, but higher (19.8%) among those with polyvascular disease. Cerebrovascular disease (CVD) patients had the highest CVD/MI/stroke rates (17.6%); PAD patients had the highest CVD/MI/stroke and hospitalization rate (33.2%). Baseline medication usage is 81.1% for antiplatelet agents, 62.6% for statins and 69% for angiotensin-converting enzyme inhibitor/angiotensin receptor blocker but four-year follow-up medication usage rates were lower.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> Filipino outpatients with or at risk for atherothrombosis experienced high long-term rates of CV events. This is the first report of long-term cardiovascular outcomes of stable Filipino outpatients with this high-risk profile.</p>