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Background@#Acute coronary syndrome (ACS) is a major cardiovascular problem due to its high hospitalization and mortality rates. One of the risk factors for atherosclerosis that leads to ACS is insulin resistance (IR) which plays a role in the pathogenesis and development of cardiovascular events. This study aims to determine the relationship between IR and in-hospital outcomes in non-diabetic patients with ACS.@*Methodology@#This was a cohort study conducted from January-June 2021. Insulin resistance was assessed using the Admission insulin resistance index (AIRI). This measurement was performed once during the patient's admission, and then the outcome was observed during hospitalization. The observed in-hospital outcomes were composite outcomes; namely, heart failure, arrhythmia, cardiogenic shock, and death. The statistical tests used were ANOVA, independent T and Chi-Square tests. Statistical test results were considered significant if p<0.05.@*Results@#This study included 60 subjects (51 males and 9 females). Analysis revealed that AIRI was higher in patients with composite outcomes (mean 9.97 ± 4.08) than in patients without composite outcomes (mean 7.71 ± 4.06) (p<0.05); AIRI was higher in patients with heart failure (mean 10.72 ± 3.83) than in patients without heart failure (mean 7.25 ± 3.84) (p<0.001). Patients with IR had a higher rate of heart failure complications [OR 5.5 95% CI (1.56-19.38) (p=0.005)].@*Conclusion@#There is an association between AIRI and composite outcomes. Patients with IR have 5.5 times the risk of developing heart failure.
Subject(s)
Insulin Resistance , Acute Coronary SyndromeABSTRACT
Background: Acute myocardial infarction (AMI) is often characterised pathologically as the death of cardiomyocytes as a consequence of persistent ischaemia result in an acute imbalance among oxygen supply and demand. Coronary artery disease (CAD) is the leading cause of death worldwide. AMI mainly affects patients older than 40 years of age, however, young can suffer MI. In the developing countries, CAD is becoming an epidemic, where it occurs in younger persons at greater rates. Clinical features and prognosis of young patients tend to vary from those of older individuals. the outcomes of a MI may be especially severe at a young age because of its larger potential influence on the patient's psyche, capacity to work, and socioeconomic burden. AMI is less prevalent in young people than in older persons, since only 2 to 6 % of the younger population suffers from the condition. Primary PCI is the optimal therapy for STEMI if it can be done promptly, preferably within 90-120 minutes of provider contact. Methods: The present research performed on 60 subjects who had AMI and treated with primary PCI. The cases were allocated into 2 groups, group 1 involved young subjects aged 40 years old or less (30 patients) and group 2 involved older patients aged more than 40 years (30 patients). All patients underwent complete history taking, cardiological clinical examination, investigations, coronary angiography and PCI. Results: Concerning age there was statistically significant difference among two groups while there was no significant difference regarding to sex. regarding risk factors there was significant difference among both groups regarding to hypertension, DM, previous MI, cerebrovascular disease and drug abuse. Regarding to laboratory investigation, there was no significant difference regarding CK, CKMB, creatinine and random blood sugar. There was no significant difference regarding to culprit artery and TIMI flow after PCI while there was statistically significant difference regarding number of vessels involved. Regarding to outcome there was no significant variation among the two groups regarding to acute HF, cardiogenic shock, re-infarction, and death. As regarding to bleeding, it was significant higher in group II. Conclusions: Prevalence of Acute ST Elevation Myocardial Infarction “STEMI” in young people is increasing due to sedentary and stressful lifestyle and bad habits as smoking and addiction. The most widespread and important risk factors in these patients are smoking, addiction, mental stress and hyperlipidemia with less prevalence of hypertension and diabetes mellitus. Young patients present most commonly with anterior then inferior STEMI.
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Background: The Thrombolysis in Myocardial Infarction (TIMI) risk score is purportedly an integral score for mortality risk prediction in fibrinolysis-eligible patients with STEMI. Attempt was made to evaluate the same by correlating risk stratification by TIMI score with hospital outcome of such patients.Methods: There were 145 cases of STEMI were studied and TIMI risk scores were calculated and analysed vis-à-vis various relevant parameters. The patients were divided into three risk groups: ‘low-risk’, ‘moderate-risk’ and ‘high-risk’ based on their TIMI scores. All patients received routine anti-ischemic therapy and were thrombolysed subsequently, monitored in ICCU and followed during hospital stay for occurrence of post-MI complications.Results: There were 79 patients (54.5%) belonged to low-risk group, 48 (33.1%) to moderate-risk group and 18 (12.4%) to high-risk group according to TIMI risk score. The mortality (total 17 deaths) was observed to be highest in the high-risk group (55.6%), followed by moderate-risk (12.2%) and low-risk group (1.28%) respectively. Out of the 7 potentially suspect variables studied, Killips classification grade 2-4 had the highest relative risk (RR-15.85), followed by systolic BP <100mmHg (RR- 10.48), diabetes mellitus (RR- 2.79) and age >65 years (RR- 2.59).Conclusions: The TIMI risk scoring system seems to be one simple, valid and practical bed side tool in quantitative risk stratification and short-term prognosis prediction in patients with STEMI.
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BACKGROUND: The aging of the patient population is one of rhe most important factirs influencing health care delivery. Currently 5% of the Korean population is elderly, defined as older than 65years of age, with this group projected to increase to 13.1% by the year 2021. Cardiovascular disease is the leading cause of death and of disability in the elderly age group. mong them, coronary heart disease is the most importane. METHOD: Study population composed of 216 patients who were admittied to the hospital with first acute myocardial infarction and they were divided into two groups according to the age(older than 65 years of age vs younger). Clonical features, risk factors of coronary heart disease, in-hospital outcome and complication were compared in elderly patients and others group. Results : 1) The risk factors of coronary heart disease is similar to younger patients but pattern of chest pain is less typical than younger patients. 2) Clinical presentation of elderly patients is similar to younger patients except Killip class on admission.(1.66vs 1.91,P=0.04) 3) In-hospital mortality of elderly patients in higher than younger patients. In addition to an increased incidence of death, recurrent ischemia, stroke, AV block, ventricular arrythmia, pulmonary edema occured more frequently with advanced age. 4) Especially in the thrombolytic therapy group, in-hospital death, reinfarction and recurrent ischemia is higher than primary PTCA group in elderly patients. CONCLUSIONS: Diagnosis of acute chest pain is difficult in elderly patients and in-hospital mortality and morbidity is higher than in younger patients. Thus more accurate diagnosis and discriminative therapeutic modality is needed.