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Objective:To explore the predictive value of HEART score combined with N-terminal pro-B-type natriuretic peptides (NT-proBNP) for 3-month major adverse cardiovascular events (MACE) in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS).Methods:This was a retrospective cohort study. Adult patients with acute chest pain who met the diagnostic criteria for NSTE-ACS in the 5th Affiliated Hospital of Sun Yat-Sen University from January 2018 to March 2018 were enrolled. Patients with cardiac chest pain caused by diseases other than NSTE-ACS, non-cardiac chest pain, renal insufficiency, acute cerebral infarction, end-stage disease, pregnant, and incomplete data were excluded. Data of all patients’ general clinical information, first electrocardiogram (ECG), cardiac troponin I (cTnI), and NT-proBNP were collected. The correlation between NT-proBNP level and the occurrence of MACE within 3 months was analyzed. The receiver operating characteristic (ROC) curves was drawn, and the predictive value of NT-proBNP, HEART score, and their combination for 3- month MACE in patients with NSTE-ACS were evaluated.Results:A total of 151 patients were enrolled. Patients with NSTE-ACS were divided into the MACE group ( n=95) and non-MACE group ( n=56) according to whether MACE occurred within 3 months of onset. The level of NT-proBNP, the HEART score, and the cTnI level in the MACE group were significantly higher than those in the non-MACE group (all P<0.001). After risk stratification assessed by HEART score in all patients with NSTE-ACS, it was found that the level of NT-proBNP and the incidence of MACE increased as the risk score increased (all P<0.05). The area under the ROC curve of HEART score, NT-proBNP and their combination were 0.819 (95% CI:0.751-0.887), 0.821 (95% CI:0.752-0.889) and 0.858 (95% CI:0.796-0.919), respectively. Conclusions:The combination of HEART score and NT-proBNP level can improve the predictive value for 3-month MACE in patients within NSTE-ACS, and provide important information for treatment decision and improving prognosis.
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Objective To explore the safety and efficacy of different doses of enoxaparin combined with ticagrelor after percutaneous coronary intervention (PCI) in patients with non-ST elevation-acute coronary syndrome (NSTE-ACS) and complex coronary artery lesions and try to find out the best combination dose of enoxaparin. Methods A total of 345 NSTE-ACS patients with complex coronary artery lesions that had undergone percutaneous coronary intervention were recruited in Beijing Anzhen Hospital affi liated to Capital University from March 2015 to October 2016. All patients were treated with aspirin and ticagrelor during the trial and randomly assigned to three groups: no enoxaparin anticoagulation therapy (non-anticoagulation group), half dose of enoxaparin anticoagulation therapy (0.5 mg / kg, half-anticoagulation group) and full dose of enoxaparin anticoagulation therapy (1 mg / kg) (total-anticoagulation group).The primary endpoints were bleeding events during hospitalization and at 12 months after PCI and the secondary endpoints were major adverse cardiac and cerebrovascular events (MACCEs) during hospitalization and at 1, 3 and 12 months after PCI. Results (1) The primary endpoints: The incidences of total bleeding events in patients treated with full dose of enoxaparin were signifi cantly higher than those in the non-anticoagulation group(29.5%vs.13.6%,P=0.005)and the two groups had comparable rates of major bleeding(1.9%vs. 0,P>0.05),but minor bleeding rates were higher in the total-anticoagulation group(27.6% vs.13.6%, P=0.012).There were no significant differences in the incidence of major and minor bleeding events between the half-anticoagulation and the non-anticoagulation groups during hospitalization (all P>0.05). Trend test showed that the incidence of total bleeding and minor bleeding were increased with the increase of the dose of enoxaparin after PCI, and there was a linear correlation between bleeding events and dose of enoxaparin (total bleeding: trend for P=0.005; minor bleeding: trend for P=0.011). (2) The secondary endpoints: there was no signifi cant diff erence in the incidence of perioperative myocardial injury and MACCE at 1 month, 3 months and 12 months post-PCI between three groups (P>0.05).Conclusions For NSTE-ACS patients with complex coronary lesions, the combination of ticagrelor and enoxaparin after PCI did not bring additional benefi ts. Subcutaneous application of full dose of enoxaparin may increase patients' bleeding risk after PCI, while reduced dose of enoxaparin is relatively safe. These results suggest that routine anticoagulation therapy after PCI is not necessary for patients with NSTE-ACS and complex coronary lesions who were treated with ticagrelor. Reduced dose of enoxaparin could be applied subcutaneously post PCI after fully assessing the ischemia and bleeding risk of patients if it is necessary.
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Objective: To clarify the predictive value for long-term prognosis of GRACE score and SYNTAX score in patients with non-ST elevation acute coronary syndrome (NSTE-ACS). Methods: A total of 784 NSTE-ACS patients treated in our hospital from 2009-01 to 2014-01 were retrospectively studied. According to the treatment, the patients were divided into 3 groups: Medication group,n=410, Stent group,n=325 and CABG group,n=49. Based on 2 scoring systems, the patients were divided into another 3 groups: Low risk group, Medium risk group and High-risk group. The relationship between GRACE score and SYNTAX score was studied by Pearson correlation analysis, survival analysis was conducted by Kaplan-Meier method, univariate and multivariate analysis were performed by Cox proportional hazard model, and the area under curve (AUC) of ROC analysis was used to compare two methods. Results: All 784 patients completed the follow-up study at the median of 47.7 months. Pearson correlation analysis showed that there was a weak positive correlation between GRACE score and SYNTAX score (r=0.40,P0.05. Cox proportional hazard model and ROC analysis indicated that GRACE and SYNTAX scores had the important predictive value for lone term prognosis of NSTE-ACS. ROC analysis of GRACE score, SYNTAX score, the combination of GRACE and SYNTAX scores showed that 3 of them all had good predictive value for MACE occurrence, three of 95% CI had signiifcant overlapping without statistic differences. Conclusion: GRACE score and SYNTAX score are related, both of them have important while similar predictive value for long term prognosis in NSTE-ACS patients, the combination of 2 scores cannot increase the predictive value. GRACE score is appropriate for the risk stratiifcation in NSTE-ACS patients.
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Objective To evaluate the diagnostic value of myeloperoxidase (MPO)in diagnosis of non-ST elevation acute cor-onary syndromes (NSTE ACS).Methods The MPO was determined in 61 unstable angina pectoris (UAP)patients and 54 non-ST-elevation myocardial infarction (NSTE MI)patients,then analyzed the data with receiver operationg characteristic curve (ROC curve)statistical software.The major adverse cardiac events (MACE)were obseved in 106 NSTE ACS patients through 1 year of follow-up.Results The MPO values of NSTE MI group and UAP group were 672±418 ng/ml and 459± 328 ng/ml,the difference was statistically significant (t=3.928,P <0.001).The cTnI values were 558±261 pg/ml and 405 ±278 pg/ml of respectively.The difference was statistically significant (t = 3.089,P = 0.003).The area under the ROC curve of MPO was 0.726 when the optimal cutoff value was 382 ng/ml in the diagnosis of NSTE MI.The sensitivity and specificity was 92.6% and 39.8%.The area under the ROC curve of cTnI was 0.799 when the optimal cutoff value was 484 ng/ml in the diagnosis of NSTE MI.The sensitivity and specificity was 65.5% and 92.3%.High MPO maintained a strong association with the risk of major adverse cardiac events through 1 year of follow-up.Conclussion MPO is ahigh sensitivity marker of the NSTE MI and of clinical value for prognosis of NSTE ACS.
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OBJECTIVE: The goal of the present study was to compare the prognoses of patients with non-ST-elevation acute coronary syndromes who were treated with invasive or conservative treatment strategies. METHODS: We performed a meta-analysis of studies of patients with non-ST-elevation acute coronary syndromes to assess the benefits of an invasive strategy vs. a conservative strategy for short- and long-term survival. We searched PubMed for studies published from 1990 to November 2012 that investigated the effects of an invasive vs. conservative strategy in patients with non-ST-elevation acute coronary syndromes. The following search terms were used: “non-ST-elevation myocardial infarction”, “unstable angina”, “acute coronary syndromes”, “invasive strategy”, and “conservative strategy”. The primary endpoints were all-cause mortality at 30 days and 1 year. RESULTS: Seven published studies were included in the present meta-analysis. The pooled analyses show that an invasive strategy decreased the risk of death (risk ratio [0.839] [95% confidence interval {0.648-1.086}; I 2, 86.46%] compared to a conservative strategy over a 30-day-period. Furthermore, invasive treatment also decreased patient mortality (risk ratio [0.276] [95% confidence interval {0.259-0.294}; I 2, 94.58%]) compared to a conservative strategy for one year. CONCLUSION: In non-ST-elevation acute coronary syndromes, an invasive strategy is comparable to a conservative strategy for decreasing short- and long-term mortality rates. .
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Humans , Acute Coronary Syndrome/therapy , Angina, Unstable/therapy , Angioplasty, Balloon, Coronary , Coronary Angiography , Electrocardiography , Myocardial Revascularization , Prognosis , Treatment OutcomeABSTRACT
BackgroundFew studies have compared change in the health-related quality of life (HRQL) following treatment of non-ST-elevation acute coronary syndrome (NSTE-ACS) with either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). This study is tocompare changes in HRQL six months after hospital discharge between NSTE-ACS pa-tients who underwent either PCI or CABG.Methods HRQL was assessed using the Seattle angina questionnaire at admission and six months after discharge in 1012 consecutive patients with NSTE-ACS. To assess associations of PCI and CABG with HRQL changes, logistic regression models were constructed treating changes in the score of each dimension of the Seattle angina question-naire as dependent variables.Results Although both the PCI and CABG groups experienced angina relief and other improvements at 6-month follow-up (P<0.001), the CABG relative to PCI group showed more significant improvements in angina frequency (P= 0.044) and quality of life (P= 0.028). In multivariable logistic analysis, CABG also was an independent predictor for both im-provement of angina frequency (OR: 1.62, 95%CI: 1.09-4.63,P= 0.042) and quality of life (OR: 2.04, 95%CI: 1.26-6.92,P= 0.038) relative to PCI.Conclusions In patients with NSTE-ACS, both PCI and CABG provide great improvement in disease-specific health status at six months, with that of CABG being more prominent in terms of angina frequency and quality of life.
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JUSTIFICATIVA E OBJETIVOS: As síndromes coronarianas agudas são resultado da ruptura de uma placa coronariana instável, complicada pela formação de trombo intraluminal, embolização e graus variáveis de obstrução coronária. Pacientes com oclusão total de uma artéria coronária apresentam infarto agudo do miocárdio (IAM) com supradesnivelamento do segmento ST. Uma oclusão parcial do vaso pode resultar em IAM sem supradesnivelamento do segmento ST ou angina instável. As manifestações clínicas e as alterações eletrocardiográficas são componentes fundamentais para identificação dos pacientes portadores destas síndromes. A triagem rápida e eficaz desses pacientes, quanto à presença ou não do supradesnivelamento do segmento ST, é fundamental para a determinação da estratégia terapêutica a ser empregada. O objetivo deste estudo foi realizar uma revisão da literatura sobre as evidências atuais e as recomendações para avaliação e tratamento das síndromes coronarianas agudas. CONTEÚDO: Revisão da literatura, utilizando as bases eletrônicas de dados MedLine e LILACS, no período de janeiro de 1990 a setembro de 2007. CONCLUSÕES: A reperfusão da artéria responsável pelo infarto é a etapa fundamental no tratamento de pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST. A terapia trombolítica ou a intervenção coronariana percutânea são duas opções terapêuticas bem estabelecidas na literatura. Pacientes portadores de IAM sem supradesnivelamento do segmento ST ou angina instável necessitam de estratificação de risco precoce. Pacientes de alto risco devem ser submetidos à estratégia invasiva precoce, que consiste na realização do cateterismo cardíaco nas primeiras 24-48 horas do início dos sintomas.
BACKGROUND AND OBJECTIVES: Acute coronary syndromes result from a disruption of a vulnerable coronary plaque complicated by intraluminal thrombus formation, embolisation, and variable degrees of coronary obstruction. Patients with total occlusion may present with acute ST Elevation Myocardial Infarction (STEMI). Partial vessel obstruction may result in Non-ST-Elevation Acute Myocardial Infarction (NSTEMI) or unstable angina (UA). Clinical symptoms and electrocardiographic changes are the main components of identification of ACS. The rapid and effective triage of such patients regarding presence or absence of ST-segment elevation is critical to dictate further therapeutic strategies. The objective of this chapter was to review current evidence and recommendations for the evaluation and early treatment of acute coronary syndromes. CONTENTS: We performed a clinical review using the electronic databases MedLine and LILACS from January 1990 to September 2007. CONCLUSIONS: Reperfusion of the infarct-related artery is the cornerstone of therapy for STEMI. Fibrinolysis and percutaneous coronary intervention are both well established as effective options. Management of UA/NSTEMI patients requires early risk stratification. High-risk patients should undergo an early invasive strategy that consists in performance of cardiac catheterization in the first 24 to 48 hours of presentation.
Subject(s)
Myocardial Infarction/therapy , Acute Coronary Syndrome/diagnosis , Acute Coronary Syndrome/therapyABSTRACT
AIM:To observe the effects of trimetazi- dine on myocardial ischemia and heart rate variability (HRV)in patients with non ST-elevation acute coronary syndrome(NSTEACS).METHODS:74 patients with NSTEACS were chosen and randomly assigned into two groups:one group was given conventional therapy with as- pirin,isosorbide mononitfate,fluvastatin and metoprolol, trimetazidine was added on the base of conventional thera- py in the other group.The total observation time of thera- py was 8 weeks.The heart rote,blood pressure,frequen- cy and persistence time of chest pain,numbers of times of using Nitroglycerin every day,the extent anti degree of myocardial isehemia,HRV of patients were observed be- fore and after treatment.RESULTS:The therapeutic ef- fect of trimetazidine treatment group(with the effective rate 94.4%,excellence rate 72.2%)was obviously bet- ter than that of the conventional treatment group(with the effective rate 65.8%,excellence rate 36.8%)(P