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Concomitant occurrence of coronary arterial disease (CAD) with abdominal aortic aneurysm (AAA) is not rare. Combined performance of open surgery (OS) of AAA repair and coronary arterial bypass grafting (CABG) has been reported to be effective as the way to avoid the risk of rupture of the aneurysm and acute coronary syndrome (ACS), while it's highly invasive. We successfully performed a combination performance of endovascular aneurysm repair (EVAR) and off-pump CABG (OPCAB) with the support of an intra-aortic balloon pump (IABP) in 2 cases with AAA and unstable angina pectoris (UAP). It was suggested that this strategy is a reasonable clinical option for the patient with UAP complicated with large AAA.
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Background:ISCHEMIC HEART DISEASES continues to be a major public health problem becoming an increasingly important problem in developing countries constitutes around 12.8% of total deaths (7.2 million).Objectives:To evaluate the clinical course of ACS patient’s admitted to KIMS HUBLI ICCU. Material & Methods:Patients admitting to ICCU KIMS, HUBLI diagnosed as Acute Coronary Syndrome.The study included 156 patients admitted to ICCU KIMS Hubli who diagnosed as ACUTE CORONORY SYNDROME. Results:There wassignificant difference in the platelet indices betweenthe three groups. The platelet Indices -mean platelet volume, platelet distribution width and platicrit were significantly higher in STEMI and NSTEMI groups when compared to the USA group and severity of CAD more in patients who were having higher platelet indices. Conclusion:The platelet indices: mean platelet volume (MPV), platelet distribution width (PDW) and platecrit are significantly higher in STEMI and NSTEMI groups when compared to USA group.
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Aim:The aim of our study was to estimate the level of HbA1c in patients with Acute Coronary Syndrome (ACS). To determine any correlation between HbA1c, admission blood glucose (Random blood sugar), serum lipid profile among the cases and to evaluate the outcome during hospitalization. Study Design and Setting:Cohort study.Place and Duration of the Study:Department of Biochemistry and General Medicine including ICCU and Cardiology unit, RIMS, Imphal, between September 2015 to August 2017.Methodology:Data were collected from 98 patients admitted in Medicine ward who were diagnosed with ACS irrespective of their diabetes status and they were divided into three groups according to their HbA1c levels (<5.7%, 5.7-6.4%, > 6.5%). The blood samples collected by venipuncture were analyzed for HbA1c level, done by RANDOX HbA1c Rx series (latex agglutination inhibition assay), admission blood glucose (measured by Trinder’s method) and serum lipid profile (RANDOX enzymatic Endpoint Method Rx series). The data were analyzed using statistical tools like Chi Square test, Independent sample t test, Pearson’s Correlation, Fisher’s exact test through SPSS 21.0.Results:Majority of the patients were men (72.4%) & (27.6%) women and in the age group of 51-65 years. The mean ageis 62.14 years. 54.1% of the ACS patients were already diagnosed cases of type 2 diabetes mellitus whereas 45.9% were non-diabetic. Out of 98 patients, 60 had HbA1c level in the diabetic range (≥6.5%), 25 in the pre-diabetic range (5.7-6.4%) and the remaining 13 were within normal range (<5.7%). Admission blood glucose, total cholesterol and LDL were positively correlated with HbA1c value. Conclusion:The mortality of the ACS patients irrespective of diabetic status during hospitalization was associated with HbA1c value irrespective of diabetic status during hospitalization. However, it was not associated with thirty days mortality
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Back Ground: Diabetes is not only predisposing factor forcardiovascular disease but once diabetes patients developcoronary artery disease, they have significant worse outcomescompared to other non-diabetic patients.Methods: We studied 80 patients who were admitted for acutecoronary syndrome (ACS), they were classified according tohistory of diabetes mellitus (DM) into 2 groups, Non diabeticgroup 40 patients and Diabetic group 40 patients and then thetwo groups were classified further into sub groups according toelevated markers indicating myocardial injury. Then werefollowed up for 3 months as regard morbidity and mortality.Results: Diabetic patients had significantly higher frequenciesof previous myocardial infarctions, left ventricle (LV)dysfunction, in hospital complications, and rehospitalisation foracute coronary syndrome (ACS) up to death, in comparison tonon-Diabetic patients.Conclusion: From this study, it can be concluded thatelevated biomarkers of myocardial necrosis have adverseeffects on patients either diabetic or non-diabetic on shortterm follow up. Diabetic patients with acute coronary syndrome(ACS) without elevated biomarkers have a mortality andmorbidity risk similar to patients who are not diabetic but haveelevated biomarkers on presentation with acute coronarysyndrome (ACS), and that diabetic patients with elevatedbiomarkers are at highest mortality and morbidity risk.
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OBJECTIVE: To investigate the effects of atorvastatin, rosuvastatin, and pravastatin on antiplatelet activity of clopidogrel in patients with acute coronary syndrome(ACS) and different CYP2C19 genotypes. METHODS: Between November 2017 and November 2018, a total of 300 patients admitted for ACS were enrolled in this study and randomly assigned to three groups. All patients received standard dual antiplatelet therapy. A, B, and C groups received atorvastatin calcium 20 mg•d-1, rosuvastatin calcium 20 mg•d-1, and pravastatin sodium 20 mg•d-1, respectively. The CYP2C19 genotype was detected by pyrosequencing. Thromboelastogram(TEG) was applied to detect the ADP-induced platelet inhibition rate 7 days after treatment. RESULTS: No significant difference was observed in baseline clinical characteristics between three groups. It was also no statistically significant difference in ADP inhibition rate and proportion of clopidogrel resistance between three groups(P>0.05). However, compared with rosuvastatin group and pravastatin group, the ADP inhibition rate was significantly reduced in atorvastatin group in poor metabolizers of CYP2C19. CONCLUSION: In intermediate metabolizers and extensive metabolizers of CYP2C19, there is no significant difference in the effects of atorvastatin, rosuvastatin, and pravastatin on antiplatelet activity of clopidogrel. Compared with rosuvastatin and pravastatin, atorvastatin significantly attenuates the antiplatelet function of clopidogrel in poor metabolizers of CYP2C19.
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Background: Ventricular Tachycardia (VT) constitutes an important manifestation of coronary artery disease (CAD). VT can occur in the immediate acute myocardial infarction (MI) period, further complicating the management. VT also occurs after long duration of acute coronary syndrome (ACS) in the healed MI. Aim: The aim of our study was to evaluate the epidemiology, clinical presentation, hemodynamic status, treatment received and finally the outcome of CAD patients manifesting as sustained VT. Materials and methods: This prospective study was conducted at Sher I Kashmir Institute of Medical Sciences (SKIMS), a tertiary care center in Srinagar, Jammu and Kashmir, India, between August 2013 to May 2016. All the cases of definite sustained VT already admitted in the hospital or Rahul Sudan, Mehroz Ahmed, Khursheed Aslam, Irfan Yaqoob, Gunjan Gupta, Shantanu Aggarwal. Sustained ventricular tachycardia (VT) in coronary artery disease (CAD): A study from tertiary care center in north India. IAIM, 2018; 5(2): 160- 167. Page 161 presenting in the emergency department including those who developed VT during the course of acute MI were evaluated. Results: In our study, a total of 35 patients of CAD manifesting as sustained VT were observed. Majority of these patients were males. The most common presenting symptom was chest pain seen in a total of 14 patients. A total of 23 patients (66%) were hemodynamically stable at the time of VT. A decreased Left Ventricular Ejection Fraction (LVEF <50%) was seen in 18 patients (51%). Monomorphic VT was seen in a total of 28 patients (80%) and the rest of 7 patients showed polymorphic VT. Mortality was seen in 8 patients (23%). Conclusion: Polymorphic pattern of sustained VT, hemodynamic instability at the time of VT and a decreased LVEF are associated with increased mortality in patients of CAD manifesting as VT.
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Background: We evaluated Correlation of Serum Uric Acid level in patients with acute coronary syndromes with severity and extent of coronary disease Materials and methods: Fifty-one patients with acute coronary syndromes between 25-60 years were included into the study. Patients with chronic kidney disease, gout, hematological malignancy, hypothyroidism, chronic alcoholism, receiving diuretic therapy, more than 2 grams per day of salicylate therapy, ethambutol, pyrazinamide, were excluded. Data regarding history, ECG, cardiac enzymes, serum uric acid, and angiographic details were recorded. Results: The mean age of the study population was in 55.68± 5.83 years. The age, gender BMI, and co morbidities such as smoking, obesity, diabetes, hypertension and family history were not statistically significant across types of ACS, such as CSA, USA and MI. We noticed that uric acid levels were not significantly (P>0.05) across types of ACS. We also found significant correlations between uric acid levels at admission with age, hypertension and family history. However, there was no significant correlation of uric acid with the type of a number of vessels involved and Killip classification. Conclusion: In the current study, serum UA level in patients with acute coronary syndromes is not associated with Killip class and extent of coronary vessels involved.
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Objective To discuss the clinical value of using three markers including ischemia modified albu-min (IMA),N terminal brain natriuretic peptide precursor (NT -proBNP)and allergic troponin I (TnI -Ultra)in diagnosis of acute coronary syndromes (ACS).Methods 80 ACS patients diagnosed by coronary artery imaging were selected,and meanwhile 80 healthy people were chosen as the control group.The serum IMA,NT -proBNP and TnI -Ultra were recorded and compared.The changes of IMA,NT -proBNP and TnI -Ultra in all ACS patients the chest pain onset time,chest pain <3h within and between 3 -6h serum were recorded and compared;And sensitivity,specif-ic and accuracy diagnosis in ACS of the three separate tests and joint detection were compared.Results In ACS patients,serum IMA,NT -proBNP and TnI -Ultra were all significantly higher than those in the control group (t =14.62,25.08,35.77,all P <0.05).In UA,NSTEMI,STEMI patients,serum IMA,NT -proBNP and TnI -Ultra all had statistically significant differences (F =10.89,29.08,40.33,all P <0.05);And in NSTEMI,STEMI patients, serum NT -proBNP and TnI -Ultra were significantly higher than those in patients with UA (all P <0.05 );In STEMII patients,serum NT -proBNP and TnI -Ultra were significantly higher than those in the NSTEMI patients (all P <0.05).In patients chest pain less than 3h,chest pain patients'serum IMA,3 -6h NT -proBNP and TnI -Ultra were significantly higher than those in the control group (all P <0.05);In chest pain less than 3 -6h patients,serum IMA,NT -proBNP and TnI -Ultra were significantly higher than those in chest pain less than 3h patients (all P <0.05).The positive detection rate of IMA,NT -proBNP and TnI -Ultra joint detection was 95.0% (76 /80),which was significantly higher than that of the single detection (P <0.05 ).Conclusion IMA,NT -proBNP and CTnI combined detection could significantly improve the sensitivity and accuracy of the early diagnosis of ACS,which testing cycle is short and easy to operate,worthy of clinical promotion.
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Magnesium is an important intracellular cation [1], actually the second most abundant cation after Potassium, which has gained an essential role in normal human homeostasis. Low serum magnesium has been detected commonly in around 12% hospitalized patients and even more commonly in Intensive Care Patients as high as 60 to 65%. The link of low serum magnesium with acute coronary syndrome is being discussed widely and its actual role is being scrutinized [2,3]. Recently, Hypomagnesaemia has also been found to play an important role in the pathogenesis of a variety of clinical disorders including Hypertension, Diabetes Mellitus, Atherosclerosis and Acute Coronary Syndromes [4-8]. Acute coronary syndrome (ACS) has been defined as a group of conditions due to decreased blood flow in the coronary arteries. Acute coronary syndrome includes a vast spectrum like: ST elevation myocardial infarction (STEMI / 30%), non ST elevation myocardial infarction (NSTEMI / 25%), or unstable angina (U.A. / 38%).These are described according to ECGs and Cardiac Biomarkers of myocardial necrosis (troponin T, troponin I, and CK MB), in patients presenting with acute cardiac chest pain (Medscape). Aim: To look for any association between Hypomagnesaemia and Acute Coronary Syndrome. Materials and Methods: It’s a retrospective study involving 1198 patients who presented to the Accident and Emergency department (A & E), Trauma Center, Rashid Hospital, Dubai, with Acute Coronary Syndrome (ACS) between April 2010 and May 2013. We reviewed the records of all patients including their clinical history and presentation. The Magnesium levels of all the patients in the ACS pathway were checked along with, Cardiac biomarkers - Troponin, CPK and CK MB and Lipid profiles were also analyzed. A Chi-Square test was performed at 5% level of significance to test the null hypothesis of no association between cardiac markers, lipid profile and magnesium level. Inclusion Criteria: All new patients presenting to A & E Department at Rashid Hospital with an acute coronary syndrome (both NSTEMI & STEMI). All new patients presenting with non-specific chest pain who test positive for cardiac markers. All the age groups presenting to A & E Department at Rashid Hospital from 11/04/2010- 30/05/2013 were included. Both the genders were included. Exclusion Criteria: Patients diagnosed initially with acute coronary syndrome that eventually had negative cardiac markers. Results: Out of 1198, 1087(91%) patients were male. 49% were between 50 and 75 years of age group whereas 46% were between 25 years and 50 years of age. 77% patients were Asians and 17% belonged to Arabic peninsula. The Magnesium level was normal in 1097(92%), low in 63(5.3%). Troponin was negative in 431(36%) and positive in 767(64%) patients with low, medium and high levels in 338(28.2%), 426(35.5%) and 03(0.3%) respectively. These results indicate that there is no statistically significant association between Magnesium levels and Troponin groups (positive and negative) (chi-square with two degree of freedom = 3.30, p = 0.192). Conclusion: Our study proves that there is no significant association between Hypomagnesaemia and Acute Coronary Syndrome.
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Objective To investigate the value of detecting HEART score and HEARTS3 score in risk stratification and prognosis of acute coronary syndrome (ACS) in patients with non-ST segment elevation chest pain in emergency department (ED).Methods Clinical data of case-control retrospective study of 775 patients with non-ST segment elevation chest pain in ED were collected from July 2011 to March 2015.The patients were estimated and risk stratification was made with HEART score and HEARTS3 score.After follow-up visiting by telephone for 30 days,outcomes were found to be ACS and myocardial infarction (MI).And the patients were categorized with score into low,intermediate and high risk groups.The correlation between the ACS and risk score in three groups was analyzed.Comparison of capability of performance in predicting 30-day ACS between the HEART score and HEARTS3 risk score.Statistical analyses were performed using SPSS13.0.Enumeration variables were expressed as percentage.For comparison of predictive value of the two sets of scores,area under the receiver operating curve (auROC) was calculated and compared by Z test.Results There were 92 cases with 30-day ACS.The rate of ACS had a trend of increase with increase in HEART score and HEARTS3 score.The patients with higher scores of HEART and HEARTS3,higher incidence of ACS in 30 days.Especially,the high-risk patients with score≥7 of HEART score and≥8 of HEARTS3 score had higher rate of ACS.And there was significant difference in predicting high-risk patients between two sets of scoring (P ＜ 0.05).The HEARTS3 score outperformed the HEART score as determined by comparison of areas under the ROC curve for MI (0.952 vs 0.813;P =0.028),30-day ACS (0.913 vs.0.815;P =0.034).Conclusions HEART score and HEARTS3 score both can be used to evaluate and perform risk stratification for non-ST segment elevation chest pain patients in ED.But HEARTS3 score can more precisely stratify high-risk patients with chest pain for 30-day ACS.
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Background and Objective : Acute coronary syndrome (ACS) is characterized by classical history of ischaemic chest pain, apprehension and sweating with definite Electro-Cardio gram (ECG) evidence or cardiac marker of ischaemia. The risk factors for Coronary Artery Disease (CAD) are modifiable and non-modifiable. CAD is a major cause of disability and the leading cause of death in women. The objective of our study was to assess the impact of various risk factors in women presented with ACS. Method: A total of 100 female patients of ACS and twenty healthy females were taken as control. The mean age of women presented with ACS was 62.62 years and all have attained menopause. Result: The prevalence of major risk factors of ACS in women are hypertension (78%), stress (74%), obesity (46%), sedentary habits (38%), genetic predisposition (36%), diabetes (32%) and tobacco use (18%),higher socio-economic status (74%). Significantly (P <0.05) high levels of total cholesterol, triglycerides along with reduced High Density Lipid (HDL). Conclusion: The prevalence of C - reactive protein (CRP) Positivity (>6 mg/L) is significant in women with (92%) as compared to healthy women (20%).
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Background: This study compared clinical outcome of Drug Eluting Stents (DES) versus Bare Metal Stents (BMS) in coronary arteries in patients with Acute Coronary Syndromes. Methods: A retrospective, observational study was carried out in an inpatient setting of the private tertiary care hospital. Patients with >18 years, diagnosed for Acute Coronary Syndromes (ACS), required intervention in coronary artery with implantation of Drug Eluting Stents (DES) or Bare Metal Stents (BMS) were recruited in the study. The data had been collected from file or database of the hospital. All subjects were followed for major adverse cardiac event. Results: A total of 202 patients who underwent percutaneous coronary intervention (PCI) were enrolled into DES group (n=101) and BMS group (n=101). All patients were followed up at 1 month, 3 months, 6 months & 12 months for Major Adverse Cardiac Events (MACE). Clinical outcomes during 12 months were compared between DES group & BMS group. Overall MACE rates were reported non-significantly high in BMS group patients (14.85%) compare to DES group patients (8.91%) (p=0.458). However, DES group had lower rates of death (0.99% vs 1.98%, p=0.57), rate of MI (3.96% vs 4.95% p=0.73), rate of revascularization (1.98% vs 3.96% p=0.42) & rate of sub acute thrombosis (1.98% vs 3.96% p=0.42) and higher rate of bleeding (1.98% vs 0.99% p=0.57) compare to cohort-II. Conclusions: The use of DES in the setting of Acute Coronary Syndrome is associated with lower Major Adverse Cardiac Event (MACE) rate compared to BMS without compromising the overall safety over the course of one-year follow-up. The long-term safety of drug-eluting stents needs to be ascertained in large, randomized trials.
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La angina inestable aguda y el infarto miocárdico sin elevación del segmento ST son dos grandes afecciones del síndrome coronario agudo. Su frecuencia se incrementa con los novedosos y rápidos procedimientos terapéuticos que mejoran la supervivencia del paciente coronario. La presente investigación expone las clasificaciones más actuales, la fisiopatología, las causas y sus mecanismos patogénicos, los hallazgos según la coronariografía y las categorías de riesgo según los elementos clínicos, enzimáticos y electrocardiográficos cuyos marcadores contribuyen al diagnóstico y al pronóstico de ambas dolencias. Se valoran los diagnósticos diferenciales, la conducta médica y el arsenal terapéutico disponible en los distintos estadios de la angina inestable aguda, del infarto, de la angina refractaria y de Prinzmetal. Finalmente se presenta un algoritmo que resume el tratamiento en el síndrome coronario agudo sin elevación del segmento ST
The acute unstable angina and the myocardial infarction without ST segment rise are two major affections of acute coronary syndrome. Its frequency is increases with the novel and fast therapeutical procedures improving the coronary patient survival. Present research shows the more current classifications, the pathophysiology, the causes and its pathogenic mechanisms, the findings according the coronarygraphy and the risk categories according to the clinical, enzymatic and electrocardiographic elements whose markers contributing to diagnosis and prognosis of both diseases. The differential diagnoses, the medical behavior and the therapeutical armamentarium available in the different stages of the acute unstable angina, of infarction, of refractory angina and or the Prinzmetal. Finally, an algorithm summarizing the treatment of the acute coronary syndrome without ST segment rise is presented
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Humans , Angina, Unstable/diagnosis , Angina, Unstable/drug therapy , Electrocardiography/methods , Myocardial Infarction/diagnosis , Myocardial Infarction/drug therapy , Risk FactorsABSTRACT
@#ObjectiveTo explore the changes of serum high sensitive C-reaction protein (HS-CRP) and matrix metalloproteinase-9 (MMP-9) in patients with acute coronary syndrome (ACS) and their effects in nursing.Methods103 ACS patients, including 56 cases of unstable angina (UA)) and 47 cases of acute myocardial infarction (AMI), and other 40 persons (no abnormal results in coronary artery angiography, selected as control group) were examined for serum levels of HS-CRP and MMP-9. The difference among the groups was analyzed.ResultsThe HS-CRP levels of UA group, AMI group and control group were (3.87± 0.76 )g/L, (4.12 ±0.67)g/L and (1.67±0.38)g/L respectively; MMP-9 were (113.25±7.76)ng/ml, (193.09±25.87)ng/ml and (42.05±3.81)ng/ml respectively. The concentrations of HS-CRP and MMP-9 of ACS patients were significatly higher than those of the control group (P<0.01).ConclusionThe changes of HS-CRP and MMP-9 concentrations of ACS patients are remarkable, and may be as the markers to instruct nursing works.
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Objective:To evaluate the efficiency and safety of fraxiparin in the treatment of patients with ACS. Method:137 patients with acute coronary syndrome(ACS)were randomly assigned to fraxiparin treatment and enoxaparin treatment for 7 days.Result:129 cases completed the whole trial and the results were obtained from ITT.The heart death rate was not statistically different between the two groups during the treatment.No Q segment acute myocardial infarction occurred.Both drugs statistically decreased CK CKMB and TnT.There was no significant difference between the two groups regarding these changes.Only two minor adverse reactions occurred and became normal soon after nadroparin withdrew. Conclusion:Fraxiparin and enoxaparin had similar efficiency and safety in the treatment of patients with ACS.
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Objective To investigate the short and longterm effect of the treatment on acute coronary syndrome(ACS) with percutaneous coronary angioplasty and stenting.Methods 65 patients suffering from ACS were treated with angiography to illuminate the features of lesions and proceeded with percutaneous coronary angioplasty and stenting when the angina was not completed controlled with internal medicine.All patients were treated with a new anti-thrombotic regimen,including aspirin,ticlopidine or clopidogrel, and low-molecular-weight heparin.Results The rates of success for patients and lesions were 96.9% and 82.7% respectively.One patient died without myocardial infarction or emergency bypass surgery.56 patients had no symptom of angina after procedure,and 5 patients had non-typical chest pain which disappeared within 2~3 days.During the 3~54 month follow-up,one patient died,one patient developed myocardial infarction and 4 patients underwent target vessel revascularization(repeated angioplasty 2 and bypass surgery 2).Conclusions With the widespread use of aspirin-ticlopidine-low molecular heparin regimen,ACS patients can undergo PTCA and stenting with high success rate,excellent immediate efficacy and long-term efficacy.