Acute Coronary Syndrome Publications (24545)

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Acute Coronary Syndrome Publications

2016Dec
Dtsch Arztebl Int
Dtsch Arztebl Int 2016 Dec;113(49):834-845
Department of Cardiology and Angiology, Hannover Medical School; Institute for General Practice, Hannover Medical School; Department of Respiratory Medicine, Hannover Medical School.
2017Jan

To estimate real-world cardiovascular disease (CVD) burden and value-based price range of evolocumab for a US-context, high-risk, secondary-prevention population.
Burden of CVD was assessed using the UK-based Clinical Practice Research Datalink (CPRD) in order to capture complete CV burden including CV mortality. Patients on standard of care (SOC; high-intensity statins) in CPRD were selected based on eligibility criteria of FOURIER, a phase 3 CV outcomes trial of evolocumab, and categorized into 4 cohorts: high-risk prevalent atherosclerotic CVD (ASCVD) cohort (N = 1448), acute coronary syndrome (ACS) (N = 602), ischemic stroke (IS) (N = 151), and heart failure (HF) (N = 291) incident cohorts. Read More

The value-based price range for evolocumab was assessed using a previously published economic model. The model incorporated CPRD CV event rates and considers CV event reduction rate ratios per 1 mmol/L reduction in low-density lipoprotein-cholesterol (LDL-C) from a meta-analysis of statin trials by the Cholesterol Treatment Trialists Collaboration (CTTC), ie, CTTC relationship.
Multiple-event rates of composite CV events (ACS, IS, or coronary revascularization) per 100 patient-years were 12.3 for the high-risk ASCVD cohort, and 25.7, 13.3, and 23.3, respectively, for incident ACS, IS, and HF cohorts. Approximately one-half (42%) of the high risk ASCVD patients with a new CV event during follow-up had a subsequent CV event (ie, ≥ 2 total CV events after the index event). Combining these real-world event rates and the CTTC relationship in the economic model, the value-based price range (credible interval) under a willingness-to-pay threshold of $150,000/quality-adjusted life-year gained for evolocumab was $11,990 ($9341-$14,833) to $16,856 ($12,903-$20,678) in patients with baseline LDL-C levels ≥70 mg/dL or ≥100 mg/dL.
Real-world CVD burden is substantial. Using the observed CVD burden in CPRD and the CTTC relationship, the cost-effectiveness analysis showed that, accounting for uncertainties, the expected value-based price for evolocumab is higher than its current annual cost as long as the payer discount off list price is greater than 20%.

2017Jan

Prasugrel is a third-generation thienopyridine that achieves potent platelet inhibition with less pharmacological variability than other thienopyridines. However, clinical experience suggests that prasugrel may be associated with a higher risk of de novo and recurrent bleeding events compared with clopidogrel in Japanese patients undergoing percutaneous coronary intervention (PCI). In this review, we evaluate the risk of bleeding in Japanese patients treated with prasugrel at the doses (loading/maintenance doses: 20/3. Read More

75 mg) adjusted for Japanese patients, evaluate the risk factors for bleeding in Japanese patients, and examine whether patients with a bleeding event are at increased risk of recurrent bleeding. This review covers published data and new analyses of the PRASFIT (PRASugrel compared with clopidogrel For Japanese patIenTs) trials of patients undergoing PCI for acute coronary syndrome or elective reasons. The bleeding risk with prasugrel was similar to that observed with the standard dose of clopidogrel (300/75 mg), including when bleeding events were re-classified using the Bleeding Academic Research Consortium criteria. The pharmacodynamics of prasugrel was not associated with the risk of bleeding events. The main risk factors for bleeding events were female sex, low body weight, advanced age, and presence of diabetes mellitus. Use of a radial puncture site was associated with a lower risk of bleeding during PCI than a femoral puncture site. Finally, the frequency and severity of recurrent bleeding events during continued treatment were similar between prasugrel and clopidogrel. In summary, this review provides important insights into the risk and types of bleeding events in prasugrel-treated patients.Trial registration numbers: JapicCTI-101339 and JapicCTI-111550.

2016Aug
Aorta (Stamford)
Aorta (Stamford) 2016 Aug 1;4(4):138-141. Epub 2016 Aug 1.
General and Specialist Surgery Department, Cardiac Surgery Unit, Parma General Hospital, Parma, Italy.

Acute coronary thrombosis after emergent surgery for acute Type A aortic dissection is a rare event that can remain undiagnosed in absence of typical electrocardiogram readings. We report a case of left anterior descending artery thrombosis without ST-segment elevation three days after surgical repair, which was successfully treated with angioplasty and stenting. Read More

2016Dec
Kardiochir Torakochirurgia Pol
Kardiochir Torakochirurgia Pol 2016 Dec 30;13(4):386-392. Epub 2016 Dec 30.
Chair and Clinic of Anesthesiology and Intensive Therapy, Medical University of Silesia, Katowice, Poland; Department of Cardiac Anesthesia and Intensive Care, Silesian Centre for Heart Diseases, Zabrze, Poland.

Health education is a component of complex cardiac rehabilitation (CCR).
To evaluate the influence of an authorial extended educational program on the knowledge of cardiovascular risk factors among subjects undergoing early in-hospital rehabilitation following acute coronary syndrome treated with percutaneous intervention.
This prospective study covered 205 consecutive subjects (153 men and 52 women, aged 62 ±9 years) undergoing CCR. Read More

They were randomly allocated to the control group (105 patients receiving standard education during CCR) or the study group (100 patients participating in the extended education program). The extended education program was conducted in the 2(nd) and 3(rd) week of CCR and included a package of educational materials and additional lectures.
Knowledge of basic rules for secondary cardiac prevention was better in the study group, both on admission and after CCR. Notwithstanding, a positive influence of the extended educational program was found with regard to awareness of recommended blood pressure levels and blood lipid profile (improvement of 15-20% in the study group). At baseline, the knowledge of risk factors was comparable between the groups (the percentage of correct questionnaire answers was 50 ±17% among the controls vs. 49 ±16% in the study group; p = 0.77), but improved significantly after education (52 ±17% among controls vs. 58 ±19% in the study group; p = 0.009) and remained better in the study group after a 3-month follow-up (56 ±19% among controls vs. 64 ±19% in the study group).
Extended education during CCR significantly improves the knowledge of cardiovascular risk factors in patients after acute coronary syndrome.

2017Jan
Circ Cardiovasc Qual Outcomes
Circ Cardiovasc Qual Outcomes 2017 Jan;10(1)
From the Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL.
2017Jan
Curr Cardiol Rev
Curr Cardiol Rev 2017 Jan 16. Epub 2017 Jan 16.
University Hospital Aintree NHS Foundation Trust, Liverpool, United Kingdom.

Heart type fatty acid protein(HFABP) is a cytosolic protein released early after acute coronary syndrome(ACS) even in the absence of myocardial necrosis.
The purpose of this systematic review was to determine whether HFABP levels in patients with suspected, or confirmed ACS, improves risk stratification when added to established means of risk assessment.
We searched Medline, Pubmed and Embase databases from inception to July 2015 to identify prospective studies with suspected or confirmed ACS, who had HFABP measured during the index admission with at least 1 month follow up data. Read More

A prognostic event was defined as all-cause mortality or acute myocardial infarction(AMI).
7 trials providing data on 6935 patients fulfilled inclusion criteria. There were considerable differences between studies and this was manifest in variation in prognostic impact of elevated HFABP(Odds ratio range 1.2-15.2 for death). All studies demonstrated that HFABP provide unadjusted prognostic information and in only one study was this negated after adjusting for covariates. A combination of both negative troponin and normal HFABP conferred a very low event rate. No study evaluated the incremental value of HFABP beyond that of standard risk scores.Only one study used a high sensitive troponin assay.
There was marked heterogeneity in prognostic impact of HFABP in ACS between studies reflecting differences in sampling times and population risk. Prospective studies of suspected ACS with early sampling of HFABP in the era of high sensitivity troponin are necessary to determine the clinical value of HFABP. HFABP should not currently be used clinically as a prognostic marker in patients with suspected ACS.

2017Jan
Hemodial Int
Hemodial Int 2017 Jan 17. Epub 2017 Jan 17.
Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD.

Coronary Artery Disease (CAD) is a large contributor to morbidity and mortality in the chronic kidney disease (CKD) and end-stage renal disease (ESRD) population. Due to the fact that many large-scale trials evaluating management for acute coronary syndromes (ACS) and CAD have excluded patients with CKD, there is a paucity of data investigating medical management of CAD and revascularization strategies of these patients. Further, while there have been many advances in the treatment for ACS and CAD, both medically and technologically, few studies have focused on the CKD population and many predate these advancements in management. Read More

Newer studies that include CKD patients have shown heterogeneity in various outcomes, making management decisions challenging. In this review, we summarize the epidemiologic significance of ACS and CAD in patients with CKD, discuss the diagnosis of ACS in this patient population, and review the therapeutic interventions in patients with CKD.

2017Jan
Immunol. Res.
Immunol Res 2017 Jan 17. Epub 2017 Jan 17.
Department of Medicine 'B', Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel, Sackler Faculty of Medicine, Tel-Aviv University, 52621, Tel-Hashomer, Israel.
2017Jan
Hellenic J Cardiol
Hellenic J Cardiol 2017 Jan 13. Epub 2017 Jan 13.
Department of Cardiology, Pudong New Area People's Hospital, ShangHai 201200, PR China. Electronic address:

To investigate the therapeutic effect of allopurinol treatment on acute coronary syndrome and to elucidate its possible mechanism.
Patients with acute coronary syndrome (n=100) were recruited as research subjects in our hospital. The patients were randomly divided into two groups (allopurinol group, n = 50) and control group, n= 50). Read More

These two groups were treated with conventional antiplatelet, anticoagulation and anti-ischemic therapy, while allopurinol was added to allopurinol group based on conventional treatment. The biochemical indexes such as serum creatinine, uric acid, BNP, blood glucose and blood lipid were compared between the two groups. Indicators of oxidative stress and inflammatory response (MDA, OX-LDL, NO, hs-CRP and TNF-α) as well as cardiovascular events during 2-years follow-up were recorded.
On admission, there is no difference in serum creatinine, uric acid, BNP, blood glucose and lipid levels between the two groups (P > 0.05), and after 1 month of treatment, these levels are better in patients in the allopurinol group than the control group (P < 0.05). After treatment on day 14, 1 month, 3 months, 6 months, 1 year and 2 years follow-up, MDA, OX-LDL and hs-CRP, TNF-α in both groups have decreased, however data from the allopurinol group are significantly lower than the control group (P < 0.05). Additionally, compared with control group, allopurinol treatment significantly elevated the level of NO (P < 0.05). The total effective rates of allopurinol group are much higher than the control group both in angina pectoris (93.2% and 76% respectively) and ECG (96% and 82% respectively). Patients in allopurinol group (n=40) and control group (n=41) received stent implantation and there is no statistical difference between them. The incidence of cardiovascular events during 2-years follow-up in allopurinol group is 10% while it is 30% in the control group.
Allopurinol has remarkable effect in the treatment of ACS and can improve the Oxidative Stress and inflammatory reaction indicators of patients. The protective mechanism of allopurinol might be achieved by suppressing the secretion and release of inflammatory mediators TNF-α, hs-CRP and OX-LDL, MDA and increasing level of NO.