Clinical Features of Precocious Acute Coronary Syndrome

Davidson, Laura; Wilcox, Jane; Kim, David; Benton, Stewart M.; Fredi, Joseph L.; Vaughan, Douglas E.

doi:10.1016/j.amjmed.2013.09.025

Cited by 29 publications

(20 citation statements)

References 18 publications

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“…Younger patients are highly characterized by having more current smokers and having a higher level of total and LDL cholesterol. This risk profile in younger patients is also documented by other authors [ 22 , 23 ]. Their higher genetic predisposition for coronary artery disease is reflected by a higher incidence of positive family history.…”

Section: Discussionsupporting

confidence: 85%

Outcome after Elective Percutaneous Coronary Intervention Depends on Age in Patients with Stable Coronary Artery Disease – An Analysis of Relative Survival in a Multicenter Cohort and an OCT Substudy

et al. 2016

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BackgroundAge is a strong predictor of survival in patients with coronary artery disease. In elder patients with increasing co-morbidities percutaneous coronary intervention (PCI) is associated with more complications and worse outcome. The calculation of relative survival rates adjusts for the “background” mortality in the general population by correcting for age and gender. We analyzed if elder patients after elective PCI have a worse relative survival compared to younger patient groups.MethodsA total of 8,342 patients who underwent elective PCI at two high volume centers between 1998 and 2009 were analyzed.ResultsThe survival of our patients after PCI (observed survival) was slightly lower compared to the general population (expected survival) resulting in a slightly decreasing relative survival curve. In a multivariate Cox regression model age amongst others was a strong predictor of survival. Stratifying patients according to their age the relative survival curves of younger patients (Quartile 1: <58 years; 2,046 patients), elder patients (Quartile 3: 66–73 years; 2,090 patients) and very old patients (Quartile 4: >73 years; 2,307 patients) were similar. The relative survival of mid-aged patients (Quartile 2: 58–65 years; 1,899 patients) was better than that of all other patient groups. The profile of cardiovascular risk factors differs between the various groups resulting in different composition and burden of coronary plaques in an optical coherence tomography sub-study.ConclusionPatients after elective PCI have a slightly worse long-term survival compared to the age- and sex-matched general population. This is also true for different groups of age except for mid-aged patients between 58 and 63 years. Elder patients between 66 and 73 years and above 73 years have a similar relative survival compared to younger patients below 58 years, and might therefore have similar benefit from elective PCI.

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Section: Discussionsupporting

confidence: 85%

Outcome after Elective Percutaneous Coronary Intervention Depends on Age in Patients with Stable Coronary Artery Disease – An Analysis of Relative Survival in a Multicenter Cohort and an OCT Substudy

et al. 2016

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“…Although hemorrhaging has traditionally been regarded as the most significant hemostatic complication of liver disease, there is increasing recognition that hypercoagulability is a prominent aspect of cirrhosis . Thus, a pathophysiological mechanism apart from traditional plaque rupture may be an underlying cause of acute coronary syndrome in an LT population, possibly via de novo thrombotic occlusion …”

Section: Discussionmentioning

confidence: 99%

“…43,44 Thus, a pathophysiological mechanism apart from traditional plaque rupture may be an underlying cause of acute coronary syndrome in an LT population, possibly via de novo thrombotic occlusion. 45…”

Section: Performance Of the Current Risk Model In The Context Of Exismentioning

confidence: 99%

High early cardiovascular mortality after liver transplantation

et al. 2014

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Cardiovascular disease (CVD) contributes to excess long-term mortality after liver transplantation (LT), however little is known about early post-operative CVD mortality in the current era. In addition, there is no model to predict early post-operative CVD mortality across centers. We analyzed adult recipients of primary LT in the Organ Procurement and Transplantation Network (OPTN) database between February 2002 and December 2012 to assess prevalence and predictors of early (30-day) CVD mortality, defined as death from arrhythmia, heart failure, myocardial infarction, cardiac arrest, thromboembolism, and/or stroke. We performed logistic regression with stepwise selection to develop a predictive model of early CVD mortality. Sex and center volume were forced into the final model, which was validated using bootstrapping techniques. Among 54,697 LT recipients, there were 1576 (2.9%) deaths within 30 days. CVD death was the leading cause of 30-day mortality (42.1%), followed by infection (27.9%) and graft failure (12.2%). In multivariate analysis, 9 (6 recipient, 2 donor, 1 operative) significant covariates were identified: age, pre-operative hospitalization, ICU and ventilator status, calculated MELD score, portal vein thrombosis, national organ sharing, donor BMI and cold ischemia time. The model showed moderate discrimination (c-statistic 0.66, 95% CI: 0.63–0.68). We provide the first multicenter prognostic model for the prediction of early post-LT CVD death, the most common cause of early post-LT mortality in the current transplant era. However, evaluation of additional CVD-related variables not collected by the OPTN are needed in order to improve model accuracy and potential clinical utility.

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“…Although the exact mechanism behind the relationship between age and jump-up progression remains unclear, a previous angiographic study demonstrated that patients with progression were younger than those without [11]. In addition, a recent study demonstrated the presence of thrombus in the absence of underlying coronary disease in young patients with acute coronary syndrome [12]. Moreover, statin tended to be less frequently used in patients with the jump-up phenomenon.…”

Section: "Jump-up" Phenomenonmentioning

confidence: 96%