Non-ST elevation acute coronary syndrome in women and the elderly: recent updates and stones still left unturned

Background In most acute coronary artery (ACS) related literature, the female gender constitutes a smaller proportion. This study is based on gender-specific data in the Saudi Acute Myocardial Infarction Registry Program (STARS-1 Program). A prospective multicenter study, conducted with patients diagnosed with ACS in 50 participating hospitals. Results In total, 762 (34.12%) patients were diagnosed with non-ST segment elevation myocardial infarction. Of this group, only 164 (21.52%) were women. The mean age (64.52 ± 12.56 years) was older and the mean body mass index (BMI) was higher (30.58 ± 6.23). A significantly proportion was diabetic or hypertensive; however, a smaller proportion was smoking. Hyperlipidemia was present in 48%. The history of angina/MI/stroke and revascularization was similar, except for renal impairment. The presentation was atypical as only 70% presented with chest pain, and the rest with shortness of breath or epigastric pain. At presentation, the female group were more tachycardiac, had higher blood pressure, and a higher incidence of being in class 11-111 Killip heart failure. Only 32% had a normal systolic function, and the majority had either mild or moderate systolic dysfunction. In particular, the rate of percutaneous coronary intervention was similar. The in-hospital mortality was similar (5%), with more women diagnosed with atrial fibrillation and heart failure at follow-up. Conclusions Women had a higher prevalence of risk factors affecting the presentation and morbidity but not mortality. Improving these risk factors and the lifestyle is a priority to improve the outcome and decrease morbidity.

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“…Although the findings are rising alarms, the effort did not match the challenge [5]. The issue is global, extending from east to west [6][7][8].…”

Section: Discussionmentioning

confidence: 99%

Gender differences in patients presenting with non-ST segment elevation myocardial infarction in the STAR registry

Kinsara

Ismail

2021

Egypt Heart J

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“…The possible mechanism of prolonged duration of TnI elevation is that in elderly NSTE-AMI patients, the degree of coronary artery disease is more severe, and such patients have more multivessel disease, calcification disease, and chronic vascular occlusion disease, 15 and the collateral circulation between the diseased vessels is complicated. After the acute occlusion of one vessel, the myocardial cells in the corresponding blood supply range are necrotic, and the level of TnI in the blood increases.…”

Section: Discussionmentioning

confidence: 99%

The Impact of the Duration of Cardiac Troponin I Elevation on the Clinical Prognosis as Well as Incidence of New-Onset Atrial Fibrillation Respectively in Elderly Non-ST-Elevation Acute Myocardial Infarction Patients without PCI

Wang¹,

Wang²,

Yao³

et al. 2021

JIR

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Objective This study aimed to investigate the impact of the duration of cardiac troponin I (TnI) elevation on the prognosis and incidence of new-onset atrial fibrillation (NOAF) in elderly patients with non-ST-elevation acute myocardial infarction (NSTE-AMI). Methods A total of 383 NSTE-AMI patients ≥75 years old were enrolled in this study and divided into two groups: in 194 cases, the duration of TnI elevation was ≥14 days (group 1), and in 189 cases, the duration of TnI elevation was <14 days (group 2). The patients were followed up for 60 months. The effect of TnI on prognosis was studied by cohort. The primary endpoint was a composite endpoint of cardiovascular death, reinfarction, ischemic stroke, and hospitalization for heart failure, and the secondary endpoint was all-cause death. A case–control study design was adopted to analyze the influencing factors of NOAF occurrence in Group 1 and Group 2. Results The median duration of follow-up was 26 months. Multivariate Cox’s regression analysis revealed that the duration of TnI elevation ≥14 days and diuretic use were independent variables of the major composite endpoint (p < 0.01 for both), and the left ventricular ejection fraction and the duration of TnI elevation ≥14 days were independent related variables of all-cause death (p < 0.05). The duration of TnI elevation ≥14 days was correlated with the occurrence of NOAF, but, in the multivariate logistic regression model, only uric acid and high-sensitivity C-reactive protein were independently associated with NOAF (p < 0.05). Conclusion The duration of TnI elevation ≥14 days was the independent correlation factor of the major composite endpoint and all-cause death; high sensitivity C-reactive protein and uric acid are independent risk factors for NOAF.

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“…Dentro de estos cambios se encuentran la mengua de la elasticidad arterial, el aumento de la poscarga, la disfunción diastólica, la disfunción endotelial, y la presencia de un estado proinflamatorio con tendencia a la coagulación. De igual manera, hay cambios como el compromiso de las funciones cognitivas y físicas, la presencia de múltiples comorbilidades y las alteraciones en el metabolismo y la excreción de los fármacos, que son variables para tener en cuenta, debido a la relevancia que tienen en el abordaje diagnóstico y terapéutico 20,29 .…”

Section: Diabetesunclassified

Síndrome coronario agudo atípico, un reto diagnóstico: revisión de tema

Gutiérrez

López²,

Agudelo³

et al. 2021

medupb

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El síndrome coronario agudo (SCA) es la principal causa de muerte, por esta razón, es fundamental reconocer sus características clínicas. Tradicionalmente ha sido descrito un cuadro denominado típico, consistente en dolor torácico retroesternal o en la región izquierda del tórax, explicado como una sensación de presión o pesadez, de duración superior a 20 minutos, que se puede irradiar a la extremidad superior izquierda o derecha, cuello o mandíbula, asociado a diaforesis y náuseas. Diversos grupos de pacientes como mujeres, diabéticos, ancianos y con antecedentes de falla cardiaca o accidente cerebrovascular presentan cuadros llamados atípicos, que en gran proporción no manifiestan dolor torácico. Varios estudios plantean que no hay síntomas suficientemente sensibles y específicos para ser considerados típicos en el contexto del SCA, por lo que el diagnóstico debe incluir además de la evaluación clínica, el electrocardiograma, los factores de riesgo y los biomarcadores. El uso de puntajes de riesgo como el HEART ha demostrado ser útil en este escenario.

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Non-ST elevation acute coronary syndrome in women and the elderly: recent updates and stones still left unturned

Cited by 20 publications

References 76 publications

Gender differences in patients presenting with non-ST segment elevation myocardial infarction in the STAR registry

Gender differences in patients presenting with non-ST segment elevation myocardial infarction in the STAR registry

The Impact of the Duration of Cardiac Troponin I Elevation on the Clinical Prognosis as Well as Incidence of New-Onset Atrial Fibrillation Respectively in Elderly Non-ST-Elevation Acute Myocardial Infarction Patients without PCI

Síndrome coronario agudo atípico, un reto diagnóstico: revisión de tema

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