The year in cardiovascular medicine 2021: acute cardiovascular care and ischaemic heart disease

Price, Susanna; Katz, Jason N.; Kaufmann, Christoph C; Huber, Kurt

doi:10.1093/eurheartj/ehab908

Cited by 9 publications

(5 citation statements)

References 38 publications

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“…Clinical care for all patients was offered at the discretion of the attending clinician based on current guidelines [ 24 , 25 ]. When clinically indicated, PCI with stenting or coronary artery bypass graft (CABG) was performed.…”

Section: Methodsmentioning

confidence: 99%

Clinical significance of obstructive sleep apnea in patients with acute coronary syndrome with or without prior stroke: a prospective cohort study

et al. 2023

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Background and objective Whether obstructive sleep apnea (OSA) is associated with worse prognosis in patients with acute coronary syndrome (ACS) with or without prior stroke remains unclear. We investigated the association of OSA with cardiovascular events in ACS patients with or without prior stroke. Methods Between June 2015 and January 2020, we prospectively recruited eligible ACS patients who underwent cardiorespiratory polygraphy during hospitalization. We defined OSA as an apnea hypopnea index (AHI) ≥ 15 events/hour. The primary composite end point was major adverse cardiovascular and cerebrovascular events (MACCEs), including cardiovascular death, myocardial infarction, stroke, ischemia-driven revascularization, or hospitalization for unstable angina or heart failure. Results Among 1927 patients enrolled, 207 patients had prior stroke (10.7%) and 1014 had OSA (52.6%). After a mean follow-up of 2.9 years, patients with stroke had significantly higher risk of MACCEs than those without stroke (hazard ratio [HR]:1.49; 95% confidence interval [CI]: 1.12–1.98, P = 0.007). The multivariate analysis showed that patients with OSA had 2.0 times the risk of MACCEs in prior stroke group (41 events [33.9%] vs 18 events [20.9%]; HR:2.04, 95% CI:1.13–3.69, P = 0.018), but not in non-prior stroke group (186 events [20.8%] vs 144 events [17.4]; HR:1.21, 95% CI 0.96–1.52, P = 0.10). No significant interaction was noted between prior stroke and OSA for MACCE (interaction P = 0.17). Conclusions Among ACS patients, the presence of OSA was associated with an increased risk of cardiovascular events in patients with prior stroke. Further trials exploring the efficacy of OSA treatment in high-risk patients with ACS and prior stroke are warranted. Trial registration Clinicaltrials.gov identifier NCT03362385.

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Section: Methodsmentioning

confidence: 99%

Clinical significance of obstructive sleep apnea in patients with acute coronary syndrome with or without prior stroke: a prospective cohort study

et al. 2023

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“…Standardized ACS treatment is performed in all hospitalized patients according to current guidelines 16) . Percutaneous coronary intervention (PCI) stenting or coronary artery bypass grafting is performed when surgery is required.…”

Section: Sleep Study and Managementmentioning

confidence: 99%

The Long-Term Prognostic Role of Nighttime Resting Heart Rate in Obstructive Sleep Apnea in Patients with Acute Coronary Syndrome

Xin,

Ai,

Gong

et al. 2024

JAT

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Aim: A close relationship exists between resting heart rate (RHR) and obstructive sleep apnea (OSA). Still, the prognostic importance of nighttime RHR in patients with acute coronary syndrome (ACS) with or without OSA remains unclear. Methods: In this prospective cohort study, OSA was defined as an apnea–hypopnea index of ≥ 15 events/h, and the high nighttime RHR (HNRHR) was defined as a heart rate of ≥ 70 bpm. The primary endpoint was a major adverse cardiovascular and cerebrovascular event (MACCE), including cardiovascular death, myocardial infarction, stroke, ischemia-driven revascularization, or hospitalization for heart failure. Results: Among the 1875 enrolled patients, the mean patient age was 56.3±10.5 years, 978 (52.2%) had OSA, and 425 (22.7%) were in HNRHR. The proportion of patients with HNRHR is higher in the OSA population than in the non-OSA population (26.5% vs. 18.5%; P ＜0.001). During 2.9 (1.5, 3.5) years of follow-up, HNRHR was associated with an increased risk of MACCE in patients with OSA (adjusted HR: 1.56, 95% CI: 1.09–2.23, P =0.014), but not in patients without OSA (adjust HR: 1.13, 95% CI: 0.69–1.84, P =0.63). Conclusions: In patients with ACS, a nighttime RHR of ≥ 70 bpm was associated with a higher risk of MACCE in those with OSA but not in those without it. This identifies a potential high-risk subgroup where heart rate may interact with the prognosis of OSA. Further research is needed to determine causative relationships and confirm whether heart rate control impacts cardiovascular outcomes in patients with ACS-OSA.

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“…Five days after pPCI (V6), we will again apply echocardiography and CMR with the addition of magnetic resonance spectroscopy (MRS). For regional myocardial metabolic profiling, 1 H and 31 P-MRS, which are key techniques for measuring fatty acids (FA) and total creatine as well as ATP, Pi and pH, will be integrated into the clinical CMR protocol 5 days and 6 months after STEMI. For 1 H-MRS, navigator-free metabolite-cycled spectroscopy using a voxel size of approximately 4-6 ml (10×15×35 mm3) and ≈144 averages (7:50 minutes) will be applied [19].…”

Section: Interventions Explanation For the Choice Of Comparators {6b}mentioning

confidence: 99%

“…In experimental models of myocardial ischemia, substrate selection is characterized by a "metabolic switch" in myocardial energy supply from predominantly aerobic FA oxidation to anaerobic glycolysis. 1 H-MRS may estimate myocardial triglyceride and total creatine levels, whereas 31 P-MRS is able to quantify metabolites such as phosphocreatine, ATP, their ratio or creatine kinase fluxes [26]. Currently, data are lacking for CMR/MRS measurements that comprehensively characterize metabolic alterations in ischemic and remote myocardium with respect to coronary artery disease severity using 1 H-and 31 P-MRS.…”

Section: Systemi Approaches To Characterize Myocardial and Systemic M...mentioning

confidence: 99%

SYSTEMI - Systemic organ communication in STEMI: Design and rationale of a cohort study of patients with ST-segment elevation myocardial infarction

Boenner

Jung

Polzin

et al. 2023

Preprint

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Background: (335/350) ST-segment elevation myocardial infarction (STEMI) still causes significant mortality and morbidity despite best-practice revascularization and adjunct medical strategies. Within the STEMI population, there is a spectrum of higher and lower risk patients with respect to major adverse cardiovascular and cerebral events (MACCE) or re-hospitalization due to heart failure. Myocardial and systemic metabolic disorders modulate patient risk in STEMI. Systematic cardiocirculatory and metabolic phenotyping to assess the bidirectional interaction of cardiac and systemic metabolism in myocardial ischemia is lacking. Methods: Systemic organ communication in STEMI (SYSTEMI) is an all-comer open-end prospective study in STEMI patients >18 years of age to assess the interaction of cardiac and systemic metabolism in STEMI by systematically collecting data on a regional and systemic level. Primary endpoint will be myocardial function, left ventricular remodelling, myocardial texture and coronary patency at 6 month after STEMI. Secondary endpoint will be all-cause death, MACCE, and re-hospitalisation due to heart failure or revascularisation assessed 12 month after STEMI. The objective of SYSTEMI is to identify metabolic systemic and myocardial master switches that determine primary and secondary endpoints. In SYSTEMI 150-200 patients are expected to be recruited per year. Patient data will be collected at the index event, within 24 hours, 5 days as well as 6 and 12 months after STEMI. Data acquisition will be performed in multilayer approaches. Myocardial function will be assessed by using serial cardiac imaging with cineventriculography, echocardiography and cardiovascular magnetic resonance. Myocardial metabolism will be analysed by multi-nuclei magnetic resonance spectroscopy. Systemic metabolism will be approached by serial liquid biopsies and analysed with respect to glucose and lipid metabolism as well as oxygen transport. In summary, SYSTEMI enables a comprehensive data analysis on the levels of organ structure and function alongside hemodynamic, genomic and transcriptomic information to assess cardiac and systemic metabolism. Discussion: SYSTEMI aims to identify novel metabolic patterns and master-switches in the interaction of cardiac and systemic metabolism to improve diagnostic and therapeutic algorithms in myocardial ischemia for patient-risk assessment and tailored therapy.

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The year in cardiovascular medicine 2021: acute cardiovascular care and ischaemic heart disease

Cited by 9 publications

References 38 publications

Clinical significance of obstructive sleep apnea in patients with acute coronary syndrome with or without prior stroke: a prospective cohort study

Clinical significance of obstructive sleep apnea in patients with acute coronary syndrome with or without prior stroke: a prospective cohort study

The Long-Term Prognostic Role of Nighttime Resting Heart Rate in Obstructive Sleep Apnea in Patients with Acute Coronary Syndrome

SYSTEMI - Systemic organ communication in STEMI: Design and rationale of a cohort study of patients with ST-segment elevation myocardial infarction

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