The Year in Non–ST-Segment Elevation Acute Coronary Syndrome

Giugliano, Robert P.; Braunwald, Eugene

doi:10.1016/j.jacc.2011.08.042

Cited by 11 publications

(9 citation statements)

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“…Many population studies have revealed that some biomarkers were specific to ACS or stable plaques, since circulating levels of macrophage activity (neopterin) and tissue remodeling (matrix metalloproteinase-9) were consistently higher among ACS patients compared to stable patients [ 4 , 5 ]. Improvements in the diagnosis of ACS through more sensitive biomarkers of ACS has partly led to the reduction in the rates of myocardial infarction (MI) over the last decade with concomitant improvements in patient survival [ 6 ]. However, clarification of new biomarkers that may be different specific for the prognosis of ACS and stable coronary artery disease (CAD) needs further clinical investigation.…”

Section: Introductionmentioning

confidence: 99%

Associations of plasma hepcidin with mortality risk in patients with coronary artery disease

Ding

Zhang

et al. 2017

Oncotarget

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BackgroundIncreased blood hepcidin may be associated with the presence and promotion of atherosclerosis, the association of hepcidin with mortality among coronary artery disease (CAD) patients remains unknown. We sought to assess the relationship of hepcidin and all-cause and cardiovascular disease (CVD) mortality among CAD patients with and without acute coronary syndrome (ACS).Methods and ResultsThis study included 759 patients with ACS and 526 patients with stable CAD. After an average follow-up of 4.1 years, 154 deaths were recorded, 114 were due to CVD. After adjusting for CVD risk factors and inflammatory markers, the plasma hepcidin was positively associated with all-cause and CVD mortality in the ACS patients, the multivariable-adjusted hazard ratios (HRs) across tertiles of hepcidin were 1.00, 2.18 (95% CI 1.23-3.94), and 2.82 (95% CI 1.59-5.12) for all-cause mortality (Ptrend=0.006), and 1.00, 2.20 (95% CI 1.12-4.05), and 2.64 (95% CI 1.41-5.65) for CVD mortality (Ptrend=0.01). The C-index and net reclassification improvement when including hepcidin in traditional CVD models were 1.6% and 21.5% for all-cause mortality, 1.4% and 23.5% for CVD mortality, respectively, (P<0.001).ConclusionsPlasma hepcidin was positively associated with mortality in ACS patients. Hepcidin may be a potential biomarker for risk prediction in ACS patients.

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Section: Introductionmentioning

confidence: 99%

Associations of plasma hepcidin with mortality risk in patients with coronary artery disease

Ding

Zhang

et al. 2017

Oncotarget

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“…The proportion of non‐ST‐elevation (NSTE) acute coronary syndrome (ACS) relative to ST‐elevation (STE)‐ACS is increasing, probably as a result of demographic changes including an aging population and higher rates of diabetes . According to current practice guidelines, an early invasive strategy is recommended for medium‐ to high‐risk patients with NSTE‐ACS .…”

Section: Introductionmentioning

confidence: 99%

Predictors of high‐risk angiographic findings in patients with non‐ST‐segment elevation acute coronary syndrome

Beigel

Matetzky

Gavrielov-Yusim

et al. 2013

Cathet Cardio Intervent

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Background: Current risk assessment of patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) may fail to identify some patients with severe coronary artery disease (CAD). We aimed to identify predictors of the angiographic extent and severity of CAD in patients with NSTE-ACS undergoing early angiography and to evaluate its impact on prognosis. Methods: We evaluated 923 patients with NSTE-ACS who underwent coronary angiography. High-risk coronary anatomy (HRCA) was defined as left main disease > 50%, proximal LAD lesion > 70%, or 2-to 3-vessel disease involving the LAD. Clinical characteristics, in-hospital, and 30-day outcome and 1-year mortality were compared between the high-risk (N 5 370) and the low-risk groups (N 5 553). Results: Proportion of patients with elevated cardiac biomarkers was similar in both groups. The presence of peripheral vascular disease (OR 5 1.88, 95% confidence interval [CI] 5 1.62-5.80, P < 0.001) and a GRACE score of >140 (OR 5 1.88, 95% CI 5 1.29-2.75, P < 0.001) were the strongest predictors of HRCA. Patients with HRCA were prone to more complications during hospitalization and at 30 days (11.9% vs. 6%, P < 0.01) and increased 1-year mortality (6.7% vs. 0.9%, P < 0.001). HRCA was the strongest predictor for 30-day MACCE (OR 5 2.32, 95% CI 5 1.42-3.79, P < 0.001). HRCA (OR 5 8.36, 95% CI 5 1.01-69.4, P 5 0.049; OR 5 3.64, 95% CI 5 1.2-11.07, P 5 0.02) and GRACE score of >140 (OR 5 6.86, 95% CI 5 1.68-27.9, P 5 0.007; OR 5 4.84, 95% CI 5 1.74-13.5, P 5 0.002) were significant predictors of 30-day and 1-year mortality, respectively. Conclusions: HRCA is predicted by clinical parameters and was not associated with elevated cardiac biomarkers. These patients fared worse when compared with those with low-risk anatomy. We suggest that HRCA predictors should be included in the risk stratification of patients with NSTE-ACS. V C 2013 Wiley Periodicals, Inc.

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“…Vrlo često u akutnom krvarenjuje je potreban prekid ATT i/ili AKT, što doprinosi trombozi stenta i drugim neželjenim ishemijskim događajima. Eksperimentalni podaci sugerišu da se nivo Hg <70 g/L toleriše ne izazivajući miokardnu ishemiju, osim ako ne postoji opstrukivna koronarna bolest 18,26 .…”

Section: Terapija Akutnog Gi Krvarenjaunclassified

“…Postoje mnogi potencijalni mehanizmi za štetni efekat transfuzija, uključujući trombocitnu akivaciju i agregaciju, smanjen kapacitet dopremanja kiseonika i azot monoksida. Generalno, strategija restrikivne transfuzije je udružena sa trendom smanjenog mortaliteta, IM i srčane insuicijencije 18,26 . Nasuprot tome, kod pacijeneta sa koronarnom bolešću, nije preporučena česta liberalna upotreba transfuzije krvi da održi ranije vrednosi Hg ako nema otvorenog krvarenja i ako je HCT >25 % ili Hg >80 g/L 2 .…”

Section: Terapija Akutnog Gi Krvarenjaunclassified