Acute Coronary Syndrome / complications

ABC

Original Article

Comparison of the Outcomes between Coronary No-Reflow and Slow-Flow Phenomenon in Non-STEMI Patients

Abstract

Background:

Coronary slow-flow phenomenon (CSFP) and coronary no-reflow phenomenon (CNP) are associated with increased risk of major cardiovascular adverse events (MACE).

Objectives:

This study aimed to evaluate and compare the one-year clinical follow-up outcomes among patients with CNP and CSFP who underwent percutaneous coronary interventions (PCI) in non-ST elevation myocardial infarction (NSTEMI).

Methods:

This study included a total of 858 patients who were diagnosed with NSTEMI and underwent PCI within 24 h of symptom onset. The patients were divided into two groups, the CSFP group (n=221) and the CNP group (n=25), regarding the angiographic characteristics of thrombolysis in myocardial infarction (TIMI) flow of the infarct-related artery. Patients were followed for one-year. A p-value of <0.05 was considered significant.

Results:

CNP was observed in 2.91%, and CSFP was observed in 25.75% of the patients. Clinical endpoints analyzed that stroke was significantly higher in the CNP group than in the CSFP group (6 (24%) vs. 6 (2.70%), p<0.001) and MACE was significantly higher in the CNP group than in the CSFP group (11 (44%) vs. 51 (23.10%), p=0.022). Forward conditional logistic regression analysis demonstrated that body mass index (BMI) (OR=1.11, 95%CI: 1.00-1.24, p=0.038) and baseline heart rate (HR) (OR=0.923, 95%CI: 0.88-0.96, p<0.001) were the independent predictors of CNP in NSTEMI.

Conclusion:

CNP patients have worse clinical outcomes and a higher risk of stroke compared with CSFP patients in NSTEMI. (Arq Bras Cardiol. 2021; 116(5):856-864)

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ABC

Viewpoint

Acute Coronary Syndromes in the Current Context of the Covid-19 Pandemic

Raphael Boesche Guimarães et al. Breno Falcão Ricardo Alves Costa Marcelo Antônio Cartaxo Queiroga Lopes … Roberto Vieira Botelho Ricardo Petraco Rogério Sarmento-Leite

Introduction

COVID-19, initially described at the end of 2019 in China, may present as atypical pneumonia and severe respiratory failure. Classified in February 2020 as a pandemic by the World Health Organization (WHO), COVID-19 has had major clinical, social, political and economic implications. Society as a whole has had to adapt to a new reality, forcing hospitals to rewrite their routine practices and clinical pathways. Specific measures have had to be put in place to prevent hospital transmission of the infection. Also, dedicated COVID units have been set up and infection control protocols implemented. Finally, additional human, material and financial resources have been allocated in order to provide patients with the best possible care, without compromising the safety of healthcare workers.

Social isolation as a way of containing the spread of the disease may have helped, in some places, to “flatten the curve”, preventing the collapse of healthcare systems. However, the duration of the pandemic, as well as the precise risk of transmission are still largely unknown.

[…]

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IJCS

Original Article

Is There Safety in the Use of Clopidogrel Loading Dose in Patients Over 75 Years of Age with Acute Coronary Syndrome?

Alexandre de Matos Soeiro et al. Guilherme Casale Maria Antonieta Albanez Albuquerque de Medeiros Lopes Lucas Colombo Godoy … Aline Siqueira Bossa Bruno Biselli Tatiana de Carvalho Andreucci Torres Leal Maria Carolina Feres de Almeida Soeiro Carlos V Serrano Jr. Múcio Tavares Oliveira Jr.

Abstract

Background:

There is limited evidence in the literature regarding the administration of clopidogrel to acute coronary syndrome (ACS) in patients over 75 years of age. Most studies excluded this age group, making the subject controversial due to the increased risk of bleeding in this population.

Objective:

This is a retrospective, unicentric, and observational study aimed at assessing whether the administration of clopidogrel loading dose increases bleeding rates in patients over 75 years of age.

Methods:

Patients were divided into two groups: group I: 75 mg of clopidogrel; group II: 300-to 600-mg loading dose of clopidogrel. A total of 174 patients (129 in group I and 45 in group II) were included between May 2010 and May 2015. Statistical analysis: The primary outcome was bleeding (major and/or minor). The secondary outcome was combined events (cardiogenic shock, reinfarction, death, stroke and bleeding). The comparison between groups was performed through Q-square and T-test. The multivariate analysis was performed by logistic regression, being considered significant p < 0.05.

Results:

Comparisons between groups I and II showed differences in the prevalence of diabetes (46.5% vs. 24.4%, p = 0.01), arterial hypertension (90.7% vs. 75, p = 0.01), dyslipidemia (62% vs. 42.2%, p = 0.021), ST segment elevation (11.6% vs. 26.6%, p = 0.016) and coronary intervention percutaneous (16.5% vs. 62.2%, p < 0.0001), respectively. In the multivariate analysis, significant differences were observed between groups I and II in relation to the occurrence of bleeding (8.5% vs. 20%, OR = 0.173, 95% CI: 0.049 – 0.614, p = 0.007).

Conclusion:

A loading dose of 300 mg or more of clopidogrel.

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ABC

Letter to the Editor

The Relation between Epicardial Fat Thickness and Prognostic Risk Scores

Sevket Balta et al. Cengiz Ozturk Turgay Celik

Dear Editor,

We read the article “The Relationship between GRACE Score and Epicardial Fat Thickness(EFT) in non-STEMI Patients” by Gul et al. The authors concluded that end-systolic and end-diastolic EFTs were found to be increased in the higher GRACE group.

[…]

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ABC

Original Article

Comparison of ACUITY and CRUSADE Scores in Predicting Major Bleeding during Acute Coronary Syndrome

Luis C. L. Correia et al. Felipe Ferreira Felipe Kalil André Silva … Luisa Pereira Manuela Carvalhal Maurício Cerqueira Fernanda Lopes Nicole de Sá Márcia Noya-Rabelo

Background:

The ACUITY and CRUSADE scores are validated models for prediction of major bleeding events in acute coronary syndrome (ACS). However, the comparative performances of these scores are not known.

Objective:

To compare the accuracy of ACUITY and CRUSADE in predicting major bleeding events during ACS.

Methods:

This study included 519 patients consecutively admitted for unstable angina, non-ST-elevation or ST-elevation myocardial infarction. The scores were calculated based on admission data. We considered major bleeding events during hospitalization and not related to cardiac surgery, according to the Bleeding Academic Research Consortium (BARC) criteria (type 3 or 5: hemodynamic instability, need for transfusion, drop in hemoglobin ≥ 3 g, and intracranial, intraocular or fatal bleeding).

Results:

Major bleeding was observed in 31 patients (23 caused by femoral puncture, 5 digestive, 3 in other sites), an incidence of 6%. While both scores were associated with bleeding, ACUITY demonstrated better C-statistics (0.73, 95% CI = 0.63 – 0.82) as compared with CRUSADE (0.62, 95% CI = 0.53 – 0.71; p = 0.04). The best performance of ACUITY was also reflected by a net reclassification improvement of + 0.19 (p = 0.02) over CRUSADE’s definition of low or high risk. Exploratory analysis suggested that the presence of the variables ‘age’ and ‘type of ACS’ in ACUITY was the main reason for its superiority.

Conclusion:

The ACUITY Score is a better predictor of major bleeding when compared with the CRUSADE Score in patients hospitalized for ACS.

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