Acute Coronary Syndrome/physiopathology

ABC

Original Article

Prognostic Contrast between Anatomical and Clinical Models Regarding Fatal and Non-Fatal Outcomes in Acute Coronary Syndromes

Mateus S. Viana et al. Vitor C. A. Correia Felipe M. Ferreira Yasmin F. Lacerda … Gabriela O. Bagano Leticia L. Fonseca Lara Q. Kertzman Milton V. Melo Marcia M. Noya-Rabelo Luis C L Correia

Abstract

Background

Recurrent ischemic events are mediated by atherosclerotic plaque instability, whereas death after an ischemic event results from gravity of insult and ability of the organism to adapt. The distinct nature of those types of events may respond for different prediction properties of clinical and anatomical information regarding type of outcome.

Objective

To identify prognostic properties of clinical and anatomical data in respect of fatal and non-fatal outcomes of patients hospitalized with acute coronary syndromes (ACS).

Methods

Patients consecutively admitted with ACS who underwent coronary angiography were recruited. The SYNTAX score was utilized as an anatomic model and the GRACE score as a clinical model. The predictive capacity of those scores was separately evaluated for prediction of non-fatal ischemic outcomes (infarction and refractory angina) and cardiovascular death during hospitalization. It was considered as significant a p-value <0,05.

Results

EAmong 365 people, cardiovascular death was observed in 4,4% and incidence of non-fatal ischemic outcomes in 11%. For cardiovascular death, SYNTAX and GRACE score presented similar C-statistic of 0,80 (95% IC: 0,70 – 0,92) and 0,89 (95% IC 0,81 – 0,96), respectively – p = 0,19. As for non-fatal ischemic outcomes, the SYNTAX score presented a moderate predictive value (C-statistic = 0,64; 95%IC 0,55 – 0,73), whereas the GRACE score did not presented association with this type of outcome (C-statistic = 0,50; 95%IC 0,40-0,61) – p = 0,027.

Conclusion

Clinical and anatomic models similarly predict cardiovascular death in ACS. However, recurrence of coronary instability is better predicted by anatomic variables than clinical data. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

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ABC

Original Article

High Serum Netrin-1 and IL-1β in Elderly Females with ACS: Worse Prognosis in 2-years Follow-up

Paola Leocádio et al. Penélope Menta Melissa Dias Júlia Fraga … Alessandra Goulart Itamar Santos Paulo Lotufo Isabela Bensenor Jacqueline Alvarez-Leite

Abstract

Background

Several markers have been evaluated for a potential impact on clinical decisions or mortality prediction in acute coronary syndrome (ACS), including Netrin-1 and IL-1β that have been associated with cardiovascular disease.

Objective

Our study examined the prognostic value of Netrin-1 and IL-1β in patients with ACS (2-year follow-up).

Methods

We evaluate Netrin-1, IL-1β and other risk factors in the serum sample of 803 patients. Kaplan-Meier curves and Cox regression were used for the analysis of all-cause mortality, cardiovascular mortality, and a combined outcome of fatal myocardial infarction (MI) or new non-fatal MI, considering p-value < 0.05.

Results

There were 115 deaths from all causes, 78 deaths due to cardiovascular causes and 67 events in combined outcomes. Netrin-1 levels above the median (>44.8 pg/mL) were associated with a worse prognosis (all-cause mortality and cardiovascular mortality) in elderly females, even after model adjustment (HR: 2.08, p = 0.038 and HR: 2.68, p = 0.036). IL-1β levels above the median (>13.4 pg/mL) in elderly females were associated with increased risk of all outcomes after adjustment (all-cause mortality – HR: 2.03, p = 0.031; cardiovascular mortality – HR: 3.01, p = 0.013; fatal MI or new non-fatal MI – HR: 3.05, p = 0.029). For males, no associations were observed between Netrin-1 or IL-1β and outcomes.

Conclusion

High serum levels of Netrin-1 and IL-1β showed significant association with worse prognosis in elderly females. They may be useful as prognostic indicators in ACS. (Arq Bras Cardiol. 2020; 114(3):507-514)

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ABC

Original Article

Clinical Significance of Platelet Volume and Other Platelet Parameters in Acute Myocardial Infarction and Stable Coronary Artery Disease

Liumei Ding et al. Lihua Sun Feng Wang Liejun Zhu … Ting Zhang Fanli Hua

Abstract

Background:

Platelets are important in the initiation of thrombosis, and their morphological and functional changes are closely related with the occurrence and development of coronary artery thrombosis. Platelet parameters might be valuable in distinguishing between acute myocardial infarction (AMI) and stable coronary artery disease (SCAD).

Objective:

This study was designed to detect and compare changes in platelet parameters, such as mean platelet volume (MPV) in patients with acute myocardial infarction (AMI) and stable coronary artery disease (SCAD) and to investigate their roles in these diseases.

Methods:

Specimen collection: Between January 2011 and December 2013, 2 mL of elbow vein blood was drawn from each of 31 patients primarily diagnosed with AMI, 34 SCAD patients and 50 healthy subjects; and placed in EDTA-K2 anticoagulant tubes. Platelet count (PLT), MPV, plateletcrit (PCT), platelet distribution width (PDW), white blood cell (WBC) and neutrophil (NEU) counts were determined using an STKS automated hematology analyzer (Beckman Courter).

Results:

Compared with the control group, MPV levels were significantly higher in the AMI and SCAD groups (p < 0.05), while PLT was significantly lower (p < 0.05).

Conclusion:

These results suggest that MPV and other related parameters have a certain value in the diagnosis of SCAD and AMI.

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ABC

Editorial

To Defer or Not Defer? The Challenges of Physiology in Acute Coronary Syndromes

Carlos M. Campos et al. Pedro A. Lemos

Conventional angiography may unreliably estimate the functional severity of coronary lesions, particularly of intermediate stenosis. It is in this context that intracoronary physiology, namely the measurement of fractional flow reserve (FFR), has been developed: to precisely differentiate stenoses that cause myocardial ischemia from those that are not significantly obstructive. Overall, FFR has been applied as a decision-making tool, helping to indicate (or defer) revascularization in intermediate or ambiguous coronary stenoses. Compared with angiography alone, the addition of FFR-derived information has been shown to improve patient outcomes and procedural cost-efficiencies, with physiology-guided coronary revascularization being currently recommended in clinical practice guidelines, on the grounds of ample scientific evidence.

Almost twenty years ago, the pivotal DEFER trial consolidated the concept that FFR-based postponement of revascularization is safe. However, numerous reasons make the translation of the DEFER trial to contemporary clinical practice outdated: i) the excessively restrictive 0.75 cutoff (as used in the study) has been supplanted by the more permissive 0.80 threshold, ii) balloon angioplasty as a stand-alone therapy has been largely replaced by drug-eluting stents, iii) more potent antiplatelet agents and other medical therapies have become available, and iv) the relation between FFR and the obstructive profile of coronary lesion is yet being questioned by some authors. Thus, the contemporary safety of deferring lesions in stable angina pectoris (SAP) and acute coronary syndrome (ACS) on the basis of FFR still deserves investigation.

[…]

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ABC

Original Article

Fractional Flow Reserve-Guided Strategy in Acute Coronary Syndrome. A Systematic Review and Meta-Analysis

José Luís Martins et al. Vera Afreixo José Santos Lino Gonçalves

Abstract

Background:

There are limited data on the prognosis of deferral of lesion treatment in patients with acute coronary syndrome (ACS) based on fractional flow reserve (FFR).

Objectives:

To provide a systematic review of the current evidence on the prognosis of deferred lesions in ACS patients compared with deferred lesions in non-ACS patients, on the basis of FFR.

Methods:

We searched Medline, EMBASE, and the Cochrane Library for studies published between January 2000 and September 2017 that compared prognosis of deferred revascularization of lesions on the basis of FFR in ACS patients compared with non-ACS patients. We conducted a pooled relative risk meta-analysis of four primary outcomes: mortality, cardiovascular (CV) mortality, myocardial infarction (MI) and target-vessel revascularization (TVR).

Results:

We identified 7 studies that included a total of 5,107 patients. A pooled meta-analysis showed no significant difference in mortality (relative risk [RR] = 1.44; 95% CI, 0.9-2.4), CV mortality (RR = 1.29; 95% CI = 0.4-4.3) and TVR (RR = 1.46; 95% CI = 0.9-2.3) after deferral of revascularization based on FFR between ACS and non-ACS patients. Such deferral was associated with significant additional risk of MI (RR = 1.83; 95% CI = 1.4-2.4) in ACS patients.

Conclusion:

The prognostic value of FFR in ACS setting is not as good as in stable patients. The results demonstrate an increased risk of MI but not of mortality, CV mortality, and TVR in ACS patients.

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IJCS

Review Article

Clinical Usefulness of Cystatin C to Assess the Prognosis of Acute Coronary Syndromes: A Systematic Review and Meta-Analysis

Karine Farnese Costa Martucheli et al. Caroline Pereira Domingueti

Abstract

Cystatin C is used as a marker of renal function and has been shown to be promising for evaluating the prognosis of acute coronary syndromes (ACSs). To evaluate the prognostic value of cystatin C in patients with ACSs. The articles were searched using PubMed, Web of Science and Scielo databases. Observational cohort studies that evaluated the association between increased cystatin C and the development of cardiovascular events and mortality in patients with ACSs were included. Only studies that evaluated similar outcomes, studies that compared the highest with the lowest quartiles of cystatin C, and studies that performed multivariate analysis that included glomerular filtration rate or serum creatinine, were included in the meta-analysis. Methodological quality of the articles was assessed using the Newcastle-Ottawa Scale questionnaire for cohort studies. After applying the eligibility criteria, 17 studies were included in the systematic review. All included studies reported a significant association between higher levels of cystatin C and outcomes. The meta-analysis demonstrated that elevated levels of cystatin C are associated with increased risk of cardiovascular mortality or non-fatal myocardial infarction in patients with ACSs, and such association is independent of renal function [OR = 1.65 (1.464 – 1.861), p < 0.001]. Among the studies included, 4 have good quality and 13 have excellent methodological quality.The systematic review and meta-analysis demonstrated that there is a significant association between increased cystatin C levels and the development of cardiovascular events and mortality in patients with ACSs.

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