Poor long-term outcome in acute coronary syndrome in a real-life setting: Ten-year outcome of the TACOS study (original) (raw)
CLINICAL OR INTERVENTIONAL TREATMENT IN ACUTE CORONARY SYNDROME (Atena Editora)
CLINICAL OR INTERVENTIONAL TREATMENT IN ACUTE CORONARY SYNDROME (Atena Editora), 2023
Introduction: ACS has a wide clinical presentation, ranging from asymptomatic conditions to cardiac arrest, with chest discomfort being the main clinical symptom. Chest pain is a challenge for doctors in the emergency room and accounts for 5 to 10% of visits. Differentiating non-cardiac chest pain from that of cardiac origin requires attention and mastery of diagnostic methods through the patient's clinic and tests such as troponin and electrocardiogram. Given the wide prognostic range, patients must receive a risk classification and, based on these data, receive appropriate therapeutic management. Goals: The main objective of this work is to understand the diagnostic methods and procedures applicable to everyday clinical practice, remaining within the recommendations of current scientific literature. Methods: This is a narrative bibliographic review. Scientific articles selected from the VHL, PubMed and Scielo databases were consulted. The eligibility of previously selected publications was based on the most recent studies available on the topic of ACS and AMI, preferably from 2019. Conclusions: The doctor must have ready access to the main recommendations and conduct of the most relevant guidelines on the subject of ACS/AMI and be able to adapt them to the local reality. This way, this work takes into consideration practical issues, based on current references and with a direct and objective reading on which flow to establish for each patient according to the technical structure of the unit where the patient with acute coronary syndrome was admitted and thus allow decision making between clinical or interventional treatment.
Acute coronary syndromes: consensus recommendations for translating knowledge into action
Medical Journal of Australia, 2010
he Australian Institute of Health and Welfare estimates that 48 700 coronary heart disease (CHD) events (deaths or hospitalisations) occurred among Australians aged 40-90 years in 2001-2002. 1 In 2007, acute myocardial infarction was the underlying cause of 11 341 deaths. It is estimated that in 2009, over 50 000 Australians will have an acute myocardial infarction, at a cost of $281 000 to the community for each event. 3 National guidelines for the management of acute coronary syndromes (ACS), 4 published in 2006 by the National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand, provided recommendations based on practices that have been shown to improve outcomes for patients with ACS. The ACS Implementation and Advocacy Working Group was established by the Heart Foundation to identify ways to enhance uptake of the guidelines. Here, we describe the development of consensus recommendations to improve the delivery of key aspects of clinical care set out in the guidelines. In 2007, the Heart Foundation, in collaboration with the Cardiac Society of Australia and New Zealand and the Australasian College for Emergency Medicine, held a national forum 7 to promote implementation of the 2006 national ACS management guidelines. The forum brought together representatives of key stakeholder organisations and key opinion leaders from the areas of clinical cardiology, nursing, cardiac rehabilitation, emergency medicine, government, general practice and rural health. Its aims were to identify key gaps in the current management of ACS and develop a set of priority actions that would achieve the greatest improvement in outcomes among ACS patients. 7 Forum workshops used the nominal group technique, a moderated group process that allows each participant to voice and then vote on identified priorities, 8 to reach consensus on priority intervention points in four areas of ACS management: • early reperfusion for patients with ST-segment-elevation myocardial infarction (STEMI); • risk stratification for patients with non-ST-segment-elevation ACS (NSTEACS); • access to invasive procedures for patients with high-and intermediate-risk NSTEACS; and • postacute care, including discharge therapies, access to rehabilitation services, and the interface between acute and primary care services. Members of the ACS Implementation and Advocacy Working Group undertook a literature review to identify gaps between guidelines and current practice, and evidence for the most effective systems of ACS management. After the forum, the Working Group developed a set of recommendations for implementation, based on the priority interventions identified at the forum. 7 The ACS Implementation and Advocacy Working Group proposed recommendations in six key priority areas, each of which will be promoted through implementation activities planned for 2009-2010 (Box). Current guidelines recommend early reperfusion for patients with STEMI. The earlier the delivery of reperfusion, the better the outcomes. 9 If delivered promptly (within 90 minutes of presentation in most settings), percutaneous coronary intervention (PCI)
2006
C oronary artery disease remains the leading cause of death of American men and women (1). It causes major economic burden, with estimated direct and indirect costs of $129.9 billion in the United States in 2003 (1). Coronary care units (CCUs) were designed to offer specialized care to patients suffering from acute myocardial infarction, with the role rapidly expanding to include unstable angina. The primary initial goal of CCUs was to monitor and prevent fatal arrhythmias. During the past 20 years, the development of various novel pharmacological and interventional strategies for the management of patients with acute coronary syndromes (ACS) has beneficially affected their outcome (2). Recently, there has been growing advocacy supporting the treatment of these patients in specialized 'Centers of Excellence' (3-5). Epidemiological information about the evolution of demographics, treatment and outcome of patients admitted to tertiary care centres over the past 15 years is limited.
Assessing Prognosis of Acute Coronary Syndrome in Recent Clinical Trials: A Systematic Review
Clinical Medicine & Research, 2019
There is no recent comprehensive overview of contemporary clinical trials assessing short and longterm outcomes in patients with acute coronary syndrome (ACS). This paper reviews factors from recent clinical trials that influenced prognosis in patients with ACS. Cochrane and PubMed databases were screened systematically for clinical trials published in the English literature reporting on ACS prognosis. Two authors independently screened titles, abstracts, and full text. Studies meeting inclusion criteria evaluated the impact of modern practice on prognosis. In vitro and animal models studies, conference abstracts, imaging studies, and review articles were excluded. Disagreement in inclusion criteria was resolved by consensus. A large study of 8,859 patients showed no difference in all-cause mortality between 31 days and 2 years in patients with ST segment elevation myocardial infarction (STEMI) compared to those with non-ST segment elevation myocardial infarction (NSTEMI) or stable ischemic heart disease (SIHD). Other studies showed a significant increase in all-cause mortality in patients with STEMI within the first 30 days, with NSTEMI patients exhibiting a higher mortality rate compared to those with SIHD during the 2-year follow-up period. Our review found that women have a poorer short-term prognosis compared to men. Additionally, reports from patients receiving comprehensive and coordinated care showed longer survival rates. In view of the improved prognosis demonstrated for patients suffering from ACS, assessing prognosis in patients represents a formidable task in modern practice. Our review highlights the need for further evidence-based studies evaluating long-term outcomes on diagnostic and treatment strategies.
The American Journal of Cardiology, 2004
The objective of this study was to determine the management and outcome of fewer selected patients with an acute coronary syndrome during hospitalization and up to 1 year after discharge. The Canadian Acute Coronary Syndromes Registry was a prospective observational study of patients admitted with suspected acute coronary syndromes. Data on demographic and clinical characteristics, in-hospital treatment, and outcomes were recorded. At 1 year, vital status, medication use, recurrent cardiac events, and procedures were determined by telephone contact. Of the 5,312 patients enrolled, 4,627 had a final diagnosis of acute coronary syndrome, with Q-wave myocardial infarction in 27.7%, non-Q-wave myocardial infarction in 33.2%, and unstable angina pectoris in 39.1%. During hospitalization, coronary angiography and revascularization were performed in 39.6% and 20.3% of patients, respectively. The in-hospital mortality rate was 2.4% overall. At discharge, 87.8%, 76.4%, 56.0%, and 54.8% of patients were prescribed aspirin,  blockers, angiotensin-converting enzyme inhibitors, and lipid-lowering agents, respectively. Unadjusted 1-year mortality rates for hospital survivors were 6.5%, 10%, and 5.4% for those with Q-wave myocardial infarction, non-Q-wave myocardial infarction, and unstable angina pectoris groups, respectively (p <0.0001). This difference in mortality rate remained significant after adjusting for other prognosticators, whereas the use of coronary angiography and revascularization after discharge was similar across patients. At 1 year, fewer patients were maintained on aspirin and  blockers, whereas the use of lipid-lowering therapy increased (all p <0.0001). Despite similar rates of coronary angiography and revascularization after discharge, patients with non-Q-wave myocardial infarction had worse outcomes at 1 year. Moreover, there was a significant opportunity to enhance the discharge and long-term use of evidence-based secondary prevention therapies. ᮊ2004 by Excerpta Medica, Inc.
The American Journal of Cardiology, 2002
Acute coronary syndrome (ACS) represents a heterogenous spectrum of conditions. The Global Registry of Acute Coronary Events (GRACE) describes the epidemiology, management, and outcomes of patients with ACS. Data were collected from 11,543 patients enrolled in 14 countries. Of these patients, 30% had ST-segment elevation myocardial infarction (STEMI), 25% had non-ST-segment elevation myocardial infarction (NSTEMI), 38% had unstable angina pectoris, and 7% had other cardiac or noncardiac diagnoses. Over half of these patients (53%) were &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;/=65 years old. Reperfusion therapy was used in 62% of patients with STEMI. Percutaneous coronary intervention was performed in 40% of these subjects during the index admission. Intravenous glycoprotein IIb/IIIa blockers were used in 23%, 20%, and 7% of patients with STEMI, NSTEMI, and unstable angina, respectively (STEMI vs NSTEMI, p = 0.0018, and for either group vs unstable angina, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). Coronary artery bypass grafting was performed in 4%, 10%, and 5% of patients, respectively (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.0001). Hospital case fatality rates were markedly different among patients with STEMI, NSTEMI, and unstable angina (7%, 6%, and 3%, respectively; STEMI vs NSTEMI, p = 0.0459, and for either group vs unstable angina, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). Congestive heart failure complicated the hospital course in 18%, 18%, and 10% of the patients, respectively (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.0001), and recurrent angina with ST-segment changes occurred before discharge in 10%, 10%, and 9% of patients, respectively (p = 0.2644). GRACE provides a detailed and comprehensive global description of the spectrum of patients with ACS.
Therapeutic marks of the acute coronary syndrome : a single-center familiarity
2020
Background: Acute coronary syndrome is a major health concern with an increase in the sedentary lifestyle in Saudi Arabia. With the spectrum ACS clinical presentations, choosing an appropriate treatment guideline is a challenge. Therefore, this study aimed to explore the therapeutic marks of ACS in a Single-center acquaintance. Methodology: Information regarding 156 ACS patients were re-claimed from King Khalid hospital, Ha’il, Northern Saudi Arabia. All patients were admitted to the hospital during a year period and diagnosed as having ACS. Results: Most of the patients in the study were presenting with STEMI followed by NSTEMI and ANALYSIS 24(105), September October, 2020 Medical Science ISSN 2321–7359 EISSN 2321–7367
Acute Coronary Syndromes in the GUSTO-IIb Trial
Circulation, 1998
Background —Recurrent ischemia after an acute coronary syndrome portends an unfavorable outcome and has major resource-use implications. This issue has not been studied systematically among the spectrum of patients with acute coronary presentations, encompassing those with and without ST-segment elevation. Methods and Results —We assessed the 1-year prognosis of the 12 142 patients enrolled in the GUSTO-IIb trial by the presence (n=4125) or absence (n=8001) of ST-segment elevation. This latter group was further categorized into those with baseline myocardial infarction (n=3513) or unstable angina (n=4488). We also assessed the incidence of recurrent ischemia and its impact on outcomes. Recurrent ischemia was significantly rarer in those with ST-segment elevation (23%) than in those without (35%; P <0.001). Mortality at 30 days was greater among patients with ST-segment elevation (6.1% versus 3.8%; P <0.001) but less so at 6 months; by 1 year, mortality did not differ significa...