2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation

Collet, J.-P.; Thiele, Holger; Barbato, E; Barthélémy, Olivier; Bauersachs, J.; Bhatt, D.L.; Dendale, Paul; Dorobanțu, Maria; Edvardsen, Thor; Folliguet, Thierry; Gale, CP; Gilard, Martine; Jobs, Alexander; Jüni, Peter; Lambrinou, Ekaterini; Lewis, Basil S.; Mehilli, J.; Meliga, Emanuele; Merkely, Béla; Mueller, C.; Roffi, Marco; Rutten, F. H.; Sibbing, Dirk; Siontis, George C.M.

doi:10.15829/1560-4071-2021-4418

Cited by 241 publications

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“…Current guidelines advise that in ACS treatment with angiotensin-converting enzyme (ACE) inhibitors should be started and maintained in patients with diabetes, hypertension, CKD and left ventricular ejection fraction <40%, excepting cases when it is contraindicated [112,138]. The utilization of these agents is not prohibited by a specific level of serum creatinine, though when serum creatinine is greater than 2.5 mg/dL, attention is required.…”

Section: Treatment Options Of Acs In Ckd Patientsmentioning

confidence: 99%

“…For patients with ACS, the preferred reperfusion strategy is primary percutaneous coronary intervention (PCI) [112,138]. In reducing reinfarction, stroke or mortality, fibrinolysis is inferior to primary PCI, as highlighted by a review [141].…”

Section: Treatment Options Of Acs In Ckd Patientsmentioning

confidence: 99%

“…In acute coronary syndrome without ST segment elevation (NSTE-ACS) subjects, the main technical considerations of PCI are not different from the harmful evaluation and revascularization strategies for other CAD expressions. Implantation of new-generation DES is the standard procedure for patients with NSTE-ACS who are considered eligible for PCI in one or several vessels [138]. Table 3 illustrates the different results regarding the best choice between PCI and CABG in CKD subjects.…”

Section: Treatment Options Of Acs In Ckd Patientsmentioning

confidence: 99%

“…About 5-10% of NSTE-ACS patients need CABG, as they present increased risk compared to patients subjected to elective CABG [138].…”

Section: Treatment Options Of Acs In Ckd Patientsmentioning

confidence: 99%

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Framing Cause-Effect Relationship of Acute Coronary Syndrome in Patients with Chronic Kidney Disease

et al. 2021

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The main causes of death in patients with chronic kidney disease (CKD) are of cardiovascular nature. The interaction between traditional cardiovascular risk factors (CVRF) and non-traditional risk factors (RF) triggers various complex pathophysiological mechanisms that will lead to accelerated atherosclerosis in the context of decreased renal function. In terms of mortality, CKD should be considered equivalent to ischemic coronary artery disease (CAD) and properly monitored. Vascular calcification, endothelial dysfunction, oxidative stress, anemia, and inflammatory syndrome represents the main uremic RF triggered by accumulation of the uremic toxins in CKD subjects. Proteinuria that appears due to kidney function decline may initiate an inflammatory status and alteration of the coagulation – fibrinolysis systems, favorizing acute coronary syndromes (ACS) occurrence. All these factors represent potential targets for future therapy that may improve CKD patient’s survival and prevention of CV events. Once installed, the CAD in CKD population is associated with negative outcome and increased mortality rate, that is the reason why discovering the complex pathophysiological connections between the two conditions and a proper control of the uremic RF are crucial and may represent the solutions for influencing the prognostic. Exclusion of CKD subjects from the important trials dealing with ACS and improper use of the therapeutical options because of the declined kidney functioned are issues that need to be surpassed. New ongoing trials with CKD subjects and platelets reactivity studies offers new perspectives for a better clinical approach and the expected results will clarify many aspects.

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Section: Treatment Options Of Acs In Ckd Patientsmentioning

confidence: 99%

Section: Treatment Options Of Acs In Ckd Patientsmentioning

confidence: 99%

Section: Treatment Options Of Acs In Ckd Patientsmentioning

confidence: 99%

“…About 5-10% of NSTE-ACS patients need CABG, as they present increased risk compared to patients subjected to elective CABG [138].…”

Section: Treatment Options Of Acs In Ckd Patientsmentioning

confidence: 99%

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Framing Cause-Effect Relationship of Acute Coronary Syndrome in Patients with Chronic Kidney Disease

et al. 2021

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“…Предложенные модели прогнозирования могут достаточно просто быть реализованы на практике и использоваться в стационаре у больных ОКС с ОЗ. Стоит отметить, что все разработанные модели включают величину содержания NT-proBNP, который предложен в руководстве по лечению ОКС без персистирующего подъема сегмента ST 2020 года в качестве прогностического биомаркера [22]. При этом определение NT-proBNP наиболее важно у больных ОКС с ОЗ, чей миокард, возможно, был скомпрометирован проведенной ранее противоопухолевой терапией.…”

Section: оригинальные статьи §unclassified

Acute coronary syndrome in patients with cancer: features of the course and the possibility of predicting hospital and long-term (6 months) periods using GDF-15, NT-proBNP, hs-CRP biomarkers

Шаленкова¹,

Иванов²,

Климкин³

2021

Kardiologiia

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Aim To evaluate clinical features of the course of acute coronary syndrome (ACS) in patients with oncological diseases (OD) and to determine the role of biomarkers GDF-15, NT-proBNP, and hs-CRP in short-term and long-term prognoses.Material and methods In 88 patients (34 patients with ACS and OD and 54 patients with ACS without OD), complaints and historical, objective, and laboratory and instrumental data were evaluated and blood concentrations of GDF-15, NT-proBNP, and hs-CRP biomarkers were measured on the first day of hospitalization. Incidence of cardiovascular complications (CVC) and outcomes of hospital and long-term (6 months) periods were analyzed. Statistical analysis of results was performed with the Statistica 12.0, MedCalc 19.1.7 software. The level of statistical significance was р<0.05.Results In the ACS+OD group as compared to the ACS without OD group, the onset of disease was mostly atypical, with shortness of breath and/or general weakness; the ACS+OD patients more frequently had III-IV Killip class acute heart failure (29 and 7 %, р=0.01); mean hemoglobin concentration (125.6±27.9 and 141±16.6 g/l, р=0.003), prothrombin index (76.4±15.2 and 84.9±17.6 %, р=0.003), and left ventricular ejection fraction (47.7±6.1 and 50.7±7.2 %, р=0.02) were lower; and median concentrations of GDF-15 (1.95 [1.3; 2.8] and 1.45 [1.2; 2.0] ng/ml, р=0.03), NT-proBNP (947.3 [517.8; 1598.2], and 491.1 [85.1; 1069.1] pg/ml, р=0.006), and hs-CRP (14.1 [8.15; 36.75] and 7.8 [4.4; 16.2] mg/l, р=0.01) were higher. The presence of OD was associated with development of CVC, including urgent endpoints in the long-term and also increased the probability of fatal outcome within 6 months after discharge from the hospital. To predict the risk of CVC in patients with ACS and OD, two models with high prognostic values (AUC>0.9) were proposed. In the long-term, the value of NT-proBNP (cut-off point >524.5 pg/ml) was a statistically significant predictor for development of endpoints with a high predictive value (AUC>0.8).Conclusion The features of the clinical course of ACS in patients with OD indicate the importance of isolating such patients into a separate group. Additional use of the developed models, along with a standard risk assessment by the GRACE scale, will allow individualized management of patients with ACS and OD during the hospital and long-term (6 months) periods.

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Effect of prehospital treatment in STEMI patients undergoing primary PCI

Fabris

Menzio

Gregorio

et al. 2022

Cathet Cardio Intervent

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Background: The appropriate timing to administer antithrombotic therapies in ST-elevation myocardial infarction (STEMI) remains uncertain. This study aims to evaluate the role of antithrombotic therapy administration at first medical contact (FMC) compared with the administration in the Cathlab. Methods:We conducted a "before-after" observational study enrolling STEMI undergoing primary percutaneous coronary intervention (PCI). Outcomes were evaluated during two successive periods, before (control group: aspirin only at FMC) and after (pretreated intervention group: heparin, aspirin plus ticagrelor at FMC) the introduction of a new regional pretreatment protocol.Results: A total of 537 consecutive patients (300 in control vs. 237 in intervention group) were enrolled. The pretreated compared with no pretreated population showed better basal reperfusion, expressed as basal Thrombolysis in Myocardial Infarction (TIMI)-flow (p for trend p < 0.001). Pretreated population showed lower frequency of TIMI 0 (56.5% vs. 73.7%, odds ratio [OR]: 0.46, 95% confidence interval [CI]: 0.32-0.67, p < 0.001) and higher frequency of TIMI 2-3 (33.3% vs.19.3% OR: 2.0, 95% CI: 1.38-2.00, p < 0.001) and TIMI 3 (14.3% vs. 9.7%, OR: 1.56, 95% CI: (0.92-2.65), p = 0.094). Pretreated compared with no pretreated population showed reduced infarct size expressed as Troponin Peak (20,286 (8726-75,027) versus 48,676 (17,229-113,900), p = 0.001), and higher left ventricular ejection fraction at discharge (53% (44-59) vs. 50% (44-56), p = 0.027). In-hospital BARC ≥ 2 bleeding were similar (2.1% vs. 2.0%, p = 0.929, in pretreated versus no pretreated population, respectively). Conclusion:This study provides support for an early pretreatment strategy in STEMI patients and confirmed the importance of an efficient organization of STEMI networks which allow initiation of antithrombotic treatment at FMC.

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2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation

Abstract: 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation

Cited by 241 publications

References 0 publications

Framing Cause-Effect Relationship of Acute Coronary Syndrome in Patients with Chronic Kidney Disease

Framing Cause-Effect Relationship of Acute Coronary Syndrome in Patients with Chronic Kidney Disease

Acute coronary syndrome in patients with cancer: features of the course and the possibility of predicting hospital and long-term (6 months) periods using GDF-15, NT-proBNP, hs-CRP biomarkers

Effect of prehospital treatment in STEMI patients undergoing primary PCI

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