Acute coronary syndromes

Karras, Constantine L.; Donlan, Sarah; Aitchison, Robert; Aitchison, Pamela; Wang, Ernest; Kharasch, M. S.

doi:10.1016/j.disamonth.2013.03.006

“…Acute coronary syndrome (ACS) is an umbrella term for a range of clinical symptoms associated with myocardial hypo-perfusion as a consequence of pathological mechanisms [1,2]. Patients with ACS are classified as ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI) or unstable angina [2].…”

Section: Introductionmentioning

confidence: 99%

“…Patients with ACS are classified as ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI) or unstable angina [2]. The adverse effects of ACS include fatal arrhythmias, heart failure and cardiogenic shock [1,3,4]. Efficacy and speed are essential if maximum benefits are to be achieved from the therapeutic interventions that are available to patients [5].…”

Section: Introductionmentioning

confidence: 99%

Improving knowledge, attitudes and beliefs about acute coronary syndrome through an individualized educational intervention: A randomized controlled trial

O’Brien

¹

,

McKee

²

,

Mooney

³

et al. 2014

Patient Education and Counseling

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CitationImproving knowledge, attitudes and beliefs about acute coronary syndrome through an individualized educational intervention: A randomized controlled trial. Methods: This multi-site, randomized controlled trial was conducted on 1947 patients with a diagnosis of ACS. Both groups received usual in-hospital education.Participants randomized to the intervention group received a 40-minute one to one individualized education session, delivered using motivational interviewing techniques. The intervention was reinforced one month and six months later.Knowledge, attitudes and beliefs were measured using the ACS Response Index. A total of 1,136 patients (control, n=551; intervention, n=585) completed the questionnaire at baseline, 3 and 12 months. Data were analysed using repeated measures analysis of variance. Ethical approval was obtained. Results:There was a significant effect of the intervention on mean knowledge (p<0.001), attitude (p=0.003) and belief (p<0.001) scores at 3 and 12 months. Conclusion:Ensuring patients retain information post education has always been difficult to attain. This study demonstrated that patient education using motivational interviewing techniques and an individualized approach has the potential to alter knowledge, attitudes and beliefs about ACS among a high risk population.Practice Implications: This relatively short, simple and effective educational intervention could be delivered by nurses in multiple settings.

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“…STEMI patients are advised to undergo PCI by a skilled provider in a wellequipped facility within 90 minutes of presenting to hospital, with fibronolytic therapy recommended if this time frame cannot be achieved. Adjunct therapies to manage both the acute phase and chronic disease include: oxygen, nitroglycerin, analegesia, antiplatelet agents, hypertensive medications, anticoagulation and statin therapy [39].…”

Section: Clinical Treatment Of Acsmentioning

confidence: 99%

Glutathione peroxidase in acute coronary syndromes

Holley¹

0

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<p>Glutathione peroxidase (GPx) and superoxide dismutase (SOD) are among the primary antioxidant enzymes that scavenge reactive oxygen species in the blood (ROS), thereby protecting against high levels of oxidative stress. The consequences of oxidative stress include cellular injury and tissue damage. High levels of oxidative stress have been implicated in the pathogenesis of acute coronary syndromes (ACS), however large clinical trials involving dietary antioxidant supplements have not shown a reduction in the rate of major adverse cardiovascular events (MACE). In a cohort of 262 ACS patients we examined the relationship between GPx activity, SOD activity and MACE. Patients with MACE were found to have significantly lower levels of GPx activity than those without MACE, whereas SOD activity did not differ between the groups. Furthermore, dividing the patients into quartiles corresponding to levels of GPx activity demonstrated significantly higher rates of MACE in the lower quartile of GPx activity compared to the highest quartile. Previous studies have demonstrated that deficiencies in GPx activity are associated with vascular dysfunction and platelet-dependent thrombosis, leading to the hypothesis that low levels of GPx activity would be associated with increased levels of platelet reactivity. In 51 ACS patients we did not observe a significant relationship between these two parameters, however we did demonstrate that increasing levels of GPx activity was associated with lower levels of ROS. ROS measures were based on the response of the platelets to addition of exogenous nitric oxide. Such an inverse relationship between GPx activity and levels of ROS is consistent with the view that GPx activity may play an important role in an ACS by reducing ROS-mediated damage, thereby protecting against MACE. We examined levels of GPx activity, protein concentration and mRNA expression across populations of ACS patients, stable coronary disease patients and healthy subjects. Cardiovascular risk factors thought to influence levels of GPx activity were controlled for in all three cohorts. These studies demonstrated that GPx activity, protein and mRNA levels were significantly elevated in the ACS patients compared to the stable coronary disease patients and healthy subjects. Oxidised low-density lipoprotein (oxLDL), a widely used marker of oxidative stress, was also significantly elevated in the ACS patients compared to the other two cohorts. In a study examining the temporal changes in GPx activity in the acute phase of an ACS, GPx activity was found to be highly dynamic, with no consistent single time point that identified when peak activity occurred. In the majority of patients, levels of oxLDL were found to peak prior to, or at the same time, as peak GPx activity, suggesting that GPx activity was modulated by changes in oxidative stress. In conclusion, the elevated levels of GPx activity observed in ACS patients were found to be highly dynamic throughout an ACS event. However those with lower levels of GPx activity have an increased risk of adverse clinical outcomes that may be due to an inadequate defence against levels of ROS. Whether these patients can be accurately identified and targeted with an appropriate therapeutic intervention warrants further investigation.</p>

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“…The main goal is to reduce the amount of myocardial necrosis thus preserving left ventricular function. This allows for the prevention and management of major adverse cardiac events such as ventricular fibrillation, decompensated heart failure and cardiogenic shock [39]. Reperfusion therapy to restore coronary blood flow to the ischemic myocardium is the primary objective for ACS treatment to limit infarct size.…”

Section: Clinical Treatment Of Acsmentioning

confidence: 99%

Glutathione peroxidase in acute coronary syndromes

Holley¹

0

View full text Add to dashboard Cite

<p>Glutathione peroxidase (GPx) and superoxide dismutase (SOD) are among the primary antioxidant enzymes that scavenge reactive oxygen species in the blood (ROS), thereby protecting against high levels of oxidative stress. The consequences of oxidative stress include cellular injury and tissue damage. High levels of oxidative stress have been implicated in the pathogenesis of acute coronary syndromes (ACS), however large clinical trials involving dietary antioxidant supplements have not shown a reduction in the rate of major adverse cardiovascular events (MACE). In a cohort of 262 ACS patients we examined the relationship between GPx activity, SOD activity and MACE. Patients with MACE were found to have significantly lower levels of GPx activity than those without MACE, whereas SOD activity did not differ between the groups. Furthermore, dividing the patients into quartiles corresponding to levels of GPx activity demonstrated significantly higher rates of MACE in the lower quartile of GPx activity compared to the highest quartile. Previous studies have demonstrated that deficiencies in GPx activity are associated with vascular dysfunction and platelet-dependent thrombosis, leading to the hypothesis that low levels of GPx activity would be associated with increased levels of platelet reactivity. In 51 ACS patients we did not observe a significant relationship between these two parameters, however we did demonstrate that increasing levels of GPx activity was associated with lower levels of ROS. ROS measures were based on the response of the platelets to addition of exogenous nitric oxide. Such an inverse relationship between GPx activity and levels of ROS is consistent with the view that GPx activity may play an important role in an ACS by reducing ROS-mediated damage, thereby protecting against MACE. We examined levels of GPx activity, protein concentration and mRNA expression across populations of ACS patients, stable coronary disease patients and healthy subjects. Cardiovascular risk factors thought to influence levels of GPx activity were controlled for in all three cohorts. These studies demonstrated that GPx activity, protein and mRNA levels were significantly elevated in the ACS patients compared to the stable coronary disease patients and healthy subjects. Oxidised low-density lipoprotein (oxLDL), a widely used marker of oxidative stress, was also significantly elevated in the ACS patients compared to the other two cohorts. In a study examining the temporal changes in GPx activity in the acute phase of an ACS, GPx activity was found to be highly dynamic, with no consistent single time point that identified when peak activity occurred. In the majority of patients, levels of oxLDL were found to peak prior to, or at the same time, as peak GPx activity, suggesting that GPx activity was modulated by changes in oxidative stress. In conclusion, the elevated levels of GPx activity observed in ACS patients were found to be highly dynamic throughout an ACS event. However those with lower levels of GPx activity have an increased risk of adverse clinical outcomes that may be due to an inadequate defence against levels of ROS. Whether these patients can be accurately identified and targeted with an appropriate therapeutic intervention warrants further investigation.</p>

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Acute coronary syndromes

Cited by 8 publications

References 3 publications

Improving knowledge, attitudes and beliefs about acute coronary syndrome through an individualized educational intervention: A randomized controlled trial

Improving knowledge, attitudes and beliefs about acute coronary syndrome through an individualized educational intervention: A randomized controlled trial

Glutathione peroxidase in acute coronary syndromes

Glutathione peroxidase in acute coronary syndromes

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