Determinants and Prognostic Impact of Heart Failure and Left Ventricular Ejection Fraction in Acute Coronary Syndrome Settings

Bermejo, Rosa Agra; Cordero, Alberto; Garcı́a-Acuña, José Marı́a; Otero, Iago; Román, Alfonso Varela; Martínez, Álvaro; Rodríguez, Leyre Álvarez; Abou-Jokh, Charigan; Rodríguez‐Mañero, Moisés; Álvarez, Belén Cid; López-Palop, Ramón; Carrillo, Pilar; González-Juanàtey, José Ramón

doi:10.1016/j.rec.2017.10.030

Cited by 17 publications

(17 citation statements)

References 31 publications

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“…This difference was not significant. Ejection fraction (less than 50%) is considered an important prognostic factor for patients with acute coronary syndromes without heart failure [9]. Revascularization techniques yield better results in patients with reduced ejection fraction [10].…”

Section: Discussionmentioning

confidence: 99%

Diurnal Variation in Outcomes of Percutaneous Coronary Intervention

Malik

Javed

2020

Cureus

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To determine whether the outcomes differ during regular hours as compared to off hours in patients with acute myocardial infarction who undergo primary percutaneous coronary intervention. Methods We conducted a prospective, interventional study of patients who presented to a specialized cardiac care center. Patients who satisfied the inclusion and exclusion criteria were included in the study. They were divided into two groups so that one group received intervention during regular working hours while the other group received intervention during 'off' hours. The data was collected through a self-constructed questionnaire. Cronbach's alpha was used to assess the internal consistency of the questionnaire, and it was found to be 0.75. The data obtained was analyzed on IBM's Statistical Package for the Social Sciences (SPSS) version 21.0 (IBM, Armonk, NY). Results Out of 100 participants, 64 (64%) were males and 36 (36%) were females. The mean age of the participants was 58.58 ± 13.21 years. Most (44%) of the patients were diabetic. Inferior wall myocardial infarcts were more common in our study. Percutaneous intervention during 'off' hours was associated with more adverse outcomes. The differences in gender and angina requiring revascularization were statistically significant (p-value<0.05). Conclusion No significant difference in outcomes was observed in both groups of patients. Metacentric data from different institutes should be gathered for a comprehensive insight on this topic where door-to-balloon times and initiation of catheterization lab procedures are practiced in different ways.

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Section: Discussionmentioning

confidence: 99%

Diurnal Variation in Outcomes of Percutaneous Coronary Intervention

Malik

Javed

2020

Cureus

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“…According to a study conducted in Spain LVEF in patients with heart failure is not related to long term prognosis in patients with ACS whereas LVEF is a strong predictor of prognosis in patients without heart failure during admission. 11 LVEF is a strong prognostic predictor in patients with acute coronary syndrome. ACS causes irreversible myocardial damage and remodelling which causes progressive dilatation and deterioration in contractile function and hence impaired left ventricular ejection fraction causing heart failure, increased mortality and life-threatening arrhythmias.…”

Section: Acs and LV Dysfunctionmentioning

confidence: 99%

“…ACS causes irreversible myocardial damage and remodelling which causes progressive dilatation and deterioration in contractile function and hence impaired left ventricular ejection fraction causing heart failure, increased mortality and life-threatening arrhythmias. 11…”

Section: Acs and LV Dysfunctionmentioning

confidence: 99%

Admission blood glucose and echocardiography to predict major adverse cardiac events in acute coronary syndrome: a review

2020

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A life-threatening presentation of coronary artery disease is acute coronary syndrome (ACS). The major adverse cardiac events (MACE) after acute coronary syndrome include life threatening arrhythmias, cardiac failure, cardiogenic shock, recurrent ischemia and sudden death. Patients with severe and moderate LV dysfunction are more likely to have triple vessel disease. Regional wall motion abnormality assessed by regional wall motion index using 2D-echocardiography correlates with infarct size which in turn predicts the occurrence of major adverse cardiac events (MACE) in patients with acute coronary syndrome. The cause for cardiogenic shock is left ventricular pump failure due to extensive damage to the myocardium and infarct related mechanical complications. In patients admitted with acute coronary syndrome, 5% develop ventricular tachycardia or ventricular fibrillation especially after 48 hours after hospital admission. Hyperglycemia causes stronger sympathetic activation in patients with severe illness and hence increased glucose levels. Insulin resistance not only causes hyperglycemia but can also lead to reduced energy production in the heart and lower tolerance to hypoperfusion and acts as an indicator of systemic and organ specific metabolic dysregulation and also stress hyperglycemia is implicated in the activation of pathological processes that causes cellular and tissue injury like increasing free radical formation and oxidative stress, inducing prothrombotic stress and worsening endothelial function. Hence higher levels of admission time blood glucose, hypoglycaemia during hospital stay, persistent hyperglycemia are considered as poor prognostic markers in patients with acute coronary syndrome.

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“…Coronary heart disease is the leading risk factor for heart failure incidence [ 1 , 2 , 3 ], and acute coronary syndrome (ACS) is the most frequent and threatening clinical presentation. The falling of in-hospital and short-term mortality of ACS patients has shifted the impact of the disease, increasing the percentage of patients with chronic coronary heart disease at risk of heart failure (HF) readmissions [ 4 , 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…In-hospital [ 4 ] and post-discharge [ 7 , 8 ] HF have a large influence on ACS prognosis and, consequently, individual estimation of the actual risk of HF might be very relevant. Several biomarkers have proven to be crucial for the diagnosis, treatment and prognosis assessment in patients with HF [ 9 , 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Predictive Value of Pro-BNP for Heart Failure Readmission after an Acute Coronary Syndrome

Cordero

Rey-Rañal

Moreno

et al. 2021

JCM

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Background: N-terminal pro-brain natural peptide (NT-pro-BNP) is a well-established biomarker of tissue congestion and has prognostic value in patients with heart failure (HF). Nonetheless, there is scarce evidence on its predictive capacity for HF re-admission after an acute coronary syndrome (ACS). We performed a prospective, single-center study in all patients discharged after an ACS. HF re-admission was analyzed by competing risk regression, taking all-cause mortality as a competing event. Results are presented as sub-hazard ratios (sHR). Recurrent hospitalizations were tested by negative binomial regression, and results are presented as incidence risk ratio (IRR). Results: Of the 2133 included patients, 528 (24.8%) had HF during the ACS hospitalization, and their pro-BNP levels were higher (3220 pg/mL vs. 684.2 pg/mL; p < 0.001). In-hospital mortality was 2.9%, and pro-BNP was similarly higher in these patients. Increased pro-BNP levels were correlated to increased risk of HF or death during the hospitalization. Over follow-up (median 38 months) 243 (11.7%) patients had at least one hospital readmission for HF and 151 (7.1%) had more than one. Complete revascularization had a preventive effect on HF readmission, whereas several other variables were associated with higher risk. Pro-BNP was independently associated with HF admission (sHR: 1.47) and readmission (IRR: 1.45) at any age. Significant interactions were found for the predictive value of pro-BNP in women, diabetes, renal dysfunction, STEMI and patients without troponin elevation. Conclusions: In-hospital determination of pro-BNP is an independent predictor of HF readmission after an ACS.

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Determinants and Prognostic Impact of Heart Failure and Left Ventricular Ejection Fraction in Acute Coronary Syndrome Settings

Cited by 17 publications

References 31 publications

Diurnal Variation in Outcomes of Percutaneous Coronary Intervention

Diurnal Variation in Outcomes of Percutaneous Coronary Intervention

Admission blood glucose and echocardiography to predict major adverse cardiac events in acute coronary syndrome: a review

Predictive Value of Pro-BNP for Heart Failure Readmission after an Acute Coronary Syndrome

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