Risk for Recurrent Cardiovascular Events and Expected Risk Reduction With Optimal Treatment 1 Year After an Acute Coronary Syndrome

Zafeiropoulos, Stefanos; Farmakis, Ioannis; Κάρτας, Αναστάσιος; Arvanitaki, Alexandra; Pagiantza, Areti; Boulmpou, Aristi; Tampaki, Athina; Kosmidis, Diamantis; Nevras, Vasileios; Markidis, Eleftherios; Arvanitakis, Konstantinos; Sianos, George; Makedou, Kali; Ziakas, Antonios; Karvounis, Haralambos; Giannakoulas, George

doi:10.1016/j.amjcard.2020.07.046

Cited by 10 publications

(7 citation statements)

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“…The terms "SMuRF" and "SMuRF-less" have been coined in 2017 by Vernon et al (6). Patients presenting with ACS without any SMuRFs have been recognized as a significant and separate clinical entity since their proportion has shown increasing trends during the last decades (5,15,16). The prevalence of SMuRF-less status in cardiovascular disease seems to range from 3 to 27% depending on the studied population (2, 5-7, 9, 14, 17-19).…”

Section: Discussionmentioning

confidence: 99%

Angiographic severity in acute coronary syndrome patients with and without standard modifiable risk factors

Papazoglou

Farmakis

Zafeiropoulos

et al. 2022

Front. Cardiovasc. Med.

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BackgroundRoutine coronary artery disease (CAD) secondary prevention strategies target standard modifiable cardiovascular risk factors (SMuRFs), which include: diabetes mellitus, dyslipidemia, hypertension, and smoking. However, a significant proportion of patients with acute coronary syndrome (ACS) present without any SMuRFs. The angiographic severity of disease in this population has not yet been investigated.MethodsAfter propensity score matching of patients without SMuRFs and patients with ≥1 SMuRFs (ratio 1:3), we used zero-inflated negative binomial regression modeling to investigate the relationship of SMuRF-less status with the angiographic severity of CAD, as measured by the SYNTAX score. Survival analysis was performed to investigate differences in all-cause mortality at 30 days and at the end of follow-up period.ResultsWe analyzed 534 patients presenting with ACS who underwent coronary angiography. Of them, 56 (10.5%) presented without any SMuRF. After propensity score matching, the median SYNTAX score was 13.8 (IQR 0–22.1) in 56 SMuRF-less patients and 14 (IQR 5–25) in 166 patients with ≥1 SMuRFs. SMuRF-less status was associated with increased odds of zero SYNTAX score [zero-part model: odds ratio = 2.11, 95% confidence interval (CI): 1.03–4.33], but not with decreased SYNTAX score among patients with non-zero SYNTAX score (count-part model: incidence rate ratio = 0.99, 95% CI: 0.79–1.24); the overall distribution of the SYNTAX score was similar between the two groups (p = 0.26). The 30-day risk for all-cause mortality was higher for SMuRF-less patients compared to patients with ≥1 SMuRFs [hazard ratio (HR) = 3.58, 95% CI: 1.30–9.88]; however, the all-cause mortality risk was not different between the two groups over a median 1.7-year follow-up (HR = 1.72, 95% CI: 0.83–3.57).ConclusionAmong patients with ACS, the absence of SMuRFs is associated with increased odds for non-obstructive CAD and with increased short-term mortality rates.

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Section: Discussionmentioning

confidence: 99%

Angiographic severity in acute coronary syndrome patients with and without standard modifiable risk factors

Papazoglou

Farmakis

Zafeiropoulos

et al. 2022

Front. Cardiovasc. Med.

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“…Кроме чисто процедурных и анатомических особенностей, риск повторных коронарных событий у пациентов, перенесших ОКС, определяют модифицируемые факторы риска (ФР), такие как уровень систолического артериального давления (АД) и холестерина липопротеидов низкой плотности (ХС-ЛНП), в особенности -их сосуществование. При активном контроле этих факторов 10-летний риск повторных ССО удается снизить до <10% в половине случаев [1].…”

Section: Discussionunclassified

Integrated solution for patients of a very high cardiovascular risk. Final results

et al. 2023

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Secondary prevention should be actively implemented at all stages of treatment and rehabilitation of patients after acute coronary syndrome (ACS). The integration of remote monitoring of patients with the transfer of vital and laboratory data into clinical practice seems promising.Aim. To evaluate the clinical and patient-centered effectiveness of the original 12-month combined face-to-face and telecare program in patients with recent ACS.Material and methods. For the present analysis the data from 84 (out of 100) patients (median age, 56 (50;61) years, 70 males) was used. These patients had to have hypertension and/or type 2 diabetes and an ACS with percutaneous revascularization within 12 months. Their low-density lipoprotein cholesterol (LDL-C) had to be above 2,4 mmol/L. Telehealth program supplemented routine care. A program contained electronic self-control diaries for blood pressure (BP) and lipid profile, and teleconsulting service (text chat). Mandatory face-to-face visits were carried out at 3 and 12 months after the enrollment. The primary end point was ∆LDL-C. Additional clinical and patient-specific endpoints were evaluated.Results. At the 12-month visit, there was a significant decrease in LDL-C by 1,6 (-2,3;-0,9) mmol/L. Besides the initial LDL-C value, the decrease in LDL-C was associated with the proper adherence to keeping diaries of BP and lipid profile (β=0,7), and the number of text messages sent by the doctor in the 1st month after the enrollment (β=0,04). In more adherent patients, the ∆LDL-C was greater by 0,49 mmol/L (95% CI (-1,2; -0,1)) after adjustment for abovementioned covariates. In 35 patients (42%), target LDL-C was achieved, in 60 patients (71%) — a decrease ≥1 mmol/l. Other lipids also have changed for the better. Moreover, adherent patients were twice as likely to achieve the target LDL-C (OR 2,2; 95% CI (0,6; 3,8)) than non-adherent ones. A decrease in office systolic BP by 5,8 mm Hg was shown (p=0,03). The number of physician-to-patient messages exceeded those from patients to physician (median 143 and 111 per patient for 12 months, respectively). The quality of life has improved, but only in terms of emotions. Satisfaction with the program remained high at all timepoints of the study.Conclusion. Our study showed the effectiveness of the integrated care in ACS patients with the telehealth tool included. Commitment to BP self-monitoring, as well as active consultative support at the first stages of rehabilitation, contributes to additional dynamic control of lipid profile, timely correction of lipid-lowering therapy with the achievement of the target LDL-C level. Most of the patients did not experience any difficulties in using the program and are ready to recommend integrated approach to other peers.

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“…In addition to the conventional risk factors, the variables with the highest predictable value determined by XGBoost included prior ASCVD and non-traditional risk factors, like education and socioeconomic levels. Similarly, other ML studies (Reduction of Atherothrombosis for Continued Health and Second Manifestations of Arterial Disease) reported consistent performance throughout the cohort in weeding out residual risk in those with established cardiovascular diseases 2 3. Nevertheless, it is essential to recognise the limitation of these models in younger lower-risk populations without prior ASCVD.…”

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confidence: 83%

Artificial intelligence and machine learning: the resurgence of the industrial revolution by robots

Alasnag

Hanfi²,

Alasnag

2022

Open Heart

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Risk for Recurrent Cardiovascular Events and Expected Risk Reduction With Optimal Treatment 1 Year After an Acute Coronary Syndrome

Cited by 10 publications

References 28 publications

Angiographic severity in acute coronary syndrome patients with and without standard modifiable risk factors

Angiographic severity in acute coronary syndrome patients with and without standard modifiable risk factors

Integrated solution for patients of a very high cardiovascular risk. Final results

Artificial intelligence and machine learning: the resurgence of the industrial revolution by robots

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