Novel predictors of acute coronary syndrome outcomes

Morbidity and mortality rates among patients with acute coronary syndrome (ACS) remain high, and it is difficult to determine which patients will progress satisfactorily and which patients will have poor outcomes. Research has indicated that the inflammatory process is involved in coronary disease. There is great interest within the research community in determining if inflammatory markers could be used to determine the severity of the disease process and therefore serve as a prognostic tool for clinicians. This article describes the inflammatory process in ACS and provides a review of the current diagnostic studies of endothelial inflammatory markers (EIMs) in heart disease. Although research results of EIMs have not all been significant in determining outcomes, there is some evidence that they may be more specific than other generalized inflammatory markers, such as C-reactive protein. Future research of EIMs in patients with ACS might provide evidence of easy-to-measure and economically feasible markers that are sound prognosticators.     

The effects of early application of simvastatin on C-reactive protein level, blood lipids, and the clinical course of acute coronary syndrome

In spite of a large number of studies on the use of HMG-CoA-reductase inhibitors (statins) in treatment of different forms of coronary artery disease, the efficacy of their early administration in acute coronary syndrome (ACS) is still unclear. The purpose of the present investigation was to study the effects of medium doses (40 mg per day) of simvastatin on the clinical course of ACS and blood levels of C-reactive protein (CRP) and lipids in ACS patients to whom the drug was administered on the first day of the disease. One hundred and eight patients with ACS were randomized into two groups: the control group receiving standard therapy, and the main group receiving in addition 40 mg of simvastatin beginning on the first day of the disease. Blood levels of lipids and CRP were measured by a precise qualitative technique on the first and fourteenth days of the disease. The clinical course of the disease was evaluated during six months from the first day of hospital stay. Mean CRP level decreased significantly within two weeks in the group of patients receiving simvastatin (from 14.9 +/- 9.7 to 7.6 +/- 6.0 mg/l; p = 0.02). In the control group CRP concentration decreased less and not significantly (from 16.1 +/- 7.3 to 13.2 +/- 6.8 mg/l; p = 0.18). Two main types of the dynamics of CRP level were revealed in the ACS patients. Most patients in both groups displayed a decrease in CRP level by the fourteenth day of the disease. At the same time, in some patients CRP level grew during this period, and these patients had stenocardia and required repeated hospital admissions due to ACS recurrence significantly more frequently during the following six months (relative risk 1.4; 95% confidence interval 1.1 to 1.8). The frequency of postinfarction stenocardia was the most substantial and significant clinical difference between the groups (50.9% in the control group, and 23.6% in the main group, p = 0.04). Thus, early therapy with simvastatin in ACS lowers SRP level and the frequency of postinfarction stenocardia. The elevation of CRP level during the first two weeks of the disease is a poor prognostic sign.     

急性冠脉综合征患者氧化低密度脂蛋白凝集素样氧化低密度脂蛋白受体-1的水平变化

目的观察不同类型冠心病患者血中氧化低密度脂蛋白(ox-LDL)、凝集素样氧化低密度脂蛋白受体-1(LOX-1)水平的变化及其之间的关系,探讨临床预测急性冠脉综合征(ACS)的血清学指标。方法采用酶联免疫吸附法测定40例冠心病患者[ACS20例、稳定型心绞痛(SAP)20例]、20例非冠心病患者血清ox-LDL、LOX-1的变化。结果ACS患者外周血清总胆固醇(TC)、低密度脂蛋白(LDL)、ox-LDL、LOX-1水平均高于SAP和非冠心病患者;SAP患者外周血清ox-LDL、LOX-1高于非冠心病患者。ACS患者治疗后ox-LDL、LOX-1水平均低于治疗前。ACS患者LOX-1与ox-LDL呈正相关(P<0.01)。结论ACS患者外周血清ox-LDL、LOX-1水平升高,二者可作为动脉粥样硬化斑块不稳定的血清学指标。     

Clinical development of bivalirudin (Angiox): rationale for thrombin-specific anticoagulation in percutaneous coronary intervention and acute coronary syndromes

As the pathophysiology of acute coronary syndromes (ACS) has been clarified in recent years, major advances have been made in the management of the disease. The magnitude of the thrombotic process triggered upon plaque disruption is modulated by different elements that determine plaque and blood thrombogenicity. Thrombin plays a pivotal role in ACS because of its extensive procoagulant and prothrombotic actions. Antithrombotic therapy and powerful antiplatelet therapies, in addition to early percutaneous coronary intervention (PCI), have become central in the management of ACS. A number of options for anticoagulation regimens are available. However, many agents currently used have significant limitations, recognition of which has led to the development, evaluation and clinical introduction of the class of thrombin-specific anticoagulant agents. This paper will discuss the clinical development of the direct thrombin inhibitor bivalirudin as the core anticoagulant in the contemporary PCI setting and the implications for its use in ACS.     

探讨Hcy、hs-CRP与急性冠脉综合征危险分层的相关性

目的探讨血清同型半胱氨酸（homocysteine,Hcy）、超敏c反应蛋白（high sensitivity—C reactiveprotein,hs—CRP）水平与急性冠脉综合征（acute coronary syndrome,ACS）危险分层的关系。方法选择2011年12月-2012年12月我院住院的ACS患者71例,根据ACS诊断标准分为不稳定型心绞痛（unstable angina peetoris,UAP）患者22例、非sT段抬高心肌梗死（non—ST—elevation myocardial infaretion,NSTEMI）患者17例和ST段抬高心肌梗死（ST—elevation myocardial infarction,STEMI）患者32例。根据GRACE评分标准将各组患者进行危险分层,分为低危组、中危组和高危组,对各组患者进行hs-CRP和Hcy水平检测,并对所有数据进行统计学分析。结果71例ACS患者一般资料分析结果显示,低危组、中危组和高危组患者间除年龄差异有统计学意义外（P〈0．05）,其余各指标差异均无统计学意义（P均〉0.05）。22例UAP患者和17例NSTEMI患者中,中危组和高危组的hs—CRP水平均显著高于低危组,差异均有统计学意义（P均〈0．05）,而在32例STEMI患者中,hs—CRP水平在低危组、中危组和高危组间差异均有统计学意义（P均〈0．05）;在三种类型的ACS患者中,Hcy水平在低危组、中危组和高危组中差异均无统计学意义（P均〉0．05）。结论ACS疾病的严重程度随着年龄的增长逐渐加重。hs—CRP水平可反映ACS患者的病程情况,对ACS的治疗和预后评估有一定价值;Hcy尚不能作为ACS危险分层的一个监测指标。     

急性冠脉综合征患者血浆白介素18、白介素10及其比值的变化和意义

目的：观察急性冠脉综合征患者血浆白介素（IL）-18、IL-10及其比值的变化,探讨其在急性冠脉综合征发生中的意义。方法：采用酶联免疫吸附（ELISA）法检测66例急性冠脉综合征患者和48例稳定型心绞痛患者血浆IL-18、IL-10等浓度变化。结果：急性冠脉综合征患者血浆IL-18、IL-10水平及其比值明显高于稳定性心绞痛患者（P〈0.01）;IL-18/IL-10比值与急性冠脉综合征的发生显著相关（OR=5.567,P〈0.01）。结论：急性冠脉综合征患者炎症反应比稳定型心绞痛明显;IL-18/IL-10比值与急性冠脉综合征的发生明显相关,提示了IL-18/IL-10对预测急性冠脉综合征的发生有一定价值。     

High frequency of aspirin resistance in patients with acute coronary syndrome

Aspirin is widely used for secondary prevention of cardiovascular disease, but is not effective for all patients. This phenomenon is called as aspirin resistance. Although the prognosis is worse in patients who develop acute coronary syndrome (ACS) while using aspirin, the frequency of aspirin resistance in these patients has not been evaluated. We aimed to evaluate the frequency of aspirin resistance in patients with ACS and to determine its relationship with the angiographic severity and extent of the associated coronary artery disease. The present study included 104 patients with ACS (75 men, 60.4 +/- 10.8 years) who were hospitalized while using aspirin for at least last 7 days and 100 patients with stable coronary artery disease (73 men, 57.6 +/- 10.6 years), documented by coronary angiography, history of revascularization or myocardial infarction (MI), and the use of aspirin for last 7 days. The latter group had no MI or ACS for last 3 months. Platelet function was assessed with PFA-100, which simulates primary homeostasis at injured blood vessels. Coronary angiography was performed in 83 cases of the patients with ACS during hospital stay. Aspirin resistance is more prevalent in patients with ACS (40.3%) when compared with stable coronary artery disease patients (27%). The difference was statistically significant (p = 0.04). The ACS patients with aspirin resistance were older and had severe myocardial damage. However, there were no significant differences in angiographic severity and extent of coronary artery disease between aspirin-resistant and aspirin-sensitive patients. Frequency of aspirin resistance is higher in patients who develop ACS while using aspirin than that in patients with stable coronary artery disease.     

血小板参数与ACS患者冠脉病变程度的相关性

目的 探讨急性冠脉综合征患者(ACS)血小板参数水平与其冠脉病变严重程度之间的关系.方法 收集ACS患者102例及无缺血性心脏病对照组50例.所有人选者术前空腹采血测定血小板参数.ACS患者行冠状动脉造影及冠脉狭窄程度的评分(Gensini评分).结果 ACS患者MPV,P-LCR较正常对照组显著升高.而PDW,PCT与对照组相比差异无统计学意义.所有ACS患者冠脉病变支数与Gensini评分均随MPV与P-LCR水平的升高而增长.结论 早期监测血小板参数的相关变化对于急性冠脉综合征患者病情的诊断和控制可能具有积极作用.     

Development of a COVID-19 alternate care site from ground zero: A nursing perspective

The novel coronavirus disease SARS-CoV-2 (COVID-19) outbreak rapidly generated an unprecedented global, national, and state public health crisis with the need to rapidly develop alternate care sites (ACS) to care for COVID-19 patients within an overburdened health care system. A hospital care model ACS to increase the health care capacity, provide care for mild to moderately symptomatic patients, and offer local self-sustainment for a surge of patients was developed in Memphis, Tennessee located in Shelby County. We completed a temporary conversion of a large unused newspaper publication building to a health care facility for COVID-19 patients. Developing an ACS from ground zero was met with many challenges, and throughout the process important lessons were learned. With the goal to complete the building conversion within a 28-day timeframe, collaboration among the numerous governmental, health care, and private agencies was critical and nursing leadership was key to this process. The purpose of this paper is to describe the development of a COVID-19 ACS in Memphis, TN, which has a large at-risk population with limited access to health care. Specifically, we will discuss the strong leadership role of nursing faculty, key challenges, and lessons learned, as well as provide checklists and models for others in similar circumstances.     

Interpreting troponin in renal disease: A narrative review for emergency clinicians

IntroductionPatients with chronic kidney disease (CKD)/end stage renal disease (ESRD) can experience several severe complications, including acute coronary syndrome (ACS). While troponin is the biomarker of choice for evaluation of ACS, interpretation of troponin in CKD/ESRD can be challenging.ObjectiveThis narrative review evaluates troponin elevation in patients with CKD/ESRD, pitfalls in the evaluation with troponin, and an approach to using troponin in these high-risk patients.DiscussionPatients with CKD/ESRD are at greater risk for ACS and possess higher levels of circulating troponin. Relatedly, these patients often present atypically for ACS. Several pitfalls must be considered in the use of troponin when evaluating for ACS. While troponin elevation in patients with CKD/ESRD is often considered to be due to underlying renal disease, this elevation has several etiologies including uremic skeletal myopathy, microinfarctions, left ventricular hypertrophy (LVH), decreased clearance, and unrecognized congestive heart failure (CHF). Utilizing troponin assays in this patient population requires a nuanced approach, as the sensitivity and specificity for troponin testing in CKD varies. Concern for ACS with elevated troponin warrants treatment for ACS until proven otherwise, with consideration of atypical presentations along with other causes for patient symptoms that may result in troponin elevation.ConclusionsPatients with CKD/ESRD presenting with symptoms concerning for ACS are challenging. The utilization of troponin assays is important in this population given their high risk of ACS but requires an educated and nuanced approach.     

Markers of myocardial injury and dysfunction

Acute coronary syndrome (ACS) is defined as the spectrum of diagnoses from angina to sudden cardiac death caused by ischemic coronary artery disease. Although cardiovascular disease is the leading cause of death of adults in the United States, the ability to diagnose ACS is not always definitive. Cardiac markers are laboratory tests that are used to assist in the diagnosis. Research continues to develop new and refine "old" cardiac markers to improve diagnostic testing that then leads to appropriate and timely interventions for patients with ACS. The purpose of this article is to review the cardiac markers and their role in the diagnosing, as well as predicting the risk of ACS.     

健康教育个体化对预防急性冠脉综合征的应用研究

目的研究健康教育预防急性冠脉综合征(ACS)的临床治疗效果。方法将62例老年ACS患者分为A组(常规教育)和B组(个体化教育),B组通过指导患者制定合适的活动度、掌握缓解疼痛的方式、改善遵医行为、减少冠心病强危险因素以及改变A型行为等方法对患者进行个体化健康教育;A组分小组实施教育。对2组患者康复效果进行对照比较。结果2组患者的康复有效率:A组低于B组,经统计学分析差异有显著性。结论在ACS患者的诊疗过程中,实施个体化教育对促进患者恢复,减少危险因素的发生具有重要辅助作用。     

急性冠状动脉综合征与现症幽门螺杆菌感染的相关性

[目的]探讨现症幽门螺杆菌（Hp）感染与急性冠状动脉综合征（ACS）的相关性,并通过相关炎症因子的变化探讨其致病机理.[方法]对113例经冠状动脉造影及临床检查确诊为ACS的患者及52例因其他疾病入院经冠状动脉造影（CAG）排除冠心病（CHD）的患者,以^14C-尿素呼气试验阳性作为现症Hp感染诊断指标,同时检测高敏C反应蛋白、肿瘤坏死因子-α、白细胞介素-1三种炎症因子及血清幽门螺杆菌抗体（Hp IgG）.[结果]ACS患者现症HP感染率（45.1%）显著高于非冠心病患者（19.2%）、三种炎症因子水平ACS组均明显高于非冠心病组（ P〈0.01）,现症HP感染者中有76.5%合并慢性Hp感染,通过多元回归分析,提示高敏C反应蛋白及Hp现症感染和慢性感染同时并存与ACS相关性最强.[结论]急性炎症反应可能是ACS发病的促发因素之一,而现症Hp感染可能通过激发急性炎症反应参与ACS的发生.     

急性冠脉综合征患者血清高密度脂蛋白胆固醇、超氧化物歧化酶、游离脂肪酸水平分析

目的:探讨高密度脂蛋白胆固醇(HDL-C)、超氧化物歧化酶(SOD)、游离脂肪酸(NEFA)水平与急性冠脉综合征(ACS)的相关性。方法:选择384例ACS患者为研究组,并选择同期住院的冠状动脉造影示无冠状动脉狭窄的285例非冠心病患者作为对照组,比较两组患者的HDL-C、SOD、NEFA。结果:与对照组比较,研究组HDL-C和SOD水平显著降低(P0.001),NEFA水平显著升高(JP0.001);研究组中HDL-C、SOD、NEFA水平均与冠状动脉病变严重程度相关。结论:ACS患者的冠脉病变严重程度和心肌坏死的进展与HDL-C、SOD、NEFA水平密切相关;HDL-C、SOD、NEFA水平的高低可作为预测心肌进一步损伤的重要指标,对冠心病的防治提供重要的临床依据。     

Chest pain and associated symptoms of acute coronary syndromes

Coronary heart disease is the primary health risk for all Americans. Acute coronary syndromes (ACS) is the term used to denote any 1 of 3 clinical manifestations of coronary heart disease: unstable angina, non-ST elevation myocardial infarction, and ST-elevation MI. The major challenge to healthcare providers is the rapid and accurate identification of patients with ACS who would benefit from immediate thrombolysis or percutaneous coronary interventions. The purpose of this article is to describe the incidence, causes, risk factors, assessment, and diagnosis of patients presenting with ACS as well as current recommendations for nurses who treat patients with ACS.     

超声造影评价颈动脉粥样硬化斑块的新生血管与冠心病的关系

目的 应用超声造影评价颈动脉粥样斑块的稳定性与冠心病的相关关系.方法 冠心病伴颈动脉粥样斑块患者67例,斑块厚度均＞2.0 mm,其中急性冠状动脉综合征(ACS)组35例,稳定性冠心病(sCAD)组32例.行颈动脉常规及超声造影检查,肉眼观测及定量分析斑块造影增强情况.结果 ACS组软斑的例数高于sCAD组,差异有统计学意义(P＜0.001).ACS组斑块造影增强比例显著高于sCAD组(P=0.037),ACS组斑块增强强度显著高于sCAD组(P＜0.001),ACS组斑块增强强度与颈动脉管腔内增强强度比值显著高于sCAD组(P=0.026).斑块增强强度预测ACS的灵敏度和特异度分别为74%和60%,斑块增强强度与颈动脉管腔内增强强度比值预测ACS的灵敏度和特异度分别为86%和67%.结论 ACS组斑块造影增强显著高于sCAD组.超声造影为评价颈动脉粥样斑块的稳定性与冠心病的相关关系及斑块的危险度分级提供了一种较为可靠的方法.     

New-onset atrial fibrillation and acute coronary syndrome

Despite advances in the diagnosis and management of acute coronary syndrome (ACS), atrial fibrillation (AF) remains a commonly encountered complication leading to adverse short- and long-term outcomes across the whole spectrum of ACS. At present, the underlying mechanisms of AF in myocardial ischemia remain incompletely understood. This article evaluates the incidence and trends of new-onset AF in ACS, its impact on ACS management and the associated prognostic significance in patients with acute ischemic heart disease. The safety and use of oral anticoagulation treatment in ACS patients on multiple antiplatelet agents are also explored. Further experimental and clinical studies are needed to improve current understanding and management of new-onset AF in ACS patients.     

血浆同型半胱氨酸、超敏C反应蛋白与中青年急性冠状动脉综合征的相关性

目的 探讨血浆同型半胱氨酸(Hcy)、超敏C反应蛋白(hs-CRP)与中青年急性冠状动脉综合征(ACS)的相关性。方法 收集天津市胸科医院心内科入院的中青年(29~45岁)ACS患者142例,包括急性心肌梗死(AMI)61例和不稳定型心绞痛(UAP)81例,并以冠状动脉正常的中青年患者60例为对照组,测定3组Hcy、hs-CRP水平,分析血浆Hcy、hs-CRP水平与ACS的相关性。结果 AMI组Hcy、hs-CRP水平明显高于对照组及UAP组(P＜0.05),UAP组与对照组比较,Hcy、hs-CRP水平差异无统计学意义(P＞0.05),血清Hcy、hs-CRP水平与Gensini积分呈正相关(r=0.17、0.26,P均＜0.05)。应用Logistic 回归模型分析结果示:Hcy为中青年ACS患者的独立危险因素。结论 血浆Hcy、hs-CRP水平升高与中青年ACS关系密切,亦可为评价冠状动脉病变程度提供参考价值。     

Increased coronary sinus blood temperature: correlation with systemic inflammation

BACKGROUND: Recent studies have shown that patients with single vessel coronary artery disease (CAD) suffering from acute coronary syndromes (ACS) have increased coronary sinus (CS) blood temperature compared with the right atrium (RA). The aim of this study was to investigate whether there is a correlation between systemic inflammatory indexes and CS temperature and whether there is a difference in CS temperature between patients with single vs. multivessel disease. MATERIALS AND METHODS We included consecutive patients scheduled for coronary angiography for recent-onset chest pain evaluation. We measured C-reactive protein (CRP) levels in the study population. Coronary sinus and RA blood temperature measurements were performed by a 7F thermography catheter. DeltaTau was calculated by subtracting the RA from the CS blood temperature. RESULTS: The study population comprised 53 patients with ACS, 25 patients with stable angina (SA) and 22 subjects without CAD (control group). DeltaTau was greater in patients with ACS and with SA compared with the control group (0.22 +/- 0.10 degrees C, 0.18 +/- 0.04 degrees C vs. 0.14 +/- 0.07 degrees C, P < 0.01 for both comparisons). The ACS group had greater DeltaTau compared with the SA group, although the difference did not reach statistical significance (P = 0.09). Eighteen (39.1%) out of 46 patients with multivessel disease had three-vessel disease and 28 (60.8%) had two-vessel disease. DeltaTau between patients with multivessel and single vessel disease was similar (0.22 +/- 0.01 degrees C, 0.19 +/- 0.01 degrees C, P = 0.17). The levels of CRP were well correlated with DeltaTau (R = 0.35b, P < 0.01). CONCLUSIONS: Systemic inflammation is well correlated with CS temperature; thus, an inflammatory process could be the underlying mechanism for increased heat production from the myocardium.     

急性冠状动脉综合征患者血浆脂联素的变化

目的 通过观察急性冠状动脉综合征（ACS）患者血浆脂联素（APN）水平的变化,推测APN与斑块稳定性的关系.方法 选取经冠状动脉造影证实的冠心病患者75例,包括ACS患者（ACS组,36例）、稳定性心绞痛患者（SAP组,39例）,并选取冠状动脉造影结果正常者为对照组（20例）.同时,根据造影结果对所有研究对象进行Gensini积分,分为0分组（20例）、1～30分组（45例）、≥30分组（30例）.ELISA检测所有研究对象血浆中APN水平变化.结果 （1）ACS组、SAP组血浆APN水平显著低于对照组,差异有统计学意义（P＜0.05）;（2） ACS组血浆APN水平显著低于SAP组,差异有统计学意义（P＜0.05）;（3） Gensini积分≥30分组APN水平显著低于＜30分组,差异有统计学意义（P＜0.05）.结论 随着冠状动脉病变程度和不稳定性的加剧,APN在研究对象血浆中的水平逐渐降低,APN的降低可能加剧了病变处斑块的不稳定性,促进了动脉粥样硬化斑块的进程进展.