Acute Coronary Syndrome ; epidemiology ; therapy ; Humans

OBJECTIVETo investigate the risk factors and angiographic features of acute coronary syndrome (ACS) in women below 50 years of age.

METHODSA total of 131 women with ACS aged 50 years or younger were enrolled in this study as the case group, with another 425 women aged below 50 years with normal coronary angiographic findings as the control group. The risk factors and clinical and coronary angiographic features of ACS were analyzed.

RESULTSCompared with the control group, significantly higher frequencies of dyslipidemia, hypertension (especially diastolic hypertension), diabetes, or a positive family history for coronary artery disease (CAD) were found in ACS group (P<0.05) . The proportion of post-menopausal women and the menopausal ages were similar between the two groups (P>0.05), but the mean diastolic pressure was significantly higher in ACS group than in the control group (P<0.05). Among the menopausal women, the conventional risk factors for ACS were similar between the two groups with the exception of family history CAD, which was more frequent in ACS group. Serum total cholesterol and triglyceride levels were significantly higher in ACS group than in the control group (P<0.05), but the levels of high- and low-density lipoprotein cholesterol levels were comparable between them. Positive findings of urine protein were more frequent in ACS group. In ACS group, 54.2% of the patients had a single diseased artery, 29.6% had more than one diseased artery, and 16.0% had slightly diseased or even normal coronary arteries; the lesion was found most commonly in the left anterior descending artery.

CONCLUSIONIn women with ACS below 50 years of age, the risk factors of ACS included the conventional risk factors of CAD and a positive finding of urine protein. Menopause is not associated with an increased incidence of ACS. A substantial portion of these ACS patients can have slightly diseased and even normal coronary arteries.

Acute Coronary Syndrome ; epidemiology ; Case-Control Studies ; Cholesterol ; blood ; Coronary Angiography ; Coronary Artery Disease ; epidemiology ; Diabetes Mellitus ; epidemiology ; Dyslipidemias ; epidemiology ; Female ; Humans ; Hypertension ; epidemiology ; Middle Aged ; Risk Factors ; Triglycerides ; blood

OBJECTIVETo observe the risk factors characteristic of patients developing acute coronary syndrome, ischemic or hemorrhagic stroke in a Chinese population aged 35 - 64 (n = 30 378).

METHODThis prospective study was carried out in 11 provinces in China from 1992 to 2003. The association between baseline risk factors and events in the 10-year follow-up period was analyzed.

RESULTS(1) A total of 809 events were recorded during the follow up period and 227 with acute coronary syndrome, 582 with stroke (ischemic 419, hemorrhagic 146, undefined 17) and the 10-year cumulative person-year incidence rates were 114/100,000, 209/100,000 and 73/100,000 for acute coronary syndrome, acute ischemic stroke and acute hemorrhagic stroke, respectively. (2) Rate of having > or = 1 modifiable risk factors was significantly higher in event group than that in subjects without events (89% vs. 64.7%, P < 0.01). (3) Sorted by intensity, the sequence of independently risk factors obtained from multivariate analysis for acute coronary syndrome were hypertension, smoking, hypercholesterolemia and low-HDL-C; for acute ischemic stroke event were hypertension, diabetes, low-HDL-C, smoking and obesity; for acute hemorrhagic stroke was hypertension.

CONCLUSIONThe morbidity for cardiovascular diseases is higher in Chinese population with various traditional risk factors than those without or having fewer traditional risk factors and there are various distinct independent risk factors pattern in patients with different cardiovascular diseases subtypes.

Acute Coronary Syndrome ; epidemiology ; Adult ; China ; epidemiology ; Female ; Humans ; Incidence ; Ischemia ; epidemiology ; Male ; Middle Aged ; Prospective Studies ; Risk Factors ; Stroke ; epidemiology

INTRODUCTIONThe elderly are often underrepresented in clinical trials for acute coronary syndrome (ACS), and cardiologists commonly face management dilemmas in the choice of treatment for this group of patients, particularly concerning the use of invasive revascularisation. This study analysed the characteristics of hospitalised elderly patients with ACS, and compared the outcomes of treatments.

METHODSFrom 29 December 2005 to 26 April 2010, 13,545 patients were admitted for ACS in 16 hospitals across Malaysia. These patients were divided into two groups - elderly (≥ 65 years) and non-elderly (< 65 years). The clinical characteristics, treatment received (invasive or non-invasive) and outcomes (in-hospital and 30-day all-cause mortality) of the two groups were compared. The elderly patients were then grouped according to the type of treatment received, and the outcomes of the two subgroups were compared.

RESULTSElderly patients had a higher cardiovascular risk burden and a higher incidence of comorbidities. They were less likely to receive urgent revascularisation for acute ST-segment elevation myocardial infarction (elderly: 73.9% vs. non-elderly: 81.4%) and had longer door-to-needle time (elderly: 60 minutes vs. non-elderly: 50 minutes, p = 0.004). The rate of cardiac catheterisation was significantly lower in the elderly group across all ACS strata. Elderly patients had poorer outcomes than non-elderly patients, but those who received invasive treatment appeared to have better outcomes than those who received non-invasive treatment.

CONCLUSIONElderly patients with ACS tend to be undertreated, both invasively and pharmacologically. Invasive treatment seems to yield better outcomes for this group of patients.

Acute Coronary Syndrome ; epidemiology ; Age Factors ; Aged ; Cardiovascular Diseases ; epidemiology ; Databases, Factual ; Female ; Humans ; Malaysia ; epidemiology ; Male ; Middle Aged ; Morbidity ; trends ; Registries ; Survival Rate ; trends

OBJECTIVE: We aimed to assess the feasibility and superiority of machine learning (ML) methods to predict the risk of Major Adverse Cardiovascular Events (MACEs) in chest pain patients with NSTE-ACS. METHODS: Enrolled chest pain patients were from two centers, Beijing Anzhen Emergency Chest Pain Center Beijing Bo'ai Hospital, China Rehabilitation Research Center. Five classifiers were used to develop ML models. Accuracy, Precision, Recall, F-Measure and AUC were used to assess the model performance and prediction effect compared with HEART risk scoring system. Ultimately, ML model constructed by Naïve Bayes was employed to predict the occurrence of MACEs. RESULTS: According to learning metrics, ML models constructed by different classifiers were superior over HEART (History, ECG, Age, Risk factors, & Troponin) scoring system when predicting acute myocardial infarction (AMI) and all-cause death. However, according to ROC curves and AUC, ML model constructed by different classifiers performed better than HEART scoring system only in prediction for AMI. Among the five ML algorithms, Linear support vector machine (SVC), Naïve Bayes and Logistic regression classifiers stood out with all Accuracy, Precision, Recall and F-Measure from 0.8 to 1.0 for predicting any event, AMI, revascularization and all-cause death ( vs. HEART ≤ 0.78), with AUC from 0.88 to 0.98 for predicting any event, AMI and revascularization ( vs. HEART ≤ 0.85). ML model developed by Naïve Bayes predicted that suspected acute coronary syndrome (ACS), abnormal electrocardiogram (ECG), elevated hs-cTn I, sex and smoking were risk factors of MACEs. CONCLUSION Compared with HEART risk scoring system, the superiority of ML method was demonstrated when employing Linear SVC classifier, Naïve Bayes and Logistic. ML method could be a promising method to predict MACEs in chest pain patients with NSTE-ACS.
Humans ; Acute Coronary Syndrome/epidemiology* ; Bayes Theorem ; Feasibility Studies ; Risk Assessment/methods* ; Chest Pain/etiology* ; Myocardial Infarction/diagnosis*

Objective: To assess the prevalence, pattern and outcome of multimorbidity in elderly patients with acute coronary syndrome (ACS). Methods: Secondary analysis was performed based on the data from the BleeMACS registry, which was conducted between 2003 and 2014. We stratified elderly patients (≥65 years) according to their multimorbidity. Multimorbidity was defined as two or more chronic diseases in the same individual. Kaplan-Meier methods were used to estimate 1 year event rates for each endpoint, and comparisons between the study groups were performed using the log-rank test. The primary endpoint was net adverse clinical events (NACE), which is a composite of all-cause mortality, myocardial infarction, or bleeding. Results: Of 7 120 evaluable patients, 6 391 (89.8%) were with morbidity (1 594 with 1, 2 156 with 2, and 2 641 with ≥3 morbidity). Patients with morbidity were older, percent of female sex and non-ST-elevation acute coronary syndromes and implantation rate with drug-eluting stents and blood creatine level were higher compared to patients without morbidity. Compared with the patients without morbidity, the proportion of participants with oral anticoagulant increased in proportion to increased number of morbidities (5.8% vs. 6.4% with 1 morbidity, 7.3% with 2 morbidities, 9.0% with ≥3 morbidities, P trend<0.01) and the proportion of participants with clopidogrel prescription decreased in proportion to increased number of morbidity (91.9% vs. 89.7% with 1 morbidity, 87.9% with 2 morbidities, 88.6% with ≥3 morbidities, P trend = 0.01). During 1 year follow-up, compared with those with no morbidity, the hazard ratio (HR) and 95% confidence interval (CI) of risk of NACE for those with 1, 2, and ≥ 3 morbidities was 1.18 (0.86-1.64), 1.49 (1.10-2.02), and 2.74 (2.06-3.66), respectively (P < 0.01). Multimorbidity was not associated with an increased risk of bleeding of various organs (P>0.05). Conclusion: Multimorbidity is common in elderly patients with ACS. These patients might benefit from coordinated and integrated multimorbidity management by multidisciplinary teams.
Acute Coronary Syndrome/epidemiology* ; Aged ; Clopidogrel ; Female ; Hemorrhage ; Humans ; Multimorbidity ; Percutaneous Coronary Intervention/methods* ; Platelet Aggregation Inhibitors/adverse effects* ; Registries ; Treatment Outcome

BACKGROUNDMany patients with acute coronary syndrome (ACS) develop recurrent angina (RA) during hospitalization. The aim of this non-randomized, prospective study was to investigate the predictive factors of RA in unselected patients with ACS enrolled in the global registry acute coronary events (GRACE) during hospitalization in China.

METHODSBetween March 2001 and October 2004, enrolled were 1433 patients with ACS, including ST segment elevation myocardial infarction (662, 46.2%), non-ST segment elevation myocardial infarction (239, 16.7%) and unstable angina (532, 37.1%). The demographic distribution, medical history and clinical data were collected to investigate the predictive factors of RA by Logistic regression.

RESULTSDuring hospitalization 275 (19.2%) patients were documented with RA including unstable angina (53.2%), non-ST segment elevation myocardial infarction (27.5%), ST segment elevation myocardial infarction (19.3%). A comorbidity of dyslipidemia, prior angina, percutaneous coronary intervention (PCI) within 6 months was more common in patients with RA, P < 0.05. In the patients with RA, a significantly higher proportion of patients with acute pulmonary edema was observed, 23 (8.4%) versus 43 (3.7%), P = 0.001. Acute renal failure was present in 8 (2.9%) of patients with RA versus 19 (1.6%) of patients without RA, P = 0.165. Hemorrhagic events were present in 6 (2.2%) of patients with RA versus 8 (0.7%) of patients without RA, ventricular tachycardia/ventricular fibrillation events in 12 patients (4.3%) versus 22 patients (1.9%), congestive heart failure in 69 patients (25.0%) versus 94 patients (8.1%), myocardial re-infarction in 28 patients (10.1%) versus 15 patients (1.3%), P < 0.05, respectively. A lower proportion of patients with RA underwent in-hospital PCI, 687 (59.3%) versus 114 (41.5%), P = 0.000. A higher proportion of patients with RA received heparin, 260 (94.5%) versus 1035 (89.4%), P = 0.006; and beta-blockers 176 (64.0%) versus 864 (74.5%), P = 0.000. Multivarible regression analysis showed that RA was associated with prior angina (OR 2.086, 95% CI 1.466 - 2.967), in-hospital PCI (OR 0.579, 95% CI 0.431 - 0.778), in-hospital congestive heart failure (OR 2.410, 95% CI 1.634 - 3.555), myocardial re-infarction (OR 7.695, 95% CI 3.701 - 15.999), beta-blocker (OR 0.626, 95% CI 0.458 - 0.855), and heparin (OR 3.411, 95% CI 1.604 - 7.382).

CONCLUSIONSIn-hospital congestive heart failure, myocardial re-infarction, prior angina history and use of heparin are stronger independent predictors of RA; beta-blockers and PCI are also important predictive factors for RA.

Acute Coronary Syndrome ; epidemiology ; Adult ; Aged ; Angina Pectoris ; etiology ; therapy ; China ; epidemiology ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Prospective Studies ; Recurrence ; Registries

OBJECTIVETo investigate the risk factors and the values of early invasive intervention in patients with acute coronary syndromes (ACS) without ST-segment elevation.

METHODSFive hundred and forty-five patients of ACS without ST-segment elevation were randomly assigned to an early conservative strategy or early invasive strategy who had been admitted to hospitals consecutively from Oct. 2001 to Oct. 2003. The combined cardiovascular events (a combination of cardiac death, nonfatal myocardial infarction, nonfatal heart failure and re-hospital admission due to recurrent ischemia angina) within 30 days and 6 months were analyzed and the primary high risk factors for combined cardiovascular events were evaluated by means of multivariate logistic regression analysis among baseline clinical characteristics and laboratory data, meanwhile, the effects of an early conservative strategy or early invasive strategy on outcomes were also investigated.

RESULTSThe incidences of combined cardiovascular events within 30 days and 6 months among 513 cases were 14.0% and 25.7% respectively. Multivariate logistic regression analysis implied ST-segment depression, elevation of troponin I level, increased C-reactive protein, lower ejection fraction of left ventricular and higher TIMI risk scores were all associated with an increases in cardiovascular events within 6 months, and they were respectively independent predictive factor for the increases of cardiovascular events. Early invasive strategy was associated with a lower rate of re-hospital admission due to recurrent ischemia angina within 30 days and a decreased incidences of combined cardiovascular events within 30 days and 6 months compared with early conservative strategy (all P < 0.05).

CONCLUSIONSST-segment depression, elevation of troponin I level, increased C-reactive protein, lower ejection fraction of left ventricular and higher TIMI risk scores are high risk factors for patients with ACS without ST-segment elevation, and early invasive strategy can have a substantial impact in reducing combined cardiovascular events.

Acute Coronary Syndrome ; epidemiology ; physiopathology ; prevention & control ; Aged ; Electrocardiography ; Female ; Humans ; Incidence ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Prognosis ; Risk Factors

BACKGROUND AND OBJECTIVES: An increased platelet volume is associated with increased platelet reactivity, and may influence the outcome following a myocardial infarction. SUBJECTS AND METHODS: One hundred patients with acute myocardial infarction, who visited Kyungpook National University Hospital between 2001 January and 2001 December, were included in this study. To determine the mean platelet volume (MPV), blood samples, taken at the time of arrival, were analyzed in an automated haematology analysis system (CELL-DYN3000, ABBOTT, USA). EDTA in the blood bottles was used as an anticoagulant. All samples were processed within 30 minutes of venipuncture, to avoid bias due to platelet swelling. The patients were followed for one year for readmission due to acute coronary syndrome, congestive heart failure or death. To stratify the prognostic value of the MPV, the patients were divided into 4 equal groups according to the percentiles of the platelet volume. RESULTS: Eight patients died, and 20 were readmitted due to acute coronary syndrome or congestive heart failure. The MPV is not a significant predictor of death. However, in the prediction of MACE, death and readmission, the MPV and age were significant factors (p<0.001 and p=0.046, respectively). The highest quartile group(MPV> 8.8fL) had a 7 times greater risk of MACE than the lowest quartile group (MPV<7.4 fL). CONCLUSION: The MPV measured in the emergency room is a significant predictor of MACE with an acute myocardial infarction. Therefore, patients with a large MPV might require more intensive, closely controlled treatment strategies for secondary prevention.
Acute Coronary Syndrome ; Bias (Epidemiology) ; Blood Platelets ; Edetic Acid ; Emergency Service, Hospital ; Gyeongsangbuk-do ; Heart Failure ; Humans ; Mean Platelet Volume* ; Myocardial Infarction* ; Phlebotomy ; Prognosis ; Secondary Prevention

We investigated the effects of weekend admission on adverse cardiac events in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Patients with NSTEACS treated with percutaneous coronary intervention (PCI) were divided into a "weekend group" and a "weekday group" according to the emergency room arrival time. The primary outcome was 30-day major adverse cardiac events (MACE) including cardiac death, recurrent myocardial infarction, repeat revascularization, and urgent PCI. Of 577 patients, 168 patients were allocated to the weekend and 409 patients to the weekday group. The incidence of 30-day MACE was significantly higher in the weekend group (Crude: 15.5% vs. 7.3%, P = 0.005; propensity score matched: 12.8% vs. 4.8%, P = 0.041). After adjustment for all the possible confounding factors, in Cox proportional hazard regression analysis, weekend admission was associated with a 2.1-fold increased hazard for MACE (HR, 2.13; 95% CI, 1.26-3.60, P = 0.005). These findings indicate that weekend admission of patients with NSTE-ACS is associated with an increase in 30-day adverse cardiac event.
Acute Coronary Syndrome/*complications/mortality/therapy ; Adult ; Aged ; *Death ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction/*epidemiology ; Patient Admission ; Percutaneous Coronary Intervention/*statistics & numerical data ; Propensity Score ; Proportional Hazards Models ; Time Factors ; Treatment Outcome