2.Atypical manifestations of acute coronary syndrome - throat discomfort: a multi-center observational study.
Yanqing FANG ; Xiaoting CHENG ; Wenhui PENG ; Xueying CHEN ; Chunping TANG ; Qiusheng HUANG ; Sihai WU ; Yibo HUANG ; Fanglu CHI ; Matthew R NAUNHEIM ; Huawei LI ; Bing CHEN ; Yilai SHU
Frontiers of Medicine 2022;16(4):651-658
To present the clinical characteristics and the misdiagnosis rate of acute coronary syndrome manifested primarily as throat discomfort, we conducted a multicentric and retrospective study in the cardiology and otorhinolaryngology departments. Records of patients with primary complaint of throat discomfort, absence of chest pain at onset, and an ultimate diagnosis of acute coronary syndrome, as well as patients with pharyngitis (as controls) were collected from May 2015 to April 2016. The patients' main manifestations were compared. Logistic regression results showed that chest tightness, dyspnea, perspiring, and exertional throat symptoms were significantly associated with acute coronary syndrome, with odds ratios of 8.3 (95% CI 2.2-31.5), 10.9 (95% CI 1.8-66.9), 25.4 (95% CI 3.6-179.9), and 81.2 (95% CI 13.0-506.7). A total of 25 (56.82%) out of 44 acute coronary syndrome patients, who were first admitted to the otorhinolaryngology department, were misdiagnosed, with a 12% (3/25) mortality rate. Throat discomfort can be the principal manifestation of acute coronary syndrome. Such patients exhibit high misdiagnosis and mortality rates. Exertional throat symptoms, chest tightness, perspiring, and dyspnea were important indicators of acute coronary syndrome in patients whose main complaint was throat discomfort. The awareness of this condition will result in prompt diagnosis and reduce morbidity and mortality.
Acute Coronary Syndrome/etiology*
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Dyspnea/etiology*
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Humans
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Pharyngitis/diagnosis*
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Pharynx
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Retrospective Studies
6.Exploring the Feasibility of Machine Learning to Predict Risk Stratification Within 3 Months in Chest Pain Patients with Suspected NSTE-ACS.
Zhi Chang ZHENG ; Wei YUAN ; Nian WANG ; Bo JIANG ; Chun Peng MA ; Hui AI ; Xiao WANG ; Shao Ping NIE
Biomedical and Environmental Sciences 2023;36(7):625-634
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
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Acute Coronary Syndrome/epidemiology*
;
Bayes Theorem
;
Feasibility Studies
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Risk Assessment/methods*
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Chest Pain/etiology*
;
Myocardial Infarction/diagnosis*
7.Thrombosis and morphology of plaque rupture using optical coherence tomography.
Jun GUO ; Yun-Dai CHEN ; Feng TIAN ; Hong-Bin LIU ; Lian CHEN ; Zhi-Jun SUN ; Yi-Hong REN ; Qin-Hua JIN ; Chang-Fu LIU ; Bao-Shi HAN ; Lu-Yue GAI ; Ting-Shu YANG
Chinese Medical Journal 2013;126(6):1092-1095
BACKGROUNDThrombosis following plaque rupture is the main cause of acute coronary syndrome, but not all plaque ruptures lead to thrombosis. There are limited in vivo data on the relationship between the morphology of ruptured plaque and thrombosis.
METHODSWe used optical coherence tomography (OCT) to investigate the morphology of plaque rupture and its relation to coronary artery thrombosis in patients with coronary heart disease. Forty-two patients with coronary artery plaque rupture detected by OCT were divided into two groups (with or without thrombus) and the morphological characteristics of ruptured plaque, including fibrous cap thickness and broken cap site, were recorded.
RESULTSThe fibrous cap of ruptured plaque with thrombus was significantly thinner compared to caps without thrombus ((57.00 ± 17.00) µm vs. (96.00 ± 48.00) µm; P = 0.0076).
CONCLUSIONSPlaque rupture associated with thrombosis occurs primarily in plaque covered by a thin fibrous cap. Thick fibrous caps are associated with greater stability of ruptured plaque.
Acute Coronary Syndrome ; diagnostic imaging ; etiology ; Adult ; Aged ; Coronary Angiography ; Female ; Humans ; Male ; Middle Aged ; Plaque, Atherosclerotic ; complications ; diagnostic imaging ; Rupture, Spontaneous ; complications ; Tomography, Optical Coherence ; methods
8.Long-term outcome of patients of over 85 years old with acute coronary syndrome undergoing percutaneous coronary stenting: a comparison of bare metal stent and drug eluting stent.
Han-ying MA ; Yu-jie ZHOU ; Ronald J DICK ; Dong-mei SHI ; Yu-yang LIU ; Wan-jun CHENG ; Yong-he GUO ; Jian-long WANG ; Hai-long GE
Chinese Medical Journal 2008;121(10):887-891
BACKGROUNDPatients aged over 85 years have been under-represented in percutaneous coronary intervention (PCI) trials despite an increase in referrals for PCI. The long-term safety and efficacy of percutaneous coronary stenting in patients aged over 85 years with acute coronary syndrome (ACS) remain unclear. Moreover it is unknown whether there are differences between bare metal stent (BMS) and drug eluting stent (DES) in this special population.
METHODSA total of 80 patients with ACS aged over 85 years undergoing stenting (BMS group n = 21 vs DES group n = 59) were retrospectively studied. In-hospital, one year and overall clinical follow-up (12 - 36 months) of major adverse cardiac events (MACEs) including cardiac deaths, myocardial infarction, target lesion revascularization (TLR) and target vessel revascularization (TVR) as well as stroke and other major bleeding were compared between the two groups.
RESULTSIn the entire cohort, the procedure success rate was 93.8% with TIMI-3 coronary flow post-PCI in 93.8% of the vessels and the procedure related complication was 17.5%. The incidence of in-hospital MACEs in BMS group was higher (14.3% vs 6.8%, P = 0.30). The 1-year incidence of MACEs in DES group was 7.0% while there was no MACE in the BMS group. Clinical follow-up for 12 - 36 months showed that the overall survival free from MACE was 82.9% and the incidence of MACE in the BMS group was lower (5.3% vs 21.1%, P = 0.20). Multivariate regression analysis showed that the creatinine level (OR: 1.013; 95% CI: 1.006 - 1.020; P = 0.004) and hypertension (OR: 3.201; 95% CI: 1.000 - 10.663; P = 0.04) are two major factors affecting the long-term MACE.
CONCLUSIONSPercutaneous coronary stenting in patients aged over 85 years is safe and provides good short and long-term efficacy. Patients with renal dysfunction and hypertension may have a relatively high incidence of MACE.
Acute Coronary Syndrome ; pathology ; therapy ; Aged, 80 and over ; Angioplasty, Balloon, Coronary ; adverse effects ; methods ; Drug-Eluting Stents ; adverse effects ; Female ; Humans ; Male ; Metals ; Myocardial Infarction ; etiology ; Retrospective Studies ; Stents ; adverse effects ; Stroke ; etiology ; Time Factors ; Treatment Outcome
10.Kounis syndrome: allergic acute coronary syndrome.
Min XU ; Xue-si WU ; Teng-yong JIANG ; Ji-qiang HE
Chinese Medical Journal 2013;126(13):2591-2592