Littérature scientifique sur le sujet « Acute Coronary Sindr »

Das akute Koronarsyndrom manifestiert sich zwar meist als Thoraxschmerzereignis, kann aber auch mit atypischer Symptomatik oder ganz asymptomatisch ablaufen, was die rasche Diagnosestellung dieser potentiell letal verlaufenden Erkrankung erschwert und zu unerwünschten Verzögerungen in der Therapieeinleitung führen kann. Die Rolle des Hausarztes ist anspruchsvoll, da mit den in der Praxis vorhandenen Mitteln ein akutes Koronarsyndrom besonders in der Frühphase einerseits schwierig auszuschließen ist, bei Nachweis eines akuten Koronarsyndroms hingegen der Umweg über die Hausarztpraxis wertvolle Zeit kosten kann. Diagnostik und Risikostratifizierung beruhen in der Frühphase vor allem auf Anamnese, klinischer Präsentation, EKG und biologischen Markern. Im Spital sind zusätzlich der Verlauf dieser Parameter, die Koronarangiographie, die Bestimmung der linksventrikulären Funktion sowie funktionelle Tests für Diagnose und Risikostratifizierung relevant. Wesentliche Neuerungen sind die Verfügbarkeit von hoch sensitiven und spezifischen Biomarkern (Troponine), die therapierelevante neue Klassifizierung in akute koronare Syndrome mit versus ohne ST-Hebung sowie die Erkenntnis, dass Entzündungsmarker als Surrogatmarker entzündlicher Vorgänge im Koronargefäß prognostisch relevant sind. Mit der Verfügbarkeit von als Bolus applizierbaren Thrombolytika und den Möglichkeiten der Telemedizin ist auch die prähospitale Diagnostik und das Management des akuten Koronarsyndroms im Umbruch.

Objectives: To characterize the clinical demonstration, risk factors, echocardiographic, and coronary angiographic profile of very young individuals presenting with their first AMI at a tertiary care hospital at NICVD Karachi Sindh, Pakistan Background: Rare cases of acute coronary syndrome (ACS) occur in relatively young persons under the age of 30. In Pakistan, <2% of people have experienced an acute myocardial infarction (AMI). When it happens at this young age, ACS has a substantial impact on the patient's psyche, morbidity, and increased financial burden. Single-vessel disease and non-obstructive stenosis are considerably more common in young individuals with ACS on coronary angiography (CAG). Materials and Methods: At the Department of Cardiology NICVD Karachi, this retrospective observational research was carried out. Very young individuals (≤30 years of age) who had their first AMI from 1st January to 30th June 2019 had their medical records gathered and examined. Results: 50 young patients aged ≤30 years old were hospitalized with their first AMI. The majority of the patients were between the ages of 25–30 years. Patients had a mean age of 28.62 ± 2.04 years, and 48 of them (96%) were men. Smoking was the most frequent risk factor for CAD, accounting for 54% of cases in individuals under the age of 30. One patient presented with a complete heart block and a temporary pacemaker was inserted as a lifesaving measure. STEMI (78%) was more common as compared to NSTEMI (22%). The mean left ventricular ejection fraction was 41.4±7.6%. The single-vessel disease was the most prevalent (60%) finding. The most common culprit vessel was the LAD artery (40%) followed by the RCA (14%). The double-vessel disease was seen in 22% of individuals and the most common combination of vessels was LAD and RCA (14%). Conclusion: When compared to older patients, very young individuals showed less severe CAD, which is probably because their coronary arteries had less atherosclerosis. Smoking and dyslipidemia are the most avoidable risk factors in Pakistan's youthful population. Primary prevention, such as public awareness campaigns about the dangers of smoking, poor eating habits, and sedentary lifestyles, may assist to avert the emergence of cardiac issues in later life. Keywords: Acute coronary syndrome, coronary artery disease, smoking, young adults

Zusammenfassung. Für ein optimales Management der COVID-19 (Coronary Virus Disease 19) sind wir auf eine schnelle und zuverlässige Diagnose sowie Schweregradeinschätzung angewiesen. Der Goldstandard ist bisher die RT-PCR (Reverse-Transkriptase-Polymerase-Kettenreaktion) aus dem nasopharyngealen Abstrich. Die aktuellen Tests weisen eine Sensitivität zwischen 60 und 90 % auf. In der Folge müssen wir mit 10–40 % falsch-negativen Ergebnissen rechnen. Neben der Sauerstoffsättigung zur Schweregradeinteilung werden das Stethoskop, das Thoraxröntgen und die Lungen-Computertomografie routinemässig für die Diagnose eingesetzt. Die Standardmethoden Stethoskop und Thoraxröntgen sind jedoch unzuverlässig. Überdies setzen alle drei diagnostischen Untersuchungsverfahren Ärztinnen, Ärzte, Hilfspersonal sowie Patientinnen und Patienten einem zusätzlichen Expositionsrisiko aus. Angesichts der Kontagiosität des SARS-CoV-2 (Severe Acute Respiratory Syndrome Corona Virus) ist der Lungen-Point-of-Care-Ultraschall (PoCUS), insbesondere in der Anwendung als Taschenkittelgerät, eine noch zu wenig genutzte, wertvolle Alternative. In dieser Review werden die aktuelle Wertigkeit und Rolle von Stethoskop, Pulsoximetrie, Thoraxröntgen, Lungen-Computertomografie und Lungen-Point-of-Care-Ultraschall anhand der vorliegenden Literatur bestimmt.

Background: l’acido urico (AU) nei pazienti che si presentano con SCA è stato riconosciuto come fattore determinante la mortalità intra-ospedaliera. Inoltre esso è anche correlato con le complicanze intraospedaliere in termini di recidiva precoce di altri eventi cardiovascolari non fatali e altri outcome intermedi interpretabili come segni di decorso intra-ospedaliero complicato (l’utilizzo di contropulsatore aortico o di ventilazione non invasiva, un maggior tempo di degenza ed una maggior frequenza di sanguinamenti ma anche la presentazione con un quadro di scompenso cardiaco acuto o con FA all’ingresso in unità coronarica). Scopo dello studio: scopo principale del nostro studio è quello di valutare il ruolo dell’AU misurato in acuto come possibile determinante di mortalità intraospedaliera (outcome primario) e di complicanze durante la degenza (outcomes secondari). Scopo secondario è stato anche quello di individuare il miglior cut-off per tale associazione. Oltre all’individuazione di uno specifico cut-off è stata anche valutata la performance diagnostica, in termini di sensibilità e specificità, del cut-off classico oggi utilizzato per definire l’iperuricemia (> 6 mg/dL nelle femmine e 7 mg/dL nei maschi) e di un cut-off più basso individuato dalla letteratura più recente (5.26 mg/dL per le femmine e 5.49 mg/dL per i maschi). Metodi: Per fare questo sono stati analizzati i dati di 563 pazienti ricoverati presso l’Unità di Cure Intensive Cardiologiche (UCIC) dell’ospedale Niguarda Ca’ Granda. Gli outcome considerati sono la mortalità intraospedaliera per tutte le cause, il re-infarto, la trombosi intrastent, la nuova rivascolarizzazione non programmata, i sanguinamenti, gli stroke, la presentazione con scompenso cardiaco, la presentazione con FA, l’utilizzo di inotropi, contropulsatore aortico e ventilazione non invasiva, l’evidenza di coronaropatia trivasale alla coronarografia e la FE in ingresso ed in dimissione dall’UCIC. Risultati: i pazienti presentavano un’età media di 66.5 ± 12.3 anni, nel 79.2% dei casi erano maschi e nel 49.9% dei casi accedevano per STEMI. Con entrambi i cut-off i soggetti iperuricemici erano più anziani e presentavano più frequentemente FRCV e pregresso infarto miocardico. Essi morivano più frequentemente durante la degenza, giungevano al ricovero in FA o con scompenso cardiaco, presentavano con maggior frequenza coronaropatia trivasale ed utilizzavano più frequentemente contropulsatore aortico e NIV. Infine i valori di FE sia all’ingresso che in dimissione dall’UCIC erano più bassi rispetto al gruppo dei non iperuricemici. All’analisi multivariata l’AU resisteva come determinante significativo di tutti gli outcomes (esclusa la coronaropatia trivasale) in un modello contenente età, genere, precedente infarto miocardico, anamnesi positiva per ipertensione arteriosa, Charlson Comorbidity Index e creatinina. Entrambi i cut-off erano in grado di discriminare in modo statisticamente significativo l’incrementata mortalità dei pazienti iperuricemici anche se in entrambi i casi la performance in termini di Sensibilità (Sn) e Specificità (Sp) presentava alcuni problemi. Abbiamo infine provato ad individuare un cut-off ideale per questa specifica popolazione che è stato di 6.35 mg/dL con un’area sotto la curva complessiva di 0.772 e con una Sn ed una Sp di 70.3% ed 81.8%. Conclusioni: in conclusione AU risulta determinante indipendente della mortalità intraospedaliera per tutte le cause e di variabili indicative di peggior presentazione al momento dei ricovero (scompenso cardiaco, FA ed FE all'ingresso), di complicanze intra-ricovero (utilizzo di contropulsatore aortico e NIV) e di un peggior risultato sulla ripresa della funzione ventricolare sinistra (FE in dimissione). Ulteriori studi con valutazione longitudinale dell'andamento dell'AU sono necessari per chiarire definitivamente la direzionalità delle relazioni individuate.
Background: Uric acid (UA) has been related to in-hospital mortality in ACS patients. Furthermore, it has been related to early relapse of non-fatal cardiovascular events and to intermediate outcome such as use of intra-aortic balloon pump, noninvasive ventilation, longer inward stay, bleeding but also clinical presentation with AF or heart failure. Aim of the study: principal aim of our study was to evaluate the role of UA as a possible determinants of in-hospital mortality (primary outcome) and in hospital complications (secondary outcomes). Secondary aim was to identify the best cut-off and to evaluate diagnostic performance of already used cut-off (the classic one of > 6 mg/dL in female and 7 mg/dL in males, and a recently described one with 5.26 mg/dL in females and 5.49 mg/dL in males). Methods: we analyze data of 563 patients admitted for ACS at the Cardiological Intensive Care Unit of the Niguarda Ca’ Granda Hospital. We consider as outcome in-hospital mortality, inward myocardial infarction, instent thrombosys, bleeding, stroke, clinical presentation with heart failure of AF, inotropes, intra-aortic balloon pump and non-invasive ventilation uses during hospital stay, three vessels coronaric involvement at the coronary angiogram and EF both at admission and at discharge. Results: mean age was 66.5 ± 12.3 years, 79.2% of the patients were males and 49.9% of the ACS were STEMI. With both cut-off hyperuricemic subjects were older, with more prominent cardiovascular risk factor and previous myocardial infarction. Furthermore, they more frequently died during hospital stay, they present more frequently heart failure and AF as clinical presentation, have more commonly three vessels disease and use more frequently intra-aortic balloon pump and non-invasive ventilation. Finally, also EF at admission and discharge were lower in hyperuricemic patients. At multivariate analysis UA was a significant determinants of primary and secondary outcomes (except for three vessels coronaric disease) in a model with age, gender, previous myocardial infarction, arterial hypertension, Charlson Comorbidity Index and creatinine as covariates. Both cut-off can significantly discriminate in-hospital mortality but with only fair results in term of Sensibility (Sn) and Specificity (Sp). Finally, we identify 6.35 mg/dL as the best cut-off for this specific population with an area under the curve of 0.772, Sn 70.3% and Sp 81.8%. Conclusions: in conclusion UA was an independent determinants of in-hospital mortality and of variables suggestive of worst clinical presentation (heart failure, AF and admission EF), in-hospital complications (intra-aortic balloon pump and non-invasive ventilation uses) and worst recovery (discharge EF). Further study with longitudinal evaluation of UA during ACS are needed in order to better clarify directionality of detected relationship.