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Showing 7 results for Acute Coronary Syndrome
Assessing The Quality Of Care In Patients With Acute Coronary Syndrome In A TUMS-Affiliated Hospital (2003-2004)
H Fakhrzadeh, M Moradi, Mj Mahmoudi, N Naderpoor, M Bagheri Rad, M Ahmadzad-Asl , H Arefi,
Volume 64, Issue 2 (4-2006)
Abstract

Background and Aim: Quality of care and its concordance with scientific evidence has a significant role in improvement of prognosis in patients with acute coronary syndrome (ACS). The present study was performed to evaluate the quality of care in a TUMS-affiliated hospital.

Materials and Methods: The quality indicators of the process and outcome of care according to guidelines of the MONICA project was used in this study. 320 cases with primary impression of ACS (including 80 cases from each trimester during Aug-2003 to Jul-2004) were evaluated according to MONICA standard definitions of diagnosis, provided care and survival in 28th day after heart attack.

Results: The Equivalent Treatment Score (ETS) was 43.4 percent (95%CI: 32.86-53.94) and the Weighted Treatment Score (WTS) was 22.2 percent (95%CI: 13.36-31.03) in patients with definite myocardial infarction. The 28-day case fatality among the evaluated patients was 9.09 percent (95%CI: 5.85-12.33).

Conclusion: Although the measures of quality of care in this patient setting were acceptable in comparison with MONICA collaborative centers, however the difference between ways of hospital sampling (in the present study) and the population-based method (applied in the MONICA populations) should be taken in to consideration. Adding pre-hospital fatal events to this data set will decrease the precision of quality measures.


Low molecular weight heparin versus Unfractionated heparin in patients with non ST-elevation acute coronary syndrome: a randomaized clinical trial
Zandparsa A F, Jafari H, Tabatabai Gh,
Volume 65, Issue 6 (9-2007)
Abstract

Background: Despite the overwhelming progress that has been accomplished in the prevention of mortality due to cardiovascular disease, coronary artery disease (CAD) is the leading cause of death in the world.

The aim of this study was to compare of the effects of enoxaparin versus unfractionated heparin (UFH) on major clinical events, including mortality, myocardial infarction (MI), and recurrent angina, as well as bleeding in patients with non ST elevation acute coronary syndrome (NSTEACS). We also studied the need for coronary angiography and revascularization (PCI or CABG) in these patients.

Method: Two-hundred patients were enrolled in this study, 100 of whom received intravenous UFH (an initial bolus of 5000 U followed by continuous infusion of 1000 U/h) and 100 received enoxaparin subcutaneous injections of 1mg/kg twice daily for a minimum of 72 h. During their admission we recorded data regarding death, MI, recurrent angina, need for angiography and revascularization, and major and minor bleeding.

Results: The incidence of recurrent angina, total mortality and the need for revascularization were significantly lower in patients receiving enoxaparin compared to those receiving UFH, at 17% vs. 39% (p=0.002), 0% vs. 3% (p=0.035), 14% vs. 33% (p=0.001), respectively. However, there was no significant difference regarding the incidence of MI, major bleeding and cardiac death between the two groups.

Conclusions: This study showed that, in patients with NSTEACS, enoxaparin was superior to UFH regarding the prevention of major in-hospital clinical events, especially recurrent angina and the need for revascularization. We therefore recommend enoxaparin as an alternative antithrombotic agent to UFH in patients with NSTEACS.


High-sensitive C-reactive protein in patients with acute coronary syndrome in statin therapy and its impact on prognosis
Samiramiss Qavam , Mohammad Reza Hafezi Ahmadi, Hamed Tavan , Monire Yaghobi , Maryam Yaghobi , Abuzar Mehrdadi ,
Volume 74, Issue 4 (7-2016)
Abstract

Background: Since high plasma level for C-reactive protein (CRP) is a risk factor for cardiovascular disease, thereby decrease in the level of high- sensitivity C-reactive protein (hs-CRP) in acute coronary syndrome (ACS) patients through anti-inflammatory drugs can reduce mortality and the incidence of heart failure. Accordingly, this research aims to investigate the effect of hs-CRP on ACS patients before and after treatment with astatines.

Methods: This cross-sectional and cohort study was performed for the population of 90 patients with acute coronary syndrome (ACS) martyrs at the Mustafa Khomeini University Hospital in the Ilam city, Iran, From July to September, 2014. Blood samples were collected at admission and demographic and clinical symptoms, echocardiography and electrocardiography were recorded. At admission, the questionnaire including demographic information and medical history of patients was filled by the researchers and echocardiography and physical examination was carried out by cardiologist. The obtained data are further explored and analyzed via SPSS software, ver. 19 (Chicago, IL, USA).

Results: The sample under study was 52.2% and 48.8% men and women, respectively. Phi correlation coefficient of 73% and positive Cramer's V of 0.879 was observed between re-admission and arrhythmia admission for the group received 40 mg atorvastatin. It means that we have more re-admission when arrhythmia increases. Only 4% correlation coefficient and very low positive Cramer's V of 0.293 was seen for the group who receive 80 mg atorvastatin. It indicates that no significant correlation exists between eject fraction of admission and re-admission (P=0.18). The results showed that hs-CRP of the group that received 80 mg atorvastatin was 0.179 which is lower than 0.37 for the group who received 40 mg atorvastatin.

Conclusion: By increasing the astatine dose, the amount of hs-CRP and consequently the risk of subsequent cardiovascular events were reduced. Hence, high starting dose of atorvastatin at preliminary stages of hospitalizing can reduce re-admission and cardiovascular consequents.


Comparison of pregnancy-associated plasma protein-A, troponin and creatine kinase-MB levels in acute coronary syndrome
Aida Alizamir , Seyed Mahdi Rezvanjoo , Elham Khanlarzadeh , Farnaz Fariba,
Volume 78, Issue 3 (6-2020)
Abstract
Background: Early diagnosis and proper treatment of patient with acute coronary syndrome (ACS) and ischemic heart disease are important in determining prognosis, preventing adverse effects, and may even save lives. In this study, the level of pregnancy-associated plasma protein-A (PAPP-A) in ACS patients was compared with the control group, in addition to cardiac Troponin (cTn) and creatine kinase-myocardial band (CK-MB) markers.
Methods: In this cross-sectional study, 116 patients with ACS were selected by convenience sampling method among patients referring to the emergency department of Farshchian Heart Center, Hamadan University of Medical Science in Iran, from June 2017 to May 2018, and then were compared with 116 healthy persons (control group) in term of PAPP-A, CK-MB and serum cTn biomarkers.
Results: The mean and standard deviation of PAPP-A in acute coronary syndrome (ACS) and control group were 93.85±27.56 and 89.63±7.29, respectively. There was no significant statistical difference between patients with ACS and control group. However, the level of PAPP-A in ST segment elevated myocardial infarction patients (STE-MI) was significantly higher than those with unstable angina (UA) and non-ST segment elevated myocardial infarction (NSTE-MI) (P<0.001). The mean and standard deviation of PAPP-A in patients with acute coronary syndrome with positive and negative troponin results was 99.42±27.52 and 90.69±18.79, respectively (P=0.021). The correlation coefficient between serum PAPP-A and creatine kinase-MB obtained 0.070 (P=0.292).
Conclusion: In patients with ACS, in addition to the increase in cardiac troponin markers (cTn), the serum level of pregnancy-associated plasma protein A (PAPP-A) also increases significantly. Therefore in addition to measuring serum cardiac troponin levels, evaluation and measurement of PAPP-A can also be used to diagnose and management of ACS.

Relationship between demographic and clinical factors with electrocardiography deviation as a prognostic factor in acute coronary syndrome patients
Mina Khanhoseini, Hossein Sheybani, Salman Daliri, Zahra Hadadi, Hengameh Khosravani,
Volume 79, Issue 3 (6-2021)
Abstract
Background: Acute coronary syndrome (ACS) is one of the causes of disability and death. Levels of Uric acid, blood glucose, and dyslipidemia are the risk factors for the disease, but their role in electrocardiographic changes has not been studied. Based on this, this study aimed to investigate the relationship between some demographic and clinical characteristics with electrocardiographic changes.
Methods: This cross-sectional study was performed on 484 patients with Acute Coronary Syndrome admitted to Shahroud Imam Hossein Hospital from the beginning of January to the end of June 2018. In this study, the relationship between demographic, clinical and laboratory variables in patients with the acute coronary syndrome with STE, STD, Dynamic changes and inverted T waves were investigated. The required information was extracted from the Patients' records using the researcher-made checklist. Statistical analysis of data was conducted by using descriptive tests for estimating mean and frequency and statistical-analytical tests including chi-square and ANOVA were performed by SPSS software version 22.
Results: The results show that the proportion of STD deviations in women with ACS was 12.6% higher than in men, but the proportion of STE and Dynamic changes in men was 10.4% and 12.2% higher than women, respectively. The proportion of STD, STE, inverted T and Dynamic changes in people with hyperlipidemia was 67.8%, 77.6%, 64.7% and 75.8%, respectively. The proportion of STD, STE, inverted T and Dynamic changes in patients with hypertension were 0.12%, 5.1%, 11.2%, and 19.1%, respectively that there was a difference with patients without high blood pressure. Between addiction, fasting blood sugar and LDL with STD; Between History of heart disease, history of angiography, hypertension, creatinine and WBC with STE; and between creatinine and fasting blood sugar statistically significant differences were observed.
Conclusion: There were significant correlations between electrocardiogram changes, gender, addiction, hypertension, creatinine, LDL level, fasting glucose and white blood cell count.

The effect of empagliflozin administration on lipid profile in diabetic patients with acute coronary syndrome after PCI.
Seyed Mohammad Hassan Adel, Saad Fazeli, Fatemeh Jorfi , Hoda Mombeini, Homeira Rashidi,
Volume 80, Issue 3 (6-2022)
Abstract
Background: Diabetes mellitus is associated with an increased risk of cardiovascular disease. The effects of add-in Sodium-glucose cotransporter 2 (SGLT2) inhibitors to standard statin treatments in acute coronary syndrome (ACS) patients remains controversial. The effects of the empagliflozin treatment after percutaneous coronary intervention (PCI) on the lipid profile of patients with type 2 diabetes mellitus (T2DM) have not been investigated yet. This study aimed to evaluate the efficacy of empagliflozin administration on lipid profile in diabetic patients with ACS after PCI.
Methods: This randomized, double-blind, placebo-controlled trial study was conducted from March until December 2020 on type 2 diabetes patients who underwent PCI and were referred to the Golestan and Imam Khomeini Hospitals. 93 patients (56 males and 37 females, mean age of 56.55 years old) were included. The patients were randomly assigned into two groups of receiving empagliflozin (10 mg, once daily) or a matching placebo, in addition to standard therapies for 6 months. The changes in metabolic parameters including lipid profile before and 6 months after interventions were assessed.
Results: After treatment in placebo group the level of LDL-C (median 0.90 mg/dl to 0.82, P=0.008) and HDL-C (median 0.40 mg/dl to 0.35, P=0.090) were decreased, while in the empagliflozin group the levels of LDL-C (median 0.87 mg/dl to 0.96, P=0.875) and HDL-C (median 0.38 mg/dl to 0.48), P=0.007) increased. Treatment with Empagliflozin and placebo had no significant effect on changing the levels of total cholesterol, TG and eGFR (P>0.05). The weight loss and FBS reduction in the empagliflozin group were significantly higher than placebo (P=0.001 and P=0.048, respectively).
Conclusion: Our results showed that adding Empagliflozin to standard treatment compared with a placebo for 6 months significantly increased LDL-C and significantly increased HDL-C. Also, except for weight loss and FBS, Empagliflozin was not more effective in improving the metabolic parameters of diabetic patients after PCI compared with placebo, so it seems that the use of this drug in diabetic patients with ACS after PCI is not very cost-effective.

Evaluating the guidelines adherence in the management of NSTE-ACS referred to shahid chamran hospital within six-month period in 2021: a brief report
Mohammad Mahdi Gholamian , Mehrnoush Dianatkhah, Mohammad Kermani-Alghoraishi, Ehsan Shirvani,
Volume 81, Issue 8 (11-2023)
Abstract
Background: The purpose of this study was to evaluate the adherence to the ESC 2020 guideline for the management of NSTE-ACS patients admitted to Shahid Chamran Cardiology Hospital affiliated to Isfahan University of Medical Sciences in 2021.
Methods: In this retrospective study which was done during April 2021 to September 2021 we reviewed the hospital documents of 239 NSTE-ACS patients, in regard to prescribed medication during the admission period in Shahid Chamran Heart Center. Guideline-adherence was evaluated according to ESC2020 guideline. Totally 18 items were evaluated including Antiplatelet (Clopidogrel, Ticagrelor, and Prasugrel) Anticoagulant (Heparin or Enoxaparin), PPI, Statin, Beta blocker, and RAAS blockers (including ACEI/ARB or MRA). In each section the selected drug and the administered dose were compared with the guideline and the guideline adherence for each part was expressed as percent.
Results: Almost complete guideline adherence was described for 12 out of 18 reviewed items (77%). However, guideline adherence in relation to the type of medicine chosen as an antiplatelet was reported to be very low, and only 1.2% of the cases received ticagrelor or prasugrel which are the guideline recommended antiplatelet agent. Additionally, most of the administered GP2b3a antagonist agents such as eptifibatide were not in accordance with the guideline (Guideline adherence 39.74%). Also, the choice of the anticoagulant agent was among the items with low guideline adherence (29.76%) and the cross-over between anticoagulants (changing heparin to enoxaparin or vice versa) which has been inhibited by the guideline was seen with high incidence in this center (78 cases).
Conclusion: The present study showed relatively high guideline adherence in the most aspects of medical management. However, compliance was reported to be low in relation to the antiplatelet selection, the choice of the anticoagulant agent, and the indication for GP2b3a antagonist use, which maybe due to the higher cost of recommended agents, and shortage of some medications and dosage forms in Iran.

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