ACS, some additional data

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Pr ognostic Utility of Fibroblast Gr owth Factor-23 Af ter an Acute Coronary
Syndrome


Background: Fibroblast growth factor (FGF)-23 is a phosphatonin that may promote myocardial fibrosis and atherothrombotic plaque instability. Higher FGF-23 levels are associated with adverse cardiovascular (CV) events in stable CAD. The prognostic utility of FGF-23 in
patients after an acute coronary syndrome (ACS) is unknown.
Methods: FGF-23 was measured in plasma using an established ELISA (Immunotopics) in 4,947 patients w/in 30 days of ACS (median 14d) in the SOLID-TIMI 52 trial (median follow-up 2.5y). Analyses were adjusted for clinical risk predictors, eGFR, cystatin C, hsTroponin I, hsCRP, BNP and treatment arm.
Results: The median FGF-23 level was 63.1 (IQR 46.0-93.5) reference units/ml. Patients with higher FGF-23 levels were older, more likely female and with a history of HTN, DM and prior MI, but less likely to present with STEMI. FGF-23 levels were moderately to weakly correlated w/ eGFR, cystatin C, hsTnI, hsCRP and BNP. After multivariable adjustment, FGF-23 levels in the top quartile were independently associated with an increased risk of CV death or heart failure hospitalization (HR 2.43, 95% CI 1.90-3.13, P<0.001, Fig A)
and the individual components. Elevated FGF-23 levels were also associated with an increased risk of CV death, MI or stroke (HR 1.46, 95% CI 1.22-1.76, P<0.001, Fig B).
Conclusion: FGF-23 is associated with recurrent major CV events in patients stabilized after ACS, providing information independent of  established clinical factors and cardiorenal biomarkers.


Telomerase Activity in Older Patients Pr esenting with Non-ST Elevation Acute
Coronary Syndrome
Conclusion: There is no correlation between TA, cardiovascular risk factors or frailty phenotype in high-risk older patients presenting with NSTEACS. Further studies are required to evaluate the underlying biological interactions of telomerase, particularly in coronary artery
disease.

Common Non-Cardiac Contributors to Anginal Pain: Experience of Emergency Chest
Pain Evaluation Center
Conclusion: In our cohort of low risk acute chest pain patients, depression, anxiety, and GERD were associated with higher self-reported severity of angina and angina frequency. These disorders were each more common than CAD in this population. Noncardiac conditions  which contribute to or mimic cardiac chest pain should be assessed to best achieve relief for patients seeking acute evaluation of their symptoms.

Platelet Function Testing and Heart-Type Fatty Acid Binding Pr otein Levels for
Risk Stratification in Patients with Acute Coronary Syndrome Who Undergo
Percutaneous Coronary Intervention

Authors: Ian Pearson, Alistair Hall, Chris Gale, Mohan Sivananthan, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom

Background: Patients with acute coronary syndrome (ACS) who undergo percutaneous coronary intervention (PCI) but fail to respond to clopidogrel are at risk of recurrent ACS. Yet the majority of poor responders do not experience recurrent events. The highly cardio-specific biomarker, Heart-type Fatty Acid Binding Protein (H-FABP), may improve risk stratification

Methods: We studied a combined endpoint (death, definite/probable stent thrombosis and recurrent myocardial infarction) at 1 year in 758 patients presenting with ACS without cardiogenic shock and undergoing PCI. Cardiac biomarkers measured at 0, 4 and 12 hours following
PCI. A platelet function test (VerifyNow) was performed prior to PCI.
Results: Clinical syndrome: 111 unstable angina; 536 non-STEMI; 111 STEMI. Mean age: 62 (12) years; female: 25%; median SYNTAX score: 8.0 (11.0). 28% IIbIIIa inhibitors. Clopidogrel hypo-response (PRU ≥ 238) found in 52.8%. H-FABP was elevated (≥ 2.0 μg/L) at baseline in 40%; of these, H-FABP was also elevated in 90% and 93% at 4 and 12 hours. Patients with both clopidogrel hypo-response and elevated baseline H-FABP (22.8%) had a higher rate of the endpoint at 1 year: adjusted hazard ratio (95% C.I.) 2.78 (1.34 to 5.69), p < 0.01. Hypo-responders with normal H-FABP levels at baseline had a similar event rate to clopidogrel responders
Conclusion: Combining H-FABP and platelet function testing improves risk stratification in ACS patients undergoing PCI.