Tag Archives: acute coronary syndrome

Introduction The management of coronary artery disease (CAD) in patients presenting with acute coronary syndromes (ACS) poses a significant challenge in interventional cardiology.1 As clinical practice evolves, the imperative to compare the outcomes of drug-coated balloons (DCB) and drug-eluting stents (DES) has gained prominence, particularly considering the distinct pathophysiological characteristics and risks associated with ACS.2 Insights from the BASKET-SMALL 2 trial, the largest randomised clinical trial assessing DCB versus DES for small-vessel CAD, provide pivotal evidence in this area. This prespecified analysis yielded three signifi

Introduction Clinical guidelines recommend routine early inpatient invasive coronary angiography (ICA) in patients presenting with non-ST-elevation acute myocardial infarction acute coronary syndrome (NSTEMI-ACS) who are considered at higher risk of future recurrent myocardial infarction (MI) and death. National Institute for Health and Care Excellence (NICE) guidance recommends early ICA in high-risk patients within three days of admission,1 and the European Society of Cardiology (ESC) recommends this investigation is completed within 24 hours.2 Most UK patients presenting with NSTEMI-ACS are admitted to hospitals that do not have invasive

Introduction Acute myocardial infarctions (AMI) occur with an increased frequency in patients receiving long-term dialysis treatment for end-stage renal disease (ESRD). Moreover, these patients have additional comorbidities, such as diabetes mellitus and systemic arterial hypertension, further predisposing individuals to the development of coronary artery disease.1,2 By its very nature, haemodialysis (HD) therapy may be highly disruptive to patients’ lifestyles, as those receiving regular sessions are less likely to perform regular exercise, adhere to a healthy diet, face difficulties complying with medications or adopt health-seeking behav

Cardiovascular disease is the primary cause of premature mortality and morbidity in people with CKD.9,10 The risk of cardiovascular disease increases as kidney function declines, but also notably with an increase in proteinuria;11 those with kidney failure (the relatively new term proposed by the Kidney Disease Improving Global Outcomes [KDIGO] group to encompass all individuals with an estimated glomerular filtration rate [eGFR] <15 ml/min/1.73 m2) experience the greatest risk. It is this association between kidney and cardiac disease that explains the high prevalence of CKD among individuals hospitalised with ACS; the population prevalen

Introduction Wellens’ syndrome is a pre-infarction electrocardiogram (ECG) pattern indicating critical proximal left anterior descending (LAD) stenosis and high risk of imminent acute myocardial infarction (MI). It is characterised by specific T-wave changes in precordial leads, typically biphasic or deeply inverted T-waves in V2–V3 (type B) or symmetrical deeply inverted T-waves in V1–V6 (type A).1 This pre-infarction state represents temporary stabilisation of an unstable coronary plaque.2 Current guidelines recommend urgent coronary angiography and revascularisation. However, for elderly patients with multiple comorbidities, invasive

Introduction Acute coronary events are commonly caused by plaque rupture, erosion and, infrequently, calcific nodules. In the majority of patients with acute coronary syndrome (ACS), occlusive or sub-occlusive thrombus on top of plaque deformation is the main angiographic finding. Resolving acute thrombotic occlusion remains the cornerstone step in restoring adequate coronary perfusion. Blind dealing with thrombi, depending only on angiography, may be an obstacle to optimal myocardial perfusion and increase in-hospital morbidity and mortality.1–4 In the past, intravascular ultrasound (IVUS) and, more recently, optical coherence tomography (

Introduction Myocarditis is a known complication of COVID-19, however, recently concerns have been raised regarding myocardial injury in the presence of a substantial coronary thrombus burden, in combination with atherosclerotic plaque.1,2 Widespread community transmission of COVID-19 has led to some presentations of myocardial infarction associated with active COVID-19 infection.1 We present the angiographic findings of such a case with a heavy burden of thrombus, despite only minor obstructive coronary disease. Case presentation A 36-year-old man was admitted to a local hospital with respiratory failure secondary to COVID-19 pneumonia. Init

European Society of Cardiology (ESC) guidelines recommend low-density lipoprotein (LDL) below 1.4 mmol/L in patients post ACS, which differs from UK National Institute for Health and Care Excellence (NICE) guideline recommendations of 1.8 mmol/L and 1.4 mmol/L in very-high-risk patients only.6,7 The fifth European survey of Cardiovascular Disease prevention and Diabetes (EUROASPIRE V) survey showed that only 30% of post-ACS patients had low-density lipoprotein cholesterol (LDL-C) levels <1.8 mmol/L one year after discharge.8 The ACS EuroPath survey showed a considerable lack of physicians’ compliance with guidelines in managing lipid low

Introduction Primary percutaneous coronary intervention (pPCI) and stenting are considered first-line management of ST-elevation myocardial infarction (STEMI).1 There is a well-recognised inflammatory component to ischaemic heart disease (IHD), and, thus, C-reactive protein (CRP) has been implicated as a poor prognostic indicator for stent re-stenosis, cardiovascular mortality and all-cause mortality post-myocardial infarction (MI).1,2 Case An 87-year-old man presented to Accident and Emergency (A&E) for “a one day history of severe neck/parietal headache on background of recent discharge from hospital with an MI”. Past medical histor

Introduction Cholesterol is a key risk factor for atheroma and coronary heart disease. The evidence-base for high-intensity lipid-lowering therapy in secondary prevention of cardiovascular disease is unequivocal.1-4 Despite the introduction of novel drugs, including ezetimibe5,6 and monoclonal antibodies,7 statins remain first-line therapy.8,9 Statins decrease hepatic cholesterol synthesis by competitively inhibiting 5-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase receptors, as they have an affinity up to 10,000 times greater than the natural substrate.10 Through reducing intra-cellular cholesterol concentration, statins up-regulate