[Risk marker stratification in coronary acute syndromes]
Carlos Jerjes-Sánchez Díaz1, Alfredo Comparan Núñez, Luis Miguel Canseco
1Servicio de Urgencias, Hospital de Enfermedades Cardiovasculares y del Tórax, Centro Médico del Norte, Instituto Mexicano del Seguro Social, Monterrey, Departamento de Biocuimica de la Facultad de Medicina, UANL. jerjes@prodigy.net.mx
Insights
Identifying high-risk patients with acute coronary syndromes is crucial for effective treatment. Inflammation, fibrinolysis, and specific genetic factors significantly impact patient outcomes and guide secondary prevention strategies.
Area of Science:
- Cardiology and Atherosclerosis Research
- Biomarkers and Genetic Risk Factors in Cardiovascular Disease
Context:
- Acute coronary syndromes (ACS) present with varied clinical outcomes, necessitating precise risk stratification.
- Understanding the shift in atherosclerosis pathophysiology towards an inflammatory basis is key for modern medicine.
- Healthcare systems require efficient risk assessment to manage costs associated with treatments like percutaneous coronary intervention.
Purpose:
- To explore novel markers and genetic factors for improved risk stratification in acute coronary syndromes.
- To investigate the association between inflammation, fibrinolysis, anticoagulation proteins, and adverse cardiovascular events.
- To evaluate the predictive value of specific biomarkers and genetic polymorphisms in coronary artery disease.
Summary:
- Clinical factors (family history, chest pain, ST abnormalities) and markers of endothelial dysfunction, necrosis, and ventricular dysfunction aid in risk stratification.
- Abnormal fibrinolysis, inflammation, and anticoagulation proteins are closely linked to adverse events in ACS.
- Persistent ST elevation, leukocytes, fibrinogen, and specific fibrinogen gene polymorphisms (-455A, -148T) are valuable predictors in acute myocardial infarction and coronary disease.
Impact:
- Enhanced risk stratification enables tailored treatment strategies, including intensive antithrombotic therapy or standard care.
- Identifying genetic predispositions improves secondary prevention efforts for coronary artery disease.
- This research supports more accurate patient management, potentially reducing healthcare costs and improving patient outcomes.
Abstract:
Acute coronary syndromes have a heterogeneous clinical presentation with a broad spectrum for mortality and adverse events. It is mandatory to identify high risk groups for percutaneous coronary intervention and intensive antithrombotic treatment or common risk for standard treatment. In contemporaneous medicine it is important to get adequate risk stratification because the impact of hospitalary costs, antithrombotic and reperfusion treatment on health systems. The current pathophysiology of atherosclerosis is moving from a disease secondary to cholesterol deposit, to an inflammatory disease. In the stratification process, familiar history, chest pain, ST dynamic abnormalities, left ventricular wall motion abnormalities, all have predictive value. The association of indirect endothelial dysfunction, micro or macronecrosis and ventricular dysfunction markers increase this value. In our experience a close relationship among abnormal fibrinolysis, inflammation and anticoagulation proteins with adverse events has been proved in acute coronary syndromes. Other interesting finding--for it accessibility--in acute myocardial infarction under coronary percutaneous intervention is persistent ST elevation, leukocytes and fibrinogen predictive value. In population allelic polymorphisms -455A and -148T and fibrinogen ( >450 mg/dL) were associated with coronary disease. These polymorphisms improve risk stratification of coronary disease to establish a better secondary prevention and treatment.
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