Cardiovascular risk factors profile in patients with acute coronary syndrome with particular reference to left
Sheeren Khaled1, Rajaa Matahen2
1King Abdullah Medical City, Muzdallfa Road, Makkah, 21955, Saudi Arabia; Banha University, Egypt.
Insights
Diabetes, mitral regurgitation, and coronary artery disease severity predict left ventricular dysfunction in acute coronary syndrome (ACS) patients. Identifying these factors aids in managing high-risk individuals for better outcomes.
Area of Science:
- Cardiology
- Internal Medicine
- Clinical Research
Background:
- Acute coronary syndrome (ACS) is a primary cause of mortality in the US.
- Left ventricular (LV) systolic dysfunction significantly impacts long-term outcomes in ACS patients.
Purpose of the Study:
- To identify key risk factors and clinical predictors influencing left ventricular ejection fraction (LVEF) in ACS patients.
- To understand predictors of impaired LVEF (<40%) in ACS.
Main Methods:
- Retrospective analysis of 299 ACS patients admitted between July and December 2015.
- Classification into two groups based on LVEF: impaired (<40%) and preserved (>=40%).
- Logistic regression analysis to identify independent predictors of LV dysfunction.
Main Results:
- Patients with impaired LVEF were older, with higher rates of diabetes mellitus (DM), chronic kidney disease (CKD), STEMI-ACS, positive troponin, ischemic mitral regurgitation (MR), and coronary artery disease (CAD).
- Independent predictors for LVEF <40% included DM (OR: 2.64), significant ischemic MR (OR: 13.7), and severe CAD (OR: 5.06).
- Higher rates of LV thrombus were observed in the impaired LVEF group.
Conclusions:
- Diabetes mellitus, significant ischemic mitral regurgitation, and severe coronary artery disease are independent predictors of LV dysfunction in ACS.
- Early identification of these predictors can help stratify high-risk ACS patients for targeted interventions and close monitoring.
- Improved risk stratification may lead to better management and improved outcomes for ACS patients with LV dysfunction.
Background:
Acute coronary syndrome (ACS) remains a leading cause of death in the United States. Numerous studies have shown that the degree of LV systolic dysfunction is a major if not the most important determinant of long-term outcome in ACS.
Objectives:
To identify the most important risk factors and other clinical predictors which might have impact on left ventricular ejection fraction in patients with ACS.
Results:
The total patients (299) admitted to our center from July, 2015 till December, 2015; with established diagnosis of ACS were classified in to two groups: Group I: 193 patients with impaired LVEF <40% (64.5%), Group II: 106 patients with LVEF equal or >40% (35.5%). The patients of group I were significant elderly compared to those of group II (60.9±11.2 vs 56.9±10.6; p=0.002), had significant history of DM and CKD (66.3% and 31.1% VS 49.1% and 19.8%; p=0.004 and 0.036 respectively), presented mainly with STEMI- ACS (51.3% VS 28.3% respectively; p<0.001) with +v cardiac biomarker (troponin) (90.2% VS 66.0%; p<0.001). Moreover, patients of group I had more significant ischemic MR compared to the patients of group II (24.9% VS 3.8% respectively; p<0.001) with higher rate of LV thrombus discovered by echocardiography (25.4% VS 1.9%; p<0.001). Extensive significant CAD disease was observed to be higher among patients of group I (69.4% VS 57.5%; p=0.039) and those patients treated mainly with PCI revascularization therapy (68.9% VS 52.8%; p=0.002) compared to patients of group II who mainly treated medically (34.9% VS 17.6 %; p<0.001). Multiple logistic regression analysis demonstrated that DM (odd ratio (OR): 2.64, 95% confidence interval (CI): 1.45-4.79, P=0.01), presence of significant ischemic MR (OR: 13.7, 95% CI:2.84-66.1, p=0.001)and presence of significantly diseased coronary vessels (odd ratio (OR): 5.06, 95% confidence interval (CI): 1.14-22.6, P=0.033,) all were independent predictors for significant LV dysfunction (LVEF <40%) which predict poor outcome in ACS patients.
Conclusion:
We concluded that DM, presence of significant ischemic MR, and increased number, severity of diseased coronaries all were independent predictors of LV dysfunction (LVEF <40%) which is known to predict poor outcome. Identification of those risk predictors upon patient evaluation could be helpful to identify high risk-patients, in need of particular care, aggressive therapy and close follow-up to improve their poor outcome.
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