Short-term outcomes of non-ST segment elevation acute coronary syndrome after percutaneous coronary intervention: a
Ha Viet Trinh1,2, Dung Viet Nguyen2, Loi Doan Do1,3
1Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam.
Insights
Prognostic value of myocardial strain in non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients in Vietnam was assessed. Global longitudinal strain (GLS) after percutaneous coronary intervention (PCI) independently predicted major adverse cardiovascular events (MACE), identifying high-risk patients.
Area of Science:
- Cardiology
- Echocardiography
- Acute Coronary Syndromes
Background:
- Limited data exists on myocardial strain's prognostic value in non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients from low- and middle-income countries.
- This study investigated the prognostic significance of left ventricular myocardial strain in Vietnamese NSTE-ACS patients post-percutaneous coronary intervention (PCI).
Purpose of the Study:
- To evaluate the prognostic significance of left ventricular myocardial strain in NSTE-ACS patients after successful PCI.
- To identify echocardiographic parameters that predict major adverse cardiovascular events (MACE) in this population.
Main Methods:
- Prospective cohort study of 127 NSTE-ACS patients treated with PCI.
- Speckle-tracking echocardiography assessed global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) within 24 hours post-PCI.
- 12-month follow-up analyzed the association between strain parameters and MACE using survival analysis and ROC curves.
Main Results:
- 20.5% of patients experienced MACE within 12 months.
- Impaired GLS, GCS, and GRS were significantly associated with MACE (p < 0.0001).
- Higher (less negative) GLS was an independent predictor of MACE (HR: 1.62; p < 0.001) with excellent prognostic performance (AUC: 0.967).
Conclusions:
- Post-PCI GLS, GCS, and GRS are impaired in NSTE-ACS patients who experience MACE, indicating cardiac dysfunction.
- GLS is a valuable independent predictor of MACE after PCI in NSTE-ACS patients.
- GLS can help identify high-risk patients for closer monitoring and tailored management.
Background:
Data on the prognostic value of myocardial strain in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) from low- and middle-income countries remain scarce. This study aimed to evaluate the prognostic significance of left ventricular myocardial strain in patients with NSTE-ACS after successful percutaneous coronary intervention (PCI) in Vietnam.
Methods:
In this prospective cohort study, consecutive patients diagnosed with NSTE-ACS and treated with PCI underwent conventional and speckle-tracking echocardiography within 24 h post-PCI to assess myocardial function, including global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS). Patients were followed for 12 months. The association between echocardiographic parameters and major adverse cardiovascular events (MACE) was analyzed using Kaplan-Meier survival curves and Cox proportional hazards models. Prognostic performance was assessed using receiver operating characteristic (ROC) curves, area under the curve (AUC), and other diagnostic indices.
Results:
A total of 127 patients were included (mean age 65.5 ± 10.5 years; 71.3% male). During 12 months of follow-up, 26 patients (20.5%) experienced MACE. The MACE group had significantly impaired GLS, GCS, and GRS compared with the event-free group (all p < 0.0001). In multivariable analysis, only higher (less negative) GLS remained an independent predictor of MACE (HR: 1.62; 95% CI: 1.26-2.08; p < 0.001). GLS demonstrated the strongest prognostic performance among echocardiographic variables, with an AUC of 0.967 (95% CI: 0.941-0.994). At the optimal cutoff, an GLS ≥ -16% demonstrated a sensitivity of 100% (95% CI: 86.8-100) and a specificity of 85.1% (95% CI: 76.7-91.4).
Conclusion:
In patients with NSTE-ACS, post-PCI GLS, GCS, and GRS were significantly more impaired in those who developed MACE compared with the event-free group, indicating underlying cardiac dysfunction or myocardial injury. Among these parameters, GLS emerged as an independent predictor of MACE after PCI and may serve as a valuable tool for identifying high-risk patients.
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