Faculty of Medicine

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Biomarkers of oxidative stress in patients with acute coronary syndrome
(2016-05-16)
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Kamceva Gordana
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Kitanoski Darko
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Purpose: To evaluate comparatively association between biomarkers of oxidative stress(OS) in patients with acute vs chronic coronary artery disease, and in comparison with healthy volunteers. Methods :Cross-sectional observational study was performed in patients admitted because of coronary artery disease (CAD). Pts were evaluated for their demographics, risk factors and co-morbidities, lipoprotein profile, HgbA1C and markers of oxidative stress: malondialdehyde (MDA) and hydroperoxids (HP), and antioxidant enzymes: superoxide dizmutaza (SOD), CATALASE and glutathione peroxidase (GPS). Pts were divided in 2 groups: pts with acute coronary syndrome (ACS) and chronic coronary artery disease (HCAD), and then subdivided, ACS pts in: STEMI, NSTEMI and APNS, HCAD in: asymptomatic CAD, revascularized and post MI patients. Statistical analysis: descriptive, t-test, ANOVA, Kruskall-Wallis ANOVA, correlation. Significance was determined at level of 0.05.Results :300 pts. 194 males and 106 females at mean age of 62.9±11,2 y were analyzed. 187 were with ACS and 113 with HCAD. 62,3% of pts. had HTA, 42,7% HLP, 28,3% DM, 57% smokers, 8% had anemia. There was no significant difference in the risk profile between the two groups. Mean values of the markers of OS (Table 1). Statistically significant differences didn’t existed between ACS and HCAD groups but inside the groups(Table 1), in lipid profile and HgbA1C in ACAD pts compared to HCAD.ACAD pts had higher HgbA1C, total, LDL and ApoB, but lower HDL-C and ApoA1. Correlation was found for HgbA1C and MDA (r=-,154**, p=0,008); age and total HP (r=-,143*, p=0,013); ApoA1 and total HP (r=-,157*, p=0,035);Conclusion: Markers of oxidative stress were significantly higher, and antioxidative activity was lower compared to healthy volunteers, but between ACAD and HCAD group significant differences were found only for HP from pro-oxidative, and SOD from anti-oxidative markers. Inside the groups, revascularized HCAD pts were with the highest pro-oxidative and lowest anti-oxidative activity, while in ACAD group, different markers of OS were the most pathological in different ACAD groups
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Predictors of early rehospitalization in patients with acute coronary syndrome
(2014-10)
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Chaparovska Emilija
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Pocesta Bekim
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Shehu Enes
Purpose:To analyze early rehospitalization rate (defined as 90 days after the acute event) in patients with ACS, and to identify predictors of risk for readmission. Methods:463 randomly selected patients with ACS,were retrospectively analyzed.Analyzed variables:type of ACS(STEMI/NSTEMI/APNS),location of MI,gender,age,risk factors:HTA,HLP,DM,COPD,CAD,PVD,CVD,EF,type of treatment(PCI vs. noninvasive),extensiveness of coronary disease,GRACE and TIMI risk score, type of morbidity,and reason for rehospitalization.Comparative analysis was performed between patients with early rehospitalisation and others.Statistical analysis:t-test,Chi square,univariate and multivariate linear regression. Results:463 patients were enrolled:68.9% males mean age 60.4±10.9, and 31.1% females mean age 64.94±12.0(p 0.000).MI type:STEMI 75.8%,NSTEMI 11.2%,APNS 13%; MI location:40.2% anterior,39,7% inferior,3% lateral and 3.7% multiple locations(p 0.000).Risk profile:15.3% HCAD,27% HF,62% HTA,28.1% DM,5.8% PVD,2.6% COPD.Mean BMI was 27±2.9,mean SBP 138.8±28.5mmHg,mean HR 84.3±24.2,mean EF (in 208 pts.) 50.2±10.4%, mean GRACE score(in 72 pts.) was 148.9±60.6,mean TIMI score(in 263 pts.) was 3.9±2.3. 87.5% were treated with PCI procedure, with mean disease’s CA 1.84(range 1-5), median 1(p 0.000). Hospital morbidity was present in 16% of pts.,6.9% minor, 3% major bleeding complications, 2.4% acute HF, 1.9% pericardial effusion, and 1.1% early stent thrombosis.Early rehospitalization rate was 6.3% (29/463):14 ischemic/trombotic events;9 acute heart failures, 3 malignant arrhythmias, and three fatal events. Univariate predictors of RH: HR(R square 0.014, p 0.014, beta .116, r -.217, p 0.002);EF(%) (R square 0.055, p 0.001, beta -.234, r -.231, p 0.001).HTA was significantly associated with reduced hospitalization risk (Chi square 4.28, p 0.039, exp B .405, p 0.054),diabetes(Chi square 10.04, p 0.002, exp B 3.45, p 0.001),PVD (expB 2.85, p 0.070),early in-hospital morbidity(expB 2.12, p 0.084),and NSTEMI pts. had OR 1.3, and APNS pts. OR 1.16 for rehospitalization(higher but not significantly in comparison to STEMI pts.). Multivariate model with variables that were found significantly associated with HR, identified two strong independent predictors of early rehospitalization(mean square.424, sig 0.000),EF(beta -.220, p 0.001),and diabetes(t 2.52, p 0.012) Conclusions:LV systolic dysfunction was again proven to be a strong predictor of clinical outcome in terms of early hospital readmission in ACS patients no matter how they were treated for ACS, and diabetes was the single strong independent predictor-risk factor for this event.
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Prognosticators of heart failure in patients after treatment because of acute coronary syndrome
(2016-05)
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Bekim Pocesta
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Gorjan Krstevski
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Hajber Taravari
Aim of the study was to identify frequency and predictors of heart failure in patients treated for acute coronary syndrome (ACS). Patients and methods: Patients with ACS treated medically or with PCI, were extracted from the hospital registry. Analyzed variables: age, gender, risk factors, SBP and HR at hospital admition, type of MI, location, CAD severity, LV function, type of treatment, in-hospital morbidity, pharmacologic treatment post discharge, time to event. Statistical analyze: descriptive and comparative analyze, uni and multivariate regression analyze, Caplan-Meier event free survival analyze. Results: 437 patients treated for ACS, at mean age 63,2±11,1 years, 294(67,3%) males and 143(32,7%) females, were followed up for mean 17,3±10,3 months. A total of 128(29,3%) patients had 136 cardiac events (CE), 32(25%) of whom heart failure (HF). Mean time to HF was 5,9±7,4 (SE), CI(3,3-8,6) (Figure 1). As univariate predictors of HF in ACS treated patients we identified: length of hospitalization (for ACS treatment) 3,9±2,2 vs 5±2,5 days (beta .169, p=0,009); diuretic utilization during ACS hospitalization (beta 1.992, p=0,001); EF (%) (beta -0.092, p=0,001); reduced EF (<40%) had OR for HF 3.282 (CI 1,129-9,542, p=0,011); receiving PPCI (beta -1.584, p=0,011, exp(B) 0.205); known DM (beta0.741, p=0,007, exp(B) 2,098); previous MI (beta 0.832, p=0,068, exp(B) 2,297); statin therapy prior ACS (beta-0.955, p=0,028, exp(B) 0,385); PCI performed (beta-0.990, p=0,043, exp(B) 0,372); in-hospital morbidity (beta 0.868, p=0.028, exp(B) 2,382). In multivariate analyze (binary logistic regression) four independent predictors were identified: known diabetes (p=0,004), PCI treatment for ACS (p=0,006), diuretic therapy during ACS hospitalization (p=0,004) and LV function (p=0,024). Conclusion: Predictors of HF development in pts. after ACS, seems to be preexisting DM, need for diuretic therapy during ACS event, and reduced LV systolic function as negative ones, but, receiving PCI (myocardial revascularization) is the most important positive predictor.
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Mid-term clinical outcome of patients treated for acute coronary syndrome-data from the registry
(2016-10)
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Bekim Pocesta
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Taravari Hajber
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Shehu Enes
Aim of the study: what are the prognosticators of mid-term outcome in patients treated because of acute coronary syndrome. Methods: Longitudinal retrospective-prospective single center study that analyze, type of ACS (STEMI/NSTEMI/APNS), hemodynamic parameters (heart rate and SBP on the admition), type of treatment (PCI vs medical), LV ejection fraction, extent and severity of CAD, medication used, medications post discharge, type and time to event. Statistical analyze: descriptive and comparative analyze, uni and multivariate regression analyze, Caplan-Meier event free survival analyze. Results: 364 patients treated for ACS, at mean age 63,1±11,1 y., 246(67,4%) males and 119(32,6%) females, were followed up for mean 18.6±10,4 months. A total of 95 cardiac events (CE) in 94(25,8%) patients during the 364pts./563.7 y. follow up were registered, or 17.6% annually. 8 (2.2%) cardiac deaths (CD) were registered, or 1.5% annually death rate. Ischemic events were the most frequent (59-15,7%): angina-14(3,9%), scheduled revascularization after ACS because of multivassel CAD-31(8.5%), and acute ischemic event leading to re-revascularization-12(3.3%) pts. Symptomatic heart failure-20(5.5%) pts. leading to CD in 5, 7(1,4%), ischemic CVI with one fatal event, atrial arrhythmias in 8(2,2%) and malignant ventricular arrhythmias in 4(1,1%) pts. one with fatal ending, and one sudden CD. 58(61,7%) out of 94 events occurred during the first 6 months after the ACS. Univariate predictors were: medications used: DAPT: beta -2.147, p=0.000, expB 0.117; beta blockers: beta -.952, p=0,004, exp(B) 0,386; BB+RAAS inhibitors: beta -.765, p=0,015, exp(B) 0,465; diuretics: beta 1,189, p=0,007; exp(B) 3.284; ASA prior the first event: beta -1.055, p=0,000; exp(B) 0.345; diabetes: beta .788, p=0.006, exp(B) 2.199; anemia: beta1,090, p=0,006, exp(B) 2.975; age: beta.155, t 2.198, p=0.029; HR beta.155, t 3.274, p=0.001; number of lesions: beta.105, t 2.009, p=0.045; In a backword conditional logistic regression model six independent predictors were identified: ASA prior the first event exp(B) .537, p=0.049; DAPT exp(B) 2.245, p=0.000; BB+RAAS exp(B) .492, p=0.046; diuretics exp(B) 3.087, p=0.18; DM exp(B), p=0.014; Conclusion: The prevalence of CE during the mid-term follow up in ACS patients was 17.6%, with 1.5% death rate annually. Diabetes is a powerful independent predictor of mid-term outcome in patients treated for ACS. But taking aspirin therapy prior to the event, DAPT, combined BB+RAAS inhibitor after the treatment for ACS are significant positive prognosticators, as opposite taking diuretic therapy is a negative prognosticator of mid-term outcome in these patients.
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Incidence of Major Gastrointestinal Bleeding in Patients with Acute Coronary Syndrome treated with dual antiplatelet and anticoagulant therapy-Data from the Registry.
(2017)
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Bekim Pocesta
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Hajber Taravari
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Shehu Enes
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Kitanoski Darko
Aim of the study: To investigate the incidence, predictors and prognosis of gastrointestinal bleeding in patients treated for acute coronary syndrome. Materials and Methods: A retrospective study with data gathered from the registry. We analyzed different variables of STEMI, NSTEMI and unstable angina treated patients: clinical, angiographic, treatment type, medications use, in-hospital outcome. Upper gastrointestinal bleeding was defined as hematemesis and/or melena with Hgb reduction, requiring cessation of antiplatelet or anti-coagulant therapy and administration of erythrocyte transfusion and, if needed, upper GIT endoscopy. Statistical Analysis: Descriptive, comparative, univariate and multivariate linear and/or binary logistic regression analysis. Statistical significance was determined at a 0,05 level. Results: 874 patients (66,6% males and 33,4% females, mean age 65,7 ± 11,04 y) were analyzed. 75,4% of the patients had STE-MI, 12.5% had NSTEMI and 12,1% APNS. The predominant risk factors were: HTA (59.9%), smoking (56,9%), overweight/obesity (66,7%) and DM (27,8%). 11% had previous MI, 11,3% revascularization, 5,3% CVI and 5% had previous GIT symptomatology. Mean eGFR was 93 ml/min, although 16,4% of the patients had eGFR < 60ml/min. Preexisting anemia was registered in 9,7%. 93,6% of STEMI, and 91,6% of NSTEMI/APNS patients received PCI. Regarding the patients medications, 98,4% were treated with ASA, 70% with 600 mg loading dose Clopidogrel, 90,4% with UFH and 18% received H 2 blockers or PPI. For the in-hospital morbidity, 5,6% of the patients had acute heart failure, 2,8% A-V block, 2,6% acute renal failure, 5,4% supraventricular arrhythmias, 6,4% ventricular arrhythmias, 0,8% in-stent thrombosis, and 0,3% of the patients had ischemic CVI. The most frequent bleeding complications were: 9,2% at the vascular access site, 1,5% GI bleedings and 1,6% UG bleedings. Hospital mortality was 6,8%, and the death Hazard Ratio among patients with GIB was 9,34 (CI 2,95-29,5). Univariate predictors of GIB were: age (beta ,085), BMI (beta-,073), eGFR < 60ml/min (beta-,081), Crusade bleeding risk score (beta ,141), Hgb (beta-,225), urea (beta ,386), old MI (OR 3,715), GPIIb/IIIa inhibitors (OR 9,267), H2/PPI (OR 10,840), anemia (OR 11,712), eGFR < 60 ml/min (OR 6,390), ARF (OR 7645), and supraventricular arrhythmias (OR 5,440). Previous MI (p = 0,010), use of GPIIb/IIIa inhibitors (p=0,031); H2 or PPI (p = 0,000); eGFR < 60 ml/min (p = 0,050); supraventricular arrhythmias (p = 0,002), and anemia prior ACS (p = 0,042) were identified as independent predictors. Conclusion: GIB is one of the most frequent bleeding complications in patients treated for acute coronary syndrome, associated with a significant in-hospital mortality risk.

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