Timing of Depressive Symptom Onset and In-Hospital Complications Among Acute Coronary Syndrome Inpatients

Objectives: Acute coronary syndrome (ACS) at a younger age is now becoming a crucial problem. This study determined the effect of gender on the clinical findings and outcomes of young patients (≤ 45 years) with ACS. Methodology: In this descriptive cross sectional study, young patients (≤45 years) who presented with ACS and underwent coronary angiography were recruited. The comparison of clinical profile, angiographic findings, in-hospital, and 90-days mortality between genders were made. Results: A total of 335 young patients with ACS were included, 80.6% of whom were men. A significant difference was found between men and women in terms of mean age: 38±6 vs. 40±5 (p=0.014), hypertension: 37.8% vs. 58.5% (p=0.002), diabetes: 17.4% vs. 35.4% (p=0.001), smoking: 50.4% vs. 6.2% (p≤0.001), use of smokeless tobacco: 14.1% vs. 4.6% (p=0.037), median time from symptom onset to first medical contact: 270 [420–165] minutes vs. 346 [499.5–240] minutes (p=0.047), ST-segment elevation myocardial infarction (STEMI) 89.6% vs. 78.5% (p=0.015), non-ST-elevation myocardial infarction (NSTEMI) 8.5% vs. 18.5% (p=0.019), and three-vessel disease (3VD) 10.7% vs. 21.5% (p=0.019), respectively. In-hospital and 90-day mortality rates were 0.4% vs. 3.1% (p=0.097) and 1.5% vs. 4.6% (p=0.136) for men and women, respectively. Conclusion: Women tended to have a higher age at presentation, more frequent traditional risk factors, late presentation after symptom onset, frequent NSTEMI, and 3VD, whereas men were distinct with frequent STEMI and higher tobacco use. In addition, women trended to have a higher in-hospital as well as short-term mortality than men did.

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Inconsistent measurement of acute coronary syndrome patients’ pre-hospital delay in research: A review of the literature

European Journal of Cardiovascular Nursing ◽

10.1177/1474515114524866 ◽

2014 ◽

Vol 13 (6) ◽

pp. 483-493 ◽

Cited By ~ 16

Author(s):

Martha H Mackay ◽

Pamela A Ratner ◽

Michelle Nguyen ◽

Myra Percy ◽

Paul Galdas ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Symptom Onset ◽

Large Body ◽

Operational Definition ◽

Treatment Seeking ◽

Total Delay ◽

Timely Initiation ◽

Hospital Arrival ◽

Coronary Syndrome ◽

Definition Of

Background: Patients’ treatment-seeking delay remains a significant barrier to timely initiation of reperfusion therapy. Measurement of treatment-seeking delay is central to the large body of research that has focused on pre-hospital delay (PHD), which is primarily patient-related. This research has aimed to quantify PHD and its effects on morbidity and mortality, identify contributing factors, and evaluate interventions to reduce such delay. A definite time of symptom onset in acute coronary syndrome (ACS) is essential for determining delay, but difficult to establish. This literature review aimed to explore the variety of operational definitions of both PHD and symptom onset in published research. Methods and results: We reviewed the English-language literature from 1998–2013 for operational definitions of PHD and symptom onset. Of 626 papers of possible interest, 175 were deemed relevant. Ninety-seven percent reported a delay time and 84% provided an operational definition of PHD. Three definitions predominated: (a) symptom onset to decision to seek help (18%); (b) symptom onset to hospital arrival (67%), (c) total delay, incorporating two or more intervals (11%). Of those that measured delay, 8% provided a definition of which symptoms triggered the start of timing. Conclusion: We found few and variable operational definitions of PHD, despite American College of Cardiology/American Heart Association recommendations to report specific intervals. Worryingly, definitions of symptom onset, the most elusive component of PHD to establish, are uncommon. We recommend that researchers (a) report two PHD delay intervals (onset to decision to seek care, and decision to seek care to hospital arrival), and (b) develop, validate and use a definition of symptom onset. This will increase clarity and confidence in the conclusions from, and comparisons within and between studies.

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Congruence of the Medical Record and Subject Interview on Time of Symptom Onset in Patients Diagnosed With Acute Coronary Syndrome

Dimensions of Critical Care Nursing ◽

10.1097/dcc.0000000000000207 ◽

2016 ◽

Vol 35 (6) ◽

pp. 332-338

Author(s):

Leslie L. Davis ◽

Thomas P. McCoy ◽

Barbara Riegel ◽

Sharon McKinley ◽

Lynn V. Doering ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Medical Record ◽

Symptom Onset ◽

Coronary Syndrome

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CONGRUENCE OF TIME FROM SYMPTOM ONSET ACCORDING TO MEDICAL RECORD VERSUS SUBJECT INTERVIEW IN PATIENTS DIAGNOSED WITH ACUTE CORONARY SYNDROME

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(15)60150-4 ◽

2015 ◽

Vol 65 (10) ◽

pp. A150

Author(s):

Leslie L. Davis ◽

Thomas P. McCoy ◽

Barbara Riegel ◽

Sharon McKinley ◽

Lynne Doering ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Medical Record ◽

Symptom Onset ◽

Coronary Syndrome

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Early Time-Dependent Dynamic Changes of TBET and GATA3 mRNA Expressions in Patients with Acute Coronary Syndrome

Disease Markers ◽

10.1155/2013/139895 ◽

2013 ◽

Vol 35 ◽

pp. 419-429 ◽

Cited By ~ 1

Author(s):

Timothy H. Rainer ◽

Colin A. Graham ◽

Rebecca W. Y. Chan ◽

Cangel P. Y. Chan ◽

Patrick C. F. Tan ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Symptom Onset ◽

Release Kinetics ◽

Early Time ◽

Blood Samples ◽

T Box ◽

Coronary Syndrome ◽

Mrna Ratio ◽

Thymine Adenine ◽

Gata3 Mrna

Background. T-box expressed in T cells (TBET) and guanine adenine thymine adenine sequence-binding protein 3 (GATA3) play important roles in the differentiation of Th1 and Th2 subsets, which contributes to the progression of acute coronary syndrome (ACS).Objective. This study aimed to investigate the temporal change of TBET/GATA3 mRNA ratio in ACS.Methods. Thirty-three patients suspected of ACS with symptom onset within 24 hours were recruited. Blood samples were taken after arrival at the emergency department and at hourly intervals until the 6th hour. The mRNA expressions of TBET and GATA3 were quantified by a real-time RT-qPCR.Results. The TBET/GATA3 mRNA ratio was elevated dramatically in patients with acute myocardial infarction (AMI) and exhibited biphasic M-shaped release kinetics with two distinct peaks. The ratio was elevated 2 hours after symptom onset, dropped to the lowest level at 10 hours, and rose to the second peak at 14 hours. A similar biphasic M-shaped curve was observed in AMI patients with blood samples taken prior to any intervention.Conclusions. The TBET/GATA3 mRNA ratio was elevated in AMI patients throughout most of the first 20 hours after symptom onset. The biphasic M-shaped release kinetics was more likely to reflect pathophysiological changes rather than treatment effects.

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Symptoms and type of symptom onset in acute coronary syndrome in relation to ST elevation, sex, age, and a history of diabetes

American Heart Journal ◽

10.1016/j.ahj.2004.08.035 ◽

2005 ◽

Vol 150 (2) ◽

pp. 234-242 ◽

Cited By ~ 51

Author(s):

Marie Thuresson ◽

Marianne Berglin Jarlöv ◽

Bertil Lindahl ◽

Leif Svensson ◽

Crister Zedigh ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Symptom Onset ◽

Coronary Syndrome ◽

History Of ◽

St Elevation

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Abstract 13546: Chromogranin-A Levels Differentiate Takotsubo From Acute Coronary Syndrome and Congestive Heart Failure in Women: A Single-center Case-control Study

Circulation ◽

10.1161/circ.142.suppl_3.13546 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Nicola Tarantino ◽

Francesco Santoro ◽

Luigi Di Biase ◽

Vito Di Terlizzi ◽

Domenico G Della Rocca ◽

...

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Acute Coronary Syndrome ◽

Symptom Onset ◽

Chromogranin A ◽

Troponin I ◽

Predictive Values ◽

Coronary Syndrome ◽

Group 2 ◽

Group 1

Background: Takotsubo syndrome (TTS) has been reported in up to 10% of women with a clinical presentation suggestive of acute coronary syndrome (ACS), making the differential diagnosis challenging. Chromogranin-A (CgA) is a pro-hormone co-released with catecholamines. Elevated levels of CgA are found in ACS and in exacerbations of congestive heart failure (CHF), indicating an imbalance of the neuroendocrine system. Hypothesis: CgA levels in women with TTS might differ from levels in other conditions featuring acute heart failure. Methods: We systematically screened CgA levels in 54 consecutive women admitted with TTS (n=29) or either CHF exacerbation or ACS (n=25) between November 2016 and September 2019. Clinical parameters including left ventricle ejection fraction, in-hospital events, troponin I (TnI), creatinine, and natriuretic peptide type B (NT-pro-BNP) values were recorded. Only samples obtained within 24 hours from symptom onset were analyzed. We excluded 18 subjects with TTS and 6 with ACS/CHF because of a history of cancer, chronic kidney disease >III stage, liver cirrhosis, or autoimmune disease. Results: Patients with TTS (Group 1, n=11) were compared with patients with ACS/CHF (Group 2, n=19). Subjects in Group 1 were significantly younger (mean age 67 vs 80, p<0.01) and presented with remarkably lower levels of CgA compared to Group 2 (1.57 nMol/l, IQR 0.56-4.6 vs 7.46, IQR 1.1-17.15, normal value <3 nMol/l, p<0.002), even adjusting for confounders such as the use of proton pump inhibitors, hypertension, and renal function. When controlling for age, there was a significant association between being in Group 2 and higher mean levels of CgA (p<0.03). At ROC curve analysis, CgA was the best predictor of TTS vs ACS/CHF when compared with TnI and NT-pro-BNP levels (AUC 0.85, 95% C.I. 0.72-0.98; 0.59, 95% C.I. 0.31-0.86; 0.5, 95% C.I. 0.28-0.72, respectively). CgA levels <5.32 could discriminate TTS from ACS/CHF with positive and negative predictive values of 22 and 100% respectively (accuracy 68%). Conclusion: In our population, systemic CgA levels collected within 24 hours from symptom onset were significantly lower in women with TTS compared to ACS/CHF, possibly indicating a different acute neuroendocrine pattern.

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