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The Clinical Characteristics of Young Patients (<45 Years) Referred with Acute Coronary Syndromes
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Abstracts CSANZ Abstracts 2011
ABSTRACTS
statins and ACE inhibitors/ARBs) in these pts can reduce MACE. Methods: Data was collected prospectively from a database of all pts admitted to Auckland City Hospital (ACH) Coronary Care Unit (CCU). The pt’s hospital records were accessed. The pt’s General Practitioner was also contacted for current pt information, medications and MACE. Results: From 1/6/2006 to 31/7/2007, we recorded 1580 CCU admissions from 1474 pts. 901 pts presented with an ACS; of these, there were a total of 338 pts with STEMI. 196 pts were within ACH catchment area; 142 pts who were transferred from elsewhere were excluded. Of these 196 pts, nine died in hospital. Of 187 discharged pts, there were 48 MACE events: 10 non-fatal myocardial infarctions, four repeat revascularisations, one congestive heart failure admission, one non-fatal stroke, and 32 deaths. At median follow-up time of 3.5 (IQR 3.0–3.8) years, 20 pts were lost to follow up and 125 pts (of 135) had undergone recent blood tests and were available for information on current therapy. Of these 125 pts, only 116 pts (93%) were on aspirin, 99 pts (79%) were on beta-blockers, 105 pts (84%) were on statins and 92 pts (74%) were on ACE inhibitors/ARBs. Conclusion: Use of secondary prevention medications remain suboptimal in this group of high risk patients and may contribute to subsequent adverse events. Ongoing efforts and awareness are needed to optimise the use of these medications. doi:10.1016/j.hlc.2011.05.105 103 Surrogate Markers of Atherosclerosis do not Predict the Presence of Subclinical Coronary Involvement in Patients at Intermediate Risk for Coronary Artery Disease A. Ellims 1,∗ , P. Lew 2 , K. Thomson 2 , A. Taylor 1 1 The 2 The
Alfred Hospital/Baker IDI Research Institute, Australia Alfred Hospital, Australia
Background: The optimal management of asymptomatic patients at intermediate risk of coronary artery disease (CAD) is not clearly established. Several surrogate markers of CAD have been advocated to improve risk stratification. We evaluated the efficacy of these markers in predicting the presence of subclinical CAD detected by cardiac computed tomography angiography (CCTA) in patients at intermediate risk of CAD. Methods: We performed 64-slice CCTA on 40 asymptomatic subjects (100% male, mean age 60 ± 6 years) at intermediate CAD risk according to the Framingham cardiovascular risk score. Coronary artery segments were assessed for the presence or absence of atherosclerotic plaque (defined as non-calcified, mixed or calcified) and the degree of any luminal narrowing. Surrogate markers of CAD risk (brachial-ankle pulse wave velocity; ankle-brachial index; carotid intima media thickness; lipoprotein(a); and high-sensitivity CRP) were measured. Results: Coronary artery plaque was identified by CCTA in 36 patients (90%), comprising 166 of a total of 576 seg-
Heart, Lung and Circulation 2011;20S:S1–S155
ments (29%). Eight segments (1.3%) were non-diagnostic. Plaque was non-calcified in 6.6%, mixed in 40.3% and calcified in 53.1%. Obstructive CAD (≥50% diameter stenosis) occurred in 13 patients (33%), comprising 38/576 segments (7%). There was no association between any surrogate marker of CAD risk and the presence of subclinical coronary atherosclerosis, nor with the composition or severity of atheroma. Conclusions: In patients at intermediate risk for CAD, the utility of surrogate markers is limited with respect to the identification of subclinical disease. Further studies are required to determine whether CCTA may be useful in predicting future coronary events. doi:10.1016/j.hlc.2011.05.106 104 The Clinical Characteristics of Young Patients (<45 Years) Referred with Acute Coronary Syndromes A. Incani 1,∗ , K. Poon 1 , T. Chen 1 , M. Dahl 1 , J. Fu 2 , H. Muller 3 , M. Dooris 3 , C. Hammett 3 , D. Walters 1 1 The
Prince Charles Hospital, Autralia Cardiac Clinical Network, Autralia 3 Royal Brisbane and Women’s Hospital, Autralia 2 Central
Background: Increasing rates of obesity and diabetes among young Australians are projected to increase the incidence of premature coronary disease. A web-based Acute Coronary Syndrome (ACS) referral and triage system in South East Queensland linking two tertiary and ten non-metropolitan hospitals has allowed analysis of characteristics and trends over time in young patients (<45 years) referred with ACS. Methods: Data from the ACS network was analysed from 01/01/2007 to 31/12/2010. The following characteristics were analysed: age, body mass index (BMI), clinical diagnosis and time from triage to transfer. Patients were divided into those <45 years (YP) and ≥45 years (OP). Results: 4845 patients were referred. 243 patients (5.01%) were <45 years of age (mean 37.57 ± 0.49 years) and 4602 (94.99%) ≥45 years old (mean 68.13 ± 0.17 years). The YP had higher BMI (mean 29.9 ± 0.518; 95%CI: 28.91–30.94) vs. OP [(mean 28.6 ± 0.094; 95%CI: 28.43–28.80) p = 0.002] but less likely to have other risk factors and had lower TIMI scores [mean 1.96 ± 0.098; 95%CI: 1.77–2.16 vs. 2.94 ± 0.025; 95%CI: 2.89–2.99 p = <0.001]. There was a higher proportion of STEMI in YP compared to OP (19.6% vs. 11.1%, p < 0.005). Despite lower risk scores YP were transferred sooner than OP (1.66 vs. 2.94 days, p = 0.002) The absolute numbers of YP increased over the four year period without a change in proportion of the total group. Conclusion: Young Patients referred with ACS have greater BMI but are a lower clinical risk group than OP. They are more likely to present with STEMI and are transferred earlier than OP for invasive services. doi:10.1016/j.hlc.2011.05.107
Abstracts CSANZ Abstracts 2011
ABSTRACTS
statins and ACE inhibitors/ARBs) in these pts can reduce MACE. Methods: Data was collected prospectively from a database of all pts admitted to Auckland City Hospital (ACH) Coronary Care Unit (CCU). The pt’s hospital records were accessed. The pt’s General Practitioner was also contacted for current pt information, medications and MACE. Results: From 1/6/2006 to 31/7/2007, we recorded 1580 CCU admissions from 1474 pts. 901 pts presented with an ACS; of these, there were a total of 338 pts with STEMI. 196 pts were within ACH catchment area; 142 pts who were transferred from elsewhere were excluded. Of these 196 pts, nine died in hospital. Of 187 discharged pts, there were 48 MACE events: 10 non-fatal myocardial infarctions, four repeat revascularisations, one congestive heart failure admission, one non-fatal stroke, and 32 deaths. At median follow-up time of 3.5 (IQR 3.0–3.8) years, 20 pts were lost to follow up and 125 pts (of 135) had undergone recent blood tests and were available for information on current therapy. Of these 125 pts, only 116 pts (93%) were on aspirin, 99 pts (79%) were on beta-blockers, 105 pts (84%) were on statins and 92 pts (74%) were on ACE inhibitors/ARBs. Conclusion: Use of secondary prevention medications remain suboptimal in this group of high risk patients and may contribute to subsequent adverse events. Ongoing efforts and awareness are needed to optimise the use of these medications. doi:10.1016/j.hlc.2011.05.105 103 Surrogate Markers of Atherosclerosis do not Predict the Presence of Subclinical Coronary Involvement in Patients at Intermediate Risk for Coronary Artery Disease A. Ellims 1,∗ , P. Lew 2 , K. Thomson 2 , A. Taylor 1 1 The 2 The
Alfred Hospital/Baker IDI Research Institute, Australia Alfred Hospital, Australia
Background: The optimal management of asymptomatic patients at intermediate risk of coronary artery disease (CAD) is not clearly established. Several surrogate markers of CAD have been advocated to improve risk stratification. We evaluated the efficacy of these markers in predicting the presence of subclinical CAD detected by cardiac computed tomography angiography (CCTA) in patients at intermediate risk of CAD. Methods: We performed 64-slice CCTA on 40 asymptomatic subjects (100% male, mean age 60 ± 6 years) at intermediate CAD risk according to the Framingham cardiovascular risk score. Coronary artery segments were assessed for the presence or absence of atherosclerotic plaque (defined as non-calcified, mixed or calcified) and the degree of any luminal narrowing. Surrogate markers of CAD risk (brachial-ankle pulse wave velocity; ankle-brachial index; carotid intima media thickness; lipoprotein(a); and high-sensitivity CRP) were measured. Results: Coronary artery plaque was identified by CCTA in 36 patients (90%), comprising 166 of a total of 576 seg-
Heart, Lung and Circulation 2011;20S:S1–S155
ments (29%). Eight segments (1.3%) were non-diagnostic. Plaque was non-calcified in 6.6%, mixed in 40.3% and calcified in 53.1%. Obstructive CAD (≥50% diameter stenosis) occurred in 13 patients (33%), comprising 38/576 segments (7%). There was no association between any surrogate marker of CAD risk and the presence of subclinical coronary atherosclerosis, nor with the composition or severity of atheroma. Conclusions: In patients at intermediate risk for CAD, the utility of surrogate markers is limited with respect to the identification of subclinical disease. Further studies are required to determine whether CCTA may be useful in predicting future coronary events. doi:10.1016/j.hlc.2011.05.106 104 The Clinical Characteristics of Young Patients (<45 Years) Referred with Acute Coronary Syndromes A. Incani 1,∗ , K. Poon 1 , T. Chen 1 , M. Dahl 1 , J. Fu 2 , H. Muller 3 , M. Dooris 3 , C. Hammett 3 , D. Walters 1 1 The
Prince Charles Hospital, Autralia Cardiac Clinical Network, Autralia 3 Royal Brisbane and Women’s Hospital, Autralia 2 Central
Background: Increasing rates of obesity and diabetes among young Australians are projected to increase the incidence of premature coronary disease. A web-based Acute Coronary Syndrome (ACS) referral and triage system in South East Queensland linking two tertiary and ten non-metropolitan hospitals has allowed analysis of characteristics and trends over time in young patients (<45 years) referred with ACS. Methods: Data from the ACS network was analysed from 01/01/2007 to 31/12/2010. The following characteristics were analysed: age, body mass index (BMI), clinical diagnosis and time from triage to transfer. Patients were divided into those <45 years (YP) and ≥45 years (OP). Results: 4845 patients were referred. 243 patients (5.01%) were <45 years of age (mean 37.57 ± 0.49 years) and 4602 (94.99%) ≥45 years old (mean 68.13 ± 0.17 years). The YP had higher BMI (mean 29.9 ± 0.518; 95%CI: 28.91–30.94) vs. OP [(mean 28.6 ± 0.094; 95%CI: 28.43–28.80) p = 0.002] but less likely to have other risk factors and had lower TIMI scores [mean 1.96 ± 0.098; 95%CI: 1.77–2.16 vs. 2.94 ± 0.025; 95%CI: 2.89–2.99 p = <0.001]. There was a higher proportion of STEMI in YP compared to OP (19.6% vs. 11.1%, p < 0.005). Despite lower risk scores YP were transferred sooner than OP (1.66 vs. 2.94 days, p = 0.002) The absolute numbers of YP increased over the four year period without a change in proportion of the total group. Conclusion: Young Patients referred with ACS have greater BMI but are a lower clinical risk group than OP. They are more likely to present with STEMI and are transferred earlier than OP for invasive services. doi:10.1016/j.hlc.2011.05.107