The authors measured the concentrations of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and C-reactive protein (CRP) in 1665 primarily medically managed NSTEACS patients enrolled in the TaRgeted platelet Inhibition to cLarify the Optimal strateGy to medicallY manage Acute Coronary Syndromes (TRILOGYACS) trial (3).
Higher B-type natriuretic peptide (BNP) concentrations are important predictors of mortality in NSTEACS (2, 4, 5).
"We at AstraZeneca are very pleased with the latest development with the AHA/ACC guideline recognizing ticagrelor as the preferred drug over the current standard of care in the treatment of NSTEACS
patients undergoing a broad range of treatment strategies," said Gagan Singh, president of AstraZeneca Philippines.
In the NSTEACS and STEAMI groups, blood samples were obtained as soon as patients arrived.
As shown in Table 2 and Figures 1 and 2, the frequencies of the CD4+LAP+ T cells, the CD4+CD25-LAP+ T cells, the CD4+CD25+ T cells, and the CD4+CD25+LAP- T cells were significantly decreased in patients with STEAMI and NSTEACS than those in the SA and control groups, but no obvious difference was found between the SA group and the control group.
The model was adjusted for a comprehensive list of covariates, including randomized drug treatment; weight; age; sex; NSTEACS vs unstable angina as presenting diagnosis; Killip class; time from presentation to start of study drug; CV risk factors such as diabetes and hypertension; past cardiac history such as previous MI and atrial fibrillation; clinical features at randomization such as blood pressure, heart rate, performance of coronary angiography, hemoglobin concentration, and serum creatinine concentration; baseline concomitant medications; and region (see online Supplemental Table 3).
Approximately two-thirds of the study population had increased troponin or creatinine kinase-MB concentrations beyond the upper reference limit (URL) and were classified as having NSTEACS (64.7%).
Risk assessment of patients with suspected NSTEACS
currently relies on medical history, electrocardiogram (ECG), and troponin measurements.
One prior large registry that included NP results was limited to patients with NSTEACS
(non-ST-segment elevation acute coronary syndrome) (5).
Several groups have demonstrated a powerful relationship between the increase in troponin and the risk of mortality in patients presenting with a non-ST-elevation acute coronary syndrome (NSTEACS
), i.e., without classical changes on the electrocardiogram consistent with an acute injury pattern (2).
At least 10 studies have demonstrated an independent association between the concentrations of hsCRP and survival in patients with non-ST elevation ACS (NSTEACS
divergence in the therapeutic approach to STEMI vs NSTEACS