Clinical outcomes following acute coronary syndrome (ACS) are documented to vary by sex in several studies. This study reports short- and long-term outcomes by sex in a large cohort of New Zealanders admitted to hospital for a first-time ACS.

Revised equations for estimated glomerular filtration rate (eGFR) were published in 2021 using creatinine (eGFR-Cr) and both creatinine and cystatin C (eGFR-Cr/CysC). This study aimed to evaluate the prognostic role of eGFR incorporating cystatin C in patients with heart failure (HF).

Plasma concentrations of growth differentiation factor-15 (GDF-15) are known to be prognostic in patients with acute coronary syndromes (ACS). However, the pattern of GDF-15 in the months post-ACS remains uncertain. This study aimed to investigate the temporal pattern of circulating GDF-15 in the intermediate to long-term post-ACS.

The prognostic value of cardiac troponin following myocardial infarction (MI) is well documented; however, the benefit in a predominantly revascularised cohort is less certain. This study reported the prognostic role of peak cardiac troponin in the Multi-Ethnic New Zealand Study of Acute Coronary Syndromes (MENZACS).

Left ventricular ejection fraction (EF) is required to differentiate heart failure (HF) phenotypes but is not collected in national datasets in Aotearoa/New Zealand. This study assessed the accuracy of models derived from the SWEDE-HF registry for predicting HF phenotypes in patients with HF.

Countries with a high incidence of coronavirus-2019 (COVID-19) reported reduced hospitalisations for acute coronary syndromes (ACS) during the pandemic. This study describes the impact of a nationwide lockdown on ACS hospitalisations in New Zealand (NZ), a country with a low incidence of COVID-19.

We have previously demonstrated in a prospective, multinational study that patients with heart failure (HF) with preserved LV ejection fraction (HFpEF) had lower mortality than those with reduced ejection fraction (HFrEF) over 2 years of follow up. We report here the longer-term clinical outcomes for patients in the NZ-arm of this study. Patients were those >18 years with clinical diagnosis of HF enrolled at 4 centres in NZ. Patients were assessed at enrolment with extensive phenotypic characterisation. The main outcome measures were death from any cause, and death or HF readmission. Cox proportional hazards model was used to assess outcome for patients with HFpEF and those with mid-range EF (HFmrEF) compared with those with HFrEF, including age and sex, medical history, aetiology, creatinine and NTproBNP in the model. 940 patients were followed for minimum of 4 years. Patients with HFpEF were older (74 vs 66yrs), more commonly women (44% vs 21%) and had higher blood pressure (128 vs. 116mmHg) compared with those with HFrEF. Over the 4 years of follow up patients with HFpEF had a lower risk of death compared to patients with HFrEF, (112 vs 143/1000 patient years) however there was a similar risk of combined end-point of death or HF admission in all EF-subgroups (57.4% vs 51.5% vs 54.9%) (Figure). This national data demonstrates that over the 4-year follow up that patients with HFpEF has a lower risk of death than those with HFrEF. However the burden of HF readmissions was high and similar across all EF subgroups.

Coronary heart disease remains one of the leading causes of mortality and morbidity in New Zealand (NZ) and globally. The All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) programme includes the CathPCI registry which records all those referred for diagnostic coronary angiography (DCA) and percutaneous coronary intervention (PCI) in NZ. We present the methods and three-years of data from the ANZACS-QI CathPCI registry. The data was extracted from the ANZACS QI CathPCI registry from 03/09/2014 to 03/09/2017. The ANZACS-QI data dictionary defines all the clinical, procedural and outcomes variables collected, and standard statistical analyses applied. 40870 patients underwent cardiac catheterisation, with a mean age of 65 years, and males making up 67% of the cohort. Indications included acute coronary syndrome 55%, angina with suspected stable coronary disease 28%, valve surgery workup 8%, planned PCI 3%, heart failure/cardiomyopathy 3%, arrhythmia 1% and other 2%. For those undergoing DCA alone, radial access was used in 85% and two-thirds had at least one major artery with >50% stenosis. PCI was performed in 39% of patients. Drug-eluting stents were used in 97%. The CathPCI registry records the characteristics and outcomes of all patients undergoing DCA and PCI in NZ hospitals. As part of the ANZACS-QI programme the registry provides an important platform for quality improvement, research and to inform clinical practice.

Acute Coronary Syndrome (ACS) risk may be modified by bacterial populations throughout the body. To explore this, we studied oral and gut bacterial microbiomes in ACS and blood markers of both inflammation and gut bacterial metabolism. ACS patients (n=47) were recruited at the Cardiac Care Unit (Waikato Hospital, NZ) and stool, oral swab, and blood samples were collected. The control group (n=13) were healthy volunteers. DNA sequencing was carried out across the signature 16S rDNA gene and then taxonomy determined. Blood plasma levels of C-reactive protein (CRP; by high sensitivity test), bacterial D-lactate, and inflammatory markers Interleukin-6, Transforming Growth Factor-β and Interleukin-10 were measured. Bacterial diversity was not significantly different between ACS and healthy controls for gut and oral populations. However, for the gut microbiome, the ACS patient group had reduced abundance of the genera Lachnospiraceae (p<0.001). C-reactive protein was also elevated in the ACS group (Healthy vs. ACS; 1.738 ± 0.3696 vs 9.647 ± 1.551 mg/l ± SEM; p<0.01), although the median level was below a clinically significant range. Interestingly, D-lactate was elevated in the ACS group (0.09221 ±0.005 vs. 0.1381 ±0.006 mM ±SD; p<0.001). Also, Transforming Growth Factor-β was reduced in ACS (0.7679 ± 0.2, vs 2.121 ± 0.7 pg/mL; p=0.012). Supplementation with bacteria from the butyrate-producing genera Lachnospiraceae may improve unhealthy patterns of gut flora in at-risk groups.

Each year, approximately 5000 New Zealanders are admitted to hospital with a first-time acute coronary syndrome (ACS). The aim of the Multi-Ethnic New Zealand Study of Acute Coronary Syndromes (MENZACS) is to examine the relationship of clinical, genomic and cardiometabolic markers in relation to presentation and outcomes post-ACS. MENZACS is a prospective, longitudinal cohort study embedded within the All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) programme in 6 hospitals. Patients with first-time ACS were enrolled and study-specific research data collected alongside the ANZACS-QI registry. Research blood samples were stored for future genetic/biomarker assays. We report here the baseline characteristics of the MENZACS cohort and compare to the ANZACS-QI registry (first-time ACS). Between 2015-2019, 2026 patients were enrolled, mean age 61yrs, 21% were female. Ethnicity and CV risk factor distribution was similar to ANZACS-QI: 13% Māori, 5% Pacific, 5% Indian and 74% NZ European. CV risk factors included 56% ex-/current smoker, 42% hypertension, 18% diabetes. 60% of the patients were aged < 65 years. ACS subtype for MENZACS vs ANZACS-QI: STEMI 40% vs 31%, NSTEMI 52% vs 59%. 99% had coronary angiography and 90% had revascularisation; there were high rates of secondary prevention medications (table).Tabled 1Discharge MedicationAspirin1927 (98%)Dual antiplatelet therapy1611 (82%)Statin1922 (97%)Beta-blocker1652 (84%)ACEi/ARB1550 (79%) Open table in a new tab MENZACS represents a cohort with optimal contemporary management and will be a significant epidemiological bioresource for the study of environmental and genetic factors contributing to ACS in New Zealand's multi-ethnic environment. The study will utilise clinical, nutritional, lifestyle, genomic and biomarker analyses to explore aetiological factors and develop risk prediction models for outcome.

To compare baseline characteristics in patients who undergo a pressure wire study (PWS). Also to describe the characteristics of patients with haemodynamically significant (FFR < 0.8) lesions and their treatment disposition. We used the "All New Zealand Acute Coronary Syndrome Quality Improvement" program (ANZACS-QI) web-based system. This data set includes all patients undergoing a diagnostic coronary angiogram (DCA) between the dates 01/09/14 – 01/09/17. During this period 46281 procedures were done. 28258 were diagnostic coronary angiograms (DCA) and 18025 underwent PCI. In total 1901 patients had 2201 PWS performed. 677 patients went on to have PCI. PWS was done in 4.6% of all patients having a coronary angiogram. Patients that had a PWS were more commonly men (71%) of European descendent (76%). The most common indication for a PWS was an acute coronary syndrome (ACS). 35% of these had a PCI. The left anterior descending artery was the most common territory for PWS. Only 60% of patients with an FFR < 0.8 proceeded to PCI. 429 FFR results were borderline positive (FFR 0.75-0.79). 34% did not have PCI. 572 FFR results were borderline negative (FFR 0.8-0.85). 16% had PCI. Performing a PWS did not increase in-hospital MACE. This is one of the largest real world analysis of PWS use. It shows which patients and coronary territories are likely to have a PWS and characteristics which lead to positive results and PCI. It shows that PWS are safe without an increase of in-hospital MACE.

Background To describe the long-term mortality of a complete national cohort of acute coronary syndrome (ACS) patients enrolled in 2002, to compare this with a national age, sex and Maori ethnicity matched population, and to assess the influence of baseline factors on the 12-year mortality. Methods We reviewed 721 patients with a discharge diagnosis of an ACS who were enrolled in the first New Zealand ACS audit group cohort over 14 days in May 2002. We matched the cohort to the national mortality database using each patient's unique national identity number. Results Over a median follow-up of 12.7 years of 721 patients discharged with an ACS, overall mortality was 52%: ST-elevation myocardial infarction (STEMI) (58%), non-ST-elevation myocardial infarction (NSTEMI) (61%) and unstable angina pectoris (UAP) (42%) patients, p < 0.0001. In an age-adjusted survival model, males had a 29% increased mortality rate compared to females with a hazard ratio of 1.29 (95% CI 1.04, 1.61, p = 0.019). Over 12 years there were 339 (47%) deaths, compared to 284 (39%) deaths observed in the matched population. The standardised mortality ratio for patients admitted with an ACS in New Zealand is 1.3 (95% CI 1.2, 1.5) with eight patients per 100 not surviving to 12 years compared to this matched population. Conclusion The high mortality rate in this ACS cohort is a stark reminder of the prognostic implications of a presentation with an ACS. It emphasises the on-going need for optimal management of these patients throughout every stage of their initial treatment and subsequent on-going care.