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Chandiramani R, Mehta A, Blumenthal RS, Williams MS. Should We Use Aspirin or P2Y 12 Inhibitor Monotherapy in Stable Ischemic Heart Disease? Curr Atheroscler Rep 2024:10.1007/s11883-024-01234-2. [PMID: 39243345 DOI: 10.1007/s11883-024-01234-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2024] [Indexed: 09/09/2024]
Abstract
PURPOSE OF REVIEW To summarize the recent evidence and guideline recommendations on aspirin or P2Y12 inhibitor monotherapy in patients with stable ischemic heart disease and provide insights into future directions on this topic, which involves transition to a personalized assessment of bleeding and thrombotic risks. RECENT FINDINGS It has been questioned whether the evidence for aspirin as the foundational component of secondary prevention in patients with coronary artery disease aligns with contemporary pharmaco-invasive strategies. The recent HOST-EXAM study randomized patients who had received dual antiplatelet therapy for 6 to 18 months without ischemic or major bleeding events to either clopidogrel or aspirin for a further 24 months, and demonstrated that the patients in the clopidogrel arm had significantly lower rates of both thrombotic and bleeding complications compared to those in the aspirin arm. The patient-level PANTHER meta-analysis showed that in patients with established coronary artery disease, P2Y12 inhibitor monotherapy was associated with lower rates of myocardial infarction, stent thrombosis as well as gastrointestinal bleeding and hemorrhagic stroke compared to aspirin monotherapy, albeit with similar rates of all-cause mortality, cardiovascular mortality and major bleeding. Long-term low-dose aspirin is recommended for secondary prevention in patients with stable ischemic heart disease, with clopidogrel monotherapy being acknowledged as a feasible alternative. Dual antiplatelet therapy for six months after percutaneous coronary intervention remains the standard recommendation for patients with stable ischemic heart disease. However, the duration of dual antiplatelet therapy may be shortened and followed by P2Y12 inhibitor monotherapy or prolonged based on individualized evaluation of the patient's risk profile.
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Affiliation(s)
| | - Adhya Mehta
- Department of Internal Medicine, Albert Einstein College of Medicine/Jacobi Medical Center, Bronx, NY, USA
| | | | - Marlene S Williams
- Department of Medicine, Division of Cardiology, The Johns Hopkins University, 301 Mason Lord Drive, Suite 2400, Baltimore, MD, 21224, USA.
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Cirillo P, Di Serafino L, Scalamogna M, De Rosa G, Calabrò P, Antonucci E, Gresele P, Palareti G, Patti G, Pengo V, Pignatelli P, Marcucci R. ACEF vs PARIS score in Predicting Cardiovascular Events in Patients With Acute Coronary Syndrome: Insights From the START ANTIPLATELET Registry. Angiology 2024:33197241278923. [PMID: 39191437 DOI: 10.1177/00033197241278923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2024]
Abstract
Several scores can predict clinical outcomes of patients with Acute Coronary Syndromes (ACS). The validated PARIS (Patterns of Non-Adherence to Anti-Platelet Regimen in Stented Patients) score is poorly used in clinical practice because it needs items that are not always easily available. The ACEF (Age, Creatinine, and Ejection Fraction) score is more attractive because it only includes three items. We compared these scores to risk-stratify ACS patients enrolled into the START (Survey on anticoagulated pAtients RegisTer)-ANTIPLATELET registry. ACS patients who completed 1-year follow-up (n = 1171) were grouped in tertiles (low, medium, and high-risk) according to their ACEF/PARIS scores. Primary endpoints were: one-year MACCE (major adverse cardiac and cerebrovascular events: death, non-fatal myocardial infarction, stroke or target vessel revascularization) and NACE (net adverse cardiac and cerebrovascular events): MACCE plus major bleeding). MACCE incidence was higher in the high-risk tertile (15%) VS low/medium (3/7 %) risk tertiles (P < .001). NACE incidence in the high-risk tertile was 24% VS low/medium (9/15 %) risk tertiles (P < .001), independently of the risk score used. The ACEF score has similar accuracy as the validated PARIS score for the estimation of ischemic/bleeding risk. Thereby, we strongly suggest its use in clinical practice to risk-stratify ACS patients and select optimal therapeutic strategies.
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Affiliation(s)
- Plinio Cirillo
- Department of Advanced Biomedical Sciences, (Division of Cardiology) School of Medicine, "Federico II" University, Naples, Italy
| | - Luigi Di Serafino
- Department of Advanced Biomedical Sciences, (Division of Cardiology) School of Medicine, "Federico II" University, Naples, Italy
| | - Maria Scalamogna
- Department of Advanced Biomedical Sciences, (Division of Cardiology) School of Medicine, "Federico II" University, Naples, Italy
| | - Gennaro De Rosa
- Department of Advanced Biomedical Sciences, (Division of Cardiology) School of Medicine, "Federico II" University, Naples, Italy
| | - Paolo Calabrò
- Department of Cardio-Thoracic and Respiratory Sciences, Università Degli Studi Della Campania "Luigi Vanvitelli", Novara, Italy
| | | | - Paolo Gresele
- Department of Medicine, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | | | - Giuseppe Patti
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, Italy
| | - Vittorio Pengo
- Department of Cardiac, Thoracic, and Vascular Sciences, Padua University Hospital, Padua, Italy
| | - Pasquale Pignatelli
- Department of Internal Medicine and Medical Specialties, University of Rome "La Sapienza", Rome, Italy
| | - Rossella Marcucci
- Center for atherothrombotic disease Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
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Paolucci L, Mangiacapra F, Viscusi MM, Sergio S, Bressi E, Colaiori I, Ricottini E, Cavallari I, Nusca A, Melfi R, Ussia GP, Grigioni F. Integrating platelet reactivity in the age, creatinine and ejection fraction score to predict clinical outcomes following percutaneous coronary intervention in patients with chronic coronary syndrome: the PR-ACEF score. Heart Vessels 2024:10.1007/s00380-024-02430-5. [PMID: 38913157 DOI: 10.1007/s00380-024-02430-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 06/13/2024] [Indexed: 06/25/2024]
Abstract
To evaluate if integrating platelet reactivity (PR) evaluation in the original age, creatinine and ejection fraction (ACEF) score could improve the diagnostic accuracy of the model in patients with stable coronary artery disease (CAD). We enrolled patients treated with percutaneous coronary intervention between 2010 and 2011. High PR was included in the model (PR-ACEF). Co-primary end points were a composite of death/myocardial infarction (MI) and major adverse cardiovascular events (MACE). Overall, 471 patients were enrolled. Compared to the ACEF score, the PR-ACEF showed an improved diagnostic accuracy for death/MI (AUC 0.610 vs 0.670, p < 0.001) and MACE (AUC 0.572 vs 0.634, p < 0.001). These findings were confirmed using internal validation with bootstrap resampling. At 5 years, the PR-ACEF value > 1.75 was independently associated with death/MI [HR 3.51, 95% CI (1.97-6.23)] and MACE [HR 2.77, 95% CI (1.69-4.53)]. The PR-ACEF score was effective in improving the diagnostic performance of the ACEF score at the long-term follow-up.
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Affiliation(s)
- Luca Paolucci
- Fondazione Policlinico Universitario Campus Bio-Medico, Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 200-00128, Rome, Italy
| | - Fabio Mangiacapra
- Fondazione Policlinico Universitario Campus Bio-Medico, Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 200-00128, Rome, Italy.
| | - Michele Mattia Viscusi
- Fondazione Policlinico Universitario Campus Bio-Medico, Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 200-00128, Rome, Italy
| | - Sara Sergio
- Fondazione Policlinico Universitario Campus Bio-Medico, Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 200-00128, Rome, Italy
| | - Edoardo Bressi
- Fondazione Policlinico Universitario Campus Bio-Medico, Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 200-00128, Rome, Italy
| | - Iginio Colaiori
- Fondazione Policlinico Universitario Campus Bio-Medico, Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 200-00128, Rome, Italy
| | - Elisabetta Ricottini
- Fondazione Policlinico Universitario Campus Bio-Medico, Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 200-00128, Rome, Italy
| | - Ilaria Cavallari
- Fondazione Policlinico Universitario Campus Bio-Medico, Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 200-00128, Rome, Italy
| | - Annunziata Nusca
- Fondazione Policlinico Universitario Campus Bio-Medico, Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 200-00128, Rome, Italy
| | - Rosetta Melfi
- Fondazione Policlinico Universitario Campus Bio-Medico, Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 200-00128, Rome, Italy
| | - Gian Paolo Ussia
- Fondazione Policlinico Universitario Campus Bio-Medico, Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 200-00128, Rome, Italy
| | - Francesco Grigioni
- Fondazione Policlinico Universitario Campus Bio-Medico, Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 200-00128, Rome, Italy
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Lin XF, Xie LF, Zhang ZF, Wu QS, Qiu ZH, Chen LW. Clinical predictive value of the age, creatinine, and ejection fraction score in patients in acute type A aortic dissection after total arch replacement. Sci Rep 2024; 14:10776. [PMID: 38734750 PMCID: PMC11088634 DOI: 10.1038/s41598-024-58608-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 04/01/2024] [Indexed: 05/13/2024] Open
Abstract
The age, creatinine, and ejection fraction (ACEF) score has been accepted as a predictor of poor outcome in elective operations. This study aimed to investigate the predictive value of ACEF score in acute type A aortic dissection (AAAD) patients after total arch replacement. A total of 227 AAAD patients from July 2021 and June 2022 were enrolled and divided into Tertiles 1 (ACEF ≤ 0.73), Tertiles 2 (0.73 < ACEF ≤ 0.95), and Tertiles 3 (ACEF > 0.95). Using inverse probability processing weighting (IPTW) to balance the baseline characteristics and compare the outcomes. Cox logistic regression was used to further evaluate the survival prediction ability of ACEF score. The in-hospital mortality was 9.8%. After IPTW, in the baseline characteristics reached an equilibrium, a higher ACEF score before operation still associated with higher in-hospital mortality. After 1 year follow-up, 184 patients (90.6%) survival. Multivariable analysis revealed that ACEF score (adjusted hazard ratio 1.68; 95% confidence interval 1.34-4.91; p = 0.036) and binary ACEF score (adjusted HR 2.26; 95% CI 1.82-6.20; p < 0.001) was independently associated with 1-year survival. In addition, net reclassification improvement (NRI) and integrated differentiation improvement (IDI) verified that the ACEF score and binary ACEF score is an accurate predictive tool in clinical settings. In conclusions, ACEF score could be considered as a useful tool to risk stratification in patients with AAAD before operation in daily clinical work.
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Affiliation(s)
- Xin-Fan Lin
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Xinquan Road 29, Fuzhou, 350001, Fujian, People's Republic of China
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, People's Republic of China
- Fujian Provincial Center for Cardiovascular Medicine, Fuzhou, Fujian, People's Republic of China
| | - Lin-Feng Xie
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Xinquan Road 29, Fuzhou, 350001, Fujian, People's Republic of China
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, People's Republic of China
- Fujian Provincial Center for Cardiovascular Medicine, Fuzhou, Fujian, People's Republic of China
| | - Zhao-Feng Zhang
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Xinquan Road 29, Fuzhou, 350001, Fujian, People's Republic of China
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, People's Republic of China
- Fujian Provincial Center for Cardiovascular Medicine, Fuzhou, Fujian, People's Republic of China
| | - Qing-Song Wu
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Xinquan Road 29, Fuzhou, 350001, Fujian, People's Republic of China
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, People's Republic of China
- Fujian Provincial Center for Cardiovascular Medicine, Fuzhou, Fujian, People's Republic of China
| | - Zhi-Huang Qiu
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Xinquan Road 29, Fuzhou, 350001, Fujian, People's Republic of China.
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, People's Republic of China.
- Fujian Provincial Center for Cardiovascular Medicine, Fuzhou, Fujian, People's Republic of China.
| | - Liang-Wan Chen
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Xinquan Road 29, Fuzhou, 350001, Fujian, People's Republic of China.
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, People's Republic of China.
- Fujian Provincial Center for Cardiovascular Medicine, Fuzhou, Fujian, People's Republic of China.
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WU SY, ZHANG R, YUAN S, CAI ZX, GUAN CD, ZOU TQ, XIE LH, DOU KF. Development and validation of a model integrating clinical and coronary lesion-based functional assessment for long-term risk prediction in PCI patients. J Geriatr Cardiol 2024; 21:44-63. [PMID: 38440338 PMCID: PMC10908582 DOI: 10.26599/1671-5411.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
OBJECTIVES To establish a scoring system combining the ACEF score and the quantitative blood flow ratio (QFR) to improve the long-term risk prediction of patients undergoing percutaneous coronary intervention (PCI). METHODS In this population-based cohort study, a total of 46 features, including patient clinical and coronary lesion characteristics, were assessed for analysis through machine learning models. The ACEF-QFR scoring system was developed using 1263 consecutive cases of CAD patients after PCI in PANDA III trial database. The newly developed score was then validated on the other remaining 542 patients in the cohort. RESULTS In both the Random Forest Model and the DeepSurv Model, age, renal function (creatinine), cardiac function (LVEF) and post-PCI coronary physiological index (QFR) were identified and confirmed to be significant predictive factors for 2-year adverse cardiac events. The ACEF-QFR score was constructed based on the developmental dataset and computed as age (years)/EF (%) + 1 (if creatinine ≥ 2.0 mg/dL) + 1 (if post-PCI QFR ≤ 0.92). The performance of the ACEF-QFR scoring system was preliminarily evaluated in the developmental dataset, and then further explored in the validation dataset. The ACEF-QFR score showed superior discrimination (C-statistic = 0.651; 95% CI: 0.611-0.691, P < 0.05 versus post-PCI physiological index and other commonly used risk scores) and excellent calibration (Hosmer-Lemeshow χ2 = 7.070; P = 0.529) for predicting 2-year patient-oriented composite endpoint (POCE). The good prognostic value of the ACEF-QFR score was further validated by multivariable Cox regression and Kaplan-Meier analysis (adjusted HR = 1.89; 95% CI: 1.18-3.04; log-rank P < 0.01) after stratified the patients into high-risk group and low-risk group. CONCLUSIONS An improved scoring system combining clinical and coronary lesion-based functional variables (ACEF-QFR) was developed, and its ability for prognostic prediction in patients with PCI was further validated to be significantly better than the post-PCI physiological index and other commonly used risk scores.
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Affiliation(s)
- Shao-Yu WU
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Cardiometabolic Medicine Center, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rui ZHANG
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Cardiometabolic Medicine Center, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sheng YUAN
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Cardiometabolic Medicine Center, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhong-Xing CAI
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Cardiometabolic Medicine Center, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chang-Dong GUAN
- Catheterization Laboratories, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tong-Qiang ZOU
- Catheterization Laboratories, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li-Hua XIE
- Catheterization Laboratories, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ke-Fei DOU
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Cardiometabolic Medicine Center, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Aktan A, Güzel T. Prognostic value of age, creatinine, and left ventricular ejection fraction risk score in patients evaluated with fractional flow reserve: a cross-sectional study. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20230533. [PMID: 37610932 PMCID: PMC10443914 DOI: 10.1590/1806-9282.20230533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 05/25/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE In this study, we investigated the relationship between age, creatinine, and left ventricular ejection fraction risk score and the severity of coronary lesions detected by applying fractional flow reserve in the patient group presenting with chronic coronary syndrome. Also, we presented long-term follow-up results in patients whose age, creatinine, and left ventricular ejection fraction score was evaluated by the fractional flow reserve procedure. METHODS This study was planned retrospectively and in two centers. For this purpose, 114 patients who met the study criteria and who underwent elective fractional flow reserve between January 2014 and January 2019 were included in the study. Age, creatinine, and left ventricular ejection fraction was calculated as age/left ventricular ejection fraction +1 (if estimated glomerular filtration rate<30 mL/min). RESULTS They were divided into two groups according to the cutoff value of the age, creatinine, and left ventricular ejection fraction score. A total of 76 patients had an age, creatinine, and left ventricular ejection fraction score of ≤1.17 (Group I) and 38 patients had an age, creatinine, and left ventricular ejection fraction score of >1.17 (Group II). The number of patients with severe lesions in fractional flow reserve was significantly higher in Group II compared with Group I (60.5 vs. 32.9%, p=0.005). According to the Kaplan-Meier analysis, a significant increase was observed in major adverse cardiac events and mortality during the follow-up period in the group with a high-risk score (Log Rank: 15.01, p<0.001 and Log Rank: 8.51, p=0.004, respectively). CONCLUSION In light of the data we obtained from our study, we found a correlation between the severity of the lesion detected in fractional flow reserve and the age, creatinine, and left ventricular ejection fraction scores. In addition, we found that patients with high age, creatinine, and left ventricular ejection fraction scores had higher mortality and major adverse cardiac events rates during follow-up.
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Affiliation(s)
- Adem Aktan
- Mardin Training and Research Hospital, Department of Cardiology - Mardin, Turkey
| | - Tuncay Güzel
- Health Science University, Gazi Yaşargil Training and Research Hospital, Department of Cardiology - Diyarbakır, Turkey
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Spirito A, Sharma A, Cao D, Sartori S, Zhang Z, Nicolas J, Pivato CA, Cohen R, Baber U, Sweeny J, Sharma SK, Dangas G, Kini A, Brener SJ, Mehran R. New Criteria to Identify Patients at Higher Risk for Cardiovascular Complications After Percutaneous Coronary Intervention. Am J Cardiol 2023; 189:22-30. [PMID: 36493579 DOI: 10.1016/j.amjcard.2022.11.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/29/2022] [Accepted: 11/12/2022] [Indexed: 12/12/2022]
Abstract
A universal definition to identify patients at higher risk of complications after percutaneous coronary intervention (PCI) is lacking. We aimed to validate a recently developed score to identify patients at increased risk of all-cause death after PCI. All consecutive patients from a large PCI registry not presenting with ST-elevation myocardial infarction or cardiogenic shock were included. Each patient was assigned a score obtained by summing the points associated with the following variables: age >80 years (3 points), dialysis (6 points), left ventricular ejection fraction <30% (2 points), and multivessel PCI (2 points). Patients were stratified in 3 groups: low risk (score 0), intermediate risk (score 2 to 3), or high risk (score ≥4). The primary outcome was all-cause death, and the secondary outcomes were major adverse cardiovascular events and major bleeding. Events were assessed at 1 year after PCI. Between January 2014 and December 2019, 12,689 patients underwent PCI. Compared with the 9,884 patients at low risk, those at intermediate and high risk had a fourfold (hazard ratio 3.99, 95% confidence interval 2.95 to 5.38) and ninefold (hazard ratio 9.55, 95% confidence interval 6.89 to 13.2) higher hazard for all-cause death at 1 year, respectively. The score had a good predictive value for all-cause death at 1 year (area under the curve 0.70). The risk of major adverse cardiovascular events and major bleeding increased consistently from the low- to the high-risk group. In conclusion, in patients who underwent PCI for stable ischemic heart disease or non-ST-elevation acute coronary syndrome, a score based on 4 variables well predicted the risk of all-cause death at 1 year.
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Affiliation(s)
- Alessandro Spirito
- Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine, Mount Sinai, New York, New York
| | - Ashutosh Sharma
- Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine, Mount Sinai, New York, New York
| | - Davide Cao
- Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine, Mount Sinai, New York, New York; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Samantha Sartori
- Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine, Mount Sinai, New York, New York
| | - Zhongjie Zhang
- Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine, Mount Sinai, New York, New York
| | - Johny Nicolas
- Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine, Mount Sinai, New York, New York
| | - Carlo Andrea Pivato
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Rebecca Cohen
- Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine, Mount Sinai, New York, New York
| | - Usman Baber
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Joseph Sweeny
- Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine, Mount Sinai, New York, New York
| | - Samin K Sharma
- Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine, Mount Sinai, New York, New York
| | - George Dangas
- Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine, Mount Sinai, New York, New York
| | - Annapoorna Kini
- Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine, Mount Sinai, New York, New York
| | - Sorin J Brener
- Division of Cardiology, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York
| | - Roxana Mehran
- Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine, Mount Sinai, New York, New York.
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Chen H, Spirito A, Sartori S, Nicolas J, Cao D, Zhang Z, Baber U, Kamaleldin K, Guthrie J, Vogel B, Sweeny J, Krishnan P, Sharma SK, Kini A, Dangas G, Mehran R. Impact of complex percutaneous coronary intervention features on clinical outcomes in patients with or without chronic kidney disease. Catheter Cardiovasc Interv 2023; 101:511-519. [PMID: 36691863 DOI: 10.1002/ccd.30569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) are at higher risk of ischemic and bleeding events after percutaneous coronary intervention (PCI). Complex PCI (CPCI) is associated with higher rates of ischemic complications. Whether CPCI confers an additive risk of adverse events in CKD patients is unclear. METHODS Patients who underwent PCI at a single tertiary-care-center between 2012 and 2019 were stratified by CKD status and CPCI. The primary outcome was major adverse cardiac events (MACE), a composite of all-cause death, myocardial infarction (MI), and target-vessel revascularization (TVR) at 1-year follow-up. Secondary outcomes included the individual components of the primary outcome and major bleeding. RESULTS Out of 15,071 patients, 4537 (30.1%) had CKD and 10,534 (69.9%) had no CKD. Patients undergoing CPCI were 1151 (25.4%) and 2983 (28.3%) in the two cohorts, respectively. At one year, CPCI compared with no CPCI was associated with higher risk of MACE in both CKD (Adj. HR 1.72, 95% confidence interval [CI] 1.45-2.06, p < 0.001) and no-CKD patients (Adj. hazard ratios [HR] 2.19, 95% CI 1.91-2.51, p < 0.001; p of interaction 0.057), determined by an excess of death, MI and TVR in CKD patients and of TVR and MI only in no-CKD. CPCI was related with a consistent increase of major bleeding in the CKD (Adj. HR 1.49, 95% CI 1.18-1.87, p < 0.001) and no-CKD group (Adj. HR 1.23, 95% CI 0.98-1.54, p = 0.071, p of interaction 0.206). CONCLUSION At 1-year follow-up, CPCI was associated with higher risk of MACE and major bleeding irrespective of concomitant CKD. CPCI predicted mortality in CKD patients only.
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Affiliation(s)
- Huazhen Chen
- The Zena and Michael A. Wiener Cardiovascular institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Alessandro Spirito
- The Zena and Michael A. Wiener Cardiovascular institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Johny Nicolas
- The Zena and Michael A. Wiener Cardiovascular institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Zhongjie Zhang
- The Zena and Michael A. Wiener Cardiovascular institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Usman Baber
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Karim Kamaleldin
- The Zena and Michael A. Wiener Cardiovascular institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Jeffers Guthrie
- The Zena and Michael A. Wiener Cardiovascular institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Birgit Vogel
- The Zena and Michael A. Wiener Cardiovascular institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Joseph Sweeny
- The Zena and Michael A. Wiener Cardiovascular institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Prakash Krishnan
- The Zena and Michael A. Wiener Cardiovascular institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Samin K Sharma
- The Zena and Michael A. Wiener Cardiovascular institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Annapoorna Kini
- The Zena and Michael A. Wiener Cardiovascular institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - George Dangas
- The Zena and Michael A. Wiener Cardiovascular institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
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9
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Abusnina W, Mostafa MR, Al-Abdouh A, Radaideh Q, Ismayl M, Alam M, Shah J, Yousfi NE, Paul TK, Ben-Dor I, Dahal K. Outcomes of atherectomy in treating severely calcified coronary lesions in patients with reduced left ventricular ejection fraction: A systematic review and meta-analysis. Front Cardiovasc Med 2022; 9:946027. [PMID: 36204563 PMCID: PMC9530054 DOI: 10.3389/fcvm.2022.946027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundSeverely calcified coronary lesions with reduced left ventricular (LV) function result in worse outcomes. Atherectomy is used in treating such lesions when technically feasible. However, there is limited data examining the safety and efficacy of atherectomy without hemodynamic support in treating severely calcified coronary lesions in patients with reduced left ventricular ejection fraction (LVEF).ObjectiveTo evaluate the clinical outcomes of atherectomy in patient with reduced LVEF.MethodsWe searched PubMed, Cochrane CENTRAL Register and ClinicalTrials.gov (inception through July 21, 2021) for studies evaluating the outcomes of atherectomy in patients with severe LV dysfunction. We used random-effect model to calculate risk ratio (RR) with 95% confidence interval (CI). The endpoints were in-hospital and long term all-cause mortality, cardiac death, myocardial infarction (MI), and target vessel revascularization (TVR).ResultsA total of 7 studies consisting of 2,238 unique patients were included in the analysis. The median follow-up duration was 22.4 months. The risk of in-hospital all-cause mortality using atherectomy in patients with severely reduced LVEF compared to the patients with moderate reduced or preserved LVEF was [2.4vs.0.5%; RR:5.28; 95%CI 1.65–16.84; P = 0.005], the risk of long term all-cause mortality was [21 vs. 8.8%; RR of 2.84; 95% CI 1.16–6.95; P = 0.02]. In-hospital TVR risk was 2.0 vs. 0.6% (RR: 4.15; 95% CI 4.15–15.67; P = 0.04) and long-term TVR was [6.0 vs. 9.9%; RR of 0.75; 95% CI 0.39–1.42; P = 0.37]. In-hospital MI was [7.1 vs. 5.4%; RR 1.63; 95% CI 0.91–2.93; P = 0.10], long-term MI was [7.5 vs. 5.7; RR 1.74; 95%CI 0.95–3.18; P = 0.07).ConclusionOur meta-analysis suggested that the patients with severely reduced LVEF when using atherectomy devices experienced higher risk of clinical outcomes in the terms of all-cause mortality and cardiac mortality. As we know that the patients with severely reduced LVEF are inherently at increased risk of adverse clinical outcomes, this information should be considered hypothesis generating and utilized while discussing the risks and benefits of atherectomy in such high risk patients. Future studies should focus on the comparison of outcomes of different atherectomy devices in such patients. Adjusting for the inherent mortality risk posed by left ventricular dysfunction may be a strategy while designing a study.
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Affiliation(s)
- Waiel Abusnina
- Department of Cardiology, Creighton University School of Medicine, Omaha, NE, United States
| | - Mostafa Reda Mostafa
- Department of Medicine, Rochester Regional/Unity Hospital, Rochester, NY, United States
| | - Ahmad Al-Abdouh
- Department of Medicine, University of Kentucky, Lexington, KY, United States
| | - Qais Radaideh
- Department of Cardiology, Creighton University School of Medicine, Omaha, NE, United States
| | - Mahmoud Ismayl
- Department of Cardiology, Creighton University School of Medicine, Omaha, NE, United States
| | - Mahboob Alam
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Jaffer Shah
- Medical Research Center, Kateb University, Kabul, Afghanistan
- *Correspondence: Jaffer Shah
| | | | - Timir K. Paul
- Department of Medical Education, University of Tennessee at Nashville, Nashville, TN, United States
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States
| | - Khagendra Dahal
- Department of Cardiology, Creighton University School of Medicine, Omaha, NE, United States
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10
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Chen H, Yu X, Qiu G, Ma L. Predictive value of ACEF score for clinical prognosis of patients with heavily calcified coronary lesions after percutaneous coronary intervention with rotational atherectomy. J Cardiothorac Surg 2022; 17:85. [PMID: 35477470 PMCID: PMC9044582 DOI: 10.1186/s13019-022-01833-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 04/17/2022] [Indexed: 11/23/2022] Open
Abstract
Background To inquiry the predictive value of the age, creatinine, and ejection fraction (ACEF) score for cardiac mortality in patients diagnosed with heavily calcified coronary lesions at 1 year after percutaneous coronary intervention (PCI) with rotational atherectomy (RA). Methods 275 patients with heavily calcified coronary lesions undergoing PCI with RA in the Department of Cardiology of Anhui Provincial Hospital from January 2017 to December 2019 were consecutively recruited. The primary endpoint event was cardiac death at postoperative 1 year. The ROC curve was used to assess ACEF scoring system and predict cardiac mortality. Results In term of ACEF score upon admission, 275 patients were divided into low-to-intermediate risk group (n = 130) with ACEF score < 1.23 and high-risk group (n = 145) with ACEF score ≥ 1.23. The age, gender proportion and left ventricular ejection fraction (LVEF) have a significant difference between the low-to-intermediate risk group and the high-risk group (all P < 0.05). The area under ROC curve for ACEF scoring system to predict cardiac mortality at 1 year after PCI with RA was 0.756 and 0.715, respectively. Conclusions ACEF value upon admission can predict the cardiac mortality at 1 year following PCI with RA in heavily calcified coronary lesions patients.
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Affiliation(s)
- Hongwu Chen
- Department of Cardiology, The First Affiliated Hospital of USTC (Anhui Provincial Hospital), Division of Life Sciences and Medicine, University of Science and Technology of China, No. 17 Lujiang Road, Luyang District, Hefei, 230001, Anhui Province, China
| | - Xiaofan Yu
- Department of Cardiology, The First Affiliated Hospital of USTC (Anhui Provincial Hospital), Division of Life Sciences and Medicine, University of Science and Technology of China, No. 17 Lujiang Road, Luyang District, Hefei, 230001, Anhui Province, China
| | - Guangquan Qiu
- Department of Cardiology, The First Affiliated Hospital of USTC (Anhui Provincial Hospital), Division of Life Sciences and Medicine, University of Science and Technology of China, No. 17 Lujiang Road, Luyang District, Hefei, 230001, Anhui Province, China
| | - Likun Ma
- Department of Cardiology, The First Affiliated Hospital of USTC (Anhui Provincial Hospital), Division of Life Sciences and Medicine, University of Science and Technology of China, No. 17 Lujiang Road, Luyang District, Hefei, 230001, Anhui Province, China.
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11
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Gao J, Shao C, Wang W, Meng X, Zhang K, Wang J, Zheng M, Tang YD. Age, creatinine clearance, and ejection fraction (mACEF) score predicts long-term cardiac mortality in patients with hypertrophic obstructive cardiomyopathy treated non-invasively. Anatol J Cardiol 2021; 25:691-698. [PMID: 34622783 DOI: 10.5152/anatoljcardiol.2021.50322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Presently, an effective model to predict long-term cardiac mortality in patients with hypertrophic obstructive cardiomyopathy (HOCM) is lacking. Therefore, the objective of this study was to evaluate the predictive value of the modified Age, Creatinine clearance, and Ejection Fraction (mACEF) score for long-term cardiac mortality in patients with HOCM. METHODS Two hundred and ninety two patients with HOCM treated non-invasively were enrolled in this study, all of whom had intact medical information. RESULTS Over a median follow-up period of 41.9 months, 28 cardiac deaths occurred. In univariate Cox regression analysis, the mACEF score was associated with long-term cardiac death [hazard ratio (HR)=1.795, 95% confidence interval (CI) 1.518-2.124, p<0.001]. Multiple Cox regression analysis identified the mACEF score as an independent risk factor for long-term cardiac death (adjusted HR=1.372, 95% CI 1.076-1.749, p=0.011). Analysis of the receiver operating characteristic (ROC) for long-term cardiac death showed that the mACEF score had a considerable predictive value (area under ROC 0.844, sensitivity 89.29%, specificity 75.00%) with an optimum cut-off value of 0.96. The study population was divided into high-risk (mACEF score ≥0.96, n=91) and low-risk (mACEF score <0.96, n=201) groups according to the optimum cut-off value. Kaplan-Meier survival analysis was performed and showed a dramatic higher rate of long-term cardiac mortality in the high-risk group than in the low-risk group (27.4% vs. 1.7%, p<0.001 by log-rank test). CONCLUSION The mACEF score has a considerable predictive value for long-term cardiac mortality in patients with HOCM treated non-invasively. A mACEF score ≥0.96 could be considered as a sign of poor prognosis in patients with HOCM.
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Affiliation(s)
- Jun Gao
- Department of Cardiology, Peking University Third Hospital; Beijing-China;Heart Center, The First Hospital of Hebei Medical University; Shijiazhuang-China
| | - Chunli Shao
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing-China
| | - Wenyao Wang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing-China
| | - Xiangbin Meng
- Department of Cardiology, Peking University Third Hospital; Beijing-China;Central China Fuwai Hospital; Central China Branch of the National Cardiovascular Center; Department of Cardiology, Zhengzhou University People's Hospital; Henan Provincial People's Hospital; Zhengzhou-China
| | - Kuo Zhang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing-China
| | - Jingjia Wang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing-China
| | - Mingqi Zheng
- Heart Center, The First Hospital of Hebei Medical University; Shijiazhuang-China
| | - Yi-Da Tang
- Department of Cardiology, Peking University Third Hospital; Beijing-China
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12
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Gawinski L, Engelseth P, Kozlowski R. Application of Modern Clinical Risk Scores in the Global Assessment of Risks Related to the Diagnosis and Treatment of Acute Coronary Syndromes in Everyday Medical Practice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179103. [PMID: 34501692 PMCID: PMC8431105 DOI: 10.3390/ijerph18179103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 08/23/2021] [Accepted: 08/25/2021] [Indexed: 11/16/2022]
Abstract
This article presents an overview of contemporary risk assessment systems used in patients with myocardial infarction. The full range of risk scales, both recommended by the European Society of Cardiology and others published in recent years, is presented. Scales for assessing the risk of ischemia/death as well as for assessing the risk of bleeding are presented. A separate section is devoted to systems assessing the integrated risk associated with both ischemia and bleeding. In the first part of the work, each of the risk scales is described in detail, including the clinical trials/registers on the basis of which they were created, the statistical methods used to develop them, as well as the specification of their individual parameters. The next chapter presents the practical application of a given scale in the patient risk assessment process, the timing of its application on the timeline of myocardial infarction, as well as a critical assessment of its potential advantages and limitations. The last part of the work is devoted to the presentation of potential directions for the development of risk assessment systems in the future.
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Affiliation(s)
- Lukasz Gawinski
- Department of Management and Logistics in Health Care, Medical University of Lodz, 90-237 Lodz, Poland
- Correspondence:
| | - Per Engelseth
- Narvik Campus, Tromsø School of Business and Economics, University of Tromsø, 8505 Narvik, Norway;
| | - Remigiusz Kozlowski
- Center of Security Technologies in Logistics, Faculty of Management, University of Lodz, 90-237 Lodz, Poland;
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13
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Gao S, Ma W, Huang S, Lin X, Yu M. Predictive value of the age, creatinine, and ejection fraction score in patients with myocardial infarction with nonobstructive coronary arteries. Clin Cardiol 2021; 44:1011-1018. [PMID: 34061375 PMCID: PMC8259146 DOI: 10.1002/clc.23650] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/11/2021] [Accepted: 05/18/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Little is known about risk stratification in patients with myocardial infarction with nonobstructive coronary arteries (MINOCA). We investigated whether the age, creatinine, and ejection fraction (ACEF) score (age [years]/ejection fraction [%] + 1 [if creatinine >176 μmol/L]) might predict long-term outcomes after MINOCA. HYPOTHESIS The ACEF score enables accurate risk prediction in patients with MINOCA. METHODS A total of 1179 patients with MINOCA were enrolled and divided based on their ACEF score tertile levels. The primary endpoint was a composite of major adverse cardiovascular events (MACE), including all-cause death, nonfatal MI, nonfatal stroke, revascularization, and hospitalization for unstable angina or heart failure. Kaplan-Meier and Cox regression analyses were performed. Discrimination was defined as the area under the curve (AUC) using receiver operating characteristic analysis. RESULTS During the median follow-up of 41.7 months, patients with MINOCA with higher ACEF score tertiles had a significantly higher incidence of MACE (6.3%, 12.5%, and 23.8%, respectively; p < .001). The adjusted risk of MACE increased with the rising ACEF score tertiles (1st tertile as reference; 2nd tertile: HR 2.70, 95% CI: 1.38-5.29, p = .004; and 3rd tertile: HR 5.35, 95% CI: 2.72-10.51, p < .001). Moreover, an elevated ACEF score was closely associated with an increased risk of MACE overall (HR 4.23, 95% CI: 3.37-5.30, p < .001) and in subgroups (all p < .05). The ACEF score also yielded a good predictive value (AUC 0.79) for MACE. CONCLUSION Elevated ACEF scores were strongly associated with a poor prognosis after MINOCA. This simple and valid risk score may facilitate risk stratification and decision making in the population with MINOCA.
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Affiliation(s)
- Side Gao
- Department of CardiologyFuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Wenjian Ma
- Department of CardiologyFuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Sizhuang Huang
- Department of CardiologyFuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Xuze Lin
- Department of CardiologyFuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Mengyue Yu
- Department of CardiologyFuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
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14
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Li H, Li C, Bai Y, Wang Z, Li M, Cai Y, Zhou W, Zhang B, Liu H. Correlation between serum free triiodothyronine levels and risk stratification in Chinese patients with acute coronary syndrome receiving percutaneous coronary intervention. J Int Med Res 2020; 48:300060520957180. [PMID: 32954890 PMCID: PMC7509761 DOI: 10.1177/0300060520957180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Low serum free triiodothyronine (FT3) levels are associated with the occurrence of coronary heart disease and with the prognosis of cardiovascular diseases. This study aimed to investigate the relationship between FT3 levels and risk stratification in Chinese Han patients with acute coronary syndrome (ACS) receiving percutaneous coronary intervention (PCI) treatment. METHODS Plasma FT3 levels and other parameters were measured in 191 patients with ACS who received PCI. The risk of adverse cardiovascular events was assessed using the Age, Creatinine, and Ejection Fraction (ACEF) score. RESULTS FT3 levels were significantly lower in the high-risk group than in the medium- and low-risk groups. Serum FT3 levels were negatively linearly correlated with the ACEF score (r = -0.590). Stepwise regression analysis showed a negative correlation between FT3 levels and the risk of adverse cardiovascular events as measured by the ACEF score (standardized β = -0.261). CONCLUSION Serum FT3 levels are negatively related to risk stratification in patients with ACS. Serum FT3 levels may be used as a potential predictor for adverse outcomes of patients with ACS undergoing PCI.
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Affiliation(s)
- Huiying Li
- Geriatric Cardiology Department, The Second Medical Center of Chinese PLA General Hospital, Beijing, China.,Medical School of PLA, Beijing, China
| | - Chunlin Li
- Department of Health Medicine, The Eighth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yongyi Bai
- Geriatric Cardiology Department, The Second Medical Center of Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Zhao Wang
- Medical School of PLA, Beijing, China
| | - Man Li
- Geriatric Cardiology Department, The Second Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yulun Cai
- Geriatric Cardiology Department, The Second Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Wenli Zhou
- Geriatric Cardiology Department, The Second Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Baohua Zhang
- Geriatric Cardiology Department, The Second Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Hongbin Liu
- Geriatric Cardiology Department, The Second Medical Center of Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China.,Beijing Key Laboratory of Chronic Heart Failure Precision Medicine, Beijing, China
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15
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Yoshida R, Ishii H, Morishima I, Tanaka A, Takagi K, Yoshioka N, Morita Y, Unno K, Yoshida Y, Tsuboi H, Murohara T. Rotational Atherectomy for Severely Calcified Lesions in Patients With Left Ventricular Systolic Dysfunction: One-Year Outcomes From aSingle-Center Registry Analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1220-1227. [PMID: 32457019 DOI: 10.1016/j.carrev.2020.03.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 03/02/2020] [Accepted: 03/31/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND High-risk percutaneous coronary intervention (PCI) in patients with left ventricular (LV) systolic dysfunction has been proven to induce reverse LV remodeling. However, the impact of high-risk PCI focusing on rotational atherectomy (RA) in patients with severe LV systolic dysfunction has not been completely addressed. METHODS Among 4339 consecutive patients who underwent PCI, 178 patients with 192 lesions were treated with RA. The reduced ejection fraction (EF) group (LVEF ≤35%) included 25 patients, the mid-range EF group (LVEF 36-50%) included 44 patients, and the preserved EF group (LVEF >50%) included 109 patients. The primary outcome was a composite of cardiac death, non-fatal myocardial infarction, target-vessel revascularization, and ischemic stroke. RESULTS The cumulative 1-year incidence of the primary outcome was similar among the three groups (reduced EF, 29%; mid-range EF, 25%; preserved EF, 26%; p = 0.95). After adjusting for confounding factors, the incidence of the primary outcome in the reduced EF group (hazard ratio [HR], 1.07; 95% confidence interval [CI], 0.43-2.37; p = 0.87) and the mid-range EF group (HR, 0.99; 95% CI, 0.47-1.94; p = 0.97) was similar to that in the preserved EF group. LVEF was significantly improved in the reduced EF and mid-range EF groups compared with the preserved EF group (absolute change in LVEF: 13.6 ± 11.3%, 9.0 ± 10.1%, and -0.7 ± 7.8%, respectively; p < 0.0001). CONCLUSIONS Reduced EF was not associated with increase in the primary outcome in patients undergoing RA. This seemed to result from the improved LV function after PCI. SUMMARY FOR ANNOTATED TABLE OF CONTENTS This single center analysis study investigated 1-year composite outcome of cardiac death, non-fatal myocardial infarction, target-vessel revascularization, and ischemic stroke in patients with severe LV systolic dysfunction undergoing RA compared with that in patients with preserved LV function. The cumulative 1-year incidence of the composite outcome was similar among the three groups (reduced EF, 29%; mid-range EF, 25%; preserved EF, 26%; p = 0.95). LVEF was significantly improved in the reduced EF and mid-range EF groups compared with the preserved EF group (absolute change in LVEF: 13.6 ± 11.3%, 9.0 ± 10.1%, and -0.7 ± 7.8%, respectively; p < 0.0001).
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Affiliation(s)
- Ruka Yoshida
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8560, Japan; Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki 503-0864, Japan; Department of Cardiology, Japanese RedCross Nagoya Daini Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya 466-8650, Japan.
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8560, Japan
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki 503-0864, Japan
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8560, Japan
| | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki 503-0864, Japan
| | - Naoki Yoshioka
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki 503-0864, Japan
| | - Yasuhiro Morita
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki 503-0864, Japan
| | - Kazumasa Unno
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8560, Japan; Department of Cardiology, Japanese RedCross Nagoya Daini Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya 466-8650, Japan
| | - Yukihiko Yoshida
- Department of Cardiology, Japanese RedCross Nagoya Daini Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya 466-8650, Japan
| | - Hideyuki Tsuboi
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki 503-0864, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8560, Japan
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16
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Gao S, Liu Q, Ding X, Chen H, Zhao X, Li H. Predictive value of the combination of age, creatinine, and ejection fraction score and diabetes in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention. Coron Artery Dis 2020; 31:109-117. [PMID: 31464730 PMCID: PMC7004452 DOI: 10.1097/mca.0000000000000791] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 07/29/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND This study investigated whether the age, creatinine, and ejection fraction (ACEF) score [age (years) /ejection fraction (%) +1 (if creatinine>176μmol/L)] could predict 1-year outcomes following ST-segment elevation myocardial infarction after percutaneous coronary intervention, and whether accuracy could be improved by establishing novel ACEF-derived risk models. METHODS A total of 1146 patients were included. The study endpoint was 1-year major adverse cardio-cerebrovascular events, including all-cause death, nonfatal myocardial infarction, unplanned revascularization, and nonfatal stroke. Accuracy was defined with area under the curve by receiver-operating characteristic curve analysis. RESULTS The incidence of 1-year major adverse cardio-cerebrovascular event increased with the rising age, creatinine, and ejection fraction score tertiles (4.8%, 8.4%, and 15.2%, P < 0.001 for all). Higher ACEF score was significantly associated with an increased risk of the endpoint in overall (odds ratio = 3.75, 95% confidence interval, 2.44-5.77, P < 0.001) and in subgroups (all P < 0.05). The accuracy of the ACEF score was equivalent to the other complex risk scores. The combination of ACEF, and diabetes (ACEF-diabetes score) yielded a superior discriminatory ability than the original ACEF score (increase in C-statistic from 0.67 to 0.71, P = 0.048; continuous net reclassification improvement = 51.9%, 95% confidence interval, 33.4-70.5%, P < 0.001; integrated discrimination improvement = 0.020, 95% confidence interval, 0.011-0.030, P < 0.001). CONCLUSIONS The simplified ACEF score performed well in predicting 1-year outcomes in ST-segment elevation myocardial infarction patients undergoing percutaneous coronary intervention. The novel ACEF-diabetes score provided a better predictive value and thus may help stratify high-risk patients and potentially facilitate decision making.
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Affiliation(s)
- Side Gao
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University
| | - Qingbo Liu
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University
| | - Xiaosong Ding
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University
| | - Hui Chen
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University
| | - Xueqiao Zhao
- Clinical Atherosclerosis Research Lab, Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Hongwei Li
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University
- Beijing Key Laboratory of Metabolic Disorders Related Cardiovascular Disease, Beijing, China
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17
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Flores-Umanzor EJ, Cepas-Guillen PL, Vázquez S, Fernandez-Valledor A, Ivey-Miranda J, Izquierdo M, Caldentey G, Jimenez-Britez G, Regueiro A, Freixa X, Farrero M, Ferreira-González I, Martin-Yuste V, Sabaté M. Survival benefit of revascularization versus optimal medical therapy alone for chronic total occlusion management in patients with diabetes. Catheter Cardiovasc Interv 2020; 97:376-383. [PMID: 32096926 DOI: 10.1002/ccd.28815] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 01/12/2020] [Accepted: 02/14/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Chronic total occlusion (CTO) is common in patients with diabetes mellitus. Data on the long-term outcomes after treatment of CTOs in this high-risk population are scarce. AIM To compare the long-term clinical outcomes of CTO revascularization either by coronary artery bypass graft (CABG) or successful percutaneous coronary intervention (PCI) versus optimal medical treatment (MT) alone in patients with diabetes. METHODS AND RESULTS A total of 538 consecutive patients with diabetes and at least one CTO were identified from 2010 to 2014 in our center. In the present analysis, patients were stratified according to the CTO treatment strategy that was selected. MT was selected in 61% of patients whereas revascularization in the remaining 39%. Patients undergoing revascularization were younger, had higher left ventricular ejection fraction (LVEF), lower ACEF score, and more positive myocardial ischemia detection results compared to the MT group (p < .001).Patients referred for CABG had higher rates of left main disease compared to the PCI and MT groups (32% vs. 3% and 11%, respectively; p < .001). Complete revascularization was more often achieved in the CABG group, compared to the PCI group (62% vs. 32% p < .001). Multivariable analysis showed that revascularization with CABG was associated with lower rates of all-cause and cardiac mortality rates compared to MT, [hazard ratio (HR) 0.41, 95% confidence interval (CI) 0.25-0.70, p < .001 and HR 0.40, 95% CI 0.20-81, p = .011, respectively]. Successful CTO-PCI showed a trend towards benefit in all-cause mortality (HR 0.58, 95% CI 0.33-1.04, p = .06). CONCLUSION In our registry, CTO revascularization in diabetic patients, especially with CABG, was associated with lower long-term mortality rates as compared to MT alone.
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Affiliation(s)
- Eduardo J Flores-Umanzor
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Pedro L Cepas-Guillen
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Sara Vázquez
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Andrea Fernandez-Valledor
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Juan Ivey-Miranda
- Hospital de Cardiología Siglo XXI, Instituto Mexicano del Seguro Social, México City, Mexico
| | - Marc Izquierdo
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Guillem Caldentey
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Cardiology Department, Hospital del Mar (Consorci Mar Parc de Salut de Barcelona), Barcelona, Spain
| | - Gustavo Jimenez-Britez
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Ander Regueiro
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Xavier Freixa
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Marta Farrero
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Ignacio Ferreira-González
- Cardiology Department, Vall d'hebron Hospital, Barcelona, and CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Victoria Martin-Yuste
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Service de Cardiologie, Centre Hospitalier de Saintonge, Saintes, France
| | - Manel Sabaté
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
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Gao G, Zhang D, Song C, Xu H, Yin D, Guan C, Yang Y, Xu B, Dou K. Integrating the residual SYNTAX score to improve the predictive ability of the age, creatinine, and ejection fraction (ACEF) score for cardiac mortality in percutaneous coronary intervention patients. Catheter Cardiovasc Interv 2019; 95 Suppl 1:534-541. [PMID: 31876352 DOI: 10.1002/ccd.28673] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 12/12/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Guofeng Gao
- Department of CardiologyCardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Dong Zhang
- Department of CardiologyCardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Chenxi Song
- Department of CardiologyCardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Han Xu
- Department of CardiologyCardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Dong Yin
- Department of CardiologyCardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Changdong Guan
- Department of CardiologyCardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Yuejin Yang
- Department of CardiologyCardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Bo Xu
- Department of CardiologyCardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Kefei Dou
- Department of CardiologyCardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
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19
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Flores‐Umanzor EJ, Vázquez S, Cepas‐Guillen P, Ivey‐Miranda J, Caldentey G, Jimenez‐Britez G, Regueiro A, Freixa X, Andrea R, Ferreira‐González I, Sabaté M, Martin‐Yuste V. Impact of revascularization versus medical therapy alone for chronic total occlusion management in older patients. Catheter Cardiovasc Interv 2019; 94:527-535. [DOI: 10.1002/ccd.28163] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 02/09/2019] [Indexed: 01/22/2023]
Affiliation(s)
| | - Sara Vázquez
- Cardiology DepartmentCardiovascular Institute, Hospital Clínic, University of Barcelona Barcelona Spain
| | - Pedro Cepas‐Guillen
- Cardiology DepartmentCardiovascular Institute, Hospital Clínic, University of Barcelona Barcelona Spain
| | - Juan Ivey‐Miranda
- Cardiology DepartmentCardiovascular Institute, Hospital Clínic, University of Barcelona Barcelona Spain
| | - Guillem Caldentey
- Cardiology DepartmentCardiovascular Institute, Hospital Clínic, University of Barcelona Barcelona Spain
| | - Gustavo Jimenez‐Britez
- Cardiology DepartmentCardiovascular Institute, Hospital Clínic, University of Barcelona Barcelona Spain
| | - Ander Regueiro
- Cardiology DepartmentCardiovascular Institute, Hospital Clínic, University of Barcelona Barcelona Spain
| | - Xavier Freixa
- Cardiology DepartmentCardiovascular Institute, Hospital Clínic, University of Barcelona Barcelona Spain
| | - Rut Andrea
- Cardiology DepartmentCardiovascular Institute, Hospital Clínic, University of Barcelona Barcelona Spain
| | - Ignacio Ferreira‐González
- Cardiology DepartmentVall d'hebron Hospital, Barcelona, and CIBER de Epidemiología y Salud Pública (CIBERESP) Barcelona Spain
| | - Manel Sabaté
- Cardiology DepartmentCardiovascular Institute, Hospital Clínic, University of Barcelona Barcelona Spain
| | - Victoria Martin‐Yuste
- Cardiology DepartmentCardiovascular Institute, Hospital Clínic, University of Barcelona Barcelona Spain
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20
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Outcomes of rotational atherectomy in patients with severe left ventricular dysfunction without hemodynamic support. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018. [DOI: 10.1016/j.carrev.2018.02.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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21
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Stähli BE, Wischnewsky MB, Jakob P, Klingenberg R, Obeid S, Heg D, Räber L, Windecker S, Roffi M, Mach F, Gencer B, Nanchen D, Jüni P, Landmesser U, Matter CM, Lüscher TF, Maier W. Predictive value of the age, creatinine, and ejection fraction (ACEF) score in patients with acute coronary syndromes. Int J Cardiol 2018; 270:7-13. [PMID: 29885826 DOI: 10.1016/j.ijcard.2018.05.134] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 05/27/2018] [Accepted: 05/31/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND This study sought to investigate the predictive value of the age, creatinine, and ejection fraction (ACEF) score in patients with acute coronary syndromes (ACS). The ACEF score (age/left ventricular ejection fraction +1 [if creatinine > 176 μmol/L]) has been established in patients evaluated for coronary artery bypass surgery. Data on its predictive value in all-comer ACS patients undergoing percutaneous coronary intervention are scarce. METHODS A total of 1901 patients prospectively enrolled in the Swiss ACS Cohort were included in the analysis. Optimal ACEF score cut-off values were calculated by decision tree analysis, and patients divided into low-risk (≤1.45), intermediate-risk (>1.45 and ≤2.0), and high-risk groups (>2.0). The primary endpoint was all-cause mortality. Major adverse cardiac and cerebrovascular events (MACCE) included all-cause death, non-fatal myocardial infarction, clinically indicated repeat coronary revascularization, definite stent thrombosis, and transient ischemic attack/stroke. RESULTS One-year rates of all-cause death increased across ACEF score groups (1.6% versus 5.6% versus 23.0%, p < 0.001). In multivariate analysis, the ACEF score was related with an increased risk of all-cause mortality (adjusted HR 3.53, 95% CI 2.90-4.31, p < 0.001), MACCE (adjusted HR 2.23, 95% CI 1.88-2.65, p < 0.001), and transient ischemic attack/stroke (adjusted HR 2.58, 95% CI 1.71-3.89, p < 0.001) at 1 year. Rates of Thrombolysis in Myocardial Infarction (TIMI) major and Global use of Strategies to Open Occluded Coronary Arteries (GUSTO) severe bleeding paralleled the increased ischemic risk across the groups (p < 0.001). CONCLUSIONS The ACEF score is a simple and useful risk stratification tool in patients with ACS referred for coronary revascularization.
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Affiliation(s)
- Barbara E Stähli
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland; Department of Cardiology, Charité Berlin - University Medicine, Campus Benjamin Franklin, Berlin, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
| | | | - Philipp Jakob
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland; Department of Cardiology, Charité Berlin - University Medicine, Campus Benjamin Franklin, Berlin, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Roland Klingenberg
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Slayman Obeid
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Dik Heg
- Clinical Trials Unit, Department of Clinical Research, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Cardiovascular Center, University Hospital Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Cardiovascular Center, University Hospital Bern, Bern, Switzerland
| | - Marco Roffi
- Division of Cardiology, Cardiovascular Center, University Hospital Geneva, Geneva, Switzerland
| | - François Mach
- Division of Cardiology, Cardiovascular Center, University Hospital Geneva, Geneva, Switzerland
| | - Baris Gencer
- Division of Cardiology, Cardiovascular Center, University Hospital Geneva, Geneva, Switzerland
| | - David Nanchen
- Department of Ambulatory Care and Community Medicine, Lausanne University, Lausanne, Switzerland
| | - Peter Jüni
- Clinical Trials Unit, Department of Clinical Research, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Ulf Landmesser
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland; Department of Cardiology, Charité Berlin - University Medicine, Campus Benjamin Franklin, Berlin, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Christian M Matter
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Thomas F Lüscher
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland; Cardiology, Royal Brompton and Harefield Hospitals and Imperial College, London, UK
| | - Willibald Maier
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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22
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Deng J, Wang X, Shi Y, Zhao X, Han Y. Prognostic value of the age, creatinine, and ejection fraction score for non-infarct-related chronic total occlusion revascularization after primary percutaneous intervention in acute ST-elevation myocardial infarction patients: A retrospective study. J Interv Cardiol 2017; 31:33-40. [PMID: 28940388 DOI: 10.1111/joic.12448] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 08/27/2017] [Accepted: 08/29/2017] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE It is not known if ACEF scores could evaluate the prognosis of recanalization of non-infarct-related coronary arteries (non-IRA) with chronic total occlusions (CTO) in patients who successfully underwent primary PCI. The objective of the current study was to assess the prognostic value of ACEF scores in acute ST-segment elevation myocardial infarction (STEMI) patients with non-IRA CTO after successful primary PCI. METHODS There were 2952 STEMI patients who underwent successful primary PCI from January 2006 to December 2014 in our hospital, among them 377 patients had a non-IRA CTO lesion. The patients were divided into successful CTO-PCI group (n = 221) and failed/non-attempted CTO-PCI group (n = 156). Patients were stratified based on the ACEF tertiles. Primary end points measured in the current study were major adverse cardiac events (MACE) defined as the composite of all-cause death, nonfatal myocardial infarction, ischemia-driven coronary revascularization and hospitalization for heart failure at 1 year. RESULTS The incidence of MACE, all-cause death and cardiac death were higher in the failed/non-attempted CTO-PCI group (P < 0.001). In the successful CTO-PCI group, the cumulative 1-year incidences of MACE and all-cause death were decreased compared to those in the failed/non-attempted CTO-PCI group (log-rank P < 0.001). The risk for MACE was reduced in the successful CTO-PCI group compared to the failed/non-attempted CTO-PCI group in patients with low and intermediate ACEF scores (log-rank P = 0.02). CONCLUSIONS Successfully staged CTO-PCI could gain advantageous clinical outcomes in those patients with low or intermediate ACEF scores.
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Affiliation(s)
- Jie Deng
- Department of Cardiology, The General Hospital of Shenyang Military Region, Chinese People's Liberation Army, Shenyang, China.,Department of Cardiology, Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Xiaozeng Wang
- Department of Cardiology, The General Hospital of Shenyang Military Region, Chinese People's Liberation Army, Shenyang, China
| | - Yana Shi
- Department of Cardiology, The General Hospital of Shenyang Military Region, Chinese People's Liberation Army, Shenyang, China
| | - Xin Zhao
- Department of Cardiology, The General Hospital of Shenyang Military Region, Chinese People's Liberation Army, Shenyang, China
| | - Yaling Han
- Department of Cardiology, The General Hospital of Shenyang Military Region, Chinese People's Liberation Army, Shenyang, China
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23
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Kalaycı A, Oduncu V, Geçmen Ç, Topcu S, Karabay CY, İzgi İA, Kırma C. A simple risk score in acute ST-elevation myocardial infarction: Modified ACEF(age, creatinine, and ejection fraction) score. Turk J Med Sci 2016; 46:1688-1693. [PMID: 28081310 DOI: 10.3906/sag-1601-11] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Accepted: 04/10/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM The aim of this study was to evaluate if the modified ACEF (age, creatinine, and ejection fraction) score is a predictor of major adverse cardiac and cerebrovascular events during 1 year of follow-up in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI). MATERIALS AND METHODS We retrospectively enrolled 1632 consecutive patients who were admitted to our emergency department diagnosed with STEMI within 12 h of chest pain and treated with primary PCI. The modified ACEF score, determined with a simplified scoring system, was calculated. The patients were grouped into tertiles according to this score (group I mACEF < 1.03, group II mACEF 1.03-1.37, group III > 1.37) . The clinical and angiographic data were compared among the tertiles. RESULTS In patients with the highest mACEF tertile, out-of-hospital cardiac arrest (1.3%, 1.8%, and 4.1% consecutively; P = 0.003), Killip class ≥ II (P < 0.001), and cardiogenic shock were more common and ejection fraction was lower (P < 0.001). Moreover, in the 1-year follow-up, there was a statistically significant difference between cardiac mortality, target vessel revascularization, stroke, reinfarction, and major adverse cardiac and cerebrovascular events of the groups, while the rates of stent thrombosis were similar. CONCLUSION The modified ACEF score is a predictor of cardiac mortality and morbidity during 1-year follow-up.
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Affiliation(s)
- Arzu Kalaycı
- Department of Cardiology, Koşuyolu Heart Education and Research Hospital, İstanbul, Turkey
| | - Vecih Oduncu
- Department of Cardiology, Koşuyolu Heart Education and Research Hospital, İstanbul, Turkey
| | - Çetin Geçmen
- Department of Cardiology, Koşuyolu Heart Education and Research Hospital, İstanbul, Turkey
| | - Selim Topcu
- Department of Cardiology, Faculty of Medicine, Atatürk University, Erzurum, Turkey
| | - Can Yücel Karabay
- Department of Cardiology, Koşuyolu Heart Education and Research Hospital, İstanbul, Turkey
| | - İbrahim Akın İzgi
- Department of Cardiology, Koşuyolu Heart Education and Research Hospital, İstanbul, Turkey
| | - Cevat Kırma
- Department of Cardiology, Koşuyolu Heart Education and Research Hospital, İstanbul, Turkey
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24
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Tsai TY, Tsai FC, Fan PC, Chang CH, Lin CY, Chang WW, Lee SY, Hsu HH, Tian YC, Fang JT, Yang CW, Chen YC. Application of the Age, Creatinine, and Left Ventricular Ejection Fraction Score for Patients on Extracorporeal Membrane Oxygenation. Artif Organs 2016; 41:146-152. [DOI: 10.1111/aor.12765] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 02/27/2016] [Accepted: 03/29/2016] [Indexed: 12/27/2022]
Affiliation(s)
| | - Feng-Chun Tsai
- Division of Cardiovascular Surgery; Chang Gung Memorial Hospital; Taipei
- Chang Gung University College of Medicine; Taipei
| | | | - Chih-Hsiang Chang
- Department of Nephrology; Taipei
- Chang Gung University College of Medicine; Taipei
| | - Chan-Yu Lin
- Department of Nephrology; Taipei
- Chang Gung University College of Medicine; Taipei
| | - Wei-Wen Chang
- Department of Nephrology; Taoyuan General Hospital, Ministry of Health and Welfare; Taoyuan Taiwan
| | - Shen-Yang Lee
- Department of Nephrology; Taipei
- Chang Gung University College of Medicine; Taipei
| | - Hsiang-Hao Hsu
- Department of Nephrology; Taipei
- Chang Gung University College of Medicine; Taipei
| | - Ya-Chung Tian
- Department of Nephrology; Taipei
- Chang Gung University College of Medicine; Taipei
| | - Ji-Tseng Fang
- Department of Nephrology; Taipei
- Chang Gung University College of Medicine; Taipei
| | - Chih-Wei Yang
- Department of Nephrology; Taipei
- Chang Gung University College of Medicine; Taipei
| | - Yung-Chang Chen
- Department of Nephrology; Taipei
- Chang Gung University College of Medicine; Taipei
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25
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Eftychiou C, Barmby DS, Wilson SJ, Ubaid S, Markwick AJ, Makri L, Blaxill JM, Spratt JC, Gunning M, Greenwood JP. Cardiovascular Outcomes Following Rotational Atherectomy: A UK Multicentre Experience. Catheter Cardiovasc Interv 2016; 88:546-553. [DOI: 10.1002/ccd.26587] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 03/25/2016] [Accepted: 04/22/2016] [Indexed: 11/10/2022]
Affiliation(s)
| | - David S. Barmby
- Department of Cardiology; Leeds General Infirmary; Leeds United Kingdom
| | - Simon J. Wilson
- Department of Cardiology; Royal Infirmary of Edinburgh; Edinburgh United Kingdom
| | - Salahaddin Ubaid
- Department of Cardiology; University Hospital of North Staffordshire; Stoke-on-Trent United Kingdom
| | - Andrew J. Markwick
- Department of Cardiology; University Hospital of North Staffordshire; Stoke-on-Trent United Kingdom
| | - Loukia Makri
- Department of Cardiology; Leeds General Infirmary; Leeds United Kingdom
| | | | - James C. Spratt
- Department of Cardiology; Forth Valley Royal; Edinburgh United Kingdom
| | - Mark Gunning
- Department of Cardiology; University Hospital of North Staffordshire; Stoke-on-Trent United Kingdom
| | - John P. Greenwood
- Department of Cardiology; Leeds General Infirmary; Leeds United Kingdom
- Division of Cardiovascular and Diabetes Research; Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds; Leeds United Kingdom
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26
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Chambers JW, Behrens AN, Martinsen BJ. Atherectomy Devices for the Treatment of Calcified Coronary Lesions. Interv Cardiol Clin 2016; 5:143-151. [PMID: 28582200 DOI: 10.1016/j.iccl.2015.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The presence of moderate and severe coronary artery calcification (CAC) is associated with higher rates of angiographic complications during percutaneous coronary intervention (PCI), as well as higher major adverse cardiac events compared with noncalcified lesions. Diabetes mellitus, a risk factor for CAC, is increasing in the United States. Vessel preparation before PCI with atherectomy can facilitate successful stent delivery and expansion that may otherwise not be possible. We review here CAC prevalence, risk factors, and impact on PCI, as well as the currently available coronary atherectomy devices including rotational atherectomy, orbital atherectomy, and laser atherectomy.
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Affiliation(s)
- Jeffrey W Chambers
- Metropolitan Heart and Vascular Institute, The Heart Center, Mercy Hospital, Suite 120, 4040 Coon Rapids Boulevard, Minneapolis, MN 55433, USA.
| | - Ann N Behrens
- Science & Research Department, Cardiovascular Systems, Inc, 1225 Old Highway 8 NW, St Paul, MN 55112, USA
| | - Brad J Martinsen
- Science & Research Department, Cardiovascular Systems, Inc, 1225 Old Highway 8 NW, St Paul, MN 55112, USA
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27
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Chen J, Tang B, Lin Y, Ru Y, Wu M, Wang X, Chen Q, Chen Y, Wang J. Validation of the Ability of SYNTAX and Clinical SYNTAX Scores to Predict Adverse Cardiovascular Events After Stent Implantation: A Systematic Review and Meta-Analysis. Angiology 2015; 67:820-8. [PMID: 26614789 DOI: 10.1177/0003319715618803] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To compare the predicative ability of SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) and clinical SYNTAX scores for major adverse cardiac events (MACEs) after stent implantation in patients with coronary artery disease (CAD). Studies were identified by electronic and manual searches. Twenty-six studies were included in the meta-analysis. The pooled C-statistics of SYNTAX score for 1- and 5-year all-cause mortality (ACM) were 0.65 (95% confidence interval [CI]: 0.61-0.68) and 0.62 (95% CI: 0.59-0.65), respectively, with weak heterogeneity. The 1- and 5-year ACM pooled C-statistics for clinical SYNTAX scores were significantly higher at 0.77 and 0.71, respectively (Ps < .05). Both scoring systems predicted 1- and 5-year MACE equally well. The pooled risk ratio of the SYNTAX score for predicting 1-year ACM per unit was 1.04 (95% CI: 1.03-1.05). Calibration analysis indicated SYNTAX scores overestimated the risk of major adverse cardiac and cerebrovascular events in each risk stratum. The SYNTAX score demonstrated minimal discrimination in predicting 1- or 5-year adverse cardiovascular events after percutaneous coronary intervention in patients with CAD. The clinical SYNTAX score could further improve the predictive capability for ACM but not MACE.
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Affiliation(s)
- JiaYuan Chen
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China
| | - Buzhou Tang
- Intelligent Computing Research Center, Harbin Institute of Technology Shenzhen Graduate School, Shenzhen, China
| | - YongQing Lin
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China
| | - Ying Ru
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China
| | - MaoXiong Wu
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China
| | - Xiaolong Wang
- Intelligent Computing Research Center, Harbin Institute of Technology Shenzhen Graduate School, Shenzhen, China
| | - Qingcai Chen
- Intelligent Computing Research Center, Harbin Institute of Technology Shenzhen Graduate School, Shenzhen, China
| | - YangXin Chen
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China
| | - JingFeng Wang
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China
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28
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The age, creatinine, and ejection fraction score to risk stratify patients who underwent percutaneous coronary intervention of coronary chronic total occlusion. Am J Cardiol 2014; 114:1158-64. [PMID: 25152423 DOI: 10.1016/j.amjcard.2014.07.034] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 07/10/2014] [Accepted: 07/10/2014] [Indexed: 12/15/2022]
Abstract
Age, creatinine, and ejection fraction (ACEF) score predict clinical outcomes in patients who underwent elective percutaneous coronary intervention (PCI) of nonocclusive coronary stenoses. We aimed at assessing the prognostic value of the ACEF score in patients who underwent successful PCI of chronic total occlusion (CTO). ACEF score was calculated in 587 patients treated with PCI of CTO: successful in 433 (74%; success group) and failed in 154 patients (26%; failure group). Patients were divided in ACEF tertiles: first <0.950, second from 0.950 to 1.207, and third ACEF tertile >1.207. Major adverse cardiac events (MACE = overall death + nonfatal myocardial infarction + clinically driven target vessel revascularization) were assessed in 558 patients (95%) up to 24 months (8 to 24 months). In success group, higher MACE rate was significantly associated with increasing ACEF tertile (first = 7%, second = 13%, third ACEF = 18%, p = 0.02). MACE-free survival was significantly decreased with increasing ACEF tertile (log-rank 5.58, p = 0.018). In the failure group, lower MACE rate was significantly associated with increasing ACEF tertile (p = 0.041). This was mainly driven by significant decreasing rate of target vessel revascularization along the tertiles (first = 34%, second = 19%, third ACEF = 10%, p = 0.007). Compared with success group, in failure group, MACE rate was significantly higher in the first tertile (p <0.001) and similar in the third tertile (p = 0.59). In conclusion, ACEF score represents a simple tool in the prognostication of patients successfully treated with PCI of CTO and identifies those patients who would not derive any significant clinical harm despite failed percutaneous revascularization of the CTO.
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