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Wongthida T, Lumkul L, Patumanond J, Wongtheptian W, Piyayotai D, Phinyo P. Development of a Clinical Risk Score for Prediction of Life-Threatening Arrhythmia Events in Patients with ST Elevated Acute Coronary Syndrome after Primary Percutaneous Coronary Intervention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19041997. [PMID: 35206186 PMCID: PMC8872110 DOI: 10.3390/ijerph19041997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/03/2022] [Accepted: 02/08/2022] [Indexed: 12/10/2022]
Abstract
ST-elevated acute coronary syndrome (STEACS) is a serious condition requiring timely treatment. Reperfusion with primary percutaneous coronary intervention (pPCI) is recommended and preferred over fibrinolysis. Despite its efficacy, lethal complications, such as life-threatening arrhythmia (LTA), are common in post-PCI patients. Although various risk assessment tools were developed, only a few focus on LTA prediction. This study aimed to develop a risk score to predict LTA events after pPCI. A risk score was developed using a retrospective cohort of consecutive patients with STEACS who underwent pPCI at Chiangrai Prachanukroh Hospital from January 2012 to December 2016. LTA is defined as the occurrence of malignant arrhythmia that requires advanced cardiovascular life support (ACLS) within 72 h after pPCI. Logistic regression was used for model derivation. Among 273 patients, 43 (15.8%) developed LTA events. Seven independent predictors were identified: female sex, hemoglobin < 12 gm/dL, pre- and intra-procedural events (i.e., respiratory failure and pulseless arrest), IABP insertion, intervention duration > 60 min, and desaturation after pPCI. The LTA score showed an AuROC of 0.93 (95%CI 0.90, 0.97). The score was categorized into three risk categories: low (<2.5), moderate (2.5–4), and high risk (>4) for LTA events. The LTA score demonstrated high predictive performance and potential clinical utility for predicting LTA events after pPCI.
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Affiliation(s)
- Thanutorn Wongthida
- Office of Research and Knowledge Management, Chiang Rai Hospital, Chiang Rai 57000, Thailand;
| | - Lalita Lumkul
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (L.L.); (J.P.)
- Center of Multidisciplinary Technology for Advanced Medicine (CMUTEAM), Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Jayanton Patumanond
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (L.L.); (J.P.)
| | - Wattana Wongtheptian
- Cardiology Unit, Department of Medicine, Chiang Rai Hospital, Chiang Rai 57000, Thailand;
| | - Dilok Piyayotai
- Cardiology Unit, Department of Medicine, Faculty of Medicine, Thammasat University, Pathum Thani 10120, Thailand;
| | - Phichayut Phinyo
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (L.L.); (J.P.)
- Department of Family Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Musculoskeletal Science and Translational Research (MSTR), Chiang Mai University, Chiang Mai 50200, Thailand
- Correspondence:
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2
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Gonzalez-Juanatey JR, Lemesle G, Puymirat E, Ducrocq G, Cachanado M, Arnaiz JA, Martínez-Sellés M, Silvain J, Ariza-Solé A, Ferrari E, Calvo G, Danchin N, Avendano-Solá C, Rousseau A, Vicaut E, Gonzalez-Ferrero T, Steg PG, Simon T. One-Year Major Cardiovascular Events After Restrictive Versus Liberal Blood Transfusion Strategy in Patients With Acute Myocardial Infarction and Anemia: The REALITY Randomized Trial. Circulation 2022; 145:486-488. [PMID: 35130052 DOI: 10.1161/circulationaha.121.057909] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jose R Gonzalez-Juanatey
- Cardiology Department, University Hospital, Health Research Institute of Santiago de Compostela, Centro de Investigación en Red de Enfermedades Cardiovasculares, University of Santiago de Compostela, Spain (J.R.G.-J., T.G.-F.)
| | - Gilles Lemesle
- Institut Cœur Poumon, Centre Hospitalier Universitaire de Lille, Faculté de Médecine de Lille, Université de Lille, French Alliance for Cardiovascular Trials, Institut Pasteur de Lille, Institut national de la santé et de la recherche médicale (INSERM) U1011 (G.L.).,French Alliance for Cardiovascular Trials, Paris (G.L.)
| | - Etienne Puymirat
- Université de Paris, AP-HP, Hôpital Européen Georges Pompidou, French Alliance for Cardiovascular Trials (E.P., N.D.)
| | - Gregory Ducrocq
- Université de Paris, AP-HP, French Alliance for Cardiovascular Trials, INSERM U1148 (G.D., P.G.S.)
| | - Marine Cachanado
- Department of Clinical Pharmacology and Clinical Research Platform of the East of Paris (Unite de Recherche Clinique de l'est parisien-Centre de Recherche Clinique-Centre de ressource biologique), AP-HP, Hôpital St Antoine, Sorbonne-Université, France (M.C., A.R.)
| | - Joan Albert Arnaiz
- Clinical Trials Unit, Clinical Pharmacology Department, Hospital Clinic, Barcelona, Spain (J.A.A.)
| | - Manuel Martínez-Sellés
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), INSERM Unité mixte de recherche 1166, Paris, France (J.S.)
| | - Johanne Silvain
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), INSERM Unité mixte de recherche 1166, Paris, France (J.S.)
| | - Albert Ariza-Solé
- University Hospital Bellvitge, Heart Disease Institute, Barcelona, Spain (A.A.-S.)
| | - Emile Ferrari
- Université Côte d'Azur, and CHU de Nice, Hôpital Pasteur 1, Service de Cardiologie, French Alliance for Cardiovascular Trials (E.F.)
| | - Gonzalo Calvo
- Àrea del Medicament, Hospital Clínic of Barcelona, University of Barcelona, Spain (G.C.)
| | - Nicolas Danchin
- Université de Paris, AP-HP, Hôpital Européen Georges Pompidou, French Alliance for Cardiovascular Trials (E.P., N.D.)
| | - Cristina Avendano-Solá
- Clinical Pharmacology Service, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain (C.A.-S.)
| | - Alexandra Rousseau
- Department of Clinical Pharmacology and Clinical Research Platform of the East of Paris (Unite de Recherche Clinique de l'est parisien-Centre de Recherche Clinique-Centre de ressource biologique), AP-HP, Hôpital St Antoine, Sorbonne-Université, France (M.C., A.R.)
| | - Eric Vicaut
- AP-HP, Department of Biostatistics, Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital, France (E.V.)
| | - Teba Gonzalez-Ferrero
- Cardiology Department, University Hospital, Health Research Institute of Santiago de Compostela, Centro de Investigación en Red de Enfermedades Cardiovasculares, University of Santiago de Compostela, Spain (J.R.G.-J., T.G.-F.)
| | - Philippe Gabriel Steg
- Université de Paris, AP-HP, French Alliance for Cardiovascular Trials, INSERM U1148 (G.D., P.G.S.).,Imperial College, Royal Brompton Hospital, London, United Kingdom (P.G.S.)
| | - Tabassome Simon
- Department of Clinical Pharmacology-Clinical Research Platform (Unite de Recherche Clinique de l'est parisien-Centre de ressource biologique-Centre de Recherche Clinique), AP-HP.SU, Hôpital Saint Antoine, French Alliance for Cardiovascular Trials, Sorbonne-Université, Paris (T.S.)
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3
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Amami K, Yamada S, Yoshihisa A, Kaneshiro T, Hijioka N, Nodera M, Nehashi T, Takeishi Y. Predictive impacts of chronic kidney disease and cardiac sympathetic nervous activity on lethal arrhythmic events in chronic heart failure. Ann Noninvasive Electrocardiol 2021; 27:e12900. [PMID: 34676627 PMCID: PMC8739613 DOI: 10.1111/anec.12900] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 09/30/2021] [Indexed: 12/18/2022] Open
Abstract
Background The clinical implications of chronic kidney disease (CKD) and cardiac sympathetic nervous activity (CSNA) regarding lethal arrhythmic events have not yet been fully elucidated in patients with chronic heart failure (CHF). We hypothesized that the combination of CKD and abnormal CSNA, assessed by 123I‐metaiodobenzylguanidine (123I‐MIBG) scintigraphy, may provide useful prognostic information for lethal arrhythmic events. Methods We studied 165 consecutive hospitalized CHF patients without dialysis. Cardiac 123I‐MIBG scintigraphy was performed in a clinically stable condition, and abnormal CSNA was defined as a late heart‐to‐mediastinum ratio of <1.6. CKD was defined as an estimated glomerular filtration rate of <60 ml/min/1.73 m2. We then investigated the incidence of lethal arrhythmic events (sustained ventricular tachyarrhythmia, appropriate implantable cardioverter‐defibrillator therapy, or sudden cardiac death). Results During a median follow‐up of 5.3 years, lethal arrhythmic events were observed in 40 patients (24.2%). The patients were divided into four groups according to the presence of CKD and CSNA abnormality: non‐CKD/normal CSNA (n = 52), CKD/normal CSNA (n = 39), non‐CKD/abnormal CSNA (n = 33), and CKD/abnormal CSNA (n = 41). Kaplan–Meier analysis showed that CKD/abnormal CSNA had the highest event rate (log‐rank p = .004). Additionally, the Cox proportional hazard analysis revealed that CKD/abnormal CSNA was a predictor for lethal arrhythmic events compared with non‐CKD/normal CSNA (hazard ratio, 5.368, p = .001). However, the other two groups did not show significant differences compared with the non‐CKD/normal CSNA group. Conclusions The combination of CKD and abnormal CSNA, assessed by 123I‐MIBG scintigraphy, had a high predictive value for lethal arrhythmic events in patients with CHF.
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Affiliation(s)
- Kazuaki Amami
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Shinya Yamada
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Akiomi Yoshihisa
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Takashi Kaneshiro
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan.,Department of Arrhythmia and Cardiac Pacing, Fukushima Medical University, Fukushima, Japan
| | - Naoko Hijioka
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Minoru Nodera
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Takeshi Nehashi
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yasuchika Takeishi
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
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Weidner K, von Zworowsky M, Schupp T, Hoppner J, Kittel M, Rusnak J, Kim SH, Abumayyaleh M, Borggrefe M, Barth C, Ellguth D, Taton G, Reiser L, Bollow A, Meininghaus DG, Bertsch T, El-Battrawy I, Akin I, Behnes M. Effect of Anemia on the Prognosis of Patients with Ventricular Tachyarrhythmias. Am J Cardiol 2021; 154:54-62. [PMID: 34247729 DOI: 10.1016/j.amjcard.2021.05.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/25/2021] [Accepted: 05/26/2021] [Indexed: 12/01/2022]
Abstract
This study evaluates the prognostic impact of anemia in patients presenting with ventricular tachyarrhythmias. The present longitudinal, observational, registry-based, monocentric cohort study included retrospectively all consecutive patients presenting with ventricular tachyarrhythmias on admission from 2002 to 2016. Anemic patients (hemoglobin levels <12.0 g/dl) were compared with non-anemic patients (hemoglobin levels ≥12.0 g/dl). The primary endpoint was all-cause mortality at 2.5 years. Secondary endpoints were cardiac death at 24 hours, all-cause mortality at index hospitalization, and the composite endpoint of cardiac death at 24 hours, recurrent ventricular tachyarrhythmias, and appropriate ICD therapies at 2.5 years. A total of 2,184 consecutive patients were included, of whom 30% were anemic and 70% non-anemic. Anemia was associated with the primary endpoint of all-cause mortality at 2.5 years (65% vs 29%, p = 0.001; HR = 2.441; 95% CI 2.086 to 2.856), cardiac death at 24 hours (26% vs 11%, p = 0.001), all-cause mortality at index hospitalization (45% vs 20%, p = 0.001), and the composite endpoint (35% vs 27%, p = 0.001; HR = 2.923; 95% CI 2.564 to 4.366). After multivariable adjustment, anemia was no longer associated with the composite endpoint. Predictors of adverse prognosis for anemics were CKD (HR = 2.191), LVEF <35% (HR = 1.651), cardiogenic shock (HR = 1.591), CPR (HR = 1.460), male gender (HR = 1.379), and age (HR = 1.017). In conclusion, anemic patients presenting with ventricular tachyarrhythmias were associated with increased long-term mortality at 2.5 years but not with the composite arrhythmic endpoint at 2.5 years. Predictors of adverse prognosis at 2.5 years were CKD, LVEF <35%, cardiogenic shock, CPR, male gender, and age.
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Affiliation(s)
- Kathrin Weidner
- First Department of Medicine, Faculty of Medicine Mannheim, University of Heidelberg, Germany
| | - Max von Zworowsky
- First Department of Medicine, Faculty of Medicine Mannheim, University of Heidelberg, Germany
| | - Tobias Schupp
- First Department of Medicine, Faculty of Medicine Mannheim, University of Heidelberg, Germany
| | - Jorge Hoppner
- Clinic for Diagnostic and Interventional Radiology Heidelberg, University Heidelberg, Germany
| | - Maximilian Kittel
- Institute of Clinical Chemistry and Laboratory Medicine, Faculty of Medicine Mannheim, University of Heidelberg, Germany
| | - Jonas Rusnak
- First Department of Medicine, Faculty of Medicine Mannheim, University of Heidelberg, Germany
| | - Seung-Hyun Kim
- First Department of Medicine, Faculty of Medicine Mannheim, University of Heidelberg, Germany
| | - Mohammad Abumayyaleh
- First Department of Medicine, Faculty of Medicine Mannheim, University of Heidelberg, Germany
| | - Martin Borggrefe
- First Department of Medicine, Faculty of Medicine Mannheim, University of Heidelberg, Germany
| | - Christian Barth
- First Department of Medicine, Faculty of Medicine Mannheim, University of Heidelberg, Germany
| | - Dominik Ellguth
- First Department of Medicine, Faculty of Medicine Mannheim, University of Heidelberg, Germany
| | - Gabriel Taton
- First Department of Medicine, Faculty of Medicine Mannheim, University of Heidelberg, Germany
| | - Linda Reiser
- First Department of Medicine, Faculty of Medicine Mannheim, University of Heidelberg, Germany
| | - Armin Bollow
- First Department of Medicine, Faculty of Medicine Mannheim, University of Heidelberg, Germany
| | | | - Thomas Bertsch
- Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany
| | - Ibrahim El-Battrawy
- First Department of Medicine, Faculty of Medicine Mannheim, University of Heidelberg, Germany
| | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine Mannheim, University of Heidelberg, Germany
| | - Michael Behnes
- First Department of Medicine, Faculty of Medicine Mannheim, University of Heidelberg, Germany.
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