Increase in white blood cell count is associated with the development of atrial fibrillation after an acute coronary syndrome

Prediction Model of New Onset Atrial Fibrillation in Patients with Acute Coronary Syndrome

OBJECTIVE

Atrial fibrillation (AF) is one of the most common complications of acute coronary syndrome (ACS) patients. Possible risk factors related to new-onset AF (NOAF) in ACS patients have been reported in some studies, and several prediction models have been established. However, the predictive power of these models was modest and lacked independent validation. The aim of this study is to define risk factors of NOAF in patients with ACS during hospitalization and to develop a prediction model and nomogram for individual risk prediction.

METHODS

Retrospective cohort studies were conducted. A total of 1535 eligible ACS patients from one hospital were recruited for model development. External validation was performed using an external cohort of 1635 ACS patients from another hospital. The prediction model was created using multivariable logistic regression and validated in an external cohort. The discrimination, calibration, and clinical utility of the model were evaluated, and a nomogram was constructed. A subgroup analysis was performed for unstable angina (UA) patients.

RESULTS

During hospitalization, the incidence of NOAF was 8.21% and 6.12% in the training and validation cohorts, respectively. Age, admission heart rate, left atrial diameter, right atrial diameter, heart failure, brain natriuretic peptide (BNP) level, less statin use, and no percutaneous coronary intervention (PCI) were independent predictors of NOAF. The AUC was 0.891 (95% CI: 0.863-0.920) and 0.839 (95% CI: 0.796-0.883) for the training and validation cohort, respectively, and the model passed the calibration test (P > 0.05). The clinical utility evaluation shows that the model has a clinical net benefit within a certain range of the threshold probability.

CONCLUSION

A model with strong predictive power was constructed for predicting the risk of NOAF in patients with ACS during hospitalization. It might help with the identification of ACS patients at risk and early intervention of NOAF during hospitalization.

Assessment of Systemic Immune-inflammation Index Levels in Patients with Retinal Vein Occlusion

PURPOSE

To assess the predictive value of inflammatory markers calculated from complete blood counts in patients with retinal vein occlusion (RVO).

METHODS

This was a retrospective cross-sectional study with a total of 56 RVO patients and 56 age- and gender-matched controls involved. All subjects went through a routine ocular examination, and the peripheral venous blood samples were collected to analyze the differences in inflammatory markers between groups.

RESULTS

The systemic immune-inflammation index (SII) and neutrophil-to-lymphocyte ratio (NLR) values were significantly higher in RVO patients than those in the controls (p=0.002, p=0.004, respectively). According to the receiver operating characteristic (ROC) curve analysis, the areas under the curve (AUC) of SII was 0.666. The AUC of NLR was 0.657.

CONCLUSION

As a novel inflammatory indicator, SII is a more promising indicator than NLR and PLR in the prediction of RVO development.

The Age-Specific Impact of Cellular Immunity on Long-Term Outcome after Acute Coronary Syndrome

BACKGROUND

 Personalized risk stratification after acute coronary syndrome (ACS) remains a challenging field in the aging society. Easily applicable strategies for risk prediction of adverse events from an age-specific perspective are needed. Considering the association of cellular immunity with coronary vessel disease, these cell lines mirror a reasonable value for risk assessment. Therefore, we aimed to elucidate the prognostic value of cellular immunity on long-term outcome after ACS from an age-specific perspective.

METHODS

 Patients presenting with ACS at the Vienna General Hospital admitted between December 1996 and January 2010 were enrolled within a clinical registry including standardized assessment of peripheral blood samples and immune phenotyping. Cox-regression hazards analysis was performed to elucidate the impact of cellular immunity on survival.

RESULTS

 A total of 832 patients were included within the final analysis and stratified according to age into individuals <65 years (n = 416) and ≥65 years (n = 416). After a median follow-up time of 8.6 years, a total of 516 (62.0%) individuals died. We found that the fraction of lymphocytes (adjusted hazard ratio [HR] of 0.61 [95% confidence interval, CI: 0.45-0.82]; p = 0.001), the fraction of neutrophil granulocytes (adjusted HR of 5.01 [95% CI: 1.62-15.46]; p = 0.005), and the neutrophil-to-lymphocyte ratio (NLR; adjusted HR of 1.47 [95% CI: 1.16-1.87]; p = 0.002) showed a strong and independent association with mortality in individuals ≥65 years. Notably, there was no effect on outcome observed for any of the tested cell lines in patients <65 years.

CONCLUSION

 The present investigation highlighted a strong and independent age-specific effect of both the fraction of neutrophil granulocytes and lymphocytes as well as the NLR on outcome. Considering an age-dependent risk stratification, these routinely available values can be easily used to identify patients at risk for fatal events and contribute to proper secondary prevention after ACS.