The association of concomitant serum potassium and glucose levels and in-hospital mortality in patients with acute myocardial infarction (AMI). Soroka acute myocardial infarction II (SAMI-II) project

Risk prediction model for major adverse cardiovascular events (MACE) during hospitalization in patients with coronary heart disease based on myocardial energy metabolic substrate

Background

The early attack of coronary heart disease (CHD) is very hidden, and clinical symptoms generally do not appear until cardiovascular events occur. Therefore, an innovative method is needed to judge the risk of cardiovascular events and guide clinical decision conveniently and sensitively. The purpose of this study is to find out the risk factors related to MACE during hospitalization. In order to develop and verify the prediction model of energy metabolism substrates, and establish a nomogram to predict the incidence of MACE during hospitalization and evaluate their performance.

Methods

The data were collected from the medical record data of Guang'anmen Hospital. This review study was collected the comprehensive clinical data of 5,935 adult patients hospitalized in the cardiovascular department from 2016 to 2021. The outcome index was the MACE during hospitalization. According to the occurrence of MACE during hospitalization, these data were divided into MACE group (n = 2,603) and non-MACE group (n = 425). Logistic regression was used to screen risk factors, and establish the nomogram to predict the risk of MACE during hospitalization. Calibration curve, C index and decision curve were used to evaluate the prediction model, and drawn ROC curve to find the best boundary value of risk factors.

Results

The logistic regression model was used to establish a risk model. Univariate logistic regression model was mainly used to screen the factors significantly related to MACE during hospitalization in the training set (each variable is put into the model in turn). According to the factors with statistical significance in univariate logistic regression, five cardiac energy metabolism risk factors, including age, albumin(ALB), free fatty acid(FFA), glucose(GLU) and apolipoprotein A1(ApoA1), were finally input into the multivariate logistic regression model as the risk model, and their nomogram were drawn. The sample size of the training set was 2,120, the sample size of the validation set was 908. The C index of the training set is 0.655 [0.621,0.689], and the C index of the validation set was 0.674 [0.623,0.724]. The calibration curve and clinical decision curve show that the model performs well. The ROC curve was used to establish the best boundary value of the five risk factors, which could quantitatively present the changes of cardiac energy metabolism substrate, and finally achieved prediction of MACE during hospitalization conveniently and sensitively.

Conclusion

Age, albumin, free fatty acid, glucose and apolipoprotein A1 are independent factors of CHD in MACE during hospitalization. The nomogram based on the above factors of myocardial energy metabolism substrate provides prognosis prediction accurately.

The association between serum glucose to potassium ratio on admission and short-term mortality in ischemic stroke patients

High serum glucose to potassium ratio (GPR) at admission is implicated for a poor outcome in acute brain injury, acute intracranial hemorrhage, and aneurysmal subarachnoid hemorrhage. However, the relationship between GPR and the outcome of ischemic stroke (IS) remains unknown. In all, 784 IS patients from a large emergency Norwegian cohort were included for secondary analysis. The exposure and outcome were GPR at baseline and all-cause mortality within 30 days after the first admission. Multivariable logistic regression analysis was performed to estimate the risk of 30-day mortality based on GPR levels. In addition, we examined whether there was a nonlinear relationship between admission GPR and 30-day mortality using two-piecewise linear regression with a smoothing function and threshold level analysis. The results of multivariable regression analysis showed that GPR at baseline was positively associated with the 30-day mortality (OR 2.01, 95% CI 1.12, 3.61) after adjusting for potential confounders (age, gender, department, serum sodium, serum albumin, serum-magnesium, hypertension, heart failure, chronic renal failure, and pneumonia). When GPR was translated to a categorical variable, the ORs and 95% CIs in the tertiles 2 to 3 versus the tertile 1 were 1.24 (0.60, 2.56) and 2.15 (1.09, 4.24), respectively (P for trend = 0.0188). Moreover, the results of the two-piecewise linear regression and curve fitting revealed a linear relationship between GPR and 30-day mortality. In IS patients, GPR is positively correlated with 30-day mortality, and the relationship between them is linear. The GPR at admission may be a promising predictor for the short-term outcome in IS patients.

Serum Albumin and Bleeding Events After Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction (from the HAGAKURE-ACS Registry)

Low serum albumin (SA) on admission in patients with acute myocardial infarction (AMI) has been reported to be associated with adverse cardiovascular events. The relation between low SA and post-AMI bleeding events is presently unknown. We analyzed 1,724 patients with AMI enrolled in the HAGAKURE-ACS registry who underwent primary percutaneous coronary intervention from January 2014 to December 2018. To assess the influence of low SA at admission, patients were divided into 3 groups according to the albumin tertiles: the low SA group (<3.8 g/100 ml), the middle SA (MSA) group (3.8 to 4.1 g/100 ml), and the normal SA (NSA) group (≥4.2 g/100 ml). The primary end point was the incidence of Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries moderate/severe bleeding. The cumulative 3-year incidence of the primary end point was significantly higher in the low SA group than in the MSA and NSA groups (30.8% and 11.9% vs 7.7%; p <0.001). In the landmark analysis at 30 days, the cumulative incidences of the primary end point were also significantly higher in the low SA group than in the MSA and NSA groups, both within and beyond 30 days (20.1% and 6.1% vs 3.5%; p <0.001, and 12.4% and 6.2% vs 4.5%; p <0.001, respectively). After adjusting for confounders, the low SA group showed excess risk of bleeding events relative to NSA (hazard ratio 1.56; 95% confidence interval 1.06 to 2.30; p = 0.026), whereas risk of bleeding was neutral in MSA relative to NSA (hazard ratio 0.94; 95% confidence interval 0.63 to 1.34; p = 0.752). In conclusion, low SA at admission was independently associated with higher risk for bleeding events in patients with AMI undergoing percutaneous coronary intervention.