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Matter MA, Candreva A, Stähli BE, Heg D, Klingenberg R, Räber L, Windecker S, Rodondi N, Nanchen D, Mach F, Gencer B, Ruschitzka F, Matter CM, Templin C. Higher 1-year mortality on rest days in patients with acute coronary syndromes and decompensated heart failure-A SPUM-ACS sub-study. Catheter Cardiovasc Interv 2024; 103:286-294. [PMID: 38145467 DOI: 10.1002/ccd.30938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/11/2023] [Accepted: 12/10/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Acute coronary syndromes (ACS) occurring on rest days have been associated with higher mortality, but the current literature remains inconsistent in this regard. This study included ACS patients presenting with acute decompensated heart failure (ADHF) investigating the relationship between time of coronary catheterization and outcomes. METHODS Analyses were performed from the prospective, multicentric Special Program University Medicine Acute Coronary Syndromes and Inflammation (SPUM-ACS) Cohort. Patients were divided into two groups according to time of coronary catheterization on either workdays (Monday, 00:00 to Friday, 23:59) or rest days (Saturday, 00:00 to Sunday, 23:59 and public holidays). ADHF was defined by Killip Class III or IV upon presentation. Patients were followed over 1 year. RESULTS Out of 4787 ACS patients enrolled in the SPUM-ACS Cohort, 207 (4.3%) presented with ADHF. 52 (25.1%) and 155 (74.9%) patients underwent coronary angiography on rest days or workdays, respectively. Baseline characteristics were similar among these groups. ACS patients with ADHF showed increased 1-year mortality on rest days (34.6% vs. 17.4%, p-value = 0.009). After correction for baseline characteristics, including the GRACE 2.0 Score, rest day presentation remained a significant predictor for 1-year mortality (adjusted hazard ratio = 2.42 [95% confidence interval: 1.14-5.17], p-value = 0.022). CONCLUSIONS One-year all-cause mortality was high in ACS patients with ADHF and doubled for patients admitted on rest days. The present data support the association of a rest day effect and long-term patient survival and indicate a need for further investigations.
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Affiliation(s)
- Michael A Matter
- Department of Cardiology, Zurich and Center for Translational and Experimental Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Alessandro Candreva
- Department of Cardiology, Zurich and Center for Translational and Experimental Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Barbara E Stähli
- Department of Cardiology, Zurich and Center for Translational and Experimental Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Dik Heg
- Clinical Trial Unit, University of Bern, Bern, Switzerland
| | | | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - David Nanchen
- Centre for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - François Mach
- Department of Cardiology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Baris Gencer
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of Cardiology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Frank Ruschitzka
- Department of Cardiology, Zurich and Center for Translational and Experimental Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christian M Matter
- Department of Cardiology, Zurich and Center for Translational and Experimental Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christian Templin
- Department of Cardiology, Zurich and Center for Translational and Experimental Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Liu M, Pan J, Meng K, Wang Y, Sun X, Ma L, Yu X. Triglyceride-glucose body mass index predicts prognosis in patients with ST-elevation myocardial infarction. Sci Rep 2024; 14:976. [PMID: 38200157 PMCID: PMC10782013 DOI: 10.1038/s41598-023-51136-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/31/2023] [Indexed: 01/12/2024] Open
Abstract
Triglyceride glycemic-body mass index (TyG-BMI) is a simple and reliable surrogate for insulin resistance (IR). However, it is still unclear if TyG-BMI has any predictive value in patients having percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). The purpose of this study was to examine the TyG-BMI index's prognostic significance and predictive power in patients with STEMI. The study comprised a total of 2648 consecutive STEMI patients who underwent PCI. The primary endpoint was the occurrence of major adverse cardiovascular events (MACE), defined as the combination of all-cause death, nonfatal myocardial infarction, nonfatal stroke, and coronary revascularization. The TyG-BMI index was formulated as ln [fasting triglycerides (mg/dL) × fasting plasma glucose (mg/dL)/2] × BMI. 193 patients in all experienced MACE over a median follow-up of 14.7 months. There was a statistically significant difference between the Kaplan-Meier survival curves for the TyG-BMI index tertiles (log-rank test, p = 0.019) for the cumulative incidence of MACE. The adjusted HRs for the incidence of MACE in the middle and highest quartiles of the TyG-BMI index compared with the lowest quartile were 1.37 (95% CI 0.92, 2.03) and 1.53 (95% CI 1.02, 2.29), respectively, in the fully adjusted Cox regression model. At six months, one year, and three years, the TyG-BMI area under the curve (AUC) for predicting MACE was 0.691, 0.666, and 0.637, respectively. Additionally, adding the TyG-BMI index to the risk prediction model enhanced outcome prediction. In STEMI patients undergoing PCI, TyG-BMI was independently linked to MACE. TyG-BMI could be a simple and solid way to assess MACE risk and prognosis.
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Affiliation(s)
- Ming Liu
- Department of Cardiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China
- Department of Cardiology, Anhui Provincial Hospital Affiliated of Anhui Medical University, Hefei, 230001, Anhui, China
| | - Jianyuan Pan
- Department of Cardiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Ke Meng
- Department of Cardiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Yuwei Wang
- Department of Cardiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Xueqing Sun
- The Second Hospital of Jilin University, Changchun, 130000, Jilin, China
| | - Likun Ma
- Department of Cardiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China.
| | - Xiaofan Yu
- Department of Cardiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China.
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Rafiqi K, Hoeks CB, Løfgren B, Mortensen MB, Bruun JM. Diagnostic Impact of Hs-CRP and IL-6 for Acute Coronary Syndrome in Patients Admitted to the ED with Chest Pain: Added Value to the HEART Score? Open Access Emerg Med 2023; 15:333-342. [PMID: 37753377 PMCID: PMC10519209 DOI: 10.2147/oaem.s425319] [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: 07/04/2023] [Accepted: 09/18/2023] [Indexed: 09/28/2023] Open
Abstract
Objective To investigate whether hs-CRP and IL-6 provide additional diagnostic value beyond that achieved by the HEART score in patients with chest pain suggestive of acute coronary syndrome (ACS) admitted to the emergency department (ED). Methods This was a post hoc analysis using data from the RACING-MI study. Baseline data, including hs-CRP and IL-6 levels, were analyzed using the plasma from the biobank. A total of 818 patients with chest pain suggestive of ACS were included in this analysis. Of these, 98 were diagnosed with ACS (12%). Logistic regression was used to identify the independent predictors of ACS development in patients with chest pain. Results hs-CRP levels >2 mg/L were observed in 50% of all ACS cases. IL-6 levels >1.3 pg/mL were observed in 71% of all ACS cases. hs-CRP had a sensitivity of 50% and specificity of 51% for the diagnosis of ACS, whereas IL-6 had a sensitivity of 71% and specificity of 29%. The diagnostic likelihood ratios for ACS was 1.0 for hs-CRP>2 mg/L and IL-6 > 1.3 pg/mL, respectively. Logistic regression analysis revealed that age, male gender, and ongoing smoking were associated with ACS in patients with acute chest pain. No association was found between IL-6 or hs-CRP level and ACS. This was observed for both IL-6 and hs-CRP, whether assessed on a continuous scale or using prespecified cut-off values. Conclusion Among the 818 patients admitted to the ED with chest pain suggestive of ACS, neither hs-CRP nor IL-6 provided an independent added diagnostic value. Our results suggest that inflammatory markers have limited diagnostic value in detecting patients with ACS in the ED.
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Affiliation(s)
- Khalil Rafiqi
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Emergency Department, Aarhus University Hospital, Aarhus, Denmark
| | - Camilla Bang Hoeks
- Department of Internal Medicine, Randers Regional Hospital, Randers, Denmark
| | - Bo Løfgren
- Department of Internal Medicine, Randers Regional Hospital, Randers, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Martin Bødtker Mortensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Ciccarone Center for Prevention of Heart Disease, Johns Hopkins, Baltimore, MD, USA
| | - Jens M Bruun
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Wereski R, Adamson P, Shek Daud NS, McDermott M, Taggart C, Bularga A, Kimenai DM, Lowry MTH, Tuck C, Anand A, Lowe DJ, Chapman AR, Mills NL. High-Sensitivity Cardiac Troponin for Risk Assessment in Patients With Chronic Coronary Artery Disease. J Am Coll Cardiol 2023; 82:473-485. [PMID: 37532417 DOI: 10.1016/j.jacc.2023.05.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Cardiac troponin is used for risk stratification of patients with acute coronary syndromes; however, the role of testing in other settings remains unclear. OBJECTIVES The aim of this study was to evaluate whether cardiac troponin testing could enhance risk stratification in patients with chronic coronary artery disease independent of disease severity and conventional risk measures. METHODS In a prospective cohort of consecutive patients with symptoms suggestive of stable angina attending for outpatient coronary angiography, high-sensitivity cardiac troponin I was measured before angiography, and clinicians were blinded to the results. The primary outcome was myocardial infarction or cardiovascular death during follow-up. RESULTS In 4,240 patients (age 66 years [IQR: 59-73 years], 33% female), coronary artery disease was identified in 3,888 (92%) who had 255 (6%) primary outcome events during a median follow-up of 2.4 years (IQR: 1.3-3.6 years). In patients with coronary artery disease, troponin concentrations were 2-fold higher in those with an event compared with those without (6.7 ng/L [IQR: 3.2-14.2 ng/L] vs 3.3 ng/L [IQR: 1.7-6.6 ng/L]; P < 0.001). Troponin concentrations were associated with the primary outcome after adjusting for cardiovascular risk factors and coronary artery disease severity (adjusted HR: 2.3; 95% CI: 1.7-3.0, log10 troponin; P < 0.001). A troponin concentration >10 ng/L identified patients with a 50% increase in the risk of myocardial infarction or cardiovascular death. CONCLUSIONS In patients with chronic coronary artery disease, cardiac troponin predicts risk of myocardial infarction or cardiovascular death independent of cardiovascular risk factors and disease severity. Further studies are required to evaluate whether routine testing could inform the selection of high-risk patients for treatment intensification. (Myocardial Injury in Patients Referred for Coronary Angiography [MICA]; ISRCTN15620297).
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Affiliation(s)
- Ryan Wereski
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom. https://twitter.com/RyanWereski
| | - Philip Adamson
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Nur Shazlin Shek Daud
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Michael McDermott
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Caelan Taggart
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Anda Bularga
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Dorien M Kimenai
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Mathew T H Lowry
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Chris Tuck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Atul Anand
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - David J Lowe
- University of Glasgow, School of Medicine, Glasgow, United Kingdom
| | - Andrew R Chapman
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom. https://twitter.com/chapdoc1
| | - Nicholas L Mills
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Usher Institute, University of Edinburgh, Edinburgh, United Kingdom.
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Denegri A, Magnani G, Kraler S, Bruno F, Klingenberg R, Mach F, Gencer B, Räber L, Rodondi N, Rossi VA, Matter CM, Nanchen D, Obeid S, Lüscher TF. History of peripheral artery disease and cardiovascular risk of real-world patients with acute coronary syndrome: Role of inflammation and comorbidities. Int J Cardiol 2023; 382:76-82. [PMID: 36958395 DOI: 10.1016/j.ijcard.2023.03.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/23/2023] [Accepted: 03/20/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Patients with acute coronary syndromes (ACS) remain at risk of cardiovascular disease (CVD) recurrences. Peripheral artery disease (PAD) may identify a very high risk (VHR) group who may derive greater benefit from intensified secondary prevention. METHODS Among ACS-patients enrolled in the prospective multi-center Special Program University Medicine (SPUM), we assessed the impact of PAD on major cardiovascular events (MACE: composite of myocardial infarction, stroke and all-cause death) and major bleeding. Multivariate analysis tested the relation of each significant variable with MACE, as well as biomarkers of inflammation and novel markers of atherogenesis. RESULTS Out of 4787 ACS patients, 6.0% (n = 285) had PAD. PAD-patients were older (p < 0.001), with established CVD and signs of increased persistent inflammation (hs-CRP; 23.6 ± 46.5 vs 10.4 ± 27.2 mg/l, p < 0.001 and sFlt-1; 1399.5 ± 1501.3 vs 1047.2 ± 1378.6 ng/l, p = 0.018). In-hospital-death (3.2% vs 1.4%, p = 0.022) and -MACE (5.6% vs 3.0%, p = 0.017) were higher in PAD-patients. MACE at 1 year (18.6% vs 7.9%,p < 0.001) remained increased even after adjustment for confounders (Adj. HR 1.53, 95% CI: 1.14-2.08, p = 0.005). Major bleeding did not differ between groups (Adj. HR 1.18; 95% CI 0.71-1.97, p = 0.512). Although PAD predicted MACE, PAD-patients were prescribed less frequently for secondary prevention at discharge. CONCLUSIONS In this real-world ACS patient cohort, concomitant PAD is a marker of VHR and is associated with increased and persistent inflammation, higher risk for MACE without an increased risk of major bleeding. Therefore, a history of PAD may be useful to identify those ACS patients at VHR who require more aggressive secondary prevention.
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Affiliation(s)
- Andrea Denegri
- Department of Cardiology, Parma University Hospital, Parma, Italy
| | - Giulia Magnani
- Department of Cardiology, Parma University Hospital, Parma, Italy
| | - Simon Kraler
- Center for Molecular Cardiology, University of Zurich, Switzerland
| | - Francesco Bruno
- Royal Brompton and Harefield Hospitals, Imperial College and Kings College, London, United Kingdom; Division of Cardiology, "Città della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences, University of Turin, Turin 10126, Italy
| | - Roland Klingenberg
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Kerckhoff-Klinik, Campus of the Justus Liebig University of Giessen, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhine-Main, Bad Nauheim, Germany
| | - Francois Mach
- Department of Cardiology, University Hospital Geneva, Switzerland
| | - Baris Gencer
- Department of Cardiology, University Hospital Geneva, Switzerland; Institute of Primary Health Care (BIHAM), University of Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, University Hospital, Bern, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Switzerland; Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | - David Nanchen
- Center for Primary Care and Public Health, University of Lausanne, Switzerland
| | - Slayman Obeid
- Division of Cardiology, Cantonal Hospital, Aarau, Switzerland
| | - Thomas F Lüscher
- Center for Molecular Cardiology, University of Zurich, Switzerland; Royal Brompton and Harefield Hospitals, Imperial College and Kings College, London, United Kingdom.
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Karpova NS, Dmitrenko OP, Budykina TS. Literature Review: The sFlt1/PlGF Ratio and Pregestational Maternal Comorbidities: New Risk Factors to Predict Pre-Eclampsia. Int J Mol Sci 2023; 24:ijms24076744. [PMID: 37047717 PMCID: PMC10095124 DOI: 10.3390/ijms24076744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/13/2023] [Accepted: 03/24/2023] [Indexed: 04/08/2023] Open
Abstract
One of the main causes of maternal and neonatal morbidity and mortality is pre-eclampsia. It is characterized by a high sFlt1/PlGF ratio, according to prior research. Pregestational diseases in mothers may increase the risk of developing pre-eclampsia. Only a few studies have looked at the connection between maternal comorbidities before conception and the sFlt1/PlGF ratio. The most recent information regarding the association between maternal pregestational diseases and the ratio of sFlt1/PlGF is described in this review. The paper also examines current research suggesting that changes in pregnancy hormones and metabolites are related to a high sFlt1/PlGF ratio. Certain maternal disorders have been found to dramatically raise sFlt-1 and sFlt1/PlGF levels, according to an analysis of the literature. There is still debate about the data on the association between the sFlt1/PlGF ratio and maternal disorders such as HIV, acute coronary syndromes, cardiovascular function in the mother between 19 and 23 weeks of pregnancy, thyroid hormones, diabetes, and cancer. Additional research is needed to confirm these findings.
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Affiliation(s)
- Nataliia Sergeevna Karpova
- Federal State Budgetary Institution “Research Institute of Pathology and Pathophysiology”, St. Baltiyskaya, House 8, Moscow 125315, Russia
| | - Olga Pavlovna Dmitrenko
- Federal State Budgetary Institution “Research Institute of Pathology and Pathophysiology”, St. Baltiyskaya, House 8, Moscow 125315, Russia
| | - Tatyana Sergeevna Budykina
- State Budgetary Health Institution of the Moscow Region “Moscow Regional Research Institute of Obstetrics and Gynecology”, St. Pokrovka, d.22a, Moscow 101000, Russia
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7
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Makkar K, Sharma YP, Batta A, Hatwal J, Panda PK. Role of fibrinogen, albumin and fibrinogen to albumin ratio in determining angiographic severity and outcomes in acute coronary syndrome. World J Cardiol 2023; 15:13-22. [PMID: 36714367 PMCID: PMC9850671 DOI: 10.4330/wjc.v15.i1.13] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/08/2022] [Accepted: 12/23/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) pandemic unmasked the huge deficit in healthcare resources worldwide. It highlighted the need for efficient risk stratification in management of cardiovascular emergencies.
AIM To study the applicability of the old, available and affordable nonconventional biomarkers: albumin and fibrinogen in their ability to predict angiographic severity and clinical outcomes in patients with acute coronary syndrome (ACS).
METHODS In this prospective, observational study, 166 consecutive patients with ACS were enrolled. Fibrinogen, albumin and their ratio were determined from serum. Patients with underlying chronic liver disease, active malignancy, autoimmune disease, active COVID-19 infection and undergoing thrombolysis were excluded.
RESULTS Mean age of the population was 60.5 ± 1.5 years, 74.1% being males. ST elevation myocardial infarction (STEMI) was most common presentation of ACS seen in 57% patients. Fibrinogen albumin ratio (FAR) ≥ 19.2, had a sensitivity of 76.9% and specificity of 78.9 % [area under the receiver operating characteristic curves (AUROC) = 0.8, P = 0.001] to predict ≤ thrombolysis in myocardial infarction (TIMI) 1 flow in culprit artery in STEMI patients. Even in non-STEMI patients, FAR ≥ 18.85 predicted the same with 80% sensitivity and 63% specificity (AUROC = 0.715, P = 0.006).
CONCLUSION Novel biomarkers, with their high cost, lack of availability and long turn over time are impractical for real-world use. Identifying ≤ TIMI 1 flow in the culprit artery has significant impact of management and outcome. Our study has shown that readily available biomarkers like fibrinogen and albumin can help identify these high-risk patients with good accuracy. This allows risk-stratification and individualization of treatment in ACS.
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Affiliation(s)
- Kunaal Makkar
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Yash Paul Sharma
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Akash Batta
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana 141001, Punjab, India
| | - Juniali Hatwal
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Prashant Kumar Panda
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
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8
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Fang C, Chen Z, Zhang J, Jin X, Yang M. Construction and evaluation of nomogram model for individualized prediction of risk of major adverse cardiovascular events during hospitalization after percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction. Front Cardiovasc Med 2022; 9:1050785. [PMID: 36620648 PMCID: PMC9810984 DOI: 10.3389/fcvm.2022.1050785] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
Background Emergency percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI) helps to reduce the occurrence of major adverse cardiovascular events (MACEs) such as death, cardiogenic shock, and malignant arrhythmia, but in-hospital MACEs may still occur after emergency PCI, and their mortality is significantly increased once they occur. The aim of this study was to investigate the risk factors associated with MACE during hospitalization after PCI in STEMI patients, construct a nomogram prediction model and evaluate its effectiveness. Methods A retrospective analysis of 466 STEMI patients admitted to our hospital from January 2018 to June 2022. According to the occurrence of MACE during hospitalization, they were divided into MACE group (n = 127) and non-MACE group (n = 339), and the clinical data of the two groups were compared; least absolute shrinkage and selection operator (LASSO) regression was used to screen out the predictors with non-zero coefficients, and multivariate Logistic regression was used to analyze STEMI Independent risk factors for in-hospital MACE in patients after emergency PCI; a nomogram model for predicting the risk of in-hospital MACE in STEMI patients after PCI was constructed based on predictive factors, and the C-index was used to evaluate the predictive performance of the prediction model; the Bootstrap method was used to repeat sampling 1,000 Internal validation was carried out for the second time, the Hosmer-Lemeshow test was used to evaluate the model fit, and the calibration curve was drawn to evaluate the calibration degree of the model. Receiver operating characteristic (ROC) curves were drawn to evaluate the efficacy of the nomogram model and thrombolysis in myocardial infarction (TIMI) score in predicting in-hospital MACE in STEMI patients after acute PCI. Results The results of LASSO regression showed that systolic blood pressure, diastolic blood pressure, Killip grade II-IV, urea nitrogen and left ventricular ejection fraction (LVEF), IABP, NT-ProBNP were important predictors with non-zero coefficients, and multivariate logistic regression analysis was performed to analyze that Killip grade II-IV, urea nitrogen, LVEF, and NT-ProBNP were independent factors for in-hospital MACE after PCI in STEMI patients; a nomogram model for predicting the risk of in-hospital MACE after PCI in STEMI patients was constructed with the above independent predictors, with a C-index of 0.826 (95% CI: 0.785-0.868) having a good predictive power; the results of H-L goodness of fit test showed χ2 = 1.3328, P = 0.25, the model calibration curve was close to the ideal model, and the internal validation C-index was 0.818; clinical decision analysis also showed that the nomogram model had a good clinical efficacy, especially when the threshold probability was 0.1-0.99, the nomogram model could bring clinical net benefits to patients. The nomogram model predicted a greater AUC (0.826) than the TIMI score (0.696) for in-hospital MACE after PCI in STEMI patients. Conclusion Urea nitrogen, Killip class II-IV, LVEF, and NT-ProBNP are independent factors for in-hospital MACE after PCI in STEMI patients, and nomogram models constructed based on the above factors have high predictive efficacy and feasibility.
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Affiliation(s)
- Caoyang Fang
- Department of Cardiology, The Second People’s Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China,Department of Cardiology, Hefei Second People’s Hospital Affiliated to Bengbu Medical College, Hefei, Anhui, China
| | - Zhenfei Chen
- Department of Cardiology, The Second People’s Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China,*Correspondence: Zhenfei Chen,
| | - Jinig Zhang
- Department of Cardiology, The Second People’s Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
| | - Xiaoqin Jin
- Department of Cardiology, The Second People’s Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China,Department of Cardiology, Hefei Second People’s Hospital Affiliated to Bengbu Medical College, Hefei, Anhui, China
| | - Mengsi Yang
- Department of Cardiology, The Second People’s Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
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9
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Choi S. Predictors of recurrent acute myocardial infarction despite initially successful percutaneous coronary intervention: back to the basic. Korean J Intern Med 2022; 37:740-741. [PMID: 35811363 PMCID: PMC9271725 DOI: 10.3904/kjim.2022.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 06/09/2022] [Indexed: 11/27/2022] Open
Affiliation(s)
- Seonghoon Choi
- Department of Cardiololgy, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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10
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Kraler S, Wenzl FA, Georgiopoulos G, Obeid S, Liberale L, von Eckardstein A, Muller O, Mach F, Räber L, Losdat S, Schmiady MO, Stellos K, Stamatelopoulos K, Camici GG, Srdic A, Paneni F, Akhmedov A, Lüscher TF. Soluble lectin-like oxidized low-density lipoprotein receptor-1 predicts premature death in acute coronary syndromes. Eur Heart J 2022; 43:1849-1860. [PMID: 35567560 DOI: 10.1093/eurheartj/ehac143] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 02/10/2022] [Accepted: 03/07/2022] [Indexed: 08/27/2023] Open
Abstract
AIMS The lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) and its shedding product [soluble LOX-1 (sLOX-1)] are implicated in atherosclerotic cardiovascular disease (ASCVD) pathogenesis. Herein, we examined the relationship of sLOX-1 with both fatal events and plaque progression in patients with acute coronary syndromes (ACS). METHODS AND RESULTS Plasma sLOX-1 was assessed at baseline in ACS and chronic coronary syndrome (CCS) patients prospectively recruited in the multicentre SPUM-ACS study, with sex- and age-matched healthy subjects serving as additional controls (n = 2924). Compared with both CCS and controls, ACS patients showed markedly elevated sLOX-1 levels (median, 2.00 and 2.00 vs. 35.08 pg/mL; P < 0.0001) which were independently associated with increased mortality risk over 30-day [tertile (T)3: adjusted hazard ratio (HR), 3.11; 95% confidence interval (CI), 1.44-10.61; P = 0.0055] and 1-year intervals (T3: adjusted HR, 2.04; 95% CI, 1.19-3.92; P = 0.0098). Results remained consistent after adjustment for GRACE 2.0 (T3: adjusted HR, 1.86; 95% CI, 1.04-3.74; P = 0.0391) and were primarily driven by the pronounced relationship of sLOX-1 with cardiovascular mortality at 30 days (T3: adjusted HR, 3.81; 95% CI, 1.62-19.62; P = 0.0036) and at 1 year (T3: adjusted HR, 2.29; 95% CI, 1.19-5.34; P = 0.0148). In ACS patients undergoing serial intracoronary imaging and statin therapy, sLOX-1 dropped significantly in those with coronary plaque regression at 1 year (ΔsLOX-1: -4.64 ± 1.80; P = 0.0057), and showed a good discrimination for predicting plaque progression (area under the curve = 0.74; 95% CI, 0.59-0.86; P = 0.0031). CONCLUSION Plasma sLOX-1 levels are increased during ACS and predict fatal events beyond traditional and emerging risk factors. Persistently high sLOX-1 associates with coronary plaque progression in patients with established ASCVD. CLINICAL TRIAL REGISTRATION NCT01000701.
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Affiliation(s)
- Simon Kraler
- Center for Molecular Cardiology, University of Zürich, Wagistrasse 12, 8952 Schlieren, Zurich, Switzerland
| | - Florian A Wenzl
- Center for Molecular Cardiology, University of Zürich, Wagistrasse 12, 8952 Schlieren, Zurich, Switzerland
| | - Georgios Georgiopoulos
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- School of Biomedical Engineering and Imaging Sciences, King's College, London, UK
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens School of Health Sciences, Athens, Greece
| | - Slayman Obeid
- University Heart Center, Department of Cardiology, University Hospital, Zurich, Switzerland
| | - Luca Liberale
- Center for Molecular Cardiology, University of Zürich, Wagistrasse 12, 8952 Schlieren, Zurich, Switzerland
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | | | - Olivier Muller
- Department of Cardiology, University Hospital of Lausanne, University of Lausanne, Lausanne, Switzerland
| | - François Mach
- Cardiology, University Hospital Geneva, Geneva, Switzerland
| | | | | | - Martin O Schmiady
- University Heart Center, Department of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland
- Department of Congenital Cardiovascular Surgery, University Children's Hospital, Zurich, Switzerland
| | - Konstantinos Stellos
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Department of Cardiology, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Department of Cardiovascular Research, European Center for Angioscience (ECAS), Heidelberg University, Mannheim, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Kimon Stamatelopoulos
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens School of Health Sciences, Athens, Greece
| | - Giovanni G Camici
- Center for Molecular Cardiology, University of Zürich, Wagistrasse 12, 8952 Schlieren, Zurich, Switzerland
- University Heart Center, Department of Cardiology, University Hospital, Zurich, Switzerland
- Department of Research and Education, University Hospital Zurich, Zurich, Switzerland
| | - Annie Srdic
- University Heart Center, Department of Cardiology, University Hospital, Zurich, Switzerland
| | - Francesco Paneni
- Center for Molecular Cardiology, University of Zürich, Wagistrasse 12, 8952 Schlieren, Zurich, Switzerland
- University Heart Center, Department of Cardiology, University Hospital, Zurich, Switzerland
| | - Alexander Akhmedov
- Center for Molecular Cardiology, University of Zürich, Wagistrasse 12, 8952 Schlieren, Zurich, Switzerland
| | - Thomas F Lüscher
- Center for Molecular Cardiology, University of Zürich, Wagistrasse 12, 8952 Schlieren, Zurich, Switzerland
- Research, Education & Development, Royal Brompton and Harefield Hospitals and Imperial College, Sydney Street, London SW3 6NP, UK
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11
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Garcia-Osuna A, Sans-Rosello J, Ferrero-Gregori A, Alquezar-Arbe A, Sionis A, Ordóñez-Llanos J. Risk Assessment after ST-Segment Elevation Myocardial Infarction: Can Biomarkers Improve the Performance of Clinical Variables? J Clin Med 2022; 11:1266. [PMID: 35268358 PMCID: PMC8910980 DOI: 10.3390/jcm11051266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/21/2022] [Accepted: 02/24/2022] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Myocardial infarction with ST-segment elevation (STEMI) is the coronary artery disease associated with the highest risk of morbimortality; however, this risk is heterogeneous, usually being evaluated by clinical scores. Risk assessment is a key factor in personalized clinical management of patients with this disease. AIM The aim of this study was to assess whether some new cardiac biomarkers considered alone, combined in a multibiomarker model or in association with clinical variables, improve the short- and long-term risk stratification of STEMI patients. MATERIALS AND METHODS This was a retrospective observational study of 253 patients with STEMI. Blood samples were obtained before or during the angiography. The assessed biomarkers were C-terminal fragment of insulin-like growth factor binding protein-4 (CT-IGFBP4), high sensitive cardiac troponin T (hs-cTnT), N-terminal fragment of probrain natriuretic peptide (NT-proBNP), and growth differentiation factor 15 (GDF-15); they reflect different cardiovascular (CV) physiopathological pathways and underlying pathologies. We registered in-hospital and follow-up mortalities and their causes (cardiovascular and all-cause) and major adverse cardiac events (MACE) during a two year follow-up. Discrimination, survival analysis, model calibration, and reclassification of the biomarkers were comprehensively evaluated. RESULTS AND DISCUSSION In total, 55 patients (21.7%) died, 33 in-hospital and 22 during the follow-up, most of them (69.1%) from CV causes; 37 MACE occurred during follow-up. Biomarkers showed good prognostic ability to predict mortality, alone and combined with the multibiomarker model. A predictive clinical model based on age, Killip-Kimball class, estimated glomerular filtration rate (eGFR), and heart rate was derived by multivariate analysis. GDF-15 and NT-proBNP significantly improved risk assessment of the clinical model, as shown by discrimination, calibration, and reclassification of all the end-points except for all-cause mortality. The combination of NT-proBNP and hs-cTnT improved CV mortality prediction. CONCLUSIONS GDF-15 and NT-proBNP added value to the usual risk assessment of STEMI patients.
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Affiliation(s)
- Alvaro Garcia-Osuna
- Department of Clinical Biochemistry, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
- Department of Clinical Biochemistry, Autonomous University of Barcelona, 08193 Barcelona, Spain
| | - Jordi Sans-Rosello
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
| | | | - Aitor Alquezar-Arbe
- Department of Clinical Biochemistry, Autonomous University of Barcelona, 08193 Barcelona, Spain
- Department of Emergency, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
| | - Alessandro Sionis
- Department of Clinical Biochemistry, Autonomous University of Barcelona, 08193 Barcelona, Spain
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
| | - Jordi Ordóñez-Llanos
- Department of Clinical Biochemistry, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
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12
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Novel multi-marker proteomics in phenotypically matched patients with ST-segment myocardial infarction: association with clinical outcomes. J Thromb Thrombolysis 2021; 53:841-850. [PMID: 34708315 DOI: 10.1007/s11239-021-02582-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/03/2021] [Indexed: 12/22/2022]
Abstract
Early prediction of significant morbidity or mortality in patients with acute ST-segment elevation myocardial infarction (STEMI) represents an unmet clinical need. In phenotypically matched population of 139 STEMI patients (72 cases, 67 controls) treated with primary percutaneous coronary intervention, we explored associations between a 24-h relative change from baseline in the concentration of 91 novel biomarkers and the composite outcome of death, heart failure, or shock within 90 days. Additionally, we used random forest models to predict the 90-day outcomes. After adjustment for false discovery rate, the 90-day composite was significantly associated with concentration changes in 14 biomarkers involved in various pathophysiologic processes including: myocardial fibrosis/remodeling (collagen alpha-1, cathepsin Z, metalloproteinase inhibitor 4, protein tyrosine phosphatase subunits), inflammation, angiogenesis and signaling (interleukin 1 and 2 subunits, growth differentiation factor 15, galectin 4, trefoil factor 3), bone/mineral metabolism (osteoprotegerin, matrix extracellular phosphoglycoprotein and tartrate-resistant acid phosphatase), thrombosis (tissue factor pathway inhibitor) and cholesterol metabolism (LDL-receptor). Random forest models suggested an independent association when inflammatory markers are included in models predicting the outcomes within 90 days. Substantial heterogeneity is apparent in the early proteomic responses among patients with acutely reperfused STEMI patients who develop death, heart failure or shock within 90 days. These findings suggest the need to consider synergistic multi-biomarker strategies for risk stratification and to inform future development of novel post-myocardial infarction therapies.
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13
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Klingenberg R, Aghlmandi S, Räber L, Akhmedov A, Gencer B, Carballo D, Nanchen D, Bucher HC, Rodondi N, Mach F, Windecker S, Landmesser U, von Eckardstein A, Hamm CW, Lüscher TF, Matter CM. Cysteine-Rich Angiogenic Inducer 61 Improves Prognostic Accuracy of GRACE (Global Registry of Acute Coronary Events) 2.0 Risk Score in Patients With Acute Coronary Syndromes. J Am Heart Assoc 2021; 10:e020488. [PMID: 34622666 PMCID: PMC8751861 DOI: 10.1161/jaha.120.020488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background It remains unclear whether the novel biomarker cysteine‐rich angiogenic inducer 61 (CCN1) adds incremental prognostic value to the GRACE 2.0 (Global Registry of Acute Coronary Events) risk score and biomarkers high‐sensitivity Troponin T, hsCRP (high‐sensitivity C‐reactive protein), and NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) in patients with acute coronary syndromes. Methods and Results Patients referred for coronary angiography with a primary diagnosis of acute coronary syndromes were enrolled in the Special Program University Medicine – Acute Coronary Syndromes and Inflammation cohort. The primary/secondary end points were 30‐day/1‐year all‐cause mortality and the composite of all‐cause mortality or myocardial infarction as used in the GRACE risk score. Associations between biomarkers and outcome were assessed using log‐transformed biomarker values and the GRACE risk score (versions 1.0 and 2.0). The incremental value of CCN1 beyond a reference model was assessed using Harrell’s C‐statistics calculated from a Cox proportional‐hazard model. The P value of the C‐statistics was derived from a likelihood ratio test. Among 2168 patients recruited, 1732 could be analyzed. CCN1 was the strongest single predictor of all‐cause mortality at 30 days (hazard ratio [HR], 1.77 [1.31, 2.40]) and 1 year (HR, 1.81 [1.47, 2.22]). Adding CCN1 alone to the GRACE 2.0 risk score improved C‐statistics for prognostic accuracy of all‐cause mortality at 30 days (0.87–0.88) and 1 year (0.81–0.82) and when combined with high‐sensitivity Troponin T, hsCRP, NT‐proBNP for 30 days (0.87–0.91), and for 1‐year follow‐up (0.81–0.84). CCN1 also increased the prognostic value for the composite of all‐cause mortality or myocardial infarction. Conclusions CCN1 predicts adverse outcomes in patients with acute coronary syndromes adding incremental information to the GRACE risk score, suggesting distinct underlying molecular mechanisms. Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT01000701.
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Affiliation(s)
- Roland Klingenberg
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland.,Department of Cardiology Kerckhoff Heart and Thorax Center Kerckhoff-Klinik Campus of the Justus Liebig University of Giessen Bad Nauheim Germany.,DZHK (German Center for Cardiovascular Research) partner site Rhine-Main Bad Nauheim Germany
| | - Soheila Aghlmandi
- Basel Institute for Clinical Epidemiology and BiostatisticsUniversity Hospital BaselUniversity of Basel Basel Switzerland
| | - Lorenz Räber
- Department of Cardiology Cardiovascular Center University Hospital Bern Bern Switzerland
| | | | - Baris Gencer
- Department of Cardiology Cardiovascular Center University Hospital Geneva Geneva Switzerland
| | - David Carballo
- Department of Cardiology Cardiovascular Center University Hospital Geneva Geneva Switzerland
| | - David Nanchen
- Department of Ambulatory Care and Community Medicine University of Lausanne Lausanne Switzerland
| | - Heiner C Bucher
- Basel Institute for Clinical Epidemiology and BiostatisticsUniversity Hospital BaselUniversity of Basel Basel Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM) University of Bern Bern Switzerland.,Department of General Internal Medicine University Hospital Bern Bern Switzerland
| | - François Mach
- Department of Cardiology Cardiovascular Center University Hospital Geneva Geneva Switzerland
| | - Stephan Windecker
- Department of Cardiology Cardiovascular Center University Hospital Bern Bern Switzerland
| | - Ulf Landmesser
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland.,Department of Cardiology Charité Campus Benjamin-Franklin Berlin Germany
| | | | - Christian W Hamm
- Department of Cardiology Kerckhoff Heart and Thorax Center Kerckhoff-Klinik Campus of the Justus Liebig University of Giessen Bad Nauheim Germany.,DZHK (German Center for Cardiovascular Research) partner site Rhine-Main Bad Nauheim Germany
| | - Thomas F Lüscher
- Center for Molecular Cardiology University of Zurich Zurich Switzerland.,Heart Division Imperial College National Heart and Lung Institute and Royal Brompton and Harefield Hospitals London United Kingdom
| | - Christian M Matter
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland.,Center for Molecular Cardiology University of Zurich Zurich Switzerland
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14
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Mahendiran T, Klingenberg R, Nanchen D, Gencer B, Meier D, Räber L, Carballo D, Matter CM, Lüscher TF, Mach F, Rodondi N, Muller O, Fournier S. CCN family member 1 (CCN1) is an early marker of infarct size and left ventricular dysfunction in STEMI patients. Atherosclerosis 2021; 335:77-83. [PMID: 34597881 DOI: 10.1016/j.atherosclerosis.2021.09.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/16/2021] [Accepted: 09/16/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND AIMS CCN family member 1 (CCN1) has recently been proposed as a novel biomarker of myocardial injury, improving prediction of 30-day and one-year mortality following acute coronary syndromes. Among ST-elevation myocardial infarction (STEMI) patients, we evaluated the utility of CCN1 measured immediately before primary percutaneous coronary intervention (PPCI) as a predictor of two earlier endpoints: final myocardial infarct size and post-infarction left ventricular ejection fraction (LVEF). Furthermore, we evaluated the impact of CCN1 on the discriminatory power of the CADILLAC score. METHODS STEMI patients were obtained from the SPUM-ACS cohort. Serum CCN1 was measured prior to PPCI. Linear regression assessed the association between CCN1, peak creatinine kinase (CK), and post-infarction LVEF. Cox models assessed an association between CCN1 and 30-day all-cause mortality. RESULTS CCN1 was measured in 989 patients with a median value of 706.2 ng/l (IQR 434.3-1319.6). A significant correlation between CCN1, myocardial infarct size (peak CK) and LVEF was observed in univariate and multivariate analysis (both p < 0.001). Even among patients with normal classical cardiac biomarker levels at the time of PPCI, CCN1 correlated significantly with final infarct size. CCN1 significantly improved prediction of 30-day all-cause mortality by the CADILLAC score (C-index 0.864, likelihood-ratio chi-square test statistic 6.331, p = 0.012; IDI 0.026, p= 0.050). CONCLUSIONS Compared with classical cardiac biomarkers, CCN1 is potentially the earliest predictor of final myocardial infarct size and post-infarction LVEF. CCN1 improved the discriminatory capacity of the CADILLAC score suggesting a potential role in the very-early risk stratification of STEMI patients.
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Affiliation(s)
- Thabo Mahendiran
- Department of Cardiology, Lausanne University Center Hospital, Lausanne, Switzerland
| | | | - David Nanchen
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Baris Gencer
- Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - David Meier
- Department of Cardiology, Lausanne University Center Hospital, Lausanne, Switzerland
| | - Lorenz Räber
- Department of Cardiology, University Hospital of Zurich, Zurich, Switzerland
| | - David Carballo
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Christian M Matter
- Department of Cardiology, University Hospital of Zurich, Zurich, Switzerland
| | - Thomas F Lüscher
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland; Imperial College and Royal Brompton & Harefield Hospitals, London, UK
| | - François Mach
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland; Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Olivier Muller
- Department of Cardiology, Lausanne University Center Hospital, Lausanne, Switzerland
| | - Stephane Fournier
- Department of Cardiology, Lausanne University Center Hospital, Lausanne, Switzerland.
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15
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Bo X, Liu Y, Yang M, Lu Z, Zhao Y, Chen L. Development and Validation of a Nomogram of In-hospital Major Adverse Cardiovascular and Cerebrovascular Events in Patients With Acute Coronary Syndrome. Front Cardiovasc Med 2021; 8:699023. [PMID: 34434977 PMCID: PMC8380764 DOI: 10.3389/fcvm.2021.699023] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/29/2021] [Indexed: 12/23/2022] Open
Abstract
Background and Objective: This study aims to develop and validate a nomogram for the occurrence of in-hospital major adverse cardiovascular and cerebrovascular events (MACCE) in acute coronary syndrome (ACS) patients. Methods: A total of 1,360 ACS patients admitted between November 2014 and October 2019 from Zhongda Hospital and Yancheng Third People's Hospital were included. Patients admitted in Zhongda Hospital before 2018 were split into the training cohort (n = 793). Those admitted after 2018 in Zhongda Hospital and patients from Yancheng Third People's Hospital were split into the validation cohort (n = 567). Twenty eight clinical features routinely assessed including baseline characteristics, past medical history and auxiliary examinations were used to inform the models to predict in-hospital MACCE (all-cause mortality, reinfarction, stroke, and heart failure) in ACS patients. The best-performing model was tested in the validation cohort. The accuracy and clinical applicability were tested by the area under the receiver operating characteristic curve (AUC), calibration plots, and decision curve analyses (DCA). Results: The in-hospital MACCE occurred in 93 (6.83%) patients. The final prediction model consists of four variables: age, Killip grading, fasting blood-glucose (FBG) and whether percutaneous coronary intervention (PCI) was performed at early stage. A nomogram was used to present the final result. Individualized nomogram exhibited comparable discrimination to the Global Registry of Acute Coronary Events (GRACE) score [AUC: 0.807 (95% CI 0.736-0.878) vs. 0.761 (95% CI 0.69-0.878)], P = 0.10) and a better discrimination than the Evaluation of the Methods and Management of Acute Coronary Events (EMMACE) score [AUC: 0.807 (95% CI 0.736-0.878) vs. 0.723(95% CI 0.648-0.798), P = 0.01] in predicting the risk of in-hospital MACCE in ACS patients. A good prediction performance was maintained in the validation cohort (AUC =0.813, 95% CI 0.738-0.889). The prediction model also exhibited decent calibration (P = 0.972) and clinical usefulness. Conclusion: The nomogram may be a simple and effective tool in predicting the occurrence of in-hospital MACCE in ACS patients. Further longitudinal studies are warranted to validate its value in guiding clinical decision-making and optimizing the treatment of high-risk patients.
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Affiliation(s)
- Xiangwei Bo
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yang Liu
- School of Medicine, Southeast University, Nanjing, China
| | - Mingming Yang
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Zhengri Lu
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yuanyuan Zhao
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Lijuan Chen
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
- Department of Cardiology, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China
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16
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Weichwald S, Candreva A, Burkholz R, Klingenberg R, Räber L, Heg D, Manka R, Gencer B, Mach F, Nanchen D, Rodondi N, Windecker S, Laaksonen R, Hazen SL, von Eckardstein A, Ruschitzka F, Lüscher TF, Buhmann JM, Matter CM. Improving 1-year mortality prediction in ACS patients using machine learning. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2021; 10:855-865. [PMID: 34015112 DOI: 10.1093/ehjacc/zuab030] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/16/2021] [Accepted: 04/21/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND The Global Registry of Acute Coronary Events (GRACE) score is an established clinical risk stratification tool for patients with acute coronary syndromes (ACS). We developed and internally validated a model for 1-year all-cause mortality prediction in ACS patients. METHODS Between 2009 and 2012, 2'168 ACS patients were enrolled into the Swiss SPUM-ACS Cohort. Biomarkers were determined in 1'892 patients and follow-up was achieved in 95.8% of patients. 1-year all-cause mortality was 4.3% (n = 80). In our analysis we consider all linear models using combinations of 8 out of 56 variables to predict 1-year all-cause mortality and to derive a variable ranking. RESULTS 1.3% of 1'420'494'075 models outperformed the GRACE 2.0 Score. The SPUM-ACS Score includes age, plasma glucose, NT-proBNP, left ventricular ejection fraction (LVEF), Killip class, history of peripheral artery disease (PAD), malignancy, and cardio-pulmonary resuscitation. For predicting 1-year mortality after ACS, the SPUM-ACS Score outperformed the GRACE 2.0 Score which achieves a 5-fold cross-validated AUC of 0.81 (95% CI 0.78-0.84). Ranking individual features according to their importance across all multivariate models revealed age, trimethylamine N-oxide, creatinine, history of PAD or malignancy, LVEF, and haemoglobin as the most relevant variables for predicting 1-year mortality. CONCLUSIONS The variable ranking and the selection for the SPUM-ACS Score highlight the relevance of age, markers of heart failure, and comorbidities for prediction of all-cause death. Before application, this score needs to be externally validated and refined in larger cohorts. CLINICAL TRIAL REGISTRATION NCT01000701.
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Affiliation(s)
- Sebastian Weichwald
- Department of Computer Science, Institute for Machine Learning, ETH Zurich, Switzerland.,Max Planck Institute for Intelligent Systems, Tübingen, Germany
| | - Alessandro Candreva
- Department of Cardiology, University Heart Center, University Hospital of Zurich, Switzerland
| | - Rebekka Burkholz
- Department of Computer Science, Institute for Machine Learning, ETH Zurich, Switzerland
| | - Roland Klingenberg
- Department of Cardiology, University Heart Center, University Hospital of Zurich, Switzerland.,Kerckhoff Heart and Thorax Center, Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany.,Campus of the Justus Liebig University of Giessen, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Rhine-Main, Bad Nauheim, Germany
| | - Lorenz Räber
- Department of Cardiology, Cardiovascular Center, University Hospital of Bern, Switzerland
| | - Dik Heg
- Clinical Trial Unit, University of Bern, Switzerland
| | - Robert Manka
- Department of Cardiology, University Heart Center, University Hospital of Zurich, Switzerland
| | - Baris Gencer
- Department of Cardiology, Cardiovascular Center, University Hospital of Geneva, Switzerland
| | - François Mach
- Department of Cardiology, Cardiovascular Center, University Hospital of Geneva, Switzerland
| | - David Nanchen
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Switzerland.,Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Cardiovascular Center, University Hospital of Bern, Switzerland
| | - Reijo Laaksonen
- Zora Biosciences, Espoo, Finland.,Finnish Cardiovascular Research Center Tampere, Tampere University, Tampere, Finland
| | - Stanley L Hazen
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital of Zurich, Switzerland
| | - Thomas F Lüscher
- Center for Molecular Cardiology, University of Zurich, Switzerland.,Cardiology, Royal Brompton & Harefield Hospitals, London, United Kingdom
| | - Joachim M Buhmann
- Department of Computer Science, Institute for Machine Learning, ETH Zurich, Switzerland
| | - Christian M Matter
- Department of Cardiology, University Heart Center, University Hospital of Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Switzerland
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17
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Kahles F, Rückbeil MV, Mertens RW, Foldenauer AC, Arrivas MC, Moellmann J, Lebherz C, Biener M, Giannitsis E, Katus HA, Marx N, Lehrke M. Glucagon-like peptide 1 levels predict cardiovascular risk in patients with acute myocardial infarction. Eur Heart J 2021; 41:882-889. [PMID: 31620788 DOI: 10.1093/eurheartj/ehz728] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/04/2019] [Accepted: 10/04/2019] [Indexed: 12/17/2022] Open
Abstract
AIMS Glucagon-like peptide 1 (GLP-1) is a gut incretin hormone inducing post-prandial insulin secretion. Glucagon-like peptide 1 levels were recently found to be increased in patients with acute myocardial infarction. Glucagon-like peptide 1 receptor agonists improve cardiovascular outcomes in patients with diabetes. The aim of this study was to assess the predictive capacity of GLP-1 serum levels for cardiovascular outcome in patients with myocardial infarction. METHODS AND RESULTS In 918 patients presenting with myocardial infarction [321 ST-segment elevation myocardial infarction and 597 non-ST-segment elevation myocardial infarction (NSTEMI)] total GLP-1, N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and the Global Registry of Acute Coronary Events (GRACE) score were assessed at time of hospital admission. The primary composite outcome of the study was the first occurrence of cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke. Kaplan-Meier survival plots and univariable Cox regression analyses found GLP-1 to be associated with adverse outcome [hazard ratio (HR) of logarithmized GLP-1 values: 6.29, 95% confidence interval (CI): 2.67-14.81; P < 0.0001]. After further adjustment for age, sex, family history of cardiovascular disease, smoking, diabetes, hypertension, hypercholesterinaemia, glomerular filtration rate (GFR) CKD-EPI, hs-CRP, hs-Troponin T, and NT-proBNP levels the HR remained significant at 10.98 (95% CI: 2.63-45.90; P = 0.0010). Time-dependent receiver operating characteristic curve analyses illustrated that GLP-1 levels are a strong indicator for early events. For events up to 30 days after admission, GLP-1 proved to be superior to other biomarkers including hs-Troponin T, GFR CKD-EPI, hs-CRP, and NT-proBNP. Adjustment of the GRACE risk estimate by addition of GLP-1 increased the area under the receiver operating characteristic curve over time in NSTEMI patients. CONCLUSION In patients hospitalized for myocardial infarction, GLP-1 levels are associated with cardiovascular events.
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Affiliation(s)
- Florian Kahles
- Department of Internal Medicine I-Cardiology, University Hospital Aachen, Pauwelsstraße 30, Aachen 52074, Germany
| | - Marcia V Rückbeil
- Department of Medical Statistics, University Hospital Aachen, Pauwelsstraße 19, Aachen 52074, Germany
| | - Robert W Mertens
- Department of Internal Medicine I-Cardiology, University Hospital Aachen, Pauwelsstraße 30, Aachen 52074, Germany
| | - Ann C Foldenauer
- Fraunhofer Institute for Molecular Biology and Applied Ecology (IME), Branch for Translational Medicine and Pharmacology (TMP), Theodor-Stern-Kai 7, Frankfurt am Main 60596, Germany
| | - Maria C Arrivas
- Department of Internal Medicine I-Cardiology, University Hospital Aachen, Pauwelsstraße 30, Aachen 52074, Germany
| | - Julia Moellmann
- Department of Internal Medicine I-Cardiology, University Hospital Aachen, Pauwelsstraße 30, Aachen 52074, Germany
| | - Corinna Lebherz
- Department of Internal Medicine I-Cardiology, University Hospital Aachen, Pauwelsstraße 30, Aachen 52074, Germany
| | - Moritz Biener
- Department of Cardiology, Angiology, and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, Heidelberg 69120, Germany
| | - Evangelos Giannitsis
- Department of Cardiology, Angiology, and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, Heidelberg 69120, Germany
| | - Hugo A Katus
- Department of Cardiology, Angiology, and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, Heidelberg 69120, Germany
| | - Nikolaus Marx
- Department of Internal Medicine I-Cardiology, University Hospital Aachen, Pauwelsstraße 30, Aachen 52074, Germany
| | - Michael Lehrke
- Department of Internal Medicine I-Cardiology, University Hospital Aachen, Pauwelsstraße 30, Aachen 52074, Germany
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18
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Zhang L, Hailati J, Ma X, Liu J, Liu Z, Yang Y, He P, Wulasihan M. Analysis of risk factors for different subtypes of acute coronary syndrome. J Int Med Res 2021; 49:3000605211008326. [PMID: 33969735 PMCID: PMC8113931 DOI: 10.1177/03000605211008326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/15/2021] [Indexed: 11/17/2022] Open
Abstract
AIMS To investigate the different risk factors among different subtypes of patients with acute coronary syndrome (ACS). METHODS A total of 296 patients who had ACS were retrospectively enrolled. Blood and echocardiographic indices were assessed within 24 hours after admission. Differences in risk factors and Gensini scores of coronary lesions among three groups were analyzed. RESULTS Univariate analysis of risk factors for ACS subtypes showed that age, and levels of fasting plasma glucose, amino-terminal pro-brain natriuretic peptide, and creatine kinase isoenzyme were significantly higher in patients with non-ST-segment elevation myocardial infarction (NSTEMI) than in those with unstable angina pectoris (UAP). Logistic multivariate regression analysis showed that amino-terminal pro-brain natriuretic peptide and the left ventricular ejection fraction (LVEF) were related to ACS subtypes. The left ventricular end-diastolic diameter was an independent risk factor for UAP and ST-segment elevation myocardial infarction (STEMI) subtypes. The severity of coronary stenosis was significantly higher in NSTEMI and STEMI than in UAP. Gensini scores in the STEMI group were positively correlated with D-dimer levels (r = 0.429) and negatively correlated with the LVEF (r = -0.602). CONCLUSION Different subtypes of ACS have different risk factors. Our findings may have important guiding significance for ACS subtype risk assessment and clinical treatment.
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Affiliation(s)
- Lei Zhang
- Department of Comprehensive Cardiology, The First
Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Province,
China
| | - Juledezi Hailati
- Department of Comprehensive Cardiology, The First
Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Province,
China
| | - Xiaoyun Ma
- Department of Comprehensive Cardiology, The First
Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Province,
China
| | - Jiangping Liu
- Department of Comprehensive Cardiology, The First
Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Province,
China
| | - Zhiqiang Liu
- Department of Comprehensive Cardiology, The First
Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Province,
China
| | - Yuchun Yang
- Department of Comprehensive Cardiology, The First
Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Province,
China
| | - Pengyi He
- Department of Comprehensive Cardiology, The First
Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Province,
China
| | - Muhuyati Wulasihan
- Department of Comprehensive Cardiology, The First
Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Province,
China
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19
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Forrer A, Schoenrath F, Torzewski M, Schmid J, Franke UFW, Göbel N, Aujesky D, Matter CM, Lüscher TF, Mach F, Nanchen D, Rodondi N, Falk V, von Eckardstein A, Gawinecka J. Novel Blood Biomarkers for a Diagnostic Workup of Acute Aortic Dissection. Diagnostics (Basel) 2021; 11:diagnostics11040615. [PMID: 33808169 PMCID: PMC8065878 DOI: 10.3390/diagnostics11040615] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/18/2021] [Accepted: 03/25/2021] [Indexed: 12/20/2022] Open
Abstract
Acute aortic dissection (AAD) is a rare condition, but together with acute myocardial infarction (AMI) and pulmonary embolism (PE) it belongs to the most relevant and life-threatening causes of acute chest pain. Until now, there has been no specific blood test in the diagnostic workup of AAD. To identify clinically relevant biomarkers for AAD, we applied Proseek® Multiplex assays to plasma samples from patients with AAD, AMI, PE, thoracic aortic aneurysm (TAA), and non-cardiovascular chest pain (nonCVD). Subsequently, we validated top hits using conventional immunoassays and examined their expression in the aortic tissue. Interleukin 10 (IL-10) alone showed the best performance with a sensitivity of 55% and a specificity of 98% for AAD diagnosis. The combination of D-dimers, high-sensitive troponin T (hs-TnT), interleukin 6 (IL-6), and plasminogen activator inhibitor 1 (PAI1) correctly classified 75% of AAD cases, delivering a sensitivity of 83% and specificity of 95% for its diagnosis. Moreover, this model provided the correct classification of 77% of all analyzed cases. Our data suggest that IL-10 shows potential to be a rule-in biomarker for AAD. Moreover, the addition of PAI1 and IL-6 to hs-TnT and D-dimers may improve the discrimination of suspected AAD, AMI, and PE in patients presenting with acute chest pain.
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Affiliation(s)
- Anja Forrer
- Institute of Clinical Chemistry, University Hospital of Zurich, University of Zurich, 8091 Zurich, Switzerland; (A.F.); (A.v.E.)
| | - Felix Schoenrath
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, 13353 Berlin, Germany; (F.S.); (V.F.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
| | - Michael Torzewski
- Department of Laboratory Medicine and Hospital Hygiene, Robert Bosch Hospital, 70376 Stuttgart, Germany; (M.T.); (J.S.)
| | - Jens Schmid
- Department of Laboratory Medicine and Hospital Hygiene, Robert Bosch Hospital, 70376 Stuttgart, Germany; (M.T.); (J.S.)
| | - Urlich F. W. Franke
- Department of Cardiovascular Surgery, Robert Bosch Hospital, 70376 Stuttgart, Germany; (U.F.W.F.); (N.G.)
| | - Nora Göbel
- Department of Cardiovascular Surgery, Robert Bosch Hospital, 70376 Stuttgart, Germany; (U.F.W.F.); (N.G.)
| | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (D.A.); (N.R.)
| | - Christian M. Matter
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (C.M.M.); (T.F.L.)
| | - Thomas F. Lüscher
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (C.M.M.); (T.F.L.)
| | - Francois Mach
- Department of Cardiology, University Hospital Geneva, 1205 Geneva, Switzerland;
| | - David Nanchen
- Center for Primary Care and Public Health, University of Lausanne, 1015 Lausanne, Switzerland;
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (D.A.); (N.R.)
- Institute of Primary Health Care (BIHAM), University of Bern, 3012 Bern, Switzerland
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, 13353 Berlin, Germany; (F.S.); (V.F.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
- Department of Cardiothoracic Surgery, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 10117 Berlin, Germany
- Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Arnold von Eckardstein
- Institute of Clinical Chemistry, University Hospital of Zurich, University of Zurich, 8091 Zurich, Switzerland; (A.F.); (A.v.E.)
| | - Joanna Gawinecka
- Institute of Clinical Chemistry, University Hospital of Zurich, University of Zurich, 8091 Zurich, Switzerland; (A.F.); (A.v.E.)
- Correspondence: ; Tel.: +41-44-255-9643; Fax: +41-44-255-4590
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20
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Rossi VA, Denegri A, Candreva A, Klingenberg R, Obeid S, Räber L, Gencer B, Mach F, Nanchen D, Rodondi N, Heg D, Windecker S, Buhmann J, Ruschitzka F, Lüscher TF, Matter CM. Prognostic value of inflammatory biomarkers and GRACE score for cardiac death and acute kidney injury after acute coronary syndromes. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2021; 10:445-452. [PMID: 33624028 DOI: 10.1093/ehjacc/zuab003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/29/2019] [Accepted: 01/12/2021] [Indexed: 11/13/2022]
Abstract
AIMS The aim of this study was to analyse the role of inflammation and established clinical scores in predicting acute kidney injury (AKI) after acute coronary syndromes (ACS). METHODS AND RESULTS In a prospective multicentre cohort including 2034 patients with ACS undergoing percutaneous coronary intervention, high-sensitivity C-reactive protein (hsCRP), neutrophil count, neutrophil-to-lymphocyte ratio (NL-ratio), and creatinine were measured at the index procedure. AKI (n = 39, defined according to RIFLE criteria) and major cardiovascular and cerebrovascular events were adjudicated after 1 year. Associations between inflammation, AKI, and cardiac death (CD) were assessed by C-statistics and Cox proportional hazard models with log-rank test to compare survival. Patients with ACS with elevated neutrophil count >7.8 × 109/L, NL-ratio >5, combined neutrophil-count/creatinine, or NL-ratio/creatinine at baseline showed a higher incidence of AKI (all P < 0.05) and CD (all P < 0.001). The risk of AKI, CD, and their combination was increased in patients with higher neutrophil count/creatinine (heart rate (HR) = 3.7, 95% cardiac index (CI) 1.9-7.1; HR = 2.7, 95% CI 1.6-4.6; HR = 3.2, 95% CI 2.1-4.9); NL-ratio/creatinine (HR = 2.1, 95% CI 1.6-4.1; HR = 2.2, 95% CI 1.3-3.8; HR = 2.3, 95% CI 1.5-3.5); and hsCRP (HR = 1.8, 95% CI 0.9-3.5; HR = 2.2, 95% CI 1.3-3.6; HR = 1.9, 95% CI 1.2-2.8) after adjustment for age, diabetes, hypertension, previous heart failure, kidney function, haemodynamic instability at admission, statin, and renin-angiotensin-aldosterone antagonists use. Subjects with higher GRACE score 1.0/NL-ratio had higher rate of AKI, CD, and both (HR = 1.4, 95% CI 0.5-4.2; HR = 2.7, 95% CI 1.3-5.9; HR = 2.1, 95% CI 1-4.3). CONCLUSIONS Inflammation markers may predict AKI after correction for renal function at the index procedure. hsCRP performed better than the NL-ratio. However, the integration of inflammation markers to traditional risk factors or scores does not add prognostic information. TRIAL REGISTRATION ClinicalTrials.gov, NCT01000701.
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Affiliation(s)
- Valentina A Rossi
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Andrea Denegri
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland.,Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via Università 4, 41125 Modena, Italy
| | - Alessandro Candreva
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Roland Klingenberg
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland.,Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany
| | - Slayman Obeid
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Cardiovascular Center, University Hospital Bern, Freiburgstrasse 4, 3010 Bern, Switzerland
| | - Baris Gencer
- Department of Cardiology, Cardiovascular Center, University Hospital Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - François Mach
- Department of Cardiology, Cardiovascular Center, University Hospital Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - David Nanchen
- Department of Ambulatory Care and Community Medicine, University Hospital of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Nicolas Rodondi
- Department of General Internal Medicine, University Hospital Bern, Freiburgstrasse 4, 3010 Bern, Switzerland.,Bern Institute of Primary Health Care (BIHAM), University of Bern, Hochschulstrasse 6, 3012 Bern, Switzerland
| | - Dik Heg
- Department of Cardiology, Cardiovascular Center, University Hospital Bern, Freiburgstrasse 4, 3010 Bern, Switzerland.,Institute of Social and Preventive Medicine, (ISPM) University of Bern, Hochschulstrasse 6, 3012 Bern, Switzerland
| | - Stephan Windecker
- Department of Clinical Research, Clinical Trials Unit, ISPM, University of Bern, Hochschulstrasse 6, 3012 Bern, Switzerland
| | - Joachim Buhmann
- Institute of Neuroinformatics, University of Zurich and ETH Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Thomas F Lüscher
- Department of Cardiology, Royal Brompton and Harefield Hospitals and Imperial College, Sydney St, Chelsea, London SW3 6NP, UK.,Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland
| | - Christian M Matter
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland
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21
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Optimization of GRACE Risk Stratification by N-Terminal Pro-B-type Natriuretic Peptide Combined With D-Dimer in Patients With Non-ST-Elevation Myocardial Infarction. Am J Cardiol 2021; 140:13-19. [PMID: 33159905 DOI: 10.1016/j.amjcard.2020.10.050] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/25/2020] [Accepted: 10/27/2020] [Indexed: 11/22/2022]
Abstract
We aimed to explore the utility of multiple biomarkers with GRACE risk stratification for non-ST-elevation myocardial infarction (NSTEMI). A total of 1,357 patients diagnosed with NSTEMI were enrolled in this study at multiple medical centers in Tianjin, China. The outcomes were 1-year all-cause death and major adverse cardiac events (MACE: all-cause death, hospital admission for unstable angina, hospital admission for heart failure, nonfatal recurrent myocardial infarction, and stroke). C-index, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were calculated to verify that the biomarkers improve the predictive accuracy of the GRACE score. A total of 57 participants died, while 211 participants experienced 231 MACEs during follow-up (mean: 339 days). For all-cause death, the combination of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and D-dimer improved the predictive accuracy of GRACE the most, with C-index, IDI, and NRI values of 0.88, 0.085, and 1.223, respectively. For MACE, trigeminal combination of NT-proBNP, fibrinogen, and D-dimer resulted in C-index, IDI, and NRI values of 0.80, 0.079, and 0.647, respectively. As a result, NT-proBNP, D-dimer, fibrinogen, and GRACE comprise a new scoring system for assessing 1-year clinical events. Kaplan-Meier analysis revealed a significant increase in 1-year mortality (score ≥3.85 vs <3.85, p < 0.0001) and 1-year MACE (score ≥1.72 vs <1.72, p < 0.0001) between different score groups. In conclusion, the combination of NT-proBNP and D-dimer added prognostic value to GRACE for all-cause death. Combining NT-proBNP, fibrinogen, and D-dimer increased the prognostic value of GRACE for MACE. This newly developed scoring system is strongly correlated with all-cause mortality and MACE, and can be easily utilized in clinical practice.
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22
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Diagnostic utility of circulating plasma microRNA-101a in severity of coronary heart disease. Ir J Med Sci 2021; 190:1391-1396. [PMID: 33474702 DOI: 10.1007/s11845-021-02512-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 01/10/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND For evaluating the severity of coronary heart disease (CHD), coronary arteriography may not be available everywhere due to technical limitations. MicroRNA-101a (miR-101a) associated with inflammation and cholesterol homeostasis. However, whether it related to presence and stratification of CHD is still unknown. AIM We aim to evaluate the value of miR-101a in stratifying CHD patients. METHODS We enrolled 200 CHD patients and 100 controls, and 200 CHD patients were divided into two groups of low and high SYNTAX score (SYNTAX score ≤ 22 versus SYNTAX score ≥ 33). Intergroup comparisons of miR-101a level were compared among the controls and two groups of low and high SYNTAX score. Correlation between miR-101a and blood lipid profiles was analyzed. The logistic regression analysis were conducted to evaluate the risk factors of CHD. RESULTS Relative level of miR-101a in the controls, SYNTAX score ≤ 22 and SYNTAX score ≥ 33 group were 4.61 (1.24-8.91), 3.28 (0.58-6.75) and 2.29 (1.04-3.62), respectively (p < 0.001). All lipid profiles significantly associated with miR-101a expression (all p < 0.001). The odds ratio (OR) of miR-101a in univariate analysis was 0.41 (95% CI, 0.33-0.52). After adjusting for the traditional risk factors, such as blood profiles and history of smoking, the odds ratio of miR-101a was 0.63 (95% CI, 0.47-0.43), which closely associated with CHD (p = 0.002). CONCLUSIONS Circulating miR-101a may be considered as a novel biomarker for evaluating the presence and severity of CHD.
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23
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Klingenberg R, Aghlmandi S, Gencer B, Nanchen D, Räber L, Carballo D, Carballo S, Stähli BE, Landmesser U, Rodondi N, Mach F, Windecker S, Bucher HC, von Eckardstein A, Lüscher TF, Matter CM. Residual inflammatory risk at 12 months after acute coronary syndromes is frequent and associated with combined adverse events. Atherosclerosis 2021; 320:31-37. [PMID: 33524907 DOI: 10.1016/j.atherosclerosis.2021.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/05/2021] [Accepted: 01/12/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS Residual inflammatory risk (RIR) after acute coronary syndromes (ACS) may identify patients likely to benefit from anti-inflammatory therapies. METHODS Patients from the Special Program University Medicine ACS cohort were divided into four groups according to level of hsCRP at baseline and after 12 months: persistently high RIR, increased RIR (first low, then high hsCRP), attenuated RIR (first high, then low hsCRP), or persistently low RIR. High RIR was defined as hsCRP ≥ 2 mg/L. An independently adjudicated incident of combined adverse events was defined as the composite of myocardial infarction, clinically indicated coronary revascularization or cerebrovascular events. RESULTS Among 1209 patients with available hsCRP, clinical and demographic data, 295 (24.4%) patients had persistently high RIR (delta hsCRP median (IQR): 2.3 (-9.9; 0.3) (mg/L) and 72 (5.96%) patients had increased RIR (delta hsCRP median (IQR): +2.45 (1.2; 8.35) (mg/L). A total of 390 (32.26%) patients had attenuated RIR (delta hsCRP median (IQR): 3.55 (-10; -2) (mg/L) and 452 (37.38%) patients had persistently low RIR (delta hsCRP median (IQR): 0.2 (-0.6; 0.1) (mg/L). Of 90 combined adverse events, 31 (10.5%) occurred in the persistently high (multivariable adjusted OR: 1.71, (95% CI 1.08-2.7), p = 0.022) compared with the three other groups combined (increased RIR: 3 (4.2%), attenuated RIR 30 (7.7%), persistently low RIR 26 (5.8%). CONCLUSIONS Persistently elevated hsCRP after ACS is found in a quarter of patients with the highest risk of combined adverse events. This underlines the need to perform anti-inflammatory intervention trials in RIR patients.
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Affiliation(s)
- Roland Klingenberg
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland; Kerckhoff Heart and Thorax Center, Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany; Campus of the Justus Liebig University of Giessen, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Rhine-Main, Bad Nauheim, Germany.
| | - Soheila Aghlmandi
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, University of Basel, Switzerland
| | - Baris Gencer
- Department of Cardiology, Cardiovascular Center, University Hospital Geneva, Switzerland
| | - David Nanchen
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - David Carballo
- Department of Cardiology, Cardiovascular Center, University Hospital Geneva, Switzerland
| | - Sebastian Carballo
- Department of Internal Medicine, University Hospital Geneva, Switzerland
| | - Barbara E Stähli
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Ulf Landmesser
- Department of Cardiology, Charité, Campus Benjamin-Franklin, Berlin, Germany
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Switzerland; Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - François Mach
- Department of Cardiology, Cardiovascular Center, University Hospital Geneva, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Heiner C Bucher
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, University of Basel, Switzerland
| | | | - Thomas F Lüscher
- Center for Molecular Cardiology, University of Zurich, Switzerland; Imperial College, National Heart and Lung Institute and Royal Brompton and Harefield Hospitals, Heart Division London, United Kingdom
| | - Christian M Matter
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland; Center for Molecular Cardiology, University of Zurich, Switzerland
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24
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Acet H, Güzel T, Aslan B, Isik MA, Ertas F, Catalkaya S. Predictive Value of C-Reactive Protein to Albumin Ratio in ST-Segment Elevation Myocardial Infarction Patients Treated With Primary Percutaneous Coronary Intervention. Angiology 2020; 72:244-251. [PMID: 33371718 DOI: 10.1177/0003319720963697] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The present study aimed to examine the association of C-reactive protein to albumin ratio (CAR) with short-term major adverse cardiac events (MACEs) in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI). We included 539 STEMI patient treated with pPCI in this study. Patients were divided into 2 groups according to MACE development. Patients with MACE had higher CAR than those without (1.18 [0.29-1.99] vs 0.21 [0.09-0.49], P < .001). Multivariate analysis showed that The Global Record for Acute Coronary Events score, Percutaneous Coronary Intervention with TAXus and cardiac surgery (SYNTAX) score, glucose and CAR (odds ratio:1.326, 95% CI: 1.212-1452, P < .001) were independent predictors of MACE. The CAR may be proven useful for risk stratification in STEMI patients undergoing pPCI.
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Affiliation(s)
- Halit Acet
- Department of Cardiology, Faculty of Medicine, 37507Dicle University, Diyarbakir, Turkey
| | - Tuncay Güzel
- Department of Cardiology, Akhisar State Hospital, Manisa, Turkey
| | - Bayram Aslan
- Department of Cardiology, Ergani State Hospital, Diyarbakir, Turkey
| | - Mehmet Ali Isik
- Department of Cardiology, 37507Mardin State Hospital, Mardin, Turkey
| | - Faruk Ertas
- Department of Cardiology, Faculty of Medicine, 37507Dicle University, Diyarbakir, Turkey
| | - Sibel Catalkaya
- Department of Cardiology, Edremit State Hospital, Edremit, Turkey
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25
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Obeid S, Yousif N, Davies A, Loretz R, Saleh L, Niederseer D, Noor HA, Amin H, Mach F, Gencer B, Räber L, Windecker S, Templin C, Nanchen D, Rodondi N, Muller O, Matter CM, von Eckardstein A, Lüscher TF. Prognostic role of plasma galectin-3 levels in acute coronary syndrome. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2020; 9:869-878. [DOI: 10.1177/2048872620974612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Aim:
Cystatin C, neutrophil gelatinase-associated lipocalin and galectin-3 have emerged as biomarker candidates to predict cardiovascular outcomes and mortality in the general population as well as in patients with coronary artery or renal disease. However, their predictive role and clinical utility in patients with acute coronary syndromes alone or in combination beyond currently used risk scores remains to be determined.
Methods and results:
Cystatin C, neutrophil gelatinase-associated lipocalin, and galectin-3 were measured in plasmas of 1832 patients at the time of presentation with acute coronary syndromes requiring percutaneous coronary intervention or coronary artery bypass grafting. The primary outcomes were major adverse cardiac and cerebrovascular events (defined as the composite of all-cause mortality, cerebrovascular events, any repeat revascularization or myocardial infarction) and all-cause mortality after 1 year and occurred in 192 (10.5%) and 78 (4.3%) of patients, respectively. All three biomarkers were increased in those with major adverse cardiac and cerebrovascular events compared with those without (p<0.001). However, only galectin-3 (all-cause mortality: hazard ratio=1.027 (95% confidence interval (1.011–1.043); p=0.001), major adverse cardiac and cerebrovascular events: hazard ratio=1.025 (95% confidence interval (1.012–1.037); p<0.001)) but not cystatin C nor neutrophil gelatinase-associated lipocalin emerged as independent predictors of both major adverse cardiac and cerebrovascular events and death. The risks were particularly high in the highest quartile of galectin-3. The integration of galectin-3 into the global registry of acute coronary events (GRACE) score improved the prediction of major adverse cardiac and cerebrovascular events and all-cause mortality significantly. The areas under the receiver operator characteristics curves increased from 0.6701 to 0.6932 for major adverse cardiac and cerebrovascular events (p=0.0474) and from 0.804 to 0.8199 for all-cause mortality (p=0.0197). Finally, we applied net reclassification improvement index using different cut-offs for major adverse cardiac and cerebrovascular events which showed negative results (for the cut-offs of 5% and 15%, net reclassification improvement index 0.028, p=0.586, for the cut-offs of 10% and 20%, net reclassification improvement index 0.072, p=0.1132 and for the cut-offs of 10% and 30% the net reclassification improvement index is 0.0843, p=0.077).
Conclusion:
In acute coronary syndromes patients, galectin-3 has moderate prognostic accuracy, provides statistically significant incremental value in some, but not all models, and that the magnitude of any improvement would seem of questionable clinical value.
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Affiliation(s)
- Slayman Obeid
- Department of Cardiology, University Hospital Zurich, Switzerland
| | - Nooraldaem Yousif
- Department of Cardiology, University Hospital Zurich, Switzerland
- Mohammed Bin Khalifa Cardiac Centre, Kingdom of Bahrain
| | - Allan Davies
- Royal Brompton and Harefield Hospitals and Imperial College, UK
| | - Ruben Loretz
- Department of Cardiology, University Hospital Zurich, Switzerland
| | - Lanja Saleh
- Institute of Clinical Chemistry, University Hospital Zurich, Switzerland
| | - David Niederseer
- Department of Cardiology, University Hospital Zurich, Switzerland
| | - Husam A Noor
- Mohammed Bin Khalifa Cardiac Centre, Kingdom of Bahrain
| | - Haitham Amin
- Mohammed Bin Khalifa Cardiac Centre, Kingdom of Bahrain
| | - François Mach
- Department of Cardiology, Hospital Universitaire de Geneve, Switzerland
| | - Baris Gencer
- Department of Cardiology, Hospital Universitaire de Geneve, Switzerland
| | - Lorenz Räber
- Department of Cardiology, University Hospital Bern, Switzerland
| | | | | | - David Nanchen
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Switzerland
| | - Nicolas Rodondi
- Department of General Medicine, University Hospital Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Switzerland
| | - Olivier Muller
- Department of Cardiology, Centre Hospitalier Universitaire Vaudois, Switzerland
| | - Christian M Matter
- Department of Cardiology, University Hospital Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Switzerland
| | | | - Thomas F Lüscher
- Royal Brompton and Harefield Hospitals and Imperial College, UK
- Center for Molecular Cardiology, University of Zurich, Switzerland
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26
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Garcia-Garcia C, Rueda F, Lupon J, Oliveras T, Labata C, Ferrer M, Cediel G, De Diego O, Rodriguez-Leor O, Carrillo X, Bayes-Genis A. Growth differentiation factor-15 is a predictive biomarker in primary ventricular fibrillation: The RUTI-STEMI-PVF study. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2020; 9:S161-S168. [DOI: 10.1177/2048872618797599] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background:
Primary ventricular fibrillation is an ominous complication of ST-segment elevation myocardial infarction, and proper biomarkers for risk prediction are lacking. Growth differentiation factor-15 is a marker of inflammation, oxidative stress and hypoxia with well-established prognostic value in ST-segment elevation myocardial infarction patients. We explored the predictive value of growth differentiation factor-15 in a subgroup of ST-segment elevation myocardial infarction patients with primary ventricular fibrillation.
Methods:
Prospective registry of ST-segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention from February 2011–August 2015. Growth differentiation factor-15 concentrations were measured on admission. Logistic regression and Cox proportional regression analyses were used.
Results:
A total of 1165 ST-segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention (men 78.5%, age 62.3±13.1 years) and 72 patients with primary ventricular fibrillation (6.2%) were included. Compared to patients without primary ventricular fibrillation, median growth differentiation factor-15 concentration was two-fold higher in ST-segment elevation myocardial infarction patients with primary ventricular fibrillation (2655 vs 1367 pg/ml, p<0.001). At 30 days, mortality was 13.9% and 3.6% in patients with and without primary ventricular fibrillation, respectively (p<0.001), and median growth differentiation factor-15 concentration in patients with primary ventricular fibrillation was five-fold higher among those who died vs survivors (13,098 vs 2415 pg/ml, p<0.001). In a comprehensive multivariable analysis including age, sex, clinical variables, reperfusion time, left ventricular ejection fraction, N-terminal pro-B-type natriuretic peptide and high-sensitivity troponin T, growth differentiation factor-15 remained an independent predictor of 30-day mortality, with odds ratios of 3.92 (95% confidence interval 1.35–11.39) in patients with primary ventricular fibrillation (p=0.012) and 1.72 (95% confidence interval 1.23–2.40) in patients without primary ventricular fibrillation (p=0.001).
Conclusions:
Growth differentiation factor-15 is a robust independent predictor of 30-day mortality in ST-segment elevation myocardial infarction patients with primary ventricular fibrillation.
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Affiliation(s)
- C Garcia-Garcia
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
- CIBER Enfermedades Cardiovasculares (CIBERCV), Spain
| | - F Rueda
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
- Department of Medicine, Autonomous University of Barcelona, Spain
| | - J Lupon
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
- Department of Medicine, Autonomous University of Barcelona, Spain
| | - T Oliveras
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
| | - C Labata
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
| | - M Ferrer
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
| | - G Cediel
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
| | - O De Diego
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
| | - O Rodriguez-Leor
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
- CIBER Enfermedades Cardiovasculares (CIBERCV), Spain
| | - X Carrillo
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
- CIBER Enfermedades Cardiovasculares (CIBERCV), Spain
| | - A Bayes-Genis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
- Department of Medicine, Autonomous University of Barcelona, Spain
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27
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Zheng YY, Wu TT, Gao Y, Guo QQ, Ma YY, Zhang JC, Xun YL, Wang DY, Pan Y, Cheng MD, Song FH, Liu ZY, Wang K, Jiang LZ, Fan L, Yue XT, Bai Y, Zhang ZL, Dai XY, Zheng RJ, Chen Y, Ma X, Ma YT, Zhang JY, Xie X. A Novel ABC Score Predicts Mortality in Non-ST-Segment Elevation Acute Coronary Syndrome Patients Who underwent Percutaneous Coronary Intervention. Thromb Haemost 2020; 121:297-308. [PMID: 33129207 DOI: 10.1055/s-0040-1718411] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE In the present study, we aimed to establish a novel score to predict long-term mortality of non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients who underwent percutaneous coronary intervention (PCI). METHODS A total of 2,174 NSTE-ACS patients from the CORFCHD-ZZ study were enrolled as the derivation cohort. The validation cohort including 1,808 NSTE-ACS patients were from the CORFCHD-PCI study. Receiver operating characteristic analysis and area under the curve (AUC) evaluation were used to select the candidate variables. The model performance was validated internally and externally. The primary outcome was cardiac mortality (CM). We also explored the model performance for all-cause mortality (ACM). RESULTS Initially, 28 risk factors were selected and ranked according to their AUC values. Finally, we selected age, N-terminal pro-B-type natriuretic peptide, and creatinine to develop a novel prediction model named "ABC" model. The ABC model had a high discriminatory ability for both CM (C-index: 0.774, p < 0.001) and ACM (C-index: 0.758, p < 0.001) in the derivation cohort. In the validation cohort, the C-index of CM was 0.802 (p < 0.001) and that of ACM was 0.797 (p < 0.001), which suggested good discrimination. In addition, this model had adequate calibration in both the derivation and validation cohorts. Furthermore, the ABC score outperformed the GRACE score to predict mortality in NSTE-ACS patients who underwent PCI. CONCLUSION In the present study, we developed and validated a novel model to predict mortality in patients with NSTE-ACS who underwent PCI. This model can be used as a credible tool for risk assessment and management of NSTE-ACS after PCI.
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Affiliation(s)
- Ying-Ying Zheng
- Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China
| | - Ting-Ting Wu
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Ying Gao
- Cadre Ward, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Qian-Qian Guo
- Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China
| | - Yan-Yan Ma
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Jian-Chao Zhang
- Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China
| | - Yi-Li Xun
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Ding-Yu Wang
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Ying Pan
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Meng-Die Cheng
- Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China
| | - Feng-Hua Song
- Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China
| | - Zhi-Yu Liu
- Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China
| | - Kai Wang
- Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China
| | - Li-Zhu Jiang
- Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China
| | - Lei Fan
- Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China
| | - Xiao-Ting Yue
- Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China
| | - Yan Bai
- Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China
| | - Zeng-Lei Zhang
- Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China
| | - Xin-Ya Dai
- Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China
| | - Ru-Jie Zheng
- Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China
| | - You Chen
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xiang Ma
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yi-Tong Ma
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Jin-Ying Zhang
- Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China
| | - Xiang Xie
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
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28
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Chattopadhyay S, George A, John J, Sathyapalan T. Two-Hour Post-Load Plasma Glucose, a Biomarker to Improve the GRACE Score in Patients without Known Diabetes. Cardiology 2020; 145:553-561. [PMID: 32784310 DOI: 10.1159/000509180] [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: 12/30/2019] [Accepted: 06/02/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess improvement in predictive performance of Global Registry of Acute Coronary Events risk score (GRS) by addition of a glucose matrix. METHODS 1,056 acute coronary syndrome (ACS) survivors without known diabetes had pre-discharge fasting (FPG) and 2-h post-load plasma glucose (2h-PG) measured. GRS was calculated. Major adverse cardiac events (MACE; death and non-fatal myocardial infarction) were recorded during follow-up. Cox proportional hazard regression predicted event-free survival. Likelihood ratio test, Akaike's information criteria, continuous net reclassification index (NRI>0), and integrated discrimination improvement (IDI) were used to test the additional prognostic value of glycaemic indices over GRS. RESULTS During a median follow-up of 36.5 months, 211 MACEs (20.0%), 96 deaths (9.1%), and 115 non-fatal re-infarctions (10.9%), occurred. 2h-PG, but not FPG, independently predicted MACE-free survival at all time points (HR 1.08, 95% CI 1.03-1.13, p = 0.002, at 3 years). Risk of MACE increased by 8-11% with every 1 mmol/L rise in 2h-PG. 2h-PG significantly improved the prognostic models containing GRS. Models containing GRS and 2h-PG yielded lowest corrected Akaike's information criteria compared to that with only GRS. 2h-PG, but not FPG, improved NRI>0 (NRI>0 0.169, p = 0.028 at 3 years) and IDI (IDI of 0.66%, p = 0.018 at 3 years) significantly at all time points during the follow-up. CONCLUSIONS 2h-PG, but not FPG, improves performance of GRS-containing models in predicting post-ACS prognosis in the short to medium term.
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Affiliation(s)
- Sudipta Chattopadhyay
- Department of Cardiology, Milton Keynes University Hospital, Milton Keynes, United Kingdom,
| | - Anish George
- Department of Cardiology, Scunthorpe General Hospital, Scunthorpe, United Kingdom
| | - Joseph John
- Department of Cardiology, Castle Hill Hospital, Kingston upon Hull, United Kingdom
| | - Thozhukat Sathyapalan
- Department of Academic Endocrinology, Diabetes, and Metabolism, Hull York Medical School, University of Hull, Kingston upon Hull, United Kingdom
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29
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Jia Y, Gao Y, Li D, Cao Y, Cheng Y, Li F, Xiao L, Jiang Y, Wan Z, Zeng Z, Zeng R. Geriatric Nutritional Risk Index Score Predicts Clinical Outcome in Patients With Acute ST-Segment Elevation Myocardial Infarction. J Cardiovasc Nurs 2020; 35:E44-E52. [DOI: 10.1097/jcn.0000000000000674] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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30
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Guo G, Huang Z, Wang S, Chen X. Sex differences in uric acid and NT-pro BNP assessments during coronary severity. Medicine (Baltimore) 2020; 99:e19653. [PMID: 32282714 PMCID: PMC7220359 DOI: 10.1097/md.0000000000019653] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 02/09/2020] [Accepted: 02/16/2020] [Indexed: 12/13/2022] Open
Abstract
To investigate the correlation between uric acid (UA) and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and coronary artery severity in acute coronary syndrome patients of different sexes.A total of 134 patients with acute coronary syndrome (ACS) were investigated. According to sex, there were 96 cases in male group and 38 cases in female group. According to the number of diseased vessels, the degree of coronary artery lesion was determined and divided into negative group (n = 21), single vessel lesion group (n = 43), double vessel lesion group (n = 38), and 3 vessel lesion group (n = 32).Univariate analysis showed that UA, NT-proBNP was correlated with the severity of ACS (P < .05). UA was an independent risk factor for the severity of coronary artery disease in female group (P < .05), but not in male group (P > .05). There was no significant correlation between NT-proBNP and severity of coronary artery disease in different sex (P > .05).UA was significantly correlated with the severity of coronary heart disease, especially in women, but not in men. The level of NT-proBNP was positively correlated with the severity of coronary artery, but no significant difference was found in different sexes.
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31
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Chen X, Shao M, Zhang T, Zhang W, Meng Y, Zhang H, Hai H, Li G. Prognostic value of the combination of GRACE risk score and mean platelet volume to lymphocyte count ratio in patients with ST-segment elevation myocardial infarction after percutaneous coronary intervention. Exp Ther Med 2020; 19:3664-3674. [PMID: 32346430 PMCID: PMC7185188 DOI: 10.3892/etm.2020.8626] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 12/17/2019] [Indexed: 12/16/2022] Open
Abstract
The Global Registry of Acute Coronary Events (GRACE) risk score and the mean platelet volume to lymphocyte count ratio (MPVLR) can be used independently to predict adverse outcomes in patients with acute coronary syndromes. However, the level of MPVLR in relation to the GRACE score, and whether a combination of these methods can better predict the clinical adverse outcome of patients with ST-segment elevation myocardial infarction (STEMI), have not been previously examined. Therefore, the aim of the present study was to investigate whether the combination of GRACE risk score and MPVLR is a good predictor of a 30-day major adverse cardiovascular events (MACE) in patients with STEMI. A total of 464 patients with STEMI undergoing percutaneous coronary intervention (PCI) were enrolled, and divided into four groups based on the optimal cut-off values for GRACE score and MPVLR. GRACE score and MPVLR levels were separately recorded during admission. Spearman's rank correlation analysis showed a positive correlation between GRACE score and MPVLR (ρ=0.304; P<0.001). Both GRACE score [hazard ratio (HR), 1.706; 95% CI, 1.435-3.058; P<0.001] and MPVLR level (HR, 1.668; 95% CI, 1.202-2.170; P<0.001) were found to be independent predictors of a 30-day MACE. Additionally, the high MPVLR + high GRACE score group of patients had an HR of 2.455 (95% CI, 1.736-3.188) for a 30-day MACE, when using the low MPVLR + low GRACE score group as a reference. Based on the area under the curve, MPVLR combined with GRACE scores achieved an improved performance in differentiating angiographic no-reflow during a 30-day MACE, compared with individual MPVLR and GRACE scores. Therefore, the present results suggested that the GRACE score may be positively correlated with MPVLR and that their combination accurately predicted the occurrence of short-term MACE in patients with STEMI after PCI.
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Affiliation(s)
- Xinsen Chen
- Department of Emergency, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang 832002, P.R. China
| | - Meng Shao
- Department of Pathophysiology, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang 832002, P.R. China
| | - Tian Zhang
- Department of Emergency, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang 832002, P.R. China
| | - Wei Zhang
- Department of Emergency, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang 832002, P.R. China
| | - Youbao Meng
- Department of Emergency, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang 832002, P.R. China
| | - Hongyan Zhang
- Department of Emergency, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang 832002, P.R. China
| | - Hua Hai
- Department of Emergency, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang 832002, P.R. China
| | - Guihua Li
- Department of Emergency, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang 832002, P.R. China
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32
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Gencer B, Carballo D, Nanchen D, Koskinas KC, Klingenberg R, Räber L, Auer R, Carballo S, Heg D, Windecker S, Lüscher TF, Matter CM, Rodondi N, Mach F. Intensified lipid lowering using ezetimibe after publication of the IMPROVE-IT trial: A contemporary analysis from the SPUM-ACS cohort. Int J Cardiol 2020; 303:8-13. [DOI: 10.1016/j.ijcard.2019.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/03/2019] [Accepted: 12/09/2019] [Indexed: 11/26/2022]
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33
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Affiliation(s)
- Thomas F Lüscher
- Professor of Cardiology, Imperial College and Director of Research, Education & Development, Royal Brompton and Harefield Hospitals London, UK.,Professor and Chairman, Center for Molecular Cardiology, University of Zurich, Switzerland.,Editor-in-Chief, EHJ Editorial Office, Zurich Heart House, Hottingerstreet 14, 8032 Zurich, Switzerland
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34
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Świątkiewicz I, Magielski P, Kubica J, Zadourian A, DeMaria AN, Taub PR. Enhanced Inflammation is a Marker for Risk of Post-Infarct Ventricular Dysfunction and Heart Failure. Int J Mol Sci 2020; 21:E807. [PMID: 31991903 PMCID: PMC7037521 DOI: 10.3390/ijms21030807] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 01/23/2020] [Accepted: 01/23/2020] [Indexed: 12/14/2022] Open
Abstract
Acute ST-segment elevation myocardial infarction (STEMI) activates inflammation that can contribute to left ventricular systolic dysfunction (LVSD) and heart failure (HF). The objective of this study was to examine whether high-sensitivity C-reactive protein (CRP) concentration is predictive of long-term post-infarct LVSD and HF. In 204 patients with a first STEMI, CRP was measured at hospital admission, 24 h (CRP24), discharge (CRPDC), and 1 month after discharge (CRP1M). LVSD at 6 months after discharge (LVSD6M) and hospitalization for HF in long-term multi-year follow-up were prospectively evaluated. LVSD6M occurred in 17.6% of patients. HF hospitalization within a median follow-up of 5.6 years occurred in 45.7% of patients with LVSD6M vs. 4.9% without LVSD6M (p < 0.0001). Compared to patients without LVSD6M, the patients with LVSD6M had higher CRP24 and CRPDC and persistent CRP1M ≥ 2 mg/L. CRP levels were also higher in patients in whom LVSD persisted at 6 months (51% of all patients who had LVSD at discharge upon index STEMI) vs. patients in whom LVSD resolved. In multivariable analysis, CRP24 ≥ 19.67 mg/L improved the prediction of LVSD6M with an increased odds ratio of 1.47 (p < 0.01). Patients with LVSD6M who developed HF had the highest CRP during index STEMI. Elevated CRP concentration during STEMI can serve as a synergistic marker for risk of long-term LVSD and HF.
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Affiliation(s)
- Iwona Świątkiewicz
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, Marii Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland
- Division of Cardiovascular Medicine, University of California San Diego, 9300 Campus Point Drive MC 7410, La Jolla, CA 92037, USA
| | - Przemysław Magielski
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, Marii Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland
| | - Jacek Kubica
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, Marii Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland
| | - Adena Zadourian
- Division of Cardiovascular Medicine, University of California San Diego, 9300 Campus Point Drive MC 7410, La Jolla, CA 92037, USA
| | - Anthony N. DeMaria
- Division of Cardiovascular Medicine, University of California San Diego, 9300 Campus Point Drive MC 7410, La Jolla, CA 92037, USA
| | - Pam R. Taub
- Division of Cardiovascular Medicine, University of California San Diego, 9300 Campus Point Drive MC 7410, La Jolla, CA 92037, USA
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35
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Wang XY, Zhang F, Zhang C, Zheng LR, Yang J. The Biomarkers for Acute Myocardial Infarction and Heart Failure. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2018035. [PMID: 32016113 PMCID: PMC6988690 DOI: 10.1155/2020/2018035] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 11/05/2019] [Accepted: 12/04/2019] [Indexed: 01/06/2023]
Abstract
The use of a large number of cardiovascular biomarkers, meant to complement the use of the electrocardiogram, echocardiography cardiac imaging, and clinical symptom assessment, has become a routine in clinical diagnosis, differential diagnosis, risk stratification, and prognosis and guides the management of patients with suspected cardiovascular diseases. There is a broad consensus that cardiac troponin and natriuretic peptides are the preferred biomarkers in clinical practice for the diagnosis of the acute coronary syndrome and heart failure, respectively, while the roles and possible clinical applications of several other potential biomarkers are still under study. This review mainly focuses on the recent studies of the roles and clinical applications of troponin and natriuretic peptides, which seem to be the best-validated markers in distinguishing and predicting the future cardiac events of patients with suspected cardiovascular diseases. Additionally, the review briefly discusses some of the large number of potential markers that may play a more prominent role in the future.
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Affiliation(s)
- Xi-Ying Wang
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Fen Zhang
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Chi Zhang
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Liang-Rong Zheng
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Jian Yang
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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Zhao X, Li J, Xian Y, Chen J, Gao Z, Qiao S, Yang Y, Gao R, Xu B, Yuan J. Prognostic value of the GRACE discharge score for predicting the mortality of patients with stable coronary artery disease who underwent percutaneous coronary intervention. Catheter Cardiovasc Interv 2020; 95 Suppl 1:550-557. [PMID: 31922352 DOI: 10.1002/ccd.28719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 12/31/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To assess the predictive value of the Global Registry of Acute Coronary Events (GRACE) discharge score for patients with stable coronary artery disease (SCAD) after percutaneous coronary intervention (PCI). BACKGROUND The GRACE score is widely used for predicting the mortality of acute coronary syndrome patients. However, the predictive value of SCAD has not been sufficiently studied. METHODS We studied 4,293 consecutive patients with SCAD who underwent PCI between January 2013 and December 2013. The primary endpoint was all-cause mortality and the secondary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE). RESULTS Among 3,915 patients with SCAD following PCI, there were 38 deaths and 394 MACCE during 2 years of follow-up. The GRACE discharge score was significantly higher for patients who died than for those who survived (86.97 ± 23.27 vs. 71.07 ± 19.84; p < .001). Risk stratification of the GRACE score indicated that the mortality risk of the intermediate-risk and high-risk groups were 3.23-fold (hazard ratio [HR], 3.23; range, 1.59-6.55; p = .001) and 15.31-fold higher (HR, 15.31; range, 4.43-51.62; p < .001), respectively, than that of the low-risk group. The MACCE risk for the intermediate-risk and high-risk groups were 1.28-fold (HR, 1.28; range, 1.02-1.62; p = .037) and 2.42-fold higher (HR, 2.42; range, 1.20-4.88; p = .014), respectively. The GRACE discharge score had prognostic value for mortality (area under the receiver operating characteristic curve, 0.692; p < .001). CONCLUSIONS The GRACE discharge score is valuable for the risk stratification of death and MACCE, as well as for the prognosis to mortality for SCAD patients who have undergone PCI.
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Affiliation(s)
- XueYan Zhao
- 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
| | - JianXin Li
- 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
| | - Ying Xian
- Department of Neurology, Duke Clinical Research Institute, Durham, North Carolina
| | - Jue Chen
- 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
| | - Zhan Gao
- 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
| | - ShuBin Qiao
- 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
| | - YueJin Yang
- 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
| | - RunLin Gao
- 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
| | - Bo Xu
- 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
| | - JinQing Yuan
- 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
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Affiliation(s)
- Thomas F Lüscher
- Professor of Cardiology, Imperial College, and Director of Research, Education & Development, Royal Brompton and Harefield Hospitals London, UK.,Professor and Chairman, Center for Molecular Cardiology, University of Zurich, Switzerland.,Editor-in-Chief, EHJ Editorial Office, Zurich Heart House, Hottingerstreet 14, 8032 Zurich, Switzerland
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Gusakova AM, Suslova TE, Ryabov VV, Kercheva MA. [Multiplex analysis on the luminex platform in complex estimation of cardiovascular biomarker dynamics in patients with acute myocardial infarction.]. Klin Lab Diagn 2019; 64:525. [PMID: 31610103 DOI: 10.18821/0869-2084-2019-64-9-525-529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 06/25/2019] [Indexed: 11/17/2022]
Abstract
The multimarker approach more accurately reflects the key mechanisms of pathogenesis and biochemical interactions, compared with the use of individual indicators. It is a reason of steadily growing interest in the development and use of various combinations of biomarkers in assessing the prognosis and stratification of cardiovascular risk in patients with a wide range of cardiological profiles. Multiplex analysis technology on the Luminex platform is the best tool for the simultaneous quantitative determination of a complex of different biomarkers in a single. Using the MILLIPLEX® MAP Human Cardiovascular Disease Panel, a multiplefold increase of FABP, Troponin I, CK-MB, BNP, Nt-proBNP, BNP in the first 24 hours after MI, decreasing in 6 months with a high degree of confidence, was shown. There were no differences in the content of LIGHT between the stages of observation, as well as in comparison with the reference range. The content of LIGHT on the first day of MI showed strong positive associations with markers of damage of myocardium and myocardial stress. On the first day of MI, a significant increase in the content of ESM-1, decreasing in 6 months after MI to the reference values was found. Strong positive associations of ESM-1 with Troponin I and BNP levels were established. A significant increase of proinflammatory cytokine OSM on the first day of MI, decreasing in the late post-infarction period to reference values was shown. Correlation analysis revealed direct relationships of OSM with Troponin I, CK-MB, Nt-proBNP and BNP. The use of the MILLIPLEX® MAP Human Cardiovascular Disease Panel 1 diagnostic multimarker panel allowed for the simultaneous quantitative analysis of 11 biochemical parameters, associated with inflammation, atherogenesis, endothelial dysfunction, ischemia and myocardial necrosis. The results can be used to improve the effectiveness of complex diagnostics in patients with primary myocardial infarction with ST segment elevation.
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Affiliation(s)
- A M Gusakova
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian academy of Sciences, 634012, Tomsk, Russia
| | - T E Suslova
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian academy of Sciences, 634012, Tomsk, Russia
| | - V V Ryabov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian academy of Sciences, 634012, Tomsk, Russia.,Siberian State Medical University, 634050, Tomsk, Russia.,National Research Tomsk State University, 634050, Tomsk, Russia
| | - M A Kercheva
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian academy of Sciences, 634012, Tomsk, Russia
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Lowered anti-beta1 adrenergic receptor antibody concentrations may have prognostic significance in acute coronary syndrome. Sci Rep 2019; 9:14552. [PMID: 31601947 PMCID: PMC6787077 DOI: 10.1038/s41598-019-51125-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 09/20/2019] [Indexed: 12/25/2022] Open
Abstract
Although several risk factors exist for acute coronary syndrome (ACS) no biomarkers for survival or risk of re-infarction have been validated. Previously, reduced serum concentrations of anti-ß1AR Ab have been implicated in poorer ACS outcomes. This study further evaluates the prognostic implications of anti-ß1AR-Ab levels at the time of ACS onset. Serum anti-ß1AR Ab concentrations were measured in randomly selected patients from within the PLATO cohort. Stratification was performed according to ACS event: ST-elevation myocardial infarct (STEMI) vs. non-ST elevation myocardial infarct (NSTEMI). Antibody concentrations at ACS presentation were compared to 12-month all-cause and cardiovascular mortality, as well as 12-month re-infarction. Sub-analysis, stratifying for age and the correlation between antibody concentration and conventional cardiac risk-factors was subsequently performed. Serum anti-ß1AR Ab concentrations were measured in 400/799 (50%) STEMI patients and 399 NSTEMI patients. Increasing anti-ß1AR Ab concentrations were associated with STEMI (p = 0.001). Across all ACS patients, no associations between anti-ß1AR Ab concentration and either all-cause cardiovascular death or myocardial re-infarction (p = 0.14) were evident. However among STEMI patients ≤60 years with anti-ß1AR Ab concentration <median higher rates of re-infarction were observed, compared to those with anti-ß1AR Ab concentrations > median (14/198 (7.1%) vs. 2/190 (1.1%)); p = 0.01). Similarly, the same sub-group demonstrated greater risk of cardiovascular death in year 1, including re-infarction and stroke (22/198 (11.1%) vs. 10/190 (5.3%); p = 0.017). ACS Patients ≤60 years, exhibiting lower concentrations of ß1AR Ab carry a greater risk for early re-infarction and cardiovascular death. Large, prospective studies quantitatively assessing the prognostic relevance of Anti-ß1AR Ab levels should be considered.
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Lipid profile, atherogenic indices, and their relationship with epicardial fat thickness and carotid intima-media thickness in celiac disease. North Clin Istanb 2019; 6:242-247. [PMID: 31650110 PMCID: PMC6790920 DOI: 10.14744/nci.2019.54936] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 01/09/2019] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE: In this study, we aimed to investigate the presence of subclinical atherosclerosis by measuring epicardial fat thickness (EFT) and carotid intima–media thickness (cIMT), evaluate low-level inflammation with high-sensitivity C-reactive protein (hsCRP), and evaluate whether there is a relationship among lipid profile, atherogenic indices, and hsCRP with these subclinical atherosclerosis markers in patients with celiac disease (CD). METHODS: After exclusion and inclusion criteria were applied, 31 patients with CD (24 female, mean age: 39.4±12.3 years) and 32 healthy controls (21 female, mean age: 39.5±4.4 years), totally 63 cases, were recruited. Subclinical atherosclerosis was evaluated with EFT by transthoracic echocardiography and cIMT by ultrasonography. Inflammatory markers including erythrocyte sedimentation rate (ESR), hsCRP, and lipid profile were recorded. Also, atherogenic indices were calculated: Castelli risk index I and II (TG/HDL-c and LDL-c/HDL-c, respectively), atherogenic index of plasma (AIP; logarithm TG/HDL-c), non-HDL-c (TG-HDL-c), and atherogenic coefficient (AC; non-HDL-c/HDL-c). RESULTS: EFT was significantly higher in the CD group (0.49±0.10 vs. 0.49±0.09; p-value: 0.02). Although cIMT was higher in the patient group, it did not reach statistical significance (0.51±0.08, 0.47±0.08; p-value: 0.10). HDL cholesterol level was found to be significantly lower (42.0±8.8 vs. 50.0±13.7; p-value: 0.01), and the plasma atherogenic index was found to be significantly higher in the patient group (0.98±0.50 vs. 0.62±0.64; p-value: 0.02). hsCRP (3.51±3.18 vs. 1.92±1.40; p-value: 0.02) and ESR (17.2±12.8 with 9.7±3.1; p-value: 0.01) were found to be significantly higher in the CD group. Although there was a significant positive correlation between EFT and hsCRP (r: 0.453; p-value: 0.01), there was a significant negative correlation between cIMT and HDL-cholesterol (−0.339; p-value: 0.05), and a significant positive correlation with the other components of the atherogenic index was found. CONCLUSION: The risk of atherosclerosis has been increased in patients with CD. Chronic inflammation may be responsible for this increase along with atherogenic indices.
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Markovic DZ, Jevtovic-Stoimenov T, Stojanovic M, Vukovic AZ, Dinic V, Markovic-Zivkovic BZ, Jankovic RJ. Cardiac biomarkers improve prediction performance of the combination of American Society of Anesthesiologists physical status classification and Americal College of Surgeons National Surgical Quality Improvement Program calculator for postoperative mortality in elderly patients: a pilot study. Aging Clin Exp Res 2019; 31:1207-1217. [PMID: 30456501 DOI: 10.1007/s40520-018-1072-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 11/02/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Our previous research has shown American Society of Anaesthesiologists physical status classification (ASA) score and Americal College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) calculator to have the most accuracy in the prediction of postoperative mortality. AIMS The aim of our research was to define the most reliable combination of cardiac biomarkers with ASA and ACS NSQIP. METHODS We have included a total of 78 patients. ASA score has been determined in standard fashion, while we used the available interactive calculator for the ACS NSQIP score. Biomarkers BIRC5, H-FABP, and hsCRP have been measured in specialized laboratories. RESULTS All of the deceased patients had survivin (BIRC5) > 4.00 pg/ml, higher values of H-FABP and hsCRP and higher estimated levels of ASA and ACS NSQIP (P = 0.0001). ASA and ACS NSQIP alone had AUC of, respectively, 0.669 and 0.813. The combination of ASA and ACS NSQIP had AUC = 0.841. Combination of hsCRP with the two risk scores had AUC = 0.926 (95% CI 0.853-1.000, P < 0.0001). If we add three cardiac biomarkers to this model, we get AUC as high as 0.941 (95% CI 0.876-1.000, P < 0.0001). The correction of statistical models with comorbidities (CIRS-G score) did not change the accuracy of prediction models that we have provided. DISCUSSION Addition of ACS NSQIP and biomarkers adds to the accuracy of ASA score, which has already been proved by other authors. CONCLUSION Cardiac biomarker hsCRP can be used as the most reliable cardiac biomarker; however, the "multimarker approach" adds the most to the accuracy of the combination of clinical risk scores.
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Li XS, Obeid S, Wang Z, Hazen BJ, Li L, Wu Y, Hurd AG, Gu X, Pratt A, Levison BS, Chung YM, Nissen SE, Tang WHW, Mach F, Räber L, Nanchen D, Matter CM, Lüscher TF, Hazen SL. Trimethyllysine, a trimethylamine N-oxide precursor, provides near- and long-term prognostic value in patients presenting with acute coronary syndromes. Eur Heart J 2019; 40:2700-2709. [PMID: 31049589 PMCID: PMC7963132 DOI: 10.1093/eurheartj/ehz259] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 01/04/2019] [Accepted: 04/17/2019] [Indexed: 12/19/2022] Open
Abstract
AIMS Trimethyllysine (TML) serves as a nutrient precursor of the gut microbiota-derived metabolite trimethylamine N-oxide (TMAO) and is associated with incident cardiovascular (CV) events in stable subjects. We examined the relationship between plasma TML levels and incident CV events in patients presenting with acute coronary syndromes (ACS). METHODS AND RESULTS Plasma levels of TML were quantified in two independent cohorts using mass spectrometry, and its relationship with CV events was investigated. In a Cleveland Cohort (N = 530), comprised of patients presenting to the emergency department with chest pain and suspected ACS, TML was associated with major adverse cardiac events (MACE, myocardial infarction, stroke, need for revascularization, or all-cause mortality) over both 30 days [3rd tertile (T3), adjusted odds ratio (OR) 1.77, 95% confidence interval (CI) 1.04-3.01; P < 0.05] and 6 months (T3, adjusted OR 1.95, 95% CI 1.15-3.32; P < 0.05) of follow-up independent of traditional CV risk factors and indices of renal function. Elevated TML levels were also associated with incident long-term (7-year) all-cause mortality [T3, adjusted hazard ratio (HR) 2.52, 95% CI 1.50-4.24; P < 0.001], and MACE even amongst patients persistently negative for cardiac Troponin T at presentation (e.g. 30-day MACE, T3, adjusted OR 4.49, 95% CI 2.06-9.79; P < 0.001). Trimethyllysine in combination with TMAO showed additive significance for near- and long-term CV events, including patients with 'negative' high-sensitivity Troponin T levels. In a multicentre Swiss Cohort (N = 1683) comprised of ACS patients, similar associations between TML and incident 1-year adverse cardiac risks were observed (e.g. mortality, adjusted T3 HR 2.74, 95% CI 1.28-5.85; P < 0.05; and MACE, adjusted T3 HR 1.55, 95% CI 1.04-2.31; P < 0.05). CONCLUSION Plasma TML levels, alone and together with TMAO, are associated with both near- and long-term CV events in patients with chest pain and ACS.
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Affiliation(s)
- Xinmin S Li
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Slayman Obeid
- Department of Cardiology, University Heart Center, University Hospital Zurich, Ramistrasse 100, CH-8091, Zurich, Switzerland
| | - Zeneng Wang
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Benjamin J Hazen
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Lin Li
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Yuping Wu
- Department of Mathematics, Cleveland State University, 2121 Euclid Avenue, Cleveland, OH 44115, USA
| | - Alex G Hurd
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Xiaodong Gu
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Alan Pratt
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Bruce S Levison
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Yoon-Mi Chung
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Steven E Nissen
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Wai Hong Wilson Tang
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - François Mach
- Department of Cardiology, Hospital Universitaire de Geneve, Geneva, Rue Gabrielle-Perret-Gentil 4, CH-1211, Geneva 14, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Swiss Heart Center, Inselspital, Freiburgstrasse 18, CH-3010, Bern, Switzerland
| | - David Nanchen
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Rue du Bugnon 44, CH-1011, Lausanne, Switzerland
| | - Christian M Matter
- Department of Cardiology, University Heart Center, University Hospital Zurich, Ramistrasse 100, CH-8091, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, CH-8952, Schlieren, Switzerland
| | - Thomas F Lüscher
- Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, CH-8952, Schlieren, Switzerland
- Department of Cardiology, Royal Brompton and Harefield Hospitals, Imperial College, London, SW3 6NP, UK
| | - Stanley L Hazen
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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Non-Linear Relationship between Anti-Apolipoprotein A-1 IgGs and Cardiovascular Outcomes in Patients with Acute Coronary Syndromes. J Clin Med 2019; 8:jcm8071002. [PMID: 31324073 PMCID: PMC6679072 DOI: 10.3390/jcm8071002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 06/26/2019] [Accepted: 07/08/2019] [Indexed: 12/13/2022] Open
Abstract
Autoantibodies against apolipoprotein A-I (anti-apoA-I IgGs) are prevalent in atherosclerosis-related conditions. It remains elusive whether they improve the prognostic accuracy of the Global Registry of Acute Coronary Events (GRACE) score 2.0 (GS) in acute coronary syndromes (ACS). In this prospective multicenter registry, 1713 ACS patients were included and followed for 1 year. The primary endpoint (major adverse cardiovascular events (MACE)) was defined as the composite of myocardial infarction, stroke (including transient ischemic attack), or cardiovascular (CV) death with individual events independently adjudicated. Plasma levels of anti-apoA-I IgGs upon study inclusion were assessed using ELISA. The association between anti-apoA-I IgGs and incident MACE was assessed using Cox models with splines and C-statistics. One-year MACE incidence was 8.4% (144/1713). Anti-apoA-I IgG levels were associated with MACE with a non-linear relationship (p = 0.01), which remained unchanged after adjusting for the GS (p = 0.04). The hazard increased progressively across the two first anti-apoA-I IgG quartiles before decreasing thereafter. Anti-apoA-I IgGs marginally improved the prognostic accuracy of the GS (c-statistics increased from 0.68 to 0.70). In this multicenter study, anti-apoA-I IgGs were predictive of incident MACE in ACS independently of the GS but in a nonlinear manner. The practical implications of these findings remain to be defined.
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Gencer B, Rigamonti F, Nanchen D, Vuilleumier N, Kern I, Aghlmandi S, Klingenberg R, Räber L, Auer R, Carballo D, Carballo S, Heg D, Windecker S, Lüscher TF, Matter CM, Rodondi N, Mach F. Prognostic value of elevated lipoprotein(a) in patients with acute coronary syndromes. Eur J Clin Invest 2019; 49:e13117. [PMID: 30937890 DOI: 10.1111/eci.13117] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/08/2019] [Accepted: 03/31/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Minimal lipoprotein(a) [Lp(a)] target values are advocated for high-risk cardiovascular patients. We investigated the prognostic value of Lp(a) in the acute setting of patients with acute coronary syndromes (ACS). MATERIALS AND METHODS Plasma levels of Lp(a) were collected at time of angiography from 1711 patients hospitalized for ACS in a multicentre Swiss prospective cohort. Associations between elevated Lp(a) ≥30 mg/dL (cut-off corresponding to the 75th percentile of the assay) or Lp(a) tertiles at baseline, and major adverse cardiovascular events (MACE) at 1 year, defined as a composite of cardiac death, myocardial infarction or stroke, were assessed using hazard ratios (HR) and 95% confidence intervals (CI) adjusting for traditional cardiovascular risk factors (age, sex, smoking, diabetes, hypertension, low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C] and triglycerides. RESULTS Lp(a) levels range between 2.5 and 132 mg/dL with a median value of 6 mg/dL and a mean value of 14.2 mg/dL. A total of 276 patients (23.0%) had Lp(a) plasma levels ≥30 mg/dL. Patients with elevated Lp(a) were more likely to be of female gender and to have higher levels of total cholesterol, LDL-C, HDL-C and triglycerides. Higher Lp(a) was associated with failure to reach the LDL-C target <1.8 mmol/L at 1 year (HR 1.71, 95% CI 1.13-2.58, P = 0.01). No association was found between elevated Lp(a) and MACE at 1 year (HR 1.05, 95% CI 0.64-1.73), nor for Lp(a) tertiles (HR 0.82, 95% CI 0.52-1.28, P > 0.20) or standardized continuous variables (0.98, 95% CI 0.82-1.19 for each increase of standard deviation). CONCLUSIONS Our real-world data suggest high Lp(a) levels at time of angiography are not predictive for cardiovascular outcomes in patients otherwise medically well controlled, but might be useful to identify patients who would not be on LDL-C targets 1 year after ACS.
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Affiliation(s)
- Baris Gencer
- Cardiology Division, Geneva University Hospitals, Geneva, Switzerland
| | - Fabio Rigamonti
- Cardiology Division, Geneva University Hospitals, Geneva, Switzerland
| | - David Nanchen
- Department of Ambulatory Care and Community Medicine, Lausanne University, Lausanne, Switzerland
| | - Nicolas Vuilleumier
- Division of Laboratory Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Ilse Kern
- Division of Laboratory Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Soheila Aghlmandi
- Department of Clinical Research, Institute of Social and Preventive Medicine, and Clinical Trials Unit, University of Bern, Bern, Switzerland
| | - Roland Klingenberg
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Lorenz Räber
- Department of Cardiology, University Hospital of Bern, Bern, Switzerland
| | - Reto Auer
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - David Carballo
- Cardiology Division, Geneva University Hospitals, Geneva, Switzerland
| | - Sebastian Carballo
- Department of Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Dik Heg
- Department of Clinical Research, Institute of Social and Preventive Medicine, and Clinical Trials Unit, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, University Hospital of Bern, Bern, Switzerland
| | - Thomas Felix Lüscher
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland.,Cardiology, Royal Brompton and Harefield Hospital and Imperial College London, London, UK
| | - Christian M Matter
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - François Mach
- Cardiology Division, Geneva University Hospitals, Geneva, Switzerland
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Nanchen D, Klingenberg R, Gencer B, Räber L, Carballo D, von Eckardstein A, Windecker S, Rodondi N, Lüscher TF, Mach F, Muller O, Matter CM. Inflammation during acute coronary syndromes — Risk of cardiovascular events and bleeding. Int J Cardiol 2019; 287:13-18. [DOI: 10.1016/j.ijcard.2019.03.049] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 03/15/2019] [Accepted: 03/24/2019] [Indexed: 10/27/2022]
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46
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Xiao L, Jia Y, Wang X, Huang H. The impact of preoperative fibrinogen-albumin ratio on mortality in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Clin Chim Acta 2019; 493:8-13. [DOI: 10.1016/j.cca.2019.02.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 02/13/2019] [Accepted: 02/19/2019] [Indexed: 02/07/2023]
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47
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Gencer B, Vuilleumier N, Nanchen D, Collet TH, Klingenberg R, Räber L, Auer R, Carballo D, Carballo S, Aghlmandi S, Heg D, Windecker S, Lüscher TF, Matter CM, Rodondi N, Mach F. Prognostic value of total testosterone levels in patients with acute coronary syndromes. Eur J Prev Cardiol 2019; 28:235–242. [PMID: 33838041 DOI: 10.1177/2047487319853343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 05/07/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Endogenous testosterone levels decrease in men with aging. Controversies persist regarding the screening and treatment of low testosterone levels in patients with acute coronary syndromes (ACS). METHODS AND RESULTS Total serum testosterone levels were measured in 1054 men hospitalized for ACS that were part of a Swiss prospective cohort. Total testosterone levels were classified first in tertiles and using the cut-off of 300 ng/dL. Primary endpoint was all-cause mortality at one year. Cox regression models adjusting for the GRACE score (composite of age, heart rate systolic blood pressure, creatinine, cardiac arrest at admission, ST segment deviation, abnormal troponin enzyme and Killip classification), preexisting diabetes and inflammation (high-sensitivity C-reactive protein). A total of 430 men (40.8%) had total testosterone levels ≤300 ng/dL. Low total testosterone levels were correlated with lower high-density lipoprotein cholesterol and higher triglycerides, high-sensitivity C-reactive protein, high-sensitivity troponin T, N-terminal-pro B-type natriuretic peptide and glucose levels (all p < 0.01). Patients in the lowest testosterone tertile had a mortality rate at one-year of 5.4% compared with 2.9% in the highest tertile with an unadjusted hazard ratio of 1.92 (95% confidence interval 0.96-1.90, p = 0.095) and adjusted hazard ratio of 1.26 (95% confidence interval 0.57-2.78, p = 0.565). In an exploratory analysis, the highest mortality rate (10.3%) was observed in men aged >65 years old belonging to the lowest testosterone tertile. CONCLUSION In this large population of men with ACS, we found a prevalence of low total endogenous testosterone levels of almost 40%. However, low testosterone levels were not significantly associated with mortality after adjustment for high-risk confounders.
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Affiliation(s)
- Baris Gencer
- Cardiology Division, Geneva University Hospitals, Switzerland.,TIMI Study Group, Brigham and Women's Hospitals, Harvard Medical School, Boston, USA
| | | | - David Nanchen
- Department of Ambulatory Care and Community Medicine, Lausanne University, Switzerland
| | - Tinh-Hai Collet
- Service of Endocrinology, Diabetes and Metabolism, Department of Medicine, Lausanne University Hospital, University of Lausanne, Switzerland
| | - Roland Klingenberg
- Department of Cardiology, University Heart Centre, University of Zurich, Switzerland
| | - Lorenz Räber
- Department of Cardiology, University Hospital of Bern, Switzerland
| | - Reto Auer
- Institute of Primary Health Care (BIHAM), University of Bern, Switzerland
| | - David Carballo
- Cardiology Division, Geneva University Hospitals, Switzerland
| | - Sebastian Carballo
- Department of Internal Medicine, Geneva University Hospitals, Switzerland
| | - Soheila Aghlmandi
- Institute of Social and Preventive Medicine, and Clinical Trials Unit, Department of Clinical Research, University of Bern, Switzerland
| | - Dik Heg
- Institute of Social and Preventive Medicine, and Clinical Trials Unit, Department of Clinical Research, University of Bern, Switzerland
| | | | - Thomas F Lüscher
- Centre for Molecular Cardiology, University of Zurich, Switzerland.,Cardiology, Royal Brompton and Harefield Hospital and Imperial College London, UK
| | - Christian M Matter
- Service of Endocrinology, Diabetes and Metabolism, Department of Medicine, Lausanne University Hospital, University of Lausanne, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Switzerland.,Department of General Internal Medicine, University Hospital of Bern, Switzerland
| | - François Mach
- Cardiology Division, Geneva University Hospitals, Switzerland
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Celli BR, Anderson JA, Brook R, Calverley P, Cowans NJ, Crim C, Dixon I, Kim V, Martinez FJ, Morris A, Newby DE, Yates J, Vestbo J. Serum biomarkers and outcomes in patients with moderate COPD: a substudy of the randomised SUMMIT trial. BMJ Open Respir Res 2019; 6:e000431. [PMID: 31258919 PMCID: PMC6561388 DOI: 10.1136/bmjresp-2019-000431] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 03/29/2019] [Indexed: 11/25/2022] Open
Abstract
Rationale Systemic levels of C reactive protein (CRP), surfactant protein D (SPD), fibrinogen, soluble receptor of activated glycogen end-product (sRAGE) and club cell protein 16 (CC-16) have been associated with chronic obstructive pulmonary disease (COPD) outcomes. However, they require validation in different cohorts. Objectives Relate systemic levels of those proteins to forced expiratory volume in 1 s (FEV1) decline, exacerbations, hospitalisations and mortality in COPD patients (FEV1 of ≥50 and ≤70% predicted) and heightened cardiovascular risk in a substudy of the Study to Understand Mortality and MorbidITy trial. Methods Participants were randomised to daily inhalations of placebo, vilanterol 25 µg (VI), fluticasone furoate 100 µg (FF) or their combination (VI 25/FF 100) and followed quarterly until 1000 deaths in the overall 16 485 participants occurred. Biomarker blood samples were available from 1673 patients. The FEV1 decline (mL/year), COPD exacerbations, hospitalisations and death were determined. Associations between biomarker levels and outcomes were adjusted by age and gender. Results Systemic levels of CC-16, CRP, sRAGE, SPD and fibrinogen did not relate to baseline FEV1, FEV1 decline, exacerbations or hospitalisations. Fibrinogen and CRP were related to mortality over a median follow-up of 2.3 years. Only the CC-16 changed with study therapy (VI, FF and FF/VI, p<0.01) at 3 months. Conclusions In COPD, systemic levels of CC-16, CRP, sRAGE, SPD and fibrinogen were not associated with FEV1 decline, exacerbations or hospitalisations. These results cast doubts about the clinical usefulness of the systemic levels of these proteins as surrogate markers of these COPD outcomes. The study confirms that CRP and fibrinogen are associated with increased risk of death in patients with COPD. Trial registration number NCT01313676.
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Affiliation(s)
- Bartolome R Celli
- Pulmonary and Critical Care Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Julie A Anderson
- Research & Development, GlaxoSmithKline Plc Stockley Park, Uxbridge, Middlesex, UK
| | - Robert Brook
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Peter Calverley
- Department of Medicine, Clinical Sciences Centre, University of Liverpool, University Hospital Aintree, Liverpool, Liverpool, UK
| | - Nicholas J Cowans
- GlaxoSmithKline Plc Stockley Park, Uxbridge, Middlesex, UK
- Veramed Ltd, Twickenham, UK
| | - Courtney Crim
- GlaxoSmithKline Research Triangle Park, Research Triangle Park, North Carolina, USA
| | - Ian Dixon
- GlaxoSmithKline Plc Stockley Park, Uxbridge, Middlesex, UK
- Veramed Ltd, Twickenham, UK
| | - Victor Kim
- Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Fernando J Martinez
- Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine Samuel J Wood Library, New York City, New York, USA
| | - Andrea Morris
- GlaxoSmithKline Research Triangle Park, Research Triangle Park, North Carolina, USA
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, Edinburgh, UK
| | - Julie Yates
- GlaxoSmithKline Research Triangle Park, Research Triangle Park, North Carolina, USA
| | - Joergen Vestbo
- Division of Infection, Immunity and Respiratory Medicine and Allergy, Manchester Academic Health Science Centre, The University of Manchester, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
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49
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The Glasgow prognostic score as a significant predictor of clinical outcomes in patients with acute coronary syndrome. J Cardiol 2019; 74:130-135. [PMID: 30878352 DOI: 10.1016/j.jjcc.2019.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 11/17/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Many studies have reported both systemic inflammatory response and malnutrition provide valuable predictions of prognosis in patients with acute coronary syndrome (ACS). This study aims to assess the association between the Glasgow prognostic score (GPS) by combining C-reactive protein and serum albumin concentration, and clinical outcomes in patients with ACS. METHODS This retrospective study included patients admitted for ACS between June 2010 and May 2013 in St. Vincent's Hospital, The Catholic University of Korea. In this study, high GPS was defined as a GPS≥1. Primary outcomes were 12-month all-cause and cardiovascular mortality, stroke, stent thrombosis and target vessel revascularization. We used an inverse probability of treatment weighting (IPTW) analysis to adjust for potential confounding covariates and presented event rates with Kaplan-Meier curves. RESULTS Total 593 patients were included and follow-up for a median 3.7 years. The patients were classified into two groups: GPS=0 (n=424, 71.5%) and GPS≥1 (n=169, 28.5%). The incidences of primary outcomes were 4% and 8.9% for the GPS=0 and GPS≥1, respectively. The primary outcomes and all-cause mortality difference between the two groups were significantly within 1 month in the Kaplan-Meier curve analysis (log rank p<0.001, log rank p<0.001, respectively). IPTW analysis showed high GPS was independently associated with higher incidence of primary outcomes (HR: 2.206; 95% CI: 1.085-4.486; p=0.029), higher all-cause mortality (HR: 5.963; 95% CI: 2.068-17.190; p<0.001) and higher cardiovascular mortality (HR: 6.122; 95% CI: 1.882-19.914; p=0.003). CONCLUSIONS High GPS is independently associated with both total and cardiovascular mortality in patients with ACS. Hence, GPS could be helpful in predicting mortality in ACS patients.
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50
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Deng XN, Wang XY, Yu HY, Chen SM, Xu XY, Huai W, Liu GH, Ma QB, Zhang YY, Dart AM, Du XJ, Gao W. Admission macrophage migration inhibitory factor predicts long-term prognosis in patients with ST-elevation myocardial infarction. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2019; 4:208-219. [PMID: 29726987 DOI: 10.1093/ehjqcco/qcy020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 05/01/2018] [Indexed: 01/21/2023]
Abstract
Aims We previously showed in patients with ST-segment elevated myocardial infarction (STEMI) that admission levels of macrophage migration inhibitory factor (MIF) predict infarct size. We studied whether admission MIF alone or in combination with other biomarkers is useful for risk assessment of acute and chronic clinical outcomes in STEMI patients. Methods and results A total of 658 STEMI patients treated with primary percutaneous coronary intervention (PCI) were consecutively recruited. MIF level was determined at admission and echocardiography performed on day-3 and then 12 months post-MI. Patients were followed for a median period of 64 months. Major endpoints included ST-segment resolution, all-cause mortality, and major adverse cardiovascular events (MACE). High MIF level was associated with larger enzymatic infarct size, incomplete resolution of ST-segment elevation post-PCI, impaired left ventricular ejection fraction (LVEF), and poorer improvement of LVEF (all P < 0.001). After adjustment for classical risk factors standard biomarkers and day-3 LVEF, admission MIF remained independently prognostic for all-cause mortality [hazard ratio (HR) 2.27, 95% confidence interval (CI) 1.43-3.22], and MACE (HR 1.39, 95% CI 1.12-1.71, both P < 0.05). MIF was a significant additive predictor of all-cause mortality with a net reclassification improvement of 0.34 (P = 0.02). Furthermore, patients in high tertile of both admission MIF and day-3 Nt-proBNP had the highest mortality risk relative to other tertile groups (HR 11.28, 95% CI 4.82-26.94; P < 0.001). Conclusion STEMI patients with high admission MIF level experienced a poorer recovery of cardiac function and worse long-term adverse outcomes. Combination of Nt-proBNP with MIF further improves prognostic capability.
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Affiliation(s)
- Xiang-Ning Deng
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, 49 Hua Yuan Bei Lu, Hai Dian District, Beijing, China.,Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Ministry of Health, Beijing, China.,Key Laboratory of Molecular Science, Ministry of Education, Beijing, China.,Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, China
| | - Xin-Yu Wang
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, 49 Hua Yuan Bei Lu, Hai Dian District, Beijing, China.,Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Ministry of Health, Beijing, China.,Key Laboratory of Molecular Science, Ministry of Education, Beijing, China.,Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, China
| | - Hai-Yi Yu
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, 49 Hua Yuan Bei Lu, Hai Dian District, Beijing, China.,Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Ministry of Health, Beijing, China.,Key Laboratory of Molecular Science, Ministry of Education, Beijing, China.,Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, China
| | - Shao-Min Chen
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, 49 Hua Yuan Bei Lu, Hai Dian District, Beijing, China.,Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Ministry of Health, Beijing, China.,Key Laboratory of Molecular Science, Ministry of Education, Beijing, China.,Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, China
| | - Xin-Ye Xu
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, 49 Hua Yuan Bei Lu, Hai Dian District, Beijing, China.,Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Ministry of Health, Beijing, China.,Key Laboratory of Molecular Science, Ministry of Education, Beijing, China.,Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, China
| | - Wei Huai
- Department of Emergency, Peking University Third Hospital, Beijing, China
| | - Gui-Hua Liu
- Department of Emergency, Peking University Third Hospital, Beijing, China
| | - Qing-Bian Ma
- Department of Emergency, Peking University Third Hospital, Beijing, China
| | - You-Yi Zhang
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, 49 Hua Yuan Bei Lu, Hai Dian District, Beijing, China.,Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Ministry of Health, Beijing, China.,Key Laboratory of Molecular Science, Ministry of Education, Beijing, China.,Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, China
| | - Anthony M Dart
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Victoria, Australia.,Department of Cardiovascular Medicine, the Alfred Hospital and Central Clinical School, Monash University, 75 Commercial Road, Melbourne, Australia
| | - Xiao-Jun Du
- Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Ministry of Health, Beijing, China.,Key Laboratory of Molecular Science, Ministry of Education, Beijing, China.,Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, China.,Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Victoria, Australia
| | - Wei Gao
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, 49 Hua Yuan Bei Lu, Hai Dian District, Beijing, China.,Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Ministry of Health, Beijing, China.,Key Laboratory of Molecular Science, Ministry of Education, Beijing, China.,Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, China
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