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Dawson LP, Rashid M, Dinh DT, Brennan A, Bloom JE, Biswas S, Lefkovits J, Shaw JA, Chan W, Clark DJ, Oqueli E, Hiew C, Freeman M, Taylor AJ, Reid CM, Ajani AE, Kaye DM, Mamas MA, Stub D. No-Reflow Prediction in Acute Coronary Syndrome During Percutaneous Coronary Intervention: The NORPACS Risk Score. Circ Cardiovasc Interv 2024; 17:e013738. [PMID: 38487882 DOI: 10.1161/circinterventions.123.013738] [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: 10/18/2023] [Accepted: 01/31/2024] [Indexed: 04/18/2024]
Abstract
BACKGROUND Suboptimal coronary reperfusion (no reflow) is common in acute coronary syndrome percutaneous coronary intervention (PCI) and is associated with poor outcomes. We aimed to develop and externally validate a clinical risk score for angiographic no reflow for use following angiography and before PCI. METHODS We developed and externally validated a logistic regression model for prediction of no reflow among adult patients undergoing PCI for acute coronary syndrome using data from the Melbourne Interventional Group PCI registry (2005-2020; development cohort) and the British Cardiovascular Interventional Society PCI registry (2006-2020; external validation cohort). RESULTS A total of 30 561 patients (mean age, 64.1 years; 24% women) were included in the Melbourne Interventional Group development cohort and 440 256 patients (mean age, 64.9 years; 27% women) in the British Cardiovascular Interventional Society external validation cohort. The primary outcome (no reflow) occurred in 4.1% (1249 patients) and 9.4% (41 222 patients) of the development and validation cohorts, respectively. From 33 candidate predictor variables, 6 final variables were selected by an adaptive least absolute shrinkage and selection operator regression model for inclusion (cardiogenic shock, ST-segment-elevation myocardial infarction with symptom onset >195 minutes pre-PCI, estimated stent length ≥20 mm, vessel diameter <2.5 mm, pre-PCI Thrombolysis in Myocardial Infarction flow <3, and lesion location). Model discrimination was very good (development C statistic, 0.808; validation C statistic, 0.741) with excellent calibration. Patients with a score of ≥8 points had a 22% and 27% risk of no reflow in the development and validation cohorts, respectively. CONCLUSIONS The no-reflow prediction in acute coronary syndrome risk score is a simple count-based scoring system based on 6 parameters available before PCI to predict the risk of no reflow. This score could be useful in guiding preventative treatment and future trials.
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Affiliation(s)
- Luke P Dawson
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (L.P.D., D.T.D., A.B., S.B., J.L., W.C., C.M.R., A.E.A., D.S.)
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia (L.P.D., J.E.B., J.A.S., A.J.T., D.M.K., D.S.)
- The Baker Institute, Melbourne, Victoria, Australia (L.P.D., J.E.B., J.A.S., D.M.K., D.S.)
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Stroke on Trent, United Kingdom (M.R., A.E.A., M.A.M.)
- Department of Cardiovascular Sciences, National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester, United Kingdom (M.R., A.E.A.)
- University Hospitals of Leicester National Health Service (NHS) Trust, United Kingdom (M.R., A.E.A.)
| | - Diem T Dinh
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (L.P.D., D.T.D., A.B., S.B., J.L., W.C., C.M.R., A.E.A., D.S.)
| | - Angela Brennan
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (L.P.D., D.T.D., A.B., S.B., J.L., W.C., C.M.R., A.E.A., D.S.)
| | - Jason E Bloom
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia (L.P.D., J.E.B., J.A.S., A.J.T., D.M.K., D.S.)
- The Baker Institute, Melbourne, Victoria, Australia (L.P.D., J.E.B., J.A.S., D.M.K., D.S.)
| | - Sinjini Biswas
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (L.P.D., D.T.D., A.B., S.B., J.L., W.C., C.M.R., A.E.A., D.S.)
| | - Jeffrey Lefkovits
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (L.P.D., D.T.D., A.B., S.B., J.L., W.C., C.M.R., A.E.A., D.S.)
- Department of Cardiology, Royal Melbourne Hospital, Victoria, Australia (J.L.)
| | - James A Shaw
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia (L.P.D., J.E.B., J.A.S., A.J.T., D.M.K., D.S.)
- The Baker Institute, Melbourne, Victoria, Australia (L.P.D., J.E.B., J.A.S., D.M.K., D.S.)
| | - William Chan
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (L.P.D., D.T.D., A.B., S.B., J.L., W.C., C.M.R., A.E.A., D.S.)
- Department of Medicine, Melbourne University, Victoria, Australia (W.C.)
| | - David J Clark
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia (D.J.C.)
| | - Ernesto Oqueli
- Department of Cardiology, Grampians Health Ballarat, Victoria, Australia (E.O.)
- School of Medicine, Faculty of Health, Deakin University, Geelong, Victoria, Australia (E.O.)
| | - Chin Hiew
- Department of Cardiology, University Hospital Geelong, Victoria, Australia (C.H.)
| | - Melanie Freeman
- Department of Cardiology, Box Hill Hospital, Melbourne, Victoria, Australia (M.F.)
| | - Andrew J Taylor
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia (L.P.D., J.E.B., J.A.S., A.J.T., D.M.K., D.S.)
| | - Christopher M Reid
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (L.P.D., D.T.D., A.B., S.B., J.L., W.C., C.M.R., A.E.A., D.S.)
- Centre of Clinical Research and Education, School of Public Health, Curtin University, Perth, Western Australia, Australia (C.M.R.)
| | - Andrew E Ajani
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (L.P.D., D.T.D., A.B., S.B., J.L., W.C., C.M.R., A.E.A., D.S.)
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Stroke on Trent, United Kingdom (M.R., A.E.A., M.A.M.)
- Department of Cardiovascular Sciences, National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester, United Kingdom (M.R., A.E.A.)
- University Hospitals of Leicester National Health Service (NHS) Trust, United Kingdom (M.R., A.E.A.)
| | - David M Kaye
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia (L.P.D., J.E.B., J.A.S., A.J.T., D.M.K., D.S.)
- The Baker Institute, Melbourne, Victoria, Australia (L.P.D., J.E.B., J.A.S., D.M.K., D.S.)
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Stroke on Trent, United Kingdom (M.R., A.E.A., M.A.M.)
| | - Dion Stub
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (L.P.D., D.T.D., A.B., S.B., J.L., W.C., C.M.R., A.E.A., D.S.)
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia (L.P.D., J.E.B., J.A.S., A.J.T., D.M.K., D.S.)
- The Baker Institute, Melbourne, Victoria, Australia (L.P.D., J.E.B., J.A.S., D.M.K., D.S.)
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Harbalıoğlu H, Genç Ö, Alıcı G, Quisi A, Yıldırım A. Impact of HAT 2CH 2 Score on the Development of No-Reflow Phenomenon in Patients With ST-Segment Elevation Myocardial Infarction. Angiology 2024; 75:44-53. [PMID: 37249481 DOI: 10.1177/00033197231171235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The HAT2CH2 score [Hypertension (1 point), Age > 75 years (1 point), Stroke/Transient ischemic attack (2 points), Chronic obstructive pulmonary disease (1 point), and Heart failure (2 points)] was originally developed to predict the occurrence of new-onset atrial fibrillation. The aim of the present study was to examine whether this score could predict the development of no-reflow phenomenon (NR) in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI). Patients (n = 1552) with STEMI were consecutively enrolled in this single-center retrospective study. The SYNTAX score (SXscore) and HAT2CH2 score were calculated. The presence of thrombolysis in myocardial infarction (TIMI) score ≤2, without significant residual stenosis and mechanical obstruction, indicated the presence of NR. The HAT2CH2 score was significantly higher in the NR (+) group compared with the NR (-) group [2.29 ± 1.43 vs 1.46 ± 1.24, p < .001]. In multivariable logistic regression analysis, the HAT2CH2 score [OR = 1.585, p < .001] and SXscore [OR = 1.028, p = .017] were found to be independent predictors of NR. Receiver operating characteristic curve analysis showed that the HAT2CH2 score with a cutoff value of >2 determined NR, with 50.2% sensitivity and 79.4% specificity (AUC = .669, p < .001). In conclusion, the HAT2CH2 score may facilitate risk stratification in estimating NR in STEMI patients undergoing pPCI.
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Affiliation(s)
- Hazar Harbalıoğlu
- Department of Cardiology, Hatay Iskenderun State Hospital, Hatay, Turkey
| | - Ömer Genç
- Department of Cardiology, Basaksehir Cam & Sakura City Hospital, Istanbul, Turkey
| | - Gökhan Alıcı
- University of Health Sciences, Department of Cardiology, Adana City Training & Research Hospital, Adana, Turkey
| | - Alaa Quisi
- Department of Cardiology, Medline Adana Hospital, Adana, Turkey
| | - Abdullah Yıldırım
- University of Health Sciences, Department of Cardiology, Adana City Training & Research Hospital, Adana, Turkey
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Genç Ö, Yildirim A, Alici G, Harbalioğlu H, Quisi A, Erdoğan A, Ibişoğlu E, Bilen MN, Çetin İ, Güler Y, Şeker T, Güler A. Thromboembolic risk scores in patients with non-obstructive coronary architecture with and without coronary slow flow: A case-control study. Int J Cardiol 2023:S0167-5273(23)00701-5. [PMID: 37178798 DOI: 10.1016/j.ijcard.2023.05.011] [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: 02/04/2023] [Revised: 04/17/2023] [Accepted: 05/10/2023] [Indexed: 05/15/2023]
Abstract
AIM Coronary slow flow phenomenon (CSFP) detected on coronary angiography (CA) has been related to poor prognosis. We sought to examine the relationship between thromboembolic risk scores, routinely used in cardiology practice, and CSFP. METHODS This single-center, retrospective, case-control study comprised 505 individuals suffering from angina and had verified ischemia between January 2021 and January 2022. Demographic and laboratory parameters were obtained from the hospital database. The following risk scores were calculated; CHA2DS2-VASc, M-CHA2DS2-VASc, CHA2DS2-VASc-HS, R2-CHA2DS2-VASc, M-R2-CHA2DS2-VASc, ATRIA, M-ATRIA, M-ATRIA-HSV. The overall population was divided into two groups; coronary slow flow and coronary normal flow. Multivariable logistic regression was performed to compare risk scores between patients with and without CSFP. Pairwise comparisons were then undertaken to test performance in determining CSFP. RESULTS The mean age was 51.7 ± 10.7 years, of whom 63.2% were male. CSFP was detected in 222 patients. Those with CSFP had higher rates of male gender, diabetes, smoking, hyperlipidemia, and vascular disease. All scores were higher in CSFP patients. Multivariable logistic regression analysis found that CHA2DS2-VASc-HS score was the most powerful determinant of CSFP among all risk schemes (for each one-point increase in score OR = 1.90, p < 0.001; for score of 2-3 OR = 5.20, p < 0.001; for score of >4 OR = 13.89, p < 0.001). Also, the CHA2DS2-VASc-HS score provided the best discriminative performance, with a cut-off value of ≥2 in identifying CSFP (AUC = 0.759, p < 0.001). CONCLUSION We showed that thromboembolic risk scores may be associated with CSFP in patients with non-obstructive coronary architecture who underwent CA. The CHA2DS2-VASc-HS score had the best discriminative ability.
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Affiliation(s)
- Ömer Genç
- Basaksehir Cam & Sakura City Hospital, Department of Cardiology, Istanbul, Turkey.
| | - Abdullah Yildirim
- University of Health Sciences, Adana City Training & Research Hospital, Department of Cardiology, Adana, Turkey
| | - Gökhan Alici
- University of Health Sciences, Adana City Training & Research Hospital, Department of Cardiology, Adana, Turkey
| | - Hazar Harbalioğlu
- Hatay Iskenderun State Hospital, Department of Cardiology, Hatay, Turkey
| | - Alaa Quisi
- Medline Hospital Adana, Department of Cardiology, Adana, Turkey
| | - Aslan Erdoğan
- Basaksehir Cam & Sakura City Hospital, Department of Cardiology, Istanbul, Turkey
| | - Ersin Ibişoğlu
- Basaksehir Cam & Sakura City Hospital, Department of Cardiology, Istanbul, Turkey
| | - Mehmet Nail Bilen
- Basaksehir Cam & Sakura City Hospital, Department of Cardiology, Istanbul, Turkey
| | - İlyas Çetin
- Basaksehir Cam & Sakura City Hospital, Department of Cardiology, Istanbul, Turkey
| | - Yeliz Güler
- Basaksehir Cam & Sakura City Hospital, Department of Cardiology, Istanbul, Turkey
| | - Taner Şeker
- University of Health Sciences, Adana City Training & Research Hospital, Department of Cardiology, Adana, Turkey
| | - Ahmet Güler
- Basaksehir Cam & Sakura City Hospital, Department of Cardiology, Istanbul, Turkey
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Li Q, Xie E, Tu Y, Wu Y, Guo Z, Li P, Li Y, Yu X, Ye Z, Yu C, Gao Y, Jingang Z. Association between kaolin-induced maximum amplitude and slow-flow/no-reflow in ST elevation myocardial infarction patients treated with primary percutaneous coronary intervention. Int J Cardiol 2022; 369:13-18. [PMID: 35970443 DOI: 10.1016/j.ijcard.2022.08.025] [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: 04/12/2022] [Revised: 07/08/2022] [Accepted: 08/10/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND ST-segment elevation myocardial infarction (STEMI) patients with a high thrombus burden have a relatively high slow-flow/no-reflow risk. However, the association between kaolin-induced maximum amplitude (MAthrombin) and slow-flow/no-reflow has been scarcely explored. METHODS STEMI patients treated with primary percutaneous coronary intervention (PCI) were retrospectively enrolled from January 2015 to December 2019 at China-Japan Friendship Hospital. MAthrombin levels were measured using thromboelastography before the PCI procedure. The patients were divided into two groups according to thrombolysis in myocardial infarction (TIMI) flow grade after primary PCI: the normal flow group (TIMI flow grade = 3) and slow-flow/no-reflow (TIMI flow grade ≤ 2). The logistic regression model and restricted cubic spline regression (RCS) were used to analyze the predictive value of MAthrombin for slow-flow/no-reflow. All patients were followed up after discharge and observed the adverse cardiovascular events between the two groups. RESULTS A total of 690 patients were enrolled, with 108(15.7%) having slow-flow/no-reflow. The multivariate logistic regression model analysis showed that MAthrombin level was an independent risk factor for slow-flow/no-reflow. The RCS analysis showed a nonlinear relationship between MAthrombin levels and slow-flow/no-reflow. The cut-off value of MAthrombin levels for predicting slow-flow/no-reflow was 68 mm. During a median follow-up time of 4.4 years, slow-flow/no-reflow (hazard ratio 1.93, 95% confidence interval 1.27-2.93, P = 0.002) and MAthrombin levels (hazard ratio 1.06, 95% confidence interval 1.03-1.08, P < 0.001) were independent risk factors for predicting the long-term of adverse clinical cardiovascular events. CONCLUSION MAthrombin was an independent risk factor for predicting slow-flow/ no-reflow in STEMI patients who underwent primary PCI.
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Affiliation(s)
- Qing Li
- Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China; Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Enmin Xie
- China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, China; Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Yimin Tu
- China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, China; Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Yaxin Wu
- Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China; Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Ziyu Guo
- Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China; Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Peizhao Li
- Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China; Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Yike Li
- China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, China; Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Xiaozhai Yu
- China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, China; Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Zixiang Ye
- Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China; Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Changan Yu
- Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Yanxiang Gao
- Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China; Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China.
| | - Zheng Jingang
- Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China; China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, China; Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China.
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5
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Deng L, Zhao X, Su X, Zhou M, Huang D, Zeng X. Machine learning to predict no reflow and in-hospital mortality in patients with ST-segment elevation myocardial infarction that underwent primary percutaneous coronary intervention. BMC Med Inform Decis Mak 2022; 22:109. [PMID: 35462531 PMCID: PMC9036765 DOI: 10.1186/s12911-022-01853-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 04/19/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The machine learning algorithm (MLA) was implemented to establish an optimal model to predict the no reflow (NR) process and in-hospital death that occurred in ST-elevation myocardial infarction (STEMI) patients who underwent primary percutaneous coronary intervention (pPCI). METHODS The data were obtained retrospectively from 854 STEMI patients who underwent pPCI. MLA was applied to predict the potential NR phenomenon and confirm the in-hospital mortality. A random sampling method was used to split the data into the training (66.7%) and testing (33.3%) sets. The final results were an average of 10 repeated procedures. The area under the curve (AUC) and the associated 95% confidence intervals (CIs) of the receiver operator characteristic were measured. RESULTS A random forest algorithm (RAN) had optimal discrimination for the NR phenomenon with an AUC of 0.7891 (95% CI: 0.7093-0.8688) compared with 0.6437 (95% CI: 0.5506-0.7368) for the decision tree (CTREE), 0.7488 (95% CI: 0.6613-0.8363) for the support vector machine (SVM), and 0.681 (95% CI: 0.5767-0.7854) for the neural network algorithm (NNET). The optimal RAN AUC for in-hospital mortality was 0.9273 (95% CI: 0.8819-0.9728), for SVM, 0.8935 (95% CI: 0.826-0.9611); NNET, 0.7756 (95% CI: 0.6559-0.8952); and CTREE, 0.7885 (95% CI: 0.6738-0.9033). CONCLUSIONS The MLA had a relatively higher performance when evaluating the NR risk and in-hospital mortality in patients with STEMI who underwent pPCI and could be utilized in clinical decision making.
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Affiliation(s)
- Lianxiang Deng
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi, China
- Department of Cardiology, The Second People's Hospital of Nanning, Guangxi, China
| | - Xianming Zhao
- Department of Cardiology, The First People's Hospital of Nanning, Guangxi, China
| | - Xiaolin Su
- Department of Cardiology, Guangxi Zhuang Autonomous Region People's Hospital, Nanning, Guangxi, China
| | - Mei Zhou
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi, China
- Guangxi Key Laboratory Base of Precision Medicine in Cardio-Cerebrovascular Diseases Control and Prevention and Guangxi Clinical Research Center for Cardio-Cerebrovascular Diseases, Nanning, Guangxi, China
| | - Daizheng Huang
- School of Basic Medical Sciences, Guangxi Medical University, 22 Shuangyong Road, Nanning, Guangxi, China.
| | - Xiaocong Zeng
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi, China.
- Guangxi Key Laboratory Base of Precision Medicine in Cardio-Cerebrovascular Diseases Control and Prevention and Guangxi Clinical Research Center for Cardio-Cerebrovascular Diseases, Nanning, Guangxi, China.
- School of Basic Medical Sciences, Guangxi Medical University, 22 Shuangyong Road, Nanning, Guangxi, China.
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Liu J, Ma Y, Bu H, Qin W, Shi F, Zhang Y. Predictive Value of CHA2DS2 -VASc-HSF Score for Severity of Acute Coronary Syndrome. Clin Appl Thromb Hemost 2022; 28:10760296211073969. [PMID: 35060399 PMCID: PMC8796080 DOI: 10.1177/10760296211073969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
CHADS2 and CHA2DS2-VASc scores have been used to assess the prognostic risk of thromboembolism in non-valvular atrial fibrillation patients. Recent studies have shown the utility of CHADS2 and CHA2DS2-VASc scores for evaluating the severity of coronary artery disease (CAD). The newly defined CHA2DS2-VASc-HSF score evaluates atherosclerosis and is associated with CAD severity. This study investigated the association between the CHA2DS2-VASc-HSF score and acute coronary syndrome (ACS) severity as assessed by the Gensini score and the number of vessels. Furthermore, this study also compared the diagnostic value of the CHADS2, CHA2 DS2-VASc, and CHA2DS2-VASc-HSF score for ACS. A total of 2367 eligible inpatients (ACS group [n = 2030]; non-CAD group [n = 337]) were consecutively enrolled in this study. Receiver operating characteristic curve diagnostic tests and logistic regression models were used to analyze the risk factors for ACS. The CHADS2, CHA2DS2-VASc, and CHA2DS2-VASc-HSF scores were significantly higher in the ACS group than those in the control group. After adjusting for numerous traditional CAD risk factors, an increased CHA2DS2-VASc-HSF score was found to be an independent risk factor for patients with ACS (odds ratio 1.401, 95% confidence interval 1.044, −1.879; P < 0.05). A newly diagnosed CHA2DS2-VASc-HSF score predicts the severity of ACS.
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Affiliation(s)
- Jingyi Liu
- Chengde Medical University Affiliated Hospital, Chengde, HeBei, 067000, China
| | - Yang Ma
- Chengde Medical University Affiliated Hospital, Chengde, HeBei, 067000, China
| | - Haiwei Bu
- Chengde Medical University Affiliated Hospital, Chengde, HeBei, 067000, China
| | - Wei Qin
- Chengde Medical University Affiliated Hospital, Chengde, HeBei, 067000, China
| | - Fei Shi
- Chengde Medical University Affiliated Hospital, Chengde, HeBei, 067000, China
| | - Ying Zhang
- Chengde Medical University Affiliated Hospital, Chengde, HeBei, 067000, China
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7
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Sanlialp SC, Sanlialp M, Guler S. CHA2DS2-VASc-HSF Score may Better Predict the Development of Total Coronary Artery Occlusion in Acute Coronary Syndrome. Angiology 2021; 73:387-388. [PMID: 34411496 DOI: 10.1177/00033197211040348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Sara C Sanlialp
- The Department of Cardiology, 430817Servergazi State Hospital, Denizli, Turkey
| | - Musa Sanlialp
- The Department of Cardiology, 558907Denizli State Hospital, Denizli, Turkey
| | - Serdar Guler
- The Department of Cardiology, Acıpayam State Hospital, Denizli, Turkey
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8
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Abacioglu OO, Yildirim A, Koyunsever NY, Kilic S. The ATRIA and Modified-ATRIA Scores in Evaluating the Risk of No-Reflow in Patients With STEMI Undergoing Primary Percutaneous Coronary Intervention. Angiology 2021; 73:79-84. [PMID: 34180260 DOI: 10.1177/00033197211026420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The no-reflow (NR) phenomenon is frequently encountered in acute coronary syndrome. We evaluated the association between anticoagulation and risk factors in atrial fibrillation (ATRIA) and modified ATRIA risk scores and NR in ST-elevation myocardial infarction (STEMI). Consecutive patients (n = 551) who underwent primary percutaneous coronary intervention between December 2019 and June 2020 due to STEMI were included. The mean age of the patients was 60.5 ± 10.8 years (n = 369, 67% male). The ATRIA and modified anticoagulation and risk factors in atrial fibrillation-hyperlipidemia, smoking, male (m-ATRIA-HS) scores were calculated. The NR group had higher frequency of diabetes mellitus (DM), serum creatine kinase-MB (CK-MB) levels, and corrected thrombolysis in myocardial infarction frame count (cTFC) (P = .002, P = .006, and P < .001, respectively). In regression analysis, ATRIA, m-ATRIA-HS, thrombus grade, and cTFC were independent predictors of NR. Age, higher CK-MB, and neutrophil-to-lymphocyte ratio and DM were the other predictors for NR. Pairwise comparison of receiver operating characteristics curve analysis showed that the m-ATRIA-HS (>2, area under curve [AUC]: 0.715) has better performance than ATRIA score (>1, AUC: 0.656), with a P < .022 and z statistics 2.279. In conclusion, ATRIA, especially the m-ATRIA-HS, can be used to evaluate NR risk in STEMI.
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Affiliation(s)
- Ozge Ozcan Abacioglu
- Department of Cardiology, Health Sciences University, Adana Research and Training Hospital, Adana, Turkey
| | - Arafat Yildirim
- Department of Cardiology, Health Sciences University, Adana Research and Training Hospital, Adana, Turkey
| | - Nermin Yildiz Koyunsever
- Department of Cardiology, Health Sciences University, Adana Research and Training Hospital, Adana, Turkey
| | - Salih Kilic
- Department of Cardiology, Health Sciences University, Adana Research and Training Hospital, Adana, Turkey
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Song NP, Zhen XW, Li LD, Zhong L, Wang H, An Y. Plasma calprotectin was associated with platelet activation and no-reflow phenomenon in acute coronary syndrome. BMC Cardiovasc Disord 2020; 20:443. [PMID: 33036574 PMCID: PMC7547482 DOI: 10.1186/s12872-020-01717-5] [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: 06/07/2020] [Accepted: 09/30/2020] [Indexed: 12/15/2022] Open
Abstract
Background No-reflow occurs in 3–4% of all percutaneous coronary interventions (PCIs) and has a strong negative impact on clinical outcomes of acute coronary syndrome (ACS). Therefore, the discovery of a biomarker that can early predict the occurrence of no-reflow has great clinical significance. Multiple factors including platelet activation are relevant to no-reflow. Calprotectin is found to be a biomarker of plaque instability and is identified to be a novel diagnostic and prognostic biomarker of cardiovascular diseases. The association of plasma calprotectin with platelet activation and no-reflow phenomenon in ACS is not clear. Methods In this prospective study performed at Yantai Yuhuangding Hospital from 2017 to 2018, a total of 176 Chinese patients with ACS who had undergone PCIs were recruited consecutively, aged from 30 to 88 years. Angiographic no-reflow was defined as thrombolysis in myocardial infarction grade less than 3. Blood samples were collected immediately at admission for the detection of plasma calprotectin and platelet–monocyte aggregates formation. Statistical analysis was performed for the variable’s comparisons between groups and the prediction value of plasma calprotectin for no-reflow. Results The mean age of the 176 included ACS patients were 64(±11) years and acute ST-segment elevation myocardial infarction (STEMI) was present in 41.5% of patients. Twenty-two patients had no-reflow during the PCI procedures and the prevalence was 12.5%. Patients with higher plasma calprotectin had a higher level of platelet–monocyte aggregates (PMA) and a higher prevalence of no-reflow (p < 0.001). The multivariate regression showed that plasma calprotectin and admission hs-cTnI were independently associated with PMA, while plasma calprotectin and serum LDL-c were independent predictors of no-reflow (p < 0.001 and p = 0.017). AUC of calprotectin for predicting no-reflow were 0.898. The cut-off value of plasma calprotectin for no-reflow was 4748.77 ng/mL with a sensitivity of 0.95 and a specificity of 0.77. Conclusion Plasma calprotectin was associated with platelet activation and may act as an early predictive biomarker of no-reflow in patients with acute coronary syndrome.
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Affiliation(s)
- Nian-Peng Song
- Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China.,Department of Cardiology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Qingdao University, Yantai, China
| | - Xiao-Wen Zhen
- Department of Diagnostics, BinZhou Medical University, Yantai, China
| | - Liu-Dong Li
- Department of Cardiology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Qingdao University, Yantai, China
| | - Lin Zhong
- Department of Cardiology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Qingdao University, Yantai, China
| | - Hua Wang
- Department of Cardiology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Qingdao University, Yantai, China
| | - Yi An
- Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China.
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