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Pareek M, Kristensen AMD, Vaduganathan M, Byrne C, Biering-Sørensen T, Højbjerg Lassen MC, Johansen ND, Skaarup KG, Rosberg V, Pallisgaard JL, Mortensen MB, Maeng M, Polcwiartek CB, Frangeskos J, McCarthy CP, Bonde AN, Lee CJY, Fosbøl EL, Køber L, Olsen NT, Gislason GH, Torp-Pedersen C, Bhatt DL, Kragholm KH. Serial troponin-I and long-term outcomes in subjects with suspected acute coronary syndrome. Eur J Prev Cardiol 2024; 31:615-626. [PMID: 38057157 DOI: 10.1093/eurjpc/zwad373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/28/2023] [Accepted: 11/30/2023] [Indexed: 12/08/2023]
Abstract
AIMS It is unclear how serial high-sensitivity troponin-I (hsTnI) concentrations affect long-term prognosis in individuals with suspected acute coronary syndrome (ACS). METHODS AND RESULTS Subjects who underwent two hsTnI measurements (Siemens TnI Flex® Reagent) separated by 1-7 h, during a first-time hospitalization for myocardial infarction, unstable angina, observation for suspected myocardial infarction, or chest pain from 2012 through 2019, were identified through Danish national registries. Individuals were stratified per their hsTnI concentration pattern (normal, rising, persistently elevated, or falling) and the magnitude of hsTnI concentration change (<20%, >20-50%, or >50% in either direction). We calculated absolute and relative mortality risks standardized to the distributions of risk factors for the entire study population. A total of 20 609 individuals were included of whom 2.3% had died at 30 days, and an additional 4.7% had died at 365 days. The standardized risk of death was highest among persons with a persistently elevated hsTnI concentration (0-30 days: 8.0%, 31-365 days: 11.1%) and lowest among those with two normal hsTnI concentrations (0-30 days: 0.5%, 31-365 days: 2.6%). In neither case did relative hsTnI concentration changes between measurements clearly affect mortality risk. Among persons with a rising hsTnI concentration pattern, 30-day mortality was higher in subjects with a >50% rise compared with those with a less pronounced rise (2.2% vs. <0.1%). CONCLUSION Among individuals with suspected ACS, those with a persistently elevated hsTnI concentration consistently had the highest risk of death. In subjects with two normal hsTnI concentrations, mortality was very low and not affected by the magnitude of change between measurements.
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Affiliation(s)
- Manan Pareek
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA, USA
| | | | - Muthiah Vaduganathan
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA, USA
| | - Christina Byrne
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Hellerup, Denmark
| | - Mats Christian Højbjerg Lassen
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Hellerup, Denmark
| | - Niklas Dyrby Johansen
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Hellerup, Denmark
| | - Kristoffer Grundtvig Skaarup
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Hellerup, Denmark
| | - Victoria Rosberg
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jannik L Pallisgaard
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Hellerup, Denmark
| | | | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark
| | | | - Julia Frangeskos
- Department of Cardiology, Peconic Bay Medical Center at Northwell Health, Riverhead, NY, USA
| | - Cian P McCarthy
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Anders Nissen Bonde
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Hellerup, Denmark
| | - Christina Ji-Young Lee
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Emil L Fosbøl
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Niels Thue Olsen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Hellerup, Denmark
| | - Gunnar H Gislason
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Hellerup, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Copenhagen University Hospital-North Zealand Hospital, Hillerød, Denmark
| | - Deepak L Bhatt
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, NewYork, NY, USA
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Rosberg V, Jessen M, Qvortrup C, Smith HG, Krarup PM. Impact of adjuvant chemotherapy on long-term overall survival in patients with high-risk stage II colon cancer: a nationwide cohort study. Acta Oncol 2023; 62:1076-1082. [PMID: 37725517 DOI: 10.1080/0284186x.2023.2251086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 07/11/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND This study aimed to investigate the impact of adjuvant chemotherapy on long-term survival in unselected patients with high-risk stage II colon cancer including an analysis of each high-risk feature. MATERIALS AND METHODS Data from the Danish Colorectal Cancer Group, the National Patient Registry and the Danish Pathology Registry from 2014 to 2018 were merged. Patients surviving > 90 days were included. High-risk features were defined as emergency presentation, including self-expanding metal stents (SEMS)/loop-ostomy as a bridge to resection, grade B or C anastomotic leakage, pT4 tumors, lymph node yield < 12 or signet cell carcinoma. Eligibility criteria for chemotherapy were age < 75 years, proficient MMR gene expression, and performance status ≤ 2. The primary outcome was 5-year overall survival. Secondary outcomes included the proportion of eligible patients allocated for adjuvant chemotherapy and the time to first administration. RESULTS In total 939 of 3937 patients with stage II colon cancer had high-risk features, of whom 408 were eligible for chemotherapy. 201 (49.3%) patients received adjuvant chemotherapy, with a median time to first administration of 35 days after surgery. The crude 5-year overall survival was 84.9% in patients receiving adjuvant chemotherapy compared with 66.3% in patients not receiving chemotherapy, p < 0.001. This association corresponded to an absolute risk difference of 14%. CONCLUSION 5-year overall survival was significantly higher in patients with high-risk stage II colon cancer treated with adjuvant chemotherapy compared with no chemotherapy. Adjuvant treatment was given to less than half of the patients who were eligible for it.
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Affiliation(s)
- Victoria Rosberg
- Department. of Surgery K, Bispebjerg Hospital, Copenhagen, Denmark
| | - Mikkel Jessen
- Department. of Surgery K, Bispebjerg Hospital, Copenhagen, Denmark
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Rosberg V, Vishram-Nielsen JKK, Kristensen AMD, Pareek M, Sehested TS, Nilsson PM, Linneberg A, Palmieri L, Giampaoli S, Donfrancesco C, Kee F, Mancia G, Cesana G, Veronesi G, Grassi G, Kuulasmaa K, Salomaa V, Palosaari T, Sans S, Ferrieres J, Dallongeville J, Söderberg S, Moitry M, Drygas W, Tamosiunas A, Peters A, Brenner H, Schöttker B, Grimsgaard S, Biering-Sørensen T, Olsen MH. Simple cardiovascular risk stratification by replacing total serum cholesterol with anthropometric measures: The MORGAM prospective cohort project. Prev Med Rep 2022; 26:101700. [PMID: 35141116 PMCID: PMC8814644 DOI: 10.1016/j.pmedr.2022.101700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 01/15/2022] [Indexed: 11/29/2022] Open
Abstract
To assess whether anthropometric measures (body mass index [BMI], waist-hip ratio [WHR], and estimated fat mass [EFM]) are independently associated with major adverse cardiovascular events (MACE), and to assess their added prognostic value compared with serum total-cholesterol. The study population comprised 109,509 individuals (53% men) from the MORGAM-Project, aged 19–97 years, without established cardiovascular disease, and not on antihypertensive treatment. While BMI was reported in all, WHR and EFM were reported in ∼52,000 participants. Prognostic importance of anthropometric measurements and total-cholesterol was evaluated using adjusted Cox proportional-hazards regression, logistic regression, area under the receiver-operating-characteristic curve (AUCROC), and net reclassification improvement (NRI). The primary endpoint was MACE, a composite of stroke, myocardial infarction, or death from coronary heart disease. Age interacted significantly with anthropometric measures and total-cholesterol on MACE (P ≤ 0.003), and therefore age-stratified analyses (<50 versus ≥ 50 years) were performed. BMI, WHR, EFM, and total-cholesterol were independently associated with MACE (P ≤ 0.003) and resulted in significantly positive NRI when added to age, sex, smoking status, and systolic blood pressure. Only total-cholesterol increased discrimination ability (AUCROC difference; P < 0.001). In subjects < 50 years, the prediction model with total-cholesterol was superior to the model including BMI, but not superior to models containing WHR or EFM, while in those ≥ 50 years, the model with total-cholesterol was superior to all models containing anthropometric variables, whether assessed individually or combined. We found a potential role for replacing total-cholesterol with anthropometric measures for MACE-prediction among individuals < 50 years when laboratory measurements are unavailable, but not among those ≥ 50 years.
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Affiliation(s)
- Victoria Rosberg
- Department of Cardiology, North Zealand Hospital, Hillerød, Denmark
| | - Julie KK Vishram-Nielsen
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Copenhagen, Frederiksberg, Denmark
- Corresponding author at: Department of Cardiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark.
| | | | - Manan Pareek
- Department of Cardiology, North Zealand Hospital, Hillerød, Denmark
- Department of Internal Medicine, Yale New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
| | | | - Peter M Nilsson
- Department for Clinical Sciences Medicine, Lund University, Skane University Hospital, Malmö, Sweden
| | - Allan Linneberg
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Copenhagen, Frederiksberg, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Luigi Palmieri
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Simona Giampaoli
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Chiara Donfrancesco
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Frank Kee
- Centre for Public Health, The Queeńs University of Belfast, Northern Ireland
| | - Giuseppe Mancia
- University of Milano-Bicocca and Policlinico di Monza, Monza, Italy
| | - Giancarlo Cesana
- Research Centre on Public Health, University of Milano Bicocca, Villa Serena, Monza, Italy
| | - Giovanni Veronesi
- Research Centre in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, Italy
| | - Guido Grassi
- Clinica Medica, University Milano Bicocca, Monza, Italy
| | - Kari Kuulasmaa
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Veikko Salomaa
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Tarja Palosaari
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Susana Sans
- Catalan Department of Health, Barcelona, Spain
| | - Jean Ferrieres
- Department of Cardiology, Toulouse University School of Medicine, Rangueil Hospital, Toulouse Cedex 9, France
| | | | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Cardiology and Heart Centre, Umeå University, Umeå, Sweden
| | - Marie Moitry
- Department of Epidemiology and Public Health, University of Strasbourg and University Hospital of Strasbourg, Strasbourg, France
| | - Wojciech Drygas
- Department of Epidemiology, CVD Prevention and Health Promotion, National Institute of Cardiology, Warsaw, Poland
| | - Abdonas Tamosiunas
- Lithuanian University of Health Sciences, Institute of Cardiology, Kaunas, Lithuania
| | - Annette Peters
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology, Neuherberg, Germany
| | - Hermann Brenner
- German Cancer Research Center (DKFZ), Heidelberg, Germany, Network Aging Research (NAR), Heidelberg University, Heidelberg, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Ageing Research, German Cancer Research Center, Heidelberg, Germany
| | - Sameline Grimsgaard
- Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen, Denmark
- Institute of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Michael H Olsen
- Department of Internal Medicine, Steno Diabetes Center Zealand, Holbaek Hospital, Holbaek, Denmark
- Department of Regional Health Research, University of Southern Denmark, Denmark
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Kristensen A, Rosberg V, Vishram-Nielsen J, Pareek M, Linneberg A, Giampaoli S, Mancia G, Cesana G, Kuulasmaa K, Salomaa V, Sans S, Ferrieres J, Soderberg S, Moitry M, Olsen M. Simple cardiovascular risk stratification using anthropometric measures instead of serum cholesterol. The MORGAM Prospective Cohort Project. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Body composition predicts cardiovascular outcomes, but it is uncertain whether anthropometric measures can replace the more expensive serum total cholesterol for cardiovascular risk stratification in low resource settings.
Purpose
The purpose of the study was to compare the additive prognostic ability of serum total cholesterol with that of body mass index (BMI), waist/hip ratio (WHR), and estimated fat mass (EFM, calculated using a validated prediction equation), individually and combined.
Methods
We used data from the MORGAM (MONICA, Risk, Genetics, Archiving, and Monograph) Prospective Cohort Project, an international pooling of cardiovascular cohorts, to determine the relationship between anthropometric measures, serum cholesterol, and cardiovascular events, using multivariable Cox proportional-hazards regression analysis. We further investigated the ability of these measures to enhance prognostication beyond a simpler prediction model, consisting of age, sex, smoking status, systolic blood pressures, and country, using comparison of area under the receiver operating characteristics curve (AUCROC) derived from binary logistic regression models. The primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of death from coronary heart disease, myocardial infarction, or stroke.
Results
The study population consisted of 52,188 apparently healthy subjects (56.3% men) aged 47±12 years ranging from 20 to 84, derived from 37 European cohorts, with baseline between 1982–2002 all followed for 10 years during which MACE occurred in 2465 (4.7%) subjects. All anthropometric measures (BMI: hazard ratio (HR) 1.04 [95% confidence interval (CI): 1.03–1.05] per kg/m2; WHR: HR 7.5 [4.0–14.0] per unit; EFM: HR 1.02 [1.01–1.02] per kg) as well as serum total cholesterol (HR 1.20 [1.16–1.24] per mmol/l) were significantly associated with MACE (P<0.001 for all), independently of age, sex, smoking status, systolic blood pressures, and country. The addition of serum cholesterol significantly improved the predictive ability of the simple model (AUCROC 0.818 vs. 0.814, P<0.001), as did the combination of WHR, BMI, and EFM (AUCROC 0.817 vs. 0.814, P=0.004). When assessed individually, BMI (AUCROC 0.816 vs. 0.814, P=0.004) and WHR (AUCROC 0.815 vs. 0.814, P=0.02) improved model performance, while EFM narrowly missed significance (AUCROC 0.815 vs. 0.814, P=0.06). There was no significant difference in the predictive ability of a model including serum cholesterol versus that including all three anthropometric measures (AUCROC 0.818 vs. 0.817, P=0.13). The figure shows the pertinent areas under the ROC curve in predicting MACE.
Conclusion
In this large population-based cohort study, the addition of a combination of anthropometric measures, i.e. BMI, WHR, and EFM, raised the predictive ability of a simple prognostic model comparable to that obtained by the addition of serum total cholesterol.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - V Rosberg
- Nordsjaellands Hospital, Hilleroed, Denmark
| | - J Vishram-Nielsen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - M Pareek
- Yale New Haven Hospital, Department of Internal Medicine, New Haven, United States of America
| | - A Linneberg
- University of Copenhagen, Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - S Giampaoli
- National Institute of Health, Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Rome, Italy
| | - G Mancia
- University of Milan-Bicocca, Monza, Italy
| | - G Cesana
- University of Milan-Bicocca, Monza, Italy
| | - K Kuulasmaa
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | - V Salomaa
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | - S Sans
- Catalan Department of Health, Barcelona, Spain
| | - J Ferrieres
- Toulouse Rangueil University Hospital of Toulouse, Department of Cardiology, Toulouse, France
| | - S Soderberg
- Umea University, Department of Public Health and Clinical Medicine, Cardiology and Heart Centre, Umea, Sweden
| | - M Moitry
- University Hospital of Strasbourg, Department of Epidemiology and Public Health, Strasbourg, France
| | - M Olsen
- Holbaek Hospital, Department of Internal Medicine, Holbaek, Denmark
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Rosberg V, Grove EL, Bøtker HE, Kristensen SD, Pareek M. [Acetylsalicylic acid for primary prevention of cardiovascular events in patients with Type 2 diabetes mellitus]. Ugeskr Laeger 2019; 181:V03190205. [PMID: 31610831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This review assesses the latest evidence and guidelines related to the use of aspirin for primary prevention among patients with Type 2 diabetes (T2D) without overt cardiovascular disease. The global burden of T2D is steadily increasing and most deaths among patients with T2D are attributed to cardiovascular events. Furthermore, several haemostatic abnormalities have been shown in this group of patients, including increased platelet turnover and aggregation.
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Kristensen AMD, Rosberg V, Juel J, Pareek M. Conservatively managed saddle pulmonary embolism. Clin Case Rep 2019; 7:1259-1260. [PMID: 31183106 PMCID: PMC6552939 DOI: 10.1002/ccr3.2174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 03/11/2019] [Accepted: 04/09/2019] [Indexed: 12/04/2022] Open
Abstract
Massive, submassive, and nonmassive pulmonary embolism relate to the hemodynamic state, while saddle pulmonary embolus is a purely radiologic term. Patients with saddle embolus often present with hemodynamic compromise. However, treatment depends on the clinical presentation, and stable patients with a saddle pulmonary embolus can respond well to conventional anticoagulation.
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Affiliation(s)
| | | | - Jacob Juel
- Department of CardiologyAalborg University HospitalAalborgDenmark
| | - Manan Pareek
- Department of CardiologyNorth Zealand HospitalHillerødDenmark
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