Association of growth differentiation factor-15 level with adverse outcomes in patients with stable coronary artery disease: A meta-analysis

Background: Growth differentiation factor 15 (GDF-15) is a stress responsive cytokine of the transforming growth factor superfamily. Circulating levels of GDF-15 are elevated in various conditions including anemia and stable coronary artery disease (CAD), and associated with the risk of mortality in patients with stable CAD. However, whether anemia modifies the relationship between GDF-15 and mortality in patients with stable CAD is unknown. Methods: Using data from a multicenter, prospective cohort of 1460 patients with stable CAD, we assessed the association between anemic status and GDF-15 and the impact of anemia on the association between GDF-15 levels and the risk of all-cause death. GDF-15 was measured in 564 anemic and 896 non-anemic patients enrolled in the ANOX Study. Results: The mean age (standard deviation [SD]) of the patients was 71.7 (9.4) years; 74.4% were men. Patients with anemia exhibited significantly higher levels of GDF-15 compared to those without anemia (median [interquartile range], 1953 [1302-3110] vs. 1175 [838-1579] pg/mL, respectively; P <0.001). Stepwise multiple linear regression analysis revealed that the log-transformed (Ln-) GDF-15 level was independently associated with higher age, diabetes, current smoking, lower estimated glomerular filtration rate, anemia, no use of aspirin, Ln-N-terminal pro-natriuretic peptide, and Ln-high-sensitivity C-reactive protein ( P <0.005 for all). In the entire patient cohort, the GDF-15 level was significantly associated with all-cause death after adjusting for potential clinical confounders (hazard ratio per 1-SD increase [HR], 1.51; 95% confidence interval [CI], 1.33-1.71). This association was still significant in patients with anemia (HR, 1.71; 95% CI, 1.44-2.05) and in those without anemia (HR, 1.44; 95% CI, 1.21-1.71). However, GDF-15 provided incremental prognostic information to the model with potential clinical confounders and the established cardiovascular biomarkers in the entire cohort and in patients with anemia, but not in those without anemia. Conclusions: Higher levels of GDF-15 were independently associated with anemia in patients with stable CAD. The prognostic value of GDF-15 on mortality was pronounced in patients with anemia.

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Discrimination capability of pretest probability of stable coronary artery disease: a systematic review and meta-analysis suggesting how to improve validation procedures

BMJ Open ◽

10.1136/bmjopen-2020-047677 ◽

2021 ◽

Vol 11 (7) ◽

pp. e047677

Author(s):

Pierpaolo Mincarone ◽

Antonella Bodini ◽

Maria Rosaria Tumolo ◽

Federico Vozzi ◽

Silvia Rocchiccioli ◽

...

Keyword(s):

Systematic Review ◽

Coronary Artery Disease ◽

Chest Pain ◽

Coronary Artery ◽

Quality Assessment ◽

Meta Analysis ◽

Stable Coronary Artery Disease ◽

First Line ◽

Discrimination Capability ◽

Artery Disease

ObjectiveExternally validated pretest probability models for risk stratification of subjects with chest pain and suspected stable coronary artery disease (CAD), determined through invasive coronary angiography or coronary CT angiography, are analysed to characterise the best validation procedures in terms of discriminatory ability, predictive variables and method completeness.DesignSystematic review and meta-analysis.Data sourcesGlobal Health (Ovid), Healthstar (Ovid) and MEDLINE (Ovid) searched on 22 April 2020.Eligibility criteriaWe included studies validating pretest models for the first-line assessment of patients with chest pain and suspected stable CAD. Reasons for exclusion: acute coronary syndrome, unstable chest pain, a history of myocardial infarction or previous revascularisation; models referring to diagnostic procedures different from the usual practices of the first-line assessment; univariable models; lack of quantitative discrimination capability.MethodsEligibility screening and review were performed independently by all the authors. Disagreements were resolved by consensus among all the authors. The quality assessment of studies conforms to the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). A random effects meta-analysis of area under the receiver operating characteristic curve (AUC) values for each validated model was performed.Results27 studies were included for a total of 15 models. Besides age, sex and symptom typicality, other risk factors are smoking, hypertension, diabetes mellitus and dyslipidaemia. Only one model considers genetic profile. AUC values range from 0.51 to 0.81. Significant heterogeneity (p<0.003) was found in all but two cases (p>0.12). Values of I2 >90% for most analyses and not significant meta-regression results undermined relevant interpretations. A detailed discussion of individual results was then carried out.ConclusionsWe recommend a clearer statement of endpoints, their consistent measurement both in the derivation and validation phases, more comprehensive validation analyses and the enhancement of threshold validations to assess the effects of pretest models on clinical management.PROSPERO registration numberCRD42019139388.

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OPTIMAL ANTITHROMBOTIC THERAPY FOR ATRIAL FIBRILLATION AND STABLE CORONARY ARTERY DISEASE - A NETWORK META-ANALYSIS

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(21)01512-6 ◽

2021 ◽

Vol 77 (18) ◽

pp. 153

Author(s):

Rahul Gupta ◽

Aaqib Malik ◽

Ross Biggs ◽

Sagar Vadhar ◽

Lekha Racharla ◽

...

Keyword(s):

Atrial Fibrillation ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Antithrombotic Therapy ◽

Meta Analysis ◽

Stable Coronary Artery Disease ◽

Artery Disease

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Sarcopenia predicts adverse outcomes in an elderly population with coronary artery disease: a systematic review and meta-analysis

BMC Geriatrics ◽

10.1186/s12877-021-02438-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Qiqi Xue ◽

Jie Wu ◽

Yan Ren ◽

Jiaan Hu ◽

Ke Yang ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Meta Analysis ◽

Psoas Muscle ◽

Coronary Intervention ◽

Adverse Outcomes ◽

Cochrane Library ◽

Muscle Area ◽

Area Index ◽

Artery Disease

Abstract Background The development of sarcopenia is attributed to normal aging and factors like type 2 diabetes, obesity, inactivity, reduced testosterone levels, and malnutrition, which are factors of poor prognosis in patients with coronary artery disease (CAD). This study aimed to perform a meta-analysis to assess whether preoperative sarcopenia can be used to predict the outcomes after cardiac surgery in elderly patients with CAD. Methods PubMed, Embase, the Cochrane library, and Web of Science were searched for available papers published up to December 2020. The primary outcome was major adverse cardiovascular outcomes (MACE). The secondary outcomes were mortality and heart failure (HF)-related hospitalization. The random-effects model was used. Hazard ratios (HRs) with 95% confidence intervals (95%CIs) were estimated. Results Ten studies were included, with 3707 patients followed for 6 months to 4.5 ± 2.3 years. The sarcopenia population had a higher rate of MACE compared to the non-sarcopenia population (HR = 2.27, 95%CI: 1.58–3.27, P < 0.001; I2 = 60.0%, Pheterogeneity = 0.02). The association between sarcopenia and MACE was significant when using the psoas muscle area index (PMI) to define sarcopenia (HR = 2.86, 95%CI: 1.84–4.46, P < 0.001; I2 = 0%, Pheterogeneity = 0.604). Sarcopenia was not associated with higher late mortality (HR = 2.15, 95%CI: 0.89–5.22, P = 0.090; I2 = 91.0%, Pheterogeneity < 0.001), all-cause mortality (HR = 1.35, 95%CI: 0.14–12.84, P = 0.792; I2 = 90.5%, Pheterogeneity = 0.001), and death, HF-related hospitalization (HR = 1.37, 95%CI: 0.59–3.16, P = 0.459; I2 = 62.0%, Pheterogeneity = 0.105). The sensitivity analysis revealed no outlying study in the analysis of the association between sarcopenia and MACE after coronary intervention. Conclusion Sarcopenia is associated with poor MACE outcomes in patients with CAD. The results could help determine subpopulations of patients needing special monitoring after CAD surgery. The present study included several kinds of participants; although non-heterogeneity was found, interpretation should be cautious.

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Treatment for Stable Coronary Artery Disease: A Network Meta-Analysis of Cost-Effectiveness Studies

PLoS ONE ◽

10.1371/journal.pone.0098371 ◽

2014 ◽

Vol 9 (6) ◽

pp. e98371 ◽

Cited By ~ 15

Author(s):

Thibaut Caruba ◽

Sandrine Katsahian ◽

Catherine Schramm ◽

Anaïs Charles Nelson ◽

Pierre Durieux ◽

...

Keyword(s):

Coronary Artery Disease ◽

Cost Effectiveness ◽

Coronary Artery ◽

Meta Analysis ◽

Stable Coronary Artery Disease ◽

Artery Disease ◽

Effectiveness Studies

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Relationship Between Platelet to Lymphocyte Ratio and Stable Coronary Artery Disease: Meta-Analysis of Observational Studies

Angiology ◽

10.1177/0003319720943810 ◽

2020 ◽

Vol 71 (10) ◽

pp. 909-915

Author(s):

Zhiqiang Qiu ◽

Yu Jiang ◽

Xinghua Jiang ◽

Renqiang Yang ◽

Yanqing Wu ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Collateral Circulation ◽

Meta Analysis ◽

Stable Coronary Artery Disease ◽

Current Evidence ◽

Platelet To Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Artery Disease ◽

Stable Cad

Recent studies have reported a relationship between the platelet to lymphocyte ratio (PLR) and acute coronary syndromes. The aim of the present study was to investigate the association between PLR and stable coronary artery disease (CAD). A systematic search was conducted based on electronic databases (Cochrane, PubMed, Elsevier, Medline, and Embase). A total of 14 studies (n = 4,871) were included in the meta-analysis. Compared with the non-CAD group, PLR was significantly higher in CAD group ( P = .002). After further classification according to the Gensini score, the cases with atherosclerosis demonstrated a higher PLR than those without atherosclerosis ( P < .001). Platelet to lymphocyte ratio was higher in the severe atherosclerosis group compared with the mild atherosclerosis group ( P < .001). Compared with the poor coronary collateral circulation (CCC) group, PLR was significantly lower in the good CCC group ( P < .001). The PLR was significantly higher in patients with coronary slow flow (CSF) than those with normal coronary flow ( P = .01). On the basis of current evidence, an elevated PLR was associated with stable CAD, and it might be useful for predicting CAD severe stenosis, collateral circulation, and CSF. Future studies are needed to clarify the relationship between PLR and stable CAD.

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