Simple risk-score model for in-hospital major bleeding based on multiple blood variables in patients with acute myocardial infarction

In ST segment elevation acute myocardial infarction (STEMI), the endothelin (ET) system imbalance, reflected by the circulating ET-1:ET-3 ratio has not been investigated. This study’s primary objective was to measure the circulating ET-1:ET-3 ratio and correlate it with the risk stratification for 1 year mortality of STEMI based on TIMI score. On admission, the TIMI risk score and at discharge, the dynamic TIMI risk score were calculated in 68 consecutive subjects with STEMI. Subjects with high TIMI risk score were associated with higher mean ET-1 level and ET-1:ET-3 ratio. The ET-1:ET-3 ratio more accurately predicted the high on admission TIMI risk score than the ET-1 level. Subjects with high dynamic TIMI risk score were associated with higher mean ET-1 level and ET-1:ET-3 ratio. The ET-1:ET-3 ratio more accurately predicted the high at discharge dynamic TIMI risk score than ET-1 level. From multivariable analysis, the ET-1:ET-3 ratio was not independently associated with high on admission TIMI risk score but independently predicted high at discharge dynamic TIMI risk score (odds ratio = 9.186, p = 0.018). In conclusion, combining the ET-1 and ET-3 levels into the ET-1:ET-3 ratio provided a prognostic value by independently predicting the increased risk to 1 year mortality as indicated by at discharge dynamic TIMI risk score in patients with STEMI.

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Association of Dephosphorylated-Uncarboxylated Matrix Gla Protein and Risk of Major Bleeding in Patients Presenting with Acute Myocardial Infarction

Life ◽

10.3390/life11080733 ◽

2021 ◽

Vol 11 (8) ◽

pp. 733

Author(s):

Admira Bilalic ◽

Tina Ticinovic Kurir ◽

Josip A. Borovac ◽

Marko Kumric ◽

Daniela Supe-Domic ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Major Bleeding ◽

Plasma Levels ◽

Adverse Outcomes ◽

Matrix Gla Protein ◽

Coagulation Cascade ◽

Bleeding Tendency ◽

Coronary Syndrome ◽

Bleeding Score

The “Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines” (CRUSADE) score emerged as a predictor of major bleeding in patients presenting with the acute coronary syndrome. On the other hand, previous studies established the association of dephosphorylated-uncarboxylated Matrix Gla protein (dp-ucMGP) and vitamin K, as well as their subsequent impact on coagulation cascade and bleeding tendency. Therefore, in the present study, we explored if dp-ucMGP plasma levels were associated with CRUSADE bleeding score. In this cross-sectional study, physical examination and clinical data, including plasma dp-ucMGP levels, were obtained from 80 consecutive patients with acute myocardial infarction (AMI). A significant positive correlation was found between CRUSADE bleeding score and both dp-ucMGP plasma levels (r = 0.442, p < 0.001) and risk score of in-hospital mortality (r = 0.520, p < 0.001), respectively. In comparing the three risk groups of risk for in-hospital bleeding, the high/very high-risk group had significantly higher dp-ucMGP levels from both very low/low group (1277 vs. 794 pmol/L, p < 0.001) and the moderate group (1277 vs. 941 pmol/L, p = 0.047). Overall, since higher dp-ucMGP levels were associated with elevated CRUSADE score and prolonged hemostasis parameters, this may suggest that there is a biological link between dp-ucMGP plasma levels and the risk of bleeding in patients who present with AMI.

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Early Stent Thrombosis in Patients Undergoing Primary Coronary Stenting for Acute Myocardial Infarction: Incidence, a Simple Risk Score, and Prognosis

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029609342092 ◽

2009 ◽

Vol 16 (1) ◽

pp. 33-41 ◽

Cited By ~ 5

Author(s):

Mehmet Ergelen ◽

Huseyin Uyarel ◽

Damirbek Osmonov ◽

Erkan Ayhan ◽

Emre Akkaya ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Stent Thrombosis ◽

Risk Score ◽

Cardiovascular Mortality ◽

Large Population ◽

Coronary Stenting ◽

Therapy Discontinuation ◽

Clopidogrel Therapy

Background: One of the major concerns remaining in the treatment with stenting of patients with acute myocardial infarction (AMI) is the occurrence of stent thrombosis (ST). The aim of the current study is to investigate the incidence, predictors, and long-term outcomes of early ST after primary coronary stenting for AMI in a large population. Methods: We reviewed 1960 consecutive patients (mean age 56 ± 11.6 years, 1658 males) treated with primary coronary stenting for AMI between 2003 and 2008. All clinical, angiographic, and follow-up data were retrospectively collected. Early ST was defined as thrombosis that occurred in the first 30 days after primary coronary stenting. Results: Early ST was observed in 89 (4.5%) patients. Five variables, selected from the multivariate analysis, were weighted proportionally to their respective odds ratio (OR) for early ST (premature clopidogrel therapy discontinuation [10 points], stent diameter ≤3 mm [5 points], current smoker [4 points], diabetes mellitus [DM; 3 points], and age >65 years [2 points]). Three strata of risks were defined (low risk, score 0-4; intermediate risk, score 5-12; and high risk, score 13-24) and had a strong association with early ST and long-term cardiovascular mortality. Long-term cardiovascular mortality was 5-fold more in patients with early ST than that without ST (24.1% vs 4.7%, respectively, P < .001). Conclusions: Early ST after primary coronary stenting in AMI is strongly related with increased long-term cardiovascular mortality. Premature clopidogrel therapy discontinuation is the most powerful predictor of early ST.

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